A>> % \ 4 \% % /^v /^/ CR 057 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1955 S. L. WRIGHT,M.D., M.R.C.P., D.P.H. 64332 3 HEALTH COMMITTEE 1955 Councillor M. Davis (Chairman) Alderman G. H. Ward, O.B. E. ,J. P. (Vice-Chairman) Alderman W. Berners Price, J. P. (Mayor of Croydon) Alderman A. V. Dammarell Councillor P. T. Adams * Councillor J. T. Bell Councillor Mrs. H. M. Bunning Councillor Mrs. V. L. Child Councillor J.J. Cooper Councillor R. H. Davies, M. B. E. Councillor K. A. Edwards Councillor E.J. Fowler Councillor Mrs. D. L. George Councillor R. Hyder, J. P. Councillor H.S. Kew Councillor Mrs. E.M. Maycock Councillor Miss L.N. Overton Councillor Mrs. C. Penman Miss Dorothy Day, M. R. C. S., L. R. C. P. O.E. Finch, Esq., M. C. ,M.D. J. S. Lane, Esq., B. A. , M. R. C. S. L. R. C.P. T.P. Rees, Esq., 0. B. E., B. Sc. , M. D. B. Ch. , M. R. C. P. , M. R. C. S. , D. P. H. Members appointed to Sub-Committees on nomination of Outside Bodies as shown:- J. Newton Hudson, Esq., M. B. , M. R. C. S., L. R. C.P. D. F. Kanaar, Esq., M.D., M.R.C.P. J.H. Thompson, Esq., M.B. , B. Ch. , B.A. 0. Miss K.C. Vost, M.B., B.S., D.P.H. Croydon Local Medical Committee A. F. Clift, Esq., F. R. C. S., M. R. C.O.G. Croydon Group Hospital Management Committee Miss M.I. Farrer ----- Royal College of Nursing Mrs, F. R. Mitchell, O.B.E. - Royal College of Midwives Miss J.C. Dickinson - Croydon District Nursing Association Mrs. H. Thatcher ----- Croydon Family Planning Association * (Died 12th December, 1955) 4 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1955 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 31st December, 1955. Some comments seem appropriate on a few aspects. Statistics I The/birth rate was the lowest since the inter-war years and a fraction only above the lowest rate yet recorded in the Borough. Deaths were above the average due mainly to the widespread occurrence of a mild form of respiratory infection of the influenzal type during the first quarter of the year. As usually occurs during such outbreaks there was a simultaneous increase in deaths ascribed to respiratory illnesses and other chronic diseases. In the latter group it seems very likely that there were many deaths which were in fact precipitated by the prevailing infection. Similarly, in very young babies the organisms which produce feverish "colds" in adults, can bring sudden death. Cases of this type were reported by the Coroner's pathologist. Cancer of the lungs gave the highest number of deaths yet reported. In Croydon during the last 10 years the number of females dying from this condition has not altered to any marked degree, but male deaths have risen steadily so that they are now some times more numerous. There is a latent period before cancer producing substances (carcinogens) stimulate new growths; so that changes in habits or surroundings to which this increase is due must have commenced in the 1920-30 period. Smoking of cigarettes is thought to have become widespread amongst men 5 after the 1914-18 war, and amongst women after the last war. The connection between heavy smoking of cigarettes and cancer of the lung is not, therefore, weakened because women now smoke and yet show a low lung cancer mortality. Infectious Diseases Over 5,000 cases of measles were notified, but fortunately only one death was registered as due to this infection. A combination of a mild type of illness and effective drugs to control complications achieved the very low death rate, but did not help in preventing the spread of the infection. Sonne dysentery was very troublesome but as its impact is mainly in school children I have covered the outbreak in the school health section of the report. All cases recorded are following bacteriological proof and in approximately 25% this was the only positive sign and discovered by examination of family contacts. Poliomyelitis was of average prevalence and on the whole cases were mild. Towards the end of the year there were three adult deaths in quick succession which caused some disquiet. All the deaths from poliomyelitis were in adults, one case being reported in a patient aged 76. Environmental Hygiene It is disappointing that new legislation to reduce atmospheric pollution has not yet been passed while the powers contained in the Clean Air Bill seem to many likely to fall short of expectations. The latter is a question which needs the test of experience before it can be answered, and it is hoped this will be possible in the near future. Housing applications on medical grounds were more numerous, probably because the normal points system was not operating. A commencement was made on the first of the small areas included in the slum clearance programme and surveys of all the houses concerned proceeded. Personal Health Services The importance of domiciliary nursing becomes steadily more apparent. A scheme for a new nurses hostel and administrative centre was approved and it is hoped building will commence very shortly. The figures given in subsequent pages show the increase in work performed, and some details of its nature. I share the general belief that in suitable cases more home nursing and domestic help will reduce pressure on hospital accommodation. It 6 would be wrong, however, to pursue this too far. Where there is no competent relative or neighbour to give some care and attention it is unreasonable or quite uneconomic to try and replace institutional by domiciliary care of the bed fast patients. Such patients living alone must either be left unattended for most of the 24 hours or covered by paid help at a total cost exceeding the rate in a suitable hostel or hospital. Continuous day and night cover with home helps and sick room attendants costs over £20 per week, and can be a temporary measure only while hospital admission is obtained. The importance of keeping in close touch with geriatric units allows admissions and discharges to be regulated so that the best use is made of all facilities. A scheme was drawn up to employ a home nurse (a S. E. A. N.) to ensure that patients rehabilitated by the geriatric unit do not relapse to a bed fast state on discharge from hospital. This is very likely to happen without skilled supervision and constant encouragement. Preparations were also made for establishing a small laundry service to assist the Home Helps. Work with problem families continued mainly as a responsibility of health visitors and selected home helps and is covered under the section dealing with the latter's duties. Home Help services were also extended to deal with family care over longer hours than usual, where this would prevent the admission of many children to children's Homes. While thus mentioning some special aspects of the work of the Department I would emphasise that other sections have been equally active and on the whole it has been a busy year. I welcome this opportunity to thank the members of the Committee for their continued encouragement and mention with appreciation the help given by other Departments of the Corporai-iAn, and members and officers of the hospital and general ^pracoiifing services. My thanks are also due to members of my staff for their work and help in the preparation of this report and I wish to pay tribute to Mr. Rush, the officer chiefly concerned in its production, who retires after 36 years service with the Department. I am, Yours faithfully, S.L. WRIGHT, Medical Officer of Health 7 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 Sanitary and Food Inspection Maternity and Child Welfare District Nursing (agency arrangements) Domestic Help Day Nurseries Vaccination and Immunisation Ambulance Service Prevention, Care and After Care Mental Health Welfare Foods Chief Clerk, Deputy Chief Clerk, 17 clerks (including 1 part time), 4 typists, 1 messenger. Chief Sanitary Inspector, Deputy, 20 Inspectors, 5 assistants, 3 Disinfectors, 2 Rodent Operatives, 9 clerks, 1 typist 1 Superintendent and 4 Porters (l part time), (Men's Hostel) 1 Labourer (abattoir) 6 Clinic Medical Officers whole time (also School duties), 4 part time. Superintendent Health Visitor, Deputy and 26 Health visitors (also School Nurses), Almoner (part time) Assistant Almoner, Superintendent Midwife, Deputy, 17 midwives, 2 Physiotherapists, 2 Ante-natal Clinic Nurses (part time), 5 clerks. (Dental Service as for School Health) Superintendent, 3 assistants, 41 nurses and 1 clerk. Supervisor, 2 assistants, 2 clerks, 16 full time and 129 part time Home Helps. 1 nursery with Matron and Deputy, nurses, students and d®mestic staff. 1 Clerical Officer. Ambulance Officer, Deputy, Second Officer, Maintenance Officer, 4 Leading Drivers, 60 Driver-attendants,3 clerks, 1 Telephone Operator, 1 Civil Defence Training Officer, 1 Depot Labourer, 1 cleaner (part time) Chest Physician (part time), Assistant Chest Physician (part time), 4 Tuberculosis Visitors, 2 Almoners, 2 clerks (l part time), 1 Occupational Therapist (part time). 5 Duly Authorised Officers, 1 clerk, 1 Occupational Centre Supervisor, 5 assistants, 1 handyman, 2 guides, 3 cleaners (part time) 2 clerks. 8 STATISTICS SUMMARY OF VITAL STATISTICS FOR 1955 Area, 12, 672 acres. Population (Census 1951), 249,870. Total Population (estimate of Registrar-General), 249,300 (Midsummer, 1955) Number of Inhabited Houses: 69,876. Rateable Value (1st April, 1955): £2,813,277. Product of a Penny Rate (1954-1955): ill,254. Rate in the £: 17s.lOd. (for year ending 31.3.55) Live Births: M F Total Legitimate 1,552 1,624 3,176 Illegitimate 74 89 163 3, 339 Birth-rate per 1,000 of the estimated resident population, 13.4 (England and Wales 15.0) Birth-rate (as adjusted by comparibility factor, 0.99), 13.3. Still Births, 69. Rate per 1,000 total (live and still) births, 20.3. Deaths, 2,835. Death-rate per 1,000 of the estimated population, 11.4. (England and Wales 11.7). Death-rate (as adjusted by comparibility factor, 0.90), 10.3. Infant mortality rate, 21 per 1,000 live births. (England and Wales 25). Legitimate Infants (69 deaths), 22 per 1,000 live births. Illegitimate Infants (no deaths). 9 principal Causes of Death in order of frequency (RegistrarGeneral' s Return) Rate per 1,000 Population (1) All Ages Deaths from diseases of Cardiac and Circulatory System 4.26 " " Cancer 2.19 " " diseases of the Nervous system 1.73 " " diseases of the Respiratory System (excluding Tuberculosis) 1.18 " " Suicide and Violent Causes 0.36 " " Tuberculosis (all forms) 0.15 '' " diseases of Digestive System 0.14 * * ulcers of stomach, duodenum: gastritis and enteritis Rate per 1,000 of age group (2) Ages 15-45 years Deaths from Cardiac and Circulatory System 0.10 " " Cancer 0.07 " Tuberculosis (all forms) 0.06 Marriages The numbter of marriages solemnised was 2,076, compared with 1,882 in 1954, 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. 986 were solemnised in Established Churches, 366 in other places of worship, and 724 in the Register Office. Births The live births registered were 3,176 legitimate and 163 illegitimate. The birth-rate consequently was 13.4. For England and Wales the rate was 15.0. The illegitimate births in Croydon were 4.8 of the total as compared with 5.5 in 1954 and 1953, 5.3 in 1952, 5.4 in 1951, 5.0 in 1950 and 4.9 in 1949. The live male births numbered 1,626, the female 1,713, being a proportion of 1,000 males to 1,053 females. Deaths The deaths numbered 2,835, compared with 2,638 in 1954. For 1955 the death-rate was 11.4 compared with 10.6 in 1954. The death-rate for England and Wales was 11.7. 10 There were 101 inquests held by Coroners in respect of Croydon residents during 1955, and 380 findings by Coroners after postmortem without inquest. Wards with the highest death-rate were South (12.7), Central (12.2) and Upper Norwood (11.7). Lowest: Addington (4.2), West Thornton (8.5), East (8.6) and South Norwood (8.7). Still Births During 1955, 69 still births were registered in respect of Croydon. Of these, 35 were male babies and 34 females; 3 males and 1 female were illegitimate. The proportion of still births to living children was 1 in 48. The still birth rate was 2.0 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 20.2 per 1, COO births. Notification of Births Notifications were received in respect of confinements conducted by: - Live Births StiLL Births Total Midwives 2, 830 55 2, 885 Doctors 860 28 888 3,690 83 3,773 Accommodation for Confinement The following table gives information concerning the accommodation utilised for confinements:- Number Percentage In Private Houses 1, 216 32. 23 In Public Institutions 2, 169 57.49 In Registered Maternity Homes 388 10. 28 3,773 11 Maternal Mortality There were 2 deaths, compared with 3 in 1954. The maternal mortality rate was 0.59 per 1,000 births, compared with 0.82 in 1954. The rate for England and Wales was 0.64. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1935-1955 Year Bi rths (Live and Still) Ma tern at Deaths Maternal Mortali ty Ra te Infan t Mortali ty Rate 1935 3.391 10 2.95 #] 1936 3.373 13 3.85 • 41 1937 3.357 13 3-87 60 1938 3,430 3 0.87 40 1939 3.511 4 1.16 38 1940 3.031 5 1.65 39 1941 2, 472 8 3.23 37 1942 3.579 12 3-35 39 1943 3,785 2 0.53 37 1944 3,680 8 2.17 44 1945 3,675 9 2.45 ' 41 1946 4,937 3 0.61 31 1947 5, 211 10 1.92 38 1948 4,597 2 0.44 27 1949 4.102 5 1.22 29 1950 3,787 2 0.53 26 1951 3,697 3 0.81 19 1952 3.548 2 0.56 20 1953 3,5 26 3 0.85 21 1954 3,649 3 0.82 19 1955 3,408 2 0.59 21 Infant Mortality The Infantile Mortality Rate was 21 per 1,000 live births. 12 For the past 5 years the number of infant deaths has been 1951 - 68; 1952 - 69; 1953 - 72 and in 1954 and 1955 - 69. Among the 69 deaths, 48 occurred in boy babies and 21 in girls. Of the births, 1,626 were males and 1,713 females. The infantile mortality rate for the two sexes was, therefore, Boys30, Girls-12. 55 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):- (1) Complications of Labour - Trauma at Birth 3 - 3 (2) Foetal States - Congenital Deformities 8 Atelectasis 4 Haemorrhagic Disease of Newborn 3 - 15 (3) Prematurity 22 - 22 (4) Post-Natal Causes 5 - 5 45 Percentage Deaths under / year per Total Infantile Dea ths Deaths under / year per 1,000 Bir ths 1955 1954 1955 1954 Premature Births 33-3 30.4 6.89 5.88 Respiratory Diseases 21.3 11.6 4.49 2.24 Infectious Diseases 2.9Ø - 0.60 - Atelectasis, Debility and Marasmus 5.8 18.8 1.20 3.64 Diseases of Digestion 2.9 * 1.4 0.60 0.28 Injury at Birth and Congenital 21.7 21.7 4.49 4.20 4 These deaths were due to Miliary Tuberculosis and Whooping Cough * These from Gastro-enteritis 13 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 1 mnth. 1-2 mnths. , — 2—3 mnths. 3-4 rnnths. 4-5 mnths. 5-6 mnths. 6-7 mnths. 7-8 mnths. 8-9 mnths. 9-10 mnths. 10-11 mnths. 11-12 mnths. TOTAL All Causes 20 3 9 3 1 1 — 3 2 3 45 8 2 4 2 — 3 1 — 2 — 2 69 Pol io-Encephalitis — — — — — — — — — — — — — — — — — — — — — — — Chicken Pox — — Measles — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — — — — — — — — — — 1 Diphtheria and Croup — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — — — — — — — — — — — — — 1 Convulsions — — — — — — — — — — — — — — — — — — — — — — — Laryngitis — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — — — — — — — — — — — — — — — — — — Pneumonia (all forms) — — — — — — — 1 1 2 4 3 — 3 1 _ 1 — _ 1 _ 2 15 Diarrhoea and Enteritis — — — — — — — — — — — — — — — — — — — — — 2 Gastritis — — — — — — — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — — — — — — — Congenital Malformations — — 3 1 1 — — 1 1 1 8 — — 1 1 _ 1 1 — — — — 12 Premature Birth 15 2 3 — — 1 — I _ — 22 1 — — — — — — — — — — 73 Atrophy, Atelectasis, Debility and Marasmus 2 _ 1 1 — — — — — — 4 — — — — — — — — — — — 4 Injury at Birth 2 — 1 — — — — — — — 3 _ — — — — — — — — — — 3 Haemorrhagic disease of newborn 1 1 1 — — — — — — — 3 — — — — — — — — — — — 3 3ther Causes — — — 1 — — — — — — 1 2 1 — — — 1 — — — — — 5 TOTALS 20 3 9 3 1 1 — 3 2 3 45 8 2 4 2 — 3 1 — 2 - 2 69 14 WARD STATISTICS WARDS Est imated Popul at ion Births Deaths Bi rth Rate Death Rate Deaths under 1 year per 1,000 Births Death Rate from Six Zymotic Diseases (excluding | Diarrhoea) Death Rate from Diarrhoea (under two years) Death Rate from Bronchit is and Pneumonia Death Rate from Pulmonary Tuberculosis Death Rate from Non-Pulmonary Tuberculosis Death Rate from Heart and Circulation Diseases Death Rate from Cancer Natural Increase or Decrease of Population Upper Norwood 17646 179 206 10.1 11.7 22 — — 1.08 0.11 — 3.80 2.32 —27 Norbury 16459 120 161 7.3 9.8 50 — — 1.34 — — 3.34 1.94 — 41 west Thornton 16005 198 136 12.4 8.5 15 — — 0.94 0.06 0.06 3.81 1.75 +62 Bensham Manor 17424 187 169 10.7 9.7 11 — — 0.69 0.34 — 4.02 1.66 + 18 Thornton Heath 16229 197 151 12.1 9.3 25 — 0.06 0.99 0. 12 — 2.59 1.91 + 46 South Norwood 16421 240 143 14.6 8.7 12 — — 0.91 0.06 — 3.17 2.25 + 97 Woodside 14853 184 135 12.4 9.1 11 — — 0.61 0.07 — 2.89 2.42 + 49 East 16383 14 2 141 8.7 8.6 14 — — 0.61 0.18 — 3.36 1.59 + 1 Shirley 12112 132 110 10.9 9.1 8 — — 0.74 — — 2.89 1.98 + 22 Addiscombe 16035 216 185 13.5 11.5 23 — — 0.62 0.12 — 4.68 2.12 + 31 Whitehcrse Manor 13682 228 156 16.7 11.4 31 — — 1.97 0.29 — 3.51 2.49 + 72 Broad Green 13806 20 2 134 14.6 9.7 25 — 0.07 0.87 0.22 — 3.11 2.25 + 68 Cent ral 11715 151 143 12.9 12.2 7 — — 1.02 0.26 — 4.35 1.54 + 8 Waddon 15635 194 151 12.4 9.7 10 0.06 — 0.77 0.06 0.06 3.20 1.92 4 43 South 16902 193 215 11.4 12.7 21 — — 1.18 0.18 — 4.13 1.83 - 22 Addington 17993 576 76 32.0 4.2 29 0.06 — 0.67 0.06 — 1.06 1.00 +500 The Borough 249300 3339 2835 13.4 11.4 21 0.01 0.01 1.10 0.13 0.01 4.26 2.20 +504 15 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX Sex 0- 1- 5- 15- 25- 45- 65- 75- Total All Causes M 48 5 9 9 58 364 398 514 1,405 F 21 2 5 4 3 229 343 783 1,430 Tuberculosis (respiratory) M — — — — 5 14 6 2 27 F — — — — 2 3 2 1 8 Tuberculosis (other forms) M — — — — — 2 — — 2 F — — 1 — — — — — 1 Syphilitic Diseases ... M — — — — — — 3 2 5 F — — — — — — 3 1 4 Diphtheria M — — — — — — — — — F — — — — — — — — — Whooping Cough M I — — — — — — — 1 F — — — — — — — — — meningococcal infections M — — — — — — — — — F I — — — — 1 — 2 Acute Poliomyelitis M — — — — 1 — — — 1 F — — — — 2 — — 1 3 Measles M — — — — — — — — — F — 1 — — — — — — 1 Other Infective and parasitic diseases M — — — — 1 1 — — 2 F — — — — — — — — — Malignant neoplasm, stomach M — — — — 1 15 10 9 35 F — — — — — 11 8 12 31 " lung, bronchus M — — — — 3 57 30 11 101 F — — — — 2 7 2 7 18 " breast M — — — — — — — — F — — — — 8 19 11 16 54 "uterus F — — — — — 6 9 3 18 Other malignant and lymphatic neoplasms M — — — 2 6 48 49 33 138 F — — — — 7 39 39 51 136 Leukaemia; aleukaemia M — — — — — 1 3 1 5 F — — 1 — 2 2 3 2 10 Diabetes M — — — — — 1 1 — 2 F — — — — — 2 2 3 7 Vascular lesions of nervous system M — — — — 3 15 48 95 161 F — — — — 4 29 76 161 270 Coronary disease, angina M — — — — 4 77 83 74 238 F — — — — 1 20 59 95 175 Hypertension with heart disease M — — — — — 8 15 9 32 F — — — — — 4 12 26 42 Other heart diseases M — — 1 1 2 25 41 123 193 F — — — — 1 22 46 196 265 Other circulatory diseases M — — — — — 8 13 25 46 F — — — — 1 12 12 47 72 Influenza M l — — — 2 2 1 4 10 F — — 1 1 — 1 1 7 11 Pneumonia M 10 — 1 — 1 5 11 29 57 F 4 — — — — 5 8 35 52 bronchitis M — — — — 1 37 34 38 110 F — — — — 1 7 11 37 56 Other diseases of respiratory system M — — — — 1 5 4 2 12 F — — — 1 1 1 2 1 6 Ulcer of stomach and duodenum M — _ _ _ 1 3 7 5 16 F _ _ _ _ 1 1 6 8 Gastritis, enteritis and diarrhoea M 1 _ _ _ _ 1 2 F 1 _ — _ _ 1 4 2 8 Nephritis and nephrosis M — — — — 4 3 5 1 13 F — — — 1 _ 4 1 5 11 Hyperplasia of prostate M _ _ _ — _ 2 5 14 21 Pregnancy, childbirth and abortion F — — — — 2 — — — 2 Congenital malformations M 10 1 1 — 1 3 1 _ 17 F 2 _ _ _ 1 •3 Other defined and illdefined diseases M 25 3 1 _ 6 20 23 29 107 F 12 2 1 4 23 20 54 116 Motor vehicle accidents M — 1 3 3 6 3 1 3 20 F — 1 _ _ _ 1 4 6 All Other accidents M — 2 2 4 3 1 4 16 F 1 — — — 1 4 4 10 20 Suicide M — — — 1 5 5 3 14 F — — — — 4 6 4 14 Homicide and operations of war M — — — — — — — 1 1 F — — — — — — — — — totals 69 7 14 13 101 593 741 1297 2835 16 Comparisons with 1954 (Registrar-General's Table) There was one death from Whooping Cough (none in 1954) and one from Measles (none in 1954). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 35 (1954 28); those from Cancer increased by 56; those from Pneumonia increased by 32; and an increase of 29 was also recorded in those caused by Bronchitis. There were 21 deaths from Influenza (1954 - 6). Deaths from suicide show an increase of 3, and motor vehicle accidents totalled 26 as in 1954. The total number of deaths was 2,835 as compared with 2,638 in 1954. The percentage of deaths under 1 year of age to the total deaths was 2.4 per cent.; deaths under 15 years, 3.2 per cent.; deaths under 65 years, 28.1 per cent.; and deaths over 65 years, 71.9 per cent. The corresponding figures for 1954 were 2.6 per cent., 3.5 per cent., 28.6 per cent., and 71.4 per cent, respectively. The Registrar-General has continued to supply a comparability factor - 0.90 - by which the crude death-rate must be adjusted for comparison with other areas of the country as a whole. It will be observed that this factor is less than unity, so that the standardised, or corrected death-rate, is less than the crude death-rate. In other words, Croydon has a greater "weighting" of elderly persons than the average for the country. CANCER Deaths from Cancer tabulated in the Department numbered 549 as compared with 486 in 1954; 540 in 1953; 567 in 1952; 479 in 1951; 501 in 1950; 481 in 1949; 510 in 1948; 492 in 1947; 451 in 1946 and 470 in 1945. Death-rate per 1,000 of the population for the last 11 years are as follows:- 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) 1955 - 2. 20 (549) 1948 - 2.03 (510) 1952 - 2.26 (567) 17 Deaths from Cancer occurred at the following Ages:- Age period Male Female Total Under 25 years 3 1 4 25 and under 35 years 4 5 9 35 and under 45 years 8 13 21 45 and under 65 years 120 83 203 65 years and over 146 166 312 281 268 549 Sites of Fatal Cancer Site Male Female Total Percentage of Total Skin 1 2 3 0.546 Oesophagus 13 7 20 3.643 Stomach 35 31 66 12.022 Liver 7 3 10 1.821 Bowel 21 38 59 10.745 Rectum 16 17 33 6.011 Bladder 9 9 18 3.279 Prostate 15 — 15 5.338 Larynx and Pharynx 6 4 10 1.821 Uterus — 18 18 6.716 Breast — 53 53 19.776 Ovary — 10 10 3.731 Pancreas 9 12 21 3.825 Gall Bladder and Duct 3 3 6 1.093 Tongue and Mouth 2 3 5 0.911 Bones 2 — 2 0.364 Lungs and Bronchus 99 20 119 21.676 Kidney 4 2 6 1.093 Brain and Nervous System 10 5 15 2.732 Thyroid Gland 1 2 3 0.546 Lymphatic G1ands and Connective Tissue 8 5 13 2.368 Haematopoietic Tissues — 2 2 0.364 Tonsil 1 - 1 0.182 Ear — 1 1 0.182 Hodgkin's Disease — 5 1 6 1.093 Leukaemia 5 9 14 2.550 Genital Organs 2 3 5 0.911 Undefined 7 8 15 2.732 281 268 549 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males - the Lungs (35.2 per cent.), the Bowels' and Rectum (13.2 per cent.) and the Stomach (12.5 per cent.); in females - the Bowels and Rectum (20.5 per cent.), the Breast (19.8 per cent.) and the Stomach (11.6 per cent.). 18 COMMUNICABLE DISEASES NOTIFIED DURING YEAR 1955 Notifiable Disease Cases notified Total cases notified in wards 1955 At all ages At ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Wood side East Add i scombe Whitehorse Manor Broad Green Central Waddon South Add i ngton Shirley M F Under 1 1-4 5-14 15 - 24 25 - 44 45 - 64 65 and over Scarlet Fever 250 _ 58 179 8 3 2 _ 6 20 16 9 17 35 23 18 18 16 11 7 6 12 25 11 139 111 Diphtheria - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Erysipelas 21 - 1 2 - 7 7 4 3 2 1 1 3 1 - 1 4 1 - - - 3 - 1 13 8 Meningococcal Infect ion 5 _ 1 2 1 1 _ _ _ _ 2 _ _ _ 1 _ _ _ - _ _ _ 1 1 2 3 Enteric and Paratyphoid 3 _ - 1 2 _ _ _ 1 _ _ . _ _ _ _ 1 _ _ 1 _ _ 2 1 Smal1 pox — _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Cholera — _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Typhus _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Puerperal Pyrexia Ophthalmia 98 - " - - 43 55 — - — — 57 1 — 1 — 1 1 — 30 1 3 2 1 — — 98 natorum 18 18 - - - - - - - - 1 - - 1 - 1 - - 15 - - - - - 13 5 Acute Poliomyeliti s 29 _ 4 10 7 8 — — 2 3 1 1 1 1 1 — 3 — 3 — 2 — 9 2 14 15 Dysentery 1179 48 302 558 47 201 18 5 4 15 23 13 20 22 16 18 14 13 32 19 10 47 907 6 571 608 Malaria _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Acute Primary and Influenzal Pneumonia 75 2 9 7 18 24 15 3 8 12 5 10 1 1 1 5 2 1 2 8 11 5 37 38 Food Poisoning 79 1 18 22 7 19 10 2 6 5 2 11 10 2 3 3 1 1 11 1 6 6 11 - 37 42 Acute Encephalitis 2 - - 1 - 1 - — 1 — - - - — - - - — - - - — 1 - 1 1 Measles 5052 160 2264 2591 17 16 4 - 238 234 306 249 230 309 226 407 333 245 208 165 298 251 1191 162 2595 2457 Whooping Cough 276 26 102 141 1 6 - - 4 42 15 5 11 11 11 38 13 10 27 2 14 23 29 21 127 149 7087 253 2752 3516 140 335 65 26 267 329 437 295 302 384 282 488 392 288 339 197 347 356 2180 204 3551 3536 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1955 Jan. Feb. March April May June July August Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 13 9 21 10 22 13 9 4 10 11 19 11 152 Non-Respi ratory Tuberculosis 3 1 2 1 _ 3 1 3 1 3 ? 70 Scarlet Fever 10 16 36 27 32 28 13 6 13 16 32 21 250 Diphtheria — — — — — — _ _ _ _ _ _ Erysipelas Meningococcal 3 3 2 1 1 3 _ _ 2 2 3 1 21 Infection 2 — 1 _ _ _ 2 _ _ _ _ _ 5 Enteric and Paratyphoid 1 1 _ 1 _ _ 3 Smal1pox — — — — _ _ _ _ Cholera — _ — _ _ _ _ _ Typhus — — — _ _ _ _ _ _ Puerperal Pyrexia 19 8 14 5 10 10 3 9 6 8 3 3 98 Ophthalmia Neonatorum 2 3 4 — 5 1 1 1 1 18 Poliomyelitis and Polio—encephalitis 1 1 7 4 5 9 7 ?9 Dysentery 2 4 6 9 673 365 38 10 19 20 21 12 1,179 Malaria — — — — — _ _ _ _ _ _ _ _ Ac. Pri. and Ac. Inf. Pneumonia 16 16 13 9 4 4 3 1 2 1 1 5 75 Food Poisoning — 4 4 7 4 8 9 8 11 15 5 4 79 Acute Encephalitis — — — 1 — _ — _ _ 1 _ _ 2 Measles 317 1,188 2, 210 888 233 160 17 12 5 10 10 2 5,052 Whooping Cough 8 17 21 28 32 77 29 32 9 9 6 8 276 total 7,259 19 20 FOOD POISONING The figures show a slight increase over last year. Some cases of Salmonella infection were discovered during enquiries into illnesses connected with the outbreak of Sonne Dysentery. Single cases might more frequently be identified if subjected to bacteriological tests. The following figures give the food poisoning notifications, as corrected, for 1955:- 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 8 19 28 24 79 Outbreaks due to identified agents:- Total Outbreaks Total Cases 10 28 Outbreaks due to:- (a) Chemical PoisonsNil (b) Salmonella Organisms 10 (c) Staphylococci cluding toxin) Nil (d) C1 Botulinum Nil (e) Other Bacteria Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases 6 19 Single Cases:- Agent identified. Unknown Cause Total 13 19 32 21 WADDON (ISOLATION) HOSPITAL I am indebted to Dr. J.J. Linehan for the following report on infectious etc. cases admitted to the Hospital during 1955. There was a total of 747 admissions of whom 631 were admitted to the acute infectious diseases wards, 100 to the pulmonary tuberculosis wards and 16 to the ward for chronic sick. In the figures for the 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 Croydon patients are shown separately in brackets. The average number of occupied beds was 101.6. Admissions to the Tuberculosis Wards:- 100(96) tuberculous patients were admitted and there were 10 deaths. The proportionate increased mortality over the previous year occurred in the higher age groups, all fatal cases being over 50 years. The average bed occupancy was 41.3 and average stay in hospital 83.7 days. Admissions to the Infectious Diseases Wards:- The following are the final diagnoses of patients admitted to the acute infectious disease wards, together with brief details relating to the common infectious diseases. The average stay in hospital of these patients was 20.8 days and the average bed occupancy 37. Measles 140 (114) Scarlet Fever 130 (124) Gastro-enteritis 57 (52) Dysentery 52 (47) Chicken-pox 37 (33) Poliomyelitis and Encephalitis 29 (23) Food Poisoning 20 (16) Whooping Cough 16 (14) Mumps 12 Erysipelas 8 Meningitis 4 Glandular Fever 4 Paratyphoid Fever 3 Rubella 3 Infectious Hepatitis 2 Herpes Zoster 2 Ophthalmia Neonatorum 1 Vincents Angina 1 Stephens Johnson Syndrome 1 Typhoid Fever 1 Pneumonia 13 (l0) Bronchitis 6 (5) Streptococcal Sore Throat 5 Tonsillitis 11 (10) Pharyngitis 14 (13) Quinsy 3 (2) Stomatitis 2 Laryngitis 2 Otitis Media 1 Rhinitis 1 Impetigo 4 Ringworm 1 Dermatitis 1 Psoriasis 1 Urticaria 1 Vulvo-vaginitis 1 Appendicitis 1 Haemorrhagic Pancreatitis 1 Ulcerative Colitis 1 Melaena 1 Fistula in Ano 1 Oesophageal Haemorrhage 1 Carcinoma of Gall Bladder 1 Scarlatinal Nephritis 1 Pyelitis 1 Cerebral Thrombosis 1 Migraine 1 Neuritis 1 Subarachnoid Haemorrhage 1 Bel 1's Palsy 1 Rheumatism 1 Anaemia 1 Diabetes 1 Drug Allergy 1 Thrombo-phlebitis 1 Fractured Tibia 1 Bronchial Carcinoma 1 Poliomyelitis Contact 1 Non-patient Baby 1 Non-patient Mother 1 Nil abnormal detected 1 22 Measles:- There was a measles epidemic during the first five months of the year. 58 of the 140 patients admitted had complications as follows; pneumonia 29, tonsillitis 7, otitis media 5, meningoencephalitis 4, gastro-enteritis 4, sinusitis 3, stomatitis 2 and one each otitis externa, conjunctivitis, laryngitis stridulosa and pleurisy. 50 patients were admitted from receiving centres, rest centres etc., 13 from other hospitals, 7 from children's homes and nurseries and 22 because of poor home conditions. Of the patients suffering from meningo-encephalitis, three were comatose and had recurring convulsions. One of these was fatal. Scarlet Fever:- Complications were relatively few and mild. There were only three cases of otitis media and there was no evidence of renal or cardiac lesions developing in any of the cases treated. The decline in the number of admissions continued and was more marked than in previous years. Gastro-enteritis:- The numbers of patients treated in the different age groups were as follows; under one year 19, 1-5 years 15, 5-15 years 1, adults 17. Classified according to severity 31 were mild, 21 moderately severe and 5 very severe. Cases classified as very severe are those who had to be placed on the dangerously ill list and required fluid other than by mouth. As compared with previous years, they were relatively few and there were no fatilities. Dysentery:- Except for one case of Flexner dysentery, all were of the Sonne type. They occurred mainly in groups of associated cases. No severe illnesses were encountered. Chicken-pox:- Admissions occurred as follows; From general hospitals - Patients 6 Residential Schools 2 Staff 3 Poor Home Conditions 6 Children's Homes 4 For complications 4 Rest Centres etc 12 Poliomyelitis:- The 29 cases admitted may be classified as follows:- Non-paralytic Meningitic 12 Paralytic Spinal Paralyses 10 Encephalitic 2 Bulbar 3 Spinal and Bulbar 1 Spinal and Respiratory 1 2: Only one case required treatment with a respirator and one postural drainage. There were no deaths. Of the cases with spinal paralysis, five fully recovered before leaving isolation, and of the remainder only two had paralysis sufficiently severe to indicate probable permanent weakness. An unusual feature was the number of cases, both paralytic and non-paralytic, in which the cell count in the C.S.F. was sufficiently raised to produce a definitely turbid fluid. There was the usual seasonal incidence, 23 of the 29 cases occurring in the months August-November inclusive. Food Poisoning:- Salmonella typhi-murium infections, as usual, predominated. The organism was isolated in 16 out of the total of 20 cases, occurring in three groups of associated cases and 6 unassociated cases. The four remaining infections were Salmonella Newport 1, Salmonella Weltevreden 1, no pathogens isolated 2. As in previous years, the convalescent carrier state remained troublesomely persistent and apparently unaffected by medication. Whooping Cough:- 14 of the 16 cases were admitted in the months June-August inclusive. There were 6 cases under one year, of whom 2 were under 4 months and 3 between 1 and 2 years of age. There was one fatal case, a baby who developed gastro-enteritis as a fatal complication. Other Infections:- Three of the four cases of meningitis treated were meningococcal and the fourth a pyogenic type of meningitis in which the organism was not isolated. The three paratyphoid B infections came from widely separated areas. The typhoid case was not a recent infection but a recrudescence in the form of a typhoid abscess. Chronic Sick Ward:- There were 16 admissions classified as follows; - Senility - 7; Hemiplegia - 3; Heart Disease - 2; Pneumonia - 2; Parkinsonism - 1; Urinary Infection - 1. Fatal Cases:- There were 19 deaths as follows:- ten deaths from pulmonary tuberculosis and one death each from measles, whooping cough, pneumonia, carcinoma of the lung, haemorrhagic pancreatitis, paralysis agitans, myocardiac degeneration, hemiplegia and senility. 24 THE PREVENTION AND CONTROL OP 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 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 19 20 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 19 23 25 - 190 0.98 1943 9 - 120 0.62 19 24 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 1935 9 - 176 0.71 1955 1 0.02 35 0.14 *Prior to 1917, rates only available for Census years. 25 I am indebted to Dr. R.H.J. Fanthorpe, Chest Physician, for the following section of the Report. Measures for the prevention and treatment of Tuberculosis are directed from the Chest Clinic and the results during 1955 may be regarded as satisfactory. The number of deaths from all forms of tuberculosis during 1955 was 35 which shows an increase by three when compared with 1954. The incidence of the disease during the year, however, has shown a very satisfactory decrease and the majority of new patients are diagnosed at an earlier stage in the disease. The employment of the tuberculous after completion of treatment is somewhat easier now than it was five years ago. The close liaison which exists between the medical staff, Almoner and Disablement Resettlement Officer of the Ministry of Labour helps greatly in placing patients in the most suitable employment. The Industrial Rehabilitation Unit at Waddon does much valuable work in this connection, particularly for the patient who has had prolonged absence from work on account of his disease. Whilst this section of the report is concerned with tuberculosis it should be realised that all chest conditions are seen and treated at the Chest Clinic. With the decline in tuberculosis we are seeing an increase in the incidence of lung cancer and chronic bronchitis. The former accounts for the highest number of cancer deaths in males and the latter causes much chronic invalidism and loss of earning capacity. Incidence 151 cases of Respiratory Tuberculosis and 20 cases of NonRespiratory Tuberculosis were notified on Form A during 1955 (Table 1 - Formal Notifications). Of these 107 males and 44 females were Respiratory cases and 10 males and 10 females were Non-Respiratory. In addition 82 Respiratory cases and 8 Non-Respiratory cases came to our notice as new cases otherwise than by notification (Table II - Supplemental Return). The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1955 by notification or otherwise was 261 as compared with 336 in 1954, 304 in 1953, 331 in 1952, and 316 in 1951. 233 of these were cases of Respiratory Tuberculosis; 160 in males and 73 in females. There were 25 fewer males and 48 fewer females than in 1954. 26 There were 6 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 7 in 1954. The number of cases in adults was 22 compared with 23 in 1954. Of the cases notified in 1955, 23 males and 2 females died from the Respiratory form of the disease during the year, equal to 3.3 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 1.04 per 1,000 of the population; for Respiratory Tuberculosis 0.93, and for Non-Respiratory 0.11 per 1,00C population. The notification rate was 0.69 per 1,000. In 1954 the corresponding figures were 1.34, 1.22, 0.12 and 0.95 per 1,000. Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1955 to 31st December, 1955:- TABLE I. Formal Notification Age Periods Number of Primary Notificat ions of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all age) Respiratory, Males 1 - 1 5 1 4 9 23 18 16 16 9 4 107 Respiratory, Females 1 1 2 1 1 11 5 7 10 1 3 1 - 44 Non-Respiratory, Males - - 2 2 - 1 - 1 - 3 - 1 10 Non-Respiratory. Females - - - 1 - - - 5 1 1 1 - 1 10 27 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, 1955 to 31st, December, 1955, otherwise than by formal notification:- 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- TOTAL Death Returns from Local Registrars Respiratory M _ _ _ _ _ _ _ _ _ _ _ _ 1 1 (A) F _ _ _ _ _ _ _ _ _ _ _ 1 _ 1 (B) Non-Respiratory M _ _ _ _ _ _ _ _ _ _ _ _ _ _ (c) F _ _ _ _ 1 —_ — _- _- -_ _ -_ _ 1 (D) Death Returns from RegistrarGeneral (Transferable Deaths) Respiratory M _ _ _ _ _ _ _ _ _ _ _ _ _ _ (A) F _ _ _ _ _ _ _ _ _ _ _ _ _ _ (B) Non-Respiratory M _ _ _ _ _ _ _ _ _ _ _ _ _ _ (c) F _ _ _ _ _ _ _ _ _ _ _ _ _ _ (D) Posthumous Not i ficat ions Respiratory M _ _ _ _ _ _ _ _ _ _ _ _ _ - (a) F _ _ _ _ _ _ _ _ _ _ _ _ _ _ (B) Non-Respiratory M _ _ _ _ _ _ _ _ _ _ _ _ _ _ (c) F _ _ _ _ _ _ _ _ _ _ _ _ _ _ (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M _ 1 1 _ 1 _ 6 20 9 6 4 2 _ 50 (A) F _ _ _ _ _ 1 9 11 4 _ 1 _ 1 27 (B) Non_Respiratory M _ _ _ 1 _ _ _ 1 _ _ _ _ 2 (C) F — _ _ _ _ 2 _ _ 1 _ _ _ _ 3 (D) Other Sources Respiratory M _ _ _ _ _ _ _ _ _ 1 _ 1 _ 2 (A) F _ _ _ _ _ _ 1 _ _ _ _ _ _ 1 (B) Non_Respiratory M _ _ _ _ _ _ _ 1 _ _ _ _ _ 1 (C) F _ _ _ — _ _ __ __ 1 __ __ _ 1 (D) totals (a) 53 (B) 29 (c) 3 (D) 5 28 Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1955:- RESPIRATORY NON-RESPIRATORY Total Cases Males Females Total Males Females Total 1,124 814 1,938 89 101 190 2,128 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1955, 137 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) 82 or 59.8 B, or T. B. plus, 1 (early cases, sputum positive) 9 or 6.6 B, or T. B. plus, 2 (intermediate cases, sputum positive) 42 30.7 B, or T. B. plus, 3 (advanced cases, sputum positive) 4 or 2.9 137 100.0% Non-Respiratory Tuberculosis There were 16 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints M2 Abdominal 3 Other Organs 9 Peripheral Glands 2 16 29 Ages at Death from Respiratory Tuberculosis Year 0-5 5- 15 15-25 25-45 45-65 over 65 TOTAL 1916 _ 2 17 38 36 8 101 1947 - 1 14 34 31 12 92 1948 - - 12 43 39 10 104 1949 2 11 38 23 15 89 1950 1 - 7 10 28 14 60 1951 - - 2 15 21 13 51 1952 - - - 10 22 20 52 1953 1 - - 5 11 14 31 1954 - - 1 6 15 6 28 1955 - - - 6 18 9 33 All but 3 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 1955 the death-rate from all forms of Tuberculosis was 0.140 per 1,000 population. The rate from Respiratory Tuberculosis was 0.132 and the rate for Non-Respiratory Tuberculosis 0.008. Similar figures for 1954 were 0.112 and 0. 016. In 1955 the total number of deaths showed a slight increase when compared with 1954. 80% of the deaths occurred in the age groups 45 years and over. There was one death in a child of school age. Deaths from Non-Respiratory Tuberculosis During 1955 2 deaths were certified to be due to Non-Respiratory Tuberculosis, compared with 4 in 1954, 6 in 1953, 2 in 1952 and 13 in 1951. 1 of the patients died in a general hospital and 1 at home. Both of them were notified during life. 30 The deaths were due to: - Males Females Total Tuberculous Kidney 1 - 1 Miliary Tuberculosis - 1 1 Totals 1 1 2 Co-ordination with the Health Department During the year 89 children were referred by the School Medical Service, and 7 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 14 selected cases for varying periods during the year, and 10 cases were in receipt of extra nourishment at the end of the year. Residential Treatment 229 men, 125 women and 12 children were admitted to Residential Institutions in Croydon during 1955. The Chest Clinic and Home Visiting 1,680 new cases were examined during the year. 134 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 14,319. There were also 5,789 attendances by patients for collapse therapy. The Clinic doctors paid 201 home visits and the Tuberculosis Visitors 3,738 visits for Clinic purposes. In addition the Tuberculosis Visitors made 362 primary visits for the purposes of the Notification Register. There were also 1,573 unsuccessful visits made. Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nursing Association, by arrangement with that organisation. Their assistance is a valuable adjunct in the care of domiciliary cases. Contact Examination The examination and subsequent supervision of persons coming into contact with patients suffering from tuberculosis plays an important part in the prevention of the spread of infection. 31 During 1955, 686 persons were examined for the first time as contacts of notified cases of tuberculosis, giving a contact-case ratio of 4 for each notified case during the year. Of these contacts, 13 were found to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 19, compared with 1.04 per 1,000 of the general population. In addition, there were 4 found to be tuberculous who had been under observation from previous years. The number of new contacts examined, together with the numbers of new cases of Tuberculosis notified in previous years are as follows: - 1954 - New contacts examined 820. 1953 - „ „ „ „ 668. 1952 - „ „ „ „ 661. 1951 - „ „ „ „ 562. 1950 - „ „ „ „ 561. New cases of tuberculosis 238 „ „ „ „ 211 „ „ „ „ 243 „ „ „ „ 214 „ „ „ „ 275 B.C. G. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1955 and regular sessions are held at the Clinic for this purpose. 259 contacts were successfully vaccinated during the year, compared with 281 in 1954. In addition, 24 nurses and domestics were successfully vaccinated, and 52 babies of tuberculous parents were vaccinated in hospital during the neonatal period. During 1955 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 66 children over the age of 13 years were successfully vaccinated. The results of the trials carried out during 1954 and 1955 coupled with the report of the Medical Research Council indicates the value of B.C.G. as a protective measure. The response of parents to the B.C.G. vaccination for their children has been good, and only in a very few instances has permission been refused. Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1955 1,886 Transfers in from other areas 92 "Lost sight of" cases returned during the year 1 New cases diagnosed as definite during the year 151 2, 130 32 Number of cases written off the Chest Clinic Register during the year as: Recovered 78 Died 49 Removed to other areas 106 "Lost sight of" and other reasons 14 247 Remaining on Register as at 31st December 1,883 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 2,366 Number of visits paid by Clinic doctors to homes of patients 201 Number of visits paid to homes of patients by Tuberculosis Health Visitors 4, 100 Attendances of patients at the Clinic:- At ordinary sessions 14,319 At refill sessions 5,789 20, 108 Number of X-ray films taken 14, 531 Rehousing of Tuberculosis Patients 25 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. X-Ray Service It is now necessary for all members of the staff of the Corporation whose duties bring them into contact with children to have an X-ray examination of the chest on their appointment and thereafter annually. In this connection 279 examinations were carried out in 1955. 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 Pu tmonary Tubercu/osis Inactive Pulmonary Tuberculosis NonTuberculous Conditions Croydon C.B. Area 15,551 16 596 482 33 TUBERCULOSIS AFTER-CARE I am indebted to Miss Bridger, Almoner of the Chest Clinic, for the following reports:- Arrangements under the Council' s scheme for prevention and after care of tuberculosis patients continued as in previous years. Bedding, free milk in certain cases, maintenance in colonies, and provision of garden shelters were some of the services supplied through the Local Health Authority. As always, close contact was maintained between the Almoner's Department and the National Assistance Board, to ensure that patients were able to take full advantage of the special provisions available to them. Similarly, the closest liaison was maintained with the Ministry of Labour's Disabled Resettlement Department to ensure that the patient's future health was safeguarded by placing him in suitable employment in proper surroundings. In some cases, a change of employment was arranged; in others training at a Government Training Centre was needed before this could be done, and in other cases again, a course at the Industrial Rehabilitation Unit was the first necessity, in order to help the patient regain his confidence and to decide on the work or training most suited to his individual requirements. Statutory provisions for the welfare of the patient and his family were only part of the story. Inevitably there were gaps people who just failed to fall into this or that category, or families who had needs over and above those covered from Government sources. To help meet these, over £250 was raised on individual appeals to voluntary funds. The outstanding development of the year was undoubtedly the recognition of the increasing, rather than decreasing need for voluntary help, which expressed itself, in the formation of the Croydon Tuberculosis Care Committee. The Inaugural Meeting was held on March 31st, 1955 when His Worship the Mayor kindly consented to become our president, and from that date much hard work has been undertaken by the Committee members. Fund raising was, and still is, our first concern and most of the period covered by this report had to be devoted to that difficult but essential task. We cannot overestimate our debt of gratitude to the Norwood Round Table, who sponsored the Committee, and by whose efforts nearly £1,500 was raised on our behalf at the Midnight Matinee at the Davis Theatre in November. Our first act was to provide Christmas parcels of groceries for 190 patients and their families, and by the end of 1955, practical schemes had been drawn up to send gifts of coal, pay fares for relatives to visit patients in sanatoria, and to arrange a summer holiday programme. The possibilities opened up by this new voluntary effort are endless, and we are confident that the welfare of the patients will gain much from this organisation before another year has passed. 34 OCCUPATIONAL THERAPY There has been a general increase in this work during the past year, and in April the weekly sessions were increased from three to four, in order to assimilate a growing waiting-list. 460 home-visits have been made and 164 attendances at the weekly class are recorded. Two Sales of patients' work were held in early December. The first, held at the Town Hall, realised £7. 10s. The second, disposed of nearly all the remaining work and brought in nearly £12, For this we are indebted to the Occupational Therapist at Mayday Hospital, who kindly provided space during their Annual Exhibition. Patients have been greatly encouraged by this success. It is felt that the results show that a Sale held near the Chest Clinic would be better attended by staff, patients, and their relatives. We therefore hope to hold another Sale at the Chest Clinic, at the end of November next. 35 VENEREAL DISEASES I am indebted to Mr. J.R. Crumbie, F. R. C. S. in charge of the Centre, for the following return relating to all persons attending at the Treatment Centre at Special Clinic, Croydon General Hospital, Croydon, during the year ended 31st December, 1955. SYPHILIS Totals Males Females 1. Patients under treatment or observation on January 1st 90 47 43 2. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 8 4 4 3. Patients transferred from other Centres after diagnosis 6 _ 6 4. Patients dealt with for the first time (excluding 2 and 3) suffering from: Syphllis, primary — — — " secondary — — — " latent in the 1st year of infection - — — " cardio-vascular - - - " of the nervous system - - — All other late or latent stages 11 8 3 Syphilis congenital aged under 1 year - - - Syphi1is congenital aged 1 but under 5 - - — Syphi1is congenital: aged 5 but under 15 — - - Syphilis congenital: aged 15 and over 3 1 2 TOTAL Item 4 14 9 5 5. Patients completing treatment and/or observation 34 16 18 6. Patients transferred elsewhere 6 3 3 7. Patients not completing treatment and/or observation _ _ _ 8. Patients under treatment or observation on December 31st (should equal Items 1 to 4 less Items 5 to 7). 78 41 37 GONORRHOEA 9. Patients under treatment or observation on January 1st 16 13 3 10. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 1 _ 1 //. Patients transferred from other Centres after diagnosis 4 _ 4 12. Patients dealt with for the first time (excluding Items 10 and ll) 49 42 7 13. Patients completing treatment and/or observation 55 43 12 14. Patients transferred elsewhere 8 6 2 15. Patients not completing treatment and/or observation 4 4 _ 16. Patients under treatment or observation on December 31st (should equal Items 9 to 12 less Items 13 to 15) 3 2 1 36 Total s Males Females OTHER CONDITIONS 17. Patients under treatment or observation on January 1st 68 46 22 18. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 20 19 1 19. Patients transferred from other Centres after observation — — — 20. Patients dealt with for the first time (excluding Items 18 and 19) suffering from:- Chancroid — — — Lymphogranuloma Venereum — — — Granuloma Inguinale — — — Non-gonococcal Urethritis 47 47 — Any other conditions requiring treatment 123 70 53 Conditions not ing treatment 205 126 79 Undiagnosed conditions - - - TOTAL Item 20 375 243 132 21. Patients completing treatment and/or observation 418 275 143 22. Patients transferred elsewhere 20 17 3 23. Patients not completing treatment and/or observation 2 2 — 24. Patients under treatment or observation on December 3lst (should equal Items 17 to 20 less Items 21 to 23) 23 14 9 ATTENDANCES BY PATIENTS At which patients saw physician Syphilis Gonorrhoea Other Conditions 288 268 1094 168 234 888 120 34 206 At which patients did not see physician Syphi1is Gonorrhoea Other Conditions 721 107 640 29 5 55 248 426 52 392 CONTACTS ATTENDING FOR EXAMINATION REFERRED BY PATIENTS SUFFERING FROM:- Syphi1is Gonorrhoea Non-gonococcal urethritis Other Conditions _ — _ 3 1 2 14 — 14 15 10 5 37  By the Physician at the Centre Sent to a Pathological Centre PATHOLOGICAL WORK NUMBER OF SPECIMENS EXAMINED Microscopical: for Syphi1is — 3 Microscopical: others — 691 Cultural — 389 Serum: for Syphi1is — 605 " Others — 279 Cerebro Spinal Fluid (Number of tic lumbar punctures — 16 SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR SHOWING THE AREAS IN WHICH PATIENTS DEALT WITH FOR THE FIRST TIME (ITEMS *. 12 AND 20) RESIDED (MAJOR AREAS TO BE SPECIFI ED. MINOR AREAS MAY BE GROUPED AS "ALL OTHERS") County, County Borough (England and Wales) and Others Syphi1is Gonorrhoea Other Conditions Croydon 10 31 217 Surrey 2 9 105 Kent 1 1 20 London 1 8 33 Totals (to agree with Items 4, 12 and 20 14 49 375 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 Dr. A.J.H. Tomlinson, the Director of the Bacteriological Laboratory, County Hall, S.E.1, 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 - 1955 Faeces outfits 5,963 Water samples 278 Milk samples 258 Ice Cream samples 159 Sundry Pood Specimens 42 Total 6,700 38 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT ANTE-NATAL AND POST-NATAL CLINICS During the year 3,860 cases were seen at the Ante-Natal Clinics, of which 2,751 were new cases. A total of 25,150 attendances was recorded, and 1,797 cases were seen at the Post-Natal Clinics (1,696 new cases) and 1,809 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 362 patients recorded 1,732 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 1955 who were born - (i) at home 41 (ii) in private nursing homes 3 (in) in hospital 124 (2) The number of those born at home - who were nursed entirely at home 39 who were transferred to hospital on or before the 28th day 2 who died during the first 24 hours 1 who survived at the end of one month 40 (3) The number of those born in private nursing homes - who died during the first 24 hours - who survived at the end of one month 3 (4) Number of those born in hospital - who died during the first 24 hours 18 who survived at the end of one month 100 (5) Number of premature still births who were born - (i) at home 4 (11) in private nursing homes 2 (lii) in hospital 39 39 CARE OF THE UNMARRIED MOTHER The Croydon Association for Moral Welfare continued to act for the Corporation and received payment on a capitation basis for cases dealt with by their Social Worker. The Corporation also paid hostel fees in respect of approved cases for whom such accommodation was required. During the year under review - 137 cases were dealt with by the Social Worker; 17 cases were admitted to Hostels; 9 cases were temporarily accommodated at Glazier House (The Croydon Home of the Moral Welfare Association) The Committee agreed to meet financial responsibility for the stay of unmarried mothers in Mother and Baby Homes 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. No infant deaths of illegitimate babies occurred in 1955. INFANT WELFARE CENTRES The work continued unchanged and a new centre was opened at St. George's Hall, The Glade, on the Monks Orchard estate. All efforts to find suitable premises in the northern part of the New Addington estate were unfortunately unsuccessful. Permission was given by the Education Committee to use the medical room in a new school, but the layout of the building made this impossible. Other building developments in the Gravel Hill area brought a similar request for Infant Welfare facilities. A suitable Church Hall was available and its use is being considered. The W.V.S. took over the central distribution centre for welfare foods and kept it staffed throughout the year, all day on week-days and on Saturday mornings, and I would pay tribute to their most efficient working of this service. A store was built at the health department and the distribution of supplies to the infant welfare centres carried out by our own transport and staff. This has greatly assisted the work of the volunteers who deal with the issue of these foods at all the centres. Total issues made during the year were:- National Dried Milk 114,880 Cod Liver Oil 32,000 Vitamins A and D (for Expectant Mothers) 12,761 Orange Juice 195,421 40 ATTENDANCES AT INFANT CENTRES - 1955 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. Fai rchiIdes, Friday, P.M. Monks Hill, Tuesday, P.M. Munic ipal, Monday, P.M. Munic ipal, 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. Georges, Monday, P.M. St. Judes Hal 1, Tuesday, A.M. St. Judes Hall, Tuesday, P.M. St. Oswalds, Thursday, A.M. St. Oswalds, Thursday, P.M. Selhurst, Wednesday, P.M. Shirley, Thursday, P.M. South Croydon, Thursday, P.M. South Norwood, Tuesday, P.M. South Norwood, Friday, P.M. Spring Park, Monday, P.M. Upper Norwood, Wednesday, P.M. Waddon, Wednesday, P.M. West Croydon, Friday, P.M. woodside, Friday, A.M. • woodside, Friday, P.M. Total, 1955 Total 1954 New cases under 1 year 76 81 101 105 108 158 84 32 97 129 132 184 66 98 87 62 97 35 61 99 57 121 49 65 109 103 155 70 147 81 31 64 86 3030 3019 No. of Re-attendances 1262 1561 1034 1795 2035 2388 1069 842 1240 1944 1911 1910 1293 1737 1353 1021 1407 237 1396 1666 898 1420 814 1176 1486 1519 1789 1166 2097 979 758 965 1270 45438 45826 New Cases ove 1 year 10 16 10 14 10 22 12 3 7 9 26 33 18 12 11 7 11 18 12 9 13 10 15 24 11 11 14 18 35 12 1 10 12 456 463 No. of Re-attendances 598 1034 562 707 774 941 380 513 358 433 1023 882 816 1140 624 586 447 108 798 919 704 1055 737 546 747 558 634 639 881 351 693 544 745 22477 24124 Attendances of Children 0-5 1946 2692 1707 2621 2927 3509 1545 1390 1702 2515 3092 3009 2193 2987 2075 1676 1962 398 2267 2693 1672 2606 1615 1811 2353 2191 2592 1893 3160 1423 1483 1583 2113 71401 73432 Consultations with Doctor 776 905 622 918 824 950 412 253 525 980 940 945 547 822 605 397 584 139 720 833 589 678 530 397 524 683 670 485 805 519 342 459 571 20949 21631 No. of Sessions 48 48 52 52 51 50 51 51 46 50 52 52 51 52 52 51 48 23 51 51 52 52 52 51 51 51 51 48 52 52 51 51 51 1647 1559 EXPECTANT MOTHERS No. of new cases - - - - - - - 2 - - - - - - - - - - - - - - - - - 1 - - - - 2 - - 5 21 No. of Re-attendances - - - - - - - 2 - - - - - - - - - - - - - - - - - - - - - 1 - - - 3 38 Total attendances of Expectant Mothers - - - - - - - 4 - - - - - - - - - - - - - - - - - 1 - - - 1 2 - - 8 59 Total Attendances 1946 2692 1707 2621 2927 3509 1545 1394 1702 2515 3092 3009 2193 2987 2075 1676 1962 398 2267 2693 1672 2606 1615 1811 2353 2192 2592 1893 3160 1424 1485 1583 2113 71409 73491 Average per Session 1955 ... 40.5 56.1 32.8 50.4 57.3 70.2 30.3 27.3 37.0 50.3 59.5 57.9 43.0 57.4 39.9 32.9 40.9 17.3 44.5 52.8 32.2 50.1 31.1 35.5 46.1 43.O 50.8 39.4 60.8 27.4 29.1 31.0 41.4 43.4 - 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 45.6 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 41 HOME NURSING This service is carried out by the Croydon District Nursing Association acting as agents of the Corporation. I am indebted to the Superintendent for the following details:- Staff at 31.12.55 Superintendent Deputy Superintendent 2 Assistant Superintendents 38 whole time Nurses (including 1 male) 3 Queen's Students Summary of work carried out during the year under review: - Patients remaining on books from 1954 874 New patients 5, 583 Total 6,457 New Patients Medical 2, 541 Surgical 2,930 Gynaecological 11 Obstetric 83 Maternity 18 Total 5, 583 Specially classified:- Cases Visits Tuberculosis 174 4, 885 Pneumonia 256 2, 283 Maternity Complications 68 494 Infectious Diseases (including influenza) 55 361 Children under five years 188 1,243 Visits:- Termmation of Cases:- Convalescent 3,471 Hospital 741 Died 506 Removed for other causes 822 Still on books 917 Total 6,457 42  Total visits January 12,712 February 12, 038 March 12,907 April 12, 248 May 12,384 June 12,926 July 12, 264 August 12, 164 September 10,952 October 12,409 November 12, 527 December 12, 353 Total 147,884 Nursing of Children "The number of children nursed up to 5 years was 188. 170 of these were injections, the other 18 being circumcision operations and dressings chiefly for burns. The children who have injections only are a small minority. Other treatment is invariably necessary including temperature, pulse and respiration. The teaching of the Mother to attend to the child forms an important part of the Nurse's work, especially in barrier nursing. During her training it is impressed on the Nurse that a child is always fearful of the unknown and all preparations for injections, dressings etc., are made outside the room where the child is. If a Mother is capable of learning to do the nursing this is preferable as the child is usually less upset. For the first two visits Nurse always carries out "General Attention", showing the Mother how this should be done. All barrier nursing is done by the Nurse, who gives advice to the parent on the application of this nursing technique between her visits. Number of children nursed between the age of 5 and 16 years during 1955 was approximately 100. The same nursing technique is applied to these patients but most children between these ages need more nursing care as the older the child is the more he or she is likely to resent the mother bathing them. The Nurses are, at times, called upon to render first aid to accidents and casualties involving children of all ages, especially during the holidays. The Nurse is often left with the responsibility of these cases as, after surgery hours, it is 43 almost impossible to find a Doctor and, if it is a hospital case, she must wait until the application for the ambulance has been put through. The Nurses are seldom called to street accidents." Hypodermic Injections Drugs covered by Dangerous Drugs Act 3,718 Insulin only 16,085 Other drugs 32,776 DAY NURSERIES Attendances at Day Nurseries, 1955 Whitehorse Road Mor land Road * Date opened 1/6/142 8/3/43 Capacity 50 56 Number on books at end of year 51 NIL Attendances: under 2 3,479 1, 295 over 2 4,366 2,461 TOTAL 7,845 3,756 Number of days opened 254 186 Average daily attendance 31 20 * Morland Road closed Sept. 1955 M. AND C.W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year Compla int No. of Cases Total M F Bow Legs 6 4 10 Knock Knees and Flat Feet 31 26 57 Valgus Ankles Chest Conditions: 8 9 17 Post T.A. and Asthma 7 7 14 Kyphosis 1 2 3 Tort i-collis 3 2 5 Pigeon-toes 11 15 26 67 65 132 Total attendances: 2,032 44 DENTAL TREATMENT (MATERNITY AND CHILD WELFARE) 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 or through personal initiative of Health Visitors; a reduced number of applications continue to be received from Day Nurseries and similar institutions still in operation. The past year has seen a noticeable reawakening of interest in the above Service, particularly with regard to the supervision of expectant and nursing mothers. This increased patronage has extended to almost all clinics and is most pronounced in the New Addington area. The improved liaison between the Dental Clinics and AnteNatal Centres in the matter of referring mothers has played a considerable part in bringing to patients' notice the range of dental care available in the Local Authority's Service, and the importance of an accurate assessment of dental requirements being made during the early months of pregnancy. Though less spectacular, an increase is also recorded in the number of pre-school children referred by Medical and Dental Officers, Health Visitors and other social workers. In view of the further curtailment of Day Nurseries, these alternative forms of publicity represent a valuable link with this special age group. It is perhaps regrettable that little has again been possible in the way of regular visits by Dentists to Welfare Centres; however, as available sessions have been fully occupied on the treatment side, it has been felt that activities of this kind must await an easing of the staffing situation. The principal item of interest of the year has been the opening of the new Dental Centre at Stroud Green, details of which were provided in a previous Report. Besides the normal service for school children this building has been designed with a view to providing more comprehensive facilities for expectant mothers and pre-school children, with special emphasis on the preventive side of this work. When staffing arrangements are complete, practical demonstrations on the correct method of 45 brushing the teeth will be given to younger children by an Oral Hygienist who will at the same time be available to carry out prophylactic treatment for mothers and advise them on general dental care. It has been somewhat unfortunate that the major increase in demand for dental welfare has occurred at New Addington, where clinic facilities are already strained by the rapid growth of the school population. Added to this, more recent developments have been so significant as to call for a drastic reassessment of future requirements for this area. To meet more immediate needs it is hoped that those in less remote sections of the Estate can receive attention at the Stroud Green Centre, though this may entail a certain delay in treatment. At the time of writing comprehensive proposals have been submitted for the erection of a Dental wing to the existing Welfare Centre in Salcot Crescent, with provision for a further extension, should this be necessary at a later date. Because of the pressing need it is hoped that early sanction will be given to these proposals which would considerably increase both school and M. and C. W. amenities for this district. Expectant and Nursing Mothers. The total number of expectant and nursing mothers referred from all sources was 744, compared with 593 in 1954. 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, almost all those applying for treatment received an initial appointment to attend the Dental Clinic. Absenteeism again shows an increase, recording 23 per cent. compared with 16 per cent. last year. Expectant mothers examined for the first time numbered 457 against 322 last year. Of these, 77.5 per cent. were seen during the first six months of pregnancy, compared with 74.5 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 little change 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 permit 46 of treatment until after the confinement; in others, names were actually received during the post-natal period. 42 nursing mothers were examined during the current year, compared with 47 in 1954. Treatment. Including those continuing treatment from the previous year, 595 mothers were dealt with, compared with 407 in 1954. 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 should be aimed at when practicable, and for this reason it is hoped that the revised method of referring patients will continue to assist in bringing this about. The Pre-School child. The number of children referred from all sources during the year was 649, compared with 605 in 1954. In the face of the further reduction in the number of Day Nurseries this may be considered a solid 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. 47 Treatment The following summary shows particulars of the work accomplished:- Expect ant Mothers Nursing Mothers Total Young Children New Cases Examined 457 42 499 486 Re-treated 87 9 96 163 Total 544 51 595 649 Expectant and Nursing Mothers Young Children Attendances 1,440 1,194 Fillings 428 503 Extractions 554 641 Gas Cases 144 263 Local Anaesthesia 129 14 Scaling and Gum Treatment 194 - Dressings 305 377 Denture Dressings 216 - Silver Nitrate - 317 Treatments Completed 283 338 Number of Sessions (treatment) 394 Dentures Fitted 72 Dentures Repaired 14 48 The Centres at which patients were examined, or from whii they were referred, are given in the following list:- Mothers Young Children Mothers Young Chiildren. Ante-Natal 690 - South Croydon 7 Municipal Midwives' 50 - St. A1ban's 3 Woodside 3 Post-Natal 3 - Norbury 8 Welfare Centres etc.: Addington 28 Municipal 1 3 St. Andrew's 3 East Croydon - - Waddon 2 Upper Norwood - 1 Boston Road 2 Holy Trinity - 1 St. Jude's 13 St. Oswald's - 3 St. John's (Shirley) 3 Bensham Manor - 1 Monks Hill Fairchildes - 2 Crossfield Nursery 2 West Croydon - 3 South Norwood - 1 Referred by Dental Officers 560 Mothers:744 Young Children: 649 Total:1,393 49 MIDWIFERY SERVICE The Corporation employ directly a Superintendent and 19 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 1955 1,204 2.-The number of spontaneous deliveries1,197 3.-The number of forceps deliveries 4.-The number of live births 1,199 5.-The number of still births 5 6.-The number of neo-natal deaths 1 7.-The number of premature infants treated in their own homes, and their weights and ultimate result 10 (1) 31 weeks - 1 lbs. Died 9 hours (2) 36 weeks - 5 lbs. 6 ozs. Discharge weight 5 lbs. 4 ozs. (3) 35 weeks - 5 lbs. 12 ozs. ,, ,, ,, 5 lbs.8 ozs. (4) 36 weeks - 4 lbs. 14 ozs. ,, ,, ,, 5 lbs. (5) 34 weeks - 4 lbs. 12 ozs.,, ,, ,, 4 lbs.12 ozs. (6) 38 weeks - 4 lbs. 12 ozs.,, ,, ,, 5 lbs. (7) 37 weeks - 5 lbs. 4 ozs.,, ,, ,, 5 lbs.14 ozs. (8) 37 weeks - 5 lbs. 4 ozs. ,, ,, ,,5 lbs.4 ozs. (9) 36 weeks - 6 lbs.) ,, ,, ,, 6 lbs. 6 ozs. (10) 36 weeks - 5 lbs.),, ,, ,, 5 lbs.6 ozs. 8.-The number of patients who received Trilene 18 9.-The number of patients who received Gas-Air Analgesia 1,113 10.-The number of cases of P.P.H 19 11.-The number of cases of manual removal of placenta - 12.-The number of patients who received blood transfusion 4 13.-The number of cases to which Flying Squad was called 6 14.-The number of cases of toxaemia of pregnancy treated at home 2 15.-The number of cases of prolonged labour (over 24 hours) 18 16.-The number of breech deliveries including 2 twin 7 17.-The number of twins delivered in their own homes and the weights of the babies 4 sets 1 still born 4 lbs.) 4 lbs. 8 ozs.) 6 lbs. ) 5 lbs. 4 ozs. 1 living 5 lbs. ) 3 lbs.12 ozs.) 5 lbs. ) 5 lbs. 4 ozs. 18.-The number of triplets - 19.-The number of cases of Puerperal Pyrexia Genital 4 Extra-Genital 22 Total 26 20.-The number of congenital malformations 15 50 Midwife Mileage Deliveries Midwifery Maternity Gas and Air AnteNatat Visits PostNata1 Visits Book ings Office Bookings Normal Abnormal Norma 1 Abnormal Midwives Pup i Is Midwives Pupi 1 s / 3664 52 33 - 19 - 49 328 - 675 - 54 60; 2 Cycle Master 69 44 - 22 3 65 361 313 758 1041 57 61 3 1402 40 35 4 1 - 36 285 - 606 - 63 61 4 Cycle Master 54 40 2 12 - 51 259 - 840 78 80 5 989 115 109 - - 6 102 244 275 1037 1206 114 134 6 3734 78 59 - 19 - 73 519 408 1008 1040 119 126 7 Cycl e Master 90 67 3 14 6 87 298 205 8 25 866 98 101 8 2948 62 49 - 13 - 55 238 361 532 1014 74 112 9 Bicycle 21 15 - 6 - 19 160 310 260 1009 34 31 10 Cycle Master 51 32 - 18 1 50 268 - 713 - 46 48 // 380 15 8 - 7 - 12 135 - 238 - 36 16 12 4399 75 73 1 - 1 65 137 - 906 - 91 89 13 2787 86 65 1 16 4 84 403 362 743 988 83 144 14 1252 19 19 - - - 19 78 - 237 - 17 7 15 5868 70 47 1 21 1 64 534 273 1182 878 114 126 16 3237 93 80 3 10 - 86 626 204 1552 782 120 120 17 3975 83 58 1 23 1 76 455 411 762 1099 138 139 18 3203 45 30 3 11 1 41 107 - 521 - - 13 19 Bicycle 44 28 - 16 - 41 263 - 664 - 40 42 20 33 2 2 - - - 2 10 - 34 - - 20 2/ 1066 30 24 3 3 - 26 154 3 393 51 33 54 22 1705 6 6 - - - 6 2 - 114 - - - 23 Bicycle 4 3 - 1 - 4 19 - 81 - 8 12 Total 40642 1204 9 26 22 232 24 1113 5883 5125 14681 9974 1431 1596; 1 Cases dealt with by the Midwifery Service were supplied with Maternity Outfits and a few sets were issued to cases under the care of independent midwives, giving a total of 1,252 issued during the year. 51 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion 4 Other Causes 29 ~~ 33 FOR COMPLICATIONS DURING LABOUR Breech 4 Maipresentation 4 Premature Labour 6 _ 14 Delayed Labour 15 Haemorrhage Ante-partum 11 Post-partum 1L 22 Other Causes Adherent and Retained Placenta 4 Torn Perineum 115 119 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 18 Pain in Breasts 5 Pain in Legs 10 Other Causes 27 60 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 31 Sti11 Birth 1 Other Causes 51 ~ 83 346 In accordance with Rule 33 of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received: - Illness of Mother 49 Defects of lactation 320 Other Causes 37 Total 406 Midwives Acts, 1902-51 The number of Midwives who notified their intention to practise as midwives or maternity nurses, within the Borough (including those in hospitals) and who were practising at the end of the year was 79. All held the certificate of the Central Midwives' Board. The Medical Supervisor of Midwives visits midwives in private practice and nursing homes, and the Superintendent Municipal Midwife carries out these duties for the domiciliary midwives. 52 THE WORK OF THE HEALTH VISITORS Co-operation with General Practitioners One of the difficulties in promoting liaison between family doctor and health visitor has been the fact that the former will normally visit only when there is illness. In contrast to the district nurse, therefore, there is no immediate common purpose which links the attendance on a family of doctor and health visitor. It was thought that an individual report covering each visit of the health visitor might help to overcome the feeling of the family doctor that advice was being given to his patient without his being consulted or informed. This note is a printed letter - "Dear Doctor, re The district Health Visitor, Miss as paid a routine visit to the above who, it is understood is, or will be on your medical list and reports. "It was used following all visits, and posted from the Department. Initial visits to infants on the 14th day after birth produced so many "negative" reports that these letters have now been given up. Otherwise the experiment seems successful and the scheme fulfils a useful purpose. Preventive Mental Health Work The Medical Superintendent of the Warlingham Park Hospital arrangedfor a regular group discussion with a psychiatrist from the Child Guidance Clinic and his report and the comments of the Superintendent Health Visitor are as follows:- "Weekly sessions were started by Dr. Zanker at the Medical Officer of Health's Department in Wellesley Road in June, 1955, with the idea of introducing Health Visitors to the field of preventive mental health work. After a few weeks experience it was felt that this could best be done by inviting Health Visitors to present cases of children under school age showing early signs of emotional disturbance or behaviour disorder, and to enable them to discuss with the psychiatrist how best they could support the parents in the management of their children. It was considered that in this way the Health Visitor could play a more active part in the preventive field of mental health work. While in the majority of cases presented by the Health Visitors a thorough discussion about the home background, the emotional attitude of the child, and the family relationships seemed to be sufficient, nevertheless it was deemed advantageous for a certain number of mothers to be invited, together with the child, for an interview with the psychiatrist, the case being 53 afterwards discussed by him and the Health Visitor and occasionally by the Medical staff of the Medical Officer of Health's Department. It was felt that this combination of an initial interview with the mother or parents and consequent analysis and discussion of the case with the Health Visitors, particularly the Health Visitor immediately responsible for the patient, has proved beneficial. The Health Visitors appear to have shown great interest in this scheme and they appreciate the necessity of understanding an emotional disturbance or behaviour difficulty either on a common sense basis or from the standpoint of psychodynamic principles, with which they have already made some considerable acquaintance. Another gain lies in the fact that dealing with the early stages of maladjustment in the setting of the Public Health Department has already helped to prevent to some extent the overloading of the Child Guidance Clinic with referrals of unsuitable cases, particularly those under school age. It is hoped that this reduction will apply at a later stage to children of school age. Up to the present thirty two cases have been discussed and among them fourteen mothers and children have also been seen. " "The Health Visitors have found these discussions stimulating and extremely useful. Knowing the lines upon which the psychiatrist is working they have been able to help the mother and children concerned so much more than has been possible in the past. This continuity of advice and help must in the long run prevent much unhappiness and physical as well as mental illhealth. They wish to thank Dr. Zanker for undertaking this type of in-service training and for making the discussions so interesting." 54 THE WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE VISITS ONLY, 1955 Visits Re Bi rd Blackmore Blest E.M.Col1ins Devaney Early Eldridge Elliott Emms Gregg Griggs Hall (deceased) Hawk ins E. La ing Llewellyn Lucey M ayo McGuiness Com. 1.2.55 Left 30.4.55 Morton Partridge Pickering Poupard Singleton Com. 2.5.55 Stevens Com. 10.10.55 The i son Thompson Toneri left 30.4.55 Tripet Vince Webb Com. 25.11.55 weller welson Wybrew Total 1955 Total 1954 Infants under 1 year - First Visits 122 149 116 92 164 91 132 94 145 53 106 24 160 139 109 112 178 48 164 116 108 210 70 30 108 102 46 147 135 15 104 52 157 3598 3411 Re-visits 334 581 535 127 278 610 519 271 559 194 661 31 534 315 585 770 915 319 579 334 689 703 608 214 350 442 242 935 695 60 305 216 630 15140 15171 Children 1-2 years - First Visits - - 4 4 28 1 - 3 3 1 - 1 8 4 4 20 19 12 9 4 - 6 - 51 - 2 - 14 6 - 4 - 18 226 160 Re-visits 255 478 345 82 253 642 355 146 380 141 411 31 218 88 366 453 721 241 468 211 374 358 275 137 172 321 125 608 1089 35 123 110 339 10351 10002 Children 2-5 years - First Visits - 1 6 5 25 3 - 2 1 1 2 - 18 8 8 11 15 7 7 1 - 1 3 54 3 1 - 2 - 2 7 - 12 206 182 Re-visits 190 746 792 83 220 497 819 186 470 164 800 64 511 68 363 636 767 383 590 461 506 485 505 214 403 405 186 1065 1278 126 439 182 840 15444 17075 Expectant Mothers - First Visits 1 78 27 3 1 10 9 9 4 16 46 3 62 4 44 33 17 - 27 34 15 28 18 4 16 17 5 95 30 - 19 13 42 730 817 Re-visits - 6 4 1 8 2 5 - 1 7 - 3 - 49 - 37 2 " 5 36 38 2 2 5 10 - 91 1 - 5 6 1 327 308 Still Births - 4 - - - - - - - - 1 - 2 - - - - - - - - - - - - - - - 1 - - - - 8 10 Deaths under 1 year 4 2 2 - - 1 - 2 - - - - 1 " - - - - 3 1 1 - - - - - - 1 - 2 - - 20 15 Miscellaneous visits 266 226 264 29 247 23 101 186 216 20 730 26 84 40 34 256 95 19 139 48 29 214 7 21 52 190 92 20 20 4 51 103 117 3969 4741 Ineffective visits 239 240 346 248 80 745 99 100 252 132 305 12 464 452 235 277 326 107 443 166 547 368 416 192 219 240 117 97 299 57 217 72 352 8461 9177 TOTALS. 1955 1411 2511 2441 674 1296 2631 2036 1004 2030 723 3069 192 2065 1118 1797 2568 3090 1138 2426 1383 2305 2412 1904 919 1328 1730 813 3074 3555 299 1276 754 2508 58480 " TOTALS. 1954 2463 2458 2230 803 2715 2852 2463 1898 79 1663 2842 1247 892 325 2281 2404 659 - 2471 1086 2633 1243 - - 1474 2329 1214 3450 3466 249 661 2180 2269 •61069 * Including Health Visitors who left in 1954 Number of families or households visited during the year. 14,307 55 IMMUNISATION AGAINST DIPHTHERIA A total of 2,478 children came from the following sources: - Of these, 19 failed to return for completion of the course. School Children 161 Children under 5 2, 317 Reinforcing injections are now being recommended, just before the child starts school, and again at 10 years of age, i.e. at about 5-yearly intervals. The number of such injections given during the year was 1,633. The ensuing comparative tables give some further details:- Year Children Completed Treatment Failed to attend for completion of Course Reinforcing Injections 1940 428 419 — _ 1941 6,639 5,833 — — 1942 6,133 5,511 — — 1943 5,200 4,854 — — 1944 2,482 1,851 — — 1945 3,174 2,707 — — 1946 3,935 3,934 386 32 1947 3,638 3.516 266 641 1948 3,799 3,704 95 1,667 1949 4,299 4,216 83 2,898 1950 3,089 3,014 75 4,512 1951 3.159 3436 23 2,921 1952 2,884 2,833 51 3,144 1953 2,646 2,634 12 1,775 1954 2,856 2,824 32 2,373 1955 2,478 2,459 19 1,633 Origin and Source of Children attending Year School Pre-school Total Per cent Total Per cent 1940 216 50.0 212 50.0 1941 4,477 67.4 2,162 32.6 1942 2,660 48.3 2,851 51.7 1943 2,818 48.1 3,036 51.9 1944 531 28.7 1,320 71.3 1945 281 9.4 2,698 90.6 1946 789 20.0 3,146 80.0 1947 588 16.2 3,050 83.8 1948 334 8.8 3,465 91. 2 1949 548 12.7 3,751 87.3 1950 587 19.0 2,502 81.0 1951 312 9.0 3,147 91.0 1952 385 13.4 2,499 86.6 1953 138 5.2 2,508 94.8 1954 302 10.6 2,554 89.4 1955 161 6.5 2,317 93.5 56 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,226 children were immunised against whooping cough, comprising 2,194 under school age and 32 school children. 332 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 2,072 persons were vaccinated against Small-pox. Under 1 year of age 1 2-4 5- 14 15 or over Total Successful Vaccinations 1,519 84 90 85 38 1,816 „ Re-vaccinations — 1 5 29 74 109 Insuscept i ble to Vaccination 129 6 7 3 2 147 2,072 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1955, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1941) Age at 31.12.55 i. e. Born in Year Under 1 1955 1 - 4 1954 - 1951 5 - 9 1950 - 1946 10 - 14 1945 - 1941 Under 15 Total Last complete course of inject ions (whether primary or booster) A. 1951 - 1955 144 9,203 7,821 1, 781 18,949 B. 1950 or earl ier — — 8,259 13,351 21,610 C. Estimated midyear child population 3,380 13,720 37,200 54,300 Immunity Index 100 A/C 4.26 67.08 23.12 3 4.9 57 AMBULANCE SERVICE To the Medical Officer of Health I submit the Fourteenth Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1955. During the year the Service was called upon to deal with 100,827 patients, which necessitated 50,491 journeys and a mileage of 440,311. This mileage shows an increase of 5.2% over that for 1954. (418,542) The following vehicles were delivered during the year: - One Bedford "Utilecon". One Austin Ambulance. One Vauxhall "Wyvern" Saloon Car. and vehicles from this Service were disposed of as under:- Two Hillman "Minx" Saloon Cars. One Austin Ambulance. Two Humber "Pullman" Ambulances. (one of the above transferred to Civil Defence). In this, the first full year that ambulances have been directed by radio-telephone, there has, as will be seen, been a noticeable saving in mileage and journeys out of the Borough. In fact, although 3,716 more patients were carried, the mileage was 937 less than the previous year. Additionally there has been a marked saving in man hours due to radio-telephony as it has avoided the necessity of men having to go to public and private telephones in order to contact Headquarters Station. In September of this year, a team of two men was entered in a Regional Competition for First Aid (both practical and theoretical) held at Surrey County Ambulance Headquarters, Kingstonupon-Thames. It is regretted that the team from this Service was not successful on this occasion. Four members of this Service were presented with Royal Humane Society certificates on the recommendation of the Police for their work of resuscitation - two in connection with a case of coal gas poisoning and two others at an accident on the railway at West Croydon Station. List of Serviceable Vehicles at 31st December, 1955 Four Humber "Pullman" Ambulances Eight Daimler Ambulances Two Bedford Sitting Case Vehicles Two Bedford Coaches (for Mental Defectives) Five Bedford "Utilecon" Sitting Case Vehicles One Vauxhall "Wyvern" Saloon Car One Austin Breakdown Vehicle 58 Classifications of Journeys, Patients and Mileage Patients Journeys Mileage Health Service Removals 77,949 (70,822) 44,006 (36, 551) 381,829 (357) Mental Defectives 18,670 (20,046) 788 (819) 23,466 (24) Spast ic Children (St. Margaret's) 478 (921) 378 (396) 2,567 (3) Accidents 3.730 (3,465) 3,577 (3,312) 18,805 (16) Abortive 225 (267) 1,350 (l Gas and Air Analgesia 900 (914) 8,059 (10) Hospitals (Conveying Drs. etc.) 12 (306) 122 (3) Parks (Conveying first aid equipment 31 (28) 311 Vehicles to Repair Depots, Testing, etc. 405 (218) 2,298 (l) Service Requirements (oxygen, visiting SubStns., etc.) 117 (143) 832 Pay Round 52 (52) 672 100,827 (95,254) 50,491 (43,006) 440,311 (416) Civil Defence 149 (125) 1,824 (2,90) 100,827 (95,254) 50,640 (43,131) 442,135 (418) 19,434 (15,718) cases were conveyed to Hospitals, etc., outside Borough boundary, and on these journeys 133,568 (133,505) miles travelled. NOTE:- 1954 figures are in brackets Classification of Accident Calls Home Accidents (Children) 402 (Adults) 364 Miscellaneous Accidents (Children) 96 (Adults) 142 Recreational Accidents (Children) 69 (Adults) 61 School Accidents 200 Street Accidents (Children) 225 (Adults) 780 Work Accidents 305 Home Illness (Children) 43 (Adults) 187 Street Illness (Children) 21 (Adults) 501 Work Illness 88 Attempted Suicide 21 Suicide 13 Common Assault 59 3,577 59 CIVIL DEFENCE (Ambulance Section) The number of Volunteers available for training at 31st December was 339, composed of 238 females and 101 males. This figure shows an increase of 48 since my last Annual Report. An average of 139 volunteers was maintained during each week of training. Since the beginning of 1955 about 25% of the volunteers having received training have asked to be placed on the reserve list but the number has been made up again by new members. The number of qualified drivers is now 49, an increase of 7 over 1954. 11 volunteers are under driving instruction, and 2 were successful during the year. The number of fully qualified First Aiders is now 117 and a new course will be starting on 31st January, 1956. An Ambulance Section has been formed at New Addington with 62 volunteers on the register, of which number about 50% are attending for training under the instruction of Mr. Perkin. These volunteers will be taking the First Aid Course. Two teams of 4 Civil Defence personnel entered for the "Buxton Trophy" Casualties Union held last June at Dorking but were not successful on this occasion. A.L. HILL Chief Officer. 60 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, 69 cases were so dealt with, 45 women, 15 men, 3 women with babies and 6 children. These figures do not include school children for whom arrangements are made by the Education Committee. LOAN OF NURSING EQUIPMENT The Corporation loan equipment and make a small weekly charge, with exemption for incomes below a certain figure. During the year the undermentioned loans were made:- Bed Pans 315 Bed Rests 195 Mackintosh Sheets 291 Feeding Cups 21 Wheel Chairs 23 Commodes 34 Crutches, pairs 1 Air Cushions 312 Bed Cradles 30 Urinals 98 Air Beds 18 Dunlopillo Mattresses 2 Bed Pulley 5 Bed Tables 6 Draw Sheets 49 Walking Aid 1 Bed Blocks 2 Sputum Mugs 2 Steam Kettles 1 DOMESTIC HELPS This service continued in great demand and an analysis of applications during the year shows the following percentages:- Maternity Cases 27.48 Sickness (including Tuberculosis 2.19) 72.52 61 (1) Number of Home Helps - January 1st and December 31st, 1955: - (a) Full-time 18 (b) Part-time 126 (2) Number of new applications:- (a) Maternity 474 (b) Sickness 1,026 (c) Sick Room Helpers 6 (3) Number of applications met:- (a) Maternity 401 (b) Tuberculosis 32 (c) Chronic Sick (including aged and infirm) 604 (d) Others (including sick room helpers) 422 (4) Number of cases attended during year 2,259 (5) Average duration of services given:- (a) Maternity 12 days (b) Sickness (acute cases) 10-21 days (6) Amount recovered for services £5,281 (7) Rate of remuneration of "Helps" at 31.12.55 was 2s. 10 3/8 d.per hour. It is of interest that for the first time for many years the percentage of maternity cases attended has shown a considerable increase. It probably reflects new assessment scales, which were devised to lessen the burden on those requiring whole-time service and the maternity grant for home confinements. At the borough cleansing station, disinfestation of women and children was undertaken by an especially trained home help. A small weekly retaining payment was made, but usually the home help carried out the ordinary work of the service. This arrangement has effected considerable saving, as the diminishing demand for disinfestation required only occasional intermittent attendances for cleansing duties. The Sick Room Attendance scheme has operated when required, but demand for such night cover was small. Five emergency calls were met, relating to patients awaiting admission to hospital. 62 In the section of my report dealing with "Problem Families" I mention the good results achieved by selected home help working with families where there has been imminent risk of family breakdown. This type of service, which combines much needed domestic assistance with a demonstration of what can be done with the money and equipment available in the home itself is perhaps an imitation of the scheme introduced by the Family Service Units. It overcomes their main difficulty of recruiting personnel as most Home Help sections have members who have learnt the necessary skills from hard experience, and are willing to cop for a temporary period with very primitive conditions as personal contribution to promoting family welfare. To accept such cases adds considerably to the responsibilities of the Super visors and in times of heavy pressure, for example, outbreaks influenza, there may have to be suspension of the scheme to meet more urgent calls. With an efficient Home Help Service, working in close cooperation with other departments and voluntary organisations, presents no major administrative difficulties. A plus rate with the extra hours of service concerned is the only additions expense and seconded staff can be re-absorbed into ordinary work as required, so that stand-by payments are avoided. During the year under review, a total of 600 hours was given to this service To help in keeping large families at home in the temporal absence of the mother, a system of extended service was intro duced. Volunteers from amongst the home helps give whatever hour of daytime cover may be necessary on a weekly wage basis with compensatory paid leave. We have not met the necessity for resi dent help, which seems to carry definite risks. It has alway so far been possible for the father, assisted if necessary, by relative to be with the children during the night. Even shift workers can generally have a temporary re-arrangement of their duties, if suitable approach is made to the employers concerned Finally, it is becoming customary for the home help to be the most regular contact with old persons living alone. Working sometimes on her own and sometimes with the District Nurse, she is fast becoming an indispensable aid in keeping old persons in their own homes. In several cases where old people have been recommended for removal for suitable institutional care (Section 47, Nations Assistance Act, 1948), action has been avoided by the use of home helps. Some patients have then agreed to hospital admission and others have been able to remain in their own homes care for by the domiciliary services. 63 HEALTH PROPAGANDA The purchase and distribution of the monthly magazine "Better Health" through the Infant Welfare and other clinics continued. Much attention was also given to the display of posters and pamphlets in connection with the prevention of accidents in the home. A collection of photographs demonstrating the work of the various sections of the department was assembled to assist the work of the Public Relations Committee. No further action was taken in regard to cancer education following the lack of response to efforts made at the close of 1954. The mainstay of health education, the day to day efforts of the doctors, health visitors and other officers of the department, was of course maintained. 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 O.P. Clinic, the Regional Hospital Board's O.P. Mental Deficiency Clinic and the Child Guidance Centre. The Deputy Medical Officer of Health continues to pay periodic visits to the Mental Deficiency Colony accepting the majority of Croydon cases. The only duty delegated to a voluntary association was the supervision of 14 mental defectives placed under guardianship in Brighton, by the Guardianship Society. Work carried out in the Community. On the recommendation of the Medical Staff of Warlingham Park Hospital, the Corporation accept financial responsibility for patients to stay at approved homes conducted by the Mental After Care Association and three cases were so dealt with during the year. 64 Under the Lunacy and Mental Treatment Acts. Patients dealt with under the Lunacy and Mental Treatment Acts during 1955, are as follows: - (a) Certified and admitted to Warlingham Park Hospital 63 (b) Admitted to Warlingham Park Hospital as voluntary patients 54 (c) Removed to Mayday Hospital under Detention Order 402 (d) Admitted to Warlingham Park Hospital as temporary patients — (e) Investigated and no action taken 108 (f) Urgency Orders — (g) Temporary Orders 2 629 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in the Borough:- 1954 1955 Under 5 years 64 78 Aged 5-16 years 120 140 Over 16 years 550 550 Total 734 768 Compared with 1954 the cases show an increase of 34. 4 Institution patients have died in hospital. The cases are distributed as follows:- In Certified Institutions 330 In Approved Homes 7 On Licence from Institutions 25 Under Statutory supervision at home 335 Under Guardianship 46 In Mental Hospitals 10 Observation cases 36 In "Place of Safety" 789 During the year the Certifying Medical Officers made examinations and paid visits to the number of 51 cases. The Mental Deficiency Visitors paid 3,730 visits. 23 new cases were examined during 1955 and certified as mentally defective. 8 of these 65 cases were recommended for the Occupation Centre and 8 were placed under statutory supervision. 7 were recommended for institutional care. During 1955, 40 cases were dealt with as follows:- 1954 1955 Sent to Certified Institutions 15 13 Placed under Guardianship — — Sent to Warlingham Park Hospital 1 — Varying Orders: (a) Change of Guardian 2 8 (b) Prom one Institution to another - 1 (c) From Guardianship to Institution 1 2 (d) Institution to Guardianship — — (e) Orders closed 7 8 (f) Patients admitted to Hospital for short term care - 8 19 Orders were renewed during the year, 11 of which were Guardianship. 14 children were admitted to the Occupation Centre during 1955. 10 left or were excluded. There were 19 cases awaiting vacancies in Institutions on the 31st December, 1955. There were 46 cases under Statutory Guardianship, 29 of these under the care of relatives, and 17 with Guardians who are not relatives. 3 males are at work. 421 visits have been paid to Guardianship cases during the year. There are 25 cases on licence from Institutions (15 males and 10 females). Report on the Occupation Centre, January-December, 1955 Number on Register, January 67 '' " " December 71 Number of Admissions 14 Number left or excluded 10 Average attendance per session 53 Times open, Morning-Afternoon. 394 Total attendance for year 20,976 66 I am indebted to Miss Cooney, Supervisor of the Occupation Centre, for the following report:- "The year opened quietly with 67 on register, the usual classes being held. A visit was made from the Board of Control in May. In June, Miss Hensher resigned, and Miss Bushby was appointed to replace her in September. Another class was admitted, and in November another new assistant, Miss Murray, was appointed. The sale of work was held early in December - pro ceeds amounted to £25.0s.0d. The total sales for the year amounted to £32. 3s. 7d. The Annual Xmas Party was held in December, the Tea, Xmas Tree, and Film Show being greatly appreciated by all " . SANITARY CIRCUMSTANCES I beg to submit a report for the year ending 31st December, 1955 of the work of the Sanitary Inspectors and other officers under my control. Housing has absorbed much of the time of the staff during the year. A survey of some 4,000 of the older houses in the Borough was completed and resulted in 705 houses being listed as likely to be dealt with in the future as unfit for habitation, The Council agreed a 5 years programme involving 4 areas of the Borough, which it was considered should be dealt with as clearance or redevelopment areas. All the properties in the 4 areas, namely Ely Road and Holmesdale Road; "Newtown" , Upper Norwood; Crescent Mews, South Norwood; and Lambert's Place and Bridge Place, Croydon; have been inspected and recommendations will be made to the Council with a view to implementing their decision, During the year 14 houses and parts of houses have been dealt with individually by either closing orders or demolition orders. Since the 31st August, 1954 when the Housing Repairs and Rents Act came into force, to the end of 1955, 287 Certificates of Disrepair have been granted and 161 Revocation Certificates have been issued in those cases where the repairs required had been carried out. In the summer some 1,100 cases of dysentery occurred, mostly in the Addington area and this strained the Section's resources to the utmost. All the households were visited and 5,961 specimens were obtained for bacteriological examination. The positive cases were followed up and appropriate action was taken to provide against the further spread of the disease. The concern was 67 to keep the outbreak confined to the area mentioned and, in this respect, our efforts met with some degree of success. The Abattoir had its biggest "through put" of animals for many years, namely 44, 829, an increase of 6, 169 over the previous year. A 100 per cent, inspection of the meat and offals from the animals slaughtered has been maintained by employing four of the District Sanitary Inspectors, on a rota system, as reliefs for the two full-time Inspectors. During a year of extra pressure on the inspectorate staff, it has still been possible to pay no small measure of attention to food inspection and food hygiene, as can be seen from the tables in the body of the report. I wish to record my thanks to all members of the staff for the ready way they have responded to the calls on their working and leisure hours during the year. GEO. GRIEVE, Chief Sanitary Inspector 68 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 3,418 Houses inspected where zymotic diseases have occurred 289 following applications for certificates of disrepair 152 Inspections of underground rooms 28 Special inspections in connection with the Housing Survey 2,128 Houses inspected for overcrowding conditions 8 Reinspect ions of work outstanding on housing notices 10,40 Number of visits regarding infectious diseases 2,33 " " " " " " food poisoning 19 Inspections of drainage work during repair 2,575 House drains tested wTth smoke and colour - routine and complaint 1,20 House drains tested with smoke (on written application) 16 House drains tested with smoke during repair 73 " " " " " water during repair 187 Inspections of cesspools and earth closets 18 " " " schools and school sanitary conveniences 42 " " " publ ic conveniences 179 " " " verminous premises 95 " " " ponds and ditches 49 " " " yards, stables and passages 232 " " " theatres, cinemas, halls, etc. 91 " " " pig styes 75 " " " tents, vans and similar structures 59 " " " knackers yards 34 Visits regarding smoke abatement 966 Inspections of swimming baths 11 " " " wells 8 " " " gathering grounds of water supply 25 " " " gipsy encampments, camps, fairs, etc 99 " " " offices 19 " " " rivers and streams for pollutions 360 Food and Drugs Acts: food and drugs samples taken 278 " " " " milk samples taken 231 Milk (Special Designations) Orders: samples taken 258 Ice Cream samples taken 159 Samples taken of swimming baths water 39 " " " " drinking water 281 " " " " subsoil water 3 " " " from rivers, streams, etc 78 " " " of rag flock and other filling materials 12 " " " " sundry specimens (food poisoning etc.) 28 Inspections of butchers premises 582 " " " meat premises (wholesale) 1,407 " " " horseflesh premi ses 11 " " " poultry and game dealers premises 83 " " " fishmongers premises 120 " " " fried fish premises 71 " " " grocers premises 948 " " " fruiterers and greengrocers premises 157 " " " bakers premises - including bakehouses 212 " " " dairies 59 " " " milk shops 54 " " " general shops and their premises 19 " " " premises where cooked meats etc. are prepared or sold 30 " " " confectioners premises 212 " " " con feetionery. manufacturers premises 23 69 Inspections of cafes, snack bars, canteens, hotels and their kitchens 456 " " " school kitchens and serveries 127 " " " hospital kitchens 41 " " " ice cream manufacturers premises 25 " " " " " vendors premises 194 " " " "barrows and carts 16 " " " markets (day inspections) 101 " " " " "(weekend inspections) 49 " " " barrows, other than in markets 99 " " " imported foods at Aerodromes 23 " " " other food premises not enumerated above 145 " " " premises where offensive trades are conducted 15 " " " factories with mechanical power 594 " " " " without mechanical power 84 " " " works of building and engineering 74 " " " outworkers premises 230 Visits to employers of outworkers 10 Inspections of shops (under Shop Acts) 840 Special early closing, evening and Sunday trading patrols of shops 430 Appointments kept with owners, builders, etc 2,145 Investigation of complaints other than housing matters 1,196 Reinspections of works outstanding (other than houses) 4,386 Inspections under Merchandise Marks Act 184 Pets Act 31 " " " " Rag Flock and Other Filling Materials Act 13 " " " " Pharmacy and Poisons Act 89 Sundry Inspections and visits 3,355 Visits regarding rats and mice infestations 7,980 Informal Notices outstanding 31.12.54 1,183 " " " " served 2,815 " " » " complied 2,445 Number of Informal Notices referred for Statutory Orders 455 Informal Notices outstanding 31.12.55 1,098 Statutory Notices outstanding 31.12.54 305 " " " " served 874 " " " " complied 851 " " " " outstanding 31.12.55 328 Total number of callers and complaints received at the office 5,705 Total number of letters received at the office 6,927 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1955 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 349 Conditions causing dampness: Defective roofs 526 Defective window frames 389 Defective walls, etc 496 Want of efficient damp-proof course 91 Defective gutters and downspouts 437 Other structural defects: Defective plaster 399 Cleansing and redecoration required 181 Defective floors and stairs 255 Insufficient ventilation under floor 68 Defective brickwork, sills, lintels, chimneys 124 Defective stoves and fireplaces and flues 213 70 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 122 Defective w.c.'s 269 Defective drainage 243 Stoppages in drains 183 Defective water services and tanks 42 Domestic nuisances: Want of cleanliness l2 Verminous conditions 24 Other nuisances and infringements: Offensive accumulations 61 Overcrowding 14 Sundry nuisances or defects 230 Particulars not inserted in Rent Book (Housing Act) 9 (2} INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924 Food cupboards defective or required 5 (3) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS Structural defects in shops and stores 74 Cleansing or repair of walls and ceilings 175 Cleansing or repair of floors, utensils, fixtures, etc. 125 Insufficient or defective sink accommodation and water supply Insufficient lighting or ventilation 15 Defective drainage W.C. accom. - Insufficient 15 " " Repair or cleansing required 50 " " Artificial light required 10 " " Want of intervening ventilated space 10 Cloakroom accommodation required or defective 12 Overalls required or dirty 7 Ablutions - Wash basins required 25 " " Hot water supplies required 24 " " Soap and towels required 17 Food improperly stored 48 Food store - Required or defective " " Animals kept in 2 Accumulation in yards or stores 24 Offal and refuse bins uncovered or defective 25 Yard paving defective 15 Vehicles - dirty or defective 13 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 95 Want of a sanitary dustbin 87 Public Urinals - defective or dirty 13 (5) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 3 W.C. defective and dirty 12 (6) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 6 (7) SMOKE ABATEMENT Nuisances observed 9 71 HOUSING During the latter part of 1954 and the early part of this ear some 4,000 of the older houses in the Borough were surveyed n order to arrive at an estimate of the number of houses conidered to be unfit for habitation and suitable for inclusion in he Council's "slum" clearance programme. 705 such houses were included in a return approved by the Council and forwarded to the Ministry of Housing and Local Govern- ment. Pour areas of the borough were listed for redevelopment within the first five years and these it was estimated would include 133 unfit houses. Action in regard to the first of these four areas, Ely Road and Holmesdale Road, is proceeding. During the year 2,163 houses were rendered fit following the service of notices requiring repairs. In four cases owners appealed to the County Court against the service of such notices but in all cases the appeals were dismissed with costs. Nine whole houses and five parts of houses were made the subject of Closing Orders during the year as being unfit for habitation. An appeal by the owner against a Closing Order in one case was unsuccessful. The number of applications for certificates of disrepair for the whole of 1955 was 152 of which 123 were granted. The total number of Certificates of Disrepair granted to tenants since the commencement of the Act, 31st August, 1954 to the 31st December, 1955 was 295. 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 2s. per night or 13s. per week, and 2s. 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 91, and the number accommodated during the year 33, 171. The receipts during the year were £2,520 and the expenditure £4,355. Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, at a fee, During the year 16 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 Inspection Wri t ten Not ices Prosecut iors Factories:- With Mechanical Power 594 160 Without Mechanical Power 84 11 — Other Premises 1 74 7 — Outworkers and Employers of outworkers 240 3 — Total. 992 181 _ Defects Parti culars Number of Defects Referred to H.M. Inspector Prosccut ions Found Remedied Want of Cleanliness 22 21 — _ Overcrowding — — — — Unreasonable Temperature — — — — Inadequate Ventilation 2 1 — — Ineffective Drainage of Floors 1 — 1 — Sanitary Conveniences — — (a) Insufficient 19 15 — — (b) Unsuitable or Defective 149 105 — — (c) Not Separate for Sexes 12 11 — — Other offences against the Act (not including offences relating to Outworkers) 50 43 — — Total 255 195 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 387 workers resident in the Borough. 230 visits were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1955 Nature of Work Number Employed Outwork in Infected Premises Outtwork in Unsatisfactory Premises Remarks Making, Cleaning, Altering and Repairinq Wearinq Apparel 194 — — — Upholstery Work — — — — Other Classes of Work 193 — — —- Total 387 — — — Inspection of Schools These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 42 inspections were made and defects found were referred to the Education Officer. SHOPS ACT The Shops Act contains 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. 840 inspections were made under the Shops Act, and the infringements found were as follows: - Hours of Closing 6 Hours of employment of staff 1 Provision of means of heating 8 Insufficient W. C. accommodation 2 Want of washing facilities 1 Defective W.C. accommodation 17 74 Defective walls, floors, ceilings, etc. 9 Defective and insufficient lighting 8 Want of seating accommodation 5 Notices to be exhibited or amended 155 DRAINAGE 2,571 visits of inspection were made to underground drains in course of repair. Of 359 Statutory Orders served, 6! 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 409 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 thf 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 factor; chimneys in their respective areas with a view to detecting the discharge of smoke or grit such as to be a nuisance. Bye-law 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. 84 such observations were carried out and in 9 instances black smoke was emitted for more than the statutory limit.The Managements were immediately interviewed and informed of the offence and advised. In one case it became necessary to serves Statutory notice to abate a smoke nuisance. By the time the next annual report is in print a new Clean Air Act will be in force and it is hoped that this will give more authority to deal with pollution problems. 75 AMUSEMENT HOUSES 94 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 supplied with steam from a newly erected gas fired boiler within the Station. The following articles were disinfected at the Disinfecting Station during the year:- By Steam 26,737 articles „ Formalin Gas 6,505 „ „ „ Spray 1,076 „ Total 34, 318 „ In addition, 537 articles were destroyed on request. Disinfection of bedding and upholstered articles is carried out for traders, who deliver them to, and collect them from, the Station. For this service a charge is made. During 1955, 307 articles were disinfected, the receipts amounting to £16. 8. 0. Disinfection was carried out after infectious or contagious disease at the following premises:- 1,346 rooms at 549 houses, hospital wards, clinics and crêches 2,595 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 44 children were cleansed of verminous conditions and 6 adults and 7 children were treated for scabies. DISINFESTATION OF PREMISES The new insecticides have provided a ready and easily applied remedy for vermin and pest infestation of premises, and occupiers are advised and instructed in their use by the Inspectors. The department assisted in the more difficult cases numbering 136, either by spraying or fumigation. 76 PHARMACY AND POISONS ACT, 1933 The object is to regulate the sale of certain poisonou substances. During the year the number of applications granted for entry of names on the list of persons entitled to sell poison under Part 2 of the Act was 24. In addition, 278 applications were made for the retention of names on the list for a further period of 12 months. 2 infringements of the Act were found. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act regulates the manufacture and sale of materials uses as fillings for upholstery, bedding, toys, etc., with the objec of compelling the use of clean fillings. During 1955, 12 samples of various fillings, as listed below were taken. were taken. All of these samples conformed with the requirements of the Regulations made under the Act: - Article No. of Samples Cotton Flock 1 Washed Flock 5 Cotton Felt 2 Cotton Millpuff 1 Curled Feathers 1 Coir Fibre 2 PET ANIMALS ACT, 1951 19 premises were licensed for the purpose of keeping Pet Shops. During the year 31 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 a pig keepers premises during the year. This and one 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. 77 During the year, 1,438 private dwellings were inspected following complaints and in 1,032 instances infestation was confirmed and dealt with by the rodent operatives. In 20 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. 125 business premises were found to be infested with rats or mice and these were all disinfested during the year. Regular inspections are made of premises where food is prepared or sold and particular attention is given to methods of prevention of rodent infestation. Corporation owned premises including sewage works, refuse tips, depots, school kitchens and serveries, etc., are periodically inspected for the presence of rodents and if infested then action is taken by the department to eradicate the pests. 30 infestations at such premises were dealt with during the year. Included in the Corporation's ownership are the sewers of the Borough and for some years now these have been systematically treated for rat infestation and the results have shown a steady decline in the rat population over the years. The Ministry of Agriculture and Fisheries through their pest control branch are constantly experimenting in the war against rodents and other pests, and are ready to pass on to Local Authorities any new findings which will be helpful in this essential public health function. FOOD SUPPLY The supervision and inspection of the food supplies is carried out by the Sanitary Inspectors who are all qualified in food inspection. The following table shows the distribution of trades among the 3,327 premises in the Borough at which food is known to be sold, manufactured or stored:- Bakehouses 65 Bakers Shops 114 Sugar Confectioners 560 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 482 Works and Club Canteens 224 Public Houses 155 Off Licences 63 Grocers 618 Butchers 201 Continued on next page 78 Chemists 75 Greengrocers 337 Fishmongers 82 Fried Fish Shops 47 Milk Distributors and Dairies 73 Premises from which Roundsmen and Mobile Shops operate 33 Stalls in Markets 101 Food Manufactories 28 Other Food premises not enumerated above 69 3,327 Of the above premises 789 are registered under Section 14 of the Food and Drugs Act, as follows:- Retail sale of ice-cream 609 Manufacturers of ice-cream 5 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 175 During the year 5,081 inspections were made of the above (for details see page 69 ). In addition, Croydon Airport was visited on 23 occasions to inspect foodstuffs arriving by air from the Continent. Suct foodstuffs included Kosher Sausage, Gouda Cheese, Butter and Delicacies. It was not found necessary to condemn any article. During the year a proprietor of a fried fish and chip shop was prosecuted for not keeping his premises, fitments and utensil; in a clean and sanitary condition. He was fined.£40 with £2. 2s. 0d, costs. Condemned Foodstuffs. Summary of meat and other articles of food found to be unfi??? and condemned by the Inspectors during 1955:- Article Weight in lbs. Carcase Meat 33,897 Offal 34, 156 Sundry Foodstuffs 9,630 Canned, Bottled and Packeted Goods 20,224 Total 97,907 79 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 :or industrial use and the remainder are destroyed. MEAT INSPECTION It can be said, with the increase in the number of animals slaughtered at the abattoir, that it is playing no small part in supplying Croydon and its environs with fresh meat. In 1954, 58,658 animals were slaughtered, and this rose to 44,827 animals luring 1955. A 100% inspection has been maintained, but this has necessitated evening and often weekend attendance of at least one Inspector. Pour of the district sanitary inspectors have assisted the two regular meat inspectors, on a rota system, with this "after normal hours" duty. The following tables summarise the meat inspection service at the abattoir:- Animals Slaughtered. Cattle excluding Cows Cows Calves Sheep and Lambs Goats Pigs Total 3,100 567 6,701 11,746 268 22,445 44,827 CARCASES INSPECTED AND CONDEMNED Cattle exc hiding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 3,100 567 6,701 11,746 22,445 268 Number inspected 3,100 567 6,701 11,746 22,445 268 All Diseases except Tuberculosis and Cysticerci Whole carcases condemned NIL NIL 4 10 55 NIL Carcases of which some part or organ was condemned 1,474 182 9 927 1,229 2 Percentage of the number inspected affected with diseases other than Tuberculosis 47.5 32.1 .19 7.9 5.7 .75 continued on next page 80  Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Tuberculosis only Whole carcases condemned 9 5 NIL NIL 7 NIL Carcases of which some part or organ was condemned 134 63 5 NIL 199 NIL Percentage inspected affected with Tuberculosis 4.6 12.0 .075 NIL .91 NIL Cysticercosis Carcases of which some part or organ was condemned 2 NIL NIL NIL NIL NIL Carcases submitted to treatment by refrigeration 2 NIL NIL NIL NIL NIL Generalised and totally condemned NIL NIL NIL NIL NIL NIL The District Sanitary Inspectors, all qualified Meat Inspec tors, inspect meat at the 8 wholesale Meat Depots in the Borough, as well as that exposed for sale in the butcher's shops. MILK SUPPLY During the year 113 inspections were made of dairies and milk-shops. Milk and Dairies Regulations, 1949 The following licences were granted during the year:- Dealers' Licences to use the designation "Tuberculin Tested" 56 Licences to use the designation "Pasteurised" - (a) Dealers' (Pasteurisers' ) Licences 2 (b) Dealers' Licences 65 Licences to use the designation "Sterilised" - Dealers' Licences 100 Dealers' Supplementary Licences to use the designation - (a) Tuberculin Tested 16 (b) Sterilised 14 (c) Pasteurised 16 Inspection of these licensed premises has been carried out during the year to see that the conditions of the licences were observed. 81 Bacteriological Examinations of Milk During the year the following samples of milk were examined:- Tuberculin-Tested Milk 18 Tuberculin-Tested Pasteurised Milk 28 Pasteurised Milk 207 Sterilised Milk 5 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 Satisfied Satisfied 18 NIL 18 Tuber cut in - Tes ted Pasteurised Mi IK Methylene Blue Test Phosphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 28 - 28 - 28 Sterilised Milk No. Samples Taken Methylene Blue Test Phosphatase Test Not Satisfied Satisfied Not Satisfied Satisfied 207 - 207 1 206 Sterilised Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied 5 NIL 5 82 BACTERIOLOGICAL EXAMINATION OF CREAM Sixteen samples of fresh cream were examined and in four cases, whilst no disease producing organisms were present, findings indicated that quicker cooling and more care in handling was required. The processes of manufacture were followed through and sampled at stages, and amendments suggested, which produced satisfactory results. BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 159 samples were taken, the results being as under:- Grade No. of Samples 1 118 2 32 3 9 4 - Of the total samples taken, 9 (5.6 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. FOOD AND DRUGS ACT, 1938 During the year 231 samples of milk and 278 other samples were taken. Summary of Samples During 1955 samples were obtained and submitted to the Public Analyst as follows:- 83 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Almond Essence 1 1 — — — Apricots, dried 1 1 — — — Apricots, tinned 2 2 — — — Aspirin Tablets 2 2 — — — Batter Mixture 1 1 — — — Beans in Tomato Sauce 1 1 — — — Beans, baked 2 2 — — — Beef Cubes 1 1 — — — Beef Loaf 1 1 — — — Beer 8 8 — — — Biscuits 2 2 — — — Boric Ointment 2 2 — — — Brawn 2 2 — — — Bread 5 5 — — — Bread and Butter 1 1 — — — Bread Rolls 2 2 — — — Butter 3 3 — — — Cake Mixture 5 4 1 — — Camphorated Oil 1 1 — — — Cereal, Sugar Puffs 1 1 — — — Cheese 2 2 — — — Cheese Spread 3 3 — — — Cherries, Glace 1 1 — — — Chocolate, drinking 1 1 — — — Chutney 1 l — — — Cocoa 1 1 — — Coconut 1 1 — — — Cod Liver Oil Emulsion 1 1 — — — Coffee 2 2 — — — Coffee Essence 1 1 — — — Cold Mixture 2 2 — — — Confectionery Flour 4 4 — — — Confectionery Sugar 23 21 2 _ — Cordial 4 4 — — — Corned Beef 1 1 — — — Cough Mixture 1 — — — — Crab 1 1 — — — Cream 6 6 — — — Currants 2 2 — — — Custard Powder 9 9 — — — Dessert, table 1 1 — — — Distilled Water 1 1 — — — Faggots 1 1 — — — Fish Cakes 2 2 — — — Fish Fingers 1 1 — — — Fruit Cocktail 1 1 — — — Fruit Syrup, Fresh 1 1 — — — Gees Li net us 1 1 — — — Gin 5 5 — — — Ginger Beer 1 1 — — — Halibut Liver Oil Capsules 1 1 — — — Health Salts 1 1 — — — Herbs, Mixed 1 1 — — — Ice Cream 9 9 — — — Ice Lolly 7 6 — — — Cream Lolly 1 — — — — Jam 6 6 — — — Jelly, Table 5 5 — — Lemon Crystals 1 1 — — — Lemon Curd 1 1 — — — (continued on next page) 84 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Liver Sausage 1 1 - - - Luncheon Meat 5 5 - - - Margarine 6 6 - - - Marmalade 5 5 - - - Milk 220 219 1 - - Milk, Channel Island 9 9 - - - Milk, South Devon 2 2 - - - Mineral Water 1 1 - - - Mint Sauce 1 1 - - - Mustard 1 1 - - - Oranges 1 1 - - - Paste 5 5 - - - Pastry Mix 2 2 - - - Peaches and Pears in Syrup 1 1 - - - Pears, tinned 1 1 - - - Peas 1 1 - - - Peas, Processed 1 1 - - - Pepper, white 1 1 - - - Pickles 3 3 - - - Pilchards 2 2 - - - Pineapple, tinned 2 2 - - - Pork, Chopped 1 - 1 - - Pork and Liver Pate 1 1 - - - Potato Powder 1 1 - - - Raisins 1 1 - - - Rice 2 2 - - - Rice Creams 1 1 - - - Rice Pudding 1 1 - - - Rum 8 8 - - - Salad Cream 1 1 - - - Sardines 2 2 - - - Sausage, beef 8 7 1 - - Sausage, pork 9 8 1 - - Sausage Meat, beef 2 2 - - - Soup 5 4 1 - - Spaghetti in Tomato Sauce 1 1 - - - Steak, Stewed 1 1 - - - Stomach Powder 1 1 - - - Strawberries, tinned 1 1 - - - Sugar 4 4 - - - Sugar, Brown 6 6 - - - Sultanas 1 1 - - - Tea 6 6 - - - Veal, Jel1ied 1 1 - - - Vegetables, Mixed 1 1 - - - Vegetable Salad 1 1 - - - Vinegar 1 1 - - - Vitamin Tablets 2 2 - - - Whisky 8 8 - - - Wine, White 1 1 - - - 509 498 11 - - 85 Result of Analysis of Milk Samples Solids not Fat (Legal standard is 8.5%) 8.5 8.6 8.7 8.8 8.9 9.0 5 35 58 75 35 12 Milk Fat (Legal standard is 3%) 3.1 3.2 3. 3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4. 1 4.3 2 2 12 31 48 46 41 24 8 2 3 1 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.5%) 9. 1 9.2 9.3 9. 4 4 5 1 1 Milk Fat (Legal standard is 4%) 4.0 4.2 4.4 4. 5 4.6 4.7 4.8 4.9 5.2 1 2 2 1 1 1 1 1 1 Average composition of Milk Samples Mi-Ik (excluding South Devon and Channel Island Milks) Solids not Pat 8.76 Milk Pat 3.59 South Devon and Channel Island Milk Solids not Pat 9. 19 Milk Pat 4.88 Total number Milk Samples 231 The samples of milk for analysis were obtained as follows:- Taken on Milk Rounds 156 „ at Dairies 63 „ at Institutions 9 „ at Local Farms 2 „ at Schools 1 231 86 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiercy Remarks Milk 1% deficient in milk solids other milk fat. The freezing point (Hortvet) did not indicate presence of added water Further samples taken proved genuine Pork, chopped Contained only 78% of meat calculated as raw pork, whereas a reasonable minimum meat content for chopped pork is 95% No action taken Cake Mixture Risk that label (with pictorial device) was calculated to mislead as to the substance of the article This matter was taken up with the Manufacturers Lollie, Cream This article was not entitled to the description cream lollie in that it contained no cream or fat derived from milk Manufacturers requested to ame??? description. Req complied with Lollie, Ice The statement printed on the bag in which this article was sold was not in accordance with the Labelling of Food Order, 1953 in that it specified ingredients for several different types of lollie instead of the actual lollie being sold Manufacturers requested to ame??? the label. Request complied with Sausage, beef It was a sample of preserved beef sausage containing 130 p.p.m. of sulphur dioxide Manufacturers warned to exhibi??? preservative notice. This has now been done Sausage, pork It was a sample of preserved pork sausage containing 165 p.p.m. of sulphur dioxide Manufacturers warned to exhibi??? preservative not ice. This has now been done Confectionery, Sugar (Buttermint Toffee) This article contained only 3.2% of butter-fat instead of a minimum of 4%. It was also advertised as being made with best butter whereas it contained 3.8% of fat other than butterfat The manufacturers have agreed to increase the but??? content Cough Mixture (Glycerin, Honey and Lemon) This article contained only 5% of glycerin and 5? of honey together with oil of lemon and other ingredients and 84% of sugar syrup. Although a quantitative declaration appeared on the label the proportions of glycerin and honey are not in my opinion sufficient to warrant the main description of the cough mixture as Glycerin, Honey and Lemon Th i s is st i 11 the subject of enqui??? Packers have agr??? to increase glycerin and ho??? and amend description Soup This canned soup contained 210 p.p.m. of tin and 120 p.p.m. of iron and possessed a metallic taste. It was of inferior quality The balance of stock was surrendered and destroyed 87 WATER I am indebted to the Water Engineer, W. C. Knill; Esq., B. Sc., M.I.C.E., M.I.Mech.E. , M.I.W.E., for the following data:- The Water Supply is drawn from deep wells in the chalk. These wells are situated at Surrey Street, Stroud Green, Waddon, Selhurst and Addington. The water from all of the wells is treated by the addition of chlorine and in the case of the water from Surrey Street and Waddon, ammonia is added after chlorination. Owing to the occasional occurrence of turbidity in the raw water from the Addington Well, this water is filtered before chlorination. A portion of the northern side of the Borough is supplied with water which is purchased in bulk from the Metropolitan Water Board. The amount of water consumed during the year was- Gallons Corporation Wells 2,498,995,000 M. W. B. Bulk Supplies 737,002,000 Total: 3,235,997,000 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 and the water going into supply after treatment. 393 raw water samples and 1062 treated water samples were thus examined during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 14 samples of raw water and 47 samples of treated water were subjected to bacteriological examination by the Consultant Bacteriologist to the Water Undertaking. Further samples were submitted by the Medical Officer of Health for examination by the Public Health Laboratory Service. The results of the bacteriological examination of the raw waters were typical of waters pumped from the chalk, some of them showing the normal deterioration in quality which occurs 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. 88 (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 69 of raw waters and 144 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are not liable to have plumbo-solvent action. The whole of the population and dwelling-houses within the area of supply are supplied from public water mains direct to the houses. Testing of Samples by the Health Department. 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 performed were:- Bacteriological 227 Chemical 10 89 SEWAGE DISPOSAL AND REFUSE COLLECTION I am indebted to the Borough Engineer, A.P. Holt, Esq., A.M. I.C.E., for the following information:- Refuse Collection and Disposal In 1955 the following tonnages were dealt with:- House Refuse 58,275 tons Street Sweepings 3,896 „ Street Markets refuse 2,423 „ 64,594 „ 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 Warlinghain 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 20 vehicles, including part of the fleet of Refuse Collecting Vehicles, have been running on this gas during 1955, and by this means about 25,000 gallons of petrol were saved. 90 MISCELLANEOUS Nursing Homes - Public Health Act, 1936. Number of Homes Number of Beds provided for:- Maternity Others Total Homes registered during the year 1 - 10 10 Homes on the Register at the end of the year 25 41 551 592 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. No applications were received during the year. Three agencies remained on the register at the end of the year. NURSERIES AND CHILD-MINDERS REGULATION ACT, 1948 The necessary preliminary inspections and routine re-inspections of Registered Minders and private Day Nurseries have been carried out in accordance with the above Act. There are no Day Nurseries which take children of all ages for the whole day. There are 3 Nurseries which take 2½ to 5-yearolds daily excepting Saturdays, the remainder being of the "part time" class receiving toddlers for mornings only. 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. NURSES AGENCIES REGULATIONS, 1945 The Registered Minders receive children for the day. They are not encouraged to take children under 2 years. Number registered, at 31.12.55 Number of children provided fo??? Premises 5 104 Daily Minders 13 100 91 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 " 1,668 5,865 Europe outside Excepted Area 461 7,121 Africa, Middle East 2 19 Asia 6 81 2,137 13,086 Included in the above figures were 1,881 Aliens carried in 579 Aircraft. CREMATION ACTS, 1902 AND 1952 During the year 2,362 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Acts. INTERNATIONAL CERTIFICATES FOR VACCINATION During the year 997 certificates were dealt with at the office (880 Smallpox, 72 Cholera, 43 T. A. B. and 2 Typhus). STAFF MEDICAL EXAMINATIONS 1,080 examinations were made during the year by the Medical Staff of the Department. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE AMENDMENT ACT, 1951 One old lady, aged 78, with severe arthritis, which confined her to her chair was admitted to hospital using the powers of the 1951 Act. 34 other cases were investigated and dealt with as follows:- 15 - Satisfactory arrangements made for home care. 14 - Agreed to enter and were admitted to hospital. 1 - Agreed to enter and was admitted to an Old People's Hostel. 2 - Admitted to hospital under Lunacy and Mental Treatment Act procedure. 1 - Case died at home. 1 - Case moved out of the Borough. 92 BLINDNESS I am indebted to the Chief Welfare Officer for access to his records regarding blind persons registered during the year. These show that of the 85 cases registered - 11 were due to glaucoma and 27 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed - 3 treatment commenced but not completed 1 admission to hospital being awaited 1 too ill for surgical treatment 1 patient deceased. PROBLEM FAMILIES Last year, I set out in some detail the system of co-ordination which operates in Croydon and mentioned the possible use of selected home helps to work in families brought forward by health visitors. This was commenced and 16 cases were visited and special home help supplied to 7. In 6 cases the home help was refused, despite the offer to remit the usual cost of the service. In the remaining cases, the Home Help Supervisor was able to deal with the problems herself. Examples of Cases:- Mrs. A. Husband in regular employment, three children under 5 years of age. Mrs. A. unable to read or write. 105 hours practical training by a special home help. Family now out of debt with local trades people and Mrs. A. managing reasonably well. Mrs. B. Husband in regular employment, four children ages 2 to 13 years. Mrs. B. has been a voluntary patient in a mental hospital. Reported as apathetic and unresponsive, taking no interest in her home or domestic responsibilities. Special home help gave 180 hours service and home conditions greatly improved. At first, Mrs. B. made little response and the home help was finally withdrawn at the husband's request. Mrs. B. now reported as pregnant, but taking a great deal more interest in her children and her home. Mrs. C. Husband in regular employment, two children ages 6 and 18 months. Case referred by family doctor. Health visitor dealt with health problems and Home Help Supervisor with debts due to various hire purchase agreements. Special help for 20 hours only. Mother felt more secure and able to manage. 93 Mrs. D. (widow). Five children 2 to 8 years of age. Income, widow's pension, National Assistance benefit and family allowinces. Mrs. D. is disabled. Standard of living very low and children most unruly. 50 hours assistance from special home help over some ten weeks. On mother's admission to hospital, arrangenents made for resident care by a relative, with continued attendance of home help. Unfortunately, as is often the case with preventive work, the demands on the home help service over the winter months were so heavy that time and staff could not be spared to the extent required. However, it has been an experiment, which shows that much can be achieved by this method and the Council authorised the work to continue. Families in Welfare Services Accommodation:- It was the policy of the Council to admit homeless families to accommodation provided under National Assistance Act powers and to allow them to remain indefinitely. Inevitably, the Welfare Services homes have acquired a number of "problem" families. The recognition of the risks to health and developing characters of children in such an environment and the virtual impossibility of effective rehabilitation of families living in these conditions, led the Council to insist on the stricter observance of the purely temporary nature of this accommodation. To assist parents with young children already in Welfare Services accommodation to re-establish their own homes, one health visitor was in October given the duty of co-ordinating this work. Families thus returned to the general community are closely followed up by the special and the district health visitors and where necessary, assisted by the special home helps. I am indebted to the health visitor concerned, for the following account of her work:- "(a) Successful cases It is true to say that many families in Receiving Homes are anxious to help themselves, but are unable to do so, due to poor mental and physical capabilities. They lack the necessary background or initiative to make the primary move. In these cases, it is necessary to give some material help to establish pride of possession, and then to give the family the necessary advice on general household management. Immaturity plays a large part in the inadequacy of family life, the younger mothers never having had the 94 necessary pattern of a home of their own upon which to build after their marriage. In my opinion, a prolonged stay in the Receiving Homes is detrimental to this type of family for the following reasons:- (1) Inadequate household work. (2) Being provided with all the necessary cleaning materials, mops, brushes, etc. (3) Lack of training in household management. There are a few young mothers who, on admission to the Receiving Homes, have a fair standard, but after many months initiative is lost and it becomes easier to adopt a lackadaisical and disinterested attitude. Generally, these cases do accept my visiting, become co-operative, and act on advice. They are successful because they wish to help themselves, and do respond to sympathy and understanding. (b) Long Stay cases. These families are of the type who simply sit and wait for any assistance from any source whatsoever. They are quite prepared to accept material help, but will not try to make a home. Their general attitude is that the authorities will eventually help, and, therefore, any effort on their part is superfluous. In some cases, the wives have shown a little co-operation, but under pressure from other tenants, and/or outside organisations, this feeling ultimately yields to an attitude of hopelessness. In some cases, the families welcome publicity, but are not able to realise that the usual effect of this is that potential landladies will no longer consider them as prospective tenants. This publicity, therefore, is harmful to the families themselves and to my work of rehabilitation. This type of family have often had long periods of separation, due to prison sentences, overcrowding in previous lodgings, or separation of the family in the Receiving Home on admission. It is true to say in these cases that when the famil ies are ultimately re-united they cannot cope with everyday problems and the result may well be a broken home. Given help and encouragement during the initial stage this break- 95 up could often be prevented and the family helped to overcome their many problems, and thus prevent much unnecessary physical and mental suffering to their children. This aspect of the work involves liaison with the man's employer, frequent visits to the family to encourage confidence and to counteract outside harmful influences. (c) Potential Homeless families. These can be grouped as under:- (1) Family quarrels. (2) Separation of families. (3) The current prevalent attitude that to be admitted to a Receiving Home is a short cut to municipal re-housing. It is generally accepted amongst many families that to be admitted to a Receiving Home is the easiest way out of their difficulties. Indeed, in some cases the parents or a landlady advise the family on these lines. They hear of other families who, after a short time in a Receiving Home, are rehoused, and without taking into consideration the many factors involved decide to try the same procedure. There are those instances also of a genuine desire to get the family together where separation has occurred due to previous hardship. It is obviously not possible to put all families into a particular category, consideration and advice being necessary to individual families to help them to overcome their individual problems. (d) Summary In my opinion the work of rehabilitation involves much more than work in Receiving Homes. Many visits are necessary to problem families wherever they are to be found, to help them to keep a fair standard in their own homes, and to thus prevent their admission to Receiving Homes. There is certainly scope for this work to be continued and enlarged, and early action will in many cases prevent family break-up or need for admission to a Receiving Home. These families appear to need help with all matters of household management, particularly the financial implication of rent, hire purchase and sundry other debts. 96 Many problems can be overcome, and in some cases prevented by close liaison with other Departments. The basis for this work is the essential need for children to have a secure home life to ensure their proper physical, mental and emotional development." Families in Receiving Homes assisted from October - December 1955 Rehoused in private accommodation 7 Rehoused in Council accommodation 2 Accommodation found before admission 2 Visits paid:- Family Departments Agents and Contacts 63 17 21 Families without permanent housing at close of year:-25 Visits paid:- Family Departments Agents and Contacts 206 40 45 Potential homeless families:-2 Visits paid:- Family Departments Agents and Contacts 5 1 2 The general scheme, which combines preventive and re-habilitation work by district health visitors and special home helps, and copies the methods of the Family Service Units, is an effective means of coping with problem families without setting up a new department and thus creating fresh difficulties of coordination. It is hoped that the conditions which allowed so many problem families to be admitted and to remain in Welfare Services Accommodation will pass with the policy and administrative action now being followed. While one health visitor should probably be given permanent responsibilities for the oversight of all day to day work of the Health Department with problem families, the need for her present concentration of effort on residents in the Receiving Homes, will I trust, steadily diminist. 97 SPASTICS 76 Spastic children up to school leaving age were known in Croydon, as at 31st of December, 1955. 15-were under school age. 7-of school age were not yet at school, not being suitable but still under review. 18-were ineducable, of whom four attended the Occupation Centre and five were in hospital, leaving nine at home. 24-were attending St. Giles' School. 1-was at St. Margaret's School, Croydon. 2-were attending Residential Schools for Physically Handicapped children. 2-were attending normal Residential Schools (St. Mary's, Bexhill). 1-was attending a Day Partially Deaf School. 6-children were at ordinary schools. (36 Spastic children were attending school) There is no change to report in local facilities for the diagnosis or treatment of this condition. EPILEPTICS Reference is made in the School Health section regarding number of cases known to the Department. In addition the Chief welfare Officer informs me that 16 adult cases are registered with his Department. 99 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1955 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, 1955. Routine Medical Inspections The timing of the four routine inspections was considered by the Committee during the year. Following consultation with the Head Teachers, it was agreed that in future two inspections during the period of primary and two during the period of secondary education should be the rule. The fall in the total number of examinations during 1955 reflects staff absences. Infectious Diseases A mild, but very catching bowel infection, called Sonne Dysentery, gave much trouble, especially at two particular schools. This illness is dangerous only to very young, very old or debilitated persons. In young children it causes diarrhoea and often vomiting and fever. The acute illness is generally over in a few days and may be so slight that it is deemed merely an ordinary digestive upset of childhood. In adults, infection may occur without any symptoms and becomes known only after laboratory tests. The spread of 100 tion is mainly by direct contact. It had been shown that 50% of children concerned in an outbreak of Sonne Dysentery carry the germs on their hands. This is readily understood if they are to young to avoid soiling their hands, or effectively washing the without adult supervision. It is thus obvious why the youngest age groups in primary schools are mainly involved in outbreak of Sonne Dysentery. These outbreaks occasion considerable work and interfere with school routine. It is necessary, however, to observe a reasonable balance between doing too much for what is a relatively mild illness or taking no action to prevent it spread. School closure was not considered justifiable, but the following measures were applied:- Advising teachers, parents and medical practitioners of the prevalence of Sonne Dysentery. Immediate check on water supplies, school milk and school meals service. Exclusion from school of all pupils with a recent history of suspicious illness, domiciliary visiting of all children reported absent and continued exclusion of any case or suspected case until proof of freedom from infection had been obtained. Exclusion of all family contacts until shown free from infection. Continuous disinfection of school premises and all articles in common use. Emphasis on the importance of toilet drill for young children and careful supervision of hand hygiene. (In one school (Rowdown) bacteriological tests were carried out on all the children in the Infant Department to detect symptomless carriers. I do not think it can be shown that the outbreak was curtailed to a degree, which justified the work involved and I would not recommend this procedure as a routine for the control of Sonne Dysentery in schools). The prevention of the illness rests mainly on the maintenance at all times of a satisfactory standard of hand hygiene and a high state of cleanliness of school sanitary annexes. Outbreaks in schools arise when unrecognised cases continue in attendance. Vigilance to detect and exclude children suffering from suspicious illnesses pending their investigation is an obvious safeguard. It is unreasonable, however, to expect this safeguard to be applied when Sonne Dysentery is not known to be prevalent in the area. In such circumstances, the exclusion of every small child suffering from some minor digestive upset, pending laboratory examinations, is virtually impossible. One can only hope for speedy recognition that a number of children have such an illness and the effectiveness of the normal hygienic arrangements in the school in preventing the condition becoming widespread amongst other scholars before special measures are applied. 101 New Clinics One floor of premises belonging to the Corporation at 47 St. James' Road, was adapted to form a Speech Therapy Clinic. A single waiting room serves three quite independent consultation and treatment rooms in which half-glass screens separate play therapy sections from the consultation portions. This arrangement allows three Therapists to work at the same time, and to have their patients under their direct observation. This scheme was from a design by the Speech Therapists themselves and has proved most successful in actual practice. On the ground floor of this building, two rooms have been turned into one and equipped for Remedial Exercises. This has allowed the giving up of a Hall previously hired for this purpose and provides a most conveniently situated permanent clinic, which serves the whole of the borough. The Principal School Dental Officer refers to a new Dental Clinic provided by the Health Committee, but used up to 80% of capacity for school dental services. While it was essential to provide accommodation for ordinary dental treatment, opportunity was taken to improve the facilities available for patients, especially to encourage the attendance of children from an early age and the promotion of dental health. I would take this opportunity to thank the Members of the Education Committee for their continued encouragement and support, despite the difficulties imposed upon them by financial limitations. I thank also the Members of the Education Department for their unfailing co-operation and the School Health Staff for the manner in which they have carried out routine and special duties. Public Health Dept., Croydon. 102 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) - (40) *Dental Officers 10 (including 4 part-time) - (80) *Physiotherapists 2 (95) Speech Therapists 3 (including 2 part-time) *School Nurses 29 (including S.H.V. and Deputy *Dental Attendants 11 (including 4 part-time) - (80) * Performing also duties in other sections of Public Health Department. Percentages in brackets show proportion of time given to school work. PARTICULARS OF CLINICS HELD The following Clinics are provided by the Education Committee: attendance thereat, with the exception of the Minor ??? ments 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.); Ashbur??? School (Mondays and Thursdays only 9 a.m.); Rockmount School (Monday ??? Thursdays only, 9 a.m.); Duppas School Goodwin Road, Waddon (Daily, Monday Friday, a.m.); Salcot Crescent, N??? Addington (Monday and Thursday, a.m.) Dental Lodge Road, Broad Green, Croydon; 2??? Selhurst Road, South Norwood; Waldr??? Hall, 55 Duppas Hill Lane, Croydon Overbury School, New Addington ??? Stroud Green. Inspection Lodge Road, Broad Green, Croydon. Remedial Exercises and Massage 47 St. James' Road, Broad Green, Croydon. Speech Defects 47 St. James' Road, Broad Green, Croydon and at Salcot Crescent, New Addington. Enuresis Lodge Road, Broad Green, Croydon. 103 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS 1955 School Average No. on Registers Average Attendance Average Attendance per cent. Average 1954 Attendance per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed 571 537 94.0 94.3 Ashburton Infants 2 27 213 93.8 93.1 Benson Junior Mixed and Infants 605 575 95.0 93.8 Beulah Junior Boys 413 386 93.5 94.2 Beulah Junior Girls 361 334 92.5 94.6 Beulah Infants 197 169 85.8 87.1 Castle Hill Infants 246 220 89.4 — Cypress Junior Mixed 250 235 94.0 92.8 Cypress Infants 152 135 88.8 88.8 Davidson Infants 233 206 88. 4 91.9 Duppas Junior Mixed 430 391 81.6 90.3 Ecclesbourne Infants 144 134 93.1 92.8 Elmwood Junior Boys 310 280 90.3 92.3 Elmwood Junior Girls 357 329 92.2 91.5 Elmwood Infants 251 221 88.0 88.7 Fairchildes Junior Mixed 420 376 89.5 91.1 Fairchildes Infants 4 25 357 84.0 87.9 Gilbert Scott Junior Mixed 520 493 94.8 93.2 Gilbert Scott Infants 199 186 93.5 91.8 Gonville Junior Mixed and Infants 500 462 92.4 93.7 Howard Junior Mixed and Infants 520 473 90.9 92.9 Ingram Infants 17 2 151 87.8 89.9 Kensington Avenue Junior Mixed and Infants 612 570 93.1 93.1 Kingsley Junior Mixed 514 480 91.8 90.7 Kingsley Infants 307 270 86.1 83.5 Monks Orchard Junior Mixed and Infants 373 346 92.8 93.7 Overbury Junior Mixed and Infants 323 297 91.9 89.6 Norbury Manor Junior Mixed 491 465 94.7 9 4.1 Norbury Manor Infants 229 203 88.6 90.1 Oval Junior Mixed 470 439 93.4 93.4 Oval Infants 161 144 89.4 89.6 Portland Infants 216 201 93.6 93.0 Purley Oaks Junior Mixed 350 322 92.0 — Purley Oaks Infants 183 165 90.2 91.5 Rockmount Junior Mixed 384 360 93.8 94.1 Rockmount Infants 170 149 87.7 90.6 Rowdown Junior Mixed 357 330 9 2.4 91.9 Rowdown Infants 383 348 90.9 87.9 South Norwood Junior Boys 354 331 93.5 93.3 South Norwood Junior Girls 312 292 93.6 92.5 South Norwood Infants 277 246 88.8 88.0 St. Peter's Junior Mixed and Infants 333 311 93.4 92.2 Spring Park Junior Mixed 427 405 94.8 94.4 Spring Park Infants 188 173 92.0 91.2 Sydenham Junior Boys 291 268 92.1 93.9 Sydenham Junior Girls and Infants 369 334 90.5 89.4 Waddon Infants 202 180 89.1 80.8 West Thornton Junior Mixed 384 360 93.2 93.9 West Thornton Infants 208 180 90.0 92.1 Whitehorse Manor Junior Girls 284 263 92.6 93.1 (table continued on next page) 104 School Average No. on Register Average Attendance Average Attendance per cent. ??? Whitehorse Infants 230 206 89.5 ??? Winterbourne Junior Boys 422 394 93.4 ??? Winterbourne Junior Girls 445 423 95.1 ??? Winterbourne Infants 348 310 89.1 ??? Wol sey Junior Mixed 578 542 93.8 ??? Wolsey Infants 273 240 87.9 ??? Woodside Junior Boys 419 391 93.3 ??? Woodside Junior Girls 411 387 94.1 ??? Woodside Infants 280 258 92.1 ??? Castle Hil1 Juniors 255 235 92.1 ??? Whitehorse Junior Boys 308 279 90.5 ??? TOTALS 20,624 18,960 91.9 ??? COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Boys 541 515 95.2 ??? Ashburton Senior Girls 514 476 92.6 ??? Davidson Senior Boys 301 281 93.3 ??? Davidson Senior Girls 171 157 91.8 ??? Ecclesbourne Senior Girls 260 237 91.1 ??? Ingram Senior Boys 485 440 90.7 ??? 1ngram Senior Girls 295 268 90.8 ??? John Newnham Senior Mixed 475 446 93.9 ??? Lanfranc Senior Boys 538 480 90.2 ??? Lanfranc Senior Girls 638 580 90.2 ??? Norbury Manor Senior Boys 310 294 94.8 ??? Norbury Manor Senior Girls 295 280 94.9 ??? Portland Senior Boys 193 182 94.3 ??? Portland Senior Girls 245 228 93.0 ??? Tavistock Senior Boys 619 545 88.0 ??? Tavistock Senior Girls 410 363 88.5 ??? South Croydon Senior Mixed 569 500 87.9 ??? Shirley Senior Mixed 201 190 94.5 ??? Fairchildes Senior Girls 355 316 89.0 ??? Fairchildes Senior Boys 380 339 90.7 ??? TOTALS 7,795 7,117 91.3 ??? St. Andrew's Vol. Sec. Mod. 206 183 88.8 ??? Our Lady's " " " 186 166 89.2 ??? St. Mary's R.C. Mixed 272 245 90.1 ??? TOTALS 664 594 89.5 ??? SPECIAL SCHOOLS St. Christopher's Educationally sub-normal 210 177 84.2 ??? St. Giles' (Delicate and Physically Handicapped) 198 172 86.9 ??? St. Luke's (Partially sighted) 26 23 88.5 ??? TOTALS 434 372 85.7 ??? 105 School Average No. on Register Average Attendance Average Attendance per cent. Average 1954 Attendance per cent. VOLUNTARY PRIMARY SCHOOLS All Saints' Mixed and Infants 262 242 92.4 91.9 Christ Church Junior Mixed and Infants 218 198 93.2 89.9 Parish Church Junior Mixed and Infants 415 380 91.6 92.0 St. Joseph's Mixed and Infants 493 443 89.9 89.1 St. Mark's Junior Mixed and Infants 222 204 91.9 91.8 St. Mary's R.C. (Junior Mixed and Infants) 366 322 87.9 89.2 St. Michael's Infants 140 120 85.7 84.9 Shirley Junior Mixed and Infants (St. John's) 273 251 91.9 93.9 Good Shepherd Junior Mixed and Infants 182 166 91.2 — TOTALS 2,571 2,326 90.5 90.5 SELECTIVE CENTRAL SCHOOLS Arch. Tenison's Senior Mixed 281 265 94.3 94.9 Heath Clark Mixed 443 422 95.3 92.4 TOTALS 724 687 94.4 94.1 GRAMMER SCHOOLS Selhurst Boys 547 523 95.6 95.1 Selhurst Girls 530 499 94.1 94.7 John Ruskin Boys 469 446 95.1 95.3 Coloma Girls 531 504 94.9 93.4 Lady Edridge Girls 466 446 95.7 95.5 TOTALS 2,543 2,418 95.1 94.7 TECHNICAL SCHOOLS Stanley Technical 281 264 93.9 95.7 Croydon Sec. Technical 260 249 95.7 93.2 TOTALS 541 513 94.8 94.5 SUMMARY OF SCHOOLS Council Primary 20,624 18,960 91.9 91.7 Voluntary Primary 2,571 2,326 90.5 90.5 Council Secondary Modern 7,795 7,117 91.3 90.9 Voluntary Sec. Modern 664 594 89.5 89.0 Grammar 2,543 2,418 95.1 94.7 Central 724 687 94.4 94.0 Technical 541 513 94.8 94.5 Specials 434 372 85.7 85.8 TOTALS 35,896 32,987 91.9 91.7 Crosfield Nursery 42 38 90.4 88.0 106 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is now as follow Primary and Modern Secondary Schools. (1) Entrants i.e., Children admitted for the first ??? to a Maintained School. (2) 8-year-old Group i.e., Children who had attained their ??? birthday at the opening date of ??? Term but have not yet reached ??? 9th birthday and who have not ??? medically examined at the age of years. (3) Primary Leavers i.e., Children in their last year of attendance in a Maintained Primary School and who have not been medical 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 medical examined in that year. (5) Special Cases (if any) i.e., Children of other ages who are appa??? ently defective and whom the ??? Teacher and parents wish the Medical Officer to see at his next visit. A total of 12, 194 children were examined as compared with 13,796 in 1954, and 8,483 parents attended the examinations. ??? percentage attendance of parents in the Entrants' group was ??? boys 87.9 per cent. and girls 94.4 per cent.; in the Intermediate group, boys 61.4 per cent., girls 67.4 per cent.; in the Leavers group, boys 10.8 per cent., girls 31.8 per cent.; and in the Other Ages and 8 to 9 year group, boys 77.5 per cent., girls 82 per cent. The total percentage of parents attending was 69. 6 as against 68.8 last year. 594 specials and 385 re-inspections of children were carried out. 107 HEIGHTS AND WEIGHTS, 1955 [##]Age Number Examined 1955 Average Height in inches Average Weight in lbs. 1955 1954 1953 1952 1939 1955 1954 1953 1952 1939 BOYS 5 Years 1196 43.3 42.7 42.9 43.0 41.8 43.5 42.9 42.5 43.0 41.5 6 " 616 44.2 44. 2 44.3 43.8 43.8 45.3 45.2 44.8 44.4 43.4 7 " 259 47.9 47.8 47.4 48.1 45.3 52.7 53.3 52.0 54.4 47.9 8 " 1203 49.9 50.2 49.9 50.0 49.5 59.1 58.6 58.1 58.3 55.5 9 " 753 51.3 51.6 50.9 51.2 51.2 61.4 61.7 61.6 61.8 58.8 10 " 365 54.3 54.7 55.1 54.9 52.7 73.9 72.2 73.0 72.9 62.9 11 " 447 55.0 55.8 55.5 55.3 53.7 74. 2 76.4 75.6 75.3 68.7 12 " 111 55.6 56.5 56.3 56.8 55.7 80.0 79.7 77.1 78.7 79.9 13 " 9 60.3 60.5 60.0 56.7 58.4 96.5 97.1 90.0 91.0 81.6 14 " 433 62.8 62.4 63.1 61.8 59.0 109.0 105.6 105.6 104.7 90.8 15 " 419 64.8 63.8 64.1 64.4 - 116.5 112.8 115.6 114.6 - 16 " 236 66.9 66.9 67.7 67.0 - 128.3 129.4 129.8 128.2 - 17 " 84 68.4 66.7 67.2 67.8 - 137.7 126.5 127.2 137.4 - GIRLS 5 Years 1125 42.7 42.6 42.6 42. 6 41.2 41.9 41.9 41.4 41.5 39.7 6 " 567 43.4 43.8 43.8 43. 2 42.7 43.8 45.3 43.4 42.8 41.4 7 " 193 47.2 47.5 46.8 47.6 44.1 53.1 52.4 50.0 52.0 43.6 8 " 1209 49.3 49.6 49.7 49.7 49.9 58.8 56.6 56.5 56.9 54.7 9 " 778 50.5 51.0 50.5 51.0 50.9 60.4 60.5 60.4 59.6 57.6 10 " 349 54.6 54.6 54.6 55.4 52.1 73.7 73.1 73.8 72.5 62.9 11 " 381 56.0 55.9 55.8 55.9 53.6 78.7 77.9 76.5 77.6 68.3 12 " 219 58. 2 57.1 57. 1 58.0 56.6 87.5 81.9 82.6 86.0 77.2 13 " 75 60.3 61.4 59.8 59.3 58.8 97.5 100.6 96.0 91.8 85.3 14 " 489 61.7 62.2 61. 8 62.0 60.3 111.3 109. 2 109.0 107.7 97.9 15 " 446 63.2 62.7 62.9 63.0 62.0 116.1 114.0 116.0 112.2 105.5 16 " 258 64.2 63.3 64.7 64.2 - 123.2 121.8 121.9 123.2 - 17 " 118 64.2 63.5 64.9 64.2 - 124.6 116.3 127.4 121.4 - 108 BOYS HEIGHTS COMPARISON WITH PREVIOUS YEARS 109 GIRLS HEIGHTS COMPARISON WITH PREVIOUS YEARS 110 BOYS WEIGHTS COMPARISON WITH PREVIOUS YEARS 1ll GIRLS WEIGHTS COMPARISON WITH PREVIOUS YEARS 112 PARENTS PRESENT 1955 ENTRANTS INTERMEDIATE LEAVERS OTHER AGES AND 8 TO 9 YEARS TOTALS 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 22 24 20 20 15 11 6 9 — — — — 32 26 23 17 69 61 Arch. Teni son's — — — — — — — — 74 — 15 — — — — — 74 — Ashburton 39 56 38 53 21 — 17 — 160 101 31 46 138 53 111 44 358 210 Benson 55 75 31 69 41 32 36 31 — — — — 94 83 83 78 190 190 Beulah 50 44 47 40 1 74 — 53 — — — — 149 128 121 111 200 246 Castle Hi11 14 8 7 2 — — — — — — — — 24 23 21 18 38 31 Christ Church 33 16 31 16 25 7 17 — — — — — 35 37 26 29 93 60 Coloma — — — — — — — — — 95 — 6 — — — — — 95 Croydon Sec. Tech. — — — — — — — — 74 — 1 — — — — — 74 — Cypress 43 20 39 19 — 2 — — — — — — 11 29 9 25 54 51 Davidson 34 32 30 31 — — — — 44 26 9 3 37 47 30 41 115 105 Duppas — — — — 89 — 43 — — — — — 63 76 41 55 152 76 Ecclesbourne 24 19 21 14 — — — — — 48 — 22 — — — — 24 67 Elmwood 69 70 6 2 65 48 81 36 53 — — — — 112 98 95 81 229 249 Fairchildes 154 177 145 171 — — — — 65 39 6 9 23 50 21 48 242 266 Gilbert Scott 38 25 36 25 21 29 13 18 — — — — 59 32 46 29 118 86 Gonville 43 37 41 33 8 1 4 1 — — — — 41 41 34 33 92 79 Heath Clark — — — — — — — — 26 66 — 2 — — — — 26 66 Howard 66 78 60 75 63 64 28 46 — — — — 58 58 41 52 187 200 1ngram 46 35 42 30 — — — — 94 62 10 29 — — — — 140 97 John Newnham — — — — — — — — 40 28 3 4 — — — — 40 28 John Ruskin — — — — — — — — 98 — 2 — — — — — 98 — Kensington 56 27 54 24 25 3 18 2 — — — — 74 57 55 50 155 87 Kingsley 57 44 48 38 54 5 30 5 — — — — 41 80 27 68 152 129 Lady Ed ridge — — — — — — — — — 129 — 34 — — — — — 129 Lanfranc — — — — — 13 — 13 84 125 6 59 — — — — 84 138 Monks Orchard 15 23 15 21 27 25 18 21 — — — — 38 48 34 49 80 96 Norbury Manor 29 33 26 27 3 4 l 2 39 64 2 39 128 110 110 90 199 211 Our Lady's Convent — — — — — 48 — 14 — 36 — 11 — — — — — ??? 113 Parish Church 14 13 13 13 2 2 — — — — — — 28 35 17 31 44 50 Portland 32 24 28 24 — 18 — 1 22 48 4 7 45 32 29 25 99 122 Purley Oaks 69 58 56 55 6 19 1 19 16 11 5 6 72 42 56 38 163 130 Rockmount 23 27 23 25 2 5 2 4 4 — 2 — 31 3 27 2 60 35 Rowdown 75 85 67 77 25 42 13 29 — — — — 20 19 18 14 120 146 St. Andrew's — — — — — — — — 33 30 2 5 — — — — 33 30 St. Joseph s 55 54 44 31 13 20 5 9 — — — — 66 50 34 28 134 124 St. Mark's 27 23 21 20 — — — — — — — — 23 22 18 18 50 45 St. Mary's R.C. 25 20 12 15 13 2 2 2 — 10 — 6 22 33 10 26 60 65 St. Michael's 43 41 36 34 — — — — — — — — — — — — 43 41 St. Peter's 45 23 40 22 — — — — — — — — 42 49 20 29 87 72 Selhurst Grammar — — — — — 25 — 18 52 192 2 70 — — — — 52 217 Shirley 31 29 29 27 10 15 4 10 — — — — 15 11 12 10 56 55 South Croydon Sec. — — — — — — — — 25 68 2 13 — — — — 25 68 South Norwood 61 64 57 59 — 14 — 6 24 — 1 — 108 178 85 146 193 256 Spring Park 34 29 29 29 1 8 1 5 — — — — 79 95 51 81 114 132 Stanley Tech. — — — — — — — — 74 — — — — — — — 74 — Sydenham 42 33 35 29 71 55 52 38 — — — — 120 78 94 51 233 166 Tavistock — — — — — — — — 60 10 2 6 36 — — — — 60 10 2 Waddon 81 74 67 69 — — — — — — — — — 2 — 2 81 76 West Thornton 68 69 62 64 35 29 25 20 — — — — 74 68 60 54 177 166 Whitehorse Manor 65 53 56 49 — 21 — 15 — — — — 23 77 17 66 88 151 Winterbourne 88 67 82 63 65 34 43 28 — — — — 145 133 130 111 298 234 Wolsey 90 108 79 101 22 1 17 1 — — — — — 16 — 15 112 125 Woodside 51 53 43 49 61 22 40 17 — — — — 95 88 70 74 207 163 1971 1848 1733 168 4 835 763 513 514 1131 1280 122 407 2210 2156 1712 1788 6147 60 47 3819 3417 1598 1027 2411 529 4366 3500 12194 PERCENTAGE OF PARENTS PRESENT AT MEDICAL INSPECTIONS Entrants Boys 87.9 89.5 69.6 " Girls 94.4 1ntermediate Boys 61.4 64.3 " Girls 67.4 Leavers Boys 10.8 21.9 " Girls 31.8 Other Ages Boys 77.5 80.2 8 to 9 years Girls 82.9 114 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1955 Defects Boys Girls No. requiring Treatment No. referred for Observation Percentage of total Examined No. requiring Treatment No. referred for Cbservation Percentage of total Examined Uncleanliness- Head — — -— — — — Body Skin Disease 16 5 0.34 17 2 0.31 Eye Disease- Defective Vision 243 30 4.44 287 20 5.08 Squint 36 6 0.68 36 16 0.86 External Eye Trouble 4 1 0.08 12 3 0.25 Ear Disease- Deafness 30 14 0.72 12 7 0.31 Otitis Media 3 8 0.18 4 2 0.10 Other Disease 3 1 0.06 1 1 0.03 Nose and Throat 164 113 4.51 146 108 4.20 Enlarged Cervical Glands (not T.B.) 7 13 0.33 2 11 0.22 Dental Defects 34 — 0.55 34 1 0.58 Speech Defects 42 19 0. 99 14 9 0.38 Heart and Circulation 16 39 0.89 27 47 1.22 Lungs 29 78 1.74 35 69 1.72 Nervous System Disorders Epilepsy 1 3 0.06 2 6 0.13 Other 5 16 0.34 7 9 0.26 Developmental- (a) Hernia 10 5 0. 24 1 — 0.02 (b) Other 10 29 0.63 2 3 0.08 Psychological- 0.23 (a) Development 11 6 0.28 9 5 (b) Stability 11 8 0.31 7 11 0.30 Deformities- Flat Feet 76 29 1.71 62 27 1.47 Posture 69 26 1.54 81 27 1.79 Others 43 21 1.04 51 25 1.26 Other Defects and Diseases 49 42 1.48 60 46 1.75 TOTALS 912 512 909 455 Total Children Examined 6147 6047 115 VISION Extent of Defect Intermediate Leavers 8 to 9 years and Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. %I No. % No. % No. % No. % No. % Normal: 6/6ths or 6/9ths 767 91.8 697 91.4 1050 92.8 1181 92.3 2088 94.4 1983 92.0 3905 93.5 3861 92.0 Up to 6/24ths 60 7.2 59 7.7 76 6.7 95 7.4 105 4.8 149 6.9 241 5.8 303 7.2 Over 6/24ths 8 1.0 7 0.9 5 0.5 4 0.3 17 0.8 24 1.1 30 0.7 35 0.8 Cost of the School Health Service The gross cost of the medical, dental and nursing services was £34,489. The expenditure is subject to Education grant. Cost of Special Schools £ Schools maintained by the Council 30,838 Other Schools (not maintained by local Education Authorities) 6,940 Adjustments with other authorities in respect of Special Schools, at rate cost 2,260 £40,038 With the exception of the £2,260 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals Meals and Milk cost £284,076. Income from payment for meals was £111,987, making a net cost of £172,089, on which grant is paid of 100 per cent. on approved expenditure. 116 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1955 (Percentages of Children examined) Defect or Disease Entrants Intermediates Leavers Other Ages and 8 to 9 yrs ??? Boys Girls Boys Girls Boys Girls Boys Girls Boy JJ Teeth 1.7 1.7 1.3 2. 2 0.5 0.5 1.7 1.3 1.1 Skin 0.5 0.3 0.5 0.7 0.3 0.5 0.4 0.4 0.4 Eyes- Vision 0.9 0.9 8.2 8.6 7.2 7.7 5.5 8.0 4.7 Squint 1.7 2.4 0.1 — — 0.3 0.8 0.8 0.8 Other 0.2 0.3 0.1 0.7 — 0.3 0.2 0.2 0.2 Ears- Hearing 1.0 0.7 0.5 — — — 0.9 0.4 0.7 Otitis Media 0.4 0.2 — — 0.1 0.1 0.2 0.1 0.2 Other 0.1 0.1 0.1 0.1 — 0.1 0.1 — 0.1 Nose or Throat 10.5 10.2 2.2 4.5 0.1 0.5 4.5 5.7 5.5 Speech 1.8 0.9 0.8 0.1 0.4 — 0.7 0.2 1.0 Cervical Glands 2.0 2.2 0.4 1.0 — 0.1 1.6 1.1 1.3 Heart and Circulation 1.5 1.3 1.0 1.2 0.4 0.9 0.9 1.5 1.0 Lungs 2.8 2.8 1.3 0.9 0.2 0.9 2.0 1.6 1.8 Development- Hernia 0.4 — 0.1 — 0.1 0.1 0.3 — 0.3 Other 0.7 0.1 1.1 — 0.1 — 0.9 0.2 0.7 Orthopaedic- Posture 1.2 1.4 2.3 2.1 0.6 2.4 2.3 2.0 1.6 Flat Feet 3.2 2.3 1.4 3.1 0.5 1.0 2.2 1.8 2.1 Other 1.9 0.8 0.6 1.4 0.4 1.4 1.3 1.8 1.2 Nervous System- Epilepsy 0.2 0.2 — 0.3 — 0.1 0.1 0.1 0.1 Other 0.5 0.3 0.5 0.3 0.1 — 0.4 0.4 0.4 Psychological- Development 0.3 0.5 1.0 0.3 0.1 0.1 0.2 0.2 0.3 Stability 0.2 0.4 0.5 0.1 0.2 — 0.4 0.4 0.3 Dul1 and Backward 0.1 0.2 0.2 0.1 — — 0.1 0.2 0.1 Other Defects 2.1 1.8 2.6 1.9 0.4 1.9 1.3 1.9 1.6 UNCLEANLINESS Cleanliness inspections are carried out by the School Nurse each term in every school, so that all pupils are brought under review. The finding of slight infestation in unexpected offende??? leads to the issue of an informal letter to the parents, setti??? out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parent of children previously found verminous. Steel combs are sold ??? 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 consta??? cleanliness to prevent relapses. A cleansing station is provide for the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection) 63,533 117 Number of children inspected (subsequent inspections) 768 Number of children found unclean (first inspection) (596 occasions of infestation) 363 Number of occasions in which children found unclean (subsequent inspections) 154 At the primary inspections vermin were found in 35 and nits alone in 561 children. On these inspections 0.6 per cent. of the children showed evidence of infestation as against 0.9 in 1954. 46 children attended the Cleansing Station for treatment. TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis- Pulmonary 8 Non-Pulmonary 3 Taking the total child population at 37,200, the pulmonary tuberculosis incidence rate per 100,000 was 21.5, and the nonpulmonary incidence rate 8.1. There was one death from tuberculosis. CAUSES OF DEATH IN SCHOOL CHILDREN Child population, 37, 200. (Registrar General's estimate) Number of deaths 14, which is equal to a death-rate of 0.38 per 1,000. The deaths were due to:- Miliary Tuberculosis 1 Broncho Pneumonia 1 Influenzal Pneumonia 1 Status Asthmaticus 1 Bronchitus 1 Lymphatic Leukaemia 1 Fibrocystic Disease 1 Intussusception 1 Accidental 6 118 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 Poliomyeltis Jaundice Conjunctivitis Sore Throat Indefinite Sickness Enteric Group Erysipelas Vermin Meningococca/ Infection Totals Body Scalp All Saints 262 7 — — 1 46 — 1 — — — — 2 — — — — — — — 1 — 58 Archbp Tenison 281 — — — — — — — — — — — 1 — — — — — — — — — 1 Ashburton 1853 17 — 4 1 2 — — — — — 1 2 — — — — — — — — — 27 Benson 605 13 — 3 3 — — — — — — 2 1 — — — — — — — — — 22 Beulah 971 53 1 3 2 5 — 2 — — — 5 2 — — — — — 1 — 7 — 81 Cast1e Hill 246 — 3 — 15 — 1 — — — — 3 2 — — — — — — — 3 — 27 Christchurch 218 19 — — 68 1 — — — — 2 — — — — — — — — 2 — 92 Coloma 531 — — — — — — — — — — 4 2 — — — — — — — — — 6 Crossfield Nursery 42 — — — 3 — — — — — — — — — — — — — — — — — 3 Croydon High 868 — — — — — — — — — — 1 — — — — — — — — — — 1 Croydon Tech. 281 — — — — 1 — — — — — — — — — — — — — — — — 1 Cypress 40 2 38 — — 6 55 — — — — — 4 1 — — — — — — — — — 104 Davidson 70 5 57 2 5 11 5 — 1 — — — 5 — 1 — — — — — — — — 87 Duppas 430 1 — — — — 2 — — — 2 1 — — — — — — — 1 — 7 Ecclesbourne 404 42 — 1 — 7 — — — — — 4 1 — — — — — — — 6 — 61 Elmwood 918 63 — 2 53 1 — 1 — — — 11 2 — — — — — — — 5 — 138 Fairchildes 1580 37 3 — 171 1 — — 1 — — 5 21 2 — — — — — — 2 — 243 Gilbert Scott 719 44 — — 1 — — 1 — — — 1 129 — — — — — — — 1 — 177 Gonvi11e 500 75 1 — — 1 — — — — — 2 — — — — — — — — — — 79 Good Shepherd 18 2 — — — — — — 1 — — — — — — — — — — — — — — 1 Heath Clark 443 — 1 — — — — — — — — — 1 — — — — — — — — — 2 Howard 520 39 — 5 23 4 — — — — — 3 1 — — — — — — 1 1 — 77 Ingram 952 52 1 — 1 12 — 4 — — — 1 5 — — — — — — — — — 76 John Newnham 475 — — — — — — — — — — — 6 — — — — — — — 1 — 7 John Ruskin 469 — — — — — — — — — — — 1 — — — — — — — — — 1 Kensington Av. 612 16 — — 1 5 — 1 — — — 6 3 1 — — — — — — — — ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? 119 Norbury Manor 1325 167 2 27 24 1 — — — — — 8 — 1 — — — 6 — — — — 136 Occupation Centre 76 — — — 2 — — — — — — — 1 — — — — — — — — — 3 Our Lady's Convent 186 — — — — — — — — — — — — 1 — — — — — — — — 1 Oval 631 44 2 1 18 3 — 8 — — — 9 2 — — 1 — 1 — — — — 89 overbury 323 27 2 1 31 2 — — — — — 1 5 — — _ — — — — — — 69 Parish Church 415 —- — 1 2 — — — — — — 2 3 — — — — — — — — — 8 Portland 654 39 — — — — — 1 — — — 3 — — — — — — — — 3 — 46 Purley Oaks 533 25 — 3 4 — — 1 — — — 1 — — — — — 2 — — — — 36 Rockmount 554 46 1 — 1 — — — — — — — — 1 — — — — — — — — 49 Rowdown 740 44 2 — 34 — — — — — — 2 218 1 — — — — — — — — 301 St. Andrew's 206 1 — — 1 — — — — — — — 2 — — — — — — — — — 4 St. Christopher's 210 1 — — 1 2 — 2 — — — — 1 — — — — — — — — — 7 St. Giles' 198 11 — 1 9 1 — — — — — — — — — — — — — — — — 22 St. Joseph's 493 — 1 — — — 4 — 1 — — — — — — — — — — — — — 6 St. Luke's 26 — — — — — — — — — — — — — — — — — — — — — — St. Mark's 222 1 — — — 4 — — — — — — 4 — — — — — — — — — 9 St. Mary's R.C. 366 11 — — 2 1 — — — 1 — 6 17 — — 1 — — — — 2 — 41 St. Michael's 140 32 — — 4 — — — — — — — 1 — — — — — — — — 1 38 St. Peter's 333 67 — 3 3 1 — — — — — — — — — — — — — — — — 74 Selhurst Grammar 1077 — — — 1 2 — — — — — 6 — — — — — — — — — — 9 Shirley (St. John's) 201 40 — — — — — — — — — 1 — — — — — — — — — — 41 South Croydon 569 — — — — — 1 — — — — 1 1 — — — — — — — — — 3 South Norwood 943 28 — — 10 20 — — — — — 23 4 — — — — 1 — — 1 — 87 Spring Park 615 3 — 1 1 1 — 2 — — — — — 3 — — — — — — — — 11 Stanley Tech. 281 — — — — — — — — — — — — — — — — — — — — — — Sydenham 660 16 — 1 1 2 — 1 — — — 5 1 — — — — — — — 3 — 30 Tavi stock 1029 2 — — 2 — — — — — — 2 — — — — — — — — 15 1 22 Waddon 202 45 1 1 1 2 — 3 — — — — — — — — — — — — 4 — 59 West Thornton 592 33 1 12 4 3 — — — — — 4 — — — — — — — — 1 — 58 Whitehorse Manor 514 56 — — 3 1 — — — — — 3 — — — — — — — — 1 — 64 Winterbourne 1215 1 — 4 10 — — — — — — 2 2 — — — — — — — 1 — 20 Wolsey 851 1 — 1 2 — — 1 — — — 2 10 1 — — — — — — — — 18 Woodside 1110 91 — 2 13 9 — 1 — — — 6 3 — — — — — — 1 — — 126 1405 24 101 598 207 6 43 3 1 — 156 476 13 — 3 — 10 1 2 63 2 3114 120 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL Condition Exclusions during 1955 Percentage of total exclusions Exclusions during 1954 Percentage of total exclusions Ringworm 4 0.13 5 0.36 Verminous Conditions 63 2.02 74 5.30 Impetigo 43 1.38 42 3.00 Scabies 6 0.19 — — Scarlet Fever 156 5.01 313 22.39 Measles (inc. German) 1,429 45.89 18 1.29 Diphtheria — — — — Whooping Cough 101 3.24 175 12.52 Chicken Pox 598 19. 20 481 34.41 Mumps 207 6.65 196 14.02 External Eye Disease 3 0.10 1 0.07 Poliomyelitis 13 0.42 2 0.14 Dysentery 4 76 15.29 77 5.51 Sore Throat — — 2 0.14 Other Causes 15 0.48 12 0.86 3.114 — 1,398 — The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show a decrease in Whooping Cough, Scarlet Fever, Vermin and Ringworm, whilst the remainder all show at increase. School Visits Visits to School Departments re Cleanliness 451 Visits re Scabies 6 Visits re Infectious Disease 312 Visits re Medical Inspections 616 Visits re Medical Preparations 603 All other reasons 780 Home Visits Concerning defects found at routine medical inspections 781 Subsequent visits re defects found at routine medical inspections 102 Visits re special cases 179 Visits re dental cases 6 Visits other than infectious cases 2,033 Visits in connection with infectious cases (including 142 visits concerning uncleanliness 5,423 121 TREATMENT The Work of the School Clinics SUMMARY OF ATTENDANCES 1955 1954 Increase or Decrease Minor Ailments and Verruca Clinics 9,415 110,581 — 1,166 Inspection Clinic 1,018 2,040 — 1,022 Dental Clinics 23,666 24,833 — 1,167 Remedial Exercises Clinic 2,836 6,515 — 3,679 Enuresis Clinic 267 — + 267 37,202 43,969 — 6,767 * Clinic closed from May to October The Minor Ailments Clinics At the Lodge Road Clinic 680 defects involved 3,427 attendances, while at the subsidiary Clinics held at Ashburton School 350 defects, 1,600 attendances; at Duppas School 164 defects, 2,235 attendances; at Rockmount School 192 defects, 1,562 attendances; and at Wolsey School 150 defects, 591 attendances. Complaint 1955 1954 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 2 7 3.5 2 7 3.5 Scabies 1 3 3.0 — — — Impetigo 30 260 8.7 35 229 6.5 Other Skin Diseases 4 29 7.2 20 53 2.7 Otorrhoea and other Ear defects 56 301 5.4 108 549 5.1 External Eye Disease 104 405 3.9 187 556 3.0 Miscel1aneous 1,093 6,410 5.9 1,645 10,087 6.1 1,290 7,415 5.7 1,997 11,481 5.8 122 SCHOOL DENTAL SERVICE Report of the Principal School Dental Officer, Mr. P.G. Oliver. The function of this Service is to provide 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. In co-ordination with the above Service 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 A major event of the past year has been the opening of the new Dental Centre at Stroud Green, Shirley Road. In addition to providing badly needed surgery accommodation, the unique siting of this building will permit a more equitable distribution of treatment facilities in this part of the Borough, thus reducing travelling time for those in the Ashburton and Monks Hill districts. Comprising two independent surgery units the New Centre has been specially planned to assist the promotion of the preventive and other Services outlined in previous Reports. Besides meeting the increased needs of the School Dental Service, special emphasis will be given to the supervision of Expectant and Nursing Mothers and Pre-school Children. Though staffing is not yet complete the new venture has fully justified its inception, and should prove a valuable acquisition to the Service. A further welcome development has been the appointment of a part-time Consultant to advise on Orthodontic problems and undertake the correction of advanced cases. This addition to the Staff will substantially increase the amenities for treatment and bring the local Service into line with other progressive Authorities. Whilst throughout the greater part of the Borough treatment has been maintained at a reasonable level, the position at New Addington is far from satisfactory, because of the rapid increase in the school population and a virtual lack of any alternative means of treatment. To relieve the serious congestion at the Overbury Clinic, certain groups of children are temporarily receiving attention 123 at the Stroud Green Centre; however, this arrangement must be regarded as an interim measure until more adequate accommodation can be provided. A scheme for the addition of a Dental Wing to the existing Welfare Centre at Salcot Crescent is being considered, and it is hoped can be proceeded with in the near future. Staffing In the realm of Staffing the acquisition of suitable candidates for this particular work continues to present a serious problem; following repeated efforts one full-time vacancy only could be filled during the year. Excluding the Consultant total staff now comprises six Pull-time and three Part-time Dentists representing the equivalent of 6.7 Pull-time Officers. Though better placed than certain Authorities the present complement is insufficient to meet existing needs, particularly in areas where the rate of acceptance is abnormally high. One result of this is to increase the time lag in treatment and reduce the amount of attention received by the individual child. Inspections The number of children on the register at maintained schools within the Borough at the close of 1955 was 36,006. Including an additional 63 free-place scholars at grant assisted schools this represents a sum total of 36,069. During the year 72.4 per cent. of the school population were examined, compared with 75. 7 per cent. in 1954, indicating a reduction of 3.3 per cent. This decline was due chiefly to lack of staff to cope with the overall increase in the school population and also the unprecedented demand for treatment in the New Addington district. According to recent returns some 7,226 children received no examination during 1955, compared with 6,570 previously. Despite this fact the greater number of schools were visited at intervals of between 12 and 15 months, indicating a slight advance on the former year. At those schools visited 26,114 were inspected and 12,874 (49.3 per cent.) referred for treatment, compared with 26,613 inspected and 12,961 (48.7 per cent.) referred in 1954. In view of the present limitations relating to work which can be carried out on temporary teeth, the above figure 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. 124 The results obtained from school inspections were as follo??? Acceptance of Treatment 47.8% Refused Treatment 41.3% Forms Not Returned 10.9% Compared with last year this represents a further fall ??? 5. 8 per cent. in the acceptance rate, and a total decrease of so??? 26.6 per cent. since the peak of 1949. The corresponding fig??? for 1937 was in the region of 57 per cent. Acceptance Rate Though where private attention is more readily obtainab??? competition with the General Practitioner Service has led to significant drop in acceptance, the net result seems to has been merely to relieve the abnormal burden of the post war years To offset these advantages the responsibilities of the Sch??? Service have been considerably increased by provision of a lar??? number of Primary and Secondary Schools in the newer sections ??? the Borough, where the demand for treatment continues to be hig??? The following Table demonstrates the variations in the acce??? tance rate during recent years:- RESULTS OF SCHOOL INSPECTIONS 1955 1954 19 53 1949 1937 No. referred for Treatment 12,874 12,961 14,998 9,404 13,49! Consents 6,158: 6,946: 8,854: 6,996: 7,762: 47.8% 53.6% 59% 74.4% 57.7% (Total Consents including Specials)* (9,370: (10,197 : (12,496: (10,098: (10,145: 58.2%) 62.8%) 66.1%) 80.7%) 63%) Re fusal s 5,321: 4,592: 4,496: 1,213: 3,241: 41.3% 3 5. 5% 30% 12. 9% 24% Forms no t returned 1,395: 1,423: 1,648: 1,195: 2,494: 10.9% 10.9% 11% 12.7% 18.5% * SPECIALS- Those referred by Head Teachers with Emergency Forms. Treatment Of 16, 086 children referred for treatment (including specials 9,918 (61.6 per cent.) were treated and 6,962 (43.2 per cent. cured completely, compared with 16,212 referred, 11,194 (69 per cent.) treated and 7,824 (42 per cent.) cured in 1954. Despite the usual staff fluctuations the total of treatment sessions increased slightly from 2,349 to 2,361. Assistance by 125 Part-time staff was rather below the. average for recent years and fell from 404 to 351 sessions. As in previous years treatment poses the difficult problem of maintaining a reasonable standard for the individual without unduly delaying the call up of those awaiting attention. Because of this a purely clinical approach cannot always be justified, and measures undertaken must conform to the patient's more obvious requirements in later life. For this reason conservation of deciduous teeth, though excellent in its way, must be restricted to those specially involved in preserving the dental arch. In dealing with large departments a system of priorities, noted at the time of the inspection, has been successfully operated for handling the most pressing work; in this way many subsequent emergencies can be avoided and a more accurate assessment can be made of the time likely to be required for the remaining routine treatment. During the later part of the year periodic visits have been made by the Orthodontist to certain branch surgeries for consultation purposes, and later it is hoped to extend this "routine" to all clinics. As a result of this liaison bolder treatment planning will be possible with a consequent saving of time on non-productive measures. In the more advanced field investigations have continued in the technique of dealing with fractured incisor teeth; considerable praise is due to a member of the staff for very laudable efforts in connection with this specialised work. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:- 1955 1954 Attendances 23,666 24,833 Treated 9,918 11,194 Re-treated 5,200 5,312 Fillings-Permanent 8,879 8,667 Temporary 1,513 1,740 No. of Teeth Filled: Permanent 8,460 8,346 Temporary 1,464 1,702 Extractions-Permanent 2,384 2,153 Temporary 9,103 10,713 continued on next page 126  1955 1954 Gas Administration 4,707 5,040 Local Anaesthetics 674 787 Other Operations- Permanent 8,670 9,196 Temporary 1,109 2,498 Cases Completed 6,962 7,824 Miscellaneous Operations These include 1955 1954 Root treatment in anterior teeth 7 2 Removal of nerves under local anaesthetic 2 2 Gingivectomy 6 1 Removal of bone sequestra 5 5 Splints for fractured incisors 3 2 Partial pulpotomy 6 2 Number of M.D. s treated 26 23 Dentures inserted 80 41 Denture repairs 17 15 After treatment of sockets etc. 41 25 Removal of impacted and difficult teeth 20 18 Ulcerated Stomatitis (Vincent's infection) — 9 Cleft Palate 1 8 Application of Penicillin "Cones" 14 26 Acrylic caps for Incisor Teeth 19 8 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 3,212 compared with 3,251 in 1954. X-Ray Examinations The number of cases referred to Mayday Hospital for the above purpose was 160, compared with 210 in 1954. Orthodontic Service A notable advance in this sphere has been the introduction of a Part-time Consultant to whom more complicated irregularities can be referred for a preliminary diagnosis. By this procedure conditions unlikely to respond to normal treatment can be dis- 127 closed without awaiting a prior visit to Hospital, whilst those selected for specialised attention can be dealt with with a minimum of delay. A further application on the consultant side has been the visits to Branch Surgeries described in a previous paragraph. Assistance of this kind is particularly helpful in dealing with cases where extraction of teeth is contemplated, and the timing of such operations is of prime importance. The number of sessions devoted to this work was 285, compared with 233 last year. The following is a summary of treatment performed:- Cases commenced during the year 337 Cases carried forward from previous year 203 Cases completed during the year 185 Cases discontinued during the year 27 Pupils treated with appliances 181 Appliances - Removable 194 ,, Fixed 41 Total Attendances 2,636 Cases treated by extraction only 92 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:- 1955 1954 Attendances 153 123 New Cases Treated 14 14 Re-treated 49 46 Fillings - Permanent 101 144 Extractions - Permanent 37 24 Temporary 9 16 Other Operations 27 40 "Gas" Cases 16 13 Local Anaesthesia 5 6 Cases Completed 39 39 Dentures Fitted 2 2 Referred X-Ray 3 2 128 DENTAL DEFECTS (1) Inspected by Dental Officers: Year 2955 Aged 5-6 1, 361 Total: 26,114 " 6-7 2,420 " 7-8 2,818 " 8-9 2, 890 " 9-10 2, 717 " 10-11 2,390 " 11-12 2, 144 " 12-13 2, 296 " 13-14 2, 483 " 14-15 2, 160 " 15-16 1,576 " 16 up 859 Specials 3,212 29,326 (2) Number found to require treatment 17,824 (3) Number referred for treatment 16,086 (4) Number actually treated 9,918 (5) Attendances made by children for treatment 23, 666 (6) Half days devoted to: Inspection 192 189 Treatment 2,361 2,349 2, 553 Number of Gas Sessions 322 Administrative Sessions 173 Orthodontic Sessions 285 (7) Fillings- Permanent Teeth 8,879 8,667 Temporary Teeth 1,513 1,740 10,392 (8) Teeth Filled- Permanent Teeth 8,460 8,346 Temporary Teeth 1,464 1,702 9,924 129 (9) Extractions- Permanent Teeth 2,384 2,153 Temporary Teeth 9,103 10,713 11,487 12,866 (10) Administrations of general anaesthetics for extractions 4,707 5,040 Administrations of local anaesthetics for extractions 674 787 (1) Other Operations- Permanent Teeth 8,670 9,196 Temporary Teeth 1,109 2,498 9,779 11,694 Attendances per session 10. 10.6 130 DIPHTHERIA IMMUNISATION Opportunities to offer immunisation were reduced because poliomyelitis was prevalent in adjoining areas during most of the summer term. At such times it is best to avoid any injections which are not urgently necessary. The number of children between the ages of 5 and 15 years immunised against Diphtheria during the year was 161 together with 1,663 who were given re-inforcing injections. SPINAL AND OTHER REMEDIAL CLINICS 1955 * 1954 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 1,366 209 6.5 2,922 487 6.0 Flat Feet 836 139 6.0 2,162 364 5.9 Breathing 634 125 5.1 1,431 254 5.6 2,836 473 6,515 1,105 224 individual cases were treated and 356 examinations were made by doctor. * Clinic closed for five months owing to staffing difficulties. 131 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED AND DELICATE CHILDREN I am indebted to the Head Teacher, Miss Lambert, for the following report:- The year 1955 has been one of steady progress and of bringing new facilities into co-ordination with established routine. The conferences, whereat a Specialist in Physical Medicine and an Orthopaedic Surgeon advise on the treatment of certain disabled children, have proved most valuable in remedial work and in strengthening co-operation between home and school. The provision of the new playing field has helped us to extend considerably the scope of Physical Education in the school. School work has approximated in curricula and in standards of work to those obtaining in ordinary schools; the boys and girls have again taken part in such activities as the Carol and Festival Choirs and Junior Sports Meetings. Physical Education has included normal and special exercises, cricket, football, netball, tennis and rounders, and there have been spirited Cricket and Netball matches School v. Staff, as well as the Netball Match St. Giles' Girls v. St. Christopher's Girls. Averages of 30 children and 5 Staff have attended the Central Swimming Baths after school, on Tuesdays and Wednesdays throughout the Summer Season; and parents were entertained in September at a gala whose events were hotly contested, the Swimming Shield being won by Stevenson House. 22 Swimming Certificates were won during the year; 2 for ¼ mile, 1 for 220 yds., 2 for 100 yds., 9 for 50 yds., 8 for 20 yds. Meetings of the Old Scholars and reports of their progress have been very gratifying. One severely disabled Old Scholar received the prize awarded to the most distinguished student of his year at Leatherhead Training College. The physical disabilities of some school leavers this year have presented serious and tedious problems to the Youth Employment Officer and his Staff, and we are, indeed, most grateful for their tireless and sympathetic work in placing our boys and girls in employment. The first two weeks of the Summer Vacation, saw 20 children and 4 teachers again at Herne Bay, in beautiful weather, following a most enjoyable programme of swimming, boating, games, excursions and other pleasures of a seaside holiday. disabilities and treatment There were in the school 80 children disabled by cerebral palsy, poliomyelitis, muscular dystrophy, tubercular bone disease, spina bifida, skeletal deformity and other causes. 95 children suffered from cardiac disability or from respiratory diseases. The remaining 95 were delicate from various causes. Physiotherapy has been given on 4½ days each week - a total of 1,878 treatments. 12 visits were made to the Dental Clinic by parties of an average of 14 per visit. The Nursing Sister has carried out the prescribed courses of treatment, dealt with minor ailments; and, assisted by the Male 132 Medical Attendant, has supervised physical welfare and kept all records of individual progress. There have been 18 medical inspections at which 3 50 children were examined and where 179 parents were present. At the inspections 18 children were immunised against Diphtheria. At the Special Conferences 38 children were seen and 28 parents were present. To Dr. Hegarty are offered the very grateful thanks of Parents, Staff and children for her wise direction, sympathy and constant efforts for the welfare of the children. The Head Teacher desires again to record her thanks to the Chief Medical Officer of Health and his Staff, to 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 7 Technical Schools 4 Other vocational training 2 Ordinary Schools 38 Hospital Schools 4 Left district 9 Family emigrated 1 133 ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL I am indebted to Mr. Ramsden, the Head Master, for the following observations:- A very satisfactory year's work has been accomplished despite frequent Staff changes. We have welcomed Messrs. Thomas, Doe and Batchelo r and Misses Wilds, McKay and Worrall to the Staff. During the year Mr. Powell, Senior Assistant, has been on leave taking a Diploma Course of the London University for Educationally Sub-Normal work. Mr. Doe has transferred to St. Giles' and Mrs. Stiles has been appointed Assistant Education Officer in Nigeria. The great event of the year was a 3-day Inspection of the School by Her Majesty's Inspectors Messrs. Parnham, Redfern and Miss Sykes, and a written report was submitted to the Education Committee. The Inspectors expressed complete satisfaction of the work being done and were impressed by the good tone and spirit due to the devotion of the Staff and to their arduous work. Our school outing to Littlehampton took place in the now, expected excellent weather, and a very enjoyable time was experienced by 139 children and Staff with no untoward incident to mar the day. We hope this year to go to the Isle of Wight for a week with several of the children. Netball and cricket were played in competition with other schools of Croydon. The Christmas entertainment took place in the lower hall from 9.30 a.m. to 3.30 p.m. around the tree given by Mr. Stenning of Redhill, which was later sent to Mayday Hospital. A long account and photograph was given in the Croydon Times. So another year's work, difficult, trying, but always full of the satisfaction that something further has been achieved to bring these handicapped children to lead a full life amongst their fellows, has been accomplished. Number on Register January 1st, 1955 198 ,, ,, ,, December 31st, 1955 213 ,, referred to Public Elementary Schools — Number discharged: (i) Ineducable and referred to Mental Health Committee 4 (ii) Unfit to work " " " " " " — (iii) Fit to work " " " " " " 7 134 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN 160 children were examined during 1955. The classifications arrived at, together with recommendations made, are as follows:- (1) Found to be mentally defective: (a) Found to be mentally defective and referred to Local Authority and Occupation Centre 8 (b) Found to be mentally defective and referred to Local Authority for Statutory Supervision 14 (c) Recommended Institutional Care and referred to Local Authority 6 (2) Found to be educationally sub-normal: (a) Recommended to St. Christopher's Special School 35 (b) Recommended to Residential School 4 (c) Referred to Slow Stream in Ordinary Elementary School 30 (d) Recommended for re-test 20 (e) Deferred for Medical Treatment — (f) Recommended for St. Giles' 4 (g) Recommended Epileptic Colony — (h) Referred back to Ordinary Elementary School 20 (3) Referred to Child Guidance Clinic 16 (4) Examined for other Authorities 3 160 Mental Tests at St. Christopher's 24 184 9 home visits have been paid to Education cases. 135 ST. LUKE'S PARTIALLY SIGHTED SCHOOL I am indebted to Miss M.C. Lewin, the Head Mistress, for the allowing observations:- During 1955 the school has continued to make steady progress in spite of the loss felt when Mrs. Davies retired in July. Mrs. Davies was in charge of St. Luke's for seven years and under her care the school has done excellent work. She had the confidence of the parents and the affection and respect of the children and she has been greatly missed by us all. However we are glad to welcome Miss J. Rundle to the staff. Although she has only been here a short time she has done splendid work with the younger children. During the year the school has maintained its customary activities. The boys continue to attend Norbury Manor School for woodwork lessons and have made good progress. One of the boys gained a Certificate of Merit in the National Savings Exhibition for a cabinet which he made in the woodwork class. The girls continued to take Cookery under Miss Newton and at Christmas had a fine show of Christmas cakes. We have also maintained our good swimming record. Two girls have obtained certificates for 4 40 yards, one boy has a certificate for 220 yards and several of the children have 25 and 50 yards certificates. Last September we started a typewriting course for the oldef boys and girls and they are making good progress. Four children left school during the year having reached the school-leaving age. All have found employment except one who _has been accepted as a full-time student at the Guildhall School of Music and Drama. The number on roll at the school on 3 1st December last was 26. 136 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS OR BOARDING IN BOARDING SCHOOLS, 1955 Blind Partiatly Sigh ted Deaf Partially Deaf De licate Physically Handicapped Educationally Sub-normal Maladjusted ??? In the Calendar year:- (1) (2) (3) (4) (5) (6) (7) (8) (9) A. Handicapped Pupils newly placed in Special Schools or Homes - 2 1 3 43 27 49 - 1 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes - 3 - 4 42 22 45 - 1 On or about December 1st:- C. Number of Handicapped Pupils from the area: (i) attending Special School s as Day Pup i1s - 22 19 6 80 111 203 - - Boardi ng Pupi ls 1 - 5 3 3 7 13 - 2 (ii) attending independent schools Tunder approved arrangements) - - 2 1 - 3 - 1 - (iii) Boarded in Homes - - - - 1 - - - - TOTAL (C) 1 22 26 10 84 121 216 1 2 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education Act, 1944 - (i) in hospitals - - - - 8 - - - - (ii) in other group - - - - - - - - - (iii) at home - - - - 6 - - - - E. Were requiring places in Speci al Schools (i) TOTAL (a) day - 1 - 2 1 4 6 - - (b) boarding - - - - 1 1 7 3 - (ii) who had not reached the age of 5:- (a) awaiting day places - - - - - - - - - (b) awaiting boarding places — - - - - - - - - (iii) who had reached the age of 5 but whose parents had not consented to their admission to a speci al school:- (a) awaiting day places - - - - - - 2 - - (b) awaiting boarding Qlaces - - - - - - - - - Number of children reported during the Calendar Year: Under Section 57(3) of Education Act, 1944 16 " " 57(4) " " " – " " 57(5) " " " 11 137 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1955 as to their fitness to following the part-time employment indicated:- 1955 1954 1953 2952 1951 Delivery of Goods for Shopkeepers 86 122 53 74 72 Delivery of Newspapers 364 501 328 338 225 Delivery of Milk 17 33 15 32 30 Shop Assistants 67 48 77 118 133 534 704 473 562 460 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1955 all milk was supplied free of charge, and approximately 30,500 children per day received l/3rd pint each. This was equal to 90 per cent, of the children attending schools. All the milk supplied is pasteurised milk, and the sources of supply are subject to the approval and constant supervision of the Medical Officer of Health. The number of meals supplied daily during 1955 was approximately 15,900. CHILD GUIDANCE CLINIC Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1955 Boys Girls Total number referred 38 26 Analysis of the above Cases:- Diagnostic only 7 4 Current Cases under treatment 16 7 Cases Closed - improved 5 10 Cases Closed - not improved 10 5 38 26 138 SPEECH DEFECTS CLINIC Total no. of cases treated 199 Cases discharged 64 Cases still attending 135 Cases referred for physical treatment 31 Cases referred for residential treatment – Cases referred to Child Guidance 1 Stammerers 30 Cleft Palate 12 Sigmatism 39 Dyslalia 84 Undeveloped Speech 25 Dysarthria 2 Developmental Aphasia 3 Deaf 4 During 1955, the work of the Speech Clinic has recei great impetus, owing to the acquisition of permanent premise at No. 4'7 St. James' Road and the appointment of a full-ti assistant. The premises have 3 large treatment rooms and a common ing room. This allows for the three Speech Therapists to simultaneously, which in past years, has never been possible. Weekly visits are being made to St. Giles' School for Physi cally Handicapped Children and St. Christopher's Special School The Speech Clinic at New Addington has been re-opened and it hoped to increase the sessions worked there, owing to the nun of cases needing treatment. With the present staff and adequate premises, the waiti list, which was considerable, has been substantially reduce and it is now possible for the Speech Therapists to underta treatment of the cases recommended to them, with little deli Because for many years the waiting period has been overs months, the more handicapped children only have been accept for treatment. A recent survey at New Addington has shown a ctf siderable number of handicapped children who need, and wool benefit greatly from speech therapy. It is not possible withU existing staff, however, to carry out such a survey of the who. borough, otherwise the centrally placed Croydon Clinic could overwhelmed with cases. 139 ENURETIC CLINIC The Enuretic Clinic started on 3.1.55. Only small numbers were seen in the first few sessions, but the numbers soon increased and by the end of the year 73 children had been seen and treated. The treatment is simple but takes about 4-6 months, and necessitates the regular attendance once a month of the child with the parent or guardian. As a fair proportion of Enuretic cases come from broken or "Problem" families, it has not been easy to get regular attendance, and out of the 73 children, 12 have been discharged because they have attended very seldom and irregularly. 4 cases were found to require psychological treatment and were referred to the Child Guidance Clinic. 3 left the district, 24 were completely cured. The remaining 30 are still under treatment, but of this number 18 only started attending in November and are, therefore, only half-way through the estimated course of treatment. No. now reputed dry 24 No. still under Treatment 30 No. left District 3 No. referred to Child Guidance Clinic 4 No. discharged for non-attendance 12 Total No. of children 73 Total number of children who have made full attendance 38 EPILEPTICS 16 epileptics were known to the School Health Service as at 31.12. 55. Of these, 7 were attending ordinary schools, 6 were in our Day school for Physically Handicapped and Delicate Children, of whom 1 is recommended for transfer to Lingfield School. One was attending our Day E.S.N. School and 2 were at Lingfield School for Epileptics. A third child was attending this school but died during the year. 140 SPASTICS 36 Croydon Spastics were attending school as at 31.12.55. 24 were attending St. Giles' School 1 was attending St. Margaret's School, Croydon 2 were at Residential Schools for Physically Handicapped children 1 was attending a Day School for Partially Deaf children 2 were attending a Residential School (St. Mary's, Bexhill) 6 were attending ordinary school In addition, 7 children of school age had not been consi ered suitable for school but were still under review. Some these will be able to attend school later. A further 15 children were known who were under school age, NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of noi maintained school children were continued in 1955, 334 childn were examined at routine examination and also 17 specials and-, re-examinations. Appendix B gives the detailed findings. Yours faithfully, S.L. WRIGHT, School Medical Officer 141 APPENDIX A MEDICAL INSPECTION RETURNS Year ended 31st December, 1955 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, 819 Second Age Group 1,598 Third Age Group 2,411 Total 7, 828 Number of other Periodic Inspections 4,366 (8 - 9 years) Grand Total 12, 194 B. -Other Inspections Number of Special Inspections 1,614 Number of Re-inspections 1,459 Total 3,073 C. -Pupils found to require Treatment (Excluding Dental Disease and Infestation with Vermin). Group (1) For defect ive vision ( excluding squint) (2) For any of the other conditions recorded in Table (3) Total Individua l Pupi1s (4) Entrants 27 469 49 2 Second Age Group 101 141 228 Thi rd Age Group 149 134 268 Total (prescribed groups) 277 744 988 Other Periodi c Inspections ..includinq 8 to 9 years 253 414 646 Grand Total 530 1, 158 1,634 142 Table II A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION Defect Code No. DEFECT OR DISEASE (n PERIODIC INSPECTIONS SPECIAL INSPEi No. of defects No. of defet Requi ring trea tmen t (2) Requiring to be kept under obs ervat ion, but not requi r ing trea tmen t (3) Requiring treatment (4) ???  4 SKIN 33 7 1 5 EYES- (a) Vision 530 50 34 (b) Squint 72 22 1 (c) Other 16 4 2 6 EARS- (a) Hearing 42 21 5 (b) Otitis Media 7 10 3 (c) Other 4 2 7 NOSE OR THROAT 310 221 8 8 SPEECH 56 28 11 9 CERVICAL GLANDS 9 24 — 10 HEART AND CIRCULATION 43 86 5 11 LUNGS 64 147 2 12 DEVELOPMENTAL- (a) Hernia 11 5 — (b) Other 12 32 — 13 ORTHOPAEDIC— (a) Posture 150 53 3 (b) Flat Foot 138 56 3 (c) Other 94 46 4 14 NERVOUS SYSTEM - (a) Epilepsy 3 9 1 (b) Other 12 25 1 15 PSYCHOLOGICAL - (a) Development 20 11 2 (b) Stabil ity 18 19 3 16 OTHER 109 88 10 * These figures refer to Special Inspection in school only. 143 B. CLASSIFICATION OP THE GENERAL CONDITION OP PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Groups Number of Pup i Is Inspected A ( Good ) B (Fair) C (Poor) No. X of col. 2 No. X of col. 2 No. X of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 3,819 3,003 78.6 770 20. 2 46 1. 2 Second Age Group 1,598 1.352 84.6 229 14.3 17 1.1 Third Age Group 2,411 2,163 89.7 241 10.0 7 0.3 Other Periodic Inspections including 8 to 9 years 4,366 3, 565 81.7 781 17.9 20 0.4 TOTAL 12, 194 10.083 82.7 2,021 16.6 90 0.7 Table III INFESTATION WITH VERMIN (i) Total number of examinations in the schools by the school nurses or other authorised persons 64,301 (ii) Total number of individual pupils found to be infested 376 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 2 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) — 144 Table IV GROUP 1. - DISEASES OF THE SKIN (excluding unci eanl i ness, font see Tabl e III) Number of esses tn or under treahn during the yen By the Authori ty Other Ringworm - (i ) Scalp – – (ii) Body 2 – Scabies 1 – Impetigo 30 – Other Skin Diseases 4 – Total 37 – GROUP 2. - EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases ??? By the Authority Other External and other, excluding errors of refraction and squint 104 – Errors of Refraction (including squint) – 1,11??? Total 104 1,48??? Number of pupils for whom spectacles were (a) Prescribed – 1,3??? (b) Obtained – 1,3??? GROUP 3.- DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases By the Authority Other Received operative treatment (a) for diseases of the ear — — (b) for adenoids and chronic tonsillitis — 405 (c) for other nose and throat conditions — — Received other forms of treatment Ear (Minor Ailments Clinic) 56 — Total 56 405 145 GROUP 4. - ORTHOPAEDIC AND POSTURAL DEFECTS (a) Number Treated as in-patients Not available By the Authority Otherwi se (b) Number treated otherwise, e.g. in clinics or out-patients departments 190 Not Avai1able GROUP 5. - CHILD GUIDANCE TREATMENT Number of cases treated in the Authority's Chi id Guidance Clinics Elsewhere Number of pupils treated at Child Guidance Clinics – 64 GROUP 6.- SPEECH THERAPY Number of cases treated By the Authori ty Otherwise lumber of pupils treated by Speech Therapists 199 – GROUP 7. - OTHER TREATMENT GIVEN Number of cases treated By the Author i ty Otherwise (a) Miscellaneous minor ailments 1,093 – (b) Other 1. Orthoptic – 81 2. Sunl ight — 4 3. Verruca 246 – 4. Enuresis 73 – Total 1,412 85 146 Table V DENTAL INSPECTION AND TREATMENT 1 (1) Number of pupils inspected by the Authority's bental OfficeERS – (a) Periodic age groups 26 (b) Specials ??? (c) TOTAL (Periodic and Specials) TOTAL 29 (2) Number found to require treatment 17 (3) Number referred for treatment 26 (4) Number actually treated 9 (5) Attendances made by pupils for treatment 29 (6) Half-days devoted to: (a) Inspection (b) Treatment ??? TOTAL 6 ??? (7) Fillings: Permanent Teeth Temporary Teeth ??? TOTAL 7 10 (8) Number of Teeth filled: Permanent Teeth 8 and Temporary Teeth TOTAL 8 9 (9) Extractions: Permanent Teeth 2 Temporary Teeth 9 TOTAL 9 11 (10) Administration of general anaesthetics for extraction ... 4 (11) Other Operations: (a) Permanent Teeth 8 (b) Temporary Teeth 1 TOTAL 11 9 147 APPENDIX B NON-MAINTAINED SCHOOLS Year ended 31st December, 1955 Table I RETURN OF MEDICAL INSPECTIONS A. -Routine Medical Inspections. Year Year 1955 1954 Age 11 or under 49 – 12 49 1 13 28 18 14 66 34 15 54 33 16 40 18 17 22 2 18 or over 26 – Total 334 106 B. -Other Inspections. Number of Special Inspections 17 – Number of Re-inspections 42 5 Total 59 5 Visits to Non-maintained Schools 13 5 The following defects were found by Medical Inspection:- Treatment Observation Defective Vision 20 1 Defective Teeth – 1 Skin 1 1 Posture 9 – Plat Foot 2 – Other Deformities 4 – Development 1 – Other Defects 3 – 149 CONTENTS A-PUBLIC HEALTH REPORT Page Air 91 Ambulance Service 57 Amusement Houses 70, 75 Aimals, Diseases of 76 Animals, Keeping of 70 Ante-Natal Clinics 38 Births 9, 10 B1 ndness 92 By laws 69 Cancer 16 Hnsus 8 Memical Analyses 88 Chest Clinic 25 Hild Minders 90 Clivil Defence 59 Hntacts, Tuberculosis 30 Convalescence 60 Committee 3 Communicable Diseases 18 Cremation 91 Dsries, Cowsheds and Milkshops 80 By Nurseries 43 Deaths 10, 13, 15, 29 Dental Treatment - M. & C. W. 44 Diphteria 56 Disinfection 75 Dinfestation 75 Domestic Helps 60 Drinage 74 Dysentery 22,66 Epilepsy 97 Extra Nourishment 30 Factories and Workshops 72 food Poisoning 20, 23 Foods 70, 77, 82, 86 Bstro-Enterit is 22 Health Propaganda 63 Health Visitors, Work of 52,54 Home Helps 60 Home Nursing 30, 41 Bspital, isolation 21 Basing 21 Housing 71 IceCream 82 Illegitimacy 8,39 Immunisation Infant Mortality 11,13 Infant Welfare Clinics 39,40 Page Infectious Diseases 18,21 Inquests 10 Laboratory Examinations 37 Local Acts 70 Marriages 9 Maternity Homes 90 Maternity Homes, Registration 90 Measles 22 Meat Inspection 79 Meat, Tuberculous 80 Medical Help Records 51 Men's Hostel 71 Mental Health 63 Midwives 51 Midwives, Municipal 49 Midwives Acts 51 Milk, Provision of 30,80 Milk, Examination of 81, 84 Milk, Tuberculous 81 Milkshops 80 Mortality in Childbirth 11 National Assistance Act 91 Neglected Children, 92 Neo-Natal Deaths 12 Notification of Birth Acts 10 Nuisances 69 Nursing Equipment 60 Nursing Homes 90 Nurses' Agencies 90 Occupation Centre 65 Offensive Trades 74 Outworkers 73 Pests 76 Physiotherapy 43 Poisons and Pharmacy Act 76 Poliomyelit is 22 Population 8 Post-Natal Clinics 38 Post-Mortems 10 Premature Infants 38 Problem Families 92 Puerperal Sepsis and Pyrexia 18 Rag Flock Act 76 Rats and Mice (Destruction)Act 76 Refuse Collection 89 Relaxation Classes 38 Rivers and Streams 74 Sanatoria, Treatment in 30 Sanitary Administration 66 Sanitary Certificates 71 Sanitary Inspectors, Work of 68 150 Page Scarlet Fever Sewage Shops Acts Slaughterhouses Small-Pox Smoke Observation Spastics Staff Examinations Staff Still-Births Street Acc idents Tuberculosis, After Care " Allowances " Contacts " Home Nursing " Home Visits " Institutional Treatment " Mass Radiography Page 22 Tuberculosis Mortality 89 Notifications 21 73 " Occupational 79 Therapy 56 " Re-Housing 74 " Vaccination 97 91 Vaccination 31, 56 7 Verminous Persons 10 Venereal Diseases 58 Vital Statistics 33 Ward Statistics 33 watercourses 30 Water Supply 30 Welfare Foods 30 Whooping Cough 23 30 X-Ray 32 Zymotic Diseases B - SCHOOL MEDICAL REPORT Page Accommodation 107 Attendances 107 B1 ind Chi ldren 136 Child Guidance 137 Cleansing of Children 116 Clinics 102, 121 Cod Liver Oil 137 Cost 115 Crippling Defects 131 Deaf Children 136 Deaths 117 Defective Children 114, 118, 134 Defective Hearing 136 Deformities 131 Dental Service 122 Ear Disease 114 Enuresis Clinic 121, 139 Epileptic Children 139 Exclusions 120 Following-up 120 Health Visitors, Work of 120 Heights and Weights 107 Immunisation, Diphtheria 130 Infectious Diseases 99 Inspection Clinic 121 Inspections 106 Juvenile Employment 137 Page Malt Meals, Provision of Mentally Defective Children Milk, etc., Prov is ion of Minor Ailments Non-maintained Schools Orthodontic Service Parents' Attendances Physically Defective Children Population Remedial Exercises Schools, Special Spastics Speech Staff Statistical Tables Surveys, Uncleanliness St. Christopher's St. Giles' St. Luke's Treatment Tuberculosis Uncleanliness Vision, Defective X-Ray