CRO 60 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1958 S.L. WRIGHT. M.D., M.R.C.P„ D.P.M. PUBLIC HEALTH DEPARTMENT, 45 WELLESLEY ROAD. CROYDON. Telephone:- CROYDON 4433 3 HEALTH COMMITTEE 1958 Councillor Keith Edwards (Chairman) Councillor Mrs. E. M. Maycock (Vice-Chairman) Alderman Mrs. V.L. Child Alderman H. Lock Kendell, 0. St. J. Councillor P. D. J. Bailey Councillor V. Burgos Councillor J.J. Cooper Councillor E.J. Powler Councillor Mrs. D.L. George Councillor M. E. Mackenzie Councillor D. McClellan Councillor Miss L.N. Overton Councillor Mrs. D. V. Paines Councillor B.H. Rawling Councillor B. C. Sparrowe Councillor D.J. Sutton Councillor J. T. Twitchett Councillor R.J. Willsher O. E. Finch, Esq.. M. C. M. D. J. S. Lane, Esq., B. A., M. R. C. S. L. R.C.P. S. A. MacKeith, Esq., O. B. E., M.R.C.S., L.R.C.P., D.P.M. Miss K.C. Vost, M.B. ,B.S. .D.P.H. Members appointed to Sub-Committees on nomination of Outside Bodies as shown:- Edith P. Newling, B. A. (Hons), M. B., B. S., M. R. C. S., L. R. C. P. Croydon Local D.P. Kanaar, Esq., M. D., M.R. C. P. Medical Committee J.H. Thompson, Esq., M. B., B. Ch., B. A.O. A. P. Clift, Esq., P. R. C. S., M. R. C. O. G. )Croydon Group Hospital Mrs. L. Ford Management Committee Mrs. E.M. Ryle Horwood - Royal College of Nursing Mrs. F.R. Mitchell, O. B. E. Royal College of Midwives Miss J.C. Dickinson Croydon District Nursing Association Mrs. H. Thatcher Croydon Family Planning Association Mrs. J. Too good Croydon Federation of Toumswomen's Guilds D.G. Goldie, Esq. The St. John Ambulance Brigade (Southern Area) H.G. Murphy, Esq. The Insurance Institute of Croydon (Note:- Alderman G.H. Ward. O.B.E..J.P. was Chairman of the Committee until his death on 26th July, 1958). COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1958 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, 1958 and make the following comments on various aspects covered in greater detail in later pages:- Statistics The birth-rate was the highest since 1949. The figure for England and Wales shows a similar rise. At present, it seems due not to a trend towards larger families, but to marriage at younger ages. It remains to be seen if this lowering of the average age at marriage will raise the size of the average family. Other figures are generally unchanged or slightly improved with two major exceptions. All concerned with maternity services regret that there should have been four maternal deaths in 1958. In each case, however, there were unusual circumstances and there is good reason to believe that it was an exceptional year and in the future, a very low maternal mortality rate or a "nil" return can be anticipated. COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1958 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, 1958 and make the following comments on various aspects covered in greater detail in later pages: - Statistics The birth-rate was the highest since 1949. The figure for England and wales shows a similar rise. At present, it seems due not to a trend towards larger families, but to marriage at younger ages. It remains to be seen if this lowering of the average age at marriage will raise the size of the average family, other figures are generally unchanged or slightly Improved with two major exceptions. All concerned with maternity services regret that there should have been four maternal deaths in 1958. In each case, however, there were unusual circumstances and there is good reason to believe that it was an exceptional year and in the future, a very low maternal mortality rate or a nil" return can be anticipated. 5 Deaths ascribed by the Registrar General to "motor vehicle accidents" were the highest ever recorded and with the steadily increasing density of road traffic, the Accident Prevention Campaign faces a formidable task. Clean Air Act, 1956 The Chief Public Health Inspector records the work done during the year under review, when the department has endeavoured to carry out as speedily as possible, the unanimous wish of the Committee to press forward with schemes to clear the air of the Borough of smoke pollution. The period is now approaching when deeds must replace words and a mounting annual expenditure will have to be met by the Ministry, the local authority and the householders. It should then be remembered that as one reason only for this campaign at least 200 Croydon residents die every year from chronic bronchitis. In many instances, there will be a long painful illness and slow suffocating death and unquestionably, they are largely the result of a lifetime of exposure to polluted air. I think the Committee may be satisfied that we are proceeding with this task with reasonable speed as long as the programme which the Council recently approved is allowed steadily to accelerate in accordance with the Committee^ plans. Infectious Diseases 1958 will be notable as the year during which efforts were made to protect all children up to fifteen years of age against poliomyelitis. There were difficulties because of the various types of vaccine available, but by the end of the year, over 75% of those eligible in Croydon had received two doses of vaccine. The next few years will show whether our hopes that vaccination will provide effective protection will be realised. Personal Health Services The Ministry has suggested that as ten years have not elapsed since the coming into operation of the National Health Service Act, a brief review of the period will be of interest. In 1949, I was able to state that no great difficulties had arisen as far as the local health authority was concerned in implementing the requirements of new health legislation. In the 6 main, the facilities were already being provided by the County Boroughs and developments rather than innovations were necessary. Except for health centres, which have failed to appear and tha. dental service, which has had a continuous struggle to maintain existing standards, this planned evolution has continued throughout the decade now under review. Dealing with the separate sections of the National Health Service Act: - Section 21, Health Centres In 1950, the Corporation received a decision from the Croydon Executive Council that there was no special need for a health centre to serve the New Addington housing estate. Consequently, the Corporation could not submit any scheme for a health centre of the type envisaged when the Health Service was being introduced. General practitioners in New Addington have since built their own accommodation and thus finally settled the question. Nevertheless, they attend the local authority antenatal clinic, where they see their booked maternity cases, and the hospital authorities may use these Oouncil premises for some out-patient sessions. To this extent, there may be some opportunity for a common meeting place for personnel from the three parts of the National Health Service. The chief regret that health centres have not materialised is the absence of buildings where such frequent direct personal contacts would be possible, and the tripartite service thus unified. Section 22, Care of mothers and Children The co-ordination of hospital and domiciliary obstetrics has been steadily developed, despite the partition of the service. As already mentioned, in the New Addington area, general practitioners are entirely responsible with the domiciliary midwives for ante-and-post-natal supervision. There is, however, centralisation of records even for this outlying clinic, so that there is close co-ordination with all other obstetric services. Since 1948, mothercraft and relaxation exercise classes have become available for all expectant mothers in Croydon whether booked for home or hospital confinement. 7 The clinics in conjunction with the hospital maternity units provide opportunities for local general practitioners to obtain further experience or training in obstetrics when their application for recognition as a general practitioner obstetrician does not satisfy the Local Obstetric Committee. At Infant Welfare Centres, attendances have fallen from 85,600 in 1949 to 71,736 in 1958. However, in the former year, the infant mortality rate was 29 infant deaths per 1,000 live births, whereas last year, it was 18. With easing of the pressure of numbers, preventive mental health, group discussion ' and opportunities for education in wider aspects of health have been possible. In 1952, I wrote about possible changes in the medical staffing of Infant Welfare Centres and concluded that their functions were not allied to hospital work. On the other hand, it was certainly within the competence of general practitioners particularly interested; but until group practice became the established pattern, in urban areas clinic medical officers not in general practice, should continue. If scrupulous care is taken always to contact the family doctor directly or by writing when medical intervention is thought to be necessary for any individual child, the supervisory and educational functions of the infant welfare centre unquestionably help the family doctor in the prevention of ill health, the early treatment of illness and the follow-up of patients discharged from his immediate care. Day Nurseries These do reverse the general pattern, which has characterised the first ten years of the Health Service as there were nine in Croydon in 1949, whereas there is now one central nursery only serving the whole borough. Unmarried Bothers In 1949, 4.9% of births were illegitimate and 123 unmarried mothers asked for help and 30 were admitted to hostels. In 1958, the illegitimacy rate was 5% but 185 mothers applied for help and 63 were admitted to hostels. It is clear that the difference is the greater use made of the facilities available. 8 Dental Care has shown a steady fall in the number of mothers seeking treatment from the Corporation's dental service, but there is no reason to believe that this implies failure to obtain dental treatment. Indeed, it seems clear that wholesale extractions, previously a feature of the dentistry required by expectant mothers is now largely a defect of the past. Improved ante-natal care and the long-term effects of education during school life by the school dental service, are important factors in this great.improvement. Section 23, Midwifery As far as Croydon is concerned, the fears of 1948 that domiciliary midwifery would entirely disappear have proved quite false. With a co-ordinated obstetric service making careful selection of the place of confinement on medical grounds, with all facilities for a rapid interchange between home and hospital and with an emergency obstetric service always on call, a safe and efficient domiciliary midwifery service has continued to flourish. Mothers who have experienced both a hospital and a home confinement have little doubt about their preference for the latter. Suggestions that a spirit of rivalry and competition would develop between general practitioner obstetricians and domiciliary midwives have proved quite wrong. The prevailing spirit has been a developing co-operation to ensure the safety and comfort of the mother and her baby. Section 24, Health Visiting Two aspects require comment. Firstly, the very great improvement in the relationship between general practitioners and health visitors during the last ten years. Latent antagonism was first replaced by acceptance, which is now changing to appreciation of the great help which the health visitor can give to the general practitioner in family care. Secondly, the widening scope of the health visitor's duties, specially in the fields of mental health and health education. There have always been close links with hospital colleagues made possible by the ease of communication in a compact county brough. The links with the mental hospitals serving Croydon have, however, been the result of deliberate policy made possible through the active help and wise advice of the former and Present Medical Superintendents. 9 Section 25, Home Nursing The voluntary association has continued to act as agents of the Corporation in the provision of home nursing. I think there has been an ideal combination of the flexibility permitted to a voluntary organisation, with the resources of a large county borough. The volume of work has increased, especially amongst the aged and infirm, for whom a special service has been provided in conjunction with the local hospital geriatric unit. Relationships with general practitioners have been very good and there seems no doubt that home nursing is now regarded as an indispensable part of the health service. Section 26, Vaccination and Immunisation The difficulty has been the increasing number of different illnesses against which protection can be given. Parents are anxious to do all they can for their children, but the programme of vaccinations and injections is becoming so lengthy as to daunt even the most enthusiastic. It has been the policy of the department to rely mainly on personal advice from the health visitors and medical officers at infant welfare centres, but to allow the family doctor the first opportunity to provide the actual service. If he does not wish to do so, or the parent does not take the necessary action, "on demand" facilities are available at infant welfare centres. For children of school age, approach through the schools unquestionably produces the best results and where appropriate, this method has been used. Section 27, Ambulance Service The problem here has been a mounting demand and the need to maintain efficiency while practising economy. This is impossible without the active co-operation of the hospital and general practitioner service, which in Croydon at least, has readily been forthcoming. The increasing emphasis on domiciliary care, the provision of day hospitals and out-patient facilities suggest that tbe pressure of the last ten years for added services is unlikely to diminish in the immediate future. 10 Section 28, Prevention of illness. Care and After Care There were fears in 1948 that the division of the tuberculosis service would have dire results. In fact the success of the anti-tuberculosis campaign has exceeded all expectations. Again, the close co-operation possible in a compact county borough has allowed an optimum combination of prevention and treatment under the clinical guidance of a single chest physician. The results fully support the soundness of the original scheme. The provision of convalescence and the arrangements for the loan of home nursing equipment have occasioned no particular difficulties. Health Education. The Corporation's scheme as approved by the Ministry of Health included under this Section of the Act, a paragraph that "the authority will seek to develop health education in its area by all appropriate means". The chief causes of disease have always been regarded as poverty and ignorance. In Croydon, the former is now relatively rare and it is clearly against ignorance that our future efforts must mainly be directed. Much of the work of health departments has always been largely educational, for example, that of the health visitors. Education is in itself a discipline for which training and experience are essential and a trained health education officer to advise and assist in the instruction of small or large groups is indispensable in the proper fulfilment of this ever growing responsibility. Section 29, Domestic Help In 1948, this was a permissive service, but as it has now developed, it would seem impossible to do without it. The limiting factor has been expense, as the home helps have assumed more and more responsibility for the aged and infirm section of the community. Supplementary schems have been developed as time has passed a washing service, a night service, a service for problem families and special family helps. One somewhat unexpected finding has emerged from our experience of the last ten years. Whilst it nay be more satisfactory and humane to look after ill and infirm persons in their own homes, the point is very soon reached when for the community the cost of so doing is greater than that of institutional care. 11 Section 51, Mental Health Services The most important feature since 1948 has been the cooperation on a voluntary basis between the staffs of the mental hospitals and the health department. It is probable that the experience thus gained of mutual benefit in Croydon and elsewhere has been an important factor in shaping the legislation now being passed. In the field of mental deficiency, the Corporation enlarged and improved the Occupation Centre for mental defectives, which is now conducted very much on the basis of a school for educationally sub-normal children. Two classes do deal with defectives over school age, but for the men, a specially trained handicraft instructor is in charge and a scheme for paid employment is operating. In the prevention of mental ill health, lectures and inservice training by regular group discussions with psychiatrists have been developed. This has allowed emphasis on preventive mental health in the maternity and child welfare services of the local authority. During the last ten years, when the National Health Service has been operating, one point has clearly emerged, namely, the relative ease of co-operation between the three branches of the service, which is possible when each is concerned with approximately the same social unit. The Executive Council, the Group Hospital Management Committee and the local authority all bear the name "Croydon" and if their efforts benefit the residents of this area, they are not greatly concerned at the exact machinery necessary to achieve an advantage for the town as a whole. At member level, therefore, there is pressure upon the officers to co-operate to produce the required results by unity rather than rivalry. I do not suggest that the contrary is to be found with other forms of local government or that difficulties may not arise where there are conditions similar to those in Croydon. I merely make the point that our experience has shown the possibilities of good co-ordination within the existing legislative framework. Living through a period when history 1s being made is always exciting, often alarming and sometimes dangerous. The founders of the Corporation chose as their motto - "Sanitate Crescamus" and in the history of the County Borough apart from minor setbacks, succeeding generations have upheld this principle. If we can equal or surpass the improvements of the last ten years, we need not be ashamed of the records we shall add to the annals of Croydon. I 12 From the information I have given, my thanks are clearly due to colleagues in other sections of the Health Service for continued help and co-operation. Of the officers of the Health Department, while thanking all, I would pay special tribute to the Chief Public Health Inspector and other members of his staff who are carrying out with efficiency and enthusiasm, all the essential detailed work to implement the Corporation's Clean Air policy. On the Immunisation Officer, Mr. Huggins, has fallen the major burden of coping with the clerical work of the Poliomyelitis campaign, with sudden changes in supply and demand of vaccine, and new developments as scientific opinion alters. I am happy to repeat my customary thanks to all the members of the Committee for their unfailing encouragement and support, especially to the Chairman, both in his present capacity and when as Vice-Chairman, he was carrying also this responsibility. I would record, my deep regret shared by very many members of the department who knew him personally, at the death of Alderman Hard during his third year as Chairman of the Health Committee. T i I an. Yours faithfully, S.L. WRIGHT, Medical Officer of Health and Principal School Medical Officer 13 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, 16 clerks cluding 1 part time), 4 typists, 1 messenger. Public Health and pood Chief Public Health Inspector, Inspection Deputy, 20 Inspectors, 1 intendent Slaughter House, 1 Poreman and 5 Assistants, Chief Disinfector and 2 Di sinf ectors, 1 Superintendent and 4 porters (men's hostel). 2 Rodent operatives, 10 clerks, 1 typist, 2 trainees. Maternity and Child Welfare 6 Clinic Medical Officers whole- time (also school duties), 4 part time. superintendent Health Visitor, Deputy, 28 Health Visitors and 1 Specialist Health Visitor (also School nurses). 1 part time Almoner and 1 part tine Almoner's clerk, Superintendent Midwife, Deputy and 17 Midwiyes, 1 Physiotherapist, 3 Ante-Natal Clinic nurses (part time), 7 clerks. (Dental service as for School Health). 10 clinic cleaners and 2 handymen (all part time). District Nursing (agency Superintendent, 3 Assistants, 39 arrangements) nurses, 2 clerks (1 part time). Domestic Help Supervisor, 2 Assistants, 1 clerk/ assistant, 1 clerk, 14 full tine and 178 part time Home Helps. Day Nurseries 1 Nursery with Matron, Deputy, 5 nurses, 2 students, handyman and 4 domestic staff (part tine). Vaccination and Immunisation 1 part time Medical Officer, 2 temporary part time nurses, 4 Clerical Officers including 2 t emporary. Ambulance Service , Ambulance Officer, Depu'y. 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 tine). Prevention. Care and After-Care Chest Physician (part time), 2 Assistant Chest physicians (par' time), 5 T.3. visitors. 2 Almoners, 2 clerks, 1 Occupational Therapist (part time). Mental Health 4 Duly Authorised Officers and 1 co-ordinating officer. 1 Clerk, 1 Occupation centre supervisor, 4 Assistants, 1 Handicraft Instructor, 1 handyman, 2 Guides and 4 domestics (part tine). Health Education 1 Qualified Health Education Of fleer. Welfare* Poods 2 clerks (1 part time) and 1 drive'- STATISTICS 15 SUMMARY OF VITAL STATISTICS FOR 1958 Area, 12,672 acres. Population (Census 1951), 249,870. Tbtal population (estimate of Registrar-General), 249,500 (Midsummer, 1958). Number of Inhabited Houses: 72,959. Rateable Value (1st April, 1958): £4,405.334. Product of a Penny Rate (1957-1958): £17, 742. Rate in the £ 15s. 2d. (for the year ending 31.3.58). Live Births: Males Females Total Legitimate 1,838 1,821 3,659 Illegitimate 95 98 193 3,852 Live Birth Rate (as adjusted hy comparability factor 0.99) 15.2 (England and Wales 16.4) Stillbirths 76 Stillbirth rate per 1,000 total (live and still) births 19.3 (England and Wales 21.6) Total Births 3928 Infant Deaths 69 Infant Mortality rate per 1,000 live births 18 (England and Wales 23) " " " 1,000 legitimate births 18 " " " 1,000 illegitimate births 21 Neo-natal Mortality rate (First four weeks) per 1,000 related live births 13 Early Neo-natal Mortality rate (First week) per 1,000 related live births 12 Perinatal Mortality rate (stillbirths + deaths during the first week) per 1,000 total live and still births 30 Percentage of illegitimate live births 5 Maternal Deaths (excluding abortion) 4 Maternal Mortality rate (including abortion) per 1,000 total births 1.02 (England and Wales 0.43) Deaths, 2,995. Death-rate per 1,000 of the estimated population 12.0 (England and Wales 11.7) Death rate (as adjusted by comparability factor 0.90) 10.8 16 Marriages When supplying these figures Mr. Stevens, the Croydon Superintendent Registrar, kindly analysed recent trends and commented "Of the total number of persons giving me notice of intention to marry at either Church or Register Office in the year 1954, 13.8% were under the age of 21 years rising in 1958 to 18.3%. The number of persons marrying in the 16 to 19 age groups has increased in the period by about 50%, at 20 years by 18% and there appears to me to be no significant change after that age". The number of marriages solemnised was 1,827, compared with 1,962 in 1957, 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 and 2,066 in 1949. 867 were solemnised in Established Churches, 383 in other places of worship, 2 Jewish Ritual and 575 in the Register Office. Births The live births registered were 3,659 legitimate and 193 illegitimate. The birth-rate consequently was 15.4 per 1,000 population. For England and Wales the rate was 16.4. The illegitimate births in Croydon were 5 per cent of the total as compared with 5.5 in 1957, 4.3 in 1956, 4.8 in 1955, 5.5 in 1954 and 1953 and 5.3 in 1952. The Uve male births numbered 1,933, the female 1,919, being a proportion of 1,007 males to 1,000 females. Notification of Births Notifications were received in respect of confinements conducted by:- Notifications were received in respect of confinements conducted by:- Live Bi r~ths Still Births Total Midwives 3,304 57 3,361 Doctors 875 28 903 4,179 85 4,264 Accoraoodation for Confinements The following table shows where babies vsere born in Croydon during 1958. 154 more babies were born at home and 174 more were born in hospital than in 1957. 47 more Croydon residents had babies outside Croydon and 46 fewer non-residents were confined in Croydon than in 1957. One private nursing home gave up maternity work 17 Number Percentage In Private Houses 1,301 30.51 In Public Institutions 2,654 62.24 In Registered Maternity Homes 309 7.25 4,264 Still Births During 1958, 76 still births were registered in respect of Croydon. Of these, 31 were male babies and 45 females; 3 females were illegitimate. The proportion of still births to living children was 1 in 51. 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 19.7 per 1,000 births. Deaths The deaths numbered 2,995, compared with 2,952 in 1957. For 1958 the crude death-rate was 12.0 compared with 11.8 in 1957. The death-rate for England and Wales was 11.7. There were 84 inquests held by Coroners in respect of Croydon residents during 1958 and 474 findings by Cftroners after post-mortem without inquest. Wards with the highest death-rate were South (17.0), and Addiscombe (13.3) Lowest: Addington (4.2), Shirley (8.6) and West Thornton (10). The Registrar General's Table is given in the appendix, page 104. Comparisons with 1957 show there were again no deaths from Whooping Cough and none from Measles (2 in 1957). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 19 (1957 29); those from Cancer decreased by 29; those from Pneumonia increased by 32 and a decrease of 2 was recorded in those caused by Bronchitis. There were 22 deaths from Influenza (1957 - 33). 30 Deaths from suicide showing a decrease of 2 and motor vehicle accidents totalled 31 (18 in 1957). 18 The percentage of deaths under 1 year of age to the total deaths was 2.3 per cent.; deaths under 15 years, 0.4 per cent.; deaths under 65 years, 24.3 per cent.; and deaths over 65 years, 73.0 per cent. The corresponding figures for 1957 were 2.1 per cent., 3.1 per cent., 28.1 per cent., and 71.9 per cent, respectively. The Registrar-General has continued to supply a comparability factor - 0.90 by which the crude death-rate must be adjusted for comparison with other areas of the country as a whole It will be observed that this factor is less than unity, so that the standardised,or corrected death-rate, is less than the crude death-rate. In other words, Croydon has a greater "weighting" of elderly persons than the average for the country. Principal Causes of Death in order of frequency (RegistrarGeneral* s Return) Rate per 1,000 Population (l) All Ages Deaths from diseases of Cardiac and Circulatory System 4.34 " " Cancer 2.25 " " Vascular lesions of the Nervous System 1.86 " " diseases of Digestive System *0.14 " " diseases of the Respiratory System (excluding Tuberculosis) 1.56 " Suicide and Violent Causes 0.35 " " Tuberculosis (all forms) 0.08 *ulcers of stomach, duodenum; gastritis and enteritis. Maternal Mortality There were 4 deaths, compared with 3 in 1957. The maternal mortality rate calculated per 1,000 total births was 1.02. The rate for England and Wales was 0.43 in 1958. 19 For figures for the years 1938 - 1958 see the appendix, page 108. Causes of death:- 1. Pulmonary embolism; phlebo thrombosis of perimetric veins and normal 11 weeks gestation. 2. Postpartum haemorrhage; spontaneous rupture of Caesarian lower segment scar following natural delivery. 3. postpartum haemorrhage; atypical acquired afibrinogenaemia. 4. Acute bronchitis following normal confinement. Chronic mitral double rheumatic lesion. Infant Mortality The 1958 figure remains at the previous low record, being 17.9. Set out in the appendix, page 110 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 69 deaths, 45 occurred in boy babies and 24 in girls. Of the births, 1,933 were males and 1,919 females. The infantile mortality rate for the two sexes was, therefore, Boys - 23, Girls - 13. 60 deaths of infants occurred in Institutions, including Registered Nursing Homes. For details of infant deaths see the appendix, page 109. CANCER For detailed tables see the Appendix, page 106. Deaths tabulated in the Department number 562 as compared with 591 in 1957; 592 in 1956; 549 in 1955; 486 in 1954; 540 in 1953; 567 in 1952; 479 in 1951; 501 in 1950 ; 481 in 1949 and 510 in 1948. 20 Death-rate per 1,000 of the population for the last 10 years is as follows:- 1949 - 1.93 (481) 1953 - 2.16 (540) 1957 - 2.37 (591) 1950 - 1.99 ( 501) 1954 - 1.95 ( 486) 1958 - 2.25 ( 562) 1951 - 1.91 (479) 1955 - 2.20 (549) 195 2 - 2. 26 ( 567) 1956 - 2.37 ( 592) The organs most often attacked in descending order of incidence are: In the males - the Lungs (36.9 per cent.), the Bowels and Rectum (19.3 per cent.) and the Stomach (13.4 per cent.); in females - the Breast (23.9 per cent.); the Bowels and Rectum (15.1 per cent.); and the Dterus (8.1 per cent.). lard Statistics These are tabulated in the usual form in the appendix, page 107. It is obvious from the high birth-rate at New Addington Ward, that it contains many young married couples. The highest death rate is recorded from the South Ward, because it has a high proportion of elderly persons. COMMUNICABLE DISEASES 4 21 FOOD POISONING The food poisoning notifications, as corrected, for 1958 were: - 1st 2nd. 3rd 4th Quarter Quarter Quarter Quarter Total 7 7 38 12 64 Outbreaks due to identified agents: - Total Outbreaks Total Cases 4 20 Outbreaks due to:- (a) Chemical Poisons Nil (d) CI. Botulinum Nil (b) Salmonella Organisms 3 (e) Other Bacteria Nil (c) Staphylococci (including toxin) 1 Outbreaks of undiscovered cause: - Total Outbreaks Total Cases 7 22 Single Cases:- Agent identified Unknown Cause Total 12 10 22 Cases due to: - Salm. typhi-murium Salm. neioport Salm. newington 6 5 1 There is now a national reference laboratory which correlates reports on the organisms found in any particular case of food poisoning, in some instances this provides a clue to the food concerned and allows the source of infection to be traced in a manner which would otherwise be impossible. 22 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1958 I am indebted to Dr. J.J. Linehan, Physician Superintendent, for the following report on infectious etc. cases admitted to the Hospital during 1958. There was a total of 592 admissions of whom 472 were admitted to the acute infectious diseases' wards, 106 to the geriatric wards temporarily evacuated from Queen's Hospital and 14 to the chest ward. The small number of chest cases was due to the closure of the chest ward on March, 31st. The average number of occupied beds for the whole hospital was 98.22. Admissions to the Infectious Diseases Wards:- The average stay in hospital for these patients was 24.2 days and the average number of occupied beds, 31.43. 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. Where patients have been admitted from outside the Borough of Croydon, the Croydon admissions are shown separately in brackets. Scarlet Fever 70(69) Gastro-enteritis 60( 47) Measles 50(32) Pneumonia (including Influenzal Pneumonia 52( 18) Chicken-pox 46(30) Whooping Cough 25(23) Dysentery 25(9) Pood Poisoning 11(8) Glandular Fever 9(8) Meningitis 6 Rubella 6 Influenza 5 Erysipelas 4 Poliomyelitis 2 Infective Encephalitis 1 Infective Hepatitis 2(1) Diphtheria 1(0) Dengue 1(0) Mumps 1 Neo-natal staphylococcal Skin Infection 7 Non-patient Mothers 5 Ophthalmia Neonatorum 1 Staphylococcal Septicaemia 2 Staphylococcal Sore Throat 3 Streptococcal Sore Throat 2 Pharyngitis 9 Tonsillitis 6(5) Quinsy 2 Otitis Media 1 Laryngitis 1 Bronchitis 12(9) Rheumatic Fever 6 Lymphadenitis 4 Parotid Abscess 1 Endometritis 1 Cellulitis 2 Impetigo 5 Herpes Zoster 1 Scabies 2(1) Toxic Erythema 1 Drug Rash 1(0) Cerebral Thrombosis 3 Neuritis 3(1) Infective Polyneuritis 2 Hysteria 1 Hydrocephalus 1 Intestinal Haemorrhage 1 Intestinal Obstruction 1(0) Congenital Pyloric Stenosis 1 Appendicitis 1(0) Foreign body in Stomach 1 Umbilical Hernia 1 Myocardiac Degeneration 1 Valvular Disease of the Heart 1(0) Bronchial Carcinoma 1 Diabetic coma 1 23 Scarlet Fever:- Cases were of the usual mild type excepting one child who had developed toxic jaundice and enteritis. Age distribution was, under 5 years -24; 5 - 15 years - 40; adults - 6. The following complications were encountered: Streptococcal fissures 6; otitis media, 4; rhinorrhoea, 3; ulcerative stomatitis 2; and one case each of enteritis, jaundice, lymphadenitis and impetigo. Gastro-enteritis: - The number of patients treated in the different age groups were, under 1 year, 30; 1-2 years, 6; 2-15 years 11; adults - 13. Of these cases 9 were very severe, 21 moderately severe and 30 mild. Pneumonia (including influenzal pneumonia):- These admissions were mainly in the winter months, 41 of the total of 52 being admitted in the months of January, February, March and December. There were seven deaths, all occurring during these months. These deaths were in elderly patients, excepting a boy, 19 years, in whom pneumonia was a terminal illness, following a long history of uraemia due to scarlet fever nephritis in childhood. Measles:- Measles was not generally prevalent during the year and no cases were admitted in the first four months. 35 patients were admitted during the months May - August, from a minor epidemic and a further 15 in the last quarter, representing the early cases of the current epidemic. The patients were in the following age groups; under one year - 7; 1-2 years, 12; 2 - 5 years, 19; 5-15 years, 10 and adults - 2. The incidence of complications were:- pneumonia - 17, bronchitis - 4, enteritis - 4. and one case each of encephalitis, otitis nedia, lobar collapse and epistaxis. Chicken-pox:- As customary, the majority of chicken-pox patients came from hospitals, rest centres and nurseries. One adult case of chicken-pox was complicated by acute gangrenous appendicitis, another with lobar pneumonia and there were two cases of chicken-pox meningoencephalitis. In these latter patients, central nervous system involvement occurred six and seven days respectively after the onset of the rash. Whooping Cough:- The age groups of the patients admitted were:under one year, 9; 1-4 years, 12; 4-8 years, 4. Complications were fewer and less severe than usual. They consisted °f four cases of secondary bronchitis and one case each of lobar collapse, enteritis, and conjunctivitis. 24 Dysentery:- 22 of the 25 admissions were of the Sonne type, the remaining three being amoebic and had recently come from abroad. All but one of the Sonne cases were admitted from residential schools, nurseries, rest centres and hospitals. Only three of the admissions were adults. Salaonella Pood Poisoning:- Admissions were mainly in September when 7 out of the total of 11 cases were admitted. The salmonella organisms isolated were 6 cases of S. typhi-murium, 3 cases of S. Newport and one of S. enteritidis. The remaining case was presumed to be staphylococcal. Two patients were seriously ill. Only three of food poisoning patients were children. Other Infections:- Glandular Fever appeared to be more prevalent than usual. The cases admitted were all between the ages of 11 and 24 years. The six cases of meningitis were comprised of 3 cases of virus meningitis, 2 of meningococcal and one tuberculous case. There was a spectacular drop in the incidence of poliomylitis. There were only two confirmed cases, one a mild spinal case and the other entirely meningitic. Polio virus type 1 was isolated from both. There was one case of virus encephalitis, aged 1% years, which was rapidly fatal and the nature of the infecting virus could not be identified. There was also a fatal case of laryngeal diphtheria, aged 45 years. The patient was in the 7th day of disease when admitted. Tracheotomy gave temporary relief but cardiac failure ensued, she had just arrived in the district and presumably had contracted her infection elsewhere. 25 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 1958 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1958 was 20 which shows a decrease of 13 when compared with 1957 and the incidence of the disease during the year has continued to fall. The General Practitioner Miniature X-ray Service continues to function in a satisfactory way and is well used hy the Local Practitioners. The results of this service are summarised below:- Number of miniature films taken 3,926 Number of patients recalled for examination and large film 719 Number of active cases of Pulmonary Tuberculosis 23 Number of cases of lung cancer found 23 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 5.86 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 Synptoms whereas many patients attending public Mass Radiography sessions have no symptoms. 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 and in the Chest Wards in Mayday Ho^iital. The incidence and mortality of Tuberculosis continues to decline in a satisfactory way but the problem of Chronic Bronchitis and Lung Cancer becomes greater in each successive year. 26 Incidence 140 cases of Respiratory Tuberculosis and 21 cases of NonRespiratory Tuberculosis were notified on Form A during 1958 (Table I - Formal Notifications). Of these 78 males and 62 females were Respiratory cases and 7 males and 14 females were Non-Respiratory. In addition 114 Respiratory cases and 5 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 1958 by notification or otherwise was 280 as compared with 294 in 1957, 349 in 1956, 261 in 1955 and 336 in 1954. 254 of these were cases of Respiratory Tuberculosis; 137 in males and 117 in females. There were 28 fewer males and 14 more females than 1957. There were 3 cases of Non-Respiratory Tuberculosis among children under 15 years as oompared with 5 in 1957. The number of cases in adults was 18 compared with 18 in 1957. Of the cases notified in 1958, 1 male and 1 female died from the Respiratory form of the disease during the year, equal to 1.4 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 1.12 per 1,000 of the population; for Respiratory Tuberculosis 1.02 and for Non-Respiratory 0.10 per 1,000 population. The notification rate was 0.65 per 1,000. In 1957 the corresponding figures were 1.18, 1.07, 0.10 and 0.65 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1958:- RESPIRATORY NON-RESPIRATORY Total Cases Males Females Total Males Females Total 1. 212 911 2,123 75 98 173 2,296 27 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1958, 140 of the new patients examined at the Clinic were found to be in the undermentioned stages of the disease on the first examination: - A, or T. B. minus (Sputum negative or absent) 97 or 69.3 B, or T. B. plus, 1 (early cases, sputum positive) 11 or 7.9 B, or T. B. plus, 2 (intermediate cases, sputum positive) 32 or 22.8 B, or T. B. plus, 3 (advanced cases, sputum positive) Non-Respiratory Tuberculosis There were 13 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints 2 Abdominal 2 Other Organs 5 Peripheral Glands 4 13 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 1956 - - - 2 11 12 25 1957 - - . 6 10 13 28 1958 - - - 1 12 6 19 28 All but 2 cases were notified during life. Where patients have not been notified during their lifetime a visit is paid by the Tuberculosis Health Visitor to the home of the deceased, to obtain particulars of the contacts and to endeavour to persuade them to attend the Clinic for examination. In 1958 the death-rate from all forms of Tuberculosis was 0.08 per 1,000 population. The rate from Respiratory Tuberculosis was 0.08 and the rate for Non-Respiratory Tuberculosis 0.00. Similar figures for 1957 were 0. 12 and 0.02. In 1958 the total number of deaths showed a slight decrease when compared with 1957. 90% of the deaths occurred in the age groups 45 years and over. There were no deaths in children of school age. Deaths froo Non-Respiratory Tuberculosis During 1958 1 death was certified to be due to Non-Respiratory Tuberculosis, compared with 4 in 1957, 1 in 1956, 2 in 1955 and 4 in 1954. The death was due to:- Mai es Femal es Total Tuberculous Spine - 1 1 Total - 1 1 Co-ordination with the Health Department During the year 27 children were referred by the School Medical Service, and 2 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 20 selected cases for varying periods during the year, and 14 cases were in receipt of extra nourishment at the end of the year. 29 Residential Treatment 200 men, 161 women and 34 children were admitted to Residential Institutions in Croydon during 1958. The Chest Clinic and Home Visiting 2,064 new cases were examined during the year. 153 were found to be definitely tuberculous. The total number of attendances for examination at the (Jiest Clinic was 19. 260. There were also 698 attendances hy patients for collapse therapy. Hie Clinic doctors paid 356 home visits and the Tuberculosis Visitors 3,585 visits for Clinic purposes. In addition the Tuberculosis Visitors made 335 primary visits for the purposes of the Notification Register. There were also 2, 245 unsuccessful visits made. Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nursing Association, by arrangement with that organisation. Their assistance is a valuable adjunct in the care of domiciliary cases. Contact Examination The examination and subsequent supervision of persons coming into contact with patients suffering from Tuberculosis plays an important part in the prevention of the spread of infection. During 1958, 748 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contactcase ratio of 4 for each notified case during the year. Of these contacts, 10 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 14 compared with 1.12 per 1,000 of the general population. In addition, there were 13 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: - 30 1957 - New contacts examined 709. New cases of Tuberculosis 168 1956 - " " " 738. " " " " 202 1955 - " " " 686. " " " " 171 1954 - " " " 820. " " * " 238- 1953 - " " " 668. " " " " 211 1952 - " ' " 661 " " " " 243 B.C.G. Vaccination The use of B.C. G. vaccination for contacts has been continued during 1958 and regular sessions are held at the Clinic for this purpose. 387 contacts were successfully vaccinated during the year, compared with 420 in 1957. In addition 41 nurses and domestics were successfully vaccinated, and 96 babies of tuberculous parents were vaccinated in hospital during the neonatal period. During the year under review the scheme for the B. C. G. Vaccination of all School Children between 13 and 14 years of age was commenced in Croydon. Staff from the Chest Clinic visit the Schools and carry out the necessary Skin Testing and vaccination with B. C. G. The response by parents to this protection for their children has been satisfactory and there were no untoward difficulties or complications. The Staff for this scheme are provided by the Local Authority but work under the direction of the Chest Physician, and this affords another practical example of co-operation between those responsible for treatment and prevention of Tuberculosis. B-C.B. Vaccination for School Leavers - The total number of children skin tested - 1,865 Number found to be negative - 1,604 Number vaccinated with B. C. G. - 1,598 For detailed, figures see appendices, pages 129-133. Rehousing of Tuberculosis Patients 13 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. 31 X-Raj service It is 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 303 examinations were carried out in 1958. 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 foun:- No. of Persons Examined Tuberculosis Re qui ri ng Treatment Tuberculosi s Requiring Close Clinic Supervision Pritarj Carclnoia of Lung Male 4. 369 4 1 3 Female 6. 155 1 - 3 Total 10, 524 5 1 6 32 TUBERCULOSIS AFTER-CARE The year 1958 has been another busy one in tuberculosis after-care, for this is still a long term illness in spite of the fact that it is now much less serious. The majority of the patients need considerable help to weather the financial difficulties and many need help in adjusting themselves to their illness and later in adjusting themselves to work again, especially when a complete change of employment is required. Special grants are available through the National Assistance Board to ease the financial burden and the Ministry of Labour provides an Industrial Rehabilitation Dnit and Training Centre for those who require new light jobs. In spite of help through Statutory bodies, there is always room for voluntary effort by Fbrces Benevolent Funds and other charitable sources, but most of all through the local Tuberculosis Care Committee, which is able to give help beyond the scope of all other sources. For example 170 families received a Christmas grocery parcel bought from voluntary funds and packed and distributed by voluntary effort; 20 children were taken to the local pantomime at the Care Committee's expense and about 72 families received 2-cwts. of coal each. In addition, money has been spent on clothing, shoes and bedding and in fares for visiting patients receiving treatment in sanatoria out of the area. We were also able to give 17 people a holiday, the first for many years. Altogether, £450 was spent on supplementing official provision for the welfare of patients. The total amount raised by voluntary effort was £617, £425 being our share in the Christmas Seal Sale sponsored by N. A.P.T. Total expenditure was £588. 17.lid. OCCUPATIONAL THERAPY At the beginning of the year there were 23 patients, 5 of whom were attending the weekly class; hy the end of the year the total number of patients had increased to 28, 8 of these were attending the class and the remainder being visited at home in three 3-hourly sessions weekly. Approximately 10 patients were visited each week and this average should now increase as since November a car has been provided for all three sessions instead of only two out of three. 33 A show-case to display patient's work for sale was installed in the entrance to the Clinic early in the summer. It has proved a great and continuing success, providing incentive and pocket money for the patients. So successful was it in selling their work that none was left with which to hold a Sale. A list of local light industry was obtained from the Disablement Resettlement Officer and several of the factories were visited by the Occupational Therapist with the idea of finding light homework for the patients. The response was not good, and in cases where work might have been available, factories required too much too soon for the good of the patients. More successful has been the homework provided by Herald Miniatures, who supplied four patients with small plastic moulds to paint at home and this has been profitable to them. One patient has been successfully assembling model knights and these have been sold in a London Club through a contact. The knights also provided a focal point at the Chest Clinic stand in the Local Government Exhibition at the Town Hall last November. Finally, in December, the Occupational Therapy patients all contributed to a farewell gift for Miss Bridger, an afternoon tea cloth, which was beautifully embroidered by one of the Class patients. VENEREAL DISEASES The usual returns for which I am indebted to J. R. Crumbie, fcQ., P. R. C. S. are set out in the Appendix, page 134. As judged by first attendances at the Croydon Special Clinic, the incidence of syphilis was the lowest on record, but there was more gonorrhoea than in 1957. Mr. Crumbie points out that V. D. Clinics at EJ>som, Reigate and Kingston have closed and this might increase the Croydon attendance figures. Nearly 40% of contacts of patients were persuaded to come for medical examination, but it was impossible to trace the contacts of a "fair number" of immigrants, who stated they had been infected after arrival in this country. 34 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 - 1958. Faeces outfits 2,024 Water samples 263 Milk samples 236 Cream samples 10 Ice Cream samples 223 Sundry Pood Specimens 18 Blood 8 Urine 3 Nose and Throat Swabs 4 Total 2,789 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 35 ANTE-NATAL AND POST-NATAL CLINICS Considerable improvements were carried out to the premises at Lodge Road, which serve both mothers booked for hospital and for home confinements. These added greatly to the convenience and comfort of the patients and staff. During the year 4,265 cases were seen at the Ante-Natal Clinics, of which 3,027 were new cases. A total of 28,088 attendances were recorded and 1,952 cases were seen at the Post-Natal Clinics (1,877 new cases) with 1,952 attendances. A scheme was also approved for additional accommodation to house mothercraft instruction classes and relaxation exercise sessions. When completed, this will allow all services to be available at this central clinic. 31 series of talks of 6 sessions each on "Mothercraft" at which 530 mothers attended were given during the year. At relaxation exercise sessions, 602 mothers recorded 3,204 attendances. CARE OP PREMATURE BABIES While the existing arrangements for the domiciliary care of premature babies continued unchanged, the emphasis was on the prevention of such births through ante-natal care. When there was any likelihood of a birth being premature to a significant degree, prior admission of the mother to hospital was always advised. The usual detailed figures are given in the Appendix, page 114. CARE OF THE UNMARRIED MOTHER The Croydon Association for Moral Welfare continued to act for the Corporation and received payment on a capitation basis for cases dealt with by their Social Worker. The Corporation also Paid hostel fees' in respect of approved cases for whom such accommodation was required. During the year under review - 185 cases were dealt with by the Social Worker; 63 cases were admitted to Hostels; 5 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, 36 for whom the period would be extended to cover a total of six months and such assistance was given in 27 cases. These younger mothers would normally go to Homes specialising in their care. Of these younger mothers, their ages at the time they applied for help were: - 15 years old - 3 cases 16 years old - 7 cases 17 years old - 13 cases MIDWIFERY SERVICE This was a busy year for the domiciliary midwives and added to our difficulties were failures to recruit promptly after resignations from the service. There was a feeling that the hours of duty of a domiciliary midwife are unreasonably long, having regard to other aspects of nursing work, and positive steps were taken to improve this position. Towards the end of the year, infection in a local maternity unit necessitated the policy of early discharge from maternity hospitals and help had to be given in the home nursing of cases so discharged. As this continued, the question of part-time maternity nurses to deal especially with these mothers was being considered. The usual details of the work carried out by the domiciliary midwives during 1958 is given in Appendix pages 111-113. Midwives Acts, 1902-51 The number of Midwives who notified their intention to practise as midwives or maternity nurses, within the Borough (including those in hospitals) and who were practising at the end of the year was 80. All held the certificate of the Central Midwives' Board. The Medical Supervisor of \fidwives visits midwives in private practice and nursing homes, and the Superintendent Municipal Midwife carries out these duties for the domiciliary midwives. 37 INFANT WELFARE CENTRES It was not possible to continue the small subsidiary centre at the northern part of the New Addington Estate, as the school premises were needed for other purposes. The numbers attending did not justify a special building and no other suitable accommodation could be found. At other centres and especially at New Addington, developments in group education were actively pursued. At Waddon, special homecraft classes with emphasis on the making of clothes for children proved most successful, thanks to the enthusiasm of the health visitor concerned and the skill of a voluntary worker Towards the end of the year, poliomyelitis vaccination was added to the other immunisation procedures available at infant welfare centres. It has so far been confined to some of the centres only, but it is anticipated that in the future, it will form part of the ordinary infant welfare centre routine. For details regarding attendances see Appendix, page 116. 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 in session. Total issues made during the year were: - National Dried Milk 73,664 Ood Liver Oil 14,744 Vitamins A and D (for Expectant Mothers) 13,185 Orange Juice 129,644 There was a further fall in the sale of national dried milk and cod liver oil. Contributory causes are earlier weaning and reluctance to retrieve milk tokens from dairymen. In the event of failure of lactation, the interim period before weaning is easily covered by the purchase without formalities of proprietary brands of dried milk. Such purchases balanced against the continued receipt of liquid milk at reduced cost make little difference to the total family budget. Cod liver oil has never been popular and there is a marked Reference for more pleasant Vitamin D products, especially amongst the mothers most careful in the feeding of their infants 38 THE WORK OF THE HEALTH VISITORS I am indebted to the Superintendent Health Visitor, Miss Oakley, for the following report. The year has been a varied one for the Health Visitors who have cheerfully undertaken all the work asked of them, in spite of the fact that their number was depleted through sickness and resignations throughout this time. Attendance at the Home Safety and Local Government Exhibitions proved to be both interesting and profitable experiences and provided opportunities of getting over the nature of their work to a far wider public than usual. All shared in carrying out the exceptionally heavy Poliomylitis Vaccination campaign, which was reaching its height at the time of the bus strike. All managed to get on to their districts and to carry on with routine work, in spite of great difficulties. Car owners were more than willing to go to the help of their less fortunate colleagues. A new venture in health education was started at New Addington where a "Mother's Club" came into being. Meetings are held on one evening each month in the Clinic premises and talks are given on subjects chosen by the members themselves concerning family health and wellbeing. The district Health Visitors have been solely responsible for the organizing and running of this successful venture. The fact that Corporation premises were available solved the most difficult problem. Health Visitors have been quick to seize the opportunities of discussion afforded by appropriate film strips and other visual aids when talking to groups such as Young Wives Clubs, Parent Teacher Associations etc. Knowledge of the problems which are causing concern to these groups is of great value to the Health Visitor in her day to day work. Group discussions ranging over the mental health field as a whole take place each month and are led by Dr. S. A. McKeith. These have proved to be stimulating, and of great help. Talks mainly centre on how to recognise the beginnings of mental illness, what the Health Visitor can do to help, and her place in the mental health team after treatment has been given. Both Dr. McKeith and the Health Visitors have derived a great deal of benefit from these informal talks. 39 Home visiting still provides the Health Visitor with her greatest opportunity for health teaching, but lack of staff and time means that this part of the work suffers. Figures of work carried out are shown in Appendix, page 115. Discussion Group Addingtoo This group was started in March 1958. Nine meetings held in 1958. 57 mothers joined in the year and a total of 213 attendances were made. Subjects Discussed Home Safety B. Devaney Teenage Problems Dr. McKeith and Dr. Hegarty Skin care and Make-up Mrs. Duffield Clean food Handling Mr. N. anith Pire prevention in the Home Mr. Peskett Health Visitor - Training and Work B. Devaney Women Police Officer - her work Inspector Layram Safe equipment for baby pram, cot, guards for fire, window and stairs B. Devaney Subjects discussed are arranged at request of the mothers. A small Cbmmittee of four mothers was formed in May 1958 who are responsible for all arrangements for teas and their Social activities of the group: especially care of new members. During the year a visit to Southend Lights and to the Grand was arranged and well attended. The Health Visitors of the Area feel this is worth while effort, as many young mothers say this is the only evening they spend away from their homes and small children. They are reluctant to leave until the last minute. SEWING CLASS Held at Waddon Infant Welfare Centre This sewing class was started 1 year ago and has been held on alternate Wednesday afternoons. 40 Throughout the year 14 people have attended although each week the attendance has been 4 or 5 persons approximately. Attendance of the individual is somewhat erratic owing to illness, school holidays, seasonal employment and forgetting which day the class was in progress. Most of the members live on the Waddon Estate, but there have been occasional attendances from expectant mothers from other areas who have heard about the class through Mothercraft classes. These mothers like to come to cut out patterns and use the sewing machine. The majority of mothers attending the classes have had no previous experience with sewing whatever and in most cases sewing needles have had to be supplied to them in order that some work may be done at home in preparation for the next session. The original object of the class was to encourage mothers to make garments for children out of other discarded garments and in this we have had a considerable amount of success, as the following examples will show. Mrs. A. who had never done any sewing before made a pleated skirt and a pair of trousers for 2 year old twins out of an old skirt of her own. She then made 2 cotton skirts for her 14 year old daughter out of 2 discarded summer dresses. She then felt more confident and bought a length of material and made a summer dress for her 14 year old daughter. Mrs. A. has been unable to attend since September owing to illness in the family, but hopes to start again this year. Mrs. 0. who had never done any needlework at all, came to the class determined we would never teach her anything because as she stated, she "had a low I.Q."; but she would come along for a social afternoon. She started attending classes in September and although she still needs a good deal of supervision and guidance she has produced a skirt and cotton dress for a 4 year old, 2 petticoats for a 4 year old and a pelmet for her window. Mrs. O. has been responsible for recruiting 2 new members. One of these is experienced at making button holes as she worked for a tailor many years ago, but has no idea of any other aspect of needlework. The sewing machine supplied by the Croydon Corporation has proved to be very satisfactory and through various interested individuals an iron and ironing board have been acquired as well as various patterns and an assortment of garments and materials to give new recruits a start. 41 There are 3 voluntary workers to help with the class. Mrs. Fairman who is an experienced dressmaker and started the same type of class in Germany during the war, helps with patterns, cutting out and general instruction. Mrs. Kitching looks after babies and toddlers who come with their mothers. Mrs. Myers makes tea and keeps accounts. A charge of 2d. is made for tea and biscuits and some of the mothers like to contribute 3d. or 6d. to the funds whenever they have finished a garment. These funds are used for replacing machine needles, cottons, pins etc. It is proposed now to hold the class every Wednesday afternoon which means that on alternate Wednesdays it is held at the same time and in the same place as the Infant Welfare Centre. It is hoped this will stimulate interest and attract more recruits to the class. Also there will not be the disadvantage of a long time lost between classes. Although the numbers attending are small each person has required intensive tuition and guidance, and it would have been impossible to cope with a larger number without additional help. It is hoped to enlist the help of more voluntary workers who are interested in this type of work. 42 HOME SAFETY Miss D. E. Blackmore, the Home Safety Officer, reports:- During 1958, the work steadily developed, people becoming nore aware of the dangers in the home. A Public Meeting was held in February at which the Mayor presided, when mothers from each of the Health Visitors' areas were invited to a "Brains Trust". The meeting was well attended and lively discussion followed. The model "Heartbreak House" aroused much interest and was loaned to Domestic Science Classes, Hospital Nurses, Schools, Infant Welfare Centres and the Flower Show. Posters were in great demand. Talks were given to the following:- Townswomens Guilds 6 Red Cross 6 The Order of St. John 4 Infant Welfare Centres 3 Hospital Nurses 1 Young Wives 4 Mothers Union 2 Parent/Teachers Meetings 3 29 The Home Safety Committee were convinced that with industry and commerce aware of the importance of Home Safety they would strive to produce and sell goods which make easier the housewife' s daily task of keeping her family safe and well. It was therefore arranged, in co-operation with all the Croydon Chambers of Commerce and Trade, for the "Guard that Fire" campaign sponsored by the Home Office to be incorporated with a Home Safety Week Exhibition held at the Town Hall during October. The purposes were: - To show the dangers to life and health which can exist in our homes and how they can be prevented. To display various articles and appliances which must be used to make a home free from dangers to old and young. About two thirds of the shops in Croydon were visited, with the valuable help of the Townswomens Guilds, offering the shopkeepers and managers posters and discussing the problems of Home Accidents. 43 Over 3,000 persons visited the Home Safety Exhibition. 50,000 "Guard that Fire" leaflets were distributed with the help of the Boy Scouts, The Order of St. John, The Red Cross and the Housing Department. It is slow work educating the public about the danger of an unguarded fire and there are too many accidents among the very young. Fireguards are cheap but in many homes where there are luxuries, a fixed guard is still considered an unnecessary expense and an eyesore. People are slow to bring old appliances to the standard of the Heating Appliances (Fireguards) Act, 1952. There are now good safe materials on the market for clothes and every effort is being made to persuade the public to purchase them. The annual figures given in the Appendix, Page 123 show that under 5 years and over 65 years are the most vulnerable ages. 1. Falls are the greatest cause of injury particularly to the very old and young. 2. Burns, scalds are mostly to children under 5 years. 3. Poisoning is common with young children due to lessness in storing drugs and various cleaning materials. May I take this opportunity to thank all the many voluntary organisations, traders, utility services, together with the various departments who have assisted in this work. Tables are given in the Appendix, page 123. 44 IMMUNISATION Most of the emphasis was laid upon vaccination against poliomyelitis and a successful programme of two injections for over two thirds of children between 6 months and 15 years of age was completed before the end of July. As regards vaccination against smallpox and immunisation for diphtheria, whooping cough and tetanus, preference was given to vaccination against poliomyelitis with the result that fewer children received these other injections. The usual tables are given in Appendix, page 128. HOME NURSING This service continues to be provided on an agency basis by the Croydon District Nursing Association. During 1958, the Nurses' Hostel and special administrative block built by the Corporation were opened by the Minister of Health. These premises provide long needed accommodation for the proper administration of this essential domiciliary service. The total of work covered during the year under review was less than the the peak reached last year and there were no staffing difficulties reported in regard to the district nurses themselves. It is, however, a service in which the higher administrative posts do not seem to be attractive and local experience confirmed this national trend. Tables given in Appendix, page 117. REHABILITATION OF ELDERLY PERSONS Last year, a detailed report was given of the work of the special S.E.A. Nurse who maintains close contact with the geriatric clinic at Queen's Hospital. This nurse has a motor car, and covers the whole of the borough. I do not propose to set out the cases dealt with in 1958 on the lines of 1957, but a summary is given in the Appendix page 118. It again proved a worthwhile service and is being continued unchanged. LOAN OF NURSING EQUIPMENT This service has become essential for the proper care of patients in their own homes and the number and variety of items which are loaned continues to increase. The usual details are given in Appendix page 119. 45 HOME HELP SERVICE I am indebted to Miss Heath, Home Help Supervisor, for the following report:- The value of the work of the Home Help Service to the whole community is often overlooked, particularly when statistics are the only written evidence of the year's work. To name a few of the workers in the social field, who have come to respect and rely on the Home Help Service will show more clearly where the Home Help fits into the pattern of social work today. The family doctor, the health visitor, the district nurse, the domiciliary midwife, the hospital almoner, the probation officer, the public health inspector, the National Assistance Board officer, the N.S.P.C.C. officer, the school attendance officer and so on. All are dependent for the success of their efforts on the acceptance of their ideas and advice. Unfortunately, these are often ignored through lack of interest or misunderstanding. The Home Help who is received into the home as a friend and companion can, by her example, encouragement and understanding, often persuade the patient to carry out the advice and suggestions of the professional advisers. At the present time, approximately 90% of the Home Helps are mainly concerned with the care of the aged. The efforts of these Helpers to provide something beyond the necessary domestic assistance cannot be fully recorded, but one thing is abundantly clear that they are all truly concerned for the well-being and happiness of their patients. Towards the end of the year, a scheme to encourage home confinements was introduced. The charge for a full-time Home Help for home confinement was reduced to £2.0.0. per week, a pro-rata for part-time service. The cost therefore of a fulltime Home Help for two weeks is covered entirely by the National Insurance home confinement grant. The scheme which will run for a trial period of twelve months is obviously popular but observations of its effectiveness as a method of reducing the demand for accommodation in local maternity units can only be made at the end of the trial period. Supplementary Schemes Washing Service The washing service for the chronic sick and elderly where home conditions are unsuitable for washing has proved both useful and successful; an average of 25 bundles are accepted every 46 week. The value of this service to Home Helps who undertake specialised work in the distressingly dirty homes of the aged, who are visited in connection with the National Assistance Act, 1948, Section 47, cannot be too highly emphasised. To be able to wash and air and return within 24 hours the accumulated washing of years is both spectacular and very satisfying. The Problem Family Service New methods of approaching this work have been sought with the invaluable aid of the health visitors. A pamphlet has been prepared giving the Home Helps who undertake this almost dedicated work, guidance and encouragement. Disinfestation The demand for this specialised work is not heavy, but the service is always available when required. Sight Service This service is never in great demand but it is nevertheless an invaluable part of successful domiciliary care. During the year, many students from all parts of the world have come to hear of the work of the Home Help Service in Croydon, several have had the opportunity of visiting homes to see the actual work being carried out. Talks usually followed by questions and discussion have been given to various organisations within the Borough. Set out in Appendix, page 120, are the details of the work performed. 47 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 57 cases were so dealt with, 44 women, 8 men, 3 children and 2 mothers with children. These figures do not include school children for whom arrangements are made by the Education committee. 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. There were two mothers who paid 12/6d. per day during 1958. The duration was for two weeks and four weeks. In both instances, the mothers were originally in one of the priority categories but became non-priority on being married and carried on at the Nursery for a while at full cost. Details of attendances - Capacity 50 Number on books at end of year 42 Attendances: under 2 2,893 over 2 5,103 Total 7,996 Number of days opened 255 Average daily attendance 31 M. AND C.W. PHYSIOTHERAPY CLINIC The trend of previous years of a fall in the demand for treatment of minor orthopaedic defects in young children and a rise in the number of expectant mothers availing themselves of relaxation exercise courses continued. Arrangements were being made for remedial exercises and physiotherapy to be available in the New Addington area, but these were not completed during the year under review. Details of attendances are given in Appendix page 119. 48 HEALTH EDUCATION I am indebted to the Health Education Officer, Miss Elliott, for the following report:- "We need from time to time to take a Look at the things that go without saying to see if they are still going". Carl Becker. "During its recent meeting in Geneva the W.H.O. Expert Committee on training of Personnel in Health Education of the Public noted that health education is now recognised as an essential element in all health programmes and that many health services can obtain lasting results only if the people understand and participate in them." (1). This year while revising the Community Health syllabus for schools, planning possible new health education methods for infant welfare centres and even during the course of the difficult smoking and lung cancer campaign we have tried to help our audiences to understand the reasons for the health measures which we are suggesting. We realised that to inform alone would not succeed and that we must make even greater efforts to interest and persuade. More and more members of this department gave talks and asked for reference books, visual aids and advice on technique for this purpose. There does seem to be an awareness now that "At present what people are taught is fundamentally less important than how they are taught" (2), although it is also realised that as health educators the staff must earn the trust of the public and the integrity of their propaganda must be unquestionable. A few general practitioners also asked for material for their surgeries and we hope that more will make use of this service next year. The smoking and lung cancer campaign continued, and as expected, it was unrewarding and uphill work. In spite of several reminders, only sixteen out of a possible thirty-five secondary and technical schools co-operated by allowing one yearly illustrated talk to be given. The coloured filmstrip "The Problem of Lung Cancer - To Smoke or not to Smoke" made in co-operation with the Chest and Heart Association, Camera Talks and our own department, was completed and is now being generally distributed. We are grateful to Mr. Manning, Headmaster of Ashburton Secondary Modern Boys School, his pupils and members of our own department for the willing help they gave with this. Again working with the Chest and Heart Association and Camera Talks, we will be taking part in a colour film on the same subject and hope it will be completed during 1959. 49 One other way of introducing the problem of lung cancer to the public was found. When asked to give a talk and show a film strip on the work of the Public Health Department the smoking and lung cancer film strip was taken also and shown, as an example of our work, as an "extra" at the end of the main talk. It was found that it always created interest and good discussion and helped in a small way to further the campaign. We are planning to introduce a more lively and interesting form of health education into infant welfare centres during 1959 and an increasing number of visual aids have been made and bought for this purpose. Displays for four pegboard triptyches were designed and mounted and illustrated the following subjects:- "Shoe fitting" "Dangerous and safe children's nightclothes and party clothes" "Your baby's needs" "Sterilisation of baby's bottles" There is an increasing amount of health education material now, but there is still a great need for adventurous experiment. A certain amount of improvision will always be necessary but we have realised that we must be dramatic, use clear and simple language, colour and motion sometimes. To keep up with the times and the interests of people a great effort is being made to raise the standard of teaching and publicity. 1958 was a busy year for exhibition stands and displays. These involved an enormous amount of work, but were used as fully as possible to "teach without tears". One rotating model containing eight scenes and made by the health visitors was later lent to the Royal College of Nursing, The London University Institute of Education and Willesden Public Health Department. It was an honour and great responsibility to be invited to the Public Health Inspectors' Conference at Blackpool in September, to join with Dr. Dalzell Ward in opening the discussion following Mr. Herrick' s paper on "Health Education in Practice". We succeeded in drawing a considerable amount of fire. Another interesting four days was spent at the Royal College of Nursing, assisting with a health visitors' refresher course. One section elected to study "Group Methods in Health Education" and became interested enough by the end of the course to produce their report to the staff and their colleagues in the form of a short three-scene play. 50 In-service training, apart from Dr. S. MacKeith's valuable monthly sessions with the health visitors, consisted of three half days when the latest films, film strips and other topical visual aids were shown and discussed. One, more formal group discussion on "The Uses and Abuses of Codliver Oil" was held under the leadership of Dr. Dalzell Ward, Medical Director of the Central Council for Health Education. A great deal of time was also spent in discussing principles, methods, and media used in health education with students of all kinds. Our main purpose in health education is not to provide services for the individual, but rather to help him remove harmful habits from his behaviour and adopt by himself a healthy attitude towards life - to depend more on his own activities for his own well-being. The continuous help, encouragement and freedom of action which Dr. Wright always gives has made this busy year a very pleasurable one. ( 1) World Health Organisation Press Release, WHO/61 - 12th November, 1957 (2) (International Journal of Health Education) - "Cancer Education (Volume II - No. 1 January, 1959 A Positive Approach" - John Wakefield. 51 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. Among the many benefits conferred by the establishment of a National Health Service, has been the increased availability of free dental treatment for the priority classes in the General Practitioners' Service. This has led to a very substantial reduction in the amount of work carried out in Local Authority Clinics. Though during recent years there have been minor fluctuations in the demand, this preference for private treatment seems to be firmly established and is likely to remain a permanent feature. Apart from the question of finance, the wider areas served by Regional Hospital Boards mean that many patients using local Maternity Clinics reside at an appreciable distance and therefore prefer to seek dental attention near their homes. Though some may deplore the reduced patronage of the Authorities' Dental Clinics, there is little doubt that whereas in pre-war days maximum efficiency tended to be jeopardised by the overwhelming demand for attention, fuller opportunities now exist to increase the scope of individual treatment and for guaranteeing the necessary priority in urgent cases. In addition to meeting actual needs for treatment, it is also the duty of Local Authority Services to ensure that adequate facilities are available for dental inspection of mothers in the early months of pregnancy; by this means individual requirements can be readily assessed, and the necessity for maintaining the health of the mouth during this important period can be explained to patients. "First attenders" at Ante-Natal Clinics are urged by the doctor to obtain the requisite oral examination, either by reference to the adjacent Dental Department in the Clinic or at the hands of their own dentist; in cases of abnormal delay in 52 meeting this request appropriate follow-up measures are instituted. Whilst at present it is not possible to register a universal acceptance, special thanks must be accorded to medical staff for their continued efforts in this field. One of the year's unsought problems has been that of providing dental facilities for expectant and nursing mothers and young children residing at New Addington, during the enforced closure of the Overbury Clinic. As an interim measure one unit at the Dental Clinic at Shirley Road was allocated for this purpose, so that patients could continue to receive attention from their usual dentist. Had it not been for the intervention of the bus dispute, which involved a somewhat lengthy period of broken appointments, there is little doubt that a reasonably adequate service could have been maintained. Plans for the introduction of a relief surgery at the Overbury Clinic, completed during the general reconstruction of the main school building, should result in greatly improved amenities for all residing in this area. As soon as staffing permits it is hoped that a limited number of visits will be possible by dentists to Welfare Centres to stimulate interest in this side of the work. Because of impending developments in the Duppas Hill area, the use of the clinic premises at the Waldrons Hall must be considered of limited duration. Efforts to secure alternative accommodation in this neighbourhood have so far met with little success, and it is probable, therefore, that arrangements will have to be considered in one of the adjoining schools. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 410, compared with 464 in 1957. As was the case in the previous year the greater proportion of these were sent from the Ante-Natal Clinic. Owing to the fact that these patients are usually also seen at pre-natal clinics, few cases are normally referred from the Municipal Midwives' Service, and then chiefly for relief of pain. The number of forms received from Welfare Centres continues to be disappointing. Except in understaffed areas, waiting time before receiving initial appointments is in general reasonably short. The percentage of mothers failing to attend for their dental examination was 27 per cent. against 28 per cent. in 1957. 53 Expectant mothers examined for the first time numbered 278 against 348 last year. Of these, 80.6 per cent. were seen during the first six months of pregnancy, compared with 81.6 per 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; otherwise names were received during the post-natal period. 25 nursing mothers were examined during the current year, compared with 32 in 1957. Treatment Including those continuing treatment from the previous year, 393 mothers were dealt with, against 476 in 1957. A welcome sign during recent years has been a decrease in the need for wholesale removal of teeth and the large scale provision of dentures. The current generation of expectant mothers also shows an increased awareness of the need for retaining their natural teeth. Certain of those attending volunteer the information that they have visited the same clinic during their school days, and have obviously benefited from treatment during this period. The Pre-School child The number of children referred from all sources during the year was 353, compared with 481 in 1957. 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. 54 A great many parents do not fully appreciate the importance of the foundation teeth in bringing about normal development of the jaws, and are therefore apt to postpone visiting the dentist until toothache intervenes. As soon as staffing permits it is hoped that more active measures will be possible to expand this side of the Service, supported by work of a preventive nature at Dental Centres. The introduction of additional Nursery classes at Primary Schools would materially assist the situation, as a greater proportion of these children would then be covered by the routine dental inspection. See also "Fluoridation" on Page 92. The usual tables are given in Appendix, page 122. 57 During 1958, nineteen members attended for driving tuition and 8 passed the driving test at their first attempt and two at the second. Of the remaining number 3 failed the driving test, 4 were discontinued after 3 lessons and 2 are still attending. When these volunteers have passed their driving tests they are given opportunities of driving Civil Defence vehicles but are accompanied for a time by drivers with longer experience. Several exercises have been held during the year, the biggest ones being "Mayflower" on Sunday, 4th May and "Turnout" on Sunday, 16th November. These exercises provided valuable practical experience for the volunteers taking part. On Sunday, 6th July two teams were entered for the Buxton Trophy eliminating rounds at "Roselands", Kingston Road, Surrey but without success. Training is now progressing for the Regional and National Competitions to be held in 1959. A special course of lectures and practical demonstrations were held at the Ambulance Headquarters for ambulance personnel on Sunday mornings for 15 weeks. These were given by Civil Defence Instructors. Future training will include exercises on the Rescue Range practical map reading and convoy driving. 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 throughout the year, which has been of great assistance to me in the administration of the duties of Chief Ambulance Officer. A. L. HILL, Chief Ambulance Officer. 58 MENTAL HEALTH As requested by the Ministry the following details of the service are set out:- Administration The administration of this service continued on similar lines to those described in previous reports, being as follows:The Medical Officer of Health in general administrative control, the Deputy Medical Officer of Health and three Assistant Medical Officer's of Health (as approved Medical Officers under the Mental Deficiency Acts), 1 Co-Ordinating Officer for Mental Deficiency/Duly Authorised Officer, 4 Duly Authorised Officers, 1 Clerk, 1 Occupation Centre Supervisor, 4 Assistant Occupation Centre Supervisors, 1 Handicraft Instructor. Co-ordination with Related Services 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. There is close personal contact between the Authority's Officers and those of the hospital services. Voluntary Associations The only duty delegated to a voluntary organisation was the supervision of 12 defectives placed under the care of the Brighton Guardianship Society. Work carried out in the Community The pages which follow give details of the work undertaken in 1958. No new developments have arisen and the over all position remains fairly static. My thanks are extended to Dr. Firmin of St. Lawrence's Hospital, and Dr. Ferguson of the Royal Earlswood Institution, whose co-operation in admitting urgent cases during 1958 has been greatly appreciated. 59 On the mental illness side the one disquieting feature is the number of elderly patients who have had to be dealt with under the Lunacy Act. 397 patients were admitted under Section 20 of the Act, 136 or nearly 35% being aged over 60, and of this group some 44 or 32% were over 80 years of age. 3 patients were admitted to homes run by the Mental After Care Association, the Corporation accepting financial responsibility. Lunacy and Mental Treatment Acts, 1890-1930 Patients admitted to Hospitals:- As Voluntary Patients - Section 1, Mental Treatment Act, 1930 14 As Temporary Patients - Section 5, " " " " 1 Under Summary Reception Orders - Section 16, Lunacy Act, 1890 4 Under 3-Day Orders - Section 20, Lunacy Act, 1890 397 416 Cases investigated but no action deemed necessary 95 The 397 patients admitted to hospitals under Section 20 of the Lunacy Act were subsequently dealt with as follows:- Remained in hospitals as Voluntary Patients 162 Certified under Section 16, Lunacy Act 1890 78 Discharged home 107 Discharged to Queens Hospital 10 Discharged to General Hospital for treatment 28 Discharged to Nursing Homes 2 Died 10 397 Patients over 60 years of age admitted to hospital under Section 20 of the Lunacy Act (included in the figures above) Males Females Aged 60 - 70 12 35 Aged 71 - 80 16 29 Over 80 16 28 44 92 60 Mental Deficiency Acts 1913-1938 Ascertainment During the year the number of new cases ascertained was 19 as compared with 26 in 1957 and the total number of cases on the Authority's registers is now 871, made up as follows:- In Mental Deficiency Hospitals 361 On licence from Hospitals 14 In Approved Homes 3 Under Statutory Supervision at home 322 Under Guardianship 20 In Mental Hospitals 8 Under friendly supervision 143 871 160 of the cases in mental deficiency hospitals have now been discharged from their Orders but are remaining as inpatients under the informal arrangements outlined in Ministry of Health Circular 2/58. During the year the Certifying Medical Officers made examinations and paid visits to the number of 53 cases. The Mental Deficiency Visitors paid 2,952 visits. Further information concerning cases dealt with in 1958 is appended below, and the 1957 figures are given for comparison purposes:- 1958 1957 Admitted to Mental Deficiency Hospitals 27 14 Admitted to Mental Hospitals 2 2 Admitted to Hospitals for Short-Term Care 12 12 Transferred from one Hospital to another 6 4 Orders closed 20 24 Varying Orders: (a) Change of Guardian 2 – (b) From Guardianship to Hospital 1 3 (c) From Hospital to Guardianship - 2 2 of the five Orders renewed during the year were in respect of Guardianship patients. 6 cases were awaiting permanent vacancies in mental deficiency hospitals on 31st December, 1958. 61 Training Occupation Centre. Number on Register, January, 1958 80 „ „ „ December, 31st 79 Number of admissions 9 Number left or excluded 7 Average attendance per session 66 Times open, morning - afternoon 400 Total attendance for year 26, 588 I am indebted to Miss Cooney, Supervisor of the Occupation Centre, for the following report:- The Centre had a quiet year and there were no staffing changes. The Annual Sale of Work held early in September was reasonably successful in spite of inclement weather and sales for the day amounted to £29.15.8. All the children thoroughly enjoyed the Annual Christmas Party which was held on December 17th, and the programme included a film show and games, followed by tea, fruit and ice cream. The Croydon & District Society for Mentally Handicapped Children maintained its interest in the work of the Centre and very kindly arranged for 55 children to attend the Circus at Olympia. Members of the Society also contributed generously to the Christmas Party. One girl who attended the Centre and had responded well to training was found employment in a local laundry. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 63 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR I beg to submit a report for the year ending 31st December, 1958, of the work of the Public Health Inspectors and other Officers under my control. The Clean Air Act, 1956 became fully operative during the year and already there are signs that industry in the Borough is prepared to co-operate in attaining a cleaner atmosphere. Positive steps have been taken by some factory owners to this end and others have schemes in hand. There is also an awareness amongst householders of their responsibilities in this matter of cleaner air, evident from the increase in the requests for the supply of smokeless fuels. It is surprising amongst one's friends the number you will find using one or other of the smokeless fuels today, compared say with a very few years ago. No opportunity is lost by the Department's Officers in fostering this new outlook, as by partaking in discussions, talking to local associations, by exhibitions, and by supplying the local Press with relevant information, they are making the public more conscious of the advantages of cleaner air, which in its attainment, may prove to be the greatest contribution to public health for many decades. During the year the Council made its first Snoke control Order, which aims at controlling smoke emissions from dwellings and other buildings in the area, and plans are in hand for the making of a second Order. In this way it is hoped that within the next few years a substantial part of the Borough will have been dealt with. The slum clearance and redevelopment programmes have progressed during the year in that the Ely Road houses have been demolished and a new block of flats has been erected on the site; Crescent Mews have been demolished and the site is now being developed for housing; and the unfit properties in the Lamberts Place and Bridge Place area will, it is hoped, be vacated within the next year. The final area in the five years Programme, the "Newtown" area of Upper Norwood, is now being surveyed with a view to the unfit properties being represented for demolition. The Rent Act, 1957 has produced 653 applications from tenants for Certificates of Disrepair, the granting of which Permits an abatement of part of the rent until such time that the repairs asked for are completed. In but 235 cases was it 64 necessary to issue such a Certificate, a very small proportion of the rented controlled properties in the Borough. I think & more important development arising, in part, no doubt from the permitted increases of rent of controlled properties, has been the tendency for more "sitting" tenants to buy their own houses and an increase in the number of owner-occupied older houses, with the consequent improvement in maintenance and amenities. Such forms of acquisition and improvements should be encouraged by easier mortgage and loan conditions to permit of the purchase of the older properties for owner-occupation and the improvement of them by the provision of modern conveniences. To one like myself, who has had many years of contact with the badly maintained tenanted house, it is indeed impressive to view some of these properties, now owner-occupied, which have been put into good repair and provided with modern amenities. Food inspection and particularly meat inspection at the Abattoir continues to take up much of the time of the staff. The number of animals slaughtered at the Abattoir continues to increase, this year being 67,526, as against 61,422 during 1957. A 100 per cent inspection has been maintained but this has entailed much evening and weekend attendance of Inspectors at the Abattoir. The buildings are over 80 years old and they were originally constructed for "booth" slaughtering, whereby one or more booths could be let to local butchers. It has now become outmoded both in layout and its form of use, necessitating consideration being given to its reconstruction or replacement. For many years now the Ministry of Agriculture, Fisheries and Food have closely liased with the Department in rodent control measures, and whilst this liaison will continue, the 50 per cent Exchequer Grant towards the cost of this service locally will end during 1959. It can truthfully be said that our combined efforts over the years have reduced very considerably the rodent population in the Borough, strikingly so in connection with the sewer rat whereby infested sewer manholes have been reduced from 1,350 in 1947 to 48 in 1958. I would like to place on record my thanks to the officers of the Ministry for their help over the years. My thanks are also due to my staff for their efforts in the past year in coping with the varied and ever changing duties they are called upon to perform. GEORGE GRIEVE, Chief Public Health Inspector. 65 HOUSING During the year the unfit houses in Crescent Mews, the second area to be dealt with in the Slum Clearance and Redevelopment Programme, were demolished and the site prepared for new building. The unfit houses in the Bridge Place, Gloucester Road and Lambert's Place area were represented and they are to be acquired by the Corporation with a view to re-development of the area. Number of parts of houses on which Closing Orders have been made 4 Number of houses on which Closing Orders have been made 2 Number of houses on which Demolition Orders have been made 11 Number of houses where Certificates of unfitness were issued. 10 During the year 1774 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, 1958: - Number of applications for certificates 330 Number of decisions not to issue certificates 7 Number of decisions to issue certificates 401 (a) in respect of some but not all defects 265 (b) in respect of all defects 136 Number of undertakings given by landlords 235 Number of undertakings refused by Local Authority Nil Number of certificates issued 168 Applications by landlords to Local Authority for cancellation of certificates 79 Objections by tenants to cancellation of certificates 33 Decisions by Local Authority to cancel in spite of tenants' objection 4 Certificates cancelled by Local Authority 57 66 West Croydon Ren'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. 6d. per night or 16s. 6d. per week, and 2s. per night or 8s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the wash-house provided. The average number of nightly lettings during the year was 97, and the number of lettings 33,149. The receipts during the year were £3,026 and the expenditure £6,013. Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, at a fee. During the year 14 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 Inspections made by Public Health Inspectors): Premises Number on Register Number of Inspections 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 319 38 10 - (ii) Factories not included In (i) In which Section 7 is enforced by the Local Authority 1, 499 371 21 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 41 115 1 - Total 1,8 59 5 24 32 - 67 Cases in which Defects were found:- Particulars Number of cases in which defects were found Number of cases in which prosecu tions were instituted Found Remedied Referred To H.U. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness(S. 1) 7 7 - - - Overcrowding (S. 2) - - - . - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S. 4) 1 1 1 - - Ineffective drainage of floors (S. 6) - - - - - Sanitary conveniences (S. 7): (a) Insufficient 5 4 - - - (b) Unsuitable or defective 54 47 - - - (c) Not separate for sexes 2 2 - - - Other offences against the Act (not including offences relating to Outwork 4 4 - - - Total 73 65 1 - - Part VIII of the Act Outwork Nature of Work Section 110 Section 111 No.of out - workers in August list required by Sect.110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (A) (5) (6) (7) Wearing Apparel 552 - - - - - Household Linen 2 - - - - - Lace, lace curtain and nets 6 - - - - - Curtain and furniture hangings 8 - - - - - furniture and upholstery 3 - - - - - Umbrellas, etc. 2 - - - - - Paper bags 29 - - - - - The making of boxes or other receptacles or Parts thereof made wholly or partially of Paper 4 - - - - - continued on next page 68 Nature of Work Section 110 Section 111 No.of out- workers in August list required by Sect.110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of stances of work in some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Carding, etc., of buttons, etc. 115 - - - - - Stuffed toys 20 - - - - - Basket making 1 - - - - - Chocolates and sweetmeats 7 - - - . . Cosaques, Christmas crackers. Christmas stockings, etc. 204 _ - - . - Lampshades 41 - - - - - Total 99 4 - - - - - Inspection of Schools The kitchens and serveries, washing facilities and sanitary accommodation are inspected and any defects or amendments requiring attention are referred to the Chief Education Officer. During the year 124 inspections were made and defects found were referred to the Chief 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. 569 inspections were made under the Shops Act, and the infringements found were as follows:- 69 Hours of Closing 17 Insufficient H. C. accommodation 2 Want of washing facilities 2 Defective ventilation 1 Defective W. C. accommodation 5 Defective walls, floors, ceilings, etc. 6 Defective and insufficient lighting 1 Want of seating accommodation 1 Notices to be exhibited or amended 64 Provision of means of heating 6 DRAINAGE 2,058 visits of inspection were made to underground drains in course of repair. Of 193 Statutory Orders served, 31 had to be done in default of the owners. In addition, repairs were carried out by the Corporation to 11 public sewers serving 51 properties. OFFENSIVE TRADES There are but few registered, and during the year there has been no cause for complaint. POLLUTION OF RIVERS AND STREAMS During the year 191 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. 70 CLEAN AIR ACT During the year 1,916 dwellings were surveyed in the WaddonSouth Croydon area with a view to ascertaining the adaptations and conversions of fireplaces necessary in order to make them capable of burning fuels smokelessly. From this survey 1,748 were found to require some works of adaptation or conversion at an estimated cost of £33,392. The Council and the Exchequer make grants towards such costs of 30% and 40% respectively. The availability of the authorised fuels was confirmed before the survey commenced. Towards the end of the year the Council made Croydon anoke Control (No. 1) Order in respect of this area and it is now awaiting confirmation by the Minister of Housing and Local Government. It is hoped to bring the Order into operation by April, 1961 by which time all adaptations and conversions will be completed. The 160 industrial and commercial etc., premises in the area will also be required to convert their fireplaces and furnaces to the use of authorised fuels by that date with the exception of three to whom conditional exemptions were granted. This is the start of what is hoped will be a succession of such areas until the whole of the Borough is smoke controlled. The District Inspectors have kept observation on the various factory chimneys within their districts with a view to observing any contravention of the Clean Air Act in respect of Smoke and Grit Emissions. 173 such observations were made and in 4 instances 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. During the year 11 plans showing the construction and heights of new chimneys have been examined and in 7 cases additional height has been requested and agreed. 24 notices of the installation of new furnaces have been received. 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. 71 DISINFECTION 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 11,554 articles By Formalin Gas 1,446 " Total 13,000 " 390 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 1958, 280 articles were disinfected, the receipts amounting to £22.16.9. Disinfection was carried out after infectious or contagious diseases at the following premises:- 612 rooms at 239 houses, hospital wards, clinics etc. 1,208 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 £44. 18. 6. was recovered for such services. In addition 163 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 26 children were cleansed of verminous conditions and 4 adults and 3 children were treated for scabies. 72 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 186, 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 25. In addition, 268 applications were made for the retention of names on the list for a further period of 12 months. No infringements of the Act were found. 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 1958, 23 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 3 Millpuff 2 Curled Feathers 4 Down and Feathers 1 Hair 2 Cotton Felt 1 Rag Flock 1 73 PET ANIMALS ACT. 1951 32 persons were licensed for the purpose of keeping Pet Shops. During the year 34 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OP ANIMALS ACTS Suspected swine fever was notified from four pig keepers' premises during the year. These and 2 cases notified from the slaughterhouses were confirmed and appropriate action was taken in conjunction with the Officers of the Ministry of Agriculture, Fisheries and Pood to provide against the spread of the disease. Fowl pest was confirmed at one premises in the Borough during the year. 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, 1,704 private dwellings were inspected following complaints and in 1,559 instances infestation was confirmed and dealt with by the rodent operatives. 118 business premises were found to be infested with rats or mice and these were all disinfested during the year. 7 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. 12 infestations at such premises were dealt with during the year. The baiting of the Corporation's foul water sewers has now been carried out at regular six monthly intervals since 1947. Prior to the winter of 1956/7, the methods and poisons used were only capable of reducing the number of infested manholes recorded at each treatment to an average of 450. The introduction of mould inhibitors made it possible to use in the 74 sewers Warfarin, a comparatively new medium for the destruction of the rat. Croydon was one of the first Authorities to take advantage of this, amending the method of laying bait in manholes in accordance with experience gained in a pilot scheme. A marked reduction in the number of infested manholes is now recorded. In the last treatment a check was made of the whole of the foul water sewerage system and the result showed that my confidence in the method now used was fully justified, less than fifty manholes being recorded as infested in each of the last two treatments. The accompanying graph shows the results of the baiting of the sewers since 1947. See Page 138. 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 3,338 premises in the Borough at which food is known to be sold, manufactured or stored. Bakehouses 56 Bakers Shops 109 Sugar Confectioners 570 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 440 Works and Club Canteens 303 Public Houses 180 Off Licences 74 Grocers 582 Butchers 211 Wholesale Meat Markets 5 Chemists 80 Greengrocers 317 Fishmongers 76 Fried Fish Shops 57 Milk Distributors and Dairies 76 Premises from which Roundsmen and Mobile Shops operate 35 Stalls 113 Pood Manufactories 16 Other Food premises not enumerated above 38 3, 338 75 Of the above premises 945 are registered under Section 16 of the Pood and Drugs Act, as follows:- Retail sale of ice-cream 766 Manufacturers of ice-cream 6 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 173 During the year 3,304 inspections were made of food businesses (for details see page 87). In addition, Croydon Airport was visited on 5 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 5 Defective condition of walls and ceilings 113 floors, utensils, fixtures, etc. 63 Insufficient lighting or ventilation 8 Defective or insufficient drainage 21 W.C. accommodation - repair or cleansing required 38 " " artificial lighting required 2 " " - want of intervening ventilated space 7 Food - improperly stored 1 " - not stored 18 off floor 6 " - means to prevent contamination required 41 " - store required or defective 23 Accumulations in yard or stores 22 Offal and refuse bins defective or uncovered 16 Yard paving defective 4 Hand washing notice not exhibited 21 Ablutions - Wash basins required 34 " - Hot water supplies required 59 " - Nail brushes, soap and towels required 20 Insufficient or defective sinks 11 Smoking offences 10 Clothing accommodation required or defective 7 Defective or unsuitable table tops, etc. 42 First Aid kits required or insufficient 10 Defective or unsuitable crockery and utensils 1 Cleanliness - advice given 27 Rodent infestation 3 Merchandise Marks 1 Vehicles - owners name and address not indicated 1 76 Prosecutions During the year a firm of grocers was prosecuted for exposing for sale a quantity of cheese which was unfit for human consumption. The Magistrates Court imposed a fine of £,3, with two guineas costs. Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1958:- Article Weight in lbs. Carcase Meat 68,494 Offal 49,928 Sundry Foodstuffs 11,105 Canned, Bottled and Packeted Foods 23,013 Total 152,540 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 1957, 61,422 animals were slaughtered, and this rose to 67,526 animals during 1958 A 100% inspection has been maintained, but this has necessitated evening and often weekend attendance of at least one Inspector. Eight 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:- 77 Animals Slaughtered Cattle excluding Cows Cows Calves Sheep and Lambs Goats Pigs Total 3,541 1,306 6,765 27,246 336 28,332 67,526 CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Horses Number killed 3,541 1,306 6,765 27,246 28,332 336 - Number Inspected 3,541 1,306 6,765 27,246 28,332 336 - All Diseases except Tuberculosis and Cysticerci Whole carcases condemned - 18 40 524 184 3 - Carcases of which some part or organ was condemned 1,252 614 35 2, 660 2,07 2 4 - Percentage of the number Inspected affected with diseases other than Tuberculosis 35.3 48.4 1.1 11.7 8.0 2.8 - tuberculosis only Whole carcases condemned 4 5 1 1 2 NIL NIL Carcases of which some part or organ was condemned 99 38 NIL NIL 386 NIL NIL Percentage Inspected affected with Tuberculosis 2.9 3.3 0.01 0. 003 1.4 NIL NIL Cysticercosis Carcases of which some part or organ was condemned 21 4 NIL NIL NIL NIL NIL Carcases submitted to treatment by refrigeration 21 4 NIL NIL NIL NIL NIL Generalised and totally condemned NIL NIL NIL NIL NIL NIL NIL 78 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. 52 inspections of licenced plants were made during the year. MILK SUPPLY During the year 93 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" 83 Licences to use the designation "Pasteurised" - (a) Dealers' (Pasteurisers') Licences 2 (b) Dealers' Licences 81 Licences to use the designation "Sterilised" Dealers' Licences 119 Dealers' Supplementary Licences to use the designation- (a) Tuberculin Tested 16 (b) Sterilised 15 (c) Pasteurised 16 Inspection of these licensed premises has been carried out during the year to see that the conditions of the licences were observed. 79 Bacteriological Examinations of Milk During the year the following samples of milk were examined: Tuberculin-Tested Pasteurised Milk 51 Pasteurised Milk 174 Sterilised Milk 11 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[/##] 51 - 51 - 51 Pasteurised Milk No. Samples Taken Methylene Blue Test Phosphatase Test Not Satisfied Satisfied Not Satisfied Satisfied[/##] 174 - 174 - 174 Sterilised Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied[/##] 11 - 11 Bacteriological Examination of Milk Churn and Milk Bottle Rinses Churn Rinse Samples 10 Satisfactory 9 Unsatisfactory 1 Bottle Rinse Samples 78 Satisfactory 72 Unsatisfactory 6 These samples were obtained at local milk bottling plants and the results, as a whole, are considered satisfactory. 80 BACTERIOLOGICAL EXAMINATION OF CREAM Ten samples of fresh cream were examined and in one case the result was unsatisfactory. In this case the manufacturing process was investigated and amendments suggested which produced satisfactory results. BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 223 samples were taken, the results being as under:- Grade No. of Samples 1 168 2 37 310 4 8 Of the total samples taken, 18 (8.07 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 Ten samples were taken from local manufacturers and were found to comply with the standard. FOOD AND DRUGS ACT, 1955 During the year, 243 samples of Milk and Cream, and 318 other samples were taken, of which number, 12 were found to be Not Genuine. Summary of Sauries During 1958 samples were obtained and submitted to the Public Analyst as follows:- 81 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Almonds, (Ground) 1 3 - - . Apples 1 1 - - - Ale, Strong 1 1 - - - Artificial Colour 1 1 • - - Arrowroot 1 1 - - - Aspirin Tablets 1 1 - - - Bacon 2 2 - - - Batter Mixture 1 1 - - - Beer, Bitter 7 7 - - - Beer, Tinned 1 1 - - - Bicarbonate Soda 2 2 - - - Beer, Mild 3 3 - - - Biscuits 2 2 - - - Black Pudding 1 1 - - - Blancmange Powder 2 2 - - - Boraclc Ointment 1 1 - - - Brawn 1 1 - - - Brisket of Beef 1 1 - - - Bread, White 1 1 - - - Bread - Stone Meal Brown 1 1 • - - Bread Crumbs 1 1 - - - Bread and Butter 1 - 1 - - Bread, Brown 1 1 - - - Butter, Danish 3 3 - - - Butter, English 1 1 - - - Butter, Dutch 1 1 - - - Butter, New Zealand 3 3 - - - Butter, Australian 1 1 - - - Buttered Rolls 1 1 - - - Calamine Ointment 1 1 - - - Camphorated Oil 1 1 - - - Calamine Compound Cream 1 1 - - - Calamine Lotion 1 1 - - - Candied Peel 1 1 . - - Cakes, Various 1 1 . - . Cake Mix 2 2 . - - Cheese, Cheddar 1 1 . - - Cheese, Processed 2 2 - - . Cheese, Cottage 1 1 - - - Cheese Biscuits 1 1 - - - Choclate 3 3 - - - Chocolate Spread 1 1 - . - Chutney 3 3 - . - Christmas Pudding 1 1 - - - Cod Liver Oil 2 2 - - - Cocoa 2 2 - - - Coconut, Dessicated 1 1 - - - Coffee, Hot white 1 1 - - - Coffee 3 3 - - - Coffee and Chicory Essence 1 1 - - - Coffee Essence, Dandelion 1 1 - - - Compound Liquorice Powder 1 1 - . - Condensed Milk 2 2 - - - Confection of senna 1 1 - - . Condiment, Non-Brewed 1 1 - - . Corned Beef 2 2 . - - Cornflour 2 2 - - - Cornflakes 1 1 - - - Cough Mixture 1 1 - - - Cough Pastilles 2 2 - - - Cream. Tinned 2 2 . . - Cream, Fresh 10 10 - - - Cream Buns and Cakes 2 2 - - - continued on next page 82 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Currants 1 1 _ - - Curry Powder 1 1 . - - Custard Powder 3 3 • - - Drinking Chocolate 2 2 . - _ Dripping 2 2 . . - Evaporated Milk 2 2 - . _ Fish Cakes 4 4 . - - Fish Fingers 1 1 - _ Fish Paste 2 2 . - - Flavouring Essence 2 2 . - _ Flour 1 . 1 . - Friar's Balsam 1 1 . - - Fruit creams 1 • 1 - _ Fruit pie 1 1 - - - Gees' Linctus 1 1 - - - Gelatine 1 1 . - - Gin 7 7 - . • Ginger Beer 1 1 . . _ Ginger Wine 1 1 • - . Ginger, Crystallised 1 1 - . _ Ginger Essence 1 1 - . . Glauber's Salt 1 1 - - _ Glycerine 1 1 - . - Golden Syrup 1 1 - - - Grapefruit Squash 1 1 - - - Gravy Powder 3 3 - - - Ground Rice 1 1 - - . Ham 1 1 - - . Halibut Liver Oil Capsules 2 2 - - - Honey 1 1 - - - Horseradish Relish 1 1 - . - Ice Cream 10 10 - • - Ice Lollies 1 1 - . . Iodine, Tincture of 2 1 1 - . Indigestion Tablets 1 1 - - - Jam 2 2 - - - Jiffi Jelli 1 1 - - - Jelly 1 1 - _ - Jelly Crystals 1 1 - . - Jellied Veal 1 1 - - - Lard 2 2 - - - Lemonade Powder 1 1 - - . Lemon Barley Water 1 1 - . - Lemon Glycerine and Honey 3 3 - . - Lemon Curd 1 1 - - - Lemon Juice 3 2 1 . - Lemon Squash 1 1 - • - Luncheon Roll 2 1 1 - - Liquid Paraffin Emulsion 1 1 - - - Macaroni 1 1 - _ - Malt Vinegar 1 1 - - - Malt, with Cod Liver Oil 1 1 - - - Malted Milk Powder 1 1 - _ - Malted Milk Tablets 1 1 - - - Margarine 2 2 - - - Marmalade 2 2 - - - Marzipan 2 1 1 - - Meat Extract and Cubes 1 1 _ - - Meat Paste 1 1 _ - - Meringues 1 1 . - - Milk, hot 1 1 • - - Milk 223 223 . - - Milk, Channel Island 10 10 . - - Milk of Magnesia 2 2 - - - continued on next page 83 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Mincemeat 1 1 - - - Minced Beef 2 2 - - - Mustard 1 1 - - - Oatmeal 1 1 - - Olive Oil 1 1 - - - Orange Squash 2 2 - - - Peanut Butter 1 1 - - - Peanuts 1 1 - - - Pickled Onions 1 1 - - - Pickled Cabbage 1 1 - - - Pineapple Squash 1 1 - - - Pudding Mixture 1 1 - - - Pressed Beef 1 1 - - - Puff Pastry 1 1 - - - Quinine, Tincture of Ammonia 1 1 - - - Rice 1 1 - • - Raisins 1 1 - - - Rice, Cream Pudding 1 1 - - - Rum 9 9 - - - Sago 1 1 - - - Salad Dressing 1 1 - - - Sandwich Spread 1 1 - - - Sauce, Tartare 1 1 - - - Sauce, chop 2 2 - - - Sausages - Beef 5 4 1 - - Sausages - Blutwurst 1 1 - - - Sausage - Meat 1 1 - - - Sausages - Mortadella 1 1 - - - Sausages - Breakfast 2 2 - - - Sausages - Slicing 1 1 - - - Sausages - Pork 2 2 - - - Sausage - Liver 4 4 - - - Sausage - Luncheon 1 1 - - - Sausage - Polonies 1 1 - - - Sausages - Frankfurt 1 1 - - - Saveloys 1 1 - - - Semolina 1 1 - - - Soda Mint Tablets 2 1 1 - - Soft Drinks 1 1 - - - Split Peas 1 1 - - - Suet, packed 1 1 - - - Sponge Mixture 1 1 - - - Sugar 1 1 - - - Sugar caster 1 1 - - - Sugar icing 1 1 - - - Sweets 9 9 - - - Soup Powder 1 1 - - - Stewed steak (Tinned) 2 1 1 - - Stuffing, sage and onion 1 1 - - - Stout, canned 1 1 - - - Sulphur Ointment 1 1 - - - Table salt 2 2 _ . - Tapioca 1 1 - - - Tea 4 4 - - _ Tinned Beans 1 1 . - - Tinned Broad Beans 1 1 . - . Tinned Fruit 1 1 . - . Tinned Peas 4 4 - - - Tinned Vegetables 2 2 - - . Tinned Soup 1 1 - - - Tinned Fish 1 1 _ - - Tinned Meat 1 - 1 - - Tinned Luncheon Meat 1 - 1 - - continued on next page 84 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Tinned Tomatoes 2 2 _ - - Veal and Ham Roll 1 1 - - . Vitamin "A" Capsules 1 1 - . . Vitaminised Iron Tonic Tablets 1 1 - - - Vitamin Capsules 1 1 . _ - Whisky 7 7 . _ - Vitamin C Tablets 1 1 . _ . Wine 1 1 - . . Yeast Tablets 1 1 - - - Total 556 544 12 - - Result of Analysis of Milk Samples Solids not Fat (Legal standard is 8.5%) 8.5 8.6 8.7 8.8 8.9 45 106 48 18 6 Milk Fat (Legal standard is 3%) 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 2 7 18 33 45 37 34 28 12 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 3-3----- (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.8 8.9 9.0 9.1 9.2 - 4 5 1- 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 5.2 5.3 5.4 - 123 - 12------1 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.62 Milk Fat 3.64 85 South Devon and Channel Island Milk Solids not Fat 8.97 Milk Fat 4.54 Total number of Milk Samples 233 The samples of milk for analysis were obtained as follows:- Taken on Milk Rounds 116 " at Dairies 92 " at Institutions 25 233 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Bread and Butter Sample consisted of bread spread with a mixture of equal amounts of butter and margarine. Vendor warned. Flour This sample contained 80 milligrams of creta praeparata whereas plain white flour should contain not less than 235 milligrams per 100. Manufacturers state deficiency due to error in mixing process and steps have been taken to prevent recurrence. Fruit creams The label on this article did not specify the ingredients, as required by the Labelling of Food Order, 1953. The producers have now amended the label on this article. Tincture of Iodine B.P. This sample was deficient in Iodine to the extent of 4 per cent and in Potassium Iodide to the extent of 3 per cent. Stocks of this article have been withdrawn from sale. Lemon Juice This article was advertised in a misleading manner. The packers have withdrawn the advertisement concerned Luncheon Roll This article had the characteristics of a cooked sausage of the luncheon or breakfast type and was sold in error. Vendor warned. Marzipan Sample contained not more than 20 per cent of ground almonds whereas, in the opinion of the Analyst marzipan should contain not less than 25 per cent of ground almonds. Vendor states quantity of processed marzipan exposed for sale in error. Stocks withdrawn from sale. 86 Article Nature of Adulteration or Deficiency Remarks Sausages, Beef This article contained preservative. The retailer has exhibited a notice on his premises concerning the presence of preservative in sausages. Soda Mint Tablets The tablets contained 0.37 g. of total carbonate whereas Soda Mint Tablets of the British Pharmacopoeia should not contain more than 0. 35 g. of total carbonate, calculated as NaHC03, in each tablet of average weight. Manufacturers state irregularity due to error in production. Stocks immediately withdrawn from sale. Tinned Stewed Steak This sample contained 55 per cent of meat whereas, in the opinion of the Analyst, the meat content should not be less than 75 per cent. The importers hare undertaken to improve the quality of this article. Tinned Rolled Beef This article was packed in a can with a paper liner which was discoloured by a black stain consisting of mixed sulphide of iron and tin caused by the action on the metal of the can of sulphur compounds derived from the meat. The Analyst reported there was no evidence that the contents of the can were unfit for human consumption. Tinned Pork Luncheon Meat The Analyst considers that a reasonable minimum meat content for pork luncheon meat is 90 per cent whereas this sample contained 69 per cent of meat The importers have undertaken to improve the quantity of this article. 87 Summary of inspections made hy the Public Health Inspectors, and other Departmental work Total number of houses inspected for housing defects under Public Health or Housing Acts 3,262 Houses inspected where zymotic diseases have occurred 216 following applications for certificates of disrepair 770 Inspections of underground rooms 69 Special inspections in connection with the Housing surrey 40 Houses inspected for overcrowding conditions 68 Reinspections of work outstanding on housing notices 8,084 Number of visits regarding infectious diseases 1,057 food poisoning 64 Inspections of drainage work during repair 2,058 House drains tested with smoke and colour - routine and complaint 865 House drains tested with smoke (on written application) 14 House drains tested with smoke during repair 44 House drains tested with water during repair 102 Inspections of cesspools and earth closets 25 " " schools and school sanitary conveniences 124 " " public conveniences 149 " " verminous premises 77 " " ponds and ditches 27 " " yards, stables and passages 241 " " theatres, cinemas, halls, etc. 98 " " pig styes 52 " " tents, vans and similar structures 64 " " knackers yards 9 Visits regarding smoke abatement 1,912 Visits regarding exhumation 1 Inspections of swimming baths 21 " " wells 6 " " gathering grounds of water supply 37 " " gipsy encampments, canps, fairs, etc. 20 " " offices 3 " " rivers and streams for pollutions 164 Food and Drugs Acts: Food and drugs samples taken 318 Food and Drugs Acts: Milk samples taken 243 Milk (Special Designations) Orders: samples taken 233 Ice cream samples taken 223 Samples taken of Fertilizers and Feeding Stuffs 21 " " swimming baths water 60 " " drinking water 274 " " subsoil water 25 " " from rivers, streams, etc. 10 " " private wells 22 " " of rag flock and other filling materials 23 " " sundry specimens (food poisoning etc.) 18 Inspections under Merchandise Marks Act 68 " " of butchers premises 304 " " meat premises (wholesale) 547 " " horseflesh premises 3 " " poultry and game dealers premises 23 " " fishmongers premises 76 " " fried fish premises 35 " " grocers premises 535 " " fruiterers and greengrocers premises 137 " " bakers premises - including bakehouses 131 " " dairies 58 " " milk shops 35 " " general shops and their premises 35 visits to premises for food condemnation 614 88 Inspections of premises where cooked meats etc. are prepared or sold 16 Inspections of confectioners premises 238 " " confectionery manufacturers premises 9 " " cafes, snack bars, canteens, hotels and their kitchens 402 " " school kitchens and serveries 106 " " hospital kitchens 12 " " ice cream manufacturers premises 20 " " ice cream vendors premises 199 " " ice cream barrows and carts 3 " " markets and barrows 154 " " imported foods at Aerodrome 5 " " other food premises not enumerated above 232 " " premises where offensive trades are conducted 7 " " factories with mechanical power 371 " " factories without mechanical power 38 " " works of building and engineering 115 " " outworkers premises 45 Visits to employers of outworkers 5 Inspections of shops (under shop Acts) 569 Special early closing, evening and Sunday trading patrols of shops 514 Appointments kept with owners, builders, etc. 1,796 Investigations of complaints other than housing matters 1,408 Reinspections of works outstanding (other than houses) 3,604 Inspections under Hydrocyanide Regulations - " " Fertilizers and Feeding stuffs Act 12 " " Diseases of Animals Act 235 " " Pets Act 34 " " Rag Flock and Other Filling Materials Act 24 Pharmacy and Poisons Act 38 Sundry Inspections and Visits 3,615 Visits regarding rats and mice infestations 6,900 Informal Notices outstanding 31. 12. 57 1,007 " " served 2,063 " " compiled 2,218 Number of Informal Notices referred for Statutory Orders 349 Informal Notices outstanding 31. 12. 58 852 Statutory Notices outstanding 31. 12. 57 297 " " served 254 " " complied 309 " " outstanding 31. 12. 58 242 Total number of callers and complaints received at the office 3,537 Total number of letters received at the office 6,738 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1958 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 539 Conditions causing dampness: Defective roofs 495 Defective window frames 503 Defective walls, etc. 280 Want of efficient damp-proof course 418 Defective gutters and downspouts 387 89 Other structural defects: Defective plaster 508 Cleansing and redecoration required 254 Defective floors and stairs 695 Insufficient ventilation under floor 59 Defective brickwork, sills, lintels, chimneys 295 Defective stoves and fireplaces and flues 258 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 169 Defective w. c. 's 368 Defective drainage 194 Stoppages in drains 170 Defective water services and tanks 69 Domestic nuisances: Want of cleanliness 3 Verminous conditions 22 Other nuisances and infringements: Offensive accumulations 86 Overcrowding 19 Sundry nuisances or defects 179 Particulars not inserted in Rent Book (Housing Act) 6 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924 Food cupboards defective or required NIL (3) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, etc. Defective Yard Paving 175 Want of a sanitary dustbin 34 Public Urinals - defective or dirty 2 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 9 w.c. defective or dirty 11 (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 2 (6) SMOKE ABATEMENT Nuisances observed 4 PUBLIC HEALTH SERVICES 91 WATER I am indebted to the Water Engineer, W. C. Knill, Esq., B.Sc., M. I.C. E., M. I. Mech. E., M. I.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 2,412,882,000 M.W. B. Bulk Supplies 712,135,000 Total 3,125,017,000 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. 490 raw water samples and 1114 treated water samples were thus examined during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 15 samples of raw water and 34 samples of treated water were subjected to bacteriological examination by the Consultant Bacteriologist to the Water Undertaking. Further samples were submitted by the Medical Officer of Health for examination by the Public Health Laboratory Service. The results of the bacteriological examination of the raw waters were typical of waters pumped from the Chalk, some of them showing the normal deterioration in quality which occurs after heavy rain. In all cases the examinations showed that the raw water was suitable for treatment. The bacteriological examinations of the treated waters showed that these waters were of uniformly excellent quality. 92 (b) chemical Analyses The arrangements for chemical analyses are similar to those for bacteriological examinations. The total numbers of samples analysed in the Water Department's laboratory and by the consultant were 89 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. FLUORIDATION Both the Health and Water Committees considered the following report on Fluoridation and resolved to await an expected statement of the Ministry of Health:- In 1957, the World Health Organisation summarising hundreds of controlled fluoridation programmes in 17 countries, some in progress for over twelve years, concluded - (i) That the use of drinking water containing one part of fluoride per million parts of water reduces dental decay in temporary (milk) teeth by 50% and in children's permanent teeth by 60%. Adults living in areas with natural fluoride in the drinking water have onethird the amount of dental decay found in adults in fluoride free areas. (ii) In areas where the natural fluoride concentration in drinking water is high, surface discolouration (mottling) of teeth has been observed, but no other adverse changes of any kind. An overwhelming majority of observers are satisfied that there is no evidence of any ill effects whatsoever from the drinking of water containing the recommended quantity of fluoride. A minority of those interested in fluoridation, however, have made the contradictory conclusion that fluoridation is actually harmful or potentially dangerous. 93 (iii) No other techniques for the application of fluorides can at present replace the fluoridation of drinking water. Experiments which are being continued include the direct application of fluoride to the teeth by Dental staff, mouthwashes and tooth-paste containing fluoride, fluoride in milk, table salt and tablets. In 1952 an official mission from the United Kingdom visited North America to study fluoridation projects in Canada and the U.S.A. In 1953 it recommended that Fluoridation should be given a trial in certain selected areas in this country and the Minister of Health announced in Parliament that the Government had accepted this recommendation. Areas which proposed to add fluoride to drinking water were the County of Anglesey, Watford, Andover, Darlington and Kilmarnock. Fluoridation has aroused great opposition in certain individuals and organised "Anti-Fluoridation Committees" were set up in some of the areas listed above. As a result Darlington decided not to proceed and Andover, where fluoridation commenced in 1956, has now given it up after being faced with a High Court action. At first, opposition was based on a host of alleged diseases said to follow fluoridation, but is now apparently centred almost entirely on the principle of the limitations in the powers of water undertakings. It is contended that they have a duty to supply pure and wholesome water and nothing whatsoever may be added to it for any other purpose. There seems little doubt that raising the fluoride content of Croydon water to one part per million will result in a significant reduction in dental caries and be without ill effects. A clarification of the legal position, however, would seem desirable before the Water Committee is pressed to undertake such a scheme. 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 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. 94 During the year under review the total number of examinations performed were:- Bacteriological 268 Chemical 12 95 SEWAGE DISPOSAL AND REFUSE COLLECTION I am indebted to the Borough Engineer, A. P. Holt. Esq., M.I.C.E., for the following information: - Refuse collection and Disposal In 1958 the following tonnages were dealt with:- House Refuse 61,012 tons Street Sweepings 3,809 " Street Markets refuse 1,764 " 66,585 tons 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. 96 RADIATION HAZARDS The question of the Corporation arranging for tests for ionizing radiations was raised by Members of the Council. The Water Engineer had samples of water examined and as would be expected, with deep chalk well water, negligible radioactivity was found. The Civil Defence Officer reported to me on the assessment of general background radiation in Croydon, as this is part of routine Civil Defence training. The results were consistently of the amounts quoted by official sources as the average normal figure for the country as a whole. The Corporation's Public Analyst in reply to my enquiries confirmed that testing of foodstuffs is exacting and expensive. Considerable outlay on equipment would be necessary before he could undertake this work and in common with all Public Analysts, he would need assurance that it will be a routine obligation of local authorities before he embarked upon the necessary capital expenditure. Since food supplies are very largely of national distribution and radioactive contamination localised to the area of one food and drugs authority is unlikely, it was clearly impossible to give the Public Analyst any such assurance. I did not know whether there were industrial or other sources of radioactive material in the borough, which might by misuse or mishap cause dangers to the general public. There was no duty to register with or notify the local authority. I had, however, no reason to believe that this danger existed in Croydon. In short, the position regarding the peacetime uses of radioactive material and possible radiation hazards was confusing but not alarming, and it was possible to await further Ministerial Circulars with equanimity. 97 Nursing Homes - Public Health Act, 1936 Number of Homes Number of Beds provided for:- Maternity Others Total Homes registered during the year 1 - - - Homes on the Register at the end of the year 24 31 530 561 Routine inspections at about four monthly intervals by a medical officer of the department continued. The Health Committee resolved that the Chief Officer of the Fire Brigade should review fire precautions in all nursing homes and report upon any necessary measures. While all new homes and all re-registering on change of ownership are required to reach the standard recommended by the Fire Brigade, the homes registered many years ago had no such standards imposed. In several instances, the need for considerable building works to minimise the risks from fire was reported and appropriate action was taken to bring all homes to a uniformly satisfactory standard. NURSES AGENCIES REGULATIONS, 1945 Of the three Agencies on the register at the end of 1957 only one applied for re-registration. In one case the owner died and in the other the Agency closed down, as the licensee was leaving the area. NURSERIES AND CHILD-MINDERS REGULATION ACT, 1948. The necessary preliminary inspections and routine re-inspections of Registered Minders and private Day Nurseries have been carried out in accordance with the above Act. There are no Day Nurseries which take children of all ages for the whole day. There is 1 Nursery which takes 2½ to 5-yearolds daily excepting Saturdays, the remainder being of the "part-time" class receiving toddlers for mornings only. The Registered Minders receive children for the day. They are not encouraged to take children under 2 years. 98 Number registered Number of children provided for 31.l2.58 Premises 4 104 Daily Minders 14 127 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 The system of continuous "on call" manning by Medical Officers continued. Aircraft and Passenger Arrivals, Croydon Airport. Aircraft Passengers "Excepted Area" 3,311 8,588 Europe outside Excepted Area 49 691 Africa, Middle East - - Asia 2 - 3,362 9,279 Included in the above figures were 2,905 Aliens carried in 1,551 Aircraft. CREMATION ACTS, 1902 AND 1952 During the year 2,327 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Acts. The following table shows the certificates completed during the last ten years:- Year Certificates 1949 1,517 1950 1,619 1951 1,967 1952 2,156 1953 2,197 1954 2,166 1955 2,362 1956 2,250 1957 2,165 1958 2,327 99 INTERNATIONAL CERTIFICATE FOR VACCINATION During the year 2,130 certificates were dealt with at the office (1.971 Smallpox, 114 Cholera and 45 T. A.B.). STAFF MEDICAL EXAMINATION The medical supervision of all Corporation staff provided by the Health Department covers:- (a) The scrutiny of the Health statements made by all successful applicants to officer grades and any follow-up or medical examination deemed necessary. (b) Medical examination of all manual workers to determine:- (i) Fitness for duty. (ii) Eligibility for inclusion in the sick pay scheme. (c) Medical examination of prospective student teachers. (d) Examination for freedom from intestinal infection:- (i) All employees of the Water undertaking. (ii) All school meal service and canteen personnel. Arrangements for re-checks. (e) Eye tests on all Corporation drivers over 50 years of age at specified intervals. (f) Scrutiny of records of all staff who have been absent for an aggregate of more than 8 weeks during the preceding 12 months. Follow-up for cause and anticipated date of return. Appropriate recommendation to Establishment Committee. (g) Arrangements for annual re-X-ray examination of staff who work in contact with children. (h) Special examination of any member of staff referred by the Department concerned. (i) Enquiries into excessive sickness in any section of the Corporation's staff. 837 examinations were made during the year by the Medical Staff of the Department including 31 vision tests for drivers. Of these, 703 were in respect of manual workers, who were classified as follows:- 100 Pit for employment and sick pay scheme 575 Deferred for review 35 Unfit for sick pay scheme 82 Pit for light employment only (Not fit for sick pay scheme) 5 Unfit for employment 6 703 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 98 cases registered:- 10 were due to glaucoma and 44 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:- 2 patients had moved from the borough. 4 consents were not forthcoming. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE AMENDMENT ACT, 1951 19 old people were visited during the year who had been reported not to be receiving adequate care and attention and were dealt with as follows:- 2 old ladies aged 74 and 76 respectively were removed to Queen's Hospital under the powers of the 1951 Act. One died on the 22nd day and the other on the 2nd day after admission. 9 other old people were admitted to Hospital voluntarily. 1 was admitted to a Corporation Old People's Home voluntarily. 7 were assisted by various services to remain in their own homes. 101 SPASTICS 80 Spastic children up to school leaving age were known in Croydon, as at 31st of December, 1958. 7 were under school age. 1 of school age was not yet at school, not being suitable but still under review. 23 were attending St. Giles' School. 2 were attending St. Margaret's School, Croydon. 4 were attending Residential Schools for Physically Handicapped children. 2 were attending normal Residential Schools (St. Mary's, Bexhill). 2 were attending a School for Partially Deaf. 1 was attending Myopic School 2 were attending St. Christopher's E. S.N. School. 6 at ordinary schools. 1 at normal private school. 2 Home Tuition. 26 Uneducable 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 34 adult cases are registered with his Department, six of whom are in special Homes. APPENDIX TABLES 103 VITAL STATISTICS - 1939-1958 104 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 45 3 6 10 55 386 413 592 1,510 F 24 2 1 10 39 226 341 842 1,485 Tuberculosis (Respiratory) M - - - - 1 7 - 1 12 F - - - - 1 4 1 1 7 Tuberculosis (other forms) M • - - - - - - - - F - - - - - 1 - - 1 Syphilitic Diseases M - . . . - 1 4 2 7 F - - - - - _ - 4 4 Diphtheria M - - - - - _ - - - F - . . - - _ - - - Whooping Cough M - _ - - - - - - - F . - . - - . - - - Meningococcal Infections M - - - - _ _ - - - F - . • - - - - - - Acute Poliomyelitis M . . . - - _ - - - F - . - -_ - - - - - Measles M . . . . . - - - - F - - - - - - - - - Other Infective and Parasitic diseases M - 1 - - - 1 1 - 1 M - - - - - - - - - Total Infective and Parasitic diseases (including Tuberculosis) - 1 - - 2 14 9 8 34 Malignant neoplasm, stomach M . . - - 3 19 11 6 39 " " lung, bronchus F - - - - 1 4 2 12 19 M - - - - 5 53 34 15 107 " " breast F - - . - 1 7 2 7 17 M . - - - - - - - - " " uterus F - . . - 6 21 20 18 65 F - - - - - 9 9 4 22 Other malignant and lymphatic neoplasms M - - 1 1 3 33 51 52 141 F - - - 1 5 45 40 46 137 Leukaemia; aleukaemia M - - 1 1 - 5 2 2 11 F - - - - 2 1 - 1 4 Total all forms of Cancer - - 2 3 26 197 171 163 562 Diabetes M - _ - _ 1 1 2 3 7 F - - - - - - 5 8 13 Vascular lesions of Nervous System M . . _ _ 1 23 46 90 160 F - - - 1 34 73 195 301 (a) coronary disease, angina M - - - 1 7 108 85 101 302 F - - - - 2 26 64 117 209 (b) Hypertension, with heart disease M - - - - - 7 7 9 23 F - - - - - 4 11 23 36 (c) Other heart diseases M - - - 1 4 25 39 101 170 F - - - - 4 11 32 169 216 (d) Other circulatory diseases M - - . - 1 10 18 21 50 F - - - - - 5 15 56 56 Total heart and circulatory diseases - - - 2 21 254 397 893 1,567 continued on next page 105  Sex 0- 1- 5- 15- 25- 45- 65- 75- Total Influenza M - . - - - 2 4 4 10 F - - - - - - 3 9 12 Pneumonia M 3 2 - - 1 9 11 43 69 F 4 - - 1 1 7 11 52 76 Bronchitis M 1 - - 1 1 34 44 46 127 F - - 1 1 1 10 20 35 68 Other diseases of respiratory system M - - 1 - - 7 9 5 22 F - - - - - 1 2 2 5 Total diseases of respiratory system - including influenza and excluding tuberculosis 8 2 2 3 4 70 104 196 389 Ulcer of stomach and duodenum M - - _ - _ 6 6 4 16 F - - - - - 2 4 4 10 Gastritis, enteritis and diarrhoea M . • . - . _ 1 1 2 F 1 - - - 1 2 1 3 8 Nephritis and nephrosis M - - - 1 3 1 1 1 7 F - - - 2 1 3 4 5 15 Hyperplasia of prostate M - - - - - 1 6 18 25 Pregnancy, childbirth and abortion F - - - - 4 - - - 4 Congenital malformations M 12 _ . 1 3 2 - - 18 F 9 - - - 1 2 - - 12 Other defined and illdefined diseases M 29 _ 1 _ 8 16 20 59 133 F 9 - - 2 3 18 14 59 105 Total Miscellaneous Di seases 60 - 1 6 24 53 57 154 355 Motor vehicle accidents M - - 2 3 4 6 - 4 19 F 1 - - 2 1 2 2 4 12 All other accidents M - . - . 3 5 4 1 13 F - 2 - 1 - 2 1 8 14 Suicide M - - - . 6 4 4 3 17 F - - - - 3 5 5 - 13 Homicide and operations of tar M - _ - _ _ - - - . F - - - - - - - - - tolal - accidents, suicide violence 1 2 2 6 17 24 16 20 88 TOTALS 69 5 7 20 94 612 754 1,434 2,995 106 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 2 2 4 35 and under 45 years 9 15 24 45 and under 65 years 97 94 191 65 years and over 177 159 336 290 272 562 Sites of Fatal Cancer Site Male Female Total Percentage of Total Skin 1 1 2 0.356 Oesophagus 4 11 15 2.669 Stomach 39 19 58 10.320 Liver 1 1 2 0.356 Bowel 31 35 66 11.726 Rectum 25 6 31 5.516 Bladder 8 5 13 2.311 Prostate 17 - 17 3.025 Larynx and Pharynx 2 1 3 0.534 Uterus - 22 22 3.915 Breast - 65 65 11.566 Ovary - 20 20 3.541 Pancreas 10 14 24 4.270 Gall Bladder and Duct 1 7 8 1.424 Tongue and Mouth 1 1 2 0.356 Bones 1 2 3 0.534 Lungs and Bronchus 107 17 124 22.064 Kidney 4 4 8 1.424 Brain and Nervous System 7 10 17 3.025 Lymphatic Glands and Connective Tissue 2 5 7 1.246 Haematopoietic Tissues - 2 2 0.356 Tonsil 1 - 1 0.178 Hodgkin's Disease 2 2 4 0.708 Leukaemia 10 4 14 2.491 Genital Organs 2 5 7 1.246 Toe - 1 1 0.178 Bye 1 - 1 0.178 Antrum 2 - 2 0.356 Undefined 11 12 23 4.092 290 272 562 h-» © -4 WARD STATISTICS WARDS Estimated Population Births Deaths Birth Rate *Death Rate Deaths under 1 year per 1,000 Births Death Rate from Diarrhoea (under two years) •Death Rate from Bronchitis and Pneumonia •Death Rate from Pulmonary Tuberculosis •Death Rate from Non-Pulmonary Tuberculosis •Death Rate from Heart and Circulatory Diseases •Death Rate from Cancer Natural Increase of births over deaths Upper Norwood 17327 310 215 17.9 12.4 13 - 1.50 0.06 - 7.27 1.90 + 95 Norbury 16080 156 191 9.7 11.9 19 - 1.24 0.12 - 6.65 2.30 35 West Thornton 16826 230 168 13.7 10.0 26 - 1.37 0.06 - 4.46 2.56 + 62 Bensham Manor 16838 210 207 12.5 12.2 14 - 1.90 - - 6.30 2.26 + 3 Thornton Heath 15848 240 176 15.1 11.1 21 - 1.51 0.19 - 5.17 2.59 + 64 South Norwood 16040 318 171 19.8 10.7 28 - 0.81 - - 5.60 2.06 + 147 Woodside 14680 203 174 13.8 11.8 10 - 1.02 0.07 - 5.59 3.20 + 29 East 16892 168 172 9.9 10.2 30 - 0.65 - - 5.74 2.25 4 Shirley 12846 147 111 11.4 8.6 7 - 0.86 - 0.08 5.14 1.40 + 36 Addiscombe 15723 255 209 16.2 13.3 8 - 1.45 - - 7.82 1.97 + 46 Whitehorse Manor 13383 253 170 18.9 12.7 8 - 2.09 0.15 - 4.71 2.99 + 83 Broad Green 13440 225 178 16.7 12.2 9 - 2.23 0.15 - 6.77 2.46 + 47 Central 10915 139 137 12.7 12.6 14 - 1.65 - - 6.50 2.38 + 2 Waddon 15461 228 189 14.7 12. 2 18 - 1.23 0.06 - 6.30 2.26 + 39 South 16449 222 279 13.5 17.0 32 - 1.94 0.24 - 10.64 2.74 57 Addington 20752 548 88 26.4 4.2 22 0.05 0.34 0.05 - 1.69 0.82 + 460 The Borough 249500 3852 2995 15.4 12.0 18 0.00 1.27 0.07 0.00 5.95 2. 22 + 1017 Deaths occurring In Queen's Hospital are not Included in the Ward figures as they are not allocated to the home address if the patients have been resident there for Bore than six months. Death Rate per 1000 population. 108 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1938-1958 Year Births (Lire and Still) Maternal Deaths Maternal Mortality Bate Infant Mortality Bate 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 1958 3,928 4 1.02 18 109 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 4 Intra-uterine asphyxia (Toxaemia) 1 5 (2) Foetal States - Congenital Malformities 11 Atelectasis 9 Haemorrhagic Disease of Newborn 9 29 (3) Prematurity 11 11 (4) Post-Natal Causes 5 5 Total 50 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1.000 Births 1958 1957 1958 1957 Injury at Birth and Congenital 33.3 28.6 5.97 5. 13 Premature Births 15.9 31.7 2.86 5.70 Respiratory Diseases 15.9 17.5 2.86 3.13 Atelectasis, Debility and Marasmus 13.0 4.8 2.34 0.85 Diseases of Digestion 1.4 3.2 0. 26 0.57 Other causes 20.3 14. 2 3.63 2.85 • These from Gastro enteritis Perinatal Deaths Stillbirths 76 Deaths in first week 45 Causes of Death in first week Prematurity 11 Congenital conditions 9 Atelectasis 9 Cerebral haemorrhage 4 Intra pulmonary haemorrhage 1 Perinatal rate - 30 per 1,000 total (live and still) births Intra uterine asphyxia 1 Haemorrhagic disease of newborn 9 Other 1 Prematurity was a contributory cause in 5 cases 110 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CAUSES OF DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th-14th day 15th-21st day 22nd-28th day Total Under 1 month 1-2 months 2-3 months 3-4 months 4-5 months 5-6 months 6-7 months 7-8 months 8-9 months 9-10 months 10-11 months 11-12 months TOTAL All Causes 29 5 3 3 2 - 4 - 4 - 50 7 5 1 2 1 2 - 1 - - - 69 Men ingo-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - 1 - 1 - 1 - - - 1 - - - - - 3 Pneumonia (all forms) - - - - - - - - 1 - 1 3 1 1 - 1 - - - - - - 7 Diarrhoea and Enteritis - - - - - - - - - - - - - - - - - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - -- - - - - - - - - - - - - - - . Congenital Malformations 3 1 2 2 - - 3 - 2 - 13 1 3 - 2 - - - - - - 19 Premature Birth 8 2 - - - - 1 - - - 11 - - - - - - - - - - - 11 Atrophy, Atelectasis, Debility and Marasmus 8 . . 1 - - . - . . 9 . . . . . - _ _ - - . 9 Injury at Birth - 2 1 - 1 - - - - - 4 - - - - - - - - - - - 4 Haemorrhagic disease of newborn 8 - - - 1 - - - - - 9 - - - - - - - - - - - 9 Other Causes 2 - - - - - - - - - 2 2 - - - - 1 - 1 - - - 6 TOTALS 29 5 3 3 2 - 4 - 4 - 50 7 5 1 2 1 2 - 1 - - - 69 111 MIDWIFERY SERVICE The work of the municipal midwives was as follows:- 1. The number of maternity deliveries by Municipal Midwives on the district in the year 1, 283 2. The number of spontaneous deliveries 1, 279 3. The number of forceps deliveries 4 4. The number of still births 13 5. The number of neo-natal deaths Nil 6. The number of premature live born Infants 10 (1) 38 weeks - 4 lbs. Discharge Weight 4 lbs. 4 ozs. (2) 40 weeks - 4 lbs. 12 ozs. Transferred to Hospital (3) 38 weeks - 4 lbs. 10 ozs. Discharge Height 4 lbs. 12 ozs. (4) 35 weeks - 4 lbs. 8 ozs. Transferred to Hospital (5) 32 weeks - 3 lbs. Transferred to Hospital (6) 39 weeks - 4 lbs. 14 ozs. Discharge Weight 5 lbs. 12 ozs. (7) 38 weeks - 4 lbs. 12 ozs. Discharge weight 5 lbs. 2 ozs. (8) 36 weeks - 4 lbs. 14 ozs. Transferred to Hospital (9) 38 weeks - 5 lbs. Transferred to Hospital (10) 36 weeks - Twins 1-3 lbs. 11 ozs. 1-4 lbs. Transferred to Hospital 7. The number of patients who received Trilene 10 8. The number of patients who received Gas-Air Analgesia 1,19 2 9. The number of cases of P.P.H. 21 Home 14: Transferred to Hospital 7 10- The number of cases of manual removal of placenta at home 1 11. The number of patients who received blood transfusion at home 2 12. The number of cases to which Flying Squad was called 3 13. The number of cases of toxaemia of pregnancy treated at home 4 14. The number of cases of prolonged labour (over 24 hours) 23 15. The number of breech deliveries including twins 8 16. The number of twins delivered 5 sets 17. The number of triplets Nil 18. The number of cases of Puerperal Pyrexia 18 (Genital Nil) (Extra-Genital Nil) 19. The number of congenital malformations 9 (spina Bifida 4) (Deformed Spine 1) (Talipes 1) (Deformed Foot 1) (Deformed Penis 1) (Imperforate Anus 1) 20. Patients given Pethedine 698 21. Patients sent to Hospital: 368 (Ante-natal 309) (During Labour 47) (After Labour 12) 22. Patients sent home for nursing: 320 (Home booked 229) (Hospital booked 91) 112 Midwifery Maternity AnteNatal Visits PostNatal Visits Bookings Office Bookings Home Visit Midwife Mileage Deliveries Normal Abnormal Normal Abnormal Gas and Air Midwives Pupils Midwives Pupils 1. 2316 - - - - - - - - - - - • - 2. 4364 96 54 1 39 2 88 432 374 1142 1205 126 140 28 3. 4475 60 49 5 4 2 56 772 147 1171 356 80 81 6 4. Bicycle 47 41 - 5 1 41 227 - 621 - 39 46 29 5. 2164 60 59 1 - - 54 233 103 639 866 66 69 1 6. 4736 116 84 6 22 4 103 689 412 1401 1291 146 147 79 7. 2881 46 37 2 6 1 44 484 - 1046 - 32 31 11 8. 3459 111 98 1 12 - 106 415 545 1337 1248 112 118 44 9. 2212 90 70 2 17 1 85 367 301 1229 1389 115 119 42 10. 3508 76 55 2 16 2 68 422 - 1108 - 62 60 10 11. 2335 38 33 - 4 1 38 261 - 716 - 41 50 13 12. 4748 83 74 1 7 1 79 423 433 108 2 1213 138 133 38 13. 2321 50 47 - 2 1 47 190 - 741 - 40 48 2 14. 4181 56 43 1 12 - 55 541 - 1037 - 63 80 40 15. 5415 83 51 2 28 2 78 704 439 1328 1237 128 170 49 16. 3888 73 66 4 1 2 69 749 358 1327 1061 125 119 1 17. 4293 85 77 - 6 2 79 461 414 978 1321 123 137 43 18. 4080 83 75 1 7 - 73 475 307 1301 129 1 96 96 39 19. 313 19 16 - 3 - 19 149 - 321 - 25 24 4 20. 110 11 10 - - 1 10 112 - 258 - 15 16 1 Totals 61799 1233 1040 29 191 23 1192 8106 38 33 18783 12478 1572 1683 486 No. 11 left service 31.8.58 No. 19 commenced duties 1. 9.58 No. 5 left service 30.9.58 No. 20 commenced duties 1.10.58 No. 13 left service 30.9.58 113 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion 3 Other Causes 29 Miscarriage 2 34 FOR COMPLICATIONS DURING LABOUR Breech 5 Post-partum haemorrhage 12 Malpresentation 2 Adherent and Retained Premature Labour 11 Placenta 4 Delayed Labour 12 Torn Perineum 117 Ante-partum haemorrhage l5 Other Causes 20 Episiotomy 4 202 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 24 Pain in Breasts 22 Pain in Legs 11 Other Causes 17 Rhesus Negative Blood 61 135 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 28 Still Birth 2 Other Causes 27 57 428 In accordance with Rule 33 of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received:- Illness of Mother 132 Defects of lactation 530 Other Causes 116 Total 778 114 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1958 who were born- (i) at home 52 (ii) in private nursing homes 1 (iii) in hospital * 177 (2) The number of those born at home- who were nursed entirely at home 47 who were transferred to hospital on or before the 28th day 5 who died during the first 24 hours who survived at the end of one month 52 (3) The number of those born in private nursing homes- who died during the first 24 hours who survived at the end of one month 1 (4) Number of those born in hospital- who died during the first 24 hours 11 who survived at the end of one month 166 (5) Number of premature still births who were born- (i) at home 4 (ii) in private nursing homes - (iii) in hospital 38 * The group under this heading will include cases which may be born in one hospital and transferred to another. THE WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE - 1958 Visit Miss Belle Coa. 17.2. 58. Left 23. 10.56. Miss Bird Miss Blacksore Miss Blest Miss. Brand Miss. Collins Sick leave from 12. 5. 58. Miss Devaney Miss Early Miss Eldridge Miss Emms Miss PltzGerald Cos. 12.5.58. Miss Hall Mrs. Hastings Miss Hawkins Miss Hodgson Miss Hughes Cos. Dec. 58. Mrs. Laing Miss Llewellyn Miss Lovell Cos. 3.2.58. Miss. Mayo Miss Morton miss Partridge Miss Ph1111ps Miss Pickering Miss Poupard Left 31.7.58. Miss Thompson Miss Theison Miss Vince Mrs. Wilson Miss Vybrew TOTAL 1958 TOTAL 1957 Infants under 1 year - Pi rat Visits 97 95 71 122 98 19 133 127 233 218 110 208 188 304 104 9 165 228 144 73 204 178 205 177 77 - 24 316 138 134 4199 3656 Re-visits 250 392 251 489 427 90 505 641 632 528 230 529 297 530 406 1 89 635 155 341 318 30 1 985 452 121 17 80 514 529 253 10988 14719 Children 1-2 years- First Visits 1 12 4 25 9 3 13 6 2 2 21 36 16 41 - 4 11 31 18 9 23 38 16 25 2 - - 157 17 2 544 228 Re-visits 146 286 221 270 301 52 555 486 303 287 287 271 327 238 196 4 31 347 138 207 160 196 267 243 80 9 18 658 337 179 7100 10114 Children 2-5 years - First Visits 1 8 3 5 4 1 14 5 9 - 8 48 18 68 6 8 30 35 29 11 23 53 16 39 1 - - 199 26 26 694 343 Re-visits 404 371 336 561 589 86 625 418 626 399 498 328 333 344 186 6 22 419 256 264 429 397 332 289 174 11 76 648 434 338 10179 14826 Expectant Mothers- First Visits 8 20 26 21 3 - 4 6 20 35 21 32 3 90 1 - - 57 33 7 17 15 19 4 9 - - 32 36 34 553 657 Re-visits 3 5 11 2 41 - 13 11 5 4 1 75 6 8 - - 1 41 4 10 4 13 98 12 5 - 11 3 18 1 406 470 Still Births - - 1 - - - - - - 2 - - 1 - - - - 2 2 - - - - 1 - - 1 - - i 11 21 Deaths under 1 year - 3 2 1 - - - - - - 1 - 1 - - - 1 2 - - - 1 - - - - - - - - 12 19 Miscellaneous Visits 67 135 27 51 19 23 96 17 23 18 6 179 40 94 25 6 22 24 59 2 5 42 42 2 57 - 18 4 35 4 1142 1289 Ineffective Visits ... 205 453 109 263 289 121 586 816 198 249 501 747 375 446 410 11 207 407 253 245 265 171 507 579 103 1 24 318 451 130 9440 8014 TOTALS. 1958 1182 1780 1062 1810 1780 375 2544 2533 2051 1742 1684 2453 1605 2163 1334 49 579 2228 1091 1169 1448 1405 2487 1823 629 38 252 2489 2021 1102 45268 - TOTALS. 1957 - 1408 237 5 1732 14 19 2252 2680 2105 1918 - 1677 1571 2241 2108 317 1849 2477 1283 1638 1945 2058 2082 1695 1363 2924 1915 1802 * 54356* * Including Health Visitors who left In 1957. Nuaber of famllles or households visited during the year 9.254. 115 116 ATTENDANCES AT INFANT CENTRES - 1958 Benaham Manor Monday A.M. Benaham Manor Monday P. M. Boston Road Thursdays P.M. Brighton Road. Wednesday P.M. East Croydon Tuesday A.M. East Croydon Friday P.M. FairchiIdes Frlday P.M. Falconwood Wednesday (alt.) P. M. Good Shepherd Saturday A.M. Monks Hill Thursday P.M. Monks Orchard Monday P.M. New Addington Wednesday A. M. New Addington Wednesday P.M. Norbury Wednesday A.M. Nonbury Wednesday P.M. St. Alban's Wednesday P. M. St. Alban s Parlay P.M. St. Andrew's Monday P.M. St. James' Thursday A.M. St. James' Thursday P.M. St. Jude's Tuesday A.M. St. Jude's Tuesday P.M. St. Oswald's Thursday A.M. St. Oswald's Thursday P.M. Selhurst Monday P. M. Shirley Thursday P.M. South Croydon Thursday P.M. South Norwood Tuesday P.M. South Norwood Frlday P.M. Spring Park Monday P.M. Upper Norwood Wednesday P.M. Waddon • ednesday P.M. Woodside Prlday A.M. Woodside Prlday P.M. TOTAL 1958 TOTAL 1957 New Cases under 1 year 86 112 127 116 120 138 47 46 10 84 65 127 137 77 99 112 85 137 101 166 75 Ill 52 73 79 69 144 158 136 78 209 62 54 111 3403 3093 No. of Re- attendances 1485 1914 1820 2408 1996 1950 640 722 109 1162 544 1675 1399 1615 1678 1331 831 1603 2127 2735 1611 1813 811 1056 1353 965 207 5 1734 1537 1118 1859 536 1005 1111 48328 46632 New Cases over 1 year 23 24 10 6 13 25 1 3 8 17 33 28 12 15 9 3 12 14 13 11 9 6 9 14 10 18 18 10 21 24 1 10 11 439 493 No. of Re-attendances 1053 1147 625 513 880 693 245 519 47 644 291 928 900 1010 1083 850 413 465 264 322 653 660 403 620 571 349 509 450 480 484 455 275 311 413 19525 22711 Attendance of Children 0-5 2647 3197 2582 304 3 3009 2806 933 1290 166 1898 917 2763 2464 2714 2875 2302 1332 2217 2506 3236 2350 2593 1272 1758 2017 1393 2746 2358 2163 1701 2547 874 1380 1646 7 1895 72904 Consultations with Doctor 945 1062 906 933 843 882 281 508 83 455 292 879 772 674 730 765 262 749 819 921 612 718 444 556 633 217 653 720 647 258 799 244 522 524 21308 21771 No. of Sessions 49 49 50 52 52 50 50 26 13 50 49 53 53 53 52 53 50 49 51 51 52 52 51 51 49 49 51 52 50 49 53 27 50 50 1641 1687 EXPECTANT MOTHERS No. of New Cases - - - - - - - * - - 9 2 - - - - - - - - - - - - - - - - - - - - - 11 5 No. of Re-attendances - - - - 1 - - - - - 3 2 - - - - - - - - - - - - - - - - - - - - - - 8 2 Total Attendances of Expectant Mothers - - - - - - - - - - 12 4 - - - - - - - - - - - - - - - - - - - - - - 19 7 Total Attendances 2647 3197 258 2 3043 30 10 2806 933 1290 166 1898 929 2767 2464 2714 2875 2302 1332 2217 2506 3236 2350 2593 1272 1758 2017 1393 2746 2358 2163 1701 2547 874 1382 1646 71714 72911 Average per Session 1958 54.0 65.2 51.6 58.5 57.9 56.1 18.7 49.6 12.8 38.0 19.0 52.2 46.5 51.2 55.3 43.4 26.6 45.2 49.1 63.5 45.2 49.9 24.9 34.5 41.2 28.4 53.8 45.4 43.3 34.7 48.1 32.4 27.6 32.9 43.7 - Average per Session 1957 49.9 62.7 51.6 54.6 60.8 66.5 18.5 51.7 17. 2 23.8 20.0 55.2 54.4 52.6 61. 4 40.2 27.7 42.7 38.4 55.8 40.6 52.8 31.4 47. 5 42.6 27.0 48.6 42.9 50.8 36.0 52.9 28.5 23.0 35.4 - 43.2 117 HOME NURSING Staff at 31.12.58 Superintendent Deputy Superintendent 2 Assistant Superintendents 30 whole time Nurses (including 3 males) 8 S.R.N's (including 1 male) 1 S.E.A.N. Nurse Summary of work carried out during the year under review:- Patients remaining on books from 1957 1,048 New patients 4,908 Total 5,956 New Patients Medical 2,295 Surgical 2,436 Gynaecological 80 Obstetric - Maternity 97 Total 4,908 Specially classified Cases Visits Tuberculosis 91 3,747 Pneumonia 172 1,592 Maternity Complications 37 484 Infectious Diseases (including influenza) 5 48 Children under five years 208 1,513 Over 65 years old 3,194 99,179 Visits:- Termination of Cases:- Convalescent 3,037 Hospital 700 Died 507 Removed for other causes 762 Still on books 950 Total 5,956 118 Total visits January 14,631 February 11,754 March 12,965 April 12,693 May 12,239 June 10,987 July 10,842 August 11,024 September 11,238 October 12,559 November 11,890 December 12,785 Total 145,607 REHABILITATION OF ELDERLY PERSONS Rehabilitation Cases - Total attended in 1958 52 Re-admitted to hospital 10 Transferred to ordinary nurse 4 Remaining under treatment 6 Completely recovered 21 Partially recovered 3 Died 8 Ages 55 to 64 years 12 65 to 74 years 10 75 to 84 years 24 85 to 94 years 5 95 and over 1 Illnesses Hemiplegia 32 Lower limb fracture 8 Cerebral thrombosis 4 Other conditions 8 119 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 7 3 10 Knock Knees and Flat Feet 8 8 16 Valgus Ankles 3 5 8 Asthma 2 1 3 Kyphosis 1 3 4 Torticollis - 1 1 Pigeon-toes 2 3 5 23 24 47 Total attendances 1,269 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 230 Bed Rests 154 Mackintosh Sheets 226 Feeding Cups 15 Wheel Chairs 35 Commodes 59 Crutches, pairs 2 Air Cushions 200 Bed Cradles 22 Urinals 78 Air Beds 17 Dunlopillo Mattresses 2 Dunlopillo Cushion 3 Bed Pulley 2 Bed Tables 1 Draw Sheets 50 Walking Aid 10 Sputum Mugs 2 Enuresis Machines 27 Ryles Tube Nil Fracture Boards 2 Bedsteads 1 Steam kettles Nil Walking Machine 1 Bed Blocks 3 Pifco Massager 1 120 HOME HELP SERVICE Staff at 31.12.58. Supervisor 2 Assistant Supervisors 1 Clerk Assistant 1 Clerk 14 Whole Time Home Helps 178 Part Time Home Helps 1 Night Attendant Summary of work carried out during the year under review:- Patients remaining on books from 1957 1,032 New Applicants 1,382 Patients carried forward to 1959 1,069 New Applicants (a)Maternity 419 (b)Sickness 792 (c)For Night Service 12 Classification of Cases Attended (a)Maternity 346 (b)Tuberculosis 22 (c)Chronic Sick including Old Age 1,824 (d)Others including Acute Sick 367 Number of Hous Service Given 198,026 Average Duration of Service Given (a)Maternity 12 days (b)Acute Sickness 10-21 days (c)Chronic Sickness indefinitely Amount Recovered for Service £4,513.13.0. Rate of Remuneration of Home Helps at 31.12.58. 3/5d. per hour - Home Helps 3/3d. „ - Sick Room Helpers 3/3d. „ - Washing Service 4/1d. „ - Problem Family Helps £8.11.2. per week - Family Helps 10/- „ - Disinfestation 121 PROBLEM ETC. FAMILIES SUMMARY OF THE WORK CARRIED OUT DURING 1958 BY THE HEALTH VISITOR SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES, AND TO PREVENT THEIR NEED FOR ADMISSION Rehoused in private accommodation 15* Rehoused in Council accommodation 66 (* Of these 5 accommodated outside the Borough) Visits paid:- Family Departments Agents and Contacts 299 123 134 Families without permanent housing at close of year:- 3. Visits paid:- Family Departments Agents and Contacts 113 60 41 Potential Homeless Families - not admitted to Receiving Homes - 41 Visits paid:- Family Departments Agents and Contacts 302 61 79 Visits re - employment 49 Families assisted with furniture 35 Families referred by various Departments 15 Families making direct contact 31 Families referred by various organisations etc 17 122 DENTAL TREATMENT- M. AND C. W. Expectant Mothers Nursing Mothers Total Young Children New Cases Examined 278 25 303 282 Re-treated 60 30 90 71 Total 338 55 395 353 Expectant and Nursing Mothers Young Children Attendances 875 689 Fillings 245 218 Extractions 338 428 Gas cases 117 170 Local Anaesthesia 73 3 Scaling and Gum Treatment 134 - Dressings 202 264 Denture Dressings 148 - Silver Nitrate - 120 Treatment Completed 201 242 Number of Sessions (treatment) 390 Dentures Fitted 51 Dentures Repaired 4 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 395 - South Croydon - 1 Municipal St. Alban's _ Midwives 12 - Woodside - - Post Natal 3 - Norbury - 4 Welfare Centres: Addington - 19 Municipal - 1 St. Andrew' s - _ East Croydon - 1 Waddon . - Upper Norwood - - Boston Road . 3 Holy Trinity - - St. Jude's - 2 St. Oswald's - - St. John's Bensham Manor - - (Shirley) - - Fairchildes - - Monks Hill - 2 Good Shepherd - 1 Crossfield Nursery - - Falconwood - - Referred by West Croydon - - Dental officers: - 318 South Norwood - 1 Mothers: 410 Young Children: 353 Total: 76 3 123 HOME SAFETY Accidents taken to Hospital by Ambulance during 1958. Type of Accident Under 5 Age Groups 45-64 65 + Sex Total 5-14 15-44 M F Falls 83 77 46 52 109 176 191 367 Burns and Scalds 29 5 14 9 3 18 42 60 Poisoning 11 - 2 2 - 8 7 15 Suffocation 1 - 1 - 1 1 2 3 Miscellaneous 41 29 28 23 7 65 63 128 Totals 165 111 91 86 120 268 305 573 Deaths Cause Number Age Group Comments Falls 9 All over 70 Mainly fractures with subsequent death in hospital. Asphyxia 1 22 years Overcome by smoke in burning house. Drowning 1 11/3 years Fell into unfenced garden pond. 124 AMBULANCE SERVICE Classification of Journeys, Patients and Mileage * Patients Journeys Mileage Health service Removals 74,998 (71,293) 44,663 (44,299) 344,643 (337,564) Accidents 3,752 ( 3,602) 3,540 (3,445) 20,137 ( 19,393) Spastics (Bramley Hill) 5,226 (4,634) 625 (579) 12,960 ( 10,681) Mental Health (Occupational Centre) 25,796 (23,879) 790 (796) 22,370 (22,605) St. Margaret's (Spastic Children) 308 (445) 306 (355) 3,498 (3,759) Services Not Required (Accidents) 284 (184) 1,408 (930) Gas and Air Analgesia 636 (562) 4,781 (4,481) Vehicles to Repair Depots, Testing etc. 278 (312) 3,106 ( 2,864) Service Requirements (Oxygen, visiting Sub-stns, parks etc.) 244 (295) 2,956 (2,877) Bus Strike (Collection of Personnel) 136 (-) 1,724 (-) 110,080 ( 10 3,853) 51,502 (50,827) 417,583 (405,154) Civil Defence 135 (158) 2,098 ( 1,686) 110,080 ( 103,853) 51,637 (50 ,985) 419,681 (406,840) Note:- 1957 Figures are in brackets. *These figures do not represent individual cases. Classification of Accident Calls Home Accidents (Children) 331 (Adults) 347 Miscellaneous Accidents (Children) 58 (Adults) 110 Recreational Accidents (Children) 91 (Adults) 64 School Accidents 230 Street Accidents (Children) 217 (Adults) 843 Work Accidents 234 125 Classification of Accident Calls (continued) Home Illness (Children) 34 (Adults) 205 Street Illness (Children) 17 (Adults) 533 Work Illness 104 Attempted Suicide 35 Suicide 23 Common Assault 64 3,540 Comparison of Patients, Journeys and Mileage since 1954. Year Patients Journeys Mileage 1954 95,254 43,358 421,684 1955 100,827 50,491 440,311 1956 104,563 51,102 413,812 1957 103,853 50,827 405,154 1958 110,080 51,502 417,583 126 COMMUNICABLE DISEASES NOTIFIED DURING 1958 Notifiable Disease Cases notified Total cases notified in wards At ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Woodside East Addisconbe Whitehorse Manor Broad Green Central Waddon South Addington Shirley M F At all ages Under 1 1-4 5-14 15 - 24 25 - 44 45 - 64 65 and over Scarlet fever 188 . 48 129 8 3 . . 25 13 9 16 36 11 13 6 7 3 4 1 16 9 12 7 100 88 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 20 - - 1 2 3 9 5 2 - 1 4 3 - - - 1 - 1 - 3 - 2 3 11 9 Meningococcal Infection 4 2 - 1 - 1 - _ - - 2 _ _ _ 1 _ _ . . _ _ . 1 . 3 1 Enteric and Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 42 - - - 13 29 - - 2 1 14 - - 1 - - 2 - 13 - 3 - 1 5 - 42 Ophthalmia Neonatorum 1 1 - - - - - - - - - - - - - - - 1 - - - - - - - 1 Acute Poliomyelitis 3 - - 2 1 - - - 2 - - - - - - - - - - - 1 - - - 3 - Dysentery 102 8 29 41 4 17 3 - - 1 - 4 - 5 - 5 - - 4 - - 23 59 1 58 44 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Primary and Influenzal Pneumonia 76 4 7 4 8 12 28 13 3 1 5 1 9 1 1 13 8 4 4 3 8 8 3 4 40 36 Food Poisoning 64 1 9 6 9 10 11 18 1 - 6 17 3 2 4 7 1 - - 3 11 1 6 2 22 42 Acute Encephalitis 1 - 1 - - - - - - - - - - 1 - - - - - - - - - - 1 - Measles 840 18 384 428 4 6 - - 18 9 23 10 23 48 4 43 14 98 5 2 15 24 492 12 459 381 Whooping Cough 356 51 171 130 - 4 - - 27 4 20 17 21 39 19 38 38 31 8 6 7 9 66 6 152 204 1697 85 649 742 49 85 51 36 80 29 80 69 95 108 42 112 71 137 39 15 64 74 642 40 849 848 The tuberculosis notifications are shown in the section relating to that disease. MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1958 Notifiable Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 24 12 9 13 16 17 8 10 8 10 6 8 141 Non-Respiratory Tuberculosis 2 _ - 2 1 2 2 4 2 3 . . 18 Scarlet Fever 30 20 27 13 18 13 10 4 2 15 14 22 188 Diphtheria - - - - - - - - - - - - - Erysipelas 2 1 3 - 2 - 3 - 2 2 3 2 20 Meningococcal Infection Enteric and 2 2 - - - - - - - • - - 4 typhoid - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Puerperal Pyrexia 2 - - 3 5 6 6 6 5 7 1 1 42 Ophthalmia Neonatorum . - - - - - - - - 1 - - 1 Poliomyelitis and Polio-encephalitis - - - - 1 - 1 - - 1 - - 3 Dysentery 1 4 - 3 - - 3 1 1 7 28 54 102 Malaria - - - - - - - - - - - - - Ac. Pri. and Act. Inf. Pneumonia 24 12 8 12 3 2 5 1 3 2 1 3 76 Food Poisoning 5 - 1 2 4 2 3 3 30 8 5 1 64 Acute Encephalitis - - - - - - - - - - - 1 1 Measles 7 3 5 4 7 15 39 18 16 65 253 408 840 Whooping Cough 12 15 33 21 34 38 37 39 39 28 42 18 356 1856 127 128 IMMUNISATION AGAINST WHOOPING COUGH A total of 1,545 children were immunised against whooping cough, comprising 1,442 under school age and 103 school children 494 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 1,647 children were immunised against Tetanus, comprising 1,546 under school age and 101 school children. VACCINATION AGAINST SMALL-POX A total of 2,639 persons were vaccinated against Small-pox. Under 1 year of age 1 2-4 5 - 14 15 or over Total Successful vaccinations 1,985 237 100 82 62 2,466 "Re-vaccinations - - - 22 32 54 Insusceptible to Vaccination 85 15 8 3 8 119 2,639 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1958, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1944). Age at 31. 12. 58 i.e. Born in year under 1 1958 1 - 4 1954-1957 5-9 1949-1953 10 - 14 1944-1948 under 15 Total Last complete course of injections 1,650 8,188 5,466 1,768 17,072 A. 1953 - 1957 B. 1952 or earlier - - 5,372 11,994 17,366 C. Estimated midyear child population 3,690 13,410 38,000 55,100 Immunity Index 100 A/C 44.71 61.05 19.03 30.98 VACCINATION AGAINST POLIOMYELITIS 37,857 children were given this protection. 129 130 TUBERCULOSIS The following tables shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All forms) 0-15 years All ages Tuberculosis (All forms) 0-15 years All ages Year Number of Deaths Death rate per thousand of popu- 1ation • Number of Deaths Death rate per thousand of population Year Number of Deaths Death rate per thousand of popu- lation • Number of Deaths Death rate per thousand of population 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 0.14 1921 29 0.57 184 0.96 1941 10 - 111 0.59 1922 30 - 209 1.09 1942 8 - 116 0.63 1923 25 - 190 0.98 1943 9 - 120 0.62 1924 18 - 188 0.96 1944 9 - 105 0.57 1925 27 - 181 0.91 1945 9 - 92 0.46 1926 27 - 208 1.01 19 46 7 - 105 0.41 1927 15 - 203 0.96 1947 4 0.08 105 0.44 1928 24 - 206 0.96 1948 3 0.06 111 0.45 1929 21 - 178 0.80 1949 6 0.12 94 0.38 1930 15 - 175 0.79 1950 4 0.08 65 0.21 1931 18 0.36 177 0.75 1951 3 0.06 64 0.25 1932 10 - 166 0.70 1952 - - 54 0.22 1933 13 - 184 0.77 1953 2 0.04 37 0.15 1934 10 - 157 0.65 1954 1 0.02 32 0.13 1935 9 - 176 0.71 1955 1 0.02 35 0.14 1936 11 - 151 0.60 1956 - - 26 0.10 1957 - - 33 0.13 1958 - - 20 0.08 * Prior to 1947, rates only available for Census years. 131 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1958 to 31st December, 1958:- TABLE I. Formal Notification Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1. 2- 5- 10- I5. 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males 2 - 2 2 2 7 6 18 15 7 12 5 - 78 Respiratory, Females - 1 1 2 3 10 6 14 9 6 6 3 1 62 Non-Respiratory, Males - - - - - - - 3 1 1 - - 2 7 Non-Respiratory, Females - - 1 1 1 1 2 2 2 3 - 1 - 14 132 TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1958 to 31st December, 1958, otherwise than by formal notification: - Source of Information Number of cases in age Groups 0. 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- TOTAL Death Returns from Local Registrars Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - 1 - - - 1 2 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - 1 - - 1 (D) Death Returns from RegistrarGeneral (Transferable Deaths) Respiratory M - - - - - - - - - - - - 1 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable Deaths) Respiratory M - - - 1 2 1 11 26 5 5 3 2 - 56 (A) F - - - 1 1 1 8 30 4 4 1 - - 50 (B) Non-Respiratory M - - - - - - - 1 1 - - - - 2 (C) F - - - - - - - - - - - - - - (D) Other Sources Respiratory M - - - - - - - - - - - 1 1 2 (A) F - - - - - - - - 1 - - 1 l 3 (B) Non - Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - 1 - - - 2 (D) 133 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1958 2,026 Transfers in from other areas 99 "Lost sight" cases returned during the year - New cases diagnosed as definite during the year 153 2,278 Number of cases written off the Chest Clinic Register during the year as:- Recovered 52 Died 41 Removed to other areas 113 "Lost sight of" and other reasons 22 228 Remaining on Register as at 31st December 2,050 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 2,812 Number of visits paid by Clinic doctors to homes of patients 356 Number of visits paid to homes of patients by Tuberculosis Health Visitors 3,920 Attendances of patients at the Clinic- At ordinary sessions 19,260* At refill sessions 698 19,958* Number of X-ray films taken 19,568 *includes 3,926 miniature film attendances 134 VENEREAL DISEASES - NEW CASES 1938-1958 135 VENEREAL DISEASES Totals Males Females  SYPHTI.TS 1 Patients under treatment or observation on January 1st 76 39 37 2. Patients removed from the Register In previous years who returned during the year for treatlent or observation of the same condition 3 1 2 3. Patients transferred from other centres after diagnosis 6 - 6 4 Patients dealt vlth for the first time (excluding 2 and 3) suffering from:- (Syphilis, primary 1 1 - "secondary - - - " latent In the 1st year of Infection - - - "cardio-cascular of the nervous system 1 - 1 All other late or latent 'stages 7 - 7 'Syphilis congenital: aged under 1 year - - - (Syphilis congenital: (aged 1 but under 5 - - - (Syphllls congenital: (aged 5 but under 15 - - - Syphilis congenital: aged 15 and over 1 1 - TOTAL Item 4 10 2 8 5. Patients completing treatment and/or observation 19 8 11 6. Patients transferred elsewhere - - - 7. Patients not completing treatment and/or observation 3 - 3 8. Patients under treatment or observation on December 31st (should equal Items 1 to 4 less Items 5 to 7) 73 34 39 9. Patients under treatment or observation on January 1st 14 9 5 GONORRHOEA 10. Patients removed from the register in previous years who returned during the year for treatlent or observation of the same condition 3 3 - U. Patients transferred from other centres after diagnosis - - - 12. Patients dealt with for the first time (excluding items 10 and 11) 86 65 21 13. Patients completing treatment and/or observation 79 63 16 14- Patients transferred elsewhere 2 - 2 15- Patients not completing treatment and/or obser- vation 8 6 2 16 Patients under treatment or observation on December 31st (should equal Items 9 to 12 less Iteas 13 to 15) 14 8 6 136  Totals Males Females 17. Patients under treatment or observation on January 1st 39 22 11 18. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 15 14 1 19. Patients transferred from other centres after observation 2 2 - 20. Patients dealt with for the first time (excluding Stems 18 and 19) suffering from:- ( Chancroid - - - OTHER CONDITIONS ( Lymphogranuloma ( Venereum - - - ( Granuloma Inguinale - - - ( Non-Gonococcal ( Urethritis 60 60 - ( Any other conditions ( requiring treatment 127 77 50 ( Conditions not requiring ( treatment 244 130 114 ( Undiagnosed conditions - - - TOTAL Item 20 431 267 164 21. Patients completing treatment and/or observation 428 266 162 22. Patients transferred elsewhere 7 4 3 23. Patients not completing treatment and/or observation 21 15 6 24. Patients under treatment or observation on December 31st (should equal Items 17 to 20 less Items 21 to 23) 31 20 11 ATTENDANCES By PATIENTS At which patients saw physician Syphilis Gonorrhoea Other conditions 188 86 102 359 296 63 1265 9 17 348 TOTALS 18 12 1299 513 At which patients saw physician Syphilis Gonorrhoea Other Conditions 739 161 578 104 30 74 586 242 344 TOTALS 1429 433 996 CONTACTS ATTENDING FOR EXAMINATION REFERRED BY PATIENTS SUFFERING FROM:- Syphilis Gonorrhoea Non-gonococcal Urethritis Other Conditions 3 2 1 32 29 3 14 14 - 51 41 10 TOTALS 100 86 14 — 137  By the Physician at the Centre Sent to a Pathological Centre PATHOLOGICAL WORK NUMBER OF SPECIMENS EXAMINED Microscopical: for Syphilis - 6 Microscopical: Others - 698 Cultural - 444 Serum: for Syphilis - 604 '' others - 294 Cerebro Spinal Fluid (Number of diagnostic lumbar punctures) - 4 SERVICES RENDERED AT TOE TREATMENT CENTOE DURING THE YEAR SHOWING TOE AREAS IN WHICH PATIENTS DEALT WITH FOR THE FIRST TIME (ITEMS 4, 12 AND 20) RESIDED (MAJOR AREAS TO BE SPECIFIED. MINOR AHEAS MAY BE GROUPED AS ALL OTHERS") County, County Borough (England and Wales) and Others Syphilis Gonorrhoea Other Condi tions To t ai s Croydon 8 63 304 375 Surrey - 16 84 100 Kent - 2 20 22 London 2 5 23 30 Totals (to agree with Items 4, 12 and 20) 10 86 431 527 138 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1958 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, 1958, it is appropriate to comment that this is the fiftyfifth Annual Report to the Croydon Education Committee. The Chief Medical Officer of the Ministry of Education noted in his Annual Report for 1957 the fiftieth anniversary of the School Medical Service, the Medical Inspection Clauses of the Education (Administrative Provisions) Act, 1907, having become operative in January 1908. In Croydon, however, the Medical Officer of Health was appointed Medical Officer of the Croydon School Board in 1901 and the relevant Council Minutes state that this continued arrangements, which had been in operation for some years. It is not, however, until 1900 that any comment on "school hygiene" appears in the Annual Report of the Medical Officer of Health. In 1904, there is for the first time a "Report to the Education Committee". It is, therefore, not easy to decide on an anniversary date, but it may be of some interest to compare 1908 with 1958. 2 Firstly, similarities - In 1908 the School Medical Officer wrote:- "Speaking generally the newer schools are excellent and with the exception of-schools about to be closed, even the older buildings are free from the grosser defects. With respect to the newer schools, these are buildings of which the borough can justly be proud and I have heard nothing but praise from numerous representatives of local authorities who have accompanied me in my visits to these schools. " "The assistance rendered by a large majority of teachers has been invaluable and I cannot speak too highly of the judgment and tact which have been displayed in connection with our work in the schools. " "The provision of a quiet suitably lighted and warm room with washing appliances in each school would materially lessen the difficulties of all concerned with medical inspection." Secondly, differences - Later in my Report, I give the causes of death of school children and averages of height and weight for 1908. In that year, 13% of children were recorded as unclean (lice and/or fleas) - a figure said to "considerably understate the actual amount of uncleanliness as we were informed the children and their clothing had been specially prepared for the medical inspection." As judged by "nits only", 40% appeared to be a fair figure for infestation. Ringworm gave much trouble, some 350 cases of infection being reported. 80% of children required dental treatment, 5% urgently. 2% of children inspected had chronic discharging ears. Finally to comfort those who feel that current improvements in physical health have been outweighed hy more mental illness, maladjustment and delinquency, there is a note in the Report for 1908 regarding - "Truants - 29 children were examined before despatch to truant schools and the necessary certificates given to the Police. " Against this background, 1958 was a year of quiet progress impeded by difficulties in staff recruitment, to which reference is made in various sections of the Report. It must be admitted that visits to schools for medical and other inspections, vaccination against poliomyelitis and to give B.C.G. vaccine occasioned more than usual interference with school routine and I can only re-emphasise the praise of the majority of school teachers as recorded over 50 years ago. 3 The Chief Education Officer and members of his staff have as always been most helpful and as usual, the Education Committee with sympathy and understanding have given the support and encouragement which makes this work possible. Public Health Dept., Croydon. 4 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) - (38%) *Dental Officers 10 (including 4 part-time) - (80%) Physiotherapists 2 Speech Therapists 3 (including 1 part-time) *School Nurses 32 (including S. H. V. and Deputy- (56%) *Dental Attendants 12 (including 5 part-time) - (80%) *Performing also duties in other sections of Public Health Department. Percentages in brackets show proportion of time given to school vork. 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 hy the School Medical Officer: - Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon. (Dally, Monday to Saturday, a.m.). Ashburton School, Shirley Road, Croydon. (Monday and Thursday, 9 a.m.) Rockmount School, Rockoount Road, Upper Norwood. (Monday and Thursday, 9 a. m.) Duppas school, Goodvln Road, Waddon. (Dally, Monday to Friday, a.m.). Salcot Crescent, New Addington. (Dally, Monday to Friday, a.m.) Dental Lodge Road, Broad Green, Croydon. 206, Selharst Road, South Norwood. Valdrons Hall, 55, Duppas Hill Lane, Croydon. Overbury School, New Addington. Strond Green, Shirley Road, Croydon. Inspection Lodge Road, Broad Green, Croydon. Twice weekly. lolsey School, New Addington. Once a month. Rockmount School, S. E. 19. Once a month. Ashburton School, Shirley Road, Croydon. Once a month. Duppas School, Goodwin Road, Croydon. Once a month. Remedial Exercises 47, St.James's Road, Broad Green.Croydon, and Massage Speech Defects 47, St. James's Road, Broad Green, Croydon and at Salcot Crescent, New Addington. Enuresis Lodge Road, Broad Green, Croydon. 5 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is as follows:- Primary and Modern Secondary Schools. (1) Entrants i.e., Children admitted for the first time to a maintained school and not already examined as Entrants, i. e. normally between 5 and 6 years. (2) 8-year-old. i.e., Children in their second year in a Group Junior School, unless previously amined in the Junior School. (3) Entrants to i.e., Children in their first year in a Secondary Secondary School who have not already School been examined as Primary Leavers. (4) *Final i.e., Children in their last year of atten- Leavers dance at a Maintained Secondary School who have not been medically examined in that year. (5) Special i.e., Children of other ages with possible Cases defects and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 10,096 children were examined as compared with 11,195 in 1957, and 5,488 parents attended the examinations. The total percentage of parents attending was 54. 4 against 58.9 last year. See Appendix B Table V. 468 specials and 258 re-inspections of children were carried out. 6 HEALTH EDUCATION IN SENIOR SCHOOLS Report from Miss Elliott:- The one term course of lessons called "Community Health" or "Your Life in Your Hands "continued in two Secondary Modern Boys Schools, one Secondary Modern Mixed School and one Grammar School. It was given to A, B, C and D streams of boys and girls and tried as part of Science, Civics and English courses. We found that it fitted in best as part of the Civics Syllabus, although it was almost as satisfactory when included with English. At first we tried giving simple accurate notes for the children to copy from the blackboard. It took some children so long to copy these and they were so often inaccurate and incomplete that the teaching staff advised that they would learn more if they were set a question each week and were given five-minute tests at intervals during the term. After this many children produced quite good written and pictorial work and certainly showed much interest in the subject. In the Grammar school the course formed part of a pre-nursing year and our department is giving the girls home nursing during the second term and mothercraft in the third term. The school staff covers invalid cookery, anatomy and physiology and other subjects. The work is still experimental but we are most anxious to maintain and expand it. Teaching kits of notes, references and some visual aids have been prepared and we continue to advertise that we are willing to arrange short coaching sessions for any interested teachers. The schools at present are quite happy for public health staff to conduct the lessons - but although the content is considered useful and satisfactory and has survived a full scale inspection by Her Majesty's Inspectors, the subject on the whole is still looked upon as an extra - a frill. However, in spite of the shortage of teachers, the crowded curriculum and examinations we hope this simple and practical preparation for the future will find its way into all secondary schools before long. Illustrated talks to Secondary school children about the risks of smoking continued. There was much give and take during the talks between the children and myself and excellent questions were asked afterwards, ffe still believe that education on this subject is a long-term policy and that the facts should be presented and discussed with children in Secondary schools at least once a year. HEALTH EDUCATION IN SENIOR SCHOOLS Report from Miss Elliott:- The one term course of lessons called "Community Health" or "Your Life in Your Hands" continued in two Secondary Modern Boys Schools, one Secondary Modern Mixed School and one Grammar School. It was given to A, B, C and D streams of boys and girls and tric-fl as part of Science, Civics and English courses. We found that it fitted in best as part of the Civics Syllabus, although it vas almost as satisfactory when included with English. At first we tried giving simple accurate notes for the children to copy from the blackboard. It took some children so long to copy these and they were so often inaccurate and incomplete that the teaching staff advised that they would learn more if they were set a question each week and were given five-minute tests at intervals during the term. After this many children produced quite good written and pictorial work and certainly showed much interest in the subject. In the Grammar school the course formed part of a pre-nursing year and our department is giving the girls home nursing during the second term and mothercraft in the third term. The school staff covers invalid cookery, anatomy and physiology and other subjects. The work is still experimental but we are most anxious to maintain and expand it. Teaching kits of notes, references and some visual aids have been prepared and we continue to advertise that we are willing to arrange short coaching sessions for any interested teachers. The schools at present are quite happy for Public health staff to conduct the lessons - but although the content is considered useful and satisfactory and has survived a full scale inspection by Her Majesty's Inspectors, the subject on the whole is still looked upon as an extra - a frill. However, in spite of the shortage of teachers, the crowded curriculum and examinations we hope this simple and practical preparation for the future will find its way into all secondary schools before long. Illustrated talks to Secondary school children about the risks of sacking continued. There was much give and take during the talks between the children and myself and excellent questions were asked afterwards. We still believe that education on this subject is a long-term policy and that the facts should be presented and discussed with children in Secondary schools at least once a year. 7 It was a great pleasure to make a display of visual aids used during the Community Health course, for St. Andrew's Secondarj Modern School Open Day and encouraging to know how much interest was shown in it. It was an interesting and stimulating experience to work in the schools during the year and I thank the members of the staffs for all their kindness, courtesy and help. INFECTIOUS DISEASES It was a year during which the wort of the schools was disturbed not by an outbreak of serious infection, but by action to prevent such an occurrence. Experience having shown that Salk vaccine for protection against poliomyelitis is safe, every effort was made to vaccinate all the children for whom consent bad been obtained before the end of the school summer term, This would have been impossible to achieve, except through the schools and the help given hy all concerned is greatly appreciated. Sonne dysentery, which had been absent from the borough for many months, returned towards the end of the year mainly in the South Croydon area. It responded to the usual methods of control in this part of the borough, but elsewhere, it was tending to become endemic at the close of year. Findings at Routine Medical Inspections. The figures shown in Appendix B, Table V, follow the usual pattern. I have included a table giving details of children noted at inspection as having had an operation for removal of tonsils and adenoids. This information was collected last year at the special request of the Ministry of Education, who reviewed the findings for the country as a whole. The conclusion to which one is forced by the large variation this revealed between different local education authority areas is that the need varies with the availability of facilities for the operation. It requires much persistance and courage to await the shrinkage of naso-pharyngeal lymphoid tissue, which generally takes place *hen children reach the age of puberty. The role of the School Health service has been to explain to parents what is taking Place when children meet at school for the first time new infections and to recommend deferment of operation in the absence if any complications. This has now become the policy of family doctors and Ear, Nose and Throat Specialists and it is perhaps one occasion when long waiting lists may be an advantage to those thus forced to wait. It might be argued that a minor operation, which can do no harm is surely justified, even if it "V do little good. It is, however, a fallacy that the operation for removal of tonsils and adenoids is entirely free from risk. One Croydon child died last year while being anaesthetised for this operation, and 32 other deaths in England and sales were recorded in 1958 as associated with the operation for removal of tonsils and adenoids. I have knowledge of at least two other such deaths having occurred in Croydon during the period I have been the Princeple School Medical Officer. HEIGHTS AND HEIGHTS Hie figures of average heights and weights are recorded Appendix B, Table II. The post-war trend of yearly increases has ceased and a new level of averages has been reached. In 1954, I showed the difference between 1908, when average figures were firs the corded by the School Medical Officer and this is repeated Appendix B, Table II to cover 50 years. It is true that a very small minority of children are being kept under observation for obesity, but this is surely acceptable price to pay for the remarkable improvement in the nutrition of the majority. VISION TESTS Experience has shown that the eyesight of entrants can tested:- (a) if the child is over five years of age. (b) school attendance has exceeded one completed school ten School nurses use either the "pictorial" or the "E-cards' may be appropriate. Letter cards are useless as apparente there is no teaching of block capitals. Results of these test are given in Appendix B, Table VIII. 9 I have knowledge of at least two other such deaths having occurred in Croydon during the period I have been the Principal School Medical Officer. HEIGHTS AND WEIGHTS The figures of average heights and weights are recorded in Appendix B, Table II. Hie post-war trend of yearly increases has ceased and a new level of averages has been reached. In 1954, I showed the difference between 1908, when average figures were first recorded by the School Medical Officer and this is repeated in Appendix B,Table II to cover 50 years. It is true that a very small minority of children are now being kept under observation for obesity, but this is surely an acceptable price to pay for the remarkable improvement in the nutrition of the majority. VISION TESTS Experience has shown that the eyesight of entrants can be tested:- (a) if the child is over five years of age. (b) school attendance has exceeded one completed school term School nurses use either the "pictorial" or the "E-cards" as may be appropriate. Letter cards are useless as apparently there is no teaching of block capitals. Results of these tests are given in Appendix B, Table VIII. 10 RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1958 WHO HAVE UNDERGONE TONSILLECTOMY Year of Birth Boys Per Cent Girls Per Cent Boys and Girls Per Cent 1953 and later 40 4.8 48 5.9 88 5.3 1952 25 6.1 30 6.7 55 6.4 1951 20 14.6 8 7.5 28 11.5 All Boys 1100 21.5% 1950 136 21.0 159 19.2 295 20.0 1949 133 22. 5 94 17.6 227 20.1 1948 23 19.9 22 22.2 45 20.9 1947 59 29.5 105 25.9 164 27.1 1946 186 30.3 124 27.7 310 29.2 1945 58 24.1 39 28.3 97 28.8 1944 132 29.8 146 31.7 278 30.8 All Girls 031 18.7% 1943 and earlier 288 31.0 156 22.6 444 27.4 All Groups Boys and Girls 2031 - 20.1% UNCLEANLINESS Cleanliness inspections are carried out by the School Nurses each term in every school, so that all pupils are brought under review. Hie 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. 11 Number of children inspected for cleanliness (first inspection) 51,953 Number of children inspected (subsequent inspections) 878 Number of children found unclean (first inspection) (508 occasions of infestation) 360 Number of occasions in which children found unclean (subsequent inspections) 135 At the primary inspections vermin were found in 22 and nits alone in 486 children. On these inspections 1.0 per cent, of the children showed evidence of infestation as against 0.9 in 1957. 26 children attended the Cleansing Station for treatment for verminous conditions and 2 for scabies. 12 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis:- Pulmonary 9 Non-Pulmonary 2 Taking the total child population at 39,500, the pulmonary tuberculosis incidence rate per 100,000 was 22.8, and the nonpulmonary incidence rate 5.1. There were no deaths from tuberculosis. While the non-pulmonary rate is the lowest on record, the incidence of pulmonary tuberculosis shows an increase from last year's record low figure. Our aim is a "nil" return for both categories and for the indigenous population is capable of achievement in the near future. CAUSES OF DEATH IN SCHOOL CHILDREN The number of deaths and the death rate are the lowest ever recorded. For comparison is set out the same item for 1948, which was not an abnormal year. It is deaths from the infectious, and rheumatic heart, diseases which have disappeared over the last decade. (For comparison the figures for 1908 are also included). Leukaemia and cancer deaths in school children show no increases as far as local figures are concerned, which perhaps allays certain fears connected with the increased interest in radiation background. For table re deaths in school children see Appendix C. CHIEF CAUSES OF EXCLUSION FROM SCHOOL Condi tion Exclusions during 1958 Percent age of total exclusions Exclusions during 19 57 Percentage of totai exclusions Ringworm - _ 2 0.11 Verminous Conditions 20 3.03 50 2.79 Impetigo - - 3 0.17 Scabies 1 0.15 - - Scarlet Fever 107 16.19 102 5.69 Measles (inc. German) 199 30.11 1,066 59.49 Diphtheria - - - - Whooping Cough 8 1.21 68 3.79 Chicken Pox 92 13.92 85 4.74 Mumps 85 12.86 304 16.96 External Eye Disease - - - - Poliomyelitis - - 10 0.56 Dysentery 144 21.79 83 4.63 Jaundice 4 0.61 8 0.46 Enteric Group - - 3 0.17 Meningococcal Infection 1 0.15 3 0.17 Other Causes - - 5 0.28 661 1,792 13 The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Scarlet Fever, Chicken Pox and Dysentery, whilst the remainder all show a decrease. Measles remained the most frequent recorded cause of absence from school WORK OP SCHOOL NURSES All the School Nurses whose work is set out below are also Health Visitors and are thus able to judge tay 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 519 Visits re Scabies 2 Visits re Infectious Disease 144 Visits re Medical Inspections 527 Visits re Medical Preparations 499 All other reasons 626 Home Visits Concerning defects found at routine medical inspections 517 Subsequent visits re defects found at routine medical inspections 198 Visits re special cases 474 Visits other than infectious cases 913 Visits in connection with infectious cases 795 14 TREATMENT The Work of the School Clinics SUKJIARY OF ATTENDANCES 1958 1957 ase or decrease Minor Ailments and Verruca Clinics 7,607 8, 165 -558 Inspection Clinic 390 605 -215 Dental Clinics 24,030 25, 274 -1244 Remedial Exercises Clinic 5.468 6.320 -852 Enuresis clinic 619 746 - 127 38,114 41, 110 -299 6 1,938 attendances; at Rockmount School 179 defects, 904 attendances; and at Addington 76 defects, 321 attendances. Complaiat 1958 1957 Cases Attendances Average No. of Attendances per case Cases Attendances Arerage No. ol Attendances per case Ringworm 1 1 1.0 2 5 2.5 Scabies 1 1 1.0 1 4 4.0 Impetigo 8 53 6.6 17 149 8.8 Other Skin Diseases 10 18 1.8 5 50 10.0 Otorrhoea and other Ear defects 24 10 5 4.4 14 118 8.5 External Eye Disease 78 182 2.4 40 307 7.7 Miscellaneous 1,484 4,594 3.1 454 5.123 11.3 1,606 4,956 3.1 533 5,756 10.8 The Minor Ailments Clinics At the Lodge Road Clinic 377 defects involved 3,009 attendances, while at the subsidiary Clinics held at Ashburton School 472 defects, 1,435 attendances; at Duppas School 676 defects, 15 SCHOOL DENTAL SERVICE Report of the Principal School Dental Officer, P. G. Oliver, Esq., L. D. S. This Service provides routine inspection and treatment for those attending Borough Primary, Secondary, Technical and Special Schools. A limited number of children from "grant aided" 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 Although inspection results for the Borough as a whole have shown a nett increase during the past year, treatment arrangements for a considerable portion of the local Service have been seriously complicated by the enforced closure of the New Addington clinic, and coverage in this district has remained relatively poor. As already forecast the unexpected loss of treatment facilities in this area with an abnormally high acceptance rate was bound to produce administrative difficulties of some magnitude, the results of which could not be confined to the district primarily concerned. Though interim arrangements for using one of the surgery units at the Shirley Road Centre were instrumental in maintaining an essential service for those on the Building Estate, a very extensive scheme of "redeployment" was immediately called for to meet the requirements of the many Senior Departments normally served by the above Centre. This problem could only be solved by means of multilateral arrangements for treatment at neighbouring clinics. In practice steps taken to "cushion" the effects of such moves proved remarkably effective, and had it not been for transport difficulties caused by the prolonged ' bus dispute, which caused many broken appointments, there would have been little loss of operative time during this period. As with "improvisions" of this sort there have been reports of some unavoidable "repercussions" from certain areas affected, and it will take some time for conditions in the Service to regain their former equilibrium. 16 Since the beginning of the year the scheme for the readaption of the Overbury Clinic has been pressed forward and the additional surgery accommodation now available should considerably increase the potential output from these premises. Onfortunately, continued work of reconstruction of the main school made it impractical to reoccupy the clinic until the early Autumn. Since that time the principal surgery has again been fully operational whilst the ancillary room, because of staffing difficulties, has been compelled to function on a part time basis. The introduction of the second surgery has meant a substantial loss in waiting room accommodation; however, structural improvements and added sources of heating in the outer corridor will, it is hoped, largely make good the lost amenities. Because of impending developments on the Waldrons Hall site the occupation of these premises must be considered of limited duration. Efforts to secure alternative accommodation in the neighbourhood have so far met with little success, and it is probable therefore that arrangements for future treatment will have to be considered in conjunction with one of the proposed school buildings. Staffing Though the current reduction in the acceptance rate has eased the situation in certain areas, the scheme is still dependent on help from part-time dentists to maintain the present level of treatment. Further deployment of existing staff is being considered to relieve hard pressed areas, but this is only possible within certain limits as frequent changes in personnel are apt to detract from the personal character of the Service. Orthodontic Ihit The Orthodontic Specialist reports a very substantial increase in the number under treatment. The list of those waiting correction has now been reduced to reasonable proportions. Since the completion of the second surgery at the Overbury School, weekly visits have been initiated at this clinic. An XRay machine has now been installed at these premises, making the full range of diagnosis available. Full details of the work carried out in this unit will be found in a later stage of the Report. 17 Dental Health Education Because of present staffing limitations little time can be spared from the chairside for public talks on dental matters and it is felt that activities of this sort are best left to be conducted through other available media. Since her appointment to the Health Department a useful liaison has existed with the Health Education Officer, and instruction on the practical aspects of Oral Hygiene is now included in the Syllabus of General Health talks at schools; when time permits this is also supplemented by the showing of appropriate dental films. At the recent Local Government Exhibition a display panel was included on "Decay Prevention ; a colour film on this subject was also presented during the week. Inspections The number of children on the register at maintained schools within the Borough at the close of 1958 was 37,116. Including an additional 49 scholars at grant assisted schools this represents a sum total of 37,165. During the year 85 per cent, of the school population were examined, compared with 82 per cent, in 1957. Despite this increase in overall coverage frequency of inspection in areas of high acceptance is well below this level, whilst in the New Addington district there has been an understandable decline. According to recent returns some 3,737 children received no examination during 1958, compared with 5,145 last year. At those schools visited 31,574 were inspected and 14,789 (46.8 per cent.) referred for treatment, compared with 30,553 inspected and 15,024 (49.2 per cent.) referred in 1957. As is customary at these inspections certain discrimination is observed in the matter of selecting cases for treatment and the above figures should not therefore be regarded as an index of the actual incidence of decay. The results obtained from school inspections were as follows: Acceptance of Treatment 41.4% Refused Treatment 45.2% Forms Not Returned 13.4% Compared with last year this represents a fall of 3.1 per cent, in the acceptance rate, and a total decrease of some 32.7 Per cent, since the peak of 1949. If for further comparison the figure of 58 per cent, acceptance is taken to represent conditions during the pre-war period, it is interesting to not that the present decline appears to be one of approximately 17 per cent. 18 Acceptance Rate As reported previously the recorded drop in the acceptance rate has come about as a direct result of the introduction of priority treatment for children under N.H.I, regulations. This trend is most discernable in areas well served by private practice. Advantage is being taken of this fact to carry out a general re-grouping of existing treatment areas in the School Service, and so make increased staff available for the new undermanned part of the Borough. RESULTS OP SCHOOL INSPECTIONS 1958 1957 1953 1949 1937 No. referred for Treatment 14,789 15,034 14,998 9,404 13,498 Consents 6, 114: 6,692: 8,854: 6,996: 7,762: 41.4% 44. 5% 59% 74. 1% 57.71 (Total Consents Including (8,188: (9,366: (12, 496: (10,098: (10,146: Specials)* 48.5%) 52.9%) 66.1%) 80.7%) 63%) Refusals 6,689: 6,516: 4.496: 1,213: 3,242: 45.2% 43.4% 30% 12.9% 24% Forms not returned 1,986: 1,816: 1,648: 1,195: 2,494: 13.4% 12.1% 11% 12.7% 18.51 • SPECIALS - Those referred by Head Teachers with Emergency Forms Treatment Of 16,863 children referred for treatment (including specials) 8,978 (53.2 per cent.) were treated and 6,617 (39.2 per cent.) cured completely, compared with 17,698 referred, 8,904 (50.3 per cent.) treated and 7,161 (40.5 per cent.)cured in 1957. Treatment sessions decreased from 2,891 to 2,761, principally because of a reduction of sessions by part-time dentists. Except for a more general application of the principle of prior treatment planning in the mouth, referred to in last year's paragraph, little else of special clinical interest can be reported. Ontil the needs of each respective area can be more effectively met, all available energy is being concentrated on the provision of an adequate basic treatment. 19 Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year.- 1958 1957 Attendances 24,030 25,274 Treated 8,978 8,904 Re-treated 4,638 4,720 Fillings - Permanent 8,745 9,032 Temporary 1,515 1, 858 No. of Teeth Filled: Permanent 8.261 8,528 Temporary 1,444 1.785 Extractions - Permanent 2,655 3.153 Temporary 6,450 7,542 Gas Administration 3,719 4,360 Local Anaesthetics 577 881 Other Operations- Permanent 9,540 9,818 Temporary 893 1,006 Cases Completed 6,617 7,161 Miscellaneous Items These include:- 1958 1957 Root treatment in anterior teeth 14 6 Removal of nerves under local anaesthetic 7 3 Removal of bone sequestra 6 21 Splints for fractured incisors 2 6 Partial pulpotomy - 1 Number of M.D. s treated 12 24 Dentures inserted 48 62 Denture repairs 11 13 After treatment of sockets, etc. 38 35 Removal of impacted and difficult teeth 69 68 Ulcerated stomatitis (Vincent's infection) 6 3 Cleft Palate cases 4 1 Application of Penicillin "Cones" 45 23 Acrylic caps for incisor teeth 10 13 20 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 2,074 compared with 2,674 in 1957. X-Ray Examination The number of cases referred for the above purpose was 396 compared with 431 in 1957. This includes 137 taken at Mayday Hospital. Orthodontic Treatment The number of sessions devoted to this work was 446, compared with 465 last year. Remarks concerning the more recent developments in this section will be found earlier in this Report. The following is a summary of treatment performed:- 1958 1957 Consultant D.O.s Total Cases commenced during the year 203 80 283 342 Cases carried forward from the previous year 433 87 520 353 Total 636 167 803 695 Cases completed during the year 77 57 134 148 Cases discontinued during the year 94 26 120 65 Pupils treated with appliances 261 100 361 368 Appliances - Removable 313 118 431 421 Fixed 61 15 76 40 Total Attendances 3,327 1,582 4,909 4,840 Cases treated by extraction only 9 140 149 179 Cases referred to Specialist for Consultation 211 - 211 271 Treatment Sessions 313 133 446 465 Treatment of "Free-Place" Scholars As previously stated, all children in the Borough Secondary Technical Schools have now been included within the routine scheme of treatment. Pupils previously attending Primary Schools who enter certain "grant-aided" schools do however continue to attend the school clinic for treatment. 21 A summary of the work performed for the above children is given below:- 1958 1957 Attendances 92 98 New Cases Treated 14 8 Re-treated 35 38 Fillings - Permanent 59 54 Extractions - Permanent 28 15 Temporary 5 10 Other Operations 18 13 "Gas" Cases 15 10 Local Anaesthesia 5 10 Cases Completed 37 32 Dentures Pitted 5 1 Referred X-Ray 3 2 See Appendix B, Table IX. 22 SPINAL AND OTHER REMEDIAL CLINICS 1958 1957 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 2,348 606 3.9 2,791 688 4.1 Plat Feet 2.462 558 4.4 2,629 480 5.5 Breathing 658 135 4.9 900 196 4.6 5,468 1,299 6, 320 1,364 255 individual cases were treated and 533 examinations were made by doctor. Cost of the School Health Service The gross cost of the medical, dental and nursing services was £50,293. The expenditure is subject to Education grant. Cost of special Schools £ Schools maintained by the Council 37,826 Other Schools (not maintained by local Education Authorities) 12,166 Adjustments with other authorities in respect of Special Schools, at rate cost 4,733 £54,725 With the exception of the £4,733 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals Meals and Milk cost £393,109. Income from payment for meals was £155,076, making a net cost of £238,033, on which grant is paid of 100 percent, on approved expenditure. 23 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED AND DELICATE CHILDREN I am indebted to the Head Teacher, Miss Lambert, for the following report:- This year we have again endeavoured to carry out our purpose of keeping our work in the main stream of school and community life in Croydon. The curriculum is framed to make entry to, and transfer from, the school as little disturbing as possible to the individual child. Association with other schools has been much enjoyed in such activities as training for and singing at the schools' Carol service and Music Festival, attending the Saturday Horning Concerts and the Ballet Performance at the Davis Theatre; and in entries sent to the Handicrafts Exhibition. The gifts at the Harvest Festival were even more generous this year and were again taken to our old friends at Cranleigh. Senior pupils were most interested in their visit to the Town Hall during Local Government week 'Everybody's Business'. Pupils of appropriate age sat the Transfer Test Examinations and Senior pupils have been successful in the examinations of the Royal society of Arts. The welcome advent, in September, of Mr. R.P. Brown to the Staff has enabled us once more to devote proportionate time and attention to Arts and crafts as well as to further academic work and to Physical Education. The latter has Included normal and special remedial exercises, football, cricket, tennis, hockey, netball and field sports. Our Summer Sports Meeting, attended by 200 parents and friends, was again honoured by the presence of Alderman Cole and of Mrs. Cole who kindly presented the Sports Cups. Attendances twice-weekly after school at the Swimming Baths by an average of 26 boys and girls and 3 staff were sadly curtailed during the weeks of the 'bus strike although the following results were obtained:- 3 x 440 yds., 4 x 220 yds., 2 x 100 yds., 3 x 50 yds., 3 x 20 yds. Transfers to other schools of children no longer in need of special educational treatment numbered 21. 17 boys and girls left school during the year for work; and in this connection the conferences between them, their parents, the attached Medical officer and the Head Teacher have proved, increasingly, their value, to all concerned. we are much Indebted to the Youth Employment Officers for their work for our boys and girls throughout the year. Among the happy events of 1958 has been the School Prize Giving and Christmas Party attended by Alderman Cole and Mrs. . Cole and Mrs. J.J. Cooper. Alderman Cole presided and Mrs.Cole presented the prizes, again autographing the special prizes given by her for service to the school. Very much enjoyed were the Parents' Social attended by 170 guests; the Old Scholars' Re-union, and the visit of the Senior Girls from Croydon High School, who later entertained fifty of our youngest children at a most happy party at their school. The Croydon Federation of Street Traders again gave to the children of the whole school a delightful party and very generous Christmas gifts. 24 We have been happy to welcome many visitors during the year Alderman Dammarell honoured us by spending a morning with us during his Mayoral Year; and among visitors from abroad were Hr. Halfdarnanson and Mr. Kristensson from Iceland and from Germany Dr. stieve. Mayor of zehlendorf, and Mrs. stlieve. The success of the Old scholars in their several callings, and their maintainance in health, continues to give us ouch encouragement. DISABILITIES AND TREATMENTS Of the 198 children on roll. 73 were disabled by poliomyelitis, cerebral palsy, spina bifida, muscular dystrophy, skeletal deformity, tubercular bone disease, and other causes. 95 suffered from cardiac disability or from respiratory diseases. The remainder were delicate from various causes. The following is a summary of Treatment during the year 1358:- Physiotherapy throughout each school day. 3188 treatments. Speech Therapy. 305 Routine Medical Inspections. 17 Number of children examined. 290 Number of parents present. 131 (here again the bus strike prevented attendances) Special Medical Inspections. 6 Number of children examined. 56 Number of parents present. 41 Dental Inspection visits. 2 Subsequent attendances of groups of 12 children at clinics. 9 Children given anti-polio injections. 51 The Nursing Sister, aided in certain duties by the Hale Attendant has carried out preparations for and the follow-up of medical examinations as well as prescribed courses of treatment; has dealt with minor ailments and has kept full records of each child's progress, supervising physical welfare In general as well as taking much interest in the educational progress of the children. Parents, Staff and children extend to Dr. Hegarty very grateful thanks for her skill, sympathy and devoted work in the service of the children. The Head Teacher desires once again 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 1958. Average number on roll 198 To employment 17 To Grammar Schools 3 To Other Schools 17 To Hospitals and Hospital Schools 7 Left district (2 abroad) 5 Further training 4 25 ST. CHRISTOPHER' S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL I am indebted to Mr. Ramsden, the Head Master, for the following observations:- The year 1958 can be called our Jubilee Tear for it was in September 1908 that a Special Class of Backward Children was commenced at whltehorse Road Infants School, and from these beginnings sprang the present St. Christopher's School. It would perhaps, therefore, in this my last Report be fitting to give a short history of the School, showing the progress during the past fifty years, with special reference to my fourteen years as Headmaster. In 1909 this Class was transferred to the Grangewood Mansion and Mrs. Holt was placed in charge. On January 8th 1917, the School was recognised by the Board of Education and Miss Polkinghorne was appointed the first Head Teacher. On May 2nd 1917, a visiting committee was formed by Members of the Education Committee to assist in the social life of the children, to visit homes to see that the teaching given here was not undone out of school hours. April 19 18 saw a Woodwork Class formed to be taken by a nan three mornings a week. On December 1st 1919, Mr. P.W. Longman commenced duties as the first Headmaster; the average attendance at this time was between 50-60. On September 5th 1927, Mr. H.G. Carter commenced duties as Teacher in Charge, later to become Headmaster. On September 8th 1930, Mr. H.J. Edmonds commenced duties as Headmaster; the number on roll at this time being 101, and the average attendance 88. On September 29tb 1933, the School left Grangewood and opened at premises in Mitcham Road. This School was closed in July 1939, and fifty-five children were evacuated to Hopton for the duration of the war. September 1942, saw the school re-opened at the present premises with twenty-one children in attendance. September 12th 1945, I commenced as Headmaster. The highlights of the past fourteen years during which I have served as Headmaster are;- February 5th 1946. December 18th 1946. July 9th 1947. May 1948. September 13th 1948. December 17th 1948. The School kitchen opened; 93 children and 7 staff present. Miss Dickinson, Cook. A Christmas Carol and Tableaux Service introduced to become an Annual Event. An open Day for parents was instituted with a Display of Work, Dancing, Singing, P.E., and a Puppet Show; approximately 100 parents attended. A Swimming class for boys was formed. A day's holiday was granted as a reward for gaining 38 swimming Certificates and 2 Intermediate Life Saving Certificates. Two Bronze Medals awarded by National Life Savings Association. 26 January 21st 1949. April 1949. May 5th 1949. June 27th 1950. July 4th 1950. December 6th 1950. May 1st 1951. May 2nd 1951. May 26th 1951. July 1951. March 11th 1952. June 20th 1955. May 19th-25th 1956. April 30th 1957. June 8th-15th 1957. June 26th 1957. March 28th to April 4th 1958. April 14th 1958. June 2nd 1958. The Headmaster was invited to serve on s Committee to consider and report upon the institution of an Educationally SubNormal diploma course sponsored by University of London. A special commendation awarded to boy for painting submitted to an Exhibition in Croydon School of Art. The school played its first Cricket Match in the Croydon School Cricket League. A day's excursion to Little hampton was revived as a yearly event. The First sports Day was held and became an Annual Event. The Bishop of Croydon (The Rt. Rev. C.K.M. Bardsley) was present at our Carol Service. A Class visited South Kensington Museum, the first time we had undertaken an outside visit. We entered seven children in the Croydon School Sports for the first time. We were invited to give a Display of Folk Dancing, by H.M. Inspector of schools,to illustrate their Course for Retarded Children to Surrey Teachers at Ewell. A display of our first Project on Croydon was held during this month and visited by the Mayor of Croydon, the Chief Education officer and the school Medical Officer and over 450 visitors. This seemed a fitting climax to my six years as Headmaster. The roll now numbered 203 children. A new building for the Infants - two classes - was opened with Miss woolverton in Charge (five children). H.M. Inspectors conducted a full Inspection and expressed complete satisfaction with the work being done and recommended further facilities to be added. First school Journey to the Isle of Wight consisting of a party of 33 children and staff went for one week's holiday at the Riviera Hotel, sandown. School gymnasium fitted with wall bars. A second school Journey to Isle of weight. Our First win in the Croydon schools Athletic Meeting. Our third School Journey to Paignton, Devonshire. New Needlework and Art rooms occupied. The Domestic Science flat occupied. During this year, to mark the Jubilee, we have been working on a Project to illustrate the march of time, and we hope to have an Exhibition during the coming Summer Term. 27 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN 140 children were examined during 1958. The classifications arrived at, together with recommendations made, are as follows:- (1) Pound to be mentally defective: (a) Pound to be mentally defective and referred to Local Authority and Occupation Centre 5 (b) Pound to be mentally defective and referred to Local Authority for Statutory Supervision 7 (c) Recommended Institutional Care and referred to Local Authority 1 (2) Pound to be educationally sub-normal: (a) Recommended to St. Christopher's Special School 32 (b) Recommended to Residential School 2 (3) Other Recommendations: (a) Referred to Slow Stream in Ordinary Elementary School 13 (b) Recommended for re-test 17 (c) Deferred for Medical Treatment 10 td) Recommended for St. Giles' 1 (e) Recommended for St. Lukes' 2 (f) Recommended for Epileptic Colony 1 (g) Referred back to Ordinary Elementary School 17 (h) Referred to Child Guidance Clinic 8 (4) Examined for other Authorities 116 Mental Tests at St. Christopher's 24 140 8 home visits have been paid to Education cases. 28 ST. LUKE'S SCHOOL FOR THE PARTIALLY SIGHTED I I am indebted to Miss J. Rundle, the Teacher-in-Charge, for the following observations:- Throughout 1958 steady progress continued in all school subjects. The senior girls attended Ecclesbourne School for Domestic Science and the boys now attend St. Christopher's School for woodwork, we are grateful to the Head Teachers and Members of Staff of these schools for their Interest In our boys and girls. Once again on Open Day we were very pleased to have Councillor Mrs. Maycock with us as well as many parents and friends We were pleased to welcome Mr. Moody, H.U.I, for Special Schools and also Miss Deavin, H.M.I, who is especially interested in Schools for the Partially sighted and whose guidance and helpful advice was much appreciated. There were many other visitors during the year. During 19 58 the first of the twice-yearly eye examinations to be held at the school took place. The parents are invited to attend these examinations and we hope that they will provide a closer link with the Ophthalmologist, the school and the home. We should like to record our appreciation for our new furniture. The new desks are proving very beneficial as they have been designed to meet the needs of partially sighted children. The Harvest Festival in September brought forth a generous number of gifts which were distributed to many elderly people. Ho children left the school during 1958 as the majority of the children are in the younger age groups. The Autumn Term ended with an enjoyable Christmas Party and Carol Service which was attended by several parents and friends The number on roll was 21 on December 31st, 1958. 29 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1958 as to their fitness to undertake the part-time employment indicated:- 195S 1957 1956 1955 1954 Delivery of Goods for Shopkeepers 43 62 62 86 122 Delivery of Newspapers 394 344 365 364 501 Delivery of Milk 13 15 13 17 33 Shop Assistants 64 53 61 67 48 514 474 501 534 704 THE PROVISION OP MEALS AND MILK AND COD LIVER OIL AND MALT During 1958 all milk was supplied free of charge and approximately 29,300 children per day received one-third of a pint each in Maintained Schools. This was equal to 85% 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 5,500 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 1958 was approximately 17,000. CHILD GUIDANCE CLINIC Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1958. Boys Girls Total Total number referred 19 12 31 Analysis of the above Cases:- Diagnostic only 2 2 4 Current Cases under treatment 12 4 16 Cases Closed - improved 2 6 8 Cases Closed . not improved 3 - 3 19 12 31 30 The details of the work carried out are shown in Appendix Table X. This table represents, of course, only a part of the work done by the Croydon Child Guidance Clinic. At present the clinic is still located at 103, Park Lane. It is maintained 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 1958, a total of 212 new cases were registered for treatment. SPEECH THERAPY. Changes of staff are inevitable in any service, but during the year under review, the work of the Speech Clinics was more disturbed than usual hy such difficulties. An attempt was made by a dual appointment with the Croydon Hospital Management Committee to link School and Hospital Speech Therapy Clinics. This was achieved with undoubted benefit to the patients, but unfortunately, only for a few months. A room was especially adapted for a Speech Therapist in the premises at New Addington, which house also Maternity and Child Welfare and School Minor Ailment Clinics. A daily Speech Therapy session which meets a real need in the New Addington area was thus made possible. Regular sessions were held at the day school for handicapped children and at the school for educationally sub-normal pupils. Visits to other schools for discussion with teaching staff were also carried out. The increase in establishment to the equivalent of three whole-time speech Therapists allowed such a proper deployment of resources, only handicapped by staff changes. Total number of cases treated 315 Total number of cases discharged: Cured 78 Improved 27 117 Non attended 12 Total number of cases still attending 198 31 ENURETIC CLINIC During 1958 114 children attended the Enuresis Clinic held at Lodge Road and New Addington. Over twice as many boys as girls were treated. This preponderance of boys over girls has been noted repeatedly in Clinics both in this country and the United States. 35 of those who attended had been treated previously with some form of drug mainly of the amphetamine group but several had received treatment with pituitary snuff. Treatment with mild psychiotherapy and a Lactose placebo was successful in the majority of cases but the Electric Buzzer machines were invaluable in those cases which did not respond or relapsed with this treatment, and 33 children used the machines during the year. 69 children were discharged dry during the year. There were 59 new cases and of these 43 were still attending at the end of the year. Some of them had only been attending for a short period and a few were irregular or poor attenders. Two cases of buttock rash were reported among children using the Enuresis machine. In one case it cleared up quickly and did not interfere with the treatment. In the second case treatment was discontinued. Number of children attended 114 Number of new cases 59 Number discharged dry 69 Number of children using machine 33 Number still attending 43 EPILEPTICS 32 epileptics were known to the School Health Service as at 31.12.58. Of these: 16 were attending Ordinary School 6 were in Day School for Physically Handicapped and Delicate Children 1 was 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 1 at Queen Mary's Hospital) 1 was at the Occupation Centre 1 was in Residential School (St. Elizabeth's) 1 was at Private Day School 32 SPASTICS 54 Croydon Spastics were receiving education as at 31.12.58. 2 children received Home Teaching. 23 were attending St. Giles' School 2 were attending St. Margaret's School, Croydon 4 were at Residential Schools for Physically Handicapped children 2 were attending a Day School for Partially Deaf children 2 were attending a Residential School (St. Mary's Bexhill) 6 were attending ordinary school 1 was attending Myope School 2 were attending St. Christopher' s School 2 were attending normal Private School In addition, 1 child of school age had not been considered suitable for school but was still under review. A further 7 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 1958, 193 children were examined at routine examination and also 1 special and 1 re-examination. Appendix C gives the detailed findings. Yours faithfully, S.L. WRIGHT, School Medical Officer. 33 STATUTORY TABLES APPENDIX A MEDICAL INSPECTION RETURNS Year ended 31st December, 1958. PART 1. - MEDICAL INSPECTION OP PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS Table A. - Periodic Medical Inspections Age Groups Inspected (By year of birth) (1) No. of Pupils Inspected (2) Physical Condition of Pupils Inspected SATISFACTORY UNSATISFACTORY No. % of Col.2 No. X of Col. 2 (3) (4) (5) (6) 1954 and later 30 30 100.00 NIL - 1953 1,625 1,608 98.95 17 1.05 1952 855 840 98.25 15 1.75 1951 243 241 99.18 2 0.82 1950 1,474 1,460 99.05 14 0.95 1949 1. 127 1. 123 99.65 4 0. 35 1948 215 212 98.60 3 1. 40 1947 606 606 100. 00 NIL - 1946 1.062 1,059 99.72 3 0.28 1945 337 334 99. 11 3 0.89 1944 903 898 99.45 5 0.55 1943 and earlier 1,619 1,618 99.94 1 0.06 TOTAL 10.096 10,029 99.34 67 0.66 34 Table B. - Pupils found to require Treatment at Periodic Medical Inspections. (Excluding Dental Diseases and Infestation with Vermin) Age Groups Inspected (By fear of birth) For defective vi si on (excluding squint) For any of tie other conditions recorded in Part II Total individual pupils (1) (2) (3) (4) 1954 and later 1 3 4 1953 49 110 151 1952 47 60 103 1951 9 18 27 1950 85 110 189 1949 63 90 147 1948 10 13 23 1947 28 45 70 1946 46 70 110 1945 13 21 32 1944 44 41 82 1943 and earlier 85 55 131 TOTAL 480 636 1,069 Table C. - Other Inspections Number of Special Inspections 810 Number of Re-inspections 1,458 Total 2,268 Table D. - Infestation with Vermin (a) Total nunber of individual examinations of pupils in schools by school nurses or other authorised persons 52,831 (b) Total number of individual pupils found to be infested 364 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act,1944) 1 (d) Number of individual pupils in respect of whom cleansing orders were issued (section 54(3), Education Act, 1944) 1 35 PART 2 TABLE A. RETURN OP DEFECTS POUND BY MEDICAL INSPECTION Defect Code No. Defect or Disease Periodic Inspections Entrants Leavers Others Total Treatment Observa tion Treatment Observa tion Treatment Observa tion Treatment Observa tion (l) (2) (3) (4) (5) (6) (7) (8) (9) (10) 4 SKIN 8 4 3 2 17 5 28 11 5 BYES - (a) Vision 97 37 129 13 254 81 480 131 (b) Squint . 14 7 2 1 13 9 29 17 (c) Other 1 2 - - 6 1 7 3 6 EARS - (a) Hearing 5 21 4 2 17 9 26 32 (b) Otitis Media - 4 3 2 3 12 6 18 (c) Other - - - - 1 1 1 1 7 NOSE AND THROAT 72 68 3 3 45 45 120 116 8 SPEECH 18 16 2 - 10 7 30 23 9 LYMPHATIC GLANDS - 4 - - - 4 - 8 10 HEART 6 20 7 8 13 27 26 55 11 LUNGS 8 48 3 1 18 33 29 82 12 (a) Hernia 2 2 1 - 3 - 6 2 (b) Other 1 4 3 2 16 42 20 48 13 ORTHOPAEDIC - (a) Posture 5 6 13 5 60 11 78 22 (b) Peet 12 28 12 7 44 52 68 87 (e) Other 19 50 10 8 41 27 70 85 14 NERVOUS SYSTEM - (a) Epilepsy 1 4 - 1 2 4 3 9 (b) Other - 1 - 1 4 2 4 4 15 PSYCHOLOGICAL - (a) Development 2 2 2 2 1 2 5 6 (b) Stability 4 8 2 - 7 9 13 17 16 ABDOMEN - - - - 1 . 1 - 17 OTHER 15 7 5 5 29 18 49 30 36 TABLE B. SPECIAL INSPECTIONS Defect Code No. Defect or Disease Special Inspections Pupils requiring Treatment Pupils requiring Observation (1) (2) (3) (4) 4 SKIN 3 - 5 EYES - (a) Vision 21 2 (b) Squint - 1 (c) Other 3 - 6 EARS - (a) Hearing (b) Otitis Media - - 1 1 (c) Other - - 7 NOSE AND THROAT 14 2 8 SPEECH 3 - 9 LYMPHATIC GLANDS - 1 10 HEART - 1 11 LONGS 2 - 12 DEVELOPMENTAL - (a) Hernia - - (b) Other 1 - 13 ORTHOPAEDIC - (a) Posture 5 1 (b) Peet _ 1 (c) Other 4 1 14 NERVOUS SYSTEM - (a) Epillepsy - - (b) Other - - 13 PSYCHOLOGICAL - (a) Development 1 - (b) Stability 1 - 16 ABDOMEN - - 17 OTHER 5 2 37 PART 3 TABLE A. - EYE DISEASES. DEFECTIVE VISION AND SQUINT External and other, excluding errors of refraction and squint Number of cases dealt with 78 Errors of Refraction (including squint) 1.711 Total 1,789 Number of pupils for whom spectacles were prescribed 1.198 TABLE B. - DISEASES AND DEFECTS OF EAR. NOSE AND THROAT Received operative treatment Number of cases known to hare been dealt with (a) for diseases of the ear - (b) for adenoids and chronic tonsillitis 290 (c) for other nose and throat conditions - Received other forms of treatment Ear (Minor Ailments Clinic) 24 Total . 314 Total number of pupils In schools who are known to have been provided with hearing aids (a) in 1958 9 (b) In previous years 22 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to bare been treated (a) Pupils treated at clinics or 169 (b) Pupils treated at school for postural defects 22 Total 191 TABLE D. - DISEASES OF THE SKIN (excluding uncle anl ines. for which see Table II) Number of cases treated or under treataent during the rear Ringworm - (i) scalp - (ii) Body 1 Scabies 1 Impetigo 8 10 Total 20 38 TABLE E. - CHILD GUIDANCE TREATMENT Number of cases treated Number of pupils treated at Child Guidance Clinics 31 TABLE P. - SPEECH THERAPY Number of cases treated Number of pupils treated by speech Therapists 315 TABLE G. - OTHER TREATMENT GIVEN Number of cases treated (a) Number of cases of miscellaneous minor ailments treated by the Authority 1,660 (b) Pupils who received convalescent treatment under School Health Service arrangements 15 (c) Pupils who received B.C.G. vaccination 1.598 (d) Other than (a), (b) and (c) above (specify) 1. Enuresis 114 Total (a) - (d) 3,387 39 PART 4. - DENTAL INSPECTION AND TREATMENT (1) Number of pnpils inspected by the Authority's Dental Officers:- (a) At Periodic Inspections 31,574) ,,, (b) As Special 2.074 Total (1) 33,648 (2) Number found to require treatment 18.399 (3) Number offered treatment 16,863 (4) Number actually treated 8,978 (5) Number of attendances made by pupils for treatment. Including those recorded at 11(h) 24,030 (6) Half days devoted to: (a) periodic (school) Inspection 241 lb) Treatment 2,761 TOTAL (6) 3'°°2 (7) Pillings: (a) Permanent Teeth 8.745 (b) Temporary Teeth 1,515 Total (7) 10,260 (B) Number of Teeth filled (a) Permanent Teeth 8,261 (b) Temporary Teeth 1,444 TOTAL (8) 9,705 (9) Extractions: (a) Permanent Teeth 2.655 (b) Temporary Teeth 6,450 Total(9) 9,105 (10) Administration of general anaesthetics for extraction 3,719 (11) Orthodontics: (a) cases commenced during the year 283 (b) Cases carried forward from previous year 520 (c) Cases completed during the year 134 (d) cases discontinued during the year 120 (e)Pupils treated with appliances361 (f)Removable appliances fitted 431 (g)Pixed appliances fitted 76 (h) Total attendances 4,909 (12) Number of pupils supplied with artificial teeth 48 (13) other operations: (a) Permanent teeth 9,540 (b) Temporary teeth 893 Total (13) 10433 40 APPENDIX B Table I AVERAGE NUMBERS AND ATTENDANCE IN MAINTAINED PRIMARY MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS DURING THE YEAR 1958. School Average No. on Registers Average Attendance Average 1958 At tendance % Average 1957 Attendance % COUNCIL PRIMARY Ashburton Junior Mixed 494 463 93.7 91.9 Ashburton Infants 181 163 90. 0 85.3 Benson Junior Mixed and Infants 612 571 93.3 90.9 Beulah Junior Boys 336 311 92.6 84.9 Beulah Junior Girls 289 267 92.4 92.3 Beulah Infants 233 196 84.1 83.1 Castle Hill Junior Mixed . 422 387 91.7 90.0 Castle Hill Infants 400 350 87. 5 83.9 Cypress Junior Mixed 260 240 92. 3 91.4 Cypress Infants 161 143 88.8 84.3 Davidson Infants 147 129 87.7 83.2 Duppas Junior Mixed and Infants 398 364 91. 5 90.2 Ecclesbourne Infants 131 117 89. 3 82.3 Elmwood Junior Boys 315 292 92. 7 91.8 Elmwood Junior Girls 322 297 92. 2 90.6 Elmwood Infants 249 219 87.9 83.1 Pairchildes Junior Mixed 688 639 9 2.9 89.1 Fairchildes Infants 420 374 89.0 83.4 Gilbert Scott Junior Mixed 540 504 93. 3 91.1 Gilbert Scott Infants 268 235 87.7 83.5 Gonville Junior Mixed and Infant 588 530 90.1 88. 4 Howard Junior Mixed and Infants 440 403 91.6 89.0 Ingram Infants 109 98 89.9 85.4 Kensington Avenue Junior Mixed 505 471 93. 2 90.6 Kensington Avenue Infants 227 202 88.9 88.5 Kingsley Junior Mixed 522 474 91. 4 89.7 Kingsley Infants 301 252 87. 4 81.7 Monks Orchard Junior Mixed and Infants 301 279 92.7 91.8 Overbnry Infants and Junior Mixed 115 107 93.0 90.2 Norbury Manor Junior Mixed 476 448 94.3 93.8 Norbury Manor Infants 227 204 89.8 84.7 Oval Junior Mixed 422 391 9 2.7 90.9 Oval Infants 181 154 85.1 84.4 Portland Infants 197 177 90.0 88.5 Purley Oaks Junior Mixed 358 324 90.5 91.1 Purley Oaks Infants 205 165 80. 5 85.0 Rocknount Junior Mixed 360 333 92. 5 92.6 Rockmount Infants 174 149 85.6 82.5 Slowdown Juniors 573 521 90.9 89.6 86.6 Rowdown Infants 377 338 89.6 South Norwood Junior Boys 319 296 9 2.8 9 2.0 South Norwood Junior Girls 297 273 91.9 91.6 South Norwood Infants 299 259 86.6 85.1 St. Peter's Junior Mixed and Infants 321 298 92.8 88.3 Spring Park Junior Mixed 289 271 93.8 93.0 Spring Park Infants 116 104 89.7 87.8 41 School Average No. on Registers Average Attendance Average 1958 Attendance % Average 1957 Attendance % Sydenham Junior Boys 216 199 92.1 91.4 Sydenham Junior Girls and Infants 305 270 88.5 87.5 Waddon Infants 199 173 86.9 83.8 west Thornton Junior Mixed 399 355 91.2 91.8 West Thornton Infants - - - 87. 8 Whitehorse Manor Junior Boys 266 247 92.8 90. 9 Whitehorse Manor Junior Girls 229 213 93.0 90.4 Whitehorse Manor Infants 225 196 87.1 83.7 Winterbourne Junior Boys 423 398 94.1 9 21 Winterbourne Junior Girls 385 362 94. 0 93.1 Winterbourne Infants 335 297 88.7 84.1 Wolsey Junior Mixed 517 479 92. 6 90.9 Wolsey Infants 308 268 87.0 84. 2 Woodside Junior Boys 384 36 2 94. 2 9 2.0 Woodside Junior Girls 429 400 93. 2 91.5 Woodside Infants 261 237 90. 8 85.8 TOTALS 20.046 18.238 90.9 88.9 COUNCIL SECONDARY modern Ashburton senior Boys 594 562 94.6 93.4 Ashburton Senior Girls 551 511 9 2.7 90.9 Davidson senior Boys and Girls 455 406 89. 2 88.7 Ecclesbourne senior Girls 351 318 90. 6 87.8 Falrchlldes' senior Boys 421 378 89. 7 88.7 Fairchlldes" Senior Girls 396 357 90. 2 87.6 Ingram Senior Boys 527 475 90.1 88.8 Lanfranc Senior Boys 655 581 88.7 88.3 Lanfranc senior Girls 645 564 89.6 90.0 Norbury Manor Senior Boys 292 272 93.1 9 2.0 Norbury Manor Senior Girls 370 346 93.5 92.3 Portland Senior Boys 411 374 93.4 92.1 Portland Senior Girls . - - 91.1 Tavistock senior Boys 537 477 88.8 87.7 Tavistock Senior Girls 380 336 88.4 86.8 South Croydon Senior Mixed 631 563 89.2 86.7 Shirley Senior Mixed 375 350 93.3 92.0 Overbury 229 205 89.4 84.5 Westwood Secondary Girls 362 325 89.8 88.3 TOTALS 8.182 7. 400 90.4 89.4 VOLUNTARY SECONDARY modern St. Andrew's 189 168 88.9 87.2 Our Lady's 173 151 87. 2 87.7 St. Mary's 332 304 91.6 89.2 TOTALS 69 4 623 89.8 88.3 special schools St. Christopher's Educationally Sub-Normal 202 177 87.6 86.2 St. Giles' (Delicate and Physically Handicapped) 193 165 85.3 82.2 St. Luke's (Partially Sighted) 19 17 89.4 85.0 TOTALS 414 359 86.7 84.4 42 School Average No. on Registers Average Attendance Average 1958 At tendance % Average 1S57 Attendance % VOLUNTARY PRIMARY All Saints' Mixed and Infants 246 224 91.0 89.3 Christ Church Junior Mixed and Infants 199 181 90.4 88.1 Good shepherd R.c. Junior Mixed and Infants 30 2 267 88.4 85.1 Parish Church junior Mixed and Infants 386 352 91.2 89.3 St. Joseph's Mixed and Infants 528 474 89.8 87.5 St. Mark's Junior Mixod and Infants 207 185 89.4 87.3 St. Mary's R.C. Junior Mixed and Infants 422 376 89.3 85.2 St. Michael's Infants. 125 108 86.4 82.9 Shirley (St. Johns) junior Mixed and Infants 278 254 91.4 89.4 TOTALS 2. 69 3 2, 421 89.9 87.3 SELECTIVE CENTRAL Arch. Tenison's Mixed 292 272 93.2 91.7 Heath Clark Mixed 621 587 94.5 93.0 John Newnham Mixed 530 495 93.4 92.8 GRAMMAR Selhurst Boys 684 648 94.7 93.1 Selhurst Girls 565 527 93.3 91.9 John Rusk In Boys 564 531 94.1 92.9 Coloma Girls 565 523 90.8 91.0 Lady Edrldge Girls 553 520 94.0 92.9 TOTALS 4. 374 4. 103 93.8 92.5 TECHNICAL Stanley Technical 327 307 93.9 93.1 Croydon Secondary Technical 386 367 95.1 93.3 TOTALS 713 674 94. 5 93.2 SUMMARY OF SCHOOL ATTENDANCE FOR THE YEAR 1958 Council Primary 20,046 18.238 90.9 88.9 Voluntary Primary 2, 69 3 2,421 89.9 87.3 Council Secondary 8.182 7,400 90. 4 89.4 Voluntary secondary Mixed 69 4 623 89.8 88.3 Grammar and Central 4. 374 4,103 93.8 92.5 Technical 713 674 94.5 93.2 Specials 414 359 86.7 84.4 TOTALS 37,116 33, 818 91.1 89.3 Crosfleld Nursery 40 34 85.1 78.5 43 Table II HEIGHTS AND WEIGHTS, 1958 Age Number Examined 1958 Average Height in inches Average Weight in lbs. 1958 1957 19 56 1955 1939 1958 1957 1956 1955 1939 BOYS 5 years 841 43.0 43. 5 43.4 43. 3 41. 8 43.0 43. 5 43.4 43.5 41.5 6 ,, 398 44. 1 44.0 43. 9 44. 2 43.8 45. 1 44. 6 44.8 45.3 43.4 7 ,, 114 43.4 47. 6 48. 1 47.9 45.3 54. 1 52.6 53.4 52.7 47.9 8 ,, 661 50.7 50. 5 50. 2 49.9 49.5 60.4 59. 5 58.9 59. 1 55.5 9 ,, 564 51. 2 50. 9 51.3 51. 3 51.2 63. 1 61.3 62.3 61.4 58.8 10 ,, 122 53. 1 52.9 52.9 54.3 52.7 69.9 66.0 67. 1 73.9 62.9 11 ,, 194 56.6 57. 1 57. 2 55.0 53.7 81. 9 83.8 83.9 74.2 68.7 12 ,, 608 57. 9 58. 1 58.0 55. 6 55.7 86.8 86. 1 86. 4 80.0 79.9 13 ,, 180 59.0 59. 6 58. 2 60.3 58.4 88.9 90. 1 82.9 96.5 81.6 14 ,, 448 63.4 63.7 61.3 62.8 59.0 112. 3 112. 6 111.9 109.0 90.8 15 ,, 575 65. 2 64.3 64. 5 64. 8 - 119.7 117.6 116.6 116.5 - 16 ,, 220 67.3 66. 8 66.6 66.9 - 131. 9 127. 6 129. 2 128.3 - 17 ,, 54 67. 6 67. 8 67.9 68.4 - 133. 5 133. 2 133.8 137.7 - GIRLS 5 years 790 42.7 42.7 42. 5 42.7 41. 2 42.0 42.3 41.7 41.9 39.7 6 ,, 463 43.7 43. 8 43. 7 43. 4 42.7 43.7 43.9 43.6 43.8 41. 4 7 ,, 107 47.2 47.5 47.5 47.2 44.1 51.8 52.1 52.6 53.1 43.6 8 ,, 816 50.0 50.1 50.1 49.3 49.9 58.8 57.9 58.3 58.8 54.7 9 ,, 555 50.9 50.9 50.9 50. 5 50.9 62. 3 60. 3 60.5 60.4 57.6 10 ,, 110 53.2 52. 5 53. 5 54. 6 52. 1 67.4 65.5 69.1 73.7 62.9 11 ,, 390 58.8 57.4 57. 2 56.0 53. 6 88.1 83. 8 83.6 78.7 68.3 12 ,, 468 58. 2 58. 3 58. 9 58. 2 56.6 87. 2 91.0 89.6 87.5 77.2 13 ,, 151 59.4 59.4 59.7 60.3 58.8 95. 6 91. 6 94.6 97.5 85.3 14 ,, 473 62.7 62. 2 61.9 61.7 60.3 108. 4 109.9 109.9 111.3 97.9 15 ,, 612 63.3 62.5 62.8 63. 2 62.0 114. 2 116.3 114.3 116. 1 105.5 16 ,, 141 63.7 64.0 64.9 64. 2 - 119. 5 123. 4 123.6 123.2 - 17 , 35 64.7 64.5 64. 6 64. 2 - 120.7 126. 6 127.8 124.6 - 44 BOYS HEIGHTS COMPARISON WITH PREVIOUS YEARS 65 1956 / s 1908 / ' / / / / / / f / ✓ ✓ ✓ ✓ ✓ / * / ✓ / * / X s S * s s t 10 AGE (YEARS) 12 14 45 46 BOYS WEIGHTS COMPARISON WITH PREVIOUS YEARS 47 48 Table III CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1958 School Population Measles German Measles Whooping Cough Chicken Pox Mumps Scabies Impetigo Ringworm Diphtheria Scarlet Ferer Dysentery Poliomyelitis Jaundice Conjunctivitis Sore Throat Other Diseases Enteric Group Erysipelas Vermin Meningococcal Infection Totals Bod v Scalp All Saints 246 - - 1 10 - - - - - - 2 - - - - - - - - 1 - 14 Arch. Tenison 292 - - - - - - - - - - - - - - - - - - - - - - Ashburton 1820 - - - - - - - - - - - - - - - - - - - - - - Benson 612 - - - - - - - - - - 2 - - - - - - - - 2 - 4 Beulah 858 - - - 10 - - - - - - 17 - - - - - - - - 1 - 28 Castle Hill 822 135 - - - - - - - - - - - - 1 - - - - - 3 - 139 Christchurch 199 - - - - - - - - - - - - - - - - - - - - - - Coloma 565 - - - - - - - - - - - - - - - - - - - - - - Crossfleld Nursery 40 - - - - - - - - - - - - - - - - - - - - - - Croydon High 896 - - - - - - - - - - 1 - - - - - - - - - - 1 Croydon Tech 386 - - - 1 - - - - - - - - - - - - - - - - - 1 Cypress 421 - 2 1 1 - - - - - - 3 - - - - - - - - - - 7 Davidson 602 - - 2 - - - - - - - - - - - - - - - - - - 2 Duppas 398 - - - - - - - - - - 2 1 - - - - - - - - 3 Ecclesbourne 482 - - - - - - - - - - - - - - - - - - - - - 1 Elmwood 886 1 - - - - - - - - - 2 - - - - - - - - - - 3 Fairchildes 1925 10 - - 2 - - - - - 2 20 - - - - - - - - 1 35 Gilbert Scott 808 - - - 5 - - - - - - 1 - - - - - - - - - - 6 Gonville 588 - - - - - - - - - - 4 - - - - - - - - - - 4 Good Shepherd 302 - - - - - - - - - - - - - - - - - - - - - - Heath Clark 621 - - - - - - - - - - - - - - - - - - - - - - Howard 440 - - - - - - - - - - 1 4 - - - - - - - - - 5 Ingram 636 - - 1 2 - - - - - - 3 - - - - - - - - - - 6 John Newnham 530 - - - - - - - - - - - - - - - - - - - - - - John Ruskin 564 - - - - - - - - - - - - - - - - - - - - - - Kensington Avenne 732 - - - - - - - - - - 7 - - - - - - - - 2 - 9 Kingsley 823 - - - 23 - - - - - 1 - - 3 - - - - - _ - 27 Lady Edridge 553 - - - - - - - - - - - - - - - - - - - - - 1 49 Lanfranc 1300 - - - - - - - - - - 1 - - - - - - - - - 1 Monks Orchard 30 1 - - - - - - - - - - - - - - - - - - - - - - Norbury Manor 1365 - - - 3 - - - - - - 2 1 6 Occupation Centre 79 - - - - - - - - - - - - - - - - - - - - - - Our Lady's Convent 173 - - - - - - - - - - -1- - - - - - - - - - - 1 Oval 60 3 - - 2 - - - - - - - - - - - - - - - - - - 2 Overbury 229 - - - - - - - - - - - - - - - - - - - - - 3 Parish Church 386 - - - 1 - - - - - - 1 - - - - - - - - 4 - 6 Portland 608 - - - - - - - - - - 1 - - - - - - - - - - 1 Purley Oaks 563 1 - - - - - - - - - 5 85 - - - - - - - - - 91 Rockmount 534 - - - 7 - - - - - - 19 - - - - - - - - - - 26 Rowdown 950 - - 1 - - - - - - - 1 13 - - - - - - - - - 15 St. Andrew's 189 - - - - - - - - - - - - - - - - - - - - - - St. Christopher's 202 - - - - - - - - - - - - - - - - - - - - - - St. Giles 19 3 - - - 2 - - - - - - - - - - - - - - - - 2 St. Joseph's 528 - - - - - - - - - - 2 - - - - - - - - - - 2 St. Luke's 19 - - - - - - - - - - - - - - - - - - - - - - St. Mark's 207 - - - - - - - - - - 2 2 - - - - - - - - - 4 St. Mary's R. C 754 - - - 4 - - - - - - - - - - - - - - - - - 4 St. Michael's 125 - - - - - - - - - - - - - - - - - - - - - - St. Peter's 3 21 3 - - - - - - - - - 1 7 - - - - - - - - - 11 Selhurst Grammar 1249 - - - - - - - - - - - 1 - - - - - - - - - 1 Shirley (St. John's) 653 - - - - - - - - - - - - - - - - - - - - - - South Croydon 631 - - - - - - - - - 1 3 - - - - - - - - - 4 South Norwood 1546 - 1 - 8 - - - - - - 8 - - - - - - - - - - 17 Spring Park 405 7 - - - - - - - - - 2 - - - - - - - - - - 9 Stanley Tech 327 - - - - - - - - - - - - - - - - - - - - - - Sydenham 521 6 - - 7 - 1 - - - - - 2 - - - - - - - - - 16 Tavistock 917 - - - - - - - - - - - - - - - - - - - 4 - 4 Trinity 588 - - - - - - - - - - - - - - - - - - - - - - Waddon 199 - - - - - - - - - - 1 - - - - - - - - - - 1 West Thornton 399 1 - - - - - - - - - 2 - - - - - - - - - - 3 Whltehorse Manor 720 1 - - 4 - - - - - - 4 - - - - - - - - - - 9 Winterbourne 1143 - - - - - - - - - - 5 - - - - - - - - - - 5 Wolsey 8 25 31 - - - - - - - - - 1 - - - - - - - 3 - 35 Woodslde 1074 - - - - - - - - - - - - - - - - - - - - 1 196 3 8 92 - 1 - - - - 107 144 - 4 - - - - - 20 1 576 50 Table IV RETURN OP DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1958 Boys Girls Defects No. requiring Treatsent No. referred for Observation Percentage of total Examined No. requiring Treatment No. referred for Observation Percentage of total Examined Uncleanllness - Head Body - - - - - • Skin Disease 16 3 0. 37 12 8 0.42 Eye Disease - Defective Vision 231 68 5. 83 249 63 6. 28 Squint 14 4 0. 35 15 13 0. 56 External Eye Trouble 3 2 0. 10 4 1 0. 10 Ear Disease - Deafness 13 19 0. 62 13 13 0. 52 Otitis Media 4 8 0. 23 2 10 0. 24 Other Disease - 1 0.02 1 - 0.02 Nose and Throat 57 53 2. 15 63 63 2. 54 Enlarged Cervical Glands (not T. B.) . 5 0. 10 _ 3 0.06 Dental Defects 14 1 0. 29 18 2 0.40 Speech Defects 17 15 0.62 13 8 0.42 Heart and Circulation 11 27 0.74 15 28 0.81 Lungs 10 42 1.01 19 40 1. 19 Developmental - (a) Hernia 5 2 0. 14 1 0.02 (b) Ot0her 20 42 1. 21 - 6 0. 12 Deformities - Posture 25 11 0. 70 53 11 1.29 flat feet 35 66 1.97 33 20 1.07 Others 30 40 1. 37 40 45 1.71 Nervous System Disorders Epilepsy - 5 0. 10 3 4 0. 14 Other - 1 0.02 4 3 0. 14 Psychological - (a) Development 3 1 0.08 2 5 0. 14 (b) stability 6 8 0. 27 7 9 0.32 Other Defects and Diseases 16 6 0. 43 33 24 1. I5 TOTALS 530 4 30 600 379 Total Children Examined 5127 4969 51 Table V PARENTS PRESENT 1958 5 years and under 6 years 7 years 5 years 9 years 10 years 11years 12 years 13 years 14 years 15 years 16 years and over TOTALS Number Examined Parents Present Number Examined. Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F F M F M F M F M F M F M F All Saints 19 33 15 27 7 3 4 2 - - - - 4 10 4 5 7 9 1 6 1 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - - 39 56 25 40 Archbisbop Tenison's - - - - - - - - - - - - - - - - - - - - - - - - 4 21 3 14 14 10 6 7 2 - - - - - - - 13 12 - - 11 10 - - 44 53 9 21 Ashburton 30 43 30 39 18 15 16 12 - 3 - 3 - 33 - 29 - 4 - 4 - - - - - 20 - 4 37 7 9 3 18 - 5 - 10 36 - 2 28 106 1 6 54 5 2 - 195 272 63 102 Benson 3 7 3 5 3 2 3 2 4 2 4 1 22 24 17 21 13 22 13 20 3 3 3 3 1 1 - 1 - - - - - - - - - - - - - - - - - - - - 49 61 43 53 Beulaii 54 35 45 29 11 15 9 13 16 3 14 - 13 53 10 42 5 21 4 14 3 - 3 - 4 1 2 - 1 - - - - - - - - - - - - - - - - - - - 107 128 87 98 Castle Hill - - - - - 10 - 7 - - - - 43 11 34 9 52 35 38 26 21 14 16 8 - - - - - - - - - - - - - - - - - - - - - - - - 116 70 88 50 Oirist Church 5 3 5 3 1 1 - 1 - - - - - - - - - 3 - 3 1 - 1 - 1 4 1 1 - - - - - - - - - - - - - - - - - - - 8 11 7 8 Moma - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 52 - 22 - 21 - 10 - - - - - - - - - - - - - 79 - 32 Crossfields 9 8 9 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9 8 9 7 Croydon High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Croydon Tech - - - - - - - - - - - - - - - - - - - - - - - - - - - - 37 - 6 - 16 - - - - - - - 45 - - - 76 - - - 174 - 6 - Cypress - - - - - - - - - - - - 7 9 5 7 10 18 5 10 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 19 27 11 17 Davidson 30 31 26 27 8 9 8 8 - - - - - - - - - - • - - - - - - - - - 34 - 13 - 8 - 3 - 11 - - - 14 - 3 - - - - - 105 40 53 35 Duppas - - - - - - - - 21 25 16 20 35 42 20 37 39 44 25 28 6 12 3 8 1 1 - - - - - - - - - - - - - - - - - - - - - - 102 124 64 93 Ecclesbourne - - - - 10 7 8 6 1 - 1 - - - - - - - - - - - - - - - - - - 35 - 15 - 14 - 4 - 31 - 6 - 23 - 3 - 1 - - 11 111 9 34 Elmood 52 44 49 40 7 11 5 7 - 3 - 2 42 56 38 49 18 23 17 16 2 1 1 1 2 - 1 - - - - - - - - - - - - - - - - - - - - - 123 138 111 115 Fairchildes - _ . _ . _ - - - - - - - - - - - 43 - 34 - 24 - 21 15 5 7 2 46 6 8 4 4 - - - 63 2 3 - 27 70 4 13 1 17 - 4 156 167 22 78 Gilbert Soott 53 53 45 41 4 13 2 11 3 2 1 - 42 37 30 27 15 12 10 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 117 117 88 86 Gonville 21 40 19 36 16 31 12 35 3 3 3 3 44 53 38 45 30 14 22 13 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 114 141 94 132 Good Siepherd - - - - 12 13 9 12 4 1 1 1 - 2 - 2 - 2 - 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - 16 20 10 17 Heath Clark - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14 - 2 16 13 - 1 45 27 4 3 Howard 7 10 1 10 9 - - - 1 - - - 9 19 6 14 1 12 1 9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 27 41 8 33 Ingram 12 16 11 16 8 16 7 15 - 1 - 1 - - - - - - - - - - - - - - - - 56 - 11 - 13 - 3 - 41 - - - 54 - 3 - 6 - - - 190 33 35 32 John Newnham - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9 22 - - 22 12 - 2 9 6 - - 80 40 3 2 John Ruskin . - - - - - - - - - - - - - - - - - - - - - - - 6 - - - 94 - 19 - 43 - 5 - 2 - - - 58 - 1 - 58 - 1 - 261 - 26 - Kensington 35 47 29 46 41 39 36 33 2 1 1 1 35 33 23 19 45 41 43 34 15 13 12 8 2 - 2 - - - - - - - - - - - - - - - - - - - - - 175 174 146 141 Kingsley 23 27 10 19 9 3 7 2 2 2 - 1 24 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 76 32 49 22 Lady Edridge - - - - - . - - - - - - - - - - - - - - - - - - - 108 - 25 - 72 - 22 - - - - - - - - - 1 - - - - - - - 181 - 47 Lanfranc - - - - - - - - - - - - - - - - - - - - - - - - - - - - 74 30 23 22 41 8 7 8 115 99 12 38 109 32 12 16 1 - 1 - 340 169 55 84 Monks Orchard 70 17 15 13 5 9 4 7 - _ _ 3 3 3 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 29 29 22 22 Norbury Manor 26 30 20 30 51 28 46 23 9 5 6 5 10 24 8 24 8 6 8 6 - r - - 40 30 15 13 19 57 9 35 - 21 - 13 36 24 2 6 32 65 6 11 12 5 - - 243 295 120 166 Our Lady's Convent - - - - - - - - - - - - - - - - - - - - - - - - - 15 - - - 5 - - - 5 - 1 - 1 - - - 23 - - - 9 - - - 58 - 1 Oval 40 46 34 41 20 27 17 22 1 6 1 4 29 34 22 29 21 10 8 9 1 1 1 1 1 . 1 - - - - - - - - - - - - - - - - - - - - - 113 124 84 106 Overbury - - - - - - - - - - - - - - - - - - - - - - - - 4 8 4 8 2 8 2 8 - - - - - - - - - - - - - - - - 6 16 6 16 Parish Oiurch ?8 17 27 13 8 12 7 8 5 - 5 - 7 16 6 13 5 4 5 4 2 1 1 - - 1 - 1 - - - - - - - - - - - - - - - - - - - - 55 50 51 39 Portland 18 5 17 4 14 9 13 8 - - _ 20 7 16 7 8 18 6 14 - - - - - 7 - 3 3 6 - 2 1 2 - 1 18 61 4 28 19 2 1 - - 1 - - 101 118 57 67 Purley Oaks 14 1 14 1 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 39 2 33 2 Rockmount 37 23 32 21 13 14 12 11 2 3 _ 3 8 5 6 3 5 2 3 1 _ 4 - - - - - - - - - - - - - - - - - - - - - - - - - - 65 51 53 42 Rowdown - - - - 14 10 11 9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14 10 11 9 St. Andrew' s - - - - - - - - - - - - - - - - - - - - - - - - 14 24 4 14 9 15 4 7 5 2 - 1 28 16 2 2 6 11 1 2 - - - - 62 69 11 26 St. Qiristopher's - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 4 1 3 9 2 2 1 12 6 3 4 St.Joseph's 34 20 27 13 13 19 11 12 4 4 2 3 25 39 19 18 42 22 27 14 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 118 104 86 60 St. Mart's 16 20 14 16 3 4 3 2 - - - - 14 12 3 8 1 5 - 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 34 41 25 29 St. Mary's - 1 - - 6 4 6 2 - - - - 7 1 1 1 13 10 7 8 1 - 1 - 13 17 6 7 12 24 3 10 7 9 3 3 1 3 - - 12 20 3 5 3 8 - 4 75 97 30 40 St. Michael's 10 17 9 13 2 1 2 1 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13 18 12 14 St' Peter's - - - - 11 6 9 5 1 - 1 - 10 9 10 7 2 4 - 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 24 19 20 16 Continued overleaf. 52  5 years and under 6 years 7 years 8 years 9 years 10 years 11 years 12 years 23 years 14 years 25 years 16 years and over TOTALS Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F Selhurst Grammar - - - - - - - - - - - - - - - - - - - - - - - - 24 - 17 - 26 - 17 2 10 - 4 - 10 - - 11 41 1 5 11 49 - 2 24 158 1 45 Shirley 7 18 6 14 12 7 12 6 - - - - 24 19 22 12 4 1 4 1 2 3 2 3 49 46 18 22 32 49 10 31 1 11 1 3 - 8 - - 8 7 1 1 2 - - 140 171 76 92 South Croydon Sec - - - - - - - - - - - - - - - - - - - - - - - - 12 - 4 - 72 12 14 2 26 22 3 2 52 37 6 2 51 37 1 4 - 1 _ 213 1(N 10 South Norwood 1 - 1 - 10 12 8 11 - 33 - 30 26 48 14 37 14 16 9 13 18 4 8 3 2 - 2 - - - - - - - - - - - - - - - - - - - - - 71 113 42 94 Spring Park 18 13 18 13 3 2 3 2 1 - 1 - 8 19 7 17 12 3 10 3 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 44 37 40 35 Stanley Technical - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6 - 2 - - - - - 24 - - - 16 - - - 64 - 8 - Sydenham 13 11 13 10 11 19 9 19 - - - - 4 26 3 21 46 16 30 15 14 - 11 - - - - - - - - - - - - - - - - - - - - - - - - - 88 74 66 65 Tavistock - - - - - - - - - - - - - - - - - - - - - - - - - 62 - 22 13 33 1 23 6 7 3 3 1 69 - 21 82 38 2 13 - 4 - 1 102 213 6 83 Trinity - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 83 - 1 - Waddon - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - West Thornton 23 16 22 13 6 12 6 10 - 1 - 1 16 24 13 20 9 11 8 10 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 54 65 49 55 Westwood - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 41 - 12 - 23 - 4 - - - - - 64 - 16 Whitehorse 43 43 37 36 11 3 9 1 - - - - 3 20 1 15 44 25 36 22 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 101 94 83 1 Winterbourne 82 61 76 54 20 26 19 24 2 2 - 2 1 62 - 53 21 26 19 25 19 5 16 5 - 4 - 4 - 1 - 1 - - - - - - - - - - - - - - - - 145 187 130 158 Wblsey 11 20 10 5 5 9 3 9 - - - - 52 23 37 18 20 21 15 17 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 88 73 65 Woodside 46 39 43 36 6 24 6 19 54 6 40 4 60 54 5l 43 40 32 30 19 3 7 2 5 - 6 - 2 - - - - - - - - - - - - - 16 - 15 - - - - 209 184 172 840 815 732 691 410 445 344 377 137 106 98 85 647 827 492 654 592 535 433 414 116 99 83 72 200 406 71 161 614 448 151 231 199 138 35 53 443 460 30 117 645 559 41 104 284 131 6 13 5127 4969 2516 1655 1423 855 721 243 183 1474 1146 1127 847 215 155 606 232 1062 382 337 88 903 147 1204 145 415 19 10096 5488 PERCENTAGE OF PARENTS PRESENT Age 5 years and under Boys Girls 87.1 84.8 86.0 Boys 49.1 Girls 60.0 All Groups 54.4 6 years Boys Girls 83.9 84.7 84.3 7 years Boys Girls 70.1 80.2 75.3 8 years Boys Girls 76. 79. 1 77.8 9 years Boys Girls 73.1 77.4 75.2 10 years Boys Girls 71.6 72.7 72.1 11 years Boys Girls 35.5 39.7 28.3 12 years Boys Girls 24.6 51.6 36.0 13 years Boys Gi rls 17.6 38.4 26.1 14 years Boys Girls 6.8 25.4 16.3 15 years Boys Girls 6.4 18.6 12.0 16 years and over Boys Girls 2.l 10.0 4.6 53 Table VI SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1958 (Percentages of Children examined)  Defect or Disease En t rant s up to 6 years Intermediates 11 and 12 years Leavers 14 and Orer Other Ages All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 1.6 2. 4 0.7 0.6 0. 4 0.6 1. 1 1. 5 1.0 1. 4 Skin 0.9 0.7 0. 1 0.8 0.2 0.7 0.8 0.6 0.5 0.7 Eyes - Vision 5.0 6. 4 6.0 7.6 6. 3 6. 4 7.5 6.9 6.3 6.8 Squint 1. 1 1. 5 0. 1 0.4 0. 1 0.3 0.5 0.7 0.5 0.8 Other 0.3 - - 0. 4 - - 0. 1 0. 2 0. 1 0. 1 Ears - Hearirg 1. 5 1.0 0.6 0. 4 0. 1 0. 4 0. 7 0.6 0. 7 0. 6 Otitis Media 0. 2 0. 2 0. 2 - 0. 2 0. 2 0. 3 0.5 0. 3 0.3 Other - 0. 1 0. 1 0. 2 - 0. 1 - - - 0. 1 Nose and Throat 6.7 7.8 0. 5 1. 2 0.3 0.3 2. 5 2.9 2. 6 3. 2 Speech 2.4 1. 1 0.4 0.6 0.7 0.3 - 0.6 0.8 0.6 Cervical Glands 0.5 0.2 0.1 0. 1 - . 0. 1 0. 2 0. 2 0. 1 Heart and Circulation 1.5 1.9 1.0 1.3 0.4 1.4 0.8 1. 1 0.9 1. 4 Lungs 3.1 2. 2 1.0 0.8 0. 2 0.7 1. 5 1.6 1.5 1.7 Developnent - Hernia 0. 5 - 0. 2 - 0. 1 0. 1 - - 0. 2 - Other 0.6 - 2.3 - 0. 4 - 2. 1 0. 4 1.3 0. 1 Orthopaedic - Posture 1.0 0. 4 0.6 3. 3 0. 1 2. 5 1. 5 1. 6 0.9 1. 8 Plat Feet 2. 3 1.6 4. 2 1.5 0.7 1.3 2. 2 1. 5 2. 2 1. 5 Other 3.7 3.2 0. 5 2.7 0.5 1. 2 1.7 1.8 1.7 2. 1 Nervouns Diseases - Epilepsy 0. 2 0. 2 0. 1 0.3 - 0. 1 0. 1 0. 1 0. 1 0. 2 Other 0. 2 - - - - - - - 0. 1 - Psychological - Development 0. 2 0. 1 - 0.1 - 0.3 0. 1 0. 1 0. 1 0. 2 Stability 0. 5 0.6 0. 2 0. 1 0. 1 0.4 0. 5 0.5 0.3 0. 4 Dull and Backward 0.4 - - - - - 0. 1 0. 2 0. 1 0. 1 Other Defects 1. 5 1.4 0. 2 2.9 0. 1 2.0 1. 4 1. 2 0.9 1.7 54 Table VII HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS APPROVED UNDER SECTION 9(5) OF TIIE EDUCATION ACT, 1944 OR BOARDING IN BOARDING HOMES  During the calendar year ended 31st December, 1958 how many handicapped pupils - (1) Blind ( 2) Partially sighted (3; Delicate (4) Partially deaf (5) Delicate (6) Physically Handicapped (7) Educationally sub-normal (8) Maladjusted (9)Epileptic Total (1)-(9) A. were newly placed In special schools (other than hospital special schools) or boarding hones? (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (a) Day - 3 1 4 27 20 32 - - 87 (b) Boarding - - - 1 4 2 4 5 3 19 B. were newly assessed as needing special educational treatment at special schools or in boarding homes? (a) Day - 5 1 3 27 25 31 - - 29 (b) Boarding - - - 2 5 4 1 6 4 22 On or about 31st January, 1959 how many handicapped pupils from the Authority's area - C. (i) were on the registers of special schools as (a) day pupils - 18 16 11 93 96 182 - - 416 (b) boarding pupils - 1 5 4 4 8 9 12 5 48 (ii) were on the registers of independent schools under arrangements made by the Authority - - 2 - - 5 - 10 - 17 (iii) were boarded In homes and not alread Included under (i) or (ii) y r TOTAL (C) - 19 23 15 97 109 191 22 5 481 D. were being educated under arrangements made under section 56 of the Education Act, 1944. (i) In hospitals - - - - 10 - - - - 10 (ii) In other groups (e.g., unit8 for spastics, convalescent homes) - - - - 1 2 - - - 3 (iii) at home - - - - - 3 - - - 3 (continued on next Page) 55  (1) Blind (2) Partially sighted (3) Deaf (4) Partially deaf (5) Delicate (6) Physically Handicapped (7) Educationally sub-normal (8) Maladjusted (9) Epileptic TOTAL (l)-(9)  (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) E. were requiring places in special schools (i) TOTAL (a) day - - - 2 1 3 1 - - 7 (b) boarding - - - 1 1 3 1 1 - 7 Please state how many pupils are Included in the totals above - (ii) who had not reached the age of 5:- (a) awaiting day places - - - - - - - - - - (b) awaiting boarding places - - - - - - - - - - (iii) who had reached the age of 5 but whose parents bad refused consent to their admission to a special school:- (a) awaiting day places - - - - - - - - - - (b) awaiting boarding places. - - - - • - - - - F. Were on the registers of hospital special schools - 12 G. During the calendar year ended 31st December, 1958, how many children were reported to the local health authority - (a) under section 57 (3) (excluding any returned under (b)) - 13 (b) under Section 57 (3) relying on Section 57(4) - Nil (c) under section 57 (5) - 5 of the Education Act, 1944? H. During the financial year ended 31st March, 1958, how much was spent on on arrangements under Section 56 of the Education Act, 1944, for the education of handicapped pupils otherwise than at school? £1, 475. 8s. 8d. 56 Table VIII VISION TESTS Summary of Findings Extant of Defect Entrants up to 6 years Intermediates 11 and 12 years Leavers 14 and orer 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 61 4.9 76 6.0 42 5. 2 58 6 .8 68 5.0 70 6. 1 117 6.9 111 6.5 288 5.6 315 6.3 Over 6/24ths 2 0. 2 5 0. 4 7 0.9 7 0.8 19 1. 4 4 0. 3 9 0.5 7 0. 4 37 0.7 23 0. 5 57 Table IX DENTAL DEFECTS (1) Inspected by Dental Officers: 1958 1957 Aged 5- 6 1,681 1,313 6-7 2, 671 2,382 7-8 2,814 2,471 8-9 2, 842 2,906 9-10 2.940 3,274 10-11 3,337 3,843 11-12 3,526 3,250 12-13 3,001 Total: 2,734 13-14 2, 249 31,574 2,899 14-15 2, 720 2,571 15-16 2,312 2,041 16 up 1,481 869 Specials 2.074 2.674 33, 648 33,227 1958 1957 (2) Number found to require treatment 18,399 19,781 (3) Number referred for treatment 16,863 17,698 (4) Number actually treated 8,978 8,904 (5) Attendances made by children for treatment 24,030 25.274 (6) Half-days devoted to: Inspection 241 228 Treatment 2.761 2.891 3,002 3,119 Number of Gas Sessions 318 345 Administrative Sessions 131 132 Orthodontic Sessions 446 465 (7) Fillings - Permanent Teeth 8, 745 9,023 Temporary Teeth 1.515 1,858 10,260 10,881 58 (8) Teeth Filled - Permanent Teeth 8,261 8,528 Temporary Teeth 1.444 9,705 1,785 10,313 (9) Extractions - Permanent Teeth 2,655 3,153 Temporary Teeth 6.450 9.105 7,542 10,695 (10) Administrations of general anaesthetics for extractions 3,719 4,360 Administrations of local anaesthetics for extractions 577 881 (11) Other Operations - Permanent Teeth 9,540 9,818 Temporary Teeth 893 10,433 1,006 10,824 Attendances per session 8.7 8.7 59 Table X SPEECH DEFECTS CLINIC SUMMARY Total number of cases treated 315 Cases discharged 117 Cases still attending 198 Cases referred for physical treatment 48 Cases referred for residential treatment 6 Cases referred to Child Guidance 2 Stammerers 46 Cleft Palate 5 Sigmati sm 74 Hyper Microphonia 10 Dyslalia 118 Undeveloped Speech 30 Dysarthria 16 Developmental Aphasia 8 Partially Deaf 8 60 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1958 RETURN OF MEDICAL INSPECTIONS A. - Routine Medical Inspections Year 1958 Year 1957 Age 11 or under 58 14 12 36 44 13 14 20 14 24 69 15 24 54 16 22 22 17 15 19 18 or over - 2 Total 193 244 B. - Other Inspections Number of Special Inspections 1 1 Number of Re-inspections 1 2 Total 2 Visits to Non-maintained Schools 9 _11_ The following defects were found by Medical Inspection: - Treat- Observa- ment tion Defective Vision 8 2 Nose and Throat 1 - Lungs - 1 Posture 1 - Development Other 1 1 Flat Faot 1 6 1 Nervous System Other - Other Orthopaedia 1 - Other Defects and Diseases 1 - 61 CAUSES OF DEATH IN SCHOOL CHILDREN Child Population - 21,800 (estimated) - 1908; - 33,767 (estimated) - 1948; - 39,500 (estinated) - 1958. Nunber of deaths - 90 - 1908 ; 24 - 1948 ; 7 - 1958. Death-rate per 1,000 - 4.1 - 1908; 0.71 - 1948; 0.18 - 1958. The deaths were due to;- 1908 1948 1958 Measles 11- Scarlet Fever 3 Influenza 1 Diphtheria 18 Typhoid Fever 1 Dysentery 2 Septicaemia 1 Meningitis 2 1 Encephalitis - 2 Poliomyelitis 1 Rheumatic Fever 1 Tuberculosis - of the brain 3 2 „ „ „ lungs 3 „ „ „ abdomen 2 „ other forms 5 1 Aplastic anaemia - 1 Cance 1 2 Leukaemia - 1 1 Congenital defects 1 1 1 Hydrocephalus - 1 Cerebral tumour 1 Other brain diseases 2 1 Ear diseases 2 1 Heart diseases - Rheumatic - 4 „ „ Pericarditis 1 „ „ Endocarditis 5 „ „ Other 11- Laryngitls 1 Pneumonia 8 1 - Nephritis - - 1 Diseases of the Mouth 1 „ „ „ Stomach 1 Abdomen 6 1 Diseases of the lymph glands 1 Bone diseases 1 Road Accidents 2 1 2 Other Accidents 2 2 1 90 24 7 CONTENTS A. - PUBLIC HEALTH REPORT Page Page Airport 98 Laboratory Examinations 34,79,91 Aibulance service 55, 124 Amusement Houses 70 Animals, Diseases of 73 Marriages 16 Animals, Keeping of 73 Maternity Homes 97 Ante-Natal clinics 35 Meat Inspection 76 Appendix Tables 103 Men' s Hostel 66 Mental Health 58 Midwlves 36 Births 16, 17 Midwlves, Municipal 36, 111 Blindness 100 Midwlves Acts 36 Byelaws 88 Milk 78 Mortality in Childbirth 15, 108 Cancer 19, 20, 106 Census 15 National Assistance Act 100 Chemical Analyses 92 Neo-Natal Deaths 109 Chest clinic 25 Notification of Births Acts 16 Child Hinders 97 Nuisances 88 Civil Defence 56 Nursing Equipment 44, 119 Clean Air Act 63, 70 Nursing Homes 97 Convalescence 47 Nurses' Agencies 97 Committee 3 Communicable Diseases 126, 127 Creiatlon 98 Occupation centre 61 Offensive Trades 69 Outworkers 67 Day Nurseries 47 Deaths 15. 17. 103. 104 Dental Treatment - M.& C. W. 51. 122 Perinatal Deaths 15. 109 Disinfection 71 Pests 73 Disinfestation 72 Physiotherapy 47, 119 Drainage 69 Pharmacy and Poisons Act 72 Poliomyelitis 24, 128 Population 15 Factories and workshops 66 Post-Natal Clinics 35 Fluoridation 92 Post-Mortems 17 Food and Drugs Act 80 Premature Infants 35, 114 Food Poisoning 21 Problem Families 121 Foods74 Prosecutions 76 Public Health Inspectors, Work of 87 Health Education 48 Health Visitors, work of 38. 115 Home Helps 45, 120 Radiation Hazards 96 Home Nursing 44, 117 Rag Flock Act 72 Home safety 142, 123 Bats and Mlce(Destruction) Homework 67 Act73, 138 Hospital, Isolation 22 Refuse Collection95 Housing 65 Relaxation Classes 35 Rivers and streams 69 Ice Cream 80 Illegitimacy15. 35 Scarlet Fever 23 Immunisatlon 44, 12B Sewage 95 Infant Mortality 15,109, 110 Shops Act 68 Infant welfare Clinics 37, 116 Slaughterhouses 76 Inquests 17 Smoke Observation 70 1964-1 Page Page Spastlcs 101 Tuberculous, Prevention and Staff Examinations 99 Control 25 Staff 13 „ Re-Housing 30 Still Births 15, 17 „ Vaccination 30 Street Accidents 124 Vaccination (Snallpox) 128 Verminous Persons 71 Tables, Appendix 103 Venereal Diseases 33, 134, 135 Tuberculous, After Care 32 Vital Statistics 15,103,104, 105 „ Allowances 32 „ Contacts 29 Ward Statistics 20, 107 „ Home Nursing 29 Watercourses 69 „ Institutional Water Supply 91 „ Institutional Treatment 29 Welfare Foods 37 „ Mass Radiography 31 „ Mortality 27,130 X-Ray 31 „ Notifications 131, 132 Occupational Therapy 32 Zymotic Diseases 22 B. - SCHOOL MEDICAL REPORT Page Page Child Guidance 29 Mentally Defective Children 27 Cleansing of Children 10 Milk, etc., Provision of 29 Clinics 4, 14 Minor Ailments 14 Cod Liver Oil 29 Cost 22 Crippling Defects 22 Non-maintained Schools 32,60 Deaf Children 14 Orthodontic Service 16 Deaths 12, 61 Defects found 35, 50, 53 Dental Service 15 Parents' Attendances 5, 51, 52 Population 12 Ear Disease 14. 37 Enuresis Clinic 31 Remedial Exercises 22 Epileptic Children 31 Exclusions 12 School Nurses, Visits 13 Schools special, cost of 21 Following-up 13 Spastlcs 32 Speech 30, 59 Staff 4 Handicapped Pupils 54 Statutory Tables 33 Health visitors, work of 13 sub-normal children 21 Heights and Weights 9,43,44,45,46,47 Surveys, Oncleanllness 10, 11 St. Christopher's 25 St. Giles' 23 Infectious Diseases 8, 48 St. Luke's 28 Inspections 8 Tonsillectomy 10 juvenile Employment 29 Tuberculosis 12 Malt 29 Uncleanliness 10, 11 34 Meals, Provision of 29 vision. Defective 9, 56