cro61 PUBLIC HEALTH IN CROYDON 1959 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1959 S.L. WRIGHT. M.D.. M.R.C.P., D.P.H. PUBLIC HEALTH DEPARTMENT. 45 WELLESLEY ROAD. CROYDON Telephone CROYDON 4433 3 HEALTH COMMITTEE 1959 Councillor Keith Edwards Councillor Miss L.N. Overton (Chairman) Councillor Mrs. D. V. Paines Councillor Mrs. E. M. Maycock Councillor B. H. Rawling (Vice-Chairman) Councillor W. E. Ross Gower, B. E. M. Alderman Mrs. V. L. Child Councillor B. C. Sparrowe Councillor F. D. J. Bailey Councillor J. T. Twitchett Councillor V. Burgos Councillor R.J. Willsher Councillor J. J. Cooper O. E. Finch, Esq., M. C. M. D. Councillor W. H. Fillery J. S. Lane, Esq., B. A., M. R. C. S. Councillor E. J. Fowler L. R. C. P. Councillor Mrs. D. L. George S. A. MacKeith, Esq., 0. B. E., Councillor M. E. Mackenzie M. R. C. S., L. R. C. P., D. P. M. Councillor D. McClellan Miss K. C. Vost, M. B., B. S., D.P.H. Members appointed to Sub-Committees on nomination of Outside Bodies as shown:- Edith F. Newling, B. A. (Hons), M. B., B. S., Croydon Local M. R. C. S., L. R. C. P. Medical Committee D.F. Kanaar, Esq., M. D., M. R. C. P. A.F. Clift, Esq., F. R. C. S., M.R.C.O.G. Croydon Group Hospital S.Y. Marsters, Esq. 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 Townswomen's Guilds D. G. Goldie, Esq. The St. John Ambulance Brigade (Southern Area) H.G. Murphy, Esq. The Insurance Institute of Croydon J. A. Keeling, Esq. COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1959 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 1959 and comment on a few of the matters covered in greater detail in later pages. Statistics These show many reverses in the recent steady trends of continuing improvement. The general death and infant mortality rates rose. There was only one maternal death, but a "Nil" return as in 1957 is the present target. There were fewer deaths from road accidents and suicide, but a record high number for cancer, especially cancer of the lung. The number of illegitimate births expressed as a percentage of all live births was the highest since 1945 and a most unwelcome return to a war-time rate. Chance can be an important factor in variations of annual figures, when the actual numbers concerned are small, but if we ignore this possibility, statistically 1959 was a somewhat disappointing year. 5 Sanitation Clean Air remains our most important task and the Chief Public Health Inspector records the real progress made in this campaign. Infectious Diseases The programme of vaccination against poliomyelitis continued and against the background of an unusually hot dry summer, the virtual disappearance of the disease was most encouraging. Prom other sources, evidence suggests that the degree of protection given hy vaccination to the individual is only adequate against average risk and it is therefore most important to ensure that as large a percentage as possible of the susceptible population are immunised. Well over 90% of children under 15 years of age have been vaccinated in Croydon and every effort is being made to maintain this coverage. Personal Health services 1959 was mainly a year of planning for new services in the light of fresh legislation, but all existing facilities were maintained, some extended in volume and others improved in detail Major Building Projects The replacement of the existing public abattoir, the provision of a public mortuary and Coroner's post-mortem room, an adult training centre and new clinic buildings for the West Croydon and Waddon areas presented problems due to failure to find suitable sites, the great amount of architectural work at present being undertaken by the Corporation and delays in actual building. While unable to report on the successful solution of all the problems thus presented, Members of the Committee will recall visits to sites and long deliberations on various Possibilities. I hope to record more definite results in my next Report. Health Education The special section which assists in the fulfilment of this fundamental duty of the Health Department continues to be of increasing value. Not only are we improving and developing our methods, but there is the constant stimulus to re-examine basic beliefs and to test the explanations for established procedures. 6 It is an exercise which confirms the paradox that the less one knows about a subject, the easier it is to be dogmatic. With statements or campaigns sponsored by the local health authority, it is necessary to correlate opposing theories, to be factual and accurate, and yet not confuse by numerous reservations. It is a challenge which is being met with a realistic appreciation of the difficulties. The Dynamic Community For 60. years, your Medical Officers of Health have expressed their thanks to members of the Committee and commended the work of their staffs. It might be thought that this is a polite gesture of traditional courtesy. With our minds attuned by the present planning of services for mental health, comes the realisation that possibly it is one of the most important phrases in the whole report. For most individuals need to be members of a defined community, with ability to comment, to strive for objectives, and to see that their contributions however small aggregate to the final achievements. A sense of purposeful united effort is the essential motive force of the sustained successful enterprise. Were I not able to record my thanks for your continued interest and encouragement, and the unfailing enthusiasm of the staff, it would constitute a serious warning of major defects. Fortunately, I can also report active cordial co-operation with other departments of the Corporation, with local hospital and executive council services, statutory and voluntary organisations, and the press. It seems permissible to suggest that as a community progressing through the disciplined interplay of integral forces, Croydon demonstrates the proper functioning of true local government. I am, Yours faithfully, S.L. WRIGHT, Medical Officer of Health and Principal School Medical Officer. 7 STAFF OF THE DEPARTMENT Medical Officer of Health and Deputy Medical Officer of Health (also Principal School Medical Officer and Deputy Principal School Medical Officer). General Administration Chief Clerk, Deputy, 16 clerks cluding 1 part time), 4 typists, 1 messenger. Public Health and Food Chief Public Health Inspector, Inspection Deputy, 20 Inspectors, 1 intendent Slaughter House, 1 Clean Air Act Assistant, 1 Foreman and 5 Assistants, Chief Disinfector and 1 Disinfector, 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), 5 part time. Superintendent Health Visitor, Deputy, 28 Health Visitors and 1 Specialist Health Visitor (also School nurses). 1 part time Almoner and 1 part time Almoner's clerk, superintendent Midwife, Deputy and 18 Midwives, 2 Maternity Nurses (part time), 1 Physiotherapist, 4 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, 41 arrangements) nurses, 5 students, 2 clerks (1 part time). Domestic Help Supervisor, 3 Assistants, 2 clerks, 22 full time and 175 part time Home Helps. Day Nurseries 1 Nursery with Matron, Deputy, 5 nurses, 2 students, handyman and 4 domestic staff (part time). Vaccination and Immunisation 1 part time Medical Officer, 2 temporary part time nurses, 4 Clerical officers including 2 temporary. Ambulance service Ambulance Officer, Deputy, Second Officer, Maintenance Officer, 4 Leading Drivers, 64 Drivers, 2 mechanics, 3 clerks, 1 telephone operator, 1 C. D. Training Officer 1 Depot labourer, 1 cleaner (part time). Prevention, Care and After-care Chest Physician (part time), 2 Assistant chest Physicians (part time), 5 T. B. Visitors, 2 Almoners, 2 clerks, 1 Occupational Therapist (part time) Mental Health 4 Duly Authorised Officers and 1 ordinating officer, 2 clerks, 1 Occupation Centre Supervisor, 5 Assistants, 1 Handicraft Instructor, 1 handyman, 3 Guides and 5 domestics (part time). Health Education 1 Qualified Health education Officer. Welfare Foods 2 clerks (1 part time) and 1 driver. STATISTICS 9 SUMMARY OF VITAL STATISTICS FOR 1959 Area, 12,672 acres. Population (Census 1951), 249,870. Total population (estimate of Registrar-General), 249,000 (Midsummer, 1959). Number of Inhabited Houses: 73,837. Rateable Value (1st April, 1959): £4,846,447. Product of a Penny Rate (1958-1959): £18,183 Rate in the £: 15s. (for the year ending 31.3.59). Live Births: Males Females Total Legitimate 1,741 1,788 3,529 Illegitimate 149 127 276 3,805 Illegitimate Live Births per cent of total live births 7.3 Live Birth Rate(as adjusted by camparability factor(l.00) 15.3 (England and Wales 16.5) Stillbirths 69 Stillbirth rate per 1,000 total (live and still)births 17.8 (England and Wales 20.7) Total Births 3,874 Infant Deaths 80 Infant Mortality rate per 1,000 live births 21 (England and Wales 22) Infant Mortality rate per 1,000 legitimate births 21 Infant Mortality rate per 1,000 illegitimate births 25 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 15 (England and Wales 15.8) Early Neo-natal Mortality rate (First week) per 1,000 total live births 13 Perinatal Mortality rate (stillbirths + deaths during the first week)per 1,000 total live and still births 31 Maternal Deaths (excluding abortion) 1 Maternal Mortality rate (including abortion) per 1,000 total live and still births 0.26 (England and Wales 0.38) Deaths, 3,037. Death-rate per 1,000 of the estimated population 12.2 (England and Wales 11.6) Death rate(as adjusted by comparability factor 0.93) 11.3 10 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 1959 to 18.03%". The number of marriages solemnised was 1,888, compared with 1,827 in 1958, 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. 823 were solemnised in Established Churches, 440 in other places of worship, none by Jewish Ritual and 625 in the Register Office. Births The live births registered were 3,529 legitimate and 276 illegitimate. The birth-rate consequently was 15.3 per 1,000 population. For England and Wales the rate was 16.5. The illegitimate births in Croydon were 7.3 per cent of the total as compared with 5 per cent in 1958, 5.5 in 1957, 4.3 in 1956, 4.8 in 1955, 5.5 in 1954 and 1953 and 5.3 in 1952. The live male births numbered 1,890, the female 1,915, being a proportion of 987 males to 1,000 females. Notification of Births Notifications were received in respect of confinements conducted by:- Live Still Births Births Total Midwives 3,088 42 3,130 Doctors 1,052 32 1,084 4,140 74 4,214 Accommodation for Confinements The following table shows where babies were born in Croydon during 1959. 45 more babies were born at home and 55 fewer were born in hospital than in 1958. 43 fewer Croydon residents had babies outside Croydon and 22 fewer non-residents were confined in Croydon than in 1958. 11 Number Percentage In Private Houses 1,346 31.94 In Public Institutions 2,599 61.68 In Registered Maternity Homes 269 6.38 4,214 Still Births During 1959, 69 still births were registered in respect of Croydon. Of these, 38 were male babies and 31 females; 2 females and 7 males were illegitimate. The proportion of still births to living children was 1 in 55. The still birth rate was 1.8 per cent. of the total births. The still birth rate, on the same basis as for Infant Mortality, was 18.1 per 1,000 births. Deaths The deaths numbered 3,037, compared with 2,995 in 1958. For 1959 the crude death-rate was 12.1 compared with 12 in 1958. The death-rate for England and Wales was 11.7. There were 85 inquests held by Coroners in respect of Croydon residents during 1959 and 487 findings by Coroners after post-mortem without inquest. Wards with the highest death-rate were South (17.8), Upper Norwood and Whitehorse Manor (13.6) Lowest: Addington (3.8), Shirley and West Thornton (10.5). The Registrar General's Table is given in the appendix, page 98. Comparisons with 1958 show there were again no deaths from Whooping Cough and one from Measles (none in 1959). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 24 (19 in 1958); those from Cancer increased by 61; those from Pneumonia increased by 30 and a decrease of 21 was recorded in those caused by Bronchitis. There were 64 deaths from Influenza (22 in 1958). 29 Deaths from suicide showing a decrease of 1 and motor vehicle accidents totalled 29 (31 in 1958). 12 The percentage of deaths under 1 year of age to the total deaths was 2. 6 per cent.; deaths under 15 years, 0.8 per cent.; deaths under 65 years, 22.9 per cent.; and deaths over 65 years, 73.7 per cent. The corresponding figures for 1958 were 2.3 per cent., 0.4 per cent.; 24.3 per cent., and 73.0 per cent. respectively. The Registrar-General has continued to supply a comparability factor - 0.93 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 (Registrar-General's Return) All Ages Rate per 1,000 Population Deaths from diseases of Cardiac and Circulatory System 4.22 " " Cancer 2.50 " " Vascular lesions of the Nervous System 1.78 " " diseases of Digestive System *0.15 " " diseases of the Respiratory System (excluding Tuberculosis) 1.60 " " Suicide and Violent Causes 0.35 " " Tuberculosis (all forms) *ulcers of stomach, duodenum; gastritis and enteritis. 0.10 Maternal Mortality There was 1 death, compared with 4 in 1958. The maternal mortality rate calculated per 1,000 total births was 0.26. The rate for England and Wales was 0.38 in 1959. 13 For figures for the years 1949 - 1959 see the appendix, page 102. Cause of death:- 1. Vaginal haemorrhage from concealed revealed accidental haemorrhage accompanying a fullterm pregnancy. Infant Mortality The 1959 figure rose from the previous low record, being 21.0. Set out in the appendix, page 104 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 80 deaths, 47 occurred in boy babies and 33 in girls. Of the births, 1,890 were males and 1,915 females. The infantile mortality rate for the two sexes was, therefore, Boys 25, Girls - 17. 70 deaths of infants occurred in Institutions, including Registered Nursing Homes. For details of infant deaths see the appendix, page 103. CANCER For detailed tables see the Appendix, page 100. Deaths tabulated in the Department number 623 as compared with 562 in 1958; 591 in 1957; 592 in 1956; 549 in 1955; 486 in 1954; 540 in 1953; 567 in 1952; 479 in 1951; 501 in 1949 and 481 in 1949. Death-rate per 1,000 of the population for the last 10 years is as follows:- 1950 - 1.99 (501) 1955 - 2.20 (549) 1951 - 1.91 (479) 1956 - 2.37 ( 592) 1952 - 2.26 (567) 1957 - 2.37 (591) 1953 - 2.16 (540) 1958 - 2.25 (562) 1954 - 1.95 ( 486) 1959 - 2.50 ( 623) The organs most often attacked in descending order of incidence are:- In the males - the Lungs (41.7 per cent.), the Bowels and Rectum (11.6 per cent.) and the Stomach (9.8 per cent.); In females - Bowels and Rectum (19.5 per cent.); the breast (17.2 per cent.); and the Ovaries (7.7 per cent.). 14 Ward Statistics These are tabulated in the usual form in the appendix, page 101. 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 15 FOOD POISONING The food poisoning notifications, as corrected, for 1959 were:- 1st 2nd 3rd 4th Total Quarter Quarter Quarter Quarter 16 14 26 11 67 Outbreaks due to identified agents:- Total Outbreaks Total Cases 4 11 Outbreaks due to:- (a) Chemical Poisons Nil (d) Cl. Botulinum Nil (b) Salmonella Organisms 4 (e) Other Bacteria Nil (c) Staphylococci (including toxin) Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases 3 6 Single Cases:- Agent identified Unknown Cause Total 37 14 51 Cases due to:- Salm. typhi-murium Salm. newport Salm.bovis- morbificans 30 3 1 Salm. thompson Salm. enteritidis 1 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. 16 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1959 Dr. J. J. Linehan, M. D., D. P. H. Physician Superintendent, Waddon Hospital Admissions to the Infectious Diseases' Wards:- The average stay in hospital for the 602 patients admitted to the Infectious diseases wards was 20.35 days and the average number of occupied beds 33.54. 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 were admitted from outside the Borough of Croydon, the Croydon admissions are shown separately in brackets. Scarlet Fever 93 (90) Measles 83 (64) Gastro-enteritis 82 (68) Pneumonia 71 (52) Dysentery 48 (43) Chicken-pox 30 (24) Food Poisoning (including salmonella infections however contracted) 23 (20) Whooping Cough 18 Glandular Fever 15 (14) Influenza 11 (7) Meningitis 9 (6) Poliomyelitis 4 Encephalitis 3 (2) Mumps 4 (2) Erysipelas 3 (2) Rubella 2 Pulmonary Tuberculosis 2 Diphtheria 1 (0) Malaria 1 Infective Hepatitis 1 Typhoid carrier 2 Roseola Infantum 1 Puerperal Infection 3(1) Ophthalmia Neonatorum 1 Staphylococcal skin Infection 4 Pemphigus 2 Generalised Vaccinia 1 Non Patient Mothers 3 Non Patient Babies 4 Bronchitis 14 (13) Pharyngitis 11 (10) Tonsillitis 8 (5) Peri-tonsillar Abscess 4 Streptococcal Sore Throat 2 Laryngitis stridulosa 2 Lung Abscess 1 Coryza 1 Asthma 2 Stomatitis 2 Ulcerative colitis 2 Appendicitis 1 perforated Gastric ulcer 1 Carcinoma of the Liver 1 Infective polyneuritis 1 (0) Brain Tumour 1 Cerebral Arterio-sclerosis 1 Cerebral Haemorrhage 1 Migraine 1 (0) Cystitis 1 Pyelo-nephritis 1 Papular Urticaria 3(1) Purpura Simplex 1 Pityriasis Rosea 1 Angio-neurotic Oedema 1 (0) Cervical Lymphadenitis Sub-maxillary Abscess 1 Cellulitis 1 Staphylococcal septicaemia 1 (0) Sickle Celled Anaemia 1 Rheumatic Fever 3 Diabetis 1 Fractured humerus 1 Pyrexia of unknown origin 1 17 Scarlet Fever:- There was only one hypertoxic case who required serum as well as pencillin. Other complications which were experienced:- 12 cases of rhinitis, 6 cases each of otitis and streptococcal sores, four each of cervical lymphadenitis and angular stomatitis, 3 cases of secondary sore throat and paronychia, 2 cases each of bronchitis and impetigo and one case of pneumonia furunculosis and pencillin allergy. One case developed due to infection of burns. The patients' age groups were - under 5, 20; 5-15, 70; adults, 3. Measles:- Measles was epidemic during the early part of the year and 75 of the 83 admissions occurred in the months of January to May inclusive. The number of cases admitted in the different age groups were as follows:- under one year, 8 (including 2 patients under 6 months), 1-2 years, 10; 2-5 years 38; 5-15 years, 16; adults, 8. This shows the increased likelihood of hospital admission being required in children who contract measles under 5 years. Approximately, one half of the measles patients were admitted with complications, the remainder being admitted from residential schools, nurseries, rest centres, children's homes, lodgings and hostels and under other circumstances where home care could not be provided; also from overcrowded homes and hospital in-patients. Complications present were as follows:- pneumonia, 27 patients; 6 cases each of enteritis and bronchitis; 3 cases each of meningo-encephalitis and rhinitis; two cases each of convulsions and secondary conjunctivitis and one case each of secondary blepharitis, tonsillitis, stomatitis, gastritis and otitis media. There was one death - a woman, aged 71 years, who developed measles encephalitis. Gastro-enteritis:- 82 cases were admitted and were in the following age groups. Under one year, 31; 1-2 years, 11; 2 15 years, 12; adults, 28. Of these cases, 8 were very severe, 46 moderately severe and 35 mild. There were two deaths, aged 19 months and 3 weeks respectively. A higher proportion of the milder cases occurred in the older age groups. On the other hand, many of the older patients were suffering from other disabilities such as cardiac failure, pneumonia, diverticulitis, pregnancy, and nervous dyspepsia. 18 Pneumonia:- Pneumonia patients were mainly admitted when the illness was super-imposed on some other serious and longstanding disability. Such disabilities were as follows:Pulmonary emphysema, 29 cases; chronic bronchitis 26; heart disease 25; pulmonary fibrosis 5; severe senile kyphosis 3; and bronchiectasis 1; healed tuberculosis 1. Other associated conditions were:- lobar collapse 7 patients; pleural effusion 2 patients and one patient each suffering from anaemia, asthma and nervous depression. 64 out of the 71 admissions were in the months January, February, March, November and December. 12 of the total had a preceding influenzal type illness. The ages of pneumonia patients admitted were:- under 15, 3 cases; 15 - 50, 6; 50 - 70, 38; and over 70, 24. There were 10 pneumonia deaths and a further pneumonia patient died suddenly from coronary thrombosis. Dysentery:- All cases admitted were of the Sonne type. In a disease seldom dangerous to life and, in a large proportion of cases, lasting only a few days, the convalescent carrier is one of its principal problems. There appears to be a growing number of drug resistent strains, suggesting that such resistence can be readily developed. A few random drug sensitivity tests gave the following results:- (a) drugs to which the dysentery bacillus was resistent:sulphonamides, 4 cases; tetracycline, 2 cases; streptomycin, one case. (b) drugs to which the dysentery bacillus was sensitive:streptomycin, 5 cases; neomycin and chloramphenicol, 4 cases each; tetracycline 3 cases; sulphonamides, 2 cases. Even where drug sensitivity has been demonstrated in vitro, it does not seem to follow that treatment with that drug will necessarily terminate the carrier state. Fortunately, though the value of drugs in the carrier state is uncertain, the great majority of patients become free from infection in the course of a few weeks and only four of the 48 patients admitted had to be discharged from hospital without securing three consecutive negative stool cultures. Chicken-pox:- As usual, the majority of chicken-pox patients were admitted because of isolation difficulties. The only complications encountered were one case each of meningo-encephalitis, pneumonia and secondary lymphadenitis. 19 Food Poisoning:- July and August were the months of highest incidence, during which more than half the total number of treated cases were admitted. One case showed evidence of staphyloccocal food poisoning, all the other cases being salmonella infections. Of these, 18 were due to Salmonella typhi-murium, one each to Salmonella thompson, Salmonella enteritidis and Salmonella bovis morbificans. One salmonella was unciassifiable. Five of the 23 patients were under one year of age, the youngest being a week old on admission. This, as well as past cross-infection experience, appears to indicate that, at least as far as the prevalent salmonella typhi-murium is concerned, spread of the infection frequently occurs without any intermediate infection of food. Checks on the drug sensitivities revealed 10 sulphonamide resistent salmonella, 5 tetracycline resistent, 2 streptomycin resistent and one neomycin resistent. It would appear to correspond to the frequency with which the different drugs have been used in salmonella infections. Whooping cough:- The age groups of the patients admitted were:Under one year - 8; 1-3 years inclusive, 9; over 4 years, 1; The complications present were - pneumonia, 4 cases; and one case of enteritis and secondary bronchitis. Other infections:- Glandular Fever showed a further increase Adolescents and young adults were mainly affected. Influenza was prevalent in the first three months of the year but was milder than in 1958. In addition to the 11 patients tabulated as suffering from influenza, twelve of the pneumonia patients admitted had an influenza-like history. Meningitis:- The types admitted were as follows:- Meningococcal, 2; pneumococcal, 1; E. C. H. O. virus type 4, 2; E. C. H.O. type 7, 1; unknown abacterial meningitis 3. In addition, 2 poliomyelitis infection showed purely meningeal symptoms. Poliomyelitis:- The low incidence of the previous year persisted. Two patients had meningeal symptoms only, whilst the other two had symptoms of both spinal and encephalitis involvement. Spinal paralysis was of mild severity in one case and moderate severity in the other. As in previous years, poliovirus Type 1 was isolated in all cases. 20 Encephalitis:- Three cases were due to an unknown virus and a further three cases developed as complications of measles, chicken-pox and vaccinia respectively. A patient,who had been a typhoid carrier for about 20 years, would seem to have been cured by cholecystectomy. The one diphtheria case belonged to a small out-break in a neighbouring Borough. It was a mild case though the patient had transient ocular paralysis. For detailed figures see appendices, pages 122-123. 21 THE PREVENTION AND CONTROL OF TUBERCULOSIS Dr. R. H. J. Fanthorpe, M. D., M. R. C. P. Chest Physician Measures for the prevention and treatment of Tuberculosis are directed from the Chest Clinic and the results during 1959 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1959 was 25 which shows an increase of 5 when compared with 1958 but 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 by the Local Practitioners. The results of this service are summarised below:- Number of miniature films taken 3,158 Number of patients recalled for examination and large film 564 Number of active cases of Pulmonary Tuberculosis 25 Number of cases of lung cancer found 28 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 7.9 per 1,000 which compares favourably with the figure of 1.45 per 1,000 from Public Mass X-ray Surveys. It should be realised that patients referred to the clinic for Miniature X-ray usually have chest symptoms whereas many patients attending public Mass Radiography sessions have no symptoms. 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 Hospital. 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. 22 Incidence 132 cases of Respiratory Tuberculosis and 16 cases of NonRespiratory Tuberculosis were notified on Form A during 1959 (Table I - Formal Notifications). Of these 88 males and 44 females were Respiratory cases and 2 males and 14 females were Non-Respiratory. In addition 110 Respiratory cases and 6 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 1959 by notification or otherwise was 264 as compared with 280 in 1958, 294 in 1957, 349 in 1956 and 261 in 1955. 242 of these were cases of Respiratory Tuberculosis; 164 in males and 78 in females. There were 27 more males and 39 fewer females than 1958. There were 2 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 3 in 1958. The number of cases in adults was 14 compared with 18 in 1958. Of the cases notified in 1959, 5 males died from the Respiratory form of the disease during the year, equal to 3.78 per cent. of those notified. The incidence rate of Tuberculosis of all forms was 1.06 per 1,000 of the population; for Respiratory Tuberculosis 0.97 and for Non-Respiratory 0.09 per 1,000 population. The notification rate was 0.60 per 1,000. In 1958 the corresponding figures were 1.12, 1.02, 0.10 and 0.65 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1959:- RESPIRATORY NONRESPIRATORY Total Cases Males Fenmales Total Males Females Total 1.214 893 2,107 69 94 163 2,270 23 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1959, 119 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) 85 or 71.4 B, or T. B. plus, 1 (early cases, sputum positive) 12 or 10.1 B, or T. B. plus, 2 (intermediate cases, sputum positive) 22 or 18.5 B, or T. B. plus, 3 (advanced cases, sputum positive) 119 100.0% Non-Respiratory Tuberculosis There were 17 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints 3 Abdominal 3 Other Organs 6 Peripheral Glands 5 77 Ages at Death from Respiratory Tuberculosis Year 0.5 5-15 15-25 25-45 45-65 over 65 TOTAL 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 29 1958 - - - 1 12 6 19 1959 - - 1 2 9 12 24 24 All but 4 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 1959 the death-rate from all forms of Tuberculosis was 0.10 per 1,000 population. The rate from Respiratory Tuberculosis was 0.10 and the rate for Non-Respiratory Tuberculosis 0.00. Similar figures for 1958 were 0.08 and 0.00. In 1959 the total number of deaths showed a slight increase when compared with 1958. 90% of the deaths occurred in the age groups 45 years and over. There were no deaths in children of school age. Deaths from Non-Respiratory Tuberculosis During 1959 1 death was certified to be due to Non-Respiratory Tuberculosis, compared with 1 in 1958, 4 in 1957, 1 in 1956 and 2 in 1955. The death was due to:- Males Females Total Tuberculous Meningitis - 1 1 Total - 1 1 Co-ordination with the Health Department During the year 22 children were referred by the School Medical Service, and 9 cases from the Maternity and Child Welfare Section of the Public Health Department. Extra Nourishment Provision of special nourishment in the form of milk was granted to 26 selected cases for varying periods during the year, and 21 cases were in receipt of extra nourishment at the end of the year. 25 Residential Treatment 183 men, 149 women and 34 children were admitted to Residential Institutions in Croydon during 1959. The Chest Clinic and Home Visiting 1,999 new cases were examined during the year. 133 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 18,388. There were also 172 attendances by patients for collapse therapy. The Clinic doctors paid 412 home visits and the Tuberculosis Visitors 4,072 visits for Clinic purposes. In addition the Tuberculosis Visitors made 334 primary visits for the purposes of the Notification Register. There were also 1,924 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 1959, 775 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contactcase ratio of 5 for each notified case during the year. Of these contacts, 8 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 10 compared with 1.06 per 1,000 of the general population. In addition, there were 5 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:- 26 1958 - New contacts examined 748. New cases of Tuberculosis 161 1957 - " " " 709. " " " " 168 1956 - " " " 738. " " " " 202 1955 - " " " 686. " " " " 171 1954 - " " " 820. " " " " 238 B.C.G. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1959 and regular sessions are held at the Clinic for this purpose. 420 contacts were successfully vaccinated during the year, compared with 387 in 1958. In addition 57 nurses and domestics were successfully vaccinated, and 62 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 continued 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. G. Vaccination for School Leavers - The total number of children skin tested - 2,488 Number found to be negative - 2,196 Number vaccinated with B. C. G. - 2,192 Rehousing of Tuberculosis Patients 19 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. 27 X-Ray 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 123 examinations were carried out in 1959. For detailed figures see appendices, pages 126-130. MASS RADIOGRAPHY I am also indebted to the Medical Director of the Surrey Area of the South-West Metropolitan Regional Hospital Board Mass Radiography Service for the following particulars of persons examined and of abnormalities found in the Croydon C.B. area. No. of Persons Examined Tuberculosis Requiring Treatment or close clinic supervision Primary Carcinoma of Lung Male 8.152 17 6 Female 9.339 8 - Total 17,491 25 6 28 TUBERCULOSIS AFTER-CARE During 1959 there was much work done for the after care of tuberculous patients. In spite of the fact that tuberculosis is now much less serious, patients still require long term treatment and experience many difficulties in adjusting themselves both to their illness and to working again after a long period of enforced idleness. A number of patients still cannot go back to their old employment because the work is too heavy. Others experience difficulty in getting accepted for Life Insurance, mortgages and emmigration, as has been discovered in a recent survey. All these patients require help and encouragement to prevent them feeling frustrated. There is statutory financial help available through the National Assistance Board and help with rehabilitation through the Ministry of Labour, which provides Industrial Rehabilitation Units, one of which is conveniently placed at Waddon, where men and women can try out different types of work and at the same time get back to the rhythm of the working day without being pressed too hard. Following 6 to 8 weeks at the Industrial Rehabilitation Unit, patients may go straight into some form of light work or undertake a training course for some particular trade. Many patients require financial help beyond that available through the National Assistance Board and this is sometimes given by Forces Benevolent Funds, but more often and in more varied ways by the local Tuberculosis Care Committee which in 1959 helped 132 families with grocery parcels at Christmas, 61 families with fuel and 24 people with holidays. In addition, nearly £50 has been spent in helping with fares for relatives visiting patients in distant Hospitals, £76 with clothing, bedding, household replacements, etc. Altogether, about £500 has been spent on helping patients, and roughly the same amount has been collected by voluntary effort. 29 OCCUPATIONAL THERAPY The year has seen many changes of Staff, but with two locum therapists, the work was carried on without any long breaks. An average of 33 patients received treatment throughout the year. Of these, 10 attended the weekly Class session and the rest were visited in their homes. There has been an improvement in Class attendance, reaching an all-time peak of eleven on one occasion. A photograph of the Class at work was shown at the Town Hall in the November Exhibition of Public Health Services. Six Occupational Therapy patients left for re-training; one young man became a hair dresser, three went to the Industrial Rehabilitation Unit, and one young girl went to the Royal School of Needlework at Leatherhead. Another young girl obtained employment at a local Engineering Works, and one man at a local store. There is still a great need to find a market for the patients' work and failure to do this often means that a patient who would benefit from treatment has to give up making things. The Show-Case continues to help, but is not sufficient. It is felt that if a few of the bigger stores in Croydon would cooperate in selling some of the patients' work, and also most important, not insist on too rigid a time schedule, this would provide an excellent outlet. Stoving routine is always carried out, and this could be emphasized to them. One profitable line which has appealed to both sexes is the making of model Galleon Lampstands, and these have sold well. A very high standard has been achieved by some patients in the making of soft toys. Two patients have continued to paint small models for Herald Miniatures. Finally, the third session with the car has proved most valuable, and has meant that outlying districts could be visited more frequently. 30 VENEREAL DISEASES As judged by first attendances at the special Clinic at the Croydon General Hospital, the unusual trend observed since 1952 continued. Syphilis was disappearing, but gonorrhoea increasing. In the past, these two infections have waxed and waned together indicating alterations in sexual promiscuity, which rises in times of war and falls when peace returns. Some new factor has therefore arisen to influence this age old pattern on which it is possible but unhelpful to speculate. For detailed figures see appendices, pages 131-134. PUBLIC HEALTH LABORATORY SERVICE Very considerable use has been made of the facilities for bacteriological and other laboratory examinations of Public Health nature. I take this opportunity to thank Dr. A.J.H. Tomlinson, the Director of the Bacteriological Laboratory, County Hall, S.E.1, for his ready assistance and most helpful advice, which have been available at all times. The following figures show the work carried out during the year under review:- Samples submitted to the Pathological Laboratory for Bacteriological Examination - 1959. Faeces outfits 4,026 Water samples 381 Milk samples 233 Cream samples 11 Ice Cream samples 236 Sundry Food Specimens 14 Blood 24 Urine 1 Nose and Throat Swabs 16 Total 4,942 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 31 ANTE-NATAL AND POST-NATAL CLINICS These combined clinics serving both hospital and domiciliary midwifery services continued unchanged. The extension to the premises, which it had been anticipated would be ready by the end of the year, was unfortunately delayed by shortages of building materials. One point on the routine conduct of these clinics seems worthy of comment. Although every effort is made to prevent mothers waiting unreasonably when they attend by appointment, some justified complaints are still received despite constant checks and vigilance to ascertain if the appointment system is working satisfactorily. It is possible to be fairly certain that the schedule of the local authority clinics will be maintained, but an emergency call can unfortunately completely disrupt a hospital session. Demands of the maternity wards understandably receive priority as far as hospital medical officers are concerned, but it would seem an important consideration when estimating hospital staffing ratios that there should be sufficient cover to allow staff adequate time and freedom from disturbance. Only if this is available, can doctors in the routine clinics give that personal attention and unhurried consultation which expectant mothers now rightly anticipate. During the year 4,174 cases were seen at the Ante-Natal Clinics, of which 2,962 were new cases. A total of 25,836 attendances were recorded and 1,870 cases were seen at the Post-Natal Clinics (1,807 new cases) with 1,870 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. 24 series of talks of 6 sessions each on "Mothereraft" at which 368 mothers attended were given during the year. At relaxation exercise sessions, 574 mothers recorded 3,120 attendances. CARE OF 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 108. 32 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 Workers. The Corporation also paid hostel fees in respect of approved cases for whom such accommodation was required. During the year under review- 182 cases were dealt with by the Social Workers; 43 cases were admitted to Mother and Baby Homes; 4 cases were temporarily accommodated at Glazier House The Croydon Home of the Moral Welfare Association). The Committee agreed' to meet financial responsibility for the stay of unmarried mothers in Mother and Baby Homes for a period of three months except for girls up to 18 years of age, for whom the period would be extended to cover a total of six months and such assistance was given in 20 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 - 6 cases 16 years old - 8 cases 17 years old - 6 cases MIDWIFERY As compared with 1958, 51 more mothers had a home confinement. Following a minor outbreak of infection in the maternity wards, the local hospital curtailed bookings. The Corporation introduced a reduced charge for maternity home helps, which greatly eased the task of refusing to many mothers a hospital bed. The practice of early discharge from hospital was also used whenever overcrowding of maternity wards was threatened and this was an added factor in increasing the work of the domiciliary midwifery service. The appointment of two part-time maternity nurses was of the greatest assistance in dealing with this aspect of the work and thus enabling the domiciliary midwives to concentrate on actual confinements. The year was also unfortunate because of a heavy incidence of sick leave amongst domiciliary midwives, which in aggregate was equivalent to the loss of one midwife throughout the year. 33 There were the usual difficulties in filling vacancies, but it was possible to maintain a full establishment. Midwives work in pairs, so that one midwife is on duty when her partner is away. Off duty is planned on a four weeks' rota, which is constant giving as far as possible a different day off in the week for three weeks and a weekend for the fourth week. A "day off" is from 5 p.m. on one day to 7 a.m. two days later (38 hours) and a "weekend" from 5 p.m. Friday to 7 a.m. Monday. Apart from the day of return from leave, two hours off duty is given each day in the morning, afternoon or evening to fit clinic attendances and the needs of the partner midwife. The Corporation have continued to provide furnished or unfurnished accommodation as may be desired and supply a car or pay a full car allowance to all domiciliary midwives. Ten general practitioner obstetricians now hold ante-natal sessions in their own surgeries at which midwives attend. This is in addition to the general practitioner sessions at the Corporation clinic at New Addington. For detailed figures see appendices, pages 105-107. 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 69. All held the certificate of the Central Midwives' Board. The Medical Supervisor of Midwives visits midwives in private practice and nursing homes, and the Superintendent Municipal Midwife carries out these duties for the domiciliary midwives. 34 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 68,925 Cod Liver Oil 14,080 Vitamins A and D (for Expectant Mothers) 13,672 Orange Juice 125,594 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 preference for more pleasant Vitamin D products, especially amongst the mothers most careful in the feeding of their infants. MATERNITY AND CHILD WELFARE AND PHYSIOTHERAPY CLINIC Arrangements were made for a session a week of physiotherapy and remedial exercises to be available at New Addington. Applications for physiotherapy for children under five years of age continue to diminish, while an anticipated increase in sessions for expectant mothers was delayed by the setback in the completion of new premises at Lodge Road. Details of attendances are given in Appendix, page 113. 35 THE WORK OF THE HEALTH VISITORS Miss L. E. Oakley, S. R. N., S.C. M., H. V. Cert. Superintendent Health Visitor 1959 saw the Health Visitor again taking part in an exceptionally heavy Poliomyelitis Vaccination Programme, which included the "teenage rush" following the death of a noted footballer. During the year the Department was responsible for giving practical training to 19 Health Visitor Students and for arranging for 90 student Nurses to see something of the work of the domiciliary services. In these circumstances routine work tends to get behind, but good grounding in practical work does mean that each piece of advice given at a home visit must be analysed and its purpose explained, whether the visit is done by the trained Health Visitor or by the student who visits selected cases in her third term. The obvious interest and enjoyment of the student nurse at all she sees and hears makes her visit to the Department extremely worth while. Thanks are due to colleagues in the statutory and voluntary services who give such willing help in this matter of training. A pilot survey into the needs of old people living alone was carried out in a small part of the Borough. Its findings showed that with one exception all were taking advantage of the Services offered nationally and locally; very few were without relatives who could be contacted in cases of emergency, but all were lonely. Some had had too hard a life to learn the art of making friends - others had outlived their contemporaries - but most welcomed the opportunity of having someone with whom to talk. However sympathetic she may be this is a task which the Health Visitor cannot undertake. It is one which must be left to voluntary organisations. The findings of a Committee on the nursing of sick children prompted the idea of a Home Nursing Course being given to the Mother's Club at New Addington. It was felt that many sick children could be nursed at home by the District Nurse if the mother had some knowledge of simple nursing techniques. The support the Course received revealed how many parents were worried as to the effect a period in hospital might have on their children. It is certain that the knowledge so obtained Will prevent many from panicking at the first sign of illness. In other Centres simple talks on the importance of drinks and rest, the taking of temperatures and how to keep a sick child occupied have been given. 36 For the rest the Health Visitor does her best work in the homes of the families visited. Because of her other commitments her visiting does tend to become selective. Those most in need of advice are always visited, whilst those more fortunately placed know where the Health Visitor is to be found and that a request to visit will always be met. Figures of work carried out are shown in Appendix, page 109. Discussion Group Addington. This Group, which was started in 1958, held fourteen meetings during the year, including a Nursing Course. Talks on the following subjects were given by:- Feet and Shoes Dr. E.M. Hegarty Infection and Prevention Miss B. Devaney The Probationer Service Mr. p. Dunhill Diet, Pood Values and Dental Defects Miss E. P. Harrington Personal and Environmental Hygiene Miss B. Devaney Pood Storage and clean food handling in the Home Miss B. Devaney Vaccination and Immunization Miss B. Devaney. Members taking the Nursing Course attended seven weekly lectures combined with practical work commencing on 14th September. The talks were given by Miss Devaney who was helped in the practical work by Miss Bird and Miss Vince. The examination was held on 11th November and of the twenty three entrants all were successful. During the year 61 mothers attended the Club and a total of 366 attendances were made. The social committee was responsible for arranging an enjoyable and successful dinner party at a country hotel on the evening of 26th May. The twenty six members attending appreciated the work done by the committee on their behalf. 37 SEWING CLASS Held at Waddon Infant Welfare Centre. During 1959 the attendance at this class has increased from 4 or 5 persons to up to 12 at some sessions. The classes are now held weekly and the person who is encouraged to come, is the one who is in real need of this individual type of instruction. The numbers have to be kept low in order, that with the limited help available, each person attending can get the maximum amount of supervision. The lack of voluntary help is still the main difficulty. Mrs. Kitching who looked after the toddlers has had to leave owing to home commitments and has not been replaced, but Mrs. Fairman and Mrs. Myers have continued to give very valuable assistance. The results produced by the mothers have been most gratifying to both pupils and instructors. Another second hand machine has been purchased. This was made possible through a kind donation from relatives of the late Miss Dodd and also from funds raised through the sale of teas, second hand clothes, and the rag-bag. It has been possible to show a Home Safety Film, and also informal talks on health and topical subjects have been given. I think the mothers enjoy these talks, and a happy atmosphere prevails. 38 HOME SAFETY Miss D. E. Blackmore, &R.N., S. C. M., H. V. Cert. Home Safety Officer The year opened with the continuation of the "Guard that Fire" Campaign. Most Infant Welfare Centres were visited with the film "Fabrics and Fireguards" and the new flame resistant cloths were demonstrated. A short talk and film were also given by Fire Officers during the same session. The most debated point was the paraffin stove. People appeared to be unaware of the dangers of oil heating in portable stoves. It was possible to repeat the programme to small groups of mothers three times during each clinic. In the autumn a "Check that Fall" campaign sponsored by R. S. P. A. was organised. 11 Clubs with a total attendance at the meetings of approximately 848 were visited. Following the talks, a card with 20 Questions were issued and from those returned completed, the following summary has been made:- 1. Have you been free from "falling about" during the past two years? 97 answered NO. 2. Is your general health good? 97 answered NO. 3. Are you free from "dizzy spells"? 114 answered NO. 4. Are you free from painful conditions of the feet? 136 answered NO. 5. Are you free from serious eye troubles 110 answered NO. 6. Are you free from rheumatism and arthritis? 203 answered NO. 7. Are you able to do your own housework with ease? 66 answered NO. 8. Are you satisfied with the lighting in your home? 26 answered NO. 9. Have you enough light, for safety, on the stairs? 28 answered ft). 10. Is your bed low enough for you to get out of it easily? 20 answered NO. 11. Is your armchair high enough for you to get out of it easily? 24 answered NO. 12. Do your shoes fit well? 15 answered NO. 13. Do you keep your shoes in good repair? 7 answered NO. 14. EX) you have any aids to help you bath safely? (e.g. rubber mat, hand-rail, etc.) 146 answered NO. 15. Is your gas meter within easy reach? (without standing on a chair) 39 answered NO. 39 16. Is your electric meter within easy reach? 22 answered NO. 17. Are your floor coverings in safe condition? 8 answered NO. 18. Are your floor boards sound? 11 answered NO. 19. Do you avoid polishing under mats? 10 answered NO. 20. Are your back door steps safe to use? 13 answered NO. Health Visitors visited homes where there appeared need of help and advice seemed necessary, and suitable action was taken. It showed that many adaptations were needed in present day houses to make them suitable for an ageing population. The Club meetings were well attended and are bringing to light the needs of old age. All pregnant mothers receiving Mothercraft lectures are instructed in Home Safety. Space was kindly given by the A. B. C. Cinemas, The Savoy Broad Green and The Rex Norbury, for two exhibitions during the showing of "Emergency Ward 10". Children at school receiving Community Health lessons have one session on Home Safety. Burns and scalds are still too frequent with children, poisoning of young children is on the increase, mostly caused by careless storage of pills and dangerous cleaning materials. This gives great concern as most of these accidents occur to children under two years of age. Enquiries were received from many sources about various dangers in the home particularly connected with oil stoves. Visits were paid to homes where particular dangers were noted. The film "Fabrics and Fireguards" was purchased; it has been in constant use by members of the department and is loaned to any interested outside group. Talks were given to the following:- Pensioners Clubs 10 Various religious groups 5 Infant Welfare Centres 15 Rangers 4 Red Cross 8 Townswomens Guild 1 Talks to mothers groups etc. Parent-Teacher meetings 7 by Health Visitors 18 School Children 2 40 Displays were lent to various schools and organisations. The assistance and co-operation of the Fire Prevention Officers has been particularly helpful in the Home Safety Campaign. Tables are given in the Appendix, page 118. IMMUNISATION Poliomyelitis vaccination was available to all persons under 25 years of age and after a slow beginning, requests for injections became very heavy. Despite temporary difficulties in obtaining extra supplies of vaccine, there were no major setbacks and results were most satisfactory for the group of children under 15 years of age and reasonably good for adolescents and adults. With the reports of diphtheria cases in various parts of the country, this protection was pressed during the Autumn months and arrangements made for an extensive campaign of "booster" doses in the schools for early 1960. Discussions took place with the Local Medical Committee regarding immunisation schedules, especially the question of vaccination against whooping cough in early infancy. Croydon's statistics showed only one death from whooping cough during the last seven years and that four years ago. Over the last decade, some 50% of infants each year were given pertussis vaccine, but analysis of records show that in 1957 and 1958, 5% only were vaccinated against whooping cough before six months of age. There was no reason to suppose that a higher percentage of very young infants were included in earlier years. It was, therefore, agreed not to vary the present programme followed by the majority of practitioners, namely, vaccination against smallpox at about three months of age, polio vaccination at six months of age and "triple vaccine" at about eight months with "booster" doses at appropriate invervals thereafter. The use of combined vaccines is avoided during the six months April to September. Tables are given in the Appendix, page 124. 41 HOME NURSING This is provided on an agency basis by the Croydon District Nursing Association and Miss Dickinson, the Superintendent reports:- It has been a rather heavy year, partly due to the long term sickness of nurses and the fact that part-time staff have taken their places. There has been a distinct change in the type of work received from the Doctors. There have not been so many Pencillen etc. injections but a good deal more general nursing which, of course, takes the nurses much longer. The Rehabilitation Nurse has been kept busy throughout the year, chiefly by the Doctors who now know that she is working for the Croydon District Nursing Association. The number of Male Nurses will be increased to five during the coming year. The need for this increase is chiefly due to heavy patients being discharged from hospitals, and also special requests by the Doctors for a male nurse to attend. In 1950 there was only one male nurse on the staff of the Association so there has been a steady increase in the work for male nurses. The students in the future will join Surrey County for their new lecture courses and the length of training will be four months for S.R.N's. and three months for S.R.N's. who have Midwifery Certificate or who have spent at least 18 months on the district instead of six and four months respectively. The number of Nurses trained for the Queen's Roll during the year was 10 and all were successful in the examinations. Tables given in Appendix, page 111. LOAN OF HOME NURSING EQUIPMENT A request was received for the loan of a patient's mechanical hoist. These are expensive items costing some £70 each. They are, however, invaluable for dealing with helpless bedridden patients and authority was obtained for two to be purchased especially for use by the District Nurses. Demands for other items showed the rising trend observed over recent years, but occasioned no particular difficulties. Tables given in Appendix, page 114. 42 HOME HELP SERVICE Miss J. E. Heath Home Help Supervisor In many aspects 1959 has been another year of quiet activity The Home Help Service continues to expand but like the passing of time it is unnoticed in the moment but clearly evident in retrospect. The year 1959 will be remembered mainly for the experimental scheme of reducing the charge for full time Home Help Service for home confinement to £2.0.0d. per week. This scheme proved very popular and was successful in reducing to some extent the demand for accommodation in local maternity units. Greater prominence is given every year through the medium of the press, radio and television to the care of the aged and the responsibility of the community towards its aged population. In the changing social structure the Home Help is filling the place vacated by relatives and neighbours who are no longer available during the day to give their time. Unlike so many developments where mechanisation eliminates the use of human hand and mind, in caring for humanity emotional factors can never be replaced. A genuine desire to help the sick and handicapped is not diminished because the responsibility is moved from one group of society to another and the work of the Home Help Service is motivated and maintained by this desire. Many unrecorded acts of kindness to the lonely aged of Croydon are performed every year by Home Helps in addition to their official duties, despite the fact that not a few older people decry the standards of the present day worker, however efficient. The perfect patient invariably receives the services of a perfect Home Help but it is also necessary to attend those who find all their fellow beings intolerable. The understanding and perseverance shown by Home Helps in the face of such difficulties can easily be understood. Every year the number of old persons remaining on the books increases, as does the proportion who become more frail and require additional help with even simple tasks. To most old people their home is the pivot of existence, consequently domiciliary care is favoured. The Home Help Service now firmly established in this field cannot remain static; future expansion and development are inevitable as the aged population increases. 43 Of the subsidiary services, i.e. Night Attendants, Disinfestation. Problem Families, Washing Service, only the Washing Service is proving inadequate to meet the demand but new equipment to be purchased in 1960 will enable more washing to be undertaken. The present problem is mainly concerned with drying but really up to date drying equipment will alleviate this difficulty. Set out in Appendix page 115 are details of the work carried out. 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 2 1/2 to 5-yearolds daily excepting Saturdays, the remainder being of the "parttime" class receiving toddlers for mornings only. The Registered Minders receive children for the day. They are not encouraged to take children under 2 years. Number of Number registered children 31.12.59 provided for Premises 7 140 Daily Minders 15 78 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. 44 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 53 cases were so dealt with, 40 women, 10 men, two mothers with children and 1 child under school age. 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 5 mothers who paid 12/6d. per day during 1959. The duration was for 5 days, 10 days, 3 months, 3 months and 6 months. In two 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, and in another two instances the cases were priority but the family income was such that the full cost was paid. The fifth case was non-priority. Details of attendances- Capacity 50 Number on books at end of year 40 Attendances: Under 2 2,451 Over 2 5,050 Total 7,501 Number of days opened 255 Average daily attendance 29 45 HEALTH EDUCATION Miss D.S. Elliott, S.R.N., H.V. Cert., Dip. H.E. Health Education Officer "Was none who would be foremost To Lead such dire attack: But those behind cried 'Forward!' And those before cried 'Back !.' ' Lord Macauley. The more the field of health education is explored, the more frighteningly wide it becomes and it is understandable that some reluctance may be found in tackling it. A talk to voluntary workers in Infant Welfare Centres at a reception given by the Mayor and an in-service training session with the health visitors were opportunities taken during the year to explain and show how one aspect of health education could be given a "New Look" from a sound and familiar base line, the Infant Welfare Centres, and still be within the scope of every member of the staff. Success with this work would give them confidence and experience to deal with more ambitious work in the future. It was explained that compulsory hygiene had banished certain epidemic diseases, but the spread of modern nuisance diseases in this country depended largely on the relationship between behaviour and health. It was now possible to make the deliberate choice between accepting or rejecting protection against certain diseases and accidents and if people were not constantly taught how to hold them at bay, ignorance and apathy would encourage their return once more. Nowadays there is an insatiable curiosity and demand by the public for this knowledge. It is expertly given and sometimes exploited by all the forms of mass communication - by commercial advertising, the glossy magazines and television whose organisors have for a long time recognised public interest. Public health staff should always be acutely aware of these needs and be the recognised local authority for providing authentic health information in a really vital way. It was explained that some more organised form of health education in Infant Welfare Centres was not intended to replace the personal advice given by the doctors and health visitors, but 46 to complement it and enable mothers who have no particular prob1ems to enjoy their visits and to look forward to learning and seeing something new and helpful each time. Secondly, success would depend on close teamwork in the Centre. The doctor and health visitors are leaders of the team and decide policy and line of action. The voluntary workers would now be even more valuable. Help would be needed with the simple displays used because they would have to be erected and dismantled at each session and the skill of many voluntary workers in making, sewing and knitting would be invaluable to a health visitor constructing a new display for herself. Two health visitors would be needed at the centre for this kind of work. One to supervise routine proceedings, new babies and prophylaxis, so that the other could concentrate on putting over the chosen topic. It was also suggested that babies should not be weighed quite so frequently, but should be undressed, weighed and examined at the first visit and thereafter at much longer intervals to create time for teaching the mothers the manv other signs of good health, growth and development. Some practical ways in which these ideas might be tried in Church Halls were then suggested: Method 1 :- A small simple display is placed on a table near the circle where the mothers are waiting with their babies and in full view of them. At intervals during the session, as five or six mothers are sitting together the doctor or health visitor will draw their attention to the subject displayed and ask them informally for their views. It should be quite easy to encourage mothers to discuss their own experiences - they will learn something from each other and something extra from the staff who will help them over difficult hurdles or point out something new; Method 2:- Once every two or three weeks by means of previous good clear advertising in the Centre, arrangements may be made to conduct the session as usual for the first hour, then one health visitor will supervise routine work and the other give a half-hour illustrated talk or show a film or film-strip. Method 3:- Once a month a purely educational session to be held on another day - either afternoon or evening, the theme to be chosen by the mothers. Other difficulties of time and number of attendances could be overcome with planning. 47 In October, the Home Safety Officer, with members of the Fire Service, initiated the winter programme by giving sessions in the Centres on "Fireguards and Fabrics". Although their presentation was more elaborate than has been suggested, because a display and two ten-minute films were used and put on for the Centres' staff, it was possible to prove that:- (a) The mothers were interested in such a programme. (b) Good advertising and encouragement from the health visitors stimulated their interest. (c) Nearly all the mothers would remain for half an hour. (d) Cups of tea and reasonable control of toddlers could almost always be organised. Well established work in two Infant Welfare Centres is described in more detail on pages 36-37 , and it is hoped that the other Centres will follow their example next year. Poliomyelitis campaign. In April help was given in publicising the Poliomyelitis Campaign for the 15-25 year olds. This was concentrated at very short notice while the subject was topical, following the unfortunate death of an international footballer. We were grateful for publicity material given to us by a British firm of poliomyelitis vaccine manufacturers and made full use of it. Posters were displayed all over the town, thousands of wage packet slips were issued to factory and other employees, gramaphone records containing a few bars of popular music followed by a strong reminder to take action were given to youth clubs and all the local dance halls and included in their programmes, a booth decorated with poliomyelitis material was on display in the busy High Street, dustcarts and cars displayed suitable posters and stickers. Much other propaganda was carried out by general practitioners and all members of the public health staff The Crystal Palace Football team helped us by allowing the press to take photographs while they were being vaccinated and finally the full co-operation of the local press did much to help the campaign. Of the age group, 13,059 or 58% received two injections and 54% were given a third injection. How much our own campaign had any influence on these numbers was difficult to assess, because there was high pressure publicity from the national press, radio and television services at this time. 48 Smoking and Lung cancer Campaign. Illustrated talks to Secondary School children about the risks of smoking have continued and are discussed in the School Section of the report on page 6. During 1960 we hope to encourage health visitors to introduce this subject at Infant Welfare Centres. A great many mothers smoke now and are thus setting the example to children from their earliest days. Exhibitions and Displays. We are constantly trying to improve the standard of this work. In March, help was given to the Public Health Inspectors in the preparation of charts and exhibits for their stand in their Clean Air Exhibition. Twelve individual displays were exhibited at the Voluntary Workers Reception at the Town Hall also in March. These were examples of material suitable for Infant Welfare Centres. Assistance was given with Home Safety Displays at the Rex and Savoy Cinemas and on one occasion for the Sutton and Cheam Borough Council. Help was also given in the designing and construction of the Home Safety exhibits for the summer Flower Show in Ashburton Park. These were made so that they could be used again in Infant Welfare Centres and schools. This year our forty-foot stand in the "Welcome to Citizenship" Exhibition was completely re-arranged. Permission was given to have official photographs taken of activities in all sections of the department and the willing co-operation of the staff, patients and school staffs was very much appreciated over this. The photographs were colourfully mounted and the display enlivened with three-dimensional and mechanical devices. Among the many visitors to the Exhibition was a party of Health Education students from the London University Institute of Education, many of whom came from abroad and were interested in English Local Administration. Other Activities:- Film and filmstrip shows were held in the Lecture Room in January, May and December to which doctors, health visitors, district nurses and midwives were invited. In May the film "Growing Old" was shown twice and staff from Welfare Services were also invited; so great was the interest in this that there was standing room only. 49 A visit was made to the District Nurses Association to demonstrate the filmstrip projector to the tutors; the filmstrip on 'Lifting Patients" was shown to the Matron of the Welfare Services Hostels for old people and later she showed it to all her staff. Much time was also spent in preparing visual material for the Ante-Natal Clinic. The number of illustrated talks to other organisations by many members of the department increased during the year and we have added a daylight screen and tape-recorder to our equipment. More students of all kinds visited the health education section and two health education students from London University Institute of Education carried out their practical work here one day a week for six months. Health Education in senior schools continued and is described in the School Section of the report on page 5. So gradually a new enthusiasm for health education is being created but in the words of Benjamin D. Paul " To teach, the health educator must be able to learn". 50 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- find 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. As stated in the School Report the principal focus of activity continues to be that of improving facilities for residents on the New Addington Estate, where shortage of clinic accommodation has for a long period been the main obstacle to meeting the needs of this community. During the past year the final stage of reconstruction at the Overbury Clinic, which was commenced in 1958, has been completed, resulting in a spacious and much improved Dental Unit. The provision of additional draught proof doors in the main corridor has greatly increased the comfort of patients during the winter months, without detracting from the general amenities of the school;whilst the introduction of a second fully equipped surgery is already playing a substantial role in reducing the previous bottle-neck in treatment. In addition to an increased coverage for schools, a greatly extended service should in future be possible for all expectant and nursing mothers and pre-school children in this district. Steps to publicise the new amenities have recently been undertaken at various Welfare Centres with the object of developing this side of the work. Some concern is felt at the delay in providing alternative dental accommodation for the Waddon area, to replace the premises in Duppas Hill Lane now scheduled for demolition. Unfortunately, because of lack of space on available sites it has not been found possible to include a clinic block as part of any schools planned for this district. A current scheme for incorporating a dental unit in a proposed Welfare Centre is much to be recommended, and could play a useful role in encouraging early attention for toddlers. Because of the very considerable increase in the school population, the need for adequate facilities for this area is becoming increasingly apparent. 51 Little of new significance has occurred with regard to existing arrangements for the oral supervision of mothers attending Ante-natal Clinics, and problems relating to the above have been adequately dealt with in previous Reports. During the year the joint "follow-up" measures, previously described, have been continued and it is interesting to note that absenteeism among those referred for routine examination has again shown a small decrease. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 406, compared with 410 in 1958. 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 during abnormal periods, waiting time before receiving initial appointments is reasonably short. The percentage of mothers failing to attend for their dental examination was 24 per cent. against 27 per cent. in 1958. Expectant mothers examined for the first time numbered 248 against 278 last year. Of these, 75.8 per cent. were seen during the first six months of pregnancy, compared with 80.6 per cent. previously recorded. Those attending at later stages of their confinements included some with pain or discomfort; others, who had but recently arrived in the Borough had been unable to arrange for prior treatment. 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, exactly equaling the total for 1958. Treatment Including those continuing treatment from the previous year, 369 mothers were dealt with, against 393 in 1958. A welcome sign during recent years has been a decrease in the need for wholesale removal of teeth and the large scale provision of 52 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 359, compared with 353 in 1958. 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; without being too dogmatic it is undoubtedly wise for most children to receive their first check-up at about the age of three years, and in any case before they attain 3½ years. Contact with these children has been considerably hampered in recent years by the closure of Day Nurseries, and greater dependence has therefore to be placed on other outside sources, such as Welfare Centres and Nursery classes at Primary Schools. In this connection the building of the new Infant Welfare Centre immediately adjacent to the Lodge Road Clinic should assist in redressing the balance in this district. Unfortunately it is still apparent that a great many parents do not fully realise 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 usual tables are given in the Appendix, page 117. 53 AMBULANCE SERVICE To the Medical Officer of Health I beg to submit the Eighteenth Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1959. During the year the Service was called upon to deal with 114,790 patients, which necessitated 51,974 journeys and a mileage of 413,119. Compared with 1958 these figures show an increase of 4,710 patients and 472 journeys with a decrease of 4,464 miles. There were 17,929 patients conveyed to places outside the Borough, and on these journeys 132,090 miles were travelled. The number of patients carried during the year was comparable with 1958 until the commencement of August when an increase became apparent. The number of patients admitted to Hospitals and Nursing Homes was 9,433 compared with 7,904 the previous year. An average of 12 patients a day were taken to Warlingham House, Park Lane, Croydon for after care treatment and were conveyed to their homes later in the day. The Spastic Adult Classes held at Bramley Hill two evenings of each week finished and this was mainly responsible for the loss of 4, 405 miles. The daily conveyance of two children to St. Margaret's School has been taken over by the Education Department Coach which passes St. Margaret's each day on the way to St. Giles' School. A saving of 3,000 miles is anticipated. Mileage for the transport of Gas and Air Analgesia Sets for the Midwives Service has decreased owing to more midwives having either Corporation or their own cars. It should be recalled that during the previous year (1958) 1,724 miles were travelled by the Service transporting personnel to and from work during the bus strike which lasted for 6 weeks. This strike was also responsible for a considerable number of extra patients being conveyed to hospitals who would normally have travelled by bus. Once again during the past year the Service has been reQuested by adjacent authorities to cover accident calls, and these requests have been attended to whenever possible. 54 First Aid Refresher Courses have again been attended by personnel and new entrants to the Service have all obtained a First Aid Certificate within the probationary period. It is with regret that I have to report the death of one man following a short illness, he had been with the Service for 14 years. I have to report that a Daimler Ambulance, LRK 289, was involved in a major accident on the 7th October at the junction of Green Lane and Northwood Road, when a lorry driver reported that his brakes had failed and crashed into the side of the Ambulance. The driver of the Ambulance was uninjured but the attendant was taken to hospital for a check up, and I am glad to report was not detained. The following vehicles were delivered during the year:- One Bedford "Utilecon" Sitting Case Vehicle One Karrier Ambulance One Karrier Coach (Mental Health) and the following vehicles were disposed of:- One Bedford "Utilecon" Sitting-Case Vehicle One Humber "Pullman" Ambulance The new Karrier Ambulance has proved reliable, comfortable for travelling and most economical. List of Serviceable Vehicles at 31st December, 1959 Eight Daimler Ambulances Two Humber "Pullman" Ambulances One Humber "super-Snipe" Ambulance Eight Bedford "Utilecon" Sitting-case Vehicles Two Bedford Sitting-case Coaches One Vauxhall "wyvern" Saloon Car One Austin Breakdown Vehicle Two Bedford Coaches (large)(Mental Health) One Karrier Coach (Mental Health) For details of journeys, patients, mileage etc. see the Appendix, page 119. 55 CIVIL DEFENCE (Ambulance Section) The total number of volunteers on the register at 31st December, 1959 was 285. Of this number 117 attended for training regularly and a further 45 occasionally. Letters have been sent to the non-attenders and many have been placed on the reserve list at their own request in conjunction with a Home Office ruling. Only three volunteers have resigned and four have moved from the area. A First Aid Course was again organised with Doctors and the St. John's Instructors and of the 86 volunteers who entered there was only one failure. The Forward Medical Aid Unit organised by the South West Regional Hospital Board held a large scale exercise at Ashburton Secondary School on Sunday, 1st November. Croydon Civil Defence Ambulance and Casualty Collecting Section were invited to participate and between 40 and 50 volunteers took part, acting as Deputy Directors, Controllers and patients. I am sure that valuable information was gathered by volunteers who attended this exercise. An exercise was also held at the Rescue Range at Eastbourne and considerable experience was gained regarding Convoy Driving and Casualty Collecting. The Regional and National Competitions were again held during the year and Croydon were runners up to Middlesex. The new programme of training includes talks by Instructors from other Sections and a First Aid Course for all Section Instructors, the latter being held at Civil Defence Headquarters, Wellesley Road, Croydon. In conclusion, may I express my sincere thanks to the Members of the Ambulance Sub-Committee, the Medical Officer of Health and the Officers and Men of the Service, for their help and encouragement which has been of great assistance to me in the administration of the duties of Chief Ambulance Officer. A.L. HILL, Chief Ambulance Officer. 56 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 two 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, 2 Clerks, 1 Occupation Centre Supervisor, 5 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. Monthly liaison meetings between the authority's mental welfare officers and the social and psychiatric workers of Warlingham Park Hospital were introduced in the early part of the year and these have now become established features of the close personal contact between the two services. Voluntary Associations The only duty delegated to a voluntary organisation was the supervision of 12 defectives placed under the care of The Guardianship Society. Work carried out in the Community The pages which follow give details of the work undertaken in 1959. I once again record with appreciation the co-operation and advice given so readily by Dr. Firmin of St. Lawrence's Hospital, Dr. Ferguson of the Royal Earlswood Hospital, and Dr. MacKeith of Warlingham Park Hospital. 57 Lunacy and Mental Treatment Acts 1890-1930 Patients admitted to Hospitals:- As Voluntary Patients - Section 1, Mental Treatment Act 1930 13 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 428 446 Cases investigated but no action deemed necessary 86 The 428 patients admitted to hospitals under Section 20 of the Lunacy Act were subsequently dealt with as follows:- Remained in hospitals as voluntary or informal patients 167 Certified under Section 16, Lunacy Act 1890 91 Became Temporary patients under Section 5, Mental Treatment Act 1930 11 Discharged home 108 Discharged to Queens Hospital 9 Discharged to General Hospital for treatment 17 Discharged to Nursing Homes 7 Discharged to Welfare Hostels 6 Discharged to Police care 2 Died 10 428 Patients over 60 years of age admitted to hospital under Section 20 of the Lunacy Act (included in figures above) Males Females Aged 60 - 70 24 31 Aged 71 - 80 14 33 Over 80 10 25 48 89 The number of cases dealt with shows a slight increase over 1958. Towards the end of the year the informal admission procedure was introduced which enabled any patient who was not unwilling for treatment to be admitted to hospital informally in the same way as patients are admitted to general hospitals and this has now supplanted voluntary admissions. 58 Four patients were admitted to Homes run by the Mental After Care Association, one for convalescence and the remaining three on a long term basis. The Corporation accepted financial responsibility subject to contributions according to means. Mental Deficiency Acts 1913-38 Ascertainment During the year the number of new cases ascertained was 22 compared with 19 in 1958 and the total number of cases on the Authority's registers is now 820 made up as follows:- In Mental Deficiency Hospitals 351 On licence from Hospitals 10 In Approved Homes 1 Under Statutory Supervision at home 257 Under Guardianship 16 In Mental Hospitals 11 Under friendly supervision 174 820 273 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 111 cases. The Mental Welfare Officers paid 3,260 visits. Further information concerning cases dealt with in 1959 is appended below, and the 1958 figures are given for comparison purposes:- 1959 1958 Admitted to Mental Deficiency Hospitals 18 27 Admitted to Mental Hospitals 3 2 Admitted to Hospitals for Short-Term Care 13 12 Transferred from one Hospital to another 9 6 Varying Orders: (a) Change of Guardian 2 2 (b) From Guardianship to Hospital 1 1 7 cases were awaiting permanent vacancies in mental deficiency hospitals on 31st December 1959. 59 The re-assessment of cases under guardianship was completed in 1959. After careful consideration it was decided to make no change in the status of patients in the care of the Guardianship Society but the number of patients under Guardianship elsewhere has now been reduced to four. At the same time a comprehensive survey was made of the needs of all cases under statutory or friendly supervision in anticipation of the new Mental Health legislation. Training Occupation Centre. Number on Register, January, 1959 79 „ „ „ December, 1959 90 Number of admissions 21 Number left or excluded 10 Average attendance per session 71 Times open, morning - afternoon 378 Total attendance for year 27,060 I am indebted to Miss Cooney, Supervisor of the Occupation Centre for the following report:- 1959 was a year of considerable activity at the Centre. In February, a small outdoor training group was set up to give some of the older boys training as gardeners/handymen. The response in attendance and performance was very promising and it is hoped to enlarge the group in 1960. The boys are under the day to day supervision of the Centre's gardener, are provided with protective clothing and are paid incentive pocket money at a commencing rate of 10/- weekly. A new class for junior children was also formed to provide vacancies for children awaiting admission. Staffing difficulties hit us rather badly. One teacher successfully applied for the post of supervisor with another authority and there was an unavoidable delay - due to the national shortage of assistant supervisors - before she could be replaced. Sickness too took its toll of the staff but on the credit side a domestic assistant was appointed and we were also fortunate enough to obtain a qualified teacher for the new junior group. 60 In spite of our troubles the output of work was not materially affected and the Annual Sale of Work in December was very successful, sales on the day amounting to £35-ll-3d. The Croydon & District Society for Mentally Handicapped Children continued to be very interested in the welfare of the children and in addition to contributing generously to the Christmas Party also presented us with a record player and records. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 61 WORK OF THE PUBLIC HEALTH INSPECTORS George Grieve, F. R. S. H., F. A. P. H. I. Chief Public Health Inspector The implementation of the Clean Air Act, and particularly that part dealing with control of smoke emissions from dwellings, occupied much time of the staff during the year. Factory smoke gave but little trouble, as industry is realising that to emit smoke in quantity is uneconomic as well as being a contravention of the law. The first Smoke Control Order made by the Council was confirmed by the Minister of Housing and Local Government during the year. This Order, which covers the Waddon-South Croydon area, provides for the control of smoke emitted from a chimney of any building, including a dwelling, in the area. Conversions and adaptations to the fireplaces in the buildings in the area are progressing satisfactorily. Approved works to fireplaces in dwellings in the area in order to make them capable of burning smokeless fuels efficiently are subject to a grant of seven-tenths the cost. A second Order will, it is hoped, be made early in 1960 in respect of an area contiguous to the first and a preliminary survey of a third area is proceeding By the end of 1963 it is anticipated that six areas of the Borough, comprising in total some 20,000 dwellings and 2,500 other premises, will be covered by anoke Control Orders. In the field of housing the clearance and redevelopment programmes are progressing in that the majority of the unfit houses in the Lamberts Place-Bridge Place area and the Eagle HillCrystal Terrace area have been acquired and rehousing of the occupants will proceed as houses are built to accommodate them. Up to the end of the year there had been, in total, 746 applications from tenants for Certificates of Disrepair, the grantipg of which permits an abatement of part of the rent until such time that the repairs requested are completed. In but 296 cases has it been necessary to issue Certificates of Disrepair. The recently adopted local act powers regarding nuisance from noise, have brought forward many complaints entailing visits at all times of day and night to the precincts of the premises complained of. On the whole we have had a fair measure of success in having the noises complained of reduced in level. Before statutory action can be taken by the Council, the inspecting Officers must be satisfied that the noise complained of is either excessive, or unreasonable, or unnecessary and is in 62 their opinion prejudicial to health or a nuisance. One finds in the majority of cases, that once convinced they are responsible for a noise which has been complained of to the Council, offenders are prepared to co-operate in an effort to reduce the noise, Food inspection, and particularly meat inspection at the Abattoir, continues to make increasing demands on the time of the staff. Again there has been another large increase in animals slaughtered at the Abattoir; this year 88,479 as against 67,526 last year. 100 per cent meat inspection has been maintained but this entails much evening and weekend attendance of the Inspectors at the Abattoir. The premises were never constructed to take such a "throughput" of animals and it is annually becoming more difficult to cope. The Council has decided, in principle, to provide a new Abattoir and it is hoped in the next year to be able to report that the difficulties attendant upon the provision of such a building have been overcome and that approval will be given for work to go ahead. Again my thanks are due to the staff for their efforts during the year and for the ready way in which they have responded to the calls on their "own" time. 63 HOUSING 37 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 3 Number of houses on which Closing Orders have been made 15 Number of houses on which Demolition Orders have been made 6 Number of houses where Certificates of unfitness were issued 26 During the year 1330 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 1959:- Number of applications for certificates 93 Number of decisions not to issue certificates Nil Number of decisions to issue certificates 93 (a) in respect of some but not all defects 50 (b) in respect of all defects 43 Number of undertakings given by landlords 61 Number of undertakings refused by Local Authority Nil Number of certificates issued 32 Applications by landlords to Local Authority for cancellation of certificates 49 Objections by tenants to cancellation of certificates 13 Decisions by Local Authority to cancel in spite of tenants' objection 9 Certificates cancelled by Local Authority 48 64 West Croydon Men's Hostel This is situated at Pit1ake 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 35,485. The receipts during the year were £3,600 and the expenditure £5, 672. Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, at a fee. During the year 11 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 (1) Number on Register (2) Number of Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 399 114 10 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,559 435 30 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 22 45 6 - Total 1,980 594 46 - 65 Cases in which Defects were found:- Particulars Number of cases in which defects re re found Number of cases in which prosecutions were ii1stituted Found Remedied Referred To H.M. Inspector By H.H. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S. 1) 3 3 - - - Overcrowding (S. 2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S. 4) 2 2 - - - Ineffective drainage of floors (S.6) 1 1 - - - Sanitary conveniences (S.7): (a) Insufficient 4 3 - 1 - (b) Unsuitable or defective 55 42 - 1 - (c) Not separate for sexes - - _ 1 - Other offences against the Act (not including offences relating to Outwork 16 11 - - - Total 81 62 - 3 - Part VIII of the Act Outwork Nature of Work Section 110 Section 111 No.of outworkers 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 No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel 384 - - _ - _ Household Linen 1 - - - - - Lace, lace curtain and nets 9 _ . _ _ - Curtain and furniture hangings 6 - _ - _ _ Furniture and upholstery 5 - - - . . Umbrellas, etc. 1 - - - - - Paper bags 27 - - • - • continued on next page 66 Nature of Work Section 110 Section 1ll No. of 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) (4) (5) (6) (7)  The making of boxes or other receptacles or parts thereof made wholly or partially of paper 8 - - - - - Carding, etc. of buttons, etc. 110 - - - - - Stuffed toys 21 - - . - . Basket making - - - - - - Chocolates and sweetmeats 7 - . . . . Cosaques, Christmas crackers, Christmas stockings, etc. 223 - - - - - Lampshades 43 - - - - Total 845 - - - - - 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 79 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 safeguarded in the matter of shop ventilation, lighting, warming, washing facilities, facilities for taking meals and suitable and sufficient sanitary accommodation, and action has been taken in the cases where these fell short of requirements. 343 inspections were made under the Shops Act, and the infringements found were as follows:- 67 Hours of Closing 3 Insufficient W.C. accommodation 1 Defective ventilation 1 Defective and insufficient lighting 1 Notices to be exhibited or amended 40 DRAINAGE 1,901 visits of inspection were made to underground drains in course of repair. Of 150 Statutory Orders served, 30 had to be done in default of the owners. In addition, repairs were carried out by the Corporation to 6 public sewers serving 29 properties. OFFENSIVE TRADES There are but two registered, and during the year there has been no cause for complaint. POLLUTION OF RIVERS AND STREAMS During the year 108 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. CLEAN AIR ACT Towards the end of 1958 the Council made Croydon smoke Control (No. 1) Order to cover parts of the Waddon-South Croydon area and this will become operative on the 1st April, 1961. In the area are 1,916 dwellings and 160 industrial, commercial etc. premises. During 1959, 2,686 dwellings and 356 industrial, commercial etc. premises were surveyed in the South Croydon area to comprise Croydon smoke Control (No. 2) Order. This area abuts the area covered by the No. 1 Order and the estimated total cost of the works of adaptation or conversion of fireplaces in dwellings 68 in the area is £42,834. The Council and the Exchequer make grants towards such costs, of 30% and 40% respectively. It is hoped to bring this second Order into operation by October, 1961. 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 Snoke and Grit Emissions. 167 such observations were made and in 3 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 18 plans showing the construction and heights of new chimneys have been examined and in 15 cases additional height has been requested and agreed. 32 notices of the installation of new furnaces have been received. AMUSEMENT HOUSES 94 inspections were made of Hieatres, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary conditions of these premises. Notices are issued to remedy any unsatisfactory conditions. DISINFECTION The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use supplied with steara from a gas fired boiler within the Station. The following articles were disinfected at the Disinfecting Station during the year: - By Steam 11,507 articles By Formalin Gas 2, 675" Tota 14,182 articles 245 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 1959, 226 articles were disinfected, the receipts amounting to £14.19.3d. Disinfection was carried out after infectious or contagious diseases at the following premises:- 229 rooms at 84 houses, hospital wards, clinics etc. 2,629 library and other books were disinfected. 69 On request disinfection was also carried out for conditions other than notifiable infectious diseases and for which a charge is made. During the year £41. 13. 0d. was recovered for such services. 15 articles for Welfare Department institutions and 1,037 Medical Cards in Home Nursing were disinfected. 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, 8 adults and 18 children were cleansed of verminous conditions and 13 adults and 11 children were treated for scabies. DISINFESTATION OF PREMISES The new insecticides have provided a ready and easily applied remedy for vermin and pest infestation of premises, etc. and occupiers are advised and instructed in their use by the Inspectors. The department assisted in the more difficult cases umbering 111, 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 ' Hie 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 23. In addition, 262 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 fillings for upholstery, bedding, toys, etc., with the object of compelling the use of clean fillings. 70 During 1958, 12 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 4 Kapok 1 Millpuff 1 Curled Feathers 2 Down and Feathers 1 Cotton Felt 1 Loose Fibre 1 Woolen Mixed Felt 1 PET ANIMALS ACT, 1951 24 persons were licensed for the purpose of keeping Pet Shops. During the year 35 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS Suspected swine fever was notified from three pig keepers' premises during the year. These and 9 cases notified from the slaughterhouses were confirmed and appropriate action was taken in conjunction with the Officers of the Ministry of Agriculture, Fisheries and Food to provide against the spread of the disease. 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, 2,046 private dwellings were inspected following complaints and in 1,972 instances infestation was confirmed and dealt with by the rodent operatives. 177 business premises were found to be infested with rats or mice and these were all disinfested during the year. One of these was treated by the occupiers. Regular inspections are made of premises where food is prepared or sold and particular attention is given 71 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. 47 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. The use of Warfarin, a comparatively new poison,in the sewers over the past five half yearly treatments has proved satisfactory. It was found at the last treatment, carried out in the summer, that so few infestations were recorded, that the usual winter treatment could be dispensed with. It is necessary to keep a close watch on the sewers to ensure that the present low infestation rate is maintained and a thorough check will be made in the early part of 1960 in order that any further infestation of the sewers is disclosed and dealt with. The accompanying graph shows the results of the baiting of the sewers since 1947. See Page 135. 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 3,368 premises in the Borough at which food is known to be sold, manufactured or stored. Bakehouses 58 Bakers shops 110 Sugar Confectioners 585 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 486 Works and Club Canteens 302 Public Houses 176 Off Licences 79 Grocers 614 Butchers 210 Wholesale Meat Markets 5 Chemists 82 72 Greengrocers 263 Fishmongers 74 Fried Fish Shops 45 Milk Distributors and Dairies 73 Premises from which Roundsmen and Mobile Shops operate 23 S talIs 112 Pood Manufactories 19 Other Pood premises not enumerated above 52 3, 368 Of the above premises 985 are registered under Section 16 of the Pood and Drugs Act, as follows: - Retail sale of ice-cream 799 Manufacturers of ice-cream 7 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 179 During the year 3,477 inspections were made of food businesses (for details see page85). INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1955/56. Structural defects in shops and stores 2 Defective condition of walls and ceilings 37 floors, utensils, fixtures, etc. 17 Defective or insufficient drainage 1 W. C. accommodation - repair or cleansing required 19 " - artificial lighting required 1 - want of intervening ventilated space 1 Pood - not stored 18 "off floor 1 - means to prevent contamination required 11 " - store required or defective 1 Accumulations in yard or stores 8 Offal and refuse bins defective or uncovered 11 Yard paving defective 3 Hand washing notice not exhibited 6 Ablutions - Wash basins required 13 " - Hot water supplies required 26 "- Nail brushes, soap and towels required 11 Insufficient or defective sinks 7 Smoking offences Clothing accommodation required or defective 3 Defective or unsuitable table tops, etc. 4 First Aid kits required or insufficient 3 Cleanliness - advice given 6 Rodent infestation 1 Merchandise Marks 1 73 Prosecutions A firm of local bakers pleaded guilty to five summonses relating to the sale of bread rolls which were unfit for human consumption. The Magistrates Court imposed fines totalling £50 with £2.12. 6., costs. Two employees at the Public Abattoir were summoned for offences under the Slaughterhouses (Hygiene) Regulations, 1958 which require that any person engaged in the handling of meat in a slaughterhouse shall wear overalls or suitable protective clothing, including a washable head covering, and shall not use tobacco in any part of a slaughterhouse. One employee was fined £10 in respect of two offences and ordered to pay one guinea costs. The second employee was fined a total of £19 in respect of five offences and was ordered to pay two guineas costs. Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1959: - Article Weight in lbs. Carcase Meat 73, 340 Offal 64,612 Sundry Foodstuffs 6. 150 Canned, Bottled and Packeted Poods 16, 140 Total 160,242 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 1958, 67,526 animals were slaughtered, and this rose to 88,479 animals during 1959 74 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:- Animals Slaughtered Cattle excluding Cows Coios Calves Sheep and Lambs Goats Pigs Total 3,064 1,309 5,644 50,168 216 28, 078 88,479 CARCASES INSPECTED AND CONDEMNED Cattle exclucling Cows Cows Cal ves Sheep and Lambs Pigs Goat s Horses Nunber killiul 3,064 1,309 5,644 50, 168 28,078 216 Nil Number inspected 3.064 1, 309 5,644 50, 168 28, 078 216 Nil 411 diseases except Tuberculosis and Cysticerci whole carcases condemned 2 36 46 631 216 3 Nil Carcases of which some part or organ was condemned 1,032 678 33 5, 483 2, 383 4 Nil Percentage of the number inspected affected with diseases other than Tuberculosis 33.7 54.6 1. 4 12. 1 9.3 3. 2 Nil Tuberculosis only Whole carcases condemned 4 3 Nil Nil 4 Nil Nil Carcases of which some part or organ was condemned 104 7 Nil Nil 256 Nil Nil Percentage inspected affected with Tuberculosis 3. 5 0. 8 Nil Nil 0.9 Nil Nil Cysticercosis Carcases of which some part or organ was condemned 42 5 Nil Nil Nil Nil Nil Carcases submitted to treatment by refrigeration 42 5 Nil Nil Nil Nil Nil Generalised and totally condemned 1 Nil Nil Nil Nil Nil Nil 75 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 Poods) 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. 29 inspections of licenced plants were made during the year. MILK SUPPLY During the year 207 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 89 Licences to use the designation "Sterilised" - Dealers' Licences 115 Dealers' Supplementary Licences to use the designation - (a) Tuberculin Tested 14 (b) Sterilised 13 (c) Pasteurised 14 Inspection of these licensed premises has been carried out during the year to see that the conditions of the licences were observed. 76 Bacteriological Examinations of Milk During the year the following samples of milk were examined: Tuberculin-Tested Pasteurised Milk 38 Pasteurised Milk 186 Sterilised Milk 9 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 38 38 - 38 Pasteurised Milk No. Samples Taken Methylene Blue Test Phosphatase Test Not Satisfied Satisfied Not Satisfied Satisfied 186 - 186 - 186 Sterilised Milk Turbidity Test No. Samples Taken 9 Not satisfied Satisfied 9 Bacteriological Examination of Milk Chum and Milk Bottle Rinses Churn Rinse Samples - 7 Satisfactory - 7 Unsatisfactory - Nil Bottle Rinse Samples - 90 Satisfactory - 84 Unsatisfactory - 6 These samples were obtained at local milk bottling plants; and the results, as a whole, are considered satisfactory. 77 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 236 samples were taken, the results being as under:- Grade No. of Samples 1 155 2 45 3 26 4 10 BACTERIOLOGICAL EXAMINATION OF CREAM Eleven samples of fresh cream were examined and produced satisfactory results. Of the total samples taken, 36 (15.06 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, 246 samples of Milk and Cream,and 299 other samples were taken, of which number, 25 were found to be Not Genuine. Sunmary of Samples During 1959 samples were obtained and submitted to the Public Analyst as follows:- 78 Samples of Total Samples Genuine Not Genuine Prosecutions Con vie tions Almonds, (Ground) 1 1 - - - Apples 1 1 - - - Ale, Strong 2 2 - - - Artificial Colour 2 2 - - - Arrowroot 1 1 - - - Ascorbic Acid Tablets 1 1 - - - Aspirin Tablets 2 2 - - - Bacon 2 2 - - - Batter mixture 1 1 - - - Beer, Bitter 6 6 - - - Beer, Tinned 1 1 - - - Bicarbonate Soda 2 2 - - - Biscuits 4 3 1 - - Black Pudding 2 2 - - - Black Treacle 1 1 - - - Blancmange Powder 2 2 - - - Boracic Ointment 1 1 - - - Brandy 2 2 - - - Brawn 1 1 - - - Brisket of Beef 1 1 - - - Bread, Brown 1 1 - - - Bread, Milk 1 1 - - Butter, Danish 3 3 - - - Butter, Dutch 3 3 - - - Butter, New Zealand 4 4 - - - Butter, Australian 2 2 - - - Buttered Rolls 1 1 - - - Calamine Ointment 1 1 - - - Camphorated Oil 2 2 - - - Calamine Compound Cream 1 1 - - - Calamine Lotion 1 1 - - - Candled Peel 1 - 1 - Cakes, Various 1 1 - - - Cake Mix 1 1 - - - Cheese, Cheddar 2 2 - - - Cheese, Danish Blue 1 1 - - - Cheese Spread 1 1 - - - Cheese Biscuits 1 1 - - - Chocolate 2 2 - - - Chocolate Powder Sweetened 1 1 - - - Chutney 1 1 - - - Cod Liver oil with Malt 1 1 - - - Cocoa 1 1 - - - Coffee and Chicory Essence 1 1 - - - Compound Liquorice Powder 1 1 - - - Condensed Milk 2 2 - - - Cooking Fat 2 2 - - - Corned Beef 3 3 - - - Cornflour 2 2 - - - Cornflakes 2 2 - - - Cough Mixture 1 1 - - - Cough Pastilles 1 1 - - - Cream, Tinned 2 2 - - - Cream, Fresh 10 10 - - - Cream Buns 1 _ 1 - - Crystallized Fruits 1 1 - - - Curry Powder 2 2 - - - Custard Powder 2 2 - - - Dried Fruit 1 1 - - - Dried Peas 1 1 - - - Drinking Chocolate 1 1 - - - Dripping 2 2 - - - Dyspepsia Tablets 1 1 - - - Evaporated Milk 1 1 - - - Fish Cakes 2 2 - - - 79 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Fish Fingers 1 1 - - . Fish Paste 5 - - - Flavouring Essence 1 1 - - - Flour 2 - - Friar's Balsam 1 1 - - - Fruit pie 2 - - • Frying Oil . 1 1 - - - Gee's Linctus 1 1 - - - Gelatine 1 1 - - - Gin 4 4 - - - Ginger, Crystallized 1 1 - - • Glauber's Salt 1 1 - - - Glycerine 1 1 - - - Golden Syrup 1 1 - - - Grapefruit juice 1 1 - - - Gravy Powder 1 1 - - - Ground Cinnamon 1 1 - - - Ground Rice 1 1 - - - Ground Ginger 1 1 - - - Ham 1 1 - - • Hamburgher 1 - 1 - - Halibut Liver oil Capsules 1 - - - Honey 1 1 - - - Honey, Glycerine and Lemon 1 - 1 - - Horseradish Relish 1 1 - - - Ice Cream 6 - - - Ice Lollies 1 1 - • - Iodine, Tincture of 1 1 - - - Iodine Ointment 1 1 - - - Indigestion Tablets 1 1 - - - Jam 1 1 - - - Jelly 2 - - - Jellied Veal 1 1 - - - Lard 4 4 - - - Lemon Barley Water 1 1 - - - Lemon Curd 2 - - - Lemon Juice 1 1 - - - Lemon Pie Pilling 1 1 - - - Linctus, Blackcurrant 1 - 1 - - Luncheon Meat 1 1 - - Liquid Paraffin Emulsion 1 1 - - - Macaroni 2 - - - Malted Milk Tablets 1 1 - - - Margarine 3 - - - Marmalade 1 1 - - - Marzipan 2 - - - Meat Extract and Cubes 1 1 - - - Meat Paste 1 1 - - - Meringue Powder 1 1 - - - Milk 236 230 6 - - Milk of Magnesia 2 - - - Mint Sauce 1 1 - - - Mincemeat 4 3 1 - - Minced Beef 2 - - - Mineral water 1 1 - - - Mixaroon 1 - 1 - - Mustard 1 1 - - - Mustard, French 1 1 • - - Mixed Herbs 1 1 - - - Nutmegs, Ground 1 1 - - - Olive Oil 1 1 - - - Orange Squash 1 1 - - - Parrish's Chemical Food 1 - 1 - - Pancake Mixture 1 1 - • - Pepper 1 1 - - - Peanut Butter 2 2 - - - Peanuts 1 1 - - - 80 Samples of Total Samples Genuine Not Genuine Prosecu tions Conric. tioos Pickled Onions 1 1 . - - Pickled Cabbage 1 1 • - - Pickled Gherkins 1 1 • - - Pickles 1 1 - - - Pickling Spice 1 1 • - - Pineapple Juice 1 1 • - - Pork Pies 2 2 - - - porage Oats 2 2 - - - Pressed Beef 1 1 . - - Puff Pastry 2 2 - - - Quinine, Tincture of Ammonia 1 . 1 - - Rice 1 1 . - - Rice, cream Pudding 1 1 - - - Rum 4 4 - - - Rum Essence 1 1 - - - Sago 1 1 • - - Salad cream 1 1 - - - Sandwich Spread 1 I - - - Sauce, Chop 2 2 - - - Sausages, Beef 3 3 - - - Sausage, Meat 2 2 - - - Sausages, pork 2 1 1 - - Sausage, Liver 2 2 - - - Sausage, Luncheon 2 2 - - - Sausages, Frankfur 1 1 - - - Saveloys 1 1 - - - Semolina 1 1 - - Senna Pods 1 1 - - - Shortbread 1 1 - - - Soda Mint Tablets 1 1 - - - Sourcrout 1 1 - - - Split Peas 1 1 . - - Steak pudding 1 1 . - - Suet, Packed 2 2 . - - Sponge Mixture 1 1 • - - Sugar 1 1 - - - Sugar, Icing 2 2 - - - Sweets 5 1 4 - - Soup Powder 1 1 - - - Steak and Kidney Pie 1 1 - - - Stuffing, Sage and Onion 1 1 - - - Sulphur Ointment 1 1 - - - Syrup of Figs 1 1 - - - Table Salt 1 1 - - - Tapioca 1 1 - - - Tea 3 3 - - - Tinned Beans 1 1 - - - Tinned Broad Beans 1 1 - - - Tinned Fruit 3 3 - - - Tinned Peas 2 2 - - - Tinned Vegetables 1 1 - - - Tinned Soup 2 2 - - - Tinned Fish 2 2 - - - Tinned Meat 5 4 - - - Tinned Marmalade 1 1 - - - Tinned Tomatoes 2 2 - - - Tomato Paste 1 . - - - Veal and Ham Roll 1 1 - - - Vitamin "a" Capsules 1 1 - - - Vitaminised Iron Tonic Tablet 1 1 - - - Vitamin Capsules 2 2 - - - Whisky 4 4 - - - Witch Hazel 1 1 - - - least Tablets 2 2 - - - Total 545 520 25 - - 81 Result of Analysis of Milk Samples Solids not Fat (Legal standard is 8.5%) 8.3 8.4 8.5 8.6 8.7 8.8 8.9 3 3 30 113 55 15 6 Milk Fat (Legal standard is 3%) 3. 1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 5 4 24 37 52 35 37 20 4 4 4.1 4.2 4.3 4.4 2 - - 1 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.rfh) 8.7 8.8 8.9 9.0 9.1 9.2 1 2 1 6 - 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 1421--1--1--1 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Pat 8.64 Milk Pat 3.56 82 South Devon and Channel Island Milk Solids not Pat 8.94 Milk Pat 4.44 Total number of Milk Samples 236 The samples of milk for analysis were obtained as follows:- Taken on Milk Round 128 " at Dairies 86 " at Institutions 22 236 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration o r Deficiency fieaarls Confectioneryflour. (Cream Buns). Contained imitation cream instead of cream. A notice exhibited in the shop did not clearly indicate the nature of the "cream" filling. The Vendor has now amended the notice. Confectionerysugar. (Fruit Creams) This sample of Sweets, traditionally known as Fruit Creams, contained a number of jelly sweets which are not entitled to this description. Vendor warned. Chemical Food This article was deficient in iron to the extent of 15 per cent. Vendor warned. Manufacturers have withdrawn stocks of this article from sale. Confectionery- sugar. (Boiled Sweets) This article was described as Boiled Sweets but, in fact, consisted of Toffees. Vendor warned. Luncheon Meat This sample contained only 71% of meat which, in the opinion of the Analyst, is not sufficient to Justify the description "Luncheon Meat . The importers have undertaken to improve the quality of this article. Sausage-pork The sample contained preservative which was not declared at the time of sale. Vendor warned. Amnion i at ed Tincture of Quinine. Deficient in ammonia to the extent of 35 per cent. Vendor warned. Stocks withdrawn from sale and destroyed. Candied Peel Consisted of cut mixed peel. This article was sold in error by an inexperienced shop assistant. Vendor warned. 83 Article Nature of Adulteration or Deficiency Reaaris Mincemeat. Tbis informal sample contained 1.05 parts of acetic acid per 100 parts of mincemeat vbereas each 100 parts sbould not contain more than 0.5 parts of acetic acid. Vendor warned. Subsequent formal samples have proved satisfactory. Biscuit Mix. This informal sample of macaroon biscuit mix contained groundnuts as an ingredient whereas, in the opinion of the Analyst, the essential nut constituent of macaroon is ground almonds. This matter has been taken up with the packers. B1 ackcurrant Linctus. The ingredients specified on the label on this article were not clearly defined. Stocks of this article were withdrawn from sale. Honey, Glycerine and Lemon. In the opinion of the Analyst the label on this article was not satisfactory in that there was no indication of a large proportion of sugar in the article. This article has now been re-labelled Syrup of Glycerine, Honey and Lemon. Casserole Steak. This sample consisted of steak and gravy containing 63% of meat whereas, in the opinion of the Analyst, the article should contain 95% of meat. Hie Importers have undertaken to secure an improvement in the quality of this article. Hilk (6) The Analyst reported a slight deficiency in milk solids, other than fat, in these samples but tests Indicated that this was not due to the presence of added water. The deficiency in milk solids is attributed to seasonal conditions and several subsequent samples from the same suppliers have proved satisfactory. Hamburgers. This article consisted of sausage croquettes containing 40% of meat. The Analyst considers that this product is quite unlike the American-type Hamburger or Hamburger Steak, and is not manufactured as such, but does in fact resemble the Austrian-type Hamburger commonly sold in cafes and restaurants in this country. Further samples are being obtained for comparison purposes. Milk Loaf. This article contained 4% of non fat milk solids and not more than 0.2% milk fat whereas, in the opinion of the Analyst, the description on the wrapper would lead a purchaser to believe that the bread was made wholly with milk. The producers have discontinued the use of the wrapper concerned. Tomato Paste. Contained 1. 5% of added salt which was not declared on the label, as required by the Labelling of Pood Order, 1953. Ttie Importers have undertaken to amend the label concerned. 84 Article Nature of Adulteration or Deficiency Remarks Confectionerysugar. (Rum Truffle) This article was in a rancid condition and unfit for human consumption. Vendor warned. Confectionerysugar. (Coffee Truffle). Biscui tsDigestive. This article was contaminated with a mould growth. The label on this article specified that the biscuits were made with pure butter whereas only one half of the fat content consisted of butter. Vendor warned. The manufacturers hare amended the label and have undertaken to revise the recipe for this article. 85 Summary of inspections made by the Public Health Inspectors, and other Departmental work. Total number of houses inspected for housing defects under Public Health or Housing Acts 2,775 Houses inspected where zymotic diseases have occurred 381 following applications for certificates of disrepair 293 Inspections of underground rooms 97 Special inspections in connection with the Housing Survey 99 Houses inspected for overcrowding conditions 62 Reinspections of work outstanding on housing notices 8.27 2 Nunber of visits regarding infectious diseases 1,262 ii n n b ... . food poisoning 67 Inspections of drainage work during repair 1,901 House drains tested with smoke and colour - routine and complaint 780 House drains tested with smoke (on written application) 11 House drains tested with smoke during repair 50 House drains tested with water during repair 62 Inspections of cesspools and earth closets 10 " " schools and school sanitary conveniences 79 " public conveniences 178 " " verminous premises 93 " ponds and ditches 20 " " yards, stables and passages 60 " theatres, cinemas, halls, etc 94 " " pig styes 29 tents, vans and similar structures 44 Visits regarding smoke abatement 3, 359 Visits regarding exhumation 2 Visits to premises for food condemnation 515 Inspections of swimming baths 10 " " wells 4 " " gathering grounds of water supply 33 " " gipsy encampments, camps, fairs, etc. 37 " "offices 4 rivers and streams for pollutions 108 Food and Drugs Acts: Pood and drugs samples taken 545 Pood and Drugs Acts: Milk samples taken 236 Ice cream samples taken 236 Samples taken of Fertilizers and Feeding Stuffs 20 " swimming baths water 88 " drinking water 288 " subsoil water 3 " from rivers, streams, etc. 12 private wells 16 " of rag flock and other filling materials 12 " sundry specimens (food poisoning etc.) 14 Inspections under Merchandise Marks Act 81 " " of butchers premises 273 "" meat premises (wholesale) 627 " " horseflesh premises 8 " " poultry and game dealers premises 26 " " fishmongers premises 64 " " fried fish premises 38 " " grocers premises 544 " " fruiterers and greengrocers premises 195 " " bakers premises - including bakehouses 150 " " dairies 109 " " milk shops 98 " " general shops and their premises 22 Inspections of premises where cooked meats etc. are prepared or sold 12 86 Inspections of confectioners premises 256 " confectionery manufacturers premises 15 " cafes, snack bars, canteens, hotels and their kitchens 427 " school kitchens and serveries 55 " hospital kitchens 9 " " ice cream manufacturers premises 28 " " ice cream vendors premises 149 " ice cream barrows and carts 8 " " market and barrows 90 " other food premises not enumerated above 274 " premises where offensive trades are conducted 2 factories with mechanical power 435 " factories without mechanical power 114 " " works of building and engineering 45 " outworkers premises 22 Visits to employers of outworkers 11 Inspections of shops (under shop Acts) 343 Special early closing, evening and Sunday trading patrols of shops 347 Appointments kept with owners, builders, etc. 1,566 Investigations of complaints other than housing matters 1,436 Reinspections of works outstanding (other than houses) 2,678 Inspections under Hydrocyanide Regulations " " Fertilizers and Feeding stuffs Act 22 " Diseases of Animals Act 31 " Pets Act 35 Rag Flock and Other Filling Materials Act 14 " Pharmacy and Poisons Act 28 Sundry Inspections and Visits 4,816 Visits regarding rats and mice infestations 8,531 Informal Notices outstanding 31.12.58 852 " served 1.565 ' " complied 1.711 Number of Informal Notices referred for Statutory Orders 595 Informal Notices outstanding 31. 12.59 706 Statutory Notices outstanding 31. 12.58 242 " served 397 " " complied 436 outstanding 31. 12.59 203 Total number of callers and complaints received at the office 2,660 Total number of letters received at the office 6,764 Nuisances, Infringements of Acts, Byelavvs, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1959 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 322 Conditions causing dampness: Defective roofs 316 Defective window frames 423 Defective walls, etc 96 Want of efficient damp-proof course 85 Defective gutters and downspouts 298 87 Other structural defects: Defective plaster 500 Cleansing and redecoration required 103 Defective floors and stairs 407 Insufficient ventilation under floor 19 Defective brickwork, sills, lintels, chimneys 154 Defective stoves and fireplaces and flues 141 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 85 Defective W. C.' s 163 Defective drainage 131 Stoppages in drains 170 Defective water services and tanks 32 Domestic nuisances: Want of cleanliness 0 Verminous conditions 11 Other nuisances and infringements: Offensive accumulations 53 Overcrowding 4 Sundry nuisances or defects 62 Particulars not inserted in Rent Book (Housing Act) 19 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924 Pood cupboards defective or required 8 (3) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, ETC. Defective Yard Paving 72 Want of a sanitary dustbin 30 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 2 W. C. defective or dirty 8 (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 2 (6) SMOKE ABATEMENT Nuisances observed 3 PUBLIC HEALTH SERVICES 89 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 2,499,906,000 M. W. B. Bulk Supplies 751,299,000 Total 3,251,205,000 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. 482 raw water samples and 1167 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 32 samples of treated water were subjected to bacteriological examination by the Consultant Bacteriologist to the Water Undertaking. Further samples were submitted by the Medical Officer of Health for examination by the Public Health Laboratory Service. The results of the bacteriological examination of the raw waters were typical of waters pumped from the Chalk, some of them showing the normal deterioration in quality which occurs after heavy rain. In all cases the examinations showed that the raw water was suitable for treatment. The bacteriological examinations of the treated waters showed that these waters were of uniformly excellent quality. 90 (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 83 of raw waters and 133 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are not liable to have plumbo-solvent action. The whole of the population and dwelling-houses within the area of supply are supplied from public water mains direct to the houses. Testing of Samples tay 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. During the year under review the total number of examinations performed were:- Bacteriological 277 Chemical 11 91 RADIATION HAZARDS The issue of Ministry of Housing and Local Government Circular 57/59 made clearer the position of local authorities. Copies of this important document were circulated to all Members of the Health Committee. It must be accepted that monitoring and testing of foodstuffs should be on a national basis, having in mind the widespread sources of supply of food,milk and water. I do not think official reports minimise possible risks, but the basis on which long term forecasts can be made must rest at this early stage on scanty data. Only time, experience and extensive research can answer many of the questions now being put and it is unfair to interpret equivocal statements as deliberate efforts to mislead. The application of atomic energy is probably proceeding with more caution and safeguard than any previous industrial process. Nursing Pomes - Public Health Act, 1936 Number of Homes Number of Beds provided for:- Maternity Others Total Homes registered daring the rear - - - - Homes on the Register at the end of the year 21 31 494 525 Routine inspections at about four monthly intervals by a medical officer of the department continued. Measures to ensure that all Homes complied with the requirements of the Fire Brigade continued. This is necessarily a slow process as in many cases, extensive building work is necessary. Very satisfactory progress was made and it was possible to anticipate that all the requirements would be completed during 1960. NURSES AGENCIES REGULATIONS, 1945 There is one Agency on the register. 92 CROYDON AIRPORT - HEALTH CONTROL The system of continuous "on call" manning by Medical Officers continued until 30th September when the Airport was closed. Aircraft and Passenger Arrivals, Croydon Airport. Aircraft Passengers "Excepted Area" 848 2,410 Europe outside Excepted Area 2 5 Africa, Middle East - - Asia - - 850 2,415 Included in the above figures were 1,300 Aliens carried in 468 Aircraft. CREMATION ACTS, 1902 AND 1952 During the year 2,222 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 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 1959 2,222 93 INTERNATIONAL CERTIFICATE FOR VACCINATION During the year 2,457 certificates were dealt with at the office (2,282 anallpox, 123 Cholera and 52 T. A. B.). STAFF MEDICAL EXAMINATION Hie 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 or who are exhausting entitlement to sick pay. Pollow-up for cause and anticipated date of return to duty. Report on financial circumstances by an Almoner of the Health Department, in order that a special Establishment Sub-Committee may decide on extension of sick pay. (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. 942 examinations were made during the year by the Medical Staff of the Department including 25 vision tests for drivers. Of these 826 were in respect of manual workers, who were classified as follows:- 94 Fit for employment and sick pay scheme 711 Deferred for review 29 Unfit for sick pay scheme 76 Pit for light employment only (Not fit for sick pay scheme) 6 Unfit for employment 4 826 Kedical examinations for Boarding Out and Admission to Children's Homes. 188 children were presented for medical examination by the Children's Department during 1959. 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 97 cases registered:- 9 were due to glaucoma and 50 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:- 3 patients had moved from the borough. 3 patients had died. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE AMENDMENT ACT, 1951 From time to time, and from various sources, information was received about elderly people, who were thought not to be receiving adequate care and attention. During the year, visits were made to the homes of 26 such persons (21 females and 5 males). On only one occasion (a man aged 80 years, who refused hospital treatment although seriously ill) were compulsory powers used. A Magistrate's Order was obtained for this patient and he was removed to Queen's Hospital, where he died a few weeks later. 95 Other cases were dealt with as follows:- 5 old people were admitted to Queen's Hospital. 1 was admitted to Croydon General Hospital, but was transferred to Queen's Hospital, where she died later. 2 were admitted to Mayday Hospital, but one was later transferred to Warlingham Park. One old lady, almost totally blind, deaf and who was living alone, was nevertheless remarkably agile. She had some private means and was eventually persuaded to enter a Nursing Home, where she has recently celebrated her 101st birthday. One was admitted to a Corporation Old People's Home and one died. 14 remained in their own homes supported by domiciliary services. 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 40 adult cases are registered with his Department, 11 of whom are in special Homes. APPENDIX TABLES 97 VITAL STATISTICS - 1939-1958 98 REGISTRAR GENERAL' S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX Sex 0- 1. 5- IS- 25- 45- 65- 75- To tal All Causes M 47 3 13 9 34 389 417 540 1,452 F 33 3 4 8 28 2Z7 348 9 34 1,585 Tuberculosis (Respiratory) M - - - - 1 6 5 4 16 P - - - 1 - 3 3 1 8 Tuberculosis (other forms) M . . . . - - - - . F - - - - 1 - - - 1 Syphilitic Diseases M - - - - - 1 2 2 5 P - - - - - 1 - 2 3 Diphtheria M P - - - - - - - - - Whooping Cough M P Meningococcal Infections K P Acute Poliomyelitis M P Measles M . P 1 - 1 Other Infectlye and Parasitic diseases M - - . . . 2 . - 2 F 1 2 3 Total Infective and Parasitic diseases (including Tuberculosis) 1 2 13 12 11 39 Malignant neoplasm, stomach M _ _ _ 2 10 16 4 32 F - - - - - 7 5 18 30 ” ” lung,bronchus M _ _ - . 4 68 50 14 136 P - - - - 1 8 8 4 21 " ” breast M _ . _ . . 1 . - 1 P - - - - 5 21 9 16 51 " " uterus P - - - - 2 6 4 4 16 Other malignant and lymphatic neoplasms M - - 1 - 5 47 53 43 149 P 1 - - 1 2 49 50 64 167 Leukaemia; aleukaemis M _ 1 2 1 1 - 2 1 8 F 1 1 1 1 1 2 4 1 12 Total all forms of Cancer 2 2 4 3 23 219 201 169 623 Diabetes M - - - - 1 2 2 5 P - 1 - - - 2 6 9 Vascular lesions of Nervous System M _ • • 2 18 43 86 149 P - - - 5 28 66 195 294 (a) Coronary disease, angina M - - - 5 108 113 90 316 P - - - 1 31 75 122 229 (b) Hypertension, with heart disease M . - - - 3 6 11 20 P - - - - 2 5 41 48 (c) Other heart diseases H - • - 2 16 14 63 95 P - - 1 2 14 23 164 204 (d) Other circulatory diseases M - - - 1 11 13 22 47 P - - 1 - 3 17 74 95 Total heart and circulatory diseases - - 1 2 18 235 379 876 1,511 99 Sex 0- 2- 5- 25- 25- 45- S5- 75- Total Influenza M - - 2 - 1 11 6 9 29 P - - - - - 4 13 18 35 Pneumonia M 8 1 - - - 8 15 49 81 F 5 - - - 1 8 14 66 94 Bronchitis M - - 1 - - 26 41 46 114 P - - - - - 5 12 43 60 Other diseases of respiratory system M - - - - - 3 1 3 7 P 1 - - - - 1 2 3 7 Total diseases of respiratory system-including influenza and excluding tuberculosis 14 1 3 - 2 66 104 237 427 Dicer of stomach and duodenum M - . . . . 6 5 7 18 P - - - 1 - 1 2 3 7 Gastritis, enteritis and diarrhoea M 1 1 - - . . 1 3 6 P - 1 - - - 1 1 3 6 Nephritis and nephrosis M - - 1 - . 6 3 3 13 F - - - - - 2 2 6 10 Hyperplasia of prostate Pregnancy, childbirth and abortion M - - - - - 2 5 13 20 F - - - - 1 - - - 1 Congenital malformations M 9 - - - 1 . 1 - 11 F 7 - 2 - 1 1 1 - 12 Other defined and ill-defined diseases M 28 - 1 1 1 15 13 57 116 F 18 1 - 1 1 19 23 66 129 Total Miscellaneous Diseases 63 3 4 3 5 53 57 161 349 Motor vehicle accidents M - - 2 6 4 6 4 2 24 F - - - - - 1 1 3 5 All other accidents M 1 - 2 - 2 7 2 3 17 F - - - - - 3 - 7 10 Suicide M - - - 1 2 7 1 2 13 P - - - - 4 6 4 2 16 Homicide and operations of war M - - 1 - - - - 1 2 F - - - 1 - - - - 1 Total-accidents, suicide and violence 1 - 5 8 12 30 12 20 88 TOTALS 80 6 17 17 62 616 765 1474 30 37 100 CANCER Deaths from Cancer occurred at the following Ages:- Age Period Male Femal e Total Under 25 years 5 6 11 25 and under 35 years 2 2 4 35 and under 45 years 9 9 18 45 and under 65 years 127 93 220 65 years and over 183 187 370 326 297 6 23 Sites of Fatal Cancer Site Mai e Feu al e Total Percentage of Total Skin 4 3 7 1,124 Oesophagus 8 7 15 2.408 Stomach 32 30 62 9,952 Liver 3 3 6 0,963 Bowel 19 39 58 9,309 Rectum 19 19 38 6,099 Bladder 16 6 22 3,531 Prostate 20 - 20 6,135 Larynx and Pharynx 5 1 6 0,963 Uterus - 16 16 5,387 Breast 1 51 52 8,347 Ovary - 23 23 7,744 Pancreas 6 8 14 2,247 Gall Bladder and Duct - 2 2 0,321 Tongue and Mouth 3 4 7 1,124 Bones 2 1 3 0,482 Lungs and Bronchus 136 21 157 25,201 Kidney 5 5 10 1,605 Brain and Nervous System 8 8 16 2,568 Lymphatic Glands and Connective Tissue 6 2 8 1,284 Haematopoietic Tissues 1 3 4 0,642 Hodgkin's Disease 2 - 2 0,321 Leukaemia 8 12 20 3,210 Genital Organs - 7 7 1,124 Leg - 1 1 0,161 Eye - 1 1 0,161 Adrenal - 1 1 0,161 Thyroid 2 2 4 0,642 Salivary Gland 1 - 1 0,161 Undefined 19 21 40 6,421 326 297 623 101 WARD STATISTICS WARDS Estimated Population Births Birth Rate Deaths Death Rate Deaths under 1 year Deaths under 1 year per 1,000 Births Deaths from Diarrhoea (under 2 .years) Death Rate from Diarrhoea (under 2 years) Deaths from Bronchitis and Pneumonia Death Rate from Bronchitis and Pneumonia Deaths from Pulmonary Tuberculosis Death Rate from Pulmonary Tuberculosis Deaths from Non-Pulmonary Tuberculosis Death Rate from Non-Pulmonary Tuberculosis Deaths from Heart and Circulatory Diseases Death Rate from Heart and Circulatory Diseases Deaths from Cancer •Death Rate from Cancer Natural IncreaBe of births over deaths Upper Norwood 17290 310 17.9 236 13.6 10 32 1 0.05 22 1. 27 - - - - 96 5.55 46 2.66 + 74 Norbury 16049 177 11.0 174 10.8 3 17 - - 16 1.00 1 0.06 - - 65 4.05 31 1.93 + 3 West Thornton 1679 5 226 13.5 176 10.5 5 22 - - 28 1.66 1 0.06 - - 46 2.74 48 2.86 + 50 Ben sham Manor 16807 193 11.5 190 11.3 3 15 - - 26 1.55 3 0.18 - - 53 3.15 46 2.74 + 3 Thornton Heath 15817 228 14.4 175 11.1 3 13 - - 20 1.26 2 0.13 1 - 65 4.11 31 1.96 + 53 South Norwood 16009 322 20.1 203 12.7 8 25 - - 29 1.81 1 0.06 - - 67 4.18 47 2.94 + 119 Woodslde 14649 201 13.7 178 12. 1 6 30 - - 18 1.23 1 0.07 - - 48 3.28 56 3.82 + 23 East 16861 186 11.0 197 11.7 5 27 - - 17 1.1 - - - - 63 3.74 43 2.55 - 11 Shirley 12815 144 11.2 134 10.5 2 14 - - 10 0.78 - - - - 52 4.06 26 2.03 + 10 Addlscorabe 1569 2 239 15.2 207 13.2 6 25 - - 30 1.91 3 0.19 - - 70 4.46 43 2.74 + 32 Whltehorse Manor 13352 237 17.8 182 13.6 6 25 - - 21 1.57 4 0.30 - - 63 4.72 35 2.62 + 55 Broad Green 13409 213 15.8 150 11.2 4 19 - - 26 1.94 2 0.15 - - 48 3.58 21 1.57 + 63 Central 10855 151 13.9 139 12.8 2 13 - - 15 1.38 1 0.09 - - 60 5.53 30 2.76 + 12 Waddon 15430 229 14.8 167 10.8 6 26 - - 13 0.84 3 0.19 - - 54 3.50 39 2.53 + 62 South 16418 217 13.2 293 17.8 2 9 1 0.06 24 1.46 1 0.06 - - 110 6.70 53 3.23 - 76 Addlngton 20752 532 25.6 78 3.8 9 17 1 0.05 8 0.39 1 0.05 - - 27 1.30 18 0.87 + 454 The Borough 249000 3805 15.3 2879 12. 2 80 21 3 0.01 323 1.30 24 0.10 1 - 987 3.96 613 2.46 + 926 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 nore than six months. *Death Rate per 1,000 population. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1940-1959 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate In (an t Mortality Rate 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 1959 3,874 1 0.26 21 103 DETAILS OF INFANT MORTALITY The following table gives the cause of death during the first month of life (Neo-natal mortality):- (l) Complications of Labour:- Trauma at Birth 3 Intra-uterine asphyxia (Toxaemia) 1 4 (a) Poetal States- Congenital Malformities 9 Atelectasis 9 Haemorrhagic Disease of Newborn 6 24 (3) Prematurity 24 24 (4) Post-Natal Causes 7 7 Total 59 Percentage Deaths under 1 year per Total Infantile Deaths under 1 year per 1,000 Births 1959 1958 1959 1958 Injury at Birth and Congenital 23.8 33. 3 4.99 5.97 Premature Births 30.0 15.9 6.31 2.86 Respiratory Diseases 12.5 15.9 2.63 2.86 Atelectasis, Debility and Marasmus - 13.0 2.34 2. 34 Diseases of Digestion* 1. 2 1. 4 0. 26 0. 26 Other Causes 21. 3 20.3 4.47 3. 63 *These from Gastro enteritis Perinatal Deaths Stillbirths - 69 Deaths in first week - 50 Causes of Death in first week Prematurity - 23 Congenital conditions - 5 Atelectasis - 9 Cerebral haemorrhage - 3 Pneumonia of the newborn - 1 Perinatal rate - 31 per 1,000 total (live and still) births Intra uterine asphyxia - 1 Haemorrhagic disease of newborn - 6 Other - 3 Prematurity was a contributory cause in 6 cases. 104 DEATHS UNDER ONE YEAR, AllRANGED IN DAYS, WEEKS AND MONTHS CAUSES OF DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8 th - 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 43 2 2 3 - - - 7 2 - 59 7 - 6 - 1 1 1 3 1 1 - 80 Meningo-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 - - - 2 Pneumonia (all forms) - - 1 - - - - 1 1 - 3 1 - 1 - 1 - 1 1 - - - 8 Diarrhoea and Enteritis - - - - - - - - - - - - - - - - - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - Congenital Malformations 2 2 -1 - - - - 3 1 - 9 2 - 3 - - - - - - 1 - 15 Premature Birth 22 - - - - - - 2 - - 24 - - - - - - - - - - 24 Atrophy, Atelectasis, Debility and Marasmus 9 - - - - - - - - - 9 - - - - - - - - - - - 9 Injury at Birth 1 - - 3 - - - - - - 4 - - - - - - - - - - - 4 Haemorrhagic disease of newborn 6 - - - - - - - - - 6 - - - - - - - - - - - 6 Other Causes 3 - - - - - - 1 - - 4 3 - 1 - - 1 - 1 1 - - 11 TOTALs 43 2 2 3 - - - 7 2 - 59 7 - 6 - 1 1 1 3 1 1 - 80 105 MIDWIFERY SERVICE The work of the municipal midwives was as follows:- l. The number of maternity deliveries by Municipal Midwives on the district in the year 1,334 2. The number of live births 1,328 3. The number of forceps deliveries 5 4. The number of still births 6 5. The number of neo-natal deaths Nil 6. The number of premature live born infants 6 (1) 36 weeks - 4 lbs. Transferred to Hospital (2) 36 weeks - 4 lbs. 8 ozs. Discharge Weight 4 lbs.8 ozs. (3) 38 weeks - Twins-4 lbs. 4 ozs. and 4 lbs. 12 ozs. Discharge weight - 4 lbs.8 ozs. and 4 lbs.8 ozs (4) 36 weeks-4 lbs. Breech delivery. Transferred to Hospital (5) 36 weeks-4 lbs. 12 ozs. Discharge Weight 4 lbs. 12 ozs. (6) 37 weeks-Not weighed-Twins. Transferred to Hospital. 7. The number of patients who received Trilene 10 8. The number of patients who received Gas-Air Analgesia 1,232 9. The number of cases of P.P. H. (Home 16. Transferred to Hospital 6) 22 10. The number of cases of manual removal of placenta at home 2 11. The number of patients who received blood transfusion at home 5 12. The number of cases to which Flying Squad was called 6 13. The number of cases of toxaemia of pregnancy treated at home 10 14. The number of cases of prolonged labour (over 24 hours) 17 15. The number of breech deliveries 5 16. The number of twins delivered 5 sets 17. The number of triplets Nil 18. The number of cases of Puerperal Pyrexia 23 (Genital Nil ) (Extra-Genital 23 ) 19. The number of congenital malformations 5 (Talipes 2 ) (Congenital heart 1) (Hermaphrodite 1) (Spina Bifida 1) 20. Patients given Pethedine 713 21. Patients sent to Hospital 36 2 (Ante-natal 288) (During Labour 67) (After Delivery 7) 22. Patients sent home for nursing 401 (Home booked 236) (Hospital booked 165) 106 Midwife Mileage Deliveries Midwifery Maternity Gas and Air AnteNatal Visits PostNatal Visits Bookings Office Booking Home Visits Normal Abnormal Normal Abnormal Midwives Pupils Midwives Pupils 1A. 7084 - - - - - - 2 - 19 36 - - - 11 1B. 2480 - - - - - - - - 9 24 - - - 4' 1. 2261 - - - - - - - - 2 - - • - 2. 4374 98 63 - 33 2 92 459 x382 1188 1289 121 160 3 3. 4521 94 85 8 - 1 85 9 13 354 1423 993 123 120 1 4. Bicycle 67 45 2 18 2 56 278 ø37 87 3 189 34 40 2 5. 2571 66 65 1 - - 54 419 - 983 - 50 57 6. 29 22 73 61 1 6 5 70 475 ø302 765 726 115 121 4 7. 3679 66 51 2 13 - 65 701 - 1240 - 60 59 8. 4498 65 53 1 11 - 62 559 - 1074 - 80 80 2 9. 3420 93 83 1 7 2 86 410 403 892 1132 131 126 3 10. 3001 84 65 - 17 2 79 462 219 1204 1099 124 150 2 11. 3855 62 49 2 10 1 58 273 X20 1053 45 66 78 12. 477 2 84 77 2 5 - 79 609 405 1063 1121 121 139 4 13. 386 2 63 51 2 8 2 58 593 - 834 - 65 77 2 14. 5544 94 51 1 41 1 87 79 2 3 23 1264 1246 149 202 1 15. 3224 70 67 1 2 - 67 765 40 2 1461 1107 122 115 16. 439 5 91 81 2 8 - 86 509 425 938 1199 151 156 4 17. 4150 108 99 - 6 3 94 637 375 1126 1293 139 124 5 18. 3210 29 23 1 5 - 28 18 5 - 628 - 15 14 19. 1696 25 17 - 6 2 24 165 - 717 - 30 41 20. 2 1 - 1 - 2 19 - 76 - - 7 Totals 75519 1334 1087 27 197 23 1232 9 225 3647 21864 11439 1696 1866 6 Note:- X- Shirley pupil. ø-Addiscombe pupil 1A. Part-time midwife commenced 6.1.59. 1B. Part-time midwife commenced 6.4.59. No. 4 Left service 5.12.59. No. 5 Sick leave and left service 14.9.59. No. 9 Two months sick leave. No. 13 One month sick leave. No. 15 Two months sick leave. No. 18 Commenced as holiday relief 1.7.59. replaced No.6 14.9.59. No. 19 Two months compassionate leave. No. 30 Replaced No. 4 14.12.59. One New Addington midwife left service 30.9.59 Vacancy not filled until 6.4.59 by No. 19. 107 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion 4 Other Causes 18 Miscarriage 2 — 24 FOB COMPLICATIONS DURING LABOUR Breech 7 Post-partum haemorrhage 19 Malpresentation 1 Adherent and Retained Premature Labour 13 Placenta 8 Delayed Labour 4 Torn Perineum 114 Ante-partum Other causes 27 haemorrhage 10 — Episiotomy 8 211 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 26 Pain in Breasts 6 Pain in Legs 7 Other Causes 39 Rhesus Negative Blood 58 - 136 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 28 Still Birth - Other Causes 31 - 59 430 In accordance with Rule 33 of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received:- Illness of Mother 52 Defects of lactation 508 Other Causes 93 Total 753 108 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1959 who were born- (i) at home 50 (ii) in private nursing homes - (iii) in hospital* 173 (2) The number of those born at home- who were nursed entirely at home 45 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 50 (3) The number of those born in private nursing homes- who died during the first 24 hours - who survived at the end of one month - (4) Number of those born in hospital- who died during the first 24 hours 22 who survived at the end of one month 151 (5) Number of premature still births who were born- (i) at home 7 (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 -1959 Visits Mrs. A. D. Batt com. 9.11.50 MIss Bird Miss Blackmore Miss Blest Mrs. Brand Left 31.5.59 Miss Brown Kenyon com. 19.5.59 Miss Devaney Miss Early Miss Eldridge Miss Emms Mrs. Green Miss Hall Miss Harrington com. 2.2.59 Mrs. Hartog Com. 2.2.59 Mrs. Hastings Miss Hawkins Miss Hodgson Miss Hughes Mrs. Laing Miss Llewellyn Miss Lovell Mr& Mayo Miss Morton Miss Partridge Miss Phillips Miss Pickering Miss Thompson Miss Vinee Mrs. Wilson Miss wybrew TOTAL 1959 TOTAL 1958 Infants under 1 year- Pirst Visits 12 99 78 150 54 121 98 100 232 200 137 160 179 181 202 242 159 107 57 133 129 145 167 113 343 124 24 338 102 143 4332 4199 Re-visits 23 324 132 374 159 324 308 654 560 495 469 454 441 508 308 516 506 221 51 616 157 546 374 235 561 480 129 328 457 461 11171 10988 Children 1-2 years- First Visits 19 5 7 4 1 8 5 10 - - 4 20 4 14 22 18 - 50 3 7 21 2 - 5 12 - - 313 23 6 586 544 Re-visits 7 305 137 211 94 131 271 452 294 358 480 295 321 386 320 278 217 153 43 379 86 403 165 145 213 242 102 328 305 304 7425 7100 Children 2-5 years- Pirst Visits 73 - 3 7 2 4 20 1 1 1 14 40 1 16 25 40 5 48 4 13 44 4 - 3 21 1 - 218 36 11 656 694 Re-visits 23 273 213 505 213 265 339 401 552 433 819 397 328 864 339 480 222 137 121 461 143 502 440 369 202 337 244 334 369 715 11040 10179 Expectant Mothers- First Visits - 9 23 21 - 13 1 3 27 24 7 - 47 8 6 40 4 12 3 60 29 14 16 19 30 11 8 3 38 35 511 553 Re-visits - - 9 8 14 6 1 3 3 21 1 - 41 - 1 9 3 33 - 32 7 38 5 14 99 15 1 4 7 - 375 406 Still Births - - 6 1 - - - - - 5 - - - 2 1 - - - - - - - - - - - - - - - 20 11 Deaths under 1 year - - 1 - - 1 - - 1 2 - 2 - - 2 - - - - 3 1 - - - - 1 1 - - - 15 12 Miscellaneous Visits 16 296 53 14 6 33 81 3 44 100 19 186 23 34 27 109 75 67 69 15 61 17 5 75 16 100 28 101 24 2 1609 1142 Ineffective Visits 26 333 95 249 96 297 186 620 245 176 747 545 477 567 437 581 560 505 224 362 185 524 245 117 351 665 344 282 418 270 10729 9440 TOTALS 1959 199 1644 757 1544 639 1206 1310 2247 1959 1815 2697 2099 1862 2580 1690 2313 1751 1333 575 2081 869 2195 1417 1095 1850 1976 881 2249 1779 1947 48559 - TOTALS 1958 - 1780 1062 1810 1780 - 2544 2533 2051 1742 1684 2453 - - 1605 2163 1334 49 579 2228 1091 1169 1448 1405 2487 1823 38 2489 2021 1102 - 45268* *Including Health Visitors who left in 1958. Number of families or households visited during the year 9.319 ATTENDANCES AT INFANT CENTRES-1959 Benshara Manor Monday A. M. Bensham Manor Monday P.M. Boston Road Thursday P. M. Brighton Road Wednesday P.M. Efcst Croydon Tuesday AM. East Croydon Friday P.M. Fairchildes Friday P.M. Falconwood Wednesday (Al t. )P. M. tanks Hill Thursday A.M. Monks Hill Thursday P. M. tanks Orchard Monday P. M. New Adding ton Wednesday A.M. New Addington Wednesday P.M. Norbury Wednesday A.M. Norbury Wednesday P.M. St. Alban's Wednesday P.M. St. Alban's Friday P.M. St. Andrew's Monday P.M. St. James' Thursday AM. St. James' Thursday P.M. St. Judes' Tuesday A.M. St. Judes' Tuesday P.M. St. Oswald,s (Closed) Thursday AM(9.3.59) St. Oswald's Thursday P.M. Seihurst monday P.M. shirley Thursday P.M. South Croydon Thursday P.M. South Norwood Tuesday P.M. South Norwood Friday P.M. &ring Park Monday P.M. Upper Norwood Wednesday P.M. Waddon Wednesday P.M. flbodside Friday A.M. Woodside Friday P.M. Ttotal 1959 total 1958 New Cases under 1 year 80 130 121 106 123 139 50 44 22 69 54 108 133 73 118 89 70 167 97 186 76 91 3 127 73 61 132 135 163 65 191 62 73 128 3359 3403 No. of Re-attendances 1329 1765 1821 1751 1940 2109 602 767 455 1353 690 1448 1206 1350 1460 1313 1181 1933 1884 2602 1330 1581 60 1894 1141 819 1735 1683 1717 1014 1900 492 1190 1533 4704f 48328 New Cases over 1 year 25 43 15 5 11 29 2 1 4 - 14 25 38 19 25 16 - 14 2 9 7 8 - 23 15 7 14 13 19 37 32 7 9 18 50( 439 to. of Re-attendances 1278 1483 729 549 749 887 241 568 223 754 414 998 803 9«8 803 550 480 531 289 318 643 592 36 776 559 402 487 377 385 514 549 204 407 505 20051 19525 Attendances of Children 0-5 2712 3421 2686 2411 2823 3164 895 1380 704 2176 1172 2579 2180 2410 2406 1968 1731 2645 2272 3115 2056 2272 99 2B20 1788 1289 2368 2208 2284 1630 2672 765 1679 2184 70964 71095 Consultations with Doctor 1061 1108 950 791 802 837 291 492 - 891 324 906 851 631 707 625 379 1033 851 808 585 607 - 989 527 150 613 634 708 228 740 260 538 720 21638 21308 No. of Sessions 48 48 50 52 52 50 50 26 52 51 48 52 52 52 52 52 50 48 52 51 52 52 9 51 48 49 51 52 50 48 52 27 50 50 1629 1641 EXPECTANT MOTHERS No. of New Coses - - - - - - - - - - 18 - - - - - - - - - - - - - - - - - - - - - - - 18 11 No. of Re-attendances - - - - - - - - - - 19 - - - - - - - - - - - - - - - - - - - - - - - 26 8 Ttatal Attendances of Expectant Mothers - - - - - - - - - - 37 - - - - - - - - - - - - - - - - - - - - - - - 44 19 Total Attendances 2712 3421 2686 2411 B823 3167 895 1380 704 2176 1209 2579 2180 2410 2406 1968 1731 2645 2272 3115 2056 2276 99 2820 1788 1289 2368 2208 2284 1630 2672 765 1679 2184 71008 71714 Average per Session 1959 56.5 71.3 53.7 46.4 54.3 63.3 17.9 53. 1 13.5 42.7 25.2 49.6 41.9 46.3 46.3 37.8 34.6 55.1 43.7 61. 1 39.5 43.8 11.0 55.3 37.3 26.3 46. 4 42.5 45.7 34.0 51.4 28.3 33.6 43.7 43.6 - Average per Session 1968 54.0 65.2 51.6 58.5 57.9 56. 1 18.7 49.6 - 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 - 43.7 110 111 HOME NURSING Staff at 31.12.59 Superintendent Deputy Superintendent 2 Assistant Superintendents 38 Queen's Nurses (including 4 males) 2 S. R. N's (including 1 part time) 1 S.E.A.N. Nurse 5 Queen's Students Summary of work carried out during the year under review: - Patients remaining on books from 1958 950 New patients 4,781 Total 5,731 New Patients:- Medical 2,448 Surgical 2,153 Gynaecological 52 Obstetric 9 Maternity 119 Total 4,781 Specially classified Cases Visits Tuberculosis 83 4,062 Pneumonia 190 1,768 Maternity Complications Infectious Diseases (including influenza) 7 30 Children under five years 286 1,997 Over 65 years old 3, 125 95,533 Visits:- Termination of Cases:- Convalescent 3,026 Hospital 666 Died 485 Removed for other causes 619 Still on books 935 Total 5,731 112 Total visits January 13,336 February 13,482 March 12,889 April 10,869 May 10,977 June 10,418 July 10,850 August 10,823 September 10, 727 October 11,452 November 11,479 December 12,521 Total 139, 823 REHABILITATION OF ELDERLY PERSONS Patients visited by Rehabilitation Nurse, 1959:- Female 46 Male 10 Total 56 Admitted to Hospital 10 Transferred for General Nursing 8 Recoveries (Rehabilitated) 27 Died 3 Remaining on books 8 Ages 40-49 years 1 50-59 years 5 60-69 years 11 70-79 years 24 80-89 years 12 90-94 years 3 Illnesses Hemiplegia 29 Arthritis 9 Lower Limb Fracture 9 Other Conditions 9 113 In the age group 40-59 years. 3 cases of hemiplegia-1 recovered-1 died-1 no change. 1 case of Parkinson's disease-improved. 1 case of Chronic Arthritis-improved. In the age group 90-94 years. 2 cases of hemiplegia - Re-admitted to hospital-1 at request of relatives-other after second stroke. 1 case with fractured femur-walking well. M. AND C. W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year:- Complain t No. of Cases Total M r Bow Legs 6 4 10 Knock Knees and Plat Peet 7 6 13 Valgus Ankles 3 5 8 Asthma 1 - 1 Kyphosis - - - Torticollis - - - Pigeon-toes 5 4 9 22 19 41 Total attendances 1,305 114 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 229 Bed Rests 160 Mackintosh Sheets 189 Feeding Cups 13 Wheel Chairs 40 Commodes 43 Crutches, pairs Nil Air Cushions 179 Bed Cradles 19 Urinals 74 Air Beds 15 Dunlopillo Mattresses 2 Dunlopillo Cushion 1 Bed Pulley 2 Bed Tables 5 Draw Sheets Cotton 42 Walking Aid 5 Sputum Mugs 3 Enuresis Machines 26 Ryles Tube Nil Fracture Boards 4 Bedsteads 1 Steam kettles Nil Walking Machines 4 Bed Blocks 4 Pifco Massager Nil Foot Suction pump 1 115 HOME HELP SERVICE Staff at 31.12.5g. Supervisor 3 Assistant Supervisors 2 Clerks 20 Whole Time Home Helps 175 Part Time Home Helps - Night Attendant Summary of work carried out during the year under review:- Patients remaining on books from 1958 1,069 New Applicants 1,511 Patients carried forward to 1960 1,155 New Applicants (a) Maternity 658 (b) Sickness 840 (c) For Night Service 2 Classification of Cases Attended (a) Maternity 479 (b) Tuberculosis 18 (c) Chronic Sick including Old Age 1,977 (d) Others including Acute Sick 336 Number of House Service Given 218,539 Average Duration of Service Given (a) Maternity 12 days (b) Acute Sickness 10-21 days (c) Chronic Sickness indefinitely Amount Recovered for Service £4, 408,10.8. Rate of Remuneration of Home Helps at 31.12.5g. 3/5d. per hour - Home Helps 3/3d. " - Sick Room Helpers 3/2 3/8 d. " - Washing Service 3/9 5/8 d. " - Problem Family Helps £8.11. 2d. per week - Family Helps 10/- " - Disinfestation 116 PROBLEM ETC. FAMILIES SUMMARY OP THE WORK CARRIED OUT DURING 1959 BY THE HEALTH VISITOR SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES. AND TO PREVENT THEIR NEED FOR ADMISSION Rehoused in private accommodation 6* Rehoused in Council accommodation 17 (* Of these 3 accommodated outside the Borough) Visits paid:- Family Departments Agents and Contacts 226 60 70 Families without permanent housing at close of year:- 3. Visits paid:- Family Departments Agents and Contacts 50 32 29 Potential Homeless Families - not admitted to Receiving Homes - 32. Visits paid:- Family Departments Agents and Contacts 210 54 52 Problem Families 65 Visits paid 229 Families referred by other Departments 22 Families referred by various organisations and private industry 16 Families making direct contact 27 Visits re employment 42 Families assisted with furniture 12 Family interviews (office) 260 Families referred to other departments and agencies 51 117 DENTAL TREATMENT - M. AND C.W. Expectant Mothers Nursing Mothers Total Young Children New cases Examined 248 25 273 282 Re-treated 74 22 96 77 Total 322 47 369 359 Expectant and Nursing Mothers Young Children Attendances 951 624 Fillings 270 215 Extractions 433 422 Gas Cases 126 160 Local Anaesthesia 69 2 Scaling and Gum Treatment 206 - Dressings 235 195 Denture Dressings 169 - Silver Nitrate - 202 Treatment Completed 168 186 Number of Sessions (treatment) 356 Dentures Pitted 46 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 Mo thers Young Children Ante-Natal 391 - South Croydon - 3 Municipal Midwives 9 - St. Alban's Woodside - 1 Post Natal 6 - Norbury - 1 welfare Centres: Addington - 24 Municipal - 2 St. Andrew's - 1 East Croydon - - Waddon - - Upper Norwood - - Boston Road - 1 Holy Trinity - 1 St. Jude's - - St. Oswald's - 1 St. Tnhn's (Shirley) - - Bensham Manor - 1 Fairchildes - - Monks Hill - 1 Good Shepherd - - crossfield Nursery - - Falconwood - 1 Referred by Dental Officers: - 321 test Croydon - - South Norwood - - Mothers: 406 Young Children: 359 Total: 765 118 HOME SAFETY Accidents taken to Hospital by Ambulance during 1959. Type of Accident Under 5 Age Groups 45-64 65 + Sex Total 5-24 15-44 M F Palls 69 69 43 65 119 162 203 365 Burns and Scalds 15 11 11 9 6 26 26 52 Poisoning 15 7 3 4 2 20 11 31 Suffocation - - - - - - - - Miscellaneous 57 63 34 16 8 89 89 178 Totals 154 150 91 92 135 297 329 626 DEATHS Cause Number Age Group Comments Falls 6 All over 70 years Prom falls Electrocution 1 53 years Mending cleaner while switched on. Burns 2 62 and 77 years Clothes caught fire. 119 AMBULANCE SERVICE Classification of Journeys, Patients and Mileage. *Patients Journeys Mileage 1959 1958 1959 1958 1959 1958 Health Service Removals 79,78 3 (74,998) 45,026 (44,663) 348,953 (344,643) Accidents 3,998 (3,752) 3,740 (3,540) 20,788 (20,137) Spastics (Bramley Hill) 4,237 (5,226) 508 (625) 8,555 (12,960) Mental Health (Occupational Centre) 26,400 (25,796) 1,158 (790) 22,649 (22,370) St. Margaret's (Spastic children) 372 (308) 366 (306) 2,730 (3,498) Services Not Required (Accidents) 277 (28 4) 1,236 (1,408) Gas and Air Analgesia 484 (636) 3,548 ( 4,781) Vehicles to Repair Depots, Testing etc. 213 (278) 2,169 ( 3,106) Service Requirements, Oxygen, visiting substations, parks, etc. 202 (244) 2,491 (2,956) Bus Strike (Collecting of Personnel) - (136) - ( 1,724) Civil Defence 114, 790 ( 110,080) 51,974 (51,50 2) 413,119 (417,58 3) 126 (135) 1,369 (2,098) 114,790 (110,080) 52,100 (51,637) 414, 488 (419,681) Note:- 1958 Figures are in brackets. *These figures do not represent individual cases. Classification of Accident Calls 1959 1958 Home Accidents (Children) 316 (331) (Adults) 337 (347) Miscellaneous Accidents (Children) 56 (58) (Adults) 61 (110) Recreational Accidents (Children) 125 (91) (Adults) 70 (64) School Accidents 231 (230) Street Accidents (Children) 191 (217) (Adults) 969 (843) Work Accidents 246 (234) Home Illness (Children) 38 (34) (Adults) 231 (205) 120 Classification of Accident Calls (continued) 1959 1958 Street Illness (Children) 12 (17) (Adults) 608 (533) Work Illness 122 (104) Attempted Suicide 24 (35) Suicide 22 (23) Common Assault 81 (64) 3, 740 (3, 540) Note:- 1958 Figures are in brackets. Comparison of Patients, Journeys and Mileage since 1955. Year Patients Journeys Mileage 1955 100,827 50,491 440,311 1956 104,563 51,102 413,812 1957 103,853 50,827 405,154 1958 110,080 51,50 2 417,583 1959 114,790 51,974 413,199 Total Mileages of Ambulance Vehicles at 31st December, 1959. Daimler Ambulances. JRK 756 1951 179,700 Miles KOY 800 1952 150,067 " LRK 3 1953 1 28, 194 " LRK 289 1953 114, 120 " LRK 555 1953 118,916 NBY 501 1954 117,599 " ORK 8 1955 98,710 " ORK 9 1955 101,767 " Humber "Pullman" Ambulances HRK 773 1949 159,182 Miles HRK 187 1949 159,078 " Humber "Super-Snipe" Ambulance SOY 400 1957 53,056 Miles Bedford Sitting-Case Coaches KBY 700 1951 121,200 Miles KRK 563 1952 122,728 " 121 Total Mileages of Ambulance Vehicles at 31st December,1959 (continued) Bedford. "Utilecon" Sitting Case LVB 901 1953 130,533 Miles LVB 896 1954 132,336 „ OVB 209 1955 9 2,827 „ SRK 187 1957 41,962 „ SIR 189 1957 42,292 „ UBY 325 1958 25,027 „ UBY 329 1958 28,302 „ WBY 247 1959 6,636 „ Karrier Ambulance WVB 293 1959 3,123 Miles Vauxhall "Vyvem" Saloon Car OBY 724 1955 59,272 Miles Bedford Coaches (Mental Health) KRK 252 1952 77,211 Miles MOY 639 1954 67,275 „ Karrier Coach (Mental Health) WVB 291 1959 807 Miles Austin Breakdown (since 1955/56) CLR 801 1940 8,055 Miles 122 COMMUNICABLE DISEASES NOTIFIED DURING 1959 Notifiable Disease Cases notified Total cases notified in wards At all ages At ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Wood side East Addiscombe Whit ehorse Manor Broad Green Central Waddon South Addington Shirley M F Under 1 1 - 4 5 - 14 15 - 24 25 - 44 45 - 64 65 and over Scarlet Fever 358 1 94 252 7 4 - - 27 26 16 22 32 16 10 9 14 4 16 18 81 4 44 19 19 2 166 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 15 - - - 2 5 7 1 - 1 1 - 3 1 1 1 - 1 2 - 1 - 3 - 8 7 Meningococcal Infection 7 - 4 3 - - - - - 1 - - 1 1 - - - - 1 - 1 - 1 1 4 3 Enteric and Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 35 - - - 14 21 - - 1 1 13 - 6 2 1 - - - 9 - 1 - 1 - - 35 Ophthalmia Neonatorum 7 7 - - - - - - 1 - 1 2 - - - - - 1 - - - 2 - 5 2 Acute Poliomyelitis 3 - - 1 - 2 - - - - - - 1 - - - - - - - 2 - 3 - Dysentery 535 10 120 249 22 105 29 - 11 19 18 27 17 4 13 10 21 26 6 8 29 10 308 8 263 27 2 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Primary and Influenzal Pneumonia 92 - 21 3 2 10 38 37 3 5 5 2 9 6 3 10 6 4 5 1 9 5 3 16 49 43 Pood poisoning 67 1 12 15 13 9 14 3 13 1 3 3 11 4 - - 1 4 1 4 1 3 14 4 33 34 Acute Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 3898 83 1959 1819 10 22 5 - 129 187 246 260 214 218 180 187 364 17 2 308 216 224 518 322 153 1988 1910 Whooping Cough 252 12 135 99 5 1 - - 16 8 12 9 25 14 15 23 18 9 7 14 6 58 11 7 124 128 5269 114 23 26 2441 75 180 93 41 200 250 314 324 320 267 223 240 424 220 356 261 353 598 711 208 26 69 2600 The tuberculosis notifications are shown in the section relating to that disease. 123 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1959 Notifiable Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 9 7 8 15 15 14 13 7 12 10 15 8 133 Non-Respiratory Tuberculosis 2 1 1 3 1 3 2 - 1 1 - 1 16 Scarlet Fever 23 22 20 15 46 27 34 20 18 34 42 57 358 Diphtheria - - - - - - - - - - - - - Erysipelas 2 1 2 1 1 2 1 1 - 1 1 2 15 Meningococcal Infection - 1 2 1 1 1 - - - - - 1 7 Enteric and Paratyphoid - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Puerperal pyrexia 6 2 2 2 3 5 3 2 2 3 3 2 35 Ophthalmia Neonatorum - - 1 - 3 1 2 - - - - - 7 Poliomyelitis and Polioencephalitis - - - - 2 - - - 1 - - - 3 Dysentery 63 78 82 54 59 60 43 22 18 19 19 18 535 Malaria - - - - - - - - - - - - - Ac. Pri. and Act. Inf. Pneumonia 8 42 33 1 1 - - - 2 2 1 2 92 Pood Poisoning 4 5 4 5 4 7 10 9 6 3 4 6 67 Acute Encephalitis - - - - - - - - - - • - - Measles 396 455 731 960 808 356 87 37 26 20 12 10 389 8 Whooping Cough 15 16 26 22 32 16 33 18 23 25 8 18 252 5418 124 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,395 children were immunised against whooping cough, comprising 2,349 under school age and 46 school children. IMMUNISATION AGAINST TETANUS A total of 1,727 children were immunised against Tetanus, comprising 1,608 under school age and 19 school children. 169 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 3,303 persons were vaccinated against Snall-pox. Under 1 year of age 1 2-4 5-14 15 or over Total Successful Vaccinations 2,551 240 106 78 55 3,030 " Re-raccinations - - 4 18 102 124 In susceptible to Vaccination 98 I8 8 7 1 132 3,286 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1959, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January. 1945. Age at 31. 12. 59 i. e. Born in Year Under 1 1959 1955-1957 1950- 1954 1945- 1949 Under 15 Total Last complete course of injections 1,536 7,669 5,232 1,762 16,199 A. 1954-1958 B. 1953 or earlier - - 5,394 11-966 17,360 C. Estimated midyear child population 3,780 13,720 37,600 55,100 Immunity Index 100 A/C 40,63 55,89 18,52 29,40 125 VACCINATION AGAINST POLIOMYELITIS The following table gives the number of persons vaccinated with 2 injections during the year. Children born 1943-1959 Young persons born 1933-1942 Expectant Mothers Other persons 10,079 13,059 1,130 143 38,584 persons received their third injections - 54% Of the age group 0-15 years - 96% had received 2 injections. Of the age group 16 - 25 years - 58% had received 2 injections. 54% of both groups had been given a third injection. 126 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATIONS AND MORTALITY - 1940-1959 127 TUBERCULOSIS The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Form) Tuberculosis (All Forms) 0-15 years All ages 0-15 years All ages Year Number of Deaths Death rate per thousand of population * Number of Deaths Death rate per thousand of population Year Number of Deaths Death rate per thousand of lation * Number of Deaths Death rate per thousand of population 1919 38 - 217 1.18 1940 8 - 146 0.74 1920 39 - 195 1.02 1941 10 - 111 0.59 1921 29 0.57 184 0.96 1942 8 - 116 0.63 1922 30 - 209 1.09 1943 9 - 120 0.62 1923 25 - 190 0.98 1944 9 - 105 0.57 1924 18 - 188 0.96 1945 9 - 92 0.46 1925 27 - 181 0.91 1946 7 - 105 0.47 1926 27 - 208 1.01 1947 4 0.08 105 0.44 1927 15 - 203 0.96 1948 3 0.06 111 0.45 1928 24 - 206 0.96 1949 6 0.12 94 0.38 1929 21 - 178 0.80 1950 4 0.08 65 0.27 1930 15 - 175 0.79 1951 3 0.06 64 0.25 1931 18 0.36 177 0.75 1952 - - 54 0.22 1932 10 - 166 0.70 1953 2 0.04 37 0.15 1933 13 - 184 0.77 1954 1 0.02 32 0.13 1934 10 - 157 0.65 1955 1 0.02 35 0.14 1935 9 - 176 0.71 1956 - - 26 0.10 1936 11 - 151 0.60 1957 - - 33 0.13 1937 11 - 155 0.64 1958 - - 20 0.08 1938 12 - 137 0.56 1959 - - 25 0.10 1939 6 - 107 0.46 * Prior to 1947, rates only available for Census years. 128 Public Health (Tuberculosis) Regulations, 1952. Summary of notifications during the period from 1st January, 1959 to 31st December, 1959:- TABLE I. Formal Notification Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males - 1 - 1 2 3 13 12 11 23 10 5 7 88 Respiratory, Females - 2 - 2 2 5 7 6 8 7 2 1 2 44 Non-Respiratory, Males 1 - - - - - 1 - - - - - - 2 Non-Respiratory, Females - - - 1 - 1 1 4 1 1 3 1 1 14 129 Source of Information Number of cases in age Groups TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1959 to 31st December, 1959, otherwise than by formal notification:- 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 6 5- 75- TOTAL Death Returns from Local Registrars Respiratory M - - - - - - - - - - - 1 - 1 (A) F - - - - - - - - - - - 2 - 2 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - Death Returns from RegistrarGeneral (Transferable Deaths) Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - 1 - - 1 (C) F - (D) " Transfers " from Other Areas (excluding transferable Deaths) Respiratory M 1 21 26 14 8 2 2 - 74 (A) F 3 12 5 7 3 1 - 1 32 (B) Non-Respiratory M - 1 1 1 - - - - 3 (C) P - - - - - - - - 1 - - 1 - 2 (D) Other Sources Respiratory M - - - - - - - - - - 1 - - 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) TOTALS (A) 76 (B) 34 (C) 4 (D) 2 130 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1959 2,050 Transfers in from other areas 75 "Lost sight" cases returned during the year New cases diagnosed as definite during the year 133 2,258 Number of cases written off the Chest Clinic Register during the year as:- Recovered 93 Died 36 Removed to other areas 95 "Lost sight of" and other reasons 25 249 Remaining on Register as at 31st December 2,009 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 2,699 Number of visits paid by Clinic doctors to homes of patients 412 Number of visits paid to homes of patients by Tuberculosis Health Visitors 4,406 Attendances of patients at the Clinic - At ordinary sessions 18,388 * At refill sessions 172 18,560 * Number of X-ray films taken 18,830 * includes 3,158 miniature film attendances. 131 VENEREAL DISEASES - NEW CASES 1939-1959 132 VENEREAL DISEASES Totals Males Females SYPHILIS 1. Patients tinder treatment or observation on January 1st 73 34 39 2. Patients removed from the Register in previous years who returned during the year for treatment or observation of the same condition 1 1 - 3. Patients transferred from other centres after diagnosis - - - 4. Patients dealt with for the first time (excluding 2 and 3) suffering from:- Syphilis, primary - - - secondary 1 1 • „ latent In the 1st year of Infection - - - „ cardio-vascular of the nervous system - - - All other late or latent stages 4 3 1 Syphilis congenital: aged under 1 year - - - Syphilis congenital: aged 1 but under 5 - - - Syphilis congenital: aged 5 but under 15 - - - Syphilis congenital: aged 15 and over 1 1 - TOTAL Item 4 6 5 1 5. Patients completing treatment and/or observation 17 5 12 6. Patients transferred elsewhere - - - 7. Patients not completing treatment and/or observation - - - 8. Patients under treatment or observation on December 31st (should equal Items 1 to 4 less Items 5 to 7) 63 35 28 GONORRHOEA . 9. Patients under treatment or observation on January 1st 14 8 6 10. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 1 1 - 11. Patients transferred from other centres after diagnosis 1 1 - 12. Patients dealt with for the first time (excluding Items 10 and 11) 114 82 32 13. Patients completing treatment and/or observation 90 65 25 14. Patients transferred elsewhere 3 3 - 15. Patients not completing treatment and/or observation 11 8 3 16. Patients under treatment or observation on December 31st (should equal Items 9 to 12 less Items 13 to 15) 26 16 10 133 Totals Males Females OTHER CONDITIONS 17. Patients under treatment or observation on January 1st 31 20 11 18. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 10 10 - 19. Patients transferred from other centres after observation - - - 20. Patients dealt with for the first time (excluding Items 18 and 19) suffering from:- Chancroid . . _ Lymphogranuloma Venereum . Granuloma Inguinale - - - Non-Gonococcal Urethritis 73 73 Yaws Any other conditions - - - requiring treatment 153 90 63 Conditions not requiring treatment 225 133 92 Undiagnosed conditions - - - TOTAL Item 20 451 296 155 21. Patients completing treatment and/or observation 417 274 143 22. Patients transferred elsewhere 11 8 3 23. Patients not completing treatment and/or observation 20 12 8 24. Patients under treatment or observation on December 31st (should equal Items 17 to 20 less Items 21 to 23) 44 32 12 ATTENDANCES By PATIENTS At which patients saw physician Syphilis 220 131 89 Gonorrhoea 36 3 280 8 3 Other Conditions 1400 1061 339 TOTALS 1983 1472 511 At which patients did not see physician Syphilis 46 2 210 252 Gonorrhoea 134 39 9 5 Other Conditions 568 295 273 TOTALS 1164 544 620 CONTACTS ATTENDING FOR EXAMINATION REFERRED BY PATIENTS SUFFERING FROM: - Syphilis - Gonorrhoea 48 38 10 Non-Gonococcal 22 22 Urethritis Other Conditions 67 49 18 TOTALS 137 109 28 134 By the Physician at the Centre Sent to a Pathological Centre PATHOLOGICAL WORK NUMBER OF SPECIMENS EXAMINED Microscopical: for Syphilis - 8 Microscopical: Others - 808 Cultural - 453 Serna: for Syphilis - 623 " Others - 368 Cerebro Spinal Fluid (Number of diagnostic luabar punctures) - 9 SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE TEAR SHOVING THE AREAS IN WHICH PATIENTS DEALT WITH FOR THE FIRST TIKE (ITEMS 4, 12 AND 20) RESIDED (MAJOR AREAS TO BE SPECIFIED. MINOR AREAS MAY BE GROUPED AS ALL OTHERS") County, County Borough (England and Wales) and Others Syphilis Gonorrhoea Other Conditions Totals Croydon 4 83 304 391 Surrey 1 14 98 113 Kent - 6 21 27 London 1 11 28 40 Totals (to agree with Items 4, 12 and 20) 6 114 451 571 135 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1959 To the Chairman and Members of the Education Committee. LADIES AND GENTLEMEN, I have the honour to present this Annual report of the Principal School Medical Officer, which is the 56th to be made to the Croydon Education Authority. During 1959 there was an intensive campaign to overtake the arrears of routine work due to medical staff having been diverted to duties in connection with poliomyelitis. It will be observed that the total number of routine inspections rose by over 30%, and this despite a period early in the year when exceptional demands were made upon the department for vaccination against polio from the 15 to 25 years old group. While it was possible to thus concentrate on medical duties, the persistent shortage of dentists was aggravated by absence through illness. Furthermore having solved the problem of accommodation in New Addington a fresh difficulty arose through the proposed demolition of the buildings in the Waldrons in which the dental clinic for South Croydon is held. A shift of school population to the Waddon area made replacement on the site inappropriate, and a suitable alternative had not been obtained at the close of the year. It had been agreed however, that subject to a site being found a combined School and Maternity Child Welfare Clinic should be erected. In regard to the prevention of dental decay I commend the measures suggested 2 by the Principal Dental Officer and await the reactions of owners and customers of School tuck shops. The ideal would seem to be a ban on snacks between meals, but if this is really going too far, the less injurious foodstuffs, from the view point of dental decay are set out. The necessity to suggest somewhat unpleasant self discipline as essential for the promotion or preservation of health becomes greater as national prosperity increases. Hence the growing importance of health education for children as well as adults. Since the formation of good habits in children is far simpler than the alteration of bad habits in adults, much thought and attention has been given to the enlargement of the work of the Health Education Officer. The manner in which this has been developed is described by Miss Elliott and 1959 was probably an important turning point. It is hoped that from the decisions made a sustained and continuous programme of expansion will result. Other improvements in existing services for maladjusted children and the deaf and partially deaf were also planned for the next financial year. Because of the financial burden of education the monetary demands, however modest, of ancillary services can be irritating for those upon whom rests the primary duty. If as I understand "education" implies far more than the mere acquisition of theoretical knowledge, then precept and practice in the development and preservation of the healthy body are surely closely allied. Their inclusion within the educational system seems incontrovertible. I record with pleasure the unfailing co-operation received from the staffs of the Education Department and of the individual schools, and thank the members of the Committee for their continued confidence and encouragement. Yours faithfully, S.L. WRIGHT, Principal School Medical Officer. Public Health Dept., Croydon. 3 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) - (39%) *Dental Officers 10 (including 4 part-time) - (80%) *Physiotherapists 3 (including 1 part-time) Speech Therapists 4 (including 2 part-time) *School Nurses 32 (including S.H.V. and Deputy (56%) *Dental Attendants 12 (including 5 part-time) - (80%) *Performing also duties In other sections of Public Health Department. Percentages in brackets show proportion of time given to school work. PARTICULARS OF CLINICS HELD The following Clinics are provided by the Education Committee; attendance thereat,with the exception of the Minor Ailments Clinic,is by appointment arranged by the School Medical Officer:- Clinic Address Minor Ailments Lodge Road,Broad Green,Croydon. (Dally,Monday to Saturday,a.m.). Ashburton School,Shirley Road,Croydon. (Monday and Thursday,9 a.m.). Rockmount School,Rockmount Road,Upper Norwood. (Monday and Thursday,2 p. ). Duppas school,Goodwin Road,laddon. (Daily,Monday to Friday,a.m.). Salcot crescent. New Addingtoa. (Dally,Monday to Friday,a.m.). Dental Lodge Road,Broad Green,Croydon. 206,Selhurst Road,South Norwood. Valdrons Hall,55,Duppas Hill Lane, Croydon. Overbury School,New Addington. Stroud Green,Shirley Road,Croydon. Inspection Lodge Road,Broad Greea,Croydon. Twice weekly. Wolsey 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 Daily at 1 p.m. and at salcot Crescent. New Addington. Weekly. Speech Defects 47,St. James's Road,Broad Green,Croydon and at salcot Crescent. New Addington. Enuresis Lodge Road,Broad Green,Croydon. Weekly. and at salcot Crescent. New Addington. Once a month. 4 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is as follows:- Primary and Modern Secondary Schools. (1) Entrants i.e.,Children admitted for the first time to a maintained school 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 al- School ready 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 13,663 children were examined as compared with 10,096 in 1958,and 6,629 parents attended the examinations. The total percentage of parents attending was 48.5 against 54.4 last year. See Appendix B Table V. 314 specials and 210 re-inspections of children were carried out. 5 HEALTH EDUCATION IN SENIOR SCHOOLS Miss D. S. Elliott,S.R.N.. H. V. Cert.. Dip. H. E. - Health Education Officer:- "To open a shop is easy,to keep it open an art "(Chinese proverb) In an article on Health Education in the School in the International Journal of Health Education in January,1960,Etienne Berthet said:- "Health education became a necessity for a number of reasons among which we may mention the following: Need for knowledge: advances in modern technique have aroused in the people a thirst for knowledge which is all the greater as it applies to one of man's most precious assets,namely his health and life. .The growing predominance of health problems in everyday life (mass health campaigns,compulsory vaccination and medical examination). Legislation for public health protection will be all the more effective and more easily accepted if public opinion is better informed " It is certain that health is improving,not only has mortality decreased,but each individual is handsomer,larger and stronger. However,the resistance to fatigue and worry seems to have weakened and our aim now is not to confine health education to the mere teaching of health rules to prevent men from dying,but to find new and interesting ways to show them how to live. It was with this objective in view that the one-term Community Health Course was introduced to Secondary Schools two and a half years ago. Hie course has continued regularly in two Secondary Schools and one Grammar School,with the help of two Health Visitors. Maintaining this service while extending it to all other Secondary Schools remained a dilemma until the autumn,when the Education and Public Health Departments co-operated to overcome it. A meeting was arranged for the Heads of Science Departments of Secondary Schools to discuss the integration of the Community Health Course in the normal school programmes,most of the lessons to be given by the school staff. Some of the subject matter was already covered by many schools and it was evident that with very little change in the curriculum the point of view 6 of prevention and responsibility to the community could be emphasized. Some of the subjects were less familiar and it was suggested that help from the Public Health Department could be given with these lessons. It was agreed that three lecturedemonstrations using the material suggested should be given by the Health Education Officer in the Technical College during 1960. After these three sessions arrangements would be made for her to visit each school and discuss individual ideas,problems and requests with the staffs concerned and in future to act as liaison between them and the health department,keeping them informed of new data and health education visual aids. By the end of the year twenty-six complete sets of lecture notes and visual aids had been prepared for distribution to teachers at the future meetings. Smoking and Lung Cancer Campaign. Illustrated talks to Secondary School children about the risks of smoking have continued but unfortunately it was not possible to cover every school. We still believe that education on this subject is a long term policy and that the facts should be presented and discussed at least once a year. There has been no recent evidence to justify changing this decision. Evaluation is extremely difficult. Some Head Teachers report less smoking on the school premises,but smoking outside probably still continues on much the same scale. It is encouraged by tobacconists selling cigarettes to children under 16 years,by the indifference of many parents and the increasing number of automatic machines from which cigarettes may be bought,thus nullifying laws against selling tobacco to children. Other Activities. Not without some trepidation an invitation was accepted in January to read one of two papers on "Health Education in Schools" to the Keppel Club at the London School of Hygiene and Tropical Medicine. The discussion which followed was a most stimulating and helpful experience. The subject was so wide that the members decided to carry on with it the following month and it was a great privilege to be invited again to listen to the concluding discussion. In November a lecture-demonstration was given to the students at Coloma Teachers' Training College. This was an important piece of work because an effective school health programme should be based on the accepted place of health in 7 general education. The classroom teacher is the only member of the school personnel who is with a group of children sufficiently long to encourage habit training,influence attitudes and give day to day support to the health practices suggested. For this work some specialist training is necessary. This work would not have been possible without the wise assistance of Dr. Weeks,Chief Inspector of Schools,the help of other members of the Education staff,and especially the enthusiasm and efforts of many teachers. 8 INFECTIOUS DISEASES There was the customary absence due to the infectious diseases of childhood,which tend to be widespread but mild in character. Details of named infections are given in the tables but especially in Infant and Junior Schools there was the usual prevalence of "feverish chills",type "colds" and upper respiratory infections,including epidemic nausea and vomiting. Several parents also raised queries about a condition which is undoubtedly communicable,viz - Plantar warts. A special report which was made to the Health Committee may be of interest and is included as Appendix D Page 55. HEIGHTS AND WEIGHTS The figures of average heights and weights are recorded in Appendix B,Table II and show once again that the post-war trend of yearly increases has ceased and a new level of averages has been reached. 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. 9 RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1959 WHO HAVE UNDERGONE TONSILLECTOMY Year of Birth Boys Per Cent Girls Per Cent Boys and Girls Per Cent 1955 and later 1 2. 7 - - 1 1. 3 1954 93 8. 4 50 4. 5 143 6. 5 1953 43 6.9 30 4.6 73 5.8 1952 34 11.9 32 11. 3 66 11. 6 All Boys 1348 20. 3% 1951 146 24.5 114 16. 8 260 20. 4 1950 21 3.6 73 14.4 94 8. 7 1949 39 20.5 29 24.8 68 22. 3 19 48 95 31.3 109 24. 8 204 27. 5 19 47 266 29.6 107 11. 3 373 20. 3 All Girls 1161 16.8% 1946 142 29.3 105 24.7 247 27. 1 1945 146 31.2 126 25. 3 272 28. 2 1944 and earlier 322 29.8 386 30.8 708 30. 2 All Groups Boys and Girls 2509 - 18.5% UNCLEANLINESS Cleanliness inspections are carried out by the School Nurses each term in most schools,so that the majority of pupils are brought under review. The finding of slight infestation in unexpected offenders leads to the issue of an informal letter to the parents,setting out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parents of children previously found verminous. Steel combs are sold or loaned where necessary. Endeavour is made to serve notices on the parents by the School Nurse personally,so that she has opportunity to emphasise that infestation may be a family complaint and not limited to the school child,and the need for constant cleanliness to prevent relapses. A cleansing station is provided for the treatment of scabies and very occasionally deals with other verminous conditions. 10 Total of first inspections for cleanliness 52,710 Number of children found unclean at first inspections 368 Total number of occasions on which these children were found unclean 626 Total of re-inspections of individual children 213 Number of occasions in which children found unclean (subsequent inspections) 126 At the primary inspections vermin were found in 32 and nits alone in 594 children. On these inspections 1.2 per cent. of the children showed evidence of infestation as against 1.0 in 1958. 18 children attended the Cleansing Station for treatment for verminous conditions and 11 for scabies. 11 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis:- Pulmonary 7 Non-Pulmonary 1 Taking the total child population at 41,170,the pulmonary tuberculosis incidence rate per 100,000 was 17.0,and the nonpulmonary incidence rate 2.4. There were no deaths from tuberculosis. CAUSES OF DEATH IN SCHOOL CHILDREN Child population,41,170 (estimated). Number of deaths 17,which is equal to a death-rate of 0.41 per 1,000. The deaths were due to:- Influenza 2 Congenital Deformity 2 Leukaemia 3 Accidental 2 Motor Accidents 2 Nephritis 1 Bronchitis 1 Other Malignant Diseases 1 Diabetes 1 Homicide 1 Other Diseases 1 CHIEF CAUSES OF EXCLUSION FROM SCHOOL Condition Exclusions during 1959 Percentage of total exclusions Exclusions during 19 5 B Percentage of total exclusions Ringworm - - - - Verminous conditions 14 1. 34 20 3.03 Inpetigo 8 0.76 - - Scabies 1 0.10 1 0. 15 Scarlet Fever 214 20. 42 107 16. 19 Measles (inc. German) 309 29. 48 199 30. 11 Diphtheria - - - - Whooping Cough 13 1. 24 8 1. 21 Chicken Pox 94 8.97 92 13.92 Humps 14 1. 34 85 12.86 External Eye Disease - - - - Polionyelitis - - - - Dysentery 370 35.31 144 21.79 Jaundice - - 4 0.61 Enteric Group - - - - Meningococcal Infection 5 0. 48 1 0. 15 Other Causes 6 0. 57 - - 1,0 48 661 12 The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Impetigo,Scarlet Fever,Measles,Whooping Cough,Dysentery,Meningococcal Infection and Other causes whilst Mumps and Jaundice show a decrease. Dysentery replaced Measles as the most frequent recorded cause of absence from school. WORK OF SCHOOL NURSES Last year I commented on the advantages of School Nurses being also Health Visitors. It is,however,clearly desirable that their special skills and ability to correlate home and school environments should not be wasted by duties capable of performance by less qualified staff. As in most occupations it is difficult to be precise about the division of functions into "essential","desirable" and "unnecessary",and School Nurses have themselves widely differing views. It was decided to follow the recommendation of a Ministry of Health circular and the appointment of an & E. A. Nurse for school clinic duties was put forward for 1960. On the results of this trial decisions regarding future establishments will be decided. School Visits Visits to School Departments re Cleanliness 418 Visits re Scabies or Ringworm 3 Visits re Infectious Disease 58 Visits re Medical Inspections 628 Visits re Medical Preparations 613 All other reasons 499 Home Visits Concerning defects found at routine medical inspections 590 Subsequent visits re defects found at routine medical inspections 186 Visits re special cases 782 Visits other than infectious cases 1,135 Visits in connection with infectious cases 947 13 TREATMENT The work of the School Clinics. SUMMARY OF ATTENDANCES 1959 1958 Increase or decrease Minor Ailments and Verruca Clinics 5,827 7,607 - 1,780 Inspection Clinic 818 390 + 428 Dental Clinics 23,083 24,030 947 Remedial Exercises Clinic 6,220 5,468 + 752 Enuresis Clinic 563 619 56 36,511 38. 114 - 1,603 The Minor Ailments Clinics. At the Lodge Road Clinic 323 defects involved 2,033 attendances,while at the subsidiary Clinics held at Ashburton School 218 defects,921 attendances; at Duppas School 517 defects,1,641 attendances; at Rockmount School 210 defects,876 attendances; and at Addington 83 defects,356 attendances. Complaint 1959 1958 Cases Attendances Average No,of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 1 1 1.0 1 1 1.0 Scabies 1 1 1.0 1 1 1.0 Impetigo 9 41 4.6 8 53 6.6 Other Skin Diseases 15 43 2.9 10 18 1.8 Otorrhoea and other Ear defects 26 75 2.9 24 105 4. 4 External Eye Disease 57 165 2.9 78 182 2. 4 Miscellaneous 1,243 5,501 4.4 1,484 4,59 4 3. 1 1,352 5,827 4. 3 1,606 4,956 3. 1 14 SCHOOL DENTAL SERVICE Report of the Principal School Dental Officer,P. G. Oliver,Esq.,L. D. S. ttiis 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 hy 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 The sale of biscuits,chocolates and sometimes toffee and sweets to pupils at maintained schools during mid morning break is causing concern among school dental officers. A recent survey shows that purchases of this kind are now commonplace in many Senior and Junior Departments and also at Grammar Schools in the Borough. This practice appears also on the increase over the whole country. Whilst it should be obvious that the distribution of "sweetmeats" of any kind is highly detrimental at such a time,the inclusion of biscuits,because of their "starchy" content,is also to be deplored. "Fillers" of this type,though of small dietetic value,are readily fermentable and by increasing the acidity in the mouth hasten the destruction of the tooth enamel. Compared with the eating of fruit they do not stimulate the corresponding volume of beneficial saliva. Because of the general worsening of the condition of children' s teeth since general derationing took place,this further incentive to sugar consumption on a national scale,can but add to the burden of an understaffed dental service. Though it is plain that children should not be expected to endure long periods without reasonable nourishment,the need for mid morning "snacks" should scarcely arise provided they have taken a satisfactory breakfast. In this respect one cannot but feel that the greater the apparent provision at school,the less will be the quota of sustaining food consumed at home. 15 Measures now being taken to acquaint teaching staff of the relevant facts concerning dental decay will,it is hoped,make clear the potential dangers of the present situation. If these sales are to continue,consumption of toffee and sweets should certainly be banned and other items dispensed should be of a less injurious character. It has been suggested that biscuits could be replaced by potato crisps and salted nuts; when practical the sale of fresh fruit would be definitely beneficial. In addition to the above precautions,pupils should be encouraged to rinse the mouth vigorously with water before returning to class. As a matter of urgency first priority continues to be extended to the New Addington Estate,which has sadly lacked adequate facilities in the past. The remodelling of the School Clinic at the Overbury School is now virtually complete and will allow a full range of treatment. The introduction of a second surgery to deal with those attending schools in the Castle Hill area is fulfilling a long felt want,and though there is still some back log of work,most of the major Departments were inspected during the year. Special efforts have also been made to deal with the large build up of Senior and Grammar Schools in the Shirley district. Along with other measures there has been an extensive regrouping of all Departments served by the Shirley Road Centre,which it is hoped will lead to more effective use of available resources. In spite of the very genuine improvement which has been possible for selected areas,difficulties in staffing present a recurrent problem,and because of a further reduction in the sessions available from Part-time Dentists and the prolonged absence through illness of another Officer,coverage for the Borough as a whole has been disappointing,and the number of schools unvisited during the year has increased appreciably. Difficulties are still being experienced in acquiring new premises in South Croydon to replace the existing Surgery at the Waldrons Hall. Because of lack of space it has not been found possible to include a clinic as part of any of the proposed schools in the neighbourhood. Unless a solution can be found before the present building has to be vacated,treatment for all children in this area will of necessity have to be conducted from Lodge Road Dental Centre. Whilst this would mean an increase in travelling time,it would be preferable to any arrangement of a make-shift nature likely to be possible in this district. 16 The work of the Orthodontic Unit continues to expand and for the first time since its inception is within sight of meeting its commitments. In understaffed areas it is now possible for the Specialist to take over the majority of irregularities and to leave the resident dentist freer for routine treatment. The recently completed dark room at the Overbury Clinic will now permit speedier x-Ray diagnosis,which is particularly desirable in the case of accidents to incisor teeth. Inspections the number of children on the register at maintained schools within the Borough at the close of 1959 was 36,878. Including an additional 48 scholars at grant assisted schools this represents a sum total of 36,926. During the year 76.4 per cent. of the school population were examined,compared with 85 per cent. in 195 8. As previously explained this decrease has come about as a result of reduced sessions by part-time officers,and absence through illness. According to recent returns some 7,138 children received no examination during 1959,compared with 3,737 last year. At those schools visited 26,145 were inspected and 11,829 (45.2 per cent.) referred for treatment,compared with 31,574 inspected and 14,789 (46.8 per cent.) referred in 1958. 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 38.4% Refused Treatment 45.4% Forms Not Returned 16. 2& Compared with last year this represents a fall of 3 per cent in the acceptance rate,and a total decrease of some 35.7 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 note that the present decline appears to be one of approximately 17 per cent. 17 RESULTS OF SCHOOL INSPECTIONS 1959 1958 1957 1949 1937 No. referred for Treatment 11,829 14,789 15,024 9,404 13,498 Consents 4,548: 6,114: 6,692: 6,996: 7,762: 38.4% 41.4% 44. 5% 74. 1% 57. 7% (Total Consents Inclnding Specials)* 6,472: 8,188: 9,366: 10,098: 10,146: 47%) 48.5%) 5 2.9%) 80. 7%) 63%) Refusals 5,376: 6,689: 6,516: 1,213: 3,242: 45.4% 45. 2% 43.4% 12.9% 24% Forms not Returned 1,914: 1,986: 1,816: 1,195: 2. 494: 16. 2% 13.4% 12. 1% 1Z7% 18. 5% *SPECIALS - Those referred by Head Teachers which Emergency Forms. Treatment Of 13,753 children referred for treatment (including specials) 7,950 (57.8 per cent.) were treated and 5,669 (41.2 per cent.) cured completely, compared with 16,863 referred, 8,978 (53.2 per cent.)treated and 6,617 (39.2 per cent.)cured in 1958. Treatment sessions decreased from 2,761 to 2, 556, principally because of a reduction of sessions by part-time dentists. Until 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. Children whose mouths show them to be specially prone to decay are placed on a rota for more frequent call-up and are not required to wait until the next school inspection. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year. 1959 195S Attendances 23,083 24,030 Treated 7,950 8,978 Re-treated 4,232 4,638 Fillings - Permanent 7,570 8,745 Temporary 1,521 1,515 No. of Teeth Pilled: Permanent 7,135 8,261 Temporary 1,454 1,444 18 1959 1958 Extractions - Permanent 2,575 2,655 Temporary 5,468 6,450 Gas Administration 3,522 3,719 Local Anaesthetics 683 577 Other Operations r Permanent 9,186 9,540 Temporary 807 893 Cases Completed 5,669 6,617 Miscellaneous Items These include:- 1959 1958 Root treatment in anterior teeth 16 14 Removal of bone sequestra 4 6 Splints for fractured incisors 4 2 Partial pulpotomy 2 Number of M. D. s treated 8 12 Dentures inserted 35 48 Denture repairs 17 11 After treatment of sockets,etc. 21 38 Removal of impacted and difficult teeth 47 69 Ulcerated Stomatitis (Vincent's infection) 10 6 Cleft Palate cases 2 4 Acrylic caps for incisor teeth 10 10 Gingivectomy 3 Applications of Calgitex Gauze 45 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 1,924 compared with 2,074 in 1958. X-Ray Examination The number of cases referred for the above purpose was 294 compared with 396 in 1958. This includes 40 taken at Mayday Hospital. 19 Orthodontic Treatment The number of sessions devoted to this work was 411,compared with 446 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:- 1959 1958 Consultant D.O.s Total Cases commenced during the year 236 51 287 283 Cases carried forward from the previous year 552 82 634 520 788 133 921 803 Cases completed during the year 119 65 184 134 Cases discontinued during the year 111 10 121 120 Pupils treated with appliances 269 87 356 361 Appliances - Removable 356 97 463 431 Fixed 126 14 140 76 Total Attendances 3,639 1,437 5,076 4,909 Cases treated by extraction only 44 115 159 149 Cases referred to Specialist for Consultation 195 - - 211 Treatment Sessions 296 115 411 446 New Cases awaiting treatment 12 30 42 - 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. 20 A summary of the work performed for the above children is given below:- 1959 1958 Attendances 106 92 New Cases Treated 8 14 Re-treated 40 35 Fillings - Permanent 98 59 Extractions - Permanent 20 28 Temporary - 5 Other Operations 11 18 "Gas" Cases 12 15 Local Anaesthesia 9 5 Cases Completed 34 37 Dentures Pitted - 5 Referred X-Ray 2 3 See Appendix B. Table IX. 21 SPINAL AND OTHER REMEDIAL CLINICS (LODGE ROAD) 1959 1958 Attendances Classes Av. att. Attendances Classes Av. att, Spinal 2,547 534 4.8 2,348 606 3.9 Flat Feet 2,541 504 5.0 2,462 558 4.4 Breathing 591 125 4. 7 658 135 4.9 5,679 1,163 5,468 1,299 207 individual cases were treated and 661 examinations were made by a doctor. SPINAL AND OTHER REMEDIAL CLINICS (NEW ADDINGTON) Attendances Classes Average Attendance Spinal 184 33 5.6 Plat Feet 221 66 3.4 Breathing 136 33 4.1 541 132 68 individual cases were treated and 52 examinations were made by a doctor. Cost of the School Health Service The gross cost of the medical,dental and nursing services was £51,273. The expenditure is subject to Education grant. Cost of Special Schools £ Schools maintained by the Council 42,873 Other Schools (not maintained by local Education Authorities) 15,060 Adjustments with other authorities in respect of Special Schools,at rate cost 6,016 £63,949 With the exception of the £6,016 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals Meals and Milk cost £412,079. Income from payment for meals was £162,635,making a net cost of £249,444,on which grant is paid of 100 per cent. on approved expenditure. 22 ST.GILES' SCHOOL FOR PHYSICALLY HANDICAPPED CHILDREN Mr. Green has kindly reported on another busy year. He shows by a long list of extra mural activities that children at St. Giles' are able to follow a full and varied programme,which often allows their return to ordinary schools. They are also able to select from a wide range of available jobs when they begin paid employment. Physiotherapy is given on each school day and speech therapy on one day per week. The School Medical Officer visits every week and an Orthopaedic Surgeon every term. Disabilities Boys Girls Total Physically Handicapped 59 55 114 1. Cerebral Palsy 20 12 32 2. Bronchiectasis 5 8 13 3. Congenital Heart 3 9 12 4. Epilepsy 5 2 7 5. Muscular Dystrophy 3 1 4 6. Perthes Disease 3 1 4 7. Poliomyelitis 6 6 12 8. Spina Bifida 5 2 7 9. Various disabilities 9 14 23 Delicate 43 41 84 1. Asthma 25 13 38 2. Bronchitis 10 13 23 3. Debility 17 8 4. Primary Tuberculosis 4 6 10 5. Various disabilities 3 2 5 Average number on roll 198 Of the 16 children who Admissions during the left for employment - year 5 took up clerical work To Employment 16 1 became a typist To Other Schools 22 2 trained as comptometer To Hospitals 4 operators. To Further Training 1 4 entered retail distribution Left District 8 1 the electrical trade Deceased 2 1 undertook further training 1 for work with ponies 1 whose occupation is,at present,unknown. 23 ST. LUKE'S SCHOOL FOR THE PARTIALLY SIGHTED Miss Rundle,the Head Mistress,reports that there were 21 pupils on the school roll at the end of the year. During 1959,apparatus for physical training was provided and fluorescent lighting was installed. Senior pupils now have domestic science or woodwork lessons in adjoining schools and accompanied ordinary pupils in visits to the Streatham Hill and Davis Theatres. ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL CHILDREN Mr. Grice has kindly reported on a year of change and reorganisation. There are now three departments - Reception and Infants,Primary and Secondary. All classes are co-educational. He stressed the need for continuity and regularity in medical supervision and commented on a backlog in the re-checking of mental capabilities. (This is being rectified). Mr. Grice draws attention to the paramount importance of speech and the high incidence of speech defects in the educationally sub-normal child. The teaching staff are co-operating with the Speech Therapists,from whom they had a series of lectures on speech correction. To the usual Open Days,School Sports,Christmas Party and outings,there was added a Golden Jubilee Exhibition,which was attended tay 200 visitors. Admissions,etc. Boys Girls Total Admitted during 1959 23 17 40 Left to go to work at sixteen 9 5 14 Transferred to Occupation Centre - 2 2 Transferred to St. Giles' School 1 - 1 Number on the Roll as at 31st December,1959. 130 83 213 24 CHILDREN EXAMINED FOR I. Q. 123 children were examined during 1959. The classifications arrived at,together with recommendations made,are as follows:- (1) Found to be educationally sub-normal: (a) Recommended to St. Christopher's Special Schoo1 41 (b) Recommended to Residential School 2 (2) Found to be unsuitable for education at school 22 (3) Other Recommendations: (a) Referred to Slow Stream in Ordinary School 8 (b) Recommended for re-test 12 (c) Deferred for Medical Treatment 2 (d) Recommended for St. Giles' 1 (e) Referred back to Ordinary School 20 108 Mental Tests at St. Christopher's 15 123 25 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1959 as to their fitness to undertake the part-time employment indicated:- 1959 195S 1957 1956 1955 Delivery of Goods for Shopkeepers 50 43 62 62 86 Delivery of Newspapers 317 394 344 365 364 Delivery of Milk 7 13 15 13 17 Shop Assistants 59 64 53 61 67 433 514 474 501 534 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1959 all milk was supplied free of charge and approximately 29,400 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 5,000 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 1959 was approximately 17,500. CHILD GUIDANCE CLINIC Return of cases referred by the School Medical Officer and the Education Department,from 1st January to 31st December,1959. Boys Girls Total Total number referred 22 14 36 Analysis of the above Cases: - Diagnostic only 7 5 12 Current Cases under treatment 11 6 17 Cases Closed - improved 2 2 4 Cases Closed - not improved 2 1 3 22 14 36 26 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 1959,a total of 211 new cases were registered. SPEECH THERAPY Unfortunately during the past year,the Speech Clinic has again been subjected to changes of staff,but is now fully staffed. During the year two complete and thorough surveys were carried out by Speech Therapists. One survey at St. Christopher's School for Educationally Sub-Normal Children,and one at St. Giles' School for Physically Handicapped Children. It was seen as a result of this survey,that the Problem of Speech Defective Children at St. Christopher's School is very considerable. At St. Giles' School the problem is not so great,and one Therapist can cope on her day's visit there. A Course of three Lectures has been given by the speech Clinic Staff at St. Christopher's School,to all the Teaching Staff,and also to those members of staff from outside schools who cared to attend. These lectures were given as a result of a request by the Education Department,who felt that perhaps the Teachers might be able to treat mild cases,without referral to the Speech Clinic,if they had some instruction. It was felt that Teachers could cope with a faulty "Th" sound only. The giving of these Lectures in no way dealt with or alleviated the Speech problem at St. Christopher's School. We have grown to realise the great need for closer cooperation between all allied Departments and Specialists,both Medical and Educational,if our work is to be really successful. Total number of cases treated 312 Total number of cases discharged: Cured 65 Improved 32 111 Non attended 14 Total number of cases still attending 201 The details of the work carried out are shown in Appendix B Table X. 27 ENURETIC CLINIC During 1959 the numbers attending the Diuresis Clinic were similar to previous years. The total number of children attending at Lodge Road where weekly clinics are held and New Addington where clinics are held once a month was 119. Of this number 76 attended for the first time in 1959. 10 of these cases were unsuitable for treatment by reason of either physical or mental defect,and were not seen again after the first visit. 7 attended only once and 8 children attended so rarely or so erratically that following three consecutive non-attendances no further appointment was sent. This casual approach of the parents is recognised as a contributing factor in the cause of enuresis. Of the remaining 94 children 54 were discharged dry during the year. The enuresis machines continued to provide an invaluable remedy in those cases which did not respond to,or were not deemed suitable for lactose tablets. Because of the increased stock of these machines the waiting list has been reduced to more manageable proportions. Two cases of buttock rash were reported this year. No. of new cases 76 No. of old cases 43 No. of cases unsuitable for treatment 10 No. of cases discharged dry 54 No. of cases discharged for non-attendance 8 No. of cases used machines 35 (Of these 1 left the area before treatment was completed,and one girl of 14 years of age refused to continue using the machine following two breakdowns of the buzzer. All other cases were successful). 28 SPASTICS 57 Croydon Spastics were receiving education as at 31.12.59. 2 children received Home Teaching. 27 were attending St. Giles' School. 2 were attending St. Margaret's School, Croydon. 5 were at Residential Schools for Physically Handicapped children. 3 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. 1 was attending St. Christopher's School. 2 were attending normal Private school. 6 were attending Spastic Centre full time. A further 2 children were known who were under school age. EPILEPTIC SCHOOL CHILDREN Epilepsy is one of the conditions which must be ascertained by the Education Authority, and qualifies for special educational arrangements. There are various forms of epilepsy, but it should not be regarded as an illness in its own right. It is a manifestation of some brain disturbance, as in the case of a child with a brain tumour. Epilepsy in children which cannot be found to be due to a particular cause is known as "idiopathic" but the number of cases of epilepsy so labelled is decreasing with improvement in medical knowledge and technique. It is of the greatest importance that children suffering from epilepsy should, as far as possible, have a normal education in an ordinary school. This is the expressed policy of the Ministry of Education and most epileptic children are in fact so educated. In general, inability to attend an ordinary school is due to: - intellectual backwardness, additional physical handicap, because of behaviour disorders or frequent major fits. Where education at an ordinary school is not possible for any of tne above reasons, the following alternatives arise - 1. Special boarding schools for epileptics. These are usually attached to epileptic colonies (as at Lingfield). Hie role of epileptic colonies is more and more that of a long stay hospital with educational facilities, to which children are sent for stabilisation and sometimes behaviour difficulties, and from which it is expected they will be able to return to ordinary schools. These schools all take children who are E.S. N. 2. Special Schools (day or boarding) for E.S.fc. children. These are suitable for well controlled epileptics of E. S. N. level with no physical handicap and little or no behaviour disorder. 3. Special schools (day or boarding) for Physically Handicapped children. These are suitable for well controlled epileptics of above E. S.N. level and with little or no behaviour disorder, who have an additional physical handicap. The physical handicap may be responsible for or associated with the epilepsy, e.g. celebral palsy, brain tumour, etc., or additional to it, e.g. heart disease, arthritis, etc. It is arguable that epilepsy itself is a physical handicap, and some Physically Handicapped Schools accept epileptic children as epileptics and educate them either with other physically handicapped children or as a special group within the school. This could be equally well applied to groups of spastic children and partially sighted children. 4. Special Schools (boarding) for Maladjusted children. Some special boarding schools for maladjusted children are prepared to consider epileptics but placement is difficult. Special boarding schools for epileptics usually accept the less seriously disturbed maladjusted epileptics. It is only very seldom that an epileptic child cannot be educated in school, but sometimes home tuition is helpful. Very severely disturbed epileptic children may have to be admitted to a children's unit in a Mental hospital. There are no special arrangements for the grammar school education of epileptic children. Most of those who are of grammar school level can go to an ordinary grammar school, and every attempt should be made to keep them there; there is no satisfactory alternative. 29 30 It not infrequently happens that a child (especially a young child) may have one or more convulsions possibly in association with an infectious illness, and may for a time receive anticonvulsive drugs. Such children are not properly called epileptics though their convulsion is in fact an epileptic fit. The more severely affected epileptics soon come to the notice of the School Health Service and helpful advice to parents on the handling of these children can often prevent behaviour difficulties. While children who have major fits are a great trial in an ordinary school and explain the reason for the duty to provide special facilities, experienced staff can usually handle mild cases without unreasonable interference with school activities. 3 2 epileptics were known to the School Health Service as at 31. 12.59. Of these: 12 were attending Ordinary School. 7 were in Day School for Physically Handicapped and Delicate Children. 4 were attending our day E. S.N. School. 2 were at Lingfield School. 1 was receiving Home Tuition. 2 were in Hospital (1 at St. Lawrence's Hospital and 1 at Queen Mary's Hospital) 2 were at the Occupation Centre. 1 was in Residential School (St. Elizabeth's) 1 was at Private Day School. NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in 1959, 358 children vere examined at routine examination and also 1 special examination. Appendix C gives the detailed findings. 31 STATUTORY TABLES APPENDIX A MEDICAL INSPECTION RETURNS Year ended 31st December, 1959. PART 1. - MEDICAL INSPECTION OP PDPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. Table A. - Periodic Medical Inspections. Age Groups Inspected (By year of birth) No. of Pupils Inspected Physical Condition of Pupils Inspected SATISFACTORY UNSATISFACTORY No. X of Col. 2 No. % of Col. 2 (1) (2) (3) (4) (S) (6) 1955 and later 75 75 100.00 - - 1954 2, 187 2,180 99.68 7 0.32 1953 1,268 1,25 2 98.74 16 1.26 1952 568 564 99.28 4 0.72 1951 1,376 1,366 99.27 10 0.73 1950 1,086 1,072 98.71 14 1.29 1949 307 306 99.67 1 0.33 1948 743 742 99.87 1 0.13 1947 1,842 1,836 99.70 6 0.30 1946 910 909 99.89 1 0.11 1945 966 961 99.48 5 0.52 1944 and earlier 2, 335 2, 331 99.83 4 0.17 TOTAL 13,663 13,594 99.49 69 0.51 32 Table B. - Pupils found to require Treatment at periodic Medical Inspections. (Excluding Dental Diseases and Infestation with Vermin) Age Groups Inspected (By year of birth) For defective ri si on (excluding squint) For any of the other conditions recorded in Part II Total individual pupils (1) (2) (3) (4) 1955 and later - 1 1 1954 63 132 189 1953 54 115 163 195 2 16 51 66 1951 49 77 119 1950 45 67 101 1949 20 25 42 1948 34 42 68 1947 92 131 214 1946 44 53 92 1945 38 46 82 1944 and earlier 129 96 223 TOTAL 584 836 1,360 Table C. - Other Inspections Number of Special Inepections 736 Number of Re-inspections 1,104 Total 1, 840 Table D. - Infestation with Vermin (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 52,923 (b) Total number of individual pupils found to be infested 372 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) - (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) - 33 TABLE A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION PART 2 TABLE A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION Defect Code No. Defect or Disease Periodic Inspections Entrants Leavers Others To tal Treatment Observa tion Treatmen t Obserra tion Treatmen t Obserra tion Treatmen t Observa tion (1) (2) (3) (4) (S) (6) (7) (8) (9) (10) 4 SKIN 7 13 7 5 21 17 41 35 5 EYES - (a) Vision 117 90 167 29 300 143 584 262 (b) squint 24 11 3 1 9 11 36 23 (c) Other 3 6 4 1 6 4 13 11 6 EARS - (a) Hearing 8 43 4 10 18 36 30 89 (b) Otitis Media 2 13 - 3 7 9 9 25 (c) Other - 2 2 2 7 3 9 7 7 NOSE AND THROAT 62 222 7 6 40 111 109 339 8 SPEECH 32 59 2 1 12 11 46 71 9 LYMPHATIC GLANDS - 30 1 1 - 15 1 46 10 HEART 3 22 7 21 6 34 16 77 11 LONGS 4 53 4 5 16 50 24 108 12 DEVELOPMENTAL - (a) Hernia 3 2 3 1 4 2 10 5 (b) Other 5 31 13 9 37 80 55 120 13 ORTHOPAEDIC - (a) Posture 15 20 25 8 79 34 119 62 (b) Feet 17 79 17 13 89 90 123 18 2 (c) Other 30 68 21 9 55 52 106 129 14 NERVOUS SYSTEM - (a) Epilepsy 1 6 1 - 1 5 3 11 (b) Other 1 7 - 3 7 14 8 24 15 PSYCHOLOGICAL - (a) Development 6 8 1 2 - 4 7 14 (b) stability 16 19 - - 12 8 28 27 16 ABDOMEN - 2 - 2 3 11 3 15 17 OTHER 27 23 12 10 18 48 57 81 34 TABLE B. SPECIAL INSPECTIONS Defect Code No. Defect or Disease Special Inspections Pupils requiring Treatment Pupils requiring Observation (1) (2) (3) (4) 4 SKIN - 1 5 EYES - (a) Vision 10 4 (b) Squint 2 1 (c) Other - - 6 EARS - (a) Hearing 3 2 (b) Otitis Media 1 - (c) Other - - 7 NOSE AND THROAT 7 5 8 SPEECH 2 2 9 LYMPHATIC GLANDS - 1 10 HEART 1 3 11 LUNGS 1 3 12 DEVELOPMENTAL - (a) Hernia 1 - (b) Other 1 5 13 ORTHOPAEDIC - (a) Posture 1 1 (b) Feet 1 - (c) Other 3 1 14 NERVOOS SYSTEM - (a) Epilepsy - - (b) Other - 1 15 PSYCHOLOGICAL - (a) Development . - (b) Stability 2 - 16 ABDOMEN - - 17 OTHER 1 - 35 PART 3 TABLE A. - EYE DISEASES. DEFECTIVE VISION AND SQUINT Number of cases dealt with External and other, excluding errors of refraction and squint 81 Errors of Refraction (Including squint) 1,675 Total 1,756 Number of pupils for whom spectacles were prescribed 1. 186 TABLE B. - DISEASES AND DEFECTS OF EAR. NOSE AND THROAT Number of cases known to hare been dealt with Received operative treatment - (a) for diseases of the ear - (b) for adenoids and chronic tonsillitis 585 (c) for other nose and throat conditions Received other forms of treatment Ear - (Minor Ailments Clinic) 26 Total 611 Total number of pupils in schools who are known to have been provided with hearing aids - (a) in 1959 19 (b) in previous years 24 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to hare been treated (a) Pupils treated at clinics or outpatients departments 216 (b) Pupils treated at school for postural defects 9 Total 225 TABLE D. - DISEASES OF THE SKIN (excluding uncleanliness, for which see Table II) Number of cases treated or under treatment during the year Ringworm - (i) Scalp - (ii) Body 1 Scabies 12 Impetigo 8 Other Skin Diseases 15 Total 36 36 TABLE E. - CHILD GUIDANCE TREATMENT Number of cases treated Number of pupils treated at Child Guidance Clinics 36 TABLE F. - SPEECH THERAPY Number of cases treated Number of pupils treated by Speech Therapists 312 TABLE G. - OTHER TREATMENT GIVEN Number of cases treated (a) Number of cases of miscellaneous minor ailments treated by the Authority 1,243 (b) Pupils who received convalescent treatment under School Health service arrangements 11 (c) Pupils who received B.C.G. vaccination 2,192 (d) Other than (a), (b) and (c) above (specify) 1. Enuresis 119 Total (a) -(d) 3,565 37 PART 4. - DENTAL INSPECTION AND TREATMENT (1) Number of pupils Inspected by the Authority's Dental Officers: (a) At Periodic Inspections 26, 145 (b) As Specials 1,9 24 28,069 (2) Nuaber found to require treatment 14,901 (3) Number offered treataent 13,753 (4) Number actually treated 7,950 (5) Number of attendances made by pupils for treataent, including ll(h) 23,083 (6) Half days devoted to: (a) Periodic school inspections 191 ( b ) Treatment 2,556 2,747 (7) Fillings: (a) Permanent Teeth 7,570 (b) Temporary Teeth 1,521 9,091 (8) Nuaber of Teeth Filled: (a) Permanent Teeth 7,135 (b) Temporary Teeth 1,454 8,589 (9) Extractions: (a) Permanent Teeth 2,575 (b) Temporary Teeth 5,468 8,043 (10) Adalnlstratlon of general anaesthetics for extractions 3,522 (11) Orthodontics: (a) cases commenced during year 287 (b) Cases carried forward from previous year 634 (c) Cases completed during year 184 (d) cases discontinued during year 121 (e) pupils treated with appliances 356 (f) Removable appliances fitted 463 (g) Fixed appliances fitted 140 (b) Total attendances 5,076 (12) Number of pupils supplied with artificial teeth 35 (13) other Operations: (a) Permanent Teeth 9,186 (b) Temporary Teeth 807 9,993 38 APPENDIX B Table I AVERAGE NUMBERS AND ATTENDANCE IN MAINTAINED PRIMARY MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS DURING THE YEAR 1959. School Average No. on Registers Average At t en dance Average 1959 Attendance % Average 19 58 Attendance % COUNCIL PRIMARY Ashburton Junior Mixed 427 389 91.1 93.7 Ashburton Infants 185 158 85.4 90.0 Benson Junior Mixed and Infants 581 533 91.7 93.3 Beulah Junior Boys 276 252 91.3 92.6 Beulah Junior Girls 259 233 90.0 92.4 Beulah Infants 245 206 84.1 84.1 Castle Hill Junior Mixed 474 437 92.4 91.7 Castle Hill Infants 483 425 88.0 87.5 Cypress Junior Mixed 241 221 91.7 92.3 Cypress Infants 168 146 86.9 88.8 Davidson Infants 143 123 86.0 87.7 Duppas Junior Mixed 365 325 89.0 91.5 Ecclesbourne Infants 120 101 84.2 89.3 Elmwood Junior Boys 309 278 89.9 92.7 Elmwood Junior Girls 300 273 91.0 92.2 Elmwood Infants 255 215 84.3 87.9 Fairchildes Junior Mixed 716 652 91.1 92.9 Faircbildes Infants 379 327 86.2 89.0 Gilbert Scott Junior Mixed 470 432 91.9 93.3 Gilbert Scott Infants 255 216 84.0 87.7 Gonville Junior Mixed and Infants 575 509 88.5 90.1 Howard Junior Mixed and Infants 379 342 90.2 91.6 Ingram Infants 141 125 88.7 89.9 Kensington Avenue Junior Mixed 484 439 90.7 93.2 Kensington Avenue Infants 235 199 84.6 88.9 Kingsley Junior Mixed 498 448 89.8 91.4 Klngsley Infants 318 267 83.9 87.4 Monks Orchard Junior Mixed and Infants 290 267 92.1 92.7 Overbury Infants and Junior Mixed 68 63 9 2.6 93.0 Norbury Manor Junior Mixed 428 393 9 1.8 94.3 Norbury Manor Infants 208 177 85.0 89.8 Oval Junior Mixed 370 339 91.6 92.7 Oval Infants 180 151 83.9 85.1 Portland Infants 156 137 87.8 90.0 Pur ley Oaks Junior Mixed 341 314 92.8 90.5 Purley Oaks Infants 186 156 83.9 80.5 Rockmount Junior Mixed 310 285 91.9 92.5 Rockmount Infants 161 139 86.3 85.6 Rowdown Juniors 615 55 2 89.7 90.9 Rowdown Infants 335 288 85.1 89.6 South Norwood Junior Mixed 368 344 93.5 92.8 South Norwood Infants 281 241 85.8 86.6 St. peter's Junior Mixed and Infants 280 259 92.5 92.8 Spring Park Junior Mixed 249 233 93.6 93.8 Spring Park Infants 128 111 86.7 89.7 Sydenham Junior Boys 178 16 2 91.0 92.1 Sydenham Junior Girls and Infants 314 273 87.1 88.5 39 School Average No. on Registers Average Attendance Average 1959 Attendance % Average 1958 Attendance % Waddon Infants 207 168 81.2 86.9 West Thornton Junior Mixed 334 298 98.2 91.2 West Thornton Infants - - • - Whitehorse Manor Junior Boys 237 215 90.7 92.8 Whitehorse Manor Junior Girls 230 18 2 91.0 93.0 Whitehorse Manor Infants 229 197 86.0 87.1 Winterbourne Junior Boys 405 375 92.6 94.1 Winterbourne Junior Girls 344 318 92.4 94.0 Winterbourne Infants 364 307 84.3 88.7 Wolsey Junior Mixed 487 444 91.2 92.6 Wolsey Infants 303 267 88.1 87.0 Woodside Junior Boys 359 333 92.4 94.2 Wbodside Junior Girls 388 357 92.0 93.2 Woodside Infants 257 223 86.7 90.8 TOTALS 18,841 16,839 89.3 90.9 COUNCIL SECONDARY KODERN Ashburton Senior Boys 641 606 94.5 94.6 Ashburton Senior Girls 609 555 91.1 92.7 Davidson Senior Boys and Girls 458 409 89.3 89.2 Ecclesbourne Senior Girls 385 343 89.1 90.6 Fairchildes' Senior Boys 460 409 88.9 89.7 Fairchildes' Senior Girls 470 417 88.7 90.2 Ingram Senior Boys 568 503 88.6 90.1 Lanfranc Senior Boys 686 613 89.3 88.7 Lanfranc senior Girls 622 558 89.7 89.6 Norbury Manor senior Boys 344 318 92.4 93.1 Norbury Manor senior Girls 469 435 92.7 93.5 Portland Senior Mixed 378 340 90.0 93.4 Tavistock senior Boys 555 482 86.9 88.8 Tavistock senior Girls 371 321 86.5 88.4 South Croydon Senior Mixed 713 632 88.6 89.2 Shirley Senior Mixed 420 385 91.7 93.3 Overbury Senior Mixed 455 404 88.8 89.4 Westwood Secondary Girls 431 38 3 88.9 89.8 TOTALS 9,035 8,113 89.7 90.4 VOLUNTARY SECONDARY MODERN St. Andrew's 204 175 85.8 88.9 Our Lady's 18 4 161 87. 5 87. 2 St. Mary* s 37 2 337 90.6 91.6 TOTALS ... 760 673 88.5 89.8 SPECIAL SCf'OOLS St. Christopher's Educationally Sub-Normal 203 177 87. 1 87. 6 St. Giles' (Delicate and Physically Handicapped) ... 198 169 85. 4 85. 3 St. Luke's (Partially Sighted)... 22 19 86. 4 89. 4 TOTALS ... 423 365 86. 2 86. 7 40 School Average No. on Registers Average Attendance Average 19S9 Attendance % Average 1958 Attendance % VOLUNTARY PRIMARY All Saints' Mixed and Infants 221 199 90.0 91.0 Good Shepherd R. C. Junior Mixed and Infants 303 264 87.1 88.4 Parish Church Junior Mixed and Infants 347 308 88.8 91.2 St. Joseph's Mixed and Infants 518 453 87.5 89.8 St. Mark's Junior Mixed and Infants 215 192 89.3 89.4 St. Mary's R. C. Junior Mixed and Infants 416 367 88.2 89.3 St. Michael's Infants 109 90 82.6 86.4 Shirley (St. Johns) Junior Mixed and Infants 278 249 89.6 91.4 TOTALS 2,407 2,122 88.1 89.9 SELECTIVE CENTRAL AND GRAMMAR Archbishop Tenison's Mixed 303 282 93.1 93.2 Heath Clark Mixed 654 605 92.5 94.5 John Newnham Mixed 539 500 92.7 93.4 Selhurst Boys 847 820 96.8 94.7 Selhurst Girls 576 534 92.7 93.3 John Rusk in Boys 591 554 93.7 94.1 Coloraa Girls 569 521 91.6 90.8 Lady Edridge Girls 621 600 96.6 94.0 TOTALS 4,700 4,416 93.9 93.8 TECHNICAL Stanley Technical 311 288 92.6 93.9 Croydon Secondary Technical 401 377 94.0 95.1 TOTALS 712 665 93.3 94.5 SUMMARY OF SCHOOL ATTENDANCE FOR THE YEAR 1959. Council Primary 18,841 16,8 39 89.3 90.9 Voluntary Primary 2,407 2,122 88.1 89.9 Council Secondary 9,035 8,113 89.7 90.4 Voluntary secondary Mixed 760 673 88.5 89.8 Grammar and Central 4,700 4,416 93.9 93.8 Technical 712 665 93.3 94.5 Specials 423 365 86.2 86.7 TOTALS 36,878 33,193 90.0 91.1 Crosfield Nursery 39 30 76.9 85.1 41 Table II HEIGHTS AND WEIGHTS, 1959 Age Number Examined Average Height in inches Average Weight in lbs. 1959 1959 19 58 1957 1956 19 39 1959 19 58 19 57 19 56 1939 BOYS 5 years 1097 43. 2 43.0 43.5 43. 4 41.8 43.4 43.0 43. 5 43. 4 41. 5 6 * 628 44.7 44. 1 44.0 43.9 43. 8 46. 7 45. 1 44.6 44.8 43. 4 7 " 289 46.9 48.4 47.6 48. 1 45. 3 50. 2 54. 1 52.6 53. 4 47.9 8 " 700 51.0 50.7 50. 5 50. 2 49. 5 60. 6 60. 4 59. 5 58.9 55. 5 9 " 591 51.9 51. 2 50.9 51. 3 51. 2 64. 3 63. 1 61. 3 62. 3 58.8 10 » 195 52.9 53. 1 52.9 52.9 52.7 68. 5 69.9 66.0 67. 1 62. 9 11 " 285 56. 4 56.6 57. 1 57. 2 53.7 79. 5 81.9 83. 8 83.9 68.7 12 ' 911 57.7 57.9 58. 1 58.0 55.7 85.7 86.8 86. 1 86. 4 79. 9 13 " 495 59. 2 59.0 59.6 58. 2 58. 4 90.9 88.9 90. 1 82.9 81. 6 14 * 518 63.9 63.4 63.7 61. 3 59.0 112. 1 112. 3 112.6 111.9 90.8 15 " 748 65.9 65. 2 64. 3 64. 5 - 120.8 119.7 117.6 116.6 - 16 " 260 67.6 67. 3 66.8 66.6 - 133. 2 131.9 127.6 129. 2 - 17 " 99 67.7 67.6 67.8 67.9 - 134. 4 133.5 133. 2 133. 8 - GIRLS 5 years 1051 42.9 42.7 42. 7 42.5 41. 2 41.7 42.0 42. 3 41.7 39. 7 6 " 637 43.9 43.7 43.8 43. 7 42. 7 44.6 43.7 43.9 43.6 4 L 4 7 " 2B0 46.5 47. 2 47.5 47.5 44. 1 49.6 51.8 52. 1 52. 6 43. 6 8 " 679 50. 2 50.0 50. 1 50. 1 48.9 59.8 58.8 57.9 58. 3 54.7 9 " 481 51.9 50.9 50.9 50.9 50.9 64. 3 62. 3 60. 3 60. 5 57. 6 10 " 118 52.9 53. 2 52.5 53.5 52. 1 68. 6 67.4 65. 5 69. 1 62. 9 11 " 457 57. 3 58.8 57.4 57. 2 53. 6 84.0 88. 1 83.8 83.6 68. 3 12 " 10 29 58. 4 58. 2 58. 3 58.9 56.6 89. 6 87. 2 91.0 89.6 77. 2 13 " 473 59.7 59. 4 59. 4 59. 7 58.8 94.4 95.6 91.6 94.6 85. 3 14 " 501 62.5 62. 7 62. 2 61.9 60.3 110. 2 108.4 109.9 109.9 97.9 15 " 806 63.8 63. 3 62.5 62.8 62.0 116. 5 114. 2 116. 3 114. 3 105. 5 16 " 395 64.0 63.7 64.0 64.9 - 121. 5 119.5 123. 4 123.6 - 17 " 126 64. 1 64.7 64. 5 64.6 - 125.0 120. 7 126.6 127.8 - 42 Table III CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1959 School Population Measles German Measles Whooping Cough Chicken Pox Mumps Scabie s Impetigo Ringworm Diphtheria Scarlet Fever Dysentery Poliomyelitis Jaundice Conjunctivitis Sore Throat Other Diseases Enteric Group Erysipelas Vermin Meningococcal Infection Totals Body Scalp All Saints 221 - - 1 1 - - - - - - - - - - - - 1 - - 3 - 6 Arch. Tenison 303 - - - - - - - - - - - - - - - - - - - - - - Ashburton 186 2 - - - - - - - - - - 7 6 - - - - - - - - - 13 Benson 581 2 - - - 2 - - - - - 10 - - - - - - - - - - 14 Beulah 780 3 - - - - - - - - - 14 4 - - - - - - - 1 - 22 Castle Hill 957 7 - 3 31 - - 2 - - - 24 36 - - - - - - - - - 103 Coloma 569 - - - - - - - - - 1 2 - - - - - - - - - 3 Crossfield Nursery 39 - - - - - - - - - - - - - - - - - - - - - - Croydon High 888 - - - - - - - - - - - - - - - - - - - - - - Croydon Tech. 401 - - - - - - - - - - - 1 - - - - - - - - - 1 Cypress 409 - - - - - - - - - - 1 - - - - - - - - - - 2 Davidson 601 29 - - - - - - - - - 5 1 - - - - - - - - - 35 Duppas 365 - - - - - - - - - - 5 4 - - - - 1 - - - 1 12 Ecclesbourne 505 - - - 2 - - - - - - 9 - - - - - - - - - - 11 Elmwood 864 - - - - - - - - - - 2 1 - - - - - - - - - 3 Fairchildes 2025 - - - - - - - - - - 5 88 - - - - 2 - - - 1 96 Gilbert Scott 725 - - 1 1 - - - - - - 3 66 - - - - - - - - - 71 Gonville 575 - - - - 1 - - - - - 8 - - - - - - - - - - 9 Good Shepherd 303 - 1 - - - - - - - - 3 28 - - - - - - - - - 32 Heath Clark 654 - - - - - - - - - - - - - - - - - - - - - - Howard 379 - 1 - - - - - - - - - 4 - - - - - - - - - 5 Ingram 709 18 - - 16 - - - - - - 1 - - - - - - - - 1 - 37 John Newnham 539 - - - - - - - - - - - - - - - - - - - - - - John Ruskin 591 - - - - - - - - - - - 1 - - - - - - - - - 1 Kensington Avenue 719 1 - - 1 - - - - - - 9 - - - - - - - - - - 11 Kingsley 816 14 - - 1 - - - - - - 3 1 - - - - - - - - - 19 Lady Edridge ... 621 - - - - - - - - - - 2 3 - - - - - - - — - 5 Lanfranc 1308 1 - - - - - - - - - - 2 - - - - - - - - - 3 Monks Orchard 290 - - - - - - - - - - - - - - - - - - - - - - Norbury Manor 1449 16 - 1 9 4 - - - - - 4 - - - - - - - - 1 - 35 Occupation Centre 85 - - - - 2 - - - - - - - - - - - - - - - - 2 Old Palace 457 - - - - - - - - - - - 1 - - - - - - - - - 1 Our Lady's Convent 184 - - - - - - - - - - - - - - - - - - - - - - Oval 550 40 - 1 - 2 - 2 - - - 1 3 - - - - - - - - - 49 Overbury 523 - - - - - - - - - - - 11 - - - - - - - - - 11 Parish church 347 - - - - - - - - - - 1 1 - - - - - - - - - 2 Portland 534 - - - - - - - - - - 3 - - - - - - - - - - 3 Purley Oaks 527 - - - - - - - - - - - 6 - - - - - - - 3 - 9 Regina Coeli 492 - - - - - - - - - - 1 1 - - - - - - - - - 2 Rockmount 471 - - - - - - - - - - 2 - - - - - - - - - - 2 Rowdown 950 - - 2 - - - - - - - 9 45 - - - - - - - - - 56 St. Andrew's 204 - - - - - - - - - - - - - - - - - - - - - - St. Christopher's 203 - - - - - - - - - - 1 3 - - - - - - - - - 4 St. Giles' 198 2 - - - - - - - - - 4 1 - - - - - - - - - 7 St. Joseph's 518 - - - - - - - - - - - - - - - - - - - 1 - 1 St. Luke's 22 - - - - - - - - - - - 2 - - - - - - - 1 - 3 St. Mark's 215 - - - - - - - - - - 2 - - - - - - - - 2 1 5 St. Mary's R. C. 788 15 - - 1 - • 1 - - - 2 2 - - - - - - - - - 21 St. Michael's 109 31 - - 14 - - - - - - 5 - - - - - - - - - - 50 St. peter's 280 1 - - - - - - - - - - 2 - - - - 1 - - - - 4 Selhurst Grammar 1423 - - - - - - - - - - 1 - - - - - - - - - - 1 Shirley (St. John's) 698 33 - - - - - - - - - - 2 - - - - - - - - - 35 South Croydon 713 - - - - - - - - - - 1 5 - - - - - - - - - 6 South Norwood 649 56 - - - - - - - - - 6 - - - - - - - - - - 62 Spring Park 377 - - - 8 - - 1 - - - 3 6 - - - - - - - - - 18 Stanley Tech. 311 - - - - - - - - - - - - - - - - - - - - - - Sydenham 492 1 - - - - - - - - - 5 - - - - - - - - - - 6 Tavistock 9 26 - - - - - - 1 - - - - 1 - - - - 1 - - 1 - 4 Trinity 597 - - - - - - - - - - - - - - - - - - - - - - Waddon 207 - - 1 - - - - - - - 20 3 - - - - - - - - - 24 West Thornton 334 - - - - - - - - - - - 2 - - - - - - - - - 2 Westwood 431 - - - - - - - - - - - - - - - - - - - - 1 1 Whitehorse Manor 1000 1 - 1 2 1 1 - - - - 11 2 - - - - - - - - - 19 Whitgift 843 - - - - - - - - - - 1 - - - - - - - - - - 1 Winterbourne 1113 - - - 1 - - - - - - 9 1 - - - - - - - - - 11 Wolsey 790 - - - 5 - - - - - - 4 20 - - - - - - - - 1 30 Woodside 1004 36 - 2 1 - - - - - - 6 2 - - - - - - - - - 47 307 2 13 94 14 1 8 - - - 214 370 - - - - 6 - - 14 5 1048 43 2 44 Table IV RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 195S Defects Boys Girls No. requiring Treatment No. referred lor Observation Percentage of total Examined No. requiring Treatment No. referred for Observation Percentage of total Examined Uncleanliness- Head 3 - 0.05 3 - 0.04 Body Skin Disease 24 9 0.49 17 26 0.62 Eye Disease - Defective Vision 273 124 5.88 311 138 6.50 Squint 15 7 0.33 21 16 0.54 External Eye Trouble 5 6 0.16 8 5 0.19 Ear Disease - Deafness 15 41 0.83 15 48 0.91 Otitis Media 5 15 0.30 4 10 0.20 Other Disease 5 2 0.10 4 5 0.13 Nose and Throat 49 172 3.27 60 167 3.29 Enlarged Cervical Glands (not T. B.) - 28 0.41 1 18 0.25 Dental Defects 53 - 0.78 36 3 0.56 Speech Defects 31 44 1.11 15 27 0.61 Heart and Circulation 11 31 0.62 5 46 0.74 Lungs 7 55 0.92 17 53 1.01 Developmental- (a) Hernia 9 5 0.21 1 - 0.02 (b) other 53 80 1.97 2 40 0.61 Deformities- Posture 36 22 0.86 83 40 1.78 Plat Feet 54 103 2.32 69 79 2.14 Others 51 62 1.67 55 67 1.78 Nervous System Disorders- Epilepsy - 5 0.07 3 6 0.13 Other 3 7 0.15 5 17 0.32 Psychological- (a) Development 5 7 0.18 2 7 0.13 (b) Stability 21 13 0.50 7 14 0.30 Abdomen 2 5 0.10 1 10 0.16 Other Defects and Diseases 30 28 0.86 27 53 1.16 TOTALS 760 871 772 895 Total Children Examined 6,754 6,909 45 Table V PARENTS PRESENT 1959 5 years and under 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years ana 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 All Saints 18 10 15 7 4 3 4 2 - 1 - 1 15 16 12 10 4 4 4 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 44 34 36 22 Archbishop Tenison's - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 - 9 - Ashburton 36 29 36 29 5 - 5 - 24 19 21 18 42 17 28 16 16 10 13 9 3 1 2 1 3 10 1 - 112 89 20 17 58 44 9 11 13 75 2 3 47 87 3 13 60 - - - 419 381 140 117 Benson 4 2 1 1 24 36 22 31 5 5 3 5 31 35 24 31 12 22 10 18 3 4 1 3 3 3 3 2 - - - - - - - - - - - - - - - - - - - - 82 107 64 91 Beulah 27 31 24 29 13 22 9 20 4 4 4 3 21 48 14 40 14 6 12 3 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 79 112 63 95 Castle Rill 19 32 16 30 100 73 83 65 21 47 15 41 1 - - - - 22 - 19 - 18 - 14 - - - - - - - - - - - - - - - - - - - - - - - - 141 192 114 169 Coloma - - - - - - - - - - - - - - - - - - - - - - - - - 71 - 11 - 90 - 16 - 28 - 3 - - - - - 63 - - - 185 - 1 - 437 - 31 Crosfield 40 33 15 16 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 33 15 16 Croydon Tech - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cypress 36 30 30 24 25 25 23 21 8 11 6 8 15 24 9 22 16 18 12 8 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 101 109 80 84 Davidson 28 27 25 26 3 2 3 2 2 2 2 2 - 1 - - - - - - - - - - 11 35 4 13 66 50 15 14 13 20 4 8 42 20 1 - 63 36 5 5 1 1 - - 229 194 59 70 Duppas - - - - - - - - - - - - 4 7 3 4 4 4 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8 11 5 6 Ecclesbourne 23 16 22 16 19 21 17 21 5 3 4 3 - - - - - - - -- - - - - - 49 - 25 - 111 - 47 - 38 - 16 - 54 - 3 - 58 - 13 - 1 - - 47 351 43 144 Elmwood 34 37 30 33 2 3 1 1 3 1 1 1 44 48 37 36 19 19 16 13 5 1 4 1 - - - - - 1 - - - - - - - - - - - - - - - - - - 107 110 89 85 Fairchildes - - - - 2 1 - - 63 48 54 38 5 7 4 6 14 5 2 4 39 - 26 - 68 2 25 - 78 47 15 24 14 24 5 7 102 1 - - 34 65 4 - - 30 - - 419 230 135 79 Gilbert Scott 49 50 42 44 2 3 2 3 1 1 - - 36 28 20 15 9 25 3 16 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 97 107 67 78 Gonville 27 39 26 37 22 10 19 10 - - - - 38 18 36 14 1 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 88 68 82 61 Good shepherd 6 5 6 5 30 16 18 12 7 5 7 2 24 11 15 6 3 8 2 5 1 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - - 71 47 48 31 Heath Clark - - - - - - - - - - - - - - - - - - - - - - - - 42 20 13 12 60 16 14 10 25 - 4 - 1 - - - 58 29 1 - 91 38 3 2 277 103 35 34 Howard 13 17 12 17 16 11 11 10 11 8 10 7 25 12 17 10 23 6 16 6 7 - 4 - - - - - - - - - - - - - - - - - - - - - - - - - 95 54 70 50 Ingram 19 13 17 12 3 3 1 3 2 - 2 - - - - - - - - - - - - - 75 - 9 - 20 - 6 - - - - - 70 - 2 - 65 - 1 - - - - - 254 16 38 15 John Newnham - - - - - - - - - - - - - - - - - - - - - - - - - 27 - 8 - 51 - 10 - 15 - 2 - 7 - - 58 30 - 3 - 37 - 3 58 167 - 26 John Ruskin - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Kensington 43 45 38 42 2 2 2 1 - - - - 44 23 30 17 24 17 18 10 2 5 1 1 1 6 1 3 1 - - - - - - - - - - - - - - - - - - - 117 98 90 74 Kingsley 83 66 73 52 32 24 29 19 2 2 1 2 37 40 30 34 37 52 28 42 5 6 3 3 2 1 2 1 - - - - - - - - - - - - - - - - - - - - 198 191 166 153 Lady Edridge - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 - - - 4 - - - - - - - 24 - - - 124 - 3 - 162 - 3 Lanfranc - - - - - - - - - - - - - - - - - - - - - - - - 18 53 4 36 128 125 29 78 114 72 20 41 48 147 7 31 39 40 2 11 - - - - 347 437 62 197 Monks Orchard 9 31 2 26 1 2 1 2 - - - - - - - - 17 23 10 11 - 3 - 3 - - - - - - - - - - - - - - - - - - - - - - - - 27 59 13 42 Morbury Manor 17 20 16 18 3 3 2 2 - - - - - - - - 22 12 12 11 14 9 11 7 2 50 1 33 1 124 1 73 - 37 - 19 8 23 - 8 18 34 3 5 - 1 - - 85 313 46 176 Our Lady's Convent - - - - - - - - - - - - - - - - - - - - - - - - - 25 - 2 - 25 - 3 - 2 - 2 - 2 - 2 - 33 - 2 - - - - - 89 - 11 Oval 28 35 26 29 9 4 7 2 2 2 2 2 33 24 24 21 17 14 9 11 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 90 80 69 65 Parish Church 26 20 25 19 9 10 9 8 3 3 2 1 36 17 26 8 9 12 8 8 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 83 62 70 44 Overbury - - - - - - - - - - - - - - - - - - - - - - - - - - - - 42 - 9 - 50 30 9 11 16 13 3 4 - - - - - - - - 108 43 21 15 Portland 8 7 8 7 6 20 5 20 2 3 2 3 4 2 4 - - 1 - 1 - - - - 17 28 4 16 42 39 12 23 12 12 6 5 26 39 1 14 43 10 3 - 1 - - - 161 161 45 89 Purley Oaks 27 21 25 17 27 32 25 27 2 1 1 - 25 18 16 9 47 31 37 21 3 2 2 2 - - - - - - - - - - - - - - - - - - - - - - - - 134 105 106 76 Regina Coeli 19 16 10 10 19 22 14 5 23 23 9 7 20 23 4 9 5 28 2 6 5 3 2 1 - 2 - 2 - - - - - - - - - - - - 4 5 - - - - - - 95 122 41 40 Rockmount 29 18 25 13 1 6 1 5 - - - - 26 11 19 7 10 6 9 3 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - 68 41 54 28 Rowdown - - - - 10 3 10 1 19 26 13 21 3 - 2 - 26 - 16 - 42 30 25 22 8 15 4 6 - - - - - - - - - - - - - - - - - - - - 108 74 70 50 St. Andrew's - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 6 2 4 9 5 - - 2 12 - 1 13 9 2 2 1 - - - 30 43 4 7 St. Joseph's 37 21 23 16 7 1 3 1 - - - - 24 14 16 6 4 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 72 37 44 23 St. Mark's 6 3 2 2 3 5 2 5 2 - 1 - 7 7 4 5 4 6 3 5 1 - 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - 23 22 13 17 St. Mary's 25 33 20 25 21 35 16 27 10 9 4 3 33 24 14 12 24 30 13 14 3 4 2 3 6 13 1 5 22 31 11 12 26 24 7 8 7 7 - 1 8 28 - 3 11 3 - - 196 241 88 113 St, Michael's 11 15 10 13 14 19 13 16 2 3 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 27 37 24 31 St. Peter's 20 21 13 18 14 15 10 11 1 4 - 2 16 12 9 5 8 7 2 5 1 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - 60 60 34 42 Continued overleaf. 46  5 years and under 6 years 7 years 8 years 9 years 10 years 11 years 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 M F M F M F M F M F M F M F Selhurst Granmar - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 10 3 2 9 25 - 12 - 28 - 13 18 47 - - 83 43 1 1 140 153 4 28 shirley 23 23 23 4 3 1 2 - 1 1 1 1 15 13 11 10 2 1 2 1 - 1 - 1 16 - 3 - q - 3 - - 1 - 1 - 13 - - 10 24 - - 9 22 - 1 88 190 45 19 South Croydon S.M - - - . - - - - - - - - - - - - - - - - - - - - - - - - 45 - 7 - 35 - 6 - 14 19 - - 21 46 1 3 - 2 - 1 115 67 14 4 South Norwood 41 35 38 32 33 84 29 70 23 11 22 9 1 16 - 12 24 - 13 - 2 1 1 1 2 - 2 - - - - - - - - - - - - - - - - - - - - - 126 147 105 124 S>ring Park 28 37 25 36 2 5 2 4 - - - - 21 18 18 16 23 8 17 8 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 74 68 62 64 Stanley Technical - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - 45 _ 6 - 30 - 1 - 2 - 1 - 8 - - - 20 - - - 105 - 8 - Sydenham 38 31 34 28 8 12 'I 10 2 14 2 11 15 18 1 12 37 29 19 13 9 9 7 4 1 4 - 3 - 2 - - - - - - - - - - - - - - - - - - 110 119 70 83 Tavistock - - - - - - ' - - - - - - - - - - - - - -- - - - 19 - 9 - 85 - 36 - 52 - 18 - 71 5 2 1 148 35 4 - 3 19 - 4 378 59 69 17 Trinity - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 46 - 1 - 38 - - - 1 - - - 85 - 1 - Waddon 26 27 26 25 42 41 36 38 18 22 17 16 1 4 - 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 87 94 79 82 West Thornton 27 19 27 18 - 2 ~ 2 - - - - 7 13 4 12 9 4 9 2 - - - - 1 - 1 - 1 - - - - - - - - - - - - - - - - - - - 45 38 41 34 Westwood - - - - - - - - - - - - - - - - - - - - _ - - - - - - - 115 - 34 - - - - - 33 - 5 - 42 - 10 - 1 - - - 235 - 58 Whitehorse 25 48 22 41 4 8 3 6 1 3 1 1 3 31 2 27 33 9 18 7 5 2 2 2 2 - 2 - - - - - - - - - - - - - - - - - - - - - 73 101 50 84 Winterboume 77 86 59 70 12 11 b 8 - - - - - 38 - 29 53 23 39 19 34 7 25 6 4 - 2 - - - - - - - - - - - - - - - - - - - - - 181 165 131 132 Wolsey 32 12 29 12 60 43 48 34 7 - 7 - 1 2 - 1 2 18 2 13 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 103 75 86 60 Woodside 62 55 59 51 9 8 4 7 9 1 8 - 23 40 21 33 8 24 7 21 1 7 1 5 - 12 - 7 - 1 - 1 - - - - - - - - - - - - - - - - 112 148 100 126 1146 1116 975 950 621 647 504 532 285 283 223 210 696 680 474 498 580 506 388 337 190 117 121 82 304 439 92 185 898 944 205 371 485 425 90 155 468 498 20 86 747 745 29 82 334 509 4 16 6754 6909 3125 3504 2262 1925 1268 103O *58 433 1376 972 1086 725 307 203 743 257 1842 576 910 245 966 106 1492 111 843 20 13663 6629 PERCENTAGE OF PARENTS PRESENT Age 5 years and aider Boys 85.1 85.1 Boys 46.3 All Groups 48.5 Girls 86.0 6 years Boys 81.2 81.7 Girls 82.2 7 years Boys 78.3 76.2 Girls 74.2 8 years 9 years Boys 68.1 70.6 66.8 Girls Boys 73.2 66.9 Girls 66.6 10 years Boys 63.7 66.1 Girls 70.1 11 years Boys 30.3 34.6 /Girls 50.7 Girls 42.1 12 years Boys 22.8 31.3 Girls 39.3 13 years Boys 18.6 26.9 Girls 36.5 14 years Boys 4.3 10.8 Girls 17.3 15 years Boys 3.9 7.4 Girls 11.0 16 years and over Boys 1.2 2.4 Girls 3.1 47 Table VI SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1959 (Percentages of children examined) Defect or Disease Entrants up to 6 years Intermediates 11 and 12 years Leavers 14 and Over Other Ages All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 1.2 1.2 3.7 1.7 2.5 1.3 2.3 2.2 2.3 1.6 Skin 1.1 1.2 1.3 1.7 1.9 1.2 1.3 0.8 1.4 1.2 Eyes - Vision 6.5 7.4 11.5 11.6 12.8 14.2 10.0 8.5 10.0 10.4 Squint 1.8 1.9 - 0.7 0.1 0.6 0.4 0.8 0.6 1.0 Other 0.4 0.3 0.2 0.4 0.6 0.4 0.4 0.2 0.4 0.3 Ears - Hearing 1.9 1.5 0.8 1.0 0.7 0.9 1.1 0.8 1.2 1.1 Otitis Media 0.7 0.3 0.2 0.2 0.2 0.1 0.3 0.3 0.4 0.3 Other 0.1 0.2 0.3 0.2 0.3 0.3 0.2 0.2 0.2 0.2 Nose and Throat 10.4 9.7 0.9 2.3 0.3 1.2 3.7 5.3 4.2 4.8 Speech 4.2 1.7 0.7 0.3 0.2 0.2 0.6 0.6 1.3 0.7 Cervical Glands 1.4 1.5 0.2 0.1 0.1 0.1 0.4 0.9 0.6 0.7 Heart and Circulation 0.9 0.7 0.7 1.0 1.2 1.4 0.7 0.6 0.8 0.9 Lungs 2.2 2.2 0.4 1.4 1.2 0.6 1.9 1.2 1.5 1.3 Development - Hernia 0.5 - 0.3 - 0.2 0.1 0.2 - 0.3 - Other 2.1 0.5 3.0 1.2 1.1 0.7 3.4 0.5 2.4 0.7 Orthopaedic - Posture 1.0 1.2 1.0 4.3 1.0 2.7 1.6 1.8 1.2 2.4 Flat Feet 4.4 1.9 4.5 4.8 2.4 1.8 2.6 3.7 3.4 3.0 Other 3.6 3.2 1.4 3.5 2.0 4.4 2.2 2.7 2.4 3.3 Nervous Diseases - Epilepsy 0.2 0.3 0.1 0.4 0.1 0.1 0.1 0.1 0.1 0.2 Other 0.3 0.2 0.2 0.6 0.1 0.3 0.5 0.6 0.3 0.4 Psychological - Development 0.5 0.5 0.1 - 0.1 0.2 0.2 0.1 0.2 0.2 Stability 1.3 0.9 1.0 0.4 0.1 - 0.7 0.2 0.8 0.4 Dull and Backward - - - 0.2 0.1 - 0.2 - 0.1 0.1 Other Defects 1.7 2.0 0.7 2.1 0.8 1.4 1.1 1.3 1.1 1.7 48 Table VII HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS APPROVED UNDER SECTION 9(5) OF THE EDUCATION ACT, 1944 OR BOARDING IN BOARDING HOMES During the calendar year ended 31st December, 1959 number of handicapped pupils- (1) Blind (3) tially sighted (3) Deaf (4) Partially deaf (5) Delicate (6) cally Handicapped (7) Educationally sub-normal (8) Maladjusted (9) Epilep tic TOTAL (l)-(9) (1) (2) (3) (4) (S) (6; (7) (8) (9) (10) A. were newly placed in special schools (other than hospital special schools) or boarding homes - 2 - 1 24 26 33 7 1 94 B. were newly assessed as needing special educational treatment at special schools or in boarding homes - - - 1 29 25 43 8 - 106 On or about 22nd January. 1960 number of handicapped pupils from the Authority's area - C. (1) were on the registers of special schools as (a) day pupils - 17 15 7 83 96 196 - 5 419 (b) boarding pupils - - 1 - 1 - 5 1 - 8 (2) Non-maintained special schools as (a) day pupils - - - - - 2 - - - 2 (b) boarding pupils 2 - 1 7 6 5 5 5 1 32 (3) were on the registers of independent schools under arrangements made by the Authority - - 2 - - 4 - 7 - 13 (4) were boarded in homes and not already included under (1) or (3) - - - - - - - - - - TOTAL (C) 2 17 19 14 90 107 206 13 6 474 (continued on next page) 49 During the calendar fear ended 31st December, 1959 number of handicapped pupils - (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) D. were being educated under arrangements made under Section 56 of the Education Act, 1944. (i) in hospitals - - - - 24 - - - - 24 (ii) in other other groups (e.g. units for spastics, convalescent homes) - - - - - 2 - - - 2 (iii) at home - - - - - 2 - 3 - 5 E. were requiring places in special schools (i) TOTAL (a) day - - - - - - 1 - - 1 (b) boarding - - - - 1 2 1 6 - 10 Number of pupils 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 had refused consent to their admission to a special schoo1: - (a) awaiting day places - - - - - - - - - - (b) awaiting boarding places - - - - - - - - - - P. Were on the registers of hospital special schools - 9 During the calendar year ended 31st December, 1959'. the following children were reported to the local health authority - (a) under Section 57(3) (excluding any returned under (b)) - 16 (b) under Section 57(3) relying on Section 57(4) - Nil (c) under Section 57(5) of the Education Act, 1944 - Nil 50 Table VIII VISION TESTS Summary of Findings Extent of Defect Entrants up to 6 years Intermediates 11 and 12 years Leavers 14 and over 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 106 6.0 123 7.0 109 9.0 124 9.0 140 9.0 197 11.2 171 8.0 151 10.9 526 7.9 595 8.6 Over 6/24ths 9 0.5 8 0.5 29 2.4 37 2.7 58 3.8 62 3.5 42 2.0 16 1.1 138 2.1 123 1.8 51 Table IX DENTAL DEFECTS (1) Inspected by Dental Officers: 1959 1958 Aged 5- 6 1,036 1,681 6- 7 1,911 2,671 7-8 2,098 2,814 8- 9 2,232 2,842 9-10 2,375 2,940 10 - 11 2,429 3,337 11-12 2,351 3,526 12-13 2,892 Total: 3,001 13-14 2,839 26,145 2,249 14-15 2,428 2,720 15-16 2,252 2,312 16 up 1,302 1,481 Specials 1,924 2,074 28,069 33,648 (s) Number found to require treatment 14,901 18,399 (3) Number referred for treatment 13,753 16,863 (4) Number actually treated 7,950 8,978 (5) Attendances made by children for treatment 23,083 24,030 (6) Half-days devoted to: Inspection 191 241 Treatment 2.556 2,747 2,761 3,002 Number of Gas Sessions 304 318 Administrative Sessions 133 131 Orthodontic Sessions 411 446 (7) Fillings - Permanent Teeth 7,570 8,745 Temporary Teeth 1,521 1,515 9,091 10,260 (8) Teeth Filled: Permanent Teeth 7,135 8, 261 Temporary Teeth 1,454 1,444 8,589 9,705 52 (9) Extractions - Permanent Teeth 2,575 2,655 Temporary Teeth 5,468 6,450 8,043 9,105 (10) Administrations of general anaesthetics for extractions 3,522 3,719 Administrations of local anaesthetics for extractions 683 577 (11) Other Operations - Permanent Teeth 9,186 9,540 Temporary Teeth 807 893 9,993 10,433 Attendances per session 9. 8.7 53 Table X SPEECH DEFECTS CLINIC SUMMARY Total number of cases treated 312 Cases discharged 111 Cases still attending 201 Cases referred for physical treatment 56 Cases referred for residential treatment 5 Cases referred to Child Guidance 3 Stammerers 40 Cleft Palate 6 Sigmatism 81 Hyper Microphonia 8 Dyslalia 124 Undeveloped Speech 20 Dysarthria 17 Developmental Aphasia 7 Partially Deaf 8 Psychotic 1 In addition 12 children were treated at St. Giles' School and 23 at St. Christopher's School. 54 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1959 RETURN OF MEDICAL INSPECTIONS A. - Routine Medical Inspections Year 1959 Year 1958 Age 11 or under 33 58 12 81 36 13 47 14 14 11 24 15 60 24 16 77 22 17 33 15 18 or over 16 - Total ... 358 193 B. - Other Inspections Number of Special Inspections 2 1 Number of Re-inspections - 1 Total 2 2 Visits to Non-maintained Schools 12 9 The following defects were found by Medical Inspection:- Treatment Observation Defective Vision 14 - Other eye defects 1 - Abdomen 1 - Nose and Throat - 1 Posture 3 - Flat Foot 2 - Other Orthopaedia 1 - Other Defects and Diseases 3 1 55 APPENDIX D PLANTAR WARTS Description Warts (verruca) occur on any part of the body. They are a reaction to infection with a microscopic virus which causes a small swelling in the superficial horny layer of the skin. On the sole of the foot where they are called plantar warts, the lump is pressed into the underlying tissue and is thus embedded and therefore painful. Recovery may be spontaneous but usually treatment is necessary to destroy the wart down to healthy skin by heat, cold, chemicals or excision. Slow removal with a chemical solvent is the simplest method, but takes 6-12 weeks. Incidence At various times, different Croydon schools have reported children suffering from plantar warts and enquiry has followed. Typical examples are: - In 1955, the school nurse examined all the children in John Neunham School (approximately 400 children) and found 24 children with plantar warts. Children attending swimming - 20; Taking showers at school - 22 Children not attending swimming - 4; Not taking showers at school - 2 All had their own towels; and none did barefoot P. T. or games. At Gilbert Scott Junior (approximately 400 children); 7 had plantar warts. All attended swimming and barefoot P. T. was performed. At Gilbert Scott Infants (approximately 186 children); No child was found with warts. Much barefoot P.T. was carried out. 56 A year later, the nurse reported no new cases for four months at these three schools and only two still receiving treatment. Clearance was ascribed to early detection through warning children; exclusion of sufferers from showers and swimming; and early treatment. Special measures described below had also been introduced in July 1956. In 1956, reports of plantar warts were received from Ashburton Secondary Modern School, both girls and boys. Here (and at Gilbert Scott) sterilising the floors of the showers with hypochlorite solutions was introduced. A year later the number of cases in the girls' school was 50% less, but there was no change in the boys' school. In 1957, I wrote to all general practitioners asking them to exclude any patient with plantar warts from swimming and offering treatment through the school clinics. All Head Teachers were asked to exclude any child from showers, swimming or barefoot P. T., who had a plantar wart. A survey in November 1958 to ascertain the present position showed 12 schools where barefoot drill and games were being performed. With the exception of two schools, the reported incidence of plantar warts was no higher in these than in schools where no barefoot P. T. was allowed. Analysis of cases of warts from four schools especially affected over the years 1956 - 8 are given below;- PLANTAR I ARTS School Period of Observation Total Cases Attends swimming from school Goes swimming from hone Takes showers at school Does barefoot P. 7. Has own towel at home There are other cases at home Ashburton Senior Girls (500 pupils) Jan. 56 to Sept. 58 82 46 54 63 7 66 12 Ashburton Senior Boys (550 pupils) Aug. 56 to March 58 27 15 18 Z7 1 27 5 Rockoount Junior Mixed (380 pupils) May 56 to March 58 15 11 11 2 3 11 3 Fairchildes Senior Girls (360 pupils) Jan. 56 to Sept. 58 23 3 4 21 2 9 1 57 This information has been obtained from questionnaires completed when children attended for treatment at school clinics. They were also asked how often they washed their feet at home. Over 70% of girls from one secondary modern school answered "daily", but 30% only from a secondary selective girls school where over 40% washed their feet three or fewer times a week. At a secondary selective boys' school, 30% of sufferers from plantar warts washed their feet everyday and 42% only three or fewer times per week. Conclusion This and other evidence is difficult to interpret. However, it is clear that plantar warts are found more frequently in older children and more in girls than boys. Reasonable action includes:- 1. To restrict barefoot drill and games for older children. 2. To impose sterilising techniques for showers and swimming baths, but to realise that these are poor safeguards. 3. To inform children, parents and especially P. T. instructors about plantar warts, so that infectious children can be referred for early treatment (see also 5). 4. Such children must be excluded from barefoot drill and games, school showers and swimming. 5. Talks on foot care should be given to older pupils especially girls, emphasising the need for well fitting shoes and socks to protect the soles of the feet. Washing the feet every night at home, particularly after school showers and bathing may understandably appear unnecessary to children but is perhaps a useful safeguard. CONTENTS A. - PUBLIC HEALTH REPORT Page Page Airport 9 2 Laboratory Examinations, Ambulance service 53, 119 Various 30,76,89 Amusement Houses 68 Animals, Diseases of 70 Animals. Keeping of 70 Marriages 10 Ante-Natal Clinics 31 Maternal Mortality 12,102 Maternity Homes 91 Meat Inspection 73 Births 10 Men's Hostel 64 Blindness 94 Mental Health 56 Byelaws 86 Midwifery 32, 105 Midlives Acts 33 Milk Supply 75 Cancer 13, 100 Census 9 Chemical Analyses 90 National Assistance Act 94 Chest Clinic 21 Neo-Natal Deaths 9,103 Child Minders 43 Notification of Births Acts 10 Civil Defence 55 Nuisances 86 Clean Air Act 67 Nursing Equipment,Loan of 41,114 Convalescence 44 Nursing Homes 91 Committee, Health 3 Nurses' Agencies 91 Communicable Diseases 16, 122, 123 Cremation 92 Occupation Centre 59 Offensive Trades 67 Day Nurseries 44 Outworkers 65 Deaths 9,11,97,98 Dental Treatment - M.& C. W. 50,117 Disinfection 68 perinatal Deaths 9,103 Disinfestation 69 Pests 70 Drainage 67 physiotherapy 34, 113 Pharmacy and poisons Act 69 Poliomyelitis 19, 125 Epileptics 95 population 9 Elderly Persons, Post-Natal Clinics 31 Rehabilitation of 112 Post-Mortems 11 Premature Infants 31,108 Problem Families 116 Factories and workshops 64 prosecutions 73 Food and Drugs Act 77 public Health Inspectors, Food Poisoning 15 work of 61,85 Food supply 71 public Health Laboratory Service 30 Health Education 45 Health Visitors, Work of 35,109 Radiation Hazards 9 1 Home Helps 42. 115 Rag Flock Act 69 Home Nursing 41, 111 Rats and Mice(Destruction) Home Safety 38,118 Act 73,135 Hospital, Isolation 16 Relaxation Classes 31 Housing 63 Rivers and Streams Pollution of 67 Ice Cream 77 Illegitimacy 9,32 scarlet Fever 17 Immunisation 40, 124 Shops Act 66 Infant Mortality 13, 102, 103, 104 Smoke Observation 67 Infant Welfare Clinics 110 staff Medical Examinations 93 Inquests 11 Staff 7 Page Page Still Births 9,11 Vaccination 93.124 Street Accidents 119 Verminous Persons 69 Venereal Diseases 30.131.132 Vital statistics 9,97,98,99 Tuberculous, After care 28 "Allowances 28 " Contacts 25 Ward Statistics 14,101 " Home Nursing 25 Water supply 89 " Hone Visits 25 Welfare Foods 34 " Mass Radiography 27 " Mortality 3, 126, 127 Notifications 126, 128, 129 X-Ray 27 Occupational Therapy 29 Residential Treatment 25 Prevention and Control 21 Re-Housing 26 Vaccination 26 Zymotic Diseases 16 B. - SCHOOL MEDICAL REPORT Page Page Child Guidance 25 Non-maintained Schools 30,54 Cleansing of Children 9 Clinics 3, 13 Cod Liver Oil 25 Orthodontic Service 19 Cost 21 Crippling Defects 21 Parents' Attendances 4,45,46 Population 11 Deaf Children 13 Defects Found 33,44,47 Remedial Exercises 21 Dental Service 14 Ear Disease 13,35 School Nurses Visits 12 Enuresis Clinic 27 Schools Special, Cost of 21 Epileptic Children 28 Spastics 28 Exclusions Speech 26,53 Staff 3 Statutory Tables 31 Sub-normal children 24 Following up Surveys, Uncleanliness 9,10 St. Christopher's 23 Handicapped Pupils 48 St. Giles' 22 Health Visitors. Work of 12 St. Luke's 23 Heights and Weights 8,41 Tonsillectomy 9 Infectious Diseases 8,42,55 Treatment 13 Tuberculosis 11 Juvenile Employment 25 Malt 25 Uncleanliness 9,10,32 Meals, Provision of 25 Mentally Defective Children 24 Milk, etc., Provision of 25 Minor Ailments 13 Vision, Defective 8,50 R 9/66