CRO58 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1956 S. I. WRIGHT,M.D., M.R.C.P., D.P.H. 3 HEALTH COMMITTEE 1956 Uderman G. H. Ward, 0. B. E. , J.P. (Chairman) Councillor Keith Edwards, (Vice-Chairman) Alderman H.Lock Kendell, O. St. J. Alderman W. Berners Price, J. P. Councillor Mrs. H.M. Bunning Councillor Mrs. V.L. Child Councillor J. J. Cooper Councillor R. H. Davies, M. B. E. Councillor E. J. Fowler Councillor Mrs. D.L. George Councillor H. S. Kew Councillor D. McClellan Councillor Mrs. E. M. Maycock Councillor Miss L.N. Overton Council lor Mrs. D. V. Paines Councillor Mrs. C. Penman Councillor R. Taverner Councillor H. A. White 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., O. B. E., B. Sc., M. D. B. Ch., M. R. C. P., M. R. C. S., D. P. H. * Miss K. C. Vost, M.B., B. 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. O. 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. p. R. Mitchell, O. B. E. Royal College of Midunves Miss J.c. Dickinson Croydon District Nursing Association Mrs. H. Thatcher Croydon Family Planning Association * (Resigned 9th October, 1956) 4 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1956 To the Chairman and Members of the HeaLth Committee LADIES AND GENTLEMEN. I have the honour to present the Annual Report on the Heal of the people of Croydon and the relevant services of theft poration for the year ending 31st December, 1956. From most aspects, it was a satisfactory year as far statistics are concerned. The standardised birth rate rosec the standardised death rate approached the lowest yet recordThe infant mortality rate was a fraction below the best previareported. The death rate from tuberculosis resumed its downs trend and confirmed the expectation that sustained efforts «i achieve the complete control of this disease within the ne decade. In 1930, Dr. Holden wrote about the inception of the Croji obstetric service, made possible by the powers granted tot Corporation under the Local Government Act 1929. The unity' institutional and domiciliary midwifery with specialist advi available at all times for any motherwasa far sighted scheme advance of its time. The National Health Service Act, 13' threatened its disruption. All concerned, however, resolved tl it should continue and be improved despite the tripartite bas of present control. It is an encouraging vindication of the efforts to report a "nil" maternal mortality rate for 19S when not one mother died through childbirth. On the debit side of the year's accounts are increases deaths from cancer and heart disease, the former showing highest rate ever recorded. Age changes in the population are. importance, but mortality from these causes in the 45 to 65 P age group represents a challenge to be met by greater efforts: 5 seeking fundamental causes and the application of established knowledge in prevention and early treatment. As regards some forms of cancer, the Clean Air Act of 1956 will bring benefits. This is only one aspect of the most important single health measure to be passed during the present century. It will be remembered that the incident which finally brought public opinion to demand such action was the London "smog" of 1952. Now that we are beginning the long frustrating period when the distant goal is obscured by present inconveniences and heavy expenses inseparable from a major revolution in habits of living, the findings and recommendations of the Beaver report are worth repeating:- November, 2954. "In presenting this Report we wish to state our emphatic belief that air pollution on the scale with which we are familiar in this country today is a social and economic evil which should no longer be tolerated, and that it needs to be combated with the same conviction and energy as were applied one hundred years ago in securing pure water. We are convinced that given the will it can be prevented. To do this will require a national effort and will entail costs and sacrifices; the recommendations made in this Report will involve expenditure by the Government, local authorities, industry and householders alike. But we are confident that our proposals, if carried out, will secure happier and more healthy living conditions for millions of people, and that on all counts the cost of the cure will be far less than the national loss in allowing the evil to continue. We are satisfied that the most serious immediate problem to be tackled is visible pollution by smoke, grit and dust, and we have been able to make definite recommendations in regard to these. We must emphasise that the problem is not one which can be solved overnight. Real improvement can be secured only by a continuous programme urgently and insistently carried out over a number of years. The objective of our recommendations is that by the end of ten to fifteen years the total smoke in all heavily populated areas would be reduced by something of the order of 80 per cent. This would mean a degree of freedom from air pollution which many parts of the country have not known for more than a century. With regard to gaseous pollution, there is not yet the knowledge to deal effectively with the whole problem; but we 6 have made a number of recommendations for preventive action and have indicated the directions in which ultimate solutions may be found." The Council supported the Health Committee in their expressed intention to use the new powers with all possible urgency withii the bounds of practicability. In the field of infectious diseases, vaccination against poliomyelitis was a new and welcomed duty. Vaccine for only llj of the children registered was available before June 30th, the final date for 1956. From this experience, the vaccine appears safe and free from any unpleasant reactions. Proof of efficacjl remains a matter for the future. Poliomyelitis cases inl956wer; I of average number in comparison with the previous ten years, I Sonn£ dysentery showed its usual winter prevalence in an outbreak associated with the infant department of a primary school. It responded to control measures established from our experience is 1955. Housing applications on medical grounds continued to increasil in number and absorbed much time of many officers of the department. In the personal health services, the schemes mentioned last I year of a laundry service and rehabilitation of elderly persons by a special home nurse were commenced. The strengthening of the home help service was approved to allow especially more time for old people. Authority was obtained from the Ministry of Healtb for the building of the administrative centre and hostel for district nurses. 1956 was thus a year of steady development in most branches of the work covered by the National Health Service Act, using well established facilities and adding new aspects to meet clearly defined needs. I thank the Chairman, Vice-Chairman and Members of the Committee for their unfailing support and encouragement. The Tow Clerk and other Chief and Senior Officers have at all times given most readily their advice and help, and the usual good relationships with other branches of the health service have continued. My staff have met new duties with resource and carried out routine work with their usual efficiency. I would mention particularly this year, the Chief and deputy Chief Public Health Inspector on whom the responsibility for applying new and important legislation has mainly resolved. 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 Chief Clerk, Deputy, 18 clerks (including I part time), 4 typists, 1 messenger. Public Health and Food Inspection Chief Public Health inspector, Deputy, 20 Inspectors, 1 Superintendent Slaughter House, l Foreman and 5 Assistants, Chief Disinfector and 2 Disinfectors, 1 Superintendent and 4 porters (men's hostel), 2 Rodent operatives, 1 abattoir labourer, 10 clerks, 1 typist, 2 trainees. Maternity and Child Welfare 6 Clinic Medical Officers whole time (also school duties), 5 part time. Superintendent Health Visitor, Deputy, 28 Health Visitors and 1 Specialist Health Visitor (also School nurses), 2 Almoners (1 part time), Superintendent Midwife, Deputy and 18 Midwives, 2 Physiotherapists (1 also school duties), 2 Ante-Natal Clinic nurses (part time), 6 clerks. (Dental Service as for School Health) 8 clinic cleaners and handyman (all part time). District Nursing (agency arrangements) Superintendent, 3 Assistants, 45 nurses, 2 clerks (1 part time). Domestic Help Supervisor, 2 Assistants, 1 clerk/ assistant, 1 clerk, 15 full time and 147 part time Home Helps. Day Nurseries 1 Nursery with Matron, Deputy, 5 nurses, 3 students, handyman and 4 domestic staff (part time). Vaccination and Immunisation 1 Clerical Officer. Ambulance Service Ambulance Officer, Deputy, Second Officer, Maintenance officer, 4 Leading Drivers, 63 Drivers, 3 clerks, 1 telephone operator, 1 C.D. Training Officer, 1 Depot labourer, 1 cleaner (part time). Prevention, Care and After-care Chest Physician (part time). Assistant chest Physician (part time), 4 T.B. Visitors, 2 Almoners, 2 clerks (1 part time), 1 Occupational Therapist (part time). Mental Health 5 Duly Authorised Officers, 1 clerk, 1 Occupation Centre Supervisor, 4 Assistants, 1 Handicraft Instructor. 1 handyman, 2 Guides, 3 cleaners (part time). Welfare Foods 2 clerks and 1 driver. STATISTICS 9 SUMMARY OF VITAL STATISTICS FOR 1956 Area, 12,672 acres. Population (Census 1951), 249,870. Total Population (estimate of Registrar-General), 249,300 (Midsummer, 1956). Number of Inhabited Houses: 71,982. Rateable Value (1st April, 1956): £4, 575, 818. Product of a Penny Rate (1955-1956): £11,007. Rate in the £: 13s. 2d. (for year ending 31.3.56). Live Births: M F Total Legitimate 1,824 1, 625 3, 449 Illegitimate 91 64 155 3, 604 Birth-rate per 1,000 of the estimated resident population, 14.5 (England and Wales 15.6). Birth-rate (as adjusted by comparability factor, 0.99), 14.4. Still Births, 74. Rate per 1,000 total (live and still) births, 20.1. Deaths, 2,977. Death-rate per 1,000 of the estimated population, 11.9. (England and Wales 11.7). Death-rate (as adjusted by comparability factor, 0.8S), 9.9. Infant mortality rate, 19 per 1,000 live births. (England and Wales 24. Legitimate Infants (63 deaths), 18 per 1,000 live births. Illegitimate Infants (4 deaths), 26 per 1,000 live births. 10 Principal Causes of Death in order of frequency (Registra General's Return) Rate Per 1,000 Population (1) All Ages Deaths from diseases of Cardiac and Circulatory System 4.31 " " Cancer 2.31 " " " diseases of the Nervous System 1.88 " " diseases of Digestive System 1.84 " " diseases of the Respiratory System (excluding Tuberculosis) 1.47 " " Suicide and Violent Causes 0.32 " " Tuberculosis (all forms) 0.10 * ulcers of stomach, duodenum: gastritis and enteritis. Rate per 1,000 of age grount (2) Ages 15-45 Deaths from Cardiac and Circulatory System 0.20 " " Cancer 0.08 " " Tuberculosis (all forms) 0.00 marriages The number of marriages solemnised was 1,947, compared with 2,076 in 1955, 1,882 in 1954, 1,987 in 1953, 1,993 in 1952, 1.98 in 1951, 2,051 in 1950, 2,066 in 1949, 2,169 in 1948 and2, 4l6 in 1947. 889 were solemnised in Established Churches, 372 in otte places of worship, and 686 in the Register Office. Births The live births registered were 3,449 legitimate and 15 illegitimate. The birth-rate consequently was 14.5. For Engl® and Wales the rate was 15.6. The illegitimate births in Croydon were 4.3 per cent of th total as compared with 4.8 in 1955, 5.5 in 1954 and 1953, 5.3i 1952, 5.4 in 1951 and 5.0 in 1950. The live male births numbered 1,915, the female 1,689, a proportion of 1,134 males to 1,000 females. 11 Deaths The deaths numbered 2,977, compared with 2,835 in 1955. For 1956 the death-rate was 11.9 compared with 11.4 in 1955. The death-rate for England and Wales was 11.7. There were 87 inquests held by Coroners in respect of Croydon residents during 1956, and 395 findings by Coroners after postmortem without inquest. Wards with the highest death-rate were South (13.9), and Upper Norwood (13.3). Lowest: Addington (3.7), SouthNorwood (8.6) and Woodside (8. 7). Still Births During 1956, 74 still births were registered in respect of Croydon. Of these, 38 were male babies and 36 females: lmale and 3 females were illegitimate. The proportion of still births to living children was 1 in 49. 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 20.1 per 1,000 births. Notification of Sirths Notifications were received in respect of confinements conducted by:- Live Bi rths Still Births Total Midwives 3,119 53 3, 172 Doctors 786 30 816 3,905 33 3,988 Accommodation for Confinement The following table gives information concerning the accommodation utilised for confinements:- Number Percentage In Private Houses In Public Institutions In Registered Maternity Homes 1, 219 2, 391 378 30. 57 59.95 9.48 3.988 Maternal Mortality There were no deaths, compared with 2 in 1955. The maternal mortality rate calculated per 1,000 births was 0.59 in 1955. The rate for England and Wales was 0.56 in 1956. For figures for the years 1936-1956 see the appendix, page 83. 12 Infant Slortality Although the rate of 19 was equalled in 1954, the 1956 figure is really the lowest yet recorded, being 18.6 as compared with 18.9 in 1954. Set out in the appendix, page 85 are the usua tables giving causes and age distribution. The greatest single factor remains prematurity of which the correction lies mainly with ante-natal care of the expectant mother. Measures suggested by the Ministry of Health to deal with still-births were put in hand during 1956 and it is hoped will prove effective in reducing the neo-natal mortality rate. There was also discussion with hospital staff about the treatment of infections in older infants, Among the 67 deaths, 35 occurred in boy babies and 32 in girls. Of the births, 1,915 were males and 1,689 females. The infantile mortality rate for the two sexes was, therefore, Boys18, Girls-19. 59 deaths of infants occurred in Institutions, including Registered Nursing Homes. For details of infant deaths see the appendix, page 84. Ward Statistics These are tabulated in the usual form in the appendix, page 86. The significance of this table must not be over estimated as many fallacies may arise since the sex and age ratios in the different areas are not known. It is obvious from the high birth rate at New Addington, which is twice that of the borough as a whole, that it contains many young married couples. On the other hand that the highest death rate is recorded from the South Ward does not imply that it is the most unhealthy area of the borough, It has a high proportion of elderly persons. However, a high infant mortality rate for example, leads to enquiry about services and the table is thus useful in planning deployment of staff and resources. Deaths The Registrar General's Table is given in the appendix, page 87. Comparisons with 1955 show there were no deaths from Whooping Cough as against 1 in 1955 and none from Measles (one in 1955). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 25 (195535); those from Cancer increased by 46; those from Pneumonia increased by 10: and an increase of 63 was also recorded in those caused by Bronchitis. There were 11 deaths from Influenza (1955 21). 13 Deaths from suicide show a decrease of 9, and motor vehicle accidents totalled 24 (26 in 1955). The total number of deaths was 2,977 as compared with 2,835 in 1955. The percentage of deaths under 1 year of age to the total deaths was 2.3 per cent.; deaths under 15 years, 3.1 per cent.; deaths under 65 years, 27. 6 per cent.; and deaths over 65 years, 72.4 per cent. The corresponding figures for 1955 were 2.4 per cent., 3.2 per cent., 28.1 per cent., and 71.9 per cent, respectively. The Registrar-General has continued to supply a comparability factor - 0.83 - 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 The gaps in our knowledge regarding the causes of cancer are very great. Nevertheless, some facts have been established on which preventive action is possible now. In cancer of the lung, the commonest form in men, the rate in town dwellers is far higher than for rural communities. We know that the air of great cities contains a substance from the combustion of fuels, which has the power of producing cancers in test animals. It seems reasonable to urge that pure wholesome air must be assured for town dwellers in the same way that we provide pure wholesome water. The cost and technical problems are certainly no greater than those overcome during the last 100 years by sanitary engineers. It may be that cancers other than those originating in the lungs will also diminish in frequency as a result of such action. We should warn young persons of the connection between the heavy smoking of cigarettes and lung cancer, which no unbiased observer °f the facts now denies. Until the reason is discovered and corrected, they would be wise not to contract the habit, or to remain very moderate smokers. If they can, confirmed smokers should similarly abandon or limit their smoking of cigarettes. With regard to other forms of cancer we can only suggest early approach for medical advice in the event of symptoms. This is particularly the case for the commonest forms of cancer in women, but I must confess that local efforts in cancer education have so far been entirely disappointing. For detailed tables see the Appendix, page 89. 14 Deaths tabulated in the Department numbered 592 as compared with 549 in 1955; 486 in 1954; 540 in 1953; 567 in 1952; 479 in 1951; 501 in 1950; 481 in 1949; 510 in 1948; 492 in 1947 and 45I in 1946. Death-rate per 1,000 of the population for the last 11 years are as follows:- 1946 - 1.93 (451) 1950 - 1.99 (501) 1954 - 1.95 (486) 1947 - 2.03 (492) 1951 - 1.91 (479) 1955 - 2.20 (543) 1948 - 2.03 (510) 1952 - 2.26 (567) 1956 - 2.37 (592) 1949 - 1.93 (481) 1953 - 2. 16 (540) The organs most often attacked in descending order of incidence are: In the males - the Lungs (35.6 per cent,), the Bowels and Rectum (13.2 per cent.) and the Stomach (12.2 per cent.); in females - the Breast (18.3 per cent.), the Bowels and Rectui (17.0 per cent.). See also tables in the Appendix, page 89. COMMUNICABLE DISEASES 15 COMMUNICABLE DISEASES It was a year of low prevalence of most notifiable infections nd apart from a brief period when special measures to control bnn£ Dysentery in one area of New Aadington were imposed, routine procedures only were required. The welcomed diminution in serious illnesses does accentuate the nuisance caused by outbreaks, particularly in schools, of fthe milder diseases of childhood. I have commented in the School wealth Report upon this question, which vexes parents and understandably prompts requests for "quarantine" or "disinfection". To hold the balance between doing too much and disrupting lormal activities unduly and doing too little is not always easy. The support of the Health Committee in such times is of great lelp and allows reason rather than emotion to be the motivating force. We continue to have an occasional outbreak of epidemic nausea and vomiting arising suddenly in one department of a school and almost over before its presence is recognised. With each occurrence, very careful enquiry is made to eliminate specific infections spread by food or water, and Sonn£ Dysentery. The illness seems to be a virus infection spread by droplets in the same manner as the common cold and as in the case of this ailment, no technique of prevention is yet known. The sufferers may be recovered in 24 hours, treatment is symptomatic and in many cases, hardly necessary. The usual tables are shown in the Appendix, page 90 , together with the report kindly supplied by Dr. Linehan,giving the clinical details regarding patients admitted to the Isolation Hospital. 16 FOOD POISONING The figures show a decrease over last year. The food poisoning notifications, as corrected, for 1956wen 1st Quarter 2nd Quarte r 3rd Quarter 4th Quarter Total 2 16 10 12 40 Outbreaks due to identified agents:- TotaL Outbreaks TotaL Cases 2 6 Outbreaks due to:- (a) Chemical Poisons Nil (b) Salmonella Organisms 2 (c) Staphylococci (including toxin) Nil (d) CI. Botulinum (e) Other Bacteria Outbreaks of undiscovered cause:- Total Outbreaks Total Cases 2 6 Single Cases:- Agent identified Unknown Cause Total 19 9 28 17 WAODON (ISOLATION) HOSPITAL I am indebted to Dr. J.J. Linehan, Physician Superintendent, for the following report on infectious etc. cases admitted to the Hospital during 1956. There was a total of 588 admissions of whom 511 were admitted to the acute infectious diseases wards, 74 to the chest ward and 3 to the ward for chronic sick. The latter ward being temporarily evacuated from Mayday Hospital returned to that hospital early in the year. Where patients were admitted from outside the Borough of Croydon, the number of Croydon patients is shown separately in brackets. The average of occupied beds was 52.16. Admissions to the Chest Ward:- 66 (62) tuberculous patients were admitted and there were 7 deaths. While the proportion of deaths remains approximately the same as in the previous year, the average age of fatal cases, 71 years, was higher and all the deaths occurred in patients over 60. Admissions to the ward also included five cases of bronchial carcinoma and one case of laryngeal carcinoma. The average bed occupancy was 18.83 and average stay in hospital 98.47 days. Admissions to the Infectioais diseases Wards: - The following are the final diagnoses of patients admitted to the acute infectious diseases' wards, together with brief details relating to the common infectious diseases. The average stay in hospital of these patients was 21.24 days and the average number of occupied beds 29.6. Scarlet Fever 77 (73) Pyaemia 1 Gastro-enteritis 71 (48) Lymphadenitis 4 (2) Pneumonia 49 (33) Gastritis 2 Whooping Cough 35 (21) Colitis 3 Measles 31 (]9) Appendicitis 1 Chicken-pox 30 (16) Intussusception 1 Dysentery 27 (17) Pyelitis 1 Poliomyelitis and Nephritis 1 Encephalitis 23 (21) Impetigo 6 Kumps 14 (11) pemphigus 1 Influenza 13 (11) Infective Dermatitis 1 Meningitis 10 (9) Purpura Simplex 1 Infective Hepatitis 10 Papular Urticaria 1 Rubella ]0 Herpes Zoster 1 Food Poisoning 9 (5) Heat Rash 1 Typhoid Carrier 1 Urticaria 1 Salmonella Septicaemia 1 (0) Angio-neurotic Oedema 1 Meningococcal Septicaemia 1 Haeraatoma of Scalp 1 Fever 5 (2) Asthma 1 Opnthalmia Neonatorum 1 Rheumatism 2 Erysipelas 3 Arthritis 1 Puerperal Pyrexia 1 Talipes 1 Streptococcal Sore Throat 3 Epilepsy 1 Pharyngitis 8 Senile Dementia 1 Tonsillitis 9 (8) Concussion 1 Laryngitis Stridulosa 2 Congenital Heart Disease 1 Bronchitis 9 Myocardiac Degeneration 1 Stomatitis 2 Pyrexia of Unknown Origin 1 Sinusitis 1 Non-patient Mother 1 Quinsy 3 Non-patient Babies 4 Otitis Media 1 18 Scarlet Fever: - The decline in the number of admissions, not in previous years, continued. There were three cases of otitis media. The persistance of haemolytic streptococci in the th??? and nose after penicillin treatment is noteworthy. They ??? isolated in seven such cases where there was recurrence of ??? throat and four cases of subsequent rhinorrhoea. Gastro-enteritis: - The number of patients treated in the differ age groups were as follows:- under 1 year, 32; 1-2 years,??? 2-3 years, 6; 3-15 years, 3; adults, 12. 43 cases were mild ??? moderately severe and 8 very severe. 7 of the 8 very severe c??? occurred in the first half of the year. 3 cases were fatal,??? admitted in January. Types of B. coli, currently regarded ??? pathogenic, were isolated in some cases but they were of t??? mild type. Faecal culture did not indicate the nature of t??? infection in the severe cases. Pneumonia: - The majority were in the older age groups, 70%, in luding all four fatal cases, being over 50. The seriousness ??? their illnesses was due either to pre-existing bronchitis ??? emphysema, heart disease and/or senility. 43 out of the 47 cas??? were admitted in the period, January - May inclusive. Whooping Cough: - The disease was most prevalent in the aut??? 19 out of the 35 cases being admitted during August-October i??? lusive. Age incidence was as follows; under 1 year, 12; 1-3 year 13; 4-8 years, 10. Complications were pneumonia, 8 cases; ??? one case each of otitis media; atelectasis and maramus. Measles: - Measles was not prevalent during the year and most: the cases were admitted in the last quarter. The majority??? cases were under 4 years. There was 1 fatal case due to fulm??? ing pneumonia in an eight months old baby. Apart from the comm??? complications, i.e. pneumonia, enteritis and otitis media, the??? was 1 case of obstructive laryngitis. Chicken-pox: - Cases were admitted as follows: - With complication 9 (pneumonia 2, skin sepsis 6, bronchitis 1); for concurre??? conditions requiring hospital treatment 5; from rest centres children homes etc., 16. Dysentery: - Except for one Plexner type infection, all cases w??? of the Sonn£ type. The disease remained mild, but adults tende??? to be more severely ill than children. The majority of patient were free from infection in the course of a few weeks but a f??? cases were found to take up to two months to get rid of the gen??? There was nothing to suggest a cause for this difference. 19 Poliomyelitis and Encephalitis:- The 23 cases admitted may be classified as follows:- Non-paralytic Meningitic 7 Paralytic Spinal paralysis 9 Encephalitic 3 Bulbar 2 Spinal and Encephalitic 1 Spinal and Bulbar 1 One of the bulbar cases required postural drainage. There were no deaths. There was the usual seasonal incidence, all cases occurring from June onwards, with maximum incidence in October. New Addington and West Croydon were the areas most affected. Though the number of cases was less than in the previous year, the incidence of severely paralysed patients was greater, five cases being so classifiable. For the first time, facilities for virus isolation were available. Specimens of faeces were sent for virus culture from 18 of the cases in the above classified list. Of these 9 gave positive results, all poliovirus Type 1. It would appear that no definite conclusion can be drawn from a negative result, as some of the negative results were obtained from obvious clinical cases. They included all four adults from whom specimens were sent. The tendency to get fewer positive results from adults has been noted elsewhere. Another limitation to the clinical value of faecal culture is the delay of upwards of one week in obtaining results. Other Infections: - Of the meningitis cases, 6 were meningococcal, 2 haemophilus and 1 pneumococcal. The pneumococcal case proved fatal, contributing causes being senility, pulmonary fibrosis and cor pulmonale. There was one fatal case of infectious hepatitis, a boy, aged nine years, admitted in hepatic coma who died within 24 hours of admission. Food poisoning cases consisted of 4 salmonella typhi-murium infections, 2 salmonella enteritidis and 3 in which the cause was not ascertained. There was one fatal case of salmonella enteritidis septicaemia. 12 of the 14 mumps cases were admitted in November and December, when the disease appeared particularly prevalent. They included 2 cases of meningoencephalitis. Influenza cases were admitted mainly in March. Fatal Cases:- There were 27 deaths as follows:- 7 deaths from Pulmonary tuberculosis, 5 from pneumonia, 3 each from gastroenteritis and bronchial carcinoma and 1 each from measles, infective hepatitis, pneumococcal meningitis, cerebral haemorrhage, royocardiac degeneration, chronic nephritis, carcinoma of the larynx, bronchitis and senility. THE PREVENTION AN!) CONTROL OF TUBERCULOSIS 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 1956 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1956 was 26 which shows a decrease by 9 when compared with 1955, The incidence of the disease during the year has shown some increase, due in the main to improved case finding methods. In January 1956, a General Practitioner Miniature X-ray service was started at the Chest Clinic. The local practitioners were given facilities for sending patients for chest x-ray by a miniature camera unit. Any abnormalities found by this method were investigated and treated at the Clinic and in the hospital beds associated with the Department. The results of this service are summarised below: - Number of miniature films taken 3,017 Number of patients recalled for examination and large film 431 Number of active cases of Pulmonary Tuberculosis found 22 Number of cases of lung cancer found 16 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 7.29 per 1,000 which compares favourably with the figure of 1.45 per 1,000 from Public Mass X-ray Surveys. It should be realised that patients referred to the clinic for Miniature X-ray usually have chest symptoms whereas many patients attending public Mass Radiograph sessions have no symptoms. The Miniature X-ray service represents a new method of case finding and it is hoped to extend its scope in the coming year, to include special groups, i.e., expectant mothers, diabetics and others. The statistics of the Miniature Camera Unit have been simplified and many other abnormalities were found and treated. 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 21 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 186 cases of Respiratory Tuberculosis and 23 cases of NonRespiratory Tuberculosis were notified on Form A during 1956 (Table 1 - Formal Notifications). Of these 115 males and 7 1 females were Respiratory cases and 9 males and 14 females were Non-Respiratory. In addition 132 Respiratory cases and 8 NonRespiratory 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 1956 by notification or otherwise was 349 as compared with 261 in 1955, 336 in 1954, 304 in 1953 and 331 in 1952. 318 of these were cases of Respiratory Tuberculosis; 183 in males and 135 in females. There were 23 more males and 62 more females than in 1955. There were 6 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 6 in 1955. The number of cases in adults was 25 compared with 22 in 1955. Of the cases notified in 1956, 20 males and 5 females died from the Respiratory form of the disease during the year, equal to 6.5 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 1.40 per 1,000 of the population; for Respiratory Tuberculosis 1.28 and for Non-Respiratory 0.12 per 1,000 population. The notification rate was 0.84 per 1,000. In 1955 the corresponding figures were !• 04, 0.93, 0.11 and 0.69 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1956: - RESPIRATORY NON-RESPIRATORY To tal Cases Ma1 es Femal es Total Mai es Femal es Total 1,184 889 2,073 87 10 2 189 2, 262 22 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1956, 182 of the new patients examined at the Clinic were found to be in the undermentioned stages of the diseas the first examination: - A, or T. B. minus (Sputum negative or absent) 110 or 60.4 B, or T. B. plus, 1 (early cases, sputum positive) 18 or 9.9 B, or T. B. plus, 2 (intermediate cases, sputum positive) 4 8 26.4 B, or T. B. plus, 3 (advanced cases, sputum positive) 6 or 3.3 182 100.0% Non-Respiratory Tuberculosis There were 20 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms: - tones and Joints 3 Abdominal 1 Other Organs 12 Peripheral Glands 4 20 Ages at Death from Respiratory Tuberculosis Year 0-5 5-15 15- 25 25-45 45-65 over 65 TOTAL 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 1956 - - - 2 11 12 25 All but 5 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 1956 the death-rate from all forms of Tuberculosis was 0.104 per 1,000 population. The rate from Respiratory Tuberculosis was 0. 100 and the rate for Non-Respiratory Tuberculosis 0.004. Similar figures for 1955 were 0.132 and 0.008. In 1956 the total number of deaths showed a slight decrease when compared with 1955. 90% of the deaths occurred in the age groups 45 years and over. There were no deaths in children of school age. Deaths from Non-Respiratory Tuberculosis During 1956 1 death was certified to be due to Non-Respiratory Tuberculosis, compared with 2 in 1955, 4 in 1954, 6 in 1953 and 2 in 1952. The patient died in a general hospital and was not notified during life. The death was due to: - Males Females To t al Tuberculous Kidney - 1 1 Miliary Tuberculosis - - - Total s - 1 1 Co-ordination with the Health Department During the year 84 children were referred by the School Medical Service, and 30 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 18 selected cases for varying periods during the year, and 15 cases were in receipt of extra nourishment at the end of the year. 24 Residential Treatment 263 men, 179 women and 15 children were admitted to Residential Institutions in Croydon during 1956. The Chest Clinic and Home Visiting 1,745 new cases were examined during the year. 202 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 18,852. There were also 4,401 attendances by patients for collapse therapy. The Clinic doctors paid 268 home visits and the Tuberculosis Visitors 2,585 visits for Clinic purposes. In addition the Tuberculosis Visitors made 327 primary visits for the purposes of the Notification Register. There were also 1, 141 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 pi ays an important part in the prevention of the spread of infection. During 1956, 738 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contact-case ratio of 3.5 for each notified case during the year. Of these contacts, 10 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 14, compared with 1.40 per 1,000 of the general population. In addition, there were 9 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 areas follows:- 1955 - New contacts examined 686. New cases of Tuberculosis 111 1954 - „ „ „ „ 820. „ „ „ „ 238 1953 - „ „ „ „ 668. „ „ „ „ 211 1952 - „ „ „ „ 661. „ „ „ „ 243 1951 - „ „ „ „ 562 „ „ „ „ 214 B. C. C. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1956 and regular sessions are held at the Clinic for this purpose. 285 contacts were successfully vaccinated during the year, compared with 259 in 1955. In addition, 29 nurses and domestics were successfully vaccinated, and 43 babies of tuberculous parents were vaccinated in hospital during the neonatal period. 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. For detailed figures see appendices, page 93. Rehousing of Tuberculosis Patients 26 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 356 examinations were carried out in 1956. 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 Active Inactive Pulmo- Non- Persons Punonary nary Tuber- Tuberculous Tuber- examined culosis Conditions culosis Croydon C.B. Area 13,095 19 568 562 26 TUBERCULOSIS AFTER-CARE I am indebted to Miss Bridger, Almoner of the Chest Clinic for the following reports: - As in previous years, official and voluntary resources have combined to help the patients in as many ways as possible. Basically, financial needs have been met by the special grants available through the National Assistance Boards and close and very helpful contact has been maintained between the Almoner's Department and officers of the Board in the interests of the patients. Again, the local authority has helped with the loan of beds and bedding, free milk in some instances, maintenance in colonies, the provision of garden shelters, an expanding and very much appreciated scheme of occupational therapy for home bound patients, and recuperative holidays where these have been medically recommended. The promise of voluntary help foreshadowed in last year's report, has been fulfilled on a larger scale than even the most optimistic had hoped. This year, the Croydon Tuberculosis Care Committee found themselves in a position to finance the programme outlined in last year's report. The Care Committee's financial year begins on April 1st but in the twelve months covered by this report something like £500 has been spent on such items as Christmas grocery parcels, coal for patients at home, fares for patients' relatives to visit them, holidays and clothing. The Committee also paid for a party of children to be taken to the pantomime at Christmas time. Of the items mentioned, the largest expenditure was £100 on groceries and £125 on holidays. At the same time, we had to keep in mind the necessity for continuing to raise funds to enable us to continue spending on this scale, or better still, on a larger scale. We are most grateful to His Worship the Mayor for allowing us to have a Flag Day, which benefitted the funds by some £187, and other fund raising activities brought our total income to something like £350 during this period. The balance of expenditure was met from the £1,500 raised previously. It is worth stressing that every penny raised by this Committee comes from voluntary sources, and that all the money is raised locally, and more important still, spent directly to the benefit of local people. By the end of 1956, we had, after much negotiation, received authority to take part in the 1957 Christmas Seal Sale, sponsored by the National Association for Prevention of Tuberculosis from which the majority of Care Committees derive the bulk of their 27 income. Half of the nett proceeds will be available to the Care Committee, and the other half will be devoted to the work of the Association. It is therefore with every optimism that we look forward to the coming year's work in the field of tuberculosis after care. OCCUPATIONAL THERAPY Occupational Therapy home visits totalled 516 between March, 1956 and 1957. During this time there were also 140 attendances at the weekly class. The Annual Sale of patients' work in late November realised over £33, an increase of 50% on last year, and hardly any articles remained unsold. We are indebted to the Occupational Therapists at Mayday Hospital for giving us 'houseroom' for the Sale, also to Mrs. England and Mrs. Fanthorpe who were responsible for the actual selling. This year, two patients have been doing regular outwork and the Occupational Therapist helped in collection and delivery of the goods, it is thought that some scheme to provide regular light work would be of great value to some of the permanently handicapped chest patients. One small business, making simple toys, was investigated with this idea in mind, but this particular concern proved unsuitable. It is hoped that further opportunities for such a scheme may arise. VENEREAL DISEASES The usual returns for which I am indebted to J. R. Crumbie, Esq., P.R. C.S., are set out in the Appendix, page 101. There is no easy method to discover the prevalence of venereal diseases in Croydon. The graph which shows the numbers of Croydon residents who made a first attendance at the Special Clinic during the last 20 years must be interpreted with caution. Thus, the apparent fall during the 1949-54 period is due to civilians only being included. There were very large attendances of noncivilians comprising the majority of the age groups normally concerned. Efforts to limit the spread of venereal diseases have been two-fold. Firstly, prevention through the advocacy of "clean living" and Secondly, prompt and effective treatment to render Patients and contacts non-infectious. On the whole, it seems likely that the post-war reduction is true fall in prevalence, due to the speed and efficiency of antibiotic treatment. 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.I Tomlinson, the Director of the Bacteriological Laboratory, Count; Hall, S.E.I, 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 - 2956 Faeces outfits 2, 271 Water samples 281 Milk samples 240 Ice Cream samples 179 Sundry Pood Specimens 20 Blood 30 Urine 21 Nose and Throat Swabs 20 Total 3,062 PUBLIC HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 29 ANTE-NATAL AND POST-NATAL CLINICS These form part of a co-ordinated maternity service and serve mothers having either a hospital or domiciliary confinement. The clinic at Lodge Road is the main centre for the whole borough. New Addington mothers booked for hospital normally attend the subsidiary clinic on the estate, but are seen at special consultative sessions at Lodge Road on at least one occasion. During the year 4,245 cases were seen at the Ante-Natal Clinics, of which 3,050 were new cases. A total of 23,484 attendances were recorded and 1,817 cases were seen at the Post-Natal Clinics (1,805 new cases) with 1,863 attendances. Mothercraft instruction classes continue firmly established, and at times more applications were outstanding than could be included in current lectures. To overcome this difficulty classes were increased in size. At relaxation exercise sessions 487 mothers recorded 2,119 attendances. CARE OF PREMATURE BABIES Increasing efforts continue to be made by improved ante-natal care to prevent premature births. A mother booked for a home confinement, who goes into premature labour at a time when the baby is of doubtful viability, is admitted to hospital as an "emergency" case. Infants below four and a half pounds birth weight or with poor home circumstances are usually admitted with the mother to hospital. Outfits are available on loan to help in the home care of a premature infant. There is close contact between hospital and domiciliary midwives and the health visitors to cover the period when one service hands over to the other. For detailed figures, see the Appendix, page 104. 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. 30 During the year under review - 157 cases were dealt with by the Social Worker; 46 cases were admitted to Hostels; 6 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 fori 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 sii months and such assistance was given in 31 cases. These younger mothers would normally go to Homes specialising in their care. None of the 4 deaths of illegitimate babies occurred with mothers dealt with under these arrangements. INFANT WELFARE CENTRES Infant Welfare Centres. The usual details regarding attendances are given in the Appendix, page 105. A new centre was opened towards the end of the year to serve the Gravel Hill area of New Addington. It is an interesting observation on the need for such centres that the demand may come from the mothers concerned. This was a case in point as letters criticising the delay in opening the clinic came from the Tenants' Association representing the area. No doubt stimulated by group discussion sessions with the Psychiatrist from the Child Guidance Clinic, the Medical Officers and Health Visitors have been developing this technique of education in their own Infant Welfare Centres. Films and film strips have been used as the method of introducing a topic and good responses have been forthcoming on most occasions. Welfare Foods The W. V. S. continued issues from 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. The store built at the health department enables the distribution of supplies to the infant welfare centres to be carried out by our own transport and staff. This greatly assists the work of the volunteers who deal with the issue of these foods at all the centres. Total issues made during the year were:- 31 National Dried Milk 111,470 Cod Liver Oil 27,077 Vitamins A and D (for Expectant Mothers) 13,523 Orange Juice 199,582 HOME NURSING This service is carried out by the Croydon District Nursing Association, which is affiliated to the Queen' s Institute for District Nursing, acting as Agents of the Corporation. The urgent need to provide a proper administrative centre for this service was recognised by the Ministry of Health authorising loan sanction for a new building for this purpose. It will be attached to an existing Corporation property, which is to be adapted to provide accommodation for six student District Nurses. The Association have resolved that their present hostel, which could not be adapted to provide accommodation for administrative purposes will be converted into self-contained flats to be rented to members of the Nursing Service. It is hoped that the new buildings will be ready towards the end of 1957. The patients treated during the year increased in number as did the actual visits carried out. No alterations were made in arrangements for nursing children under five years of age and the number of visits for this purpose diminished in comparison with last year. The new work of rehabilitation of immobile patients began in March. This is carried out by a State Enrolled Assistant Nurse, following instruction given in the Geriatric Unit of Queen's Hospital. Three previously immobile patients are now walking and no longer receiving nursing attention. Four more are improving and cessation of nursing attention is anticipated in the near future. Two patients died from second " strokes " . All the patients were cases of cerebral haemorrhage. This work does take much time both in nursing and travelling, so that five is the maximum number of patients visited during one day. The importance of keeping these patients mobile is not only for their own happiness, but eliminates the heavy burden which otherwise falls on those concerned with their care. When not fully occupied on these duties, the Nurse assists with ordinary work. The usual statistical tables are shown in the Appendix, page 106. 32 CORPORATION DAY NURSERIES One only, situated roughly in the centre of the town, at Whitehorse Road, now remains. It is available for children whose mothers are required to work because they are widows, unmarried legally separated or divorced. By prior Committee permission, children from families with temporary difficulties - illness of the mother or father - may also be accepted. The minimum charge is 2/-perda^. It may be increased according to net income, on a scale approved by the Corporation. Subject to places being available, children may be accepted at tk full rate of 12/6d. per day. Only one child for one week was admitted on this basis in 1956. Details of attendances - Capacity 50 Number on books at end of year 43 Attendances: under 2 2,910 over 2 4,957 TOTAL 7,867 Number of days opened 253 Average daily attendance 31 M. AND C.W. PHYSIOTHERAPY CLINIC The demand for these facilities for correction of mim??? defects of children under 5 years of age has markedly diminished during the last few years. Fortunately, this has coincided with increased requests for physiotherapy sessions for the instruction of mothers in relaxation exercises for painless childbirth, and the staff were thus available for this purpose. Total attendances of children were 1,269, and the details are given in the Appendix Page 107. 33 DENTAL TREATMENT (MATERNITY AND CHILD WELFARE) I am indebted to the Principal Dental Officer, P.G. Oliver, Esq., L. D. S., for the following report:- Expectant and nursing mothers requiring dental treatment are referred by Medical Officers attending Ante- and Post-Natal Clinics. In the case of children below school age introduction is effected by the Dentists themselves, from Infant Welfare Centres or through personal initiative of Health Visitors. Treatment of the above patients is carried out at School Dental Clinics, being closely co-ordinated with work on the Education side. Following last year' s improved response it is somewhat disappointing to again report a fall in the number of expectant mothers referred for dental examination, together with a corresponding decline in/those receiving treatment. Whilst it is understandable that many of those visiting Ante-Natal Clinics should prefer to attend their own dentists, there are clearly a proportion attending for the first time who do not fully appreciate the value of early advice regarding the condition of their mouths, andwhoare therefore 1ikely to postpone this necessary precaution. For such patients the carrying out of a periodic dental check up by doctors can be of special value in disclosing possible oral neglect. Some anxiety is also felt for expectant mothers remaining in the care of outside medical practitioners, to whom similar precautions should apply. For those not in possession of a regular dental adviser, visits to Local Authority Clinics can be arranged. Though there has been some reduction in the number of preschool children seen at the clinic, periodic fluctuations have been common place during recent years and the position is relatively more satisfactory. Despite continued efforts by Health Visitors and Dental staff it has not been possible entirely to make good the effects of the closure of Day Nurseries, which in the past provided a valuable contact with this age group. At present the greater proportion of requests for treatment are received at the Dental Clinic and references from Welfare Centres have been disappointing, but until more time is available for personal visits by dentists, little improvement can be expected from this quarter. As on the Education side coverage for the Borough as a whole is reasonably adequate, but pressure of work continues to be greatest at New Addington where facilities for treatment are 34 limited. Plans for providing a supplementary Dental Unit, in connection with the existing Welfare Centre at Sal cot Crescent, have made substantial headway and building is likely to commence during the Autumn of 1957. To fill the interim period patients from certain sections of the Building Estate are being dealt with at the Shirley Road Centre, where additional part time sessions will shortly commence. Treatment at the Stroud Green Centre, opened in 1955, is being gradually expanded, though at present this clinic is not completed staffed. This has handicapped the development of certain work on the preventative side outlined in last year's Report; this part of the programme will, however, be implemented as the position allows. Experience gained in the functioning of this particular lay-out will be of considerable value in catering for the requirements of other areas. As in the case of the School Service difficulties in staffing continue to be a major obstacle to meeting existing commitments and emphasis has, therefore, at present to be placed on the remedial rather than preventive aspect of the work. Renovations and re-equipping of less modern clinics are continuing, with the object of providing a higher standard of working conditions for Staff and thus encouraging the intake of dentists into the Service. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 491, compared with 744 in 1955. As was the case in the previous year the greater proportion of these were sent from the Ante-Natal Clinic; 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. The percentage of mothers failing to attend for their dental examination was the same as in the previous year, namely 23 per cent. Expectant mothers examined for the first time numbered 324 against 457 last year. Of these, 72.5 per cent, were seen during the first six months of pregnancy, compared with 77.5 per cent. previously recorded. Those attending at later stages of then confinements included some with pain or discomfort, which might have been avoided had treatment been sought at an early date. 35 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 of treatment until after the confinement; in others, names were actually received during the post-natal period. 39 nursing mothers were examined during the current year, compared with 42 in 1955. Treatment Including those continuing treatment from the previous year, 475 mothers were dealt with, compared with 595 in 1955. A full range of treatment, including provision of dentures, is available, and whilst the need for conservation is stressed, not all patients are, unfortunately, willing to submit to this type of work. For those approaching confinements, removal of possible oral sepsis must remain the first consideration, and completion of treatment is urged at an early date. . The Pre-School Child The number of children referred from all sources during the year was 541, compared with 649 in 1955. As previously, this figure included a proportion of "Toddlers" due for re-inspec- tion and treatment. Because of the freer diet available in post-war years more decay in now being reported in the "under fives" , and earlier supervision is therefore more desirable than was previously the case. Unfortunately, contact with these children has been considerably hampered by the closure of the Day Nurseries and greater dependence has therefore to be placed on other outside sources, such as Welfare Centres and Nursery classes at Primary Schools. A great many parents do not fully appreciate the importance of the foundation teeth in bringing about normal development of the jaws, and are therefore apt to postpone visiting the dentist until toothache intervenes. As soon as staffing permits it is hoped that more active measures will be possible to expand this side of the Service, supported by work of a preventive nature at Dental Centres. The introduction of additional Nursery Classes at Primary Schools would materially assist the situation, as a greater proPortion of these children would then be covered by the routine dental inspection. Details of treatment etc. carried out are shown in the Appendix. Page 108. 36 MIDWIFERY SERVICE The Corporation employs directly a Superintendent and 19??? Domiciliary Midwives. Ten Midwives are recognised by the Central Midwives Board to train pupils for the second three months of their Part II C. M. B. training. The Domiciliary Midwives have their headquarters in the clinic premises, which house the antenatal and post-natal clinics. Consequently, they are in constant touch with the Hospital Consultants and other medical staff and with the Hospital Midwives. The personal contact is obviously of great help in promoting co-ordination of maternity services, The Corporation has pursued a policy of encouraging Midwives to have a motor car for their work, recognising all Domiciliary Midwives as essential users for car allowances. For those not able to buy their own, they have now agreed to supply departmental vehicles. The advantages to the mother and to the Midwife of having all the staff thus available with apparatus at the shortest possible notice needs no comment. The usual statistical returns are set out in the Appendices, pages 109 - 110 and the following points are of interest:- Although the birth-rate rose, only four more mothers were delivered in their own homes than in the previous year. Out of the total of over 1,200 deliveries, there were only two stillbirths and no neonatal deaths. The Obstetric Emergency Service was called out on two occasions. These figures do demonstrate that the policy of careful selection and immediate admission to hospital of all complicated cases is operating efficiently. 94% of mothers had either Trilene of gas/air analgesia and some 56% were given the pain reducing drug "Pethedine". The interchange between domiciliary and hospital confinement is also shown by the figures of mothers booked for domiciliary care and transferred to hospital and those sent home from hospital home nursing. 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 78. 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. 37 THE WORK OF THE HEALTH VISITORS It was a year of steady development in the concept of the Health Visitor as the advisor on family health and on social aspects in the work of the domiciliary team. The use of report forms to keep the family doctor aware of visits to his patients continued. They appear to meet a need and have received the approval of members of the Local Medical Committee. It has, therefore, now become an established procedure. One of the difficulties in the development of closer relationship with family doctors relates to the relatively large changeover in the staff of the Health visitors' section. As with nursing in general, marriage, promotion and transfers to other branches of their profession result in constant resignations and new appointments. In areas where the Health Visitors change fairly frequently, the building up of a personal relationship of trust and understanding between all concerned is for obvious reasons more difficult to achieve. Recruitment was somewhat easier, but throughout the year, one or two posts were vacant for varying periods. Group discussion sessions with a psychiatrist continued and were well supported. Training of student Health visitors in practical work, observation visits by student nurses, pupil midwives and Diploma of Public Health students are constant features in the Health Visitors' routine. The need to explain procedures, to see things through the eyes of many observers, and to re-examine views Questioned by others is a constant safeguard against complacency and meaningless repetition. Set out in the Appendix, page 112, are the usual tables giving details of the work performed during 1956. IMMUNISATION The urgent problem is perhaps not to discover more methods of protecting against different illnesses, but a system of combining procedures to reduce the number of separate courses of injection now required. Thus, for children who are likely to remain in this country, we have at present, vaccination against smallpox, injections against diphtheria, whooping cough, tetanus, Poliomyelitis and finally vaccination with B.C.G. against tuberculosis. For diphtheria, tetanus and probably poliomyelitis, "booster" doses are also required. It is possible to combine diphtheria, whooping cough and tetanus into a single immunising fluid and to protect against all three by one course of injections. 38 This is now being offered to parents in Croydon. It is to such combined products that we look for future simplification of immunisation procedures. The first supplies of vaccine against poliomyelitis became available earlier in the year. There was some doubt in the public mind about its safety. The local press was helpful in publicising the Corporation's view that in offering the vaccine, they were convinced that it was as safe as any other facility provided as part of the National Health Service Great care was exercised in the administration of the vaccine and the follow-up of the children. No untoward incident occurred In anticipation of the anti-poliomyelitis campaign, every effort was made to step up protection against other illnesses during the months that poliomyelitis vaccination was not being given. As a result, more children were protected against diphtheria and vaccinated than in 1955. The usual detailed tables are given in the Appendix, page 113. HOME HELP SERVICE When we reflect that the mother represents the pivot of the family circle, it is easy to understand the importance of the service which supports or temporarily replaces her function. Thus, it is that the Home Help has become an indispensable member of the domiciliary team and the range of her duties steadily expands. Set out in the Appendix, page 116, are the factual records of the work performed on which the following comments are made:- Maternity cases Although the birth rate rose, more mothers had their babies in hospital. The number of maternity cases attended by full-time helps fell, but there was an increasing demand for part-time help. Despite the additional grant for a domiciliary confinement, cost of full-time help seems to be a deterrent. Domiciliary Care of the Aged The demands increase steadily as the percentage of elderly persons in the community rises. This type of work needs resource of cheerfulness, tact and understanding. Routine household tasks become very personal when performed by a "stranger" for the first time. Methods and materials vary as much as temperaments. The skill of the Supervisors lies in selecting the right help for each case and in meeting the greatest need rather than loudest demand. 39 The Welfare Committee investigating the programme for additional hostels asked that domiciliary services should be strengthened and for more co-ordination between visitors to the elderly. Where a home help is regularly attending, the duty of observation is obviously fulfilled. Family Help Service This extension of the Home Help Service inaugurated in 1955 to care for children in their own homes in the absence of the mother for a longer period than is covered by an ordinary fulltime help has not been used as widely as was at first anticipated. Experience has shown that with the suggestions and planning of the Supervisor, many families are able to make private arrangements for the care of their children after 5 p.m. and need rely on the local authority for the early morning and day-time period which can be covered by the ordinary service. Two families were attended under this scheme in 1956; one for a period of seven weeks after the mother had deserted a family with five children, ages 9 to 2 years, to enable the father to find a suitable housekeeper. A second family of five children was attended for one week whilst the mother was in hospital. In both cases, an average of 55 hours a week was given. Sick Room Attendance Scheme The demand during the year was not heavy. Eight patients were attended for a total of thirteen nights. Pour died whilst the home help was in attendance, three were admitted to hospital and one recovered. Laundry Service This began in October for an experimental period of one year. Two rooms have been provided at the Disinfecting Station and equipped with sinks, a domestic washing machine, a spin dryer and a drying cabinet. A home help gives at present 20 hours a week, during which she deals with some 300 articles representing the washing of 25 elderly persons who are being attended by home helps. Collection and delivery are included in appropriate journeys of disinfecting vans and soiled linen is disinfected before washing, a fixed weekly charge of 2/6d. is added to the home help costs for this service. I anticipate reporting at the end of the experimental period that the scheme is working successfully. 40 D isinfestation At the Borough Disinfecting Station, the home help who operates the washing service also continued to carry out the duties of disinfestation of women and children. 23 persons were cleansed of verminous conditions and 4 were treated for scabies. AMBULANCE SERVICE To the Medical Officer of Health I submit the Fifteenth Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1956. During the year the Service was called upon to deal with 104,563 (100,827) patients, which necessitated 51,102 (50,491) journeys and a mileage of 413,812 (440,311). All calls for ambulance transport are received at Headquarters Station, where they are collated. At the commencement of daily shifts the crews of vehicles are each given initial journeys, and thereafter the bulk of the vehicles are directed by radiotelephone to suit the ever varying circumstances, e.g. accident and emergency cases, extra bookings, etc. It will be seen from the figures quoted above that even thougth both the number of patients carried and journeys travelled have increased, the mileage covered was considerably less (6.02%) than in the previous year, and this saving is substantially due to use of the radio-telephone, with which all vehicles are equipped. Once again this year a two-man team was entered in the Regional First Aid Competition held at Surrey county Council Ambulance Training Station, Morden, and I am very pleased to be able to report that the team from this Service was placed joint third with Brighton County Borough Ambulance Service. List of Serviceable Vehicles at 31st December, 1956. Four number Pullman Ambulances Eight Daimler Ambulances Two Bedford Sitting case Vehicles One Vauxhall "Wyvern" Saloon car 5 Bedford Utilicons One Austin breakdown vehicle 2 Bedford Coaches (for Mental Defectives) For details of journeys, patients, mileage, etc., see the Appendix, page 115. 41 CIVIL DEFENCE (Ambulance Section) The number of Volunteers on the register at 31st December was 390 (303 at Shirley Depot and 37 at New Addington) composed of 121 males and 269 females. Of this 303 registered:- 8 are Instructors. 131 attend for regular training. 115 attend for some training. 43 have not yet reported. 6 have moved from the area. A First Aid Course was run in February and March, and of the 43 Volunteers who entered for the examination I am pleased to report that all passed. Nine Volunteers took an Instructors course in May, and at the examination 5 passed. At a further course held in August, 6 Volunteers took part and all passed the examination. In June two teams of six were entered for the " Buxton Trophy" Competition held at Dorking, and I am very glad to be able to report that one of our teams was placed third. Five Casualty Collecting Teams of 7 men each have been formed, and these have thus received specialised training. There are at present 87 qualified First Aiders and 48 qualified drivers. A.L. HILL, Chief Ambulance Officer. CONVALESCENCE The Corporation accept financial responsibility for convalescent treatment for approved cases, subject to recovery of cost according to the income of the patient. The conditions imposed are that convalescence must follow some definite illness or accident, must be recommended by a doctor, and taken at a recognised convalescent home. During the year, 50 cases were so dealt with, 34 women, 13 men, 2 women with babies and 1 child. These figures do not include school children for whom arrangements are made by the Education committee. 42 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 301 Bed Rests 207 Mackintosh Sheets 310 Feeding Cups 15 Wheel Chairs 31 Commodes 40 Crutches, pairs 1 Air Cushions 294 Bed Cradles 27 Urinals 106 Air Beds 35 Dunlopillo Mattresses 5 Dunlopillo Cushion 1 Bed Pulley 2 Bed Tables 2 Draw Sheets 124 Walking Aid 1 Sputum Mugs 1 Enuresis Machines 6 Ryles Tube 1 Fracture Boards 7 HEALTH EDUCATION It is only with the co-operation of the community and the personal effort of individuals that progress towards better health can be achieved. Health education is thus a fundamental duty of local authorities. It has two main aspects, the "message", and the "medium". Direct advice by members of the staff does of course represent a major contribution to health education, which varies as scientific knowledge changes. When we consider group instruction, however, which seeks to alter the views of large sections of the population, we cannot ignore the influence on the medium of developing publicity techniques. On this subject, most health departments need officers with special aptitudes and training In recognition of this fact, the Corporation allowed the secondment of a Health Visitor to undertake a full-time Health Education Course and the establishment of the post of Health Education Officer. I think this decision will be of great benefit in strengthening this aspect of the work of the department. 43 The purchase and distribution of the monthly magazine "Better Health" has continued. Posters and pamphlets have been displayed at Infant Welfare Centres on appropriate topics at different times and displays demonstrating the work of the department were used to assist functions arranged by the Public Relations Committee. Speakers have been provided by the department to various organisations throughout the year and active work was in progress for the setting-up of a Home Safety committee. The local press has also been helpful in publicising matters of health interest and seeking the views of the department on such items. 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 and 1 Handicraft Instructor. 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 13 mental defectives placed under guardianship in Brighton, by the Guardianship Society. ttork carried out in the Community On the recommendation of the Medical Staff of warlingham Park Hospital, the corporation accept financial responsibility tor Patients to stay at approved homes conducted by the Mental After care Association and four cases were so dealt with during the year. 44 Lunacy and Mental Treatment Act 1956 Patients admitted to Mayday Hospital under Section 20 347 Cases admitted as above disposed of as follows:- Certified and admitted to warlingham Park Hospital or other Mental Hospitals 65 Admitted to Warlingham Park Hospital or other Mental Hospitals under Temporary Order 1 Admitted to Warlingham Park Hospital or other Mental Hospitals under Urgency Orders 2 Admitted to Warlingham Park Hospital or other Mental Hospitals as Voluntary Patients 136 Transferred to ordinary Sick Wards 1 Discharged Home 109 DECEASED 11 Transferred to Queen's Hospital 1 Discharged to Mental Defective Colony 1 374 Cases admitted to Warlingham Park Hospital Direct under Section 20 15 Cases admitted to Warlingham Park Hospital Direct as Voluntary Patients 60 Cases investigated and no action deemed necessary 113 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in the Borough" 1955 1950 Under 5 years 78 54 Aged 5-16 years 140 150 Over 16 years 550 600 Total 768 804 Compared with 1955 the cases show an increase of 36. 3 Institution patients have died in hospital. 45 The cases are distributed as follows:- In certified Institutions 335 In Approved Homes 4 On Licence from Institutions 20 Under Statutory supervision at home 360 Under Guardianship 36 In Mental Hospitals 9 Observation cases 40 In "Place of Safety" - 804 During the year the Certifying Medical Officers made examinations and paid visits to the number of 49 cases. The Mental Deficiency Visitors paid 3,635 visits. 26 new cases were examined during 1956 and certified as mentally defective. Ten of these cases were recommended for the Occupation centre and 10 were placed under statutory supervision.6 were recommended for institutional care. During 1956, 40 cases were dealt with as follows: - 1955 1956 Sent to certified Institutions 13 8 Placed under Guardianship - - Sent to warlingham Park Hospital - 1 Varying Orders: (a) Change of Guardian 8 3 (b) From one Institution to another 1 2 (c) Prom Guardianship to Institution 2 1 (d) Institution to Guardianship - - (e) Orders closed 8 15 (f) Patients admitted to Hospital for short term care 8 10 24 Orders were renewed during the year, 6 of which were Guardianship. 19 children were admitted to the Occupation centre during 1956. 14 left or were excluded. There were 10 cases awaiting vacancies in Institutions on the 31st December, 1956. There were 43 cases under Statutory Guardianship, 28 of these under the care of relatives, and 15 with Guardians who are not relatives, 3 males are at work. 46 371 visits have been paid to Guardianship cases during tta year. There are 25 cases on licence from Institutions (15 males and 10 females). Report on the Occupation Centre, January-December, 1956. Number on Register, January 71 " " " December 76 Number of Admissions 19 Number left or excluded 14 Average attendance 'per session 63 Times open, Morning-Afternoon 404 Total attendance for year 25,588 I am indebted to Miss Cooney, Supervisor of the Occupation Centre, for the following report: - "The Centre opened with 71 on roll. There was no school on the first two days as owing to road conditions it was not possible to get the coaches out. On January 11th the staff took a party of 55 children from the centre to the circus at the Olympia. The Board of Control Inspector visited on March 6th. Miss Bushby resigned in July and as no replacement was made her class was added to the existing class taken by Miss Murray who resigned in November following her marriage, to take up residence in slough. Later in the month replacements were made Mr. Heath joined the staff to take charge of the senior boys and Mrs. McCullogh was appointed for the senior girls. The Sale of Work was held on December 5th and sales amounted to £30. 9. 6. Owing to the many changes in staff the sale of goods during the year was below average - £32 in all. The Christmas Party was held in December. Ninety-three students visited the centre during the year." ENVIRONMENTAL HYGIENE 47 REPORT OF CHIEF PUBLIC HEALTH INSPECTOR I beg to submit a report for the year ending 31st December, 1956 of the work of the Public Health Inspectors and other offi- cers under my control. It will be observed that there has been a change of designation in respect of the qualified members of the staff from Sanitary Inspector to Public Health Inspector, as it is thought the new title better describes the duties now undertaken by these officers. Last year new housing legislation absorbed much of the time of the staff with the survey of the older houses for the preparation of clearance and redevelopment areas and the inspection of properties where certificates of disrepair had been applied for. This year new legislation in the formof the Food Hygiene Regulations has occupied a considerable amount of the working time of the inspectorate. Shortly after the Regulations came into force a summary of the Regulations, accompanied by a letter explaining their import and asking for co-operation was sent to all proprietors of food businesses in the Borough. There has been a readiness generally, in the part of traders, to co-operate and this, allied to the public relations work done by the inspectorate together with the enforcement work undertaken in connection with previous legislation, has been responsible for much progress in complying with the Regulations. I am pleased to take this opportunity of thanking the traders who responded so well to the appeal for co-operation and thus lightened the burden of enforcement. The pages of the report given over to food inspection shows the progress in detail. In the field of "housing", progress has been made in dealing with properties unfit for habitation in that in the Ely Road area the worst of the houses have been demolished and others, when vacated, will be dealt with similarly. The Crescent Mews area of Warminster Road is now being dealt with. In addition many individual houses have been made the subject of either demolition or closing orders. Again I have to report an increase in the "through put" of finals at the Abattoir, the number slaughtered being 56,362, 25 Percent, more than last year's total. This amount of slaughtering 48 is the more remarkable when one considers the out-dated layout of the premises. Consideration is now being given to the modemisation of the Abattoir. During the year further new legislation in the Clean Air Act 1956 was passed and this, when it comes into operation early in 1957, will put considerable extra duties on the section. I wish to record my thanks to all members of the staff for their efforts during the year to cope with the new legislation and to deal with the numerous other duties they have been called upon to perform. G. GRIEVE, Chief Public Health Inspector 49 Summary of inspections made by the Public Health Inspectors, and other Departmental work Total number of houses inspected for housing defects under Public Health or Housing Acts 3,060 Houses inspected where zymotic diseases have occurred 293 „ „ „ „ following applications for certificates of disrepair 30 Inspections of underground rooms 62 Special inspections in connection with the Housing Survey 17 Houses inspected for overcrowding conditions 83 Reinspections of work outstanding on housing notices 10,216 Number of visits regarding infectious diseases 736 „ „ „ „ food poisoning 81 Inspections of drainage work during repair 2,509 House drains tested with smoke and colour - routine and complaint 1,229 House drains tested with smoke (on written application) 15 House drains tested with smoke during repair 40 „ „ „ „ water during repair 153 Inspections of cesspools and earth closets 8 „ „ „ 'schools and school sanitary conveniences 33 „ „ „ public conveniences 349 „ „ „ 'verminous premises 76 „ „ „ ponds and ditches 49 „ „ „ yards, stables and passages 218 „ „ „ theatres, cinemas, halls, etc 120 „ „ „ pig styes 53 „ „ „ tents, vans and similar structures 51 „ „ „ knackers yards 19 Visits regarding smoke abatement 1,190 „ „ „ Exhumations 31 Inspections of swimming baths 4 „ „ „'wells 9 „ „ „ gathering grounds of water supply 19 „ „ „ gipsy encampments, camps, fairs, etc 2 „ „ „ offices 33 „ „ „ rivers and streams for pollutions 358 Pood and Drugs Acts: food and drugs samples taken 288 „ „ „ milk samples taken 241 Milk (Special Designations) Orders: samples taken 243 Ice Cream samples taken 179 Samples taken of Fertilizers and Feeding Stuffs 13 „ „ „ swimming baths water 25 „ „ „ drinking water 281 „ „ „ subsoil water 11 „ „ from rivers, streams, etc 9 „ „of rag flock and other filling materials 14 „ „ „ sundry specimens (food poisoning etc.) 20 Inspections of butchers premises 1,628 „ „ „ meat premises (wholesale) 1,379 „ „ „ horseflesh premises 5 „ „ „ poultry and game dealers premises 90 „ „ „ fishmongers premises 124 „ „ „ fried fish premises 76 „ „ „ grocers premises 1,051 „ „ „ fruiterers and greengrocers premises 313 „ „ „ bakers premises - including bakehouses 219 „ „ „ dairies 30 „ „ „ milk shops 60 „ „ „ general shops and their premises 66 „ „ „ premises where cooked meats etc. are prepared or sold 58 „ „ „ confectioners premises 447 „ „ „ confectionery manufacturers premises 35 50 Inspections of cafes, snack bars, canteens, hotels and their kitchens 806 „ „ „ school kitchens and serveries 109 „ „ „ hospital kitchens 36 „ „ „ ice cream manufacturers premises 34 „ „ „ „ „ vendors premises 267 „ „ „ „ „ barrows and carts 9 „ „ „ markets (day inspections) 80 „ „ „ „ „ (weekend inspections) 49 „ „ „ barrows, other than in markets 87 „ „ „ imported foods at Aerodrome 13 „ „ „ other food premises not enumerated above 390 „ „ „ premises where offensive trades are conducted 35 „ „ „ factories with mechanical power 650 „ „ „ „ „ without mechanical power 92 „ „ „ works of building and engineering , 146 „ „ „ outworkers premises 338 Visits to employers of outworkers 15 Inspections of shops (under Shop Acts) 1,280 Special early closing, evening and Sunday trading patrols of shops 606 Appointments kept with owners, builders, etc 2,142 Investigation of complaints other than housing matters 1,635 Reinspections of works outstanding (other than houses) 5,951 Inspections under Hydrocyanide Regulations 2 „ „ „ Fertilizers and Feeding Stuffs Act 4 „ „ „ Diseases of Animals Act 47 „ „ „ Merchandise Marks Act 129 „ „ „ Pets Act 39 „ „ „ Rag Flock and Other Filling Materials Act 16 „ „ „ Pharmacy and Poisons Act 75 Sundry Inspections and visits 3,166 Visits regarding rats and mice infestations 8,901 Informal Notices outstanding 31.12.55 1,098 „ „ „ served 3,989 „ „ „ complied 2,955 Number of Informal Notices referred for Statutory Orders 448 Informal Notices outstanding 31.12.56 1,684 Statutory Notices outstanding 31.12.55 323 " " '* served 865 „ „ „ complied 845 „ „ „ outstanding 31.12.56 343 Total number of callers and complaints received at the office 4,513 Total number of letters received at the office 6,580 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders ascertained by the Public Health Inspectors during the year 1956 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 341 Conditions causing dampness: Defective roofs 476 Defective window frames 226 Defective walls, etc 280 Want of efficient damp-proof course 82 Defective gutters and downspouts 259 Other structural defects: Defective plaster 335 Cleansing and redecoration required 44 Defective floors and stairs 234 Insufficient ventilation under floor 43 Defective brickwork, sills, lintels, chimneys 157 Defective stoves and fireplaces and flues 167 51 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 121 Defective w.c.'s 320 Defective drainage 290 Stoppages in drains 120 Defective water services and tanks 32 Domestic nuisances: Want of cleanliness 8 Verminous conditions 15 Other nuisances and infringements: Offensive accumulations 58 Overcrowding 32 Sundry nuisances or defects 209 Particulars not inserted in Rent Book (Housing Act) 12 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924 Food cupboards defective or required 10 (3) INFRINGEMENTS OP PUBLIC HEALTH ACT, PAVING,etc. Defective Yard Paving 53 Want of a sanitary dustbin 105 Public Urinals - defective or dirty 14 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 6 W.C. defective and dirty 23 (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 11 (6) SMOKE ABATEMENT Nuisances observed 4 HOUSING Some progress has been made during 1956 in dealing with the unfit house. In Ely Road, 12 houses were declared unfit for human habitation and by the end of the year 8 of these had been demolished and 3 of the remaining 4 were vacated. Plans are in hand for the redevelopment of this area. In addition, 9 demolition orders and 15 closing orders involving 11 whole houses and parts of 13 other houses were made during the year. This action resulted in 28 families being rehoused. Crescent Mews, Warminster Road, has been agreed as the next area to be dealt with in the programme to clear the town of unfit and substandard houses. During the year 2,041 houses were rendered fit following the service of notices requiring repairs. The number of applications for certificates of disrepair for the whole of 1956 was 30, of which 20 were granted. The total number of certificates of disrepair granted to tenants since the commencement of the Act, 52 31st August, 1954 to the 31st December, 1956, is 394. 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 95, and the number accommodated during the year 34,487. The receipts during the year were £2, 777 and the expenditure £4,556 Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, at a fee. During the year 15 such requests were made FACTORIES ACTS, 1937 AND 1948 During the year the under-mentioned inspections have been mde and defects were found as set out:- Part 1 of the Act Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors): Premises Number on Register Number of Inspections Written notices Occupiers p rosecuted (1) (2) (3) (4) (5) (i ) Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 350 92 4 - (ii ) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,509 650 30 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 79 146 4 - Total 1,938 888 38 - 53 Cases in which Defects were found: Particulars Number of cases in which defects were found Number of cases in which cutions were instituted Found Remedied Referred To H.M. Inspector By H. M Inspector (1) (2) (3) (4) (5) (6) Want of cleanl iness (S. 1) 12 8 – – _ Overcrowding (S. 2) - - - _ _ Unreasonable temperature (S. 3) 1 – – – – Inadequate ventilation (S. 4) 1 – – – – Ineffective drainage of floors (S. 6) – – – – – Sanitary conveniences (S. 7): (a) Insufficient 16 11 - 1 _ (b) Unsuitable or defective 100 56 – – – (c) Not separate for sexes 5 3 – – – Other offences against the Act (not including offences relating to Outwork) 25 8 1 – – Total 160 86 1 1 – Part VIII of the Act Outwork Section 110 Section 111 Nature of Work No.of out- workers in August list requi red by Sect.110 (1) (c) No. of cases of defaul t in sending lists to the Council No. of prosecutions for failure to supply lists No. of in - stances of work in un whole- some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel 195 - - 2 2 _ "ousenold Linen 3 – _ – – – Lace Curtains and Nets 7 – – – – – Curtains and Furniture Hangings 8 – – – – – Furniture and Upholstery 1 – – – – – Brass and Brass Articles ] – – – – – Locks, Latches and Keys 3 – – – – – Paper Baes 13 _ – _ _ _ Carding, etc.of Buttons, etc. 24 – – – – – Stuffed Toys 1 - _ _ – – Cosaques, Christmas Crackers etc 29 – – – – – Lampshades 18 – - - - - Total 303 – - 2 2 - 54 Inspection of Schools These are inspected with particular reference to sanitar; accommodation including washing facilities. During the year 33 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. 1,280 inspections were made under the Shops Act, and the infringements found were as follows:- Hours of Closing 8 Hours of employment of staff 1 Provision of means of heating 20 Insufficient W. C. accommodation 6 Want of washing facilities 4 Defective W.C. accommodation 24 Defective walls, floors, ceilings, etc. 25 Defective and insufficient lighting 14 Want of seating accommodation 3 Notices to be exhibited or amended 221 DRAINAGE 2, 509 visits of inspection were made to underground drains in course of repair. Of 258 Statutory Orders served, 63 had to be done in default of the owners. In addition, repairs were carried out by the Corporation to 33 public sewers serving 177 properties. OFFENSIVE TRADES There are but few registered, and during the year there been no cause for complaint. 55 POLLUTION OF RIVERS AND STREAMS During the year 407 inspections were made to ascertain if any evidence of pollution or obstruction was apparent in the watercourses within the Borough and in addition samples of the waters were taken for analysis. Appropriate action was taken where pollution was observed. It should be remembered that all surface water drainage in the Borough is discharged into streams, and it is an offence to permit a polluting material to enter surface water drainage systems. SMOKE ABATEMENT The District Public Health Inspectors observe the various factory chimneys in their respective areas with a view to detecting the discharge of smoke or grit such as to be a nuisance. Byelaws 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. 104 such observations were carried out and in 4 instances black smoke was emitted for more than the statutory limit. The Managements were immediately interviewed and informed of the offence and advised. In 2 cases it became necessary to serve a Statutory notice to abate smoke nuisances. The Clean Air Act 1956 was passed during the year and although it did not come into force until the 31st December 1956, and then only in part, its provisions were brought to the notice of the Health Committee with a view to action being taken early in 1957 to implement its operative sections. AMUSEMENT HOUSES 120 inspections were made of Theatres, Music Halls, Cinemas, Dance Halls, and premises where stage plays are given. A report ls submitted annually to the Licensing Authorities on the sanitary condition of these premises. Notices are issued to remedy arV unsatisfactory conditions. 56 HISINFESTATION The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use supplied with steam from a gas fired boiler within the Station. The following articles were disinfected at the Disinfecting Station during the year:- By Steam 14,873 articles By Formalin Gas 2,604 '' Total 17,477 In addition, 298 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 1956, 335 articles were disinfected, the receipts amounting to £22. 15. 9. Disinfection was carried out after infectious or contagious disease at the following premises:- 774 rooms at 433 houses, hospital wards, clinics and creches 2,095 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 9 adults and 15 children were cleansed of verminous conditions and 4 adults and 6 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 122, either by spraying or fumigation. Weekly visits are made to the abattoir when the manure storage and walls adjoining are sprayed with an insecticide. 57 PHARMACY AND POISONS ACT, 1933 The object is to regulate the sale of certain poisonous substances. During the year the number of applications granted for entry of names on the list of persons entitled to sell poisons under Part 2 of the Act was 22. In addition, 272 applications were made for the retention of names on the list for a further period of 12 months. 10 infringements of the Act were found, and these were remedied during the year. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act regulates the manufacture and sale of materials used as fillings for upholstery, bedding, toys, etc., with the object of compelling the use of clean fillings. During 1956, 14 samples of various fillings, as listed below were taken. All of these samples conformed with the requirements of the Regulations made under the Act: - Article Washed Flock Kapok Kapok Substitute Millpuff Cotton Felt Hair Coir Fibre Wool Pads No. of Samples 6 1 1 1 2 1 1 1 PET ANIMALS ACT, 1951 21 premises were licensed for the purpose of keeping Pet Shops. During the year 39 inspections were made and there were no infringements of the conditions, specified in the licences. HISEASES 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. 58 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, a:< employed to deal with such complaints. During the year, 1,531 private dwellings were inspected following complaints and in 1,112 instances infestation was codfirmed and dealt with by the rodent operatives. In 15 instances defective drainage was permitting the egress of rats from tie sewers - appropriate action was taken to have the drains repaired and the adjacent sewers treated. 177 business premises were found to be infested with rats or mice and these were all disinfestei during the year. 32 of these were treated by the occupiers. Regular inspections are made of premises where food is prepare! 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. 25 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 whilst the results have shown a steady decline in the rat population over the years, certain areas still persist in showing infestation. These areas were given a special treatment during the year with very good results. 688 manholes were involved and these were treated initially with antu, a rodenticide. After this treatment 190 manholes were still found to be infested and in consequence a warfarin treatment was applied to all the manholes in the areas over a period of three weeks. Warfarin is an anti blood coagulant which has been used with good results in the treatment of surface infestations. A preservative was added to the warfarin in order to retain its palatability. The warfarin was renewed after eact seven days during the three weeks treatment. The final observations showed that all the 688 manholes were free from rat infes" tation. The summer treatment to be carried out in the months of May and June, 1957 will be interesting in that it will show the real. effectiveness of this special and concentrated attack on the sewer rat. 59 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, and they have kept in close touch with the department during the above mentioned experimental treatment. FOOD SUPPLY The supervision and inspection of the food supplies is carried out by the Public Health Inspectors who are all qualified in food inspection. The following table shows the distribution of trades among the 3,224 premises in the Borough at which food is known to be sold, manufactured or stored: - Bakehouses 59 Bakers Shops 115 Sugar Confectioners 565 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 457 Works and Club Canteens 273 Public Houses 155 Off Licences 71 Grocers 616 Butchers 204 Wholesale Meat Markets 8 Chemists 82 Greengrocers 239 Fishmongers 85 Pried Fish Shops 41 Milk Distributors and Dairies 65 Premises from which Roundsmen and Mobile Shops operate 22 Stalls in Markets 83 Food Manufactories 17 Other Food premises not enumerated above 67 3, 224 Of the above premises 814 are registered under Section 16 of the Pood and Drugs Act, as follows: - 60 Retail sale of ice-cream 659 Manufacturers of ice-cream 6 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 149 During the year 8, 478 inspections were madeoffood businesses (for details see page 50.) In addition, Croydon Airport was visited on 13 occasions to inspect foodstuffs arriving by air from the Continent. Suck foodstuffs consisted of lettuces and strawberries. INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1955/56 Structural defects in shops and stores 51 Defective condition of walls and ceilings 271 " " " " floors, utensils, fixtures, etc. 164 Insufficient lighting or ventilation 33 Defective or insufficient drainage 42 W.C. accommodation - insufficient11 " " '' - repair or cleansing required 112 " " " - artificial lighting required 21 - want of intervening ventilated space 11 Overalls required or dirty 7 Food - improperly stored 24 " - not stored 18'' off floor 40 " - means to prevent contamination required 171 " - improperly handled 24 " - store required or defective 32 Animals found in food store 2 Accumulations in yard or stores 40 Offal and refuse bins defective or uncovered 54 Yard paving defective 25 Hand washing notice not exhibited 273 Ablutions - Wash basins required 433 ■ * - Hot water supplies required 475 '' - Nail brushes, soap and towels required 199 Insufficient or defective sinks 151 Smoking offences 24 Clothing accommodation required or defective 104 Defective or unsuitable table tops, etc 128 First Aid kits required or insufficient 267 Defective or unsuitable crockery and utensils 15 Prosecutions During the year a firm of bakers was prosecuted for selling a loaf of bread which was unfit for consumption. A fine of £20, with 3 guineas costs, was imposed and the firm lodged an appeal. The appeal, which was heard in the Queens Bench Division, was dismissed with costs. An employee of a firm of butchers who had been warned previously, was prosecuted for smoking whilst handling meat. He was fined £10 with one guinea costs. 61 Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1956: - Article Weight in lbs. Carcase Meat 47,751 Offal 44,906 Sundry Foodstuffs 3,257 Canned, Bottled and Packeted Goods 25, 172 Total 121,086 Disposal of Condemned Foodstuffs Meat condemned at the Public Abattoir, wholesale meat markets or at shops is disposed of, after being dyed green, to firms of repute for industrial use and some for animal feeding. The disposal is supervised by the Meat Inspectors and those carcases or parts not considered suitable for this type of disposal are destroyed by incineration. The other condemned foodstuffs where not suitable for industrial use 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 1955, 44,827 animals were slaughtered, and this rose to 56,362 animals during 1956. A 100% inspection has been maintained, but this has necessitated evening and often weekend attendance of at least one Inspector. Four of the District Public Health 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 3,464 Cows 658 Calves 8, 536 Sheep ana Lambs 17,389 Goats 418 Pigs 25, 897 Total 56,362 62 CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Colves Sheep and Lambs Pigs Goots Number killed 3,464 658 8,536 17,389 25, 897 418 Number inspected 3,464 658 8, 536 17,389 25,897 418 All Diseases except Tuberculosis and Cysticerci Whole carcases condemned 3 4 20 75 89 NIL Carcases of which some part or organ was condemned 1,673 290 53 1, 088 2. 319 2 Percentage of the number inspected affected with diseases other than Tuberculosis 48. 4 44.7 0.85 6.7 9.3 0.48 Tuberculosis only Whole carcases condemned 4 7 1 NIL 7 NIL Carcases of which some part or organ was condemned 144 78 3 NIL 269 NIL Percentage inspected affected with Tuberculosis 4.3 12.9 0.05 NIL 1.06 NIL Cysticercosis Carcases of which some part or organ was condemned 10 NIL NIL NIL NIL NIL Carcases submitted to treatment by refrigeration 10 NIL NIL NIL NIL NIL Generalised and totally condemned NIL NIL NIL NIL NIL NIL The District Public Health Inspectors, all qualified Meat Inspectors, inspect meat at the 8 wholesale Meat Depots in the Borough, as well as that exposed for sale in the butcher's shops. 63 MILK SUPPLY During the year 90 inspections were made of dairies and premises from which milk was sold. 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 71 Licences to use the designation "Sterilised" - Dealers' Licences 104 Dealers' Supplementary Licences to use the designation - (a) Tuberculin Tested 13 (b) Sterilised 13 (c) Pasteurised 12 Inspection of these licensed premises has been carried out during the year to see that the conditions of the licences were observed. Bacteriological Examinations of Milk During the year the following samples of milk were examined:- Tuberculin-Tested Pasteurised Milk 26 Pasteurised Milk 212 Sterilised Milk 5 The following table summarises the results of the bacteriological examinations of Tuberculin Tested, Pasteurised and Sterllised milk samples during the year: - TubercuJin* Test ed Pasteurised Milk Methylene Blue Test Pho sphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 26 - 26 - 26 64 Pasteurised Milk No. Samples Taken Methylene Blue Test Phosphatase Test Not Satisfied Sat isf ied Not Satisfied Sat isfied 212 - 212 - 212 Sterili sed Milk No. Samples Taken Turbidi ty Test Not Satisfied Satisfied 5 NIL 5 BACTERIOLOGICAL EXAMINATION OF CREAM Fifteen 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 produce: satisfactory results. BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 179 samples were taken, the results being as under:- Grade No. of Samples 1 130 2 36 3 9 4 4 Of the total samples taken, 13 (7.26 per cent.) failed tt 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, 65 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 6 samples were taken from local manufacturers and were found to comply with the standard. FOOD AND DRUGS ACT, 1938 During the year 241 samples of milk and 288 other samples were taken. Summary of Samples During 1956 samples were obtained and submitted to the Public Analyst as follows: - Samples of Total Samples Genuine No t Genuine Prosecutions Convictions Almonds, Ground 1 1 _ _ _ Arrowroot 1 1 _ _ _ Aspirin Tablets 1 1 _ _ _ Barley Crystals 1 1 _ _ _ Batter Mixture 2 2 _ _ _ Beer, Bitter 8 8 _ _ _ Bicarb. Soda 1 1 _ _ Biscuits 2 2 _ _ Black Pudding 1 1 - - - Blancmange Powder 1 1 - - Boracic Ointment ... ,, , 1 1 - - - Brawn 1 1 - - - Bread, Large 1 1 - - - Bread Crumbs 1 1 - - - Bread and Butter 1 1 - - - Butter 1 1 - - - Buttered Rolls 1 - 1 - - Calamine Ointment 2 2 - - - Candied Peel 1 1 - - - Cakes, various ,,, ... 3 3 _ _ Cakes, Fruit 3 3 - - - Cheese 1 1 - - - Cheese Spread 2 2 - - - Cheese, Processed 1 1 - - - Chickiettes 3 3 - - - Chocolate 1 1 - - - Chutney 1 1 - - - Christmas Pudding 1 1 - - - Cod Liver Oil 1 1 - - - Coconut, Dessicated 2 2 - - - Coffee 5 5 - - - Coffee and Chic. Essence 1 1 - - - Cornflour 1 1 - - - continued on next page 66 Samples of To tal Samples Genuine Not Genuine Prosecutions Conric tion Cornflakes 1 1 - . - Cough Mixture 1 1 - - - Cream of Tartar 1 1 - - - Cream, tinned 4 4 - - - Cream, clotted 1 - 1 - - Currants 3 3 - - - Curry Powder 1 1 - - - Custard Powder 2 2 - - - Dates 1 1 - - - Dessert Powder 1 1 - - - Drinking Chocolate 1 1 1 . - - Dripping 1 1 - - - Essence of Rennet 1 1 - - - Faggots 2 2 - - - Pish Cakes 1 1 - - - Fish Paste 1 1 - - - Flavouring Essence 3 3 - - - Gees Linctus 1 1 - - - Galantine of Pork 1 1 - - - Gin 7 7 - - - Ginger Beer 1 1 - - - Glycerine and Honey 1 - 1 - - Glycerine and Lemon 1 - 1 - - Golden Syrup 1 1 - - - Gravy Powder 2 2 - - - Ground Rice 1 1 - - - Ice Cream 6 6 - - - Ice Lollies 1 1 - - - Isinglass 1 1 - - - Halibut Liver Oil 1 1 - - - Horseradish Cream 1 1 - - - Iodine, Tine, of 1 1 - - - Indigestion Tablets 1 1 - - - Jam 3 3 - - - Jelly 2 2 - - - Jelly Crystals, Veg. 2 2 - - - Lard 2 2 - - - Lemonade 1 1 - - - Lemonade Powder 1 1 - - - Lemon and Honey 1 1 - - - Lemon Pie Filling 1 1 - - - Lemon Curd 2 2 - - - Lemon Juice 2 2 - - - Lemon Squash 2 2 - - - Lime Juice Cordial 2 2 - - - Liquid Paraffin 2 2 - - - Malt Vinegar 1 1 - - - Malt Loaf 1 1 - - - Margarine 1 1 - - - Marmalade 2 2 - - - Marzipan 1 1 - - - Meat Paste 3 3 - - - Meringues 1 1 - - - Milk, hot 2 2 - - - Milk of Magnesia 2 2 - - - Mincemeat 2 2 - - - Minced Beef 2 2 - - - Milk 233 233 - - - Milk, Channel Island 7 7 - - - Milk, South Devon 1 1 - - - Mixed Spice 1 1 - - - continued on next page 67 Samples of To tal Samples Genuine Not Genuine Prosecution £ Convictions Mustard 1 1 _ Mustard, French 1 1 - - - Nutmegs, ground 1 1 - - - Oatmeal 1 1 - - - Olive Oil - - - Orange Squash 1 1 - - - Orange Juice 1 1 - - - Peanut Butter 1 1 - - - Pepper 1 1 - - - Pepper, cayenne 1 1 - - - Pickled Gherkins 1 1 - - _ Pickled Cabbage 1 1 - - - Popcorn (cheese flavoured) 1 1 - - - Pineapple Curd 1 1 - - _ Pineapple Squash 1 1 - - _ Potato Salad 1 1 - _ _ Pills, Blauds 1 1 _ _ Pudding Mixture 1 1 - - Quinine, Tine, of 1 1 - _ Raising Powder 1 1 - - _ Roes, tinned 1 1 _ _ _ Rice ] 1 _ _ Rice, creamed 1 1 _ _ _ Rissoles 1 1 _ _ _ Rum _ _ _ Salad Dressing _ _ _ Sandwich Spread 1 1 _ - _ Sauce, chop 1 1 _ - _ Sausage, beef 4 3 1 _ _ Sausage-meat 7 6 1 _ Sausage, breakfast 2 2 - _ Sausage, pork 6 6 _ _ _ Sausage, liver 2 2 _ _ _ Sausage, luncheon 3 3 _ . _ Sausage, smoked 1 1 _ _ _ Saveloys 1 1 _ _ _ Semolina 1 1 _ _ _ Soda Mint tabs 1 1 _ _ Suet, packed 2 2 _ _ _ Sugar 1 1 _ Sugar, brown 2 2 _ _ _ Sugar, icing 1 ] _ _ _ Sultanas 1 I Sweets 17 17 _ _ Soup Powder 1 1 _ _ _ Stuffing, Sage and onion 1 1 _ _ Syrup of Pigs 2 2 _ _ _ Tapioca 1 1 _ _ _ Tea 5 5 _ _ _ Tionic Wine 1 - 1 - - Tinned Peas 2 2 - - - Tinned Broad Beans 1 1 - - - Tinned Fruit 16 16 - - - Tinned Peas 5 5 - - - Tinned Soup 1 1 - - - Tinned Fish 3 3 - - - Tinned Tomatoes 1 1 - - - Whisky 7 7 - - - Yast Tablets 1 1 - - - 5 29 518 11 - - 68 Result of Analysis of Milk Samples Solids not Fat (Legal standard is S.'flo) 8. 5 14 8.6 65 8.7 77 8.8 62 8. 9 12 9.0 3 Milk Fat (Legal standard is M 3. 1 1 3.2 2 3.3 14 3. 4 38 3. 5 43 3.6 62 3.7 36 3. 8 18 3. 9 11 4.0 6 4.1 2 (Excluding South Devon and Channel Islands milks) South Devon and Channel Island Milks Solids not Fat (Legal standard is 8.^fh) 8.9 1 9.0 4 9. 1 2 9.2 1 Milk Fat (Legal standard is 4%) 4.4 2 4. 5 3 4.6 2 4.7 1 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.70 Milk Fat 3.58 South Devon and Channel Island Milk Solids not Fat 9.04 Milk Fat 4.52 Total number of Milk Samples 241 The samples of milk for analysis were obtained as follows:- Taken on Milk Rounds 161 " at Dairies 60 " at Institutions 20 241 69 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Buttered Rolls This sample consisted of bread rolls and margarine Vendor warned Clotted Cream This article had the characteristics of a sterilised cream with sugar added and contained 24.6% of milk fat whereas clotted cream is an unsweetened rich cream containing not less than 48% of milk fat Vendor warned and requested to amend description. Request complied with Drinking Chocolate The Analyst is of the opinion that the description on the label is misleading This matter has been taken up with the manufacturers who agreed to alter their labels Glycerine and Honey This article contained 40% of Sugar Syrup which was not included in the quantitive description appearing on the label Manufacturers requested to amend the label. Request complied with Glycerine and Lemon This article was labelled in a misleading manner Manufacturers have amended label Little Blaud's Pills These pills were found to contain saccharated iron carbonate as the active constituent instead of a mixture of exsiccated ferrous sulphate and exsiccated sodium carbonate as stated in the B. P.C. formulary Vendor has ceased to dispense this article and has destroyed remaining stock Pudding Mixture The description on the carton containing this article was inadequate since it did not indicate the necessity to use eggs and fat in the making of a pudding Manufacturers have amended label Sausage, Beef This article contained a substantial proportion of mutton in addition to beef, and 47% of fat in relation to total meat content whereas a reasonable proportion of fat is 40% Vendor warned Pork Sausage Meat The meat contained 59% of meat, including fat, whereas a reasonable minimum meat content is 65% Vendor warned. Further samples have proved satisfactory Sultanas This sample contained 780 parts per million by weight of sulphur dioxide. The proportion of sulphur dioxide, as a preservative, should not exceed 750 parts per million Vendor warned fonic wine This article was incorrectly labelled in that the expression "Vitamin B " was used as a synonym for Niacin Manufacturers have amended label 70 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, W addon, 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 rat water from the Addington Well, this water is filtered before chlorination. A portion of the northern side of the Borough is supplied with water which is purchased in bulk from the Metropolitan Water Board. The amount of water consumed during the year was - Corporation Wells M. W. B. Bulk Supplies East Surrey Water Company Total Gallons 2,487,035,000 727,879,000 107,000 3, 215,021,000 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. 428 raw water samples and 1023 treated water samples were thus examined during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 16 samples of raw water and 39 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 ra« 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. 71 (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 70 of raw waters and 135 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 Oepartment 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 220 Chemical 12 72 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 1956 the following tonnages were dealt with:- House Refuse 58,563 tons Street Sweepings 3,684 " Street Markets refuse 1,591 " 63, 838" This was disposed of by Controlled Tipping and two sites were in use during the year, viz. Ballards School and Mitcham Common. The former, at present in use, is being levelled for eventual use as school playing fields. Sewage Disposal The sewage of the Borough is dealt with at Beddington and South Norwood. The Addington area drains into the West Kent Drainage Board Works and a small part of Upper Norwood into the L. C. C. system. The main works at Beddington deals not only with the sewage from the major part of the Borough, but takes the sewage under agreement from four outside authorities, viz. Coulsdon and Purley U.D.C., Caterham and Warlingham U. D. C., Banstead U.D.C., and Carshalton U. D. C. The sewage flow from an estimated population of 319,000 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 maintaing temperature in the Digestors, and, by compressing it, for use on vehicles as a fuel in lieu of petrol. MISCELLANEOUS 73 Nursing Homes - Public Health Act, 1936 Number of Homes Number of Beds provided for:- Maternity Others Total Homes registered during the year - - - - Homes on the Register at the end of the year 25 41 549 590 Premises in which it is proposed to establish new homes are visited as frequently as is necessary so that the appropriate recommendations can be made to the Health Committee. The Chief Officer of the Fire Brigade Department advises on essential fire precautions and these usually entail building alterations. Established nursing homes were visited by a Medical Officer of the Department once every quarter and, except for some minor matters, were all satisfactory. NURSES AGENCIES REGULATIONS, 1945 No applications were received during the year. Three agencies remained on the register at the end of the year. NURSERIES AND CHILD-MINDERS REGULATION ACT, 1948 The necessary preliminary inspections and routine re-inspections of Registered Minders and private Day Nurseries have been carried out in accordance with the above Act. There are no Day Nurseries which take children of all ages for the whole day. There are 3 Nurseries which take 2½ to 5-yearolds daily excepting Saturdays, the remainder being of the "part time" class receiving toddlers for mornings only. The Registered Minders receive children for the day. They are not encouraged to take children under 2 years. Number registered at 31.12.56 Number of children provided for Premises 6 134 Daily Minders 15 100 74 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. CROYDON AIRPORT - HEALTH CONTROL With the partial withdrawal of Immigration Officers, the work formerly performed by the Medical Receptionists was placed up the Customs Officers. The system of continuous "on call " manning by Medical Officers has continued. Refugees from Hungary (333) were all seen by Medical Officers on arrival. Aircraft and Passenger Arrivals, Croydon Airport. Aircraft Passenger "Excepted Area" 3,522 11,097 Europe outside Excepted Area 219 4,969 Africa, Middle East 4 36 Asia 2 28 3, 747 16,130 Included in the above figures were 2,672 Aliens carried 754 Aircraft. CREMATION ACTS, 1902 AND 1952 During the year 2,250 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 1,267 certificates were dealt with at the office (1,134 Smallpox, 95 Cholera and 38 T. A. B.) STAFF MEDICAL EXAMINATIONS 1,248 examinations were made during the year by the Medical Staff of the Department including 370 vision tests for drivers. As the employers of a staff totalling many thousands, Corporation must maintain a form of industrial health service and this is provided by the Health Department. A Health Questionnaire is completed by every officer to whom an appointment is 75 offered, for scrutiny by the Medical Officer of Health. The candidate may be recommended for acceptance forthwith or after further enquiries or medical examinations. Other staff are all examined by Medical Officers of the department to ascertain fitness for work and for inclusion in the Sick Pay Scheme. An X-ray of chest is required for all those whose duties bring then into contact with children and agreement to have an annual re-Xray is a condition of employment. Staff who handle food in the School Meals and Canteen sections have, in addition to a chest X-ray, tests to exclude a carrier state of intestinal infections. Copies of Sick Pay Returns showing long-term absences are sent each month to the Medical Officer of Health, who makes the necessary enquiries into such cases, including where necessary, domiciliary visits. Cases of frequent short-term absences are also referred as necessary by the Chief Officer concerned and employees may be asked to attend for examination. A system of periodic re-checking of the eyesight of all Corporation drivers has been introduced. The time seems to be approaching when this work should be combined with the preventive outlook of considering posts where sickness appears more frequent, in order that possible remedial action can be recommended. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE AMENDMENT ACT, 1951 Ten old people were followed up from 1955 of whom:- An old lady aged 98 with failing sight was admitted to Coombe Lodge Hostel under the powers of the 1951 Act 3 were admitted to Hospital voluntarily 1 was admitted to Hostel voluntarily 5 continued to manage at home with varying degrees of assistance Twenty three new cases were brought to notice during the year of whom: - 1 died 8 were admitted to Hospital voluntarily during the year 2 on the waiting list for Hospital (one admitted in January, 1957) 1 was admitted to Hostel 11 remained in their own homes 76 BLINDNESS I am indebted to the Chief Welfare Officer for access to Ms records regarding blind persons registered during the year. These show that of the 66 cases registered - 7 were due to glaucoma and 20 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had been performed except:- 2 too ill for surgical treatment 1 patient deceased 2 consents not forthcoming PROBLEM FAMILIES The established procedure of the monthly Conference of voluntary organisations, and statutory authorities concerned with "Children Neglected or Ill-treated in their own Homes" continued throughout the year. The Health Committee agreed that the experiment of allocating selected Home Helps to potential problem families should go on and eight cases were dealt with during 1956. The position at the end of the year was:- Case 1. Mother now in a mental hospital for an indefinite period. Five children being cared for by a relative. Case 2. Mother of two children. Father in regular employment. Family now managing well without help. Case 3. Widowed mother of five children. Mother physically handicapped, now managing very well with assistance of ordinary Home Help for heavy work. Case 4. Mother of three children. Father working spasmodically. This family was rehoused and given a great deal of assistance and encouragement. The home conditions are improved and the children better fed and clothed. Over the year progress has been made, but it has been slow and intermittent. Case 5. Divorced mother of five children. In spite of much help and encouragement, the three youngest children were admitted to Dr. Barnardo' s Homes, the mother and two remaining children have been rehoused and are managing without help. 77 Case 6. Mother of four children. Father working spasmodically. A very unco-operative and apathetic family. The mother is capable and has a fairly good knowledge of housekeeping, but fails to maintain a reasonable standard in the home. Case 7. Divorced mother of five children. Mother physically handicapped, now managing with the help of ordinary Home Help for heavy work. Case 8. This family have now moved out of the district. A total of 1,580 hours was given to this service and in all but one case, it was free of charge to the recipients. The lessons learned are no doubt familiar to experienced workers in this field. Although the need for help may be obvious to all observers and would be welcomed by the majority of ordinary families, it may, nevertheless, be refused despite the most careful approach. Refusal may be anticipated and the true reason understood, and time, skill and patience are the only solutions. Pressure of impending legal action or eviction makes masterly inactivity a difficult matter for the social worker however much it may be indicated. Working with family units and undertaking the long-term follow-up of children does develop the ability to sense the general trend of a family's progress. It is essential not to be too distracted by setbacks or over-encouraged by sudden improvements. When this work commenced, some 18 months ago, a number of families were immediately brought forward by the Health Visitors. This initial pressure now seems over and it appears well within the scope of the Home Help Service to cope with this kind of work as a routine duty. One Health Visitor has also continued to give a major part of her time to assisting families with children admitted to Welfare Services Receiving Homes under Part III of the National Assistance Act. (see the Appendix, page 117). families in Welfare Services Accommodation:- Report by the Health Visitor co-ordinating this work. The work has changed during the past year. More emphasis has been placed on helping the families either in the Receiving Homes or on the district to achieve a better standard of home conditions. 78 It must be understood that the type of family in need of constant supervision is less likely to respond to social re-education if there is unemployment or lack of matrimonial happiness. In many families the lack of initiative is the first noticeable feature and usually this arises from an insufficient income and in the case of the husbands, the inability to keep employment. I have tried to make these families understand that the well being of the family is part of the family life and not a burden to be passed to another person. If the families are willing to be helped, e.g. with employment, budgetting and care of the children, then one could say that the rehabil itationof that particular family had commenced. A problem family could exist quite happily within the home, but when the children suffer through lack of proper food and clothing and the community suffers through continued non-payment of rent or essential services then some one must help this family back to be part of a community and nota burden to it. In my opinion many families in the Receiving Homes could be helped but because of the fact that they are living in a Receiving Home (and this appears in some cases to beget a grudge) they will not accept the fact that they could start under their present conditions to prepare for a permanent home for the future. It is necessary to find out why admission to a Receiving Home was necessary and then to build up a family unit to be independent and self -supporting in the future. I would like to point out that the children in the Receiving Homes are as well cared for as other children in the same income group living in their own homes. The constant supervision in the Receiving Homes also helps to keep the standard from falling below the accepted standard of this group. I would also like to say that these children sutler physically nowadays, but it would also be necessary to bear in mind that family matters - non-payment of debts and all particulars relating to the family and other families are discussed in front of these children. Therefore, it could be assumed that these children grow up with an intimate knowledge of family affairs which is not conductive to good citizenship later. As the Receiving Homes are being used as a residential centre for the Homeless Families it would appear that the social case work could be more advantageously applied if the Homes were used not merely as a place for Homeless Families but as a centre for the gradual rehabilitation of the families progress towards their ultimate new living. 79 This policy of social rehabilitation could not be applied to every family indiscriminately but the needs of each family considered and the necessary remedy found and applied. This could only be achieved by the co-operation of the persons concerned with these families. In the first instance it is necessary to help with immediate problems and then to anticipate other problems which might arise, either by a prolonged stay in the Receiving Homes or by re-housing. In many cases families would continue to stay in the Receiving Homes as long as possible because of the sense of security which it brings, and also because it is a very easy way of non-acceptance of a life in a community. SPASTICS 85 Spastic children up to school leaving age were known in Croydon, as at 31st of December, 1956. 8 - were under school age. 6 - of school age were not yet at school, not being suitable but still under review. 25 - were ineducable, of whom 3 attended the pation Centre and 10 ware in hospital, leaving 12 at home. 26 - were attending St. Giles' School. 2 - were at St. Margaret's School, Croydon. 5 - 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. 7 children were at ordinary schools. 2 - had Home Teachers. 1 - attending Myopic School. (44 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 23 adult cases are registered with his Department, six of whom are in special Homes. APPENDIX TABLES 81 83 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1936-1956 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate Infant Mortality Rate 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 3,526 3 0.85 21 1954 3,649 3 0.82 19 1955 3,408 2 0.59 21 1956 3,604 - - 19 84 DETAILS OF INFANT MORTALITY The following table gives the cause of death during the first month of life (Neo-natal mortality):- (l) Complications of Labour - Trauma at Birth 3 - 3 (2) Foetal States - Congenital Malformities 4 Atelectasis 2 Haemorrhagic Disease of Newborn 4 - 10 (3)Prematurity 19 - 19 (4) Post-Natal Causes 4 - 4 36 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1,000 Births 1956 1955 1956 1955 Premature Births 31.3 33.3 5.83 6.89 Respiratory Diseases 23. 9 21.3 4.44 4.49 Infectious Diseases 1.5 0 2.9 0.28 0.60 Atelectasis, Debility and Marasmus 3.0 5.8 0.56 l.20 Diseases of Digestion 6.0* 2.9 1.11 0.60 Injury at Birth and Congenital 23.9 21.7 4.44 4.49 ø This death was due to polio-encephalitis * These from Gastro-enteritis 85 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CAUSES OP DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th-14th day 15th-21st day 22nd-28th day Under l mnth. 1-2 mnths. 2-3 mnths. 3-4 mnths. 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 17 7 2 1 - 3 - 3 2 1 36 5 5 6 7 3 - 3 - 1 - 1 67 Polio-Encephalitis - - - - - - - - - - - - 1 - - - - - - - - - 1 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) Convulsions - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (all forms) - - - 1 - 1 - - 1 - 3 2 3 2 2 2 - - - - - - 14 Diarrhoea and Enteritis - - - - - - - - - 1 1 - - - 2. - - - - - - 1 4 Gastritis - - - - - - - - - - - - - - - - - - - - - - syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 1 - 1 - - 1 - - 1 - 4 1 1 3 1 1 - 1 - 1 - - 13 Premature Birth 10 6 1 - - - - 2 - - 19 2 - - - - - - - - - - 21 Atrophy, Atelectasis, Debility and Marasmus 2 - - - - - - - - - 2 - - - - - - - - - - - 2 Injury at Birth 1 - - - - 1 - 1 - - 3 - - - - - - - - - - - 3 Haemorrhagic disease of newborn 3 1 - - - - - - - - 4 - - - - - - - - - - - 4 Other causes - - - - - - - - - - - - - - - - - - - - - - 1 TOTALS 17 7 2 1 - 3 - 3 2 1 36 5 5 6 7 3 - 3 - 1 - 1 67 86 WARD STATISTICS WARDS Estimated Population Births Deaths Birth Rate Death Rate Deaths under 1 year per 1,000 Births Death Rate from Six Zymotic Diseases (excluding Diarrhoea) Death Rate from Diarrhoea (under two years) Death Rate from Bronchitis and Pneumonia Death Rate from Pulmonary Tuberculosis Death Rate from Non-Pulmonary Tuberculosis Death Rate from Heart and circulation Diseases Death Rate from Cancer Natural Increase or Decrease of Population Upper Norwood 17535 192 234 10.9 13.3 36 - - 1.08 - - 5. 93 2. 17 - 42 Norbury 16354 142 174 8.7 10.6 21 - - 1.22 0.06 - 3. 49 2. 14 - 32 West Thornton 15900 208 162 13.1 10.2 24 - - 0.82 0.06 - 3. 58 2.83 + 46 Bensham Manor 17313 207 190 12.0 11.0 10 - - 1.62 0.23 0.06 3. 47 2. 54 + 17 Thornton Heath 16122 276 163 17.1 10.1 7 - - 0.87 0.25 - 4.03 2.23 +113 South Norwood 16314 237 141 14.5 8.6 25 - 0.06 1.10 0.06 - 2. 51 1.74 + 96 Woodside 14755 221 129 14.9 8.7 9 - - 1.22 0.27 - 2.78 2. 10 + 92 East 16278 152 158 9.3 9.7 7 - - 0.74 - - 3.93 2.58 - 6 Shirley 12032 139 114 11.6 9.5 7 - - 0. 99 0.08 - 3.41 2. 41 + 25 Addiscombe 15930 235 177 14.8 11.1 17 - 0.06 1.51 0.19 - 3.70 2. 57 + 58 Whitehorse Manor 13596 260 153 19.1 11.3 12 - 0.07 1.77 0.15 - 4.41 2.13 + 107 Broad Green 13714 209 129 15.2 9.4 14 - 0.07 1.60 - - 3.43 1.97 + 80 Central 11635 158 131 13.6 11.3 25 - - 2. 06 - - 4.04 2. 32 + 27 Waddon 15536 170 149 10.9 9.6 18 - - 1.54 0.06 - 3.80 1.42 + 21 South 16791 218 234 13.0 13.9 28 - - 0.95 0. 12 - 6.02 2. 62 - 16 Addington 19495 580 72 29.8 3.7 26 - - 0.36 0.05 - 0. 92 0.82 +508 The Borough 249300 360 4 2977 1 4.5 11.9 19 - 0.02 1.40 0.10 0.00 4.31 2. 37 +627 Deaths occurring in Queen's Hospital are not included in the Ward figures as they are no longer allocated to the home address 87 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX Sex 0- 1- 5- 15- 25- 45- 65- 75- To tal all causes M 35 4 9 5 57 399 394 524 1,427 F 32 5 7 4 43 221 326 912 1, 550 Tuberculosis (Respiratory) M - - - - 1 10 5 4 20 F - - - - - 1 3 1 5 Tuberculosis (other forms) M - - - - - - - - - F - - - - - - 1 - 1 Syphilitic Diseases M - - - - - 3 1 3 7 F - - - - - - - 2 2 Diphtheria M - - - - - - - - - F - - - - - - - - - Whooping Cough M - - - - - - - - - F - - - - - - - - - Meningococcal Infections M - - - - - - - - - F - 1 - - - - - - 1 Acute Poliomyelitis M - - - - - - - - F 1 - - - - - - - 1 Measles M - - - - - - - - - F - - - - - - - - - Other Infective and M 1 - - - 1 - - - 2 Parasitic diseases F - - - - - 1 - - 1 Total Infective and Parasitic diseases (excluding Tuberculosis) - 2 1 - - 2 15 10 10 40 MaIignant neoplasm, stomach M - - - - 2 16 12 8 38 F - - - - 1 7 5 9 22 "" " lung, bronchus M - - - - 4 58 35 12 109 F - - - 4 9 5 5 23 " " " breast M - - - - - - - - - F - - - - 7 23 6 18 54 " " " uterus F - - - - 1 16 5 8 30 Other malignant and lymphatic M - - 1 - 8 53 53 37 152 neoplasms F - 1 - 1 7 36 42 58 145 Leukaemia; aleukaemia M - 1 2 - - 3 2 1 9 F - 1 2 - 3 3 1 - 10 Total forms of Cancer - 3 5 1 37 224 166 156 592 Diabetes M - - - - 1 4 1 2 8 F - - - - - 3 3 2 8 Vascular lesions of Nervous M - - - - 3 22 51 96 172 System F - - - - 3 29 60 204 296 Coronary disease, angina M - - - - 6 86 78 74 244 F - - - - 1 26 49 86 162 Hypertension, with heart M - - - - 1 9 6 7 23 disease F - - - - - 4 6 31 41 Other heart diseases M - - - - 6 26 28 104 164 Other F - - - 1 4 12 59 215 291 Other circlatory diseases M - - - - 2 14 13 33 62 F - - - 1 - 7 19 60 87 Total heart and circulatory diseases - - - 2 20 184 258 614 1,074 continued on next page 88  Sex 0- - 5- 15- 25- 45- 65- 75- (???) Influenza M - - - - 1 1 - 4 F - - - - - - - 5 Pneumonia M 7 1 - - 1 8 11 24 F 6 1 2 - 1 3 15 39 Bronchitis M 1 - - - - 41 50 41 F 1 - - - 1 6 19 6 Other diseases of respiratory system M - - - - - 4 4 5 F - - - - - 2 1 2 Total diseases of respiratory system including influenza and excluding tuberculosis 15 2 2 - 4 65 100 189 Ulcer of stomach and duodenum M - - - - 2 4 8 10 F - - - - - 2 1 9 Gastritis, enteritis and diarrhoea M 3 - - - - 1 - - F 1 1 - - - - 1 2 Nephritis and nephrosis M - - 1 1 2 4 1 4 F - - - - 1 1 4 4 Hyperplasia of prostate M - - - - - 1 11 13 Pregnancy, childbirth and abortion F - - - - - - - - - Congenital malformations M 6 - 1 - - 1 - 1 F 5 - - - 1 1 - Other defined and ill-defined diseases M 16 2 1 1 4 15 14 29 F 18 - 1 1 4 23 18 73 Motor vehicle accidents M - - 1 1 5 5 5 2 F - - - - - 1 2 2 All other accidents M 1 - 2 2 1 6 4 4 F - - 2 - 3 2 - 11 Suicide M - - - - 6 4 1 - F - - - - 1 3 1 3 Homicide and operations of war M - - - - - - - - F - - - - - - - Total - Occidents, suicide and violence 1 - 5 3 16 21 13 22 TOTALS 67 9 16 9 100 620 720 1436 (???) 89 CANCER Deaths from Cancer occurred at the following Ages:- Age period Male Female Total Under 25 years 4 5 9 25 and under 35 years 4 4 8 35 and under 45 years 10 18 28 45 and under 65 years 127 91 218 65 years and over 158 171 3 29 303 289 592 Sites of Fatal Cancer Site Male Fewale Total Percentage of Total Skin 4 1 5 0.845 Oesophagus 8 5 13 2.196 Stomach 37 22 59 9.966 liver 5 1 6 1.014 Bowel 26 38 64 10.811 Rectum 14 11 25 4. 223 Bladder 11 3 14 2.365 Prostate 18 - 18 3.041 Larynx and Pharynx 8 2 10 1.690 Uterus - 32 32 11.073 Breast - 53 53 18.339 Ovary - 25 25 8.651 Pancreas 16 15 31 5. 236 Gall Bladder and Duct 1 3 4 0.676 Tongue and Mouth 3 1 4 0. 676 Bones 3 3 6 1.014 Lungs and Bronchus 108 22 130 21.959 Kidney 2 4 6 1.014 Brain and Nervous System 5 10 15 2.534 Thyroid Gland Lymphatic Glands and 2 3 5 0.845 Connective Tissue 7 1 8 1.351 Haematopoietic Tissues 4 3 7 1. 182 Tonsil 1 1 2 0.338 Ear 1 - 1 0. 169 Hodgkin's Disease 1 1 2 0.338 Leukaemia 7 11 18 3.041 Genital Organs 3 1 4 0.676 Nose 1 - 1 0.169 Mediastinum - 1 1 0.169 jaw - 1 1 0.169 Adrenal.Gland - 1 1 0.169 Mrenal Antrum - 1 1 0. 169 Undefined - 2 2 0.338 7 11 18 3.041 303 289 592 06 COMMUNICABLE DISEASES NOTIFIED DURING 1956 Notifiable Disease Cases notified Total cases notified in wards At all ages At ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Woodside East Addiscombe Whitehorse Manor Broad Green Central Waddon South Addington Shirley M F Under 1 1-4 I5-14 15-24 25 - 44 45 - 64 65 and over Scarlet Fever 168 - 43 116 6 3 - - 6 10 25 13 4 17 7 8 2 12 18 6 7 9 18 6 86 82 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 29 - 1 1 2 4 17 4 - 2 3 4 3 2 1 3 - - 2 1 2 3 1 2 19 10 Meningococcal Infection 8 2 3 1 1 - - 1 1 1 - 1 - - 1 - - 1 1 - 2 - - 4 4 Enteric and Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 47 - - - 16 31 - - 1 1 34 - 5 1 1 - 1 - 1 1 - 1 - - - 47 Ophthalmia Neonatorum 7 7 - - - - - - 1 - 1 1 1 - - - - 3 - - - - - - 5 2 Acute Poliomyelitis 26 - 8 11 - 7 - - 2 - 1 2 - 1 - 1 2 1 - 1 4 - 11 - 10 16 Dysentery 334 13 90 123 26 76 5 1 5 11 4 2 2 7 4 3 - 1 4 - 3 1 285 2 159 175 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Primary and Influenzal Pneumonia 58 3 5 1 7 16 26 3 2 5 1 5 1 1 7 4 1 2 5 6 11 2 2 29 29 Food Poisoning 40 5 9 8 3 8 6 1 1 1 4 6 6 8 1 - - 4 - 1 1 2 3 2 19 21 Acute Encephalitis 4 1 - 1 1 1 - - - 2 - 1 - - - - - - - - - - 1 - 2 2 Measles 852 26 395 421 ! 8 2 - - 16 9 9 5 9 88 56 97 37 1 2 2 4 3 19 342 144 441 411 Whooping Cough 405 34 186 180 - 5 - - 16 17 38 16 37 3 4 28 18 38 20 17 8 17 16 58 27 176 2 29 1978 88 738 867 64 144 44 33 52 56 124 52 72 159 100 137 84 55 47 27 45 62 721 185 950 1028 91 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1956 J an . Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 10 15 33 15 15 9 10 19 6 16 20 18 186 Non-Respiratory Tuberculosis 2 1 3 1 1 2 2 2 3 1 3 2 23 Scarlet Fever 17 20 33 18 17 23 12 8 1 6 6 7 168 Diphtheria - - - - - - - - - - - - - Erysipelas 3 1 3 5 2 2 1 1 5 1 3 2 29 Meningococcal Infection 1 2 - - - - 2 - - - 1 2 8 Enteric and Paratyphoid - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Puerperal Pyrexia 8 7 3 2 - 4 4 5 4 - 3 7 47 Ophthalmia Neonatorum - - - 1 - - 2 - - - 3 1 7 Poliomyelitis and Polio-encephalitis 2 - 1 - 1 - 5 8 - 8 - 1 26 Dysentery 8 108 130 37 15 5 7 11 1 3 6 3 334 Malaria - - - - - - - - - - - - - Ac. Pri. and Ac. Inf. Pneumonia 3 16 10 5 2 4 2 3 - 2 7 4 58 Food Poisoning - 1 1 8 2 6 - 7 3 6 5 1 40 Acute Encephalitis - - - - 1 2 - - - - 1 - 4 Measles 8 60 61 9 92 104 63 50 12 12 171 210 852 Whooping Cough 6 37 32 11 16 33 36 105 67 16 26 20 405 2187 93 95 TUBERCULOSIS The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) Tuberculosi s (All Forms) 0-15 years All ages 0*IS years All ages Year Number of Deaths Death rate per thousand of 1ation * Number o f Deaths Death rate per thousand of popu1ation Year Number of Deaths Death rate per thousand of 1ation Number of Deaths Death rate per thousand of 1ation 1917 50 - 256 1.37 1937 10 - 155 0.64 1918 58 - 283 1.68 1938 12 - 137 0.56 1919 38 - 217 1.18 1939 6 - 107 0.46 1920 39 - 195 1.02 1940 8 - 146 0.74 1921 29 0.57 184 0.96 1941 10 - 111 0.59 1922 30 - 209 1.09 1942 8 - 116 0.63 1923 25 - 190 0.98 1943 9 - 120 0.62 1924 18 - 188 0.96 1944 9 - 105 0.57 1925 27 - 181 0.91 1945 9 - 92 0.46 1926 27 - 203 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 1936 11 - 151 0.60 1956 - - 26 0.10 Prior to 1947, rates only available for Census years 96 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1956 to 31st December, 1956: - TABLE 1. Formal Notification Age Periods Number of Primary Noti fi cations of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 4 5- 55- 65- 75- Total (???) Respiratory, Males 1 - - 3 - 5 11 22 16 22 23 10 2 115 Respiratory,Females - 1 - 3 3 5 18 19 14 5 2 1 - 11 Non-Respiratory, Males - - - 1 1 - 1 - 1 2 2 1 - (???) Non-Respiratory, Females - - - 3 - - 1 5 1 3 - - 1 14 97 TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1956 to 31st December, 1956, otherwise than by formal notification:- NuMber of cases In Age Groups TOTAL 2 (A) 1 (B) 2 (C) - (D) - (A) - (B) - (C) - (D) - (A) 2 (B) - (C) - (D) 65 (A) 61 (B) 2 (C) 3 (D) 1 (A) - (B) - (C) 1 (D) TOTALS (A) 68 (B) 64 (C) 4 (D) 4 75- | 1 1 - - - - - - - - - - - - - - - - - - 65- - - - - - - - - 1 - - - - - - - - - - 55- 1 - - - - - - - - - - 1 2 - - - - - - 45- - 1 - - - - - - - - - 7 6 1 - - - - - 35- - - - - - - - - - 1 - - 16 6 - 1 - - - 1 25- - - 1 - - - - - - - - - 28 26 - 1 1 - - - 20- - - - - - - - - - - - - 9 17 - 1 - - - - 1 5- - - - - - - - - - - - - 3 3 - - - - - - 10- - - - - - - - - - - - - 1 1 1 - - - - - 5- - - - - - - - - - - - - - - - - - - - - 2- - - - - - - - - - - - - - - - - - - - - - 1- - - - - - - - - - - - - - - - - - - - - 0- - - 1 - - - - - - - - - - - - - - - - - - M F M F M F M F M F M F: M F M .F M F M F Respi ratory Non-Respiratory Respiratory Non-Respiratory Respiratory Non-Respi ratory Respiratory Non-Respiratory Respiratory Non-Respiratory Sou ree o f In format! on Death Returns from Local Registrars Death Returns from RegistrarGeneral (Transferable Deaths) Posthumous Notifications "Transfers " from Other Areas (excluding transferable deaths) Other Sources 98 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January,1956 1,883 Transfers in from other areas 101 "Lost sight of " cases returned during the year 3 New cases diagnosed as definite during the year 202 2,196 Number of cases written off the Chest Clinic Register during the year as:- Recovered 61 Died 30 Removed to other areas 88 "Lost sight of" and other reasons 1 199 Remaining on Register as at 31st December 1,997 The following particulars give a summary of the work done is connection with the Clinic:- Number of patients examined for the first time, excluding inward transfers, i.e. patients who have removed from other areas 2,448 Number of visits paid by Clinic doctors to homes of patients 268 Number of visits paid to homes of patients by Tuberculosis Health Visitors 2,912 Attendances of patients at the Clinic - At ordinary sessions 18,852 At refill sessions 4,401 237253 Number of X-ray films taken 17,508 * includes 3,017 miniature film attendances 99 101 VENEREAL DISEASES Totals Maies Females l. Patients under treatment or observation on January 1st 78 41 37 2. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 1 1 _ 3. Patients transferred from other Centres after diagnosis 5 1 4 SYPHILIS 4. Patients dealt with for the first time (excluding 2 and 3) suffering from:- Syphilis, primary 1 1 _ '' secondary 3 1 2 '' latent in the 1st year of infection _ _ _ 1' cardio-vascular _ _ _ " of the nervous system - - - All other late or latent stages 6 3 3 Syphilis congenital: aged under 1 year _ _ _ Syphilis congenital: aged 1 but under 5 _ _ _ Syphilis congenital: aged 5 but under 15 - - - Syphilis congenital: aged 15 and over 7 - 7 TOTAL Item 4 17 5 12 5. Patients completing treatment and/or observation 16 6 10 6. Patients transferred elsewhe 3 2 1 7. Patients not completing treatment and/or observation _ _ _ 8. Patients under treatment or observation on December 3ist (should equal Items 1 to 4 less Items 5 to 7) 82 40 42 GONORRHOEA 9. Patients under treatment or observation on January 1st 3 2 1 10. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 2 2 11. Patients transferred from other Centres after diagnosis 3 _ 3 12. Patients dealt with for the first time (excluding Items 10 and 11 56 44 12 13. Patients completing treatment and/or observatior 39 32 7 14. Patients transferred elsewhere 2 1 1 15. Patients not completing treatment and/or observation 6 6 _ 16. Patients under treatment or observation on December 31st (should equal Items 9 to 12 less Items 13 to 15) 17 9 8 102  Totals Males Femals OTHER CONDITIONS 17. Patients under treatment or observation on January 1st 23 14 9 18. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 21 19 2 19. Patients transferred from other Centres after observation 3 2 1 20. Patients dealt with for the first time (excluding Items 18 and 19) suffering from: - • (Chancroid - - (Lymphogranuloma ( Venereum - - - (Granuloma Inguinale - - - (Non-gonococcal ( Urethritis 45 45 (Any other conditions ( requiring treatment 88 53 35 (Conditions not requir( ing treatment 241 142 99 (Undiagnosed conditions - - - TOTAL Item 20 374 240 134 21. Patients completing treatment and/or observation 376 241 135 22. Patients transferred elsewhere 3 2 1 23. Patients not completing treatment and/or observation 5 4 1 24. Patients under treatment or observation on December 31st (should equal Items 17 to 20 less Items 21 to 23) 37 28 9 ATTENDANCES BY PATIENTS At which patients saw physician At which patients did not see physician Syphilis Gonorrhoea Other Conditions TOTALS Syphilis Gonorrhoea Other Conditions TOTALS 3 28 169 159 302 259 43 1146 904 1776 1332 444 9741 204 537 103 45 58 524 240 284__ 1368 489 879 CONTACTS ATTENDING FOR EXAMINATION REFERRED BY PATIENTS SUFFERING FROM:- Syphilis Gonorrhoea Non-gonococcal urethritis Other conditions TOTALS 1 - 1 10 9 1 14 14 - 30 26 4 55 49 103 By the Physici an at the Centre Sent to a Pathological Centre PATHOLOGICAL WORK NUMBER OF SPECIMENS EXAMINED Microscopical: for Syphilis Microscopical: others Cultural Serum: for Syphilis others Cerebro Spinal Fluid (Number of diagnostic lumbar punctures) 2 727 3 28 560 206 9 SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR SHOWING THE AREAS IN WHICH PATIENTS DEALT WITH FOR THE FIRST TIME (ITEMS 4, 12 AND 20) RESIDED (MAJOR AREAS TO BE SPECIFIED. MINOR AREAS MAY BE GROUPED AS "ALL OTHERS " ) County, County Borough (England and Wales ) and Others Syphilis Gonorrhoea Other Condi tions Totals Croydon 12 33 240 285 Surrey 3 9 92 104 Kent 2 3 19 24 London - 11 23 34 Totals (to agree with Items 4, 12 and 20 17 56 374 447 104 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1956 who wen born - (i) at home 46 (ii) in private nursing homes 1 (iit) in hospital 125 (2) The number of those born at home - who were nursed entirely at home 44 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 45 (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 1 (4) Number of those born in hospital - who died during the first 24 hours 13 who survived at the end of one month 107 (5) Number of premature still births who were born - (i) at home 1 (ii) in private nursing homes (iii) in hospital 34 105 ATTENDANCES AT INFANT CENTRES - 1956 Addington. Monday, p.m. Croydon, Monday, p.m. East Croydon. | Tuesday. A.M. East Croydon, Friday, p. m. New Addlngton, Wednesday, a. m. New Addlngton, Wednesday, p.m. New Addlngton, Friday. P.m. Norbury, Wednesday, A. m. Norbury, Wednesday, p.m. Norbury, Thursday, A.M. Norbury, Thursday, p.m. Selhurst, Wednesday, p.m. Selhurst, Prlday, P.M. Shirley. Monday, A.M. Shirley, Monday. P.m. Shirley. Thursday, p.m. South Croydon, Tuesday, p.m. South Croydon, Wednesday, p.m. South Croydon, Thursday, p.m. South Norwood, Wednesday, p.m. South Norwood, Friday, P.M. Soutb Norwood. Tuesday, P.m. South Norwood, Friday. P.M. Thornton Heath, Monday, A.M. Thornton Heath, Monday, P.M. Thornton Heath, Tuesday, A. M. Thornton Heath, Tuesday, P.M. Upper Norwood, Wednesday, p.m. Waddon, Wednesday, P.M. West Croydon, Monday, P.m. West Croydon. Thursday. P.m. West Croydon. Thursday. P.M. Woodslde, Friday, A.M. Woodslde, Friday. P.m. Total, 1956 Total, 1955 New cases under 1 year 26 97 115 162 123 170 69 89 107 51 76 83 34 70 52 70 51 113 106 133 65 138 136 73 104 68 97 152 64 119 109 133 60 89 3204 3030 No. of Re-attendances 263 1609 1943 2217 1998 2115 913 1470 1685 937 1393 970 832 1102 805 1152 765 1768 1631 1699 1264 1936 1816 1238 1591 1381 1800 1951 1069 1371 1264 2421 969 1388 48726 45438 New cases over 1 year 5 22 22 18 21 37 8 11 14 8 18 11 - 13 11 14 4 19 18 29 11 12 19 18 29 11 7 25 7 4 18 17 9 7 497 456 No. of Re-attendances. 145 552 643 813 1035 979 347 985 1126 621 851 603 677 527 320 504 472 705 746 773 607 550 556 833 1063 677 770 706 440 329 634 328 417 666 22100 22477 Attendances of Children 0-5 439 2280 2723 3310 3177 T 01 1337 2555 2932 1617 2338 1667 1543 1712 1188 1740 1292 2605 2501 2634 1947 2636 2527 2162 27 87 2137 2674 2834 1580 1823 2025 2899 1455 2150 74527 71401 Consultations vlth Doctor 149 791 731 821 955 982 418 703 828 579 772 599 381 381 373 370 218 835 725 746 548 670 655 912 1096 599 762 711 521 597 731 834 566 694 22253 20949 No. of Sessions 9 50 51 51 51 51 51 51 51 52 52 51 51 50 49 50 51 51 52 51 51 51 51 50 49 51 51 50 51 48 51 52 51 51 1684 1647 EXPECTANT MOTHERS No. of new cases - - - - 3 - - - - - - 2 1 - - - - - - - - - - - - - - - - - - - - - 8 5 No of Re- attendances - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 2 3 3 Total attendances of Expectant Mothers - - - 3 - - - - - - - 2 1 - - - - - - - - - - - - - - - - - - 1 - 2 11 8 Total Attendances 439 2280 2723 3313 3177 3301 1337 2555 2932 1617 2338 1669 1544 1712 1188 1740 1292 2607 2501 2634 1947 2636 2527 2162 2787 2137 2674 2834 1580 1823 2025 2900 1455 2152 74538 71409 Average per Session 1056 48.8 45.6 53.4 65.0 62.3 64.7 26. 2 50. 1 57. 5 31. 1 45.0 32.7 30.3 34.2 24.2 34.8 25.3 51. 1 48. 1 51.6 38. 2 51.7 49.5 43. 2 56.9 41.9 52.4 56.7 31.0 38.0 39.7 55.8 28. 5 42.2 44.3 - Average per Session 1955 - 40.9 57.3 70.2 59.5 57.9 30.3 43.0 57.4 32.2 50. 1 31. 1 29. 1 39.4 17. 3 35. 5 27.3 50.4 46. 1 39.9 32.9 43.0 50.8 40. 5 56. 1 44. 5 52.8 60.8 27.4 37.0 32.8 50. 3 31.0 41.4 • 43.4 106 HOME NURSING Staff at 31.12.56 Superintendent Deputy Superintendent 2 Assistant Superintendents 38 whole time Nurses (including 4 males) 1 S. E.A.N. Nurse 6 Queen's Students Summary of work carried out during the year under.review Patients remaining on books from 1955 917 New patients 5.774 Total 6,691 New Patients:- Medical 2,618 Surgical 3,057 Gynaecological 67 Obstetric 22 Maternity 10 Total 5,774 Specially classified Cases Visits Tuberculosis 142 4,413 Pneumonia 243 2,204 Maternity Complications 60 591 Infectious Diseases (including influenza) 20 119 Children under five years 187 1,104 Visits:Termination of Cases:- Convalescent 3,492 Hospital 790 Died 521 Removed for other causes 900 Still on books 988 Total 6,691 107 Total visits January 13,923 February 13,576 March 14,329 April 13,166 May 13,691 June 12,031 July 11,704 August 11,938 September 11,464 October 12,170 November 12,596 December 13,368 Total 153,956 M. AND C.W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year:- Compl aint No. of Cases Total M F Bow Legs 3 4 7 Knock Knees and Flat Feet 15 10 25 Valgus Ankles 5 4 9 Chest Conditions: Post T. A. and Asthma ... 8 2 10 Kyphosis 2 2 4 Torticollis 2 2 4 Pigeon-toes 8 6 14 43 30 73 Total attendances: 1,269 108 DENTAL TREATMENT - M. AND C. W. Expectant Mo thers Nursing Mo thers Total Young Childres New Cases Examined 324 39 363 445 1 Re-treated 81 31 112 96 Total 405 70 475 541 Expectant and Nursing Mothers _ Young Children Attendances 1,186 981 Fillings 380 339 Extractions 488 666 Gas Cases 139 216 Local Anaesthesia 122 17 Scaling and Gum Treatment 169 - Dressings 261 340 Denture Dressings 289 - Silver Nitrate - 174 Treatments Completed 291 281 Number of Sessions (treatment) 404 Dentures Pitted 60 Dentures Repaired 14 The Centres at which patients were examined, or from which they were referred, are given in the following list:- Wothers Young Children Mothers Young Childres Ante-Natal 465 - South Croydon - 3 Municipal Midwives 17 - St. Alban's - 3 Woodside - - Post-Natal 6 - Norbury - 15 Welfare etc. Centres: - Addington - 16 Municipal 2 3 St. Andrew's - 5 East Croydon - 6 Waddon - 6 Upper Norwood - 4 Boston Road - 2 Holy Trinity - 7 St. Jude's - 8 St. Oswald's - 7 St.john's (Shirley) - 6 Bensham Manor - - Monks Hill 1 FairchiIdes - 1 Crossfield Nursery) - - West Croydon - - Referred by Dental Officers 448 South Norwood - - Mothers: 491 Young Children: 541 Total: 1,032 109 MIDWIFERY SERVICE The work of the municipal midwives was as follows: - 1. The number of maternity deliveries by Municipal Midwives on the district in the year 1,208 2. The number of spontaneous deliveries 1,203 3. The number of forceps deliveries 5 4. The number of live births 1,206 5. The number of still births 2 6. The number of neo-natal deaths - 7. The number of premature infants and their weights 9 (!) 36 weeks - 4 lbs. 12 ozs. Transferred to Mayday Hospital (2) 39 weeks - 4 lbs. 4 ozs. " " (3) 34 weeks -) (twins) not weighed " " " " (4) 34 weeks) (5) 34 weeks - 3 lbs. 8 ozs. " " " " (6) 39 weeks - 3 lbs. 12 ozs. " " " " (7) 36 weeks - 3 lbs. 12 ozs. " " " " (8) 32 weeks - not weighed " " " " (9) 36 weeks - 4 lbs. 4 ozs. Treated at home: Discharge weight 5lbs. 8. The number of patients who received Trilene 16 9. The number of patients who received Gas-Air Analgesia 1,119 10. The number of cases of P.P. 27 11. The number of cases of manual removal of placenta - 12. The number of patients who received blood transfusion 1 13. The number of cases to which Plying Squad was called 2 14. The number of cases of toxaemia of pregnancy treated at home 1 15. The number of cases of prolonged labour (over 24 hours) 16 16. The number of breech deliveries including 2 twin 6 17. The number of twins delivered in their own homes 2 sets 18. The number of triplets - 19. The number of cases of Puerperal Pyrexia Genital - Extra-Genital 11 Total 11 20. The number of congenital malformations 9 21. Patients given Pethedine 683 22. Patients sent into Hospital: Ante-natal 275 During labour 76 After labour 41 Total 392 23. Patients sent home for nursing: Home booked 188 Hospital booked 27 Total 215 110 Midwifery Maternity AnteNatal Visits PostNatal Visits Midwife Mileage Deliveries Norm al Abnormal Normal Abnormal Gas and Air Mid wives Pupils Midwives Pupils Bookings 1 2447 - • - - - - 9 - 23 - - 2 Cycle Master 67 43 2 22 • 60 346 258 844 955 98 3 2840 75 63 6 3 3 68 591 - 1175 - 61 4 Bicycle 9 7 - 2 - 8 49 - 154 - 1 5 1745 82 81 1 - - 79 206 166 1046 1028 101 6 4704 102 87 2 12 1 97 642 276 1336 934 101 7 144 37 28 - 8 1 35 454 - 523 - 10 8 4138 107 94 2 10 1 93 337 457 149 1124 110 9 Bicycle 33 62 56 - 6 - 56 441 229 1007 930 109 10 Cycle Master 58 50 I 7 - 56 317 - 895 - 63 11 3544 36 21 1 13 1 34 297 - 843 - 1! 12 18 27 57 45 - 10 2 54 6 47 137 886 313 84 13 611 22 22 - - - 18 65 - 406 - 34 14 2641 21 16 - 5 - 18 137 - 513 - 11 15 5682 66 54 3 8 1 63 522 305 1093 1036 12! 16 3908 103 91 7 3 2 98 816 278 1540 1055 99 17 4410 74 55 4 15 - 69 526 382 836 1082 108 18 4841 105 88 3 13 1 95 378 252 993 776 95 19 Cycle Master 15 11 4 - - 15 48 - 218 - 14 20 Cycle Master 56 49 3 4 - 53 268 205 685 803 80 21 501 16 11 1 4 - 16 87 86 178 237 29 22 3158 38 35 - 1 2 34 180 - 7 46 - 45 Total 47174 1208 1007 40 146 15 1119 7363 3031 16089 10273 1483 1 - Deputy Superintendent: 4 - from 1.10.56: 7 - from 1.4.56: 13 - from 1.8.5 14 - from 1.5.56: 19 - left 31.3.56: 20 - left 24.9. 56: 21 - sick since 1.4.5 22 - left 31. 10. 56. 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 1254 issued during the year. Ill The following table gives the details of the reasons for Midwives summoning medical aid: - FOR COMPLICATIONS DURING PREGNANCY Abortion 7 Other Causes 9 16 FOR COMPLICATIONS DURING LABOUR Breech 7 Post-partum haemorrhage 21 Malpresentation 5 Adherent and Retained Placenta 7 Premature Labour 6 Delayed Labour 29 Torn Perineum 145 Ante-partum haemorrhage 15 Other Causes 15 250 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 25 Pain in Breasts 9 Pain in Legs 7 Other Causes 32 73 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 27 Still Birth 2 Other Causes 54 83 422 In accordance with Rule 33 of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received: - Illness of Mother 54 Defects of lactation 373 Other Causes 49 Total 476 112 THE WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE Visits Miss Bird Miss Blackmore Miss Blest Mrs. Cripps Com. 1.3.56. Mrs. Collins Part-time Miss Devaney Miss Early Miss Edwards Com. 3.9.56. Miss Eldridge Miss Elliott To 30.9.56. Miss Emms Miss Francis Com. 1. 10.52. Mrs. Hastings Com. 20.2.56. Miss Hawkins Miss Hodgson Com. 13. 8.56. Mrs. Laing Part-time Miss Llewellyn Mrs. Mayo Miss Morton Miss Partridge Miss Phillips Com. 11.1.56. Miss Pickering Miss Poupard Mrs. Singleton Left 29.10.56. Mrs. Stevens Miss Thieson Miss Thompson Mrs. Tripet Miss Vince Mrs. Weinbren Com. 3.9.56. Miss Webb Left 8,4.56. Mrs. Wilson Miss Wybrew Total 1956 Total 1955 Infants under 1 year - Plrst Visits 113 167 148 125 24 197 58 48 230 105 110 37 61 142 34 203 142 144 181 142 102 112 271 74 143 97 110 8 111 56 75 134 145 3849 3598 Re-visits 382 790 578 670 16 496 592 389 502 394 652 99 304 487 300 332 615 708 409 369 285 612 504 52 590 377 641 140 703 161 119 668 505 14441 15140 Children 1-2 years Plrst Visits 3 4 4 2 - 20 - - - 1 - - 8 13 - 3 7 3 - 5 7 - 9 13 94 - 6 1 - 4 3 8 8 226 226 Re-visits 336 621 251 402 4 459 478 236 293 134 339 36 288 257 201 90 424 594 233 222 195 236 387 15 334 149 361 60 835 107 47 399 297 9320 10351 Children 2-9 years - First Visits 2 3 4 1 - 19 1 - - 8 1 - - 21 - 1 9 3 - 6 2 - 5 3 92 - 1 5 - 1 4 5 14 211 206 Re-visits 208 1006 690 377 10 538 364 197 625 181 412 103 362 511 292 61 512 709 404 465 181 427 456 1 398 356 390 56 1073 191 111 463 652 12782 15444 Expectant Mothers - First Visits 3 05 14 22 - 6 1 1 16 17 8 4 12 50 - 12 60 5 26 36 31 - 18 - 28 30 21 14 13 9 13 48 54 667 730 Re-visits 2 27 2 14 - - 3 - - 11 1 5 7 7 - 4 28 68 4 7 9 21 15 1 3 10 26 29 3 - - 5 1 313 327 Still Births - 1 - - - - - - - - - 2 2 1 - 2 2 - - - 1 - - - - - - - - - - - - 11 8 Deaths under 1 year - 1 1 - - - - - - - - 1 1 1 - 1 5 1 - - - - 3 - 1 1 - - - - - - 17 20 Miscellaneous visits 288 211 178 83 6 320 55 19 129 208 140 28 66 115 11 63 24 80 66 67 68 23 277 - 23 62 140 - 6 23 23 179 60 3041 3969 Ineffective visits 301 206 300 417 22 284 505 193 95 173 282 51 226 395 323 450 325 201 433 145 80 557 315 41 549 224 394 1 184 230 90 187 344 8523 8461 TOTALS, 1956 1638 3132 2170 2113 82 2339 2057 1083 1890 1232 1945 366 1337 2000 1161 1222 2153 2516 1756 1464 961 1988 2260 200 2255 1305 2091 314 2928 782 485 2096 2080 53401 - TOTALS, 1955 1411 2511 2441 - 674 1208 2631 - 2036 1004 2030 - - 2088 - 1118 1797 3090 2426 1383 - 2305 2412 1904 919 1328 1730 3074 3555 - 299 754 2508 -0 58480 113 IMMUNISATION AGAINST DIPHTHERIA A total of 2.98G children came from the following sources:- Of these, 17 failed to return for completion of the course. School children 311 Children under 5 2,675 Reinforcing injections are now being recommended, just before the child starts school, and again at 10 years of age, i.e. at about 5-yearly intervals. The number of such injections given during the year was 2, 094. The ensuing comparative tables give some further details:- Year Children Completed Treatment Failed to attend for completion of Course Rein forcing Injections 1940 428 419 . - 1941 6,639 5,833 - - 1942 6, 133 5, 511 - - 1943 S, 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, 459 3, 436 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 1956 2,986 2, 969 17 2, 094 Origin and Source of Children attending Year School Pre-school Total Percent Total Percent 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 1956 311 10.4 2,675 89.6 114 IMMUNISATION AGAINST WHOOPING COUGII A total of 2,596 children were immunised against whooping cough, comprising 2,544 under school age and 52 school children, 418 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 2,207 persons were vaccinated against Small-pox. Under 1 year of age 1 2 - 4 5 - 14 15 or over Total Successful Vaccinations 1, 632 178 78 42 21 1,951 " Re-vaccinations - - 4 15 85 104 Insusceptible to Vaccination 137 13 1 - 1 152 2,207 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1956, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1942). Age at 31.12. 56 i.e. Born in Year Under 1 1956 1 - 4 1952-1955 5 - 9 1947-1951 10 - 14 1942-1946 Under 15 Total  Last complete course of injections (whether primary or booster) A. 1952 - 1956 1, 942 9, 125 7, 450 1, 823 20,340 B. 1951 or earlier - - 8,018 13,657 21,0 C. Estimated midyear child population 3, 520 13,480 38,100 55,100 Immunity Index 100 A/C 55. 17 67. 69 24. 34 36.91 VACCINATION AGAINST POLIOMYELITIS 873 children were given this protection. 115 AMBULANCE SERVICE Classification of Journeys, Patients and Mileage. Patients Journeys Mileage Health Service Removals 72,240 (77,949) 44, 309 (44, 006) 345, 809 (381,829) Spastics 4, 232 (- ) 731 ( - ) 12,060 ( - ) Mental Defectives 23, 984 ( 18, 670) 812 (788) 23, 249 (23,466) St. Margaret's School 487 (478) 365 (378) 3,096 (2,567) Accidents 3, 620 (3, 730) 3, 464 (3,577) 18,264 (18,805) Abortive 249 (225) 1,094 (1,350) Gas and Air Analgesia 626 (900) 5,063 (8,059) Miscellaneous, (Testing, Pay Round, etc.) 546 (617) 5,177 (4,235) 104,563 (100, 827) 51,102 (50,491) 413,812 (440,311) Civil Defence 188 (149) 1,876 (1,824) 104,563 (100,827) 51,290 (50,640) 415,688 (442,135) 18,925 (19,434) cases were conveyed to places outside the Borough, and on these journeys 132,756 ( 132,568) miles were travelled. N.B. All figures in brackets are for previous year. Classification of Accident Calls Home Accidents (Children) 336 (Adults) 354 Miscellaneous Accidents (Children) 74 (Adults) 164 Recreational Accidents (Children) 55 (Adults) 66 School Accidents ... ... 238 Street Accidents (Children) 174 (Adults) 755 Work Accidents ... ... 308 Home Illness (Children) 36 (Adults) 164 Street Illness (Children) 9 (Adults) 558 Work illness ... ... 81 Attempted Suicide ... ... 36 Suicide ... ... 9 Common Assault ... ... 47 3,464 116 HOME HELP SERVICE Staff at 31.12.56. Supervisor 2 Assistant Supervisors 1 Clerk Assistant 1 Clerk 15 Whole Time Home Helps 150 Part Time Home Helps Summary of ujork carried out during the year under review- Patients remaining on books from 1955 872 New Applicants1,295 Patients carried forward to 1957 986 New Applicants (a) Maternit 420 (b) Sickness 866 (c) For Night Service 9 Classification of Cases Attended (a) Maternity 333 (b) Tuberculosis 30 (c) Chronic Sick including O/A 1,475 (d) Others including Acute Sick 388 Number of Hours Service Given 174,827 Average Duration of Service Given (a) Maternity12 days (b) Acute Sickness 10-21 days (c) Chronic sickness indefinite Amount Recovered for Service £5,153. 5.8. Rate of Remuneration of Home Helps at 31.12.56. 3/l5/8d. per hour - Home Helps 2/1l5/8d. " - Sick Room Helpers 2/115/8d. " - Washing Service 3/75/8d. " - Problem Family Helps £7.16.9d. per week - Family Helps 10/- " - Disinfestation 117 PROBLEM ETC. FAMILIES SUMMARY OF THE WORK CARRIED OUT DURING 1956 BY THE HEALTH VISITOR SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES, AND TO PREVENT THEIR NEED FOR ADMISSION Rehoused in private accommodation 15 Rehoused in Council accommodation 50 (Of these 4 accommodated outside the Borough) Visits paid:- Family Departments Agents and Contacts 445 69 105 Families without permanent housing at close of year: - 40. Visits paid:- Family Departments Agents and. Contacts 702 135 78 Potential Homeless Families -not admitted to Receiving Homes - 13. Visits paid:- Family Departments Agents and Contacts 78 29 24 Visits re - employment 16 Families assisted with furniture 15 Families referred by Members of the council 8 Families referred by the Housing Department owing to risk of eviction 11 Families making direct contact 3 1 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1956 To the Chairman and Members of the Education Committee. ladies and gentlemen. I have the honour to present for your consideration the Annua] Report of the Principal School Medical Officer for the year ending December 31st, 1956. It has been a period of quiet development. The alteration of routine medical examinations so that two fall in the primary school phase and two in the secondary took effect on January 1st and no difficulties arose. It seems probable that the advantages foreseen will be realised. Despite the efforts made to ensure that every child concerned was examined, the totals are slightly less than those of the previous year. This was due to the need to divert staff to deal with poliomyelitis vaccination, which was available for the first time in this country and was introduced with every possible measure to make certain of its safety. For the actual giving of the vaccine, which was left entirely to Health Departments, equally stringent precautions were taken, so that many more sessions of doctors' and nurses' time were used for this purpose than would usually be the case. I have now been authorised to arrange for the employment in future of special staff, in order that the ordinary work of the department shall not be interrupted. 2 Following the outbreak of Sonne Dysentery in 1955, an informal survey was carried out of hand-washing facilities in all Corporation schools. As the Committee knows, there are older schools with buildings not up to the standard now thought necessary and a policy of steady modernisation is being carried through as rapidly as finances permit. Apart from building adaptations, however, there are matters such as the number of towels provided and the frequency with which they are changed and it was to this that attention was directed. In some cases, improvement was possible without awaiting capital expenditure. There were no major outbreaks of infection during the year under review, although minor illnesses, especially in primary schools continued to cause short-term absences of many scholars. I have commented before on our inability to prevent the spread of less serious illnesses, which invade the body through the nose and throat. Family units now being much smaller than formerly results in most children meeting infection for the first time when they commence school life. It is disappointing for parents and teachers that the most modern buildings have little effect in reducing these infections. New schools frequently draw children from new catchment areas and the fresh cross sections of population generally have more infection troubles than established communities. Fortunately, the size of primary school classes is now falling with beneficial results. While not suggesting a return to former educational methods, it is probable that the mobility of children in presentday infant classes encourages the spread of infections of the upper respiratory tract. The placing of handicapped children in special schools produced no particular difficulties. The former shortage of residential places for educationally sub-normal children is disappearing with the opening of schools by other authorities with facilities for Croydon scholars. The Principal Dental Officer deals with the continuing difficulties of recruitment to the School Dental Service, but even here, some improvement can be reported. Once again, I have pleasure in thanking the Chief Education Officer and his Staff for continued help and co-operation. The Head Teachers into whose schools we sometimes intrude at inconvenient times, have nevertheless, done all in their power M make us welcome. I think it is realised that our aim is to give 3 whatever help we can in the discharge of their great responsibility to educate children in wisdom and in health. Finally, on behalf of the staff of the department, I thank the Members of the Committee for their unfailing readiness to support and encourage worthwhile developments to safeguard and improve the well-being of the children for whom we are responsible. Public Health Dept., Croydon. 4 STAFF OF THE SCHOOL HEALTH SERVICE Medical Officers 9 (including 1 part-time) - (38%) Dental Officers 10 (including 4 part-time) - (80%) Physiotherapists 2 (95%) Speech Therapists 3 (including 1 part-time) School Nurses 32 (including s.H.V. and Deputy - (56%) Dental Attendants 12 (including 5 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 Ailments Clinic, is by appointment arranged by the School Medical Officer:- Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon (Daily, Monday to Saturday, a.m.); Ashburton School (Mondays and Thursdays only, 9 a.m.); Rockmount school (Mondays am Thursdays only, 9 a.m.); Duppas School, Goodwin Road, Waddon (Daily, Monday to Friday, a.m.); Salcot Crescent, New Addington (Monday to Friday, a.m.). Dental Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood; waldrons Hall, 55 Duppas Hill Lane, Croydon, Overbury School, New Addington; and Stroud Green, Shirley Road, Croydon. Inspection Lodge Road, Broad Green, Croydon. Remedial Exercises and Massage 47 St. James's Road, Broad Green, Croydon. Speech Defects 47 St. James's Road, Broad Green, Croydon and at Salcot Crescent, New Addington Enuresis Lodge Road, Broad Green, Croydon. 5 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is now as follows: Primary and Modern Secondary Schools. (1) Entrants i.e., Children admitted for the first time to a Maintained School. (2) 8-year-old Group i.e. (3) mediates (4) Leavers (Final) i.e. (5) Special Cases (if any) i.e. i.e. Children who had attained their 8th birthday at the opening date of the Term but have not yet reached their 9th birthday and who have not been medically examined at the age of 8 years. Children in their first year at a Maintained Secondary School. Children in their last year of attendance in a Maintained Secondary School who have not been medically examined in that year. Children of other ages who are apparently defective and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 12,050 children were examined as compared with 12,194 in 1955, and 7,868 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for toys 88.4 per cent, and girls 87.9 per cent.; in the Intermediate group, boys 43.0 per cent.; girls 59. 6 per cent.; in the Leavers' group, boys 9.0 per cent., girls 25.6 per cent.; and in the Other Ages and 8 to 9 year group, boys 77.0 per cent., girls 78.5 Per cent. The total percentage of parents attending was 65.3 as against 69.6 last year. (See Appendix B, Table 3). 769 specials and 555 re-inspections of children were carried out. 6 INFECTIOUS DISEASES An outbreak of Sonne Dysentery occurred in a school at New Addington. It responded to the measures outlined in ray Report last year. The school concerned was of the latest design with sanitary annexes adjoining the infant classrooms. The initial disappointment of the staff that entry to their new school should be followed by an outbreak of Dysentery is understandable. While control was much easier with a building of this type, the outbreak emphasised that school buildings however well designed can no more replace training and supervision in the. teaching of hygiene than in the pursuit of general education. Sonnd Dysentery is a stringent test and few children of five or six years of age have the knowledge or ability to achieve unaided a satisfactory standard of toilet hygiene. The cases of Ringworm of the body were traced to infected cats and as the animals were obviously ill, the sources of the infection were dealt with promptly. Infectious Jaundice was more prevalent than recorded cases suggest and one child died from subsequent hepatic failure. Medical and Nursing personnel were warned to keep this illness in mind to ensure prompt exclusion and adequate treatment of cases. Poliomyelitis was of average prevalence and cases were mainly mild in character. Findings at Routine Medical Inspections. The figures shown in Appendix B, Table 5 follow the usual pattern. Defects of the nose and throat in Entrants relate to enlargement of the tonsils and adenoids. This is part of the general reaction of children to infections of the respiratory tract. In this connection, a record was made for the first tine of the number of children seen at routine-medical inspections who had undergone the operation for removal of tonsils and adenoids. It will be observed that one third of all school leavers in Croydon had undergone this operation. Vision tests depend upon ability to read letters or figures and consequently the first age group to have this examination as a routine measure are the eight years old. Where there is a defect which obviously interferes with education amongst younger children, they are, of course, dealt with individually as is shown by the small percentage recorded in the general table relating to defects found at medical inspections. 7 HEIGHTS AND WEIGHTS The figures of average heights and weights are recorded in Appendix B. 2. For some years, it has given me satisfaction to comment that children are taller and heavier than formerly and to quote this evidence as proof of better feeding and general care. Some observers now assert, however, that far from having improved the health of children, our efforts have resulted only in hastening maturity and may eventually shorten their lives. Fortunately, the history of science is comforting in that gloomy forecasts, which seem contrary to common sense, have generally proved wrong. The pattern of our national diet is no doubt capable of much improvement. That children would tend to grow bigger if adequately fed seems, however, a result to be anticipated and accepted as being to their advantage. I am not aware that underfeeding of the young has ever been associated with subsequent longevity. It may well be that in adult life, restrictions on total intake and avoidance of certain foods are beneficial. With the evidence so far available, I think we are justified in continuing to meet to a reasonable degree, the keen appetites of active growing children. There is probably a developing need to watch for unnecessary obesity, to enquire regarding possible causes and to warn against the establishment of a habit of overeating. VISION TESTS Summary of Findings Extent of Defect Intermediate Leavers 8 to 9 years and Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % No. % No. % Up to 6/24ths 38 5. 5 58 7. 4 56 4.4 80 7.3 142 6.7 155 8.2 236 5.8 293 7.4 0ver 6/24ths - - 5 0.6 4 0.3 8 0.7 7 0.3 13 0.7 11 0.3 26 0.7 8 All Groups Boys and Girls 2645 - 22% UNCLEANLINESS Cleanliness inspections are carried out by the School Nurses each term in every school, so that all pupils are brought under review. The finding of slight infestation in unexpected offenders leads to the issue of an informal letter to the parents, setting out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parents of children previously found verminous. Steel combs are sold or loaned where necessary. Endeavour is made to serve notices on the parents by the School Nurse personally, so that she has opportunity to emphasise that infestation may be a family complaint and not limited to the school child, and the need for constant cleanliness to prevent relapses. A cleansing station is provided for the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection) 66,862 Number of children inspected (subsequent inspections) 990 Number of children found unclean (first inspection) (570 occasions of infestation) 259 Number of occasions in which children found unclean (subsequent inspections) 178 At the primary inspections vermin were found in 31 and nits alone in 456 children. On these inspections 0.7 per cent, of the children showed evidence of infestation as against 0.6 in 1955 20 children attended the Cleansing Station for treatment. RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1956 WHO HAVE UNDERGONE TONSILLECTOMY Entrants t t Boys 164 - 8.2% Girls 180 - 8.9% All Entrants 344-8.6% 8-9 yrs. Boys 550 - 25.8% Girls 458 - 24.3% All 8-9 yrs. 1008-25.1% All Boys 1368-22.4 Inter " Boys 225 - 32.5% Girls 213 - 27.2% All Inter 438-29.7% All Girls 1271-21.55 Leavers " Boys 429 - 33.8% Girls 426 - 33.6% All Leavers 855-33.7% 9 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis - Pulmonary 9 Non-Pulmonary5 Taking the total child population at 38,100, the pulmonary tuberculosis incidence rate per 100,000 was 24.6, and the nonpulmonary incidence rate 13.1. There were no deaths from tuberculosis. CAUSES OF DEATH IN SCHOOL CHILDREN Child population, 38,100. (Registrar General's estimate) Number of deaths 16, which is equal to a death-rate of 0.42 per 1,000. The deaths were due to: - Broncho pneumonia 2 Nephritis 1 Hepatic atrophy 1 Hydrocephalus 1 Spastic paraplegia 1 Lymphosarcoma 1 Leukaemia 4 Accidental Causes 5 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL Condition Exclusions during 1956 Percent age of total exclusion s Exclusions during 1955 Percentage of total exclusions Ringworm 8 0.64 4 0.13 Verninous Conditions 69 5.51 63 2.02 Impetigo 34 2.72 43 1.38 Scabies 2 0.16 6 0.19 Scarlet Fever 106 8.47 156 5.01 Measles (inc. German) 197 15.73 1,429 45.89 Diphtheria - - - _ Whooping Cough 88 7.03 101 3.24 Chicken Pox 457 36.50 598 19.20 Mumps 160 12.78 207 6.65 External Eye Disease 1 0.08 3 0.10 Polomyelitis 12 0.96 13 0.42 Dysentery 108 8.63 476 15.29 Jaundice 5 0.40 - - Other Causes 5 0.40 15 0. 48 1,252 - 3, 114 - 10 The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Vermin and Ringworm, whilst the remainder all show a decrease. WORK OF SCHOOL NURSES All the School Nurses whose work is set out below are also Health Visitors and are thus able to judge by direct observation the inter-action of influences at home and in school on any particular child. With changes in school catchment areas, the ideal of the Health Visitor to a family being also the School Nurse for its school children members may not be achieved. Even so, she has daily contact with colleagues from whom the necessary information can readily be obtained. There is also the obvious economy which results from district visiting being for the school health and maternity and infant welfare services at the same time, by the single visitor. School Visits Visits to School Departments re Cleanliness 526 Visits re Scabies 1 Visits re Infectious Disease 53 Visits re Medical Inspections 591 Visits re Medical Preparations 560 All other reasons 789 Home Visits Concerning defects found at routine medical inspections 266 Subsequent visits re defects found at routine medical inspections 68 Visits re special cases 344 Visits re dental cases 8 Visits other than infectious cases 1,044 Visits in connection with infectious cases (including 241 visits concerning uncleanliness) 2,086 11 TREATMENT The Work of the School Clinics SUMMARY OF ATTENDANCES 1956 1955 Increase or decrease Minor Ailments and Verruca Clinics 9,614 9,415 +199 Inspection Clinic 906 1,018 -112 Dental Clinics 26,963 23,666 +3.297 Remedial Exercises Clinic 6,246 2,836 +3,410 Enuresis Clinic 586 267 +319 44,315 37,202 +7,113 *Clinic closed from May to October 1955 The Minor Ailments Clinics At the Lodge Road Clinic 544 defects involved 3,783 attendances, while at the subsidiary Clinics held at Ashburton School 163 defects, 1,595 attendances; at Duppas School 364 defects, 2,497 attendances; at Rockmount School 37 defects, 1, 180 attendances; and at Wolsey School 103 defects, 559 attendances. Complaint 1956 1955 Cases Attendances Average No. of Attendances per case Cases dances Average No.of Attendances per case Ringworm 1 1 1.0 2 7 3.5 Scabies - - - 1 3 3.0 Impetigo 36 229 6.4 30 260 8.7 other Skin Diseases 13 65 5.0 4 29 7.2 Diarrhoea and other Ear defects 45 245 5.4 56 301 5.4 External Eye Disease 55 294 5.3 104 405 3.9 Miscellaneous 822 5,979 7.3 1,093 6,410 5.9 972 6,813 7.0 1,290 7,415 5.7 12 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 Health, Maternity Welfare and Mental Deficiency Schemes. Particulars of work carried out in connection with the former will be found in the appropriate Report. Introduction Shortage of Staff together with a dearth of surgery accomodation at certain vital points, continue to hamper efforts to cope with an ever increasing school population. Although, taking the Borough as a whole, over 70 percent. of those on the register received a dental examination during the past year, coverage for certain areas, notably Shirley and New Addington, was at a much lower level, resulting in substantial delays in treatment. The contributing factor in both districts has been the extensive build-up of new schools, together with the high proportion of senior age groups attending these institutions. Because of its greater dependence on clinic facilities the Building Estate at New Addington has been particularly handicapped and despite interim measures instituted last year the position at the Overbury Clinic continues to cause concern. Plans for an additional Dental Unit adjoining the existing Welfare Centre at Salcot Crescent have now recieved general approval by the Ministry concerned; however, because of other Education commitments it is likely to be some time before the above accommodation is available. To cover this period additional part-time sessions are being introduced at other clinics. Following its official opening last year developments at the new Centre in Shirley Road have proceeded satisfactorily, and this venture has already proved itself an important asset to the local Service. The advantages of integrating all branches of this work under one roof have been freely commented on by members of the Staff, whilst attendances by children have confirmed the public appreciation of the facilities provided. 13 Experience gained in the working of the somewhat unusual layout will be of considerable assistance in meeting future requirements of other areas. Because of staffing limitations this clinic is at present only able to function to approximately three-quarters of its full capacity; additional sessions will, it is hoped, be possible in the near future. A further area affected by recent developments on the Education side is that of South Croydon. Though less pressing than those already mentioned, responsibilities for treatment in this district are likely to become progressively heavier as time proceeds, particularly in meeting the requirements of older children. The present clinic, situated in rented premises, is seriously below standard and cannot be satisfactorily extended. The provision in the vicinity of more adequate facilities will therefore have to be considered in the not far distant future. The Orthodontic Consultant appointed last year reports very satisfactory progress in dealing with more advanced irregularities of the teeth, but states that the number awaiting attention continues to be somewhat large. At present special priority is being given to those approaching school leaving age, who would be likely to experience difficulty in securing this treatment at a later date. A substantial amount of diagnosis has been carried out for younger children together with certain vital remedial work. Further aspects of this treatment are described later in the Report. Staffing Though the position remains difficult there appears to be a greater interest in the treatment of children within the Dental Profession, as evinced by recent enquiries relating to Local Authority work. Unfortunately actual offers of assistance are chiefly of a Part-time character, sometimes of very limited duration. Whilst every endeavour is made to meet such requests, the introduction of multiple personnel, particularly over short periods, does create serious administrative problems, besides detracting from the personal character of the treatment. Whatever future trends may be, the full-time officer will continue to represent the cornerstone of the service, and for this reason every possible incentive must be offered to encourage a higher proportion of graduates from training Hospitals to specialise in this most vital work. 14 The total of Staff, including the Orthodontic Consultant now comprises six Full-time and four Part-time Dentists, repre senting the equivalent of 7.3 Full-time Officers. Inspections The number of children on the register at maintained schools within the Borough at the close of 1956 was 36,698. Including an additional 44 free-place scholars at grant assisted schools this represents a sum total of 36,742. During the year 78.9 per cent. of the school population were examined compared with 72.4 per cent. in 1955. Whilst the above figure indicates a slight gain, the interval between successive inspections in areas on the eastern side of the Borough has also increased very appreciably because of the high acceptance rate. According to recent returns some 7,134 children received no examination during 1956, compared with 7,226 previously, indicating little change since last year. At those schools visited 28,962 were inspected and 14,370 (49.6 per cent.) referred for treatment, compared with 26,114 inspected and 12,874 (49.3 per cent.) referred in 1955. 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 regarded as "functional" unless the case is actually referred for treatment. The results obtained from school inspections were as follows:- Acceptance of Treatment 48.1% Refused Treatment 41. % Forms Not Returned 10.9% Compared with last year this represents a rise of 0.3 Per cent. in the acceptance rate, and a decrease of some 26.3 Per cent. since the peak of 1949. The corresponding figure for 1937 was in the region of 57 per cent. Acceptance Rate As indicated above increased attention for children under the N.H.I. Regulations has in the main been beneficial to the School Service by removing the extreme burden of post war years. If uniformly distributed this reduced patronage should, in theory. allow for a higher standard of attention for those remaining. 15 within the Scheme. In practice, advantages so gained are to a large degree offset by increased provision for the newer areas of the Borough where the demand is abnormally high. The following Table demonstrates the variations in the acceptance rate during recent years:- RESULTS OF SCHOOL INSPECTIONS 1956 1955 1953 1949 1937 No. referred for Treatment 14,370 12,874 14,998 9,404 13, 498 Consents 6,915: 48.1% 6,158: 47.8% 8,854: 59% 6,996: 74.1% 7,762: 57.7% (Total Consents including Specials)* (10.102: 57.5% (9,370: 58.2% (12,496: 66.1% (10,098: 80.7% (10,146: 63% Refusals 5,986: 41% 5,321: 41.3% 4,496: 30% 1,213: 12.9% 3,242: 24% Forms not returned 1,559: 10.9% 1,395: 10.9% 1,648: 11% 1,195: 12.7% 2,494: 18.5% * SPECIALS - Those referred by Head Teachers with Emergency Forms. Treatment Of 17,557 children referred for treatment (including specials) 9,399 (53.5 per cent.) were treated and 7,287 (41.5 per cent.) cured completely, compared with 16,086 referred, 9,918 (61.6 per cent.) treated and 6,962 (43.2 per cent.) cured in 1955. Despite the usual staff fluctuations the total of treatment sessions increased from 2,361 to 2,776. Assistance by Part-time staff was again rather less than average for recent years and fell from 351 to 304 sessions. Whilst clinically the aim of the Service is to give as complete a treatment as possible, the scope of the work must to some extent be related to the resources available in any particular district. For this reason patients requiring specialised attention are on occasion referred to the Central Clinic, provided they are willing to undertake the journey. Because of the obvious amount of overcrowding present in many mouths, special emphasis is now being given to advanced planning of treatment for particular children; the role played by the Orthodontist in this matter is discussed later in this Report. 16 Items of Treatment The ensuing Table gives particulars of the principal iteis of treatment compared with those obtained last year:- 1956 1955 Attendances 26,963 23,666 Treated 9,399 9,918 Re-treated 4,909 5,200 Fillings - Permanent 9,877 8,879 Temporary 1,585 1,513 No. of Teeth Pilled: Permanent 9,631 8,460 Temporary 1,521 1,464 Extractions - Permanent 2, 691 2,384 Temporary 8, 936 9,103 Gas Administration 4,733 4,707 Local Anaesthetics 880 674 Other Operations - Permanent 10,187 8,670 Temporary 1,000 1,109 Cases Completed 7,287 6,962 Miscellaneous Items These include:- 1956 1955 Root treatment in anterior teeth 4 7 Removal of nerves under local anaesthetic 3 2 Gingivectomy - 6 Removal of bone sequestra 25 5 Splints for fractured incisors 4 3 Partial pulpotomy 3 6 Number of M.D.s treated 29 26 Dentures inserted 55 80 Denture repairs 22 17 After treatment of sockets, etc. 33 41 Removal of impacted and difficult teeth 68 20 Ulcerated Stomatitis (Vincent's infection) 5 Cleft Palate 2 1 Application of Penicillin "Cones" 29 14 Acrylic caps for Incisor Teeth 8 19 17 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 3,187 compared with 3,212 in 1955. X-Ray Examinations The number of cases referred for the above purpose was 456, compared with 160 in 1955. Orthodontic Service Unit Since its inception last year the sessions worked by the Specialist have been further extended, and numbers under treatment have increased very considerably during this period. Because of the back log of cases priority continues to be given to those requiring immediate attention, whilst for younger children there has been much useful preliminary work. A very substantial amount of consultation with other Dental Officers has been possible in connection with their own cases, particularly where removal of teeth is contemplated as part of treatment; a limited number of visits have been paid by the Orthodontist to branch clinics for this purpose, and it is hoped that later these facilities can be further extended. Another interesting development has been a closer liaison with staff at the Speech Therapy clinic over cases of special complexity, where reciprocal action in both Departments can materially assist treatment. The number of sessions devoted to this work was 443, compared with 285 last year. The following is a summary of treatment performed:- 1956 19 55 Consultant D.O.s Total Cases commenced during the year 291 110 401 337 Cases carried forward from the previous year 110 160 270 203 Cases completed during the year 29 73 102 185 Cases discontinued during the year 24 25 49 27 Pupils treated with appliances 190 143 333 181 Appliances - Removable 216 142 358 194 Fixed 14 12 26 41 Total Attendances 2,518 2,133 4,651 2,636 Cases treated by extraction only 18 110 128 92 Cases referred to Specialist for Consultation 412 Treatment sessions 264 179 443 285 18 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: - 1056 1955 Attendances 113 153 New Cases Treated 15 14 Re-treated 29 49 Fillings - Permanent 66 101 Extractions - Permament 19 37 Temporary 12 9 Other Operations 27 27 "Gas" Cases 11 16 Local Anaesthesia 10 5 Cases Completed 26 39 Dentures Fitted - 2 Referred X-Ray 2 3 DENTAL DEFECTS (l) Inspected by Dental Officers:- 1956 1955 Aged 5 - 6 1,455 1,361 6-7 2,157 2,420 7-8 2,444 2,818 8-9 2,983 2,890 9-10 3,766 2,717 10-11 3,520 Total: 28,962 2,390 11-12 2,474 2,144 12-13 2,621 2,296 13-14 2,516 2,483 14-15 2,432 2,160 15-16 1,658 1,576 16 up 936 859 Specials 3,187 3,212 32,149 29,326 19 (2) Number found to require treatment 19,448 17,824 Number referred for treatment 17,557 16,086 (4) Number actually treated 9,399 9,918 (5) Attendances made by children for treatment 26,963 23,666 (6) Half-days devoted to: Inspection 204 192 Treatment 2,776 2,361 2,980 2,553 Number of Gas Sessions 342 322 Administrative sessions 154 173 Orthodontic Sessions 443 285 (7) Fillings- Permanent Teeth 9,877 8,879 Temporary Teeth 1,585 11,462 1,513 10,392 (8) Teeth Pilled- Permanent Teeth 9,631 8,460 Temporary Teeth 1,521 1,464 11,152 9,924 (9) Extractions- Permanent Teeth 2,691 2,384 Temporary Teeth 8,936 11,627 9,103 11,487 (10) Administrations of general anaesthetics for extractions 4,733 4,707 Administrations of local anaesthetics for extractions 880 674 (11) Other Operations- Permanent Teeth 10,187 8,670 Temporary Teeth 1, 109 11,187 1,109 9,779 Attendances per session 9.7 10. 20 DIPTHERIA IMMUNISATION Opportunities to offer immunisation were reduced because o vaccination against poliomyelitis. The number of children between the ages of 5 and 15 years immunised against Diphtheria during the year was 311 together with 1,581 who were given re-inforcing injections. SPINAL AND OTHER REMEDIAL CLINICS Attendances 1956 Classes Au..att. Attendances 1955 Classes Av. att. Spinal 3,072 828 3.7 1,366 209 6.5 Flat Feet 2,141 400 5.4 836 139 6.0 Breathing 1,033 194 5.3 634 125 5.1 6,246 1,422 2,836 473 613 individual cases were treated and 542 examinations were made by doctor. Cost of the School Health Service The gross cost of the medical, dental and nursing services was £42,129. The expenditure is subject to Education grant. Cost of Special Schools £ Schools maintained by the Council 32,639 Other Schools (not maintained by local Education Authorities) 6,160 Adjustments with other authorities in respect of Special Schools, at rate cost 3,353 £42,152 With the exception of the £3, 353 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals Meals and Milk cost £342,853. Income from payment for meals was £121,378, making a net cost of £221,475, on which grant is paid of 100 per cent. on approved expenditure. 21 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED AND DELICATE CHILDREN I am indebted to the Head Teacher, Miss Lambert, for the following report:- A year's steady work has been pursued during 1956. There was one change of Staff on the retirement of Mr.A.C. Carter, our much esteemed Handicraft Master, whose work has been taken over by Mr, A. H. Nicholson. A very welcome structural addition is the new greenhouse, which adds much to the value of the gardening classes for the active, and enriches the interests of the more disabled individuals. Endeavour has continued to keep our pupils in the main stream of educational life in the Borough. Those of appropriate age have sat the Transfer Test and Technical School examinations, one girl qualifying for admission to a Grammar School and two boys to Technical Schools. Physical Education has included normal and special activities, football, cricket, tennis, netball, hockey and rounders. Averages of 34 children and 5 staff attended the Swimming Baths after school on Tuesdays and Wednesdays throughout the Summer Season, during which 31 certificates were won; 2 for ¼ mile, 4 for 220 yds., 7 for 100 yds., 7 for 50 yds. and 11 for 20 yds. Fine weather once more favoured the Summer Sports Meeting honoured by the presence of the Chairman of the Education Committee, Alderman G.J. Cole and of Mrs. Cole; Councillor A.J. Lewis, Mr. R. Wearing King, Chief Education Officer and Miss Moore, Assistant Inspector. Again, this year, our pupils have taken part in the Croydon Schools' Carol and Festival Choirs; and parties of them have attended each of the Saturday concerts of the Schools' Music Association. Frequent visits during school holidays have been made by senior boys and girls with their teachers, to places of interest and to dramatic performances. The School Harvest Festival was a happy event following which some of the children were able to renew their association with the residents of an Old People's Home. Each term conferences have been held at the school between Parents of each pupil about to leave for employment, the Youth Employment Officer, the attached Medical Officer, the boy or girl concerned and the Head Teacher. These conferences have proved most helpful in placing "leavers" in suitable employment; though, in cases of severe disability the follow-up has been tedious and difficult; and for their devoted work in placing our boys and girls we are most grateful to the Employment Officers. During the Autumn Term we were visited by Dr.Huss, M.R.C.S., Ministry of Education Special Services, and Mr. Moody, H.M.I., and other visitors have been numerous and from many parts of the world. Senior girls of the Croydon High School have maintained heir friendly association with the school and once more very 22 kindly entertained fifty of the youngest children to a delightful Christmas Party. Other generous benefactors were the members of the Croydon Market Traders' Federation who gave great pleasure to thirty of the more disabled children by taking them, in the Summer Holiday, for a day's outing by coach to Hastings; and who gave the whole school in the New Year a most happily memorable party, greatly appreciated by all. From Old Scholars at reunions, and by letter, some from points as far distant as Australia, New Zealand, Canada, Malaya, Cyprus and Germany, come encouraging reports of their well being, their community interests, their very diverse pursuits at work, and at recreation, and of the happy families they are founding. DISABILITIES AND TREATMENT There were, of the 200 children on roll, 77 disabled by cerebral palsy, poliomyelitis, muscular dystrophy, spina bifida, skeletal deformity, tubercular bone disease, accidental injury and other causes; 97 suffering from cardiac disability or from respiratory diseases. The remaining 26 were delicate from various causes. 18 routine medical inspections were made during the year, at which 327 children were examined and 185 parents were present. Once each term an Orthopaedic surgeon and a Specialist in Physical Medicine examined children and advised upon their treatment. At these examinations the parents, the attached School Medical Officer, the Nursing Sister, the Physiotherapist and the Head Teacher were also present. Physiotherapy treatment has been given on days per week, a total of 2, 105 treatments. Following the Dental Inspection of all children, nine attendances were made at Lodge Road Clinic by parties of 12 children each time. The Nursing sister, aided in certain duties by the male Medical Attendant, has carried out preparations and follow-up of medical examinations; as well as prescribed courses of treatment, has dealt with many ailments and has kept full records of each child's progress, and supervised physical welfare in general. Parents, Staff and children offer to Dr. Hegarty very grateful thanks for the skill, wisdom and sympathy expended by her in the service of the children. The Head Teacher desires to record once again her thanks to the Principal School Medical Officer and his Staff, to the Chief Education Officer and his Staff and to the Staff of St. Giles' School, for guidance and help during the year 1956. Average No. on roll 199 Employment 5 Technical School 2 Technical College 1 Grammar School 1 Ordinary Schools 28 Hospitals and Hospital Schools 2 Left district 2 Family emigrated 1 23 ST. CHRISTOPHER' S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL I am indebted to Mr. Ramsden, the Head Master, for the following observations:- The year 1956 has been one of steady progress, building and consolidating the new ventures started in the previous years. We have been very fortunate in having few staff alterations, yet we welcome Mrs. Wilkinson and Mrs. Springett to the Staff, and the promotion of Mr. John H. Powell, whom we congratulate on obtaining the E.S.N. Diploma of London University, on his appointment as deputy Headmaster. At Whitsuntide, four teachers, (Mr. Batchelor, Mr. Thomas, Miss Knight and Miss McKay), spent their Whitsuntide holiday taking a party of twenty-nine boys and girls on a School Journey to Sandown, Isle of Wight. A very enjoyable time was spent exploring the Island and its famous places of interest. We especially wish to thank Mr. Batchelor for the admirable way in which he organised the affair, and we hope it will be possible to renew this venture next year, and maybe it will develop into an annual event. In July, we undertook our annual excursion to Littlehampton and once again about 160 staff and scholars spent a very enjoyable day by the sea. Among the many small but important items of interest that have been undertaken during the past year we would like to record that the girls of the school are taking weekly swimming lessons, under the guidance of Miss McKay, and also that we were honoured by a visit from the B. B. C. Producer, Miss Foulger, who listened in with the children during the Broadcasts of her particular Programmes - "The Jackson Family" and "The World at Work " . Our Sports Day, Carol Concert and Christmas Dinner and entertainment were all an unqualified success, due entirely to the hard work, keeness and conscientiousness of all members of the Staff. Class l.a., under the able guidance of Miss Knight, produced their first class magazine, and Mr. Towes and the boys set up and printed it in our own Printing Workshop. 24 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN 230 children were examined during 1956. The classification arrived at, together with recommendations made, are as follows (1) Pound to be mentally defective: (a) Found to be mentally defective and referred to Local Authority and Occupation Centre (b) Pound to be mentally defective and referred to Local Authority for Statutory Supervision (c) Recommended Institutional Care and referred to Local Authority (2) Found to be educationally sub-normal: (a) Recommended to St. Christopher's Special School 4 (b) Recommended to Residential School 4 (c) Referred to Slow Stream in Ordinary Elementary School 33 (d) Recommended for re-test 18 (e) Deferred for Medical Treatment 10 (f) Recommended for St. Giles' 2 (g) Recommended Epileptic Colony - (h) Referred back to Ordinary Elementary School 38 (3) Referred to Child Guidance Clinic 8 (4) Examined for other Authorities - 190 Mental Tests at St. Christopher's 40 230 9 home visits have been paid to Education cases. 25 ST. LUKE'S PARTIALLY SIGHTED SCHOOL I am indebted to Miss J. Rundle, the Teacher-in-charge, for the following observations:- Miss M. Lewin left St. Luke's in December 1956. We were extremely sorry at her leaving and would like to record our appreciation of her work here for the past eight years. We wish her every success in her work in Uganda. We welcome Mrs. Cleaver and hope that she will be very happy in her work here. Throughout the year steady progress of work has been maintained in all age groups. The typewriting course, begun last year, has been very successful. it has helped two of our leavers in obtaining clerical posts and a third is continuing with a Commercial Course at the Polytechnic. Other boys and girls who have left during the year have all found suitable employment and we are very grateful to the Yough Employment Officer and his staff for their help in this matter. The weekly visit to the Croydon Swimming Baths has continued throughout the year and there is continued good progress. Instruction in woodwork is in the care of Mr. Maddox of Norbury Manor School, and Miss Newton of St. Mary'-s School takes the girls for domestic science, and we appreciate the interest shown in our children. We were very glad to welcome Mrs. Maycock on Open Day and should like to express our gratitude to her and Alderman Maycock for their interest in the school. Many parents also visited us and we thank them for their co-operation and interest. Her Majesty's Inspector for Special Schools, Mr. Moody visited us during the year. Twenty-two children were present for the annual medical inspection and seven parents attended. The number on roll was 23 on December 31st last. 26 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1956 as to their fitness to undertake the part-time employment indicated:- 1956 1955 1954 1959 1952 Delivery of Goods for Shopkeepers 62 86 122 53 74 Delivery of Newspapers 365 364 501 328 338 Delivery of Milk 13 17 33 15 32 Shop Assistants 61 67 48 77 138 501 534 704 473 562 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1956 all milk was supplied free of charge and approximately 30,100 children per day received one-third of a pint each in Maintained Schools. This was equal to 90% of children attending in such schools. Since 1st September, 1956, milk has also been supplied by the Education Committee to children in the Non-Maintained School in accordance with instructions from the Ministry of Education. Approximately 4,900 bottles per day are supplied to the NonMaintained schools. All milk supplied is pasteurised, 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 to children during 1956 was approximately 16, 500. CHILD GUIDANCE CLINIC Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1956 Boys Girls Total number referred 44 21 Analysis of the above Cases:- Diagnostic only 11 4 Current Cases under treatment 18 8 Cases Closed - improved 8 5 Cases Closed - not improved 7 4 44 21 27 SPEECH DEFECTS CLINIC Total no. of cases treated 255 Cases discharged 80 Cases still attending 175 Cases referred for physical treatment 42 Cases referred for residential treatment 1 Cases referred to Child Guidance 2 Stammerers 47 Cleft Palate 7 Sigmatism 49 Hyper Microphonia 12 Dyslalia 94 Undeveloped Speech 23 Dysarthria 14 Developmental Aphasia 3 Partially Deaf 6 Since September 1956 there has been a further full time Speech Therapist appointed, to replace the part time Miss Carter who had rendered valuable service to the Clinic for a number of years. The staff now numbers three, providing an adequate service to cope with cases requiring treatment in the school population. Now that the Speech Clinic can offer a full service, the Therapists have been able to do a numberof visits to the Schools to select cases requiring treatment. This has been of great help to them, in making a more personal contact with the Head Teachers and staff, as well as facilitating early diagnosis and treatment. We should like to thank the schools for their generous and willing co-operation. The experiment undertaken to attend St. Christopher's school for a session a week, has fully justified the undertaking, as there is now a very considerable waiting list and urgent requests for more time to be spent there in treatment. 28 ENURETIC CLINIC The numbers attending the enuresis clinic in 1956 increased on the 1955 total. 98 children attending compared with 73 in 1955. 13.3 were discharged because of poor or very irregular attendance. During the year a monthly clinic has been started at New Addington to save the New Addington parents the journey to Croydon. The attendance at this clinic has not been as high as at the Lodge Road Clinic. The total attendances were 586. During the year the Corporation as a local health authority issued on loan three Enuretic "machines" , which have been of great value in treating resistant cases. So far there has not been a single failure among the children treated with these machines. They have the advantage of clearing up the condition in two months as opposed to the average of six months in the ordinary clinic cases. Total number of children attending 98 Number discharged reported dry 47 Number discharged for non-attendance 13 Number attending at end of year 35 Number referred to Child Guidance Clinic 3 EPILEPTICS 19 epileptics were known to the School Health Service as at 31.12.56. Of these, 12 were attending ordinary schools, 4 were in our Day school for Physically Handicapped and Delicate Children. 1 was attending our Day E.S.N. School and 2 were at Lingfield School for Epileptics. SPASTICS 46 Croydon Spastics were attending school as at 31.12.56. 2 children received Home Teaching 26 were attending St. Giles' School 2 were attending St. Margaret's School, Croydon 5 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) 7 were attending ordinary school 1 was attending Myope School 29 In addition, 6 children of school age had not been considered suitable for school but were still under review. Some of these will be able to attend school later. A further 8 children were known who were under school age. NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in 1956, 203 children were examined at routine examination and also 1 special and 5 re-examinations. Appendix C gives the detailed findings. Yours faithfully, S. L. WRIGHT, School Wedical Officer 30 STATUTORY TABLES APPENDIX A MEDICAL INSPECTION RETURNS Year ended 31st December, 1956 Table I MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS A.-Periodic Medical Inspections Number of Inspections in the prescribed Groups: Entrants 4,022 Second Age Group 1,477 Third Age Group 2,538 Total 8,037 Number of other Periodic Inspections 4,013 (8 - 9 years) . Grand TotaL 12,050 B. -Other Inspections Number of Special Inspections 1,441 Number of Re-inspections 1,585 TotaL 3,026 C. -Pupils found to require Treatment (Excluding Dental Disease and Infestation with Vermin) Group For defective vision ( excluding squint Forany of the other conditions recorded in Table IIIA Total Individual Pupils (1) (2) (3) (4) Entrants 31 462 411 Second Age Group 68 117 182 Third Age Group 126 161 279 Total (prescribed groups) 225 740 949 Other Periodic Inspections including 8 to 9 years 235 353 580 Grand Total 460 1,093 1,529 31 Table II INFESTATION WITH VERMIN (i) Total number of examinations in the schools by the school nurses or other authorised persons 66,862 (ii) Total number of individual pupils found to be infested 289 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) NIL (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) _ Table III A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION Defect Code No. DEFECT OR DISEASE (1) Periodic Inspections TOTAL (including all other age groups inspected) Entrants Leavers Treatment (2) Observation (3) Treatment (4) Observation (5) Treatment (6) Observation (7) 4 SKIN 16 4 8 1 36 10 5 EYES - (a) Vision 31 4 126 7 460 94 (b) Squint 42 9 3 - 67 15 (c) Other 7 3 2 1 26 7 6 EARS - (a) Hearing 7 20 - 2 17 34 (b) Otitis Media 6 6 1 2 11 10 (c) other - 3 1 - - 4 7 NOSE OR THROAT 145 140 8 4 252 195 8 SPEECH 24 28 - - 36 33 9 CERVICAL GLANDS 1 8 - - 2 16 10 11 HEART AND CIRCULATION 11 43 10 20 35 117 LUNGS 49 69 13 12 88 129 12 DEVELOPMENTAL - (a) Hernia 1 4 - - 7 7 (b) Other 2 10 10 3 25 35 13 ORTHOPAEDIC - (a) Posture 27 12 45 3 171 39 (b) Flat Foot 42 29 24 6 151 104 (c) Other 47 44 19 4 111 73 14 NERVOUS SYSTEM - (a) Epilepsy 1 2 1 4 4 12 (b) Other 3 7 1 2 11 16 15 PSYCHOLOGICAL - (a) Development 2 5 1 - 9 7 (b) Stability 15 9 1 1 27 19 16 ABDOMEN - - - - - - 17 OTHER 62 20 22 7 134 63 32 B. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Groups (1) Number of pupils inspected (2) Satisfactory Unsatisfactory No. (3) % (4) No, (5) * (6) Entrants 4,022 3, 943 98. 0 79 2.1 Second Age Group 1, 477 1, 463 99. 1 14 0.9 Third Age Group 2, 538 2, 533 99.8 5 0.2 Other Periodic Inspections including 8 to 9 years 4, 013 3,883 96.8 130 3.2 TOTAL 12,050 11,822 98. 1 228 1.9 C. SPECIAL INSPECTIONS De fect Code No. (1) DEFECT OR DISEASE (2) Special Inspections Requiring Treatment (3) Requiring Observatin (4) 4 SKIN 5 – 5 EYES - (a) Vision 40 6 (b)Squint 4 1 (c) Other 1 – 6 EARS - (a) Hearing 7 2 (b) Otitis Media 1 1 (c) Other 1 – 7 NOSE AND THROAT 22 8 8 SPEECH 8 1 9 LYMPHATIC GLANDS – – 10 HEART 5 9 11 LUNGS 13 8 12 DEVELOPMENTAL - (a) Hernia – 1 (b) other 1 3 13 ORTHOPAEDIC - (a) Posture 5 1 (b) Feet 14 11 (c) Other 12 4 14 NERVOUS SYSTEM - (a) Epilepsy 1 2 (b) Other 2 3 15 PSYCHOLOGICAL - (a) Development 5 7 (b) stability 9 4 16 ABDOMEN – – 17 OTHER 13 6 33 Table IV GROUP 1.- EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases dealt with By the Authority Otherwise External and other, excluding errors of refraction and squint 55 _ Errors of Refraction (including squint) – 1, 893 Total 55 1, 893 Number of pupils for whom spectacles were prescribed – 1, 110 GROUP 2.– DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases treated By the Authority Otherwise Received operative treatment (a) for diseases of the ear – _ (b) for adenoids and chronic tonsillitis – 270 (c) for other nose and throat conditions – – Received other forms of treatment Ear (Minor Ailments Clinic) 45 - Total 45 270 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1956 – 9 (b) in previous years 1 26 GROUP 3.– ORTHOPAEDIC AND POSTURAL DEFECTS (a) Number treated as in-patients Not available By the Authority Otherwise (b) Number treated otherwise, e.g. in clinics or out-patients departments 594 Not Available GROUP 4, - DISEASES OF THE SKIN (excluding uncieanliness, for which see Table II) Number of cases treated or under treatment during the year Ringworm - (i) Scalp – (ii)Body 1 Scabies – Impetigo 36 Other skin Diseases 13 Total 50 34 GROUP 5.– CHILD GUIDANCE TREATMENT Number of coses treated Number of pupils treated at Child Guidance Clinics 65 GROUP 6.- SPEECH THERAPY Number of coses treated Number of pupils treated by Speech Therapists 255 GROUP 7.- OTHER TREATMENT GIVEN Number of coses treated (a) Number of cases of miscellaneous minor ailments treated by the Authority 1,062 (b) Pupils who received convalescent treatment under School Health Service arrangements 21 (c) Pupils who received B.C.G. vaccination - (d) Other than (a). (b) and (c) above (specify) 1. Enuresis 98 Total (a) – (d) 1,181 35 Table V DENTAL INSPECTION AND TREATMENT (1) Number of pupils inspected by the Authority's Dental Officers - (a) Periodic age groups 28,962 (b) Specials 3, 187 (c) TOTAL (Periodic and Specials) 32, 149 (2) Number found to require treatment 19,448 (3) Number referred for treatment 17,557 (4) Number actually treated 9,399 (5) Attendances made by pupils for treatment 26,963 (6) Half-days devoted to: (a) Inspection 204 (b) Treatment 2, 776 TOTAL 6 2,980 (1) Fillings: Permanent Teeth 9, 877 Temporary Teeth 1,585 TOTAL 7 11,462 (8) Number of Teeth filled: Permanent Teeth 9,361 and Temporary Teeth 1, 521 TOTAL 8 10,882 (9) Extractions: Permanent Teeth 2,691 Temporary Teeth 8,936 TOTAL 9 11,627 (10)Administrations of general anaesthetics for extraction 4,73 3 (11) Orthodontics: (a) Cases commenced during the year 401 (b) Cases carried forward from previous year 270 (c) Cases completed during the year 102 (d) Cases discontinued during the year 49 (e) Pupils treated with appliances 333 (f) Removable appliances fitted 358 (g) Fixed appliances fitted 26 (h) Total attendances 4,651 (12) Number of pupils supplied with artificial dentures 55 (13) Other Operations: (a) Permanent Teeth 10, 187 (b) Temporary Teeth 1, 000 TOTAL 11 11, 187 36 APPENDIX B Table 1 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS 1956 School Average No. on Register Average Attendance Average Attendance per cent. Average 1955 Attendance per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed 570 529 93.8 94.0 Ashburton Infants 183 164 89.6 93.8 Benson Junior Mixed and Infants 611 580 94.9 95.0 Beulah Junior Boys 383 362 94.5 93.5 Beulah Junior Girls 334 316 94.6 92.5 Beulah Infants 192 170 88. 5 85.8 Castle Hill Junior Mixed 348 320 92.0 92.1 Castle Hill Infants 302 269 89.1 89.4 Cypress Junior Mixed 283 263 92.9 94.0 Cypress Infants 154 141 91.6 88.8 Davidson Infants 125 113 90. 4 88.4 Duppas Junior Mixed and Infants 438 407 92.9 81.6 Ecclesbourne Infants 125 114 91.2 93.1 Elmwood Junior Boys 352 325 92.3 90.3 Elmwood Junior Girls 346 322 93. 1 92.2 Elmwood Infants 228 194 85.1 88.1 Fairchildes Junior Mixed 550 507 92.2 89.5 Fairchildes Infants 411 365 88.8 84.0 Gilbert Scott Junior Mixed 544 503 92.5 94.8 Gilbert Scott Infants 230 198 86.1 93.5 Gonville Junior Mixed and Infants 521 481 92. 3 92.4 Howard Junior Mixed and Infants 5 22 478 91.5 90.9 Ingram Infants 162 147 90.8 87.8 Kensington Avenue Junior Mixed and Infants 635 595 93.7 93.1 Kingsley Junior Mixed 545 493 90.5 91.8 Kingsley Infants 300 246 82.0 G.I. 86.1 Monks Orchard Junior Mixed and Infants 336 312 92.9 92.8 Overbury Junior Mixed and Infants 240 221 92.1 91.9 Norbury Manor Junior Mixed 497 475 95.5 94.7 Norbury Manor Infants 223 201 90.1 88.6 Oval Junior Mixed 495 458 92.5 93.4 Oval Infants 157 133 84.7 89.4 Portland Infants 191 180 94.2 93.6 Purley Oaks Junior Mixed 381 351 92.1 92.0 Purley Oaks Infants 194 168 86.6 90.2 Rockmount Junior Mixed 384 364 94.8 93.8 Rockmount Infants 164 151 92.1 87.7 Rowdown Junior Mixed 446 409 91.7 92.4 Rowdown Infants 388 336 86.7 90.6 South Norwood Junior Boys 364 342 93.9 93.5 South Norwood Junior Girls 307 287 93.5 93.6 South Norwood Infants 265 240 90.6 88.8 St. Peter's Junior Mixed and Infants 329 305 92.7 93.8 Spring Park Junior Mixed 391 372 95.1 94.8 Spring Park Infants 159 147 92.5 92.0 Sydenham Junior Boys 276 255 92. 4 92.1 Sydenham Junior Girls and Infants 331 304 91.8 90.5 Waddon Junior Mixed and Infants 163 150 92.0 89.1 West Thornton Junior Mixed 374 342 91.4 93.2 West Thornton Infants 154 135 87.7 (table continued on next page) 37 School Average No. on Register Average At tendance Average Attendance per cent. Average 1955 Attendance per cent. Whitehorse Manor Junior Boys 293 267 91.1 90.5 Whitehorse Manor Junior Girls 291 266 91.4 92.6 Whitehorse Manor Infants 211 182 86.2 89.5 Winterbourne Junior Boys 425 402 94.6 93.4 Winterbourne Junior Girls 440 419 95. 2 95.1 Winterbourne Infants 325 295 90.8 89.1 wolsey Junior Mixed 560 522 93. 2 93.8 Wolsey Infants 284 251 88.4 87.9 Woodside Junior Boys 435 414 95. 1 93.3 Woodside Junior Girls 430 403 93. 7 94.1 Woodside Infants 262 247 94.6 92.1 TOTALS 20,559 18,908 91.9 91.9 COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Boys 567 540 95. 2 95. 2 Ashburton Senior Girls 528 490 92. 8 92.8 Davidson Senior Boys and Girls 486 447 91.9 Ecclesbourne Senior Girls 308 283 91.9 91.1 Fairchildes Senior Boys 427 385 90.2 89.2 Fairchildes Senior Girls 407 364 89.4 89.0 Ingram Senior Boys 521 480 92.1 90.7 Ingram Senior Girls 301 276 91.7 90.8 John Newnham Senior Mixed 540 510 94.4 93.9 Lanfranc Senior Boys 599 548 91.5 90.2 Lanfranc Senior Girls 639 589 92.2 90.2 Norbury Manor Senior Boys 305 286 93.7 94.8 Norbury Manor Senior Girls 311 295 94.8 94.9 Portland Senior Boys 211 199 94.3 94. 3 Portland Senior Girls 258 241 93.4 93.0 Tavistock Senior Boys 616 548 89.0 88.0 Tavistock Senior Girls 414 368 88.8 88.5 South Croydon Senior Mixed 594 528 88.8 87.9 Shirley Senior Mixed 266 254 95.5 94.5 TOTALS 8,298 7,631 91.9 91.3 St. Andrew's Vol. Sec. Mod. 194 174 89.7 88.8 Our Lady's Vol. Sec. Mod. 191 169 88.5 89.2 St. Mary's Vol. Sec. Mod. 311 282 90.7 90.1 696 625 89. 8 89.5 SPECIAL SCHOOLS St. Christopher's (E.S.N.) 200 175 87. 5 84. 2 St. Giles' (Delicate and Physically Handicapped) 199 166 83.4 G.I. 86.9 St. Luke's (Partially Sighted) 23 20 86.9 88.5 TOTALS 422 361 85. 5 85.7 38 School Average No . on Register Average Attendance Average Attendance per cent. Average 1955 Attendance per cent. VOLUNTARY PRIMARY SCHOOLS All Saints' Mixed and Infants 277 257 92.8 92.4 Christ Church Junior Mixed and Infants 214 196 91.6 93.2 Good Shepherd R.C. Junior Mixed and Infants 261 233 89. 3 91.2 Parish Church Junior Mixed and Infants 398 363 91.2 91.6 St. Joseph's Mixed and Infants 507 454 89.5 89.9 St. Mark's Junior Mixed and Infants 209 194 92.8 91.9 St. Mary's R.C. (Junior Mixed and Infants) 4 08 355 87.0 87.9 St. Michael's Infants 128 107 83.6G.I 85.7 Shirley Junior Mixed and Infants (St. John's) 277 257 92.8 91.1 TOTALS 2, 679 2, 416 90. 2 90.5 G.I. General Illness SELECTIVE CENTRAL SCHOOLS Arch. Tenison's Sec. Mixed 296 279 94.3 94.3 Heath Clark Sec. Mixed 535 514 96.0 95.3 TOTAL CARRIED FORWARD 831 793 95. 4 94.4 GRAMMAR SCHOOLS Selhurst Boys 570 548 96.1 95.6 Selhurst Girls 531 505 95.1 94.1 John Ruskin Boys 508 482 94.9 95.1 Coloma Girls 546 515 94. 3 94.9 Lady Edridge Girls 494 471 96.0 95.7 TOTALS 3,480 3,314 95. 2 95.1 TECHNICAL SCHOOLS Stanley Technical Trade 282 263 93.3 93.9 Croydon Secondary Technical 282 268 95.0 95.7 TOTALS 564 531 93. 1 94.8 SUMMARY OF SCHOOLS Council Primary 20,559 18,908 91.9 91.9 Voluntary Primary 2,679 2, 416 90. 2 90.5 Council Secondary 8, 298 7, 631 91.9 91.3 Voluntary Secondary Mixed 696 625 89.8 89.5 Grammar, Central 3,480 3,314 96.0 94.7 Technical 564 531 93. 1 94.8 Specials 422 361 85.5 85.7 TOTALS 36,698 33,786 92.0 91.9 Crosfield Nursery 43 36 83.7 90.4 39 Table II HEIGHTS AND WEIGHTS, 1956 Age Number Examined 1956 Average Height in inches Average Weight in lbs. 1956 1955 1954 1953 1939 1956 1955 1954 1953 1939 BOYS 5 years 1204 43. 4 43. 3 42.7 42. 9 41.8 43. 4 43. 5 42. 9 42. 5 41. 5 6 " 495 43.9 44.2 44.2 44.3 43.8 44.8 45.3 45.2 44.8 43.4 7 " 221 48.1 47.9 47.8 47.4 45.3 53.4 52.7 53. 3 52.0 47.9 8 " 1153 50.2 49.9 50.2 49.9 49.5 58.9 59.1 58.6 58.1 55.5 9 " 852 51.3 51.3 51.6 50.9 51.2 62.3 61.4 61.7 61.6 58.8 10 " 151 52.9 54.3 54.7 55.1 52.7 67.1 73.9 72.2 73.0 62.9 11 " 351 57.2 55.0 55.8 55.5 53.7 83.9 74.2 76.4 75.6 68.7 12 " 214 58.0 55.6 56.5 56.3 55.7 86.4 80.0 79.7 77.1 79.9 13 " 34 58. 2 60. 3 60. 5 60.0 58. 4 82. 9 96. 5 97. 1 90.0 81.6 14 " 446 61.3 62.8 62.4 63.1 59.0 111.9 109.0 105.6 105.6 90.8 15 " 478 64.5 64.8 63.8 64.1 - 116.6 116.5 112.8 115.6 - 16 " 178 66.6 66.9 66.9 67.7 - 129.2 128.3 129.4 129.8 - 17 " 53 67.9 68.4 66.7 67.2 - 133.8 137.7 126.5 127.2 - GIRLS 5 years 1168 42.5 42.7 42.6 42.6 41.2 41.7 41.9 41.9 41.4 39.7 6 " 519 43.7 43.4 43.8 43.8 42.7 43.6 43.8 45.3 43.4 41.4 7 ,, 217 47.5 47.2 47.5 46.8 44.1 52.6 53.1 52.4 50.0 43.6 8 " 985 50.1 49.3 49.6 49.7 49.9 58.3 58.8 56.6 56.5 54.7 9 " 802 50.9 50.5 51.0 50.5 50.9 60.5 60.4 60.5 60.4 57.6 10 " 112 53.5 54.6 54.6 54.6 52.1 69.1 73.7 73.1 73.8 62.9 11 " 332 57.2 56.0 55.9 55.8 53.6 83.6 78.7 77.9 76.5 68.3 12 " 338 58.9 58.2 57.1 57.1 56.6 89.6 87.5 81.9 82.6 77.2 13 " 108 59.7 60.3 61.4 59.8 58.8 94.6 97.5 100.6 96.0 85.3 14 " 634 61.9 61.7 62.2 61.8 60.3 109.9 111.3 109.2 109.0 97.9 15 " 496 62.8 63. 2 62.7 62.9 62.0 114.3 116. 1 114.0 116.0 105.5 16 " 163 64.9 64.2 63.3 64.7 – 123. 6 123.2 121.8 121.9 - 17 " 54 64.6 64.2 63.5 64.9 – 127.8 124.6 116.3 127.4 - 40 Table III PARENTS PRESENT 1956 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 19 18 19 17 – – – – – – – – 19 30 14 19 38 48 Archbishop Tenison's – – – – 20 – 8 – 25 24 1 3 – – – – 45 24 Ashburton 71 39 50 37 108 131 51 81 18 138 – 46 105 40 69 28 302 348 Benson 34 33 33 32 – – – – – – – – 55 40 50 32 89 73 Beulah 56 41 53 38 – – – – – – – – 65 83 61 73 121 124 Castle Hill 116 132 106 117 – – – – – – – – 21 40 2 15 137 172 Christ Church 19 15 20 14 – – – – – – – – 18 11 14 11 37 26 Coloma – – – – – – – – – 75 – – – – – – – 75 Crossfields 37 17 36 16 – – – – – – – – – – – – 37 17 Croydon Sec. Tech. – – – – – – – – 88 – 2 – – – – – 88 – Cypress 56 49 50 42 – – – – – – – – 51 65 44 56 107 114 Davidson 44 42 40 39 17 – 6 – 64 43 14 17 32 26 28 20 157 111 Duppas – – – – – – – – – – – – 45 51 27 38 45 51 Ecclesbourne 44 58 43 51 – 28 – 19 – 86 – 22 – – – – 44 17 2 Elmwood 81 43 69 43 – – – – – – – – 54 79 44 62 135 122 Fairchildes 56 52 54 49 126 35 52 23 83 141 8 20 65 _ 55 – 330 228 Gilbert Scott 52 74 46 67 – – – – – – – – 67 63 49 34 119 137 Gonville 39 37 34 37 – – – – – – – – 73 62 58 54 112 99 Good Shepherd 26 24 21 17 – – – – – – – – 15 25 6 17 41 49 Heath Clark – – – – – – – – 44 – 4 – – – – – 44 - Howard 41 33 39 31 2 – – – – – – – 39 48 33 38 82 81 Ingram 27 39 27 37 45 26 15 12 72 70 8 27 25 – 4 – 169 135 John Newnham – – – – – – – – 20 47 3 8 – – – – 20 47 John Ruskin – – – – – – – – 71 – – – – – – – 71 – Kensington 32 32 29 30 23 15 17 11 _ _ – _ 70 41 65 32 125 88 Kingsley 57 69 52 49 – – – – – – – – 132 94 98 76 189 163 Lady Edridge – – – – – – – – – 54 – 18 – – – – – 54 Lanfranc – 62 – 32 75 27 21 11 100 138 11 64 – – – – 175 227 Monks Orchard 24 19 22 16 – – – – – – – – 52 21 43 16 76 40 Norbury Manor 40 52 37 49 68 63 22 42 44 50 l 23 49 40 37 36 201 205 Our Lady's Convent – – – – – 23 – 5 – 33 – 2 – – – – – 56 Oval 57 57 46 54 9 9 7 9 – – – – 81 85 62 64 147 151 Overbury 35 34 31 31 – – – – – – – – 41 45 32 38 76 79 Continued below 41 parish church 35 38 29 31 – – – – – – – – 63 48 49 41 98 86 portland 17 55 15 47 44 17 12 7 4 2 5 1 7 1 2 29 5 23 3 132 128 Purley Oaks 56 54 54 5 1 – – – – – – – – 30 45 23 36 86 99 Rockmount 55 84 44 70 – – – – – – – – 81 72 68 60 136 156 Rowdown 65 62 57 45 22 8 18 7 – – – – 3 5 53 2 9 48 122 123 St. Andrew's – 8 – 5 62 30 30 11 24 15 9 4 – – – – 86 53 St. Joseph's 42 41 35 27 – – – – – – – – 34 29 16 10 76 70 St. Mark's 21 7 10 7 – – – – – – – – 16 13 14 10 37 20 St. Mary's 33 36 23 27 35 47 10 15 39 3 1 8 4 18 3 1 9 19 125 31 145 35 St. Michael's 31 35 23 30 – – – – – – – – – – – – St. Peter's 18 24 15 19 – 6 – 3 – – – – 47 23 36 16 65 53 Selhurst Grammar – – – – – 197 – 117 142 88 4 12 – – – – 142 285 Shirley 40 39 36 35 7 42 3 30 14 4 5 3 40 29 31 27 101 114 South Croydon Sec. – – – – – – – – 76 72 5 7 – – – – 76 72 South Norwood 111 76 92 75 – – – – – – – – 88 70 52 52 199 146 Spring Park 52 45 52 41 – – – – – – – – 59 27 55 26 111 72 Stanley Technical – – – – – – – – 79 – – – – – – – 79 – Sydenham 24 28 21 28 – – – – – – – – 33 38 24 17 57 66 Tavistock – – – – – 22 – 19 139 108 20 33 – – – – 139 130 Trinity – – – – – – – – 86 – 4 – – – – – 86 – Waddon 37 38 28 33 – – – – – – – – – – – – 37 38 West Thornton 28 33 27 31 – – – – – – – – 26 41 12 34 54 74 Whitehorse Manor 54 54 41 50 – – – – – – – – 75 84 55 73 129 138 Winterbourne 60 48 58 42 – – – – – – – – 110 114 94 95 170 162 Wolsey 100 82 94 78 30 34 26 30 – – – – 10 2 102 94 93 232 218 Woodside 64 58 62 56 – 24 – 15 – – – – 70 70 61 57 134 152 2006 2016 1773 1773 693 784 298 467 1270 1268 114 325 2130 1883 1640 1478 6099 59 51 4022 3546 1477 765 2538 439 4013 3118 12050 PERCENTAGE OP PARENTS PRESENT AT MEDICAL INSPECTIONS Entrants Boys 88. 4) 88. 2 65. 3 " Girls 87. 9) Intermediate Soys 43.0) 51.8 " Girls 59.6) Leavers Boys 9.0 17. 3 " Girls 25. 6 Other Ages Boys 77.0 77. 5 8 to 9 years Girls 78. 5 42 Table IV RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1956 Defects Boys Girls No. requiring Treatment No. referred for Observation Percentage of total Examined No. requiring Treatment No. referred for Observation Percentage of total Examined Uncleanliness - Head - - - - - Body Skin Disease 24 10 0.56 12 - 0.20 Eye Disease - Defective Vision 204 43 4.05 256 51 5.16 Squint 33 5 0.62 34 10 0.74 External Eye Trouble 11 1 0.20 15 6 0.35 Ear Disease - Deafness 13 20 0.54 4 14 0.30 Otitis Media 8 8 0.26 3 2 0.08 Other Disease 4 3 0.11 1 1 0.03 Nose and Throat 123 87 3.44 129 108 3.91 Enlarged Cervical Glands (not T. B. ) 1 10 0.18 1 6 0.12 Dental Defects 24 2 0.43 30 2 0.54 Speech Defects 24 22 0.75 12 11 0.38 Heart and Circulation 6 46 0. 85 29 71 1.68 Lungs 37 77 1.87 51 52 1.73 Nervous System Disorders - Epilepsy 2 7 0.15 2 5 0.12 Other 6 6 0.20 5 10 0.25 Developmental - (a) Hernia 5 5 0.16 2 2 0.07 (b) Other 24 29 0.87 1 6 0.12 Psychological - (a) Development 6 4 0.16 3 3 0.10 (b) Stability 15 13 0.45 12 6 0.30 Deformities - Plat Feet 80 57 2.25 71 47 1.91 Posture 55 15 1.15 116 24 2.35 Others 42 35 1.25 69 38 1.80 Other Defects and Diseases 56 29 1.39 78 34 1.88 TOTALS 803 534 936 509 Total Children Examined 6099 5951 43 Table V SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1956 (Percentages of Children examined) Defect or Disease Entrants Intermediates Leavers Other Ages and 8 to9 yrs. All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 1.4 1.3 0.7 1.2 0.6 0.4 1.4 1.2 1.0 1.1 Skin 0.8 0.5 0.4 0.3 0.2 0.4 0.8 0.5 0.7 0.5 Vision 0.8 1.1 5.5 8.0 4.7 6.9 7.0 8.9 4.3 5.8 Squint 1.2 1.6 0.1 0.5 0.2 0.1 0.8 0.8 0.7 0.9 Other 0.2 0.4 0.1 0.7 0.2 0.2 0.4 0.4 0.2 0.4 Ears - Hearing 0.9 0.6 0.3 0.4 0.2 0.2 0.7 0. 2 0.6 0.4 Otitis Media 0.5 0.1 – 0.1 0.2 – 0.1 0.1 0.3 0.1 Other 0.2 0.1 0.4 – – 0.1 0.1 – 0.2 0.1 Nose and Throat 11.0 11.2 1.4 2.2 0.3 1.6 6.0 7.3 5.9 6.7 Speech 1.7 1.0 – 0.3 – – 0.6 0.1 0.8 0.4 Cervical Glands 0.5 0.6 0.3 0.4 – – 0.9 1.2 0.5 0.7 Heart and Circulation 1.1 2.0 0.7 1.7 0.6 1.8 1.3 2.0 1.0 1.9 Lungs 3.3 3.2 1.0 0.9 0.5 1.7 2.1 1.2 2.0 1.9 Development- Hernia 0.2 0.1 0.1 0.1 – – 0.4 0.1 0.2 0.1 0ther 0.7 0.1 1.6 0.4 1.2 – 1.1 0.2 1.0 0.1 Orthopaedic Posture 0.8 1.1 1.6 4.5 0.4 3.7 1.8 2.4 1.2 2.5 Flat Feet 2. 2 2.2 3.8 1.9 0. 9 1.8 4.0 2.8 2.8 2.3 Other 2. 5 2. 8 1.3 1.8 0. 8 1. 7 1.2 1.6 1.6 2. 1 Nervous system Epilepsy 0.1 0.1 0.4 – 0.1 0.3 0.1 0.1 0.1 0.1 Other 0.2 0.3 0.3 0.1 – 0. 2 0. 4 0.3 0. 2 0.3 Psychological - Development 0.3 0. 1 _ 0.3 – 0. 1 0. 4 _ 0.2 0.1 Stability 0.7 0.4 – 0.1 – 0.2 0.7 0.4 0.5 0.3 Dull and Bcckward 0.1 0.1 – – – – 0.5 0.3 0.2 0.1 Other Defects 2.1 1.7 1.3 1.9 0.8 1.5 1.6 2.2 1.5 2.0 44 Table VI CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1956 School Population Measles German Measles Whooping Cough Chicken Pox Mumps Scabies Impetigo Ringworm Diphtheria Scarlet Fever Dysentery Poliomyelitis Jaundice Conjunctivitis Sore Throat Indefinite Sickness Enteric Group Erysipelas Vermin Meningococcal Infection Totals Body Scalp All Saints 277 1 2 4 1 – – 1 – – – – – – – – – – – – – – 9 Arch.Tenison 296 – – – – – – – – – – – – – – – – – – – – – Ashburton 1848 1 – – – 1 – – – – – 3 – – – – – – – – – – 5 Benson 611 2 – – 60 1 – – – – – 1 – – – – – – – – – – 64 Beulah 909 – – 5 45 – – 1 – – – 4 – – – – – – – – 2 – 57 Castle Hill 650 7 1 4 9 6 2 1 – – – – 81 – 2 – – – – – 1 – 114 Christchurch 214 – – – – 12 – – – – – 4 – – – – – – – – 11 – 27 Coloma 546 – – – – – – – – – – 1 – – – – – – – – – – 1 Crossfield Nursery 43 _ 1 _ 1 – – – – – – 4 – – – – – – – – – 1 7 Croydon High 876 – – – – – – – – – – – – – – – – – – – – – Croydon Tech. 282 – – – – – – – – – – – – – – – – – – – – – – Cypress 437 – – 3 10 – – – – – – 2 – – – – – – – – – 1 16 Davidson 611 13 – 4 16 – – – – – – – – – – – – – – – – – 33 Duppas 438 – – – – – – 3 – – – – 1 1 – – – – – – 2 – 7 Ecclesbourne 43 3 – – – – – – – – – – 1 – 1 – – – – – – 1 – 3 Elmwood 926 – – 1 9 7 – – – – – 2 1 – 1 – – – – – 4 – 25 Fairchildes 1795 2 – – 2 1 – 3 3 – – 3 3 2 – – – – – – – – 19 Gilbert Scott 774 – 1 4 3 4 – – – – – 4 1 – – – – – – – – – 17 Gonville 521 – – 1 – – – – – – – 11 – 1 – – – – – – 2 – 15 Good Shepherd 261 – – – – – – – – – – – 5 – – – – – – – – – 5 Heath Clark 535 – – – 1 – – – – – – – – – – – – – – – – – 1 Howard 522 – 3 2 22 7 – – – – – 4 – – – – – – – – – – 38 Ingram 984 – 1 5 22 – – 2 – – – – 1 – – – – – – – – – 3 1 John Newnham 540 – – – – – – – – – – – 2 — – – – – — – — — 2 John Ruskin 508 – – – – – – – –– – – – – – – – – – – – – – – Kensington AV. 635 1 – ??? 45 8 Norbury Manor 1336 – 1 – 7 2 – 1 – – – 3 – 1 – – – – – – – 1 16 Occupation Centre 76 – – – – 2 – – – – – _ – – – – – – – – – – 2 Our Lady's Convent 191 – – – – – – – – – – – – – – – – – – – – – – Oval 652 – 2 8 36 37 – – – – – - – – – – – – – – – – 83 Overbury 240 1 – 1 2 2 – – – – – – 1 1 – – – – – – – – 8 Parish Church 398 – – – 5 1 – – – – – – – – – – – – – – – – 6 Portland 660 – – 1 1 1 – – – – – – – – – – – – – – l – 4 Purley Oaks 575 – 3 1 1 17 – – – – – 3 – – – – – – – – – – 25 Rockmount 548 – – – – – – – – – – – – – – – – – – – – 1 1 Rowdown 834 37 – – 1 – – 2 2 – – 2 4 – – – – – – – – – 47 St. Andrew's 194 – – – – – – – – – – – – – – – – – – – 2 – – St.Christopher's 200 – – 1 _ – – – – – – – – – – – – – – – 2 – 4 St. Giles 199 – – – 2 1 – 1 – – – 1 1 – – – – – – – – – 6 St. Joseph's 507 – – – – – – – – – – – – – – – – – – – – – – St. Luke's 23 – – – – – – – – – – – – – – – – – – – – – – St. Mark's 209 20 – 2 – – – – – – – 2 – – – – – – – – – – 24 St. Mary's R.C 408 – – 1 2 3 – 1 – – – 1 – 1 – – – – – – 5 – 14 St. Michael's 128 – – – 17 7 – – – – – 1 – – – – – – – – – – 25 St. Peter's 329 – – – 10 1 – – – – – – – – – – – – – – – – 11 Selhurst Grammar 1101 _ _ – – – – – – – – 1 – – – – – – – – – – 1 Shirley (St. John's) 543 1 _ _ _ – – – – – – 5 – – – – – – – – – – 6 South Croydon 594 – – – – – – 1 – – – – 1 – – – – – – – – – 2 South Norwood 936 10 – 4 23 5 – – – – – 9 – – 2 – – – – – 2 – 55 Spring Park 550 70 – 9 6 2 – 1 – – – – – – – 1 – – – – – – 90 Stanley Tech. 28 2 – – – – – – – – – – – – – – – – – – – – – – Sydenham 607 – – – 1 – – – – – – 10 – – – – – – – – – – 11 Tavistock 1030 – – – – – – – – – – – – – – – – – – – 12 – 12 Trinity 596 – – – – – – – – – – 1 – – – – – – – – – – 1 Waddon 163 – – 3 – – – 2 – – – – – – – – – – – – – – 5 West Thornton 5 28 – 1 2 – – – 1 – – – 8 1 – – – – – – – 4 – 17 Whitehorse Manor 795 _ _ 3 2 3 – – – – – 1 – – – – – – – – 1 – 10 Winterbourne 1190 – 1 – 4 – – – – – – 7 – – – – – – – – – – 12 Wolsey 844 – – – 6 – – – – – – 1 1 1 – – – – – – 1 – 10 Woodside 1127 2 – 7 118 – – ~ – – – 1 1 1 – – – – – – 1 131 175 22 88 457 160 2 34 8 – – 106 108 12 5 1 – 1 – – 69 4 1252 46 Table VII HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS OR BOARDING IN BOARDING SCHOOLS, 1956 Blind Parti ally Sighted Deaf Partially Deaf Delicate Physically Handicapped Educationally Sub-normal Maladjusted Epileptic Total In the Calendar year:- (1) (2) (3) (4) (5) (6) (7) (8) (9) (10 A. Handicapped Pupils newly placed in Special Schools or Homes – 4 – 3 31 23 36 2 1 100 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes – 6 1 3 30 24 35 5 1 105 On or about December 1st:- C. Number of Handicapped Pupils from the area: (i) attending Special Schools as Day Pupils – 13 19 8 86 106 196 – – 428 Boarding Pupils 1 1 2 2 3 8 15 2 3 37 (ii) attending independent schools (under approved arrangements) – – 2 1 – 4 – – – 7 (iii)Boarded in Homes – – – – – – – – – – TOTAL (C) 1 14 23 11 89 118 211 2 3 472 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education Act, 1944 - (i) in hospitals – – – – 11 – – – – 11 (ii) in other group – – – – – 1 – – 1 (iii) at home – – – – – 2 – – – 2 E. Were requiring places in Special Schools (i ) TOTAL (a) day – 2 – – 3 4 – – – 9 (b) boarding – – 1 – – 1 6 5 – 13 (ii) who had not reached the age of 5: - (a) awaiting day places – 1 – – – – – – – 1 (b) awaiting boarding places – – 1 – – – – – – 1 (iii) who had reached the age of 5 but whose parents had not consented to their admission to a special school:(a) awaiting day places – 1 – – – – – – – 1 (b) awaiting boarding places – – – – – – – – – – F. Were on the registers of hospital special schools - 4 Number of children reported during the Calendar Year: Under Section 57(3) of Education Act, 1944 13 " " 57(4) " - " "57(5) 14 47 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1956 RETURN OF MEDICAL INSPECTIONS A.-Routine Medical Inspections Year 1956 Year 1955 Age 11 or under 31 49 12 30 49 13 20 28 14 22 66 15 30 54 16 51 40 17 19 22 18 or over – 26 Total 203 334 B,-Other Inspections Number of Special Inspections 1 17 Number of Re-inspections 5 42 Total 6 59 Visits to Non-maintained Schools _8 13 The following defects were found by Medical Inspection: - Treatment Observation Defective Vision 10 – Squint 1 - Other defects - Eye 1 - Nose and Throat 1 - Lungs 1 1 Posture 6 - Flat Foot 1 - Other Orthopaedia 1 - Other Defects and Diseases 2 - CONTENTS A - PUBLIC HEALTH REPORT Page Airport 74 Ambulance Service 40 Amusement Houses 55 Animals, Diseases of 57 Animals, Keeping of 57 Ante-Natal Clinics 29 Appendix Tables 81 Births 10,11 Blindness 76 Byelaws 51 Cancer 13 Census 9 Chemical Analyses 71 Chest Clinic 20 Child Minders 73 Civil Defence 41 Convalescence 41 Committee 3 Communicable Diseases 15 Cremation 74 Day Nurseries 32 Deaths 11,12 Dental Treatment - M. & C. W. 33 Disinfection 56 Disinfestation 40, 56 Drainage 54 Dysentery 15 Epilepsy 79 Extra Nourishment 23 Factories and Workshops 52 Food Poisoning 16 Foods 59 Health Education 42 Health Visitors, Work of 37 Home Helps 38 Home Nursing 31 Homework 53 Hospital, Isolation 17 Housing 51 Ice Cream 64 Illegitimacy 9, 29 Immunisation 37 Infant Mortality 12 Infant welfare Clinics 30 Inquests 11 Page Laboratory Examinations 28, 64, 70 Laundry service 39 Marriages 10 Maternity Homes 73 Meat Inspection 61 Men's Hostel 52 Mental Health 43 Midwives 36 Midwives, Municipal 36 Midwives Acts 36 Milk63 Mortality in Childbirth 11 National Assistance Act 75 Neo-Natal Deaths 84 Notification of Birth Acts 11 Nuisances 50 Nursing Equipment 42 Nursing Homes 73 Nurses' Agencies 73 Occupation Centre 46 Offensive Trades 54 Outworkers 53 Pests 58 Physiotherapy 32 Poisons and Pharmacy Act 57 Poliomyelitis 19 Population 9 Post-Natal Clinics 29 Post-Mortems 11 Premature Infants 29 Problem Families 76 Prosecutions 60 Public Health Inspectors, Work of 49 Rag Flock Act 57 Rats and Mice (Destruction) Act 58 Refuse Collection 72 Relaxation Classes 29 Rivers and Streams 55 Scarlet Fever 18 Sewage 72 Sick Room Attendants 39 Slaughterhouses 61 Smoke Observation 55 Spastics 79 Staff Examinations 74 Staff 7 Page Still Births 11 Street Accidents 115 Tables, Appendix 81 Tuberculosis, After Care 26 Allowances 26 Contacts 24 Home Nursing 24 Home Visits 24 " Institutional Treatment 24 Mass Radiography 25 Mortality 22 " Notifications 96 " Occupational Therapy 27 Re-Housing 25 " Vaccination 25 Pages Vaccination 74 Verminous Persons 56 Venereal Diseases 21 Vital Statistics 1 Ward Statistics 12 Watercourses 55 Water supply10 Welfare Foods 30 X- Ray25 Zymotic Diseases 12 B - SCHOOL MEDICAL REPORT Page Child Guidance 26 Cleansing of Children 8 Clinics 4, 11 Cod Liver Oil 26 Cost 20 Crippling Defects 22 Deaf Children 11 Deaths 9 Deformities 21 Dental Service 12 Ear Disease 11 Enuresis Clinic 28 Epileptic Children 28 Exclusions 9 Following-up 10 Health Visitors, Work of 10 Heights and Weights 7 Immunisation, Diphtheria 20 Infectious Diseases 6 Inspection Clinic 11 Inspections 5 Juvenile Employment 26 Malt 26 Meals, Provision of 26 Mentally Defective Children 24 Milk, etc., Provision of 26 Minor Ailments 11 Page Non-maintained Schools 29 Orthodontic service 17 Parents' Attendances 5 Physically Defective Children 21 Population 9 Remedial Exercises 20 Schools, special 20 Spastic 28 Speech 27 Staff 4 Statistical Tables 30 Surveys, Uncleanliness 8 St. Christopher's 23 St. Giles' 21 St. Luke's 25 Treatment 11 Tuberculosis 9 Uncleanliness 8 Vision, Defective 7 X-Ray 17