CR 059 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1957 S. L. WRIGHT,M.D., M.R.C.P., D.P.H. 3 HEALTH COMMITTEE 1957 Alderman G. H. Ward, O. B. E.,J. P. Councillor H. S. Kew (Chairman) Councillor D. McClellan Councillor Keith Edwards, Councillor Mrs. E. M. Maycock (Vice-Chairman) Councillor Miss L.N. Overton Alderman H. Lock Kendell. O. St. J. Councillor Mrs. D. V. Paines Alderman W. Berners Price, J.P. Councillor Mrs. C. Penman Councillor F.D.J. Bailey Councillor H.A. White Councillor V. Burgos O.E. Finch, Esq., M. C., M. D. Councillor Mrs. V. L. Child J.S. Lane, Esq., B. A., M. R. C. S., Councillor J.J. Cooper L. R.C. P. Councillor R. H. Davies, M. B. E. S. A. MacKeith, Esq., O. B. E., Councillor E. J. Fowler M. R. C. S.. L. R.C.P.. D.P.M. Councillor Mrs. D.L. George 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.P. Kanaar, Esq., M. D., M. R.C.P. J.H. Thompson, Esq., M. B., B. Ch., B. A. 0. A.F. Clift, Esq., F.R.C.S. , W.R. C.O. G. Croydon Local Medical Committee Croydon Group Hospital Management Committee Mrs. LM. Ryle Horvrood Royal College of Nursing Irs. P.R. Mitchell, O.B.E. College of Midwives Miss J.C. Dickinson Croydon District Nursing Association Mrs. H. Thatcher Croydon Family Planning Association Mrs. J. Too good Croydon Federation of Townswomen 's Guilds D.G. Goldie, Esq. The St. John Ambulance Brigade (Southern Area) T.C.F. Millard, Esq. The Insurance Institute of Croydon * (Resigned 26th November, 1957) 4 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 To the Chairman and Members of the Health Committee LADIES AND GENTLEMEN. I have the honour to present the Annual Report on the health of the people of Croydon and the relevant services of the Corporation for the year ending 31st December, 1957 and make the following brief comments on various matters covered in greater detail on other pages:- Statistics Despite a fall in the birth-rate last year, the RegistrarGeneral estimates a slight rise in the total population of the borough. This is of interest in reversing the trend of the last few years of outward movement of population from Greater London into the surrounding counties. There was no change in the standardised death rate and infant mortality was again reduced. Last year's record of no maternal death was not, unfortunately, repeated. Clean Air Act, 1956 The necessary action was commenced to establish a Smoke Control Area covering a sizeable district on the south west aspect of the borough. 5 Infectious Diseases If for no other reason, 1957 will certainly be noted for an influenza epidemic. Although there was ample warning of the likelihood of "Asian" influenza, no simple measures could be advised to prevent its spread. The forecast that it would be mild in character was upheld and in Croydon, the general upset to the adult community was less than anticipated. Vaccine for special groups became available somewhat late and reports of adverse reactions did not encourage those for whom it was issued. As far as can be judged, it would be difficult to justify the effort required to vaccinate large numbers of the population against this form of infection. The campaign for vaccination against poliomyelitis developed slowly because of shortage of vaccine, but as earlier fears of possible ill effects proved unfounded, the demand increased. In the early part of 1957, there was an outbreak of measles, with a record number of notified cases. That improvements in nutrition and hygiene do not reduce the numbers inwalved in such outbreaks of respiratory infection is disappointing. Clearly, it would be unreasonable to attempt specific immunisation as used against dangerous illnesses such as poliomyelitis or diphtheria. The problem of enhancing general immunity to all infections remains unsolved and 1957 »ith influenza and measles, as striking examples, shows that much further research is still needed. Personal Health Services No major changes are recorded, but existing schemes were improved in detail and developed as required. The new administrative centre and hostel for District Nurses was completed by the end of the year. Health Education The importance of this function was recognised by the Corporation appointing a Health Education Officer to the staff of the Department. Attention was given especially to the difficult task of convincing smokers that there is a direct causal relationship between the smoking of tobacco, especially cigarettes, 6 and cancer of the lung. While the evidence shows that heavy smokers, who give up smoking, thereby reduce considerably the risk of lung cancer, it was thought that efforts to prevent young people acquiring the habit were lik y to be more successful. Home Safety is perhaps a branch of Health Education, since it is concerned mainly with making individuals aware of possible dangers, in order that reasonable preventive action can be taken. A Sub-Committee of the main Health Committee was set up during the year and a good deal was achieved on a very modest budget. Cordial relationships have continued with other branches of the Health Service and I express my appreciation of the manner in which all my requests for assistance or advice have been met with courtesy and generosity. My thanks are due to the Chairman, Vice-Chairman and Members of the Committee for their help and encouragement and to the members of my staff for their continued attention to routine duties and many helpful suggestions for improvements in the working of the department. I am, Yours faithfully, S. L. WRIGHT, Medical Officer of Health and Principal School Medical Officer 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. 17 clerks cluding 1 part tine), 4 typists, 1 messenger. Public Health and Pood Chief Public Health Inspector, Inspection Deputy, 21 Inspectors, 1 intendent Slaughter House, 1 Foreman and 5 Assistants, Chief Disinfector and 2 Disinfectors, 1 Superintendent and 4 porters (men's hostel), 2 Rodent operatives, 9 clerks, 1 typist, 2 trainees. Haternity 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 Mldwlves, 1 Physiotherapist, 2 Ante-Natal Clinic nurses (part time), 6 clerks. (Dental Service as for School Health). 10 clinic cleaners and 2 handymen (all part time). District Nursing (agency Superintendent, 3 Assistants, 45 arrangements) nurses, 2 clerks (1 part time). toiestic Help Supervisor, 2 Assistants, 1 clerk/ assistant, 1 clerk, 15 full time and 162 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 3 Clerical Officers including 1 temporary. Ambulance Service Ambulance Officer. Deputy, Second Officer, Maintenance Officer, 4 Leading Drivers, 61 Drivers, 2 mechanics, 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), 2 Assistant Chest Physicians (part time), 5 T.B. Visitors, 2 Almoners, 2 clerks, 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. 4 cleaners (part time). Health Education 1 Qualified Health Education Officer. Welfare Foods 2 clerks (1 part time) and 1 driver. STATISTICS 9 SUMMARY OF VITAL STATISTICS FOR 1957 Area, 12,672 acres. Population (Census 1951), 249,870. Total population (estimate of Registrar-General), 249,500 (Midsummer, 1957). Number of Inhabited Houses: 72,077. Rateable Value (1st April, 1957): £4,351,850. Product of a Penny Rate (1956-1957): £18,711. Rate in the £: 13s. 2d. (for the year ending 31.3.57). Live Births: M F Total Legitimate 1,726 1,590 3,316 Illegitimate 94 100 194 3, 510 Birth-rate per 1,000 of the estimated resident population, 14.1. (England and Wales 16.1). Birth-rate (as adjusted by comparability factor, 0.99), 14.0. Still Births, 72. Rate per 1,000 total (live and still) births, 20.1. Deaths, 2,952. Death-rate per 1,000 of the estimated population, 11.8. (England and Wales 11.5). Death-rate (as adjusted by comparability factor, 0.84), 9.9. Infant mortality rate, 17.9per 1,000 live births. (England and Wales 24). Legitimate Infants (60 deaths), 18 per 1,000 live births. Illegitimate Infants (3 deaths). 15 per 1,000 live births. Perinatal death-rate, per 1,000 total (live and still) births, 30. 10 Principal Causes of Death in order of frequency (RegistrarGeneral' s Return) Rate per 1,000 Population (1) ALL Ages Deaths from diseases of Cardiac and Circulatory System 4.36 " " Cancer 2.37 " " diseases of the Nervous System 1.76 " " diseases of Digestive System *0.14 " " diseases of the Respiratory System (excluding Tuberculosis) 1.33 " Suicide and Violent Causes 0.34 " Tuberculosis (all forms) 0.13 * ulcers of stomach, duodenum; gastritis and enteritis. Marriages The number of marriages solemnised was 1,962, compared with 1,947 in 1956, 2,076 in 1955, 1,882 in 1954, 1,987 in 1953, 1,993 in 1952, 1,960 in 1951, 2,051 in 1950, 2,066 in 1949, and 2,169 in 1948. 875 were solemnised in Established Churches, 409 in other places of worship, 1 Jewish Ritual and 677 in the Register Office. Births The live births registered were 3,316 legitimate and 194 illegitimate. The birth-rate consequently was 14.1 per 1,000 population. Fbr Bigland and Wales the rate was 16.1. The illegitimate births in Croydon were 5.5 per cent of the total as compared with 4.3 in 1956, 4.8 in 1955, 5.5 in 1954 and 1953, 5.3 in 1952, and 5.4 in 1951. The live male births numbered 1,820, the female 1,690,being a proportion of 1,077 males to 1,000 females. 11 Deaths The deaths numbered 2,952, compared with 2,977 in 1956. For 1957 the crude death-rate was 11.8 compared with 11.9 in 1956. The death-rate for England and Wales was 11.5. There were 88 inquests held by Coroners in respect of Croydon residents during 1957 and 417 findings by Coroners after post-mortem without inquest. Wards with the highest death-rate were South (14.6), and Bensham Manor (12.5) Lowest: Addington (3.8), Shirley (7.3) and West Thornton (8.6). Still Births During 1957, 72 still births were registered in respect of Croydon. Of these, 31 were male babies and 41 females; 4 males 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. Notifications of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,111 50 3, 161 Doctors 808 28 836 3,919 78 3,997 Accommodation for Confinements The following table shows where babies were born in Croydon during 1957. These figures include 798 confinements of mothers who were not residents of Croydon and exclude some 312 residents of the borough who had their babies elsewhere. On balance Croydon hospitals and maternity homes had an additional 486 cases with which to deal. The comparable figure for 1956 was 341, and since the Croydon birth rate fell in 1957, it is clear that here is one reason for the present shortage of hospital maternity beds in Croydon. 12 Number Percentage In Private Houses 1,137 28.45 In Public Institutions 2,482 62.10 In Registered Maternity Barnes 378 9.45 3,997 Maternal Mortality There were 3 deaths, compared with 0 in 1956. The maternal mortality rate calculated per 1,000 total births was 0.84. The rate for England and Wales was 0.47 in 1957. For figures for the years 1937 - 1957 see the appendix,page 101. Causes of death:- 1. Septicaemia, following self-induced abortion. 2. Antepartum haemorrhage. 3. Eclampsia. Infant Mortality The 1957 figure is the lowest yet recorded, being 17.9 as compared with 18.6 in 1956. Set out in the appendix, page 103 are the usual 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. Among the 63 deaths, 37 occurred in boy babies and 26 in girls. Of the births, 1,820 were males and 1,690 females. infantile mortality rate for the two sexes was, therefore, Boys-20, Girls-15. 55 deaths of infants occurred in Institutions, including Registered Nursing Homes. Por details of infant deaths see the appendix, page 102. Ward Statistics These are tabulated in the usual form in the appendix, page 100. 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 13 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. Deaths The Registrar General's Table is given in the appendix, page 97. Comparisons with 1956 show there were again no deaths from Whooping Oough and 2 from Measles (none in 1956). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 29 (1956 26); those from Cancer decreased by 1; those from Pneumonia decreased by 6 and a decrease of 32 was recorded in those caused by Bronchitis. There were 33 deaths from Influenza (1956 - 11). Deaths from suicide show an increase of 13, and motor vehicle accidents totalled 18 (24 in 1956). The total number of deaths was 2,952 as compared with 2,977 in 1956. The percentage of deaths under 1 year of age to the total deaths was 2.1 per cent.; deaths under 15 years, 3.1 per cent.; deaths under 65 years, 28.1 per cent.; and deaths over 65 years, 71.9 per cent. The corresponding figures for 1956 were 2.3 per cent., 3.1 per cent., 27.6 per cent., and 72.4 per cent, respectively. The Registrar-General has continued to supply a comparability factor-0.84 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. 14 CANCER For detailed tables see the Appendix, page 99. Deaths tabulated in the Department number 591 as compared with 592 in 1956; 549 in 1955; 486 in 1954; 540 in 1953; 567 in 1952; 479 in 1951; 501 in 1950 ; 481 in 1949; 510 in 1948; and 492 in 1947. Death-rate per 1,000 of the population for the last 11 years is as follows:- 1947-2.03 (492) 1951-1.91 (479) 1955-2.20 (549) 1948-2.03 (510) 1952-2.26 (567) 1956-2.37 (592) 1949-1.93 (481) 1953-2. 16 (540) 1957-2.37 (591) 1950-1.99 ( 501) 1954-1.95 ( 486) The organs most often attacked in descending order of incidence are: In the males-the Lungs (38.1 per cent.), the Bowels and Rectum (10.3 per cent.) and the Stomach (9.9 per cent.); in females-the Bowels and Rectum (21.5 per cent.), and the Breast (17.9 per cent.). COMMUNICABLE DISEASES 15 INFLUENZA This is not a notifiable condition and the extent of an outbreak can be judged by:- (1) Comments of general practitioners. (а) Reports of Head Teachers. (3) Applications for sickness benefit received by local offices of the Ministry of National Insurance. (4) Notification of influenzal pneumonia. (5) Deaths registered as due to influenza. (б) Reports from district nursing and home help services. (7) Need for emergency arrangements to deal with applications for in-patient hospital treatment. (8) Staff absences in large organisations. From such sources, reports of possible "Asian Flu" came first from New Addington and Thornton Heath during the latter part of September, spread to other parts of the borough was rapid, and for three weeks total absences of school children rose, to reach a peak of about 27% in the week ending October 11th. Thereafter, the absence rate fell steadily. Amongst adults, cases developed more slowly, with a peak about the middle of October. As shown by the graph in the appendix, the general sickness rate remained above the average and influenza seemed to merge with and increase the usual winter incidence of respiratory disease. 51 cases of influenzal pneumonia were notified in the four months, September to December, (1956-5) and 29 deaths from influenza, (1956-3). No exceptional demands were made on the nursing or home help services. 16 FOOD POISONING In 1956, there was a marked fall in the number of cases notified and 1957's increase represents a return to the numbers of previous years rather than an unusual rise. These figures do not include an outbreak which occurred in a corporation special school. This affected both staff and children and was shown to be due to a staphylococcal infection of canned peas. No-one was seriously ill, but the matter was investigated very fully in conjunction with the Public Health Laboratory service. A meeting was held in London with representatives of the canners, their research organisation and the Laboratory Service. It was quite clear that no blame rested on the School Meals service, as the can had been infected before being opened. Appropriate action was taken to prevent a repetition of this incident. The food poisoning notifications, as corrected, for 1957 were:- 1st Quarter 21 2nd Quarter 9 3rd. Quarter 30 4th Quarter 14 Total 74 Outbreaks due to identified agents:- Total Outbreaks Total Cases 4 13 Outbreaks due to:- (a) Chemical Poisons Nil (d) Cl. Botulinum Nil (b) Salmonella Organisms 4 (e) Other Bacteria Nil (c) Staphylococci (including toxin) Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases 8 23 Single Cases:- Agent identified Unknoun Cause Total 16 22 38 17 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1957 I am indebted to Dr. J. J.Linehan, Physician Superintendent, for the following report on infectious etc. cases admitted to the Hospital during 1957. There was a total of 1026 admissions of whom 572 were admitted to the acute infectious diseases wards, 372 to an acute medical ward temporarily evacuated from Croydon General Hospital, 55 to the chest ward and 27 to a chronic sick ward temporarily evacuated from Mayday Hospital. The average number of occupied beds was 71.6. In the following paragraphs and table, figures shown in brackets denote Croydon patients, Amissions to the Oiest Ward:- 50 (48) cases of pulmonary tuberculosis were admitted and there were two deaths, aged 55 and 66 years respectively. Also admitted to this ward were three cases of bronchial carcinoma, one of congestive heart failure and one of collagen disease. The average bed occupancy was 17.12 and the average stay in hospital 85.6 days. Admissions to the Infectious 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 19.9 days and the average number of occupied beds, 31.1. Measles 86 (60) Gastritis 1 Scarlet Fever 55 (54) Colitis 2 Whooping Cough 45 (36) Cholangitis 1 Gastro-enteritis 45 (35) Strangulated Hernia 1 Poliomyelitis and Peptic Ulcer 1 Encephalitis 39 ( 34) Pyloric Stenosis 1 Influenza 29 (24) Carcinoma of the Rectum 1 Pneumonia (including Osteomyelitis 2 Influenzal pneumonia) 66 ( 48) Thrombophlebitis 2 Rubella 27 (20) Pelvic Abscess 1 Chicken-pox 25 (17) Vulvar Abscess 1 Mumps 21 (15) Brain Abscess 1 Food Poisoning 11 (8) Nephritis 1 Hysentery 10 (6) Infective Endocarditis Infective Hepatitis 8 (staphylococcal) 1 Meningitis 6 Rheumatic Endocarditis 1 Paratyphoid Fever 1 Myocardiac Degeneration 1 Dndulant Fever 1 Congestive Heart Failure 1 Glandular Fever 1 Aortic Aneurism 1 Erysipelas 1 Impetigo3 (2) Malaria 1 Allergic Dermatitis 1 Herpes Zoster 1 Papular Urticaria 2 Bronchitis 14 (11) Toxic Erythema 1 Pharyngitis 4 (3) Sub-arachnoid Haemorrhage 3 Tonsillitis 11 (10) Cerebral Tumour 1 Streptococcal Sore Throat 2 Infective Polyneuritis 1 Otitis Media 6 (5) Migraine 1 Thrush 1 Epilepsy1 Septic Parotitis 1 Prostatic Hypertrophy 1 Cervical Lymphadenitis 4 Carcinoma of the Ovary Pleurisy 1 Pyrexia of unknown origin 1 Enpyema 1 Nil abnormal detected 8 Pulmonary Collapse 1 Non-patient Baby 1 18 Measles: - The disease was epidemic during the early part of the year and 76 out of the total of 86 admissions were admitted during the months of February-April inclusive. The ages of patients admitted were as follows:-under 2 years, 29; 2-4 years, 23; 4-7 years, 27; over 7 years, 7. Complications present were pneumonia, 25 cases; otitis media, 5 cases; tonsillitis, 4 cases; three cases each of enteritis, conjunctivitis, rhinitis and bronchitis, and one case each of encephalitis, convulsions, tetany and epistaxis. The only fatal case was that complicated by encephalitis. It concerned a girl, aged 12 years, and death occurred within a few hours of admission. Scarlet Fever:-The decline in the number of admissions continued. The number of cases admitted showed the usual seasonal variation and customary highest incidence between 5 and 7 years of age i.e. early school age. There were two cases of otitis media. Other complications were of a minor nature. looping Cough:-The patients admitted were in the following age groups: under one year, 19 (of whom 11 were under 6 months); 1-4 years, 15; 4-9 years, 1L Complications were present as follows: pneumonia. 13, bronchitis 4 and one case each of lobar collapse, conjunctivitis, epistaxis and gastro-enteritis. Gastro-enteritis:-The number of cases treated in the different age groups were as follows: under one year, 22; 1-2 years, 12; 2-15 years, 3; adults, 9. 21 cases were mild, 20 moderately severe and 5 cases very severe. There was one fatal case, a one day old baby, who also had developed pneumonia. Faecal culture was carried out in all cases but gave no indication as to the infecting organisms. Poliomyelitis and Bicephalitis:- Poliomyelitis cases were above average in numbers and severity. Of the 39 patients diagnosed as suffering from poliomyelitis, five had meningitis without paralysis and 34 were paralytic cases. The paralytic cases could be classified as follows - Spinal paralysis only Spinal and respiratory Spinal and bulbar Bulbar only 22 5 2 3 Of the above patients, 9 were severely paralysed and there were two fatal cases. 19 The patients were in the following age groups:- Under 5 years 8 20-30 years 6 5-10 years 13 30-40 years 5 10 - 20 years 6 Over 40 years 1 The two fatal cases were aged 25 and 43 years respectively. All cases of respiratory paralysis and five of the nine severely paralysed patients were adults. Polio-virus Type 1 was isolated from the faeces of 33 of the total of 39 cases, including all the non-paralytic cases. The six cases from whom the virus could not be recovered, included one case which proved fatal, before a specimen could be obtained. All six patients were adults and include three of the five patients with respiratory paralysis. The disease had the usual seasonal incidence and 29 of the 32 cases occurred in the months of July - October inclusive. Influenza and Pneumonia:- The influenza epidemic in the last four months of the year proved to be a most unusual and important occurrence. It commenced in September and, excluding pneumonia cases, October was the peak month for admissions. Again excluding pneumonia, vomiting was the most troublesome symptom and patients were notably in the younger age groups, age distribution being as follows: 0-10 years, 9; 10-20 years, 11; 20 - 30 years, 7; 30-40 years, 2. Linked with the influenza outbreak was an increased number of admissions for pneumonia. Thus 41 of the 66 pneumonia admissions were in the last three months of the year, a season not normally associated with a high incidence. Many of the pneumonia cases were recognizably of influenzal origin, either from the history or symptoms. All eight fatal cases of Pneumonia occurred in the peak months for influenza of October and December. The most unusual and tragic feature of the epidemic was the occurrence of two fulminating fatal cases of influenzal pneumonia in children. Similar fatalities have been reported elsewhere throughout the country. Other infections:- Cases of rubella and chicken-pox did not Present any unusual features and were admitted under the usual circumstances. Of the mumps patients, 11 of the 21 admissions were adults. There were four cases of meningoencephalitis and of orchitis. The incidence of the disease and particularly of nervous complications appeared to be higher than usual. 20 The food poisoning cases consisted of eight adults and three children. Six were infections with the prevalent Salmonella typhi-murium. There was one case each of infection with Salmonella Heidelberg, Thompson, Anatum and Enteritidis, and one case in which pathogens were not isolated. All dysentery cases were children and of the prevalent Sonne type. Of the meningitis patients, two were Coxsacki B virus infections and one each of listerial, meningococcal, tuberculous and benign lymphocytic of unknown aetiology. The tuberculous case was unusual in that death occurred the day after admission to hospital after, apparently, only a short period of illness. THE PREVENTION AND 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 1957 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1957 was 33 which shows an increase of 7 when compared with 1956, but the incidence of the disease during the year has decreased somewhat. The General Practitioner Miniature X-ray Service continues to function in a satisfactory way and is well used by the Local Practitioners. The results of this service are summarised below:- Number of miniature films taken 3,476 Number of patients recalled for examination and large film 490 Number of active cases of Pulmonary Tuberculosis 24 Number of cases of lung cancer found 17 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 6.90 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 Radiography sessions have no symptoms. 21 Whilst this section of the report is concerned with Tuberculosis it should be realised that all chest conditions are seen and treated at the Chest Clinic. With the decline in Tuberculosis we are seeing an increase in the incidence of lung cancer and chronic bronchitis. The former accounts for the highest number of cancer deaths in males and the latter causes much chronic invalidism and loss of earning capacity. Incidence 147 cases of Respiratory Tuberculosis and 15 cases of NonRespiratory Tuberculosis were notified on Form A during 1957 (Table I - Formal Notifications). Of these 94 males and 53 females were Respiratory cases and 7 males and 3 females were Non-Respiratory, in addition 121 Respiratory cases and 11 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 1957 by notification or otherwise was 294 as compared with 349 in 1956, 261 in 1955, 336 in 1954 and 304 in 1953. 268 of these were cases of Respiratory Tuberculosis; 165 in males and 103 in females. There were 18 fewer males and 32 fewer females than in 1956. There were 5 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 6 in 1956. The number of cases in adults was 18 compared with 25 in 1956. Of the cases notified in 1957, 2 males and 5 females died from the Respiratory form of the disease during the year, equal to 4.8 per cent. of those notified. The incidence rate of Tuberculosis of all forms was 1. 18 Per 1,000 of the population; for Respiratory Tuberculosis 1.07 and for Non-Respiratory 0.10 per 1,000 population. The notification rate was 0.65 per 1,000. In 1956 the corresponding figures were 1.40, 1.28, 0.12 and 0.84 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1957:- 22 RESPIRATORY NON-RESPIRATORY Total Cases Wales Females Total Males Females Total 1. 202 890 2,09 2 78 99 177 2,269 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1957, 139 of the new patients examined at the Clinic were found to be in the undermentioned stages of the disease on the first examination: - A. or T. B. minus (Scutum negative or absent) 83 or 59.7 8, or T. B. plus, 1 (early cases, sputum positive) 12 or 8.6 B, or T. B. plus, 2 (intermediate cases, sputum positive) 42 or 30.2 B, or T. B. plus, 3 (advanced cases, sputum positive) 2 or 1.5 139 100.01 Non-Respiratory Tuberculosis There were 15 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints 3 Abdominal 1 Other Organs 4 Peripheral Glands 7 15 23 Ages at Death from Respiratory Tuberculosis Year 0.5 5-15 15-25 25-45 45-65 over 65 TOTAL 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 1958 - - - 2 11 12 25 1957 - - - 6 10 13 29 All but 8 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 contracts and to endeavour to persuade them to attend the Clinic for examination. In 1957 the death-rate from all forms of Tuberculosis was 0.14 per 1,000 population. The rate from Respiratory Tuberculosis was 0.12 and the rate for Non-Respiratory Tuberculosis 0.02. Similar figures for 1956 were 0.100 and 0.004. In 1957 the total number of deaths showed a slight increase when compared with 1956. 80% 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 1957 4 deaths were certified to be due to NonRespiratory Tuberculosis, compared with 1 in 1956, 2 in 1955, 4 in 1954 and 6 in 1953. The deaths were due to:- 24  Males Females Total Tuberculous Kidney 1 - 1 Miliary Tuberculosis - 1 1 Tuberculous Meningitis 1 1 2 Totals 2 2 4 Co-ordination with the Health Department During the year 47 children were referred by the School Medical Service, and 21 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 22 selected cases for varying periods during the year, and 17 cases were in receipt of extra nourishment at the end of the year. Residential Treatment 250 men, 148 women and 13 children were admitted to Residential Institutions in Croydon during 1957. The Chest Clinic and Home Visiting 1, 920 new cases were examined during the year. 153 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 19,817. There were also 1,958 attendances Iff patients for collapse therapy. The Clinic doctors paid 377 home visits and the Tuberculosis Visitors 2,896 visits for Clinic purposes. In addition the Tuberculosis Visitors made 417 primary visits for the Purposes of the Notification Register. There were also 1,534 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 isa valuable adjunct in the care of domiciliary cases. 25 Contact Examination The examination and subsequent supervision of persons coming into contact with patients suffering from Tuberculosis plays an important part in the prevention of the spread of infection. During 1957, 709 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contact-case ratio of 4 for each notified case during the year. Of these contacts, 11 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 15 compared with 1.18 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 are as follows:- 1956 - New contacts examined 738. 1955 - " " " " 686. 1954 - " " " " 820. 1953 - " " " " 668. 1952 - " " " " 661. New cases of Tuberculosis 202 " " " " 171 " " " " 238 " " " " 211 " " " " 243 B.C.G. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1957 and regular sessions are held at the Clinic for this purpose. 420 contacts were successfully vaccinated during the year, compared with 285 in 1956. In addition, 37 nurses and domestics were successfully vaccinated, and 55 babies of tuberculous parents were vaccinated in hospital during the neonatal period. Towards the end of 1957 details were worked out of a scheme for offering B.C.G. to children in their 14th year and attending local Schools. This scheme has been approved by the Ministry of Health and will be put into operation during 1958, and it is anticipated that approximately 2,500 children will be offered B-C.G. during each year. This represents a further advance in the prevention of Tuberculosis by protecting children at a vulnerable age and should contribute to the general decline ine in Tuberculosis in the country. 26 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, pages 121 - 126. Rehousing of Tuberculosis Patients 29 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 285 examinations were carried out in 1957. MASS RADIOGRAPHY I am also indebted to the Medical Director of the Surrey Area of the South-West Metropolitan Regional Hospital Board Mass Radiography Service for the following particulars of persons examined and of abnormalities found:- No. of Persons examined Active Pulmonary Tubercuiosis Inactive Pulmo nary Tubercuiosis Croydon C. B. Area 17 , 505 18 545 27 TUBERCULOSIS AFTER-CARE The year 1957 has been a very busy one from the point of view of tuberculosis after-care. Despite the continued decrease in the number of deaths, there are still very many patients and their families who need considerable help from all possible sources to enable them to face what is still a long period of treatment, readjustment and rehabilitation. Most of these problems can be solved by co-operation with the many statutory authorities whose job it is to provide these services. Special grants are arranged through the National Assistance Board to maintain the home while the patient is ill, and the Ministry of Labour Training Centre and Industrial Rehabilitation Unit at Waddon are invaluable in helping to place disabled patients in suitable work as soon as they are fit. However comprehensive official schemes may be, there is always room for voluntary help and in this sphere development has been most marked. The Croydon Tuberculosis Care Committee were able to help patients to a degree and in a manner quite beyond the scope of any Government sponsored scheme. For instance, close on 200 patients received a Christmas grocery parcel, bought from voluntary funds and packed and distributed by voluntary effort, and a party of children enjoyed a visit to the pantomime at the Committee's expense. The winter programme included gifts of coal to 73 families as well as warm clothing and shoes mainly for the children. The holiday programme increased in popularity and consequently in expense, but as 35 people were enabled to have the first holiday they had enjoyed during many years of illness it was £220 well spent. In addition, the closing of Coombe Wood Hospital meant that patients had to so further afield for part of their treatment so that help with fares to visit was especially welcome. In all, over £650 was spent on supplementing official provision for the welfare of the Patients. It is even more gratifying to report that almost £800 was raised during the year by voluntary effort, over £500 of which came from our share in the Christmas Seal Sale, sponsored by the National Association for the Prevention of Tuberculosis. The beginning of 1958 finds us therefore, confident of being able to help Croydon T. B. patients in a manner worthy of a County Borough of this size. 28 OCCUPATIONAL THERAPY There is little to report in the field of occupational therapy as for several months there was no occupational therapist and the scheme was unfortunately in abeyance. However, in the autumn a new appointment was made and home bound patients were able to resume their programme of handiwork during the winter months. A small sale of work was held just before Cristmas, and it is hoped to arrange a permanent show case in the Chest Clinic to display goods made by the patients, in order both to stimulate interest and orders. 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 127. The graph which shows the number of Croydon residents who made a first attendance at the clinic at the Croydon General Hospital records a further rise in the prevalence of gonorrhoea. Although small, this conforms with the national trend and suggests a real increase in this infection. Last year, in commenting on the incidence of venereal diseases, I concluded that the efficacy of antibiotic treatment was the probable reason for the post-war reduction. Reports from Venereologists suggest that the gonococcus-the germ which causes gonorrhoea-is becoming resistant to penicillin and changes in treatment will be needed. Since there are different methods of using penicillin and other antibiotics are also available, it is reasonable to assume that this is only a temporary setback in the struggle of man against microbe. 29 PUBLIC HEALTH LABORATORY SERVICE Very considerable use has been made of the facilities for bacteriological and other laboratory examinations of Public Health nature. I take this opportunity to thank Dr. A.J.H. Tomlinson, the Director of the Bacteriological Laboratory, County Hall, S.E.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 - 1957. Faeces outfits 1,124 Water samples 270 Milk samples 244 Cream samples 8 Ice Cream samples 259 Sundry Food Specimens 20 Blood 24 Urine 26 Nose and Throat Swabs 122 Total 2,097 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 31 ANTE-NATAL AND POST-NATAL CLINICS The use of single clinic premises for both mothers booked for hospital or for home confinement continued unchanged. A full range of services includes consultative clinics, demonstrations of gas/air analgesia, mothercraft instruction classes and relaxation exercise sessions. Attendances were as follows: - During the year 4,272 cases were seen at the Ante-Natal Clinics, of which 3,106 were new cases. A total of 28,615 attendances were recorded and 1,958 cases were seen at the Post-Natal Clinics (1,752 new cases) with 2,008 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 511 mothers recorded 2,904 attendances. CARE OF PREMATURE BABIES Emphasis continued to be upon the prevention of premature births, but the special facilities available to assist in the care of a premature infant being nursed at home remained available. Prematurity and its high infant mortality rate is the Problem which confronts the present generation of those concerned with maternal and infant welfare and no easy solution has yet been suggested. With some mothers, adequate rest during the later stages of the ante-natal period seems an important factor, but unfortunately, those with the greatest need not infrequently are the least inclined to accept medical advice. There is authority to use home helps as a less drastic measure than admission to hospital, but with the type of mother concerned, consent for even this is just as difficult if not more difficult to obtain. For detailed figures, see the Appendix, page 107. 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. 32 During the year under review- 168 cases were dealt with by the Social Worker; 41 cases were admitted to Hostels; 4 cases were temporarily accommodated at Glazier House (The Croydon Home of the Moral Welfare Association) The Committee agreed to meet financial responsibility for the stay of unmarried mothers in Mother and Baby Homes for a period of three months except for girls up to 18 years of age, for whom the period would be extended to cover a total of six months and such assistance was given in 25 cases. These younger mothers would normally go to Homes specialising in their care. MIDWIFERY SERVICE The Corporation employ directly a Superintendent and 19 Domiciliary Midwives. The Midwives are recognised by the Central Midwives Board to train pupils for the second three months of their Part II C. M. B. training. This scheme operates in conjunction with St. Mary's Maternity Hospital where the first three months of pupil training is carried out. The Domiciliary Midwives have their headquarters in the Ante- and Post-Natal Clinic premises which adjoins the hospital and very close integration of teaching is thus possible. The Corporation have continued to encourage Midwives to have a motor car for their work and two vehicles were purchased and issued to those Midwives who preferred not to buy their own. It remains the wish of the majority of mothers to have their confinement in hospital. When it is remembered that official policy between the wars was the provision of maternity units for normal confinements; and the great convenience for an expectant mother to leave the planning of the confinement almost entirely to others, with no resulting expense to herself; ttie demand for hospital accommodation is readily understood. On the other hand, having dealt with the apparent difficulties of domestic arrangements, mothers who experience both types of confinement, have little doubt of their preference to remain at home. With an obstetric service making a careful selection of the place of confinement on medical grounds and 33 with all facilities for a rapid interchange between home and hospital and with an Emergency Obstetric Service always on call, her own home is a very safe and satisfactory place for a mother to have her confinement. In support of this assertion, the usual statistical details are set out in the Appendices on pages 104 - 106. 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 72. 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. INFANT WELFARE CENTRES Infant Welfare Centres The usual details regarding attendances are given in the Appendix, page 109. A subsidiary centre was opened to serve the northern part of the New Addington Estate, but as no building was available during the week, a Saturday morning session was held. Attendances were small and by numbers alone continuation would not have been justified. However, as the medical room of a school building formed the main part of the clinic, running costs were sufficiently low to allow the experiment to continue. In the well established centres, emphasis was again on group education and psychological development of the child as a developing part of educational work, which is permitted by the striking improvement in physical health. Welfare Foods The W. V. S. continued issues from their central office throughout the week and on Saturday mornings, and supplies were available at all Infant Welfare Centres while is session. Total issues made during the year were:- National Dried Milk 82,632 Cod Liver Oil 22,274 Vitamins A and D (for Expectant Mothers) 13,169 Orange Juice 208,572 34 THE WORK OF THE HEALTH VISITORS I am indebted to the Superintendent Health Visitor, Miss Oakley, for the following report. Throughout the year the Health Visitors have continued their work amongst the families in the Borough, teaching and advising on positive health in the homes. Infant Welfare Centres, School Clinics and Schools. Opportunity to make their work known to a wider public was taken by talks given to Women's Groups and Parent Teachers Associations. The "Welcome to Citizenship" and Municipal Exhibition gave the Health Visitors a chance to bring home to the general public, the changes brought about by the teaching of preventive medicine and environmental hygiene in the life of the community as a whole. This was done by means of a model made hy themselves, in conjunction with the Home Helps Department, depicting school and home life at the beginning of the century and now. In these changes Health Visitors have played a bigger part than is generally realised. Thirty courses of Mothercraft Talks were held during the year, some 516 expectant mothers attending. These have proved invaluable not only for the teaching given by the Health Visitor, but for the interchange of ideas amongst the members of the class in the discussion which follows the talk. There has been a gradual development of group teaching in some of the Infant Welfare Centres which it is hoped to extend during the coming year. Advantage has been taken of the appointment of the Health Education Officer to obtain insight into modern teaching methods. Realizing the influence the Health Visitors have with the mothers of the Borough, the W. V. S. asked for help in disseminating knowledge of their One in Five Scheme which, with the approval of the Home Office, aims at spreading basic Civil Defence measures to the Women of the country. A meeting was arranged and the scheme outlined by speakers from the Educational Department of the W. V. S. and from the St. John Ambulance Brigade. As a result some Health Visitors have co-operated by addressing groups of women and all have undertaken to pass information on whenever it is asked for. The problem of the aged is coming more to the fore of the Health Visitors' work, and during the year an increasing number of visits have been paid to old people living alone. Advice is 35 given on the facilities available to them and help given in obtaining them. After the initial call, periodic visits arepaid to ensure that' their needs are being adequately met and that there are no signs of physical or mental deterioration which may necessitate a period of specialist treatment. However much the scope of the Health Visitor's work may change, her best work will always be done in the homes of the families under her care. Figures of work carried out are shown in Appendix, page 108. IMMUNISATION Last year, I commented upon the use of triple antigen, which combined in a course of three injections immunity against diphtheria, whooping cough and tetanus. A report of the Medical Research Council and a subsequent Circular from the Ministry of Health drew attention to the small but measurable risk of provocation paralysis associated with the use of certain immunising agents. After consultation with the Local Medical Committee, it was agreed that the use of triple antigen should be restricted to the six months, October to March inclusive, and single diphtheria or whooping cough antigens used in the remaining months. Vaccinations against smallpox or poliomyelitis are not affected by this decision and in fact, I think that the timing of other immunisation procedures will depend not upon the age of the child but upon the period of year concerned. Supplies of poliomyelitis vaccine were small and no special measures were necessary until the promise of Salk vaccine at the end of the year necessitated a fresh offer to the new groups who were to be eligible for vaccination in 1958. The usual tables are given in the Appendix, page 120. 36 HOME HELP SERVICE Although the number of new applications for this Service fell slightly the total number of hours of service provided was higher. The ageing section of the population makes greater demands on the Service every year, and the number of cases carried forward steadily increases. With the national economy more dependent on woman power, the aged and chronic sick can no longer be cared for entirely by relatives and friends and must therefore seek help from some outside source. Without the Home Help Service with a graduated scale of charges, essential help would be denied to these people. The supplementary schemes, i.e., Washing Service; Night Service; Problem Family Service, and Disinfestation continued to provide specialised help where it was required. Set out in Appendix, page 113 are the details of the work performed. HOME NURSING The Superintendent of the Croydon District Nursing Association estimates that without the attention of the District Nurses, some 50% of the patients attended would need hospital care. 25% of patients accepted from hospitals are discharged only on condition that further treatment is given by the District Nurses. In making these comments. Miss Dickinson emphasised that the District Nurse is one member of the domiciliary team and however important these duties may be, the full benefit can only be obtained in co-operation with all the other domiciliary services. In addition to routine District Nursing work, the employment of the State Enrolled Assistant Nurse, who works in conjunction with the Hospital Geriatric Department has continued. It may be of some interest to list details of the cases she attended during the 12 months period and these are set out below. It is essential that the Nurse concerned can cover the whole of the borough as she deals with selected cases only, and her case load is necessary small in comparison with her colleagues doing general district work. On occasions, she has been engaged herself upon such general duties. 37 RETAILS OF THE WORK OF THE STATE ENROLLED ASSISTANT NURSE Age Disease Treatment Duration of visits Remarks Result 52 Hemiplegia *G. A. & Exercises 3 weeks Slight Hemiplegia Complete recovery. 78 Fractured Femur G. A. & Exercises 2 weeks Admitted back to Queen's Hospital as patient lived entirely alone. Returned to hospital. 76 Hemiplegia G. A. &Exercises 12 weeks This patient made a good recovery from first stroke but died after second. Died. 65 + Injured spine G.A.& Exercises 5 weeks This patient was rehabilitated but needs assistance with special corset. Transferred to another nurse. 76 Hemiplegia G. A. 4 weeks Found this patient to be mentally confused. Left district to live with son. Other causes. 64 Hemiplegia G. A.& Exercises 2 weeks Responded quickly to treatment. Complete recovery. 76 Hemiplegia G. A. & Exercises 2 weeks Responded quickly to treatment. Complete recovery. 58 Hemiplegia G. A.& Exercises 8 weeks This patient was totally blind. Complete recovery. 76 Fractured Femur G.A.& Exercises 12 weeks Patient walked with crutches then with stick. Good, will always need stick. 76 Hemiplegia G.A.& Exercises 2 weeks Responded quickly to treatment. Complete recovery. 72 Operation on Femur G. A.& Exercises 6 weeks Crippled with arthritis but could walk with stick. Complete recovery. 80 Hemiplegla G.A.& Exercises 2 weeks Very co-operative. Complete recovery. 58 Fractured Femur. G.A.& Exercises 16 weeks Patient extremely nervous. Taught to walk with crutches, then stick. Complete recovery. 83 Hemiplegia G. A.& Exercises 14 weeks Patient proved too much for daughter to nurse. Did not respond to treatment. Admitted to Queen's Hospital. Died. 75 Hemiplegla G. A. & Exercises Still under care Patient has had one previous stroke. Walked well with tripod. Partial recovery. R. O. B. 90 Hemiplegia G. A. & Exercises Few days. Died. 65 + Hemiplegia Exercises 4 weeks Patient spent most time in hospital. Complete recovery. 82 Hemiplegia G. A. 6 weeks Doctor did not wish patient to get up. Had second stroke. Died. * G. A.-General attention. 38 Age Disease Treatment Duration of visits Remarks Result 86 Hemiplegia G.A.& Exercises Still under care This patient was rehabilitated but is now back on books. Transferred to another nurse. 76 Hemiplegia G.A.& Exercises 8 weeks Very co-operative. Complete recovery. 93 Fractured Femur G.A.& Exercises Still under care Can walk with difficulty. Partial recovery. 76 Hemiplegia G.A. & Exercises 8 weeks Made good recovery. Walks very well. 46 Cerebral Tumour G.A.& Exercises 5 weeks There is nothing that can be done here. Transferred to another nurse. 86 Hemiplegia G.A.& Exercises 5 days Patient fell while alone in the house. Admitted to Mayday with fractured Femur. Admitted to hospital. 86 Hemiplegia G.A.& Exercises 8 weeks This patient is totally blind. Can walk unaided. 76 Hemiplegia G.A.& Exercises 14 weeks Patient could not speak. Responded to treatment. Walks with tripod,. speech has returned. 76 Cardiac & Debility Encourage to get up 4 days Died. 86 General Debility G.A. 1 week This patient was making a good recovery but developed Gastritis. Admitted to hospital. 76 Hemiplegia Exercises 4 weeks Patient very co-operative. Now attending Speech Clinic. Complete recovery except speech. 57 Hemiplegia G.A.& Exercises Still under care Patient has made a remarkable recovery. Remaining on books for bed bath. R.O. B. 85 Hemiplegia G.A. 1 week Relatives requested patient to go into nursing home. Nursing home. 87 Cerebral Thrombosis G.A. 5 days Died. 83 Hemiplegia G.A.& Exercises Still under care Patient has made good progress. Home conditions not good. R. O. B. 84 Hemiplegia G. A .& Exercises Still under care Patient made good progress but doctor wishes her to rest. R. O. B. 18 Hemiplegia Q. A.& Exercises 3 weeks Patient had a very slight stroke, made a quick recovery. Complete recovery. 39 76 Hemlplegia G.A.& Exercises still under care This patient's 2nd stroke, was making good progress until Thrombosis and Phlebitis developed in her leg. Transferred to another nurse. 79 Fractured left Femur G.A.& Exercises Still under care Patient can walk very well with aid of crutches. Remaining on books for bed bath. R.O.B. 58 Rheumatoid Arthritis G.A.& Dress Still under care This patient is a Chronic. R.O.B. 83 Hemiplegia G.A. Still under care Patient making very slow progress. R.0. B. 76 Hemiplegia G.A. Few days Sisters wished patient to be removed to Queen's Hospital Hospital. Summary- 18 Completely recovered and partially recovered. 5 Died. 6 Admitted to Hospital. 4 Transferred to another Nurse. 1 Other Causes (Left the District). 6 Remaining on Books. Total • 40 40 LOAN OF NURSING EQUIPMENT In the appendix to the report is given a list of items loaned during the year under review. These prosaic details summarise the work of a small but important section of services available for patients being nursed at home. "Enuresis machines" are now a standard issue for the treatment of nocturnal enuresis in children. These consist of a pad, a small dry battery, a relay and an electric bell. A drop of moisture falling on the pad allows sufficient electric current to operate the relay and complete the circuit which rings the bell until the pad is disconnected. Experience in the use of various methods of treatment gained by the doctor in charge of the School Enuresis Clinic, has shown that these machines constitute one of the most effective forms of treatment. As the cheapest costs over £5 and is needed, if successful, for a few months only, their availability on loan from the Corporation is a great advantage. CONVALESCENCE The Corporation accepts 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 52 cases were so dealt with, 37 women, 9 men, 5 children and 1 married couple. These figures do not include school children for whom arrangements are made by the Education Committee. 41 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/-per day. 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 the full rate of 12/6d. per day. Only one child for one week was admitted on this basis in 1957. Details of attendances - Capacity 50 Number on books at end of year 42 Attendances: under 2 2,293 over 2 5,821 TOTAL 8,114 Number of days opened 254 Average daily attendance 32 M. AND C.W. PHYSIOTHERAPY CLINIC One Physiotherapist continues to combine duties in relation to children under five years of age and to hold physiotherapy sessions for the instruction of mothers in relaxation exercises for painless childbirth. As recorded in previous years, the demand for the treatment of minor orthopaedic defects in young children has markedly declined, but an increasing number of mothers are availing themselves of relaxation exercise courses. Details of attendances are given in the Appendix, page 111. 42 HEALTH EDUCATION I am indebted to the Health Education Officer, Miss Elliott, for the following report. "Soap and education are not as sudden as a massacre, but they are more deadly in the long run." Mark Twain. Education as a basic approach to health work is now well recognised and accepted. The National Health Service has brought early diagnosis and treatment within the reach of every man, woman and child; the aim of health education is to help people to achieve health by their own actions and efforts and develop a sense of responsibility for it as individuals and as members of families and communities. This is the first time a Health Education Officer has been appointed in Croydon, and therefore some time was spent in planning a scheme of work, preparing visual aids and acquiring the necessary basic equipment. A gradual survey of personnel, facilities and resources, both official and voluntary was also made and co-operation and goodwill were freely given. Before this appointment was taken up, School Medical Officers had reported a definite increase in smoking amongst older pupils in secondary Schools; this observation was reinforced by a circular from the Ministry of Health to all Local Authorities, drawing attention to the Medical Research Council's report, which showed that the most reasonable interpretation of the very great increase in deaths from lung cancer in males during the past twenty-five years, is that a major part of it is caused by smoking tobacco, particularly heavy cigarette smoking. The Health Committee suggested that my first and primary duty should be to inaugurate a campaign through parent-teachers' associations, youth clubs and schools to advise "teenagers" of the dangers involved in smoking. After careful research a suitable talk for these groups was devised. However, it became increasingly obvious that-with the exception of two excellent posters, the supporting visual material for this campaign was rather poor and too juvenile. There is still no film or film-strip available for this subject, so a series of sixteen coloured posters was designed and painted to illustrate and enliven the talk. These were becoming worn with constant use and "Camera Talks" were asked to photograph them and make them into slides. 43 "Camera Talks" had been approached earlier by the National Association for the Prevention of Tuberculosis about making a film strip on this subject. As a result of our ideas and interest we were asked to co-operate with them in the making of a professional strip. Scenes for about half the frames were shot in Croydon and we hope the strip will be ready for general distribution by the end of June. After speaking to a Croydon Teachers' Science Society, Dr. Wright thought that the rising generation would be the most profitable group to tackle. After a period of trial and error the following programme is being carried out in Secondary schools (boys and girls):- 1. A pegboard triptych displaying coloured cardboard cutouts about the effects of smoking is put up in the school for one or two weeks. 2. Leaflets expanding on the subject and written in a simple style are distributed among the older children. 3. The illustrated talk is given. 4. Evaluation of the effects of this propaganda is attempted by asking each group to either:- (a) Write an essay on smoking-after seeing the display, and before hearing the talk. (b) Write an essay on smoking after seeing the display and hearing the talk. or (c) To evaluate the leaflet simply as a piece of propaganda. These essays are still being assessed, but already one clear fact has emerged from them-children can take the facts and they are interested in the methods of research. We have also observed that quite a number of boys are smoking regularly at thirteen years old, but many of them have given it up for reasons of sport or finance by fifteen years old. Dnfortunately, there are very few parent-teachers' associations among secondary schools, but through these we are trying to encourage parents to dissuade their children from starting the smoking habit. Education on this subject is a long term policy and dramatic results are not expected: it is planned to repeat this programme annually in these schools. Having to talk to school children about the effects of 44 smoking on health, gave an opportunity to suggest a longer series of health talks for senior children. The syllabus for these is described in the school health section of the report on page 5. During the year many students, e.g.:- Doctors taking the Diploma in Public Health, Health Visitors, Student Nurses, W.H.O. fellows and teachers have visited the section and discussed some of the aspects of health education; this subject is receiving a stronger bias in their training now and it is important that they should learn to keep an open mind about testing new ideas and ways of approaching modern public health problems. It is difficult for those who have been in the field for a long time to change from comfortable routines and didactic methods; the change spells uncertainty and insecurity; but change also means progress. Research has shown that in spite of wide differences in kinds and rates of learning, there is a capacity for significant change in ideas, attitudes and modes of behaviour at all ages. To stimulate further interest in the educational aspect of public health work two short informal sessions have been held in the department. The first was a film on the topical subject of the manufacture of poliomyelitis vaccine which was shown just before this year's vaccination clinics began. The second was a display of available visual aids and a showing of teaching film strips and provocative sound film strips-which are useful for promoting informal group discussions. An increasing number of members of the staff is borrowing equipment and trying out new ideas, but subjects which it is thought people ought to know about are not always those which they want or need to know about. For example a Health Visitor was asked recently to give a talk to a Young Wives' Club on Mothercraft. She guessed that most of their children would be past the very young infant stage, so dealt with two problems concerning children a little older. Firstly infectious diseases and secondly, she showed a sound film-strip which posed the problem of a widowed mother-in-law living with her son and daughter-in-law and two young children. In this instance the group was not at all interested in the complications and effects of this arrangement on the management of young children, but had a lively discussion on the problems, needs and care of older people. Five displays and two exhibitions have been prepared during 45 the year. Displays were erected for the Health Committee showing:- 1. The visual aids used for the lung cancer campaign. 2. Methods and media used in health education. Help was also given towards a display used for the Home Safety Conference and another depicting simple health education aids for use in Infant Welfare Centres was shown at the Infant Welfare Centre Voluntary Helpers' Conference. A display, showing the health education materials used in an English Local Authority, was shown at the same time as a talk was given during an Overseas Seminar at the London University Institute of Education. The two bigger exhibitions were the result of the combined efforts of the department and showed some of its work. They formed part of the "Welcome to Citizenship" and Local Government Exhibitions held in the Town Hall during the year. There is also a constant demand for the making, maintenance and ordering of notices, illustrations and other visual aids. A small reference library has been started for the use of members of the department. A few books, unlikely to date, form the basis at present and we subscribe to the current medical, nursing, public health and health education journals, in order to keep our information as up-to-date and accurate as possible. Finally, useful information about the town is also obtained by compiling the local weekly vital statistics and helping to assemble this Annual Report. 46 HOME SAFETY In 1956, two Members of the Council drew attention to the need to co-ordinate the work of many organisations and departments of the Corporation dealing with the prevention of home accidents. The matter was considered by the Health Committee and the holding of a town's meeting early in 1957 was recommended. This proved a well attended and successful function at which it was decided to set up a special Home Safety Sub-Committee of the Corporation's Health Committee with powers to co-opt individuals particularly interested in this subject. In June, a One-day Study Course was arranged in conjunction with the Central Council for Health Education to instruct potential speakers, who form a panel available to lecture to voluntary organisations. A transportable stand was also obtained for use at fetes, flower shows and similar gatherings for display of appropriate publicity material and distribution of leaflets. A steady demand for speakers during the autumn and spring of 1957/58 developed and 13 talks had been given by the end of the year. Reports of all accidents sufficiently serious to require ambulance transport for hospital treatment were obtained from the Ambulance Service, but owing to clerical difficulties, hospitals were not able to supply figures of patients treated in "Casualty" as a result of accidents in the home. During 1957, 639 patients were conveyed to hospital following a home accident and there were 24 home accident deaths. 47 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 under school age introduction is effected through Infant Welfare Centres and similar institutions. A substantial number of applications is also made direct to the Dental Clinics themselves, or as a result of requests from Health Visitors. Treatment for patients in all categories is carried out at School Dental Clinics and is closely linked with work on the Education side. Since the inception of the National Health Service, added facilities for treatment in the General Dental Service have resulted in a very substantial reduction in the amount of work undertaken for expectant and nursing mothers at Local Authority Clinics. Though there have been minor fluctuations in demand over the years, this preference for attending general practitioners seems to be firmly established and likely to remain a Permanent feature. Whilst it is reasonable that those in receipt of regular attention should continue to visit the dentist of their choice, this desirable habit is by no means universal, and there is still evidence to suggest that at least a proportion of those at present opting for outside treatment do not fully appreciate the preventive aspect of the Scheme, and are inclined to delay matters if no discomfort is felt. Because of these omissions the necessity for an overall supervision is still apparent, and thus Dental Officers perform a worth-while function by their endeavours to see that as many as possible attending Ante-Natal Clinics are in receipt of an initial examination of the mouth during the early months of pregnancy. By so doing, requirements can be assessed whilst the Patient is in a receptive state of mind and more likely to accede to treatment. Though in practice not all those to whom forms are issued present themselves for the required inspection, this procedure is of great value, and if linked with suitable 'follow-up" measures by medical colleagues, concrete results can be obtained. One benefit resulting from the reduction in numbers referred to Local Authority Clinics has been the virtual 48 tion of the waiting period for attention; if, therefore, for any reason those attending at private practitioners' surgeries are unable to obtain a reasonable priority, speedy arrangements can now be made for Corporation Staff to carry out the work. Though the number of pre-school children referred continue to be influenced adversely by the closure of the Day Nurseries, a substantial amount of conservation for the "baby teeth" has been carried out, and this attention is well appreciated hy the more discerning parent, particularly as there is still a disinclination on the part of many outside practitioners to undertake this type of treatment. As staffing permits, it is hoped that more active measures can be taken to further expand this side of the Service, which has such an important bearing on the dental care of the school population. 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 plans for providing additional facilities have experienced recurrent setbacks. An explanation of existing difficulties will be found in the School Dental Report. 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 464, compared with 491 in 1956. 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. Fewer cases were 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 rather higher than in the previous year, namely 28 per cent. against 23 per cent. in 1956. Expectant mothers examined for the first time number 348 against 324 last year. Of these, 81.6 per cent. were seen during the first six months of pregnancy, compared with 72.5 per 49 cent. previously recorded. Those attending at later stages of their confinements included some with pain or discomfort, which might have been avoided had treatment been sought at an early date. There has been little change in the amount of work carried out for nursing mothers. In some cases this resulted from late reference from the Ante-Natal Department, which did not permit of treatment until after the confinement; in others, names were actually received during the post-natal period. 32 nursing mothers were examined during the current year, compared with 39 in 1956. Treatment Including those continuing treatment from the previous year. 476 mothers were dealt with, and exactly equalled those seen in 1956. 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 481 compared with 541 in 1956. As previously, this figure included a proportion of "Toddlers" due for re inspection and treatment. Because of the freer diet available in post-war years more decay is 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, 50 supported by work of a preventive nature at Dental Centres. The introduction of additional Nursery classes as Primary Schools would materially assist the situation, as a greater proportion of these children would then be covered by the routine dental inspection. AMBULANCE SERVICE To the Medical Officer of Health I beg to submit the Sixteenth Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1957. During the year the Service was called upon to deal with 103,853 patients, which necessitated 50,827 journeys and a mileage of 405,154. Compared with 1956, these figures show a decrease as follows:- 710 patients-275 journeys-8,658 miles. There were 15,626 patients conveyed to places outside the Borough, and on these journeys 121, 155 miles were travelled. The following vehicles were delivered during the year:- One Humber "Super-snipe" Ambulance Two Bedford "Utilecon" Sitting-Case Vehicles. and the following vehicle is awaiting disposal. One Bedford "Utilecon" Sitting-Case Vehicle. In June of this year, a team of two men was entered in the Chief Ambulance Officers' Association, No. 5 Regional Cup for First Aid Efficiency (both practical and theoretical), held at Surrey County Ambulance Headquarters, Kingston-upon-Thames. I am pleased to inform you that of the thirteen teams entered from various County and County Boroughs, the team from this Service was placed first. This enabled them to compete with six other Regional winners in the Chief Ambulance Officers' Association National Cup Competition for the whole of England and Wales, and was held at Warwick during September. On this occasion the team was placed third. Two Officers of this Service entered the Civil Defence Ambulance and Casualty Clearing Examination, and both were successful. For details of journeys, patients, mileage etc. see the appendix page 116. 51 CIVIL DEFENCE (Ambulance Section) The total number of Volunteers on the register at 31st December, 1957 was 323, composed of 117 males and 206 females. Of this 323 registered:- 9 are Instructors. 138 attend for regular training. 135 attend for some training. 41 have not yet reported. The full First Aid Course was once again conducted by the St. John's Ambulance Association, and was held in January, with a record entry of 83 volunteers, some of whom were re-qualifying. At the examination there was only 1 who failed. The number of qualified drivers is now 58, an increase of 10 over 1956. The driving tuition is still being given by Onward Driving School, with good results. The number of fully qualified First Aiders is now 123 and a new course will be commencing in January, 1958. Teams were entered for the Casualties Union Competition but unfortunately were unsuccessful. Some of the old members have gone on the reserve list, and only two have resigned. In conclusion, may I express my sincere thanks to the Members of the Ambulance Sub-Committee and to the Medical Officer of Health, for their help and encouragement which has been of great assistance to me in the administration of the duties of Chief Ambulance Officer. A.L. HILL, Chief Anbulance Officer. 52 DENTAL HEALTH As requested by the Ministry the following details of the service are set out:- Adainistration 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. Work carried out in the Community On the recommendation of the Medical Staff of Warlingham Park Hospital, the Corporation accept financial responsibility for patients to stay at approved homes conducted by the Mental After Care Association and three cases were so dealt with during the year. Other facilities A considerable proportion of the total mental health facilities available in the County Borough of Croydon are represented by services provided by the Hospital Management Committee of Warlingham Park Hospital. In addition to the Child Guidance Clinic and the numerous Adult Out-patient Clinics conducted at the Mayday Hospital and the Croydon General Hospital, these services include psycho-therapeutic out-patient group meetings, alcoholic group meetings, an old people's club, other psychiatric out-patients social clubs, and a Day Treatment Centre. These activities are conducted at 103, Park Lane and are organised by the Physician Superintendent of Warlingham Park Hospital. 53 Lunacy and Mental Treatment Act, 1956 Patients admitted to Mayday Hospital under Section 20 403 Cases admitted as above disposed of as follows:- Certified and admitted to Warlingham Park Hospital or other Mental Hospitals 52 Admitted to Warlingham Park Hospital or other Mental Hospitals under Temporary Order 9 Admitted to Warlingham Park Hospital or other Mental Hospitals under Urgency Orders 16 Admitted to Warlingham Park Hospital or other Mental Hospitals as Voluntary Patients 171 Transferred to ordinary Sick Wards 17 Discharged Home 106 DECEASED 9 Transferred to Queen's Hospital 10 Discharged to Mental Defective Colony - Discharged to Nursing Homes 13 403 Cases admitted to Warlingham Park Hospital Direct under Section 20 12 Cases admitted to Warlingham Park Hospital Direct as Voluntary Patients 16 Cases investigated and no action deemed necessary 90 Under the Mental Deficiency Act Number of known Mentally Defective Patients in the Borough:- 1956 1957 Under 5 years 54 80 Aged 5-16 years 150 126 Over 16 years 600 624 Total 804 830 Compared with 1956 the cases show an increase of 26. 8 Institution patients have died in hospital. 54 The cases are distributed as follows:- In Certified Institutions 342 In Approved Homes 4 On Licence from Institutions 50 Under Statutory supervision at home 326 Under Guardianship 26 In Mental Hospitals 14 Observation cases 68 In "Places of Safety" - 830 During the year the Certifying Medical Officers made examinations and paid visits to the number of 40 cases. The Mental Deficiency Visitors paid 3,676 visits. 26 new cases were examined during 1957 and certified as mentally defective. 8 of these cases were recommended for the Occupation Centre and 12 were placed under statutory supervision. 6 were recommended for institutional care. During 1957, 61 cases were dealt with as follows:- 1956 1957 Sent to Certified Institutions 8 14 Placed under Guardianship - - Sent to Warlingham Park Hospital 1 Varying Orders: (a) Change of Guardian 3 - (b) Prom one Institution to another 2 4 (c) From Guardianship to Institution 1 3 (d) Institution to Guardianship - 2 (e) Orders closed 15 24 (f) Patients admitted to Hospital for short term care 10 12 9 Orders were renewed during the year, 4 of which were Guardianship. 12 children were admitted to the Occupation Centre during 1957. 10 left or were excluded. There were 11 cases awaiting vacancies in Institutions on the 31st December, 1957. There were 22 cases under Statutory Guardianship, 14 of these under the care of relatives, and 15 with Guardians who are not relatives, 3 males are at work. 55 363 visits have been paid to Guardianship cases during the year. There are 50 cases on licence from Institutions (28 males and 22 females). Report on the Occupation Centre, January - December, 1957. Number on Register, January 75 „ „ „December 77 Number of Admissions 12 Number left or excluded 10 Average attendance per session 64 Times open. Morning-Afternoon 398 Total attendance for year 25,492 I am indebted to Miss Cooney, Supervisor of the Occupation Centre, for the following report:- In January the Centre re-opened with 75 patients on roll. Slight alterations were made in staffing. - Mrs. Neale was appointed to undertake the Senior Female Class, and Mrs. McCullough moved downstairs to take charge of the Junior Class. This arrangement has been a great improvement to these two classes. On January 10th we were able to take 60 of the patients to the Circus at Olympia. Tickets were obtained for this through the Parents Association for Backward Children. At the beginning of December, the Annual Sale of Work was held, and in spite of a very foggy afternoon, the parents came along in good force. The sales for this day amounted to £35.0.2. The amount taken in sales for the year amounted to £53.8.8. This was a record year. In December the Annual Christmas Party was held on December 17th with film shows, games, tea and ice cream. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 57 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR I beg to submit a report for the year ending 31st December, 1957, of the work of the Public Health Inspectors and other Officers under my control. Again, new legislation in the form of the Rent Act, 1957 and the Clean Air Act, 1956 and the completion of inspections of food premises under the Food Hygiene Regulations, 1955, absorbed much of the time of the staff. Whilst the food premises in the Borough now, in the main, satisfy the structural requirements of the Regulations, regular inspections will be required to see that the other important provisions are receiving attention. The new Rent Act places the responsibility with the Inspectorate of being the arbiters as between landlord and tenant regarding the extent and type of repairs considered necessary to merit the permitted increased rent. Up to the end of the year, the number of Certificates of Disrepair applied for had been comparatively few. Further progress has been made with the slum clearance and redevelopment programme in that new flats are being built on the site of the demolished unfit dwellings in Ely Road-Holmesdale Road; and the Crescent Mews lettings are likely soon to be vacated with a view to early redevelopment of that site also. The Clean Air Act, 1956 came into operation, in part, during the year and the Council quickly signified their support of its intentions by agreeing in principle to the establishment of a Smoke Control Area in the Waddon-South Croydon district, and by agreeing to adopt a byelaw requiring all new buildings to be provided with fireplaces capable of burning fuels smokelessly. The Act also requires occupiers of buildings to give notice to the Council of their intention to fix new furnaces in connection with boiler plant and quite a number of these have been received. Any new chimneys in connection with such plant have to be carried up to a sufficient height to disperse properly the products of combustion. All occupiers of factories, firms of architects and surveyors, trade organisations etc. were communicated with and given copies of a summary of the Act. During 1958 the remaining provisions of the Act which will aim at controlling the emission of smoke from factory plants 58 will come into force. Already there is evidence, by the approaches which have been made to the Department, that factory owners are aware of their responsibilities in this regard. I have again to report an increase in the number of animals slaughtered at the Abbattoir, namely 61,422 as against 56,362 last year. A 100 per cent inspection has been maintained but this has necessitated evening, and very often weekend attendance of at least one Inspector. The compensatory leave for such late evening and weekend duties reduces the time these Inspectors can give to their district work. Annually, I have to report on new legislation of one form or another, imposing additional workupon the members of my staff, and I wish to record my thanks to them for their efforts over the years in coping with this in addition to the numerous other duties they are called upon to carry out. GEO. GRIEVE, Chief Public Health Inspector 59 HOUSING During the year the unfit houses in Ely Road were demolished and new flats are in course of construction on the sites. Crescent Mews, the second area to be dealt with in the slum clearance and re-development programme has now been acquired and the dwellings are being emptied of their occupants with a view to demolition and re-development. During the year 1986 houses were rendered fit following the service of notices requiring repairs. Rent Act, 1957 - Certificates of Disrepair Applications for Certificates of Disrepair during the year, 1957:- Number of applications for certificates 323 Number of decisions not to issue certificates Nil Number of decisions to issue certificates 246 (a) in respect of some but not all defects 174 (b) in respect of all defects 72 Number of undertakings given by landlords 112 Number of undertakings refused by Local Authority Nil Number of certificates issued 63 Applications by landlords to Local Authority for cancellation of certificates 10 Objections by tenants to cancellation of certificates 1 Decisions by Local Authority to cancel in spite of tenants' objection 1 Certificates cancelled by Local Authority 6 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. 60 Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the washhouse provided. The average number of nightly lettings during the year was 97, and the number of lettings 34,973. The receipts during the year were £2,960 and the expenditure £5,040. 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 made and defects were found as set out:- Part 1 of the Act Inspections for purposes of provisions as to health (Including lnspections made by Public Health Inspectors): Premises Number on Register Number of lnspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 364 155 8 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,611 521 64 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 57 64 8 1 Total 2. 032 740 80 - 61 Cases in which Defects were found:- Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) died (3) Referred To H.N. Inspector (4) By H.M. Inspector (5) Want of cleanliness(S. 1) 4 4 - - - Overcrowding (S. 2). - - - - - Unreasonable temperature (S. 3) - - - - Inadequate ventilation (S. 4) - - - - - Ineffective drainage of floors (S.6) 4 4 - - - Sanitary conveniences (S.7): (a) Insufficient 8 8 - - - (b) Unsuitable or defective 61 42 - 3 - (c) Not separate for Sexes 5 2 - 1 - Other offences against the Act (not including offences relating to Outwork) 9 9 4 - - Total 91 69 4 4 - Part VIII of the Act Outwork Nature of Work (1) Section 110 Section 111 No. of out- workers in August list required by Sect.110 (1) (c) (2) No. of cases of default in sending lists to tie Council (3) No. of prosecutions for failure to supply lists (4) No. of stances of work in of some premises (5) Notices served (6) Pro seditions (7) tearing Apparel 221 - - 1 1 _ Household Linen 1 _ - - - - Curtains and furniture Hangings 1 - - - - - Furniture and Upholstery 2 - - - - - Umbrellas, etc. 3 - - - - - Paper Bags 6 - - - - - Carding, etc. of Buttons, etc. 39 - - - - - Cosaques, Christmas Crackers, etc. 76 - - - - - Lampshades 10 - - - - - Total 359 - - 1 1 - 62 Inspection of Schools These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 43 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 safe-guarded 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. 1,128 inspections were made under the Shops Act, and the infringements found were as follows:- Hours of Closing 12 Hours of employment of staff 4 Insufficient W. C. accommodation 7 Want of washing facilities 4 Defective ventilation 1 Defective W.C. accommodation 49 Defective walls, floors, ceilings, etc. 36 Defective and insufficient lighting 13 Want of seating accommodation 3 Notices to be exhibited or amended 143 DRAINAGE 2,588 visits of inspection were made to underground drains in course of repair. Of 191 Statutory Orders served, 67 had to be done in default of the owners. In addition, repairs were carried out by the Corporation to 27 public sewers serving 151 properties. OFFENSIVE TRADES There are but few registered, and during the year there has been no cause for complaint. 63 POLLUTION OF RIVERS AND STREAMS During the year 329 inspections were made to ascertain if any evidence of pollution or obstruction was apparent in the water courses 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 as to be a nuisance. Bye-laws are in force regarding the emission of "black" smoke, whereby it is an offence if such smoke is discharged for more than two minutes, in total, over a period of half an hour's observation. 123 such observations were carried out and in 2 instances black smoke was emitted for more than the statutory limit. The Managements were immediately interviewed and informed of the offence and advised. In no case did it become necessary to serve a Statutory notice to abate smoke nuisances. The Clean Air Act, 1956 was first operative during the year, but only in part, involving the giving of notice prior to the fixing of new furnaces; the control of the height of new chimneys to boiler plant, and provisions regarding the establishment of Smoke Control Areas. The prior notice provision is useful as itgives the Department an opportunity of discussing with the factory occupier and his advisers the technical aspect of smoke prevention before the plant is fitted. Heights of new chimney stacks present something of a problem as so many conditions affecting the relationship of other buildings, topography, prevailing wind direction, fuels used, type of construction of the building, and the stack all influence the decision as to what may be considered to be a suitable height whereby the products of combustion will be properly dispersed. A number of cases have been dealt with during the year where additional height was requested and agreed. 64 The proposed Smoke Control Area covers part of the Waddon and South Croydon area occupying the South-West corner of the Borough. It comprises:- Dwellings (privately owned) 583 " (Council owned) 1,167 Hotels and Homes 6 Schools and Churches 10 Shops 31 Industrial Buildings 55 The Ministry of Fuel and Power, the local gas and electricity boards and local merchants have assured the Council that sufficient smokeless fuels would be available. The dwellings in private ownership are now being surveyed with a view to arriving at the cost of the necessary adaptation and the Council-owned dwellings will follow. AMUSEMENT HOUSES 98 inspections were made of Theatres, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary condition of these premises. Notices are issued to remedy any unsatisfactory conditions. DISINFESTATION 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 10,108 articles By Formalin Gas 3,855 " Total 13,963 709 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 1957, 282 articles were disinfected, the receipts amounting to £29.8.3. 65 Disinfection was carried out after infectious or contagious diseases at the following premises:- 655 rooms at 340 houses, hospital wards, clinics etc. 2,568 library and other books were disinfected. On request disinfection was also carried out for conditions other than notifiable infectious diseases and for which a charge is made. During the year £37.10.0. was recovered for such services. In addition 255 articles were disinfected for Welfare Department institutions. CLEANSING OF VERMINOUS, Etc., PERSONS A Cleansing Station consisting of a reception room, four bathrooms and a discharge room, is attached to the Disinfecting Station, and is used for dealing with verminous, etc., conditions in adults and children. A woman attendant deals with children and women. During the year, 2 adults and 14 children were cleansed of verminous conditions and 1 adult and 1 child 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, etc. and occupiers are advised and instructed in their use by the Inspectors. The department assisted in the more difficult cases numbering 83, either by spraying or fumigation. Weekly visits are made to the abattoir when the manure storage and walls adjoining are sprayed with an insecticide. 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 29. In addition, 272 applications were made for the retention of names on the list for a further Period of 12 months. 4 infringements of the Act were found, and these were remedied during the year. 66 RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 The 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 1957, 19 samples of various fillings, as listed below were taken. All of these samples conformed with the requirements of the Regulations made under the Act:- Article No. of Samples Washed Flock 9 Kapok 2 Millpuff 2 Coir Fibre 1 Woollen Mixture Felt 1 Curled Feathers 1 Down and Feathers 3 PET ANIMALS ACT, 1951 21 persons were licensed for the purpose of keeping Pet Shops. During the year 74 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS Suspected swine fever was notified from two pig keepers premises during the year. These and 7 cases notified from the slaughterhouses were confirmed and appropriate action was taken in conjunction with the Officers of the Ministry of Agriculture, Fisheries and Food to provide against the spread of the disease. PREVENTION OF DAMAGE BY PESTS ACT, 1949 This Act is mainly concerned with the destruction of rats and mice and it places a duty on the occupier of any premises to report to the Local Authority any infestation by such rodents. 2 ratcatchers, officially designated rodent operatives, are employed to deal with such complaints. During the year, 1,514 private dwellings were inspected 67 following complaints and in 1,368 instances infestation was confirmed and dealt with by the rodent operatives. 100 business premises were found to be infested with rats or mice and these were all disinfested during the year. 24 of these were treated by the occupiers. Regular inspections are made of premises where food is prepared or sold and particular attention is given to methods of prevention of rodent infestation. Corporation owned premises including sewage works, refuse tips, depots, school kitchens and serveries, etc., are periodically inspected for the presence of rodents and if infested then action is taken by the department to eradicate the pests. 10 infestations at such premises were dealt with during the year. The baiting of the Corporation's sewers has now been carried out at regular six-monthly intervals since 1947 and although the rat population was markedly reduced at the first treatment, subsequent maintenance treatments have shown that the method and types of poison used was only capable of reducing the number of infested manholes recorded at each treatment to an average of 450. This method consisted of laying unpoisoned bait on the benching in manholes on two consecutive days in order to attract rats to a feeding point and then following up with a bait containing Arsenic, Antu or Zinc Phosphide on the third day. A substance known as Warfarin, an anti blood coagulant, was introduced in 1952 and has been used to deal with infestations on the surface with very good results, but as this has to be laid in sufficient quantities to be available to the rat for several days it was found impossible to leave it down in the humid conditions of the sewers without becoming affected with mould growth consequently affecting its palatability. In 1956 the introduction of two mould inhibitors, Paranytrophenol and Dehydroacetic Acid, in a bait base of pinhead oatmeal made it possible to use Warfarin in the sewers. A selected area of the more heavily infested sewers, numbering 650, was prepared in order to test the efficacy in the use of Warfarin in the sewers and to arrive at the most economical method of applying treatments without loss in efficiency. These manholes were treated in the Winter of 1956/7 and in the following Summer only 60 of the manholes in this area showed any activity. Following this the remaining manholes in the Borough were checked and where necessary were incorporated in the treatment at this time. The last treatment carried out in the Winter of 1957/8 has shown that the use of Warfarin in the sewers has been fully justified, only 30 manholes being found to contain rat infestations. 68 Further similar treatments will be carried out, and it is confidently expected that this should result in a considerable reduction in the cost and labour involved. The Ministry of Agriculture, Fisheries and Food 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 3,230 premises in the Borough at which food is known to be sold, manufactured or stored. Bakehouses 58 Bakers Shops 116 Sugar Confectioners 565 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 512 Works and Club Canteens 209 Public Houses 170 Off Licences 75 Grocers 597 Butchers 201 Wholesale Meat Markets 6 Chemists 76 Greengrocers 259 Fishmongers 76 Fried Fish Shops 57 Milk Distributors and Dairies 77 Premises from which Roundsmen and Mobile Shops operate 21 Stalls 99 Pood Manufactories 15 Other Food premises not enumerated above 41 3,230 69 Of the above premises 878 are registered under Section 16 of the Food and Drugs Act, as follows:- Retail sale of ice-cream 709 Manufacturers of ice-cream 6 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 163 During the year 5,966 inspections were made of food businesses (for details see page 83.) In addition, Croydon Airport was visited on 26 occasions to inspect foodstuffs arriving by air from the Continent. INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1955/56 Structural defects In shops and stores 4 Defective condition of walls and ceilings 206 " " " " floors, utensils, fixtures, etc. 147 Insufficient lighting or ventilation 16 Defective or insufficient drainage 36 W.C. accommodation - repair or cleansing required 70 " " " - artificial lighting required 17 " " " - want of Intervening ventilated space 11 Food - improperly stored 8 " - not stored 18" off floor 18 " - means to prevent contamination required 99 " - store required or defective 44 " - rooms etc. used for sleeping 3 Accumulations in yard or stores 55 Offal and refuse bins defective or uncovered 28 Yard paving defective Hand washing notice not exhibited 117 Ablutions - Wash basins required 173 " " - Hot water supplies required 306 " " - Nail brushes, soap and towels required 103 Insufficient or defective sinks 81 Smoking offences 18 Clothing accommodation required or defective 47 Defective or unsuitable table tops, etc 108 First Aid kits required or insufficient 90 Defective or unsuitable crockery and utensils 1 Cleanliness - advice given 93 Rodent infestation 19 Merchandise Marks 20 Vehicles - owners name and address not indicated 8 Prosecutions During the year a firm of butchers was prosecuted and convicted for failure to provide separate washing facilities for food and equipment on their premises, in accordance with the Pood Hygiene Regulations, 1955. The Magistrates Court imposed a fine of £5, with £5 costs. 70 Appeal Case A local greengrocer was asked to provide a wash-hand basin with hot and cold water supply, on his premises, to comply with the Food Hygiene Regulations, 1955. He applied for an exemption from this requirement, on the grounds of restricted space and other special circumstances, and this was refused by the Corporation. An appeal against the refusal was taken to the Magistrates' Court. The appeal was allowed by the Court which awarded three guineas costs against the Corporation. Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1957:- Article Weight in lbs. Carcase Meat 54, 217 Offal 41, 958 Sundry Foodstuffs 3,690 Canned, Bottled and Packeted Foods 72, 139 Total . 172,004 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 continues to play no small part in supplying Croydon and its environs with fresh meat. In 1956, 56,362 animals were slaughtered, and this rose to 61,422 animals during 1957. A 100% inspection has been maintained, but this has necessitated evening and often weekend attendance of at least one 71 Inspector. Six 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 Cows Calves Sheep and Lambs Goats Pigs Total 3,344 822 8,468 22, 182 512 26, 094 61, 422 CARCASES INSPECTED AND CONDEMNED Cattle ing Cows Cows Calves Sheep and Lambs Pigs Goats Horses Number killed 3,344 822 8,468 22,182 26,094 512 - Number Inspected 3,344 822 8,468 22,182 26,094 512 - All Diseases except Tuberculosis and Cysticerci Whole carcases condemned - 6 34 197 154 1 - Carcases of which some part or organ was condemned 1,790 342 44 1,089 2,261 5 - Percentage of the number inspected affected with diseases other than Tuberculosis 53.5 42.3 0.92 5.8 9.3 1.2 - Tuberculosis only Whole carcases condemned 5 17 1 NIL 6 NIL NIL Carcases of which some part or organ was condemned 130 79 1 NIL 236 NIL NIL Percentage inspected affected with Tuberculosis 4.0 11.7 0.02 NIL 0.93 NIL NIL Cysticercosis Carcases of which some part or organ was condemned 27 NIL NIL NIL NIL NIL NIL Carcases submitted to treatment by refrigeration 27 NIL NIL NIL NIL NIL NIL Generalised and totally condemned NIL NIL NIL NIL NIL NIL NIL 72 The District Public Health Inspectors, all qualified Meat Inspectors, inspect meat at the 6 wholesale Meat Depots in the Borough, as well as that exposed for sale in the butcher's shops. The Diseases of Animals (Waste Foods) Order, 1957 The Order provides that, in general, all waste food must be boiled before feeding to animals to minimise the spread of animal diseases. Licences to operate boiling plants and equipment are issued after inspection of the premises and plants. 80 inspections were made and 24 licences issued during the year. MILK SUPPLY During the year 135 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 77 Licences to use the designation "Sterilised" - Dealers' Licences 110 Dealers' Supplementary Licences to use the designation- (a) Tuberculin Tested 15 (b) Sterilised 14 (c) Pasteurised 15 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:- 73 Tuberculin-Tested Pasteurised Milk 41 Pasteurised Milk 191 Sterilised Milk 12 The following table summarises the results of the bacteriological examinations of Tuberculin Tested, Pasteurised and Sterilised milk samples during the year:- Tuberculin- Tested Pasteurised Milk Methylene Blue Test Phosphatase Test No. samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 41 - 41 - 41 Pasteurised Milk Methylene Blue Test Phosphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 191 - 191 - 191 Sterilised Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied 12 - 12 Bacteriological Examination of Milk Chum and Milk Bottle Rinses Chum Rinse Samples - 21 Satisfactory - 20 Unsatisfactory - 1 Bottle Rinse Samples - 126 Satisfactory - 107 Unsatisfactory - 19 These samples were obtained at local milk bottling plants and the results, as a whole, are considered satisfactory. 74 BACTERIOLOGICAL EXAMINATION OF CREAM Eight samples of fresh cream were examined and were found to be satisfactory. BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 259 samples were taken, the results being as under:- Grade No. of Samples 1 157 2 57 3 27 4 18 Of the total samples taken, 45 (17.37 per cent.) failed to reach a satisfactory standard of bacterial purity. In all cases after the results of sampling are known, the vendors and/or manufacturers are made aware of the results, and where the Gradings are 3 or 4, then a visit is made, methods of service or manufacture are investigated, faults rectified and further samples taken. CHEMICAL EXAMINATIONS OF ICE CREAM Two samples were taken from local manufacturers and were found to comply with the standard. FOOD AND DRUGS ACT, 1955 During the year, 249 samples of Milk and Cream, and 378 other samples were taken, of which number, 38 were found to be Not Genuine. Summary of Samples During 1957 samples were obtained and submitted to the Public Analyst as follows:- 75 Sample of Total Samples Genuine Not Genuine Prosecutions Convictions Almonds (Ground) 3 3 - - - Apples 2 - 2 - - Arrowroot 1 1 - - - Aspirin Tablets 2 2 - - - Bacon 1 1 - - - Barley Flour 1 1 - - - Batter Mixture 1 1 - - - Beer, Tonic (Packet) 1 - 1 - - Beer, (Bitter) 11 11 — - - Beer (Tinned) 1 1 - - - Beer (Mild) 3 3 - - - Bicarbonate of Soda 2 2 - - - Biscuits 2 2 - - - Black Pudding 1 1 - - - Blancmange Powder 2 2 - - - Boraclc Ointment 1 1 - - - Brawn 1 1 - - - Bread (white) 2 2 - - - Bread Crumbs 1 1 - - - Bread and Butter 1 1 - - - Butter 3 3 - - - Buttered Rolls 1 1 - - - Calamine Ointment 1 - 1 - - Calamine Compound Cream 1 1 - - - Calamine Lotion 1 1 - - - Camphorated Oil 1 1 - - - Candied Peel 2 1 1 - - Cakes (Various) 2 1 1 - - Cake Mixture 1 1 - - - Cakes (Fruit) 1 1 - - - Castor Oil 2 2 - - - Celery Salt 1 1 - - - Cheese 2 2 - - - Cheese Spread 1 1 - - - Cheese (Processed) 1 1 - - - Cheese (Cream) 1 - 1 - - Cheese Straws 1 1 - - - Chicklette Rissoles 1 1 - - - Chocolate 4 4 - - - Chocolate Spread 1 1 - - - Chutney 2 2 - - - Christmas Pudding 1 1 - - - Cockles (Cereal) 1 - 1 - - Cod Liver oil 1 1 - - - Cocoa 2 2 - - - Coconut (Dessicated) 2 2 - - - Coffee 2 2 - - - Coffee and chicory 1 1 - - - Coffee and Chicory Essence 2 2 - - - Compound Syrup of Figs 2 2 - - - Condensed Milk 8 7 1 - - Confection of Senna 1 1 - - - Cooking Fat 1 1 - - - Corned Beef 1 1 - - - Cornflour 2 2 . - - Cornflakes 1 1 - - - Cough Mixture 2 2 - - - Cough sweets 2 2 - - - Crab (Potted-Dressed) 1 1 - - - Cream of Tartar 1 1 - - - Cream (Tinned) 2 2 - - - continued on next page 76 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Cream (Fresh) 8 8 - - - Cream Buns and Cakes 1 - 1 - - Currants 6 3 3 - Curry Powder 1 1 - - - Custard Powder 2 2 - - - Dates (stoned) 1 1 - - - Dessert Powder 1 1 - - - Drinking Chocolate 1 1 - - - Dripping 2 2 - - - Essence of Rennet 1 1 - - - Evaporated Milk 8 3 5 - - Fish Cakes 2 2 - - - Fish Fingers 1 1 - - - Fish Paste 2 2 - - - Flavour Essence 1 1 - - - "Flu" Cure 1 - 1 - - Flour 2 2 - - - Friar's Balsam 1 1 - - - Fruit Pie 1 1 - - - Gelatine 1 1 - - - Gin 7 7 - - - Ginger Ale 1 1 - - - Ginger Beer 1 1 • - - Ginger wine 1 1 - - - Ginger (Crystallised) 1 1 - - - Ginger Essence 1 1 • - - Glauber's Salts 2 2 - - - Glycerine 1 1 - - - Golden Syrup 1 1 - - - Grapefruit Squash 1 1 - - - Gravy powder 1 1 - - - Ground Ginger 2 2 - - - Ground Cinnamon 1 1 - - - Ground Rice 2 2 - - - Ham 1 1 - - - Halibut Liver Oil Capsules 1 1 - - - Honey 1 1 - - - Horseradish Sauce 2 2 - - • Ice Cream 2 1 1 - - Ice Lollies 1 1 - - - Isinglass 1 1 - - - Iodine (Tincture of) 1 1 - - - Indigestion Tablets 1 1 - - - Jam 3 3 - - - Jelly 2 2 - - - Jelly Crystals 1 1 - - - Jellied Veal 2 2 - - - Lard 2 2 - - - Lemonade Powder 3 3 - - - Lemon Barley Water 1 1 - - - Lemon Glycerine and Honey 2 2 - - • Lemon Meringue Tart 1 1 - - - Lemon Pie Filling 1 1 - - • Lemon Curd 2 2 - - • Lemon Juice 2 2 - - - Lemon Squash 1 1 - - - Lime Juice Cordial 2 2 - - • Llnctus 1 1 - - - Liquid Paraffin 2 2 - - - Luncheon Roll 2 - 2 - - Macaroni 2 2 - - - Malt Vinegar 2 2 - - - continued on next page 77 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Malt Loaf 1 1 - - - Malted Milk Tablets 1 I - - - Margarine 2 2 - - - Marmalade 2 2 - - - Marzipan 1 1 - - - Meat Extract and Cubes 2 2 - - - Meat Paste 1 1 - - - Meringues 1 1 - - - Milk (Hot) 1 1 - - - Milk 227 227 - - - Milk (channel Island) 14 14 - - - Milk of Magnesia 1 1 - - - Mincemeat 2 2 - - - Minced Beef 1 1 - - - Mineral Waters 1 1 - - - Mint Sauce 1 1 - - - Mixed Fruit 2 - 2 - - Mixed Spices 2 2 - - - Mixed Herbs 1 1 - - - Mustard 1 1 - - - Mustard (French) 1 1 - - - Nutmegs (Ground) 1 1 - - - Oatmeal 2 2 - - - Olive Oil 1 1 - - - Orange Squash 1 1 - - - Parish's Pood 2 1 1 - - Peanut Butter 2 2 - - - Pearl Barley 1 1 - - - Pepper 1 1 - - - Pickled Onions 2 2 - - - Pickled Cabbage 1 1 - - - Pickles 1 1 - - - Pineapple Juice 1 1 - - - Pills (Blaud's Iron) 1 1 - - - Potato (Instant) 1 1 - - - Pudding Mixture 1 1 - - - Pumpernickel 1 1 - - - Pressed Beef 1 1 - - - Pressed Pork and Veal 1 1 - - - Puff Pastry 1 1 - - - Quinine (Ammoniated Tincture) 2 - 2 - - Rice 2 2 - - - Raisins 5 4 1 - - Rice Pudding (Creamed) 1 1 - - - Rissoles 1 1 - - - Rum 7 7 - - - Sago 1 1 - - - Salad Dressing 2 2 - - - Sandwich Spread 1 1 - - - Sauce (Chop) 2 2 - - - Sauerkraut 1 1 - - - Sausages (Beef) 3 3 - - - Sausage Meat (Pork) 1 1 - - - Sausage Meat (Beef) 2 2 - - - Sausage (Breakfast) 1 1 - - - Sausages (Pork) 4 4 - - - Sausage (Liver) 2 2 - - - Sausage (Luncheon) 1 1 - - - Savoury Ducks 1 1 - - - Semolina 2 2 - - - Soda Mint Tablets 1 1 - - - Suet (Packed) 2 2 - - - continued on next page 78 Staples of Total Samples Genuine Not Genuine Prosecutions Convictions Suet (Loose) 2 2 - - - Sponge Mixture 1 1 - - - Sulphur and Treacle 1 1 . . - Sugar 1 1 - - - Sugar (Brown) 1 1 - - - Sugar (Icing) 1 1 - - - Sultanas 6 2 4 - - Surgical Spirit (No. 1) 1 1 - - - Sweets 5 5 - - - Soup Powder 2 2 - - - Steak add Kidney Pie 1 1 - - - Stuffing (Sage and Onion) 2 2 - - - Stout (Canned) 1 1 - - - Table Salt 2 2 - - - Tapiocoa 1 1 - - - Tea 3 3 • - - Tinned Beans 1 1 - - - Tinned Marmalade 1 1 - - - Tinned Broad Beans 1 1 - - - Tinned fruit 6 3 3 - - Tinned Peas 4 4 - - - Tinned Vegetables 2 2 - - - Tinned Stewed Steak 1 1 - - - Tinned Frankfurt Sausages 2 2 - - - Tinned Soup 2 2 - - - Tinned Fish 2 2 - - - Tinned Meat 2 1 1 - - Tinned Luncheon Meat 3 1 2 - - Tinned Tomatoes 1 1 - - - Tinned Tomato Puree 1 1 - - - Tinned Tomato Juice 1 1 - - - Vitamin "A" Capsules 1 1 - - - Vitamin "A" and "D" Capsules 1 1 - - - Vitamin "C" Tablets 1 1 - - - Whisky 7 7 - - - Wine 2 2 - - - Yeast Tablets 1 1 - - - Total 627 589 38 - - Result of Analysis of Milk Samples Solids not Fat (Legal standard is 8.5%) 8.5 8.6 8.7 8.8 8.9 9.0 17 7 5 8 1 38 11 5 Milk Fat (Legal standard is 3%) 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 3 11 26 33 38 41 32 25 13 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 2 1 - 1 - - - 1 (Excluding South Devon and Channel Islands milks) 79 South Devon and Channel Islands Milks SoLids not Fat (Legal standard is 8.5%) 8.8 8.9 9.0 9.1 9.2 1 - 6 2 5 Milk Fat (Legal standard is 4%) 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5.0 5.1 1 1 1 4 1 1 2 2 - - 1 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Pat 8.69 Milk Fat 3.59 South Devon and Channel Island Milk Solids not Pat 9.07 Milk Pat 4.53 Total number of Milk Samples 241 The samples of milk for analysis were obtained as follows:- Taken on Milk Rounds 122 " at Dairies 96 " at Institutions 23 241 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Reworks Sultanas (4) Currants (3) Mixed Fruit (2) Stoned Raisins (1) These informal samples of cleaned dried fruit each contained a quantity of sand and other earthy matter exceeding 0.01 per cent. In the opinion of the Public Analyst cleaned dried fruit should not contain more than 0.01 per cent. of sand and other earthy matter. The packers were informed of the Analyst's opinion and are endeavouring to improve the standard of cleanliness of these dried fruits by the introduction of improved methods and new machinery 80 Article Nature of Adulteration or Deficiency Remarks "Cockles" (Cereal) This article, which is a new commodity, was incorrectly labelled and the oil content was in a rancid condition Manufacturers have amended label and are using more stable fats to improve the storage life of the article Tonic Beer This article was not correctly labelled in accordance with the Labelling of Pood Order, 1953 Manufacturers have amended 1abel Condensed Milk (1) Evaporated Milk (5) These informal samples each contained more than 170 parts per million of tin due to prolonged storage. Although a maximum figure of 250 parts of tin per million is permissible for canned foods this milk was not considered suitable for infant feeding as prescribed on the labels Stocks of this milk were withdrawn from sale by the retailers Cut Mixed Peel This sample contained 51 per cent. of sugar whereas, in the opinion of the Analyst. a reasonable sugar content for this article is 66 per cent. Importers have withdrawn existing stock and obtained further supplies which are of satisfactory quality Ice Cream Sample contained a quantity of iron or steel shavings amounting to 2.3 milligrams in 74 grammes of Ice cream Investigations disclosed that the metal shavings originated from a defective machine at the manufacturers' premises. The foreign matter was observed at the time of sampling and the firm's stocks were Immediately withdrawn from sale and destroyed. Manufacturers warned. Apples (2) These apples were labelled "Granny Smiths" by the retailers but were found to consist of a variety of apple different in shape, size, appearance, structure, and of inferior taste and eating quality as compared with the Granny Smith Vendors warned 81 Article Nature of Adulteration or Deficiency Remarks Cake This article possessed an unpleasant malty smell and taste due to diastatic action The bakers and their production research organisation have devised improved production methods to eliminate future contamination Flu' Cure The Public Analyst considered that this product was labelled in a misleading manner This matter was taken up with the retailer/ manufacturer Tinned Peaches This article was described on the label as sliced peaches in heavy syrup. In the opinion of the Public Analyst the density of a heavy syrup should correspond to at least 19 degrees Brix whereas the syrup density of this article was only 11.7 degrees Brix The packers have undertaken to improve the quality of this product Cream Buns This article contained imitation cream Notice has now been exhibited by vendor regarding use of imitation cream in confectionery Parrlsh's Food B.P. Parrlsh's Food is no longer included in the British Pharmacopoeia and should not be described as "B.P." The vendor has amended the label on this article Pork Luncheon Meat (2) The Analyst considers that a reasonable minimum meat content for pork luncheon meat is 90 per cent. whereas these samples contained less than 80 per cent. of meat The importers have undertaken to improve the quality of this meat Irish stew This prepacked article was not labelled as required by the Labelling of Food Order, 1953 The producers have now amended the label on this article Calamine Ointment Sample consisted of Compound Calamine Ointment B.P.C. Vendor warned Apricots in Rich Syrup This article had a syrup density of only 12.4 degrees Brix whereas, in the opinion of the Analyst, syrup density of apricots packed in heavy or rich syrup should correspond to at least 21 degrees Brix. The canners have undertaken to improve the quality of this product Pineapple Chunks in 25% Sugar Syrup The percentage of sugar in the syrup, as sold, was not more than 19 per cent. The packers have amended the label on this article to indicate the strength of syrup to be found on opening the can the can 82 Article Nature of Adulteration or Deficiency ks Luncheon Meat (2) These samples each contained less than 80 per cent. of meat which, in the opinion of the Analyst, is a reasonable minimum meat content for this article The producers undertook to increase the meat content of this article forth with Ammoniated Tincture of Quinine (2) These samples were each deficient in ammonia as judged by the minimum standard of the B.P.C. Manufacturers found that deficiency was caused by evaporation due to loose screw caps on bottles. Stocks were immediately withdrawn from sale Cream cheese Consisted of a soft whole milk cheese containing only 22 per cent. of fat instead of a minimum of 52 per cent. which is appropriate for cream cheese The vendors stated that this article was not sold as Cream Cheese and a reasonable doubt exists as to whether it was sold as such. No action taken 83 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 3.216 Houses inspected where zymotic diseases have occurred 333 " " " following applications for certificates of disrepair 331 Inspections of underground rooms 37 Special inspections in connection with the Housing Survey 90 Houses inspected for overcrowding conditions 92 Reinspections of work outstanding on housing notices 10,035 Number of visits regarding Infectious diseases 565 " " " " " food poisoning 74 Inspections of drainage work during repair 2,588 House drains tested with smoke and colour - routine and complaint 1,098 House drains tested with smoke (on written application) 15 House drains tested with smoke during repair 46 " " " " " water during repair 176 Inspections of cesspools and earth closets 5 " " " schools and school sanitary conveniences 43 " " " public conveniences 273 " " " verminous premises 98 " " " ponds and ditches 30 " " " yards, stables and passages 390 " " " theatres, cinemas, halls, etc 98 " " " pig styes 80 " " " tents, vans and similar structures 69 " " " knackers yards 25 Visits regarding smoke abatement 1, 188 exhumation 2 Inspections of swimming baths 7 wells 14 gathering grounds of water supply 70 " " " gipsy encampments, camps, fairs, etc 3 offices 9 " " " rivers and streams for pollutions 299 Pood and Drugs Acts: food and drugs samples taken 378 " " " " milk samples taken 249 Milk (Special Designations) Orders: samples taken 244 Ice Cream samples taken 259 Samples taken of Fertilizers and Feeding Stuffs 17 " " " swimming baths water 79 " " " drinking water 282 " " " subsoil water 36 " " " from rivers, streams, etc. 18 " " private wells 18 " "of rag flock and other filling materials 19 " " " sundry specimens (food poisoning etc.) 20 Inspections under Merchandise Marks Act 222 " of butchers premises 536 " " " meat premises (wholesale) 1,203 " " " horseflesh premises 5 " " " poultry and game dealers premises 79 " " " fishmongers premises 126 " " " fried fish premises 83 " " " grocers premises 822 " " fruiterers and greengrocers premises 280 " " bakers premises - including bakehouses 271 dairies 48 milk shops " " general shops and their premises 50 84 Inspections of premises where cooked meats etc. are prepared or sold 26 " " " confectioners premises 274 " " " confectionery manufacturers premises 18 " " " cafes, snack bars, canteens, hotels and their kitchens 953 " " " school kitchens and serveries 146 " " " hospital kitchens 22 " " " Ice cream manufacturers premises 82 " " " " " vendors premises 224 " " " " " barrows and carts 9 " " " markets (day inspections) 120 " " " " (weekend inspections) 31 " " " barrows, other than in markets 95 " " " imported foods at Aerodrome 26 " " " other food premises not enumerated above 350 " " " premises where offensive trades are conducted 29 " " " factories with mechanical power 661 " " " " " without mechanical power 105 " " " works of building and engineering 179 " " " outworkers premises 194 Visits to employers of outworkers 15 Inspections of shops (under Shop Acts) 1,128 Special early closing, evening and Sunday trading patrols of shops 834 Appointments kept with owners, builders, etc 2,180 Investigation of complaints other than housing matters 1.868 Reinspections of works outstanding (other than houses) 8,721 Inspections under Hydrocyanide Regulations - " " " Fertilizers and Feeding Stuffs Act 51 " " " Diseases of Animals Act 90 " " " Merchandise Marks Act 222 Pets Act 74 " " " Rag Flock and Other Filling Materials Act 11 " " " Pharmacy and Poisons Act 57 Sundry Inspections and Visits 3,174 Visits regarding rats and mice infestations 7,459 Informal Notices outstanding 31. 12. 56. 1,684 " " " served 2,869 " " " complied 3,545 Number of Informal Notices referred for Statutory Orders 339 Informal Notices outstanding 31. 12. 57. 1,007 Statutory Notices outstanding 31. 12.56 343 " " " served 594 " " " complied 640 outstanding 31. 12. 57 297 Total number of callers and complaints received at the office 4,762 Total number of letters received at the office 6,904 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1957 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 213 Conditions causing dampness: Defective roofs 259 Defective window frames164 Defective walls, etc. 204 Want of efficient damp-proof course65 Defective gutters and downspouts 203 85 Other structural defects: Defective plaster 200 Cleansing and redecoration required 36 Defective floors and stairs 187 Insufficient ventilation under floor 38 Defective brickwork, sills, lintels, chimneys 109 Defective stoves and fireplaces and flues 90 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 91 Defective w.c. s 165 Defective drainage 142 Stoppages in drains 131 Defective water services and tanks 18 Domestic nuisances: Want of cleanliness 8 Verminous conditions 25 Other nuisances and Infringements: Offensive accumulations 75 Overcrowding 15 Sundry nuisances or defects 11 Particulars not Inserted in Rent Book (Housing Act) 10 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT. 1924 Pood cupboards defective or required 3 (3) INFRINGEMENTS OF PUBLIC HEALTH ACT. PAVING, etc. Defective Yard Paving 51 Want of a sanitary dustbin 11 Public Urinals - defective or dirty 9 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 4 W.C. defective or dirty 5 (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 13 (6) SMOKE ABATEMENT Nuisances observed 2 PUBLIC HEALTH SERVICES 86 WATER I am indebted to the Water Engineer, W.C. Knill, Esq., B. Sc., M. I.C. E., M. I. Mech. E., M. I.W.E., for the following data:- The Water Supply is drawn from deep wells in the Chalk. These wells are situated at Surrey Street, Stroud Green, Waddon, Selhurst and Addington. The water from all of the wells is treated by the addition of chlorine and in the case of the water from Surrey Street and Waddon, ammonia is added after chlorination. Owing to the occasional occurrence of turbidity in the raw water from the Addington Well, this water is filtered before chlorination. A portion of the northern side of the Borough is supplied with water which is purchased in bulk from the Metropolitan Water Board. The amount of water consumed during the year was- Gallons Corporation Wells 2,451,439,000 M. W. B. Bulk Supplies 732, 674,000 East Surrey Water Company 103,000 Tbtal 3, 184,216,000 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. 496 raw water samples and 1146 treated water samples were thus examined during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 12 samples of raw water and 32 samples of treated water were subjected to bacteriological examination by the Consultant Bacteriologist to the Water Undertaking. Further samples were submitted by the Medical Officer of Health for examination by the Public Health Laboratory Service. The results of the bacteriological examination of the raw waters were typical of waters pumped from the Chalk, some of them showing the normal deterioration in quality which occurs after heavy rain. In all cases the examinations showed that the raw water was suitable for treatment. The bacteriological examinations of the treated waters 87 showed that these waters were of uniformly excellent quality. (b) Chemical Analyses The arrangements for chemical analyses are similar to those for bacteriological examinations. The total numbers of samples analysed in the Water Department' s laboratory and by the consultant were 97 of raw waters and 137 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are not liable to have plumbo-solvent action. The whole of the population and dwelling-houses within the area of supply are supplied from public water mains direct to the houses. Testing of Samples by the Health Department Weekly samples have been submitted to the area Public Health Laboratory, for bacteriological examination. The premises from which the samples are taken are selected to cover each week the different sources of supply to the several areas of the borough. In addition, a monthly chemical analysis is carried out by the Public Analyst, who is furnished with copies of the reports of the bacteriologist. During the year under review the total number of examinations performed were:- Bacteriological 270 Chemical 12 88 SEWAGE DISPOSAL AND REFUSE COLLECTION I am indebted to the Borough Engineer, A. F. Holt, Esq., M. I. C. E., for the following information:- Refuse collection and Disposal In 1957 the following tonnages were dealt with:- House Refuse 61,697 tons Street Sweepings 2,758 " Street Markets refuse 1,632 " 66,087 " 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 332,000 is treated at the Beddington Works, the dry weather flow being about 12 million gallons per day. The Works include a very modern Sludge Digestion Plant, from which Methane Gas is evolved as a natural by-product of the process. This gas is used for generating all the electricity required for power and lighting of the Works, for maintaining temperature in the Digestors, and, by compressing it, for use on vehicles as a fuel in lieu of petrol. 89 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 38 552 590 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 reinspections 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 is 1 Nursery which takes 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. 90 Number registered at 31.12.57 Number of children Provided for Premises 6 140 Daily Minders 14 109 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 upon the Customs Officers. The system of continuous "on call" manning by Medical Officers has continued. Aircraft and Passenger Arrivals, Croydon Airport. Aircraft Passengers "Excepted Area" 5,600 12,182 Europe outside Excepted Area 91 1,642 Africa, Middle East 3 4 Asia 2 7 5,696 13,835 Included in the above figures were 3,109 Aliens carried in 1,272 Aircraft. CREMATION ACTS, 1902 AND 1952 During the year 2,165 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Acts. 91 INTERNATIONAL CERTIFICATES FOR VACCINATION During the year 2,049 certificates were dealt with at the office (1,897 anallpox, 105 Cholera and 47 T. A.B.). STAFF MEDICAL EXAMINATIONS 863 examinations were made during the year by the Medical Staff of the Department including 18 vision tests for drivers. BLINDNESS I am indebted to the Chief Welfare Officer for access to his records regarding blind persons registered during the year. These show that of the 82 cases registered:- 12 were due to glaucoma and 26 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had either been performed or would be carried out except:- 1 patient had moved from the borough. 2 consents were not forthcoming. 92 NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE AMENDMENT ACT, 1951 15 old people were visited during the year who were reported not to be receiving adequate care and attention and were dealt with as follows:- An old lady aged 80 plus with failing sight was admitted to Queen's Hospital under the powers of the 1951 Acts. The Order was renewed under the 1948 Act after three weeks and she was later transferred to Warlingham Park Hospital. 4 were admitted to Hospital voluntarily. 2 were dealt with under the Lunacy and Mental Treatment Acts and finally admitted to a Geriatric Unit. 2 were admitted to private nursing homes; arranged by their own doctors. 6 were assisted in their own homes of whom two died during the year and one was temporarily admitted to Hospital but discharged himself. 93 Families in Welfare Services Accommodation:- Report by the Health Visitor co-ordinating this work. Throughout the year, the emphasis was again on assisting families, either in the Receiving Homes, or on the District, to achieve a better standard of home conditions, and to help them to a more settled mode of living. There was particular effort on the prevention of homelessness, with a corresponding increase in the work of visiting potentially homeless families. I found, generally speaking, that families were more ready to co-operate with all those willing to help solve their problems, and that families, generally, assumed a greater responsibility towards themselves and towards the community. The co-operation between the various Corporation Departments and Voluntary Societies, was again on a very high level, with good interchange of home visiting, reports and records, all of which resulted in less duplication of visiting and a greater time being spent with individual families. Although a certain amount of cross-visiting occurred, in my opinion there was little over-visiting. On the whole the children in the Receiving Homes were well cared for during the year, and the parents were more appreciative of the social services. The number of families actually resident in the Receiving Homes declined towards the end of the year. The constant supervision in the Receiving Homes was of great assistance in keeping family standards at a fairly high level. It is undoubtedly true to say that, with the solving of the problems of those families who have remained in the Receiving Homes for long periods, has come a readier co-operation from other families to solve their own difficulties, to accept their responsibilities, and to meet their commitments, e.g., rent. The Receiving Homes are now accepted as temporary accommodation units only, and, as a consequence, I have found individual families willing to investigate any possibility of solving their problems. Advice is accepted readily, and with supervision, is usually carried out. 94 SPASTICS 85 Spastic children up to school leaving age were known in Croydon, as at 31st of December, 1957. 9 were under school age. 5 of school age were not yet at school, not being suitable but still under review. 27 were attending St. Giles' School. 1 was attending St. Margaret's School, Croydon. 2 were attending Residential Schools for Physically Handicapped children. 2 were attending normal Residential Schools (St. Mary's, Bexhill). 1 was attending a School for Partially Deaf. 1 was attending Myopic School. 1 was attending St. Christopher's E-S.N. School. 10 at ordinary schools. 1 at normal private school. 2 Home Tuition. 23 Ineducable. There is no change to report in local facilities for the diagnosis of 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 33 adult cases are registered with his Department, six of whom are in special Homes. APPENDIX TABLES 95 VITAL STATISTICS - 1935-1957 97 REGISTRAR GENERAL' S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX Sex 0- 1- 5- 15. 25- 45- 65- 75- Total All Causes. M 37 6 13 11 57 391 397 549 1,46 1 F 26 3 6 3 40 237 346 830 1.491 Tuberculosis (Respiratory) M - - - - 1 8 5 3 17 F - - 1 - 3 2 2 4 12 Tuberculosis (other forms) M - 1 - 1 - 1 - - 3 F - 1 - - - - - - 1 Syphilitic Diseases M - - - - - 2 3 3 8 F - - - - - - - 1 1 Diphtheria M - - - - - - - - - F - - - - - - - - _ Whooping Cough M - - - - - - - - - F - - - - - - - - - Meningococcal Infections M 1 - - - - - - - 1 F - - - - - 1 1 - 2 Acute Poliomyelitis M - - - 1 - - - - 1 F - - - - - - - - - Measles M 1 - - - - - - - 1 F - - 1 - - - - - 1 Other infective and Parasitic diseases H - - - - - 1 - - 1 F - - - - - - - - - Total Infective and Para• sitic diseases (including Tuberculosis) 2 2 2 2 4 15 11 11 49 Malignant neoplasm, stomach M _ . _ - - 12 10 9 31 F - - - - - 9 13 12 34 " " " lung, bronchus M - - - - 5 55 43 16 119 F - - - - - 12 10 4 26 breast M - - - - - - - - - F - - - - 4 21 12 13 50 " " uterus F - - - - 2 5 9 7 23 Other malignant and lymphatic neoplasms M - 1 3 1 9 50 39 56 159 F - - - - 4 49 39 48 140 Leukaemia; aleukaemia M - - - 1 - - 1 1 3 F - - 1 - - 4 1 - 6 Total all forms of Cancer - 1 4 2 24 217 177 166 591 Diabetes M _ • _ _ _ 1 1 2 F - - - - 2 2 5 2 11 Vascular lesions of Nervous System M - . 2 - 3 20 51 91 167 F _ _ _ . 3 19 70 181 273 Coronary disease, angina M - . - - 13 94 80 66 253 F . • • _ _ 23 48 72 143 Hypertension, with heart disease M _ _ m _ 1 5 12 12 30 F _ _ . _ 1 5 7 33 46 other heart diseases M - - - - 2 25 36 116 179 F - - . _ 4 24 45 231 304 Other circulatory diseases M - - - - 1 14 9 27 51 F - - - - 2 3 17 61 83 Totol heart and circulatory diseases - - - - 24 193 254 618 1. 089 continued on next page 98 Sex 0- 1- 5- 15- 25- 45- 65- 75- Total Influenza M 1 - 3 - 1 4 7 4 20 F - - - 1 2 2 1 7 13 Pneumonia M 7 1 - - - 11 16 27 62 F 2 1 - - 1 5 8 34 50 Bronchitis M 2 - - - 1 42 53 45 143 F - - - - - 7 16 31 54 Other diseases of respiratory system M 1 - - 1 - 4 5 1 12 F - - - - 2 3 3 2 10 Total diseases of respiratory system - including influenza and excluding tuberculosis 13 2 3 2 7 78 109 151 365 Ulcer of stomach and duodenum M - _ _ _ 1 6 3 10 20 F - - - - - 1 2 6 9 Gastritis, enteritis and diarrhoea M - _ _ 1 - - 1 - 2 F 1 - - - - 3 _ 1 5 Nephritis and nephrosis M _ _ _ - 2 3 1 2 8 F _ _ _ 1 2 3 2 3 11 Hyperplasia of prostate M _ _ _ - - - 4 10 14 Pregnancy, childbirth and abortion F _ - _ _ 3 _ _ _ 1 Congenital malformations M 6 2 _ _ 2 3 _ _ 12 F 9 _ _ _ _ 2 _ _ 11 Other defined and ill- defined diseases M 18 _ 1 1 2 20 9 42 90 F 14 _ 2 _ 2 19 28 65 130 Motor vehicle accidents M _ _ 2 2 3 _ 3 3 13 F _ _ _ 1 _ _ 2 2 5 All other accidents M _ 1 2 1 3 4 5 3 19 F _ 1 1 _ _ 3 2 9 16 Suicide M _ _ _ _ 7 7 _ 1 15 F _ _ _ _ 3 10 3 1 17 Homicide and operations of war M _ _ _ 1 _ _ _ 1 F _ _ _ _ _ _ _ _ _ Total - accidents, suicide and violence. _ 2 5 5 16 24 15 19 86 TOTALS 63 9 19 14 97 628 743 1,379 2,952 99 CANCER Deaths from Cancer occurred at the following Ages:- Age Period Male Female Total Under 25 years 5 2 7 25 and under 35 years 3 1 4 35 and under 45 years 12 9 21 45 and under 65 years 120 102 222 65 years and over 172 165 337 312 279 591 Sites of Fatal Cancer Site Male Female Total Percentage of Total Skin 3 4 7 1.184 Oesophagus 10 4 14 2.369 Stomach 31 34 65 10.998 Liver 1 3 4 0.677 Bowel 24 48 72 12.183 Rectum 8 12 20 3.384 Bladder 17 3 20 3.384 Prostate 20 - 20 6.410 Larynx and Pharynx 10 2 12 2.030 Uterus - 23 23 8.244 Breast - 50 50 17.921 Ovary - 17 17 6.093 Pancreas 12 10 22 3.723 Gall Bladder and Duct 4 3 7 1.184 Tongue and Mouth 1 1 2 0.338 Bones 2 - 2 0.338 Lungs and Bronchus 119 26 145 24.535 Kidney 3 2 5 0.846 Brain and Nervous System 14 8 22 3.723 Thyroid Gland 1 3 4 0.677 Lymphatic Gland and connective tissue 5 3 8 1.354 Haematopoietic Tissues 2 3 5 0.846 Tonsil - 1 1 0.169 Hodgkin's Disease 5 - 5 0.846 Leukaemia 3 6 9 1.523 Genital Organs 2 3 5 0.846 Adrenal Gland 1 - 1 0.169 Undefined 14 10 24 4.060 312 279 591 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 Tuberculosls Death Rate from Non-Pulmonary Tuberculosi s Death Rate from Heart and Circulatory Diseases Death Rate from Cancer Natural Increase of births over deaths Upper Norwood 17460 195 196 11.2 11.2 15 - - 1.09 0.11 - 4.41 2.00 - 1 Norbury 16280 138 156 8.5 9.6 7 - - 0.74 0.25 - 3.81 1.66 - 18 West Thornton 15826 248 136 15.7 8.6 24 - - 0.88 0.06 - 3.29 2.09 + 112 Bensham Manor 17238 209 215 12.1 12.5 19 - - 0.93 0.06 - 3.65 2.55 - 6 Thornton Heath 16048 209 162 13.0 10.1 24 - - 1.25 0.06 0.06 3.74 1.80 + 47 South Norwood 16240 262 160 16. ] 9.9 19 - - 1.11 0.18 0.06 3.69 1.97 + 102 Woodside 14680 194 154 13.2 10. 5 15 - - 1.57 0.14 - 3.00 2. 11 + 40 East 16892 147 179 8.7 10.6 7 - - 0.53 0.12 - 4.20 2.43 - 32 Shirley 12846 136 94 10.6 7.3 22 - - 0. 70 - - 3.81 1.79 + 42 Addlscorn be 15856 227 187 14.3 11.8 13 - - 1.51 0.19 - 3.97 2.96 + 40 Whltehorse Manor 13516 231 157 17.9 11.6 30 - - 1.92 0.22 - 3. 48 2.74 + 74 Broad Green 13640 250 129 18.3 9.5 16 - - 1.25 0.07 - 2.86 2.57 + 121 Central 11048 164 132 14.8 11.9 18 - - 1.00 0. 18 - 4.71 2.72 + 32 Waddon 1546 1 177 145 11.5 9.4 11 - - 1.42 0.06 0.06 4.07 2.13 + 32 South 16717 217 244 13.0 14.6 14 - - 1.26 0.06 - 5. 08 2.39 - 27 Addlngton 19752 506 75 25.6 3. 8 20 0. 05 0. 10 0.20 - 0. 05 1. 11 0.91 + 431 The Borough 249500 35 10 2952 14.1 11.8 18 0. 00 0. 00 1.30 0. 16 0.02 4. 15 2. 37 + 989 100 Deaths occurring In Queen* s Hospital are not Included In the Ward figures as they are no longer allocated to the homo address 101 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1937-1957 Year Births (Live and Still) Meternal Deaths Maternal Mortality Rate Infant Mortality Rate 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 1957 3,510 3 0.84 18 102 DETAILS OF INFANT MORTALITY The following table gives the cause of death during the first month of life (Neo-natal mortality):- (1) Complications of Labour - Trauma at Birth 3 3 (2) Foetal States - Congenital Maiformities 10 Atelectasis 3 Haemorrhagic Disease of Newborn 1 14 (3) Prematurity 20 20 (4) Post-Natal Causes 2 - 2 Total 39 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1,000 Births Deaths 1956 1957 1956 1957 Premature Births 31.3 31.7 5.83 5.70 Respiratory Diseases 23.9 17. 5 4.44 3.13 Infectious Diseases 1. 5 ø 3.2 0. 28 0.57 Atelectasis. Debility and Marasmus 3.0 4.8 0. 56 0.85 Diseases of Digestion 6. 0 * 3. 2 1. 11 0. 57 Injury at Birth and Congenital 23.9 28.6 4. 44 5. 13 ø This death was due to meningoencephalitis • These from Gastro enteritis Perinatal Deaths Stillbirths - 72) Deaths in first week - 35) Causes of Death in first week Prematurity - 20 Congenital conditions- 9 Atelectasis - 3) Cerebral haemorrhage - 3) 35 Perinatal rate - 30 per 1,000 total (live and still) births Prematurity was a contributory cause in 3 cases 103 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CAUSES OF DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th- 14th day 15th-21st day 2 2nd-28 th days Total Under 1 month] 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 Al1 Causes 26 5 1 2 1 - - 1 1 2 39 9 1 2 2 - 2 2 3 - - 3 63 Meningo-Encephalitis - - - - - - - - - - - - - - - - - 1 - - - - 1 Chicken pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - — - - - - - - - - 1 - - - 1 Scarlet Fever - — - - - - - - - - - - - - - - - - - - - - - Whooping cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - - - -- - - Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - — - - - - — - - - Bronchitis - - - - - - - - - - - - 1 1 - - - - - - - - 2 Pneumonia (all forms) - - - - - - - - - - - 4 - 1 1 - 2 - - - - 1 9 Diarrhoea and Enteritis - - - - - - - - - - - - - - - - - - - - - 1 2 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - _ - _ - - - - - - - - - - - - - - - - Rickets - - - - - _ - - - - - _ - - _ _ _ - _ - - - _ Congenital Malformations 4 2 - 1 - - - 1 - 2 10 3 - - 1 - - 1 - - - - 15 Premature Birth 17 3 - - - - - - - - 20 - - - - - - - - - - - 20 Atrophy. Atelectasis, Debility and Marasmus 2 - 1 - - - - - - - 3 - - - - - - - - - - - 3 Injury at Birth 2 - - - - - - - - - - - - - - - - - - - - - 3 Haemorrhagic disease of new born 1 - - - - - - - - - 1 - - - - - - - - - - - 1 Other Causes - - • 1 - - - - 1 - 2 2 - - • • - - 1 - - 1 6 TOTALS 26 5 1 2 1 - - 1 1 2 39 9 1 2 2 - 2 2 3 - - 3 63 104 MIDWIFERY SERVICE The work of the municipal midwives was as follows:- l. The nunber of naternlty deliveries by Municipal Midvives on the district in the year 1,119 2. The number of spontaneous deliveries 1.113 3. The nunber of forceps deliveries 6 4. The nunber of still births 1 5. The number of neo-natal deaths 1 died 1 hour: 1 died 3 days. 2 6. The nunber of prenature live born Infants 7 (1) 34 veeks - 5 lbs. 8 ozs. Transferred to Hospital. (2) Emergency. Approx. 3 lbs. 8 ozs. 3½ weeks. Transferred to Hospital. (3) 38 veeks • 3 lbs. 8 ozs. Discharge leight 3 lbs. 12 ozs. Home. (4) 32 veeks - 4 lbs. 4 ozs. Transferred to Hospital. (5) 36 veeks - ) (twins) 1-4 lbs. 8 ozs.; 1-5 lbs. Discharge (6) 36 veeks - ) weight 4 lbs. 10½ ozs.; 4 lbs. 15 ozs. (7) 36 veeks - 5 lbs. Transferred to Hospital. 7. The number of patients vho received Trilene 20 8. Hie number of patients vho received Gas-Air Analgesia 1,032 9. The number of cases of P. P. H. Home 11; Transferred to Hospital 15 26 10. The number of cases of nanual removal of placenta at home Nil 11. The number of patients vho received blood transfusion at home 6 12. Hie number of cases to vhlch Plying Squad vas called 1 13. The number of cases of toxaemia of pregnancy treated at home 5 14. The number of cases of prolonged labour (over 24 hours) 22 15. The nunber of breech deliveries 4 16. The nunber of tvins delivered 2 lit 17. The nunber of triplets Nil 18. The nunber of cases of Puerperal Pyrexia 20 (Genital Nil) (Extra-Genital 20) 19. The nunber of congenital nalfornations 5 (Hare Lip: Cleft Palate 1) (Talipes 1) (Mongol 1) (Heart (Died 3 days) 1) (Heart (Died 1 hour) 1) 20. Patients given Pethedlne 610 21. Patients sent to Hospital: 341 (Ante-natal 254) (During Labour 58) (After Labour 29) 22. Patients sent hone for nursing: 341 (Home booked 265) (Hospital bookec 76) 105 Midwi fe Mil eage Deliveries Mid wifery Waternity Gas and Air AnteNatal Visits PostNatal Visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnormal Mid wires Pupils Midwives Pupils 1. 2281 - • - - - - 3 - 23 - - - 1 2. Bicycle 69 38 1 26 4 61 371 363 916 1020 91 101 33 3. 3769 63 53 5 4 1 59 657 62 1035 222 82 86 5 4. Bicycle 42 34 - 6 2 35 289 - 632 - 51 52 33 5. 2645 74 72 2 - - 69 190 131 942 965 83 93 - 6. 4147 71 52 - 19 - 65 531 378 929 1089 131 123 85 7. 3202 45 28 2 11 4 45 796 - 1012 - 47 46 28 8. 4439 103 95 - 6 2 96 377 380 1188 1122 134 147 73 9. 2507 67 56 1 8 2 61 432 226 1097 1032 110 123 67 10. 1179 63 46 2 14 1 59 411 - 790 - 68 74 20 11. 3135 47 32 1 14 - 46 432 - 953 - 55 61 15 12. 4902 85 76 - 8 1 79 529 419 97 5 1050 126 142 49 13. 2063 59 57 2 - - 54 320 - 893 - 54 56 3 14. 2628 28 22 2 2 2 28 445 - 519 - 46 64 20 I5. 5437 73 58 3 11 1 64 624 339 1117 1086 133 168 57 16. 3993 69 62 3 3 1 63 734 345 1225 980 81 96 3 17. 4268 74 66 4 4 - 69 517 411 935 1216 136 142 54 18. 3551 87 75 1 11 - 79 549 3 56 1047 10 58 107 105 51 Totals 54146 1119 9 22 29 147 21 1032 8207 3410 16228 10840 1535 1679 597 1 - Deputy Superintendent: 10 - Sick leave 6 weeks: 14 - Sick leave 4 months. 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 midlives, giving a total of 1164 issued during the year. 106 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion 7 Other Causes 22 90 FOR COMPLICATIONS DURING LABOUR Breech 5 Post-partum haemorrhage 12 Malpresentation 2 Adherent and Retained Premature Labour 5 Placenta 6 Delayed Labour 21 Torn Perineum 122 Ante-partum haemorrhage 14 Other Causes 13 200 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 23 Pain in Breasts 13 Pain in Legs 6 Other Causes 50 92 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 25 Still Birth 1 Other Causes 48 74 395 In accordance with Rule33of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received: - Illness of Mother 72 Defects of lactation 435 Other Causes 49 Total 556 107 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1957 who were born - i) at home 40 (ii) in private nursing homes 4 (iii) in hospital * 135 (2) The number of those born at home - who were nursed entirely at home 33 who were transferred to hospital on or before the 28th day 7 who died during the first 24 hours - who survived at the end of one month ... 40 (3) The number of those born in private nursing homes - who died during the first 24 hours - who survived at the end of one month 4 (4) Number of those born in hospital - who died during the first 24 hours 15 who survived at the end of one month 114 (5) Number of premature still births who were bom - (i) at home 1 (ii) in private nursing homes - (iii) in hospital 33 * The group under this heading will include cases which may be born in one hospital and transferred to another. 108 THE WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE visits Miss Bird Miss Bleckaore Miss Blest Mrs. Brsad Miss Devsney Miss Early Miss Edvsrda Left 26.3. 51. 1 Miss Eldrldge Miss Eans Miss Frsncls Left 9.11. 57. Miss Hall Coe. 8.4.57. Mrs. Meetings Miss Haekins Miss Hodgson Mrs. Laing Miss Llesellyn Miss M< Daniel COB. 1.4.57. Mrs. Mayo Miss Morton Miss Partridge Ml as Phillips Miss pickering Miss pouperd Ml as M. Saunders COB. 8.4.57. Mrs. Stevens Miss Thelson Miss TOoapson Miss Vtnce Mrs. Selnbren Left 30.4.57. Mrs. Mil son Miss fybree Total 19 57 Total 1968 first Visits 71 181 118 110 153 87 72 213 128 115 124 66 209 120 37 141 94 118 123 129 27 3 142 169 106 151 117 79 104 27 99 - 3656 38 49 Re-visits 38 2 572 468 402 51 1 655 190 844 59 5 589 471 416 526 7 28 103 553 236 634 389 333 550 279 507 30 4 530 505 528 890 101 611 510 147 19 14441 Children 1-2 yssrs first Visits 5 - 3 - 15 - 4 13 1 . 42 9 18 - 3 4 6 5 4 3 31 - 3 3 41 1 4 3 2 5 - 228 226 Re-visits 318 473 239 182 522 584 128 350 403 384 181 392 253 425 13 340 212 614 234 278 337 323 378 131 402 154 306 841 31 38 5 318 10114 9320 Children 2-5 years first Visits - 1 3 - 14 - - 17 - - 84 8 54 - - 5 5 II 7 5 6 - 4 6 95 - 2 • 1 14 23 343 311 Re-vlslts 314 832 587 558 654 543 101 743 490 825 198 431 653 326 23 4 49 20 1 816 441 857 357 561 500 342 385 300 350 891 50 643 689 148 26 12782 Expectant Mothers - first Visits 1 1 14 14 4 1 15 3 13 17 23 15 13 80 3 3 55 3 6 15 32 36 2 43 7 15 20 26 8 2 41 49 857 687 Re-vlslts - 32 1 * 1 12 • • * 28 37 8 9 5 37 4 23 4 21 85 46 44 4 23 7 31 17 2 5 6 470 313 Still Births 1 6 1 1 - 2 1 1 - 1 - • 1 - - 1 1 3 1 * 21 11 Deaths under 1 year - 1 • - • 1 2 • - 1 • 1 1 - 3 1 - - 2 • - 2 * 1 2 - - - 1 - 19 17 Miscellaneous Visits T 78 21 30 82 27 1 13 8 45 85 34 80 16 15 25 60 59 21 49 63 18 185 37 12 149 42 2 4 22 35 1289 3041 Ineffective Visits 309 109 277 142 289 7 54 113 90 289 131 482 195 399 491 1 15 238 155 191 44 129 218 686 248 251 66 2 108 318 no 83 188 174 8014 8623 TOTALS. 19 87 1408 237 5 17 32 14 19 2252 28 8 0 812 2105 1918 2119 1877 157 1 2241 2108 317 1849 977 2477 1283 1638 1945 2058 2082 I 194 23 17 1363 1695 29 24 303 1915 1803 54358 - TOTALS.1956 1638 3132 2170 - 2339 20 57 1083 1890 1945 388 - 1337 2000 1161 1222 2153 - 2518 1758 1484 961 1988 2280 - 2255 1305 309 1 2928 782 2096 2080 - 63 401 * * Including Health Visitors who left in 1956. Nuaber of families or households visited during the year 9,499 ATTENDANCES AT INFANT CENTRES - 1957 All Salnts*. Monday, P.M. Benshan Manor, Monday, A.M. Bensham Manor, Monday, P.M. Boston Road, Thursday. P.M. Brighton Road, Wednesday. P.M. East Croydon, Tuesday. A.M. East Croydon, Friday. P.M. Falrchlldes, Friday. P.M. Falconvood. wednesday. P.M. (alt.) •Good Shepherd. Saturday. A.M. Monks Hill, Tuesday. P.M. Monks Orchard, Monday. P.M. Municipal. Thursday. A.M. Municipal, Thursday. P.M. New Addlngton, Wednesday, A.M. New Addlngton.* Wednesday, P.M. Norbury. Wednesday, A.M. Norbury, Wednesday, P.M. St. Alhan's. Wednesday. P.M. St. Alban's. Friday. P.m. St. Andrew's, Monday. P.M. St. Jude's, Tuesday. A. M. St. jude's. Tuesday, P.M. St. Oswald' a. Thursday, A.M. St. Oswald's, Thursday. P.M. SeI hurst, Monday. P.M. Shirley. Thursday, P.M. South Croydon. Thursday. P.M. South Norwood. Tuesday. P.M. South Norwood, Friday. P.M. Upper Norwood. Wednesday, P.M. Waddon. Wednesday, P.M. Woodslde, Friday. A.M. woodslde, Friday. P.M. Total. 1967 Total. 1958 New Cases under 1 year 68 84 110 137 124 134 134 47 30 58 68 42 86 147 95 139 72 99 76 39 90 71 112 46 84 75 59 131 132 155 174 56 44 75 3093 3204 No. of Re-attendances 1186 1461 1806 1741 2116 2159 2117 549 693 426 689 612 1611 2225 1581 1633 1639 1843 1298 852 1307 1382 1790 865 1420 1435 744 1563 1555 1882 1743 843 781 1105 46632 48726 New cases ovar 1 year 7 23 19 9 17 11 15 4 6 12 13 6 15 9 37 36 13 IS 22 3 16 S 13 9 17 16 12 15 14 16 34 3 4 2 493 497 No. of Re-attendances 503 877 1136 691 530 908 1123 397 512 158 494 322 246 464 1104 965 957 1178 655 S18 678 694 830 678 894 519 510 771 575 540 749 550 362 625 22711 22100 Attendances of Children 0-5 1764 2445 i071 2573 2787 3212 33B9 997 1241 654 1264 982 1956 2845 2817 2773 2681 3133 2051 1412 2091 2152 2745 1598 2415 204 S 1325 2480 2276 2593 2700 1452 1171 1807 72904 74527 Consultations with Doctor 275 99 5 1090 810 914 931 912 385 441 218 229 305 800 907 1042 850 701 776 638 246 710 646 704 462 767 748 244 671 701 668 664 394 396 531 21771 22253 No. of Sessions 49 49 49 50 51 53 51 51 24 38 53 49 51 51 51 51 51 51 51 51 49 53 •52 51 51 48 49 51 53 51 51 51 51 Sl 1687 1684 EXPECTANT MOTHERS No. of new cases - - - - - - - - - - - - - - - - - - - - - - - 1 4 - - - - - - - - - S 8 No. of Re-attendances - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - 2 3 Total attendances of Expectant Mothers - - - - - - - - - - - - - - - - - - - - - - - 2 5 - - - - - - - - - 7 11 Total Attendances 1764 2445 3071 2578 2787 3212 3389 997 1241 654 1264 982 1958 2845 2817 2773 2681 3133 2051 1412 2091 2152 2745 1800 24 20 204 5 1325 2480 2276 2593 2700 1452 1171 1807 72911 74 538 Average per Session 1957 36.0 49. 9 62.7 51.6 54. 6 60.8 68. 5 19. 5 51.7 17. 2 23. 8 20.0 38.4 55.8 55. 2 54.4 52.8 61.4 40. 2 27.7 42.7 40.6 52.8 31.4 47. 5 42.6 27.0 48.6 42.9 50. 8 52. 9 28.5 23.0 35.4 43. 2 - Average per Sesalon 1956 34.2 43. 2 56. 9 55.8 51. 1 53. 4 65. 0 26.2 48.8 25. 3 24. 2 39. 7 39. 7 62. 3 64.7 50. 1 57. 5 51.6 38. 2 45. 6 41.9 52. 4 31. 1 45.0 38.0 34. 8 38. 1 51. 7 49. 5 56.7 31.0 28. 5 42. 2 - 44.3 601 * Opened In April, 1957 110 HOME NURSING Staff at 31.12.57 Superintendent Deputy Superintendent 2 Assistant Superintendents 35 whole time Nurses (including 3 males) 4 S. R. N.'s (including 1 male) 1 S. E. A. N. Nurse 1 S.R.N, part-time Summary of work carried out during the year under review:- Patients remaining on books from 1956 New patients 988 5,614 Total 6, 602 Mew Patients:- Medical 2, 579 Surgical 2,928 Gynaecological 80 Obstetric 6 Maternity 21 Total 5,614 Specially classified Cases Visits Tuberculosis 315 3, 747 Pneumonia 274 1,932 Maternity Complications 61 362 Infectious Diseases (including influenza) 106 761 Children under five years 280 1,410 Visits:- Termination of Cases:- Convalescent 3,362 Hospital 712 Di ed 518 Removed for other causes 1,005 Still on books 1,005 Total 6,602 Ill Total visits January 13,735 February 12,411 March 12,780 April 12,793 May 13,049 June 12,190 July 12,332 August 12,696 September 11,862 October 13,332 November 12, 152 December 13,494 Total 152,826 M. AND C. W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year:- Complaint No. of Cases Total M F Bow Legs 4 2 6 Knock Knees and Flat Feet 10 14 24 Valgus Ankles 4 4 8 Chest Conditions: Post T. A. and Asthma 5 2 7 Kyphosis 3 2 5 Torticollis 2 2 4 Pigeon-toes 7 4 11 35 30 65 Total attendances: 1,635 112 LOAN OF NURSING EQUIPMENT The Corporation loans equipment and makes a small weekly charge, with exemption for incomes below a certain figure. During the year the undermentioned loans were made: - Bed Pans 249 Bed Rests 163 Mackintosh Sheets 246 Feeding Cups 14 Wheel Chairs 30 Commodes 55 Crutches, pairs 2 Air Cushions 234 Bed Cradles 20 Urinals 96 Air Beds 29 Dunlopillo Mattresss 7 Dunlopillo Cushion 1 Bed Pulley 5 Bed Tables 10 Draw Sheets 82 Walking Aid 4 Snutum Mugs 2 Enuresis Machines 23 Ryles Tube Nil Fracture Boards 4 Bedsteads 3 Steam kettles 1 113 HOME HELP SERVICE Staff at 31.12.57. Supervisor 2 Assistant Supervisors 1 Clerk Assistant 1 Clerk 15 Whole Time Home Helps 161 Part Time Home Helps 1 Night Attendant Summary of work carried out during the year under review:- Patients remaining on books from 1956 986 New Applicants 1,230 Patients carried forward to 1958 1,032 New Applicants (a) Maternity 393 (b) Sickness 837 (c) For Night Service 8 Classification of Cases Attended (a) Maternity 277 (b) Tuberculosis 26 (c) Chronic Sick including Old Age 1,658 (d) Others including Acute Sick 391 Umber of Hours Service Given 200, 573 Average Duration of Service Given (a) Maternity 12 days (b) Acute Sickness 10-21 days (c) Chronic Sickness indefinitely Anount Recovered for Service £4,016.15.2. Rate of Remuneration of Home Helps at 32.12.57. 3/3½d. per hour - Home Helps 3/l½d. ” - Sick Room Helpers 3/l½d. ” - Washing Service 3/9½d. ” - Problem Family Helps £8.4.9. per week - Family Helps 10/- ” - Disinfestation 114 PROBLEM ETC. FAMILIES SUMMARY OF THE WORK CARRIED OUT DURING 1957 BY THE HEALTH VISITOR SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES, AND TO PREVENT THEIR NEED FOR ADMISSION Rehoused in private accommodation 25* Rehoused in Council accommodation 41 (* Of these 12 accommodated outside the Borough) Visits paid:- Family Departments Agents and Contacts 530 178 151 Families without permanent housing at close of year:- 33. Visits paid:- Family Departments Agents and Contacts 696 148 102 Potential Homeless Families -not admitted to Receiving Homes - 36. Kisits paid:- Family Departments Agents and Contacts 250 43 41 Visits re - employment 35 Families assisted with furniture 32 Families referred by Members of the council 7 Families referred by the Housing Department owing to risk of eviction 9 Families making direct contact 24 115 DENTAL TREATMENT - M. AND C. W. Expectant Mothers Nursing Mothers Total Young Children New Cases Examined 348 32 380 372 Re-treated 75 21 96 106 Total 423 53 476 478 Expectant and Nursing Mothers Young Children Attendances 1,0452 1,104 Fillings 403 406 Extractions 580 653 Gas Cases 154 246 Local Anaesthesia 137 19 Scaling and Gum Treatment 207 - Dressings 319 439 Denture Dressings 242 - Silver Nitrate - 273 Treatment Completed 321 335 Number of Sessions (treatment) 395 Dentures Fitted 61 Dentures Repaired 13 The Centres at which patients were examined, or from which they were referred, are given in the following list:- Mothers Young Children Mothers Young Children Ante-Natal 452 - South Croydon - 3 Municipal Midwives 10 - St. Alban* s . 2 Woodside - 2 Post Natal 1 - Norbury • 7 Welfare etc. centers: - Addington - 27 Municipal - 2 St. Andrew's - 1 East Croydon - 4 waddon - 1 Upper Norwood - - Boston Road - - Holy Trinity - - St. Jude's 1 10 St. Oswald's - 3 St. John's (Shirley) - 2 Benshan Manor _ _ Fairchildes - 1 Monks Hill - _ Good Shepherd - 2 Crossfield Nursery - - Palconwood . 1 Referred by Dental officers: 412 west Croydon - 1 South Norwood - - Mothers: 464 Young Children: 481 Total: 945 116 AMBULANCE SERVICE Classification of Journeys, Patients and Mileage. * Patients Journeys Mileage Health Service Removals 71,293 (72,240) 44,299 (44,309) 337,564 (345,809) Spastics (Bramley Hill 4,634 (4,232) 579 (731) 10,681 (12,060) Mental Defectives (Occupational Centre) 23,879 (23,98 4) 796 (812) 22,605 ( 23,249) St. Margaret's (Spastic Children) 445 (487) 355 (365) 3,759 (3,096) Accidents 3,602 (3,620) 3,445 (3,464) 19,393 (18,264) Abortive 184 (249) 930 (1,094) Gas and Air Analgesia 562 (626) 4,481 (5,063) Vehicles to Repair Depots, Testing etc. 312 (256) 2,864 (2,378) Service Requirement (Oxygen,visiting Sub-stns, parks etc 295 (290) 2,877 (2,799) 103,8 53 (104,563) 50,827 (51,102) 405,154 (413,812) Civil Defence 158 (188) 1,686 (1,876) 103,853 (10 4,563) 50,985 (51,290) 406,840 (415,688) Note:- 1956 Figures are in brackets. * These figures do not represent individual cases. Classification of Accident Calls Home Accidents (Children) 329 (Adults) 310 Miscellaneous Accidents (Children) 85 (Adults) 117 Recreational Accidents (Children) 55 (Adults) 68 School Accidents 232 Street Accidents (Children) 172 (Adults) 780 Work Accidents 259 Home Illness (Children) 38 (Adults) 179 Street Illness (Children) 5 (Adults) 641 117 Classification of Accident Calls (continued) Work Illness 62 Attempted Suicide 37 Suicide 15 Common Assault 61 3,445 Comparison of Patients, Journeys and Mileage since 1953. Year Patients Journeys Mileage 1953 87, 790 35,183 412,178 1954 95, 254 43,358 421, 684 1955 100,827 50,491 440,311 1956 104, 563 51,102 413,812 1957 103,853 50,811 405,013 118 COMMUNICABLE DISEASES NOTIFIED DURING 1957 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 5-14 15 - 24 25 - 44 45 - 64 65 and over Scarlet Fever 133 - 26 102 3 2 - _ 5 4 8 5 11 18 13 7 13 3 4 2 4 7 19 10 70 63 Diphtheria . - - - . - - . . - - - - . _ . • . • . . . . . Erysipelas 27 - - - 2 3 14 8 1 1 1 5 5 1 - 6 1 . 4 - 1 • . 1 13 14 Meningococcal Infection 4 • . 1 . 1 1 1 . _ 2 . . - - _ _ 1 _ . . . 1 1 3 Enteric and Paratyphoid 3 - - 1 1 1 _ 1 _ _ 1 - - - - _ - 1 - - - - - 2 1 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 78 - - - 43 35 - - - 1 53 - - 1 3 1 - 2 16 - - 1 - - - 78 Ophthalmia Neonatorum 6 6 - - - - - - - - 3 - - 1 1 - 1 - - - - - - - 3 3 Acute Poliomyelitis 36 - 7 18 3 8 - 7 4 2 2 - 3 1 1 2 1 - 2 3 3 - 27 9 Dysentery 139 4 25 72 7 28 2 1 • - 4 2 1 1 - 2 - - - 10 - - 113 6 72 67 Malaria 3 - - - 2 - 1 - - - - 2 - - - - - - - - - - - 1 1 2 Acute Primary and Influenzal Pneumonia 90 4 5 12 10 8 33 18 5 6 6 2 9 4 1 11 6 6 3 1 12 10 1 7 48 42 Food Poisoning 74 1 7 20 9 22 10 5 4 1 4 3 12 4 5 9 5 6 2 3 10 1 3 2 34 40 Acute Encephalitis 4 - - 1 1 2 - - - - - - - - - - - 1 1 - - - 2 3 1 Measles 3904 1 16 1787 1969 15 15 2 - 248 228 236 225 276 248 127 116 191 207 241 126 242 208 831 154 1913 199 1 Whooping Cough 469 48 202 213 2 4 - - 20 16 18 11 14 31 16 81 27 17 19 6 22 17 128 26 240 229 4970 179 20 59 2409 98 129 63 33 291 261 337 258 328 314 169 234 245 243 293 149 293 247 1098 210 2427 2543 The tuberculosis notifications are shown in the section relating to that disease. 119 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1957 Jan. Feb. Mar. April May June July Aug. Sept. Oct. Now. Dec. Total Respiratory Tuberculosis 15 15 9 18 8 9 11 9 7 9 21 16 147 Non-Respiratory Tuberculosis 2 - - 2 1 1 2 3 1 1 2 - 15 Scarlet Fever 10 14 15 9 12 8 11 4 6 8 18 18 133 Diphtheria - - - - - - - - - - - - - Erysipelas 7 2 4 2 1 1 3 1 2 1 1 2 27 Meningococcal Infection - - 1 - - - 1 - - 1 - 1 4 Enteric ana Paratyphoid - - - 1 - - 1 - - 1 - - 3 Smallpox - - - - - - - - • - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Puerperal Pyrexia 1 2 11 5 9 6 5 5 6 11 15 2 78 Ophthalmla Neonatorum - - - - - - - 3 3 - - - 6 Poliomyelitis and Polio-encephalitis 1 - _ 1 _ 3 6 6 11 4 2 2 36 Dysentery 2 1 5 7 10 104 4 3 - - 2 1 139 Malaria 1 - - - 2 - - - - - - - 3 Ac. Prl. and Act. Inf. Pneumonia 4 7 4 4 3 - 2 1 2 32 10 21 90 Food Poisoning 4 9 8 1 6 2 5 13 12 7 3 4 74 Acute Encephalitis 2 - - - 1 - - - 1 - - - 4 Measles 6 54 819 1371 610 241 118 57 23 10 - 1 - 390 4 Whooping Cough 69 68 75 38 43 31 37 38 35 15 7 13 469 5132 120 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,111 children were immunised against whooping cough, comprising 2,054 under school age and 57 school children. 314 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 1,137 children were immunised against Tetanus, comprising 1,109 under school age and 28 school children. VACCINATION AGAINST SMALL-POX A total of 2,638 persons were vaccinated against Small-pox. Under 1 year of age 1 2 - 4 5 -14 15 or orer Total Successful Vaccinations 1,820 199 112 143 52 2,326 " Re-vaccinations - - 4 41 159 204 Insusceptible to Vaccination 69 16 8 7 8 108 2,638 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1957, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1943). ]Age at 31.12. 57 i.e. Born in Year Under 1 19 57 1-4 1953.1956 5-9 1948. 1952 10 - 14 1943.1947 Under 15 Total Last complete course of injections 1,820 8,616 6,899 1,837 19,172 A. 1953 - 1957 B. 1952 or earlier - - 7,367 13,054 20,421 C. Estimated midyear child population 3,370 13,430 37,600 54,400 Immunity Index 100 A/C 54.01 64.15 23.23 35.24 VACCINATION AGAINST POLIOMYELITIS 6,014 children were given this protection. 121 TUBERCULOSIS (All norms) PRIMARY NOTIFICATIONS AND MORTALITY - 1937-1957 123 TUBERCULOSIS The following tables shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) Tuberculosis (All Forms) 0-15 years All ages 0-15 years All ages Year Number of Deaths Death rate per thousand of lation Number of Deaths Death rate per thousand of lation Year Number of Deaths Death rate per thousand of lation Number of Deaths Death rate per thousand of lation 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 19 44 9 - 105 0. 57 1925 27 - 181 0.91 1945 9 - 92 0.46 1926 27 - 208 1.01 1946 7 - 105 0.47 1927 15 - 203 0.96 1947 4 0. 08 105 0.44 1928 24 - 206 0.96 1948 3 0. 06 111 0.45 1929 21 - 178 0.80 1949 6 0. 12 94 0.38 1930 15 - 17 5 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 19 53 2 0.04 37 0.15 1934 10 - 157 0.65 19 54 1 0.02 32 0.13 1935 9 - 176 0.71 19 55 1 0.02 35 0.14 1936 11 - 151 0.60 19 56 - - 26 0.10 1957 - - 33 0.13 * Prior to 1947, rates only available for Census years 124 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1957 to 31st December, 1957:- TABLE I. Formal Notification Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males 1 - 3 1 2 5 6 17 17 21 14 5 2 94 Respiratory, Females 1 2 3 2 - 2 10 14 8 3 5 2 1 53 Non-Respiratory, Males - - - - 1 - 1 1 3 - - 1 - 7 Non-Respiratory, Females - - 1 - 1 1 - - 3 2 - - - 8 125 TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1957 to 31st December, 1957, otherwise than by formal notification: - Source of In form at i on Number of cases in age Groups 0- 1- 2- 5- 10- 15- 20- 25- 35- 45-0 55- 65- 75- TOTAL Death Returns from Local Registrars M Respiratory F - - - - - - - - - - - - - - (A) - - - - - - - - - 1 - 1 2 4 (B) M Non-Respiratory F - - - - - - - - - - - - - - (C) - - - - - - - - - - - - - - (D) Death Returns from RegistrarGeneral (Transferable Deaths) M Respiratory F - - - - - - - - - - - - - - (A) - - - - - - - - - - - - - - (B) M Non-Respiratory F - - - - - - - - - - - - - - (C) - - - - - - - - - - - - - - (D) Posthumous Notifications M Respiratory F - - - - - - - - - - - 1 - 1 (A) - - - - - - - - - - - - - - (B) M Non-Respiratory F - - - - - - - - - - - - - - (C) - - 1 - - - - - - - - - - 1 (D) "Transfers" from Other Areas (excluding transferable Deaths) M Respiratory F - - - - - 3 12 20 17 8 5 3 - 68 (A) . - . _ - 4 13 18 6 1 2 - 1 45 (B) M Non-Respiratory F _ _ _ 1 1 _ . _ 2 . - - - 4 (C) - . . - - 2 - 1 1 - - - - 4 (D) M Respiratory F - - - - - - - 1 - - - - 1 2 (A) Other Sources - - - - - - - 1 - - - - - 1 (B) M Non-Respiratory F - - - - - - - - - - - - - - (C) - - - - - - - - 1 - 1 - - 2 (D) TOTALS (A) 71 (B) 50 (C) 4 (D) 7 126 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1957 1,997 Transfers in from other areas 114 "Lost sight of" cases returned during the year 3 New cases diagnosed as definite during the year 153 2, 267 Number of cases written off the Chest Clinic Register during the year as: - Recovered 81 Died 40 Removed to other areas 99 "Lost sight of" and other reasons 21 241 Remaining on Register as at 31st December 2,026 The following particulars give a summary of the work done in connection with the Clinic:- Number of patients examined for the first time, excluding inward transfers, i.e. patients who have removed from other areas 2,618 Number of visits paid by Clinic doctors to homes of patients 377 Number of visits paid to homes of patients by Tuberculosis Health Visitors 3,313 Attendances of patients at the Clinic - At ordinary sessions 19,817* At refill sessions 1,958 21,775 * Number of X-ray films taken 18,763 * includes 3,476 miniature film attendances 127 VENEREAL DISEASES - NEW CASES 1937-1957 129 VENEREAL DISEASES Totals Males Females GONORRHOEA SYPHILIS 1. Patients under treatment or observation on January 1st 82 40 42 2. Patients removed from the Register in previous years who returned during the year for treatment or observation of the same condition - . . 3. Patients transferred from other centres after diagnosis 4 1 3 4. Patients dealt with for the first tine (excluding 2 and 3) suffering from: - Syphilis, primary - - - „ secondary _ - - „ latent in the 1st year of Infection 3 1 2 „ cardio-vascular 1 - 1 „ of the nervous system 3 2 1 ;All other late or latent stages 11 5 6 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 6 2 4 TOTAL 1 ten 4 24 10 14 5. Patients completing treatment and/or observatior 29 9 20 6. Patients transferred elsewhere 3 3 - 7. Patients not completing treatment and/or observation 2 - 2 8. Patients under treatment or observation on December 31st (should equal Items 1 to 4 less I terns 5 to 7) 76 39 37 9. Patients under treatment or observation on January 1st 17 9 8 10. Patients removed from the register in previous years who returned during the year for treatment or observation, of the sane condition 2 2 - 11. Patients transferred from other centres after diagnosis . 2 1 1 12. Patients dealt with for the first time (excluding Items 10 and 11) 64 51 13 13. Patients completing treatment and/or observation 56 42 14 14. Patients transferred elsewhere 1 1 - 15. Patients not completing treatment and/or observation 14 11 3 16. Patients under treatment or observation on December 31st (should equal Items 9 to 12 less 11ems 13 to 15) 14 9 5 130 OTHER CONDITIONS ] Totals Males Females 17. Patients under treatment or observation on January 1st 37 28 9 18. Patients removed from the register in pervious years who returned during the year for treatment or observation of the same condition 13 13 - 19. 20. Patients transferred from other centres after observation 3 3 - Patients dealt with for the first tine (excluding Items 18 and 19) suffering from:- Chancroid - - - Lymphogranuloma Venereum - - - Granuloma Inguinale Non-Gonococcal - - - Urethritis 41 41 - Any other conditions requiring treatment 123 70 53 Conditions not requiring treatment 184 119 65 Undiagnosed conditions - - - TOTAL Item 20 348 230 118 21. Patients completing treatment and/or observation 347 241 106 22. Patients transferred elsewhere 3 3 • 23. Patients not completing treatment and/or observation 12 8 4 24. Patients under treatment or observation on December 31st (should equal Items 17 to 20 less Items 21 to 23) 39 22 17 ATTENDANCES By PATIENTS At which patients saw physician Syphilis 257 118 139 Gonorrhoea 294 237 57 Other Conditions 1163 876 287 TOTALS 1714 1231 483 At which patients did not see physician Syphilis 860 261 599 Gonorrhoea 151 55 96 Other Conditions 685 269 416 TOTALS 1696 585 1111 CONTACTS ATTENDING FOR EXAMINATION REFERRED BY PATIENTS SUFFERING FROM:- Syphilis 3 - 3 Gonorrhoea 29 25 4 Nod-gonococcal Urethritis 10 10 - Other Conditions 40 32 8 TOTALS 82 67 15 131  By the physician at the Centre Sent to a Pathological Centre PATHOLOGICAL WORK NUMBER OF SPECIMENS EXAMINED Microscopical: for Syphilis - 4 Microscopical: others - 602 Cultural - 308 Serum: for Syphilis - 584 others - 238 Cerebro Spinal Fluid (Number of diagnostic lumbar punctures) - 16 SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR SHOWING THE AREAS IN WHICH PATIENTS DEALT WITH FOR THE FIRST TIME (ITEMS 4, 12 AND 20) RESIDED (MAJOR AREAS TO BE SPECIFIED. MINOR AREAS MAY BE GROUPED AS "ALL OTHERS") County, County Borough (England and Vales) and Others Syphilis Gonorrhoea Other Condi tions Totals Croydon 17 48 218 283 Surrey 1 11 80 92 Kent 4 3 26 33 London 2 2 24 28 Totals (to agree wi th Items 4, 12 and 20) 24 64 348 436 133 "ASIAN" INFLUENZA 1957 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1957 To the Chairman and Members of the Education Committee. LADIES AND GENTLEMEN, In presenting for your consideration, the Report of the Principal School Medical Officer for the year ending December 31st, 1957, I make the following preliminary comments: - The basic functions of the service continued unchanged, namely, to supervise general hygiene and prevent the spread of infection: to detect by routine medical and dental examinations, significant deviations, from normal development: to ascertain special categories of handicapped pupils and advise on appropriate methods of education; to provide general dental treatment and also some essential medical services not available from other sources. Emphasis on another aspect of School Health work was made possible by the appointment to the Health Department of an Officer concerned solely with Health Education. While individual doctors and nurses do take every opportunity to give advice on health matters at interviews with parents and children, they are not usually trained to give formal group instruction in the schools. In this activity, we are now judged against modern teaching methods and even perhaps in relation to advertising television techniques. It is not therefore a task for the untrained amateur. 2 On the other hand, I have the impression that at primary and secondary level, all necessary instruction is deemed to be within the scope of the school staff. Our original approach to the schools, therefore, offered a demonstration of a series of Health Education lessons complete with suggested visual aid material for subsequent inclusion in the general curriculum under a permanent member of the school staff. The first ventures, however, have brought requests for repetitions, which are flattering indications of success, but somewhat embarrassing because of the limited time which one officer can give to this aspect of the work. Further comments by Miss Elliott are included in later pages. As far as infectious illnesses were concerned, it was an unfortunate year since an outbreak of measles in the early months caused widespread absences and influenza in the autumn involved very large numbers. The extent of the latter epidemic is described in my general health report. The principal Dental Officer comments on difficulties from lack of staff and in New Addington, the absence of suitable accommodation. Efforts to reduce the cost of a dental unit in this area by adding to the existing clinic were, unfortunately, unsuccessful because the site is unsuitable and a fresh approach was needed to obtain a new surgery to serve the estate. Meanwhile, children were diverted to the Shirley Dental Centre, but the urgent need to improve facilities for New Addington were still unsolved by the end of the year. An endeavour has been made by the School Nurses to test the vision of school entrants. Success has varied and although early ascertainment is clearly desirable, it seems doubtful if reliable results can be achieved with children of five years of age. Whether at a slightly older age, the effort may be justified by results, remains a matter for future reports. My thanks are due to the Chief Education Officer and other members of his department for their help and co-operation at all times. I thank the Chairman and Members of the committee for their constant encouragement in further worthwhile developments and the members of the department for their performance of routine duties and enthusiasm in suggesting and applying new improvements. Public Health Dept., Croydon. 3 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) - (38%) *Dental Officers 10 (including 4 part-time) - (80%) Physiotherapists 2 Speech Therapists 3 (including 1 part-timp) *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, Shirley Road, Croydon. (Monday and Thursday, 9 a.m.). Rockmount School, Rockmount Road, Dpper Norwood. (Monday and Thursday, 9a.m.). Duppas School, Goodwin Road, Vaddon. (Daily, Monday to Friday, a.m.). Salcot Crescent, New Addington. (Daily, 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. Stroud Green, Shirley Road. Croydon. Inspection Lodge Road, Broad Green, Croydon. Twice weekly. Wolsey School, New Addington. Once a month. Rockmount school, S.G. 19. Once a month. Ashburton School, Shirley Road, Croydon. Once a month. Duppas school, Goodwin Road, Croydon. Once a month. 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. 4 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is 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 i.e., Children who had attained their 8th Group birthday at the opening date of the Term but have not yet reached their 9th birthday and who have not been medically examined at the age of 8 years. (3) Inter- i.e., Children in their first year at a mediates Maintained Secondary School. (4) Leavers i.e.. Children in their last year of atten- (Final) dance in a Maintained Secondary School who have not been medically examined in that year. (5) Special i.e.. Children of other ages who are Cases (if ently defective and whom the Head any) Teacher and parents wish the Medical Officer to see at his next visit. A total of 11,195 children were examined as compared with 12,050 in 1956, and 6,592 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 86.7 per cent. and girls 89.6 per cent.; in the Intermediate group, boys 38.8 per cent.; girls 51.7 per cent.; in the Leavers' group, boys 9.3 per cent., girls 23.4 per cent.; and in the Other Ages and 8 to 9 year group, boys 74.3 per cent., girls 81.3 per cent. The total percentage of parents attending was 58.9 as against 65.3 last year. (See Appendix B, Table 3). 745 specials and 516 re-inspections of children were carried out. 5 HEALTH EDUCATION IN SENIOR SCHOOLS Report from Miss Elliott:- Talks to school children about the effects of smoking on health presented an opportunity to suggest a longer series of health talks for senior school children. The syllabus covers fourteen weeks or one term, and each lesson lasts just under an hour each week. It has been called "Community Health" or "Your Life in Your Hands". It is designed for school leavers, to give practical help and understanding on common health matters which may be encountered in the future, so that they may take sensible preventive action. The first part of the syllabus deals briefly with the diseases of yesterday and why they are not seen today. The second group of lessons covers the cause, effect and prevention of infectious and nuisance diseases. Local, national and international health services are explained and are followed by a group of lessons on nutrition, personal health and hygiene and family relationships or 'living with other people'. The course concludes with an interesting and lively lesson given by members of the Fire Service. Throughout the course the adverse effects of smoking are emphasised from as many angles as possible. Visual aids, including brightly coloured flannel-graphs, films and film-strips are used as illustrations and members from certain sections of this department gave some of the talks. A pilot course was given at Ashburton secondary Modern Boys School, where the help and co-operation of the staff was very much appreciated. The course is continuing there and is also being run in three other Secondary schools and we hope others will include it too. when these courses are really well established we plan to provide teaching kits (of notes and some visual aids) which may be used by teaching or public health staff, with perhaps in some instances, outside help for lessons on vaccination, immunisation and public health services. 6 INFECTIOUS DISEASES Reference has been made elsewhere to major epidemics of measles and influenza, which affected the school children, in the early months and in the autumn of 1957. There is little doubt that primary schools are now the main focus for the spread of infections of the respiratory type amongst children and, as a sequel, to a lesser degree, amongst the general population. Smaller families and improved housing have reduced considerably the risks of pre-school children meeting infections. Consequently, they succumb readily at school to the childhood ailments - measles, chicken pox, rubella, etc. and to repeated attacks of the common cold. I have commented on this in previous reports and concluded that apart from the maintenance of good nutrition and a high standard of hygiene in the schools, there are no special methods for the direct control of such minor respiratory illnesses. It should be remembered that the postponement of these illnesses until children are over five years of age is probably an important factor in the reduced mortality from these causes. The older child is better able to combat diseases than the infant or toddler. Class or school closure or stringent exclusion of healthy contacts produce more loss of schooling than is suffered at present. This should not imply any relaxation of strict exclusion of patients and avoidance of their too rapid return and these are measures to which school staff and school nurses give constant attention. Findings at Routine Medical Inspections. The figures shown in Appendix B, Table V, follow the usual pattern. Defects of the nose and throat in Entrants are mainly due to enlargement of the tonsils and adenoids which follow repeated exposures to respiratory infections. As noted in Appendix B, Table VIII, vision testing of Entrants was extended and a greater number of children are therefore recorded as having had these tests as five year Entrants. 7 HEIGHTS AND WEIGHTS The figures of average heights and weights are recorded in Appendix B, Table II. for the last few years, these figures have shown a steady rise and at least one authority on nutrition has questioned the interpretation that these increases indicated a general improvement in the children's health. I have been satisfied that on balance the advantages of having the average child taller and heavier far exceeded the risk of some being overweight or unduly precocious, or the theoretical dangers forecast for later life. From the 1957 figures, it seems that stability has now been reached, since there is very little change from the previous year. VISION TESTS A preliminary trial in vision testing of the five year old Entrant group was commenced in 1956 and extended to all Entrants during 1957 (see Appendix B, Table VIII). The school nurses consider that such examinations can be usefully undertaken if: - 1. The child has had time to settle into the school routine (preferably not in child's first term). 2. A suitable and quiet room is available for the testing with adequate light. 3. The school is co-operative in providing assistance in testing the children. It will be understood that such conditions are not found in all schools. 8 RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1957 WHO HAVE UNDERGONE TONSILLECTOMY Entrants Boys 137 - 8.5 % Girls 91-7.0% AU Entrants 228 - 7.8% All boys 13 6 2 - 24.2% 8-9yrs. Boys 351 - 23.3% All 8 - 9 yrs 711 - 22 9% „ Girls 360 - 22.6% Inter Boys 368 - 31. 1% „ Girls 264 - 18.4% All Intet 632-24.1% All Girls 1088 - 19.5% Leavers Boys 506 - 38.4% „ Girls 373 - 30.0% All Leaves 879-34.4% All Groups Boys and Girls 2450 - 21.9% 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) 61,293 Number of children inspected (subsequent inspections) 1,859 Number of children found unclean (first inspection) (531 occasions of infestation) 321 Number of occasions in which children found unclean (subsequent inspections) 223 At the primary inspections vermin were found in 36 and nits alone in 495 children. On these inspections 0.9 per cent. of the children showed evidence of infestation as against 0.7 in 1956. 14 children attended the Cleansing Station for treatment. 9 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis - Pulmonary 5 Non-PulMonary 2 Taking the total child population at 37,600, the pulmonary tuberculosis incidence rate per 100,000 was 13.3, and the nonpulmonary incidence rate 5.3. There was one death from nonpulmonary tuberculosis. CAUSES OF DEATH IN SCHOOL CHILDREN Child population, 37,600. (Registrar General's estimate) Number of deaths 19, which is equal to a death-rate of 0.51 per 1,000. The deaths were due to: - Miliary Tuberculosis 1 Influenzal Pneumonia 3 Lymphatic Leukaemia 1 Accidental 4 Measles 1 Sub arachnoid haemorrhage 2 Peritonitis 1 Agranulocytosis 1 Aplastic anaemia 1 Cancer 4 CHIEF CAUSES OF EXCLUSION FROM SCHOOL Condition Exclusion during 19 57 Percentage of total exclusion Exclusions during 1956 Percentage of total exclusions Ringworm 2 0. 11 8 0.64 Verminous Conditions 50 2.79 69 5. 51 Impetigo 3 0. 17 34 2.72 Scabies . - 2 0.16 Scarlet Fever 102 5.69 106 8.47 Measles (inc. German) 1, 066 59. 49 197 15.73 Diphtheria -- -_ - - Whooping Cough 68 3.79 88 7.03 Chicken pox 85 4.74 457 36. 50 Mumps 304 16.96 160 12.78 External Eye Disease - - 1 0. 08 Poliomyelitis 10 0. 56 12 0.96 Dysentery 83 4.63 108 8,63 Jaundice 8 0.46 5 0. 40 Enteric Group 3 0. 17 - - Meningococcal Infection 3 0. 17 -_ - Other Causes 5 0. 28 5 0.40 1,792 1,252 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 Measles, Mumps and Jaundice, 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 460 Visits re Scabies Visits re Infectious Disease 43 Visits re Medical Inspections 629 Visits re Medical Preparations 640 All other reasons 535 Home Visits Concerning defects found at routine medical inspections 196 Subsequent visits re defects found at routine medical inspections 91 Visits re special cases 127 Visits re dental cases 2 Visits other than infectious cases 1,112 Visits in connection with infectious cases (including 307 visits concerning uncleanliness)2,882 11 TREATMENT The Work of the School Clinics SUMMARY OF ATTENDANCES 1957 1956 Increase or decrease Minor Ailments and Verruca Clinics 8,165 9,614 - 1,449 Inspection clinic 605 906 301 Dental Clinics 25,274 26,963 - 1,689 Remedial Exercises Clinic 6,320 6,246 + 74 Enuresis clinic 746 586 + 160 41,110 44,315 - 3,205 The Minor Ailments clinics At the Lodge Road Clinic 403 defects involved 2,876 attendances, while at the subsidiary Clinics held at Ashburton School 52 defects, 1,361 attendances; at Duppas School 138 defects, 2,662 attendances; at Rockmount School 13 defects, 701 attendances; and at Addington 87 defects, 565 attendances. Complaint 1957 1956 Cases Attendances Aver age No. of At tendances per case Cases At tendances Average No. of At tendances per case Ringworm 2 5 2. 5 1 1 1. 0 Scabies 1 4 4. 0 - - - Impetigo 17 149 8.8 36 229 6. 4 Other skin Diseases 5 50 10. 0 13 65 5 0 Otorrhoea and other Ear defects 14 118 8. 5 45 245 5. 4 External Eye Disease 40 307 7.7 55 294 5. 3 Miscellaneous 454 5.123 11.3 822 5,979 7.3 533 5, 756 10.8 972 6,813 7.0 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 conjunction 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 Though over 80 per cent. of children were dentally examined during the year, treatment coverage throughout the Borough varied considerably, and because of recurring "set-backs" in securing added clinic accommodation, facilities in more remote districts continue to be substantially below the level originally planned. At New Addington where commitments are unusually high, existing resources have been particularly strained, and owing to unforseen difficulties the position has lately given cause for considerable concern. In this area, proposals previously outlined for establishing an additional dental unit atthe Welfare Centre, Salcot Crescent, have unfortunately had to be abandoned at an advanced stage because of structural difficulties, and it has not so far been possible to fix an alternative site for this project. More recently the whole treatment situation has been complicated by building operations at the (old) Overbury School, which has necessitated the temporary closure of the only existing surgery on the Estate, and the withdrawal of services to the Stroud Green Dental centre. At the time of writing an emergency scheme is being considered for the incorporation of a "relief" surgery at the main premises in Overbury Crescent, and given early approval it is hoped that this adaption can be completed whilst the major reconstruction to the school is taking place. On a conservative estimate this addition should permit an improved service in the early summer of 1958. During the intervening period the needs of all effected schools will continue to be met at Shirley Road, though treatment may be required to be restricted to more essential work. 13 Whilst during the greater part of the year the envisaged "build-up" at the Shirley centre had been proceeding satisfactorily, recent events at New Addington, involving the "occupation" of one surgery, have caused serious repercussions and necessitated a partial replanning of treatment arrangements for this area. To maintain a reasonable balance a number of local Schools will until further notice be required to attend at the Lodge Road Centre, though as far as possible this change will be confined to more Senior Departments. Should the remaining Dental Unit be unable to cope with the present situation, additional measures will be taken as required. In the South Norwood area where shortage of staff has led to some lag in treatment, additional sessions have again been introduced, and it is hoped that the position will improve in the immediate future. As stated in last year's Report, the position in south Croydon is likely to become more difficult, particularly with regard to meeting requirements for children at the new Senior Schools. 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. Staffing The position in this respect remains substantially the same as in the previous year, with a continued lack of applicants for full-time posts. Fortunately assistance of a part-time nature is still forthcoming, if on a somewhat limited scale. Though helpful to a point it should be kept in mind that 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. The total of Staff, including the Orthodontic Consultant, now comprises six Full-time and four Part-time Dentists, representing the equivalent of 7.5 Full-time Officers. 14 Orthodontic Unit. Excellent work continues to be carried out by the Orthodontic Unit in meeting the requirements of those with more complicated dental irregularities. Though there has been a substantial increase in those attending, the Specialist reports that there is still a limited waiting list for treatment at the Shirley Centre, which also serves the New Addington Estate. Consultation with dental officers in prior planning of treatment has now become an established practice in the local service, and special emphasis in the "timing" of remedial measures is proving of considerable help in shortening the duration of treatment. Additional comments regarding this treatment will be found in a later paragraph of this Report. Dental Health Education During the year talks to children on Oral Hygiene have been undertaken by the Health Education Officer as part of her general Health Course to Schools, and it is hoped that these can be extended in the future. At a time of shortage of dental manpower the above appears to be a realistic method of imparting at least the basic knowledge of the more important factors in reducing decay, together with more detailed instruction in the correct method of cleaning the teeth. Inspections The number of children on the register at maintained schools within the Borough at the close of 1957 was 36,909. Including an additional 46 free-place scholars at grant assisted schools this represents a sum total of 36,955. During the year 82 per cent. of the school population were examined compared with 78.9 per cent. in 1956. 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 5,145 children received no examination during 1957, compared with 7,134 previously, indicating a slight advance since last year. 15 At those schools visited 30,553 were inspected and 15,024 (49.2 per cent.) referred for treatment, compared with 28,962 inspected and 14,370 (49.6 per cent.) referred in 1956. 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 44.5% Refused Treatment 43.4% Forms Not Returned 12.1% Compared with last year this represents a fall of 3.6 per cent. in the acceptance rate, and a total decrease of some 29.6 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 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 19 57 1956 1953 1949 1937 No. referred for Treatment 15,024 14,370 14,998 9,404 13,498 Consents 6,692: 44.5% 6,915: 48. 1% 8.854: 59% 6,996: 74. 1% 7,762: 57.7% (Total Consents including Specials)* (9,366: 52. 9%) (10,102: 57. 5%) (12,496: 66. 1%) (10,098: 80.7%) (10,146: 63%) Refusals 6, 516: 43.4% 5,986: 41% 4,496: 30% 1,213: 12. 9% 3, 242: 24% Forns not returned 1,816: 12. 1% 1,559: 10.9% 1,648 11% 1,195: 12.7% 2,494: 18.5% * SPECIALS - Those referred by Head Teachers with Emergency Forms. 16 Treatment Of 17,698-children referred for treatment (including specials) 8,904 (50.3 per cent.) were treated and 7,161 (40.5 per cent.) cured completely, compared with 17,557 referred, 9,399 (53.5 per cent.) treated and 7,287 (41.5 per cent.) cured in 1956. Despite the usual staff fluctuations the total of treatment sessions increased from 2,776 to 2,891. Assistance by Part-time staff rose from 304 to 455 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. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:- 1957 1956 Attendances 25,274 26,963 Treated 8,904 9,399 Re-treated 4,720 4,909 Fillings - Permanent 9,023 9,877 Temporary 1,858 1,585 No. of Teeth Filled: Permanent 8,528 9,631 Temporary 1,785 1,521 Extractions - Permanent 3,153 2,691 Temporary 7,542 8,936 Gas Administration 4,360 4,733 Local Anaesthetics 881 880 Other Operations Permanent 9,818 10,187 Temporary 1,006 1,000 Cases completed 7,161 7,287 17 Miscellaneous Items These include:- 1957 1956 Root treatment in anterior teeth 6 4 Removal of nerves under local anaesthetic 3 3 Removal of bone sequestra 21 25 Splints for fractured incisors 6 4 Partial pulpotomy 1 3 Number of M. D. s treated 24 29 Dentures inserted 62 55 Denture repairs 13 22 After treatment of sockets, etc. 35 33 Removal of impacted and difficult teeth 68 68 Ulcerated Stomatitis (Vincent's infection) 3 5 Cleft Palate 1 2 Denture for Cleft Palate 1 Application of Penicillin "Cones" 23 29 Acrylic caps for incisor teeth 13 8 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 2,674, compared with 3,187 in 1956. X-Ray Examinations The number of cases referred for the above purpose was 431, compared with 456 in 1956. Orthodontic Service In addition to the work carried out by the Orthodontic Unit, an appreciable number of irregularities continue to be handled by Dental officers as part of their normal duties. When the cause of malocclusion is obscure, advice on this aspect is first obtained from the Consultant, and correction is then proceeded by the Dentist; if at a later stage more advanced measures are indicated, the patient is returned to the Unit for completion. By this means an optimum number can be handled and much of the previous waiting period avoided. The number of sessions devoted to this work was 465, compared with 443 last year. 18 The following is a summary of treatment performed:- 1957 19 56 Consultant D.O.s Total Cases commenced during the year 236 106 342 401 Cases carried forward from the previous year 215 138 353 270 Cases completed during the year 62 86 148 102 Cases discontinued during the year 45 20 65 49 Pupils treated with appliances 231 137 368 333 Appliances - Removable 304 117 421 358 „ Fixed 16 24 40 26 Total Attendances 3,118 1,722 4,840 4,651 Cases treated by extraction only 30 149 179 128 Cases referred to specialist for Consultation 271 - 271 412 Treatment sessions 311 154 465 443 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: - 1957 1956 Attendances 98 113 New cases Treated 8 15 Re-treated 38 29 Fillings - Permanent 54 66 Extractions - Permanent 15 19 Temporary 10 12 Other Operations 13 27 " Gas" Cases 10 11 Local Anaesthesia 10 10 Cases Completed 32 26 Dentures Fitted 1 - Referred X-Ray 2 2 19 DENTAL DEFECTS (1) Inspected by Dental Officers:- 1957 1956 Aged 5-6 1,313 1,455 6 - 7 2,382 2,157 7-8 2,471 2,444 8 - 9 2,906 2,983 9 - 10 3,274 3,766 10 - 11 3,843 3,520 11 - 12 3,250 2,474 12 - 13 2,734 Total 2,621 13 - 14 2,899 30,553 2,516 14 - 15 2,571 2,432 15-16 2,041 1,658 16 up 869 936 Specials 2,674 3,187 33, 227 32,149 1957 1956 (2) Number found to require treatment 19,781 19,488 (3) Number referred for treatment 17,698 17,557 (4I Number actually treated 8,904 9,399 (5) Attendances made by children for treatment 25,274 26,963 (6) Half-days devoted to: Inspection 228 204 Treatment 2,891 2,776 3,119 2,980 Number of Gas Sessions 345 342 Administrative Sessions 132 154 Orthodontic Sessions 465 443 (7)Fillings - Permanent Teeth 9,023 9,877 Temporary Teeth 1,858 1,585 10,881 11,462 (Si Teeth Filled - Permanent Teeth 8,528 9,631 Temporary Teeth 1,785 1,521 10,313 11,152 20 1957 1956 (g) Extractions - Permanent Teeth 3,153 2,691 Temporary Teeth 7,542 8.936 10,695 11,627 (10) Administrations of general anaesthetics for extractions 4 , 360 4,733 Administrations of local anaesthetics for extractions 881 880 (n) Other Operations - Permanent Teeth 9,818 10,187 Temporary Teeth 1,006 1,109 10,824 11,296 Attendances per session 8.7 9.7 21 SPINAL AND OTHER REMEDIAL CLINICS 1957 1956 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 2,791 688 4.1 3,072 828 3.7 Flat Feet 2,629 480 5.5 2,141 400 5.4 Breathing 900 196 4.6 1,033 194 5.3 6,320 1,364 6,246 1,422 257 individual cases were treated and 658 examinations were made by doctor. Cost of the School Health service The gross cost of the medical, dental and nursing services was £47,705. The expenditure is subject to Education grant. Cost of Special Schools £ Schools maintained by the Council 3,634 Other Schools (not maintained by local Education Authorities) 10,372 Adjustments with other authorities in respect of Special Schools, at rate cost 3,532 £50,538 With the exception of the £3,532 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals Meals and Milk cost £397,333. Income from payment for meals was £138,227, making a net cost of £259,106, on which grant is paid of 100 per cent. on approved expenditure. 22 ST. GILES SCHOOL FOR PHYSICALLY HANDICAPPED AND DELICATE CHILDREN I am indebted to the Head Teacher, Miss Lambert, for the following report:- This year, though with reduced attendances due to Influenza during the Autumn Term, the school has followed its dual pattern of work, educational and remedial. There have been Staff changes this year. We were regretful to lose Miss Tasker on her marriage, and we are happy to welcome Miss Osborn and Mrs. Matthews to our number. Pupils of the appropriate age sat the Transfer Test; and two, one boy and one girl, qualified for admission to Grammar schools; whilst 9 others, who have regained normal health, have been able to proceed to other schools. Physical Education has included normal and special remedial exercises, swimming, football, cricket, netball, tennis, hockey and rounders as well as field sports. An average of 20 children and 3 Staff attended the Swimming Baths after school twice weekly throughout the Summer season; and 32 certificates were awarded, 1 for 14 mile, 4 for ¼ mile, 4 for 220 yds., 5 for 100 yds., 9 for 50 yds. and 9 for 20 yds. The Summer Sports meeting, at which we were happy to welco«e 150 guests, was honoured by the presence of the Chairman of the Education committee. Alderman G.J. Cole and of Mrs. cole, the late Alderman Maycock and Councillor Mrs. Maycock, Councillor and Mrs. J.J. Cooper, Councillor Lewis, Miss Newton and Mr. E.P. Smith, Inspector for physical Training. Members of the school have enjoyed taking part in corporate activities such as the Schools' Carol and Festival Choirs; and have attended all the Saturday morning concerts of the Croydon Schools Music Association. Senior girls and boys, with their teachers, have made visits in school holidays to places of interest and to dramatic performances; and, with other Croydon schools, have attended the Sadlers Wells Ballet performances and the filmof the Russian Ballet at the Davis Theatre. Again this year some of the seniors took the School Harvest Festival gifts to the Cranleigh residents. Each term there has been a conference between those about to leave for employment, their parents, the Youth Employment officer, the attached Medical Officer and the Head Teacher. These conferences and their " follow-up" prove. Increasingly, their value; and the school and the boys and girls concerned, wish to record their grateful thanks to the Youth Employment officers. Social life has been active, and parent-teacher association happily maintained throughout the year which was rounded off by a most successful Christmas social attended by 180 parents. The School Prize-Giving and Party was attended by Aldeman and Mrs. Cole, Councillor and Mrs. Cooper, Councillor and Mrs. Edwards and Mr. E.F. Smith, Inspector. Alderman Cole presided and Mrs. Cole presented the prizes, autographing her special prizes for service to the school. Visitors to the school have been widely representative, very welcome being our friends from Croydon High School who, again kindly entertained fifty of the younger children to a greatlJ enjoyed Christmas Party. 23 In the Summer Holidays the Croydon Traders' Federation again provided, very generously, a day's outing for fifty of our children, by coach to Littlehampton - and in the New Year, for the whole school, a delightful party. Old Scholars' Reunions, as well as letters from old Scholars in many parts of the world, continue to be a source of much encouragement. DISABILITIES AND TREATMENTS Of the 200 children on roll 74 were disabled by cerebral palsy, poliomyelitis, muscular dystrophy, spina bifida, skeletal deformity, tubercular bone disease and other causes; 89 suffering Cram cardiac disability or from respiratory diseases. The remainder were delicate from various causes. 16 routine medical inspections took place at which 290 children were seen and 161 parents were present. One visit each term has been made by an Orthopaedic Surgeon and a Specialist in Physical Medicine who examined, at each session, 11 children, whose parents were also present. In attendance were the attached School Medical officer, the School Nursing sister, the Physiotherapist and the Head Teacher. Physiotherapy has been given each school day; a total of 3,016 treatments. The Nursing Sister, aided in certain duties by the male Medical Attendant has carried out the preparation and follow-up of medical examinations as well as prescribed courses of treatment; has dealt with many ailments, has kept full records of each child's progress and has supervised physical welfare in general. To Dr. Hegarty, from parents, Staff and children, are extended most grateful appreciation of her devoted work in the service of the children. The Head Teacher desires to record her thanks to the principal School Medical Officer and his Staff, the chief Education officer and his Staff and to the Staff of St. Giles' school for guidance and help during the year 1957. Average number on roll 200 To Employment 19 „ Grammar Schools 2 „ other Schools 20 „ Hospitals and Hospital Schools 6 Left district 4 Further training 1 24 ST. CHRISTOPHER' S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL I am indebted to Mr. Ramsden, the Head Master, for the following observations: - The year 1957 has been one of re-building; the new Domestic Science flat, Art, Needlework and printing rooms are beginning to take shape and we hope that in the last term of 1958 they will be in active use and prove a great asset. At Whitsuntide we again took a party of children to the Isle of Wight and spent a glorious week exploring the Island. Mr. Batchelor was again the ever efficient organiser, and it was entirely due to his efforts that everything progressed smoothly. The Croydon schools sports this year provided us with a Red Letter Day as we obtained a "First". Colin Brewer, 11 years old, threw the Cricket Ball 189 feet and was only 2' 6" short of a town record. This success was due to the efforts of Mr. Batchelor and Mr. Powell, who. by their efforts together, have raised the tone of class 2.a boys to a very high standard. On July 24th we held a very successful and enjoyable Sports Day on the Barclays Bank Sports Ground. At Christmas our Carol Service and Tableaux attracted a large audience of parents and our Christmas Dinner and entertainment was again an unqualified success. We have welcomed Mrs. Springett for Domestic Science and Mrs. Lupton for infants to our staff during the year. Altogether, despite confusion in re-building and illness of Staff and Scholars, we have managed to make a steady if not spectacular progress in our school subjects and much praise is due to the Staff for their constant endeavour in face of great handicaps. 25 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN 220 children were examined during 1957. The classifications arrived at, together with recommendations made, are as follows:- (1) Found to be mentally defective: (a) Found to be mentally defective and referred to Local Authority and Occupation Centre ... 10 (b) Found to be mentally defective and referred to Local Authority for Statutory Supervision 20 (c) Recommended Institutional Care and referred to Local Authority 8 (2) Pound to be educationally sub-normal: (a) Recommended to St. Christopher's Special School 36 (b) Recommended to Residential School 6 (c) Referred to Slow Stream in Ordinary Elementary School 38 (d) Recommended for re-test 20 (e) Deferred for Medical Treatment 6 (f) Recommended for St. Giles' 2 (g) Recommended for Epileptic Colony (h) Referred back to Ordinary Elementary School 40 (3) Referred to Child Guidance Clinic 4 (4) Examined for other Authorities 190 Mental Tests at St. Christopher' s 30 220 6 home visits have been paid to Education cases. 26 ST. LUKE' S PARTIALLY SIGHTED SCHOOL I am indebted to Miss J. Rundle, the Teacher-in-charge, for the following observations: - During 1957 steady progress was achieved in all branches of our school work. In September Miss E. R. Conboy was appointed to take charge of the Senior group and we hope that she will be very happy In her work at St. Luke's. The health of the children throughout the year was very good and the attendance did not fall greatly in spite of the epidemic of Asian Influenza. We are pleased to report that on three occasions we had 100% attendance for the week. The senior girls now attend Ecclesbourne School for Domestic Science and we are grateful to Miss Jones for her Interest in our children. The boys continued under Mr. Maddox of Norbury Manor School for Woodwork instruction and we appreciate his continued Interest. The highlight of the year was a visit by the Senior Group to the Royal Festival Hall to hear the lecture given by The Duke of Edinburgh on his Commonwealth Tour. This excursion was greatly enjoyed, and much was gained from the Lecture. We were very pleased to have Councillor Mrs. Maycock with us on Open Day also many parents and friends. During the year we welcomed Mr. Moody, H.M.I, and many other visitors from Home and Overseas. Three children were transferred to Schools for the Blind and one boy was transferred to the Technical College where he is not taking a G. C.E. Course. The number on roll was 20 on December 31st last. The year closed with a Carol service at which we welcomed the presence of several friends. 27 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1957 as to their fitness to undertake the part-time employment indicated: - 1957 1956 1955 1954 19 53 Delivery of Goods for Shopkeepers 62 62 86 122 53 Delivery of Newspapers 344 365 364 501 328 Delivery of Milk 15 13 17 33 15 Shop Assistants 53 61 67 48 77 474 501 534 704 473 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1957 all milk was supplied free of charge and approximately 29,000 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, 1957, milk has also been supplied by the Education committee to children in the Non-Maintained Schools in accordance with instructions from the Ministry of Education. Approximately 4,800 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 1957 was approximately 15,000. CHILD GUIDANCE CLINIC Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1957. Boys Girls Total number referred 33 27 Analysis of the above Cases: - Diagnostic only 7 6 Current Cases under treatment 12 7 Cases Closed - improved 7 6 Cases Closed - not improved 7 8 33 27 28 This table represents, of course, only a part of the work done by the Child Guidance Clinic at 103, Park Lane. The clinic is financed by the Hospital Management Committee of Warlingham Park Hospital. It is staffed by the clinical team of that hospital and supervised by its consultants. During 1957, a total of 192 new cases were registered for treatment. SPEECH DEFECTS CLINIC Total number of cases treated 267 Cases discharged 102 Cases still attending165 Cases referred for physical treatment 58 Cases referred for residential treatment 3 Cases referred to child Guidance 4 Stammerers 50 Cleft Palate 5 Sigmatism 52 Hyper Rhino-phonia 10 Dyslalia 101 Undeveloped Speech 25 Dysarthria 13 Developmental Aphasia 6 Partially Deaf 5 1957 has been an active year for the Speech Clinic. The staff are continually trying to widen the understanding and appreciation of the difficulties, not only social, but educational and emotional that are encountered by the child with a speech problem. To this end the Speech Therapists have addressed a number of parent-teacher meetings, and also had a visit from the Croydon Advertiser, who published a long account of the activities of the Speech Clinic. As a result of this, several parents called, requesting help for their children. It is hoped that further staff will be appointed to cope with the growing needs of the speech Department. 29 ENURETIC CLINIC During 1957 124 children between 5-15 attended the clinics at Lodge Road and New Addington. Clinics are held weekly at Lodge Road and monthly at New Addington. Of this number 52 made their first attendance in 1957: 72 cases had begun treatment in 1956. 70 children were discharged dry during the year, and 3 left the district. At the end of the year 51 children were still attending for treatment, most of whom had only started to attend towards the end of the year. The average time of treatment being 6 months. The enuretic machines bought by the Health department and hired out to the parents of the children were of the greatest assistance in curing those children who did not respond to the routine treatment, and during the year 26 children were successfully treated with the aid of these machines. The average time taken to become dry in these cases being only 8 weeks. Number of children registered 161 Number of children attended 124 Number of new cases 52 Number discharged dry 70 Number of children using machine 26 Number still attending 51 EPILEPTICS 32 epileptics were known to the school Health Service as at 31.12.57. Of these: 12 were attending Ordinary School 10 were in Day School for Physically Handicapped and Delicate Children 2 were attending our day E. S.N. School 2 were at Lingfield School 2 were receiving Home Tuition 2 were in Hospital (1 at St. Lawrence's Hospital and 1at Queen Mary's Hospital) 1 was at the Occupation centre 1 was ineducable (in Queen Mary's Hospital) 30 SPASTICS 48 Croydon Spastics were receiving education as at 31.12.57. 2 children received Home Teaching 27 were attending St. Giles' School 1 was attending St. Margaret's School, Croydon 2 were at Residential schools for Physically Handicapped children 1 was attending a Day School for Partially Deaf children 2 were attending a Residential School (St. Mary's Bexhill) 10 were attending ordinary school 1 was attending Myope School 1 was attending St. Christopher's School 1 was attending normal Private School In addition. 5 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 9 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 1957, 244 children were examined at routine examination and also 1 special and 2 re-examinations. Appendix C gives the detailed findings. Yours faithfully, S.L. WRIGHT, School Medical Officer. 31 STATUTORY TABLES APPENDIX A MEDICAL INSPECTION RETURNS Year ended 31st December, 1957 Table I MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS A. -Periodic Medical Inspections Number of Inspections in the prescribed Groups: Entrants 2,914 Second Age Group 2,620 Third Age Group 2,557 Total 8,091 Number of other Periodic Inspections . 3,104 (8 - 9 years) Grand Total 11,195 B. -Other Inspections Number of Special Inspections 1,380 Number of Re-inspections 1,994 Total 3,374 C. -Pupils found to require Treatment (Excluding Dental Disease and Infestation with Vermin) Group For defecti ve vision ( excluding squint) For any of the other conditions recorded in Table IIIA Total Individual Pupils (1) (2) (3) (4) Entrants 105 280 376 Second Age Group 175 203 373 Third Age Group 156 107 258 Total (prescribed groups) 436 590 1,007 Other Periodic Inspections Including 8 to 9 years 160 272 416 Grand Total 596 862 1,423 32 D.-Classification of the Physical Condition of pupils Inspected in the Age Groups Recorded in Table l.A. Age Groups Number of pupils inspected Satisfactory Unsatisfactory No. % No. % (1) (2) (3) (4) ( S) (6) Entrants 2,914 2,873 98.6 41 1.4 Second Age Group 2,620 2,609 99.6 11 0.4 Third Age Group 2,557 2,545 99.5 12 0.5 Other Periodic Inspections including 8 to 9 years 3,104 3,036 97.8 68 2.2 TOTAL 11,195 11,063 98.8 132 1.2 Table II INFESTATION WITH VERMIN (i) Total number of examinations in the schools by the school nurses or other authorised persons 63,152 (ii) Total number of individual pupils found to be infested 341 (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) NIL 33 Table III A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION Defect Code No. DEFECT OR DISEASE Periodic Inspections TOTAL (including all other age groups inspected) Entrants Leavers Treatment Observation Treatment Observation Treatment Observation (1) (2) (3) (4) (5) (6) (7) 4 SKIN 3 5 6 4 33 16 5 EYES- (a) Vision 105 26 156 10 596 115 (b) Squint 20 8 - - 45 15 (c) Other 5 3 7 - 27 5 6 EARS- (a) Hearing 5 20 2 7 8 46 (b) Otitis Media 5 13 - 7 9 33 (c) Other 4 5 4 - 13 9 7 NOSE OR THROAT 78 97 3 2 148 175 8 SPEECH 35 23 2 2 51 31 9 CERVICAL GLANDS 1 7 1 - 3 16 10 HEART AND CIRCULATION 5 32 3 16 21 87 11 LUNGS 25 49 6 4 49 99 12 DEVELOPMENTAL- (a) Hernia - 6 2 - 3 9 (b) Other 5 10 6 - 27 38 13 ORTHOPAEDIC- (a) Posture 23 4 18 15 135 54 (b) Flat Foot 21 32 10 5 96 108 (c) Other 30 43 14 10 102 91 14 NERVOUS SYSTEM- (a) Epilepsy 1 6 - 1 5 9 (b) Other 1 8 - 2 3 16 15 PSYCHOLOGICAL- (a) Development 4 2 - 2 9 11 (b) Stability 10 9 1 4 30 24 16 ABDOMEN - - - - - - 17 OTHER 31 35 18 18 104 115 34 B. SPECIAL INSPECTIONS Defect Code No. DEFECT OR DISEASE Special Inspections Requiring Treatment Requiring Observation (1) (2) (3) (4) 4 SKIN 2 2 5 EYES- (a) Vision 44 6 (b) squint 2 2 (c) Other 9 - 6 EARS- (a) Hearing 5 3 (b) Otitis Media - 2 (c) Other 2 - 7 NOSE AND THROAT 13 7 8 SPEECH 10 3 9 LYMPHATIC GLANDS - - 10 HEART 1 5 11 LUNGS 5 2 12 DEVELOPMENTAL- (a) Hernia - 1 (b) Other 6 - 13 ORTHOPAEDIC- (a) Posture 8 3 (b) Feet 7 2 (c) Other 6 6 14 NERVOUS SYSTEM- (a) Epilepsy 2 4 (b) Other 3 - 15 PSYCHOLOGICAL- (a) Development 2 7 (b) Stability 6 3 16 ABDOMEN - - 17 OTHER 15 5 35 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 40 Errors of Refraction (including squint) 1.627 Total 40 1,627 Number of pupils for whom spectacles were prescribed - 982 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 - 425 (c) for other nose and throat conditions - - Received other forms of treatment Ear (Minor Ailments Clinic) 14 - Total 14 425 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1956 - 12 (b) in previous years - 32 GROUP 3.- ORTHOPAEDIC AND POSTURAL DEFECTS (a) Number treated as in-patients Not available By the Authority Other wise (b) Number treated otherwise, e.g. in clinics or out-patients departments 254 Not Available GROUP 4.- DISEASES OF THE SKIN (excluding uncleanliness, for which see Table II) Number of cases treated or under treatment during the year Ringworm - (i) scalp 1 (ii) Body 1 Scabies 1 Impetigo 17 Other Skin Diseases 8 Total 28 36 GROUP 5.- CHILD GUIDANCE TREATMENT Number of cases treated Number of pupils treated at Child Guidance Clinics 60 GROUP 6. - SPEECH THERAPY Number of cases treated Number of pupils treated by Speech Therapists 261 GROUP 7.- OTHER TREATMENT GIVEN Number of cases treated (a) Number of cases of miscellaneous minor ailments treated by the Authority 617 (b) Pupils who received convalescent treatment under School Health Service arrangements 19 (c) Pupils who received B. C. G. vaccination - ( d) Other than (a), (b) and (c) above (specify) 1. Enuresis 161 Total (a) - (d) 797 37 Table V DENTAL INSPECTION AND TREATMENT (1) Number of pupils inspected by the Authority's Dental Officers- (a) Periodic age groups 30,553 (b) Specials 2,674 (c) TOTAL (Periodic and Specials) 33,227 (2) Number found to require treatment 19,781 (3) Number referred for treatment 17,698 (4) Number actually treated 8,904 (5) Attendances made by pupils for treatment 25,274 (6) Half-days devoted to: (a) Inspection 228 (b) Treatment 2,891 TOTAL 6 3,119 (7) Fillings: Permanent Teeth 9,023 Temporary Teeth 1,858 TOTAL 7 10,881 (8) Number of Teeth filled: Permanent Teeth 8,528 and Temporary Teeth 1,785 TOTAL 8 10,313 (9) Extractions: Permanent Teeth 3,153 Temporary Teeth 7,542 TOTAL 9 10,695 (10) (11) Administrations of general anaesthetics for extraction Orthodontics: 4,360 (a) Cases commenced during the year 342 (b) Cases carried forward from previous year 353 (c) Cases completed during the year 148 (d) Cases discontinued during the year 65 (e) Pupils treated with appliances 368 (f) Removable appliances fitted 421 (g) Fixed appliances fitted 30 (h) Total attendances 4,840 (12) Number of pupils supplied with artificial dentures 62 (13) Other Operations: (a) Permanent Teeth 9,818 (b) Temporary Teeth 1,006 TOTAL 11 10, 824 38 APPENDIX B Table 1 RETURN OF AVERAGE NUMBERS AND ATTENDANCE IN MAINTAINED PRIMARY, MODERN, SELECTIVE, TECHNICAL AND GRAMMAR SCHOOLS DURING THE YEAR 1957 School Average No. on Registers Average Attendence Average Attendance Average 1956 Attendance COUNCIL PRIMARY Ashburton Junior Mixed 555 509 91.7 92.6 Ashburton Infants 191 163 85.3 88.3 Benson Junior Mixed and Infants 628 571 90.9 92.0 Beulah Junior Boys 383 325 84.9 92.2 Beulah Junior Girls 323 298 92.3 92.4 Beulah Infants 207 172 83.1 86.1 Castle Hill Junior Mixed 370 333 90.0 89.1 Castle Hill Infants 343 288 83.9 83.1 Cypress Junior Mixed 282 258 91.4 92.0 Cypress Infants 173 146 84.3 87.0 Davidson Infants 143 119 83.2 86.3 Duppas Junior Mixed and infants 429 387 90.2 90.7 Ecclesbourne infants 136 112 82.3 88.4 Elmwood Junior Boys 340 312 91.8 92.1 Elmwood Junior Girls 341 309 90.6 91.0 Elmwood Infants 248 206 83.1 86.2 Fairchildes junior Mixed 588 524 89.1 90.6 Fairchildes Infants 446 372 83.4 87.5 Gilbert Scott Junior Mixed 554 505 91.1 92.2 Gilbert Scott Infants 256 214 83.5 87.1 Gonville Junior Mixed and Infants 565 500 88.4 90.2 Howard Junior Mixed and Infants 511 455 89.0 89.01 Ingram Infants 151 129 85.4 87.0 Kensington Avenue Junior Mixed 558 506 90.6 91.6 Kensington Avenue Infants 122 108 88.5 Kingsley Junior Mixed 534 479 89.7 89.1 Kingsley- Infants 306 250 81.7 83.8 Monks Orchard Junior Mixed and Infants 328 301 91.8 91.5 Overbury Junior Mixed and Infants 193 174 90.2 90.5 Norbury Manor Junior Mixed 490 460 93.8 93.9 Norbury Manor infants 243 206 84.7 88.4 Oval Junior Mixed 476 433 90.9 90.5 Oval Infants 167 141 84.4 83.6 Portland Infants 201 178 88.5 87.3 purley Oaks Junior Mixed 384 350 91.1 92.1 Purley Oaks Infants 221 188 85.0 87.4 Rockmount Junior Mixed 380 352 92.6 93.9 Rockmount Infants 172 142 82.5 89.3 Rowdown Junior 483 433 89.6 90.2 Rowdown infants 413 358 86.6 87.6 South Norwood Junior Boys 352 324 92.0 92.5 South Norwood Junior Girls 312 286 91.6 92.6 South Norwood Infants 303 258 85.1 87.2 St. Peter's Junior Mixed and Infants 336 297 88.3 90.8 Spring Park Junior Mixed 359 334 93.0 92.6 Spring Park Infants 156 137 87.8 87.3 39 School Average No. on Registers Average Attendance Average Attendance Average 1956 Attendance Sydenham Junior Boys 256 234 91.4 91.4 Sydenham Junior Girls and Infants 329 288 87.5 90.0 Waddon Junior Mixed and Infants 185 155 83.8 88.7 West Thornton Junior Mixed 357 328 91.8 91.9 West Thornton Infants 148 130 87.8 86.9 Whitehorse Manor Junior Boys 287 261 90.9 90.6 Whitehorse Manor Junior Girls 273 247 90.4 92.3 Whitehorse Manor Infants 228 191 83.7 86.5 Winterbourne Junior Boys 433 399 92. 1 93.4 Winterbourne Junior Girls 424 395 93. 1 93.8 Winterbourne Infants 347 292 84. 1 88.2 Wolsey Junior Mixed 543 494 90.9 92.1 Wolsey Infants 298 251 84. 2 85.9 Woodside Junior Boys 416 384 92.0 93.2 Woodside Junior Girls 437 400 91. 5 91.5 Woodside Infants 275 236 85.8 87.6 TOTALS 20,888 18,587 88.9 89.8 COUNCIL SECONDARY MODERN Ashburton Senior Boys 558 521 93.4 94.2 Ashburton Senior Girls 507 461 90.9 92.1 Davidson senior Boys and Girls 460 408 88.7 91.9 Ecclesbourne Senior Girls 304 267 87.8 90.6 Fairchildes senior Boys 399 354 88.7 89.3 Fairchildes Senior Girls 363 318 87.6 88.5 Ingram Senior Boys 498 442 88.8 91.3 Ingram Senior Girls 308 272 88.3 90.2 Lanfranc Senior Boys 576 509 88.3 90.4 Lanfranc senior Girls 625 563 90.0 91.5 Norbury Manor senior Boys 287 264 92.0 93.8 Norbury Manor senior Girls 314 290 92.3 94.2 Portland senior Boys 189 174 92.1 93.8 Portland senior Girls 237 216 91.1 91.9 Tavistock senior Boys 553 485 87.7 87.5 Tavistock Senior Girls 393 341 86.8 88.2 South Croydon Senior Mixed 565 490 86.7 87.6 Shirley Senior Mixed 289 266 92.0 93.8 Shepherds Hill Senior Mixed 123 104 84.5 TOTALS 7, 548 6,745 89.4 90.5 VOLUNTARY SECONDARY MODERN St. Andrew's 180 157 87.2 87.7 Our Lady's 179 157 87.7 88.8 St. Mary's 298 266 89.2 90.3 TOTALS 657 580 88.3 89.2 SPECIAL SCHOOLS St. Christopher's Educationally Sub-Normal 206 178 86.4 86.1 St. Giles' (Delicate and Physically Handicapped) 197 162 82.2 81.8 St. Luke's (Partially Sighted) 20 17 85.0 85.2 TOTALS 423 357 84.4 84.0 40 School Average No. on Registers Average Attendance Average Attendance Average 1956 Attendance VOLUNTARY PRIMARY All Saints' Mixed and Infants 270 241 89.3 92.8 Christ Church Junior Mixed and Infants 211 186 88.1 91.6 Good Shepherd R.C. Junior Mixed and infants 276 235 85.1 86.1 Parish Church Junior Mixed and Infants 403 360 89.3 89.4 St. Joseph's Mixed and Infants 519 454 87.5 87.7 St. Mark's Junior Girls and Infants 213 186 87.3 88.6 St. Mary's R.C. Junior Mixed and Infants 420 358 85.2 86.5 St. Michael's Infants 135 112 82.9 82.8 Shirley Junior Mixed and Infants (St. John's) 282 252 89.4 89.3 TOTALS 2,729 2,384 87.3 88.5 SELECTIVE CENTRAL Arch. Tenison's Mixed 290 266 91.7 93.6 Heath Clark Mixed 559 520 93.0 93.4 John Newnham Mixed 516 479 92.8 93.5 TOTALS 1,365 1,265 92.6 93.6 GRAMMAR Selhurst Boys 581 541 93.1 93.4 Selhurst Girls 536 493 91.9 92.4 John Ruskin Boys 523 486 92.9 94.5 Coloma Girls 545 496 91.0 90.5 Lady Edridge Girls 494 459 92.9 94.1 TOTALS 2,679 2,475 92.4 93.1 TECHNICAL Stanley Technical 278 259 93.1 94.0 Croydon secondary Technical 342 319 93.3 94.8 TOTALS 620 578 93.2 94.4 SUMMARY OF SCHOOL ATTENDANCE FOR THE YEAR 1957 Council Primary 20,888 18,587 88.9 89.8 Voluntary primary 2,729 2,384 87.3 88.5 Council Secondary 7,548 6,745 89.4 90.5 Voluntary Secondary Mixed 657 580 88.3 89.2 Selective 1,365 1,265 92.6 93.6 Grammar 2,679 2,475 92.4 93.1 Technical 620 578 93.2 94.4 Specials 423 357 84.4 84.0 TOTALS 36,909 32,971 89.3 90.1 Crosfield Nursery 42 33 78.5 83.5 41 Table II HEIGHTS AND WEIGHTS, 1957 Age Number Examined 1957 Average Height in inches Average Weight in lbs. 19 57 1956 1955 1954 1939 1957 1956 1955 1954 1939 BOYS 5 years 937 43.5 43.4 43.3 42.7 41.8 43.5 43.4 43.5 42.9 41.5 6 ,, 449 44.0 43.9 44.2 44.2 43.8 44.6 44.8 45.3 45.2 43.4 7 ,, 174 47.6 48.1 47.9 47.8 45.3 52.6 53.4 52.7 53.3 47.9 8 ,, 791 50.5 50.2 49.9 50.2 49.5 59.5 58.9 59.1 58.6 55.5 9 ,, 571 50.9 51.3 51.3 51.6 51.2 61.3 62.3 61.4 61.7 58.8 10 ,, 68 52.9 52.9 54. 3 54.7 52.7 66.0 67.1 73.9 72.2 62.9 11 ,, 423 57.1 57.2 55.0 55.8 53.7 83.8 83.9 74.2 76.4 68.7 12 ,, 532 58.1 58.0 55.6 56.5 55.7 86.1 86.4 80.0 79.7 79.9 13 ,, 210 59.6 58.2 60.3 60.5 58.4 90.1 82.9 96.5 97.1 81.6 14 ,, 427 63.7 61.3 62.8 62.4 59.0 112.6 111.9 109.0 105.6 90.8 15 ,, 583 64.3 64. 5 64.8 63.8 - 117.6 116.6 116.5 112.8 - 16 ,, 201 66.8 66.6 66.9 66.9 - 127.6 129.2 128.3 129.4 - 17 ,, 52 67.8 67.9 68.4 66.7 - 133.2 133.8 137.7 126.5 - GIRLS 5 years 774 42.7 42. 5 42.7 42.6 41.2 42.3 41.7 41.9 41.9 39.7 6 ,, 405 43.8 43.7 43.4 43.8 42.7 43.9 43.6 43.8 45.3 41.4 7 ,, 127 47.5 47.5 47. 2 47.5 44.1 52.1 52.6 531 52.4 43.6 8 ,, 847 50.1 50.1 49.3 49.6 49.9 57.9 58.3 58.8 56.6 54.7 9 ,, 586 50.9 50.9 50.5 51.0 50.9 60.3 60.5 60.4 60.5 57.6 10 ,, 76 52. 5 53. 5 54.6 54.6 52.1 65.5 69. 1 73.7 73. 1 62.9 11 ,, 622 57.4 57.2 56.0 55.9 53.6 83.8 83.6 78.7 77.9 68.3 12 ,, 653 58.3 58.9 58.2 57.1 56.6 91.0 89.6 87.5 81.9 77.2 13 ,, 197 59.4 59.7 60.3 61.4 58.8 91.6 94.6 97.5 100.6 85.3 14 ,, 459 62.2 61.9 61.7 62.2 60.3 109.9 109.9 111.3 109.2 97.9 15 ,, 522 62.5 62.8 63.2 62.7 62.0 116.3 114.3 116.1 114.0 105.5 16 ,, 249 64.0 64.9 64.2 63.3 - 123.4 123.6 123.2 121.8 - 17 ,, 84 64.5 64.6 64.2 63.5 - 126.6 127.8 124.6 116.3 - 42 Table III PARENTS PRESENT 1957 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 30 13 25 12 3 - 3 - - - - - 19 21 12 16 52 34 Archbishop Tenison's - - - - 18 51 12 32 17 25 - 6 - - - - 35 76 Ashburton 41 23 36 20 68 5 25 3 120 33 5 2 68 76 47 64 297 137 Benson 36 46 35 46 17 3 16 3 - - - - 35 46 30 25 88 95 Beulah 50 39 49 35 - - - - - - - - 81 69 63 59 131 108 Castle Hill 136 42 123 39 - - - - - - - - 48 5 33 5 184 47 Christ Church 9 14 6 13 3 2 3 2 - - - - 22 12 10 8 34 28 Coloma - - - - - 22 - 5 - 209 - 5 - - - - - 231 Crossfields 26 18 24 17 - - - - - - - - - - - - 26 18 Croydon sec. Tech. - - - - - - - - 101 - - - - - - - 101 - Cypress 23 27 20 20 - - - - - - - - 42 24 36 18 65 51 Davidson 30 28 26 25 103 86 31 32 78 23 6 3 - - - - 211 137 Duppas - - - - - - - - - - - - 23 - 15 - 23 - Ecclesbourne 19 34 18 36 - 48 - 28 - 30 - 8 - - - - 19 112 Elmwood 49 39 46 37 3 - 3 - - - - - 95 85 79 68 147 124 Falrchlldes 48 30 40 30 61 165 19 106 98 38 20 10 44 81 34 62 251 314 Gilbert Scott 39 50 35 39 - - - - - - - - 68 59 42 40 107 109 Gonville 55 38 53 35 - - - - - - - - 28 28 22 24 83 66 Good shepherd - - - - - 18 - 15 - - - - 44 16 31 8 44 34 Heath Clark - - - - 39 126 17 51 15 60 3 11 - - - - 54 186 Howard 15 15 15 9 - - - - - - - - 46 48 35 37 61 63 Ingram 13 20 10 17 22 82 11 49 115 89 26 24 - - - - 150 191 John Newnham - - - - 75 109 35 52 14 48 1 3 - • - - 89 157 John Ruskln - - - - 101 - 14 - 56 - - - - - • - 157 - Kensington 35 29 31 28 5 - 5 - - - - - 22 - 15 - 62 29 Klngsley 73 49 67 48 - - - - - - - - 21 45 13 32 94 94 Lady Edrldge - - - - - 154 - 80 - 103 - 16 - • - - - 257 Lanfranc - - - - 66 124 29 70 94 180 2 112 - - - - 160 304 Monks orchard 19 21 18 21 7 - 5 - - - - - 14 32 12 25 40 53 Norbury Manor 37 48 30 45 114 41 48 30 80 43 12 IB 25 23 22 18 256 155 Our Lady's convent - - - - - 33 - 11 - 29 - - - - - - - 62 Oval 14 21 14 19 - - - - - - - - 30 56 31 47 53 77 Overbury - - - - - - - - - - — - 10 5 5 4 10 5 Continued below 43 Parish Church 17 19 14 19 - l - l - - - - 33 31 26 23 50 51 Portland 26 11 20 10 44 88 16 45 50 70 5 15 - 22 - 20 120 191 purley oaks 59 35 42 32 - - - - - - - - 43 52 23 45 102 87 Rockmount 26 26 24 19 - - - - - - - - 33 44 29 36 59 70 Rowdown 98 89 85 78 - - - - - - - - 101 72 78 68 199 161 St. Andrew's - - - - 20 28 8 12 31 10 7 5 - - - - 51 38 St. Joseph's 55 52 40 36 - - - - - - - - 23 21 13 10 78 73 St. Mark's 16 12 14 11 - — - - - - - - 6 24 5 23 22 36 St. Mary's 56 41 35 31 11 6 2 1 20 19 2 4 37 31 27 18 124 97 St. Michael's 32 26 28 26 - - - - - - - - - - - - 32 26 St. peter's 10 18 5 16 1 - 1 - - - - - 29 21 14 18 40 39 Selhurst Grammar - - - - 199 72 85 38 110 106 2 1 - - - - 309 178 Shirley 19 10 19 9 51 21 21 6 22 - 8 - 17 26 11 21 109 57 South Croydon Sec. - - - - 53 55 12 17 38 35 3 3 50 - 36 - 141 90 South Norwood 39 50 30 47 - - - - - - - - - 19 - 15 39 69 Spring park 21 27 19 24 - - - - - - - 33 51 27 35 54 78 Stanley Technical - - - - 20 - 10 - 89 - - - - - - - 109 - Sydenham 28 19 23 17 - - - - - - - - - 37 - 30 28 56 Tavistock - - - - 80 81 29 44 165 94 19 44 - - - - 245 175 Trinity - - - - - - - - - - - - - - - - - - Waddon 29 22 28 21 - - - - - - - - - - - - 29 22 West Thornton 25 11 23 9 - - - - - - - - 53 31 34 28 78 42 Whitehorse 56 47 48 45 - - - - - - - - 39 57 29 52 95 104 Winterbourne 77 76 65 67 - 13 - 10 - - - - 77 99 60 87 154 188 Wolsey 65 42 57 35 - - - - - - - - 56 48 49 42 121 90 Woodside 60 26 56 24 - 2 - - - - - - 88 175 76 159 148 203 1611 130 3 1396 1167 1184 1436 460 743 1313 1244 121 291 1512 1592 1124 1290 5620 5575 2914 2563 2620 1203 2557 412 3104 2414 11195 PERCENTAGE OF PARENTS PRESENT AT MEDICAL INSPECTIONS Entrants Boys 86.7 87.9 58.9 ,, Girls 89.6 Intermediate Boys 38.8 45.9 ,, Girls 51.7 Leavers Boys 9.3 16.1 ,, Girls 23.4 Other Ages Boys 74.3 77.5 8 to 9 years Girls 81.3 44 Table IV RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1957 Defects Boys Girls No. requiring Treatment No. referred for Observation Percentage of total Examined No requiring Treatment No. referred for Observation Percent age of total Examined Uncleanliness- Head - - - - - - Body Skin Disease 13 7 0.36 20 9 0.52 Eye Disease- Defective Vision 277 67 6.12 319 48 6.58 Squint 17 8 0.44 23 7 0.63 External Eye Trouble 5 3 0.14 22 2 0.43 Ear Disease- Deafness 4 24 0.50 4 22 0.47 Otitis Media 4 24 0.50 5 9 0.25 Other Disease 5 5 0.18 8 4 0.22 Nose and Throat 79 84 2.90 69 91 2.81 Enlarged Cervical Glands (not T. B. ) 3 9 0.21 - 7 0.13 Dental Defects 42 8 0.89 29 1 0.54 Speech Defects 37 16 0.94 14 15 0.52 Heart and Circulation 8 30 0.68 13 57 1.26 Lungs 23 53 1.35 26 46 1.29 Nervous System Disorders- Epilepsy 2 6 0.14 3 3 0.11 Other 2 9 0.19 1 7 0.14 Developmental- (a) Hernia 3 7 0.18 - 2 0.04 (b) other 27 36 1.12 - 2 0.04 Psychological- (a) Development 4 5 0.16 5 6 0.20 (b) Stability 15 11 0.46 15 13 0.50 Deformities- Flat Feet 46 75 2.15 50 33 1.49 Posture 47 12 1.05 88 42 2.33 Others 45 46 1.62 57 45 1.83 Other Defects and Diseases 43 38 1.44 61 77 2.48 TOTALS 751 583 837 548 Total Children Examined 5620 5575 45 Table V SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1957 (Percentages of Children examined) Defect or Disease Entrants Intermediates Leavers Other Ages and 8 to 9 yrs. All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 2.5 3.0 2.9 1.9 4.5 1.7 2.3 3.1 3.0 2.5 Skin 0.4 0.3 0.3 1.1 1.4 1.6 0.8 0.4 0.7 0.8 Eyes- Vision 4.8 4.9 10.1 10.2 7.6 13.5 7.6 6.8 7.3 8.8 Squint 1.0 1.5 0.1 0.7 0.1 0.2 1.1 1.1 0.6 0.9 Other 0.4 0.2 0.3 0.4 0. 2 0.6 0.3 0.6 0.3 0.5 Ears- Hearing 0.9 0.8 0.8 0.4 0.9 0.3 0.3 0.4 0.7 0.5 Otitis Media 0.9 0.5 0.8 0.5 0.7 0.3 0.2 0.2 0.6 0.4 Other 0.6 0.2 - 0.2 - 0.3 0.2 0.2 0.2 0.2 Nose and Throat 8.3 7.8 0.8 2.4 0.2 0.6 5.0 5.0 3.9 4.0 Speech 2.5 1.4 0.2 0.4 0.1 0.2 0.7 0.2 1.0 0.5 Cervical Glands 0.8 0.6 0.2 0.1 0.1 - 0.7 0.9 0.5 0.4 Heart and Circulation 1.2 1.7 0.8 1.5 0.6 1.4 1.1 1.0 0.9 1.4 Lungs 3.0 2.4 0.8 1.1 0.7 0.8 1.6 1.4 1.6 1.4 Development- Hernia 0.3 0.1 0.3 - 0.2 - 0.1 0.1 0.4 0.1 Other 0.9 0.1 3.4 0.1 0.5 - 1.3 - 0.4 0.1 Orthopaedic- Posture 1.6 0.6 1.0 3.6 0.8 0.8 2.1 3.0 2.4 2.4 Flat Feet 3.0 1.2 5.7 3.1 1.4 1.1 2.2 1.2 1.9 1.9 Other 3.5 2.1 2.0 2.9 2.7 1.9 1.8 1.2 2.2 2.2 Nervous Diseases- Epilepsy 0.4 0.1 0.1 0.1 0.2 0.1 0.1 0.1 0.1 0.1 Other 0.3 0.3 0.2 0.1 0.2 0.2 0.2 01 0.2 0.2 Psychological- Development 0.4 0.1 0.1 2.8 - 0.2 0.3 0.3 0.2 0.2 Stability 0.9 0.4 2.5 0.8 - 0.4 0.7 0.6 0.6 0.6 Dull and Backward 0.3 0.1 - 0.1 - - 0.4 0.1 0.1 0.1 Other Defects 2.5 2.2 1.4 3.3 0.1 3.1 2.0 1.9 1.6 2.6 46 Table VI CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1957 School Population Measles German Measles Whooping Cough Chicken Pox Mumps Scabies Impetigo Ringworm Diphtheria Scarlet Fever Dysentery Polioomylitis Jaundice Conjunctivities Sore Throat Other Diseases Enteric Group Erysipelas Vermin Meningococcal Infection Totals Body Scalp All Saints 270 37 13 - 4 1 - - - - - - - - - - - - - - - - 57 Arch. Tenison 290 - - - - - - - - - - - - - - - - - - - - - - Ashburton 1811 - 1 5 2 3 - - - - - - - - - - - - - - - - 11 Benson 628 47 - 1 - 28 - - - - - 1 - - - - - - - - - 77 Beulah 913 59 3 - 2 12 - - - - - 7 - - - - - - - - - - 83 Castle Hill 713 37 - 12 19 3 - - - - - 4 5 - 5 - - - - - 10 - 95 Christchurch 211 19 2 - 1 10 - - - - - - - - - - - - - - 4 - 36 Coloma 545 - - - - - - - - - - - - - - - - - - - - - - Crossfield Nursery 42 - - - - 1 - - - - - - - - - - - - - - - - 1 Croydon High 886 - - - - - - - - - - 2 - - - - - - - - - - 2 Croydon Tech. 342 - 1 - - - - - - - - 1 - - - - - - - - - - 2 Cypress 455 37 - - 5 3 - - - - - 5 - - - - - - - - - - 50 Davidson 603 37 2 5 - 17 - - - - - 5 - - - - - 1 - - 3 1 71 Duppas 429 - - 4 - 4 - - - - - - - 1 - - - - - - - - 9 Ecclesbourne 440 2 - 1 - 5 - - - - - - - - - - - - - - 2 - 10 Elmwood 929 57 3 - - 3 - - - - - 4 - 1 - - - - - - 4 - 72 Falrchildes 1776 - - 8 2 - - - - 2 - 2 1 - - - - - - - - 15 Gilbert scott 810 22 - 2 - - - - - - - 12 66 - - - - - - - - 1 103 Gonville 565 68 - 1 2 3 - - - - - 2 1 - 1 - - - - - 3 - 81 Good Shepherd 276 - - - - - - - - - - - 1 - - - - - - - - - 1 Heath Clark 559 - - - - - - - - - - - 1 - - - - - - - - - 1 Howard 511 26 1 - - 24 - - - - - - - - - - - - 1 - - - 52 Ingram 957 23 2 - 1 1 - - - - - - - - - - - - - - - - 30 John Newnham 516 - - - - - - - - - - - - - - - - - - - - - 1 John Ruskln 523 - - - - - - - - - - - - - - - - - - - - - - Kensington Avenue 680 37 - - - 1 - - - - - 1 - - - - - - - - - - 39 Kingsley 840 62 - 2 1 3 - - - - - 2 - - - - - - - - - - 70 Lady Edridge 494 - - - - - - - - - - - - - - - - - - - - - - Lanfranc 1201 2 - - - 4 - 1 - - - 1 - - 1 - - - - - 4 - 13 Monks orchard 328 - - - - - - - - - - 2 - - - - - - - - - - 2 continued below 47 Norbury Manor 1334 43 1 5 l 31 - 1 - - - 3 - l - - - - - - - - 86 Occupation Centre 77 - 9 - - - - - - - - - - - - - - - - - - - 9 Our Lady's Convent 179 - - - - - - - - - - - - - - - - - - - - - - Oval 645 8 1 - 23 17 - - - - - 3 - - - - - - - - - - 52 Overbury 193 - - - - - - - - - - - - - - - - - - - - - - Parish church 403 - - 1 1 2 - - - - - - - - - - - - - - 3 - 7 Portland 627 19 - - - - - - - - - 3 - - - - - - - - - - 22 Purley Oaks 605 44 2 - 2 5 - - - - - 1 8 - - - - - - - - - 62 Rockmount 552 - 1 - - - - - - - - - - - - - - - - - - - 1 Rowdown 896 - 1 - 2 1 - - - - - • - - - - - - - - 3 - 7 St. Andrew's 180 - - - - - - - - - - - - - - - - - - - 1 - 2 St. Christopher's 206 - - - - - - 1 - - - 1 - - - - • - - - - - 2 St. Giles' 197 5 1 - 1 3 - - - - - - - - - - - - - - - - 10 St. Joseph's 519 - - - - - - - - - - - - - - - - - - - - - - St. Luke's 20 - - - - - - - - - - - - - - - - - - - - - 1 St. Mark's 213 1 1 2 - - - - - - - 8 - 1 - - - - - - - - 13 St. Mary's R.C. 718 14 1 1 - 2 - - - - - - - - - - - - - - - - 19 St. Michael's 135 32 - 2 - 6 - - - - - - - - - - - - - - - - 40 St. Peter's 336 2 - - - - - - - - - - - - - - - - - - - - 4 Selhurst Grammar 1117 - - - - - - - - - - - - - - - - - - - - - 1 Shirley (St. John's) 571 7 - - - 27 - - - - - 1 - - - - - - - - - - 35 South Croydon 565 - - - - 1 - - - - - 1 - - - - 1 1 - - - - 4 South Norwood 967 33 35 - - 27 - - - - - 13 - 1 - - - - - - - - 109 Spring park 515 13 6 - 2 6 - - - - - - - - - - - - - - - - 28 Stanley Tech. 278 - - - - - - - - - - - - - - - - - - - - - - Sydenham 585 31 1 - 1 20 - - - - - 1 - 1 - - - - - - 6 - 61 Tavistock 946 - - - - - - - - - - - - - - - - - 1 - 4 1 7 Trinity 586 - - - - - - - - - - - - - - - - - - - - - 1 Waddon 185 27 1 3 2 11 - - - - - - - - - - - - - - - - 44 West Thornton 505 5 - 1 - - - - - - - - - - - - - - - - 2 - 10 Whitehorse Manor 788 5 1 1 2 2 - - - - - - - - - - - - - - - - 12 Winterbourne 1204 40 3 - 8 4 - - - - - 2 - - - - - - 1 - - - 58 Wolsey 841 - - 7 - - - - - - - 4 - - 1 - - 1 - - 1 - 14 Woodside 1128 68 4 1 - 11 - - - - - - - - - - - - - - - - 87 969 97 68 85 304 - 3 - 2 - 102 83 10 8 - 1 4 3 - 50 3 1792 2 48 Table VII HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS OR BOARDING IN BOARDING SCHOOLS, 1957 Blind Parti ally Sighted Deaf Partially Deal Delicate Physically Handicapped Educationally Sub-normal Maladjusted Epileptic TOTAL During the calendar year ended 31st December, 1957 the undermentioned handicapped pupils:- (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. were newly placed in Special Schools (other than Hospital Special schools) or Boarding Homes - 6 - 1 25 25 28 3 - 88 B. were newly assessed as requiring education at Special Schools or boarding in Homes 1 5 - 4 21 23 29 5 - 88 C. Number of Handicapped pupils from the area:- (i) were on the registers of Special Schools as Day Pupils - 13 17 11 84 103 196 - - 424 Boarding pupils 1 1 3 3 2 6 8 4 3 31 (ii) were on the registers of independent schools (under approved arrangements) - - 2 - - 3 - 3 - 8 (iii) were boarded in Homes - - - - - - - - - - TOTAL (C) 1 14 22 14 86 112 204 7 3 463 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education Act. 1944- (i) in hospitals - - - - 27 - - - - 21 (ii) in other group - - - - 1 2 - - - 3 (iii) at home - - - - - 4 - - - 4 E. Were requiring places in Special schools (i) TOTAL (a) day - - - - 1 - 2 - - 3 (b) boarding - - - - - 3 6 1 - 10 (ii) who had not reached the age of 5:- - - - - - - - - - - (a) awaiting day places - - - - - - - - - - (b) awaiting boarding places - - - - - - - - - - (continued on next page) 49  Blind Partially Sighted Deaf Partially Deaf Delicate Physically Handicapped Educationally Sub-normal Maladjuted Epileptic TOTAL (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (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 11 ,, ,,57(4) ,, ,, ,, ,, ,, 1 ,, ,, 57(5) ,, ,, ,, ,, ,,10 50 Table VIII VISION TESTS Summary of Findings Extent of Defect Entrants Intermediates Leavers 8 to 9 years and Other Ages TOTAL Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % Up to 6/24ths 74 4.7 63 3.9 97 8.2 138 9.6 64 4.9 159 12.8 107 7.1 100 6.3 342 6.1 460 8.3 Over 6/24ths 4 0.2 1 0.1 23 1.9 9 0.6 36 2.7 9 0.7 8 0.5 9 0.6 71 1.2 28 0.5 51 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1957 RETURN OF MEDICAL INSPECTIONS A.-Routine Medical inspections Year Year 1957 1956 Age 11 or under 14 31 12 44 30 13 20 20 14 69 22 15 54 30 16 22 51 17 19 19 18 or over 2 - Total 244 203 B.-Other Inspections Number of Special Inspections 1 1 Number of Re-inspections 2 5 Total 3 6 Visits to Non-maintained schools 11 8 The following defects were found by Medical Inspection:- Treatment Observation Defective Vision 11 - Other defects - Eye 2 - Lungs 1 - Posture 6 - Plat Foot 2 - Other Orthopaedia 1 - Other Defects and Diseases 3 1 CONTENTS A - PUBLIC HEALTH REPORT Page Airport 90 Ambulance Service 50, 116 Amusement Houses 64 Animals, Diseases of 66 Animals, Keeping of 66 Ante-Natal Clinics 31 Appendix Tables 95 Births 10, 11 Blindness 91 Byelaws 84 Cancer 14, 99 Census 9 Chemical Analyses 87 Chest Clinic 20 Child Minders 89 Civil Defence 51 Convalescence 40 Committee 3 Communicable Diseases 118, 119 Cremation 90 Day Nurseries 41 Deaths 11, 13, 97 Dental Treatment - M.& C. W. 47, 115 Disinfection 64 Disinfestation 64 Drainage 62 Epilepsy 94 Extra Nourishment 24 Factories and Workshops 60 Food and Drugs Act 74 Food Poisoning 16 Poods 68 Health Education 42 Health visitors, Work of 34, 108 Home Helps 36, 113 Home Nursing 36, 110 Home Safety 46 Homework 61 Hospital, Isolation 17 Housing 59 Ice Cream 74 Illegitimacy 9, 31, 120 Immunisation 35 Infant Mortality 12, 101, 103 Infant Welfare Clinics 33, 109 Influenza 15, 133 Inquests 11 Page Laboratory Examinations 29 , 74, 86 Marriages 10 Maternity Homes 89 Meat Inspection 70 Men's Hostel 59 Mental Health 52 Midwives 32 Midvives, Municipal 33, 104 Midwives Acts 33 Milk 72 Mortality in Childbirth 12, 101 National Assistance Act 92 Neo-Natal Deaths 102 Notification of Births Acts 11 Nuisances 84 Nursing Equipment 40, 112 Nursing Homes 89 Nurses' Agencies 89 Occupation Centre 55 Offensive Trades 62 Outworkers 61 Perinatal Deaths 9, 102 Pests 66 Physiotherapy 41, 111 Pharmacy and Poisons Act 65 Poliomyelitis 18 Population 9 Post-Natal Clinics 31 Post-Mortems 11 Premature Infants 31, 107 Problem Families 93, 114 Prosecutions 69 Public Health Inspectors, Work of 83 Rag Flock Act 66 Rats and Mice (Destruction) Act 66 Refuse Collection 88 Relaxation Classes 31 Rivers and Streams 63 Scarlet Fever 18 Sewage 88 Shops Act 62 Slaughterhouses 70 Smoke Observation 63 Spastics 94 Staff Examinations 91 Staff 7 Still Births 11 Street Accidents 116 Page Tables, Appendix 95 Tuberculous, After Care 27 ,, ,, Allowances 27 ,, ,, Contacts 25 ,, ,, Home Nursing 24 ,, ,, Home Visits 24 ,, ,, Institutional Treatment 24 ,, ,, Mass Radiography 26 ,, ,, Mortality 23 ,, ,, Notifications 121, 124 ,, ,, Occupational Therapy 28 ,, ,, Prevention and Control 20 ,, ,, Re-Housing 26 ,, ,, Vaccination 25 B - SCHOOL MEDICAL REPORT Page Child Guidance 27 Cleansing of Children 8 Clinics 3, 11 Cod Liver Oil 27 Cost 21 Crippling Defects 22 Deaf Children 10 Deaths 9 Deformities 21 Dental Service 12 Ear Disease 11, 35 Enuresis Clinic 29 Epileptic Children 29 Exclusions 9 Following-up 10 Health Visitors, Work of 10 Heights and Weights 7, 41 Infectious Diseases 6, 46 Inspection Clinic 11 Inspections 6 Juvenile Employment 27 Malt 27 Meals. Provision of 27 Mentally Defective Children 24 Milk, etc. Provision of 27 Minor Ailments 11 Paqe Vaccination 91 Verminous Persons 65 Venereal Diseases 28, 127, 129 Vital Statistics 9, 95 Ward Statistics 12, 100 Watercourses 63 Water Supply 86 Welfare Poods 33 X-Ray 26 Zymotic Diseases 13 Page Non-maintained Schools 30, 51 Orthodontic Service 17 Parents' Attendances 4 Physically Defective children 21 Population 9 Remedial Exercises 21 Schools, Special 22 Spastics 30 Speech 28 Staff 3 Statistical Tables 31 Surveys, uncleanliness 8 St. Christopher's 24 St. Giles' 22 St. Luke' 26 Treatment 11 Tuberculosis 9 Uncleanliness 8 Vision. Defective 7, 50