C 44132 CRO 64 PUBLIC HEALTH IN CROYDON 1962 PUBLIC HEALTH IN CROYDON 1962 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1962 S.L. WRIGHT. M.D., M.R.C.P.. D.P.H. PUBLIC HEALTH DEPARTMENT. 45 WELLESLEY ROAD, CROYDON. Telephone:- CROYDON 4433 3 HEALTH COMMITTEE 1962 Councillor Keith Edwards Councillor Mrs. M. C. V. Parfitt (Chairman) Councillor B.H. Rawling Councillor Mrs. E.M. Maycock Councillor Mrs. B. Saunders (Vice-Chairman) Councillor B.C. Sparrowe Alderman Mrs. V.L. Child Councillor H.E. Styles Alderman a.V. Dammarell Councillor R. E. Thorpe Councillor P. Byrne Councillor J. T. Twitchett Councillor j.j. Cooper J. P. J.S. Lane, Esq., B. A. ,M. R. C. S., Councillor E.J. Fowler L.R.C.P. Councillor Mrs. D.L. George J.J. Linehan, Esq., M. D. D.P.H. Councillor G. Levy Miss K. C. Vost, M. B., B. S., D. P.H. Councillor M.E. Mackenzie T. G.E. White, Esq., M.D. Councillor Mrs. A. M. Massie M.R.C. 0. G. Members appointed to Sub-Committees on nomination of Outside Bodies as shown:- G. Clementson Esq. M. B., B. S. Edith P. Newling, B. A. (Hons), M. B., B. S., Croydon Local M. R. C. S. ,L. R. C.P. Medical Comnittee d.P. Kanaar, Esq., M. D., M. R. C. P. A.P. Clift, Esq., P.R.c.S., M.R.C.0.G. Croydon Group Hospital S.Y. Marsters, Esq. Management Committee Mrs. E.M. Ryle Horwood Royal College of Nursing Mrs. P.R. Mitchell, 0.B.E. Royal College of Midwives Miss J.c. Dickinson Croydon District Nursing Association Mrs. G.c. Browning Croydon Family Planning Association Mrs. j. Toogood Croydon Federation of Tomnswomen 's Guilds E.B. Hajnley, 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 5 COUNTY BOROUGH OF CROYDON annual report of the medical officer of health and principal school medical officer for the year 1962 To the Chairman and Members of the Health Committee LADIES AND GENTLEMEN The first circular issued by the Ministry of Health in 1963 to all local authorities begins:- "I am directed by the Minister of Health to refer to Regulation 5(3) and Regulation 15(5) of the Public Health Officers Regulations, 1959, under which the Medical Officer of Health is required as soon as practicable after the 31st December in each year to make a report for that year to the Council, with copies to the Minister, dealing with the sanitary circumstances, sanitary administration and vital statistics of the area and any other matters upon which he may consider it desirable to report. I am to ask that the Council will give directions for the preparation as soon as possible of the Annual Report of the Medical Officer of Health for the year 1962." In short this is a statutory report which must be written, fortunately for local authority members satiated by a surfeit of official documents, it is not compulsory reading. 6 Originally these reports were intended to ensure that backward Councils were not able to suppress proofs of their deficiences. I think most Medical Officers of Health now find this annual exercise a painful reminder of fleeting time, too short for the completion of many projects which Members have authorised. By requiring surveys from the heads of various sections of the department, which are credited by name, the yearly stocktaking can be made to stimulate all staff. What was intended as a check on elected members, has become instead, an instrument to speed the administrative machine. Statistics The Registrar General estimates an increase of 1,220 on the population shown by the census of 1961. The Birth rate continued to rise. One explanation of this trend was the tendency to marriage at earlier ages. The increase would thus be a passing phase. It is of interest that the Croydon Superintendent Registrar reports a slight fall in the percentage of those giving notice of intention to marry, who were under 21 years of age. The comment that the contemporary status symbol is not the second motor car but the larger family, may touch upon the truth. Unfortunately there is a disquieting aspect of the figures. The number of illegitimate births rose by nearly 20% in comparison with 1961, and made up 23% of the total increase in births for the year. The infant mortality rate, especially for these illegitimate babies, was higher, as was the general death rate, but there was not a single death of a woman in childbirth. Lung cancer deaths were more numerous than in any previous year. Communicable Diseases Deaths from Pulmonary Tuberculosis fell to a record low number of 12. When one reflects that this disease was "Captain of the Men of Death" for the age groups 15 to 45 years, it is a remarkable transformation. No case of Poliomyelitis was notifiedCases of syphilis in Croydon residents attending for treatment at special clinics rose slightly, but numbers for other venereal diseases were smaller. Rubella (German Measles) was unusually prevalent, and caused concern when expectant mothers were involved. The surveillance of contacts of Smallpox made demands upon the staff during the early months of the year. 7 Personal Health Services The chief feature of the year was the submission of schemes to the Ministry of Health, covering the next 10 years in the development of community care. The increase in births put heavy strains on the maternity services, especially the hospitals. As in previous years the situation was contained by co-operation between hospitals and the local authority which ensured definite arrangements for every mother. Early discharge from hospitals for home care by specially appointed domiciliary midwives is not a good system, but gave essential relief for overbooked local maternity units. Infant Welfare Centre figures show a rise in the numbers first attending, but a fall in total attendances. Some of the rented halls used for this purpose unquestionably deter mothers. Building programmes are unfortunately subject to delays for a variety of reasons, so that even Clinic buildings approved or being constructed are disappointingly slow in becoming available. In 1954 a booklet explaining the functions of Health Visitors was sent to all family doctors, with an invitation to contact the department whenever such services might be helpful. Health Visitors are urged to approach the family doctor of a family they are visiting whenever this seems appropriate. Alternatively a note is sent to the family doctor on a printed form explaining why the Health Visitor has called and what she has found. It has not been possible to allocate Health Visitors to particular medical practitioners. Mental Health Services are developing as planned, and there was considerable success in recruitment of essential staff. Vaccination and Immunisation programmes were disrupted because cases of smallpox in this country caused heavy demands at the beginning of the year. Changing advice about timing of procedures, and doubts about the safety of oral vaccine, were added troubles. Protection rates for the two important diseases of childhood, diphtheria and poliomyelitis, suffered setbacks. Clean Air Steady progress continued in this vital programme to make all Croydon a Smoke control area. Housing There were more applications for rehousing on medical grounds, reflecting continued suspension of the ordinary "points" list. 8 Co-ordination Co-operation with other branches of the health service was close and cordial; a situation essential if efficient and economical facilities are to be provided for the area for which we have a common duty. It is not achieved without effort and might not be possible without the unifying force of all three sections giving service to roughly identical populations. It is not the tripartite separation of the health service which is insurmountable, but disparate areas. When at least Hospital Management Committee, Executive Council, and local health authority boundaries more or less co-incide, feasible working arrangements can be fashioned. My thanks are due to the staff of my department, and to other Chief Officers and their staffs, for much help during a busy year. The local press gave great assistance on several occasions, by publishing factual information on behalf of the department, which could not otherwise be brought readily to public notice. Finally as always, enthusiasm and support have been the constant attitudes of the Committee, and of the Council, for which I am most grateful. 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(lncluding 1 part tine), 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, 10 Clerks, 2 Typists, 4 Trainees. Maternity and Child Welfare 6 Clinic Medical Officers whole time (also school duties), 5 part time, Superintendent Health Visitor, Deputy, 29 health Visitors and 2 Specialist Health Visitors (also School Nurses), 4 Nurse Assistants, 1 part time Almoner and 1 part time Almoner's Clerk, Superintendent Midwife, Deputy and 20 Midwives, 3 Maternity Nurses (part time), 1 Physiotherapist (also school duties), 5 Ante-Natal Clinic Nurses (part time, 8 Clerks, (Dental Service as for School Health), 8 Clinic Cleaners and 2 Handymen (all part time). District Nursing Superintendent, 3 Assistants, 45 Nurses, (agency arrangements) (1 part time), 6 Students, 2 Clerks ( 1 part time). Domestic Help Supervisor, 4 Assistants, 2 Clerks, 15 full time and 184 part time Home Helps. Day Nurseries 1 Nursery with Matron, Deputy, Warden, 4 Nurses, 4 Students, Handyman and 4 Domestic Staff (part time). Vaccination and 3 clerical Officers including 1 part Immunisation time. Ambulance Service Ambulance Officer, Deputy, Second Officer, Third Officer, Maintenance Officer, 4 Leading Drivers, 72 Drivers,2 Mechanics, 4 Clerks, 1 Telephone Operator, 1 C. D. Training Officer, 1 Depot Labourer, 1 Cleaner (part time). prevention, care Chest Physician (part time), 2 Assistant and After-Care Chest Physicians (part time), 4 T. B. Visitors, 1 part time Almoner, 2 Clerks 1 Occupational Therapist (part time). Mental Health 1 senior Mental Welfare Officer, 2 Psychiatric Social Workers, 4 Mental Welfare Officers, 1 Planning and Senior Clerical Officer, 1 Social Welfare officer, 2 Welfare Assistants, 3 Clerks 1 Junior Training Centre Supervisor, 6 Assistants, 1 Handyman, 3 Guides and 8 Domestics (part time). 1 Senior Instructor Adult Training Centre, 3 Instructors, 2 Domestics (1 part time), 2 Day Centre Domestics (lpart time). Health Education J Qualified Health Education Officer, 1 Qualified Assistant Health Education Officer, 1 Clerk. welfare Poods 2 Clerks (lpart time) and 1 Storekeeper. Mortuary Superintendent, Attendant and 1 part time cleaner. STATISTICS 11 SUMMARY OF VITAL STATISTICS FOR 1962 Area, 12,672 acres. Population (Census 1961), 252,501 Total population (estimate of Registrar-General), 253,690 (Midsummer, 1962 ) Number of Inhabited Houses: 76, 424 Rateable Value of Borough (1st April,) 1962. £5,184,042 Product of a Penny Rate (1961-1962): £21,039.0s. Id. Rate in the £. 19s.0d. (for the year ending 31 3.62. Live Births: Males Females Total Legitimate 2,135 1,950 4,085 Illegitimate 172 183 355 4, 440 Illegitimate Live Births per cent of total births 8.0 Live Birth Rate(as adjusted by comparability factor 0.99) 17.3 (England and Wales) 18. 0 Stillbirths 65 Stillbirth rate per 1,000 total(live and still) births 14.4 (England and Wales) 18. 1 Total Births 4,505 Infant Deaths 75 Infant Mortality rate per 1, 000 live births 16. 9 (England and Wales) 21. 4 Infant Mortality rate per 1,000 legitimate births 17 Infant Mortality rate per 1,000 illegitimate births 20 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 14.2 (England and Wales) 15.1 Early Neo-natal Mortality rate (First week) per 1,000 total live births 12.8 Perinatal Mortality rate (stillbirths + deaths during the first week)per 1,000 total live and still births 24.9 Maternal Deaths (excluding abortion) Nil Maternal Mortality rate (including abortion) per 1,000 total live and still births ... Nil (England and Wales) 0. 35 Deaths, 3,179. Death-rate per 1, 000 of the estimated population 12.5 (England and Wales) 11.9 Death rate (as adjusted by comparability factor 0.94) 11.8 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%, and falling slightly to 20.28% in 1962". The number of marriages solemnised was 1,987, compared with 2,041 in 1961, 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 and 1,993 in 1952. 837 were solemnised in Established Churches, 475 in other places of worship, none by Jewish Ritual and 675 in the Register Office. Births The live births registered were 4,085 legitimate and 355 illegitimate. The birth-rate consequently was 17.3 per 1,000 population. For England and Wales the rate was 18.0 The illegitimate births in Croydon were 8.0 per cent. of the total as compared with 7.1 per cent. in 1961, 7.2 in 1960, 7.3 in 1959, 5 per cent. in 1958, 5.5 in 1957 and 4.3 in 1956. The live male births numbered 2, 307, the female 2,133, being a proportion of 1,081 males to 1,000 females. Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,244 32 3,276 Doctors 1,372 31 1,403 4, 616 63 4,679 Accommodation for Confinements The following table shows where babies were born in Croydon during 1962. The same number of babies was born at home and 79 more were born in hospital than in 1961. Just one less in the number of residents had babies outside Croydon and 77 fewer nonresidents were confined in Croydon than in 1961. Number Percentage In Private Houses 1,438 30.73 In Public Institutions 3,045 65.08 In Registered Maternity Homes 196 4.19 Total 4,679 13 Still Births During 1962, 65 still births were registered in respect of Croydon. Of these, 31 were male babies and 34 females; 7 females and 4 males were illegitimate. The proportion of still births to living children was 1 in 68. The still birth rate was 1.3 per cent. of the total births. The still birth rate, on the sane basis as for infant Mortality, was 14.6 per 1,000 births. Deaths The deaths numbered 3,179, compared with 3,089 in 1961. For 1962 the crude death-rate was 12.5 compared with 12.2 in 1961. The death-rate for England and Wales was 11.9 There were 95 inquests held by Coroners in respect of Croydon residents during 1962 and 442 findings by Coroners after post. mortem without inquest. Wards with the highest death-rate were South (18.7), Central (15.9), Addiscombe (14.4) and Whitehorse Manor (14.4). Lowest: Addington (3.7) Shirley (8.4) and East (10.8). The Register General's Table is given in the Appendix, page 94, Comparisons with 1961 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 12 (21 in 1961;) those from Cancer increased by 14, those from Pneumonia increased by 19 and an increase of 55 was recorded in those caused hy Bronchitis. There were 13 deaths from Influenza (17 in 1961). 32 deaths from suicide showing an increase of 3 and motor vehicle accidents totalled 34 ( 27 in 1961). The percentage of deaths under 1 year of age to the total deaths was 2.4 per cent.; deaths under 1-14 years, 0.4 per cent.; deaths tinder 15 - 64 years, 23.1 per cent.; and deaths over 65 years, 74.1 per cent. The corresponding figures for 1961 were 2.0 per cent., 0.8 per cent.; 24.2 per cent., and 78.0 per cent. respectively. The Registrar-General has continued to supply a comparability factor - 0.94 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) All Ages Rate per 1,000 Population Deaths from diseases of Cardiac and Circulatory system 6.44 Deaths from Cancer (all forms) 2.48 Deaths from Vascular lesions of the Nervous System 2.04 Deaths from diseases of the Respiratory System (excluding Tuberculosis) 1.76 Deaths from Cancer of Lung 0.69 Deaths from Suicide and Violent Causes 0.39 Deaths from diseases of Digestive System *0.17 Deaths from Tuberculosis (all forms) 0.06 *ulcers of stomach, duodenum; gastritis and enteritis. Maternal Mortality There were no deaths, compared with 1 in 1961. The maternal mortality rate calculated per 1,000 total births was nil. The rate for England and Wales was 0. 35 in 1962. For figures for the years 1952 - 1962 see the Appendix, page 98. Infant Mortality The 1962 figure was 16.9. Set out in the Appendix, page 100 are the usual tables giving causes and age distribution. The greatest single factor remains prematurity of which the correction lies mainly with ante-natal care of the expectant mother. Among the 75 deaths, 47 occurred in boy babies and 28 in girls. Of the births, 2,307 were males and 2,133 females. The infantile mortality rate for the two sexes was, therefore, Boys - 20. Girls 13. 72 deaths of infants occurred in Institutions, including Registered Nursing Homes. For details of infant deaths see Appendix, page 99. 15 CANCER For detailed tables see the Appendix, page 96. Deaths tabulated in the Department number 628 as compared with 614 in 1961; 585 in 1960; 623 in 1959; 562 in 1958; 591 in 1957; 592 in 1956 ; 549 in 1955; 486 in 1954; 540 in 1953 and 567 in 1952. Death-rate per 1,000 of the population for the last 10 years is as follows:- 1953 - 2. 16 ( 540) 19 58 - 2. 25 ( 562) 1954 - 1. 95 (486) 19 59 - 2. 50 ( 6 23) 1955 - 2.20 ( 549) 1960 - 2.34 ( 585) 1956 - 2. 37 ( 592) 1961 - 2.43 (614) 1957 - 2.37 ( 591) 196 2 - 2.48 (628) He organs most often attacked in descending order of incidence are:- In the males - the Lungs (43.9 per cent.), the Stomach (13.3 per cent.) and the Bowels and Rectum (8.0 per cent.); In females - the Breast (23.2 per cent.); Bowels and Rectum (14.9 per cent.); and the Lungs (10.4 per cent.). Ward Statistics These are tabulated in the usual form in the Appendix, page 97. COMMUNICABLE DISEASES 17 COMMUNICABLE DISEASES Rubella (German Measles) was remarkably prevalent. It is not notifiable but records of absences from schools due to this illness showed that the outbreak ran from March to July with a peak in June. Dr. Linehan comments on some complications which required treatment in hospital. Because rubella in an expectant mother during the first 3 months of pregnancy may harm the unborn child, spread of rubella to the adult population occasioned concern. Passive immunity can be given by an injection of blood extract, and family doctors made heavy demands on stocks of this material. Some mothers who sustained a definite attack during the first trimester had the pregnancy terminated. Health Visitors were asked to pay particular attention to babies born during late 1962 and early 1963 to ensure the early detection of congenital deafness. Diphtheria - Dr. Linehan comments on a case of possible diphtheria. The child had some faucial exudate and a preliminary swab result was doubtfully positive. Subsequent examinations of the culture failed to show any organisms of diphtheria. No contacts were found carrying organisms nor did any secondary cases arise. The diagnosis of diphtheria was finally rejected. Pood Poisoning - There were fewer notifications than in 1961. Of a party of 40 people from Croydon who attended a wedding reception in London, 6 were subsequently found to be infected with a food poisoning germ (S. bredeney). The source was traced by the Public Health Laboratory Service to ham used to prepare one of the foods served at the reception. 18 FOOD POISONING The food poisoning notifications, as corrected, for 1962 were:- 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total 12 6 5 15 38 Outbreaks due to identified agents:- Total Outbreaks Total Cases 2 9 Outbreaks due to:- (a) Chemical Poisons Nil (d) botulinum ... Nil (b) Salmonella Organisms 1 (e) welchii Nil (c) Staphylococci (including (f) Other Bacteria Nil toiin) 1 Outbreaks of undiscovered cause:- Total Outbreaks Total Cases Nil Nil Single Cases:- Agent identified Unknown Cause Total 21 17 38 Cases due to:- Salm. enteritides Salm. typhi-murium Salm. Stanley 1 7 1 Salm. oranienburg Salm. give Salm. bredeney 1 1 7 19 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1962 J.J. Linehan, Esq., M. D., D. P. H. Physician Superintendent, Waddon Hospital Admissions to the Infectious Diseases' Wards:- A total of 483 patients were admitted to the infectious diseases' wards, giving an average bed occupancy of 26. 83 and an average stay in hospital of 20.06 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. Gastro-enteritls 107 (68) Thrush 1 Rubella 50 (47) Otitis Media 4 (3) Dysentery 45 (29) Tracheitis 1 (0) Pneumonia 38 (31) Gastritis 1 Chicken-Pox 32 (21) Appendicitis 2 scarlet Fever 27 ( 24) Ulcerative Colitis 3(2) Measles 13 (7) Ulcerative Ileitis 1 Infective Hepatitis 12 (7) Osteomyelitis 1 Salmonella Infections 7 (6) Cervical Lymphadenitis 5(3) Influenza 10 (9) Gas Gangrene 1 Glandular Fever 8 (5) Cellulitis 1 Meningitis 6 (5) Vulvitis1 Mumps 4 (3) Puerperal Infection 1 (0) Whooping Cough 3 Pyelitis 1 Diphtheria 1 Impetigo 7 Herpes Zoster 2 Scabies 6 vaccinia 2 Eczema 2(1) Roseola Infantum 1 (0) Stephen Johnson Syndrome 2 Streptococcal Sore Throat 1 (0) Exfoliative Dermatitis 1 Erythema Infectiosum 1 Exfoliative Dermatitis 1 Typhoid Fever 1 Erythema Multiforme 1 Paratyphoid B 1 Ace 1 Typhoid Contacts 5 Papular Urticaria 1 Rubella Contacts 2 Epilepsy 1 Small-pox Contact 1 (1) Infective Polyneuritis 2 (1) Dysentery Contact 1 Psychosis 1 (0) Staphylococcal Infection 5 Subarachnoid Haemorrhage 1 Bronchitis 11 Cerebral Thrombosis 1 Phyaryngitis 10 Brain Tumour 1 Tonsillitis 7 (9) Carcinoma of the Larynx 1 (0) Quinsy 2 (8) My ocardiac Degeneration 1 Laryngitis Stridulosa 3 (5) Heart Block 1 Stomatitis 3 (1) Diabetes 1 Anaemia 1 Non-patient Baby 1 (0) Nil abnormal Detected 1 20 Gastro-enteritis:-107 cases were admitted in the following age groups:- Under one year-52; 1-3 years-26; 4-15 years18; Adults-15. 13 were gravely ill, 62 moderately severe and 32 mild. Recognised pathogens were isolated as follows:E. Coli 0. Il-12 cases; E. Cbli 0. 128 - 7 cases; E. Coli 0.55 -3 cases; E. Coli 0.26-1 case; Staph. Aureus-1 case. Associated illnesses were present as follows:- Rhinitis-9 ceses; Bronchitis-8 cases; Anaemia-5 cases; Tonsillitis-3 cases; and one case each nf Pneumonia, otitis media, stomatitis, conjunctivitis, dermatitis, eczema, coeliac disease and congestive heart failure. No fatalities occurred. Rubella: - Rubella was the only infectious disease which showed an unusually high incidence of complications and admissions. The period of high prevalence was from April to July inclusive during which 44 of the total of 50 admissions occurred. The following complications were encountered:- Encephalitis-3 cases; Gastro-enteritis-2 cases; Thrombocytopenic Meningitis -1 case; Tonsillitis-4 cases; Purpura-1 case; Neuritis-1 case; Pneumonia-1 case; Convulsions-1 case; Lobar Collapse -1 case; Admissions for residential reasons were made in respect of 12 nurses, 3 patients from Children's Homes, 3 from hostels and 2 from remand homes. Rubella patients in hospital because of other illnesses were as follows:- tonsillectomy-2, fractures-2 and one case each hernia, hydrocele, eczema, diabetes, carcinoma and head injury. Dysenteiy:-42 cases were of the Sonne type, 2 of the flexner and one shiga. Only 7 patients were admitted free from their own homes, the remainder coming from hospitals, hostels, hotels, nurseries and residential schools. 15 patients were admitted in November due to an outbreak at a local nursery but otherwise there was no particular seasonal incidence. 28 patients were in the 0-5 year age group, 9 were 5-15 years and 8 adults. Co-existing illnesses were:- upper respiratory infections 13, measles and rubella 3 each, 2 cases of tonsillitis and one case of diabetes, myocardiac degeneration, appendicitis, impetigo and dental abscess. The one patient suffering from shiga dysentery was severely ill. He was a B.O. A. C. employee and would have appeared to have contracted the infection in Karachi. Only one patient left hospital while still infectious (onemonth after admission) Drug resistant strains were encountered as follows:- Sulphonamide resistant - K; Chloramphenicol resistant -2; Tetracycline resistant-10, Neomycin resistant-1: Streptomycin resistant-10. 21 PneuDonia:-31 of the 38 patients were admitted in the months of January, February, March and December. 23 of the patients were over 60 years, 8 patients between 15 and 60, 2 between 5 and 15 and 5 under 5 years. The great majority had some underlying or co-existing illness. They occurred as follows:-Chronic Bronchitis and emphysema - 11, myocardiac degeneration-7, cardiac failure-4, valvular heart disease-2, Hypertension-2 and one case each of lobar collapse, mitral stenosis, pulmonary oedema, asthma, arterio-sclerosis, mental confusion, glaucoma, prostatic obstruction, gastro-enteritis and arthritis. Chicken-Pox:-A high proportion of chicken.pox admissions were due to complicating or co-existing illnesses, the majority being transferred from other hospitals. These illnesses were as follows:- Measles-2, convulsions-2 and one case each of Pneumonia, tonsillitis, bronchitis, otitis media, skin sepsis, tonsillectomy, epistaxis, diabetes, urticaria, appendicectomy, osteomyelitis, encephalopathy, fracture and Perthes disease. Scarlet Fever:- All patients were children, 18 being of school age and 9 under school age. Of the total of 27 cases, 14 occurred in January and March. Complications were present as follows:2 cases each of otitis media and secondary sore throat, and one case each of tonsillitis, rhinitis, bronchitis, paronychia, and herpes simplex. Measles:- the disease was not epidemic and most of the few cases admitted were in the last quarter. The only complications were pneumonia-2 cases and one case each of epistaxis and laryngitis. Glandular Fever:- This illness was confined to patients between the ages of 10 and 25 years. One glandular fever patient developed abacterial Meningo-encephalitis due presumably to the glandular fever virus. Infective Hepatitis:- The 12 cases admitted were aged from 12 to ® years. Complications were relapse in the severity of jaundice 2. epistaxis-1 and petechiae-1. The two severest cases were Siven a course of prednisolene which appeared to help. Two Patients were in hospital for more than two months. 22 Salmonella Infections:- Admissions were confined to five children and two adults. There were two cases each of S. typhi-murium and S. infantis and one each of S. Bredeney, S. give, and S. Stanley. All infections appeared to occur independently. Drug resistances shown were streptomycin-5 cases, tetracycline-4 cases and one case each in respect of sulphonamide, colamycin and chloramphenicol. Two cases were still carriers on discharge from hospital. Meningo-encephalitis:- Some cases have already been described in connection with the foregoing infections. The full list is as follows:- Rubella Meningo-encephalitis-2; Chicken-poi Meningo-encephalitis-1; Glandular Fever Meningo-encephalitis1; Mumps Meningo-encephalitis-1; E. C.H. 0. Virus type 6-1. In addition, there were three cases of benign lymphocytic Meningitis and one of pyogenic meningitis in which the nature of the infecting organism could not be ascertained. Other Infections:- The Typhoid patient, 61 years, suffered from chronic ill-health arising from myocardiac degeneration, ulcerated legs and cerebral thrombosis. These conditions obscured any symptoms that might be due to the typhoid infection. No recent possible source of infection was known and the patient may have been only a carrier. The Diphtheria patient, a boy 6 years, after a throat swab was reported positive for K.L.B. was admitted with the appearance of mild faucial diphtheria. He later showed tenderness of the heels presumably due to neuritis. There were no associated cases. for detailed figures see appendices, pages 120, 121. 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 1962 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1962 was 14 which shows a decrease of 7 when compared with 1961. The number of new cases of tuberculosis diagnosed during the year shows a decrease compared with 1961. Whilst this may be considered to be satisfactory it would be quite wrong to acquire a complacent attitude. It is only hy persistent and well organized case finding methods that this disease can be eradicated. At the present time good progress is being made, and this progress should encourage us to redouble our efforts in dealing with this eminently treatable disease. 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 4, 553 Number of patients recalled for examination and large film 687 Number of active cases of Pulmonary Tuberculosis 31 Number of cases of lung cancer found 34 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 7.0 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 105 cases of Respiratory Tuberculosis and 11 cases of NonRespiratory Tuberculosis were notified on Form A during 1962 (Table I-Formal Notifications). Of these 77 males and 28 females were Respiratory cases and 5 males and 6 females were Non-Respiratory. In addition 80 Respiratory cases and 4 NonRespiratory cases came to our notice as new cases otherwise than hy 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 1962 by notification or otherwise was 200 as compared with 286 in 1961, 218 in 1960, 264 in 1950 and 280 in 1958. 185 of these were cases of Respiratory Tuberculosis; 117 in males and 68 in females. There were 35 fewer males and 48 fewer females than 1961. There were no cases of Non-Respiratory Tuberculosis among children under 15 years as compared with one in 1961. The number of cases in adults was 15 compared with 16 in 1961. Of the cases notified in 1962, one male and no females died from the Respiratory form of the disease during the year, equal to .95 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 0.79 per 1,000 of the population; for Respiratory Tuberculosis 0.73 and for Non-Respiratory 0.06 per 1,000 population. The notification rate was 0.46 per 1,000. In 1961 the corresponding figures were 1.13, 1.06, 0.07 and 0.75 per 1,000 Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1962:- RESPIRATORY NON-RESPIRATORY Total Cases Males Females Total Males Females Total 1, 049 765 1,814 57 79 136 1,950 25 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1962, 100 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) 63 or 63.0 B, or T. B. plus, 1 (early cases, sputum positive) 6 or 6.0 B, or T. B. plus, 2 (intermediate cases, sputum positive) 29 or 29.0 B, or T.B. plus, 3 (advanced cases, sputum positive) 2 or 2.0 100 100.0% Non-Respiratory Tuberculosis There were 9 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints 3 Abdominal 1 Other Organs 2 Peripheral Glands 3 9 Ages at Death from Respiratory Tuberculosis year 0-5 5-15 IS-25 25-45 45-65 over 65 TOTAL 1952 - - - 10 22 30 52 1953 1 - - 5 11 14 31 1954 - -- 1 6 15 0 28 1955 - - _ 6 18 9 33 1956 - - _ 2 11 12 25 1951 - - - 6 10 13 29 1958 - - - 1 12 6 19 1959 - - 1 2 9 12 24 1960 - . _ 3 6 9 18 1961 - - _ 2 5 14 21 1962 - - 1 1 6 4 12 26 All but 3 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 1962 the death-rate from all forms of Tuberculosis was 0.06 per 1,000 population. The rate from Respiratory Tuberculosis was 0. 05 and the rate for Non-Respiratory Tuberculosis 0.01. Similar figures for 1961 were 0.08 and 0.00. In 1962 the total number of deaths showed a decrease of seven when compared with 1961. 80% of the deaths occurred in the age groups 45 years and over. There were no deaths in children of school age. Deaths from Non-Respiratory Tuberculosis During 1962 two deaths were certified to be due to Non-Respiratory Tuberculosis, compared with nil in 1961, 2 in 1960, 1 in 1959 and 1 in 1958. Co-ordination with the Health Department During the year 11 children were referred by the School Medical Service, and 2 cases from the Maternity and Child Welfare Section of the Public Health Department. Extra Nourishment Provision of special nourishment in the form of milk was granted to 28 selected cases for varying periods during the year and 23 cases were in receipt of extra nourishment at the end of the year. Residential Treatment 271 men, 214 women and 10 children were admitted to Residential Institutions in Croydon during 1962. 27 The Chest Clinic and Home Visiting 1,930 new cases were examined during the year. 109 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 17, 637. The Clinic doctors paid 135 home visits and the Tuberculosis Visitors 3,228 visits for Clinic purposes. In addition the Tuberculosis Visitors made 267 primary visits for the purposes of the Notification Register. There were also 1, 490 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 1962, 717 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contactcase ratio of 6 for each notified case during the year. Of these contacts, 15 were found to be tuberculous. This is equal to a Tuberculosis rate per 1, 000 contacts of 20 compared with 0.79 per 1,000 of the general population. In addition, there were 2 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: - 1961-New contacts examined 742. New cases of Tuberculosis 190 1960 - „ „ „ 676 „ „ „ „ 139 1959- „ „ „ 775 „ „ „ „ 148 1958-„ „ „ 748 „ „ „ „ 161 1957- „ „ „ 709 „ „ „ „ 168 28 B. C. G. Vaccination The use of B. C. G. vaccination for contacts has been continued during 1962 and regular sessions are held at the Clinic for this purpose. 387 contacts were successfully vaccinated during the year, compared with 426 in 1961. In addition 41 nurses and domestics were successfully vaccinated, and 49 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 Physycian, 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, 266 Number found to be negative-2,857 Number vaccinated with B. C. G.-2, 854 Rehousing of Tuberculosis Patients 10 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 313 examinations were carried out in 1962 For detailed figures see Appendices, pages 124-128. 29 MASS RADIOGRAPHY During 1962 the only public session was a 3 day period at he Community Centre in New Addington. The following figures kindly supplied by the Medical Director of the Surrey Area of the South-west Metropolitan Regional Hospital Board Mass Radiography Service include all attendances at public and private sessions: - No. of Persons Examined Tuberculosis Requiring Treatment or close clinic supervision Primary Carcinoma of Lung Male 7.602 20 4 Female 4,976 3 - Total 12. 578 2 4 New Addington General Practitioner Chest X-Ray Service No. of Persons Examined Tuberculosis Requiring Treatment or close clinic supervision Primary Carcinoma of Lang Male 261 3 1 Female 232 2 - Total 493 5 1 30 AFTER-CARE OF THE TUBERCULOUS PATIENT The tuberculous patient often has fears and doubts as well as practical problems. Help and encouragement are needed not only immediately following diagnosis but also in the months ahead. The increase in unemployment generally in the year 1962 has made it more difficult for the tuberculous patient to find alternative work should a change of job be necessary. The unskilled worker requiring a light job seems to present the chief problem. Patients are advised about registration as a Disabled Person and the Disablement Resettlement Officer, co-operating with the Chest Clinic, gives all help possible to them in finding work. Constant encouragement is needed by the patient during unemployment. In the majority of cases a grant from the National Assistance Board is made in addition to unemployment benefit. If a patient has given up his job in order to undergo treatment for tuberculosis a special National Assistance rate is paid both during sickness and unemployment. The patient is always very glad to have advice about these grants. The voluntary Care Committee once again has given great support by making grants for special needs which are not covered by statutory help. They also have given food vouchers at Christmas to over 50 tuberculous patients and a coal grant to about 60 patients. During the summer, through Care Committee finances, several couples were sent on holiday to Bognor whilst help was given to other patients to enable them to have a holiday with relatives or friends. If a mother of a family has to come into hospital it may be there is no one to look after the children. This is the time when the Children's Department is contacted and, if no other arrangements can be made, it will mean a foster home or nursery for the children. The mother naturally wants to be with the children again at the earliest opportunity, and the Home Help Service often gives invaluable help on the Mother's discharge from hospital to make this possible. The Home Help Service also arranges temporary help for other tuberculous patients on dis charge from hospital and indefinite help to certain chronic cases. The weather of 1962 with its long drawn out winter, pour summer and November smog has not made it an easy year for the tuberculous patient and it has been especially difficult for the elderly, chronically ill person. The importance of after-care has been very apparent. 31 OCCUPATIONAL THERAPY 1962 was a busy, but most rewarding year for the Occupational Therapy Department of the Chest Clinic. The patients continued to enjoy producing large quantities of much improved cane work articles, and at one point the demand for these goods was greater than the output. In the case of some of the other patients a big effort was made to break away from the continuous production of lampshades and some other articles for which it is becoming difficult to find a market. This has proved to be a slow process, as the very thought of change causes the chronic patients acute despair. Most of the patients visited are still very keen to be kept busy and are most grateful for the help they are given. There were more than the usual number of new patients on the Occupational Therapy Register in the latter months of 1962, creating something of a problem from the visiting view point. However, these patients are all so enthusiastic and full of new ideas that it was a pleasure to reshuffle and fit them all in. The Sale of Work held at Queen's Hospital in November was again a great success, and will probably become an annual event. 32 VENEREAL DISEASES the usual figures are given in Appendices pages 130 - 132 There were more cases of syphilis but fewer of other conditions. It will be remembered that there was a time lag before the number of syphilis cases began to increase, thus following the pattern of gonorrhoea. One would hope that this time lag may now be maintaining the increase in syphilis, and that the future will show a fall In both infections. PUBLIC HEALTH LABORATORY SERVICE Very considerable use has been made of the facilities for bacteriological and other laboratory examinations of Public Health nature. I take this opportunity to thank Dr. A. J. H. Tomlinson, the Director of the Bacteriological Laboratory, County Hall, S.E.I, for his ready assistance and most helpful advice, which have been available at all times. The following figures show the work carried out during the year under review. Samples submitted to the Pathological Laboratory for Bacteriological Examination - 1962 Faeces outfits 624 Drinking Water samples 271 Public Swimming Bath Water samples 77 Private Swimming Bath Water samples 100 Private Wells 33 Milk samples 193 Cream samples 10 Ice Cream samples 209 Sundry Pood Specimens 18 Blood 35 Urine 49 Nose and Throat Swabs 11 Total 1,630 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 1962, reflecting the increase in the birth-rate. At ante-natal clinics a total of 4, 886 mothers attended during the year, 3,329 for the first time. 26,960 attendances were recorded. At the post-natal clinic, 1,815 mothers attended for the first time and made a total of 1,823 visits. At relaxation classes 752 mothers made 4,521 attendances. 483 mothers attended 24 Mother craft courses; each of 7 lectures. Care of Premature Babies. There were 33 more premature babies born than in 1961, and 18 more died. All those born at home were alive at the end of one month. Arrangements were made with the Children's Department of Mayday Hospital for the supervision of premature babies after discharge from Hospital. Estimations of haemoglobin are now made at Infant Welfare Clinics, if the mother prefers to visit a local centre, instead of returning to hospital. They are referred back should a reading of less than 60% be found at the Clinic. For detailed figures see Appendix, page 105. 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:- 219 cases were dealt with by the Social Workers 71 cases were admitted to Mother and Baby Homes 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 when they applied for help were: - 14 years old-5 15 „ „ - 15 16 „ „ - 7 17 „ „ - 10 18 „ „ - 8 Total - 45 During 1962 the ages of the younger mothers when their babies were born were:- Age 14 4 „ 15 14 „ 16 9 „ 17 10 „ 18 8 Total 45 Of these babies 2 died. 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 maternity nursing. Part-time midwives have been recruited for these duties, and provide relief assistance at other periods to the domiciliary midwives. Increase in the establishment of municipal midwives was authorised to allow more generous off-duty periods and fewer nights "on call". It was possible, but difficult to recruit staff to fill vacancies. For detailed figures see Appendices, pages 101-104 35 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 of babies under 1 year of age increased. Opportunities for general health education of mothers were still further developed. We nave 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. The number of special toddler sessions was increased. For other detailed figures see Appendix, page 107 Welfare Foods It has always been the policy in Croydon to distribute at the Infant Welfare Centres only National Dried Milk and Vitamin preparations, and there has never been any question of mothers being attracted to the Centres because a large variety of proprietory supplies are available at special prices. In Croydon the final distribution of National Dried Milk and Vitamin preparations to the mothers concerned is performed almost entirely by Voluntary Workers. The central office in Park Street which is open for 5& 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. Rebuilding of Park Street interrupted considerably the functioning of the W. V. S. office. Steps to rehouse them in St. Michael's Road were made. Total issues of Welfare Poods during 1962:- National Dried Milk 61663 Cod Liver Oil 5580 Vitamin A and D Tablets 8645 Orange Juice 61610 36 THE WORK OF THE HEALTH VISITOR Miss L. E. Oakley, S.R.N., S. C. M., H. V. Cert. Superintendent Health Visitor 1962 was the Centenary year of Health Visiting. In 1862 the Ladies Sanitary Reform Association of Manchester and Salford appointed paid visiting staff 'to visit all and sundry in their district, concentrating on cleanliness, good management and good living, helping the sick and advising mothers on the care of their children.' Just over 60 years ago Croydon appointed 2 women Sanitary Inspectors to do this work in the Borough and now there are 29 Health Visitors whose terms of reference as set out in the 1956 Working Party Report are:- Ihe functions of Health Visitors should primarily be health education and social advice; they may usefully undertake other functions, but these should arise from or be incidental to their primary functions. In carrying out all their functions, Health Visitors should have full regard to the needs of the family and the part played hy other workers. Although the Health Visitor is aware of the nature of the part played fcy most Mother workers', they tend to associate her with the care of mothers and babies only-not realising ho* much she knows about families in the widest sense of the wordand how much she could help them. This year with no major immunising or vaccination programmes to deal with, Health Visitors have been able to devote more of their time to their primary functions than has been the case in some previous years. Mothers Clubs and Toddlers clubs have given opportunity for more group teaching and discussion and Health Visitors are realising the amount of time saved by these techniques. "Father's Night" has now become the recognised means of finishing the teaching in the Mothercraft Classes and have been greatly appreciated. Miss Hall and Miss Butcher fully justified the opportunity given them to attend a parentcraft Teaching Course', by obtaining 1st and 2nd place in the final examination-both being commended for work of an exceptionally high standard. Group teaching is not everyone's strong point, but individual teaching in the homes and infant welfare centres is within the scope of all. As in the case of group discussion a wide range of subjects is covered, including infant feeding, prophylaxis, prevention of minor defects and the early recognition of illness whether mental or physical, the problems of the school child and adolescent, budgetting, the place of the ageing in the family, etc. 37 Because of her knowledge of nursing and of family backgrounds she should be invaluable working in conjunction with the family doctor. With approximately ten times as many doctors as Health Visitors practising in Croydon, this liaison is by no means as close as one would wish-like the curate's egg it is good in parts. The two specialist Health Visitors dealing with problem families and those threatened with eviction have tackled seemingly insoluble problems with understanding and persistance. Some they know will always need support, others they have set on the road to recovery ably seconded by colleagues both in the statutory and voluntary agencies. Without this co-operation their work would be of necessity incomplete. Good team work brings its ownreward. During the year there have been the usual number of Health Visitor students seconded for practical work in Croydon, as well as student nurses from the local hospitals to be shown something of the Health Visitor's work. Figures of work carried out are shown in Appendix, page 106. 38 IMMUNISATION Smallpox cases in other parts of the country led to an unusual demand for vaccination. Over 28,000 persons were vaccinated or re-vaccinated during the year; a sevenfold increase on 1961. To this setback to the ordinary immunisation programme was added a report of suspicion of the safety of oral polio vaccine. Finally more discussions at national level questioned the timing of various procedures. Consequently it is not surprising that our records of children protected against diphtheria and polio are not as good as is usually the case. Fortunately doubts about polio vaccine proved unfounded and arrangements were made to intensify primary and "booster" immunisation efforts during the current year. Tables are given in the Appendix, page 122 HOME NURSING The national trend of fewer visits by District Nurses is reflected in local figures. This is undoubtedly due to the development of oral antibiotics which do away with the need for injections. Lectures on "New Surgical Procedures", "The treatment of Varicose Veins" and on "Mental Illnesses" were arranged. These were subjects specifically chosen hy the nursing staff. For detail ed statistics see page, 108-110 CONVALESCENCE The Corporation accepts financial responsibility for convalescence recommended by general practitioners. Each patient recommended must have had a definite illness or accident and must go to a recognised Convalescent Home. The Corporation recovers part or all the cost according to the income of the patient and in accordance with a definite assessment scale. Certain patients may receive convalescent treatment free, including Old Age Pensioners. Every effort is made to suit the Patient to the particular Home, as different Homes cater for different age groups and different kinds of medical or surgical condition. During the year 27 cases were so dealt with, 18 women and 9 men. There were in addition, 13 cases where the patients cancelled their applications after the arrangements had been made. These figures do not include school children for whom arrangements are made by the Education Committee. 39 HOME HELP SERVICE Miss J. E. Heath Home Help Supervisor "This is our special duty, that if anyone specially needs our help we should give him such help to the utmost of our power." Cicero. What will posterity write and say about the development of the Home Help Service? Already the early struggles for recognition are dim, standards and values have changed and today the Service, far from settling down, is on the brink of new and exciting changes. The emphasis in the future must be on economy of time and energy. In this age of specialisation all skills must be fully developed and to achieve this, training is essential. The Institute of Home Help Organisers have established a training course for organisers. Three of the Assistant Organisers have completed the course during the year and are now awaiting examination results. A student organiser was recommended by the Institute to apply to Croydon for in-service training. She was accepted and took the examination with the established staff. Plans are being prepared for an in-service training scheme for Home Helps to set a standard of work and an understanding of the responsibilities involved in caring for the sick and aged who are so dependent on the Home Help Service. It is recognised that one standard cannot be applied in the 2,000 or more homes attended every year hy Home Helps. At present energy is sometimes misdirected in trying to achieve near miracles in long-neglected homes, when perhaps the health and happiness of the patient are better met by the provision of nourishing meals and understanding companionship. From this established point, a change of attitude can often be achieved, for there are many reasons for dirt and disorder, not one of the least being the loneliness that besets the aged and infirm. It is not very difficult to understand that nothing matters if nobody cares. Training will not make a Home Help; the desire to help must always be the starting point, but the advantages of being trained to use skills and energies cannot be emphasised too highly. The Home Help of the future will take her place in the team of domiciliary workers, trained and confident to carry out her own work and accept the special instructions of her professional leaders, the General Practitioner and the District Nurse. 40 The statistical record of the year's work is detailed in the Appendix on page 112 These are facts; the real spirit of the service was displayed during the appalling weather conditions of 1962-1963, when few old people could venture out to the shops. In several parts of the Borough even milk had to be collected; coal was carried from depots, borrowed from neighbours, and brought from home, and literally gallons of water were taken to homes where supplies were frozen. Attitudes of mind do not always change with external events; Cicero's words of 2, 000 years ago might well have been written about the Home Helps of 1962. 41 HEALTH EDUCATION AND HOME SAFETY Miss D. S. Elliott, S.R.N., H. V. Cert., Dip. H. E. Health Education Officer "If you are planning for a year - grow rice. If you are planning for ten years-grow trees. If you are planning for a hundred years - educate the people. " Chinese Proverb. Home Safety activities were amalgamated with the Health Education Section during the year, following the retirement of Miss D. E. Black more, Home Safety Officer. Although legislation with regard to housing, domestic articles and appliances is effective it was felt that the greatest emphasis in the prevention of accidents in the home should be on education and the encouragement of a sense of personal responsibility. Health education, as all education, should be more than just a means of satisfying immediate needs and reducing new knowledge to simple terms. Like the yeast in dough it becomes real and alive to those participating in group activities and is concerned firstly with attitudes towards personal and community mental and physical health, secondly with a critical examination of the facts presented and thirdly as a result of the first two, with encouraging voluntary individual or group action. "A great oxford teacher, Walter Raleigh, used to say to his students, Don't look at me; look where I am looking.' " Group Activities The educational work in mothercraft classes, parents' clubs and toddlers' clubs has continued and matured during the year. Three toddlers' clubs are now well established and plans are being made to put another six into operation during 1963. In all these groups the sincerity and genuine care of the leaders for their members is building up a good relationship which is noticeably extending, so that members of the groups now matter to each other. In some parents' clubs, in particular, this influence has spread beyond the clubs into the members' everyday lives. New and particularly shy members are not only made welcome in the groups but are deliberately invited to the frequent tea and coffee parties in each others homes. Several members helped another in the home when a new baby was born, some of them acted as baby sitters for each other and one offered to have a child for a week to enable the mother to take a much needed holiday. A very anxious and depressed mother of a subnormal child was quite dramatically helped by the friendliness of & group. 42 Experienced health visitors in the toddlers' clubs are handing over some of the responsibility for the children during the sessions to members and are encouraging them to take a much more active part in the discussions and activities. All these groups are helping to maintain good mental health and are developing a real spirit of community responsibility. In-Service Training Daily, throughout the year, the Assistant Health Education Officer gave informal but important help to many members of the Public Health team either singly or in small groups. Other more formal sessions of particular interest were: - Human Relationships in Obstetrics The second of two sessions on this Subject for doctors, hospital and domiciliary midwives, health visitors and district nurses was held at Mayday Hospital and the speakers taking part were:- Dr. S. A. MacKeith, Physician Superintendent, Warlingham Park Hospital. Mr. J. C. Miller, Consultant Obstetrician and Gynaecologist, Croydon Group Hospital Management Committee. Dr. D.J. Gordon-Smith, Deputy Medical Director, The Central Council for Health Education. The second part of the programme during the first session was devoted to role-playing. On this occasion, however, it was decided to have four groups who discussed:- (a) The lack of tolerence and understanding in maternity Units (b) Do the recent criticisms indicate that the public is expecting the impossible? (c) Are the maternity units which would be a "home from home only a pipe dream or are they a possibility? (d.) What are the factors in the world of midwifery which lead to the development of a domineering and inconsiderate manner in some midwives? This method produced a more positive result in that constructive suggestions were made and some action taken. Two other formal sessions on "Planning for the Toddler (Toddlers' Clubs) were held for doctors and health visitors. The Medical Officer of Health introduced the sessions and on each occasion a doctor and a health visitor presented papers which were fully discussed and resulted in the confirmation of the Policy of establishing more such clubs with the threefold pur pose of mental and physical examination of the two to five year olds, social development of the children through play and health education sessions for the mothers. 43 Demonstrations and lectures on the principals and administration of health education and the social aspects of disease were again given at:- The Central Council for Health Education Battersea College of Technology The Royal College of Nursing King Edward's Hospital Fund The Women Public Health Officers' Association The London Hospital Croydon, General and Mayday Hospitals Croydon Technical College - Pre-Nursing Course Sessions were also devoted to students from many of the above organisations and from the London University Institute of Education and the London School of Hygiene and Tropical Medicine. The great upsurge of activity and interest in health education projects during the year was most stimulating and keeping information and materials flowing smoothly certainly fully stretched the administrative ability and ingenuity of the health education staff. It was, however, greatly facilitated by the completion of the new health education unit, a fully equipped lecture-cum-workroom and new offices. Smoking and Lung Cancer See p. 8 in the Section of the Annual Report of the Principal School Medical Officer. Home Safety Once again falls accounted for the greatest number of home accidents and fatalities in the Borough and most of the accidents and all the fatalities occurred in the older age groups. Many of the injuries were fractures which are slow to heal in the elderly increasing the risk of death by pneumonia or pulmonary embolism. New dwellings or improved dwellings for the old and in time new household equipment designed for safety, will doubtless help to reduce these accidents in the future. In the meantime education for growing old needs to begin much earlier in life and those caring for the elderly need to be made aware that in time normal tasks become dangerous due to faculties failing more than is apparent. Poor circulation causes dizziness and poor balance, and hearing and vision gradually deteriorate without this being realised. Blurred vision may then give rise to tripPing, to difficulty in reading instructions on bottles, and there is always danger from spectacles steaming up. Emotional difficulties too predispose to accidents and old people, especially those living alone, need looking after and loving. 44 Ashburton Flower Show, July 14th. A twenty foot stand was exhibited in one of the large marquees and proved of considerable interest to those attending. Colourful, animated displays on water safety and broken bottles on beaches were shown. There was also a plastigraph of a bathroom cupboard full of safe, dangerous, necessary and unnecessary bottles and boxes and the audience participated hy clearing the cupboard and deciding whether the contents should be kept or thrown away. The R. So. P. A. poster "Don't Monkey with Electricity" was mounted and animated and attracted much attention from the men. Fire Prevention During September, October and November, illustrated talks and demonstrations were given hy the Fire Prevention Officers of the Croydon Fire Service in the 26 Infant Welfare Centres and Toddlers' Clubs. The talks were much appreciated by the mothers and this educational work was considered by the Fire Prevention Officers to be invaluable. "A First Aider in every Home" campaign A lecture demonstration on teaching techniques and aids was given to the St. John Ambulance Brigade, Cadet Officers, Leaders and N.C.O's of the Nol District, South West Area. In the 1962 Welcome to Citizenship Exhibition part of the Health Education Section of the Health Department's stand was devoted to a demonstration entitled "A First Aider in every Home. " A pegboard display was mounted in the centre and demonstrations of first-aid pressure dressings were given by a St. John Cadet Officer using a cadet as a model. Following the exhibition the pegboard was displayed at five Infant Welfare Centres and was also put on show at Lodge Road Minor Ailments and Dental Clinic for several weeks. Other material was displayed in the front hall of the Health Department. Flame-Proof Materials Health Visitors completed a simple questionnaire, on this subject in order to determine the value of lecturing on the use of proofed materials and garments if they were not available in the shops. Last autumn the local Chambers of Commerce were offered a speaker to lead a discussion on the reasons for the failure of retailers to keep stocks of flame-proof materials, and the possibility of overcoming the problems involved. In response to an invitation received from the Croydon Chamber of Commerce a talk was given by the Home Safety Officer. 45 Further talks have been given to the Electrical Association for Women at Electric House, Wellesley Road, Croydon on this subject and also at three Infant Welfare Centres. Proban and Bri-Nylon display boards were on show at all Infant Welfare Centres during last autumn. At present research and processing on these materials is costly and only constant demand will reduce the price. It is hoped that a wider variety of flare-free materials will be available within the next two years. Housework with Ease Although R. So. P. A. arranged courses at their London headquarters to train local instructors it would have meant releasing a number of the Corporation's staff, and a more convenient and economical method was to arrange training sessions for Health Visitors in Croydon. Following the procedure adopted by the Royal Society, a teacher-organiser of the Women's League of Health and Beauty, Mrs. W. R. Elliott, was asked to give two sessions in one afternoon in Croydon for the Corporation's Health Visitors. These were most useful and were followed up by demonstrations at two Infant Welfare Centres and a Toddlers' Club. Three other sessions were given by health visitors and the health education officers. Tables are given in the Appendix, page 115. 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 treatment and 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. No special innovations can be reported in arrangements for those referred from Ante and Post-Natal Clinics, and apart from isolated holiday periods, sessions at present allowed for this work have been found to be reasonably adequate. During recent years the volume of patients has remained remarkably constant and it would appear that a position of equilibrium has now been reached in relation to the public demand, which may well continue for an indefinite period. In meeting the dental requirements of the expectant mothers the optimum period is that period between the fourth and seventh month, as this allows for more comprehensive measures than during the later stages of pregnancy. With respect to those in the last category the position has progressively improved since the early years, and the fact that nowadays some three-quarters of those examined are seen before the sixth month is ample tribute to the system now in operation. In spite of this achievement absenteeism among those in receipt of appointments for the initial dental examination, continues to be substantial, and can on occasion result in an appreciable loss of surgery time. To meet this situation "follow-up" measures have been instituted, in the shape of a mild reproof, when such patients are due for the next A.N.C. visit. Whilst such tactics have produced only a limited response, the routine will be continued on the score that further exhortations from the doctor can lead to alternative advice being sought. Though there appears to be a genuine appreciation by parents of the work carried out for pre-school children at clinics, the position continues to be somewhat "static" and it is felt that a further expansion of this service should be possible, provided means could be found for reaching potential untapped sources. Unfortunately the decline in the number of Day Nurseries has sadly reduced the routine supervision of the younger age groups, without any compensating increase in the development of the Nursery School on the Education side. 47 In the face of these and other limitations such as the increase of mothers in employment, the most promising scope for activity would appear to lie in increased publicity at Welfare Centres, particularly during "Toddler Sessions", and by more direct contacts with the younger parent through "Mothers' Clubs" and adult social gatherings. Here again much must depend on the amount of time which can be devoted to the furthering of Dental Health Education, and little changes can be expected from shortterm results. During the past year further "invited" talks and film shows have been continued at regular meetings of Methodist "Young lives" and similar Church organisations; as on previous occasions ensuing discussion showed an intelligent interest in the subject. As has been noted in the case of the school children, continued lack of on the spot facilities has also caused a falling off in attendance by the "under fives" from the South Croydon area. Whilst this apathy is to some extent understandable it is hoped that it will prove to be a passing phase, and that the opening of the combined Welfare and Dental Centre in Coldharbour Road will serve to re-kindle interest in the use of the Local Authority Service for the district. From the preventive angle remarks in the current School Dental Report, concerning the addition of fluoride to the general water supply, are of particular importance to the preschool child, as it is in the teeth of the very young that protection has been found to be most effective. An important feature of this mode of application is that it also automatically secures the requisite concentration (of the salt) in the blood stream of the expectant mother during the formative period of the infant's first dentition. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 269, compared with 288 in 1961. 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 33 per cent. from 32 per cent. in 1961. 48 Expectant mothers examined for the first time numbered 199 against 202 last year. Of these, 76.4 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. There has been little change in the amount of work carried out 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; otherwisw names were received during the post-natal period. 20 nursing mothers were examined during the current year, compared with 17 in 1961. Treatment Including those continuing treatment from the previous year, 274 mothers were dealt with, against 307 in 1961. 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 394, compared with 399 in 1961. As previously, this figure included a proportion of "toddlers" due for re-inspection and treatment. In common with the condition found among school children, 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"; earlier supervision of these youngsters is therefore becoming of great importance. Though cases of deliberate neglect are rare, the growth in part-time employment of 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 114. 49 AMBULANCE SERVICE A.L. Hill, Esq., Chief Ambulance Officer. During the year the service was called upon to deal with 125,331 patients which necessitated 53,325 journeys and a mileage of 425, 955. Compared with 1961 these figures show an increase of 5, 278 patients, 2,353 miles and 131 journeys. There were 15,487 patients conveyed to places outside the Borough, and on these journeys 125,876 miles were travelled. The number of patients admitted to Hospitals and Nursing Homes was 9,352 compared with 9,614 the previous year. It should be noted that the London Road Day Centre classification has been recorded this year but for 1961 it was included with the Health Service Removals. The volume of work has remained fairly constant apart from an increase of Mental Health patients to the Occupation Centres. The difficult periods were again experienced during the winter lonths when weather conditions and sickness of staff occurred when conveyance of patients was at its peak. Fog and snow towards the end of the year delayed transport but all admissions and accidents were dealt with. A total of 808 days sickness compared with 914 during 1961 and 879 during 1960 were lost. Three men resigned, two died suddenly and one was withdrawn from driving because of illness and placed on the Clerical strength. One extra man together with 6 replacements were employed and trained. In accordance with the instructions of the Health Committee, children who were taken ill at School and did not require immediate medical attention were taken home and on these journeys 41 children were conveyed. Various demonstrations and discussions were held giving First Aid Instruction including Mouth to Mouth Resuscitation by Officers of the Service. My Second Officer and one Leading Driver attended a Civil Defence Course held at Pal field, Gloucester. The Chairman of the Health Committee presented Drivers of the Service with Safety First Driving Awards for accident free living, 55 Drivers qualified for such awards in 1961. Work was started on the site at Headquarters Station where the new Garage is to be erected but was delayed owing to weather Conditions. A new Fire Alarm system was fitted in the existing Garage which will raise an automatic alarm in the Watchroom in the event of fire. for details of journeys, patients, mileage etc. see the Appindix, pages 117 - 119. 50 CIVIL DEFENCE (Ambulance Section) There were 367 Volunteers on the register at 31st December, 1962, and of this number 53 were attending at the New Addington Training Centre. This figure shows an increase of 18. The number of Instructors was 7 including two of my Officers. The annual First Aid Course was held at the Civil Defence Headquarters, Wellesley Road under the St. John's instruction. Twenty-five volunteers entered and 21 were successful. Various exercises were held during the year and first aid instruction was again given to the Electricity Board's Ambulance and First Aid Section. Driving Instruction was given by the Onward Driving School and of 27 who took tuition, 5 passed, 7 failed and 15 are still awaiting their driving tests. A Film Strip Projector was supplied and has been very useful during lectures, particularly for illustrations. My Civil Defence Training Officer attended Falfield, Gloucester to requaliftr for the Ambulance and Casualty Collecting Section Instructor's Certificate, and was successful. The new classes were started during the year in preparation for the New Organisation Tests which will take place in January, 1963. 51 MENTAL HEALTH SERVICE For the Mental Health Service, 1962 has been a year of promising development. The difficulty referred to in my last report of recruiting suitably qualified Social Workers has happily resolved itself, and by the end of the year all vacancies had been filled. This has in turn enabled positive advances to be made in the creation of a Psychiatric Social Work Service in which the Local Authority and Warlingham Park Hospital Social Workers have joined together in a single integrated team. This carries a stage further traditionally close Hospital/Local Authority ties in Croydon, and further reference to the Social Work activities are made in the pages which follow. Other reasonably successful ventures have included the introduction of a Boarding Out Scheme for the mentally disordered, and the extension of industrial work facilities for the mentally subnormal. Administration The Medical Officer of Health is in administrative control; the Medical Superintendent of Warlingham Park Hospital serves as Psychiatric Adviser under arrangements agreed with the Regional Hospital Board, and the Deputy and two Assistant Medical Officers of Health are approved for the purpose of the Mental Health Act. There is a Senior Mental Welfare Officer, a Planning Officer, five Mental Welfare Officers, two Psychiatric Social Workers, one Social Welfare Officer, one Boarding-Out Officer, and a Welfare Assistant. Voluntaiy Associations The only duty delegated to a voluntary organisation was the care and supervision of seventeen severely subnormal patients placed with the Guardianship Society. The service has close and cordial ties with the Croydon and District Society for Mentally Handicapped Children, who have organised excellent weekly social clubs for the subnormal; the Mental After Care Association, and the Croydon Guild of Social Service. Work carried out in the Community The pages which follow give details of the work undertaken in 1962. I record' with appreciation, my thanks to Dr. MacKeith in the staff of Warlingham Park Hospital, Dr. Gibson and Dr. Richards of St. Lawrence's Hospital, and Dr. Ferguson of the Royal Earlswood Hospital, for their help and co-operation. 52 Mental Health Act 1959 - Mental Illness M. F. Total Patients admitted to hospital:- Informally 64 67 131 Under Section 25 (for observation) 23 24 47 Under Section 26 (for treatment) 24 33 57 Under Section 29 (for observation in emergency) 83 109 192 Under Section 136 (Police action) 9 1 10 Under Section 60 (hospital Order through Court) 2 - 2 Investigated but not admitted to hospitals 19 14 33 The total number of admissions was slightly less than in 1961 and the proportion of patients admitted informally increased substantially whilst Section 29 admissions dropped by 27%. The above figures refer to cases dealt with by Mental Welfare Officers and comprise approximately one third of the total admissions to Warlingham Park Hospital. Residential Accommodation Long Term Six patients were admitted to Homes run by The Mental AfterCare Association, one inmate returned home and the total number accommodated is now eight. Hostel At the beginning of the year thirteen patients were inmates of the Mental After Care Hostel in Croydon for employable recovered mentally ill patients. Five patients were subsequently admitted, two were found lodgings under the Boarding Out Scheie, four moved on under their own arrangements and two returned to Hospital, leaving 10 in occupation at 31st December. Two patients were admitted for periods of a few months to hostels outside Croydon. Convalescence Pour 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 - Subnormal i ty During 1962 hospital admissions were as follows and the corresponding figures for 1961 are shown for comparison purposes- 53 1962 1961 To psychiatric hospitals (subnormality) 24 25 To psychiatric hospitals (mental illness) 1 5 Transferred from one hospital to another 1 7 Admitted for short term care 18 16 Total number of patients in hospitals 385 382 12 cases were awaiting permanent hospital vacancies on 31st December 1962 Pour patients were placed under the guardianship of the Local Authority, bringing the total to eighteen. Residential Accommodation Long Term Financial responsibility was accepted by the Corporation in respect of the maintenance of one severely subnormal girl in a Home outside Croydon. Hostel One subnormal girl was admitted to a Hostel for a trial period. Other Seventeen severely subnormal patients (seven males, ten females) are placed in foster homes supervised by the Guardianship Society. Information concerning patients Boarded out under the Council's scheme appears later in this report. Training Junior Training Centre Number on register January 1962 75 Number on register December 1962 68 Number of admissions 12 Number left 19 (10 to adult Centre) Average Attendance per Session 57 Times open (whole days) 194 Total attendances 22,086 It was decided to split the existing Nursery group and make half into a Special Care Group. This took place in February, and has proved well worth while. 54 Adult Training Centre On 1st January 1962, 37 subnormal or severely subnormal trainees were attending this industrial work centre, and by the end of the year this figure had risen to 63 (38 males, 25 females), of whom 8 males were accommodated in a supplementary unit for higher grade trainees, A small number of mentally ill persons was successfully assimilated into the Centre. Some headway was made in obtaining suitable work and a small warehousing and despatch section was set up, but much more work is required before the Centre can work at full capacity all the year round. Work undertaken included laundry of both training centres, linen repairs; kitchen duties; making natural wood birdcage perches; fitting inserts into metal caps; assembling and packing a wide range of plastic toys. Money earned during the year amounted to £944.7s. 1d. and £1, 119. 11s. 9d. was paid out in pocket money and bonus. 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. A bonus scheme operates where the money earned is more than the pocket money payable. 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, although those capable of making their own way are encouraged to do so. Mental Health 1959 - General Boarding Out Scheme This scheme was introduced in February 1962 as a means of encouraging private individuals to offer lodgings or foster homes for mentally disordered persons in need, in particular mentally ill persons on discharge from hospital and homeless subnormal or severely subnormal persons. The Corporation pays Boarding Out allowances as required. A Boarding Out Officer has been appointed with special responsibility in connection with the scheme, and close medical and social work support is provided. Progress was inevitably time exhausting and laborious, hut at 31st December, 17 patients were in lodgings and information concerning the year's work is shown below:- 55 Patients referred by Warlingham Park Hospital 17 Patients referred by Mental After Care Hostel 4 Patients from the community and other services 19 40 Referred and subsequently withdrawn 8 32 Boarded out - later re-admitted to hospital 2 „„ - later left to own accommodation 5 „„ - transferred to c/o Guardianship Society 1 „„ - still in lodgings 17 25 Awaiting places 7 32 Of the 17 in lodgings (10 males and 7 females) 10 are mentally ill, 6 subnormal and one severely subnormal. Social Work The Social Work Service which is being developed jointly with Warlingham Park Hospital, has made a promising start during the past year. Social problems are dealt with affecting all categories of mentally disordered persons and their families. The service is organised so that the Social Workers and Doctors responsible for the patient's treatment work together as a team, and so that there can be continuity of care before, during and after treatment as required. This is greatly facilitated by the joint use of staff by Hospital and Local Authority. The expansion of the staff towards the end of the year by one Mental Welfare Officer, and three Psychiatric Social Workers, has resulted in better coverage of the various clinical units of the Mental Health Service. There is now one Psychiatric Social Worker full time at the Day Hospital, and three at Warlingham Park Hospital who are also available to deal with Out-Patients. Despite this increase in staff, the needs of the developing Mental Health Service are still some way from being met. At the beginning of the year the number of persons whom the Social Workers were helping at any time was around 500. This number was increased by the end of the year to almost 650. Over the whole year the Social Workers were engaged in helping some 1.100 cases, and the type of help needed was very varied. Although most of the persons referred to the Social Workers are Patients attending for treatment at one or other of the Psychiatric Units, others have been referred by a wide range of social service agencies including other Local Authority Departments, as well as byy members of the general public. 56 During the year 9 students, 8 of them from various Universities have visited the Croydon Psychiatric Social Service for varying periods of practical work in connection with their training courses. The calls on the Social Workers of the service for participation in training schemes for Social Workers, is likely to increase in the future, and in this connection mention should be made of the new general training in social work which is to commence at the Croydon Technical College in September 1963. 57 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, inmarried, 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. 9d. per day. This had been raised from 15s.3d. (luring the year. There was one mother who paid the full rate of 15s. 9d. in 1962. She became liable to pay the full rate In September and the child is still attending. Details of attendances- Capacity 50 Number on books at the end of year 45 Attendances: Under 2 2, 463 Over 2 5,720 Total 8, 183 Number of days opened 254 Average daily attendance 32 DEAFNESS The scheme for the early ascertainment of deafness which provides for the examination of all babies "at risk" was continued. Details are given in the Appendix - page 116. CHIROPODY The system of using the services of Chiropodists working in their own surgeriws was continued and attendances rose steadily. Satisfactory reports on the premises and mode of practice of all Chiropodists in the scheme were received from the Corporation's visiting specialist. A few requests for domiciliary treatment were made to the department, but finance available was fully comitted to the demands of those able to visit a nearby practitioner. Possible future developments may include domiciliary visits, and clinics in parts of the Borough without practising chiropodists. During 1962 the Chiropodists gave a total of 8,194 treatments of which the Corporation paid the whole cost for 2, 437 and cost for 5,757. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 59 WORK OF THE PUBLIC HEALTH INSPECTORS George Grieve, F.R.S.H., F.A.P.H.I. Chief Public Health Inspector During the year new legislation in connection with the house let off to more than one family became operative. Standards were formulated and approved by the Council and already, following inspection, improvements are in hand in many of these houses. As the completion of the so called "slum" clearance programme is in sight, more time of the inspectorate will be given to these houses in multiple occupation, some of which can quickly, through lack of facilities and default in management become much worse slums than any of the houses included in the clearance programme. Unfortunately the staffing situation, so far as the Inspectorate is concerned, has deteriorated and unless the vacancies can be filled, enforcement of the new provisions mentioned above will be slowed down. Annually new legislation, in one form or another, which it is the duty of the Inspectorate to enforce, reaches the Statute Book, and with the limited qualified staff available it has, over recent years been a problem to so organise the staff to give the more important public health functions the attention which is their due. We now have five trainees in the Department, but some years must elapse before any benefit accrues from such recruitment-in the meantime a policy of priorities must be adopted. Meat inspection at the Public Abattoir is one of these, and even with increasing throughput a 100% inspection has been maintained, necessitating the Inspectorate being on duty in the evening and at weekends. The new Abattoir is still at the drawing board stage but it is hoped some positive progress will be made early in 1963 in negotiations with the prospective users, to enable a date of building to be decided upon. Owners of property and residents have co-operated well in complying with the Clean Air Act and this has enabled the Council to declare its intention to make the whole of the present Borough smoke controlled by 1971. The Commercial re-development of the Centre of the Borough adds to the duties of the Inspectorate and will so continue with the Passing of the Offices, Shops and Railway premises Act in 1963legislation, long overdue, to improve the working conditions of those employed in such premises. There should be no difficulty in rehousing from slum" offices etc. in Croydon in the years ahead, except perhaps the "old bogey" of rents. This is my nineteenth annual report and my last as I retire early in 1963, I was appointed at the time the town was being haphazardly destroyed from the air, and retire as it is being systematically and purposefully destroyed by the planners to mane way for a newer and progressive Croydon, and vacate office happy in the thought that I, along with my staff, have had a part to play in such exciting times. 60 HOUSING 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; Upper and Lower Drayton Place. Number of parts of houses on which Closing Orders have been made 6 Number of houses on which Closing Orders have been made 6 Number of houses on which Demolition Orders have been made 13 Number of houses where Certificates of unfitness were issued 25 During the year 898 houses were rendered fit following the service of notices requiring repairs. Rent Act, 1957-Certificates of Disrepair Applications for Certificates of Disrepair during the year 1962:- Number of applications for certificates 18 Number of decisions not to issue certificates 2 Number of decisions to issue certificates 16 (a) in respect of some but not all defects 11 (b) in respect of all defects 5 Number of undertakings given by landlords 5 Number of undertakings refused by Local Authority Nil Number of certificates issued 11 Applications by landlords to Local Authority for cancellation of certificates 18 Objections by tenants to cancellation of certificates 8 Decisions by Local Authority to cancel in spite of tenants' objection 4 Certificates cancelled by Local Authority 14 61 West Croydon Men's Hostel This is situated at Pitlake and is available for use by nightly lodgers. It has 104 cubicle beds, four of which are reserved for staff. The charge is 2b. 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 96, and the total number of lettings 35, 138. The receipts during the year were £4,023 and the expenditure £6,370. 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 Inspections for purposes of provisions as to health (Including Inspections made by Public Health Inspectors). Premise 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 365 35 6 - (ii) Factories not Included in (i) in which Section 7 is enforced by the Local Authority 1, 354 302 30 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' Premises) 85 65 15 - Total 1,804 402 51 - 62 Cases in which Defects were found:- Particulars Number of coses in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S. 1) - - - - - Overcrowding (S. 2) - - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S.4) 3 - - - - Ineffective drainage of floors (S. 6) 2 2 - - - Sanitary conveniences (S. 7):- (a) Insufficient 12 6 - 3 - (b) Unsuitable or defective 45 33 - 5 - (c) Not separate for sexes 3 1 - 1 - Other offences against the Act (not including offences relating to Outwork 23 19 - 1 - Total 88 61 - 10 - 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 unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Hearing Apparel 207 _ _ _ _ _ Household Linen 3 _ _ _ _ _ Lace, lace curtain and nets 3 _ _ _ _ _ Curtain and furniture hangings 11 _ _ _ _ _ Furniture and upholstery 2 _ _ _ _ _ Umbrellas, etc. 2 _ _ _ _ _ Paper bags 12 _ _ _ _ _ continued on next page. 63 ature of Work Section 110 Section 111 No.of outworkers in August list required by Sect.110 (l)(c) No. of cases of default in seeding lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole- 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. 2 - - - - - Carding, etc. of buttons, etc. 41 - - - - - Staffed toys 36 - - - - - Brush making 6 - - - - - Chocolates and sweetmeats - - - - - - Cosaques, Christmas crackers, Christmas stockings, etc. 242 - - - - - Lampshades 39 - - - - - Total 606 - - - - - 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 101 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. 1,074 inspections were made under the Shops Act, and the infringements found were as follows:- 64 Hours of Closing 2 Insufficient and defective W.C. accommodation 2 Defective floors, walls etc 4 Notices to be exhibited or amended 39 Insufficient heating 1 Insufficient ventilation 1 Washing facilities required 3 hairdressing establishments Legislation now calls for the registration of hairdressers and 204 such businesses are now registered. During the year 118 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 1,738 visits of inspection were made to underground drains in course of repair. Of 222 Statutory Orders served, in 95 cases work was carried out in default of the owners. In addition, repairs were carried out by the Corporation to 5 public sewers serving 18 properties. offensive trades There are two registered premises, and during the year there has been no cause for complaint. pollution of rivers and streams During the year 148 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. 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. 65 CLEAN AIR ACT, 1956 The Council has implemented the relevant provisions of this Act in making Smoke Control Orders covering the South and South Western areas of the Borough and it is the intention that one Smoke Control Order shall be made each year. The progress of these Orders is shown below: - Smoke Control Order No. of premises (incl. Factories and Commercial No. of dwellings Acreage Date of Order Date of Operation No. 1 2,076 1,916 620 22.12.58 1.4.61 No. 2 3,042 2,686 265 26. 2.60 1.10.61 No. 3 4 , 50 1 3, 9 1 5 3 3 2 22.11.60 1.10. 62 No. 4 5,547 4,112 710 24. 11.61 1. 7.63 No. 5 7,042 6,651 570 17.12.62 1. 7.64 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. In one instance smoke was emitted for more than the statutory limit. The management concerned were at once interviewed and informed of the offence and advised. In no case did it become necessary to serve a Statutory notice. During the year 30 plans showing the construction and heights of new chimneys have been examined and in 15 cases additional height has been requested and agreed. 39 notices of the installation of new furnaces have been received, 32 of these being oil fired Plants. AMUSEMENT HOUSES 87 inspections were made of Theatres, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licencing Authorities on the sanitary conditions of these premises. Notices are issued to remedy any unsatisfactory conditions. 66 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 6,881 articles By Formalin Gas 1,738 ,, Total 8,619 articles 158 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 1962, 45 articles were disinfected, the receipts amounting to £2.16s.0d. Disinfection was carried out after infectious or contagious diseases at the following premises:- 123 rooms at 35 houses, hospital wards, clinics etc. 1,528 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 £20.5s.0d. was recovered for such services. 26 articles for Welfare Department institutions and 1,007 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, 4 adults and 3 children were cleansed of verminous conditions and 18 adults and 25 children were treated for scabies. 67 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 63, 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 51 complaints were made regarding noise alleged to be a nuisance. In 20 cases no action was warrented. In 13 instances the noise complained of was finally abated, in 7 cases the noise was reduced so as not to be a nuisance and 11 cases are still under investigation. An ice cream vendor pleaded guilty to a summons relating to the use of chimes for the purpose of advertising the sale of ice cream after 7p.m. The Court imposed a fine of £2 with 10/6d costs. The local police also instituted proceedings against an ice cream vendor for a similar offence and in this case a fine of £1 was imposed, with 10/6d costs. 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 17. In addition, 225 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 1962, 9 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 1 Curled Feathers 2 Cotton Felt 2 Superfil 2 68 PET ANIMALS ACT, 1951 21 persons were licenced for the purpose of keeping Pet Shops. During the year 21 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS Ten cases of suspected swine fever notified 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, 2,481 private dwellings were inspected following complaints and in 2,411 instances infestation was confirmed and dealt with by the rodent operatives. 213 business premises were found to be infested with rats or mice and these were all disinfected 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. 47 infestations at such premises were dealt with during the year. The baiting of the Corporation's foul water sewers is carried out annually. 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 23 manholes. These manholes were treated until no further baits were taken. 69 FOOD SUPPLY The supervision and inspection of the food supplies is carried out by the Public Health Inspectors who are all qualified in food inspections. The following table shows the distribution of premises in the Borough at which food is known to be sold, manufactured or stored. Bakehouses 55 Bakers Shops 114 Sugar Confectioners 548 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 543 Works and Club Canteens 281 Licenced Premises 177 Off Licences 82 Grocers 583 Butchers 202 Wholesale Meat Markets 8 Chemists 81 Greengrocers 269 Fishmongers 64 Pried Pish Shops 39 Milk Distributors and Dairies 194 Premises from which Roundsmen and Mobile Shops operate 18 Stalls 112 Pood Manufacturers 19 Other Pood premises not enumerated above 35 Total 3,424 Of the above premises 1,008 are registered under Section 16 of the Food and Drugs Act, as follows: - Retail sale of ice-cream 817 Manufacturers of ice-cream 3 Preparation or manufacture for sale of sausages, or Potted, pressed, pickled or preserved food 188 During the year 6,368 inspections and re-inspections were made of food businesses (for details see Page 81). 70 INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1955/56 Structural defects In shops and stores 9 Defective condition of walls and ceilings 136 Defective condition of floors, utensils, fixtures, etc. 61 Defective or Insufficient drainage 34 Insufficient lighting or ventilation 18 W.C. accommodation -repair or cleansing required 39 ,, ,, -artificial lighting required 5 ,, ,, -want of Intervening ventilated space 1 Food- not stored 18" off floor 7 ,, -means to prevent contamination required 45 ,, -store required or defective 10 Accumulations in yard or stores 33 Offal and refuse bins defective or uncovered 20 Yard paving defective 2 Hand washing notice not exhibited 6 Ablutions -Wash basins required 25 ,, -Hot water supplies required 49 ,, -Nail brushes, soap and towels required 10 Clothing accommodation required 13 Insufficient or defective sinks 18 Smoking offences 4 Defective or unsuitable table tops, etc 34 First Aid kits required or insufficient 5 Cleanliness - advice given 7 Cracked crockery 1 Rodent Infestation 6 Prosecutions The proprietor of a local fried fish shop pleaded guilty to a summons relating to the sale of fried fish contaminated with foreign matter and unfit for consumption. The Court imposed a fine of £10, with 10/6d costs. A local grocer pleaded guilty to a summons relating to the sale of a pork pie which was affected with mould and unfit for consumption. The Court imposed a fine of £25, with 2 guineas costs. 71 Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1962:- Article Weight in lbs. Carcase Meat 64,636 Offal 76,504 Sundry Foodstuffs 4,572 Canned, Bottled and Packeted Poods 21, 241 Total 166,953 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 1961, 105, 395 animals were slaughtered and in 1962 the numbers increased by 5% to 110,457. 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 after normal hours duty. The following tables summarise the meat inspection service at the abattoir:- Animals Slaughtered Cattle Sheep excluding Cows Calves and Goats Pigs Total Cows Lambs 4,889 1,704 9,003 54,982 134 39,745 110,457 72 CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Horses Number killed 4889 1704 9003 54982 39745 134 Nil Number inspected 4889 1704 9003 54982 39745 134 Nil All Diseases except Tuberculosis and Cysticerci Whole carcases condemned 1 20 76 339 233 3 Nil Carcases of which some part or organ was condemned 1718 820 63 3279 4122 2 Nil Percentage of the number inspected affected with diseases other than Tuberculosis 35.1 48.2 1.5 6.5 10.9 3.7 Nil Tuberculosis only whole carcases condemned 2 2 Nil Nil Nil Nil Nil Carcases of which some part or organ was condemned 25 1 Nil Nil 16.2 1 Nil Percentage Inspected affected with Tuberculosis 0. 5 0.1 Nil Nil 0.4 0.7 Nil Cysticercosis Carcases of which some part or organ was condemned 90 17 Nil Nil Nil Nil Nil Carcases submitted to treatment by refrigeration 90 17 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 Foods) Order, 1957 The Order provides that, in general, all waste food must be boiled before feeding to animals to minimise the spread of animal diseases. Licences to operate boiling plants and equipment are issued after inspection of the premises and plants. 42 inspections of licenced plants were made during the year. 73 MILK SUPPLY During the year 79 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 122 Licences to use the designation "Sterilised" - (a)Dealer's (Pre-packed Milk) Licences 106 Licences to use the designation "Tuberculin Tested" - (a)Dealer's (Tuberculin Tested) Licences 2 (b)Dealer's (Pre-packed Milk) Licences 94 Inspection of these licenced premises has been carried out during the year to see that the conditions of the licences were observed. Bacteriological Examinations of Milk During the year the following samples of milk were examined: Tuberculin-Tested Pasteurised Milk 48 Pasteurised Milk 106 Sterilised Milk 39 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 Methyline Blue Test Phosphatase Test No Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 48 - 48 - 48 74  Pasteurised Milk Methylene Blue Test Phosphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 106 1 105 - 106 Sterilised Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied 39 - 39 Bacteriological Examination of Milk Churn and Milk Bottle Rinses Churn Rinse Samples- 7 Satisfactory- 6 Unsatisfactory- 1 Bottle Rinse Samples- 14 Satisfactory- 14 Unsatisfactory- Nil BACTERIOLOGICAL EXAMINATION OF CREAM Ten 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 1 148 2 20 3 21 4 20 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. 75 CHEMICAL EXAMINATIONS OF ICE CREAM Four samples were taken from local manufacturers and were found to comply with the standard. FOOD AND DRUGS ACT, 1955 During the year, 204 samples of Milk and Cream, and 400 other samples were taken, of which number, 5 were found to be "Not Genuine." Summary of Samples During 1962 samples were obtained and submitted to the Public Analyst as follows: - Total Samples Genuine Not Genuine Prosecutions Convictions Almonds(Ground) 2 2 - - - Apple Juice 1 1 - - - Artificial Colour 2 2 - - - Arrowroot 1 1 - - - Ascorbic Acid Tablets 2 2 - - - Aspirin Tablets 2 2 - - - Bacon 1 1 - - - Baked Beans 1 1 - - - Baking Powder 1 1 - - - Batter Mixture 2 2 - - - Beer, Bitter 7 7 - - - Beer, Burton 1 1 - - - Bicarbonate Soda 1 1 - - - Beer, Mild 1 1 - - - Biscuits 4 4 - - - Black Pudding 1 1 - - - Black Treacle 1 1 - - - Blancmange Powder 1 1 - - - Boracic Ointment 2 2 - - - Brandy 2 2 - - - Brawn 1 1 - - - Brisket of Beef 1 1 - - - Bread, White 2 2 - - - Bread, Wholemeal 1 1 - - - Bread Crumbs 2 2 - - - Bread, Milk 1 1 - - - Butter, English 3 3 - - - Butter, New Zealand 4 4 - - - Butter, Australian 1 1 - - - Butter, Danish 2 2 - - - Butter, Unsalted 1 1 - - - Buttered Rolls 2 1 1 - - Butter Beans 1 1 - - - Calamine Ointment 1 1 - - - Camphorated Oil 2 2 - - - Calamine Lotion 1 1 - - - Candled Peel 1 1 - - - Cakes, Various 2 2 - - - Cake Mix 2 2 - - - Cheese, Cheddar 1 1 - - - Cheese, Cottage 1 1 - - - Cheese, Danish Blue 1 1 - - - 76  Total Samples Genuine Not Genuine Prosecutions tions Cheese Spread 3 3 - - - Cheese Biscuits 2 2 - - - Chocolate 1 1 - - - Chocolate Flavoured Drink 1 1 - - - Chocolate Spread 4 4 - - - Chopped Pork 1 - 1 - - Chutney 2 2 - - - Christmas Pudding 1 1 - - - Cod Liver Oil 1 1 - - - Cod Liver Oil with Malt 2 2 - - - Cocoa 1 1 - - - Coconut, Desiccated 2 2 - - - Coffee, Hot 1 1 - - - Coffee 1 1 - - - Coffee Essence 1 1 - - - Coffee and Chicory 2 2 - - - Coffee and Chicory Essence 1 1 - - - Condensed Milk 1 1 - - - Condiment, Non-Brewed 1 1 - - - Cooking Fat 2 2 - - - Cordial 1 1 - - - Corned Beef 1 1 - - - Cornflour 1 1 - - - Cornflakes 2 2 - - - Cornish Pasties 1 1 - - - Corn Oil 1 1 - - - Cough Mixture 1 1 - - - Cough Pastilles 1 1 - - - Crab, Dressed 2 2 - - - Crab Spread 1 1 - - - Cream of Tartar 1 1 - - - Cream, Tinned 2 2 - - - Cream, Fresh 5 5 - - - Cream, Clotted 1 1 - - - Cream Buns 1 1 - - - Crystallised Fruits 1 1 - - - Curry Powder 3 3 - - - Custard Powder 1 1 - - - Dates 1 1 - - - Dried Fruit Salad 3 3 - - - Drinking Chocolate 1 1 - - - Dripping 2 2 - - - Essence of Rennet 2 2 - - - Evaporated Milk 2 2 - - - Faggots 1 1 - - - Fish Cakes 2 2 - - - Fish Fingers 2 2 - - - Fish Paste 3 3 - - - Flavouring Essence 2 2 - - - Flour 2 2 - - - Fresh Fruit 3 3 - - - Friars Balsam 1 1 - - - Fruit Pie 1 1 - - - Frying Oil 1 1 - - - Gees Linctus 2 2 - - - Gin 9 9 - - - Ginger Ale 1 1 - - - Ginger Beer 1 1 - - - Ginger Wine 1 1 - - - Ginger, Crystallised 2 2 - - - Glauber's Salt 2 2 - - - Glycerine, Lemon and Honey 1 1 - - - Glycerine 1 1 - - - Golden Syrup 1 1 - - - 77  Total Samples Genuine Not Genuine Prosecutions Convictions Grapefruit Juice 1 1 - - - Gravy Powder 4 4 - - - Ground Cinnamon 1 1 - - - Ground Ginger 1 1 - - - Ground Rice 1 1 - - - Ground Nut Oil 1 1 - - - Ham 2 1 1 - - Hamburger 1 1 - - - Halibut Liver Oil Capsules 1 1 - - - Honey 1 1 - - - Horseradish Relish 1 1 - - - Isinglass 1 1 - - - Ice Cream 2 2 - - - Ice Cream Mix 1 1 - - - Ice Lollies 1 1 - - - Insect Cream 1 1 - - - Instant Whip 1 1 - - - Iodine, Tincture of 1 1 - - - Iodine Ointment 2 2 - - - Indigestion Tablets 3 3 - - - Jam 1 1 - - - Jelly 3 3 - - - Jellied Veal 1 1 - - - Lard 2 2 - - - Lemonade Powder 1 1 - - - Lemon Barley Water 2 2 - - - Lemon Flavouring 2 2 - - - Lemon Curd 2 2 - - - Lemon Pie Pilling 2 2 - - . Line Juice Cordial 1 1 - _ - Luncheon Meat 3 3 - - - Liquid Paraffin 1 1 - - - Lobster Paste 2 2 - - - Macaroni 1 1 - - - Malt Vinegar 2 2 - - - Baited Milk Tablets 2 1 1 - - Margarine 1 1 - - - Marmalade 2 2 - - - Marzipan 3 3 - - - Meat Extract Cubes 1 1 - - - Meat Paste 2 2 - - - Meat Pie 2 2 - - - Meringues 1 1 - - - Meringue Powder 1 1 - - - Milk of Magnesia 2 2 - - - Milk 196 196 - - - Milk Powder 1 1 - - - Mincemeat 1 1 - - - Minced Meat 1 1 - - - Minced Beef 1 1 - - - Mint Jelly 1 1 - - - Mint Sauce 3 3 - - - Mineral Water 1 1 - - - Mixed Herbs 2 2 - - - Mustard 1 1 - - - Mustard, French 2 2 - - - Nutmeg, Ground 1 1 - - - Olive Oil 1 1 - - - Orange Squash l 1 - - - Orange Juice 1 1 - - - Ox Tongue 1 1 - - - Parrish's Chemical Food 1 1 - - - Pancake Mixture 1 1 - - - 78  Total Samples Genuine Not Genuine Prosecutions tions Peanut Butter 3 3 - - - Pearl Barley 1 1 - - - Pepper 1 1 - - - Pepper, Cayenne 1 1 - - - Pickled Beetroot 1 1 - - - Pickled Onions 2 2 - - - Pickled Cabbage 1 1 - - - Pickled Gherkins 2 2 - - - Pickles 1 1 - - - Pickling Spice 1 1 - - - Pineapple Juice 1 1 - - - Pork Pies 1 1 - - - Pork Sausage Meat 1 1 - - - Porridge Oats 2 2 - - - Puff Pastry 2 2 - - - Red Cabbage 3 3 - - - Roes, Tinned 2 2 - - - Rice 1 1 - - - Rice Pudding, Creamed 1 1 - - - Rissoles 3 3 - - - Rum 10 10 - - - Rum Essence 1 1 - - - Sago 1 1 - - - Salad Cream 1 1 - - - Sauerkraut 1 1 - - - Sandwich Spread 1 1 - - - Sausage Meat, Beef 1 1 - - - Sausages, Beef 3 2 - - - Sausage, Breakfast 1 1 - - - Sausages, Pork 1 1 - - - Sausage, Liver 3 3 - - - Sausage, Frankfurt 2 2 - - - Sausage, Luncheon 1 1 - - - Saveloys 1 1 - - - Sea Food Dressing 1 1 - - - Soda Water 1 1 - - - Split Peas 1 1 - - - Steak and Kidney Pie 4 4 - - - Steak and Kidney Pudding 1 1 - - - Steak Pie 1 1 - - - Suet, Packed 3 3 - - - Sponge Mixture 1 1 - - - Sugar, Caster 1 1 - - - Sugar, Brown 2 2 - - - Sugar, Icing 2 2 - - - Surgical Spirit 1 1 - - - Sweets 7 7 • - - Soup Powder 2 2 - - - Sage and Onion Stuffing 2 2 - - - Sulphur Ointment 1 1 - - - Stout 1 1 - • - Syrup of Figs 1 1 - - - Table Salt 1 1 - - - Tapioca 1 1 - - - Tea 2 2 - - - Tinned Asparagus 1 1 - - - Tinned Broad Beans 1 1 - - - Tinned Runner Beans 1 1 - - - Tinned Fruit 1 1 - - - Tinned Peas 3 3 - - - Tinned Vegetables 2 2 - - - Tinned Soup 1 1 - - - Tinned Fish 3 3 - - - 79  Total Samples Genuine Not Genuine Prosecutions Convictions Tinned Meat 3 3 - - - Tinned Mushrooms 1 1 - - - Tinned Tomatoes 1 1 - - - Tinned Sausages 2 2 - - - Tinned Tomato Juice 1 1 - - - Tomato Puree 1 1 - - - Tomato Ketchup 1 1 - - - Veal and Ham Roll 1 1 - - - Vinegar 1 - 1 - - Vitamin Iron Tablets 1 1 - - - Vitamin "A" and D Tablets 1 1 - - - Vitamin "A" Capsules 1 1 - - - Vitamin "C" Tablets 2 2 - - - Vitamin Capsules 1 1 - - - Whiskey 7 7 - - - Wine 1 1 - - - Hitch Hazel 1 1 - - - Yeast Tablets 1 1 - - - Yogurt 1 1 - - - Totals 604 599 5 - - 80 Result of Analysis of Milk Samples The samples of milk were obtained as follows:- Taken on Milk Rounds 80 Taken at Dairies 109 Taken at Institutions 7 Total 196 Average composition of samples:- Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.70 (Legal standard is 8.5%) Milk Fat 3.51 (Legal standard is 3%) South Devon and Channel Island Milk Solids not fat 9.05 (Legal standard is 8.5%) Milk Fat 4.56 (Legal standard is 4%) DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Buttered Rolls Consisted of bread rolls spread with margarine Vendor warned. Subsequent sample proved satisfactory. Chopped Pork This article consisted of pork luncheon meat containing 85 per cent of meat and 6 per cent of starch whereas chopped pork is a description applicable only to a meat product with no added starch and containing about 95% of meat. No legal standard exists for this product at present but legislation relating to canned meat products is expected to be introduced in the near future Malted Milk These tablets had become soft through long storage and absorption of moisture and were unsuitable for sale. Stocks of this article were withdrawn from sale and destroyed. Shoulder Ham The word "Ham" is applicable only to meat from the hind leg of the pig. Vendor warned Vinegar This article contained 3.84 per cent of acetic acid whereas vinegar should contain not less than 4 per cent of acetic acid. Vendor and manufacturer warned. Subsequent sample proved satisfactory. 81 Summary of Inspections made by the Public Health Inspectors, and other Departmental work. Total number of houses Inspected for bousing defects under Public Health or Housing Acts 2,520 Houses inspected where zymotic diseases have occurred 152 Houses inspected following applications for certificates of disrepair 57 Inspections of underground rooms 22 Special inspections in connection with the Housing survey 102 Houses Inspected for overcrowding conditions 65 Re-inspections of work outstanding on housing notices 6,935 Number of visits regarding infectious diseases 608 Number of visits regarding food poisoning 57 Inspections of drainage work during repair 1,738 House drains tested with smoke and colour - routine and complaint 888 House drains tested with smoke (on written application) 11 House drains tested with smoke during repair 16 House drains tested with water during repair 114 Inspections of cesspools and earth closets 9 ,, ,, schools and school sanitary conveniences 101 ,, ,, public conveniences 213 ,, ,, verminous premises 41 ,, ,, ponds and ditches 81 ,, ,, yards, stables and passages 132 ,, ,, theatres, cinemas, halls, etc. 87 ,, ,, pig styes 21 ,, ,, tents, vans and similar structures 46 Inspections and re-inspect ions in connection with Smoke Control Orders 15,739 Sundry visits regarding Smoke Abatement 775 Smoke Observations 140 Visits regarding exhumation 1 Visits to premises for food condemnation 502 Inspections of swimming baths 19 ,, ,, wells 3 ,, ,, gathering grounds of water supply 30 ,, ,, gipsy encampments, camps, fairs, etc. 11 ,, ,, offices 15 ,, ,, rivers and streams for pollutions 148 ,, ,, hairdressers 118 Pood and Drugs Acts: Food and drugs samples taken 604 rood and Drugs Acts: Milk samples taken (special designations) 196 Ice Cream samples taken (bacteriological) 219 Samples taken of Fertilizers and Feeding Stuffs 22 ,, ,, swimming baths water 177 ,, ,, drinking water (bacteriological and chemical) 283 ,, ,, subsoil water 2 ,, ,, rivers, streams, etc 11 ,, ,, private wells 33 ,, ,, rag flock and other filling materials 9 ,, ,, sundry specimens (food poisoning etc.) 41 inspections under Merchandise Marks Act 550 ,, ,, of butchers premises 243 ,, ,, meat premises (wholesale) 1,518 ,, ,, poultry and game dealers premises 191 ,, ,, fishmongers premises 74 ,, ,, fried fish premises 51 ,, ,, grocers premises 541 ,, ,, fruiterers and greengrocers premises 686 ,, ,, bakers premises - including bakehouses 171 ,, ,, dairies 32 ,, ,, Milk shops 47 ,, ,, general shops and their premises 15 82 Inspections of premises where cooked meats etc. are prepared or sold 25 Inspections of confectioners premises 303 ,, ,, confectionery manufacturers premises 15 ,, ,, cafes, snack bars, canteens, hotels and their kitchens 632 ,, ,, school kitchens and serveries 85 ,, ,, hospital kitchens 14 ,, ,, ice cream manufacturers premises 17 ,, ,, ice cream vendors premises 281 ,, ,, ice cream barrows and carts 14 ,, ,, market and barrows 81 ,, ,, other food premises not enumerated above 240 ,, ,, premises where offensive trades are conducted 1 ,, ,, factories with mechanical power 302 ,, ,, factories without mechanical 35 ,, ,, works of building and engineering 65 ,, ,, outworkers premises 17 Visits to employers of outworkers 1 Inspections of shops (under Shop Acts) 1,074 Special early closing, evening and Sunday trading patrols of shops 488 Appointments kept with owners, builders, etc 1,940 Investigations of complaints other than housing matters 1,168 Re-inspections of works outstanding(other than houses) 3,313 Inspections under Hydrocyanide Regulations ,, ,, Fertilizers and Feeding Stuffs Act 3 ,, ,, Diseases of Animals Act 33 ,, ,, Pets Act 21 ,, ,, Rag Flock and Other Filling Materials Act 6 ,, ,, Pharmacy and Poisons Act 66 ,, ,, Noise Abatement Act 529 Sundry Inspections and Visits 3,948 Visits regarding rats and nice infestations 8,907 Informal Notices outstanding 31.12.61 895 Informal Notices served 1,084 Informal Notices complied 1,183 Informal Notices outstanding 31.12.62 769 Statutory Notices outstanding 31.12.61 128 Statutory Notices served 397 Statutory Notices complied 361 Statutory Notices outstanding 31. 12.62 164 Total number of callers and complaints received at the office 5,106 Total number of letters received at the office 9,973 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1962 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 268 Conditions causing dampness: Defective roofs 392 Defective window frames 270 Defective walls, etc. 186 Want of efficient damp-proof course 7 Defective gutters and downspouts 224 83 Other structural defects: Defective plaster 327 Cleansing and redecoration required 4 Defective floors and stairs 110 Insufficient ventilation under floor 21 Defective brickwork, sills, lintels, chimneys 140 Defective stoves and fireplaces and flues 30 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 133 Defective W.C' s 130 Defective drainage 55 Stoppages in drains 64 Defective water services and tanks 5 Domestic nuisances: Want of cleanliness 5 Verminous conditions 8 Other nuisances and infringements: Offensive accumulations 43 Overcrowding 3 Sundry nuisances or defects 15 Particulars not Inserted in Rent Book (Housing Act) 13 Public Urinals 3 Noise 11 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT Food cupboards defective or required 12 (3) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, ETC. Defective Yard Paving 32 Want of a sanitary dustbin 16 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 3 W.C.defective or dirty 10 (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 1 (6) SMOKE ABATEMENT Nuisances observed 16 PUBLIC HEALTH SERVICES 85 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 Nell, this water is filtered before chlorination. The quantity of water supplied during the year 1962 was: From Corporation Wells 2,602, 104, 000 gallons Purchased in bulk from M.W.B. 770, 688, 000 gallons 3,372, 792, 000 (a) Bacteriological Examinations Regular bacteriological examinations were made of the raw waters going into supply following treatment. 501 samples of raw waters and 1,036 samples of treated waters were examined by the chemist and Bacteriologist of the Water Undertaking. In addition, 15 samples of raw waters and 31 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. 86 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 satisfactory quality. (b)Chemical Analysis The arrangements for chemical analysis 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 98 samples of raw waters and 123 of treated waters going into supply. The results of these analyses were uniformly satisfactory. (c)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 271 Chemical 12 (d)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. 87 Nursing Homes - Public Health Act, 1936 Number of Homes Number of Beds provided for:- Maternity Others Total Hones registered during the year - - - - Nones on the Register at the end of the year 14 10 350 360 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 2,465 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 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 1962 2,465 88 PUBLIC MORTUARY AND CORONER'S POST MORTEM ROOM The new premises were opened on March 6th 1962. They provide cold storage facilities for 15 bodies, and a deep-freeze unit for 3 bodies. The Post Mortem Room has two post mortem tables. There are Waiting and Viewing rooms for the relatives, and offices for the Pathologist, the Coroner's Officers and the Mortuary Superintendent. There is an adjoining bungalow for the Superintendent. From March 6th to December 31st, 1962-463 bodies were received and 443 post mortem examinations were performed. 89 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. 1,249 examinations were made during the year by the Medical Staff of the Department including 206 vision tests for drivers. Of these 1,009 were in respect of manual workers, who were classified as follows:- Pit for employment and sick pay scheme 772 Deferred for review 59 Unfit for sick pay scheme 162 Pit for light employment only (Not fit for sick pay scheme) 11 Unfit for employment 5 Total 1, 009 90 MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDRENS' DEPARTMENT During the year 309 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 to 5 year olds daily excepting Saturdays, the remainder being of the "parttime" class, receiving toddlers for mornings only. These part time Play Groups are meeting a need in the residential areas in which they are established, by providing opportunities for young children to play with others of their own age and to accustom them to the break from home, which must inevitably come at the age of 5 years. The registered Minders receive children for the day. They are not encouraged to take children under 2 years. Number registered 31.12.62 Number of children provided for Premises 8 239 Daily Minders 19 161 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. 91 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 88 cases registered:- 14 were due to glaucoma and 35 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had either been performed or would be carried out except 2 patients had 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 62 adult cases are registered with his department, 8 of whom are in special Homes. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 During 1962 no order for compulsory removal was required. 4 cases were reported as possibly requiring this action, but on investigation were dealt with by other means. Admitted to Queen's Hospital voluntarily - 1 Admitted to Mayday Hospital voluntarily - - Admitted to local authority Hostel voluntarily - 1 Awaiting admission to a Hostel (on 31.12.62.) - - Admitted to private Nursing Home - - Provided with additional help (e.g. Home Help and/or Nurse) and remaining under observation - 2 Died before action could be taken Total - 4 3 of the above were women and 1 man. Their ages ranged from 12 to 83. APPENDIX TABLES 93 94 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 47 5 3 11 50 403 385 602 1,506 F 28 1 4 6 35 229 349 1021 1,673 Tuberculosis (Respiratory) M - - - - 1 4 2 2 9 F - - - 1 - 1 1 - 3 Tuberculosis (other forms) M - - - - 1 - - - 1 F - - - - - - 1 - 1 Syphilitic Diseases M - - - - - 1 4 3 8 F - - - - - 1 - 8 9 Diphtheria M - - - - - - - - - F - - - - - - - - - Whooping Cough M - - - - - - - - - F - - - - - - - - - Meningococcal Infections M - 1 - - - - - - 1 F - - - - - - - - - Acute Poliomyelitis M - - - - - - - - - F - - - - - - - - - Measles M - - - - - - - - - F - - - - - - - - - Other Infective and Parasitic diseases M - - - - - 1 - 1 2 F - - - - 1 1 - 2 4 Total Infective and Parasitic diseases (including Tuberculosis) - 1 _ 1 3 9 8 16 38 Malignant neoplasm, stomach M - - - - 3 21 12 9 45 F - - - - 1 7 6 17 31 lung,bronchus M - - - - 4 72 44 26 146 F - - - - 1 10 10 9 30 breast M - - - - - - - - - F - - - - 2 32 13 20 67 uterus F - - - - 2 4 6 1 13 Other malignant and lymphatic neoplasms M - 1 - . 6 48 43 42 140 F 1 - - 1 5 34 44 57 142 Leukaemia; aleukaemia M - - - - 2 1 4 1 8 F - - 2 - - 1 2 1 6 Total all forms of Cancer 1 1 2 1 26 230 184 183 628 Diabetes M - - - - - - 2 3 5 F - - - - - 2 7 7 16 Vascular lesions of Nervous System M - - - - 1 38 42 104 185 F - - - - 4 23 60 245 332 (a) Coronary disease, angina M - - - - 8 107 92 109 316 F - - - - - 23 68 168 259 (b) Hypertension, with heart disease M - - - - - 3 6 7 16 F - - - - - 1 14 28 43 (c) Other heart diseases M - - - 1 3 13 13 63 93 F - - - 1 1 19 27 174 222 (d) Other circulatory diseases M - - - - - 7 11 35 53 F - - - - 3 16 22 55 96 Total heart and circulatory diseases - - - 2 20 252 364 998 1,636 95  Sex 0- 1- 5- 15- 25- 45- 65- 75- Total Influenza M - - - - - 1 1 4 6 F - - - - 1 - 2 4 7 Pneumonia M 6 - - - 3 4 12 58 83 F 3 - - - 3 10 21 87 124 Bronchitis M - - - - - 36 50 59 145 F - - - 1 - 5 9 46 61 Other diseases of respiratory system M - - - - 1 2 4 4 11 F - - - - - 3 - 6 9 Total diseases of respiratory system - including influenza and excluding tuberculosis 9 - - 1 8 61 99 268 446 Ulcer of stomach and duodenum M - - - _ 1 4 3 12 20 F - - - - - 1 5 2 8 Gastritis, enteritis and diarrhoea M - 1 - - - - 1 3 5 F 1 - - - - 1 2 6 10 Nephritis and nephrosis M - - - - 2 5 1 1 9 F - - - 1 1 - - 2 4 Hyperplasia of prostate Pregnancy, childbirth and abortion M - - - - - 4 4 17 25 F - - - - - - - - - Congenital malformations M 5 1 . . . _ 2 . 8 F 6 - 1 - - - 2 1 10 Other defined and ill-defined diseases M 34 - - 2 2 15 21 31 105 F 17 1 - - 3 24 23 59 127 Total Miscellaneous Diseases 63 3 1 3 9 54 64 134 331 Motor vehicle accidents M - 1 2 7 4 5 3 2 24 F - - 1 1 1 - 2 5 10 All other accidents M 2 . 1 . 2 3 5 5 18 F - - - - 1 3 2 10 16 Suicide M - - - 1 6 8 3 1 19 F - - - 5 7 - 1 13 Homicide and operations of war M - - - - - - - - - F - - - - - - - - - Total - accidents, suicide and violence 2 1 4 9 19 26 15 24 100 Totals 75 6 7 17 85 63 2 734 16 23 3, 179 96 CANCER Deaths from Cancer occurred at the following Ages:- Age Period Male Female Total Under 25 years 1 4 5 25 and under 35 years 2 5 7 35 and under 45 years 12 7 19 45 and under 65 years 142 88 230 65 years and over 181 186 367 Total 339 289 628 Sites of Fatal Cancer Site Mal e Female Total Percentage of Total Skin 8 3 11 1.75 Oesophagus 9 5 14 2.23 Stomach 45 31 76 12.11 Liver . - - - Bowel 22 31 53 8.44 Rectum 5 12 17 2.70 Bladder 12 6 18 2.87 Prostate 25 - 25 7.37 Larynx and Pharynx 7 1 8 1.27 Uterus - 13 13 4.50 Breast - 67 67 23.18 Ovary - 17 17 2.70 Pancreas 14 11 25 3.98 Gall Bladder and Duct 2 2 4 0.64 Tongue and Mouth 1 4 5 0.80 Bones 3 3 6 0.96 Lungs and Bronchus 146 30 176 28.03 Kidney 1 - 1 0.16 Brain and Nervous System 11 10 21 3.34 Lymphatic Glands and Connective Tissue 3 1 4 0.64 Haematopoitic Tissues 1 1 2 0.32 Hodgkin's Disease 2 1 3 0.48 Leukaemia 8 6 14 2.23 Genital Organs 1 4 5 0.80 Antrum - 1 1 0.16 Ear 2 - 2 0.32 Thyroid - 4 4 0.64 Maxilla 1 - 1 0.16 Neck 1 - 1 0.16 Undefined 9 25 34 5.41 Total 339 289 628 97 WARD STATISTICS Estimated Population Births *Birth flats Deaths *Death Rate Death under 1 ye err Deaths under I year per 1.000 Births Deaths from Diarrhoea (under 2 year) *Death Rate from Diarrhoea (under 2 year) Deaths from Bronchitis and Pneumonia Death Bate from Bronchitis and Pneumonia Deaths from Pulmonary Tuberculosis *Death Rate from Pulmonary Tuberculosis Deaths from Non-Pulmonary Tuberculosis Death Rate from Non-Pulmonary Tuberculosis Deaths from Heart and Circulatory Diseases *Death Rate from Heart and Circulatory Diseases Deaths from Cancer Death Bate from Cancer Natural Increase of births over deaths Upper Norwood 18589 300 16.1 237 12.7 4 13 - - 24 1.3 1 0.05 - - 129 6.9 40 2.2 +63 Norbury 16168 198 12.2 221 13.7 3 15 1 0.06 19 1.2 - - 1 0.06 121 7.5 55 3.4 -23 Vest Thornton 15262 258 16.9 169 11.1 3 12 - - 23 1.5 1 0.07 - - 85 5.6 42 2.7 +89 Bensham Manor 15849 264 16.7 193 12.2 7 27 - - 32 2.0 1 0.06 - - 89 5.6 37 2.3 +71 Thornton Heath 15325 261 17.0 181 11.8 7 27 - - 25 1.6 1 0.07 - - 81 5.3 44 2.9 +80 South Norwood 16409 354 21.6 186 11.3 6 17 - - 18 1.1 1 0.06 - - 93 5.7 45 2.7 +168 Woodslde 14130 287 20.3 184 13.0 3 10 - - 24 1.7 1 0.07 - - 97 6.9 31 2.2 +103 Eas t 18259 199 10.9 198 10.8 2 10 - - 17 0.9 2 0. 11 - - 103 5.6 43 2.4 +1 Shirley 13618 189 13.9 114 8.4 4 21 - - 8 0.6 - - - - 67 4.9 26 1.9 +76 Addlscoobe 15326 321 20.9 220 14.4 4 12 - - 22 1.4 1 0.07 - - 107 7.0 49 3.2 +101 Whltehorse Manor 13230 342 25.9 191 14.4 10 29 - - 24 1.8 - - - - 82 6. 2 35 2.6 +151 Broad Green 13424 255 19.0 156 11.6 4 16 - - 30 2.2 2 0.15 - - 62 4.6 32 2.4 +69 Central 9154 186 20.3 146 15.9 1 5 - - 20 2.2 - - - - 75 8.2 24 2.6 +40 Waddon 15421 231 15.0 176 11.4 4 17 - - 21 1.4 - - - 0.07 94 6.1 38 2.5 +56 South 16495 241 14.6 308 18.7 6 25 - - 41 2.5 - - - - 16 2 9.8 54 3.3 -67 Addington 27031 554 30.5 100 3.7 7 13 - - 10 0. 4 1 0.04 - - 44 1.6 22 0.8 +454 The Borough 253690 4,440 17. 5 3,179 12.5 75 17 1 0.00 413 1.6 12 0.05 2 0.01 1,615 6.4 628 2.5 +1460 "Death Rate per 1,000 population and excluding those who died in Queen's Hospital 98 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1943 - 1962 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate In font Mortality Rate 1943 3,785 2 0.53 37 1944 3,680 8 2.17 44 1945 3,675 9 2.45 41 1946 4,937 3 0.61 31 1947 5,211 10 1.92 38 1948 4,597 2 0.44 27 1949 4,102 5 1.22 29 1950 3,787 2 0.53 26 1951 3,697 3 0.81 19 1952 3,548 2 0.56 20 1953 3,526 3 0.85 21 1954 3,649 3 0.82 19 1955 3,408 2 0.59 21 1956 3,604 - - 19 1957 3,510 3 0.84 18 1958 3,928 4 1.02 18 1959 3,874 1 0.26 21 1960 4,069 1 0.25 20 1961 4,243 1 0.24 15 1962 4,505 - - 16.9 99 DETAILS OF INFANT MORTALITY The following table gives the cause of death during the first month of life (Neo-natal mortality):- (1) Complications of Labour- Trauma, at Birth 7 Anoxia 1 8 (2) Foetal States - Congenital Malformities 9 Atelectasis 4 Haemorrhagic Disease of Newborn - 13 (3) Prematurity 36 36 (4) Post-Natal Causes 6 6 Total 63 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1,000 Births 1962 1961 1962 1961 Injury at Birth and Congenital 24.0 41.3 4.05 6.21 Premature Births 48.0 25.4 8.10 3.82 Respiratory Diseases 12.0 19.0 2.03 2.87 Atelectasis, Debility and Marasmus 5.3 3.2 0.90 0.48 Diseases of Digestion 1.3 1.6 0.23 0.24 Other Causes 9.4 9.5 1.58 1.43 *These from Gastro Enteritis Perinatal Deaths Stillbirths - 65 Perinatal rate - 25.2 per 1,000 Deaths in first week - 57 total (live and still) births Causes of Death in first week Prematurity - 36 Infective cellulitis of neck - 1 Congenital conditions - 5 intestinal obstruction - 1 Atelectasis - 4 Broncho pneumonia - 1 Birth trauma - 7 Prematurity was a contributory Ante-partum haemorrhage - 2 cause in 6 cases. 100 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CAUSES OF DEATH 1st day 2nd day 3rd day 4 th day 5th day 6th day 7th day 8th - 14th day 15th - 21st day 22nd - 28th day Total Under 1 month 1 + months 2 + months 3 + months 4 + months 5 + months 6 + months 7 + months 8 + months 9 + months 10 + mon ths 11 + months TOTAL All Causes 45 3 4 2 2 1 - 5 1 - 63 7 - 2 - - 2 - - - - 1 75 Meningo-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - - - - - - - - - - - 1 - - - - - 1 Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (all forms) - 1 - - - - - 2 - - 3 4 - 1 - - 1 - - - - - 9 Diarrhoea and enteritis - - - - - - - - - - - 1 - - - - - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 2 - 1 2 1 1 - 1 1 - 9 2 - - - - - - - - - - 11 Premature Birth 33 1 2 - - - - - - - 36 - - - - - - - - - - - 36 Atrophy, Atelectasis, Debility and Marasmus 3 - - - 1 - - - - - 4 - - - - - - - - - - - 4 Injury at Birth 5 l 1 - - - - - - - 7 - - - - - - - - - - 7 Haemorrhagic disease of newborn - - - - - - - - - - - - - - - - - - - - - - - Other Causes 2 - - - - - - 2 - - 4 - - 1 - - - - - - - 1 6 TOTALS 45 3 4 2 2 1 - 5 1 - 63 7 - 2 - - 2 - - - - - 75 101 MIDWIFERY SERVICE The work of the municipal midwives was as follows:- 1. The number of maternity deliveries by Municipal Midwives on the district in the year 1,422 2. The number of live births 1,418 3. The number of forceps deliveries 4 4. The number of still births 4 5. The number of neo.natal deaths Nil 6. The number of premature live born infants 4 (1) 36 weeks - 4 lbs. Transferred to Hospital. (2) 35 weeks - 4 lbs. Transferred to Hospital. (3) 35 weeks - 4 lbs. 4ozs Transferred to Hospital Emergency - Unbooked (4) 34 weeks - 4 lbs. 6ozs Transferred to Hospital. 7. The number of patients who received Trilene 12 8. The number of patients who received Gas-Air Analgesia 1,320 9. The number of cases of P.P.H. (Home 22 - Trans, to Hospital 10) 32 10. The number of cases of manual removal of placenta at home Nil 11. The number of patients who received blood transfusion at home 6 12. The number of cases to which Plying Squad was called 10 13. The number of cases of toxaemia of pregnancy treated at home 8 14. The number of cases of prolonged labour (over 24 hours) 15 15. The number of breech deliveries 4 16. The number of twins delivered 1 set 17. The number of triplets Nil 18. The number of cases of Puerperal Pyrexia 30 (Genital 5 (Extra-Genital 25 19. The number of congenital malformations 10 (Talipes 6 (Hypospadias 2 (No Arms 1 (Mongol 1 20. Patients given Pethedine 668 21. Patients sent to Hospital 354 (Ante-natal 270 (During Labour 66 (After Delivery 18 22. Patients sent home for nursing 837 (Home booked 324 (Hospital booked 513 102 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion - Other Causes 8 Miscarriage - Total 8 FOR COMPLICATIONS DURING LABOUR Breech 3 Eplsiotomy 11 Malpresentation 1 Post-partum haemorrhage 20 Premature Labour 11 Adherent and Retained Placenta 7 Delayed Labour 24 Torn Perineum 71 Ante-partum haemorrhage 17 Other Causes 21 Total 186 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 23 Pain in Breasts 12 Pain in Legs 1 Other Causes 34 Rhesus Negative Blood 16 Total 86 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 26 Still Birth 5 Other Causes 14 Total 45 Grand Total 325 Reasons for the discontinuance of breast feeding are no longer notified. 103 Midwife Mi1eage Deliveries Midwifery Maternity Gas and Air Ante-Natal Visits Post-Natal Visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnormal Midwives Pupils Midwives Pupils 1. 1938 - - - - - - - - - - - - - 2. 3107 101+5 68 1 32 - 89 642 323 1228 1085 140 150 43 3. 3265 54+2 44 3 6 1 50 474 - 1103 - 60 56 4 4. 7225 53+3 37 1 14 1 52 828 - 1112 - 69 57 3 5. 3114 90+3 74 5 9 2 79 670 244 1357 863 107 103 6 6. 3537 93+5 63 2 27 1 90 812 - 1204 - 63 74 11 7. 3694 57+4 51 1 5 - 52 654 - 984 - 85 82 12 8. 4094 97+4 66 2 28 1 91 687 120 1067 316 115 124 26 9. 3739 52+9 50 2 - - 49 657 177 1088 994 81 99 16 10. 4159 99+5 75 1 21 2 92 472 350 1118 1005 102 117 13 11. 2960 94+7 52 - 41 1 88 708 130 1028 931 138 151 15 12. 5623 75+2 47 - 28 - 74 761 417 1181 954 130 130 5 13. 5287 86+3 53 6 23 4 81 911 - 1151 - 66 76 18 14. 4251 79+6 62 1 15 1 72 670 300 1088 1088 155 170 17 *15. 1090 4 2 - 2 - 3 9 - 334 - 1 10 2 *16. 3414 50 43 - 7 - 45 464 - 692 - 51 55 15 17. 3867 63+1 31 - 31 1 58 928 241 1060 942 154 139 17 18. 2748 62 52 - 9 1 52 402 309 570 847 80 79 20 19. 3267 88+6 63 1 20 4 87 640 320 1282 1182 160 157 29 20. 3464 70+3 43 2 23 2 67 376 - 974 - 59 57 18 °21. Bicycle 21+2 19 - - 2 19 105 - 534 - 19 20 1 °22. 313 16+1 12 - 4 - 15 43 - 295 - 19 18 1 °23. 1003 14 12 - 2 - 13 253 - 309 - 33 30 2 °24. Bicycle 4 3 - 1 - 4 41 - 117 - 4 5 - Part Time Midwives 25. 3890 - - - - - - 12 - 1133 - - - 41 26. 4828 - - - - - - 15 - 1631 - - - 31 27. 3204 - - - - - - 1 - 1228 - - - 14 28. 1057 - - - - - - - - 754 - - - 22 29. 455 - - - - - - - - 161 - - - - Total 88184 1422+71 1022 28 348 24 1322 12235 2931 25783 10207 1891 1959 402 (Continued on next Page) 104 No. *15 Commenced Service 13.2.62 - Left 18.5.6 2 No. *16 Left Service - 3.9.62 No. * 18 Retired - 25.8.62 No. *26 Part Time - Commenced 2.4.62 Left Service 7.10.62 - Not yet replaced No.*29 Left Service - 17.2.62 replaced by No. 27 - 2.4.62 No.o21 Commenced Service 30.4.62 (extra midwife for New Addington to make off duty rota and six weeks holiday possible.) No. °22 Commenced Service 1.5.62 - replaced *15 No.o23 Commenced Service 3.9.62 - replaced *16 No.°24 Commenced Service 5.11.62 - Replaced *18 Pupil Midwives - 10 *No.18 - Pupil Midwife taken over by No.8 - 26.8.62 Deliveries + following number of deliveries = number of cases attended by midwives during labour, but finally sent into hospital for delivery - i.e. 101 + 5 = 101 cases delivered + 5 cases attended in labour but transferred to hospital for delivery. 105 CARE OF PREMATURE INFANTS h) Number of live premature babies notified during 1962 who were *born - (i) at home 29 (ii) in private nursing homes 1 (iii) in hospital* 239 (2) The number of those born at home - who were nursed entirely at home 26 who were transferred to hospital on or before the 28th day 3 who died during the first 24 hours - who survived at the end of the month 29 (3) Hie number of those born in private nursing homes - who died during the first 24 hours - who survived at the end of the month 1 (4) Number of those born in hospital - who died during the first 24 hours 32 who survived at the end of one month 207 I5I Number of premature still births who were born - (1) at home 4 (ii) in private nursing homes (iii) in hospital 36 *The group under this heading will include cases which may be bom in one hospital and transferred to another. 106 THE WORK OF THE HEALTH VISITORS - MAT E R N I TY AND CHILD WELFARE - 1962 Visits Miss Batt Miss Bird Mrs. Blackburn Miss Blackmore Left 27.4.62 Miss Blest Miss Brown Kenyon Left 26.4.62 Miss Butcher Mrs. D. Cannell Com. 17.9.62 Mrs. Collins Miss Devaney Miss Edridge Miss Emms Miss Flaxman Com. 5.2.62 Miss Gabian Mrs. Glucksmam Miss Grace Miss Hall Mrs. Hartog Miss Hastings Miss Hawkins Mrs. Ivens Mrs. Laing Miss Llewellyn Mrs. McAlister Com. 3.9.62 Mrs. Mayo Miss Otway Miss Partridge Miss Vince Mrs. Wilson Miss Wybrow Total 1962 Total 1961 Infants under 1 year - First Visits 76 88 172 32 201 51 236 44 205 126 102 197 145 147 276 167 200 184 185 245 291 127 146 61 128 158 144 106 154 181 4875 4889 Re-Visits 392 346 761 64 287 90 416 115 523 402 366 645 333 454 1062 632 516 544 404 545 288 309 467 80 502 378 360 817 588 400 13086 13747 Children 1-2 years - First Visits 1 9 - 3 85 6 - 2 23 38 11 - - 5 17 3 20 17 27 13 47 7 9 4 3 3 40 - 40 8 441 375 Re-Visits 178 306 276 64 106 72 240 85 296 310 248 439 198 258 500 178 305 343 584 240 78 69 228 53 457 255 236 699 383 380 8064 8483 Children 2-5 years - First Visits 1 11 - 2 204 5 - - 22 42 9 - - 9 27 6 30 36 15 40 53 7 16 3 - 10 28 2 40 18 636 509 Re-Visits 291 308 418 88 210 148 359 145 364 354 564 375 376 613 794 365 413 731 657 453 87 148 399 25 583 413 656 725 458 805 12528 13666 Expectant Mothers - First Visits 7 14 6 6 25 9 25 - 56 1 15 17 25 21 53 15 44 32 11 22 16 5 56 11 2 77 27 12 60 51 721 740 Re-Visits 2 1 25 2 7 1 5 - 35 1 2 24 1 10 39 3 37 2 12 6 7 3 17 5 16 30 26 4 9 - 332 509 Still Births - - 2 - 1 3 - - - - - 2 - - - - - - 1 1 - 1 - - - - - - - 11 9 Deaths under 1 year - 1 1 - 1 1 - - - 1 - 1 - - 1 - - 1 - 1 - - 1 1 - - 1 - - - 12 16 Miscellaneous Visits 61 129 1 8 14 49 85 11 - 74 49 72 18 83 107 63 241 3 - 217 163 39 95 35 1 110 71 9 - 26 1834 4728 Ineffective Visits 158 369 663 40 268 59 389 95 363 415 153 184 254 494 390 434 511 461 342 356 293 312 382 88 461 412 147 265 321 314 9393 10576 Totals - 1962 1167 1582 2325 309 1409 494 1755 497 1887 1764 1519 2156 1350 2094 3266 1866 2317 2354 2237 2139 1324 1026 1817 366 2153 1846 1736 2639 2053 2183 51630 - Totals - 1961 1111 2811 1984 898 1481 1933 1882 - 2155 957 1713 2163 - 2325 3583 616 2822 2967 1848 2122 648 646 - - 2215 1120 1627 2096 2049 2787 - *58247 Includes Health Visitors rtio left In 1961 Number of families or households visited during the year 10,994 106 ATTENDANCES AT INFANT CENTRES- 1962 Addlngton Wednesday A.M. Addingtoo Wednesday P.M. Bensham Manor Monday A.M. Bensham Manor Monday P.M. Boston Road Thursday P.M. Brighton Road Wednesday P.M. East Croydon Thesday A.M. East Croydon Friday P.M. Fairchlldes Rriday P.M. Falcanwood Wednesday (Alt.) P.M. Lodge Road Thursday A.M. Lodge Road Thursday P.M. Monks Hill Thursday A.M. Monks Hill Thursday P.M. Monks Orchard Monday P.M. Norbury Wednesday A.M. Norbury Wednesday P.M. St Andrew's Monday P.M. St Jude's Tuesday A.M. St.Jude's Tuesday P.M. St. Oswald's Thursday P.M. St. Paul's Wednesday P.M. 8t. Pail's Friday P.M. Selhurst Monday P.M. Siirley Thursday P.M. South Crqydcn Thursday P.M. South Norwood Tuesday P.M. South Norwood Friday P.M. Spring Park Monday P.M. Spring park Friday P.M. Upper Norwood Wednesday A.M. Upper Norwood Wednesday P.M. Waddon Wednesday P.M. Woodside Friday A.M. WoodBide Friday P.M. Total - 1962 Total - 1961 New Cases under 1 year 134 190 116 140 140 107 145 197 50 39 139 186 19 47 57 90 176 153 85 114 150 80 100 140 89 133 790 212 97 9 19 210 53 105 123 4634 3759 No. of Re-attendances 1804 1568 1510 1852 1607 2070 2248 2382 481 543 1795 1565 229 750 690 1678 1629 1961 1343 1520 1812 1004 1173 1557 958 1818 1940 2022 1490 49 134 2113 469 1062 1282 48108 48035 New Cases over 1 year 52 73 55 78 22 2 21 20 11 2 8 23 2 9 17 12 14 16 11 8 7 20 9 17 19 17 29 26 22 2 6 18 12 19 22 701 674 No. of Re-attendances 1048 983 1266 1362 813 796 672 793 296 413 295 339 208 787 372 752 758 619 523 597 662 405 340 430 348 609 285 290 1025 25 28 685 434 365 494 20117 21313 Attendances of Children 0-5 3038 2814 2947 3432 2582 2975 3086 3392 838 997 2237 2113 458 1593 1136 2532 2577 2749 1962 2239 2631 1509 1622 2144 1414 2777 2444 2550 2634 85 187 3026 968 1551 1921 72960 73799 Consultations with Doctor 1137 1054 1070 1156 1231 747 1087 1288 318 379 1027 1063 16 720 558 769 880 1095 780 857 931 459 368 905 176 716 865 980 1135 48 64 919 353 828 904 26883 27905 No. of Sessions 51 51 49 49 50 51 51 51 50 26 51 51 52 52 49 51 51 49 51 51 52 36 50 49 49 52 51 51 49 7 8 51 25 51 51 1619 1827 Expectant Mothers No. of cases - - - - - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 7 No. of Re-attendances - - - - - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 4 Total Attendances of Expectant Mothers - - - - - - - 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - 4 11 Total Attendances 3038 2814 2947 3432 2582 2975 3086 3396 838 997 2237 2113 458 1593 1136 2532 2577 2749 1962 2239 2631 1509 1622 2144 1414 2577 2441 2550 2634 85 187 3026 968 1551 1921 72964 73810 Average per Session 1962 59.6 55.2 60.1 70.0 51.6 58.3 60.5 66.6 16.8 38.3 43.9 4L4 8.8 30.6 23.2 49.6 50.5 56.1 38.5 43.9 50.6 41.9 32.4 43.8 28.9 49.6 47.9 50.0 53.8 12.1 23.4 59.3 38.7 30.4 37.7 45.1 - Average per Session 1961 53.1 7.6 56.7 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 65.8 39.9 41.1 61.0 41.5 26.2 38.6 27.5 52.4 41.6 42.6 44.6 - - 63.4 32.4 26.9 42.1 - 45.4 108 HOME NURSING Staff at 31.12.62 Superintendent Deputy Superintendent 2 Assistant Superintendents 38 Queen's Nurses (including 5 males) 3 S. R.N's (1 part-time) 4 S.E.A.N. Nurses (including 1 male) 6 Queen's Students (including 1 male) Summary of work carried out during the year under revieu:- Patients remaining on books from 1961 882 New Patients 3,278 Total 4,160 New Patients:- Medical 1,897 Surgical 1,336 Gynaecological 33 Obstetric 7 Maternity 5 Total 3,278 Specially classified Cases Visits Tuberculosis 103 3,913 Pneumonia 79 1,169 Maternity Complications 7 32 Infectious Diseases (measles) 5 33 Children under five years 107 Over 65 years old 2,6 09 90,790 Visits:- Termination of Cases:- Convalescent 1,852 Hospital 734 Died 413 Removed for other causes 244 Still on books 917 Total 4,160 109 Total visits January 11,950 February 10,152 March 11,412 April 10,962 May 10,968 June 9,915 July 10,077 August 10, 303 September 9, 499 October 10,701 November 11, 123 December 11,651 Total 128,713 REHABILITATION OF ELDERLY PERSONS Patients visited by Rehabilitation Nurse, 1962:- Female 40 Male 16 56 Admitted to hospital 8 Transferred for General Nursing 5 Recoveries (Rehabilitated) 30 Died 1 Remaining on books 12 Total 56 Ages: 40 - 49 years 1 50 - 59 years 5 60 - 69 years 12 70 - 79 years 20 80 - 89 years 15 90 - 95 years 3 Illnesses: Hemiplegia 28 Arthritis, Rheumatism & Fibrositis 11 Lower Limb Fracture or Amputation 5 Other conditions (Parkinson's Disease, Carcinoma, Cardiac) 12 110 In the age group 30 - 59. 2 cases of Hemiplegia - both walking with a little difficulty, 1 case of Parkinson's Disease - no improvement at present - remaining on books. 1 case of Thrombosis & Amputation of left leg - Walking well with arm crutches, stump ready for artificial leg. 1 case of Arthritis & fractured hip - walking fairly well on crutches - remaining on books. 1 case of Disseminated Sclerosis - patient feeding himself more easily - remaining on books. In the age group go - 95 years. 1 case of Fractured Femur & Arthritis - patient responded well considering age, first walking with crutches and later with Zimmer walking aid. 1 case of Arthritis & Senility - Able to walk with assistance, 1 case of Arthritis & fall - patient walked fairly well considering age. M. AND C. W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year:- Complaint No. of Cases Total M F Bow Legs 2 - 2 Knock Knees and Flat Feet 6 6 12 Valgus Ankles 7 5 12 Asthma - 2 2 Kyphosis and Scoliosis - 2 2 Torticollis 2 - 2 Pigeon-toes 4 3 7 21 18 39 Total attendances 1,243 111 LOAN OF NURSING EQUIPMENT The Corporation loans equipment and makes a small weekly charge, with exemption for incomes below a certain figure. During the year the undermentioned loans were made:- Bed Pans 160 Bed Rests 114 Mackintosh Sheets 147 Feeding Cups 10 Wheel Chairs 53 Commodes 79 Crutches, pairs 6 Air Cushions 144 Bed Cradles 28 Urinals 71 Air Beds 11 Dunlopillo Mattresses 2 Dunlopillo Cushion 1 Bed Pulley 5 Bed Tables 4 Draw Sheets Cotton 38 Walking Aid 47 Sputum Mugs 1 Enuresis Machines 75 Fracture Boards 4 Bedsteads 8 Steam Kettles Nil Walking Machines 3 Bed Blocks 2 Pifco Massager Nil Foot Suction pump 1 Hydraulic Hoists 4 Walking sticks 1 Foot Support Nil Rubber Suction Bath Mat Nil Dunlopillo Bath Pillow Nil 112 HOME HELP SERVICE Staff at 31.12.62 Supervisor 4 Assistant Supervisors 2 Clerks 13 Whole Time Home Helps 188 Part Time Home Helps 1 Night Attendant Summary of work carried out during the year under review:- Patients remaining on books from 1961 1,306 New Applicants 1,395 Patients carried forward to 1962 1,276 New Applicants (a) Maternity 473 (b) Sickness 922 (c) For Night Service Classification of Cases Attended (a) Maternity 393 (b) Tuberculosis 15 (c) Chronic Sick including Old Age 2,035 (d) Others including Acute Sick 148 Number of Hours of Service Given 222,256 Average Duration of Service Given (a) Maternity 10 days (b) Acute Sickness 10-21 days (c) Chronic Sickness Indefinitely Amount Recovered for Service £8,336.4.11 Rate of Remuneration of Home Helps at 31.13.62 3/11½d per hour - Home Helps 3/9½d ,, - Sick Room Helpers 3/⅞8d ,, - Washing Service 4/⅛4d ,, - Problem Family Helps £9.18.9d per week - Family Helps 10/-d ,, - Disinfestation 113 PROBLEM ETC. FAMILIES SUMMARY OF THE WORK CARRIED OUT DURING 1962 BY THE HEALTH VISITORS SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES, TO PREVENT THEIR NEED FOR ADMISSION AND ALSO TO DEAL WITH THOSE WHO ARE REFERRED BECAUSE OF SPECIAL SOCIAL DIFFICULTIES. Families admitted to Walmer House in 1962 58 Rehoused in private accommodation 9 Rehoused in Council accommodation 42 Rehoused in special problem family units 3 (Of these 2 were accommodated outside the Borough) Visits paid:- Fmily Departments Agents and Contacts 651 133 125 Families without permanent housing at close of year:- 7 Potential Homeless Families - not admitted to Receiving Homes-57 Visits paid:- Family Departments Agents and Contacts 252 6 2 55 Problem Families 73 Visits paid:- Family Departments Agents and Contacts 665 126 101 Families referred by all departments 115 Families referred by various organisations and Private industry 35 Families making direct contact 22 Contacts re employment 40 Families assisted with furniture 63 Family interviews (office) 393 Families referred to other departments and agencies 63 114 DENTAL TREATMENT - M. AND C. W. Expectant Mothers Nursing Mothers Total Young Children New Cases Examined 199 20 219 297 Re-treated 48 7 55 97 247 27 274 394 Expectant and Nursing Mothers Young Children Attendances 559 697 Fillings 169 264 Extractions 202 242 Gas Cases 64 131 Local Anaesthesia 58 4 Scaling and Gum Treatment 99 - Dressings 102 230 Denture Dressings 167 - Silver Nitrate - 136 Treatment Completed 108 278 Number of Sessions (treatment) 279 Dentures Pitted 31 Dentures Repaired 5 Mother Young Children Mothers young Children Ante-Natal 264 - South Norwood - Municipal South Croydon - 1 Midwives 3 - St. Alban's - - Post Natal 2 - Woodside - - Welf are Centres: Norbury - 2 Municipal - - Addington - - East Croydon - 1 St. Andrew's - - Upper Norwood - - waddon - - Holy Trinity - - Boston Road - - St.Oswald's - - st. Jude's - - Bensham Manor - - st. John's (Shirley) - - Falrchildes - - Monks Hill - 1 Good Shepherd - - Crosfield Nursery - - Falconwood - - Referred by West Croydon - - Dental Officers: 389 Mothers: 269 Young Children: 394 Total: 663 115 HOME SAFETY Accidents taken to Hospital by Ambulance during 1962 Type of Accident Under 5 Age Groups 45-64 65+ Sex Total 5-14 15-44 M F Falls 113 89 54 83 119 215 243 458 Burns and Scalds 26 11 14 9 9 37 32 69 Poisoning 13 - 8 11 7 17 22 39 Suffocation - 1 - 1 - 2 - 2 Miscellaneous 56 57 65 23 14 133 82 215 Totals 208 158 141 127 140 404 379 783 Deaths from accidents in the Home Cause No. Details Falls 9 There were 8 women between 62 and 83 years of age and one man aged 92 years. Burns and Scalds 4 One woman aged 87 - night clothes caught alight from contact with an electric fire. One woman aged 80 - dressing gown caught alight from an electric fire One woman aged 54 - dressing gown caught alight from a gas fire. One woman aged 84 - multiple scalds. Poisoning 1 One woman aged 82 - coal gas poisoning Suffocation 3 One woman aged 85 - inhalation of vomit whilst under the Influence of alcohol. One boy aged 12 years - suspension. One boy aged 3 months - traumatic asphyxia from suspension in the chain mesh of a cot. Miscellaneous 1 Man aged 63 - blow on the head when coming through a door. Total 18 116 DEAFNESS Children registered "at risk" - 220 Tested during the year - 90 Premature 62 Bom to Rh. negative mothers 11 Family history of deafness 8 Severe illness in infancy 3 Birth injury 1 Delay in speaking 2 Doctor's referral 2 Parent' s request 1 Re-tested - 11 Deaf - Nil Partially Deaf - 1 (High frequency loss - under observation.) Thought to have some degree of deafness not requiring immediate treatment. - 11 Under 1 year of age 6 Between 1 and 2 years of age Between 2 and 3 years of age 1 Between 3 and 4 years of age 4 Speech defects only - 1 Slow response, probably not deaf, but kept under observation. - 12 Mentally subnormal - 2 Of the 11 re-tested after preliminary screening: 8 were premature babies 1 had severe illness in infancy 2 not speaking at age of 2 years 52 failed to attend although an appointment had been accepted 4 were not taken for further examination after a doubtful result of first test. Of these - 6 parents had refused 24 babies were apparently normal 2 have promised to attend 20 still awaiting further appointments 4 moved out of area 117 AMBULANCE SERVICE Classification of Patients, Journeys and Mileage 'Patients Journeys Mileage Health Service Removals 1962 1961 1962 1961 1962 1961 73,932 (80,060) 46,013 (46. 520) 347.185 (358,899) Accidents 4,258 (4. 243) 4, 174 (4, 093) 22. 397 (21,947) Spastics (Bramley Hill) 2, 986 (3, 560) 476 (488) 5, 262 (4,765) Mental Health (Occupation Centre) 38,530 (32, 190) 1. 300 (1. 227) 34, 389 (31,096) London Road Day Centre 5,6 25 ( - ) 480 ( - ) 9, 438 ( - ) Services Not Required (Accidents) 308 ( 264) 1. 147 ( 903) Vehicles to Repair Depots, Testing, etc. 266 ( 273) 2, 141 ( 2,184) Service Requirements, Oxygen, visiting substations, parks, etc. 308 ( 267) 3,996 ( 3,319) Gas and Air Analgesia - ( 62) - ( 489) 125, 331 (120, 053) 53, 325 (53, 194) 425,955 (423,602) Civil Defence 141 ( 202) 1, 392 ( 2,315) 125, 331 (120, 053) 53, 466 (53. 396) 427, 347 (425,917) *These figures do not represent individual cases. Note:- 1961 figures are in brackets Classification of Accident Calls 1962 1961 Home Accidents (Children) 392 407 (Adults) 429 342 Miscellaneous Accidents (Children) 29 57 (Adults) 148 117 Recreational Accidents (Children) 68 55 (Adults) 99 95 School Accidents and Illness 319 294 Street Accidents (Children) 190 218 (Adults) 952 914 Work Accidents 265 284 Home Illness (Children) 62 36 (Adults) 371 367 Street Illness (Children) 16 19 (Adults) 611 658 Work Illness 92 119 118  1962 1961 Attempted Suicide 16 14 Suicide 13 20 Common Assault 102 77 4,174 4,093 Comparison of Patients, Journeys and Mileage since 1957 Year Patients Journeys Mileage 1957 103, 853 50,827 405,154 1958 110, 080 51,502 417,583 1959 114,790 51,974 413,199 1960 115, 257 51, 704 416,436 1961 120, 053 53, 194 423,602 1962 125, 331 53,325 425,955 Details of Ambulance Service Vehicles One new Bedford "tJtilecon" Sitting-case Vehicle and two Dennis Ambulances were delivered to replace one Bedford "utilecon", one Humber 'Pullman", and one Daimler. The two Dennis Ambulances have given satisfactory service. One new Commer Diesel Van was also delivered for the Mental Health. List of Serviceable Vehicles at 31st December 1962 Seven Daimler Ambulances One Humber "Supersnipe" Ambulance Two Karrier Ambulances Two Dennis Ambulances One Karrier Coach Eight Bedford "tJtilecon" 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, 1962 Daimler Ambulances KOY 800 1952 193,639 LRK 3 1953 170,803 LRK 289 1953 169, 837 LRK 555 1953 157, 714 119 NBY 501 1954 182, 723 ORK 9 1955 154, 394 ORK 8 1955 152, 747 Humber "Supersnipe" Ambulance soy 400 1957 118, 492 Karrier Anbulances WVB 293 1959 49,551 1110 BY 1960 30, 976 Dennis Ambulances 1883 VB 1962 4, 749 5261 RK 1962 17, 701 Karrier Coaches (Mental Health) 3111 RK 1961 6,329 1547 RK 1961 13, 450 Karrier Coach WVB 291 1959 44, 281 Bedford Sitting-Case Coaches KBY 700 1951 149,931 KRK 653 1952 151, 743 Bedford "Utilecon" Sitting-Case OVB 209 1955 141, 295 SRK 189 1957 104, 783 SRK 187 1957 99, 479 UBY 329 1958 92, 398 UBY 325 1958 90, 292 WBY 247 1959 69,485 4676 BY 1961 35, 696 3117 RK 1962 17,652 Vauxhall "Wyvern" Car OBY 724 1955 89, 831 Austin Breakdown (since 1955/56) GLR 801 1940 13,994 Bedford Coaches (Mental Health) KRK 252 1952 106, 460 MOY 639 1954 101,855 COMMUNICABLE DISEASES NOTIFIED DURING 1962 Notifiable Disease Cases notified Total cases notified in wards At all ages At ages - years Upper Norwood Norbury Vest Thornton Bensham Manor Thornton Heath South Norwood Woodside East Addiscombe Whitehorse Manor Broad Green Central Waddon South Addington Shirley M F Under 1 1 - 4 5 - 14 15 - 24 25 • 44 45 - 64 65 and over Scarlet Fever 140 - 36 107 3 3 - - 4 8 3 15 19 12 2 8 13 9 6 5 13 4 20 10 70 79 Diphtheria - - - - - - - - - - - - - - - _ - _ _ - - - - - - - Erysipelas 4 - - - - 2 2 - - - - - 2 - - 1 1 - - - - - - - 1 3 Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric and Paratyphoid 3 - - 2 - - 1 - - - 1 - - - - - - - 1 - - 1 - - - 3 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 0 - - - 3 6 _ - - - 1 3 _ 1 _ - 2 _ 1 _ 1 - - - - 9 Ophthalmia Neonatorum 1 1 - - - - - - - - - - - - - - - - - - - - - - - 1 Acute Poliomyelitis - - - - - - - - - - - - _ _ - _ _ _ _ _ - - - - - - Dysentery 50 2 18 16 8 4 2 - 9 3 1 - 7 3 - 2 3 - _ _ 3 - 15 4 25 25 Malaria - - - - - _ - - - - - _ _ _ _ _ - - - - - - - - - - Acute Primary and Influenzal Pneumonia 30 1 2 5 4 2 7 6 1 1 3 2 - 1 4 - 2 3 1 6 3 1 1 1 15 15 Food Poisoning 38 2 5 6 5 8 7 5 6 - - 4 5 5 _ _ 3 8 - - - - 6 1 20 18 Acute Encephalitis - - - - - - - - - _ _ - - - _ _ - - _ - - - - - - - Measles 848 34 409 309 6 - - - 82 78 69 32 51 19 48 77 26 40 51 68 34 25 102 48 457 391 Whooping Cough 51 6 21 23 1 - - - 3 - 4 1 7 - 6 2 3 8 1 - 5 5 3 3 29 22 1183 46 491 58 30 25 19 14 l05 88 82 57 9 1 41 60 89 53 68 61 79 59 36 14 7 67 6 17 566 120 The tuberculosis notifications are shown In the section relating to that disease MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1862 Notifiable Disease Jan. Fab. Mar. April May June July Aug . Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 9 15 8 8 14 7 14 8 3 8 7 4 105 Non-Respiratory Tuberculosis 1 2 1 1 1 2 1 - 2 - - - 11 Scarlet Fever 25 24 29 11 4 8 9 4 3 l5 12 15 149 Diphtheria - - - - - - - - - - - - - Erysipelas 1 1 - - - - - 2 - - - - 4 Meningococcal Infection - - - - - - - - - - - - - Enteric and Paratyphoid - - - - - - 2 - 1 - - - 3 Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Puerperal Pyrexia - - - 2 1 1 1 - 1 - 1 2 9 Ophthalmia Neonatorum - 1 - - - - - - - - - - 1 Acute Poliomyelitis - - - - - - - - - - - - - Dysentery - 2 - 2 1 2 1 1 4 11 19 7 60 Malaria - - - - - - - - - - - - - Ac. Prl. and Act. Inf. Pneumonia 12 3 5 1 1 1 1 3 1 2 . . 30 Food Poisoning 4 6 2 - 1 5 - 2 3 10 4 1 38 Acute Encephalitis - - - - - - - - - - - - - Measles 15 30 31 50 74 78 133 186 23 28 60 140 848 Whooping Cough 11 12 4 3 2 1 - 7 2 2 5 2 51 1299 121 122 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,978 children were immunised against whooping cough, comprising 2,822 under school age and 156 school children, IMMUNISATION AGAINST TETANUS A total of 3,017 children were immunised against Tetanus, comprising 2,806 under school age and 211 school children. 1,014 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 28, 138 persons were vaccinated against Small-poi. Under 1 year of age 1 2-4 5 - 14 15 or over Total Successful Vaccinations 2.851 870 1,060 3.796 5,590 14,167 Successful Re-vaccinations - - 263 2,633 10,977 13,873 Insusceptible to Vaccination 32 16 11 14 25 58 28.138 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1962, who have completed a course of Immunisation. Age at 31.12. 62 i.e. Born in Year Under 1 1962 1958-1961 1953-1957 1948-1952 Total Completed course of Injections 476 2, 389 194 44 3,103 Reinforcing Injections - 236 996 54 1,286 Estimated mid year child population 4. 250 15.050 35, 700 55,000 123 VACCINATION AGAINST POLIOMYELITIS The following table gives the number of persons who received a course of primary vaccination during the year. Vaccinated Children born 1962 Children horn 1961 Young persons born 1960 - 43 Persons born 1942 -33 Persons over 30 years of aqe with two Injections 71 897 553 322 514 with three Oral Doses. 410 1,145 657 290 507 Number of persons who completed a course of vaccination as at 31st December, 1962. Vaccinated Persons given a Third Vaccination during 1962 Persons given a Fourth Vaccination during 1962 By Injection 4,711 607 With Oral vaccine following course of Injections 5,005 2, 519 9,716 3, 126 TOTAL since Vaccination began 81,635 20,072 124 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATIONS AND MORTALITY - 1942 - 1962 125 TUBERCULOSIS The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) Tuberculosis (All Forms) 0-15 years All ages 0-15 years All ages Year Number of Deaths Death rate per thousand of population * Number of Deaths Death rate per thousand of population * Year Number of Deaths Death rate per thousand of population * Number of Deaths Death rate per thousand of population * 1922 30 - 209 1.09 1943 9 - 120 0.62 1923 25 - 190 0.98 1944 9 - 105 0.57 1924 18 - 188 0.96 1945 9 - 92 0.46 1925 27 - 181 0.91 1946 7 - 105 0. 47 1926 27 - 208 1.01 1947 4 0.08 105 0. 44 1927 15 - 203 0.96 1948 3 0. 06 111 0.45 1928 24 - 206 0.96 1949 6 0. 12 94 0. 38 1929 21 - 178 0.80 1950 4 0. 08 65 0. 27 1930 15 - 175 0. 79 1951 3 0. 06 64 0.25 1931 18 0.36 177 0. 75 1952 - - 54 0.22 1932 10 - 166 0. 70 1953 2 0. 04 37 0. 15 1933 13 - 184 0.77 1954 1 0.02 32 0. 13 1934 10 - 157 0.65 1955 1 0. 02 35 0. 14 1935 9 - 178 0. 71 1956 - - 26 0. 10 1936 11 - 151 0. 60 1957 - - 33 0. 13 1937 11 - 155 0. 64 1958 - - 20 0.08 1938 12 - 137 0. 56 1959 - - 25 0. 10 1939 6 - 107 0. 46 1960 - - 20 0.08 1940 8 - 146 0. 74 1961 - - 21 0.08 1941 10 - 111 0.59 1962 - - 14 0.06 1942 8 - 116 0.63 *Prior to 1947, rotes only avail able for Census years 126 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1962 to 31st December, 1962. TABLE I. Formal Notification Age Periods Number of Primary Notifications of new cases of Tube culosis 0- 1- 2- 5- 10- 15- 20 - 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males - 1 5 1 2 4 7 7 18 13 14 3 2 77 Respiratory, Females - 1 - - 2 2 3 6 4 3 4 2 1 28 Non-Respiratory, Males - - - - - 1 - 1 - 2 1 - - 5 Non-Respiratory, Females - - - - - 1 - 2 - - 1 2 - 6 Source of Information Number of cases In age Group a TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1962 to 31st December, 1962 otherwise than by formal notification: - 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- TOTAL Death Returns from Local Registrars M _ - - -- - - - - - - - - 2 2 (A) Respiratory F - - - - - - - - - - - - - - (B) M - - - - - - - - - - - - - - (C) Non-Respiratory F - - - - - - - - - - - - - - (D) Death Returns from RegistrarGeneral (Transferable Deaths) M - - - - - - - - - - - - - - (A) Respiratory F - - - - - - - - - - - - - - (B) M - - - - - - - - - - - - - - (C) Non-Respiratory F - - - - - - - - - - - - - - (D) Posthumous Notifications M - - - - - - - - - - - - - - (A) Respiratory F - - - - - - - - - - - - - - (B) M - - - - - - - - - - - - - - (C) Non-Respiratory F - - - - - - - - - - 1 - 1 (D) "Transfers" from Other Areas (excluding transferable Deaths) M - - 1 1 - 2 7 8 12 3 2 2 - 38 (A) Respiratory F - - - - - - 7 19 11 1 5 1 - 40 (B) M - - _ _ - 1 _ - - - . - - 1 (C) Non-Respiratory F - - - - - - - 1 - 1 - - - 2 (D) Other Sources M - - - - - - - - - - - - (A) Respiratory F - - - - - - - - - - - - (B) M - - - - - - - - - - - - (C) Non-Respiratory F - - - - - - - - - - - - (D) TOTALS (A) 40 (B) 40 (C) 1 (D) 3 127 128 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1962 1,871 Transfers in from other areas 81 "Lost sight" cases returned during the year New cases diagnosed as definite during the year 107 2,059 Number of cases written off the Chest Clinic Register during the year as:- Recovered 185 Died 37 Removed to other areas 71 "Lost sight of" and other reasons 23 316 Remaining on Register as at 31st December 1,743 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 2.566 Number of visits paid by Clinic doctors to homes of patients Number of visits paid to homes of patients by Tuberculosis Health Visitors 3,495 Attendances of patients at the Clinic - At ordinary sessions 17,637 Number of X-Ray films taken 20,052 *Includes 4,553 miniature film attendances 129 VENEREAL DISEASES - NEW CASES 1943 - 1962 130 VENEREAL DISEASES Totals Males Females SYPHILIS 1. Patients under treatment or observation on January 1st 45 35 10 2. Patients removed from the Register in previous years who returned during the year for treatment or observation of the same condition 2 - 2 3. Patients transferred from other centres after diagnosis - - - 4. Patients dealt with for the first time (excluding 2 and 3 suffering from:- (Syphilis, primary 1 1 - (,, secondary 3 2 1 (,, latent in the ( 1st year of ( infection 1 - 1 ( ,, cardio-vascular ( of the nervous ( system - - - (All other late or latent (stages 19 8 11 (Syphilis congenital:(aged under 1 year _ - - (Syphilis congenital:(aged 1 but under 5 _ - - (Syphilis congenital:(aged 5 but under 15 - - - (Syphilis congenital:(aged 15 and over 1 - 1 Total Item 4 25 11 14 5. Patients completing treatment and/or observation 18 15 3 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) 54 33 21 GONORRHOEA 9. Patients under treatment or observation on January 1st 12 11 1 10. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 2 2 - 11. Patients transferred from other centres after diagnosis - - - 12. Patients dealt with for the first time (excluding Items 10 and 11) 115 85 30 13. Patients completing treatment and/or observation 88 74 14 14. Patients transferred elsewhere - - - 15. Patients not completing treatment and/or observation 15 12 3 16. Patients under treatment or observation on December 31st (should equal Items 9 to 12 less Items 13 to 15) 26 12 14 131  (Totals Males Females OTHER CONDITIONS 17, Patients under treatment or observation on January 1st 29 20 9 18. Patients removed from the register in previous years who returned during the year for treatment or observation of the same condition 13 13 - 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 98 98 - (Yaws 2 - 2 (Any other conditions (requiring treatment 203 122 81 (Conditions not requiring (treatment 244 145 99 (Undiagnosed conditions 1 - 1 TOTAL Item 20 548 365 183 21. Patients completing treatment and/or observation 524 358 166 22, Patients transferred elsewhere - - - 23 Patients not completing treatment and/or observation 10 6 4 24, Patients under treatment or observation on December 31st (should equal Items 17 to 20 less Items 21 to 23) 56 34 22 attendances BY PATIENTS At which patients saw physician Syphilis 231 130 101 Gonorrhoea 399 293 106 Other Conditions 199 1436 556 TOTALS 2622 1859 763 At which patients did not see Physician Syphilis 721 403 318 Gonorrhoea 125 51 74 Other Conditions 592 346 246 TOTALS 1438 800 638 CONTACTS ATTENDING FOR EXAMINATION REFERRED BY PATIENTS SUFFERING FROM:- Syphilis 8 6 2 Gonorrhoea 60 56 4 Non-Gonococcal Urethritis 68 68 - Other Conditions 18 10 8 TOTALS 154 140 14 132  By the Physician at the Centre Sent to a Pathological Centre PATHOLOGICAL WORK NUMBER OP SPECIMENS EXAMINED Microscopical:for Syphilis _ 5 Microscopical:Others _ 990 Cultural - 580 Serum: for Syphilis 772 ,, Others - 378 Cerebro Spinal Fluid (Number of diagnostic lumbar punctures) - 7 SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR SHOWING THE AREAS IN WHICH PATIENTS DEALT WITH FOR THE FIRST TIME (ITEMS 4, 12 AND 20) RESIDED (MAJOR AREAS TO BE SPECIFIED. MINOR AREAS MAY BE GROUPED AS "ALL OTHERS'' ). County, County Borough (England and Wales) and Others Syphilis Gonorrhoea Other Conditions Total Croydon 20 69 372 461 Surrey 4 18 100 122 Kent - 10 36 ??? London 1 18 40 ??? Totals (to agree with Items 4. 12 and 20) 25 115 548 ??? COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1962 To the Chairman and Members of the Education Committee. LADIES AND GENTLEMEN, This is the 59th Annual Report of the work of the Croydon School Health Service. Routine Medical Inspections The system continued unchanged. Plans for a pilot study of possible alternatives which I mentioned last year were postponed. Instead enquiry was commenced into the final outcome of cases of children, in the intermediate age groups, referred for specialist treatment following routine medical inspection. Some interesting results were appearing to support the value of direct medical examination particularly of 12 year old boys. Unfortunately the work was interrupted by Dr. Graham's appointment to another Authority, and no conclusion could be made. The matter is being persued. Fewer inspections were performed than in the previous year which attained a record high figure because it included arrears. Infectious Diseases The year was remarkable for an outbreak of German Measles (Rubella). A mild illness of short duration, it is a trivial complaint except for expectant mothers during their first three months of pregnancy, when damage to the foetus may result. 2 1523 cases were reported by Head Teachers. The previous highest figure in any one year was 345 in 1952. There was considerable spread to the adult population for whom figures are not available as it is not a notifiable disease. It gave concern to Maternity services. As good immunity results from a single attack of the illness, there are advantages in school girls being exposed to Rubella. Our present rules of exclusion for 7 days might be questioned for girls schools on the grounds that we should encourage this age group to acquire immunity against Rubella. Handicapped Children A current trend in school health work is to bring forward the age of first finding defects. Thus the Teacher of the Deaf co-operates in the testing of young infants whose names are recorded on the "at risk" register. Sweep testing for hearing loss, and examination of eye sight were established as routine for all school entrants. At St. Giles School a second Physiotherapist was appointed; and routine sessions for the reassessment of intelligence were doubled at St. Christopher's School. The Psychiatrist of the Child Guidance Clinic refers to the success of the special class for maladjusted children. Proposals for a second class to be established were put forward. A most helpful conference was held with officers of the Ministry of Education on future plans for special units in the Borough covering children with partial hearing, partial sight, maladjustment, inability to communicate and those of doubtful educability. As the Committee knows, local provision is being made for these various groups in the near future. Dental Health The Principal School Dental Officer comments on changing aspects of the campaign to promote dental health. While we must strive to prevent dental caries, I doubt if we can persuade children to forego all the pleasures of sophisticated foods and the confectioners art. If they must indulge, as do their parents, we still need to emphasize the importance of routine dental treatment. It was not possible to accept an offer to be one of the areas to conduct a pilot scheme for intensive dental health education. It is something we will recommend to yon when we think it justified by the chances of better results than those we achieve at present. 3 Clinic Premises Linked with a possible dental health campaign are the facilities to be provided by the new Clinic at Waddon. Unfortunately building delays did not allow its completion during 1962. Authority was received for the replacement of the temporary clinics in the New Addington area and this scheme is now going forward. Health Education The Health Education Officer reports on continued progress in the schools. A new development was a combined Education and Health Department Study Day for Head Teachers and Heads of Science Departments, on the subject of "Smoking and Health". My thanks are due to the Chief Education Officer, members of his central office staff, Head Teachers and their staffs, who have met our many requests with courtesy and co-operation. Finally, as always, you have by your support and encouragement ensured that all worth while innovations are made available without delay, for all the children in your schools. Public Health Dept., Croydon. 4 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 8 (full time) - (41%) *Medical Officers 6 (part time) - (100%) *Dental Officers 9 (including 3 part-time) - (80%) *Physiotherapists 4 (including 1 part-time) - (80%) Speech Therapists 4 *School Nurses and Nurse/Assistants 36 (including S.H.V. and Deputy)(58%) *Dental Attendants 11 (including 5 part-time) (80%) *Performing also duties in other sections of Public Health Department. Percentages in brackets show proportion of time given to school work. PARTICULARS OF CLINICS HELD The following Clinics are provided by the Education Committee; attendance thereat, with the exception of the Minor Ailments Clinic, is by appointment arranged by the School Medical Officer:- Clinic Address Minor Ailments Lodge Road, Broad Green, Croydun. (Daily, Monday to Saturday, a.m.). Ashburton School, Shirley Road, Croydon. (Monday and Thursday, 9 a.i.). Rockmount School, Rockmount Road, Upper Norwood. (Monday and Thursday, 2 p.m.). Duppas School, Goodwin Road, fladdon. (Dally, Monday to Friday, a.m.). Salcot Crescent, New Addington. (Daily, Monday to Friday, a.m.). Dental Lodge Road, Broad Green, Croydon. 206, Selhurst Road, South Norwood. Waldrons Hall, 55, Duppas Hill Lane Croydon. Overbury School, New Addington. Stroud Green, Shirley Road, Croydon. Inspection Lodge Road, Broad Green, Croydon Twice weekly. 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 Crescens, New Addington. Weekly. Speech Defects 47, St. James's Road, Broad Green, Croydon. and at Salcot Crescent, New Addington. Audiology 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 Adding 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 al ready examined as Entrants, i.e. normally between 5 and 6 years. (2) 8-Year-old i.e., Group Children in their second year in a Junior School, unless previously examined in the Junior School. (3) Entrants to i.e., Secondary School Children in their first year in a Secondary School who have not already been examined as Primary Leavers. (4) Final i.e., Leavers Children in their last year of attendance at a Maintained Secondary School who have not been medically examined in that year. (5) Special i.e., Cases Children of other ages with possible defects and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 13,947 children were examined as compared with 14,165 in 1961, and 6.035 parents attended the examinations. The total percentage of parents attending was 43.3 against 50.8 last year. (See Appendix B, Table V). 455 specials and 526 re-inspections of children were carried out, 6 HEALTH EDUCATION IN SCHOOLS Miss D. S. Elliott, S.R.N., H.V. Cert., Dip. H.E. Health Education Officer "Knowledge that is acquired, through compulsion hath little or no hold on the mind." Plato. When any vast new area of human knowledge is opened up, man quickly exploits its various regions, In the field of public health the work of sanitary engineers, bacteriologists, virologists, immunologists, vital statisticians and many other public health, medical and scientific personnel have helped to increase the expectancy of life. Nevertheless man is an individual and his "individuality is by no means a free gift; it has its price. Our differences make life interesting, but they also make it difficult." 1 Concentration on the statistical average may be useful in plotting a set of human measurements or describing the human population, but as a guide to the understanding of an individual and the management of his life it occasionally creates more difficulties than it solves. Today, by means of direct instruction and free discussion, health education involves helping individuals to choose ways of behaviour which will help them to live healthy, happy and useful lives in a community in which "no man can be an island." Secondary Schools With this principle in mind the forging of stronger links between the health and education departments has continued. The health education work started in some secondary and grammar schools has been consolidated. Requests from teachers for information and help are slowly but steadily increasing and more are visiting the health education section to view materials and discuss programmes. The staff of Coloma and Lady Edridge grammar schools were anxious that in addition to academic subjects, the girls should have opportunities to learn more about the community in which they live and human relationships at home, at work and at play, Helped and encouraged by the staff of the health education section the health visitors taking the one year course in the sixth forms reported that the longer period of time with the same group of girls enabled them to establish a really good relationship with them. It was also a pleasure to have the help of a district nurse with the practical work during the home nursing section of the course at Coloma. 7 The mothercraft and hygiene syllabus at Portland secondary school was considerably widened and the health visitor, working with the domestic science mistress, introduced the content of the community health course. The health education officer continued to give the full community health course to fourth year boys at Ashburton secondary school and St. Andrews secondary school and the domestic science mistress now includes it in the domestic science course for St. Andrews fourth year girls. At the end of one of the sessions on human relationships at Ashburton secondary school it was decided to try including the simple emotional and physical facts about pregnancy, labour and puerperium and to illustrate the lesson with the ten-minute film "Brother for Susan." The boys reported so favourably on the usefulness of this that a shortened form of the course was given to all five classes in the fourth year so that this lesson could be included. During the year two programmes on "Shoes for Teenagers" to which parents were invited, were held in the girls' departments at Portland secondary school and Archbishop Tenison's grammar school and consisted of:- (a) An illustrated talk given by the school doctor. (b) A short talk and demonstration of the fitting of shoes in a shop by a consultant fitter. (c) The modelling of shoes by girls in each age group. (d) Questions and discussion. As a result of this one school was able to choose a suitable type of shoe for school uniform. Junior Schools During the year the two evening sessions on the subj ect of Growing Girls"-the first for mothers and the second for Bothers with daughters in the fourth year group, were held in twenty-six schools. Evaluation was extremely difficult but could only be assessed by:- (a) Head teachers wishing the meetings to become an annual event. (b) The attendance of at least some of the parents who would not normally come to any school functions held in the evenings, and (c)Meeting some of the mothers again when the schools were visited during the second year and learning that the children were thrilled with the information and after a day or two were equally thrilled with something else so that this was no longer "news," it had been put into Perspective. 8 The inevitable question recurred many times "What are you doing about boys?" But when mothers were asked "When do you think boys need the help and by whom do you think it should be given?" there were always a tremendous number of opinions and few helpful suggestions. However, one of the following three methods are always carried out now in an attempt to overcome this difficulty:- (a) The mothers of boys as well as girls are invited to the first discussion group, or (b) The mothers and fathers of both boys and girls are invited to the first discussion group. or (c) The mothers and fathers of boys are invited to a third meeting run jointly by the Deputy Medical Officer of Health and the Health Education Officer. The headmaster of All Saints School overcame this problem by obtaining the permission of parents and school governors to talk about 'growing up' to boys and girls together during normal school lessons and avoiding a 'special' occasion so that they could learn about this naturally and side by side as they did everything else at this stage. He used the book "Peter and Pamela Grow Up" by H.W. Tame, as a guide. Smoking and Lung Cancer In order to encourage the maximum interest and participation among teachers in secondary schools, a study day was arranged jointly by the Health and Education Departments, for head teachers and heads of science and domestic science departments at Coombe Cliff Education Centre in June. A symposium on smoking and health was chaired by the Medical Officer of Health. The speakers were:- Dr. J.R. Bignall, Medical Director of the Institute of Diseases of the Chest, Assistant Physician Brompton Hospital. Dr. S.A. MacKeith, Consultant Psychiatrist, Physician Superintendent of Warlingham Park Hospital. Dr. D. A. Cadman, Senior Lecturer in Health Education, Gypsy Hill Training College. During the afternoon group discussions were led by:- Miss W. M. Warden, Senior Lecturer in Health Education, Institute of Education, London University. Mr E.P. Smith, Inspector of Schools, Croydon. Mrs. M. Jeffries, Lecturer in Public Health, London School of Hygiene and Tropical Medicine. Dr. S. A. MacKeith. 9 An exhibition of visual aids suitable for use in schools, arranged by the Health Education Section, was also on show on this occasion. Following this study day, a copy of the Royal College of Physicians' report was given to each head teacher and many were also given posters and leaflets. The Public Health staff continued to discuss the many aspects of smoking during community health courses held in secondary schools. Spontaneous discussions were held in other schools when the health education officer delivered the copies of the Royal College of Physicians' report. A psychiatrist from the Child Guidance Clinic visited the fifth year boys in Ashburton Secondary School with the health education Officer and took part in a lively discussion. She thought that the optimum periods for undertaking smoking education were during the first and second years in the secondary school and again between the ages of fifteen and sixteen. She felt that these were periods of insecurity, the first on entering a school in which the older boys were almost adults and the second on leaving school to enter the outside world as young adults. Two pairs of secondary schools-Ashburton Boys; Davidson mixed and Shirley Boys; St. Mary's Mixed (controls) took part in an assessment of the effect on school children of a television programme in the 'Spotlight' series and of recent publicity on the ill-effects of smoking. This was undertaken by Margot Jefferys, B.Sc. (Econ) of the Public Health Department, London School of Hygiene and Tropical Medicine. 2 The report stated that the negligible effects of the "Spotlight" programme in persuading children to refrain from smoking should not be viewed with unrelieved pessimism or used as an excuse for inaction. The Problem is, after all, one of creating a climate of opinion among school children, and this cannot be achieved in a single day, nor by a single television programme, however well produced and informative." 10 Miscellaneous Lectures on health education were given again to students at Coloma Teacher's Training College, West Wickham, and health education equipment was lent to several schools for display on open days. It is a great pleasure to be able to report the increase of work in schools and the closer links with so many members of staffs. Without their interest and co-operation none of these projects could have been attempted and we are looking forward to working together again in 1963. References: 1. "Man and His Body" by Benjamin P. Miller, M.D. and Ruth Goode. P. 337. 2. "Smoking Amongst Schoolchildren" by Margot Jefferys, B. Sc. (Econ). the Medical Officer 15th February, 1962 Vol. CIX No.7. P. 91. 11 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 Deed 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) 56,259 Number of children inspected (subsequent inspections) 2,019 Number of children found unclean (first inspection) 576 Number of occasions in which children found unclean (subsequent inspections) 226 At the primary inspections vermin were found in 21 and nits alone in 555 children. On these inspections 1.0 per cent, of the children showed evidence of infestation as against 1.0 in 1961. 3 children attended the Cleansing Station for treatment for verminous conditions and 25 for scabies. 12 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis:- Pulmonary 5 Non-Pulmonary — Taking the total child population at 35,700 (estimated), the pulmonary tuberculosis incidence rate per 100,000 was 14.0, and the non-pulmonary nil. 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 7 in 1962 equal to a death rate for this group of 0.20 per thousand. This equals the record low figure and the details were:- Leukaemia 2 Congenital Diseases 1 Motor Accidents 3 Other Accidents 1 Total 7 CAUSES OF EXCLUSION FROM SCHOOL During 1962, German Measles was the specific infection causing the most absences from school, followed by Chicken Pox, Measles, Mumps and Scarlet Fever, 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 with queries which may arise in regard to individual children. For details of visits, see Appendix P, 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. 13 SCHOOL DENTAL SERVICE P.G. Oliver Esq., L. D. S., Principal School Dental Officer:- This Service provides routine inspection and treatment for those attending Borough Primary, Secondary, Technical and Special Schools. A limited number of children from "grant aided" schools approved by the local Education Committee are also eligible for treatment. In conjunction with the above Service facilities are also provided for those referred under Health, Maternity Welfare and Mental Deficiency Schemes. Particulars of work carried out in connection with the above will be found in the appropriate Report. Introduction The decision by the Borough Council to give general approval to a scheme for the addition of fluoride to the town's water supplies, is in full accord with the policy lately recommended by the Minister of Health, and will be specially welcomed by all those interested in the welfare of the young. In addition to being relatively simple to apply, the plan represents an imaginative step in preventive medicine, and compared with other methods of application produces the most uniform results. Findings from world wide Surveys on the application of this salt (at approved levels) are now so overwhelming as to merit serious attention of all major Health Authorities in the country. Careful and painstaking research has for some years been conducted into possible medical and dental hazards resulting from the intake of fluoride, and it is comforting to note that such dangers are now fully discounted in expert circles; even so it can be presupposed that following any general application of this method any "new trends" would receive constant study, and the interest of the public would remain paramount. For those assailed hy doubts regarding the wisdom of this so-called "mass medication" it can be fairly argued that far from causing contamination, the essence of this therapy is merely to replace certain "trace elements" so necessary for our dental welfare, and in so doing to bring the water nearer to the ideal and natural state. Because of the several "undertakings" involved, some delays must be anticipated before the scheme can become operative, even so it is hoped that obstacles encountered will be of a minor character and not lead to any undue postponement of this worthwhile measure. 14 Whilst for the most part the arrangements for treatment in the School Dental Service can be said to be reasonably satisfactory, commitments entered into during recent years mean that available personnel is now fully extended in meeting the requirements of the newer areas. For these reasons the staffing position continues to be delicate, and recently a drop in sessions by part-time officers has given rise to some anxiety. Though in 1962 a new level in coverage of schools has been achieved, this was largely as the result of favourable conditions earlier in the year, and in the light of subsequent setbacks this advance may be difficult to maintain. A relevant factor in this connection is the continuing growth in the school population, which necessitates an increased amount of time for routine inspections, thus reducing the available sessions for treatment. Because of the importance of maintaining an appropriate balance between statutory and clinical requirements, plans for any future expansion must remain tentative until it is possible to forecast more accurately the demand-rate in certain localities. In an attempt to improve efficiency and at the same time encourage new entrants into the Service, further attention has been given to the up-grading of older clinics and increasing the comfort of patients and staff. Large scale repairs and maintenance have been carried out to the Dental Clinic in Selhurst Road, so as to bring these premises more into line with modern requirements. Very substantial progress is now reported with the construction of the joint Welfare and Dental Centre on the Coldharbour Site, and given favourable conditions occupation should be possible during the early summer months. Unfortunately continued lack of "on the spot" facilities has produced a marked "falling off" of patronage of the Dental Service from schools in this area, and it is anticipated even after commencing operation an appropriate "build-up" period will be required to reawaken local interest. In the matter of siting and general amenities the new premises should be particularly well placed in meeting the requirements of expectant mothers and young children, and at the same time serving the needs of all major schools in this area. Plans for stepping up the amount of Dental Health Education to schools, outlined in the last Report, have met with some success and an increasing number of "Talks", "Toothbrush Drill etc. have been reported by Health Visitors in Infant and Junior Departments. An improved range of posters, instruction models and other "novelties" are now available to assist these act ivities, as well as attractive and colourful exhibits construct ed by the Health Education section. Efforts have also been made 15 to enlist the support of certain teaching staff in the idea of introducing dental topics at suitable intervals and by so doing maintain the "tempo"; However, it must be admitted that time is likely to be a limiting factor in this matter. Arrangements for film shows at schools have been handicapped by projector difficulties and until these can be overcome little progress can be expected. Because of the magnitude of the task it is plain that resources now available can never adequately meet the situation, and that in the long term the introduction of additional suitably trained personnel will be desirable to provide more specialised instruction and thus assist in closing "gaps" in the scheme. Inspections The number of children on the register at maintained schools within the Borough at the close of 1962 was 36, 155. Including an additional 45 scholars at "grant assisted" schools this represents a sum total of 36, 200. During the year 92.6 per cent, of the school population were examined, compared with 87 per cent, in 1961. This increase has come about largely as a result of favourable conditions prevailing during the early months of the year. According to recent returns only 1,458 children remained unexamined during 1962, compared with 2,479 last year. At those schools visited 33,486 were inspected and 12,863 (38.4 per cent.) referred for treatment, compared with 31,824 inspected and 13,097 (41.4 per cent.) referred in 1961. 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 inspectors were as follows: - Acceptance of Treatment 36.0% Refused Treatment 49.7% Forms Not Returned 14. 3% The slight increase in the figure for "acceptances" is interesting and may to some extent be attributed to increased pressure applied in cases of persistent "refusal" resulting in ana agreement to receive treatment. Though in recent years the general trend" has been a lessening demand for clinic attention, Picture is by no means a happy one and in certain districts observations at school inspections disclose the fact that, despite facilities now available in the General Practitioner Service, many defects previously notified to parents still remain untreated, and that the actual need for attention continues to be much as before. 16 RESULTS OF SCHOOL INSPECTIONS 1962 1961 1960 1949 1937 No. referred for Treatment 12, 863 13,097 11,752 9,404 13,498 Consents 4,638: 4,637: 4, 586: 6,996: 7,762: 36% 35. 4% 39% 74.1% 57.7% (Total Consents Including Specials)* 6,048: 6, 148: 6, 542: 10,098: 10,146: 47% 47% 47.7% 80.7% 63% Refusals 6, 390: 6, 281: 5, 531: 1, 213: 3, 242: 49. 7% 48% 47% 12.9% 24% Forms not Returned 1,835: 2, 179: 1, 635: 1,195: 2,494: 14. 3% 16.6% 14% 12.7% 18.5% *Specials -Those referred hy Head Teachers with Emergency Forms. Treatment Of 14,273 children referred for treatment (including specials) 7,167 (50. 2 per cent.) were treated and 5,533 (38.7 per cent.) cured completely, compared with 14,608 referred, 7,376 (54.9 per cent.) treated and 5,936 (40.6 per cent.) cured in 1961. Treatment sessions fell from 2,751 to 2,604, 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. 1962 1961 Attendances 19,259 21,806 Treated 7,167 7,376 Re-treated 4, 003 3,960 Fillings Permanent 6,541 8,016 Temporary 1,985 2,091 No. of Teeth Filled - Permanent 6,107 7,093 Temporary 1,929 1,819 Extractions Permanent 1,695 2,029 Temporary 4, 328 4,616 Gas Administrations 2,435 2,754 Local Anaesthetics 498 635 Other Operations Permanent 7,389 8,l79 Temporary 685 950 Cases Completed 5, 533 5,936 17 Miscellaneous Items These include: 1962 1961 Root treatment in anterior teeth 20 39 Removal of bone sequestra 13 9 Splints for fractured incisors 6 4 Partial pulpotomy 1 2 Number of adult M. D. s treated 10 12 Dentures inserted 29 21 Denture Repairs 8 8 Removal of Impacted teeth 47 69 Ulcerated Stomatitis (Vincent's Infection) 1 3 Cleft Palate cases — 1 Acrylic caps for inciser teeth 10 19 Gingivectomy 5 7 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 1,410 compared with 1,511 in 1961. X-Ray Examination The number of cases referred for the above purpose was 312, compared with 380 in 1961. This includes 109 taken at Mayday Hospital. Orthodontic Treatment The number of sessions devoted to this work was 381, compared with 404 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:- 1962 1961 Consultant. D.O.s Total Total Cases commenced during the year 184 82 266 248 Cases carried forward from the previous year 521 73 594 661 705 155 860 909 Cases completed during the year 165 53 218 189 Cases discontinued during the year 79 12 91 108 Pupils treated with appliances 247 116 363 381 Appliances - Removable 263 106 369 365 Pixed 72 13 85 85 Total Attendances 3,486 1, 372 4,858 5, 203 18  1962 1961 Consult- D.O.s Total Total Cases treated by extraction only — 150 150 142 Cases referred to Specialist for consultation 153 — 153 142 Treatment sessions 289 92 381 404 New cases awaiting treatment 9 21 30 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:- 1962 1961 Attendances 59 78 New Cases Treated 3 5 Re-treated 42 38 Fillings-Permanent 68 62 Extractions-Permanent 6 10 Temporary 11 8 Other Operations 10 10 "Gas" Cases 5 9 Local Anaesthesia 4 4 Cases Completed 36 35 Referred X-Ray 3 6 See Appendix B. Table IX. 19 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED CHILDREN Mr Green, the Headmaster, reports that the outstanding feature of the year has undoubtedly been the bringing into full use of the swimming pool and the tremendous impact that this has had upon the life of School. With the appointment of a full-time swimming Instructor it rapidly proved possible to extend the swimming programme until over 180 children were regularly using the pool. This meant for many children, previously severely limited in their physucal range, the opening up of a completely new sphere of Interest, in that physical activity now became a reality. At present some 87 children are now able to swim and the award of 16 Interned late or Advanced Certificates for Physically Handicapped Children by the English Schools' Swimming Association, together with 73 swimming certificates, gives some measure of the success of this nature. With the appointment of a further full-time physiotherapist, the hydrotherapy pool was also brought into use for the specific treatment of certain children. At the same time the number of treatments during the year increased to a total of 5, 853, and the level of each treatment was intensified. Towards the end of the year part-time untrained help was also granted In this department. Routine medical inspections took place on 21 occasions when 308 children were inspected and 169 parents were present. Specialist medical examinations were held each term by specialists In orthopaedic and physical medicine, some 51 children being seen on these occasions. Speech therapy has been given to an average of 18 children on two sessions each week; a total number of 468 treatments. 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 various prescribed courses of treatment; a wide variety of aliments have been treated and full records of each child's progress have been maintained. The Parents, Staff and children extend to Dr. Hegarty their most grateful thanks and appreciation for her devoted work on behalf of the children. Record of Disabilities as at December 1962. Physically Handicapped Boys Girls Total 1. Cerebral Palsy 18 11 29 2. Bronchiectasis 3 8 11 3. Congenital Heart 4 6 10 4. Epilepsy 7 4 11 5. Muscular Dystrophy 4 2 6 6. Speech Defect q 1 4 7. Poliomyelitis 4 8 12 8. Spina Bifida 2 5 7 9. Various Disabilities 16 15 31 61 60 121 Delicate 1. Asthma 24 15 39 2. Bronchitis 9 10 19 3. Debility 6 7 13 4. Primary T.B. 1 3 4 5. Various Disabilities 2 2 4 42 37 79 20 There has been further changes in the teaching and ancillary staff Including a new appointment of a teacher to deal specifically with problems of maladjustment and backwardness. Social activities during the year have Included the Annual Sports Day, numerous school visits to places of interest and the School Holiday -again held in the Isle of Wight in June. Further successes were recorded in the examinations of the Royal Society of Arts and the commercial course was extended to cover at least two years. It is significant that a majority of our recent leavers have found employment in local offices and department stores where this comerclal bias has been of value. Adaptations to the School building were begun in that the open corridors were closed in, to give more protection to the children during bad weather. A vehicle specially adapted for the transport of handicapped children was brought into service to supplement existing transport arrangements. The average number on roll was 198. The average attendance was 85%. There were 44 admissions during the year whilst 14 children left for employment, 24 children returned to other schools. Finally I wish to place on record my thanks to the Principal School Medical Officer and his Staff, the Chief Education Officer and Staff and to all members of the Staff of St. Giles' School for their support during 19 62. 21 ST. CHRISTOPHER' S SCHOOL FOR EDUCATIONALLY SUB-NORMAL CHILDREN Mr. Grice the Headmaster reports:- Organisation The past year saw a broadening of the curriculum by an extensive programme of Educational Visits to all the London Museums, Art Galleries and Historical Buildings, local works and factories, farms, etc. In addition, the two Senior Classes paid a visit to Calais on Friday, June 22nd. Building Improvements The provision of concrete edging around both playgrounds, and the re-surfacing of the Junior Playground were completed and are a great improvement. Sport (a) Swimming Certificates gained during 1962 Distance No. Obtained Boys Girls 20 Yards 13 7 6 50 Yards 10 5 5 100 Yards 3 3 - (b) Cross Country The School entered teams in the Croydon Schools and Youth Cross Country Championships for the first time. In the latter, our first man came In sixth out of over 100 entries. (c) In addition to matches against local schools, the presentation of trophies by various friends, has enabled us to hold Inter-House Competitions for Football, Cricket, Netball, Rounders and Swimming and these events are very keenly contested. Art Competition In an Art Competition organised by the National Society for Mentally Hadicapped Children, and open to all E.S.N. Schools in Great Britain, to choose 15 paintings for entry into an Exhibition In Australia in connection with the Empire Games, Janet Reed of Class 1 was awarded Second Prize and Henry Cooke, Class IV and Anthony Phillips, Class III, had their paintings selected for inclusion In the Exhibition In Perth. The Old Scholars Club Help its Second Birthday Party on October 1st. We are extremely grateful to the parents who Provided a birthday cake, refreshments and prizes for competitions. The Club continues to flourish and is lnvaluable as a means of keeping in contact with the pupils after leaving school and also affording them the opportunity to obtain reassurance, advice and encouragement during the difficult period of adjustment to working conditions. The pleasing feature Is the fact that many are proud to bring along and Introduce us to their boy or girl friends. I an extremely grateful to the members of my staff who so willingly give of theit spare time to this most important social work, and also to the Education Committee for granting the Club free use of the school premises for weekly meetings. 22 The Parents Association Has been a tower of strength during the year. In addition to kill gifts of bulbs for the garden, indoor games and recreational equipment, we are also indebted to its panel of volunteers who baby sit for our mothers of young children and thus enable these mothers to take our children to keep Clinic Appointments in person which otherwise they could not do. Statistics Boys Girls Total Number on Roll 31st December, 1961 123 78 201 Admitted during 1962 26 18 44 Left to work at 16 14 12 26 Left to work at 15 - 1 1 Removed to other areas 4 1 5 Transferred to St. Giles' School - 1 1 Transferred to Residential E.S.N. Schools 1 1 1 Transferred to Normal School 1 - 1 Transferred to Approved Schools 2 - 2 Excluded as unsuitable for education at School 3 1 4 Number on roll 31st December, 1962 124 79 303 23 ST LUKE'S SCHOOL FOR THE PARTIALLY SIGHTED Miss Rundle, the Headmistress, reports that during 1962 no children were admitted, one boy was transferred to a school for the blind and a a girl was transferred to a school for children with multiple handicaps. I. Q. tests revealed that more than half of the children are well below average intelligence. This handicap combined with poor sight makes learning a slow and difficult process. During the year the school was re-decorated and the building is now Much lighter which is a great improvement. Well-lit classrooms are essential for partially sighted children. Various excursions took place Including a visit to a farm, the London Zoo and Pets' Corner at the Crystal Palace. Apart from the great value of these visits, the experience gained In the use of public transport is very helpful to the children. Hailing the right ' bus, getting on and off are difficulties with which these children find it particularly hard to cope. A large revolving blackboard has been added to the school equipment. This is very useful as there Is a greater area for the large Writing which is necessary for partially sighted children. During the year there was a routine medical examination and the opthalmic surgeon examined the children at school. Two children were referred to the Eye Unit for further examination. Children on Roll 31.12.62. 13 Left for employment 1 Transferred to Residential School 1 Transferred to School for the Blind l 24 CHILDREN EXAMINED FOR I.Q. 108 children were examined during 1962. The classifications arrived at, together with recommendations made, are as follows:- (1) Found to be educationally sub-normal:- (a) Recommended to St. Christopher's Special School 28 (b) Recommended to Residential E.S.N. School — (2) Found to be unsuitable for education at School 15 (3) Other Recommendations: (a) Referred to Slow Stream in Ordinary School 7 (b) Recommended for re-test 16 (c) Deferred for Medical Treatment 12 (d) Recommended for St. Giles' 5 (e) Recommended Residential School for Deaf 1 (f) Recommended Residential normal School 4 (g) Recommended Residential School for Speech Defects 1 (h) Referred back to Ordinary School 19 108 Awaiting testing on 31.12.62 9 In addition, a further 60 intelligence tests were given to children attending St. Christopher's Special School. 25 CHILD GUIDANCE CLINIC Dr. G. Crosse, Consultant Psychiatrist for the Croydon Child Guidance Clinic, reports that during the year the investigation of problem children was given a new dimension by the opening of the short stay psychiatric unit at Queen Mary's Hospital last April. The Borough Child Guidance team are represented on the Unit staff and are able to arrange admissions direct from the clinic. Many children have been admitted and we have had some good clinical results. Occasionally the Unit has been able to absorb even child psychotics. The Child Guidance sessions at the New Addington Infant Welfare Centre continues to thrive and Dr. Marjorie Le Vay, senior registrar, has been able to deepen relations with the other agencies in this relatively isolated area. The tutorial class for maladjusted children under Mr. Doe has surmounted the initial difficulties and is now providing an excellent service for children whose emotional problems are complicated by education and social factors. A close contact between the clinic and this class has enabled psychotherapeutic efforts and remedial activity to proceed hand in hand. Source of Referral Boys Girls Total General Practitioners 39 28 67 Parents 9 7 16 Education Department/Schools 6 4 10 Medical Officer of Health Service 37 10 47 Juvenile Court/Probation Officers 9 1 10 Milton House Remand Home — 87 87 Other Agencies 22 11 33 122 148 270 Analysis of the above cases: - Boys Girls Total Diagnostic 10 91 101 Current cases under treatment 71 34 105 Closed cases - Improved 21 16 37 Closed cases - No change/ Unco-operative 13 3 16 Cases transferred to other agencies 7 4 11 122 148 270 26 SPEECH THERAPY The Speech Clinic staff during 1962 consisted of four fulltime therapists. The pressure of work continued to increase and the waiting list for treatment, at both the St. James's Road, and the New Addington Clinics are long. Case loads are heavy at both the special schools too. The Senior Therapist has therefore requested one additional full-time therapist. It is felt that eventually larger premises will become necessary. Two Parent's Evenings were again held during the year, and were successful, they will therefore definitely be accepted as a bi-annual occurence. As noted in the previous year's report, the problem of the Aphasic child with associated specific difficulties is of paramount importance, and the problem is not yet solved. To date no special class has been set up, but the Speech Clinic Staff hope to see one established during the coming year. Dr. Worster-Drought continues to attend as consultant Neurologist, and his visits are of great help and interest to the Staff. Further details of the work carried out are shown in Appendix B Table 10. 27 ENURESIS CLINIC The number of children attending the enuresis clinics was much the same as in the past few years: 182 this year (176 and 183 in the two previous years). The percentage of boys to girls stayed as before with over twice as many boys as girls. There was an increase in the number of electric buzzers which reduced the waiting list for these machines to two or three weeks, and there was consequently an increase in the number of children able to avail themselves of this efficient method of cure. The age groups of those attending was as follows:- Age:- 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Numbers Attending:- 2 2 34 25 30 24 13 16 9 10 5 5 5 2 The largest number in any age group being 34 children who were five years old at their first attendance. 60 of the children who attended had been treated previously by the general practitioner or hospital (59 last year). 4 children were considered not suitable for treatment and referred for consultant treatment. Number of children who attended in 1962:- 182 (126 boys, 56 girls): Lodge Road - 129, New Addington - 53. Results Discharged Dry 96 Still attending 66 Discharged for non-attendance 10 Left District 5 Too young for treatment 1 Referred elsewhere 4 Number who used machines 70 28 DEAF AND PARTIALLY HEARING CHILDREN At the beginning of the year, we were pleased to welcome Mr. J.C. Oakley, to replace Miss Dimond-Hogg, as Peripatetic Teacher of the Deaf. 1962 was an extremely busy year for the Audiology Clinic. In addition to the routine use of the Clinic, it felt the full effects of the first complete year of sweep testing. During the year, 89 children received regular auditory training, some at home, some in school and some in the clinic. 738 audiometric tests were also carried out in the clinic, this included sweep test failures, routine follow-up cases and cases referred by School Medical Officers. All Infant Schools were visited at least once during the year, by Mrs. Roberts, the part time Audiometrician and apart from absentees, all children newly admitted to school during the year were sweep tested. Of the 3,525 tested, 3,147 passed the test. The 378 failures were re-tested in the clinic, where it was possible to pass a further 51. The remaining 303, were further examined by a School Medical Officer and the appropriate treatment prescribed. 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. 12 hearing aids were issued in 1962. Seven of these were the National Health Service "Medresco" aids and the other five, were commercial aids paid for hy 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. Approval has been given for the formation of a Unit for Partially Hearing and Severely Deaf Children in the age range, 3-7 years. This will provide up to 4 years training with a specialist teacher, during the vital early years, when concentrated individual attention can make all the difference to a deaf child's future. It will also avoid sending very young severely deaf children on long daily bus journeys to day special schools outside the Borough. The Royal National Institute of the Deaf, held a two-day conference on Deaf Education, at Church House, Westminster, in October. This was attended by Mr. J.C.Oakley. For further statistical details see Appendix G Page 61. 29 EPILEPTIC SCHOOL CHILDREN 40 epileptics were known to School Health Services as at 31.12.62. Of these - 11 were attending Ordinary School 11 were in Day School for Physically Handicapped and Delicate Children 5 were attending our day E. S.N. School 2 were at Lingfield School 4 were at the Junior Training Centre 5 were in Residential School 1 was at Private Residential School 1 was at St. Luke's School SPASTICS 71 Croydon Spastics were receiving education as at 31. 12. 62. 32 were attending St. Giles' School 3 were attending St. Margaret's School, Croydon 8 were at Residential Schools for Physically Handicapped children 7 were attending ordinary school 8 were attending St. Christopher's School 4 »ere attending Spastic Centre full time 3 were attending Spastic Centre part time 2 were attending Old Kent Road Day School for Partially Deaf 3 were attending Junior Training Centre. 1 was attending a Normal Private School 30 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1962 as to their fitness to undertake the part-time employment indicated:- 1962 1961 1960 1959 1958 Delivery of Goods for Shopkeepers 28 33 57 50 43 Delivery of Newspapers 320 303 316 317 394 Delivery of Milk 6 9 1 7 13 Shop Assistants 64 75 69 59 64 418 420 443 433 514 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1962 all milk was supplied free of charge and approximately 27,400 children per day received one-third of a pint each in Maintained Schools. This was equal to 63% of children attending in Secondary Schools, and 96% 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, 800 bottles per day are supplied to the NonMaintained Schools. All milk supplied is pasturised, 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 1962 was approximately 20, 500. Cost of Special Schools The cost of the medical, dental and nursing services was £67,726. Cost of Special Schools Schools maintained by the Council £59,562 Other Schools (not maintained by local Education Authorities) £23,800 Adjustments with other authorities in respect of Special Schools £12,530 £95,892 Cost of Milk and Meals Meals and Milk cost £505, 061. Income from payment for meals was £184,780, making a net cost of £320,281, on which grant is paid of 100 per cent. on approved expenditure. 31 NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in 1962, 329 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, 1962 Number of pupils on. registers of maintained primary and secondary schools (including nursery and special schools) in January, 19 63 as in Form 7,7 M. and 11 Schools. 36,208 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) (1) No. of Pupils Inspected (2) Physical Condition of Pupils Inspected SATISFACTORY UNSATISFACTORY No. % of Col. 2 No. % of Col. 2 (3) (4) (5) (6) 1958 and later 1957 2,900 2,905 99.86 4 0. 14 1956 588 588 100.00 - - 1955 167 166 99. 40 1 0.60 1954 1. 139 1, 139 100. 00 - - 1953 1. 435 1. 435 100. 00 - - 1952 571 571 100. 00 - - 1951 694 694 100.00 - - 1950 1, 655 1,653 99. 88 2 0.12 1949 889 887 99. 77 2 0. 23 1948 776 776 100.00 - - 1947 and earlier 3, 124 3, 123 99.97 1 0.03 TOTAL 13, 947 13,937 99. 93 10 0.07 34 PUPILS FOUND TO REQUIRED TREATMENT AT PERIODIC MEDICAL INSPECTIONS (excluding Dental Diseases and Infestation with vernial) 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) 1958 and later 1957 58 167 211 1956 14 44 58 1955 3 18 19 1954 41 59 95 1953 49 50 93 1952 21 12 31 1951 32 32 61 1950 62 74 133 1949 51 33 77 1948 42 29 67 1947 and earlier 128 62 184 TOTAL 501 580 1033 TABLE B. - OTHER INSPECTIONS notes:. A special inspection is one that is carried out at the special request of a parent, doctor, nurse, teacher, or other person. A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. Number of Special Inspections 1,360 Number of Re-inspections 2,057 Total 3,417 35 TABLE C. - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 58, 278 lb) Total number of individual pupils found to be infested 385 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2) Education Act, 1944) Nil (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Nil 36 PART 2 TABLE A. - RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION 1962 Defect Code No. Defect or Disease Periodic Inspections Entrants Leavers Others To til TreatBent Obserra tion Treatmeat Observa tion Treatsent Observa- tion Treatment Observa tion (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 4 SKIN 6 14 7 2 20 14 33 30 5 EYES - (a) Vision 72 96 170 24 259 176 501 296 (b) Squint 17 9 - 1 9 4 26 14 (c) Other 5 5 2 - 5 2 12 7 6 EARS - (a) Hearing 28 91 9 7 21 43 58 141 (b) Otitis Media 2 18 1 1 3 2 6 21 (c) Other 4 7 6 1 3 1 13 9 7 NOSE AND THROAT 58 183 4 5 43 83 106 271 8 SPEECH 31 49 3 1 18 15 52 65 9 LYMPHATIC - 16 - 1 • 18 • 27 10 HEART 5 39 - - 13 26 18 65 11 LUNGS 6 50 3 3 5 35 M 88 12 DEVELOPMENTAL (a) Hernia 2 1 1 - 6 3 9 4 (b) Other 3 60 11 17 41 172 55 249 13 ORTHOPAEDIC (a) Postnre 6 26 16 1 28 39 50 66 (b) Feet 20 47 10 7 25 42 55 96 (c) Other 9 65 9 7 26 40 44 112 14 NERVOUS SYSTEM (a) Epilepsy - 1 - 1 4 2 4 4 (b) Other 3 9 2 - 4 6 9 15 15 PSYCHOLOGICAL (a) Development 4 12 - 2 2 10 6 24 (b) Stability 6 36 1 1 6 11 13 38 16 ABDOMEN 1 3 - - - 4 1 7 17 OTHER 20 31 2 4 14 47 36 82 37 TABLE B. - SPECIAL INSPECTIONS Defect Code So. Defect or Disease Special Inspections Pupils requiring Treatment Pupils requiring Observation (1) (2) (3) (4) 4 SKIN 3 - 5 EYES - (a) Vision 10 4 (b) Squint _ _ (c) Other 1 _ 6 EARS - (a) Hearing 3 _ (b) Otitis _ _ (c) Other 2 _ 7 NOSE AND THROAT 8 5 8 SPEECH 2 1 9 LYMPHATIC GLANDS _ _ 10 HEART 1 _ 11 LUNGS _ _ 12 DEVELOPMENT - (a) Hernia _ _ (b) Other 6 6 13 ORTHOPAEDIC - (a) Posture 1 _ (b) Feet 1 2 (c) Other 9 2 14 NERVOUS SYSTEM - Epilepsy _ _ (b) Other 2 1 15 PSYCHOLOGICAL - (a) Development 3 1 (b) Stability 5 1 16 ABDOMEN _ _ 17 OTHER 4 2 38 PART 3 TABLE A. . EYE DISEASES. DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint Errors of refraction (Including squint) 1,419 Total 1,419 Number of pupils for whom spectacles were prescribed 908 TABLE B. . DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases known to hare bee a dealt with Received operative treatment - (a) for diseases of the ear - (b) for adenoids and chronic tonsillitis 106 (c) for other nose and throat conditions - Received other forms of treatment 43 Total 149 Total number of pupils In schools who are known to have been provided with hearing aids - *(a) in 1962 12 (b) in previous years 64 *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 hare been treated (a) Pupils treated at clinics (No figures available for out-patients Department) 253 (b) Pupils treated at school for postural defects 64 Total 317 TABLE D. - DISEASES OF THE SKIN (excluding uncleaniness. for which tee Table D. of Part I) Number of cases known to hare been treated Ringworm - (a) Scalp - (b) Body - Scabies 25 Impetigo 4 Other skin diseases 14 Total 43 39 TABLE E. . CHILD GUIDANCE TREATMENT Number of cases known to have been treated Number of pupils treated at Child Guidance Clinics 47 TABLE F. * SPEECH THERAPY Number of cases known to have been treated Number of pupils treated by Speech Therapists 533 TABLE G. - OTHER TREATMENT GIVEN Number of cases known to have been dealt with (a) Pupils with minor ailments 1. 046 (b) Pupils who received convalescent treatment under School Health Service arrangenents 18 c) Pupils who received B.C.G. vaccination 3,241 (d) Other than (a), (b) and (c) above. Please specify:- 1. Enuresis 182 2. Audiology 606 Total (a) - (d) 5.093 40 APPENDIX B Table I AVERAGE NUMBERS AND ATTENDANCE IN MAINTAINED PRIMARY SECONDARY NON-SELECTIVE, SELECTIVE, TECHNICAL AND GRAMMAR SCHOOLS DURING THE YEAR 1962 School Average No. on Registers Average Attendance Average 1962 At tendance % Average 1961 At tendance % COUNCIL PRIMARY Ashburton Junior Mixed 440 404 91.8 91.9 Ashburton Infants 239 213 89. 1 86.8 Benson Junior Mixed and Infants 532 496 93.2 92.4 Beulah Junior Boys 222 201 90.5 93.7 Beulah Junior Girls 227 209 92.0 91.7 Beulah Infants 279 237 84.0* 87.3 Castle Hill Junior Mixed 684 630 92.1 91.1 Castle Hill Infants 327 292 89.3 89.7 Cypress Junior Mixed 230 213 92.6 92.8 Cypress Infants 191 167 87.4 87.2 Davidson Infants 139 121 87.1 87.4 David Livingstone Junior Mixed and Infants 183 166 90.7 88.1 Duppas Junior Mixed 341 308 90.3 91.5 Ecclesbourne Infants 141 121 85.8* 86.7 Elmwood Junior Boys 244 222 90.9 92.7 Elmwood Junior Girls 234 213 91.0 92.1 Elmwood Infants 276 241 87.3 87.1 Fairchildes Junior Mixed 595 548 92.1 91.6 Fairchildes Infants 373 330 88.5 86.1 Gilbert Scott Junior Mixed 372 348 93.5 93.1 Gilbert Scott Infants 289 256 87.8 88.6 Gonville Junior Mixed and Infants 535 468 91.2 91.4 Howard Junior Mixed and Infants 272 248 91.2 89.9 Kensington Avenue Junior Mixed 469 425 90.6 91.9 Kensington Avenue Infants 231 202 87.4 86.5 Kingsley Junior Mixed 447 398 89.4 91.4 Kingsley Infants 325 275 84.6* 83.4 Monks Orchard Junior Mixed and Infants 388 350 90.2 90.8 Norbury Manor Junior Mixed 358 332 92.7 94.2 Norbury Manor Infants 225 201 89.3 90.5 93.1 Oval Junior Mixed 347 318 91.6 Oval Infants 158 137 86.7 87.7 Portland Infants 96 84 87.5 87.7 Purley Oaks Junior Mixed 260 242 93. 1 92.3 Purley Oaks Infants 203 177 87. 2 90.0 Rockmount Junior Mixed 221 202 91.4 93.4 Rockmount Infants 158 141 89.2 89.4 Rowdown Junior Mixed 519 477 91.9 91.2 Rowdown Infants 309 280 90.6 89.0 South Norwood Junior Mixed 458 427 93.2 93.8 South Norwood Infants 265 235 88.7 90.0 St. Peter's Junior Mixed and Infants 242 220 90.9 91.5 Spring Park Junior Mixed 221 20 2 91.8 93.5 Spring Park Infants 242 212 87.6 89.3 Sydenham Junior Mixed 268 245 91.4 91.9 Sydenham Infants 174 148 85.1* 87.0 41 School Average No. on Register* Average Atten dance Average 1962 Attendance % Average 1961 Attendance % Waddon Infants 214 187 87.4 87. 7 lest Thornton Junior Mixed and Infants 246 221 90. 0 90.2 Whlteborse Manor Junior Mixed 336 309 92.0 90. 8 Whiteborse Infants 241 210 87. 1 90. 1 Vinterbourne Junior Boys 377 354 93.9 94. 2 Vinterbourne Junior Girls 342 320 93. 2 94. 1 Vinterbourne Infants 356 321 90. 1 87.4 Wolsey Junior Mixed 457 417 91. 2 91.8 Wolsey Infants 305 270 88. 5 87. 2 Woodslde Junior Mixed 600 555 9 2. 5 92. 9 Toodside Infants 277 241 87.0 90.0 TOTALS 17, 700 16. 007 90. 4 90. 7 council secondary NON-SELECTIVE schools Ashburton Senior Boys 656 602 91.8 94. 2 Ashburton Senior Girls 623 574 92. 1 92. 0 Davidson Senior Mixed 426 380 89. 2 90. 0 Ecclesbourne Senior Girls 343 302 88.0 89. 1 Falrchildes Senior Boys 651 584 89. 7 89. 1 Fairchildes Senior Girls 694 611 84. 2 87. 9 Ingram Senior Boys 512 456 89. 1 89.0 Lanfranc Senior Boys 564 491 87. 1 88. 8 Lanfranc Senior Girls 513 463 90. 2 89.9 norbury Manor Senior Boys 414 380 91.8 05 1 Norbury Manor Senior Girls 506 465 91.9 92. 1 Portland Senior Mixed 357 323 90. 5 90. 3 Tavistock Senior Boys 437 380 87. 0 87. 0 Tavistock Senior Girls 331 286 86. 7 87. 0 South Croydon Senior Mixed 658 593 90.0 89. 8 Shirley Senior Mixed 574 515 89.7 92. 2 Ocerbury Senior Mixed 530 460 86. 8 85.9 Westwood Senior Girls 428 386 90. 2 90.4 TOTALS 9. 217 8. 251 89. 5 89.9 VOLUNTARY secondary NON-SELECTIVE St. Andrew's Mixed 217 191 88.0 88.0 Our Lady's Girls 201 175 87. 1 88. 6 St. Mary's Mixed 390 364 93. 3 94. 1 TOTALS 808 730 90. 3 90. 1 special schools St. Christopher's Educationally sub-Normal Mixed 211 184 87. 2 87. 5 St. Giles' physically Handicapped and Dedicate Mixed 199 169 84.9* 85. 2 St. Luke's (Partially Sighted) 14 13 92.8 88.8 TOTALS 424 366 86. 1 86. 3 42 School Average No. on Registers Average Attendance Average 1962 Attendance % Average 1961 Attendance VOLUNTARY PRIMARY All Saints' Mixed and Infants (C. of E.) 228 209 91.6 91.7 Good Shepherd (R.C.) Junior Mixed and Infants 339 311 91j7 89.3 Parish Church Junior Mixed and Infants (C. of E.) 367 330 90.0 90.7 St. Joseph's Mixed and Infants (R.C.) 545 490 90.0 89.5 St. Mark's Junior Mixed and Infants (C. of E.) 224 204 91.1 89.2 St. Michael's Infants 117 101 86.3 89.6 St. Mary's (R.C.) Junior Mixed and Infants 421 375 89.7 90.9 Shirley (St. John's) Junior Mixed and Infants (C. of E.) 271 249 91.8 92.3 TOTALS 2. 512 2, 269 90.3 90.4 SECONDARY SELECTIVE AND GRAMMAR SCHOOLS Archbishop Tenison's Mixed 323 303 93.8 93.6 Heath Clark Mixed 693 647 93.4 93.4 John Newnham Selective Mixed 507 472 93.0 93.6 Selhurst Boys 936 884 94.4 94.0 Selhurst Girls 552 518 93.9 91.1 John Ruskin Boys 605 555 93.0 93,6 Coloma Girls 540 504 93.3 93.2 Lady Edrldge Girls 630 588 93.3 93.1 TOTALS 4, 786 4, 471 93.4 93.6 TECHNICAL SCHOOLS Stanley Technical Boys 292 273 93.5 92.4 Croydon Secondary Technical Boys 416 388 93.3 94.6 TOTALS 708 661 93.2 93.7 SUMMARY OF SCHOOL ATTENDANCE FOR THE YEAR 1962 Council Primary 17. 700 16,007 90.4 90.7 Voluntary Primary 2,512 2. 269 90.3 90.4 Council Secondary 9. 217 8, 251 89.5 89.9 Voluntary Secondary Mixed 808 730 90.3 90.1 Grammar and Selective 4,786 4,471 93.4 93.6 Technical 708 661 93.2 93.7 Specials 424 366 86.1 86.3 TOTALS 36, 155 32, 755 90.6 90.9 Crosfield Nursery Full Time - 26 20 77.0 82.1 A.M. 12 9 75.0 P.M. 12 9 75.0 *General Sickness 43 Table II HEIGHTS AND WEIGHTS 1962 Number Examined 1962 Average Height in inches Average Height in lbs. 1962 1961 1960 1959 1939 1962 1961 1960 1959 1939 BOYS 5 yeas 1468 42. 6 43. 3 43. 1 43. 2 41. 8 42.9 43. 4 43.2 43. 4 41. 5 6 " 297 44.0 44. 7 44. 3 44. 7 43. 8 44.6 45. 8 45. 4 46.7 43. 4 7 " - - - 46.7 46. 9 45. 3 - - 50. 2 50. 2 47.0 8 " - - - 50. 4 51.0 49. 5 - - 59. 1 60. 6 55. 5 9 " - - - 51. 5 51. 9 51. 2 - - 64. 2 64. 3 58. 8 10 " - - - 52.0 52.9 52. 7 - - 67. 7 68. 5 62. 9 11 " - - - 56. 5 56.4 53. 7 - - 80.5 79. 5 68. 7 12 " - - - 58. 2 57.7 55. 7 - - 87. 2 85. 7 79.9 13 " • - - 59. 7 59. 2 58.4 - - 95. 1 90. 9 81.6 14 " 432 63. 7 63.9 63. 3 63. 9 59.0 113.8 114.1 110.1 112.1 90. 8 15 " 605 64. 6 65.0 65. 1 65.9 - 119.3 120.6 120.7 120.8 - 16 " 371 67. 4 67. 2 67. 7 67. 6 - 131.4 133. 0 130.3 133. 2 - 17 " 143 67.9 68. 1 68.0 67.7 - 136.5 138.0 137.0 134. 4 - GIRLS 5 years 1296 42.9 42. 8 42. 6 42. 9 41. 2 42. 3 42. 1 42.0 41.7 39.7 6 " 219 44. 0 44.0 43. 6 43. 9 42. 7 44. 2 44. 8 43.7 44. 6 41. 4 7 " - - - 46. 3 46. 5 44. 1 - - 49. 3 49.6 43. 6 8 " - - - 50. 2 50. 2 49.9 - - 59. 7 59. 8 54. 7 8 " - - - 51.3 51. 9 50. 9 - - 63. 1 64. 3 57. 6 10 " - - - 52. 5 52. 9 52. 1 - - 66.0 68. 6 62. 9 11 " - - - 56. 5 57.3 53.6 _ _ 83.0 84.0 68. 3 12 " - - - 58. 3 58.4 56.6 - - 89. 6 89. 6 77. 2 13 " - - - 59.4 59. 7 58. 8 - - 95. 6 94. 4 85. 3 14 " 319 62. 2 61.9 62. 1 62. 5 60. 3 113. 6 111. 5 110. 8 110. 2 97.9 15 " 1225 63. 0 62.9 62.7 63.8 6 2. 0 117.9 115. 5 117. 1 116. 5 105.5 16 " 366 63. 4 64. 1 63. 7 64. 0 - 121. 2 122. 8 122. 1 121. 5 - 17 " 63 64. 2 64. 4 64. 2 64. 1 - 127. 3 128. 1 123.6 125.0 - 44 Table III CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1962 School School Population Chicken Pox Conjunctivitis Diphtieria Dysentery Enteric Group Erysipelas German Measles Impetigo Indefinite Sickness Jaundice Measles Meningococcal Infection Mumps Other Diseases Poliomyelitis Ringworm Scabies Scarlet Fever Sore Throat Vermin Whooping Cough Tot als Body Scalp All Saints 228 4 - - - - - 19 _ 1 - 11 - 7 - - - - - - - - - 42 Arch. Tenison 323 - - - - - - - - - - - - - - - - - - - - - - • Ashburton 1958 7 - - 1 - - 33 - - - 21 - - 3 - - - - 1 - - 1 67 Benson 532 12 - - - - - - - - - - - - - - - - - - - - - 12 Beulah 728 25 - - 1 - - 4 - - - - - 6 - - - - - - - - - 36 Castle Hill 1011 48 - - 2 - - 45 1 1 1 2 - 1 - - - - - - - - 1 102 Colons 540 - - - - - - - - - - - - - - - - - - - - - - - Crosfleld Nursery 50 - - - - - - - - - - - - - - - - - - - - - - - Croydon High 911 - - - - - - - - - - - - - - - - - - - - - - - Croydon Tech. 418 1 - - - - - 91 - - - 1 - - - - - - - - - - - 93 Cypress 421 3 - - - - - 32 - - - 2 - 48 - - - - - - - - 1 86 David Livingstone 183 7 - - - - - 16 - - - 3 - 2 - - - - - - - - 1 29 Davidson 565 1 - - - - - 57 - - - 25 - - - - - - - 4 - - - 87 Duppas 341 - - - - - - - - - - - - - - - - - - - - - - - Ecclesbourne 484 36 - - - - - - - - - - - - - - - - - - - - - 36 Elmwood 754 27 - - - - - 149 2 1 - 1 - 2 - - - - - 1 - - 2 185 Fairchildes 2313 1 - - - - - 3 - - - - - - - - - - - - - - - 4 Gilbert Scott 861 - - - - - - - - - - - - - - - - - - - - - - - Gonville 535 29 - - - - - 11 - - - 14 - - - - - - - 6 - - - 60 Good shepherd 339 - - - - - - - - - - - - - - - - - - - - - - - Heath Clark 693 - - - - - - - - - - - - - - - - - - - - - - - Howard 272 4 - - - - - 14 - - - 1 - 2 - - - - - 3 - - 2 26 Ingram 512 - - - - - - - - - - - - - - - - - - - - - - - John Newnham 507 - - - - - - - - - - - - - - - - - - - - - - - John Ruskln 605 2 - - - - - 19 - - - - - - - - - - - - - - - 21 Kensington Avenue 700 34 — — — — — 78 - l _ 10 _ 2 - - - - - - - - - 125 Kingsley 772 14 — — - — — 124 _ l _ 2 _ — _ _ _ _ _ 8 _ — 1 150 Lady Edrldge 630 — - _ _ _ _ 6 _ _ _ _ _ 1 _ _ — - — - — — — 7 Lanfranc 1077 - - - - - - 19 - - - - - - - - - - - - - - 1 22 45 Monks Orchard 38 8 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Norbury Manor 150 3 11 2 - - - - 88 - - - 8 - 3 5 - - - - 3 - - 2 122 Occupation Centre 69 - - _ - - - - - - - - - - - - - - _ - - - - - Old Palace 311 4 - - - - - 8 - - - 1 - - - - - - - 1 - - - 14 Our Lady's Convent 201 - — - - - - - - - - - - - - - - - - - - - - - Oval 50 5 5 3 - - - - 30 - - - 12 - 1 - - - - - 2 - - - 53 Overbury 530 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - Parish Church 367 - - - - - - 51 - - - 4 _ _ _ _ _ _ _ _ _ _ 1 56 Portland 453 6 - - - - - 1 - - - 2 - 17 - - - - - 1 - - - 27 Purley Oaks 463 59 - - - - - 54 - 14 - - - 1 - - - - - 1 - - - 129 Reglna Coeli 349 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - Rockmount 379 2 - - - - - 21 - - - - - 1 - - - - 1 - - - - 25 Rowdown 8 28 - - - - - - 25 - - - - - - - - - - - - - - - 25 St. Andrew's 217 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ St. Christopher's 211 _ _ _ _ _ _ 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4 St. Giles' 199 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ St. Joseph's 545 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ St. Luke's 14 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ St. Mark's 224 2 - - - - - 32 - - - 7 - 5 - - - - - 5 - - - 51 St. Mary's R. C. 811 71 - - - - - 92 - - - - - 1 - - - - - 3 - - - 167 St. Michael's 117 2 - - - - - 18 - - - 1 - 5 - - - - - . - - 3 29 St. Peter' s 242 15 - - - - - 2 - 23 - - - 1 1 - - - - 1 - - - 43 Selhurst 1488 3 _ _ _ _ _ 35 _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ 39 Shirley 845 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ South Croydon 658 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ South Norwood 723 - - - - - - 59 - - - 83 - 2 - - - - - 2 - - - 146 Spring Park 463 1 - - - - - 30 - - - 7 - 10 - - - - - 1 - - - 49 Stanley Tech. 292 - - - - - - 21 - - - - - - - - - - - 1 - - - 22 Sydenham 442 5 - - - - 91 - - - 18 - 1 - - - - - 4 - - 3 122 Tavistock 768 _ _ _ _ _ _ 16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 16 Trinity 331 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Waddon 214 3 _ _ _ _ _ _ _ _ 4 8 - 2 _ _ _ _ _ _ _ _ _ 17 West Thornton 246 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 _ _ _ 5 Bestwood 428 - - - - - - - - - - - - . - - - . - - • - - . Whitehorse Manor 577 18 2 - - - - 24 - 3 - 2 - 13 - - - - - 2 - - 10 74 Whitgift 833 - - - - - - - - - - - - - - - - - - - - - _ . Wlnterbourne 1075 6 1 - - - - 44 - 1 - 8 - 14 - - - - - 2 - - - 76 Wolsey 76 2 - - - - - - - - - - - - - - - - - - . - - . Woodslde 877 116 - - - - - 57 - - - 3 - - 3 - - - - 4 - - 1 184 587 8 - 4 - - 1523 3 46 5 257 - 149 12 - - - 1 60 - - 30 2685 46 Table IV RETURN OF DEFECTS POUND IN TOE COURSE OF ROUTINE MEDICAL INSPECTION, 1962 Boys Girls Defects No. requiring Treatment No. referred for Observation Percentage of total Examined No. requiring Treatment No. referred for Obervation P*rcentage of tota; Uncleanliness - Head ) - 2 0. 12 - - - Body ) Skin Disease 16 18 2. 11 17 12 2.23 Eye Disease - Defective Vision 230 178 25. 26 271 118 29.88 Squint 14 7 1.30 12 7 1.46 External Eye Trouble 4 3 0. 43 8 4 0.92 Ear Disease - Deafness 43 58 6. 25 15 83 7.53 Otitis Media 6 11 1. 05 . 10 0.77 Other Diseases 7 5 0.74 6 4 0.77 Nose and Throat 54 143 12. 20 52 128 13.82 Enlarged Cervical Glands (not T. B.) - 17 1.05 - 10 0.77 Dental Defects 27 4 1.92 31 1 2.46 Speech Defects 30 44 4.58 22 21 3.30 Heart and Circulation 10 35 2.79 8 30 2.92 Lungs 5 56 3.78 9 32 3.15 Developmental - (a) Hernia 7 3 0.62 2 1 0.23 (b) Other 53 176 14. 18 2 73 5.77 Deformities - Posture 22 26 2. 97 28 40 5..22 Flat Feet 31 66 6. 01 24 30 4.15 Others 18 64 5. 08 26 48 5.68 Nervous System Disorders - Epilepsy 3 3 0. 37 1 1 0.15 Other 5 8 0.80 4 7 0.84 Psychological - 1.30 (a) Development 5 8 0. 80 1 16 (b) Stability 9 19 1.73 4 19 1.77 Abdomen 1 5 0.37 - 2 0.15 Other Defects and Diseases 19 37 3. 46 17 45 4..76 TOTALS 619 996 560 742 Total Children Examined 6, 991 6,956 47 Table V PARENTS PRESENT 1962 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 aver TOTALS Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present M F M F M F M F M F m F M F M F m F M F M F M F m F M F M F M F m F M F m f M F M F m F M F M F M F M F 11 Stints 23 13 17 11 7 1 7 1 - 3 - 3 15 13 10 - 2 2 - 2 1 1 1 - 1 - 1 - - 1 - - - - - - - - - . . _ _ _ _ _ - 49 34 36 17 Archbishop - - - - - - - - - - - - - - - - - - - - - - - - - - - 19 21 1 7 5 4 - - - - - - - - - - 25 27 _ _ 49 52 1 7 Ashbarton 45 38 39 35 7 7 7 5 3 - 1 - 47 13 35 12 21 12 6 10 4 - 3 - 96 - 23 - 123 67 22 23 43 77 4 8 36 - 1 - 68 118 1 _ 63 66 _ 1 553 34B 142 94 Beulab 42 2D 37 18 20 22 20 21 3 1 3 - 28 31 22 24 15 4 7 2 - 4 - 3 2 1 - - - - - - - _ - _ . _ _ _ . _ _ - - - _ - 110 83 89 68 Benson 36 30 32 25 17 3 17 3 - 4 - 4 32 48 26 39 14 15 10 7 6 - 3 - - 1 - - - - - - - - - - - - - _ _ _ _ _ - _ _ - 105 101 88 78 Broad Green College - - - - - - - - - - - - - - - - - - - - 1 - - - 24 2 2 1 20 2 - - 34 3 1 - 36 6 - - 51 7 1 29 5 _ _ 195 25 4 1 Castle Hill 74 54 64 41 4 3 3 2 4 3 3 3 1 1 1 - 77 62 45 43 33 77 23 16 - - - - 1 - 1 - - - - - - - - - - - - - - - - - 194 150 140 105 Coloma " " • " ~ - ■ " - - - - - - - - * - - - - - - - - 53 - - - 76 - 8 - 36 - 1 - 1 - - - - - _ _ 112 _ 1 _ 278 - 10 Crosfield 27 13 25 11 - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - 77 13 25 11 Croydon Sec. Tech. ~ - • - - - - - - - - - - - - - - - - - - - - - - - - - 40 - 1 - 16 - 1 - - - _ - _ _ _ _ 81 _ _ - 137 2 Cypress 46 2R 32 25 5 4 5 4 2 1 2 1 1 1 1 - 14 16 9 10 10 11 7 9 2 5 - 2 - 1 - - - - - - - - - - - - - - - - - - 80 67 56 51 David Livingstone 10 13 9 11 1 2 1 2 - - - - 13 13 11 12 3 1 1 1 1 - - - - - - - - - - - - - - - - - - - - - _ _ _ _ _ - 28 29 22 26 Davidson 2D 28 18 2D 12 9 7 7 - 2 - - 1 - - - - - - - - - - - 10 25 1 7 11 25 - 3 4 5 - 2 52 32 - 1 23 9 1 1 - - _ _ 133 135 77 41 Duppas - - - - - - - - - - - - 4 - 4 - 35 28 16 17 10 11 5 9 1 2 1 - - - - - - - - - - - - - - - - . . _ _ 50 41 26 26 Ecclesbourne 30 29 27 28 5 2 4 1 1 - - - - - - - - - - - - - - - - - - - - 77 - 14 - 17 - 7 - 1 - 1 - 107 _ 29 . 8 _ 4 36 191 31 84 Elswood 56 45 52 41 2 2 1 1 4 1 1 1 4 2 - 2 46 40 35 24 14 21 11 19 8 3 5 - - - - - - - - - - - - . - _ _ _ _ - _ 134 114 105 88 Fairchildes 69 74 59 57 1 - 1 - - - - - 1 24 - - 2 3 - 2 5 4 1 2 - - - - 76 103 9 18 72 29 14 5 4 43 _ 11 115 141 5 25 1 20 _ 3 346 441 89 123 Gilbert Scott 39 66 32 60 3 5 3 4 2 2 2 - - 5 - 3 40 36 28 28 19 16 14 9 - 8 - 3 - - - - - - - - - - - - - . . - - . - - 103 138 79 107 Gonville 52 39 46 37 10 4 9 1 1 1 1 - 40 37 35 33 7 6 6 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 110 87 97 73 Good Shepherd 14 15 11 12 14 20 11 16 6 4 3 2 10 17 8 10 5 5 1 1 1 1 1 1 - - - - - - - - - - - - - - - - - - - - - - - - 50 62 35 42 Meath Clark " - - - - - - - - - - - - - - - - - - - - - - - - 36 - 4 - 20 - 9 - - - - _ - _ _ . 39 - 2 _ 24 _ 2 - 119 - 17 Howard 19 21 16 16 3 4 2 4 1 - 1 - 2 15 2 10 - 2 - 1 - 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - . 25 43 21 32 John Newnham - - - - - - - - - - - - - - - - - - - - - - - - 79 17 7 1 6 - 2 - - - - - 73 - 3 - 54 - 5 - 1 - - - 213 17 17 1 John Raskin - - - - - - - - - - - - - - - - - - - - - - - - - - - - 18 39 4 19 14 15 5 4 - - - - - - - - 40 43 - 3 72 97 9 28 Kensington - - - - - - - - - - - - - - - - - - - - - - - - - - - - 69 - 10 - 22 - 2 - 1 - 1 - - - - . 115 . _ _ 2DT _ 13 - Kingsley 29 31 12 28 3 2 2 1 7 1 4 1 28 2 24 1 IP 1 11 - 9 2 4 1 3 1 1 - - - - - - - - - - - - - - - - - - - - _ 97 40 56 32 Lady Edridge or 63 53 36 7 7 5 5 1 2 - 2 - 2 " 1 43 31 29 21 33 11 15 8 10 1 5 1 2 - - - - - - - - - - - - - - - _ _ _ _ 164 117 107 74 Lanfranc - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 58 - 13 - 27 - 6 - 17 - - - 14 - - - 79 - - . 195 . 19 Monks Orchard - - - - - - - - - - - - - - - - - - - - - - - - - - - - 33 66 10 33 - 46 - 18 81 12 1 6 34 115 . 23 1 1 _ _ 221 240 21 80 Norbury Manor 29 35 23 33 9 16 8 15 1 1 1 1 14 23 9 18 7 2 5 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 61 77 46 69 Our Lady's Convent 46 37 36 28 2 4 2 3 - 4 - 4 - 2 - - 77 20 20 16 14 20 7 14 3 1 3 1 - 65 - 35 - 30 - 16 45 - - - 23 163 1 30 - 3 - 1 160 349 69 148 Oval - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 26 - 4 - 19 - - - 3 - - - 25 - . . 6 . _ _ 79 _ 4 Overbury 32 45 27 38 2D 15 16 9 4 2 3 1 25 36 16 26 15 14 P 10 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 96 112 70 84 Parish Church - - - - - - - - - - - - - - - - - - - - - - - - - - - - 30 28 12 11 28 33 7 4 - 25 - 6 75 89 . 5 28 7 _ - 161 177 19 25 portland 25 16 16 11 5 4 4 3 1 3 - 1 35 21 14 10 3 5 1 1 1 1 1 - 1 2 - - - - - - - - - - - - - - - - - - - _ _ - 62 52 36 26 Purley Oaks 22 13 19 12 3 1 3 1 1 - 1 - - - - - - - - - - - - - 30 16 10 10 41 44 12 30 5 11 2 4 37 77 2 3 32 40 1 1 2 17 1 11 173 169 51 72 Regina Coeli 38 33 31 28 7 2 6 1 - - - - 14 16 9 12 36 32 20 14 4 2 1 1 - - - - - - - - - - - - - - - - - - . _ _ - _ _ 99 85 67 56 Rockmount 25 10 18 4 4 2 2 - 2 1 2 1 20 4 5 2 10 - 3 - 2 - - - - - - - 7 4 - - 5 11 - - - - - - 7 5 - - - - - - 82 37 30 7 Rowdown 33 22 32 21 3 4 1 2 - 1 - 1 - - - - 16 14 13 9 9 6 7 4 - 2 - - - - - - - _ _ - - _ - - - - - - - - - - 61 49 53 37 St. Andre's 38 64 32 51 14 5 11 4 1 1 1 - 6 9 1 9 34 30 25 22 14 13 9 7 - - - - - - - - - - - - - - - - - - - - - - - 107 122 79 93 St. Christopher's - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 6 2 1 13 7 - 2 5 3 - - 8 - 1 - 1 - - - 47 16 3 3 St.John's - - - - - - - - 3 2 1 1 2 1 - - 1 1 - - 1 4 - 2 2 2 - - 2 - - - 3 1 1 - - 2 - 1 8 3 2 . 4 3 _ 1 35 19 4 5 St. Joseph's 24 21 24 20 - 2 - 1 - 1 - 1 22 25 17 17 1 2 1 1 - - - - - - - - - - - - - - _ _ . . _ _ _ - _ - - _ - - 47 51 42 40 St. Luke's 42 IP 38 14 8 8 1 6 6 4 2 3 77 18 17 8 37 31 15 15 12 4 2 1 2 1 1 - - - - - - - - - - - - - - - - - - - - - 134 84 83 47 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - 1 - - - - - - • 1 2 - - 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 Total Number Exanined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Exanined Parents Present Number Examined Parents Present Number Examined Parents Present Number Exanined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined ??? M F M F M F M F M F M F M F M F M F 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 St. Mark's 25 14 25 12 5 4 4 4 1 1 - 1 10 9 8 6 10 3 7 2j 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 54 31 45 St. Mary's 2 19 2 15 2 9 2 7 8 - 2 - 26 35 10 17 9 12 3 5 7 - 3 - 32 28 10 6 9 15 - 8 2 6 - 1 40 40 - 2 14 24 - 2 - - - - 151 179 32 St. Michael's 2P 24 18 19 3 12 2 6 1 5 - 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 32 41 20 St. Peter's 24 16 18 10 1 5 - 1 3 2 2 1 12 18 8 16 7 4 5 3 2 2 2 1 - 1 - - - - - - - - - - - - - - - - - - - - - - 49 48 35 Sslhurst Grammar - - - - - - - - - - - - - - - - - - - - - - - - - - - 23 67 81 11 26 28 28 8 6 1 1 - - 1 59 - - 86 150 - 4 183 374 19 Shirley - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 70 21 11 2 1 - - - 22 22 - - 6 6 - - 99 49 11 South Croydon - - - - - - - - - - - - - - - - - - - - - - - - - - - - 46 36 8 8 18 26 2 7 - 2 1 30 45 - 1 36 13 - - 130 122 10 South Norwood 60 47 57 36 14 4 10 3 2 4 1 1 1 2 - 2 19 29 6 15 22 27 15 16 3 4 - - 1 1 - - - - - - - - - - - - - - - - - - 122 118 89 Spring Park 35 23 33 18 17 10 14 10 - - - - 37 36 10 24 25 8 6 6 1 4 1 3 - - - - - - - - - - - - - - - - - - - - - - - - 115 81 64 Stanley Technical - - - - - - - - - - - - - - - - - - - - - - - - - - - - 39 - 6 - 18 - 2 - 4 - - - 3 - - - - 46 - 1 110 - 9 Sydenham 38 34 31 29 12 5 9 4 5 9 3 6 25 24 21 17 12 11 6 8 12 12 7 4 3 1 2 1 - - - - - - - - - - - - - - - - - - - - 107 96 79 Tavistock - - - - - - - - - - - - - - - - - - - - - - - - - 9 - 5 44 62 11 35 14 29 2 9 4 73 - 14 135 53 5 13 16 1 - - 213 227 18 Trinity - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 63 - - - 29 - - - - - - - 92 - - Waddon 37 35 30 30 20 3 19 3 - - - - 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 59 38 51 West Thornton 14 8 10 6 10 10 7 6 2 1 2 1 5 9 - 7 4 6 3 4 1 - 1 - 1 - - - - - - - - 13 - 1 - - - - - - - - - - - - 37 47 23 Westwood - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 53 - 10 - 27 - 6 - 3 - - - 125 - 13 - 13 - - - 221 - Whitehorse 45 44 38 38 19 9 12 7 5 2 5 1 28 27 22 23 16 14 7 8 12 - 5 - 1 - 1 - - - - - - - - - - - - - - - - - - - - - 127 96 90 Winter bourne 71 67 69 66 6 11 4 8 4 2 4 1 - 63 - 50 68 35 43 25 29 8 23 5 - 4 - 2 - - - - - - - - - - - - - - - - - - - - 178 190 143 Win ten House 6 - 2 - 2 - 2 - 1 - 1 - 4 - 3 - 1 - - - 2 - 2 - 9 - 5 - 6 - - - 8 - - - 2 - - - 2 - - - 1 - - - 44 - 15 Wolsey 62 59 56 49 4 - 2 - - 1 - 1 1 - - - 44 36 36 28 20 9 14 3 - - - - - - - - - - - - - - - - - - - - - - - - 131 105 108 Woodside 39 45 36 45 23 12 16 9 4 4 4 2 8 4 5 3 53 65 28 41 20 13 17 7 5 13 3 7 1 - - - - - - - - - - - - - - - - - - - 153 156 109 1540 1369 1302 1145 334 254 269 191 90 77 56 51 542 597 356 414 797 638 465 406 336 235 206 146 400 294 91 74 728 927 122 315 422 467 62 109 485 291 8 46 735 1X3 23 145 582 604 2 31 6991 6956 2962 2909 2447 588 460 167 107 1139 770 1435 871 571 352 694 165 1655 437 889 171 776 54 1938 168 1186 33 13947 8035 PERCENTAGE OF PARENTS PRESENT Age 5 years and under Boys Girls 84.5) 83.6) 84. 1 6 years Boys Girls 80.5) 75. 2) 78.3 7 years Boys Girls 62.2) 66. 2) 70.1 8 years Boys Girls 65.7) 68.3) 67.6 9 years Boys Girls 58.4) 63.6) 60.7 Boys 42.4 10 years Boys Girls 61.3) 62.1) 61.6 All Groups 43. 3 11 years Boys Girls 22.8) 25.2) 23.8 Girls 44.2 12 years Bqys Girls 16.8) 34.0) 26.4 13 years Boys Girls 14.7) 23.3) 19.2 14 years Boys Girls 1.6) 15.8) 7.0 15 years Beys Girls 3.1) 12.1) 8.7 16 years and over Boys Girls 0.3) 5.1) 2.8 49 Table VI SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1962 (Percentages of Children examined) Defect or Disease Ed tracts Intermediates Entrants to Secondary School Final Leavers All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 3.3 3.9 2.0 2.5 1.7 1. 7 0.7 1.0 2.0 2. 2 Skin 0.9 1.0 1. 1 0.9 0.8 1. 1 0. 4 1.0 0.8 1. 0 Eyes - Vision 6.6 5.0 9. 2 8.9 11. 4 11.0 9.5 11.6 10. 3 9. 3 Squint 0.9 1. 5 0. 6 0.8 0. 3 _ 0. 2 0. 1 0. 5 0. 6 Other 0.3 0. 5 0. 1 - 0.9 0. 4 0. 5 0. 2 0.4 0.3 Ears Hearing 3. 3 4.7 1. 4 1.2 1. 2 0.6 0.8 0.9 1.7 1. 8 Otitis Media 0. 7 0. 6 - 0. 1 0.3 0. 1 0. 2 0. 1 0. 3 0.2 Other 0. 3 0. 4 0. 1 0. 1 0. 1 0.3 0.2 0.2 0. 2 0. 3 Nose and Throat 8.7 8. 5 2. 6 3.9 1. 2 1.5 0. 5 0. 4 3.5 3.4 Speech 3. 5 1. 8 0.8 0.8 0. 5 0. 3 0. 2 0. 1 1. 3 0.7 Cervical Glands 0.9 0. 4 0. 3 0. 5 0. 1 0. 1 0.1 - 0. 4 0. 2 Heart and Circulation 1.7 1.0 0.8 0. 9 0. 1 0.7 0. 2 0. 1 0.8 0. 6 Lungs 1.9 1. 4 1.4 0.5 0. 7 0.5 0.2 0.3 1. 1 0.7 Development Hernia 0. 1 0. 1 0.3 0. 1 0. 2 0. 1 0. 1 - 0. 2 0. 1 otner 3.0 1. 1 5.7 1.9 6. 3 1. 5 1. 3 0. 5 3.9 1.2 Orthopaedic Posture 1.0 0.9 1.2 2.0 0. 6 1.7 0.4 0.6 0.8 1.2 Flat Feet Other 3. 3 1.4 1. 5 1.0 1. 5 1.8 0.7 0. 5 1.8 1. 1 other 3. 1 2.0 1.4 1.6 1.2 1. 5 0.7 1. 1 1.7 1. 5 Nervous Diseases Epilepsy 0. 1 0. 1 0.2 0. 1 0. 2 - 0. 1 0. 1 0. 1 0. 1 other 0. 5 0. 3 0. 2 0.3 0. 3 0. 2 0. 1 0. 1 0. 3 0. 2 Psychological Development 0. 4 0.6 0.4 0. 4 0. 1 0. 1 0. 1 - 0. 3 0.3 Stability 0.8 1. 1 0.7 0. 2 0. 2 0. 1 0. 1 0. 1 0. 4 0.4 Dull and Backward 0. 2 - - - _ _ _ - 0. 1 _ Abdomen 0. 2 0. 1 0. 1 0. 4 0. 1 0.3 0. 1 0. 1 0.1 0. 2 Other Defects 1. 2 2.0 1.0 1. 1 1.3 0.9 0.4 0.3 1.0 1.0 50 Table VII HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS APPROVED UNDER SECTION 9(5) OF THE EDUCATION ACT, 1944 OR BOARDING IN BOARDING HOMES. During the calendar year ended 31s t. December. 1962 number of handicapped pupils - (1) Blind (2) Partially lighted (3) Deal (4) Partially deaf (5) Physically Handicap ped (6) Delicate (7) Maladjusted (8) Educationally sub-normal (9) Epileptic (10 ) Speech defects TOTAL (1)-(10) A. Number of handicapped pupils newly assessed ae needing special educational treatment at special schools or In boarding homes. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 2 - - 1 17 17 5 27 2 2 73 B. (i) of the children Included at A, number newly placed In special schools (other than hospital special schools) or boarding homes. 2 - - 1 10 15 3 23 2 - 56 (ii) of the children assessed prior to 1st January, 1982, number newly placed In special schools (other than hospital special schools) or boarding homes. 1 - 1 - 3 6 2 7 - 1 21 TOTAL (B(i) and B(ii)) 3 - 1 1 13 21 5 30 2 1 77 C. (i) Number requiring places In special schools - TOTAL (a) day - - - - 4 3 - 2 - - 9 (b) boarding - - - . 2 1 3 3 - 2 11 (11) Number Included at (1) who had not reached the age of 5 and were waiting; (a) day places - - - - 1 - - - - - 1 (b) boarding places - - - - - - - - - - - continued below. 51 (iii) Number Included at fx} who had reached the age of 6, 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 - 12 10 10 100 75 - 182 - - 389 (b) boarding pupils 1 1 - - - 2 - 1 - - 5 (2) non-maintained specials schools as - (a) day pupils - - - - 3 - - - - - 3 (b) boarding pupils 2 - 1 6 0 7 1 3 4 2 32 TOTAL 3 13 11 16 109 84 1 186 4 2 429 (ii) Number on the registers of independent schools under arrangements made by the Authority - - 3 - 3 - 12 3 21 TOTAL (D(i) and D(ii)) 3 13 14 16 112 84 13 189 4 2 450 (iii) Number boarded In homes and not already Included under (1) and (ii ) above - - - - - - 1 - - - 1 TOTAL (D (l).(ii) and (iii)) 3 13 14 16 112 84 14 189 4 2 451 (continued overleaf) 52 During the calendar year ended 31st December, 1962 number of handicapped pupils - (1) Blind (2) Partially sighted (3) Deaf (4) Partially deaf (5) Physically Handicapped (6) Delicate (7) Maladjusted (8) Educationally sub-normal (9) Epileptic (10) Speech defects TOTAL (1) - (10) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) E. were being educated under arrangements made under Section 56 of the Education Act, 1844. (i) In hospitals - - - - - 15 - - - - 15 (ii) In other groups (e.g. units for spastlcs, convalescent homes) 2 1 3 (iii) at home - - - - - - - - - - - PART IV CHILDREN FOUND UNSUITABLE FDR EDUCATION AT SCHOOL During the calendar year ended 31st December, 1962 - (i) Number of children who were the subject of new decisions recorded under Section 57(4) of the Education Act, 1944 - 14 (ii) Number of reviews carried out under the provisions of 57A of the Education Act, 1944 - Nil (iii) Number of decisions which were cancelled under Section 57A(2) of the Education Act, 1944 - Nil 53 vision tests Summary of Findings Entrants 8 year old group Entrants Secondary School Final Leavers TOTAL Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % Up to 6/24ths 118 6.0 78 4.6 141 8.4 111 7.6 150 9.7 148 8.8 144 8.0 178 8. 5 553 7.9 515 7.4 Over 8/24ths 11 0.6 7 0. 4 13 0.8 20 1. 4 26 1.7 38 2. 3 28 1.6 66 3. 1 78 1. 1 131 1.9 54 Table IX DENTAL DEFECTS (1) Inspected by Dental Officers:- 1962 1961 Aged 5-6 1,942 2,001 6-7 2,816 2,889 7-8 2,926 2,575 8-9 2, 975 2,823 9—10 2, 971 2,812 10-11 3, 081 2,922 11—12 3,073 2,987 12-13 2,926 2,800 13—14 2,971 2,858 14-15 3,370 3,200 15 — 16 2, 792 2,330 16 up 1,643 1,627 Total 33, 486 31,824 Specials 1,410 1,511 34,896 33,335 (2) Number found to require treatment 17, 560 17,354 (3) Number referred for treatment 14, 273 14,608 (4) Number actually treated 7,167 7,376 (5) Attendances made by children for treatment 19, 259 21,806 (6) Half-days devoted to: Inspection 276 211 Treatment 2.604 2,751 2, 880 2,997 (7) Fillings - Permanent Teeth 6,541 8,016 Temporary Teeth 1,985 2,091 8,526 10,107 (8) Teeth Filled - Permanent Teeth 6, 107 7,093 Temporary Teeth 1,929 1,819 8,036 8,912 55 (9) Extractions- 1962 1961 Permanent Teeth 1, 695 2,029 Temporary Teeth 4,328 4,616 6,023 6,645 (10) Administrations of general anaesthetics for extractions 2,435 2,754 Administrations of local anaesthetics for extractions 498 635 (11) Other Operations - Permanent Teeth 7,389 8,179 Temporary Teeth 685 950 8,074 9,129 Attendances per session 7.39 7.92 56 Table X speech defects clinic summary Total number of cases treated 533 Cases discharged 267 Analysis of Discharged Cases Under review pending possible further treatment in the future 29 Left District 9 Unsatisfactory e.g. non-attendance 30 Satisfactory 190 Left School before treatment completed 5 Transferred to Residential School or Occupation Centre 3 Cases still attending 266 Cases referred for physical treatment 54 Cases referred for residential treatment 1 Cases referred for Child Guidance 2 Cases referred by Neurologist 32 Stammerers 93 Sigmatism 68 Cleft Palate 8 Excessive Nasality, including supra-bulbar palsy. 9 Dyslalia 298 Undeveloped Speech 28 Developmental Aphasia, including Dyspraxia, Dysarthria, and learning difficulties 23 Partially Deaf 4 Dy sphonia 2 Special Schools St. Christopher's School 27 Some of these are under supervision only St. Giles' School 18 Some additional cases have been seen for assessment only. appendix c NON-MAINTAINED SCHOOLS Year ended 31st December, 1962 return of medical inspections a - Routine Medical Inspections Year 1962 Year 1961 Age 11 or under 29 39 12 55 73 13 41 34 14 34 20 15 76 51 16 64 52 17 22 23 18 or over 8 11 Total 329 303 B - Other Inspections Number of Special Inspections - - Number of Re-inspections - - Total - - Visits to Non-maintained Schools 13 12 The following defects were found by Medical Inspection:- Treatment Observation Skin 1 - Defective Vision 9 - Other eye defects 1 - Nose and Throat 4 - Heart and Circulation 1 - Lungs 1 - Orthopaedia Other 1 - Other Defects and Diseases 1 - 57 58 APPENDIX D RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1962 WHO HAVE UNDERGONE TONSILLECTOMY Year of Birth Boys Per Cent. Girls Per Cent. Boys and Girls Per Cent. 19 57 and later 69 4.5 47 3.4 116 4.0 All Boys 1019 14.7% 1956 22 6.6 8 3.1 30 5.1 1955 4 4.4 7 9.0 11 7.2 1954 62 11.4 69 11.6 131 11.5 1953 45 5.7 102 16.0 147 10.2 1952 44 13. 1 45 19.1 89 15.6 1951 80 20.0 49 16.7 129 18.6 All Girls 1178 16.9% 1950 171 23.5 194 20.9 365 22.0 1949 107 25.4 116 24.8 223 25.1 1948 91 10.9 71 24.4 162 20.9 1947 179 24.4 353 29.3 532 27.5 1946 and earlier 145 24.9 117 19.4 262 22.1 All Groups Boys and Girls 2197 - 15. 7% CHIEF CAUSES OF EXCLUSION FROM SCHOOL Condition Exclusions during 1962 Percent age of total exclusions Exclusions during 1961 Percentage of total exclusions Ringworm - - 1 0.06 Verminous Conditions - - - - Impetigo 3 0.11 6 0.33 Scabies 1 0.04 - - Scarlet Fever 60 2.24 66 3.66 Measles (inc. German) 1,780 66.29 1,087 60.69 Diphtheria - - - - Whooping Cough 30 1.12 50 2.78 Chicken Pox 587 21.86 331 18.39 Mumps 149 5.55 100 5.56 External Eye Disease 8 0.30 - - Poliomyelitis - - - - Dysentry 4 0.15 6 0.33 Jaundice 5 0.19 - - Enteric Group - - - - Meningococcal Infection - - - - Other Causes 58 2.16 153 8.50 2,685 1,800 59 APPENDIX E TREATMENT The Work of the School Clinics SUMMARY OF ATTENDANCES 1962 1961 Increase or decrease Minor Ailments and Verruca Clinics 5,737 6,989 - 1,252 Inspection Clinic 1,477 1,127 + 350 Dental Clinics 19,259 21,806 - 2,547 Remedial Exercises Clinic 5,223 6,485 - 1,262 Enuresis Clinic 732 717 + 15 Audiology Clinic 189 251 - 62 32,617 37,375 - 4,758 MINOR AILMENTS CLINICS Clinic Defects Attendances Lodge Road 531 3,002 Ashburton School 160 914 Duppas School 384 842 Rockmount School 212 605 Addington 96 374 Complaint 1962 1961 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm - - - - - - Scabies 1 2 2.0 - - - Impetigo 4 14 3.5 4 18 4.5 Other Skin Diseases 15 40 2.7 24 50 2.1 Otorrhoea and other Ear Defects 73 111 1.5 64 100 1.6 External Eye Disease 59 126 2.1 80 174 2.2 Miscellaneous (Including Verruca) 1,231 5,444 4.4 1,787 6,647 3.7 1,383 5,737 4.2 1,959 6,989 3.6 60 APPENDIX F SPINAL AND OTHER REMEDIAL CLINICS (LODGE ROAD) 1962 1961 Attendances Classes Av. att. Attendances Classes Av. att. Spinal 1,640 413 4.0 1,761 420 4.2 Plat Feet 1,525 416 3.7 2,542* 479 5.3 Breathing 275 80 3.4 390 195 2.0 3,440 909 4,693 1,094 *45 treated by Faradism. 153 individual cases were treated and 318 examinations were made by a doctor. SPINAL AND OTHER REMEDIAL CLINICS (NEW ADDINGT0N) 1962 19 61 Attendances Classes Av. att. Attendances Classes ki. att. Spinal 552 43 12.8 562 46 12.2 Flat Feet 905 86 10.5 906 92 9.8 Breathing 320 43 7.4 324 46 7.0 1,777 172 1,792 184 124 individual cases were treated. WORK OF SCHOOL NURSES School Visits Visits to School Departments re Cleanliness 291 Visits re Scabies or Ringworm 10 Visits re Infectious Disease 2 Visits re Medical Inspections 634 Visits re Medical Preparations 460 All other reasons 497 Home Visits Concerning defects found at routine medical inspections 526 Subsequent visits re defects found at routine medical inspections 175 Visits re special cases 1,167 Visits other than infectious cases 1,688 Visits in connection with infectious cases 162 61 APPENDIX G DEAF AND PARTIALLY DEAF CHILDREN OF SCHOOL AGE December 31st, 1962 Numbers attending Special Schools or Units: (a) Day Schools: Old Kent Road 10 Oak Lodge 6 Holman Hunt 3 Peckham Park 1 (b) Residential Schools: Ovingdean 5 Hamilton Lodge 2 Mill Hall, Cuckfield 1 Margate 1 Mary Hare Grammer 1 Rudolpm Steiner, Aberdeenshire 1 Total 31 (17 of these 31 children are of secondary school age). Numbers attending Croydon Day Schools: (a) With hearing sufficiently impaired to require regular auditory training: Primary School Pupils 57 Secondary School Pupils 53 Total 110 (b) With hearing loss not severe enough to require regular auditory training, but who need to be tested regularly: Primary School Pupils 156 Secondary School Pupils 25 Total 181 Total Number of Croydon School Children wit Impaired hearing of all Grades of severity: Children of Primary School age 527 Children of Secondary School age 104 Total 631 62 Pure Tone Audiometer Tests: Number of individual children tested during the year: (a) For the First time 618 (b) As a review case 120 738 Auditory Training: 89 individual children received regular auditory training during the year. Number of attendance sessions: (a) At the Audiology Clinic 189 (b) At home or school 417 Total 606 Sweep Testing of five year old school entrants: Number of schools visited 40 Number of children tested 3,525 Number of children passed 3,147 Number of children failed 378 Number of children not tested (absent or unco-operative) 532 The 378 failures were followed up: No hearing loss 51 Negligible hearing loss 73 Slight hearing loss 52 Moderate hearing loss 93 Moderately severe hearing loss 77 Severe hearing loss 8 Absent or failed to keep appointment 21 Left district 3 Total 378 Issue of Hearing Aids (a) National Health Service "Medresco" Aids 7 (b) Commercial Aids bought by Croydon L.E. A. 5 Total 12 Supplied in previous years 64 Total 76 2 children using hearing aids are under school age. CONTENTS A. - public health report Page Ambulance Service 49, 117 Amusement Houses 65 Animals, Diseases of 68 Animals, Keeping of 68 Ante-Natal Clinics 33 Births 12 Blindness 91 Byelaws 82 Cancer 15,96 Care of Mothers and Young Children 33 Census 11 Chemical Analyses 86 Chest Clinic, Work of 23 Child Minders 90 Chiropody 57 Civil Defence 50 Clean Air Act 65 Convalescence 38 Committee, Health 3 Communicable Diseases 17, 19, 120 - 121 Cremation 87 Day Nurseries 57 Deafness 57, 116 Deaths 11, 13, 14, 94, 95 96 Dental Treatment (M.& C.W. ) 46, 114 Disinfection 66 Dinfestation 67 Drainage 64 Epileptics 91 Elderly Persons, Rehabilitation of 109, 110 Factories and Workshops 61-63 Food and Drugs Act 70 Food Poisoning 18 Food Supply 69 Health Education 45 Health Visitors,work of 36, 106 Home Helps 39, 112 Home Nursing 38, 108 Home Safety 44, 115 Hospital, Isolation 19 HOusing 60 Ice Cream - Bacteriological Examination of 74 Illegtimacy 11, 33 Page Immunisation 38, 122 Infant Mortality 11, 14, 98, 99, 100 Infant Welfare Clinics 107 Inquests 13 Laboratory Examinations, Various 32, 74, 75, 86 Marriages 12 Maternal Mortality 14, 98 Maternity Homes 87 Meat Inspection 71 Men's Hostel 61 Mental Health 51 Midwifery 34, 101-104 Midwlves Acts 35 Milk Supply 73 Mortuary 8 8 National Assistance Act 9 1 Neo-Natal Deaths 11,99 Notification of Births Acts 12 Nuisances 82 Nursing Equipment, Loan of 111 Nursing Homes 87 Nurses' Agencies 87 Offensive Trades 6 4 Outworkers 6 2,63 Perinatal Deaths 11, 99 Pests 68 Physiotherapy 110 Pharmacy and Poisons Act 67 Poliomyelitis 123 Population 11 Post-Natal Clinics 33 Post-Mortems 13 Premature Infants 33, 105 Problem Families 113 Prosecutions 70 Public Health Inspectors, Work of 59, 81-8 2 Public Health Laboratory Service 32 Rag Flock Act 67 Rats & Mice(Destruction)Act 68 Rivers and Streams Pollution of 64 Page Scarlet Fever 19,21 Shops Act 63 Staff Medical Examinations 89 Staff 9 Still Births 11, 13 Street Accidents 117 Tuberculous, After Care 30 „ Allowances 30 „ Contacts 27 „ Hone Nursing 27 „ Home Visits 27 „ Mass Radiography 29 „ Mortality 26, 124-125 „ Notifications 126, 127 Occupational „ Therapy 31 Residential „ Treatment 26 „ Prevention and Control 23 „ Re-Housing 28 „ Vaccination 28 Training Centres 53, 54 Page Unmarried Mothers 33 Vaccination 122, 123 Verminous Persons 66 Venereal Diseases 32, 128, 130-132 Vital Statistics 11, 93, 94, 95 Ward Statistics 97 later Supply 85 Welfare Foods 35 X-Ray 28 Zymotic Diseases 19 B. - SCHOOL MEDICAL REPORT Page Child Guidance 25 Cleansing of Children 11 Clinics 4,59 Cod Liver Oil 30 Cost 30 Deaf Children 28,61 Deaths 12 Defects Found 34,46,49 Dental Service 13,54 Enuresis Clinic 27 Epileptic Children 29 Exclusions 12,44, 58 Handicapped Pupils 50,51,52 Health Visitors, Work of 12,60 Heights and Weights 11,43 Infectious Diseases 44 Juvenile Employment 30 Malt 30 Meals, Provision of 30 Medical Inspection in Schools 5, 33 Mentally Defective Children 21 Page Milk, etc., Provision of 30 Non-maintained Schools 31, 51 Orthodontic Service 17 Parents' Attendances 47, 48 Population 33 Remedial Exercises 60 School Nurses 12, 60 Schools Special, Cost of Spastics 39 Speech „ Staff „ Statutory Tables„ 33 Sub-normal children 24 St. Christopher 21 St. Giles* 93 St. Luke's 23 Tonsillectomy 58 Tuberculosis 12 Uncleanliness 11 Vision, Defective 11, 53