44132 CRO 65 PUBLIC HEALTH IN CROYDON 1963 PUBLIC HEALTH IN CROYDON 1963 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1963 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 1963 Councillor B.H. Rawling (Chairman) Councillor Keith Edwards (Vice-Chairman) Alderman Mrs. V.L. Child Alderman A.V. Dammarell Councillor P. Byrne Councillor J.J. Cooper J. P. Councillor E.J. Fowler Councillor Mrs. D. L. George Councillor G. Levy Councillor M. E. Mackenzie Councillor Mrs. E.M. Maycock Councillor Mrs. M.C.V. Parfitt Councillor Mrs. B. Saunders Councillor Miss L.L. Scott Councillor B.C. Sparrowe Councillor H.E. Styles Councillor R.E. Thorpe Councillor J.T. Twitchett J.S. Lane, Esq., B. A. , M. R. C. S., L.R.C.P. J.J. Linehan, Esq. ,M.D. D. P.H. Miss K.C. Vost, M.B., B. S. , D.P.H. T.G.E. White, Esq., M.D. M.R.C.O. 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., M.R. C. S. .L.R.C.P. D.F. Kanaar, Esq., M. D., M. R. C. P. Croydon Local Medical Committee A.F. Clift, Esq., P.R.C. S., M.R.C.O.G. S.Y. Marsters, Esq. Croydon Group Hospital Management Committee Mrs. E.M. Ryle Horwood Royal College of Nursing Mrs. P.R. Mitchell, O.B.E. Royal College of Midlives Mrs. M. Roberts Croydon District Nursing Association Mrs. G.C. Browning Croydon Family Planning Association Mrs. J. Toogood Croydon Federation of Townswomen 's Guilds E.B. Hamley, Esq. The St. John Ambulance Brigade (Southern Area) J R. Hardy, 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 1963 To the Chairman and Members of the Health Committee LADIES AND GENTLEMEN I have the honour to present the Annual Report of the health of the people of Croydon and the relevant services of the Corporation for the year ending December 31st, 1963, and comment on a few of the matters covered in greater detail in later pages. Statistics The increase in population continued. The birth rate rose sharply to reach almost the levels of the peak post war years 1946 and 1947. This rise was once again partly explained by the continuing trend of marriage at earlier ages. Thus 23% of those giving notice of intention to marry during 1963 were under 21 years of age, in comparison with 10 years ago when the percentage was 14. Illegitimate births reached a record figure of 9% of total births. The infant death rate amongst these illegitimate babies was also high, resulting in an increase in the total infant mortality rate in comparison with last year. The general death rate was high due to a rise in mortality throughout the very cold early months of the year. The increase in deaths from suicide drew comment and was a matter for investigation. No explanation is so far forthcoming, and although national statistics are not yet available, from reports of other areas it does not seem that the increase was peculiar to Croydon. 6 There was one death due to an undiagnosed complication of early pregnancy, but for the second year running not a single death of a mother in childbirth. In considering fresh advances in preventive medicine it should be remembered that the greatest single factor causing death under 65 years of age was Cancer. Of the 278 deaths ascribed to this cause, 102 were from cancer of the lung. Diseases of the heart and circulatory system in ages under 65 came next in frequency with 221 deaths, of which 147 were from Coronary Thrombosis. It is usual to comment that further intensive research is needed to discover the causes of these conditions so that they may be prevented, but the situation in regard to cancer of the lung shows that knowledge about an important cause may not result in action to prevent deaths. Communicable Diseases The anticipated outbreak of Measles produced over 3,000 notifications but without a single fatal case. Another year free from poliomyelitis is a gratifying tribute to the efficacy of vaccination, but increased the difficulty of persuading parents to have their children given this protection. A case of Typhoid Fever (contracted abroad) in a member of a family with several food handlers gave rise to some anxiety, but fortunately all went well. Personal Health Services The further rise in the birth rate threw additional burdens upon the hospital obstetric service, but with the usual help from the domiciliary Midwives in dealing with mothers discharged early after confinement, no special problems arose. The opening of new specially built clinic premises for the Waddon area was very welcome, as it was formerly an inadequately served part of the Borough. The Superintendent Health Visitor deals with efforts to promote co-operation between general practitioners and health visitors. It has proved very difficult recently to recruit Health Visitors and staffing shortages impede the development of new schemes. Authority to sponser Health Visitor students was granted and it is anticipated that this measure will in due course ensure a full establishment of Health Visitors. 7 Mental Health Services were developed and undoubtedly the Corporation's scheme based on active co-operation with the Mental Hospital was shown again to be practicable and effective. There were disappointing delays in obtaining authority for new buildings which seemed to be due chiefly to the high cost of construction in Croydon in comparison with other parts of the country. Thanks to the very helpful support of the Finance Committee, temporary buildings have been made available, so that new developments have gone forward. Against the frustration of delays there must be set the advantage of learning by actual experience of pilot schemes. The knowledge so gained has unquestionably been of help in building up valuable connections with industry, and practice in handling industrial projects. The Housing Committee were also of great assistance in allocating a suitable property for a trial of a small residential group unit, and this was arranged at the close of the year. Health Education programmes included efforts to persuade parents to have their children protected against the various diseases for which active immunisation is now available. The value of a Health Education section in supporting such campaigns, in initiating new developments and in sponsering in-service study sessions was again emphasised during the year under review. Clean Air The Chief Public Health Inspector is able to report steady progress in the agreed campaign to cover the whole of the Borough with Smoke Control Orders. Forecasts about changes in fuel policy necessitated some fresh surveys, but it is hoped rising costs will not impede future schemes. The recommendations of the Beaver Committee that as a first step we should seek to clear smoke and dirt from the atmosphere is still unchallangable, although admittedly the problem of sulphur pollution remains. Housing Appeals on medical grounds for rehousing continued to increase, reflecting the difficult position as regards the "points" allocation scheme. There was also an increase in requests for transfers on supposed medical grounds, which required a good deal of investigation before suitable recommendations could be made. 8 Co-ordination The Reorganisation of Local Government in the London area threatened disruption of the close and cordial co-operation which has been built up over many years in Croydon between the three branches of the National Health Service. Meanwhile the usual goodwill and mutual assistance continued. As always my thanks are due to the Chairman, Vice-Chairman and Members of the Committee for their unfailing encouragement and support. 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. 21 Administrative and Clerical Staff, (including 1 part time), 4 Typists. 1 Messenger. Public Health Inspection Chief Public Health Inspector. Deputy. 21 Inspectors. 1 Superintendent Abattoir 4 Clean Air Act Assistants. 1 Foreman and 5 Assistants. Chief Disinfector. 1 Superintendent and 4 Porters (Men's Hostel). 2 Rodent Operatives. 11 Administrative and Clerical Staff. 2 Typists. 5 Trainees. Maternity and Child Welfare 6 Clinic Medical Officers whole time (also school duties). 8 part time. Superintendent Health Visitor. Deputy. 29 Health Visitors (also School Nurses) 2 Social Welfare Officers. 1 Specialist Health Visitor 1 Clerk (Problem Family duties). 4 Nurse Assistants. 1 part time Almoner. 1 part time Almoner's Clerk. Superintendent Midwife. Deputy. 20 Midwives. 4 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) 2 Handymen) all part time. District Nursing (agency arrangements) Superintendent. Deputy and 2 Assistants. 47 Nurses. 5 Students. 2 Clerks (1 part time). Domestic Help Supervisor. 4 Assistants. 2 Clerks. 8 full time and 188 part time Home Helps. Day Nurseries 1 Nursery with Macron. Deputy. Warden. 4 Nurses. 4 Students. Handyman and 4 Domestic Staff (part time). 10 Ambulance Service Ambulance Officer. Deputy. Second Officer. Third Officer. Maintenance Officer. 4 Station Officers. 76 Drivers. 2 Mechanics. 4 Clerks. 1 Telephone Operator. 1 C.D. Training Officer. 1 Depot Labourer. 1 Cleaner (part time). Prevention, Care and After-Care Chest Physician (part time). 2 Assistant Chest Physicians (part tine). 4 T.B. Visitors. 1 part time Almoner. 2 Clerks 1 Occupational Therapist (part time). Mental Health 1 Senior Mental Welfare Officer. 1 Training Officer. 3 Psychiatric Social Workers. 5 Mental Welfare Officers. 1 Planning and Senior Clerical Officer. 1 Social Welfare Officer. 1 Boarding-out Officer. 2 Welfare Assistants. 4 Clerks. 1 Typist. 1 Junior Training Centre Supervisor. 6 Assistants. 1 Handyman. 4 Guides. 6 Domestics (part time). 1 Adult Training Centre Senior Instructor. 3 Instructors. 1 Domestic 1 Industrial Unit Instructor-in-charge. 2 Instructors. 1 Storekeeper. 1 Driver. 1 Porter. 1 Domestic. 2 Day Centre Domestics (1 part time). Health Education 1 Qualified Health Education Officer. 1 Qualified Assistant Health Education Officer. 1 Clerk. Welfare Poods 2 Clerks (1 part time) 1 Storekeeper. Mortuary Superintendent. Attendant. 1 part time cleaner. STATISTICS 13 SUMMARY OF STATISTICS FOR 1963 Area, 12,672 acres. Population (Census 1961), 252,501 Total population (estimate of Registrar-General), 254,130 (Midsummer, 1963) Number of Inhabited Houses: 76,747 Rateable Value of Borough 1963, £13,922,648 Product of a Penny Rate, £59, 348 Rate in the £. 8s. 0d. (for the year ending 31.12.63) Live Births: Males Females Total Legitimate 2,329 2,310 4,639 Illegitimate 251 206 457 5,096 Illegitimate Live Births per cent. of total births 9.0 Live Birth Rate (as adjusted by comparability factor 1.00) 20.1 (England and Wales) 18.2 Stillbirths 69 Stillbirth rate per 1,000 total (live and still) births 13.4 (England and Wales) 17.3 Total Births 5,165 Infant Deaths 91 Infant Mortality rate per 1,000 live births 18.5 (England and Wales) 20.9 Infant Mortality rate per 1,000 legitimate births 17..2 Infant Mortality rate per 1,000 illegitimate births 24.1 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 11.6 (England and Wales) 14.2 Early Neo-natal Mortality rate (First week) per 1,000 total live births 9.2 Perinatal Mortality rate (stillbirths + deaths during the first week) per 1,000 total live and still births 22.5 Maternal Deaths (excluding abortion) 1 Maternal Mortality rate (including abortion) per 1,000 total live and still births 0.19 (England and Wales) 0.28 Deaths, 3,280. Death-rate per 1,000 of the estimated population 12.9 (England and Wales) 12.2 Death rate (as adjusted by comparability factor 0.94) 12.1 14 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 1963 to 23.05. The number of marriages solemnised was 2,075, compared with 1,987 in 1962, 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 and 1,987 in 1953. 795 were solemnised in Established Churches, 475 in other places of worship, none by Jewish Ritual and 805 in the Register Office. Births The live births registered were 4,639 legitimate and 457 illegitimate. The birth-rate consequently was 20.1 per 1,000 population. For England and Wales the rate was 18.2. The illegitimate births in Croydon were 9. 0 per cent. of the total as compared with 8.0 per cent. in 1962. 7.1 in 1961, 7.2 in 1960, 7.3 in 1959, 5 per cent. in 1958 and 5.5 in 1957. The live male births numbered 2, 580, the female 2, 516, being a proportion of 1,025 males to 1000 females. Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,510 31 3,541 Doctors 1,339 39 1,378 4,849 70 4,919 Accommodation for Confinements The following table shows where babies were born in Croydon during 1963. 139 fewer were born at home and 355 more were born in hospital than in 1962. Six more residents had babies outside Croydon and 46 more non-residents were confined in Croydon than in 1962 Number Percentage In Private Houses 1,299 26.20 In Public Institutions 3,400 69.58 In Registered Maternity Homes 220 4.23 Total 4,919 15 Still Births During 1963, 69 still births were registered in respect of Croydon.. Of these, 36 were male babies and 33 females; 3 females and 2 males were illegitimate. The proportion of still births to living children was 1 in 74. The still birth rate was 1.3 per cent. of the total births. The still birth rate, on the same basis as for infant Mortality, was 13.5 per 1,000 births. Deaths The deaths numbered 3,280, compared with 3,179 in 1962. For 1963 the crude death-rate was 12.9 compared with 12.5 in 1962. The death-rate for England and Wales was 12.2. There were 156 inquests held by Coroners in respect of Croydon residents during 1963 and 458 findings by Coroners after post-mortem without inquest. Wards with the highest death-rate were South (19.1), Central (16.4) and Broad Green (14.9). Lowest:' Addington (4.5), South Norwood (8.0) and East (11.6). The Registrar General's Table is given in the Appendix, page 108 Comparisons with 1962 show there were again no deaths from Whooping Cough and none from Measles., There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 21 (12 in 1962;) those from Cancer decreased by 29, those from Pneumonia increased by 65 and an increase of 1 was recorded in those caused by Bronchitis. There were 17 deaths from Influenza (13 in 1962). 50 deaths from suicide showing an increase of 18 and motor vehicle accidents totalled 31 (34 in 1962). The percentage of deaths under 1 year of age to the total deaths was 2.8 per cent.; deaths under 1-14 years, 0.9 per cent.; deaths under 15 - 64 years, 24.0 per cent.; and deaths over 65 years, 72. 3 per cent. The corresponding figures for 1962 were 2.4 per cent.; 0.4 per cent.; 23.1 per cent.; and 74.1 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. 16 Principal Causes of Death in order of frequency (Registrar-General* s Return) Rate per 1,000 Population All Ages Deaths from diseases of Cardiac and Circulatory System 4,43 Deaths from Cancer (all forms) 2.36 Deaths from Vascular lesions of the Nervous System 1.89 Deaths from diseases of the Respiratory System (excluding Tuberculosis) 2.03 Deaths from Cancer of Lung 0.72 Deaths from Suicide and Violent Causes 0.57 Deaths from diseases of Digestive System 0.19 Deaths from Tuberculosis (all forms) 0.08 *ulcers of stomach, duodenum; gastritis and enteritis. Maternal Mortality There was 1 death, compared with Nil in 1962. The maternal mortality rate calculated per 1,000 total births and still births was 0.19. The rate for England and Wales was 0. 28 in 1963. For figures for the years 1953 - 1963 see the Appendix, page 112 Infant Mortality The 1963 figure was 91. Set out in the Appendix, page 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 91 deaths, 51 occurred in boy babies and 40 in girls. Of the births, 2,580 were males and 2,516 females. The infantile mortality rate for the two sexes was, therefore, Boys - 20. Girls 16. 76 deaths of infants occurred in Institutions, including Registered Nursing Homes. For details of infant deaths see Appendix, pages 108 & 109. 17 CANCER For detailed tables see the Appendix, page 110. Deaths tabulated in the Department number 599 as compared with, 628 in 1962; 614 in 1961; 585 in 1960; 623 in 1959; 562 in 1958; 591 in 1957; 592 in 1956; 549 in 1955; 486 in 1954 and 540 in 1953. Death-rate per 1,000 of the population for the last 10 years is as follows: - 1954 - 1.95 (486) 1959 - 2.50 (623) 1955 - 2.20 (549) 1960 - 2.34 (585) 1956 - 2.37 (592) 1961 - 2.43 (614) 1957 - 2.37 (591) 1962 - 2.48 (628) 1958 - 2.25 (562) 1963 - 2.36 (599) The organs most often attacked in descending order of incidence are:- In the males - the Lungs (46.5 per cent.), the stomach (12.4 per cent.,) and the Bowels and Rectum (10.9 per cent.); In females - the Breast (21.6 per cent.); Bowels (18.3 per cent.); and the Lungs (10..8 per cent. ). Ward Statistics These are tabulated in the usual form in the Appendix, page 111. COMMUNICABLE DISEASES 21 COMMUNICABLE DISEASES Measles was prevalent following the usual two years cycle. The Public Health Laboratory Service carried out a national survey through local health departments and family doctors, to ascertain how serious were the complications of this infection. Follow up of the results is still continuing. On the final findings will depend decisions about vaccination to prevent measles. From Dr. Linehan' s report it seems that number of patients suffering from measles who needed admission to hospital for the treatment of complications was less than usual. Sonne Dysentery was somewhat prevalent, and although maintaining its usual mild character, one death was recorded in an elderly person, seriously ill from other causes. A small outbreak of Para typhoid B. infection occurred in one ward of a general hospital, involving 6 patients and 4 staff. Three patients gravely ill from other causes died. Very thorough investigations both within the hospital and the community failed to trace the source of infection of the first case. In my view it originated outside the hospital and spread might have been prevented by a rule to isolate or at least barrier nurse, any febrile patient suffering from diarrhoea, despite a firm clinical diagnosis of a non-infectious condition. There was an increase in the number of cases of Food Poisoning, and special investigations were carried out in an effort to help the staff at the Central Salmonella Laboratory who are trying to establish specific sources of this infection. 22 FOOD POISONING The food poisoning notifications, as corrected, for 1963 were:- 1St Quarter 9 2nd Quarter 22 3rd Quarter 15 4th Quarter 16 Total 62 Outbreaks due to identified agents:- Total Outbreaks Nil Total Cases Nil Outbreaks due to:- (a) Chemical Poisons Nil (b) Salmonella Organisms Nil (c) Staphylococci (including toxin) Nil (d) botulinum Nil (e) welchii Nil (f) Other Bacteria Nil Outbreaks of undiscovered cause:- Total Outbreaks Nil Total Cases Nil Single Cases:- Agent identified 16 Unknown Cause 35 Total 51 Cases due to:- Salm. brandenberg 6 Salm. typhi-murium 7 Salm. bareilly 1 Salm. heidelberg 1 Salm. Untypable 1 Salmonella Infections not food-borne:- Outbreaks due to:- Total Outbreaks Total Cases S. Typhi-murium 1 9 S. brandenberg 1 2 23 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1963 J.J. Linehan, Esq., M.D., D.P.H. Physician Superintendent, Waddon Hospital A total of 562 cases were admitted to the infectious diseases' wards, giving an average occupancy of 30.26 beds and an average stay in hospital of 19. 49 days. The following are the final diagnoses of the patients admitted, together with brief details of the common infectious diseases treated. Where cases were admitted from outside the Borough of Croydon, the Croydon cases are shown separately in brackets. Gastro-enteritis 96 (79) Dysentery 89 (76) Measles 58 (47) Chicken-pox 55 (48) Infective Hepatitis 22 Mumps 22 (18) Scarlet Fever 19 (17) Pneumonia 16 (14) Whooping Cough 15 Glandular Fever 15 Salmonella Enteritis 9 (8) Paratyphoid Fever 9 (8) Typhoid Fever 4 (3) Influenza 5 (1) Influenzal Pneumonia 2 Meningitis 5 (4) Encephalitis 1 Herpes Zoster 6 (5) Rubella 4 Erysipelas 1 Bronchitis 19 (18) Tonsillitis 14 (13) Pharyngitis 12 (10) Otitis Media 3 Streptococcal Sore Throat 1 Stomatitis 2 Thrush 1 Laryngitis 2 Pneumothorax 1 Asthma1 Lymphadenitis 8 Abscess 5 (4) Cellulitis 1 Osteo-myelitis 1 Fractured Ribs 1 Thrombo-phlebitis 1 Infective Endocarditis 1 Myocardiac Degeneration 1 Anaemia 1 Ulcerative Colitis 3 Colitis 1 Appendicitis 1 Carcinoma of Colon 1 (0) Pyelitis 2 Urinary Tract Infection 1 (0) Impetigo 3 (2) Urticaria 2 Scabies 1 Eczema 2 Pemphigus 1 Folliculitis of Face 1 Papular Urticaria 1 Herpes Simplex 1 Toxic Erythema 2 Polyneuritis 3 (2) Epilepsy 1 Cerebral Thrombosis 1 Neurosis 1 Psychiatric Disorder 1 Pyrexia of Unknown Origin 2 Nil Abnormal Detected 1 24 Gastro-enteritis: - 96 cases were admitted in the following age groups: - Under one year - 37;. 1-4 years - 26; 5 - 15 years-2; Adults - 24. 11 were gravely ill, 53 moderately severe and 32 mild. Recognised pathogens were isolated as follows: - E. Coli 0.111 - 5 cases; E. Coli 0.119, E. Coli 0.26, staphylococcus aureus, B, proteus and enterococcus, one case each. Thus, in the great majority of cases, including all the severe ones, tie organism was not isolated. Associated illnesses were present as follows: - Bronchitis - 5 cases; Anaemia - 5 cases; Bronchopneumonia, Congestive Heart Failure, Tonsillitis, Rhinitis aid Eczema - 3 cases each; Rheumatoid Arthritis and Diabetes -2 cases each; and one case each of appendicitis, impetigo, paronychia, boils, measles, chicken-pox, hypertension, mental confusion, parkinsonism, thrush, emphysema, conjunctivitis, prolapse and pharyngitis. Two deaths occurred, one a child of four months who also was suffering from broncho-pneumonia and died two days after admission, and the other a lady of 78 years. Dysentery: - 86 cases were Same and 3 of flexner type. The great majority of the cases were mild though one child was gravely ill. Several old people were already seriously ill from other conditions and one died. 40 patients were admitted from residential schools and Corporation homes and 12 were admitted from other hospitals. The following were the age groups of the cases admitted: - Under one year - 10 cases; 1-4 years - 22 cases; 5-15 years - 27 cases; 15 - 65 years - 17 cases and over 65 13 cases. 7 dysentery organisms were tetracycline resistant, 6 streptomycin resistant and one resistant to chloramphenicol. All, except a few who prematurely discharged themselves, gave three consecutive negative faecal results before discharge from hospital. Co-existing illnesses were :- emphysema 7 cases, bronchitis 5 cases, heart failure 3 cases, 2 cases each of appendicectomy, myocardiac degeneration, senile dementia, pneumonia and diabetes and one case each of osteo-arthritis, slipped epiphysis, tonsillitis, anaemia, hemiparesis, influenza, fractured femur, otorrhoea, mouth sores, rhinitis, myxoedena, mytonia dystroplasia and cholecystitis. 25 Measles: - The total of 58 admissions was rather less than that usually admitted in a measles year. The disease was epidemic during the first five m oths of the year during which period 53 of the 58 cases were admitted. The number of cases admitted in the different age groups were as follows: - Under one year - 8 cases; 1-2 years - 9 cases; 2-5 years - 22 cases;. 5-15 years - 14 cases; adults - 3 cases. The following complications were present: - pneumonia - 22 cases, rhinitis - 3 cases, 2 cases of enteritis and tonsillitis and one case each of meningoencephalitis, styes and boils, bronchitis, otitis media, blepharitis and epistaxis. 5 patients were transferred from other hospitals and 8 from nurseries and Corporation homes. There were no deaths. Chicken-pox - 54 patients were admitted in the following age groups: - Under one year - 3 cases; 1-5 years - 22 cases; 5 15 years - 21 cases and adults - 8 cases. 12 patients were already in hospital, 15 patients were admitted from nurseries, 8 patients from Corporation homes and 19 patients from their own homes. The following co-existing illnesses were present:Eczema and bronchitis, 2 cases each and one case each of valvular disease of the heart, appendicitis, colostomy, kyphoscoliosis, septic sores, ulcer of the leg, boils, paronychia and impetigo. The disease was generally more severe in adults amongst whom one particularly severe case was encountered. Infective Hepatitis - 22 patients were admitted in the following age groups: - 0 - 5 years - 3 cases; 5-15 years - 13 cases and 15 - 33 years - 6 cases. There were 8 cases in New Addington and 5 cases in Walmer House. One patient, in whom there was well narked liver enlargement, was treated with prednisolone: Even though the patient had made a good clinical recovery, the biochemical results were seldom entirely normal before the patient left hospital. Mumps - 22 patients were admitted in the following age groups:0 - 5 years - 7 cases; 5-15 years - 10 cases and 15 - 25 years - 5 cases. 7 were associated cases admitted from Walmer House. Complications were pancreatitis 2 cases, labyrinthitis 2 cases and orchitis one case. Associated illnesses were one case each of diabetes, boils and angular stomatitis. 26 Glandular Fever - 15 patients were admitted, all between the ages of 14 and 25. All cases were confirmed by Paul Bunnell reaction. 13 patients had obvious glandular enlargement and Iliad exudate on the throat. One had sore throat without exudate, 5 patients had a rash and one had petechial haemorrhage. Scarlet Fever - 19 patients were admitted in the following age groups: - 0 - 4 years - 5 cases; 5-15 years - 14 cases and 16 25 years 1 case. Thus, they were predominantly school children. Complications consisted of one case each of haematemesis, folliculitis of face, arthritis and otitis media. Concomitant illnesses consisted of an allergic rash and a fractured elbow. Pneumonia - There were three deaths amongst the 16 cases of pneumonia admitted. One was a lady of 78 with myocardiac degeneration, a second was a patient of 37 years with advanced congenital heart disease and the third was a baby, one year old, who suffered from toxaemia and heart failure on admission and died within two days. Among the remaining patients, there was one case each of heart failure, pleural effusion and otitis media. Whooping Cough - 15 patients were admitted in the following age groups: - 0 - 1 year - 10 cases; 1-2 years - 4 cases; 2 - 5 years - lease. Complications were present as follows: - pneumonia - 4 cases, anaemia - 3 cases and one case each of rhinorrhoea, stomatitis, enteritis and lobar collapse. Oo-existing illnesses were two cases of eczema and a fractured radius and ulna. Other Infections - The salmonella infections consisted of 4 cases of S. Typhi-murium, 2 cases each of S. Heidelberg and S. Brandenberg and one case of S. Bareilly. The Paratyphoid patients came from an outbreak in Croydon General Hospital and consisted of five patients and four staff. Three of the patients, who were gravely ill from other causes, died. In the three pyogenic cases of meningitis, penicillin had already been given and so the organism was not isolated. The fourth case was due to osteomyelitis of the skull and the fifth to E.C.H.O. type 14 virus. Of the Typhoid cases, one was infected in Switzerland. another in Calcutta, a third was in contact with cases in Harlow but it was not possible to say where the fourth case contacts the infection. For detailed figures see appendices, pages 135 - 136. 27 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 1963 may be regarded as satisfactory. Hie number of deaths from all forms of Tuberculosis during 1963 was 21 which shows an increase of 7 when compared with 1962. Hie number of new cases of tuberculosis diagnosed during the year shows a very slight increase compared with 1962. This fact makes it quite clear that we must continue our efforts at case finding in order that this disease may ultimately be eradicated. Hie General Practitioner Miniature X-Ray Service continues to function in a satisfactory way and is well used by the Local practitioners. Hie results of this service are summarised below:- Number of miniature films taken 4,259 Number of patients recalled for examination and large film 695 Number of active cases of Pulmonary Tuberculosis 33 Number of cases of lung cancer found 43 It will be seen that the number of patients found suffering from Pulmonary Tuberculosis represents a rate of 7.7 per 1,000 which compares favourably with the figure of 1.1 per 1, 000 from Public Mass X-Ray Surveys. It should be realised that patients referred to the clinic for Miniature X-Ray usually have chest symptoms whereas many patients attending public Mass Radiography sessions have no symptoms. Whilst this section of the report is concerned with Tuberculosis it should be realised that all chest conditions are seen and treated at the Chest Clinic and in the Chest Wards in Mayday Hospital. The incidence and mortality of Tuberculosis continues to decline in a satisfactory way but the problem of Chronic Bronchitis and Lung Cancer becomes greater in each successive year. 28 Incidence 113 cases of Respiratory Tuberculosis and 8 cases of NonRespiratory Tuberculosis were notified on Form A during 1963 (Table I - Formal Notifications). Of these 71 males and 42 females were Respiratory cases and 2 males and 6 females were Non-Respiratory. In addition 65 Respiratory cases and 1 NonRespiratory case came to our notice as new cases otherwise than by notification. (Table II - Supplemental Return). The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1963 by notification or otherwise was 187 as compared with 200 in 1962, 286 in 1961, 218 in 1960 and 265 in 1959. 178 of these were cases of Respiratory Tuberculosis; 106 in males and 72 in females. There were 11 fewer males and 4 more females than 1962. There were no cases of Non-Respiratory Tuberculosis among children under 15 years in 1961 or 1962. The number of cases in adults was 8 compared with 15 in 1962. Of the cases notified in 1963, 3 males and one female died from the Respiratory form of the disease during the year, equal to 3.3 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 0.74 per 1,000 of the population; for Respiratory Tuberculosis 0.70 and for Non-Respiratory 0.04 per 1,000 population- The notification rate was 0. 48 per 1, 000. In 1962 the corresponding figures were 0.79, 0.73, 0.06 and 0.46 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1963:- RESPIRATORY NON-RESPIRATORY Males Females Total Males Females Total Total Cases 997 734 1,731 55 74 129 1,860 29 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1963, 107 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) 68 or 63.5 B, or T. B. plus, 1 (early cases, sputum positive) 7 or 6.5 B, or T.B. plus, 2 (intermediate cases, sputum positive) 30 or 28.1 B, or T. B. plus, 3 (advanced cases, sputum positive) 2 or 1.9 107 100.0% Non-Respiratory Tuberculosis There were 5 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms: - Bones and Joints 1 Abdominal l Other Organs 1 Peripheral Glands 2 5 Ages at Death from Respiratory Tuberculosis Year 0-5 5-15 15-25 25-45 45-65 over 65 TOTAL 1953 1 - - 5 11 14 31 1954 - - 1 6 15 6 28 1955 - - . 6 18 9 33 1956 - - . 2 11 12 25 1957 - - - 6 10 13 29 1958 - - . 1 12 6 19 1959 - - 1 2 9 12 24 1960 - - _ 3 6 9 18 1961 - - _ 2 5 14 21 1962 - - 1 1 6 4 12 1963 - - » 1 11 9 21 30 All but 6 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 1963 the death-rate from all forms of Tuberculosis was 0.08 per 1,000 population. The rate from Respiratory Tuberculosis was 0.08 and the rate for Non-Respiratory Tuberculosis 0.00. Similar figures for 1962 were 0.05 and 0.01. In 1963 the total number of deaths showed an increase of seven when compared with 1962. 95% 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 1963 no deaths were certified to be due to Non-Respiratory Tuberculosis, compared with 2 in 1962, Nil in 1961, 2 in 1960 and 1 in 1959. Co-ordination with the Health Department During the year 22 children were referred by the School Medical Service, and 4 cases from the Maternity and Child Welfare Section of the Public Health Department. Extra Nourishment Provision of special nourishment in the form of milk granted to 34 selected cases for varying periods during the year and 25 cases were in receipt of extra nourishment at the end of the year. Residential Treatment 71 men, 45 women and one child were admitted to Residential Institutions in Croydon during 1963, suffering from tuberculosis. 31 The Chest Clinic and Home Visiting 2,202 new cases were examined during the year. 107 were found to be definitely tuberculous.. The total number of attendances for examination at the Chest Clinic was 17,696. The Clinic doctors paid 158 home visits and the Tuberculosis Visitors 2,209 visits for Clinic purposes. In addition the Tuberculosis Visitors made 194 primary visits for the purposes of the Notification Register. There were also 951 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 1963, 651 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contactcase ratio of 5 for each notified case during the year. Of these contacts, 8 were found to be tuberculous. This is equal to a Tuberculosis rate per 1, 000 contacts of 12 compared with 0.74 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: — 1962 - New contacts examined 717 New cases of Tuberculosis 116 1961 - „ „ „ „ 742 „ „ „ „ 190 I960- „ „ „ „ 676 „ „ „ „ 139 1959 - „ „ „ „ 775 „ „ „ „ 148 1958 - „ „ „ „ 748 „ „ „ „ 161 32 B. C. G. Vaccination The use of B.. C. G. vaccination for contacts has been continued during 1963 and regular sessions are held at the clinic for this purpose. 313 contacts were successfully vaccinated during the year, compared with 387 in 1962. In addition 14 nurses and domestics were successfully vaccinated, and 54 babies of tuberculous parents were vaccinated in hospital during the neonatal period. During the year under review the scheme for the B.C.G. Vaccination of all school children between 13 and 14 years of age was continued in Croydon. Staff from the Chest Clinic visit the Schools and carry out the necessary Skin Testing and vaccination with B.C.G. The response by parents to this protection for their children has been satisfactory and there were no untoward difficulties or complications. The Staff for this scheme are provided by the Local Authority but work under the direction of the chest Physician, and this affords another practical example of co-operation between those responsible for treatment and prevention of Tuberculosis. B„ C. G. Vaccination for School Leavers The total number of children skin tested - 2,984 Number found to be negative - 2,537 Number vaccinated with B.C.G - 2,536 Rehousing of Tuberculosis Patients 11 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 318 examinations were carried out in 1963. For detailed figures see Appendices, page 143. 33 MASS RADIOGRAPHY 1963 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 10,902 17 9 Female 10,349 6 1 Total 21, 251 23 10 New Addington General Practitioner Chest X-Ray Service No. of Persons Examined Tuberculosis Requiring Treatment or close clinic supervision Primary i Carcinoma of Lung Male 298 1 3 Female 308 2 1 Total 606 3 4 34 AFTER-CARE OF THE TUBERCULOUS PATIENT The after-care needed by the tuberculous patient is varied, due to such differences as home conditions, financial circumstances, nature of employment, nationality, as well as physical condition and personality. Every year, new notifications produce patients with varied after-care needs, and help is given both to these patients and to previously notified tuberculosis cases. The foreign patients often have problems and require help and guidance. Frequently, they are living in lodgings and have no relatives to give them practical and moral support. They may only have been in this country for a short while and are still looking for a job when taken ill, or if in employment, they may not have worked long enough to entitle them to National Insurance Sickness Benefit. These patients generally experience difficulty in obtaining employment when fit enough to work again. Employment can also be a problem for some of the British tuberculosis patients, and especially for the older man who has to give up his job and find light work. Once again, the Disablement Resettlement Officer has given all help possible. Retirement Pensions, Sickness Benefit and National Assistance rates have increased this year, but with the rise in cost of living, patients have still found it very difficult to put money aside for special needs. The bitter weather of January and February increased fuel expenses, and many patients could illafford this. Requests for assistance with fuel were made to our Care Committee, and generous help was given. The Committee have also helped to meet other special needs, and at Christinas issued grocery vouchers and fuel grants to a large number of patients. It would be difficult to over-emphasise the pleasure obtained by patients from their summer holidays at a Guest House or with relatives, and they are always very grateful to the Care Committee for making these holidays possible. 1963 has been a busy year from all aspects of after-care work. 35 OCCUPATIONAL THERAPY 1963 was again a busy year for the Occupational Therapy Department of the Chest Clinic. Most of the Patients were keen to do useful work, and managed to keep going remarkably well on the whole, even through the bitterly cold Winter. The Showcase in the Chest Clinic entrance hall is becoming invaluable, and Patients receive a steady flow of orders for the goods displayed there. We have been a little more ambitious this year over producing goods for Christmas and for the Annual Sale of Work at Queen's Hospital, and the Patients turned out some original rooden toys, tables and trays. The Sale was most successful. The extra three-hour Occupational Therapy session per week provided by the Welfare Department is proying very helpful and leans that more time can be spent with each patient than was previously possible. 36 VENEREAL DISEASES The usual figures are given in Appendices pages 144 - 147, There has been a change in the method of keeping records. Age groups are now quoted, but without any previous records for comparison, no comment can be made. As regards total figures of new cases reported, both for syphilis and for gonorrhoea the numbers are slightly smaller. 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 - 1963 Faeces outfits 3686 Drinking Water samples 268 Public Swimming Bath Water samples 76 Private Swimming Bath Water samples 105 Private Wells 61 Milk samples 203 Cream samples 12 Ice Cream samples 173 Sundry Pood Specimens 34 Blood 23 Urine 20 Nose and Throat Swabs 6 Total 4,667 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 39 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics The rise in the birth rate increased considerably the work of the clinics despite a growing practice of referring mothers to family doctors for interim ante-natal care. There has always been a joint domiciliary midwifery and hospital obstetric service in Croydon, under the unified clinical supervision of the Consultant Obstetricians. A Maternity Liaison Committee has functioned since the inception of the National Health Service, but in recent years has met very infrequebtly as most major matters of policy have been decided. One of the Consultant Obstetricians serves as a co-opted member of the local authority Health, Maternity and Welfare Sub-Committee. The percentage of mothers confined in hospital reached a record high figure of almost 70%. This was possible only by the policy of early discharge for home care. There are many inconveniences in operating such a policy, but it did enable a firm decision as to the place of confinement for every mother attending for ante-natal care, and priority for all who needed institutional care for medical or social reasons. As always there *as no question of deliberate use of the Emergency Bed Service. At ante-natal clinics a total of 5,459 mothers attended during the year. 1,849 mothers attended the post-natal clinic. At relaxation classes 899 mothers made 5,402 attendances. 436 mothers attended Mothercraft courses each consisting of 7 lectures. Care of Premature Babies There were 29 more premature babies born than in 1962, and 4 more died. Arrangements continued with the Children's Department of Mayday Hospital for the supervision of premature babies after discharge from Hospital. Estimations of haemoglobin are made at Infant Welfare Clinics if the mother prefers to visit a local centre instead of returning to hospital. They are referred tack should a reading of less than 60% be found at the Clinic. For detailed figures see Appendix, page 119. 40 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:- 203 cases were dealt with by the Social Workers 56 cases were admitted to Mother and Baby Homes 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:- 13 years old - 1 14 „ „ - 1 15 „ „ 11 16 „ „ - 13 17 „ „ - 14 18 „ „ - 18 Total - 58 Of these girls 26 went to Mother and Baby Homes, 22 of them being financially assisted by the Local Authority. During 1963 the ages of the younger mothers when their babies were born were:- Age 14 1 „ 15 8 „ 16 13 „ 17* 16 „ 18 16 „ 19 3 Total - 58 Of these babies 2 died. *1 girl in this group had a miscarriage. 41 Domiciliary Midwifery Despite the rise in the birth rate the number of home confinements during the year under review was less than in 1962. This was due to a deliberate emphasis on careful selection for admission to hospital. The risk to women who have borne four or more children is considerable, and all recommendations about safer midwifery stress the need for these mothers to be confined in hospital. For obvious reasons they are often most reluctant to leave home, but they can usually be persuaded to enter hospital for the delivery of the child, on the understanding that early discharge for subsequent home care will be arranged. That for the second year runnung there was not a single death in childbirth in Croydon indicates the value of this policy. It did result in 1,134 mothers booked for hospital confinement being referred for subsequent domiciliary care, a rise of almost 50% on the figure for 1962. The recruitment of midwives to fill vacancies remained difficult, but it was nevertheless possible to maintain the permitted establishment. For detailed figures see Appendices, pages 115 - 118 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 88. 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 There was a fall in the number of attendances associated with the very bad weather at the beginning of the year. Toddler clinics and Health Education facilities were steadily augmented during the year. The opening of new Clinic premises at Waddon allowed an immediate improvement to the services available in the area. The replacement of an unsatisfactory hall by an up to date clinic has resulted in a new interest in all aspects of our work. for other detailed figures see Appendix, page 121. 42 Welfare poods It has always been the policy in Croydon to distribute at the Infant Welfare centres only National Dried Milk and vitamin preparations, and there has never been any question of mothers being attracted to the Centres because a large variety of proprietory supplies are available at special prices. In Croydon the final distribution of National Dried Milk and vitamin preparations to the mothers concerned is performed almost entirely by Voluntary Workers. The central office now at St. Michael's Road is open for 5½ days a week and 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 the Centre. Total issues of Welfare Poods during 1963:- National Dried Milk 58637 Cod Liver Oil 5412 Vitamin A and D Tablets 9057 Orange Juice 68112 43 THE WORK OF THE HEALTH VISITOR Miss L,E. Oakley, S.R.N., S.C.M., H.V. Cert. Superintendent Health Visitor Each year brings its special problems for the Health Visitor, and in the year under review there was fresh emphasis on old problems in a new guise. Houses in multiple occupation, mothers going out to work, large families making do in one or two rooms - paying rent which they could ill afford and children now with one, now with another daily minder. These have occurred chiefly in those parts of the Borough where immigrants tended to congregate. Cultures were different, there was no hope of rehousing by the Council, and places in the Corporation Nursery were not possible because both parents were working. If admission to the nursery was authorised distance from home or to work sometimes made the arrangement impractible. At first the numbers involved and the manifold difficulties baffled the Health Visitor, but now she realises that these are conditions she was trained to meet- Her visits were welcomed, and in the majority of cases efforts were made to adjust to the need for healthy living in a strange environment with a somewhat inclement climate. By and large the children and the homes were clean and cared for, and once a good relationship had been established the Health Visitor felt that she could achieve much to help these families. The promotion of mental as well as physical health is now a routine part of the Health Visitor's work. This has meant a close liaison with her colleagues in the mental health field, and it was achieved by further in-service training and case discussions. Health Visitors were often involved in coping with problems posed by unmarried mothers. Particular difficulties arose in finding suitable accommodation for girls away from their families. Proper care for the child of an unmarried mother who decided to work was not always easy to arrange. The Corporation's Day Nursery was sometimes too far away from her home, or full at the moment it was needed. Daily minders for very young babies were not easy to find. To support the unmarried mother by sympathy and understanding until she was able to find work, to discover a friendly neighbour willing and competent to look after the child, were sometimes time-consuming but rewarding tasks for Health Visitors. 44 Better co-operation between General Practitioners and Health Visitors is a topic frequently discussed but little understood, possibly because both parties lacked time to really get to know and understand each other's work. One family doctor practising on a Corporation Housing Estate acts as the Medical Officer for one session a week in a Corporation Infant Welfare Centre, at which only children on his medical list attend. During the year under review this arrangement has overcome initial difficulties and a Health Education programme shared between the Doctor and the Health Visitor was working very well. In another part of the town a family doctor invited the Health Visitor to assist him at the Infant Welfare Clinic which he holds weekly in his own surgery. Not only does she weigh babies but advises generally on health problems. In addition this Health Visitor deals with all the families with children under five years of age on the particular doctor's medical list. She is thus able to discuss with him problems which she meets on her visits, and to coordinate the work of the family doctor and the Health Department. Where such direct liaison is not possible, Health Visitors try to make special opportunities to discuss the more pressing problems which they meet with the family doctor concerned. 1963 was the year in which our former ability to recruit trained Health Visitors virtually ceased. With the prospect of vacancies early in 1964 it was agreed that sponsoring of students for Health Visitor training had become essential, and this policy was initiated. Figures of work carried out are shown in Appendix, page 120. 45 PROBLEM FAMILIES Mrs. M. A. Tripet. S. R. N., R. P. N. ,H. V. Cert.. Dip. Social Studies. Specialist Health Visitor In a review of the work with Problem and Potentially Homeless Families it is not possible to put facts and figures in various columns for an annual review, as the Problem Family or a family with a Problem are people who need help, and in many cases they do not ask for it until the problem is so acute that it may lead to a mental or physical breakdown. Rehabilitation work cannot be measured in any given time, but when families respond to a social pattern, and realise that by help and guidance a breakdown of family life is averted, then life becomes easier and the children benefit. In any discussion about Problem Families one assumes that arrears of rent, numerous debts, and large families are the common factors, but recently one new problem has arisen. Owing to the number of "teen age" marriages there is an increasing number of referrals in the under 25 year old group. The main problem is financial. Because of the high rates of pay earned by young men and women before marriage they do not realise that to bring up a family on one wage is often beyond their means as they have not followed a pattern, of making a home before marriage. This group usually asks for help more easily than the older type, but they are resentful of any advice. In the young group the girl is usually more intelligent than the boy, and tends to make the decisions. Another aspect of this problem is that as women nowadays can get employment and earn enough to support themselves, they leave their families without apparent thought of the effect on their children or the strain caused to the Social Services. In addition to the Receiving Home, which can take 12 homeless families under Part III of the National Assistance Act, 1948, there are now 6 Problem Family Units which are administered by Welfare Services. These families are selected because they have shown an irresponsible attitude to their commitments. They are helped initially by financial and material means to reestablish a home and constant visiting is maintained to help with budgetting and advice on the daily routine of home life. Since this scheme commenced in November 1962, 8 families have been selected and of this number 2 families have been transferred to permanent accommodation. The latter are still visited, but not so intensively. It is interesting to note that both families wished to keep in contact with the Workers, but on the basis of the family coming to the Worker rather than as in the first instance the Worker approaching the family. 46 In the Problem Family Units the father lives with his family. He is encouraged to find and keep employment and take interest in the home budget. These Units provide a service because children can be returned to their parents. In our group 13 children have been reunited and taking into consideration the 6 Units, they house 37 children between them. This type of work could not be carried on without the help and support from other Departments, voluntary organisations and the Statutory Bodies. The Potential Homeless Family is an acute problem, mainly because they move from district to district either seeking better employment or less expensive accommodation, and as the family increases the threat of eviction becomes a reality. In this group matrimonial troubles are more prominent and family life less stable. They tend to think that permanent re-housing will solve all their problems, but fail to realise that after so many changes of accommodation, usually furnished, they have not laid a foundation within the family for a definite plan for their own happiness as a family group. As these families could be presented as the makings of Problem Families, the necessity of passing records from borough to borough is shown here as in many cases continued supervision in the new area may prevent family breakdown. Owing to the Children and Young Person Act, 1963, which gave more power to the Local Authority to give financial and material help to families to prevent their breakdown and the necessity of receiving children into care, it was decided that the Social Welfare Officers dealing with Problem Families should be transferred to the Children's Department. The work is essentially unchanged and owing to the new legislation some aspects of rehabilitation can be dealt with more quickly. The general picture remains the same, but on the whole early signs of a family breakdown are now more easily recognised by the Officers in all branches of social work, and an additional help is the new method of rehabilitation recently introduced. For detailed figures see Appendix, page 127. 47 IMMUNISATION Advice was received from the Ministry of Health about the best time for primary vaccination against smallpox. Evidence now suggests that this should be offered between 1-2 years of age. and not at about 4 months as was previously thought. Two study sessions were held with clinic medical officers and Health Visitors to discuss the timing of immunisation procedures, and as a result the following schedule was put into operation. 6, 7 and 8 months - 1st, 2nd and 3rd Oral Polio 9, 10 and 11 months - 1st, 2nd and 3rd Triple (Whooping Cough/Diphtheria/Tetanus). 12 months - Smallpox vaccination 4½-5 years - Diphtheria/Tetanus Booster 5 + years - Polio Booster 8-10 years - Diphtheria Booster 13 years - B. C. G. These variations do tend to confuse parents, and with the fortunate absence of cases of disease, and with the postponement of primary vaccination for newborn infants, it is understandable that there was a fall in applications for this protection. Oral vaccine against poliomyelitis has proved safe and satisfactory, and it is disappointing that acceptances have tended to fall. The virtual elimination of this disease, once the major anxiety of all parents, has been so successful that a dangerous sense of security is tending to arise, which is very difficult to combat by health education. Concerted efforts covering the whole of the Home Counties to improve the immunisation rates were being planned with the Ministry of Health and other Authorities. Tables are given in the Appendix, page 137 HOME NURSING The number of calls upon home Nurses was almost the same as in 1962, thus ending the downward trend in the number of patients. The pattern of the service now seems to be well established. The work of the rehabilitation nurse continues as a valuable supplement to the active treatment policy of the geriatric hospital. For detailed statistics see page 122. 48 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 23 cases were so dealt with, 14 women and 9 men. There were in addition, 10 cases where the patients cancelled their applications after the arrangements had been made. These figures do not include school children for whoi arrangements are made by the Education Committee. 49 HOME HELP SERVICE Miss J.E. Heath Home Help Supervisor "We must help each other; it is the law of nature.." La Fontaine The history of the Home Help Service is a comparatively short one. The roots of it lie deep in the early works of charity. Although the pioneers of the service were primarily concerned with the care of the mother and her new baby, today, following the sweeping social changes wrought by two wars, a much more comprehensive service is necessary. Relatives and friends who once provided the domestic support for the sick and aged are now part of the vast economic pattern of modern society, and have limited time and energy available. Many families are scattered and private domestic help is at a premium. The National Health Service Act 1946 consolidating the acts and orders concerned refers to the Domestic Help. This somewhat formal title has given way to the simple but more descriptive name "Home Help.." The home is described as the abode of the family of which one forms a member. To those in full health home is a centre of ideas, activity, ambitions, plans and hopes. To the sick and aged it is not only an abode, it assumes a much greater significance. It is a world and in many instances the last refuge and the right to remain in it will be defended by every ounce of failing strength. Today, as always when the responsibility for maintenance becomes too great it must be shared. Adding its contribution to the vast unrecorded effort of relatives and friends, the Home Help Service plays its part. Some idea of the work carried out by the Croydon Home Help Service can be gained from statistics given on page 126 of the Appendix. The problems of a mother confined to bed are manifold and great are the responsibilities of the Home Help in trying to relieve some of these problems, but an extract from a letter of appreciation gives a personal answer... "It is natural at such times as these to be rather apprehensive about the type of woman who would come into the house and have a completely free hand without any supervision. However, after just one day with us Mrs. put our minds completely at rest and indeed we found that we have gained a very valued friend. We have been most impressed by her energy, competence, thoroughness and honesty...." 50 HEALTH EDUCATION AND HOME SAFETY Miss D. S. Elliott, S.R.N., H.V. Cert., Dip. H.E. Health Education Officer "It is good to rub and polish our minds against those of others" (Montaigne) Health education is undergoing rapid change. During the year those interested in it became increasingly aware that the imparting of health knowledge alone was not enough to change preconceived ideas, attitudes and behaviour. There was an increasing appreciation of the need to learn more about the skills for promoting discussion and practical action. The Health Education Section, now firmly established and well-equipped, was used by increasing numbers of public health staff, teachers, general practitioners, youth club leaders, students and others- Inservice Training The routine work of the section continued as before but much more time was devoted to inservice training and staff meetings, some of which were formal, others short and informal to avoid disrupting services. The progress and effectiveness of health education depends largely on the enthusiasm, attitudes and skill of all field workers and continuous help and training for them was felt to be a primary duty. Multidisciplinary groups were popular and stimulating. Active participation was encouraged.. The exchange of knowledge and experience was thought to be valuable and particularly the opportunity for individuals to communicate regularly and informally with their colleagues- Two examples of this work were:- (a) Two voluntary courses on group discussion techniques given by the Assistant Health Education Officer, The date, time and number of sessions were decided by the staff attending and resulted in some excellent work being done. (b) As a form of revision and preparation for including some simple applied physiology in the programmes for Toddlers' and Parents' Clubs, three tutors from Mayday Hospital gave two courses of eleven lectures to public health staff. These were greatly appreciated and the two-way exchange also helped to strengthen goodwill between the hospital and health department. 51 Smoking and Lung Cancer There was no large publicity drive during the year, but every opportunity was taken to lead discussions with groups of the public, e.g. mothercraft classes Toddler's and Parent's Clubs other societies and organisations and to demonstrate new teaching aids to the staff. Help was given with the anti¬smoking clinic - called "The Thursday Club" run by Dr. S. MacKeith and a member of his staff, which closed at the end of the year. New practices in health so obviously necessary and important in the eyes of public health officers appear to most individuals as a series of difficult and often embarrassing choices; they demand additional effort and some kind of break with habitual ways of living. See also School Section of the Report, page 7. Venereal Diseases See School Section of the Report, page 7. Toddlers' Clinics and Parents' Clubs Fortnightly health education programmes in the ten Toddlers' Clinics and three Parents' Clubs run by the Health Visitors were based on the members' interests and the current annual statistics, the major purpose being to involve people. As more and more become involved, they not only become imbued with a knowledge and understanding of a particular health problem, but they also become effective as "health educators" in their own right to bring such knowledge and understanding to others. An example of group dynamics may illustrate this. One of the Clubs has established a small dramatic group- A friend of one member wrote a play illustrating a social problem. Without any help from the staff the group produced the play and gave a repeat performance to another club. This time it was deliberately used as an educational exercise. The curtain dropped before the final scene; the audience was divided into four groups each led by an experienced health visitor and suggested a possible final scene (i.e. audience participation). The Players then enacted their own version, which was slightly fantastic and amusing and had the virtue of reducing tension and allowing the audience to leave in a relaxed frame of mind. The members were so stimulated by their success that another play of this kind was written and will shortly be produced. Other ideas are being discussed and this form of "role playing" nay well be educationally useful in the future. 52 Other Activities Lectures on the social aspects of disease and health education continued at Croydon and Mayday Hospitals. Because it was felt that those who are trained in health education techniques should do all they can to help in the training of other professional groups, lectures were willingly given at nine other colleges and training schools in London. Two courses on "Preparation for Retirement" were run by Croydon Technical College and it was an interesting venture to give the lectures on "Health." They highlighted the need of the public for knowledge about the normal mechanism and functions of the human body and for the opportunity to discuss habits and behaviour. Home Safety Talks and discussions were given regularly during the year by various members of the staff and outside organisations. Exhibitions and Displays Again a twenty¬foot exhibition stand was arranged at the Ashburton Flower Show in July and staff discussed the exhibits with the public throughout the day. Home Safety was featured on the Public Health Stand at the "Welcome to Citizenship" exhibition and also played a large part in the Health Education Open Week for Junior Teachers held at Coombe Cliff Education Centre. Fire Prevention During the autumn the Fire Prevention Officers gave thirtysix talks and demonstrations at Infant Welfare Centres and Toddlers' Clinics. This was a tremendous effort, but it is hoped their work will continue. In spite of all the publicity the number of children under five years of age taken to hospital by ambulance for injuries sustained from burns and scalds rose from 26 to 36. It is depressing to note that Croydon has followed the national pattern of an increase in the number of accidents taken to hospital by ambulance and in the number of deaths. For the first time the number of deaths from home accidents exceeded the number of deaths from motor accidents - although it should be observed that seven of the deaths occurred when a multi¬occupied house caught fire, the fire being caused by an oil heater. 53 The number of cases taken by ambulance to hospital for 'poisoning' also increased by over three times and showed an increase from 13 to 40 in children under five years of age, one of whom died. This means that home safety publicity and education must be revised and greater concentration given to it. In the future experiments to find more effective ways of preventing many of these avoidable injuries and tragedies must be attempted. Tables are given in the Appendix, page 129. 54 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 are referred for this purpose by Doctors and Consultants at Ante- and Post¬Natal Clinics; reference can also be made by Medical Practitioners attending similar patients. In the case of children under school age introduction is effected via Welfare Centres or as a result of requests by Health Visitors. By far the greater proportion of such children, however, continue to be seen following application by parents to respective Dental Clinics. Treatment in all categories is carried out at School Dental Clinics and is closely integrated with work on the Education side. Since the introduction of routine dental attention under the General Dental Service there has been a marked change in the pattern of treatment in Local Authority Clinics and this has been chiefly discernable in respect of altered requirements for the expectant and nursing mothers. As had been anticipated the greater proportion of mothers currently attending Ante¬Natal Clinics are now in the habit of paying regular visits to their own dentists, and for this reason the number deemed to require attention bears little resemblance to the bulk of those seen on the medical side. As a result of improved living conditions and general social advancement, gross oral sepsis calling for wholesale removal of teeth is largely a thing of the past, and preservation of the natural dentition is more readily accepted as being a true and normal aim. Because of its reduced commitments Local Dental Services are now better able to meet the special need of those expectant mothers newly arrived in the Borough, who for one reason or another are unable to secure the priority for treatment which their condition demands. In addition to the above, more adequate provision is now possible for those less prudent in their dental care who, as the result of previous neglect, are found to require urgent treatment; in practice reluctance is still shown by some practitioners in carrying out work for those nearing their confinement, and such cases are therefore advised to seek attention at a local clinic. The now well established "routine" whereby all ante¬natal patients not in receipt of periodic oral su pervision are automatically referred for dental examination, continues to yield a reasonable dividend, and despite the usual quota of "missed appointments, can result in attention for a substantial number who would otherwise remain untreated; once contact has been made many of these become model patients and show a welcome appreciation of the preventive aspect of the work. 55 Remarks in previous Reports concerning the problem of securing more comprehensive supervision for those in the preschool stage continue to be valid, and though some progress has been made, further initial study is desirable in this direction, and the ultimate solution will doubtless depend upon a measure of long term planning. In this connection the practice recently adopted for including a Dental Unit in the newly erected Welfare Centre for the Waddon area is much to be recommended, for allowing a natural integration of Medical and Dental Services and periodic surveys of the younger children visiting this centre, should permit a realistic assessment as to possible requirements in similar areas of the Borough. General approval has been expressed by both parents and staff at the very comprehensive amenities provided by this newest venture, which it is hoped will stimulate the demand for attention in this growing community. In the field of Dental Health further efforts are being made to bring home to parents the need for early and sustained supervision of the pre¬school child, and useful support has been forthcoming from staff at Welfare Centres during Toddler Sessions. Informal talks on this theme have also been continued to members of Church and other Organisations during the past year. In spite of the many doubts expressed over this controversy, it is the firm opinion of leading experts in both medical and dental professions, that fluoridation of public water supplies still represents the most effective method yet devised for raising the resistance to tooth decay, particularly in respect of the very young. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 238, compared with 324 in 1962; 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 now stands at 31 per cent., compared with 33 per cent. in 1962. 56 Expectant mothers examined for the first time numbered 166 against 199 last year. Of these 76.5 percent. 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. As a result of improved supervision during the pre¬natal period, the amount of work for nursing mothers has shown a steady decline during recent years, and has therefore ceased to present any special problem. Of those seen, some such cases resulted from late reference from the Ante¬Natal Department, which did not permit of treatment until after the confinement; otherwise names were received during the post¬natal stage. 22 nursing mothers were examined or re¬treated during the current year, compared with 27 in 1962. Treatment Including those continuing treatment from the previous year, 223 mothers were dealt with, against 274 in 1962. 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 384, compared with 394 in 1962. As previously, this figure included a proportion of "toddlers" due for re¬inspection and treatment. As in the case of the school population, the rise in sugar consumption of post war years has also been responsible for an appreciable increase in decay in the mouths ot the "under fives; earlier supervision of these youngsters is therefore becoming of prior 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 some evidence to suggest that this routine survey is not, in certain cases, obtained elsewhere. The usual tables are given in the Appendix, page 128. 57 AMBULANCE SERVICE A. L. Hill, M.B.E., Chief Ambulance Officer During the year the Service was called upon to deal with 130,391 patients which necessitated 54,420 journeys and a mileage of 446,166. Compared with 1962 these figures show an increase of 5,060 patients (4%), 20,211 miles (5%) and 1,095 journeys (2%). There were 17,007 patients conveyed to places outside the Borough, and on these journeys 147,141 miles were travelled which shows an increase of 1,520 patients and 21,265 miles. The number of patients admitted to Hospitals and Nursing Homes was 9,906 compared with 9,352 the previous year. Apart from the first quarter of the year when snow and ice restricted the Service, the work has steadily increased particularly from October when the mileage showed an increase of 14, 757 compared with the last quarter of 1962, and there is every indication that this will continue during 1964. Accident Calls were higher than 1962 showing a 17% increase which at times caused difficulties with the General Health Service transport. Street Accidents accounted for the majority of this increase. Transport requests for patients to attend Hospitals out of the Borough again rose and with traffic congestion in London vehicles were delayed. A total of 952 days sickness was recorded compared with 808 during 1962. Eight Driver¬attendants resigned and replacements were employed and trained. A team was again entered for the Chief Ambulance Officers' Association Regional First Aid Competition held at Battersea Park and were placed third out of fifteen teams entered. The new Garage at Headquarters Station was completed allowing efficient parking of vehicles at night and weekends. Alterations were made to the Control Room and Offices in the administrative block which have proved satisfactory. For details of journeys, patients, mileage etc. see the App- endix, page 132. 58 CIVIL DEFENCE (Ambulance Section) Under the new organisation 108 Volunteers were on the register at 31st December 1963 and of this number 38 attended for Standard Training, 53 signed for three years on 'A' Service with Advance Training, 14 were placed on Reserve and 3 were Current Absentees. Three volunteers were successful candidates at the Instructor' s Course and Examination held from April to June and increased the number of Instructors from 7 to 10. This number includes two of my Officers. The annual First Aid Course was again held from 26th September to 14th November, 36 volunteers were examined by the St. John's Society and 33 were successful. The Standard Civil Defence Test was held in February and of the 50 volunteers who were examined 40 passed. Several exercises were held during the year including a Convoy Exercise with my Second Officer in Charge also an exercise was held at the Rescue Range with our Local Forward Medical Aid Unit, followed by an all day exercise with the London County Council and the F.M.A.U. at Sandown Park. 59 MENTAL HEALTH SERVICES During 1963 progress in the Mental Health Service has been marked both by further expansion of the different branches of the work - industrial, social and residential provision - and by considerable consolidation of the service in these various sides. Progress has been solid and soundly based, and there is now a good foundation for further development. Administration The Medical Officer of Health has administrative control, and the deputy and two Assistant Medical Officers of Health are approved for the purpose of the Mental Health Act. Under arrangements agreed with the Regional Hospital Board, the Physician Superintendent of Warlingham Park Hospital serves as Psychiatric Advisor to the local health authority, a Consultant Psychiatrist from the same hospital is in charge of the day to day running of the services as Medical Director of the Community Mental Health Services, and a Consultant Psychiatrist from St. Lawrence's Hospital advises on the work for the mentally subnormal. Voluntary Associations Thirteen severely subnormal patients are placed with the Guardianship Society and their care by the Society constitutes the only duty delegated to a voluntary organisation. The service continues to have the use of ten beds in the Mental After Care Association short stay home in Croydon. The service also has close and cordial ties with Croydon and District Society for Mentally Handicapped Children, who continue to organise excellent social club activities for the Mentally handicapped in the district. The Croydon Guild of Social Service are often able to render most valuable assistance. Work carried out in the Community The pages which follow give details of the work undertaken ln 1963. I record with appreciation my thanks to medical colleagues in our local psychiatric hospitals for their help and co¬operation. 60 Mental Health Act 1959 - Mental Illness Patients admitted to hospitals:- M. F. Total. Informally 50 79 129 Under Section 25 (for observation) 16 26 42 Under Section 26 (for treatment) 23 26 49 Under Section 29 (for observation in emergency) 73 122 195 Under Section 136 (Police action) 4 1 5 Under Section 60 (hospital Order through Court) 3 2 5 Investigated but not admitted to hospitals 13 18 31 182 274 456 Residential Accommodation Long Term Pour patients were admitted to Homes run by the Mental After Care Association, three patients have left and the total accommodated is now nine. Hostel At the beginning of the year ten patients were resident in the Mental After Care Hostel in Croydon for employable recovered mentally ill patients and seven patients were admitted during the year. Of those who left, three were found lodgings under the Boarding Out Scheme, one returned to her parents, two returned to hospital and one was transferred to a long term hostel leaving ten in occupation at 31st December. Three patients were admitted for periods of a few months to hostels outside Croydon. Convalescence One person was provided with a convalescent holiday during the year. In all the above instances the Corporation accepted financial responsibility for the services given, subject to contributions according to means. Information concerning patients Boarded Out under the Council's scheme appears later in this report. Mental Health Act 1959 - Subnormality 61 During 1963 hospital admissions were as follows and the corresponding figures for 1962 are shown for comparison purposes:- 1963 1962 To psychiatric hospitals (subnormality) 24 24 To psychiatric hospitals (mental illness) Nil 1 Transferred from one hospital to another 3 1 Admitted for short¬term care 19 18 Total number of patients in hospitals 384 385 Ten patients were awaiting long term hospital vacancies on 31st December, 1963. Six patients were placed under the guardianship of the Local Authority, and one was discharged from guardianship, bringing the total to twenty¬three. Residential Accomodation Financial responsibility was accepted by the Corporation in respect of the maintenance of one severely subnormal girl in a Hone outside Croydon. Thirteen severely subnormal patients, (six males, seven females) are placed in foster homes supervised by the Guardianship Society. Training Junior Training Centre The special care group at this centre is now firmly established and is proving very useful in catering for some of the nore severely handicapped children. Number on register January 1963 69 Number on register December 1963 61 Number of new entrants 14 Number transferred to Adult Training Centre 14 Number left 8 Average attendance per session 50 Times open (whole days) 189 Total attendances 19,518 Adult Training Centre d) Bensham Training Centre This centre as well as providing suitable training and work for the nore severely handicapped trainees, also provides an initial stage of training for those who are less handicapped. Assessment, stabilisation and introduction to work habits and working conditions are important functions of this centre. 62 On 31st December 1963, 60 trainees (32 males, 28 females) were on the register comprising 9 subnormal, 49 severely subnormal and 2 mentally ill persons. Work projects included laundry for the three centres, screw driver assembly, fitting inserts into metal caps, assembling and packing a wide range of plastic toys and filling and despatching various types of bath salts novelties. Money earned by the trainees amounted to approximately £750, and £1,276 was paid out in incentive pocket money. 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. (ii) Crosfield Industrial Unit On 1st January 1963, eight trainees were attending the unit and by 31st December this figure had risen to 35 (24 males, 11 females) made up of 13 subnormal, 17 severely subnormal and 5 mentally ill persons. Work projects have included soldering and assembling leads and components for television sets, filling and despatching bath salts novelties and packing plastic toys. Money earned during the year amounted to approximately £2,300 and £1,381 was paid out in pocket money. 11 trainees left the unit for open employment of whom 8 were still working at 31st December, the remaining 3 having returned to the unit. The unit opens from 9-a.m. to 5-p.m. on a five day week throughout the year. Special coaches are not provided and the use of public transport is, for some, an essential part of the stage 1 training. Mental Health Act 1959 - General Boarding Out Scheme for the mentally disordered This scheme has steadily grown since its inception in February 1962 and is now an established part of the residential services for the mentally disordered. 25 persons were place during 1963 and the tables below give further information. 63 All patients boarded out are carefully medically assessed and only four required re¬admission to hospital during the year. The ready availability of psychiatric help and advice, and the close support available to the landladies through the Boarding Out Officer are still vital parts of the scheme and may go some way to explaining why no landlady has so far withdrawn her services. Boarding Out allowances paid to landladies by the Corporation in 1963 totalled £1,143. 8. 0. and the average weekly cost per patient (excluding the Boarding Out Officer's salary) was £1. 4. 0. Number of patients already boarded out on 1.1.63 17 Number of patients placed during the year 25 Total 42 Subsequently left to live with relatives 9 „ „ lodgings of own choice 6 „ „ residential employment 3 Subsequently re¬admitted to hospital 4 Total 22 On 31.12.63 there were thus 20 patients in lodgings categorised as follows: - M. F. Total Mentally ill 5 7 12 Subnormal 3 2 5 Severely subnormal 2 1 3 10 10 20 Analysis of mentally ill patients boarded out at 31.12.63. Age Groups Male Female Totals. 21 - 30 years - 1 1 31-40 „ 2 - 2 41 - 50 „ 1 2 3 51-60 „ 1 4 5 over 60 1 - 1 5 7 12 Length of previous, stay as hospital inpatient Male Female Totals. less than 1 year 3 1 4 1-2 years l - 1 3-4 years l - 1 over 20 years l 2 3 6 3 9 64 The admission to hospital of the remaining 3 patients was avoided by lodgings placements direct from psychiatric outpatient clinics. *1 patient via mental after-care hostel. Social Work Development of the social work side of the mental health service has been maintained. At the end of 1962 patients receiving assistance from the social workers numbered 642 and by the end of 1962 this figure had increased to 848. In the course of the year 838 cases were referred for help and the social workers were in touch with over 1,450 cases. One social worker returned from training during the year and an additional Mental Welfare Officer was recruited. A training officer was appointed to supervise students placed for practical work from the newly started general training course at the Croydon Technical College. Students from university courses in Social Science and Mental Health and from the National Institute for Social Work Training have also visited the service for varying periods of time. Visitors to the service, including students, totalled 48 in the year representing a wide range of medical and other professional interests. There were several overseas visitors from eight different countries. 65 CORPORATION DAY NURSERIES One only, situated roughly in the centre of the town, at whitehorse Road, now remains. It is available for children whose mothers are required to work because they are widows, unmarried, legally separated or divorced. By prior Committee permission, children from families with temporary difficulties - illness of the mother or father - may also be accepted. The minimum charge is 2/- per day. It may be increased according to net income, on a scale approved by the Corporation. Subject to places being available, children may be accepted at the full rate of 17s.4d. per day. This had been raised from 15s. 9d. during the year. Details of attendances - Capacity 50 Number on books at the end of year 44 Attendances: Under 2 2,661 Over 2 6,015 Total 8,676 Number of days opened 255 Average daily attendance 34 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 130. CHIROPODY The system of using the services of approved Chiropodists working in their own surgeries 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 committed 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 1963 the chiropodists gave a total of 9,340 treatments of which the Corporation paid the whole cost for 2,746 and Part cost for 6,594. The scheme covers elderly persons, expectant mothers and the Permanently handicapped. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 69 WORK OF THE PUBLIC HEALTH INSPECTORS Norman Smith, M.R.S.H. ,M.A.P.H.I. Chief Public Health Inspector I have the honour to submit to you my first Annual Report. With the continued shortage of staff and the effect of recent legislation the Department has been fully extended, but I am satisfied that a good level of achievement has been demonstrated. Details of the various aspects of the work are set out in the Tables which follow, but I would refer to the new regulations concerning Meat Inspection at the Abattoir which now require that an Inspector shall be present at the time each animal is slaughtered. This requires additional staff to be present, and slaughtering is carried out each weekday and also on Saturdays and Sundays, but despite this - 100 per cent meat inspection has been maintained. The Slum Clearance programme has and is being continued, and some 192 houses in multiple occupation have been visited and notices have been served calling for the provision of facilities, fire precautions etc., and we await with interest the strengthening of the law as contained in the Housing Bill at present before Parliament. The No. 6 Smoke Control Order was made by the Council in December and is now awaiting confirmation by the Ministry of Housing and Local Government. Following the White Paper on the supply of fuel a Circular was issued by the Ministry on 17th December, 1963 in which local authorities were advised of the technicological advance in the production of Gas which will affect the future supply of Gas Coke, and attention was drawn to a variety of appliances which should now be regarded as "reasonably necessary", that is openable stoves, under¬floor draught open fires, fixed gas, electric storage and oil heaters, and that whilst these are of a more expensive type, they are far more efficient and economic, and that full expenditure on such installations should rank for grant. The Council will consider the implications of the Circular in due course. 70 In July, 1963 the Offices, Shops and Railway Premises Act came into operation - an Act to make fresh provision for securing the health, safety and welfare of persons employed to work in office and shop premises and certain railway premises. The Act provides for the registration and inspection of this type of premises and there are many provisions for the making of regulations which will be made by the Minister of Labour to become operative during the year 1964. There are approximately some 6,500 premises in Croydon to which the Act applies. The implementation of these regulations will call for an increase in staff, and the resultant responsibilities will be undertaken. I would wish to express my thanks to the members of the various Committees for their kindly support, and to the staff of my Department for their help during the year under review. 71 HOUSING Number of parts of houses on which Closing Orders have been made 7 Number of houses on which Closing Orders have been made 7 Number of houses on which Demolition Orders have been made 12 Number of houses where Certificates of unfitness were issued 2 During the year 1,232 houses were rendered fit following the service of notices requiring repairs. Bent Act, 1957 - Certificates of Disrepair Since Commencement of Act Applications made in 1963 Number of Applications for Certificates 907 21 Number of decisions not to issue Certificates 50 1 Number of decisions to issue Certificates 857 20 Number of undertakings given by Landlords 520 10 Number of Certificates issued 337 10 Applications by Landlords to Local Authority for cancellation of certificates 224 11 Cancellation of certificates refused 42 4 Certificates cancelled by Local Authority 182 7 Applications for certificates as to the remedying of defects which the Landlords have undertaken to remedy 124 5 Certificates issued as to the remedying of defects which landlords have undertaken to remedy 124 5 72 Housing Act, 1961 - Houses in Multiple Occupation Prom the date of the commencement of the Act: - Number of Houses Inspected 192 Number of Statutory Notices served 97 Number of Notices complied 17 Number of Notices sent to Housing Manager for default action 15 73 West Croydon Men's Hostel This is situated at Pitlake and is available for use by nightly lodgers. It has 104 cubicle beds, four of which are reserved for staff. The charge is 2s.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 35,242. The receipts during the year were £4,262 and the expenditure £6,772. There are no private common Lodging Houses. Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, for a fee of one guinea. During the year 6 such requests were made. FACTORIES ACT, 1961 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). Premises Number on Register Number of Inspections written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 169 22 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,106 138 20 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out¬workers' premises) 194 104 31 - Total 1,469 264 54 - 74 Cases in which Defects were found:- Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Reme- died Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 1 1 – – – Overcrowding (S.2) – – – –- – Unreasonable temperature (S.3) – – – – – Inadequate ventilation (S.4) – – – – – Ineffective drainage of floors (S.6) – – – – – Sanitary conveniences (S.7):- (a) Insufficient 2 2 – 1 – (b) Unsuitable or defective 28 13 – 2 – (c) Not separate for sexes - - – – – Other offences against the Act (not including offences relating to Outwork 15 9 – 2 – Total 46 25 – 5 – Part VIII of the Act Outwork Section 110 Section 111 Nature of Work 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) (1) Wearing Apparel 224 _ _ - _ _ Household Linen 4 _ _ _ _ _ Lace, lace curtain and nets 1 _ _ _ _ _ Curtain and furniture hangings 11 _ _ _ _ _ Umbrellas, etc. 2 _ _ _ _ _ Paper bags 18 _ _ _ _ _ continued on next page. 75 Nature of Work Section 110 Section 111 No.of outworkers in August list required by Sect.110 (IX c) No. of cases of default in sending lists to tie Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (S) (6) (7) The making of boxes or other receptacles or parts thereof lade wholly or partially of paper. 1 – – – – – Carding, etc. of buttons, etc. 13 – – – – – Stuffed toys 72 – – – – – Brush making 2 – – – – – Artificial Flowers 12 – – – – – Cosaques, Christnas crackers, Christmas stockings, etc. 101 – – – – – Lampshades 22 – – – – – Total 471 – – – – – 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 56 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. 504 inspections were made under the Shops Act, and the infringements found were as follows:- 76 Hours of Closing 3 Insufficient and defective W.C. accommodation 14 Defective floors, walls etc 9 Notices to be exhibited or amended 138 Insufficient heating 3 Washing facilities required 3 HAIRDRESSING ESTABLISHMENTS Legislation now calls for the registration of hairdressers and barbers premises. During the year 27 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 2,032 visits of inspection were made to underground drains in course of repair. Of 553 Statutory Orders served, in 245 cases work was carried out in default of the owners. OFFENSIVE TRADES There is one registered premises, and during the year there has been no cause for complaint. POLLUTION OF RIVERS AND STREAMS During the year 13 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. During 1963 an Effluent Inspector was appointed to the Borough Engineer's Department. 77 CLEAN AIR ACT, 1956 The Council has implemented the relevant provisions of this Act in making Smoke Control Orders covering the South and Western areas of the Borough and it is the intention that one anoke Control Order shall be made each year. The progress of these Orders is shown below:- Smoke Control Order Mo. of premises Unci. 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, 501 3,915 332 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 No. 6 6,220 5,885 470 18.11.63 1.7.65 The District Inspectors keep 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 no case was it necessary to serve a Statutory notice. During the year 54 plans showing the construction and heights of new chimneys have been examined and in 23 cases additional height has been requested and agreed. 56 notices of the installation of new furnaces have been received, 47 of these being oil fired plants. AMUSEMENT HOUSES 76 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. 78 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 10,539 articles By Formalin Gas 764 ,, Total 11,303 articles 116 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 1963, 54 articles were disinfected, the receipts amounting to £4.4s.9d. Disinfection was carried out after infectious or contagious diseases at the following premises:- 106 rooms at 38 houses, hospital wards, clinics etc. 531 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 £15.17s. 6d. was paid for such services. 24 articles for Welfare Department institutions and 881 Medical Aids in Home Nursing were disinfected. CLEANSING OF VERMINOUS, ETC., PERSONS The 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, 5 adults were cleansed of verminous conditions and 12 adults and 14 children were treated for scabies. 79 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 54, 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 47 complaints were made regarding noise alleged to be a nuisance. In 9 cases no action was warranted. In 18 instances the noise complained of was finally abated, in 11 cases the noise was reduced so as not to be a nuisance and 9 cases are still under investigation. PHARMACY AND POISONS ACT, 1933 The object is to regulate the sale of certain poisonous substances. During the year the number of applications granted for entry of names on the list of persons entitled to sell poisons under Part 2 of the Act was 30. In addition, 190 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. Five 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 1 Kapok 2 Curled Feathers 1 Cotton Felt 1 80 PET ANIMALS ACT, 1951 22 persons were licenced for the purpose of keeping Pet Shops. During the year 19 inspections were made and there were no infringements of the. conditions, specified in the licences. DISEASES OF ANIMALS ACTS Thirteen 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, 1,972 private dwellings were inspected following complaints and in 1,384 instances infestation was confirmed and dealt with by the rodent operatives. 128 business premises were found to be infested with rats or mice and these were all disinfested during the year. Regular inspections are made of premises where food is prepared or sold and particular attention is given to methods of prevention of rodent infestation. Corporation owned premises including sewage works, refuse tips, depots, school kitchens and serveries, etc., are periodically inspected for the presence of rodents and if infestation is confirmed action is taken by the department to eradicate the pests. 36 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 31 manholes. These manholes were treated until no further baits were taken. 81 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 59 Bakers Shops 109 Sugar Confectioners 551 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 537 Works and Club Canteens 227 Licenced Premises 178 Off Licences 84 Grocers 588 Butchers 206 Wholesale Meat Markets 8 Chemists 74 Greengrocers 258 Fishmongers 61 Fried Fish Shops 38 Milk Distributors and Dairies 181 Premises from which Roundsmen and Mobile Shops operate 9 Stalls 116 Food Manufacturers 24 Other Pood premises not enumerated above 30 Total 3,380 Of the above premises 998 are registered under Section 16 of the Pood and Drugs Act, as follows:- Retail sale of ice-cream 815 Manufacturers of ice-cream 4 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 179 During the year 4,166 inspections and re-inspections were made of food businesses (for details see Page 92.). 82 INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1955/56 Structural defects in shops and stores 10 Defective condition of walls and ceilings 108 Defective condition of floors, utensils, fixtures, etc. 40 Defective or insufficient drainage 10 Insufficient lighting or ventilation 5 W.C. accommodation - repair or cleansing required 33 ,, ,, artificial lighting required 18 ,, ,, want of intervening ventilated space 2 Pood - not stored 18" off floor 1 ,, - means to prevent contamination required 41 ,, - store required or defective 6 Accumulations in yard or stores 20 Offal and refuse bins defective or uncovered 19 Yard paving defective 7 Hand washing notice not exhibited 4 Ablutions - Wash basins required 13 ,, - Hot water supplies required 20 ,, - Nail brushes, soap and towels required 8 Clothing accommodation required 10 Insufficient or defective sinks 13 Smoking offences 2 Defective or unsuitable table tops, etc 18 First Aid kits required or insufficient 29 Cleanliness - advice given 2 Cracked crockery 1 Prosecutions A local dairyman pleaded guilty to a summons relating to the sale of milk containing fragments of glass The Court imposed a fine of 5 guineas, with £3. 12. Od. costs 83 Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1963:- Article Weight in lbs. Carcase Meat 62,022 Offal 75,283 Sundry Foodstuffs 2,636 Canned, Bottled and Packeted Foods 21,047 Total 160,988 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 A 100% inspection is maintained, but this necessitates evening and regular weekend attendance of at least one Inspector. Eight District Public Health Inspectors assist the two regular meat inspectors, on a rota system, with duties carried out after normal working hours. The following tables summarise the meat inspection service at the abattoir; - Animals Slaughtered Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Total 5,195 1,274 4, 595 45, 478 43,894 96 100,532 84 CABCASES INSPECTED AND CONDEMNED Cattle excluding Co ws Cows Calves Sheep and Lambs Pigs Goats Horses Number killed and Inspected 5195 1274 4595 45478 43894 96 Nil All Diseases except Tuberculosis and Cysticerci Whole carcases condemned 3 27 59 249 148 Nil Nil Carcases of which some part or organ was condemned 1534 744 39 4086 4830 1 Nil Percentage of the number inspected affected with diseases other than Tuberculosis 29.57 60.43 2. 13 9.53 11.34 1.04 Nil Tuberculosis only Whole carcases condemned 3 Nil 1 Nil 1 Nil Nil Carcases of which some part or organ was condemned 14 12 Nil Nil 169 Nil Nil Percentage inspected affected with Tuberculosis 0.32 0. 94 0. 02 Nil 0.38 Nil Nil Cysticercosis Carcases of which some part or organ was condemned 120 21 Nil Nil Nil Nil Nil Carcases submitted to treatment by refrigeration 120 21 Nil Nil Nil Nil Nil Generalised and totally condemned 1 Nil Nil Nil Nil Nil Nil The District Public Health Inspectors, all Qualified Meat Inspectors, inspect meat at the 8 wholesale Meat Depots in the Borough, and meat exposed for sale in the Butcher's shops. The Diseases of Animals (Waste Poods) Order, 1957 The Order provides that, in general, all waste food must be boiled before feeding to animals to minimise the spread of animal diseases. Licences to operate boiling plants and equip ment are issued after inspection of the premises and plants. 21 inspections of licenced plants were made during the year. 85 MILK SUPPLY During the year 58 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 lb) Dealer's (Pre-packed Milk) Licences 145 Licences to use the designation "Sterilised"- (a) Dealer's (Pre-packed Milk) Licences 120 Licences to use the designation "Tuberculin Tested"- (a) Dealer's (Tuberculin Tested) Licences 2 (b) Dealer' s (Pre-packed Milk) Licences 112 Frequent inspection of these licenced premises is carried out during the year to see that the conditions of the licences are observed Bacteriological Examinations of Milk During the year the following samples of milk were examined Tuberculin:-Tested Pasteurised Milk 43 Pasteurised Milk 96 Sterilised Milk 43 Tuberculin Tested (untreated) Milk 4 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 46 1 45 – 46 86 Tuberculin-Tested (Untreated) Milk Methyline Blue Test No. Samples Taken Not Satisfied Satisfied 4 - 4 Pasteurised Milk Wethyline Blue Test Phosphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 93 – 93 93 Sterilised Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied 46 – 46 Bacteriological Examination of Milk Churn and Milk Bottle Rinses Churn Rinse Samples - 10 Satisfactory - 6 Unsatisfactory - 4 Bottle Rinse Samples - 24 Satisfactory - 20 Unsatisfactory - 4 BACTERIOLOGICAL EXAMINATION OF CREAM Twelve samples of fresh cream were examined and produced satisfactory results. BACTERIOLOGICAL EXAMINATION OF ICE CREAM 173 samples were taken, the results being as under:Grade No. of Samples 1 151 2 12 3 4 4 6 In all cases after the results of sampling are known, 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. 87 CHEMICAL EXAMINATIONS OF ICE CREAM Five samples were taken from local manufacturers and were found to comply with the standard. FOOD AND DRUGS ACT, 1955 During the year, 207 samples of Milk and Cream, and 383 other samples were taken, of which number, 8 were found to be "Not Genuine".. Summary of Samples During 1963 samples were obtained and submitted to the Public Analyst as follows:- Total Samples Genuine Not Genuine Prosecutions tions  Apple Juice 1 1 – – – Artificial Colour 1 1 – – – Arrowroot 2 2 – – – Aspirin Tablets 1 1 – – – Baby Pood 1 1 – – – Bacon 3 3 – – – Baked Beans 3 3 – – – Baking Powder 1 1 – – – Batter Mixture 1 1 – – – Beer, Bitter 4 4 – – – Beer, Tinned 2 2 – – – Beer, Mild 5 5 – – – Bicarbonate soda 2 2 – – – Biscuits 2 2 – – – Black Pudding 1 1 – – – Blancmange Powder 3 3 – – – Boraclc Ointment 1 1 – – – Brandy 1 1 – – – Brawn 1 1 – – – Brisket of Beef 1 1 – – – Bread and Butter 2 2 – – – Bread, Wholemeal Brown 1 1 – – – Bread Crumbs 2 2 – – – Bread, Milk 1 – 1 – – Bread Mix 1 1 – – – Batter, English 1 1 – – – Butter, New Zealand 1 1 – – – Butter, Australian 1 1 – – – Butter, Danish 1 1 – – – Buttered Toast 2 – – – Butter Beans 1 1 – – – Calamine Ointment 1 1 – – – Camphorated Oil 1 1 – – – Calamine Lotion 1 1 – – – Candled Peel 1 1 – – – Cake Mix 4 4 – – – Cheese, Cheddar 1 1 – – – Cheese, Danish Blue 2 2 – – – Cheese Spread 2 2 – – – 88  Total Samples Genuine Not Genuine Prosecutions Convictions Chocolate 2 1 1 – – Chocolate Biscuits 1 1 – – – Chocolate Spread 1 1 – – – Chopped Pork 1 1 – – – Christmas Pudding 1 1 – – – Cod Liver Oil 2 2 – – – Cod Liver Oil with Malt 2 2 – – – Coconut, Desiccated 1 1 – – – Coffee 2 2 – – – Coffee and Chicory Essence 3 3 – – – Condensed Milk 4 4 – – – Condiment, Non-Brewed 2 1 1 – – Cooking Pat 3 3 – – – Cordial 3 3 – – – Corned Beef 4 4 – – – Cornflour 1 1 – – – Cornflakes 3 3 – – – Cornish Pasties 1 1 – – – Corn Oil 2 2 – – – Cough Pastilles 3 3 – – – Crab, Dressed 2 2 – – – Cream of Tartar 1 1 – – – Cream, Tinned 2 2 – – – Cream, Fresh 9 9 – – – Cream Biscuits 1 1 – – – Curry Powder 2 2 – – – Custard Powder 1 1 – – – Dates 1 1 – – – Drinking Chocolate 3 3 – – – Dripping 1 1 – – – Essence of Rennet 3 3 – – – Evaporated Milk 2 2 – – – Fish Cakes 3 3 – – – Fish Fingers 2 2 – – – Fish Paste 4 4 – – – Flavouring Essence 3 3 – – – Flour 1 1 – – – Friars Balsam 2 2 – – – Fruit Pie 3 3 – – – Gees Linctus 1 1 – – – Gin 7 7 – – – Ginger Wine 1 1 – – – Ginger, Crystallised 1 1 – – – Glauber's Salt 1 1 – – – Glycerine, Lemon and Honey 2 2 – – – Golden Syrup 1 1 – – – Grapefruit Juice 2 2 – – – Gravy Powder 2 2 – – – Ground Rice 1 1 – – – Ground Nut Oil 2 2 – – – Ham 3 3 – – – Hamburger 2 2 – – – Halibut Liver Oil Capsules 3 3 – – – Honey 2 2 – – – Horseradish Relish 2 2 – – – Isinglass 1 1 – – – Ice Cream 5 5 – – – Ice Cream Mix 3 3 – – – Ice Lollies 1 1 – – – Insect Cream 2 2 – – – Instant Whip 2 2 – – – Iodine, Tincture of 1 1 – – – Iodine Ointment 1 1 – – – Indigestion Tablets 1 1 – – – 89  Total Samples Genuine Not Genuine Prosecutions Convictions Jam 3 3 – – – Jelly 2 2 – – – Jellied Veal 1 1 – – – Lard 2 2 – – – Lemonade Powder 1 1 – – – Lemon Barley Water 1 1 – – – Lemon Curd 1 1 – – – Lemon Pie Filling 3 3 – – – Luncheon Meat 2 2 – – – Liquid Paraffin 3 3 – – – Macaroni Creamed Milk Pudding 1 1 – – – Macaroni 2 2 – – – Malt Vinegar 1 1 – – – Malted Milk Tablets 2 2 – – – Malted Milk Powder 1 1 – – – Margarine 2 2 – – – Marmalade 2 2 – – – Marzipan 1 1 – – – Meat Extract Cubes 2 2 – – – Meat Extract Spread 1 1 – – – Meat Paste 1 1 – – – Mentholated Balsam 2 2 – – – Milk of Magnesia 1 1 – – – Milk 196 195 1 – – Milk, Hot 2 2 – – – Milk Powder 2 2 – – – Milk Filled Chocolate Egg 1 1 – – – Mincemeat 1 1 – – – Mince Pies 1 1 – – – Minced Meat 2 2 – – – Minced Beef 1 1 – – – Mint Sauce 1 1 – – – Mineral Water 1 1 – – – Mushrooms 1 1 – – – Mustard 1 1 – – – Mutton Curry 1 1 – – – Nutmeg, Ground 1 1 – – – Oatmeal 1 1 – – – Olive Oil 2 2 – – – Orange Squash 1 1 – – – Orange Juice 1 1 – – – Ox Tongue 1 1 – – – Parrish's Chemical Food 1 1 – – – Peanut Butter 2 2 – – – Pepper, Cayenne 1 1 – – – Pickled Onions 3 3 – – – Pickled Cabbage 1 1 – – – Pickled Gherkins 1 1 – – – Pickles 2 2 – – – Pineapple Juice 1 1 – – – Pork Pies 1 1 – – – Pork Sausage Meat 3 3 – – – Porridge Oats 2 2 – – – Pressed Beef 2 2 – – – Puff Pastry 2 2 – – – Raisin wine 1 1 – – – Red Cabbage 1 1 – – – Roes, Tinned 2 2 – – – Rice Pudding, Creamed 1 1 – – – Rissoles 1 1 – – – Raspberry Pie Filling 1 1 – – – Rum 6 6 – – – Sago 1 1 – – – Salad Cream 3 3 – – – 90  Total Samples Genuine Not Genuine Prosecutions Courier- tions Salami 1 1 – – – Sauerkraut 1 1 – – – Sandwich Spread 1 1 – – – Sauce, Chop 1 1 – – – Sausages, Beef 2 2 – – – Sausage Meat, Pork 1 – – – – Sausage, Breakfast 3 3 – – – Sausage colouring 1 1 – – – Sausages, Pork 2 1 – – – Sausage, Liver 1 1 – – – Sausage, Frankfurt 1 . 1 – – – Sausage, Luncheon 3 3 – – – Saveloys 1 1 – – – Soda Water 1 1 – – – Split Peas 1 1 – – – Steak and Kidney Pie 3 3 – – – Steak and Kidney Pudding 2 2 – – – Suet, Packed 1 1 – – – Sponge Mixture 3 3 – – – Sugar, Caster 2 2 – – – Sugar, Brown 1 1 – – – Sugar, Icing 1 – 1 – – Sugar 1 1 – – – Surgical Spirit 1 1 – – – Sweets 1 1 – – – Soup Powder 3 3 – – – Soup, Hot 1 1 – – – Sage and Onion Stuffing 1 1 – – – Sulphur Ointment 2 2 – – – Table Salt 1 1 – – – Tea 3 3 – – – Tinned Jam 1 1 – – – Tinned Fruit 1 1 – – – Tinned Peas 2 2 – – – Tinned Vegetables 3 3 – – – Tinned Soup 2 2 – – – Tinned Sponge Pudding 2 2 – – – Tinned stewed Steak 2 1 1 – – Tinned Beetroot 1 1 – – – Tinned Tomato Juice 1 1 – – – Toffee Apple Mix 1 1 – – – Tomato Paste 1 1 – – – Tomato Puree 1 1 – – – Veal and Ham Pie 1 1 – – – Veal and Ham Sausage 1 1 – – – Vinegar 2 2 – – – Vitamin Iron Tablets 1 1 – – – Vitamin "A" and "D" Tablets 1 1 – – – Vitamin A Capsules 2 2 – – – Vitamin "C" Tablets 2 2 – – – Vitamin Capsules 1 1 – – – Vodka 2 2 – – – Whiskey 9 9 – – – Wine, Cherry 1 1 – – – Witch Hazel 2 2 – – – Yeast Tablets 1 1 – – – Yogurt 4 4 – – – Totals 590 582 8 – – 91 Result of Analysis of Milk Samples The samples of milk were obtained as follows: Taken on Milk Rounds 89 Taken at Dairies 101 Taken at Institutions 6 Total 196 Average composition of samples:- Milk (excluding South Devon and Channel Island Milks) Solids not Pat 8. 64 (Legal standard is 8.5%) Milk Fat 3.56 (Legal standard is 3%) South Devon and Channel Island Milk Solids not Fat 8.99 (Legal standard is 8.5%) Milk Fat 4.55 (Legal standard is 4%) DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Bilk Bread This article consisted of bread made with skimmed milk powder and contained no significant proportion of whole milk solids whereas, in the opinion of the Analyst, milk bread should contain not less than 6.3% by weight of whole milk solids. No action taken pending legislation recommended by Food Standards Committee Chocolate Consisted of skimmed milk chocolate substitute. This article has now been labelled correctly Condiment, Non-brewed The sample contained 3.5 per cent. of acetic acid whereas this article should contain not less than 4 per cent w/v of acetic acid. Vendor warned Milk This sample was deficient in milk fat, the deficiency corresponding to the extraction of 19 per cent of the milk fat. Sample obtained from unsealed churn at local hospital. Enquiries revealed cream had been skimmed from milk by a member of hospital staff. Subsequent samples sat isfactory. Pork Sausage Heat Article consisted of preserved pork sausage meat. A notice declaring the presence of preservative in this article has been exhibited on the Vendor's premises. 92 Article Nature of Adulteration or Deficiency Remarks Pork Sausages Article consisted of preserved pork sausages. A notice declaring the presence of preservative in this article has been exhibited on the Vendor's premises, Stewed Steak This sample contained 60 per cent of meat, including fat, whereas, in the opinion of the Analyst the meat content should not be less than 75 per cent. The packers have undertaken to improve the quality of this article. Further sample satisfactory. Icing Sugar The ingredients of this article were not specified on the label in the manner prescribed by Part 2 of the Labelling of Pood Order, 1953. The label on this article has no* been amended by the packers Summary of Inspections made by the Public Health Inspectors, and other Departmental work. Total number of houses inspected for housing defects under Public Health or Housing Acts 3,594 Houses inspected where zymotic diseases have occurred 130 Houses inspected following applications for certificates of disrepair 44 Inspections of underground rooms 40 Special inspections in connection with the Housing survey 80 Houses inspected for overcrowding conditions 39 Re-inspections of work outstanding on housing notices 7,328 Number of visits regarding infectious diseases 1,156 Number of visits regarding food poisoning 57 Inspections of drainage work during repair 2,032 House drains tested with smoke and colour - routine and complaint 1,047 House drains tested with smoke (on written application) 6 14 House drains tested with smoke during repair House drains tested with water during repair 80 Inspections of cesspools and earth closets 13 ,, ,, schools and school sanitary conveniences 56 ,, ,, public conveniences 175 ,, ,, verminous premises 47 ,, ,, ponds and ditches 11 ,, ,, yards, stables and passages 60 ,, ,,theatres, cinemas, halls, etc. 76 ,, ,, pig styes 16 ,, ,, tents, vans and similar structures 39 Inspections and re-inspections in connection with Smoke control Orders 12,843 Sundry visits regarding Smoke Abatement 247 Smoke Observations 90 Visits regarding exhumation 1 Visits to premises for food condemnation 473 Inspections of swimming baths 14 ,, ,, wells 5 ,, ,, gathering grounds of water supply 12 ,, ,, gipsy encampments, camps, fairs, etc. 2 ,, ,, offices 3 ,, ,, rivers and streams for pollution 13 ii,, ,, hairdressers 27 93 Food and Drugs Acts: Food and drugs samples taken 591 Food and Drugs Acts: Milk samples taken (special designations) 196 Icecream samples taken (bacteriological) 173 Samples taken of Fertilizers and Feeding Stuffs 25 ,, ,, swimming baths water 181 ,, ,, drinking water (bacteriological and chemical) 268 ,, ,, subsoil water 3 ,, ,, rivers, streams, etc 6 ,, ,, private wells 61 ,, ,, rag flock and other filling materials 5 ,, ,, sundry specimens (food poisoning etc.) 34 Inspections under Merchandise Marks Act 241 ,, ,, of butchers premises 105 ,, ,, meat premises (wholesale) 1, 174 ,, ,, poultry and game dealers premises 214 ,, ,, fishmongers premises 37 ,, ,, fried fish premises 23 i,, ,, grocers premises 295 ,, ,, fruiterers and greengrocers premises 523 ,, ,, bakers premises - including bakehouses 108 ,, ,, dairies 27 ,, ,, Milk shops 31 ,, ,, general shops and their premises 11 Inspections of premises where cooked meats etc. are prepared or sold 2 Inspections of confectioners premises 150 ,, ,, confectionery manufacturers premises 26 ,, ,, cafes, snack bars, canteens, hotels and their ,, ,, kitchens 350 ,, ,, school kitchens and serveries 31 ,, ,, hospital kitchens 6 ,, ,, ice cream manufacturers premises 8 ,, ,, ice cream vendors premises 121 ,, ,, ice cream barrows and carts 3 ,, ,, market and barrows 99 ,, ,, other food premises not enumerated above 61 Re-inspections of food premises 520 Inspections of premises where offensive trades ate conducted 1 ,, ,, factories with mechanical power 138 ,, ,, factories without mechanical power 22 ,, ,, works of building and engineering 104 ,, ,, shops (under Shop Acts) 504 Special early closing, evening and Sunday trading patrols of shops 325 Appointments kept with owners, builders, etc 1,886 Investigations of complaints other than housing matters 1,172 Re-inspections of works outstanding (other than houses) 3,222 Inspections under Fertilizers and Feeding Stuffs Act 3 ,, ,, Diseases of Animals Act 6 ,, ,, Pets Act 19 ,, ,, Pharmacy and Poisons Act 54 ,, ,, Noise Abatement Act 367 Sundry Inspections and Visits 2,490 Visits regarding rats and mice infestation 7,705 Informal Notices outstanding 31.12.62 796 Informal Notices served 1,308 Informal Notices complied 1,230 Informal Notices outstanding 31.12.63 974 statutory Notices outstanding 31.12.62 164 statutory Notices served 1, 011 Statutory Notices complied 656 Statutory Notices outstanding 31.12.63 522 Total number of callers and complaints received at the office 5,228 Toal number of letters received at the office 11,811 94 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1963 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 291 Conditions causing dampness: Defective roofs 455 Defective window frames 230 Defective walls, etc 277 Want of efficient damp-roof course 38 Defective gutters and downspouts 470 Other structural defects: Defective plaster 452 Cleansing and redecorating required 12 Defective floors and stairs 206 Insufficient ventilation under floor 7 Defective brickwork, sills, lintels, chimneys 125 Defective stoves and fireplaces and flues 47 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 132 Defective W.C's 186 Defective drainage 152 Stoppages in drains 119 Defective water services and tanks 2 Domestic nuisances: Want of cleanliness 1 Verminous conditions 7 Other nuisances and infringements: Offensive accumulations 30 Overcrowding 3 Sundry nuisances or defects 9 15 Particulars not inserted in Rent Book (Housing Act) Public Urinals 12 Noise 10 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT Food cupboards defective or required 61 (3) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING.ETC. Defective Yard Paving 86 Want of a sanitary dustbin 30 (4) INSPECTION OF AMUSEMENT HOUSES 4 Defective sanitary fittings W.C. defective or dirty (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals (6) SMOKE ABATEMENT 9 Nuisances observed PUBLIC HEALTH SERVICES 97 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 fell, this water is filtered before chlorination. The quantity of water supplied during the year 1963 was:Prom Corporation Wells 2,585,619,000 gallons Purchased in bulk from M.W.B. 897,885,000 gallons 3,483,504,000 gallons la) Bacteriological Examinations. Regular bacteriological examinations were made of the raw waters going into supply following treatment. 478 samples of raw waters and 1,003 samples of treated waters were examined by the Chemist and Bacteriologist of the Water Undertaking. In addition, 13 samples of raw waters and 32 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. 98 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 analyses are similar to those for bacteriological examinations. The total numbers of samples analysed in the laboratory of the Water Undertaking and by the Consultants were 90 samples of raw waters and 121 of treated waters going into supply. The results of these analyses were uniformly satisfactory. (c) Testing of Samples of Drinking Water by the Health Department Samples are submitted weekly 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 sample is submitted each month for chemical analysis which 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 268 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. 99 Nursing Homes - Nursing Homes Act, 1963 Number of Homes Number of Beds provided for:- Maternity Others Total Homes registered during the year _ _ _ _ Hones on the Register at the end of the year 12 10 313 323 The conduct of Nursing Homes Regulations 1963, made under the above Act, greatly strengthened the powers of local authorities. The Corporation had already extensive requirements covering all aspects of Nursing Homes, and over the years had applied them by persuasion and agreement. A copy of the Regulations and the Corporation's Schedule of Requirements, together with a note about the approved number of patients for each room, were circulated to the owners of all Nursing Homes registered in the Borough. Two Nursing Homes closed during the year, one being the largest and best equipped for acute cases. Plans for its replacement on another site were going forward but no specific proposals had been submitted to the Corporation. The majority of places in other Nursing Homes cater for elderly and chronic sick patients. NURSES AGENCIES REGULATIONS, 1945 There is one agency on the Register which supplies nurses for home nursing on a private patient paying basis. 100 CREMATION ACTS, 1902 and 1952 During the year 2,742 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 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 1963 2,742 PUBLIC MORTUARY AND CORONER'S POST MORTEM ROOM Total number of Bodies received for December 1963 84 Total number of Post Mortem Preparations for December 83 Total number of Bodies received January 1st 1963 - December 31st, 1963 663 Total number of Post Mortem Preparations January 1st, 1963 - December 31st, 1963 629 101 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. 1,307 examinations were made during the year by the Medical Staff of the Department including 194 vision tests for drivers. of these 977 were in respect of manual workers, who were classified as follows: - Pit for employment and sick pay scheme 684 Deferred for review 91 Unfit for sick pay scheme 187 Pit for light employment only (Not fit for sick pay scheme) 7 Unfit for employment 8 Total 977 102 MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDRENS' DEPARTMENT During the year 234 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 2½ to 5 year olds daily excepting Saturdays and 1 Nursery which takes 3 to 5 year olds daily, the remainder being of the "part-time" 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 inevitable 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 31.22.63 Number of children provided for Premises 11 316 Daily Minders 21 198 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 if the daily minder is under 30 years of age - over that age appointments are made every 3 years. 103 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 82 cases registered:- 7 were due to glaucoma and 41 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had either been performed or would be carried out except:- 3 patients had died. 2 patients had removed from the Borough. 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 54 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 1963 no order for compulsory removal was required. 3 cases (two women and one man) 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 Awaiting admission to a Hostel (on 31.12.63.) 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 3 APPENDIX TABLES 107 VITAL STATISTICS - 1944 - 1963 108 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks and under 1 year AGE IN YEARS I_ 5_ 15_ 25_ 35_ 45_ 55_ 65_ 75 & over 1. Tuberculosis, (Respiratory) M 16 _ _ _ _ _ _ 1 1 7 5 2 F 5 _ _ _ _ _ _ _ 2 1 2 _ 2. Tuberculosis (other forms) M _ _ _ _ _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 3. syphilitic Disease M 4 _ _ _ _ _ _ _ _ 3 _ 1 F 5 _ _ _ _ _ _ _ _ _ 2 3 4. Diphtheria M _ _ _ _ _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 5. Whooping Cough M _ _ _ _ _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 6. Meningococcal Infections M 2 _ 2 _ _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 7. Acute Poliomyelitis M _ _ _ _ _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 8. Measles M _ _ _ _ _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 9. Other Infective and Parasitic Diseases M 2 _ _ 1 _ _ _ _ 1 _ _ _ F 4 1 _ _ _ 1 _ _ 1 _ _ 1 Total Infective and Parasitic diseases inc. Tuberculosis. 38 1 2 1 1 _ 1 5 11 9 7 10. Malignant Neoplasm, Stomach M 41 _ _ _ _ 2 3 11 15 10 F 28 _ _ _ _ _ _ _ 3 3 8 14 11. Malignant Neoplasm, Lung, Bronchus M 154 _ _ _ _ 2 20 66 38 28 F 29 _ _ _ _ _ _ _ 8 6 11 4 12. Malignant Neoplasm, Breast M _ _ _ _ _ _ _ _ _ _ _ _ F 58 _ _ _ _ _ 2 1 13 18 9 15 13. Malignant Neoplasm, Uterus F 16 _ _ _ _ _ _ 1 _ 2 6 7 14. Other Malignant and Lymphatic Neoplasms M 130 _ _ 1 3 1 6 18 24 30 47 F 130 _ _ 2 1 _ 1 4 21 27 29 45 15. Leukaemia, Aleukaemia M 6 _ _ _ _ _ 1 _ 3 _ 1 1 F 7 _ _ 2 _ _ _ 1 1 _ 1 2 Total all forms of Can cer 599 _ _ 5 1 3 5 17 90 157 148 173 16. Diabetes M 7 _ _ _ _ _ _ 1 _ 1 5 F 8 _ _ _ _ _ _ _ _ 1 2 5 17. Vascular Lesions of Nervous System M 135 _ _ _ _ 1 2 5 26 27 74 F 344 _ _ _ _ _ _ _ 6 23 71 244 18. Coronary Disease, Angina M 326 _ _ _ _ _ _ 10 42 71 81 122 F 224 _ _ _ _ _ _ _ 3 21 56 144 19. Hypertension with Heart Disease M 24 _ _ _ _ _ _ _ _ 7 7 10 F 33 _ _ _ _ _ _ _ _ _ 6 27 20. Other Heart Disease M 109 _ _ _ _ _ 1 1 4 13 17 73 F 245 _ _ _ _ _ 1 4 7 16 32 185 21. Other Circulatory Disease M 54 _ _ _ _ _ _ 1 _ 7 17 29 F 110 _ _ _ _ _ _ 1 3 8 22 76 Total Heart and Circulatory Diseases 1125 _ _ _ _ _ 2 17 59 143 238 666 109 CAUSE OF DEATH Sex Total all ages Under 4 weeks 4 weeks and under 1 year age in YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 & over 22. Influenza M 7 _ _ _ _ _ _ _ _ 2 5 F 10 _ _ _ _ _ _ _ _ 3 4 3 23. Pneumonia — M 95 1 7 3 _ _ _ 1 1 5 18 59 F 177 _ 9 2 _ _ _ 2 2 2 25 135 24. Bronchitis M 143 _ - _ _ _ _ _ 8 31 43 61 F 84 _ 1 _ _ _ _ _ _ 9 21 53 25. Other Diseases of Respiratory System M 14 _ _ _ _ _ _ _ 1 2 4 7 F 9 _ _ 2 _ _ _ 1 _ 2 1 3 Total diseases of Respiratory system - including influenza and excluding tuberculosis 539 1 17 7 _ _ 4 12 54 118 326 26. Ulcer of stomach and Duodenum M 18 _ _ _ _ _ _ _ 2 3 7 6 F 13 _ _ _ _ _ _ _ _ _ 3 10 27. Gastritis, Enteritis and Diarrhoea M 11 _ 2 _ _ _ _ 1 1 3 1 3 F 7 _ _ _ _ _ _ _ 2 1 2 2 28. Nephritis and Nephrosis M 7 _ _ _ _ 1 1 _ 1 1 3 F 9 _ _ _ 1 _ _ _ 3 _ 2 3 29. Hyperplasia of Prostate M 17 _ _ _ _ _ _ _ _ 2 2 13 30. Pregnancy, childbirth, Abortion F 1 _ _ _ _ _ 1 _ _ _ _ _ 31. Congenital Malformations M 18 8 4 _ 1 1 _ 2 1 1 F 10 5 2 _ _ _ _ 2 1 _ _ 32. Other Defined and Ill-defined diseases M 100 24 2 _ 3 1 3 3 5 14 13 32 F 130 20 _ _ _ 1 1 2 6 13 26 61 Total Miscellaneous diseases 341 57 10 _ 5 3 7 6 24 38 60 131 33. Motor Vehicle accidents M 19 _ _ _ 3 8 2 2 1 1 _ 2 F 12 _ _ _ _ 1 2 _ 1 _ 4 4 34. All Other Accidents M 26 _ 1 4 _ 2 2 1 _ 3 5 8 F 32 _ 1 3 _ _ 2 _ _ _ 4 22 35. Suicide M 26 _ _ _ _ 1 2 3 5 6 7 2 F 24 _ _ _ _ 3 2 7 1 3 6 2 36. Homicide and operations of war M 1 _ _ _ _ _ _ 1 _ _ _ _ F 4 _ 1 2 _ _ 1 _ _ _ _ _ Total - accidents, suicide and violence 144 _ 3 9 3 15 13 14 8 13 26 40 total all causes M 1. 512 33 18 9 7 16 15 37 125 306 345 601 F 1,768 26 14 13 2 6 13 24 85 160 355 1,070 3, 280 59 32 22 9 22 28 61 210 466 700 1,671 110 CANCER Deaths from Cancer occurred at the following Ages:- Age Period Male Female Total Under 25 years 4 5 9 25 and under 35 years 2 3 5 35 and under 45 years 10 7 17 45 and under 65 years 145 102 247 65 years and over 170 151 321 Total 331 268 599 Sites of Fatal Cancer Site Male Female Total Percentage of Total Skin 4 5 9 1.50 Oesophagus 9 11 20 3.34 Stomach 41 28 69 11.52 Liver 3 _ 3 1.50 Bowel 14 37 51 8..50 Rectum 22 12 34 5.68 Bladder 10 4 14 2.34 Prostate 27 _ 27 8.16 Larynx and Pharynx 4 _ 4 0.61 Uterus _ 19 19 7.09 Breast _ 58 58 21.64 Ovary _ 19 19 7.09 Pancreas 8 8 16 2. 61 Gall Bladder and Duct 1 2 3 O.50 Tongue and Mouth _ _ _ _ Bones 2 1 3 0.50 Lungs and Bronchus 154 29 183 30.55 Kidney _ 3 3 0.50 Brain and Nervous system 9 6 15 2.50 Lymphatic Glands and Connective Tissue 2 4 6 1.00 Haematopoietic Tissues 4 2 6 1.00 Hodgkin's Disease 3 _ 3 0.50 Leukaemia 6 7 13 2.17 Genital Organs 1 3 4 0.61 Ureter 1 _ 1 0. 17 Eye 1 1 2 0.33 Thyroid _ 1 1 0.17 Adrenal _ 1 1 0.17 Muscle _ 1 1 0.17 Undefined 5 6 11 0.84 Total 331 268 599 111 WARD STATISTICS Eatfated Population Births 'Birth Rata Deaths 'Death Rats Deaths under J year Deaths under 1 year par 1.000 births Deaths from Diarrhoea (under 2 years) 'Death Rate from Diarrhoea (under 2 years) Deaths from Bronchitis and Pneuaonia Death Rate from Bronchitis and Pneuaonia Deaths from Pulmonary Tuberculosis Death Rate from Pulmonary Tuberculosis Deaths from Tuberculosis 'Death Rate from Non-Pulmonary Tuberculosis Deatha from Heart and drew latory Diseases Death Rate from Heart and Circulatory Diseases Deaths from Cancer Death Rate from Cancer Natural Increase of birtha over deaths Upper Norwood 18621 396 21.3 210 11.8 8 20 - - 33 1.8 1 0. 06 - - 81 4. 3 35 1. 0 177 Norbury 16106 244 15.1 205 12.7 2 8 - - 28 1.7 3 0. 10 - - 86 5.3 20 1. 2 30 West Thornton 16293 260 17.0 224 14.6 6 22 - - 30 2. 6 3 0. 20 - - 73 4.8 40 2. 6 36 Bensbaa Manor 16877 310 10.5 233 14.7 2 6 - - 33 2. 1 1 0. 06 - - 82 5. 2 45 2.8 77 Thornton Heath 15352 322 21.0 105 12.7 5 16 - - 21 1. 4 3 0. 20 - - 65 4. 2 47 3. 1 127 South Norwood 16438 466 28.4 132 8.0 11 23 - - 19 1. 2 1 0. 06 - - 50 3.0 27 1. 6 334 Woodside 14153 300 21.2 179 12.6 5 17 - - 26 1.8 1 0. 07 - - 67 4.7 28 2. 0 121 East 18280 260 14.2 212 11.6 4 15 - - 31 1. 6 - - - - 07 5. 1 45 2. 4 48 Shirley 13642 255 18.7 141 13.4 7 27 - - 13 1.0 - - - - 30 2. 0 36 2. 6 114 Addlscoabe 16352 333 21.7 226 14.7 6 18 - - 40 2. 6 1 0. 07 - - 66 4. 3 40 2. 6 107 Whitehorse Manor 13252 200 22.6 177 13.4 5 17 1 0. 08 40 3.0 2 0. 15 - - 50 4. 5 26 2.0 122 Broad Green 13445 272 20.2 200 14.0 6 22 - - 41 3.0 - - - - 63 4.7 47 3. 6 72 Central 9168 229 25.0 150 16.4 1 4 - - 21 2. 3 1 - - 32 3.5 18 2..0 70 Waddon 15453 274 17.7 204 13.2 5 18 1 0.06 22 1. 4 3 0. 10 - - 66 4. 3 45 2.0 70 South 16523 302 18.3 316 19.1 6 20 - - 46 2.8 - - - - 123 7.4 48 2.0 14 Addington 27076 574 21. 2 121 4.5 12 21 - - 18 0.7 1 0.04 - - 31 1..I 31 1. 1 453 The Borough 254130 5096 20.1 3280 12.0 91 18.5 2 0. 01 400 2. 0 21 0. 00 • 1125 4.4 500 2.4 1816 * Death Rate per 1,000 population and excluding those who died In queen's Hospital 112 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1944 - 1963 Year Births (Lire and Still) Maternal Deaths Maternal Mortality Rate Infant Mortality Rate 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 1963 5,165 1 0.19 18.5 113 DETAILS OF INFANT MORTALITY The following table gives the cause of death during the first month of life (Neo-natal mortality) (1) Complications of Labour Trauma at Birth 5 Anoxia 1 6 (2) Foetal States - Congenital Malformities 13 Atelestasis 1 Haemorrhagic Disease of Newborn 1 15 (3) Prematurity 36 36 (4) Post-Natal causes 2 2 Total 59  Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1. 000 Births 19 63 19 62 19 63 1962 Injury at Birth and Congenital 26.3 24.0 4.51 4.05 Premature Births 39.5 48.0 7.06 8.10 Respiratory Diseases 19.8 12.0 3.53 2.03 Atelectasis, Debility and Marasmus 1.1 5.3 0.20 0.90 Diseases of Digestion* 2.2 1.3 0.39 0.23 Other Causes 12.1 9.4 2.16 1.58 *These from Gastro Enteritis Perinatal Deaths Stillbirths 69 Perinatal rate 22. 5 per 1,000 Deaths in first week 47 Total (live and still) births Causes of Death in first week Prematurity 32 Prolapsed cord - 1 Congenital conditions 8 Polycystic Kidneys - 1 Atelectasis 1 White asphyxia - 1 Birth trauma 2 Prematurity was a contributory Haemorrhagic disease of cause in 1 case the newborn l 114 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CAUSES OF DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th - 14th day 15th — 21st day * 22nd - 28th day Total Under 1 month 1 + months 2 + months 3 + months 4 + months 5 + months 6 + months 7 + months 8 + months 9 + months 10 + months 11 + months TOTAL All Causes 36 7 6 - - 1 - 6 - 3 59 8 4 7 3 3 3 - 1 2 - 1 91 Meningoencephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - - - - 1 1 1 - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - 1 Pneumonia (all forms) - - - - - - - 1 - - 1 3 2 6 1 - 3 - - 1 - - 17 Diarrhoea and enteritis - - - - - - - - - - - - - - - - - - - - - - - Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 5 3 2 - - - - 2 - 1 13 1 1 - - 3 - - - - - - 18 Premature Birth 26 4 2 - - 1 - 3 - - 36 - - - - - - - - - - - 36 Atrophy, Atelectasis, Debility and Marasmus 1 - - - - - - - - - 1 - - - - - - - - - - - 1 Injury at Birth 4 - 2 - - - - - - - 6 - - - - - - - - - - - 6 Haemorrhagie disease of newborn - - - - - - - - - l 1 - - - - - - - - - - - 1 Other Causes - - - - - - - - - - - 2 I I I - - - - 1 - l 7 TOTALS 36 7 6 - - - - 6 - 3 59 8 4 7 3 3 3 - 1 2 - 1 91 115 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 1,288 2. The number of live births 1,282 3. The number of forceps deliveries Nil 4. The number of still births - including one twin 6 5. The number of neo-natal deaths 1 6. The number of premature live born infants 10 (1) 35 weeks - 4 lbs. 14 ozs. (2) 38 weeks - 4 lbs. 12 ozs.) (3) 38 weeks - 4 lbs. 10 ozs.) Twins. Transferred to Hospital (4) 36 weeks - 4 lbs. 10 ozs. Transferred to Hospital, second twin born in Hospital. (5) 35 weeks - 4 lbs. Transferred to Hospital (6) 39 weeks - 4 lbs. 12 ozs. Transferred to Hospital (7) 38 weeks - 6 lbs. Transferred to Hospital (6) 39 weeks - 4 lbs. 5 ozs. Transferred to Hospital (9) 37 weeks - 3 lbs. 8 ozs.) (10) 37 weeks - 3 lbs. ) Twins. Transferred to Hospital 7. The number of patients who received Trilene 7 8. The number of patients who received Gas-Air Analgesia 1,184 9. The number of cases of P.P. H. (Home 26 - Trans, to Hospital 4) 30 10. The number of cases of manual removal of placenta at home Nil 11. The number of patients who received blood transfusion at home 2 12. The number of cases to which Flying Squad was called 7 13. The number of cases of toxaemia of pregnancy treated at home 11 14. The number of cases of prolonged labour (over 24 hours) 6 15. The number of breech deliveries 4 16. The number of twins delivered ( 5 (sets 17. The number of triplets Nil 18. The number of cases of Puerperal Pyrexia 28 (Genital 5 (Extra-Genital 23 19. The number of congenital malformations 6 (Talipes 3 (Hare lip 1 (Cleft palate, hare lip 1 (Spina bifida 1 20. Patients given Pethedine 646 21. Patients sent to Hospital 402 (Ante-natal 297 (During Labour 86 (After Delivery 19 22. Patients sent home for nursing 1,144 (Home booked 333 (Hospital booked 811 116 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion _ Other Causes 29 Miscarriage Total 29 FOR COMPLICATIONS DURING LABOUR Breech 18 Episiotomy 16 Maipresentation 7 Post-partum haemorrhage 14 Premature Labour 15 Adherent and Retained Placenta 3 Delayed Labour 18 Torn Perineum 69 Ante-partum haemorrhage 12 Other Causes 46 Total 218 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 28 Pain in Breasts 9 Pain in Legs 6 Other Causes 26 Rhesus Negative Blood 7 Total 76 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Byes 30 Still Birth 2 Other Causes 21 Total 53 Grand Total 376 Reasons for the discontinuance of breast feeding are no longer notified. 117 Midwife Mi1cage Deliveries Midwifery Maternity Gas and Air Ante-Natal Post-Natal Visits Visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnormal Midwives Pupils Midwives Pupils 1. 1527 1 1 - - - - - - - - - - - 2. 3729 93 + 9 67 - 24 2 88 677 292 1147 992 116 103 20 3. 2089 55 + 5 45 - 10 - 49 474 - 732 - 74 75 18 4. 2714 62+1 52 - 10 • 59 729 - 1111 - 83 89 22 5. 2791 50 + 3 37 5 7 1 41 423 220 1035 843 85 82 4 6. 3170 85 + 2 55 4 26 - 84 748 - 1217 - 69 82 8 7. 4588 103 + 9 80 1 21 1 90 905 340 1129 1168 179 180 37 8. 3324 43 + 4 41 2 - - 41 483 120 1032 553 68 75 14 9. 3495 69 + 9 44 2 22 1 66 668 185 1185 946 128 146 12 10. 4424 76 + 6 52 - 24 - 74 537 - 1143 - 54 59 21 11. 5910 77+5 57 1 14 5 72 895 559 1215 964 184 170 14 112. 121 - - - - - - 15 - 43 - - - 1 13 Bicycle 50+1 49 - 1 - 45 243 - 827 - 37 45 3 14. 4839 79 + 6 45 2 31 1 68 1277 404 1354 685 113 115 27 15. 4044 76 + 8 33 - 40 3 69 1026 221 1113 1041 141 154 13 16. Bicycle 8 2 - 6 - 5 37 - 53 - 3 3 - 17. 3980 105 + 4 86 1 17 1 92 843 244 1219 1143 152 140 42 18. 791 9 + 1 7 - 2 - 9 120 - 148 - 13 12 1 19. 3413 68+5 54 2 12 - 66 669 323 1220 749 138 132 28 20. 3899 38 + 1 30 2 6 - 36 468 - 927 . 36 40 6 21 47 1 1 - - - - - - - - - . - 22. 1175 27 + 2 21 - 6 - 27 234 67 334 344 28 51 9 23. 3005 23 + 4 20 - 3 - 21 329 - 564 - 21 16 4 24. 2856 52+1 44 1 7 - 50 464 - 870 - 55 56 19 25. 2045 38 22 1 14 - 32 413 - 793 - 53 27 16 Part Time Midwives 26. 1243 - - - - - - 11 - 408 _ . _ 10 27. 5088 - - - - - - 47 - 1565 - - - 61 28. 4280 - - - - - - 20 - 1410 - - - 35 29. 4326 - - - - - - 20 - 1508 - - - 56 Totals 82913 1288 +86 945 24 303 16 1184 12775 2975 25302 9428 1830 1852 501 (Continued on next Page) 118 No. X 22 Left Service 30.4.63 replaced by No. 12. 16.12.63 - 7½ months lapse No. o 24 Left Service 30.9.63 replaced by No. 18. 4.11.63 - 1 month lapse No. * 21 Left Service 7.1.63 replaced by No. 25. 1.4.63 - 3 months lapse No. ø 23 Left Service 30.6.63 replaced by No. 16. 1.12.63 - 5 months lapse No. ø 20 Left Service 27.12.63. not yet replaced No. ↕ 26 P/T commenced 30.6.63 - vacancy since 1962 - 6 months laps 22½ months (equivalent to two midwives short in 1963 No. of deliveries + = cases sent into hospital in labour. 119 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1962 who were born* - (i) at home or in a nursing home 34 (ii) in hospital* 264 (2) The number of those born at home or in a nursing home - who were nursed entirely there 28 who were transferred to hospital on or before the 28th day 6 who died during the first 24 hours - who died in 1 and under 7 days 2 who died in 7 and under 28 days - who survived at the end of one month 32 (3) Number of those born in hospital - who died during the first 24 hours 14 who died in 1 and under 7 days 16 who died in 7 and under 28 days 4 who survived at the end of one month 230 (4) Number of premature still births who were born (i) at home or in a nursing home 2 (ii) in hospital 40 *The group under this heading will include cases which may be born in one hospital and transferred to another. 120 HOME VISITS BY HEALTH VISITORS 1963 Visits Miss Batt Miss Bird Mrs. Blackburn Miss Blest Left 31.3.63 Miss Butcher Mrs. D. Cannell Mrs. Coles Mrs. Collins Miss Devaney Miss Eldrldge Miss Etas Miss Flauan Left 8.6.63 Miss Gabaln Mrs. Glucksoann Miss Grace Miss Hall Mrs. Hartog Mrs. Hastings Miss Hawkins Mrs. Ivens Mrs. Lalng Miss Llewellyn Mrs. McAllster Left 18.12.63 Mrs. McDanlel (Part-tlae) Con. March 1963 Miss Martin Coo. Sept. 1963 Mrs. Mayo Miss Otway Miss Partridge Mrs. Sweetl and COB. 18.3.63 Miss Valentin Co«. 1.7.63 Miss Vince Mrs. Wilson Miss Wybrew Left 29.6.63 Totals 1963 Totals 1962 Infants born 1963 - First Visits 63 91 145 41 182 166 133 217 168 166 236 55 142 285 194 199 247 247 183 237 116 199 137 83 45 156 160 138 77 127 163 180 77 5055 4575 Re-Visits 201 162 437 16 352 230 216 173 262 208 314 72 219 549 337 338 400 387 451 255 135 335 273 251 170 309 223 237 141 166 602 446 27 8893 13068 Children born 1962 - First Visits 115 146 59 61 105 115 129 152 399 138 154 135 116 270 201 129 206 272 160 85 98 175 86 82 17 97 154 123 42 26 386 169 83 4685 441 Re-Visits 120 139 301 45 230 98 232 200 179 113 293 49 208 559 201 194 274 383 219 157 67 288 333 201 114 270 308 302 61 96 505 385 31 7155 8064 Other children under 5 years First Visits 242 171 90 91 131 170 141 156 421 422 218 221 273 288 423 198 551 304 359 94 108 262 10 98 26 151 282 230 78 53 420 156 219 7057 636 Re-Visits 125 117 283 33 415 117 200 272 150 240 419 24 434 569 237 326 739 444 318 274 52 240 119 147 129 289 311 632 91 158 494 410 84 8892 12525 Expectant Mothers First Visits 1 8 17 4 14 9 3 51 4 23 26 9 19 69 24 36 55 18 36 13 10 60 8 4 11 15 44 30 12 9 13 69 10 734 721 Re-Visits - - 5 4 1 1 10 5 5 6 9 35 4 40 11 17 15 3 8 27 12 3 2 24 16 29 3 . 7 25 _ 327 332 Still Births 1 - 1 - - 2 - - - - 1 - 1 5 1 1 1 1 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ 17 11 Deaths under 1 year - - 2 - - 1 _ - - - 1 1 1 2 1 - 3 - 3 - - 1 - - - - 1 2 _ _ _ _ _ 19 12 Miscellaneous Visits 31 306 199 66 246 384 90 313 529 383 303 106 252 264 373 717 873 272 754 245 170 309 304 19 21 59 359 152 145 114 110 347 26 8841 1834 Ineffective Visits 125 193 518 44 260 204 341 75 267 114 136 135 350 275 350 333 439 257 341 135 306 216 88 82 43 213 450 90 141 197 158 119 80 7075 9393 Totals - 1963 1024 1333 2057 405 1936 1496 1485 1619 2384 1812 2107 807 2024 3170 2346 2511 3799 2602 2840 1499 1070 2112 1370 970 578 1583 2308 1965 791 946 2858 2306 637 58750 _ Totals - 1962 1167 1582 2325 1409 1755 497 _ 1887 1764 1519 2156 1350 2094 3266 1866 2317 2354 2237 2139 1324 1026 1817 366 _ - 2153 1846 1736 - - 2639 2053 2183 - 51360 *Includes Health Visitors who left in 1962 121 ATTENDANCES AT INFANT CENTRES - 1963 Addlngton Wednesday A.M. Addlngton Wednesday P.M. Bensham Manor Monday A.M. Benshao Manor Monday P.M. Boston Road Thursday P.M. Brighton Ro&d Wednesday P.M. East Croydon Tuesday A.M. East Croydon Friday P.M. Fairchlldes Friday P.M. Falconwood 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' 8 Tuesday P.M. St. Oswald's Thursday P.M. St. Paul's Friday P.M. Selhurst Monday P.M. Shirley Thursday P.M. South Croydon Thursday P.M. South Norwood Tuesday P.M. South Norwood Friday P.M. Spring Park Monday P.M. Spring Park Friday P.M. Upper Norwood Wednesday A.M. Upper Norwood Wednesday P.M. Waddon Wednesday P.M. Woodslde Friday A.M. Woodslde Friday P.M. TOTAL - 1963 TOTAL - 1962 New Cases Born During 1963 116 119 98 138 128 131 139 152 34 34 138 177 21 61 63 102 93 165 73 107 128 168 151 54 126 193 195 80 58 76 143 51 90 131 3733 4634 No. of Re-Attendances 725 654 794 1049 935 1266 1199 1347 189 253 1189 1148 119 388 424 1033 962 1287 828 827 879 1123 1074 438 1203 892 1331 42 0 270 674 702 362 554 672 27210 48108 New Cases Under 5 Tears 256 282 111 166 215 81 173 183 70 119 156 213 41 229 161 61 56 271 138 173 29 46 80 115 44 106 134 188 97 121 131 46 118 194 4604 701 No. of Re-Attendances 921 984 1259 1762 1288 1247 1259 1468 300 440 1236 1023 152 840 559 1467 1315 1036 882 928 1531 920 981 480 883 1034 891 571 276 853 719 584 595 783 31467 20117 Consultations with Doctor 722 699 907 992 1058 632 859 858 260 357 1124 988 4 685 506 862 819 775 708 846 857 567 787 219 493 795 730 606 296 529 531 274 654 699 22698 26883 No. of Sessions 51 51 49 49 50 51 53 50 50 26 51 51 44 51 49 51 51 49 52 51 51 49 47 49 51 52 50 49 48 51 51 36 51 50 1665 1619 Total Attendances 2018 2039 2262 3115 2566 2725 2770 3150 593 846 2719 2561 333 1518 1207 2663 2426 2759 1921 2035 2567 2 257 2286 1087 2256 2225 2551 1259 701 1724 1695 1043 1357 1780 67014 73560 Average Per Session 1963 39. 6 40.0 46.2 63.6 51.3 53.4 52.3 63.0 11.9 32. 5 53.3 50.2 7.6 29.4 24.6 52.2 47.6 56.3 36.9 39.9 50.3 46. 1 48.6 22.1 44.2 42.8 51.0 25.7 14.6 33.8 33.2 29.0 26.6 35.6 40.2 - 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 41.4 8.8 30.6 23.2 49.6 50.5 56.1 38.5 43.9 60.6 32.4 43.8 28.9 49.6 59.7 50.0 53.8 12. 1 23.4 59.3 38.7 30.4 37.7 - 45.4 * Closed - October 1963 122 HOME NURSING Staff at 31.12.63 Superintendent Deputy Superintendent 2 Assistant Superintendents 44 Queen's Nurses (including 7 males) 3 S.R.N's awaiting training 3 S.E.A.N. Nurses 2 Queen's Students (including 1 male) Summary of work carried out during the year under review:- Patients remaining on books from 1962 917 New Patients 3,312 Total 4,229 New Patients:- Medical 1,880 Surgical 1,392 Gynaecological 31 Obstetric 1 Maternity 8 Total 3,312 Specially classified Cases Visits Tuberculosis 95 3,343 Pneumonia 57 652 Maternity Complications 14 122 Infectious Diseases (measles) 2 12 Children under five years 92 740 Over 65 years old 2,650 89,429 Visits:- Termination of Cases:- Convalescent 1,839 Hospital 692 Died 435 Removed for other causes 254 Still on books 1,009 Total 4,229 123 Total visits January 12,059 February 11, 264 March 11,546 April 10,717 May 11,164 June 9,733 July 10,147 August 9,475 September 10, 490 October 10,623 November 10,451 December 11,021 Total 128,690 REHABILITATION OF ELDERLY PERSONS Patients visited by Rehabilitation Nurse, 1963:- Female 49 Male 10 59 Admitted to hospital 5 Transferred for General Nursing - Recoveries (Rehabilitated) 36 No success 2 Remaining on books 16 Total 59 Ages: 30 - 39 years 2 40 - 49 years 1 50 - 59 years 2 60 - 69 years 17 70 - 79 years 26 80 - 89 years 10 90 - 95 years 1 Illnesses: Hemiplegia 21 Arthritis, Rheumatism & Fibrositis 19 Lower Limb Fracture or Amputation 7 Other conditions (Parkinson's Disease, Carcinoma, Cardiac) 12 124 In the age group 30 - 59 years. 1 case of Fractured Tibia and Simmonds disease - Infra Red and Massage. Patient walking again, but awaiting operation as bone has not united properly. Massage continued to strengthen Muscles. 1 case, Disseminated Sclerosis. Walking Exercises. Walking fairly well with Zimmer Walking Aid. Progress has been slow as patient had not been walking for some time. In the age group go - 95 years. 1 case Arthritis. Walking Exercises. Patient responded well. Walking about house with a stick. 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 3 1 4 Knock Knees and Flat Feet 7 6 13 Valgus Ankles 5 5 10 Asthma 1 1 2 Kyphosis 2 2 4 Torticollis 1 - 1 Pigeon Toes 3 4 7 22 19 41 Total Attendances 1, 264 125 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:- Air Cushions 120 Air Beds 5 Bed Pans 171 Bed Tables 6 Bedsteads 5 Bed Pulley 3 Bed Rests 111 Bed Blocks 2 Bed Cradles 34 Commodes 101 Cotton Sheets (draw) 33 Crutches 6 Dunlopillo Cushions 1 Dunlopillo Mattresses 3 Dunlopillo Bath Pillow Nil Enuresis Machines 75 Feeding Cups 11 Fracture Boards 3 Foot Suction Pump 1 Hydraulic Hoists 3 Mackintosh Sheets 120 North Pads 4 Pifco Massager Nil Sputum Mugs Nil Urinals 36 Walking Aids 41 Walking Machines 1 Walking Sticks Nil Wheel Chairs 45 126 HOME HELP SERVICE Staff at 31.12.63. Supervisor 4 Assistant Supervisors 2 Clerks 14 Whole Time Home Helps 187 Part Time Home Helps 1 Night Attendant Summary of work carried out during the year under review:- Patients remaining on books from 1963 1,276 New Applicants 1,319 Patients carried forward to 1964 1,304 New Applicants (a) Maternity 423 (b) Sickness 892 (c) For Night Service 5 Classification of Cases Attended (a) Maternity 334 (b) Tuberculosis 17 (c) Chronic Sick including Old Age 2,013 (d) Others including Acute Sick 158 Number of Hours of Service Given 217,629 Average Duration of Service Given (a) Maternity 10 days (b) Acute Sickness 10-21 days (c) Chronic Sickness Indefinitely Amount Recovered for Service £5,158.19.10 Rate of Remuneration of Home Helps at 31.12.63. 4/2½ per hour - Home Helps 4/-½ „ - Sick Room Helpers 3/1l7/8d „ - Washing Service 4/71/8d „ - Problem Family Helps £10.10.6d per week - Family Helps 10/-d „ - Disinfestation 127 PROBLEM FAMILIES SUMMARY OF THE WORK CARRIED OUT DURING 1963 BY THE SOCIAL WELFARE OFFICERS SECONDED TO ASSIST FAMILIES IN RECEIVING HOMES, TO PREVENT THEIR NEED FOR ADMISSION AND ALSO TO DEAL WITH THOSE KHO ARE REFERRED BECAUSE OF SPECIAL SOCIAL DIFFICULTIES. Families admitted to Walmer House in 1963 55 Rehoused in private accommodation 9* Rehoused in Council accommodation 35 Rehoused in special problem family units 3 *(0f these 3 were accommodated outside the Borough) Fisits paid:- Family Departments Agents and Contacts 2,860 156 160 Families without permanent housing at close of year: - 8 Potential Homeless Families - not admitted to Receiving Homes:-68 Visits paid:- Family Departments Agents and Contacts 396 93 114 Problem Families 89 Tisits paid:- Family Departments Agents and Contacts 910 214 240 Families referred by all departments 105 Families referred by various organisations and private industry 51 Families making direct contact 29 Families assisted with furniture 81 Family interviews (office) 656 Families referred to other departments and agencies 39 128 DENTAL TREATMENT - M. AND C.W. Expectant Mothers Nursing Mothers Total Young Children New Cases Examined 166 14 180 274 Re-treated 35 8 43 102 201 22 223 376 Expectant and Nursing Mothers Young Children Attendances 500 597 Fillings 152 259 Extractions 190 176 Gas Cases 63 95 Local Anaesthesia 25 6 Scaling and Gum Treatment 80 - Dressings 115 142 Denture Dressings 104 - Silver Nitrate - 90 Treatment Completed 158 285 Number of Sessions (treatment) 308 Dentures Fitted 34 Dentures Repaired 4 Mothers Young Children Mothers Young Children Ante-Natal 175 - South Norwood - • Municipal Midwives Midwives 17 - South Croydon - • St. Alban's - • Post Natal 3 - Woodside - 1 Welfare Centres Norbury - - Municipal - - Addington - 8 East Croydon - - St. Andrew's - Upper Norwood - - Waddon - - Holy Trinity - - Boston Road - " St Oswald's - - St. Jude"s - " Bensham Manor - 3 St. John's (Shirley) - " Fairchildes - - Monks Hill - 2 Good Shepherd - - Referred by Dental Officers: 369 Falconwood - 1 West Croydon - - Mothers: 195 Young Children: 384 Total: 579 129 HOME SAFETY Accidents taken to Hospital by Ambulance during 1963 Type of Accident Under 5 Age Groups 45-64 65+ Sex Total 5-14 15-44 M F Falls 115 84 48 66 134 203 244 447 Burns and Scalds 36 13 23 8 9 46 43 89 Poisoning 40 5 70 15 20 66 84 150 Suffocation 4 1 - - - 2 3 5 Miscellaneous 55 58 60 19 11 125 78 203 Totals 250 161 201 108 174 442 452 894 Deaths from accidents in the Home Cause No. Details Palls 22 There were 19 women between 33 and 91 years of age, 2 men over 70 years and 1 girl aged 3 months. Burns and Scalds 9 One woman, 3 girls and 3 boys under 5 years of age died when a house caught fire. One woman aged 87 years - carbon monoxide poisoning from inhalation of smoke and fumes. One man aged 78 years - multiple burns. Set his clothing on fire from an oil heater. Poisoning 8 5 women between 73 and 91 years of age died of accidental carbon monoxide poisoning and one man aged 77 years.. One woman aged 69 years - poisoning by sodium amytal. One boy aged 2 years - poisoning by aspirin. Suffocation 1 One boy aged 2 months - asphyxia from smothering whilst prone on bedding. Total 40 130 DEAFNESS Children registered "at risk" - 248 Tested during year - 172 Premature 106 Born to Rh. negative mothers 31 Family history of deafness 8 Severe illness in infancy 9 Birth injury 3 Delay in speaking 5 Rubella in early pregnancy 4 Doctor's referral 2 Parent's request 4. Re-tested - 27 Deaf - Nil Partially deaf - 3 (High frequency loss - under observation.) Thought to have some degree of deafness not requiring immediate treatment - 12 Under 1 year of age 6 Between 1 and 2 years of age 4 Between 2 and 3 years of age 2 Between 3 and 4 years of age - Between 4 and 5 years of age 2 Speech defects only - 3 Slow response, probably not deaf, but kept under observation - 4 Mentally subnormal - 1 Of the 27 re-tested after preliminary screening: 14 were premature babies 1 had severe illness in infancy 1 was mentally subnormal 6 had family history of deafness 2 at parents' request 3 born to Rh. negative mothers. 131 102 failed to attend although an appointment had been accepted. 12 were not taken for re-examination after doubtful result of first test. Of these - 10 parents had refused 72 babies were apparently normal 7 have romised to attend 25 have moved out of the area Cases referred to Dr. Morgan's Special Monthly Session commenced October - 16 Did not attend - 7 Of the 9 seen: Query high frequency loss (No further action) - 2 Delayed Speech - 2 1 referred for Speech Therapy & Audiometry 1 recommended for E.N.T. Appointment Poor response to sound - 1 Referred to E.N.T. Specialist Spastic child - variable response - 1 Referred to E.N.T. Specialist Failed Stycar at I-W. Sessions - 3 Hearing normal, but referred back to I.ff.C. to watch general development 132 AMBULANCE SERVICE Classification of Patients, Journeys and Mileage *Patients Journeys Mileaae 1963 1962 196 3 1962 1963 1962 Health Service Removals 77, 570 (73,932) 46,174 (46,013) 356,618 (3 4 7,185) Accidents 4, 984 (4,258) 4,869 (4,174) 26,408 (22,391) Spastics (Bramley Hill) 3,416 (2,986) 454 (476) 8,424 (5,262) Mental Health (Occupational Centre) 41,095 (38,530) 1, 621 (1,300) 40,676 (34,389) London Road Day Centre 3,326 (5,625) 474 (480) 7,398 (9,438) Services Not Required (Accidents) 327 (308) 1,363 (1,147) Vehicles to Repair Depots, Testing, etc. 197 (266) 1,552 (2,141) Service Requirements, Oxygen, visiting substations, parks, etc. 304 (308) 3,727 (3 , 996) 30,391 (125,331) 54,420 (53,325) 446,166 (42 5,955) Civil Defence 184 (141) 2,850 (1,392) 30,391 (125,331) 54,604 (53,466) 449,016 (427,341) •These figures do not represent individual cases. Note:- 1962 figures are in brackets Classification of Accident Calls 1963 1962 Home Accidents (Children) 414 392 (Adults) 552 429 Miscellaneous Accidents (Children) 9 29 (Adults) 30 148 Recreational Accidents (Children) 87 68 (Adults) 88 99 School Accidents and Illness 300 319 Street Accidents (Children) 225 190 (Adults) 1,367 952 Work Accidents 300 265 Home Illness (Children) 54 62 (Adults) 389 371 Street Illness (Children) 19 16 (Adults) 699 611 Work Illness 124 92 133  1963 1962 Attempted Suicide 38 16 Suicide 7 13 Common Assault 167 102 4,869 4,174 Comparison of Patients, Journeys and Mileage since 1958 Year Patients Journeys Mileage 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 1963 130,391 54,420 446,166 Details of Ambulance Service Vehicles Two new Commer Karrier sitting-case vehicles were delivered, replacing two Bedford sitting-case coaches. Three new Bedford "Utilecon" sitting case vehicles were also delivered, and one was disposed of, permission was granted by the Committee to retain two of the "Utilecons" that were due for disposal. A new 44 seater Bedford coach was delivered for Mental Health Patients, but will not be in service until January 1964. List of Serviceable Vehicles at 31st December 1963.. Seven Daimler Ambulances One Humber "Super Snipe" Ambulance Two Karrier Ambulances Two Dennis Ambulances One Karrier Coach Two Karrier Sitting-case vehicles Ten Bedford "Utilecon" Sitting-case Vehicles One Vauxhall "Wyvern" Saloon Car One Austin Breakdown Vehicle Three Bedford Coaches (Large) (Mental Health) Two Karrier Coaches (Mental Health) Total Mileage of Ambulance Vehicles at 31st December, 1963 Daimler Ambulances K0Y 800 1952 207,315 LRK 3 1953 188,902 LRK 289 1953 188,151 LRK 555 1953 175, 583 134 NBY 501 1954 203,220 ORK 9 1955 173,153 ORK 8 1955 174,146 Humber "Super Snipe" Ambulance SOY 400 1957 129,102 Karrier Ambulances WVB 293 1959 66,185 1110 BY 1960 40,918 Dennis Ambulances 1883 VB 1962 28,205 5261 RK 1962 40,434 Karrier Coach WVB 291 1959 58,268 Karrier Sitting-case Vehicles 802 AOY 1963 2,637 809 AOY 1963 3,128 Bedford "Utilecon" Sitting-case Vehicles SRK 189 1957 123,117 SRK 187 1957 117,108 UBY 329 1958 108,852 UBY 325 1958 107,197 WBY 247 1959 89,518 4676 BY 1961 56,072 3117 RK 1962 38,358 4181 VB 1963 22,512 51 BOY 1963 998 53 BOY 1963 692 Vauxha 11 "Wyve m" Car OBY 724 1955 99,275 Austin Breakdown (Since 1955/6J GLR 801 1940 15,588 Karrier Coaches (Mental Health 3111 RK 1961 16,143 1547 RK 1961 24,952 Bedford Coaches (Mental Health) KRK 252 1952 115,635 MOY 639 1954 112,685 350 AVB 1963 Nil: New Venicle 135 COMMUNICABLE DISEASES NOTIFIED DURING 1963 Noti fiable Disease Cases notified Total cases noti fied in wards all ages At ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Woodside East Addiscombe Whitehorse Manor Broad Green Central Waddon South Adding ton Shirley M F Under 1 1 - 4 5 - 14 15 - 24 25 - 44 45 - 64 65 and over Scarlet Fever 111 — 28 79 4 — — — 6 2 8 5 16 13 5 5 11 4 1 1 16 2 12 4 54 57 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — Erysipelas 7 — — — — — 5 2 — — — 1 4 1 — — — 1 — — — — — — — 7 Meningococcal Infection 5 4 1 — — — — — 2 — 1 — 1 1 — — — — — — — — — — 3 2 Enteric and Paratyphoid 11 — 1 — 3 2 2 3 — — — — 2 4 — 1 — 1 1 1 — 1 — — 2 9 Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — Typhus — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia 17 — — — 7 10 — — — i — 2 — 1 — — 3 — 8 — — 1 — 1 — 17 Ophthalmia Neonatorum 2 2 — — — — — — — — — — — — 1 — — 1 — — — — — — 1 1 Acute Poliomyelitis — — - — — — — — — — — — — — — — — — — — — — — — — — Dysentery 1086 55 245 521 49 166 50 — 15 12 26 15 20 16 31 18 9 5 16 21 33 19 251 579 473 613 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Primary and Influenzal Pneumonia 35 1 3 1 2 4 9 15 2 1 4 1 6 3 2 — 5 1 4 1 1 2 1 1 19 16 Pood Poisoning 62 1 8 11 13 16 10 3 4 — — 5 3 — 7 9 12 6 4 3 4 1 4 — 26 36 Acute Encephalitis 3 — 1 1 1 — — — 1 — — — 1 — — — — — — — — - 1 — 2 1 Measles 3286 88 1664 1511 17 6 — — 187 164 253 190 142 207 241 160 184 101 291 187 289 126 390 174 1700 1586 Whooping Cough 134 15 68 43 4 4 — — 8 4 12 2 10 9 4 7 — 9 7 8 16 6 22 10 53 81 4759 166 2019 2167 100 208 76 23 225 184 304 221 205 255 291 200 224 129 332 222 359 158 681 769 2333 2426 The tuberculosis notifications are shown in the section relating to that disease 136 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1963 Notifiable Disease Jan.. Feb. Mar. April May June July Aug. Sept. Oct. Nor. Dec.. Total Respiratory Tuberculosis 11 9 15 13 6 10 12 4 8 12 7 0 113 Non-Respiratory Tuberculosis 1 - 1 1 - 1 2 - - 1 - 1 8 Scarlet Fever 22 12 18 12 11 6 5 1 5 10 5 4 111 Diphtheria - - - - - - - - - - - - - Erysipelas - 1 - - - - 2 - - 3 1 - 7 Meningococcal Infection - - - 2 - - - - 1 1 1 - 5 Enteric and Paratyphoid - - - - 1 - 3 3 2 2 - - 11 Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - ' - - - Typhus - - - - - - - - - - - - - Puerperal Pyrexia - 4 2 1 1 - 2 3 - 1 2 1 17 Ophthalmia Neonatorum - - - - - - - 1 - - 1 - 2 Acute Poliomyelitis - - - - - - - - - - - - - Dysentery 33 458 134 99 97 70 78 28 22 19 15 33 1086 Malaria - - - - - - - - - - - - - Ac. Pri. and Act. Inf. Pneumonia 7 14 3 2 2 - 1 1 1 - 1 3 35 Pood Poisoning 1 1 9 10 8 2 7 4 3 12 4 1 62 Acute Encephalitis - - 2 - - - - - 1 - - - 3 Measles 341 546 77 2 703 419 195 173 42 13 21 25 36 3286 whooping Cough 1 2 7 5 1 6 B 10 18 13 32 30 134 4880 137 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,977 children were immunised against whooping cough, comprising 2,897 under school age and 80 school children. 766 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 3,059 children were immunised against Tetanus, comprising 2,910 under school age and 149 school chi ldren. 2,015 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 1,454 persons were vaccinated against Small-pox. Under 1 year of age 1 2-4 5-14 15 or over Total Successful Vaccinations 285 325 78 68 146 902 Successful Re-vaccinations - - 13 62 436 511 Insusceptible to Vaccination 8 20 9 2 2 41 1,454 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 3ist December, 1963 who completed a course of Immunisation during the year. Age at 31.12.B3 i.e. Born in Year Under 1 1963 1959-1962 1954-1958 1949-1953 Total Completed course of Injections 469 2, 453 133 27 3,082 Reinforcing Injections - 326 3, 141 606 4,073 Total 469 2,779 3. 274 633 7,155 Estimated mid year child population 4,460 15,840 34, 600 54,900 138 VACCINATION AGAINST POLIOMYELITIS The following table gives the number of persons who received 1 a course of primary vaccination during the year. Vaccinated. Children born 1963 Children born 1962 Children born 1961 Young persons born 1960-43 Persons born 1942-33 Person mr 30 years of age With two Injections 50 183 43 32 19 29 With three Oral Doses 568 1,982 381 553 170 304 With Quadruple Vaccine 17 60 7 - - - Number of persons who completed a course of vaccination as at 31st December, 1963. Vaccinated Persons given a Third Vaccination during 1963 Persons given a Fourth Vaccination during 1963 By Injection 561 236 With Oral vaccine following course of Injections 431 3,093 With (fciadruple Vaccine - 17 Annual Total 992 3,346 TOTAL since Vaccination began 82,627 23,418 INTERNATIONAL VACCINATION CERTIFICATES During the year 2,482 certificates were authenticated, 2,118 Smallpox, 247 Cholera, 104 T. A. B., 23 Yellow Fever. 139 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATIONS AND MORTALITY-1943-1963 140 TUBERCULOSIS The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) Tuberculosis (All Foras) 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 Deati rate per thousand of population * 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 19 50 4 0.08 65 0.27 1930 15 - 175 0.79 1951 3 0.06 64 0.25 1931 18 0. 36 177 0.75 1952 - - 54 0.22 1932 10 - 166 0.70 1953 2 0.04 37 0.15 1933 13 - 184 0.77 1954 1 0.02 32 0.13 1934 10 - 157 0. 65 1955 1 0.02 35 0.14 1935 9 - 176 0.71 1956 - - 26 0.10 1936 11 - 151 0. 60 1957 - - 33 0.13 1937 11 - 155 0..64 1958 - - 20 0.08 1938 12 - 137 0. 56 19 59 - - 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 1963 - - 21 0.08 1943 9 - 120 0. 62 *Prior to 1947. rates only available for Census years 141 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1963 to 31st December, 1963 TABLE I Formal Notification Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 4S- 55- 65- 75- Total (all ages) Respiratory, Males - - 2 - 2 - 6 6 8 18 17 9 3 71 Respiratory, Females • 1 2 2 1 3 3 7 10 S 4 2 2 42 Non-Respiratory, Hales - - - - - - 1 1 - - - - - 2 Non-Respiratory, Females - - - - - - - 4 - 1 - 1 - 6 Source of Information Number of cases In age Groups TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1963 to 31st December, 1963 otherwise than by formal notification:- 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- TOTAL Death Returns from Local Registrars Respiratory M - - - - - . - . 1 - 1 1 1 4 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Death Returns from RegistrarGeneral (Transferable Deaths) Respiratory M - - - - - - - - - - 1 - - 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) M - - - - - - - - - - - - - - (C) Non-Respiratory F - - - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable Deaths) Respiratory M - - - - . - 5 13 8 2 2 - - 30 A) F - - - - - - 4 11 10 5 - - - 30 B) Non-Respiratory M - - - - - - - - 1 - - - - 1 C) F - - - - - - - - - - - - - - D) | Other Sources Respiratory M - - - - - - - - - - - - - - A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - -(D) TOTALS (A) 35 (B) 30 (C) 1 (D) - 142 143 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1963 1, 743 Transfers in from other areas 43 "Lost sight" cases returned during the year - New cases diagnosed as definite during the year 112 1,898 Number of cases written off the Chest Clinic Register during the year as:- Recovered 144 Died 41 Removed to other areas 67 "Lost sight of" and other reasons 12 264 Remaining on Register as at 31st December 1,634 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 2,814 Number of visits paid by Clinic doctors to homes of patients 158 Number of visits paid to homes of patients by Tuberculosis Health Visitors 2, 403 Attendances of patients at the Clinic At ordinary sessions 17, 696* Number of X-Ray films taken 20, 183 *Includes 4,259 miniature film attendances 144 VENEREAL DISEASES - NEW CASES 1944 - 1963 RESIDING IN CROYDON 145 VENEREAL DISEASES SYPHILIS Totals Males Females 1, NEW CASES OF SYPHILIS (i) Primary 3 3 - (ii) secondary - - (iii) Latent in the first year of infection 1 - 1 (iv) Cardio-vascular - - - (r) of the nervous system - - - (ri) All other late and latent stages 14 8 6 (rii) Congenital aged under 1 year - - - (riii) " " 1 but under 5 years - - - (ix) " " 5 but under 15 years - - - (x) " " 15 and over 1 - 1 2. TOTAL OF LINES INCLUDED IN 1 19 11 8 3. AGE GROUPS OF CASES IN ITEM 1 (i) and (ii ) ABOVE AGE GROUPS Onder 16 - - • 16 and 17 - - - 18 and 19 - - - 20-24 1 1 - 26 and over 2 2 - 4. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLA1V AND WALES AFTER DIAGNOSIS 1 1 - 5. CASES IN WHICH TREATMENT AND OBSERVATION WERE COMPLETED - - - GONORRHOEA 6. NEW CASES OF GONORRHOEA 105 75 30 7. AGE GROUPS OF CASES IN ITEM 6 ABOVE AGE GROUPS Onder 16 - - - 16 and 17 8 1 7 18 and 19 15 8 7 20 - 24 38 31 7 25 and over 44 35 9 8. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLAND AND WALES AFTER DIAGNOSIS 1 - 1 9- CASES IN WHICH TREATMENT AND OBSERVATION WERE COMPLETED 68 58 10 146 OTHER CONDITIONS  Totals Males Females 10. NEW CASES OF OTHER CONDITIONS (i) Chancroid . - - (ii) Lymphogranuloma Venereum - • - (iii) Granuloma Inguinale - - - (ir) Non Gonococcal Urethritis 83 93 - (r) Non Gonococcal Urethritis with Arthritis - • „ (ri) Late or Latent Treponematoses presumed to be non-Syphilitic 3 . 3 (rii) Other conditions requiring treatment within the centre 213 128 85 (riii) Conditions requiring no treatment within the centre 331 129 102 (ix) Undiagnosed conditions 5 4 1 11. TOTAL OF LINES INCLUDED IN 10 545 327 218 12. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLAND AND WALES AFTER DIAGNOSIS 2 1 1 13. CASES IN WHICH TREATMENT AND OBSERVATION WERE COMPLETED 482 302 180 14. NUMBER OF INDIVIDUAL PATIENTS ATTENDING WITH RE-INFECTIONS WITHIN THE YEAR: (i) Primary or secondary Syphilis AGE GROUP Under 16 . - - 16 and 17 - - - 18 and 19 - - - 20-24 1 1 - 25 and over 2 2 - (ii) Gonorrhœa AGE GROUP Under 16 - - - 16 and 17 1 - 1 18 and 18 - - - 20 - 24 - - - 25 and over 7 7 - 147  Totals Males Females 15. LOCALITIES IN WHICH INFECTIONS TOOK PLACE (i) Primary or secondary Syphilis (a) In locality of Centre - - - (b) Elsewhere in Great Britain and* Northern Ireland 2 2 - (c) Outside Great Britain and Northern Ireland - . . (d) Not known 1 1 - (ii) Gonorrhœa (a) In locality of Centre 18 10 8 (b) Elsewhere in Great Britain and Northern Ireland 32 23 9 (c) Outside Great Britain and Northern Ireland 6 6 - (d) Not known 49 36 13 16. ATTENDANCES AND DIAGNOSES OF CONTACTS (i) Contact slips issued to patients with (a) syphilis, primary and secondary - - - (b) Gonorrhœa 30 25 5 (ii) Contacts attending with (a) syphilis, primary and secondary - - - (b) Gonorrhœa 10 1 9 (c) Other conditions 5 1 4 17. TOTAL ATTENDANCES OF ALL PATIENTS (i) Syphilis 824 585 239 (ii) Gonorrhœa 444 275 169 (Hi) Other conditions 2. 533 1,708 825 (ir) ALL CONDITIONS (TOTAL OF 17(i). (ii) and (iii) 3,801 2, 568 1,233 18. Cultures for the Gonococcus 446 8 438 Services Rendered at the Treatment Centre during the Year showing the Areas in «hich Patients dealt with for the First Time (Items 2, 6 and 11) resided. County, County Borough (England and Vales) and Others Syphilis Gonorrhœa Other Conditions Totals Croydon 14 67 325 406 Surrey 2 18 124 144 Kent 1 7 50 58 London 2 13 46 61 Totals (to agree with Items 2,6 and 11) 19 105 545 669 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1963 To the Chairman and Members of the Education Comnittee LADIES AND GENTLEMEN, This is the 60th Annual Report of the work of the Croydon School Health Service. Routine Medical Inspections As recently reported to the Committee, the system of four routine medical inspections continues, but a pilot scheme of Questionnaires to parents is to be introduced before some of the intermediate age group children are to be seen. The results of these questionnaires will be assessed in the light of the subsequent findings of the examining School Medical Officer, and will be the basis of future recommendations. The trend of current articles on this question of medical inspections indicates that areas where new systems have been adopted are somewhat less enthusiastic about their findings, although such experiments still have firm support by the medical staff of the Ministry of Education. Some two-thirds of all local Education Authorities continue the established pattern which is maintained in Croydon, and I am still convinced that a policy of cautious enquiry into alternatives rather than immediate wholesale changes should be Pursued. 2 Infectious Diseases Chicken pox and Measles were prevalent, but followed the pattern of recent years in being mild in character. The Department co-operated with the Public Health Laboratory Service in carrying out a survey of complications of Measles to determine if the after effects of this illness warrant attempts to provide active immunisation by the use of a vaccine. This investigation is still continuing, and no results are yet forthcoming. Sonne dysentery proved troublesome in a few schools, but not to the extent met with in previous outbreaks. Difficulties arose because intestinal upsets due to other causes probably virus infections, were also prevalent and made diagnosis more difficult. Handicapped Children The setting up of a class for partially hearing children, ages 3-7 years, was completed during the year under review, and this was opened on January 1st, 1964. The class for maladjusted children was moved to the new premises allocated temporarily for the School Psychological Service. On the question of early diagnosis of handicapped children, it will be remembered that the Education Act places a responsibility for remedial services upon Education authorities, when children reach the age of 2 years. It is our constant endeavour to find children with any handicaps at as early an age as possible. To this end the Health Department have established an "at risk" register of babies who for reasons connected with the pregnancy or labour, or the immediate post-natal period, may have suffered injury as foetus or infant. They are kept under special observation. Parents of toddlers are sent definite invitations to bring their children for medical examinations at 2, 3 and 4 years of age, and these are in effect pre-school routine medical inspections. Approximately one-third of all pre-school children in the borough are surveyed in this manner, and efforts to increase this coverage are being made. Health Education The scope of the facilities which we are able to make available has now been well established, and the present task is to extend these to all the schools. No formal pattern has been established, and it remains a question of finding in each school a member of the teaching staff or a School Nurse who is prepared to carry out the basic programme with help from the Health Education Officers. 3 Dental Health The Principal School Dental Officer mentions again the changing pattern in demands for school dentistry. Parents refuse treatment by the School Dental Service with the excuse that the child is attending a private Dentist, when in fact no routine dentistry is being obtained. It is for this reason that programmes of Dental Health Education have become even more necessary, and are receiving serious attention. New Development The opening of the Waddon Clinic gave much needed Dental and School Health Service facilities for the southern part of the Borough. The Psychiatrist to the Child Guidance Clinic mentions the need for a day observation and treatment unit for psychotic children. A good deal of thought has been given to such a project, and on balance it seems primarily a responsibility for the Hospital service rather than the duty of an Education Authority. Some teaching facilities will certainly be needed, but the analogy seems the part-time service of a teacher to a Hospital unit rather than the attendance of Psychiatrists and other therapists, at an educational establishment. The extension of the partially hearing classes to include older children was initiated, and it is hoped that this will operate during 1964. An increase in the establishment of Speech Therapists will allow more treatment sessions, and the policy of providing these in outlying clinics, for example, at Waddon, is being followed. It is with pleasure that I record the continued help and co-operation of Head Teachers, into whose Schools we sometimes intrude at difficult times. The Chief Education Officer and members of his staff have invariably met our requests for additional facilities with a helpful and sympathetic response. Finally, on behalf of the staff of the Department, I thank the Members of the Committee for their unfailing readiness to support and encourage our efforts to improve the services for the children for whom we are responsibleL Public Health Dept., Croydon. 4 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 8 (full time) - (40%) *Medical Officers 7 (part time) *Dental Officers 9 (including 3 part-time) - (80%) *Physiotherapists 4 (including 1 part-time) Speech Therapists 5 *School Nurses and Nurse/Assistants 36 (including S.H.V.and Deputy)(58%) *Dental Attendants 12 (including 5 part-time) (80%) •Also performing duties in other sections of Public Health Department. Percentages in brackets show proportion of time given to school work. PARTICULARS OF CLINICS HELD The following Clinics are provided by the Education Committee; attendance thereat, with the exception of the Minor Ailments Clinic, is by appointment arranged by the School Medical Officer:- Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon. (Daily, Monday to Saturday, a.m.). Ashburton School, Shirley Road, Croydon. (Monday and Thursday, 9 a.m.). Rockmount School, Rockmount Road, Upper Norwood. (Monday and Thursday, 2 p.m.). Health Centre, Coldharbour Road, Waddon. (Daily, Monday to Friday, a.u.). 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 Health Centre, Coldharbour Road, Waddon. 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. Health Centre. Coldharbour Road. Waddon Remedial Exercises and Massage 47, St. James's Road, Broad Green, Croydon Daily at 1 p.m. and at Salcot Crescent, New Addington Weekly. Speech Defects 47, St. James's Road, Broad Green, Croydon and at Salcot Crescent, New Addington Health Centre, Coldharbour Road, Waddon. 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 Addington Once a month. 5 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is as follows: - Primary and Modern Secondary Schools (1) Entrants (2) 8-Year-old Group (3) Entrants to Secondary School (4) Final Leavers (5) Special Cases i.e. i.e., i.e., i.e., i.e. Children admitted for the first time to a maintained school and not already examined as Entrants, i.e. normally between 5 and 6 years. Children in their second year in a Junior School, unless previously examined in the Junior School. Children in their first year in a Secondary School who have not already been examined as Primary Leavers. Children in their last year of attendance at a Maintained Secondary School who have not been medically examined in that year. Children of other ages with possible defects and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 12,806 children were examined as compared with 13,047 in 1962, and 6,272 parents attended the examinations. The total percentage of parents attending was 49.0 against 43.3 last year. (See Appendix B, Table V). 422 specials and 496 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 "The training of children is a profession where we must know hou to lose time in order to gam it. " Jean Jaques Rousseau. Health education sessions given by health education staff, health visitors and teachers in some secondary and grammar schools continued during the year in which enormous publicity was given to "adolescents." Publicity focused on their faults rather than their virtues worried teachers and the school health team. The Health Education Section welcomed an increasing demand for factual information and advice on visual aids which came from both school and public health staffs. There seemed to be a growing realisation that somehow more time must be found in school for sessions on health and human relationships. Like all experimental social sciences, the field of health education is constantly developing. The experience of the last few years enabled those giving the Community Health Courses to the fourteen year old pupils and lower sixth forms to widen them and make them more flexible. There was strong feeling, however, that greater effect and understanding would have been achieved if a good foundation of human biology and simple applied physiology had been laid throughout the preceding years, starting in the junior schools. The subjects fall within the field of the educationist and help can be given later in the preventive medicine field by public health staff. A very satisfying piece of teamwork was carried out among all fourth year boys at Ashburton School by the Head Master, Science Master and Health Education Officer linking scientific, moral and community health subjects. The Certificate of Secondary Education There have been one or two tentative requests for suggestions for including health education in some of the courses for the new Certificate of Secondary Education. These present a great challenge. Time and opportunity could be allowed for thorough and dynamic health education during a general course in sociology. To do this an even greater understanding of objectives between education and public health staffs would be necessary and it might be profitable to spend some time in short multi-disciplinary meetings or inservice refresher courses to work them out. 7 Health Education Open Week at Coombe Cliffe Education Centre. The help and co-operation of the Education Department was very much appreciated in allowing facilities at Coombe Cliffe for a week's health education exhibition and demonstration of methods and media. This was primarily for junior schools, was a practical and informal way of stimulating interest among teachers, and seemed to be enjoyed. Several of them have followed it up and are now making use of the Health Education Section. There is still a regular demand from many junior schools for the two evening sessions on the subject of "Growing Girls" - the first session for mothers and the second for mothers with daughters in the fourth year group. Venereal Diseases During the evening sessions in junior schools when mothers only are present, the facts about venereal diseases are given as simply and clearly as possible They are also discussed at some point with the groups in secondary schools taking the Community Health Courses. Several teachers have come to the Health Department for information and a demonstration of visual aids on the subject and are including it in their own courses. Smoking and Lung Cancer Because it was felt that resistance to all the publicity and propaganda was building up in the town, it was decided not to have a big anti-smoking drive in all the schools for a year.. However, discussion continued during the Community Health Courses and invitations were received from several youth clubs. The new film for secondary schools "Smoking and You" was purchased and will be used during discussion sessions in all secondary schools, starting again in January. Parent-Teacher Associations The health education of children cannot be effective in isolation - and must be developed with the co-operation and understanding of parents and teachers. Therefore invitations to speak at these meetings were always received with pleasure during the year. A great deal of health education was also carried out among parents in the mothers' clubs and toddlers' clinics run by the Health Department staff. 8 Coloma Teacher Training College The Deputy Medical Officer of Health and Health Education Officer gave lectures during the year, but again felt that more time was needed to inculcate lively attitudes to health education without which future teachers cannot hope to stimulate the interest of the next generation. 9 HEIGHTS AND WEIGHTS The figures of average heights and weights are recorded in Appendix B, Table II and show once again that the post-war trend of yearly increases has ceased and a new level of averages has been reached. For the two intermediate age groups presented for routine medical examinations, weighing and measuring was not carried out. VISION TESTS Routine vision tests for entrants is now an established procedure and considered of such importance that where an immediate result cannot be obtained the nurse returns especially to complete the test. For the usual Tables, see Appendix VIII. UNCLEANLINESS Cleanliness inspections are carried out by the School Nurses each term in most schools, so that the majority of pupils are brought under review. The finding of slight infestation in unexpected offenders leads to the issue of an informal letter to the parents, setting out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parents of children previously found verminous. Steel combs are sold or loaned where necessary. Endeavour is made to serve notices on the parents by the School Nurse personally, so that she has opportunity to emphasise that infestation may be a family complaint and not limited to the school child, and the need for constant cleanliness to prevent relapses. A cleansing station is provided for the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection) 50,159 Number of children inspected (subsequent inspections) 2,829 Number of children found unclean (first inspection) 442 Number of occasions in which children found unclean (subsequent inspections) 256 At the primary inspections vermin were found in 36 and nits alone in 634 children. On these inspections 1.3 per cent, of the children showed evidence of infestation as against 1.0 in 1962. 14 children attended the Cleansing Station for treatment for scabies. 10 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis:Pulmonary 5 Non-Pulmonary - Taking the total child population at 40,344 (estimated),the pulmonary tuberculosis incidence rate per 100,000 was 12.4, and the non-pulmonary nil. There were no deaths from tuberculosis. CAUSES OF DEATH IN SCHOOL CHILDREN From the weekly returns of the local Registrar and from the inward transfers, it is possible to abstract the causes of death of all school children. There were 8 in 1963 equal to a death rate for this group of 0.20 per thousand. This equals the record low figure and the details were Epilepsy 2 Cancer of Kidney 1 Cerebral Abscess 1 Fulminant Friederichson Waterhouse Syndrome (Meningococcal) 1 Motor Accidents 3 Total 8 CAUSES OF EXCLUSION FROM SCHOOL During 1963, Chicken Pox and Measles were the specific infections causing the most absences from school, followed by Mumps, German Measles and Dysentery, in that order. The detailed figures given in Appendix D, Page 56 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 As in 1963, the Health Visitor/School Nurse worked harmoniously with the teaching staffs of the schools in her district. There were no major outbreaks of infection in any school, but the school nurse was only too willing to give whatever help she could in the many queries which occur in every school relating to the health and well-being of the children. The nurses' knowledge of particular families where difficulties were likely to occur was at the disposal of the teaching staff and proved helpful when dealing with problems of attendance etc. The State Enrolled Nurses have been of great help in the preparation of children for medical inspection and at the inspections when the school nurse has been prevented from attending. The time spent by highly skilled staff in making hyginene inspections has been halved since they have been assisted by S.E.N.'s who have also been accepted by the teaching staff. 11 SCHOOL DENTAL SERVICE, 1963. 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. Since mention was last made of this subject fluoridation of public water supplies has received considerable prominence in both local and national press, and as a result of the ensuing controversy, some anxieties have been expressed by parents at Corporation Dental Clinics. In dealing with such enquiries dental staff have been advised to aim at straight-forward and factual guidance, so as to permit the position to be seen in truer perspective. As was expected, lack of uniformity in the supply arrangements throughout the Borough have so far precluded any positive progress with this project during the year, and the position has of late been further complicated by requirements in connection with the Greater London Scheme. Whilst from the clinical aspect such delay is regrettable, a suitable "breathing space" can doubtless be welcomed, not only to assist clarification by the public, but also to permit much needed investigation by individual supply Boards into the many problems with which they will ultimately be faced. In the field of Health Education measures for stepping up basic dental instruction for the school population have been further developed, and new "routines" for this purpose have been tried out at certain clinics. An experiment commenced last year for enlisting the services of Health Visitors to undertake Dental Hygiene talks and "Tooth Brush Drill" during their routine visits to Infant and Junior Departments has been continued, and to assist these efforts a certain amount of intraining has been undertaken by the Health Education Section. An extended range of poster material, visual aids, etc. are now available, including further "topical" exhibits for touring Schools, Welfare Centres and Dental Clinics. 12 Though laudable efforts have been made in certain areas it must be admitted that the time available for such work represents a limiting factor and much must depend on the level of other outside activities. Whilst such staff can no doubt make a worth while contribution, the problem of securing adequate "dental" coverage for all schools is now considerable, and as has been found in the case of many Authorities, the introduction of additional suitably trained personnel will in future have to be considered for a further expansion of this work. Talks of a more advanced nature have been undertaken by the Health Education Officer and a member of her staff at Grammar Schools and Senior Departments. Special efforts have been made to encourage Teaching Staff to participate in this work. Dental subjects are now introduced by certain schools when organising their own fill programmes. Timely enterprise has been shown by the School Meals Service by the introduction of apples to the mid-day menu. Unfortunately, because of limitations imposed by the existing budget, these offerings had to be received in lieu of "afters" and the reception by pupils was somewhat mixed. In view of the obvious benefit from a dental angle it is suggested that in future a grant might well be considered by the Health Committee to enable such luxuries to be supplied as "extras". Earlier in the year an approach was made to the local Fruit Distributors Association in the hope that some form of group purchasing of apples could be arranged for schools. Because of a difficulty in assessing prior demand and a subsequent reduction in market prices, it was finally agreed that little would be gained at that time as the ultimate saving would be negligible. Considerable interest was generated at a local Secondary Modern School by a small clinical trial carried out by members of the staff of the Royal Dental Hospital School of Hygiene, to test the efficacy of a new tooth paste ingredient on the oral mucosa. Some 150 girls participated in these activities, which covered a period of approximately two months. The Oral Hygiene Service "Exhibition Van" visited some ten Departments on the New Addington Estate. Unfortunately, the usual "playground" activities had to be curtailed because of an abnormally cold spell, and the entire programme mounted in the school halls. Subject matter chosen for each occasion excellent, and it is hoped therefore that similar visits can be paid to other areas during 1964. General satisfaction has been expressed by both parents ana staff at the comprehensive amenities provided at the newly acquired combined Welfare and Dental Centre for the Waddon area. 13 The new building is admirably situated for dealing with the great majority of existing schools and should, it is hoped, be able to meet the requirements of any foreseeable developments in the area. Arrangements for integration with the Welfare side of the work are dealt with in the appropriate Report. With regard to the general conduct of the School Dental Service, statistics show that progress on the clinical side has been satisfactory and whilst, because of earlier staffing difficulties, coverage of schools was rather below the previous year, a reasonable balance of inspection and treatment has been maintained. Inspections The number of children on the register at maintained schools within the Borough at the close of 1963 was 36,269. Including an additional 45 scholars at 'grant assisted" schools this represents a sum total of 36,314. During the year 89.4 per cent, of the school population were examined, compared with 92.6 per cent, in 1962. This decrease has come about largely as a result of unfavourable conditions prevailing during the early months of the year. According to recent returns 1,636 children remained unexamined during 1963, compared with 1, 458 last year. At those schools visited 32,416 were inspected and 11,247 (34.7 per cent.) referred for treatment, compared with 33,486 inspected and 12,863 (38.4 per cent.) referred in 1962. Because of discrimination exercised in the matter of certain conditions deemed inadvisable to treat, the above figures should not be regarded as an index of the actual incidence of decay. The results obtained from school inspections were as follows: - Acceptance of Treatment 35.3% Refused Treatment 50 % Forms Not Returned 14.7% Prom the above figures it will be seen that rather less children were found to be in need of treatment at school inspections. Though there has been a rise of a few points in the percentage of refusals, the current trend of lower acceptances has now appreciably lessened, and quite a proportion of those "opting out"at inspections are subsequently treated as "specials" when trouble intervenes. Though every effort is made by members of the staff to stress the importance of early attention, it is clear that a certain proportion of parents still adopt a noncommittal attitude in this matter as regards clinic treatment, partly no doubt on the assumption that ready attention can be secured elsewhere. 14 RESULTS OF SCHOOL INSPECTIONS No. referred for 1963 1962 1960 1949 1937 Treatment 11,247 12, 863 11,752 9,404 13,498 34.7% 38.4% 46.3% 45.9% 76% Consents 3,974: 4, 638: 4,586: 6,996: 7,762: 35.3% 36% 39% 74.1% 57.7% (Total Consents Including Specials)* 5,174: 6,048: 6,542: 10,098: 10,146: 47% 47% 47.7% 80.7% 63% Refusals 5,625: 6,390: 5,531: 1,213: 3,242: 50% 49.7% 47% 12.9% 24% Forms not Returned 1,648: 1,835: 1,635: 1,195: 2,494: 14.7% 14.3% 14% 12.7% 18.5% *Specials - Those referred by Head Teachers with Emergency Pons. The above comparative Table is of interest in demonstrating the progressive reduction in the percentage referred for treatment at routine inspections over the years, and particularly so when the figure for 1937 is compared with current results. Though the percentage of those attending for emergency treatment also shows a marked decline, the amount of this work is still appreciable when compared with the number accepting regular attention, and therefore constitutes an important factor when assessing the actual "need"for treatment. Treatment Of 12,447 children referred for treatment (including specials) 6,803 (54.6 per cent.) were treated and 5,145 (41.3 per cent.) cured completely, compared with 14,273 referred, 7,167 (50.2 per cent.) treated and 5,533 (38.7 per cent.) cured in 1962. Treatment sessions fell from 2, 604 to 2, 572 principally on account of fewer sessions by part-time officers. 15 Whilst during post war years the volume of work carried out at Clinics has progressively decreased, this fact has resulted in a corresponding change in the pattern of treatment, and permitted a higher level of conservation for the individual child. In addition, the general introduction of planned treatment, prophylactic measures and other specialised work, though reducing the apparent output, has in practice greatly raised the potential value of the service. Though for the present there is still some local "drift" in opting for outside arrangements, there are signs that parents are becoming increasingly aware of the facilities now available at clinics, particularly for the care of the younger child. Whilst from the clinical angle there is at present some lessening of responsibility, the general growth in the school population has greatly increased the time required for routine inspections, and in view of the condition of mouths in certain areas this duty must continue to receive a special priority. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those last year. 1963 1962 Attendances 18,409 19,259 Treated 6,803 7,167 Re-treated 3,716 4,003 Fillings - Permanent 6,273 6,541 Temporary 2,052 1,985 No. of Teeth Pilled - Permanent 5,742 6,107 Temporary 1,955 1,929 Extractions - Permanent 1,594 1,695 Temporary 3,762 4,328 Gas Administrations 2,190 2,435 Local Anaesthetics 508 498 Other Operations Permanent 6,697 7,389 Temporary 585 685 Cases Completed 5,145 5,533 16 Miscellaneous Items These include: 1963 1962 Root treatment in anterior teeth 5 20 Removal of bone sequestra 9 13 Splints for fractured incisors - 6 Partial Pulpotomy - 1 Number of adult M. D.'s treated 14 10 Dentures inserted 37 29 Denture repairs 9 8 Removal of impacted teeth 44 47 Ulcerated Stomatitis (Vincent's Infection) - 1 Acrylic caps for incisor teeth 5 10 Gingivectomy - 5 Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 1,200 compared with 1,410 in 1962. X-Ray Examination The number of cases referred for the above purpose was 273. compared with 312 in 1962. This includes 95 taken at Mayday Hospital. Orthodontic Treatment The number of sessions devoted to this work was 404, compared with 381 last year. "Hie work in this section is proceeding satisfactorily and there have been no developments worthy of report. The following is a summary of treatment performed:- Consultant. 1963 D.O.s Total 1962 Total Cases commenced during the year 156 42 198 266 Cases carried forward from the previous year 494 56 550 594 650 98 748 860 Cases completed during the year 149 37 186 218 Cases discontinued during the year 57 7 64 91 Pupils treated with appliances 233 79 312 363 Appliances - Removable 301 73 374 369 Fixed 10 - 10 85 Total Attendances 3,326 1,253 4,579 4,858 17 Consultant 1963 D.O.s Total 1962 Total Cases treated by extraction only - 153 153 150 Cases referred to Specialist for consultation 148 _ 148 153 Treatment sessions 305 99 404 381 New cases awaiting treatment 9 - 9 30 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:- 1963 1962 Attendances 70 59 New Cases Treated 5 3 Re-treated 40 42 Fillings - Permanent 77 68 Extractions - Permanent 11 6 Temporary 7 11 Other Operations 10 10 "Gas" Cases 8 5 Local Anaesthesia 3 4 Cases Completed 40 36 Referred X-Ray 3 3 18 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED CHILDREN Mr. Green, the Headmaster reports that the year 1963 has been characterised by the continued development and consolidation of facilities and organisation for the complete development of the handicapped child. Further progress has been made in reducing the size of the teaching units - children with special learning difficulties were organised into classes of about 10 children, so that the overall average size of class in the School became 15. The range of educational activities was once again widened; pottery and archery, to name but two aspects, were added to the curriculum Within the smaller teaching groups there was a noticeable improvement in reading ability. On the physical side it will be noted that the level of treatment has again been increased. Routine medical examinations were held weekly, hydrotherapy became a daily activity, whilst the total number of treatments carried out in the Physiotherapy Dept., reached the very high level of 6,765. Some 60 orthopaedic cases received regular treatment along with 56 postural cases. During the year there was a further increase in ancillary medical help. Routine medical inspections took place on 23 occasions, 356 children were inspected and 144 parents were present. Specialist medical examinations were held termly by specialists in orthopaedic and physical medicine, some 62 children being seen on these occasions. Speech therapy has been given regularly to an average of 21 children. The Senior Speech Therapist also conducted a survey of the incidence of Speech defects in the School. 199 children were examined, some 60 of whom were found to have some defect of speech. Resulting from this survey it was recommended that the speech therapy treatment facilities should be increased. The Nursing Sister, aided in certain duties by the Medical Attendants, has carried out the preparations and follow-up of medical examinations as well as the various prescribed courses of treatment; a wide variety of ailments 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 1963. Physically Handicapped Boys Girls Total Spina Bifida 4 6 10 Cerebral Palsy 17 14 31 Bronchiectasis 2 6 8 Congenital Heart 3 5 8 Epilepsy 9 5 14 Muscular Dystrophy 5 2 7 Speech Defect 2 2 4 Poliomyelitis 4 7 11 Various Disabilities 19 17 36 65 64 129 Delicate Asthma 23 16 39 Bronchitis 5 8 13 Debility 4 5 9 2 Primary T.B. - 2 Various Disabilities 1 2 3 33 33 66 19 The death of Miss D.W.M.Lyell, Deputy Head and a member of the Staff for 33 years was indeed a tragic loss to the School. It was agreed that a permanent reminder of her years of devoted service to so many handicapped persons should be established in the form of an 'Adventure Playground' . Swimming continued at a very high level until the percentage of children receiving swimming certificates reached 67% and further advanced awards were made by the English Schools' Swimming Association. The average number on the roll was 196, the attendance was 86%. There were 50 admissions during the year, whilst 18 children left for employment, 25 returned to other schools and 2 children died. Finally I wish to place on record my thanks to the Principal School Medical Officer and Staff and to all members of the Staff of St, Giles' School for their support during 1963. 20 ST. CHRISTOPHER'S SCHOOL FOR EDUCATIONALLY SUB-NORMAL CHILDREN Mr. Grice the Headmaster reports:- (1) Organisation (a) The provision of an electric kiln has seen the introduction of pottery as an extra craft subject in the curriculum, (b) The extensive programme of Educational Visits commenced last year has been continued and increased. In addition to all the visits undertaken in the London Area the two Senior classes paid a visit to Dieppe on July 17th. (2) Building Improvements Shower Baths for the girls were installed during the year and the existing ones for the boys improved (3) School Functions (a) Parents Day was held most successfully on July 3rd. Every child in the School 1b d a visitor. (b) The Annual Sports took place on Thursday. July 11th. (c) The School Harvest Festival was held on September 26th. An increased number of parents attended this year and joined in our service of thanks. As a result, 56 food parcels were made up and delivered to old people in the district by the Senior Pupils. (d) The Annual Carol Service was held on December llth, at which all the lessons were read by pupils. (4) The Old Scholars Club Held its third Birthday Party on October 7th. The Club continues to flourish and old pupils continue to obtain re-assurance, encouragement and advice during the difficult period of adjustment to working conditions. (51 The Parents Association Held a New Year Party for the children on January 26th. The children greatly enjoyed themselves and the Punch and Judy Show and Conjuror proving to be most popular. In addition each child received a present. We are also very grateful to the parents for providing three dozen rose bushes for the planting of a new rose bed in the school grounds. (6) Swimming Certificates gained during 1963:- Distance Boys Girls Total 25 yards 17 8 25 50 yards 7 6 13 100 yards 9 4 13 440 yards 3 - 3 Half Mile 3 - 3 One Mile 1 - 1 21 Statistics Boys Girls Total Number on Roll 31.12.1962 124 79 203 Admitted during 1963 29 10 39 Left to work at 16 10 9 19 Transferred to other Areas 1 2 3 Transferred to St. Luke's - 1 1 Transferred to Residential E.S.N. Schools 4 . 4 Transferred to Approved Schools 1 - 1 Excluded as unsuitable for Education at School 5 4 9 Transferred to Normal Schools - 2 2 Number on Roll 31.12.1963 132 71 203 22 ST LUKE'S SCHOOL FOR THE PARTIALLY SIGHTED Miss Rundle, the Headmistress, reports that during 1963 there were no major changes in the organisation and curriculum of the school. Increased emphasis has been made on the necessity of helping our visually handicapped pupils to become more independent. The co-operation of the parents is constantly sought to help the children to become self-reliant. The parents were invited to the school each term to maintain contact with them and to provide an opportunity to discuss their children's progress. Each term the children visited places of interest. For the first time the school was invited to take part in the London Inter-School Sports for Partially Sighted Shildren. This was a welcome opportunity for the children to meet and compete with others similarly handicapped, Another revolving blackboard has been added to the school equipment. This addition is proving very valuable. Two anglepoise lamps have also been provided - these help the more severely handicapped on dull days. During the year a routine medical and a dental examination was held. The ophthalmologist also carried out an examination at the school. Number on Roll 31.12.63 16 Admissions 3 Transfers to other schools 1 Left for employment Nil 23 CHILDREN EXAMINED FOR I. Q. 107 children were examined during 1963. The classifications arrived at, together with recommendations made, are as follows:- (l) pound to be educationally sub-normal:- (a) Recommended to St. Christopher's Special School 30 (b) Recommended to Residential E.S.N. School 7 (2) Found to be unsuitable for education at School 21 (3) Other Recommendations: (a) Referred to Slow Stream in Ordinary School 7 (b) Recommended for re-test 3 (c) Deferred for Medical Treatment 12 (d) Recommended for St. Giles' 11 (e) Recommended Residential School for Deaf (f) Recommended Residential normal School 1 (g) Recommended Residential School for Speech Defects 1 (h) Referred back to Ordinary School 14 107 Awaiting testing on 31.12.63. 7 In addition, a further 68 intelligence tests were given to children attending St. Christopher's Special School. 24 CHILD GUIDANCE CLINIC The short stay psychiatric inpatient unit opened last year at Queen Mary's Hospital, Carshalton, is proving to be an invaluable instrument for the diagnostic investigation of the occasional very severe emotionally disturbed child referred to the Child Guidance Clinic. The appointment of Dr. A. Zarrabi as Psychiatric registrar to both the short stay unit and the Child Guidance Clinic in Croydon has improved integration and followup between the two organisations. Diminishing pressures on the adolescent inpatient unit at Long Grove Hospital has enabled us to secure admissions to it more easily than in previous years. This means that the Child Guidance Service is not now being taxed by the very acute serious behaviour disorders, and that we can plan on methodical lines the treatment of the 'cold' cases. The Tutorial Class under Mr. G.W. Doe continues to provide an effective first line of defence against school phobias and we have had some real successes in the management of this perennial problem. An outstanding need which has emerged over the last two years is that of day facilities for the education of psychotic children. It is hoped that the next Annual Report will show that this tragic gap in our service has been finally closed. Source of Referral Boys Girls Total General Practitioners 58 34 92 Parents 3 14 Education Dept/Schools 17 10 27 Medical Officer of Health Service 40 16 56 Juvenile Court/Probation Officer 9 9 Milton House Remand Home - 82 82 Hospitals 8 14 22 Other Agencies 4 15 139 158 297 Analysis of'the above cases Boys Girls Total Diagnostic 9 83 92 Current cases under treatment 95 48 143 Closed Cases - Improve 16 18 34 Closed Cases - No Change 2 2 4 Closed Cases - Unco-operative 7 3 10 Cases transferred to other agencies 10 2 12 Domiciliary Visits - 2 2 139 158 297 Current treatment cases carried over from 1962 94 48 142 25 SPEECH THERAPY The Speech Clinic staff during 1963 consisted of four fulltime speech therapists, two of these are new members of the staff. As the case load is still heavy, the staff will be increased to five during the coming year. Eventually larger premises will be necessary and, to help ease cramped conditions, a therapist commenced attending Waddon Clinic in December, 1963, once weekly. A survey was carried out at the two special schools, and it was found that, at St. Giles' School in particular, there was a high incidence of speech defect. The number of sessions worked there must be increased as soon as suitable accommodation is provided. A "Parents' evening" was again held and was successful, and a "Mother's Discussion Morning" was also held, and proved to be most beneficial. Several visitors have been to the clinic during the year, including Dr. Mary Sheridan, who was investigating the problem of non-communicating pre-school children. The Speech Clinic Staff have given several talks to interested parties, e.g. Social Workers, and careers lectures. As noted previously, the problem of the aphasic child with associated learning difficulties persists, and as yet no special remedial unit has been formed. Dr. Worster-Drought continues to attend as consultant Neurologist and advises us on such cases. Further details of the work carried out are shown in Appendix B Table X 26 ENURESIS CLINIC During the year a total of 181 children attended the enuresis clinics at Lodge Road and New Addington, as usual the number of boys attending was far in excess of the number of girls. An interesting feature was that 88, nearly half, showed some family history of nocturnal enuresis. This tends to confirm the theory that many of these children are naturally late in developing control of their bladder, and the condition becomes chronic because this cannot be accepted by the parents, who try all forms of treatment from bribery to beating. Just over a third had had previous treatment from other doctors, mainly amphetamine tablets, although several had tried pituitrin snuff. The buzzers were used continuously where the parents were prepared to co-operate, but owing to slight mechanical difficulties there was a series of breakdowns. This has now been rectified and they are working well again. Number of children who attended in 1963:- 181 (121 boys, 80 girls): Lodge Road - 119, New Addington - 62 Results Discharged Dry 94 Still Attending 61 Discharged for non-attendance 23 Left district 2 Too young for treatment 1 Used Buzzer 77 Previous treatment 71 Family history 88 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:- 1 3 40 26 13 23 19 20 10 7 8 6 2 3 27 DEAF AND PARTIALLY HEARING CHILDREN - AUDIOLOGY CLINIC The pressure of work on the Audiology Clinic this year, was eased considerably by a change of policy in the sweep testing arrangements. In order to reduce the number of children attending the Clinic, it was decided not to refer immediately the failures with a hearing loss not greater than 30dB, as this small loss could be caused by a cold or a temporary catarrhal condition. The children in this group, were noted by Mrs.Roberts, the part time Audiometrician, and re-tested, at the next visit to the School. Of the children re-tested, approximately 65% passed the second test. The failures were referred in the usual way to the Audiology Clinic for further investigation. All Infant Schools were visited at least twice during the year by Mrs. Roberts and apart from the absentees and uncooperative children (386), all children newly admitted to school during the year were tested. Of the 3, 964 children tested, 573 failed the test. This figure includes 170 children in the 30dB group, waiting to be re-tested. The failures were referred to the Audiology Clinic for further investigation and the appropriate action taken. A monthly clinic was started during the latter part of the year, in conjunction with Dr. Morgan, to deal with the difficult to diagnose, babies 'at risk'. This has proved to be well worthwhile in the early ascertainment of deafness in these very young and difficult cases. 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. 11 hearing aids were issued in 1963. Eight of these were the National Health Service "Medresco" aids and the other three, were commercial aids paid for by the Corporation. Commercial aids are needed if the hearing loss is very severe, or if there is a sharp perceptive loss in the higher frequencies. As there is no automatic volume control on the Medresco aid, it cannot be tolerated by children with such a loss, as the hearing for low notes is often normal and general amplification of sound soon becomes painful. A Unit for Partially Hearing and Severely Deaf Children in the age range 3-7 years was formed at the Kingsley Road Infants School and will open in January 1964. This will provide up to 4 years training with a qualified teacher of the deaf, 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. For further statistical details see Appendix G. page 59 28 EPILEPTIC SCHOOL CHILDREN 33 epileptics were known to School Health Services as at 31.12.63 Of these - 7 were attending Ordinary School 14 were in Day School for Physically Handicapped and Delicate Children 3 were attending our day E.S.N. School 2 were at Lingfield School 2 were at the Junior Training Centre 3 were in Residential School 1 was at Private Residential School 1 was at St. Luke's School SPASTICS 59 Croydon Spastics were receiving education as at 31.12.63. 31 were attending St. Giles' School 3 were attending St. Margaret's School, Croydon 7 were at Residential Schools for Physically Handicapped children 5 were attending ordinary school 3 were attending St. Christopher's School 3 were attending Spastic Centre full time 4 were attending Spastic Centre part time 2 were attending Old Kent Road Day School for Partially Deaf 1 was attending a Normal Private School 29 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1963 as to their fitness to undertake the part-time employment indicated:- 1963 1962 1962 1960 1959 Delivery of Goods for Shopkeepers 33 28 33 57 50 Delivery of Newspapers 244 320 303 316 317 Delivery of Milk 6 6 9 1 7 Shop Assistants 42 64 75 69 59 325 418 420 443 433 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1963 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 pasteurised, and the sources of supply are subject to the approval and constant supervision of the Medical Officer of Health. The number of meals supplied daily to children during 1963 was approximately 20, 500. Cost of Special Schools The cost of the medical, dental and nursing services was £69,546. Cost of Special Schools Schools maintained by the Council £63, 971 Other Schools (not maintained by local Education Authorities) £25,937 Adjustments with other authorities in respect of Special Schools £ 7,160 £97, 068 Cost of Milk and Meals Meals and Milk cost £512,090. Income from payment for meals was £182,275, making a net cost of £329,815, on which grant is Paid of 100 per cent. on approved expenditure. 30 NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in 1963, 412 children were examined at routine examinations. Appendix C gives the detailed findings. Yours faithfully S.L. WRIGHT School Medical Officer. 31 STATUTORY TABLES APPENDIX A. MEDICAL INSPECTION RETURNS Year ended 31st December, 1963 Number of pupils on registers of maintained primary and secondary schools (including nursery and special schools) in January, 1964, as in Form 7, 7 M. and 11 Schools. 36,344 PART 1.- MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE A.- PERIODIC MEDICAL INSPECTIONS Age Groups Inspected (By year of birth) No. of Pupils Inspected Physical Condition of Pupils Inspected SATISFACTORY UNSATISFACTORY No. % of Col.2 No. % of Col.2 (1) (2) (3) (4) (5) (6) 1959 and later 66 66 100.00 – – 1958 2,973 2,970 99.90 3 0.10 1957 635 635 100.00 – – 1956 181 178 98.31 3 1.69 1955 1. 072 1,071 99.91 1 0.09 1954 1, 514 1,512 99.87 2 0.13 1953 596 594 99.66 2 0.34 1952 634 633 99.84 1 0.16 1951 1,384 1,383 99.93 1 0.07 1950 660 660 100.00 – – 1949 735 733 99.73 2 0.27 1948 and earlier 2,356 2,354 99.92 2 0.08 TOTAL 12,806 12,789 99.87 17 0.13 32 PUPILS FOUND TO REQUIRE TREATMENT AT PERIODIC MEDICAL INSPECTIONS. (excluding Dental Diseases and Infestation with Vermin) Age Groups Inspected (By year of birth) For defective vision (excluding squint) For any of the other conditions recorded in Part II Total individual pupils (1) (2) (3) (4) 1959 and later – 2 2 1958 112 229 319 1957 21 53 75 1956 6 16 22 1955 63 70 122 1954 82 94 165 1953 23 38 56 1952 28 33 60 1951 48 85 136 1950 30 38 65 1949 45 33 75 1948 and earlier 91 67 143 TOTAL 549 758 1,240 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 829 Number of Re-inspections 1,521 Total 2,350 33 TABLE C . - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 52,988 (b) Total number of individual pupils found to be infested 467 (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 34 PART 2 TABLE A. - RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION 1963 Defect Code No. Defect or Disease Periodic Inspections Entrants Leavers Others Total Treatment Observa tion Treatment Observa tion Treatment Observa tion Treatment tion (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 4 SKIN 11 19 10 3 25 27 46 49 5 EYES - (a) Vision 133 163 136 38 280 201 549 402 (b) Squint 28 9 5 – 19 6 52 15 (c) Other 4 4 1 1 5 6 10 11 6 EARS - (a) Hearing 42 106 14 2 61 36 117 144 (b) Otitis Media 3 25 1 – 3 7 7 32 (c) Other 5 8 1 1 3 6 9 15 7 NOSE AND THROAT 67 228 6 4 37 90 110 322 8 SPEECH 26 56 – 1 12 10 38 67 9 LYMPHATIC 3 33 – – – 12 3 45 10 HEART 10 29 9 8 14 22 33 59 11 LUNGS 19 64 4 4 6 35 29 103 12 DEVELOPMENTAL - (a) Hernia 7 7 1 – 1 7 9 14 (b) Other 5 62 13 6 39 89 57 151 13 ORTHOPAEDIC - (a) Posture 12 37 22 9 44 55 78 101 (b) Feet 19 56 7 3 38 30 64 89 (c) Other 27 71 7 3 28 35 62 109 14 NERVOUS SYSTEM - (a) Epilepsy – 2 – 1 – – – 3 (b) Other 5 12 – 3 7 4 12 19 15 PSYCHOLOGICAL - (a) Development 4 11 1 – 5 9 10 20 (b) Stability 9 17 – 1 7 14 16 32 16 ABDOMEN – 2 – – – 6 – 8 17 OTHER 17 44 9 7 15 31 41 82 35 TABLE B. - SPECIAL INSPECTIONS Defect Code No. Defect or Disease Special Inspections Pupils requiring Treatment Pupils requiring Observation (1) (2) (3) (4) 4 SKIN 2 1 5 EYES - (a) Vision 9 3 (b) Squint – – (c) Other – – 6 7 EARS (a) Hearing 2 4 (b) Otitis – 1 (c) Other – 1 NOSE AND THROAT 7 1 8 SPEECH 3 1 9 LYMPHATIC GLANDS – – 10 HEART 1 – 11 LUNGS 3 1 12 DEVELOPMENT - (a) Hernia – – (b) Other 3 5 13 ORTHOPAEDIC (a) Posture – – (b) Feet – – (c) Other 2 – 14 NERVOUS SYSTEM - (a) Epilepsy 1 – (b) Other 1 – 15 PSYCHOLOGICAL - (a) Development – – (b) Stability 3 1 16 ABDOMEN – – 17 OTHER 7 – 36 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) 1,452 Total 1,452 Number of pupils for whom spectacles were prescribed 740 TABLE B. - DISEASES AND DEFECTS OF EAR. NOSE AND THROAT Number of cases known to have been dealt with Received operative treatment - (a) for diseases of the ear – (b) for adenoids and chronic tonsillitis 95 (c) for other nose and throat conditions – Received other forms of treatment – Total 95 Total number of pupils in schools who are known to have been provided with hearing aids - (a) in 1962 11 (b) in previous years 73 *A pupil recorded under (a) above should be recorded at (b) in respect of the supply of a hearing aid in a previous year. TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to have been treated (a) Pupils treated at clinics (No figures available for out-patients Department) 243 (b) Pupils treated at school for postural defects 56 Total 299 TABLE D. - DISEASES OF THE SKIN (excluding uncleanliness, for which see Table D. of Part I) Number of cases known to have been treated Ringworm - (a) Scalp – (b) Body – Scabies 14 Impetigo 6 Other skin diseases 10 Total 30 37 TABLE E. - CHILD GUIDANCE TREATMENT Number of eases known to have been treated Number of pupils treated at Child Guidance Clinics 56 TABLE F. - SPEECH THERAPY Number of cases known to have been treated Number of pupils treated by Speech Therapists 527 TABLE G. - OTHER TREATMENT GIVEN Number of cases known to have been dealt with (a) Pupils with minor ailments 782 (b) Pupils who received convalescent treatment under School Health Service arrangements 2 (c) Pupils who received B.C.G. vaccination 2, 829 (d) Other than (a), (b) and (c) above Please specify:- 1. Enuresis 181 2. Audiology 81 Total (a) (d) 3,875 38 APPENDIX B Table I AVERAGE NUMBERS AND ATTENDANCE IN MAINTAINED PRIMARY, SECONDARY NON-SELECTIVE, SELECTIVE, TECHNICAL AND GRAMMAR SCHOOLS DURING THE YEAR 1963 School Average No. on Registers Average Attendance Average Attendance % Average Nearly Attendance % COUNCIL PRIMARY Ashburton Junior Mixed 447 405 90.6 91.8 Ashburton Infants 237 203 85.7 89.1 Benson Junior Mixed and Infants 544 498 91.5 93.2 Beulah Junior Boys 212 194 91.5 90.5 Beulah Junior Girls 213 192 90.1 92.0 Beulah Infants 303 249 82.1 84.0 Castle Hill Junior Mixed 678 621 91.6 92.1 Castle Hill Infants 308 267 86.7 89.3 Cypress Junior Mixed 227 207 91.2 92.6 Cypress Infants 194 165 85.5 87.4 Davidson Infants 142 123 86.6 87.1 David Livingstone Junior Mixed and Infants 226 200 88.4 90.7 Duppas Junior Mixed 348 308 88.5 90.3 Ecclesbourne Infants 149 124 83.2 85.8 Elmwood Junior Boys 243 223 91.7 90.9 Elmwood Junior Girls 246 220 89.4 91.0 Elmwood Infants 293 245 83.6 87.3 Fairchildes Junior Mixed 556 505 90.8 92.1 Fairchildes Infants 361 307 85.0 88.5 Gilbert Scott Junior Mixed 382 347 91.0 93.5 Gilbert Scott Infants 299 247 82.6 87.8 Gonville Junior Mixed and Infants 550 495 90.0 91.2 Howard Junior Mixed and Infants 258 233 90.3 91.2 Kensington Avenue Junior Mixed 440 397 90.2 90.6 Kensington Avenue Infants 220 187 85.0 87.4 Kingsley Junior Mixed 444 408 90.2 89.4 Kingsley Infants 356 291 81.4 84.6 Monks Orchard Junior Mixed and Infants 393 349 88.8 90.2 Norbury Manor Junior Mixed 349 319 91.4 92.7 Norbury Manor Infants 234 196 83.7 89.3 Oval Junior Mixed 341 310 90.9 91.6 Oval Infants 185 156 84.3 86.7 Portland Infants 92 80 87.0 87.5 Purley Oaks Junior Mixed 261 242 92.7 93.1 Purley Oaks Infants 205 178 86.8 87.2 Rockmount Junior Mixed 215 195 90.6 91.4 Rockmount Infants 162 136 83.9 89.2 Rowdown Junior Mixed 488 440 92.0 91.9 Rowdown Infants 313 265 84.7 90.6 South Norwood Junior Mixed 405 375 92.6 93.7 South Norwood Infants 273 233 85.4 88.7 St. Peter's Junior Mixed and Infants 248 225 90.7 90.9 Spring Park Junior Mixed 362 326 90.0 91.8 Spring Park Infants 263 217 82.5 87.6 Sydenham Junior Mixed 257 231 89.9 91.4 39 School Average No. on Registers Average Attendance Average dance % Average Yearly Attendance % Sydenham Infants 188 160 85.1 85.1 Waddon Infants 219 183 83.6 87.4 West Thornton Junior Mixed and Infants 254 221 87.0 90.0 Whitehorse Manor Junior Mixed 364 331 90.9 92.0 Whttehorse Infants 251 205 81.7 87.1 Winterbourne Junior Boys 378 348 92.0 93.9 Winterbourne Junior Girls 368 340 92.3 93.2 Winterbourne Infants 374 309 82.6 90.1 Wolsey Junior Mixed 445 403 90.6 91.2 Wolsey Infants 327 276 84.4 88.5 Woodside Junior Mixed 566 517 91.3 92.5 Woodslde Infants 307 264 86.0 87.0 TOTALS 17. 963 15,891 88.4 90.4 COUNCIL SECONDARY NON- SELECTIVE Ashburton Senior Boys 629 585 93.0 93.1 Ashburton Senior Girls 593 542 91.4 92.1 Davidson Senior Mixed 401 350 89.3 89.2 Ecclesbourne Senior Girls 312 273 87.5 88.0 Fairchildes Senior Boys 647 570 88.9 89.7 Fairchildes Senior Girls 665 585 87.9 84.2 Ingram Senior Boys 483 425 87.9 89.1 Lanfranc Senior Boys 522 443 84.8 87.1 Lanfranc Senior Girls 486 437 89.8 90.2 Norbury Manor Senior Boys 360 330 91.6 91.8 Norbury Manor Senior Girls 462 419 90.7 91.9 Portland Senior Mixed 339 303 89.4 90.5 Tavistock Senior Boys 419 358 85.4 87.0 Tavistock Senior Girls 270 235 87.0 86.7 South Croydon Senior Mixed 614 536 87.3 90.0 Shirley Senior Mixed 602 539 89.5 89.7 Overbury Senior Mixed 506 438 86.5 86.8 Westwood Senior Girls 395 340 86.0 90.2 TOTALS 8,705 7,708 88.5 89.5 VOLUNTARY SECONDARY NON-SELECTIVE St. Andrew's Mixed 206 177 86.0 88.0 Our Lady's Girls 195 174 89.2 87.1 St. Mary's Mixed 381 354 92.9 93.3 TOTALS 782 705 90.1 90.3 SPECIAL SCHOOLS St. Christopher's Educationally Sub-Normal School Mixed 201 174 86.6 87.2 St. Giles' Physically Handicapped and Delicate Mixed 191 160 83.8 84.9 St. Luke's (Partially Sighted) 14 12 85.7 92.8 TOTALS 406 346 85.2 86.1 40 School Average No. on Registers Average Attendance Average Attendance % Average yearly Attendance % VOLUNTARY PRIMARY SCHOOLS All Saints' Mixed and Infants (C. of E.) 261 215 82.3 91.6 Good Shepherd (R.C.) Junior Mixed and Infants 347 308 88.8 91.7 Parish Church Junior Mixed and Infants (C. of E.) 358 315 88.0 90.0 St. Joseph's Mixed and Infants (R-C.) 541 484 89.4 90.0 St. Mark's Junior Mixed and Infants (C. of E.) 239 211 88.3 91.1 St. Michael's Infants 131 107 81.6 86.3 St. Mary's Junior Mixed and Infants (R.C.) 419 374 89.3 89.7 Shirley (St. John's) Junior Mixed and Infants (C. of E.) 278 256 92.0 91.8 TOTALS 2.574 2,270 88.1 90.3 SECONDARY SELECTIVE AND GRAMMAR SCHOOLS Archbishop Tenlson's Mixed 325 305 93.8 93.8 Heath Clark Mixed 705 652 92.5 93.4 John Newnham Selective Mixed 511 476 93.1 93.0 Selhurst Boys 899 849 94.5 94.4 Selhurst Girls 542 504 93.0 93.9 John Ruskin Boys 593 544 91.7 93.0 Coloma Girls 531 497 93.6 93.3 Lady Edridge Girls 621 573 92.3 93.3 TOTALS 4,727 4,400 93.0 93.4 TECHNICAL SCHOOLS Stanley Technical Boys 298 277 93.0 93.5 Croydon Secondary Technical Boys 417 398 93.3 93.3 TOTALS 715 666 93.1 93.2 SUMMARY OF SCHOOL ATTENDANCE FOR THE YEAR 1963 Council Primary 17,963 15,891 88.4 90.4 Voluntary Primary 2,574 2,270 88.1 90.3 Council Secondary Non-Selective 8,705 7,708 88.5 89.5 Voluntary Secondary Non-Selective 782 705 90.1 90.3 Grammar and Selective 4,727 4.400 93.0 93.4 Technical 715 666 93.1 93.2 Specials 406 346 85.2 86.1 TOTALS 35,872 31,986 89.1 90.6 Crosfield Nursery: Pull-tine - 19 14 73.7 77.0 A.M. 19 15 79.0 75.0 P.M. 19 14 73.7 75.0 41 Table II HEIGHTS AND WEIGHTS 1963 Number Examined 1963 Average Height in inches Average Weight in lbs. 1963 1962 1961 1960 1939 1963 19 62 1961 1960 1939 BOYS 5 years 1429 42.6 42.6 43.3 43.1 41.8 42.7 42.9 43.4 43.2 41.5 6 „ 236 43.8 44.0 44.7 44.3 43.8 44.8 44.6 45.8 45.4 43.4 7 „ - - - - 46.7 45.3 - - - 50.2 47.0 8 „ - - - - 50.4 49.5 - - - 59.1 55.5 9 „ - - - - 51.5 51.2 - - - 64.2 58.8 10 „ - - - - 52.0 52.7 - - - 67.7 62.9 11 „ - - - - 56.5 53.7 - - - 80.5 68.7 12 „ - - - - 58.2 55.7 - - - 87.2 79.9 13 „ - - - - 59.7 58.4 - - - 95.1 81.6 14 „ 244 63.9 63.7 63.9 63.3 59.0 117.6 113.8 114.1 110.1 90.8 15 „ 468 64.4 64.6 65.0 65.1 - 118.3 119.3 120.6 120.7 - 16 „ 283 67.1 67.4 67.2 67.7 - 131.8 131.4 133.0 130.3 - 17 „ 144 67.7 67.9 68.1 68.0 - 134.7 136.5 138.0 137.0 - GIRLS 5 years 1317 42.3 42.9 42.8 42.6 41.2 41.5 42.3 42.1 42.0 39.7 6 „ 246 43.6 44.0 44.0 43.6 42.7 43.1 44.2 44.8 43.7 41.4 7 „ - - - - 46.3 44.1 - - - 49.3 43.6 8 „ - - - - 50.2 49.9 - - - 59.7 54.7 9 „ - - - - 51.3 50.9 - - - 63.1 57.6 10„ - - - - 52.5 52.1 - - - 66.0 62.9 11 „ - - - - 56.5 53.6 - - - 83.0 68.3 12 „ - - - - 58.3 56.6 - - - 89.6 77.2 13 „ - - - - 59.4 58.8 - - - 95.6 85.3 14 „ 403 62.3 62.2 61.9 62.1 60.3 113.6 113.6 111.5 110.8 97.9 15 „ 897 63.3 63.0 62.9 62.7 62.0 116.3 117.9 115.5 117.1 105.5 16 „ 390 63.9 63.4 64.1 63.7 - 122.4 121.2 122.8 122.1 - 17 „ 114 64.3 64.2 64.4 64.2 - 126.3 127.3 128.1 123.6 - 42 Table III CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1963 School School Population Chicken Pox Conjunctivitis Diphtheria 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 Totals Body Scalp All Saints 261 23 – – – – – 3 – – – 4 – – – – – – – – – – 30 Arch. Tenlson 325 – – – – – – – – – – – – – – – – – – – – – – – Ashburton 1906 7 – – 3 – – 22 – – – 4 – 23 – – – – – 3 – – – 62 Benson 544 36 – – 2 – – 8 – – – 42 – 14 1 – – – – 1 – – – 104 Beulah 728 15 – – – – – 14 – – – 19 – 1 – – – – – – – – 1 50 Castle Hill 986 1 – – – – – 12 – – 3 12 – 5 – – – – – – – – – 33 Coloma 531 – – – – – – – – – – – – – – – – – – – – – – – Crosfield Nursery 57 – – – – – – – – – – – – – – – – – – – – – – – Croydon High 912 – – – – – – – – – – – – – – – – – – – – – – – Croydon Tech. 417 3 – – – – – – – – – 3 – 1 – – – – – 1 – – – 8 Cypress 421 21 – – 20 – – 22 – – – 28 – 5 – – – – – – – – 4 100 David Livingstone 226 17 – – – – – 15 – – – 14 – – – – – – – 1 – – – 47 Davidson 543 1 – – – – – – – – 7 – 1 – – – – – 3 – – – 12 Duppas 348 – – – – – – – – – – – – – – – – – – – – – – – Ecclesbourne 461 1 – – 1 – – 1 – – – 76 – 7 – – – – – 2 – – – 88 Elmwood 782 33 – – 32 – – 2 2 – – 6 – 17 – – – – – – – – – 92 Fairchildes 2229 – – – – – – – – – – – – – – – – – – – – – – Gilbert Scott 681 – – – – – – – – – – – – – – – – – – – – – – – Gonville 550 – – – – – – 2 – – – 8 – 26 – – – – – 1 – – – 37 Good Shepherd 347 – – – – – – – – – – – – – – – – – – – – – – – Heath Clark 705 2 – – – – – – – – – 1 – 2. – – – – – 3 – – – 8 Howard 258 – – – 1 – – 20 – – – 29 – 45 – – – – – – – – – 95 Ingram 483 – – – – – – – – – – – – – – – – – – – – – – – John Newnham 511 – – – – – – – – – – – – – – – – – – – – – – – John Ruskln 593 – – – – – – – – – – – – – – – – – – – – – – – Kensington Avenue 660 – – – – – – 26 – – – 18 – 41 – – – – – – – 2 22 141 Kings ley 800 – – – 6 – – 1 – l 6 27 – 13 – – – – – 2 – – – 56 Lady Edridge 621 – – – – – – – – – – – – – – – – – – – – – – – Lanfrane 1008 5 – – 2 – – – – i – – – 2 – – – – – – – – – 10 43 Monks Orchard 393 – – – – – – – – – – – – – – – – – – – – – – – Norbury Manor 1405 59 4 – – – – 10 – 3 – 89 – 103 15 – – – – – – – 3 286 Occupation Centre 61 – – – – – – – – – – – – – – – – – – – – – – – Old Palace 475 – – – – – – – – – – – – – – – – – – – – – – – Our Lady's Convent 195 – – – – – – – – – – – – – – – – – – – – – – – Oval 526 12 – – – – – – – – – 30 – 3 – _ – – – 3 – – – 48 Overbury 506 – – – – – – – – – – – – – – – – – – – – – – – Parish Church 358 22 – – – – – – – – – 5 – – – – – – – – – – – 27 Portland 431 4 – – – – – 1 – – – – – 3 – – – – – – – – 1 9 Purley Oaks 466 – – – – – – 1 – – – 72 – 11 1 – – – – – – – – 85 Regina Coeli 361 – – – – – – – – – – – – – – – – – – – – – – – Rockmount 377 25 – – – – – 1 – – – 15 – 4 – – – – – – – – – 45 Rowdown 801 – – – – – – – – – – – – – – – – – – – – – – – St. Andrew's 206 – – – – – – – – – – – – – – – – – – – – – – – St. Christopher's 201 – – – – – – 8 – – 1 4 – – – – – – – – – – – 13 St. Giles' 191 – – – – – – – – – – – – – – – – – – – – – – – St. Joseph's 541 – – – – – – – – – – – – – – – – – – – – – – – St. Luke's 14 – – – – – – – – – – – – – – – – – – – – – – – St. Mark's 239 22 – – – – – – – – 10 – 16 – – – – – – – – – 48 St. Mary's R.C 800 1 – – – – – – – – 2 17 – 3 – – – – – – – – – 23 St. Michael's 131 32 – – – – – – – – 39 – 17 – – – – – – – – – 88 St. Peter's 248 – – – – – – – – – – – – – – – – – – – – – – – Selhurst Grammar 1441 1 – – – – – – – – – 1 – 4 – – – – – – – – – 6 Shirley 880 – – – – – – – – – – – – – – – – – – – – – – – South Croydon 614 – – – – – – – – – – – – – – – – – – – – – – – South Norwood 678 47 – – – – – – – – 1 6 – 48 – – – – – 10 – – – 112 Spring Park 625 25 – – – – – – – – – 6 – 2 – – – – – – – – 2 35 Stanley Tech. 298 3 – – – – – 2 – – – – – – – – – – – – – – – 5 Sydenham 445 41 – – – – – – – – 6 3 – 9 – – – – – – – – – 59 Tavistock 689 3 – – – – – – – – – – – – – – – – – – – – – 6 Trinity 623 – – – – – – – – – – – – – – – – – – – – – – – Waddon 219 3 – – – – – – – – – 9 – 1 – – – – – – – – – 13 West Thornton 254 – – – – – – – – – – – – – – – – – – – – – – – Westwood 395 – – – – – – – – – – – – – – – – – – – – – – – Whitehorse Manor 615 87 – – 3 – – 2 – – – 25 – 11 1 – – – – 1 – – 1 131 Whitgift 810 – – – – – – – – – – – – – – – – – – – – – – Winterbourne 1120 173 – – 2 – – 14 – – – 96 – 56 1 – – – – 4 – – 1 347 Wolsey 772 – – – – – – – – – – – – – – – – – – – – – – – Woodside 873 – – – 13 – – 2 – – – – – 1 1 – – – – 1 – – – 18 757 4 – 85 – – 191 2 5 19 725 – 495 20 – – 1 – 36 – 2 35 2377 1 44 Table IV RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1963 Defects Boys Girls No. requiring Treatment No. referred for Observation Percentage of total Defects No. requiring Treatment No. referred for Observation Percentage of total Defect s Uncleanliness - Head – – – – – – Body Skin Disease 32 25 3.20 14 24 2.55 Eye Disease - Defective Vision 236 200 24.48 120 313 29.06 Squint 23 7 1.68 29 8 2.48 External Eye Trouble 6 1 0.39 4 10 0.94 Ear Disease - Deafness 64 80 8.09 53 64 7.85 Otitis Media 1 13 0.79 6 19 1.68 Other Diseases 5 10 0.84 4 5 0.60 Nose and Throat 53 169 12.47 57 153 14.10 Enlarged Cervical Glands (not T.B. ) 2 23 1.40 1 22 1.54 Dental Defects 55 4 3.31 36 8 2.95 Speech Defects 26 36 3.48 12 31 2.89 Heart and Circulation 11 30 2.30 22 29 3.42 Lungs 15 58 4.10 14 45 3.96 Developmental - (a) Hernia 8 12 1.12 1 2 0.20 (b) Other 48 125 9.71 9 32 2.75 Deformities - Posture 24 53 4.32 54 48 6.85 Plat Feet 37 55 5.17 27 34 4.09 Others 35 75 6.18 27 34 4.09 Nervous System Disorders - Epilepsy – 1 0.06 – 2 0.13 Other 6 11 0.95 6 8 0.94 Psychological - (a) Development 7 10 0.95 3 10 0.87 (b) Stability 12 14 1.46 4 18 1.48 Abdomen – 5 0.28 – 3 0.20 Other Defects and Diseases 15 43 3.26 26 39 4.36 TOTALS 721 1,060 529 961 Total Children Examined 5,963 6,843 4 5 Table V PARENTS PRESENT 1963 5 years and under 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years ana 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 All Saints 21 20 20 19 – – – – 1 2 – 1 14 20 9 8 1 8 1 6 5 1 3 1 – – – – – – – – – – – – – – – – – – – – – – – – 42 51 33 35 Archbishop Tenison – – – – – – – – – – – – – – – – – – – – – – – – – – – – 20 16 2 9 9 8 2 4 – – – – – – – – 24 26 1 – 53 50 5 13 Ashburton 44 39 26 34 9 11 7 10 2 3 2 4 39 7 30 6 23 68 17 531 8 – 2 – – 25 – 11 – 99 – 38 – 64 – 24 – 118 – 10 – 124 – 7 – 29 – – 125 587 84 197 Benson 37 41 36 41 4 – 3 – – 2 – 2 31 25 27 21 13 11 9 11 – – – – – – – – – – – – – – – – – – – – – – – – – – – – 85 79 75 75 Beulah 57 38 49 31 29 33 28 17 – 1 – – 37 38 24 23 9 13 9 9 – 5 – 2 – 1 – 1 – – – – – – – – – – – – – – – – – – – – 132 129 110 83 Broad Green College – – – – – – – – – – – – – – – – – – – – – – – – 10 – – – 2 – – – 9 – 2 – 2 – – – 9 – 1 – 18 – – – 50 – 3 – Castle Hill 57 62 46 54 6 11 5 9 5 7 1 5 – 1 – 1 60 78 45 60 42 29 28 22 2 1 1 1 – – – – – – – – – – – – – – – – – – – – 172 189 126 152 Coloma – – – – – – – – – – – – – – – – – – – – – – – – – 43 – 8 – 29 – 5 – 2 – – – – – – – 52 – – – 98 – – – 224 – 13 Croydon Sec. Tech. – – – – – – – – – – – – – – – – – – – – – – – – – – – – 38 – 16 – 23 – 10 – 5 – – – 1 – – – 80 – – – 147 – 26 – Cypress 49 38 46 38 4 3 4 2 2 1 1 – 1 2 1 2 25 19 19 16 10 9 7 8 1 – – – – – – – – – – – – – – – – – – – – – – – 92 72 78 66 David Livingstone 18 28 17 26 1 – 1 – 13 15 12 13 18 20 14 15 7 4 6 3 – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – 57 68 50 57 Davidson 11 18 11 17 – 1 – 1 6 1 2 1 – – – – – 12 – 9 – – – – – 27 – 17 – 6 – 1 – 4 – 1 18 34 1 3 12 13 1 – – – – – 47 116 15 50 Duppas – – – – – – – – – – – – – – – – 34 34 21 22 16 11 9 9 1 – 1 – – 1 – – – – – – – – – – – – – – – – – – 51 46 31 31 Ecclesboune 32 25 30 15 8 4 5 2 – – – – – – – – – – – – – – – – – – – – – 1 – – – – – – – 25 – 4 – 85 – 22 – 2 – 1 40 142 35 44 Elmwood 66 67 57 64 12 13 10 11 6 10 4 9 6 – 5 – 32 42 16 32 26 19 18 14 5 2 3 1 – – – – – – – – – – – – – – – – – – – – 153 153 113 131 Pairchildes 60 64 48 54 3 2 2 1 – – – – – – – – 31 54 16 32 16 16 12 – – 79 – 19 108 123 23 38 38 94 9 15 – 114 – 23 144 117 10 22 2 1 – – 402 664 120 204 Gilbert Scott 68 59 58 54 1 3 1 – 1 – – – – – – – 32 28 25 24 16 15 12 9 – – – – – – – – – – – – – – – – – – – – – – – – 118 105 96 87 Gonville 50 28 49 25 1 5 1 3 – – – – 21 39 15 26 2 3 1 2 1 1 1 – – – – – – – – – – – – – – – – – – – – – – – – – 75 76 67 56 Good Shepherd 13 7 11 4 2 19 1 10 6 6 4 3 24 12 13 10 7 6 4 5 1 1 1 – 3 1 1 – – – – – – – – – – – – – – – – – – – – – 56 52 35 32 Heath Clark – – – – – – – – – – – – – – – – – – – – – – – – – 40 – 27 38 20 5 9 23 1 4 1 3 – – – 3 38 – 2 65 25 – – 132 124 9 39 Howard 28 13 19 13 3 1 3 – 1 – – – 17 12 14 6 7 4 5 4 1 1 1 – – – – – – – – – – – – – – – – – – – – – – – – – 57 31 42 23 Ingram – – – – – – – – – – – – – – – – – – – – – – – – 79 – 27 – 27 – 5 – – – – – 77 – – – 39 – – – – – – – 222 – 32 – John Newnham – – – – – – – – – – – – – – – – – – – – – – – – – – – – 19 12 5 5 12 – 2 – – – – – – – – – 29 33 – 1 60 45 – 6 John Ruskin – – – – – – – – – – – – – – – – – – – – – – – – – – – – 59 – 1 – 30 – 3 – – – – – – – – – 115 – – – 204 – 4 – Kensington Ave. 33 38 28 32 5 6 5 5 2 1 2 1 41 44 30 30 8 10 7 7 2 3 – 2 1 – – – 1 – – – – – – – – – – – – – – – – – – – 93 102 72 77 Kingsley 62 61 52 51 5 8 3 7 – – – – – – – – 41 31 22 22 29 18 23 13 – – – – – – – – – – – – – – – – – – – – – – – – 137 118 100 93 Eady Edridge – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 58 – 13 – 28 – 2 – – – – – – – – – 182 – 1 – 268 – 16 Lanfrane – – – – – – – – – – – – – – – – – – – – – – – – 60 – 20 – 32 69 6 27 – 38 – 12 89 32 6 10 46 105 5 15 – – – – 227 244 37 64 Monks Orchard 39 34 36 29 3 9 3 9 2 1 1 1 16 19 13 14 12 19 6 18 – – – – – – – – – – – – – – – – – – – – – – – – – – – – 72 82 59 71 Norbury Manor 35 37 27 30 6 9 4 7 – 1 – – – 1 – 1 29 32 19 19 13 15 7 8 53 – 2 – 49 70 – 16 – 34 – 7 26 – – – 22 136 – 22 4 1 – – 237 336 59 110 Our Lady's Convent – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 25 – 4 – 14 – – – 8 – – – 27 – – – 9 – 1 – 83 – 5 Oval 20 15 20 13 3 5 3 3 – 3 – 2 17 21 14 17 8 12 7 6 3 – – – – – – – – – – – – – – – – – – – – – – – – – – – 51 56 44 41 Overbury – – – – – – – – – – – – – – – – – – – – – – – – – – – – 31 45 3 22 22 16 2 6 2 17 – – 42 23 4 1 10 – 1 – 107 101 10 29 Parish Church 32 27 25 21 4 4 2 3 2 2 1 2 31 27 18 15 3 1 2 – 1 – 1 – – 1 – 1 – – – – – – – – – – – – – – – – – – – – 73 62 49 42 Portland 14 27 14 26 7 5 4 2 2 1 1 – 1 – 1 – – – – – – – – – 24 28 6 9 9 6 2 5 3 3 – – 34 39 5 2 9 7 2 – – – – – 103 116 35 44 Purley Oaks 37 24 35 20 8 17 8 15 1 – – – 25 17 20 8 10 10 5 8 2 1 – – – – – – – – – – – – – – – – – – – – – – – – – – 83 69 68 51 Regina Coeli 27 25 17 23 1 2 1 2 – 1 – – – 17 – 9 – 1 – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – 28 46 18 35 Rockmount 23 22 18 19 9 11 8 6 4 5 2 3 – – – – 25 21 18 15 5 14 3 10 1 – – – – – – – – – – – – – – – – – – – – – – – 67 73 49 53 Rowdown 52 54 41 48 1 5 – 3 1 2 – 2 – – – – 41 33 38 15 24 18 16 16 – – – – – – – – – – – – – – – – – – – – – – – – 120 112 95 84 St. Andre's – – – – – – – – – – – – – – – – – – – – – – – – – – – – 32 13 10 – 12 5 1 – 4 – – – 33 3 1 – 2 – – – 83 21 12 – St. John's 25 16 25 15 – 4 – 4 – 2 – 1 10 1 8 1 – – – – 2 1 1 – – – – – – – – – – – – – – – – – – – – – – – – – 37 24 34 21 St. Joseph's 28 23 20 18 19 11 16 6 8 4 3 1 26 20 16 15 23 17 12 10 13 8 4 4 1 7 – – – – – – – – – – – – – – – – – – – – – – 118 90 71 54 St. Mark's 11 14 10 11 – 1 – – – 1 – 1 13 7 9 6 4 4 3 2 – 2 – – – – – – – – – – – – – – – – – – – – – – – – – – 28 29 22 20 Continued Overleaf 46  5 years and under 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years and over totals Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examinee Parents Present Number Examined Parents Present Number Examined Parents Present Number Examinee 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 St. Mary's R. C. 48 26 38 22 17 19 10 11 2 1 1 1 16 41 10 25 6 11 1 6 2 3 - - 38 24 12 3 18 16 4 2 - - - - 26 14 4 - 11 5 - - - - - - 184 160 80 70 St. Michael's 26 24 20 20 3 4 1 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 30 28 22 23 St. Peter's 15 26 13 23 16 4 10 - 1 1 1 - 2 1 1 1 4 2 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 38 34 27 25 Selhurst Grammar - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13 - 1 - 37 - 1 - 50 - 2 Shirley - - - - - - - - - - - - - - - - - - - - - - - - - - - - 37 34 2 3 23 40 2 4 2 2 1 - 16 16 - - 25 28 - 3 103 120 5 10 South Croydon - - - - - - - - - - - - - - - - - - - - - - - - - - - - 31 43 7 3 15 20 1 3 - - - - 2 32 - - 62 39 1 - 110 134 9 6 South Norwood 58 43 50 36 15 11 11 9 12 2 10 1 2 - 1 - 42 28 21 25 17 23 12 13 - 4 - - 2 - - - - - - - - - - - - - - - - - - - 148 111 105 84 Spring Park 37 35 29 29 18 13 14 1C - 2 - 2 33 38 23 28 3 2 3 1 - - - - 2 2 - 1 - - - - - - - - - - - - - - - - - - - - 93 92 69 7 Stanley Technical - - - - - - - - - - - - - - - - - - - - - - - - - - - - 38 - 3 - 24 - 5 - - - - - - - - - 40 - - - 102 - 8 - Sydenham 38 35 33 29 13 13 10 1C - 2 - 1 13 13 9 9 14 13 12 11 2 5 1 2 - 2 - 2 - - - - - - - - - - - - - - - - - - - - 80 83 65 64 Tavistock - - - - - - - - - - - - - - - - - - - - - - - - - 39 - 30 22 15 3 8 21 - 1 - - 43 - 6 76 33 6 9 - - - - 119 130 10 53 Waddon 36 46 31 28 4 8 3 7 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 42 54 36 35 West Thornton 10 12 8 10 7 13 7 11 - 1 - - 10 12 10 12 22 7 13 11 3 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - 52 45 40 44 Westwood - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 67 - 19 - 25 - 5 - - - - - 68 - 5 - 8 - 1 - 168 - 30 Whitehorse 46 53 40 40 30 12 22 10 6 - 4 - 40 43 24 36 28 6 17 5 1 3 1 1 - - - - - - - - - - - - - - - - - - - - - - - - 151 117 108 92 Winterbourne 75 59 51 58 5 9 3 6 - 2 - - - 62 - 51 65 35 52 16 25 5 15 4 - 6 - 5 - - - - - - - - - - - - - - - - - - - - 170 178 121 140 Wolsey 75 65 70 62 14 7 12 6 2 - 1 - 1 2 - 1 46 30 28 27 26 26 14 19 2 - 1 - 2 - 2 - - - - - - - - - - - - - - - - - 168 130 128 115 Woodside 70 68 65 60 11 12 5 6 5 3 2 2 - 5 - 3 35 53 22 41 3 27 2 21 13 6 9 3 - - - - - - - - - - - - - - - - - - - - 137 174 105 136 1583 1456 1339 1262 307 328 236 227 95 86 57 59 505 567 359 400 752 762 504 555 315 281 196 178 296 338 83 139 616 768 99 227 264 396 44 84 289 446 18 58 465 897 30 106 476 518 3 9 5963 6843 2968 3304 3039 2601 635 463 181 116 1072 759 1514 1059 596 374 634 222 1384 326 660 128 735 76 1362 136 994 12 12806 6272 PERCENTAGE OF PARENTS PRESENT Age 5 years and under Boys 84.6 85.6 Boys 49.8 All Groups 49.0 Girls 86.7 6 years Boys 76.9 72.9 Girls 69.2 7 years Boys 60.0 64.1 Girls 68.6 8 years Boys 71.1 70.8 Girls 70.5 9 years Boys 67.0 69.9 Girls 72.8 10 years Boys 62.2 62.8 Girls 63.3 11 years Boys 28.0 35.0 Girls 48.3 Girls 41.1 12 years Boys 16.1 23.6 Girls 29.6 13 years Boys 12.9 19.4 Girls 21.2 14 years Boys 6.2 10.3 Girls 13.0 15 years Boys 6. 5 10.0 Girls 11.8 16 years and over Boys 0.6 1.2 Girls 1.8