p21W*™ CRO 62 PUBLIC HEALTH IN CROYDON 1960 / A PUBLIC HEALTH IN CROYDON 1960 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1960 S.L. WRIGHT. M.D., M.R.C.P., D.PJI. PUBLIC HEALTH DEPARTMENT, 45 WELLESLEY ROAD. CROYDON. Telephone :— CROYDON 4433 3 HEALTH COMMITTEE 1060 Councillor Keith Edwards (Chairman) Councillor Mrs. E. M. Maycock (Vice-Chairman) Alderman Mrs. V. L. Child Alderman A. V. Dammarell Councillor V. Burgos Councillor J. J. Cooper, J. P. Councillor E. J. Fowler. Councillor Mrs. D. L. George Councillor C. E. Kelly Councillor G. Levy Councillor M. E. Mackenzie Councillor Mrs. A. M. Massie Councillor Miss L.N. Overton Councillor Mrs. M. C. V. Parfitt Councillor B. H. Rawling Councillor B.C. Sparrowe Councillor H. E. Styles Councillor J.T. Twitchett J. S. Lane, Esq., B. A., M. R. C. S., L. R. C. P. S. A. MacKeith, Esq., 0. B. E., M. R. C. S. , L. R. C. P., D. P. M. Miss K. C. Vost, M. B., B. S., D. P. H. T.G.E. White, M. D., M. R. C. 0. G. Members appointed to Sub-Committees on nomination of Outside Bodies as shown: - J. Newton Hudson, M. B. , Ch. B., M. R. C. S., L. R. C. P. Edith F. Newling, B. A. (Hons), M. B., B. S., M. R. C. S. , L. R. C. P. D. F. Kanaar, Esq., M. D., M. R. C. P. A.F. Clift, Esq., F. R. C. & , M.R.C.O. G. S.Y. Marsters, Esq. Mrs. E. M. Ryle Horwood Mrs. F.R. Mitchell, 0. B. E. Miss J. C. Dickinson Mrs. H. Thatcher Mrs. J. Toogood D.G. Goldie, Esq. H. G. Murphy, Esq. F. Rivers, Esq. Croydon Local Medical Committee Croydon Group Hospital Management Committee Royal College of Nursing Royal College of Midwives Croydon District Nursing Association Croydon Family Planning Association Croydon Federation of Townswomen's Guids The St. John Anbulance Brigade (Southern Area) The Insurance Institute of Croydon (Councillor J. A. Keeling served as a Member of the Home Safety Sub-Committee) 5 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MFDICAL OFFICER FOR THE YEAR 1960 To the Chairman and Members of the Health Committee LADIES AND GENTLEMEN, The following comments summarize some of the items in my Report. Statistics The Registrar General estimates an increase of nearly 700 in the population of the Borough. The Birth rate was the highest since 1949. The Death rate and the Infant Mortality rate were less than in 1959. There was only one Maternal death, but the example of 1958 when a "Nil" report was achieved is still the target. Coronary disease, Cancer, and Chronic Bronchitis were the principal causes of death, notably in the age range 45 - 64 years. In striking contrast, deaths from infectious diseases (including Tuberculosis) for all ages, totalled only 30. There was a record high number of 40 deaths from motor vehicle accidents. The percentage of illegitimate births was a fraction less than last year, but still remained over 7%. 6 There was an increase in first attendances at the V. D. Clinic. Prom the viewpoint of physical health, it was a reasonably good year. Communicable Diseases. The absence of a single case of Poliomyelitis vindicated the policy of vaccination. Notifications of Whooping Cough increased markedly,but generally the illness remained of a mild character. Other infections gave rise to no particular difficulties. One of the cases of Typhoid Fever, which is reported in some detail, emphasized the old adage "where there's dirt there's danger". The Chest Physician reports upon another successful year's work. During the year under review what was originally the Tuberculosis Dispensary and later the Chest Clinic,became a full Out-Patient service in the general pattern of hospital provision. Such a trend had been foreseen in Croydon, when the premises in Mayday Road were acquired by the Regional Board. Their proximity to Mayday Hospital allowed the changeover without any difficulties. On the local health authority side it was possible to re-distribute work amongst a smaller staff. Personal Health Services. The most important event was the coming into operation of the Mental Health Act. Planning in Croydon was greatly simplified by existing co-operation between the three branches of the Health Service, and especially with the Mental Hospital. Developments went forward very much as planned, and the "appointed day" brought no particular difficulties. In the field of Maternity and Child Welfare, the rise in the birth-rate increased the demand on the Hospital and Domiciliary Maternity Services. The continued employment of Maternity Nurses allowed much needed relief to be given to the Hospitals, who were thus able to discharge mothers to their homes early in the lying-in period. Health Visitors were equally busy, but nevertheless successfully developed new aspects of their work. The Home Help Service recorded a further increase in the hours of service given to patients. The Home Nurses had fewer new cases, and there was a reduction in the total visits paid to patients. However, as explained last year, the change was due to the replacement of many drugs which must be given by injection, by new types which can be taken by mouth. This aspect of the District Nurses' work has also been simplified by the introduction of a Central Sterile Syringe Service. 7 The Health Education Officer developed group instruction techniques, and projects, both for mothers of young children and in the schools. The connection between the smoking of tobacco and cancer of the lung is always included in discussions on Community Health. It was not thought to be an opportune time for any special campaign on this subject. 1961 will provide results from a 10-year prospective survey on members of the medical profession and these may provide a suitable National background to make further local efforts worthwhile. It was a somewhat difficult year for the Ambulance Service. Temporary staffing difficulties and heavy calls brought inevitable delays in dealing with routine journeys. The rising traffic density increased the calls made upon the Accident service and impeded its response. Emergency cover for the northern part of the Borough was strengthened to meet these worsening conditions. A new Chiropody service was successfully introduced and is described in detail in the main report. Co-operation with Hospitals and General Practitioners was further developed by the setting up of a Maternity Liaison Committee to consider the Cranbrook Report on Obstetric Services The Hospital Management Committee commenced the experiment of follow-up Out Patient clinics in the New Addington area, and were given accommodation in Corporation premises. Discussions were commenced with the Regional Hospital Board for a joint appointment of a Geriatrician. The constant interchange between the Corporation's Old Peoples' Hostels and the Geriatric Hospital should greatly benefit from such unified medical supervision. A scheme for the interchange of Paediatric House Officers and Assistant Medical Officers of Health was also approved. The Regional Hospital Board invited members of the Health Committee to attend for discussion on Mental Health planning. The Regional Hospital Board also invited the Medical Officer of Health to serve as one of the co-opted medical representatives of local health authorities on the Mental Health Sub-Committee of the Board. Special arrangements for the nursing of sick children at home were reviewed, after the issue in 1959, of a Circular letter from the Ministry of Health. As there were close working arrangements between Hospital Almoners, District Nurses and Health Visitors, it was decided that these duties were fully covered. 8 Mention has been made of arrangements for the nursing at home of maternity patients discharged early from hospital units. Although the offer has been made to consider similar schemes for the home nursing of other patients following early discharge from hospital, it has so far not been thought practicable by the Consultants concerned. Sanitation The Health Committee emphasized that their present minimum target under the Clean Air Act is to have the whole Borough covered by smoke control orders within the next ten years. This accords with the views of the Beaver Committee, who suggested that a determined effort would achieve such a target within fifteen years of the issue of their report. Unless unforseen difficulties arise, our experience to date encourages belief that the programme can be fulfilled. In comparison Slum Clearance efforts may seem small. In fact, the Corporation are proceeding by direct purchase of houses and sites to ensure replacement by new housing units at the earliest opportunity. The problem is not to convince owners that properties are unfit, but to provide alternative housing for the displaced residents. Complaints of nuisance from noise increased considerably the work of the Public Health Inspectors. In particular, one industry engaged in night work and sited in a residential area, proved an especially difficult problem. Public reaction to nuisance from noise is increasing; and effective measures are not easy to decide or to enforce. In recognition of their responsibilities in this field, the Health Committee authorised the employment where necessary of Consultant Advisors. The siting of the new abattoir was again given considerable attention but no suitable solution was forthcoming at the end of the year under review. As requested by the Ministry of Health, I have included reports upon the Water Supply, the Public Swimming Baths, and the Sewage Disposal systems. 9 In paying my usual tribute to the work of the staff, I recognise that delays in filling vacancies increased the burdens in most sections. Failure to obtain staff is a universal complaint and no vocation, profession, trade or unskilled calling seems able to attract sufficient recruits. Viewed against this background we appear to do at least as well as most other areas. Training schemes for various national qualifications were being operated in the department to help to meet local and general demands. In supporting these and other measures which require an understanding and farsighted view, the Committee continued to give their unfailing encouragement and support, for which I take this opportunity of expressing my appreciation. I am, Yours faithfully, S.L. WRIGHT. Medical Officer of Health and Principal School Medical Officer. 10 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 (including 1 part time), 4 typists, 1 messenger. Public Health and Food Inspection Chief Public Health Inspector, Deputy, 20 Inspectors, 1 Superintendent Slaughter House, 3 Clean Air Act Assistants, 1 Foreman and 4 Assistants, Chief Disinfector and 1 Disinfector, 1 Superintendent and 4 porters (men's hostel), 2 Rodent operatives, 9 clerks, 1 typist, 2 trainees. Maternity and Child Welfare 6 clinic Medical Officers wholetime (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 17 Midwlves, 2 Maternity Nurses (part time), 1 Physiotherapist, 4 Ante-Natal clinic nurses (part time), 7 clerks. (Dental Service as for School Health). 9 clinic cleaners and 2 handymen (all part time). District Nursing (agency arrangements) Superintendent, 3 Assistants, 42 nurses, 5 students, 2 clerks (1 part time). Domestic Help Supervisor, 4 Assistants, 2 clerks, 15 full time and 190 part time Home Helps. Day Nurseries 1 Nursery with Matron, Deputy, 5 nurses, 3 students, handyman and 4 domestic staff (part time). Vaccination and Immunisation 1 part time Medical Officer, 1 temporary part time nurse, 3 Clerical officers including 1 part time. Ambulance Service Ambulance Officer, Deputy, Second Officer, Third Officer, Maintenance Officer, 4 Leading Drivers, 63 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 Mental Welfare Officers and 1 Planning and Senior Clerical Officer. 2 clerks, 1 Training Centre Supervisor, 5 Assistants, 1 Handicraft Instructor, 1 handyman. 3 Guides and 5 domestics (parttime). Health Education 1 Qualified Health Education Officer Welfare Poods 2 clerks (1 part time) and 1 driver STATISTICS 11 SUMMARY OF VITAL STATISTICS FOR 1960 Area, 12, 672 acres. Population (Census 1951), 249,870. Total population (estimate of Registrar-General), 249,690 (Midsummer, 1960) Number of Inhabited Houses: 74,411 Rateable Value (1st April, 1960: £4,951,250. Product of a Penny Rate (1959-1960): £19,985.3s. 7d. Rate in the £. 16s. 6d. (for the year ending 31.3.60). Live Births: Males Females Total Legitimate 1,924 1,796 3,720 Illegitimate 150 138 288 4,008 Illegitimate Live Births per cent of total live births 7.2 Live Birth Rate(as adjusted by comparability factor (1.00) 16.1 (England and Wales 17. 1) Stillbirths 61 Stillbirth rate per 1,000 total(live and still)births 15.0 (England and Wales 19.7) Total Births 4,069 Infant Deaths 80 Infant Mortality rate per 1,000 live births 20 (England and Wales 21.7) Infant Mortality rate per 1,000 legitimate births 18 Infant Mortality rate per 1,000 illegitimate births 45 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 13 (England and Wales 15. 6) Early Neo-natal Mortality rate (First week) per 1,000 total live births 11.5 Perinatal Mortality rate (stillbirths + deaths during the first week)per 1,000 total live and still births 26.3 Maternal Deaths (excluding abortion) - Maternal Mortality rate (including abortion) per 1,000 total live and still births 0. 25 (England and Wales 0.39 Deaths, 2,934. Death-rate per 1,000 of the estimated population 11.8 (England and Wales 11.5 Death rate(as adjusted by comparability factor 0.93 10.9 12 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 1960 to 20.33%". The number of marriages solemnised was 1,890, compared with 1,888 in 1959, 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 and 2,051 in 1950. 849 were solemnised in Established Churches, 403 in other places of worship, one by Jewist Ritual and 637 in the Register Office. Births The live births registered were 3,720 legitimate and 28! illegitimate. The birth-rate consequently was 16.1 per 1,000 population. For England and Wales the rate was 17.1. The illegitimate births in Croydon were 7.2 per cent of the total as compared with 7.3 in 1959, 5 per cent in 1958, 5.5 in 1957, 4.3 in 1956, 4.8 in 1955, 5.5 in 1954 and 1953. The live male births numbered 2,074, the female 1,934, beins a proportion of 1,072 males to 1,000 females. Notification of Births Notifications were received in respect of confinement conducted by:- Live Births Still Births Total Midwives 3,291 33 3,324 Doctors 1,059 29 1,088 4,350 62 4,412 Accommodation for Confinements The following table shows where babies were born in Croydor during 1960. 68 more babies were born at home and 158 fewer were born in hospital than in 1959. 47 fewer Croydon residents had babies outside Croydon and 81 fewer non-residents were confine! in Croydon than in 1959. Number Percentage In Private Houses 1, 414 32.05 In Public Institutions 2,757 62.49 In Registered Maternity Homes 241 5.46 4,412 13 Still Births During 1960, 61 still births were registered in respect of Croydon. Of these,34 were male babies and 27 females; 3 females and 7 males were illegitimate. The proportion of still births to living children was 1 in 66. The still birth rate was 1.5 per cent. of the total births. The still birth rate, on the same basis as for Infant Mortality, was 15.2 per 1,000 births. Deaths The deaths numbered 2,934, compared with 3,037 in 1959. For 1960 the crude death-rate was 11.8 compared with 12.2 in 1959. The death-rate for England and Wales was 11.5. There were 104 inquests held by Coroners in respect of Croydon residents during 1960 and 473 findings by Coroners after post-mortem without inquest. Wards with the highest death-rate were South (18.2), Central (14.3) and Bensham Manor (12.9) Lowest: Addington (4.3), Shirley (9. 4) and West Thornton (9. 2). The Registrar General's Table is given in the appendix, page 94. Comparisons with 1959 show there were again no deaths from Whooping Cough and none from Measles (one in 1959). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 20 (24 in 1959); those from Cancer decreased by 38; those from Pneumonia decreased by 9 and a decrease of 18 was recorded in those caused by Bronchitis. There were 6 deaths from Influenza (64 in 1959). 31 deaths from suicide showing an increase of 2 and motor vehicle accidents totalled 40 (29 in 1959). The percentage of deaths under 1 year of age to the total deaths was 2.7 per cent.; deaths under 15 years, 0.7 per cent.; deaths under 65 years, 23.8 per cent.; and deaths over 65 years, 72.7 per cent. The corresponding figures for 1959 were 2.6 per cent., 0.8 per cent.; 22.9 per cent., and 73.7 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. 14 Principal Causes of Death in order of frequency (Registrar-General's Return) Rate per 1,000 Population All Ages Deaths from diseases of Cardiac and Circulatory System 4.42 " " Cancer 2.33 " " Vascular lesions of the Nervous System 1.86 " " diseases of Digestive System *0.15 " " diseases of the Respiratory System (excluding Tuberculosis) 1.37 " " Suicide and Violent Causes 0.42 " " Tuberculosis (all forms) 0.08 *ulcers of stomach, duodenum; gastritis and enteritis. Maternal Mortality There was 1 death, compared with 1 in 1959. The maternal mortality rate calculated per 1,000 total births was 0.25. The rate for England and Wales was 0.39 in 1960. For figures for the years 1950 - 1960 see the appendix, page 98. Cause of death:- 1. Pulmonary embolism. Deep venous thrombosis of right calf; 6 weeks gestation. Normal pregnancy. Infant Mortality The 1960 figure dropped to 20. Set out in the appendix, page 100 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, 50 occurred in boy babies and 30 in girls. Of the births, 2,074 were males and 1,934 females. The infantile mortality rate for the two sexes was, therefore, Boys 24, Girls - 16. 68 deaths of infants occurred in Institutions, including Registered Nursing Homes. For details of infant deaths see the appendix, page 99. 15 CANCER For detailed tables see the Appendix, page 96. Deaths tabulated in the Department number 585 as compared with 623 in 1959; 562 in 1958; 591 in 1957; 592 in 1956, 549 in 1955; 486 in 1954; 540 in 1953; 567 in 1952; 479 in 1951 and 501 in 1950. Death-rate per 1,000 of the population for the last 10 years is as follows:- 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) 1955 - 2. 20 (549) 1960 - 2.34 (585) The organs most often attacked in descending order of incidence are:- In the males - the Lungs (41.4 per cent.), the Bowels and Rectum (15.2 per cent.) and the Stomach (12.6 per cent.); In females the Breast (21.7 per cent.); Bowels and Rectum (17.7 per cent.); and the Uterus (10.9 per cent.). Ward Statistics These are tabulated in the usual form in the appendix, page 97. 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 17 COMMUNICABLE DISEASES Cases of Scarlet Fever and Whooping Cough were more numerous than in previous years, but the illnesses remained generally mild in character. The complete absence of Poliomyelitis throughout 1960 was very encouraging. Of the two cases of Typhoid Fever notified, one patient aged 71 was undoubtedly a "carrier" of Typhoid Fever. During an illness which was thought to be a mild attack of Sonne Dysentery a faeces specimen was sent for laboratory test and this resulted in the carrier state being detected. There were no other members of the family at risk, and in view of the age of the patient surgical treatment was not thought appropriate when chemotherapy proved ineffective. The other patient was a boy of 14, who while playing (trespassing) in a field used for the drying of sewage sludge, fell into one of the sludge lagoons. He was apparently completely submerged and may have ingested or inhaled some of the material. He seemed dazed by the immersion but on arrival home was seen by the family doctor who could find no injury. Some three weeks later the boy complained of headache and four weeks after the incident he was unable to attend school. He took to his bed some ten days later and shortly afterwards was admitted to hospital and diagnosed as suffering from a fairly severe attack of typhoid fever. The organism recovered from his faeces was not of the type being excreted by any known carrier in the Borough. It was, however, the type prevalent during the outbreak of typhoid fever in Croydon in 1937. All investigations of family contacts were negative, and efforts to grow typhoid bacilli from the sewage sludge were unsuccessful. The drainage area of these sewage works extends beyond the County Borough boundaries, and the population served is about a third of a million. All the sludge has some six weeks of treatment before being pumped on to the drying areas. In 1956 the Medical Officer of Health of Sutton and Cheamdrew my attention to a 13 year old resident of his area, who when trespassing on the same sewage farm, fell into a "sewagetank" and swallowed some sewage. Twenty one days later he developed typhoid fever. No other source of infection could be found. The typhoid organism recovered differed from that of any known carrier in the Borough, and from the case described above. 18 There is no record of a case of typhoid fever amongst the sewage farm workers, but it was thought prudent to offer them vaccination against typhoid fever. Warnings were issued to members of a Bird Watchers' Club, who are allowed access to the sewage farm land, and there was a re-check of the fencing and warning notices intended to keep out unauthorised persons. Sewage farm staff were also asked to notify the Medical Officer of Health of any person suffering similar accidents to those described so that approach could be made to the family doctor for prophylactic chemotherapy to be administered. The danger seems limited to the actual swallowing of the semi-liquid sewage sludge and the dried product after it has been dug into the land is free from risk. FOOD POISONING The food poisoning notifications,as corrected,for 1960 were: - 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 1 4 11 7 23 Outbreaks due to identified agents:- Total Outbreaks Total Cases Nil Nil Outbreaks due to:- (a) Chemical Poisons ... Nil (d) CI. Botulinum Nil (b) Salmonella Organisms Nil (e) Other Bacteria Nil (c) Staphylococci(including toxin) Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases Nil Nil Single Cases:- Agent identified Unknown Cause Total 8 15 23 Cases due to:- Salm. anatum Salm. typhi-murium Salm. newport Salm. bovis??? morbific??? 1 4 Nil Nil CI. welchie Salm. thompson Salm. enteritidis 1 Nil 2 19 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1960 J.J. Linehan, Esq., M. D., D. P. H. Physician Superintendent, Waddon Hospital Admissions to the Infectious Diseases' Wards:- A total of 594 patients were admitted to these wards giving an average bed occupancy of 34.7 and an average stay in hospital of 21.3 days. The following are the final diagnoses of the patients admitted, together with brief details regarding the common infectious diseases treated. Where patients were admitted from outside the Croydon Borough, the Croydon cases are shown separately in brackets. Scarlet Fever 111 (99) Stomatitis 2 Gastro-enteritis 75 (50) Gingivitis 2 Dysenterry 55 (33) Cervical Lymphadenitis 2 (1) Pneumonia 47 (31) Pylorospasm 1 whooping cough 37 (27) Appendicitis 4 Humps 35 (26) Diverticulitis 1 Chicken-pox 30 (26) Crohn's Disease 1 Infective Hepatitis 18 (17) Heerfordts's Disease 1 Measles 12 (7) Dermatitis 1 Meningitis 9 (7) Urticaria 3 Encephalitis 4 (3) Impetigo 2 Salmonella Enteritis 8 (5) Conjunctivitis 1 Influenza 8 (6) Pemphigus vulgaris 1 Glandular Fever 7 (5) Cellulitis 2 Rubella 5 (4) Angio-neurotic Oedema 1 Typhoid Fever 3 (2) Osteo-myelitis 3 Paratyphoid B. 3 Nephritis 2 Paratyphoid Contacts 3 Endocarditis 1 Herpes Zoster 3 (2) Anaemia 1 Streptococcal sore Throat 4 Lead Poisoning 1 Rheumatic Fever 4 (3) Glycogen Storage Disease 1 Erysipelas 2 Fractured Skull 1 Pulmonary Tuberculosis 1 Carcinoma of Bronchus 1 Malaria 1 Carcinoma of Pancreas 1 Tonsillitis 11 (9) Carcinoma of Colon 1 Peritonsillar Abscess 4 (3) Mediastinal Tumour 2 Pharyngitis 14 (12) Cerebral Haemorrhage 1 Otitis Media 2 Vestibular Neuronitis 1 Bronchitis 25 (21) Hysteria 1 Pneumoconiosis 1 No abnormality Diagnosed 1 Laryngitis Stridulosa 3 Non-patient Mothers 3 20 Scarlet Fever:- Three-fourths of the cases were admitted during the first five months of the year, and there was the usual preponderance of school age children. Complications - Rhinitis - 13; Secondary Sore Throat - 12; Septic Sores - 7; Lymphadenitis (cervical) - 5; Angular Stomatitis - 4; Endocarditis - 3; Furuncuiosis - 3; Otitis Media - 1; Nephritis - 1; Paronychia - 1; Bronchitis - 1; Facial Herpes - 1; Vaginitis - 1. Gastro-Enteritis: - 75 patients were admitted in the following age groups - under one year - 43; 1-2 years - 8; 2-15 years - 13; Adults - 11; In 11 cases the illness was very severe, in 30 moderately severe and in 33 patients the illness was mild. The incidence of very severe attacks was highest in patients under one year. In a few cases each, B. proteus, staphylococcus aureus, atypical B.Coli and monilia were isolated as predominant organisms in faecal culture, but in the large majority of cases the nature of the infecting organism remained obscure. There were no deaths. Dysentery:- Of the total of 55 Datients admitted, 40 were due to Shigella Sonne, 11 to Shigella Boydii and 4 to Shigella Flexner. Though, in tne majority of patients the illness was of a mild type, two patients were dangerously ill, one a boy of 6 years with Flexner type infection and the other a woman aged 50 years - Sonne type. Drug sensitivities were carried out in a high proportion of cases and resistent strains revealed as follows:- Sulphonamide resistent - 15; Streptomycin resistent - 4; Tetracycline resistent - 1; Chloramphenicol resistent - 2; Of the total, there were five patients in whom the carrier state persisted for more than one month. Pneumonia:- Hospital admissions tended as usual to involve the very young and the elderly debilitated type of patient. These debilitating conditions were experienced as follows:Chronic bronchitis - 12 cases; pulmonary emphysema - 11 cases; arterio-sclerosis - 4; valvular heart disease - 3; 2 cases each of anaemia and pleural effusion and one case each of pulmonary fibrosis, pneumothorax, severe senile kyphosis, strangulated hernia and severe rectal prolapse. The majority of these patients were admitted in the first three months of the year. 21 Whooping Cough:- As in previous years, admissions were largely confined to the very young. Their age groups were as follows:Under one year - 20; 1-3 years - 13; over four years - 4. The following complications were encountered:- Bronchitis - 10 cases; pneumonia - 6; lobar collapse - 3; tonsillitis - 1; skin sepsis - 1. Mumps: - The number of mumps complications was unusually large. There were 12 cases of meningo-encephalitis. Of these, ten were preceded by salivary gland involvement, one case was diagnosed by the rise in anti-body complement fixation titre and one on mumps antibody estimations and co-existing orchitis. There was one case of mumps paralysis affecting the right deltoid. Other complications experienced were five cases of orchitis and one case each of pancreatitis, labyrinthitis, epistaxis, bronchitis and asthma. Chicken-pox: - Three of the chicken-pox cases were primarily severe.Complications in the remaining patients were as follows:One case each of lymphadenitis, conjunctivitis, bronchitis, furunculosis, skin sepsis and eczema. Seven patients were already in hospital suffering from various other illnesses. Four patients were hospital nursing staff. Eight patients were from Residential Homes and Hostels. Infective Hepatitis:- The increased number of infective hepatitis patients admitted was due to an outbreak in a residential nursery during the months of October and November. Six staff and eight children were affected. Two of the children were nonicteric, and were diagnosed by associated symptoms, confirmed by other tests for liver damage. Of the remaining four cases, one was associated with pregnancy and was of the severe relapsing type. Tests in almost all cases showed that liver dysfunction persists after the jaundice has subsided. Meningo-encephalitis:- A total of 23 cases of meningoencephalitis were encountered. Of these 12 cases appeared to be due to the mumps virus as already detailed. There was one case each of meningococcal meningitis and haemophilis influenza meningitis. This leaves nine cases to be classified as meningoencephalitis of unknown or uncertain origin. In one of those patients, serum antibody tests were suggestive of poliovirus type III infection. In another case, the late development of Parkinsonism and drowsiness suggested encephalitis lethargica. 22 Other Infections:- Measles was not prevalent during the year and five of the total of 12 cases admitted, occurred in December. Complications were bronchitis - 2 cases, and one case each of otitis media, tonsillitis, convulsions and ecchymosis. Two of the three typhoid cases were definitely infected outside the Croydon Area. The paratyphoid patients and admitted contacts were all members of the same family. Deaths:- Infectious diseases were only contributary causes in the fatalities which occurred. Five deaths were due to chronic lung and heart disease with cardiac failure, three were due to cancer and two to cerebral haemorrhage. For detailed figures see appendices, pages 128-129. 23 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 1960 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1960 was 20 which shows a decrease of 5 when compared with 1959 and the incidence of the disease during the year has continued to fall. The General Practitioner Miniature X-ray Service continues to function in a satisfactory way and is well used by the Local Practitioners. The results of this service are summarised below:- Number of miniature films taken 3,385 Number of patients recalled for examination and large film 703 Number of active cases of Pulmonary Tuberculosis 37 Number of cases of lung cancer found 34 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 10.9 per 1,000 which compares favourably with the figure of 1.1 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. 24 Incidence 121 cases of Respiratory Tuberculosis and 18 cases of NonRespiratory Tuberculosis were notified on Form A during 1960 (Table I - Formal Notifications). Of these 86 males and 35 females were Respiratory cases and 12 males and 6 females were Non-Respiratory. In addition 71 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 1960 by notification or otherwise was 213 as compared with 264 in 1959, 280 in 1958, 294 in 1957 and 349 in 1956. 192 of these were cases of Respiratory Tuberculosis; 125 in males and 67 in females. There were 39 fewer males and 11 fewer females than 1959. There were no cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 2 in 1959. The number of cases in adults was 18 compared with 14 in 1959. Of the cases notified in 1960, 1 male and 2 females died from the Respiratory form of the disease during the year, equal to 2.15 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 0.85 per 1,000 of the population; for Respiratory Tuberculosis 0.77 and for Non-Respiratory 0.08 per 1,000 population. The notification rate was 0.51 per 1,000. In 1959 the corresponding figures were 1.06, 0.97, 0.09 and 0.60 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1960:- RESPIRATORY NON-RESPIRATORY Total Cases Males Females Total Males Females Total 1, 136 831 1,967 63 81 144 2. Ill 25 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1960, 112 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) 71 or 63.4 B, or T. B. plus, 1 (early cases, sputum positive) 12 or 10.1 B, or T. B. plus, 2 (intermediate cases, sputum positive) 27 or 24. 1 B, or T. B. plus, 3 (advanced cases, sputum positive) 2 or 1.8 112 100.0% Non-Respiratory Tuberculosis There were 13 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints 3 Abdominal 1 Other Organs 5 Peripheral Glands 4 13 Ages at Death from Respiratory Tuberculosis Year 0-5 5-15 25- 25 25-45 45-65 over 65 TOTAL 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 1960 - - - 3 6 9 18 26 All but 1 case 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 1960 the death-rate from all forms of Tuberculosis was 0.08 per 1,000 population. The rate from Respiratory Tuberculosis was 0.08 and the rate for Non-Respiratory Tuberculosis 0.00. Similar figures for 1959 were 0.10 and 0.00. In 1960 the total number of deaths showed a slight decrease when compared with 1959. 80% of the deaths occurred in the age groups 45 years and over. There were no deaths in children of school age. Deaths from Non-Respiratory Tuberculosis During 1960 2 deaths were certified to be due to Non-Respiratory Tuberculosis, compared with 1 in 1959, 1 in 1958, 4 in 1957 and 1 in 1956. The deaths were due to:- Hales Females Total Tuberculous Adrenal Glands 1 - 1 Renal Tuberculosis 1 - 1 Total 2 - 2 Co-ordination with the Health Department During the year 15 children were referred by the School Medical Service, and 8 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 30 selected cases for varying periods during the year and 25 cases were in receipt of extra nourishment at the end of the year. 27 Residential Treatment 224 men, 171 women and 21 children were admitted to Residential Institutions in Croydon during 1960. The Chest Clinic and Home Visiting 1,857 new cases were examined during the year. 127 were found to be definitely tuberculous. The total number of attendances for examination at the chest Clinic was 17,148. There were also 23 attendances by patients for collapse therapy. The Clinic doctors paid 308 home visits and the Tuberculosis Visitors 4,177 visits for Clinic purposes. In addition the Tuberculosis Visitors made 240 primary visits for the purposes of the Notification Register. There were also 2, 115 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 1960, 676 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, 9 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 13 compared with 0.85 per 1,000 of the general population. In addition, there were 4 found to be tuberculous who had been under observation from previous years. The number of new contacts examined, together with the numbers of new cases of Tuberculosis notified in previous years are as follows:- 28 1959 - New contacts examined 775. New cases of Tuberculosis 148 1958 - „ „ „ 748. „ „ „ 161 1957 - „ „ „ 709. „ „ „ 168 1956 - „ „ „ 738. „ „ „ 202 1955 - „ „ „ 686. „ „ „ 171 B. C. G. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1960 and regular sessions are held at the Clinic for this purpose. 356 contacts were successfully vaccinated during the year, compared with 420 in 1959. In addition 48 nurses and domestics were successfully vaccinated, and 45 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 - 2,981 Number found to be negative - 2,588 Number vaccinated with B.C.G 2,585 Rehousing of tuberculosis Patients 16 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. 29 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 299 examinations were carried out in 1960. For detailed figures see appendices, pages 132-136. 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. Only small localised surveys among factory groups were made during 1960 No. of Persons Examined Tuberculosis Requiring Treatment or ciose clinic supervision Primary Carcinoma of Lung Male Female 3, 730 4. 174 3 2 Total 7.904 3 2 New Addington General Practitioner Chest X-Ray Service. No. of Persons Examined Tuberculosis Requiring Treatment or close clinic supervision Primary Carcinoma of Lung Male 329 1 1 Female 320 1 - Total 658 2 1 30 TUBERCULOSIS AFTER-CARE Once again during the year 1960 much has been done in a variety of ways to help the tuberculous patient. Each new patient is seen and told of the statutory and voluntary means of help and is given a chance to discuss the family problems which will arise as a direct result of the patient's illness, such as the loss of income, care of the children and home, and perhaps the possibilities of a change of employment when the patient is fit for work once more. Sometimes all that is needed is a willing listener. The National Assistance Board is still often called upon to help the tuberculous patient and will give a special allowance to encourage the patient to take treatment. Fortunately an increasing number of firms give sick pay for a certain period, but the manual worker, unless employed by a Local Authority, is not so fortunate. It often happens that the unskilled worker has been earning large wages and has taken on many Hire Purchase commitments, so that when his earnings come to a sudden stop, he is in a sorry plight. Here, much can be done with letters to Hire Purchase Firms explaining the situation and asking that weekly payments may be reduced or stopped for the time being; and sometimes with help from Voluntary Bodies. The Ministry of Labour Disabled Section is often called upon to find suitable light work for tuberculous patients. This may necessitate a period at the Rehabilitation Unit in Croydon, possibly followed by a specific training if the patient is young enough to benefit. There is a close liaison between the Ministry of Labour and the Chest Clinic. Rehousing is another important factor in the final recovery of the patient, and in Croydon we are fortunate in having been able to get many tuberculous patients rehoused. We still have a flourishing Voluntary Care Committee which helps tuberculous patients in many ways. Some of those who are chronically ill and unable to work have been helped to get holidays. At Christmas 160 grocery parcels were distributed and earlier in the year a number of patients were helped to buy fuel In addition, some have been helped with clothing and household replacements and some relatives with fares to visit patients in distant hospitals. 31 OCCUPATIONAL THERAPY 1960 was a busy year for Occupational Therapy at the Chest Clinic, with 52 patients receiving treatment. Only a small number of these, however, have been able to attend the weekly class session as there is no provision for transport. Thus, some patients have been deprived of the stimulus of meeting and working with other people, due to their inability to travel and the high cost of fares. Some patients have improved enough to need day or part-day occupation in a workshop atmosphere. This is not possible in the Chest Clinic, and the need seems to be for a day centre geared to the needs of chest patients regarding room temperature and smoking. The rather creative type of craftwork so often associated with Occupational Therapy is not always suitable for patients whose previous work has been of a repetitive nature. The possibility of their sharing the services of an officer concerned with procuring suitable work for other types of handicapped persons will be kept in mind. The 9iow Case of patients' work for sale in the entrance of the Clinic continues to do well. Much of the work is of a very high standard and reasonably priced. The best selling lines were modern lampshades, stools and basketry. 32 VENEREAL DISEASES The usual figures are given in appendices, pages 137-140. These show a record low figure for new cases of Syphilis and despite national statistics, a fall in the number of new cases of Gonorrhoea. However, the number of new cases of Non-Gonococcal Urethritis, a condition undoubtedly venereal, showed a considerable rise. One must conclude that in Croydon, as elsewhere in the country, the records of the Venereal Diseases Clinic support the assertion that promiscuity has increased. The old slogan of "Preach and Treat" seems once more applicable in dealing with these conditions. 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 - 2960. Faeces outfits 1,083 Drinking Water samples 270 Public Swimming Bath Water samples 76 Private Swimming Bath Water samples 26 Milk samples 223 Cream samples 10 Ice Cream samples 166 Sundry Pood Specimens 14 Blood 30 Urine 35 Nose and Throat Swabs 21 Total 1,754 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 33 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics The unified Hospital and Local Authority service under the clinical direction of the Hospital Consultant Obstetricians continued unchanged, with central ante-natal and post-natal clinics at Lodge Road, and a subsidiary clinic at New Addington. The advantages and disadvantages of centralization have been discussed in previous reports. The main drawback of expectant mothers being required to travel to and from outlying parts of the borough, diminishes with the increasing amount of interim ante-natal care given by General Practitioner Obstetricians in their own surgeries. The extension to the Lodge Road Clinic was completed, enabling Mothercraft Lectures and Relaxation Exercise Classes to be held in satisfactory and accessible premises. All services are now available for expectant mothers at the one central clinic. Despite the increase in attention given by family doctors, clinic attendances rose during 1960, reflecting the increase in the birth-rate. At ante-natal clinics a total of 4,203 mothers attended during the year, 3,023 for the first time. 26,327 attendances were recorded. At the post-natal clinic, 1,674 mothers attended for the first time and made a total of 1,714 visits. During the year 24 series of talks of six sessions each on "Mothercraft" at which 329 mothers attended were given. At Relaxation Exercise sessions, 598 mothers made 3,267 attendances. Care of Premature Babies Where premature labour is threatened every effort is made to secure the admission of the expectant mother to hospital. Although there were 24 more premature births in 1960 than in 1959, 20% fewer premature babies were born at home. The percentage of all premature babies who survived the first dangerous month of life was also larger in 1960 than in the previous year. For detailed figures see appendix, page 104. Care of the Unmarried Mother The Croydon Association for Moral Welfare continued to act for the Corporation and received payment on a capitation basis for cases dealt with by their Social Workers. The Corporation also paid hostel fees in respect of approved cases for whom such accommodation was required. 34 During the year under review:- 174 cases were dealt with by the Social Workers; 57 cases were admitted to Mother and Baby Homes; 2 cases were temporarily accommodated at Glazier House (not financially assisted)(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. For girls up to 18 years of age the period was extended to an average of six months. These younger mothers normally went to homes specialising in their care. Of these younger mothers, their ages at the time they applied for help were:- 13 years old - 1 14 „ „ - 1 15 „ „ - 4 16 „ „ - 7 17 „ „ - 3 18 „ „ 4 20 During 1960 the ages of the younger mothers when their babies were born were:- Age 15 - 7 „ 16 - 6 „ 17 - 8 „ 18 - 5 26 Of these babies:2 were stillborn 1 died aged 2 months 1 now in hospital with congenital deformities. 35 Domiciliary Midwifery It was a busy year for the Municipal Midwives, who delivered 63 more babies than in 1959. Early discharge from local hospitals also continued as a means of relieving overcrowding in Maternity Wards, and 2 part-time Maternity Nurses were employed to meet this added duty. Despite the growing interest of General Practitioners in obstetrics, of the mothers for whom doctors had been booked for maternity medical care, 80% were delivered by the domiciliary midwife on her own. 94% of mothers were given an inhalation and analgesic during labour, the great majority receiving gas/air. R>r detailed figures see appendices,pages 101-103. 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 82. 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. Day Nursery The single central Day Nursery provided more than sufficient Places for applications in the priority group. At the end of the year there were 35 children on the register, 14 under and 21 over 2 years of age. During the year the average daily attendance of the under 2 year olds was 9, and of the over 2 year old - 21. Child Welfare Centres The number of children under 1 year who first attended in 1960 was some 15% greater than in 1959. Total attendances for all ages under 5 years of 69,891 showed a fall of just under 3% from last year. Health Education by group discussion was emphasized at New Addington, where 17 special evening sessions for mothers totalled 390 attendances. Topics included "Ante-Natal Care", "Food Hygiene", "care of the Teeth", "Home Safety", "Vaccination and Immunisation". 19 members of the group attended a full First Aid Course and 18 qualified for a certificate. At the Waddon Welfare Centre, the class to interest mothers without domestic skills in making and mending children's clothes, had an average attendance of 10 mothers per session. The tuition is essentially simple and practical and aimed at those who are quite unable to learn through their own initiative. 36 For other detailed figures regarding child welfare centres see Appendix, page 106. Wel fare Foods It has always been the policy in Croydon to distribute at the Infant Welfare Centres only National Dried Milk and Vitamin preparations, and there has never been any question of mothers being attracted to the Centres because a large variety of proprietory supplies are available at special prices. In Croydon the final distribution of National Dried Milk and Vitamin preparations to the mothers concerned is performed almost entirely by Voluntary Workers. The central office in Park Street, which is open for 5½ days a week is staffed by members of the Women's Voluntary Services. At the Infant Welfare Centres it is usually the duty of one or other of the voluntary workers regularly attending at the Centre. We owe a considerable debt of gratitude to all those who have given so generously of time and effort, and on whose voluntary assistance the smooth working of this distribution system rests. There is little change in the amount of Vitamins supplied in 1960, but there was a further fall of 10% in the amount of National Dried Milk supplied to mothers. The actual figures were:- National Dried Milk 63,217 Cod Liver Oil 13,968 Vitamins A and D (for Expectant Mothers) 14,123 Orange Juice 125,069 37 THE WORK OF THE HEALTH VISITORS Miss L. E. Oakley, S.R.N., S.C.M., H. V. Cert. Superintendent Health Visitor With Poliomyelitis vaccination settling into a steady routine, Health Visitors have been able to give more attention to other aspects of their work. The introduction of the Phenylketonuria Test has necessitated more visiting in the early days of an infant's life. The test is carried out when the babe is between five and six weeks old. The reason for the procedure is explained to the mother at the first visit and the test is done either in the home or at the Infant Welfare Centre some three to four weeks later. All that is required from the babe is a wet napkin - surprisingly difficult to get sometimes. Over 2,800 such tests - all negative have been carried out since the scheme was started on 1st April. It says much for the good relationship existing between mother and Health Visitor that there have been only four definite refusals. The programme for the early detection of deafness in babies at nine months of age, which was commenced during the year, is based upon a register compiled by the Superintendent Health Visitor. To the usual discharge reports from hospital and domiciliary midwives, which are sent to the Health Department, there has been added an item about any of the conditions liable to cause deafness in babies. Further names are added from reports of family doctors or Health Visitors and a list of children "at risk" is thus obtained. Until a definite decision has been made about any particular child, it is the Health Visitor's responsibility to follow-up the case for attendance at the special Audiology Clinic. To suggest the possibility of deafness to an unsuspecting parent is a serious matter and must clearly be handled most carefully. Initial efforts to approach parents by letter were not very successful and it was felt that if the first approach must come from the Health Department, the Health Visitor, who is known to the family, should do so by means of a personal visit. As the one home visitor in the social set-up who visits families without waiting to be called in because things have gone wrong, the Health Visitor is in an excellent position to see the first signs of stress. She tries not only to prevent Physical breakdowns from occurring, but mental and social ones 38 as well. Routine home visiting carried out at regular intervals and with time to spend in homes where help is most needed are the keys to good preventive work. High case loads make this a heavy task, but in spite of this the standard of work is maintained at a high level and Health Visitors are always available to those who need help and advice. Towards the end of the year the discussions with Dr. Crosse, Child-Psychiatrist, recommenced. To recognise signs which may lead to a child's unhappiness and eventual attendance at the Child Guidance Clinic is an important part of the Health Visitors' work and a knowledge of how to deal with them is essential. Special group discussion study days were arranged within the Health Department and were attended by the majority of health visitors. They proved a stimulating experience and of great assistance in showing techniques for health education projects in infant welfare centres. The example of the mothers' club at New Addington, which continues to flourish, was followed by the health visitors of the South Norwood area. They have sponsored a monthly meeting for mothers at the Stanley Halls to discuss matters aff ecting the health and well-being of children. It has been well received and attendances at each session vary between 20 to 24 mothers. Health Visitors have also assisted in health education projects in the infant welfare centres and this aspect of their work is being steadily developed. A Health Visitor attached to a Secondary Modern School has completed two successful terms' work in giving practical talks and demonstrations in the Mothercraft Section of the Domestic Science Programme. It is hoped that this will prove to be a fore-runner of other similar ventures in which the Health Visitors' practical knowledge illustrates the more academic teaching. Health Education, practical training of Student Health Visitors and others, work in Infant Welfare Centres and schools all tend to make the Health Visitor's life a very busy one. With an increased staff it is hoped to bring forward other plans which will benefit both the young and old. Figures of work carried out are shown in Appendix, page 105. 39 HOME SAFETY Miss D. E. Blackmore, S.R.N., S.C. M., H. V. Cert. Home Safety Officer The Campaign "Check that Fall" continued into 1960 with particular interest centred on the housewife. The Home Safety Committee rented a stand at the Millenary Exhibition at the Croydon Airport. It attracted much attention and it was estimated that 75% of those visiting the Exhibition examined the Home Safety exhibits. The interest shewn by children who delighted in demonstrating the various models to their parents, was particularly noteworthy and this seems to have been a most successful venture in giving publicity to Home Safety topics. Many voluntary organisations helped to man the exhibits. The Ashburton Flower Show gave another opportunity for publicity, the emphasis being on garden,country and water accidents. The Poison Campaign opened in the Winter, posters and leaflets were sent to medical practitioners, chemists and vendors of certain poisons for display and distribution. Following requests for guidance about paraffin heaters, it was arranged with the Fire Prevention Officers for visits to be paid to Infant Welfare Centres to discuss this with the mothers. This was very popular and also gave an opportunity to discuss other fire hazards in the home. Six visits were paid on request to homes where there were special hazards and advice given. The householders were put in contact with the specialised technical officers. Although the cases taken to hospital through accidents in the home by the Ambulances are less, the deaths have increased to 13. There has been an increase in burning, scalding and poisoning, mostly to children under 5 years. There have been three fatal accidents from suffocation (See Table Page 114 ) The parents are still loathe to buy protected and safe materials for children's nightwear although several large stores now stock these in Croydon; they seem to begrudge the few extra shillings required although much money is spent on other unimportant garments. Lectures were given to the following:- Religious women's gatherings - 12; Old Age Pensioners' Clubs - 4; Students - 3;Parent Teachers' meetings - 3; Red Cross Cadets - 4; Mothercraft - 10; School Children - 2; Townswomen's Guild - 1. Tables are given in the Appendix, page 114. 40 IMMUNISATION After the emphasis given in recent years to vaccination against poliomyelitis,it was thought necessary to turn attention once again to reinforcing protection against diphtheria. To this end, all primary school children were given an appropriate letter for their parents and special immunizing sessions were held on school premises. Although the reporting of cases of diphtheria in the London area was a stimulus to parents to give consent for these "booster" doses, the percentage of children in the general population protected against diphtheria is still too low. The need to direct attention first to one condition and then to another is a major drawback in arranging immunizing programmes. In my view, it is of greater value in preventing outbreaks of disease to have a large majority of the population reasonably well protected than a small elite section impeccably immunized. Poliomyelitis and diphtheria are the main targets at present and it would therefore be helpful to have a combined antigen against these diseases. Tables are given in the Appendix, Page 130. HOME NURSING This service continues to be provided by the Croydon District Nursing Association, acting as agents of the Corporation. There were fewer new cases and visits in 1960 than in the previous year. This was due not only to the absence of any major outbreak of infectious disease, but to a somewhat changing pattern in the method of giving anti-biotics. New discoveries and new production methods now allow drugs to be given by mouth instead of by injection. Nevertheless, this form of administration still occupies a considerable part of a District Nurse's time, and arrangements were made during the year for them to participate in a central Sterile Syringe Service. All glass sterile syringes in containers have been obtained from a commercial source and the District Nursing Headquarters serves as the central distribution point for all sections of the Public Health Department. In addition to this method being the theoretical ideal, it has in practice proved entirely successful and welcomed by all concerned. For detailed statistics see Page 107. 41 LOAN OF HOME NURSING EQUIPMENT Demands for the loan of the enuresis machines increased substantially and there was a long waiting list at the end of the year. There have been many reports from various parts of the country about the success of this method for treating enuresis, which supports our own findings, and arrangements were made to increase the supply of machines available for loan. A request was also received during the year for the loan of a patient's hoist. This is an expensive item of equipment, costing over £70 but in selected cases, it may greatly ease the burden of home nursing. It requires a fair amount of floor space and in some houses, its use is not possible. For those who are permanently crippled, the question of loan does not arise, since the apparatus is needed permanently and for such cases, it was agreed with the Chief Welfare Officer that the Welfare Committee would consider applications as for similar permanent adaptations of premises to accommodate crippled persons. Two hoists were purchased by the Corporation and a third machine was donated to the Croydon District Nursing Association. For the usual details of issues, see Appendix, page 110. 42 HOME HELP SERVICE Miss J. E. Heath Home Help Supervisor "He is a friend who in difficulty helps by deeds inhere there is need of deeds " Plautus. It is doubtful if a more apt description could be found for the Home Help Service than these words written more than 2000 years ago. The Home Help undoubtedly "helps by deeds" but success lies in careful assessment of "where there is need of deeds". This Service continues to expand with the increase in the Borough's aged population and in spite of offers of attractive residential accommodation the popular demand is for home care. Fundamentally this desire may well be based on a natural resistance to being uprooted from familiar surroundings but the desire to remain independant is so strong that far from wishing to abandon responsibilities many old people readily accept the challenge of daily efforts. The helping hand of the Home Help is not gloved with officialdom but is the extension of the motivating force of humanity which starts with the firm grasp of Mother's hand and is found throughout life in friendship and neighbourliness. The Home Help Service does not pretend to accept full responsibility for the domestic work in the home, but selective help with difficult tasks preserves limited strength for lighter everyday duties. The Home Help is often taken for granted and this can be poor reward for untiring efforts but what greater compliment could be paid than to be accepted as essential for the wellbeing of another person. The word "problem" is freely used today, the problem of the aged, the problem family, etc., but perhaps society should carry the title for its inability to accept responsibility for sections which for one reason or another are unable to fit into the present day pattern of life. The most valuable asset of a good Home Help is her ability to accept a situation as she finds it without condemnation, and to proffer help in a way which will alleviate the immediate difficulty without embarrassment. With an ever increasing number of employees personal contact could become harder but whilst the desire to serve is the link 43 throughout the service there is a personal touch in every effort. For the unrecorded acts of kindness are not official duties but genuine expressions of compassion. The Helpers who pushed an elderly athritic wife from South Norwood to Queens Hospital and back in a wheel chair in order that she should see her husband for the last time did so, not out of a sense of duty, but because it was in their opinion the natural thing to do. A period of'administration spanning fifteen years came to an end this year with the retirement of Mrs. Rudd, the Senior Assistant Home Help Supervisor. At the same time the section suffered another loss when Mrs. Wake resigned after nearly seven years' service. Their knowledge and experience will be sadly missed, but change although often uncomfortable, can bring its own compensations with the infusion of new ideas and new approaches to old difficulties. Set out in Appendix page 111 are details of the work carried out. 44 HEALTH EDUCATION Miss D. S. Elliott, S.R.N., H. V. Cert., Dip. H. E. Health Education Officer "When a leaf trembles, the bough begins to shake". Chinese Proverb. A new enthusiasm for health education is stirring in the department. There are encouraging signs of an increase in interest and confidence among the staff as they become more used to new apparatus and teaching methods which, as they can see for themselves, are so well received by the public. The fostering of this fragile but vital spirit is the most important part of any health educator's work, because without it no health education programme can hope to succeed. Mothercraft Classes. These successful courses of six lecture-demonstrations given by a team of Health Visitors for many years have begun to expand their scope a little more. Regularly now at the end of their courses two or three classes combine for an afternoon of mothercraft films and more Health Visitors are arranging an extra evening session to which the fathers are invited. All the equipment used during the course is displayed and lively demonstrations and discussions on management take place,in an attempt to prepare both parents for the first few months ahead and to teach them the elements of consistent discipline. Infant Welfare Centres. There has been an improvement in the use of visual aids during the year and in one Infant Welfare Centre the Health Visitors have a rota for health teaching which continues all the afternoon as small groups of mothers gather. Simple displays, sound filmstrips and sometimes just posters have been used to promote discussion. This and other centres are organising play tables through which it is hoped to teach toddlers (and through them their mothers) simple skills and discipline. Toddlers' Clubs Plans are being made to begin toddlers' clubs in two Infant Welfare Centres to be held on a separate day once a fortnight. Health Visitors from three or four surrounding districts will combine in running these. About twelve children will be given 45 appointments for a routine examination by the doctor, but the Clinic will be open for any other mothers who wish to come for health education sessions. Films, demonstrations and discussions are being planned and it is hoped that before long requests will come from the mothers for talks on subjects which interest them most. Once again the aim of the teaching will be to prepare parents for the next stages of child development both physical and emotional and for the stresses and problems of the first year at school. Mothers' Clubs. There are two flourishing Mothers' Clubs in existence and a third one is shortly to be opened. They are held in the evening when mothers are able to attend without their children and can be free and unharrassed to discuss problems, relax and enjoy, the friendly atmosphere. The clubs were organised and launched by the Health Visitors in the areas and are now run by the mothers themselves, who also draw up their programme of activities. This is real education, enlisting the active participation of individuals. Its objective is less to inculcate rules than to create "a health mindedness" and once again to help prepare parents for the next stage ahead with their children - in this case teenage problems loom large. However, a medical philosopher Dr. Rene Dubos has said that change and struggle are essential conditions of life - a paradise is static, but life is dynamic and existence free from stress is an idle dream. In-Service Training Short sessions to demonstrate new material, films and filmstrips to Doctors, Health Visitors and District Nurses were arranged during the winter and spring. In October two whole study days were organised and attended by nursing representatives from all the hospitals in the Croydon Group, District Nurses, Health Visitors and Public Health Inspectors - half the staff attending on each day. The theme was "Some Methods and Media in Health Education". Following an introduction by Dr. S.L. Wright, the programme consisted of a film "Successful Instruction" which illustrated the principles of didactic teaching,a demonstration of all kinds of visual aids involving participation and a session on group discussion methods lead by Mrs. M. Fassam, a Consultant in Industrial Human Relationships. Snoking and Lung Cancer Campaign. See School Section of the Report - Page 7 - 46 Health Education in schools See School Section of the Report - Page 6 Miscellaneous Other activities of the Health Education Officer included acting as a Group Leader during the Royal College of Nursing's Refresher Course at Bedford College in July and lecturing during the October Refresher Course. Training students, lecturing to nurses on the social aspects of disease, preparing exhibitions and displays and other routine work continued during the year. All Health Educators are expected to act as shining examples of their theories but to the patient who said "But doctor you tell me to do this and to do that, and yet I know that you don't follow this good advice yourself '' The doctor replied "Dear madam, you must look at me as a signpost on the road to health: I need not therefore walk beside you". (l) (1)International Journal of Health Education Vol. 11, No. 1. January 1959. - Page 42 47 DENTAL TREATMENT (MATERNITY AND CHILD WELFARE) I am indebted to the Principal Dental Officer, P.G. Oliver, Esq., L. D. S., for the following report: - Expectant and nursing mothers requiring dental treatment are referred by Medical Officers attending Ante- and Post-Natal Clinics. In the case of children under school age introduction is effected through Infant Welfare Centres and similar institutions. A substantial number of applications is also made direct to the Dental Clinics themselves, or as a result of requests from Health Visitors. Treatment for patients in all categories is carried out at School Dental clinics and is closely linked with work on the Education side. Though no major developments can be reported during the year further progress has been made in "ironing out" irregularities in the Service, and following the introduction of additional sessions at the Overbury Clinic the position at New Addington has shown a radical improvement. As a result of the increased coverage of schools, measures can now be considered for a modest expansion of facilities for mothers and pre-school children in this district. A pressing need is that of establishing earlier contact with many young children whose mothers are in part or full time employment; because of the closure of public Day Nurseries such children now habitually spend considerable periods in the care of grandparents or friends, and there is a tendency for visits to dental clinics to be delayed until toothache intervenes. In an attempt to counter this situation a closer liaison is being established with Infant Welfare Centres, and it is hoped by this means to further enlist the interest of Health Visitors, Doctors and Social Workers in this problem. To help bring renewed attention to existing facilities for such children, an improved supply of Posters, Pamphlets and Circulars should shortly be available for those able to assist in this work. As part of the general campaign for Health Education, periodic Talks and Table demonstrations on dental subjects have been given by Health Visitors at selected Welfare Centres; such activities will, it is hoped, be instrumental in bringing home to mothers the necessity for earlier supervision of the "milk" teeth. Much credit is due to those initiating this experiment in what may be considered a rather special field of work. 48 A future development contemplated for extending this idea of "group" instruction to "toddlers" and older children could do much to re-establish some of the lost "contacts" with those in the 3-5 year age groups. As stated in the current Education Report concern continues to be felt over the delay in obtaining a replacement for the now defunct Duppas Hill Clinic, and it is comforting to learn that a satisfactory location has now been decided upon for a combined Welfare and Dental Centre to serve the whole Waddon area. As previously outlined the aim of this joint venture is to allow better integration of medical and dental Services and thus improve existing contacts with the expanding pre-School population in this district. It is hoped that adequate priority can now be secured to allow an early completion of this worth while project. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 367, compared with 406 in 1959. 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 have usually also visited pre-natal clinics, few cases are normally referred from the Municipal Midwives' Service, and then chiefly for relief of pain. When compared with the overall total dealt with by the above clinics, the number opting for a dental examination continues to be small, but as the large majority can now be said to receive periodic attention from their regular dental practitioner, responsibilities formerly undertaken by Local Authorities in this matter have substantially diminished. Even so, the percentage of those desiring such an examination, who failed their appointments, still tends to exhibit wide variations and is now shown as 30 per cent. against 24 per cent. in 1959. Expectant mothers examined for the first time numbered 281 against 248 last year. Of these, 75.8 per cent. were seen during the first six months of pregnancy, a figure exactly equalling that obtained during the previous year.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. 49 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. 19 nursing mothers were examined during the current year, compared with 25 in 1959. Treatment Including those continuing treatment from the previous year, 295 mothers were dealt with, against 369 in 1959. A welcome sign during recent years has been a decrease in the need for wholesale removal of teeth and the large scale provision of dentures. The current generation of expectant mothers also shows an increased awareness of the need for retaining their natural teeth. Certain of those attending volunteer the information that they have visited the same clinic during their school days, and have obviously benefited from treatment during this period. The Pre-School Child The number of children referred from all sources during the year was 368, compared with 359 in 1959. As previously, this figure included a proportion of "toddlers" due for re-inspection and treatment. As demonstrated among the school population, the added sugar consumption of post war years has also been responsible for an appreciable increase in decay in the mouths of the "under fives," early supervision of these youngsters is therefore becoming of even greater importance. Though cases of deliberate neglect are on the wane, the increase in part and full time employment by mothers has tended to reduce the proportion of the younger children attending for routine "check-up" at dental clinics, and there is as yet no evidence that this service is obtained elsewhere. New and more positive methods of approach will be required to deal with this increasing social problem. The usual tables are given in the Appendix, page 113. 50 AMBULANCE SERVICE A.L. Hill. Esq., Chief Ambulance Officer During the year the Service was called upon to deal with 115,257 patients, which necessitated 51,704 journeys and a mileage of 416,436. Compared with 1959 these figures show an increase of 467 patients and 3,317 miles with a decrease of 270 journeys. There were 17,513 patients conveyed to places outside the Borough, and on these journeys 132,585 miles were travelled. The number of patients admitted to Hospitals and Nursing Homes was 9,548 compared with 9,433 the previous year. An experimental period of six months during which a Leading Driver was made a temporary Third Officer with special duties, proved successful and the position was later made permanent. These duties were directed particularly to the speedy turnround of ambulances and sitting-case vehicles at local and London Hospitals. The Third Officer has also been included in the weekend and evening rota to give officer cover, he has obtained the Home Office Certificate for Civil Defence Training and has dealt with the instruction of new entrants to the Service. Difficulties have been experienced with shortage of staff during the year due to sickness and resignations. The number of days lost because of sickness total 879 as compared with 800 during 1959 and 681 in 1958. Twelve men left the Service and the training of new men took approximately 3 weeks before they became established apart from a two week delay before the man was employed. Conditions on the road are continually deteriorating and many valuable hours were wasted during a normal week particularly by vehicles in London. A team was entered for the Regional First Aid Competition at Brighton but unfortunately were unsuccessful. Personnel attended Mayday Hospital voluntarily to watch demonstrations of the Dunedin Emergency Lung Inflating Bellows and useful information was gained. Several organised visits were made to Headquarters Station among these were the German Local Government Officials and Sisters from the Staff College for Ward Sisters. Officers and men were honoured when they were required to line the route of Her Majesty the Queen during her visit to Croydon on Wednesday, 2nd November. For details of journeys, patients, mileage etc. see the Appendix page 117. 51 CIVIL DEFENCE (Ambulance Section) The total number of volunteers on the register at 31st December,1960 was 293 and of this number 47 are at New Addington Towards the end of the year a full First Aid Course was concluded with an examination. This Course was again conducted by the St. John's Ambulance Association and 75 volunteers entered, 46 at Headquarters Station and 29 at Training H.Q,,Fishers Farm, New Addington. Driving tuition is still being given by the Onward Driving School at South Croydon and since my last report 12 volunteers have taken their driving tests and six passed. Of the remainder, 5 will be given another chance but one who failed for a second time must now train privately. There have been numerous and varied activities during the year, the most important exercises are as follows:- Sunday, 7th February we were asked to supply two Ambulances and a First Aid party for an exercise at the Rescue Range conducted by the Lambeth Civil Defence. Sunday, loth April a Mobility Exercise was arranged and this Section was asked to supply 4 Ambulances and 2 First Aid Party Vehicles with drivers, two ambulances being loaned from Bromley. The Convoy left Croydon at 8.15 a.m. and met up with the main convoy at Kingston, where it proceeded to Aldershot and a Map Reading Exercise was held. The Party arrived back at Croydon at 10.30 p. m. Thursday, 5th May the annual exercises began with the Army and continued every other Thursday until 25th August. Ambulances and First Aid teams were supplied. A First Aid Course for Instructors was held at Wellesley Road and lasted for seven weeks. 52 MENTAL HEALTH Set out in Appendix, page 120, are the proposals of the Corporation under the Mental Health Act, 1959, as approved by the Minister of Health. These show that within the scope of previous legislation, much had been done in Croydon to unify hospital and community care for the mentally disordered. The Regional Hospital Board agreed to the Medical Superintendent of Warlingham Park Hospital giving part of his time to the Corporation on the basis of re-imbursement of an appropriate part of his salary and this is now functioning. Despite advertisements, we have so far failed to recruit a suitable Senior Mental Welfare Officer, but two very promising trainees have been appointed and are awaiting secondment to suitable courses. New premises were secured adjoining the Health Department and these have been converted to form a Mental Health Centre. Here, are accommodated all Mental Health staff working in the community, both hospital and local authority. This Centre is not intended primarily for treatment of mentally disordered persons, but for the co-ordination of administration and as a Centre to which patients or relatives may apply at any time for help and advice. Premises for a temporary Adult Training Centre for subnormal patients have been found and should be functioning early in 1961. Plans for a permanent building to provide training and workshop facilities for both mentally subnormal and mentally disordered patients are being drawn up and it is hoped that building will commence towards the end of 1961. A short-stay Mental After Care Hostel for patients discharged from mental hospital has been opened in Croydon and responsibility accepted for ten beds. These are now gradually being filled in consultation with the medical staff of Warlingham Park Hospital. Responsibility has also been accepted for a growing number of long-stay patients in voluntary hostels. Arrangements have continued with the Guardianship Society, who are supervising 14 severely subnormal patients placed in their area. The promotion of good mental health through maternity and child welfare services has continued, using the established procedure of in-service training through group discussion. We have been fortunate in the assistance and leadership given by the Psychiatrist of the Croydon Child Guidance Clinic. 53 Inclusion of mental health features within the series of Health Education talks to school children initiated by the Health Education Officer has taken this work into the schools. The difficulty here has been the choice of material and decision on the advice which can and should be given. As a very small effort in the prevention of mental subnormality, routine testing of infants for phenylketonuria was established during the year under review. While I must record especially our thanks to the staff of Warlingham Park Hospital for unfailing help and assistance, I also record with appreciation similar services from Dr. Gibson and Dr. Richards of St. Lawrence's Hospital and Dr. Ferguson of the Royal Earlswood Hospital. Statistical details are given in Appendix, page 126. Training There was no significant change in training arrangements and statistics are given below: Occupation Centre Number on Register, January, 1960 90 Number on Register, December, 1960 94 Number of admissions 18 Number left or excluded 14 Average attendance per Session 74 Times open, morning - afternoon 394 Total attendance for year 28,932 The outdoor training group was enlarged and results have been very gratifying. One girl received two certificates of merit for general needlework and embroidery at the Olympia "Do it yourself" Exhibition. The Croydon and District Society for mentally handicapped children maintained its interest in the welfare of the children and in addition to contributing generously to the Christmas Party also arranged a Circus outing. 54 CONVALESCENCE The Corporation accepts financial responsibility for convalescence recommended by general practitioners. Each patient recommended must have had a definite illness or accident and must go to a recognised Convalescent Home. The Corporation recovers part or all the cost according to the income of the patient and in accordance with a definite assessment scale. Certain patients may receive convalescent treatment free, including Old Age Pensioners. Every effort is made to suit the patient to the particular Home, as different Homes cater for different age groups and different kinds of medical or surgical condition. During the year 58 cases were so dealt with, 39 women, 11 men, 7 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 2 mothers who paid 12/6d. per day during 1960. The duration of one was for 3 days, and the other was admitted on the 5th September and is still attending. Details of attendances - Capacity 50 Number on books at end of year 35 Attendances: Under 2 2, 381 Over 2 5,313 Total 7,694 Number of days opened 256 Average daily attendance 30 55 DEAFNESS The development of the electronic hearing aid has made the early detection of deafness of great importance. The younger the child when the diagnosis of deafness is first made, the greater the possibility of compensating fully for this handicap. It is an important duty of the Audiology Unit, as described in the School Health Service, to deal with the ascertainment of deafness in babies as soon after nine months of age as possible. Where there is a family history of deafness, or a history of certain complications of pregnancy, or of the confinement, or of illness during the early weeks of life, deafness is more likely to occur. Doctors, midwives and health visitors have been asked to notify to the Health Department, the names of babies with such a history. At the end of the year, a list of 60 names had been recorded. 15 have been examined, of whom 10 were under one year of age, 11 were found to have normal hearing, 2 were probably not deaf but are to be seen again, and two were thought to have significant hearing loss. They were twins aged years and were referred because of failure to learn to speak, and behaviour problems. Appropriate treatment and auditory training commenced, and at the time of writing they are reported as greatly improved in behaviour and beginning to speak. We hope in the future that such cases will be found at about nine months of age and not 4 years later. CHIROPODY SERVICE There were some difficulties in establishing this service. Individual Pensioners' Associations had more or less informal arrangements with local Chiropodists for treatment for their members at concessionary rates, but there were no organised facilities covering the borough. Members of the Health Committee met representatives of the Society of Chiropodists and after a good deal of thought had been given to the matter, a scheme based on the use of Chiropodists' own premises was drawn up. The details are set out in Appendix All Chiropodists known to be practising in Croydon were invited to join by public advertisement and direct approach. By August, 14 Chiropodists qualified in accordance with the Regulations began operating this scheme. No major difficulties arose and arrangements were made with a Member of the Society of Chiropodists not practising in Croydon to carry out examination of premises, records and mode of practice of those concerned. By the end of the year, a total of 1,255 treatments had been given at a cost of £223.19.0d. Of these,the Corporation Paid the whole cost for 238 and part cost of 1,017. Further details are given in the Appendix, page 115. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 57 WORK OF THE PUBLIC HEALTH INSPECTORS George Grieve, P. R. S. H., F. A. P. H.I. Chief Public Health Inspector A feature of the year's work has been the progress in Smoke Control, in that the Council during the year made the Croydon (No. 2) and Croydon (No. 3) Smoke Control Orders to cover areas of the Borough abutting that covered by the Croydon (No.1) Order. Thus by October 1962, some 8,500 dwellings and 1,100 industrial, commercial etc. premises in the southern part of the Borough will be fully smoke controlled. The current five year programme of slum clearance is proceeding and up to the end of the year, 160 of the 183 houses included in the programme had been either demolished or closed. The proposals for the next five years provide for an additional 273 houses to be dealt with. There has been no reduction in the amount of slaughtering at the Abattoir, and 100 per cent meat inspection has been attained only by the inspectorate attending in the evening and at weekends. Some progress has been made regarding the provision of a new Abattoir, in that a site which is favoured by the present users, is likely to be made available during the next twelve months. Whilst on meat inspection I think one important fact should be noted, namely the victory over tuberculosis in cattle made possible by the Government's eradication schemes. Meat inspection at an Abattoir like ours shows the effectiveness of such schemes, in that in 1950, with a throughput of cows somewhat similar to 1960, the percentage found affected with tuberculosis was 28.6 per cent whilst in 1960 it was but 0.4 per cent The statistical tables and comments in this report indicate the amount and variety of work which has been done by the staff under my control, and I wish to record my grateful thanks to them for their efforts during the year. 58 HOUSING 38 unfit houses in the Crystal Terrace, Dover Road, Eagle Hill, Naseby and Oxford Road 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 1 Number of houses on which Demolition Orders have been made 3 Number of houses where Certificates of unfitness were issued 68 During the year 1283 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 1960:- Number of applications for certificates 70 Number of decisions not to issue certificates Nil Number of decisions to issue certificates 70 (a) in respect of some but not all defects 46 (b) in respect of all defects 24 Number of undertakings given by landlords 37 Number of undertakings refused by Local Authority Nil Number of certificates issued 33 Applications by landlords to Local Authority for cancellation of certificates 42 Objections by tenants to cancellation of certificates 11 Decisions by Local Authority to cancel in spite of tenants' objection 8 Certificates cancelled by Local Authority 42 59 West Croydon Men's Hostel This is situated at Pitlake and is available for use by "nightly lodgers". It has 104 cubicle beds, four of which are reserved for staff. The charge is 2s. 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 98, and the number of lettings 35,427. The receipts during the year were £3,665 and the expenditure £5,527. Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, at a fee. During the year 5 such requests were made. FACTORIES ACTS, 1937 AND 1948 During the year the under-mentioned inspections have been made and defects were found as set out:- Part 1 of the Act Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises Number of Number on Register Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 420 108 14 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1. 60 5 610 51 - (iii) other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 66 176 2 - Total 2,091 89 4 67 - 60 Cases in which Defects were found:- Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S. 1) 9 4 — — — Overcrowding (S. 2) — — — — — Unreasonable temperature (S. 3) — — — — — Inadequate ventilation (S. 4) 4 4 — — — Ineffective drainage of floors (S. 6) — — — — — Sanitary conveniences (S. 7): (a) Insufficient 15 12 — — — (b) Unsuitable or defective 45 37 — 12 — (c) Not separate for sexes 4 3 — — — Other offences against the Act (not including offences relating to Outwork 14 12 — — — Total 9 1 72 — 12 — Part VIII of the Act Outwork Section 110 Section 111 Nature of Work No.of outworkers in August list required by Sect. 110 (l)(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) Wearing Apparel 409 — — — — — Household Linen — — — — — — Lace, lace curtain and nets 8 — — — — — Curtain and furniture hangings — — — — — — Furniture and upholstery 3 — — — — — Umbrellas, etc. 1 — — — — — Paper bags 13 — — — — — continued on next page 61 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 tie 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. 4 — — — — — Carding, etc. of buttons, etc. 95 — — — — — Stuffed toys 15 — — — — — Brush making 4 — — — — — Chocolates and sweetmeats — — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 241 — — — — — Lampshades 45 — — — — — Total 8 38 — — — — — 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 140 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. 2, 172 inspections were made under the Shops Act, and the infringements found were as follows:- 62 Hours of Closing 5 Insufficient and defective W. C. accommodation 4 Defective ventilation 2 Defective floors, walls etc. 5 Notices to be exhibited or amended 34 Insufficient heating 2 Washing facilities required 1 DRAINAGE 2,350 visits of inspection were made to underground drains in course of repair. Of 228 Statutory Orders served, 80 had to be done in default of the owners. In addition, repairs were carried out by the Corporation to 5 public sewers serving 13 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 154 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 1960 the Council made the Croydon Smoke Control (No. 2) Order, which covers 2,686 dwellings and 356 industrial and commercial premises in the South Croydon area and comes into operation on the 1st October, 1961. 63 Daring the year the Council also made Croydon Smoke Control (No. 3) Order which covers 3,915 dwellings and 586 industrial, commercial etc. premises in an area of South Croydon abutting areas 1 and 2. This Order will become operative on the 1st October, 1962. 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. 56 such observations were made and in one instance smoke was emitted for more than the statutory limit. The management 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 41 plans showing the construction and heights of new chimneys have been examined and in 26 cases additional height has been requested and agreed. 47 notices of the installation of new furnaces have been received, 38 of these being oil fired plants. AMUSEMENT HOUSES 110 inspections were made of Theatres, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary 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 steam from a gas fired boiler within the Station. The following articles were disinfected at the Disinfecting Station during the year:- By Steam 9,285 articles By Formalin Gas 2,784 " Total 12,069 articles 505 articles were destroyed on request. 64 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 1960, 79 articles were disinfected, the receipts amounting to £9. 10. 6d. Disinfection was carried out after infectious or contagious diseases at the following premises:- 271 rooms at 85 houses, hospital wards, clinics etc. 2,693 library and other books were disinfected. On request disinfection was also carried out for conditions other than notifiable infectious diseases and for which a charge is made. During the year £28. 6. 0d. was recovered for such services. 6 articles for Welfare Department institutions and 1,138 Medical Aids 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, 16 adults and 5 children were cleansed of verminous conditions and 3 adults and 5 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 numbering 164, either hy spraying or fumigation. Weekly visits are made to the abattoir when the manure storage and walls adjoining are sprayed with an insecticide. PHARMACY AND POISONS ACT, 1933 The object is to regulate the sale of certain poisonous substances. During the year the number of applications granted for ent0 of names on the list of persons entitled to sell poisons under Part 2 of the Act was 21. In addition, 249 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. 65 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Act regulates the manufacture and sale of materials used as fillings for upholstery, bedding, toys, etc., with the object of compelling the use of clean fillings. During 1960, 11 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 3 Kapok 2 Millpuff 1 Curled Feathers 1 Down and Feathers 2 Loose Fibre 2 PET ANIMALS ACT, 1951 21 persons were licensed for the purpose of keeping Pet Shops. During the year 37 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS Eight cases of swine fever notified from the slaughterhouses were confirmed and appropriate action was taken in conjunction with the Officers of the Ministry of Agriculture, Fisheries and Food to provide against the spread of the disease. PREVENTION OF DAMAGE BY PESTS ACT, 1949 This Act is mainly concerned with the destruction of rats and mice and it places a duty on the occupier of any premises to report to the Local Authority any infestation by such rodents. 2 ratcatchers, officially designated rodent operatives, are employed to deal with such complaints. During the year, 1,805 private dwellings were inspected following complaints and in 1,716 instances infestation was confirmed and dealt with by the rodent operatives. 227 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 to methods of prevention of rodent infestation. Corporation 66 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 hy the department to eradicate the pests. 46 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 six 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 1961 in order that any further infestation of the sewers is disclosed and dealt with. 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 2, 772 premises in the Borough at which food is known to be sold, manufactured or stored. Bakehouses 58 Bakers Shops 113 Sugar Confectioners 589 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 533 Works and Club Canteens 298 Public Houses 189 Off Licences 73 Grocers 617 Butchers 210 Wholesale Meat Markets 7 Chemists 85 Greengrocers 361 Fishmongers 74 Fried Fish Shops 48 67 Milk Distributors and Dairies 171 Premises from which Roundsmen and Mobile Shops operate 23 Stalls 107 Food Manufactories 29 Other Pood premises not enumerated above 53 3,638 Of the above premises 1,004 are registered under Section 16 of the Pood and Drugs Act, as follows:- Retail sale of ice-cream 817 Manufacturers of ice-cream 5 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 182 During the year 4,964 inspections were made of food businesses (for details see page 80). INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1955/56. Structural defects in shops and stores 12 Defective condition of walls and ceilings 127 „ „ floors, utensils, fixtures, etc. 44 Defective or insufficient drainage 21 W.C. accommodation - repair or cleansing required 40 „ „ -artificial lighting required 8 „ „ -want of intervening ventilated space 4 Food - not stored 18" off floor 6 „ „ -means to prevent contamination required 26 „ „ -store required or defective 1 Accumulations in yard or stores 31 Offal and refuse bins defective or uncovered 32 Yard paving defective 7 Hand washing notice not exhibited 9 Ablutions - flash basins required 44 „ „ -Hot water supplies required 59 „ „ -Nail brushes, soap and towels required 15 Clothing accommodation required 3 Insufficient or defective sinks 20 Smoking offences 5 Clothing accommodation required or defective 5 Defective or unsuitable table tops, etc. 9 First Aid kits required or insufficient 9 Cleanliness - advice given 17 Rodent infestation 10 Merchandise Marks 2 68 Prosecutions A firm of local bakers pleaded guilty to a summons relating to the sale of a loaf of bread containing pieces of cotton cloth The Court imposed a fine of £10 with £5.5.0d. costs. A formal sample of hot milk purchased from a local cafe was found to be adulterated with water. The proprietor of the cafe, who pleaded guilty, was fined £10.10.0d. with 10s. 6d. costs. One formal sample of Rum, obtained from a public house, contained not less than 13 per cent of added water. The licencee concerned, who pleaded guilty, was fined £15.0.0d. with £6.8.0d. costs. Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1960:- Article Weight in lbs. Carcase Meat 79,693 Offal 81,580 Sundry Foodstuffs 3,331 Canned, Bottled and Packeted Poods 17,165 Total 181,769 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, and whilst during 1960 the number of animals slaughtered fell to 78,242 there was a 60% increase in cattle slaughtered. 69 A 100% inspection has been maintained, but this has necessitated evening and regular 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 Cows Calves Sheep and Lambs Goats Pigs Total 5,111 1,913 6,185 36,468 269 28,296 78,242 CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Horses Number killed 5111 1913 6185 36468 28 296 269 Nil Number Inspected 5111 19 13 6185 36468 28 296 269 Nil All Diseases except Tuberculosis and Cysticerci Whole carcases condemned 6 46 46 459 238 8 Nil Carcases of which some part or organ was condemned 2416 100 2 68 328 2 29 25 6 Nil Percentage of the number inspected affected with diseases other than Tuberculosis 47.3 54.7 1.8 10.2 11.1 5.2 Nil Tuberculosis only Whole carcases condemned 6 2 1 Nil 6 Nil Nil Carcases of which some part or organ was condemned 56 6 Nil Nil 228 Nil Nil Percentage inspected affected with Tuberculosis 1.2 0.4 Nil Nil 0.8 Nil Nil Cysticercosis Carcases of which some part or organ was condemned 72 17 Nil Nil Nil Nil Nil Carcases submitted to treatment by refrigeration 72 17 Nil Nil Nil Nil Nil Generalised and totally condemned Nil 1 Nil Nil Nil Nil Nil 70 The District Public Health Inspectors, all qualified Meat Inspectors, inspect meat at the 6 wholesale Meat Depots in the Borough, as well as that exposed for sale in the butcher's shops. The Diseases of Animals (Waste Foods) Order, 1957 The Order provides that, in general, all waste food must be boiled before feeding to animals to minimise the spread of animal diseases. Licences to operate boiling plants and equipment are issued after inspection of the premises and plants. 55 inspections of licenced plants were made during the year. MILK SUPPLY During the year 266 inspections were made of dairies and premises from which milk was sold. The Milk (Special Designation) pegulations 1949. The following licences were granted during the year:- Dealers' Licences to use the designation "Tuberculin Tested" 74 Licences to use the designation "Pasteurised"- (a) Dealers' (Pasteurisers') Licences 2 (b) Dealers' Licences 96 Licences to use the designation "Sterilised"- Dealers' Licences 113 Dealers' Supplementary Licences to use the designation- (a) Tuberculin Tested 15 (b) Sterilised 17 (c) Pasteurised 16 Inspection of these licensed premises has been carried out during the year to see that the conditions of the licences were observed. 71 Bacteriological Examinations of Milk During the year the following samples of milk were examined: Tuberculin-Tested Pasteurised Milk 47 Pasteurised Milk 146 Sterilised Milk 19 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 47 — 47 — 47 Pasteurised Milk No. Samples Taken Methylene Blue Test Phosphatase Test Not Satisfied Satisfied Not Satisfied Satisfied 146 1 145 — 146 Sterilised Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied 19 — 19 Bacteriological Examination of Milk churn and Milk Bottle Rinses Chum Rinse Samples 5 Satisfactory 7 Unsatisfactory Nil Bottle Rinse Samples 84 Satisfactory 84 Unsatisfactory Nil 72 BACTERIOLOGICAL EXAMINATION OF CREAM Ten samples of fresh cream were examined and produced satisfactory results. Of the total samples taken, 46 (27.7 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, 223 samples of Milk and Cream, and 339 other samples were taken, of which number, 16 were found to be Not Genuine. Summary of Samples During 1960 samples were obtained and submitted to the Public Analyst as follows:- BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 166 samples were taken, the results being as under:- Grade No. of Samples 1 76 2 44 3 20 4 26 73 Result of Analysis of Milk Samples Solids not Fat (Legal standard is 8.5%) 8.5 8.6 8.7 8.8 8.9 36 96 59 20 1 Milk Fat (Legal standard is 3%) 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 8 17 32 59 50 25 10 10 — 1 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.5%) 8.9 9.0 9.1 9.2 3 — 31 Milk Fat (Legal standard is 4%) 4.4 4.5 4.6 2 2 3 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.63 Milk Fat 3.54 South Devon and Channel Island Milk Solids not Fat 9.01 Milk Fat 4.51 Total number of Milk Samples 219 The samples of milk for analysis were obtained as follows:- Taken on Milk Rounds 110 Taken at Dairies 100 Taken at Institutions 9 219 74 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Almonds (Ground) 2 2 - - - Apple Juice 1 1 - - - Artificial Colour 1 1 - - - Arrowroot 1 1 - - - Asprin Tablets 2 2 - - - Bacon 1 1 - - - Baking Powder 1 1 - - - Batter Mixture 2 2 - - - Beer, Bitter 6 6 - - - Bicarbonate Soda 1 1 - - - Beer, Mild 2 2 - - - Biscuits 2 2 - - - Black Pudding 2 2 - - - Blancmange Powder 1 1 - - - Boracic Ointment 1 1 - - - Brandy 1 1 - - - Brisket of Beef 1 1 - - - Bread, White 1 1 - - - Bread, Wholemeal 1 - 1 - - Bread Crumbs 1 1 - - - Bread and Butter 1 1 - - - Bread, Brown 1 1 - - - Bread, Milk 1 - 1 - - Bun Flour 1 1 - - - Butter, New Zealand 2 2 - - - Butter, Australian 2 2 - - - Butter, Danish 1 1 - - - Buttered Rolls 1 1 - - - Calamine Ointment 1 1 - - - Camphorated Oil 2 2 - - - Calamine Lotion 1 1 - - - Candied Peel 1 1 - - - Cakes, Various 3 3 - - - Cake Mix 2 2 - - - Cheese, Cheddar 2 2 - - - Cheese, Danish Blue 1 1 - - - Cheese Spread 2 2 - - - Cheese, Lactic 1 - 1 - - Cheese Biscuits 1 1 - - - Chicken and Ham Rissoles 1 1 - - - Chocolate 5 4 1 - - Chocolate Spread 2 2 - - - Chopped Pork 3 2 1 - - Chutney 1 1 - - - Christmas Pudding 1 1 - - - Cod Liver Oil 1 1 - - - Cod Liver Oil with Malt 1 1 - - - Cocoa 2 2 - - - Coconut, Dessicated 1 1 - - - Coffee, Hot 1 1 - - - Coffee 1 1 - - - Coffee, Instant 1 1 - - - Coffee and Chicory Essence 2 2 - - - Condensed Milk 1 1 - - - Condiment, Non-Brewed 1 1 - - - Cooking pat 2 2 - - - Cooking Oil 1 - 1 - - Corned Beef 1 1 - - - Cornflour 1 1 - - - Cornflakes 1 1 - - - Cough Mixture 2 2 - - - Cough Pastilles 1 1 - - - Crab, Dressed 1 1 - - - 75 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Cream of Tartar 1 1 - - - Cream, Tinned 2 2 - - - Cream, Fresh 2 2 - - - Cream Buns 1 - 1 - - Cream Biscuits 1 1 - - - Crystallised Fruits 2 2 - - - Curry Powder 1 1 - - - Custard Powder 2 2 - - - Dates 1 1 - . - Dried Milk 1 1 . - - Drinking chocolate 3 3 - - - Dripping 1 1 - - - Dyspepsia Tablets 1 1 - - - Essence of Rennet 1 1 - - . Evaporated Milk 1 1 - - - Faggots 1 1 . - - Fish Cakes 1 1 - - - Figs 1 1 - . - Fish Fingers 1 1 - - - Fish Paste 2 2 - - - Flavouring Essence 1 1 - - - Flour 1 1 - - - Frying Oil 2 2 - - - Fruit Pie 1 1 - - - Gees Linctus 2 2 - - - Gelatine 1 1 - - - Gin 4 4 - - - Ginger Beer 1 1 - - - Glauber's Salt 1 1 - - - Glycerine, Lemon and Honey 1 1 - - - Glycerine 1 1 - - - Golden syrup 1 1 - - - Grapefruit Juice 1 1 - - - Gravy Powder 2 2 - - - Ground cinnamon 1 1 - - - Ground Rice 1 1 - - - Groundnut Oil 1 1 - - - Ham 1 1 - - - Han and Beef Roll 1 1 - - - Hamburgher 1 1 - - - Halibut Liver Oil Capsules 1 1 - - - Honey 2 2 - - - Horseradish Relish 1 1 - - - Isinglass 1 1 - - - Ice Cream 1 1 - - - Ice Cream Mix 1 1 - - - Instant whip 1 1 - - - Instant Icing Mix 1 1 - - - Insect Sting Cream 1 1 - - - Iodine, Tincture of 1 1 - - - Iodine ointment 1 1 - - - Indigestion Tablets 2 2 - - - Jam 4 4 - - - Jelly 5 5 - - - Jellied Veal 1 1 - - - Lard 1 1 - - - Lemonade Powder 1 1 - - - Lemon Barley water 1 1 - - - Lemon Flavouring 1 1 - - - Lemon curd 1 1 - - - Lemon Pie Filling 1 1 - - - Lemon Juice 1 1 - - - Lime Juice Cordial 1 1 - - - 76 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Luncheon Roll 1 1 - - - Luncheon Meat 3 3 - - - Liquid Paraffin 2 2 - - - Lobster Paste 1 1 - - - Macaroni 1 1 - - - Malt Vinegar 1 1 - - - Malted Milk Tablets 1 1 - - - Margarine 2 2 - - - Marmalade 1 1 - - - Marzipan 4 4 - - - Meat Extract Cubes 1 - 1 - - Meat Paste 1 1 - - - Meringues 1 1 - - - Milk of Magnesia 1 1 - - - Milk 219 219 - - - Milk, Hot 1 - 1 1 1 Mincemeat 2 2 - - - Minced Beef 2 2 - - - Mint Sauce 1 1 - - - Mixed Spices 1 1 - - - Mixed Kerbs 2 2 - - - Mustard 3 3 - - - Mutton Curry 1 1 - - - Oatmeal 1 1 - - - Octopus on skewer 1 1 - - - Olive Oil 1 1 - - - Orange Squash 3 3 - - - Orange juice 1 1 - - - Parrish's Chemical Food 1 - 1 - - Peanut Butter 1 1 - - - Pepper 1 1 - - - Pepper, Cayenne 1 1 - - - Pickled Onions 1 1 - - - Pickled Cabbage 1 1 - - - Pickles 3 3 - - - Pineapple Juice 1 1 - - • Pork Pies 2 2 - - • Pork sausage Meat 1 1 - - - Pressed Beef 2 2 - - - Puff Pastry 1 1 - - - Quinine, Ammoniated 3 1 2 - - Roes, Tinned 1 1 - - - Rice 1 1 - - - Rice Pudding, Creamed 1 1 - - - Rissoles 1 1 - - - Rum 7 6 1 1 1 Rum Essence 1 1 - - - Sago 1 1 - - - Salad Cream 1 1 - - - Sandwich Spread - - - - - Sauce, Chop - - - - - Sausages, Beef 4 4 - - - Sausages. Pork 1 1 - - - Sausage, Liver 2 2 - - - Sausage, Smoked 1 1 - - - Sausage, Luncheon 1 1 - - - Sea Food Dressing 1 1 - - - Soda water 1 1 - - - Soda Mint Tablets 2 2 - - - Split Peas 1 1 - - - Steak and Kidney Pie 2 2 - - - Steak Pie 1 1 - - - Suet, Packed 3 3 - - - 77 Samples of Total Samples Genuine Not Genuine Prosecutions tions Sponge Mixture 3 3 - - - Sugar, Caster 1 1 - - - Sugar, Brown 2 2 - - - Surgical Spirit 1 1 - - - Sweet Corn 1 1 - - - Sweets 7 7 - - - Soup powder 1 1 - - - Steak Pudding 1 1 - - - Stewed Steak 2 2 - - - Sage and Onion Stuffing 1 1 - - - Sulphur Ointment 1 1 - - - Syrup of pigs 2 2 - - - Table Salt 1 1 - - - Tapioca 1 1 - - - Tea 3 3 - - - Tinned Asparagus 1 1 - - - Tinned Runner Beans 1 1 - - - Tinned Marmalade 1 1 - - - Tinned Broad Beans 1 1 - - - Tinned Fruit 2 2 - - - Tinned Peas 2 2 - - - Tinned Vegetables 2 2 - - - Tinned Pork Sausages 1 1 - - - Tinned Soup 2 2 - - - Tinned Fish 2 2 - - - Tinned Meat 4 4 - - - Tinned Tomatoes 1 - 1 - - Tinned Tomato Juice 1 1 - - - Tomato Puree 1 - 1 - - Tomato Ketchup 1 1 - - - Veal and Ham Roll 1 1 - - - Vinegar 1 - 1 - - Vitamin Iron Tablets 1 1 - - - Whiskey 6 6 - - - Vitamin 'c' Tablets 2 2 - - - Yeast Tablets 1 1 - - - Total 558 542 16 2 2 78 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Amnioniated Tincture of Quinine (2) The Analyst reported a deficiency in ammonia in these samples which was probably due to loss by evaporation. Stocks of this article were withdrawn from sale. Brewed Vinegar This article contained 3.5 grams of acetic acid per 100 millilitres whereas each 100 millilitres should contain not less than 4 grams of acetic acid. Vendor warned. Chopped Pork This sample contained 73 per cent of meat, including fat whereas, in the opinion of the Analyst, chopped pork must contain not less than 90 per cent of meat. This matter has been taken up with the packers Cooking Oil The Ingredients in this article were not specified on the label as required by the Labelling of Pood Order, 19 53. The manufacturers have amended the label on this article. Cream Bun Contained imitation cream instead of cream. A notice has now been exhibited in the shop indicating the nature of the "cream" filling. Hot Milk This article consisted of 36 per cent of milk and 64 per cent of water. Vendor prosecuted. Irish Coffee Milk Chocolate. In the opinion of the Analyst this article was labelled in a misleading manner. The importers have amended the label concerned. Lactic Cheese In the opinion of the Analyst this article was incorrectly described in advertisements and on the label. The manufacturers have withdrawn the advertisements and amended the label concerned. Meat Extract Cube One of the ingredients in this article was not specified on the label. The importers have amended the label concerned. Milk Bread In the opinion of the Analyst a declaration that this article contained skimmed milk should have been made at the time of sale. This matter is being investigated. Parrish's Chemical Food This article was labelled in a misleading manner. Stocks of this article have been re-labelled. Rum This sample contained not less than 13 per cent of added water. Vendor prosecuted. Tinned Tomatoes The sample contained 9 20 parts per million of tin and was therefore unfit for consumption. Stocks of this article were surrendered and destroyed. 79 Article Nature of Adulteration or Deficiency Remarks Tomato Puree The presence of salt as an ingredient of this article was not declared on the label as required by the Labelling of Pood Order, 1953. The importers have amended the label concerned. Wholemeal Bread. This article was made with flour of about 85 per cent extraction whereas the entire flour content should consist of wholemeal flour. The producers have now ceased to describe this article as wholemeal bread. 80 Summary of inspections made by the Public Health Inspectors, and other Departmental work. Total number of bouses inspected for housing defects under Public Health or Housing Acts 2,688 Houses inspected where zymotic diseases have occurred 347 „ „ following applications for certificates of disrepair 267 Inspections of underground rooms 75 Special inspections in connection with the Housing Survey 77 Houses inspected for overcrowding conditions 34 Re-inspections of work outstanding on housing notices 9,109 Number of visits regarding infectious diseases 738 „ „ „ food poisoning 23 Inspections of drainage work during repair 2,350 House drains tested with smoke and colour - routine and complaint 869 House drains tested with smoke (on written application) 5 House drains tested with smoke during repair 31 House drains tested with water during repair 84 Inspections of cesspools and earth closets 15 „ „ schools and school sanitary conveniences 140 „ „ public conveniences 301 „ „ verminous premises 100 „ „ ponds and ditches 45 „ „ yards, stables and passages 126 „ „ theatres, cinemas, halls, etc. 110 „ „ pig styes 55 „ „ tents, vans and similar structures 106 Inspections and re-inspections in connection with smoke Control Orders 7,722 Sundry visits regarding Smoke Abatement 676 Smoke Observations 56 Visits regarding exhumation 53 Visits to premises for food condemnation 611 Inspections of swimming baths 6 „ „ wells 7 „ „ gathering grounds of water supply 42 „ „ gipsy encampments, camps, fairs, etc. 43 „ „ offices 36 „ „ rivers and streams for pollutions 154 Food and Drugs Acts: Food and drugs samples taken 562 Food and Drugs Acts: Milk samples taken (special designations) 223 Ice Cream samples taken 166 Samples taken of Fertilizers and Feeding Stuffs 12 „ „ swimming baths water 107 „ „ drinking water (bacteriological and chemical) 282 „ „ subsoil water 2 „ „ from rivers, streams, etc. 7 „ „ private wells 13 „ „ of rag flock and other filling materials 11 „ „ sundry specimens (food poisoning etc.) 14 Inspections under Merchandise Marks Act 480 „ „ of butchers premises 448 „ „ meat premises (wholesale) 566 „ „ poultry and game dealers premises 51 „ „ fishmongers premises 77 „ „ fried fish premises 62 „ „ grocers premises 737 „ „ fruiterers and greengrocers premises ... 303 „ „ bakers premises - including bakehouses ... 192 „ „ dairies 134 „ „ milk shops 132 „ „ general shops and their premises 36 Inspections of premises where cooked meats etc. are prepared or sold 58 81 Inspections of confectioners premises 428 „ „ confectionery manufacturers premises 10 „ „ cafes, snack bars, canteens, hotels and their „ „ kitchens 700 „ „ school kitchens and serveries 103 „ „ hospital kitchens 11 „ „ ice cream manufacturers premises 33 „ „ ice cream vendors premises 378 „ „ ice cream barrows and carts 17 „ „ market and barrows 145 „ „ other food premises not enumerated above 343 „ „ premises where offensive trades are conducted 4 „ „ factories with mechanical power 610 „ „ factories without mechanical power 108 „ „ works of building and engineering 176 „ „ outworkers premises 50 Visits to employers of outworkers 4 Inspections of shops (under Shop Acts) 2,17 2 Special early closing, evening and Sunday trading patrols of shops 413 Appointments kept with owners, builders, etc. 1,943 Investigations of complaints other than housing matters 1,347 Re-inspections of works outstanding (other than houses) 2. 419 Inspections under Hydrocyanide Regulations — „ „ Fertilizers and Feeding Stuffs Act 3 „ „ Diseases of Animals Act 43 „ „ Pets Act 37 „ „ Rag Flock and Other Filling Materials Act 11 „ „ Pharmacy and Poisons Act 65 Sundry Inspections and Visits 6,097 Visits regarding rats and mice Infestations 8, 823 Informal Notices outstanding 31.12.59 706 „ „ served 945 „ „ complied 877 Number of Informal Notices referred for Statutory Orders Informal Notices outstanding 31.12.60 774 Statutory Notices outstanding 31.12.59 203 „ „ served 442 „ „ complied 406 „ „ outstanding 31.12.60 239 Total number of callers and complaints received at the office 3, 632 Total number of letters received at the office Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1960 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 383 Conditions causing dampness: Defective roofs 348 Defective window frames 428 Defective walls, etc. 96 Want of efficient damp-proof course 103 Defective gutters and downspouts 377 Other structural defects: Defective plaster 626 Cleansing and redecoration required 54 Defective floors and stairs 444 Insufficient ventilation under floor 26 Defective brickwork, sills, lintels, chimneys 244 Defective stoves and fireplaces and flues 83 82 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 109 Defective W.C' s 177 Defective drainage 172 Stoppages in drains 103 Defective water services and tanks 31 Domestic nuisances: Want of cleanliness 7 Verminous conditions 1 Other nuisances and infringements: Offensive accumulations 44 Overcrowding 8 Sundry nuisances or defects 31 Particulars not inserted in Rent Book (Housing Act) 47 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924 Food cupboards defective or required 9 (3) INFRINGEMENTS OF PUBLIC HEALTH ACT. PAVING, ETC. Defective Yard Paving 62 Want of a sanitary dustbin 35 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 4 W.C. defective or dirty 4 (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 1 (6) SMOKE ABATEMENT Nuisances observed 6 PUBLIC HEALTH SERVICES 83 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: - About nine-tenths of the Borough is supplied with water by the Corporation. The districts of Spring Park and New Addington, comprising about two square miles in area, are supplied directly by the Metropolitan Water Board, this water being derived from wells in the Chalk. Public supply mains are laid throughout the Borough and every dwelling house is connected to them; the entire population thus receives piped supplies from statutory supply authorities. The supplies have been satisfactory in quantity and quality throughout the year. None of the waters in supply have "plumbosolvent" characteristics. Most of the Corporation's supplies are drawn from deep wells in the Chalk, but a supplementary supply, of Thames-derived water, is purchased in bulk from the Metropolitan Water Board and distributed by the Corporation in the northern part of the Borough. The wells are situated at the Surrey Street, Stroud Green, Waddon, Selhurst and Addington pumping stations. The water from all of the wells is treated by the addition of chlorine, and ammonia is added after chlorination to the Surrey Street, Waddon and Addington supplies. Owing to the occasional occurrence of turbidity in the raw water from the Addington Well, this water is filtered before chlorination. The quantity of water supplied during the year 1960 was: From Corporation Wells 2,543,541,000 gallons Purchased in bulk from M. W. B. 794,415,000 gallons 3, 292, 205, 000 gallons (a) Bacteriological Examinations. Regular bacteriological examinations were made of the raw waters going into supply following treatment. 496 samples of raw waters and 1,034 samples of treated waters were examined by the Chemist and Bacteriologist of the Water Undertaking. In addition, 14 samples of raw waters and 30 samples of treated waters were bacteriologically examined by the Consultants to the Corporation. Further samples were submitted by the Medical Officer of Health for examination by the Public Health Laboratory Service. 84 The results of the bacteriological examination of the raw waters were typical of waters derived from the Chalk, some of which showed the normal deterioration in quality which occurs after heavy rainfall. In all cases the results indicated that the waters were suitable for treatment. Bacteriological examinations of the treated waters indicated that these were of uniformly excellent quality. (b) Chemical Analyses. The arrangements for chemical analyses are similar to those for bacteriological examinations. The total numbers of samples analysed in the laboratory of the Water Undertaking and by the Consultants were 101 samples of raw waters and 123 of treated waters going into supply. The results of these analyses were uniformly satisfactory. (c) Unsatisfactory Samples. The Health Department is warned by telephone whenever preliminary results of bacteriological tests show presumptive coli. The Water Engineer is immediately notified. If there is no apparent cause simultaneous re-sampling by the Water and Health Departments is performed. Further action depends on the findings of these re-tests. Last year one re-test was needed and showed the water was not at fault. Testing of Samples by the Health Department. Weekly samples have been submitted to the area Public Health Laboratory, for bacteriological examination. The premises from which samples are taken are selected to cover each week the different sources of supply to the several areas of the borough. In addition, a monthly chemical analysis is carried out by the Public Analyst, who is furnished with copies of the reports of the bacteriologist. During the year under review the total number of examinations performed were:- Bacteriological 270 Chemical 12 85 The Ministry of Health requested the inclusion of the following information, for which I am largely indebted to the Borough Engineer, A. F. Holt, Esq., M. I.C.E. - 1. Public Swimming Baths (a) Croydon Suimming Baths Croydon Central Baths, Scarbrook Road - 2 Pools. Large Pool - Length 100', width 35', depth shallow end 3'6" deep end 7'6" Water capacity 115,664 gallons. Snail Pool - Length 75', width 25', depth shallow end 3'0" deep end 6'3" Water capacity 57,000 gallons. lb) Thornton Heath Baths - 2 Pools. Large Pool - Length 100', width 36', depth shallow end 3'6" deep end 10'0" Water capacity 135,000 gallons. Snail Pool - Length 66', width 33', depth shallow end 3'0" deep end 5' Water capacity 60,000 gallons. Central Baths and Thornton Heath Baths are open for swimming throughout the year and a complete water change is carried out at each pool once every two years. Water losses incurred by bathers and filter washing are made good from day to day from the town mains supply. (c) Purley Way Bathing Pool - 1 Pool - 1 Paddling Pool. Large Pool - Length 200', width 100', depth shallow end 2'9" deep end 15' Water capacity 650,000 gallons. Paddling Pool - 18' x 30' x 6" The Pool is open for swimming only during the summer season to September. The water is changed at the start of each season. The Paddling Pool is on continuous circulation to the pool Alters, but is emptied and refilled daily. 86 (d) Filtration and Sterilisation of Water (All Pools) The water at all the pools is filtered by pressure filters at approximately a four hour turn over period. The water is sterilised by operating super chlorination of average free chlorine content 2 p. p.m. at a pH of 7.8. Bacteriological tests are taken frequently by the Public Health Department and no adverse reports were received. (See "Laboratory Examinations"). The water to all Baths is supplied by the Croydon Water Department. 2. Sewage Sewerage and sewage disposal of the Borough are reasonably adequate. There were difficulties due to flooding just outside the Borough. An extensive scheme of remedial works was awaiting Ministerial sanction. 87 Nursing Homes - Public Health Act, 1936 Homes registered during the year . Number of Homes Number of Beds provided for:- Maternity Others Total _ . Homes on the Register at the end of the year 20 26 501 527 Routine inspections at about four monthly intervals by a medical officer of the department continued, and no special difficulties arose. Measures to ensure that all Homes complied with the requirements of the Fire Brigade were concluded. NURSES AGENCIES REGULATIONS, 1945 There is one Agency on the register. CREMATION ACTS, 1902 and 1952 During the year 2,202 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Acts. under the above Acts. The following table shows the certificates completed during the last ten years: - Year Certificates 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 1960 2,202 88 STAFF MEDICAL EXAMINATION The medical supervision of all Corporation staff provided by the Health Department covers:- (a) The scrutiny of the Health Statements made by all successful applicants to officer grades and any follow-up or medical examination deemed necessary. (b) Medical examination of all manual workers to determine:- (i) Fitness for duty. (ii) Eligibility for inclusion in the sick pay scheme. (c) Medical examination of prospective student teachers. (d) Examination for freedom from intestinal infection:- (i) All employees of the Water undertaking. (ii) All school meal service and canteen personnel. Arrangements for re-checks. (e) Eye tests on all Corporation drivers over 50 years of age at specified intervals. (f) Scrutiny of records of all staff who have been absent for an aggregate of more than 8 weeks during the preceding 12 months or who are exhausting entitlement to sick pay. Follow-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. 927 examinations were made during the year by the Medical Staff of the Department including 41 vision tests for drivers. Of these 702 were in respect of manual workers, who were classified as follows: - Fit for employment and sick pay scheme ... 622 Deferred for review 24 Unfit for sick pay scheme 138 Fit for light employment only (Not fit for sick pay scheme) 3 Unfit for employment 5 792 89 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 to 5 year olds daily excepting Saturdays,the remainder being of the "parttime" class, receiving toddlers for mornings only. These part time Play Groups are meeting a need in the residential areas in which they are established, by providing opportunities for young children to play with others of their own age and to accustom them to the break from home, which must inevitably come at the age of 5 years. The registered Minders receive children for the day. They are not encouraged to take children under 2 years. Nwnber Number of registered children 31.12.60 provided for Premises 5 134 Daily Minders 12 96 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. 90 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 92 cases registered: - 13 were due to glaucoma and 35 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had either been performed or would be carried out except:- 2 patients had moved from the Borough. 4 patients had died. 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 47 adult cases are registered with his Department, 10 of whom are in special Homes. 91 NATIONAL ASSISTANCE ACT, 1948, SECTION 47. NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951. In previous Annual Reports I have commented on the painful duty to use the powers given to Medical Officers of Health under this legislation. With the counter-signature of another registered medical practitioner he may recommend his local authority to apply for the compulsory removal of a resident of the area to an appropriate place, if the said person is "suffering from grave chronic disease or being aged, infirm and physically incapacitated, is living in insanitary conditions and is unable to devote to himself, and is not receiving from other persons, proper care and attention." Liberty may be the last cherished possession against which the elderly do not rate very high the risk of death. It is the fears and feelings of neighbours or other residents living in the same house, which demand action. During the year under review, 25 cases were reported from numerous sources, including family doctors, welfare officers of the Corporation, the National Assistance Board and voluntary organisations, neighbours, relatives, health visitors, home helps and the Police. The age range was 67 to 91 years. There were 6 males and 19 females. They were dealt with as follows:- Admitted to Queen's Hospital under a Magistrate's Order - 1 Admitted to Queen's Hospital voluntarily 7 Admitted to Mayday Hospital voluntarily 2 Admitted to local authority Hostel voluntarily 3 Died before action could be taken 1 Provided with additional domiciliary help 4 Awaiting admission to a Hostel (on 31.12.60) 1 Remaining under observation 6 Total - 25 The case admitted under Order was an elderly and infirm lady of 82 years of age, who did not fully recover from an attack of acute bronchitis. Following admission to hospital, she improved for a time but finally died a few months later. APPENDIX TABLES 93 94 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX All Causes Sex 0- 1- 5- 15- 25- 45- 65- 75- Total M 50 5 4 17 44 373 370 518 1, 381 F 30 4 9 8 27 229 339 907 1, 553 Tuberculosis (Respiratory) M - - - - 1 6 4 2 13 F - - - - 2 2 1 - 5 Tuberculosis (other forms) M - - - 1 - - - - 1 F - - - - - - 1 - 1 Syphilitic Diseases M - - - - - - 1 2 3 F - - - - - 1 - 4 5 Diphtheria M - - - - - - - - - F - - - - - - - - - Whooping Cough M - - - - - - - - - F - - - - - - - - - Meningococcal Infections M - - - - - - - - - F - - - - - - - - - Acute Poliomyelitis M - - - - - - - - - P - - - - - - - - - Measles M - - - - - - - - - P - - - - - - - - - Other Infective and Parasitic diseases M - - - - - - - - - F 1 - - - - - - 1 2 Total Infective and Parasitic diseases (including Tuberculosis) 1 - - 1 3 9 7 9 30 Malignant neoplasm, stomach M - . - - 2 14 10 13 39 F - - - - - 3 15 8 26 " " lung, bronchus M - - - - 2 66 39 21 128 F - - - - - 10 7 1 18 " " breast M - - - - - - - - - F - - - - 3 29 12 16 60 " uterus F - - - - - 13 9 8 30 Other malignant and lymphatic neoplasms M 1 1 1 1 4 35 51 42 136 F - - 3 1 5 40 36 49 134 Leukaemia; aleukaemis M - - - - 3 1 - 2 6 F - - - - 1 2 4 1 8 Total all forms of Cancer 1 1 4 2 20 213 183 161 585 Diabetes M - - - - 1 3 3 1 8 F - - - - - 1 - 2 3 Vascular lesions of Nervous System M - - - - 2 27 38 80 147 F - - - - 3 23 56 236 318 (a) Coronary disease, angina 11 - - - - 9 112 106 10 5 332 F - - - - - 30 75 129 234 (b) Hypertension, with heart disease M - - - . - 5 3 4 12 F - - - - - 2 6 18 26 (c) Other heart diseases M - . - 2 2 16 36 79 135 F - - - - 3 13 37 166 219 (d) Other circulatory diseases M - - - - 1 14 5 27 47 F - - - - - 7 11 80 98 Total heart and circulatory diseases . - - - 2 21 253 376 927 1,579 95 Sex 0- 1- 5- 15- 25- 45- 65- 75- Total Influenza M - - - - - - - - - F - - 1 - - - 2 3 6 Pneumonia M 13 - - - 1 7 11 50 82 F 4 - - 1 - 9 13 57 84 Bronchitis M 1 - - - 1 30 29 35 96 F - - - - 6 16 38 60 Other diseases of respiratory system M - - - - 1 _ 4 2 7 P - - - - 1 - 2 4 7 Total diseases of respiratory system - including influenza and excluding tuberculosis 18 - 1 1 4 52 77 189 342 Ulcer of stomach and duodenum M - - - - 1 2 7 4 14 F - - - - - 1 2 5 8 Gastritis, enteritis and diarrhoea M 1 - - - 1 2 1 3 8 F 1 - - - - 1 2 4 8 Nephritis and nephrosis M 1 1 - 1 - 5 3 1 12 F 1 - - - - 1 1 1 4 Hyperplasia of prostate M - - - - - 2 2 7 11 Pregnancy, childbirth and abortion F - - - - 1 - - - 1 Congenital malformations M 2 2 - - - - - - 4 F 5 - 1 - - 1 1 - 8 Other defined and ill-defined diseases M 30 1 1 1 1 12 8 27 81 F 15 3 3 4 2 20 21 66 134 Total Miscellaneous Diseases 56 7 5 6 6 47 48 118 293 Motor vehicle accidents M - - - 8 6 4 4 4 26 F - - - 1 3 3 2 5 14 All other accidents M 1 - 2 - 2 8 2 6 21 F 3 1 1 - - 1 3 4 13 Suicide M - - - 3 3 2 3 1 12 F - - - 1 3 10 4 1 19 Homicide and operations of war M - - - - - - - - - F - - - - - - - - - Total - accident s, suicide and violence 4 1 3 13 17 28 18 21 105 TOTALS 80 9 13 25 71 602 709 1, 425 2,934 96 CANCER Deaths from Cancer occurred at the following Ages:- Age Period Male Female Total Under 25 years 4 4 8 25 and under 35 years 1 3 4 35 and under 45 years 10 6 16 45 and under 65 years 116 97 213 65 years and over 178 166 344 Total 309 276 585 Sites of Fatal Cancer Site Hale Female Total Percentage of Total Skin 2 3 5 0. 855 Oesophagus 4 5 9 1. 538 Stomach 38 26 64 10. 940 Liver 5 1 6 1.0 26 Bowel 33 32 65 11. 111 Rectus 14 17 31 5. 299 Bladder 15 6 21 3. 590 Prostate 15 - 15 4. 81 Larynx and Pharynx 3 - 3 0. 513 Uterus - 30 30 10. 870 Breast - 60 60 21. 740 Ovary - 16 16 5. 797 Pancreas 13 6 19 3. 248 Gall Bladder and Duct - 3 3 0. 513 Tongue and Mouth 4 - 4 0. 684 Bones 3 2 5 0. 8 55 Lungs and Bronchus 128 18 146 24.9 57 Kidney 3 4 7 1. 198 Brain and Nervous System Lymphatic Glands and 6 6 12 2.051 Connective Tissue 5 5 10 1. 709 Haematopoietic Tissues 3 6 9 1. 538 Hodgkin's Disease 2 - 2 0. 342 Leukaemia 5 8 13 2. 222 Genital Organs 1 3 4 0. 684 Antrum 1 - 1 0. 171 Ear 1 - 1 0. 171 Adrenal - 2 2 0. 342 Tonsils - 1 1 0. 171 Undefined 5 16 21 3. 590 309 276 585 97 WARD STATISTICS WARDS Estimated Populat ion Births Birth Rat* Deaths 'Death Bate Deaths under 1 year Deaths under 1 year per 1.000 Birth Deaths from Diarrhoea (under 2 years) 'Death Bate from Diarrhoea (under 2 years) Deaths from Bronchitis and Pneumonia *Death Bate from Bronchitis and Pneumonia Deaths from Pulmonary Tuberculosis 'Death Bate from Pulmonary Tuberculosis Deaths from Non-Pulmonary Tuberculosis 'Death Bate from Non-Pulmonary Tuberculosis Deaths from Heart and Circulatory Diseases *Deaths Rate from Heart and Circulatory Diseases Deaths from Cancer 'Death Bate from Cancer Natural Increase of births ovrer deaths Upper Norwood 17338 221 12.7 209 12. 1 5 25 - - 16 0.92 - - - - 92 5. 31 44 2. 54 + 12 Norbury 1609 5 200 12.4 199 12. 4 6 34 - - 13 0.81 - - - 80 4. 97 39 2. 42 +1 West Thornton 16841 210 12. 5 162 9.6 2 11 - - 25 1. 48 3 0. 18 - - 57 3. 38 31 1.84 + 48 Ben sham Manor 16853 244 14. 5 227 13. 5 7 32 - - 27 1.60 1 0.05 - - 79 4. 69 43 2. 55 + 17 Thornton Heath 15860 253 16.0 174 11.0 4 18 - - 23 1. 45 1 0.06 - - 62 3.91 38 2. 40 + 79 South Norwood 16055 351 21.9 19 2 12.0 5 16 - - 23 1. 43 1 0.06 1 0.06 62 3.86 45 2. 80 + 159 Woodside 14689 237 16. 1 178 12. 1 5 24 1 0.07 23 1. 57 - - - - 61 4. 15 33 2. 24 + 59 East 16907 195 11. 5 186 11.0 3 17 - - 15 0.89 2 0. 12 - - 69 4.08 39 2. 31 + 9 Shirley 12850 124 9.6 128 10.0 1 9 - - 14 1.09 - - - - 52 4.05 19 1. 48 4 Addiscoabe 15736 290 18. 4 209 13.3 4 16 - - 20 1. 27 1 0.07 - - 84 5. 34 39 2. 48 + 81 White horse Manor 13389 284 21. 2 170 12.7 6 24 - - 14 1.05 1 0.08 - - 60 4. 48 35 2.81 + 114 Broad Green 13446 237 17.6 146 10.9 6 29 1 0.07 12 0.89 5 0. 37 - - 45 3. 35 36 2. 68 + 91 Central 10884 170 15.6 167 15. 3 4 28 - - 13 1. 19 - - - - 66 6.06 30 2.76 + 3 Waddon 15473 227 14.6 18 2 11.8 4 20 - - 25 1.62 - - - - 55 3. 55 33 2. 13 + 45 South 16464 247 14. 5 313 19.0 5 23 - - 25 1. 52 2 1. 21 1 0.06 117 7. 11 35 2. 13 66 Addington 20810 518 24.9 92 4. 4 13 27 - - 12 0. 58 1 0.05 - - 27 1. 30 20 0.96 + 426 The Borough 249690 4008 16. 1 2934 11.8 80 2D 2 0.01 300 1. 20 18 0.07 2 1068 4. 24 559 2. 24 + 1074 •Death Rate per 1,000 population. 98 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1941 - 1960 Year Births (Lire and Still ) Maternal Deaths Maternal Mortality Rate Infant Mortality Bate 1941 2. 472 8 3. 23 37 19 4 2 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 19 48 4, 59 7 2 0. 44 27 19 49 4, 102 5 1. 22 29 1950 3, 787 2 0. 53 26 1951 3, 697 3 0.81 19 1952 3, 548 2 0. 56 20 1953 3, 5 26 3 0. 85 21 1954 3, 649 3 0.82 19 1955 3. 408 2 0. 59 21 1956 3, 604 - - 19 1957 3, 510 3 0. 84 18 1958 3, 9 28 4 1. 02 18 1959 3, 874 1 0. 26 21 1960 4, 069 1 0. 25 20 99 DETAILS OF INFANT MORTALITY The following table gives the cause of death during the first month of life (Neo-natal mortality) (1) Complications of Labour - Trauma at Birth 5 Asphyxia (Toxaemia) 3 8 (2) Foetal States - Congenital Malformities 7 Atelectasis 2 Haemorrhagic Disease of Newborn 3 12 (3) Prematurity 28 28 (4) Post-Natal Causes 4 4 Total 52 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1,000 Births 1960 1959 1960 1959 Injury at Birth and Congenital 17. 5 23. 8 3. 50 4.99 Premature Births 35.0 30.0 6.98 6. 31 Respiratory Diseases 22. 5 12. 5 4. 49 2. 63 Atelectasis. Debility and Marasmus 2. 5 0. 50 2. 34 Diseases of Digestion* 2.5 1. 2 0. 50 0. 26 Other causes 20.0 21.3 4.00 4. 47 •These from Gastro enteritis Perinatal Deaths Stillbirths - 61 Perinatal rate - 26 per 1,000 Deaths in first week - 46 total (live and still) births Causes of Death in first week Prematurity - 27 Breech delivery after Congenital conditions - 6 rapid labour - 1 Atelectasis - 2 Asphyxia - 2 Cerebral haemorrhage - 3 Haemorrhagic disease of Ante-partum haemorrhage - 1 newborn - 3 Toxaemia of pregnancy - 1 Prematurity was a contributory cause in 3 cases. 8 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CAUSES OF DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th - 14th day 15th - 21st day 22nd - 28th day Total Under 1 month 1-2 months 2-3 months 3-4 months 4-5 months 5-6 months 6-7 months 7-8 months 8-9 months 9-10 months 10 - 11 months 11 - 12 months TOTAL All Causes 37 3 1 - 1 - 4 1 1 4 52 6 7 5 3 1 - 1 2 2 1 - 80 Meningoencephalitis - - - - - - - - - - - - - - - - - - - - - - - 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 Pneumonia (all forms) - - - - - - - - 1 2 3 4 4 2 2 - - - 1 1 - - 17 Diarrhoea and Enteritis - - - - - - - - - - - - 1 1 - - - - - - - - 2 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 2 1 1 - - - 2 - - 1 7 - - - - - - - - - - 7 Premature Birth 25 1 - - - - 1 1 - - 28 - - - - - - - - - - - 28 Atrophy, Atelectasis, Debility and Marasmus 2 - - - - - - - - - 2 - - - - - - - - - - - 2 Injury at Birth Haemorrhagic disease of 5 - - - 1 - 1 - - - 7 - - - - - - - - - - - 7 newborn 3 - - - - - - - - - 3 - - - - - - - - - - - 3 Other Causes - 1 - - - - - - - 1 2 2 2 1 1 1 - 1 1 1 1 _ 13 TOTALS 37 3 1 - l - 4 1 1 4 52 6 7 5 3 1 - 1 2 2 1 - 80 101 MIDWIFERY SERVICE The work of the municipal midwives was as follows:- 1. The number of maternity deliveries by Municipal Midwives on the district in the year 1, 397 2. The number of live births 1,387 3. The number of forceps deliveries 3 4. The number of still births 10 5. The number of neo-natal deaths Nil 6. The number of premature live born infants 10 (1) 34 weeks - 3 lbs. 4ozs. Transferred to Hospital (2) 30 weeks - Not weighed. Transferred to Hospital (3) 38 weeks - 41bs. 12ozs. Home (4) 36 weeks - 41bs. 8ozs. Home (5) 35 weeks - 41bs. 4ozs. Home (6) 36 weeks - 31bs. 5ozs. Transferred to Hospital (7) and (8) 36 weeks - Twins - 51bs. 8ozs. and 51bs. 4ozs. Home (9) and (10) 36 weeks - Twins - 2 lbs and 5 lbs. Transferred to Hospital. 7. The number of patients who received Trilene 19 8. The number of patients who received Gas-Air Analgesia 1. 297 9. The number of cases of P.P.H. (Home 16) 16 10. The number of cases of manual removal of placenta at home 2 The number of patients who received blood transfusion at home 4 12. The number of cases to which Plying squad was called ... 4 13. The number of cases of toxaemia of pregnancy treated at home 10 14. The number of cases of prolonged labour (over 24 hours) 2 15. The number of breech deliveries 6 16. The number of twins delivered 4 4 sets 17. The number of triplets Nil 18. The number of cases of Puerperal Pyrexia 31 (Genital Nil) (Extra-Genital 31) 19. The number of congenital malformations 6 (Talipes 3) (Cleft palate 1) (Extra digits 1) (Spina Bifida 1) Patients given Pethedlne 741 21 Patients sent to Hospital 401 (Ante-natal 306) (During Labour 74) (After Delivery 21) Patients sent home for nursing 458 (Home booked 233) (Hospital booked 225) 102 Midwife Mileage Deliveries Mid- wifery Maternity Gas and Air Ante-Natal Visits Post-Natal Visits Bookings Office Booking Home Visits Normal AbDo rmal Normal Abnormal Mid wives Pupils Mid wives Pupils 1. 2132 1 1 - - - 1 - - 1 - - - - 2. 3611 110 86 6 18 - 101 589 459 1171 1180 165 145 28 3. 7259 85 64 2 18 1 80 758 - 1123 - 89 92 2 4. 3529 82 74 5 3 - 72 812 360 1430 1006 115 111 - 5A. 1563 18 17 1 - - 15 231 - 417 - 30 29 3 5. 1803 32 32 - - - 31 226 - 606 - 36 37 6 6. 1725 57 39 - 16 2 47 707 - 1071 - 66 60 13 7. 38 21 91 68 3 19 1 89 713 - 1462 - 72 76 13 8. 4248 77 65 3 9 - 74 600 - 1104 - 94 95 18 9. 4403 110 98 - 12 - 104 487 50 2 1136 1107 124 158 29 10. 3280 82 56 2 23 1 80 558 299 1111 1134 147 135 29 11 7023 84 61 5 16 2 76 1000 657 120 6 978 175 141 14 12. 4934 100 86 1 11 2 93 635 425 1015 1249 158 18 2 39 13. 4580 68 59 3 6 - 66 78 2 - 1085 - 83 78 23 14. 4212 78 52 1 23 2 74 837 345 1170 1160 145 180 26 15. 3615 76 67 5 3 1 74 903 380 1555 1086 114 115 3 16. 4350 83 76 1 6 - 80 647 469 852 1261 169 163 47 17. 3866 97 84 3 8 2 80 766 45 2 1363 1269 140 135 41 18. 4507 66 51 - 12 3 60 451 - 980 - 70 73 13 19. 6176 - - - - - - 3 - 1798 - - - 58 20. 4036 - - - - - - - - 1461 - - - 62 Totals 84673 1397 1136 41 203 17 1297 11705 4348 23087 11430 199 2 200 5 461 No. 5 Left Service 22.7.60 No. 5A Joined Service 29.7.60 103 / The following table gives the details of the reasons for Midwives summoning medical aid: - FOR COMPLICATIONS DURING PREGNANCY Abortion 4 Other causes 13 Miscarriage 3 20 FOR COMPLICATIONS DURING LABOUR Breech 4 Post-partum haemorrhage 16 Malpresentation 2 Adherent and Retained Premature Labour 4 Placenta 13 Delayed Labour 15 Torn Perineum 126 Ante-partum Other Causes 46 haemorrhage 13 Episiotomy 11 248 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 14 Pain in Breasts 7 Pain in Legs 6 Other Causes 47 Rhesus Negative Blood 45 119 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 38 Still Birth 7 Other Causes 43 88 475 Reasons for the discontinuance of breast feeding are no longer notified. 104 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1960 who were born - (i) at home 41 (ii) in private nursing homes (iii) in hospital* 206 (2) The number of those born at home - who were nursed entirely at home 34 who were transferred to hospital on or before the 28th day 7 who died during the first 24 hours 1 who survived at the end of one month 40 (3) The number of those born in private nursing homes - who died during the first 24 hours who survived at the end of one month (4) Number of those born in hospital - who died during the first 24 hours 22 who survived at the end of one month 184 (5) Number of premature still births who were born - (1) at home 6 (11) in private nursing homes 1 (111) in hospital 28 The group under this heading will include cases which may be born in one hospital and transferred to another. 105 the work of the visitors -maternity and child WELFARE - 1 900 Visits Miss Barnes Com. 3. 10.60 Mrs. A.CL Batt Miss Bird Mrs. Blackburn Miss Blackmore Miss Blest Miss Brown Kenyon Miss Butcher Com. 25. 4.60 Miss Devaney Miss Early Miss Eldridge Miss Dnms Miss Gabain Com. L2.60 Mrs. Green Miss Hall Miss Harrington Mrs. Hartog Mrs. Hastings Miss Hawkins Miss Hodgson Left 17. 6760 Mrs. Laing Miss Llewellyn Miss Love 11 Mrs. Mayo Miss Storton Miss Partridge Miss Phillips Miss Vince Mrs. Wilson Miss wybrew Total - I960 Total - 1959 Infants under 1 year - First Visits 61 130 105 132 82 162 132 127 126 85 207 186 153 126 181 210 214 208 197 88 111 133 112 145 215 148 396 146 123 144 4585 4332 Re-Visits 122 218 353 667 174 373 454 399 404 756 641 529 576 380 605 598 634 309 371 177 183 52 207 590 437 306 747 488 463 590 12803 11171 Children 1-2 years - First Visits - 49 4 - 6 6 8 - 46 6 8 - 5 25 17 4 37 38 21 - 13 24 30 17 1 19 5 80 21 9 499 586 Re-Visits 34 110 265 272 138 203 241 192 336 575 396 379 194 422 274 359 414 394 252 84 63 33 87 460 176 217 345 464 275 368 8022 7425 Children 2-5 years - First Visits - 158 4 - 4 - 21 - 48 2 5 - 7 12 39 3 88 35 44 - 11 39 33 3 2 27 10 76 19 16 706 656 Re- Visits 48 275 294 408 223 497 386 277 384 414 550 463 503 712 563 399 820 404 458 53 94 47 152 539 525 548 357 430 319 821 11963 11040 Expectant Mothers - First Visits 2 1 8 1 17 8 32 12 9 3 13 14 18 14 46 57 7 1 45 2 4 11 34 10 49 24 69 10 37 64 622 511 Re-Visits - - - 30 - 4 32 6 5 - 16 5 3 - 58 71 - 1 22 1 3 2 3 20 4 23 159 7 11 - 486 375 Still Births - - - - - - 3 - - - - 1 - - 1 - - 4 - - - 1 1 - - - 3 - - - 14 20 Deaths under 1 year - - 1 - - - 3 - - -- - - - - 1 - 3 2 1 - - - - - - - - - - - 11 15 Miscellaneous Visits 30 36 286 2 54 17 215 54 52 2 46 79 7 - 255 17 43 47 101 40 25 740 80 4 24 53 15 72 14 4 2414 1699 Ineffective Visits 68 216 357 723 129 257 324 479 131 627 138 215 763 490 755 477 680 419 323 196 206 111 212 437 405 143 343 199 344 329 10496 10729 Totals - 1960 365 1193 1677 2235 827 1527 1851 1546 1541 2470 2020 1871 2229 2181 2795 2195 2940 1862 1835 641 713 1193 951 2225 1838 1508 2449 1972 1626 2345 52621 - Totals - I959 - 199 1644 1976 757 1544 1206 - 1310 2247 1959 1815 - 2697 2099 1862 2580 1690 2313 1751 575 2081 869 2195 1417 1095 1850 2249 1779 1947 - 48559* •Including Health Visitors who left in 1959. Nunber of families or household visited during the year 10,411 106 ATTENDANCES AT INFANT CENTRES - 1960 Bensham Manor Monday A. v. Bensham Manor Mbnday P.M. Boston Road Thursday P.M. Brighton Road Wednesday P.M. East Croydon Tuesday A. M. East Croydon Friday P.M. Falrchildes Friday P. m. Fal conwood Wednesday P.M. (Alt.) Monks Hill Thursday A.M. Monks Hill Thursday P.M. Monks Orchard Monday P.M. New Addington Wednesday A. M. New Addington Wednesday P.M. Norbury Wednesday A.M. Norbury Wednesday p.m. St. Albans Wednesday P.M. St. Albans Friday p.m. St. Andrews Monday P.M. St. James' Thursday A.M. St. James' Thursday p.m. St. Judes' Tuesday A. M. St. Judes' Tuesday P.M. St. Oswalds Thursday P.M. Selhurst Monday P.M. Siirley Thursday P.M. South Croydon Thursday P.M. South Norwood Tuesday P. M. South Norwood Friday P.M. Spring Park Monday P.M. Upper Norwood Wednesday P.M. Waddon Wednesday P.M. Woodside Friday A.M. Woodside Friday P.M. Total - 1960 Total - 1959. New Cases under 1 year 93 134 137 115 136 167 35 34 18 45 69 128 162 89 122 111 70 173 85 145 65 88 133 99 56 154 183 176 86 200 41 72 120 3541 3359 No. of Re-attendances 1425 1888 1635 1961 1859 2071 488 627 432 1083 762 1419 1280 1546 1563 1191 975 2056 1634 1892 1223 1481 1793 1490 657 2161 1553 1837 1078 1931 477 1054 1624 46146 47048 New Cases over 1 year 8 37 19 10 18 32 19 - 3 2 8 112 114 18 22 14 3 20 3 16 6 5 31 19 13 10 18 22 18 33 4 12 16 685 506 No. of Re-attendances 1109 1428 766 599 736 801 275 449 321 642 402 867 833 813 776 457 411 783 377 435 488 591 954 314 381 449 319 333 555 538 255 456 606 19519 20051 Attendances of Children 0-5 2635 3487 2557 2685 2749 3071 817 1110 774 1772 1241 2526 2389 2466 2483 1773 1459 3032 2099 2488 1782 2165 2911 1922 1107 2774 2073 2368 1737 2702 777 1594 2366 69891 70964 Consultations with Doctor 1059 1195 912 899 766 960 315 368 12 736 366 1180 1108 746 899 687 276 1122 655 818 525 628 1072 571 171 734 710 725 282 877 317 685 898 23274 21638 No. of Sessions 46 48 51 52 50 52 51 27 52 52 48 52 52 52 52 52 51 48 52 52 51 51 52 48 50 52 51 52 48 52 26 51 52 1630 1629 Expectant Mothers - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - No. of New Cases - - - - 1 5 - - - - 1 - - - - - - - - - - - - - - - - - - - - - - 7 18 No. of Re-attendances - - - - 1 21 - - - - 3 - - - - - - - - - - - - - - - - - - - - - - 25 26 Total Attendances of Expectant Mothers - - - - 2 26 - - - - - - - - - - - - - - - - - - - - - - - - - - - 32 44 Total Attendances 2635 3487 2557 2685 2751 3097 817 1110 774 1772 1245 2520 2389 2466 2483 1773 1459 3032 2099 2488 1782 2165 2911 1922 1107 2774 2073 2368 1737 2702 777 1594 2366 69923 71008 Average per Session 1960 54.9 72.6 50. 1 51.6 55.0 59.6 16.0 41. 1 14.9 34. 1 25.9 48.6 45.9 47.4 47.8 34. 1 28.6 63.2 40.4 47.8 34.9 42.5 56.0 40.0 22. 1 53.3 40.6 45.5 36.2 52.0 29.9 31.3 45. 5 42.9 - 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 55.3 37.3 26.3 46.4 42.5 45.7 34.0 51.4 28.3 33.6 43.7 - 43.6 107 HOME NURSING Staff at 31.12.60 Superintendent Deputy Superintendent 2 Assistant Superintendents 38 Queen's Nurses (including 4 males) 3 S. R. N's 1 S. E. A. N. Nurse 5 Queen's Students (including 1 male) Summary of work carried out during the year under review:- Patients remaining on books from 1959 952 New patients 3,613 Total 4,565 Sew Patients:- Medical 2,134 Surgical 1,416 Gynaecological 43 Obstetric 9 Maternity 11 Total 3, 613 Specially classified Cases Visits Tuberculosis 85 3, 283 Pneumonia 89 906 Maternity Complications - Infectious Diseases (including influenza) - Children under five years 165 881 Over 65 years old 2,711 93,995 Visits:- Termination of Cases:- Convalescent 2,275 Hospital 657 Died 417 Removed for other causes 247 Still on books 952 Total 4,548 108 Total visits January 12, 749 February 12,526 March 12,173 April 11,076 May 11, 262 June 9,710 July 10, 159 August 10,414 September 9,878 October 10,229 November 11,541 December 12, 072 Total 133, 789 REHABILITATION OF ELDERLY PERSONS Patients visited by Rehabilitation Nurse, 1960:- Female 42 Male 13 Total 55 Admitted to Hospital 7 Transferred for General Nursing 4 Recoveries (Rehabilitated) 26 Died 9 Remaining on books 5 Treatment discontinued 1 Ages 30 - 39 years 2 40 - 49 years 2 50 - 59 years 7 60 - 69 years 11 70 - 79 years 23 80 - 89 years 8 90 - 94 years 2 Illnesses Hemiplegia 29 Arthritis 11 Lower Limb Fracture 8 Other Conditions 7 109 In the age group 30-59 years. 4 cases of hemiplegia - 3 improved - 1 died. 2 cases of Parkinson's disease - 1 improved - 1 no change. 3 cases of Chronic Arthritis - 1 improved - 1 no change,but pain relieved - 1 transferred. 1 case of Fractured Carpus - 1 improved. 1 case of Carcinoma and Secondaries - Deteriorating. In the age group go - 94 years. 1 case of hemiplegia . Died. 1 case with fractured femur - Recovery as complete as age will permit. M. AND C. W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year:- Complaint No. of Cases Total M F Bow Legs 4 2 6 Knock Knees and Flat Feet 5 3 8 Valgns Ankles 4 7 11 Asthma 1 1 2 Kyphosis 1 1 2 Torticollis 1 1 2 Pigeon-toes 5 4 9 21 19 40 Total attendances 1, 109 110 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 241 Bed Rests 119 Mackintosh Sheets 199 Feeding Cups 8 Wheel Chairs 34 Commodes 61 Crutches, pairs 4 Air Cushions 156 Bed Cradles 25 Urinals 65 Air Beds 23 Dunlopillo Mattresses 4 Dunlopillo Cushion 2 Bed Pulley 3 Bed Tables 6 Draw Sheets Cotton 45 Walking Aid 8 Sputum Mugs 2 Enuresis Machines 31 Fracture Boards 5 Bedsteads 3 Steam kettles Nil Walking Machines 8 Bed Blocks 3 Pifco Massager Nil Foot Suction pump Nil Hydraulic Hoists 6 Walking Sticks 3 Foot Support 1 Ill HOME HELP SERVICE Staff at 31.12.60. Supervisor 4 Assistant Supervisors 2 Clerks 15 Whole Time Home Helps 189 Part Time Home Helps 1 Night Attendant Summary of unrk carried out during the year under review:- Patients remaining on books from 1959 1,155 New Applicants 1,463 Patients carried forward to 1960 1,212 New Applicants (a) Maternity 533 (b) Sickness 926 (c) For Night Service 4 Classification of Cases Attended (a) Maternity 449 (b) Tuberculosis 31 (c) Chronic Sick including Old Age 1,969 (d) Others including Acute Sick 409 Number of Hours of Service Given 222, 756 Average Duration of Service Given (a) Maternity 12 days (b) Acute Sickness 10-21 days (c) Chronic Sickness indefinitely Amount Recovered for Service £6,516.5.11. Rite of Remuneration of Home Helps at 31.12.60. 3/6&L per hour - Home Helps 3/4!4d. " - Sick Room Hglpers 3/3§d. " - Washing Service 3/llgd. " - Problem Family Helps £8.17.6d. per week - Family Helps 10/-d. " - Disinfestation 112 PROBLEM ETC. FAMILIES SUMMARY OF THE WORK CARRIED OUT DURING 1960 BY THE HEALTH VISITOR SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES. AND TO PREVENT THEIR NEED FOR ADMISSION Families admitted to Walmer House in 1960 46 Rehoused in private accommodation 18* Rehoused in Council accommodation 27 *(Of these 7 accommodated outside the Borough) Visits paid:- Family Departments Agents and Contacts 401 63 90 Families without permanent housing at close of year:- 4 Potential Homeless Families - not admitted to Receiving Homes -43 Visits paid:- Family Departments Agents and Contacts. 90 41 35 Problem Families 53 Visits paid:- Family Departments Agents and Contacts 308 95 64 Families referred hy other departments 48 Families referred by various organisations and private industry 9 Families making direct contact 18 Visits re employment 27 Families assisted with furniture 22 Family interviews (office) 284 Families referred to other departments and agencies 45 113 DENTAL TREATMENT - H. AND C. W. Expectant Mothers Nursing Mother Total Young Children. New Cases Examined 281 19 300 269 Re-treated 62 33 95 99 Total 343 52 395 368 Expectant and Nursing Mother Young Children. Attendances 944 595 Fillings 321 178 Extractions 331 310 Gas Cases 78 148 Local Anaesthesia 131 6 Scaling and Gum Treatment 222 - Dressings 163 166 Denture Dressings 207 - Silver Nitrate - 162 Treatment Completed 157 176 Number of Sessions (treatment) 347 Dentures Fitted 47 Dentures Repaired 7 The Centres at which patients were examined, or from which they were referred, are given in the following list:- Mothers Young Children Mothers Young Children. Ant e-Natal 346 - South Norwood - 1 Municipal _ South Croydon _ 1 Midwives 17 St. Alban' s 3 Post Natal 4 - Woodside - 1 Welfare Centres: Norbury - 1 Municipal - 1 Addington - 12 East Croydon - 2 St. Andrew's - - Upper Norwood - - Waddon - - Holy Trinity - - Boston Road - 1 St. Oswald's - 1 St. Jude's - - Bensham Manor - - St. John's(shirley) - Pairchildes - - Monks Hill - 6 Good Shepherd - - Crosfield Nursery - 1 Falconwood - - Referred by West Croydon - 1 Dental Officers: 336 Mothers: 367 Young Children: 368 Total: 735 114 HOME SAFETY Accidents taken to Hospital by Ambulance during 1960. Type of Accident Under 5 Age Groups 45-64 65 + Sex Total 5-14 15-44 M F Falls 78 67 34 64 88 158 173 331 Burns and Scalds 15 13 22 9 3 27 35 62 Poisoning 35 3 5 2 9 26 28 54 Suffocation 2 1 - - - 1 2 3 (fatal) Miscellaneous 29 39 34 12 8 77 45 122 Totals 159 123 95 87 108 289 283 572 DEATHS Cause No. Age Comments Falls 4 All over 78 years Burns 3 1. Girl 2 years Matches found in bed. 2. Lady 84 years Nightdress caught fire. 3. Lady 59 years Cooking. Poisoning 2 Ladles 68 and 72 years Carbon-monoxide. Suffocation 3 2 girl babies under 1. Overlaying 3 months old 2. Smothered by turning over into pillow. 1 boy 6 years Smothered by swimming cap over face. Electrocution 1 Male 50 years Using electric drill outside building. Total 13 115 CHIROPODY SERVICE Explanatory Leaflet and conditions of Service for chiropodists The Corporation intend to introduce a limited Chiropody Service for the following persons, who are permanent residents of the county Borough of Croydon:- (1) Old Age Pensioners. (drawing old age pensions from the Ministry of Pensions or the National Assistance Board). (2) Permanently Handicapped Persons. whose disability makes Chiropody necessary. (3) Expectant Mothers. Treatment will be provided by Chiropodists in their own surgeries as for their other fee paying patients. The Corporation will pay 3/- towards the cost of each treatment, the balance of the Chiropodist's normal charge to be met by the patient. However, for patients in receipt of non-contributory old age pensions or National Assistance Board benefit, the Corporation will pay 6/- for each treatment, on the understanding that no additional fee is to be charged by the Chiropodist to the patient. (These are interim amounts to be reviewed when a National Whitley Council scale is agreed). Payment will be claimed by the Chiropodist on forms to be supplied by the Corporation. As there is a limited sum available for this service, each Chiropodist will be notified the total amount he or she may claim during any one financial year. It will be necessary for the Chiropodist to refuse patients under this scheme if this amount is expended before the end of the financial year, as payment will not be made by the Corporation in excess of the sum allocated to the Chiropodist. Before treatment is given, expectant mothers must show a medical certificate confirming pregnancy or a booking slip signed by a general practitioner under, the National Health Service Maternity Regulations or an ante-natal clinic card. Handicapped persons must hand in a certificate from the family doctor certifying permanent disability and need for Chiropody. The Corporation may only make arrangements for this scheme with Chiropodists qualified in accordance with the National Service (Medical Auxiliaries) Regulations, 1954. 116 Authorised Officers of the Corporation shall be allowed at all reasonable times to inspect the premises at which Chiropody is carried out and any relevant records regarding the treatment of patients under this scheme. All treatment must be performed by the Chiropodist in person and approval must be obtained from the Corporation for any proposed deputising arrangements. The Corporation may refuse to accept or exclude individual Chiropodists from this scheme if so advised by the Health Commi ttee. 117 AMBULANCE SERVICE Classification of Journeys, Patients and Mileage. *Patients Journeys Mileage Health Service Removals 1960 1959 I960 1959 1960 1959 77,421 (79. 783) 44,377 (45,0 26) 349.065 (348,953) Accidents 4,265 (3,998) 3,981 (3,740) 21,954 ( 20,788) Spastics (Bramley Hill) 4,210 (4. 237) 492 (508) 8, 183 (8, 555) Mental Health Occupation centre) 29,361 ( 26, 400) 1,236 ( 1, 158) 27,0 34 (22,649) St. Margaret's (Spastic Children) _ (372) - (366) - (2,730) Services Not Required (Accidents) 329 (277) 1,426 (1,236) Gas and Air Analgesia 375 (484) 3,099 (3,548) Vehicles to Repair Depots, Testing etc. 254 (213) 2, 510 (2,169) Service Requirements, Oxygen, visiting SubStations, parks, etc. 660 (202) 3, 165 ( 2,491) 115,257 (114, 790) 51,704 (51,974) 416, 436 (413, 119) Civil Defence 109 (126) 1, 161 ( 1,369) 115,257 (114, 790) 51, 813 (52, 100) 417. 597 (414, 488) Note:- 1959 figures are In brackets. *These figures do not represent individual cases. It should also be noted that Service Requirement Journeys and mileage have increased mainly because of newly appointed Third Officer's extra duties of visiting Hospitals etc. Classification of Accident calls 1960 1956 Home Accidents (Children) 307 (316) (Adults) 327 (337) Miscellaneous Accidents (Children) 60 (56) (Adults) 64 (61) Recreational Accidents (Children) 146 (125) (Adults) 67 (70) School Accidents 279 (231) Street Accidents (Children) 210 (191) (Adults) 1, 002 (969) Work Accidents 283 (246) Home Illness (Children) 32 (38) (Adults) 245 (231) Street Illness (Children) 14 (12) (Adults) 701 (608) 118 Classification of Accident Calls (continued) 1960 1959 Work Illness 121 (122) Attempted Suicide 24 (24) Suicide 14 (22) Common Assault 85 (81) 3,981 (3, 740) Note:- 1959 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 51,502 417,583 1959 114, 790 51,974 413, 199 1960 115,257 51,704 416, 436 Details of Ambulance Service Vehicles One new Karrier Ambulance was delivered and one Humber "Pullman" Ambulance was disposed of during the year. List of Serviceable Vehicles at 31st December, i960 Eight Daimler Ambulances One Humber "Pullman" Ambulance One Humber "Super-Snipe" Ambulance Two Karrier Ambulances 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). Total Mileages of Ambulance Vehicles at 31st December, 1960. Daimler Anbulances JRK 756 1951 193,939 KOY 800 1952 163, 895 LRK 3 1953 140,084 LRK 289 1953 135,161 119 Daimler Ambulances (continued) LRK 555 1953 129, 324 NBY 501 1954 141,685 ORK 9 1955 120,227 ORK 8 1955 114,185 Bedford "UtiIecon" Sitting Case LVB 901 1953 145,608 LVB 896 1954 140,054 OVB 209 1955 113,096 SRK 189 1957 64,741 SRK 187 1957 61,892 UBY 329 1958 51,983 UBY 325 1958 44,851 WBY 247 1959 27,617 Humber "Pullman" Anbulances HRK 773 1949 168,076 Karrier Anbulances WVB 293 1959 22, 633 1110 BY 1960 6,379 Humber "Super-Snipe" Anbulances SOY 400 1957 74,824 Vauxhall "Wyvern" Saloon Car OBY 724 1955 69, 671 Bedford Sitting-Case Coaches KBY 700 1951 134,211 KRK 563 1952 135,146 Bedford Coaches (Mental Health) KRK 252 1952 87,026 MOY 639 1954 77,401 Austin Breakdown (since1955/56) GLR 801 1940 10,047 Karrier Coach (Mental Health) WVB 291 1959 13,916 120 MENTAL HEALTH ACT, 1959 Proposals Approved by the Minister of Health under Section 20 of the National Health Service Act, 1946 for the Provision of Mental Health Services under Section 28 of that Act. General (1) These proposals replace all existing proposals approved by the Minister relating to the prevention of mental illness, the care of persons suffering from mental illness or mental defectiveness, and the after-care of such persons under Section 28 of the National Health Service Act, 1946, but existing proposals for carrying out duties under the Lunacy and Mental Treatment Acts, 1890 to 1930 and the Mental Deficiency Acts, 1913 to 1938 will continue in operation until the relevant provisions of those Acts are replaced by the provisions of the Mental Health Act, 1959 on dates appointed by the Minister by Order under Section 153 of the Mental Health Act, 1959, when the proposals set out below will become effective in substitution. (2) The Corporation propose to make appropriate arrangements for the provision of services to meet the needs of mentally disordered persons living in the community and to make the services known to and available to those who are in need of them. Organisation and Staff of the Services (3) The Corporation's present arrangements are as follows:- Acting under fully delegated powers the Health Committee deals directly with mental health matters and includes among its co-opted members the Medical Superintendent of Warlingham Park Hospital, the mental hospital serving Croydon. The Medical Officer of Health, who is also the Principal School Medical Officer, is in administrative control and the Deputy and two Assistant Medical Officers of Health are approved for duties under the Mental Deficiency Acts. There are five Duly Authorised Officers with one acting as a Co-ordinating Officer for mental deficiency duties and two clerks. (4) Other mental health facilities available in the Borough are provided by the Hospital Management Committee of Warlingham Park Hospital and include numerous adult out-patient clinics in general hospitals, psychotherapeutic outpatient group meetings, psychiatric outpatient social clubs and a day-treatment centre. Psychiatrists from the mental hospital conduct regular group discussion meetings with the Mental Welfare and Health Visitor staffs of the local health authority. 121 (5) Four of the Duly Authorised Officers act as Mental Deficiency Visitors and each is responsible for an area of the Borough in which he carries out routine visiting of patients under guardianship or on statutory or friendly supervision. (6) The Corporation consider that the close co-ordination of hospital and domiciliary mental health services is essential for the full benefits to be available to those concerned. To this end, they will consult as may be required with the Regional Hospital Board or Hospital Management Committees regarding interlocking membership of relevant Committees, co-optation of officers or ad hoc liaison Committees as may be appropriate. (7) General administration of the mental health service will continue as a responsibility of the Medical Officer of Health. (8) The Regional Hospital Board will be asked to make formal arrangements for consultant psychiatric sessions to be available for the Corporation from the psychiatrists in contract with the Board at mental hospitals serving Croydon. (9) As regards Warlingham Park Hospital, whose staff will be mainly concerned, the allocation of these sessions will be through the Medical Superintendent of that hospital. (10) The Corporation will augment their existing staff of lay officers and begin by the appointment of a suitably qualified Senior Mental Welfare Officer (preferably a Psychiatric Social Worker). The Corporation will commence a training scheme for Mental Welfare Officers and propose the early appointment of two trainees, and will make other arrangements by secondment if necessary, to ensure that staff are adequately trained and qualified. Pending the Minister's approval of national training standards, such trainees will be given supervised experience and allowed to attend appropriate courses of instruction, which may be arranged by other local health authorities or voluntary organisations (11) They will appoint such additional administrative and clerical staff as may be required to support the work of the clinical officers. To support the co-ordination of hospital and domiciliary services for the prevention, treatment and aftercare of mental disorder, the Corporation will make available suitable and adequate accommodation for the use of all staff concerned with these duties in as close proximity as possible to Corporation departments concerned with health and social services. 122 (12) The Corporation will consult with the Executive Council and Local Medical Committee regarding any necessary administrative arrangements to ensure close co-ordination with family doctors. Every effort will be made to acquaint general practitioners with matters concerning their patients by personal approach of the officers concerned, by correspondence and by invitationsto attend any relevant clinical conferences. (13) The Corporation will continue their support of voluntary organisations concerned with mental health, such as the National Association for Mental Health, the Mental After-Care Association and the Guardianship Society, by using their services, membership of appropriate councils or committees and subscriptions to their funds. Services to be Provided (14) The Corporation propose to carry out their duties under Section 28 of the National Health Service Act, 1946, in accordance with the following provisions:- Junior Training Centres. (15) The Corporation maintain an Occupation Centre with 90 places, staffed by a Supervisor, five Assistants and a Handicraft Instructor. Those attending are transported to and from the Centre and a mid-day meal is supplied. (16) Medical and dental inspections are carried out by the staff of the School Health Service and dental treatment is provided by school dentists. There is a small scheme for the employment of suitable male defectives on gardening duties, for which they are paid pocket money. (17) It is proposed that the existing Occupation Centre of 90 places shall be continued until provision of an adult training centre allows the separation of individuals over 16 years of age, who are at present in attendance. Approximately 60 places will then be needed for children between the ages of five and sixteen years, to which may be added a small nursery section of approximately six places. (18) Arrangements for transport to and from the Centre will continue, together with the provision of a mid-day meal, dental treatment and medical inspection. (19) As a future development, the Corporation are considering the replacement of the existing adapted buildings by new premises designed especially for this purpose. 123 Adult Training Centres (20) Active consideration is now being given to the provision of an adult training centre of approximately 70 places to be available for those of 16 years of age and over, which should be adequate to meet immediate demands. Further provision will be made as necessary to ensure that training facilities will be available to all persons over 16 who can benefit by them. The Corporation are considering whether a special building with suitable workshops should be erected to serve both mentally and physically handicapped persons, for whom such facilities must be provided by the local authority. Under such arrangements, there would be joint usage of staff, for example, for the approach to industry, the marketing of products, the use of trained handicraft instructors and catering staff supplying meals. Transport will be provided and meals and medical inspection arranged as necessary. It is proposed, however, that the Supervisor of the Mental Health Section will have experience and training in the care of mentally disordered patients. Residential Accommodation (21) The Corporation are now making arrangements with the Mental After-care Association for the reservation of ten beds in a hostel, which is being established in Croydon, for ex-mental hospital patients, who are fit to go to work. The Corporation will increase the number of places or consider the establishment of their own hostel of this type in the light of experience of these initial arrangements. This type of accommodation is thought to be relatively short-term, the patient returning eventually to an ordinary life in the community. (22) The Corporation will provide accommodation for approximately sixty mentally ill patients no longer in need of, or who from the outset do not require hospital care, either in Corporation owned premises administered by the Health Committee or by arrangements with other local authorities or voluntary organisations. (23) Accommodation will also be provided in a similar manner for approximately twelve mentally sub-normal or severely sub-normal Patients with the same needs. Arrangements will be made, where suitable for residents to attend a training centre or work in ordinary or sheltered employment. 124 (24) The Corporation will, as necessary, provide further residential accommodation for mentally disordered persons, or will make arrangements for its provision by other bodies or authorities, or otherwise. (25) The Corporation will continue to make arrangements for short-term care. Home Training (26) No home or group teachers are employed at present for mentally disordered persons, as the number with an added physical handicap, which prohibits their attendance at a training centre, is small. The Corporation will review the position from time to time and if satisfied that a sufficient demand exists, will consider, the employment of one or more suitably qualified parapetetic teachers to give instruction in the homes of those concerned. If instituted, such a service would operate from one or other of the training centres. Ray Centres, Social Clubs and other Activities (27) As indicated, the Management Committee of Warlingham Park Hospital (the mental hospital serving Croydon) already operates in Croydon a day centre for mentally handicapped persons, which now accepts 20 patients all day for five days a week. Cases of mild senile dementia and partly recovered psychotics, who by past treatment in the mental hospital have been rendered able to live at home, but not able to earn their own living, are attending. (28) In addition, there are weekly afternoon psychiatric club meeting for old folk and three evening therapeutic social clubs for younger patients. There are two sessions weekly for evening group psychotherapy and facilities for a twice weekly meeting of the local branch of "Alcoholics Anonymous". (29) It is understood that the Warlingham Park Hospital Management Committee intend to continue and expand these activities as may be necessary and are now anticipating acquiring alternative accommodation, which will allow the day hospital to accept 40 to 50 patients in place of the present 20 per day. It would appear unnecessary, therefore, for the Corporation to duplicate any of these services, but they will provide or accept financial responsibility for day centres and social clubs meetings, where no psychiatric treatment or nursing is given. 125 Home Visiting Service (30) At the present time, four of the Duly Authorised Officers act as Mental Deficiency Visitors, each having an area of the Borough for which he is responsible. A monthly case conference is also being held with the staff of the mental hospital, so that these local authority officers may carry out the community care of a small number of selected ex-hospital patients. (31) With the appointment of a Psychiatric Social Worker and two trainee Mental Welfare Officers, the scope and extent of these follow-up duties will be extended. The Corporation will take such measures as are necessary to ensure that the staff of the home visiting service are adequately trained or qualified, and will encourage them to take the necessary training. Guardianship (32) The Corporation use the Guardianship Society for the Placement and subsequent supervision of a small number of mental defectives (at present 12). They also accept financial responsibility for suitable patients placed in after-care homes of the Mental After-Care Association. The Medical Superintendent of St. Lawrence's Hospital for mental defectives has regularly examined in the local health authority's spremises patients put forward for hospital treatment. (33) The Corporation undertake to exercise their functions under the Mental Health Act, 1959 in respect of persons placed under guardianship whether under the guardianship of the Corporation or of other persons. It is proposed to continue the present system of placing suitable patients under guardianship in the area of other authorities to be supervised by officers of the Guardianship Society. Health Education (34) The Corporation regard education for mental health as a most important growing part of their general programme of Health Education. They intend to use the staff of the mental section for in-service training of other Health Department personnel and in programmes of general Health Education especially for services provided under Sections 22, 23 and 24 of the National Health Service Act, 1946. 126 MENTAL ILLNESS Period 1.1.60 to 31.10.60. - Lunacy and Mental Treatment Acts 2890-1930. Patients admitted to Hospitals:- As informal patients 13 As voluntary patients - Section 1, Mental Treatment Act 1930 7 Under 3 Day Orders - Section 20 Lunacy Act 1890 345 365 Cases investigated but not admitted to hospitals 62 The 345 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 149 Certified under Section 16, Lunacy Act 1890 48 Became Temporary patients under Section 5, Mental Treatment Act 1930 1 Discharged home 112 Discharged to Queens Hospital 5 Discharged to General Hospital for treatment 18 Discharged to Nursing Homes 10 Discharged to Police Care 1 Died 1 345 Period 1.11.60 to 31.12.60 - Mental Health Act 1959 Patients admitted to Hospitals:- As informal patients 8 Under Section 25 7 Under Section 26 5 Under Section 29 50 70 Cases investigated but not admitted to hospitals / u 19 Mental After Care o patients were admitted to Homes run by the Mental Aftercare Association. 5 for convalescence and the remaining 3 on a long term basis. The Corporation accepted financial responsibility subject to contributions according to means. 127 The Mental Welfare Officers paid 287 follow-up visits to patients who had been discharged from hospital. Mental Health Act 1959 - Subnormality and Severe Subnormality During the year 15 new cases were ascertained, compared with 22 in 1959, and the total number of cases on the authority's registers is now 841 made up as follows:- In psychiatric hospitals 359 On leave of absence from hospitals 9 Under guardianship 14 Under friendly supervision 459 841 Further information concerning cases dealt with in 1960 is appended below and the 1959 figures are given for comparison purposes: - 1960 1959 Admitted to Psychiatric Hospitals 21 18 Admitted to Psychiatric Hospitals(mental illness) 1 3 Admitted to Hospitals for Siort-Term Care 15 13 Transferred from one hospital to another 6 9 10 cases were awaiting permanent hospital vacancies on 31st December, 1960. 3,396 visits were paid by the Mental Welfare Officers and the number of cases dealt with shows a slight decrease when compared with the 1959 figure. 128 COMMUNICABLE DISEASES NOTIFIED DURING 1900 Notifiable Disease Cases notified Total cases notified in wards At all ages At ages - years Upper Norwood Norbury West Thornton Ben sham Manor Thornton Heath South Norwood Woodside East Addiscombe Whitehorse Manor Broad Green Central Waddon South Addington Shirley M F. Under 1 1-4 5-14 J5-24 25-44 45-64 65 and over Scarlet Fever 337 1 99 230 6 1 - - 27 13 23 17 43 18 16 12 17 21 58 16 18 8 11 19 182 155 Diphtheria Erysipelas 17 - - - - 3 11 3 - 1 - 1 1 1 1 - - 1 3 1 - 2 1 4 8 9 Meningococcal Infection 4 1 1 - 1 1 - - - - - - - - - - 1 1 1 _ 1 - _ - 2 2 Enteric and Paratyphoid 6 _ 2 _ 1 1 1 1 - _ 1 - - 3 _ 1 _ _ _ - _ 1 - 2 4 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 12 - - - 8 4 - - 1 - 2 - - - 1 1 - - 5 - - 2 - - - 12 Ophthalmia Neonatorum 13 13 - - - - - - - - - 2 - - 1 2 - - 7 - 1 - - - 5 8 Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 181 1 46 80 8 38 8 - 6 26 6 16 19 7 6 14 2 4 7 3 16 4 39 6 92 89 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Primaryary and Influenzal Pneumonia 28 1 3 9 3 4 8 - 2 2 1 - 3 2 - 4 2 - - 1 3 2 3 3 12 18 Food Poisoning 23 - 5 6 1 4 5 2 - - - - 7 7 - - 1 1 3 - 1 3 - 10 13 Acute Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 129 5 90 30 2 2 - - 16 14 10 7 12 9 - - 8 6 9 2 7 16 12 1 89 60 Whooping cough 481 55 184 235 4 3 - - 35 20 19 19 70 16 10 36 31 42 18 11 21 12 80 41 24 2 239 1231 77 430 590 34 61 33 6 87 76 62 82 155 63 35 70 62 76 111 34 67 47 150 74 624 607 The tuberculosis notifications are shown In the section relating to that disease 129 MONTHLY INCIDENCE OE COMMUNICABLE DISEASES 1960 Notifiable Disease Jan . Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 12 10 14 16 5 6 14 9 5 6 13 11 121 Non-Respiratory Tuberculosis 3 2 3 1 3 1 1 1 - - 2 1 18 Scarlet Fever 59 60 50 51 29 23 18 9 6 8 13 11 337 Diphtheria - - - - - - - - - - - - - Erysipelas - 2 2 3 1 - 2 1 3 1 - 2 17 Meningococcal Infection 1 1 - - - - 1 - - - 1 - 4 Enteric and Paratyphoid - - - - - - - 1 1 - - 4 6 Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - _ Typhus - - - - - - - - - - - - - Puerperal Pyrexia - - 2 - - 2 2 - 2 1 1 2 12 Ophthalmia Neonatorum - - - - - 1 - - - 4 7 1 13 Poliomyelitis and Polioencephalitis _ - - _ - - - - - - Dysentery 9 15 16 17 24 26 32 13 16 6 1 6 181 Malaria - - - - - - - - - - _ - _ Ac. Pri. and Act. Inf. Pneumonia 6 5 9 1 - - 1 1 3 - - 2 28 Food Poisoning 1 - - 2 - 2 1 3 7 2 2 3 23 Acute Encephalitis - - - - - - - - - - - - - Measles 39 2 3 2 10 6 9 8 7 9 28 6 129 Whooping Cough 12 8 4 15 41 72 52 64 100 48 35 30 48 1 1370 130 IMMUNISATION AGAINST WHOOPING COUGH A total of 3,321 children were immunised against whooping cough, comprising 3,137 under school age and 184 school children. IMMUNISATION AGAINST TETANUS A total of 3,016 children were immunised against Tetanus, comprising 2,828 under school age and 188 school children. 498 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 2,812 persons were vaccinated against Small-pox. Under 1 year of age 1 2-4 5-14 15 or over Total Successful vaccinations 2, 195 150 87 95 58 2,585 "Re-vaccinations - 1 2 17 117 137 Insusceptible to Vaccination 79 3 5 1 2 90 2,812 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, I960, who had completed a course of Immunisation at any time before that date (i.e at any time since 1st January, 1946. Age at 31. 12. 60 i.e. Born in Year Under 1 1960 1956-1959 1951-1955 1946-1950 Under Total Last complete course of inJections A. 1956 - 1960 1,850 8,099 5,808 2, 199 17,956 B. 1955 or earlier - - 5,521 12, 223 17,744 C. Estimated midyear child population 3, 570 14,130 37,300 55,000 Immunity Index 100 A/C 51.82 57. 31 21. 46 32.64 131 VACCINATION AGAINST POLIOMYELITIS The following table gives the number of persons vaccinated with 2 injections during the year. Children born 1943-1960 Young persons born 1933-1942 Persons born 1920-1932 Expectant Mothers Persons over 40 4,116 1,584 6,722 335 54 19,90b persons received their third injection during 1960 making a total of 58,490. Of the age group 0-17 years 94.4% had received 2 injections. Of the age group 18 - 27 years 50.2% had received 2 injections. Of the age group 28 - 40 years 10.9% had received 2 injections. Over 40 years of age .05% had received 2 injections. Others 3,497 had received 2 injections. INTERNATIONAL CERTIFICATE FOR VACCINATION During the year 2,487 certificates were dealt with at the office (2,309 Smallpox, 137 Cholera and 41 T. A. B.). 132 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATIONS AND MORTALITY - 1940 - 1960 133 TUBERCULOSIS The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) Tuberculosis (All Forms) 0-15 years All ages 0-15 years All ages Year Number of Deaths Death rate per thousand of population * Number of Deaths Death rate per thousand of population Year Number of Deaths Death rate per thousand of population * Number of Deaths Death rate per thousand of population 19 20 39 - 195 1.02 1941 10 - 111 0. 59 19 21 29 0. 57 184 0.96 1942 8 - 116 0.63 19 22 30 - 209 1.09 1943 9 - 120 0.62 19 23 25 - 190 0.98 1944 9 - 10 5 0.57 19 24 18 - 188 0.96 1945 9 - 92 0.46 19 25 27 - 181 0.91 1946 7 - 10 5 0.47 19 26 27 - 208 1.01 1947 4 0.08 105 0.44 1927 15 - 203 0.96 1948 3 0.06 111 0.45 19 28 24 - 206 0.96 19 49 6 0. 12 94 0.38 19 29 21 - 178 0.80 19 50 4 0.08 65 0.27 19 30 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 19 34 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 19 57 - - 33 0.13 1937 11 - 155 0. 64 1958 - - 20 0.08 1938 12 - 137 0. 56 19 59 - - 25 0.10 19 39 6 - 107 0. 46 1960 - - 20 0.08 1940 8 - 146 0. 74 *Prior to 1947, rates only available for Census years. 134 Public Health (Tuberculosis) Regulations, 1952. Summary of notifications during the period from 1st January, 1960 to 31st December, 1960: - 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 4 2 1 4 9 16 18 14 7 7 2 86 Respiratory, Females - 1 1 4 1 3 2 7 8 3 1 3 1 35 Non-Respiratory, Males - - - - - 1 - 3 2 3 - 3 - 12 Non-Respiratory. Females - - - - - 2 - 1 2 - 1 - - 6 135 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, 1960 to 31st December, 1960, otherwise than by formal notification: - 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- TOTAL Death Returns from Local Registrars Respiratory M - - - - - - - - - - - - 1 1 (A) F - - - - - - - - - - 1 - - 1 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) 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 - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable Deaths) Respiratory M - - - 1 1 - 7 14 6 3 3 2 - 37 (A) F - - - - 1 2 9 12 4 1 1 1 - 31 (B) Nod-Respiratory M - - - - - - - 1 - - - - - 1 (C) F - - 1 - - - - - - - - - - 1 (D) Other Sources Respiratory M - - - - - - - - - - 1 - • 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - 1 - - - - - 1 (C) F - - - - - - - - - - - - - -(D) TOTALS (A) 39 (B) 32 (C) 2 (D) 1. 136 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1960 2,009 Transfers in from other areas 71 '' Lost sight" cases returned during the year - New cases diagnosed as definite during the year 127 2,207 Number of cases written off the Chest Clinic Register during the year as: - Recovered 127 Died 43 Removed to other areas 77 ''Lost sight of" and other reasons 28 275 Remaining on Register as at 31st December 1,932 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 2,533 Number of visits paid by Clinic doctors to homes of patients . 308 Number of visits paid to homes of patients by Tuberculosis Health Visitors 4,417 Attendances of patients at the Clinic - At ordinary sessions 17,148* At refill sessions 23 17,171* Number of X-ray films taken 18,237 *includes 3,385 miniature film attendances. 137 VENEREAL DISEASES - NEW CASES 1940-1960 138 VENEREAL DISEASES SYPHILIS Totals Males Females L Patients under treatment or observation on January 1st 63 35 28 2. Patients removed from the Register in previous years who returned during the year for treatment or observation of the same condition - - - 3. Patients transferred from other centres after diagnosis - - - 4. Patients dealt with for the first time (excluding 2 and 3) suffering from:- Syphpis, primary 1 1 - ,, secondary - - - ,, latent in the ,, 1st year of ,, infection - - - cardio-vascular of the nervous system - - - All other late or latent stages 1 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 - - - TOTAL Item 4 2 2 - 5. Patients completing treatment and/or observation 26 6 20 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) 39 31 8 GONORRHOEA 9. Patients under treatment or observation on January 1st 26 16 10 10. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 3 3 11. Patients transferred from other centres after diagnosis - - _ 12. Patients dealt with for the first tine (excluding Items 10 and 11) 112 88 24 13. Patients completing treatment and/or observation 14. Patients transferred elsewhere 118 90 28 15. Patients not completing treatment and/or observation 10 8 2 16. Patients under treatment or observation on December 31st (should equal Items 9 to 12 less Items 13 to 15) 13 9 4 139 OTHER CONDITIONS  Totals Males Females 17. Patients under treatment or observation on January 1st 44 32 12 18. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 12 12 _ 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 85 85 _ Yaws _ _ _ Any other conditions requiring treatment 191 10 2 89 conditions not requiring treatment 249 155 94 Undiagnosed conditions _ _ _ TOTAL Item 20 525 342 183 21. Patients completing treatment and/or observation 542 358 184 22. Patients transferred elsewhere _ _ _ 23. Patients not completing treatment and/or observation 12 9 3 21. Patients under treatment or observation on December 31st (should equal Items 17 to 20 less Items 21 to 23) 27 19 8 ATTENDANCES BY PATIENTS At which patients saw physician Syphilis 115 69 46 Gonorrhoea 439 357 82 Other Conditions 1611 1236 375 TOTALS 2165 1662 503 At which patients did not see physician Syphilis 272 161 111 Gonorrhoea 132 79 53 Other Conditions 678 370 308 TOTALS 1082 610 472 CONTACTS ATTENDING FOR EXAMINATION REFERRED BY PATIENTS SUFFERING FROM: - Syphilis _ _ _ Gonorrhoea 72 62 10 Non-Gonococci Urethritis il 59 59 _ Other conditions 63 41 22 TOTALS 194 16 2 32 140  By the Physician at the Centre Sent to a Pathological Centre PATHOLOGICAL WORK NUMBER OF SPECIMENS EXAMINED Microscopical: for Syphilis _ 5 Microscopical: Others _ 878 Cultural _ 646 Serum: for Syphilis _ 648 Others _ 401 Cerebro spinal Fluid (Number of diagnostic lumbar punctures) _ 5 SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR SHOWING THE AREAS IN WHICH PATIENTS DEALT WITH FOR THE FIRST TIME (ITEMS 4, 12 AND 20) RESIDED (MAJOR AREAS TO BE SPECIFIED. MINOR AREAS MAY BE GROUPED AS "ALL OTHERS ) County. County Borough (England and Wales) and Others Syphilis Gonorrhoea Other Conditions Totals Croydon 1 73 337 411 Surrey 1 18 112 131 Kent - 8 29 37 London - 13 47 60 Totals (to agree with Items 4, 12 and 20) 2 112 525 639 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1960 To the Chairman and Members of the Education Committee. LADIES AND GENTLEMEN, This is the 57th Annual Report to be made to the Croydon Education Authority by the Principal School Medical Officer. Mainly, it is a record of the normal performance of routine duties. Medical inspections in the schools were less than last year, when an especial effort was made to deal with arrears due to the polio vaccination campaign of 1958. All the names of children brought forward by Head Teachers were included in examination sessions and work was therefore up-to-date at the close of the year. The results call for no special comments. Because Heights and Weights now seem to have reached a constant level after the post-war rise, there may be no need to continue taking and recording these figures for the two intermediate age groups. A check on children entering and leaving school should be sufficient to show any significant changes. Specific infectious diseases caused the average amount of absence, but there were no major epidemics requiring special measures. 2 A local service for the early ascertainment and treatment of deafness combining local authority and hospital facilities was established and is working smoothly. In my Annual Report for 1950, I first suggested the desirability of such a scheme and it may seem a long interval before it has been brought into being. However, there have been many changes and developments over the last decade and we have had the advantages of learning from the mistakes of others. It is true that parents have had to travel to and from London for a service which is now available in Croydon, but there have been many difficulties which a pioneer clinic controlled by a voluntary hospital could readily overcome in a manner hardly possible for a local authority. In short, I think the quality of the service we are now offering would not have been possible until quite recently and is well worth the waiting period. The next step would seem to be local educational facilities for deaf or partially deaf children, but once again I think we must be cautious in giving up the excellent facilities now available through the assistance of the London County Council. Only when you are certain of equal quality in a local service should you allow the time, inconvenience and expense of sending children into London to influence the Committee's present policy. There was also a marked strengthening in the Child Guidance service, firstly by the appointment of a full-time Consultant Child Psychiatrist and on the local authority side, the appointment of an Educational Psychologist. The latter is, of course, a member of the Child Guidance Clinic team and a minor defect of co-ordination with Education staff has been remedied. The Principal Dental Officer deals with the persistent problems of this service and it is particularly disappointing that the replacement of the clinic for south Croydon and Waddon made very little real progress. It was necessary to await the results of an application to the Ministry of Housing and Local Government regarding the use of a site and in the end, permission was refused. An alternative was available, subject to access being allowed and by the close of the year, all the site problems had been solved. 3 The Health Education Officer reports on another year of steady progress in bringing Health Education into the ordinary school curriculum. The Chief Education Officer and members of his department and the Head Teachers have as always proved most helpful and co-operative. Finally, I would express appreciation for the customary unfailing interest and encouragement shown by all members of the Education Committee towards the work of the School Health Service. Public Health Dept., Croydon. 4 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 10 (including 2 part-time) (41%) *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 & 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 tine 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.). Asbburton school, Shirley Road, croydon. (Monday and Thursday, 9 a.m.). Rockmount school, Rockmount Road, Upper Norwood. (Monday and Thursday, 2 p.m.). Duppas School, Goodwin Road, Waddon. (Dally, Monday to Friday, a.m.). salcot crescent. New Addington. (Daily, Monday to Friday, a.m.). Dental Lodge Road, Broad Green, Croydon. 20 6, Selhurst Road, south Norwood. Waldrons Hall, 55, Duppas Hill Lace. Croydon. Overbury School, New Addington. Stroud Green, Shirley Road, croydon. Inspection Lodge Road, Broad Green, croydon. Twice weekly. Wolsey school. New Addington. Once a month. Rockmount school, s. E. 18. Once a month. Ashburton School, Shirley Road, Croydon. Once a month. Duppas School, Goodwin Road, croydon. Once a month. Remedial Exercises and Massage 47, St. James's Road, Broad Green. Croydon. 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. Audlology Clinic Lodge Road, Broad Green, croydon. Enuresis Lodge Road, Broad Green, Croydon. weekly, and at Salcot Crescent, New Addington. Once a month. 5 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is as follows: - Primary and Modern Secondary Schools. (l) 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., Group Children in their second year in a Junior School, unless previously examined in the Junior School. (3) Entrants to i.e., Secondary School Children in their first year in a Secondary school who have not already been examined as Primary Leavers. (4) Final i.e. Leavers Children in their last year of attendance at a Maintained Secondary School who have not been medically examined in that year. (5) Special i.e., Cases Children of other ages with possible defects and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 12,792 children were examined as compared with 13,663 in 1959, and 6,090 parents attended the examinations. The total percentage of parents attending was 47.6 against 48.5 last year. See Appendix B, Table V. 638 specials and 463 re-inspections of children were carried out. 6 HEALTH EDUCATION IN SCHOOLS Miss D. S. Elliott, S. R. N. , H. V. Cert. , Dip. K. E. - Health Education Officer:- "Why" said the Dodo "the best way to explain it is to do it" Lewis Carroll Secondary Schools Last year 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. It was agreed that three lecture demonstrations using the material suggested should be given by the Health Education Officer in the Technical College during 1960. These sessions, attended also by the School Inspectors, were held during January, February and March and were introduced and supported by Dr. S.L. Wright with whom the teachers discussed many questions. The theme was developed that traditional health policy has always been to make the environment fit the man, but that now there were circumstances in which man needed to be helped to adapt himself to his environment. Sets of lecture notes and visual aids on these subjects were issued too. Following the meetings the Health Education Officer began visiting each school with the School Inspector, talking to the staffs and listening to lessons concerned with health. In future help will be available with new material and facts and already many requests have been received to give some of the talks. In order to keep in touch with children of this age the Health Education Officer continues to give the full Community Health Course in Ashburton Secondary School and St. Andrews School (Mixed). Grammar Schools A year's programme was completed for the sixteen to seventeen year old girls in the sixth form at Coloma Grammar School. The Community Health Course was given by a Health Visitor during the Autumn Term 1959, the British Red Cross Society first year Home Nursing Course was given by the Health Education Officer during the Spring Term and a Mothercraft Course was given by another Health Visitor during the Summer Term. This experiment appears to be so useful that advice was given to the school on the purchasing of all the necessary Home Nursing equipment for future courses, when it is also proposed to enter the classes for the British Red Cross Society examination in home nursing. 7 A preliminary meeting was held at Heath Clark School between Mr. Houslop, Headmaster, Dr. Weeks, Chief School Inspector, Miss May, Senior Woman Inspector and the Health Education Officer to discuss the content and presentation of health education to senior pupils in Grammar Schools. Some members of the sixth form (girls and boys) were asked to write down anonymously and without previous warning any health questions to which they would like an answer. From this very small investigation it was realised that there was a considerable lack of basic knowledge on health and human biology and a considerable amount of didactic teaching, as well as discussion, would have to be included in such a course. It was thought that in future much of this basic information could be given in the General Science courses lower down the school and more emphasis placed on its practical application to daily life and the family. Junior Schools Another experiment has been tried in Junior Schools following the request by the Headmaster of Spring Park Junior School for advice on dealing with the early onset of menstruation among some of the girls. The mothers of the girls in the senior class were invited to an evening discussion group led by the Health Education Officer. The discussion was introduced by showing the short film (intended for children) called "Growing Girls" in order that the whole group should have accurate knowledge before trying to discuss the subject. Mothers who had succeeded in explaining the facts to their children were encouraged to describe the opportunities and methods they used, thereby helping those who had experienced difficulty in broaching the subject. Discussion was lively and constructive. The mothers requested another meeting to which they could bring their daughters to see the film and be given a short talk. Mothers and daughters would then have had a common experience and would be able to discuss Quietly at home any queries that might arise. This was successfully carried out and two other schools asked for the same service. It is hoped that this will encourage all Junior Schools to make these two meetings an annual event. Smoking and Lung Cancer Campaign. Progress in the smoking and lung cancer campaign continued to be disappointingly slow. Fewer schools requested discussions general apathy, smoking publicity and automatic cigarette machines form an overwhelming barrier, but the service continues to be offered. 8 Exhibition An exhibition "Education To-Day" was held in the Technical College during the summer as part of Croydon's Millenary Year Celebrations and it was a great pleasure to arrange a lively stand showing the "School Health Service". Miscellaneous Talks, films and filmstrips were also given during the year to Selhurst Grammar School, Wallington County School for Girls, Castle Hill Junior School, Parent Teachers Associations and participation on a panel at the Junior Teacher's Club was a most enjoyable experience. There does appear to be a greater appreciation of the benefits of health education and the opportunities for extending the service are steadily increasing. 9 INFECTIOUS DISEASES No particular illnesses gave especial difficulties, but there was the usual prevalence of the common infections of childhood. A campaign to ensure that as many children as possible had reinforcing injections against diphtheria was carried out during the early part of the year. The reporting.of cases in adjacent London boroughs was an added stimulus to parents and there was a satisfactory response. 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. It was decided that for the two intermediate age groups presented for routine medical examinations, weighing and measuring will not be carried out in future. VISION TESTS For the usual Tables, see Appendix VIII . The results now being obtained from the routine testing of school entrants suggest that significant defects may exist in babies for which early ascertainment and treatment are required. How this can be achieved is not yet clear, but it may be possible to comment further in a future report. TONSILLECTOMY The Report of the Chief Medical Officer of the Ministry of Education 1958/9 included tables showing for the different local authority areas of the country the percentages of children who had undergone the operation for removal of tonsils. These differ markedly from one area to another without any apparent geographical reasons. Thus, for children of 14 years of age, living in County Boroughs, the percentages range from 13.9 to 35. The percentages in County Boroughs were higher than in Counties and it would be possible to assume that the children living in towns were more prone to infections of the nose and throat than those living in country areas. In the Counties themselves, however, the percentages vary so widely that one cannot accept this conclusion as valid; for example, in Bedfordshire, the percentage amongst all 14-year old 10 children was 9.2 and in Buckinghamshire, 34.8. Seaside towns show similar differences for this age group, for example, 1.3 in Swansea and 32 in Newport. Appendix d . Page 57 , sets out the figures for Croydon for 1960. These show a rise in comparison with the percentages for 1959 and on the total of all children, who have undergone tonsillectomy, the increase is just over 4%. Croydon must now be amongst the areas of the country with the highest rates for tonsillectomy. I do not think this indicates that the children of Croydon have particularly unhealthy tonsils, but that Croydon parents tend to press for surgical treatment for symptoms and signs, which in other parts of the country would be treated medically or perhaps ignored. This raises the query about differences in the health of adults, who have or who have not undergone tonsillectomy. It does not seem possible to have a properly controlled experiment to answer this question. It is probable, however, that during childhood, those who undergo the operation for valid reasons benefit, but that changes after the age of puberty achieve for many not having the operation, the same end result. In an area where the operation is commonly performed and there are adequate facilities, it requires considerable courage and persistence for parents and family doctor to wait while the child "grows out of it". 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 condi tions. Number of children inspected for Cleanliness (first inspection) 54,603 Number of children inspected (subsequent inspections) 1, 282 Number of children found unclean (first inspection) 337 Number of occasions in which children found unclean (subsequent inspections) 186 At the primary inspections vermin were found in 25 and nits alone in 468 children. On these inspections 0.9 per cent. of the children showed evidence of infestation as against 1.2 in 1959. 5 children attended the Cleansing Station for treatment for verminous conditions and 5 for scabies. 11 12 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis:- Pulmonary 8 Non-Pulmonary Nil Taking the total child population at 39,929 (estimated), the pulmonary tuberculosis incidence rate per 100,000 was 20.0, and the non-pulmonary nil. There were no deaths from tuberculosis. CAUSES OF DEATH IN SCHOOL CHILDREN From the weekly returns of the local Registrar and from the inward transfers, it is possible to abstract the causes of death of all school children. There were 15 in 1960 equal to a death rate for this group of 0.38 per thousand. This is an average low figure and the details were:- Influenza 1 Pyelonephritis 1 Bronchial Asthma 1 Malignant Diseases 4 Congenital Heart 1 Accidental 4 Other Diseases 3 The death from influenza was in a child with other congenital defects. The case of bronchial asthma was a child well known to the department and for whom the Corporation accepted financial responsibility for a period of treatment abroad. Unfortunately, this proved as unsuccessful as all other attempts to control the condition and at the time of death, the child was attending the day school for physically handicapped pupils. The deaths from malignant diseases, congenital heart and other diseases could not, as far as it is possible to judge, have been prevented by any action on our part. The accidental deaths no doubt represent a failure in our road safety and home safety campaigns and are thus a spur to greater effort. The case of pyelonephritis (Coroner's decision) does not appear to have been diagnosed during life, when presumably there were no signs or symptoms to suggest that this infection was present and a fatal termination was imminent. All the rest of the family were presented for examination and found to be well. This was a most unusual case and I do not think any change in examination procedures is indicated from this single occurrence. 13 CAUSES OF EXCLUSION FROM SCHOOL During 1960, Mumps was the specific infection causing the most absences from school, followed by chicken Pox, Scarlet Fever, whooping Cough and Sonne Dysentery in that order. The last named was present in small numbers throughout the year and a policy of early exclusion and strict attention to school hygiene was successful in preventing explosive outbreaks. In one school, there were several cases at the end of a school term and enquiries showed the usual history of at least two children who attended school while suffering from severe diarrhoea. The onset of the long summer holiday in this particular instance made control a very simple matter. The detailed figures given in Appendix D , Page 57 , refer only to named infectious diseases. There was the usual amount of absence through ill defined upper respiratory infections, feverish colds, etc., which are not recorded in these returns. WORK OF SCHOOL NURSES Every effort is made to build up close co-operation by the health visitor/school nurse and the teaching staffs of the schools in her district. V.hen there are particular difficulties, for example, undue prevalence of infectious illness, the school nurse would be expected to call every day at the school to deal with queries which may arise in regard to individual children. During the year, the experiment of appointing a State Enrolled Assistant Nurse to deal with clinic duties commenced. The results of the first few months working were quite satisfactory. It does seem a proper method to relieve health visitor/school nurses of certain routine tasks, so that they may be available for duties more appropriate to their training and ability. For details of visits, see Appendix F, Page 59. 14 FACILITIES FOR TREATMENT It has always been the policy not to duplicate facilities for treatment available under other aspects of the National Health Service. Thus, at the minor ailment clinics are treated mainly plantar warts, otorrhoea and similar conditions, which tend to be of long standing and need frequent repetition of relatively simple nursing techniques. Where there is a minor ailment clinic, children with other troubles, which could be dealt with by the family doctor may be presented and the standing instruction is that they are to be referred to their general practitioner. The special clinics for enuresis, remedial exercises, speech therapy, deafness do accord with the rule stated above, as no other authority or organisation is available to ensure as required by the Education Act 1944 - "for securing that comprehensive facilities for free treatment are available". It has also been the policy when setting up any such facilities for treatment to make certain that they are coordinated with the hospital service and that the family doctor is informed about patients on his medical list. The usual tables recording attendances at these treatment clinics is given in Appendix E, Page 58. 15 SCHOOL DENTAL SERVICE P. G. Oliver Esq., L. D. S., Principal School Dental Officer:- This Service provides routine inspection and treatment for those attending Borough Primary, Secondary, Technical and Special Schools. A limited number of children from "grant aided" schools approved by the local Education Committee are also eligible for treatment. In conjunction with the above Service facilities are also provided for those referred under Health, Maternity Welfare and Mental Deficiency Schemes. Particulars of work carried out in connection with the former will be found in the appropriate Report. Introduction Last year's remarks on the sale of sweets and other fermentable substances at schools have attracted due attention on the Education side, and special interest has also been shown by social workers and those engaged in welfare activities; from subsequent comments it is clear that earlier information was in no way exaggerated. Some excellent reporting in the local press ensured a degree of "home" publicity, and it is hoped that discerning parents will have given thought to the amount of expendable income to be set aside for this purpose. Thanks are due to the Health Education Officer and others for solid endeavour to bring home to pupils and school staff the hazards of these sales, also for the distribution of appropriate literature and scientific data to support the facts. It is fair to say that comment from the Head Teachers' Association has shown a measure of sympathy for the dental point of view and the suggestion that a larger measure of control be exercised over purchases in future. As the result of enquiries many older scholars have shown a definite preference for confections of a savoury nature compared with those of a "sugary" kind; it also appears that the sale of apples would be welcomed, at least during the summer months. It is suggested, therefore, that experiments on these lines might be made at Grammar and Senior Schools to test the correctness of these suppositions. Another aspect of preventive dentistry, namely the addition of fluorine to public water supplies as a means of rendering teeth more resistant to decay,has received some recent publicity Whilst from evidence obtained from natural sources there appears little doubt regarding the benefits of such schemes, it would seen undesirable to anticipate the results of the controlled experiments now in progress in certain areas, by any premature move locally. 16 The findings of a Working Party relating to a parallel experiment by the Ministry, involving the topical application of the above drug to the surfaces of the teeth, have confirmed the fact that compared with the results obtained, this method was too "time consuming" to warrant introduction on a major scale, Because of fluctuations in staff no major developments have been possible during the year, and attention has been principally directed to a build up of services in areas of over average acceptance. Despite the above handicaps overall coverage was maintained at approximately the 1959 level. Since the introduction of an additional surgery at the Overbury Clinic the position at New Addington has shown substantial improvement, and it is hoped that ability to carry out more frequent inspection and treatment for these schools will have a cumulative effect. The installation of X-Ray equipment, together with "dark room" facilities recently added, are proving major assets in the diagnosis of dental irregularities and other obscure conditions in the mouth. Waddon Delays in the provision of new premises to replace those vacated in Duppas Hill Lane have been a source of comment from parents of younger children (in this district) who are unfortunately compelled to travel some distance to obtain treatment, After many set-backs a satisfactory site has now been secured for a combined Welfare and Dental Centre to serve this growing district, and it is hoped that present plans can be expedited to allow building to be carried out during the coming financial year. To test their practical application new-type "turbine dental engines have been installed in certain surgeries, and despite minor "teething" troubles their arrival has been welcomed by patients and dentists alike. Arrangements for the extension of the new system to other clinics has now been planned. Inspections The number of children on the register at maintained schools within the Borough at the close of 1960 was 36,653. Including an additional 47 scholars at grant assisted schools this represents a sum total of 36,700. During the year 74.5 per cent, of the school population were examined, compared with 76.4 per cent, in 1959. As previously explained this decrease has come about as a result of staffing fluctuations. 17 According to recent returns some 6,000 children received no examination during 1960, compared with 7,138 last year. At those schools visited 25,356 were inspected and 11,752 (46.3 per cent.) referred for treatment, compared with 26,145 inspected and 11, 829 (45. 2 per cent. ) referred in 1959. 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 39% Refused Treatment 47% Forms Not Returned 14% Though recent returns show a slight increase in acceptance for the year there has been a substantial decrease in the patronage of school clinics since the introduction of free treatment through the General Practitioner Service. Whilst this trend has eased the burden in some areas, these gains have been largely offset by the overall increases in the school population, and existing variations in demand for treatment in other districts have resulted in new administrative problems. RESULTS OF SCHOOL INSPECTIONS 196O 1959 1957 1949 1937 No. referred for Treatment 11, 752 11, 829 15,024 9, 404 13,496 Consents 4. 586: 4. 548: 6,692: 6,996: 7,762: 39% 38. 4% 44. 5% 74. 1% 57.7% (Total Consents Including 6. 542: 6. 472: 9, 366: 10,098: 10, 146: Specials)* 47. 7% 47% 52.9% 80.7% 63% Refusals 5, 531: 5, 376: 6, 516: 1. 213: 3, 242: 47% 45. 4% 43. 4% 12.9% 24% Forms not 1,635: 1, 9 14: 1,816: 1. 195: 2, 494: Returned 14% 16. 2% 12. 1% 12. 7% 18. 5% SPECIALS - Those referred by Head Teachers with Emergency Forms. 18 Treatment Of 13,708 children referred for treatment (including specials) 9,773 (71.3 per cent.) were treated and 5,199 (37.7 per cent.) cured completely, compared with 13,753 referred, 7,950 (57.8 per cent.) treated and 5,669(41.2 per cent.) cured in 1959. Treatment sessions rose from 2,556 to 2,868, chiefly on account of extra sessions worked by a locum dental officer during the last quarter. 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. 1960 1959 Attendances 23,367 23,083 Treated 9,773 7,950 Re-treated 5,419 4, 232 Fillings - Permanent 8,722 7,570 Temporary 2,016 1,521 No. of Teeth Pilled: Permanent 8,069 7,135 Temporary 1,940 1,454 Extractions: Permanent 2, 211 2,575 Temporary 4,961 5,468 Gas Administration 3,037 3,522 Local Anaesthetics 1, 264 683 Other Operations: Permanent 8,978 9,186 Temporary 843 807 Cases Completed 5,199 5,669 19 Miscellaneous Items These include:- 1960 1959 Root treatment in anterior teeth 72 16 Removal of bone sequestra 11 4 Splints for fractured incisors 3 4 Partial pulpotomy 1 2 Number of adult M. Ds treated 8 8 Dentures inserted 29 35 Denture repairs 15 17 After treatment of sockets, etc 27 21 Removal of impacted teeth 85 47 Ulcerated Stomatitis (Vincent's infection) 5 10 Cleft Palate cases 3 2 Acrylic caps for incisor teeth 12 10 Gingivectomy 6 3 Supernumary teeth removed 15 - Gold Inlay 1 - Large compound composite odonture 1 - Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 1,956 compared with 1,924 in 1959. X-Ray Examination The number of cases referred for the above purpose was 466, compared with 294 in 1959. This includes 183 taken at Mayday Hospital. Orthodontic Treatment. The number of sessions devoted to this work was 390, compared with 411 last year. The work in this section is proceeding satisfactorily and there have been no developments worthy of report. The following is a summary of treatment performed:- 20 1960 1959 Consultant D.0. s Total Cases commenced during the year 215 55 270 287 Cases carried forward from the previous year 490 64 554 634 Total 705 119 824 921 Cases completed during the year 105 45 150 184 Cases discontinued during the year 79 16 95 121 Pupils treated with appliances ; 373 78 451 356 Appliances - Removable 322 94 416 463 Fixed 105 11 116 140 Total Attendances 3,797 1,366 5, 163 5,076 Cases treated by extraction only 8 96 104 159 Cases referred to Specialist for Consultation 272 _ 272 195 Treatment Sessions 301 89 390 411 New cases awaiting treatment 15 23 38 42 Treatment of "Free-Place" Scholars As previously stated, all children in the Borough Secondary and Technical Schools have now been included within the routine scheme of treatment. Pupils previously attending Primary Schools who enter certain "grant-aided" schools do, however, continue to attend the school clinic for treatment. A summary of the work performed for the above children is given below:- 1960 1959 Attendances 101 106 New Cases Treated 17 8 Re- treated 30 40 Fillings - Permanent 115 98 Extractions - Permanent 23 20 Temporary 2 - Other Operations 16 11 "Gag" Cases 12 12 Local Anaesthesia 11 9 Cases Completed 37 34 Referred X-Ray 4 2 See Appendix B. Table II 21 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED CHILDREN Mr. Green, the Headmaster, reports that the year 1960 has been part of a period of transition, in which the first stage of the development programme has begun. The building work in progress consists of a new heated indoor swimming pool, a separate physiotherapy treatment pool and a dining hall and kitchen. There have also been additions to the staff in order that the proposed re-organisation of the School may go forward. Whilst the fundamental processes of teaching have gone on, the school has tried to maintain a programme of activities to develop a breadth of outlook in the children. To this end. School activities have included the following educational visits. Parties of Senior boys and girls have made numerous visits to a wide range of local industries including a local department store, radio and television manufacturers and the Croydon Telephone Exchange. Visits have also been arranged to local concerts and theatres, whilst the largest group ever, took part in the C. S.M. A. Festival at the Civic Hall and also in the Annual Carol Service in December. One hundred children took part in a tour of the Tower of London and the Dock area of the River Thames. An average of 25 children and three Staff attended the Central Baths throughout the Summer months and the following certificates were gained: - 2 x 100 yards - 5 x 50 yards - 7 x 20 yards. Whilst much of the accepted pattern of school life has continued as outlined, certain changes have been noted in the types of children admitted and these changes have high-lighted the necessity for smaller teaching groups and greater opportunities for therapeutic treatment. Routine medical inspections took place on 20 occasions; 294 children were seen and 161 parents were present. One visit each term has been made by an Orthopaedic surgeon and a specialist in Physical medicine. Both examined 7 children at each session, the parents of the children were also present. In attendance were the Medical Officer, the School Nursing Sister, the Physiotherapist and the Head Teacher. Physiotherapy has been given on each school day; a total of 3,870 treatments to an average of 46 orthopaedic cases. Speech Therapy has been given on one day each week; some 313 treatments to an average of 16 children. 22 The Nursing Sister, aided in certain duties by the Male Medical attendant, has carried out the preparation and follow-up of medical examinations as well as the prescribed courses of treatment; a wide variety of ailments have been treated and full records of each child's progress have been kept. Disabilities and Treatment Physically Handicapped Boys Girls Total 1. Cerebral Palsy 20 10 30 2. Bronchiectasis 4 7 11 3. Congenital Heart 3 6 9 4. Epilepsy 6 2 8 5. Muscular Dystrophy 3 2 5 6. Speech Defect 4 1 5 7. Poliomyelitis 6 5 11 8. Spina Bifida 3 2 5 9. Various disabilities 11 17 28 Total 60 52 112 Delicate Boys Girls Total 1. Asthma 23 11 34 2. Bronchitis 10 13 23 3. Debility 3 11 14 4. Primary T. B. 3 7 10 5. Various Disabilities 4 2 6 Total 43 44 87 Average number on roll 198 Admissions during year 43 To employment 11 To other schools 14 To residential schools 7 To further training 1 Left district 3 Deceased 2 Home teaching 3 Of the 11 children who left for employment - 4 took up Clerical work 1 is training for hairdressing 5 became shop assistants 1 is a Nursery Assistant 23 ST. CHRISTOPHER' S SCHOOL FOR EDUCATIONALLY SUB-NORMAL CHILDREN Mr. Grice has reported on a year of further improvements and consolidation of earlier gains. (a) Re-organisation The re-organisation of the Curriculum on individual lines has been extended to practical subjects. The aim is to get each child to work independently from simple work cards, and these have been introduced with great success. Review of I.Qs. There has been a great improvement in the review of I. Q. results in the school, though there is still leeway to be made up. lb) Speech Defects. There is at St. Christopher's a very high incidence of Speech Defects. The team of Speech Therapists are working extremely hard to alleviate this - they not only treat some of the children at the Clinic but visit the School to give Speech Therapy each Monday morning. But in spite of their efforts, some 20 children with marked Speech Defects are not receiving treatment, as the Speech Therapists are not able to grant them appointments. Speech Training Sessions for all children are undertaken by the Teaching Staff, for speech is of paramount importance; it is in some cases the sole means of communication of the E. S.N. child. (c) Social Training. As part of the Social Training Programme, Pet Keeping has now been introduced. The boys have converted an old hut into a Pets' Corner, and in it are fantail pigeons, guinea pigs, a tortoise and rabbits. The two infant classes have pet dogs, while other classes have hamsters, tame rats, mice and budgerigars. It is found that when handling pets, the emotional tension of Speech Defective children is eased, and more progress is made towards their cure, apart from the great value derived in the field of social training. (d) Admissions. It is universally agreed that if a child is to profit from Special School Education, he should not start on it too late. Although many examples can be given of children entering E. S.N. Schools for the first time at thirteen or fourteen, there is nothing whatever to commend the practice. The children are old enough to feel shame and resentment at the transfer, and are often troublesome. Even though a skilful and patient teacher may eventually win them round, that is no justification. Such a skilful and patient teacher could have done more had he had them earlier. Except in exceptional circumstances all future admissions must come from younger age groups, and this must become an established principle, otherwise promotion from Junior to Senior Departments will be seriously hampered. Departments will be seriously hampered. Pupils need to be admitted as young as possible and to work up through the School to obtain maximum benefit from their education here. Statistics Boys Girls Total Number on Roll 31.12.59 130 83 213 Admitted during 1960 28 13 41 Left to work at 16 13 6 19 Left to work at 15 2 - 2 Removed to other Areas 7 2 9 Transferred to Partially Deaf School 1 - 1 Transferred to Residential E. & N. Schoo1 1 - 1 Transferred to Normal Schools 3 1 4 Transferred to Approved School 1 - 1 Excluded as unsuitable for education at school 6 4 10 Deceased 1 - 1 Number on Roll 31. 12.1960 123 83 206 25 ST. LUKE'S SCHOOL FOR THE PARTIALLY SIGHTED Miss Randle, the Headmistress, reports steady progress throughout the year in all school activities. The emphasis, as in other years, was on individual teaching which is particularly necessary for the children who are handicapped, mentally or physically, in addition to being partially sighted. The children who attended the Swimming Baths all made very good progress under the kindly and helpful direction of the Swimming Instructor now appointed to the Baths. Apart from the' physical benefit, the children have gained very much in selfconfidence. The formation of a School Library has enabled the children to have a wider variety of reading material, the selection of books being suited to their needs as regards the clarity of print. Two boys who left during the year both found suitable employment. Average number on roll 21 Admissions 3 Transferred to other schools for the partially sighted 3 School Leavers 2 26 CHILDREN EXAMINED FOR I.Q. 142 children were examined during 1960. The classifications arrived at, together with recommendations made, are as follows:- (l) Pound to be educationally sub-normal:- (a] Recommended to St. Christopher's special School 30 (b) Recommended to Residential E. S. N. School 1 (2) Pound to be unsuitable for education at school 13 (3) Other Recommendations: (a) Referred to Slow Stream in Ordinary School 6 (b) Recommended for re-test 17 (c) Deferred for Medical Treatment 3 (d) Recommended for St. Giles' 2 (e) Recommended Residential Physically Handicapped School 1 (f) Recommended Residential normal school 1 (g) Recommended Residential school for Speech defects 4 (h) Referred back to Ordinary School 34 112 Mental Tests at St. Christopher's 30 142 27 CHILD GUIDANCE CLINIC The Consultant Child Psychiatrist of the Croydon Child Guidance Service - Dr. G. Crosse, W. B., B. S., D. P. M. - reports that the start of a new decade in the Borough Child Guidance Service was marked by the appointment of a full time Consultant Child Psychiatrict and Educational Psychologist. This filled the only gap in a mature and co-ordinated service, the fabric of which has been slowly woven over the past twenty years. However, complacency has been quite rightly eschewed, and the chief officers of the three arms of the services - Hospital, Borough Health and Education Department - have agreed on further developments aimed at expanding the facilities, both curative and preventive. The main proj ects are: - 1. A day Class for maladjusted children. 2. Evening Group activities for children attending the Child Guidance Clinic at 103, Park Lane, Croydon. 3. Weekly Health Visitors Discussion Groups conducted by the Child Psychiatrist. This has pure training and educational motives and is linked with the overall programme of prevention of mental illness in the communi ty. 4. The strengthening of the Child Guidance team by the inclusion of the Borough Educational Psychologist. This will make another bridge between the Hospital Service and the Local Authority. These projects, however, are in no way to be considered the limit of expansion. Until the day when we can boast of local residential facilities for investigation and treatment of both neurotic and psychotic children, the Child Guidance Service cannot be regarded as being truly comprehensive. Total number referred Boys 37 Girls 19 Analysis of the above Cases - Boys Girls Diagnostic 6 3 Current Treatment 25 12 Closed Improved 1 3 Closed No Change 5 1 37 19 28 SPEECH THERAPY The Speech Clinic has again suffered changes of staff. We were sorry to lose the services of Mrs. Colby, who had been Senior Therapist for many years and had done so much to improve and expand the service in this Borough. The pressure of work is still very great, and there are long waiting lists of cases requiring treatment at all the Clinics. We shall welcome the addition of one whole time Therapist, who it is hoped will join the staff early in 1961. The heavy case load at St. Christopher's School is still a great problem. It is hoped to expand the service there shortly by at least one more session per week. The pressure is less severe at St. Giles' School, though an extra session there is also desirable. Work in New Addington is continuing to expand, and though an extra session has been added to the working week there, there is still a long list of cases awaiting treatment. Two parents meetings were held by the Speech Clinic staff during the past year, one at Croydon and one at New Addington. Both were well attended and provided an interesting and beneficial evening for both parents and staff. It is hoped to hold similar meetings in the coming year. During the past year we were pleased to have the added help and co-operation of two new colleagues. Miss Diraond Hogg,Teacher of the Deaf, and Mr. Reid, Educational Psychologist. The aphasic child with allied specific difficulties continues to present a recurring problem. Such children require intensive investigations. The possibility of setting up a special class for them is under consideration. Total number of cases treated 314 (312) Total number of cases discharged 74 (111) Total number of cases still attending 240 (201) (The figures for 1959 are in brackets) Further details of the work carried out are shown in Appendix B. Table X. 29 ENURESIS CLINIC The numbers attending the Enuresis clinics during 1960 rose by nearly 50%, to 177 and clinics are now held every two weeks in New Addington. Attendance is in general very good, but there are a few families who make little attempt to see that their children keep their appointments. In six cases no attendances at all were made after the parents had themselves asked for treatment and several appointments sent. A further 17 children were crossed off the list after they had not attended on four consequentive occasions. The number of new cases was 103 of these five were referred elsewhere, 3 for investigation at the local hospitals and two to the Child Guidance Clinics. In these last two cases it was considered the enuresis was only one facet of a much larger problem. 74 children were discharged during the year, and 66 were attending at the end of the year. 29 children used the enuresis machine. The new aluminum foil pads prevented any cases of buttock rash. The age groups of those attending was as follows:- Age:- 4 5 6 7 8 9 10 11 12 13 14 15 Numbers attending:- 8 18 30 30 20 30 10 6 12 10 5 4 Total number who attended during I960:- 183 (119) New Cases 103 (76) Discharged dry 74 (54) Still Attending 66 Discharged for non-attendance 23 (8) Left District 15 Referred Elsewhere 5 Number who used machines 29 (35) (The figures in brackets are those for 1959) Six of the children who attended during the year were in fact re-attendances. They were children who had attended some years before and then had relapsed following a period (usually 18 months to two years) during which they had been quite dry. 30 SPASTICS 64 Croydon Spastics were receiving education as at 31.12.60. 2 children received Home Teaching 30 were attending St. Giles' School 2 were attending St. Margaret's School, Croydon 6 were at Residential Schools for Physically Handicapped children 2 were attending a Residential School (St. Mary's Bexhill) 8 were attending ordinary school 1 was attending Myope School 2 were attending St. Christopher's School 1 was attending normal Private school 8 were attending spastic Centre full time. DEAF AND PARTIALLY DEAF CHILDREN For many years we used the excellent facilities of the Audiology Unit of the Royal Ear, Nose and Throat Hospital, London. The very considerable developments in the early diagnosis of deafness and the consequent increase in the number of partially deaf children who can remain in ordinary schools, emphasised the need for a local service. In this, we were given encouragement and practical help by the staff of the Audiology Unit, whose assistance remains available for cases of special difficulty. During the year under review, the Corporation arranged for the Consultant Otologist to the Croydon Group of Hospitals to supervise their service and appointed a fully trained Peripatetic Teacher of the Deaf to deal both with pre-school and school children. Miss Dimond-Hogg took up this post in May. A room was specially adapted and equipped at the central school clinic, from which she works and where a monthly consultant clinic is held by the Otologist. With one of the Assistant Medical Officers of Health, for whom special training was arranged, Miss Dimond-Hogg carries out the preliminary tests for deafness in very young babies. She visits all schools, examines individual children, checks their hearing aids and advises teachers and parents. She concentrates on known cases and those likely to be deaf, namely, children who are educationally backward or with a speech defect or suspected of deafness by doctors, school nurses, teachers or parents. For statistical details of her work, see Appendix G, Page 60. 31 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1960 as to their fitness to undertake the part-time employment indicated: - 1960 1959 1958 1957 1956 Delivery of Goods for Shopkeepers 57 50 43 62 62 Delivery of Newspapers 316 317 394 344 365 Delivery of Milk 1 7 13 15 13 Shop Assistants 69 59 64 53 61 443 433 514 474 501 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1960 all milk was supplied free of charge and approximately 28,100 children per day received one-third of a pint each in Maintained Schools. This was equal to 85% of children attending in Secondary Schools, and 95% in Primary Schools. Since 1st September, 1957, milk has also been supplied by the Education Committee to children in the Non-Maintained Schools in accordance with instructions from the Ministry of Education. Approximately 4,600 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 1960 was approximately 19,000. Cost of the School Health Service The cost of the medical, dental and nursing services was £58,091. Cost of Special Schools Schools maintained by the Council £43,745 Other Schools (not maintained by local Education Authorities) £17,456 Adjustments with other authorities in respect of Special Schools £17,662 £78,863 Cost of Milk and Meals Meals and Milk cost £452,592. Income from payment for meals was £173,029, making a net cost of £279,563, on which grant is Paid of 100 per cent. on approved expenditure. 32 EPILEPTIC SCHOOL CHILDREN 36 epileptics were known to School Health Services as at 31. 12.60. Of these - 14 were attending Ordinary School 8 were in Day School for Physically Handicapped and Delicate Children 4 were attending our day E. S. N. School 3 were at Lingfield school 2 were in Hospital (1 at St. Lawrence's Hospital and 1 at Quesn Mary's Hospital) 1 was at the Occupation Centre 2 were in Residential School (1 at Drayton Manor and 1 at St. Elizabeth's) 1 was at Private Day School 1 was at Private Residential School NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in I960, 170 children were examined at routine examinations. Appendix C gives the detailed findings. Yours faithfully, S. L. WRIGHT, School Medical Officer. 33 STATUTORY TABLES APPENDIX A MEDICAL INSPECTION RETURNS Year ended 31st December, 1960 PART 1. - MEDICAL INSPECTION OP PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL 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. % of Col. 2 No. % of Col. 2 (1) (2) (3) (4) (S) (6) 1956 and later 67 67 100.00 . - 1955 1,787 1,786 99.94 1 0. 06 1954 997 994 99.70 3 0. 30 1953 410 409 99.76 1 0. 24 1952 893 888 99. 44 5 0. 56 1951 1. 185 1. 181 99. 66 4 0. 34 1950 590 590 100.00 - - 1949 1,007 1.005 99. 80 2 0. 20 1948 1, 981 1, 981 100.00 - - 1947 1. 162 1. 160 99.83 2 0. 17 1946 1, 100 1. 100 100.00 - - 1945 and earlier 1,613 1, 613 100.00 - - TOTAL 12. 792 12,774 99. 86 18 0. 14 34 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 rision (excluding squint) For any of the other conditions recorded in Part II Total individual pupils (1) (2) (3) (4) 1956 and later - 8 8 1955 69 149 203 1954 23 111 129 1953 19 56 72 1952 45 97 131 1951 57 81 132 1950 27 42 68 1949 48 84 127 1948 100 114 211 1947 45 63 106 1946 52 52 100 1945 and earlier 80 59 137 TOTAL 565 908 1, 424 TABLE C. - OTHER INSPECTIONS Number of Special Inspections 1,369 Number of Re-inspections 2,261 Total 3,630 TABLE D. - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 55,885 (b) Total number of individual pupils found to be infested 358 (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) 35 PART 2 TABLE A. - RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION 1960 Defect Code No. Defect or Disease Periodic Inspections Entrants Leavers Others Total Treatment Observa tion Treatwen t Observa tion Treatmen t Observa tion Treatmen t Observa tion (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 4 SKIN 8 15 6 4 27 26 41 45 5 EYES - (a) vision 92 48 132 32 341 181 565 261 (b) squint 14 10 - 1 12 14 26 25 (e) Other 2 5 5 3 11 6 18 14 6 EARS (a) Hearing 10 61 5 14 23 48 38 123 (b) otitis Media 2 14 3 3 9 22 14 39 (c) Other - 8 2 2 4 7 6 17 7 NOSE AND THROAT 63 141 6 9 62 116 131 266 .8 speech 37 41 2 1 16 12 55 54 9 lymphatic glands 1 77 - 3 1 10 2 90 10 HEART 4 43 12 9 3 42 19 94 11 LUNGS 4 61 2 11 12 61 18 133 12 DEVELOPMENTAL (a) Hernia 2 3 2 - 5 1 9 4 (b) Other 7 29 12 6 45 85 64 120 13 ORTHOPAEDIC (a) Posture 18 15 14 5 89 38 121 58 (b) peet 27 48 17 4 92 69 136 121 (c) Other 20 54 8 7 45 51 73 112 14 NERVOUS SYSTEM (a) Epilepsy - 4 - 3 2 4 2 11 (b) Other 2 9 - 2 5 10 7 21 15 PSYCHOLOGICAL (a) Development 2 15 - 2 4 7 6 24 (b) Stability 3 9 1 3 16 10 20 22 16 abdomen - 4 - 2 2 7 2 13 17 OTHER 23 24 9 9 35 46 67 79 36 TABLE B. SPECIAL INSPECTIONS Defect Code No. Defect or Disease Special Inspections Pupils requiring Treatment Pupils requiring Observation (1) (2) (3) (4) 4 SKIN 4 - 5 EYES - (a) vision 36 11 (b) Squint 1 2 (c) Other - - 6 EARS - (a) Hearing 3 7 (b) Otitis Media 1 1 (c) Other 1 - 7 NOSE AND THROAT 12 11 8 SPEECH 10 2 9 LYMPHATIC GLANDS 1 1 10 HEART - 1 11 LUNGS 4 1 12 DEVELOPMENTAL - (a) Hernia 1 _ (b) Other 6 9 13 ORTHOPAEDIC - (a) Posture 12 3 (b) Feet 7 1 (c) Other 6 5 14 NERVOUS SYSTEM - (a) Epilepsy 1 1 (b) other 4 1 15 PSYCHOLOGICAL - (a) Development _ 1 (b) Stability 8 1 16 ABDOMEN - - 17 OTHER 8 2 37 PART 3 TABLE A. - EYE DISEASES. DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint Errors of refraction (including squint) 124 1.804 Total 1,9 28 Number of pupils for whom spectacles were prescribed 1,097 TABLE B. - DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases inovo to have been dealt with Received operative treatment (a) for diseases of the ear - (b) for adenoids and chronic tonsillitis 199 (c) for other nose and throat conditions - Received other forms of treatment 42 Total 241 Total number of pupils in schools who are known to have been provided with hearing aids - *(a) in 1960 14 (b) in previous years 38 *A pupil recorded under (a) above should be recorded at (b) in respect of the supply of a hearing aid in a previous year. TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to have been treated (a) Pupils treated at clinics (No figures available for out-patients Department) 283 (b) Pupils treated at school for postural defects 12 Total 295 TABLE D. DISEASES OF THE SKIN (excluding uncleanliness. for which see Table D of Part I) Number of cases known to have been treated Ringworm - Scalp 1 Body - Scabies - Impetigo 13 Other skin diseases 28 Total 42 38 TABLE E. - CHILD GUIDANCE TREATMENT Number of cases known to have been treated Number of pupils treated at child Guidance Clinics 56 TABLE F. • SPEECH THERAPY Number of cases inora to bare been treated Number of pupils treated by speech Therapists 330 TABLE G. - OTHER TREATMENT GIVEN Number of cases known to bare been dealt witb (a) pupils with minor ailments 1.990 (b) pupils who received convalescent treatment under School Health Service arrangements 27 (c) pupils who received B.C. G. vaccination 2. 585 (d) Other than (a), (b) and (e) above. Please specify: 1. Enuresis 183 2. Audiology 272 Total (a)-(d) 5. 057 39 PART 4. - DENTAL INSPECTION AND TREATMENT (1) Number of pupils inspected by the Authority's Dental Officers: (a) At Periodic Inspections 25. 356 (b) As Specials 1.956 27. 312 (2) Number found to require treatment 15. 533 (3) Number offered treatment 13, 708 (4) Number actually treated 9. 773 (5) Number of attendances made by pupils for treatment including 11(h) 23, 367 (6) Half days devoted to: (a) Periodic school inspections 211 (b) Treatment 2. 868 (7) Fillings 3,079 (a) Permanent Teeth 8,722 (b) Temporary Teeth 2.016 10.738 (8) Namber of Teeth Filled: (a) Permanent Teeth 8.069 (b) Temporary Teeth 1,940 10,009 (9) Extractions: (a) Permanent Teeth 2. 211 (b) Temporary Teeth 4.961 7, 172 (10) Administrations of general anaesthetics for extractions 3.0 37 (11) Orthodontics: (a) Cases commenced during year 270 (b) cases carried forward from previous year 554 (c) Cases completed during year 150 (d) Cases discontinued during year 95 (e) Pupils treated with appliances 451 (f) Removable appliances fitted 416 (g) Fixed appliances fitted 116 (h) Total attendances 5, 163 (12) Number of pupils supplied with artificial teeth 29 (13) other Operations: (a) Permanent Teeth 8,978 (b) Temporary Teeth 843 9.821 40 APPENDIX B Table I AVERAGE NUMBERS AND ATTENDANCE IN MAINTAINED PRIMARY, SECONDARY NON-SELECTIVE, SELECTIVE, TECHNICAL AND GRAMMAR SCHOOLS DURING THE YEAR 1960 School Average No. on Registers Average Attendance Average 1960 Attendance % Average 1959 Attendance % COUNCIL PRIMARY Ashburton Junior Mixed 409 375 9 1.6 9L 1 Ashburton Infants 214 18 2 85.0 85.4 Benson Junior Mixed and Infants 577 531 92.0 91.7 Beulah Junior Boys 265 243 91.6 91.3 Beulah Junior Girls 244 224 9 1.8 90.0 Beulab Infants 250 212 84.8 84. 1 Castle Hill Junior Mixed 550 504 91.6 92. 4 Castle Hill Infants 487 433 88.9 88.0 Cypress Junior Mixed 233 214 9 1.9 91.7 Cypress Infants 178 153 86.0 86.9 Davidson Infants 142 123 86. 6 86.0 Duppas Junior Mixed 345 314 91.0 89.0 Ecclesbourne Infants 131 114 87.0 84. 2 Elmwood Junior Boys 282 261 92.5 89.9 Elmwood Junior Girls 271 249 9 1.9 91.0 Elmwood Infants 245 215 87.7 84.3 Pairchildes Junior Mixed 703 644 9 1.6 91.1 Fairchildes Infants 360 313 86.9 86. 2 Gilbert Scott Junior Mixed 417 387 9 2.8 9 L 9 Gilbert Scott Infants 259 224 86. 4 84.0 Gonville Junior Mixed and Infants 571 503 88. 1 88.5 Howard Junior Mixed and Infants 328 302 92.0 90. 2 Ingram Junior Mixed and Infants 102 88 86. 2 88.7 Kensington Avenue Junior Mixed 468 430 91.8 90.7 Kensington Avenue Infants 226 195 86. 3 84.6 Kingsley Junior Mixed 442 409 90. 3 89.8 Kingsley Infants 323 278 86. 1 83.9 Monks Orchard Junior Mixed and Infants 328 296 90. 2 92. 1 Norbury Manor junior Mixed 384 357 9 3.0 91.8 Norbury Manor Infants 212 182 85.9 85.0 Oval Junior Mixed 338 315 90. 3 91.6 Oval Infants 179 152 84.9 83.9 Portland Infants 104 91 87. 5 87.8 Purley Oaks Junior Mixed 309 284 9 1.9 92.8 Purley Oaks Infants 157 134 85. 4 83.9 Rockmount Junior Mixed 268 246 9 1.7 91. 9 Rockmount Infants 160 136 85.0 86. 3 Rowdown Juniors 619 564 9 1. 1 89. 7 Rowdown Infants 339 302 89. 1 85. 1 South Norwood junior Mixed 507 471 92.9 93. 5 South Norwood Infants 265 228 86.0 8 5.8 St. Peter's Junior Mixed and Infants 258 237 91.9 92.5 Spring Park Junior Mixed 213 2)0 9 3.9 93.0 Spring Park Infants 141 122 86. 5 86. 7 Sydenham Junior Boys 164 153 9 3. 3 91.0 Sydenham Junior Girls and Infants 308 280 90.9 87. 1 41 School Average No. on Registers Average Attendance Average 1960 Attendance % Average 1959 Attendance % Waddon Infants 216 182 84.2 81.2 Rest Thornton Junior Mixed and Infants 285 253 89.4 89.2 Whltehorse Manor Junior Boys 205 187 91.2 90.7 Whitehorse Manor Junior Girls 179 164 91.6 91.0 Whitehorse Manor Infants 239 201 84.1 86.0 Wlnterbourne Junior Boys 383 357 93.2 92.6 Winterbourne Junior Girls 336 316 94.0 92.4 Winterbourne Infants 365 318 87.1 84.3 Wolsey Junior Mixed 473 428 90.5 91.2 Wolsey Infants 298 258 86.6 88.1 Woodslde Junior Mixed 708 656 92.6 92.4 Woodside Infants 264 227 85.9 86.7 TOTALS 18,226 16,417 90.0 89.3 COUNCIL SECONDARY NON-selective SCHOOLS Ashburton Senior Boys 652 614 94.2 94.5 Ashburton Senior Girls 622 570 91.6 91.1 Davidson Senior Mixed 471 424 90.0 89.3 Ecclesbourne Senior Girls 373 336 90.1 89.1 Fairchildes Senior Boys 548 491 89.6 88.9 Fairchildes Senior Girls 560 494 88.2 88.7 Ingram senior Boys 557 500 89.7 88.6 Lanfranc Senior Boys 661 588 88.9 89.3 Lanfranc Senior Girls 555 502 90.5 89.7 Norbury Manor Senior Boys 407 377 92.6 92.4 Norbury Manor Senior Girls 528 491 92.9 92.7 Portland Senior Mixed 365 329 90.1 90.0 Tavistock Senior Boys 539 476 88.3 86.9 Tavistock Senior Girls 362 316 87.3 86.5 South Croydon Senior Mixed 709 636 89.7 88.6 Shirley Senior Mixed 457 421 9 2.1 91.7 Overbury Senior Mixed 551 482 87.5 88.8 Westwood senior Girls 466 420 90.1 88.9 TOTALS 9,383 8,467 90.2 89.7 VOLUNTARY secondary nOn-selective St. Andrew's Mixed 214 189 88.3 85.8 Our Lady's Girls 17 2 150 87.2 87.5 St. Mary's Mixed 399 372 93.2 90.6 TOTALS 785 711 90.5 88.5 special schools St. Christopher's Educationally Sub-Normal Mixed 219 190 86.7 87.1 St. Giles' Physically Handicapped and Delicate Mixed 197 166 84.3 85.4 St. Luke's (Partially Sighted) 21 18 85.7 86.4 TOTALS 437 374 8 5.5 86.2 42 School Average No. on Registers Average Attendance Average 1960 Attendance % Average 1959 Attendance % VOLUNTARY PRIMARY All Saints' Mixed and Infants (C. of E.) 217 199 91.6 90.0 Good Shepherd (R.C.) Junior Mixed and Infants 291 259 89.0 87.1 Parish Church Junior Mixed and Infants (C. of E. ) 343 306 89.2 88.8 St. Joseph's Mixed and Infants (R. C. ) 531 474 89.2 87.5 St. Mark's Junior Mixed and Infants (C. of E.) 209 188 90.0 89.3 St. Mary's (R. C.) Junior Mixed and Infants 423 381 90.1 88.2 St. Michael's Infants 94 82 87.2 82.6 Shirley (St. John's) Junior Mixed and Infants (C. of E.) 277 250 90.3 89.6 TOTALS 2,385 2,139 89.6 88.1 SECONDARY SELECTIVE AND GRAMMAR SCHOOLS Archbishop Tenison's Mixed 315 294 9 3.3 93.1 Heath Clark Mixed 654 618 94.5 92.5 John Newnham Selective Mixed 508 474 93.3 92.7 Selhurst Boys 915 869 95.0 96.8 Selhurst Girls 573 536 93.5 92.7 John Ruskin Boys 609 571 93.8 93.7 Coloma Girls 558 520 93.2 91.6 Lady Edridge Girls 630 590 93.7 96.6 TOTALS 4,76 2 4, 472 93.9 93.9 TECHNICAL SCHOOLS Stanley Technical school Boys 293 273 93.2 92.6 Croydon Secondary Technical Boys 382 359 94.0 94.0 TOTALS 675 632 93.6 93.3 SUMMARY OF SCHOOL ATTENDANCE FOR THE YEAR 1980 Council Primary 18,226 16,417 90.0 89.3 Voluntary Primary 2,385 2,139 89.6 88.1 Council Secondary 9,383 8,467 90.2 89.7 Voluntary Secondary Mixed 785 711 90.5 88.5 Grammar and Selective 4,762 4,47 2 93.9 93.9 Technical 675 632 93.6 93.3 Specials 437 374 85.5 86.2 TOTALS 36,653 33,212 90.6 90.0 Crosfield Nursery 39 30 76.4 76.9 43 Table II heights and weights 1960 Age Number Examined Average Height in inches Average Weight in lbs. 1960 1960 1959 1958 1957 1939 1960 1959 1958 1957 19 39 BOYS 5 years 829 43.1 43.2 43.0 43.5 41.8 43.2 43.4 43.0 43.5 41.5 6 " 488 44.3 44.7 44.1 44.0 43.8 45.4 46.7 45.1 44.6 43.4 7 " 192 46.7 46.9 48.4 47.6 45.3 50.2 50.2 54.1 52.6 47.9 8 " 436 50.4 51.0 50.7 50.5 49.5 59.1 60.6 60.4 59.5 55.5 9 " 586 51.5 51.9 51.2 50.9 51.2 64.2 64.3 63.1 61.3 58.8 10 " 298 52.0 52.9 53.1 52.9 52.7 67.7 68.5 69.9 66.0 62.9 11 " 543 56.5 56.4 56.6 57.1 53.7 80.5 79.5 81.9 83.8 68.7 12 " 1077 58.2 57.7 57.9 58.1 55.7 87.2 85.7 86.8 86.1 79.9 13 " 683 59.7 59.2 59.0 59.6 58.4 95.1 90.9 88.9 90.1 81.6 14 " 581 63.3 63.9 63.4 63.7 59.0 110.1 112.1 112.3 112.6 90.8 15 " 495 65.1 65.9 65.2 64.3 — 120.7 120.8 119.7 117.6 — 16 " 250 67.7 67.6 67.3 66.8 — 130.3 133.2 131.9 127.6 — 17 " 76 68.0 67.7 67.6 67.8 — 137.0 134.4 133.5 133.3 — GIRLS 5 years 977 42.6 42.9 42.7 42.7 41.2 42.0 41.7 42.0 42.3 39.7 6 " 506 43.6 43.9 43.7 43.8 42.7 43.7 44.6 43.7 43.9 41.4 7 " 201 46.3 46.5 47.2 47.5 44.1 49.3 49.6 51.8 52.1 43.6 8 " 474 50.2 50.2 50.0 50.1 49.9 59.7 59.8 58.8 57.9 54.7 9 " 612 51.3 51.9 50.9 50.9 50.9 63.1 64.3 62.3 60.3 57.6 10 " 308 52.5 52.9 53.2 52.5 52.1 66.0 68.6 67.4 65.5 62.9 11 " 489 56.5 57.3 58.8 57.4 53.6 83.0 84.0 88.1 83.8 68.3 12 " 990 58.3 58.4 58.2 58.3 56.6 89.6 89.6 87.2 91.0 77.2 13 " 548 59.4 59.7 59.4 59.4 58.8 95.6 94.4 95.6 91.6 85.3 14 " 523 62.1 62.5 62.7 62.2 60.3 110.8 110.2 108.4 109.9 97.9 15 " 583 62.7 63.8 63.3 62.5 62.0 117.1 116.5 114.2 116.3 105.5 16 " 201 63.7 64.0 63.7 64.0 — 122.1 121.5 119.5 123.4 — 17 " 55 64.2 64.1 64.7 64.5 — 123.6 125.0 120.7 126.6 — Table III CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1960 School Population Chicken Pox Conjunctivitis Diphtheria Dysentery Enteric Group Erysipelas German Measles Impetigo Indefinate Sickness Jaundice Measles Meningococcal Infection Mumps Other Diseases Poliomyelitis Ringworm Scabies Scarlet Fever Sore Throat Vermin Whooping Cough Totals Body Scalp All Saints 217 2 — — — — — — — — — — — 4 — — — — — 11 — — — 17 Arch. Tenison 315 — — — — — — — — — — — — — — — — — — — — — — -— Ashburton 1897 4 — — — — — — — — — — — — — — — — — 4 — — — 9 Benson 577 2 — — 2 — — — — — — — — 6 — — — — — 5 — — — 15 Beulah 759 3 — — 4 — — — 1 — — — — 42 — — — — — 8 — 1 6 65 Castle Hill 1037 5 — — 4 — — 4 3 — — — — 2 — — — — — 18 — — 3 39 Coloma 558 — — — — — — — — — — — — — — — — — — 6 — — — 6 Crosfield Nursery 39 — — — — — — — — — — — — — — — — — — — — — — — Croydon High 900 — — — — — — — — — — — — — — — — — — — — — — — Croydon Tech. 382 2 — — — — — — — — — — 3 — — — — — — — — — 5 Cypress 411 23 — — — — — 1 — — — — — 19 — — — — — 13 — 1 — 57 Davidson 613 — — — — — — — — — — — — — — — — — — — 8 — 8 Duppas 345 — — — — — — — — — — — — — — — — — — — — — — 5 Ecclesbourne 504 — — — 2 — — — — — — — — — — — — — — 5 — — — 7 Elmwood 798 — — — 1 — — — — — — — — — — — — — — 1 — — 1 3 Fairchildes 2171 — — — 1 — — — — — — — — — — — — — — 4 — — — 5 Gilbert Scott 676 — — — — — — — — — — — — — — — — — — 3 — 1 — 4 Gonville 571 38 — — 1 — — 2 — — — — 2 82 — — — — — 24 — — 4 153 Good Shepherd 291 — — — — — — — — — — — — — — — — — — — — — — — Heath Clark 654 2 — — — — — — — — — — — 2 — — — — — 1 — — — 5 Howard 328 — — — — — — — — — — — — 2 — — — — — 1 — — — 3 Ingram 659 1 — — — — — — — — — — — 1 — — — — — 4 — — 5 11 John Newnham 508 — — — — — — — — — — — — — — — — — — — — — — — John Ruskin 609 — — — — — — — — — — — — — — — — — — — — — — 2 Kensington Avenue 694 4 — — 3 — — — — 1 — — — — — — — — — 4 — 2 3 17 Klngsley 765 — — — 2 — — — — — — — 2 14 — — — — 1 5 — — — 24 Lady Edrldge 630 — — — 2 — — — — — — — — — — — — — — 2 — — — 4 Lanfranc 1216 — — — — — — — 3 — — — — l — — — — l 4 — — — 9 44 Monks Orchard 328 — — — — — — — — — — — — 5 — — — — — 1 — — — 6 Norbury Manor 1531 27 — — 1 — — — 1 — — — — 6 — — — — — 6 — 4 13 58 Occupation Centre 94 — — — — — — — — — — — — 1 — — — — — — — — — 1 Old Palace 461 — — — — — — — — — — — — — — — — — — — — — — — Our Lady's Convent 172 — — — — — — — — — — — — — — — — — — — — — — — Oval 517 10 — — — — — — — — — — — 17 — — — — — 4 — — 13 44 Overbury 457 — — — 1 — — — — — — — — — — — — — — — — — — 1 Parish Church 343 — — — — — — — — — — — — — — — — — — 3 — 1 — 4 Portland 469 — — — — — — — — — — 1 — 3 — — — — — — — — — 4 Purley Oaks 466 56 — — — — — — — — — 1 — 9 — — — — — 1 — — 1 68 Reglna Coeli 372 — — — — — — — — — — — — — — — — — — — — — — — Rockmount 428 — — — 2 — — — — — — — — — — — — — — 1 — 2 — 5 Rowdown 958 — — — 1 — — — — — — — — — — — — — — 10 — — — 11 St. Andrew's 214 — — — — — — — — — — — — 1 — — — — — — — — — 1 St. Christopher's 219 — — — — — — — 1 — — — — 1 — — — — 1 — — — — 3 St. Giles' 197 6 — — — — — 1 — — — — — 6 — — — — — — — — 1 14 St. Joseph's 531 — — — — — — — — — — — — — — — — — — 2 — — — 2 St. Luke's 21 — — — — — — — 1 — — — — — — — — — — — — — — 1 St. Mark's 209 2 — — — — — — — — — — — 2 — — — — — — — — — 4 8t. Mary's r. C. 822 — — — — — — — — 1 — — — 1 — — — — — 3 — — 1 6 St. Michael's 94 — — — — — — — — — — 1 — 1 — — — — — 1 — — 1 4 St. Peter's 258 — — — — — — — 1 — — — — 1 — — — — — 6 — — 2 10 Selhurst Grammar 1488 — — — — — — — — — — — — — — — — — — 2 — 1 — 3 Shirley (St. John's) 734 — — — — — — — — — — — — — — — — — — — — — — — South Croydon 709 — — — 1 — — — — — — — — — — — — — — — — — — 1 South Norwood 772 47 — — 1 — — — — — — — — 44 — — — — — 8 — — 2 102 Spring Park 354 2 — — — — — — — — — — — 11 1 — — — — 7 — — 1 22 Stanley Tech. 293 — — — — — — — — — — — — — — — — — — — — — — — Sydenham 472 — — — — — — — 1 — — — — 3 — — — — — — — — — 4 Tavistock 901 — — — 1 — — — — — — — — — — — — — — 2 — 5 — 8 Trinity 626 — — — — — — — — — — — — — — — — — — — — — — — Waddon 216 33 — — 7 — — — 1 — — — — 55 — — — — — 1 — — — 97 West Thornton 285 — — — 1 — — — — — — — — 1 — — — — — 5 — — — 7 Westwood 466 1 — — — — — — — — — — — — — — — — — — — — 1 2 Whitehorse Manor 623 27 — — 6 — — — — 1 — — — 16 — — — — — 12 — 1 4 67 Whitgift 843 — — — — — — — — — — — — — — — — — — — — — — — Wlnterbourne 1084 3 — — 7 — — — — — — — — 2 — — — — — 11 — — — 23 Wolsey 771 1 — — — — — 1 — — — — — — — — — — — 8 — — 1 11 Woodslde 972 10 — — — — — — — — — — — 17 — — — — — 5 — — 2 34 311 — — 56 — — 9 13 3 — 3 4 381 1 — 1 — 3 224 — 27 65 1101 1 45 46 Table IV RETURN OF DEFECTS POUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION. 1960 Defects Boys Girls No. requiring Treatment No. referred for Observation Percentage of total Examined No. requiring Treatment No. referred for Observation Percentage of total Examined Uncleanliness - Head - - 1 - 0.02 Body Skin Disease 17 21 0.58 24 24 0.77 Eye Disease - Defective Vision 284 145 6.56 281 116 6.35 Squint 12 13 0.38 14 12 0.42 External Eye Trouble 7 7 0.21 11 7 0.29 Ear Disease - Deafness 23 56 1.21 15 67 1.31 Otitis Media 9 20 0.44 5 19 0.38 Other Disease 4 10 0.21 2 7 0.11 Nose and Throat 68 115 2.80 63 151 3.42 Enlarged Cervical Glands (not T. B. ) 2 19 0.32 - 71 1.14 Dental Defects 23 1 0.37 21 2 0.35 Speech Defects 30 29 0.90 25 25 0.80 Heart and Circulation 10 43 0.81 9 51 0.96 Lungs 11 64 1.15 7 69 1.22 Developmental - (a) Hernia 9 3 0.18 - 1 0.02 (b) Other 56 80 2.08 8 40 0.77 Deformities - Posture 43 18 0.93 78 40 1.89 Flat Feet 65 65 1.99 71 56 2.03 Others 36 44 1.22 37 68 1.68 Nervous system Disorders Epilepsy 2 5 0.11 - 6 0.10 Other 5 11 0.24 2 10 0.19 Psychological - (a) Development 5 16 0.32 1 8 0.14 (b) Stability 15 9 0.37 5 13 0.29 Abdomen 1 6 0.11 1 7 0.13 Other Defects and Diseases 28 32 0.92 39 47 1.37 TOTALS 765 832 720 917 Total Children Examined 6,538 6,254 Table V PARENTS PRESENT 1960 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 TOTAL 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 3 8 3 6 - 1 - 1 - - - - 11 7 14 5 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 21 16 18 12 Archbishop Tenison's - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25 17 14 1 5 13 - 3 - - - - - - - - 23 23 1 1 53 53 15 5 Ashburton 25 21 23 20 6 5 5 4 2 4 2 2 3 21 - 16 1 16 1 11 1 9 - 9 - 3 - 1 79 62 25 28 42 28 12 13 - 37 1 25 56 - 2 75 - 4 - 259 263 72 107 Benson 10 10 9 9 33 28 31 27 6 1 5 1 - 2 - 2 - 1 - 1 2 2 2 2 - - - - - - - - - - - - - - - - - - - - - - - - 51 44 47 42 Beulah 43 57 40 53 18 19 16 17 2 - 1 - 34 51 29 33 19 20 14 16 2 6 1 4 - 1 - - - 1 1 - - - - - - - - - - - - - - - - 118 155 101 124 Castle Hill 29 24 26 20 65 85 58 71 22 20 18 14 1 - 1 - 53 46 38 35 10 23 4 17 - - - - - - - - - - - - - - - - - - - - - - - - 180 198 145 157 Coloma - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 28 - 2 Crosfield 30 23 28 22 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 31 23 30 22 Croydon Sec. Tech. - - - - - - - - - - - - - - - - - - - - - - - - - - - - 42 - 6 - 17 - 1 - 3 - 1 - 30 - - - 31 - - - 123 - 8 - Cypress 17 15 17 12 4 14 2 13 1 3 1 2 - - - - 2 3 2 3 10 1 6 - - - - - - - - - - - - - - - - - - - - - - - - - 34 36 28 30 Davidson 6 22 5 21 7 4 6 4 5 1 4 - 1 - 1 - - - - - - - - - 21 36 7 16 63 18 21 9 22 1 8 - 46 28 2 3 20 11 1 - 1 - - - 192 121 55 53 Duppas - - - - - - - - - - - - - - - - 1 1 1 - 2 5 - 1 4 2 - 1 2 1 1 1 - - - - - - - - - - - - - - - - 9 9 2 3 Ecclesbourne 32 33 27 28 10 6 10 6 - 3 - 1 - - - - - - - - - - - - - 55 - 37 - 32 - 14 - 4 . 4 - 63 - 10 - 33 - 4 - - - - 42 229 37 104 Elmwood 26 20 24 25 3 6 2 6 1 3 1 3 2 3 - 3 9 6 5 6 9 1 6 1 1 - 1 - - - - - - - - - - - - - - - - - - - - - 50 44 39 44 Fairchildes 64 79 49 68 82 54 64 49 52 58 38 54 40 18 34 7 82 105 56 68 68 58 36 44 29 125 17 67 112 164 39 61 47 96 2 43 1 86 - 18 - 96 - 30 - 26 - 3 577 965 335 512 Gilbert Scott 24 23 20 22 - 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- 24 25 20 21 Gonville 32 41 28 40 5 4 5 4 - - - - 28 48 21 39 14 14 13 10 2 - 1 - 2 - 1 - - - - - - - - - - - - - - - - - - - - - 83 107 69 93 Good Shepherd - - - - 3 6 3 4 4 2 4 2 - - - - 2 - 2 - - - - - 1 1 1 1 - - - - - - - - - - - - - - - - - - - - 10 10 10 7 Heath Clark - - - - - - - - - - - - - - - - - - - - - - - - 38 36 15 16 15 30 4 14 4 4 1 - 6 4 1 1 49 26 - - 23 16 - 1 135 116 21 32 Howard 8 13 7 13 2 8 2 6 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 21 9 19 Ingram 13 23 13 18 - 2 - 2 - - - - - - - - - - - - - - - - 80 - 25 - 28 - 10 - - - - - 88 - 3 - 62 - - - - - - - 271 25 51 20 John Newnham - - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 1 15 - 13 1 3 - - - - - 9 15 - 1 47 18 1 2 99 35 19 3 John Ruskin - - - - - - - - - - - - - - - - - - - - - - - - - - - - 56 - 6 - 39 - 3 - - - - - - - - - 20 - - - 115 - 9 - Kensington 42 37 38 34 2 6 2 4 1 1 1 - 39 31 28 25 5 38 3 25 - 2 - 1 4 - 3 - - 1 - 1 - - - - - - - - - - - - - - - - 93 116 75 90 Kingsley 21 13 18 13 4 11 4 11 - 2 - 1 1 - - - 3 4 1 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 30 23 27 Lady Edridge - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 81 - 13 - 56 - 10 - 6 - - - 1 - - - 34 - 1 - 178 - 24 Lanfranc - - - - - - - - - - - - - - - - - - - - - - - - 121 - 32 - 123 8 33 2 60 9 4 2 137 36 10 5 112 - 7 - 7 - 3 - 560 53 89 9 Monks Orchard 12 12 7 2 3 6 1 1 - 1 - - - - - - 13 17 - 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 28 37 8 5 Norbury Manor 3 4 2 4 20 21 18 20 5 4 4 3 1 1 1 1 31 42 23 28 13 19 9 13 78 3 13 2 138 53 21 30 73 41 13 11 63 24 4 5 35 51 1 7 5 4 - 1 465 267 109 125 Our Lady's Convent - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 - - - 9 - 1 - 7 - 1 - 22 - - - 1 - - - 44 - 2 Oval 25 21 21 18 9 7 7 6 - 1 - 1 27 23 21 17 7 10 3 7 3 2 1 - 1 1 - - - - - - - - - - - - - - - - - - - - - - 72 65 53 49 Overbury - - - - - - - - - - - - - - - - - - - - - - - - - 26 - 7 1 45 1 21 44 20 10 8 58 40 7 5 11 20 - 1 - - - - 114 151 18 42 Parish Church 11 8 9 5 9 5 9 5 3 - 1 - 6 8 3 7 1 3 1 1 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - 32 24 25 18 Portland 13 23 11 21 14 13 IS 12 1 - 1 - - - - - - - - - - - - - - - - - 10 2 3 - 3 - - - 25 34 1 3 16 9 2 1 - - - - 82 81 33 37 Purley Oaks 17 23 15 18 6 6 5 3 2 5 1 2 28 24 16 18 11 5 10 4 1 17 1 15 - - - - - - - - - - - - - - - - - - - - - - - - 65 80 48 60 Regina Coeli 27 25 16 13 8 19 6 13 1 - 1 - 5 9 4 2 18 5 3 1 30 3 2 - 36 32 8 2 23 18 2 3 26 15 1 2 9 18 - - 8 10 - - - 2| - - 193 156 43 36 Rockmount b 11 5 10 5 9 3 6 3 1 1 - 13 22 9 14 7 32 3 21 2 11 1 7 - - - - - - - - - - - - - - - - - - - - - - - - 36 86 22 58 Rowdown 27 31 24 28 72 62 57 46 55 56 49 48 3 1 3 1 14 36 12 33 35 94 22 72 5 22 2 17 2 - 1 - 1 - 1 - - - - - - - - - - - - - 214 302 171 245 St. Andrew's - - - - - - - - - - - - - - - - - - - - - - - - - - - - 22 4 10 1 11 1 2 1 3 1 - - 22 7 2 - 1 - - - 59 13 14 2 St. John's 20 19 15 14 - 4 - 4 2 - 2 - 22 12 15 10 8 7 5 6 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 53 43 37 34 St. Joseph's 9 9 7 8 6 7 2 6 2 6 2 4 22 9 12 7 22 17 8 7 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - 62 50 31 32 St. Mark's 11 5 9 4 9 7 8 6 2 3 2 3 - 1 - - 4 3 2 3 1 3 - - - - - - - - - - - - - - - - - - - - - - - - - - 28 22 21 19 St. Mary's 18 17 15 12 - 9 - 6 - 7 - 4 10 10 4 7 6 1 3 1 2 3 - 1 31 23 12 7 24 15 10 1 7 7 - l 32 36 - 5 26 31 - 1 12 3 - - 168 167 44 46 St. Michael's 13 23 12 21 3 1 3 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16 25 15 22 St. Peter's 11 6 5 6 - 1 - 1 2 - - - 1 1 - 1 2 - - - - - - - 1 1 - - - - - - - - - - - - - - - - - - - - - - 17 9 5 8 47 Continued Overleaf. 48  5 years and wider 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 - - - - - - - - - - - - - - - - - - - - - - - - 66 61 34 30 191 77 68 19 231 29 26 7 91 - 6 - 1 55 - 12 4 108 - 10 584 330 134 78 Shirley - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13 24 3 9 11 21 3 4 - - - - 14 4 1 - 35 1 1 - 74 50 8 13 South Croydon S.M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - 48 - 8 - 52 - 11 - 8 - 2 - 4 - - - - - - - 112 - 21 South Norwood 38 46 34 39 17 8 16 5 2 1 - 2 1 2 - 28 10 13 8 19 4 2 4 2 - 1 - - 2 - 2 - - - - - - - - - - - - - - - - 108 72 68 58 Spring Park 19 37 19 31 2 1 2 1 1 1 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 22 39 22 33 Stanley Tech. - - - - - - - - - - - - - - - - - - - - - - - - - - - 47 - 11 - 18 - 3 - - - - - 13 - - - 27 - 1 - 105 - 15 - Sydenham 15 12 14 10 5 7 5 5 3 - 3 19 9 17 8 18 20 9 12 6 - 1 - 1 2 - 1 - - - - - - - - - - - - - - - - - - - - 67 50 41 36 Tavistock - - - - - - - - - - - - - - - - - - - - - - - - - 43 - 18 22 91 12 44 1 37 - 15 - 49 - 13 1 63 - 14 - 1 - - 21 284 12 104 Trinity - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 58 - 2 - 31 - - - - - - - 89 - 2 - Waddon 18 25 17 22 14 23 11 22 - 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 32 50 28 45 West Thornton 8 10 7 10 2 1 2 1 - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11 11 10 11 Westwood - - - - - - - - - - - - - - - - . - - - - - - - - - 4 - 1 - 91 - 21 - 30 - 12 - - - - - 61 - 14 - - - - - 186 48 Whitehorse Manor 44 56 38 44 20 4 18 4 3 27 2 19 - 47 - 36 37 15 28 12 9 3 3 1 - 3 - - 4 1 - 1 - - - - - - - - - - - - - - - - 117 156 89 117 Winterbourne 41 41 41 38 8 6 8 6 1 5 1 3 43 52 35 44 76 55 63 35 28 3 21 - - 2 - 1 - - - - - - - - - - - - - - - - - - - - 197 164 16! 127 Wolsey - - - - - 22 - 20 1 1 - 1 - - - - 33 36 19 30 19 18 12 15 - - - - - - - - - - - - - - - - - - - - - - - - 53 77 31 66 Woodside 47 46 44 44 8 2 7 1 5 - 3 - 62 52 47 39 48 40 36 31 11 9 7 7 - 2 - 1 - - - - - - - - - - - - - - - - - - - - 181 151 144 123 877 977 763 846 485 512 114 432 190 220 149 170 430 463 317 342 577 608 379 419 290 300 140 217 523 484 172 226 1075 906 316 305 675 487 93 150 620 180 37 72 485 575 14 87 311 242 11 19 6538 6254 2805 2385 1854 1609 997 846 410 319 893 659 1185 796 590 357 1007 398 1981 621 1162 243 1100 109 1060 101 553 30 12792 6090 PERCENTAGE OF PARENTS PRESENT Age 5 years and under Boys 87.0 86.8 Boys 42.9 All Groups 47.6 Girls 86.6 6 years Boys 85.4 85.0 Girls 84.4 7 years Boys 78.4 77.8 Girls 77.3 8 years Boys 73.7 73.8 Girls 73.9 9 years Boys 65.7 67.3 Girls 68.9 10 years Boys 48.3 60.5 Girls 72.3 11 years Boys 32.9 39.5 Girls 52.5 Girls 46.7 12 years Boys 29.4 31.3 Girls 33.7 13 years Boys 13.8 20.9 Girls 30.8 14 years Boys 6.0 9.9 Girls 15.0 15 years Boys 2.9 9.5 Girls 15.1 16 years and over Boys 3.5 5.4 Girls 7.9 49 Table VI SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1960 (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 2.2 2.1 1.4 2.1 1.1 0.8 1.5 1.3 1.5 1.6 Skin 0.9 0.9 2.0 2.3 2.3 1.4 1.1 1.1 1.5 1.4 Eyes - Vision 6.0 6.6 15.5 12.2 12.6 8.0 10.0 12.0 11.1 9.9 Squint 1.5 1.1 0.1 0. 4 - 0.2 0.7 0.9 0.6 0.7 Other 0.5 0.2 0.4 0.6 0.3 0.7 0.3 0.4 0.4 0.4 Ears - Hearing 3.2 2.1 0.9 1.5 0.6 1.2 1.1 1.1 1.4 1.4 Otitis Media 0.7 0.7 0.6 0.6 0.2 0.3 0.6 0.4 0.6 0.5 Other 0.7 2.0 0.1 0.2 0.4 0.2 0.2 0.2 0.3 0.2 Nose and Throat 9.7 9.9 1.3 3.4 0.6 1.2 3.2 5.0 3.5 5.0 Speech 4.2 2.1 0.3 0.4 0.2 0.1 0.6 1.0 1.2 0.9 Cervical Glands 2.5 2.0 0.1 0.3 0.1 0.3 0.4 1.0 0.7 0.9 Heart and Circulation 1.6 1.9 0.9 0.9 1.1 1.1 0.8 0.9 1.1 1.2 Lungs 2.8 1.8 1.6 0.9 1.2 0.9 1.9 1.5 1.8 1.4 Development Hernia 0.3 0.1 0.2 - 0.2 - 0.2 - 0.2 - Other 2.6 0.7 3.9 1.4 1.3 0.7 3.3 1.0 2.9 0.9 Orthopaedic Posture 1.5 1.2 1.3 3.7 0.9 1.9 1.5 3.2 1.3 2.5 Fiat Feet 4.3 1.8 2.6 4.0 0.6 1.5 2.8 2.4 2.6 2.5 Other 3.5 3.4 1.4 2.6 1.1 3.0 1.5 2.3 1.8 2.8 Nervous Diseases Epilepsy 0.2 0.1 0.1 0.1 0.1 0.2 0.1 - 0.1 0.1 Other 0.7 0.1 0.3 0.3 - 0.3 0.2 0.3 0.3 0.3 Psychological Development 1.0 0.5 0. 3 0.1 0.1 - 0.3 0.1 0. 4 0.2 Stability 0.6 0.3 0.4 0.3 0. 1 0.2 0.7 0.3 0.5 0.3 Dull and Backward 0.3 0.1 - - - - 0.2 0.1 0.1 - Other Defects 1.8 1.7 1.4 1.5 0.4 1.4 1.3 1.4 1.2 1.6 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, 1960 number of handicapped pupils - (1) Blind (2) Partially sighted (3) Deaf (4) Partially deaf (5) Delicate (6) Physically Handicapped (7) Education ally sub-normal (6) Maladjusted (9) Epileptic (10) Speech defects TOTAL (1)-(10) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) A. were newly placed in special schools (other than hospital special schools) or boarding homes. - 2 1 3 25 16 37 8 1 2 95 B. were newly assessed as needing special educational treatment at special schools or in boarding homes. - 3 2 3 28 14 31 12 1 1 95 On or about 20th January, 1961 number of handicapped pupils from the Authority's area - C. (i) were on the registers of 1. maintained special schools (a) as day pupils - 17 15 8 86 99 19 2 - - - 417 (b) as boarding pupils - - 1 - 1 - 4 1 - - 7 2. non-maintained special schools (a) as day pupils - - - - - 2 - - - - 2 (b) as boarding pupils - - 1 9 7 3 6 5 1 2 34 (ii) were on the registers of independent schools under arrangements made by the Authority - - 1 .- - 4 1 13 - - 19 (iii) were boarded in homes and not already included under (i) or (ii) - - - - - - - - - - - total (c) - 17 18 17 94 108 203 19 1 2 479 50 (continued below) D. were being educated under arrangements made under Section 56 of the education Act, 1944. (i) in hospitals - - - - 2 19 - - - - 21 (ii) in other groups (e.g. units for spastica, convalescent homes) - - - - - 1 _ _ - _ 1 (iii) at home - - - - - 3 - 2 - - 5 E. were requiring places In special schools (I) TOTAL - (a) day - - 1 1 - - 1 - - - 3 (b) boarding - - - - - 1 1 4 - 1 7 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 school (a) awaiting day places - - - - - - 1 - - - 1 (b) awaiting boarding places - - - - - - - - - - - P. were on the registers of hospital special schools - 24 G. During t he calendar year ended 31st December, 1960, (i) how many children were reported to the local health authority - (a) either under Section 57(3) (prior to1.11.60) or under Section 57(4) (from 1.11.60) - 15 (b) under Section 57(5) prior to 1.11.60 - Nil (ii) how many decisions that a child is unsuitable for education at school have been cancelled under Section 57A(2) - 1 of the Education Act, 1944. 51 Table VIII VISION TESTS Summary of Findings Extent of Defect En fronts up to 6 years Intermediates II and 12 years Leavers 14 and oyer 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 72 5.3 65 4.4 185 11.6 119 8.6 144 10.2 114 8.8 180 8.4 181 8.7 581 8.9 479 7.7 Over 6/24ths 10 0.7 9 0.6 62 3.9 33 2.4 34 2.4 55 4.2 36 1.7 46 2.2 142 2.2 143 2.3 52 53 Table IX DENTAL DEFECTS (1) Inspected by Dental Officers:- 1960 1959 Aged 5 - 6 1,569 Total: 25,356 1,036 6-7 2, 471 1,911 7-8 2,660 2, 098 8-9 2,359 2, 232 9-10 2,514 2,375 10-11 2,570 2, 429 11 - 12 2, 222 2, 351 12-13 2,322 2, 892 13-14 2,451 2,839 14-15 2,133 2, 428 15-16 1,257 2, 252 16 up 828 1,302 Specials: 1, 956 1,924 27,312 28,069 (2) Number found to require treatment 15,533 14,901 (3) Number referred for treatment 13, 708 13, 753 (4) Number actually treated 9,773 7. 950 (5) Attendances made by children for treatment 23, 367 23,083 (6) Half-days devoted to: Inspection 211 3,079 191 2,747 Treatment 2,868 2,556 Number of Gas Sessions 272 304 Administrative Sessions 141 133 Orthodontic Sessions 390 411 (7) Fillings - Permanent Teeth 8,722 10,738 7,570 9,091 Temporary Teeth 2,016 1,521 (8) Teeth Pilled: Permanent Teeth 8,069 10,009 7,135 8,589 Temporary Teeth 1,940 1,454 (9)Extractions - Permanent Teeth 2, 211 7,172 2,575 8,043 Temporary Teeth 4,961 5,468 54 (10) Administrations of general anaesthetics for extractions 3,037 3,522 Administrations of local anaesthetics for extractions 1, 264 683 (11) Other Operations - Permanent Teeth 8,978 9,821 9,186 9,993 Temporary Teeth 843 807 Attendances per session 8.1 9. 0 55 Table X speech defects clinic summary Total number of cases treated 314 Cases discharged 74 Cases still attending 240 Cases referred for physical treatment 44 Cases referred for residential treatment 3 Cases referred to Child Guidance — Stammerers 53 Sigmatism 44 Cleft Palate 6 Hyper Rhinogsjonia, including Supra-bulbar palsy 9 Dyslalia 153 Undeveloped Speech 31 Developmental Aphasia, including Dysprapia & Dysarthria 13 Partially Deaf 4 Dysphonia 1 St. Christopher's School is included in the above summary. In addition 16 children were treated at St. Giles' School. 56 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1960 RETURN OF MEDICAL INSPECTIONS A. - Routine Medical Inspections Year Year 1960 1959 Age 11 or under 13 33 12 58 81 13 46 47 14 32 11 15 10 60 16 - 77 17 8 33 18 or over 3 16 Total 170 358 B. - Other Inspections Number of Special Inspections - 2 Number of Re-inspections - - Total - Visits to Non-maintained Schools 10 12 The following defects were found by Medical Inspection:- Treatment Observation Skin 1 - Defective Vision 5 - Other eye defects 2 - Nose and Throat 1 - Posture 3 - Other Defects and Diseases 1 - 57 APPENDIX D RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1960 WHO HAVE UNDERGONE TONSILLECTOMY Year of Birth Boys Per Cent Girls Per Cent Boys and Girls Per Cent 1955 and later 43 4.9 37 3.8 80 4.3 All Boys 1543 23.6% 1954 33 6.8 35 6.8 68 6.8 1953 16 8.4 28 12.7 44 10.7 1952 67 15.6 71 15.3 138 115.5 1951 129 22.4 110 18.1 239 20.2 1950 58 20.0 61 20.1 119 20.2 1949 161 30.8 128 26.4 289 28.7 1948 328 30.5 237 26.2 565 28.0 All Girls 1220 19. 5% 1947 228 33.8 126 25.9 354 30.5 1946 208 33.6 141 29.4 349 31.7 1945 164 33.8 164 28.5 328 30.9 1944 and earlier 108 34.7 82 33.9 190 34.4 All Groups Boys and Girls 27 6 3 - 21.6% CHIEF CAUSES OF EXCLUSION FROM SCHOOL Condition Exclusions during 1960 Percent age of total exclusions Exclusions during 1959 Percentage of total exclusions Ringworm 1 0.09 — — Verminous Conditions 27 2.45 14 1.34 Impetigo 13 1.18 8 0.76 Scabies 3 0.27 1 0.10 Scarlet Fever 224 20.35 214 20.42 Measles (inc. German) 12 1.09 309 29.48 Diphtheria — — — — Whooping Cough 65 5.90 13 1.24 Chicken pox 311 28.25 94 8.97 Mumps 381 34.65 14 1.34 External Eye Disease — — — — Poliomyelitis — — — — Dysentery 56 5.09 370 35.31 Jaundice — — — — Enteric Group — — — — Meningococcal Infection 4 0.36 5 0.48 Other Causes 4 0.36 6 0.57 1,101 1,048 58 APPENDIX E TREATMENT The Work of the School Clinics. SUMMARY OF ATTENDANCES 1960 1959 Increase or decrease Minor Ailments and Verruca Clinics 6,553 5,827 + 726 Inspection Clinic 1,180 8 18 + 362 Dental clinics 23,367 23,083 + 284 Remedial Exercises Clinic 6,819 6,220 + 599 Enuresis Clinic 743 563 + 180 Audiology Clinic 300 — + 300 38,962 36,511 + 2,451 MINOR AILMENTS CLINICS Clinic Defects At tendances Lodge Road 395 2,527 Ashburton school 399 803 Duppas School 485 1,854 Rockmount School 530 917 Addington 181 452 Complaint 1960 1959 Cases At tendances Average No. of Attendances per case Cases At tendances Average No. of Attendances per case Ringworm 1 1 1.0 1 1 1.0 Scabies — — — 1 1 1.0 Impetigo 13 30 2.3 9 41 4.6 Other Skin Diseases 28 57 2.0 15 43 2.9 Otorrhoea and other Ear Defects 42 66 1.6 26 75 2.9 External Eye Disease 124 190 1.5 57 165 2.9 Miscellaneous 1,349 3,540 2.6 1, 243 5,501 4.4 1,557 3,884 2.5 1. 352 5,827 4.3 59 APPENDIX F SPINAL AND OTHER REMEDIAL CLINICS (LODGE ROAD) 1960 1959 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 2,313 546 4.2 2,547 534 4.8 Flat Feet 2,647* 493 5.4 2,541 504 5.0 Breathing 424 115 3.7 591 125 4.7 5,384 1,154 5,679 1,163 *97 treated by Faradism. 210 individual cases were treated and 588 examinations were made by a doctor. SPINAL AND OTHER REMEDIAL CLINICS (NEW ADDINGTON) 1960 1959 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 464 42 11.0 184 33 5.6 Flat Feet 739 84 8.8 221 66 3.4 Breathing 232 42 5.5 136 33 4.1 1,435 168 541 132 125 individual cases were treated and 76 examinations were made by a doctor. WORK OF SCHOOL NURSES School Visits Visits to School Departments re Cleanliness 373 Visits re Scabies or Ringworm 8 Visits re Infectious Disease 31 Visits re Medical Inspections 629 Visits re Medical Preparations 546 All other reasons 388 Home Visits Concerning defects found at routine medical inspections 448 Subsequent visits re defects found at routine medical inspections 145 Visits re special cases 1,046 Visits other than infectious cases 2,229 Visits in connection with infectious cases 413 60 APPENDIX G DEAF AND PARTIALLY DEAF CHILDREN Children referred to special teacher - 243 Number of audiometric tests - 396 Of these children - 151 had no significant hearing loss 62 had a slight loss and will be re-tested 22 were referred to Otologist 8 were referred for medical treatment Otologist's Clinic 30 children made 32 attendances, of these 10 were referred for auditory training 5 were recommended for a special school for deaf or partially deaf pupils 4 were recommended for medical treatment 2 recommended speech therapy 2 for further testing 2 considered to have normal hearing 5 other recommendations not connected with deafness Hearing Aids National Health Service "Medresco" 12 Supplied in 1960 Bought by Corporation 2 gupplied in previous years 38 Total 52 Placement of Deaf and Partially Deaf Children on December 31st, 1960 Primary Schools Secondary Schools Croydon Day schools 47 48 Special Day Schools for Deaf 15 3 Special Day Schools for Partially Deaf 6 — Residential Deaf Schools 1 5 Residential Partially Deaf Schools — 4 52 of the children in Croydon Day Schools wear a hearing aid. CONTENTS A. - PUBLIC HEALTH REPORT Page Ambulance Service 50,117 Amusement Houses 63 Animals, Diseases of ... 65 Animals. Keeping of ... 65 Ante-Natal Clinics 33 Births 12 Blindness 90 Byelaws 81 Cancer 15, 96 Care of Mothers and young Children 33 Census 11 Chemical Analyses 84 Chest Clinic. Work of ... 23 Child Minders 89 Chiropody 55, 115 Civil Defence 51 Clean Air Act 62 Convalescence 54 Committee, Health 3 Communicable Diseases 17,128,129 Cremation 87 Day Nurseries 54 Deafness 55 Deaths 11.13.93.94 Dental Treatment - M. & C. W. 47,113 Disinfection 63 Dlslnfestatlon 64 Drainage 62 Epileptics 90 Elderly persons. Rehabilitation of ... 108 Factories and Workshops ... 59 Food and Drugs Act 72 Food Poisoning 18 Food Supply 66 Health Education 44 Health Visitors. Work of ... 37,105 Home Helps 42, 111 Home Nursing 40. 107 Home safety 39. 114 Hospital, Isolation ... 19 Housing 63 Ice Cream - Bacteriological Examination of 72 Illegitimacy 11,33 Page Immunisation 40, 130 infant Mortality 11.14.98.99.100 Infant Welfare Clinics ... 106 Inquests 13 Laboratory Examinations, Various 32,71,83 Marriages 12 Maternal Mortality 14,98 Maternity Homes 87 Meat Inspection 68 Men's Hostel 59 Mental Health 120 Mental Illness 126 Midwifery 35,101 Mldwlves Acts 35 Milk Supply 70 National Assistance Act ... 91 Neo-Natal Deaths 11,99 Notification of Births Acts 12 Nuisances 81 Nursing Equipment, Loan of 41, 110 Nursing Homes 87 Nurses' Agencies 87 Occupation Centre 53 Offensive Trades 62 Outworkers 60 Perinatal Deaths 11,99 Pests 65 physiotherapy 109 Pharmacy and poisons Act ... 64 poliomyelitis 131 population 11 Post-Natal Clinics 33 Post-Mortems 13 Premature Infants 33,104 -Problem Families 112 Prosecutions 68 Public Health Inspectors, Work of 57,80 Public Health Laboratory Service 32 Rag Flock Act 65 Rats and Mice (Destruction)Act 65 Relaxation Classes 33 Rivers and Streams Pollution of 62 Page Scarlet Fever 20 Shops Act 61 Staff Medical Examinations ... 88 Staff 10 Still Births 11. 13 Street Accidents 117 Swinming Baths 85 Tuberculous,After Care 30 n Allowances 30 n Contacts 27 n Hone Nursing ... 27 n Home Visits 27 n Mass Radiography ... 29 ii Mortality ... 26.13 2.133 it Notifications 132, 133, 134 n Occupational Therapy 31 n Residential Treatment 27 n Prevention and Control 23 n Re-Housing 28 n Vaccination 28 B. - SCHOOL MEDICAL REPORT Page Child Guidance 27 Cleansing of Children 10 Clinics 4,58 Cod Liver Oil 31 Cos t 31 Deaf Children 30, 60 Deaths 12 Defects Found 35,46,49 Dental Service 15,39 Ear Disease 58, 37 Enuresis clinic 29 Epileptic Children 32 Exclusions 13,44,57 Facilities for Treatment 14 Handicapped Pupils 50,51 Health Visitors, Work of ... 13,59 Heights and Weights 9,43 Infectious Diseases 9, 44 Juvenile Employment 31 Malt 31 Meals, Provision of 31 Mentally Defective Children 26 Page Unmarried Mothers ... 33 Vaccination 130,131 Verminous Persons ... 64 Venereal Diseases 32, 137,138 Vital Statistics 11,93,94 Ward Statistics 15,HI Water Supply 83 Welfare Foods 36 X-Ray 29 Zymotic Diseases ... 19 Page Milk, etc.. Provision of 31 Minor Ailments ... 1* Non-maintained Schools 32,56 Orthodontic Service ... " Parents' Attendances ... Population " Remedial ExerclEes ... 55 School Nurses, visits 13 Schools special. Cost of 3' Spastlcs Speech J8>53 Staff Statutory Tables ... Sub-normal children ... St. Christopher's ... ~ St. Giles' ;! St. Luke's a Tonsillectomy 8,|' Treatment .! Tuberculosis Uncleanl lness 10,11 Vision, Defective •••