Ac 44132 CR 063 PUBLIC HEALTH IN CROYDON 1961 PUBLIC HEALTH IN CROYDON 1961 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1961 S.L. WRIGHT. M.D.. M.R.C.P.. D.P.H. PUBLIC HEALTH DEPARTMENT. 45 WELI ESLEY ROAD CROYDON Telephone:-CROYDON 4433 3 HEALTH COMMITTEE 1961 Councillor Keith Edwards Councillor Mrs. A.M. Massie (Chairman) Councillor Mrs. M.C.V. Parfitt Councillor Mrs. E. M. Maycock Councillor B. H. Rawling (Vice-Chairman) councillor Mrs. B. Saunders Alderman Mrs. V.L. Child Councillor B.C. Sparrowe Alderman A.V. Dammarell Councillor H. E. Styles Councillor J.J. Cooper, J.P. Councillor J.T. Twitchett Councillor E.J. Fowler Councillor K.F. Urwin Councillor Mrs. D. L. George J. S. Lane, Esq., B. A., M. R. C. S., Councillor C. E. Kelly L.R. C.P. Councillor G. Levy Miss K. C. Vost, M. B. ,B.S. .D.P.H. Councillor M.E. Mackenzie T. G. E. White, M.D. .M.R.C. O. 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. Croydon Local Medical Committee A.F. Clift, Esq., F.R.C.S., M.R.C.O.G. S.Y. Marsters, Esq. Croydon Group Hospital Management Committee Mrs. E.M. Ryle Horwood Royal College of Nursing Mrs. F.R. Mitchell, O.B.E. Royal College of Midwives Miss J.C. Dickinson Croydon District Nursing Association Mrs. G.C. Browning Croydon Family Planning Association Mrs. J. Too good Croydon Federation of Townswmen's Guilds *D.G. Goldie, Esq. The St. John Ambulance Brigade (Southern Area) H.G. Murphy, Esq. The Insurance Institute of Croydon Councillor J. a. Keeling served as a Member of the Home Safety Sub-Committee *(On 5.12.61- Mr. E. B. Hamley was appointed to the Home Safety Sub-Committee on the nomination of the St. John Ambulance Brigade in succession to Mr. D. G. Goldie). 5 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1961 To the Chairman and Members of the Health Committee ladies and gentlemen This report for 1961 presents the usual figures relating to the health of Croydon. Twelve months is a short period in such a history. Abrupt changes from year to year are uncommon and when they occur are most frequently the results of mishaps. Fortunately last year continued the trend towards improvement Statistics The census figure showed the population had risen to well over the quarter million. The corrected death rate was a little higher, but 73% of those who died were over 65, and 51% were over 75 years of age. In contrast 25 years ago the figures were 54% and 31%. An illustration that under present conditions we have all a good chance of living to ripe old age. In the age group 45 to 64 three quarters of the deaths were from coronary thrombosis and cancer. The infant mortality rate was the lowest ever recorded. As measires of habits, rather than health, the illegitimate birth rate remained high at just over 7% of all births, and attendances at venereal diseases clinics exceeded last year's figures. 6 Communicable diseases No special comments are needed except about tuberculosis. Here the marked increase in the number of notified cases, and the unaltered death rate from this disease were disappointing. The total number of deaths was however only 21, and nearly onethird of those who died were over 75 years of age. The disappearance in the near future of deaths from this cause among those under 45, (of which there were 7 last year) is anticipated. The Chest Physician explains how a special Mass X-ray campaign in 1961, and changes in notifying primary infections, previously disregarded, raised the number of notifications. A question was put about immigrants in Croydon. A analysis of cases during the first 9 months of the year showed that only 5% of tuberculous patients could be regarded as recent immigrants to this country. Personal Health Services The rising number of attendances at Infant Welfare Centres shows the value placed by mothers on this service. This is despite the fact that in Croydon the only Welfare Foods distributed are those issued by the Ministry of Pood. Furthermore the majority of centres are held in rented halls offering few amenities. Properly restricted to immunisation, education and supervision, our infant welfare centres have shown that they do not compete with the care given by family doctors, but are entirely supportive and complementary to the general medical services. The domiciliary midwives had a busy year, and close coordination with hospital maternity units ensured for every mother definite arrangements for her confinement. Health Visitors continued to develop new measures for the early detection of abnormalities, end despite staffing shortages, were adopting fresh techniques in health education. Health visiting was introduced in the 19th century to combat the high infant mortality rate; I doubt if those concerned ever thought that an urban area such as Croydon would record a rate of 15. The Ambulance service was hard pressed and during the winter months routine calls could not always be met punctually. Steps to solve this problem of peak loads are being taken. Home Nurses and Home Helps continued to assume as their major duty an increasing responsibility for the home care of the aged. 7 The Mental Health service developed as planned with the opening of a new Day Centre/Hospital, and an Adult Training Centre, both in temporary buildings. New premises are being designed. The use of not less than 10 places in a Mental After Care Association's Home in Croydon, for ex-hospital patients able to go to work, has operated well. Recruitment with Warlingham Park Hospital of social workers was commenced and the building up of a mental health team for hospital and community care was begun. Progress has been slower than we had hoped, but a national shortage of trained staff makes this inevitable. To help in meeting this need the Education Committee agreed to arrange as speedily as possible a 2 year social workers' course, leading to a national qualification, at the Croydon Technical College. In short much was accomplished, the results of which will show in the near future. Health Education It is a valid claim that the routine duties of the staffs of Public Health departments, especially Medical Officers, Health Visitors and Public Health Inspectors, are directed mainly to education for the promotion of health and prevention of disease. Necessarily the first requirement is knowledge of what to teach. Here we are wise to be cautious and admit that there are still many fundamental problems to be solved. When however facts are known, the methods for their presentation are all important. Even born teachers are improved by training. For those without this gift it is essential to learn how best to impart knowledge to others. Furthermore there should be continuous testing of results, so that time, energy and opportunities are not wasted. These are the functions of a trained Health Education Officer and it is difficult to understand how any Health department can properly fulfil its duties without such an appointment. It was very encouraging therefore to obtain authority for an additional Post of this status at Annual Review of Staff. It was also decided that 'Home Safety' which obviously deals mainly with education, should become a responsibility of the Health Education section. Clean Air The Corporation have naintained their programme and steady Progress was made towards the 10 year target of all Croydon as a Smoke control area. I am certain that clean air must be our 8 major contribution to the health of the community, and its ultimate benefits will surpass our present hopes. Housing As judged by the number of Explications with medical certificates which were referred to me, the problem of providing sufficient housing accommodation seems no nearer solution. Some applicants undoubtedly blame housing conditions for troubles really due to other causes, but the majority have a genuine need and would benefit from rehousing. It was an unpleasant task to select the very few exceptional medical cases for the snail number of houses which can be allocated for this group. Co-ordination Co-operation with general practitioners and hospital services remained close and cordial, being greatly facilitated by Croydon's County Borough status. In conclusion I thank the members of the staff of the Health Department and other sections of the Corporation for unfailing support, and the members of the Committee for their sustained enthusiasm, interest, and practical advice, during a bus; formative year. I am, Yours faithfully, S. L. WRIGHT, Medical Officer of Health and Principal School Medical Officer. 9 STAFF OF THE DEPARTMENT Medical Officer of Health and Deputy Medical Officer of Health (also Principal School Medical Officer and Deputy Principal School Medical Officer). General Administration Chief clerk, Deputy, 17 Clerks(includlng 1 part time), 4 Typists, 1 Messenger. Public Health and Food Chief Public Health Inspector, Deputy, 20 Inspectors, 1 Superintendent Abattoir 3 Clean Air Act Assistants, 1 Foreman and 5 Assistants, chief Disinfector, 1 Superintendent and 4 Porters (Men's Hostel), 2 Rodent Operatives, 9 Clerks, 2 Typists, 2 Trainees. Maternity and Child Welfare 6 Clinic Medical Officers whole time (also school duties), 5 part time. Superintendent Health visitor. Deputy, 30 Health Visitors and 2 Specialist Health Visitors (also School Nurses). 1 part time Almoner and 1 part time Almoner's Clerk, Superintendent Midwife, Deputy and 19 Midwives, 2 Maternity Nurses (part time), 1 Physiotherapist (also school duties), 4 Ante-Natal Clinic Nurses (part time), 8 clerks, (Dental service as for School Health), 9 Clinic Cleaners and 2 Handymen (all part time). District Nursing Superintendent, 3 Assistants, 39 Nurses, (agency arrangements) 4 Students, 2 Clerks (1 part time). Domestic Help Supervisor, 4 Assistants, 2 Clerks, 16 full time and 20 2 part time Home Helps. Day Nurseries 1 Nursery with Matron, Deputy, 5 Nurses, 3 Students, Handyman and 4 Domestic Staff (part time) Vaccination and 2 clerical Officers including 1 part- Immunisation time. Ambulance Service Ambulance Officer. Deputy, Second Officer, Third Officer, Maintenance Officer, 4 Leading Drivers, 70 Drivers, 2 Mechanics, 3 Clerks, 1 Telephone Operator, 1 C. D. Training Officer, 1 Depot Labourer, 1 Cleaner (part time). Prevention. care Chest Physician (part time), 2 Assistant After-care Chest Physicians (part time), 4 T. B. Visitors, 1 Almoner, 2 Clerks, 1 Occupational Therapist (part time). Mental Health 1 senior Mental welfare Officer, 4 Mental Welfare Officers, 1 Planning and senior Clerical Officer, 2 Welfare Assistants, 2 Clerks, 1 Junior Training Centre Supervisor, S Assistants, l Handyman, 3 Guides and 6 Domestics (part time). 1 Senior Instructor Adult Training Centre 2 Instructors, 1 Domestic, 2 Day centra Domestics (1 part time). Health Education I Qualified Health Education Officer. Welfare Foods 2 Clerks (1 part time) and 1 Driver. STATISTICS 11 SUMMARY OF VITAL STATISTICS FOR 1961 Area, 12,672 acres. Population (Census 1961), 252,470. Total population (estimate of Registrar-General), 252,470 (Midsummer, 1961) Number of Inhabited Houses: 75, 587 Rateable Value of Borough (1st April, 1961: £5,184,042. Product of a Penny Rate (1960-1961): £20, 445. 11s. 5d. Rate in the £. 18s. 0d. (for the year ending 31.3.61). Live Births: Males Females Total Legitimate 1,933 1,959 3,892 Illegitimate 140 157 297 4,189 Illegitimate Live Births per cent of total live births 7.1 Live Birth Rate(as adjusted by comparability factor (0.99) 16.4 (England and Wales 17.4 Stillbirths 54 Stillbirth rate per 1,000 total(live and still)births 12.7 (England and Wales 18.7 Total Births 4,243 Infant Deaths 63 Infant Mortality rate per 1,000 live births 15 (England and Wales 21.4 Infant Mortality rate per 1,000 legitimate births 15 Infant Mortality rate per 1,000 illegitimate births 17 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 10 (England and Wales 15.5 Early Neo-natal Mortality rate (First week) per 1,000 total live births 8.8 Perinatal Mortality rate (stillbirths + deaths during the first week)per 1,000 total live and still births 2L4 Maternal Deaths (excluding abortion) 1 Maternal Mortality rate (including abortion) per 1,000 total live and still births 0.24 (England and Wales 0.33 Deaths, 3,089. Death-rate per 1,000 of the estimated population 12.2 (England and Wales 12.0 Death rate(as adjusted by comparability factor 0.93 11.3 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 1961 to 20.80%.* The number of marriages solemnised was 2,041. compared with 1,890 in 1960, 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 and 1,960 in 195L 839 were solemnised in Established Churches, 467 in other places of worship, none by Jewish Ritual and 735 in the Register Office. Births The live births registered were 3,892 legitimate and 297 illegitimate. The birth-rate consequently was 16.4 per 1,000 population. For England and Wales the rate was 17.4. The illegitimate births in Croydon were 7.1 per cent of the total as compared with 7.2 in I960, 7.3 in 1959, 5 per cent in 1958, 5.5 in 1957, 4.3 in 1956 and 4. 8 in 1955. The live male births numbered 2,073, the female 2,116, being a proportion of 980 males to 1,000 females. Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,320 28 3,348 Doctors 1,250 35 1, 285 4,570 63 4,633 Accomodation for Confinements The following table shows where babies were born in Croydon during 196L 24 more babies were born at home and 209 more were born in hospital than in 1960. 69 more Croydon residents had babies outside Croydon and 43 more non-residents were confined in Croydon than in 1960. Percentage. In Private Houses 1,438 31.04 In Public Institutions 2,966 64.02 In Registered Maternity Homes 229 4.94 Total 4,633 13 Still Births During 1961, 54 still births were registered in respect of Croydon. Of these, 29 were male babies and 25 females; 4 females and 5 males were illegitimate. The proportion of still births to living children was 1 in 78. The still birth rate was 1.3 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 12.7 per 1,000 births. Deaths The deaths numbered 3,089, compared with 2,934 in 1960. For 1961 the crude death-rate was 12.2 compared with 11.8 in 1960. The death-rate for England and Wales was 12. 0. There were 109 inquests held by Coroners in respect of Croydon residents during 1961 and 522 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 90. comparisons with 1960 show there were again no deaths from Whooping cough and none from Measles. There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 21 (20 in 1960); those from cancer increased by 29, those from Pneumonia increased hy 22 and a decrease of 4 was recorded in those caused hy Bronchitis. There were 17 deaths from Influenza (6 in 1960). 29 deaths from suicide showing a decrease of 2 and motor vehicle accidents totalled 27 (40 in 1960). The percentage of deaths under 1 year of age to the total deaths was 2. 0 per cent.; deaths under 1-14 years, 0. 8 per cent.; deaths under 15 - 64 years, 24.2 per cent.; and deaths °ver 65 years, 73. 0 per cent. The corresponding figures for I960 were Z7 per cent., 0.7 per cent.; 23.8 per cent., aid 72.7 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. 47 Deaths from Cancer (all forms) 2.43 Deaths from Vascular lesions of the Nervous System 1.88 Deaths from diseases of the Respiratory System (excluding Tuberculosis) 1.47 Deaths from cancer of Lung 0.59 Deaths from Suicide and Violent Causes 0.35 Deaths from diseases of Digestive System *0.21 Deaths from Tuberculosis (all forms) 0.08 *ulcers of stomach, duodenum; gastritis and enteritis. Maternal Mortality There was 1 death, compared with 1 in 1960. The maternal mortality rate calculated per 1,000 total births was 0.24. The rate for England and Wales was 0. 33 in 1961. For figures for the years 1951 - 1961 see the Appendix, page 94. Cause of death:- 1. Subarachnoid haemorrhage Toxaemia of pregnancy Infant Mortality The 1961 figure dropped to 15. Set out In the Appendix, page 96 are the usual tables giving causes and age distribution. The greatest single factor remains prematurity of which the correction lies mainly with ante-natal care of the expectant mother. Among the 63 deaths, 32 occurred in boy babies and 31 in girls. Of the births, 2,073 were males and 2,116 females. The infantile mortality rate for the two sexes was, therefore, Boys-15. Girls-15. 49 deaths of infants occurred in Institutions, including Registered Nursing Homes. For details of infant deaths see the Appendix, page 95. 15 CANCER For detailed tables see the Appendix, page 9 2. Deaths tabulated in the Department number 614 as compared with 585 in 1960; 623 in 1959; 562 in 1958; 591 in 1957; 592 in 1956; 549 in 1955; 486 in 1954; 540 in 19 55 567 in 1952 and 479 in 1951. Death-rate per 1,000 of the population for the last 10 years is as follows:- 1952-2.26 ( 567) 1957-2.37 ( 591) 1953-2. 16 ( 540) 1958-2. 25 (562) 1954-1.95 ( 486) 1950-2.50 ( 623) 1955-2 20 (549) 1960-2.34 ( 585) 1956-2.37 (592) 1961-2.43 (614) The organs most often attacked in descending order of incidence are;- In the males - the Lungs (38. 1 per cent.), the Stomach (12.5 per cent.) and the Bowels and Rectum (10.4 per cent.); In females - the Breast (20.6 per cent.); Bowels and Rectum (16.8 per cent.); and the Uterus (11.9 per cent.). Ward Statistics These are tabulated in the usual form in the Appendix, page 93. 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 Measles-Following its two year cycle, there was an outbreak which continued over a longer period than usual. Most cases were mild and there were no deaths. There are reports of an experimental vaccine to protect against Measles. With such widespread but mild infections it is difficult to decide how much effort should be given to active immunisation. Parents too, do not relish an increase in the number of inoculations to which children can be subjected. Poliomyelitis-There was one paralytic and one non-paralytic case notified. The children were related, and from both Type 2 virus was isolated. The child who was paralysed had received one injection only of polio vaccine in 1959. The other patient had received two injections in 19 58 Pood Poisoning-There were two notable outbreaks of mild food poisoning. One involved 40 of the staff of a factory, and the other 100 office workers. From our enquiries and laboratory reports, both were due to failure to follow one of the requirements of the Pood Hygiene Regulations, viz:- the need for prompt cooling and cold storage of food which is cooked and kept for some hours before being served. Both Canteens were well designed and equipped, and the failure to obey the rules was due to ignorance. Offers of lecture demonstrations to catering staff were accepted. Same years ago similar lecture demonstrations on "Clean Food" were offered to all owners of food premises and canteens in Croydon. The response was fairly satisfactory. This offer was therefore repeated in a letter from the Chairman of the Health Committee, attention being drawn to the outbreaks described above. 18 FOOD POISONING The food poisoning notifications, as corrected, for 1961 were:- 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 7 22 8 20 57 Outbreaks due to identified agents:- Total Outbreaks Total Cases 1 6 Outbreaks due to:- (a) Chemical Poisons Nil (d) cl. Botulinum Nil (b) Salmonella Organisms Nil (e) cl. Welchii 1 (c) Staphylococci(including (f) Other Bacteria Nil toxin) Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases Nil Nil Single Cases:- Agent identified Unknown Cause Total 21 36 57 Cases due to:- Salm. brandenburg Salm, typhi-murium Salm. Stanley 1 19 1 19 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1961 J.J. Linehan, Esq., M. D., D.P.H. Physician Superintendent, Waddon Hospital Admissions to the Infectious Diseases' Wards:- A total of 610 patients were admitted to the infectious diseases' wards, giving an average bed occupancy of 31.74 and an average stay in hospital of 19.77 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 Borough of Croydon, the Croydon cases are shown separately in brackets. Measles 112 (53) stomatitis 1 Gastro-enteritis 104 (86) Dental Abscess 1 (0) Dysentery 63 ( 28) Asthma Scarlet Fever 38 (34) Gastric Ulcer 1 Pneuaonla 32 (21) Carcinoma of the Pancreas 1 Chick en-pox 28 ( 22) Appendicitis 3 whooping cough 21 (14) Intussusception 1 Influenza 21 (16) cholelithiasis 1 Meningitis and Encephalitis 20 (14) Ulcerative Colitis l Rubella 18 (15) Diverticulitis 1 (0) Glandular Fever 13 (10) Scabies 7 Infective Hepatitis 11 (8) Dermatitis 3 Salmonella Infection 10 Impetigo 3 Mumps 8 ( 5) Conjunctivitis 3 (2) Streptococcal Sore Throat 4 ( 2) Toxic Erythema Herpes Zoster 4 (3) Whitlow 1(0) Erysipelas 3 Papular Urticaria 1 Poliomyelitis 2 Vaccinia 1 (0) Paratyphoid 1 Napkin Rash 1 (0) Roseola Infantum 1(0) Lymphadenitis 3 Tonsillitis 13 (11) Acute Rheumatism 1 (0) Pharyngitis 16 (14) Infective Polyneuritis 3 (2) Rhinitis 1 Mental Depression 1 Bronchitis 15 (11) Subarachnoid Haemorrhage 1 Otitis Media 2 Non-patient Babies 3 (2) 2(0) 20 Measles:- Measles was epidemic in the first four months of the year during which period 89 of the total of 112 measles patients were admitted. The number of cases admitted in the different age groups were as follows:- under one year-12; 1-2 years-20; 2-5 years-55; 5-15 years-26; and adults-5. 55 patients were admitted from their own homes and of the remainder 39 were admitted from hostels, 6 from nurseries, 5 from residential schools, 3 from hospitals, 2 from childrens' homes and 2 hospital staff. The following complications were present:- Pneumonia-34; Bronchitis-14; Tonsillitis-8; Gastro-enteritis-7; Meningo-encephalitis-4 Convulsions-4; Rhinitis-4; three cases each of laryngitis stridulosa; epistaxis; stomatitis; impetigo; two cases each of lobar collapse; anaemia; otitis media and one case each of purpura; styes and hypertoxaemia. There was one death, a child 1 year 4 months who had developed pneumonia and was also found to be suffering from subendocardial fibro-elastosis. Gastro-enteritis:- 104 cases were admitted in the following age groups:- Under one year-40; 1-3 years-35; 3-15 years14; adults-15. Classified as to severity-13 were very severe; 49 moderately severe and 42 mild. The illness was most prevalent in January and February, 32 patients being admitted during that period. As usual, no specific pathogen was isolated in the great majority of cases. E. Coli of the types associated with diarrhoea were isolated as follows:- E. Coli-0.111-6 cases; E. Coli-0.119, 0.126 and 0.128 - one case each. There was one death, a mongol child who also developed fulminating pneumonia. Dysentery:- All cases admitted were of the Sonne type. Requests for admission were almost entirely institutional, 36 admissions being from hostels, 22 from residential schools and 4 from other hospitals. This also accounted for the predominance of young children, 5 being under one year; 23 - one to three years; 22three to six; 7-six to fifteen years and 6 adults. Admissions tended to concentrate on certain periods. Thus, in the months of January to May inclusive and August, there were 59 admissions as against 4 in the remaining six months. Drug resistances showed a similar pattern to previous years. There were 25 sulphonamide resistant cultures, 9 streptomycin resistant and 7 tetracycline resistant. There was only one persistent carrier. 21 Scarlet Fever: - Probably on account of the small number admitted no definite seasonal prevalence was noticeable. 8 patients admitted in March was the highest monthly incidence. Of the total 9 were under five; 27-five to fifteen and 3 adults. Complications present were mild. They occurred as follows:- three cases of angular stomatitis, two cases each of otitis media, impetigo, lymphadenitis, rhinitis and secondary sore throat; one case each of abscess, secondary tonsillitis and paronychia. Pneumonia:- As a group, the pneumonia patients tended to be very ill due to co-existing diseases and disabilities, and there were seven deaths among the 32 patients admitted. Thus, there were 7 cases of myocardiac degeneration, 5 of chronic bronchitis and emphysema, 4 of lobar collapse, 2 cases each of valvular heart disease and pleural effusion and one case each of pulmonary fibrosis, pneumonectomy, bronchiectasis, advanced muscular dystrophy, infective polyneuritis, deltoid paralysis, perforated gastric ulcer and chronic nephritis and uraemia. 13 of the total number were admitted in December. Chicken-pox:- Of the 30 patients admitted, 14 were adults in whom the illness tends to be more severe. Most of the requests for admission came from other hospitals either in respect of their patients or their staff. Disregarding the unrelated illnesses from which the patients from other hospitals were suffering, the only complications met were bronchitis and herpes zoster. The greatest prevalence was in December when 8 patients were admitted ftooping Oougji:- as usual, whooping cough admissions were mainly confined to infants. Age groups were as follows:- 0-1 year9: 1-3 years-10; over 4 years-2 patients. Complications Present were bronchitis-7 cases; pneumonia-2 cases; lobar collapse-2 cases and gastro-enteritis-1 case. Concurrent illnesses present were anaemia and muscular dystrophy. Meningitis and Encephalitis:-15 of the total of 21 were virus infections of unidentified nature. The remaining cases were:meningococcal-3; staphylococcal-1; unknown pyogenic infection-l; coxsackie B-1. The cases listed above are in addition to 4 cases of measles and one case of glandular fever meningo-encephalitis and one poliomyelitis meningitis. 22 Other Infections;- Influenza patients consisted of 14 adults and 7 children. The highest incidence was in December when 8 cases were admitted. Rubella patients were, in the main, from childrens' Homes, hostels and hospital wards. Glandular Fever patients were generally sent to hospital on account of the severity of the angina present. One case of meningo-encephalitis was encountered. One severe case of Infective Hepatitis occurred during pregnancy and developed a haemorrhagic rash. She also had to be re-admitted for relapse but ultimately made a good recovery. Ten patients were admitted with Salmonella infections. Of these,8 were due to salmonella typhi-murium and there was one of salmonella brandenberg and one of salmonella Stanley infection. Poliomyelitis infections were limited to two associated cases,one severe spinal infection and the other meningitic only. Unexpectedly, Type 2 virus was isolated, all previous isolations having been of type 1. There were two cases of Mumps orchitis. Other memps admissions were because of concurrent illness or were members of the hospitals' nursing staffs. for detailed figures see appendices, pages 116, 116. ******************** 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 1961 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1961 was 21 which shows and increase of 1 when compared with 196a The number of new cases of tuberculosis diagnosed during the year shows an increase when compared with 1960, and there are several factors which would account for this. During 1960 there was no Mass X-Ray survey in the Borough whereas in 1961 there was such a survey and 25 cases of tuberculosis were notified as a direct result of this. In addition the number of new cases of tuberculosis diagnosed as a result of contact examination has risen. This is seen particularly in the symptomless child contacts who were found to be suffering from primary tuberculosis. I consider that the increased incidence in the current year is an isolated finding and need not cause undue concern that tuberculosis is increasing in this area. 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 3,913 Number of patients recalled for examination and large film 736 Number of active cases of Pulmonary Tuberculosis 31 Number of cases of lung cancer found 27 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 7.92 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. 24 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. Incidence 173 cases of Respiratory Tuberculosis and 17 cases of NonRespiratory Tuberculosis were notified on Form A during 1961 (Table I-Formal Notifications). Of these 108 males and 65 females were Respiratory cases and 5 males and 12 females were Non-Respiratory. In addition 95 Respiratory cases and 1 NonRespiratory case 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 1961 by notification or otherwise was 286 as compared with 213 in 1960, 264 in 1959, 280 in 1958 and 294 in 1957. 268 of these were cases of Respiratory Tuberculosis; 152 in males and 116 in females. There were 27 more males and 49 more females than 1960. There was one case of Non-Respiratory Tuberculosis among children under 15 years as compared with none in 1960. The number of cases in adults was 16 compared with 18 in 1960. Of the cases notified in 1961, 4 males and no females died from the Respiratory form of the disease during the year, equal to 2.1 per cent. of those notified. The incidence rate of Tuberculosis of all forms was L 13 per 1,000 of the population; for Respiratory Tuberculosis 1.06 and for Non-Respiratory 0.07 per 1,000 population. The notification rate was 0.75 per 1,000. In 1960 the corresponding figures were 0.85, 0.77, 0.08 and 0.51 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1961:- RESPIRATORY NON-RESPIRATORY Total Cases Males Female Total Male Females Total 1. 110 820 1. 9 30 SO 83 142 2.072 25 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1961, 157 of the new patients examined at the Clinic were found to be in the undermentioned stages of the disease on the first examination:- A, or T. B. minus (Sputum negative or absent) 97 or 61.8 B, or T.B. plus, 1 (early cases, sputum positive) 15 or 9.6 B, or T. B. plus, 2 (intermediate cases, sputum positive) 41 or 26.1 B, or T.B. plus. 3 (advanced cases, sputum positive) 4 or 2.5 157 100.0% Non-Respiratory Tuberculosis There were 11 cases examined at the clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints Abdominal 2 Other Organs 4 Peripheral Glands 5 11 Ages at Death Trom Respiratory Tuberculosis Year 0-5 5-15 15-25 25-45 45-65 over 65 TOTAL 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 8 9 18 1961 - - - 2 5 14 21 26 All but 7 cases were notified during life. Where patients have not been notified during their lifetime a visit is paid by the Tuberculosis Health Visitor to the home of the deceased, to obtain particulars of the contacts and to endeavour to persuade them to attend the Clinic for examination. In 1961 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 1960 were 0.08 and 0.00. In 1961 the total number of deaths showed an increase of one when compared with 1960. 90% of the deaths occurred in the age groups 45 years and over. There were no deaths in children of school age. Deaths from Non-Respiratory Tuberculosis During 1961 no deaths were certified to be due to Non-Respiratory' Tuberculosis, compared with 2 in 1960, 1 in 1959, 1 in 1958 and 4 in 1957. Co-ordination with the Health Department During the year 28 children were referred by the School Medical Service, and 3 cases from the Maternity and Child Welfare Section of the Public Health Department. Extra Nourishment Provision of special nourishment in the form of milk granted to 29 selected cases for varying periods during the year and 22 cases were in receipt of extra nourishment at the end of the year. Residential Treatment 245 men, 155 women and 17 children were admitted to Residential Institutions in Croydon during 1961. 27 The Chest Clinic and Home Visiting 2,154 new cases were examined during the year. 168 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 17,657. The Clinic doctors paid 214 home visits and the Tuberculosis Visitors 3,199 visits for Clinic purposes. In addition the Tuberculosis visitors made 321 primary visits for the purposes of the Notification Register. There were also 1,640 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 1961, 742 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contactcase ratio of 4 for each notified case during the year. Of these contacts, 17 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 23 compared with 1.13 per 1,000 of the general population. In addition, there were 7 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:- 1960 - New contacts examined 676. New cases of Tuberculosis 139 1959 - ” ” ” 775. ” ” ” ” 148 1958 - ” ” ” 748. ” ” ” ” 161 1957 - ” ” ” 709. ” ” ” ” 168 1956 - ” ” ” 738. ” ” ” ” 202 28 B. C. G. Vaccination The use of B. C. G. vaccination for contacts has been continued during 1961 and regular sessions are held at the Clinic for this purpose. 426 contacts were successfully vaccinated during the year, compared with 356 in 1960. In addition 25 nurses and domestics were successfully vaccinated, and 54 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 - 3, 423 Number found to be negative - 3,010 Number vaccinated with B. C. G. - 3,008 Rehousing of Tuberculosis Patients 17 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. X-Ray Service It is 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 274 examinations were carried out in 1961. For detailed figures see Appendices, pages 119-123. 29 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. In contrast to 1960 when there were only small localised surveys of factory groups, public mass X-Ray sessions were resumed in 1961. As shewn below a total of 52,010 persons attended No. of Persons Examined Tuberculosis Requiring Treatment or close clinic supervision Primary Carcinoma of Lung male 12,422 18 10 Female 13,583 18 - Total 26,005 36 10 New Addington General Practitioner Chest X-Ray Service. No. of Persons Examined Tuberculosis Requiring Treatment or close clinic supervision Primary Carcinoma of Lung Male 305 2 2 Female 324 - - Total 629 2 2 30 TUBERCULOSIS AFTER-CARE There is still a great need for help amongst tuberculous patients despite the fact that the normal length of treatment is now considerably shorter. It is always a great shock for a man or woman to be told that hospital treatment is needed and much help can be given simply by discussing the necessary adjustments to be made, as well as the various forms of help available. Many more people are now entitled to sick pay for varying periods, but there are many who are not, including those who are self employed as well as those in unskilled work. More firms now keep jobs open, but there are still a number of patients who have to look for new work when they are fit again. The greatest problem is to find suitable work for those who have to change their type of work, but the Ministry of Labour's Disablement Resettlement Officers are most co-operative in finding suitable light work or in re-training both men and women. When patients are discharged from hospital they need considerable help especially where the patient is the mother of a family, who will find it difficult to take life easily when she sees all the tasks that need to be done. Here the Home Help Service does a valuable job. Our Occupational Therapist is able to help patients who are confined to the house and her report appears separately. Now there are two Centres run by the Welfare Services and a number of patients who are not fit for work are able to have occupation good company and good food at these Centres. The voluntary Care committee is still able to give the extra help which often means so much. Particularly valuable help has been given by arranging holidays at spero Homes for couples who would not otherwise get away and who in many cases have not bad a holiday for years. This Christmas the Care Committee has given Pood Vouchers in place of the parcels given in previous years, and the recipients have expressed great pleasure in being able to choose for thamselves. Over 50 patients also received money for fuel. Throughout the year grants have been given for clothing, prans, furnishings, and in one case, repair of an invalid chair. Altogether, 1961 has been another busy year in spite of the increase of statutory help in the Welfare State. 31 OCCUPATIONAL THERAPY In 1961 thirty five patients received treatment from the Occupational Therapy Department of the Chest Clinic. As only a very small proportion of these were able to attend classes it was decided to discontinue the class sessions and send any patients who were able to attend to the Welfare Occupational Therapy departments. The classes finished in July. From the productivity point of view, 1961 was a good year and patients made large Quantities of saleable articles of a high standard. A successful sale of work was held at Queen's Hospital in December and practically all the goods were sold. The showcase in the entrance hall at the Clinic continues to serve a very useful purpose and patients have received many orders for the articles which are displayed there. Receiving orders for their work gives the patients a great deal of pleasure and a sense of being useful. ******************* 32 VENEREAL DISEASES The usual figures are given in Appendices page These show that more patients were treated for both syphilis and gonorrhoea than in 1960. 10 deaths were recorded as due to syphilis but all were in persons over 45 and 6 were over 75 years of age. Presumably they were infected before the use of penicillin. We cannot be certain that there will be no late effects from syphilis or gonorrhoea even after penicillin treatment, but antibiotics do seem to eliminate the infection in a manner not previously achieved. Consequently, while we may deplore illnesses usually due to promiscuity we can no longer forecast dire physical results. 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 - 1961. Faeces outfits 471 Drinking Water samples 270 Public Swimming Bath Water samples 86 Private Swimming Bath Water samples 44 Milk samples 199 Cream samples 7 Ice Cream samples 232 Sundry Pood Specimens 12 Blood 47 Urine 52 Nose aid Throat Swabs 18 total 1,438 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 33 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics The value of joint domiciliary midwifery and hospital services under unified clinical supervision in Croydon has been amply demonstrated in recent years. With no increase in the number of hospital beds and accommodation for only 2/3rds of all births, every expectant mother has clear and proper arrangements made for her confinement. I am assured by the Consultant Obstetricians that the routine use of the E.B.S. to obtain at the last moment a maternity bed, has not extended to Croydon. This does not mean that every mother who wishes to be confined in hospital is admitted, but any mother who for medical or social reasons is deemed at the Ante-Natal Clinics to require a bed in hospital will be so booked. Clinic attendances rose during 1961, reflecting the increase in the birth-rate. At ante-natal clinics a total of 4, 535 mothers attended during the year, 3,372 for the first time. 23,520 attendances were recorded. At the post-natal clinic, 1,883 mothers attended for the first time and made a total of 1,906 visits. Care of Premature Babies There were fewer premature babies born than in 1960 and more survived. All those born at home were alive at the end of one month For detailed figures see Appendix, page 100 Care of the Unmarried Mother The Croydon Association for Moral Welfare continued to act for the Corporation and received payment on a capitation basis for cases dealt with by their Social Workers. The Corporation also paid hostel fees in respect of approved cases for whom such accommodation was required. During the year under review:- 178 cases were dealt with by the Social workers; 42 cases were admitted to Mother and Baby Homes; 1 case was temporarily accommodated at Glazier House (not financially assisted) (The Croydon Home of the Moral Welfare Association) 34 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:- 14 years old - 6 15 " " - 15 16 " " - 17 17 " " - 18 18 " " - 19 Total - 75 During 1961 the ages of the younger mothers when their babies were born were:- Age 14 -2 "15 -10 "16 -11 "17 -9 "18 -8 Total - 40 Of these babies:- 4 were stillborn 2 died 1 now in hospital Domiciliary Midwifery The rising birth rate increased the work of the midwives in coping with home confinements and with early discharges from maternity units. Even with the rigid selection of all mothers asking for a place in hospital, local maternity departments cannot deal with the heavy demands during February, March and April. All mothers being admitted were warned that they might be required to go home earlier than anticipated, and their case notes had a comment on the suitability of home conditions for matemitt nursing. Part-time midwives have been recruited for these duties, and provide relief assistance at other periods to the domiciliary midwives. There is the risk of the practice of early discharge being used when there are no excess demands on hospital beds. This has not been our experience. The reason is clearly the strain imposed upon hospital midwifery staff and the conditions 35 to which mothers are subjected when maternity units are used for a rapid succession of deliveries. For detailed figures see Appendices, pages 97 - 100 Midwives Acts, 1902-51 The number of Midwives who notified their intention to practice as midwives within the Borough (including those in hospitals) and who were practising at the end of the year was 83. 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. Child Welfare Centres Attendances at these centres increased. Opportunities for general health education of mothers were still further developed and are described elsewhere. We have always recognised the mother in the family as the most important, receptive and influential member upon whose wisdom and care the health of the children depend. Advice to individual mothers is being augmented by talks, lectures, and especially by group discussion. For other detailed figures see Appendix, page 102 Welfare Poods 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 Part 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. No difficulties arose from the change to payment by cash. Total issues of Welfare Poods during 1961:- National Dried Milk 64077 Cod Liver Oil 10301 Vitamin A and D Tablets 11917 Orange Juice 85855 36 THE WORK OF THE HEALTH VISITORS Miss L. E. Oakley, S.R.N., S. C. M., H. V. Cert. Superintendent Health Visitor The demands of the School Health service dominated 1961. An exceptionally heavy programme of medical inspections was carried through and was not allowed to interfere with the home visiting of the 'under-fives' which is the most important part of the Health Visitor's work. An increased birth rate added to the number of first visits which had to be paid, and these were often fitted in after school sessions. The Phenylketonuria test, carried out when an infant is between three and six weeks old, has now become generally accepted by parents. Unfortunately the simple test for the early detection of deafness in babies of nine months who have been subjected to any condition liable to cause deafness has not been so well received, in spite of personal calls by the Health Visitor to explain the necessity. It would seem that sound Mothercraft teaching backed up by good health teaching in the homes is the one sure method of breaking down this indifference. It will be some time before parents realise that the time for dealing with minor defects of eyes, ears and posture is before the child enters school - not afterwards. School is a new world for the five year old and he should enter it as physically and mentally well-equipped as possible, if he is to reap its benefits. To help towards this end a Toddlers' Club has been set up in the East Croydon Area, to which mothers and toddlers come; the mothers to form a discussion group under the guidance of the Health Visitor to talk over the many health problems which arise in their families and the children to join a play group run by voluntary workers. A Medical Officer is in attendance and each toddler is given a complete medical examination once a year, any minor defect found being referred for the appropriate treatment or advice. This appears to have been very successful and it is hoped to start similar clubs in other parts of the Borough. The Mother' s Clubs at New Addington and South Norwood continue to flourish, whilst the Parent's Club at Lodge Road does attract a few fathers when the subject to be discussed is of more than usual interest. The Health visitors concerned with the running of the clubs are to be thanked for the cheerful way in which they undertake this voluntary effort after a hard day's 37 work. A more detailed account of these activities is given in the report of the Health Education Officer from whom the Health Visitors have received great assistance. At Waddon, the Sewing Club held on alternate afternoons still attracts support, each year new members joining to replace those who have mastered the rudiments of 'make, do and mend'. It is a worth while effort as the mothers attending would never go to an Evening Institute for this purpose, therefore the class of necessity remains small. Figures of work carried out are shown in Appendix, page 101. 38 RONE SAFETY Miss D.E. Blackmore, S.R.N., S.C.M.. H.V. Cert. Home Safety Officer Work on the various aspects of Home Safety continued into 1961. Of particular importance was the poison campaign carried out in conjunction with the South Eastern Gas Board, aimed particularly at the elderly, against the dangers of faulty gas appliances. The necessity of checking old and probably leaky apparatus was stressed and Mr. Driver, an official lecturer of the Board, visited Old Peoples' Clubs and spoke on "The Safe Use of Gas." His assistant demonstrated the special cooker for handicapped people, with particular emphasis on simple meals for the elderly, which provided an opportunity for the old people to discuss their problems with the expert; these talks, followed up by visits to their homes by gas officials, were very much appreciated. Prior to National Fire Prevention Week, Health Visitors and Public Health Inspectors had an opportunity of visiting the new Fire Station,Old Town,to discuss hazards with the Fire Officers. During this week, the station was open to the public in the evenings when film shows and discussions were held and fire apparatus and non-inflammable night-wear etc., were on show. The film "Fireguards and Fabrics" was shown when the Home Safety Officer was invited to speak to the staff of a Croydon firm which now sells non-inflammable night-wear. Another store put on a special display of fireguards. The arrangements for this week represented a combined effort with the Fire Officers who also visited Infant Welfare Centres and Toddlers' clubs to instruct mothers on fire prevention. The dangers connected with water, swimming and picnicing were demonstrated at summer fetes. A demonstration plastic bathroom cupboard, designed to show the dangers in the storage of drugs, attracted a great deal of Interest as parents and children were allowed to participate. As indicated in the Table below, the number of deaths from home accidents has increased as well as the cases taken to hospital, and although continued publicity was given, people appeared to be reluctant to take elementary precautions. Accidents usually result as the culmination of three main causes, one of which is the gradual adopting of a careless attitude towards faulty equipment. An example of this is where 39 families from warm countries do not always understand the use of oil stoves and sometimes buy unmodified second-hand equipment which does not comply with up-to-date safety standards. Another cause is the accessibility of potentially dangerous articles, such as matches left within the reach of children or inflammable clothing airing in an unsuitable position. Thirdly, young children who were left alone died as a result of burns and scalds, and it cannot be over emphasised that it is the parents' duty to see that their children are never left unattended. A further contributary factor is that, unfortunately, noninflammable garments and materials are still not widely available, and the public, including the trade, need still more education on this aspect. Two hundred delegates from seventy Home Safety Committees attended the South East Area Conference at Denning Hall which was opened by the Mayor. During the year, talks on Home safety were given to the following meetings:- Infant Welfare Centres-20; Religious Women's Gatherings-7; Old Peoples' Clubs-5; Women's Clubs-2; British Red Cross Society-9; Toddlers' Clubs-2; Mothers' Clubs-1; Fetes-2; Schools-3; Parent-Teacher Meetings-1; Home Visits-6 Tables are given in the Appendix, page 110. ******************* 40 IMMUNISATION Special efforts were made to encourage completion of polio vaccination courses by 3rd injections, and offers made to eligible groups of 4th injections. Unfortunately shortages of vaccine made temporary difficulties. Routine injections against diphtheria, tetanus and whooping cough were unchanged in timing or method, but too few children are being protected to ensure safety against diphtheria. Tables are given in the Appendix, page 117 - 118. HOME NURSING The extension to the Administrative buildings erected by the Corporation for the District Nurses was completed, and gave much needed additional room. there was no major change in this well established service, but more nurses were provided with car allowances, in-service training was augmented, equipment improved and similar minor developments put in hand. For detailed statistics see page 103 - 105. CONVALESCENCE Ibe 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 38 cases were so dealt with, 30 women, 5 men, 2 mothers with children and 1 child under school age. These figures do not include school children for wbon arrangements are made by the Education Committee. 41 HOME HELP SERVICE Miss J. E. Heath Home Help Supervisor This service continued in great demand and an analysis of the work carried out is given in the Appendix, page 107 . it has been a year of change and a time for reflection. The new Assistant Supervisors have tackled some of the old problems with new ideas and fresh enthusiasm, but generally speaking the Service has settled down into a regular feature of the daily life of the Borough. It is rare today to meet anyone who has not heard of the Home Help and the green overall is at last being recognised and accepted as a symbol of service. The subsidiary services Washing Night infestation Problem Family Family Help the demand has been very limited but it has always been possible to provide the service required although all the staff with the exception of the Night Attendant are actively engaged on routine duties when they are not required for their specialised work. Many students and visitors from all parts of the world have shewn great interest in this growing service. As the social pattern changes more and more women are required to undertake work outside the home; with no member of the family to fill the breach at a time of crisis the Home Help has become an essential part of the domiciliary health team. All new recruits to the service are reminded that they are part of the National Health Service and the truth of this remark is becoming ever more obvious. 42 HEALTH EDUCATION Miss &S. Elliott, S.R.N.. H. V. Cert., Dip. H. E. Health Education Officer "(Sir,) I have found you an argument; but I am not obliged to find you an understanding." Dr. Johnson. Health education techniques of all kinds have been used by many members of the staff during the year, but the greatest progress of all has been made in the running of discussion groups. These are some of the most effective weapons of health education. New ideas, stimulation of thought and active participation are thoroughly enjoyed by these friendly well established groups. It is refreshing to see individuals trying to understand the problems of others and by so doing sometimes seeing their own in perspective. Mothereraft Classes These courses of six classes (run by the Health Visitors) have now been extended to cover an extra session to which tbe fathers are invited. This is held half way through the course so that during the following week or two the mothers can continue to ask Questions which have occurred to both parents. The groups are kept as small as possible; the attendances are so good and the discussions on tbe emotional, social and physiological aspects of parenthood are enjoyed so much that the staff feels that the extra time and effort involved is very well worth while. The general attitude of many of the staff towards these classes is changing too. The practical work and demonstrations of course continue, but the lectures are less formal and the discussions more provocative. For example, some have altered the talk on clothing and equipment. Information about these items is easily obtained from many sources and so clothing Is discussed from points of view like these:- What do clothes mean? Warmth? Protection? culture? Are the quality and quantity of clothes and equipment a necessity, a demonstration of love and care or are they sometimes status symbols? This kind of approach is refreshing for the staff and much appreciated fay the groups. Toddlers' and Parents' clubs:- The two Toddlers Clubs are also thriving. They are held on days other than those of the regular Infant Welfare Centres. At fortnightly sessions the doctors see about six children only by 43 special appointment so that adequate time can be given to a general examination of each child and talk to each mother. The other mothers attend for purely educational sessions each time. In both clubs it was decided to combine the educational sessions for the mothers with nursery play groups for the children and the demand in one club soon became so great that a larger room was needed, an average of 40 mothers and 50-60 children were attending. The health visitors running the clubs could not cope with the heavy demands made on them were it not for the continued support of the voluntary workers who look after the nursery sections. There is no doubt that there is a great need for more clubs of this nature in the town. The popularity of the mothers' and parents' clubs held in the evenings, and also run by the health visitors, continues and membership increases steadily. They have grown in strength to become well-integrated groups with wide interests and showing marked capabilities and initiative. They have also revealed the great extent of loneliness even among young happily married couples. Labour saving devices, television and only the company all day of a young baby, still unable to talk, do not provide enough stimulation for girls who have held interesting posts, generally in the company of other people, before they were married. Some have been in Croydon for many months and for various reasons were unable to make friends until introduced to one of these clubs by another member or a health visitor. The year's programmes have been chosen by the members and have been very varied and interesting. One club is hoping to start a small library for its members. The project is being put to them and it is hoped that they will organise the fund raising, buying and lending of the books. The members of another club were anxious to find out if someone could sit with mothers during labour in hospital, so they wrote to the Matrons of the local Maternity Hospitals and received most courteous and encouraging replies. Infant Welfare Centres Progress in health education in the Infant Welfare Centres, with one or two exceptions, was disappointing. By trial and error and with enthusiasm and different techniques it has been proved that with the skilful use of simple displays, centres can be made more interesting. There is no lack of public interest or demand for information and it is a pity not to make the best use of every opportunity. 44 Assistant Health Education Officer The arrival of a full time qualified Assistant Health Education Officer has made a tremendous difference to the Health Education Section. It has been possible to give much more help to the staff and to show by example many of the teaching techniques. Many more good quality visual aids have been made and every possible encouragement was given to people both inside and outside the department to use them to the best advantage. In-Service Training Short sessions of in-service training, particularly with the health visitors have continued during the year. Regular sessions were held with Dr. Crosse, Child Psychiatrist for Croydon, the discussions following the showing of Mental Health films; they were a great help in the understanding of emotional problems in children. In October, the first of two courses on "Human Relations in Obstetrics" was held for half the staff. This was the result of consideration of a circular from the Ministry of Health in which reference was made to a report from the Committee of the Central Health services Council designed to improve human relations in obstetrics. This two day course was run in Croydon by the Central Council for Health Education. Doctors, hospital and domiciliary midwives, health visitors, district nurses and mental welfare officers were invited. The following subjects were covered on the first day:- "The promotion of mental health by human relations and methods of human relations teaching" by Dr. A. J. Dalzell-Ward, "Mental Illness (hiring pregnancy" by Dr. S.A. MacKeith (Psydiiatrist), "The problems of human relations specific to pregnancy, labour and puerperium" by Dr. S. A. MacKeith (Psychiatrist) and Mr. A Gift (Obstetrician). The second day was devoted to role playing and case study sessions. These were not entirely successful with a mixed group of professional people, not very well known to each other and only meeting for a short time and it was resolved to hold properly led group discussions during the second course in the Spring. It was also found to be administratively difficult to release so many staff for two whole days and it was decided that the second course could be covered in one day by having morning, afternoon and evening sessions. However, the participants thought that the course had been helpful and enjoyable. Several other short sessions were held for the staff during the year by the health education section mainly to demonstrate new material. 45 Continual short training sessions for all kinds of professional staff are necessary if the general standard of health education is to be raised and interest in it maintained. Therefore it was a pleasure to help with this by giving lectures or acting as a group leader to the following organisations during the year:- The British Red cross Society's Training Centre at Barnett Hill. King Edward's Hospital Fund. The Royal College of Nursing-Refresher Course at Southampton University. The central Council for Health Education-Summer school at Bangor. London school of Hygiene and Tropical Medicine-Health Education Seminar. Croydon Marriage Guidance Council. Routine talks to other organisations, lectures to nurses on the social aspects of disease and the training of students continued as usual. Miscellaneous-Health Education in Schools- (See School Section of the Report - page 6) An exhibition was prepared for the South Eastern Home Safety Conference held in the Denning Hall in June and a demonstration on the making and display of visual aids was given. This was repeated at the Home Safety Conference held in the Westminster Hall, London, in November. Following an outbreak of food poisoning during the summer, lecture demonstrations were given with the Deputy Chief Public Health Inspector to food handlers in a large Croydon firm. Since then efforts have been made by the Public Health Inspector's Department to do this sort of work in other firms and factories, but the response has been poor. It is thought that greater interest may be aroused if the next study day is held for industrial doctors, nurses, managers and public health inspectors on "The Principles and Practice of Health Education in Industry". 46 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. During the past year arrangements with Ante-Natal clinics have continued to function satisfactorily and have resulted in a reasonably even flow of patients; no radical changes in procedure have therefore been called for from the administrative angle. In contrast with the congestion of the post-war peak period, the progressive reduction in the numbers referred has led to a more even tempo on the dental side; this has greatly facilitated the carrying out of initial treatment, whilst at the same time permitting priority to be given to more urgent cases. Minor problems have arisen over meeting the needs of patients residing in "fringe" areas of the Borough, but these have been met by fixing dental appointments to coincide with subsequent visits to the Ante-Natal Clinic and thus eliminating unnecessary travelling. Though the percentage of broken appointments continued at about the same level as in previous years, the proportion of those inspected who opt for full treatment would appear to be on the increase. Even discounting the amount of treatment given, there is little doubt that existing provision for inspection continues to perform a worthwhile function by the early disclosure of possible defects, and by stressing the importance of sustained dental care for both Ante and Post Natal periods. The response on the part of expectant and nursing mothers to the improved facilities on the New Addington Estate has so far been disappointing; an increase in attendances by pre-school children at the Overbury Clinic has, however, been noted, and it is hoped that this build-op will continue. 47 As mentioned in the School Dental Service Report, special efforts are being made to direct the attention of parents to the increasing dental decay in the young and the need for active cooperation on the "home front" to reverse this trend. Because of increased susceptibility to decay caused by overindulgence of sugary foods, eternal vigilance should be maintained over children during the 3-5 year period, if early damage is to be avoided to the foundation teeth. Practical talks and instruction on the correct use of the tooth brush, and the avoidance of "Pitfalls of Modern Diet" recently introduced at "Toddler Sessions" will it is hoped, assist in spreading the gospel of "self-help" in these matters, which is essential to produce a lasting result. Development of dental services in South Croydon continues to be hampered by lack of clinic accommodation and though, since the closure of the Duppas Hill surgery, essential treatment has been provided at Lodge Road Centre, there has lately been a substantial drop in attendances, particularly among the pre-school section. It is now gratifying to report that concrete progress has been possible in connection with the scheme for a joint Welfare and Dental Centre to serve the Waddon Estate, and that active construction should commence during the early Summer of 1962. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 288, compared with 367 in 1960. 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. The percentage of those desiring the initial inspection who failed their appointments tends to show variations, and has now increased to 32 per cent. from 30 per cent. in 1960. Expectant mothers examined for the first time numbered 202 against 281 last year. Of these, 72.3 per cent. were seen during the first six months of pregnancy. 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. 48 There has been little change in the amount of work carried oat for nursing mothers, which during recent years has suffered a decline. Some cases 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. 17 nursing mothers were examined during the current year, compared with 19 in 1960. Treatment Including those continuing treatment from the previous year, 307 mothers were dealt with, against 395 in 1960. 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 399, compared with 368 in 1960. 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 are being tried to deal with this increasing social problem. The usual tables are given in the Appendix, page 109. 49 AMBULANCE SERVICE A.L. Hill, Esq., Chief Ambulance Officer During the year the Service was called upon to deal with 120,053 patients, which necessitated 53, 194 journeys and a mileage of 423,602. Compared with 1960 these figures show an increase of 4,796 patients, 7,166 miles and 1,490 journeys. There were 16,545 patients conveyed to places outside the Borough, and on these journeys 134, 323 miles were travelled. The number of patients admitted to Hospitals and Nursing Homes were 9,614 compared with 9,548 the previous year. Traffic congestion and sickness of staff again provided difficulties with increasing transportation. A total of 914 days sickness compared with 879 during 1960 and 800 during 1959 was experienced. Six men resigned, two retired owing to bad health and I regret to say that one man died suddenly at home after 19 years service. Three extra men together with nine replacements were employed and trained. With effect from September 14th all casualties were taken to Croydon General Hospital between the hours of 6 p.m. and 9 a.m. as Mayday and Purley Hospitals Casualty Departments were closed, in accordance with instructions from the Croydon Group Hospital Management Committee. This closure did not present any difficulties and from an Ambulance point of view is operating efficiently. All Emergency Ambulances were fitted with new blue flashing warning lights. A new Mess Room has been opened for personnel and is situated opposite the main building adjacent to the garages. It offers better facilities for the Men and leaves only Administrative Officers in the main building. In June of this year, a team of two men was entered for the Chief Ambulance Officers' Association, No. 5 Regional Cup for First Aid Efficiency (both practical and theoretical) which was held at the Surrey County Ambulance Headquarters, Kingston Road, Kingston-upon-Thames. Fourteen teams from various County and County Boroughs entered and the team from this Service was Placed second, winning a Shield. 50 A fire was discovered at Surrey Hills Clinic and two of ay personnel played an important part in checking the spread of fire and the removal of patients. Letters of thanks were received from the Medical Officer of Health of Caterham and Warlingham and the Matron of Surrey Hills Clinic. For details of journeys, patients, mileage etc. see the Appendix, page 112-114. CIVIL DEFENCE (Ambulance Section) The total number of volunteers on the register at 31st December, 1961, was 349 and of this number 49 are attending at the New Addington Training Centre. This figure shows an increase of 56 and the usual Recruiting Campaign which was held in October was responsible for the enrolment of most of these new volunteers. Driving tuition is still being given by the Onward Driving School at South Croydon and since my last report 3 volunteers have taken their driving tests and passed. A further twelve volunteers are completing their tuition and will be taking tests in the near future. A First Aid Course was again organised with Doctors and St. John's Instructors and of the 87 volunteers who entered only 2 failed to gain their certificate. First Aid instruction has also been given to the Electricity Board Civil Defence First Aid and Rescue Section and exercises were held at the Rescue Range, Albert Road, south Norwood where Civil Defence Ambulances were loaned. A new Ford Thames Ambulance was delivered and the Austin Ambulance (GLR 483) was disposed of. This new vehicle and Bedford Ambulance RVB 353 are maintained by my Mechanical staff and routine inspections are carried out during the year by the Home Office. In conclusion, may I express my sincere thanks to the Members of the Ambulance Sub-Committee, the Medical Officer of Health and the Officers and Men of the Service, for their help and encouragement which has been of great assistance to me in the administration of the duties of Chief Ambulance Officer. 51 MENTAL HEALTH 1961 has seen the completion of the first full year's operation under the Mental Health Act, and no insuperable difficulties have been encountered. Arrangements for admissions to mental hospitals in particular have been facilitated by the short notice consultative domiciliary visiting service introduced by the Medical Superintendent of Warlingham Park Hospital. This has ensured that all but a few patients dealt with under compulsory powers have been examined both by their general practitioners and an approved doctor from the admitting hospital As a result of discussions between the practitioners concerned it has also often been possible to treat patients without the necessity of admission to hospital. The Mental welfare Officers have had to spend considerably more time on admission formalities, but this was an inescapable outcome of the new procedures Developments during the year have included the appointment of a Senior Mental Welfare Officer, the opening of a training centre for sub normal adults, and the transfer to larger premises (provided and maintained by the Corporation) of the Day Centre for the mentally handicapped which is organised and run by the Warlingham Park Hospital Management Committee. Essential expansion of the social work activities has been hampered by the difficulty of recruiting qualified officers, and in the case of welfare assistants, of obtaining places on Courses carrying nationally recognised social work qualifications. Administration The Medical Officer of Health is in administrative control, the Deputy and two Assistant Medical Officers of Health are approved for the purpose of the Mental Health Act, and the Medical Superintendent of Warlingham Park Hospital serves as Psychiatric Adviser under arrangements agreed with the Regional Hospital Board. There is a Senior Mental Welfare Officer (a Qualified Psychiatric social worker), a Planning Officer, four Mental Welfare officers and a Welfare Assistant. Posts yet to be filled include a Psychiatric Social worker, a Social worker and a welfare Assistant. Voluntary Associations The only duty delegated to a voluntary organisation was the care and supervision of sixteen severely subnormal patients Placed with the Guardianship Society. The service also has close and cordial ties with the Croydon and District Society for 52 Mentally Handicapped Children, whose active support and interest is welcomed, and with the Mental After Care Association, whoBe splendid Hostel in Croydon was opened during the year. Wort Carried out in the Community The pages which follow give details of the work undertaken in 1961. I record with appreciation my thanks to Dr. MacKeith and the staff of Warlingham Park Hospital, Dr. Gibson and Dr. Richards of St. Lawrence's Hospital, Dr. Ferguson of the Royal Earlswood Hospital and Dr. Lawson of Queen Mary's Hospital, Carshalton, for their help and co-operation. Mental Health Act 1959-Mental Illness. M. F. Total Patients admitted to hospitals:- Informally 45 51 96 Under Section 25(for observation) 9 25 34 Under Section 26(for treatment) 20 26 46 Under Section 29(for observation in emergency) 84 179 263 Under Section 136(Police action) 1 1 2 Under Section 60(hospital Order through Court) 3 1 4 162 283 445 Investigated but not admitted to hospitals 38 39 77 The total number of admissions was slightly more than in 1960 and a significantly greater proportion was dealt with Informally. Although the figures for admissions under Section 29 (which requires only one medical recommendation) appear to be high most of these patients were in fact examined prior to admission by two medical practitioners, any necessary extension of the detention powers being undertaken at the hospital. Residential Accommodation long term Two patients were admitted to Homes run by the Mental After Care Association, two inmates were transferred elsewhere and the total number accommodated is now three. 53 Hostel Eighteen persons were admitted to the Mental After Care Hostel in Croydon for employable recovered mentally ill patients five left or returned to hospital and the total number of inmates at 31st December was thirteen. Convalescence Three persons were provided with convalescent holidays during the year. In all the above instances the Corporation accepted financial responsibility for the services given subject to contributions according to means. Mental Health Act 1959-Subnormality During the year ten severely subnormal cases were ascertained as unsuitable for education at school, seventeen subnormal cases were referred for friendly supervision on leaving special school and referrals from other sources totalled twentyfour. The total number of cases on the authority's registers is now 818, made up as follows:- Males Females Total In psychiatric hospitals 205 177 382 On leave of absence from hospitals - 2 2 Under guardianship 9 5 14 Boarded out 1 4 5 Under friendly supervision 226 189 415 Further information concerning cases dealt with in 1961 is appended below and the 1960 figures are given for comparison Purposes:- 1961 1960 Admitted to Psychiatric hospitals 25 21 Admitted to Psychiatric hospitals (mental illness) 5 1 Provided with short term care 16 15 Transferred from one hospital to another 7 6 Eleven cases were awaiting permanent hospital vacancies on 31st December, 1961. 54 Training Junior Training Centre During the year 28 severly subnormal adults were transferred to the Bensham Training Centre, but in other respects there was no significant change in training arrangements, and statistics are given below:- Number on register January 1961 94 Number on register December 1961 76 Number of admissions 20 Number left 10 Number transferred to Adult Centre 28 Average Attendance per session 73 Times open morning and afternoon 390 Total attendance 2 28,224 Bensham Training Centre This centre for adult subnormal and severely subnormal persons opened on 5th September 1961, and will eventually provide training facilities for approximately 60 persons. Initial admissions which numbered 32 had risen to 37 ( 20 males, 17 females) by the end of the year. The Centre is a temporary one pending the provision of a specially built unit and activities, designed to be purposeful rather than purely occupational, include carpentry, laundry and domestic work, and assembly or simple repetitive projects. Obtaining suitable work from industry has been the main problem and although there has been some progress further advancements could be achieved with more enthusiastic support from local firms. The efforts of the Disablement Resettlement Officer to overcome this difficulty have been greatly welcomed. Particulars of work undertaken are shown below. Carpentry Group (males). Domestic Group (females). Workshop Groups (males and females) woodwork repairs to furniture and equipment. Stool, tray making. Laundry of both training centres, linen repairs, kitchen duties. Pitting Inserts into metal caps Making natural wood birdcage perches 55 Workshop Groups (males and females) (continued) Dismantling electric meters Folding paper hats for Christmas crackers Bending metal components for display stands. The Centre opens from 9-a.m. to 4-p.m. Mondays to Fridays throughout the year, apart from Bank Holidays. Incentive pocket money is paid to each trainee based on aptitude, ability and regularity of attendance, protective clothing is provided and mid-day meals supplied at a subsidised rate. The Corporation provides special coaches to take the trainees to and from the Centre. 56 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 15s. 3d. per day. This had been raised from 14/and earlier, from 12s. 6d. during the year. There were 2 mothers who paid the former full rate of 12s. 6d. in 1961. One child, admitted the previous year, remained for 8 months and, by Committee permission at the old rate. The duration of the other's stay was 8 days. Details of attendances- Capacity 50 Number on books at end of year 37 Attendances: Under 2 2,383 Over 2 5,625 Total 8,008 Number of days opened 253 Average daily attendance 31 DEAFNESS As described last year, arrangements have been made to diagnose deafness at an early age. The scheme was operating throughout 1961, and figures are given in the Appendix, page 111. CHIROPODY SERVICE This service continued unchanged. Inspections by the visiting Chiropodist resulted in satisfactory reports except for one practice, which was subsequently given up by the individual concerned. During 1961 the Chiropodists gave a total of 6646 treatments of which the Corporation paid the whole cost for 1828 and 1828 and part cost for 4818. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 57 WORK OF THE PUBLIC HEALTH INSPECTORS George Grieve, F.R.S.H., F.A.P.H.I. Chief Public Health Inspector Further progress has been made in Smoke Control, and by the end of the year the Council had made orders covering 15, 166 premises in the Borough. Already the effectiveness of the schemes is becoming evident by the improved condition of the atmosphere, especially in the southern part of the Borough. It is encouraging to note the co-operative attitude of owners and occupiers of premises in the areas already surveyed. The current programme of the clearance of the unfit houses is almost complete and a survey is progressing of the houses included in the next five years programme. New legislation is pending to give additional powers to enable conditions in houses in multiple occupation to be improved. These will be welcomed as there has been a rapid growth in the numbers of this type of house, many of which are short of adequate facilities for decent family living - a condition it is hoped the new legislation will assist in improving. The number of animals slaughtered at the Abattoir again increased, necessitating evening and weekend attendance of the staff in order to maintain 100% meat inspection; some progress has been made towards the provision of a new Abattoir in that a site has been agreed upon and plans are now being prepared. The statistical tables and comments in this report indicate the amount and variety of work which has to be 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 The unfit houses in Bridge Place and Lambert Place have not been demolished as have those in Crystal Terrace, Upper Norwood. Surveys of the following areas are in progress with a view to determining and representing the unfit houses; Handcroft Road, Adelaide Street and Mitcham Road; Lahore Road, Russell Road and Gloucester Road; Upper and Lower Drayton Place and Tamworth Place. During the year Shaftesbury Buildings, a large tenement building, housing 32 families, was made the subject of a Demolition Order and the council, by the end of the year, had rehoused the majority of the occupants. Number of parts of houses on which closing Orders have been made 11 Number of houses on which Closing Orders have been made 1 Number of houses on which Demolition Orders have been made 12 Number of bouses where Certificates of unfitness were issued 14 During the year 1,154 bouses were rendered fit following the service of notices requiring repairs. Rent Act, 1957 - Certificates of Disrepair Applications for Certificates of Disrepair during the year 1961:- Number of applications for certificates 27 Number of decisions not to issue certificates 2 Number of decisions to issue certificates 23 (a) in respect of some but not all defects 15 (b) in respect of all defects 8 Number of undertakings given by landlords 11 Number of undertakings refused by Local Authority Nil Number of certificates issued 12 Applications by landlords to Local Authority for cancellation of certificates 1 Objections by tenants to cancellation of certificates 3 Decisions by Local Authority to cancel in spite of tenants' objection Nil Certificates cancelled by Local Authority 7 59 Nature of Work Section 110 Section 111 No. of workers 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 some 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. 1 - - - - - Carding, etc. of buttons, etc. 68 - - - - - Stuffed toys 38 - - - - - Brush making 5 - - - - - Chocolates and sweetmeats - - - - - - Cosaques, Christmas crackers, Christmas stockings, etc. 269 - - - - - Lampshades 49 - - - - - Total 920 - - - - - 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 70 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. 1,393 inspections were made under the Shops Act, and the infringements found were as follows:- 60 Cases in which Defects were found:- Particulars Number of cases is which defects were found Number of cases in which cutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (s. 1) 3 1 . . . Overcrowding (S. 2) - - - - - Unreasonable temperature (S. 3) 1 1 - - - Inadequate ventilation (S. 4) - - - - - Ineffective drainage of floors (S. 6) 4 3 - - - Sanitary conveniences (S.7):- (a) Insufficient 2 2 . 1 . (b) Unsuitable or defective 31 27 4 - (c) Not separate for sexes 1 1 . 1 - Other offences against the Act (not including offences relating to Outwork 15 7 - - - Total 57 42 - 6 - Part VIII of the Act Outwork Nature of Work Section 110 Section 111 No. of outworkers in August list required by Sect.110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) wearing Apparel 447 - - - - - Household Linen 1 - - - - - Lace, lace curtain and nets 13 - - - - - Curtain and furniture hangings 9 - - - - - Furniture and upholstery 2 - - - - - Umbrellas, etc. 3 - - - - - Paper bags 15 - - - - - continued on next page. 61 lest 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. 9d. per night or 18s. 0d. per week, and 2s.9d. per night or 9s. 6d. 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 36,099. The receipts during the year were £3,694 and the expenditure £5,554. Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, at a fee. During the year 11 such requests were made. FACTORIES ACTS, 1937 AND 1948 During the year the under-mentioned inspections have been made and defects were found as set out:- Part I of the Act Infections for purposes of provisions as to health (including inspections made by Public Health Inspectors). Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 449 63 9 - (ii) Factories not included in (i) in which section 7 is enforced by the Local Authority 1,694 486 32 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' Premises) 96 66 5 - Total 2,239 615 46 - 62 Hours of Closing 3 Insufficient and defective W. C. accommodation 2 Defective floors, walls etc. 5 Notices to be exhibited or amended 17 Insufficient heating 1 Hashing facilities required 2 A shopkeeper was fined £2 with 10s. 6d. costs for selling articles on a Sunday contrary to the provisions of the Shops Act 1950. HAIRDRESSING ESTABLISHMENTS New legislation called for the registration of hairdressers and 202 such businesses are now registered. During the year 68 inspections were made of registered premises to check that the Byelaws, now in force, were being observed. Generally little cause for complaint was found at such inspections. DRAINAGE 1,840 visits of inspection were made to underground drains in course of repair. Of 173 Statutory Orders served, 75 had to be done in default of the owners. In addition, repairs were carried out by the Corporation to 3 public sewers serving 22 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 184 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. 63 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 became 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 came into operation on the 1st October, 1961. Towards the end of 1960 the Council 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 In December 1961 Croydon Smoke Control (No. 4) Order was made covering 4,112 dwellings, 1,435 industrial and commercial premises. This Order will become operative on 1st July, 1963. The District Inspectors have kept observation on the various factory chimneys within their districts with a view to observing any contravention of the Clean Air Act in respect of Smoke and Grit Emissions. 21 such observations were made and in 3 instances smoke was emitted for more than the statutory limit. The managements were immediately interviewed and informed of the offence and advised. In no case did it become necessary to serve a Statutory notice. During the year 35 plans showing the construction and heights of new chimneys have been examined and in 20 cases additional height has been requested and agreed. 44 notices of the installation of new furnaces have been received, 38 of these being oil fired plants. AMUSEMENT HOUSES 93 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. 64 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 6,679 articles By Formalin Gas 2,268 " Total 8,947 articles 113 articles were destroyed on request. Disinfection of bedding and upholstered articles is carried out for traders, who deliver them to, and collect them from, the Station. For this service a charge is made. During 1961, 70 articles were disinfected, the receipts amounting to £7. 2s. 6d. Disinfection was carried out after infectious or contagious diseases at the following premises:- 227 rooms at 68 houses, hospital wards, clinics etc. 2,256 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 £16. 18. 6d. was recovered for such services. 37 articles for Welfare Department institutions and 1,061 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, 8 adults and 7 children were cleansed of verminous conditions and 11 adults and 8 children were treated for scabies. 65 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 116, either by spraying or fumigation. Weekly visits are made to the abattoir when the manure storage and walls adjoining are sprayed with an insecticide. NOISE ABATEMENT During the year 53 complaints were made regarding noise alleged to be a nuisance. In 9 cases no action was warranted. In 30 instances the noise complained of was finally abated, in 10 cases the noise was reduced so as not to be a nuisance, and 4 cases are still under investigation. PHARMACY AND POISONS ACT. 1933 The object is to regulate the sale of certain poisonous substances. During the year the number of applications granted for entry of names on the list of persons entitled to sell poisons under Part 2 of the Act was 25. In addition, 233 applications were made for the retention of names on the list for a further period of 12 months. No infringements of the Act were found. RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 The Act regulates the manufacture and sale of materials used as fillings for upholstery, bedding, toys, etc., with the object of compelling the use of clean fillings. During 1961, 8 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 2 Kapok 2 Millpuff 1 Curled Feathers 1 Down and Feathers 1 Cotton Felt 1 66 PET ANIMALS ACT. 1951 21 persons were licensed for the purpose of keeping Pet Shops. During the year 61 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS Seven cases of suspected 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. Two rodent operatives are employed to deal with such complaints. During the year, 2, 169 private dwellings were inspected following complaints and in 2,088 instances infestation was confirmed and dealt with by the rodent operatives. 218 business premises were found to be infested with rats or mice and these were all disinfested during the year. Regular inspections are made of premises where food is prepared or sold and particular attention is given to methods of prevention of rodent infestation. Corporation owned premises including sewage works, refuse tips, depots, school kitchens and serveries, etc., are periodically inspected for the presence of rodents and if infested then action is taken by the department to eradicate the pests. 54 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 6ince 1947. During the early part of the year the whole of the sewerage system in the Borough was test baited and showed takes of bait at but 26 manholes. These manholes were treated until no further baits were taken. 67 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 2,753 premises in the Borough at which food is known to be sold, manufactured or stored. Bak ehouses 59 Bakers Shops 134 Sugar Confectioners 560 Cafes. Restaurants, snack Bars and Eating Houses and Kitchens 563 Works and dub Canteens 296 Public Houses 185 Off Licences 80 Grocers 602 Butchers 211 Wholesale Meat Markets 8 Chemists 84 Greengrocers 368 Fi shmongers 72 Fried Fish Shops 48 Milk Distributors and Dairies 170 Premises from which Roundsmen and Mobile &Shops operate 9 Stalls 102 Food Manufactories 22 Other Food premises not enumerated above 17 Total 3, 590 Of the above premises 1,0 37 are registered under Section 16 of the Food and Drugs Act, as follows: - Retail sale of ice-cream 844 Manufacturers of ice-cream 4 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 189 During the year 6,814 inspections and re-inspections were made of food businesses (for details see page 80 ). 68 INFRINGEMENTS OF FOOD AND DRUGS ACT, 1935 AND FOOD HYGIENE REGULATIONS 1955/56 Structural defects In shops and stores 8 Defective condition of vaills and ceilings 47 Defective condition of floors, utensils, fixtures, etc. 23 Defective or Insufficient drainage 10 W.C. accommodation - repair or cleansing required 25 „ „ - artificial lighting required 1 „ „ want of Intervening ventilated space 10 Food - not stored 18" off floor 11 „ „ - means to prevent contamination required 23 „ - store required or defective 6 Accumulations In yard or stores 21 Offal and refuse bins defective or uncovered 16 Yard paving defective 6 Hand washing notice not exhibited 4 Ablutions - wash basins required 24 „ - Hot water supplies required 23 „ - Nail brushes, soap and towels required 7 Clothing accommodation required 9 Insufficient or defective sinks 13 Smoking off ences 4 Defective or unsuitable table tops, etc 19 First Aid kits required or insufficient 2 Cleanliness - advice given 9 Rodent infestation 4 Merchandise Marks 1 Prosecutions A fins of bakers pleaded guilty to 15 summonses under the Food Hygiene Regulations in respect of unsatisfactory conditions at a local bakehouse. The Court imposed fines totalling £105, with 10 guineas costs. The proprietor of a cafe pleaded guilty to 16 summonses relating to contraventions of the Food Hygiene Regulations. The Court imposed fines totalling £48, with 2 guineas costs. A firm of local bakers pleaded guilty to a summons relating to the sale of a gateaux which was affected with mould and unfit for consumption. The court imposed a fine of £2, with one guinea costas. 69 Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 196:- Article Weight in lbs. Carcase Meat 70,749 Offal 79,212 Sundry Foodstuffs 7,621 Canned, Bottled and Packeted poods 18, 512 Total 176,094 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 1960, 78, 242 animals were slaughtered whilst in 1961 the numbers increased by 35% to 105, 395. 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 Sheep excluding Cows Calves and Goats Pies Total Cows Lambs 6.971 1,644 7,69 1 53,537 183 35, 369 105,39 5 70 CARCASES INSPECTED AND CONDEMNED Cat tle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Horses Number killed 6971 1644 7691 53537 35369 183 Nil Number Inspected 6971 1644 7691 53537 35369 183 Nil All Diseases except Tuberculosis aid Cysticerci Whole carcases condemned 3 29 66 386 143 3 Nil Carcases of which some part or organ was condemned 2968 915 53 3726 3802 10 Nil Percentage of the number Inspected affected with diseases other than Tuberculosis 42.6 57. 4 1.5 7.6 11. 1 7. 1 Nil Tuberculosis only whole carcases condemned 1 - - 1 1 Nil Nil Carcases of which some part or organ was condemned 38 3 Nil Nil 137 Nil Nil Percentage Inspected affected with Tuberculosis 0.5 0.1 Nil 0.0001 0.3 Nil Nil Cysticercosis Carcases of which some part or organ was condemned 120 8 Nil Nil Nil Nil Nil Carcases submitted to treatment by refrigeration 120 8 Nil Nil Nil Nil Nil Generalised and totally condemned Nil Nil Nil Nil Nil Nil Nil The District Public Health Inspectors, all qualified Meat Inspectors, inspect meat at the 6 wholesale Meat Depots in the Borough, as well as that exposed for sale in the butcher’s shops. The Diseases of Animals (Waste Poods) Order, 1957 The Order provides that, in general, all waste food must be boiled before feeding to animals to minimise the spread of animal diseases. Licences to operate boiling plants and equipment are issued after inspection of the premises and plants. 47 inspections of licenced plants were made during the year. 71 MILK SUPPLY During the year 123 inspections were made of dairies and premises from which milk is sold. The Milk (Special Designation) Regulations 1960 The following licences, which are valid for a period of five years, have been granted to dealers distributing milk from premises in Croydon:- Licences to use the designation Pasteurised" - (a) Dealer's (Pasteuriser's) Licences 2 (b) Dealer's (Pre-packed Milk) Licences 121 Licences to use the designation “Sterilised" - (a) Dealer's (pre-packed Milk) Licences 111 Licences to use the designation "Tuberculin Tested" - (a) Dealer's (Tuberculin Tested) Licences 2 (b) Dealer's (pre-packed Milk) Licences 91 Inspection of these licenced premises has been carried out (luring the year to see that the conditions of the licences were observed. Bacteriological Examinations of Milk During the year the following samples of milk were examined: Tuberculin-Tested Pasteurised Milk 33 Pasteurised Milk 130 Sterilised Milk 36 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. Staples Taken Not Satisfied Satisfied Not Satisfied Satisfied 33 - 33 - 33 72 Pasteurised Milk Methylene Blue Test Phosphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 130 2 128 - 130 Sterilised Milk No. Samples Taken Turbidity Teat Not Satisfied Satisfied 36 - 36 Bacteriological Examination of Milk Churn and Milk Bottle Rinses Churn Rinse Samples - 5 Satisfactory - 4 Unsatisfactory - 1 Bottle Rinse Samples - 75 Satisfactory - 74 Unsatisfactory - 1 BACTERIOLOGICAL EXAMINATION OF CREAM Seven samples of fresh cream were examined and produced satisfactory results. BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 232 samples were taken, the results being as under:- Grade No. of Samples 1 199 2 22 3 6 4 5 Of the total samples taken, 11 (4.7 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. 73 CHEMICAL EXAMINATIONS OF ICE CREAM Six samples were taken from local manufacturers and were found to comply with the standard. FOOD AND DRUGS ACT, 1955 During the year, 206 samples of Milk and Cream, and 446 other samples were taken, of which number, 18 were found to be Not Genuine. Summary of Samples During 1961 samples were obtained and submitted to the Public Analyst as follows:- Total Samples Genuine Not Genuine Prosecutions Convictions Alionds (Ground) 4 4 - - - Apple Juice 1 1 - - - Artificial Colour 2 2 - - - Arrowroot 1 1 • - - Aspirin Tablets 3 3 - - - Bacon 2 2 - - - Batter Mixture 2 2 - - - Beer, Bitter 3 3 - - - Bicarbonate Soda 1 1 - - - Beer. Mild 3 3 - - - Biscuits 3 3 - - - Back Pudding 3 3 - - - Blancmange Powder 1 1 - - - Boracic Ointnent 2 2 - - - Brandy 1 1 - - - Brisket of Beef 1 1 - - - Bread. White 1 1 - - - Bread, Wholemeal 1 1 - - - Bread cruabs 2 2 - - - Bread and Butter 1 1 - - - Bread, Brown 1 1 - - - Bread, milk 1 1 - - - Butter, New Zealand 2 2 - - - Butter, Australian 1 1 - - - Butter,Danish 2 2 - - - Buttered Rolls 4 2 2 - _ Calamine ointment 1 1 - - - Camphorated Oil 1 1 - - - Calamine Lotion 1 1 - - - Candied Peel 1 1 - - - Cakes 1 1 - - - Cakes,various 6 6 - • - Cake mix 1 1 • - - Cheese, Cheddar 3 3 - - - Cheese, Danish Bule 2 2 - - - Cheese Spread 3 3 . m Cheese Biscuits 2 2 • - - Cheese with Smoked saith 1 1 • • - Chocolate 2 - 2 - Chocolate Covered Caterpillars 1 1 - - - Chocolate Spread 2 2 - - - 74  Total Samples Genuine Not Genuine Prosecutions Confictions Chopped Pork 1 1 - . - Chutney 1 1 - - - Christmas Pudding 2 2 - - - Cod Liver Oil with Malt 2 2 • - - Cocoa 1 1 - - - Coconut, Desiccated 1 1 - - - Coffee, Hot 1 - 1 - - Coffee 1 1 - - - Coffee. Instant 1 1 - - - Coffee and Chicory Essence 4 4 • - - Condensed Milk 2 2 - - - Condiment. Non-Brewed 1 1 - - - Cooking Fat 2 2 - - - Cooking Oil 1 1 - - - Corned Beef 5 5 - - - Cornflour 2 2 - - - Cornflakes 1 1 • - - Cornish Pasties 2 2 - • - Cough Mixture 1 1 • - - Cough Pastilles 2 2 • - - Crab, Dressed 4 4 - - - Cream of Tartar 1 1 - - - Cream. Tinned 7 6 1 - - Cream, Fresh 7 7 - - - Cream Buns 1 1 - - - Crystallised Fruits 2 2 - - - Curry Powder 3 3 • - - Custard Powder 3 3 - - - Dates 2 2 - - - Dates, Chocolate 1 - 1 - - Diabetic and Dietetic Sugar Syrup 1 - 1 - - Diabetic and Dietetic Chocolate syrup 1 - 1 - - Drinking Chocolate 1 1 - - - Dripping 2 2 - - - Dyspepsia Tablets 1 1 - - - Essence of Rennet 1 1 - - - Evaporated Milk 4 4 - - - Figs 2 2 - - - Fish Fingers 3 3 - - - Fish Paste 2 2 - - - Flavouring Essence 6 6 - - - Flour 2 1 1 - - Friars Balsas 1 1 - - - Fruit Pie 2 2 - - - Gees Linctns 3 3 - - - Gin 5 5 - - - Ginger Beer 2 2 - - - Glace Cherries 1 1 - • - Glauber's Salt 1 1 • - - Glycerine, Leaon and Honey 1 1 - - - Glycerine 1 1 - - - Golden Syrup 3 3 - - - Grapefruit Juice 1 1 - - - Grasshoppers. Fried 1 • 2 - - Gravy Powder 2 2 - - - Ground Cinnamon 1 1 - - - Ground Rice 1 1 - - - Has 2 2 • • - Ham and Beef Roll 1 1 - • - Halibut Liver Oil Capsules 1 1 • - - Honey 2 2 - • - 75  Total Samples Genuine Not Genuine Prosecutions Conrictions Horseradish Relish 2 2 - - - Isinglass 1 1 - - - Ice Cream 6 6 - - - Ice Lollies 2 2 - - - Insect Sting cream 1 1 - - - Iodine. Tincture of 1 1 - - • Iodine Ointment 1 1 - - - Indigestion Tablets 3 3 - - - Jam 4 4 - - - Jelly 2 2 - - - Jellied Veal 1 1 - - - Lard 1 1 - - - Lemonade Powder 1 1 - - - Lemon Barley Water 3 3 - - - Lemon Flavouring 1 1 - - - Lemon Curd 2 2 - - - Lemon Pie Filling 2 2 - - - Lime Juice Cordial 1 1 - - - Luncheon Roll 1 1 - - - Luncheon Meat 5 S - - - Liquid Paraffin 1 1 - - - Lobster Paste 1 1 - - - Macaroni 2 2 - - - Halt Vinegar 3 3 - - - Malted Milk Tablets 2 2 - - - Margarine 2 2 - - - Marmalade 3 3 - - - Marzipan 3 3 - - - Meat Balls 1 1 - - - Meat Extract Cubes 1 1 - - - Meat Paste 4 4 . - - Meringues 2 2 - - - Milk of Magnesia 2 2 - - - Milk 192 192 . - - Milk Hot 1 1 - . - Milk Shake 1 1 . . - Mincemeat 1 1 - - - Minced Beef 3 3 . . • Mint Sauce 3 3 • . - Mixed Herbs 2 2 . - - Mustard 3 3 - - - Mutton curry 3 3 - - - Oatmeal 2 2 - - - Octopus on Skewer 1 1 - - - Olive Oil 1 1 - - - Orange Squash 3 3 - - - Orange juice 2 2 - - - Parrish's chemical Food 1 1 - - - Peanut Butter 1 1 - - - Pearl Barley 1 1 - - - Pease Pudding 1 1 - - - Pepper 2 2 - - - Pepper, Cayenne 1 l - - - Pickled Onions 2 2 - - - Pickled Cabbage 2 2 - - - Pickles 3 3 - - - Pickling Spice 1 1 - - - Pineapple Juice 1 1 - - - Pork Pies 1 1 - - - Pork Sausage Meat 2 2 - - - Porridge oats 2 2 - - - Pressed Beef 1 1 - - - Puff Pastry 2 2 - - - 76  Total Samples Genuine Not Genuine Prosecution Conic tion Quinine, Ammoniated 1 1 - _ - Roes. Tinned 1 - 1 - - Rice 2 2 . - - Rice Pudding, Creamed 4 4 - - - Rissoles 1 1 - - - Rum 6 6 - - - Rum Essence 2 2 - - - Salad cream 1 1 . - - sandwich spread 3 3 - - - Sauce 4 4 - - - Sausages, Beef 3 3 - - - Sausages, Pork 4 4 - - - Sausage, Liver 3 3 - . - Sausage, Smoked 1 1 - - - Sausage, Luncheon 2 2 . - - Seasoned Snake Meat 1 - 1 - - Skimmed Milk Powder 1 - 1 - - Sod a Water 2 2 . - - Soda Mint Tablets 2 2 - - - Spilt Peas 1 1 - - - Steak and Kidney Pie 4 4 - - - Steak and Kidney Pudding 3 3 - - - Steak Pie 3 2 1 - - Suet, packed 2 2 - - - Sponge Mixture 3 3 - - - Sugar, caster 4 4 - - - Sugar, Brown 1 1 - - - Sugar, Icing 1 1 - - - Surgical Spirit 1 1 - - - Sweets 6 5 1 - - Soup Powder 2 2 - - - Stewed Steak 2 2 - - - Sage and Onion Stuffing 3 3 . - - Sulphur Ointment 1 1 - - - Table salt 2 2 - - - Tapiocs 2 2 - - - Tea 1 1 - - - Tinned Asparagus 1 - 1 - - Tinned Broad Beans 2 2 - - - Tinned Fruit 6 6 - - - Tinned Peas 3 3 - - - Tinned vegetables 4 4 - - - Tinned Soup 3 3 - - - Tinned Fish 3 3 - • - Tinned Meat 3 2 1 - - Tinned Tomatoes 2 2 - - - Tinned Tomato Juice 1 1 - - - Tomato Puree 1 1 - - - Tomato Ketchup 2 2 - - - Vinegar 2 2 - - - Vitamin Iron Tablets 3 3 - - - Vitamin a" and "D" Tablets 1 1 - - - Vitamin "c" Tablets 3 3 - - - whiskey 10 10 - - - Wine 4 4 - - - Yeast Tablets 3 3 - - - Totals 652 634 18 - - 77 Result of Analysis of Milk Samples Solids not Fat (Legal standard is 8.5%) 8. 5 8.6 8.7 8.8 8.9 28 77 53 20 4 Milk Fat (Legal standard is 3%) 3.2 3. 3. 4 3. 5 3.6 3.7 3.8 3.9 4.0 4. 1 4. 2 1 14 27 43 24 40 20 7 2 1 3 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.5%) 8.8 8.9 9.0 9.1 9.2 4 1 2 2 1 Milk Fat (Legal standard is 4%) 4. 2 4. 3 4. 4 4. 5 4. 6 4.7 3 2 1 1 2 1 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.64 Milk Fat 3.59 The samples of milk for analysis were obtained as follows:- Taken on Milk Rounds 95 Taken at Dairies 90 Taken at Institutions 7 Total 192 South Devon and Channel Island Milk Solids not Fat 8.95 Milk Fat 4.40 Total number of Milk Samples 19 2 78 DETAILS OF NON-GENUINE SAMPLES TAKEN Artlcle Nature of Adulteration or Deficiency Remarks Buttered Macaroons This sample consisted of buttered coconut macaroons whereas. In the opinion of the Analyst, the term macaroons" Is applicable only to those made with almonds as the nut Ingredient. The manufacturers have labelled this article to indicate that it is made with coconut. Battered Roll Consisted of bread roll spread with a mixture of margarine and butter. Vendor warned. Subsequent sample proved satisfactory. Buttered Rolls Consisted of bread rolls spread with a mixture of margarine and butter. Vendor warned. Casserole Steak In the opinion of the Analyst this article was Incorrectly described since It had not been prepared in a casserole. This matter has been taken up with the Importers. Chocolate Dates The sample consisted of dates coated with a chocolate substitute containing a vegetable fat other than cocoa butter. This matter has been taken up with the manufacturers. Cod Roe This article consisted of canned cod roe with salt added. The added salt was not specified on the label in accordance with the Labelling of Food Order, 1953. The packers have nor amended the label concerned. Diabetic and Diatetic Sugar Syrup This imported article was labelled in a misleading manner. Stocks of this article were witheld fros sale until the label bad been amended. Diabetic and Diatetlc Chocolate Syrup This Imported article was labelled in a misleading manner. Stocks of this artlcle were witheld from sale until the label had been amended. Flour. Plain Contained 410 milligrams per 100 grams of creta praeparata in excess of the Quantity specified in the Flour (Composition) Regulations, 1956. Changed sampling technique gave a satisfactory sample. Fried Grasshoppers The Ingredients of this article were not specified on the label In the manner required by the Labelling of Food Order, 1953. Stocks of this article were withdrawn fro sale. Hot coffee with Milk This sample, obtained from an automatic vending machine, consisted of coffee with skimmed milk. The proportion of skimmed milk was not sufficient to Justify the description. The description of this article has now been amended. Milk Chocolate This article was labelled in a misleading manner. The packers have now amended the label on this article. 79 Article Nature of Adulteration or Deficiency Remarks Milk chocolate This sample consisted of a biscuit covered with chocolate which, in the opinion of the Analyst, did not contain a sufficient proportion of milk fat to Justify the description on the label. The manufacturers have undertaken to improve the quality of this product. Quick Frozen Devonshire Cream. In the opinion of the Analyst this article was unfit for consumption due to bacterial development during storage over a long period. Vendor warned. Remainder of stock destroyed. Seasoned Snake Meat The ingredients of this article were not specified on the label in the manner required by the Labelling of Pood Order, 1953. Stocks of this article were withdrawn from sale. Skimmed Milk The container In which this article was sold was not labelled in accordance with the Public Health (Dried Milk) Regulations. Stocks of this article were withdrawn from sale. Steak Pie This sample contained a small proportion of comminuted meat and thickened gravy which, in the opinion of the Analyst, did not justify the description"steak pie". Subsequent sample proved satisfactory. Tinned Asparagus The label on the container did not specify salt as an Ingredient of this article as required by the Labelling of Food Order, 1953. Stocks of this article were withdrawn from sale. 80 Summary of inspections made by the Public Health Inspectors, and other Departmental work. Total number of houses Inspected for housing defects under Public Health or Housing Acts 2,798 Houses Inspected where zymotic diseases have occurred 211 Houses Inspected following applications for certificates of disrepair 89 Inspections of underground rooms 108 Special inspections in connection with the Housing survey 221 Houses inspected for overcrowding conditions 42 Re-inspections of work outstanding on housing notices 7,755 Number of visits regarding Infectious diseases 531 Number of visits regarding food poisoning 139 Inspections of drainage work during repair 1,840 House drains tested with smoke and colour - routine and complaint 846 House drains tested with smoke (on.written application) 11 House drains tested with smoke during repair 27 House drains tested with water during repair 83 Inspections of cesspools and earth closets 19 „ „ schools and school sanitary conveniences 70 „ „ public conveniences 240 „ „ verminous premises 67 „ „ ponds and ditches 55 „ „ yards, stables and passages 116 „ „ theatres, cinemas, halls, etc 93 „ „ pig styes 51 „ „ tents, vans and similar structures 56 Inspections and re-inspections in connection with Smoke Control Orders 33, 336 Sundry visits regarding Smoke Abatement 749 Smoke observations 95 Visits regarding exhumation 3 Visits to premises for food condemnation 637 Inspections of swimming baths 12 „ „ wells 15 „ „ gathering grounds of water supply 24 „ „ gipsy encampments, camps, fairs, etc. 1 „ „ offices 367 „ „ rivers and streams for pollutions 384 „ „ hairdressers 117 Pood and Drugs Acts: Pood and drugs staples taken 652 Food and Drugs Acts: Milk Samples taken (special designations) 192 Ice Cream samples taken 232 Samples taken of Fertilizers and Peeding Stuffs 24 „ „ swimming baths water 338 „ „ drinking water (bacteriological and chemical) 282 „ „ subsoil water 5 „ „ from rivers, streams, etc 18 „ „ private wells 34 „ „ of rag flock and other filling materials 8 „ „ sundry specimens (food poisoning etc.) 12 Inspections under Merchandise Harks Act 608 „ „ of butchers premises 313 „ „ meat premises (wholesale) 1,251 „ „ poultry and game dealers premises 76 „ „ fishmongers premises 120 „ „ fried fish premises 39 „ „ grocers premises 544 „ „ fruiterers and greengrocers premises 434 „ „ bakers premises - Including bakehouses 154 „ „ dairies 68 „ „ milk shops 55 „ „ general shops and their premises 23 81 Inspections of premises where cooked Beats etc. are prepared or sold 21 Inspections of confectioners premises 308 „ „ confectionery manufacturers premises 10 „ „ cafes, snack bars, canteens, hotels and their kitchens 540 „ „ school kitchens and serveries 45 „ „hospital kitchens 9 „ „ ice cream manufacturers premises 15 „ „ ice cream vendors premises 298 „ „ ice cream barrows and carts 6 „ „market and barrows 214 „ „other food premises not enumerated above 210 „ „premises where offensive trades are conducted 2 „ „factories with mechanical power 486 „ „factories without mechanical power 63 „ „works of building and engineering 66 „ „outworkers premises 216 Visits to employers of outworkers 16 Inspections of shops (under Shop Acts) 1. 393 Special early closing, evening and Sunday trading patrols of shops 466 Appointments kept with owners, builders, etc 1,884 Investigations of complaints other than housing matters 1, 129 Re-Inspections of works outstanding (other than houses) 3, 617 Inspections under Hydrocyanide Regulations - „ „ Fertilizers and Feeding Stuffs Act 6 „ „ Diseases of Animals Act 16 „ „ Pets Act 61 „ „ Rag Flock and Other Filling Materials Act 8 „ „ Pharmacy and Poisons Act 75 „ „ Noise Abatement Act 499 Sundry Inspections and Visits 4, 941 Visits regarding rats and mice infestations 8, 780 Informal Notices outstanding 31.12.60 774 Informal Notices served 872 Informal Notices complied 751 Informal Notices outstanding 31.12.61 895 Statutory Notices outstanding 31.12.60 239 Statutory Notices served 340 Statutory Notices complied 481 Statutory Notices outstanding 31.12.61 128 Total number of callers and complaints received at the office 2,967 Total number of letters received at the office 9. 660 Nuisances, Infringements of Acts, Byelaws, Regulations or orders ascertained by the Public Health Inspectors during the year 1961 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 343 Conditions causing dampness: Defective roofs 287 Defective window frames 260 Defective walls, etc 114 Want of efficient damp-proof course 47 Defective gutters and downspouts 216 82 Other structural defects: Defective plaster 481 Cleansing and redecoration required . Defective floors and stairs 238 Insufficient ventilation under floor 21 Defective brickwork, sills, lintels, chimneys 180 Defective stoves and fireplaces and flues 67 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 90 Defective W.C's 105 Defective drainage 110 Stoppages In drains 113 Defective water services and tanks 8 Domestic nuisance: Rant of cleanliness 12 Verminous conditions 11 Other nuisances and Infringements: Offensive accumulations 43 Overcrowding 6 Sundry nuisances or defects 32 Particulars not inserted in Rent Book (Housing Act) 16 Public Urinals 4 Noise 40 (2) INFRINGEMENTS OP CROYDON CORPORATION ACT Food cupboards defective or required 6 (3) INFRINGEMENTS OP PUBLIC HEALTH ACT, PAVING, ETC. Defective Yard Paving 32 Want of a sanitary dustbin 10 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 6 W.C. defective or dirty 13 C5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals (6) SMOKE ABATEMENT Nuisances observed 3 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 1961 was:From Corporation Wells 2,581,941,000 gallons Purchased in bulk from M.W.B. 754,417,000 gallons 3, 336, 358,000 gallons (a) Bacteriological Examinations. Regular bacteriological examinations were made of the raw waters going into supply following treatment. 485 samples of raw waters and 1,020 samples of treated waters were examined by the Chemist and Bacteriologist of the Water Undertaking. In addition, 11 samples of raw waters and 22 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 87 samples of raw waters and 116 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 Nursing Homes - Public Health Act, 1936 Number of Homes Number of Beds provided for:- Maternity Others Total Hones registered during the year - - - - Hones on the Register at the end of the year 16 34 432 466 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 2,320 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Acts. The following table shows the certificates completed during the last ten years:- Year Certificates 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 1961 2, 320 86 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. 996 examinations were made during the year by the Medical Staff of the Department including 57 vision tests for drivers. Of these 837 were in respect of manual workers, who were classified as follows:- Fit for employment and sick pay scheme 673 Deferred for review 36 Unfit for sick pay scheme 113 Fit for light employment only (Not fit for sick pay scheme) unfit for employment 8 Total 837 87 MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDRENS' DEPARTMENT During the year 250 children were medically examined prior to admission to a childrens' Home or private foster home. 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 26 to 5 year olds daily excepting Saturdays, the remainder being of the 'tarttime" 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. Number Number of registered children 31.12.61 provided for Premises 5 134 Daily Minders 16 136 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. 88 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 84 cases registered:- 5 were due to glaucoma and 46 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had either been performed or would be carried out except:- 1 patient had moved from the Borough. 2 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 52 adult cases are registered with his Department, 6 of whom are in special Homes. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 During 1961 no order for compulsory removal was required. 18 cases were reported as possibly requiring this action, but on investigation were dealt with by other means. Admitted to Queen's Hospital voluntarily -4 Admitted to Mayday Hospital voluntarily -1 Admitted to local authority Hostel voluntarily -1 Awaiting admission to a Hostel (on 31. 12.6L) -1 Admitted to private Nursing Home -1 Provided with additional help (e. g. Home Help and/or Nurse) and remaining under observation -7 Died before action could be taken -3 Total -18 11 of the above were women and 7 men. Their ages ranged from 69 to 96. APPENDIX TABLES 89 vital statistics - 1942 - 1961 90 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX Sex 0- 1- 5- 15- 25- 45- 65- 75- Total All CAUSES M 32 9 8 11 55 400 368 596 1,479 F 31 4 5 9 36 238 295 992 1,610 Tuberculosis (Respiratory) M - - - - 1 5 6 5 17 F - • - - 1 - 2 1 4 Tuberculosis (other forms) M - - - - - - - - - F - - - - - - - - - Syphilitic Diseases M _ - _ _ _ - 2 - - F - - - - - 2 - 6 8 Diphtheria M - - - - - - - - - F - - - - - - - - - Whooping Cough H - - - - - - - - - F - - - - - - - - - Meningococcal Infections M - - - - - - - - - F - - - - - - - - - Acute Poliomyelitis M - 1 - - - - - - 1 F - - - 1 - - - - 1 Measles M - - - - - - - - - F - - - - - - - - - Other Infective and Parasitic diseases M - - - - - - - 1 1 F - - - - 3 - 1 1 5 Total Infective and Parasitic diseases (including Tuberculosis) - 1 - 1 5 7 11 14 39 Malignant neoplasm, stomach M - _ _ _ 2 13 13 13 41 F - - - - - 6 12 13 31 lung, bronchus M - - - - 6 65 35 19 125 F - - - - - 8 12 4 24 breast M • • _ - - - - 1 1 F - - - 5 31 4 19 59 uterus F - - - - 6 11 9 8 34 Other malignant and lymphatic neoplasm s M 1 1 1 7 48 32 60 150 F - 1 1 7 53 27 43 132 Leukaemia; aleukaenis M - - 2 1 2 3 2 1 11 F - - - - 4 1 1 6 Total all forms of Cancer - 2 4 2 35 242 147 182 614 Diabetes M - . . - - - 2 4 6 F - - 1 - - 2 5 8 Vascular lesions of Nervous System M - - - - 2 32 33 82 149 F - - - 3 21 54 248 326 (a) Coronary disease, angina M - _ _ _ 8 117 92 119 336 F - - - - 2 23 60 174 259 (b) Hypertension, with heart disease M 3 5 9 17 F - - - - - 2 3 26 31 (c) Other heart diseases M - - - - 3 16 27 76 122 F - - - - 1 17 32 175 225 (d) Other circulatory diseases M - - - - 2 11 23 30 66 F - - - - - 10 11 52 73 Total heart and circulatory diseases - - - 1 21 252 344 1000 1,618 91  Sex 0- 1- 5- 15- 25- 45- 65- 75- Total Influenza M _ - - 1 2 2 3 8 F - - - - - 1 1 7 0 Pneumonia M 3 1 2 1 1 11 19 60 98 F 7 - 1 - 1 6 9 66 90 Bronchitis M - - - - 1 27 34 42 104 F 2 - - - - 5 9 31 47 Other diseases of respiratory system M 1 - - - - 3 1 4 e F - - — - 1 1 3 5 Total diseases of respiratory system - including influenza and excluding tuberculosis 13 1 3 1 5 55 76 216 370 Ulcer of stomach and duodenum M - _ - _ 1 6 2 8 17 F - - - - 1 2 4 7 14 Gastritis, enteritis and diarrhoea M 1 - - _ 1 3 2 8 15 F - - - 1 - 2 - 5 8 Nephritis and nephrosis M - - - - - 1 5 1 7 F - - 1 2 - 1 1 8 13 Hyperplasia of prostate M - - - - - 3 5 10 18 Pregnancy, childbirth and abortion F - _ - 1 - - _ - 1 Congenital malformations M 9 2 2 - - 1 - 1 15 F 7 1 - - - 3 - 1 12 Other defined and ill-defined diseases M 18 - - _ 4 14 24 35 95 F 14 2 1 2 1 18 31 76 144 Total Miscellaneous Diseases 49 5 4 6 8 54 74 160 359 Motor vehicle accidents M _ 1 - 7 3 3 2 3 19 F - - 1 1 - - 2 4 8 All other accidents M 1 2 1 - 4 4 - - 12 F 1 1 - - 2 4 5 7 20 Suicide M . . _ - 6 9 - 1 16 F - - - - 2 8 2 1 13 Homicide and operations of war M - - - 1 - - - - 1 F - - - - - - - - - Total accidents, suicide and violence 2 4 2 9 17 28 11 16 89 TOTALS 63 13 13 20 91 638 663 1588 30 89 92 CANCER Deaths from Cancer occurred at the following Ages:- Age Period Male Female Total Under 25 years 6 2 8 25 and under 35 years 3 2 5 35 and under 45 years 13 13 26 45 and under 65 years 126 115 241 65 years and over 180 154 334 Total 328 286 614 Sites of Fatal Cancer Site Male Female Total Percentage of Total skin 5 2 7 1.16 Oesophagus 8 7 15 2.44 Stomach 41 31 72 11.73 Liver 2 1 3 0.49 Bowel 18 29 47 7.65 Rectum 16 19 35 5.70 B1adder 6 4 10 1.63 Prostate 27 - 71 4.40 Larynx and Pharynx 6 1 7 1.16 Uterus - 34 34 11.90 Breast . 1 59 60 20.98 Ovary - 11 11 3.85 Pancreas 15 14 29 4.72 Gall Bladder and Duct - 2 2 0.33 Tongue and Mouth 4 l 5 0.81 Bones 2 5 7 1.16 Lungs and Bronchus 125 24 149 24.27 Kidney 5 5 10 1.63 Brain and Nervous System 12 7 19 3.09 Lymphatic Glands and Connective Tissue - 5 5 0.81 Haematopoietic Tissues 4 - 4 0.65 Hodgkin's Disease 1 2 3 1.49 Leukaemia 11 6 17 2.77 Genital Organs 2 1 3 0.49 Antrum 1 - 1 0.16 Ear 1 - 1 0.16 Spleen 1 - 1 0.16 Adrenal 1 - 1 0.16 Thyroid - 4 4 0.65 Undefined 14 11 25 4.07 328 286 614 93 WARD STATISTICS Estimated Population Births Birth Rate Deaths Death Rate Deaths under 1 year Deaths under 1 year per 1,000 Births _ Deaths from Diarrhoea (under 2 years Death Rate from Diarrhoea (under 2 year Deaths from Bronchitis and Pneumonia Death Rata from Bronchitis and Pneuaonia Deaths from Pulmonary Tuberculosis Death Rate from Pulmonary Tuberculosis Deaths from Non-Pulmonary Tuberculosis Death Rate from Non-Pulmonary Tuberculosis Deaths from Heart and Circulatory Disease Death Rata from Heart and Circulatory Diseases Deaths from Cancer Death Rate from Cancer Natural Incrsase of births over deaths. Upper Norwood 17527 352 20.1 230 13.1 3 9 - - 24 1.4 2 0.1 - - 87 5.0 51 2.9 +122 Norbury 16271 198 12.2 209 12.8 5 25 - - 24 1.5 1 0.1 - - 80 4.9 43 2.7 -11 West Thornton 17026 247 14.5 185 10.9 4 18 - - 14 0.8 - - - - 67 3.9 33 1.9 + 62 Bensham Manor 17038 212 12.4 222 13.0 6 28 - - 26 1.5 - - - - 77 4.5 50 2.9 -10 Thornton Heath 16033 268 16.7 189 11.8 5 19 - - 22 1.4 3 0.2 - - 63 3.9 36 2.2 + 79 South Norwood 16231 388 23.9 214 13.2 5 13 - - 26 1.6 1 0.1 - - 96 3.9 35 2.2 + 174 woodside 14849 245 16.5 209 14.1 4 16 - - 22 1.5 2 0.1 - - 79 5.3 44 2.0 + 36 East 17092 18 2 11.2 192 11. 2 2 10 - - 18 1.1 1 0.1 - - 71 4.1 48 2.8 Nil Shirley 12990 175 13.5 113 8.7 4 23 - - 14 1.1 - - - - 42 3.2 19 1.5 + 62 Addiscombe 15908 238 15.0 246 15.5 2 8 - - 28 1.8 3 0.2 - - 87 5.5 44 2.8 -8 Whitehorse Manor 13535 230 17.0 195 14.4 3 13 - - 31 2.3 1 0.1 - - 70 5.2 45 3.3 + 35 Broad Green 13593 222 16.3 160 11.8 2 9 - - 27 2.0 2 0.2 - - 46 3.4 39 2.9 + 62 central 11002 176 16.0 137 12.4 3 17 - - 14 1.3 - - - - 50 4.5 24 1.2 + 39 waddon 15642 241 15.4 186 11.9 4 17 - - 18 1.2 3 0.2 - - 63 4.0 42 2.7 + 55 South 16644 260 15.6 283 17.0 4 15 - - 21 1.3 1 0.1 - - 120 7.2 29 1.7 -23 Addington 21089 545 25.8 92 4.4 7 13 1 0.05 8 0.4 1 0.0 - - 21 1.0 22 1.4 + 453 The Borough . 252470 4189 16.6 3062 12.1 63 15 1 0.00 338 1.3 21 0. 1 - - 1119 4. 4 604 2. 4 +1127 *Death Rate per 1.000 population and excluding those who died In (fceen's Hospital 94 maternal and infant mortality for the years 1942 - 1961 Year Births (Live and Still) Maternal Deaths Maternal Mortality Bate Infont Mortality Rate 1942 3,579 12 3.35 39 1343 3,785 2 0.53 37 1944 3,680 8 2.17 44 1945 3,675 9 2.45 41 1946 4,937 3 0.61 31 1947 5,211 10 1.92 38 1948 4,597 2 0.44 27 1949 4,102 5 1.22 29 1950 3,787 2 0.53 26 1951 3,697 3 0.81 19 1952 3,548 2 0.56 20 1953 3,526 3 0.85 21 1954 3,649 3 0.82 19 1955 3,408 2 0.59 21 1956 3,604 - - 19 1957 3,510 3 0.84 18 1958 3,928 4 L 02 18 1959 3,874 1 0. 26 21 1960 4,069 1 0. 25 20 1961 4,243 1 0. 24 15 95 details of infant mortality The following table gives the cause of death during the first month of life (Neo-natal mortality):- (l) Complications of Labour- Trauma at Birth 9 Asphyxia (Toxaemia) 2 11 (2) Foetal States- Congenital Malformities 10 Atelectasis 2 Haemorrhagic Disease of Newborn 2 14 (3) Prematurity 16 16 (14) Post-Natal Causes - - Total 41 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1.000 Births L 1961 1960 1961 1960 Injury at Birth and Congenital 41.3 17.5 6.21 3.50 Premature Births 25.4 35.0 3.8 2 6.98 Respiratory Diseases 19.0 22.5 2.87 4.49 Atelectasis, Debility and Marasmus 3.2 2.5 0.48 0.50 Diseases of Digestion* 1.6 2.5 0.24 0.50 Other causes 9.5 20.0 1.43 4.00 'These from Gastro Enteritis Perinatal Deaths Stillbirths - 54 Perinatal rate - 21.4 per 1,000 Deaths in first week - 37 total (live and still) births Causes of Death In first week Prematurity - 13 Accidental -1 Congenital conditions - 8 Cerebral oedema - 1 Atelectasis - 2 Haemorrhagic disease of newborn -2 Cerebral haemorrhage - 8 Ante-partum haemorrhage - 2 Prematurity was a tributory cause in 1 case. 96 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 55th - 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 25 6 4 1 1 - - 2 1 1 41 2 3 5 3 2 2 3 - - - 2 63 Meningo - Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - • - - - - - - Measles - - • - - - - - - - - - - - - - • - - - - - - Scarlet Fever - - - - - - - • - - - - - - - - • - - - - - - Whooping Cough - - - - - - - • - - - - - - - - - - - - - - - Diphtheria and croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchltls - - - - - - - - - - - - - - - - 1 1 - - - - 2 Pneumonia (all forms) - - - - - - - - - - - 1 3 2 3 - - - - - - 1 10 Diarrhoea and Enteritis - - - - - - - - - - - - - - - - - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - • Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 4 1 3 - - - - 1 - 1 10 1 - 2 - 1 1 1 - - - 1 17 Premature Birth 12 2 - - - - - 1 1 - 16 - - - - - - - - - - - 16 Atrophy, Atelectasis, Debility and Marasmus - - - - - - - - - - 2 - - - - - - - - - - - 2 Injury at Birth 3 3 1 1 1 - - - - - 9 - - - - - - - - - - - 9 Haemorrhaglc disease of newborn 2 - - - - - - - - - 2 - - - - - - - - - - - 2 Other Casuses . 2 - - - - - - - - 2 - - 1 - - - 1 - - - - 4 Totyals 25 6 4 1 1 - - 2 l l 4 1 2 3 5 3 2 2 3 - - - 2 63 97 midwifery service Ttie work of the municipal midwives was as follows:- 1.The number of maternity deliveries by Municipal Midwives on the district in the year 1, 428 2. The number of live births 1,427 3. The number of forceps deliveries Nil 4. The number of still births 1 5. The number of neo-natal deaths Nil 6. The number of premature live born infants 16 (1) 35 weeks - not weighed. Transferred to Hospital. (2) 36 weeks - 31bs. 8ozs. Transferred to Hospital. (31 36 weeks - 31bs. 8ozs. Transferred to Hospital. (4) 38 weeks - 41bs. 4ozs. Transferred to Hospital. (5) 38 weeks - 41bs. 8ozs. Home Nursing - Discharge 51bs. weight (6) 40?weeks - 31bs. 14ozb. Transferred to Hospital. (7) 37 weeks - 51bs. 4ozs. Transferred to Hospital. (8) 36 weeks - 4lbs. 12ozs. Transferred to Hospital. (9) 37 weeks - 4lbs. 8ozs. Transferred to Hospital. (10) 36 weeks - 41bs. -ozs. Transferred to Hospital. (11) 36 weeks - 51bs. -ozs. Home Nursing - Discharge 51bs. 80zs. weight (12) 36 weeks - 4lbs. lOozs. Transferred to Hospital. (13) 36 weeks - 41bs. -ozs. Transferred to Hospital. (14) 38 weeks - 4lbs. -ozs. Transferred to Hospital. (15) 34 weeks - 41bs. 12ozs. Transferred to Hospital. Twins (16) 34 weeks - 41bs. 4ozs. Transferred to Hospital. 7. The number of patients who received Trilene 11 8. The number of patients who received Gas-Air Analgesia 1,320 9. The number of cases of P.P.H. (Home 12 - Trans, to Hospital 9) 21 10. The number of cases of manual removal of placenta at home 1 11. The number of patients who received blood transfusion at home 8 12. The number of cases to which Plying Squad was called 9 13. The number of cases of toxaemia of pregnancy treated at home 7 14. The number of cases of prolonged labour (over 24 hours) 11 15. The number of breech deliveries 4 16. The number of twins delivered 3 (sets 17. The number of triplets Nil 18. The number of cases of Puerperal Pyrexia 20 (Genital 1 (Extra-Genital 19 The number of congenital malformations 11 (Talipes 1 (Hare lip and cleft palate 1 (Exomphalus 4 (Spina Bifida 3 (Mongol 2 20- Patients given Pethedlne 763 21- Patients sent to Hospital 417 (Ante-natal 317 (During Labour 76 (After Delivery 24 Patlents sent home for nursing 745 (Hone booked 315 (Hospital booked 430 98 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion 1 Other Causes 17 Miscarriage 1 Total 19 FOR COMPLICATIONS DURING LABOUR Breech 12 Episiotomy 7 Malpresentatlon 2 Post-partum haemorrhage 14 Premature Labour 5 Adherent and Retained Placenta 5 Delayed Labour 25 Torn Perineum 104 Ante-par turn haemorrhage 6 Other Causes 49 Total 229 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 19 Pain Id Breasts 3 Pain in Legs 2 Other Causes 54 Rhesus Negative Blood 32 Total 110 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 26 Stl11 Birth 2 Other Causes 46 Toted 74 Grand Total 432 Reasons for the discontinuance of breast feeding are no longer notified. 99 Midwife Mileage Deliveries Midmiwifery Maternity Gas and Air An te-Nata Visits 1 PoMt-Natal Visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnomal Midwives Pupils Midwive a Pupils 1. 2218 1 - - 1 - - -- - - - - - - *2. 3461 92+6 60 1 28 3 89 651 319 1231 1177 147 176 38 3. 7342 64+3 51 - 12 1 60 799 - 1124 - 72 68 5 *4. 3643 75+2 65 2 7 1 65 808 288 1390 956 131 127 7 *5. 3730 61+4 60 1 - - 58 489 £164 1232 852 111 110 6 6. 932 23 22 1 - - 23 159 - 38 3 - 24 30 - 7. 3868 92+2 78 1 11 2 89 838 - 1317 - 75 75 12 8. 3743 70 + 4 51 2 15 2 67 587 - 1100 - 75 82 22 *9 3798 92 + 4 74 1 15 2 90 570 486 1142 1186 154 144 21 *10. 3439 101+8 69 1 28 3 93 69 4 241 1280 1117 138 146 24 *11. 6326 86 +10 66 1 16 3 77 888 534 1257 1038 161 157 5 *12. 5163 93+2 77 - 16 - 80 880 525 1143 1399 157 174 22 13. 4793 79 + 1 64 2 12 1 79 793 - 1249 - 69 82 23 *14. 4390 78 + 9 32 - 46 - 69 9 46 316 1276 1244 179 171 17 *15. 1416 35+2 35 - - - 33 36 2 104 611 313 38 37 3 *16. 4101 76 + 8 67 1 8 - 67 617 477 917 1365 163 191 39 *17. 3714 86 + 4 72 - 14 - 75 720 329 1229 1241 157 146 30 18. 4126 72+2 51 2 18 - 66 419 - 1019 - 62 66 14 19. 37 80 60+1 45 1 13 1 59 404 - 1001 - 15 16 17 20. 1411 45 31 - 13 1 40 283 - 774 - 32 27 18 21. 3863 46 + 4 34 - 12 . 41 511 - 1083 - 47 46 27 21 3183 - - - . . . - - 1187 - - - 20 23. 5037 1 - - 1 - - 2 - 1343 - - - 39 Totals 87607 1428 1104 17 287 20 1320 12420 3780 24288 11898 2007 2071 407 No. 15 Left Service 30.4.61 No. 19 commenced 27.2.61) Holiday reliefs until September No. 20 Commenced 4.4.61) then allocated districts. No. 6 Commenced 7.5.61 - replaced No. 5 who replaced No. 15. No. 2i Part-time from October - not yet replaced No.23 Clinic duties from October Deliveries+ = Cases sent into hospital during labour. * = Mldwlves with Pupil Midwives. ¢ = New Addlngton pupil taken over by No. 5 when No. 15 left service. 100 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1961 who were born- (i) at home 31 (ii) in private nursing homes (Hi) in hospital* 205 (2) The number of those born at home - who were nursed entirely at home 21 who were transferred to hospital on or before the 28th day 10 who died during the first 24 hours who survived at the end of one month 31 (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 14 who survived at the end of one month 191 (5) Number of premature still births who were born - (i) at home 1 (ii) in private nursing homes (iii) in hospital 37 The group under this heading will include cases which may be born in one hospital and transferred to another. 101 THE WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE - 1961 Ml 8a Y. Barnes Was Batt Miss Bird Mrs. Blackburn Miss Blackoore Miss Blest Miss Brow Kenyan Ml88 Butcher Miss Devany Miss Qdridge Mi 88 ftns Ml 88 Gabaln Mrs. Gluckaomn Miss Grace Ct*. 9. 10.61 Mrs. Green Left 2B. fl. 61 Miss Hall Miss Harrington Mr 8. Hartog Mrs. Hastings Miss Haakins Mrs. Ivens CDo. 14.8.61 Mrs. Lalng Ml 88 Lovell Mrs. Mayo Miss Morton Miss Otaway CDm. 1861 Miss Partridge Miss Phillips Mrs. Reed ODD. 5.6.61 Left 3L 12 61 Mrs. Tripet Miss Vlnce Mrs. Wilson Miss Mybre Total 1961 Total 1960 Infnts under 1 year - First Visits 100 72 162 120 83 148 140 171 75 205 224 148 248 65 86 183 248 219 185 222 156 57 50 123 207 71 153 387 125 107 89 90 170 4889 4585 Re-Visits 248 342 396 605 197 319 500 417 1P7 374 616 587 955 131 278 543 607 700 332 530 41 201 78 532 594 230 329 686 195 278 650 536 533 13747 12803 Chlldren 1-2 jears First Visits . 1 10 1 3 - 3 5 24 8 2 5 34 - 8 11 25 8 18 14 88 - 10 5 5 5 22 17 11 3 - 31 7 375 499 Re- Visits 72 173 311 280 167 207 258 262 170 285 458 272 414 75 291 283 282 293 398 258 21 89 47 456 233 132 214 422 124 211 549 322 474 8483 8022 Qilldrm 2-5 years First Visits 1 - 6 _ - 2 19 5 30 24 3 11 53 - 11 36 23 21 16 23 95 2 5 4 11 4 6 22 16 2 - 71 16 509 706 Re-Visits 167 312 497 280 259 442 407 440 193 476 535 638 905 131 505 499 465 835 491 449 18 82 59 539 494 250 619 346 130 282 559 350 1012 13666 11963 Expectant Mothers First Visits 9 2 20 _ 8 18 39 34 2 6 34 32 59 6 3 48 42 6 13 28 - 8 13 2 35 37 20 63 14 21 11 45 72 740 622 Re-VIsits 6 1 5 29 4 3 17 8 - 3 16 28 28 1 - 36 34 4 8 23 19 1 6 24 6 5 20 138 3 6 2 24 1 509 486 Stillbirths - - - - - - - - - - - - 3 - - - - 2 - - - - - - 1 1 - - - - - - - 9 14 Deaths under 1 year - - - - 1 - 2 - - - 1 - 1 - - 3 - 1 1 1 - 2 - - - - 2 - 1 - - - - 16 11 Miscellæous visits 166 26 938 86 77 108 274 90 129 120 120 180 108 28 41 510 111 300 65 162 53 49 40 45 55 81 97 228 43 16 50 204 130 4728 3414 Ineffective Visits 211 182 468 583 99 234 772 450 147 232 164 424 785 179 289 670 317 578 321 407 157 155 132 485 512 304 145 170 273 263 186 410 372 10576 13496 Totals 1961 980 1111 281 1984 898 1481 1933 1882 95 1713 2163 2325 3583 616 1512 2822 2155 2967 1848 2122 648 646 440 2215 2153 1120 1627 2479 935 1189 2096 2049 7787 58247 - Totls 1960 385 1193 1677 2235 827 1577 1851 1546 1541 2020 1871 2229 - - 2181 7795 2195 2940 1862 1835 - 713 951 2225 1838 - 1508 2449 - - 1972 1626 2345 - 52821 *Includes Health Visitors who left in 1960 Nunber of failles or households Tisited Airing the jear - 10925 o to ATTENDANCES AT INFANT CENTRES - 1961 Addlngion Wednesday A. M Addlngton Wednesday P.M. Boishan Manor Monday A.M. Benshan Manor Monday P.M. Boston Road Thursday P.M. Brighton Road Wednesday P.M. East Croydon Tuesday A.M. East Croydon Friday P.M. Pal rchlides Friday P.M. Faloonwod Wednesday (Alt. )P. M. Lodge Road Thursday A.M. Lodge Road Thursday P.M. Hanks Hill Thursday A M Monks Hill Thursday P.M. Monks Orchard Monday P M Norbury Wednesday A. M Norbury Wednesdqy P.M. St, Albais Wednesday P.M. St. Albans Friday P.M. St. Andrews Monday P.M. St. Judes Tuesday A. M. St. Judes Tuesday P.M. St. Oswalds Thursday P.m. Selhurst Monday P.M. Shirley 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 fettoesday P.M. Woddon We&esday P.M. Woodsied Friday A.M. Woodside Friday P.M. Total - 1961 Total - I960 New cases under 1 year 125 186 67 131 126 113 157 176 50 43 100 203 21 53 58 85 113 131 74 158 81 100 167 117 57 163 160 179 86 209 52 67 19 3759 3541 No. of Re-Attendances 1565 1621 1403 1839 1681 2116 2102 2379 635 647 1694 1589 346 1066 735 1587 1464 1407 863 2010 1333 1347 2212 1349 940 2386 1672 1711 1178 2429 432 925 1390 48053 46146 New Cases over 1 year 52 37 19 43 40 10 24 34 9 3 5 77 1 13 9 21 20 53 6 36 2 1 30 17 9 11 21 20 15 31 5 10 20 674 685 No. of Re-Attendances 1018 1133 1212 1426 793 647 678 804 349 471 456 472 255 722 438 890 789 567 391 954 620 647 764 368 367 687 310 265 863 827 354 370 606 21313 19519 Attendances of Children 0-5 2700 2997 7721 3439 3640 2886 2961 3395 1043 1164 2255 2291 623 1854 1240 2583 2386 2158 1334 3158 2036 3095 3173 1851 1373 3247 2163 2175 2142 3296 843 1372 2145 73789 69891 Consulation with Doctor 1342 1529 1047 1206 1122 1024 1021 1246 426 413 962 920 - 854 597 772 961 938 270 1306 716 752 1030 761 158 802 824 856 779 1252 367 628 924 77905 23774 No. of Sessions 52 52 48 48 51 52 51 51 50 26 52 52 52 52 48 52 52 52 51 48 51 51 52 48 50 52 52 51 48 52 26 51 51 1627 1630 Expectant mothers No. of New Cases - - - - - - 2 3 - - - - - - 2 - - - - - - - - - - - - - - - - - - 7 7 No. of Re-Attendances - - - - - - - 4 - - - - - - - - - - - - - - - - - - - - - - - - - 4 25 TOtal Attendances of Expectant Mothers - - - - - - 2 7 - - - - - - 2 - - - - - - - - - - - - - - - - - - 11 32 Total Attendances 2760 2907 7721 3439 2640 2886 2963 3402 1043 1164 2255 2291 623 1854 1242 2583 2386 2158 1334 3158 2036 2095 3173 1851 1373 3247 2183 2175 2142 3296 843 1772 2145 73810 69923 Average per Session 1961 53.1 57.6 58.7 71.6 51.8 55.5 58.1 66.7 20.9 44.8 43.4 44. 1 12.0 35.7 25.9 49.7 45.9 41.5 26.2 65.8 39.9 41.1 61.0 38.6 77.5 62.4 41.6 42.6 44.6 63.4 32.4 26.9 42.1 45.4 - Average per Session 1960 48.0 45.9 54.9 72/6 50.1 51.6 55.0 59.6 16.0 41. 1 40.4 47. 8 14.9 34. 1 25.9 47. 4 47.8 34.1 28.6 61.2 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 - 42.9 103 home nursing Staff at 31.12.61 Superintendent Deputy Superintendent 2 Assistant superintendents 33 Queen's Nurses (including 4 males and 1 part-time) 3 S.R.N's (2 part-time) 3 S.E.A.N. Nurses 4 Queen's Students (including 1 male) Summary of icork carried out during the year under review:- Patients remaining on books from 1960 952 New Patients 3,602 Tbtal 4,554 Hew Patients Medical 1, 988 Surgical 1,555 Gynaecological 33 Obstetric 7 Maternity 19 Total 3,602 Specially classified Cases Visits Tuberculosis 99 3,962 Pneumonia 100 1,218 Maternity Complications 10 53 Infectious Diseases 7 56 Children under five years 173 1,017 Over 65 years old 2,819 96,134 Visits:- Termination of Cases:- Convalescent 2,210 Hospital 280 Died 455 Removed for other causes 727 Still on books 882 Total 4,554 104 Tbtal visits January 13,122 February 11,324 March 11,466 April 10,815 May 11,399 June 11,176 July 11,201 August 11,138 September 10,178 October 10,572 November 10,325 December 10,877 Total 133, 593 rehabilitation of elderly persons Patients visited by Rehabilitation Nurse, 1961:- Female 46 Maie 15 61 Admitted to hospital 5 Transferred for General Nursing 3 Recoveries (Rehabilitated) 38 Died 7 Remaining on books 8 Ages: 18 years (Car Accident) 1 30 - 39 years 1 40 - 49 years 1 50 - 59 years 5 60 - 69 years 11 70 - 79 years 18 80 - 89 years 19 90 - 95 years 5 Illnesses: Hemiplegia 30 Arthritis, Rheumatism & Fibrositis 7 Lower Limb Fracture 8 Other conditions (Parkinson's Disease, Carcinoma, Cardiac) 16 105 In the age group 30-59 years. 1 case of Hemiplegia - making slow progress - Remaining on books. 1 case of Parkinson's disease - walking after 6 months treatment. 1 case of Leukaemia removed to hospital. 2 cases of Rheumatoid Arthritis - one walking without assistance after 4 months treatment and one regained the use of her hands after wax baths. 2 cases of Carcinoma - both died. In the age group 90 - 95 years. 1 case with fractured Femur - patient had a stroke from which she did not recover. 1 patient had a fall, then a stroke from which he did not recover. 1 case of old age - patient is helped to dress and come downstairs daily - R.O.B. 1 patient had a fall and is being encouraged to walk again. r. O. b. 1 case of Hemiplegia - had a stroke from which she did not recover. M. AND C. W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year:- Coapiaiat No. of Cases Total M r Bow Legs 2 2 4 Knock Knees and Plat Feet 2 6 11 Valgus Ankles 5 5 10 Asthma - - - Kyphosis 1 2 3 Torticollis 1 1 2 Pigeon-toes 4 1 5 18 17 35 Total attendances 1,004 106 LOAN OP NURSING EQUIPMENT The Corporation loans equipment and makes a snail weekly charge, with exemption for incomes below a certain figure. During the year the undermentioned loans were made:- Bed Pans 218 Bed Rests 112 Mackintosh Sheets 174 Feeding Cups 7 Mieel Chairs 50 Commodes50 Crutches, p airs 5 Air Cushions 148 Bed Cradles 22 Urinals 68 Air Beds 15 Dunlopillo Mattresses Nil Dunlopillo cushion 2 Bed Pulley 4 Bed Tables 2 Draw Sheets Cotton 68 Walking Aid 25 gmtum Mugs 1 Enuresis Machines 53 Fracture Boards 4 Bedsteads 7 Steam kettles Nil Walking Machines 6 Bed Blocks Nil Pifco Massager Nil Foot Sunction pump 1 Hydraulic Hoists 2 Walking Sticks 1 Foot Support 1 Rubber Suction Bath Mat 1 Dunlopillo Bath Pillow 1 107 HOME HELP SERVICE Staff at 31.12.61 Supervisor 4 Assistant Supervisors 2 Clerks 16 Whole Time Home Helps 198 Part Time Home Helps 1 Night Attendant Summary of work earned, out during the year under review:- Patients remaining on books from 1960 1, 226 New Applicants 1, 518 Patients carried forward to 1961 . 1, 222 New Applicants (a) Maternity 574 (b) Sickness . 943 (c) For Night Service 1 Classification of Cases Attended (a) Maternity 451 (b) Tuberculosis 22 (c) chronic Sick including Old Age 2,001 (d) Others including Acute Sick 141 Number of Hours of Service Given 237, 270 Average [kration of Service Given (a) Maternity 12 days (b) Acute Sickness 10-21 days (c) Chronic Sickness Indefinitely Mount Recovered for Service £7,893. 1L 4. Rate of Remuneration of Home Helps at 31.12.61 3/10d. per hour - Home Helps 3/8 d. ,, sick Room Helpers 3/7⅜d. " - washing Service 4/2⅝d. " - Problem Family Helps £9.1£ 5d. per week - Family Helps W-d. " - Disinfestation 108 PROBLEM ETC. FAMILIES SUMMARY OF THE WORK CARRIED OUT DURING 196 1 BY THE HEALTH VISITOR SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES, AND TO PREVENT THEIR NEED FOR ADMISSION Families admitted to Walmer House in 1961 52 Rehoused in private accommodation 13* Rehoused in Council accommodation 38 (Of these 6 accommodated outside the Borough) Visits paid:- Family Departments Agents and Contacts 560 126 118 Families without permanent housing at close of year:- 8 Potential Homeless Families - not admitted to Receiving Homes-45 Ft sits paid:- Family Departments Agents and Contacts 159 49 44 Problem Families 60 Visits paid:- Family Departments Agents and Contacts 581 113 91 Families referred by other departments 40 Fanilies referred by various organisations and private industry 12 Families making direct contact 20 Contacts re employment 31 Families assisted with furniture 35 Family interviews (office) 205 Families referred to other departments and agencies 52 109 DENTAL TREATMENT - M. AND C. W. Expect an t Mothers Nursing Mothers Total Young Children- Net Cases Examined 202 17 219 309 Re-treated 69 19 19 88 90 271 36 307 399 Expectant and Nursing Mothers Young Children Attendances 654 718 Fillings 224 278 Extractions 238 341 Gas Cases 68 177 Local Anaesthesia 70 5 Scaling and Gum Treatment 123 - Dressings 132 232 Denture Dressings 114 - Silver Nitrate - 150 Treatment Completed 150 256 Number of Sessions (treatment) 325 Dentures Fitted 28 Dentures Repaired 4 Mothers Young Children Young Ante-Natal 280 - South Norwood - 2 Municipal South Crydon - - Midlives 6 St. Alban's - Post Natal 2 _ ,, _ Woodslde - 1 Welfare Centres: Municipal - . N°rbUry * 3 East Croydon - 1 Addington - 13 St. Andrev's - Upper Norwood Waddon - Holy Trinity ct Boston Road St. Oswald's Bensha. Manor St. JUde'8 - 1 Palrchlldes . 2 St. John'S(shirley) Good shepgerd Monks Hill - 1 Good Shepherd Palconwood . . Crosfield Nursery West Croydon - 2 Referred by Dental Officers: 372 Mothers: 288 Young Children: 399 Total: 687 110 HOME SAFETY Accidents taken to Hospital by Ambulance during 1961. Type of Accident Under S Age Groups 45- 64 65 + Sex Total 5 -14 15-44 H F FalIs 87 89 54 52 104 191 195 386 Burns and Scalds 28 10 17 4 5 36 28 64 Poisoning 24 3 13 6 8 26 28 54 Suffocation 3 - - 1 - 2 2 4 Miscellaneous 54 85 31 18 5 116 77 193 Totals 196 187 115 81 122 371 330 701 Deaths from accidents in the Home. Cause No. Details Fall 8 8 All women between 58 and 8 3 years. Burns and Scalds 4 One woman aged 79 - clothes caught fire while lighting gas cooker One boy aged 3 - burns and suffocation. Child left alone in house. Night-dress airing on fireguard. One girl aged 2 - Nightdress caught fire while playing with matches. Mother had just left the house to telephone; kiosk almost outside home. One boy aged 1 year three months. Severe scalds. Crawled off the bed into bath of very hot water. Mother out of room. Poisoning 5 Four women aged 63 to 83 years Overdoses of sleeping pills. One woman aged 81 years Gas poisoning. Fire-arm shot 1 Man aged 21 years - Accident while gun being shown to a friened Total 18 111 deafness Children registered as "at risk" - 169 Tested (luring the year - 100 Premature 61 Born to Rh. negative mothers 10 Family history of deafness 6 Severe illness in infancy 5 Spastic 1 Delay in speaking 10 Parents request 7 Re-tested - 25 Deaf - Nil Partially Deaf - 1 (Age 3 years. Fitted with hearing aid) Thought to have some degree of deafness not requiring immediate treatment - 8 Under 1 year of age 5 Between 1 and 2 years of age 1 Between 2 and 3 years of age 2 3>eech defects only - 6 Slow response, probably not deaf, but kept under observation - 9 Mentally subnormal - 1 Of the 25 re-tested after preliminary screening: 10 were premature babies 3 were born to Rh. negative mothers 12 had a family history of deafness or were not speaking by 2 years of age. 13 babies failed to attend although an appointment had been accepted 3 children were not taken for further examination after a doubtful result from the first test (6 months later of these 16 - 2 had moved out of the area 1 Parent refused 9 premature babies are apparently normal 1 has promised to attend ? deafness 3 still under observation ) 112 AMBULANCE SERVICE Classification of Journeys, Patients and Mileage. *Patients Journeys Mileage 1961 1962 1961 1962 1961 1962 Health service Removals 80,060 (77,421) 46,520 (44,377) 358,899 (349,065) Accidents 4,243 (4,265) 4,093 (3,981) 21,947 (21,954) Spastics (Bramley Hill) 3,560 (4,210) 488 (492) 4,765 (8,183) Mental Health (Occupation Centre) 32,190 (29,361) 1, 227 (1,236) 31,096 (27,034) Services Not Required (Accidents) 264 (329) 903 (1,426) Gas and Air Analgesia 62 ( 375) 489 (3,099) Vehicles to Repair Depots, Testing etc. 273 (254) 2,184 (2,510) Service Requirements, Oxygen, visiting SubStations, Parks, etc. 267 (660) 3,319 ( 3,165) 120,053 (115, 257) 53, 194 (51,704) 423,602 (416,436) Civil Defence 202 (109) 2,315 (1,161) 120,053 (115, 257) 53,396 (51,813) 425,917 (417,597) These figures do not represent Individual cases. Note:- 1860 figures are In brackets. Classification of Accident Calls 1961 1960 Home Accidents (Children) 407 307 (Adults) 342 327 Miscellaneous Accidents (Children) 57 60 (Adults) 117 64 Recreational Accidents (Children) 55 146 (Adults) 95 67 School Accidents 294 279 Street Accidents (Children) 218 210 (Adults) 914 1,002 Work Accidents 284 283 Home Illness (Children) 36 32 (Adults) 367 245 Street Illness (Children) 19 14 (Adults) 658 701 Work Illness 119 121 113 Classification of Accident Calls (continued) 1961 1960 Attempted Suicide 14 24 Suicide 20 14 Common Assault 77 85 4,093 3,981 Comparison of Patients, Journeys and Mileage since 1956 Year Patients Journeys Mileage 1956 104,563 51,10 2 413,812 1957 103,853 50,827 405, 154 1958 110,080 51,502 417,583 1959 114,790 51,974 413, 199 1960 115,257 51,70 4 416,436 1961 120,053 53, 194 423,602 Details of Ambulance Service Vehicles One new Bedford "Utilecon" sitting Case vehicle and two Diesel Karrier Coaches (Mental Health) were delivered and one Bedford "Utilecon" Sitting Case Vehicle was disposed of during the year. List of Serviceable Vehicles at 31st December, 1961 Eight Daimler Ambulances One Humber "Pullman" Ambulance One Humber "supersnipe" Ambulance Two Karrier Ambulances One Karrier Coach 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) Two Karrier Coaches (Mental Health) Total Mileage of Ambulance Vehicles at 31st December, 1961 Daimler Mbulances JRK 756 1951 210,510 JRK 800 1952 179,229 LRK 3 1953 156, 165 LRK 289 1953 156,237 LRK 555 1953 143,816 NBY 501 1954 159,360 0RK 9 1955 137,616 0RK 8 1955 134,435 114 Bedford "Utilecon" Sitting Case LVB 901 1953 156,902 OVB 209 1955 130,643 SRK 189 1957 85.769 SRK 187 1957 79,312 UBY 329 1958 73,062 UBY 325 1958 69,635 WHY 247 1959 50,032 4676 BY 1961 14,340 Sumber "Pullman" Anbulance HRK 773 1949 175,865 Harrier Anbulances WVB 293 1959 38,221 1110 BY I960 18,626 Humber "Super-Snipe" Anbulance SOY 400 1957 96,404 Vauxhall "Vyvern" Saloon Car OBY 724 1955 79,115 Bedford Sitting-Case Coaches KBY 700 1951 144,389 KRK 563 1952 147,065 Karrier Coach WVB 291 1959 28,255 Austin Breakdown (since 2955/56) GLR 801 1940 12,143 Bedford Coaches (Mental Health) KRK 252 1952 96,889 MOY 639 1954 88,807 Karrier Coaches (Mental Health) 3111 RK 1961 302 1547 RK 1961 2,708 115 COMMUNICABLE DISEASES NOTIFIED DURING 1961 Notifiable Disaeses Cases notified Total casern notified In wards At all ages Under 1 At ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Woodside East Addis con be Whitehorse Manor Broad Green Central Waddon South Addington Shirley M F 1 - 4 5-14 15 - 24 25 - 44. 45 - 64 65 and over Scarlet Fever 204 1 61 132 10 - - - 8 12 5 13 32 7 9 14 12 8 21 6 12 6 28 11 122 82 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 15 - 1 - 3 2 9 - 1 2 1 - 3 1 1 - - 1 - 1 - 1 1 2 8 7 Meningococcal Infection 5 - 1 2 2 - - - - - - - 1 - - 1 1 - 1 - - - 1 - 2 3 Enteric and Paratyphoid 1 - - - - - 1 - - - - - - - - - - - - - - 1 - - - 1 Small pox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 38 - - - 17 21 - - 2 1 - - 3 4 - 2 1 3 9 - 6 - 5 2 - 38 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis 2 - 1 1 - - - - - - - - - - - . - - - - 1 - 1 - - 2 Dysentery 39 4 16 11 2 4 2 - 1 - 1 - 1 1 1 1 - 2 - - 6 - 16 9 20 19 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Primary and Influenzal Pneumonia 40 - 4 4 2 5 19 6 3 3 1 5 1 4 3 2 5 8 2 4 1 5 7 6 25 15 Pood Poisoning 56 2 7 12 6 9 14 6 3 7 2 2 15 5 9 1 2 - 1 4 3 - 2 - 24 32 Acute Encephalitis 1 - - - - - - 1 - - - - - - - - - - 1 - - - - - - 1 Measles 4301 140 2057 2065 24 15 - - 287 201 269 284 305 167 221 245 318 279 244 100 291 215 516 359 2117 2184 Whooping Cough 118 14 53 45 3 3 - - 8 4 6 6 2 7 18 7 8 6 2 9 3 8 18 6 60 58 4820 161 2201 2272 69 59 45 13 313 230 285 310 363 196 262 273 347 307 281 124 323 236 595 395 2378 2442 The tuberculosis notifications ore shown In the section relating to that disease. 116 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1961 Notifiable Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nor. Dec. Total Respiratory Tuberculosis 6 9 13 18 31 12 15 19 12 9 15 16 175 Non-Respiratory Tuberculosis - 2 1 2 2 2 1 2 - - 2 2 16 Scarlet Fever 10 27 21 13 9 11 17 8 12 29 27 20 204 Diphtheria - - - - - - - - - - - - - Erysipelas 1 4 1 - - 2 1 3 1 - 2 - 15 Meningococcal Infection 1 - 1 2 - 1 - - - - - - 5 Enteric and Paratyphoid - - - - - - - - - - - - 1 Small pox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Puerperal Pyrexia 6 10 5 4 - - 3 - - 3 4 - 38 Ophthalmia Neonatorum - - - - - - - - - - - - - Acute Poliomyelitis - - - 2 - - - - - - - - 2 Dysentery 6 9 1 9 7 1 2 1 - 1 1 1 39 Malaria - - - - - - - - - - - - - Ac. Prl. and Act. Inf. Pneumonia 8 19 1 6 3 2 - 1 - - - - 40 Food Poisoning 3 2 2 6 11 5 6 - 2 6 10 3 56 Acute Encephalitis - - - 1 - - - - - - - - 1 Measles 21 289 1361 926 859 415 277 159 16 8 4 6 4301 Whooping Cough 28 19 2 13 11 5 15 9 a 4 3 3 118 5011 117 IMMUNISATION AGAINST WHOOPING COUGH A total of 4,132 children were immunised against whooping cough,comprising 3,766 under school age and 366 school children. IMMUNISATION AGAINST TETANUS A total of 4,207 children were immunised against Tetanus, comprising 3,732 under school age and 475 school children. 1,254 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 3,045 persons were vaccinated against Small-pox. Under 1 year of age 1 2-4 5-14 15 or over Total Successful vaccinations 1,9 37 508 153 131 114 2,843 Successful Re-vaccinations - - 8 13 70 91 Insusceptible to Vaccination 76 19 5 2 10 111 3,045 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1961, who have completed a course of Immunisation. Age at 31.12. 61 i.e. Born in Year Under 1 1961 1957-1960 1952-1956 1947-1951 Total Completed course of injections 620 3. 212 498 176 4,506 Reinforcing njections - - 2,526 349 2,875 Estimated mid-year child population 4,140 14,260 37,000 55,400 Immunity index % of population figure for each age group:- 0-5 years 5 - 15 years Croydon 59% 42% England and Wales 64% 51% 118 VACCINATION AGAINST POLIOMYELITIS The following table gives the number of persons vaccinated with 2 injections during the year. Children born 1961-1943 Young persons born 1942-1933 Persons born 1932-1920 Expectant Mothers Persons over 40 6,010 1,742 3,962 159 970 13, 429 persons received their third injection during 1961 making a total of 71,919 since vaccination began and 16,946 school children received a fourth injection during the year. INTERNATIONAL CERTIFICATES FOR VACCINATION During the year 1,729 certificates were dealt with at the office (1,494 smallpox, 134 Cholera, 94 T. A. B. and 7 Yellow Fever). 119 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATIONS AND MORTALITY - 1941 - 1961 120 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 popu1ation * 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 * 1921 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 - 105 0.57 19 24 18 - 188 0.96 1945 9 - 92 0.46 1925 27 - 181 0.91 1946 7 - 105 0.47 1926 27 - 208 1.01 1947 4 0.08 105 0.44 1927 15 - 203 0. 96 1948 3 0.06 111 0.45 1928 24 - 206 0.96 1949 6 0. 12 94 0.38 19 29 21 - 178 0.80 1950 4 0.08 65 0.27 1930 15 - 175 0.79 1951 3 0. 06 64 0.25 1931 18 0.36 177 0.75 1952 - - 54 0. 22 19 32 10 - 166 0.70 1953 2 0.04 37 0.15 1933 13 - 184 0. 77 1954 1 0.02 32 0.13 1934 10 - 157 0.65 1955 1 0.02 35 0. 14 19 35 9 - 176 0.71 1956 - - 26 0. 10 1936 11 - 151 0.60 1957 - - 33 0.13 19 37 11 - 155 0.64 1958 - - 20 0.08 19 38 12 - 137 0.56 1959 - - 25 0.10 1939 6 - 107 0.46 1960 - - 20 0.08 1940 8 - 146 0.74 1961 - . 21 0.08 1941 10 - 111 0. 59 *Prior to 1947, rates only available for Census years. 121 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1961 to 31st December, 1961:- 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 agom) Respiratory, Males 2 - 4 3 3 7 7 8 19 22 21 7 5 108 Respiratory, Females - - - 2 3 3 6 14 18 4 9 4 2 65 Non-Respiratory, Hales - - - - - - 1 1 - - 3 - - 5 Non-Respiratory, Females - - - - 1 1 - 3 2 3 1 1 - 12 122 TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1961 to 31st December, 1961 otherwise than by formal tion:- Source of Information Number of cases in age Groups 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- TOTAL Death Returns from Local Registrars Respiratory M - - - - - - - - - - - - 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-Respi ratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - 1 - 1 (B) Non-Respiratory M F - - - - - - - - - - - - - - (C) - - - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable Deaths) Respiratory M F - - - - - - 5 15 9 3 5 4 1 42 (A) - - - 2 1 2 14 19 9 1 - - - 48 (B) Non-Respi ratory M F - - - - - - - - - - - - - - (C) - - - - - - - - - - - - - - (D) Other Sources Respiratory M F - - - - - - 1 - - - - - . 1 (A) - - - - - - - - - 1 - - - 1 (B) Non-Respiratory M F - - - - - - - - - - - - - - (C) - - - - - - - - - - 1 - - 1 (D) TOTALS (A)44 (B)51 (C) - (D)1. 123 Giest clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1961 1,932 Transfers in from other areas 86 'Lost sight" cases returned during the year New cases diagnosed as definite during the year 168 2,186 Number of cases written off the Chest Clinic Register during the year as:- Recovered 156 Died 22 Removed to other areas 116 'Lost sight of" and other reasons 21 315 Remaining on Register as at 31st December 1,871 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, 810 Number of visits paid by Clinic doctors to homes of patients 214 Number of visits paid to homes of patients by Tuberculosis Health Visitors 3,520 Attendances of patients at the Clinic - At ordinary sessions 17,657* Number of X-Ray films taken 19, 335* *Includes 3,913 miniature film attendances. 124 125 VENEREAL DISEASES Totals Males Females SYPHILIS 1. Patients under treatment or observation on January 1st 39 31 8 2. Patients removed from the Register in previous years who returned during the year for treatuent or observation of the sane condition 1 - 1 3. Patients transferred from other centres after diagnosis - - - 4.Patients dealt with for the first time (excluding 2 and 3) suffering from:- Syphilis, primary 7 7 - „ secondary 3 2 1 „ latent in the 1st year of infection - - - „ cardlo-vascular of the nervous system 1 - 1 All other late or latent stages 9 6 3 Syphilis congenital:- aged under 1 year - - - Syphilis congenital:- aged 1 but under 5 - - - syphilis congenital:- aged 5 but under 16 - - - syphilis congenital: - aged 15 and over 2 - 2 Total Item 4 22 15 7 5. Patients completing treatment and/or observation 17 11 6 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) 45 35 10 GONORRHOEA 8. Patients under treatment or observation on January 1st 13 9 4 10. Patients removed from the register in previous years who returned during the year for treatBent or observation of the same condition 3 3 - 11. Patients transferred from other centres after diagnosis - - - 12. Patients dealt with for the first time (excluding Items 10 and 11) 127 98 29 13. Patients completing treatment and/or observation 121 91 30 14. Patients transferred elsewhere - - - 15. Patients not completing treatment and/or observation 7 5 2 16. Patients under treatment or observation on December 31st (should equal Items 9 to 12 less Items 13 to 15) 12 11 1 126  Totals Males Females OTHER CONDITIONS 17. Patients under treatment or observation on January 1st 27 19 8 18. Patients removed from the register In previous years who returned during the year for treatment or observation of the same condition 9 8 1 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 93 93 - Yaws 2 1 1 Any other conditions requiring treatment 192 117 75 Conditions not requiring treatment 267 175 92 Undiagnosed conditions - - - TOTAL Item 20 554 386 168 21. Patients completing treatment and/or observation 547 383 164 22. Patients transferred elsewhere - - - 23. Patients not completing treatment and/or observation 14 10 4 24. Patients under treatment or observation on December 31st (should equal Items 17 to 20 less Items 21 to 23) 29 20 9 At which patients saw physician Syphilis 143 95 48 Gonorrhoea 430 346 84 Other Conditions 1909 1420 489 TOTALS 2482 1861 621 ATTENDANCES BY PATIENTS At which patients did not see physician Syphilis 547 416 131 Gonorrhoea 81 41 40 Other Conditions 711 439 272 TOTALS 1339 896 443 Contacts attending for examination referred by patients suffering from:- Syphilis 5 4 1 Gonorrhoea 81 70 11 Non-Gonococcal Urethritis 51 51 - Other Conditions 75 55 20 TOTALS 212 180 32 127 By tbe Physician at the Centre Sent to a Pathological Centre Microscopical for Syphilis - 7 Microscopical:Others - 823 PATHOLOGICAL WORK NUMBER OF SPECIMENS EXAMINED Cultural - 535 Serum: for Syphilis 751 „ Others - 469 Cerebro Spinal Fluid (Number of diagnostic lumbar punctures) - 9 SERVICES RENDERED AT TOE 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 S'ECIFIED. MINOR AREAS MAY BE GROUPED AS "ALL OTHERS") County, County Borough (England and Wales.) and Others Syphilis Gonorrhoea Other Conditions Totals Croydon 17 88 364 469 Surrey 3 22 105 130 Kent 1 7 35 43 London 1 10 50 61 Totals (to agree with Items 4, 12 and 20) 22 127 554 703 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1961 To the Chairman and Members of the Education Committee. LADIES AMD GENTLEMEN, In presenting this 58th Annual Report covering the wark of the School Health Service I make a few comments on matters of interest. The number of children seen at routine medical inspections was the largest ever recorded and reflects great efforts to deal with all those covered by the Committee's scheme of four inspections during a child's school life. This achievement would be regarded with some scepticism by many authorities, including the dief Medical Officer of the Ministry of Education, who doubt whether routine examinations justify by results, the time and work allotted to them. They suggest that defects in children of any significance are now discovered by other means to an extent which makes routine checks unnecessary, except for new entrants and school leavers. For the intermediate age groups various alternatives are put forward designed to allow greater attention to smaller numbers who may have special needs, selection of such children may be by Head Teachers, Class Teachers, School Nurses. Medical Officer observing P.T. sessions, scrutiny of Agisters for absentees, or by questionnaires to parents. 2 One fact must be emphasised, that there seems to be no economy in staff or time by any of the different methods put forward. The reaction of parents appears favourable. These alternative systems help the anxious parents who have easier access to medical advice, at perhaps the expense of those who tend to be apathetic or neglectful, selective examinations demand extra time and co-operation from teaching staff and may interfere more with the school curriculum. It is claimed that the better service afforded is deemed adequate compensation. I have always regarded routine inspections not as medical examinations but as medical interviews from which are selected short lists of children who need further investigation. Selection by single interview is a technique receiving adverse criticisn in other fields, where efforts to replace it resemble the changes urged for medical inspections. The Committee will understand that despite the apparent smooth working of existing arrangements in Croydon, it will be necessary to report on pilot trials of alternative measures if only to show the value of existing schemes. The Principal School Dental Officer draws attention to the disquieting failure of children to obtain dental care, either from the school or the general dental service. This is increasingly allied to diminishing parental control and the avoidance of the unpleasant duty of compelling children to accept immediate discomfort for future benefits. It places a greater responsibility on dental health education progranmes to which we are attaching growing importance. Hie clinic needed in the Waddon area was approved, and should be built this year. Waiting lists for speech therapy gave concern. A surrey was carried out to assess priorities and younger age groups will be left waiting for possible spontaneous improvement. Parents understanding^ are increasingly conscious of speech defects in their children for which they demand treatment and more staff and facilities seem inescapable. For the aphasic child in whom some disorder of the brain exists which prevents the proper development of speech, precise diagnosis is difficult and methods of effective treatment may be still undiscovered. Ihis aspect of speech therapy is being supervised by a School Medical Officer particularly Interested and greatly helped by the appointment of a Consultant Neurologist who gives regular sessions at the central speech clinic. 3 The Medical Officer of the Enuresis Clinic considers "buzzers infallible if used properly." .The stock of machines available on loan to parents as articles of home nursing equipment under the National Health Service Act has been augmented to meet the demands. The Audiology Clinic has become firmly established and fulfils all expectations in providing a local service of increasing importance in the detection and early correction of deafness. Health education programmes have been expanded and proved embarrassingly popular when given by the Health Education Officer. It was not intended that she should act as a visiting teacher,but would demonstrate programmes, supply auxiliary aids, and cover special items. Efforts to this end were continued. The basic duty of the School Health Service to supervise hygiene and control infections presented no major problems. The infectious diseases, especially measles were prevalent but generally mild in character. They constituted a nuisance particularly in primary schools, but not a real hazard to health. The usual cordial help has been readily forthcoming from the Chief Education Officer and members-of his staff, and from Head Teachers. My thanks are due to them, and to all the members of the Committee whose Interest and support have been unfailing. Public Health Dept., Croydon. 4 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) - (47%) *Dental Officers 10 (including 4 part-time) - (80%) *Physiotherapists 3 (including 1 part-time) - (73%) Speech Therapists 4 (including 2 part-time) *School Nurses and Nurse/Assistant 34 (including S.H.V. and Deputy) (57%) *Dental Attendants 12 (including 5 part-time) (80%) *Performing also duties In other sections of Public Health Department. Percentages in brackets show proportion of time given to school vork. PARTICULARS OF CLINICS HELD The following Clinics are provided by the Education Committee; attendance thereat, with the exception of the Minor Ailments Clinic, is by appointment arranged by the School Medical Officer: - Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon. (Dally, Monday to Saturday, a.m. ). Ashburton School, Shirley Road, Croydon. (Monday and Thursday, 9 a.m.). Rockmount School, Rockmount Road, Upper Norwood. (Monday and Thursday, 2 p.m.). Duppas School, Goodwin Road, Vaddon. (Dally, Monday to Friday, a.m. ) Salcot Crescent, New Addington. (Dally, Monday to Friday, a.m.). Dental Lodge Road, Broad Green, croydon. 206, Selhurst Road, South Norwood. Waldrons Hall, 55, Duppas Hill Lane. Croydon. Overbury School, New Addington. Stroud Green, Shirley Road, Croydon. Inspection Lodge Road, Broad Green, Croydon. Twice weekly. Salcot Crescent, New Addington. Once a month. Rockmount School, S. E. 19. Once a month. Ashburton School, Shirley Road, Croydon. Once a month. Duppas School, Goodwin Road, croydon. Once a month. Remedial Exercises 47, St. James's Road, Broad Green, croydon. and Massage Daily at 1 p.m. and at salcot Crescent, New Addington. weekly. Speech Defects 47, st.James's Road, Broad Green, Croydon, and at Salcot Crescent, New Addington. Audlolog? Clinic Lodge Road, Broad Green, croydon. Salcot Crescent, New Addington. Thursday p.m. 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. (1) Entrants i.e., Children admitted for the first time to a maintained school and not already examined as Entrants, i.e. normally between 5 and 6 years. (2) 8-year-old i.e., Children in their second year in a Group Junior School, unless previously examined in the Junior School. (3) Entrants to i.e., children in their first year in a Secondary Secondary school who have not alSchool ready been examined as Primary Leavers. (4) Final i.e., Children in their last year of atten- Leavers dance at a Maintained Secondary School who have not been medically examined in that year. (5) Special i.e., Children of other ages with possible Cases defects and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 14,165 children were examined as compared with 12,792 in 1960, and 7, 202 parents attended the examinations. The total percentage of parents attending was 50.8 against 47.6 last year. (See Appendix B, Table V). 398 specials and 300 re-inspections of children were carried out. 6 HEALTH EDUCATION IN SCHOOLS Mi ss D. S. Elliott, S.R.N., H.V. Cert.. Dip.H.E. Health Education Officer "It is always better to light one candle than to curse the darkness". The fields of action open to health education increase in number with the passing of time, partly as a result of the trend of social diseases and partly as a result of the prolongation of life. Health Education is not confined to making the individual "health conscious" and to developing the sense of responsibility but strives to help him to a full understanding of the very essence of life. Therefore, it is widely believed now that health education cannot be considered apart from general education either of children or of adults. Secondary Schools. (Oonmunity Health Syllabus - See Appendii H) Throughout the year continued efforts were made to encourage the inclusion of the whole or part of the Community Health Course into the school curriculum. It becomes increasingly obvious, however, that although ideally most of the content could be included, this rarely happens. The case for the health education appearing as a separate subject in the syllabus, therefore, becomes much stronger. The whole one-term course was given six times hy the Health Education Officer and one Health Visitor in one Boys' secondary School, one Girls' Secondary School, one mixed Secondary School and one Girls' Grammar School. In the latter school the second term was devoted to the British Red Cross Society's Home Nursing Course for which the school now has all the necessary equipment. The course was given by the Health Education Officer and her Assistant and twelve out of fourteen girls passed the British Red Cross Society* s first year examination. In future the third term will cover a Mothercraft Course for which the school is now being equipped and the school health visitor will take over all this teaching with the help of the Assistant Health Education Officer. Tuo Health Visitors were welcomed at another Girls' secondary School to assist the Domestic Science staff with their courses in Hygiene and child Care. This syllabus was based on the British Red cross Junior Mothercraft Manual find was presented to the 14+ age group. The girls especially enjoyed the practical 7 work, some of which was demonstrated on Open Day. It is felt that this course could very well be widened to give the girls a greater awareness of community Health. An average of two teaching sessions to supplement the school programmes and advice on content and sources of information were given hy the Health Education Officer in nine other schools. One other Domestic Science Mistress who wished to be brought up-to-date with Mothercraft teaching attended an evening course of seven Mothercraft classes given to expectant mothers by the Assistant Health Education Officer at Lodge Road clinic. It was found to be a very valuable experience and this service will be extended with pleasure to any mistress who would find it interesting and helpful. This shows clearly that interest can be aroused and maintained with the necessary help given to the teaching staff and that time can be found for the inclusion of health education in the syllabus. Junior Schools Last year in some Junior schools two evening sessions were held, the first for mothers and the second for mothers with their daughters of the fourth year group, on the subject of "Growing Girls". These proved so successful and helpful to the mothers that the service was offered to the thirty-six Junior Schools in the Borough, it is hoped to have visited than all by the end of the school year and in future to hold these talks annually. Moral Welfare of School-Age Girls Towards the end of 1960 and throughout 1961 the Health Education Officer was invited to take part in meetings arranged tjy the Chairman of the Education committee during which a number of persons who were concerned could discuss the incidence of pregnancy among girls still at school and whether there were any steps which could be taken to help in this disturbing problem. As a result of the advice of the Reverend Chad Varah, founder of the "Samaritans" Society and the example of schemes carried out in the southwark Diocese the following two-part programme was arranged:- To train a panel of speakers who would be ready to talk to girls of all denominations in Secondary Schools on Personal Relationships" if invited to do so by the Head Teacher. The training included lectures on theology of sex and marriage, Personal relationships, physiology and preparation for marriage. 8 The Health Education Officer has given additional assistance during three sessions on specific points of presentation, with reference to experience in local schools. The panel consists of six married women in their thirties, five of whom have children. Most of them have had a University training and include one woman doctor and four former ex-teachers. One member also works for the Marriage Guidance Council in Croydon. The general pattern followed by members of the panel on completion of their training is:- (a) The speaker visits the headmistress on invitation and discusses the procedure, time allowed, content of talks and the method of delivery. (b) During the second visit a talk is given to the girls and at the conclusion of this they are asked for written questions on points about which they need further information. (c) The third visit is devoted to answering the questions and any points which might arise from them. (2) A one-day Conference was held in July on 'Personal Relationships "for schoolgirls drawn from all the Croydon schools (there was no selection). The Reverend (Sad varah gave the necessary guidance for this and took part in the programme. This was divided into three topics, followed by written and oral questions:- (a) "The First Meeting" - The Reverend (Sad varah (b) "Going steady" - Dr. Marcia Hall (c) "For Better, For Worse" - The Reverend F. A. Wainwrigbt and Mrs. Wainwright. The conference was followed up by speakers from the panel visiting the schools. Some of the comments from the girls taking part as related by the Head Teachers who were present at the meeting were:- (a) The first Conference was valuable, but would be of better effect if it were supported by a similar conference for boys. (This is now being organised for early in 1962). (b) It was enjoyable and profitable and the pupils were impressed by the willingness of the speakers to accept children into adult confidence and they were relieved to talk about these matters in the open. 9 (c) Head teachers made other suggestions such as another meeting to be held on a two-hourly basis for children of lower intelligence and powers of concentration. Venereal Disease In July a memorandum was received by all Local Authorities from the Ministry of Health stating that "the continued rise in the incidence of venereal disease, particularly among the young, has been giving cause for increasing concern". With this in mind, the Health Education Officer found it was possible to introduce the facts simply and clearly and to discuss them thoroughly during one of the lessons on "human Relationships" at the end of the Community Health Course in one Girls' Secondary School and one Boys' Secondary School. It was interesting to observe that these facts were quite unknown to all the children except a few boys who had been well instructed by their Youth Club Leaders. The second opportunity for introducing the facts about Venereal Disease into the Community was found during the talks to Mothers on "Growing Girls" in the Junior Schools. They asked for information about Venereal Disease because their children had noticed the posters displayed in public lavatories and were asking questions about them which they were unable to answer. The "syphillis and Gonorrhoea" leaflets published by the Central Council for Health Education were also given to these mothers, the majority of whom would discuss the subject with their husbands and so help to spread the information. Miscellaneous During the year talks and lectures were also given to Portland, Oval and All Saints Parent Teacher Associations, Pairchildes Senior Girls School's "Past and Present Society",the Pre-nursing Course at Croydon Technical College and Coloma Teachers' Training College. The kindness and co-operation of the staff in all the schools has once again made this year's work - so much of it experimental - a most enjoyable experience and it is hoped that 1952 will be a year of confirmation and consolidation of the work begun and still produce opportunities for widening this aspect of general education. 10 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. For the two intermediate age groups presented for routine medical examinations, weighing and measuring was not carried out. VISION TESTS Routine vision tests for entrants is now an established procedure and considered of such importance that where an immediate result cannot be obtained the nurse returns especially to complete the test. For the usual Tables, see Appendix VIII. UNCLEANLINESS Cleanliness inspections are carried out by the School Nurses each term in most schools, so that the majority of pupils are brought under review. The finding of slight infestation in unexpected offenders leads to the issue of an informal letter to the parents, setting out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parents of children previously found verminous. Steel combs are sold or loaned where necessary. Endeavour is made to serve notices on the parents by the School Nurse personally, so that she has opportunity to emphasise that infestation may be a family complaint and not limited to the school child, and the need for constant cleanliness to prevent relapses. A cleansing station is provided for the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for cleanliness (first inspection) 52,648 Number of children inspected (subsequent inspections) 955 Number of children found unclean (first inspection) 535 Number of occasions in which children found unclean (subsequent inspections) 148 At the primary inspections vermin were found in 22 and nits alone in 513 children. On these inspections 1.0 per cent. of the children showed evidence of infestation as against 0.9 in 1960. 7 children attended the Cleansing Station for treatment for verminous conditions and 8 for scabies. 11 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis:- Pulmonary 11 Non-Pulmonary 1 Taking the total child population at 42,47 9 (estimated), the pulmonary tuberculosis incidence rate per 100,000 was 25.9, and the non-pulmonary 2. 4. There were no deaths from tuberculosis. CAUSES OF DEATH IN SCHOOL CHILDREN prom 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 13 in 1961 equal to a death rate for this group of 0.36 per thousand. This is an average low figure and the details were:- Leukaemia 2 Other Malignant Diseases 2 Pneumonia 3 Congenital Diseases 3 Nephritis 1 Motor Accidents 1 Other Accidents 1 Total 13 CAUSES OF EXCLUSION FROM SCHOOL During 1961, Measles was the specific infection causing the most absences from school, followed by chicken Pox, German Measles and Mumps in that order. The detailed figures given in Appendix D, Page 58, 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. When 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 *ith queries which may arise in regard to individual children. For details of visits, see Appendix F, Page 60. The experimenting of appointing a State Enrolled Nurse for clinic duties proved entirely satisfactory. It was shown to be a proper method to relieve health visitors who are also school nurses of certain routine tasks so that they were available for duties which only they can do. Additional staff in this grade will be recruited. 12 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 3>ecial 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 above will be found in the appropriate Report. Introduction During the year efforts have been continued to bring to the attention of parents and teachers the worsening condition of children's teeth and the need for active co-operation of all concerned to reverse the present trend. Experience from early studies has shown that much of the present parental apathy is due to lack of basic knowledge regarding the immediate causes of dental decay and failure to appreciate the importance of other contributory factors, such as regular meals, sufficient hours of sleep for the young, as well as the granting of undue spending allowances, all of which it should be within their power to control. To this can be added the general hypnotic effect of certain mass media associated with commercial advertising to boost the sales of products of doubtful dietetic value. Given this background the task of changing the existing outlook on dental matters is likely to be considerable, and calls for concerted action at both local and national levels. As a practical move Dental Clinic staff will in future place special emphasis on measures to promote "improved Methods of Tooth Cleaning", "Systematic Oral Hygiene" and in drawing attention to "Pitfalls of Modern Diet". Whilst continuing to meet essential clinical needs it is felt that a direct approach from the Dentist would do much to stimulate a desire for "selfhelp" among patients, which could in time exert a growing influence on contacts in every day life. As a further step a constructive programme for Dental Health Instruction, Demonstrations and Films has been drawn up f°r Corporation Schools; material for such programmes will be carefully selected, allowing a colourful approach for younger age groups and a more scientific bias in the case of senior departments. 13 Pressure has been maintained on Departments where certain "Tuck &op" sales have continued to give cause for alarm. In this connection practical guidance has been offered by visiting Health Education staff, and there are signs in many quarters of an increasing awareness of existing hazards, resulting in the exclusion of more injurious "confections". Whilst this is encouraging it should be stressed that to secure a permanent improvement in the dental "climate" at schools, fuller participation is urged on the part of teaching staff, particularly those concerned with Community Health Programmes. In the realm of the pre-school child valuable assistance has been forthcoming from Health Visitors by the inclusion of Talks and Discussions with parents during Infant and "toddler sessions, at various welfare Centres. Innovations of this kind, supported fay topical exhibits and other visual means, have been well received and could with advantage be extended to Mothers Clubs and also to church and other social gatherings. As with all activities of this kind, however, specialised staff training represents a particular problem. A novel attempt to catch the eye of those entering upon adult status was staged in the Autumn as part of an exhibit specially designed for the "Welcome to Citizenship" celebration. In relation to the day to day working of the School Service attention has been given to a general up-grading of older clinic buildings, by improving staff amenities and providing extra comfort in existing waiting rooms. To meet a universal demand additional turbine type "drills" have been installed in certain major centres. Dissatisfaction continues to be expressed by mothers of small children from the south Croydon area at the travelling time involved in journeying to Lodge Road Clinic. Fortunately, substantial progress can be reported in connection with the scheme for a combined welfare and Dental Centre planned for the Coldharbour Site, and it is hoped that active construction will commence during the early part of the coming Summer. Current returns for the School Dental Service show an increase in the number of Departments inspected, as well as an improved turn round of treatment. In general the position is substantially brighter, and provided existing levels of staff can be maintained, the requirement whereby all those entering the scheme receive the requisite annual treatment may soon become a Practical reality. 14 Inspections The number of children on the register at maintained schools within the Borough at the close of 1961 was 36,56 3. Including an additional 43 scholars at "grant assisted" schools this represents a sum total of 36,606. During the year 87 per cent. of the school population were examined, compared with 74. 5 per cent. in 1960. This increase has come about largely as a result of the improved treatment position in the New Addington area. According to recent returns only 2,479 children remained unexamined during 1961, compared with 6,000 last year. At those schools visited 31,824 were inspected and 13,097 (41. 1 per cent.) referred for treatment, compared with 25,456 inspected and 11,752 (46.3 per cent.) referred in 1960. Because of discrimination exercised in the matter of certain conditions deemed inadvisable to treat, the above figures should not be regarded as an index of the actual incidence of decay. The results obtained from school inspections were as follows:- Acceptance of Treatment 35.4% Refused Treatment 48 % Forms Not Returned 16.6% The above figure represents a decrease of 3.6 per cent. acceptance compared with 1960 and is in line with the general trend since the introduction of alternative provision under the National Health Service. Though, as stated later, this has had a significant effect on the general treatment position, anxiety continues regarding the very appreciable number of children now opting out of the school Service, who are subsequently found to have received little if any outside attention. Where there is conspicuous neglect "follow up" measures are usually instituted through the Head Teacher, generally with only limited success. 15 RESULTS OF SCHOOL INSPECTIONS 1961 1960 1957 1949 1937 No. referred for Treatment 13,097 11,752 15,024 9,404 13,498 Consents 4,637: 4,586: 6,692: 6,996: 7,762: 35.4% 39% 44.5% 74.1% 57.7% (Total Consents Including Specials)* 6,148: 6,542: 9,366: 10,098: 10,146: 47% 47.7% 52.9% 80.7% 63% Refusals 6, 281: 5,531: 6,516: 1,213: 3,242: 48% 47% 43.4% 12.9% 24% Forms not Returned 2,179: 1,635: 1,816: 1,195: 2,494: 16.6% 14% 12.1% 12.7% 18.5% *Specials - Those referred by Head Teachers with Emergency Forms Treatment Whilst the lower acceptance rate has had the effect of reducing the previous burden of treatment, new problems have been created by the overall growth of the Borough and the very substantial increase in child population. This has necessitated the redeployment of existing personnel over a larger area, in addition to an increase in time devoted to routine inspection. Despite this fact a larger number of Departments were visited, as well as meeting treatment requirements. Of 14,608 children referred for treatment (including specials) 7,376 (54.9 per cent.) were treated and 5,9 36 ( 40.6 Per cent.) cured completely, compared with 13,708 referred, 9.773 (71.3 per cent.) treated and 5,199 ( 37.7 per cent.) cured In 1960. Treatment sessions fell from 2,868 to 2,751, principally on account of fewer sessions by part-time officers. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year. 16  1961 1960 Attendances 21,806 23,367 Treated 7,376 9,773 Re-treated 3,960 5,419 Fillings - Permanent 8,016 8,722 Temporary 2,091 2,016 No. of Teeth Filled - Permanent 7,093 8,069 Temporary 1,819 1,940 Extractions - Permanent 2,029 2,211 Temporary 4,616 4,961 Gas Administrations 2,754 3,037 Local Anaesthetics 635 1,264 Other Operations - Permanent 8,179 8,978 Temporary 950 843 Cases Completed 5,936 5,199 Miscellaneous Items These include: Root treatment in anterior teeth 39 72 Removal of bone sequestra 9 11 Splints for fractured incisors 4 3 Partial pulpotomy 2 1 Number of adult M. Ds treated 12 8 Dentures inserted 21 29 Denture repairs 8 15 After treatment of sockets, etc. 33 27 Removal of impacted teeth 69 85 Ulcerated Stomatitis (Vincent's Infection) 3 5 Cleft Palate cases 1 3 Acrylic caps for incisor teeth 19 12 Gingivectomy 7 6 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 1,511 compared with 1,956 in 1960. X-Ray Examination The number of cases referred for the above purpose was 380, compared with 466 in 1960. This includes 211 taken at Mayday Hospital. 17 Orthodontic Treatment The number of sessions devoted to this work was 404, compared with 390 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:- Consultant D.O.s Total Cases commenced during the year 180 68 248 Cases carried forward from the previous year 601 60 661 781 128 909 Cases completed during the year 131 58 189 Cases discontinued during the year 96 12 108 Pupils treated with appliances 273 108 381 Appliances - Removable 275 90 365 Fixed 72 13 85 Total Attendances 3,876 1,327 1,203 Cases treated by extraction only 8 134 142 Cases referred to Specialist for consultation 142 - 142 Treatment Sessions 313 91 404 New Cases awaiting treatment 21 11 32 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:- 1961 1960 Attendances 78 101 New Cases Treated 5 17 Re-treated 38 30 Fillings - Permanent 62 115 Extractions Permanent 10 23 Temporary 8 2 Other Operations 10 16 "Gas" Cases 9 12 Local Anaesthesia 4 11 Cases Completed 35 37 Referred X-Ray 6 4 See Appendix B. Table IX. 18 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED CHILDREN Mr. Green, the Headmaster, reports the period of transition begun In 1960 has continued throughout 1961 in that the new dining/assembly hall and kitchen were completed and brought into use whilst further progress was made with the construction of the swimming pool. Consequent upon these works the re-organisation of the School (as carried out so as to reduce the number of children in each class. Staff changes on the medical side have included the appointment of Mrs.Jordan as Nursing Sister and Mrs. Lee as Physiotherapist to replace Mrs. Hodgson and Mrs. Raghan both of whom retired from the Committee's service. An additional medical attendant was also appointed. We have endeavoured to provide a wide range of activities for the children, some 30 children accompanied by 5 Staff spent a very enjoyable week on the Isle of Wight in June and visits were made during the Summer Term to London, Hampton Court, Greenwich and various Museums. In addition to the customary Sports Day. Visitors' Day and Annual Prize-giving, a School Pete was held in July when £287 was raised to provide equipment to enable the School to create Its own Film Unit. Routine Medical Inspections took place on 19 occasions; when 27S children were seen and 140 parents were present. Specialist medical examinations were held termly, an average of 8 children being seen on each occasion, also present were the children's parents, the Medical Officer, the School Nursing Sister, the Physiotherapist and the Head Teacher. Physiotherapy has been given on each school day; a total of 3,630 treatments to an average of SO orthopaedic cases. Speech Therapy has been given on two sessions each week; some 443 treatments to an average of 19 children. The Nursing Sister, aided in certain duties by the Medical Attendants, 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 22 13 35 2. Bronchiectasis 4 8 12 3. Congenital Heart 5 6 11 4. Epilepsy 6 2 8 5. Muscular Dystrophy 4 2 6 6. Speech Defect. 3 1 4 7. Poliomyelitis 5 5 10 8. Spina Bifida 3 4 7 9. various Disabilities 10 13 23 62 54 116 Delicate Boys Girls Total 1. Asthma 27 14 41 2. Bronchitis 10 9 19 3. Debility 5 8 13 4. Primary T.B. 1 5 6 5. Various Disabilities 4 1 5 47 37 84 19 Average number on roll 198 Admissions during the year 41 To employment 14 To other schools 26 To Hospital 1 Deceased 1 The parents, Staff and children extend to Dr. E. M. Hegarty their most grateful thanks and appreciation for her devoted works on behalf of the children. The Head Master also desires to record his thanks to the Principal School Medical Officer and his Staff, the Chief Education Officer and his Staff and to all members of the Staff of St. Giles' School for their guidance and help during the year of 1961. 20 ST. CHRISTOPHER'S SCHOOL FOR EDUCATIONALLY SUB-NORMAL CHILDREN Mr. Grice the Headmaster reports:- (1) Organisation. 1961 has been another year of further lmprovenents and consolidtion of earlier gains. The re-organisation of the school is now complete. The kindergarten class for young children relieves Infant schools of children who are problems, and provides an opportunity to tackle difficulties before they become really acute. The school is veil equipped to do this having a self-contained kindergarten unit for kindergarten and infant classes, and a Nursery Assistant to help the Teaching Staff in their work. The main School is divided into Upper and Lover Schools, the division being roughly at the 12-year level. The Lover School has static classes, as in ordinary Primary Schools, but the Upper School provides a full range of Specialist Subjects as well as standard work in English and Arithmetic. The grouping of the children Is largely on an 'adjustment basis, though some regard must of course be paid to chronological age. 1961 has seen a narrowing of the vide range of attainment in each class. For a variety of reasons many of the children present problems of adjustment as well as purely educational problems. The school is therefore concerned to a great extent with personality development, and re-orientation, and with the family situation.Children are encouraged to take responsibility and to develop independence as early as possible. In addition to the Prefects, who have been established in the Upper School, there is also a group of 'Leaders' who. as veil as having routine responsibilities, also serve as Monitors on a rota basis. During this period of duty they vork entirely unsupervised. (2) Building Improvements. Sinks have been fixed in all Junior classrooms and display boards in every classroom. A large brick pillar was removed from the centre of the Woodwork Room. This has not only enlarged the working space but has made class supervision much easier. The interior of the school has been completely redecorated. ( 3) Gardening. In the School Gardens competition for 1961, I am pleased to report that St. Christopher's School was awarded First Prize - The Aldernan Mrs. Squire Cup. This is the first time that St. Christopher's has been successful and the children were very pleased that their efforts had been revarded. (4) The Old Scholars Club. Held its first Birthday Party on October 9th. The Club is flourishing and is Invaluable as a means of keeping contact vith our pupils after leaving school, and they themselves feel more secure as they knov that they can always obtain re-assurance, encouragement and advice during the difficult period of adjustment to working conditions. I am extremely grateful to the members of my Staff who so willinglJ give of their spare time to this Important social work. (5) Equipment. A film projector was received for use in the School on September 20th, and a climbing frame complete with scrambling net was received on November 20th. 21 (7) The past year has seen the formation of a School Parents' Association. Although parents have to travel quite considerable distances the meetings are well attended and visiting Speakers have been received most enthusiastically. The Association has also provided the School with a Sandpit, Rabbit hutches, Swing, etc. Statistics Boys Girls Total Number on Roll 31st December, 1960 123 83 206 Admitted during 1961 28 12 35 Left to work at 16 16 9 25 Left to work at 15 1 1 Removed to other areas 1 1 Transferred to St. Giles' 1 - 1 Transferred to Residential E.S.N. Schools - 4 4 Transferred to Normal Schools 3 1 4 Excluded as unsuitable for education at School 3 1 4 Number on roll 31st December 1961 123 78 201 22 ST LUKE'S SCHOOL FOR THE PARTIALLY SIGHTED Miss Handle, the Headmistress, reports 1961 was a year of steady progress and Improvement. Two valuable additions were made to the school equipment - a fllmstrip projector and screen which will help to further the children's knowledge and interest them In things which they would not otherwise see. A room was re-decorated and the lighting Improved and is now used as a Library which is a very welcome addition to the school. Various excursions were undertaken with the purpose of widening the children's experiences. These Included visits to the sea, St. Paul's Cathedral and Westminster Abbey. The science Museum and the London Zoo were also visited and special lecture-tours were arranged to meet the needs of partially-sighted children. A group of children attended the Swimming Baths throughout the year and all made very good progress under the guidance of the Swimming Instructor. The following certificates were gained:- A routine Medical Examination was held during the year and an Ophthalmologist visited the school to carry out an Eye Examination. Three children were found to be in need of further examination at the Eye Unit. More time was given to Dramatic Work with a consequent improvement in speech and this also helped to Increase the children's selfconfidence. One pupil of above-average Intelligence was transferred to Exhall Grange School, Coventry which offers a Grammar School Course for partially-sighted children. This boy was admitted to school at the age of four and benefited from the early start. All partially sighted children progress at a slower rate than normally sighted children and early admission for special help and teaching is essential. 5 x 20 yards, 5 x 50 yards, 2 x 100 yards. Number on Roll 31.12.61 17 Admissions 3 Left district 1 Transferred to Residential School 1 Left for Employment 4 23 CHILDREN EXAMINED FOR I.Q. 144 children were examined during 1961. The classifications arrived at, together with recommendations made, are as follows:- (l) Found 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 11 (3) Other Recommendations: (a) Referred to slow Stream in Ordinary School 3 (b) Recommended for re-test 22 (c) Deferred for Medical Treatment 6 (d) Recommended for St. Giles' 4 (e) Recommended Residential School for Deaf 1 (f) Recommended Residential normal School 1 (g) Recommended Residential School for Speech Defects 1 (h) Referred back to Ordinary School 17 Mental Tests at St. Christopher's 47 144 Awaiting Testing on 31.12.61 11 155 24 CHILD GUIDANCE CLINIC Dr. G. Crosse, Consultant Psychiatrist for the Croydon Child Guidance Clinic, reports that there were during the year 244 new cases registered, 60, or nearly a quarter, being referred by the Local Authority. Of these, 20 children were referred directly by the Education Department or by schools, and 40 by medical officers of the School Health Service. Children were referred in several ways:- Source of Reference Boys Girls Total General Practitioners 38 23 61 Parents 7 4 11 Education Department/Schools 16 4 20 Medical Officers of School Health Service 29 11 40 Hilton Home Remand Home - 85 85 Juvenile Court/Probation Officers 10 - 10 Other Agencies 7 10 17 107 137 244 Analysis of the above cases:- Boys Girls Total Diagnostic 19 96 115 Currently under treatment 65 30 95 Closed - improved 14 8 22 Closed - no change 9 3 12 107 137 244 Analysing further the 40 cases referred through the School Health Service:- 4 children not yet attending school were referred from Infant Welfare Clinics; 24 school age children were referred following a special examination, (for the most part at school inspection clinics); and 12 school age children were referred following routine medical examinations in school. With regard to the 36 children of school age, the following break-down is of interest:- 25 Sex incidence: 27 boys - 9 girls - i.e. 3 to 1. Age incidence: Ranged from 4 to 15 years, but 26 of the 36 were in group of 5 - 9 year olds. School incidence: All the schools in the" borough, except 2, were visited at least once in the year. The 36 children referred to the Child Guidance Clinic were from 30 different schools fairly evenly distributed, but with a slightly higher incidence in the New Addington area. 10 of the 36 children came from New Addington, attending 8 of the 12 schools in this area. Reason for referral: by far the largest number fall into the group "behaviour disorders" - meaning anything from temper tantrums in the younger children to persistent stealing by young teenagers. Many were brought to the school clinic by parents anxious for help with children showing difficult, aggressive or defiant behaviour at home or school. The 36 referrals could be broadly classified as follows:- Behaviour problems 22 Emotional problems 4 Enuresis and/or Encopresis 5 Sleep difficulties 2 Truancy 1 School Phobia 1 Poor educational progress 1 36 26 SPEECH THERAPY The speech Clinic staff was increased in 1961 to a total of four full-time therapists. However, the pressure of work was not abated, and the waiting list for treatment at both the central St. James's Road and the New Addington Clinics were long. The Case loads were also heavy at both Special schools. The amount of work suggests the need for a further increase in staff by possibly another whole-time therapist. This would, however, necessitate either larger premises, or more de-centralization. In this connection the authority to provide premises for school Health Service purposes in the Waddon area has been noticed. Parents' Evenings were held again during the year and were most successful. Because of their popularity it was agreed that they should be a regular bi-annual occurrence. Speech Therapists gave talks at several other Parent/Teachers' Association meetings, and equipped and attended the Speech Therapy stand at a Careers Exhibition held as part of the Commonwealth Technical Training Week. The Aphasic child with associated specific difficulties continued to be of great interest, and presented many problems. Dr. Worster-Drought was appointed as a Consultant Neurologist, and gave a session approximately once every 6 weeks. This help has proved of the very greatest value in deciding the best course of treatment to be followed in any particular case. In the Annual Report for last year the possibility of setting up a special class for these children was mentioned, but so far the educational arrangements cannot be considered fully adequate. Total number of cases treated 466 (314) Total number of cases discharged 183 ( 74) Total number of cases still attending 283 (240) (The figures for 1960 are in brackets) Further details of the work carried out are shown in Appendix B, Table X. 27 ENURESIS CLINIC During the year a total of 176 children attended the Enuresis Clinics, 112 at Lodge Road and 64 at New Addington. As usual the number of boys attending (124) was far in excess of the number of girls (51). Their ages ranged from 4 years to 15 years, the largest number in any one age group being 32 six year olds. The familial nature of Enuresis was demonstrated by the number of children who had near relatives who had been or still were enuretic; namely 71 out of 176, or 40%, 9 children, or 5% of the total number attending the clinics, were either adopted or living with foster parents. 59 of the children seen had been treated previously, either by the general practitioner or in Hospital. 12 children had previously attended the Enuresis Clinic and had relapsed after being dry for a period varying between a few months and four years, in over half of these relapses there was an obvious precipitating factor such as a recent bereavement. The electric buzzers again were of immense value, and when used properly were an infallible cure; 56 children used them during the year. The age groups of those attending was as follows:- Age:- 3 4 5 6 7 8 9 10 11 12 13 14 15 Numbers Attending:- 1 4 23 32 20 14 20 18 15 11 6 7 5 Number of children who attended in 1961:- 176 (183) (124 boys: 51 girls) Total number of attendances made 717 Discharged dry 87 (74) Still attending 68 (66) Discharged for non-attendance 7 (23) Left district 8 (15) Too young for treatment 1 Referred elsewhere 5 (5) Number using machines 56 (29) (The figures in brackets are those for 1960). 28 DEAF AND PARTIALLY DEAF CHILDREN 1961 was a busy year for the Audiology Clinic. Begun in May 1960 the scope of its work was widened and earlier ground work was consolidated. We were sorry to lose, through marriage, the services of our Peripatetic Teacher of the Deaf, Miss DimondHogg, whose efforts have so greatly helped to get the clinic firmly established. During the year, 493 audiometric tests were carried out and 96 children with impaired hearing received regular auditory training, either in the home, in school or at the clinic. The frequency of training varied with each child. Some required weekly training: others only fortnightly or monthly. 361 training sessions at Lodge Road and 147 school or home visits were made during the year. "Sweep testing" of five year olds began in September, and by the end of the year 737 children in 20 infant schools had been tested by this screening method. A part-time audiometrician is employed for this purpose for four sessions a week during school term, and it is planned that all five year olds will be tested at some time during their first year at school. Already the value of this new branch of the work has been shown. 17 of the 737 children tested had a slight to moderate hearing loss and will require periodic testing, and five children were found to have a serious hearing loss. Two of these are to receive a hearing aid and auditory training, and the other three may need this after medical treatment. During the year all the pupils at St. Christopher's school for educationally sub-normal children had at least one audiometric test. Those who could not manage the full test with the pure tone audiometer were given the simpler sweep test. Of the 212 children tested 84 failed, but only 19 of these need cause any concern. It is, however, evident that tests should be made on the hearing of all children whose I.Q, is low. In one case, the hearing loss was so severe that a hearing aid, and auditory training were essential. 12 hearing aids were issued in 1961. Five of these were the National Health Service "Medresco" Aids and the other seven were commercial aids paid for by the Corporation. Commercial Aids are needed if the hearing loss is very severe, or if there is a sharp perceptive loss in the higher frequencies. As there is no automatic volume control on the Medresco Aid, it cannot be tolerated by children with such a loss, as the hearing for low notes is often normal and a general amplification of sound soon becomes painful. 29 All the children recommended for a hearing aid were seen by Mr. Parsons, the Corporation's Consultant Otologist, who has held monthly consultant sessions at the Audiology Clinic throughout the year. At two of these sessions we. were pleased to welcome visitors - Dr. Mary Sheridan from the Ministry of Health and Dr. Huss from the Ministry of Education. Two conferences were attended by Miss Dimond-Hogg during the year; a weekend conference in January at Condover Hall, Shrewsbury on the problems of blind/deaf children, and a five day international course in June on "Paedo-Audiology" at Groningen Dniversity, Holland. In September, an important circular was issued jointly by the Ministry of Health and the Ministry of Education to all Local Health and Education Authorities on "Young Children handicapped by impaired hearing". With this circular was a memorandum outlining the services which should be provided, and also a leaflet giving advice on the use of hearing aids by children. These were distributed to all who were likely to be concerned with the problems of deafness in children, including all Head Teachers. Though there are, of course, still aspects of our audiology service which will be developed, all the suggestions and recommendations of the two Ministries are now being carried out in Croydon. For further statistical details see Appendix G, page 61. 30 EPILEPTIC SCHOOL CHILDREN 32 epileptics were known to School Health Services as at 31.12.61. Of these - 10 were attending Ordinary School 8 were in Day School for Physically Handicapped and Delicate Children 5 were attending our day E.S.N. School 2 were at Lingfield School 3 were at the Occupation Centre 3 were in Residential School 1 was at Private Residential School SPASTICS 68 Croydon Spastics were receiving education as at 31.12.61. 1 child received Home Teaching 37 were attending St. Giles' School 3 were attending St. Margaret's School, Croydon 6 were at Residential Schools for Physically Handicapped children 8 were attending ordinary school 1 was attending St. Luke's School 3 were attending St. Christopher's School 7 were attending Spastic Centre full time. 2 were attending Old Kent Road Day School for Partially Deaf. 31 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1961 as to their fitness to undertake the part-time employment indicated:- 1961 1960 1959 1958 1957 Delivery of Goods for Shopkeepers 33 57 50 43 62 Delivery of Newspapers 303 316 317 394 344 Delivery of Milk 9 1 7 13 15 Shop Assistants 75 69 59 64 53 420 443 433 514 474 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1961 all milk was supplied free of charge and approximately 28,200 children per day received one-third of a pint each in Maintained Schools. This was equal to 67% of children attending in Secondary Schools, and 97% 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 4,680 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 1961 was approximately 20,000. Cost of special Schools The cost of the medical, dental and nursing services was £62,720. Cost of special Schools Schools maintained by the Council £49, 213 Other Schools (not maintained by local Education Authorities) £20,859 Adjustments with other authorities in respect of fecial Schools £ 8,481 £78,553 Cost of Milk and Meals Meals and Milk cost £452,121. Income from payment for meals was £176,403, making a net cost of £275,718, on which grant is Paid of 100 per cent. on approved expenditure. 32 NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in 1961, 303 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, 1961 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) (5) (6) 1857 and later 134 134 100.00 - - 1956 2,906 2,906 100.00 - - 1955 1,356 1,356 100.00 - - 1954 302 302 100.00 - - 1953 1,232 1,231 99.92 1 0.08 1952 1,570 1,578 99.94 1 0.06 1951 706 706 100.00 - - 1950 632 632 100.00 - - 1949 1,458 1,457 99.93 1 0.07 1948 819 818 99.88 1 0.12 1947 925 925 100.00 - - 1946 and earlier 2,116 2,115 99.95 1 0.05 TOTAL 14,165 14,160 99.96 5 0.04 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 vision (excluding squint) For any of the other conditions recorded in Part II Total individual pupils (1) (2) (3) (4) 1957 and later 6 7 13 1956 94 174 260 1955 38 82 119 1954 15 18 32 1953 51 68 116 1952 69 83 147 1951 28 34 61 1950 18 29 45 1949 84 81 162 1948 48 39 86 1947 29 51 76 1946 and earlier 105 57 162 TOTAL 585 723 1,279 TABLE C. - OTHER INSPECTIONS Number of special Inspections 1,406 Number of Re-inspections 1,443 Total 2,849 TABLE D. - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 53,603 (b) Total number of individual pupils found to be infested 380 (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 1961 Defect code No. Defect or Disease Periodic Inspections Entrants Leavers Others Total Treatment Observa tion Treatment Observa tion Treatment Observa tion Treatment Observa tion (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 4 SKIN 7 22 12 8 9 14 28 44 5 EYES - (a) Vision 138 76 266 77 181 92 585 245 (b) Squint 19 10 6 2 9 9 34 21 (c) other 1 6 3 1 5 9 9 16 6 EARS - (a) Hearing 17 74 16 18 24 34 57 126 (b) Otitis Media 2 9 4 9 4 9 10 27 (c) Other 8 4 4 1 6 4 18 9 7 NOSE AND THROAT 68 210 16 27 27 78 111 315 8 SPEECH 24 42 3 3 11 15 38 60 9 LYMPHATIC GLANDS - 16 - 5 1 11 1 32 10 HEART 11 20 4 17 9 19 24 56 11 LUNGS 9 57 6 23 10 42 25 122 12 DEVELOPMENTAL - (a) Hernia 3 6 1 2 4 3 8 11 (b) other 11 53 40 37 10 96 61 186 13 ORTHOPAEDIC - (a) Posture 12 22 42 27 37 33 91 82 (b) Feet 26 54 35 21 29 31 90 106 (c) Other 18 86 23 21 17 44 58 151 14 NERVOUS SYSTEM - (a) Epilepsy - - - 1 1 4 1 5 lb) Other 7 5 1 4 7 12 15 21 15 PSYCHOLOGICAL - (a) Development 4 14 - 1 2 7 6 22 (b) Stability 9 15 2 4 6 12 17 31 16 ABDOMEN 1 2 1 4 1 4 3 10 17 OTHER 19 18 11 23 21 29 51 70 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 1 - 5 EYES - (a)vision 26 1 (b)Squint - - (c)Other 3 - 6 EARS - (a)Hearing - - (b)Otitis Media - - (c)Other - - 7 NOSE AND THROAT 4 - 8 SPEECH 4 - 9 LYMPHATIC GLANDS - 1 10 HEART - - 11 LUNGS 1 2 12 DEVELOPMENTAL - (a)Hernia - - (b)Other 2 4 13 ORTHOPAEDIC - (a)Posture 2 - (b)Feet 1 2 (c)Other 3 1 14 NERVOUS SYSTEM- (a)Epilepsy 2 - (b)Other 1 1 15 PSYCHOLOGICAL - (a)Development 2 - (b)Stability 1 - 16 ABDOMEN 1 - 17 OTHER 8 1 37 PART 3 TABLE A. - EYE DISEASES. DEFECTIVE VISION AND SQUINT External and other, excluding errors of refraction and squint Number of cases known to have been dealt with . Errors of refraction (including squint) 1,786 Total 1,786 Number of pupils for whom spectacles were prescribed 991 TABLE B. • DISEASES AND DEFECTS OF EAR. NOSE AND THROAT Received operative treatment - Number of cases known to have been dealt with (a) for diseases of the ear - (b) for adenoids and chronic tonsillitis 112 (c) for other nose and throat conditions • Received other forms of treatment 64 Total 176 Total number of pupils in schools who are known to have been provided with hearing aids - *(a) in 1961 12 (b) in previous years 46 *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) 259 (b) Pupils treated at school for postural defects 5O Total 309 TABLE D.- DISEASES OF THE SKIN (excluding uncleanliness. for which see Table D. of Part I) Ringworm - Number of cases known to have been treated (a) Scalp . (b) Body - Scabies 8 Impetigo 4 Other skin diseases 24 Total 36 38 TABLE E.- CHILD GUIDANCE TREATMENT Number of pupils treated at child Guidance clinics Number of cases known to have been treated 40 TABLE F.- SPEECH THERAPY Number of pupils treated by Speech Therapists Number of cases known to have been treated 466 TABLE G. - OTHER TREATMENT GIVEN Number of cases known to have been dealt with (a) Pupils with minor ailments 1,867 (b) Pupils who received convalescent treatment under School Health Service arrangements 25 (c) Pupils who received B. C. G. vaccination 3,008 (d) Other than (a), (b) and (c) above. Please specify:- 1. Enuresis 176 2. Audiology 251 Total (a) - (d) 5,327 39 PART 4. - DENTAL INSPECTION AND TREATMENT (1) Number of pupils inspected by the Authority's Dental Officers. (a) At Periodic Inspections 31,824 (b) As Specials 1,511 33,335 (2) Number found to require treatment 17,354 (3) Number offered treatment 14,608 (4) Number actually treated 7,376 (5) Number of attendances made by pupils for treatment including ll(h) 21,806 (6) Half days devoted to: (a) Periodic school inspections 246 (b) Treatment 2,751 2,997 (7) Fillings (a) Permanent Teeth 8,0 16 (b) Temporary Teeth 2,09 1 10, 107 (8) Number of Teeth Filled: (a) Permanent Teeth 7,093 (b) Temporary Teeth 1,819 8,912 (9) Extractions: (a) Permanent Teeth 2,029 (b) Temporary Teeth 4,616 6,645 (10) Administrations of general anaesthetics for extractions 2,754 (11) Orthodontics: (a) Cases commenced during year 248 (b) Cases carried forward from previous year 661 (c) Cases completed during year 189 (d) Cases discontinued during year 108 (e) Pupils treated with appliances 381 (f) Removable appliances fitted 365 (g) Fixed appliances fitted 85 (h) Total attendances 5,203 (12) Number of pupils supplied with artificial teeth 21 (13) other Operations: (a) Permanent Teeth 8,179 (b) Temporary Teeth 9 50 9,129 40 APPENDIX B Table I AVERAGE NUMBERS AND ATTENDANCE IN MAINTAINED PRIMARY, SECONDARY NON-SELECTIVE, SELECTIVE, TECHNICAL AND GRAMMAR SCHOOLS DURING THE YEAR 1961 School Average No. on Registers Average Attendance Average 1961 Attendance % Average 1960 Attendance % COUNCIL PRIMARY Ashburton Junior Mixed 421 387 91.9 91.6 Ashburton Infants 234 203 86.8 85.0 Benson Junior Mixed and Infants 553 511 92.4 92.0 Beulah Junior Boys 258 242 93.7 91.6 Beulah Junior Girls 233 216 92.7 91.8 Beulah Infants 252 220 87.3 84.8 Castle Hill Junior Mixed 634 581 91. 1 91.6 Castle Hill Infants 409 367 89.7 88.9 Cypress Junior Mixed 237 220 92. 8 91.9 Cypress Infants 196 171 87. 2 86.0 Davidson Infants 135 118 87.4 86.6 David Livingstone 143 126 88. 1 86.2 Duppas Junior Mixed 331 303 91. 5 91.0 Ecclesbourne Infants 128 111 86. 7 87.0 Elmwood Junior Boys 246 228 92.7 92.5 Elmwood Junior Girls 255 235 92. 1 91.9 Elmwood Infants 264 230 87. 1 87.1 Fairchildes Junior Mixed 644 590 91. 6 91.6 Fairchildes Infants 376 324 86. 1 86.9 Gilbert Scott Junior Mixed 389 362 93. 1 92.8 Gilbert Scott Infants 271 240 88.6 86.4 Gonville Junior Mixed and Infants 559 511 91.4 88.1 Howard Junior Mixed and Infants 298 268 89.9 92.0 Kensington Avenue Junior Mixed 457 420 91.9 91.8 Kensington Avenue Infants 238 206 86. 5 86.3 Kingsley Junior Mixed 431 394 91.4 90.3 Kingsley Infants 306 255 83.4* 86.1 Monks Orchard Junior Mixed and Infants 368 334 90.8 90.2 Norbury Manor Junior Mixed 365 344 94. 2 93.0 Norbury Manor Infants 221 200 90. 5 85.9 Oval Junior Mixed 347 323 93. 1 90.3 Oval Infants 170 149 87.7 84.9 Portland Infants 98 86 87.7 87.5 Purley Oaks Junior Mixed 274 253 92. 3 91.9 Purley Oaks Infants 172 155 90.0 85.4 Rockmount Junior Mixed 246 230 93.4 91.7 Rockmount Infants 151 135 89.4 85.0 Rowdown Junior 573 524 91. 2 91.1 Rowdown Infants 327 291 89.0 89.1 South Norwood Junior Mixed 467 438 93.8 92.9 South Norwood Infants 255 229 90.0 86.0 St. Peter's Junior Mixed and Infants 248 227 91.5 91.9 Spring Park Junior Mixed 26 2 245 93. 5 93.9 Spring Park Infants 205 183 89. 3 86.5 Sydenham Junior Mixed 270 248 91.9 93.3 Sydenham Infants 145 126 87.0 90. 0 41 School Average No. on Registers Average Attendance Aver age 1961 At tendance % Average 1960 At tendance % Waddon Infants 212 186 87. 7 84. 2 West Thornton Junior Mixed and Infants 264 238 90. 2 89.4 Whitehorse Manor Junior Hixed 335 304 90.8 91.4 Whitehorse Infants 213 192 90. 1 84. 1 Winterbourne Junior Boys 367 346 94. 2 93. 2 Winterbourne Junior Girls 340 320 94. 1 94.0 Winterbourne Infants 366 320 87. 4 87. 1 Wolsey Junior Mixed 478 439 91.8 90.5 Wolsey Infants 305 266 87. 2 86. 6 Woodside Junior Mixed 648 602 92.9 92. 6 Woodside Infants 261 233 90.0 85.9 TOTALS 17,851 16,205 90.7 90.0 council secondary non-selective schools Ashburton Senior Boys 655 617 94.2 94. 2 Ashburton Senior Girls 635 584 92.0 91.6 Davidson Senior Mixed 457 411 90.0 90.0 Ecclesbourne Senior Girls 369 329 89.1 90.1 Fairchildes Senior Boys 600 535 89.1 89.6 Fairchildes Senior Girls 645 567 87.9 88.2 Ingram Senior Boys 550 490 89.0 89.7 Lanfranc Senior Boys 636 565 88.8 88.9 Lanfranc Senior Girls 535 481 89.9 90.5 Norbury Manor Senior Boys 431 397 92.1 92.6 Norbury Manor Senior Girls 535 493 92.1 92.9 Portland Senior Mixed 360 325 90.3 90.1 Tavistock Senior Boys 494 430 87.0 88.3 Tavistock Senior Girls 352 307 87.0 87.3 South Croydon Senior Mixed 695 624 89.8 89.7 Shirley Senior Mixed 537 495 92. 2 92.1 Overbury Senior Mixed 578 497 85. 9 87.5 Westwood Senior Girls 459 414 90.4 90.1 TOTALS 9.523 8.561 89.9 90.2 voluntary secondary non-selectivE St. Andrew's Mixed 233 205 88.0 88.3 Our Lady's Girls 193 171 88.6 87. 2 St. Mary's Mixed 407 383 94.1 93.2 totals 833 759 90.1 90.5 SPecial schools St. Christopher's Educationally Sub-Normal Mixed 208 182 87.5 86.7 St. Giles' Physically Handicapped and Delicate Mixed 196 166 85. 2* 84. 3 St. Lake' s (Partially Sighted) 18 16 88.8 85.7 TOTALS 422 364 86.3 85.5 42 School Average No. on Registers Average At t endance Average 1961 At tendance % Average I960 Attendance % VOLUNTARY PRIMARY All Saints' Mixed and Infants (C. of E) 218 200 91.7 91.6 Good Shepherd (R.C.) Junior Mixed and Infants 318 284 89.3 89.0 Parish Church Junior Mixed and Infants (C. of E.) 365 331 90.7 89.2 St. Joseph's Mixed and Infants (R. C.) 536 480 89.5 89.2 St. Mark's Junior Mixed and Infants (C. of E.) 204 182 89.2 90.0 St. Michael's Infants 96 86 89.6 87.2 St. Mary's (R. C. ) Junior Mixed and Infants 420 382 90.9 90.1 Shirley (St. John's) Junior Mixed and Infants (C. of E.) 272 251 92.3 90.3 TOTALS 2,429 2,196 90.4 89.6 SECONDARY SELECTIVE AND GRAMMAR SCHOOLS Archbishop Tenison's Mixed 318 298 93.6 93.3 Heath Clark Mixed 678 633 93.4 94.5 John Newnham Selective Mixed 507 475 93.6 93.3 Selhurst Boys 954 894 94.0 95.0 Selhurst Girls 558 527 94.1 93.5 John Ruskin Boys 607 568 93.6 93.8 Colomn Girls 542 505 93.2 93.2 Lady Edridge Girls 623 580 93.1 93.7 TOTALS 4,787 4,480 93.6 93.8 TECHNICAL SCHOOLS Stanley Technical School Boys 290 268 92.4 93.2 Croydon Secondary Technical Boys 389 368 94.6 94.0 TOTALS 679 636 93.7 93.6 SUMMARY OP SCHOOL ATTENDANCE FOR THE YEAR 1961 R Council Primary 17,851 16,205 90.7 90.0 Voluntary Primary 2,429 2,196 90.4 89.6 Council Secondary 9,523 8,561 89.9 90. 2 Voluntary Secondary Mixed 833 759 90.1 90.5 Grammar and Selective 4,787 4,480 93.6 93.9 Technical 679 636 9 3.7 93.6 Specials 422 364 86.3 85.5 TOTALS 36,524 33,201 90.9 90.6 Crosfield Nursery 39 32 82.1 76.4 *General Sickness 41 School Average No. on Registers Average Attendance Aver age 1961 At tendance % Average 1960 At tendance % Waddon Infants 212 186 87.7 84.2 West Thornton Junior Mixed and Infants 264 238 90.2 89.4 Whitehorse Manor Junior Mixed 335 304 90.8 91.4 Whitehorse Infants 213 192 90.1 84.1 Winterbourne Junior Boys 367 346 94.2 93.2 Winterbourne Junior Girls 340 320 94.1 94.0 Winterbourne Infants 366 320 87.4 87.1 Wolsey Junior Mixed 478 439 91.8 90.5 Wolsey Infants 305 266 87.2 86.6 Woodside Junior Mixed 648 602 92.9 92.6 Woodside Infants 261 233 90.0 85.9 TOTALS 17,851 16,205 90.7 90.0 COUNCIL SECONDARY NON-SELECTIVE SCHOOLS Ashburton Senior Boys 655 617 94.2 94.2 Ashburton Senior Girls 635 584 92.0 91.6 Davidson Senior Mixed 457 411 90.0 90.0 Bcclesbourne Senior Girls 369 329 89.1 90.1 Fairchildes Senior Boys 600 535 89.1 89.6 Fairchildes Senior Girls 645 567 87.9 88.2 Ingram Senior Boys 550 490 89.0 89.7 Lanfranc Senior Boys 636 565 88.8 88.9 Lanfranc Senior Girls 535 481 89.9 90.5 Norbury Manor Senior Boys 431 397 92.1 92.6 Norbury Manor Senior Girls 535 493 92.1 92.9 Portland Senior Mixed 360 325 90.3 90.1 Tavistock Senior Boys 494 430 87.0 88.3 Tavistock Senior Girls 352 307 87.0 87.3 South Croydon Senior Mixed 695 624 89.8 89.7 Shirley Senior Mixed 537 495 92.2 92.1 Overbury Senior Mixed 578 49 7 85.9 87.5 Westwood Senior Girls 459 414 90.4 90.1 TOTALS 9,523 8.561 89.9 90.2 VOLUNTARY SECONDARY NON-SELECTIVE Andrew's Mixed 233 205 88.0 88. 3 Our Lady's Girls 193 171 88.6 87.2 St. Mary's Mixed 407 383 94.1 93.2 TOTALS 833 759 90.1 90.5 SPECIAL SCHOOLS St. Christopher' Educationally Sub-Normal Mixed 208 182 87.5 86.7 St. Giles' Physically Handicapped and Delicate Mixed 196 166 85. 2* 84. 3 St. Luke's (Partially sighted) 18 16 88.8 85.7 TOTALS 422 364 86.3 85.5 42 School Average No. on Registers Average Attendance Average 1961 At tendance % Average 1960 Attea- dance % VOLUNTARY PRIMARY All saints' Mixed and Infants (C. of E.) 218 200 91.7 91.6 Good Shepherd (R.C.) Junior Mixed and Infants 318 284 89.3 89.0 Parish Church Junior Mixed and Infants (C. of E.) 365 331 90.7 89.2 St. Joseph's Mixed and Infants (R. C.) 536 480 89.5 89.2 St. Mark's Junior Mixed and Infants (C. of E.) 204 182 89.2 90.0 St. Michael's Infants 96 86 89.6 87.2 St. Mary's (R. C.) Junior Mixed and Infants 420 382 90.9 90.1 Shirley (St. John's) Junior Mixed and Infants (C. of E.) 272 251 92.3 90.3 TOTALS 2,429 2,196 90.4 89.6 SECONDARY SELECTIVE AND GRAMMAR SCHOOLS Archbishop Tenison's Mixed 318 298 93.6 93.3 Heath Clark Mixed 678 633 93.4 94.5 John Newnham Selective Mixed 507 475 93.6 93.3 Selhurst Boys 954 89 4 94.0 95.0 Selhurst Girls 558 527 94.1 93.5 John Ruskin Boys 607 568 93.6 93.8 Coloma Girls 542 505 93.2 93.2 Lady Edridge Girls 623 580 93.1 93.1 TOTALS 4,787 4,480 93.6 93.9 TECHNICAL SCHOOLS Stanley Technical School Boys 290 268 92.4 93.2 Croydon Secondary Technical Boys 389 368 94.6 94.0 TOTALS 679 636 93.7 93.6 SUMMARY OF SCHOOL ATTENDANCE FOR THE YEAR 1961 Council Primary 17,851 16,205 90.7 90.0 Voluntary Primary 2,429 2,196 90.4 89.6 Council Secondary 9,523 8,561 89.9 90.2 Voluntary Secondary Mixed 833 756 90.1 90.5 Grammar and Selective 4,787 4,480 93.6 93.9 Technical 679 636 93. 7 93.6 Specials 422 364 86.3 85.5 TOTALS 36,524 33,201 90.9 90.6 Crosfield Nursery 39 32 82.1 76.4 *General Sickness 43 Table II HEIGHTS and weights 1961 Age Number Examined 1961 Average Height in inches Average Weight in lbs. 1961 1960 1959 1958 1939 1961 1960 1959 1958 1939 BOYS 5 rears 1506 43.3 43.1 43.2 43.0 41.8 43. 4 43.2 43.4 43.0 41.5 6" 675 44.7 44.3 44.7 44.1 43.8 45.8 45.4 46.7 45.1 43.4 7" - - 46.7 46.9 48.4 45.3 - 50.2 50.2 54.1 47.9 8" - - 50.4 51.0 50.7 49.5 - 59.1 60.6 60.4 55.5 9" - - 51.5 51.9 51.2 51.2 - 64.2 64.3 63.1 58.8 10" - - 52.0 52.9 53.1 52.7 - 67.7 68.5 69.9 62.9 11" - - 56.5 56.4 56.6 53.7 - 80.5 79.5 81.9 68.7 12" - - 58.2 57.7 57.9 55.7 - 87.2 85.7 86.8 79.9 13" - - 59.7 59.2 59.0 58.4 - 95.1 90.9 88.9 81.6 14" 612 63.9 63.3 63.9 63.4 59.0 114.1 110.1 112.1 112.3 90.8 15" 588 65.0 65.1 65.9 65.2 - 120.6 120.7 120.8 119.7 - 16" 251 67.2 67.7 67.6 67.3 - 133.0 130. 3 133.2 131.9 - 17" 114 68.1 68.0 67.7 67.6 - 138.0 137.0 134.4 133.5 - girls 5 years 1332 42.8 42.6 42.9 42. 7 41.2 42.1 42.0 41.7 42.0 39. 7 6" 647 44.0 43.6 43.9 43.7 42.7 44.8 43.7 44.6 43.7 41.4 7" - - 46.3 46.5 47.2 44.1 - 49.3 49.6 51.8 43.6 8" - - 50.2 50.2 50.0 49.9 - 59.7 59.8 58.8 54.7 9" - - 51.3 51.9 50.9 50.9 - 63.1 64.3 62.3 57.6 10" - - 52.5 52.9 53.2 52.1 - 66.0 68.6 67.4 62.9 11" - - 56.5 57.3 58.8 53.6 - 83.0 84.0 88.1 68.3 12" - - 58.3 58.4 58.2 56.6 - 89.6 89.6 87.2 77.2 13" - - 59.4 59.7 59.4 58.8 - 95.6 94.4 95.6 85.3 14" 293 61.9 62.1 62.5 62.7 60.3 111.5 110.8 110.2 108.4 97. 9 15" 746 62.9 62.7 63.8 63.3 62.0 115.5 117.1 116.5 114.2 105.5 16" 256 64.1 63.7 64.0 63.7 - 122.8 122.1 121.5 119. 5 - 17" 84 64.4 64. 2 64.1 64.7 - 128.1 123.6 125.0 120.7 - 44 Table III CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1961 School 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 218 4 - - - - - - - - - 33 - 2 - - - - - - - - - 39 Arch. Tenison 318 - - - - - - - - - - - - - - - - - - - - - - - Ashburton 19 45 2 - - - - - 22 - - - 22 - . - - - - - 2 - - 3 53 Benson 553 - - - - - - 2 - - - 60 - - - - - - - - - - - 62 Beulah 743 - - - - - - 4 - - - 21 - 2 - - - - - 2 - - - 29 Castle Hill 1043 2 - - 2 - - 8 - - - - - 1 - - - - - 3 - - 2 19 Colom 542 - - - - - - 10 - - - • - . - - - - - - - - - 10 Crossfield Nursury 36 14 - - - - - - - - - 1 - - - - - - - 2 - - - 17 Croydon High 902 - - - - - - - - - - - - - - - - - - - - - - Croydon Tech 389 - - - - - - - - - - 1 - . - - - - - - - - - 1 Cypress 433 4 - - - - - 4 - - - 32 - 2 - - - - - 4 - - - 46 David Livingstone 143 - - - - - 1 - - - - - - - - - - - 4 - - - 5 Davidson 592 24 - - - - - 1 - - - 1 - - - - - - - - - - - 26 Duppas 331 - - - - - - _ - - - - - - - - - - - - - - - Ecclesbourne 497 8 - - - - - - - - - 43 - 1 - - - - - - - - - 52 Elamwood 785 6 - - - - - 2 - - - 1 - 2 9 - - - - 1 - - - 21 Pairchildes 2265 6 - - - - - 13 2 - - 52 - - - - - - - -- - - - 74 Gilbert Scott 660 • - - - - 16 - - - 1 - • - - - - -- 1 - - 3 21 Gonville 559 22 - - - - - 5 - - - 48 - 1 - - - - - - - - 1 77 Good Shepherd 318 - - - - - - - - - - - - - - - - - - - - - - - Heath Clark 678 • - - - - -- - - - - - - 3 - - - - - - - - - 3 Howard 298 34 - - - - - - - - - 21 - 6 - - - - - 1 - - 1 63 Ingram 550 8 - - . - . 9 - - - 16- 1 - - - - 11 - - 1 45 John Newnham 507 - - - - - - - - - - - - - - - - - - - - - - - John Ruskln 607 - - - - - - - - - - - - - - - - - - - - - - - Kensington Avenue 60 5 9 1 - - - - - - - - 45 - - - - - - - - - - - — Kingsley 7 37 30 - - - - - - - - - 39 - - - - - 1 - l - - 2 144 Lady Edridge 623 - - - - - - - - - - — l l ~ _ — 5 — — 2 78 Lanfranc 1171 4 - - - - i 2 - - l - 2 - - - - - — - ~ - 1 10 45 Monks Orchard 368 - - - - - - - - - - - - - - - - - - - - - - - Norbury Manor 1552 10 - - l - - 26 l - - 12 - 4 - - - - - 4 - - 1 59 Occupation Centre 76 _ • • . - 2 - - - - - 1 - - - - - - - - • 3 Old Palace 455 - - - - - 1 - - - - - - - - - - - - - - - 1 Our Lady's Convent 193 - - - . - - - - - - - - - - - - - - - - - - Oval 517 11 - - - - - 2 - 36 - 11 • 1 - - - • - - - - 2 63 Over bury 578 • . . - - • - - - - - - - - - - - - - - - - - Parish church 365 • - - - - - - - - - - - - - - - - - 1 - - 6 7 Portland 458 - - - - - - 2 - - - 22 - 1 - - - - - - - - - 25 Purley Oaks 446 1 - - - - - 1 - 42 - 33 - 1 - - - - - - - - 6 84 Reglna Coell 500 . - . - - - - - - - - - - - - - - - - - - - Rockmount 397 2 - . - . - 2 - - - 7 - 2 - - - - - -• - - - 13 Rowdown 900 1 - . - - - 3 - - - 54 - 1 - - - . - 1 - - - 60 St. Andrew's 233 - - - - - - - - - - - - - - - - - - - - - - • St. Christopher's 208 . - . - - - 8 - - - - - 1 - - - - - - - - - 9 St. Giles' 196 1 - - - - - 28 - - - 9 - 5 - - - - 4 - - 3 50 St. Joseph's 536 - - - - - - 3 - - - 12 - - - - - - - - - - - 15 St. Luke's 18 - - - - - - - - - - 2 - - - - - - - - - - - 2 St. Mark's 204 - - . - - - 1 1 - - 22 - - - - - . - 1 - - 1 26 St. Mary's R. C 827 4 - • - - - 6 - - - 27 - - - - - . - 3 - - - 40 St. Michael's 96 16 - . - - - - - - - 1 - 25 - - - • - - - - -* 42 St. Peter's 248 1 - - - - - 4 - 41 - 29 - 1 20 - - • - - - - 4 102 Selhurst Grammar 1512 3 - - - - - 18 - - - 2 - - - - -- - - - - 3 26 Shirley 7 34 - - - - - - - - - - - - - - - - - - - - - - - South Croydon 695 - - - - - - - - - - - - - - - - - - - - - - - South Norwood 7 22 3 - - - - - 1 - - - 4 - - - - - --- - - - - 8 Spring Park 467 . - . - - - 2 - - - 27 - - - - - . - 2 - - - 31 Stanley Tech. 290 2 - - - - - 2 - - - 1 - - - - - - - - - - - 7 Sydenham 415 5 - - - - - 3 - - - 1 - 1 - - - - - 2 - - - 12 Tavistock 846 2 - . - - - 1 - - - - - - - - - • - 1 - - - 4 Trinity 6 37 - - - - - - - - - - - - - - - - - - - - - - - Waddon 212 - - - - - - 1 - - - 23 - - - - - - - - - - - 24 West Thornton 264 - - - - - - - - - - 13 - 10 - - - - - - - - - 23 Westwood 459 1 - . - - - . - - - . - - - - - -- - - - - 1 Whitehorse Manor 548 4 - . - - - 2 - - - 39 - 17 - - - - - 5 - - - 72 Whitgift 851 • - - - - - - - - - - - - - - - - - - - - - - Winterbourne 1073 3 - . - - - 10 - - - . - - - - - - - 1 - - 2 20 Wolsey 783 . - - - - - - - - - - - - - - - - - - - - - • Woodside 9 09 2 - - 1 - - 13 - - - 53 - - - - - - - 4 - - 2 75 331 - • 6 - - 245 6 120 - 842 - 100 33 • - 1 • 66 • - 50 1800 46 Table IV RETURN OP DEFECTS FOUND IN THE COURSE OF ROUTINE HEDICAL INSPECTION, 1961. Defects Boys Girls No. requiring Treatment No. referred for Observation Percentage of total Examined No. requiring Treatment No. referred for Observation Percen t age of total Examined Uncleanliness- Head ... ... ... ) 1 - 0.01 1 - 0.01 Body ... ... ...) Skin Disease 14 33 0.62 14 11 0. 38 Eye Disease- Defective vision 283 116 5.26 302 129 6.54 Squint 16 8 0.32 18 13 0.47 External Eye Trouble 3 7 0.13 6 9 0. 23 Ear Disease- Deafness 25 63 1.16 32 63 1.44 Otitis Media 6 10 0.21 4 17 0.32 Other Disease 9 3 0.16 9 6 0.23 Nose and Throat 61 155 2.85 50 160 3.19 Enlarged Cervical Glands (not T. B. ) 1 24 0.33 - 8 0.12 Dental Defects 33 - 0.44 31 3 0.52 Speech Defects 29 30 0.78 9 30 0.59 Heart and Circulation 15 24 0.51 9 32 0.62 Lungs 16 76 1.21 9 46 0.84 Developmental- (a) Hernia 7 7 0. 18 1 4 0.08 (b), Other 59 138 2. 60 2 48 0.76 Deformities- Posture 41 30 0.94 50 52 1.55 Flat Feet 57 60 1.54 33 46 1. 20 Others 34 85 1.57 24 66 1.37 Nervous System Disorders- Epilepsy 1 2 0.04 - 3 0.05 Other 10 14 0.32 5 7 0.18 Psychological- (a) Development 3 17 0. 26 3 5 0. 12 (b) stability 12 20 0.42 5 11 0.24 Abdomen 1 4 0.07 2 6 0.12 Other Defects and Diseases 32 29 0. 80 19 41 0.91 TOTALS 769 955 638 8 16 Total Children Examined 7,579 6,586 47 Table V PARENTS PRESENT 1961 5 years and under 6 years 7 years 8 years 9 years 10 years 12 years 12 years 23 years 14 years 15 years 26 years and crvef TOTALS Number Exanined Parents Present Number Examined. Parents Present Number Examinee Parents Present Number Exaninec Parents Present Number Examinee Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Exaninec Parents Present Number Examined Parents Present Number Examined Parents Present Number Examines 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 H F M F ALL Saints 17 14 14 10 14 10 12 7 - 3 - 2 17 19 13 16 9 3 5 3 1 2 1 2 - - - - - - - - - - - - - - - - - - - - - - - - 58 51 45 40 Archbishop Tenison's - - - - - - - - - - - - - - - - - - - - - - - - - - - - 18 14 3 10 11 10 4 8 - - - - - - - - 28 20 - - 57 44 7 18 Ash-burton 41 40 33 .77 29 23 22 19 4 2 3 2 38 42 30 34 18 19 18 9 5 1 4 - 2 1 1 - 81 95 32 45 48 42 19 18 42 9 - - 77 31 1 1 75 4 5 - 460 309 168 165 Benson 77 28 34 29 29 28 34 26 7 2 6 2 45 39 34 30 27 43 22 77 10 15 9 14 2 1 - - - - - - - - - - - - - - - - - - - - - - 157 156 129 139 Benlah 54 49 49 44 8 1 6 1 - 3 - 1 29 60 14 49 16 14 6 12 - 1 - 1 - 4 - 2 - - - - - - - - - - - - - - - - - - - - 107 13? 75 110 Castle Hill 75 66 66 51 51 49 42 40 10 3 9 2 2 - 2 - 49 45 29 31 29 26 21 16 - - - - - - - - - - - - - - - - - - - - - - - - 216 189 189 140 COLOMS - - - - - - - - - - - - - - - - - - - - - - - - - - - - 52 - 8 - 34 - 8 - - - - - - - - - 109 - - - 195 - 16 Crosfield 26 10 26 10 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 26 10 26 10 Croydon Sec. Tech. - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35 - 4 - 20 - 3 - - - - - - - - - 22 - - - 77 - 7 - Cypress 45 38 37 31 25 13 23 12 3 3 2 2 1 2 1 2 23 26 16 15 6 8 3 5 1 1 1 - - - - - - - - - - - - - - - - - - - - - 104 91 83 67 Devid Livingstone 11 21 10 17 - 2 - 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11 24 10 19 Davidson 26 22 22 17 6 17 6 14 1 3 - 1 - 2 - 2 - - - - - - - - 23 40 2 10 11 18 - 1 - - - - 51 39 1 1 23 17 2 - - - - - 138 158 33 46 Duppas - - - - - - - - - - - - - - - - 24 22 8 17 10 13 3 12 - - - - - - - - - - - - - - - - - - - - - - - - 34 35 11 29 Ecclestonme 26 26 25 22 1 4 1 2 - - - - - - - - - - - - - - - - - 23 - 10 - 13 - 3 - - - - - 4 - - - 27 - 4 - - - - 27 97 26 41 Elmwood 61 78 57 68 77 31 33 29 6 2 1 - 2 3 - 3 42 38 20 30 24 19 16 12 172 174 127 144 Fairchilds 80 79 67 70 4 4 4 3 - - - - 42 3 24 0 56 33 34 19 5 1 4 1 - 18 - 12 109 7 27 3 67 - 2D - 3 - - - 102 23 7 1 - - - - 468 168 187 109 albert Scott 69 63 61 50 15 28 14 26 4 1 2 - 1 - 1 - 14 28 10 7 22 19 14 7 1 4 - 2 1 - 1 - - - - - - - - - - - - - - - - - 127 14: 103 92 Gonville 41 30 23 30 6 10 - 2 1 - - - 35 52 13 44 1 2 - - 1 1 1 - 3 1 - - - - - - - - - - - - - - - - - - - - - - 88 96 77 76 Good Shepherd 16 10 13 10 24 17 16 8 4 5 3 5 30 20 14 9 22 22 11 10 12 7 6 3 1 - 1 - - - - - - - - - - - - - - - - - - - - 109 82 64 45 Heath Clark - - - - - - - - - - - - - - - - - - - - - - - - 19 75 4 27 19 14 3 5 2 2 - - 4 2 2 - 29 35 - - 51 30 - - 124 158 9 32 Howard 20 5 14 5 17 3 13 2 3 - 1 - 19 19 13 15 26 23 2D 14 4 5 2 5 - - - - - - - - - - - - - - - - - - - - - - - - 89 58 63 43 Ingran 14 1 9 - 8 3 4 2 - - - - 14 16 10 13 - - - - - - - - 88 - 16 - 53 - 7 - 4 - - - 131 - 4 - 33 - 1 - 1 - - - 346 25 49 15 John Newnham - - - - - - - - - - - - - - - - - - - - - - - - - - - - 17 28 1 5 18 14 2 6 11 - 3 - - - - - 35 26 4 - 81 62 10 11 John Raskin - - - - - - - - - - - - - - - - - - - - - - - - - - - - 69 - 12 - 29 - 4 - 1 - - - 12 - - - 75 - 1 - 186 - 17 - Kensington 45 40 37 32 10 10 8 6 12 44 6 34 32 58 17 42 17 20 11 10 1 8 - 5 1 1 - - - - - - - - - - - - - - - - - - - - - - 118 183 79 132 Kingsley 72 60 59 50 27 33 21 28 3 6 2 5 1 2 1 - 24 24 13 20 30 18 18 15 12 4 6 1 2 3 1 1 - - - - - - - - - - - - - - - - 171 150 121 120 Lady Eridge - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 62 - 14 - 25 - 4 - 1 - 1 - 1 - 1 - 69 - - - 158 - 2D Lanfranc - - - - - - - - - - - - - - - - - - - - - - - - 85 38 10 14 29 86 2 46 - 57 - 39 106 2 2 1 57 124 2 35 - - - - 277 307 16 135 Monks Orchard 20 23 20 21 14 5 12 4 - 1 - 1 28 25 30 25 9 37 - 34 3 5 - - - - - - - - - - - - - - - - - - - - - - - - - - 74 96 52 86 Norbury Manor 45 40 41 31 28 40 22 24 7 10 2 5 5 1 4 - 24 28 12 19 15 15 7 10 46 - 6 - 39 55 11 25 1 26 - 14 81 1 - - 35 117 - 27 - - - - 326 333 105 155 for Lady' b Cburent - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 36 - 6 - 26 - 1 - 7 - - - 17 - 2 - 3 - - - 89 - 9 Oval 29 29 23 25 4 7 3 5 5 3 1 2 33 32 19 16 13 22 10 13 - 1 - 1 1 5 1 - - - - - - - - - - - - - - - - - - - - - 85 99 57 62 Overbury - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40 9 21 2 43 10 7 3 29 56 6 9 12 33 - 5 3 3 - - 136 11 34 19 Parish Church 33 29 23 24 12 17 11 14 4 1 3 - 30 79 21 17 74 ?1 14 14 1 2. - - 1 - - 1 3 - - - - - - - - - - - - - - - - - - - 108 10 77 70 Portlmd 19 20 15 18 2. 1 2 1 - - - - - - - - - - - - - - - - - - - - 26 23 4 7 14 16 2 4 6 33 - - 19 14 3 1 1 1 - - 87 108 26 31 Purley Oaks 38 42 36 30 12 X 10 18 2 _ 1 _ 6 - 4 - 9 8 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 67 7t0 51 53 Regina Coeli 25 31 18 18 4 6 7 5 7 3 1 3 17 74 7 7 22 10 3 3 13 - 5 - 1 - 1 - - - - - - - - - - - - - 2 4 - - - - - - 86 79 38 36 Rock-mount 30 27 28 21 23 35 19 26 3 2 1 2 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 57 64 49 49 Row-down 42 47 34 38 43 34 36 28 2 1 1 - - - - - 48 48 27 38 64 26 41 22 26 - - - - - - - - - - - - - - - - - - - - - - - 226 156 155 126 St. Andrew's - - - - - - - - - - - - - - - - - - - - - - - - - - - - 33 13 5 2 7 11 1 1 17 35 - 2 29 39 2 6 - - - - 86 98 8 11 St Christopher's - - _ - - - - - 1 2 - 2 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13 5 - 2 18 7 - 4 St. John's 17 22 15 19 3 - 3 - - - - - 16 21 11 16 - - - 10 - 9 - - - - - - - - - - - - - - - - - - - - - - - - - 46 43 38 35 St. Joseph's 39 34 34 27 32 18 28 14 1 4 - 2 4 3 3 2 26 25 16 18 3 3 2 1 - - - - - - - - - - - - - - - - - - - - - - - - 105 8* 83 64 St. Luke's 1 - 1 - - 1 - - - - - - 1 - 1 - 1 - 1 - 4 - 1 - 1 - - - - 2 - 2 2 - - - - - - - - 1 - 1 - - - - 10 4 4 3 Continued Overleaf 48 5 years and under 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years and over totals Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Exanined Parents Present Number Examinea Parents Present Number Examined Parents Present Number Examined Parents Present Number Excumned Parents Present Number Examined Parents Present thnrbtr Examined Parents Present m F u F M F M F M F M F M F M F M F H F M F M F H F M F M F M F M F M F M F H F M F H F H F H F M F M St. Mark's 19 16 17 15 8 4 7 4 - 3 - 2 11 14 4 4 17 17 12 7 3 13 - 4 - - - - - - - - - - - - - - - - - - - - - - - - 58 67 40 St. Maiy' s 35 5 32 2 13 10 11 7 5 2 3 - 22 29 14 23 23 21 6 8 11 4 5 3 26 29 3 8 15 12 3 3 20 28 2 9 55 43 21 27 33 21 10 10 1 - - - 246 204 110 St. Michael's 23 22 17 19 3 4 3 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 26 26 20 St. Peter's 18 14 36 12 16 10 12 7 3 2 2 2 12 17 7 12 19 20 4 6 4 12 2 6 - - - - - - - - - - - - - - - - - - - - - - - - 72 75 43 Selhurst Grammar - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 90 - 2 Shirley - - - - - - - - - - - - - - - - - - - - - - - - - - - - 45 44 8 16 31 31 4 7 1 1 - - 37 33 1 1 10 15 - - 124 124 13 South Croydon - - - - - - - - - - - - - - - - - - - - - - - - - - - - 55 45 19 19 61 24 13 4 23 1 3 - 21 40 1 - 13 9 - - 173 119 36 South Norwood 55 36 50 30 10 11 9 8 3 4 2 - 4 - 2 - 38 44 29 33 16 24 11 18 2 5 2 3 1 - - - - - - - - - - - - - - - - - - - 129 124 105 Spring Part 45 33 40 22 6 3 5 2 - 2 - 2 27 13 21 10 24 21 16 16 13 12 7 9 1 116 84 M| Stanley Technical - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 86 - 16 Sydenham 48 29 41 26 15 14 10 10 8 7 7 6 2 23 1 16 9 16 8 9 4 1 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - 87 90 68 Tavistock - - - - - - - - - - - - - - - - - - - - - - - - 2 - 2 - 22 - 4 - 24 - 4 - 4 51 - 12 125 34 4 7 9 1 1 - 186 86 15 Trinity - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9 - - Wadon 26 27 25 21 21 22 17 20 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 49 42 West Thornton 18 6 17 6 9 9 8 9 2 2 1 2 17 11 14 10 23 21 9 20 7 6 4 5 - - - - - - - - - - - - - - - - - - - - - - - - 6 55 5 West wood - - - - - - - - - - - - - - - - - - - - - - - - - 16 - 7 - 42 - 17 - 27 - 7 - 6 - - - 88 - 9 - - - - - 119 - Whitehorse 31 28 23 23 9 5 8 1 1 2 - 1 33 4 23 3 21 - 13 - 30 4 17 3 - - - - - - - - - - - - - - - - - - - - - - - - 25 43 84 Winter-bourne 60 62 55 54 25 38 21 29 3 2 1 1 - 56 - 42 15 32 11 16 17 1 16 - - - - - - - - - - - - - - - - - - - - - - - - - 120 194 104 Winton House 4 - 1 - 14 - 6 - 8 - 6 - 7 - 3 - 9 - - - 2 - - - 1 - - - 8 - 1 - 14 - 9 - 10 - 2 - 7 - 1 - 1 - - - 84 - 2 Wolsey 70 58 64 55 43 58 36 52 35 17 26 15 3 - - - 42 22 23 18 25 24 13 19 - - - - - - - - - - - - - - - - - - - - - - - - 218 119 162 Woodside 57 57 53 53 9 9 6 5 - 1 - - 2 2 1 2 8 12 6 11 2 2 - 2 4 3 1 2 - - - - - - - - - - - - - - - - - - - - 82 87 67 1623 1417 1400 1193 689 667 555 524 153 149 93 104 591 641 368 464 792 787 443 522 407 299 243 232 351 281 72 105 781 677 180 243 436 383 100 133 534 291 44 53 569 699 35 111 453 295 13 2 7579 6586 3546 3040 2593 1356 1079 302 197 1232 832 1579 965 706 445 632 177 1458 423 819 233 925 97 1368 146 748 15 14165 720 PERCENTAGE OF PARENTS PRESENT Age 5 years and under Boys 86. 3) 85.7 Boys 46.8 All Groups 50.9 Girls 84. 2) 6 years Boys 80.6) 79.6 Girls 78. 6) 7 years Boys 60. 8) 65.2 Girls 69.8) 8 years Boys 62. 3) 67.5 Girls 72. 4) 9 years Boys 55. 9) 61. 1 Girls 66. 3) 10 years Boys 59.7) 63.0 Girls 67. 6) 11 years Boys 20. 5) 28.0 Girls 37. 4) 12 years Boys 23. 0) 29.0 I Girls 55.5 Girls 35. 9) 13 years Boys 22.9) 28.3 Girls 34. 7) 14 years Boys 6.9) 10.5 I Girls 18.2) 15 years Boys 5. 2) 10.7 1 Girls 15.9) 16 years and over Boys 2.9) 2.0 / Girls 0.7) 49 Table VI SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1961 (Percentages of Children examined) Defect or Disease Entrants latermediates Leavers Other Ages All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 2.5 2.4 1.7 2.0 1.4 0.9 1.5 2.8 1.8 1.8 Skin 1.3 0.4 1.4 0.8 0.8 0.9 0.8 1.4 1.1 0.8 Eyes- Vision 5.1 6.4 8. 5 8.3 10.5 13.2 7.9 9.7 9.2 9.6 Squint 0.8 1.1 0.8 0.6 0.4 0.3 0.5 0.7 0.6 0.6 Other 0.3 0.2 0.3 1.0 0.7 0.2 0.1 0.5 0.4 0.4 Ears- Hearing 2.2 2.1 1.0 1.7 0.8 0.9 1.9 1.2 1.4 1.5 Otitis Media 0.3 0.3 0.3 0.4 0.1 0.4 0.3 - 0.2 0.3 Other 0.2 0.3 0.3 0.3 0.1 0.1 0.3 0.2 0.2 0.2 Nose and Throat 8.4 7.5 3.9 4.7 0.7 1.5 2.2 2.6 3.9 4.3 Speech 2.0 1.4 1.0 0.8 0.2 0.1 0.7 0.7 1.0 0.7 Cervical Glands 1.2 1.3 1. 5 1.0 0.1 0.1 1.3 1.0 0.9 0.8 Heart and Circulation 1.0 0.6 0. 5 0.6 0.5 0.8 0.5 1.6 0.7 0.8 Lungs 2.0 1.2 2.0 0.9 0.7 0.9 2.0 0.7 1.5 1.0 DevelopmentHernia 0.3 0.2 0.3 0.2 0.1 - 0.1 0.2 0.2 0.1 Other 2.6 0.7 3. 4 0.8 2.3 0.8 6.1 1.6 3.0 0.8 OrthopaedicPosture 0.9 0.8 2.0 1.6 0.7 2.7 1.5 1.9 1.1 1.8 Plat Feet 2.3 2.1 2. 3 1.0 1.6 1.7 3.0 1.9 1.1 1.7 Other 3.5 2.4 2.0 2.2 1.4 1.5 2.5 1.4 2.3 1.9 Nervous DiseasesEpilepsy - - 0.2 0.2 0.1 0.1 - - 0.1 0.1 Other 0.5 0.1 0.8 0.3 0.1 0.3 0.4 0.5 0.4 0.3 PsychologicalDevelopment 0.6 0.3 0. 4 0.3 0.1 - 1.3 - 0.4 0.2 Stability 0.7 0.6 0.7 0.3 0.1 0.1 0.4 - 0.5 0.3 Dull and Backward 0.1 0.1 0.1 - - 0.2 - 0.2 0.1 0.1 Abdomen 0.1 0.1 0.1 0.1 0.1 0.1 0.1 1.2 0.1 0.2 Other Defects 1.2 1.0 2.0 1.0 0.7 1.4 1.5 1.7 1.2 1.2 s Table VII HANDICAPPED PlIPILS 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, 1961 number of handicapped pupils- (1) Blind (3) Deaf (S) Physically Handicapped (7) Haladjusted (9) Epileptic TOTAL (2) Partially sight ed (4) Partially deaf (6) Delicate (8) Educationally sub-normal (10) Speech defects (D-(IO) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) A. Nunber of handicapped pupils newly assessed as needing special educational treatment at special schools or in boarding homes. 1 3 4 4 16 25 12 32 1 1 99 B. (i) of the children Included at A, number newly placed in special schools (other than hospital special schools) or boarding homes. - 3 3 3 12 18 4 25 1 - 69 (ii) of the children assessed prior to 1st January, 1961, number newly placed in special schools (other than hospital special schools) or boarding homes. 1 1 2 4 10 8 5 1 32 TOTAL B(i) and B(ii) - 4 4 5 16 28 12 30 1 1 101 C. (1) Number requiring places in special schools - TOTAL (a) day - - 1 - 1 2 - • - - 4 (b) boarding 1 - - 1 1 1 9 1 - 1 15 (11) Number Included at (i) who had not reached the age of 5 and were awaiting (a) day places - - 1 - - - - - - • l (b) boarding places - - - - - - - - - - - oi (iil) Number Included at (i) who had reached the age of 5, but whose parents had refused consent to their admission to a special school, were awaiting - (a) day places - - - _ - - - - - - - (b) boarding places - - - - - - - - - - - D. (i) Number on the registers of (1) maintained special schools as- (a) day pupils - 16 10 10 98 81 - 190 - - 405 (b) boarding pupils - 1 - - - 1 1 2 - - 5 (2) non-maintained special schools as- (a) day pupils - - - - 3 - - - - - 3 (b) boarding pupils - - 1 8 4 7 3 3 4 2 32 TOTAL - 17 11 18 105 89 4 195 4 2 445 (11) Number on the registers of Independent schools under arrangements made by the Authority - - 3 - 2 - 12 - - - 19 TOTAL (D(i) and D(ii) - 17 14 18 107 89 16 197 4 2 464 (iii) Number boarded in homes and not already Included under (1) and (ii) above - - - - - - 2 - - - 2 TOTAL (D(i).(li) and (iii) - 17 14 18 107 89 18 197 4 2 466 (continued overleaf) cn to During the calendar year ended 31st December, 1961 number of handicapped pupils - (1) Blind (3) Deaf (5) Physically Handi- (7) Mai- adjusted (9) Epileptic TOTAL (2) Partially sighted (4) Partially deaf (6) Delicate (8) Educationally sub-aormal (10) Speech defects (1) - (10) (iJ (2) (3) (4) (S) (6; (7) (8) (9) (10) (11) E. were being educated under arrangements aade under Section 56 of the Education Act, 1944. (1) in hospitals - - - - - 18 - - - - 18 (ii) in other groups (e.g. units for spastica, convalescent hones) - - - - - - - - - - - (iii)at hone - - - - 5 - - - - - 5 PART IV CHILDREN POUND UNSUITABLE FOR EDUCATION AT SCHOOL During the calendar year ended 31st December, 1961 - (!) Number of children who were the subject of new decisions recorded under Section 57(4) of the Education Act, 1944- 12 (11) Number of decisions which were cancelled under Section 57A(2) of the Education Act, 1944- Nil U1 CO Table VIII VISION TESTS Summary of Findings Up to 6/24ths Entrants Intermediates Leavers Other Ages TOTAL Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % 97 4.2 111 5.3 107 7.0 109 6.9 237 8. 1 241 10. 3 44 5.8 44 7. 6 485 6.4 505 7.7 Over 6/24ths 21 0.9 22 1.5 24 1.6 22 1.4 75 2.5 69 2.9 16 2.1 12 2.1 136 1.8 125 1.9 54 Table IX DENTAL DEFECTS (1) Inspected by Dental Officers:- 1961 1960 Aged 5 - 6 2,001 1, 569 6 - 7 2,889 2,471 7 - 8 2,575 2,660 8 - 9 2,823 2, 359 9 - 10 2,812 2,514 10 - 11 2,922 2,570 11 - 12 2, 987 2,222 12 - 13 2, 800 2, 322 13 - 14 2,858 2, 451 14 - 15 3,200 2, 133 15 - 16 2,330 1, 257 16 1,627 828 Total 31,824 25, 356 Specials 1,511 1,956 33, 335 27,312 (2) Number found to require treatment 17, 354 15, 533 (3) Number referred for treatment 14, 608 13,708 (4) Number actually treated 7,376 9,773 (5) Attendances made by children for treatment 21,806 23, 367 (6) Half-days devoted to: Inspection 246 211 Treatment 2,751 2,868 2,997 3,079 Number of Gas Sessions 273 272 Administrative Sessions 149 141 Orthodontic Sessions 404 390 (7) Fillings Permanent Teeth 8.016 8,722 Temporary Teeth 2.091 2,016 10,107 10,738 55 (8) Teeth Filled- Permanent Teeth 7,093 8,069 Temporary Teeth 1,819 1,940 8,912 10,009 (9) Extractions- Permanent Teeth 2,029 2, 211 Temporary Teeth 4,616 4,961 6,645 7, 172 (10) Administrations of general anaesthetics for extractions 2,754 3,037 Administrations of local anaesthetics for extractions 635 1,264 (11) Other OperationsPermanent Teeth 8, 179 8,978 Temporary Teeth 950 9, 129 843 9,821 Attendances per session 7.9 8.1 56 Table X SPEECH DEFECTS CLINIC SUMMARY Total number of cases treated 466 Cases discharged 183 Cases still attending 283 Cases referred for physical treatment 17 Cases referred for residential treatment 3 Cases referred to Child Guidance 1 Cases seen by Neurologist 21 Stammerers 87 Sigmatism 77 Cleft Palate 6 Hyper Rhinogsjonia, including Supra-bulbar palsy 7 Dyslalla 229 Undeveloped Speech 30 Developmental Aphasia, including Dysprapia and Dysarthria and allied learning difficulties 26 Partially Deaf 3 Dysphonia 1 St. Christopher's School is included in the above summary. In addition 18 children were treated at St. Giles' School. 57 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1961 RETURN OF MEDICAL INSPECTIONS A. –Routine Medical Inspections Year 1961 Year 1960 Age 11 or under 39 13 12 73 58 13 34 46 14 20 32 15 51 10 16 52 — 17 23 8 18 or over 11 3 Total. 303 170 B. Other Inspections Number of Special Inspections — — Number of Re-inspections 2 — Total 2 — Visits to Non-maintained Schools 12 10 The following defects were found by Medical Inspection:— Treatment Observation Skin 1 — Defective Vision 28 1 Other eye defects 3 — Nose and Throat 1 — Heart and Circulation 1 — Development Other 1 — Orthopaedia Other 1 — Nervous System Other 2 — Other Defects and Diseases 2 — Posture 2 — 58 APPENDIX D RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1961 WHO HAVE UNDERGONE TONSILLECTOMY Year of Birth Boys Per Cent Girls Per Cent Boys and Girls Per Cent 1957 and later 1 1.3 1 1.7 2 1. 5 All Boys 1359 17.9% 1956 64 4.1 55 4.0 119 4.1 1955 50 7.3 30 4.5 80 5.9 1954 16 1.0 4 2.7 20 6.6 1953 85 14.4 83 12.9 168 13.6 1952 130 16.4 118 14.0 248 15.6 1951 88 21.6 39 13.0 127 18.0 1950 95 27.1 51 18.1 146 23.1 All Girls 851 12. 9% 1949 214 27.4 145 21.4 359 24.6 1948 113 25.9 92 24.0 205 25.0 1947 175 27.6 56 19. 3 231 25.0 1946 and earlier 328 29. 2 177 17.8 505 23.9 All Groups Boys and Girls 2210 - 15.6% CHIEF CAUSES OF EXCLUSION FROM SCHOOL Condition Exclusions during 1961 Percentage of total exclusions Exclusions during 1960 Percentage of total exclusion Ringworm 1 0.06 1 0.09 Verminous Conditions – - 27 2.45 Impetigo 6 0.33 13 1.18 Scabies - - 3 0.27 Scarlet Fever 66 3.66 224 20.35 Measles (inc. German) 1,087 60.69 12 1.09 Diphtheria - - - - Whooping Cough 50 2.78 65 5.90 Chicken Pox 331 18.39 311 28.25 Mumps 100 5.56 381 34.65 External Eye Disease - - - – Poliomyelitis - - - - Dysentery 6 0.33 56 5.08 Jaundice – - - - Enteric Group - - - – Meningococcal Infection - - 4 0.36 Other causes 153 8.50 4 0.36 1,800 1,101 59 APPENDIX E TREATMENT The Work of the School Clinics. SUMMARY OF ATTENDANCES 1961 1960 Increase or decrease Minor Ailments and verruca Clinics 6,989 6,553 + 436 Inspection Clinic 1,127 1,180 - 53 Dental Clinics 21,806 23,367 - 1,561 Remedial Exercises Clinic 6,485 6,819 - 334 Enuresis Clinic 717 743 - 26 Audiology Clinic 251 300 - 49 37,375 38,962 - 1,587 MINOR AILMENTS CLINICS Clinic Defects Attendances Lodge Road 346 2,984 Ashburton School 412 903 Duppas School 463 1,535 Rockmount School 536 948 Addington 202 619 Complaint 1961 1960 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of At tendances per case Ringworm – – – 1 1 1.0 Scabies _ – _ – – – Impetigo 4 18 4.5 13 30 2.3 Other skin Diseases 24 50 2.1 28 57 2.0 Otorrhoea and other Ear Defects 64 100 1.6 42 66 1.6 External Eye Disease 80 174 2.2 124 190 1.5 Miscellaneous (including Verruca) 1,787 6,647 3.7 1,349 3,540 2.6 1,959 6,989 3.6 1,557 3,884 2.5 60 APPENDIX F SPINAL AND OTHER REMEDIAL CLINICS (LODGE ROAD) 1961 1960 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 1,761 420 4.2 2,313 546 4.2 Flat Feet 2,542* 479 5.3 2,647 493 5.4 Breathing 390 195 2.0 424 115 3.7 4,693 1,094 5,384 1,154 *62 treated by Faradism. 179 individual cases were treated and 515 examinations were made by a doctor. SPINAL AND OTHER REMEDIAL CLINICS (NEW ADDINGTON) 1961 1960 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 562 46 12.2 464 42 11.0 Flat Feet 906 92 9.8 739 84 8.8 Breathing 324 46 7.0 232 42 5.5 1,792 184 1,435 168 125 individual cases were treated. WORK OF SCHOOL NURSES School Visits Visits to School Departments re Cleanliness 3 Visits re Scabies or Ringworm 1 Visits re Infectious Disease 8 Visits re Medical Inspections 662 Visits re Medical Preparations 578 All other reasons 537 Home Visits Concerning defects found at routine medical inspections 578 Subsequent visits re defects found at routine medical inspections 169 Visits re special cases 1.086 Visits other than infectious cases 2,037 Visits in connection with infectious cases 262 APPENDIX G DEAF AND PARTIALLY DEAF CHILDREN OF SCHOOL AGE December 31st, 1961 Numbers attending Special schools or Units: (a) Day Schools: Old Kent Road 11 Oak Lodge 6 Holman Hunt 2 (b) Residential Schools: Ovingdean 9 Hamilton Lodge 2 Mill Hall, Cuckfield 1 Margate 1 Mary Hare Grammar 1 Burwood Park Technical 1 Rudolph Steiner (Aberdeenshire) 1 John Horniman (for speech defects) 1 Total 36 (21 of these 36 children are of secondary school age). Numbers attending Croydon Day Schools: (a) with hearing sufficiently impaired to require regular auditory training: Primary School Pupils 45 Secondary school Pupils 51 Total 96 (b) with hearing loss not severe enough to require regular auditory training, but who need to be tested regularly: Primary School Pupils 127 Secondary School Pupils 18 Total 145 Total Number of Croydon School children with impaired hearing of all grades of severity: Children of Primary school age 187 Children of Secondary School age 90 Total 277 61 62 Pure Tone Audiometer Tests: Number of individual children tested during the year: (a) For first time 329 (b) As a review case 167 Total 493 Auditory Training: 96 individual children receiving regular auditory training during the year. Number of attendance sessions: (a) At Lodge Road Audiology Clinic 361 (b) At home or school 147 Total 508 Sweep Testing of five year old school entrants. (Commenced September 1961) Number of schools visited 20 Number of children tested 737 Number of children passed 641 Number of children failed 96 Number of children not tested (absent or unco-operative) 62 The 96 failures were followed up:- No hearing loss 23 Negligible hearing loss 16 Slight to moderate hearing loss 17 Serious hearing loss 5 Absent or failed to keep appointment 34 Left district 1 Total 96 Issue of Hearing Aids (a) National Health Service "Medresco" Aids 7 (b) Commercial Aids bought by Croydon L. E. A. 5 12 Supplied in previous years 52 Total 64 2 of the children using hearing aids are under school age. 63 APPENDIX H COMMUNITY HEALTH or YOUR LIFE IN YOUR HANDS Syllabus for secondary School Children (Age 14+ years) One weekly period for 14 weeks - One hour Lesson l. Diseases of Yesterday Why they are not seen today. Environmental sanitation - Public Health Services. Visual Aids - Large pictures from School History Department. Lesson 2. Nuisance Diseases of today Cause, effect and prevention. Effects of absenteeism on work, society, economy. The common cold - Bronchitis. (Effects of irritants such as dust, atmospheric fumes and smoking). Flannelgraph from Health Education Section, Croydon. Film "how to Catch a Cold. " Colour - Runs 10 mins. Free from:- Kimberley-clark Ltd., 27, Hill Street, Berkeley Square, London, W. 1. Lesson 3. Nuisance Diseases of today Snail pox and Poliomyelitis Discussion on attitudes (Vaccination) to these procedures and Diphtheria (Immunisation) reasons for co-operating with national campaigns. 1. Film (Snallpox)"surprise Attack" black and white, 1 reel, runs 11 mins. 5/- per day. Central Film Library. 2. Film "The Fight against Disease" black and white. Runs 8 mins. Free except for carriage. I.C.I. Film Library. Imperial Chemical House, Millbank, S. W. 1. 3. Flannelgraph "Defence Against Invasion" Public Health Department, Croydon. 4. Flannelgraph "Chains of Infection" From the Central Council for Health Education. 64 Lesson 4. Nuisance Diseases of today Tuberculosis - The importance of co-operation in its prevention Effects of smoking Filmstrip "Prevention of Tuberculosis" Colour. £2. 12.6d. From Camera Talks, 21, Denmark Place, London, W.C. 2. Lesson 5. Nuisance Diseases of today Dental Caries Effects of tobacco staining on teeth Film "lets Keep our Teeth" Colour. Runs 20 mins. Free. From Unilever. Posters General Dental Council, 37, Wimpole Street, W.1. Lesson 6. Nuisance Diseases of today Food Poisoning Smoking Poliomyelitis Film "Room for Hygiene" - Colour - Runs 16 mins. Free - Unilever Filmstrip "Food Poisoning" Colour. 33 frames. From Central Council for Health Education. Flannelgraphs "Vicious Circle" and "Chains of Infection" - Both from Central Council for Health Education. Lesson 7. Port Health Service World Health Organisation International Red Cross Photographs for epidiascope or other pictures. Film "yours in Good Health" Black and White. Free. From National Union of Teachers, Hamilton House, Mabledon Place, London, W.C.1. Lesson 8. Hospital Services and Personal Health Services Film "Your Very Good Health" Colour. Runs 9 mins. 1 reel. (Cartoon). 10/- per day. From Central Film Library. Filmstrip "Medical Officer of Health" (Health Education and preventable disease, e.g. lung cancer, bronchitis) Black and White. Educational Productions Ltd., 17, Denbigh Street, S.W.1. 65 Lesson 9. Feeding the Inner Man Pood, nutrition and health. Effects of smoking Flannelgraph "Nutrition and Pood Hygiene" From Central Council for Health Education. Milk Pasteur (isation) Film "The Milky way" Black and White. Runs 40 mins. (too long for classroom use) Free. From United Dairies. or Film "The Daily Round" Colour. Runs 20 mins. Free. From T.W. Evans, Director, Sales Development, Express Dairy Co. Ltd., Tavistock Place, London, W.C.1 Lesson 10. Work, Health, (Personal Hygiene); Leisure (two or Flannelgraph "Personal Health" from Central Council more for Health Education (unattractive effects of smoking) lessons) Filmstrips (1) "Look Your Best" Colour. 31 frames. Free. Loan - Talkiestrips Ltd. 7, Exchange Courts, Strand, W.C.2. or (2) "Care of Your Feet" Colour. 31 frames. £2.12.6d. Camera Talks, 23, Denmark Place, W.C.2. or (3) "If the Shoe Pits" Black and White 51 frames. 12/6d. National Film Board of Canada, Colquhoun House, Broadwick Street, W.1. Film "Your Skin" Colour. 20 mins. Free. Unilever. or Girls Only Film "Growing Girls" Runs 13 mins. Free hire. Sound Service Ltd., Wilton Crescent, S. W.19. Film "The Best of Yourself" Colour. 18 mins. Free. Unilever. (Unattractive effects of smoking). Lesson 11 Family Relationships and 12. Use of Leisure. (two or Sound Filmstrips - 5 mins. more lessons) (a) "Mother may I go out tonight?" (b) "For Better or Worse" Smoking as a status symbol (c) "A Mother's Place" and budgeting are included in these discussions and the facts about venereal disease. 66 From Central Council for Health Education. Hire 15/- per week or part week. For sale 35/- to subscribers; 50/- to non-subscribers. or (d) Filmstrip "How to Behave at Work "(Smoking dangers in certain occupations) Black and White. 37 frames 16/6d. Educational Supply Association Ltd. 181, High Holborn, W.C.1 Lesson 13. Cancer - General Description - The Problem of Lung Cancer - To Smoke or Not to Smoke 16 Coloured drawings 20" x 30" - Health Education Film "Time Pulls the Trigger" Section. Croydon. £2.2. 0d. (Hire) - Colour - 24 mins. New Gallery Evangelistic Centre, 123, Regent Street. Filmstrip "The Problem of Lung Cancer" 34 frames - Colour - £2.12. 6d. Camera Talks, 23, Denmark Place, W.C.Z Flannelgraph "smoking and Lung Cancer" Central council for Health Education £2.0.0d. Lesson 14. A Chapter of Accidents (Fires caused by cigarette ends) Film and Talk given by the Fire service. or Illustrated Talk on Home Safety. Some other Topics or Projects 1. History of Medicine or) Hippocrates, Pasteur, Lister, Koch, Pioneers in Medicine. Jenner, Fleming, Florence Nightingale 2. Dress in different countries. 3. Dress in different ages. 4. Housing through the ages. 5. Towns through the ages. 6. Personal cleanliness through the ages. 7. Care of the sick through the ages. 8. Superstitions. 9. the Industrial Revolution. 10. The History of X-rays. CONTENTS A. - PUBLIC HEALTH REPORT Page Pag• Ambulance service 49,112 Immunisation 40,117 Amusement Houses 63 Infant Mortality 11. 14.94.95.96 Animals, Diseases of 66 Infant Welfare Clinics 102 Animals, Keeping of 66 InQuests 13 Ante-Natal Clinics 33 Births 12 Laboratory Examinations, Blindness 88 Various 32,72,73,84 Byelaws 81 Cancer 15.92 Marriages 12 Care of Mothers and Young Maternal Mortality14,94 Children 33 Maternity Homes 85 Census 11' Meat Inspection 67 Chemical Analyses84 Men's Hostel 59 Chest Clinic, Work of 23 Mental Health 51 Child Minders 7 Midwifery 34,97- 100 Chiropody 56 Midwives Acts 35 Civil Defence 50 Milk Supply 71 Clean Air Act 63 Convalescence 40 Committee, Health 3 National Assistance Act 88 Communicable Diseases 17,19,115-116 Neo-Natal Deaths 11,95 Cremation 85 Notification of Births Acts 12 Nuisances 81 Day Nurseries 56 Nursing Equipment, Loan of 106 Deafness 56,111 Nursing Homes 85 Deaths 11,13, 14,90,91,9 2 Nurses' Agencies 85 Dental Treatment (M.& C.W.) 46,109 Disinfection 64 Disinfestation 65 Offensive Trades 62 Drainage 62 Outworkers 60-61 Epileptics 88 Perinatal Deaths 11,95 Elderly Persons. Pests 66 Rehabilitation of 104-105 Physiotherapy 105 Pharmacy and Poisons Act 65 Factories and workshops 59-61 Polimyelitis 118 Food and Drugs Act 67 Population 11 Food Poisoning 18 Post-Natal Clinics 33 Food Supply 67 Post-Mortems 13 Premature Infants 33,100 Problem Families 108 Health Education 42 Prosecutions 68 Health visitors, work of 36,101 Public Health Inspectors, Home Helps 41,107 Work of 57,80-82 Home Nursing 40,103 Public Health Laboratory Home Safety 38, 110 service 32 Hospital. Isolation 19 Housing 58 Rag Flock Act 65 Ice Cream - Bacteriological Rats & Mice (Destructlon)Act 65 Examination of 72 Rivers and Streams Illegitimacy 11,33 Pollution of 62 Page Scarlet Fever 19,21 Unmarried Mothers 33 Shops Act 61 Staff Medical Examinations 86 Vaccination 117,118 Staff 9 Verminous Persons 64 Still Births 11,13 Venereal Diseases 32, 124, 125-127 Street Accidents 112 Vital Statistics 11, 89,90,91 Tuberculous. After Care 30 ward Statistics 15,93 „Allowances 30 water Supply 83 „ Contacts 27 welfare poods 35 „ Home Nursing 27 „ Home Visits 27 „ Mass Radiography 29 „ Mortality 26,119-120 „ Notifications 121, 122 Occupational „ Therapy 31 x-Ray 28 Residential „ Treatment 26 „ Prevention and Control 23 Re-Housing 28 Vaccination 28 Training centres 53-54,55 Zymotic Diseases 19 B.-SCHOOL MEDICAL REPORT Page Paqe Child Guidance 24 Milk, etc., Provision of 31 Cleansing of Children 10 Cod Liver Oil 4,31 Non-maintained Schools 32.57 Cost 31 Orthodontic Service 17 Deaf Children 28,61 Deaths 11 Parents' Attendances 47,48 Defects Pound 35,46,49 Population 12 Dental Service 12,39 Remedial Exercises 60 Ear Disease 59,37 Enuresis Clinic 27 Epileptic Children 30 School Nurses Visits 11 Exclusions 11,44,58 Schools Special, cost of 31 Spastics 30 Handicapped Pupils 50,51,52 speech 26, 56 Health Visitors, work of 11,60 staff 4 Heights and Weights 10.43 Statutory Table 33 sub-normal children 23 St. Christopher's 20 Infectious Diseases 44 St. Giles' 18 St. Luke' 22 Juvenile Employment 31 Tonsillectomy 58 Tuberculosis 11 Malt 31 Meals, Provision of 31 uncleanllness 10 Mentally Defective' Children 23 Vision, Defective 10,53