EX AC 43337 CRO 67 PUBLIC HEALTH IN CROYDON 1965 VOL. I I PART 2. NO. 1. PUBLIC HEALTH IN CROYDON 1965 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1965 S. L. WRIGHT, M. D. , M. R. C. P. , D. P. H. , Q. H. P. PUBLIC HEALTH DEPARTMENT, 43, VELLESLEY ROAD, CROYDON, Telephone: - MUNiclpal 4433 HEALTH COMMITTEE 1965 Alderman Keith Edwards (Chairman) Councillor B.H. Rawling (Vice-Chairman) Alderman A. V. Dammarell Alderman D. M. Weightman M.A. Councillor Mrs. N. B. Booth Councillor A.E. Buddie Councillor Mrs. D.L. George Councillor C. E. KellyCouncillor R. W. Kersey, B. Sc. Councillor G. Levy Councillor M.E. Mackenzie Councillor Mrs. E.M. Maycock Councillor Miss L.N. Overton Councillor Mrs. B. Saunders Councillor B. C. Sparrowe Councillor H.E. Styles Councillor J. T. Twitchett Councillor K.F. Urwin J. S. Lane, Esq., B. A. ,M. R. C. S., L. R. C.P. J.C. Miller, Esq., P. R. C. S., F. R. C: 0. G. Edith F. 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. 0. G. Members appointed to Sub-Committees on nomination of Outside Bodies as shown:- J.F. Boyle, Esq., M. B., B. Chir., D. Obst., R. C. 0. G. G. Clementson Esq. ,M. B., B. S. Edith F. Newling, B.A.(Hons.), M. B., B. S. , M. R. C. S., L. R. C. P. L. Williams, Esq., M. B. ,B. S. A. F. Clift, Esq., F. R. C. S., M. R. C. 0. G. S.Y. Marsters, Esq. Mrs. E. M. Ryle Horwood - - - Mrs. F.R. Mitchell, O.B.E. - - - Mrs. G. C. Browning ------ Mrs. J. Toogood ------ J. S. Horner, Esq., M. B., Ch. B., D.P.H. ,D.I.H., (Ehg.). G. J. Cottier, Esq. Local Medical Committee Croydon Group Hospital Management Committee Royal College of Nursing Royal College of Midwives Croydon Family Planning Association Croydon Federation of Toumswomen's Guilds The St. John Ambulance Brigade (Southern Area) The Insurance Institute of Croydon 5 LONDON BOROUGH OF CROYDON annual report of the medical officer of health and principal school medical officer for the year 1965 To the Chairman and Members of the Health Committee LADIES AND GENTLEMEN I have the honour to present the first Annual Report on the health of the people of the London Borough of Croydon and the relevant services of the Corporation, for the year ending December 31st 1965, Statistics Although the London Borough became the local authority as from April 1st, statistics for the first 3 months of the year for the two constituent authorities have been aggregated and added, so that a period of 12 months is covered. Comments on the figures which are deemed to reflect health conditions are difficult to make, as there are no returns for previous years which are strictly comparable. Nevertheless it seems that apart from the infant mortality rate which was greater in 1965 than in either of the constituent authority's areas in 1964, both the former County Borough and the Urban District maintained their usual pattern of steady improvements. It is especially noteworthy that although there were nearly 6,000 births, tnere was not a single death throughout the year associated with pregnancy or 6 childbirth. It has been possible to record this annual proof of the efficiency of contemporary maternity services on a number of occasions during the last few years, so that it has now become the expected pattern in Croydon and elsewhere. It represents a triumph of achievement never previously attained in human history. Nor is there any reason to believe that in pre-historic or primitive societies where women had no alternative to "natural childbirth" was there any similar approach to complete absence of maternal mortality. While adverse criticisms of some lack of amenities in our present maternity facilities may be valid, their unprecedented success in ensuring essential safety for mothers should not be forgotten. Communicable Diseases There were no cases of typhoid or paratyphoid fever, and a record low incidence of reported food poisoning. One case of poliomyelitis was notified, but after a period of hospital treatment the infection was not confirmed. The diagnosis was changed to polyneuritis so that 1965 was another year free from cases of poliomyelitis. Personal Health Services The generally accepted major defect of the National Health Service is the tripartite division of actainistration between the hospital boards, executive councils, and local authorities. In the former Croydon County Borough the advantages of the same boundaries for the last two named authorities, and a roughly identical catchment area for the hospital management committee facilitated the establishment of closely co-ordinated local services. On these arrangements the effect of the London Government Act was wholly adverse. The Croydon Executive Council was merged into the South West London and Surrey Executive Council, and part of the present borough came into the catchment area of a general hospital outside its boundaries. Arrangements to compensate for these difficulties were initiated. It will however take time to obtain results. Furthermore, proposals in the Ministry of Health's 10-year plan for a new district hospital "between Croydon and Redhill" indicate how deficient are present facilities, and the complications which fall upon interim schemes. Staffing shortages were seriously aggravated by the advent of 32 new all purpose London Boroughs and affected every section of the department. Nursing personnel, particularly Health visitors, were especially difficult to recruit. Preliminary 7 steps were taken to establish a training course for Health Visitors at the Croydon Technical College as an endeavour to help in the solution of a national problem. Careful assessment was made of the duties of all professional staff, to ensure that work which could be delegated to other personnel was not left as an unnecessary burden on depleted establishments. New clinic premises were opened at New Addington, and provided excellent Maternity and Child Welfare facilities for this somewhat isolated part of the borough. Discussion commenced with local general prectitioners about sharing of accommodation. The approach came from some of the doctors, was a reversal of previous attitudes, and by no means unanimous. It raised considerable problems but had obvious advantages for doctors and their patients, and the Health Committee indicated their approval to schemes being put forward. Mental Health Services continued their planned development and good progress was made in increasing facilities for industrial work. Much less successful was the establishment of group homes, which suffered from the deferment of capital expenditure, lack of suitable buildings and delays in buying suitable properties. One house was acquired and its conversion for a supervised group of mentally subnormal girls was begun. This failure to add to residential accommodation was disappointing, as increased facilities for employment would have allowed more patients to be placed in the community. Health Education Comprehensive programmes which co-ordinate with similar efforts in schools were extended to cover the whole of the borough. They include references to the connection between smoking and lung cancer, and to venereal diseases, but these topics were not the subjects of special campaigns. Cervical Cytology No success was achieved in obtaining local facilities because the Regional Board could not provide laboratory services and the Ministry of Health ruled that it was not within the powers of the Corporation. 8 Public Health Services The Chief Public Health Inspector reports in detail on an exceptionally busy year. New national legislation of major importance relating to commercial premises and to houses in multiple occupation became operative, while certain extra minor duties were placed by the Council on the department. 1965 was a year of great adjustment in local government in Croydon, and every effort was made to ensure that services continued without interruption. Abrupt changes merely to ensure uniformity were avoided. It was deemed a matter for satisfaction if recipients of services were unaware of any alterations in administrative control, and on the whole these efforts were successful. For the members of the staff I record appreciation of the manner in which they met and solved many new and perplexing problems, and for showing the sense of vocation essential in those providing health services. Finally I take this opportunity to express to the Members of the Health Committee and the Council, the Department's and my own gratitude for sustained support and encouragement which enabled your policy to be implemented with a minimum of administrative difficulty. I am Yours faithfully, S. L. WRIGHT, Medical Officer of Health and Principal School Medical Officer STATISTICS 11 SUMMARY OF STATISTICS FOR 1965 Area. 23,815 acres. Population (Census 1961), 327,239 Total population (estimate of Registrar-General), 328,380 (Midsummer, 1965) Number of Inhabited Houses: 99,761 Rateable Value of Borough 1965 as from 1.4.65, £18,413,014 Product of a Penny Rate, for London Borough of Croydon Purposes £76,430. Rate in the £. 10s.0d. (for the year 1.4.65 to 1.4.66.) Live Births Males Females Total Legitimate 2,635 2,555 5,190 Illegitimate 298 241 539 5,729 Illegitimate Live Births per cent, of total births 9.4 Live Birth Rate (as adjusted by comparability factor 1.02) 17.8 (England and Wales) 18.0 Stillbirths 71 Stillbirth rate per 1,000 total (live and still) births 12.2 (England and Wales) 15.7 Total Births 5,800 Infant Deaths 101 Infant Mortality rate per 1,000 live births 17.6 (England and Wales) 19.0 Infant Mortality rate per 1,000 legitimate births. 17.1 Infant Mortality rate per 1,000 illegitimate births 22.2 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 12.1 (England and Wales) 13.0 Early Neo-natal Mortality rate (First week) per 1,000 total live births 10.5 Perinatal Mortality rate (stillbirths + deaths during the first week)per 1,000 total live and stillbirths 22.6 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, 3,874 Death-rate per 1,000 of the estimated population 11.8 (England and Wales) 11.5 Death rate (as adjusted hy comparability factor 0.88) 10.4 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 1965 to 22%." The number of marriages solemnised in 1965 was as follows:- Church of England. Nonconformist. Register Office County Borough of Croydon March Quarter 206 91 254 London Borough of Croydon June Quarter 232 108 170 September Quarter 443 179 262 December Quarter 221 126 250 896 413 682 Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,662 29 3,691 Doctors 1,550 32 1,582 5,212 61 5,273 Accommodation for Confinements The following table shows where babies were born in the Borough of Croydon during the whole of 1965. 513 residents had babies outside Croydon and 389 non-residents were confined in Croydon. Number Percentage In Private Houses 1,546 29.57 In Public Institutions 3,447 65.96 In Registered Maternity Homes 219 4.194 Total 5,212 13 Urban District of Coulsdon and Parley In the Surrey Urban District of Coulsdon and Purley the total births for the first three months of 1965 were 256. Born in Surrey In private houses (within Urban District) 87 In Public Institutions elsewhere in Surrey 61 148 Born Outside Surrey In private houses 1 In registered Nursing Homes 8 In Public Institutions 99 108 The total number of births for the year 1965, including the Urban District of Coulsdon and Purley, plus the County Borough of Croydon, and the London Borough of Croydon was 5,519. COMMUNICABLE DISEASES 17 COMMUNICABLE DISEASES Measles was again the most prevalent infection (3,589 cases) and for the first time since 1957 a death from measles was recorded. This gives a mortality rate over the years of 1 death in some 18,000 notified cases. The details of the case were unusual. An infant of 7 months of age after 2 days indefinite malaise, was found dead in her cot. Following a post mortem ordered by the Coroner death was recorded as due to Measles viraemia and Bronchopneumonia. 2 older siblings were suffering from measles, but the baby had neither rash nor Koplik's spots. Vaccination as advised at about 12 months of age could obviously not influence directly such a case history, but protection of the older children i.n the family might have prevented the introduction of illness into the household. As previously noted the one case of supposed poliomyelitis was subsequently diagnosed as a quite different illness, so that 1965 was another year free from cases of this disease. Total notifications of food poisoning was a record low number. Tuberculosis continued to decline in prevalence, and a total of 4 deaths from all forms of this infection is a record low figure. Comparable figures are 1956 - 26 deaths; 1946 - 47 deaths. For details see Appendix, Page 131. 18 FOOD POISONING The food poisoning notifications, as corrected, for 1965 were:- lst Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 4 6 3 7 20 Outbreaks due to identified agents:- Total Outbreaks Total Cases 1 2 Outbreaks due to:- (a) Chemical poisons Nil (b) Salmonella Organisms 1 (c) Staphylococci (including toxin) Nil (d) botulinum Nil (e) welchii Nil (f) Other Bacteria Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases 2 5 Single Cases:- Agent identified Unknown Cause Total 6 7 13 Cases due to:- Salm. panama Salm. typhi-murium Salm. enteritidis 2 11 Salm. Mendoza Salm. Virchow 1 1 Salmonella Infections not food-borne:- Nil 19 REPORT ON CASES ADMITTED TO WADDON HOSPITAL IN 1965 J.J. Linehan, Esq., M. D., D. P.H. Physician Superintendent, Waddon Hospital A total of 451 patients were admitted to the infectious diseases wards giving an average occupancy of 22.77 beds and an average stay in hospital of 17.689 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. Gastroenteritis 98 (88) Measles 89 (73) Chicken-pox 42 ( 39) Scarlet Fever 36 (32) Dysentery 22 (14) Glandular Fever 13 (9) Pneumonia 12(10) Infective Hepatitis 10 (7) Meningitis and Encephalitis 9 (7) Erysipelas 5 Whooping Cough 4 (3) Mumps 3 (1) Rubella 3 Herpes Zoster 3 Salmonella enteritis 2 Malaria 2 (1) Typhoid Fever 1 Paratyphoid Carrier 1 Syphills 1 Bronchitis 10 (9) Tonsillitis 7 (8) Otitis Media 7 Quinsy 3 Rhinitis 2 Stomatitis 5 Pharyngitis 5 Laryngitis 1 Gastritis 2 Furunculosis 2 Adenitis 2 Cellulitis 2 Rheumatic Fever 2 Pediculosis 1 Ptyriasis Rosea 1 Pemphigus 1 Papular Urticaria 3 Erythema Multiforme 1 Allergic Rash 5 (3) Jaundice 1 Gall Stones 1 Diverticulitis 2 (1) Carcinoma of Colon 1 Intestinal Adhesions 1 Ulcerative Colitis 1 Asthma 1 Sub-arachnoid Harmorrhage 4 (2) Polyneuritis 1 Anxiety Neurosis 1 Nervous Debility 1 Convulsions 1 Sunstroke 1 Diabetes Mellitls 1 Temporal Arteritis 1 Nephritis 1 Urinary Infection 2 (1) Anaemia 1 Thalassaenia 1 Aneurism 1 Dog Bites 1 Fractured Ankle 1 Coronary Thrombosis 1 Retention of Faeces 1 Pyrexia of Unknown Origin 2 (1) Nil Abnormal Detected 2 (1) Non-patient Baby 1 For details of cases see Appendix, Page 131 20 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 1965 may be regarded as satisfactory. The number of deaths from all forms of Tuberculosis during 1965 was 4. 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 4,976 Number of patients recalled for examination and 1arge film 651 Number of active cases of Pulmonary Tuberculosis 18 Number of cases of lung cancer found 39 Incidence 81 cases of Respiratory Tuberculosis and 9 cases of NonRespiratory Tuberculosis were notified on Form A during 1965 (Table I - Formal Notifications). Of these 56 males and 25 females were Respiratory cases and 5 males and 4 females were Non-Respiratory. In addition 63 Respiratory cases and 5 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 1965 by notification or otherwise was 158. 144 of these were cases of Respiratory Tuberculosis; 91 in males and 53 in females, There was 1 case of Non-Respiratory Tuberculosis among children under 15 years. The number of cases in adults was 13. The incidence rate of Tuberculosis of all forms was 0.47 per 1,000 of the population; for Respiratory Tuberculosis 0.43 and for Non-Respiratory 0.04 per 1,000 population. The notification rate was 0. 27 per 1, 000. 21 Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1965:- RESPIRATORY NON-RESPIRATORY Males Females Total Males Females Total Total Cases 1,018 722 1,740 62 88 150 1,890 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1965, 66 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) 38 or 57.6 B, or T.B. plus, 1 (early cases, sputum positive) 6 or 9.1 B, or T.B. plus, 2 (intermediate cases, sputum positive) 22 or 33.3 B, or T.B. plus, 3 (advanced cases, sputum positive) - - 66 100.0% Non-Respiratory Tuberculosis There were 10 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints Abdominal 1 Other Organs 2 Peripheral Glands 7 10 Ages at Death from Respiratory Tuberculosis Year 0-5 5-15 15-25 25-45 45-65 over 65 TOTAL 1965 - - - - 2 2 4 22 All but 3 cases were notified during life. Where patients have not been notified during their lifetime a visit is paid by the Tuberculosis Health Visitor to the home of the deceased, to obtain particulars of the contacts and to endeavour to persuade them to attend the Clinic for examination. In 1965 the death-rate from all forms of Tuberculosis was 0.01 per 1,000 population. The rate from Respiratory Tuberculosis was 0.01 and the rate for Non-Respiratory Tuberculosis 0.00. In 1965 the total number of deaths was 4. All 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 1965 no deaths were certified to be due to Non-Respiratory Tuberculosis. Co-ordination with the Health Department During the year 9 children were referred by the School Medical Service, and 6 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 36 selected cases for varying periods during the year and 31 cases were in receipt of extra nourishment at the end of the year. Residential Treatment 58 men and 17 women were admitted to Residential Institutions in Croydon during 1965, suffering from tuberculosis. Hie Chest Clinic and Home Visiting 1,971 new cases were examined during the year. 76 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 17,671. The Clinic doctors paid 181 home visits and the Tuberculosis Visitors 2,568 visits for Clinic purposes. In addition the Tuberculosis Visitors made 170 primary visits for the purposes of the Notification Register. There were also 1,233 unsuccessful visits made. 23 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 1965, 544 persons were examined for the first time as contacts of notified cases of Tuberculosis, giving a contactcase ratio of 6 for each notified case during the year. Of these contacts, 4 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 8 compared with 0.47 per 1,000 of the general population. In addition, there were 3 found to be tuberculous who had been under observation from previous years. B. C. G. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1965 and regular sessions are held at the Clinic for this purpose. 330 contacts were successfully vaccinated during the year. In addition 11 nurses and domestics were successfully vaccinated, and 61 babies of tuberculous parents were vaccinated in hospital during the neonatal period. During the year under review the scheme for the B.C.G. Vaccination of all school children between 13 and 14 years of age was continued in Croydon. Staff from the Chest Clinic visit the Schools and carry out the necessary Skin Testing and vaccination with B.C.G. The response by parents to this protection for their children has been satisfactory and there were no untoward difficulties or complications. The Staff for this scheme are provided by the Local Authority but work under the direction of the Chest Physician, and this affords another practical example of co-operation between those responsible for treatment and prevention of Tuberculosis. B.C.G. Vaccination for School Leavers The total number of children skin tested - 2,936 Number found to be negative- 2,435 Number vaccinated with B.C.G- 2,423 24 Rehousing of Tuberculosis Patients 8 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 than into contact with children to have an X-Ray examination of the chest on their appointment and thereafter annually. In this connection 339 examinations were carried out in 1965 For detailed figures see Appendices, page 138 MASS RADIOGRAPHY 1965 The following figures kindly supplied by the Medical Director of the Surrey Area of the South-West Metropolitan Regional Hospital Board Mass Radiography Service include all attendances at public and private sessions:- No. of Persons Examined Significant Pulmonary Tuberculosis Primary Carcinoma of Lung Male 8,686 11 9 Female 9,249 7 3 TOTAL 17,935 18 12 New addington General Practitioner Chest X-Ray Service No.of Persons Examined Significant Pulmonary Tuberculosis Primary Carcinoma of Lung Male 329 2 4 Female 296 - - TOTAL 625 2 4 25 AFTER-CARE OF THE TUBERCULOUS PATIENT The general pattern of after-care of the tuberculous patient has continued in the form of advice and assistance with finances or personal problems, supervision and follow-up. Prom 1st April of this year, the after-care work has included tuberculous patients living in Coulsdon and Purley. Both Croydon and the Coulsdon and Purley areas did have their own Care Committees, but now the two Committees have combined. Assistance has been given by the new Committee on similar lines to previously and in the same generous way. As the area now being served is larger the number of requests for assistance made to the Care Committee has increased. Grants have been given for holidays and varied needs, and at Christmas grocery vouchers to the value of £90 were distributed, and £144 for fuel. Retirement Pensions were raised at the beginning of this year together with National Insurance and Unemployment Benefits and National Assistance Rates. The increase in the National Assistance scales included the special Tuberculosis Treatment Allowance. The increases generally have helped to meet the rise in the cost of living, but it is still difficult for the sick person to manage on Pension or National Insurance, supplemented by National Assistance. In 1965, the tuberculous patient has had little difficulty in finding suitable employment. The one exception is the very frail patient who is only fit for the lightest work in a job close to his Home. The Disablement Resettlement Officer gives help and advice, but it may be impossible to place this type of patient in employment- and, generally, the patient is then referred to the Occupational Therapist. Help has been given to a number of tuberculous patients by the Home Help Service. The Children's Department has also been contacted on certain cases and has arranged for the care of the children when the mother of a family has to be admitted to Hospital for treatment. The co-operation received from all Departments over the past year, as well as the assistance which has been given from time to time by voluntary organisations, is greatly appreciated. 26 OCCUPATIONAL THERAPY 1965 has again been a very active year in the Occupational Therapy Department at the Chest Clinic. There have been more new patients on treatment than usual, partly due to the extra people attending Purley Chest Clinic, but largely due to an increasing interest in home Occupational Therapy. The possibility of Chest Patients doing some Industrial Homework has been discussed with the Welfare Department and with the Croydon Disablement Resettlement Officer, and if the Scheme can be made to work, will be very satisfactory and beneficial to the patients. The Christmas Sale of Work was held at Queen's Hospital again at the beginning of December, and most of the articles made during the year were sold. 27 VENEREAL DISEASES New cases of Syphilis were fewer in 1965 than in 1964, but still above the numbers for previous years. There was a substantial rise in cases of gonorrhoea and these included 2 girls under 16 years of age. Our routine health education programmes including those for older school children, stress the avoidance of these infections and the importance of prompt and effective treatment. For detailed figures see Appendix Page 140 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 at 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 133 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 31 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics For the former County Borough area the joint domiciliary midwifery and hospital obstetric service continued to operate under the unified clinical supervision of the Consultant Obstetricians. One of the Obstetricians is a co-opted member of the local authority Health, Maternity and Welfare Sub-Committee. No similar unified service could be arranged for the former Urban District, served by Redhill Hospital, because the pressure of work on the staff of the Hospital Maternity unit did not allow their attendance at outlying clinics. Nevertheless their agreement to co-operate was forthcoming and further efforts will be made. There were meetings of the Maternity Liaison Committee where questions of improvements in arrangements for early discharge of mothers were discussed. At ante-natal clinics a total of 7,491 mothers attended during the year. 1,780 mothers attended the post-natal clinic. At relaxation classes 715 mothers made 4,329 attendances. 335 mothers attended Mothercraft courses each consisting of 7 lectures. 3,624 patients had an initial blood test. 35 were found to have Rh. anti-bodies. 21 were referred to the fecial Clinic for Venereal Disease. Care of Premature Babies Arrangements for the supervision of premature babies after discharge from hospital were extended to the whole borough within the catchment area of Mayday Hospital. These include routine estimations of haemoglobin with reference back to the hospital of any infant found to have less than 60%. For detailed figures see Appendix Page 109. Phenylketonuria All babies had a urine test by a midwife at home or in hospital at 9 - 10 days after birth, and a second test by a Health Visitor between 5 and 6 weeks of age. In 1965 Health Visitors carried out 5,190 tests. No child was found to be suffering from Phenylketonuria in 1965. "At Risk" Register Since 1963 Midwives and Health Visitors have notified babies who may have a greater liability than the ordinary infant to show congenital defects, so that thay may be kept under special surveillance. These "risks" are as follows:- 32 Genetic: Family history of deafness, blindness, etc. Pre-natal: Rubella or other virus infection in first 16 weeks of pregnancy. Rhesus incompatibilities. Severe illness necessitating chemotherapy or major surgery in early months of pregnancy. Peri-natal: Prolonged or difficult labour. Prematurity. Neo-natal jaundice. Post-natal: Treatment with streptomycin for any illness. Otitis Media. Cerebral Palsy. Not speaking at the age of two years. Mother worried about child's hearing. 980 children were reported during 1965. 33 Care of the Unmarried Mother Three voluntary organisations act as agents of the Corporation. Grants are made to them to cover the work of their Social Welfare Officers and the costs of sending mothers to Mother and Baby Homes. These arrangements continue schemes in operation in the former constituent authority areas. The Southwark Catholic Children's Society covering the whole London Borough; the Croydon Association for Moral Welfare the former County Borough; and the Southwark Diocesan Association the former Coulsdon and Purley areas. Merging the work of the two latter organisations was possible but would have resulted in a substantial loss of voluntary contributions. No administrative difficulties arose during the year under review. During the year under review: - 267 cases were dealt with by the Social Workers 61 girls were admitted to Mother and Baby Homes 34 cases were financially assisted by the Local Authority (This includes mothers who applied for help in 1964 whose babies were born in 1965 and those who applied in 1965 whose babies were not due until 1966). 2 babies were stillborn, 4 babies died. Ages of the younger mothers when they applied for help. 13 years old 1 14 3 15 10 16 11 17 18 18 22 Age when baby was born 13 years old - 14 1 15 8 16 10 17 15 18 23 19 6 34 Domiciliary Midwifery Emphasis continued to be placed om admission to hospital of mothers who had borne 4 or more children. For such mothers early discharge is sometimes a concession which obtains their consent. The domiciliary midwives dealt with nearly a third of all confinements in the borough, in addition to an increasing number of mothers discharged from hospital early in the puerperium. For detailed figures see Appendix page 104 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 100. 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. New premises were opened at New Addington. For other detailed figures see Appendix page 112. 35 Congenital Malformation The scheme introduced in 1963 continued unchanged, regular returns being made to the Registrar General. A total of 74 babies with congenital conditions was notified in 1965. See Appendix, page 119. Welfare Poods and Medicaments In the area of the former County Borough only Ministry of Food dried milk and vitamins were sold, and Clinic medical officers prescribed from a strictly limited list of "household" medicines. Where suppliers of proprietary items had clinic voucher schemes these were allowed to operate. Such arrangements were based on the concept that the functions of Welfare Centres are the prevention of disease, advice to parents on child care, health education, and supervision of the progress of children. Pood, vitamins and medicines are available for convenience, but the war-time advent of the Welfare Foods scheme covered all essential nutritional needs and the National Health Service the supply of medicines. In the former Drban District, Infant Welfare Centres (as is common in many parts of the country) sold a wide variety of proprietary preparations in "clinic" packs. Medical Officers also had powers to prescribe whatever medicines they deemed necessary. After very careful consideration the Committee resolved to apply the former County Borough policy. Issue of Welfare Foods in 1965:- National Dried Milk 56,903 Cod Liver Oil 6,019 Vitamin A and D Tablets 8,532 Orange Juice 97,831 36 THE WORK OF THE HEALTH VISITOR Mrs. M.I. Pointer, S.R.N. S.C.M. M.T.D. H.V. Assistant Superintendent Nursing Officer for Health Visitors A momentous year has drawn to a close and we can now look forward to the future with greater optimism than we probably did this time last year. Despite many discussions and consultations which took place before the first of April, we found in practice that in order to select from each amalgamating authority the most progressive ideas for developing our services in the new Borough, many adjustments still had to be made. We hope we have taken the "best of both worlds" and established a united team of Health Visitors. District boundaries have been re-arranged and new areas created, all of which has helped to foster the concept of one complete Authority. There has also been an exchange of areas between Health Visitors of the two former Authorities. During the year the Health Visitors have faced many pressures, staff shortage being the most acute problem. Vacancies are difficult to fill and the hope of increasing our establishment of Health Visitors to cope with the growing population seems rather remote. The situation has been eased in school work by increasing the number of school nurse assistants but several Health Visitors are still carrying double case loads in maternity and child welfare. The movement of families within and into the Borough involves a great deal of extra work, particularly in maintaining contact with the families who move about frequently, for it is often those families who most need help. Overseas immigrants have presented special problems and one Health Visitor has been assigned to deal with matters concerning their welfare and integration into the community. More and more mothers are finding themselves obliged to go out to work, thus giving rise to concern for the care of their young children. One Health Visitor has been appointed to deal with the supervision of play - groups, foster-mothers and daily minders, including the inspection of premises and equipment of prospective daily minders. 37 We are very much aware that the changes in the social and economic life of the community require changes in the scope of our service. We have taken a close look at our established patterns of work to see where we can adapt them to these new conditions and to prepare today to meet the challenge of tomorrow. It is unfortunate that because of staff shortage enthusiasm for expansion and the introduction of new mediums of service is often frustrated through sheer weight of case loads. Meanwhile the day to day work of advising mothers on the care of their children, dealing with family social problems and the promotion of health education for all age groups continues as before. By consolidating proved and established procedures and applying such new ideas and techniques as time may bring, we hope in 1966 to achieve the maximum beneficial impact on the community. Figures of work carried out are shown in Appendix, page 110. 38 IMMUNISATION Last year I reported to the County Borough Health Committee on the adoption of a new schedule for the timing of the various procedures now available for protection against Poliomyelitis, Whooping Cough, Diphtheria, Tetanus, Smallpox and Tuberculosis. The expert advisory committee which drew up schedules for the Ministry of Health recommended local authorities to select one of two programmes. The first was based on the supposed need to protect very young infants against whooping cough, and began with injections of triple vaccine as soon as possible after the baby reaches one month of age. The second had regard to the age at which the child will respond best to a minimum of injections, discounts the early risk from whooping cough, and commences with oral poliomyelitis vaccine at 6 months of age. Of recent years whooping cough in Croydon (and Surrey) has been mild in character with negligible mortality. Whooping cough vaccine is a relatively crude antigen, producing local or general reactions in half the children injected and I have always been reluctant to suggest its use as the introduction to a series of protective inoculations. For all these reasons the second alternative was used in the former County Borough. Surrey, however, advocated ♦the first schedule. Abrupt change of advice to parents should obviously be avoided. It was left to the judgment of medical officers to explain and alter arrangements as opportunity allowed so that the second schedule was gradually applied to the London Borough area. No special campaigns were possible in view of the need to consolidate administrative arrangements. Against a fortunate background of absence of cases of disease, acceptance rates showed the usual tendency to fall. Action for joint campaigns with other London Boroughs was under discussion for application in 1966. For Tables see Appendix page 134. HOME NURSING This continued as a direct responsibility of the Corporation. Suitable training arrangements were made and students accepted for courses leading to qualification as district nurses through the Queen's Institute for District Nursing. For details of work carried out see Appendix page 114. 39 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 38 cases were so dealt with, 27 women, 10 men and 1 child under 5 years. There were in addition, 9 cases where the patients cancelled their applications after the arrangements had been made. These figures include the Surrey Urban District of Coulsdon and Purley as from the 1st April 1965, they do not include children for whom arrangements are made by the Education Committee. HOME HELP SERVICE Difficulties in recruiting Supervisors and Home Helps persisted. Owing to these and delays in completion of adaptations to the rooms in the basement flat at St. James's Road, it was not possible to begin the in-service training school for Home Helps. One very encouraging factor emerged from a new approach to staff recruitment, applied towards the end of the year. Stress was laid on the vocational aspect of this work, and the fact that it transcends mere domestic duties. Response was coming from a new section of the community, raising hopes that long standing vacancies might be filled. The value of a training scheme was emphasised and I anticipate being able to report upon its success in a future report. For details of work carried out see Appendix page 118. 40 HEALTH EDUCATION AND HOME SAFETY Miss D. S. Elliott, S.R.N., H. V. Cert., Dip. H.E. Health Education Officer The health education section has tried to remain 'in statu quo' in spite of changes in the team and during the integration of existing services into the larger London Borough of Croydon. Opportunities were made to welcome staff from the new part of the town, often by meeting formally and informally in the health education unit; there its purpose and the help that could be given to them was explained by the staff and there were demonstrations of the types of teaching and reference material which are always at their disposal. One assistant health education officer has been made responsible for the southern part of the town. To prevent staff from that area from wasting time by calling at the central office for equipment a small subsidiary office has been opened at 115, Brighton Road. The assistant health education officer attends there every Wednesday morning and on other occasions as necessary, and is available for reference, advice, encouragement, taking orders for equipment and introducing new visual aids. There are now twelve toddlers' clinics at which, beside medical examinations conducted by doctors, proper discussion groups organised by health visitors and dealing with mental, physical and social subjects, are running regularly. The parents in the majority of these groups are given the opportunity to suggest the subjects in which they are most interested, for the programmes this is an important educational principle and the subjects chosen usually coincide fairly closely with those which the professional staff would have suggested and it has been found that there is never any shortage of ideas. Public knowledge about the extent of the environmental, personal and school health services and how they may be used is still very poor and an increasing number of talks have been given by members of the respective staffs to all kinds of groups during the year. One assistant health education officer trained in the Marie Stopes Memorial Clinic in contraceptive techniques is working in co-operation with the Croydon Family Planning Clinic in explaining the social aspects of Family Planning to women; the department has purchased a special female pelvis and other material for demonstration purposes. 41 Until a year or so ago almost any form of cancer education was resisted by both the public and the staff. However, since the publicity given to the possibility of smear tests being made available for healthy women to detect the early signs of cervical cancer, there have been a number of requests from women's groups to discuss this. The opportunity was always taken to explain the outward signs of early cancer in accessable parts of the body and the importance of the giving up of cigarette smoking in the prevention of lung cancer. The health education team has enjoyed co-operating with Dr. Gibbons in her Weight Control Clinics for school children. (See the "School Health Section" page 64 ). These have been held in the health education lecture room and help and advice have been given with visual aids to stimulate discussion. This project demonstrates the practical application of health education in a particular condition and aims to prevent future mental and physical ill health. Home Safety In 1964 information had been received from the Croydon Ambulance Service of the number of children taken to hospital following poisoning accidents. During 1965 extra efforts were made to educate young mothers and school children about this risk. Poisoning accidents also formed the main theme of the stand for the Ashburton Flower Show; we were greatly indebted to the curator at Kew Gardens who donated many common poisonous plants and berries free of charge for the occasion and this part of the stand was a great attraction to the public. Following a recommendation from the Medical Officer of Health, the Housing Committee and Borough Engineer's Architects agreed at the end of the year to the "Barry Bucknell Safety Device" being fitted to medicine cupboards which in future will be incorporated in standard kitchen equipment, one to each dwelling unit. In recognition of the Golden Jubilee of the Royal Society for the Prevention of Accidents in 1966 a recommendation was also made to the Housing Committee that bath rails should be fitted in all council houses and flats built in Croydon in future. Demonstrations of Mouth to Mouth Resuscitation were given to many groups during the year. The department purchased a ResusciAnne model and the complete set of Admiralty Films on this subject. 42 The evaluation of home safety education will now be extremely difficult because the London Ambulance Service is unable to provide a breakdown according to cause of the accident cases admitted to hospital. Perhaps the introduction of computers in Local Government Service in the future will overcome this difficulty. Details of Home Safety Statistics see Appendix page 126. 43 DENTAL TREATMENT (MATERNITY AND CHILD WELFARE) W.G.Everett Esq., L. D. S., R. C. S., (Eng.) f Principal Dental Officer Dental treatment is provided for all expectant and nursing mothers, also children under five who are not yet eligible for treatment within the School Dental Service. Expectant and nursing mothers may be referred by doctors and consultants at Ante- and Post-natal clinics. They are also accepted if referred from other sources. Pre-school children are seen at the request of parents and health visitors, or are referred from Toddlers' Clinics held at Welfare Centres. Inspection and treatment is carried out at the school dental clinics by the dental officers, who devote a small part of their time to this work. As is the case of the School Dental Service statistics, the geographical increase of the Borough and the increase in staff and clinic premises has made detailed comparison of this year's figures with those of previous years impossible. It would appear that the trend of the decrease in numbers of mothers seen, and the increase in numbers of pre-school children, has been maintained. As has been mentioned in previous reports, it is more desirable for mothers to attend their general dental practitioners regularly, rather than attending Local Authority clinics only during and after pregnancies. The effort in the future must be to persuade mothers to bring their children for inspection long before school age is reached. Children have most of their temporary teeth by the time they are two years old. Unwise feeding habits and indiscriminate sweet eating can and do create havoc in these teeth. From every point of view it is most desirable that the first visit to a dental surgeon should not be associated with toothache, or pain from extensive conservative work necessitated by grossly carious teeth. In order to achieve early inspection it is planned to introduce a birthday card scheme. By this method all three year old children are sent a birthday card, calling the parents' attention to the need for early inspection and treatment, and offering them an appointment at a clinic near their home. Sessions would be specifically organised to cater for such young patients. 44 Arrangements also are being made for all children seen at Toddlers' Clinics to be invited to attend the dental surgery at the same visit. Where Clinics are held in the same premises this poses no problem. Whenever new clinics are designed and built, it is most desirable that medical and dental facilities should be combined. Dental Health Education talks are undertaken for mothers attending Toddlers' Clinics. It is hoped to develop this aspect of Dentistry, and the appointment of an oral hygienist will be most helpful. The usual tables are given in the Appendix, page 121. 45 MENTAL HEALTH SERVICES The year 1965 has seen a number of important developments in the Mental Health Services. These include the opening of a second day hospital, the establishment of a sheltered workshop catering for both mentally and physically disabled persons, the formal establishment under the Local Health Authority of a single social work team to serve the needs of mentally disordered persons and their families and the opening of a mental health office in the Purley and Coulsdon part of the Borough at 115, Brighton Road. In addition to these particular features the year has seen a general advance in the service on many fronts. Administration The Medical Officer of Health was in administrative control, and the Deputy and two Assistant Medical Officers of Health were approved for the purpose of the Mental Health Act, Dr. A. R. May who was Psychiatric Adviser to the Local Health Authority and the Medical Director of their Community Mental Health Services was appointed as a Principal Medical Officer to the Ministry of Health. Dr. J.D.W. Fisher, Consultant Psychiatrist at Warlingham Park Hospital, succeeded Dr. May as Psychiatric Adviser and Medical Director. Dr. B.W. Richards, Consultant Psychiatrist at St. Lawrence's Hospital continued as Adviser in Mental Subnormality to the Local Health Authority. The continued successful operation and development 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 The guardianship Society looked after eleven severely subnormal patients on behalf of the Local Health Authority (9 under guardianship and 2 placed informally). The Mental After Care Association both through its temporary stay Hostel in Croydon and through its long stay homes elsewhere continued to give invaluable help to Croydon patients of whom there were 35 in the care of the Association at the end of the year. The Mental Health Service continued to have close and friendly ties with the Croydon and District Society for Mentally Handicapped Children and it is hoped that these will now extend e<iually to include the Purley and District Society. The Croydon Society continued to provide social club activities for severely handicapped patients, and is currently helping in the establishment of a small group home for mentally handicapped working girls. 46 The interest and help afforded by the Croydon Guild of Social Service has again been greatly appreciated, and it is hoped that useful links can now also be established with the Guild's work in the Purley and Coulsdon area. Thanks are due to all the voluntary organisations and individuals whose assistance in one way and another has been so much appreciated and readily given. Mental Health Act 1959 As might be expected the larger London Borough area has given rise to more calls on the Mental Welfare Officers in respect of their statutory duties under the Mental Health Act than arose from the County Borough area the preceding year. However, the increase is attributable more to the inclusion of Netherne and Cane Hill Hospitals in the area of the London Borough of Croydon and to duties in respect of patients in these hospitals, than to the increased population of the Borough. In fact the recent slow but steady decline in the number of cases where statutory admissions become necessary appears happily to be continuing. Details of admissions by mental welfare officers of all categories of patients under different sections of the Mental Health Act are given below:- Male Female Total Informally 32 37 69 Under Section 25 (For Observation) 55 31 86 Under Section 26 (For Treatment) 30 43 73 Under Section 29 (For Observation in Emergency) 71 103 174 Under Section 136 (Police Action) 2 1 3 Under Section 60 (Hospital Order Through Court) 3 - 3 Investigated but not Admitted 13 12 25 206 227 433 In Netherne and Cane Hill hospitals mental welfare officers were concerned with 63 Section 25 procedures and 55 Section 26 procedures. This more than accounts for the increase in procedure under these sections as shown in the table. 47 Admissions of mentally subnormal patients to hospital during the year are shown below. To Psychiatric hospital-subnormality 23 To psychiatric hospital-mental illness - Transfer from one hospital to another 4 Admitted for short term care 32 Total number of patients in hospital 485 On 31st December 1965, 10 patients were awaiting hospital beds. Guardianship No patients were placed under guardianship during the year and 2 were discharged, bringing the total number under guardianship to 18 at the end of the year. Training Centres (i) Junior Training Centre The difficult working conditions occasioned in 1964 by commencement of building operations on the site of the new adult centre still continue. Despite this the work of the Centre has continued as satisfactorily as conditions allow, and appreciation is due to the Supervisor and staff of the Centre for the hard work put in and the way training standards have been maintained under discouraging and difficult conditions. In February the conversion of rooms in the former Supervisor's flat was completed to allow an extension of the special care facilities. While not ideal this special accommodation did permit the admission of an additional 10 children too handicapped for the ordinary classes of the Centre. At the end of the year there were 63 trainees on the books of the Centre (40 boys and 23 girls). (ii) Bensham Adult Training Centre This continued to provide training and work for subnormal and severely subnormal persons. Most entrants were from the Junior Training Centre, and some progressed to the Crosfield Industrial Unit. On the 31st December, 63 trainees (36 male and 27 female) were attending. Work included laundering, tool assembly, filling and packing, soldering and simple electronic sub-assemblies. The hours were 9 a.m, to 4 p.m. Mondays to Fridays throughout the year, except on Bank Holidays. Incentive pocket money was paid based on aptitude ability, and regularity of attendance. A bonus scheme applied when the money earned exceeded the pocket money rate. Protective clothing was provided, and meals at a low cost. Coaches took trainees to and from the Centre, but encouragement was given to those capable of making their own way. 48 Crosfield Industrial Unit Despite the inadequacy of these premises there were considerable developments during the year under review. On the administrative side the co-ordination of all industrial work for the local authority and for the mental hospital was ensured by the joint appointment of the Corporation's Industrial Organiser by the Hospital Management Committee, who reimbursed 2/llths of salary. In August part of the Unit was approved by the Ministry of Labour as a sheltered workshop, so that two sections were formed (i) an assessment, training and rehabilitation unit, (ii) a sheltered workshop. By agreement with the Welfare Services Committee both sections admitted physically as well as mentally handicapped persons. Acceptance, review, and discharge of trainees, were covered at weekly meetings attended by a Psychiatrist, Psychologist, Disablement Rehabilitation Officer, Social Worker, and a representative of each Centre. A Social Club was held on one evening per week, with a Social Worker acting as the Club leader. An average of 30 trainees attended. Music, table games, handwork, and tuition in reading, writing and simple arithmetic, were the main activities. Rambles and visits to places of interest were also arranged. At the 31st December there were 57 patients in the Assessment unit - 46% were mentally ill, 23% were subnormal, 14% severely subnormal, and 17% were physically disabled. On the same date there were 43 patients in the Sheltered Workshop - 44% were mentally ill, 14% subnormal, 28% severely subnormal and 14% physically handicapped. Terms and conditions of service were as agreed with the Ministry of Labour, and conformed in essence to those at "Remploy". A full 40 hour week was worked, travelling expenses upf to 2/-d per day repaid, and a free mid-day meal provided. Employees were free to join a Trade Union, and a physically handicapped person acted as a shop steward. Work processes included assembly and packing, wire bending and spot welding, soldering, drilling and fly press work, and manufacturing breeze blocks. Hospital Group The experiment of allowing a group of mentally ill patients to attend from Warlingham Park Hospital was surprisingly successful. Of the 20 patients referred during the year, 6 had to be withdrawn but 9 progressed to employment in the sheltered workshop, 1 to open employment, and 4 remained under assessment at the end of the year. 49 Work Group Placement The possibility of open employment for groups of severely disabled persons, whose mental and physical handicaps might be balanced by suitable selection of individuals, had been considered for some time, and one opportunity arose to place a group of 4 in a factory to deal with machine operating and packing. 5 female trainees were involved, and 1 mentally ill and 1 physically handicapped patient were unsuccessful and had to be withdrawn. Another physically handicapped patient obtained employment with the firm, and two others remained on extended trial. Despite the limited success, this procedure of placing a group initially with an instructor in a factory was thought to be practicable, and further opportunities will be sought. A co-ordinated Industrial Work Service When we were considering some years ago the establishment of facilities in Croydon for mentally disordered persons, visits to the Government Industrial Training Centre at Waddon made clear the advantages of a single service for the mentally and physically handicapped. These observations were on individuals far less handicapped than those with whom the local authority are required to deal, but our experiences have upheld this original conclusion. With reasonable preparation and selection, severely disabled persons of all types can benefit by mixing in a work situation, and so far there has been no evidence to indicate the need for a fixed ratio between the physically and mentally ill. We have also confirmed that a few severely subnormal persons can reach wage-earning standards, and be trained to be proficient in more than one type of job. The distinction between a Rehabilitation Unit and a Sheltered Workshop, which must be maintained to meet definitions imposed by the Ministry of Labour, seemed difficult to justify when there was a preponderence of mentally ill patients. This is probably due to the fact that the work limitations of the physically handicapped can be assessed with some accuracy, but with psychiatric patients there may be very considerable variations with exacerbations and remissions of the mental illness. Residential Care (i) Temporary Care Continued use has been made during the year of the Mental After Care Association Hostel in Croydon to provide temporary care for patients recovering from mental illness. Short term care in hospital has been arranged for 32 subnormal patients during the year and 3 patients have had convalescent holidays arranged for them. 50 (ii) Long Term Care (a) Boarding Out Scheme During the year a further 33 patients were placed in lodgings under the scheme. Of these 23 were still boarded out at the end of the year, 6 had moved on to other accommodation outside the scheme, 2 had been re-admitted to hospital and two had died. The help and interest of the many landladies who participate in this scheme are vital to its success and appreciation of their work must be recorded. If the scheme is to continue to expand additional landladies will be required, and increasing difficulty in finding them has to some extent limited the number of patients placed during the year. The scheme remains of great benefit to patients and by the end of the year 132 persons had been helped by it since its inception in 1962. The average weekly cost per patient remains at about £1. 16s. Od. (b) Small Group Homes The first Small Group Home which was established in 1964 has continued to run very satisfactorily. The home is rented from the Housing Department and the five residents are supervised by the Boarding Out Officer. One resident became ill during the year but has now recovered and is back at work. The other residents have kept well and all appear to have benefited from the support of the home which has greatly facilitated their rehabilitation in the community. (c) Voluntary Homes At the end of the year there were 28 patients placed in long stay voluntary homes, and for whom the Corporation had accepted financial responsibility, including 15 under the Mental After Care Association and 11 under the Guardianship Society. Social Work From 1962 to 1965 Warlingham Park Hospital and the Local Health Authority have by agreement staffed and operated a joint social work service. This service was available to help mentally disordered patients and their families whether or not the patient was in hospital or undergoing medical treatment. The scheme has proved beneficial in practice and in 1965 this informal arrangement was given formal shape by a further agreement 51 between the two authorities. This provided for all the social workers in the Mental Health Service to be employed by the Local Health Authority and for an appropriate re-imbursement to be made by the Hospital Authority, and thus confirms and consolidates the joint arrangements. The first half of 1965 saw some further staff losses among the social workers, but it was possible to make these good towards the end of the year. The enlargement of the Borough by the addition of the Purley and Coulsdon area had the immediate effect of increasing by about 100 the number of mentally subnormal patients to be cared for in the community. There has also been an increase in the number of mentally ill patients needing social work help, but the full impact of the new area in this respect has not yet been felt. An additional Mental Health Office has been established at 115 Brighton Road to deal with the work of the new area. In the service generally the demand for social work continues to grow. The first table shows the actual number of active cases carried by the social workers at the end of 1965. The second table shows the actual number of cases referred to the social workers for help during 1965. Active Caseload of Social Work Date Subnormal and Severely Subnormal Mentally III Others Total 31st Dec. 1965 527 499 81 1,107 Numbers of Cases referred for Social Work Date Subnormal and Severely Subnormal Mentally III Others Total 1965 251 657 232 1,140 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 for psychiatric patients is now run at The Crescent Day Hospital, New Addington. A fifth 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 sixth 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. 52 Students Throughout 1965, 8 students from the training course in Social Work at the Croydon Technical College have attended for practical work at the Mental Health Centre, 49 Wellesley Road. A number of students from University Social Science Departments have also come for periods of practical work in the Mental Health Service, as have also Mental Health Course students from Manchester University. In addition medical, nursing, social work and administrative students of various kinds have been on visits of observation to the service. All training matters and student activities are the responsibility of the Training Officer. Visitors The Croydon Psychiatric Service continues to attract its quota of visitors. In addition to the various students, visitors in 1965 have included representatives of a wide range of medical and other professional personnel. Some of these have been from other parts of the country, and over 20 from overseas representing some 10 different nations. 53 CORPORATION DAY NURSERIES There are now two Day Nurseries in the London Borough of Croydon, one at Whitehorse Road, West Croydon and the other at Sanderstead Road, Sanderstead. They are 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 4/- 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 21s.7d. per day. Whitehorse Road Hazleglen Sanderstead Road Details of attendances- Capacity 50 30 Number on books at the end of year 46 24 Attendances: Under 2 3,024 1,219 Over 2 5, 055 3, 568 Total 8,079 4,787 Number of days opened 256 255 Average daily attendance 31¼ 181¾ DEAFNESS Schemes for testing all infants during the first year of life, whose names were included on the "At Risk" register, were continued. Furthermore this assessment of hearing ability was extended to all infants attending Infant Welfare Centres, and where staffing permitted, by home visits of Health Visitors. For detailed figures see Appendix page 122. 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. Domiciliary treatment was also included, but the fees paid came out of the financial allocation allowed to each practitioner. It was thus left to individual Chiropodists to decide how they allocated services within their global budgets. The scheme covers elderly persons, expectant mothers and the permanently handicapped. On December 31st 1965, 24 Chiropodists were operating this scheme. During the period April 1st to December 31st 1965 they gave 14,659 treatments at their surgeries and 1,491 by domiciliary visits. 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 submit- my annual report for the year 1965, and following the practice of previous reports, the statistical details are presented in the tables which follow. Following the amalgamation of the late County Borough with the Coulsdon and Purley Urban District Council in April, 1965 the figures quoted include those of the former Urban District Council as from the 1st January, 1965, The administration of much new legislation enacted late in 1964 has had its effect during 1965 on the work of the Department. Amendments to former Statutes have been made enabling more positive action to be taken in certain housing matters. Technical Assistants have been engaged and Specialist Inspectors have been appointed to deal especially with Clean Air, Offices, Shops and Railway Premises, and Houses in Multiple Occupation. Progress in Clean Air continued when the Council made its No.8 Smoke Control Order in December, 1965 which now awaits confirmation by the Ministry of Housing and Local Government. Comment is made in the report on the progress made in the administration of the Offices, Shops and Railway Premises Act, 1963. The Council has made its first Registration Order respecting houses let in multiple occupation covering one ward in the Borough, and this has been submitted to the Ministry of Housing and Local Government for confirmation. During the year the responsibility for the administration of the following Statutes has been directed to this Department: Consumer Protection Act, 1961, and Regulations made thereunder covering Heating Appliances (Fireguards); Oil Heaters; Childrens Nightdresses; Fabrics Misdescription Regulations; Mines and Quarries Act, 1954, Scrap Metal Dealers Act, 1964. The redevelopment which is continually taking place throughout the Borough has caused time-consuming efforts by the Inspectors in tracing and arranging for the sealing off of the former drain connections to the Corporation sewers. The increase in acreage and population occasioned by the formation of the new London Borough has, not unnaturally, increased the number of problems to be dealt with together with their attendant anxieties. 58 I have, however, received the utmost help and loyalty from the staff of my Department to whom my thanks are due for their efforts in the administration of the many and varied duties we are called upon to effect. This is the last report I shall make as I am due to retire in May, 1966 following some 39 years service in this Department of the Corporation. I would wish to express my thanks to Dr. Wright for the guidance, advice and counsel which he has at all times afforded to me, and to the Chairman, Vice-Chairman and Members of the various Committees for their kindly support and encouragement. 59 HOUSING Number of parts of houses on which Closing Orders have been made 10 Number of houses on which Closing Orders have been made 7 Number or houses on which Demolition Orders have been made 3 During the year 1,237 houses were rendered fit following the service of notices requiring repairs. Rent Act, 1957 - Certificates of Disrepair Since Commencement of Act Applications made in 1965 Number of Applications for Certificates 950 24 Number of decisions not to issue Certificates 51 1 Number of decisions to issue Certificates 899 23 Number of undertakings given by Landlords 537 8 Number of Certificates issued 358 12 Applications by Landlords to Local Authority for cancellation of Certificates 250 5 Cancellation of certificates refused 50 - Certificates cancelled by Local Authoiry 200 5 Applications for certificates as to the remedying of defects which the Landlords have undertaken to remedy 133 3 Certificates issued as to the remedying of defects which landlords have undertaken to remedy 133 3 60 Housing Acts, 1961/1964 - Houses in Multiple Occupation From the date of the commencement of the Act:- Number of Houses Inspected 451 Number of Statutory Notices' served 204 Number of Notices complied 74 Number of Notices sent to Housing Manager for default action 20 61 West Croydon Men* s Hostel This is situated at Pitlake and is available for use by nightly lodgers. It has 104 cubicle beds, four of which are reserved for staff. The charge was 4s. 6d. per night or 30s. 0d. per week. 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 92, and the total number of lettings 33, 415. The receipts during the year were £6,284, and the expenditure £6,866. There are no private common Lodging Houses. 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 (1) Number on Register (2) Number of Inspections (3) Written notices (4) Occupiers prosecuted (5) <i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 103 39 5 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1, 237 263 37 - (Hi) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 224 149 10 - TOTAL 1,564 451 52 - 62 Cases in which Defects were found Particulars Number of cases in which defects were found Number of cases in which prose* cutions were im* stituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S. 1) 2 2 - - - Overcrowding (S. 2) - - - - - Unreasonable temperature (S.3) 2 - - - • Inadequate ventilation (S. 4) Ineffective drainage of 4 1 - - - floors (S.6) 4 - • - - Sanitary conveniences (S.7):- (a) Insufficient 4 2 - - - (b) Unsuitable or defective 23 15 - 2 - (c) Not separate for sexes 1 - - - - Other offences against the Act (not including offences relating to Outwork) 53 22 1 3 - TOTAL 93 42 1 5 - Part VIII of the Act Outwork Nature of Work Section 110 Section 111 No,of workers in August list required by Sect• 110 (1) (c) No. of cases of default in sending lists to the Council No. Of cutions for failure to supply lists No. of stances of work in some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel 264 - - - - - Household Linen 113 - - - - - Lace, lace curtain and nets 2 - _ - - - Curtain and furniture hangings 13 - - - - - Paper bags - - - - - - continued on next page. 63 Nature of Work Section 110 Section 111 No.of out- workers in August list required by Sect,110 (l)(c) No, of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of stances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Tool Assembly 9 - - - - - Carding,etc. of buttons, etc. 194 - - - - - Stuffed toys 40 - - - - - Brush making 2 - - - - - Sachet making 23 • - - - - Tapestry printing 6 - - - - - Cosaques,Christ mas crackers, Christmas stockings, etc. 199 - - - - - Lampshades 16 - - - - - TOTAL 881 - - - - - OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Inspection of offices and shops of all types has progressed through the period under review. Unsatisfactory conditions have been found and remedied and an analysis of Contraventions of the Act is given below. During inspection of offices in particular, it is common for a wash basin in the lobby to the sanitary convenience to be used for washing up cups and saucers used for light refreshments. Wash basins have been found filled with crockery and accumulations of milk bottles beneath the basins, obstructing access to the water closet compartment. A good deal of work has been accomplished in requesting firms to install sinks with hot and cold water supplies in some other part of the office premises, and co-operation in this respect has been received. A feature found in some office blocks is so to partition offices as to provide unventilated inner offices usually appointed as reception and telephone areas. Ventilation or total rearrangement of these inner rooms has been requested and obtained. 64 Investigation into the cause of accidents has proved interesting. Iron steps to a boiler house in a new office block were found to be railed on one side only. A serious accident was sustained by an employee falling off the unrailed side. Persons slipping on passage floors and staircases have sustained serious accidents even where the surfaces have been of non-slip construction, usually of terrazzo, although some surfaces, stated to be non-slip- leave much to be desired in this respect. Accidents due to falling on restaurant and canteen floors upon which liquids have been accidently deposited on so-called nonslip floors have also been reported. A total of 113 accidents to employees in offices and shops were reported, and investigations into the causes were made in all cases. In a number of these, recommendations were submitted with the object of preventing a recurrence. Insufficient attention has been given to some office staircases where there is too much blending of colour of staircases and wall surfaces. Edges of treads could often better be indicated by inserted material of prominent and different colour than the remainder of the staircase, and non-slip tiles inserted in treads. Inspections of staircases used as means of escape from fire have revealed obstructions and deposits, and too little attention at times has been given to storage of refuse bins, their adequacy and for the disposal of their contents. The comfort of receptionists at office entrances has sometimes been overlooked. In some offices of normally good standard amenities, the receptionist has suffered discomfort through draughts and insufficient heating. A number of these complaints have been remedied by screening or resiting the heating apparatus. During the month of November, two members of the Specialist Staff carried out a survey of shops and offices in order to present a report, which had been specially requested by the Ministry of Labour, on the standard of natural and artificial lighting found in this type of premises. A similar survey has been carried out throughout the whole country and will form the basis on which a National Standard will eventually become operative in prospective Regulations. As regards action in cases of default, three cases were referred to the Town Clerk. 65 In the first case, a firm was prosecuted for not having a conveyor belt securely fixed, permitting injury to a young person. A fine of £20 was imposed with £1. 15s. -d. costs. In the second case, a firm failing to renew a defective sink, to provide hot water, to renew a cold water supply tap, to ventilate adequately the water closet and to provide handrails to a staircase, was sent a warning letter by the Town Clerk, and the notice was duly complied. In the third case, respecting undue delay in notification of accidents, the Town Clerk did not consider legal action to be advisable. 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 a general inspection during the year (1) (2) (3) (4) Offices 126 1.015 210 Retail Shops 263 1,918 1,307 Wholesale Shops, Warehouses 15 97 40 Catering Establishments open to the public, Canteen 6 168 116 Fuel Storage Depots 2 - TOTALS 410 3, 200 1,673 TABLE B- Number of Visits of all kinds by Inspectors to Registered Premises 4,564 66 TABLE C - Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace Number of Persons Employed (1) (2) Offices 23,065 Retail Shops 11,999 Wholesale Departments Warehouses 2,176 Catering Establishments open to the public 2,247 Canteens 420 Fuel storage depots 22 TOTAL 39,929 Total Males 18,840 Total Females 21,089 TABLE D - Exemptions No exemptions were granted under the Act during 1965. TABLE E - Prosecutions Section of Act or Title of Regulation or Order No. of Persons or Companies Prosecuted No. of Informations Laid No. of In formations Leading to a Conviction Section 17 One One One The number of Inspectors appointed under the Act is twentyfive and three members of the clerical staff are employed fulltime on work in connection with the Act. 67 CONTRAVENTIONS Accident Prevention Measures 26 Abstract of Act required 541 Clothing Accommodation required 37 Drainage insufficient or defective 11 Lack of Cleanliness 166 Drinking Water/Vessels required 31 Lack of Eating Facilities 7 First Aid Equipment required 437 Lack of First Aid Staff 2 Floors, Stairs, Passages defective etc. 219 Insufficient Heating 67 Insufficient Lighting 101 Machines not guarded 47 Overcrowding 42 Premises not registered 131 Sanitary Accommodation insufficient 39 Sanitary Accommodation defective 227 Staff seating facilities insufficient 16 Thermometers required 351 Ventilation insufficient 113 Walls, Ceilings etc. defective 245 Washing facilities insufficient/defective 193 SHOPS ACTS The Shops Acts regulate the closing hours of shops and the working hours of Shop Assistants. Closing hours have during the year given little cause for complaint. 703 inspections were made under the Shops Acts, and the infringements found were as follows:- Hours of Closing 7 Notices to be exhibited or amended 227 deal Intervals not granted to Staff 5 68 PROSECUTIONS UNDER SHOPS ACT, 1950 One case was taken against a local shopkeeper for the sale of goods not permitted on a Sunday. A fine of £4 was imposed. Another local shopkeeper was fined for failing to close the shop for the serving of customers after half past one o'clock on the Early Closing Day. 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 163 inspections were made and defects found were referred to the Chief Education Officer. HAIRDRESSING ESTABLISHMENTS Legislation calls for the registration of hairdressers and barbers premises. During the year 74 inspections were made of registered premises to check that the Byelaws in force were being observed. Generally little cause for complaint was found at such inspections. Following the amalgamation with the Coulsdon and Purley Urban District Council, application for the administration of new By elaws has been made. DRAINAGE 2,741 visits of inspection were made to underground drains in course of repair. Of 577 Statutory Orders served, in 206 cases work was carried out in default of the owners. POLLUTION OF RIVERS AND STREAMS During the year 17 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. During 1963 an Effluent Inspector was appointed to the Borough Engineer' s Department. 69 CONSUMER PROTECTION ACT 1961 The provisions of the Heating Appliances (Fireguards) Act, 1952 and Regulations made thereunder have now been incorporated in the Consumer Protection Act, 1961 which empowers the Secretary of State to make Regulations in respect of any goods which he may prescribe, imposing such requirements as he may think expedient, to prevent or reduce risk of death or personal injury. The Oil Heaters Regulations 1962, which came into force in June 1962 impose requirements as to construction, design and performance of domestic space heaters, which burn paraffin oil and are not designed for use with a flue, came into operation. In October 1964, the Children's Nightdresses Regulations 1964 case into operation. These Regulations require all nightdresses coming within the scope of the Regulations to be made of a fabric which conforms to the low flammability requirements of a British Standard. Visits are made to shops trading in these articles to ensure that the requirements of the Regulations are complied with. THE FABRICS (MISDESCRIPTION) ACT, 1913. THE FABRICS (MISDESCRIPTION) REGULATIONS 1959 The above mentioned Regulations prescribe standards of noninflammability for textile fabrics to which is attributed the quality of non-inflammability or safety from fire or any degree of that quality. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 The above Act came into operation on the 1st January, 1964, and prohibits the keeping of a boarding establishment for animals (which in the Act means cats and dogs) except under the authority of a licence granted by the local authority. Licences are granted subject to conditions attached thereto and during the year seven such licences were issued. MINES AND QUARRIES ACT, 1954 This Act requires compliance with provisions designed to prevent accidents arising through lack of proper fencing or too easy access. Routine visits are made to quarries in the district as necessary. 70 THE SCRAP METAL DEALERS ACT, 1964 This Act required dealers in scrap metal to be licenced by the local authority. Dealers are required to maintain, in a prescribed manner, records of their business transactions. Special provision is made for "itinerant" dealers who may be exempted from the keeping of full records of their transactions and this, and other provisions of the Act, are administered in co-operation with the local police. During the year 88 licences were issued to local dealers. THE RIDING ESTABLISHMENTS ACT, 1964 This Act came into operation during the year and provides for the licencing and inspection of riding establishments by the local authority. Licences are granted subject to conditions attached thereto and inspections are carried out, at six-monthly intervals, by authorised veterinary surgeons. Seven licences have been granted to local establishments. CAMPING SITES The Caravan Sites and Control of Development Act, I960, confers on Local Authorities powers for the control of caravan sites and apart from improved planning powers it provides for a system of site licencing to be administered by District Councils. Site Licences in force during the year were as follows:- Address So. of Caravans Period of Licence Dean Lane Park£ Dean Lane, Merstham. 180 3 years from 21.12.63. Hall & Co., Depot, Marlpit Lane, Coulsdon. 1 1 year from 10.12.63. Windmill Farm, Coulsdon Common. 2 5 years from 29.12.60 Caterham Drive, Old Coulsdon. 1 3 years from 8.8.64. Royal Russell School, Coombe Read, Croydon. 1 2 years from 9.12.63. 71 Site licence conditions in all cases require a water carriage system of drainage, main water supply and fire precautions. In the case of Dean Lane Park, communal ablution and laundry facilities with a constant supply of hot and cold water are additional requirements, 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 Order . No. of premises (incl. Factories and Commercial) No. of dwellings Acreage Date of Order Date of Operation No. 1 2,076 1,916 620 22. 12. 58 1 .4.61 No. 2 3,042 2, 686 265 26. 2.60 1. 10. 61 No. 3 4, 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 65 220 5, 885 470 18.11.63 1. 7.65 No, 7 8,198 7,788 1, 060 21.12.64 1. 7.66 No. 8 7, 198 6,777 460 20o 12.65 1. 7.67 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 anoke and Grit Emissions. During the year 23 plans showing the construction and heights of new chimneys have been examined and in 19 cases additional height ha3 been requested and agreed. 32 notices of the installation of new furnaces have been received, 27 of these being oil fired plants. 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:- 72 By Steam 10,013 articles By Formalin Gas 150 " Total 10,163 articles 51 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 1965, 61 articles were disinfected, the receipts amounting to £5, 3s. 6d. Disinfection was carried out after infectious or contagious diseases at the following premises:- 77 rooms at 18 houses, hospital wards, clinics etc. 42 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 £24.16s. -d. was paid for such services. 884 Medical Aids in Home Nursing were disinfected. CLEANSING OF VERMINOUS, ETC., PERSONS A cleansing Station consisting of a reception room, four bathrooms and a discharge room, is attached to the Disinfecting Station, and is used for dealing with verminous, etc., conditions in adults and children. A woman attendant deals with children and women. During the year 12 adults and 5 children were cleansed of verminous conditions and 16 adults and 21 children were treated for scabies. DISINFESTATION OF PREMISES The new insecticides have provided a ready and easily applied remedy for vermin and pest infestation of premises, etc. and occupiers are advised and instructed in their use by the Inspectors. The department assisted in the more difficult cases numbering 91, either by spraying or fumigation. 73 NOISE ABATEMENT During the year 39 complaints were made regarding noise alleged to be a nuisance, In, 9 cases no action was warranted. In 12 instances the noise complained of was finally abated, in 13 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 12. In addition, 239 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. Only two firms are now engaged in this type of business within the Borough. Six 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 Ho. of Samples Curled Feathers 3 Cotton Felt 1 Down 1 Hair 1 PET ANIMALS ACT, 1951 19 persons were licenced for the purpose of keeping Pet Shops. During the year 37 inspections were made and there were no infringements of the conditions, specified in the licences. 74 DISEASES OF ANIMALS ACTS One case of suspected swine fever notified was 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, 2,997 private dwellings were inspected following complaints and in 2,283 instances infestation was confirmed and dealt with by the rodent operatives. 165 business premises were found to be infested with rats or mice and these were ail 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. 68 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 52 manholes. These manholes were treated until no further baits were taken. 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. Of the premises in the Borough where food is stored, manufactured or sold, 1,132 are registered under Section 16 of the Food and Drugs Act, as follows:- 75 Retell sale of ice-creama 925 Manufacturers of ice-cream Nil Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 207 During the year 7,145 inspections and re-inspections were made of food businesses (for details see Page 86 ). FOOD HYGIENE (GENERAL) REGULATIONS, 1960 The following table shows the premises in the Borough at which food is 3old, manufactured or stored. These premises are subject to the above Regulations and special reference is made to the provision of wash hand basins (Section 16) and sinks (Section 19) at premises where unwrapped food is handled. Description No. of Premises Wash hand basins provided during 1865 No. to which Sec. 19 applies No. fitted to comply with Sec. 19 during 13 65 Bakehouses 64 1 64 - Bakers Shops 131 2 131 1 Sugar Confectioners 626 7 594 5 Cafes, Restaurants, Snack Bars, etc. 571 5 571 6 Works & Club Canteens 251 2 251 1 Licenced Premises 204 1 204 1 Off Licences 84 - 6 - Srocars 665 8 630 6 Butchers 241 2 241 1 Wholesale Meat Markets 8 - 8 - Chemists 94 - 90 - Greengrocers 296 3 296 2 Fishmongers 74 1 74 - Pried Pish Shops 42 - 42 - Milk Distributers and Dairies 191 3 170 2 Premises from which Roundsmen & Mobile Shops operate 12 - 12 - Stalls 119 - 119 - Pood Manufacturers 24 - 24 - Other Food Premises not enumerated above 51 4 26 3 INFRINGEMENTS OF FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE REGULATIONS 1960 Structural defects In shops and stores 18 Defective condition of walls and ceilings 182 Defective condition of floors, utensils, fixtures, etc. 71 Defective or insufficient drainage 16 Insufficient lighting or ventilation 15 W.C. accommodation - repair or cleansing required 41 ,, ,, - artificial lighting required 16 ,, ,, - want of Intervening ventilated space 17 Pood - not stored 18" off floor 5 ,, - means to prevent risk of contamination required 28 ,, - store required or defective 20 Accumulations in yard or stores 40 Offal and refuse bins defective or uncovered 17 Yard paving defective 30 Hand washing notice not exhibited 59 Ablutions - Wash basins required 57 ,, - Hot water supplies required 90 ,, - Nail brushes, soap and towels required 63 Clothing accommodation required 17 Insufficient or defective sinks 15 Smoking offences 24 Defective or unsuitable table tops, etc 15 First Aid kits required or insufficient 51 Cleanliness - advice given 13 Cracked crockery 2 Rats/Mice Infestation 5 76 Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1965:- Article Weight in Lbs. Carcase Meat 6,357 Offal 4,642 sundry Foodstuffs 10,509 Canned, Bottled and Packeted Foods 18, 030 Total 39,538 Disposal of Condemned Foodstuffs Meat condemned at wholesale meat markets or at shops is disposed of, after being dyed green, and other condemned foodstuffs are destroyed by incineration. 77 SEAT INSPECTION The District Public Health Inspectors inspect home killed and imported carcase meat and offal 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. 18 inspections of licenced plants were made during the year. MILK SUPPLY During the year 153 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 2 (b) Dealer s (Pre-packed Milk) Licences 178 Licences to use the designation "Sterilised" - (a) Dealer s (Pre-packed Milk) Licences 171 Licences to use the designation "untreated" - (a) Dealer s (Pre-packed Milk) Licences 42 Licences to use the Designation "Ultra Heat Treated" - (a) Dealer's (Pre-packed Milk) Licences 13 Frequent inspection of these licenced premises is carried out during the year to see that the conditions of the licences are observed. 78 Bacteriological Examinations of Milk Daring the year the following samples of milk were examined: Pasteurised Milk 208 Sterilised Milk 42 Untreated Milk 6 The following table summarises the results of the bacteriological examinations of Pasteurised, Sterilised and Untreated milk samples during the year:- Untreated Milk Methyline Blue Test No. Samples Taken 6 Satisfied Satisfied 6 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 208 7 201 - 208 Sterilised Milk No. Samples Taken 42 Turbidity Teat Not Satisfied Satisfied 42 Bacteriological Examination of Milk Bottle Rinses Satisfactory - 18 Bottle Rinse Samples - 18 Unsatisfactory - BACTERIOLOGICAL EXAMINATION OF CREAM Five samples of fresh cream were examined and produced satisfactory results. 79 BACTERIOLOGICAL EXAMINATION OF ICE CREAM 142 samples were taken, the results being as under:Grade No. of Samples 1 99 2 21 3 19 4 3 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. CHEMICAL EXAMINATION OF ICE CREAM Five samples were taken from local shops and were found to comply with the standard, THE LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 These Regulations provide chat liquid egg shall be pasteurised before use in food intended for human consumption. There are no egg pasteurisation plants in Croydon and eight samples of liquid egg obtained from local bakeries and submitted to the prescribed alpha-amylase test proved satisfactory. FOOD AND DRUGS ACT, 19 55 During the year, 190 samples of Milk and Cream, and 531 other samples were taken, of which number, 16 were found to be "Not Genuine" Summary of Samples During 1965 samples were obtained and submitted to the Public Analyst as follows:- 80  Total Samples Genuine Not Genuine Prosecutions Convictions Ale, Mild 1 1 - - - Almond Flavouring 1 1 - - - Apples 1 1 - - - Angelica 1 1 - - - Apple Juice 1 1 - - - Artificial Colour 1 1 - - - Arrowroot 2 2 - - - Ascorbic Acid Tablets 3 3 - - - Aspirin Tablets 2 2 - - - Baby Food 3 3 - - - Bacon 5 5 - - - Baked Beans 1 1 - - - Baking Powder 1 1 - - - Batter Mixture 3 3 - - - Beefburgers 3 3 - - - Beer Bitter 13 13 - - - Bicarb Soda 4 4 - - - Biscuits 5 5 - - - Black Currant Juice 4 4 - - - Black Pudding 2 2 - - - Black Treacle 3 3 - - - Blancmange Powder 2 2 - - - Boracic Ointment 2 2 - - - Brandy 1 1 - - - Brisket of Beef 1 1 - - - Bread, Brown 1 1 - - - Bread, White 2 2 - - - Bread, Wholemeal Brown 1 1 - - - Bread Crumbs 1 1 - - - Bread, Milk 6 1 5 - - Bread Mix 1 1 - - - Brewers Yeast 1 1 - - - Browning 3 3 - - - Butter, Australian 2 2 - - - Butter, Danish 2 2 - - - Butter, English 1 1 - - - Butter, New Zealand 3 3 - - - Butter, Unsalted 3 3 - - - Butter Beans 1 1 - - - Buttered Bread 2 1 1 - - Buttered Rolls 4 2 2 - - Buttered Scone 1 1 - - - Buttered Toast 3 3 - - - Calamine Lotion 2 2 - - - Camphorated Oil 2 2 - - - Candled Peel 1 1 - - - Cake Mix 4 4 - - - Cakes Yarious 6 8 - - - Cheese, Cheddar 5 5 - - - Cheese, Cottage 4 4 - - - Cheese, Danish Blue 3 3 - - - Cheese Sauce 1 1 - - - Cheese Spread 2 2 - - - Cheese Biscuits 1 1 - - - Chocolate Biscuits 1 1 - - - Chicken Croquettes 1 1 - - - Cocolate 5 5 - - - Chocolate Spread 2 2 - - - chutney 2 2 - - - Christmas Pudding 2 2 - - - Cod Liver Oil 3 3 - - - Cocoa 3 3 - - - Coconut, Dessicated 2 2 - - 81  Total Samples Genuine Not Genuine Prosecutions ctions Coffee (Hot) 6 6 - - - Coffee and Chicory 1 1 - - - Coffee and Chicory Essence 1 1 - - - Chopped Ham with Pork 1 1 - - - Condensed Milk 2 2 - - - Cooking Pat 3 3 - - - Corned Beef 7 7 - - - Cornflakes 2 2 - - - Cornish Pasty 2 2 - - - Corn Oil 2 2 - - - Cough Mixture 1 1 - - - Cough Pastilles 3 3 - - - Crab, Dressed 1 1 - - - Crab Spread 1 1 - - - Cream, Tinned 5 5 - - - Cream, Fresh 4 4 - - - Cream, Clotted 2 2 - - - Cream Buns and Cakes 3 3 - - - Cream Biscuits 1 1 - - - Crumpets 1 1 - - - Custard Powder 3 3 - - - Dates 1 1 - - - Dried Milk Powder 2 1 - - - Drinking Chocolate 4 4 - - - Dripping 1 1 - - - Evaporated Milk 3 3 - - - Faggots 3 3 - - - Fish Cakes 5 5 - - - Fish (Frozen) 1 1 - - - Pigs 2 2 - - - Fish Fingers 3 3 - - - Fish Paste 3 3 - - - Flavour Essence 3 3 - - - Flour (incl. S.R.) 1 1 - - - Friars Balsam 2 2 - - - Fruit, Dried 1 1 - - - Fruit, Washed 4 4 - - - Fruit Pie 3 3 - - - Gees Linctus 2 2 - - - Gin 7 7 - - - Ginger Beer 1 1 - - - Golden Syrup 1 1 - - - Grapefruit Juice 2 2 - - - Gravy Powde 1 1 - - - Ground Ginger 1 1 - - - Ground Almonds 1 1 - - - Ground Mixed Spice 1 1 - - - Ground Nut Megs 3 3 - - - Ground Nut Oil 2 2 - - - Ham 4 4 - - - Ham and Chicken Roll 1 1 - - - Hay Fever Tablets 1 1 - - - Honey 2 2 - - - Horseradish Relish 1 1 - - - Ice Lollies 2 2 - - - Ice Cream Lolly 1 1 - - - Ice Cream 5 5 - - - Instant Whip 3 3 - - - Instant Non-Fat Milk 1 1 - - - Insect Bite Lotion 1 1 - - - Iodine Ointment 2 2 - - - Indigestion Tablets 1 1 - - - Jam 3 3 - - - 82  Total Samples Genuine Not Genuine Prosecutions Convictions Jelly 3 3 - - - +Jellied Veal 3 3 - - - Lard 1 1 - - - Lemonade 2 2 - - - Lemon Flavouring 2 2 - - - Lemon Curd 2 2 - - - Lemons 1 1 - - - Luncheon Meat 5 4 1 - - Liquid Paraffin 2 2 - - - Lamb Tongues 1 1 - - - Liver, Calves 1 1 - - - Liver, Lambs 4 4 - - - Liver, Ox 1 1 - - - Macaroni, Creamed 2 2 - - - Margarine 5 5 - - - Marmalade 1 1 - - - Marzipan 1 1 - - - Meat Extract Cubes 3 3 - - - Meat Extract Spread 1 1 - - - Meat Paste 1 1 - - - Meat Pie 5 5 - - - Meat Pudding 1 1 - - - Mentholated Balsam 1 1 - - - Meringue 1 1 - - - Milk 186 185 1 - - Milk of Magnesia 2 2 - - - Milk Filled Chocolate Eggs 1 1 - - - Mincemeat 4 4 - - Minced Beef 1 1 - - - Mint Sauce 2 2 - - - Mint Jelly 1 1 - - - Mixed Herbs 1 1 - - - Mushrooms, Tinned 2 2 - - - Mustard, French 1 1 - - - Mustard 2 2 - - - oatmeal 2 2 - - - Oranges 1 1 - - - Orange Juice 1 1 - - - Orange Crush 2 2 - - - Peanut Butter| 3 3 - - - Pearl Barley 1 1 - - - Peas, Garden 1 1 - - - Pepper 1 1 - - - Pepper, Cayenne 1 1 - - - Pickled Onions 3 3 - - - Pickled Cabbage 1 1 - - - Pickled Gherkins 1 1 - - - Pickles 1 1 - - - Pork Pies 3 3 - - - Pork Sausage Meat 3 2 1 - - Porridge Oats 2 2 - - - Prepared Meal 1 1 - - - Red Cabbage 1 1 - - - Roes Tinne 2 1 1 - - Rice 3 3 - - - Rice, Creamed Pudding 1 1 - - - Pie Filling 2 1 1 - - Rum 8 8 - - - Salad Cream 1 1 - - - Sandwich Spread 3 3 - - - Saveloys 1 1 - - - Salmon Paste 1 1 - - - Sausage, Beef 3 3 - - - Sausage, Breakfast 1 1 1 - - - 83  Total Samples Genuine Not Genuine Prose" cut ions Convictions Sausage, Pork 5 5 - - - Sausage, Liver 2 2 - - - Sausage, Smoked 1 1 - - - Sausage, Luncheon 1 1 - - - Sausage Soll 2 2 - - - Sausage, Chipolata 1 - 1 - - Sherry, Cooking 1 1 - - - Soda Mint Tablets 1 1 - - - Spaghetti, Bolognese Sauce 1 1 - - - Steak and Kidney Pie 3 3 - - - Steak and Kidney Pudding 1 1 - - - Steak Pie 3 3 - - - Suet, Packed 1 1 - - - Suet Pudding Mix 1 1 - - - Sponge Pudding, Tinned 1 1 - - - Sweets 2 2 - - - Surgical Spirit 1 1 - - - Sugar, White 2 2 - - - Sugar, Castor 1 1 - - - Sugar, Brown 1 1 - - - Sugar, Icing 1 1 - - - Sugar, Demerara 1 1 - - - Soup Powder 2 2 - - - Stewed Steak, Tinned 2 2 - - - Stuffing, Sage and Onion 1 1 - - - Stuffing, Parsley and Thyme 1 1 - - - Syrup of Pigs 2 2 - - - Table Salt 2 2 - - - Tea 2 2 - - - Tinned Asparagus 1 1 - - - Tinned Jam 1 1 - - - Tinned Drink 1 1 - - - Tinned Pruit 6 6 - - Tinned Peas 3 3 - - - Tinned Sardines 1 1 - - - Tinned Vegetables 1 1 - - - Tinned Baked Beans and Sausages 2 2 - - - Tinned Beetroot 1 1 - - - Tinned Vegetable Salad 1 1 - - - Tinned Soup 5 4 1 - - Tinned Pish 3 3 - - - Tinned Salmon 3 3 - - - Tinned Rhubarb 2 2 - - - Treacle 1 1 - - - Tomato Ketchup 1 1 - - - Tongue, Calves 1 1 - - - Tongue, Ox 1 1 - - - T.C.P 1 1 - - - Veal and Ham Roll 2 2 - - - Veal and Ham Pie 3 3 - - - Vinegar 3 3 - - - Vitamin A. & D. 1 1 - - - Vitamin C. Capsules 2 2 - - - Vitasin Drink Powder 1 1 - - - Vodka 2 2 - - - Whiskey 12 12 - - - Yeast Tablets 1 1 - - - Yoghurt 4 4 - - - TOTALS 721 705 16 3 - 84 Result of Analysis of Milk Samples The samples of milk were obtained as follows- Taken on Milk Rounds 89 Taken at Dairies 134 Taken at Institutions 9 Total 232 Average composition of samples:- Milk (excluding South Devon and Channel Islands Milks) Solids not Pat 8.68 (Legal standard is 8.5%) Milk Pat 3.56 (Legal standard is 3%) South Devon and Channel Island Milk Solids not Pat 9.0 (Legal standard is 8.5%) Milk Pat 4.44 (Legal standard is 4%) DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Milk Bread (5 samples) All five samples had been made with skimmed milk powder and were not entitled to the description "Milk Bread". Manufacturers warned Milk Powder Milk powder was not an appropriate name for this article as it contained fat other than milk fat. Vendor warned. Article now being sold as Baby Pood. Sterilised Milk This sample was deficient in milk solids other than milk fat, in that it contained a small amount of added water. The water has entered this bottle during the sterilisation process, due to a faulty cork liner of cap. Fault now rectified. Pork Sausage Meat Consisted of preserved pork sausage meat. A Notice declaring the presence of preservative in this article has now been exhibited on the Vendors Premises Chlpolata Sausages Consisted of preserved sausage meat. A Notice declaring presence of preservatlv In this article has now been exhibited on the Vendors Premises. 85 Article Nature of Adulteration or Deficiency Remarks Pure Pork This article earried an unsatisfactory description, as the sample contained pork with ham trimmings and flavourings. The packers have now amended the label to "Picnic Pork". Bread and Butter Consisted of Bread and Margarine. Vendor Prosecuted. Buttered Roll (2 samples) Consisted of Bread Roll and Margarine. Vendors Prosecuted. Blue Berry Pie Pilling The ingredients of this article were not specified on the label in accordance with the Labelling of Pood Order 1953. The label on this article has now been amended by the Packers. Tinned Scotch Broth Soup Did not contain significant proportion of meat in soup, should contain 6% meat including bone and fat or 3% boned meat. Meat deficiency due to fault in canning. Pour cans were found to contain more than 3% boned meat. Soft Herring Roes This sample of herring roes contained in a tin which had been leaking round the top seam where the lid is super-imposed. All stocks were withdrawn and destroyed. ANALYSIS OF PROSECUTIONS UNDER FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE (GENERAL) REGULATIONS, 1960. OFFENCE RESULT Two Christmas Puddings unfit for human consumption. Pined £20 in each case. Two loaves of bread, one containing a nail and one containing plaster. Pined £20 in each case. Two loaves of bread containing grease. Fined £40 and £50 respectively. Selling roll with margarine instead of buttered roll (2 cases) First case had a conditional discharge for one year, the other case a fine of £5 was imposed. Chocolate covered roll unfit for human consumption. Fined £25. Unsound Gingerbread cake. Fined £20. Mould in sausage roll. Fined £15. Two cases of smoking whilst handling open food. Fined £5 and £3 respectively. 86 Suamary 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 4,354 Houses Inspected where zymotic diseases have occurred 31 Houses Inspected following applications for certificates of disrepair 35 Inspections of underground rooms 89 Special inspections in connection with the Housing Survey 425 Houses Inspected for overcrowding conditions 86 Re-inspections of work outstanding on housing notices 7,544 Number of visits regarding infectious diseases 633 Number of visits regarding food poisoning 36 Inspections of drainage work during repair 2,741 House drains tested with smoke and colour - routine and complaint 1,343 House drains tested with smoke during repair 36 House drains tested with water during repair 112 Inspections of cesspools and earth closets 51 " " schools and school sanitary conveniences 87 " " public conveniences 106 " " verminous premises 67 " " ponds and ditches 26 " " yards, stables and passages 110 " " theatres, cinemas, halls, etc 14 " " pig styes 87 " " tents, vans and similar structures 79 " " premises In connection with Improvement Grants 1,011 Inspections and re-inspections in connection with Smoke Control Orders 11,918 Sundry visits regarding Smoke Abatement 541 Smoke Observations 308 Visits regarding exhumation 2 Visits to premises for food condemnation 571 Inspections of swimming baths 128 " " wells 7 " " gathering grounds of water supply 26 " " gipsy encampments, camps, fairs, etc. 8 " " scrap metal dealers premises . 104 " " rivers and streams for pollutions 5 " " hairdressers 74 Food and Drugs Acts; Food and drugs samples taken 535 Food and Drugs Acts: Milk samples taken (special designations) 186 Ice Cream samples taken (bacteriological) 142 Samples taken of Fertilizers and Feeding Stuffs 10 " " swimming baths water 177 " " drinking water (bacteriological and chemical) 365 " " subsoil water 7 " " private wells 75 " " rag flock and other filling materials 6 " " sundry specimens (food poisoning etc.) 30 Visits in connection with Food Complaints 183 Inspections under Merchandise Marks Act 154 " " of butchers premises 242 " " meat premises (wholesale) 735 " " poultry and game dealers premises 176 " " fishmongers premises 95 " " fried fish premises 42 " " grocers premises 545 " " fruiterers and greengrocers premises 557 " " bakers premises - including bakehouses 167 " " dairies 37 " " Milk shops 118 " " general shops and their premises 71 87 Inspections of premises where cooked meats, etc. are prepared or sold 120 Inspections of confectioners premises 297 " " confectionery manufacturers premises 4 " " cafes, snack bars, canteens, hotels and their kitchens 582 " " school kitchens and serveries 76 " " hospital kitchens 36 " " ice cream vendors premises 167 " " ice cream barrows and carts 17 " " market and barrows 206 " " other food premises not enumerated above 233 Re-inspections of food premises 432 Inspections of premises where offensive trades are conducted 2 " " factories with mechanical power 263 " " factories without mechanical power 39 " " works of building and engineering 149 " " shops (under Shop Acts) 447 Special early closing, evening and Sunday trading patrols of shops 286 Appointments kept with owners, builders, etc. 2,698 Investigations of complaints other than housing matters 1,504 Re-inspections of works outstanding (other than houses) 3,129 Inspections under Fertilizers and Feeding Stuffs Act 16 " " Diseases of Animals Act 12 " " Pets Act 29 " " Pharmacy and Poisons Act 39 " " Noise Abatement Act 746 " " Consumer Protection Act 196 Sundry Inspections and Visits 3,962 Visits regarding rats and mice infestation 13,084 Informal Notices outstanding 31.12.63 1,266 Informal Notices served 1,066 Informal Notices complied 1,012 Informal Notices outstanding 31.12.64 1,320 Statutory Notices outstanding 31. 12.63 755 Statutory Notices served 851 Statutory Notices complied 747 Statutory Notices outstanding 31.12.64 859 Total number of callers and complaints received at the office 5,601 Total number of letters received at the office 15,690 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Public Health Inspectors during the year 1965 and for which action was taken to enforce compliance: (1) NUISANCES AND HOUSING DEFECTS AT HOUSES, ETC. Insufficient means of ventilation: Defective ventilation, windows and sashcords 462 Conditions causing dampness: Defective roofs 359 Defective windor frames 272 Defective walls, etc. 354 Want of efficient damp-proof course 37 Defective gutters and downspouts 265 Other structural defects: Defective plaster 375 Cleansing and redecorating required 24 Defective floors and stairs 289 Insufficient ventilation under floor 34 Defective brickwork, sills lintels, chimneys 226 Defective stoves and fireplaces and flues 171 88 Defective drains, sanitary fittings, etc: Defective sinks and waste pipes 105 Defective W. C' s. 142 Defective drainage 171 Stoppages in drains 95 Defective water services and tanks 5 Domestic nuisances: Want of cleanliness 19 Verminous conditions 15 Other nuisances and Infringements: Offensive accumulations 110 Overcrowding 15 Sundry nuisances or defects 29 Particulars not inserted in Rent Book (Housing Act) 33 Public Urinals 2 Noise 30 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT Pood cupboards defective or required 141 (3) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING,ETC. Defective Yard Paving 88 Want of a sanitary dustbin 43 (4) SMOKE ABATEMENT Nuisances observed 16 PUBLIC HEALTH SERVICES 91 WATER SUPPLY The London Borough is served by four statutory supply authorities, as undermentioned:- Sup-ply Authority Square Miles. Estimated Population. Croydon Corporation (Central and northern part of the Borough) 17.0 227, 000 Metropolitan Water Board (Spring Park Estate and New Addington) 2.8 27,000 East Surrey Water Company (Sanderstead, Selsdon, Kenley, Purley and Coulsdon West) 15.5 59. 500 Sutton District Water Company (Woodcote and Coulsdon East) 1.9 14, 500 37.2 328, 000 The waters in supply are of good organic quality and moderately hard in character. They have no plumbo-solvent characteristics and the fluoride content averages about one-sixth of a part per million. All houses are supplied from mains and there are no standpipes for this purpose. Excluding M. W. B. supplies, 1,811 samples of raw water and 2,713 samples of water going into supply were tested bacteriologically. For results of consumer samples of water sent by the Health Department to the Public .Health Laboratory Service see Appendix page 133. 92 SEWAGE DISPOSAL I am indebted to the Borough Engineer, A. P. Holt, Esq., M.I.C.E., for the following information:- "I make the following comments on the progress of the new Sewage Treatment Works at Beddington. The scheme provides for an entirely new Sewage Treatment Works to serve a population of 365,000. A preliminary Civil Engineering Contract (£320,000) is in progress and about 75% complete. Several contracts for machinery required in the new Works have now been let at an approximate total cost of £450,000. A major Civil Engineering Contract for the bulk of the new treatment plant will be let early in 1966 at an estimated value of over one million pounds. The programme of construction is such that it is anticipated that the new Works will be in operation by 1969/70," 93 MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDREN' S DEPARTMENT During the year 275 children were medically examined prior to admission to a Childrens' Home or private foster home. NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 Full time Registered Child Minders are 16 in number. Providing places for 127 children Part time Child Minders (Playgroups) 33 in minders own homes Providing places for 349 children Playgroups on Premises other than private homes 27 premises Providing places for 722 children In addition to the above places there are assisted daily minders, partly paid for by the Council for the aid of the unsupported mother. Chest X-rays are demanded as for Registered Child Minders and all homes are inspected by a Fire Officer and Senior Health Visitor. Number of homes passed as suitable at 31st December, 1965 10 Children placed 16 94 BLINDNESS 1 am indebted to the Chief Welfare Officer for access to his records regarding blind persons registered during the year. These show that of the 126 cases registered:- 23 were due to glaucoma and 50 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:- 6 patients had died. 2 patients had removed from the Borough. 1 patient had refused treatment. 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 74 adult cases are registered with his Department, 11 of whom are in special Homes. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 During 1965 no order for compulsory removal was required. 2 cases (both women) were reported as possibly requiring this action, but on investigation were dealt with by other means. Admitted to private Nursing Home 1 Statutory action not appropriate - no further action necessary 1 Total 2 APPENDIX TABLES 97 1965 VITAL STATISTICS - 1965 98 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- 75 & over 1. Tuberculosis, (Respiratory) M 2 - - - - - - - - - - 2 F 2 - - - - - - - - 2 - - 2. Tuberculosis (other forms) M - - - - - - - - - - - - F - - - - - - - - - - - - 3. Syphilitic Disease M 1 - - - - - - - - - 1 - F 4 - - - - - - - - - 2 2 4. Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - 5. Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - 6. Meningococcal Infections M - - - - - - - - - - - - F - - - - - - - - - - - - 7. Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - 8. Measles M - - - - - - - - - - - - F 1 - 1 - - - - - - - - - 9. Other Infective and Parasitic Diseases M 2 - - - - l - - - 1 - - F Total Infective and Parasitic diseases inc. Tuberculosis. 12 1 l „ _ 3 3 4? 10. Malignant Neoplasm, Stomach M 40 - - - 1 4 14 12 9? F 42 - - - - - 1 - 3 10 9 19? 11. Malignant Neoplasm Lung, Bronchus M 162 - - - - - - 2 23 61 50 26? F 35 - - - - - - - 5 8 11 11? 12. Malignant Neoplasm Breast M 1 - - - - - - - - - - 1? F 74 - - - - - 1 5 13 21 16 18? 13. Malignant Neoplasm Uterus F 23 - - - - - - - 2 8 7 6? 14. Other Malignant and Lymphatic Neoplasms M 184 - - - 1 - 2 7 16 40 53 65? F 193 - - 1 2 3 2 7 18 40 48 72? 15. Leukaemia,Aleukaemla M 17 - - - 2 1 1 3 4 a 3? F. 15 - 1 - 1 1 1 - 1 1 5 4? Total all forms of Cancar 786 - 1 1 6 5 8 25 85 207 214 234? 16. Diabetes M 6 1 - - - - - 1 - - 1 3? F 11 - - - - - - - 1 1 3 6? 17. Vascular Lesions of Nervous System M 192 - - - - - - 3 6 31 49 103? F 350 - - - - - - 1 10 29 64 246? 18. Coronary Disease, Angina M 438 - - - - - - 16 46 113 141 122? F 301 - - - - - - 2 12 31 68 188? 19. Hypertension with Heart Disease M 15 - - _ - - - - 1 2 4 8? F 32 - - - - - - - 1 2 5 24? 20. Other Heart Disease M 126 - - - - - 1 2 4 16 24 79? F 275 - - - - - 1 3 5 13 38 215? 21. Other Circulatory Disease M 60 - - - - - - 2 8 8 19 23? F 103 - - - - - 1 - 2 6 i 26 68? Total Heart and Circulatory Diseases 1,909 1 - - - - 3 30 96 252 442 1,085 99 CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 reeks and under 1 year AGE IN YEARS 1. 5- 15- 25- 35. 45. 55. 65. 75 & over 22. Influenza M 2 — — — — — — — — 1 1 — P 1 — — — — — — — — — — 1 23. Pneumonia M 188 3 6 1 — 1 1 — 1 7 42 126 F 201 1 3 1 — — 1 1 4 12 24 154 24. Bronchitis M 134 — — — — 1 — 1 7 30 50 45 F 62 — — — — — 1 4 — 7 14 36 25. Other Diseases of Respiratory System M 13 — 1 1 — — — — 1 2 3 5 F 12 — — — — — — — — 1 1 10 Total diseases of Respiratory System - including influenza and excluding tuberculosiS 613 4 10 3 2 3 6 13 60 135 377 26. Dicer of stomach and Duodenum M 14 — — — — — — 1 2 2 4 5 F 19 — — — — — — — 1 3 5 10 27. Gastritis, Enteritis amd Diarrhoea M 7 — 1 1 — — — — — — 3 2 F 17 — 1 1 — — — 1 — 2 — 12 28. Nephritis and Nephrosis M 11 — — — — — 1 1 1 4 3 1 F 12 — — — — — — 1 2 1 8 29. Hyperplasia of Prostate M 18 — — — — — — — — 2 3 13 30. Pregnancy, Childbirth, Abortion F — — — — — — — — — — — — 31. Congenital Malformations M 16 6 5 1 — — — 1 1 1 1 — F 12 7 — — 1 — — 1 2 — — 1 32. Other Defined and ill-defined diseases M 122 34 3 — 1 3 5 2 6 14 18 36 F 183 17 5 — 2 1 2 10 8 17 34 87 Total Miscellaneous diseases 431 64 15 3 4 4 8 17 22 47 72 175 33. Motor Vehicle accidents M 34 — — — 1 9 4 3 6 6 3 2 F 8 — — — 1 — — — — 2 2 3 34. All Other Accidents M 18 — — 1 1 1 — 2 2 3 5 3 F 21 — 4 2 — — — 1 — — 5 9 35. Suicide M 18 — — — — 1 3 4 3 3 1 3 F 22 — — — — 2 4 5 4 4 1 2 36. Homicide and operations of War M 1 — — — — 1 — — — — — — F 1 — 1 — — — — — — — — — Total - accidents suicide and violence 123 _ 5 3 3 14 11 15 15 18 17 22 TOTAL ALL CAUSES M 1.842 44 16 5 6 19 18 52 138 365 494 685 F 2,032 25 16 5 7 7 15 41 93 222 389 1,212 3,374 69 32 10 13 26 33 93 231 587 883 1,897 100 CANCER Deaths from Cancer occurred at the following Ages:- Age Period Male Female Total Under 25 years 4 9 13 25 and under 35 years 3 5 8 35 and under 45 years 13 12 25 45 and under 65 years 162 130 290 65 years and over 222 226 448 Total 404 382 786 Sites of Fatal Cancer Site Male Female Total Percentage of Total Skin 5 8 13 1.65 Oesophagus 4 12 16 2.04 Stomach 40 42 82 10.43 Liver 4 4 8 1.02 Bowel 29 36 65 8.27 Rectum 22 25 47 5.98 Bladder 20 15 35 4.45 Prostate 25 - 25 6.19 Larynx and pharynx 7 4 11 1.40 Uterus - 12 12 3.14 Cervix - 11 11 2.88 Breast 1 74 75 9.55 Ovary - 29 29 7.60 Pancreas 16 13 29 3.68 Gall Bladder and Duct 2 2 4 0.51 Tongue and Mouth 2 8 10 1.27 Bones 4 2 6 0.77 Lungs and Bronchus 162 35 197 25.06 Kidney 5 2 7 0.89 Brain and Nervous System 8 9 17 2.16 Lymphatic Glands and Connective Tissue 6 5 11 1.40 Haematopoitic Tissues - - - - Hodgkin's Disease 2 - 2 0.25 Leukaemia 17 15 32 4.07 Genital Organs 2 6 8 1.04 Ureter - 1 1 0.13 Supra Renal Gland 1 - 1 0.13 Ear 1 - 1 0.13 Undefined 19 12 31 3.94 Total 404 382 786 101 WARD STATISTICS Estimated Population Birtha (live) *Birth Rate Deaths *Death Rate Deaths under 1 year Deaths under 1 year per 1,000 birtha Deaths From Diarrhoea funder 2 yeara) *Death Rate from Diarrhoea (under 2 years.) Deatha from Bronchitis and Pneusonia *Death Rate from Bronchitis and Pneusonia Deatha from Pulmoaary Tuberculosis. *Death flats from Puiaonary Tuberculosis Deaths froa Non-Puiaonary Tuberculosis *Death Rate from Non-Pulmonary Tuberculosis Deaths froa Heart and Circulatory Diseases *Death Rate from Heart and Circulatory Diseases Deaths from Cancer *Death Rate from Cancer Natural Increase of Birtha over Deaths Addsicombe. 15,860 330 20.8 aor 12.7 8 24 - - 36 2.3 - - - - 57 3.5 38 2.4 +129 Bensam Manor 10,320 306 18.8 196 12.0 2 7 - - 33 2.1 - - - - 66 4.0 38 2.3 +110 Broad Green 15,160 331 21.8 168 11. 1 6 18 1 0.07 30 2.0 1 0.07 - - 48 3.2 39 2.6 +163 Central 15.450 266 17.2 280 18. 2 12 45 1 0.06 37 2.4 1 0.06 - - 93 6.0 42 2.7 - 14 Coulsdon East 15,070 281 18.5 302 20.0 4 14 - - 76 5. 0 - - - - 89 5.9 41 2.7 - 21 East 16,470 183 11.1 183 11. 1 5 27 - - 19 1.2 - - - - 66 4.0 34 2.1 Nil New Addington 21.630 425 19.7 99 4.6 10 24 - - 10 0.5 - - - - 10 0.5 21 1.0 +326 Norbury 16.580 206 12.4 211 12.7 1 5 - - 23 1.4 - - - - 68 4.1 43 2.6 - 5 Purley 18,490 197 11.9 180 10.9 4 20 1 0. 06 9 0.5 - - - - 35 2.1 32 1.9 + 17 Sanderstead North 17,260 288 16.7 197 11.4 3 10 - - 21 1.2 - - - - 59 3.4 29 1.7 + 91 Sanderstead It Seladon 16.180 242 14.9 142 8.8 5 21 1 0.06 10 0.6 - - - - 40 2.5 27 1.7 +100 Shirley 18,230 217 11.9 148 8. 1 3 14 - - 20 1.1 - - - - 43 2.4 40 2.2 + 69 South Norwood 16,820 407 24.2 220 13. 1 6 15 - - 21 1.3 1 0.06 - - 73 4.3 46 2.7 + 187 Thornton Heath 15,370 295 19. 2 167 10. 9 5 17 - - 15 1.0 - - - - 44 2.9 54 3.5 +128 Upper Norwood 16,110 297 18. 4 185 11.5 5 17 - - 21 1.3 - - - - 62 3.8 32 2.0 +112 Waddon 16,950 268 15.8 279 16. 5 11 41 - - 49 2.9 - - - - 99 5.8 53 3.1 - 11 West Thornton 15,500 283 18.3 171 11.0 7 - - 25 1.6 - - - - 43 2.8 46 3.0 +112 Whitehorse Manor 15.410 338 22.0 170 11.0 4 12 - 24 1.6 - - - - 58 3.8 35 2.3 +168 Woodcote Coulsdon West 15.720 236 15.0 199 12.6 1 4 - 26 1.7 1 0.06 - - 58 3.7 36 2.3 + 37 Woodsids 15,800 333 21.0 174 11.0 4 12 - - 23 1.5 - - - - 52 3.3 55 3. 5 +159 Borough 328,380 5,729 17.4 3,874 11.8 101 17.6 4 0.01 585 1.8 4 0.01 - - 1.350 4. 1 781 2.4 +1,855 *Death rata per 1,000 population and excluding those who died in Queen's Hospital 102 DETAILS OF INFANT MORTALITY The following table gives the cause of death during the first month of life (Neo-natal mortality):- (l) Complications of Labour - Trauma at Birth 7 Anoxia - (2) Foetal States - Congenital Malformities 13 Atelectasis 1 Haemorrhagic Disease of Newborn 2 (3) Prematurity 41 (4) Post-Natal Causes 5 Total 69 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1,000 Births 1965 1965 Injury at Birth and Congenital 18.8 3.32 Premature Births 40.6 7.15 Respiratory Diseases 14.9 2.62 Atelectasis, Debility and Marasmus 1.0 0.17 Diseases of Digestion* 2,0 0.35 Other Causes 22.8 4.02 *These from Gastro Enteritis Perinatal Deaths Stillbirths - 71 Perinatal Rate - 22.6 per 1,000 Deaths in first week - 60 Total (live and still) births Causes of Death in first week Prematurity - 39 Congenital' conditions - 10 Atelectasis - 1 Birth Trauma - 7 Pneumonia - 1 Haemorrhagic Disease of the Newborn - 2 103 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 I + months 2 + months 3 + months 4 + mentis 5 +months 6 + months 7 + months 8 + months 9 + months. 10 + months 11 + months TOTAL All Causes 43 10 4 1 2 - - 3 4 2 69 5 2 6 4 - 3 6 1 3 1 1 101 Meningo Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - - - - - - - - - - - - - - - - - 1 Convulsions - - - - - - - - - - - - - - - - - - - - - - ft Laryngitis - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (all forms) 1 - - - - - - - 2 1 4 1 - 1 1 - 1 4 - 2 1 15 15 Diarrhoea and enteritis - - - - - - - - - - - 1 - 1 - - - - - - 2 2 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 4 2 2 1 1 - - 1 1 1 13 1 2 1 - - 1 1 - - - - 19 Premature Birth 30 1 1 - 1 - - 2 - - 41 - - - - - - - - - - - 41 Atrophy, Atelectasis, Debility and Marasmus 1 - - - - - - - - - 1 - - - - - - - - - - - 1 Injury at Birth 5 1 1 - - - - - - - 7 - - - - - - - - - - - 7 Haemorrhaglc disease of newborn 2 - - - - - - - - - 2 - - 1 - - - - - - - - 3 Other Causes - - - - - - - - 1 - 1 2 - 2 2 - 1 - 1 1 - 1 11 TOTALS 43 10 4 i 2 - • 3 4 2 69 5 2 6 4 - 3 6 1 3 1 1 101 104 MIDWIFERY SERVICE The work of the municipal midwives was as follows:N.B. S.C.C. = Surrey County Council i.e. Prior to April 1965 1. Number of deliveries (Including 86 for S.C.C.) 1,604 2. Prlmigravida 221 Multipara 1,383 3. Midwifery cases 107 Maternity cases 1,458 4. Live Births 1,597 5. Still Births (1 S.C.C.) (2 Breech, 4 Macerated, 1 Intra-uterine death) 7 6. Neo-natal deaths (3 days Congenital Heart) 1 7. Premature Infants (Including 2 Stillborn) 24 (1) 36 weeks - 4 lbs. 8 oz. - Admitted to Hospital (2) 37 weeks - 5 lbs. 4 oz. (3) 36 weeks - 4 lbs. 8 oz. (4) 39 weeks - 4 lbs. 8 oz. (5) 36 weeks - 5 lbs. 1 oz. (6) 29 weeks - 2 lbs. - B. B.A. Hospital booked case » Transferred (7) 38 weeks - 5 lbs. (8) 36 weeks - 4 lbs. 8 oz. (9) 38 weeks - 4 lbs. 12 oz. (10) 37 weeks • 5 lbs. 4 oz. (11) 34 weeks - 4 lbs. 4 oz. - Admitted to Hospital (12) 37ft weeks - 5 lbs. and 4 lbs.-Undiagnosed twins - admitted to Hospital (13) 35ft weeks - 3 lbs. 12 oz. - Admitted to Hospital (14)?34 weeks - 6 lbs. (Premature by dates and behaviour) (15) 36 weeks - 4 lbs. 12 oz. - Admitted to Hospital (IB) 37 weeks - 5 lbs. 8 oz. and 3 lbs. 4 oz. - Undiagnosed twins - Admitted to Hospital (17) 36 weeks - 4 lbs. 8 oz. - Admitted to Hospital (18) 38 weeks - 4 lbs. 8 oz. - Admitted to Hospital (19) 38ft weeks - 5 lbs. 4 oz. (20)?Tera - 4 lbs. 2 oz. - Admitted to Hospital (21) 38 weeks - 4 lbs. (22) 36ft weeks - 4 lbs. 8 oz. (23)?6estation - 4 lbs. 8 oz. - Emergency - no A/N care macerated S.B. (24) 33ft weeks - 2 lbs. - Breech S.B. 8. Trllene Analgesia given (45 for S.C.C.) 259 9. Gas and Air analgesia given (41 for S.C.C.) 1,237 10. Post partum haemorrhage cases 35 treated at Home) 41 6 transferred to Hospital) (5 for S.C.C, 11. Retained Placenta 12 transferred to Hospital 15 12. Manual removal of placenta at home 1 13. Plying Squad calls 5 14. Blood transfusions at home 3 15. Toxaemia of pregnancy treated at home 8 16. Prolonged labour (over 24 hours) 18 17. Forceps deliveries (11 for S.C.C.) 16 18. Ventouse Vacuum Extractions 3 105 19. Breech deliveries (1 for S.C.C.) 6 20. Twins delivered (1 for S.C.C.) 3 sets 21. Triplets delivered Nil 22. Puerperal Pyrexia 27 Genital 5 Extra Genital 22 23. Congenital Abnormalities 20 Congenital Heart - N.N.D. at home 1 Congenital Heart with Talipes 1 Mongol 1 Webbed Toes 1 Haemorrhagic Disease (I.N.N.D.in Hospital) 2 Septic spots at Birth 1 Hiatus Hernia 1 Atelectasis N.N.D. in Hospital 1 Cleft Palate 1 Talipes 6 Malformed left arm 1 Right hand absent 1 Deformed thumbs both hands 1 Multiple abnormalities 1 24. Patients given Pethedine or Pethelorfan 1,026 25. Patients sent to Hospital 342 Ante-natal 225 During labour 99 After Delivery 18 26. Patients sent home for nursing 1,286 Home nursing 448 Hospital nursing 838 27. Reasons for summoning Medical Aid DURING PREGNANCY DURING LABOUR Multiple pregnancy 1 Delay in 1st Stage 2 Raised Blood Pressure 7 Delay in 2nd Stage 3 Raised Blood Pressure with Ruptured Membranes over Albuminuria 1 24 hours 3 Premature Ruptured Membranes 1 Intra-uterine death 2 Ruptured Membranes with Episiotomy 1 Toxaemia 1 Rigid Perineum 5 High Head 1 Ruptured Perineum 28 Dizziness ?Epilepsy 1 Post partum Haemorrhage 6 Post-Maturity with Oedema Retained Placenta 1 of Legs 1 Foetal Distress 5 Low Haemoglobin 1 Undiagnosed Twins 1 Ante-Partum Haemorrhage 5 Appendicitis 1 DURING PUERPERIUM For Mother:* For Baby:* Full Breasts 2 Inflammation of eyes 14 Mastitis 3 Feeding difficulty 1 Phlebitis 8 Cough 1 Sub-involution 3 Catarrhal cold 5 Pyrexia 19 Prematurity 2 Heavy Blood loss 1 Jaundice 2 Haematoma 1 Sore Buttocks 1 Maternal Blood Test 6 Paronychia 1 Suppression of Lactation 9 Blood in Stools 1 Influenza 1 Poor Colour and rapid Supervision of Unsatis- respirations 1 factory unbooked case 1 Talipes 1 Vomiting 2 Asphyxia Pallida 1 106 The following table gives the details of the reasons for Midwives summoning medical aid:- FOR COMPLICATIONS DURING PREGNANCY Abortion - Other Causes 17 Miscarriage - Total 17 FOR COMPLICATIONS DURING LABOUR Breech 2 Episiotomy 11 Malpresentation - Post-parturn haemorrhage 5 Premature Labour 2 Adherent and Retained Placenta - Delayed Labour 8 Torn Perineum 46 Anti-partum haemorrhage 3 Other Causes 24 Total 101 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 21 Pain in Breasts - Pain in Legs 0 Other Causes 15 Rhesus Negative Blood 5 Total 47 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 15 Still Birth 3 Other Causes 14 Total 32 Grand Total 187 The figures include the Surrey Urban District of Coulsdon and Purley area as from the 1st April, 1965. MATERNAL AND INFANT MORTALITY FOR THE YEAR 1965 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate Infant Mortality Rate 1965 5,800 - - 17.6 107 Midwife Mileage Deliveries Midwifiry Haternity Gas and Air Anti-Natal Visits Post-nataJ Visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnormal Mldwife Pupil Midwife Pupil 1. 3745 49 + 4 4 _ 43 2 43 325 98 467 167 45 65 6 2. 1856 61 + 2 1 - 54 6 - 593 - 538 - 43 11 - 3. 2788 46+2 - - 45 1 44 482 - 843 - 68 4 - 4. 2508 50 + 3 - - 48 2 1 582 - 651 - 43 2 - 5. 3054 61 + 16 - - 58 3 53 631 177 1257 739 163 127 5 6. 1295 59 + 6 - - 59 - - 430 237 653 356 104 124 20 7. 3394 55 + 2 - - 52 3 47 534 227 662 261 59 8 - 8. 3875 64 + 4 - - 61 3 - 540 - 532 - 50 9 6 9. 3677 80+5 8 - 70 2 71 867 - 978 - 107 116 24 10. 2830 109 + 6 17 - 88 4 104 1009 - 1196 - 77 96 9 11. 2944 72 + 7 6 - 64 2 65 816 124 1002 89 105 98 18 12. 3577 46 + 5 3 - 43 - 39 494 301 415 612 92 76 18 13. 2351 71 + 1 5 - 83 3 60 532 269 890 730 113 130 10 14. 1372 22 + 2 - - 18 4 20 141 - 404 - 21 28 1 15. 5933 95 + 8 8 - 81 6 86 979 732 946 768 171 180 18 16. 2472 75 + 2 4 - 67 4 65 382 216 628 443 68 79 16 17. 4475 109 + 6 10 2 94 3 93 1221 504 1167 751 143 160 14 18. 5284 72 + 6 3 - 66 3 54 1144 410 995 706 114 110 2 19. 2855 41 + 6 1 - 34 6 29 286 17 788 64 46 35 - 20. 4208 99 + 2 7 - 89 3 '91 698 337 1417 802 168 183 31 21. 5018 99 + 5 7 - 86 6 81 849 636 1160 1034 111 148 14 22. 1507 22 + 5 4 - 17 1 16 219 - 415 - 20 23 7 23. 3948 68 + 11 15 - 53 - 59 548 - 919 - 59 60 22 24. 3415 63 + 3 - - 50 13 62 690 - 870 - 60 13 - 25. 604 4 1 - 3 - 3 61 - 67 - 11 13 3 26. 68 1 1 - - - 1 10 - 27 - 7 3 - 27. 446 7 - - 7 - 5 77 - 138 - 12 19 5 28. Commenced duties 4.1.66 Part-time Midwives 1. Clinic Duties temporarily 2. 1446 1 - - 1 - 1 19 - 592 - - ' - 29 3. 5260 - - - - - - 16 - 1537 - - - 35 4. 3382 - - - - - - 175 - 843 - - - - 5. 4514 - - - - - - 17 - 1331 - - - 56 6. 331 1 - - 1 - 1 10 - 167 - - - 8 7. 4718 2 - - 2 - 2 17 - 1396 - - - 58 Total 99400 1604 105 2 1377 81 1196 15394 4285 25891 7522 2080 1920 435 (Continued on next page) 108 N.B. DELIVERIES for No. 2 includes 19 (Maternity 16 Normal and 3 Abnormal) No. 3 includes 9 (Maternity 8 Normal and 1 Abnormal) (1 twins) No. 4 includes 9 (Maternity 8 Normal and 1 Abnormal) No. 7 includes 13 (Maternity 10 Normal and 3 Abnormal) No. 8 includes 16 (Maternity 16 Normal) No. 24 includes 20 (Maternity 8 Normal and 12 Abnormal including one breech) N.N.B. No. of DELIVERIES + = Cases sent into Hospital during labour. SUPERVISOR OP MIDWIVES - Retired 31.3.65 - Replaced 1.4.65 DEPUTY SUPERVISOR OP MIDWIVES - Retired 31.12.64 - Replaced by No.1 1.1.66 MIDWIVES:- No. 1 Not replaced - Returned to District June 1965 Replaced by No. 12 1.7.65. No.12 Not replaced yet on district. No.14 Left Service May 1965 - Not replaced No.19 Left Service Sept. 1965 - Replaced by No.28 4.1.65 No.26 Left Service April 1965 - Replaced by No.6 March 1965 No. 16 Left Service August 1965 - Not replaced No.22 Transferred temporarily to Infant Welfare duties following sick leave and left Service on.20.10.65 No. 23 Left Service 20.10.65 - Replaced by No. 27 8. 11.65. No.13 Transferred to Part-time Midwives (No.6) Nov. 1965 Replaced by No.25 29.11.65. Nos. 2, 3, 4, 7, 8, 24 and Part-time midwife No.4 Transferred to Service from Surrey County Council April 1st 1965. PART-TIME MIDWIPE No.1 Commenced October 1965 - Temporary Clinic Duties No.2 Commenced July 1965. PART-TIME MIDWIVES Nos. 2, 6 & 7 Undertake Deliveries if required since 1st Nov. 1965. 4 vacancies caused by 3 Resignations and 1 Retirement in 1964 have not been replaced. 109 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1965 who were born* - (i) at home or in a nursing home 50 (li) in hospital* 261 (2) The number of those born at home or in a nursing home - who ware nursed entirely there 50 who were transferred to hospital on or before the 28th day 6 who died during the first 24 hours 1 who died in 1 ana under 7 days 2 who died in 7 and under 28 days who survived at the end of one month 47 (3) Number of those born in hospital - who died during the first 24 hours 28 who died in 1 and under 7 days 7 who died in 7 and under 28 days 3 who survived at the end of one month 223 (4) Number of premature still births who were born (i) at home or in a nursing home 2 (ii) in hospital 29 *The group under this heading will include cases which may be born in one hospital and transferred to another. 110 HOME VISITS BY HEALTH VISITORS 1965 Home Visits Comm. May Part-Time Conn. Dec. Left March Comm. Oct. Comm. Oct. Part-Time Left July 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Infants born 1965 - First Visits 78 167 121 167 127 11 19 193 120 216 19 47 151 78 119 198 177 159 191 5 85 206 46 135 Re-Visits 164 264 165 266 303 5 12 209 218 257 25 106 163 233 280 295 335 349 529 5 167 285 55 191 Children born 1964 - First Visits 78 39 176 60 89 37 86 305 82 77 4 27 147 70 98 147 104 116 249 17 260 179 268 75 Re-Vlslts 208 209 172 238 257 4 21 116 166 242 19 37 137 252 224 417 61 276 435 5 187 109 28 150 Other children under 5 years - First Visits 325 68 215 115 159 32 131 340 309 55 21 26 417 188 238 265 338 200 238 47 317 372 377 131 Re-Vlslts 184 377 131 241 425 9 26 114 374 310 19 22 385 724 449 588 189 392 349 10 133 207 3 231 Expectant Mothers - First Visits 22 14 11 13 78 2 - 6 13 23 2 7 29 13 24 66 17 32 6 4 5 26 12 7 Re-Vlslts - 9 - 20 7 - - 12 7 6 8 - 3 19 9 10 3 17 2 - 8 9 - 1 Miscellaneous Visits 146 69 125 84 168 1 10 394 202 161 7 24 96 82 66 196 188 456 210 7 99 335 4 102 TOTALS - 1065 1205 1216 1116 1204 1613 101 305 1689 1491 1347 124 296 1528 1659 1507 2182 1412 1997 2209 100 1261 1728 793 1023 (Continued below) 111 HOME VISITS BY HEALTH VISITORS 1965 Home Visits Comm. Oct. Part-Time Part-Time Left Aug. Part-Time Comm. May Conn. Aug. 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 TOTALS Infants born 1965 - First Visits 109 320 36 149 168 191 95 94 93 162 124 136 198 167 144 95 89 214 159 149 73 216 6,012 Re-Visits 210 266 260 310 130 286 203 241 319 375 548 280 271 175 206 378 203 273 170 634 66 381 11,066 Children born 1964 - First Visits 82 53 4 11 45 115 76 111 44 182 111 75 108 139 105 67 44 61 129 209 35 145 4,741 Re-Visits 282 167 144 294 59 190 235 109 425 289 362 225 190 302 258 235 81 197 118 566 7 402 9,107 Other Children under 5 years - First Visits 143 137 4 13 60 262 79 338 66 321 157 143 247 254 214 121 78 74 259 207 152 178 8,431 Re-Visits 442 662 138 322 59 215 214 278 416 382 284 612 217 632 271 243 167 268 299 605 9 428 13,055 Expectant Mothers - First Visits 88 22 9 1 1 53 - 40 60 35 21 21 22 37 69 12 25 - 23 10 3 63 1,047 Re-Visits 3 11 - 2 1 12 - 15 26 28 9 22 5 17 12 57 4 - 5 7 - 12 398 Miscellaneous Visits 56 386 16 65 92 143 9 66 34 94 114 156 185 97 146 77 220 164 75 98 68 203 5,796 TOTALS - 1965 1415 2024 611 1167 615 1467 911 1292 1483 1868 1730 1670 1443 1820 1425 1285 911 1251 1233 2485 413 2028 59,653 112 ATTENDANCES AT INFANT WELFARE CENTRES- 1965 Benshas Manor Monday A.M. Benshas Manor Monday P.M. Boston Road Thursday P-M. Brighton Rd. Coulsdon Thursday P.M. Brighton Rd. S. Croydon Wednesday P.M. Cherry Tree Green Wednesday P.M. Coulsdon Youth Club Monday A.M. & P.M. East Croydon Tuesday A.M. East Croydon Friday P.M. Fairchildes Friday P.M. Palconwood Wednesday P.M.. Kenley Friday P.M. Lodge Road Thursday A.M. Lodge Road Thursday P.M. Lodge Road Friday P.M. Mitchley Avenue Tuesday (Alt.) P.M. Monks Hill Thursday P.M. Monks Orchard Monday P.M. New Addington Wednesday A.M. New Addington Wednesday P.M. Nor bury Wednesday A.M. Norbury Wednesday P.M. Old Coulsdon Tuesday P.M. Purley Tuesday A.M. New Cases Born During 1965 104 111 95 90 125 41 84 153 158 18 28 84 135 183 66 35 38 60 141 150 102 100 127 152 No. of Re-Attendances 687 757 772 655 1028 316 643 1222 1183 103 177 689 831 775 543 171 276 397 848 907 783 811 748 838 New Cases Under 5 Years 275 294 255 270 212 112 375 302 285 85 103 231 265 300 38 160 247 235 341 353 128 156 314 262 No. of Re-Attendances 1260 1382 1266 1302 1862 768 2487 1342 1485 211 325 955 1023 1052 261 748 628 595 1407 1223 1247 1120 1297 860 Consultations with Doctor 933 996 810 913 828 5 503 674 1057 158 376 520 1032 983 380 268 600 535 954 937 768 821 685 908 No. of Sessions 46 46 51 52 52 52 94 51 50 41 39 51 51 51 30 24 50 47 52 52 50 50 52 52 Total Attendances 2326 2544 2388 2317 3027 1237 3589 3019 3111 417 633 1959 2254 2290 908 1114 1189 1287 2737 2633 2260 2187 2486 2112 Average Per Session 1965 50.5 55.3 46.8 44.5 58.2 23.7 38. 2 59. 2 61.0 10.1 16. 2 38.4 44.2 44.9 30.2 46.4 23.7 27.3 52.6 50.6 45.2 43.7 47.8 40.6 Average Per Session 1964 52.8 66.1 65.0 - 62.8 - - 53. 2 74.8 19. 2 24.3 - 60.7 61.7 - - 29.9 25.9 49.8 44. 2 52.8 47.3 - - Continued Below 113 ATTENDANCES AT INFANT WELFARE CENTRES - 196 5 Reedhaas Park Friday P.M. St. Albans Wednesday P.M. St. Andrews Monday P.M. St. Judes Tuesday A.M. St. Judes Tuesday P.M. St. Oswalds Thursday P.M. St. Pauls Friday F.M. Sanderstead Hill Wednesday P.M. Selhurst Monday P.M. Selsdon Monday A.M. A P.M. Shirley Thursday P.M. South Croydon Thursday P.M. South Norwood Tuesday P.M. South Norwood Friday P.M. Spring Park Monday P.M. Spring Park Friday P M. Upper Norwood Wednesday A.M. Upper Norwood Wednesday P.M. Weddon Wednesday P.M. Woods!de Friday A.M. foodside Friday P.M. TCTAL - 1965 TOTAL - 1964 New Cases Born During 1966 35 146 143 80 108 116 126 57 125 92 76 156 160 154 55 53 114 112 101 103 137 4609 3817 No. of Re-Attendances 263 1027 ' 855 792 848 883 728 250 893 795 433 1486 1007 1006 318 270 613 619 806 528 712 31092 29009 New Cases Under 5 Years 104 217 261 207 191 205 194 189 214 343 153 156 198 178 119 183 305 258 189 223 280 9863 6768 No. of Re-Attendances 623 1178 1550 1087 1019 1352 917 485 1408 2186 950 833 1339 1005 628 629 826 898 979 798 931 47557 37458 Consultations with Doctor 220 940 900 727 765 953 885 233 1010 827 225 600 1000 779 645 814 761 775 663 654 783 31903 26930 No. of Sessions 51 53 47 52 51 52 50 52 48 94 50 51 53 50 46 50 52 52 52 50 50 2242 1643 Total Attendances 1025 2568 2809 2166 2166 2556 1965 981 2640 3416 1612 2631 2704 2341 1120 1135 1758 1887 1875 1652 2090 93121 77152 Average Per Session 1965 20.0 48. 4 59.7 41.6 42.4 49.1 39.3 18.8 55.0 36.3 32.2 51.5 51.0 46.8 24.3 22.7 33.8 36.2 36.0 33.0 41.8 41.5 - Average Per Session 1964 - 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 42.8 - 47.0 114 HOME NURSING Staff at 31.12.65. Assistant Superintendent Nursing Officer (District Nursing] Deputy Assistant Superintendent Nursing Officer (District Nursing) 2 Assistant Superintendents 53 Queen's Nurses (including 4 males) 3 S.E.N. Nurses 3 Queen's Students Summary of work carried out during the year 1965; Patients remaining on books at December 1964 (Croydon & New Addington) 1,027 New Patients, January - March, 1965 879 Transferred from Purley 1.4.1965 233 New Patients from 1.4.1965 (Croydon, New Addington & Purley) 3,041 Total 5,180 New Patients:- Medical 2.153 Surgical 1,722 Gynaecological 12 Obstetric 10 Maternity 23 Total 3,920 Specially Classified Cases Visits Tuberculosis 98 3,335 Pneumonia 52 402 Maternity Complications 38 273 Infectious Diseases 4 30 Erysipelas 5 46 Children under five years 76 637 Over 65 years old 2,773 105,933 Termination of Cases:- Convalescent 2,400 Hospital 899 Died 444 Removed for other causes 169 Still on books 1,268 Total 5,180 115 Visits:- January 11,349 February . Croydon & New Addington 10,899 March 12.144 April Croydon, New Addington & Purley 13,732 May 13,702 June 12,405 July 12,966 August 12,757 September 12,784 October 13,557 November 13,607 December 13,355 Total 153,257 REHABILITATION OF ELDERLY PERSONS Patients visited by Rehabilitation Nurse, 1965;- Female 52 Male 18 70 Admitted to hospital 6 Rehabilitated 35 No Success 3 Died 6 Remaining on books 20 70 Ages: 30 - 39 years 2 40 - 49 years 2 50 - 59 years 3 60 - 69 years 17 70 - 79 years 20 80 - 89 years 22 90 - 95 years 4 70 Illnesses:- Hemiplegia 26 Arthritis, Rheumatism and Fibrositis 25 Fracture lower limb 4 Other conditions (Parkinson's Disease, Carcinoma, Cardiac, and Disseminated Sclerosis) 15 70" 116 In the age group 30-59 years. 7 Cases. 1 case of Fractured Fibula - Infra Red and Massage. factory progress. 2 cases. Disseminated Sclerosis - Walking exercises. One patient - slight improvement, the other - no success 1 case of Hemiplegia (with carcinoma) - Died 2 cases, Arthritis - Both now walking 1 case. Emphysema and Oxygen addiction - Patient improving. In the age group 90-95 years. 4 Cases. 3 cases of Arthritis - Two cases now walking, the other - no success. 1 case of Debility following fall.- Patient now walking. 117 LOAN OF NURSING EQUIPMENT The Corporation loans equipment and snakes a small weekly charge with exemption for incomes below a certain figure. 1965 Health Dept. British Bed Cross Society 1965 Central Purlev (A) Purley (B) Solsdon Shirley Norbury Air beds - - 1 - - - - Air bellows - - 1 - - - - Air rings 106 16 21 17 5 8 9 Bed pans 137 38 31 17 6 8 24 Bed tables 5 1 5 3 - 1 - Bedsteads 9 - - - - - - Bed Pulley 6 - - - - - - Bed rests 112 21 26 28 - 15 13 Bed blocks 8 - 3 - - 2 - Bed cradles 20 18 10 8 1 4 9 Carrying chairs - - 2 - - - - Commodes 94 39 27 29 4 13 22 Cotton sheets (draw) 2 - - - - - - Crutches 10 8 11 5 - - 2 Dunlopillo Mattresses 7 - - - - - - Enuresis Machines 60 - - - - - - Feeding cups 6 3 3 2 2 - 2 Fracture boards 8 3 2 - - - - Foot Suction pump 4 - - - - - - Heat Lamp - - - - - 1 - Hydraulic hoists 7 _ - - - _ - Inhaler - - 1 - - - - Mackintosh sheets 89 13 15 17 6 5 6 North pads 40 - - - - - - Urinals 40 8 12 9 4 3 10 Walking Aids 46 - 3 - - 1 - Walking Machines 1 - - - - - - Walking sticks 1 - - - - - - Walking tripods - - 4 - - 1 - Wheel Chairs 56 79 19 9 7 12 33 Incontinence Pads Issued 7,668 * • - - - - 118 HOME HELP SERVICE Staff at 31.12.65. 1 Principal Home Help Organiser 5 District Organisers 1 Tutor Organiser 5 Clerical Assistants 1 Assessment Officer 23 Full Time Home Helps 174 Part Time Home Helps Summary of work carried out during the year under review:- Patients remaining on books from 1964 1,311 New Applicants 1,278 Patients carried forward to 1966 1,561 New Applicants (a) Maternity 491 (b) Sickness 896 (c) For Night Service Classification of Cases Attended (a) Maternity 382 (b) Tuberculosis 8 (c) Chronic Sick including Old Age 2,152 (d) Others including Acute sick 85 Number of Hours of Service Given 207,670 Average Duration of Service Given (a) Maternity 10 days (b) Acute sickness 10-21 days (c) Chronic Sickness Indefinitely Amount Recovered for Service £7,856.18.10 Rate of Remuneration of Some Helps at 31.12.65. 4/107/8 per hour - Home Helps 4/87/8 ,, - Sick Room Helpers 4/8¾ ,, - Washing Service 5/3½ ,, Problem Family Helps £12.1.8dper week - Family Helps 10/-d ,, - Disinfestation 119 CONGENITAL ABNORMALITIES No. registered in 1965 - 74 of these 57 were live-births 4 were still-births 13 died (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Central Nervous System Eye, Ear ALImentary System Heart and Great Vessels Respiratory System Uro-genital System Limbs Other Skeletal Other Systems Other Mai» formations TOTALS OVERALL TOTALS M F M F M F M F M F M F M F M F M F M F M F LIVE 8 1 - 1 11 2 3 1 1 - 5 1 9 7 1 - - 1 3 2 41 16 57 STILLBIRTHS 2 2 - - - - - - - - - - - - - - - - - - 2 2 4 DEATHS - - - - 3 1 3 - - - 1 - 1 - - 1 - - 2 1 10 3 13 TOTALS 10 3 - 1 14 3 6 1 1 - 6 1 10 7 1 1 - 1 5 3 53 22 74 CAUSES OF DEATH OR STILL-BIRTH Col: 1. Anencephalous 4 Col: 3. (Esophageal Atresia 2 ,, ,, and Intestinal Atresia 1 Hiatus Hernia and Intestinal Atresia 1 Col: 4. Tetralogy of Fallot 2 Other defects 1 Col: 6. Hypospadias and other defects 1 Col: 7, Defects of pelvic girdle, lower limb and hand 1 Col: 8. Defects of face and skull 1 Col: 9. Congenital malformations (N.O.S.) 3 120 ISSUE OF WELFARE FOODS Year National Dried Milk Orange Juice Cod Liver Oil Vitamin A & D Tablets 1965 56,903 97,831 6,019 8, 532 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 1 1 Knock Knees and Flat Feet 8 9 17 Valgus Ankles 7 8 15 Asthma 3 3 8 Kyphosis 1 1 2 Pigeon Toes 2 2 4 Torticollis - - - 22 23 45 Total Attendances 974 121 DENTAL TREATMENT - M. AND C.W. Expectant and Nursing Mothers Young Children Number of persons examined during the year 146 386 Number of persons commenced treatment during the year 127 225 Number of courses of treatment completed during the year 73 202 Attendances 315 635 Fillings 142 385 Extractions 103 146 General Anaesthetics 30 68 Scaling and Gum Treatment 65 - Crowns and Inlays ,, Silver Nitrate ,, 216 Dentures Pitted ,, Full 5 Partial 9 • Other Operations 153 140 X-Rays 7 4 Number of treatment sessions: 180 122 DEAFNESS Of 577 tested 513 were found to have normal hearing and no further recommendation was made. The remaining 64 cases where some doubt was felt as to hearing ability were either followed up in Infant Welfare Centres and found to be normal or were referred for retest at Dr. Morgan's Stycar Hearing Clinic. DR. MORGAN'S STYCAR HEARING SESSION No. of Clinics held in year 1965 14 No. of Appointments sent out during year 126 Non Attendances 53 Of the 73 seen:- A. Referred to Clinic from Infant Welfare Centres 34 Suspected Hearing Loss 5 1-Normal Responses but referred to Mr. Parsons re adenoids. 4-Normal responses. Retarded Speech 10 1-Hearing satisfactory but referred to Ear, Nose and Throat Dept. re Tonsils and Adenoids 1-No co-operation? normal hearing. To be seen again. 1-Hearing satisfactory but? poor intelligence, T. C. A. 6 months. 1-Severe hearing loss, referred to Mr. Stewart. 1-Appears to be satisfactory but T.C.A. 2 months for check. 5-Normal Responses. Retarded Child 1 1-Normal Responses 123 Doubtful Responses to Hearing Test in 12 Infant Welfare centre Mr. Stewart. 2-Appeared to have satisfactory hearing but T.C.A. in 3 months for check. 1-?High Frequency loss. T.C.A. 1 month. 1-?Slight loss; Hearing to be checked in school. 6-Normal Responses. Parent's Request 3 1-?Low Frequency loss, referred to Mr. Parsons. 1-Appears to have hearing loss, referred to Mr. Stewart. 1-Normal Responses. Frequent Under Review Investigations 2 2-Normal Responses. Mother Rubella in early pregnancy 1 1-Uncertain Responses, referred to Mr. Stewart. B. Referred to Clinic from Sources other than Infant Welfare Centres 27 Respiratory Infections 1 1-Normal Responses. Difficult Labour & Toxaemia 3 3-Normal Responses. Parents' and/or Doctor's Request 5 1-Unco-operative, to be seen again 4-Normal Responses. Suspected Hearing Loss 6 2-Five year old children, referred to Mr. Oakley for audiogram. 1-? Right side loss, T.C.A. 2 months. 3-Normal Responses. 124 Mother Rubella in early pregnancy 1 1-Normal Responses. Referred by Mr. Oakley, Audiometry not Possible. 2 1-Uncertain Responses, referred to Mr. Stewart. 1-Uncertain Responses, T.C.A. 1 month. Prematurity. 1 1-?Loss Left Ear, T.C.A. 6 months. Speech Retarded 5 1-Normal Responses but? speech therapy later. 1-Poor Responses beyond 3 feet, referred to Mr. Stewart and to Speech Clinic. 3-Normal Responses. Mentally Subnormal 1 1-Uncertain Responses, T.C.A. 1 month. Family History of Deafness 2 2-Normal Responses. C. Retests 12 Unco-operative at first test 4 1-Normal Responses. 1-Unco-operative, to be seen again. 2-Unsatisfactory Responses, referred to Mr. Stewart. ?High Frequency Loss. 1 1-?Some hearing loss, T.C.A. 1 month ?Poor Intelligence 1 1-Impossible to test, T.C.A. 1 month. Retarded Speech. 1 1-Normal Responses. 125 Doubtful responses to first test 3 3-Normal Responses. ?For Referral to Mr. Parsons 2 2-Unsatisfactory Responses, T.C.A. 1 month. 126 HOME ACCIDENTS Details of patients removed to hospital by the London Ambulance Service following a Home Accident, April 1st-December 31st, 1965, inclusive. Age Males Females Sex not stated Total Under 1 year 10 6 2 18 1-4 years 113 102 1 216 5-14 years 98 48 1 147 15 - 24 years 36 27 - 63 25 - 44 years 45 62 - 107 45 - 64 years 55 76 - 131 65 years and over 50 158 - 208 Not stated 8 10 2 20 TOTAL 415 489 6 910 DEATHS FROM ACCIDENTS IN THE HOME, 1965 Cause No. Details Falls 9 There were 5 women between 58 and 86 years of age, 3 men over 70 years and 1 girl age 3 months. Burns 1 Woman-Age 77 years. Nightdress caught fire when lighting an oil heater with an oily rag. Poisoning 5 2 women between 69 and 75 years of age and 3 men between 65 and 77 years died of accidental carbon monoxide poisoning. Suffocation 2 1 boy-age 4 years and 1 girl age 3 years died from asphyxia following inhalation of smoke and fumes. 1 Girl-age 8 months-died from asphyxia following suspension from a pram harness. Electrocution 1 Woman-age 69 years. TOTAL 19 127 Nursing Homes-Nursing Homes Act, 1964. Number of Homes Number of beds provided for:- Maternity Others Total Homes registered during the yea4rr - - - - Homes on the Register at the end of the year 17 46 387 433 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. 128 CREMATION ACTS, 1902 and 1952 During the year 2,525 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Acts. PUBLIC MORTUARY AND CORONER'S POST MORTEM ROOM 1965 Total number of Bodies received 745 Total number of Post Mortem Preparations 738 Total number of Post Mortem Examinations for Coroner 738 Total number of Post Mortem Examinations for Medical Officer of Health - 129 COMMUNICABLE DISEASES NOTIFIED CURING 1965 Notifiable Disease Cases Notified Total cases notified in wards At all ages At ages - years Upper Norwood Norbury Vest Thornton Bensham Manor Thornton Heath South Norwood Woodside East Addiscombe Whitehorse Manor Broad Green Central waddcn South Aldington Shirley Sander stead North Sanderstead and deIsdon Wpodcote and Coulsdon nest Coulsdon East Purley M F Total. Under l I - 4 5 - 14 !5 - 24 ^5-44 45-64 65 and over Scarlet Fever 202 1 65 125 8 3 — — 17 14 3 8 34 16 3 8 1 7 6 3 10 1 32 10 8 7 — 2 12 107 95 202 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Erysepilas 13 — — — — 2 7 4 — — — — 3 2 — — — 1 1 — 3 — 3 — — — — — — 8 5 13 Meningococcal Infection 3 1 1 — 1 — — — — — — — — — — — 1 1 — — — — — — 1 — — — — 2 1 3 Enteric and Paratyphoid — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Typhus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia 9 — — — 5 4 — — — — — — 1 2 — — 1 1 — 1 1 — — — — — 1 1 — — 9 9 Ophthalmia Neonatorum 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 Acute Poliomyelitis 1 — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 Dysentery 237 7 46 124 9 35 10 6 1 3 9 1 3 — 6 — 3 — 10 64 37 1 35 29 26 1 1 5 2 111 126 237 Malaria 1 — — — — 1 — — — — — — — — — — — — — — — — — — — — — — 1 1 — 1 Acute Primary and Influenzal Pneumonia 30 4 7 4 1 3 8 3 1 2 — 2 10 1 1 — 5 — 1 — 1 — 1 5 — — — — — 15 15 30 Food Poisoning 20 — 3 1 4 4 5 3 3 — 1 2 2 3 1 — 1 — — — 4 — 2 — — — 1 — — 12 8 20 Acute Encephalitis 1 1 — — — — — — — — — — 1 — — — — — — — — — — — — — — — — 1 — 1 Measles 3589 93 1704 1769 11 9 3 — 147 172 92 63 494 481 45 66 122 139 120 69 128 173 577 368 149 59 12 49 64 1905 1684 3589 Whooping Cough 31 4 16 11 — — — — 1 — — — 8 2 — — 1 5 — — 3 — 2 1 — — 1 1 6 21 10 31 4138 112 1842 2034 39 62 33 16 170 191 105 76 556 507 56 74 135 154 138 138 187 175 652 413 184 67 17 58 85 2185 1953 4138 The tuberculosis notifications are shown in the section relating to that disease 130 MONTHLY INCIDENCE OF COMMUNICABLE DISEASE 1965 Notifiable Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 7 5 1 6 4 5 11 6 10 10 9 8 82 Non-Respiratory Tuberculosis 1 2 1 1 — — 1 1 — 1 1 — 9 Scarlet Fever 14 13 36 36 18 12 16 5 8 4 23 17 202 Diphtheria — — — — — — — — — — — — — Erysipelas 3 3 2 2 — 1 — — — 1 — 1 13 Meningococcal Infection — — — — 3 — — — — — — — 3 Enteric and Paratyphoid — — — — — — — — — — — — — Smallpox — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — Typhus — — — — — — — — — — — — — Puerperal Pyrexia — 1 1 1 1 — 2 — — 1 2 — 9 Ophthalmia Neomatorum — — — — — 1 — — — — — — 1 Acute Poliomyelitis — — — — — — — 1 — — — — 1 Dysentery 12 5 10 4 3 4 6 2 15 81 52 43 237 Malaria — — — — — 1 — — — — — — 1 Ac. Pri. and Ac. Inf. Pneumonia 4 4 6 2 — 1 — 2 — 4 1 6 30 Pood Poisoning — 1 3 1 2 3 2 — 1 2 — 5 20 Acute Encephalitis 1 — — — — — — — — — — — 1 Measles 735 972 974 375 98 113 66 26 30 41 87 72 3,589 Whooping Cough 4 2 — — 2 1 — 1 5 5 7 4 31 4, 229 131 DETAILS OF CASES ADMITTED TO WADDON HOSPITAL Gastro-enteritis:-98 cases were admitted in the following age groups:- Under one year-38; 1-4 years-30; 5-15 years-2; Adults-28. 11 were gravely ill, 58 moderately severe and 29 were mild cases. In one case each E. Coli 0 26, 0111, 0 55 and 0 119 was isolated but in the great majority of cases no pathogenic organism was detected. Associated illnesses were present as follows:-4 cases each of bronchitis, otitis media, and rhinitis; 3 cases each of pneumonia and anaemia; 2 cases each of arthritis and hypertension and one case each of colostomy, dermatitis, fractured clavicle, shell shock, convulsions, cerebral thrombosis, empyema, post anal fissures, impetigo, boils and mitral stenosis. One Gastro-enteritis case where the disease was complicated by pneumonia died within 5 minutes of admission. There were no other deaths. Measles:-There was a measles epidemic in the first five months of the year during which all but four of the cases were admitted. The numbers of cases admitted in the different age groups were as follows:-under one year-8 cases; 1-2 years-22 cases; 2-4 years-42 cases; 5-15 years-13 cases; Adults-4 cases. The following complications were present:-pneumoni-40 cases; tonsilitis-6 cases; bronchitis-6 cases; rhinitis-4 cases; gastro-enteritis-4 cases; 2 cases each of laryngitis stridu-losa, otitis media, septic fissures and thrush; one case each of adenitis, haematuria, pharyngitis, convulsions and stomatitis. One case was associated with chicken-pox. There was one death occurring in a child 2¾ years who was a severe spastic and had developed measles pneumonia. The child died 2 days after admission. Chicken-Pox:-42 cases were admitted in the following age groups:-0-4 years-23 cases; 5-15 years-6 cases and Adults-13 cases. 20 cases were admitted in the months of March and April as there was an epidemic in Coombe Wood Nursery at that time, Hospital nurses comprise 12 of the 13 adults. A further 13 cases were admitted from nurseries. There were 2 cases who were already in hospital with some other complaint and two from institutions with communal living. Complications were as follows:-3 cases of impetigo, two cases each of bronchitis and otitis media, one case each of encaphalitis, stomatitis, boils, styes, and rhinitis. Co-existing diseases were osteomyelitis, coronary thrombosis, eczema, and cut chin. 132 Scarlet Fever:-36 patients were admitted in the following age groups:-0-4 years-12 cases; 5 and 6 years - 11 cases; 7-15 years - 10 cases and adults 3 cases. Complications consisted of two cases each of appendicitis and skin fissures, and one case each of conjunctivitis, stomatitis, bronchitis, pharyngitis, and herpes simplex. Co-existing diseases consisted of one case each of asthma, chicken-pox and chronic adenitis. Dysentery:-22 cases were admitted in the following age groups:0-1 year-one case; 1-4 years-13 cases; 5-15 yearsone case; Adults-7 cases. 7 cases came from their own homes, 5 from communal dwellings, 3 from hospitals, 3 from residential schools, and two from nurseries. Co-existing illnesses were one case each of pneumonia, arthritis, mastoiditis, appendicitis, anaemia, sinusitis, ringworm, myocardiac degeneration and pulmonary oedema. Among the dysentery organisms isolated 10 were resistant to ampicillin, 4 to streptomycin and 3 to tetracycline. One death occurred in a lady of 81 years. Pneumonia:-12 cases were admitted in the following age groups:0-1 year-2 cases; 1-4 years-6 cases; 5-15 years-1 case; Adults-3 cases. 8 of the 12 cases were admitted in the first quarter of the year. 5 of the 12 cases had to be given oxygen on admission. Infective Hepatitis:-The 10 cases admitted at various ages between 6 and 43 years. The latter patient, a woman, was the only severe case encountered. After 58 days in hospital she was discharged still having a raised serum bilirubin and glucose pyruvate transaminase. There was one anicteric case. Meningitis and Encephalitis:-The 9 cases admitted under this category can be classified as follows:-Coxsackie B5 meningitis 4, Meningitis due to an unknown virus-2. Meningococcal Meningitis-1, Haemophilis Influenza Meningitis-1. Encephalitis due to an unknown virus-1. This latter case was the most severe and resulted in damage to the brain and visual tracts. The haemophilis influenza case was also severe and accompanied by a high degree of anaemia. 133 SAMPLES SUBMITTED TO THE PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION-1965 Faeces outfits 1,670 Drinking Water samples 365 Public Swimming Bath Water samples 101 Private Swimming Bath Water samples 85 Private Wells 65 Milk samples 256 Cream samples 5 Ice Cream samples 128 Sundry Food Specimens 32 Blood 42 Urine 150 Nose and Throat Swabs 26 Total 2,925 Samples of Drinking Water During the year under review the total number of examinations performed were:- Bacteriological 353 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. 134 IMMUNISATION AGAINST WHOOPING COUGH A total of 5,831 children were immunised against whooping cough, comprising 4,612 under school age and 140 school children. In addition 1,079 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 5,018 children were immunised against Tetanus, comprising 4,641 under school age and 377 school children. In addition 4,622 children were given reinforcing injections. VACCINATION AGAINST SMALLPOX A total of 3,549 persons were vaccinated against Smallpox. Under 1 year of age i 2-4 5-14 15 or over Total Successful Vaccinations 180 2,008 980 92 32 3,292 Successful Re-vaccinations - 1 24 83 147 255 Insusceptible to Vaccination - - 2 - - 2 3,549 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1965 who completed a course of Immunisation during the year. Age at 31,12.65 i.e. Born in year Under 1 1965 1962-1964 1961-1958 1957-1949 Total Completed course of injections 921 3,725 204 62 4,912 Reinforcing Injections - 583 3,242 1,907 5,732 TOTAL 921 4,308 3,446 1,969 10,644 Under 1 1-4 Total under 5 5-14 Total under 1 Estimated mid year Child Population 5,590 22,510 28,100 45,500 73,600 135 VACCINATION AGAINST POLIOMYELITIS The following table gives the number of persons who received a course of primary vaccination during the year. VACCINATED Children born 1965 Children born 1964 Children born 1963 Children born 1962 Young persons born 1961-58 Persons born 1957-49 Persons over 16 years of age With Salk Vaccine 8 41 10 2 9 5 9 With Oral Vaccine 982 3,171 479 252 455 284 633 With Quadruple Vaccine 30 80 4 1 3 - - Number of persons who received a reinforcing vaccination as at 31st December, 1965. VACCINATED Persons given a first reinforcing Vaccination during 1965 With Salk Vaccine 142 With Oral Vaccine 4, 787 With Quadruple Vaccine 76 Annual Total 5, 005 TOTAL since Vaccination began 115,509 INTERNATIONAL VACCINATION CERTIFICATES During the year 6,151 certificates were authenticated, 5,306 Smallpox, 650 Cholera, 195 T.A.B. and Yellow Fever. 136 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATIONS AND MORTALITY-1965 137 Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1965 to 31st December, 1965. 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- Toted (all ages) Respiratory, Males - 1 - 2 2 2 6 6 7 7 18 3 2 56 Respiratory, Females - - 2 3 2 1 2 2 6 3 3 1 - 25 Non-Respiratory, Males - - - - - - 2 3 - - - - - 5 Non-Respiratory, Females - - - - - - 2 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, 1965 to 31st December, 1965 otherwise than by formal notification:- RESPIRATORY NON-RESPIRATORY Males Females Males Females 35 28 1 4 138 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1965 1,426 Transfers in from other areas 36 "Lost sight" cases returned during the year - New cases diagnosed as definite during the year 76 1,538 Number of cases written off the Chest Clinic Register during the year as:- Recovered 80 Died 27 Removed to other areas 32 "Lost sight of" and other reasons 10 149 Remaining on Register as at 31st December 1,389 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 2,480 Number of visits paid by Clinic doctors to homes of patients 181 Number of visits paid to homes of patients by Tuberculosis Health Visitors 2,738 Attendances of patients at the Clinic- At ordinary sessions *17,671 Number of X-Ray films taken *19,250 *Includes 4,976 miniature film attendances 139 VENEREAL DISEASES-NEW CASES-1965 RESIDING IN CROYDON 140 VENEREAL DISEASES SYPHILIS 1. NEW CASES OF SYPHILIS Totals Males Females (1) Primary 2 2 - (11) Secondary 4 3 1 (III) TOTAL OP LINES 1 (1) and 1 (11) 6 5 1 (IV) Latent in the first year of infection 3 2 1 (V) Cardio-vascular .. . - - - (VI) Of the nervous system - - - (VII) All other late and latent stages ... 14 2 12 (VIII) Congenital, aged nnder 1 year ... - - - (ix) Congenital, aged 1 but under 5 years - - - (x) Congenital, aged 5 but under 15 years - - - (xi) Congenital, aged 15 and over ... - - - (xll) TOTAL OP LINES 1 (Hi) to 1 (xi) ... 17 4 13 2. AGE GROUPS OF CASES IN ITEM I (i) & 1 (II) ABOVE (l) Under 16 - - - (11) 16 and 17 - - - (III) 18 and 19 - - - (IV) 20-24 3 2 l ( V) 25 and over 3 3 - 3. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLAND AND VALES AFTER DIAGNOSIS - - - 4. CASES IN WHICH TREATMENT AND OBSERVATION WERE COMPLETED 10 1 9 5. NEW CASES OF GONORRHOEA (i) Post-pubertal infections 126 86 40 (II) Vulvo-vaglnitis - - - (III) Ophthalmia neonatorum - - - (IV) TOTAL OF LINES 5 (1) to 5 (III) 126 86 40 GONORRHOEA 6. AGE GROUPS OF CASES IN ITEM 5 (I) ABOVE (l) Under 16 2 - 2 (II) 16 and 17 2 1 1 (III) 18 and 19 12 4 8 (IV) 20-24 44 30 14 (v) 25 and over 63 51 12 7. CASES TRANSFERRED FROM OTHER CENTRES IN ENGLAND AND WALES AFTER DIAGNOSIS - - - 8. CASES IN WHICH TREATMENT AND OBSERVATION WERE COMPLETED 85 54 31 141 OTHER CONDITIONS  Totals Males Females 9. NEW CASES OF OTHER CONDITIONS (i) Chancroid — — — (ii) Lymphogranuloma — — — (iii) Granuloma Inguinale — — — (iv) Non Gonococcal Urethritis 116 116 — (v)Non Gonococcal Urethritis with Arthritis 2 2 — (vi) Late or Latent Treponematoses presumed to be non-Syphilitic 8 1 7 (vii) Other conditions requiring treatment within the centre 215 112 103 (viii) Conditions requiring no treatment within the centre 304 157 147 (ix) Undiagnosed conditions 81 44 37 TOTAL OF LINES 9 (i) to 9 (ix) 726 432 294 10. CASES TRANSFERRED FROM OTHER CENTRES in england AND wales AFTER diagnosis — — 11. cases in WHICH treatment and observation were completed 519 334 185 12. number of individual patients attending year with new infections of: (1) PRIMARY OR SECONDARY SYPHILIS age groups (1) Under 16 — — — (ii) 16 and 17 — — — (iii) 18 and 19 — — — (iv) 20-24 3 2 1 (v) 25 and over 3 3 — (2) GONORRHOEA (Post-pubertal) Age groups (i) Under 16 2 — 2 (ii) 16 and 17 2 1 1 (iii) 18 and 19 12 4 8 (iv) 20-24 44 30 14 (v) 25 and over 63 51 12 142  Totals Males Females 13. LOCALITIES IN WHICH INFECTIONS TOOK PLACE (1) PRIMARY OR SECONDARY SYPHILIS (i) In locality of Centre 1 1 - (ii) Elsewhere in Great Britain and Northern Ireland 1 1 - (iii) Outside Great Britain and Northern Ireland - - - (iv) Not Known 4 3 1 (2) GONORRHOEA (i) In locality of Centre 32 24 8 (ii) Elsewhere in Great Britain and Northern Ireland 23 13 10 (iii) Outside Great Britain and Northern Ireland - - - (iv) Not known 71 49 22 14. ATTENDANCES AND DIAGNOSES OF CONTACTS (1) Contact slips Issued to patients with (i) Syphilis, primary and secondary 2 2 - (11) Gonorrhoea 58 57 1 (2) Contacts attending with (i) Syphilis, primary and secondary - - - (ii) Gonorrhoea 12 12 - (iii) Other conditions 44 42 2 15. TOTAL ATTENDANCES OF ALL PATIENTS (i) Syphilis 702 337 365 (ii) Gonorrhoea 340 201 139 (iii) Other conditions 2,692 1,682 1,010 (iv) ALL CONDITIONS (TOTAL Of 15 (i)(ii) and (III) 3,734 2,220 1,514 16. Cultures for the Gonococcus 708 17 691 Services Rendered at the Treatment Centre during the Year showing the Areas in which Patients dealt with for the First Time (Items 1, 5 and 9) resided. County, County Borough (England and Wales) and Others Syphilis Gonorrhoea Other Conditions Totals Croydon 12 79 368 459 Surrey 5 19 174 198 Kent - 9 35 44 London 5 18 68 91 Others 1 1 - 2 Totals (to agree with Items 1,5 and 9) 23 126 645 + 81 undiagnosed 794 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1965 To the Chairman and Members of the Education Committee: LADIES AND GENTLEMEN, This is the first Annual Report of the work of the School Health Service for the London Borough of Croydon. It covers the period of integration of two systems operated by different Authorities, which was made somewhat difficult by staffing changes and shortages, but which otherwise proceeded according to pre-arranged plans. Routine Medical Inspections The former County Borough Council authorised a pilot scheme of selective inspection using a questionnaire devised by Dr. Horner. His careful study of the results did not require a recommendation for fundamental changes in the present procedure. The possibility of using a questionnaire as an improvement and not in substitution of the present method was being considered. As routine medical inspection has been the basis of the School Health Service since its inception, it was encouraging to have this confirmation of the effectiveness of existing arrangements. 2 Infectious Diseases A moderate outbreak of Sonne dysentery in a South Croydon school responded to the usual control measures. The annoyance of submitting specimens and the exclusion of apparently healthy children produced complaints from several parents, in which both the staff of the school and the department were involved. Sonne dysentery is not a serious disease, and action for its suppression may seem more irksome than the actual illness. Previous local experience has shown, however, that in Infants' schools it can be ignored only at the risk of an outbreak involving the majority of scholars. Some disruption of school routine and inconvenience for parents, inseparable from preventive action, are therefore justified. Plantar warts were diagnosed as affecting an unusually large number of children, especially in New Addington. A similar frequency was observed some years ago in the County Borough area, and I included the results of a survey in my Report for 1959. The conclusions made then still apply. Although the condition is a reaction to a microscopic virus, it cannot be eliminated merely by disinfection. Restraints on barefoot drill and games, careful sterilising techniques for changing rooms, showers, and swimming baths, the early detection and treatment of affected children and their exclusion from barefoot activities, and talks on the care of the feet, especially for older girls, are all essential. Plantar warts are minor but painful afflictions of which prevention is fallible and treatment tedious. With present knowledge they must be accepted as a small risk of children's athletics. Handicapped Children A preoccupation during the year was the lengthening waiting list for educationally subnormal pupils. Despite conferences with officers of the Department of Education and Science, no early solution could be foreseen. Although our duty in the School Health Service may be limited to ascertainment and recommendations for special education, we cannot escape involvement in the difficulties which arise when suitable facilities are not available. Even more disturbing was the failure to recruit staff for the day unit for partially hearing children. In my last County Borough report I drew attention to the increase in the number of severely deaf pre-school children, whose defect probably related to the 1962 outbreak of Rubella. It was not possible to meet all their needs because no trained teacher applied in response to repeated advertisements. It may be that the time lost in this vital early stage of their education can 3 never be recovered fully. Again this was an educational and not a medical problem, but it is distressing to succeed in early diagnosis only to meet failure in the provision of remedial training. Against these setbacks can be recorded the recruitment of the full establishment of Speech Therapists, and the completion of premises for a day class for children with severe speech disorders. This will operate early in 1966. Plans were also well advanced for a pilot scheme to deal with a group of autistic children at the Child Guidance Clinic. New Clinics Two new clinics in purpose-built accommodation were completed, one at New Addington and the other at Sanderstead, and provided excellent facilities for all School Health duties in these areas. Special rooms in the Community Centre on the Shrublands housing estate also bacame available at the end of the year, and should allow decentralisation of some services for the convenience of parents and children in the area. Dental Health During the year Mr. R.G. Oliver, Principal School Dental Officer since 1938, retired after an extended period of office following his 65th birthday. I take this opportunity to record appreciation of his long and distinguished service to the former County Borough, and for his help in ensuring a smooth transition to the new Authority on April 1st. The report is presented by his successor, Mr. Everett, who reinforces the comments in Mr. Oliver's last report, that improvement in children's teeth observed in recent years follows acceptance of treatment and not any reduction in dental decay. Both the Principal Dental Officers thus re-emphasize the need for prevention, which rests on education in dental hygiene and an adequate fluorine content of drinking water. Health Education A joint working party from the Education and Health Departments produced a comprehensive Teachers' Guide, explaining how this subject can be included in the curriculum at different age levels. Steps to introduce and circulate this document were being taken. It was the logical development of our original concept that a Health Education section gives or revises basic knowledge, supplies teaching aids, and delivers occasional specialist talks. Otherwise hygiene-the science of healthy living-is part of ordinary education. 4 1965, as a year of reorganisation of Local Government in London, imposed heavy burdens on all Committees, to which were added for Education the need to make far reaching policy decisions on the whole basis of the system. Against this background, the continued interest and support of the Committee in the relatively small School Health Service section are especially appreciated. Also the efforts of the Chief Education Officer and his staff, hard pressed to decide priorities and hampered by failures to recruit, who have nevertheless striven constantly to provide the services authorised for handicapped children. Head Teachers have assisted in pilot studies, and I am grateful for their increasing acceptence of us as helpful colleagues, rather than disrupting intruders, into their Schools. Finally, my thanks are due to the members of my own staff for routine duties, to those who have contributed items about activities which may be of special interest to Members of the Committee, and to my deputy, Dr. Horner, for detailed administration of the Service and compilation of this report. Yours faithfully, S.L. WRIGHT, Principal School Medical Officer. 5 PARTICULARS OF SCHOOL CLINICS as at 31.12.1SS5 The following Clinics are provided by the Education Committee; attendance, with the exception of the Minor Ailments Clinics, is by appointment arranged by the Principal School Medical Officer:- Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon. (Daily a.m. Monday to Friday and alternate Saturday a.m.) Parkway Clinic, New Addington. (Daily a.m. Monday to Friday and every 4th Saturday a. m.) Waddon Clinic, Coldliarbour Road, Waddon. (daily a.m. Monday to Friday) Ashburton School, Shirley Road, Croydon. (Monday and Thursday a.m. during term time. ) Rockmount School, Rockmount Road, Upper Norwood. (Monday and Thursday p.m. during term time. Purley.Clinic, Whytecliffe Road, Purley. (Wednesday 3-4 p.m. and every 4th Saturday a.m.) Dental Lodge Road, Broad Green, Croydon. 206,. Selhurst Road, South Norwood. Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. Shirley Road, Shirley, Croydon. Waddon Clinic, Coldharbour Road, Croydon, Inspection Lodge Road, Broad Green, Croydon. (Fortnightly. Saturday a.m.) Purley Clinic, Whytecliffe Road, Purley. (Monthly. Saturday a.m.) Parkway Clinic, New Addington. (Monthly. Saturday a.m.) Ashburton School, Shirley Road, Croydon. (as required) Rockmount School, Rockmount Road, Upper Norwood, (as required) Waddon Clinic, Coldharbour Road, Croydon. (as required) Physiotherapy 47, St.James's Road, Broad Green, Croydon. (Monday to Friday) Parkway Clinic, New Addington. (Thursday a.m.) Speech 47, St,James's Road, Broad Green, Croydon. Parkway Clinic, New Addington. Purley, 115, Brighton Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. Waddon Clinic, Coldharbour Road, Croydon. Audiology Lodge Road, Broad Green, Croydon. (a.m. Monday to Friday and Monday p.m.) Parkway Clinic, New Addington. (Thursday p.m.) Purley Clinic, Whytecliffe Road, Purley. (Fortnightly. Wednesday a.m.) Sanderstead Clinic, Rectory Park, Sanderstead (as required) 6 Clinic Address Enuresis Lodge Road, Broad Green, Croydon. (Weekly. Tuesday p.m.) Parkway Clinic, New Addington. (Monthly. Monday p.m.) Purley Clinic, Whytecliffe Road, Purley. (Monthly. Friday p.m.) Eye Purley Clinic, Whytecliffe Road, Purley. (every Wednesday a.m. and Friday) STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 11 (full time) (39.5%) *Medical Officers 1 (part time) Consultants and Specialists 9 (part time) *Dental Officers 10 (including 2 part-time) (80%) *Physiotherapists 4 (including 1 part-time) Speech Therapists 7 *School Nurses and Nurse/Assistants 54 (including S.H.V. and Deputy) (55%) *Dental Surgery Assistants 12 (including 3 part-time) (80%) *Also performing duties in other sections of Public Health Department. Percentages in brackets show proportion of time given to school work. COST OF THE SCHOOL HEALTH SERVICE The cost of the medical, dental and nursing services was £79,438. Cost of Special Schools Schools maintained by the Council £90,116 Other Schools (not maintained by local Education Authorities) £32,210 Adjustments with other authorities in respect of Special Schools £8,392 £130,718 7 PART I MEDICAL INSPECTION IN SCHOOLS The medical inspection of schoolchildren at fixed intervals during their school lives has been an integral part of the development of the School Health Service although in recent years attempts have been made to create a system which would involve the examination of a selected number of children only. An experiment conducted during 1964 in one of the constituent authorities suggested that although a selective scheme was practicable in Croydon, it might well be less effective than the present procedure. The following system of routine medical inspection has been adopted in all maintained schools within the Borough and in other schools which have requested it. (i) Entrants Children admitted for the first time to school and not already examined as Entrants, i.e. normally between 5 years and 6 years. (it) 8 Year Old Group Children in their second year in a Junior School, unless previously examined in the Junior School. (iii) Entrants to Secondary School Children in their first year in a Secondary School. (iv) Final Leavers Children in their last year of attendance at school who have not been medically examined in that year. (v) Special Cases Children of any age whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A number of improvements in the system of routine medical inspection have been introduced as a result of last year' s experiment. A reduction in the total number of children examined at each session has allowed more time to be given by the school medical officer to each individual child. (It is interesting to note that a greater proportion of defects has been discovered since this alteration and it is tempting to assume a causal relationship). School medical officers have each an area in the Borough in which they are responsible for the schools and most of the infant welfare clinics, so that continuity of care before and after the commencement of school life can become a practical 8 reality. Arrangements have been made for school medical officers to visit each infant school at least once every term and so permit a closer relationship between the teacher and the medical officer at a particularly important stage in the child's development. In addition a number of medical officers now visit schools at other times and this provides an opportunity for the discussion of particular problems affecting individual children. Table 1. Numbers seen at Medical Inspections, 1965 Routine Inspections 16,712 Special Inspections:- at school medical sessions 525 at inspection clinics 17 542 Reinspections- at school medical sessions 982 at inspection clinics 981 1,963 Although precisely comparable figures for previous years are not available, the proportion of school children who were medically examined in 1965 compares favourably with the recent experience of the constituent authorities. Similarly, the proportion of parents who attended the medical inspection (Table 2) is comparable with earlier years and indicates a continuing interest in the Service. Experimental evidence suggests that many parents are anxious that the regular examination of their children should continue. Table 2. Attendances of Parents at School Medical Inspections London Borough County Borough 1965 1964 163 Boys Girls Boys Girls Boys. Girls Entrants 88.1% 85.2% 89.5% 90. 8% 83.3% 83.5% Leavers 4.3% 8.0% 2.9% 10.1% 4.1% 9.3% Others 58.3% 59.8% 50.9% 58.0% 52.8% 51.3% Total Number of Children Examined 8, 180 8,532 7,174 5,624 5,963 6,843 Total Attendance of Parents 54.5% 52.% 49.0% 9 Table 3 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1965 Defects Boys Girls Number requiring Treatment Number re ferred for Observation Percentage of total Defects Number requiring Treatment Number referred for Observation Percentage of total Defects Uncleanliness- Head/Body 2 1 0.1 2 0.1 Skin Disease 277 143 8.8 203 96 6.6 Eye Disease- Defective Vision 630 484 23,3 835 581 31.2 Squint 62 18 1.7 72 24 2. 1 External Eye Trouble 18 48 1.4 37 35 1.6 Ear Disease- Deafness 103 127 4.8 91 110 4.4 Otitis Media 34 41 1.6 25 40 1.4 Other Diseases 13 18 0.6 17 23 0.9 Nose and Throat 117 328 9.3 113 285 8.8 Enlarged Cervical Glands (not T.B.) 14 43 1.2 7 40 1.0 Dental Defects 356 25 8.0 306 6 6.9 Speech Defects 50 79 2.7 47 49 2.1 Heart and Circulation 55 111 3.5 61 120 4.0 Lungs 42 92 2.8 37 83 2.7 Developmental- (a) Hernia 25 18 0.9 7 3 0.2 (b) Other 73 311 8.0 14 83 2.1 Deformities- Posture 33 71 2.2 92 118 4.6 Plat Feet 87 160 5.1 95 122 4.8 Others 82 152 4.9 96 135 5.1 Nervous System Disorders- Epilepsy 11 5 0.3 7 5 0.3 Other 24 29 1.1 21 31 1.2 Psychological- (a) Development 10 59 1.4 9 32 0.9 (b) stability 44 76 2.5 37 55 2.1 Abdomen 8 26 0.7 15 33 1.1 Other Defects and Diseases 63 84 3.1 89 86 3.8 TOTALS 2,233 2,549 2,335 2,195 Total Children Examined 8,180 Boys 8,532 Girls 10 Table 4 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1965 (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 6.7 5.3 6.4 5.8 7.7 6.0 6.2 4.0 6.8 5.3 Skin 2. 2 2.9 3.9 3.3 7.5 5.5 16.9 5.0 7.1 4.2 Eyes- Vision 13.4 15.2 15. 2 16.1 17.1 20.0 18.4 22.1 15.9 18.5 Squint 1.8 2.2 1.2 1.4 0.7 1.0 0.4 0.6 1.1 1.3 Other 1.1 0.9 0.9 1.2 1.4 1. 2 1.3 0.7 1.2 1.0 Ears- Hearing 6.1 4.9 3.1 3.0 1.5 1.6 0.8 1.1 3.1 2.6 Otitis Media 2. 2 2.2 0.8 0.7 0.5 0. 2 0.3 0.3 1.0 0.8 Other 0.6 0.7 0.8 0.5 0.9 0.7 0.5 1.0 0.7 0.7 Nose and Throat 12.9 10.5 6.3 7.3 4.3 4.1 3.2 1.8 7.0 5.9 Speech 4.3 3.0 0.8 0.8 0.6 0.9 0.3 0.5 1.7 1.3 Cervical Glands 1.4 1.2 0.4 0.6 1.1 0.3 1.2 0.6 1.0 0.7 Heart and Circulation 3.4 3.0 2.1 2.3 1.7 2.1 1.5 1.5 2.2 2.2 Lungs 3.0 2.5 2.3 1.1 1.4 1.6 1.8 1.1 2.1 1.6 Development- Hernia 0.8 0.2 0.7 0. 2 0.5 0.1 0.3 0.1 0.6 0.2 Other 5.5 1.2 4.7 1. 4 8.5 1.7 2.8 1.0 5.6 1.1 Orthopaedic Posture 1.3 1.4 2.5 2.3 1.7 4.6 0.7 3.1 1.5 2.9 Flat Feet 4.8 2.5 4.5 4.1 4.2 4.5 4.6 3.4 4.5 3.6 Other 5.1 3.8 3.5 3.2 4.0 3.3 3.7 3.5 4.1 3.5 Nervous Diseases- Epilepsy 0.2 0.2 0.2 0.1 0.3 0.3 0.3 - 0.2 0.2 Other 1.1 1.1 0.8 0.7 0.8 0.4 0.3 0.6 0.8 0.7 Psychological- Development 1.8 1.0 0.8 0.6 0.5 0.3 0.2 0.1 0.9 0.5 Stability 2.9 2.6 1.7 1.0 1.2 1.0 0.4 0.2 1.6 1.2 Dull and Backward - - 0.1 - - - - - 0.1 - Abdomen 0.9 1.0 0.5 0.8 0.4 0.3 0.1 0.4 0.5 0.6 Other Defects 2.0 1.6 2.3 1.6 4.8 3.1 1.4 3.2 2.7 2.4 11 Medical inspections in non-maintained schools were continued during the year in those schools which have requested such facilities. Two schools have made enquiries about the possible commencement of medical inspections but no formal requests have yet been received. Arrangements have been completed for the introduction of annual medical inspections at the Croydon Spastics Centre which already receives a financial grant from the Education Committee. Following a request by the Head Mistress at Croydon High School for Girls, arrangements have been made for routine sweep tests of hearing to be introduced in the Infant Department. A total of 764 children were medically examined at non-maintained schools in 1965, and detailed findings have been recorded in Appendix C, page 59 As a result of medical inspections in all schools a total of 4,568 defects were receiving or were thought to require medical treatment and a further 4,744 defects were referred for further observation by the school medical officer. A summary of the defects which were found has been recorded in Table 3 from which it will be noted that vision defects, upper respiratory defects and orthopaedic conditions accounted for almost half of the conditions which were reported. The proportion of defects which were discovered in every hundred children examined has been recorded in Table 4. It is interesting to note that every seventh child in Croydon fails to achieve a "normal" standard of vision when the appropriate examination is undertaken in school. Personal Hygiene Infestation with nits continues to be a small but persistent problem in Croydon. Cleanliness inspections have been carried out by the school nurses each term in most schools and as a result of primary inspections vermin were found in 17 children and nits alone in 437 children. Thus 0.9% of the children showed evidence of infestation as against 1.1% in 1964. Parents are advised about the best method of dealing with the condition and a cleansing station is provided for the treatment of scabies and persistent verminous conditions. 16 schoolchildren attended the Cleansing Station for treatment of scabies, and five schoolchildren were treated for head vermin. 12 Table 5. Cleanliness Inspections Number of children inspected for cleanliness (first inspection) 48,206 Number of children inspected at follow up visits 2,764 Number of children found unclean for the first time in 1965 341 Number of occasions in which children were found unclean at follow up visits 108 Infestation is now a minor problem and the school nursing service is to be congratulated for its efforts over a long period of time to teach children and their parents the need for cleanliness. The small reservoir of infestation which remains creates social and legal problems but it is doubtful whether the mass inspection of all schoolchildren for cleanliness is necessary in modern conditions. Despite its emotional overtones, infestation can and does occur in the best regulated households since, like all infectious disease, it has no respect for persons. It is difficult, therefore, to define any group of children who are free from risk and who may be excluded from inspection. Clearly attention must be focused upon those schools in which cases do still occur but in the remainder an annual epidemiological survey is probably sufficient so that some index of infestation in the Borough as a whole may be obtained. Such a survey could be carried out in conjunction with the intermediate medical inspections at eight years and eleven years, and it is hoped that a revised scheme may be introduced during 1966. Defects of the Skin Significant outbreaks of plantar warts (verrucae) appeared in various parts of the Borough during the year. It was necessary to establish a clinic in the Purley area to provide treatment but large numbers of cases were treated in all clinics and especially at New Addington. A teacher at Fairchildes Secondary School carried out an epidemiological survey of the boys suffering from plantar warts in that school and he was able to show a significant association with showers at school and also attendance at the local swimming baths. Unfortunately it was not possible to differentiate between the two factors since most of the boys took part in both. The exclusion of any child thought to be suffering from a plantar wart from all forms of barefoot activity in school and elsewhere, is the minimum requirement for arresting the spread of this troublesome condition. Treatment is usually prolonged and preventive measures are obviously preferred. 13 Plantar warts are not always recognised until pain is experienced and it seems reasonable to suggest that the condition may be infectious before this point is reached. This argues the need to prohibit all forms of barefoot physical activity in schools, a policy which has been constantly advocated by the School Health Service in Croydon for many years. It is claimed, however, that such a policy is impractical on both educational and social grounds. It must be admitted that opportunities for the spread of the condition will still exist at swimming baths and in school showers even if children wear plimsolls in the gymnasium but when plantar warts are prevalent in an area it seems sensible to reduce the opportunities for spread to a minimum. A number of disinfectants have been advocated in the control or eradication of the problem: The popularity of particular products seems to vary with the efficiency of their sales organisations. Some of the claims which have been made certainly seem to be encouraging but it would be unwise to regard disinfectants as an alternative to other methods of prevention. It would be preferable to use them only as an additional safeguard. The recent history of disinfectants, antiseptics and antibiotics hardly justifies the hopes of the lay public that such products are the final or even complete answer to diseases caused by micro-organisms. In any event, children should be taught to wear well fitting shoes and socks in order to protect the skin, and to wash the feet every night at home particularly after physical education, games and swimming. Dr. Simmonds has drawn attention to the prevalence of athlete's foot (Tinea pedis) especially in New Addington and Dr. Roberts has noted its frequency in the Eastern area of the Borough. This condition is characterised by scaling of the skin between the toes and can be so common in senior schoolboys that it might almost be regarded an an acceptable variation from the normal. Laboratory tests have identified a fungus in the majority of cases. There seems little justification for the exclusion of affected children from games although some head teachers insist that this should be done. Attention to foot hygiene is an important safeguard: after washing, the feet should be dried very carefully, especially between the toes. A little dusting powder should be applied although excessive amounts will lead to irritation which is itself a characteristic symptom of the condition. 14 Defects of Vision Defects of vision constitute the largest single group of abnormalities discovered by the School Health Service. In 1965 27.2% of all defects were in this group (Table 3). Dr. Clarke has commented on the high degree of accuracy of visual acuity testing achieved at the school medical inspections, on the basis of the cases referred to him at Purley Eye Clinic (page 27). This is particularly encouraging since it is sometimes difficult, especially in older schools, to find suitably illuminated accommodation in which the tests may be completed at the usually recognised distance of six metres. In addition to the vision tests conducted in association with routine medical inspections, a further examination of vision was introduced in all secondary schools at the age of thirteen years. This is a period of school life during which a large proportion of children may expect to devote an increasing amount of time to study' and close work. Defects of vision are likely to interfere with this process so that it is important to develop a progressively more sophisticated service of detection. Indeed some medical officers have advocated annual vision tests during the major part of school life. Waiting lists at the various Eye Clinics have gradually declined during the year and it has been possible to arrange for all children to see an ophthalmic surgeon or ophthalmic medical practitioner within a reasonable period of time. Every effort is made to persuade parents to accept a further examination by a medical practitioner with special experience in the field, when a defect of vision is found in school. After this initial examination either at the Hospital or School Clinic the parent is given a free choice of opticians if glasses have been prescribed. Colour vision is tested routinely at the age of 11 years in all secondary schoolboys so that preliminary warning can be given before the child has chosen a career in which normal colour vision is an absolute condition. Abnormal colour vision is a familial condition which is not capable of correction. Most affected children develop a remarkable skill in associating colours so that the discovery of the condition sometimes produces obvious surprise or even frank disbelief. 15 Table 6. Summary of Findings at Routine Inspections of Vision Boys Girls Number Examined Number of Defects % Number Examined Number of Defects % Entrants 2,468 332 13.4 2,386 374 15.7 8 year old group 2,107 323 15.3 1,974 314 15.9 Entrants to Secondary School 1,905 331 17.4 2,005 407 20.3 13 year old group 607 136 22.4 779 169 21.7 Pinal leavers 1,700 313 18.4 2,167 480 22.1 Total (all age groups) 8,787 1,435 16.3 9,311 1,744 18.7 Defects of Ears, Nose and Throat The number of children who failed the sweep test of hearing in school showed a slight reduction compared with previous years. It is possible that this reflects slightly different standards of acceptable response by the audiometricians since there have been changes of staff during the year. The current figure of 8% is still considerably in excess of the anticipated incidence of significant hearing defects in the Borough. Children who fail the sweep test are examined in greater detail and if a real hearing loss is confirmed, they are seen by one of the school medical officers who decides whether further investigation is appropriate. The number of children found to be suffering from middle ear disease (otitis media) at school medical inspections has shown a marked increase during 1965. It is disturbing to note that the acute episodes of this condition which were so familiar before the discovery of penicillin and sulphonamides have apparently been replaced by the development of sub-acute cases in which the infection may not be finally eradicated. In 1963 three general practitioners reported a series of 218 attacks of acute otitis media (Lancet 2 p. 1129) and showed that almost one-third had not been cured at the end of one month and that six months later only 23% of those children followed up were completely normal. Recently a further survey in general practice (Brit. med. J. (1966) I P. 75) has shown that following an attack of acute otitis media, a considerable number of children spend an appreciable period of time with a deafness which can affect 16 their progress at school. It is clear that middle ear disease must still be regarded as a serious condition and that the School Health Service must be vigilant for possible long term sequelae. Defects of the heart and circulation The significance of cardiac murmurs in symptomless children is a matter for dispute even amongst leading specialists in the field, so that the discovery of an increased number of defects in this category last year must be viewed with some caution. When a previously unsuspected cardiac condition is found to be amenable to surgery, the Service may be forgiven for selfcongratulation. Unfortunately, the price which must be paid for such satisfying discoveries is a large number of children and parents who must experience some anxiety whilst lengthy investigation and observation confirm that other heart murmurs are not associated with any apparent abnormality. Twenty-one children were thought to be clinically anaemic and the subsequent requests for blood examination revealed, in almost every case, results well below the range of accepted normal values. Anaemia is an unexpected condition in a population of healthy schoolchildren and it would be helpful to know whether low haemoglobin values are common in the absence of clinical anaemia. A detailed survey of a whole secondary school using a simple screening test would be a valuable contribution to our existing knowledge. Defects of the Lungs There was no significant change in the pattern of lung defects during the year. Number of cases of Notified Tuberculosis in children of school age:- Pulmonary 9 Non-Pulmonary Nil The school population was 50,000 (approx.) so that the incidence rate of pulmonary tuberculosis per 100,000 was 18, and there were no deaths from tuberculosis. Developmental Defects The school medical inspection procedure continues to make a useful contribution to the detection of undescended testicles. This condition is readily amenable to surgery and most authorities seem to be agreed that treatment is desirable not later 17 than the onset of puberty. Parents are often reluctant to raise a matter which is obviously one of embarrassment to their sons and the school medical officers are particularly vigilant in ensuring that medical recommendations are diligently pursued. Orthopaedic Defects There was a significant rise in the number of cases of flat feet which were referred for treatment. This is somewhat surprising since the facilities for physiotherapy treatment were restricted during the year owing to staff shortages. Many medical officers regard the treatment of symptomless flat foot with some suspicion. Certainly, attention to the tone of all muscles by the encouragement of more general physical education seems preferable to intensive and prolonged remedial work when the condition is well developed. The discovery of large numbers of younger schoolchildren with flat feet argues the need for preventive action in earlier years. Children suffering from milder forms of spasticity (cerebral palsy) are encouraged to attend ordinary schools and no complete record of their disabilities is kept. 66 children with more severe forms of the condition were known to the service on 31.12.65 and they were receiving education as follows:- 35 were attending St. Giles' School 5 were attending St. Margaret's School, Croydon 6 were attending Residential Schools for Physically Handicapped children 3 were attending St. Christopher's School 4 were attending Spastic Centre full time 10 were attending Spastic Centre part time 1 was attending a Unit for Partially Hearing Pupils 1 was attending a normal private school 1 was receiving Home Tuition Psychological Defects Special surveys have drawn attention to the steady increase in the number of psychological defects which are now being revealed by the School Health Service. Indeed some workers consider that the discovery of such defects is the major task of the Service in modern conditions. The observation that more such defects were identified in Croydon by the school medical officers need not, therefore, occasion much surprise. The number of children referred for treatment was similar to that in the previous year but there was a significant increase in the number of children supervised by the school medical officers themselves. 18 This reflects the increasing interest in psychological problems within the Service and justifies the in-service training which has been given during the year on psychiatric problems in childhood. Relationships between the School Health Service and the Child Guidance Clinic continue to be excellent and have been strengthened by the attachment of a school medical officer for two sessions each week and by the provision of ancillary staff in recognition of the increased area for which the Clinic has agreed to assume responsibility. Height and Weight The figures of average heights and weights are recorded in Table 7. It was not the practice to weigh and measure children in the southern part of the Borough so that figures for 1965 must be compared with those from the County Borough area only in previous years. It is apparent that the steady increase in average heights and weights which was such a feature of earlier years has now ceased. Increasing attention is now being given to variations within these averages. There is some evidence that only children are taller and heavier than their colleagues who are members of large families. Moreover the problem of individual children who are seriously overweight is causing increasing concern. Research studies confirm that overweight children become overweight adults and the risks to health which the latter experience have long been known. It is difficult to persuade parents who may themselves have experienced want in childhood, that it may not be in the interests of their own children for them to be fed indiscriminately. Dr. Thelma Wield has drawn attention this year to the increasing number of overweight children especially amongst the girls in secondary schools. Whilst many of the latter are willing to try to lose weight, a proportion of them are not, and occasionally mothers express indignation at the suggestion that it is necessary. Dr. Phyllis Gibbons has reviewed the subject of obesity in an Appendix to this report (page 64) and she has described the work of an experimental clinic which has been created under her supervision to determine whether the School Health Service can make a useful contribution in this field. 19 Table 7 Average Heights and Weights in 1965 and Previous Years Number Examined 1965 Average Height in inches Average Weight in lbs. 1965 County Borough 1965 County Borough 1964 1963 1962 1939 1964 1963 1962 1939 BOYS 5 years 1421 43.1 42.8 42.6 42.6 41.8 43.1 43.0 42.7 42.9 41. 5 6 years 218 44.5 43.9 43.8 44.0 43.8 45.3 45.2 44.8 44.6 43.4 14 years 215 64.2 63.6 63.9 63.7 59.0 117.8 113.9 117.6 113.8 90.8 15 years 387 64.9 64.9 64.4 64.6 - 119.6 120.3 118.3 119.3 - 16 years 419 66.4 67.2 67.1 67.4 - 130.1 130.5 131.8 131.4 - 17 years 168 68.3 68.0 67.7 67.9 - 137.6 137.7 134.7 136.5 - GIRLS 5 years 1413 42.6 42.4 42.3 42.9 41.2 41.9 42.2 41.5 42.3 39.7 6 years 248 43.2 44.9 43.6 44.0 42.7 42.8 44.8 43.1 44.2 41.4 14 years 351 61.9 62.2 62.3 62.2 60.3 115.8 113.3 113.6 113.6 97.9 15 years 759 62.6 63.5 63.3 63.0 62.0 117.9 115.3 116.3 117.9 105.5 16 years 451 63.3 63.7 63.9 63.4 - 122.4 121.8 122.4 121.2 - 17 years 97 64.2 64.1 64.3 64.2 - 128.4 125.2 126.3 127.3 - 20 PART II SPECIALIST SERVICES AUDIOLOGY SERVICE Mr. J.C. Oakley, Peripatetic Teacher of the Deaf 1965 was an extremely busy year for the Audiology Clinic, 789 children were tested by pure tone audiometer, this included routine follow up cases, cases referred by School Medical Officers, and 338 Sweep Test failures. In addition to the regular clinics held at Lodge Road, Croydon and Parkway, New Addington, new clinics were also established at Whytecliffe Road, Purley and Rectory Park, Sanderstead, to deal with children attending schools in the Coulsdon and Purley area. 60 babies were also tested at the special clinic held in conjunction with Dr. Morgan, for the early ascertainment of deafness in young babies known to be 'at risk'. 7 of these were referred to Mr. Stewart, the Corporation's Otologist. The number of deaf and partially deaf children under the age of 3 years, increased to 21 and it was necessary to arrange for their auditory training to be carried out on a group basis, The group met weekly at the Civil Defence Headquarters, Tavistock Road. In addition to the Teacher of the Deaf, a Speech Therapist and Nursery Assistant, were also in attendance. Extra speech training was also carried out in the Speech and Audiology Clinics. 78 children were seen by Mr, Stewart, who held regular sessions at Lodge Road. 9 hearing aids were recommended, 7 of these were National Health Service 'Medresco' aids and the other 2 commercial aids, paid for by the Corporation. Commercial aids are considered necessary if the hearing loss is very severe, or if there is a sharp perceptive loss in the higher frequencies. The Medresco' 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 causes a considerable amount of distortion and soon becomes painful. During the year, all infant schools were visited at least once, and apart from absentees and unco-operative children (387), all children newly admitted to the school during the year were tested. Of the 4,721 children tested, 378 (approx. 8%), failed the test and were referred to the Audiology Clinic for further assessment. 21 Mrs. E. Goad, was appointed in April, to work as a part-time Audiometrician in the Coulsdon and Purley area. We were sorry to lose Mrs. Roberts at the end of the Summer Term. Her place was taken by Mrs. J. Margetts. For additional statistical details, see Appendix B, Page 54. CHILD GUIDANCE CLINIC The Child Guidance Clinic in Croydon has hitherto been provided entirely by the Regional Hospital Board. The Report of the Underwood Committee, which was published in 1955 recommended that Local Education Authorities should assume responsibility for the provision of Child Guidance Clinics and for ensuring adequate ancillary staff whilst the hospital services should provide suitable specialist medical staff. Dr. Crosse had indicated his willingness to accept consultant psychiatric responsibility for the whole area of the new Borough and on 2nd February 1965 the Education Committee agreed to provide the additional ancillary staff. I am grateful to Dr. G. Crosse for the following report. "The extension of the clinic catchment area associated with the creation of the London Borough of Croydon was reflected in a sharp rise in the number of children referred for psychiatric attention. Since these new commitments were unaccompanied by any increase in medical staff, the waiting list which had previously been negligible soon acquired a depressing length. However, the secondment of Dr. Mills from the School Health Service for two sessions a week and a general drive to accelerate the turnover has reduced considerably the waiting time for new appointments. The practice of seeing urgent cases (such as school refusal) without delay continues. It is hoped that the increase in the establishment of one psychiatric social worker, one psychologist and one typist will help the clinic to balance supply against damand. The important new clinic project which is being developed is a Day Hospital Unit for severely maladjusted children. Plans have been completed for this unit to be housed on the ground floor of the clinic and it is hoped that an early appointment of a charge male nurse/nursing sister will get the project off the ground. The unit will fill a big gap in the service in as much as it will facilitate the treatment of autistic children and other clinical groups whose therapeutic needs are not adequately met either by orthodox outpatient attendance or admission to the inpatient unit at Queen Mary' s Hospital for Children at Carshalton. 22 Neighbouring university centres are beginning to take an interest in training facilities provided by the clinic, and it is pleasing to report that during the year one trainee social worker and two teachers joined the clinic team for experience in the management of emotionally disturbed children. The presence of qualified teachers in the team has not produced any interdisciplinary problems, rather it has demonstrated quite clearly that there is much to be gained by a close integration of psychiatric and teaching disciplines." Source of Referral Boys Girls Total General Practitioners 55 32 87 Parents 1 1 2 Education Dept./Schools 4 5 9 School Health 29 22 51 Children's Dept. 4 3 7 Juvenile Court/Probation Officer 8 7 15 Milton House Remand Home - 119 119 Hospitals 11 11 22 Other Agencies 2 2 4 114 202 316 Analysis of above cases Boys Girls Total Diagnostic 6 129 135 Current cases under treatment 70 46 116 Closed cases - Improved 19 15 34 Closed cases - No Change 1 1 2 Closed cases - Unco-operative 14 7 21 Cases Transferred to other agencies 1 1 2 Domiciliary Visits - - - Cases Moved out of Area 3 3 6 114 202 316 Current treatment cases carried over from 1964 147 THE SCHOOL DENTAL SERVICE Mr. W.G. Everett, Principal School Dental Officer The aim of the Service is to ensure that as far as possible, children shall leave school free from dental disease and irregularity, with an understanding of the importance of good natural teeth, and zealous in looking after them. The scope of the Service includes routine inspection in schools, routine and emergency treatment in clinics, and dental health education in both. 23 Dental Inspections in schools are organised to advise parents when there appears to be a need for treatment. Ideally, all children would be inspected every year, but owing to shortage of staff in the past this has not yet been achieved. Efforts will continue to be made to attain this. A system of recalls for regular inspection within the year is being developed to ensure that, for children accepting treatment in the school service, the same attention is available as that offered by an increasing number of general dental practitioners. Early diagnosis and treatment is essential if dental caries is to be controlled. The aim of all dental treatment is to conserve as far as possible all teeth, except where overcrowding contra-indicates this. In the past, the shortage of dental officers has prevented the best possible treatment being offered to all children, but now it seems that more dental surgeons are available for local authority dental work in Croydon, as in other parts of London and the South-East. Included in the treatment offered are the services of a consultant orthodontist who, in addition to treating children, is available to give advice to dental officers in complex cases. A comprehensive scheme of general anaesthetic sessions with a consultant anaesthetist from the Regional Hospital Board, provides a specialist service. This is also available for general dental practitioners to refer appropriate cases. Treatment is also provided for those handicapped patients eligible under the Mental Health Scheme. At the end of 1965 the staff of dental officers consisted of five full-time and two part-time. There were seven full-time dental surgery assistants and five part-time. There were vacancies for one full-time and two part-time dental officers and one dental surgery assistant. It is hoped to fill these posts early in the new year. There is also a vacancy for a dental hygienist to be appointed. A suitable officer will be able to make a great contribution to the programme of Dental Health Education. There is an ever increasing need for development of this aspect of the School Dental Service, and a planned and sustained programme will benefit the community generally, as correct habits of oral hygiene inculcated in childhood and sustained into adult life cannot but improve the standard of general health. Retirements have included that of Mr. P.G. Oliver, Principal School Dental Officer since 1938. During his service the general dental condition has improved considerably. The pattern of treatment has changed also. In 1938 for every 100 teeth filled 145 were extracted. It was not until 1958 that the number of teeth filled exceeded those extracted. 24 1938 for every 100 teeth filled 145 were extracted 1958 „ „ 100 „ „ 95 „ „ 1964 „ „ 100 „ „ 53 „ „ 1965 „ „ 100 „ „ 47 „ „ In 1938, 16,679 school children were inspected, of whom 12,634 were found to require treatment - 75.7%. In 1965, 36,851 were inspected and 14,362 were found to require treatment - 38%. Dental caries decreased during and just after the war, but the subsequent increase presents a serious public health problem. The following table shows the number of children with naturally perfect teeth amongst (l) five year olds, and (2) twelve year olds. Naturally perfect teeth are those with no fillings, no decay and where no teeth have been extracted. 5 year olds 12 year olds 1948 21.7% 19.2% 1953 14.8% 12.0% 1958 12.8% 5.0% 1963 17.4% 3.8% It can be seen from this that while pre-school children's teeth are now improving, those of school children show a continuing decline. Knowledge of the chemical and bacterial mechanism of dental decay indicates most strongly that the sale of biscuits, sweets and cakes in school tuck-shops can do nothing but aggravate this trend. With the extension of the Borough through the Greater London reorganisation, the clinics of the old County Borough have been supplemented by two inherited from Surrey County Council. One of these is the new building at Rectory Park, Sanderstead, where there is one dental surgery with associated rooms. The other is at 62, Whytecliffe Road, Purley, which has two surgeries. The existing premises consist of the main dental centre at Lodge Road which has, at present, five surgeries. This building is in need of modernising and reorganising, and it is hoped to proceed with this soon. The dental centre at Shirley Road which was opened in 1955, provides two main surgeries and an auxiliary surgery. The dental clinic at 206, Selhurst Road is in a converted private house. It is hoped to replace this by more modern buildings which will serve the Upper Norwood and Thornton Heath areas and reduce the travelling at present necessary for children attending schools in those areas. The clinic at Parkway, New Addington was opened in March of this year, and provides two surgeries in a modern building. It is anticipated that the demand for treatment at this centre will increase as the development of the adjacent housing estate continues. The clinic at Coldharbour Road, Waddon, opened in 1963, provides a fully 25 furnished dental surgery. All clinics have air-turbine dental drills, in addition to the conventional items. With the exception of the Selhurst Road clinic all have dental X-Ray machines, and all have dental anaesthetic equipment with facilities for patients' recovery after anaesthetic sessions. Appended are the figures giving details of the number and nature of items of treatment performed by dental officers during the year. Not only has there been an increase in staff and school population, but also new and different returns are now required by the Department of Education and Science. This is to facilitate comparison of the School Dental Service productivity with that of the General Dental Services of the National Health Service. The immediate result of this is that the figures collected for 1965 are no longer comparable with those of previous years, and no conclusions may be drawn. In previous years not all children with decayed teeth were offered treatment for the reason mentioned above. However, it is hoped to be able to implement the policy that all requiring treatment should be referred. The benefit of regular visits to a dentist cannot be stressed too much, and even if no immediate treatment is desirable, the oral condition may be discussed with child and parent and advice given about dental care. 1965 1964 School population 45,584 35,885 Number inspected 36,851 31,460 % inspected 82.6% 89.4% Number requiring treatment 14,362 10,548 % requiring treatment 38% 33.5% Number offered treatment 12,016 10,548 Number of consents 4,098 3,745 % of consents 34.1% 35.5% * Number refusing treatment 6,009 5,164 % refusing treatment 50% 48.9% Forms not returned 1,909 1,639 % of forms not returned 15.9% 15.6% *This figure includes those attending for treatment outside the school service. A new consent form has been introduced and it is hoped to collect information as to the actual numbers of such patients. The percentage of school children inspected this year is lower because of changes in staff and unavoidable intervals between resignations and appointments. The percentage of children requiring treatment appears to be higher because of the change of policy previously mentioned. 26 The Orthodontic Service The pattern of this work reflects that found in other branches of the School Dental Service. Whereas in previous years there was a waiting list for treatment, a balance has now been achieved and more time can be devoted to individual cases so that the best possible result may be attained. ENURESIS CLINIC I am grateful to Dr. Margaret White for the following report:- During 1965 a total of 246 children attended the Enuresis Clinics in the Borough. This is an increase of 69 over 1964. A certain proportion of the increase is due to the opening of a Clinic in Purley in April. 166 children were boys as compared with 90 girls. 127 cases were still attending at the end of the year and 91 were discharged dry. There is always a percentage of parents whose attendance is very erratic, and during 1965 22 patients were discharged for non-attendance after they had failed to keep three consecutive appointments. A larger number than usual - 15 - were transferred to other Clinics, half were referred to Renal Specialists to exclude organic disease. Two of these children had kidney disease for which they were treated. The other cases referred were considered to need psychological treatment. 101 of the children had been previously treated, mainly with amphetamine type drugs before they started to attend the Clinic. In over half of the children there was a family history of enuresis. 84 children used the buzzers. These are now issued with a larger foil pad, and the patients find there is less likelihood of the bell ringing without cause, with these larger pads. No. of children attending - Lodge Road - 167 - New Addington - 49 - Purley - 32 No. of children discharged dry - 91 No. of children discharged for non-attendance - 22 No. of children still attending - 127 No. of children used buzzer - 84 Age(in years) - 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 No. of children - 1 1 8 34 56 39 33 24 21 3 9 6 4 3 3 1 27 SCHOOL EYE CLINIC, PURLEY In February 1965 the Education Committee resolved to provide a School Eye Clinic in Purley for an experimental period of one year. A similar clinic had been provided previously by the Surrey County Council although no sessions were held for some months prior to March 31st owing to the sudden death of Dr. L.J. Green. In the light of experience obtained since the 2nd April when the Clinic re-opened, the Education Committee have now agreed to establish it as a permanent part of the treatment facilities of the School, Health Service. I am grateful to Dr. Derek Clarke for the following report. "Although the waiting list for examination and re-examination had become inflated, a substantial amelioration has now been achieved and the waiting time between referral and examination is now reasonable. Schoolchildren are referred to the Clinic by school medical officers, local authority staff and family doctors. Children to be treated by spectacles (including occlusion) and those who require advice or review are kept on the books of the Clinic. Children who need other forms of treatment are referred to their own Doctor or to the Croydon Eye Unit or elsewhere as indicated. Some cases needing the help of the Orthoptist only are shared between the Purley Eye Clinic and the Orthoptist at the Croydon Eye Unit. Dr. Dunnet, one of the school medical officers, has been seeing and treating unselected cases and keeps a close liaison with me over their treatment and disposal. The equipment at the Purley Eye Clinic has been brought up to the standard which I have recommended (notably by the addition of symbol-test-cubes for visual acuity) and is now entirely satisfactory as is the accommodation. The symbol-test-cubes have enabled vision testing to be done on children of three years and they are particularly useful for the "late reader" schoolchild of 5 or 6 years or for the very nervous. The referrals from routine medical inspections at school have been notable for the high accuracy of visual acuity testing. Many cases have been detected of refractive errors causing sub-standard visual acuity, several of amblyopia due to squint, several of squint without amblyopia and one of severe ocular disease (congenitally dislocated lenses) as well as a variety of minor afflictions such as inflamation of the eyelids (blepharitis). The work of the clinic is to be regarded as doubly worthwhile since it not only provides diagnosis and treatment of the children as patients but also ensures a satisfactory standard of visual acuity for school purposes and may thereby avoid educational retardation. The staff of the Purley Eye Clinic have been exemplary in efficiency and courtesy." 28 HEALTH EDUCATION IN SCHOOLS Miss D. S. Elliott, S. R. N., H.V. Cert., Dip. H. E. Health Education Officer In spite of certain difficulties in maintaining existing interest and projects during a year of great changes, a small working party from the health and education departments completed the draft of a book "Suggestions for Health Education in Croydon Schools". It was an attempt to stress the importance of regular and systematic health education in schools, to avoid children being presented with a serie's of isolated fragments of health information which they cannot relate to each other and which they cannot therefore fully understand. As stated in the preface, the contents of the book are grouped in relation to the mental, physical and social development of children and attitudes to bear in mind. The book will have fulfilled its mission if it helps teachers to provide a wide range of learning experiences, leading to the development of desirable health habits, attitudes and knowledge and so to assist children to achieve "health behaviour" as a matter of personal choice. A short bibliography has been included at the end of the book. It is emphasised that school doctors, health visitors and local education authority inspectors of schools are available to give current information and help. Further help with information and advice on teaching aids may be obtained from the health education section of the health department. Two meetings were arranged with head teachers, doctors and health visitors to introduce the book to them. The first dealt with primary schools and the second which was also supported by the Chief Education Officer and the Principal School Medical Officer discussed its application in Secondary Schools. After discussion the head teachers accepted the thesis in principal. It will be some time before individual schools will be able to work out in detail how much can be included in their curricula. Some difficulty will be experienced due to the small number of staff with sufficient knowledge in this field, but it is hoped that the stimulus of the book will help in the general orientation of attitude towards modern health education. In-Service Training. Two study days were held for members of the school health team on "Child Health and the School". The principal speakers were Dr. R. de Mowbray, Endocrinologist and Dr. J.K. Lloyd, Lecturer in Paediatrics and Child Health at the Institute of 29 Child Health, Great Ormond Street, who spoke about "Growth and Development of the School Child" and "Nutrition and the School Child" respectively. Their lectures were followed by short talks from representatives of various parts of the school health service, i.e. speech therapist, peripatetic teacher of the deaf, principal dental officer, deputy principal school medical officer, youth employment officer and health education officer, who took the opportunity to explain and give each member of the staff a copy of "Suggestions for Health Education in Croydon Schools". Venereal Disease The previous policy of giving personal instruction and inservice training to teachers in school continued. Special talks were given on request to groups in secondary and grammar schools. Information continues to be given to parents of primary school children during the special sessions held for them on "Talking to Children about Growing Up". Smoking and Lung Cancer. An intensive programme was carried out throughout the Borough in 1964. The subject has been followed up since in the community health programmes and, by special request, in some secondary and grammar schools. Miscellaneous A growing interest in "Social Studies" in secondary schools has caused many teachers to seek help from the Health Education Section. Much of the work undertaken under this title is health education and there is a growing awareness of its value in general education. Successful experimental discussion groups have been led by health education staff with fourteen year old girls and boys together at South Croydon Secondary School. A first aid course was given at Lady Edridge Grammar School and the girls took the British Red Cross Society examination afterwards. The Health Education Section has purchased a "Resusci-Anne" model and the Admiralty Series of films on "Emergency Resuscitation". An extensive programme on "Mouth-to-Mouth" life saving is planned to cover as many schools as possible in 1966. Lectures were given to the Croydon Youth Leadership Training Council Stage II Training Course and to students at Coloma Teacher Training College. A course at ffoodcote County Secondary School and various examinations in Home safety for the Duke of Edinburgh's award were also undertaken during the year. 30 The time and attention given by so many teachers to health education when they were so hard pressed was very much appreciated. INTELLIGENCE ASSESSMENTS Children who are not making progress in an ordinary school are referred to the School Health Service to determine whether special education may be necessary. A test of intelligence is carried out not only when there is any suggestion of educational subnormality but also during the investigation of a large number of other medical problems. During the year the head master requested information about the intelligence of children admitted to St. Giles' School. 126 children were examined during 1965. The classifications arrived at, together with recommendations made, were as follows:- (1) Pound to be educationally subnormal:- (a) Recommended for Day School for E.S.N, pupils 69 (b) Recommended for Residential School for E.S.N. pupils 2 (2) Pound to be unsuitable for education in School 22 (3) Other Recommendations:- (a) Referred back to an Ordinary School 12 (b) Referred for further investigation by School Psychological Service 9 (c) Recommended for Day Special Schools for other handicaps 7 (d) Referred for Speech Therapy 2 (e) Referred for Medical Treatment 3 (f) Referred for further assessment 10 136 Awaiting assessment on 31.12.65. 10 In addition, 49 intelligence tests were given to children attending St. Christopher's Special School. A further 6 intelligence tests were given to children who were about to attend St. Giles' Special School 31 SPEECH CLINIC Mrs. S.M. Wickerson, L. C. S. T., Senior speech Therapist 1965 marked a significant change and increase in Croydon's Speech Therapy Service. Two members of the staff - Mrs. Coates and Mrs. Kent, left, and for a time the service was under great stress and pressure of work. However, five new Speech Therapists commenced their duties in September and October. Fortunately the Service is now fully staffed. A great deal of time has been devoted to increasing and improving the Service in the new areas of the Borough. Speech Therapy Services were increased from two only in the southern area to six in Purley and four in Sanderstead - the latter commencing in November when the new clinic became available. As in the past schools have been visited, to select and assess children for treatment, and the senior Speech Therapist visited every school in the southern parts of the new Borough. The response was good, and as a result the number of sessions in the Purley and Sanderstead clinics may have to be increased. Towards the end of the year plans were formed and passed to create a Day Unit for severely speech disordered children to open in January 1966. This I feel sure will be of immense value to the Borough. Help has been given by the Speech Therapy staff to severely deaf pre-school children owing to a shortage of teachers of the deaf. As mentioned in previous reports, the speech clinic has had several official visitors during the year, and it has also provided clinical experience for speech therapy students. Talks have also been given to voluntary organisations - Young wives Clubs, etc. As in the past both of Croydon's special schools have been visited regularly and treatments given by the Speech Therapists. OTHER SERVICES Transport of Children to Ordinary Schools In the event of an accident or illness resulting in temporary disability, the school medical officer is asked to decide whether special transport should be provided to enable the child 32 to attend school. Before making any recommendation careful enquiries must be made to ensure not only that the transport is justified but that the child will be able to work satisfactorily when he eventually reaches the school. A child in a leg plaster may have great difficulty in negotiating several flights of stairs in order to attend various classes during the course of the day. School medical officers recommended that special transport should be provided for 15 such children during the year. Convalescent Treatment Twelve children received a convalescent holiday on the recommendation of the school medical officer. These arrangements are not intended to provide annual holidays for children whose parents are unable to provide them: they are an essential part of the recuperative treatment provided for a child who has been found to be in poor general health or a child suffering from a particular disability. particular disability. Details of the diagnoses and periods of stay are shown in the accompanying table. Diagnosis No. of Children Period of Stay Debility and Underweight 1 8 weeks Eczema 1 4 weeks Debility and Underweight 1 3 weeks Diabetes 1 2 weeks Fibrocystic Disease with chest symptoms 1 2 weeks Recurrent upper respiratory infection 1 2 weeks Chronic conjunctivitis 1 2 weeks General Debility 4 2 weeks Other 1 2 weeks TOTAL CHILDREN 12 Juvenile Employment Return The following numbers of children were examined by the medical officers during 1965 as to their fitness to undertake the part-time employment indicated. 33 1965 1964 1963 1962 Delivery of Goods for Shopkeepers 57 39 33 28 Delivery of Newspapers 202 222 244 320 Delivery of Milk 5 4 6 6 Shop Assistants 83 81 42 64 Examined by Surrey C. C. 1.1.65 to 31.3.65 47 Provision of Meals and Milk During 1965 all milk was supplied free of charge and approximately 34,100 children per day received one-third of a pint each in Maintained Schools. This was equal to 62% of children attending in Secondary Schools, and 93% in Junior Schools, and Infants 98%. Since 1st September, 1957, milk has also been supplied by the Education Commmttee to children in the Non-Maintained Schools in accordance with instructions from the Ministry of Education. Approximately 7,000 bottles per day are supplied to the Non-Maintained 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 1965 was approximately 28,000. Cost of Milk and Meals Meals and Milk cost £561,909. Income from payment for meals was £193,367, making a net cost of £368,542, on which grant is paid of 100 per cent. on approved expenditure. Causes of Death in School children Prom the weekly returns of the local Registrar and from the inward transfers, it is possible to abstract the causes of death of all schoolchildren. There were 13 in 1965 equal to a death rate for this group of 0.257 per thousand. The details were:- Accidental 4 Cancer 3 Cirrhosis of the liver 1 Epilepsy 1 Primary pulmonary hypertension 1 Progressive muscular atrophy (Werdnig Hoffmann syndrome) 1 34 Pulmonary haemosiderosis 1 Virus encephalitis 1 Total 13 35 PART III HANDICAPPED PUPILS The introduction of a card index system has considerably improved the recording system within the Service. It is now possible to obtain information about the nature and extent of various handcaps for which special educational provision is made and such information will be invaluable for future planning. wherever possible handicapped pupils should be educated in ordinary school although it is recognised that many practical difficulties Militate against such an ideal. Unusually large classes, unsatisfactory environmental conditions in the local school, and not least, failure to make educational progress are all factor which must be considered by the school medical officer when he gives advice concerning special education. wherever possible handicapped children are educated on a day special and the Authority has steadily increased the range of its special educational provision so that it may educate such children within its borders. Where suitable local provision is not available, residential education is considered by a special sub-committee. Table 8 Children requiring Special Education 1965 category 1965 Number of Children Receiving Special Educational Treatment 20.1.66 No. of Children awaiting placement on 20.1.66 New Cases Assessed * New Admissions Special Schools Independen t Schools Hospitals Home Tuition Total Day Residential Day Residential blind 2 1 - 5 5 - - partially sighted 0 4 13 2 15 - - deaf 2 2 8 7 1 16 - 1 partially hearing 7 6 16 5 21 4 1 educational ally sub- normal 71 51 206 16 4 226 36 2 epileptic 2 2 17 4 21 - m malad justed 14 7 5 6 20 31 - 8 physically handi capped 25 26 92 14 2 4 112 6 1 speech 11 1 13 3 16 - 3 delicate 15 10 49 5 3 total 18 1 76 2 2 149 110 419 67 30 18 5 538 48 18 Including cases ascertained in previous years. 36 Blind and Partially Sighted Pupils Blind Partially Sighted In Residential Schools 5 2 In Day Schools 0 13 Blind During the year two blind pupils were found to require special educational treatment. One child, previously categorised as partially sighted, was admitted to Heathersett Training Centre for the Blind so that she could receive further education and vocational training by methods not involving the use of sight. Partially Sighted During the year no medical recommendations under this category were made by the Service in respect of children living in Croydon. One child attending a Croydon school was found to be partially sighted and recommended for admission to St. Luke's Special School. At the end of the year a proposal to amalgamate St. Luke's School as a separate unit within St. Giles' School was reconsidered by the Committee in view of the doubts expressed concerning the available accommodation at Addington. It was decided to transfer only children of secondary age and so leave the younger children in the present buildings. I am grateful to Miss J. Rundle for the following report of the work of the school during 1965. St. Luke's School for the Partially Sighted During 1965 several children were admitted to the school, these were mainly in the infant and junior age groups. The Educational Psychologist carried out intelligence tests which revealed that the children's intelligence quotients range from 52 to 170. The children of average and above-average intelligence are able to make steady progress in spite of their visual handicap but the less able children, hampered further by defective vision, are faced with many learning problems. A senior pupil continued with Braille lessons given by a visiting home teacher for the blind. In September this pupil was transferred to the Heathersett Centre for the Blind at Reigate. Her first report was very satisfactory. 37 Many educational visits were made during the year, these included visits to the Royal Mews, the Natural History and Science Museums, the London Zoo, Windsor Castle and other places of interest. In addition to the educational value of these excursions the children gain in mobility, have experience in coping with busy roads and in using public transport. Many parents and friends visited the school on Open Day and at Christmas for the Nativity Play. The good attendance of parents on these occasions and at other meetings with them have proved their keen interest in the school and in their children's progress. The ophthalmologist, Mr. Davies, visited the school to examine the children's eyes. The Deputy Principal School Medical Officer carried out the annual medical examination. His interest in the children is greatly appreciated. The Education Committee had, for some time, been considering the re-organisation of the school. At the end of the year it was finally decided to transfer the senior pupils to St. Giles' School so that they would be able to benefit from the increased facilities available at a larger school. Children on Roll 31.12.65 - 22 Admissions during the year - 9 Transferred to Centre for the Blind - l Deaf and Partially Hearing Pupils Deaf Partially Hearing In residential schools 8 5 In day schools and units 8 16 Awaiting placement 1 4 The year was marked by a growing anxiety concerning suitable educational provision for a number of children who had reached, or were about to reach, the age of 3 years at the end of 1965. It was known that the Unit at Kingsley Infants' School was unlikely to be able to accommodate all the children known to the Audiology Service whilst the inability to open the newly equipped Unit at Kingsley Junior School owing to staff shortages offered little hope of early improvement in the general situation. During the last two years the Audiology Service has identified some twenty deaf or partially hearing children under the age of three years and in a number of cases there is a correlation between the child's condition and german measles (rubella) in the mother in 1962. There is little virtue in detecting such children unless treatment can be instituted as soon as possible. 38 Early stimulation of speech is vitally important to these children and every month of delay is likely to hamper the child's long term development. The reserves of the pre-school services have been severely taxed by the unexpected influx of young hearing impaired children, and Dr. Lilian Morgan and Mr. Oakley are to be congratulated for their efforts in this field. An auditory training class has been established where these young children may attend to receive special help with speech, and where mothers may receive advice on the problems which are experienced. The speech therapists have also given invaluable help. The Committee were pleased to accept the gift of a speech trainer from the Surrey Regional Association of the National Deaf Children's Society, and this machine is proving to be extremely useful. Nevertheless the pre-school services cannot be expected to supervise children who now need day special school provision in addition to their work with pre-school children. Suitable educational provision was being considered as a matter of great urgency. 38 deaf or partially hearing pupils are at present placed in the following special schools or units and 18 of these pupils are of secondary age. Day Pupils Residential Pupils Kingsley Partially Hearing St. John's School, Boston Spa 1 Unit 9 Hamilton Lodge 1 Partially Hearing Units, Mary Hare Grammar School l Greater London - Ovingdean Hall, Brighton 2 Holman Hunt 3 Burwood Park School, Surrey Sedgehill 1 (deaf) j Stockwell Manor 1 Nutfield Priory School, Oak Lodge School (for the Surrey (deaf) 3 deaf) 3 Portley House School, Surrey Old Kent Road School (deaf) 4 (deaf) 1 Portley House School, Royal School for the Deaf, Surrey 3 Margate 3 Rudolf Steiner school 1 Since it is often difficult to determine the educational category of young children with impaired hearing, some nursery departments may contain pupils of both categories; transfers to other schools are arranged at a later stage when necessary. This is particularly true of the Kingsley Unit and I am grateful to Mrs. R. Parsons for the following report. 39 Partially Hearing Unit, Kingsley Infants' School Premises The accommodation for partially hearing children at the Kingsley Infant School consists of three rooms, one of which is acoustically tiled to ensure sound-proofing. This room is used for general teaching. It is equipped with one group aid adjusted to the loop system, ten desks fitted with individual headphones, microphones, and sound level meters by which the child can adjust the sound received to its own requirements. Children are also issued with their own individual aids, adapted to the loop system. Under-fives have one play-room and one rest-room. Wash basins and toilet facilities are easily accessible to all rooms. The Unit was opened in January 1964, and during this period fourteen children have been admitted for special educational treatment. Ten are still on roll. Of the four who left, one girl was transferred to a junior unit for partially hearing pupils, one boy to a junior school for hearing children, one boy to a school for the physically handicapped, and the family of one girl removed to another district. The children now on roll can be classified as under. 4 children are attaining a reasonable level of intelligible speech. 1 is responding to speech training and should acquire some useful speech. 1 repeats only what is offered in a very limited context. 4 do not respond to speech teaching at present. Of the four children at present making little, if any response, to speech, or speech sounds, three are immigrant children under the age of 5, and may therefore be suffering from the additional handicap of language difficulties. The remaining child aged 4%, now in school 16 months, is profoundly deaf. Integration into the ordinary school. All children integrate for meals, play and social activities. Pour children integrate for limited periods of normal school work, according to their age and ability. Most children admitted to the Unit appear to benefit either socially or academically, or both, according to the child's innate ability, and the degree of co-operation given by the home. 40 Dr. Lilian Morgan, the school medical officer who is specially responsible for children with hearing difficulties, comments - "I have noted on my visits (twice a year) the remarkable progress which these children are making. Their Teacher Mrs. Parsons, is to be congratulated on the tremendous effort she has put into her activities at the Unit. Credit should also go to the Head Mistress, her teaching staff and the ancillary help at Kingsley Infants School for their help in integrating the children of the "Special Unit" into the school. Unfortunately the Junior P.H.U. which has been equipped for some time remains unopened owing to lack of a suitable teacher." Educationally Sub-normal Pupils In Day Special Schools 206 In Residential Special Schools 20 Awaiting Placement 38 During the year 71 medical recommendations were made in this category and three of these were passed to the London Borough of Sutton since that Authority was administratively responsible for the children concerned. The need for additional educational provision for the educationally sub-normal was recognised by the Committee's decision to erect a new purpose-built special school for such children. Unfortunately this additional accommodation is not likely to be available for at least two years and in the meantime the anticipated increase in children ascertained in this category has continued. It had been recognised that additional provision would be necessary and indeed the last report of the County Borough drew attention to an increasing waiting list. The larger population of the London Borough, together with the trend towards ascertainment at an earlier age than formerly have combined to make the immediate problem more acute. A number of meetings were arranged between officers of the Education and Health Departments and discussions were continued during the year. On two occasions representatives from the Department of Education and Science were invited to attend in an effort to secure urgent action, bearing in mind the large number of children who are now awaiting placement together with the difficulties which educationally sub-normal children inevitably face in ordinary schools. I am grateful to Mr. R. G. Grice for a report of which the following items relate to the School Health Service. 41 St. Christopher's School for Educationally Sub-normal Children Statistics Boys Girls Total Number on Roll 3lst December, 1964 126 79 205 Admitted during 1965 24 18 42 Left to work at 16 12 5 17 Transferred to other areas 7 3 10 Transferred to Residential Schools 3 1 4 Transferred to Approved School - 1 1 Excluded as unsuitable for Ed ucation at School 1 4 1 5 Number on Roll 3lst December, 1965 124 86 210 Waiting List There are 39 children on the waiting list, which grows week by week. Although another school is being planned, I feel that consideration must be urgently given for the provision of extra places at St. Christopher's - even in temporary accommodation until the new school is a reality. Damage to Building through fire The Autumn proved to be a frustrating one, due to makeshift arrangements for accommodating the senior classes. A fire destroyed the Art and Needlework rooms on August 12th during the Summer holidays. Local C.I.D. officers suspected arson. I must place on record the excellent work of the Schools Supplies and Services Department and also Mr. J. Wilson, the School Caretaker and his staff. All supplies and stores that were destroyed were replaced immediately and the rebuilding and redecorating completed by December 20th. Parents' Association The Parents' Association continues to flourish and to play a vital part in the life of the School. (a) January 23rd. Its members gave the pupils a New Year's Party, consisting of tea, Punch and Judy Show, a conjurer, and presents from Father Christmas. We are also grateful to its members for providing the following amenities:- (b) a trolley for percussion band instruments (c) a swing for the Reception Class; (d) a fishpond; (e) timber from which the Senior Boys constructed a Wendy House for the Infants' Department. 42 Swimming The Swimming Gala was held at the Central Baths on February 2lst. The following Swimming Certificates were gained during 1965:- Distance Boys Girls Total 25 yards 17 11 28 50 yards 9 10 19 100 yards 8 5 13 440 yards - 2 2 Half mile 1 2 3 One mile 2 1 3 School Functions (a) The Annual School Sports were held at the Barclays Bank Sports Ground on July 15th. (b) The Annual Parents' Day and Exhibition of Work was held on July 17th. (c) The Harvest Festival was held on September 30th. The guest preacher was Captain Joy Webb, leader of the Salvation Army Beat Group "The Joy Strings" who not only gave an excellent address, but played her guitar and sang solos. Consequently, we had a crowded congregation and a record number of parents. (d) The Annual Carol Service was held on December 15th. (e) The whole school attended the Final Dress Rehearsal of the Bertram Mills Circus at Olympia on December 16th. Old Scholars' Club This continues to be well supported and is invaluable as a means of keeping in contact with the pupils after leaving school. Many receive reassurance, advice and encouragement during the difficult period of adjustment to working conditions. Two pleasing features are : - (1) The fact that many are proud to bring along and introduce their boy or girl friends; in fact, five engagements were celebrated during the year. (2) A growing number ask for assistance in getting themselves enrolled in various classes in local Evening Institutes. I am grateful to the members of my staff who so willingly give up their spare time to undertake this valuable social work. 43 Equipment A television set was installed during the Summer Vacation in order to enable the Senior Glasses to use the school television programmes. A pleasing feature of 1965 has been the spontaneous desire among the pupils of the Senior Classes to undertake social work. This is probably the direct result of contacts made among the local Old Age Pensioners during the delivery of food parcels following the Harvest Festival. The Senior Boys collected scrap wood from which they delivered free bundles of firewood, while the Senior Girls provided a Christmas Party (all paid for by themselves) for local old ladies. Epileptic Pupils In Day Special Schools 17 In Residential Special Schools 4 During the year four epileptic children were recommended for placement in special schools. Wherever possible epileptic childi ren are educated in ordinary schools subject only to minor restrictions relating to certain forms of physical education. Nevertheless an epileptic attack can be very disturbing to some children and it is sometimes necessary to recommend the transfer of the affected child because of the effect of the condition on the remaining members of the class. It has been usual for some years to recommend that epileptic pupils should be accommodated at St. Giles' Special School. Mr. Pettman notes in his report (page 45) that epilepsy is now the third largest disease process in the school and it may eventually be necessary to consider whether some limit should be placed upon the number of epileptic children attending St. Giles'. Maladjusted Pupils In Day Dnit 5 In Residential Special Schools 26 Awaiting Placement 8 It is difficult to give any precise definition of a maladjusted child so that diagnosis will often depend upon the judgement of individual specialists and sometimes even upon the facilities available. It is noticeable that recommendations are more usually made because of the effect of the child's behaviour upon the school and relatively little consideration is given to 44 the use of special educational facilities as a therapeutic tool in the treatment of environmental maladjustment. The Committee's decision to erect a purpose-built school for the accommodation of 70 children represents an important advance in the treatment of emotional problems within the Borough. Although it may be four or five years before the new building can be opened, the prospect presents an exciting challenge to all those concerned with this development. During 1965 a total of 14 medical recommendations were made on behalf of children who were thought to be maladjusted. The problem presented by the autistic child continues to cause concern. Autism is a small but significant problem about which little is known, but about which much has been written. Present theories suggest that many autistic children could be educated in a suitable school environment and our inability to give the sorely tried parents of these children the help which they so obviously need was regretted. Physically Handicapped Pupils In Day Special Schools 92 In Residential Special Schools 16 Awaiting Placement 7 During the year 22 physically handicapped children were recommended for admission to a suitable special school. A large majority of the children are accepted into St. Giles' School and it was possible to offer such facilities to a number of children living in the southern part of the Borough who had previously been receiving various forms of home tuition. Several parents subsequently complimented the medical officers, and the officers of the Education Department for the speed and efficiency with which the appropriate arrangements were made so soon after a major reorganisation in local government structure. I am grateful to Mr. D.B. Pettman for the following report. St. Giles' School for Physically Handicapped Pupils A number of major changes and developments occurred in 1965. Mr. D. B. Pettman took over as Head Master from Mr. F.H. Green at the beginning of the Summer Term. The new block of three classrooms was completed in November and internal reorganisation resulted in improved facilities for specialist teaching in the Secondary Dept. of the school. 45 A full programme of educational visits and school journeys including a most successful Belgium holiday was completed; swimming proved to be one of the more rewarding activities, there being 183 swimmers out of a roll of 197 at the end of the Summer Term and pupils gaining l gold, 2 silver and 5 bronze awards in the Personal Survival Test of the A.S.A. During the year 389 children were inspected at the 36 routine medical inspections, 139 parents being present. At 5 Termly Specialist Medical Examinations, 31 children were seen by Dr. Pearnley and Mr. McQueen, 9 parents being present. The preparation and follow-up of all these medical examinations was carried out by the Nursing Sister and her staff, in addition to maintaining full records of the children's progress and treating a variety of ailments including dealing with 112 major epileptic fits. In the Physiotherapy Dept. 9,141 treatments were given despite the limited space available. The number of orthopaedic cases treated was 50 and the number of postural cases 42. Regular Speech Therapy was given throughout the year, 455 treatments being given in addition to the assessment of new admissions. The average number on roll was 190 and attendance 84%. There were 40 admissions, 44 leavers and 2 deaths. A feature of the year was the marked increase in Epileptics who now make the third largest group in the School. Record of Disabilities, December 1965 Physically Handicapped. Boys Gi rls Total Spina Bifida 4 6 10 Cerebral Palsy 19 16 35 Epilepsy 8 10 18 Poliomyelitis 3 7 10 Muscular Dystrophy 4 1 5 Congenital Heart 3 5 8 Speech Defect 1 3 4 Bronchiectasis - 2 2 Partially Sighted 4 1 5 Others 21 16 37 67 67 134 46 Delicate Boys Girls Total Asthma 23 7 30 Bronchitis 6 5 11 Debility 5 3 8 Others 1 3 4 35 18 53 Finally, I wish to thank Dr. Hegarty for her continued good work for the school and to thank the Principal School Medical Officer and Staff for their support. Pupils Suffering From Speech Defect In Day Special Schools 13 In Residential Special Schools 3 The London Borough resolved to make provision for the education of pupils suffering from a speech defect before taking up its executive functions and this early decision enabled the necessary adaptations to be completed at West Thornton Primary School by the end of the year. In consequence 8 children were recommended for day special education owing to a speech disorder, and four of these children were already on the waiting list for a place in a residential school. It is hoped that this latter provision will now become unnecessary since the children concerned are all less than 6 years of age. The new unit will provide highly specialised facilities within an ordinary school and every effort will be made to integrate the children into the general life of the school and to rehabilitate them into the educational work of the school as soon as possible. Prolonged investigations are likely to be necessary before any child can be considered for admission to the Unit and the final decision will be taken by Dr. C. WorsterDrought, the consultant adviser on speech disorders. It will be necessary to confirm that the child's total speech vocabulary is seriously impaired and that the cause of this aphasia cannot be related to hearing or emotional difficulties or to low intelligence. This is a small problem and it is surprising that so many of these children have been identified in Croydon. Since there is no conceivable local aetological factor which might account for this, one can only conclude that it reflects the efficiency of the excellent diagnostic service which has been developed during the last five years. It is extremely gratifying that, having been shown that such children exist in this area, the Committee has felt able to provide this pioneer unit for their special educational treatment. The Unit opened on January 10th, 1966. 47 Delicate Pupils In Day Special Schools 49 In Residential Special Schools 8 Awaiting Placement 4 During the year 15 children were found to be delicate and recommended for admission to a special school. It is difficult to define a delicate child so that much depends on the judgement of the school medical officer and upon other factors such as the child's attendance and educational progress at an ordinary school. Recently there has been a tendency, particularly outside the Service, to suggest that other children should be included. Occasionally the school medical officer is told that the child is not sufficiently emotionally and socially mature to stand up to the stresses of a secondary school and sometimes children are ' referred because school attendance is bad although there may be no medical reason to account for this. Finally the point at which a specific disease process ceases to make a child delicate and now justifies the term physically handicapped is essentially an arbitrary one. The present regulations specifically refer to an impairment of physical condition and it seems undesirable to include in this category handicaps which are essentially emotional. No doubt the continued improvement in the general health of children together with the fact that only 0.13% of those inspected at school medical inspections were found to be of unsatisfactory general condition accounts for the decline in importance of this j particular category. Certainly its deletion from the Regulations would be unlikely to result in difficulties since almost all the children for whom special education is really justified could be absorbed into other categories. Children who are categorised as delicate in Croydon at present are admitted to St. Giles' School or to a residential open air school if a change of environment is essential. Home Tuition If a child is not fit to attend any school, arrangements are made for home tuition. wherever possible such children are returned to a school environment as quickly as possible, since it is recognised that social contact with other children is an essential part of normal child development. During the year 3 children were recommended for home tuition and a further 3 children were already receiving such tuition. 48 Unsuitable for Education in School 16 children were ascertained as unsuitable for education in school under Section 57 of the Education Act, 1944 (as amended by the Mental Health Act, 1959). Of these children seven had never previously attended a State school and six had failed to make progress despite a prolonged trial at St. Christopher's School. All the children were referred to the Health Committee and they were subsequently offered places in the various local Training Centres. One child who had been ascertained previously as unsuitable for education in school was reviewed under Section 57A of the Education Act, 1944 (as amended) and was found to be now suitable for education in school. Further investigations showed a specific disability in communication and he was recommended for placement at the special unit for speech disordered children. 49 PART IV STATISTICAL RETURNS APPENDIX A STATUTORY TABLES Number of pupils on registers of maintained primary and secondary schools (including nursery and special schools) in January, 1966,as in forms 7,7M., and 11 Schools. 45,584 PART l - MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE A. - PERIODIC MEDICAL INSPECTIONS Age Groups Inspected (By year of birth) No. of Pupils Inspected PHYSICAL CONDITION OF PUPILS INSPECTED Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory Unsatisfactory for defective vision ( excluding squint) for any other condition re corded at Part II Total individual pupils No. No. 1961 and later 228 228 _ 2 33 33 1960 3. 458 3. 455 3 128 471 573 1959 932 930 2 51 122 16 2 1958 236 236 _ 16 27 41 1957 1.977 1.977 _ 149 214 333 1956 1.470 1,468 2 87 185 261 1955 634 634 _ 46 103 129 1954 1953 885 860 5 67 103 16 2 1952 2,055 2,054 1 237 256 445 1951 990 887 3 129 118 220 1950 and earlier 1.070 1,065 5 137 113 224 2.797 2,797 - 416 36 2 696 TOTAL 16.712 16,691 21 1.465 2,107 3, 279 cal.(3)total as a percentage of col.(2) total 99.87% Col.(4) total as a percentage of Col. (2) total 0.13% 50 TABLE B.- OTHER MEDICAL 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 542 Number of Re-inspections 1,963 Total 2,505 TABLE C.- INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 50,970 (b) Total number of individual pupils found to be infested 369 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 2 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) 2 51 PART 2 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS DURING THE YEAR 1965 T = requiring Treatment 0 = requiring Observation Defect or Disease PERIODIC INSPECTIONS SPECIAL ENTRANTS LEAVERS OTHERS TOTAL INSPECTIONS SKIN T 46 176 258 480 2 O 52 100 87 239 1 EYES - (a) Vision T 181 553 731 1465 30 O 424 107 534 1065 8 (b) Squint T 61 14 59 134 2 O 27 3 12 42 _ (c) Other T 15 7 33 55 4 O 20 20 43 83 EARS - (a) Hearing T 84 26 84 194 7 O 146 6 85 237 1 (b) Otitis Media T 41 2 16 59 1 O 50 6 25 81 _ (c) Other T 3 10 17 30 1 O 17 6 18 41 1 NOSE AND THROAT T 124 22 84 230 11 O 354 29 230 613 4 SPEECH T 66 4 27 97 6 O 97 6 25 128 3 LYMPHATIC C-LANDS T 16 1 4 21 _ O 32 23 28 83 _ HEART T 47 24 45 116 4 O 92 31 108 231 1 LONGS T 22 15 42 79 3 O 89 20 66 175 1 DEVELOPMENTAL - (a) Hernia T 9 4 19 32 1 O 10 1 10 21 - (b) Other T 9 14 64 87 2 O 118 29 247 394 3 ORTHOPAEDIC - (a) Posture T 19 33 73 125 3 O 39 23 127 189 2 (b) Feet T 43 37 102 182 3 O 96 49 137 282 3 (c) Other T 43 57 80 180 6 O 135 28 124 287 3 NERVOUS) SYSTEM - (a) Epilepsy T 6 1 11 18 1 O 3 1 6 10 _ (b) Other T 19 8 18 45 4 O 28 8 24 60 1 PSYCHOLOGICAL - (a) Development T 8 1 10 19 _ O 56 3 32 91 - (b) Stability T 43 5 33 81 8 O 75 5 51 131 5 ABDOMEN T 7 5 11 23 1 O 36 3 20 59 _ OTHER T 39 37 76 152 7 O 33 40 97 170 8 52 PART 3 TABLE A. - EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 1 Errors of refraction (including squint) 1,060 Toted 1, 061 Number of pupils for whom spectacles were prescribed 406 TABLE B. - DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases known to hare been dealt with Received operative treatment - (a) for diseases of the ear _ (b) for adenoids and chronic tonsillitis 130 (c) for other nose and throat conditions _ Received other forms of treatment - Total 130 Total number of pupils in schools who are known to have been provided with hearing aids - (a) in 1965 8 (b) in previous years 80 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated (a) Pupils treated at clinics 232 (b) Pupils treated at school for postural defects 42 Total 274 TABLE D. - DISEASES OF THE SKIN Number of pupils known to have been treated Ringworm - (a) Scalp - (b) Body ' - Scabies 16 Impetigo 8 Other skin diseases 19 Total 43 TABLE E. CHILD GUIDANCE TREATMENT Pupils treated at Child Guidance clinics Number known to have been treated 181 53 TABLE F. - SPEECH THERAPY Pupils treated by speech therapists Number known to have been treated 793 TABLE G. - OTHER TREATMENT GIVEN Number known to have been dealt with (a) Pupils with minor ailments 1146 (b) Pupils who received convalescent treatment under School Health Service arrangements 12 (c) Pupils who received B. C. G. vaccination 2423 (d) Other than (a), (b) and (c) above, Please specify: (1) Audiology 66 (2) Enuresis 246 (3) weight Control clinic 27 (4) Consultant for Speech Disorders 19 Total (a) _ (d) 3939 APPENDIX B - TREATMENT CLINICS SUMMARY OF ATTENDANCES 1965 1964 Increase or Decrease Audiology Clinic 176 182 -6 Dental Clinics 16,977 17,504 -527 Enuresis Clinics 767 699 +68 Eye Clinic, Purley (from April 1965) 642 _ +642 Inspection Clinics 977 1, 263 -286 Minor Ailments and Verruca Clinics 7, 214 5. 078 +2136 Physiotherapy Clinics 3,879 5, 046 -1167 30,632 29,772 + 860 54 AUDIOLOGY CLINIC Numbers attending Croydon Bay Schools and Pre-School Children (a) With hearing sufficiently impaired to require regular auditory training: Primary School Pupils 42 Secondary School Pupils 24 Pre-School Children 15 Pure Tone Audiometer Tests Total 81 Number of individual children tested during the year. (a) For the first time 203 (b) As a review case Total 248 451 Auditory Training 81 individual children received regular auditory training during the year. Number of attendance sessions: (a) At the Audiology Clinic 176 (b) At home or school 278 Total 454 Sweep Testing of five year old school entrants: Number of schools visited 57 Number of children tested 4,721 Number of children passed 3,878 Number of children failed 378 Number of children to be re-tested 465 Number of children not tested 387 (absent or unco-operative) The failures were re-assessed as follows: No hearing loss 58 Negligible hearing loss 34 Slight hearing loss 61 Moderate hearing loss 132 Moderately severe hearing loss 48 Severe hearing loss 5 Failed to keep appointment 19 Left district 6 Waiting to be tested 15 Total 378 55 Issue of Hearing Aids (a) National Health Service 'Medresco' Aids 7 (b) Commercial Aids bought by Croydon L.E. A. 2 Total 9 (15 children under school age are using hearing aids.) DENTAL CLINICS (l) Number of'children first inspected at school 33, 252 (2) Number of children first inspected at clinic 2,574 (o) Number of (1) and (2) found to require treatment 14, 049 (4) Number of (1) and (2) offered treatment 11,384 ($) Number re-inspected at school or clinic 3,991 (6) Number of (5) requiring treatment 1,647 (7) Visits - First 5,239 Subsequent 11,738 16,977 (8) Additional courses commenced 687 (q) Fillings - Permanent 6,933 Deciduous 3,371 10,304 (10) Teeth Filled - Permanent 6,328 Deciduous 3,056 9,384 (11) Extractions - Permanent 1,365 Deciduous 3,035 4. 400 (±2) General Anaesthetics 1,789 (iq) Emergencies 461 (14) X-Rays (Number of patients) 449 (15) Prophylaxis 1,103 (16) Teeth otherwise conserved 192 (17) Teeth root filled 151 (18) Inlays 15 (lg) Crowns 33 (20) Other operations 3,232 (21) Advice only 1,763 (22) Appointments not kept 4,972 56 (23) Courses of treatment completed 5, 391 (24) Orthodontics - Cases remaining from previous year 164 New cases commenced during year 147 Cases completed during year 121 Cases discontinued during year 16 Appliances - Removable 320 Fixed 32 (25) Number of dentures supplied 14 (26) Number of sessions - Treatment 2,920 Inspection 315 Dental Health Education 6 EYE CLINIC, PURLEY No. of New Cases examined 581 No. of Refractions 360 No. of Re-examinations 61 Total number of children examined No. of children for whom spectacles were prescribed 642 171 On 3lst December 1965, the number of:- (1) New Cases referred but not yet examined was 6 (2) Children due for review in 1965 and still awaiting re-examination was Nil. MINOR AILMENTS CLINICS Clinic Defects Attendances Ashburton School 79 957 Lodge Road 285 2, 204 Nev Addington 499 2,524 Purley (from September 1965) 4 20 Rockmount School 131 791 Waddon 148 718 57 MINOR AILMENTS CLINICS (continued) Defects 196S 1964 Cases Attendances Average No. of Attendances per case Cases Attendan ce s Average No. of Attendances per case Ringworm _ - - - - - Scabies 1 1 1.0 - Impetigo 8 36 4.5 5 30 6.0 Other skin Diseases 19 99 5.2 6 11 1.8 Otorrhoea and other Ear defects 11 20 1.8 34 67 2.0 External Eye Disease 22 52 2.3 37 82 2.2 Verruca 719 5,551 7.7 315 2,9 40 9.3 Miscellaneous 341 1,464 4.3 364 1,9 48 5.3 TOTAL 1, 121 7,223 6.4 761 5, 078 6.7 PHYSIOTHERAPY CLINICS I. ST. JAMES'S ROAD 1965 1964 Attendances Classes Ave. Att. Attendances Classes Ave. Att. Breathing 499 131 3.8 511 96 5.3 Plat Feet 1,081* 341 3.2 1,560 389 4.0 Posture 1,588 405 3.9 1,845 427 4.3 TOTAL 3,168 877 3,916 912 ♦includes 31 treated by Paradism 119 cases were treated and 211 examinations were made by doctors. Ho NEW ADDINGTON 1965 2964 Attendances Classes Ave. Att. Attendances Classes Ave. Att. Breathing 65 35 1.9 185 40 4.6 Flat Feet 291 70 4.2 520 80 6.5 Posture 355 35 10.1 425 40 10.6 TOTAL 711 140 1,130 160 91 cases were treated. 58 SPEECH CLINICS Total number of cases treated 793 -do- discharged 394 -do- still attending 399 Analysis of Discharged Cases Under review pending possible further treatment 191 Left district 9 Unsatisfactory, e. g. non-attendance 36 Satisfactory 152 Left school before treatment completed 5 Cases referred for physical treatment and/or further advice 53 Cases referred for residential treatment 1 Cases referred for Child Guidance 5 Cases examined by Neurologist 19 Analysis of type of cases treated Stammer 144 Sigmatism 147 Cleft palate 13 Excessive Nasality 8 Dyslalia 406 Undeveloped speech 62 Aphasia 17 Dysphoria - Deaf (in co-operation with Mr. Oakley) 12 Special Schools St. Christopher's School 30 St. Giles' School (Some additional cases in each school are under review only.) 31 PURLEY SPEECH CLINIC, from JANUARY TO MARCH 1965 Number of cases treated 18 Number of cases discharged 2 Number of cases on waiting list 20 Analysis of Defects Stammer 2 Dyslalia 6 Cleft Palate 3 Undeveloped Speech 7 59 APPENDIX C RETURN OF MEDICAL INSPECTIONS - NON-MAINTAINED SCHOOLS A - Routine Medical Inspections Year 1965 Year 1964 Year 1963 Age 5 and under 81 - - 6 51 10 - 7 9 15 - 8 45 5 - 9 62 19 - 10 31 24 - 11 20 8 73 12 129 49 85 13 63 17 58 14 57 1 52 15 110 33 77 16 66 33 63 17 37 13 4 18 or over 3 2 - Total 764 229 412 Visits to Non-maintained Schools 47 12 18 B - Other Inspections There were no Special Medical Inspections or Re-inspections C - The following defects were found:- Requiring Treatmnt Observation Skin 22 4 Vision 130 39 Squint 1 1 Efres - other defects 2 4 Hearing 1 4 Otitis Media - 3 Ears - other defects - 1 Nose and Throat 3 10 Speech 3 1 Lymphatic Glands - 4 Heart and Circulation 2 6 Lungs 2 1 Development - 33 Orthopaedic 22 17 Nervous System 1 4 Psychological 3 4 Other Defects 4 1 60 APPENDIX D AVERAGE ATTENDANCE (3.12.65) AND NUMBERS OF CHILDREN EXAMINED AT ROUTINE MEDICAL INSPECTIONS IN MAINTAINED SCHOOLS DURING THE YEAR 1965. Council Primary Schools Number on Registers Average Attendance % No. of Children Examined Boys Girls Total Atwood J. M. & I. 269 88 55 40 95 Ashburton Jr. Mxd. 466 93 83 52 135 Ashburton Infants 228 89 60 53 113 Benson J. M. & I. 532 92 79 62 141 Beuiah Jr. Boys 252 92 74 • 74 Beulah Jr. Girls 206 91 63 63 Beuiah Infants 274 82 61 64 125 Castle Hill Jr. Mxd. 503 94 89 81 170 Castle Hill Infants 272 88 49 57 106 Chipstead Valley J. M. & I. 354 90 56 45 101 Cypress Jr. Mxd. 258 89 35 43 78 Cypress Infants 205 89 52 59 111 David Livingstone J. M. & I. 237 86 50 44 94 Davidson Infants 116 89 20 17 37 Duppas Jr. Mxd. 333 90 50 45 95 Ecclesbourne Infants 185 67* 42 40 82 Elmwood Jr. Boys 275 90 91 •• 91 Elmwood Jr. Girls 270 89 90 90 Elmwood Infants 291 87 69 52 121 Fairchildes Jr. Mxd. 539 86 77 79 156 Fairchildes Infants 306 82 104 89 193 Gilbert Scott Jr. Mxd. 454 91 48 61 109 Gilbert Scott Infants 327 85 87 84 171 Gonville J. M. & I. 498 93 97 80 177 Gresham J. M. & I. 321 92 140 84 224 Hayes J. M. & I. 431 92 134 142 276 Howard J. M. & I. 231 78* 55 42 97 Kenley J. M. & I. 280 92 42 50 92 Kensington Avenue J. M. 413 89 59 37 96 Kensington Avenue Infants 221 85 53 64 117 Keston Jr. Mxd. 330 92 41 48 89 Keston Infants 240 91 64 51 115 Kingsley Jr. Mxd. 456 89 65 57 122 Kingsley Infants 337 84 72 67 139 Monks Orchard J. M. & I. 399 94 61 74 135 Norbury Manor Jr. Mxd. 352 92 - • Norbury Manor Infants 244 90 55 58 113 Oval Jr. Mxd 325 92 38 40 78 Oval Infants 191 84 43 41 84 Portland Infants 75 93 10 23 33 Purley Oaks Jr. Mxd. 302 93 1 16 17 Purley Oaks Infants 214 88 72 62 134 Reedham J. M. & I. 127 98 28 18 46 Ridgeway Jr. Mxd. 263 94 38 40 78 Ridgeway Infants 186 93 39 48 87 Rockmount Jr. Mxd. 261 95 31 22 53 Rockmount Infants 160 90 38 39 77 Roke Jr. Mxd. 169 88 26 27 53 Roke Infants 120 91 31 29 60 Rowdown Jr. Mxd. 471 87 26 55 81 Rowdown Infants 271 86 90 128 218 Figures not representative; outbreaks of infectious diseases. 61 Council Primary Schools Number on Registers Average At tendon ce % No. of Children Examined Boys Girls Total St. Peter's J. M„ & I. 263 90 50 52 102 Selsdon J. M. & I. 406 92 49 70 119 Smitham J. M. & I. 465 87 75 120 195 Soutb Norwood Jr. Mxd. 424 93 58 69 127 South Norwood Infants 268 89 81 56 137 Spring Park Jr. Mxd. 488 90 77 51 128 Spring Park Infants 344 86 81 74 155 Sydenham Jr. Mxd. 264 92 50 45 95 Sydenham Infants 159 89 40 59 99 Toldene J. M. & I. 254 90 88 82 170 Waddon Infants 209 87 39 47 86 West Thornton J. M. & I. 284 90 62 53 115 Whitehorse Manor Jr. Mxd. 403 89 67 48 115 Whitehorse Infants 249 90 55 64 119 Wlnterbourne Jr. Boys 405 93 121 - 121 Winterboume Jr. Girls 376 94 - 87 87 Winterbourne Infants 382 88 65 81 146 Wolsey Jr. Mxd. 509 87 60 64 124 Wolsey Infants 401 82 91 87 178 Woodside Jr. Mxd. 538 94 81 80 161 Woodside Infants 274 92 72 47 119 Woodcote Jr. Mxd. 244 94 35 32 67 Woodcote Infants 194 90 96 66 16 2 TOTAL 22, 843 90 4, 273 4, 096 8, 369 VOLUNTARY PRIMARY SCHOOLS All Saints' (C. of E.) J. M. & I. 225 93 53 45 98 Christ Church (C. of E.) Jr. Mxd. 139 92 33 21 54 Christ Church (C. of E.) Infants 83 89 Coulsdon (C. of E.) J. M. & I. 120 94 24 30 54 Good Shepherd (R. C.) J. M. & I. 326 88 90 82 172 Margaret Roper (R. C.) J. M. & I. 253 91 45 41 86 Parish Church (C. of E.) J. M. & I. 365 92 67 64 131 St. John's Shirley (C. of E.) J. M. & I. 272 94 69 54 123 St. Joseph's (R. C. ) J. M. & I. 510 87 114 75 189 St. Mark's (C. of E. ) J. M. & I. 252 91 45 39 84 St. Mary's (R. C.) J. M. & I. 401 88 101 143 244 St. Michael's (C. of E.) Infants 130 87 33 44 77 TOTAL 3. 076 90 674 638 1, 312 SPECIAL SCHOOLS St. Christopher's (E. S. N..) Mixed 211 86 47 38 85 St. Giles' (Del. & P/H) Mixed 183 81 100 83 183 St. Luke's (Partially Sighted) Mixed 22 95 16 6 22 TOTAL 416 85 163 127 290 62 Number on Registers Average Attendance % No. of Children Examined Boys Girls Total NURSERY SCHOOLS Coulsdon - Pull-time 23 91 a.m. part-time 13 70 29 24 53 p.m. part-time 11 82 Crosfield Pull-time 21 76 a.m. part-time 20 85 22 19 41 p.m. part-time 20 80 Purley Pull-time 42 88 12 12 24 TOTAL 150 83 63 55 118 COUNCIL NON-SELECTIVE SECONDARY SCHOOLS - Ashburton Boys 613 92 231 231 Ashburton Girls 614 91 - 307 307 Chipstead Valley Mixed 222 88 60 55 115 Davidson Mixed 394 88 78 79 157 Ecclesbourne Girls Fairchildes Boys 314 648 87 82 302 198 n 198 302 Fairchildes Girls 547 83 - 382 382 Ingram Boys 527 89 299 - 299 Lanfranc Boys 436 87 185 - 185 Lanfranc Girls 467 89 - 282 28 2 Norbury Manor Boys 322 91 168 - 168 Norbury Manor Girls 442 88 - 275 275 Overbury Mixed 617 83 110 106 216 Portland Mixed 333 90 98 56 154 Riddlesdown Mixed 703 94 156 110 266 Roke Mixed 240 92 65 44 109 Shirley Mixed 610 90 114 131 245 South Croydon Mixed 474 86 - 143 143 Tavistock Boys 346 85 164 - 164 Tavistock Girls 222 85 - 102 102 Taunton Manor Mixed 303 90 - 77 77 Westwood Girls 371 88 - 185 185 Woodcote Mixed 603 91 153 174 327 TOTAL 10, 368 88 2, 18 3 2,706 4,889 VOLUNTARY NON-SELECTIVE SECONDARY Our Lady's (R. C. ) Girls 196 87 116 116 St. Andrew's (C. of E.) Mixed 278 87 70 54 124 St. Mary's (R.C. ) Mixed 390 94 71 52 123 Thomas More (R.C.) Mixed 489 90 67 84 151 TOTAL 1. 353 90 208 306 514 GRAMMAR AND SELECTIVE INCLUDING TECHNICAL Archbishop Tenison Mixed 343 93 93 93 186 Coloma Girls 591 93 - 166 166 Croydon Technical Boys 431 91 166 - 166 Heath ClarlL Mixed 666 94 234 102 336 John Newnham Mixed 49 5 93 58 124 182 John Ruskin Boys 623 94 206 - 206 Lady Edridge Girls 519 92 - 168 168 Purley Boys 606 93 152 - 152 Purley Girls 566 95 - 189 189 Selhurst Boys 709 94 75 - 75 Selhurst Girls 531 92 - 203 203 Stanley Technical Boys 305 92 128 - 128 TOTAL 6,385 93 1,112 1,045 2,157 63 CASES OF INFECTIOUS DISEASES NOTIFIED BY HEAD TEACHERS Disease 2965 1964 2963 Chicken Pox 273 364 757 Conjunctivitis - - 4 Diphtheria - - - Gastro-Enteritis 4 - - German Measles 134 54 191 Impetigo 10 2. 2 Jaundice 1 21 19 Measles 291 zl4 725 Mumps 30 610 495 Non-Specific Diarrhoea incl. Dysentery 593 27 85 Non Specific Vomiting 107 191 5 Other Diseases 34 5 20 Poliomyelitis - - - Body 2 _ _ Ringworm or Vermin Scalp - - 1 Scabies 6 - - Scarlet Fever 61 21 36 Sore Throat (incl. Tonsillitis) 15 - - Whooping Cough 19 62 35 TOTAL 1,581 1,571 2,375 WORK OF SCHOOL NURSES School visits re Cleanliness 477 School visits re Scabies, Ringworm, Impetigo 43 School visits re Infectious Diseases 43 School visits re Medical Inspections 918 School visits re Medical Preparations 814 School visits for all other reasons 137 Attendances at school clinics 1,205 Home visits re Infectious Diseases 226 84 APPENDIX E An Approach to the Treatment of Overweight Adolescents by Phyllis M. Gibbons, M. B. , B. S., D. R. C. 0. G., (School Medical Officer) At the inception of the School Health Service the nutritional problems encountered by the Medical Officer were predominantly those of malnutrition. During the past decade, however, he has become increasingly confronted by those of obesity. Various surveys to show the incidence of childhood obesity have been carried out, and show that 5 - 15% of schoolchildren are now at least 10% above the mean weight for their age, height, and body build: (the standards used in this paper are based on Scott's survey of L.C.C. schoolchildren in 1955). The full cause of this increase is not known but a change in eating habits since 1945 with a higher standard of living, has certainly contributed. The illnesses precipitated by obesity occur predominantly after the child-bearing age, and, since there are marked hereditary tendencies to obesity, the incidence of this condition is likely to rise steadily if unchecked. Although the majority of doctors agree that obesity is detrimental to health and should be treated, opinions differ about the age at which such treatment should commence. While a few physicians do not treat obesity in pre-pubertal children, most now believe that, once a child is diagnosed as being overweight, he should be treated, no matter how young. Recent investigations have confirmed this, and show that spontaneous return to a satisfactory weight is the exception rather than the rule, and that as the patient becomes older the obesity will tend to get even worse. There are differing opinions also about the ideal therapeutic approach; various ancillary forms of treatment, such as the use of anorectic drugs, are being carried out, but most agree that reduction of the total calorie intake should be the prime objective. There are, many thousands of overweight children being treated in Britain at the present time; a few hospitals and many Local Authorities have established special clinics devoted to the problem. Almost without exception the approach is an individual one with regular dietetic supervision and follow-up. 65 Results and relapse rates vary but all doctors agree that there are special difficulties involved in treating childhood obesity. The parents of these children must co-operate fully in all dietetic treatment and must provide the right emotional climate of encouragement and praise for success: this may prove difficult, especially if the parents themselves are overweight and have failed to achieve weight reduction with a diet. There is also a danger that individual treatment may increase the child's sense of isolation from his peers. Even if all conditions are ideal it is difficult for any clinic to see the children as frequently as necessary since the numbers involved are now so great. Equally there are problems in following-up these children as they should be supervised indefinitely: obesity is a chronic, not an acute condition. A group approach to the problem has much to recommend it. On a strictly practical basis it is possible to see larger numbers more frequently. Prom a dietetic point of view the group discussion often reveals hitherto undiscovered nutritional fallacies which might not be mentioned in an individual interview. Its greatest advantage, however, is in the sense of companionship and competition which develops within the group. As the group develops its own identity, the children wish to lose weight not only for their own satisfaction and to earn praise from their parents and the doctor, but also for the approbation of the group. The Education Committee resolved to establish an experimental Weight Control Clinic in Croydon where treatment by diet alone could be given on a group basis. Previously, overweight children seen at school medical examinations had been referred to hospital, or given dietetic advice and followed up at school inspection clinics. The objects of this new clinic have been to determine whether greater success could be achieved and also if greater numbers could be dealt with satisfactorily. The first meeting was held on June 11th, 1965. This group consisted of ten girls, six of whom were already attending school inspection clinics and were not achieving satisfactory weight reduction, and four who heard of the group at its inception and asked to join. Hie age range was from 10-16 years and all attend schools in the Croydon area: permission for them to attend was first obtained from their schools and their General Practitioners. All the girls were between 10 - 50% above the weight estimated for their age and height. They had previously been medically examined to exclude the extremely rare cases of 66 glandular obesity, but even if this had been missed the dieting would have caused no harm and the regular medical supervision would have brought the condition to light. As well as the regular weight recordings the girls' heights and girths are checked periodically; their Blood Pressures are recorded and urine tests carried out also. At the initial meeting the girls' mothers are asked to attend as well, and the purpose and aims of the group are explained. It is stressed that the only way to reduce and control weight, is by a sensible diet which involves an overall reduction in calorie intake while maintaining an adequate protein, vitamin and mineral intake. Diet sheets have been especially prepared to achieve simplicity and fit in with the rest of the family's meals. After the initial meeting the girls attend fortnightly for the first three months, and then monthly, provided that weight loss is satisfactory; it is planned that the interval between meetings should be lengthened until they are held every three months. As well as the discussion of each girl's weight reduction and dietary problems, visual aids have been used extensively to maintain interest. The results of the first group are shown below. The initial rate of weight loss Is rapid, but then becomes slower: other workers have found a similar pattern. The peaks of weight gain occurred during school holidays, and indicate the need for more intense control at this time. 67 One further result which has been clearly demonstrated is that those girls who asked to join the group (and therefore were presumably more strongly motivated to lose weight) were twice as successful in attaining weight loss; in the first six months they lost an average of lbs. while the average loss of the others was only 4 lbs. A second group of fifteen girls has been started, their results are as follows:- To succeed in treating obesity certain factors are essential. laJ Strong motivation to lose weight on the part of the patient. lb) Adequate medical support and dietetic advice. (c) Regular supervision and indefinite follow-up. While it is too early to say whether the group situation provides the ideal climate for the treatment of childhood obesity, the results so far justify a continued investigation of this type of therapy. Hie girls who have attended the weight control clinic so far have been selected at random and are by no means the most overweight of Croydon's schoolchildren. It rapidly became obvious that the potential numbers needing treatment were too great to be all treated in this way. It was therefore decided to investigate the height and weight distribution in a secondary girls' school. 68 Age Range * Height (in inches) Weight (in pounds) Mean S.D. Mean S.D. 11.5 - 12 years 58.36 2.692 90.73 17.66 12 - 12.5 ,, 59.20 3.341 94. 33 20.53 12.5 - 13 ,, 61.43 2.877 103.34 18.09 13 - 13.5 ,, 61.90 2.430 107.01** 18.90 13.5- 14 ,, 63.42 2.887 114.87 21.69 14 - 14.5 ,,63.54 2.468 121.36 25.19 14.5-15 ,, 63.58 2.475 1 20.57 17. 17 15 - 15.5 ,, 4.29 2.588 120.72 13.31 15.5 - 16 ,, 64.88 2.050 123.68 19.51 (*Girls under 11.5 years or over 16 were excluded as the groups were too small to be statistically significant.) (**Qne weight (180 lbs.) excluded.) Comparing these results with the 1955 figures, from Scott there is an increase per cent from 5.9% - 15.6% in mean weight, but only 1.98% to 3.02% increase in mean height. Approximately 8% of the girls were thought to need treatment for their obesity. To cope with these large numbers, experiments have been started to deal with the problem at school level. The girls who have wanted dietetic advice have been seen as a group and then followed-up regularly at school. Hie response and results so far have been encouraging. Summary The numbers of overweight schoolchildren appear to be increasing, and experience suggests that this will present further health hazards in the future, since the obesity is expected to continue into adult life. At present the increase in mean weight of schoolchildren is proportionally higher than that of mean height, and this suggests rather that the modern schoolchild is becoming overweight than that the malnourishment of earlier years is still being corrected. Prevention and treatment of this condition is largely a matter for nutritional re-education than medical therapeutics. This fact, and the large numbers involved suggest that the School Health Service has a unique role to play in the care of the overweight schoolchild. CONTENTS A. - PUBLIC HEALTH REPORT Page Animals, Diseases of 74 Animals, Keeping of 69, 73 Ante-Natal Clinics 31 At Risk Register 31 Births 11. 12 Blindness 94 Bye laws 87 Camping Sites 70 Cancer 100 Care of Mothers and Young Children 31, 109 Census 11 Chest Clinic, Work of 20 Child Minders 93 Chiropody 54 Clean Air Act 71 Committee, Health 3 Communicable Diseases 17,129,130 Congenital Malformations 35, 119 Consumer Protection Act 69 Contraventions 67 Convalescence 39 Cremation 128 Day Nurseries 53, 93 Deafness 53, 122 Deaths 11, 98 Dental Treatment (M.& C.W.) 43, 121 Disinfection 71 Dlslnfestatlon 72 Drainage 68 Epileptics 94 Elderly Persons Rehabilitation of 115 Fabrics (Misdescription) Act, 1913 69 Factories and Workshops 61-63 Food and Drugs Act 79 Food Hygiene Regulations, 1960 75 Food Poisoning 18 Food Supply 74 Halrdressing 68 Health Education 40 Health Visitors, Work of 36, 110 Home Helps 39, 118 Home Nursing 38, 114 Home Safety 41, 126 Hospital, Isolation 19, 131 Housing 59 Ice Cream - Bacteriological Examination of 79 Illegitimacy 11, 33 Immunisation 38, 134 Infant Mortality 11,102,103 Infant Welfare Clinics 34, 112 Page Liquid Egg 79 Marriages 12 Maternal Mortality 11, 106 Maternity Homes 127 Meat Inspection 76, 77 Men's Hostel 61 Mental Health 45 Midwifery 34, 104 Midwives Act 34 Milk Supply 77 Mines and Quarries Act, 1954 69 Mortuary 128 National Assistance Act 94 Neo Natal Deaths 11, 102 Noise Abatement 73 Notification of Births Acts 12 Nuisances 87 Nursing Equipment, Loan of 117 Nursing Homes 127 Nurses' Agencies 127 Offices, Shops and Railways Act, 1963 63 Outworkers 62 Perinatal Deaths 11, 102 Pests 74 Phenylketonuria 31 Physiotherapy 120 Pharmacy and Poisons Act 73 Poliomyelitis 135 Population 11 Post-Natal Clinics 31 Post-Mortems 128 Premature Infants 31, 109 Public Health Inspectors, Work of 57, 86 Public Health Laboratory Service 27, 133 Rag, Flock Act 73 Rats & Mice (Destruction) Act 74 Riding Establishments Act, 1964 70 Rivers and Streams Pollution of 68 Scrap Metal Dealers Act, 1964 70 Sewage Disposal 92 Shops Act 67 Statistics, Summary of 11 Still Births 11 Page Tuberculosis, After Care 25 rr Allowances 25 rr Contacts 23 rr Home Nursing 23 rr Home Visits 22 rr Mass Radiography 24 rr Mortality 21 rr Notifications 137 rr Occupational Therapy 26 rr Residential Treatment 22 rr Prevention and Control 20 rr Re-Housing 24 rr Vaccination 23 B.- SCHOOL MEDICAL REPORT Page Athlete's Foot (Tinea pedis) 13 Average Attendance 60 Child Guidance 21, 43 Cleansing of Children 11,12,50 Clinics 5,53,56,57,58 Convalescent Treatment 32 Costs 6, 33 Deaf Children 20,37,39,54 Deaths 33, 34 Defects found 9, 10, 51 Delicate Children 32, 47 Dental Service 3, 22, 55 Developmental defects 16 Ear, Nose and Throat defects 15 Enuresis Clinic 26 Epileptic Children 43 Handicapped pupils 2,35,44 Health Education 3, 28 Heart and Circulation defects 16 Heights and Weights 18,19,68 Home Tuition 47 Infectious diseases 2, 63 Intelligence Tests 30 Juvenile employment 32, 33 Page Unmarried Mothers 33 Vaccination (Smallpox) 134 Verminous Persons 72 Venereal Diseases 27, 140 Vital Statistics 11, 98 Ward Statistics 101 Water Supply 91, 133 Welfare Foods 35, 120 X-Ray 24, 138 Zymotic Diseases 19, 131 Page Meals, Provision of 33 Medical Inspections 1,7,8,49,60 Milk, provision of 33 Non-Maintained Schools 11, 59 Orthodontic Service 26 Orthopaedic defects 17, 44 Overweight children 18, 64 Parents attendances 8 Partially Hearing Unit 39 Physiotherapy Clinics 57 Plantar Warts 12 Population of Schools 49, 60 Psychological defects 17 School Nurses, Work of 63 Spastics 17 Special Inspections 7, 8, 50 Speech 31,46,58 Staff 6 Statutory Tables 49 Sub-normal Children 40,41,48 St. Christopher's School 41 St. Giles' School 44 St. Luke's School 36 Transport of Children 31 Tuberculosis 16 Uncleanliness 11,12,50 Verrucae 12 Vision Defects 14,27,36,56