44132 CR066 PUBLIC HEALTH IN CROYDON 1964 PUBLIC HEALTH IN CROYDON 1964 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1964 S.L. WRIGHT. M.D., M.R.C.P.. D.P.H. PUBLIC HEALTH DEPARTMENT, 45 WELLESLEY ROAD, CROYDON. Telephone:- MUNcipal 4433 3 HEALTH COMMITTEE 1964 Councillor B.H. Rawling (Chairman) Councillor Mrs. E. M. Maycock' (Vice-Chairman) Alderman Mrs. V. L. Child Alderman A. V. Dammarell Councillor P. Byrne Councillor J.J. Cooper J.P. Councillor Keith Edwards (the Mayor) Councillor E.J. Fowler Councillor Mrs. D. L. George Councillor G. Levy Councillor M. E. Mackenzie 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. Edith P. Newling, B. A. (Hons.) M. B., B. S., M. R. C. S., L. R. C. P. T. G. E. White, Esq., M. D. M.R.C.O.G. Members appointed to Sub-Committees on nomination of Outside Bodies as shown:- J.P. Boyle, Esq. ,M.B., B. Chir., D. Obst., R. C. 0. G. G. Clementson Esq. ,M. B., B. S. J.S. Lane, Esq., B. A., M. R. C. S., L.R. C.P. Edith P. Newling, B. A. (Hons.), M.B..B. S..M.R. C.S..L.R. C.P. L. Williams, Esq., M.B., B. S. Croydon Local Medical Committee A.P. Clift, Esq. .F.R.C.S. .M.R.C.O.G. S.Y. Marsters, Esq. Croydon Group Hospital Management Committee Mrs. E.M. Ryle Horwood Royal College of Nursing Mrs. p.R. Mitchell, 0.B.E. Royal College of Miduives Mrs. M. Roberts Croydon District Nursing Association Mrs. G.C. Browning Croydon Family Planning Association Mrs. J. Toogood Croydon Federation of Towswomen's Guilds J.S. Horner, Esq., M. B., Ch. B., The St. John Ambulance D.P.H., D. I.H., (Eng.). Brigade (Southern Area) H.G. Murphy, Esq. The Insurance Institute of Croydon Councillor J. A. Keeling served as a Member of the Home Safety Sub-Committee 5 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1964 To the Chairman and Members of the Health Committee LADIES AND GENTLEMEN I have the honour to present the last Annual Report on the health of the people of the County Borough of Croydon and the relevant services of the County Borough of Croydon, for the year ending December 31st 1964. Statistics These show levels of general good health which my predecessor in 1889, presenting his first report to the County Borough Council would have forecast with diffidence. The Registrar General estimated a decrease in the population and there were fever births than in 1963. This fall in the birth rate may be related to a change in the trend to marriage at earlier ages, The percentage of couples under 21 years of age who were married to 1964 was below the record high figure of the preceding year, The infant mortality and the general death rates equalled the lowest rates yet recorded. There was not a single death due to Pregnancy or childbirth. The increase in the percentage of illegitimate babies continued, but infant mortality in this group was fractionally less than that for all babies. Deaths from suicide were fewer than the record high number in 1963. The number of deaths from cancer, amongst those under 65 years of was lower than in previous years. In 1889 the major public health problems were infectious diseases and infant mortality. 6 In 1964 it was the degenerative diseases, especially of the heart and blood vessels, and cancer, which demanded attention, Unfortunately the advice which could be given was mainly for self application by individuals and imposed austerity, or frugality, or at least moderation in the enjoyment of pleasurable habits. The cynical could repeat, with truth, that if the advice failed to prolong life, it would certainly make it seem longer. Communicable Disease Including tuberculosis deaths from this cause were less than 1% of total deaths. There was no case of poliomyelitis, typhoid or para typhoid, notified throughout the year. Personal Health Services Throughout the year there was constant concern over recruitment of staff. Despite the policy of the Corporation to train locally, or to second staff for training courses elsewhere, it was never possible to fill all vacancies for health visitors and social workers, midwives and administrators in home nursing. These shortages were part of a general staffing problem, and were met by re-casting duties, using other grades of personnel and sometimes leaving tasks unattempted. The fall in the birth rate eased the burden on midwives and a rise in the numbers discharged early from hospital units for care at home was met by employing part-time midwives. Health visitors faced again old problems in a new guise in those parts of the Borough housing recent immigrants. One health visitor particularly involved became the department's representative on a local liaison committee. In October the Corporation assumed direct control of the Home Nursing Service in anticipation of local government changes. The Health Education Officers maintained existing programmes, and were especially concerned with increasing the numbers covered by their courses for school children, by seeking help from all teaching staffs. The Mental Health Service surmounted the resignation from Warlingham Park Hospital of Dr. MacKeith, who had been concerned with its initial planning and establishment. The steady development of facilities for care and after care of the mentally disordered proceeded, with the commencement of building of a new Adult Training Centre, the opening of the first group unit and acceptance for loan sanction of a purpose built mental health centre. 7 The Chief Ambulance Officer presents his last annual report of a year of increased demands. The Croydon Ambulance Service was a relatively small organisation, but this had compensatory advantages. It allowed for rank and file identity with a recognised locality and direct approach to management. At a time when staff shortages affect these grades, smaller units can often achieve good staff relationships more easily than large complex systems. Chiropody services provided by private chiropodists in their own surgeries were further developed. In the loan of home nursing equipment incontinence pads were introduced as a free issue to necessitous patients and at cost price to others. Disposal of such items after use where home conditions were unsuitable was carried out by the disinfecting service, using the incinerators at local hospitals. Clean Air Despite national policy changes, steady progress in the agreed campaign to cover the whole borough with smoke control orders was maintained. This slow and perhaps unnoticed revolution in domestic heating methods was still the major contribution of present day applied sanitary science, to the promotion of good health. As always costs have been exceeding original estimates but the good effects of clean air have been reflected in lower infant mortality rates and increased longevity. It represents capital investment equalled only in returns in good health by past schemes for pure water, sewage disposal and good housing. Housing An increase of 455 inhabited houses since 1963 was recorded but unfortunately produced no effect on the demands for priority for re-housing on medical grounds. Furthermore requests for transfer from one Corporation unit to another became so numerous that medical support became necessary before they could be considered. Much time was given to enquiries about the relative merits of these claims, of which the majority were rejected because so few units were available. This necessity of disappointing over 90% was, as always, a painful and onerous duty. 8 Co-ordination This was the last year in which the Hospital Management Committee, the Executive Council and the Local Health Authority served approximately the same population and impending changes threatened the close relationships which had been developed, There was happily a carry over of good will and a pattern of mutual assistance to help in solving future problems. My thanks are due to the Chairman, Vice-Chairman and members of the Committee for encouragement and support in a very difficult year of impending changes. I am, Yours faithfully, S.L. WRIGHT Medical Officer of Health and Principal School Medical Officer STATISTICS 11 SUMMARY OF STATISTICS FOR 1964 Area, 12,672 acres. Population (Census 1961), 252,501 Total population (estimate of Registrar-General), 253,430 (Midsummer, 1964) Number of Inhabited Houses: 77,202 Rateable Value of Borough 1964, £14,310,733 Product of a Penny Rate, £59,601 Rate in the £. 8s. 6d. (for the year ending 31.12.64) Live Births: Males Females Total Legitimate 2,166 2,089 4,255 Illegitimate 234 235 469 4,724 Illegitimate Live Births per cent, of total births 9.9 Live Birth Rate (as adjusted by comparability factor 1.00) 18.6 (England and Wales) 18. 4 Stillbirths 58 Stillbirth rate per 1,000 total (live and still) births 12.1 (England and Wales) 16.3 Total Births 4,782 Infant Deaths 72 Infant Mortality rate per 1,000 live births 15.2 (England and Wales) 20.0 Infant Mortality rate per 1,000 legitimate births 15.3 Infant Mortality rate per 1,000 illegitimate births 15.0 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 11.6 (England and Wales) 13.8 Early Neo-natal Mortality rate (First week) per 1,000 total live births 11.0 Perinatal Mortality rate (stillbirths + deaths during the first week) per 1,000 total live and still births 23.0 Maternal Deaths (excluding abortion) nil Maternal Mortality rate (including abortion) per 1,000 total live and still births nil (England and Wales) 0. 25 Deaths, 2,871 Death-rate per 1,000 of the estimated population 11.3 (England and Wales) 11.3 Death rate (as adjusted by comparability factor 0.94) 10.6 12 Marriages When supplying these figures Mr. Stevens, the Croydon Superintendent Registrar, kindly analysed recent trends and commented "Of the total number of persons giving me notice of intention to marry at either Church or Register Office in the year 1954, 13.8% were under the age of 21 years rising in 1963 to 23.05% and falling slightly to 21.37% in 1964. The number of marriages solemnised was 2,040, compared with 2.075 in 1963, 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 and 1,882 in 1954. 836 were solemnised in Established Churches, 446 in other places of worship, none by Jewish Ritual and 758 in the Register Office. Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,746 32 3,778 Doctors 1,271 23 1,294 5,017 ~55 5,072 Accommodation for Confinements The following table shows where babies were born in Croydon during 1964. 25 fewer were born at home and 182 more were born in hospital than in 1963. 19 fewer residents had babies outside Croydon and 24 more non-residents were confined in Croydon than in 1963. Number ntage In Privete Houses 1,274 25.11 In Public Institutions 3,582 70.63 In Registered Maternity Homes 216 4.25 Total 5,072 COMMUNICABLE DISEASES 15 COMMUNICABLE DISEASES Measles was the most prevalent infection notified in 1964, thus repeating the pattern of all recent years. There was no fatality amongst nearly 1,500 cases. The last recorded death of a child from measles in Croydon was in 1957. Since that year nearly 15,000 cases have been notified. It is difficult to decide how much emphasis should be placed on active immunisation against this illness. Trials of vaccine were introduced in selected areas of the country and the results, on which a decision may be made, are awaited. 1964 was another year completely free from cases of poliomyelitis and diphtheria. No case was notified of typhoid or para typhoid fever. There was a small rise in notified cases of food poisoning, but no significant outbreak. 16 FOOD POISONING The food poisoning notifications, as corrected, for 1964 were:- lSt Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 17 25 16 7 65 Outbreaks due to identified agents:- Total Outbreaks Total Cases Nil Nil Outbreaks due to:- (a) Chemical poisons Nil (d) botulinum Nil (b) Salmonella Organisms Nil (e) welchii Nil (c) Staphylococci (including toxin) 1 (f) Other Bacteria Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases Nil Nil Single Cases:- Agent identified Unknown Cause Total 16 50 66 Cases due to: - Salm. brandenberg Salm. typhi-murium Salm. enteritidis 3 7 2 Staphylococci Salm. Untypable 3 1 Salmonella Infections not food-borne:- Nil 17 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1964 J.J. Linehan, Esq., M. D., D. P.H. Physician Superintendent, Waddon Hospital A total of 473 patients were admitted to the infectious diseases' wards giving an average occupancy of 24.55 beds and an average stay in hospital of 19.4 days. The following are the final diagnoses of patients admitted together with brief details of the common infectious diseases treated. Where patients were admitted from outside the Borough of Croydon, the Croydon cases-are shown separately in brackets. Gastro-enteritls 102 (85) Measles 43 (42) Whooping Cough 36 Dysentery 34 (21) Scarlet Fever 30 (28) Chicken-pox 18 Humps 18 (14) Infective Hepatitis 17 Pneumonia 15 (14) Glandular Fever 14 (10) Meningitis 9 (7) Salmonella Enteritis 8 Salmonella Contacts 4 Erysipelas 3 (2) Encephalitis 2 Paratyphoid B 2(1) Typhoid Carriers 2 Herpes Zoster 2 Influenza 2 Rubella 2 Streptococcal Sore Throat 1 Measles Contact 1 Tuberculous Adenitis 1 looping Cough Contact l Herpes Simplex 1 Staphylococcal Endocarditis l Staphylococcal Infection of Face 1 Rheumatic Fever 1 Bronchitis 23 (19) Tonsillitis 13 (11) Quinsy 7 (5) Pharyngitis 5 Stomatitis 4 (3) Laryngitis Stridulosa 2 Otitis Media 2 Laryngo-tracheo-bronchitis 1 Sinusitis 1 Rhinitis 1 Status Asthmaticus 1 Tracheitis 1 Carcinoma of Bronchus 1 Appendicitis 2 Carcinoma of Pancreas 2 Gall Stones 1 Jaundice 1 Carcinoma of Stomach 1 Abscess 4 Lymphadenitis 2 (1) Cellulitis 1 Osteo-myelitis 1 Salpingitis 1 Varicose Dicers 1 Impetigo 4 Urticaria 2 Papular Urticaria 2 Allergic Rash 2 Scabies 1 Purpura 1 Infective Polyneuritis 1 Puerperal Sepsis 1 Heart Disease 2 (1) Arterio-sclerosis 1 Coronory Thrombosis 1 Drug Toxaemia 1 P.D.O. 2 Non-patient Baby 1 For details of cases see Appendix Page 125. 18 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 1964 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1964 was 11 which shows a decrease of 10 when compared with 1963, The General Practitioner Miniature X-Ray Service continues to function in a satisfactory way and is well used by the Local practitioners. The results of this service are summarised below:- Number of miniature films taken 4,588 Number of patients recalled for examination and large film 691 Number of active cases of Pulmonary tuberculosis 16 Number of cases of lung cancer found 37 Incidence 90 cases of Respiratory Tuberculosis and 10 cases of NonRespiratory Tuberculosis were notified on Form A during 1964 (Table I - Formal Notifications). Of these 64 males and 26 females were Respiratory cases and 6 males and 4 females were Non-Respiratory. In addition 44 Respiratory cases and 6 NonRespiratory cases came to our notice as new cases otherwise than by notification. (Table II - Supplemental Return). The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1964 by notification or otherwise was 150 as compared with 187 in 1963, 200 in 1962, 286 in 1961 and 218 in 1960. 134 of these were cases of Respiratory Tuberculosis; 91 in males and 43 in females. There were 15 fewer males and 29 fewer females than 1963. There were 3 cases of Non-Respiratory Tuberculosis among children under 15 years. The number of cases in adults was 13 compared with 8 in 1963. Of the cases notified in 1964, there were no deaths from the Respiratory form of the disease during the year. The incidence rate of Tuberculosis of all forms was 0.58 per 1,000 of the population; for Respiratory Tuberculosis 0.52 and for Non-Respiratory 0.06 per 1,000 population. The notification rate was 0.39 per 1, 000. In 1963 the corresponding figures were 0.74, 0.70, 0.04 and 0.48 per 1,000. 19 Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1964:- RESPIRATORY NON-RESPIRATORY Males Females Total Males Females Total Total Cases 876 645 1, 521 55 75 130 1,651 20 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1964, 84 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) 53 or 63.1 B, or T. B. Plus, 1 (early cases, sputum positive) 10 or 11.9 B. or T. B. Plus, 2 (intermediate cases, sputum positive) 20 or 23.8 B, or T. B. Plus, 3 (advanced cases, sputum positive) 1 or 1.2 84 100.0% Non-Respiratory Tuberculosis There were 7 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints 1 Abdominal - Other Organs 2 Peripheral Glands 4 7 Ages at Death from Respiratory Tuberculosis Year 0-5 5-15 15-25 25-45 45-65 over 65 TOTAL 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 1964 - - - 1 4 5 10 21 All but 5 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 1964 the death-rate from all forms of Tuberculosis was 0.03 per 1,000 population. The rate from Respiratory Tuberculosis was 0.03 and the rate for Non-Respiratory Tuberculosis 0. 00. Similar figures for 1963 sere 0.08 and 0.00. In 1964 the total number of deaths showed a decrease of 10 when compared with 1963. 90% of the deaths occurred in the age groups 45 years and over. There were no deaths in children of school age. Deaths from Non-Respiratory Tuberculosis During 1964 one death was certified to be due to Non-Respiratory Tuberculosis, compared with Nil in 1963, 2 in 1962, Nil in 1961 and 2 in 1960. Co-ordination with the Health Department During the year 21 children were referred by the School Medical Service; and 5 cases from the Maternity and Child Welfare Section of the Public Health Department. Extra Nourishment Provision of special nourishment in the form of milk was granted to 29 selected cases for varying periods during the year and 21 cases were in receipt of extra nourishment at the end of the year. Residential Treatment 68 men and 41 women were admitted to Residential Institutions in Croydon during 1964, suffering from tuberculosis. 22 The Chest Clinic and Home Visiting 2,005 new cases were examined during the year. 91 were found to, be definitely tuberculous.. The total number of attendances for examination at the Chest Clinic was 17,344. The Clinic doctors paid 213 home visits and the Tuberculosis Visitors 1,927 visits for Clinic purposes. In addition the Tuberculosis Visitors made 167 primary visits for the purposes of the Notification Register. There were also 1,134 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 1964, 484 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, 6 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 12 compared with 0.58 per 1,000 of the general population. In addition, there were 4 found to be tuberculous who had been under observation from previous years. The number of new contacts examined, together with the numbers of new cases of Tuberculosis notified in previous years are as follows:- 1963 - New contacts examined 651 New cases of Tuberculosis 121 1962 - „ „ „ 717 „ „ „ „ 116 1961 - „ „ „ 742 „ „ „ „ 190 1960 - „ „ „ 676 „ „ „ „ 139 1959 - „ „ „ 775 „ „ „ „ 148 23 B.C.G. Vaccination The use of B. C. G. vaccination for contacts has been continued during 1964 and regular sessions are held at the Clinic for this purpose. 260 contacts were successfully vaccinated during the year, compared with 313 in 1963. In addition 7 nurses and domestics were successfully vaccinated, and 58 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. BC.G. Vaccination for School Leavers The total number of children skin tested 2,560 Number found to be negative 2,175 Number vaccinated with B. C.G 2,173 Rehousing of Tuberculosis Patients 3 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 320 examinations were carried out in 1964. For detailed figures see Appendices, page 134 24 MASS RADIOGRAPHY 1964 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 Examinded Significant Pulmonary Tuberculosis Primary Carcinoma of Lung Male 11.108 12 10 Female 8. 194 3 3 Total 19,302 15 13 New Addington General Practitioner Chest X-Ray Service No. of Persons Examined Significant Pulmonary Tuberculosis Primary Carcinoma of Lang Male 289 4 3 Female 28 2 3 - Total 571 7 3 25 AFTER-CARE OF THE TUBERCULOUS PATIENT In 1964, as in previous years, after-care has been given to newly notified tuberculous patients, and this after-care may continue for a very long period. Home visits can establish good personal contact with the patient and his family, and visits to the Clinic for medical check-ups provide an opportunity for the patient to discuss any social problems. The financial position is a great source of worry to any patient who is the breadwinner of the family and who is not entitled to his salary or wages whilst off sick. The patient is advised about National Insurance and National Assistance, as a person suffering from pulmonary tuberculosis who has given up his employment to undergo treatment, he is entitled to a special rate of National Assistance. The pensioner suffering from tuberculosis will probably receive an extra nourishment grant from the Assistance Board in addition to his normal grant, and a certain number of chronic cases are allowed a pint of milk daily, free of charge, through the Council's Milk Scheme for tuberculous patients. Heating is a heavy item of expenditure for the sick person at home all day. During the past year or two, many patients have changed from solid fuel to gas or electricity. Some of these patients have found it difficult to learn to budget for the quarterly accounts and have required help and encouragement. Despite statutory grants, voluntary assistance is still needed. The Care Committee has again given invaluable help with holidays, fares for relatives to visit patients in Hospital, clothing, fuel and other needs. At Christmas £110 was distributed amongst patients for fuel, and grocery vouchers were given away to the value of £60. 1964 has been a good year for employment. Some patients have been recommended for a rehabilitation course before returning to work, and arrangements for this have been made by the Disablement Resettlement Officer. It has been very helpful to have a close liaison with the Ministry of Labour Disabled Section. Tuberculous patients need practical help and support, and after-care has continued throughout 1964. 26 OCCUPATIONAL THERAPY The turnover of patients in the Occupational Therapy Department of the Chest Clinic was rather greater than usual in 1964. There were more short-term patients who were anxious to be kept busy while they were at home before returning to work. It was possible to fit in these extra people mainly because a number of the long-term patients were admitted to hospital from time to time, and in some cases died. The Occupational Therapy Department has had a good year from the productivity point of view, and most of the patients have been keen to break away from the usual standard crafts. The present trend of 'Gonk-like' creatures has been most useful, and the patients have enjoyed being creative in making up their own versions. Once again, the Sales Showcase and the Annual Sale have been a great success, and with very few exceptions, the articles made by patients were all sold before Christmas. 27 VENEREAL DISEASES In 1963 the numbers of cases of syphilis and gonorrhoea diminished. In 1964 the numbers of persons attending the Croydon special clinic and resident in the Borough showed a 10% rise in new cases of gonorrhoea and 65% rise in new cases of syphilis. these percentages are based on relatively few cases e.g. the 65% rise in new syphilis patients was due to 9 more on a previous year's total of 14. It is nevertheless an adverse trend, and while there can be little ignorance about how these infections are acquired, our health education programmes do stress avoidance and the importance of prompt and effective treatment. The venereal diseases are included in general health lectures with other communicable diseases, which individuals can by their own actions prevent. 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. W.R.G. Thomas, Consultant Bacteriologist, Mayday Hospital, who took over this work on 10th February 1965, for his ready assistance and most helpful advice, which have been available at all times. For detailed figures, see Appendix page 127. PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 31 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics 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 nas met very infrequently as lost 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 remained the record high figure of 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 was no question of deliberate use of the Emergency Bed Service. At ante-natal clinics a total of 4,714 mothers attended during the year. 1,688 mothers attended the post-natal clinic. At relaxation classes 963 mothers made 5,961 attendances. 332 mothers attended Mothercraft courses each consisting of 7 lectures. Care of Premature Babies There were 9 more premature babies born than in 1963, and 5 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 back should a reading of less than 60% be found at the Clinic. For detailed figures see Appendix, page 103 32 Care of the Unmarried Mother. The Croydon Association for Moral Welfare continued to act for the Corporation and received payment on a capitation basis for cases dealt with by their Social Workers. The Corporation also paid hostel fees in respect of approved cases for whom such accommodation was required. During the year under review:- 288 cases were dealt with by the Social Workers 54 cases were admitted to Mother and Baby Homes (This includes mothers who applied for help in 1963 whose babies were born in 1964, and those who applied in 1964 whose babies were not due until 1965) There were 4 miscarriages, 2 of which were in the 18-year- old group. (2 who applied as maternity cases were later found not to be pregnant) The Committee agreed to meet financial responsibility for the stay of unmarried mothers in Mother and Baby Homes for a period of three months. Of the younger mothers their ages when they applied for help were:- 1964 1963 1962 1961 1960 13 years old — 1 — — 1 14 „ „ 1 1 5 6 1 15 „ „ 6 11 15 15 4 16 „ „ 6 13 7 17 7 17 „ „ 3 14 10 18 3 18 „ „ 16 18 8 19 4 Total 32 58 45 75 20 During 1964, of these girls 25 went to Mother and Baby Homes, 15 being financially assisted by the Local Authority. The ages of the younger mothers when their babies were born were:- 1964 1963 1962 1962 1960 14 years old — 1 4 2 — 15 „ „ 3 8 14 10 7 16„ „ 4 13 9 11 6 17„ „ 4 16 10 9 8 18 „ „ 10 16 8 8 5 19„ „ 3 3 — — — Total 24 57 45 40 26 33 Domiciliary Midwifery The number of home confinements during the year under review was less than in 1963. 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 third year running there was not a single death in childbirth in Croydon indicates the value of this policy. It did result in 1.173 mothers booked for hospital confinement being referred for subsequent domiciliary care. A small rise on the figure for 1963. The recruitment of midwives to fill vacancies remained difficult, and it was not possible at all times to maintain the permitted establishment. For detailed figures see Appendices, pages 99 - 102 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 91. 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 considerable rise in the number of attendances. Toddler clinics and Health Education facilities were steadily augmented during the year. Stress was laid upon the diagnosis of remediable defects at as early an age as possible. For other detailed figures see Appendix, page 105 34 Congenital Malformation In 1963 the Ministry of Health suggested a voluntary scheme for "notification of congenital abnormalities apparent at birth, by family doctors, hospital medical and nursing staff, and domiciliary midwives. This was introduced in Croydon in February of that year, and over 30 infants were notified to the department in the following months. A more formal scheme covering the shole country was introduced by the Ministry of Health in November 1963, and returns were made to the General Register Office on a standard form. This continued throughout 1964, using information added to notifications of births and stillbirths. The purpose of these arrangements is to ensure more understanding of the incidence, distribution, and occurrence of congenital abnormalities, and to add a further safeguard to prevent repetition of the Thalidomide episode. Welfare Poods It was always policy in Croydon to sell at Infant Welfare Centres, only National Dried Milk and vitamin preparations. The final distribution was performed almost entirely by voluntary workers. In addition a central office, staffed by members of the Women's Voluntary Services, was open for five and a half days each week. The issues have altered over the years, following price variations and the availability of branded goods. A table (see Appendix page 111) does show however, the diminishing uptake of cod liver oil. Although a more elegant preparation than formerly, parents tend to prefer concentrated alternatives, perhaps of less nutritional value, but without such obvious fish oil smell. The Ministry might consider either an authorititive statement confirming the vitamin superiority of natural cod liver oil, or its replacement by a concentrate more acceptable to parents. Issues of Welfare Poods in 1964:- National Dried Milk 59,185 tins Cod Liver Oil 5,224 bottles Vitamin A and D Tablets 8,333 packets Orange juice 73,272 bottles 35 THE WORK OF THE HEALTH VISITOR Miss L.E. Oakley, S.R.N., S.C.M., H.V. Cert Superintendent Health Visitor. 1964 has been a year in which the Health Visitor's work has gone Quietly on. A much depleted staff over the greater part of the year has meant a great effort on the part of all to carry out the essential duties. The high birth-rate and the numbers of new families coming into the district has made the greatest demand on the Health Visitor's time, but at these visits she has the best opportunity of putting over health education. The work in the Infant Welfare Centres and Toddler Clubs goes on, and there have been some interesting discussions on health topics in the Mothers' and Parents' Groups. The problem of the working mother as opposed to that of the mother who is the sole bread-winner for her family, is an increasing one causing concern to the Health Visitor who finds herself in conflict with the national policy on the employment of married women. This is not made easier by her knowledge that staff shortages in her own profession are made worse by early marriages, followed by the birth of children Perhaps 1964 might be said to be one of consolidation before the changes coming in 1965. Figures of work carried out are shown in Appendix, page 104. 36 IMMUNISATION In 1963 a new schedule was introduced, following fresh advice from the Ministry of Health. The timing of procedures was: 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. I commented last year about variations confusing parents and one reason for choosing the above sequence was the similarity to that previously used. It is an unfortunate fact that the strongest incentive to parents to present children for protection is the reporting of fatal cases of the disease. The success of immunisation creates the major obstacle to persuading new parents of its value. Much credit is due to Health Visitors and Health Education Officers and the staff of the immunisation section, in improving considerably in 1964 the uptake of all forms of immunisation. A joint advertising campaign was arranged in September to cover the Greater London area. Tables are given in Appendix Page 128 . HOME NURSING Since 1948 the Croydon District Nursing Association carried out this service in Croydon as agent of the Corporation, subject to general supervision by the Medical Officer of Health. To meet possible staffing difficulties due to pending changes in local Government, the Corporation assumed direct control on October 1st 1964. The Association with the Queen's Institute for District Nursing was maintained and probably no patients were aware of any changes having occurred. For detailed statistics see Appendix Page 106 . 37 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 42 cases were so dealt with, 25 women. 14 men and 3 children under 5 years. There were in addition, 5 cases where the patients cancelled their applications after the arrangements had been made. These figures do not include school children for whom arrangements are made by the Education Committee. HOME HELP SERVICE This remained unchanged in scope and character, but for the first time experienced difficulties in recruiting staff. Plans were prepared for a scheme of formal in-service training. As a first step the semi-basement of the clinic premises 47 St. James's Road a large 19th century house - was adapted to simulate conditions the Home Helps are likely to meet. The introduction of the scheme now awaits the appointment of a training supervisor. The usual details of work carried out during the year are set out in the Appendix, page 110. 38 HEALTH EDUCATION AND HOME SAFETY Miss D.S. Elliott, S.R.N., H.V. Cert., Dip. H.E. Health Education Officer All established activities continued during the year. Every opportunity was taken to expand them and to make the health education service better known to those with professional interests in health education and to the general public. In-Service Training During the year mixed discussion groups involving public health, hospital and welfare services staffs were enjoyable and important occasions and were of considerable help in promoting co-operation and interest. Repeat sessions led by guest speakers covered the following subj ects:- Youth Services. "Growing Old" - Health and Retirement. Dental Health Education. Psvchoprophylactic Preparation for Childbirth. Modern Paediatrics - with special emphasis on Infant Feeding. Three courses in Elementary First Aid were organised for members of the Croydon Fire Brigade and a twelve week course in Advanced First Aid for members of the Croydon Ambulance Service. Food Hygiene A course in Food Hygiene followed by an examination was given to the staff of a large local bakery and other food hygiene talks to the catering staff of the Fairfield Halls and the Kitchen Staffs of all Croydon Schools. Members of the Health Department staff also lectured during the certificated course in food hygiene held at Croydon Technical College. The Training of Students and Those on Post-Graduate Courses The success of the Health Services in the future will depend on the quality of training given to all types of health service students now. An increasing amount of time was spent in organising practical work for students and visitors to the department; this was made possible by the co-operation of the staff of all sections who undertook the extra work involved in spite of heavy commitments. 39 Members of the staff also lectured regularly to courses in training establishments of all kinds both in Croydon and London. Home Safety Lectures and demonstrations in clinics, schools and other organisations continued steadily. The work by Croydon Fire Prevention Officers in giving over forty talks in clinics was greatly appreciated and also considered by them to be useful. A Home Safety Exhibition was arranged at Croydon Central Fire Station on the occasion of a St. John Ambulance Association First Aid Competition. A Croydon Ambulance Service Officer gave many demonstrations on "Mouth to Mouth Resuscitation", during afternoon and evening health education sessions run by the health visitors. Because of the increase in the number of children under five years of age taken to hospital following accidental poisoning, greater emphasis was given to warning about poisoning hazards and these formed the theme for the Home Safety Stand at the Ashburton Flower Show. Smoking and Health Venereal Diseases See School Health Section Pages 6 and 7. 40 DENTAL TREATMENT (MATERNITY AND CHILD WELFARE) P.G. Oliver Esq., L.D.S., Chief Dental Officer Expectant and nursing mothers are referred for this purpose by Doctors and Consultants at Ante- and Post-Natal Clinics; reference for such patients can also be arranged through their own medical advisors. 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. As in the case of the School Dental Service, extended dental provision within the National Health Service has also led to a progressive change in the role of those Local Authority Services catering primarily for the expectant and nursing mother. The ensuing benefits, though not at first apparent to all, are now specially noticeable at the local level. Improved social environment has during recent years produced a fuller awareness of the value of regular dental supervision in its relationship to personal health, and where adequate "outside" facilities exist this has in turn led to a more extensive use of the General Practitioner Service; as a direct result of this enlightened attitude there has been a corresponding falling off in demand for attention, devoted mainly to the period of pregnancy. Remarking on this trend in his latest Report the Chief Medical Officer to the Ministry of Health underlines this change and states that "It is more satisfactory that women should be under the regular care of their own dentist than that they should seek priority treatment periodically." Largely as a result of this reduced patronage staff at local clinics have been relieved of much of the "tedium" of former years and are now better placed to meet the needs of those prospective mothers newly arrived in the district, who for one reason or another are unable to secure the priority which their condition demands; in the case of those approaching their confinement this is of particular importance. Because of improved working conditions a far fuller range of treatment is now possible for the individual patient and more time can be devoted to the therapeutic and preventive side of the work, for which this Service was originally designed. 41 With this aspect in mind the existing "procedure" initiated from the medical side, for the offer of a "routine dental check" to all patients in attendance at Ante- and Post-Natal Clinics, has assumed a greater importance, not only in emphasizing this particular need, but in the possible disclosure of early defects in those less prudent with their dental care which, if left ontreated, could result in unnecessary suffering at a later stage of pregnancy. In the absence of active clinical requirements, contact with the prospective parent at this particular time can provide a welcome opportunity for guidance relating to those essential measures to secure a sound and functional dentition for the unborn child. Because of decreasing commitments for adult patients more time is becoming available for meeting the requirements of children under school age, and special efforts are now being made to expand this branch of the Service. During the past year there has been an increase in the number of visits by Dental Staff to Welfare Centres and Toddler Sessions, and a further rise is shown in attendances for treatment by the younger child. Whilst recent observation of those seen would seem to indicate a general improvement in the oral condition, coverage for such children is at present very incomplete and it would be unwise, therefore, to draw any final conclusions at this point. Unfortunately, certain post war developments such as the increase in employment for the younger mothers, has tended to limit contact with many in the 3-5 age group, whilst the progressive closure of Day Nurseries has further reduced routine supervision for these children. Restrictions of this kind continue to pose some difficult administrative problems for which there is as yet no clear solution. For the present the answer would appear to lie in increased publicity at Toddler Sessions and Parents' Clubs, and the establishment of closer links with outside Women's organisations. The existing policy of including a Dental Unit in newly designed Health and Welfare Centres should provide an opportunity for fuller integration of existing Services, which should in turn favour earlier attention for the pre-school child. Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 194, compared with 238 in 1963; 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 the bulk of these patients have usually visited pre-natal clinics, few cases are normally referred from the Municipal Midwives' Service. 42 The percentage of those desiring the initial inspection who failed their appointments tends to show variations, and now stands at 23 per cent., compared with 31 per cent. in 1963. Expectant mothers examined for the first time numbered 121 against 166 last year. Of these 75.2 per cent. were seen during the first six months of pregnancy. Those attending at later stages of their confinements included some who had but recently arrived in the Borough and 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. 18 nursing mothers were examined or re-treated during the current year, compared with 22 in 1963. Treatment Including those continuing treatment from the previous year, 171 mothers were dealt with, against 223 in 1963. 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 As mentioned earlier in this Report current observation of these children would appear to indicate an improvement in oral conditions compared with pre-war years, but until better coverage can be obtained it would be folly to be too dogmatic. A point of interest, generally agreed by those carrying out routine school inspections for "beginners" is that whilst most children arrive with better teeth, some deterioration is noticeable after the age of about 7 years, possibly due to an increased consumption of sugar and other fermentable substances. The usual tables are given in the Appendix, page 112. 43 AMBULANCE SERVICE A. L. Hill, M.B.E.. Chief Ambulance Officer During the year the Service was called upon to deal with 136,76 3 patients which necessitated 57,528 journeys and a mileage of 490,886. Compared with 1963 these figures show an increase of 6,372 patients (5%), 44,720 miles (10%), and 3,108 journeys (6%). There were 18,711 patients conveyed to places outside the Borough and on these journeys 167,301 miles were travelled, which shows an increase of 1,704 patients and 20,160 miles. The number of patients admitted to Hospitals and Nursing Homes was 9,727 compared with 9,906 the previous year. A total of 1,142 days sickness was recorded compared with 952 days during 1963. Twelve Driver-attendants resigned and replacements were employed and trained, a further four men were engaged owing to the increase in work. A First Aid Training Course was held at Headquarter Station and the thirty men who entered the examination passed. I would like to express my thanks to Dr. Horner, Deputy Medical Officer of Health, together with his colleagues who assisted him, for their tuition and demonstrations to my personnel. Lectures and demonstrations were given by my Officers to various organizations in the Borough, mainly on mouth-to-mouth resuscitation. A Major Incident Exercise was held, with permission from British Railways, in the tunnel adjacent to Coombe Road Railway Station on Sunday, 13th December. This proved successful, with Civil Defence, Police, Fire Brigade, and Hospitals working in conjunction with the Ambulance Service to clear "casualties" supplied by the Casualty Unit. A conference was held following this exercise from which considerable experience was gained. For details of work carried out see Appendix Page 118. 44 CIVIL DEFENCE (Ambulance Section) The number of Volunteers receiving Civil Defence Training is now 114, an increase of 6 from the previous year. In February nine members entered for and passed the Standard Test. On Monday 9th March an Advanced First Aid Course commenced at Mayday Hospital and lasted for eight weeks. The examination took place on Monday and Tuesday 15-16 June, 32 members were successful. Two week-end exercises were held, one at Aldershot on the 11-12 July, and the other at Thetford, Norfolk on the 26-27 September. The full First Aid Course commenced on Thursday 22nd October and the examination was held on Thursday 17th December, 28 members entered the examination and 27 members passed The Hospital Service Reserve Finals were held at the Fairfield Halls on Saturday 28th November, and 12 of the Volunteers assisted. 45 MENTAL HEALTH SERVICES The expansion and consolidation of the work of the Mental Health Services which was achieved in 1963 has served as a base from which further developments have been possible in 1964. These advances have again extended to many varied aspects of the service including social work, industrial work, residential care and social clubs. Administration The Medical Officer of Health is in 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, Dr.A.R.May, Consultant Psychiatrist at Warlingham Park Hospital was appointed in succession to Dr.S.A. MacKeith, as Psychiatric Adviser to the Local Health Authority and as Medical Director of their Community Mental Health Services. Dr. B. W. Richards, Consultant Psychiatrist at St.Lawrence's Hospital has continued as adviser in mental subnormality to the Local Health Authority. The successful operation of the Mental Health Services depends on the help and co-operation of medical colleagues, whether in hospitals or in general practice, and I should like again to record my thanks to all of them for their continued willing support. Voluntary Associations Twelve 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. Valuable help has also been given by the Croydon Guild of Social Service, and from other voluntary bodies and individuals to all of whom appreciation and thanks are due for their ready assistance. 46 Mental Health Act 1959 In addition to their social work for patients and their families, the Mental Welfare Officers are concerned with the statutory admission of patients to hospital where necessary. Happily it can be said that the recent slow but steady decline in the number of cases where statutory admissions become necessary has continued during the year. necessary has continued during the year. Details of admissions of all categories of patient under different sections of the Mental Health Act are given below:- 1964 1963 M. F. Total Total Informally 51 66 117 129 Under Section 25 (for observation) 9 17 26 42 Under Section 26 (for treatment) 11 19 30 49 Under Section 29 (for observation in emergency) 79 108 187 195 Under Section 136 (Police action) 3 2 5 5 Under Section 60 (Hospital Order through Court) 3 _ 3 5 Investigated but not admitted 8 10 18 31 164 222 386 456 Admissions of mentally subnormal patients to hospital for the year with comparative figures for 1963 are shown below:- 1964 1963 To psychiatric hospitals - subnormality 24 24 To psychiatric hospitals - mental illness - - Transferred from one hospital to another 9 3 Admitted for short-term case 27 19 Total number of patients in hospital 395 384 On 31st December 1964 eight patients were awaiting hospital beds. Guardianship Five patients were placed under the guardianship of the Local Authority and six were discharged from guardianship (two being admitted to hospital) bringing the total to twenty two. Training Centres (i) Junior Training Centre Some difficulties were encountered during the year when part of one wing of the Centre was demolished to make way for a new purpose built adult training centre. Temporary re-organisations have been effected and meanwhile plans are being prepared for a new junior training centre. 47 Children are transported to the centre by special coach. A second special care group will open at the centre early in 1965. Number on register January 1964 61 Number on register December 1964 58 Number of new entrants 11 Number transferred to Adult Training Centre 8 Number left 6 Average attendance per session 53 Times open (whole days) 180 Total attendance (half days) 19,058 (ii) Bensham Adult Training Centre. This centre provides suitable long term training and work for the more severely handicapped trainees, and gives 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 the centre. On 31st December 1964, 60 trainees (34 males, 26 females) were on the register comprising 7 subnormal, 51 severely subnormal and 2 mentally ill persons. Work done included laundering for the three centres, screwdriver assembly, fitting inserts into metal caps, assembling and packing a wide range of plastic toys, filling and despatching various types of bath salts novelties, assembling printed literature into plastic bags, punching rubber washers and soldering leads and components for television sets. Money earned by the trainees amounted to approximately £1,025, and £1,725 was paid out in incentive pocket money. The centre opens from 9.00 a.m. to 4.00 p.m. Mondays to Fridays throughout the year, apart from Bank Holidays. Incentive pocket money paid to each trainee is 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 are supplied at a subsidised rate. The Corporation provides special coaches to take trainees to and from the Centre, although those capable of making their own way are encouraged to do so. 48 Crosfield Industrial Unit This Unit was transferred to larger but temporary premises in an old factory on 31st March. It now not only provides long term work or rehabilitation facilities for all categories of the severely disabled but also acts as the co-ordinating headquarters for industrial work undertaken by the other Centres in Croydon. This unified organisation has facilitated the rationalisation of contract seeking and the allocation, control and continuity of work projects throughout the various centres. Needless competition has been eliminated and larger contracts can be accepted whilst the distribution of work and the movement of patients between the centres has been made much simpler. The Adult Training Centre for the subnormal, the Craft and Industrial Work Centre for the physically handicapped, the Day Hospital for the mentally ill and Warlingham Park Hospital all provide the special services or particular emphasis which their patients require. Each centre also assesses and prepares those patients who need to move on to the more realistic factory setting which the Crosfield Industrial Unit can provide. At the Crosfield Industrial Unit attention is focused more on the working ability of the trainee and rather less on his particular handicap. This difference of emphasis as compared with the more specialised centres both helps and is helped by the mixture of disabilities represented. This, in turn, is made possible by careful selection and preparation of the trainees. The Unit has a weekly Works Committee of trainees and an instructor to discuss work problems and policy. Another weekly meeting attended by a psychiatrist, psychologist, disablement resettlement officer, social worker and senior unit staff is concerned with the medical, social and other needs of the trainees and reviews their general progress. A social club is held for the trainees one evening each week. In addition to games, handicrafts and an art group, the club has the help of a qualified teacher to teach elementary arithmetic, reading and writing. Payment to most of the trainees is by way of incentive pocket money supplementation to state benefits although a group of 7 trainees are paid wages under special schemes. Application has been made to the Ministry of Labour for sheltered workshop recognition which would enable wages to be paid to approved trainees. 49 During the year contracts were obtained from 14 firms. Work included soldering, taping, assembling radio and television components, filling and packing various toilet requisites (bath salts, soap, talcum powder), wire bending, making concrete blocks, packaging cleaning materials, assembling cardboard boxes and car accessories. Further information concerning the Unit is given below: Number of severely disabled persons attending 1.1.64 31.12.64 Type of Disability M F M F Mental Illness 5 - 20* 11* Mental Subnormality 9 4 9 6 Severe subnormality 10 7 8 9 Physical Handicap - - 9 5 24 11 46 31 * 3 Male and 4 female patients attending daily from Warlingham Park Hospital. M F 10 persons transferred to Unit from Adult Training Centre 4 6 17 persons transferred to Unit from Day Hospital 11 6 22 persons transferred to Unit from Centre for Physically Handicapped 16 6 Number placed in open employment 19 Number placed at Remploy 1 ₤. s. d. Total amount paid out as pocket money Total Amount paid out as gross wages Total earnings from industry - 3,604. 10. 0. 1,235. 10. 11. approximately 9,463. 0. 0. It is already clear that this type of Unit can undertake most semi-skilled forms of work to high standards. Two general points emerge of importance to the development of industrial work for the disabled which call for more than local attention: 1. Industry needs to be made aware of the commercial possibilities open to them by giving contracts to workshops for the severely disabled. 2. Research is needed to identify the very many suitable jobs in all kinds of trades which, if they were known about, could be satisfactorily undertaken by workshops for the disabled. 50 Residential Care (i) Temporary Care Short term care in hospital has been arranged for 27 mentally subnormal patients and 11 patients have been provided with convalescent holidays. The Mental After-Care Association's Hostel in Croydon has continued to provide temporary care for patients recovering from mental illness and the Local Health Authority has made full use of its ten beds in the hostel. (ii) Long Term Care (a) The Boarding Out Scheme for mentally disordered patients has continued to expand successfully. On 1.1.64 20 patients were in lodgings under the scheme and during the year a further 41 patients were found accommodation. By the end of the year 40 of the 61 patients were still in lodgings under the scheme and 14 had moved on either to relatives or to accommodation of their own selection. Of the remaining 7, 1 had moved to hostel accommodation, 1 had been admitted and 5 had been re-admitted to hospital. The re-admission rate for patients placed under the scheme was the same as in the previous year, namely about 10%. The system of allowances and the amount available to the landladies has operated satisfactorily and total expenditure incurred by the Corporation on this account over the year was £2, 303. The average weekly cost per patient was £1. 16. 6d. (b) Group Units The Local Health Authority this year followed the establishment of the Boarding Out Scheme by initiating the next phase of its programme for residential provision for mentally disordered patients in the community. These units are normal housing units which provide for the placement of a small group of suitable patients who would not be catered for under the boarding out arrangements. 51 One such unit was established and the group is made up of five female patients all of whom have recovered from long psychiatric illnesses and are now capable of normal employment in the community, given appropriate accommodation and social support. The group itself which was carefully selected affords some support, but a weekly meeting with mental welfare staff gives further help and supervision. The unit has run very satisfactorily and all the residents have remained well and in work. The house is rented from the Housing Department who maintain the property and the group is supervised by the Boarding Out Officer. (c) Voluntary Homes In addition to the 12 patients placed with the Guardianship Society, 10 patients are placed in homes under the Mental After-Care Association, two having been admitted during the year and one having left. One patient is placed in a voluntary home for the mentally subnormal. The Corporation has accepted financial responsibility in all these cases, subject to contributions according to means. Social Work The social work service for mentally disordered patients provided jointly by Warlingham Park Hospital and the Local Health Authority has been further developed during the year. There has been no increase in staff, and in the latter half of the year there has been an effective reduction of two social workers - one having left the service and another being seconded for a period of training. Despite this the number of active cases carried has continued to increase as has also the rate of referral of new cases to the social workers. Figures illustrating these trends are shown below. Active Caseload of Social Work Date Subnormal and Severely Subnormal Mentally Ill Others Total Dec. 1962 379 253 10 642 Dec. 1963 407 420 21 848 Dec. 1964 416 513 48 977 52 Number of Cases Referred for Social Work Annually Year Subnormal and Severely Subnormal' Mentally Ill Others Total 1962 45 465 63 573 1963 82 637 96 815 1964 67 735 131 933 The above figures reflect the heavy and increasing demands for social work throughout the Mental Health Service. They also underline the value of a flexible and closely knit service covering both hospital and local authority fields of operation and making optimum use of the available staff. Social Clubs Three clubs are run at The Oaks Day Hospital, one on Tuesday afternoons for mentally infirm old people and two on Thursday and Monday evenings for psychiatric patients. Another club is run by the Local Health Authority on Wednesday evenings at the Causton Hall for trainees attending the Crosfield Industrial Unit and other physically or mentally handicapped people. A fifth club is run for severely mentally subnormal people by the Society for Mentally Handicapped children and is held at St. James's Church Hall on Monday evenings. Students In January 1964 the first students from the new course of training in social work at the Croydon Technical College started to attend for practical training at the Mental Health Centre, 49 Wellesley Road. They attended for a seven month period and a second group started in September. Social Science Departments of a number of universities continue to ask for their students to come for periods of practical work to the Mental Health Service and several of the students have been accepted for periods of eight weeks. Another j group of psychiatric social work students from the London School of Economics came for a week* s visit of observation. In all 16 students attended for periods from one week to seven months in duration. Visits In addition to the students referred to above the Mental Health Service has been the subject of visits by a very wide variety of people in different professions and from different countries amounting to over 70 visitors. Seventeen visitors were from 11 different overseas countries. 53 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. Details of attendances - Capacity 50 Number on books at the end of year 48 Attendances: ... Under 2 3,373 Over 2 5,854 Total 9,227 Number of days opened 256 Average daily attendance 36 DEAFNESS The scheme for examining children for deafness was reviewed. The "at risk" register was unreasonably loaded with babies included as "premature" because of a birth weight less than 5½ lbs but over 5 lbs. These infants produced no greater incidence of abnormal findings and impeded the assessment of those more likely to show abnormalities. It was consequently decided to define prematurity for the "at risk" register as a birth weight of less than 5 lbs. Furthermore, the testing of all infants at Infant Welfare Centres by clinic medical officers (using "stycar" equipment) was introduced. Those showing any defect were sent for re-assessment to a special central clinic. For detailed figures see Appendix page 113. 54 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. The scheme covers elderly persons, expectant mothers and the permanently handicapped. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 57 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 present my second Annual Report. Statistical details of the varied duties are set out in the tables which follow. I would refer in particular to the continued progress in Clean Air, when the Council made its No. 7 Smoke Control Order in December 1964 and which is now awaiting confirmation by the Ministry of Housing and Local Government. Slum clearance work continues to receive close attention and it is considered that all the remaining unfit houses in the Borough will be dealt with within the next 2 to 3 years. The Housing Act 1964 came into operation on 16th August 1964. This Act has greatly strengthened the law contained in the Housing Act 1961 respecting houses let in multiple occupation. The new statute gives additional powers as to the carrying out of work in default, prosecutions, stiffer penalties, control orders, and as to the preparation of Registration Areas. Certain parts of the Offices, Shops and Railway Premises Act 1963 came into operation during the year, when it became obligatory on employers to register their premises as from 1st June 1964, and by the and of the year premises were registered, and inspected, where 31,636 persons were found to be employed. In addition to the existing staff of Public Health Inspectors, a Specialist Inspector has been appointed to co-ordinate this work, together with 2 Technical Assistants. The Croydon Public Abattoir had been in use for over 100 years and it had reached the conclusion of its useful life. The Council therefore gave one year's notice to the operators of its intention to close the premises, and this took effect on 30th September 1964. I would again wish to express my thanks to the Chairman and Members of the various Committees for their kindly support, and to the staff of my Department for their help during the year under review. 58 HOUSING Number of parts of houses on which Closing Orders have been made 7 Number of houses on which Closing Orders have been made 6 Number of houses on which Demolition Orders have been made Number of houses where Certificates of unfitness were issued 20 23 During the year 1,106 houses were rendered fit following the service of notices requiring repairs. Rent Act, 1957 - Certificates of Disrepair Since Commencement of Act Applications made in 1964 Number of Applications for Certificates 926 19 Number of decisions not to issue Certificates 50 - Number of decisions to issue Certificates 876 19 Number of undertakings given by Landlords 529 10 Number of Certificates issued 246 9 Applications by Landlords to Local Authority for cancellation of certificates 245 21 Cancellation of certificates refused 50 8 Certificates cancelled by Local Authority 195 13 Applications for certificates as to the remedying of defects which the Landlords have undertaken to remedy 130 6 Certificates issued as to the remedying of defects which landlords have undertaken to remedy 130 6 59 Housing Act, 1961 - Houses in Multiple Occupation From the date of the commencement of the Act:- Number of Houses Inspected 346 Number of Statutory Notices served 118 Number of Notices complied 60 Number of Notices sent to Housing Manager for default action 15 60 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 was 4s. Od. per night or 28s. 0d. per week, and 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 91. and the total number of lettings 33,395. The receipts during the year were £4,233 and the expenditure £6.889. 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 81 17 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,093 105 16 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 189 157 14 - Total 1,363 279 33 - 61 Cases in which Defects were found:- Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) 3 - - - - Inadequate ventilation (S.4) 3 1 - - Ineffective drainage of floors (S.6) 1 - - - - Sanitary conveniences (S.7): — (a) Insufficient 5 2 - - - (b) Unsuitable or defective 15 15 - 1 - (e) Not separate for sexes 2 1 - - - Other offences against the Act (not including offences relating to Outwork 43 33 - 2 - Total 72 52 ... 3 - Part VIII of the Act Outwork Nature of Work Section 110 Section 111 No. of outworkers in August list required by Sect. 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (A) (5) (6) (7) Wearing Apparel 251 - - - - - Household Linen 48 - - - - - Lace, lace cur- tain and nets 3 - - - - - Curtain and niture hangings 11 - - - - - Paper bags 28 - - - - - continued on next page. 62 Nature of Work Section 110 Section 111 No.of outworkers in August list required by Sect.110 (l)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) The making of boxes or other receptacles or parts thereof made wholly or partially of paper. 1 - - - - - Carding,etc.of buttons, etc. 16 - - - - - Stuffed toys 22 - - - - - Brush making 2 - - - - - Artificial Flowers 2 -- - - - - Cosaques,Christmas crackers, Christmas stockings, etc. 126 - - - - - Lampshades 23 - - - - - Total 533 - - - - - OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963. TABLE A - Registrations and General Inspections. Class of Premises Number of Premises Registered during tie year Total Number of Registered Premises at end of year Number of Registered Premises receiving o general inspection during the year (1) (2) (3) (4) Offices 783 780 174 Retail Shops 1332 1328 311 Wholesale Shops, Warehouses 77 77 8 Catering Establishments open to the public. Canteen 137 137 40 Fuel Storage Depots 1 1 - Totals 2330 2323 533 63 TABLE B- Number of Visits of all kinds by Inspectors to Registered Premises 782 TABLE C - Analysis of Persons Etaployed in Registered Premises by Workplace. Class of Workplace Number of Persons Employed (1) (2) Offices 18392 Retail Shops 9512 Wholesale Departments, Warehouses 1781 Catering Establishments open to the public 1566 Canteens 378 Fuel storage depots 7 Total 31636 Total Males 14466 Total Females 17170 No exemptions were granted or prosecutions instituted under the Act during 1964. The number of Inspectors appointed under the Act is twenty and three other members of the staff are employed for most of their time on work in connection with the Act. 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. 700 inspections were made under the Shops Act, and the infringements found were as follows:- Hours of Closing 4 Insufficient and defective W.C. accommodation 2 Defective floors, walls etc 2 Notices to be exhibited or amended 52 Insufficient heating 4 Washing facilities required 1 64 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 92 inspections were made and defects found were referred to the Chief Education Officer. HAIRDRESSING ESTABLISHMENTS Legislation now calls for the registration of hairdressers and barbers premises. During the year 21 inspections were made of registered premises to check that the Byelaws, now in force were being observed. Generally little cause for complaint was found at such inspections. DRAINAGE 1,940 visits of inspection were made to underground drains in course of repair. Of 468 Statutory Orders served, in 184 cases work was carried out in default of the owners. POLLUTION OF RIVERS AND STREAMS During the year 12 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. 65 CLEAN AIR ACT, 1956 The Council has implemented the relevant provisions of this Act in making Smoke Control Orders covering the South, West and Northern areas of the Borough and it is the intention that one Smoke Control Order shall be made each year. The progress of these Orders is shown below:- Smoke Control drier No. of premises (incl. Factories and Commercial No. of duellings 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 No. 7 8,198 7,788 1,060 21.12.64 1.7.66 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. During the year 32 plans showing the construction and heights of new chimneys have been examined and in 24 cases additional height has been requested and agreed. 37 notices of the installation of new furnaces have been received. 33 of these being oil fired plants. AMUSEMENT HOUSES 60 inspections were made of Theatres, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licencing Authorities on the sanitary conditions of these premises. Notices are issued to remedy any unsatisfactory conditions. 66 DISINFECTION The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use supplied with steam from a gas fired boiler within the Station. The following articles were disinfected at the Disinfecting Station during the year:- By Steam 8,220 articles By Formalin Gas 191 „ Total 8,411 articles 153 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 1964, 32 articles were disinfected, the receipts amounting to £2.6s.6d. Disinfection was carried out after infectious or contagious diseases at the following premises:- 103 rooms at 26 houses, hospital wards, clinics etc. 60 library and other books were disinfected. On request disinfection was also carried out for conditions other than notifiable infectious diseases and for which a charge is made. During the year £28. 8s. 6d. was paid for such services. 894 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 8 adults and 12 children were cleansed of verminous conditions and 7 adults and 5 children were treated for scabies. 67 DISINFESTATION OF PREMISES The new insecticides have provided a ready and easily applied remedy for vermin and pest infestation of premises, etc. and occupiers are advised and instructed in their use by the Inspectors. The department assisted in the more difficult cases numbering 90, 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 23 complaints were made regarding noise alleged to be a nuisance. In 5 cases no action was warranted. In 5 instances the noise complained of was finally abated, in 8 cases the noise was reduced so as not to be a nuisance and 5 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 14. In addition, 196 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 1 Curled Feathers 2 Cotton Felt 1 68 PET ANIMALS ACT, 1951 22 persons were licenced for the purpose of keeping Pet Shops. During the year 18 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS Three cases of suspected swine fever notified were confirmed and appropriate action was taken in conjunction with the Officers of the Ministry of Agriculture, Fisheries and Food to provide against the spread of the disease. PREVENTION OF DAMAGE BY PESTS ACT, 1949 This Act is mainly concerned with the destruction of rats and mice and it places a duty on the occupier of any premises to report to the Local Authority any infestation by such rodents. Two rodent operatives are employed to deal with such complaints. During the year, 2,413 private dwellings were inspected following complaints and in 1,885 instances infestation was confirmed and dealt with by the rodent operatives. 147 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.. 21 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 50 manholes. These manholes were treated until no further baits were taken. 69 FOOD SUPPLY The supervision and inspection of the food supplies is carried out by the Public Health Inspectors who are all qualified in food inspection. There are 2, 577 premises in the Borough where food is stored, manufactured or sold and of these 980 are registered under Section 16 of the Food and Drugs Act, as follows: - Retail sale of ice-cream 786 Manufacturers of ice-cream 3 preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 191 During the year 5,498 inspections and re-inspections were made of food businesses (for details see Page 79 ). INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1960. Structural defects in shops and stores 9 Defective condition of wails and ceilings 168 Defective condition of floors, utensils, fixtures, etc. 51 Defective or insufficient drainage 14 Insufficient lighting or ventilation 12 W.C. - accommodation - repair or cleansing required 35 „ „ „ - artificial lighting required 9 „ „ „ - want of Intervening ventilated space 9 Food - not stored 18" off floor 3 „ „ means to prevent risk of contamination required 56 „ „ store required or defective 6 Accumulations in yard or stores 23 Offal and refuse bins defective or uncovered 21 Yard paving defective 6 Hand lashing notice not exhibited 9 Ablutions - Wash basins required 29 „ - Hot water supplies required 31 „ - Nail brushes, soap and towels required 29 Clothing accommodation required 17 Insufficient or defective sinks 21 Smoking offences 5 Defective or unsuitable table tops, etc 39 First Aid kits required or insufficient 23 Cleanliness - advice given 4 Cracked crockery 1 Rats/Mice Infestation 3 70 Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1964:- Article Weight in lbs. Carcase Meat 47,610 Offal 44, 985 Sundry Foodstuffs 1,966 Canned, Bottled and Packeted Foods 21,874 Total 116, 435 Disposal of Condemned Foodstuffs Meat condemned at the Public Abattoir, up to 30th September 1964, 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, and other condemned foodstuffs, are destroyed by incineration. MEAT INSPECTION From 1st January to 30th September the following numbers of animals were slaughtered at the Public Abattoir:- Cattle (excluding Cows) Cows Calves Sheep and Lambs Pigs Goats Total 2,724 551 959 12, 110 22,101 33 38,478 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 Foods) Order, 1957 The Order provides that, in general, all waste food must be boiled before feeding to animals to minimise the spread of animal diseases. Licences to operate boiling plants and equipment are issued after inspection of the premises and plants. 16 inspections of licenced plants were made during the year. 71 MILK SUPPLY During the year 5 2 inspections were made of dairies and premises from which milk is sold. The Milk (Special Designation) Regulations 1963 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 1 (b) Dealer's (Pre-packed Milk) Licences 151 Licences to use the designation "Sterilised" - (a) Dealer's (Pre-packed Milk) Licences 127 Licences to use the designation "Tuberculin Tested" - (a) Dealer's (Tuberculin Tested) Licences 1 (b) Dealer's (Pre-packed Milk) Licences 113 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 41 Pasteurised Milk 102 Sterilised Milk 46 Tuberculin Tested (untreated) Milk 12 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 41 - 41 - 41 72 Tuberculin-Tested (Untreated) Milk Methyline Blue Test No. Samples Taken Not Satisfied Satisfied 12 - 12 The above samples of raw milk were also examined for the presence of brucella abortus and antibiotics. In all cases the results of the tests were negative. Pasteurised Milk Methyline Blue Test Phosphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfied Satisfied 102 - 102 - 102 Sterilised Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied 46 - 46 Bacteriological Examination of Milk Churn and Milk Bottle Rinses Churn Rinse Samples 6 Satisfactory 6 Unsatisfactory - Bottle Rinse Samples 23 Satisfactory Unsatisfactory 20 3 BACTERIOLOGICAL EXAMINATION OF CREAM Sixteen samples of fresh cream were examined and produced satisfactory results. BACTERIOLOGICAL EXAMINATION OF ICE CREAM 112 samples were taken, the results being as under:- Grade No. of Samples 1 94 2 9 3 2 4 7 In all cases after the results of sampling are Known, the vendors and/or manufacturers are made aware of the results, and where the gradings are 3 or 4, a visit is made, methods of service or manufacture are investigated, faults rectified and further samples taken. 73 CHEMICAL EXAMINATIONS OF ICE CREAM Seven samples were taken from local manufacturers and were found to comply with the standard. THE LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 These Regulations provide that liquid egg shall be pasteurised before use in food intended for human consumption. There are no egg pasteurisation plants in Croydon and twelve samples of liquid egg obtained from local bakeries and submitted to the prescribed alpha-amylase test proved satisfactory. FOOD AND DRUGS ACT, 1955 During the year, 192 samples of Milk and Cream, and 425 other samples were taken, of which number, 14 were found to be "Not Genuine". Summary of Samples During 1964 samples were obtained and submitted to the Public Analyst as follows:- Total Samples Genuine Not Genuine Prosecutions Convictions Alnond Flavouring 3 3 „ „ „ Apples 1 1 „ „ „ Angelica 1 1 „ „ „ Apple Juice 1 1 „ „ „ Artificial Colour 1 1 „ „ „ Arrowroot 2 2 „ „ „ Ascorbic Acid Tablets 2 2 „ „ „ Aspirin Tablets 3 3 „ „ „ Baby Food 2 2 „ „ „ Bacon 2 2 „ „ „ Baked Beans 1 1 „ „ „ Baking Powder 2 2 „ „ „ Batter Mixture 1 1 „ „ „ Beefburgers 1 1 „ „ „ Beer Bitter 9 9 „ „ „ Bicarb, soda 1 1 „ „ „ Biscuits 3 3 „ „ „ Black Currant Juice 1 1 „ „ „ Black Pudding 2 2 „ „ „ Black Treacle 1 1 „ „ „ Blancmange Powder 2 2 „ „ „ Boracic Ointment 1 1 „ „ „ Brandy 2 2 „ „ „ Brawn 2 2 „ „ „ Brisket of Beef 1 1 „ „ „ Bread Brown 1 1 „ „ „ Bread white 1 1 „ „ „ Bread Wholemeal Brown 2 2 „ „ „ Bread Milk 2 .„ 2 „ „ Bread Mix 1 1 „ „ „ 74  Total Samples Genuine Not Genuine Prosecations Confictions Browning 1 1 – – – Butter Australian 2 2 – – – Butter Danish 1 1 – – – Butter English 1 1 – – – Butter New Zealand 1 1 – – – Butter Unsalted 3 3 – – – Butter Beans 2 2 – – – Buttered Rolls 1 1 – – – Buttered Toast 1 1 – – – Calamine Lotion 1 1 – – – Camphorated Oil 2 2 – – – Calamine Ointment 1 1 – – – Candied Peel 2 1 1 – – Cake Mix 1 1 – – – Cakes Various 1 1 – – – Cheese Cheddar 3 3 – – – Cheese Cottage 2 2 – – – Cheese Danish Blue 2 2 – – – Cheese Spread 3 3 – – – Cheese Biscuits 1 1 – – – Chocolate Biscuits 1 1 – – – Chocolate Powder Sweetened 1 1 – – – Chicken Meat Paste 1 1 – – – Chocolate 3 2 1 – – Chocolate Spread 1 1 – – – Chutney 1 1 – – – Christmas Pudding 1 1 – – – Cod Liver Oil 1 1 – – – Cod Liver Oil and Malt 1 1 – – – Cocoa 1 1 – – – Coconut Dessicated 2 2 – – – Cocktail Cherries 1 1 – – – Coffee 1 1 – – – Coffee and Chicory 1 1 – – – Coffee and Chicory Essence 1 1 – – – Chopped Ham with Pork 2 2 – – – Condensed Milk 1 1 – – – Cooking Fat 1 1 – – – Cordial 1 1 – – – Corned Beef 1 1 – – – Cornflour 1 1 – – – Cornflakes 2 2 – – – Cornish Pasty 2 2 – – – Corn Oil 2 2 – – – Cough Mixture 3 3 – – – Cough Pastilles 1 1 – – – Crab Dressed 2 2 – – – Crab Spread 2 2 – – – Cream of Tartar 1 1 – – – Cream Tinned 1 1 – – – Cream Fresh 4 3 1 – – Cream Clotted 1 1 – – – Cream Buns and Cakes 3 – – – Cream Biscuits 1 1 – – – Crumpets 1 1 – – – Curry Powder 1 1 – – – Custard Powder 1 1 – – – Dates 2 2 – – – Dried Milk Powder 1 1 – – – Drinking Chocolate 4 4 – – – Dripping 2 2 – – – Dyspepsia Tablets 1 1 – – – Evaporated Milk 1 1 – – – 75  Total Samples Genuine Not Genuine Prosecutions Convictions Fish Cakes 1 1 – – – Figs 1 1 – – – Fish Fingers 2 2 – – – Fish Paste 2 2 – – – Flavour Essence 2 2 – – – Flour (incl. S. R.) 1 1 – – – Friars Balsam 1 1 – – – Frying Oil 1 1 – – – Fruit - washed 1 1 – – – Fruit Pie 1 1 – – – Gees Linctus 1 1 – – – Gelatine 1 1 – – – Gin 10 10 – – – Ginger Ale 1 1 – – – Ginger Beer 1 1 – – – Glauber's Salt 1 1 – – – Golden Syrup 2 2 – – – Grapefruit Juice 1 1 – – – Gravy Powder 1 1 – – – Ground Cinnamon 1 1 – – – Ground Ginger 1 1 – – – Ground Almonds 2 2 – – – Ground Rice 1 1 – – – Ground Nut Oil 2 2 – – – Ham 3 3 – – – Herbs 2 1 1 – – Horseradish Relish 1 1 – – – Ice Lollies 2 2 – – – Isinglass 1 1 – – – Ice Cream 7 7 – – – Instant Whip 1 1 – – – Insect Bite Lotion 1 1 – – – Iodine 1 1 – – – Indigestion Tablets 1 1 – – – Jan 3 3 – – – Jelly 2 1 1 – – Mint Jelly 1 1 – – – Jellied Veal 1 1 – – – Lard 1 1 – – – Lemonade 1 1 – – – Lemonade Powder 1 1 – – – Lemon Barley Water 2 2 – – – Lemon Flavouring 1 1 – – – Lemon Curd 3 3 – – – Lemon Pie Filling 1 1 – – – Luncheon Roll 1 1 – – – Luncheon Meat 3 3 – – – Liquid Paraffin 2 2 – – – Lobster Paste 1 1 – – – Lamb Tongues 1 1 – – – Lambs Liver 1 1 – – – Macaroni 1 1 – – – Macaroni- Creamed 1 1 – – – Malted Milk Powder 1 1 – – – Milk 188 188 – – – Margarine 3 3 – – – Margarine unsalted 1 1 – – – Marmalade 2 2 – – – Marzipan 2 2 – – – Meat Extract Cubes 1 1 – – – Meat Extract Spread 1 1 – – – Meat Paste 1 l – – – Meat Pie 1 1 – – – Mentholated Balsam 1 1 – – – 76  Total Samples Genuine Not Genuine Prosecutions Convictions Meringue 1 1 – – – Milk of Magnesia 1 1 – – – Milk Filled Chocolate Eggs 1 1 – – – Mincemeat 1 1 – – – Minced Beef 1 1 – – – Minced Meat 3 3 – – – Mint Sauce 2 2 – – – Mixed Spices 1 1 – – – Mixed Herbs 1 1 – – – Tinned Mushrooms 1 1 – – – Mustard French 1 1 – – – Mustard 1 1 – – – Mustard Sauce 1 1 – – – Nutmegs Ground 1 1 – – – Oatmeal 1 1 – – – Olive Oil 1 1 – – – Orange Squash 1 1 – – – Orange Juice 1 1 – – – Ox Tongue 2 2 – – – Parish's Food 1 1 – – – Pasty Meat 1 – 1 – – Orange Crush 1 1 – – – Peanut Butter 2 2 – – – Pearl Barley 1 1 – – – Pepper 2 2 – – – Pepper Cayenne 1 1 – – – Pickled Onions 1 1 – – – Pickled Cabbage 1 1 – – – Pickled Gherkins 1 1 – – – Pickles 1 1 – – – Pineapple 1 1 – – – Pork Pies 2 2 – – – Pork Sausage Meat 1 – 1 – – Porridge Oats 3 3 – – – Puff Pastry 1 1 – – – Red Cabbage 1 1 – – – Roes Tinned 1 1 – – – Rice 1 1 – – – Rice Creamed Pudding 1 1 – – – Raspberry Pie Filling 1 – 1 – – Rose Hip Syrup 1 1 – – – Rum 8 8 – – – Rum Essence 1 1 – – – Sago 1 1 – – – Salad Cream 1 1 – – – Sandwich Spread 1 1 – – – Sauerkraut 1 1 – – – Salami 1 1 – – – Salmon Paste 1 1 – – – Sausage Beef 3 2 1 – – Sausage Breakfast 2 2 – – – Sausage Pork 2 1 1 – – Sausage Liver 3 3 – – – Sausage Frankfurt 3 3 – – – Sherry Cooking 1 1 – – – Shrimps 1 1 – – – Split Peas 1 1 – – – Steak and Kidney Pie 1 1 – – – Steak and Kidney Pudding 0 0 – – – Steak Pie 1 1 – – – Suet Packed 2 2 – – – Sponge Mixture 1 1 – – – Sponge Pudding Tinned 2 2 – – – Sweets 2 2 – – – 77  Total Samples Genuine Not Genuine Prosecutions Convictions Surgical Spirit 1 1 – – – Sugar Castor 1 1 – – – Sugar Brown 2 2 – – – Sugar Icing 1 1 – – – Soup Powder 2 2 – – – Stewed Steak Tinned 3 3 – – – Stuffing sage and onion 2 2 – – – Stuffing Parsley and Thyme 1 1 – – – Stout canned 1 1 – – – Sulphur Ointment 3 3 – – – Syrup of Figs 2 2 – – – Table Salt 2 2 – – – Tapioca 2 2 – – – Tea 2 2 – – – Tinned Asparagus 3 3 – – – Tinned Runner Beans 1 1 – – – Tinned Marmalade 1 1 – – – Tinned Jam 1 1 – – – Tinned Broad Beans 1 1 – – – Tinned Fruit 10 10 – – – Tinned Peas 2 2 – – – Tinned Sweet Corn 1 1 – – – Tinned Vegetables 1 1 – – – Tinned Pork Sausages 1 1 – – – Tinned Vegetable Salad 1 1 – – – Tinned Soup 2 2 – – – Tinned Fish 2 1 1 – – Tinned Salmon 1 1 – – – Tinned Rhubarb 1 1 – – – Tomato Ketchup 1 1 – – – Veal and Ham Roll 1 1 – – – Ve&l and Ham Pie 1 1 – – – Vinegar 1 1 – – – Vitamin Iron Tablets 1 1 – – – Vitamin A. & D 1 1 – – – Vodka 2 2 – – – Whisky 9 9 – – – Vitamin C. capsules 1 1 – – – Walnuts 1 1 – – – Witch Hazel 1 1 – – – least Tablets 2 2 – – – Yoghurt 1 – 1 – – Ice Cream Mix 1 1 – – – Essence of Rennet 1 1 – – – Vienna Steaklets 1 1 – – – Currants 1 1 – – – Dried Apricots 1 1 – – – Whole Kernel Oil 1 1 – – – Han and Chicken Roll 1 1 – – – Totals 616 602 14 – – 78 Result of Analysis of Milk Samples The samples of milk were obtained as follows:- Taken on Milk Rounds 79 Taken at Dairies 102 Taken at Institutions 7 Total 188 Average composition of samples:- Milk (excluding South Devon and Channel Island Milks) Solids not Pat (Legal standard is 8.5%) 8.67 Milk Fat (Legal standard is 3%) 3. 58 South Devon and Channel Island Milk Solids not Pat (Legal standard is 8.5%) 8.86 Milk Pat (Legal standard is 4%) 4.33 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Milk Bread (2 samples) Both samples had been made with skimmed milk powder and were not entitled to the description "Milk Bread". Manufacturers warned Milk Chocolate Consisted of skimmed milk chocolate substitute. Vendor warned. Article withdrawn from sale. Cream, Fresh This sample was .4% deficient in milk fat. Samples taken simultaneously by producer proved satisfactory, Balmony Herbs This article was Infested with insects. Vendor warned. Remainder of stock removed from shop and destroyed. Jelly The ingredients of this article were not specified on the label in accordance with the Labelling of Food Order, 1953. The label on this article has no* been amended by the Packers. Meat Pasty Consisted of a meat and potato pasty of low meat content. Vendor warned. Manufacture of this article has been discontinued. Pork Sausage Consisted of preserved pork sausage meat. A notice declaring the presence of preservative in this article now been exhibited on the Vendor's premises. 79 Article Nature of Adulteration or Deficiency Remarks Raspberry Pie Pilling The ingredients of this article were not specified on the label in the manner prescribed by the Labelling of Food Order, 1953. This article has now been labelled correctly. Sausages, Beef Consisted of preserved beef sausages. A notice declaring the presence of preservative in this article has been exhibited on the Vendor's premises. Sausages, Pork This article contained 620 parts per million of sulphur dioxide vhereas the sulphur dioxide content must not exceed 450 parts per million. Vendor warned Tinned Fish The label on this article did not comply with the Labelling of Food Order, 1953. The label has now been amended by the Packers. Yoghurt Consisted of a low fat milk product not entitled to the description "Yoghurt" unqualified. The label on this article has now been amended to include the words "low fat content". Candled Peel The ingredients of this article were not specified on the label in accordance with the Labelling of Food Order, 1953. The label has now 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 3,856 Houses inspected where zymotic diseases have occurred 156 Houses inspected following applications for certificates of disrepair 19 Inspections of underground rooms 26 Special inspections in connection with the Housing survey 184 Houses inspected for overcrowding conditions 61 Re-inspections of work outstanding on housing notices 8, 106 Number of visits regarding infectious diseases 414 Number of visits regarding food poisoning 70 Inspections of drainage work during repair 1,940 House drains tested with smoke and colour - routine and complaint 1, 199 House drains tested with smoke (on written application) 6 House drains tested with smoke during repair 30 House drains tested with water during repair 130 Inspections of cesspools and earth closets 10 ,, ,, schools and school sanitary conveniences 67 ,, ,, public conveniences 94 ,, ,,verminous premises 46 ,, ,,ponds and ditches 12 ,, ,,yards, stables and passages 103 ,, ,,theatres, cinemas, halls, etc. 60 ,, ,, pig styes 24 ,, ,,tents, vans and similar structures 68 Inspections and re-inspections in connection with Smoke Control Orders 11,755 sundry visits regarding Smoke Abatement 738 Smoke Observations 291 Visits regarding exhumation 3 Visits to premises for food condemnation 443 Inspections of swimming baths 13 ,, ,, wells 3 ,, ,, gathering grounds of water supply 20 ,, ,, gipsy encampments, camps, fairs, etc. 2 80 Inspections of rivers and streams for pollutions 12 ,, ,, hairdressers 21 Food and Drugs Acts: Food and drugs samples taken 617 Food and Drugs Acts: Milk samples taken (special designations) 192 Ice Cream samples taken (bacteriological) 112 Samples taken of Fertilizers and Feeding Stuffs 26 ,, ,, swimming baths water 214 ,, ,, drinking water (bacteriological and chemical) 265 ,, ,, subsoil water 6 ,, ,, private wells 84 ,, ,, rag flock and other filling materials 5 ,, ,, sundry specimens (food poisoning etc.) 28 Inspections under Merchandise Marks Act 211 ,, ,, of butchers premises 284 ,, ,, meat premises (wholesale) 1,247 ,, ,, poultry and game dealers premises 212 ,, ,, fishmongers premises 52 ,, ,, fried fish premises 23 ,, ,, grocers premises 639 ,, ,, fruiterers and greengrocers premises 585 ,, ,, bakers premises - including bakehouses 157 ,, ,, dairies 28 ,, ,, Milk shops 24 ,, ,, general shops and their premises 31 Inspections of premises where cooked meats etc. are prepared or sold 140 Inspections of confectioners premises 161 ,, ,, confectionery manufacturers premises 9 ,, ,, cafes, snack bars, canteens, hotels and their 554 ,, ,, kitchens 75 ,, ,, school kitchens and serveries 9 ,, ,, hospital kitchens 6 ,, ,, ice cream manufacturers premises 140 ,, ,, ice cream vendors premises 5 ,, ,, ice cream barrows and carts 104 ,, ,, market and barrows 140 ,, ,, other food premises not enumerated above 662 Re-inspections of food premises 3 Inspections of premises where offensive trades are conducted 105 ,, ,, factories with mechanical power 17 ,, ,, factories without mechanical power 157 ,, ,, works of building and engineering 397 ,, ,, shops (under Shop Acts) 303 Special early closing, evening and Sunday trading patrols of shops 2,227 Appointments kept with owners, builders, etc. 1,734 Investigations of complaints other than housing matters 2,357 Re-inspections of works outstanding (other than houses) 5 Inspections under Fertilizers and Feeding Stuffs Act — 18 ,, ,, Diseases of Animals Act 18 ,, ,, Pets Act 36 ,, ,, Pharmacy and Poisons Act 444 ,, ,, Noise Abatement Act 2,208 Sundry Inspections and Visits 10,388 Visits regarding rats and mice infestation 974 Informal Notices outstanding 31.12.62 1,450 Informal Notices served 1,158 Informal Notices complied 1,266 Informal Notices-outstanding 31.12.63 522 Statutory Notices outstanding 31.12.62 797 Statutory Notices served 564 Statutory Notices complied 755 Statutory Notices outstanding 31.12.63 5,864 Total number of callers and complaints received at the office 16,155 Total number of letters received at the office 81 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1964 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 363 Conditions causing dampness: Defective roofs 295 Defective window frames 261 Defective walls, etc. 304 Want of efficient damp-proof course 26 Defective gutters and downspouts 235 Other structural defects: Defective plaster 353 Cleansing and redecorating required 34 Defective floors and stairs 248 Insufficient ventilation under floor 24 Defective brickwork, sills, lintels, chimneys 186 Defective stoves and fireplaces and flues 63 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 37 Defective W.C s 184 Defective drainage 144 Stoppages in drains 105 Defective water services and tanks 6 Domestic nuisances: Want of cleanliness 14 Verminous conditions 10 Other nuisances and Infringements: Offensive accumulations 103 Overcrowding 7 Sundry nuisances or defects 16 Particulars not inserted in Rent Book (Housing Act) 36 Public Urinals 6 Noise 18 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT Pood cupboards defective or required 104 (3) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING,ETC Defective Yard Paving 95 Want of a sanitary dustbin 22 (4) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 7 W.C. defective or dirty 1 (5) KEEPING OF ANIMALS Nuisances arising from the keeping of animals – (6) SMOKE ABATEMENT Nuisances observed 15 PUBLIC HEALTH SERVICES 85 WATER I am indebted to the Water Engineer, W.C. Knill, Esq., B. Sc., M.I.C.E., M.I.Mech.E., M.I.W.E., for the following data: - About nine-tenths of the Borough is supplied with water by the Corporation. The districts of Spring Park and New Addington, comprising about two square miles in area, are supplied directly by the Metropolitan Water Board, this water being derived from wells in the Chalk. Public supply mains are laid throughout the Borough and every dwelling house is connected to them; the entire population thus receives piped supplies from statutory supply authorities. The supplies have been satisfactory in quantity and quality throughout the year. None of the waters in supply have "plumbosolvent" characteristics. Most of the Corporation's supplies are drawn from deep wells in the Chalk, but a supplementary supply, of Thames-derived water, is purchased in bulk from the Metropolitan Water Board and distributed by the Corporation in the northern part of the Borough. The wells are situated at the Surrey Street, Stroud Green, Waddon, Selhurst and Addington pumping stations. The water from all of the wells is treated by the addition of chlorine, and ammonia is added after chlorination to the Surrey Street, Waddon and Addington supplies. Owing to the occasional occurrence -of turbidity in the raw water from the Addington Well, this water is filtered before chlorination. The quantity of water supplied during the year 1964 was:Prom Corporation Wells 2,610,740,000 gallons Purchased in bulk from M.W.B. 855,805,000 gallons 3,466,545,000 gallons (a) Bacteriological Examinations. Regular bacteriological examinations were made of the raw waters going into supply following treatment. 509 samples of raw waters and 1,026 samples of treated waters were examined by the Chemist and Bacteriologist of the Water Undertaking. In addition, 10 samples of raw waters and 20 samples of treated waters were bacteriologically examined by the Consultants to the Corporation. Further samples were submitted by the Medical Officer of Health for examination by the Public Health Laboratory Service. 86 The results of the bacteriological examination of the raw waters were typical of waters derived from the Chalk, some of which showed the normal deterioration in quality which occurs after heavy rainfall. In all cases the results indicated that the waters were suitable for treatment. Bacteriological examinations of the treated waters indicated that these were of uniformly satisfactory quality. (b) Chemical Analysis. The arrangements for chemical analyses are simiiar to those for bacteriological examinations. The total numbers of samples analysed in the laboratory of the Water Undertaking and by the Consultants were 89 samples of raw waters and 114 of treated waters going into supply. The results of these analyses were uniformly satisfactory. For results of samples tested by the Public Health Laboratories see Appendix page 127. 87 MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDRENS' DEPARTMENT During the year 257 children were medically examined prior to admission to a Children's Home or private foster home. NURSERIES AND CHILD-MINDERS REGULATION ACT, 1948 The registered Minders receive children for the day. They are not encouraged to take children under 2 years. Number registered 31.12.64 Number of children provided for Premises 13 336 Daily Minders 21 209 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. 88 BLINDNESS I am indebted to the Chief Welfare Officer for access to his records regarding blind persons registered during the year. These show that of the 99 cases registered:- 11 were due to glaucoma and 52 to cataract. Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had either been performed or would be carried out except:- 1 patient had died. 1 patient 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 65 adult cases are registered with his Department, 9 of whom are in special Homes. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 During 1964 no order for compulsory removal was required. 8 cases (six women and two men) 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 31.12.64.) – Admitted to private Nursing Home – Provided with additional help (e. g. Home Help and/or Nurse) and remaining under observation 5 Died before action could be taken – Statutory action not appropriate - no further action necessary 2 Total 8 APPENDIX TABLES 91 VITAL STATISTICS - 1945 - 1964 92 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 1- 5- 15- 25- 35- 45- 55- 65- 756 over 1. Tuberculosis, (Respiratory) M 7 – – – – – – – – 4 2 1 F 3 – – – – – – 1 – – 2 – 2. Tuberculosis (other forms) M 1 – – – – – – – – 1 – – F – – – – – – – – – – – – 3. Syphilitic Disease M 5 – – – – – – 1 – 1 3 – F 5 – – – – – – – – 2 – 3 4. Diphtheria M – – – – – – – – – – – – F – – – – – – – – – – – – 5. Whooping Cough M – – – – – – – – – – – – F – – – – – – – – – – – – 6. Meningococcal Infections M – – – – – – – – – – – – F – – – – – – – – – – – – 7. Acute Poliomyelitis M – – – – – – – – – – – – F – – – – – – – – – – – – 8. Measles M – – – – – – – – – – – – F – – – – – – – – – – – – 9. Other Infective and Parasitic Diseases M 2 – – 1 – – – – – 1 – – F 3 – – – – – 1 – – – – 2 Total Infective and Parasitic diseases inc. Tuberculosis. – 26 – – 1 – _ 1 2 _ 9 7 6 10. Malignant Neoplasm, Stomach M 36 – – – – – – 1 2 10 16 7 F 28 – – – – – – 1 2 3 9 13 11. Malignant Neoplasm, Lung, Bronchus M 160 – – – – – – 4 16 56 64 29 F 31 – – – – – 1 2 2 10 7 9 12.. Malignant Neoplasm, Breast M 1 – – – – – – – – - – 1 F 68 – – – – – – 1 10 20 18 19 13. Malignant Neoplasm, Uterus F 26 – – – – – – 6 § 3 5 7 14. Other Malignant and Lymphatic Neoplasms M 128 – – 2 – 3 1 4 11 29 37 41 F 173 – – – – 2 4 2 12 34 44 75 15. Leukaemia,Aleukaemia M 8 – – – – 1 1 – 1 3 1 1 F 8 – – – – 1 – 2 2 – – 3 Total all forms of Cancer 667 – – 2 – 7 7 23 63 168 201 196 16. Diabetes M 8 _ – – – – – – – 1 2 5 F 9 – – – – – – – – 2 2 5 17. Vascular Lesions of Nervous System M 148 – – – – – – 2 8 20 41 77 F 258 – – – – – – 2 10 20 40 186 18. Coronary Disease, Angina M 316 – – – – – – 10 33 89 61 103 F 217 – – – – – – 2 9 13 63 130 19. Hypertension with Heart Disease M 12 – – – – – – 1 – 2 4 5 F 29 – – – – – – – 1 – 7 21 20. Other Heart Disease M 100 – – – – – 1 5 4 8 16 66 F 183 – – – – – 1 2 4 7 32 137 21. Other Circulatory Disease M 51 – – – – – – – 5 10 9 27 F 53 – – – – – – 1 3 5 9 35 Total Heart and Circulatory Diseases – 1,384 – – – – – 2 25 77 171 306 797 93 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 _ _ _ _ _ _ _ _ _ _ _ _ F 2 _ _ _ _ _ _ _ _ 1 1 23. pneumonia M 73 4 7 1 _ _ _ 1 1 5 20 34 F 95 1 1 2 _ _ _ _ _ 4 16 7 1 24. Bronchitis M 106 _ _ _ _ _ _ 2 4 23 39 38 F 5 1 _ _ _ _ _ _ _ 5 7 39 25, Other Diseases of Respiratory system M 8 _ _ _ _ 1 _ _ 1 3 3 _ F 1 _ _ _ _ _ _ _ 1 _ _ Total diseases of Respiratory system -including influenza and excluding tuberculos is 336 5 8 3 _ 1 _ 3 6 41 86 183 26. Dicer of stomach and Duodenum M 12 _ _ _ _ _ _ 1 _ 1 5 5 F 9 _ _ _ _ _ _ _ _ _ 3 6 27. Gastritis, Enteritis and Diarrhoea M 7 _ 1 _ _ _ _ _ _ 2 3 F 10 _ 1 _ _ _ 1 1 _ 2 5 38. Nephritis and Nephrosis M 8 _ _ _ _ _ _ 1 1 1 4 1 F 4 _ _ _ _ _ _ _ _ 1 _ 3 29. Hyperplasia of Prostate M 11 _ _ _ _ _ _ _ _ 1 1 9 30. Pregnancy, Childbirth Abortion F _ _ _ _ _ _ _ _ _ _ _ 31. Congenital Malformations M 7 4 1 1 _ _ _ _ 1 _ _ _ F 10 3 2 2 1 _ _ _ 2 1 _ _ 32. Other Defined and Ill-defined diseases M 93 20 2 2 _ 1 3 7 5 1 7 20 51 F 158 22 2 2 1 _ 2 3 10 15 26 75 Total Miscellaneous diseases 329 49 9 6 2 1 6 13 19 36 62 126 33. Motor Vehicle accidents M 23 _ _ 1 2 fi 4 1 2 1 3 3 F 11 _ _ 2 _ 2 _ _ 1 1 2 3 34. All Other Accidents M 17 _ _ 2 _ 2 _ 2 2 2 1 6 F 24 _ _ 1 _ _ _ 1 1 1 1 19 35. Suicide M 31 _ _ _ _ _ 2 7 5 1 1 2 4 F 18 _ _ _ _ _ _ 6 1 5 3 3 36. Homicide and operations of war M 3 _ _ _ 2 1 _ _ _ _ _ _ f 2 1 _ _ _ 1 _ _ _ _ _ Total - accidents, suicide and violence 129 1 _ 6 4 12 6 17 12 21 12 38 total all causes m 1, 382 28 11 10 4 15 12 50 102 297 377 476 F 1, 489 27 6 8 2 6 10 33 75 155 297 870 2, 871 55 17 18 6 21 22 83 177 452 674 1,346 94 CANCER Deaths from Cancer occurred at the following Ages: Age Period Male Female Total Under 25 years 5 3 8 25 and under 35 years 2 6 8 35 and under 45 years 10 14 24 45 and under 65 years 132 104 236 65 years and over 184 207 391 Total 333 334 687 Sites of Fatal Cancer Site Male Female Total Percentage of Total Skin – 3 3 0. 45 Oesophagus 5 2 7 1.05 Stomach 36 28 64 9.60 Liver 5 5 10 1. 50 Bowel 19 41 60 9.00 Rectum 17 17 34 5. 10 Bladder 13 8 21 3. 14 Prostate 10 – 10 3.02 Larynx and pharynx 3 4 7 1.05 Uterus – 26 26 7.78 Breast 1 68 69 10. 34 Ovary – 32 32 9.60 Pancreas 6 14 20 3.00 Gall Bladder and Duct 1 1 2 0. 30 Tongue and Mouth 4 2 6 0.90 Bones 2 6 8 1. 20 Lungs and Bronchus 160 31 191 28.64 Kidney 2 6 8 1. 20 Brain and Nervous System 14 12 26 3.90 Lymphatic Glands and Connective Tissue 1 – 1 0.15 Hematopoietic Tissues 4 4 8 1. 20 Hodgkin's Disease 4 3 7 1.05 Leukaemia 8 8 16 2. 40 Genital Organs 2 3 5 0.75 Antrum 4 1 5 0.75 Spleen 1 – 1 0. 15 Thyroid – 2 2 0.30 Muscle – 1 1 0. 15 Undefined 6 11 17 2. 55 Total 333 334 667 95 WARD STATISTICS Estimated Population Births (live) *Birth Bate Deaths *Death Bate Deaths under i year Deaths under i year per 1,000 births Deaths from Diarrhoea (under 2 years) 8Death Bate from Diarrhoea (under 2. farm) Deaths from Bronchitis and Pneumonia *Deaths Bate from Bronchitis and Pneumoniae Deaths from Pulmonary Tuberculosis *Death Bate from Pulmonary Tuberculosis Deaths from Non-Pulmonary Tuberculosis *Death Bate from Non-Pulmonary Tuberculosis Deaths from Heart and Circu latory Diseases *Death Bate from Heart and Clrculatory Diseases Deaths from Cancer *Deaths Bate from Cancer Natural Increase of Births over Deaths Upper Norwood 18621 345 18. 5 196 10. 5 6 15 - - 17 0.9 - - - - 68 3.6 52 2.8 149 Norbury 16146 330 20.0 136 10.3 1 3 - - 15 0.9 1 0.06 - - 69 4.5 30 1.9 164 Vest Thornton 16243 266 17.4 176 11.6 3 11 - - 18 1. 1 - - - - 46 3.0 57 3.8 90 Benshas Manor 16827 266 16.8 185 11.7 4 15 - - 20 1.3 - - - - 61 5. 1 45 2.8 81 Thornton Heath 15302 300 19.6 163 10.7 7 23 - - 19 1. 2 - - - - 47 3. 1 39 2. 5 137 South Norwood 16388 482 29.4 198 12. 1 9 19 - - 30 1.8 - - - - 60 3.7 52 3. 2 284 Woodside 14103 297 21. 1 159 11.3 7 23 - - 25 1.8 - - - - 45 3. 2 33 2.3 138 Bast 18239 206 11. 3 187 10.3 4 19 - - 12 0.7 1 0. 06 - 0. 06 77 4.2 32 1.8 19 Shirley 13592 204 15.0 147 10.8 2 10 - - 11 0.8 - - - - 57 4. 2 37 2.7 57 Addlsconbe 16302 316 20.6 212 13.9 4 13 - - 28 1.8 1 0. 07 - - 68 5.8 49 3. 2 103 Vhitehorse Manor 13202 282 21.4 145 11.0 4 14 - - 20 1. 5 1 0.08 - - 51 3.9 34 2.6 137 Broad Green 13395 263 19.6 148 11.0 1 4 - - 25 1.9 3 0. 22 - - 55 4. 1 33 2.5 115 Central 9118 192 21. 1 121 13. 3 3 16 - - 12 1.3 1 0 11 - - 44 4.8 31 3.4 71 Vaddon 15403 278 18. 5 18 5 12.0 5 18 - - 23 1.5 1 0. 07 - - 60 3.9 41 2.7 93 South 16473 256 15. 5 263 15.9 4 16 - - 30 1.8 1 0.06 - - 85 5. 2 29 1.8 - 7 Addlngton 27076 442 16. 3 123 4. 5 9 20 2 0. 02 8 1.03 - - - - 25 0.9 47 1.7 319 The Borough 253.430 4.724 18.4 2. 871 11.3 72 15. 2 2 0. 01 325 1.3 10 0.04 1 0.01 961 3.8 661 2.6 1.853 *Death Rate per 1,000 population and excluding those who died in Queen's Hospital 96 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1945 - 1964 Year Births (Live and Still) Maternal Deaths Ma tern al Mortality Bate In {ant Mortality Bate 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 1964 4,782 - - 15. 2 97 DETAILS OF INFANT MORTALITY Hie following table gives the cause of death during the first month of life (Neo-natal mortality) (l) Complications of Labour - Trauma at Birth 3 Anoxia 5 (2) Foetal States - Congenital Malformities 7 Atelestasis 3 Haemorrhagic Disease of Newborn 2 (3) Prematurity 29 (4) Post-Natal Causes 6 Total 55 Percentage Deaths tinder 1 year per Total Infantile Deaths Deaths under 1 year per 1,000 Births 1963 1964 1963 1964 Injury at Birth and congenital 25.3 18.1 4. 51 2.75 Premature Births 39.5 40.3 7.06 6.14 Respiratory Diseases 19.8 4.2 3.53 0.63 Atelectasis, Debility and Marasmus 1.1 4.2 0.20 0.63 Diseases of Digestion* 2.2 2.8 0.39 0.42 Other Causes 12.1 30.5 2. 16 4.66 *These from Gastro Enteritis Perinatal Deaths Stillbirths - 58 Perinatal rate - 23.0 per 1, 000 Deaths in first week - 52 Total (live and still) births Causes of Death in first week Prematurity - 28 Asphyxia - 5 Congenital conditions 6 Haemorrhagic Disease of the Newborn - 2 Atelectasis 3 Birth Trauma - 3 Murder - 1 Pneumonia 3 Meningitis - 1 98 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 + Booths 5 + months 6 + months 7 + months 8 + months 9 + months 10 + months 1 + months TOTAL All Causes 36 7 5 8 1 - - 1 2 - 55 7 1 - - 3 2 1 - - 1 1 72 Menlngo-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox • - - - - - - - • - - • - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - • - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis • - - - - - - - - - • - - - - - • - - - - - - Bronchitis - - - - - - - - - • - - - - - - - - - - - - - Pneumonia (all forms) 1 - 1 1 - - - - 1 - 4 3 1 - - 3 - - • - 1 - 12 Diarrhoea and enteritis - - - - - - - - - - - - - - - - - - 1 - - 1 2 Gastritis - - - - - - - - - - - - - - - - - - - - - • - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - • • - - • - Congenital Malformations 5 - 1 6 2 - - - - 1 - - - - - 9 Premature Birth 20 4 2 1 1 - - 1 - - 29 - - - - - - - - - - - 29 Atrophy, Atelectasis. Debility and Marasmus 1 2 - - - - - - - - 3 - - - - - - - - - - - 3 Injury at Birth 1 1 - 1 - - - - - - 3 - - - - - - - - - - - 3 Haamorrhaglc disease of newborn 1 1 _ - - - - 2 2 Other Causes 7 - - - - - - - 1 - 8 2 - - - - 1 1 - - - - 12 TOTALS 36 7 5 3 l - - l 2 - 55 7 l - - 3 2 l 1 - 1 1 72 99 MIDWIFERY SERVICE The work of the municipal midwives was as follows:- 1. Number of deliverie 1, 267 2. Primlgravida 204 Multlplra 1,063 3. Midwifery cases 931 Maternity cases 336 4. Live Births 1,261 Still Births 6 5. Forceps 6 6. Neonatal deaths 1 7. Premature births 5 (1) 2 lbs. unbooked emergency Transferred to Hospital (2) 4 lbs. 36 weeks Transferred to Hospital (3) 4 lbs. 4 ozs. and 4 lbs. 8 ozs. 36 weeks twins Transferred to Hospital (4) 3 lbs. 8 ozs. and 4 lbs. 36 weeks twins Transferred to Hospital (5) 3 lbs. 12 ozs. 35 weeks Transferred to Hospital 8. Trllene given 9 9. Gas and Air given 1,115 10. Post partus haemorrhage cases 31 11. Manual removal of placenta at home nil 12. Blood transfusions at home 2 13. Flying squad calls 6 14. Toxaemia of pregnancy treated at home 6 15. Prolonged labour (over 24 hours) 9 16. Breech deliveries 2 17. Twins (3 (sets 18. Puerperal Pyrexia 11 Genital 2 Extra Genital 9 19. Congenital Malformations 8 Mongols 3 Spina Bifida 1 Hare lips 2 Talipes 2 20. Patients given Pethedine 702 21. Patients sent to hospital 286 Ante natal 201 During labour 70 After delivery 15 22. Patients sent home for nursing 1, 173 Home booked 264 Hospital booked 909 100 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 7 Eplslotomy 6 Malpresentation 6 Post-partum haemorrhage 21 Premature Labour 8 Adherent and Retained Placenta 5 Delayed Labour 5 Torn Perineum 78 Ante-partum haemorrhage 15 Other Causes 19 Total 171 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 14 Pain In Breasts 9 Pain In Legs 9 Other Causes . 9 Rhesus Negative Blood 14 Total 55 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 24 Still Birth 3 Other Causes 3 Total 30 Grand Total 285 101 [???] Mileage Deliveries Midwifery Mater ni ty Gas and Air Ante-Natal Visits Post-Natal Visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnormal Midwife Pupil Midwife Pupil 1. 4693 79+5 50 1 28 — 73 794 373 1028 789 126 96 19 2. 2133 61 53 5 2 1 53 433 211 968 768 85 76 2 3. 916 15 10 - 5 - 15 238 — 254 — 20 34 5 4. 3499 85+6 56 2 25 2 82 852 — 1210 — 56 64 7 5. 3329 59+5 46 2 9 2 49 539 — 1027 — 78 86 30 6. 6131 86 + 14 63 2 18 3 72 1052 503 842 1146 186 188 37 7. 2160 22 18 — 4 — 10 307 — 531 — 39 43 6 8. 2878 82 53 — 27 2 75 616 288 1044 1026 131 144 29 9. 2471 26 22 3 1 — 24 202 — 692 — 42 41 — 10. 6121 85+8 49 5 29 2 69 1140 578 1074 739 159 157 21 11. 3634 79 + 11 62 1 16 — 66 558 — 1090 — 76 84 17 12. 4679 107 + 4 58 1 41 7 102 1237 359 1259 1140 136 150 17 13. 2355 44 25 — 19 — 34 483 — 735 — 55 54 2 14. 1203 9 8 — 1 — 6 81 — 331 — 21 24 — 15. 2898 59+4 56 3 — — 52 506 212 759 716 89 105 22 16. 4602 98+8 76 2 20 — 93 1007 441 1207 1019 116 105 18 17. Commenced 1/1/65 18. 19. 2131 20. 4269 57 55 1 — 1 56 564 48 976 162 58 55 10 21. 2593 47 34 3 9 1 40 559 — 769 — 59 52 19 22. 1876 47+5 31 1 15 — 45 49 2 — 654 — 37 31 12 23. 2894 27 9 — 18 — 27 475 56 384 482 58 51 9 24. 3439 68 48 — 20 — 64 753 169 916 581 88 82 18 25. 25 24 — 1 — 24 189 — 564 — 23 20 1 [???] Time Midwives 1. 4493 — — — — — — 22 — 1610 — — — 29 2. 4675 — — — — — — 5 — 1611 — — — 30 3. 4676 — — — — — — 1 — 1662 — — — 14 4. 2306 — — — — — — 15 — 697 — — — 10 Total 86654 1267+70 906 32 308 21 1131 13190 3238 23894 8568 1738 1742 384 (Continued on next page) 102 * No.22 Left service 31/8/64 replaced by No.3. 1/10/64 X No. 21 Left service 31/10/64 + No.24 Left service 7/10/64 *No.23 Retired 3/9/64 *No. 25 Left service 31/7/64 replaced by No. 14. 3/8/64 || No. 19 Retired 31/12/64 replaced by No. 1 = 1/1/65 who has not yet been replaced. // No. 20 Left service 30/12/64 - not yet replaced #No. 9 Commenced 24/2/64 \\No. 7 Commenced 1/5/64 N B. No. of deliveries + = no. of cases sent into hospital during labour. 103 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1964 who were born*- (i) at home or in a nursing home 48 (ii) in hospital* 259 (2) The number of those born at home or in a nursing home - who were nursed entirely there 45 who were transferred to hospital on or before the 28th day 3 who died during the first 24 hours 3 who died in 1 and under 7 days — who died in 7 and under 28 days — who survived at the end of one month 36 (3) Number of those born in hospital - who died during the first 24 hours 30 who died in 1 and under 7 days 8 who died in 7 and under 28 days — who survived at the end of one month 221 (41 Number of premature still births who were born (i) at home or in a nursing home — (ii) in hospital 29 *The group under this heading will include cases which may be born in one hospital and transferred to another. 104 HOME VISITS BY HEALTH VISITORS 1964 Visits Sames of Visitors Miss Batt Miss Bird Mrs. Blackburn Miss Butcher Mrs. Collins Left October Miss Devaney Miss Eldridge Miss Bnms Miss Gabain Mrs. Glucksmann Miss Grace Miss Hall Mrs. Hargrpaves Com. December Mrs. Hartog Left October Mrs. Haslett Com. December Mrs. Hastings Miss Hawkins Miss Hill Com. August Mrs. Ivens Mrs. Laing Miss Llewellyn Mrs. McDaniel Part Time Miss Martin Mrs. Mayo Mrs. Odewale Com. August Miss Otway Miss Partridge Miss Valentin Miss Vlnce Mrs. Wilson Totals 1964 Totals 1063 Infants born 1964- Plrst Visits 100 72 130 190 131 190 181 174 167 314 165 167 17 169 2 203 189 81 278 233 263 47 162 286 54 142 147 214 241 190 4899 5055 Re-Visits 197 194 218 248 55 239 295 350 300 436 385 414 52 286 - 344 345 94 246 253 372 185 554 402 141 246 246 153 555 455 8260 8893 Children born 1963- First Visits 86 179 41 150 115 355 106 102 91 156 235 112 1 137 6 207 133 17 46 69 140 105 79 137 7 130 127 138 203 126 3536 4685 Re-Visits 135 238 282 216 54 128 184 274 213 350 118 159 33 237 6 366 140 38 196 47 264 203 463 413 133 241 295 78 351 351 6206 7155 Other children under 5 years - first Visits 246 246 54 271 249 361 388 115 202 223 398 208 7 356 13 232 295 18 93 97 297 149 95 205 9 241 212 209 157 150 5796 7057 Re-Visits 83 141 305 320 50 139 314 367 587 520 242 370 60 575 7 351 194 48 522 83 184 126 449 438 354 343 587 149 294 420 8622 8892 Expectant Mothers - First Visits 3 8 5 21 9 4 11 23 28 62 17 32 — 38 — 13 19 5 13 6 55 — 56 13 11 24 23 27 15 55 596 734 Re-Visits - - 17 6 - 5 5 24 8 22 11 26 — 13 — 14 15 2 2 5 8 1 12 25 9 8 27 3 2 18 288 327 Still Births - - 3 - - ■ - - - I 1 — — — — — — — — — — — — — — — — — — — 10 17 Deaths under 1 year — 1 1 - - - 1 1 - - 1 2 — 1 — - 1 — — — 1 — 2 — — — — 1 — — 13 19 Miscellaneous Visits 136 272 76 115 71 308 182 160 127 115 139 516 10 658 9 122 433 86 308 107 137 24 34 44 47 146 110 52 61 188 4793 8841 Ineffective Visits 119 277 404 276 186 269 192 138 386 340 466 317 48 415 4 287 311 179 161 350 210 61 220 206 111 386 109 362 104 108 7002 7075 TOTALS - 1964 1105 1628 1536 1813 920 1998 1859 1728 2109 2539 2178 2323 228 2885 47 2142 2075 568 1865 1250 1932 901 2126 2169 877 1907 1883 1386 1983 2061 50021 — TOTALS - 1963 1024 11333 2057 1936 1619 2384 1812 2107 2024 3170 2346 2511 — 3799 — 2602 2840 — 1499 1070 2112 970 578 1583 — 2308 1965 946 2858 2306 — 58750 *Includes Health Visitors who left in 1963 ATTENDANCES AT INFANT CENTRES - 1964 Addlngton Wednesday A.M. Addlngton Wednesday P.M. Bensham Manor Monday A.M. Bensham Manor Monday P.M. Boston Road Thursday P.M. Brighton Road Wednesday P.M. East Croydon Tuesday A.M. East Croydon Friday P.M. Falrchildes Friday P.M. Falconwood Wednesday (Alt.) P.M. Lodge Road Thursday A.M. Lodge Road Thursday P.M. Monks Hill Thursday P.M. J Monks Orchard Monday P.M. Norbury Wednesday A.M. Norbury Wednesday P.M. St. Albans Wednesday P.M. St. Andrew's Monday P.M. St. Jude's Tuesday A.M. St. Jude's Tuesday P.M. St. Oswald's Thursday P.M. St. Paul's Friday P.M. Selnurst Monday P.M. Shirley Tnursday 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. Woodstde Friday A.H. Woodside Friday P.M. TOTAL - 1964 TOTAL - 1963 General Practitioner Wednesday P.M. New Cases Born During 1964 104 142 94 142 124 153 109 180 18 29 186 181 40 59 101 111 44 161 84 80 107 145 170 54 150 221 233 53 67 88 146 93 107 141 3917 3733 20 No. of Re-Attendances 952 752 799 930 1236 1315 1028 1418 233 189 1446 1357 269 356 1099 880 199 1227 791 722 879 1096 946 605 1384 1266 1244 269 464 731 827 734 695 671 29009 27210 131 New Cases Under 5 Years 254 298 306 284 280 213 223 297 82 47 250 307 213 179 159 154 15 311 193 201 214 190 173 104 89 128 212 161 200 216 219 125 176 295 6768 4604 60 No. of Re-Attendances 1330 1151 1337 1750 1610 1587 1088 1846 512 393 1335 1304 1031 625 1442 1364 98 1586 1216 1063 1519 1667 1110 689 932 997 1122 541 622 932 875 1012 790 982 37458 31467 298 Consultations with Doctor 1012 836 953 1082 1158 900 778 969 325 279 1295 1261 698 552 899 962 153 1022 929 954 1129 798 760 212 585 952 883 605 612 625 700 607 686 759 26930 22698 250 No. of Sessions 53 53 48 47 50 52 46 50 44 27 53 51 52 47 53 53 15 47 51 49 51 50 45 50 53 50 50 42 48 53 52 53 50 49 1643 1665 39 Total Attendances 2640 2343 2536 3106 3250 3268 2448 3741 845 658 3217 3149 1553 1219 2801 2509 356 3285 2284 2066 2719 3098 2399 1452 2555 2612 2811 1024 1353 1967 2067 1964 1763 2089 77152 67014 509 Average Per Session 1964 49.8 44.2 52.8 66.1 65.0 62.8 53.2 74.8 19. 2 24. 3 60.7 61.7 29.9 25.9 52.8 47.3 23.7 69.9 44.8 42.2 53.3 62.0 53.1 29.0 48.2 52.2 56.2 24.4 28.6 37.1 39.8 37.1 35.4 42.6 47.0 13. 1 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 29.4 24.6 52.2 47.6 56.3 36.9 39.9 50.3 46.1 48.6 22.7 44.2 42.8 51.0 25.7 14.6 33.8 33.2 29.0 26.6 35.6 40.2 *Opened - September 1964 105 106 HOME NURSING Staff at 31.12.64. Superintendent Deputy Superintendent 2 Assistant Superintendents 47 Queen's Nurses (including 6 males) 3 S.E.N. Nurses 2 Queen's Students Summary of work carried out during the year 1964:- Patients remaining on books from 1963 1.009 New Patients 3,241 Total 4,250 New Patients:- Medical 1,784 Surgical 1,427 Gynaecological 17 Obstetric 3 Maternity 10 Total 3,241 Specially classified:- Cases Visits Tuberculosis 72 2,350 Pneumonia 53 607 Maternity Complications 19 181 Infectious Diseases: — typhoid Carrier 1 9 E.R.Y 5 145 Children under five years 72 573 Over 65 years old 2, 588 96,254 Visits: Termination of Cases:- Convalescent 1,943 Hospital 716 Died 411 Removed for other causes 153 Still on books 1,027 Total 4,250 107  Total Visits January 12,797 February 11,772 March 12,215 April 11,961 May 11,514 June 10,878 July 10,783 August 10,502 September 10,135 October 11,107 November 11,151 December 11,161 Total 135,976 REHABILITATION OF ELDERLY PERSONS Patients visited by Rehabilitation Nurse, 1964:- Female 45 Male 16 61 Admitted to hospital 5 Recoveries (Rehabilitated) 29 No success 1 Died 7 Remaining on books 19 Ages: 61 30 - 39 years 3 40 - 49 years — 50 - 59 years 5 60 - 69 years 10 70 - 79 years 21 80 - 89 years 19 90 - 95 years 3 61 Illnesses: Hemiplegia 31 Paraplegia 1 Arthritis, Rheumatism & Pibrositis 17 Fracture of Lower Limb 4 Other Conditions (Parkinson's Disease, Carcinoma, Cardiac & Disseminated Sclerosis 8 108 In the age group 30 - 59 years. 1 case of Fractured Fibula Infra Red and Massage. Patient making steady progress. 3 cases of Disseminated Sclerosis Walking Exercises. All patients walking better. 2 cases of Hemiplegia (1 also with C. A.) 1 patient admitted to hospital, the other is walking better. 1 case of Carcinomotosis Massage & exercises. Treatment given for psychological reasons. Patient deteriorated and died. 1 case of Carcinoma of Lung/Kidney. Massage & exercises. Treatment given for psychological reasons. Patient deteriorated and died. In the age group go - 95 years. 1 case of Fractured Femur Walking exercises. Patient walking fairly well with Zimmer Walking Aid. 2 cases of Arthritis (1 also had a stroke) Walking exercises. Patient with Arthritis only making steady progress, the other is making fair progress considering her condition. 109 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 115 Air beds 1 Bed Pans 154 Bed Tables 8 Bedsteads 5 Bed Pulley 5 Bed Rests 97 Bed Blocks 1 Bed Cradles 31 Commodes 105 Cotton Sheets (draw) 28 Crutches 10 Dunlopillo Cushions 3 Dunlopillo Mattresses 4 Dunlopillo Bath Pillow Nil Enerusis Machines 58 Feeding Cups 8 Fracture Boards 7 Foot Suction Pump 2 Hydraulic Hoists 3 Mackintosh Sheets 74 North Pads 19 Pifco Massager Nil Sputum Mugs 1 Urinals 53 Walking Aids 36 Walking Machines Nil Walking Sticks 1 Wheel Chairs 38 2,250 Incontinence Pads were sold at 4d. each 110 HOME HELP SERVICE Staff at 31.12.64. Supervisor 4 Assistant Supervisors 2 Clerks 11 Whole Time Home Helps 173 Part Time Home Helps Summary of work carried out during the year under review:- Patients remaining on books from 1963 1,304 New Applicants 1,085 Patients carried forward to 1965 1,311 New Applicants (a) Maternity 386 (b) Sickness 799 (c) For Night Service 1 Classification of Cases Attended (a) Maternity 301 (b) Tuberculosis 8 (c) Chronic Sick including Old Age 1,964 (d) Others including Acute Sick 132 Number of Hours of Service Given 203,728 Average Duration of Service Given (a) Maternity 10 days (b) Acute Sickness 10-21 days (c) Chronic Sickness Indefinitely Amount Recovered for Service £6,651. 3. 2 Rate of Remuneration of Home Helps at 31.12.64. 4/4⅞ per hour - Home Helps 4/2⅞ „ - Sick Room Helpers 4/2¼ „ - Washing Service 4/9½ „ - Problem Family Helps £11.0.8d per week - Family Helps 10/-d „ - Disinfestation 111 ISSUE OF WELFARE FOODS Year National Dried Milk Orange Juice Cod Liver Oil Vitamin A S D Tablets 1954 67,391 102,887 18,173 6,248 1955 114,880 195,421 32,000 12,761 1956 111,470 199,582 27,077 13,523 1957 82,632 208,572 22,274 13,169 1958 73,664 129,644 14,744 13,185 1959 68,925 125,594 14,080 13,672 1960 63,217 125,069 13,968 14,123 1961 64,077 85,955 10,301 11,917 1962 61,663 61,610 5,580 8,645 1963 58,637 68,112 5,412 9,057 1964 59,185 73,272 5,224 8,333 M. AND C.W. PHYSIOTHERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year:- Complaint No. of Cases Total M F Bow Legs 2 — 2 Knock Knees and Plat Feet 8 8 16 Valgus Ankles 6 4 10 Asthma 2 3 5 Kyphosis 1 1 2 Torticollis 1 — 1 Pigeon Toes 2 6 8 22 22 44 Total Attendances 1,271 112 DENTAL TREATMENT - M. AND C. W. Expectant and Nursing Mothers Voting Children Number of persons examined during the year 159 364 Number of persons commenced treatment during the year 121 261 Number of courses of treatment completed during the year 136 362 Attendances 355 633 Fillings 106 317 Extractions 113 166 Gas Cases 39 82 Local Anaesthesia 34 10 Scaling and Gum Treatment 82 — Dressings 22 152 Denture Dressings 84 — Silver Nitrate — 108 Number of Sessions (treatment) 243 Dentures Fitted 22 Dentures Repaired 7  Mothers Young Children Mothers Young Children Ante-Natal 147 — South Norwood — — Municipal Midwives 1 — South Croydon — — Post Natal 3 — St. Alban's — — Welfare Centres Woodside — — Municipal 1 — Norbury — — East Croydon 2 2 Addington — 4 Upper Norwood — — St. Andrew's — — Holy Trinity — — Waddon — 3 St. Oswald's — — Boston Road — — Bensham Manor — — St. Jude's — — Fairchildes — — St. John's (Shirley) 1 2 Good Shepherd — — Monks Hill — 1 Falconwood — — Referred by Dental Officers: 277 West Croydon — 1 Mothers: 155 Young Children: 290 Total: 445 113 DEAFNESS Children registered "at risk" during the year - 316 Tested during year at Infant Welfare Centres - 167 Prematurity 100 Rh. Negative mothers 27 Family History of deafness 3 Severe illness in infancy 4 Birth injury 2 Delay in Speaking 7 Jaundice 9 Illness of mother 3 Difficult Labour and Toxaemia 9 Doctor's Request, a) Mongol 3 b) Retarted - c) ?deafness - Of these 149 were found to have normal hearing and no further recommendation was made. Of the remaining 18:- Prematurity 7 6 were referred to Dr. Morgan's Clinic - poor responses. 1 was to be seen, again in 3 months at Infant Welfare Centre (not yet attended). Delayed Speech 5 3 were referred to Dr. Morgan's Clinic 1 is to be kept under observation at Infant Welfare Centre 1 was referred to Mr. Parsons Jaundice 1 1 - Responses poor (retarded) - for further test when condition permits. Rh. Negative Mother 1 1 - To be seen in 3 months, (catarrhal throat infection when tested). Difficult Labour and Toxaemia 2 1 - To be seen again in 1 week (was then referred to Mr. Oakley and from there to Dr. Morgan where hearing was found to be normal). 1 - To be seen in 1 month at Dr. Morgan's Clinic. 114 Suspected Hearing Loss 5 3 - Normal hearing 1 - Referred to Mr. Parsons - Doubtful responses. 1 - To be seen again in 3 months E.N.T. Infections 1 1 - Normal responses - but in view of history to keep under observation for 1 year. Prematurity 15 13 - Normal responses. No further action 1 - Doubtful responses - To come again 1 month. 1 - To come again Mother Deaf 1 1 - Normal responses. No further action. Mother Epileptic 1 1 - Normal responses. No further action. Toxaemia in pregnancy 2 2 - Normal responses. No further action. Cold Syndrome 1 1 - Normal responses. No further action Parent's Request 3 3 - Normal responses. No further action. Referred to Clinic from Infant Welfare Centres 24 Of these:- Doubtful responses to tests in Infant Welfare Centres 10 7 - Normal responses. No further action. 2 - Poor responses - To Mr. Parsons. 1 - To come again in 3 months - Doubtful responses. Delayed Speech 8 5 - Normal responses. 1 - for follow up - retarded 2 - Poor responses - to Mr. Parsons. Referred for retest from Wimbledon (Transfer.) 1 1 - Normal responses 115 Illness of Babe 2 1 - a) Mongol - failed tests - to Dr. Morgan's clinic 1 - b) retarded - Failed tests - to Dr. Morgan's clinic Of the number registered:- Died or removed from Borough 23 Appointments offered - not kept 92 Of these:- Tested in Hospital - Normal 3 Hearing appears normal 5 Parents so far unco-operative 68 Parents refuse test absolutely 16 Children added to register - transfers in from other boroughs:- 19 Prematurity - Birth Weight 5lbs. to 5lbs.8ozs. (NOT included in other figures.) Tested-Normal. 8 Appointments not kept. 8 Removed from Borough. 3 Cases Referred to Dr. Morgan's Special Monthly Session total Number of Appointments sent out during year 99 Non Attendances 36 Of the 63 seen:- Referred to Clinic from sources other than Infant Welfare Centres 39 Pneumonia 2 1 referred to be seen again in 2 months slow responses. 1 - Normal responses Rh. Negative Mothers 4 All four found to have normal hearing No further action. Delayed Speech 3 2 - Normal responses 1 - No responses - to Mr. Parsons Jaundice 1 1 - Normal response 116 Mongol Child 1 1 - Normal responses. Referred back to Clinic from Mr. Oakley (impossible to test) ... 1 1 - Satisfactory responses. Family History of Deafness 1 1 - Normal responses. Jaundice 1 1 - Normal responses. Difficult Labour 1 1 - Normal responses. 117 HOME SAFETY Accidents taken to Hospital by Ambulance during 1964 Type of Accident Under 5 Age Groups 45-64 65+ Sex Total 5-14 15- 44 M F Falls 131 85 64 61 138 213 266 479 Burns and Scalds 30 11 19 7 6 43 30 73 Poisoning 44 2 12 6 11 40 35 75 Suffocation 4 1 2 - - 4 3 7 Miscellaneous 49 68 68 23 11 119 100 219 Totals 258 167 165 97 166 419 434 853 Deaths from accidents in the Home Cause No. Details Falls 19 There were 15 women between 69 and 92 years of age and 4 men over 70 years. Burns and Scalds nil Poisoning 7 5 women between 61 and 95 years of age died of accidental carbon monoxide poisoning. One woman - age 51. died from inhalation of smoke and fumes (carbon monoxide poisoning) One girl - age 1 year - poisoning by migral tablets. Suffocation 2 1 boy - age 19 months - asphyxia from smothering in a plastic bag. 1 man - age 81 years - asphyxia following inhalation of stomach contants. Total 28 118 AMBULANCE SERVICE Classification of Patients, Journeys and Mileage Patients* Journeys Mileage 1964 1963 1964 1963 1964 1963 Health Service Removals 79,871 (77.570) 48,427 (46, 174) 382,808 (356,618) Accidents 5. 501 (4,984) 5, 226 (4,869) 30,048 (26 , 408) Spastics (Bramley Hill) 5,374 (3.416) 476 (454) 13.265 (8,424) Mental Health (Occupational Centre) 42.971 (41. 095) 1, 828 (1. 621) 45. 251 (40,676) London Road Day Centre 3, 046 (3,326) 512 (474) 9,748 (7,398) Services Not Required (Accidents) 552 (327) 2.157 (1, 363) Vehicles to Repair Depots, Testing, etc. 179 (197) 1,368 ( 1,552) Service Requirements, Oxygen, visiting substations, parks, etc. 313 (304) 3,685 (3,727) Major Incident Exercise 246 Civil Defence 136.763 (130.391) 57,513 (54, 420) 488,576 (446,166) 170 (184) 5,210 (2,850) 136,763 (130, 391) 57,683 (54, 604) 493,786 (449,016) *These figures do not represent Individual cases. Classification of Accident Calls 1964 1963 Home Accidents (Children) 443 414 (Adults) 471 552 Miscellaneous Accidents (Children) 17 9 (Adults) 74 30 Recreational Accidents (Children) 114 87 (Adults) 120 88 School Accidents and Illness 321 300 Street Accidents (Children) 232 225 (Adults) 1,342 1,367 Work Accidents 317 300 Home Illness (Children) 62 54 (Adults) 577 389 Street Illness (Children) 13 19 (Adults) 796 699 Work Illness 127 124 119 1964 1963 Attempted Suicide 20 38 Suicide 11 7 Common Assault 169 167 5,226 4,869 Comparison of Patients, Journeys and Mileage since 1959 Year Patients Journeys Mileage 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 1964 136,763 57,513 488,576 Details of Ambulance Service Vehicles Four new Karrier-Dennis ambulances were delivered replacing three Daimler ambulances and one Humber ambulance. Two new Bedford "Utilecon" sitting case vehicles were delivered and two disposed of. The Vauxhall "Wyvern" car was replaced by a new Vauxhall "Victor" car. A new Bedford coach for Mental Health Patients was delivered replacing one of the old coaches. List of Serviceable Vehicles at 31st December 1964 Four Daimler Ambulances Two Karrier Ambulances Two Dennis Ambulances Two Karrier-Dennis Ambulances (Pnuride Suspension) Two Karrier-Dennis Ambulances Ten Bedford "Utilecon" Sitting case vehicles One Vauxhall "Victor" car One Austin Breakdown vehicle Three Bedford Coaches (Large) (Mental Health) Two Karrier Coaches (Mental Health) Two Karrier Sitting case vehicles One Karrier Coach Total Mileage of Ambulance Vehicles at 31st December 1964 Daimler Ambulances LRK 555 1953 190,511 NBY 501 1954 221,187 0RK 9. 1955 186,879 0RK 8 1955 192,726 120 Karrier Ambulances WVB 293 1959 77,532 1110 BY 1960 48,821 Dennis Ambulances 1883 VB 1962 52,407 5261 RK 1962 55,329 Karrier-Dennis Ambulances 60 BOY 1964 21,990 59 BOY 1964 21,278 756 DOY 1964 4,148 757 DOY 1964 4,236 Austin Breakdown (Since 1955/6) GLR 801 1940 16,969 Karrier Coaches (Mental Health) 3111 RK 1961 27,138 1547 RK 1961 29,317 Karrier Coach WVB 291 1959 73,060 Karrier Sitting case vehicles 802 AOY 1963 16,248 807 AOY 1963 15,689 Bedford "Utilecon" Sitting case vehicles UBY 329 1958 119,859 UBY 325 1958 123,213 WBY 247 1959 108,917 4676 BY 1961 75,974 3117 RK 1962 58,885 4181 VB 1963 45,283 51 BOY 1963 22,176 53 BOY 1963 23,372 16 DBY 1964 9,426 17 DBY 1964 9,016 Vauxhall "Victor" car 42 CBY 1964 5,892 Bedford Coaches (Mental Health) KRK 252 1952 124,121 350 AVB 1963 11,652 932 EBY 1964 1,193 121 Nursing Homes - Nursing Homes Act, 1964. Number of Homes Number of beds provided for:- Maternity Others Total Hones registered during the year - - - - Homes on the Register at the end of the year 12 10 313 323 There were no changes during the year under review. NURSES AGENCIES REGULATIONS, 1945 There is one agency on the Register which supplies nurses for home nursing on a private patient paying basis. 122 CREMATION ACTS, 1902 and 1952 During the year 2,429 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 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 1964 2,429 PUBLIC MORTUARY AND CORONER' S POST MORTEM ROOM 1964 Total number of Bodies received 605 Total number of Post Mortem Preparations 558 Total number of Post Mortem Examinations for Coroner 557 Total number of Post Mortem Examinations for Medical Officer of Health 1 COMMUNICABLE DISEASES NOTIFIED DURING 196 4 Notifiable Disease Cases notified Total cases notified in wards At all ages At ages - years Upper Norwood Norbury West Thorn ton Bensham Manor Thornton Heath South Norwood Roodside East Addiscoabe Whitehorse Manor Broad Green Central Vaddon South Addington Shirley M F Total Under 1 1 - 4 5-14 15 - 24 25 - 44 45 - 64 65 and over Scarlet Fever 142 1 44 93 4 - - - 11 4 8 5 13 9 6 4 16 4 9 3 12 13 21 4 74 68 142 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 14 - - - - 4 5 5 1 - - 2 1 3 - - 2 - - 1 - - 4 - 6 8 14 Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric and Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 10 - - - 8 2 - - - - - - - - 3 - - - 7 - - - • - - 10 10 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis • - • - - - - - - - - - • - - - - - - - - - - - - - - Dysentery 103 2 22 46 8 18 7 - 15 2 - 5 6 3 21 16 23 2 - 1 - - 9 - 55 48 103 Malaria — - — - • - - - - - - - • - - - - - - - - - - • - - Acute Primary and Influenzal Pneumonia 13 - 1 2 1 1 3 5 - 1 - 4 2 - 2 - - - 1 - 1 - - 2 7 6 13 Food Poisoning 65 2 15 11 14 8 11 4 8 5 2 6 5 5 7 2 12 - 3 1 5 2 2 - 28 37 65 Acute Encephalitis - - • - - - - - - - - - - - - • - - - - - - - - - - - Measles 1456 39 661 745 7 4 - - 66 82 40 87 147 196 82 41 1ll 28 41 15 27 28 316 149 787 669 1456 Whooping Cough 3 28 30 147 144 3 4 - - 17 18 22 7 41 23 15 21 27 9 13 20 36 14 27 18 151 177 328 2131 74 890 1041 45 41 26 14 118 112 72 116 215 239 136 84 191 43 74 41 81 57 379 173 1108 1023 2131 The tuberculosis notifications are shown In the section relating to that disease 123 132 124 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1964 Noti fiable Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec.. Total Respiratory Tuberculosis 7 8 6 8 11 9 5 6 13 4 7 6 90 Non-Respiratory Tuberculosis . 1 . _ - 4 - . 1 3 1 - 10 Scarlet Fever 5 11 18 10 13 19 10 4 2 16 18 18 142 Diphtheria - - - - - - - - - - - - - Erysipelas 1 2 - 1 1 1 1 - 2 2 2 1 14 Meningococcal Infection - - - - - - - - - - - - - Enteric and Paratyphoid - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Puerperal Pyrexia - - 2 - - 1 - - 3 1 3 - 10 Ophthalmia Neonatorum - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - Dysentery 9 5 6 3 26 17 2 4 8 - 2 21 103 Malaria - - - - - - - - - - - - - Ac. Pri. and Ac. Inf. Pneumonia 2 3 2 _ - - . _ - - 2 4 13 Pood Poisoning 10 1 1 5 8 13 3 8 11 4 1 2 65 Acute Encephalitis - - - - - - - - - - - - - Measles 34 27 35 55 14 19 14 43 41 149 276 749 1456 Whooping Cough 17 18 43 62 33 42 37 22 31 12 5 6 328 2231 125 DETAILS OF CASES ADMITTED TO WADDON HOSPITAL Gastro-enteritis:- 102 cases were admitted in the following age groups: - Under one year - 47; 1-4 years - 36; 5 - 15 years - 2; adults - 17. 13 were gravely ill, 44 moderately severe and 40 were mild cases. Except for two cases each of E. Coli 055 and staphylococcus aureus and one case each of E. Coli 0111 and E. Coli 026, no pathogens were isolated from faecal culture. Associated illnesses were 6 cases of bronchitis, 5 cases of anaemia, 2 cases each of otitis media and rhinitis and one case of eczema, severe napkin rash, thrush, thrombosis, Parkinsonism, and post auricular abscess. There were no deaths. Measles: - The 43 cases of measles were due to an early start in the current epidemic. No cases were admitted in the year up till September. 3, 6, and 5 cases were admitted in September, October and November respectively. During December the epidemic got under way and 29 cases were admitted. The numbers in the different age groups were:- under one year - 4 cases; 1-2 years - 9 cases; 2-4 years - 19 cases; 5-15 years - 11 cases; adults nil. The following complications were present:- pneumonia 18 cases, bronchitis 5 cases, enteritis 3 cases, tonsillitis 3 cases and one case each of encephalitis, epistaxis, anaemia, post-auricular fissure and blepharitis. There were no deaths. Whooping Cough:- 36 cases were admitted in the following age groups:- Under one year - 16; 1-2 years - 8 cases; 2-4 years - 7; 5-15 years - 3; and adults 2 cases. 29 of the 36 patients were admitted in the first seven months of the year. Complications were present as follows:- bronchitis - 10 cases, pneumonia - 9 cases, lobar collapse 2 cases, and one case each of emphysema and subconjunctival haemorrhage. Associated conditions present were anaemia 2, drug poisoning 2 and one case each of cerebral spasticity and haemoglobinopathy. Dysentery: - 34 cases, all of the Sonne type, were admitted. There were no severely ill cases. They were in the following age groups:- 0-1 years - 1; 1-4 years 16; 5-15 years 9; and adults - 8 cases. They tended to occur in spasmodic outbreaks. Thus in April there were 7 cases. In September 8 cases, and in December, ll cases. 22 cases came from childrens' homes or other communal dwellings, 6 cases from their own homes, 4 cases from hospital and two cases from residential schools. Of the intestinal antibiotics in common use, the dysentery bacilli were resistant to tetracycline in 4 and streptomycin in 3 cases. There were no old people admitted this year the oldest being 37 years. Co-existing illnesses were bronchitis 2 cases and one case each of anaemia and valvular heart disease. 126 Scarlet Fever: - 30 patients were admitted in the following age groups:- 0 - 4 years - 5; 5 - 15 years - 24; and one case 16 years of age. Of the 24 five to fifteen year olds, 16 were 5 or 6 years of age. Thus the preponderence of cases were of the early school age. Months of greatest prevalence were March, October and November during which 20 of the 30 cases were admitted. Complications were bronchitis - 2 cases and one case each of boils, sores on nostrils, cracked lips and transient albuminuria. Chicken-pox:- 18 cases were admitted in the following age groups:- 0-4 years - 7; 5-15 years - 4; adults - 7 cases. 13 of the patients were admitted in the first 3 months of the year. Most of the adults were members of the hospital nursing staff. Complications consisted of two cases of bronchitis and conjunctivitis and one case each of tonsillitis, stomatitis, adenitis and tetany, co-existing illnesses consisted of one case each of spastic paralysis, tuberculosis and foreign body in the eye. Infective Hepatitis:- Of the 17 cases admitted 3 were severe. Two of the severe cases, both male adults, had a long relapsing jaundice and were in hospital 82 and 103 days respectively. They were treated with corticosteroids. The patient who was in hospital 82 days had still slight jaundice on discharge from hospital. The third severe case, a woman of 30 years, became comatose the day after admission and died within four days. Pneumonia: - 15 cases were admitted in the following age groups: 0-1 year - 7; 1-4 years - l; 5-15 years - 2; and adults 5 cases. There were four deaths at the ages of 5 weeks, 10 months, 1 year and 75 years respectively. The 5 weeks old child bad congenital coarctation of the aorta, the ten months old child was a inongol, the 1 year old was admitted in a comatose condition and died the same day and the 75 year old man had hyperpiesia and heart block. Other Infections:- The meningitis cases consisted of three patients with pyogenic meningitis of uncertain origin, two patients with pneumococcal meningitis, two patients with aseptic meningitis, one patient with meningococcal meningitis and one patient with haemophilis influenza meningitis. The three cases of uncertain pyogenic origin had all had antibiotics before admission. The haemophilis influenza meningitis got paralysis of an arm which recovered. The other patients also made a good recovery. Of the eight salmonella infections, four were salmonella enteritidis isolated in August from members of the same family. Two salmonella Brandenberg infections were isolated in June and two salmonella typhi-murium infections in September. 127 SAMPLES SUBMITTED TO THE PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION - 1964 Faeces outfits 1,428 Drinking Water samples 253 Public Swimming Bath Water samples 111 Private Swimming Bath Water samples 103 Private Wells 84 Milk samples 201 Cream samples 16 Ice Cream samples 112 Sundry Food Specimens 28 Blood 31 Urine 29 Nose and Throat Swabs 12 Total 2,408 Samples of Drinking Water During the year under review the total number of examinations performed were:- Bacteriological 253 Chemical 12 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. 128 IMMUNISATION AGAINST WHOOPING COUGH A total of 3,720 children were immunised against whooping cough, comprising 3,656 under school age and 64 school children. In addition 878 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 3,865 children were immunised against Tetanus, comprising 3, 682 under school age and 183 school children. In addition 3,470 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 2,573 persons were vaccinated against Snall-pox. Under 1 year of age 1 2-4 5 - 14 15 or over Total Successful Vaccinations 71 1,367 629 51 99 2,217 Successful Re-vaccinations - - 20 55 254 329 Insusceptible to Vaccination 2 5 18 2 - 27 2.573 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 3ist December, 1964 who completed a course of Immunisation during the year. Age at 31.12.64 i.e. Born in Year Under 1 1964 1960-1963 1955-1959 19S0-1954 Total Completed course of inj ections 529 3. 136 92 43 3,800 Reinforcing Injections - 515 3,850 326 4,691 Total 529 3.651 3. 942 369 8,491 Estimated mid year child population 4. 620 16.580 34.400 55,600 129 DIPHTHERIA IMMUNISATION This year, the 30th anniversary of the commencement of public clinics offering diphtheria immunisation in Croydon, the total numbers of children immunised exceeded all previous figures. DIPHTHERIA PRIMARY BOOSTER TOTAL 5/2/1934 185 - 185 1835 781 - 781 1936 1, 264 - 1, 264 1937 1, 222 - 1, 222 1938 1, 152 - 1, 152 1939 1, 201 - 1, 201 1940 419 - 419 1941 5,833 . 5,833 - (Commencement of Publicity Campaigns) 1942 5, 511 - 5, 511 1943 5,854 - 5,854 1944 1,851 - 1,851 1945 2,707 - 2,707 1946 3,934 32 3,966 1947 3,638 641 4. 279 1948 3,704 1,667 5,371 1949 4, 216 2,898 7, 114 1950 3, 014 4, 512 7,526 1951 3, 436 2.921 6, 357 1952 2,833 3, 144 5,977 1953 2,634 1,775 4, 409 1954 2,824 2,373 5, 197 1955 2. 459 1,637 4,092 TETANUS TOXOID 1956 2, 969 2, 094 5,063 PRIMARY BOOSTER TOTAL 1957 2. 297 865 3. 162 1, 137 19 1, 156 1958 2,309 738 3, 047 1,647 67 1,714 1959 2, 461 978 3, 439 1,727 169 1, 896 1960 4. 137 3,786 7, 923 3, 016 498 3, 514 1961 4,635 2,917 7, 552 .4,207 1, 254 5, 461 196 2 3, 103 1, 286 4, 389 3, 017 1,014 4, 031 1963 3. 086 4,073 7, 159 3, 060 2. 015 5, 075 1964 3,800 4,691 8, 491 3,865 3, 470 7,335 130 VACCINATION AGAINST POLIOMYELITIS The following table gives the number of persons who received a course of primary vaccination during the year. Vaccinated Children born 1964 Children born 1963 Children born 1962 Young persons born 1961-44 Persons born 1943'34 Persons over 30 years of age With Salk Vaccine 108 21 9 6 3 17 With Oral Vaccine 2406 448 236 543 173 416 With Quadruple Vaccine 99 20 5 8 3 - Number of persons who received a reinforcing vaccination as at 31st December, 1964 Vaccinated Persons given a first reinforcing Vaccination during 1964 Persons given a second reinforcing Vaccination during 1964 With Salk Vaccine 221 140 With Oral Vaccine 92 3,911 With Quadruple Vaccine 56 39 Annual Total 369 4,090 TOTAL since Vaccination began 82,996 27,508 INTERNATIONAL VACCINATION CERTIFICATES During the year 2,894 certificates were authenticated, 2,474 anallpox, 308 Cholera, 78 T. A.B., 34 Yellow Fever. 131 132 TUBERCULOSIS The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) Tuberculosis (All Forms) 0-15 years Ail ages 0-15 years All ages Year Number of Deaths Death rate per thousand of population • Number of Deaths Death rate per thousand of population • Year Number of Deaths Death rate per thousand of population * Number of Deaths Death rate per thousand of population  1924 18 - 188 0.96 1945 9 - 92 0.46 1925 27 - 181 0.91 1946 7 - 105 0.47 1926 27 - 208 0. 01 1947 4 1.08 105 0.44 1927 15 - 203 0.96 1948 3 0. 06 111 0. 45 192 8 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..0 2 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 195g - ■ - 25 0.10 1939 6 - 107 0.40 I9 60 - - 20 0.08 19 40 8 - 146 0.74 196 1 - - 21 0.08 1941 10 - 111 0.59 196 2 - - 14 0.06 1942 8 - 116 0.63 1963 - - 21 0.08 1943 9 - 120 0.62 196 4 - - 11 0.03 1944 9 - 105 0.57 'Prior to 1947. rates only available for Census years 133 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1964 to 31st December, 1964. TABLE I Formal Notification Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total fail ages ) Respiratory, Males - - 2 1 1 1 9 9 9 16 10 5 1 64 Respiratory, Females - - 2 1 2 3 4 3 6 4 1 - - 26 Non-Respiratory, Males - - - - - - - 3 2 - 1 - - 6 Non-Respiratory, Females - - 1 - 1 - - 1 - - - - 1 4 TABLE II. Supplemental Return New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1964 to 31st December, 1964 otherwise than by formal notification: - RESPIRATORY NON-RESPIRATORY Males Females Males Females 27 17 3 3 134 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1964 1,634 Transfers in from other areas 42 "Lost sight" cases returned during the year - New cases diagnosed as definite during the year 91 1,767 Number of cases written off the Chest Clinic Register during the year as: - Recovered 245 Died 26 Removed to other areas 48 "Lost sight of" and other reasons 22 341 Remaining on Register as at 31st December 1,426 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 2,453 Number of visits paid by Clinic doctors to homes of patients 213 Number of visits paid to homes of patients by Tuberculosis Health Visitors 2,094 Attendances of patients at the Clinic- At ordinary sessions 17,344 Number of X-Ray films taken 19,234 *Includes 4,588 miniature film attendances 135 136 VENEREAL DISEASES Totals Males Females I. NEW CASES OF SYPHILIS (i) Primary - - . (ii) Secondary 2 2 . (iii) Latent In the first year of Infection 2 2 - (iv) Cardio-vascular - - . (v) of the nervous system 1 - 1 (vi ) All other late and latent stages 14 9 5 (vii) Congenital aged under 1 year 1 - 1 (viii) " " 1 but under 5 years - - . (ix) " " 5 but under 15 years - - . SYPHILIS (x) " " 15 and over 5 2 3 2. TOTAL OF LINES INCLUDED IN 1 25 15 10 3. AGE GROUPS OF CASES IN ITEM 1(i) and (ii) ABOVE ' AGE GROUPS Under 16 - _ - 16 and 17 _ - 18 and 19 - . - 20-24 - - - 25 and over 2 2 - 4. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLAND AND WALES AFTER DIAGNOSIS 1 1 5. CASES IN WHICH TREATMENT AND OBSERVATION WERE COMPLETED 6. NEW CASES OF GONORRHOEA 108 78 30 7. AGE GROUPS OF CASES IN ITEM 6 ABOVE AGE GROUPS GONORRHOEA Under 16 m . - 16 and 17 8 2 6 18 and 19 20 10 10 20-24 19 15 4 25 and over 61 51 10 8. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLAND AND WALES AFTER DIAGNOSIS - - - 9. CASES IN WHICH TREATMENT AND OBSERVATION WERI COMPLETED 75 60 15 137 [???] Totals Males Females 10. NEW CASES OF OTHER CONDITIONS (i) Chancroid . . (ii) Lymphogranuloma Venereum - (iii) Granuloma Inguinale - » - (iv) Non Gonococcal Urethritis 167 167 - (r) Non Gonococcal Urethritis with Arthritis 1 1 - (vi) Late or Latent Treponematoses presumed to be non-Syphilitic 12 - 12 (vii) Other conditions requiring treatment within the centre 210 130 80 (viii) Conditions requiring no treatment within the centre 256 141 115 (ix) Undiagnosed conditions 32 20 12 11. TOTAL OF LINES INCLUDED IN 10 678 459 219 12. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLAI* AND WALES AFTER DIAGNOSIS ID . _ 13. CASES IN WHICH TREATMENT AND OBSERVATION WERE COMPLETED 581 402 179 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 - - - 25 and oyer 2 2 - (ii) Gonorrhoea AGE GROUP Under 16 - - - 16 and 17 8 2 6 18 and 19 19 10 9 20 - 24 18 14 4 25 and over. 59 49 10 138 Totals Males Female 15. LOCALITIES IN WHICH INFECTIONS TOOK PLACE (i) Primary or secondary Syphilis (a) In locality of Centre 1 1 - (b) Elsewhere in Great Britain and Northern Ireland - - - (c) Outside Great Britain and Northern Ireland - - - (d) Not known 1 1 - (ii) Gonorrhoea (a) In locality of Centre 15 10 5 (b) Elsewhere in Great Britain and Northern Ireland 17 10 7 (c) Outside Great Britain and Northern Ireland 1 1 (d) Not known 75 58 17 16. ATTENDANCES AND DIAGNOSES OF CONTACTS (i) Contact slips issued to patients with (a) Syphilis, primary and secondary - ♦ - (b) Gonorrhoea 22 22 - (ii) Contacts attending with (a) Syphilis, primary and secondary - - - (b) Gonorrhoea 11 11 - (c) Other conditions 46 46 - 17. TOTAL ATTENDANCES OF ALL PATIENTS (i) syphilis 699 481 218 (ii) Gonorrhoea 419 216 203 (iii) Other conditions 3.032 2. 163 864 (ir) ALL CONDITIONS (TOTAL OF 17(i). (ii) and (iii) 4. 150 2,865 1,285 18. Cultures for the Gonococcus 532 2 530 Services Rendered at the Treatment Centre during the Year-showing the Areas in which Patients dealt with for the First Time (Items 2, 6 and 11) resided. County, County Borough (England and Wales) and Others Syphilis Gonorrhoea Other Conditions Totals Croydon 23 60 425 508 Surrey 2 22 140 164 Kent - 6 50 56 London - 18 59 77 Others - 2 4 6 Totals (to agree with Items 2.6 and 11) 25 108 678 811 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1964 To the Chairman and Members of the Education Committee LADIES AND GENTLEMEN, This is the 61st and final Annual Report of the work of the School Health Service in the County Borough of Croydon. The Service began in January 1904 when the appointment of the Medical Officer of Health as Medical Adviser to the School Board was confirmed by the County Borough Council. In the early years infectious disease and infestation were prominent in the reports. In 1904, 17 separate school departments were closed at least once because of measles - a step not considered necessary during the past year despite the anticipated prevalence in the Autumn Term. Infestation has also ceased to be a significant problem only 1.1% last year compared with some 40% sixty years previously. School Medical Inspections Routine school medical inspections were introduced in 1908 when national legislation made such examinations compulsory. Some exceptions were made if "complete examinations were likely to be resented" or where there was "lack of privacy". A total of 3,659 children were inspected in 1908 and the attendance of parents was 35%. In 1964, 12,798 children were examined and 52.3% of the parents attended. 2 Originally Croydon had experimented with a form of selective inspection. In 1905 measurements of height and weight were made in selected schools in the hope that such preliminary investigations might reduce the number of children "concerning whom an expert medical opinion was desirable" to 25% of the total. The current Report includes a summary of an experiment in selection from which I must conclude that at present the general inspection of all children is to be preferred to the selective examination of a smaller number. Dental Health In 1905, defective teeth were found amongst 75% of the children who were medically examined. Although this figure is not strictly comparable, the Principal School Dental Officer's observation that 33. 5% of the children inspected last year were referred for treatment does indicate the improvement which has taken place, especially since it continues the downward trend of recent years. Nevertheless determined dental health education will be necessary to counter the rising consumption of refined sugar which is an important factor in the aetiology of dental caries. Health Education The very first annual report to the Education Committee drew attention to the need for hygiene and the simple rules of health to be taught in schools. The view was expressed that teachers should be taught hygiene and pass an examination in the subject. It is disappointing that even today, health education is not a compulsory subject in the examinations at some Teacher Training Colleges. In Croydon we enjoy the confidence of most teachers and I am convinced that this comment from 1904 is just as apposite today:- "Until the whole subject is grasped by the teachers very little can be done, as the appointment of mere peripatetic instructors will have comparatively little effect on the habits of the children and on the school atmosphere". During 1964 preliminary discussions between officers of the Health and Education Departments have attempted to define a comprehensive programme of health education which could be integrated into the general life of the schools. Handicapped Pupils In 1907 a special auxiliary class for backward children was created at Vthitehorse Road and after a transfer to Grange Wood, this became St. Christopher's School for educationally subnormal pupils. This year the Head Master draws attention to the need for more day places for children in this category and this is a matter which must command the urgent attention of the new Borough. Other forms of learning difficulty are now recognised and these are usually referred by the medical officer to the School Psychological Service for further investigation. 3 In 1922, a class was established at Woodside School where "during the Summer 30 children selected from those who have some physical disablement have their lessons in a shed in the playground". Three years later a school for 40 physically defective children was opened adjacent to Winterbourne School and when it was moved to Addington, St. Luke's School was established from a special class for myopic children which had been created in Thornton Heath Library. The provision of additional accommodation on the St. Giles' site so that St. Luke's School may be transferred there was made possible by one of the last decisions taken by the County Borough. The work of the Unit for maladjusted children was extended, in spite of staffing difficulties, by the formation of an additional class. Partially hearing children have been less fortunate: although the unit in Kingsley Infants' School which was opened in 1964 has been very successful, the anticipated opening of a second unit for Junior School children later in the year did not take place owing to the lack of a suitable teacher. The Chief Education Officer and his staff have been most generous in their advice and help, and special thanks are due to Head Teachers for continued co-operation. I am particularly grateful to my deputy, Dr. Horner, who deals with the detailed medical administration of this service, for enthusiasm, initiative and efficiency in the discharge of these heavy responsibilities. Finally it is my pleasure to thank once again the Members of the Committee for their essential support and encouragement which provide the basis for all progress and development. Public Health Department, Croydon. 4 STAFF OF THE SCHOOL HEALTH SERVICE •Medical Officers 8 (full time) (40%) •Medical Officers 8 (part time) •Dental Officers 9 (including 3 part-time) - (80%) •Physiotherapists 4 (including 1 part-time) Speech Therapists 5 •School Nurses and Nurse/Assistants 37 (including S.H.V. and Deputy] 1(59%) •Dental Attendants 11 (including 4 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 as at 31. 12. 1964. 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 Principal 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 Tharsday, 9 a.m.). Rockmount School, Rockmount Road, Upper Norwood. (Monday and Thursday. 2 p.m.). Waddon Clinic, Coldharbour Road, Waddon. (Daily, Monday to Friday. a.m.). Salcot Crescent, New Addington. (Daily, Monday to Friday, a.m.). Dental Lodge Road, Broad Green, Croydon. 206, Selhurst Road, South Norwood. Overbury School, New Addington. Shirley Road, Croydon. Waddon Clinic, Coldharbour Road, Waddon. Inspection Lodge Road, Broad Green, Croydon. Weekly. Salcot Crescent, New Addington. Once a month. Rockmount School, S. E. 19. Once a month. Ashburton School, Shirley Road, Croydon. Once a month. Waddon Clinic, Coldharbour Road, Waddon. Remedial Exercises and Massage 47, St. James's Road, Broad Green, Croydon. Dally at 1 p.m. Salcot Crescent, New Addington, Weekly. Speech Defects 47, St.James's Road, Broad Green, Croydon. Salcot Crescent, New Addington. Waddon Clinic, Coldharbour Road, Waddon. Audiology Clinic Lodge Road, Broad Green, Croydon. Salcot Crescent, New Addington. Thursday p.m. Enuresis Lodge Road, Broad Green, Croydon. Weekly. Salcot Crescent, New Addington. Once a month. 5 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is as follows:- Primary and Modern Secondary Schools (l) Entrants i.e., Children admitted for the first time to a maintained school and not already examined as Entrants, i. e. normally between 5 and 6 years (2) 8-Year-old. Group i.e., Children in their second year in a Junior School, unless previously examined in the Junior School. (3) Entrants to Secondary School i.e., Children in their first year in a Secondary School who have not already been examined as Primary Leavers. (4J Final Leavers i.e., Children in their last year of attendance at a Maintained Secondary School who have not been medically examined in that year. (5) Special Cases i.e., 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 12,798 children were examined as compared with 12,806 in 1963, and 6,696 parents attended the examinations. The total percentage of parents attending was 52.3 against 49.0 last year. (See Appendix B, Table VIII) 549 special inspections and 547 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 Secondary Schools The established Community Health, Nursing and Parentcraft Courses in Grammar and Secondary Schools continued satisfactorily during the year and an increasing number of teachers visited the Health Education Section for information and a preview of various visual aids. Primary Schools Evening sessions on "Growing Up" continued to be held for the parents of boys and girls in the fourth year. These were followed as usual by second sessions a week later for mothers and daughters only. Home Safety talks were given to some parent-teacher associations and Pierre Picton, the television clown, emphasised care with fireworks during performances at ten junior and infant schools. Six schools were also visited by the Oral Hygiene Service. With the co-operation of the headmistress and health visitor at Wolsey Infants' School, New Addington, one of the school medical officers undertook an excellent piece of health education. During a series of entrants' examinations he had observed a number of ear infections. An invitation was sent to each parent to return on the last day for a half-hour talk and short films on the prevention of these conditions. Seventy-four mothers attended at 3.00 p.m. and were in the school and able to collect their children at 3.30 p.m. to take them home. Because the doctor had examined their children, the mothers felt he had a personal interest in them and were only too happy to come and listen to his advice. Smoking and Health Following a year when no particular emphasis was put on this subject, a concentrated effort was made again in Secondary Schools. Sessions with the new film "Smoking and You" followed by discussion were held in thirty Secondary Departments. Selhurst Girls' Grammar School organised a week's campaign making use of a survey among staff and pupils, a poster campaign, displays and a series of lectures and discussions. 7 The film "The Snoking Machine" made for Primary Schools was successfully pre-tested in two schools. It has since been purchased and it is hoped that it will be shown generally by 1965. Venereal Diseases Information continued to be given during the talks to parents on "Growing Up", to Secondary School and Grammar School children taking the Community Health Course and to teachers in some schools during special lunch-time sessions. Other teachers visited the Health Education Department for information and a preview of visual aids. Miscellaneous During the year a small working party from the Health and Education Departments began planning a health education guide for teachers. This is based on the mental, physical and social growth and development of children and will be offered to Head Teachers for discussion during 1965. 8 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 VII. 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: At the primary inspections vermin were found in 16 and nits alone in 564 children. On these inspections 1.1 per cent of the children showed evidence of infestation as against 1.3 in 1963. Parents are advised as to the best method of dealing with the infection. 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) 53,265 Number of children inspected (subsequent inspections) 2,284 Number of children found unclean for the first time in 1964 Number of occasions in which children found unclean (subsequent inspections) 435 239 5 children attended the Cleansing Station for treatment for scabies. 9 TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Number of cases of Notified Tuberculosis:- Pulmonary 5 Non-Pulmonary 1 Taking the total child population at 41,000 (estimated), the pulmonary tuberculosis incidence rate per 100,000 was 12.2, and the non-pulmonary 2.4. 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 6 in 1964 equal to a death rate for this group of 0.15 per thousand. This was a record low figure and the details were:- Congenital Heart Disease 1 Bronchial Asthma 1 Motor Accidents 2 Murder 2 Total 6 CAUSES OF EXCLUSION FROM SCHOOL During 1964, Mumps, Chicken Pox and Measles were the specific infections causing the most absences from school. The detailed figures given in Appendix D, Page 50 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 The Health Visitor/School Nurse with the help of her assistant, the State Enrolled nurse, has carried out her full range of duties under the School Health Service. Her relationships with members of the teaching staffs have been good and have gone a long way in helping the children get the best out of their school years. 10 SCHOOL DENTAL SERVICE, 1964. 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 Health Schemes. Particulars of work carried out in connection with the above will be found in the appropriate Report. Among the many concrete benefits conferred by the National Health Service not the least has been the widening of responsibility for the dental care of the young. Whilst the above was first discernible in relation to the General Practitioner's Service, the progressive "easing of the load" has, over the years, led to welcome changes in many local authority services, though this impact has varied considerably throughout the country. At the local level there has been a noticeable improvement in the "climate" at school clinics in that, because of the great reduction in the amount of emergency work requiring to be dealt with, attention can now more effectively be focused on the essential task of providing full and comprehensive treatment for all entering the scheme. A continuation of the above trend could do much to reduce existing staffing difficulties and allow for other much needed developments. As noted in the comparative Table included at a later stage of this Report, a further and encouraging sign has been the continued reduction in the percentage of pupils found to require attention at routine school inspections. Whilst not wishing to detract from present achievements, it should be appreciated that this advance has come about primarily as the result of an increase in treatment and does not necessarily point to any reduction in the rate of dental decay. Measures to meet this more complex problem have already received attention in these pages and must remain the true objective of our work. Since its expansion of the post-war period to meet the needs of the newly developed areas, activities in the dental services have been principally directed towards the upgrading of the older clinics and improving facilities in districts where, because of the unprecedented rise in the school population, coverage has been considerably restricted. During the current year further progress has been possible in removing those anomalies and establishing a more uniform pattern of treatment. 11 In more established areas a much more satisfactory balance has now been obtained and six monthly "call ups" are now the order of the day. Though slightly below that recorded during the previous year, routine school inspections for the Borough as a whole covered just under 90 per cent, of the child population and represents a substantial attainment. Since the opening of the Coldharbour Centre public interest in the Service has again increased and results obtained at individual school inspections have been generally encouraging. In liaison with the Health Education Section attention continues to be paid towards improving the quality of dental instruction in Infant and Junior Departments, and securing a fuller utilisation of existing personnel. The solution to this and other current problems were among the subjects discussed at a joint meeting of medical and dental staff held earlier in the year. To stimulate interest of those Teachers working with the younger age groups, an exhibition of "visual aids" and other material was mounted at one of their periodic gatherings. Experience over the whole field of this work would seem to indicate that because of the tightness of the curriculum at more advanced levels, the time which can in practice be made available for non-academic study is strictly limited, and fullest advantage must therefore be taken of the early and formative years in Education. During the summer a modest campaign for improved dental health was held in the South Norwood area, supported by a visit by the Oral Hygiene Service Van to some dozen schools. Activities of a similar nature will, it is hoped, be possible in other districts of the Borough during 1965. Though there has been much genuine support for this idea, little positive action has, unfortunately, been possible to last year's suggestion for a special "Health" grant to assist the regular distribution of apple "slices" at the end of school meals, one unforesoon difficulty would appear to be considerable price fluctuations occurring in any one season, irrespective of the quality of the crop. As an interim measure, parents visiting clinics are being urged to try out this simple "routine" in their own homes, as a practical step to improved oral hygiene. Inspections The number of children on the register at maintained schools within the Borough at the close of 1964 was 35,885. As the result of illness among the dental staff rather less schools were visited during the year. 12 During the year 87.6 per cent, of the school population were examined, compared with 89.4 per cent, in 1963. According to recent returns 1,870 children remained unexamined during 1964, compared with 1,636 last year. At those schools visited 31,460 were inspected and 10,548 (33.5 per cent.) referred for treatment, compared with 32,416 inspected and 11,247 (34.7 per cent.) referred in 1963. Because of discrimination exercised in the matter of certain conditions deemed inadvisable to treat, the above figure should not be regarded as an index of the actual incidence of decay. Hie results obtained from school inspections were as follows: - Acceptance of Treatment 35.5% Refused Treatment 48.9% Forms Not Returned 15.6% Prom the above figures it will be seen that rather less children were found to be in need of treatment at school inspections. After a fall in the acceptance rate over a number of years, this has now slowed down very considerably and during the current year there has once again been a small increase. As mentioned earlier in the Report the ensuing Table is of interest in showing the various trends since the pre-war period. RESULTS OF SCHOOL INSPECTIONS 1964 1963 1960 1949 1937 No. referred for Treatment 10,548: 11,247: 11,752: 9,404: 13,498: 33. 5% 34.7% 46.3% 45. 9% 76% Consents 3,745: 3,974: 4, 586: 6,996: 7,762: 35. 5% 35. 3% 39% 74. 4% 57.7% (Total Consents Including Specials)* 4,729: 5,174: 6,542: 10, 098: 10,146: 44. 8% 47% 47. 7% 80.7% 63% Refusals 5,164: 5,625: 5,531: 1,213: 3,242: 48.9% 50% 47% 12.9% 24% Forms Not Returned 1,639: 1,648: 1,635: 1,195: 2, 494: 15.6% 14. 7% 14% 12. 7% 18.5% *Specials - Those referred by Head Teachers with Emergency Forms. 13 This comparative Table is of interest in demonstrating the progressive reduction in the percentage referred for treatment at routine inspection 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 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 11,532 children referred for treatment (including specials) 5,929 (51.4 per cent.) were treated and 4,133 (35.8 per cent.) cured completely, compared with 12,447 referred, 6,803 (54.5 per cent.) treated and 5,145 (41.3 per cent.) cured in 1963. Treatment sessions at 2,572 were similar to those recorded during the previous year. Thpugh during more recent years the numbers visiting the Clinics have progressively decreased, this has resulted in a corresponding change in the pattern of treatment, and permitted a higher level of conservation for the individual child. 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. As a direct result of the reduction of clinical commitments, increased time is now available for the carrying out of routine school inspections. Whilst as stated there has been an overall improvement in the mouths of most children, "pockets of neglect" are still discernible in many otherwise satisfactory Departments, and for this reason regular supervision of schools is of great importance and must continue to receive a high priority. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those last year. 1964 1963 Attendances 17,504 18,409 Treated 5,925 6,803 Re-treated 3,144 3,716 Fillings - Permanent 6,344 6,273 Temporary 2,532 2,052 14 1964 1963 No. of Teeth Filled Permanent 5,793 5,742 Temporary 2,423 1,955 Extractions - Permanent 1,154 1,594 Temporary 3,177 3,762 Gas Administrations 1,821 2,190 Local Anaesthetics 555 508 Other Operations Permanent 6,406 6,697 Temporary 768 585 Cases Completed 4,133 5,145 Miscellaneous Items These include 1964 1963 Root treatment in anterior teeth 7 5 Removal of bone sequestra 10 9 Splints for fractured incisors 4 - Partial Pulpotomy 7 - Number of M.D's (adults) treated 12 14 Dentures inserted 21 '37 Denture repairs 5 9 Removal of impacted teeth 61 44 Acrylic caps for incisor teeth 4 5 Gingivectomy . 3 - Forms from Head Teachers The number of forms issued by Head Teachers for emergency treatment was 984, compared with 1,200 in 1963. X-Ray Examination The number of cases referred for the above purpose was 120, compared with 273 in 1963. This includes 32 taken at Mayday Hospital. Orthodontic Treatment The number of sessions devoted to this work was 379, compared with 404 last year. The work in this section is proceeding satisfactorily and there have been no developments worthy of special report. 15 The following is a summary of treatment performed:- 1964 1963 Consult ant - D.0.s Total Total Cases commenced during the year 198 29 227 198 Cases carried forward from the previous year 429 43 472 550 627 72 699 748 Cases completed during the year 123 48 171 186 Cases discontinued during the year 84 15 99 64 Pupils treated with appliances 191 57 248 312 Appliances - Removable 259 80 339 374 Fixed 20 3 23 10 Total Attendances 3,076 1,261 4,337 4,579 Cases treated by extraction only _ 63 63 153 Cases referred to Specialist for consultation 98 _ 98 148 Treatment sessions 298 81 379 404 New cases awaiting treatment 13 14 27 9 16 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED CHILDREN The year 1964 has been one of relative stability in which further progress has been made, particularly in improving the teaching environment. Minor building works completed during the year have included a new medical toilet and bathroom block to deal with the increasing problem of incontinence; the provision of supplementary heating in the Physiotherapy Room and the link corridor to the swimming pool. Improved facilities for the teaching of Handicraft, Music and Art have also been provi ded. Mr. G. Doe was appointed Deputy Head and Mr. G. Hallam was given charge of remedial education throughout the School. A room has been equipped with a very wide range of apparatus to function as a remedial workshop. Those aspects which have now become an established part of the life of the school - i.e. swimming, school journeys at home and abroad, participation in a very wide range of educational and social activities have continued throughout the year. We were, for a time, without a second physiotherapist but the vacancy has now been filled. The vacant position of male medical attendant was filled by a re-allocation of duties among part-time female attendants - the number of such posts being increased to four. Routine medical examinations were held on 32 occasions when 426 children were inspected, 188 parents were present. Specialist medicals were held termly. Dr. Fearnley examined 18 children, 10 parents being present. Mr. McQueen took over Mr. Robertson's clinic and saw 16 children, - 7 parents being present. The preparation and follow-up of all such medicals was carried out by the Nursing Sister and her staff. A wide range of ailments was treated and full records of each child's progress have been maintained. In the Psysiotherapy Dept., 8,952 treatments were given and among those children being treated were 53 orthopaedic and 58 postural cases. We are indebted to Dr. E.M. Hegarty for her continued interest in and work on behalf of, our children. Speech therapy is a regular feature of the school's medical provision, 33 children being treated regularly whilst others were seen for assessment. Total number of treatments given amounted to 422. The average number on roll was 197, the attendance was 86%. There were 46 admissions, 21 children left for employment and 28 went to other schools; 2 died. Record of Disabilities as at December 1964 Physically Handicapped Boys Girls Total Spina Bifida 3 7 10 Cerebral Palsy 18 18 36 Bronchiectasis _ 5 5 Congenital Heart 2 5 7 Epilepsy 6 7 13 Muscular Dystrophy 4 1 5 Speech Defect 1 2 3 Poliomyelitis 3 7 10 Various disabilities 27 18 45 64 70 134 17 Delicate Boys Girls Total Asthma 24 9 33 Bronchitis 7 4 11 Debility 4 5 9 Various disabilities 1 5 6 36 23 59 Finally I wish to place on record my thanks to the Principal School Medical Officer and Staff and to all the members of the Staff of St. Giles' School for their support during 1964. 18 ST. CHRISTOPHER'S SCHOOL FOR EDUCATIONALLY SUB-NORMAL CHILDREN Mr. Grice the Headmaster reports:- (1) Waiting List. There are at present 21 children on the waiting list. By next July, this number will be much higher, and, as only 4 pupils leave at Easter and twelve next July, there will not be enough vacancies to cover the present waiting list alone by then. I feel that consideration must be urgently given for the provision of extra places. (2) Camping Club. The Parents' Association has generously provided us with camping equipment, and a school camping club has been formed. The excursions so far have been a great success, as have been the out-of-door cooking exercises in the school grounds. (3) After-Care arrangements. The new arrangements for after care supervision are most satisfactory, The Mental Health Department Officers are visiting the school regularly to discuss each child recommended for supervision and also attending meetings of the Old Scholars' Club. One member of the School Staff is also acting as a liaison officer from the school in conjunction with the new venture run for those who attend the Crosfield Industrial Unit. (A) School's ftinctions. (a) The parents gave the children a New Year Party at the School on Saturday, January 25th. (b) The Annual Parents' Day was held on Wednesday, July 1st. Cc) The Annual Harvest Festival was held on September 30th. The Service was conducted by the Senior Pupils, and the Rev. Gordon Jones of South Croydon gave the Address. As a result, 72 food parcels were distributed by the Senior Pupils to Old Age Pensioners living in the district. (d) The Annual Carol Service was held on Wednesday, December 9th, at which all the Lessons were read by pupils. C5J Equipment. An outdoor climbing frame was provided for the Junior Playground. (6) Swimming. The following Certificates were gained during 1964:- Distance Boys Girls Total 25 yards 16 10 26 50 yards 8 5 13 100 yards 8 6 14 440 yards 2 _ 2 Half mile 2 _ 2 One mile 3 _ 3 The first Special Schools' Swimming Gala was held on July 22nd. St. Giles' P.H. School and St. Christopher's E.S.N. School, Mitchaa Joined this school at Croydon Central Baths and a most successful and enjoyable afternoon resulted. 19 (7) The Old Scholars' Club held Its 4th Birthday Party on October 5th. The Club continues to flourish and the members have made several contributions to the School amenities. Statistics Boys Girl: Total Number on roll 31st December, 1963 132 71 203 Admitted during 1964 28 26 54 Left to work at 16 16 14 30 Transferred to other areas 7 4 11 Transferred to Residential Schools 7 _ 7 Excluded as unsuitable for education at School 4 _ 4 Number on Roll 31st December, 1964 126 79 205 20 ST LUKE' S SCHOOL FOR TOE PARTIALLY SIGHTED Miss Rundle, the Headmistress, reports that during 1964 steady progress continued in all aspects of school activities. The children's wide range of ability and visual acuity present many problems but these are dealt with individually as far as possible, seeking to meet the children's own particular needs. Various educational excursions were made during the year including visits to the London Zoo, Hampton Court, the Greenwich Museum, etc. For many of the children home and school are the only aspect of life with which thay are familiar. It is, therefore, very necessary to widen their interests and experiences as much as possible. A group of children attended swimming regularly with the result that four children gained their 400 yards certificates. Visually handicapped children are generally lacking in self-confidence and it takes a long time for them to build up sufficient confidence to swim a length of the baths but when able to do this they derive a great sense of achievement. In this connection the older children are encouraged to travel to and from school on their own with the object of helping them to become independent when they leave school. It is very important to bridge the gap between school and work. One pupil who was able to take the Transfer Test was allocated a grammar school place. It was thought to be to his advantage to transfer him to Exhall Grange School, Coventry, where there is a grammar school for partially sighted children. A visiting teacher began Braille lessons for a severely handicapped older pupil. It is hoped that this will enable the pupil to undertake some form of training suitable for blind people. Regrettably as yet, there is no specialised training for the partially sighted. The Ophthalmologist's examination revealed two cases where children had failed to keep their appointments at the Eye Dnit. These have now been followed up. The School Medical Officer visited each term and his help and interest are much appreciated. Children on Roll 31.12.64 14 Left school during the year 2 Admissions 2 Transferred to Grammar School 1 21 INTELLIGENCE ASSESSMENTS 126 children were examined during 1964. The classifications arrived at. together with recommendations made, are as follows:- (1) Pound to be educationally sub-normal:- (a) Recommended for St. Christopher' s Special School 48 (b) Recommended for Residential School for E.S.N, pupils 5 (c) Recommended for Day School for E.S.N. pupils 1 (2) Pound to be unsuitable for education in School 16 (3) Other Recommendations:- (a) Referred back to an Ordinary School 15 (b) Referred for further investigation by School Psychological Service 11 (c) Recommended for Residential Special Schools for other handicaps 6 (d.) Recommended for Day Special Schools for other handicaps 5 (e) Referred for Speech Therapy 5 (f) Referred for Medical treatment 5 (g) Referred for further assessment 5 (h) Recommended for Slow Stream in an Ordinary School 4 126 Awaiting assessment on 31.12.64. 8 In addition, a further 48 intelligence tests were given to children attending St. Christopher's Special School. 22 CHILD GUIDANCE CLINIC The amalgamation of the Croydon and Warlingham Park Hospital Groups has resulted in a re-adjustment of the staff establishment. Miss H. Stringer was appointed Psychiatric Social Worker, and Miss S. Mumford, Clinical Psychologist. To facilitate co-ordination with the adult psychiatric service it was resolved at the time of their appointment that they should make regular visits to Warlingham Park Hospital to link up with their colleagues on the adult service. Consultations between Dr. S.L. Wright, Principal School Medical Officer, and representatives of the newly formed Hospital Management Committee prepared the ground for a radical revision of the administrative structure of the Child Guidance service. The appointment of Dr. Stella Ring 3/11 sessions to the Croydon Child Guidance Clinic and 8/11 to the short stay psychiatric unit at Queen Mary* s Hospital for Children, Carshalton, reinforces our link with this expanding comprehensive hospital for children. The regular attendance of Dr. Marjorie Hare at the Mayday Paediatric Department means that there is now a link with the two paediatric organisations in the area. Source of Referral Boys Girls Total General Practitioners 65 39 104 Parents 5 3 8 Education Dept/Schools 6 5 11 Medical Officer of Health Service 35 15 50 Childrens Dept. 3 3 6 Juvenile Court/Probation Officer 11 1 12 Milton House Remand Home - 115 115 Hospitals 12 6 18 Other Agencies - 1 1 Deceased 1 - 1 138 188 326 23 Analysis of above cases Boys Girls Total Diagnostic 18 120 138 Current cases under treatment 70 30 100 Closed Cases - Improved 36 22 58 Closed Cases - No Change ^ 10 9 19 Closed Cases - Unco-operative) 1 1 2 Cases Transferred to other agencies 1 3 4 Domiciliary Visits - 2 2 Cases Moved out of Area 2 1 3 138 188 326 Current treatment cases carried over from 1963 _ 160 SPEECH THERAPY During 1964, the Speech Clinic Staff consisted of four fulltime Speech Therapists. Miss Deakin left Croydon to work in Canada, and was replaced by Miss Connery. As the pressure of work is high, it is hoped to increase the staff by at least two further full-time Speech Therapists. One extra Treatment session has been allocated to St. Giles' School, making a total of three sessions in all. In addition, two sessions per week are given to the new clinic in ffaddon. The Speech Clinic has had several visitors during the course of the year, including two official overseas visitors sent by the College of Speech Therapists. As in the past, several talks have been given to interested Parties e.g. Guild of Social Service, Mothers groups at Welfare Centres etc. A "Parent* s Evening" and two "Mother's Discussion Groups" have again been held at this clinic and were most successful. As mentioned in previous reports, the problem of the severely Speech Defective Child, his Treatment and Education has continued to cause concern. Further details of the work carried out are shown on page 48. 24 ENURESIS CLINIC During 1964 the total number of children attending the clinic was 177; a similar number to the past two years. 116 were boys and 61 girls, showing the usual proportion of two boys attending for every girl. 74 children were discharged dry and 67 were still attending at the end of the year. As the average length of treatment is six months most of these had only started attending in the latter part of the period. A larger number than usual (11) left the district, and 21 were crossed off the list after they had failed to attend after three consecutive appointments had been sent. In four cases the enuresis was considered to be part of a larger physical or psychological problem and consequently the children were referred to other clinics. In nearly half the cases there was a history of enuresis in the immediate family; and 25 children showed minor signs of emotional disturbance. A third of the children had already received treatment for enuresis without success before attending the clinic. 73 children used the buzzers which were particularly useful with the older children. Number of children who attended in 1964:- 177 Lodge Road Clinic 134 New Addington 43 (Boys 116, Girls 61) Results Discharged Dry 74 Still Attending 67 Discharged for non-attendance 21 Referred elsewhere 4 Left district 11 Used buzzer 73 Age:- 5 6 7 8 9 10 11 12 13 14 15 Numbers Attending: 25, 40, 27, 16, 23, 13, 14, 9, 5, 4, 1. 25 DEAF AND PARTIALLY HEARING CHILDREN - AUDIOLOGY CLINIC 1964 was a busy year for the Audiology Clinic, the scope of its work widened to provide a monthly clinic, in conjunction with Dr. Morgan, for the early ascertainment of deafness in very young babies known to be 'at risk' . During the year, 64 babies were seen and 3 were found to be severely deaf. All cases recommended for hearing aids, were seen either by Mr. Parsons or Mr. Stewart, the Corporation's Consultant Otologists, who held regular sessions at the Audiology Clinic. It was necessary to hold 3 extra sessions during the year to keep pace with the number of outstanding cases. 89 children were seen and 17 hearing aids recommended, 14 of these were the National Health Service "Medresco" aids and the other 3, 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. The Medresco aid has no automatic volume control and cannot be tolerated by children with such a loss, as the hearing for low tones is often normal and a general amplification of sound soon becomes painfuL There was a sharp increase in the number of severely deaf pre-school children. 11 new cases were discovered and in each case a hearing aid and auditory training were recommended. It is interesting to note that 6 of the cases could be related to the 1962 Rubella outbreak. During the year, Mrs. Roberts, the part-time audiometrician, visited all infant schools at least twice during the year and apart from absentees and unco-operative children, (318), all children newly admitted to school during the year were tested. Of the 4,383 children tested, 473 (approx. 11%), failed the test and were referred to the Audiology Clinic for further assessment. For further statistical details, see Appendix G Page 53. 26 EPILEPTIC SCHOOL CHILDREN 36 epileptics were known to School Health Service as at 31.12.64. Of these - 7 were attending Ordinary School 16 were attending St. Giles' School 3 were attending St. Christopher's School 2 were at St. Luke's School 4 were attending Residential Schools 1 was attending a Private Residential School 3 were at the Junior Training Centre SPASTICS 62 Croydon Spastics were receiving education as at 31.12.64. 39 were attending St. Giles' School 4 were attending St. Margaret's School, Croydon 4 were attending Residential Schools for Physically Handicapped children 3 were attending ordinary school 3 were attending St. Christopher's School 2 were attending Spastic Centre full time 3 were attending Spastic Centre part time 2 were attending Old Kent Road Day School for Partially Deaf 1 was attending a Normal Private School 1 was receiving Home Tuition 27 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1964 as to their fitness to undertake the part-time employment indicated. 1964 1963 1962 1961 960 Delivery of Goods for Shopkeepers 39 33 28 33 57 Delivery of Newspapers 222 244 320 303 316 Delivery of Milk 4 6 6 9 1 Shop Assistants 81 42 64 75 69 346 325 418 420 443 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1964 all milk was supplied free of charge and approximately 27,300 children per day received one-third of a pint each in Maintained Schools. This was equal to 65% of children attending in Secondary Schools, and 95% in Primary Schools. Since 1st September 1957, milk has also been supplied by the Education Committee to children in the Non-Maintained Schools in accordance with instructions from the Ministry of Education. Approximately 4,700 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 1964 was approximately 20,000. Cost of the School Health Service The cost of the medical, dental and nursing services was £76,830. Cost of Special Schools Schools maintained by the Council £72,358 Other Schools (not maintained by local Education Authorities £27,475 Adjustments with other authorities in respect of Special Schools £9,090 £108,923 Cost of Milk and Meals Meals and Milk cost £500,162. Income from payment for meals was £182,327, making a net cost of £317,835, on which grant is paid of 100 per cent, on approved expenditure. 28 NON -MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in 1964, 229 children were examined at routine examinations. Appendix C gives the detailed findings. Yours faithfully S.L. WRIGHT Principal School Medical Officer. 29 STATUTORY TABLES APPENDIX A. MEDICAL INSPECTION RETURNS Year ended 31st December, 1964 Number of pupils on registers of maintained primary and secondary schools (including nursery and special schools) in January, 1965, as in Forms 7, 7M., 8B and 11 Schools. 37,417 PART 1.- MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE A.- PERIODIC MEDICAL INSPECTIONS Aqe Groups Inspected (By year of birth) No. of Pupils Inspected PHYSICAL CONDITION OF PUPILS INSPECTED Pupils found to require treatment (excluding dental diseases and infestation irith vermin) Satisfactory Unsatisfactory for defective vision (excluding squin t) for any other condi tion recorded at Partll Total individual pupils No. No. 1960 and later ) 1959 ) 2,784 2,776 8 90 446 523 1958 678 677 1 25 121 138 1957 219 219 - 12 39 47 1956 1. 139 1, 138 1 103 147 231 1955 1. 440 1, 438 2 118 226 332 1954 595 594 1 52 86 131 1953 649 649 - 56 71 122 1952 1, 441 1. 441 - 131 130 242 1951 821 821 - 86 99 174 1950 544 542 2 58 43 88 1949 and earlier 2. 488 2, 487 1 355 159 489 TOTAL 12.798 12,782 16 1. 086 1. 567 2, 517 Col.(3) total as a percentage of Col. (2) total 99.87% Col.(4) total as a percentage of Col. (2) total 0. 13% 30 TABLE B.- OTHER INSPECTIONS NOTES:- A special inspection is one that is carried out at the special request of a parent, doctor, nurse, teacher, or other person. A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. Number of Special Inspections 1,203 Number of Re-inspections 2,140 Total 3,343 TABLE C. - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 55,549 (b) Total number of individual pupils found to be infested 465 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2) Education Act, 1944) 4 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944 ... Nil 31 PART 2 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS DURING THE YEAR 1964 T = requiring Treatment 0 = requiring Observation Defect or Disease PERIODIC INSPECTIONS SPECIAL ENTRANTS LEAVERS OTHERS TOTAL INSPECTIONS SKIN T 31 37 116 184 2 0 23 6 36 65 1 EYES - (a) Vision ... T 127 413 546 1086 35 0 197 72 299 568 7 (b) Squint T 37 4 27 68 5 0 14 - 1 15 - (c) Other T 7 3 16 26 2 0 5 1 10 16 - EARS - (a) Hearing T 93 25 104 222 10 0 110 9 49 168 - (b) Otitis Media T 16 3 10 29 1 0 22 4 12 38 (c) Other T 6 4 10 20 - 0 10 - 14 24 - NOSE AND THROAT T 140 12 105 257 10 0 337 3 161 501 4 SPEECH T 52 1 17 70 4 0 80 3 21 104 1 LYMPHATIC GLANDS T 11 - 2 13 - 0 45 - 13 58 " HEART T 39 7 33 79 3 0 78 9 45 132 - LUNGS T 27 7 33 67 3 0 71 8 48 127 1 DEVELOPMENTAL . (a) Hernia T 10 1 11 22 1 0 15 - 6 21 (b) Other T 15 10 62 87 6 0 58 7 183 248 4 ORTHOPAEDIC - (a) Posture T 16 37 83 136 4 0 48 12 114 174 4 (b) Feet T 26 17 52 95 5 0 64 7 89 160 2 (c) Other T 40 26 51 117 2 0 103 10 83 196 3 NERVOUS SYSTEM (a) Epilepsy T 3 2 4 9 2 0 4 - 2 6 - (b) Other T 6 2 16 24 2 0 17 - 14 31 1 PSYCHO LOGICAI "j- (a) Development T 18 16 34 _ 0 19 - 11 30 1 (b) Stability T 28 2 36 66 5 0 72 1 31 104 1 ABDOMEN T 7 4 2 13 - 0 6 - 14 20 - OTHER T 40 13 48 101 7 0 64 11 106 181 3 32 PART 3 TABLE A. . EYE DISEASES. DEFECTIVE VISION AND SQUINT External and other, excluding errors of refraction and squint Errors of refraction (including squint) Total Number of pupils for vhom spectacles were prescribed Number of cases jccown to hare been dealt with _ 774 774 309 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 (c) for other nose and throat conditions 163 Received other forms of treatment ... - Total 163 Total number of pupils in schools who are known to have been provided with hearing aids - (a) in 1964 (b) in previous years 3 77 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to hare been treated (a) Pupils treated at clinics (No figures available for outpatients department) 314 (b) Pupils treated at school for postural defects 58 Total 37 2 TABLE D. - DISEASES OF THE SKIN Ringworm - Number of cases known to hare been treated (a) Scalp _ (b) Body - Scabies 5 Impetigo 5 Other Skin Diseases 6 Total 16 TABLE E. - CHILD GUIDANCE TREATMENT Pupils treated at Child Guidance clinics Number of cases known to have been treated 50 TABLE F. - SPEECH THERAPY Pupils treated by speech therapists Number of cases known to have been treated 490 TABLE G. - OTHER TREATMENT GIVEN Number of cases known ti have been dealt with (a) Pupils with minor ailments 761 (b) Pupils who received convalescent 23 treatment under School Health Service arrangements (c) Pupils who received B.C.G. vaccination 2173 (d) Other than (a), (b) and (cj above. please specify:- 2. Audiology 73 2. Enuresis 191 Total (a) - (d) 3221 33 34 APPENDIX B Table I AVERAGE ATTENDANCE AND NUMBERS OF CHILDREN EXAMINED AT ROUTINE MEDICAL INSPECTIONS IN MAINTAINED SCHOOLS DURING THE YEAR 1964. School Average Nos. on Registers Average Attendance % No. of Children Examined Boys Girls Total COUNCIL PRIMARY Ashburton Jr. Mxd 463 92.0 79 96 175 Ashburton Infants 235 88. 1 36 53 89 Benson J. M. & I. 553 93. 1 102 75 177 Beulah Jr. Boys 221 91. 9 65 - 65 Beulah Jr. Girls 201 92.0 - 74 74 Beulah Infants 303 86. 5 71 54 125 Castle Hill Jr. Mxd. 626 91.9 64 67 131 Castle Hill Infants 297 87.9 56 50 106 Cypress Jr. Mxd. 257 93.8 34 27 61 Cypress Infants 210 88. 1 49 41 90 Davidson Infants 133 89. 5 19 31 50 David Livingstone 243 89.7 45 44 89 Duppas Jr. Mxd. 337 92.0 41 50 91 Ecclesbourne Infants 153 88. 2 36 42 78 Elmwood Jr. Boys 241 93.7 64 • 64 Elmwood Jr. Girls 259 91.8 - 102 102 Elmwood Infants 297 88. 5 71 69 140 Fairchildes Jr. Mxd. 538 91. 2 54 66 120 Fairchlldes Infants 363 85.0 72 75 147 Gilbert Scott Jr. Mxd. 405 86. 6 51 54 105 Gilbert Scott Infants 328 87. 8 85 51 136 Gonville J. M. & I. 536 92.7 103 95 198 Howard J. M. & I. 256 91.8 56 48 104 Kensington Ave. J. M. 431 91. 4 75 68 143 Kensington Ave. Infants 224 86.6 57 55 .112 Kingsley Jr. Mxd. 457 91. 2 51 64 115 Kingsley Infants 389 86. 2 89 109 198 Monks Orchard J. M. & I. 411 91.0 102 47 149 Norbury Manor Jr. Mxd. 339 92.9 39 44 83 Norbury Manor Infants 247 88. 2 35 34 69 Oval Jr. Mxd 348 92.8 34 41 75 Oval Infants 211 86. 2 59 66 125 Portland Infants 90 88.9 23 17 40 Parley Oaks Jr. Mxd. 278 93. 2 37 48 85 Purley Oaks Infants 220 88. 1 40 70 110 Rockmount Jr. Mxd. 251 92. 4 32 29 61 Rockmount Infants 170 88. 2 51 29 80 Rowdown Jr. 465 91. 2 37 - 37 Rowdown Infants 314 88. 2 72 72 144 S. Norwood Jr. Mxd. 413 93. 5 51 23 74 S. Norwood Infants 286 88.8 67 58 125 St. Peter's J. M. & I. 277 92. 0 41 29 70 Spring Park Jr. Mxd. 408 93.8 62 54 116 Spring Park Infants 298 89.3 81 82 163 Sydenham Jr. Mxd. 244 93.0 38 39 77 Sydenham Infants 178 88.8 27 28 55 Waddon Infants 233 86.7 45 60 105 W, Thornton J. M. & I. 275 91.7 61 47 108 35 School Average Nos. OD Registers Average A11 en - dance % No. of Children Examined Boys Girls Total Whltehorse Manor Jr. Mxd. 381 93. 0 67 50 117 Whitehorse Manor Infants 250 88.0 71 56 127 Winterbourne J. Boys 386 94.8 108 _ 108 Winterbourne J. Girls 386 94. 3 _ 112 112 Winterbourne Infants 392 89. 0 94 80 174 Wolsey Jr. Mxd. 454 91. 4 61 53 114 Wolsey Infants 330 89. 4 85 43 128 Woodside Jr. Mxd. 562 92. 9 85 51 136 Woodside Infants 311 87. 5 73 57 130 TOTAL 18, 364 90.7 3, 203 2,979 6, 182 COUNCIL SECONDARY NON-SELECTIVE Ashburton Sr. Boys 616 93.7 406 _ 406 Ashburton Sr. Girls 590 91. 3 - _ _ Davidson Sr. Mxd. 380 89. 5 103 83 186 Eoclesbourne Sr. Girls 306 87. 9 - 207 207 Fairchildes Sr. Boys 647 89. 2 305 _ 305 Fairchildes Sr. Girls 623 86. 2 _ _ Ingram Sr. Boys 494 89.0 226 _ 226 Lanfranc Sr. Boys 486 85. 6 229 _ 229 Lanfranc Sr. Girls 467 88. 2 - 201 201 Norbury Manor Sr. Boys 345 91. 9 154 154 Norbury Manor Sr. Girls Portland Sr. Mxd. 439 339 90. 0 90. 9 68 184 82 184 150 Tavistock Sr. Boys 391 86.0 . 206 . 206 Tavistock Sr. Girls 251 86. 5 _ 115 115 South Croydon Sr. Mxd. 539 86. 5 88 98 186 Shirley Sr. Mxd. 599 90. 4 119 110 229 Overbury Sr. Mxd. ... 525 87. 2 115 89 204 Westwood Sr. Girls 373 88. 7 119 159 159 TOTAL 8, 410 88. 9 2, 019 1,328 3,347 VOLUNTARY SECONDARY NON-SELECTIVE St. Andrew's Mxd. 238 86.6 78 44 122 Our Lady's Girls 183 89. 6 71 71 St. Mary's Mxd. 395 94. 6 78 101 179 TOTAL 816 91. 1 156 216 372 SPECIAL SCHOOLS St. Christopher's E.S.N. Mxd St. Giles' P.H. & D. Mxd St. Luke's (Partially Sighted) 206 196 16 85. 9 84.7 87. 5 80 9 _ 28 _ _ 108 9 _ TOTAL 418 85.4 89 28 117 36 School Average Nos. on Registers Average Attendance % No. of Children Examined Boys Girls Total VOLUNTARY PRIMARY SCHOOLS All Saints' M. & I. (C. of E.) 235 92.3 46 39 85 Good Shepherd (R. C.) J.M.& I. 341 91. 2 24 19 43 Parish Church J.M.& I. (C.of E. ) 370 89.0 42 52 94 St. Joseph's M. & I. (R. C.) 529 91. 3 113 95 208 St. Mark's J.M.& I. (C.of E.) 242 91.7 48 27 75 St. Michael's Infants 145 86. 1 41 37 78 St. Mary's (R. C.) J. M. & I. 413 94. 6 76 66 142 Shirley (St.John's J.M.& I. (C.of E.) 274 92. 7 50 55 105 TOTAL 2, 549 91. 0 440 390 830 SECONDARY SELECTIVE AND GRAMMAR SCHOOLS Archbishop Tenison's Mxd. 319 94. 4 49 57 106 Heath Clark Mxd. 681 92. 0 114 116 230 John Newnham Selective Mxd. 505 93. 2 86 110 196 Selhurst Boys 832 94. 2 416 416 Selhurst Girls 533 93. 8 - 173 173 John Ruskin Boys 59 2 92. 3 182 - 182 Coloma Girls 560 93. 4 - 51 51 Lady Edridge Girls 571 92. 6 - 212 212 TOTAL 4, 593 93. 2 847 719 1,566 TECHNICAL SCHOOLS Stanley Technical School 311 93.1 115 - 115 Croydon Secondary Tech. 424 93.9 146 - 146 TOTAL 785 93.6 261 - 261 Crosfield Nursery School 60 80.0 14 6 20 37 Table II HEIGHTS AND WEIGHTS 1964 Number Examined Average Height in inches Average Weight in lbs. 1964 1964 1963 1962 1961 1939 1964 1963 1962 1961 1939 BOYS 5 years 1459 42.8 42.6 42.6 43.3 41.8 43.0 42.7 42.9 43.4 41.5 6 years 270 43.9 43.8 44.0 44.7 43.8 45.2 44.8 44.6 45.8 43.4 14 years 274 63.6 63.9 63.7 63.9 59.0 113.9 117.6 113.8 114.1 90.8 15 years 295 64.9 64.4 64.6 65.0 - 120.3 118.3 119.3 120.6 - 16 years 492 67.2 67.1 67.4 67.2 - 130.5 131.8 131.4 133.0 - 17 years 330 68.0 67.7 67.9 68.1 - 137.7 134.7 136.5 138.0 - GIRLS 5 years 1371 42.4 42.3 42.9 42.8 41.2 42.2 41.5 42.3 42.1 39.7 6 years 320 44.9 43.6 44.0 44.0 42.7 44.8 43.1 44.2 44.8 41.4 14 years 172 62.2 62.3 62.2 61.9 60.3 113.3 113.6 113.6 111.5 97.9 15 years 283 63.5 63.3 63.0 62.9 62.0 115.3 116.3 117.9 115.5 105.5 16 years 242 63. 7 63. 9 63. 4 64. 1 - 121.8 122.4 121.2 122.8 - 17 years 109 64.1 64.3 64.2 64.4 - 125. 126.3 127.3 128.1 - Table III CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS 1964. 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 235 2 - - - - - - - 1 - 18 - 34 - - - - - - - - - 55 Arch. Tenison 319 - - - - - - - - - - - - - - - - - - - - - - - Ashburton 1904 2 - - 7 - - 1 - 23 1 12 - 2 - - - - - - - - - 48 Benson 553 8 - - - - - 7 - - - - - 58 1 - - - - 2 - - - 71 Beulah 725 4 - - - - - 2 - 1 - 6 - 3 - - - - - 1 - - 11 28 Castle Hill 923 40 - - 1 - - 5 - 12 4 1 - 1 1 - - - - - - - 3 68 Coloma 560 - - - - - - _ - - - - - - - - - - - - - - - - Crosfield Nursery 60 - - - - - - - - - - - - - - - - - - - - - - - Croydon High 932 - - - - - - - - - - - - - - - - - - - - - - - Croydon Tech 424 - - - - - - - - - - - - 2 - - - - - - - - - 2 Cypress 467 13 - - - - - 1 - - - - - 26 - - - - - 2 - - 4 46 David Livingstone 243 2 - - - - - 3 - - - 12 - 81 - - - - - 3 - - 7 108 Davidson 513 9 - - - - - - - - - 27 - - - - - - - - - - - 36 Duppas 337 - - - - - _ - - - - - - - - - - - - - - - - - Ecclesbourne 459 1 - - - - - - - - - - - - - - - - - - - - - 5 Elmwood 797 39 - - - - - 1 1 1 _ 3 - 4 - - - - - - - - - 49 Fairchildes 2171 - - - - - - - - - 10 - - - - - - - - - - - - 10 Gilbert Scott 733 - - - - - - - - - - - - - - - - - - - - - - 6 Gonville 536 - - - - - - - - - - - - - - - - - - - - - - - Good Shepherd 341 - - - - - - - - - - - - - - - - - - - - - - - Heath Clark 681 2 - - - - - - - - - - - - - - - - - - - - - 2 Howard 256 4 - - - - - 1 - 2 - 47 - 25 - - - - - - - - - 79 Ingram 494 - - - - - - - - - - - - - - - - - - - - - - - John Newnham 505 - - - - - - - - - - - - - - - - - - - - - - - John Ruskin 592 - - - - - - - - - - - - - - - - - - - - - - - Kensington Avenue 655 11 - - - - - - - - - - - - - - - - - - - - - 54 Klngsley 846 12 - - - - - - - 3 - 2 - - 1 - - - - - - - - 18 Lady Edridge 571 - - - - - - - - - - - - - - - - - - - - - - - Lanfranc 953 4 - - - - - 1 - 1 - - - 1 - - - - - 1 - - 1 9 38 Monks Orchard 411 - - - - - - - - - - - - - - - - - - - - - - - Norbury Manor 1370 50 - - 2 - - 5 - 7 - 1 _ 38 2 - - - - - - - 1 106 Occupation Centre 58 - - - - - - - - - - - - - - - - - - - - - - - Old Palace 486 2 - - - - - 1 _ - _ _ - - _ - - - - - - - - 3 Our Lady's Convent 183 _ - - - - - - - - - - - - - - - - - - - - - - Oval 559 - - - - - - - - 3 - 3 - 18 - - - - - - - - - 24 Overbury 525 - - - - - - - - - _ - - - - - - - - - - - - - Parish Church 370 - - - - - - 14 - _ 3 28 - 48 - - - - - - - - - 97 Portland 429 4 - - - - - - - - - - - 1 - - - - - - - - - 5 Purley Oaks 498 6 - - - - - - - 126 - - - 79 - - - - - 1 - - - 217 Regina Coeli 383 - - - - - - _ - - - _ _ - - - - - - - - - - - Rockmount 421 1 - - - - - - - - - - - - - - - - - - - - - 1 Rowdown 779 - - - - - - - - - - _ - - - - - - - 1 - - - 1 St. Andrew's 238 - - - - - - - - - - - - - - - - - - - - - - - St. Christopher's 206 3 - - - - - - - - 2 _ _ 8 - - - - - - - - - 16 St. Giles' 196 - - - - - - - - - - - - - - - - - - - - - - - St. Joseph's 529 - - - - - - - - - - - - - - - - - - - - - - - St. Luke's 16 - - - - - - - - - - - - - - - - - - - - - - - St. Mark's 242 - - - - - - 1 - - - - - - - - - - - 1 - - - 4 St. Mary's R. C. 808 5 - - - - - 1 - - - - - 50 - - - - - - - - - 59 St. Michael's 145 - - - - - - - _ - - 8 - - - - - - - 1 - - - 9 St. Peter's 277 - - - - - - - - - - - - - - - - - - - - - - - Selhurst Grammar 1365 2 - - - - - 2 - - - - - - - - - - - - - - - 4 Shirley 873 57 - - - - - - - - - - - - - - - - - - - - - 57 South Croydon 539 - - - - - - - - - - - - - - - - - - - - - - - South Norwood 699 21 - - 2 - - - - - - - - 5 - - - - - - - - - 29 Spring Park 706 1 - - - - - - - 4 - - - - - - - - - - - - - 5 Stanley Tech. 311 1 - - - - - - - - - - - - - - - - - - - - - 2 Sydenham 422 6 - - - - - - 1 - _ 1 _ 17 - - - - - - - - - 25 Tavistock 642 - - - - - - - - - - - - - - - - - - - - - - 1 Trinity 628 - - - - - - - - - - - - - - - - - - - - - - - Waddon 233 - - - - - - - - - 1 - - 43 - - - - - - - - - 46 West Thornton 275 - - - - - - - - - - - - - - - - - - - - - - - Westwood 373 - - - - - - - - - - - - - - - - - - - - - - - Whltehorse Manor 634 9 - - - - - 2 - - - 1 - - - - - - - 1 - - 13 35 Whltgift 800 - - - - - - - - - - - - - - - - - - - - - - - Wlnterbourne 1164 12 - - - - - - - - - 43 - - - - - - - 1 - - - 59 Wolsey 784 - - - - - - - - - - - - - - - - - - - - - - - Woodside 873 31 - - 8 - - 1 - 4 - 1 - 20 - - - - - l - - 6 72 364 - - 27 - - 54 2 191 21 214 - 610 5 - - - - 21 - - 62 1571 39 40 Table IV RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1964 Defects Boys Girls Number requiring Treatment Number referred for Observation Percentage of total Defects Number requiring Treatment Number referred for Observation Percentage of total Defects Uncleanliness - Head - - - 2 - 0.1 Body - - - - - - Skin Disease 103 42 4.0 81 23 3.8 Eye Disease Defective Vision 618 305 25.8 468 263 27.0 Squint 32 8 1.1 36 7 1.6 External Eye Trouble 14 7 0.6 12 9 0.7 Ear Disease - Deafness 134 90 6.2 88 78 6.0 Otitis Media 19 15 1.0 10 23 1.2 Other Diseases 11 12 0.6 9 12 0.7 Nose and Throat 143 253 11.0 114 248 13.1 Enlarged Cervical Glands (not T.B.) 7 38 1.3 6 20 0.9 Dental Defects 245 5 7.0 268 4 9.9 Speech Defects 49 68 3.2 21 36 2.1 Heart and Circulation 37 69 3.0 42 63 3.8 Lungs 40 76 3.2 27 51 2.8 Developmental - (a) Hernia 17 10 0.8 5 11 0.5 (b) Other 84 200 7.9 3 48 1.9 Deformities - Posture 51 86 3.8 85 88 6.3 Flat Feet 50 101 4.2 45 59 3.8 Others 65 122 5.2 52 74 4.6 Nervous System Disorders Epilepsy 4 2 0.2 5 4 0.3 Other 14 21 1.0 10 10 0.7 Psychological - (a) Development 22 24 1.3 12 6 0.6 (b) Stability 43 63 3.0 23 41 2.3 Abdomen 4 10 0.4 9 10 0.6 Other Defects and Diseases 57 94 4.2 44 87 4.7 TOTALS 1,863 1,721 1.477 1,275 Total Children Examined 7,174 Boys 5,624 Girls 41 Table V SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1964 (Percentages of Children Examined) Defect or Disease Entrants Intermediates Entrants to Secondary School Final Leavers All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 9.6 11.9 5.5 8.1 4.7 7.7 2.1 2.6 5.4 8.0 Skin 2.3 1.8 3.6 1.9 3.1 3.5 1.7 2.7 2.6 2.4 Eyes Vision 9.1 10.5 16.4 15.0 15.0 17.8 18.3 21.4 14.7 15.7 Squint 1.6 1.7 0.6 1.0 0.4 0.4 0.2 0.3 0.7 0.9 Other 0.3 0.5 0.5 0.6 0.5 0.6 0.3 0.3 0.4 0.5 Ears Hearing 6.6 5.7 3.5 3.0 2.6 1.9 1.2 1.5 3.4 3.2 Otitis Media 1.2 1.2 0.3 0.4 0.4 0.3 0.3 0.2 0.6 0.6 Other 0.5 0.5 0.7 0.3 0.2 0.4 0.1 0.3 0.3 0.4 Nose and Throat 15.0 15.4 7.4 8.8 3.8 2.9 0.7 1.5 6.5 7.8 Speech 5.2 2.7 1.7 1.0 0.5 0.2 0.1 0.4 1.8 1.2 Cervical Glands 2.2 1.8 0.8 0.3 0.2 0.1 - - 0.8 0.6 Heart and Circulation 3.7 3.2 1.4 1.6 1.2 2.0 0.9 1.2 1.8 2.1 Lungs 3.2 2.4 1.8 1.8 1.5 1.3 0.6 0.6 1.8 1.6 Development Hernia 1.0 0.7 0.5 0.2 0.3 0.1 0.1 - 0.5 0.3 Other 4.0 1.0 5.6 2.1 6.8 1.0 1.0 0.1 4.3 1.1 Orthopaedic Posture 1.7 2.0 3.2 5.4 2.5 3.5 1.4 3.1 2.1 3.4 Plat Feet 4.0 2.2 3.8 2.8 3.0 2.8 1.4 1.3 3.0 2.3 Other 5.2 3.9 4.5 2.5 2.6 2.6 1.0 3.2 3. 2 3.1 Nervous Diseases Epilepsy 0.1 0.3 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 Other 1.0 0.4 0.7 0.4 0.6 0.5 0.1 0.3 0.6 0.4 Psychological Development 1.6 0.6 0.8 0.4 0.4 0.5 - - 0.7 0.4 Stability 3.2 2.8 2.1 1.1 1.2 0.6 0.1 0.3 1.5 1.3 Dull and Backward 0.1 0.2 0.1 - - - - - 0.1 0.1 Abdomen 0.5 0.5 0.2 0.6 0.2 0.2 0.1 0.4 0.2 0.4 Other Defects 4.1 2.1 3.0 4.0 2.8 3.1 0.7 1.8 2.6 2.8 Table VI HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS APPROVED UNDER SECTION 9(5) OF THE EDUCATION ACT, 1944 OR BOARDING IN BOARDING HOMES. During the calendar year ended 31st. December. 1964 number of handicapped pupils- (1) Blind (3) Deaf (5) Physically Handicapped (7) Maiadjusted (9) Epileptic TOTAL (2) Partially sighted (4) Par' ti ally deaf (6) Delicate (8) Education ally sub-normal (10) Speech defects (1)-(10) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) A. Number of handicapped pupils newly assessed as needing special educational treatment at special schools or in boarding homes - 5 1 1 31 19 4 54 2 3 120 B. (1) of the children included at A, number newly placed in special schools (other than hospital special schools) or boarding homes. - 1 - 1 20 16 2 33 2 1 76 (ii) of the children assessed prior to 1st January, 1864 number newly placed in special schools (other than hospital special schools or boarding homes. - - - - 6 1 - 14 - 2 23 TOTAL (B(i) and B(ii) ) - 1 - 1 26 17 2 47 2 3 99 C. (i) Number requiring places in special schools - TOTAL ON 28th JANUARY 1965. (a) day - 1 1 - 12 3 - 15 - - 32 (b) boarding 1 - - - - 2 2 3 - 3 11 (ii) Number Included at (i) who had not reached the age of 5 and were waiting (a) day places - - - - - - - - - - - (b) boarding places 1 - - - - - - _ - _ 1 (continued below) 42 C. (iii) Number Included at (i) who had reached the age of 5, but whose parents had refused consent to their admission to a special school, were awaiting - (a) day places - - - - - - - - - - - (b) boarding places - - - - - - - - - - - (iv) Number included at C (i) who had been awaiting admission to special schools for more than one year (a) day places - - - - - - - - - - - (b) boarding places - - - - - - - - - 1 1 D. (i) Number on the registers of (i) maintained special schools as at 28th JAN.1965 (a) day pupils - 16 8 8 91 55 6 186 12 4 386 (b) boarding pupils 1 2 - - 1 - 2 4 - - 10 (2) non-maintained special schools as - (a) day pupils - - - - 2 - - - - - 2 (b) boarding pupils 3 - 2 6 11 5 1 4 2 4 38 (ii) Number on the registers of independent schools under arrangement made by the Authority - - 3 - 2 3 11 5 - - 24 TOTAL D. 4 18 13 14 107 63 20 199 14 8 460 Number of children from the Authority's area who are awaiting places or who are receiving special education in special schools or who are boarded in homes TOTAL of Sections C(i) (a) and (b) and D 5 19 14 14 119 68 22 217 14 11 503 continued overleaf 43 On 28th January 1965, number of handicapped pupils. (1) Blind (3) Deaf (S) Physically Handicapped (7) Maladjusted (9) Epileptic TOTAL (2) Partially sighted (4) Partially deaf (6) Delicate (8) Educationally sub-normal (10) Speech defects (1)-(10) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) E. being educated under arrangements made under Section 56 of the Education Act, 1944, (1) in hospitals - - - - - 17 - - - - 17 (ii) in other groups (e.g. units for spastics, convalescent homes) - - - - - - - - - - - (iii) at home - - - - 2 2 - - - - 4 44 PART IV CHILDREN FOUND UNSUITABLE FOR EDUCATION AT SCHOOL During the calendar year ended 31st December.1964.- (i) Number of children who were the subject of new decisions recorded under Section 57(4) of the Education Act,1944- 16 (ii) Number of reviews carried out under the provisions of 57A of the Education Act,1944- Nil (iii) Number of decisions which were cancelled under Section 57A(2) of the Education Act,1944- Nil 45 Table VII VISION TESTS Summary of Findings Up to 6/24ths Over6/24ths Boys Girls Boys Girls Number % Number % Number % Number % ENTRANTS 155 8.7 166 9.8 6 0.4 12 0.7 8 YEAR OLD GROUP 218 15.0 187 13.9 20 1.4 13 1.1 ENTRANTS TO SECONDARY SCHOOL 257 12.6 220 15.0 48 2.4 42 2.8 PINAL LEAVERS 220 11.5 197 17.5 130 6.8 44 3.9 TOTAL 850 11.9 770 13.7 204 2.8 111 2.0 Table VIII ATTENDANCES OF PARENTS AT SCHOOL MEDICAL INSPECTIONS 1964 1963 Boys Girls Boys Girls ENTRANTS 89.5% 90.8% 83.3% 83.5% LEAVERS 2.9% 10.1% 4.1% 9.3% OTHERS 50.9% 58.0% 52.8% 51.3% TOTAL No. OF CHILDREN EXAMINED 7,174 5,624 5,963 6,843 Total Attendance of Parents % 52.3% 49.0% 46 Table IX DENTAL DEFECTS 1964 1963 (1) Inspected by Dental Officers:Aged 5-6 1,861 1,901 6-7 3,239 2,749 7-8 2,952 3,002 8-9 2,772 3,016 9-10 2,738 3,160 10-11 2,943 2,957 11-12 2,820 2,905 12-13 2,579 2,881 13-14 2,773 2,703 14-15 2,783 2,693 15-16 2,381 2,397 16up 1,619 2,052 Total 31,460 32,416 Specials 984 1,200 32,444 33,616 (2) Number found to require treatment 14,622 15,519 (3) Number referred for treatment 11,532 12,447 (4) Number actually treated 5,925 6,803 (5) Attendances made by children for treatment 17,504 18,409 (6) Half-days devoted to: Inspection 252 2,824 261 2,833 Treatment 2,572 2,572 (7) Fillings - Permanent Teeth 6,344 8,876 6,273 8,325 Temporary Teeth 2,532 2,052 (8) Teeth Pilled- Permanent Teeth 5,793 8,216 5,742 7,697 Temporary Teeth 2,423 1,955 47  1964 1963 (g) Extractions - Permanent Teeth 1,154 4,331 1,594 5,356 Temporary Teeth 3,177 3,762 (10) Administrations of general anaesthetics for extractions 1,821 2,190 Administrations of local anaesthetics for extractions 555 508 (11) Other Operations- Permanent Teeth 6,406 7,174 6,697 7,282 Temporary Teeth 768 585 Attendances per session 6.16 7.16 48 Table X SPEECH DEFECTS CLINIC SUMMARY Total number of cases treated 490 Cases discharged 285 Analysis of Discharged Cases Under review pending possible further treatment 1ll Left District 11 Unsatisfactory e.g. non-attendance 28 Satisfactory 131 Left School before Treatment completed 2 Transferred to Residential School or Occupation Centre 2 Cases still attending 205 Cases referred for physical treatment 32 Cases referred for residential treatment 3 Cases referred for Child Guidance 4 Cases Examined by Neurologist 14 Analysis of Type of Cases Treated Stammerers 92 Sigmatism 80 Cleft Palate 12 Excessive Nasality, including Supra Bulbar Palsy 7 Dyslalia 250 Undeveloped Speech 31 Aphasia 14 (Additional Aphasic cases are attending Special Schools and are not shown in this total). Partially Deaf 1 Dysphonia 3 Special Schools St. Christopher's School 34 (In addition some cases have been seen for assessment only). St. Giles' School 33 (Some additional cases are under review only). 49 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1964. RETURN OF MEDICAL INSPECTIONS A - Routine Medical Inspections Year Year Year 1964 1963 1962 Age 6 10 7 15 8 5 9 19 10 24 11 8 73 29 12 49 85 55 13 17 58 41 14 1 52 34 15 33 77 76 16 33 63 64 17 13 4 22 18 or over 2 - 8 229 412 329 B - Other Inspections Number of Special Inspections - - - Number of Re-inspections - - - Total - - - Visits to Non-Maintained Schools 12 18 13 The following defects were found by Medical Inspection:- Treatment Observation Skin 2 1 Defective Vision 35 10 Hearing 1 2 Nose and Throat 4 4 Posture 4 Other Defects and Diseases 3 - 50 APPENDIX D RETURN SHOWING NUMBERS OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1964 WHO HAVE UNDERGONE TONSILLECTOMY DURING THEIR LIFE. Year of Birth Boys Girls TOTAL 1959 and later 46 45 91 1958 12 14 26 1957 7 3 10 1956 71 68 139 1955 108 88 196 1954 44 34 78 1953 47 44 91 1952 159 116 275 1951 108 82 190 1950 70 61 131 1949 100 102 202 1948 and earlier 280 105 385 TOTALS 1,052 762 1,814 PERCENTAGES OF CHILDREN EXAMINED. 14.7% 13.5% 14.2% CHIEF CAUSES OF EXCLUSION FROM SCHOOL Conditions Exclusions during 1964 Percentage of total exclusions Exclusions during 1963 Percentage of total exclusions Ringworm - - 1 0.04 Verminous Conditions - - 2 0.08 Impetigo 2 0.1 2 0.08 Scabies - - - - Scarlet Fever 21 1.3 36 1.51 Measles (inc. German) 268 17.1 916 38.54 Diphtheria - - - - Whooping Cough 62 4.0 35 1.46 Chicken Pox 364 23.2 757 31.85 Mumps 610 38.8 495 20.82 External Eye Disease - - 4 0.17 Poliomyelitis _ _ - - Dysentery 27 1.7 85 3.58 Jaundice 21 1.3 19 0.80 Enteric Group - - - - Meningococcal Infection - - - - Other Causes 196 12.5 25 1.05 1.571 2.377 51 APPENDIX E TREATMENT The Work of the School Clinics SUMMARY OF ATTENDANCES 1964 1963 Increase or decrease Minor Ailments and Verruca Clinics 5.078 4,932 + 146 Inspection Clinic 1.63 807 + 456 Dental Clinics 17,504 18,409 905 Remedial Exercises Clinic 5,046 5,217 171 Enuresis Clinic 699 706 7 Audiology Clinic 182 154 + 28 29,772 30,225 453 MINOR AILMENTS CLINICS Clinic Defects Attendances Lodge Road 200 1,919 Asbburton School 65 589 Duppas School 163 528 Rockmount School 164 964 Addington 169 1,078 Complaint Cases 19 64 1963 Attendances Average So. of Attendances per case Cases Attendances Average No.of Attendances per case Ringworm _ _ - - - - Scabies - - - _ _ _ Impetigo 5 30 6.0 6 25 4.2 Other Skin Diseases 6 11 1.8 10 27 2.7 Otorrhoea and other Ear Defects 34 67 2.0 15 43 2.9 External Eye Disease 37 82 2.2 35 70 2.0 Miscellaneous (Including Verruca) 679 4,888 7.2 716 4,767 6.7 761 5,078 6.7 782 4,932 6.3 52 APPENDIX F SPINAL AND OTHER REMEDIAL CLINICS (LODGE ROAD) Attendances 1964 Av. att. Atten. dances 1963 Av. att. Classes Classes Spinal 1,845 427 4.3 1,668 420 4.0 Flat Feet 1,560* 389 4.0 1,325 400 3.3 Breathing 511 96 5.3 397 91 4.3 3,916 912 3,390 911 *60 treated by Paradism 256 individual cases were treated and 319 examinations were made by a doctor. SPINAL AND OTHER REMEDIAL CLINICS (NEW ADDINGTON) 1964 Classes Av. att. Attendances 1963 Av. att. Attendances Classes Spinal 425 40 10.6 551 43 12.8 Flat Feet 520 80 6.5 916 86 10.7 Breathing 185 40 4.6 312 43 7.3 1,130 l60 1,779 172 128 individual cases were treated. WORK OF SCHOOL NURSES School Visits Visits to School Departments re Cleanliness 485 Visits re Scabies or Ringworm 3 Visits re Infectious Disease 4 Visits re Medical Inspections 696 Visits re Medical Preparations 717 All other reasons 330 Home Visits Concerning defects found at routine medical inspections, special cases and non-infectious cases 3,695 Visits in connection with infectious cases 244 53 APPENDIX G DEAF AND PARTIALLY DEAF CHILDREN OF SCHOOL AGE December 31st, 1964 Numbers attending Special Schools or Units (a) Day Schools Kingsley Road 6 Holman Hunt 3 Stockwell Manor 1 Old Kent Road 5 Oak Lodge 5 (b) Residential Schools Boston Spa 1 Burwood Park 1 Hamilton Lodge 2 Mill Hall, Cuckfield 1 Margate 2 Ovingdean 3 Rudolph Steiner 1 R.N.I.D. Training Centre, Abbots Kerswell 1 Total 32 (17 of these 32 children are of secondary school age). Numbers attending Croydon Day Schools and Pre-School Children. (a) With hearing sufficiently impaired to require regular auditory training: Primary School Pupils 57 Secondary School Pupils 28 Pre School Children 14 Total 99 Pure Tone Audiometer Tests Number of individual children tested during the year. (a) For the first time 305 (b) As a review case 249 Total 554 54 Auditory Training 73 individual children received regular auditory training during the year. Number of attendance sessions: (a) At the Audiology Clinic 182 (b) At home or school 243 Total 425 Sweep Testing of five year old school entrants: Number of schools visited 41 Number of children tested 4,383 Number of children passed 3,727 Number of children failed 473 Number of children to be re-tested 183 Number of children not tested (absent or unco-operative) 318 The failures were re-assessed as follows: No hearing loss 56 Negligible hearing loss 27 Slight hearing loss 105 Moderate hearing loss 146 Moderately severe hearing loss 48 Severe hearing loss 4 Failed to keep appointment 42 Left district 11 Waiting to be re-tested 34 Total 473 Issue of Hearing Aids (a) National Health Service "Medresco" Aids 14 (b) Commercial Aids bought by Croydon L.E.A. 3 Total 17 14 children under school age are using hearing aids. 55 APPENDIX H THE USE OF HEALTH QUESTIONNAIRES AT SCHOOL MEDICAL INSPECTIONS An experiment in selection by J. STUART HORNER, M.B.,Ch.B..D.P.H.. D.I.H. Deputy Principal School Medical Officer In April 1964, the Education Committee agreed that detailed health questionnaires could be circulated to parents of children receiving eight year old and eleven year old medical inspections. The experiment was to continue for a period of six months and was designed to answer three questions:- 1. What administrative difficulties are involved? 2. Will parents complete and return forms giving this type of information? g. Can the information produced be used to select a group of children for examination? l. Practical Difficulties. 853 parents of children in the younger age group and 576 parents of older children took part in the survey. The number of girls and boys was roughly the same although rather more girls than boys took part in the 8 year old inspection whilst at the later inspection the reverse was the case. No attempt was made to select any particular school and almost all parts of the Borough were represented. One parent formally objected to the questionnaire: He claimed that the information required was too confidential although the accompanying letter had made it clear that parents were quite free to complete only part of the form, if they so wished. A number of forms were returned incomplete and one parent complained to the doctor about the questions although she had, in fact, completed them all. Against this extremely small number, one should compare the overwhelming majority who completed the questionnaire in great detail. Moreover a large number of parents provided a considerable amount of additional (and highly personal) information on the reverse side of the form. In some cases this was relevant to the child* s present health but in many cases it seemed to have been given entirely for the assistance of the examining medical officer. 56 A number of head teachers expressed disappointment that they were not allowed to examine the completed questionnaires. No practical difficulties were experienced in the distribution and return of the questionnaires. 2. Completion of the Questionnaires. A total of 62 questionnaires were not returned amongst 1,429 which were distributed. This represents 2.5% of the questionnaires distributed at the eight year old inspection and 7% of those given to the parents of older children. 10 questionnaires in the younger group were too incomplete to be of value and 12 questionnaires were inadequate at the 11 year old inspection. This means that approximately 3.5% of parents of younger children and 9.4% of parents of older children failed to co-operate in the experiment. Amongst tne questionnaires returned, the degree of completion reached a very high standard. Over 95% of parents gave details of previous medical history, name of family doctor etc. Parental occupation was reported in 94% of returned questionnaires. At the eight year old inspections these figures were even higher. Most parents completed the questions about current symptoms: Again the results were slightly better at the younger inspection and the physical symptoms were 1% better completed than the mental and emotional ones. This just reaches the level of statistical significance but it should be noted that even mental symptoms were still completed in over 96% of returned questionnaires. 3. Selection. It had been anticipated that questionnaires would divide themselves simply into children with symptoms and those without. It had been hoped that the former would represent a very small minority. In fact some 24% of children due for inspection showed at least one symptom on the questionnaire. Moreover certain symptoms were regarded as absolute indications for selection and all those who fail to return questionnaires and those who return incomplete ones would have to be examined if a selective type inspection was introduced in Croydon. Amongst the parents of eight year old children, 22% specifically requested a school medical inspection and at eleven years the figure was 16%. Whilst these numbers are highly encouraging support for the concept of school medical inspections, it does mean that the number of children selected for examination in Croydon would approach 50% and, if every positive symptom on the questionnaire was included, would exceed this figure. This suggests that the questionnaire is not sufficiently selective in the identification of those most in need of a medical examination. 57 Compared with an unselected group of control schools there was an increase in the attendance of mothers at the inspections in schools using questionnaires. In Junior Schools (where the figure is already over 70%) it was raised to an overall figure of approximately 81%. In Secondary Schools where the figure is only about 30% the rise was far less marked and not statistically significant. The questionnaires did not increase the total number of health defects which were recognised but there was a marked shift in experimental schools towards the treatment (as opposed to the observation) of any defect which was discovered. Conclusions. It is concluded that the overwhelming majority of parents will provide any additional information at the school medical inspection which the doctor may feel to be necessary. Even when such information is highly confidential or personal it will be given in written form if it is in the interests of the child. An extremely small minority will complain as they already do, from time to time, about the present system. As a result of this co-operation school medical officers would be able to select some children for a more detailed examination than others but from the experience of this survey it would seem that such a selection cannot be based on the questionnaire alone and the doctor would require additional information from other sources before his selection can be sufficiently specific to be practicable. This would necessitate detailed discussions with teachers, Health Visitors and School Welfare Officers which have not been possible in the County Borough of Croydon. CONTENTS A. - PUBLIC HEALTH REPORT Page Ambulance Service 43, 118 Amusement Houses 65 Animals, Diseases of 68 Animals, Keeping of 68 Ante-Natal Clinics 31 Births 12 Blindness 88 Byelaws 81 Cancer 94 Care of Mothers and Young Children 31. 103 Census 11 Chemical Analyses 86 Chest Clinic. Work of 18 Child Minders 87 Chiropody 54 Civil Defence 44 Clean Air Act 65 Committee, Health 3 Communicable Diseases 15. 17, 123 Congenital Malformation 34 Convalescence 37 Cremation 122 Day Nurseries 53 Deafness 53, 113 Deaths 11. 92 Dental Treatment (M.& C. W.) 40, 112 Disinfection 66 Dlslnfestation 67 Drainage 64 Epileptics 88 Elderly Persons, Rehabilitation of 107 Factories and Workshops 60-63 Food and Drugs Act 73-77 Food Poisoning 16 Food Supply 69 Health Education 38 Health Visitors, Work of 35,104 Home Helps 37,110 Home Nursing 36.106 Home safety 38,117 Hospital, Isolation 17,125 Housing 58 Ice Cream - Bacteriological Examination of 72 Illegitimacy 11, 32 Page Immunisation 36, 128 Infant Mortality 11, 97 Infant Welfare Clinics 33,105 Marriages 12 Maternal Mortality 96 Maternity Homes 121 Meat Inspection 70 Men's Hostel 60 Mental Health 45 Midwifery 33.99-102 Midwives Act 33 Milk Supply 71 Mortuary 122 National Assistance Act 88 Neo.Natal Deaths 11.96 Notification of Births Acts 12 Nuisances 81 Nursing Equipment, Loan of 109 Nursing Homes 121 Nurses' Agencies 121 Offensive Trades 64 Outworkers 61 Perinatal Deaths 11,97 Pests 68 Physiotherapy 1ll Pharmacy and Poisons Act 67 Poliomyelitis 130 Population 11 Post-Natal Clinics 31 Post-Mortems 122 Premature Infants 31, 103 Public Health Inspectors, Work of 57. 79 Public Health Laboratory Service 27.127 Rag. Flock Act 67 Rats & Mice (Destruction) Act 68 Rivers and Streams, Pollution of 64 Page Shops Act 63 Statistics, Summary of 11 Still Births 11 Street Accidents 118 Tuberculosis, After Care 25 ,, Allowances 25 ,, Contacts 22 ,, Home Nursing 22 ,, Home Visits 22 ,, Mass Radiography 24 ,, Mortality 21, 132 ,, Notifications 133 ,, Occupational Therapy 26 ,, Residential Treatment 21 ,, Prevention and Control 18 ,, Re-Housing 23 ,, Vaccination 23 B. - SCHOOL MEDICAL REPORT Page Child Guidance 22 Cleansing of Children 8 Clinics 4. 51 Cod Liver Oil and Malt 27 Cost 27 Deaf Children 25,53 Deaths 9 Defects Pound 29,31, 40,41, 46 Dental Service 10,46 Enuresis Clinic 24 Epileptic Children 26 Exclusions 9,38,50 Handicapped Pupils 42,43,44 Heights and Weights 8,37 Infectious Diseases 38 Juvenile Employment 27 Meals, Provision of 27 Medical Inspection in Schools 5,29 Mentally Defective Children 18 Milk, etc. Provision of 27 Page Unmarried Mothers 32 Vaccination (Smallpox) 128 Verminous Persons 66 Venereal Diseases 27, 136 Vital Statistics 92 Ward Statistics 95 Water Supply 85,127 Welfare Foods 34,111 X-Ray 23, 134 Zymotic Diseases 17,125 Page Non-Maintained Schools 28,49 Orthodontic Service 14 Parents' Attendances 45 Population 34 Remedial Exercises 52 School Nurses, Work of 9.52 Schools Special. Cost of 27 Spastics 26 Special Inspections 31 Speech 23,48 Staff 4 Statutory Tables 29 Sub-normal children 21 St. Christopher's 18 St. Giles' 16 St. Luke's 20 Tonsillectomy 50 Tuberculosis 9 Uncleanliness 8,30 Vision, Defective 8.45 47 Table VI SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1963 (Percentages of Children examined) Defect or Disease Entrants Intermediates Entrants to Secondary School final Leavers All Groups Boys Girls Boys Girls Boys Girls Boys Girls Beys Girl Teeth 2.8 2.5 2.4 2.9 1.5 1.6 1.0 1.4 2.0 2. 1 Skin 1.1 1.0 1.5 1.1 1.5 2.1 1.1 0. 6 1.3 1.2 Eyes Vision 9.1 8.7 9. 6 13. 6 12.1 10. 8 15.4 13. 1 11. I 11.5 Squint 1.5 1.3 0.7 1.1 0.4 0.3 0.2 0.3 0. 8 0.7 Other 0.4 0.3 0.1 0.4 0.8 0.3 0.7 0.2 0. 5 0.3 Ears Hearing 4.7 4.3 2.1 1.8 1.7 1.3 1.4 0. 6 2.7 2.0 Otitis Media 0.6 1.1 0.1 0.4 0.3 0.2 - 0. 1 0.3 0. 4 Other 0.5 0.3 0.2 0.3 0.2 0.2 0.3 0.1 0.3 0.2 Nose and Throat 9.9 8.7 3.0 3.0 2.0 2.5 0.3 0.5 4.5 3.7 Speech 3.1 2.1 0.5 0.4 0.4 0.3 0.2 0.1 1.2 0. 7 Cervical Glands 1.3 1.1 0.2 0.5 0.1 0.2 - - 0.5 0.4 Heart and Circulation 1.2 1.0 0.7 0.6 0.6 1.1 0.7 0.6 0. 8 0.8 Lungs 2. 9 2. 0 1.1 0.9 0.5 0.7 0.9 0.3 1.5 1.0 Development Hernia 0.6 0.2 0.3 0.1 0.3 0.1 0.4 0. 1 Other 3.2 0.8 3.4 0.7 4.6 0.6 1.2 0.7 3.3 0. 7 Orthopaedic Posture 1.4 1.3 1.4 1.4 1.9 2.5 0.8 2.1 1.4 1.9 Plat Feet 3.2 1.3 1.9 0.8 0.3 1.3 0.7 0.4 2.0 1.0 Other 4.2 2.2 2.1 0.8 1.5 1.6 0.7 0.9 2.1 1.4 Nervous Diseases Epilepsy 0.1 0.1 0.1 0. 1 0.l 0.1 0.1 Other 0.7 0.3 0.3 0.3 0.3 0.2 - 0.3 0.4 0.3 Psychological Development 0.4 0.5 0.5 0.2 0.1 0. 1 0.1 - 0.3 0.2 Stability 1.0 0.6 0.6 0.6 0.1 0.3 0.1 - 0.5 0.4 Dull and Backward 0.1 - 0.2 0.1 - - - 0. 1 - Abdomen 0 1 0. 1 0.2 0.1 0.1 - 0.1 0.1 0.1 0.1 Other Defects 1.9 1.8 0.5 0. 9 0.7 1.1 1.1 0.8 1.1 1.1 48 Table VII HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS APPROVED UNDER SECTION 9(5) OF THE EDUCATION ACT, 1944 OR BOARDING IN BOARDING HOMES. During the calendar year ended 31st. December, 1963 number of handicapped pupils - (1) Blind (2) Partially sighted (3) Deaf (4) Partially deaf (5) Physically Handicapped (6) Delicate (7) Maladjusted (8) Educationally sub-normal (9) Epileptic (10) Speech defects TOTAL (1)-(10) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) A. Number of handicapped pupils newly assessed as needing special educational treatment at special schools or in boarding homes 1 2 1 2 35 6 3 44 1 2 97 B. (i) of the children Included at A, number newly placed In special schools (other than hospital special schools) or boarding homes. 1 2 1 2 28 5 1 29 1 70 (ii) of the children assessed prior to 1st January, 1963, number newly placed in special schools (other than hospital special schools) or boarding homes. 7 2 3 4 1 17 TOTAL (B(i) and B(ii)) 1 2 1 2 35 7 4 33 2 - 87 C. (i) Number requiring places in special schools - TOTAL (a) day - - - - 5 3 - 4 - - 12 (b) boarding - - - - 1 - 2 4 - 3 10 (ii) Number Included at (i) who had not reached the age of 5 and were waiting (a) day places - - - - - - - - - - - (b) boarding places - - 7 - - - - continu ad below 1 49 (Hi) Number included at (i) who had reached the age of 5, but whose parents had refused consent to their admission to a special school, were awaiting - (a) day places _ _ _ _ _ _ _ _ _ _ _ (b) boarding places _ _ _ _ _ _ _ _ _ _ _ D. (i) Number on the registers of (1) maintained special schools as - (a) day pupils _ 14 10 10 66 87 5 185 14 4 395 (b) boarding pupils 1 1 _ _ _ 1 2 3 _ _ 8 (2) non-maintained special schools as - (a) day pupils _ _ _ _ 2 _ _ _ _ _ 2 (b) boarding pupils 3 _ 3 7 8 7 1 3 3 2 37 TOTAL 4 15 13 17 76 95 8 191 17 6 442 (11) Number on the registers of independent schools under arrangement made by the Authority _ _ 3 _ 3 _ 14 4 _ _ 24 TOTAL (D(i) and D(ii) 4 15 16 17 79 95 22 195 17 6 466 (Hi) Number boarded in homes and not already Included under (i) and (li) above _ _ _ _ _ _ 1 _ _ _ 1 TOTAL (D (i).(ii) and (iii) 4 15 16 17 79 95 23 195 17 6 467 (continued overleaf) 50  (1) Blind (2) Partially sighted (3) Deaf (4) Partially deaf (5) Physi— cally Handicapped (6) Delicate (7) Mai adjusted (8) Educationally sub-normal (9) Epileptic (10) Speech defects TOTAL (1) - (10) During the calendar year ended 31st December,1963 number of handicapped pupils (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) E. were being educated under arrangements made under Section 56 of the Education Act, 1944. (i) in hospitals - - • - • 24 - - - • 24 (ii) in other groups (e.g. units for spastics, convalescent homes) - - - - 2 - - - - - 2 (iii) at home - - - - - - - - - - - PART IV - - - - - - - - - - - CHILDREN FOUND UNSUITABLE FOR EDUCATION AT SCHOOL During the calendar year ended 31st December, 1963 - (i) Number of children who were the subject of new decisions recorded under Section 57(4) of the Education Act, 1944 - 21 (11) Number of reviews carried out under the provisions of 57A of the Education Act, 1944 - Nil (iii) Number of decisions which were cancelled under Section 57A(2) of the Education Act, 1944 - Nil 51 Table VIII VISION TESTS Summary of Findings Entrants 8 year old group Entrants to Secondary School Final Leavers TOTAL Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % Up to 6/24ths 159 8.4 150 8.4 117 8.7 178 12.6 152 10.2 157 8.8 120 9.8 180 9.7 548 9.2 665 9.7 Over 6/24ths 13 0.7 6 0.4 13 1.0 15 1.1 28 1.9 35 2.0 60 4.9 64 3.4 114 1.9 120 1.8 52 Table IX DENTAL DEFECTS (l) Inspected by Dental Officers: - ... 1963 1962 Aged 5-6 ... 1,901 1,942 6-7 ... 2,749 2,816 7-8 ... 3,002 2,926 8-9 ... 3,016 2,975 9-10 ... 3, 160 2, 971 10-11 ... 2,957 3,081 11-12 ... 2,905 3,073 12-13 ... 2,881 2,926 13-14 ... 2,703 2,971 14-15 ... 2,693 3,370 15-16 ... 2,397 2,792 16 up ... 2, 052 1,642 Total ... 32,416 33, 486 Specials ... 1,200 1,410 ... 33,616 34. 896 (2) Number found to require treatment ... 15, 519 17,560 (3) Number referred for treatment 12, 447 14, 273 (4) Number actually treated 6,803 7,167 (5) Attendances made by children for treatment 18, 409 19, 259 (6) Half-days devoted to: Inspection 261 276 Treatment 2, 572 2,604 2,833 2. 880 (7) Fillings - Permanent Teeth 6,273 6,541 Temporary Teeth 2, 052 1, 985 8, 325 8, 526 (8) Teeth Filled Permanent Teeth 5.742 6, 107 Temporary Teeth 1,955 1,929 7,697 8,036 53 (9) Extractions - 1963 1962 Permanent Teeth 1,594 1,695 Temporary Teeth 3,762 4, 328 5,356 6, 023 (10) Administrations of general anaesthetics for extractions 2,190 2,435 Administrations of local anaesthetics for extractions 508 498 (11) Other Operations - Permanent Teeth 6,697 7, 389 Temporary Teeth 585 685 7,282 8,074 Attendances per session 7.16 7.39 54 Table X SPEECH DEFECTS CLINIC SUMMARY Total number of cases treated 527 Cases discharged 229 Analysis of Discharged Cases Under review pending possible further treatment in the future 82 Left District 11 Unsatisfactory e.g. non-attendance 29 Sat i s f act ory 103 Left School before treatment completed 2 Transferred to Residential School or Occupation Centre 2 Cases still attending 298 Cases referred for physical treatment 26 Cases referred for residential treatment 2 Cases referred for Child Guidance 1 Cases referred by Neurologist 20 Analysis of Type of Cases treated Stsummerers 106 Si gmatism 92 Cleft Palate 7 Excessive Nasality, including supra-bulbar palsy 9 Dysialla 254 Undeveloped Speech 32 Aph asia 20 Partially Deaf 4 Dysphonia 3 Special Schools St. Christopher's School 28 Some of these are under supervision only St. Giles' School 24 Some of these cases are under review only. Additional cases have been seen for assessment only. 55 APPENDIX C NON-MAINTAINED SCHOOLS Year ended 31st December, 1963. RETURN OF MEDICAL INSPECTIONS A - Routine Medical Inspections Year Year 1963 1962 Age 11 or under 73 29 12 85 55 13 58 41 14 52 34 15 77 76 16 63 64 17 4 22 18 or over - 8 Total 412 329 B - Other Inspections Number of Special Inspections - - Number of Re-inspections - - Total - - Visits to Non-maintained Schools 18 13 The following defects were found by Medical Inspection:- ment tion Skin 2 - Defective Vision 26 - Hearing 1 1 Nose and Throat 1 - Posture 1 - Flat Feet 1 - Orthopaedia Other 1 - Other Defects and Diseases 4 - 56 APPENDIX D RETURN SHOWING THE NUMBER OF CHILDREN SEEN AT ROUTINE MEDICAL INSPECTIONS DURING 1963 WHO HAVE UNDERGONE TONSILLECTOMY Year of Birth Boys Per. Cent. Girls Per Cent. Boys and Girls Per Cent. 1958 and later 49 3. 1 38 2.6 87 2.9 1957 10 3.2 11 3.4 21 3.3 1956 7 7.4 5 5.8 12 6.6 1955 64 12.7 47 8.3 111 10.4 All Boys 931 15.6% 1954 123 16.4 10 1.3 133 8.8 1953 41 13. 0 57 20.3 98 16.4 1952 56 19.0 50 14.8 106 16.7 1951 158 25.7 137 17.8 295 21.3 All Girls 935 13.7% 1950 56 21.2 84 21.2 140 21.2 1949 92 31.8 105 23.5 197 26.8 1948 136 29.3 220 24.5 356 26.1 1947 and earlier 139 29.2 171 33.0 310 31.2 All Groups Boys and Girls 1,866 - 14.6% CHIEF CAUSES OF EXCLUSION FROM SCHOOL Condi ti on Exclusions during 1963 Percentage of total exclusions Exclusions during 2962 Percentage of total exclusions Ringworm 1 0. 04 - - Verminous Conditions 2 0. 08 - - Impetigo 2 0. 08 3 0.11 Scabies - - 1 0.04 Scarlet Fever 36 1.51 60 2.24 Measles (inc. German) 916 38. 54 1,780 66.29 Diphtheria - - - - Whooping Cough 35 1.46 30 1.12 Chicken Pox 757 31.85 587 21.86 Mumps 495 20.82 149 5.55 External Eye Disease 4 0. 17 8 0.30 Poliomyelitis - - - - Dysentery 85 3.58 4 0.15 Jaundice 19 0.80 5 0.19 Enteric Group - - - - Meningococcal Infection - - - - Other Causes 25 1. 05 58 2.16 2,377 2,685 57 APPENDIX E TREATMENT The Work of the School Clinics SUMMARY OF ATTENDANCES 1963 1962 Increase or decrease Minor Ailments and Verruca Clinics 4, 932 5, 737 805 Inspection Clinic 807 1, 477 670 Dental Clinics 18,409 19, 259 850 Remedial Exercises Clinic 5, 217 5. 223 6 Enuresis Clinic 706 732 26 Audiology Clinic 154 189 35 30,225 32, 617 - 2,392 MINOR AILMENTS CLINICS Clinic De fects At tendances Lodge Road 321 2. 070 Ashburton School 87 730 Duppas School 209 636 Rockmount School 183 930 Addington 82 566 Complaint 1963 1962 Cases Attendances Average No. of At ten' Cases At tendances Average No. of Attendances per case Ringworm Scabies 1 2 20 Impetigo 25 4.2 4 14 3^5 Other Skin Diseases io 27 2.7 15 40 2.7 Otorrhoea and other Ear Defects 15 43 2.9 73 111 1.5 External Eye Disease 35 70 2.0 59 126 2.1 Miscellaneous (including Verruca) 716 4,767 6.7 1,231 5,444 4.4 782 4,932 6.3 1,383 5,737 4.2 APPENDIX F SPINAL AND OTHER REMEDIAL CLINICS (LODGE ROAD) 2963 2962 Attendances Classes Au. att. Attendances Classes Au. att. Spinal 1,668 420 4.0 1,640 413 4.0 Flat Feet 1,325* 400 3.3 1,525 416 3.7 Breathing 397 91 4.3 275 80 3.4 3,390 911 3,440 909 *76 treated by Faradism. 138 individual cases were treated and 235 examinations were made by a doctor. SPINAL AND OTHER REMEDIAL CLINICS (NEW ADDINGTON) 1963 2962 Attendances Classes Au. att. Attendances Classes Au. att. Spinal 551 43 12.8 552 43 12.8 Plat Feet 916 86 10.7 905 86 10.5 Breathing 312 43 7.3 320 43 7.4 1,779 172 1,777 172 120 individual cases were treated. WORK OF SCHOOL NURSES School Visits Visits to School Departments re Cleanliness 367 Visits re Scabies or Ringworm 4 Visits re Infectious Disease 41 Visits re Medical Inspections 591 Visits re Medical Preparations 536 All other reasons 346 Home Visits Concerning defects found at routine medical inspections, special cases and non-infectious cases 3,556 Visits in connection with infectious cases 284 58 59 APPENDIX G DEAF AND PARTIALLY DEAF CHILDREN OF SCHOOL AGE December 31st, 1963 Numbers attending Special Schools or Units. (a) Day Schools: Old Kent Road 7 Oak Lodge 7 Holman Hunt 4 Peckham Park 1 (b) Residential Schools: Burwood Park 1 Jewish School 1 Ovingdean 4 Hamilton Lodge 2 Mill Hall, Cuckfield 1 Margate 2 Mary Hare 1 Rudolph Steiner 1 R.N.I.D. Training Centre, Abbots Kerswell 1 Total 33 (21 of these 33 children are of secondary school age). Numbers attending Croydon Day Schools: (a) With hearing sufficiently impaired to require regular auditory training: Primary School Pupils - 61 Secondary School Pupils - 42 Total - 103 (b) With hearing loss not severe enough to require regular auditory training, but who need to be tested regularly: Primary School Pupils - 188 Secondary School Pupils - 27 Total - 215 60 Pure Tone Audiometer Tests: Number of individual children tested during the year: (a) For the first time - 584 (b) As a review case - 257 Total - 841 Auditory Training: 81 individual children received regular auditory training during the year. Number of attendance sessions: (a) At the Audiology Clinic - 154 (b) At home or school - 381 Total - 535 Sweep Testing of five year old school entrants: Number of schools visited 40 Number of children tested 3,964 Number of children passed 3,391 Number of children failed 403 Number of children to be re-tested 170 Number of children not tested (absent or unco-operative) 386 The 403 failures were followed up: No hearing loss 22 Negligible hearing loss 18 Slight hearing loss 121 Moderate hearing loss 131 Moderately severe hearing loss 58 Severe hearing loss 20 Failed to keep appointment 28 Left district 5 Total 403 Issue of Hearing Aids (a) National Health Service "Medresco" Aids - 8 (b) Commercial Aids bought by Croydon L.E. A. - 3 Total 11 3 children under school age are using hearing aids. CONTENTS A. - PUBLIC HEALTH REPORT Page Ambulance Service 57, 132 Amusement Houses 77 Animals, Diseases of 80 Animals, Keeping of 80 Ante-Natal Clinics 39 Births 14 Blindness 103 Bye laws 94 Cancer 17, 110 Care of Mothers and Young Children 39.119 Census 13 Chemical Analyses 98 Chest Clinic, Work of 27 Child Minders 102 Child Welfare Centres 41,121 Chiropody 65 Civil Defence 58 Clean Air Act 77 Convalescence 47 Committee, Health 3 Communicable Diseases 21, 23, 135, 136 Cremation 100 Day Nurseries 65 Deafness 65.130 Deaths 13, 15.16,108.109.110 Dental Treatment (M.&C. W. ) 54,128 Disinfection 78 Dislnfestation 79 Drainage 76 Epileptics 103 Elderly Persons, Rehabilitation of 123,124 Factories and Workshops 73—75 Food and Drugs Act 82 Food Poisoning 22 Food Supply 81,92 Health Education 50 Health Visitors. Work of 43,120 Home Helps 49,126 Home Nursing 47,122 Home Safety 52, 129 Hospital, Isolation 23-26,135 Housing 71 Ice Cream - Bacteriological Examination of 86 Illegitimacy 13, 40 Page Immunisation 47, 137 Infant Mortality 13,16,112,113,114 Infant Welfare Clinics 41,121 Inquests 15 Laboratory Examinations Various 36,85,86,98 Marriages 14 Maternal Mortality 16, 112 Maternity Homes 99 Meat Inspection 83 Men's Hostel 73 Mental Health 59 Midwifery 41,115-118 Midwlves Acts 41 Milk Supply 8 5 Mortuary 100 National Assistance Act 103 Neo Natal Deaths 13, 113 Notification of Births Acts 14 Nuisances 94 Nursing Equipment, Loan of 125 Nursing Homes 90 Nurses' Agencies 99 Offensive Trades 76 Outworkers 74,75 Perinatal Deaths 13,113 Pests 80 Physiotherapy 124 Pharmacy and Poisons Act 79 Poliomyelitis 138 Population 13 Post-Natal Clinics 39 Post;-Mortems 15 Premature Infants 39 Problem Families 45,127 Prosecutions 82 Public Health Inspectors, Work of 69,92,93 Public Health Laboratory Service 36 Rag, Flock Act 79 Rats & Mice(Destruction)Act 80 Rivers and Streams, Pollution of 76 Page Scarlet Fever 23!26 Shops Act 75 Staff Medical Examinations 101 Staff 9 Statistics, Summary of 13 Still Births 13,15 Street Accidents 132 Tuberculosis. After Care 34 " Allowances 34 " Contacts 31 " Home Nursing 31 " Home Visits 31 " Mass Radiography 33 " Mortality 30.139.140 " Notifications 141,142 " Occupational Therapy 35 " Residential Treatment 30 " Prevention and Control 27 " Re-Housing 32 " vaccination 32 Training Centres 61 B. - SCHOOL MEDICAL REPORT Page Child Guidance 24 Cleansing of Children 9 Clinics 4, 57 Cod Liver Oil 29 Cost 29 Deaf Children 27, 59 Deaths 10 Defects Pound 31,34,44,47,52 Dental Service 11,52 Enuresis Clinic 26 Epileptic Children 28 Exclusions 10.42,56 Handicapped Pupils 48,49.50 Heights and Weights 9,41 Infectious Diseases 42 Juvenile Employment 29 Malt 29 Meals, Provision of 29 Medical Inspection in Schools 5,31 Mentally Defective Children 20 Milk, etc., Provision of 29 Page Unmarried Mothers 40 Vaccination 137-139 Verminous Persons 78 Venereal Diseases 36,144-147 Vital Statistics 107-109 Ward Statistics 17,111 Water Supply 97 Welfare Poods 42 X-Ray 32. 143 Zymotic Diseases 23 Page Non-maintained Schools 30,55 Orthodontic Service 16 Parents' Attendances 45,46 Population 31 Remedial Exercises 58 School Nurses, Work of 10.58 Schools Special, Cost of 29 Spastlcs 28 Special Inspections 35 Speech 25,54 Staff 4 Statutory Tables 31 Sub-normal children 23 St. Christopher's 20 St. Giles' 18 St. Luke's 22 Tonsillectomy 56 Tuberculosis 10 Uncleanllness 9, 33 Vision, Defective 9,51