Ac.43331 Ack d CR0 71 PUBLIC HEALTH IN CROYDON 1969 PUBLIC HEALTH IN CROYDON 1969 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEAL' AND PRINCIPAL SCHOOL MEDICAL OFFIC1 FOR THE YEAR 1969 S.L. WRIGHT. M.D., F.R.C.P.. D.P.H. PUBLIC HEALTH DEPARTMENT. TABERNER HOUSE, PARK LANE. CROYDON. CR9 3BT Telephone:- 01-686 4433 3 HEALTH AND PUBLIC SERVICES CONTROL COMMITTEE 1969 Alderman Keith Edwards (Chairman) Councillor R.W. Kersey, B.Sc. Councillor B.H.Rawling (Vice-Chairman) Councillor G. Levy Alderman A.V. Dammarell Councillor Miss I.S. Rodda Alderman B.C. Sparrowe Councillor W.E. Ross Gower, Alderman D.M. Weightman M.A. B.E.M. Councillor Mrs. N.B. Booth Councillor Mrs. B. Saunders Councillor A.E. Buddie Councillor H.G. Whitwell Councillor Mrs. M.E. Campbell P.S. Boffa, Esq. M.D. Councillor J,G, Davies G. Hirst, Esq., M.A., M.B., B.Chir. Councillor Mrs. D.C.H. Hobbs J.C. Miller, Esq., F.R.C.S., Councillor C. Johnston, A.I.S.T., M.R.S.H. F.R.C.O.G. Councillor C.E. Kelly K.T. Tighe, Esq.,M.B..B.S.,D.Obst. R.C.O.G. Members appointed to Sub-Committees on nomination of Outside Bodies as shown:— P.S. Boffa, Esq., M.D. D.H. Clarke,Esq., M.B.,B.S.,D.O. Eng. D.Obst. R.C.O.G. K.T. Tighe, Esq., M.B., B.S., D.Obst. R.C^O.G. Miss A.C. Dunbar, F.R.C.S., M.R.C.O.G. Mrs. L.M. Anderson Mrs. E.M. Ryle Horwood Miss I.Lowenstein,S.R.N.,S.C.M., M.T.D. P. De-La-Mere, Esq. Mrs. J. Toogood Mrs. N. McGhie, S.R.N. G.J. Cottier, Esq. F.R. Jamieson, Esq., M.P.S. Local Medical Committee Croydon amd Warlingham Park Group Hospital Management Committee Royal College of Nursing Royal College of Midwives Family Planning Associatfon Croydon Federation of Townswomen's Guilds The St. John Ambulance Brigade (Southern Area) The Insurance Institute of Croydon The Pharmaceutical Society of Great Britain (Croydon Branch) 5 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1969 To the Chairman and Members of the Health Committee LADIES AND GENTLEMEN) In accordance with statutory requirements I present this Report for 1969 on the health of the residents of the London Borough of Croydon, and comment on a few of the matters covered later in greater detail. Statistics The birth rate was very slightly lower than in 1968, and the general and infant mortality rates much reduced. There was no death of a mother in childbirth but 1 death from abortion. This was self-induced and there had been no application for a therapeutic termination. The percentage of illegitimate births rose from 9.8 last year to a record high figure of 11. Deaths from cancer of the lungs and bronchus rose for both men and women, and were the most prevalent form amongst ail deaths from cancer. A less sombre observation is that marriages of persons under 21 registered in 1969 reversed the trend of previous years and fell from 24% in 1968 to 20%. Whettier this was merely deferment pending a change in the law will be shown next year. Health Centres The adaptations at the Parkway Clinic, New Addington, were deferred, despite the receipt of acceptable tenders, because agreement on charges had not been concluded. Reports by other Authorities show that this is not 6 a difficulty peculiar to Croydon, but arose here before building had begun. The purchase of a site for the South Norwood Centre made some progress and this project was still up to schedule. The Domiciliary Nursing Team The trend to attachment of Health Visitors, District Nurses and Midwives to groups of Family Doctors was continued, hampered by staff shortages. So far these have met only requests from general practitioners, and no effort has been made to initiate such arrangements. Difficulties of staff crossing Borough boundaries were met by proposals for mutual cover by adjoining Authorities, but these arrangements were not functioning in the year under review. It does seem that the combined team results in great benefits to the patients, and is a pattern for application throughout the Borough. Home Helps The development of this service as an essential part of domiciliary care was pursued with emphasis on in-service training, stressing the responsibilities involved. Recruitment of Home Helps has been difficult in Croydon due to the many other opportunities for employment. This new image of essential help through domestic skills is now attracting recruits, who understand the real importance of the work. Care of Pre-School Children The continued demand for more Nursery Groups and Child Minding facilities entailed much more work for the supervisory staff involved. A new Corporation Day Nursery was approved under the Urban Aid scheme and should be functioning by 1971. Mental Health There was an official opening of the new Coldharbour School which replaced the former Junior Training Centre on the adjoining site. In anticipation of transfer to the Education Committee the Education Department was involved in the setting up of a Parent/Teachers Association, which emphasized to parents the pending changes which they have sought for so many years. The temporary sheltered workshop was replaced by a purpose-built factory unit, which provides also accommodation for the industrial rehabilitation services, and this too was formerly opened in 1969. Made possible by a generous grant from the Department of Employment and Productivity, it was an important contribution to the mental health services of the Borough. As with all these facilities physically disabled persons were also accepted. Another combined hospital and local authority day hospital and day mental health centre was opened in a specially adapted part of the former Council offices in Purley. Although not purpose built to th*» standard of Rees House, these are most satisfactory premises and the unit provides excellent facilities for the former Coulsdon and Purley area. The premises of the similar Centre in Thornton Heath were maintained temporarily by the Corporation alone as a mental health day centre accepting persons not in need of medical or nursing 7 care. Although a temporary expedient in anticipation of its re-opening in 1970 with day hospital facilities, the help and support given to former patients and their relatives demonstrated a need which should be continued as a permanent aspect of a comprehensive mental health service. Despite much work it was not possible during the year under review to obtain suitable premises for additional Group homes, either by building or adaptation. This important part of the mental health programme posed questions of adverse public reactions, and doubts of the type of accommodation which should be built. The Boarding-Out scheme continued to expand, and the extra places obtained equalled in numbers several group homes. However, for some former patients this is not suitable accommodation. Health Education Although the Health Education Officer mentions matters of particular interest, it is the routine and perhaps humdrum work which is probably of the most importance. Thus education about the dangers of venereal disease or drug addiction is included in general health education programmes to school children and teenagers. In this way knowledge and warnings can be imparted without implying that these are exceptional hazards and thus stimulating morbid curiosity. Communicable Diseases Limited supplies of vaccine curtailed protection against measles. Nevertheless the anticipated outbreak due in 1969 produced less than half the cases noted in previous years. Cautious optimism is justifiable. There were cases of typhoid fever contracted by holiday makers visiting Tunisia, and one young woman died suddenly from a sequal to this infection. Intending travellers were advised to have vaccination against the enteric diseases. Attendances for treatment of all forms of venereal disease at the Special Clinic at the Croydon General Hospital rose by 42% over 1968. Clean Air The programme was not affected by lack of smokeless solid fuel, but there were warnings of difficulties ahead. The benefits of clean air have become too obvious for this to be more than a passing interruption in the programme to make the whole Borough subject to Smoke Control Orders. Health Services Co-ordination Collaboration at Member and at Officer level, which has achieved unification of many services since 1948, continued. Joint decisions on the effectiveness of schemes rested on their value to the residents of Croydon rather than the source of supporting finance. Thus efficiency was combined with economy to a degree which supports the delegation of powers to local authorities having common boundaries and united civic interests. We hope that any new legislation will not disript these efforts. 8 Acknowledgements Members of the Health Committee and the Council were generous but rightly prudent in their support of constantly expanding programmes for additional services. Their wise advice in translating desirable theories intc practical policies was as always most helpful. I give my thanks to officers of other departments of the Corporation and to many statutory bodies for much assistance and support. Individual volunteers and organised Societies gave valuable help by services or donations, and I welcome this chance to express my thanks. Finally I am very pleased to commend once again the continuing efficiency and resource of the staff of the department in maintaining routine and in meeting many new and challenging responsibilities. I am. Yours faithfully, S.L. WRIGHT, Medical Officer of Health and Principal School Medical Officer. STATISTICS 11 SUMMARY OF STATISTICS FOR 1969 Area, 21,395 Population (Census 1961), 327,239 Total population (estimate of Registrar General), 327,130 (Midsummer, 1969) Number of Domestic Dwellings; 105,800 Rateable Value of Borough 1969 as from 1.4.69 £20,643,640 Product of a Penny Rate, for London Borough of Croydon purposes, £87,350 Rate in the £. 11.1 Od. (for the year 1.4.69 to 1.4.70) Live Births Males Females Total Legitimate 2,475 Illegitimate 291 2,387 293 4,862 584 5,446 Illegitimate Live Births per cent, of total births 11.0 Live Birth Rate (as adjusted by comparability factor 1.02) 16.9 (England and Wales) 16.3 Stillbirths 67 Stillbirth rate per 1,000 total (live and still) births 12 (England and Wales) 13 Total Births (Live and Still) 5,513 Infant Deaths 83 Infant Mortality rate per 1,000 live births 15.0 (England and Wales) 18.0 Infant Mortality rate per 1,000 legitimate births 14.0 Infant Mortality rate per 1,000 illegitimate births 24.0 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 10.0 (England and Wales) 12.0 Early neo-natal Mortality rate (First week) per 1,000 total live births 9.0 (England and Wales) 10.0 Perinatal Mortality rate (stillbirths + deaths during the first week) per 1,000 total live and still births 21 (England and Wales) 23 Maternal Deaths (excluding abortion) Maternal Mortality rate (including abortion) per 1,000 total live and still births 0.18 (England and Wales) 0.19 Deaths, 3,860 Death-rate per 1,000 of the estimated population 11.8 (England and Wales) 11.9 Death rate (as adjusted by comparability factor 0.86) 10.1 12 Marriages The number of marriages solemnised in 1969 in the Croydon Registration District are as follows:— Church of England 1,074 Nonconformist Places of Worship 680 Register Office 1,196 When supplying these figures Mr. Dayies, the Croydon Superintendent Registrar, kindly analysed recent trends and commented "Of the totai number of persons giving notice of intention ta marry either at Nonconformist Places of Worship or Register Office in 1969, 19.8% were under the age of 21 years, compared with 23.72% in 1968 and 22.96% in 1967". Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,788 40 3,828 Doctors 966 19 985 4,754 59 4,813 Accommodation for Confinements The following table shows where babies were born in the Borough of Croydon during the whole of 1969. 668 residents had babies outside Croydon and 121 non-residents were confined in Croydon. Number Percentage In Private Houses 1,033 21.5 In Public Institutions 3,723 773 In registered Maternity Homes 57 12 Total 4,813 COMMUNICABLE DISEASES 15 THE PREVENTION AND CONTROL OF TUBERCULOSIS Dr. R.H.J. Fanthorpe, M.D., F.R.C.P. Chest Physician Measures for the prevention and treatment of Tuberculosis are directed from the Chest Clinic and the results during 1969 may be regarded as satisfactory. Incidence 56 cases of Respiratory Tuberculosis and 15 cases of Non-Respiratory Tuberculosis were notified on Form A during 1969 (Table 1 - Formal Notifications). Of these 43 males and 13 females were Respiratory cases and 5 males and 10 females were Non-Respiratory. In addition 34 Respiratory cases and 3 Non-Respiratory cases came to our notice as new cases otherwise than by notification. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1969 by notification or otherwise was 108. 90 of these were cases of Respiratory Tuberculosis; 64 in males and 26 in females. There were no cases of Non-Respiratory Tuberculosis among children under 15 years. The number of cases in adults was 15. The incidence rate of Tuberculosis, all forms, was 0.33 per 1,000 of the population, for Respiratory Tuberculosis 0.28 and for Non-Respiratory Tuberculosis 0.05 per 1,000 population. The notification rate was 0.22 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31 st December, 1969: RESPIRATORY NON-RESPIRATORY Males Females Total Males Females Total Total Cases 702 510 Y ,212 56 88 144 1.356 In 1969 the death-rate from all forms of Tuberculosis was 0.03 per 1,000 population. The rate from Respiratory Tuberculosis was 0.03 and the rate for NonRespiratory 0.00 In 1969 the total number of deaths was 10. All of the deaths occurred in the age groups 45 years and over. There was no death in children of school age. For Notifications: See Appendix page 135. 16 Deaths from Non-Respiratory Tuberculosis During 1969 no deaths were certified to be due to Non-Respiratory Tuberculosis. Co-ordination with the Health Department During the year 15 children were referred by the School Health Service of the Public Health Department. Extra Nourishment Provision of special nourishment in the form of milk was granted to 38 selected cases for varying periods during the year and 30 cases were in receipt of extra nourishment at the end of the year. The Chest Clinic and Home Visiting 1,719 new cases were examined during the year. 55 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 15,511. The Clinic doctors paid 250 home visits and the Tuberculosis Visitors 2,567 visits for Clinic purposes. In addition the Tuberculosis Visitors made 114 primary visits for the purposes of the Notificetion Register. There were also 781 unsuccessful visits. The General Practitioner Miniature X-Ray Service continues to function in a satisfactory way and is well used by local practitioners. The results of this service are summarised below:— Number of miniature films taken 3,904 Number of patients recalled for examination and large film 443 Number of active cases of Pulmonary Tuberculosis found 16 Number of cases of lung cancer found 22 Contact Examination During 1969, 392 persons were examined for the first time as contacts of notified cases of Tuberculosis. Of these contacts, 7 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 18 compared with 0.33 per 1,000 of the general population. In addition there was 1 found to be tuberculous who had been under observation from previous years. 17 B.C.G. Vaccination Vaccination The use of B.C.G. vaccination for contacts has been continued during 1969 and regular sessions were held at the Clinic for this purpose. 395 contacts were successfully vaccinated during the year. In addition 7 nurses and domestics were successfully vaccinated, and 30 babies of tuberculous parents were vaccinated in hospital during the neonatal period. B.C.G. Vaccination for School Leavers. Total number of children skin tested 3,870 Number found to be negative 3,018 Number vaccinated with B.C.G. 3,002 For detailed figures see Appendix page 135. AFTER-CARE OF THE TUBERCULOUS PATIENT The tuberculous patient may need encouragement, reassurance and practical help. Fears can be alleviated by a home visit or a financial query solved by advice regarding statutory benefits. Over the past year heating costs have again been a major problem for the person living on a low income and the help given by the Croydon Care Committee has been much appreciated. This Committee has made grants for fuel, helped with the settlement of electricity and gas accounts and has given assistance with special needs. At Christmas they issued £120 grocery vouchers which were distributed amongst needy patients attending Croydon and Purley Chest Clinics. An allowance of £525 from the Public Health Department for milk has been used to provide certain patients with one pint of free milk daily. These patients are mainly elderly who find it a struggle to afford nourishing foods. There has been little change in the employment position for the tuberculous patient. Light jobs for the more elderly and unskilled workers remain scarce, but for others the position is much easier. Patients seeking work are referred to the Disablement Resettlement Officer who gives all guidance possible. Certain patients needing sheltered employment attend the Industrial Unit and others who are unfit for wcrk can have occupational therapy at home or they may be referred to the Occupation Centre. Sometimes the patient has to rest as much as possible, but for the mother of a family or a person living alone, this recommendation can be difficult to carry out. However, once again the Home Help Service has given valuable assistance in such cases.Helpful contacts with the Children's Department, District Nursing Association and Housing Department have also been made, and with the cooperation of all concerned the after-care work of the trterculous patient has continued throughout the year. 18 OCCUPATIONAL THERAPY The Chest Clinic Occupational Therapy Department has been kept busy in 1969 with an increasing demand for patients to be found occupation in their own homes. Rather more of these patients have been elderly or too poorly to be able to attend Waylands this year and they find useful occupation satisfying and reassuring. The chronic shortness of breath from which most of our patients suffer restricts the variety of craft work to some extent but this year we have made a big effort to introduce new items to sustain the interest and enthusiasm of the long term patients. We have been very successful with our sales again and most of the articles sold quite quickly from the show case at the Chest Clinic and others went at a small sale held at Purley Hospital just before Christmas. This year the demand has been for more canework and hand woven stools. 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 for his ready assistance and most helpful advice which have been available at all times. For detailed figures, see Appendix, page 131. PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 21 ANTE AND POST NATAL CLINICS Existing arrangements for a unified service at Lodge Road and at New Addington Clinics continued. Although there was a slight fall in attendances at Lodge Road, expectant mothers have in recent years tended to bring with them several members of the family. Older relatives to act as interpreters, and children because they could not be left alone. Authority was obtained to build an additional Waiting Room to be equipped as a play centre, to accommodate the children. Its possible use as premises for a nursery group outside the times of Clinic sessions was also considered, as this would add much needed facilities in an area of the Borough where the demand is great. It was anticipated that a pre-fabricated unit would be provided under the Urban Aid scheme early in 1970. The numbers attending the Relaxation and Mothercraft Classes were considerably greater than in 1968. Furthermore, attention was given to coordinating the contributions of the midwives, health visitors, and physiotherapists, who combine to provide this service. At the ante-natal clinics a total of 5,795 mothers attended during the year. 1. No. of patients seen for first blood test 3,299 2. No. of patients found to have antibodies 67 3. No. of patients sent to Special Clinic 30 Care of Premature Babies Arrangements for the supervision of premature babies after discharge from hospital extend 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 102 Phenylketonuria During 1969 all babies born in the Borough or normally resident there had a Guthrie test. The programme is co-ordinated by the Supervisor of Midwives, and she ensures that results are notified to interested professional personnel. Likewise the Domiciliary Midwives obtain any repeat specimens. Although there were several requests for repeat tests, no new cases were discovered during the year. 22 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.- The following figures apply only in regard to cases dealt with by Croydon Association for Moral Welfare. During the year under review:— 304 cases were dealt with by the social workers. 29 girls were admitted to mother and baby homes. 56 girls were financially assisted by the Local Authority. Ages of the younger mothers when they applied for help. 12 years old - 13 " " 1 14 " " 1 15 " " 4 16 " " 23 17 " " 32 18 " " 32 Total 93 Age when baby was born 12 years old - 13 " " 1 14 " " 1 15 " " 3 16 " " 20 17 " " 25 18 " " 26 19 " " 17 Total 93 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 114. 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. Congenital Malformation The scheme introduced in 1963 continued unchanged, regular returns being made to the Registrar General. A total of 91 babies with congenital conditions was notified in 1969. For details see Appendix, page 103. 23 Child Health Centres The demand for these services which comprise the education of parents, developmental assessment and immunisation of children has fallen slightly this year. No doubt this is due in part to the fall in the birth rate. One new Child Health Centre was opened to meet the needs of the developing Forestdale Estate and this has proved very successful. For detailed figures see Appendix page 110. Welfare Foods and Medicaments The policy of restricting sales at Child Health Centres to National dried milk and Ministry of Food vitamin preparations was relaxed to include a vitamin A and D concentrate. Many mothers said their infants would accept only this form of A and D supplement, and could not be persuaded to take cod liver oil. Most of the former objectionable taste has been removed from the cod liver oil now available, and prejudice relates probably more to parents than children. The dangers from lack of vitamins A & D are too real to permit any excuse for their being withheld, and with the agreement of the local Pharmaceutical Committee a clinic packof A & D concentrate is now sold. For detailed figures see Appendix page 103. 24 THE WORK OF THE PUBLIC HEALTH NURSING SERVICES Miss A. Hayward, A.R.R.C., T.D., S.R.N., S.C.M., H.V.Cert., Although staffing shortages seem to have dominated 1969 and all the nursing services have carried vacancies at some time during the year, Inservice Training has continued. To help the S.E.N./District Nurse training become truly integrated, Clinical Instructors from Croydon General Hospital were invited to a five day course for Group Leaders and Practical Work Instructors in the District Nursing Service. This course, held early in the year, was followed nine months later by a study day. Colleagues in the Hospital Maternity Services were welcomed by Health Visitors, Physiotherapists and Domiciliary Midwives to a study day held in an endeavour to sort out the role of each worker and so avoid confusion in the mind of the expectant mother. A series of two day courses have been held for Health Visitors to prepare them to carry out hearing tests on babies. So far 75% of. the staff have received this training. Lunch time seminars with a consultant psychiatrist, and outside speakers at staff meetings have all played a part in In-service Training, and the nursing services are deeply indebted to Miss Elliott, Croydon's Health Education Officer, amd her staff for their enthusiasm and help. District Nursing Service This branch of the service experienced a good deal of change during the year. The Superintendent moved away from the area, and one of the Assistant Nursing Officers retired after many years in home nursing. It was gratifying to be able to fill these vacancies from within the Service. The use of Nursing Auxiliaries has proceeded with great success. Six have been recruited during the year bringing the total to 8. All are car drivers and all have had previous hospital experience. Although they have initial introductory training and attend staff meetings, further inservice training may well be necessary to maintain interest, and provide a stimulating atmosphere. They have fully justified their inclusion in the domiciliary team. For detailed figures see Appendix page 111 Domiciliary Midwifery Service The number of home confinements has again shown a downward trend, but the midwives have been fully employed caring for planned and unplanned early discharges, and ensuring that every baby born or residing in the borough has a Guthrie test. 25 One interesting development in this service was the choice of a midwife in March, 1969 to start a pilot scheme for domiciliary family planning. All the families are referred to her by other workers and they are invariably families under a good deai of stress. The midwife who works closely with the Local Family Planning Association, has had some success, but the scheme, at present, is only operating on a small scale. For detailed figures see Appendix page 95. Health Visiting Service The staff situation decreased during the last trimester of the year, due mainly to retirement and promotion. Miss M. Warman, Deputy Superintendent Health Visitor, retired in December after more than 30 years devoted service to health visiting in Croydon. Sponsored students continue to be the main source of recruitment. Five successfully completed their training at Croydon Technical College, and a further six students are currently training. The London Borough of Croydon enjoys the services of over 200 Voluntary Workers helping in the Child Health Clinics. Their co-operation has enabled the health visitors to start appointments systems for medical officers in twelve Child Health Centres. It is hoped that by reducing the waiting time in the Centres, the quality of the service to the public will improve. The full effect of the amended legislation relating to child minders has been felt this year in the greatly increased volume of requests for Registration. This has placed a considerable burden of work on this section. Following the retirement of the Specialist Health Visitor, a Deputy Superintendent Health Visitor was appointed to undertake the responsible work of all initial assessments for registration. She continues to inspect and advise the playgroups, whilst the health visitors pay follow up visits to daily minders; but the Deputy Superintendent is always available to help and advise, and even 'wield the big stick' should this be necessary. The Working Party Report on Management Structure in the Local Authority Nursing Services was published in October, 1969, and the recommendations in Chapter Nine, relating to management training have been noted. The necessity to anticipate administrative changes and prepare staff be secondmant to appropriate courses is very much in mind. For detailed figures see Appendix page 106. 26 IMMUNISATION Towards the end of 1968 new recommendations were issued by the Department of Health regarding the timing of the various procedures. The suggested age to commence became 6 months, which agreed with the schedule in use in Croydon Child Health Centres. However, the interval between the 2nd and 3rd doses of polio and triple vaccine was increased to 6 months. Thus many children who received two doses in 1969 will not complete their immunisation until 1970, and the percentage who have been fully protected has necessarily fallen. Every effort will be made to ensure their return for this completion of primary protection, but this scheme is less easily operated than the former schedule of attendances for three consecutive months. As regards vaccination against smallpox, authorities were advised that because of the possibility of accidental infection of an eczematous member of the family, it would be preferable for all routine smallpox vaccinations to be carried out by, or with the knowledge of the family doctor. Efforts to obtain prior agreement of the family doctor or his performance of vaccination were most unsuccessful. The percentage vaccinated between one and two years of age fell to less than half the number in 1968. All family doctors were informed and asked to indicate definitely if they would undertake routine smallpox vaccination, or allow the doctor at the Child Health Centre to proceed after careful questioning of the mother. A list of the doctors specifically requesting reference of all children to them has been compiled, and the figure for 1970 will be examined with this in mind. Measles immunisation was partially suspended because cases of illness followed the use of a certain type of vaccine. There was some alarm by mothers in Croydon whose children had received this suspect virus, but no harmful effects resulted. For Tables see Appendix page 132 27 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 Retirement 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 conditions. During the year 42 cases were so dealt with, 33 women and 9 men. There were in addition, 15 cases where the patients cancelled their applications after the arrangements had been made. HOME HELP SERVICE Miss J.E. Heath, Principal Home Help Organiser It is often said "that women's work is never done", certainly this comment applies to the Home Help Service. The work of a Home Help is not glamourous, exciting or exceptional, but it is rewarding. The reward comes from seeing other people enjoying the privacy and comfort of their own homes even when supportive help is required to manage the home. The provision of physical help is the obvious part of the story, it is viable and can be assessed in hours worked and performance achieved. The friendship and comfort a Home Help brings cannot be calculated. Mechanical aids have taken much of the drudgery from household chores,but nothing has been invented to replace a cheerful greeting and friendly conversation. There were two highlights in the Croydon H.H.S. during 1969, both of which gave further recognition to the training scheme for Home Helps. In June the Chairman of the Health, Maternity and Welfare Sub-Committee was the guest at a meeting at which the Medical Officer of Health took the chair. On this occasion 40 Home Helps were presented with their certificates following the successful completion of their training courses. Press photographs taken there now form part of a collection of a permanent record of achievement within the service. The second event was the filming of some of the Croydon Home Helps in their training flat and in the Health Education lecture room. This excerpt is included in a national colour film which has been produced by the Institute of Home Help Organisers. The film will be available during 1970 on standard 8 mm. The institute hopes to sell copies to Local Authorities throughout the country. 28 Students from overseas, other parts of the United Kingdom and local sources have visited the Croydon Home Help Service and the training flat. They have discussed the value of the Home Help's work in the community and commented on the possible future of the service in the light of the Seebohm Report and the Green Paper on The Future Structure of the National Health Service. For detailed figures see Appendix page 116. HEALTH EDUCATION AND HOME SAFETY Miss D.S. Elliott, S.R.N., H.V. Cert., Dip. H.E. Principal Health Education Officer Throughout the world today health education is accepted as an integral part, a vital component of all public health programmes. As a major approach to gain the participation of people in bringing about immediate action or enduring changes in personal and community health behaviour, it is now often woven completely into the fabric of a programme. A small incident illustrated this thesis during the year. Improved laboratory facilities made it possible for more women to receive a cervical cytology test. Various methods of publicising the extended service were adopted, including in Taberner House, the displaying of posters and application forms in all the ladies' rooms. A satisfying number of forms were returned, but on inspection it was noticed that they came from groups of women in more senior or responsible positions. None came from groups normally 'hard-to-reach' and possibly at greater risk such as the domestic staff, some of whom have large families. To find out more about their reluctance, arrangements were made with their Supervisor for an informal discussion in the Health Education Section one evening. Their reasons for inaction proved to be;— (a) Ignorance (b) Previous operation for hysterectomy (c) Fear of being 'cut' (d) Their husbands did not want them to have it (e) Family planning - those taking the 'pill' being tested regularly at the family planning clinic (f) and basically - shyness. Answers to questions and reassurance that the test would be carried out by a married midwife resulted in eight of the group being tested. An important factor with groups of this kind is that the means for action must follow persuasion within a few days - before the conviction and impetus is lost. Discussion Groups with Mothers Another venture during the year was a series of six talks given by a health education officer and designed especially for mothers assisting in playgroups. They were given in co-operation with a pre-school playgroup and included such topics as heredity, growth and development, play, home safety and sex education, 29 A valuable part of each session was a demonstration with children in the group of different forms of play. The course provided opportunities to study some of the beliefs, attitudes, motives, values and knowledge of the mothers; it demonstrated the potential for involving them and attempted to foster their participation in solving their own problems. Discussion groups in toddlers' clinics continued to flourish in spite of disruption in some areas due to staff changes. It was encouraging to see how well and enthusiastically some of the newly qualified health visitors approached this work. Imagination and energy however, are still required in all groups if mothers are to be persuaded to take an active part and gain the maximum benefit from educational opportunities. Mental Health The Croydon Association for Mental Health organised an exhibition in the Sun Lounge of the Fairfield Hall during Mental Health Week, with the assistance of the Health Education and Mental Health Sections and were satisfied that this was a good public relations exercise. In an attempt to stimulate and interest patients, Mr. Muller - Organiser of the Volunteer Aid Project asked for Health Education staff to hold sessions in Rees House, the Oaks and Salcot Crescent Day Centres. Topics included:— Housework with ease, diet and weight control, and accident prevention. The demonstrations evoked some amusement and response. Health Education in Commerce and Industry Staff from the Food Information Centre in Park Lane visited the Health Education Section several times and members of the health and welfare departments reviewed a pamphlet on nutrition for elderly people living alone. Sessions on personal hygiene were given during a training course for new staff at Grants Bros.; on food hygiene to the whole staff at Marks and Spencers and on smoking and health at I.P.S. Business Press. In'service Training Sessions held in the Health Education Section 1. Health visitors held monthly meetings, to which guest speakers were invited. 2. Doctors and health visitors continued to benefit from fortnightly lunchtime meetings with Dr. Crosse, Child Psychiatrist, on early diagnosis and treatment of behaviour problems in young children. 3. Mr. Palmer, Chief Dental Officer, discussed with the doctors the incidence and types of dental disease in children. 4. Regular sessions on the prevention of food poisoning were given throughout the year with school cooks and kitchen staffs. 5. Dr. Rosemary Graham, Paediatrician, spoke on modern methods of infant feeding at a special evening meeting for doctors, health visitors and midwives. 30 6. Sessions on the supporting services for the family, accident prevention and childbirth were given by health education staff to the Home Help courses. 7. A week's course was held for district nurse group leaders learning to manage a small group of nurses and to train pupil nurses. 8. Health visitors, midwives and physiotherapists took part in a one-day course on preparation for childbirth, which resulted in a better understanding of the role of each discipline and a new syllabus. The Health Education Section was also visited regularly by pre-nursing and nursery nurse students from Croydon Technical College and by teachers, health visitor students, health visitor fieldwork instructors, health visitor and nurse tutors for discussion and demonstrations of health education in practice. They came one or more times from fourteen different colleges in London and the South East. Regular sessions on the social aspects of disease continued at Mayday and Croydon General Hospitals. Time was also given to World Health Organisation Fellows and other visitors from overseas studying public health and health education services in Great Britain. Thev came from:— Finland Sweden Denmark Greece Yugoslavia Australia Ireland Israel Pakistan and Ceylon Home Safety A completely new set of home safety and health education topics were demonstrated at the Ashburton Flower Show and each stand was designed to encourage the participation of the public and also so that it could be used in other educational activities afterwards. Education in accident prevention becomes more difficult as more dangerous drugs and substances and more complicated domestic appliances appear on the market. There will be an increased need soon for the in-service training of staff on the technical aspects of accident prevention. In spite of staff changes within the Health Education Section the volume of work increased greatly during the year. The additional help given by health visitors, public health inspectors and doctors was very much appreciated. For details see Appendix page 114. 31 DENTAL SERVICE (MATERNITY AND CHILD WELFARE) J.D. Palmer, B.D.S.(Lond.) L.D.S., R.C.S.(Eng.)Chief Dental Officer Some general comments on the Local Authority Dental Service are contained in the Annual Report of the School Dental Service. A free dental service is provided for expectant and nursing mothers and pre-school children in the Local Authority's clinics. Taking the figures from last year's report that there approximately 11,400 three and four year old children in Croydon, only 911 (8%) were examined at the dental clinics during the year. In a recent article a professor of children's dentistry pointed out the inadequacy of dental care for pre-schooi children; less than 25% of this priority group receive any dental treatment at all, and at a national level only 3% under the local authority services. There is an obvious need to improve the services for these children, particularly if it is hoped to limit the onset of dental disease or control its severity. In many cases parents just do not know that children should be seen regularly from about the age of three onwards, and few realise that a comprehensive service is available in the dental clinics as well as under the National Health Service for these patients. Educating the parents in the establishment of favourable dietry and oral hygiene patterns, as well as the need for routine dental care from an early age, is very important. Throughout the year talks have been given to groups of mothers at Toddlers' Clubs on these matters, and with the arrival of the Dental Auxiliary in October/who is trained in dental health education, this important contact with mothers of the very young is being extended and expanded at the ante- and post-natal clinics in the Borough by enlisting the active support and co-operation of the Health Visitors and others in the promotion of good dental health from the beginning of life. The three year old birthday card scheme continues successfully at Sanderstead, with 245 cards being sent out in 1969, and in response to this 77 children (31%) attended for routine examination. However, it is impossible to assess how many parents were made aware of the need for dental care by the receipt of this card. When finances permit it is hoped to enlarge this scheme to cover the rest of the Borough. For details of treatment see Appendix, page 117. 32 MENTAL HEALTH SERVICES Administration The Medical Officer of Health is in administrative control, and the Deputy and two Assistant Medical Officers of Health are approved for the purpose of the Mental Health Act. Dr. J.D.W. Fisher, Consultant Psychiatrist at Warlingham Park Hospital is Psychiatric Adviser to the Local Health Authority and the Medical Director of their community mental health services. Dr. B.W. Richards, Consultant Psychiatrist at St. Lawrence's Hospital continues as adviser in mental subnormality. My thanks are again due to medical colleagues both in hospitals and general practice for their help and co-operation without which the continuing successful operation and development of the Mental Health Services would not be possible. Voluntary Associations Thanks are due to the increasing number of volunteers and voluntary organisations who have given generously of time, effort and money during the year to help the mentally handicapped and the mentally ill. The interest and concern expressed in this very practical way is tremendously encouraging and enables the scope and quality of the Mental Health Service to be greatly extended. Special mention must be made of The Croydon and District Society for Mentally Handicapped Children, The Mental After-Care Association, The Guardianship Society and The Croydon Association for Mental Health all of whom have been very closely associated with the Mental Health Service and with direct help to patients, but reference is also due to The Croydon Guild of Social Service and to many other voluntary organisations and individuals who give so wiilingly of time and resources to help Croydon patients. The Croydon Volunteer Aid Project has continued, successfully during the year, and it is hoped when this experiment is concluded to continue the work as an established part of the Mental Health Service. Through its residential homes the Mental After Care Association continues to help many Croydon patients 27 of whom were resident in the Association's Homes at the end of the year. Admissions under the Mental Health Act 1959 Males Females Total Admitted informally 40 52 92 Under Section 25 (For observation) 35 67 102 Under Section 26 (For treatment) 24 35 59 Under Section 29 (for observation in emergency) 63 142 205 33 Males Females Total Under Section 60 (Hospital Order through Court) 3 3 Under Section 136 (Police Action) 1 2 3 Investigated but not admitted 48 92 140 214 390 604 In Netherne and Cane Hill Hospitals Mental Welfare Officers were concerned with 28 Section 25 procedures, 23 Section 26 procedures, and 3 Section 29 procedures. 1968 1969 Informal Admissions 95 92 i.e. fall of 3.1% Emergency admissions S.29 191 205 i.e. rise of 7.3% Investigated but not admitted 73 140 i.e. rise of 91.8% Total admissions under Sections 353 372 i.e. rise of 5.4% Total cases dealt with 521 604 i.e. rise of 15.9% Guardianship During 1969 the Guardianship of one patient under the Local Health Authority lapsed, and the total number under Guardianship was thus reduced to 15. Training Centre Coldharbour School, the new purpose built centre in Purley Way, was officially opened by His Worship the Mayor in March 1969. This school provides 108 places for mentally handicapped children including 24 special care places for severely handicapped children and 24 nursery places. In addition 15 p aces are still provided in the Surrey County Council's centre at Caterham. There are plans for a second purpose-built school in the north of the Borough. During the year a parent-teacher association was started at the new Coldharbour School. Parents have also shown their keen interest through the Croydon and District Society for Mentally Handicapped Children. The society has been keen to help in any way and special thanks are due for the gifts of a television set and a teaching machine. Day Hospital/Day Centre Adaptation of part of the former CounciI Offices in Purley provided very good accommodation for a 50 place Unit representing a further joint scheme of the hospital and local authority. It was opened in October. If the former day hospital in Thornton Heath can be re-opened in 1970, the plan to provide one of these centres for each 100,000 of the population will be fulfilled. 34 Day Centre For some time the need has been felt for a day centre where elderly or more chronically disabled patients could attend by the day for care and occupation. An opportunity was taken in 1969 to run such a centre experimentally at "The Oaks", Thornton Heath. This experiment confirmed the need and proved so successful that it is planned to develop this facility further in the future. During the year between 30 and 40 patients were able to attend with consequent benefit to themselves and help to their relatives. Residential Care (i) Temporary Care In 39 instances short term care for mentally handicapped patients was made through the hospital service, and convalescent holidays were arranged for 20 patients, and 31 on two group holidays during the year. Temporary residential care for patients recovering from mental illness continues to be provided through the Mental After Care Association's hostel in Croydon. (ii) Long Term Care (a) Boarding Out Scheme During 1969 41 patients were found lodgings through the scheme, 9 more than the previous year. Of these 25 were still in lodgings at the end of the year, 12 had moved on to other accommodation and 4 had been re-admitted to hospital. A total of 83 patients were living in such lodgings at the end of the year. Again tribute must be paid to the landladies who participate in the scheme and make it such a successful aid to the rehabilitation of patients. (b) Group Homes The 5 small group homes already established continue to run smoothly and provide accommodation for 31 residents. Social Work At the end of 1968 the number of active cases carried by the social worker was over 1300 and represented new high level in the history of the service. During 1969 the pressure of work has increased still further and despite a number of staff changes the total work load ran at over 1400 action cases throughout the year. The number of requests for social work assistance was also substantially greater than in any previous year and the social workers were concerned in helping about 2,500 people during the year. In addition to social work assistance to individual patients and relatives group work has also been developed whereby a number of persons can be helped together. The social workers are concerned in five such groups catering for about 50 persons and representing different categories of need. 35 Students The Training Officer continues to supervise the practical work of student social workers in the service. In 1969 some 20 students attended for practical training and contributed to the life and work of the service. Visitors Again this year visitors have come from many countries and from other local authorities and Hospitals in this country, to be shown the mental health services provided by this Borough. The Unified Industrial Therapy Service The progress of this service was steady and unspectacular in a year dominated by the transfer of the headquarters of the service (the Crosfield Industrial Unit) to a new purpose built factory. Diagrams showing the structure of the service and the functions of the centres in it can be found on pages 125 - 127. Other relevant statistics appear on pages 122 - 124. The principles of the service - the rationalisation and centralisation of contract seeking - have now been applied for over four years and are firmly established. During 1969 a Psychiatric Day Centre and a Day Hospital (new additions to the mental health service) were incorporated into the organisation. The total value of completed contracts amounted to £72,000. I again record with appreciation the support, guidance and advice given by the local industrialists who make up the Crosfield Industrial Advisory Panel, and the Croydon & District Society for Mentally Handicapped Children. Mention must be made of the Department of Employment & Productivity, not only for its generous grant towards the cost of building the new Crosfield factory, but for the co-operation which has been extended at all levels by officers of that Department. The three principal Health Department units in the service are:— (i) the Crosfield Industrial Unit (the Sheltered Workshop); (ii) the Bensham Assessment & Rehabilitation Centre and (iii) the Waylands Craftwork, Training & Social Centre (Health Wing). 1. Crosfield Industrial Unit This unit for severely disabled persons of all categories is a sheltered workshop, approved as such under the Disabled Persons (Employment) Acts 1944/58. It is the headquarters and principal co-ordinating agency of the industrial therapy service. 36 All but four of the severely disabled are full-time employees, appointed under special terms and conditions of service. A full 40-hour week is worked, with the men earning £10. 16s. 8d. per week and the women £8. 0s. 10d. Responsibility allowances of up to £2 weekly may also be paid. Travelling expenses up to 4/- daily and free midday meals are provided. Two weeks paid holiday is given each year and trade union membership is open to every employee. An interesting opportunity arose during the year to place a supervised group of disabled persons with an outside firm to meet a short term labour need. See Appendix, page 122. 2. Bensham Assessment & Rehabilitation Centre This centre provides industrial work assessment for disabled persons who may eventually be capable of open employment. It was primarily established to provide a service for the mentally disordered, although some physically disabled persons can also be accommodated if alternative provision is not available. It is run by the Council, with the active support and participation of the Department of Employment & Productivity. Persons admitted to the centre are allowed to attend for up to 12 months. By the end of that time, and preferably sooner, they must move on - either to open employment, to sheltered work, or, in the event of failure, back to the centre or hospital which referred them. See Appendix, page 123. 3. Waylands Craftwork. Training & Social Centre This centre has three aims - to provide social activities and entertainment for disabled persons of all categories in leisure hours, i.e. evenings and weekends; to supply a wide range of occupational pastimes for 80 physically handicapped persons during weekdays and to function - in a separate wing-as an adult training centre for 120 mentally handicapped persons. The information given in Appendix, page 123, refers only to the latter section - the remainder being the responsibility of the Chief Welfare Officer. 37 CORPORATION DAY NURSERIES There are two day nurseries in the London Borough of Croydon, one at Whitehorse Road, 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, cn a scale approved by the Corporation. Subject to places being available, children may be accepted at the full rate of £1. 8. Od. as from 1st December 1969. Whitehorse Road Hazleglen Sanderstead Road Details of attendances - Capacity 50 30 Number on books at the end of year 50 30 Attendances: Under 2 3,674 1,210 Over 2 5,907 4,008 Total 9,581 5,218 Number of days opened 255 255 Average daily attendance 37.6 20.5 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 child health centres, and where staffing permitted, by home visits of health visitors. For detailed figures see Appendix, page 105. 38 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 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. It has proved a successful and popular service, and requests for increases were limited only by financial consideration. For the past three years in New Addington, the complete absence of any private chiropodist's surgery within the scheme has necessitated the provision of a Corporation clinic, and the engagement of a part-time chiropodist for 2 sessions a week, Similar facilities were provided at the "Waylands" Training Centre where up to 100 physically handicapped persons may attend each day and many need chiropody. On December 31st 1969, 26 chiropodists were operating this scheme. During the period January 1st to December 31st 1969, they gave 21,837 treatments at their surgeries and 6,162 by domiciliary visits. 459 treatments were given at Parkway Clinic, New Addington and 289 at "Waylands". CERVICAL CYTOLOGY Early in 1969 the Regional Hospital Board Laboratory increased their facilities and offered to take one hundred new cases per week. In spite of increased publicity this target was not reached. The approach to industrial and commercial firms offering sessions in their premises was disappointing, nevertheless fifteen sessions were held as a result of this publicity, and there was an overall increase of 1,000 slides during the year. Requests for this service from younger women increased and late in 1969 the age was reduced from thirty-five years and over, to twenty-five years, priority being given to the older age groups. This reduction in age produced two class three results. For detailed figures see Appendix, page 119. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 41 WORK OF THE PUBLIC HEALTH INSPECTORS W. Haworth, F.A.P.H.I. Chief Public Health Inspector. I have the honour to submit a report on the work of the Public Health Inspectors for the year 1969. In the early part of the year a re-appraisal of the duties and establishment of the Public Health Inspectorate took place and as a result three District Inspectors were promoted to Senior Inspector one of whom will concentrate in future on the inspection of food premises and catering establishments in the centre of the town. Two Technical Assistants have been appointed to assist with general district work and it is hoped to fill the two remaining vacancies for Inspectors, with students who should qualify in 1970. The new arrangement appears to be working reasonably well. As always, housing duties continued to provide a lot of work, and during the year the coming into force of the Housing Act, 1969, involved the Department, In liaison with the Borough Valuer, in a completely new sphere of activities. The introduction of a new and higher standard of conditions to qualify for an Improvement Grant and/or a Qualification Certificate, (the latter to enable a rent increase to be obtained), necessitates a very close working arrangement with the Borough Valuer who administers the Improvement Grant provisions of the Act. This has now been put into operation and early experience suggests a satisfactory outcome. It is hoped that the provisions in the Act, which has the object of improving the general condition of the housing stock in the country, will prove successful. The new Act also amends certain provisions dealing with houses in multiple occupation, and this sphere of activity in the Department is only limited by the staff available. Another chapter in the long history of the department, came to an end with the closing down of the West Croydon Men's Hostel, Pitlake in November, consequent upon the road improvement scheme in the Pitlake area. All the remaining residents were accommodated elsewhere and the building has since been demolished. The building was officially opened in July 1894 as the Municipal Lodging House and it provided accommodation at the time for sixty-six men and thirty-four women. In 1897 control of the building was taken over by the Croydon Sanitary Committee and two years later in 1899 rising costs made it necessary to increase charges from 5d to 6d a night or 3s weekly. Apparently inflation was something of a problem even in those days. 42 The Borough's Smoke Control Policy has continued and Smoke Control Order No. 12 was made in December, 1969 and awaits confirmation. It is regrettable that in spite of Government pressure to implement a Clean Air Policy in the "black areas" the coal industry has not kept pace with the demands for solid smokeless fuel. It is hoped and believed that this is only a temporary phase aggravated by the gas industry's rapid change-over from coal carbonisation to oil reforming in the production of town gas. If anyone has any doubts as to the benefits obtained from smoke control he should study the recent report produced by the Greater London Council Research and Intelligence Unit for the London Boroughs Association, on the Progress and Effects of Smoke Control in London." This report is a complete vindication of a policy sometimes critised on the grounds of expense. The administration of the Offices, Shops and Railway Premises Act, 1963 has continued at a reasonable pace, again limited by the availability of staff and in many cases the complex nature of the work. More detailed comment is made on page 67 of this report and the Inspectors concerned are to be complimented on the results achieved. In concluding this introduction to the report I should like to express my appreciation of the support and encouragement of the Chairman, ViceChairman, and members of the various Committees, the guidance and confi* dence of Dr. S.L. Wright, Medical Officer of Health and the very willing help and loyalty of the whole of my staff. 43 HOUSING The following is a summary of work carried out in respect of the sanitary condition of dwelling houses during the year:- 1. Inspection of Dwelling Houses (i) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 4,209 (ii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (a) In Clearance Areas - (b) Other than in Clearance Areas 11 2. Remedy of Defects during the year without service of Formal Notices - Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 900 3. Action under Statutory Powers during the year (a) Proceedings under Sections 9, 10 and 12 of the Housing Act, 1957:- (i) Number of dwelling houses in respect of which notices were served requiring repairs 231 (ii) Number of dwelling houses which were rendered fit after service of formal notices (a) By owners 252 (b) By Local Authority in default of owners 22 (b) Proceedings under the Public Health Acts - (i) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 925 (ii) Number of dwelling houses in which defects were remedies after service of formal notices (a) By owners 648 (b) By Local Authority in default of owners 72 (c) Proceedings tinder Sections 17 and 23 of the Housing Act. 1957 - (i) Number of dwelling houses in respect of which Demolition Orders were made 7 (ii) Number of dwelling houses demolished in pursuance of Demolition Orders 13 (iii)Number of dwelling houses in respect of which Closing Orders were made 4 44 (d) Proceedings under Section 18 of the Housing Act, 1957 - (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made 9 (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 7 4. Houses in Multiple Occupation- (i) Number of Houses in multiple occupation inspected during the year 165 (ii) Number of houses in which defects were remedied following service of formal or informal notice under Section 9, Housing Act 90 (iii) Number of houses in which additional amenities were provided following service of formal or informal notices under Section 15 of the Housing Act. 103 (iv) Number of houses in which fire prevention works were completed following service of formal or informal notices under Section 16, Housing Act 118 5. Rent Act, 1957 - Certificate of Disrepair - (i) Number of applications for certificates 6 (ii) Number of certificates issued 5 (iii) Number of applications by landlords for cancellation of certificates 6 (iv) Certificates cancelled 6 HOUSING ACT, 1969 Since the introduction of this Act in August, 1969 some 344 houses have been inspected and reported upon to enable the Borough Valuer to determine applications for Improvement Grants and/or Qualification Certificates. 45 FACTORIES ACT. 1961 During the year the under-mentioned inspections have been made and defects were found as set out. Part 1 of the Act INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors) PREMISES Number on Register Number of Inspectlons Written notices Occupiers prosecuted (1) (2) (3) (4) (6) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 65 17 1 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 1,137 193 11 - (iii) Other Premises In which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 77 85 - - 1,279 295 12 - Cases In which DEFECTS were found:— PARTICULARS Number of cases In which defects were found N umber of cases in which prosecutions were Instituted Found Remedied Referred To H.M. Inspector Br H.M. Inspector (1) (21 (3) (4) (5) (6) Want of cleanliness (S.I) 2 2 - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 2 2 - - - Ineffective drainage of floors (S.6) - - - - - Sanitary-conveniences (S.7) (a) Insufficient 5 5 - - - (b) Unsuitable or defective 23 23 - 2 - (c) Not separate for sexes 3 3 - - - Other offences against the Act (not including offences relating to Outwork) 29 29 - - - TOTAL 64 64 - 2 - 46 PART VIII OF THE ACT Outwork Section 110 Section 111 Nature of Work No. of out workers in August list required by Sect. 10 11) (c) No. of cases of default In sending lists to the Council No. of prosecutions for fellure to supply lists No. of Instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Lampshades 19 - - - - - Embroidery and Tapestry Printlno 13 - - - - - Paper bags and Cardboard boxes 10 - - - - - Christmas cards, Christmas crackers and stockings 37 - - - - - Tool assembly 13 - - - - - Wearing apparel 112 - - - - - Perfumery, Toiletries, etc. 8 - - - - - Carding of buttons etc. 149 - - - - - Artificial flcwars 1 - - - - - Curtain and furniture hangings 16 - - - - - TOTAL 378 - - - - - OFFICES, SHOPS AND RAILWAY PREMISES ACT. 1963 TABLE A * Registrations and General Inspections Class of Premises Number of Premises Registered during the year Total Number of Registered Premises at end of year Number of Registered Premises receiving a general Inspection during the year (1) 12) (31 (4) Off ices 108 1,263 110 Retail Shops 133 1,943 350 Wholesale Shops, Warehouses 7 111 24 Catering Establishments open to the public. Canteens 62 229 46 Fuel Storage Depot - 2 - TOTALS 310 3,648 530 TABLE 8 - Number of Visits of all kinds by Inspectors to Registered Premises 3,124 47 TABLE C - Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace Number of Persona Employed (1) (2) Offices 30,305 Retail Shops 12,707 Wholesale Departments, Warehouses 2,231 Catering Establishments open to the public 3,019 Canteens 583 Fuel storage depots 23 TOTAL 48,868 Total Males 23,487 Total Females 25,381 TABLE D - Exemptions No exemptions were granted under the Act during the year TABLE E - Prosecutions There were no prosecutions under the Act during the year. The majority of inspections carried out under the Act are undertaken by a Specialist Public Health Inspector assisted by three Technical Assistants. In addition, the public health inspectorate (establishment - 21)carry out inspections at food premises to avoid duplication of visits. Three members of the clerical staff are employed part time on work in connection with the Act. 48 REMEDIAL WORKS ETC. CARRIED OUT Accident Prevention Measures 36 Abstract of Act Provided 190 Clothing Accommodation Provided 29 Drainage Defects Repaired Lack of Cleanliness Remedied 10 Drinking Water/Vessels Provided 6 Eating Facilities Provided First Aid Equipment Provided 191 Floors, Stairs, Passages Repaired etc. 163 Heating Provided 26 Lighting Provided 73 Machines Guarded 44 Overcrowding abated 13 Premises registered 310 Sanitary Accommodation Provided 3 Intervening Ventilated Space Provided 9 Defective Sanitary Accommodation Repaired 46 Labelling of Sanitary Accommodation 26 Staff seating facilities Provided 7 Thermometers Provided 142 Ventilation Provided 96 Walls, Ceilings etc. Repaired 244 Washing Facilities - Wash Basins Renewed/Provided 28 " Hot Water Provided 61 - Nail Brushes, Soap and Towels Provided 14 Provision of Disposal for Sanitary Dressings 3 Defective Electrical Wiring Remedied 32 Accumulations of Rubbish Removed 23 49 EMPLOYMENT AGENCIES These Agencies, which include "au-pair" agencies are licenced annually and inspection of the records kept by these firms is carried out to ensure that the provisions of the Act are complied. In most cases the premises concerned are also subject to the provisions of the Offices, Shops and Railway Premises Act, 1963. There are 91 agencies registered and regularly inspected in the Borough. SHOPS ACTS, 1960 - 65 The Shops Acts regulate the closing hours of shops and the working hours of shop assistants. Failure to observe "closing hours" has given little cause for complaint during the year. 520 inspections were made under the Shops Acts; infringements remedied were as follows:— Hours of Closing 1 Notices to be exhibited or amended 213 Meal Intervals not granted to Staff 1 Opening Hours of Launderettes 4 The following complaints were received during the year and investigated. 1. Selling motor cars on seven days per week and after the general closing hours. 2 2. Selling goods from a "general" shop on a Sunday not permitted by the Fifth Schedule of the Shops Act, 1950. 1 3. Insufficient meal intervals for a shop assistant in a restaurant. 1 4. Excessive hours of work of a young person in a hairdresser's establishment. 1 5. Loss of Assistants' Weekly Half Holiday 3 6. Failure to exhibit statutory notices respecting Assistants' Weekly Half Holiday and statutory records of young persons employment not kept. 1 PROSECUTIONS UNDER SHOPS ACT, 1950 There were no prosecutions under the Act during the year. 50 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 77 such inspections were made. HAIRDRESSING ESTABLISHMENTS Legislation calls for the registration of hairdressers' and barbers' premises. During the year 156 inspections were made of registered premises to check that the Byelaws in force were being observed. Generally little cause for complaint was found. 13 new Registration Certificates were issued. DRAINAGE 2,968 visits of inspection were made to underground drains in course of repair. The transfer of Hooley and Farleigh to Banstead and Godstone respectively had the effect of reducing the number of cesspools within the Borough and there are now 40 cesspools serving premises without main drainage. POLLUTION OF RIVERS AND STREAMS During the year 5 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. CONSUMER PROTECTION ACT 1961 The provisions of the Heating Appliances (Fireguards) Act, 1952 and Regulations made thereunder have now been incorporated in the Consumer Protections 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, 1966, came into force on 1st June, 1966 to amend and extend the 1962 Regulations, which imposed requirements as to construction, design and performance of domestic space heaters. In October 1964, the Children's Nightdresses Regulations 1964 came 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. 51 Regulations have been introduced governing the safety of stands for carrycots, and the labelling of nightdresses to indicate the flammability of the materials used. Regulations also govern the use of certain materials in the manufacture of toys and, during the year, two toys were submitted for chemical examination and found satisfactory. Visits are made to shops trading in these articles to ensure that the requirements of the Regulations are conplied with. THE FABRICS (MISDESCRIPTION) ACT, 1913 THE FABRICS (MISDESCRIPTION) REGULATIONS, 1959 The above mentioned Regulations prescribe standards of non-flammability for textile fabrics which claim to be non-flammable. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 The above Act, prohibits the keeping of a boarding establishment for animals (defined by the Act as cats and dogs) except under licence granted by the local authority. Licences are granted subject to conditions attached thereto. During the year five 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. THE SCRAP METAL DEALERS ACT, 1964 This Act requires 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. Speciai 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 5 new licences were issued to local dealers. 52 THE RIDING ESTABLISHMENTS ACT, 1964 This Act 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. Two licences have been granted to local establishments. CAMPING SITES The Caravan Sites and Control of Development Act, 1960, 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. One site licence was in force during the year as follows:— Address No. of Caravans Period of Licence Dennards Yard, Magdala Road, Croydon. 1 Indefinite period. Site licence conditions require a water carriage system of drainage, main water supply and fire precautions. 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. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 No. 8 No.'9 No. 10 No. 11 No. 12 No. of premises (incl. Factories and Commercial) 2,076 3,042 4,501 5,547 7,042 6,220 8,198 7,198 6,158 6,670 7,099 6,007 No. of dwellings 1,916 2,686 3,915 4,112 6,651 5,885 7,788 6,777 5,605 6,351 6,573 5,865 Acreage 620 265 332 710 570 470 1,060 460 554 596 588 439 Date of Order 22.12.58 26. 2.60 22.11.60 24.11.61 17.12.62 18.11.63 21.12.64 20.12.65 19.12.66 18.12.67 27. 1.69 15.12.69 Date of Operation 1. 4.61 1.10.61 1.10.62 1. 7.63 1. 7.64 1. 7.65 1. 7.66 1. 7.67 1. 7.68 1. 7.69 1. 7.70 1. 7.71 53 The District Inspectors keep observation on the various factory chimneys within their districts with a view to observing any contravention of the Clean Air Act in respect of smoke and grit emissions. During the year 39 plans showing the construction and heights of new chimneys were examined and in 33 cases additional height was requested and agreed. 57 notices of the installation of new furnaces were received, 36 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 during the year:— By Steam 9,316 articles. By Formalin Gas 453 articles Total 9,769 articles 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. Disinfection was carried out after infectious or contagious diseases as follows:— 46 rooms, hospital wards, clinics etc. 39 library and other books. On request disinfection was also carried out for conditions other than notifiable infectious diseases and for which a charge is made. During the year £36. 15s. 6d was paid for such services. 1,472 items of home nursing equipment were disinfected. CLEANSING OF VERMINOUS, ETC.. PERSONS A cleansing station consisting of a reception room, three bathrooms and a discharge room is attached to the Disinfecting Station and is used for dealing with verminous, etc. conditions in adults and children. A woman attendant deals with children and women. During the year 5 adults and 8 children were cleansed of verminous conditions and 15 adults and 21 children were treated for scabies. 54 DISINFESTATION OF PREMISES Modern insecticides provide 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 151, either by spraying or fumigation. NOISE ABATEMENT During the year 116 complaints were made regarding noise alleged to be a nuisance. In 80 cases no action was warranted. In 29 instances the noise complained of was abated, or reduced so as not to be a nuisance and 7 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 15. In addition, 165 applications were made for the retention of names on the list for a further 12 months. No infringement of the Act was 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 corrpelIing the use of clean fillings. Only one firm is now engaged in this type of business within the Borough. Three samples of cotton felt were taken. All of these samples conformed with the requirements of the Regulations made under the Act. PET ANIMALS ACT, 1951 This Act governs the sale of pet animals and during the year 20 licences were renewed and 3 new licences issued. During the year 55 inspections were made and little cause for complaint relating to conditions specified in the licences were found. 55 DISEASES OF ANIMALS ACT No case of contagious animal disease was reported within the Borough during the year. In such cases action is taken in conjunction with officers of the Ministry of Agriculture, Fisheries and Food to provide against the spread of the disease. Regular visits are made by district inspectors to premises where animals are kept to ensure that precautionary measures and a high standard of cleanliness are maintained. The recent cases of rabies among animals imported from abroad has given rise to amended legislation and increased vigilance against this disease and appropriate action was taken when a local veterinary surgeon reported a suspected case of rabies in a young dog. Subsequent laboratory examinations fortunately revealed that the animal had suffered from a less serious and non-infectious illness. PREVENTION OF DAMAGE BY PESTS ACT, 1949 This Act is mainly concerned with the destruction of rats and mice and places a duty upon the occupier of any premises to report to the Local Authority any infestation by such rodents. Three rodent operatives are employed full time to deal with complaints. During the year 3,673 premises were inspected following complaint and in 3,222 instances infestation was confirmed and dealt with by the rodent operatives. In addition, 30 premises were inspected for reasons other than complaint. 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, depots, school kitchens and serveries etc. are periodically inspected for the presence of rodents and appropriate action taken if the premises are infested. Recent evidence indicates that there is no heavy rat infestation of the Corporation's foul water sewers and, during the year, 202 manholes were test baited. Further treatments are planned to cover the whole Borough and treatment has also been carried out in two areas where sewer infestations were suspected. FOOD SUPPLY The supervision and inspection of 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, 1,339 are registered under Section 16 of the Food and Drugs Act, as follows:— 56 Retail sale of ice-cream 1,048 Manufactures of ice-cream Nil Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 291 During the year 4,403 inspections and re-inspections were made of food businesses. FOOD HYGIENE (GENERAL) REGULATIONS, 1960 The following table shows the premises in the Borough at which food is sold, 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 1969 No. to which Sec. 19 applies No. of sinks fitted to comply with Sec. 19 during 1969 Bakehouses and Bakers Shops 116 1 116 1 Sugar Confectioners Cafes, Restaurants. 418 2 376 3 Snack Bars, etc. 257 9 257 8 Works & Club Canteens 426 12 426 18 Licensed Premises 166 10 166 8 Off Licences 116 4 24 - Grocers 405 3 372 3 Butchers 185 6 185 4 Wholesale Meat Markets 11 - - - Chemists 85 - 85 - Greengrocers 205 - 205 1 Fishmongers 46 3 46 3 Fried Fish Shops 44 2 44 4 Milk Distributors and Dairies 287 2 256 2 Premises from which Roundsmen & Mobile Shops operate 101 - 101 - Food Manufacturers 17 - 17 - Supermarkets and General Shops 180 3 94 7 57 FOOD AND DRUGS ACT, 1955. FOOD HYGIENE (GENERAL) REGULATIONS, 1960, AS AMENDED AND FOOD HYGIENE (MARKETS, STALLS AND DELIVERY VEHICLES) REGULATIONS. 1966, AS AMENDED Food Premises Structural defects In shops and stores remedies - Defective condition of walls, ceilings, doors and window glazing 304 Defective condition of floors, utensils, fixtures, etc. remedied 180 Defective or insufficient drainage repaired 10 Lighting, heating or ventilation provided 64 W.C. accommodation - repair or cleansing 65 - artificial lighting provided 3 - Intervening ventilated space provided 8 Food - now stored 18 ins. off floor 11 " - means to prevent risk of contamination provided 79 * -store provided or repaired 28 Accumulations in yard or stores removed 57 Offal and refuse bins provided 44 Yard paving repaired 1 Hand washing notices exhibited 52 Ablutions - Wash basins provided 56 - Hot water supplies provided 96 " - Nail brushes, soap and towels provided 79 Clothing accommodation provided 13 Sinks installed 62 Smoking offences abated 9 Defective or unsuitable table tops replaced 24 First Aid kits provided 38 Cleanliness - advice given 8 Rats/Mice Infestation abated 16 Repair/Cleansing of Machinery/Refrigerators 97 Leaflets on Food Hygiene supplied 87 Stalls and Delivery Vehicles Wash hand basins/Sinks with hot water provided 16 Nail brushes, soap, towels provided 7 First Aid kits provided 7 Washable overclothing provided 19 Name and address boards supplied 51 Food now stored 18 ins. off floor 3 Accumulation of refuse etc. 4 Receptacles for waste food provided 7 Screening for stalls provided 12 Cleanliness of Stalls and Vehicles remedies 18 Advice given on Storage of Stalls - Lighting of StalIs/Vans improved - Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by Inspectors during the year:- 58 Articles Weight in lbs. Carcase Meat 24,591 Offal 2,815 Sundry Foodstuffs 13,681 Canned, Bottled and Packet Foods 29,612 Total 70,699 Disposal of Condemned Foodstuffs Meat condemned at wholesale meat markets or at shops, and other condemned foodstuffs, are destroyed by incineration. MEAT INSPECTION District inspectors examine home killed and imported carcase meat and offal at the 11 wholesale meat depots in the Borough. Meat exposed for sale is inspected in butchers' shops. The Diseases of Animals (Waste Foods) Order, 1957 The uraer provides that, in general, all waste foods 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. MILK SUPPLY During the year 62 inspections were made of dairies and premises from which milk is sold. The Milk (Special Designation) Regulations 1963 The following licences have been granted during the year to dealers distributing milk from premises in Croydon. Licences to use the designation "Pasteurised" - (a) Dealer s (Pre-packed Milk) Licences 35 Licences to use the designation "Sterilised" - (a) Dealer's (Pre-packed Milk) Licences 10 Licences to use the designation "Untreated" — (a) Dealer's (Pre-packed Milk) Licences - Licences to use the Designation "Ultra Heat Treated" — (a) Dealer's (Pre-packed Milk) Licences 7 Frequent inspections of these licenced premises are carried out during the year to see that the conditions of the licences are observed. 59 Bacteriological Examinations of Milk During the year the following samples of milk were examined:- Pasteurised Milk 123 Sterilised Milk 17 Untreated Milk 12 Ultra Heat Treated 6 The following tables summarise the results of bacteriological examinations of pasteurised, sterilised and untreated milk samples during the year:- Untreatad Milk Methylene Blue Teat No. Samples Taken Not Satisfied Satisfied 12 - 12 The above samples of raw milk were also examined for the presence of brucella abortus and antibiotics. In all cases the results of the tests were negative. Pasteurised Milk Methylene Blue Teat No. Samples Taken Not Satisfied Satisfied 123 - 123 Sterilised Milk Turbidity Teat No. Samples Taken Not Satisfied Satisfied 17 • 17 Ultra Heat Treated Milk Colony Count No. Samples Taken Not Satisfied Satisfied 6 - 8 Bacteriological Examination of Milk Bottls Rinses Bottle Rinse Samples -25 Satisfactory - 23 Unsatisfactory -2 BACTERIOLOGICAL EXAMINATION OF CREAM One sample of fresh cream was examined and gave a satisfactory result. 60 BACTERIOLOGICAL EXAMINATION OF ICE CREAM 105 samples were taken, the results being:- Grade No. of Samples 1 74 2 15 3 10 4 6 In all cases after the results of sampling are known, the vendors and/ or manufacturers are made aware of the reports, 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 One sample was taken from a local shop and was found to comply with the standard. THE LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 These Regulations provide that liquid egg shall be pasteurised before use in food intended for human consumption. There is no egg pasteurisation plant in Croydon. 16 samples of liquid egg obtained from local bakeries and submitted to the prescribed alpha-amylese test proved satisfactory. FOOD AND DRUGS ACT, 1955 During the year, 158 samples of milk and cream, and 298 other samples were taken, of which number, 20 were found to be "Not Genuine", details of which are set out below:— Article Nature of Adulteration or Deficiency Remarks Pasteurised Milk Pasteurised/Homogenised Milk Sterilised Milk These samples contained a small amount of added water Precautions taken by Firms concerned to avoid any recurrence, and subsequent samples taken have proved satisfactory Sterilised Milk This sarrple was deficient In milk solids other than milk fat ,, ,, Pork Sausage (Preserved) Beef and Onion Pattle These samples were deficient In meat Matter taken up with the Firms concerned and subsequent samples proved satisfactory. Irish Stew Sample was deficient in meat Appropriate action Is being taken with the Company concerned. Smoked Salmon Sample was In a blown container The rest of the stock was condemned. 61 Article Nature of Adulteration Remarks Orange Juice (Canned) Sample contained .270 parts per million of tin derived from th9 interior lacquer of the can. In the Public Analyst's opinion any excess of 100 parts per million is liable to produce a metallic taint It was ascertained this can was from old stock. Remaining stock on Vendor's premises destroyed. Cough Syrup The sample was deficient of chloroform to the extent of 40% of the declared amount. In the Public Analyst's opinion the deficiency was due to the article being old. Stocks checked No other old stock on Sale. Minced Beef with Onion & Gravy In the Public Analyst's opinion this sample is deficient in meat to the extent of 24% Necessary action has been taken to comply with the Regulations. The Public Analyst reported that nine other samples were not labelled in accordance with the Labelling of Food Order, 1953. In each case the manufacturer or packer was informed of the offence and the labels concerned have since been amended or withdrawn. Result of Analysis of Milk Samples The samples of milk were obtained as follows:— Taken on Milk Rounds 20 Taken at Dairies 122 Taken at Institutions 9 Total 151 Average composition of samples:— Milk (excluding South Devon and Channel Islands Milks) Solids not Fat (Legal standard is 8.5%) 8.62 Milk Fat (Legal standard is 3%) 3.68 South Devon and Channel Island Milk Solids not Fat (Legal standard is 4%) 9.1 Milk Fat (Legal standard is 4%) 4.25 62 ANALYSIS OF PROSECUTIONS UNDER: - FOOD & DRUGS ACT. 1955 FOOD HYGIENE (GENERAL) REGULATIONS, 1960 FOOD HYGIENE (MARKETS, STALLS & DELIVERY VEHICLES) REGULATIONS, 1966 THE MILK & DAIRIES (GENERAL) REGULATIONS, 1959 OFFENCE RESULT Packet of Mixed fruit containing insects Fined £20 Loaf of Bread containing a fly Fined £10 Bread Roll containing metal bolt Fined £10 Liver & Bacon Croquettes containing mould growth Fined £50 Bread Roll containing fragments of an Insect Fined £5 Meat filled Roll containing piece of glass Fined £20 Two Fruit Pies not of the substance demanded Fines totalling £50 were Imposed Pork Sausages unfit for human consumption Fined £20 Chocolate Roll unfit for human consumption Fined £20 Fruit bun containing piece of metal Fined £20 Bottled Milk (2 Cases) containing fragment of glass Fines totalling £100 were imposed Pie containing mould growth Fined £25 Cream Puff not of the quality demanded Fined £15 Two cases of selling apples not of the quality demanded In that they were bruised Case dismissed Bakeweli Tart containing mouse dropping Fined £10 Loaf of Bread containing a cigarette end Fined £20 Sausages not of the quality of food demanded Fined £25 Seven cases of smoking whilst handling open Food Fines totalling £35 were Imposed Loaf of sliced Bread containing pieces of a paper handkerchief Fined £10 Food carrying vehicle not suitably covered and inadequate washing facilities etc. Fines totalling £12 were imposed Packet of Cheese Popples unfit for human consumption Fined £20 Floor & Equipment of Food Premises Insanitary Fines totalling £40 were imposed Loaf of Bread containing miscellaneous dirt Fined £10 63 OFFENCE RESULT Milk Bottle not In a state of thorough cleanliness Fined £15 Pork Pie not of quality demanded Fined £20 Packet of Baby Food not of the quality demanded Fined £25 Meat containing a mouse dropping Case dismissed Falling to clear an accumulation of rubbish Fined £5 Insanitary Food Premises & Equipment Fines totalling £100 were imposed. FOOD COMPLAINTS During the year 271 food complaints of various types were received, fully investigated and appropriate action taken where necessary. Twentyseven prosecutions were taken against firms concerned as reported above. SUMMARY OF INSPECTIONS MADE BY THE PUBLIC HEALTH INSPECTORS, AND OTHER DEPARTMENTAL WORK. Total number of houses Inspected for housing defects under Public Health or Housing Acts 4,209 Houses Inspected following applications for certificates of disrepair 20 Inspection of underground rooms 77 Special inspections In connection with the Housing Survey 544 Houses inspected for overcrowding conditions 52 Re-inspections of work outstanding on housing notices 10,532 Number of visits regarding Infectious diseases 872 Number of visits regarding food poisoning 73 Inspections of drainage work during repair 2,382 Drainage systems inspected, surveyed or traced 2,870 Drains tested 486 Inspections of cesspools and earth closets 28 do schools and school sanitary conveniences 11 do public conveniences 125 do verminous premises 91 do Ponds and ditches 13 do premises in course of demolition 893 do theatres, cinemas, halls, etc. 10 do tents, vans and similar structures 88 do premises in connection with improvement grants 525 Inspection and re-Inspection of houses In multiple occupation 5,402 Inspection and re-inspection in connection with Smoke Control Orders 14,869 observations 131 Visits regarding exhumation 5 Visits to premises for food condemnation 834 Inspections of wells and gathering grounds of water supply 17 do scrap metal dealer's premises 21 do rivers and streams for pollutions 5 do hairdressers 154 64 Food arid Drugs Acts; Food and drugs samples taken •412 Food and Drugs Acts; Milk samples taken (special designation) 141 Ice Cream samples taken (bacteriological) 106 Samples taken of Fertilizers and Feeding Stuffs 20 do swimming baths water 288 do drinking water, bacteriological and chemical 474 do subsoil water 5 do private wells 141 do rag flock and other filling material 4 do sundry specimens (food poisoning etc.) 51 Visits In connection with Food Complaints 382 do do miscellaneous public health nuisances 2,162 Inspections under Merchandise Marks Act 9 do of butchers' premises 312 do meat premises (wholesale) 210 do poultry and game dealers' premises 16 do fishmongers' premises 92 do fried fish premises 79 do grocers' premises 478 do fruiterers' and greengrocers' premises 259 do bakers' premises - Including bakehouses 219 do dairies 18 do milk shops 44 do general shops and supermarkets 109 Visits In connection with Animal Boarding Establishments Act 11 do do Rag Flock Act 6 do do Mines and Quarries 4 do do Croydon Corporation Act 2 Visits to Immigrants 160 Unsuccessful calls 5,827 Inspection of Employment Agencies 115 Examination of Imported Food 618 Inspections of premises where cooked meats etc. are prepared or sold 21 Inspections of confectioners' premises 295 do confectionery manufacturers' premises 11 do cafes, snack bars, canteens, hotels and their kitchens 1,089 do school kitchens and serveries 77 do hospital kitchens 31 do Ice cream vendors' premises 2 do Ice cream barrows and carts 131 do market and barrows 498 do other food premises not enumerated above 134 Licenced premises 269 Inspections of factories with mechanical power 193 do factories without mechanical power 17 do works of building and engineering 85 do shops (under Shops Acts) 520 do outworkers' premises 1 Appointments kept with owners, builders, etc. 5,239 Investigations of complaints other than housing matters 823 Inspections under Fertilizers and Feeding Stuffs Act 11 do Diseases of Animals Act 3 do Pets Act 55 do Pharmacy and Poisons Act 22 do Noise Abatement Act 490 do Consumer Protection Act 18 do Offices, Shops and Railway Premises Act 2.826 65 Visits regarding rats and mice infestation by rodent operators 21,879 Visits regarding rats and mice infestation by district inspectors 894 Informal Notices outstanding 31.12 68 1,206 Informal Notices served 1,595 Informal Notices complied with 1,893 Informal Notices outstanding at 31.12.69 908 Statutory Notices outstanding 31.12.68 1,108 Statutory Notices served 1,650 Statutory Notices complied with 1,826 Statutory Notices outstanding 31.12.69 932 Total number of callers and complaints received at the office 2,538 Total number of letters received at the office 14,529 Planning applications relating to new development or the alteration of existing buildings are subjected to detailed scrutiny by the appropriate technical staff to ensure that the extensive and varied legislation administered by the Department is ap fiied to the proposed development. Applicants are advised of the legal requirements applicable to the development and, during the year, the staff concerned have spent a considerable time examining and reporting upon the 2,945 plans submitted for approval. During the year 10,093 Local Land Charge enquiries have been referred to the Department by the Town Clerk and, in each case, a detailed investigation is carried out to ensure that the prospective purchaser of any property is made aware of whatever legal requirements may have been imposed by this Department currently, or which may apply to the property at some future date. Nuisances, Infringements of Acts, Byelaws, Regulations or Orders ascertained by the Public Health Inspectors during the year and for which action was taken to enforce compliance: (1) NUISANCES ABATED AND DEFECTS REMEDIED, ETC. Insufficient means of ventilation: Defective ventilation, windows and sashcords 423 Conditions causing dampness: Defective roofs 364 Defective window frames 109 Defective walls, etc. 125 Want of efficient damp-proof course 15 Defective gutters and downspouts 243 Other structural defects: Defective plaster 512 Cleansing and redecorating required 1 Defective floors, stairs and woodwork 253 Insufficient ventilation under floor 20 Defective brickwork, sills, lintels, chimneys 346 Defective stoves and fireplaces and flues 21 66 Defective drains, sanitary fittings, etc; Defective sinks and waste pipes 100 Defective W.C.'s 75 Defective drainage 81 Stoppage In drains 47 Defective water services and tanks 8 Cesspools filled in 1 Drains sealed off 182 Defective Cesspools 1 Domestic nuisances: Want of cleanliness 2 Verminous conditions 10 Other nuisaricas and infringements: Offensive accumulations 102 Sundry nuisances or defects 6 Particulars inserted in Rent Book (Housing Act) 11 Smoke nuisances 1 Keeping of animals 2 Food cupboards provided 129 Defective yard paving 30 Dustbins provided ... 17 Unlicenced Caravans removed - LECTURES During the year 30 lectures were given by qualified members of the staff to local community associations, schools and commercial and industrial organisations. These lectures provide an opportunity to stimulate public interest in food hygiene, smoke abatement and the other varied aspects of the work of the public health inspector and are valuable contribution to both public relations and health education. 67 OFFICES, SHOPS AND RAILWAY PREMISES ACT. 1963 The inspection of premises has proceeded throughout the year although not with the speed desired, as a result of staff shortages and additional legislation. Nevertheless much has been accomplished, and by the increased number of complaints and requests for advice on the various requirements of the Act from architects, builders, employers and members of the public, it is apparent that there is a growing awareness of the existence of an Act of Parliament containing wide provisions for the welfare of office and shop workers. Properties in the Borough are continually undergoing change, and it is a common experience to inspect individual offices and shops consecutively in a road and, within a year or so of completion, demolition of large areas for redevelopment has taken place. The town centre particularly, has been affected, but this is inevitable in a rapidly developing shopping area such as Croydon. A new estate, the Whitgift Centre, including over 200 offices and shops, together with a tower block of offices, is rapidly undergoing development, and frequent visits have to be made to the site to meet architects, ventilating and heating engineers and intending shopkeepers in addition to examining and reporting on the plans prior to submission to the appropriate Committee of the Council. The practice of inspecting all plans relating to offices, shops, warehouses and factories continues. During the year no fewer than 930 plans have been inspected and reported upon. Particular vigilance, in inspecting plans, has to be given to those parts of the properties to which the public are not admitted, and strict observation is kept on the proposed means of access to lift motor rooms, lift towers, boiler rooms etc. to which mechanics and maintenance staff must have access, not overlooking the fact that the Council's Inspectors must also inspect such parts of the building in the course of their duties. Adequacy and safety of access to loading docks also receives attention. In connection with general inspections, accumulations and deposits are frequently found. Some employees, particularly those of a lethargic nature, look for some place to deposit unwanted articles rather than deposit them in the refuse collection area. In the course of time (and apparently unnoticed by senior officers) passages and rooms become packed with unwanted stock and rubbish. In some cases it has been found necessary to request the fire Authority to co-operate in order to require occupiers to clear premises of inflammable refuse. Laundry receiving offices, without hot water facilities as mentioned in a previous report, are still being found. In one such office, during 1969, the only means of washing and supply of drinking water was a standpipe tap in 68 the yard. This type of business often lacks sufficient heating apparatus to maintain a reasonable temperature, and spot checks, from time to time, are found necessary. Success has been achieved' in a large degree particularly in offices, in obtaining the provision of sinks, with hot and cold water supplies, as a tea making facility, Worn linoleum and floor coverings in offices and shops are still found and likely to give rise to accidents. In one office a hole in the carpet was found covered over with cellotape and adhesive plaster. After much persuasion, with a threat of prosecution, the carpet was renewed. Frayed wire connections to electric fires and duplicating and printing machines receive inspection, as do defective light switches, and the occupiers'attention is directed to the.remedying of these defective and dangerous conditions. Rickety chairs, tea chests and boxes used to gain access to high shelves, have been removed on the instruction of the Inspectors. Steps and ladders not regularly overhauled and in a condition likely to cause accidents, lack of handrails, defective stair treads, broken.sashcords, sagging and dangerous ceiling plaster are types of defect quite frequently found during inspection. 30 complaints were received during the year, made up as follows:- Inadequate ventilation of shop premises 2 Low temperatures of offices and shops 9 Overheating of offices and workplaces 3 Alleged overcrowding 3 Insufficient lighting of work area 1 Defective and dangerous construction of office floors 1 Lack of adequate ventilation of sanitary accommodation 5 Alleged insufficient sanitary accommodation 1 Sanitary accommodation out of use due to defective appliances 1 Dropping of lift below floor level due to over-running 1 Three complaints received concerned excessive hours of employment in offices and did not come within the provisions of the Act. The Offices, Shops and Railway Premises (Hoists and Lifts) Regulations, 1968, came into force on 28th May, 1969. Although the total number of lifts and hoists in offices, warehouses and shops in the Borough cannot be estimated at the present time, this must be very large; and checking reports of competent inspectors of their inspections of electric goods and passenger lifts (which inspections must be carried out twice a year) and of manually operated hoists (which must be inspected at least once a year) will be an ever growing and time consuming duty. 69 Up to the end of 1969, 10 adverse reports were received on manually operated hoists. 11 adverse reports were received on electric passenger lifts or hoists. In connection with these adverse reports visits were made to the premises concerned and notices subsequantly served upon the owners of the properties. On reinspection 5 notices have been complied with and in the remaining cases works were in progress and the most urgent defects had received attention to enable the lifts to operate in a safe condition. An adverse report was received in respect of an electric overhead travelling crane. The crane is in a warehouse not under the jurisdiction of H.M. District Inspector of Factories, and the Hoists and Lifts Regulations, 1968, are not applicable to this type of apparatus. However a communication was addressed to the owners of the apparatus and attention is being given as recommended by the Insurance Company's Engineering Surveyor. In all 40 visits have been paid during 1969 to premises containing 48 lifts and hoists, and, in the case of four such electric appliances defects were found by the Council's Inspectors and notices served. One manually operated hoist was found to be in such a dangerous condition that, on the Instruction of the Inspector, it was removed from the premises. In two cases of inspections of doors to manually operated food hoists, the sash cords were wedged open by spoons. The number of accidents reported during the year was 132, and in each case, the cause was investigated. Interviewing injured persons in their homes has been time consuming but rewarding in that, to a large degree, the injured person's version of the accident, has differed from that reported by the employing Company. An accident occurred on a manually operated goods lift in a warehouse, whereby an employee, entering the hoist on the ground floor to load boxes of goods, was struck on the head by a cardboard box containing a large toy, and he sustained superficial head injuries. The box had fallen from the third floor. The accident took place before the Hoists and Lifts Regulations, 1968, became operative, but the requirements of the Regulations were enforced, including the provision of a roof to the hoist cab to prevent a recurrence of this type of accident.There had been cverstacking of goods near the lift opening on the third floor, and the sliding door to the liftway opening had not been closed. Another employee in a store stood on a low shelf to reach an article on a shelf above tiis head. He overreached and dislocated his shoulder. An ample supply of steps of varying heights was already provided by the employer to reach a shelf of any height in the store. In another case an empty fork lift truck was being driven through a door opening with the forks raised. As the driver was unable to stop the vehicle in time, the truck collided with the door lintel and supporting brickwork of the warehouse door opening, not only causing structural damage, but injuring 70 the driver by fracturing an elbow. "Horseplay" was suspected in this case and the management forthwith forbade the injured person to drive a fork lift truck in the future. A male employee was leaving an office block and tripped over the inner door base plate, which was not level with the floor. In falling he struck and fell through the outer glass entrance door and received head and hand injuries. On investigation, all four base plates were found not to be flush with the surrounding floor and the Company's attention was drawn to the contravention of Section 16. As a result, all brass plates were countersunk flush with the floor surface. The last card through a burster machine (record card dissector) failed to be carried through the rollers. A female employee, in endeavouring to flick the card through the rollers, sustained chipping and bruising of a finger bone by the in-running nips of the rollers. The machine was considered to be fully guarded, but, through the co-operation of the firm, and with the advice of the Inspector appointed under Section 57 of the Act {H.M. Deputy Superintending Inspector of Factories) the protection of the machine was so amended as to prevent staff obtaining access to the rollers when the machine was in motion. An employee opening tea chests received deep laceration of a finger caused when detaching meta! lining. Protective gloves which were provided by the Company for use when opening boxes of this nature were not worn. A resharpened guillotine blade, 3 feet long and 3 inches wide, and weighing 20 lbs. was received back from the grinders, unwrapped, and put on a shelf about 5 feet high, on top of some folded cardboard boxes in a shop store. In course of time, papers and other documents were put on top of the guillotine blade, and no more thought was given to the location of the blade. A youth went some time later, to get the cardboard covers apparently unaware of the presence of the blade. In pulling the box covers sharply the guillotine blade fell, first striking the floor and then falling across the instep of the employee causing laceration of the foot. The culprit could not be identified because of changes in personnel, including shop managers, and investigation was rendered so much more difficult. Following upon the investigation, an old fashioned guillotine was found on the premises, used only by the manager for price ticket cutting. The company were instructed forthwith to guard the machine in accordance with the requirements of Section 17 of the Act, or to remove the guillotine from the premises. The guillotine was removed. In a large retail shop a female employee opened a boiler house door and fell down three steps into the boiler house injuring her back and head. She had mistaken the adjoining boiler house door for the door to the ladies' toilet.The premises had been inspected some time previously when the sanitary accommodation was found to be properly marked. As a result of the accident the Company was instructed to paint on the respective doors words indicating the sanitary accommodation and the boiler house respectively; the boiler house door to be kept locked and the key to be held only by authorised persons. 71 During the year two cases were reported to the Town Clerk with a view to legal action being taken. (1) The occupiers of a dyer's and cleaner's receiving office were reported for failure:— (a) To maintain the walls and ceiling of a corridor in a clean condition, contrary to Section 4(1). (b) To maintain artificial lighting in the corridor, contrary to Section 3(1). (c) To provide effective artificial lighting to the water closet compartment, contrary to Section 9(2). (d) To provide a supply of clean, running hot water for ablution purposes, contrary to Section 10(1). (e) To provide soap and clean towels or other available means of cleaning or drying, contrary to Section 10(1). (f) To provide in the first aid box first aid requisites and appliances of such description and in such quantities as may be prescribed, contrary to Section 24(2). A Setter was sent to the Company by the Town Clerk as a result of which all the contraventions were remedied. (2) The owners of a public house were reported for failing securely to fence the opening in the bar floor giving access to the cellar, A summons was served but was withdrawn on an undertaking being given securely to fence the opening when the cellar flap is raised, in compliance with Section 16(4). PUBLIC HEALTH SERVICES 75 WATER SUPPLY The London Borough is served by four statutory supply authorities, as undermentioned:— Supply Authority Square Miles Estimated Population Croydon Corporation (Central and northern part of the Borough) 17.0 221,500 Metropolitan Water Board (Spring Park Estate and New Addington) 2.8 36,600 East Surrey Water Company (Sanderstead, Selsdon, Kenley, Purley and Coulsdon East) 15.5 56,400 Sutton District Water Company (Woodcote and Coulsdon West) 1.9 13,800 37.2 328,300 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. In the Croydon Undertaking's area, 674 samples of raw water and 1,279 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 131. SEWAGE DISPOSAL I am indebted to the Borough Engineer, Mr. H.M. Collins, for the following information:— Beddington Sewage Treatment Works The new sewage treatment works at Beddington was formally commissioned by the Mayor on the 6th December, 1969 and the old works was finally closed down on the 17th December. This has now brought to an end the practice of irrigating partially treated sewage on land which has been carried on at Beddington since 1860 but which has more recently, as a result of overloading, been the cause of complaint. The new works has been built over a period of five years at a cost of £3,500,000 and serves a drainage area of 53 sq. miles, including Caterham and Warlingham, parts of the London Borough of Sutton and part of Banstead in addition to the major part of Croydon. The daily sewage flow is 18,150,000 Gallons in dry weather from a population of 365,000. 76 On arrival at the works the sewage first passes through automatic screens where rags are removed and thence to special tanks where the mineral grit is removed. Flow in excess of three times the dry weather flow rate is diverted to storm water tanks where it is stored until it can be returned for full treatment. Flows up to 50,000,000 gallons daily pass forward for primary settlement in eight circular tanks, 105 ft. dia., where the suspended solid matter is removed as a thick sludge. The liquid from the primary settlement tanks is passed into twelve aeration channels, each 25ft. wide and 420 ft. long into which compressed air is introduced, together with biologically active sludge. The subsequent biological action results in a highly purified liquor. The final effluent is separated from the activated sludge in sixteen conical bottomed tanks 67ft, dia., and discharged through a culvert to the River Wandle some two miles away. The sludge removed from the primary settlement tanks is pumped to the existing heated sludge digestion plant. Here it is rendered innocuous in a fermentation process which yields approximately 300,000. cu. ft. of methane gas daily. After digestion, the sludge is pumped onto land, allowed to dry and then ploughed into the top-soil. The gas collected from the digestion process is used as fuel in six engine-generator sets, totally 4,500 b.h.p. which supply all the power required for the treatment works. Further stages of treatment are to be introduced, so as to improve the effluent quality above the normal requirements, due to the poor dilution ratio of effluent to river water. Construction of these units will commence during 1970/71 and these are expected to cost a further £600,000. The new works will become vested in the Greater London Council in April, 1970. OTHER SERVICES 79 FAMILY PLANNING For over 20 years the Corporation have made grants to the Croydon Family Planning Association, have appointed a representative to their Committee, and co-opted a representative to the Health, Maternity & Welfare Sub-Committee. With the advent of the Family Planning Act the Association were asked if the grant, and the use without charge of Corporation clinics and equipment would cover free advice and supplies for all women for whom pregnancy was a danger to health. It was agreed that this statutory responsibility of the Corporation could be met fully. The permissive powers to extend the free service to cases of social need was being considered in the year under review. A domiciliary service was introduced for special cases, and was provided by a part-time midwife. During 1969 she made a total of 162 visits to 29 women, of whom 19 were successfully helped, 4 were already pregnant, and the remainder were in the process of being advised. 80 MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDREN'S DEPARTMENT During the year 295 children were medically examined prior to admission to a children's home or private foster home. NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 As amended by the Health Services and Public Health Act, 1968 Full time Registered Child Minders are 356 in number. Providing places for 689 children Part time Child Minders (Playgroups) 31 in minders' own homes Providing places for 371 children Playgroups on premises other than private homes 72 premises Providing places for 2,262 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. All homes are inspected by a senior health visitor who also checks for fire precautions. Number of homes passed as suitable at 31st December, 1967 19 Children placed 23 MANUAL WORKERS - HEALTH STATEMENTS Commencing September 1967 manual workers were required to complete health statements. These employees are now only medically examined if so required by the Principal Medical Officer. Number of health statements received from manual employees 1232 Considered not fit for inclusion in sickness pay scheme 16 Deferred for review 51 Unfit for employment 4 81 STAFF MEDICAL EXAMINATION The Medical supervision of all Corporation staff provided by the health department includes:- Scrutiny of health statements made by successful applicants for officer grades and any follow-up or medical examination deemed necessary. Medical examination of prospective student teachers. Examination for freedom from intestinal infection:— (i) All employees of the water undertaking. (ii) All school meal service and canteen personnel. Arrangements for re-checks. Vision tests on all Corporation drivers and again at specified intervals over the age of 50. Scrutiny of records of all staff who have been absent for an aggregate of more than 8 weeks during the preceding 12 months or who are exhausting entitlement to sick pay. Follow-up for cause and anticipated date of return to duty. Report on financial circumstances by an Almoner of the Health Department, in order that a special Establishment Sub-Committee may decide on extension of sick-pay. Arrangements for radiological examination of staff who work in contact with children. Special examination of any member of staff referred by the department concerned. Enquiries into excessive sickness in any section of the Corporation staff. 874 examinations were made during the year by the medical staff of the department including 141 vision tests for drivers. Of these 201 were in respect of manual workers, who were classified as follows:— Fit for employment and sick pay scheme 123 Deferred for review 58 Unfit for sick pay scheme 15 Fit for light employment only (Not fit for sick pay scheme) 1 Unfit for employment 4 201 82 BLINDNESS I am indebted to the Chief Welfare Officer for access to his records regarding blind persons registered during the year. These show that of the 98 cases registered:— 16 were due to glaucoma and 30 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:— 9 patients had died EPILEPTICS Reference is made in the school health section of this report regarding the number of cases known to the department. In addition the Chief Welfare Officer informs me that 125 adult cases are registered with his department, 9 of whom are in special homes. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 During 1969 one order for compulsory removal was required:— One elderly lady, over 80 years of age, seriously Ml and unable to care for herself, was admitted to Queen's Hospital. 83 LONGSTAY IMMIGRANTS Visits were made to long-stay immigrants so that they may be made aware of the health and social facilities available, particularly to children. The department was notified of ail new arrivals to the borough. Parents with families and single women were visited in the first instance by the specialist Health Visitor appointed to deal with the problems of the immigrants, and single men by the public health inspector. After the initial visit families became the responsibility of the district health visitor unless there was some reason why they should remain under the care of the specialist Health Visitor. Mrs. Glucksmann, the Health Visitor seconded to these duties, represented the department on the Committee of Croydon International Association, which deals exclusively with the welfare of any immigrant. She also attended any meetings arranged by other bodies dealing with this section of the population. For details of arrivals in 1969, see Appendix page 120. REHOUSING ON MEDICAL GROUNDS Dr. C.G. Nicol, Principal Medical Officer inquired into 804 applications for rehousing on medical grounds in 1969, making 37 personal visits, usually jointly with a public health inspector, health visitor, or welfare officer. A further 20 applicants were interviewed at this office. Sub-division of applications recommended to the Housing and Lettings Sub-Committee showed the following approximate frequencies:- Mental disorders 27% Crippling conditions 19% Heart Disease 15% Lung Diseases 13% Illnesses of children 9% Cancers 5% Strokes 3% Tuberculosis 2% Other conditions 7% All the cases involved severe illnesses in circumstances which showed clearly that ill health was due to housing conditions or that effective treatment could not be attempted without prior rehousing APPENDIX TABLES 87 VITAL STATISTICS 1965 - 1969 88 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 yeer AGE IN YEARS 1• 5- 75- 25- 35- 45- 55- 65- 75 & over B2 Typhoid Fever M . . . . . . • . . • _ . F 1 . . . . . 1 . . • - . 84 Enteritis and other Diarrhoeal Diseases M . . . . . . . . . . . . F 1 . . . . . . . . - . B5 Tuberculosis of Respiratory System M 5 . . . . . . . 1 1 2 1 F - . . . . . . . . • - . B6 Other Tuberculosis, incl. Late effects M 4 . . . . . . . . 2 1 . F 1 . . . . . . . . 1 - . Bit Meningococcal Infection M 1 . . . . . . . . . . . F 2 . . . . . . . . - - . B17 Syphilis and its Sequelae M 6 . . . . . . . . . 4 2 F 4 . . . . . . . . - 1 3 818 Other Infective and Parasitic Diseases M 3 . . . . . 1 . . 2 • • F 3 . . . . . - . 1 - - 2 TOTAL 31 . 2 1 1 . 2 1 2. 6 8 8 B19(1) Malignant Neoplasrr Buccal Cavity etc. M 5 . . . . . . . - 2 1 2 F 5 . . . . . . - 1 - 2 1 B19(2) Malignant Neoplasrr Oesophagus M 9 . . . . . . . . 2 3 4 F 12 . . . . . . - - 2 3 7 819(3) Malignant Neoplasrr Stomach M 42 . . . . . . 2 1 11 17 11 F 21 . . . . . . 1 . 2 4 14 B19(4) Malignant Neoplasrr Intestine M 34 . . . . . . 5 3 6 9 11 F 66 . . . . . . 1 5 11 18 31 819(5) Malignant NeoplasnLarynx M 4 . . . . . . . . . 2 2 F . . . . . . . - - - - • B19(6) Malignant Neoplasrr Lung, Bronchus M 167 . . . . . . • 16 62 61 28 F 55 . . . . . . 1 6 11 21 16 819(7) Malignant Neoplasrr Breast M . . . . . . . . . . . •. F 82 . . . . . . 4 14 24 23 17 B19(8) Malignant Neoplasrr Uterus F 20 . . . . . . 1 2 9 5 3 B19(9) Malignant Neoplasrr Prostate M 24 . . . . . . • - 3 10 11 819(10) Leukaemia M 10 . . . 1 . . - 2 3 - 4 F 8 . . . . . . 1 • • 3 4 B19(11) Other Malignant Neoplasms M 99 . . . 1 . 2 7 7 28 33 19 F 107 . . . . . 2 3 13 36 21 32 820 Benign and Unspeci fled Neoplasms M 5 . . . . . . . . 1 3 1 F 7 . . . 1 . - 1 1 1 1 2 TOTAL 782 . . 1 3 2 4 27 71 214 240 220 B21 Diabetes Mellltus M 13 . . . . . . . 2 3 5 3 F 9 . . . . . . . . 1 1 7 B22 Avitamir.oses, etc. M . . . . . . . . . . - • F 1 . . . . . . . . - 1 . 846(1) Other Endocrine etc. Diseases M 8 . 2 . 1 . . . 1 1 2 1 F 4 . . . . . . . . 1 1 2 823 Anaemias M 1 . . . . . . . . • 1 • F 7 . . . . . . . . 1 - 5 B46(2) Other Diseases of Blood, etc. M . . . . . . . . . . • • F 1 1 . . . . . . . - - . 89 CAUSE OF DEATH Sex Total all ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5 - 75- 25- 35- 45' 55- 65- 75 & over B46(3) Mental Disorders M 9 . . . . . 2 . 1 2 1 3 F 6 . • - - - - . . • 1 5 B24 Meningitis M . . . . . . - . . . . . F 2 . . - • - - . . - 2 • B46(4) Other Diseases of Nervous System etc. M 22 . 2 1 2 1 1 . . 3 6 6 F 25 . 1 . . . . . 2 6 6 10 TOTAL 108 1 5 2 3 1 3 . 6 18 27 42 B26 Chronic Rheumatic Heart Disease M 19 . . . . . 1 1 2 5 6 4 F 38 . . . . . 1 2 5 4 7 19 B27 Hypertensive Disease M 24 . . . . . . . 3 6 -9 6 F 51 . . . . . • - 1 4 9 37 B28 Ischaemic Heart Disease M 486 . . . . . 1 8 51 134 148 144 F 354 . . . . . • - 6 22 94 232 B29 Other Forms of Heart Disease M 72 . . . . . - . . 3 20 49 ' F 165 . . . . • 2 - 1- 15 147 B30 Cerebrovascular Disease M 160 . . . . . 1 . 6 24 41 86 F 363 . . . . . 2 3 8 21 67 262 B46(5) Other Diseases of Circulatory System M 73 . . . . . . 3 1 6 25 38 F 105 . . . . . • 1 2 5 12 85 TOTAL 1,910 . 1 . . 1 6 20 85 235 453 1,109 B31 Influenza M 8 . . . . . . - . 2 5 1 F 13 . - . . . 1 - 2 1 - 9 B32 Pneumonia M 142 . 6 1 . . . . 3 14 30 87 F 230 . 2 2 . . . 1 5 4 31 184 B33(1) Bronchitis and Emphysema M 158 . . - . . . . 10 28 54 65 F 61 . 1 - . . . 1 2 8 14 35 B33(2) Asthma M . . . . . . . . . . . . F 5 . - - . . . 1 - 1 2 1 B46(6) Other Diseases of Respiratory System M 13 . . 1 . . . 1 1 3 4 3 F 1? . 3 . . . . . . . 1 8 TOTAL 642 1 12 4 '1 2 4 23 61 141 393 B34 Peptic Ulcer M 12 . . . . . . 1 2 2 3 4 F 15 . . . . . . . . 1 6 8 B35 Appendicitis M 3 . . . . . . . 1 1 1 . F - . . . . . . . . - • - B36 Intestinal Obstruction and Hernia M 6 . . . . . . . . 1 . 5 F 13 . . . . . . . . 2 3 7 837 Cirrhosis of Liver M 3 . . . . . . . . 1 . . F 3 . . . . . . . . 1 1 1 B46(7) Other Diseases of Digestive System M 14 . . . . . . . 1 4 3 5 F 29 . . . . . 2 . . 1 4 18 B38 Nephritis and Nephrosis M 13 . . . . . 1 . 1 3 4 3 F 4 . . . . . . . . - 1 1 B39 Hyperplasia of Prostate M 11 . . . . . . . . 1 1 9 B46(8) Other Diseases, Genito-Urinary System M 10 . . . . . . . . . 3 7 F 22 . . . . . . . 2 4 6 10 B40 Abortion F 1 . . . . . . . . - - . B46(9) Diseases of Skin, Subcutaneous Tissue M 2 . . . . . . . . 2 . . F 1 • . . . . . . . - - 1 90 CAUSE OF DEATH Sex Total ell ages Under 4 weeks 4 weeks and under 1 yeer AGE IN YEARS 1 - 5- 75- 25- 35- 45- 55- 65- 75 & over 846(10) Diseases of Musculoskeletal System M 4 . . . . . . . _ 2 1 \ F 15 - - - . . . . 1 1 1 12 842 Congenital Anomalies M 14 3 5 2 . . 1 . . 1 1 1 F 18 7 4 2 . . . . 1 1 . • 843 Birth ln|ury. Difficult Labour, etc. M 11 11 . . . . . . . . . F 14 13 1 . . . . . - . . • B44 Other Causes of Perinatal Mortality M 12 12 . . . . . . _ . . . F 4 4 - . . . . - . . • B45 Symptoms and III Defined Conditions M 5 . . . . . . . . . 5 F 11 - • . . . . - . . 11 TOTAL 270 51 10 6 4 4 4 14 29 39 109 BE47 Motor Vehicle Accidents M 20 . . . 2 5 1 3 3 2 1 3 F 10 . . . . . . . . 3 1 5 8E48 All Other Accidents M 18 . . 1 2 2 1 2 1 2 1 6 F 27 . . . . . . 5 1 3 18 BE49 Suicide and Selfinflicted Injuries M 17 . . . . 3 . 3 5 3 2 1 F 17 . . - . 1 3 3 5 4 1 • BE50 All Other External Causes M 5 . . 1 . 1 1 1 • 1 . . F 3 - 1 - - • 1 1 • TOTAL 117 . . 2 4 13 6 12 20 17 10 33 TOTAL ALL CAUSES M 1,806 27 17 10 10 14 14 40 125 383 524 642 F 2,054 26 13 6 2 9 11 28 96 197 394 1,272 3,860 53 30 16 12 23 25 88 221 580 918 1,914 91 CANCER Deaths from Cancer occurred at the following ages - Age Period Male Female Total Under 25 years 4 2 6 25 and under 35 years 2 2 4 35 and under 45 years 14 13 27 45 and under 55 years 29 42 71 55 and under 65 years 118 96 214 65 and under 75 years 139 101 240 75 and over 93 127 220 Total 399 383 782 Site Male Female Total Percentage of Total Bowel and Rectum 34 66 100 12.8 Brain 11 8 19 2.4 Breast • 82 82 21.4 Buccal Cavity 5 5 10 1.3 Cervix • 8 8 2.1 Gallbladder & Duct 5 4 9 1.2 Hodgkins 5 4 9 1.2 Larynx & Pharynx 4 . 4 0.5 Leukaemia 10 8 18 2.3 Lungs and Bronchus 167 55 222 28.4 Oesophagus 9 12 21 2.7 Ovary • 21 21 5.5 Pancreas 20 21 41 5.3 Prostate 24 - 24 6.0 Stomach 42 21 63 8.1 Uterus 12 12 3.1 Other Malignant Neoplasms 63 56 119 15.4 Total 399 383 782 92 WARD STATISTICS Estimated Population Births (Live) Birth Bate Deaths *Death Rate Deaths under 1 year Deaths under 1 year per 1,000 births Deaths from Diarrhoea (under 2 veers) *Death Rate from Di err hoe a (under 2 years) Deeths from Bronchitis and Pneumonia *Death Rate from Bronchitis end Pneumonia Deeths from Pulmonary Tuberculosis *Deeth Rate from Pulmonary Tuberculosis Deaths from Non~ Pulmonary Tuberculosis *Deeth Rate from Non~ Pulmonary Tuberculosis Deaths from Heart and Circulatory Diseases 'Death Rate from Heart and Circulatory Diseases Deaths from Cancer *Death Rate from Cancer Natural Increase of Births over Deaths Addlscombe 15,230 309 20.3 185 12.2 5 16 – – 30 2.0 – – – – 74 4.9 38 2.6 + 124 Bensham Manor 15,1 20 253 16.7 210 13.9 2 8 – – 33 2.2 – – 1 0.07 118 7.8 28 1.9 +43 Broad Green 13,510 248 18.4 163 12.1 2 8 – – 27 2.0 1 0.07 – – 77 5.7 34 2.5 +86 Central 15,070 225 14.9 231 15.3 5 22 – – 34 2.3 1 0.07 1 0.07 130 8.6 36 2.3 – 6 Coulsdon East 14,080 190 13.5 134 9.6 – – – – 27 1.9 – – – – 60 4.3 28 2.0 +66 East 16,830 184 11.0 164 9.8 4 22 – – 22 1.3 – – – – 81 4.8 35 2.1 + 20 New Addlngton 27,230 663 24.3 116 4.2 12 18 – – 16 0.6 – – – – 60 1.8 22 0.8 + 547 Norbury 15,930 221 13.9 205 12.9 6 27 – – 35 2.2 – – – – 108 6.8 40 2.6 +16 Purley 16,530 164 9.9 175 10.6 3 18 – – 28 1.7 – – – – 80 4.8 46 2.7 –11 Sanderstead North 17,040 224 13.1 172 10.1 4 18 1 0.06 21 1.2 – – – – 83 4.9 41 2.4 + 52 Sanderatead & Selsdon 16,490 188 11.4 142 8.6 1 5 – – 12 0.7 1 0.06 – – 87 6.3 32 1.9 +46 Shirley 20,720 404 19.5 177 8.6 4 10 – – 20 1.0 – – – – 91 4.4 42 2.0 +227 South Norwood 16,770 366 21.8 196 11.7 10 27 – – 27 1.6 – – 1 0.06 97 6.8 42 2.6 + 170 Thornton Heath 14,840 287 19.4 154 10.4 3 10 – – 14 0.9 – – – – 66 4.4 44 3.0 + 133 Upper Norwood 16,120 224 13.9 166 9.7 3 13 – – 16 1.0 – – – – 80 6.0 35 2.2 + 68 Waddon 16,480 222 13.5 246 14.9 3 13 – – 43 2.6 1 0.06 – – 118 7.2 51 3.1 – 24 West Thornton 14,570 286 19.6 169 11.6 3 10 – – 23 1.6 1 0.07 – – 85 5.8 41 2.8 + 117 Whltehorae Manor 14,200 327 23.0 195 13.7 6 18 – – 28 2.0 – – – – 82 6.8 30 2.1 + 132 Woodcota & Coulsdon West 15,580 171 11.0 316 20.2 1 6 – – 60 3.9 – – – – 138 8.9 64 4.1 –114 Woodside 14,790 290 19.6 176 11.9 6 21 – – 23 1.6 – – 1 0.07 81 6.6 51 3.6 + 114 The Borough 327,130 5,446 16.7 3,860 11.8 83 15.2 1 0.003 591 1.8 5 0.02 4 0.01 1,910 5.8 782 2.4 + 1,586 *Death Rate per 1,000 population and excluding those who died In Queen's Hospital 93 DETAILS OF INFANT MORTALITY The following table gives the causes of death during the first month of life (Neo-natal Mortality):– (1) Complications of Labour Trauma of Labour Nil (2) Foetal States - Congenital Malformations 10 Atelectasis 2 Haemorrhagic Diseases of Newborn 2 (3) Prematurity 35 (4) Post-Natal Causes 4 Total 53 Percentage Deaths under 1 year per Totel Infantile Deaths Deaths under 1 year per 1,000 Births 1968 1969 1968 1969 Injury at Birth and Congenital 26.8 12.0 4.66 1.84 Premature Births 38.2 42.2 6.63 6.41 Respiratory Diseases 8.2 2.4 1.43 0.37 Atalectasis, Debility and Marasmus 7.2 2.4 1.26 0.37 Diseases of Digestion* 1.0 . 0.18 • Other causes 18.6 41.0 3.22 6.25 •These from Gastro Enteritis Perinatal Deaths Stillbirths 67 Deaths in first week 49 Perinatal Rate - 21 per 1,000 Total (live and still) births Causes of Death in first week Prematurity 34 Congenital conditions 9 Atelectasis 2 Birth Trauma – Pneumonia – Haemorrhagic disease 3 Other causes 1 94 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CAUSES OF DEATH 1st Day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th – 14th day 15th - 21st day 22nd - 28th day Total Under 1 month 1 + months 2 + months 3 + months 4 + months 5 + months 6 + months 7 + months 8 + months 9 + months 10 + months 11 + months TOTAL  All Causes 40 2 3 1 2 1 – 3 – 1 53 8 7 4 2 – 1 1 2 1 – 4 83 Meningoencephalitis – – – – – – – – – – – – – – – – – – – – – – – Chickenpox – – – – – – – – – – – – – – – – – – – – – – – Measles – – – – – – – – – – – – – – – – – – – – – – – Scarlet Fever – – – – – – – – – – – – – – – – – – – – – – – Whooping Cough – – – – – – – – – – – – – – – – – – – – – – – Diphtheria and Croup – – – – – – – – – – – – – – – – – – – – – – – Tuberculous Meningitis – – – – – – – – – – – – – – – – – – – – – – – Abdominal Tuberculosis – – – – – – – – – – – – – – – – – – – – – – – Other Tuberculous Diseases – – – – – – – – – – – – – – – – – – – – – – – Meningitis (not tuberculous) – – – – – – – – – – – – – – – – – – – – – – – Convulsions – – – – – – – – – – – – – – – – – – – – – – – Laryngitis – – – – – – – – – – – – – – – – – – – – – – – Bronchitis – – – – – – – 1 – – 1 1 1 – – – – – 1 – – – 4 Pneumonia (all forms) – – – – – – – – – 1 1 1 2 2 2 – – – – – – 1 9 Diarrhoea and enteritis – – – – – – – – – – – – – – – – – – – 1 – – 1 Gastritis – – – – – – – – – – – – – – – – – – – – – – – Syphilis – – – – – – – – – – – – – – – – – – – – – – – Rickets – – – – – – – – – – – – – – – – – – – – – – – Congenital Malformations 5 – 1 – 2 1 – 1 – – 10 2 3 1 – – 1 1 1 – – – 19 Premature Births 33 – – 1 – – – 1 – – 35 – – – – – – – – – – – 35 Atrophy, Atelectasis, Debility and Marasmus – 1 1 – – – – – – – 2 – – – – – – – – – – – 2 Injury at Birth – – – – – – – – – – – 1 – – – – – – – – – – 1 Haemorrhagic disease of newborn 2 – 1 – – – – – – – 3 – – – – – – – – – – – 3 Other Causes – 1 – – – – – – – – 1 3 1 1 – – – – – – – 3 9 TOTALS 40 2 3 1 2 1 – 3 – 1 53 8 7 4 2 – 1 1 2 1 – 4 83 95 MIDWIFERY SERVICE Municipal midwives attended:— 1. Home confinements 1,434 2. Planned early discharges booked 427 3. Patients delivered at home 1,042 Midwifery cases Nil Maternity cases 1,042 4* Prima gravida 59 Multigravlda 983 5* Live Births 1,041 6. Still Births (Asphyxia) 1 7. Neo-natal deaths (Atelectasis) 1 8. Premature Births (including 3 sets of twins) 32 (1) Term - 5lbs. 4ozs. (2) 36 weeks 6 lbs. (3) Term - 5lbs. 3ozs (undiag. twins admitted) (4) Term - 5lbs. 4ozs. (5) Term - 5lbs. 4ozs. (6) Term - 5lbs. 6ozs- admitted Cyanosis (7) 36 weeks - 6lbs. 8ozs. (8) Term 5lbs. 4ozs. (9) 35 weeks • 5lbs. 4ozs. (10) 36 weeks - 6lbs. 4ozs (11) Term - 5lbs. 4ozs. (12) 38 weeks 5lbs. 4ozs. (13) 36 weeks -4lbs., 3lbs. 15ozs. undiagnosed twins - admitted (14) 38 weeks 5lbs. 4ozs (15) 36 weeks - 7lbs (16) 37 weeks - 5lbs. 8ozs. admitted twitching. (17) Term + 1 5lbs. 6ozs. (18) 736 weeks 4lbs. 8ozs. Buccal Pitocin and arm Breech • admitted (19) 38 weeks Bibs. (20) ? 34 weeks 5lbs. (21) ? 36 weeks 5lbs. (22) Term - 5lbs. 8ozs - admitted Hypertensive mother (23) Term - 5lbs. 8ozs. (24) 38% weeks - 5lbs. 8ozs. (25) Term - 5lbs. 8ozs. (26) 39 weeks 5 lbs. 8ozs. (27) Term + 1 » 5lbs. (28) 37 weeks - 5lbs. 4ozs.- Hypertensive mother (29) ? - B.B.A. 2lbs. 1oz. - admitted emergency (30) 36% weeks » 5lbs. 12ozs. (31) ? 36 weeks 5lbs. 6ozs. 9. Trllene Analgesia given 88 10. Gas and Air Analgesia given 8 11. "Entonox" Analgesia given 792 12. Patients given Pethidine or Pethllorfan 602 13. Post Partum Haemorrhages 13 Treated at home 11 Admitted to hospital 2 14. Retained Placentae 5 Treated at home 4 Admitted to hospital 11 15. "Flying Squad" calls 7 16. Manual removal of Plecenta at home Nil 17. Blood Transfusions at home Nil 18. Prolonged labours (over 24 hours) delivered at home 6 19. Forceps deliveries at home 1 96 20. Breech deliveries at home 2 21. Sets of twins delivered at home 1½ 22. Anaemia of pregnancy treated at home 110 23. Toxaemia of pregnancy treated at home 17 24. Puerperal Pyrexias 30 Genital 6 Extra Genital 24 25. Congenital abnormalities delivered at home 22 Talipes 7 Haemangioma of neck 1 Hurschprungs disease 1 Cephalocele 1 Hydrocele 1 Large Naevus? Meningocele 1 Umbilical Hernia 1 Extra Digits 2 Umbilical Hernia Into cord 1 Heart Murmur 1 Webbed toes 1 Oesophogeal Atresia 1 Abnormal Penis 1 26. Patients admitted to hospital 398 Ante-natal 263 During labour 110 After delivery 25 27. Patients received for Home Nursing 1,427 Booked for home confinement 230 Booked for Hospital " 1,197 (Including 335 booked for planned early discharge) 28. infants admitted to hospital 28 Undiagnosed twins-(prems.)3 infants Hypocalcaemia (prem.) 1 Cyanosis - (inc. 1 prem.) 4 "Coffee-Ground " vomit 1 Hurschsprung's disease 1 Cardiac Murmur 1 White Asphyxia 1 Large umbilical hernia "Mucosy" & not passed 1 Into cord 1 Meconium 3rd day Jaundice 3 Breech for observation 2 Respiratory distress 1 (Inc. 1 prem.) Oesophogeal Atresia 1 Blood In stools 1 Large Naevus? Unbooked emergency B.B.A 2 Meningocele 1 (inc. 1 prem.) Cephalocele Premature weight associa with hypertension In labour ted 2 29. Guthrie Tests for Phenylketonuria sent to Laboratory 4,866 Repeat tests sent to Lab. 97 30. Pupil Midwlves trained 40 31. District visits of obstetric course students 62 32. RH. Negative patients delivered at home 105 33. Anti-D Immunoglobulin 2 34. Visits made by Specialist Midwife for family planning advice 106 35. The following conditions required medical attention:— FOR THE MOTHER ANTE-NATAL & IN LABOUR Threatened Abortion Pre Eclamptlc Toxaemia Multiple Pregnancies Breech presentation Unstable Lie Small for dates Low Haemoglobin Oedema and Headaches Raised Blood Pressure Urinary Infection 97 FOR THE MOTHER ANTE-NATAL & IN LABOUR Lumbar pain Depression RH. Incompatability Swelling at site of Injection Premature rupture of Membranes Ante Partum Haemorrhage Post Maturity Stillborn Infant Prolonged labour Prolapsed cord in labour Delay 1st stage in labour Foetal distress In labour Maternal distress in labour Brow Presentation Posterior position Undiagnosed twins Episiotomies Post Partum haemorrhages Varicose veins Intra-Uterine death Anti-bodies In RH. Positive patients Hydramnios Premature onset of Labour Unbooked emergency In labour Induction of labour by O.B.E. Arm Arm & Buccal Pitocin FOR THE MOTHER Maternal Blood samples Pyrexia & rapid pulse rates Sub involution Painful Micturition Tender Uterus Odoema of legs Depression Sore Nipples Suppression of Lactation Re-suturing of Perineum Perineal Abscess Emergency unbooked B.B.A. Vomiting Delay 2nd stage in labour Meconium stained liquor in labour Hypertension in labour Face presentation Breech presentation Suturing of Perineal laceration Third degree tear Retained Placentae FOR THE INFANT Congenital Abnormalities Prematurity Immaturity Undiagnosed Twins Asphyxia Pallida Asphyxia Livida Poor muscle tone Sore buttocks Oral Thrush Mastitis Sticky eyes Septic spots Paronychia Large Head ?Hydrocephalus Hernia, when crying Persistent vomiting (Fontanelle & sutures closed) POST-NATAL Low Haemaglobin Offensive lochia Secondary P.P.H. Lumbar pain Reaction to Ergometrine, Penicillin Hypertension & Headaches Phlebitis Mastitis Non-union of Perineum Swollen Labia Diarrhoea Desertion by Husband Vomiting Projectile vomiting Coffee-ground vomit Offensive Stools Retention Urine Retention Meconium Pink Stained Urine Blood in stools Loose Motions Cephal haematoma Cough & Cold Rapid Respirations Twitching of limbs Irritability Tooth Ritual Circumcision Excessive Mucus Cyanosis Jaundice 98 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1965-1969 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate (inc. abortion) Infant Mortality Rate 1965 5,800 — — 17.6 1966 5,750 1 0.17 10.9 1967 5,669 4 0.71 20.0 1968 5,654 2 0.35 17.0 1969 5,513 — 0.18 14.0 Midwife Miles Deliveries Midwifery Mater- nity Analgesia Ante-Netal Vists Post-Natal Visits Bookings Office Bookings Home Visits Clinic Sessions Normal Abnormal Normal Abnormal Gas Si Air Entonox Trilene Midwife Pupil Midwife Pupil 1. 1.135 14+1 — — 14 — — 6 — 164 — 171 — 26 28 12 2. 4,940 55+12 — — 55 — — 51 1 820 526 763 619 119 121 39 3. 5,653 82+ 8 — — 78 4 — 78 — 986 — 745 — 72 78 27 4. — 51+ 5 — — 49 2 — — 41 1,1 77 — 733 — 63 69 19 5. 3,761 57+ 2 — — 57 — — 51 — 721 — 1,004 — 69 79 40 6. 897 9+41 — — 8 1 — 9 — 134 — 185 — 29 18 8 7. 3,696 41+ 5 — — 38 3 — — 37 935 — 782 — 60 47 31 8. 3,074 66+16 — — 69 7 — 60 — 1,687 1,060 1,008 763 125 126 35 9. 4,514 55+ 7 — — 53 2 — 49 — 791 433 735 359 99 90 1 10. 780 10+ 1 — — 10 — — — 8 106 — 174 — 6 9 1 11. 5,507 72+ 3 — — 70 2 — 74 — 852 97 596 79 106 97 21 12. 2,404 67+ 6 — — 64 3 — 63 — 650 908 627 880 89 63 16 13. 2,329 — — — — — — — — 1 — — — — — — 14. + 6,591 84+14 — — 83 1 — 63 — 1,453 1,242 713 548 89 86 13 15. 196 — — — — — — — — — — 28 — — — — 18. + 4,470 80+ 7 — — 78 2 — 67 — 956 695 725 778 112 93 25 17 P/T „ F/T 605 1,730 8+ 0 — — 8 — — 6 — 45 91 — 118 256 — 3 6 11 17 99 100 Midwife Miles Deliveries Midwifery Maternity Analgesia Ante-Natal Visits Post-Natal Visits Bookings Office Bookings Home Visits Clinic Sessions Family Planning Normal Abnormal Normal Abnormal Gas & Air Entonox Trllene Midwife Pupil Midwife Pupil 18. 4,791 63+ 7 — — 63 — — 49 — 946 842 731 636 46 66 71 19. 4,218 89+ 3 — — 88 1 — 67 — 773 976 670 790 118 119 12 20. 3,341 68+ 6 — — 66 — — 60 — 1,660 — 952 — 69 61 19 21. 3,787 39+ 3 — — 38 1 — 36 — 1,226 1,100 876 1,379 101 99 24 22. 2,976 38+ 2 — — 37 1 — 36 — 416 — 742 16 13 17 Part-time Staff 1. 6,333 1+ 0 — — 1 — — — 1 691 — 622 — — — 73 69 2. 5,372 — — — — — — — — 413 — 1,017 — — — 52 120 3. 4,597 — — — — — — — — 1,404 — 1,014 — — — 104 120 4. 2,042 1+ 0 — — 1 — — — 1 340 — 579 — — — 28 128 5. 3,120 8+ 1 — — — — 5 1 — 561 — 645 — — — 49 79 6. 4,686 — — — — — — — — 282 — 926 — — — 46 84 7. 3,230 4+ 0 — — 4 — 2 — — 377 — 478 — — — 66 70 106 Totals 100,973 1042+110 Nil Nil 1,009 33 8 792 88 20,625 7,679 10,603 6,730 1,411 1,293 856 670 106 101 * Part-time midwives No. 1 & 4 attended patients in labour in emergency No. 5 & 7 undertake day-time deliveries if required No. of Deliveries + = No. of deliveries + No. of patients admitted in labour. General Practitioner Obstetricians + Denotes 4 midwives working in attachment schemes but who also undertake a percentage of normal duties. # Denotes 12 midwives in liaison with General Practitioner Obstetricians. The Midwifery staff in full have assisted 36 doctors at their Ante-nata sessions in the year. Staff Changes - Full-time Midwives No. 1 commenced duty August 1969 ) No. 15 commenced duty December 1969 To replace 1968 vacancies No. 17 commenced duty August 1969 Part-time and transferred to full-time Sept. 1969 to replace No. 10. No. 10 left service July 1969 No. 7 left service April 1969 Not yet replacedaced No. 22 left service August 1969 Staff Changes - Part-time Midwives No. 4 retired June 1969 No. 6 commenced duty March 1969 102 CARE OF PREMATURE INFANTS (1) Number of live premature infants notified during 1969 who were born* (i) at home or in a nursing home 28 (ii) in hospital* 289 (2) The number of those born at home or in a nursing home - who were nursed entirely there 22 who were transferred to hospital on or before the 28th day 6 who died during the first 24 hours — who died in 1 and under 7 days 1 who died in 7 and under 28 days — who survived at the end of one month 27 (3) Number of those born in hospital - who died during the first 24 hours 8 who died in 1 and under 7 days 30 who died in 7 and under 28 days 2 who survived at the end of one month 249 (4) Number of premature still births who were born (i) at home or in a nursing home 2 (ii) in hospital 33 The group under this heading includes cases which may be born in one hospital and transferred to another. 103 CONGENITAL ABNORMALITIES No. registered in 1969 - 91 of these 61 were live-births 14 were still-births 16 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-genltal System Limbs Other Skeletal Other Systems Other Malformations 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 2 4 1 — 4 S 1 — — — 4 — 18 16 — 1 1 2 1 1 32 29 61 STILLBIRTHS 7 3 — — — — — — — — — — — — — — — — 1 1 10 4 14 DEATHS — 4 — — 1 1 4 3 — — 1 1 — — — — — — — 1 6 10 16 TOTALS 9 11 1 — 6 6 5 3 — — 6 1 18 16 — 1 1 2 2 3 48 43 91 CAUSES OF DEATH OR STILL-BIRTH Col, 1. Anencephalus 8 Hydrocephalus 4 Microcephalus 1 Encephalocele 1 Col. 3. Cleft Lip and Palate 2 Rectal and Anai atresia 1 Col. 4. Specified malformations of heart and great vessels 4 Unspecified malformations of heart and great vessels 3 Col. 6. Hermaphroditism 1 Malformations of urlnogenital organs 1 Indeterminate sex and multiple malformations of male and female external genitalia 1 Col. 10. Mongolism 2 Multiple congenital malformations 1 ISSUE OF WELFARE FOODS FOR 1969. National Dried Milk 35,745 Cod Liver Oil 5,327 Vitamin A & D Tablets 6,941 Orange Juice 117,346 104 AT RISK REGISTER YEAR ENDING 31st DECEMBER, 1969. Number added to Register during 1969 728 Number on Register at 31.12.69 2,001 No. of 8 month checks carried out during 1969 546 No. of 2 year checks carried out during 1969 727 Referrals and Retests 1969 Born 1969. No. to be seen again at Child Health Centre 5 Born 1968. No. to be seen again at Child Health Centre 24 No. referred to Stycar Hearing Clinic, Dr. Morgan 11 No. referred to Hospital for Specialist opinion 2 Born 1967. No. still to be kept under observation 79 No. referred to Stycar Hearing Clinic, Dr. Morgan 8 No. referred to Handicapped Register 2 No. referred to Hospital for Specialist opinion 2 Born 1966 and 1965. No. still to be kept under observation 39 No. referred to Stycar Hearing Clinic, Dr. Morgan 2 No. referred to Speech Clinic 1 No. referred to Handicapped Register 5 No. referred for I.Q. assessment 6 105 STYCAR HEARING TESTS There were 2,001 children on the "AT RISK" Register at the end of 1969. From 1st January, 1968 names remained on the Register until the child's second birthday instead of being removed at eight months. Number of Clinics held in 1969 13 Number of appointments made during year 118 Non-attenders 31 SOURCE OF REFERRAL AND RESULT SOURCE HEARING SATISFACTORY HEARING UNSATISFACTORY UNCERTAIN TOTAL Referred E.N.T. Referred Speech Clinic For Obser vetlon Referred I.O. Discharged Referred Audio Treining Referred E.N.T. Referred Speech Clinic For Retest Child Health Centres 6 6 3 1 37 1 — — 3 57 L.A. Doctor — — — — 2 — — — 1 3 General Practitioner — 1 — 1 6 — 2 — 4 14 Mr. Oakley, Peripatetic Teacher of the Deaf — 1 — — — — — 1 1 3 School Health Service — — — — — — — — — 1 REASON AND SOURCE OF REFERRAL REASON FOR REFERRAL SOURCE OF REFERRAL TOTAL Child Health Centres L.A. Doctor General Practitioner Mr. Oakley School Health Service 1. Failed Stycar Test 27 • 7 • - 34 2. Poor Speech 18 ' 4 • 1 23 3. Suspected Hearing Loss 10 (Inc. of 4) 3 2 3 * 18 (Inc. of 4) 4. Parent's Request 3 - - - - 3 5. Other Reasons 1 - 1 • • 2 RETESTS REASON FOR RETEST HEARING SATISFACTORY HEARING UNSATISFACTORY TOTAL Referred Speech Clinic For Observation Discharged Referred E.N.T. For Further Retest Referred from previous Stycar Session 2 1 1 2 2 8 No Speech • - • - 1 1 106 HOME VISITS BY HEALTH VISITORS 1969 Part-time Comm. July Left July Comm. April 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Children born 1969 141 107 73 77 73 111 111 67 74 126 129 182 79 81 144 124 140 164 156 Children born 1968 66 160 106 106 4 148 122 71 118 95 166 86 85 76 159 124 125 219 161 Children born 1964/67 225 499 189 149 2 170 214 244 244 163 440 91 240 237 340 246 266 544 626 Re-vlslts 0-5 years 612 429 143 410 190 435 609 605 428 696 661 347 902 628 990 670 487 431 446 Persons 66 or over 26 9 13 7 30 10 5 6 3 46 1 17 11 13 16 18 1 9 14 Mentally disordered persons 7 — 1 6 4 19 — — — 7 14 5 2 7 10 3 1 6 2 Persons discharged from Hospitals 1 — 1 — — 2 1 2 1 3 — — — 1 1 2 — 2 1 Households visited reInfectious diseases (Including T.B.) — — — — — 1 — — 1 2 — — — — — — 1 — 2 Other home visits 42 24 21 21 36 16 64 31 133 71 183 9 154 77 210 607 174 285 159 TOTALS 1,009 1,228 .547 776 338 912 1,016 1,026 1,002 1,108 1,494 737 1,473 1,020 1,870 1,694 1,195 1,649 1,466 (Continued on next page) 107 HOME VISITS BY HEALTH VISITORS (Continued) Part-time Comm.July Part-time Transferred July 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Children born 1869 104 107 116 162 199 179 134 83 166 82 99 133 195 138 42 60 88 200 161 Children born 1968 116 317 138 123 86 211 112 71 166 178 101 110 196 135 16 71 117 299 109 Children born 1964/67 474 307 198 90 247 2 94 413 81 382 169 87 177 427 181 41 271 352 448 280 Re-visis 0-6 years 856 920 662 824 716 750 308 428 1,025 231 248 495 421 249 659 476 302 235 466 Persons 65 or over 3 14 5 67 16 1 12 2 5 9 — 26 4 29 1 23 14 8 60 Mentally disordered persons 16 — 3 15 9 1 4 5 7 2 — 12 2 16 6 6 2 1 9 Persons discharged from Hospitals 10 — 2 14 1 — — 2 1 4 — 6 2 3 1 2 1 2 Households visited reInfectious diseases (Including T.B.) 81 3 — 1 1 — — — — — — — 1 2 3 7 1 — — Other home visits 263 274 210 401 118 261 13 63 200 77 42 148 82 24 111 18 151 253 TOTALS 2,012 2,022 1,334 1,697 1,392 1,687 1,496 736 1,952 742 535 1,000 1,393 834 695 1,025 896 1,343 1,330 (Continued on next page) 108 HOME VISITS BY HEALTH VISITORS (Continued) Left Oct. Comm. July Comm. July Part-time Part-time Pert-time Comm. June Comm. July TOTALS FOR 1989 39 40 41 42 43 44 46 46 47 48 49 50 Chlldran bom 1969 136 132 156 32 116 155 77 117 60 94 182 42 6,976 Children born 1968 56 196 46 22 123 114 84 112 17 132 440 92 6,291 Children born 1964/67 70 404 102 79 199 174 179 160 33 249 134 62 11,782 Re-vlslts 0-6 years 539 418 364 229 161 403 263 305 454 650 441 498 26,003 Persons 66 or over 45 3 28 - 9 3 5 97 8 13 3 78 8 842 Mentally disordered persons 2 2 4 1 9 — 15 — 1 — 10 3 265 Persons discharged from Hospitals — — 2 1 — — 23 — — — — 1 96 Households visited reInfectious diseases (Including T.B.) — 13 9 — 1 — 1 — — — — — 131 Other home visits 23 52 40 32 139 159 112 118 7 42 203 33 6,965 TOTALS 870 1,220 761 405 741 1,010 851 820 585 1,170 1,488 739 56,330 109 ATTENDANCES AT CHILD HEALTH CENTRES - 1960 Addiscombe Grove Monday P.M. All Saints Monday P.M. Benshem Manor Monday A.M. 8. P.M. Boston Road Thursday P.M. Brighton Road,Coulsdon Thursday P.M. Brighton Road, S. Croydon Wednesday P.M. C herry Tree Green Thursday A.M. Coulsdon Youth Club Monday P.M. East Croydon Thursday A.M. & P.M. Falconwood/Forestdale Wednesday P.M. Hazleglen Wednesday A.M. Kenley Friday P.M. Lodge Road (Alt.) Monday P.M. Lodge Road Thursday A.M. & P.M. Lodge Road Friday P.M. Mltchley Avenue (Alt.) Tuesday P.M. Monks Hill Thursday P.M. Monks Orchard Monday P.M. New Addington Wednesday A.M. & P.M. New Addington Thursday P.M. New Addington Friday A.M. Norbury Wednesday A.M. & P.M. Old Coulsdon Tuesday A.M. & P.M. Parish Church Monday P.M. Infants born 1809 61 91 159 125 103 93 30 85 248 98 29 69 26 224 85 26 40 83 286 133 100 204 94 98 No. of re-attendancas 327 535 1092 914 616 769 251 672 1440 798 230 483 61 854 354 99 288 399 1679 699 489 1634 925 690 Children 1 - 6 years 148 180 210 217 204 198 118 276 397 153 85 295 69 462 91 103 107 276 783 379 206 292 183 142 No. of re-attendances 489 951 1227 860 634 632 787 944 2029 710 487 1047 187 1094 367 332 758 697 2301 1605 786 2129 2007 772 Total attendances 1025 1757 2688 2116 1557 1692 1186 1977 4114 1759 831 1894 343 2624 897 560 1283 1465 4948 2816 1581 4269 3209 1602 Consultations with doctors 389 707 867 634 587 508 — 568 1400 604 163 636 198 1229 424 161 422 875 1684 855 703 1493 627 507 No. of sessions 51 49 88 50 51 52 48 55 101 51 52 50 21 97 50 23 46 44 104 51 50 106 92 50 Average per session 1969 20.1 35.9 27.4 42.3 30.5 32.6 24.7 36.9 40.7 34.5 16.0 37.9 16.3 27.1 17.9 24.3 27.9 33.1 47.6 55.2 31.6 40.6 34.9 32.0 Average per session 1968 25.2 31.4 33.9 37.0 30.7 40.3 22.0 22.0 48.3 32.8 17.5 44.4 — 38.3 23.8 25.6 32.6 32.3 66.5 64.0 12.4 41.1 29.4 39.3 Continued on next page 110 ATTENDANCES AT CHILD HEALTH CENTRES -1969 (continued)  Purley Tuesday A.M. Rectory Park Thursday P.M. Reedham Park Avenue (Alt.) Friday P.M. St. Alban's Wednesday P.M. St. Jude's Tuesday A.M. & P.M. St. Oswald's Thursday P.M. St. Paul's Friday P.M. Sethurst Monday P.M. Seledon Monday A.M. & P.M. Shirley Thursday P.M. Shrublands Monday P.M. Shrublands Friday P.M. South Croydon Thursday A.M. South Norwood Tuesday P.M. South Norwood Friday P.M. Upper Norwood Thursday A.M. & P.M. Waddon Wednesday P.M. Woods ide Friday P.M. TOTAL- 1969 TOTAL' 1968 Clinics held at General Practitioners Surgeries in 1 969 Infants born 1969 96 126 25 108 152 80 108 72 96 62 56 52 109 91 129 244 89 128 4422 4622 540 No. of re-attendances 600 855 103 694 1023 641 662 418 726 354 357 312 756 632 804 1523 640 449 27237 26595 2596 Children 1 to 6 years 223 349 72 189 329 150 151 162 304 216 180 278 220 68 186 407 232 373 9742 10572 883 No. of re-attendances 728 1184 277 1318 1354 979 891 697 1622 714 477 678 823 604 704 1969 600 811 401 62 44073 2916 Total attendances 1547 2624 477 2309 2858 1860 1702 1349 2748 1345 1070 1320 1908 1195 1823 4133 1461 1761 81563 85862 6936 Consultations with doctors 593 787 224 645 877 818 595 508 645 575 610 763 576 542 842 1622 485 854 28591 32416 3411 No. of sessions 52 51 26 48 88 51 46 47 98 49 49 49 51 62 49 102 62 63 2466 2604 311 Average per session 1968 29.8 48.5 18.3 48.1 '32.1 36.5 37.0 28.7 28.0 27.4 21.8 26.9 37.4 23.0 37.2 40.5 28.1 28.0 33.1 — 22.3 Average per session 1968 37.1 40.2 16.8 34.5 31.6 36.4 40.0 38.1 32.5 34.8 24.8 28.7 34.2 30.5 31.7 33.9 30.3 27.2 — 34.3 24.5 111 HOME NURSING Staff at 31.12.69. 1 Assistant Superintendent Nursing Officer (District Nursing) 1 Deputy Assistant Superintendent Nursing Officer (District Nursing) 2 Assistant Superintendents 42 Queen's Nurses (including 3 males) 3 S.E.N. Nurses 4 Queen's Students 7 Nursing Auxiliaries. Summary of Work carried out during the year 1969. Patients remaining on books at 31st December 1968 1,530 New Patients 4,736 Total 6,266 New Patients. Medical 2,277 Surgical 2,424 Gynaecological 22 Obstetric 4 Maternity 9 Total 4,736 Specially Classified Cases Visits Tuberculosis 54 1,878 Pneumonia 25 254 Maternal Complications 9 38 Infectious Diseases 18 41 Erysipelas 2 11 Children under five years 139 733 Children five to fifteen years 82 787 Over 65 years old 2,898 110,659 Termination of Cases., Convalescent 2,977 Hospital 1,001 Died 406 Removed - other causes 348 Remaining on books - December 31st 1969 1,514 Total 6,246 112 Visits. January 13,530 February 13,096 March 13,527 April 13,063 May 13,246 June 12,621 July 12,182 August 11,813 September 12,610 October 13,170 November 13,271 December 13,759 Total 155,888 REHABILITATION OF ELDERLY PERSONS Patients visited during 1969. Female 95 Male 46 141 Patients not suitable 31 Hospital 11 Rehabilitation 36 Limited or no success 51 Died 11 one of these completely rehabiIitable at 90) Maximum reached 32 Remaining on Books 34 141 +34 R.O.B. Ages Under 30 years 3 30 - 39 years — 40 - 49 years 6 50 - 59 years 15 60 - 69 years 30 70 - 79 years 45 80 - 89 years 34 90 - 95 years 8 141 113 Illnesses. Cerebrovascular accident & Hemiplegic 73 Arthritis 16 Amputation 2 Fractures 12 Multiple Sclerosis Parkinsons 13 Carcinoma, Cardiac Condition 8 Others not covered by above e.g. Mental Illness, Debility Diseases of unknown origin 17 141 In the Age Group 30 to 59 years 19 cases Arthritis 1 Hemiplegia 9 Disseminated Sclerosis 3 Carcinoma 3 Paraplegia 1 Others 2 19 114 DEATHS FROM ACCIDENTS IN THE HOME 1969 Cause No. Details Falls 20 There were 15 women and 5 men between 57 and 94 years of age. Suffocation 1 There was 1 woman - aged 52 years - Asphyxia, Carbon monoxide poisoning, Inhalation of smoke and fumes. Scalds Nil Burns Nil Poisoning 5 1 man - Age 53 years - Seconal and ethyl alcohol 1 woman - Age 50 years - Discipal 1 man - Age 29 years - Carbon monoxide (oil stove) 1 woman - Age 74 years - Carbon monoxide 1 woman - Age 38 years - Carbon monoxide TOTAL 26 GENERAL PRACTITIONER ATTACHMENT SCHEMES (a) Attachment (Health visitor, domiciliary midwife or home nurse is responsible for all patients on the lists of specified general practitioners within the local authority boundaries without a traditional geographical district). Health Visitor Attachments 10 Domiciliary Midwife Attachments 4 Home Nurse Attachments 19 (b) Liaison (Health visitor, domocoliary midwife or home nurse is responsible both for a geographical district and for the patients on the lists of specified general practitioners. Where patients live outside the nurse's district, though within the local authority boundaries, she does not herself visit them but is responsible for liaison between the general practitioner and the appropriate nurse). Health Visitor Liaison 5 Domiciliary Midwife Liaison 23 Home Nurse Liaison 7 These figures are those for the year ended 31.12.69. 115 LOAN OF NURSING EQUIPMENT The Corporation lends equipment and makes a small weekly charge, with exemption for incomes below a certain figure. 1969 Health Dept. British Red Cross Society Central (A) Shirley (B) Air Rings 67 17 2 Bed Blocks 18 2 — Bed Pans 114 46 6 Bed Rests 118 4 10 Bedsteads 12 — — Bed Tables 4 4 1 Commodes 243 95 9 Cradles 63 30 6 Crutches 15 13 1 Diapers 357 — — Dunlopillo Mattresses 6 — — Enureses Machines 106 — — Feeding cups 9 — — Foam Squares and rings 28 — — Foot suction pumps 4 — — Fracture boards (Sets) 13 — — Hydraulic Hoists 13 — — Incontinence pads 36926 — — Kidney bowls 1 — — Mackintosh sheets 63 12 4 North pads 30 — — Paddi pads 32 — — Paddi rolls 3440 — — Pick-up-stick — — — Plastic sheets 31 — — Protective Under-garments 137 — — Pulleys 19 — — Ripple beds 43 — — Urinals 67 16 4 Walking aids 150 24 — Walking sticks 9 19 — Wheelchairs 102 135 8 116 HOME HELP SERVICE Staff at 31.12.1969 1 Principal Home Help Organiser 1 Deputy Principal Home Help Organiser 1 Tutor Organiser, 5 District Organisers 1 Assessment Officer 5 Clerical Assistants 14 Full Time Home Helps 204 Part Time Home Helps Summary of work carried out during the year under review:— Patients remaining on books from 1968 1,694 New Applicants 1,275 Patients carried forward to 1970 1,814 New Applicants (a) Maternity 235 (b) Sickness 1,040 (c) Night Service Nil Classification of Cases attended (a) Maternity 197 (b) Mental Health 21 (c) Chronic Sick including Old Age and T.B. 2,275 (d) Other - including Acute Sick and problem Families 250 Number of Hours Service given 215,034 Average Duration of Service given (a) Maternity 10 days (b) Acute Sick 10-21 days (c) Chronic Sick Indefinitely Amount Recovered for Service £12,384.5.11d Rate of Remuneration of Home Helps at 31.12.1969 Home Helps 6/5 7/8d (dated from 29.9.69) per hour Washing Service 6/57/8d do '' '' Disinfestation 10/- per week. 117 Dental Services for Expectant and Nursing Mothers and Children under 5 years Part A. Attendances and Treatment Number of visits for treatment during year Children 0-4 (inc.) Expectant and Nursing Mothers First visit 572 117 Subsequent visits 765 207 Total visits 1,337 324 Number of additional courses of treatment other than the first course commenced during the year t 43 9 Treatment provided during the year - Number of fillings 1,055 196 Teeth filled 948 184 Teeth extracted 301 86 General anaesthetics given 111 23 Emergency visits by patients 115 32 Patients X-rayed 10 25 Patients treated by scaling and/or remo of stains from the teeth (prophylaxis) val 48 40 Teeth otherwise conserved 137 Teeth root filled - 3 Inlays - - Crowns - - Number of courses of treatment complet during the year ed 444 57 Part B. Prosthetics Patients supplied with F.U. or F.L. (First time) 6 Patients supplied with other dentures 7 Number of dentures supplied 13 Part C. Anaesthetics General anaesthetics administered by dental officers Nil 118 Part D. Inspections Children 0 - 4 (inc.). Expectant and Nursing Mothers Number of patients given first inspections during year 911 116 Number of patients in A and D above who required treatment 427 94 Number of patients in B and E who were offered treatment 427 94 Part E. Sessions Number of dental officer sessions (i.e. equivalent complete half-days) devoted to Maternity and Child Welfare patients: For treatment 330 For health education 12 119 CERVICAL CYTOLOGY Number of Tests Taken Month No. of Clinica Class I Class II Class III Class IV Class V TOTALS New Ceses Repeats New Ceses Repeats New Ceses Repeats New Ceses Repeats New Cases Repeats Mew Cases Repeets TOTALS January 13 124 78 69 66 2 - - - - - 195 144 339 February 12 111 95 54 37 1 - - - - - 166 132 298 March 14 84 88 46 65 - - - - - - 130 155 285 April 11 102 87 50 43 3 1 1 - - - 156 131 287 May 12 136 84 61 45 - - 1 - - - 198 129 327 June 13 132 128 40 49 2 1 - - - - 174 178 352 July 14 144 106 49 49 1 1 - - - - 194 156 350 August 12 87 68 55 55 2 - - - 1 - 145 123 268 September 13 72 97 44 62 3 - - - - - 119 159 278 October 13 101 98 57 67 1 - - - - - 159 165 324 November 12 112 91 60 60 1 3 - - 1 - 174 154 328 December 13 93 51 56 45 2 - 1 - - - 152 96 248 TOTAL 152 1,298 1,071 641 643 18 8 3 - 2 - 1,962 1,722 3.684 Numbers referred to Family Doctors for Treatment January 21 April 21 July 30 October 19 February 15 May 37 August 22 November 23 March 13 June 28 September 20 December 25 TOTAL REFERRALS = 274 AGE GROUPS 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 50-64 65-69 70-74 Total Class 1 5 46 141 299 536 511 447 213 107 52 12 - 2.369 Class II 2 26 68 147 215 246 229 174 139 35 13 2 1.284 Class III - 1 1 4 6 7 3 2 - 2 - - 26 Class IV - - - - 1 1 - 1 - - - -- 3 Class V - - - - - - - 2 - - - - 2 TOTAL 7 72 200 460 766 764 679 392 246 89 25 2 3,684 Class I • NORMAL SMEAR PATTERN according to age and hysioiogical state (Including pregnancy). Class II . "INFLAMMATORY* PATTERN - may be due to erosion, bacterial or Monllial Infections. Trlchomonad Infestation. Pill, I.U.D. etc. Malignant cells NOT seen. Treat If clinically advisable. Class III . DYSKARYOTIC CELLS PRESENT - Implies that nuclei of epithelial cells are abnormal and may be a reflection of some atypicallty of cervical epithelium. Current opinion suggests that at this stage such a condition may be reversible. Careful follow-up end specialist management required. Class IV - ISOlATED CELLS SUGGEST MALIGNANCY • Early gynaecological review essential. Class V - MALIGNANCY PROBABLE • Early gynaecological review essential. 120 LONG STAY IMMIGRANTS Country Issuing Passport Notifications Received Successful Visits Unsuccessful Visits Commonwealth Countries Carribean 103 91 12 India 119 78 41 Pakistan 69 37 32 Other Asian 16 14 2 African 130 76 54 Others 84 75 9 Non-Commonwealth Coun ries European 54 54 - Others 40 33 7 TOTAL 615 458 157 MALES 158 FEMALES 231 CHILDREN 226 (under 18 years) 121 Nursing Homes • Nursing Homes Act, 1964 Number of Homes Number of beds provided for Meternlty Other Totel Homes registered during the year - - - - Homes on the Register at the end of the year 16 36 366 432 One Nursing Home was closed during the year under review. NURSES AGENCIES ACT, 1957 There are three agencies on the Register which supply nurses for home nursing on a private patient paying basis. CREMATION ACTS, 1902 and 1952 During the year 2,822 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 1969 Total number of Bodies received 1,064 One Adult no Post Mortem Examination. One Stillborn no Post Mortem Examination. Total number of Post Mortem Examinations for H.M. Coroner 1,062 122 CROSFIELD INDUSTRIAL UNIT The number of severely disabled persons employed on 31.12.69 was 94. The comparable figures for 1968 are shown in brackets. Type of disability Mate Female Total *Mental illness 24 (29) 18 (18) 42 (47) Subnormality 16 (12) 6 ( 7) 22 (19) Severe subnormality 8 ( 9) 7 ( 7) 15 (16) Physical handicap 13 (13) 2 ( 4) 15 (17) 61 (63) 33 (36) 94 (99) *7 male (12) and 1 female (3) attend daily from Warlingham Park Hospital. Totals of employees admitted via: Male Female Total Warlingham Park Hospital 3 2 5 Day Hospitals 1 2 3 Bensham Assessment & Rehabilitation Centre 11 2 13 Disabled Resettlement Officer 4 - 4 19 6 25 Number of employees leaving unit: Open employment 13 (1) Wayiands 1 (2) Died 4 (2) Other causes 12 (2) 30 (7) The number of non-sheltered workshop trainees as at 31.12.69 was 4 (5) there being three admissions during the year and 4 discharges. Remuneration 1969 1968 £ s. d. £ s. d. Total amount paid out as pocket mon ey 473. 0. 6. 482. 8. 0. Total amount paid out as wages 49,652 18. 7. 44,362. 13. 5. 50,125 19. 1. 44,845. 1. 5. Income £ s. d. £ s. d. (a) Industrial contracts: Packing, assembly, electrical subassembly 39,505. 1. 9. 33,332. 10. 0. (b) Mobile Work Group 3,521. 14. 5. 1,250. 18. 3. (c) Furniture, repairs and renovation s 315. 7. 3. 256. 13. 0. (dj Manufactured breeze blocks sold 5,443. 3. 1. 9,061. 0. 0. £48,785. 6. 6 £43,901, 1. 3. 123 Value of raw materials and breeze blocks in stock 31.12.69: £1,698. 16. 8d. Average daily attendance: 94 (85) (excluding paid and approved unpaid holidays) BENSHAM ASSESSMENT AND REHABILITATION CENTRE Number of rehabilitees attending on 31.12.69: 37 Type of Disability Male Female Total Mental illness 16 6 22 Subnormality 7 6 13 Physical handicap 2 - 2 25 12 37 Referral Source Warlingham Park Hospital 10 2 12 Waylands - Health Wing 4 4 8 Day Hospitals 12 2 14 Department of Employment & Productivity 9 6 15 Social Workers 7 2 9 Others 6 - 6 * 48 16 64 Totals of rehabilitees discharged during the year: Male Female Total Open employment 16 6 22 Sheltered employment 12 2 14 Industrial Rehabilitation Unit 4 - 4 Day Hospital 3 - 3 Waylands - 1 1 Terminated 16 4 20 51 13 64 Average daily attendance during the year: 30 (28) Total income from industrial work (approx.): £6,679. 14. 4. WAYLANDS. CRAFTWORK, TRAINING AND SOCIAL CENTRE Numbers of severely disabled persons attending the Health Wing at 31.12.69. were as follows:— Type of Disability Male Female Total Mental illness 5 1 6 Subnormality 11 20 31 Severe subnormality 48 30 78 Physical handicap 2 1 3 66 52 118 124 Totals of Trainees admitted from: Male Female Total Coldharbour School 1 1 2 St. Christopher's E.S.N. School 2 1 3 Careers Officer 1 2 3 Social Workers 3 - 3 Bensham Assessment & Rehabilitation Centre - 1 1 Other Sources 2 2 4 9 7 16 Totals of trainees discharged to: Male Female Total Bensham Assessment & Rehabilitation Centre 4 4 8 Spastics Centre - 1 1 Voluntary Termination 1 3 4 Open employment - 1 1 Left area 2 1 3 Died 1 - 1 8 10 18 Remuneration 1969 1968 £. s. d. £. s. d. Total merit payments, fares, craftwork payments to whole centre 10,297. 2. 8 8,737 . 8, . 8. Total earnings for whole centre 11,278. 16. 1 12,909 . 17. , 6. Average daily attendance (Health Wing only) during the year: 105. 125 126 127 128 COMMUNICABLE DISEASES NOTIFIED DURING 1969 Notifiable Disease At all ages Cases notified Total cases notified In wards At ages - years U. Norwood Nor bury IV. Thornton Ben. Manor Thornton Heath S. Norwood Woods Ida East Addlscombe Wh.'tehorse M. Broad Green Centre! Waddon Addington Shlrle y Sandersteed North Sandersteed end Selsdon Wood cote and Coulsdon West Coulsdon Eest Pur ley M F TOTAL Under 1 1 - 4 5 - 14 16- 24 25 - 44 45 - 64 65 & over Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 137 - 51 80 4 2 - - 16 5 6 4 19 8 11 3 4 1 5 2 6 18 3 4 5 8 . 11 70 67 137 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Meningitis 10 3 4 2 - - 1 - - - 1 - - - - - 2 - 2 2 1 1 - - - - 1 - 6 4 10 Typhoid & Para- Typhoid 6 - 1 - 2 2 - - - 1 - - - - - 1 - 1 - 1 - - - - - - 1 - 2 3 6 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 79 3 30 20 7 18 1 2 1 1 2 20 2 2 - 5 3 4 7 1 1 13 2 1 1 3 7 3 36 43 79 Malaria 3 - - - - 2 1 - - - - - - 1 - 1 - - - - - - 1 - - - - - 3 - 3 Infective Jaundice 49 - 1 13 6 19 6 4 6 4 1 3 4 2 3 - 3 1 2 1 2 8 4 1 3 - - 1 27 22 49 Food Poisoning 31 2 7 8 3 6 7 - 1 - 1 1 1 - 2 2 3 - 1 1 - 5 3 2 2 1 1 4 14 17 31 Acute Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles Whooping Cough 1927 74 77 7 1161 38 684 28 10 - 4 3 1 - - - 79 - 23 1 48 3 64 - 160 9 85 - 80 - 30 3 60 2 100 1 24 2 27 1 103 - 654 42 41 1 150 1 139 2 61 2 62 1 47 3 1004 33 923 41 1927 74 Leptospirosls - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tetanus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Yallow Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2316 92 1283 831 32 54 17 6 102 35 62 92 195 98 96 46 77 108 43 36 112 641 55 1B9 162 75 63 69 1196 1170 2316 Tuberculosis notifications are shown In the section relating to that diasase 129 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1969 Notifiable Diseases Jen. Feb. Merch April Mey June July Aug. Sept. Oct. Nov. Dec. Totel Respiratory Tuberculosis 3 6 3 4 8 6 4 4 4 7 6 3 66 Nonrespiratory Tuberculosis 2 1 - 1 1 1 - 3 3 1 - 2 16 Anthrax - - - - - - - - - - - - - Scarlet Fever 10 15 30 8 26 8 8 6 4 4 - 4 137 Diphtheria - - - - - - - - - - - - - Acute Meningitis 2 - 1 1 - - - - - 2 - 4 10 Typhoid & Para-typhold - - - - 1 - - 2 1 - - 1 5 Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Ophthalmia Neonatorum. - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - Dysentery 8 6 5 17 6 6 16 8 6 - - 1 78 Malaria - - - 2 1 - - - - - - - 3 Infective Jaundice 4 0 2 4 12 6 1 5 4 4 - 1 48 Food Poisoning 1 - 1 9 1 5 6 3 8 7 - - 31 Acute Encephalitis - - - - - - - - - - - - - Measles 217 278 301 181 233 218 221 88 28 88 42 20 1927 Whooping Cough 3 11 3 4 4 3 4 - 21 8 2 e 74 Leptospirosis - - - - - - - - - - - - - Tetanus - - - - - - - - - - - - - Yellow Fever - - - - - - - - - - - - - 2386 130 FOOD POISONING Corrected food poisoning notifications and cases ascertained in 1969 n umbered:- 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 2 14 21 8 45 Outbreaks due to identified agents:- Total Outbreaks Total Cases 9 26 Outbreaks due to:— (a) Chemical poisons Nil (d) botulinum Nil (b) Salmonella organisms 7 (e) welchii 2 (c) Staphylococci (including (f) other bacteria Nil toxin Nil Outbreaks of undiscovered cause:— Total Outbreaks Total Cases Nil Nil Single Cases:— Agent identified Unknown Cause Total 18 1 19 Cases due to:- Salm. typhi murium Salm. enteritidis Salm. heidelberc. 6 1 1 Salm. penftenberg Salm. virchow Salm. Stanley 1 1 2 Salm. oranienburg Salm. brandenburg Salm. poleypark 1 2 1 CI. welchii Salm. undentified 1 1 Salmonella infection not food-borne:- Nil 131 SAMPLES SUBMITTED TO THE PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION - 1969 Faeces outfits 2,700 Drinking Water samples 474 Public Swimming Bath Water samples 123 Private Swimming Bath Water samples 165 Private Wells 141 Milk samples 158 Cream samples 1 Ice Cream samples 105 Sundry Food specimens <38 Blood 39 Urine 803 Nose and Throat Swabs 54 Total 4,801 Samples of Drinking Water During the year under review the total number of examinations performet were:— Bacteriological 463 Chemical 11 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 resampling by the Water and Health Departments is performed. Further action depends on the findings of these re-tests. 132 IMMUNISATION AGAINST WHOOPING COUGH A total of 3,806 children were immunised against whooping cough, comprising 3,624 under school age and 172 school children. In addition 1,431 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 4,784 children were immunised against Tetanus, comprising 3,768 under school age and 1,016 school children. In addition 7,044 children were given reinforcing injections VACCINATION AGAINST SMALLPOX A total of 5,349 persons were vaccinated against Smallpox. Under 1 veer of ege 1 2-4 5 - 16 16 or over Totel Successful Vaccinations 9 1 .096 1,240 168 309 2.822 Successful Re-vaccinations - - 47 421 2,059 2,527 Insusceptible to Vaccination - - - - - - 5.349 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1969 who completed a course of immunisation during the year. Age et 31.12.69 I.e. Born In veer Under 1 1963 1966-1968 1966-1962 1961-1963 Totel Completed course of injections 439 3,325 383 169 4,316 Reinforcing Injections • 848 4.509 1,025 6,382 TOTAL 439 4.173 4.892 1.194 10,698 Under 1 1- 4 Totel under S 5- 14 Tote1 under 16 Estimated mid year Child population 5.520 22.280 27.800 50,600 78.400 133 VACCINATED AGAINST POLIOMYELITIS The following table gives the number of persons who received a course of primary vaccination during the year. VACCINATED Children born 1969 Children born 1968 Children born 1967 Children born 1966 Young Persons born 1965-62 Persons over 1961-53 Persons over 16 years of age With Salk Vaccine - 5 2 - - - - With Oral Vaccine 341 2.521 319 150 347 280 97 With Quadruple Vaccine - - - - - - - Number of persons who received a reinforcing vaccination as at 31st December, 1969. VACCINATED Persons given a first reinforcing Vaccination during 1969 With Salk Vaccine 7 With Oral Vaccine 7.538 With Quadruple Vaccine - Annual Total 7.545 TOTAL since Vaccination began 138.124 INTERNATIONAL VACCINATION CERTIFICATES During the year 6,508 certificates were authenticated, 5,322 Smallpox, 559 Cholera, 627 T.A.B. IMMUNISATION OF CHILDREN BORN IN 1968 Polio Diphtheria 1968 Live Births 1,245 - (Immunised 1968) - 814 2,521 - (Immunised 1969) - 2,628 3,766 3,442 5,583 (67%) (62%) 134 135 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Summary or notifications during the period from 1st January, 1969 to 31st December, 1969. Formal Notification Age Periods Number of Primery Notifications of new ceses of Tuberculosis 0- r- 2- 5- 10- 16- 20- 25- 36- 45- 55- 65- 75- Total (ell ages Respiratory, Males 1 1 1 2 1 - 3 6 8 7 6 5 2 43 Respiratory, Females - 1 3 - 2 - 1 2 2 1 - 1 - 13 Non-Respiratory, Males - - - - - 1 1 1 1 1 - - - 5 Non-Respiratory, Females - - - - - 1 2 - 3 1 1 2 - 10 Rehousing of Tuberculous Patients 4 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1969, 55 new patients examined at the clinic were found to be in the undermentioned stages of the disease at the first examination. A, or T.B. minus (Sputum negative or absent) 35 63.6 B, or T.B. plus, 1 (early cases, sputum positive) 4 7.3 B, or T.B. plus, 2 (intermediate cases, sputum positive) 16 29.1 B, or T.B. plus, 3 (advanced cases, sputum positive) 55 100.0% Non-Respiratory Tuberculosis There were 8 cases examined at the Clinic and found to have NonRespiratory Tuberculosis in the following forms:— Bones and Joints 1 Abdominal 2 Other Organs 1 Peripheral Glands 4 8 136 Ages at Death from Respiratory Tuberculosis Year 0 - B 5 - 15 16 - 25 25 - 45 45 - 65 over 65 TOTAL 1969 - - - - 5 5 10 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1969 1,264 Transfers in from other areas 22 New cases confirmed during the year 55 1,341 Number of cases written off the Chest Clinic Register during the year as:- Recovered 317 Died 29 Removed to other areas 21 "Lost sight of" and other reasons 35 402 Remaining on Register as at 31st December 939 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 from other areas 1,909 Number of visits paid by Clinic doctors to homes of patients 250 Number of visits paid to homes of patients by Tuberculosis Health Visitors 2,681 Attendances of patients at the Clinic - At ordinary sessions *15,511 Number of X-Ray films taken *17,959 *Includes 3,904 miniature film attendances 137 VENEREAL DISEASES 1969 New cases residing in Croydon and treated at:— Croydon General Hospital St. Bartholomew's Hospital St. Helier County Hospital St. Thomas's Hospital Westminster Hospital Whitechapel Clinic 138 VENEREAL DISEASES Croydon General Hospital Centre 1. New Cases of Syphilis Totals Males Females (I) Primary 9 8 1 (II) Secondary 5 5 - (III) TOTAL OF LINES 1 (1) and 1 (II) 13 13 - (IV) Latent In the first year of Infection 8 8 - (V) Cardiovascular - - - (VI) Of the nervous system 1 - 1 (VII) All other late and latent stages 19 6 13 (VIII) Congenital, aged under 1 year - - - (IX) Congenital, aged 1 but under 5 years - - - (X) Congenital, aged 5 but under 15 years - - - (XI) Congenital, aged 16 and over 1 - 1 (XII) TOTAL OF LINES 1 (III) to 1 (XI) 43 27 16 2. Age Groups of Cases in Item 1 (i) & (ii) Above (I) Under 16 - - - (Il) 16 and 17 - - - (Ill) 18 and 19 4 3 1 (IV) 20 - 24 3 3 - (V) 25 and over 7 7 - (VI) TOTAL OF LINES 2 (I) to 2 (v) 14 13 1 3. Cases Transferred from other Centres in England and Wales after Diagnosis - - - 4. Cases in Which Treatment and Observation were Completed 4 2 2 5. New Cases of Gonorrhoea (I) Post-pubertal Infections 316 231 85 (Ill Vulvovaginitis - - - (Ill) Ophthalmia Neonatorum - - - TOTAL OF LINES 5 (1) to 5 (III) 316 231 85 6. Age Groups of Cases in Item 5 (i) Above (I) Under 16 1 - 1 (II) 16 and 17 16 6 10 (Ill) 18 and 19 33 17 18 (IV) 20 - 24 222 189 33 (V) 25 and over 144 119 25 (Vll) TOTAL OF LINES 6 (I) to 6 (v) 316 231 85 7. Cases Transferred from Other Centres in England and Wales after Diagnosis 6 5 1 8. Cases in which Treatment and Observation were Completed 56 28 28 SYPHILIS GONORRHOEA 139 OTHER CONDITIONS 9. New Cases of Other Conditions Totals Males Females (i) Chancroid - - - (ii) Lymphogranuloma - - - (iii) Granuloma Inguinale - - - (iv) Non Gonococcal Urethritis 446 446 - (v) Non Gonococcal Urethritis with Arthritis 2 2 - (vi) Late or Latent Treponematoses presumed to be non-Syphilitic 16 4 12 (vii) Other conditions requiring treatment within the centre 600 237 363 (viii) Conditions requiring no treatment within the centre 434 275 159 (ix) Undiagnosed conditions 42 - 42 (x) TOTAL OF LINES 9 (ii) to 9 (ix) 1540 964 576 10. Cases Transferred from Other Centres in England and Wales after Diagnosis 1 1 - 11. Cases in which Treatment and Observation were Completed 611 303 308 12. Number of Individual Patients Attending in Year with New Infections of (1) PRIMARY OR SECONDARY SYPHILIS Age Groups (i) Under 16 - - - (ii) 16 and 17 - - - (iii) 18 and 19 4 3 1 (iv) 20 -24 3 3 - (v) 25 and over 7 7 - (vi) TOTAL OF LINES 12 (1) (i) to 12 (1) (V) 14 13 1 (2) GONORRHOEA (Post-pubertal) Age Groups (i) Under 16 1 - 1 (ii) 16 and 17 16 6 10 (iii) 18 and 19 32 16 16 (iv) 20 - 24 112 79 33 (v) 26 and over 128 103 25 (vi) TOTAL OF LINES 12 (2) (i) to 12 (2) (v) 280 204 85 13. Localities in which Infections Took Place (1) PRIMARY OR SECONDARY SYPHILIS (i) In locality of Centre 12 11 1 (ii) Elsewhere in Great Britain and Northern Ireland 1 1 - (iii) Outside Great Britain and Northern Ireland 1 1 - (iv) Not known - - - (v) TOTAL OF LINES 13 (1) (i) to 13 (1) (iv) to agree with line 1 (iii) 14 13 1 (2) GONORRHOEA (i) In locality of Centre 219 168 61 (ii) Elsewhere in Great Britain and Northern Ireland 85 61 24 (iii) Outside Great Britain and Northern Ireland 12 12 - (iv) Not known - - - (v) TOTAL OF LINES 13 (2) (i) to 13 (2) (iv) to agree with line 5 (1) 316 231 85 140 14. Attendances and Diagnoses of Contacts Totals Males Females (1) Contacts slips Issued to patients with (i) Syphilis, primary and secondary 14 14 - (ii) Gonorrhoea 247 214 33 (2) Contacts attending with (i) Syphilis, primary and secondary 4 3 1 (ii) Gonorrhoea 49 5 44 (iii) Other conditions 195 36 159 15. Total Attendances of All Patients (i) Syphilis 621 451 170 (ii) Gonorrhoea 927 567 360 (iii) Other conditions 4361 2703 1658 (iv) ALL CONDITIONS (TOTAL OF 15 (i) (ii) and (iii) 5909 3721 2188 16. Cultures for the Gonococcus 1058 21 1037 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. Name of Local Health Authority Number of New Ceses In year Syphilis Gonorrhoea Primary and Secondary (1) (iii) Other (1) (iv) to (1) (xi) (5) (iv) Other Venereal Conditions (9) (x) Totals all Venereal Conditions CROYDON 10 27 214 997 1248 BROMLEY - - 21 65 86 LAMBETH 1 - 11 32 44 MERTON - - 9 32 41 SURREY 1 - 18 146 165 SUSSEX EAST - 1 1 18 20 SUSSEX WEST - - - 5 5 SUTTON 1 - 9 50 60 WANDSWORTH 1 1 5 11 18 OTHERS - - 28 142 170 TOTALS 14 29 314 1498c * 1857 * Excluding 42 undiagnosed cases. 37 PART III HANDICAPPED PUPILS There are some 716 children in Croydon who are sufficiently handicapped to warrant admission to a special school. This number shows a slight increase (3.8%) compared with each of the two preceding years. This increase has occurred mainly in the number of children requiring admission to schools for the educationally subnormal, representing increased ascertainment in anticipation of additional special school provision in 1970. The category of educational subnormality accounts for exactly half the total number of children requiring special educational treatment who were known to the School Health Service. An analysis of handicapped children by year of birth shows a significant increase in the number of young children who are recognised to require special educational treatment, and this trend is most marked in the category of physical handicap. In addition to the increase in total numbers, reference is made (page 51 ) to the changing character of the handicap, so that much more severely disabled children are now being brought forward for admission to St. Giles' School. This increase in the number of handicapped children suggests that some of the children with less disability must remain within ordinary schools. The decision by the Department of Education and Science to conduct an enquiry into the care of physically handicapped children in ordinary schools was timely, and should reveal much useful information. The Service does not keep clinical records about all such children at the present time, but Croydon Head Teachers were most helpful in notifying handicapped children who were attending their schools, enabling further enquiries to be made. Problems of definition inevitably arose, and it was clear that some children were regarded as handicapped when the medical justification for such a view was limited. In some cases children were being accommodated in an ordinary school in deference to the wishes of their parents, although the detrimental effect of some arrangements upon the child's educational progress was clearly recognised by the teaching staff. Of necessity such children are not able to receive the intensive support which would be available from medical and other professional staff at a sDecial school. These initial investigations have again shown the extent to which teachers in Croydon are willing to vary normal arrangements in order to allow the majority of children with a handicap to attend ordinary schools. In 1969 a total of 130 pupils were newly ascertained by the Education Committee as requiring special educational facilities in special schools or special units (Table 10). Unfortunately in many instances these new cases merely resulted in an extension of waiting lists, but the commencement of building operations at the sites of two new special schools during the year raised hopes of early improvement in this situation. In all cases the medical recommendations were straightforward, and the Consultant Panel did not meet during the year. 38 TABLE 10 Children requiring Special Education, 1969 CATEGORY New Cases Ascertained by Committee * New AdmiSsi oris Number of Children receiving Special Educational Treatment 23.1.1970 No. of children awaiting placement on 23.1.70 Special Schools Independent Schools Hospitals Day Units Home Tuition Total Day Residential Day Residential BLIND 1 2 0 8 1 9 - - PARTIALLY SIGHTED 4 4 21 2 23 - - DEAF 1 3 6 17 23 2 1 PARTIALLY HEARING 7 7 3 2 31 36 1 2 EDUCATION. ALLY SUBNORMAL 67 38 251 16 6 273 73 6 EPILEPTIC 2 5 12 5 17 - - MALADJUSTED 17 11 4 8 39 17 1 69 - 8 PHYSICALLY HANOI- CAPPED 26 23 97 14 2 4 - 117 5 - SPEECH 2 2 3 0 12 15 1 - DELICATE 3 9 35 7 42 3 1 TOTAL 130 104 432 79 48 0 64 1 624 85 18 *Including cases ascertained in previous years. TABLE 11 PRE-SCHOOL HANDICAPPED CHILDREN Category Age on the 31st December, 1969 5 years 4 years 3 years 2 years 1 year or less Vision Defect - 1 3 - 1 Hearing Defect - 2 1 6 2 Mental Disorder 3 14 36 9 14 Epileptic - 1 4 3 - Physically Handicapped or Delicate - 18 26 17 32 Total 3 36 70 35 49 39 The importance of early detection of handicapped children so that adequate educational arrangements may be made in good time has been recognised within the Service for a number of years. It is encouraging to note that a total of 193 pre-school handicapped children are now known to the School Health Service (Table II). The number of children recorded has increased steadily since the system was introduced several years ago, but concern had been expressed that such children were generally recognised from specialist reports rather than from the observations of the pre-school child health services. During the year extensive reorganisation has taken place within the Department and the services for the pre-school child have been combined with those of the School Health Service, to create a single Child Health Service responsible for all health services involving children. An immediate practical result has been to link the existing systems for the detection of handicapped children into a single comprehensive service of progressive assessment. Any child who is considered to be at risk of a serious handicapping condition is included within this system either at birth or at any point thereafter. Such children receive particular attention from the pre-school services until the age of two years when, if no obvious defect has emerged, the child is discharged from the system. The remaining children, together with others who are recognised to be potentially handicapped, are reviewed each birthday to assess the extent of any handicap which may be present. Again, some children are found to be developing normally during these assessments, and are discharged from the system. There remains a group of children who may need special educational treatment, and arrangements are made to review each of these children about six months before a place in a special school is.likely to be required. Formal ascertainment, or advice to the teacher of the ordinary school likely to admit the child, then follows. The objective is, of course, to concentrate effort upon the children who are likely to be most in need, whilst ensuring that those children who do not fall within the system continue to receive all the services necessary for the pre-school child. In future years it will be necessary to modify Table 11 to take account of this revised system of assessment so that a temporary reduction in numbers of children must be anticipated. Future Tables will not include children less than two years. It must also be recognised that the value of this Table lies not so much in the numbers recorded, as the general trend which it indicates. By including some children who may not require admission to a special school, there is a tendency to over-estimate demand in some categories. Nevertheless, the Table has already provided timely warning of the number of physically handicapped children who are likely to require admission to St. Giles' School. BLIND AND PARTIALLY SIGHTED PUPILS Blind Partially Sighted In Residential Schools 9 2 In Day Schools - 21 40 Blind One blind child was ascertained in 1969 and admitted to a residential special school. Partially Sighted During the year four children were found to require special educational treatment in this category, and all of them were admitted to St. Luke's School. Some of the older children were able to integrate for part of the school day with children in the adjacent Winterbourne Schools, and this experiment was so successful in one case that the boy was finally discharged to continue his education in an ordinary school. Traditionally, special educational treatment has been provided only when it has been shown that the child is failing in an ordinary school, and such a policy can have very damaging effects upon the attitude of the handicapped child towards education. For some years in Croydon the reverse policy has been followed providing an early start to education in a special school with later transfer to an ordinary school if progress is satisfactory. By this approach the child has success to encourage further effort rather than failure that skilled teachers must then do their best to overcome. Two children with multiple handicaps in attendance at St. Luke's School were reviewed during the year in anticipation of the need for continued special educational treatment beyond the age of eleven years. In view of their multiple handicaps applications were made for both children to be admitted to residential special schools. I am grateful to Miss J. Rundle for the following report of the work of the School. St. Luke's Special School for Partially Sighted Children During 1969, as in previous years, every endeavour was made to help the children gain as many new experiences as possible in spite of a very limiting handicap. The children work along normal lines as far as they are able, though their rate of progress is slower than that of normally sighted children. Various educational visits were made with the aim of widening the children's experiences and of increasing their mobility. Most of the visits were made by public transport so that the children had the opportunity of using buses and trains thus helping them towards self-reliance and independence later on. Among the places visited were The Commonwealth Institute, a farm, Outwood Mill,The London Zoo and Brighton. More than 50% of the children in the unit regularly attended the Swimming Baths. Apart from the pleasure of going to the Baths and the satisfaction of learning to swim it is hoped to improve the children's posture. Visually handicapped children often become round-shouldered particularly as their progress through school involves more and more close work. Several children have gained Swimming Certificates. 41 One boy has been transferred to Winterbourne Junior Boys' School. His progress as a part-time pupil was so successful that he has now become fully integrated in the normal school system. Another boy continues to attend part-time. The help and interest of the Headmaster of Winterbourne Boys' School is much appreciated. Two ophthalmologists have visited the school to carry out eye examinations. Dr. J.S. Horner carried out the yearly medical examinations and Mr. J.D. Palmer, the Principal School Dental Officer, examined the children's teeth. It is satisfactory to report that Mr. Palmer found the condition of the teeth to be generally good. I am extremely grateful to all these people for their interest in the children. There have been opportunities each term for the parents to meet and visit the school. An Easter Service was well attended at the end of the Spring Term. There were many visitors to the Open Day in July. Many parents and friends attended the Harvest Festival Service. Later in the term a Coffee Evening was held in aid of the School Fund. The year ended with a Nativity Play performed by the children and the usual Christmas Festivities including the Christmas Party at which each child received a Christmas present kindly provided by the Education Committee. No. of children on Roll 31.12.69 15 Admissions 4 Returned to normal school 1 Transferred to St. Giles' School 1 Transferred to School for the Blind 1 DEAF AND PARTIALLY HEARING PUPILS Deaf Partially Hearing In Residential Schools 17 2 In Day Schools and Units 4 37 Deaf One child was ascertained as deaf during the year, and because of social difficulties was admitted to a residential school. In addition, two children who had been attending the Partially Hearing Unit for infant pupils were found to require education in a school for the deaf, and appropriate recommendations were made. The parents of both children wish them to attend day schools for the deaf and, since the Committee does not provide such a school, an approach was made to adjacent Authorities. Unfortunately by the end of the year a vacancy had still not been obtained, and the children were attending the Partially Hearing Unit for Junior Pupils. This Unit was not designed to care for the severely deaf, and even the temporary placement of such children within it is a source of some concern. Moreover, the situation is likely to deteriorate still further, since there are indications that up 42 to seven more children currently attending the Infant Unit may require admission to schools for the deaf during 1970. It may be necessary to persuade some parents to allow their deaf children to attend residential rather than day special schools. This situation has arisen chiefly because an outbreak of German measles in 1962/1963 affected some pregnant women, so that their children were born severely deaf. A sharp increase in the demand for places in the Partially Hearing Units occurred in 1965, and these same children are now reaching the age of admission to Junior Schools. It will clearly be necessary to make exceptional arrangements to deal with this temporary situation, and urgent discussions are planned to formulate specific proposals. Partially Hearing Seven children were ascertained partially hearing during the year, and six of them were admitted to appropriate day units. The energetic efforts of recent years resulting in the creation of a complete system of special education for the partially hearing child using day units attached to ordinary schools have largely eliminated previous problems of long waiting lists. Difficulties, however, still remain. Attention must now be directed towards a clarification of objectives within the units. In the younger age groups the inclusion of both deaf and partially hearing pupils in the same unit avoids the need for young children to travel long distances, or for admission to residential schools. Nevertheless, it presents great problems for the teacher, since the needs of the two groups are not always the same. In the older age groups other difficulties emerge, not least of which is the age spread of the children within a single unit. An ingenious use of integration within the school can overcome many difficulties, but may be prejudiced by other factors. The need to accommodate the whole of the first year of Riddlesdown Secondary School in the buildings of the former Roke School has created some problems in the Partially Hearing Unit which is housed in the main school buildings, and which accepts children direct from the Junior Unit. During the year it was necessary to recommend that two partially hearing children of eleven years should be admitted to residential special schools, and in a third case the parents requested such a transfer, although the balance of professional advice indicated that the child was satisfactorily placed at the Riddlesdown Unit. Dr. Lilian Morgan, the Senior Medical Officer, who is specially responsible for children with hearing difficulties, comments:— " At present there are some difficulties being experienced at these Units as a result of a high proportion of severely deaf children in the 5-7 year age group. There is also the problem of finding suitable schools for the future education of this deaf group. The Senior Unit for partially hearing pupils, which opened at Riddlesdown County Secondary School in September 1968, provides education for older children (11 +). There have been anticipated difficulties in the integration of 43 the first year pupils attending the Unit, since the first year pupils of the School have been moved to Roke School. I understand that efforts are being made to resolve these difficulties. Mr. Parsons (Consultant Otologist) has visited each of the Units once a year. At these visits the teacher concerned, Mr. Oakley, the parent (if present) and myself are present, when the progress, problems, and the future education of each child are discussed individually. Regular visits have been made by myself to these Units throughout the year to observe the progress and supervise the general health of the children. The children attending all four Units are making satisfactory progress within the limitations (already referred to) of the Units." I am grateful to the Chief Education Officer for the following reports on the work of the Units for the Partially Hearing:— Partially Hearing Unit for Nursery Children, Kingsley Infants' School This year the Unit roll has varied between 6 and 8 children with an age range of 2½ to 5 years. It is thought most of the children concerned are severely deaf but all use spontaneous vocalisation. Three children use intelligible words or phrases. Two of the latter children are partially hearing and constantly use spontaneous speech. The integration with the hearing Nursery children has been successfully increased to include occasional whole days. One child remains in the hearing Nursery every afternoon. One child from the main school visits the Unit for speech and language work. While continuing with the previous Nursery method of Education an increase of auditory training has been considered essential. This has been achieved very happily by all the children. Extra attention has been given tc the maintenance of all aids to hearing since the recent survey in Inner London. Our thanks are given to Mr. Wootton of New Cross Hospital for his ready help with our Medresco aids. It is certain that the children's experience of sound has to be increased (where possible). Minor technical improvements have been made and it is expected that a Peters Senior Speech Trainer (and further acoustic tiling) will help substantially. It is hoped to release the present Unit trainer for home use shortly. Our children are very keen to attend school. Parents also have attended the Unit and with the Infant Unit have helped to make two very well attended and successful meetings in October and November. There is a general desire that these meetings continue and provide help and information concerning speech, language and basic (technical) knowledge. Our thanks are due and given freely to our colleagues in the main school whose help is so valuable to us. 44 Partially Hearing Unit for Infant Children, Kingsley Infants' School During the Summer Term of 1969, our number increased to eleven but in the September term three seven year old children were transferred to the Junior Partial Hearing Unit and one six year old to the residential school in Margate. With the entrance of three children from the Nursery Unit, there are now ten children in the Infants Unit. There will be a considerable upheaval in the next September term as seven children will have reached their seventh birthday and decisions will soon have to be taken as to the most suitable form of Junior education for each of them. The children in the Unit vary in their abilities and degrees of deafness, most of them having a severe hearing loss. The class can be roughly divided into two groups; - one group of six is given the basic auditory and visual training necessary for the acquisition of a rudimentary vocabulary; four are producing spontaneous and recognisable speech, albeit of a limited vocabulary range. - the other, more advanced, group is progressing well; these children are using simple sentences and phrases, employing quite extensive vocabularies and using reading as a means of developing and extending their language. Reading lessons are built around the children's own experiences and activities; for example a recent project concerned food - how it is prepared, where it is found etc. Much help is given here by the parents using home note books, for work done in the school can be consolidated at home. The Unit has been fortunate in having the services of Mrs. Bevis for certain times during the week. As she is a trained teacher of the deaf, the second group can work separately at their own level on the same project. Such work has proved very valuable. The loop induction system and group aid system are used for such lessons to achieve the maximum sound input. Individual speech lessons are also given as frequently as possible using the speech trainers provided. All the children attempt some form of number work and their achievements vary from simple number recognition to a mastery of simple multiplication. The children integrate with the hearing children during lunch times and play times, and presented their own play for the school Christmas Concert. The hearing children accept the deaf children very well and several friendships have been formed. Many thanks are given to the staff of the hearing school for their help and co-operation. Partially Hearing Unit for Junior Children, Kingsley Junior School There are six full-time pupils in the unit at present, three boys - 7-8 years, one boy and one girl 8-9 years and one girl 9-10 years. One girl who used to attend for two mornings a week is now managing full-time at the Margaret Roper Junior School. 45 In most cases there are additional handicaps of varying severity, some of which are a direct result of deafness (e.g. backwardness, maladjustment, spasticity). Group and individual work is carried out, children work at their own level because of their differing abilities and needs. The children integrate in classes with the normally hearing children of their own age group for practical activities such as P.E., art, needlework. The amount of integration varies according to the individual child. All the children integrate at school assembly, playtimes, and dinner times. Underlying all subjects is the basic need for speech and language (oral and written), and children are encouraged to make full use of all residual hearing. Hearing aids are worn all the time except for P.E. and some children leave aids off in the playground. Partially Hearing Unit for Secondary Children, Riddlesdown Secondary School. In September 1969, three girls aged 11+ came from Kingsley Junior P.H. Unit bringing the number at the Senior Unit to ten. At half term one girl aged 12+ left the district. The opening of the annexe for all 1st year pupils has raised several problems for the Unit. The three 1st year girls miss opportunities to make friends within their own year group at break and lunchtimes. They integrate with first years only for Cookery, Needlework, Art and Games. Arrangements have been made for them to take three periods a week for P.E. with 2nd year girls. They are unable to join Music and Drama classes. Despite these drawbacks, they have settled down well and are working satisfactorily. Three boys aged 12+ had to be placed in 2nd year classes, although it would have been more satisfactory had two of them been placed with 1st years. (These two will most likely stay in 2nd year classes for two years). The third boy is coping well in all subjects and now plays basketball in a school team. The other two boys are already doing very good work in practical subjects. One boy of 13+ is still placed in the 2nd year and, at his mother's request, spends six periods per week in the P.H.U. for English. A 13+ girl is in a 3rd year class and (also at parents' request) spends five periods a week in the Unit for English. A 14+ girl anticipated leaving school next year. She is now learning typing and commerce. She has no remedial lessons in the Unit now. Integration in Hearing Classes 3 1st year girls 11/40 periods = 27.5% 1 13+girl 35/40 periods = 87.5% 1 12+ boy 16/40 " = 40% 1 12+ boy 39/40 " = 97.5% 1 12+boy 24/40 " = 60% 1 14+girl 40/40 " = 100% 1 13+ boy 34/40 " = 85% 46 The annual visit to New Cross Hospital was made on October 17th for renewal of ear-moulds. The three 1st year girls were fitted with post-aural aids. These aids are now worn by every pupil except one boy (with the severest hearing loss) who must still use a body-worn aid. Visitors have included foreign students, student teachers, a hospital tutor, local Head Teachers, Mr. Oakley, Dr. Morgan and Mr. Parsons. The latter examined all pupils on November 18th and was satisfied with their progress and placement and suggested that the 4th year girl need no longer be attached to the Unit. A parents' meeting was arranged, for the first time, in the evening of October 22nd. Parents of only four pupils (all the boys) attended. Despite the most disappointing response many 'domestic' problems were fully discussed with the Headmaster and the Unit teacher. It is hoped that two meetings each year will be held in future. One most satisfactory aspect of the growing independence and 'normality' of the pupils is that only four of them now use the taxi service. It is hoped to persuade all parents that their children can quickly learn the public transport route to school and that independent travel will do a great deal to help them to a maturity and self confidence equal to that of the rest of the school's pupils. Use continues to be made of the audio and visual aids and the Unit is building up a useful selection of subject textbooks and library books. A most welcome gift from a local Townswomen's Guild last year increased the latter. Interest and help from over thirty members of the staff concerned with the children's education is much appreciated. It is hoped that the partially hearing children will make good progress and join in excursions and activities increasingly. EDUCATIONALLY SUBNORMAL PUPILS In Day Special Schools - 251 In Residential Special Schools - 22 Awaiting Placement - 79 During the year 67 children were found to be educationally subnormal in Croydon, and although this number is considerably greater (34%) than in 1968, it is similar to those of earlier years. The inevitable result has been the lengthening of an already considerable waiting list. Progress at the site of the new St. Nicholas' School has not been as rapid as had been hoped, and the opening of the school will now be deferred late into 1970. The total number of children who have been formally ascertained as educationally subnormal in Croydon still falls short of the number expected on the basis of the distribution of this handicap within the general population. Evidence has been adduced in previous reports to support comments by Head Teachers that a large number of educationally subnormal pupils remain within the ordinary 47 schools. It has been pleasing to note that a larger number of children have been referred for assessment by the School Medical Officers during the year (page 28 ) although relatively few of these children were found to require formal ascertainment as handicapped pupils. It is anticipated that Head Teachers will review all retarded children within their schools to determine which of them might benefit from the type of facilities which only a special school can provide. The opening of the first purpose-built special school in Croydon for 36 years will offer exciting possibilities for special education within the Borough, and the School Health Service is anxious to give all possible assistance in this field. The burden of the ever increasing waiting list for places in this category has fallen heavily upon St. Christopher's School, which now accommodates many more children than originally seemed possible. The opening of the new school will allow the pressure upon St. Christopher's School to be reduced with consequent increased educational opportunities. I am grateful to Mr. R.G. Grice for the following report on the work of the School during 1969. St. Christopher's Special School for Educationally Subnormal Children Statistics Boys Girls Total Number on Roll 31st December 1968. 150 91 241 Admitted during 1969. 29 15 44 Left to work at 16 years. 15 9 24 Transferred to other areas. 3 2 5 Transferred to P.H. School 1 - 1 Deceased. 1 - 1 Transferred to Residential Schools. 6 3 9 Transferred as unsuitable for Education in School. 2 4 6 Roll 31st December 1969. 151 88 239 2. Lower-Hall Gymnasium The repairs to the floor were completed and the room handed over on Monday, October 6th, exactly one year after the flood damage. It is a relief to have the use of it again for having no hall during the past year has been extremely trying and our activities have been curtailed. 3. Sport (a) Swimming During the year the following certificates have been obtained:- 48 Distance No. obtained Boys Girls 25 yards 27 13 14 50 yards 33 18 15 100 yards 34 18 16 ¼ mile 9 5 4 ½ mile 8 4 4 1 mile 2 1 1 Two boys and one girl out of 4 entries were successful in obtaining All Round Proficiency Certificates issued by the All England Schools Swimming Association. As 30% of the entrants failed this year we were very pleased with our results. The School Swimming Team competed in the Surrey Special Schools Championships at Epsom Baths on July 9th. The Girl's Victor Ludorum Trophy was won by one of the girls,Mandy Otten. (b) Athletics The School Athletic Team competed in the Surrey County Special Schools Sports at Imber Court on July 6th. This School won both the Boys' and Girls' Championship Trophies and one of our girls Barbara Dyer won the Lady George Cup for the outstanding girl athlete. (c) Football and Netball A full programme of football and netball fixtures have commenced in the Surrey Special Schools' Leagues. (d) Boxing Frank Lucas won the Surrey 10 st. 9 lbs. Championship and Clinton McKenzie was runner-up in the final of the 7st. 3lbs. Junior Class. 4. Visit to Cardiff Following a visit to Canterbury last year a party of pupils and Staff visited Cardiff for a week-end in January. They took part in a Youth Festival and contributed musical items to the programmes. The children were billeted in private homes and spent a memorable weekend. As a result a link has been established between this School and Craig-y-Parc School for Spastics, Cardiff. The same party has also given many concerts for Old People's Associations in the Croydon Area. 5. The Parents Association has continued to meet and a full programme of talks and discussions has been carried out. On Wednesday, July 16th, the meeting discussed music for the handicapped at School and in the home.and the children illustrated the talk and later entertained the parents to a concert. 49 6. Events (a) The School's Annual Sports were held at the Barclay's Bank Sports Ground on Tuesday, June 25th. (b) Harvest Festival This was held in the School on October 9th. Many parents and friends attended. The Rev. Donald Reeves M.A. of Carshalton gave the address and afterwards the Senior Scholars distributed many parcels of produce to the old people in the area. (c) The School was open for Parents and friends on Wednesday, July 16th. 7. The Old Scholars' Club has continued to flourish. It is now run by a Committee of Parents with the School Staff acting in an advisory capacity. 8. Thank You (a) To the members of the Staff of Telephone House, Croydon, who again visited the School during the Christmas period and brought a present for each child. On July 5th they took forty of our children by coach to Arundel and Littlehampton. A very enjoyable time was had, and we are grateful to the Supervisor and Staff for their kindness. (b) To the School's Parents Association and to the Local Branch of the National Association for Mentally Handicapped Children, who provided us with another Television Set for use by the Junior Classes in the School. (c) To the Editor and Readers of Stamp Weekly who collected stamps and albums for our School Philatelic Club. EPILEPTIC PUPILS In Day Special Schools -12 In Residential Special Schools - 5 During the year two epileptic children were recommended for placement in a special school. Although every effort is made to retain an epileptic child in an ordinary school, many factors may make this ideal impossible to attain, and when special difficulties arise the epileptic pupil is usually recommended for admission to St. Giles' School. One factor which will certainly affect the placement of the epileptic child is the degree of behaviour disturbance which accompanies the condition. In both of the children recognised during 1969, the degree of disturbance was sufficient to question the wisdom of placement at St. Giles' School. Indeed, one child was found to be so disturbed in spite of the specialised facilities available to deal with the 50 condition, that it was necessary to exclude him from St. Giles' School and transfer him to a residential school for epileptic children. The behaviour of one older boy caused such concern that the residential school which he was attending decided to discharge him. It was possible to make alternative arrangements for his day care in Croydon. MALADJUSTED PUPILS In Day Unit 17 In Day Special Schools 4 In Residential Special Schools 47 Awaiting Placement 8 Seventeen children were ascertained as maladjusted in 1969 and recommended for admission to appropriate special schools. Reference was made in last year's report (page 47) to the wide variations in the incidence of maladjustment throughout the country. There has been a sharp increase in the number of maladjusted children in the Borough who have been admitted to special schools, but the proportion of such children in Croydon is still much lower than that in most adjacent London Boroughs. There have been a number of classifications of maladjustment in school children, but the one devised by the Report of the Committee on Maladjusted Children in 1955 (The Under wood Report) is a useful one. Classification of 71 maladjusted children in Croydon thought to require special educational treatment showed the ing distribution:— Nervous Disorders - 21 Habit Disorders - 8 Behaviour Disorders - 21 Organic Disorders - 6 Psychotic Behaviour - 10 Educational Difficulties - 5 Although there is some overlap between the groups, these figures indicate the tendency to select for special educational treatment those maladjusted children who show behaviour disturbances in school. It should be remembered that symptoms of maladjustment may be manifest outside school, although there is little evidence of disturbed behaviour in the classroom. Moreover, in some cases the quiet withdrawn child whose school progress is poor may be even more disturbed than a child whose behaviour presents obvious problems to the teacher in the classroom situation. All of these different groups of maladjusted children should have an equal claim upon special educational treatment and the tendency to identify the maladjusted child with the naughty child must be firmly resisted. 51 It will be seen from the number of children currently awaiting admission to special schools that the placement of a maladjusted child often presents as many problems as his early detection. The commencement of building works at the site of the Sir Cyril Burt School for maladjusted children in Croydon was therefore most welcome. During the year 26 children were ascertained physically handicapped and recommended for admission to a special school. The majority of the children had been placed in special schools by the end of the year. The Committee again included in its building programme provision for a Nursery Unit at St. Giles' School, and a decision from the Department of Education and Science was anxiously awaited. It is unfortunate that, at a time when all are agreed on the benefits to be obtained from nursery school education for the handicapped child, the Committee's wish to proceed with such provision has not yet been approved by the Department. Reference has been made in previous Reports (1967 p. 43; 1968 p. 49) to the impact upon St. Giles' School of the increasing number of severely handicapped children, particularly those suffering from spina bifida. Whilst it is clear that St. Giles' School will be able to accommodate the actual number of children involved, providing admissions from other Authorities are restricted, the character of the school must change in some important respects. A reorganised physiotherapy service at the school is already showing that dramatic improvements in mobility are possible with modem techniques, but it remains true that the total amount of severe physical handicap in the school must increase. During 1969 the Deputy Principal School Medical Officer (Dr. J.S. Horner) visited St. Giles' School to talk to all the professional staff about the condition known as spina bifida. On the basis of the study currently being undertaken by the Research and Intelligence Unit of the Greater London Council, Dr. Horner estimated that there would be between 35 and 40 children suffering from spina bifida at the school by 1979, with an additional 10 children in the proposed nursery unit. All of these children will be too severely physically handicapped to cope in an ordinary school, at least in the early stages of their education, and a significant proportion may also be educationally subnormal. These figures do not suggest - as some specialists have alleged - that schools for the physically handicapped will be unable to cope with the numbers involved, but they do indicate the extent of structural alterations and changes in teaching techniques which will be necessary during the next five years. PHYSICALLY HANDICAPPED PUPILS In Day Special Schools In Residential Special Schools Awaiting Placement - 103 - 14 - 5 52 I am grateful to Mr. D.B. Pettman for the following report: - St. Giles' Special School for Physically Handicapped and Delicate Children This year has been marked by a considerable change in the school population. Seventeen pupils left to employment or further education; twenty pupils transferred to other schools and three puDils died. There were thirty-one admissions during the year, the majori'ty being heavily handicapped children of infant age The following are the main handicaps in the school at present:- Boys Girls Total Cerebral Palsy 22 10 32 Asthma 17 8 25 Spina Bifida 8 11 19 Epilepsy 3 8 11 Congenital Heart Disease 4 4 8 Muscular Dystrophy 6 - 6 Fibrocystic Disease 2 3 5 The rising incidence of Spina Bifida cases, now the second largest group of physically handicapped in the school, is changing the character of the school. Already alterations have been made to existing lavatory arrangements to cater for the increased number of wheelchairs, and the medical staff and infant teachers are hard pressed to deal with the heavy demands made by these children. The estimate of approx. 40 spina bifida cases in the school by the mid seventies poses many problems. There is already congestion in the corridors and lavatories with the present number of wheelchairs. The possibility of double the number of chairs calls for considerable modifications within the school. Furniture and fittings throughout the school will need adapting to suit wheelchair cases. Additional auxiliary staff will be necessary to deal with the problem of movement of children and adequate transport arrangements will have to be made. It is urgent that plans be made now to deal with these problems in order that further obstacles are not placed in the already difficult lives of these children. During the year routine medical examinations were held by Dr. Thelma Wield and 338 children were seen, 139 parents being present. Specialist medical examinations were held by Mr. MacQueen who saw 20 children, 18 parents being present; Dr. Fanthorpe, who saw 33 children, 17 parents being present and Dr. Robson who saw 20 children, 19 parents being present. The arrangements for the medical examinations and the keeping of detailed records were made by Sister and her staff in addition to dealing with routine medical matters and 46 major epileptic fits. 53 The Physiotherapy Department augmented to three full time members has done first class work during the year. 37 chest cases, 26 cerebral palsy, 15 spina bifida, 5 muscular dystrophy and 14 miscellaneous cases were treated. A total of 10,904 treatments being given. Speech Therapy has continued to be given and 1,325 treatments were given, 31 initial assessments made and 25 cases under review. PUPILS SUFFERING FROM A SPEECH DEFECT In Day Special Schools or Units • 15 Two children wsre ascertained in this category during 1969, and both of them were admitted to the Special Unit at West Thornton Primary School. A critical review of the progress of this Unit was made by senior members of the two Departments to determine what lessons had been learned from this experimental approach since its inception in 1966. It was clear that the character and purpose of the Unit had shown a distinct change; the exclusion of severe articulatory disorders could no longer be justified, and admission should depend in future upon the child's need for - and the ability to profit from - the intensive speech therapy programme, often involving twice daily treatment. On the teaching side, the wide age range, together with the varying type and severity of the speech problem presented an unreasonable task for a single teacher, and additional teaching assistance was sought during the year. The review again demonstrated the considerable financial advantage of a day unit, and the steady stream of visitors from other Authorities indicates the extent of the interest which the unit has attracted. I am grateful to the Chief Education Officer for the following report:— Unit for Speech Disordered Children, West Thornton Primary School During the year three children have left the Unit to return to normal Primary Schools, and one has gone to a Secondary School. Four new children have been admitted, so the full compliment of twelve children has been maintained. At present there are three children in the Unit whose spoken language is limited to a few isolated words. These three have severe difficulty in understanding spoken language. Two others have some speech but are often difficult to understand, four have a fair amount of speech and two have practically normal speech. These two are working happily in Junior Classes, only returning to the Unit for speech therapy. Three others spend limited periods in Junior Classes, and all the children join with other classes for P.E. and dancing. The kindness of the Staff and children at West Thornton is a great factor in the growing confidence and ability of the children in the Unit. 54 The group of children now in the Unit range from 5-10 years old, and present a very wide range of ability as well as a variety of learning difficulties. This disparity presents a very real problem if each child is to be fully extended and not merely contained in the Unit. The speech therapists and teacher are increasingly aware of the necessity of working together on a structured language programme designed to meet the needs of each child. Programmed learning techniques are beginning to be used as a means to more effective learning and better use of available teaching time. Miss Fenn left to continue her studies at Cambridge. The staff and children at West Thornton enjoyed her stay. Miss Evans has returned after a twelve month absence on a Course and Staff and children welcome her and are glad that she has decided to return here. DELICATE PUPILS In Day Special Schools - 35 In Residential Special Schools - 7 During the year three children were found to be delicate and admitted to a suitable special school, and both this number and the total number of children thought to require special educational treatment in this category are the lowest yet recorded in Croydon. It is clear that from a purely medical point of view this category is no longer necessary. Children who are now brought forward as "delicate" present a variety of medico-social and medico-educational problems. Two factors consistently emerge; firstly frequent absence from school usually for real or assumed medical reasons, and secondly considerable educational retardation often associated with below average ability bordering on educational subnormality. Clearly most of these children cannot cope in an ordinary school, so that special educational treatment is indicated. The real problem is the type of special education which should be provided. Even when medical factors are prominent the children rarely require regular medical treatment. Some might benefit from the regime of the former open air schools but as Dr. Thelma Wield has pointed out, there is no open air school in Croydon. The considerable building alterations at St. Giles' School, and the influx of large numbers of heavily handicapped children have resulted in a school better suited to the needs of the latter than to the non-handicapped child who is not making the anticipated progress in an ordinary school. Moreover, whilst remedial teaching facilities at St. Giles' School have been developed to a high level to meet the multiplicity of handicaps from which the children increasingly suffer, it would clearly be wrong to regard the school as a remedial teaching unit for the education of any slow learning child whose leight or weight happened to fall below the mean. Children are sometimes put forward for consideration in this category when the level of intelligence falls within the range associated with educational subnormality, and it is difficult to understand why a school for the delicate rather than a school for the educationally subnormal is suggested in such cases. 55 Nevertheless the very presence of children who are put forward for consideration as delicate indicates that they represent a group of children who do not seem able to benefit from the facilities available in an ordinary school. The number of such children is almost certainly greater than the number currently categorised as delicate. Whether such children will become more or less common as larger units of secondary education are developed is a question which the School Health Service must continue to observe. Equally, the question whether such children should be transferred to a new type of special school along with other groups of apparently normal children with learning difficulties, or whether they should be encouraged to attend more regularly an ordinary school where increased teaching and social work support are available, raises much wider policy issues. 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 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 14 children were recommended for home tuition, and a further one child was already receiving such tuition. UNSUITABLE FOR EDUCATION IN SCHOOL Twenty-three 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 13 had never previously attended a maintained school, and 9 had failed to make progress despite a prolonged trial at a special school. All the children were referred to the Health Committee, and they were subsequently offered places in the various local Training Centres or, in some cases, admitted to hospital. Three children who had been ascertained previously as unsuitable for education in school were reviewed under Section 57A of the Education Act, 1944 (as amended). In one case it was found that the child was still unsuitable for education in school, but the other two children had made some improvement ana were recommended for a trial at an E.S.N. School. The Committee therefore concluded that the children were now suitable for education in school, and varied the previous decisions accordingly. 56 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 1970, as in Forms 7, 7M, and 11 Schools 52,618 PART 1. - MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE A - PERIODIC MEDICAL INSPECTIONS Age Groups Inspected (By year of Birth) No. of Pupils Inspected PHYSICAL CONDITION OF PUPILS INSPECTED Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory Unsatisfactory for defective vision (excluding squint) for any other condition recorded at Part II Total Individual pupils No. No. (1) (2) (3) (4) (5) (6) (7) 1 965 and later 295 291 4 4 33 36 1964 3,542 3,536 6 133 473 565 1963 1,705 1,705 - 91 284 347 1962 267 266 1 9 50 55 1961 2,224 2,221 3 174 365 479 1960 2,218 2,218 - 190 363 517 1959 721 721 - 84 124 184 1958 411 411 - 39 73 102 1957 2,497 2,497 - 272 482 695 1956 1,168 1,168 - 136 236 346 1955 1,511 1,511 - 175 264 394 1954 and earlier 1,819 1,819 - 299 370 599 TOTAL 18,378 18,364 14 1,606 3,117 4,319 Column (3) total as a percentage of Column (2) total 99.92% Column (4) total as a percentage of Column (2) total 0.08% 57 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 995 Number of Re-inspections 3,674 Total 4,669 TABLE C - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 39,509 (b) Total number of individual pupils found to be infested 334 (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) Nil 58 PART 2 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS DURING THE YEAR 1969 T = requiring Treatment 0 = requiring Observation Defect or O/sease PERIODIC INSPECTIONS SPECIAL ENTRANTS LEAVERS OTHERS TOTAL INSPECTIONS SKIN T 108 393 684 1185 18 0 83 52 117 252 6 EYES . (a) Vision T 228 474 904 1606 66 0 498 129 719 1346 48 (b) Squint T 117 12 119 248 13 0 17 3 10 30 2 (c) Other T 25 3 27 55 4 0 22 8 13 43 3 EARS • (a) Hearing T 68 25 119 212 20 0 232 10 129 371 10 (b) Otitis Media T 46 7 37 90 6 0 168 13 78 259 4 (c) Other T 7 13 20 0 24 5 26 55 1 NOSE AND THROAT T 133 34 184 351 13 0 465 44 402 911 39 SPEECH T 78 8 46 132 21 0 102 4 54 160 13 LYMPHATIC GLANDS T 9 1 9 19 1 0 55 2 49 106 4 HEART T 23 24 44 91 1 0 88 30 103 221 9 LUNGS T 56 36 119 211 6 0 115 9 68 192 9 DEVELOPMENTAL - (a) Hernia T 9 4 17 30 1 0 25 2 16 43 4 (b) Other T 37 59 149 245 15 0 123 65 364 552 23 ORTHOPAEDIC - (a) Posture T 10 10 18 38 3 0 17 21 59 97 1 (b) Feet T 23 17 45 85 8 0 58 43 108 209 8 (e) Other T 35 17 76 128 7 0 96 26 123 245 9 NERVOUS SYSTEM (a) Epilepsy T 9 7 16 32 6 0 11 2 15 28 1 (b) Other T 38 5 36 79 11 0 44 7 44 95 13 PSYCHOLOGICAL) (a) Development T 14 1 26 41 13 0 66 5 48 119 24 (b) Stability T 19 9 58 86 23 0 142 16 169 327 31 ABDOMEN T 22 7 25 54 6 0 32 5 43 80 5 OTHER T 16 6 31 53 5 0 55 18 105 178 5 59 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 7 Errors of refraction (including squint) 1058 Total 1065 dumber of pupils for whom spectacles were prescribed 603 TABLE B - DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases known to have been dealt with deceived operative treatment - (a) for diseases of the ear 102 (b) for adenoids and chronic tonsillitis 420 (c) for other nose and throat conditions - deceived other forms of treatment 111 Total 633 Total number of pupils still on the register of schools at 31st December 1969, known to have been provided with hearing aids:— fa) during the calendar year 1969 4 (b) in previous years 87 TABLE C . ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated (a) Pupils treated at clinics or out-patients depts. 445 (b) Pupils treated at school for postural defects 50 Total 495 TABLE D - DISEASES OF THE SKIN Number of pupils known to have been treated Ringworm - (a) Scalp - (b)Body - Scabies 17 mpetigo 4 Other skin diseases 90 Total 111 TABLE E - CHILD GUIDANCE TREATMENT Nupiber known to have been treated 3upils treated at Child Guidance clinics 268 60 TABLE F - SPEECH THERAPY Number known to have been treated Pupils treated by speech therapists 1067 TABLEG - OTHER TREATMENT GIVEN Number known to have been treated (a) Pupils with minor ailments 1464 (b) Pupils who received convalescent treatment under School Health Service arrangements 12 (c) Pupils who received B.C.G. vaccination 3002 (d) Other than (a), (b) and (c) above, Please specify (7) Audiology 39 (2) Enuresis 289 (3) Overweight Clinics 212 (4) Consultant for Speech Disorders 40 Total (a) - (d) 5058 APPENDIX B - TREATMENT CLINICS Summary of Attendances 1969 7968 Incnase or Dacnase Audiology Clinic 197 221 - 24 Dental Clinics 25,000 24,679 + 321 Enuresis Clinics 1,068 1,060 + 8 Eye Clinics 1,179 1,096 + 83 Inspection Clinics 1,007 728 + 279 Minor Ailmants and Verruca Clinics 9,714 9,808 -94 Physiotherapy Clinics 3,434 3,162 + 272 Weight Control Clinics 920 783 + 132 42,519 41,542 + 977 61 AUDIOLOGY CLINIC Numbers attending Croydon Day Schools and Pre-School Children (a) With hearing sufficiently impaired to require regular supervision: Pre School Pupils 14 Primary School Pupils 27 Secondary School Pupils Nil Total 41 Pure Tone Audiometer Tests. (Excluding Sweep Test Failures). (a) Tested for the first time 342 (b) Tested as a review case 309 Total 651 Auditory Training 39children received regular auditory training during the year. Number of attendance sessions; (a) At the Audiology Clinic 197 (b) At home 135 Total 332 Sweep Testing of Five Year Old School Entrants Number of schools visited 65 Number of children tested 7,096 Number of children passed 5,702 Number of children failed 632 Number of children to be re-tested 762 Number of children not tested 512 (absent or unco-operative). The failures were re-assessed as follows: No hearing loss 126 Slight hearing loss 244 Moderate hearing loss 141 Moderately severe hearing loss 54 Severe hearing loss 4 Failed to keep appointments 31 Left district 20 Waiting to be tested 12 Total 632 Issue of Hearing Aids (a) National Health Service 'Medresco' Aids 9 (b) Commercial aids bought by Croydon L.E.A 1 Total -DE 12 children under school age are using hearing aids. 62 DENTAL SERVICE Items of Treatment 1969 1968 (1) Number of children first inspected at school 36,569 36,561 (2) Number of children first inspected at clinic 5,463 4,897 (3) Number of (1) and (2) found to require treatment 21,808 21,149 (4) Number of (1) and (2) offered treatment 21,808 21,149 (5) Number re-inspected at school or clinic 5,902 5,314 (6) Number of (5) requiring treatment 3,315 2,738 (7) Visits • First 8,328 7,936 Subsequent 16,672 16,743 25,000 24,679 (8) Additional courses commenced 894 1,195 (9) Fillings - Permanent 12,592 11,719 Deciduous 8,016 20,608 6,706 18,425 (10) Teeth Filled - Permanent 11,322 10,515 Deciduous 7,182 18,504 6,105 16,620 (11) Extractions • Permanent 1,646 1,776 Deciduous 3,467 5,113 3,203 4,979 (12) General Anaesthetics 1,702 1,772 (13) Emergencies 1,172 1,167 (14) X-Rays (Number of patients) 1,209 1,101 (IB) Prophylaxis 951 1,075 (16) Teeth otherwise conserved 1,065 1,265 (17) Teeth root filled 110 82 (18) Inlays 8 42 (19) Crowns 58 63 (20) Other operations 4,529 3,698 (21) Advice 1,373 1,489 (22) Appointments not kept 7,982 7,187 . (23) Courses of treatment completed 7,473 7,551 63 (24) Orthodontics - 1969 1968 Cases remaining from previous year 241 514 New cases commenced during year 240 214 Cases completed during year 157 208 Appliances - Removable 462 488 Fixed 31 63 (25) Number of dentures supplied 37 31 (26) Number of sessions - Treatment 3,262 3,195 Inspection 358 339 Dental Health Educatior i 8 6 EYE CLINICS PURLEY, SANDERSTEAD AND ADDINGTON No. of New cases examined 813 No. of Re-examinations 366 Total number of examinations 1,179 No. of children for whom spectacles were prescribed 496 On 31st December 1969 the number of:- (1) New Cases referred but not yet examined was 28 (2) Children due for review in 1969 and still awaiting re-examination was 50 MINOR AILMENTS CLINICS Clinic Defects A ttendances Ashburton School 323 1,610 Lodge Road 202 1,886 New Addfngton 308 1,929 Norbury Manor School 46 295 Pur ley 88 615 Rectory Park 145 1,007 Rockmount School 83 931 Waddon 269 1,441 64 MINOR AILMENTS CLINICS (continued) Defects 1969 J 968 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm - - - 2 4 2.0 Scabies 1 1 1.0 1 1 1.0 Impetigo 4 6 1.5 5 10 2.0 Other Skin Diseases 90 240 2.7 47 136 2.9 Otorrhoea and other Ear defects 2 3 1.5 6 12 2.0 External Eye defects 7 19 2.7 6 23 3.8 Verrucae 821 6,774 8.3 883 6,962 7.9 Miscellaneous 53.9 2,671 5.0 421 2,661 6.3 TOTALS 1,464 9,714 6.6 1,371 9,809 7.2 PHYSIOTHERAPY CLINICS Total number of pupils treated 589 Total number of new cases 224 Total number of Orthopaedic conditions 377 Total number of Respiratory conditions 212 Individual treatments 467 Number of classes 187 SPEECH CLINICS Total number of cases treated during 1969 1,067 Number of new cases 90 Number of cases discharged 343 Number of reviews 716 Treatment sessions 8,946 65 APPENDIX C RETURN OF MEDICAL INSPECTIONS - NON-MAINTAINED SCHOOLS A. Routine Medical Inspections Year 1969 Year 1968 Aged 11 and under 4 - 12 129 60 13 55 37 14 74 54 15 and over 169 181 Total Children 431 332 Visits to non-maintained schools 29 23 B. The following defects were found Requiring Treatment Observation Skin 41 6 Vision 97 36 Squint 2 - Hearing 4 2 Otitis Media 1 1 Nose and Throat 12 8 Speech 1 - Cervical Glands - 1 Heart and Circulation - 5 Lungs - 2 Development (Other) 20 16 Posture 4 6 Flat Foot 20 4 Other 12 12 Nervous System 1 2 Psychological 2 5 Other Defects 16 11 C. Other Inspections There were 5 Special Medical Inspections and 66 Re-inspections 66 APPENDIX D NUMBERS OF PUPILS ON SCHOOL REGISTERS, AND NUMBERS OF CHILDREN EXAMINED AT ROUTINE MEDICAL INSPECTIONS IN MAINTAINED SCHOOLS DURING THE YEAR 1969 Primary Schools Numbers on Registers No. of Children Examined Boys Girls Total All Saints (C. of E.) J.M. 250 52 27 79 All Saints County I. 222 28 43 71 Applsgarth J.M. 471 60 55 115 Applegarth I. 339 68 73 141 Ashburton J.M. 541 75 63 143 Ashburton I. 346 71 55 126 Atwood J.M. & I. 340 50 63 113 Beaumont J.M. & I. 183 28 27 55 Benson J.M. & I. 567 94 94 188 Beulah J.M. 481 67 71 138 Beulah I. 400 106 85 191 Byron J.M. & I. 316 52 45 97 Castle Hill J.M. 565 61 73 134 Castle Hill I. 442 123 114 237 Chipstead Valley J.M. & I. 528 81 92 173 Christ Church (C. of E.) J.M. & I. 255 42 56 98 Coulsdon (C. of E.) J.M. & I. 141 26 27 53 Courtwood J.M. & I. 153 32 22 54 Cypress J.M. 263 52 15 67 Cypress I. 249 44 48 92 David Livingstone J.M. & I. 258 43 36 79 Davidson I. 154 30 25 55 Duppas J.M. 320 42 51 93 Ecclesbourne I. 193 31 27 58 E Imwood J. Boys . 286 80 . 80 Eimwood J. Girls . 333 - 133 133 Elmwood I. 401 53 72 125 Fairchildes J.M. 456 56 56 112 Fairchi Ides I. 319 63 67 130 Field Way J.M. & I. 276 39 49 88 Gilbert Scott J.M. 657 80 72 152 Gilbert Scott I. 413 49 62 111 Gonville J.M. & I. 506 64 93 157 Good Shepherd (R.C.) J.M. & I. 399 83 75 158 Gresham J.M. & I. 344 68 57 125 Hayes J.M. & I. 384 74 69 143 Howard J.M. & I. 269 52 40 92 Kenley J.M. & I. 299 52 39 91 Kensington Avenue J.M. 510 69 54 123 Kensington Avenue I. 300 58 60 118 Keston J.M. 369 46 36 82 Keston I. 253 85 78 163 Kingsley J.M. 520 95 53 148 Kingsley I. 354 95 69 164 Margaret Roper (R.C.) J.M. & I. 259 38 55 93 Monks Orchard J.M. & I. 391 57 63 120 Norbury Manor J.M. 427 67 46 113 Norbury Manor I. 304 51 61 112 Orchard Way J.M. & I. 130 7 1 8 Oval J.M. 336 44 68 112 Oval I. 193 47 35 82 Parish Church (C. of E.) J.M. 291 43 29 72 Parish Church (C. of E.) I. 220 47 80 127 Park Hill J.M. 256 43 43 86 Portland I. 128 20 29 49 67 Primary Schools Numbers on Registers No. of Children Examined Boys Girls T otal Purley Oaks J.M. 347 48 45 93 Purley Oaks I. 241 58 59 117 Regina Coeli (R.C.) J.M. & I. 368 39 67 106 Ridgeway J.M. 351 35 40 75 Ridgeway I. 216 55 43 98 Rockmount J.M. 316 30 43 73 Rockmount I. 251 68 76 144 Roke J.M. & I. 381 66 47 113 Rowdown J.M. 388 46 51 97 Rowdown I. 394 69 65 134 St. John's (C. of E.) J.M. & I. 307 39 34 73 St. Joseph's (R.C.) J.M. & I. 506 67 44 111 St. Mark's (C. of E.) J.M. & I. 244 34 44 78 St. Mary's (R.C.) J.M. 302 59 68 127 St. Mary's (R.C.) I. 228 33 36 69 St. Michael's (C. of E.) I. 95 29 12 41 St. Peter's J.M. & I. 252 35 32 67 Selsdon J.M. & I. 590 115 96 211 Smitham J.M. & I. 442 67 55 122 South Norwood J.M. 485 54 64 118 South Norwood I. 352 90 107 197 Spring Park J.M. 485 120 103 223 Spring Park I. 311 61 55 116 Sydenham J.M. 271 42 57 99 Sydenham I. 222 51 45 96 Thomas Becket (R.C.) J.M. & I. 288 47 63 110 Toldene J.M. & I. 250 41 32 73 Waddon I. 238 55 44 99 Wattenden J.M. & I. 156 23 25 48 West Thornton J.M. & I. 412 64 70 134 Whitehorse Manor J.M. 499 38 63 101 Whitehorse Manor I. 360 59 57 116 Winterbourne J. Boys . 440 184 184 Winterbourne J. Girls 442 - 103 103 Winterbourne I. 420 77 83 160 Wolsey J.M. 548 73 59 132 Wolsey I. 400 87 46 133 Woodcote J.M. 343 101 49 150 Woodcote I. 278 51 75 126 Woods ide J.M. 524 119 123 242 Woodside I. 284 56 65 121 TOTAL 32,787 5,572 5,377 10,949 SPECIAL SCHOOLS St. Christopher's (E.S.N.) Mixed 241 32 28 60 St. Giles' (Del. & P.H.) Mixed 156 87 69 156 St. Luke's (Partially Sighted) Mixed 16 10 5 15 TOTAL 413 129 102 231 NURSERY SCHOOLS Coulsdon 50 12 9 21 Crosfiold 56 28 28 56 Purley 42 25 17 42 TOTAL 148 65 54 119 68 Secondary Schools Numbers on Registers No. of Children Examined Boys Girls Total Archbishop Tenison (C. of E.) Mixed 376 62 59 121 Ashburton Boys 652 256 _ 256 Ashburton Girls 602 _ 279 279 Colonic (R.C.) Girls 627 - 184 184 Croydon Sec. Technical Boys 353 108 - 108 Davidson Mixed 434 91 75 166 Ecclesbourne Girls 395 - 192 192 Fairchildes Boys 631 268 - 268 Fairchildes Girls 570 - 232 232 Heath Clark Mixed 782 114 127 241 Ingram Boys 587 248 _ 248 John Newnham Mixed 529 114 106 220 John Ruskin Boys 628 178 - 178 Lady Edridge Girls 509 - 163 163 Lanfranc Boys 567 269 - 269 Lanfranc Girls 447 _ 96 96 Norbury Manor Boys 418 162 - 162 Norbury Manor Girls 478 - 193 193 Our Lady's (R.C.j Girls 160 - 68 68 Overbury Mixed 737 144 136 280 Portland Mixed 433 97 79 176 Parley Boys 612 176 - 176 Purley Girls 603 _ 161 161 Riddlesdown Mixed 839 203 137 340 St. Andrew's (C. of E.) Mixed 261 60 59 119 St. Mary's (R.C.) Mixed 443 86 75 161 Selhurst Boys 591 175 - 175 Selhurst Girls 540 - 161 161 Shirley Mixed 670 125 146 271 South Croydon Mixed 570 131 97 228 Stanley Technical Boys 340 120 - 120 Tavistock Boys 371 161 - 161 Tavistock Girls 289 _ 148 148 Taunton Manor Mixed 497 112 112 224 Thomas More (R.C.) Mixed 561 132 109 241 Westwood Girls 483 - 174 174 Woodcote Mixed 685 133 123 256 TOTAL 19,270 3,725 3,491 7,216 69 CASES OF INFECTIOUS DISEASES AS NOTIFIED BY HEAD TEACHERS Disease 1969 1968 1967 Chicken Pox 721 841 1,320 Conjunctivitis 14 3 16 Diphtheria - - - Gastro-Enteritis 9 12 4 German Measles 485 477 863 Impetigo 46 10 12 Jaundice 22 37 2 Measles 506 75 1,201 Mumps 1,295 135 806 Non-Specific Diarrhoea including Dysentery 551 615 573 Non-Specific Vomiting 43 98 115 Other Diseases 553 246 47 Poliomyelitis - - - Ringworm or Vermin Body 1 3 - Scalp - 2 1 Scabies 13 2 1 Scarlet Fever 87 96 167 Sore Throat including Tonsillitis 112 72 11 Whooping Cough 19 21 175 TOTALS 4,477 2,749 5,314 WORK OF THE SCHOOL HEALTH VISITORS AND NURSES Home Visits re pupils 2,723 visits Social/Welfare visits to Schools 354 ,, Minor Ailments 1,108 sessions Hygiene 551,, Pre-Medicals 1,067,, Routine Medical Inspections 1,322,, Follow-up 8,, Contagious and Infectious Diseases 5,, Immunisation 68,, Health Survey 30 Health Education 423,, Enuresis Clinics 71,, Eye Clinics 86,, Inspection Clinics 69 70 APPENDIX E LIFE YOUR LIFE IN YOUR HANDS COMMUNITY HEALTH Scheme of Work for Secondary School Children (Age 14+ years) AIMS 1. To give the children a greater understanding of their own development. 2. To enlarge their understanding of external influence on growth and behaviour. 3. To emphasise the individual's responsibility for his own behaviour and its possible effects on other people. One unit can be a double period or can be expanded - depending on the demands of the timetable and the ability of the pupils. At the end of each unit themes which could be developed as project work and the type of normal subject with which they link are suggested. Visits to clinics, training centres for the mentally handicapped, Old People's Homes, Housing Estates, Sewage Works, etc., are all interesting practical background for the course. Information about reference books, leaflets, films, slides and posters is available from the Health Education Section, Health Department, 3rd Floor Room 18, Taberner House, Park Lane, Croydon, CR9 3BT. Telephone 686-4433 Ext. 2128. UNIT 1 Growth and Development (1) From Conception to One Year (a) The factors of heredity. fb) The start of life. (c) The child before birth - with emphasis on the importance of nutrition and prevention of disease in the mother's ante-natal care. (d) The importance of environment in the first year of life on:- (i) Emotional security of the child. (ii) The mother figure. (iii) Health and growth of the child. Some Suggested Visual Aids Flannelgraph or plastigraph of somatotypes. Flannelgraph or plastigraph of heredity. Growth Charts. Film: "Human Heredity". Sound, Colour, Runs 14 minutes from: Boulter-Hawker Films Ltd., Hadleigh, Ipswich, Suffolk. 71 Themes for Follow-up Discussion (a) The role of parents. The unmarried mother. How does she cope alone? What services are available to help her? (Religious instruction. English literature) (b) The relationship between children and their parents. Consider (1) The unwanted child. (2) Children in homes. (3) Adoption. (4) Foster children. (Social history. Religious instruction. English literature) UNIT 2 Growth and Development (2) The Basis of Adulthood • The First Eleven Years (a) Physical growth and development. (b) The formation of personality and growth of social awareness. (c) The influence of environment and nutrition. Some Suggested Visual Aids Growth Charts. Selection of slides from filmstrips:— "Nutritional Values" from: Camera Talks Ltd., "The food We Eat" 31, North Row (Park Lane,) "The Story of Vitamins" London. W.1. "Nutrition for Athletes" from: Diana Wyllie Ltd., 3, Park Road, London,N.W.1 Films: "The Terrible Twos and Trusting Threes" Sound, Colour Runs 22 minutes. OR "The Frustrating Fours and Fascinating Fives" Sound, Colour Runs 22 minutes. OR "The Sociable Sixes to Noisy Nines" Sound, Colour, Runs 21 minutes. from: The Central Film Library, Government Building, Bromyard Avenue, London, W.3. OR "The Way to Independence" Silent, Black and White, Runs 5 minutes. from: The Health Education Council, 10-12, Russell Square,London, W.C.1. Themes for Follow-up Discussion (a) Physical development - different parts of the body grow at different rates. (Mathematics, Biology, Chemistry) 72 (b) Nutritional needs. (Domestic Science. Geography) (c) Home accidents. Vulnerability at different ages. (Needlework. Making baby and toddler clothes using flare-free materials) (d) The importance of the family unit, security, love and encourage* ment of independence. (Religious instruction. English literature) (e) The effect of housing on personality. Does living in city, town, village or country have an effect? (English literature. Geography. Art. History. Religious instruction.) (f) Compare and contrast family units in other cultures with those in this country. (g) Practical work: Helping with children in play groups, day nurseries and Local Authority toddler clinics. UNIT 3 Growth and Development (3) Puberty (a) Brief outline of physical growth and development. (b) The development of emotional maturity leading to expanding independence and increasing personal responsibility for decisions on such health habits as:— Overeating, Smoking, Dental Care, Care of the Feet. Some Suggested Visual Aids Growth charts Film: "Girl to Woman" Sound, Colour Runs 18 minutes. "Boy to Man" Sound, Colour, Runs 16 minutes. from: Boulton-Hawker Films Ltd., Hadleigh, Ipswich, Suffolk. Themes for Follow-up Discussion (a) What was the effect of the industrial revolution on the age of puberty. (History. English literature) (b) Compare individual growth rates. (Mathematics) (c) Should young people vote at 18 years? (English literature. History) 73 (d) Is 16 too young for marriage? Compare periods and societies. (English. History) (e) Invite a young boy and girl at work to discuss some problems of entering adult societv. UNIT 4 Growth and Development (4) The Process of Ageing (a) The age of social responsibility (b) The peak of achievement (c) Slowing down (d) The influence of the environment on the process of ageing. Discussion on the individual's responsibility to the older section of the community. Some Suggested Visual Aids Film: "Growing Old" Sound, Black and White, Runs 40 minutes. (This might be shown later during a lunch break). from: The Nutrition Information Centre, Vitamins Ltd., Upper Mall, London, W.6. Filmstrips: "Care of the Aged" series from Camera Talks Ltd, 31, North Row (Park Lane), London W.1. Themes for Follow-up Discussion (a) Changes in the parental role as children grow up and the changing role of children. (Religious instruction. History. English literature) (b) The working wife, (Religious instruction. History. English literature) (c) Should people prepare for retirement? (Religious instruction. Domestic science. English literature) (d) The problems of the elderly in their society. Investigation of local services for the elderly. (Social studies) UNIT 5 Health Hazards of Today Infectious Diseases (1) (a) Natural and acquired immunity. (b) Prevention, by vaccination or immunisation of:Poliomyelitis, Diphtheria, Whooping Cough, Tetanus, Measles. Smallpox and Tuberculosis. (c) Discussion on attitudes to vaccination and immunisation procedures and reasons for co-operating with national campaigns. 74 Some Suggested Visual Aids Flannelgraph illustrating the principles of immunity. Selected slides from the filmstrips: (a) "Vaccination and Immunisation" (b) "Droplet Infection" (c) "Immunity" from: Camera Talks Ltd., 31, North Row, Park Lane, London, W.1. Films: "Surprise Attack" Sound, Black and White, Runs 11 minutes from: Central Film Library, Government Building, Bromyard Avenue, London W.3. OR "Smallpox" Sound, Black and White, Runs 8 minutes from: British Film Institute, 43, Lower Marsh, S.E.1. Themes for Follow-up Discussion (a) Ancient beliefs about the causes of epidemics. (History. Religious instruction. English literature) (b) Old wives' tales which exist today about health. (Biology. English literature. Religious instruction.) (c) What health controls are there for travellers? (Geography. English literature. Social studies) UNIT 6 Health Hazards of Today Infectious Diseases (2) Venereal Diseases: (a) The nature of the disease. (b) The social implications. Some Suggested Visual Aids Selection of slides from the filmstrip "Venereal Diseases" from Camera Talks Ltd., 31, North Row, Park Lane, London, W.1. Filmstrip: "Venereal Diseases" (New strip in production) from Health Education Council, 10-12, Russell Square,W.C.1. Film: "A Quarter Million Teenagers" Sound, Colour, Runs 16 minutes from: Boulton-Hawker Films Ltd., Hadleigh, Ipswich, Suffolk. OR "V.D. - Don't Take the Risk" Sound, Black and White, Runs 19 minutes from: Central Film Library, Government Building, Bromyard Avenue, London, W.3. Themes for Follow-up Discussion (a) Does knowledge affect personal behaviour? (Biology. English literature. Religious instruction) (b) Has moral behaviour really changed? (English literature. History. Religious instruction) 75 UNIT 7 Health Hazards of Today Food Poisoning (a) Nature of the illness; effects on various age groups. (b) Methods of spread. (c) Smoking and food hygiene. (d) Individual responsibility in prevention. Some Suggested Visual Aids Flannelgraphs: Vicious Circle Fighting Germs by degrees Chains of Infection from: Health Education Council, 10-12 Russell Square, W.C.1, Selection of Slides from Filmstrips: Food Hygiene Meat Handling from: Camera Talks Ltd., 31, North Row, Park Lane, London, W.1. Films: "Room for Hygiene" Sound, Colour, Runs 16 minutes. from Unilever Film Library, Unilever House, Blackfriars,London, E.C.4. Culture Dishes. Themes for Follow-up Discussion (a) The Physical and social effects of careless food handling, e.g. in home and school. (Domestic science. Biology. Mathematics) (b) How does the law safeguard people buying food in restaurants and shops. (Domestic science. Social studies) (c) Ways of preserving food. (Domestic science. Biology. Chemistry) (d) Design a school toilet block or kitchen unit in a private home. (Art. Domestic. science. Woodwork. Mathematics) UNIT 8 Health Hazards of Today The Common Cold. Bronchitis. (a) The effects of absenteeism on work, society, economy. (b) The direct causes. (c) Predisposing factors e.g. Effects of irritants such as Dust, Atmospheric fumes (smog), Smoking, overcrowding. (d) The Clean Air Acts. (e) The individual's responsibility in controlling his own environment. Some Suggested Visual Aids Selection of slides from filmstrips: "Bronchitis" from Camera Talks Ltd., 31, North Row, Park Lane, "Clean Air" W.1. "Cures and Colds" from Pfizer Ltd., Sandgate Road, Folkestone, Kent. 76 Themes for Follow-up Discussion (a) How does industry protect its workers? (b) Study the design of a new town. What have planners tried to do? Compare with a 19th Century town. (Geography. History) (c) Why do young people smoke? (English literature. Religious instruction) UNIT 9 Health Hazards of Today What is Cancer? (a) The nature of the disease. (b) Warning signs, early detection and treatment. (c) Predisposing factors. (d) Smoking and health. Some Suggested Visual Aids Selection of slides from filmstrips: "Cancer"; "The Problem of Lung Cancer"; "How to give up Smoking"; from: Camera Talks Ltd., 31, North Row,Park Lane, W.1. "Cigarettes and You" Central Office of Information. Films: "Smoking and You" Sound, Colour Runs 11 minutes "The Smoking Machine" Sound, Colour, Runs 16 minutes (for Younger children) "Dying for a Smoke" (Cartoon) Sound, Colour, Runs 10 minutes from: Central Film Library, Government Building, Bromyard Avenue, W.3. Themes for Follow'up Discussion (a) Construct a simple cigarette smoking machine. Collect and measure the amount of tar from a set number of cigarettes. (Biology. Chemistry. Mathematics) fb) Trace the history and conquest of a former chronic illness such as tuberculosis. (Biology) UNIT 10 Health Hazards of Today Addiction Alcohol and Drugs (a) The effects on the body. (b) The social aspects at home and abroad. (c) The effects of addiction in the family group. 77 Some Suggested Visual Aids Films: "To Your Health" Sound, Colour, Runs 10 minutes from: Central Film Library, Government Building, Bromyard Avenue, W.3. OR "Alcohol and the Human Body" Sound, Black and White, Runs 15 minutes, from: Rank Film Library, 1, Aintree Road, Perivale, Greenford, Middlesex, OR "Drugs and the Nervous System" Sound, Colour, Runs 18 minutes, from: Boulton-Hawker Films Ltd., Hadleigh, Ipswich, Suffolk. Themes for Follow-up Discussion (a) Discuss different types of dependence throughout history. (History, English literature) (b) What is black market? (History, Social studies) (c) Investiage the effect of caffeine (by drinking strong coffee) on such things as pulse rate and mental alertness e.g. as measured by the time taken to add up a column of figures. (Mathematics, Biology. Science) (d) Are patent medicines really necessary? Collect advertisements of patent medicines and drugs and try to find out which part of the body they will affect. Which are in common use by the pupils themselves or their families? (Biology. Science) (e) How do mature people cope with their problems? Are drugs and alcohol really necessary? (Religious instruction. English literature. History) UNIT 11 The Health Services (a) General Structure. (b) The prevention of disease and health education. (c) How the individual can use the services properly. N.B. It is suggested that schools invite a member of the Public Health Department to give this talk. Some Suggested Visual Aids Films: "Your Very Good Health" Sound, Colour (Cartoon) Runs 9 minutes, from: Central Film Library, Government Buildings, Bromyard Avenue, W.3. "Health Services in Britain" Sound, Black and White, Runs 14 minutes from: Central Film Library, Government Buildings, Bromyard Avenue, W.3. Slides: From local Health Department. 78 Themes for Follow-up Discussion (a) Trace the claim for service involved if a young mother with young children is admitted to hospital for a planned operation. (Social studies. History) (b) Collect information about the blood transfusion service and find out the cost of a pint of blood. Visit a blood donation centre try to discover blood group. Volunteer to help with making and distributing tea to donors. (Social studies. Biology. Science) (c) How can the health and welfare services enable a handicapped person to live an independent, useful and happy life? Design and make a useful aid for a handicapped person. (Social studies. Geography. Art. Woodwork) (d) Study the local environment. On a large-scale map plot the child health centres, day nurseries, family planning clinics, hospitals, old people's homes, open spaces or parks, doctors' surgeries and other services (Geography,Social studies. History.) UNIT 12 What is a Family? Discussion on:- (a) The status and role of individual members of a family group. (b) Human relationships within the family (c) The importance of family attitudes and prejudices on the individual. (d) Influences from groups outside the family on the attitudes and prejudices on the individual. (e) Outside influence and attitudes acquired by the individual and their effect on the family. Some Suggested Visual Aids Film: "Chain Reaction" Silent, Black and White, Runs 15 minutes from: Health Education Council, 10-12 Russell Square, London, W.C.1. UNIT 13 The Family and the World (a) World Health and Population (b) The economy of health Some Suggested Visual Aids Photographs Maps Charts and Statistics 79 Themes for Follow-up Discussion (a) Family customs as related to race, religion and nationality. (b) Invite a foreign student to talk about his country. (c) Arrange a school debate on the problems of (i) World Aid (ii) Integration of races (d) Contact Oxfam (or similar organisation) and help with a project (e) Compare the problems of families in underdeveloped countries with families in this country. (Geography. History. English literature. Religious instruction) (f) How can food production be increased? (Biology. Geography. Chemistry) 80 APPENDIX F St. James' House Hilary R.G. Lennox, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. St. James' House was opened in September 1968 as a special reception and education centre for immigrant children. The centre caters for the following children. (a) those of school age, newly arrived in the U.K. who have not previously attended school; (b) those of school age who have come to Croydon, having recently arrived in the U.K., having attended a British school for less than one term. (c) those of 5 years of age who arrived in the U.K. after their first birthday. The children registered at St. James' House are interviewed with a parent by the Advisor to the Centre, so that their educational attainments can be assessed and the children placed, as soon as possible, in a suitable local school. Most children stay at the Centre for only a short time. Pupils of secondary age are interviewed by Inspectors to determine the type of secondary school to which they should be admitted. The aim of St. James' House is to give, where necessary, immigrant children the simple rudiments of the English language before they are admitted to school. Children who have been registered at the Centre are called back there for a routine medical examination at the earliest opportunity. It is usual for a parent to be present at the medical so that any problems arising can be discussed with the Medical Officer, and appropriate advice given, e.g. Specialist and/or General Practitioner referral, immunisations needed, etc. Ten children are sent for each session, this being fewer than at routine medical inspections at local schools. The presence of the parent gives the child confidence, and the longer time given for each appointment enables the Medical Officer to obtain as full a medical history as possible, as well as time to explain how the necessary referrals will be undertaken. Between October 1968 and December 1969 , 377 children between the age of 5 and 16 were medically examined. The numbers are given in the table below together with a summary of findings (see Table 4, page for comparison). The immigrant children have been divided into four groups on the basis of place of origin, as follows:— European - includes those from Europe, North America, New Zealand, Australia, Canada. Asian - includes those from Pakistan, India and Asian from African Continent. British West Indies. Others - includes Singapore, Burma, Africa, Middle East, Japan. 81 The summary of defects found at the Reception Centre 1968/69 does not include all those types of defects given in Table 4 because total numbers are small and only those defects showing numerical significance are given. Summary of Findings * St. James' House 1968/69 (Percentage of Children Examined) DEFECTS ALL ACE GROUPS EUROPEAN ASIAN BRITISH OTHERS India - Pakistan WEST INDIES 48 50 69 60 60 45 25 20 Boys Girls Boys Girls Boys Girls Boys Girls Skin 6.3 6.0 2.9 5.0 8.3 - 4.0 - Vision 8.3 30.0 18.9 26.6 20.0 24.4 12.0 25.0 Hearing – – 1.5 1.7 1.7 – 8.0 5.0 Nose and Throat 2.1 6.0 4.4 6.7 1.7 4.4 8.0 10.0 Heart and Circulation – 2.0 5.8 – 3.3 – 4.0 – Lungs 2.1 2.0 1.5 - - – 4.0 – Stability 2.1 4.0 – 1.7 – 2.2 – – By comparison with 1969 local figures the following conclusions seem justified - (i) Vision defects in all groups of female immigrants vary between 50% and 100% above the rates for locally born. West Indian and Asian boys also have a raised incidence of vision defects, but the proportion is lower. (ii) Nose and throat defects in the "others" group is higher, whereas the West Indian is lower. (iii) Heart defects in Asian boys show a marked excess, with slight rise in boys of West Indian and "other" groups. (iv) Stability - with the exception of the European group, the proportion of defects is lower. It must be noted that although these figures are of interest, in a survey of this number of children, no definite significance can be argued. A medical examination will reveal overt defects, e.g. vision and heart, but may not reveal others, e.g. chest defect, nervous system and psychological defects for which a history of symptoms is required. Many immigrant parents have limited English and therefore are not always able to give a history of symptoms; while others have only recently been re-united with their children, after several years of separation, and have a limited knowledge of their child's medical history, with the result that some problems may be overlooked at the medical inspection. This is probably the case with psychological development and stability, where difficulties become manifest later on. At the medical examination the heights and weights of all the children are measured. 82 Bearing in mind that the number for each age in each group is small, it does appear that Asian children are smaller and less heavy than other groups, and that European children are taller and heavier. Boys and Girls European Asian B.W.I. Others Ages in Years Height Weight Height Weight Height Weight Height Weight 5 & 6 years 44.4 in. 42.7 lb. 43.3 in. 39.4 lb. 43.5 in. 39.4 lb. 43.4 in. 41.9 lb. 7 & 8 years 49.6 in. 59.2 lb. 48.5 in. 49.4 lb 49.4 in. 53 lb. 48.7 in. 51.7 lb. 9 & 10 years 53.5 in. 68.8 lb. 52.3 in. 60.8 lb. 51.7 in. 61.8 lb. 52.8 in. 67.6 lb. 11 & 12 years 57.7 in. 83.21b. 55.4 in. 70.7 lb. 56.5 in. 75.9lb. 57.4 in. 75.5 lb. 1 3 & 14 years 61.5 in. 106.7 lb. 59.5 in. 86.7 lb. 61.4 in. 98.6 lb. 62.1 in. 105 lb. 15 & 1 6 years 65 in. 118.5lb. 62.7 in. 102.3 lb. 63 in. 111.4 lb ... ... Since October 1969 the parents of all children from areas with endemic hookworm have been asked to co-operate by collecting a specimen for pathological examination. 66 requests were made for specimens and 44 were returned and examined with 7 positive results. Those with a positive result were notified and treatment arranged with their own general practitioner. Of the stool specimens examined 29 were from children from British West Indies of which 5 were positive; 14 were from Asian children of which 2 were positive; 1 from Sierre Leone was negative; i.e. 16.3% were positive with parasitic infection. The following results from the positive specimens are given below:— (1) Entamoeba coli cysts found in 5 specimens. (2) Hookworm ova found in 2 specimens. (3) Trichuris trichura ova found in 1 specimen. (4) Giardia lamblia cysts found in 1 specimen. (5) Hymenolepis nana ova found in 1 specimen. 2 specimens had mixed infection - one contained (1) (2) (3) from B.W.I. - one contained (1) (4) from Africa. CONTENTS A. - PUBLIC HEALTH REPORT Page Accommodation for confinements 12 Animals, diseases of 55 Animals, keeping of 51 Ante-Natal clinics 21 At Risk register 104 Bacteriological examination 131 Births 11,12 Blindness 82 Bye laws 65 Camping sites 52 Cancer 91 Census 11 Cervical cytology 38, 119 Chest clinic, work of 15 Child health centres 23, 109 Child minders 80 Chiropody 38 Clean air act 52 Committee, health 3 Communicable diseases 128,129 Congenital malformations 22, 103 Consumer Protection act 50 Convalescence 27 Cremation 121 Day nurseries 80 Deafness 37,105 Deaths 11,87,88 Dental treatment 31,117 Disinfection 53 Disinfestation 54 Drainage 50 Employment agencies 49 Epileptics 82 Elderly persons, rehabilitation of 112 Fabrics (Misdescription) act, 1913 51 Factories and workshops 45 Family Planning 79 Food complaints 63 Food and drugs act, 1 955 57, 60, 62 Food hygiene regulations, 1960 56 Food poisoning 130 Food supply 55 General practitioner attachment schemes 114 Hairdressing 50 Health education 28 Health visitors, work of 25,106 Home helps 27,116 Home nursing 24,111 Home safety 30, 114 Housing 43, 83 Page Ice-cream • bacteriological examination of 60 Illegitimacy 11,22 Immigrants 83,120 Immunisation 26,132 Infant mortality 11, 93, 94, 98 Inspections Public Health Inspectors 63 Liquid egg 60 Marriages 12 Maternal mortality 11,98 Maternity homes 121 Meat inspection 58 Medical examinations 80, 81 Men's hostel 41 Mental Health 32, 122 Midwifery 24, 95 Midwives act 22 Midwives, work of 99 Milk supply 58 Mines and Quarries act, 1954 51 Mortuary 121 Mothercraft classes 21 National assistance 82 Neo.nataI deaths 11 Noise abatement 54 Notification of births acts 12 Nuisances 65 Nursing equipment, loan of 115 Nursing homes 121 Nurses agencies 121 Offices, shops and railway premises act 46, 67 Outwork 46 Perinatal deaths 11 Pests 55 Pet Animals Act 54 Phenylketonuria 21 Pharmacy and Poisons Act 54 Poliomyelitis 133 Population 11 Post-natal clinics 21 Post-mortems 121 Premature infants 21, 102 Public health inspectors, work of 41, 63 Public health laboratory , service 131 Public health nursing services 24 Rag, Flock Act 54 Rats and Mice (destruction ) Act 55 Rehousing for medical reasons 83 Relaxation classes 21 Remedial works carried out 48 Riding establishments Act, 1964 52 River and streams, pollution of 50 Page Schools 50 Scrap metal dealers Act, 1964 51 Sewage disposal 75 Shops Act 49 Stalls and delivery vehicles 57 Statistics, summary of 11 Stillbirths 11 Tuberculosis, after care 17 „ allowances 17 „ contacts 16 „ home visits 16 „ mortality 15,16 „ notifications 134,135 „ occupational therapy 18 Page Tuberculosis, prevention and control 15 Tuberculosis, vaccination 17 Unmarried mothers 22 Vaccinations (smallpox) 132 Verminous persons 53 Venereal diseases 137-140 Vital statistics 11, 87, 88 Ward statistics 92 Water supply 75,131 Welfare foods 22,103 X-ray 16 B. - SCHOOL MEDICAL REPORT Page Audiology 2,14,19,61 Child Guidance 20, 50, 59 Cleansing of children 2, 8, 57 Clinica 4, 63 Convalescent treatment 35 Costs 5, 35 Deaf children 19,41 Deaths 36 Defects found 8, 9, 58 Delicate children 37, 52, 54 Dental service 22, 62 Developmental defects 15 Dysmenorrhoea 15 Enuresis clinic 25 Epileptic chiIdren 16,49,52 Eye clinics 13, 25, 59, 63 Handicapped children 2, 37 Health education 26, 70 Heart and circulation defects 14 Heights and weights 1 7, 31 Home tuition 55 Immigrant pupiIs 2,80 Infectious diseases 69 Intelligence tests 28 Juvenile employment 35 Maladjusted pupils 17,50 Meals and Milk 35 Medical inspections 1, 7, 56, 66 Minor ailments tables 60, 63, 64 Page Non-maintained schools 7, 65 Nutrition 17,31 Orthodontic service 22, 62 Orthopaedic defects 16,51 Overweight children 17,31 Parents, attendances of 8 Partially hearing units 41 Physiotherapy 29, 64 Populations of schools 56, 66 Psychological defects 17, 20, 50 School nurses, work of 69 Special inspections 7, 57, 58 Speech 30, 53 , 60, 64 Staff 5, 24 Statutory tables 56 Sub-normal children 46,55 St. Christopher's School 47 St. Giles' School 15, 37, 49 St. Luke's School 40 Transport of children 34 Tuberculosis 15 Uncleanliness 2, 8, 67 Verrucae 12, 64 Vision defects 13,39 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1969 To the Chairman and Members of the Education Committee: LADIES AND GENTLEMEN, This is the fifth Annual Report of the work of the School Health Service in the London Borough of Croydon, and I draw attention to some items of particular interest, which are covered in more detail in the Report itself. Routine School Medical Inspections It was possible to begin the centralization of Medical Record Cards for the former County Borough area. When completed this will facilitate variations in the present system of routine inspections, made necessary by the falling yield of defects being detected. Some of the disadvantages of the alternatives being used by other Authorities are noted. Despite these drawbacks it will be necessary to suggest changes to conform with current trends. Like many contemporary developments, the pressure for change comes from the providers and not the recipients of the service, for there were no demands for cessation from parents. Furthermore it will be observed that parents with children at private schools asked for the introduction of routine medical inspections. Basically it' is yet again a problem of deciding how best to use scarce and expensive facilities in a manner which satisfies all concerned. 2 Personal Hygiene It is disappointing that there were more cases of scabies and of ringworm. Well established methods of control, which in recent years have been largely unnecessary, were re-applied, and should again prove fully effective, Diseases of the Ear The formerly dreaded mastoid infection has virtually disappeared, but a new middle ear condition, which causes partial deafness, has become more frequent. The special steps taken are described. Handicapped Pupils The building of a second school for E.S.N. pupils went forward, and in view of the lengthy waiting list for such facilities will be of great benefit. The pressure on the Child Guidance Clinic continued, and the decision to strengthen the School Psychological Service will be helpful. The building progress being made on the special school for maladjusted children suggests that it should be completed next year. It was disappointing that the Nursery Unit at the school for physically handicapped children could not be authorised by the Department of Education and Science. Handicapped children were accepted by the Health Committee for admission to Corporation Day Nurseries, but this was possible only by lengthening the already considerable waiting list for the central day nursery. Immigrants Originally no special facilities were provided but children were brought forward as soon as possible at routine school medical inspections. This was deliberate policy as we dealt with immigrant children on the same basis as those whose parents moved to Croydon from other parts of the British Isles. However, the establishment of a Reception Centre called for co-operation by the School Health Service, and immigrant children are now medically examined at this Centre. The Medical Officer concerned with this work has submitted a special report. It shows that on the whole the health of these children gave rise to no special problems. Future of the School Health Service Now that this is under discussion, the report which follows, covering the work of a single year, clearly emphasizes the continuing need for this service, however it is administered. That it has attained its present development in Croydon is a tribute to 65 years of local authority direction. If a different organisation is eventually to become responsible, it will have a high standard to maintain, and a record which it is unlikely to surpass. 3 In thanking members of the Committee for their usual support, and understanding, I would also express appreciation to members of the Education Department, Head Teachers and school staff, for much cordial and sympathetic assistance. Finally, Dr. Homer, responsible for day to day administration and the compiling of this Report, and the staff of the Department, have, as always, given of their best. Yours faithfully, S.L. WRIGHT, Principal School Medical Officer. 4 PARTICULARS OF SCHOOL CLINICS as at 31.12.1969 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 DAILY A.M. Lodge Road, Broad Green Croydon. Parkway Clinic, New Addington. Waddon Clinic, Coldharbour Road, Waddon. MON. & THURS. IN TERM TIME Ashburton School, Shirley Road, Croydon.(a.m.) Rockmount School, Upper Norwood. (p.m.) WEEKLY Purley Clinic, Whytecliffe Road, Purley. (Wed. p.m.) Sanderstead Clinic, Rectory Park. (Fri. p.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. Sanderstead Clinic, Rectory Park, Sanderstead. Waddon Clinic, Coidharbour Road, Croydon. INSPECTION ONE CLINIC APPROX. WEEKLY IN P.M. Lodge Road, Broad Green, Croydon. Purley Clinic, Whytecliffe Road, Purley. Parkway Clinic, New Addington. AS REQUIRED Ashburton School, Shirley Road, Croydon. Rockmount School, Rockmount Road, Upper Norwood, Waddon Clinic, Coidharbour Road, Croydon. PHYSIOTHERAPY Lodge Road Clinic Annexe, Lodge Road, Croydon. 47, St. James's Road, Broad Green, Croydon. Parkway Clinic, New Addington. Sanderstead Clinic, Rectory Park. Purley Clinic, Whytecliffe Road, Purley. Old Coulsdon Clinic, Coulsdon Road. SPEECH 47, St, James's Road, Broad Green, Croydon. Parkway Clinic, New Addington. Purley, Council Offices, Brighton Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. Shrublands Clinic, Bridle Road, Shirley. Waddon Clinic, Coidharbour Road, Croydon. AUDIOLOGY Lodge Road, Broad Green, Croydon. Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. ENURESIS Lodge Road, Broad Green, Croydon. (Weekly) TWICE MONTHLY Parkway Clinic, New Addington. (Monday p.m.) Purley Clinic, Whytecliffe Road, Purley. (Friday pm.) 5 EYE Purley Clinic, Whytecliffe Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. Parkway Clinic, New Addington. OVERWEIGHT Public Health Department (Girls) and various schools and clinics (Boys) both on Friday a.m. STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 11 (full-time) (36.7%) *Medical Officers 7 (part-time) Consultants and Specialists 9 (part-time) (80%) *Dental Officers 13 (including 4 part-time and 1 Dental Auxiliary) *Physiotherapists 9 (including 6 part-time) Speech Therapists 8 *School Nurses and Nurse/Assistants 66 (including S.H.V. and Deputy) (52%) *Dental Surgery Assistants 16 (including 7 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 £156,277. Cost of Special Schools Schools maintained by the Council £146,125 Other Schools (not maintained by local Education Authorities) £62,755 Adjustments with other authorities in respect of Special Schools £42,650 £251,530 6 PART I. MEDICAL INSPECTION IN SCHOOLS The medical Inspection of school children at fixed intervals during their school lives has been an integral part of the development of the School Health Service, and 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. (ii) 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. The number of routine medical inspections completed during the year showed a further increase, and the total figure of 18,378 is the highest yet recorded in the Borough. This represents a large investment in both finance and manpower, so that the need for these examinations must be constantly reviewed. The proportion of medical defects discovered during these routine inspections continues to fall, and it is argued by many that an examination of every child is no longer necessary. If a smaller number of children were examined, the medical time available to those children would be significantly increased to the benefit of both the child and the doctor who would find such comprehensive examinations more attractive than the inspection of large numbers of healthy children. It is known that a large proportion of the medical defects which are found at these routine inspections occur amongst a small proportion of the children who are examined, so that the concept of selecting children for a medical examination is theoretically very attractive. Unfortunately, despite experimental work extending over fifteen years, none of the schemes of selective medical inspections which have so far been introduced have shown themselves capable of identifying satisfactorily the small group of children who are likely to have medical defects. It is quite clear that the various methods of selection which have been advocated are not sufficiently precise to ensure that only those children with medical defects will be exartined, nor even to ensure that the children who have such defects will in fact be selected. The need to ensure maximum 7 use of financial resources and the need to consider the job satisfaction of medical staff may well lead to the conclusion that a scheme of selective medical inspections should be introduced in Croydon. At the same time it must be recognised that such a scheme is likely to have significant disadvantages unless some method can be devised which will allow all children to be screened by medical examination for a certain number of specified conditions. Table 1. Numbers seen at Medical Inspections 1969 Routine Inspections — 18,378 Special Inspections — at school medical sessions 953 at inspection clinics 42 995 Reinspections - at school medical sessions 3,199 at inspection clinics 475 3,674 A number of schemes of reorganisation of medical inspections have stressed that the routine system has been replaced by a system of special inspections which allow the child to be examined whenever it seems necessary. It is interesting to note therefore that although the routine system has been retained in Croydon, the number of special inspections has shown a dramatic increase. The number of children brought forward to the School Medical Officer for a special examination in school increased by 36% during 1969. The number of children examined at school inspection clinics showed a further slight fall, and it is now rare for these inspections to take place outside school. This is most welcome, since the opportunity is readily available for discussion of the problem between the teacher and the medical officer. The number of re-inspections (Table I) again confirms the trend for these to be undertaken in school rather than at a school clinic. There was a slight increase during the year in the number of re-inspections which were carried out, suggesting that medical officers are continuing to supervise the medical defects which they discover. During the year a number of parents whose children attend private schools requested a routine school medical inspection, and these examinations were carried out in appropriate school clinics. Enquiries continue to be received from private schools about the introduction of medical inspections in such schools. A number of private schools enjoy this facility, and details of the examinations are given in Appendix C, page 65. 8 The proportion of parents who attended the school medical inspections has shown minor fluctuations around a stationary level of 53%, and the slight improvement upon this figure in 1969 is welcome. It is the first medical inspection where the attendance of parents is so important, since it is at this examination that most defects are found, and any problems in adjustment to school life are most likely to be identified and remedied. The proportion of parents who attend this examination continues to be high, but there has been a slight decline in this proportion during each of the last five years. The reasons for this decline are not clear; the reason most frequently given is that the mother is out at work. In any event mothers are particularly urged to be present during this first examination, since the information which they can provide for the medical officer probably exceeds that which can be obtained from the physical inspection of the child. Table 2. Attendance of Parents at School Medical Inspections 1969 1968 Boys Girls Boys Girls Entrants 82.3% 81.5% 84.0% 84.2% Leavers 3.9% 6.5% 4.5% 6.6% Others 55.4% 59.2% 54.4% 56.0% Total Numbers of Children examined 9,373 9,005 8,957 8,841 Total Attendance of Parents 55.3% 53.4% As a result of medical inspections in all schools, a total of 6,476 defects were receiving or were thought to require medical treatment. This total is almost identical with that for 1968, so that the proportion of defects discovered per child examined again shows a slight reduction. This is mainly due to reductions in the number of orthopaedic defects which were recorded. A further 6,097 defects were referred for observation by the school medical officers. A summary of the defects which were found has been recorded in Table 3. The proportion of defects which were discovered in every hundred children examined has been recorded in Table 4. Personal Hygiene The further reduction in the number of cleanliness inspections, together with an increase in the number of cases detected, again confirms the effectiveness of the revised procedure which has been introduced to deal with this small but persistent problem. It is disappointing to record an increase of 11.1% in the number of cases detected, but evidence suggests that the increased prevalence of infestation is by no means confined to Croydon. Similar findings have been recorded in a number of widely separated urban areas. 9 Table 3 RETURN OF DEFECTS FOUND AT ROUTINE MEDICAL INSPECTIONS 1969 Defects Boys Girls Number requiring Treatment Number requiring Observation Percentage of total Defects Number requiring T reatment Number requiring Observation Percentage of total Defects Uncleanliness - Head/Body 1 12 0.2 4 6 0.2 Teeth 615 72 10.3 765 88 14.4 Skin 841 107 14.3 344 145 8.3 Eyes - Defective Vision 792 628 21.3 814 718 25.8 Squint 126 18 2.2 122 12 2.3 External Eye Trouble 28 28 0.8 27 15 0.7 Ears - Deafness 108 195 4.6 104 176 4.7 Otitis Media 45 116 2.4 45 143 3.2 Other Defects 6 31 0.6 14 24 0.6 Nose and Throat 186 494 10.2 165 417 9.8 Enlarged Cervical Glands 8 67 1.1 11 39 0.8 Speech 92 98 2.9 40 62 1.7 Heart and Circulation 49 114 2.4 42 107 2.5 Lungs 147 117 4.0 .64 75 2.3 Developmental - Hernia 22 21 0.6 8 22 0.5 Other Defects 156 319 7.1 89 233 5.4 Deformities - Posture 12 32 0.7 26 65 1.5 Flat Feet 56 138 2.9 29 71 1.7 Other 66 118 2.8 62 127 3.2 Nervous System - Epilepsy 16 11 0.4 16 17 0.6 Other 45 49 1.4 34 46 1.4 Psychological - Development 24 61 1.3 17 58 1.3 Stability 52 165 3.3 34 162 3.3 Abdomen 21 33 0.8 33 47 1.4 Other Defects 25 65 1.4 28 113 2.4 TOTAL DEFECTS 3,539 3,109 2,937 2,988 Total Children Examined 9,373 Boys 9,005 Girl. 10 Table 4 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1969 (Percentages of Children Examined) Defects Entrants Intermediates Entrants to Secondary Schools Final Leavers AII Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 9.4 8.8 8.7 9.5 5.8 7.0 4.2 14.2 7.3 9.5 Skin 3.3 3.6 6.2 5.8 15.7 5.8 19.2 7.4 10.1 5.4 Eyes - Vision 13.1 13.1 15.3 16.9 16.9 19.4 16.0 20.4 15.1 17.0 Squint 2.5 2.3 2.0 1.8 0.9 0.7 0.2 0.7 1.5 1.5 Other 1.1 0.6 0.5 0.4 2.5 0.4 2.1 0.4 1.8 0.5 Ears - Hearing 5.2 5.6 3.0 3.0 2.8 1.7 1.0 1.1 3.2 3.1 Otitis Media 3.6 4.1 1.8 1.8 0.4 0.9 0.3 0.9 1.7 2.1 Other 0.4 0.7 0.4 0.3 0.5 0.4 0.2 0.1 0.4 0.4 Nose and Throat 11.2 10.4 7.5 7.1 5.9 4.1 2.4 2.3 7.2 6.4 Speech 4.1 2.4 1.8 1.1 0.9 0.4 0.5 0.2 2.0 1.1 Cervical Glands 1.4 0.9 0.7 0.9 0.7 0.1 0.1 0.1 0.8 0.6 Heart and Circulation 2.2 1.8 1.3 1.8 1.8 1.4 1.5 1.7 1.7 1.7 Lungs 3.7 2.4 2.5 1.5 2.6 1.2 2.0 0.7 2.8 1.5 Developmental - Hernia 0.6 0.6 0.5 0.4 0.4 0.2 0.2 0.1 0.5 0.3 Other 4.2 1.5 4.8 3.2 8.6 4.9 1.8 5.7 5.1 3.6 Orthopaedic Posture 0.5 0.4 0.5 0.7 0.5 1.5 0.2 1.6 0.5 1.0 Flat Feet 2.1 0.8 1.2 1.1 2.6 1.4 2.4 1.2 2.1 1.1 Other 2.4 2.3 1.8 1.5 2.1 3.0 1.4 1.2 2.0 2.1 Nervous System Epilepsy 0.4 0.3 0.4 0.3 0.1 0.6 0.2 0.3 0.3 0.4 Other 1.5 1.5 1.4 0.9 0.6 0.5 0.2 0.5 1.0 0.9 Psychological- Development 1.8 1.1 1.0 1.1 0.3 0.7 0.2 0.2 0.9 0.8 Stability 3.1 2.7 3.1 2.4 1.9 2.1 0.4 1.1 2.3 2.2 Abdomen 0.9 1.0 0.6 1.2 0.5 0.6 0.1 0.7 0.6 0.9 Other Defects 1.2 1.4 1.5 2.1 0.8 1.3 0.1 1.5 1.0 1.6 11 The marked increase of uncleanliness at follow-up visits is a source of some concern. The chance discovery of infestation is always possible in any school child since, like other infectious diseases, infestation has no respect for persons. When the condition remains untreated or inadequately treated, however, doubts must be raised about the determination of a parent to eradicate the condition, and it is perhaps surprising that it has been necessary to invoke the statutory procedure laid down in the Education Act for the cleansing of these pupils on an increasing number of occasions. There have been two incidents this year involving children who were not infested with head lice but who were generally so dirty that complaints were received from other children and from teachers. The children themselves were naturally disturbed by their rejection by their contemporaries, and energetic efforts were necessary by the nursing staff to ensure some improvement in the situation. A small outbreak of scabies proved troublesome but responded to treatment by family doctors and careful fol low-up by the staff of the Department. A cleansing station is provided for the treatment of scabies, and persistent verminous conditions. Sixteen school children attended the cleansing station for treatment of scabies, and six school children were treated for head vermin. Both of these figures are smaller than those for 1968. Table 5. Cleanliness Inspections Number of children inspected for cleanliness 37,787 Number of children inspected at follow-up visits 1,722 Number found unclean for the first time in 1969 309 Number of occasions in which children were found unclean at follow-up visits 95 12 Skin Defects There was an overall reduction in the number of skin defects reported due to a sharp decline in the number which required treatment. During the year a scheme for the laboratory investigation of Athlete's Foot, to which reference was made in last year's Report (p. 12) was successfully introduced. Specimens of affected skin are sent to a Mycology Laboratory in London, and subsequent reports confirm or exclude the presence of a fungal infection. During the year 116 specimens were sent to the laboratory, and 24 (20.7%) were reported positive. This relatively low proportion was of some initial concern but assurances have subsequently been received that similarrates have been found in investigations completed in other areas of the country. It is often difficult to separate the relatively small number of fungal infections from the very much larger group of "Athlete's Foot" caused by other conditions and these laboratory investigations have been a welcome addition to the diagnostic facilities available to the Service. Indeed, it is possible that the reduction in skin defects reported is partly due to the improved opportunities for diagnosis which are now available. When a positive specimen is identified, treatment may be given either by the family doctor or at a School Minor Ailment Clinic. During the year 3 cases were referred to family doctors, and 21 cases were offered treatment at the School Clinics. A number of cases of ringworm were reported during the year. The usual measures were taken to exclude possible spread to other pupils, including screening the children in some classes with ultra-violet light. This technique identifies certain strains of ringworm at a stage before loss of hair becomes obvious. The education of affected children also presents some problems, since they must remain absent from school until the lengthy treatment is complete .Unfortunately the service is not always informed of the diagnosis at an early stage, and such delays add to the problems presented by the condition. The return of these once common conditions is a timely warning that standards of control must not be relaxed. There is a natural tendency for parents, teachers and School Health Service staff to assume that the absence of these conditions obviates the need for the preventive measures which ensured their eradication. Some Head Teachers have been reluctant to permit hygiene inspections in their schools, but it is clear that the price of freedom from these conditions is indeed constant vigilance. 13 Table 6. Summary of Findings at Routine Inspections of Vision Boys Girls Number Examined Number of defects % Number Examined Number of defects % Entrants 2,938 378 12.9 2,871 381 13.3 8 year old group 2,657 438 16.5 2,506 423 16.9 Entrants to Secondary Schools 2,091 335 16.0 1,985 394 19.8 13 year old group 1,778 378 21.3 1,818 438 24.1 Final Leavers 1,687 269 15.9 1,643 334 20.3 Totals (All age groups) 11,151 1,798 16.1 10,823 1,970 18.2 Vision Defects Defects of vision constitute the largest single group of abnormalities discovered by the School Health Service (Table 3). The number of such defects noted at routine school medical inspections showed a slight fall during the year, but the proportion of defects discovered during vision inspections at other times remained similar to that in 1968. Although the primary objective of the service must be the discovery and specialist investigation of such defects, its overall responsibilities must continue after appropriate treatment has been given. Regular reviews are necessary to ensure that the spectacles being used are still suitable, since some children do not return to the optician for regular examination. Moreover, efforts must be made to persuade the child to wear the spectacles which have been provided. Reference was made in last year's Report (p. 13) to the number of children who were not wearing the glasses which had been prescribed for them on the day of a routine vision test in secondary schools. In earlier Reports (1966, 1967) reference was made to the difficulty in obtaining appropriate treatment for vision defects, and in consequence the Education Committee agreed in 1965 to continue a School Eye Clinic in Purley, formerly administered by the Surrey County Council, and to extend treatment facilities to a new Clinic in Sanderstead. Subsequently a further extension of services was permitted to cover the New Addington area in 1967. Since that time waiting lists at all Eye Clinics providing facilities for school children have been contained. During 1969 the Regional Hospital Board offered to assume responsibility for all School Eye Clinics in the Borough, but although it was recognised that the existing service is not without cost to the Corporation, the Education Committee decided that it would retain responsibility for the existing School Eye Clinics in the Borough. Nevertheless, it is possible to ensure adequate co-ordination 14 between the School Eye Clinics and the Mayday Eye Unit, since the appointment of Mr. Dermot Pierse as Consultant Ophthalmologist to the Committee allows him to exercise a general oversight of both services. Defects of Ears, Nose and Throat The number of children found to be suffering or to have suffered from middle ear disease (otitis media) showed an increase for the fourth successive year. Indeed, during the last four years the number of such defects has increased by 50%. Previous reports have emphasised the significance of the rising incidence of this serious condition (1966, page 13; 1967, page 13; 1968, page 14). It is noteworthy that the number of hearing defects in 1968 also shows a significant increase (Table 3), since disease of the middle ear is likely to affect the child's ability to hear. It was helpful therefore to have a visit during the year from Mr. H.M. Parsons, the Committee's Consultant Otologist, who gave a talk to the medical officers on a related medical condition with the descriptive title of "Glue Ears". This is a condition which has emerged since the treatment of otitis media with antibiotics, and it has many features similar to middle ear disease. Although the cause of the condition is not fully understood, its treatment is now clearly determined, and it is helpful to know how the condition can be recognised in its early stages when treatment will result in a dramatic improvement of hearing. There was an increase in the number of National Health Service (Medresco) hearing aids which were issued to school children during the year with a compensatory reduction in the number of commercial hearing aids purchased by the Committee. The decision to issue head worn Medresco hearing aids to older children was welcome, and arrangements were made for the children in the partially hearing unit for secondary pupils to be fitted with such aids as a single group. The need for automatic volume control on hearing aids for some school children will still make it necessary for the purchase of some commercial hearing aids, and it is hoped that this provision will soon be available on hearing aids issued to children by the National Health Service. Defects of Heart and Circulation There was no significant change in the pattern of these defects during the year. Defects of the Lungs The number of lung defects shows a marginal increase, but a significant trend towards their treatment rather than their observation by the school medical officer. Increased attention has been directed towards bronchial asthma following the recognition of an increased mortality in school children associated with the use of pressurised aerosols. Surveys in various parts of the country suggest that bronchial asthma in children is relatively common especially in association with respiratory infection 15 or with symptoms of allergic conditions. Dr. Thelma Wield, who has special responsibilities for some of the more severely affected children at St Giles' School, expresses concern about over-protective attitudes towards the asthmatic child in an ordinary school. It is important that an affected child should be treated as normally as possible, drawing the least possible attention to his difficulties. Asthmatic children should NOT be discouraged from taking physical exercise provided that they do not become excessively wheezy, nor should they be sent to lie down as soon as the first signs of wheezing appear. The education of such children presents its own difficulties; in general the I.Q. of an asthmatic child is above average, but frequent absence from school leads to inevitable educational retardation. There is some evidence that these children find it difficult to cope with the natural competition within an ordinary school. Nevertheless, it must be remembered that the adaptations progressively introduced at St. Giles' School to make it more suitable for the severely physically handicapped child have made it Jess like the open air schools for delicate children which have traditionally provided education for the child with chest disease. It seems preferable in this situation to encourage the asthmatic child to remain in an ordinary school unless symptoms have progressed to the point where regular physiotherapy is essential. Nevertheless, the child with very severe bronchial asthma will continue to require the special facilities which only St. Giles' School can satisfactorily provide. The incidence of pulmonary tuberculosis in school children was similar to that in 1968. The number of cases of notified tuberculosis in children of school age was - Pulmonary - 5 Non-Pulmonary - Nil The school population was 51,000 (approx.) so that the incidence rate of pulmonary tuberculosis per 100,000 was 9.8. In 1968 the rate was 10/100,000. Once again there were no deaths from tuberculosis in school children. Abdominal Defects The number of defects reported was similar to that in the previous year but with a trend towards the treatment of such defects as soon as they are recognised. In view of the reference to dysmenorrhoea in last year's Report (page 15) such a trend is welcome. Developmental Defects There was no significant change in the pattern of these defects during the year. 16 Orthopaedic Defects There are significant reductions in the number of defects reported in each of the three categories of orthopaedic defects. This decline in incidence is particularly marked in the categories of posture and flat foot, which suggests that a change may be occurring in the pattern of defects now thought worthy of attention. The Physiotherapy Service has moved away from the somewhat restricted emphasis upon exercises to correct a particular deformity towards a more dynamic approach which assesses the total needs of the child. Active participation by the child and active encouragement by the parents are now seen to be the keys to successful treatment, and every effort is made to ensure that such objectives are achieved. Medical officers differ concerning the significance of minor postural defects, and of symptomless flat foot. There is a suggestion that the correction of the former have not been assisted by the changes in methods of physical education in schools. Whilst the physiotherapist may rightly argue that training in routine gymnastic exercises is a waste of her valuable therapeutic time, the absence of such exercises at school may result in the child receiving no treatment whatever. The danger to health probably lies not in the actual defect but in the apparent approval by default of unhealthy habits. At a time when health is becoming a matter of conscious choice, requiring certain specific actions by the individual, the encouragement of such attitudes is clearly unfortunate. Similarly, in the condition of flat foot, Dr. Roberts, a school medical officer, working in secondary boys' schools, points out that the condition is relatively frequent at the medical inspection on admission to secondary school. By the time of the examination in the final year at school, flat foot is less common, but those that remain show permanent deformity, with a slightly awkward gait and a tendency to callouses (corns, etc.) The condition is largely preventable by regular exercises designed to strengthen the arch of the foot. Both the number of children involved and the long term nature of the exercises make it quite impracticable to use physiotherapists in the alleviation of the condition, and it is to teachers of physical education that the service must look for assistance with this aspect of preventative medicine. Defects of the Nervous System There was no significant change in the pattern of these defects during the year. The number of children with minimal evidence of epilepsy sometimes causes surprise, and it is useful to compare the incidence in Croydon in 1969 (3.2/1,000) with the most recently available fiaures in England and Wales which show an overall incidence in 1967 of 3.7/1,000 It will be seen from page 28 of this Report that there has been a sharp increase in the number of children referred to the service for an intelligence assessment. The Table shows that this is not due to an increasing recognition of educational subnormality in anticipation of the opening of 17 the new school. Most of the larger number of children assessed were found to have intelligence quotients within the average range and were therefore referred back to ordinary schools. Since all such children had initially been referred by those schools for educational failure, the Service can hardly be satisfied that it has remedied a problem which seems more properly a responsibility of the School Psychological Service. Psychological Defects There was a further increase in the number of psychological defects reported during the year, confirming once again that emotional problems in school were more widely recognised. Moreover, despite efforts to improve treatment services, already more adequate than in many other parts of the country, it was still difficult to cope with the demand for such facilities. One school medical officer arranged to see a group of mothers and children whose problems did not require immediate attention of the Child Guidance Clinic, and found that the number of mothers who were prepared to attend such special sessions would far outstrip the ability of the Service to make adequate arrangements. The training of medical and health visiting staff to recognise emotional problems and to provide supervision and support for suitable cases continued. Dr, G. Crosse, Consultant Psychiatrist to the Regional Hospital Board,visited the Department regularly to lead seminars for doctors and health visitors. These sessions were held during the lunch hour and indicate the willingness of staff to devote time to this problem. In the year under review, emphasis was on prevention by action directed to pre-school ages. The problems of drug dependence and drug experimentation continue to excite general interest. Efforts to obtain accurate information were maintained and there was no satisfactory evidence that drug dependence was a problem in Croydon schools. The local advisory panel on drug dependence concluded, nevertheless, that a further study day should be held for teachers and other professional staff, and this was planned to take place in February 1970. Nutrition The figures of average heights and weights are recorded in Table 7. The average height of 5 year old boys and girls has remained remarkably stable for the past five years and, whilst there has been some fluctuation of average weight, the impression is conveyed of a slight welcome fall during the same period. 18 At 15 and 16 years the average height of girls seems to have become stable but there is a continuing slight tendency for weight to increase. Boys on the other hand continue to show a slight increase in average height, with a continued increase in weight which is quite marked. It seems clear that girls have completed their pubertal growth spurt by the age of 15 years, whilst the growth spurt for boys still continues. The unwelcome increases in weight still require attention, and the Weight Control Clinics have continued during the year. During the absence of Dr. Phyllis Mortimer during the last two months of 1969, arrangements were made for Dr, Simmonds to supervise the progress of all children attending the Weight Control Clinics. Table 7. Average Heights and Weights in 1969 and Previous Years Ages Number Examined in 1969 Average Height in Inches Average Weight in lbs. 1969 1968 1967 1966 1939 1969 1968 1967 1966 1939 BOYS 5 years 1,604 43.2 43.2 43.3 43.2 41.8 42.9 43.1 44.0 43.3 41.5 6 years 711 43.9 44.2 44.2 44.2 43.8 44.0 44.6 45.0 44.7 43.4 14 years 568 64.0 65.7 64.0 63.5 59.0 112.5 114.2 115.5 113.3 90.8 15 years 516 66.3 65.8 65.6 65.6 - 125.9 123.3 122.6 121.4 - 16 years 180 67.7 67.1 67.5 66.9 - 133.6 129.5 131.4 130.0 - 17 years 23 68.8 67.5 68.1 68.6 - 134.9 134.9 135.3 137.6 - GIRLS 5 years 1,531 43.1 43.2 43.0 42.8 41.2 41.9 42.8 42.2 42.0 39.7 6 years 729 43.5 44.2 43.6 43.9 42.7 43.4 44.0 43.3 44.0 41.4 14 years 729 62.3 62.6 62.4 62.1 60.3 114.4 115.0 113.8 113.6 97.9 15 years 564 63.5 63.5 63.1 63.2 62.0 120.6 118.5 117.7 120.1 105.5 16 years 118 64.7 64.0 63.8 63.5 - 120.7 122.2 121.5 121.1 - 17 years 19 63.1 64.8 64.1 63.9 - 121.0 127.8 126.0 126.0 - 19 PART II SPECIALIST SERVICES AUDIOLOGY SERVICE Mr. J.C. Oakley, Peripatetic Teacher of the Deaf During the year, 1,220 children were tested in the Audiology Clinic by pure tone audiometer. This included routine follow-up cases, cases referred by School Medical Officers, Child Study Survey tests and 569 Sweep Test Failures. Regular clinics were held at Lodge Road; Parkway, New Addington; and Whytecliffe Road, Purley. The pre-school children requiring auditory training, were seen regularly in the Lodge Road clinic or at home. Extra speech training was given by the Speech Therapists and Speech Training machines were loaned to the parents. 95 children were seen either by Mr. Parsons or Mr. Stewart, the Corporation's Consultant Otologist, who held regular sessions at Lodge Road, Kingsley Nursery, Infant and Junior Partially Hearing Units and the Riddlesdown Senior Partially Hearing Unit. 10 hearing aids were recommended during the year, 9 of these were National Health Service 'Medresco' aids and the other one a commercial aid paid for by the Corporation. This was necessary because the child's hearing loss was greater than the range covered by the 'Medresco' aid. During the year, the National Health Service introduced a post aural aid and where suitable, this was issued to the children in the 12 - 16 age range. This was very warmly received by the children in the Riddlesdown Unit. 67 babies were seen at the special clinic held in conjunction with Dr. Morgan, for the early assessment of deafness in young babies, 11 of these were referred to Mr. Parsons for further assessment. This clinic, now well established, has been very successful in diagnosing deafness in these young babies, enabling a hearing aid to be prescribed and auditory training commenced with the minimum of delay. Early diagnosis and the institution of auditory training, together with a hearing aid and speech training machine, greatly improve the outlook for a child with impaired hearing, particularly the more severely deaf. During the year, all Infant schools were visited at least once, and apart from absentees and unco-operative children (512), all children newly admitted to school during the year were tested. Of the 7,096 children tested, 632 (approx. 8.9%), failed the test and were referred to the Audiology Clinic for further assessment. For further additional statistical details, see Appendix B, Page 61. 20 CHILD GUIDANCE CLINIC I am grateful to Dr. G. Crosse, Consultant Psychiatrist, South West Metropolitan Regional Hospital Board, for the following report:— The key note of the service this year has been the ceaseless effort to narrow the gap between the demand for consultation, treatment, etc., and the supply of available clinic facilities. The current annual assess* ment shows that the final balance, in much the same vein as in previous years, is weighed heavily against supply. In fact much hard thought has been given to the optimum deployment of our slim resources, and to this end various tactics have been tested out during the year. How to reconcile the demands of acute urgent cases with those who have waited for months on a waiting list that is in danger of becoming stagnant, how to reconcile shortened versions of treatment with the principles of proper care of the patient, are some of the problems which have had to be tackled by the staff. Much of theburden of work aimed at establishing priorities has been carried out by our psychiatric social workers, Miss M.S. Gradwell and Mrs. E. Gee, and the appointment of Mrs. P. Ollerenshaw as third social worker late last year has given her colleagues much needed support. Pressures create pressures, and the expansion of staff to meet an increasing case load has in turn created problems of accommodation at the clinic. These have more or less been resolved by the good will and common sense of the staff members concerned, but it is now absolutely clear that the present cljnic premises will just not be big enough to cope with an expanding service. The Day Unit continues to be in demand and its role in coping with the seriously disturbed children should never be underestimated. Some children, awaiting residential placement, are too ill to attend day school and one or two in this category have been supported by the unit staff for almost a year. This is an appropriate moment to record the sad death of Mr. D.G. Griggs, the first to hold the appointment of Charge Nurse to the unit, and there can be no higher tribute of his devotion to the work than the manifest grief shown by the children who were under his care. His successor is Charge Nurse H. Allen who was appointed from the staff of Warlingham Park Hospital. He is assisted by Staff Nurse Mrs. J. Furnish whose experienced and mature handling of so many of the disturbed children is appreciated by all who know the unit well. Another appointment was that of Mrs. A.M. Ball who replaced Mrs. B. Tindle as teacher to the day unit. The latter was seconded to a course at the University of London for the education of maladjusted children. The new appointments of a music therapist, Mr. F. Knight, for two sessions a week and Mrs. J. Glass, art therapist, for two sessions a week, has enabled the clinic to develop further therapeutic activities. 21 The'access to beds in the in-patient unit at Queen Mary's Hospital for Children, Carshalton, has saved the clinic from many a tight corner, and it is a relief to know that children who are severely depressed and who show a complete disintegration of behaviour can be admitted at short notice to this hospital. There has been some reorganisation of our secretarial services. Mrs. J.I. Meadows was appointed as Senior secretary and she is assisted by Misses K. Knott, I. Boggis and L. Pickett, the last named acts as Receptionist and telephonist. Dr. S.M. Ring continues as Senior Registrar and Dr. S. Shivanathan has succeeded Dr. A. Fraser as Psychiatric Registrar at the clinic. Our peripheral clinics continue to prosper well and our thanks are due to Miss M.S. Gradwell at the Parkway clinic, New Addington, and Mrs. E, Gee who acts at the Lodge Road and Purley clinics. Dr. J. Mills, seconded from the Croydon health authority for two sessions a few years ago, now has the experience and confidence to take a valuable therapeutic role at the central and Purley clinics. This report should not end without expressing our sincere appreciation of the help given us by Dr. S.L. Wright, Principal School Medical Officer, and Mr. K.G. Revell, Chief Education Officer, who have had to deal with the complex problem of co-ordination of the multi-disciplinary framework of our service. Sources of Referral Boys Girls Total Principal School Medical Officer 53 39 92 General Practitioners 63 26 89 Children's Department 4 4 8 School Psychological Service 19 7 26 Juvenile Court 17 1 18 Other Hospitals 13 11 24 Other Agencies 7 4 11 Milton House Remand Home 67 67 176 159 335 Action Diagnostic 36 73 109 Current Treatment 126 72 198 Closed Cases - Improved 6 8 14 No change 2 2 4 Unco-operative 4 2 6 Transferred 2 2 4 176 159 335 22 DENTAL SERVICE Mr. J.D. Palmer, Principal School Dental Officer What does one want from the Local Authority Dental Service in Croydon today? In my view it should concern itself with the dental health of the whole community it serves. The realistic control of dental disease and the initiation of broad dental health education are most important, whilst the maintenance and development of good and efficient treatment services is essential. Despite the increasing school population in recent years the demand for routine treatment remains reasonably constant. Over the last 20 years the percentage acceptance rate for treatment has declined steadily, although it has remained fairly static over the last three years. At the same time the percentage referral rate as needing treatment has also slowly declined, whilst the badly neglected mouths and those requiring vast amounts of treatment have largely disappeared. This indicates a general improvement in terms of treatment received, but not necessarily an improvement in dental health. Unfortunately the incidence of dental disease remains as high as ever, as evidenced by the total numbers of teeth requiring treatment. Year School Popln. % referred requiring treatment % requesting treatment in school dental service Total teeth treated per child (fills. pr exts.) 1949 29,106 46% 74.4% 1.9 1959 36,878 45.2% 38.8% 2.1 1967 46,835 41.6% 28.5% 2.9 1968 49,020 44.2% 30.0% 2.7 1969 50,945 44.7% 30.1% 2.8 The favourable treatment facilities provided under the general dental services locally (for each dentist on the National Health Service executive list in the Croydon area there are 2,974 persons, whilst the national average per dentist is 4,219) as well as the efforts of the public dental officers over the years account for the improvement in the quantity and quality of dental treatment received. By working in liaison with the general dental and hospital services locally, this enables the development of the local authority treatment services to be complementary to, rather than competitive with, those of dental practitioners. The extension and provision of those services which are not well provided for in the community becomes possible; e.g. the specialised or time consuming techniques for children, mentally and 23 physically handicapped individuals, etc. Co-operation has been obtained amongst the various dental services with a proper referral system established so that patients obtain the best treatment in the most suitable way. During the year some 150 patients have been referred to the dental section for advice and/or treatment in this way. An extension during 1969 of the provision of treatment facilities for mentally disordered and physically handicapped individuals, for whom the Corporation has special responsibility to include all ages, has been approved by the appropriate ministerial departments and is now operative. The provision of such a service, which in practice is often difficult to obtain under other dental services, is a benefit to the individuals and a realistic improvement to the overall dental service in Croydon. Dental inspections Only 12 out of 144 school departments were not inspected during the year, which is the best record for some years; however, 8 of the schools not inspected were at New Addington where the treatment demand is considerably higher than elsewhere in the Borough, due to the limited general dental services in that area. Out of the school population of 50,945, some 42,032 were inspected. Dental Treatment The amount of restorative treatment has again increased in relation to the number of teeth extracted, thus continuing the trend towards conservation of the dentition which has been emerging.over the past few years. The number of fillings has increased by 11.8% and root fillings by 34% over the 1968 figures. There is also a slight increase (134 - 2.7%) in the number of teeth extracted; however 301 teeth were extracted under general anaesthesia for patients referred from other dental services. In 1965 for every 100 teeth filled 47 were extracted In 1967 for every 100 teeth filled 30 were extracted In 1969 for every 100 teeth filled 27.5 were extracted. Dental Health Education With the continued invaluable assistance from the Health Education section the programmes have been extended. The implementation of project participation dental health education in primary schools has started with the active support of the educationists. The teachers and children choose and manage their own projects on dental topics, with advice and guidance frorr. the dental section as necessary, thus finding out about teeth and dental health for themselves. As in previous years the student hygienists from the Royal Dental Hospital have visited infant and junior departments to talk on dental health and demonstrate oral hygiene procedures. 24 During November and December a pilot study was undertaken to see if it is possible to evaluate the effectiveness of dental health education over a period, and also if the present dental message is understood and correctly emphasizes the important factors for good dental health. For instance it appears that the oral condition often receives reasonable attention during the 'waking' hours whilst the 'sleeping' hours are largely ignored in many cases. Staff There were various staff changes during the year which were disturbing for both the patients and the section; however as we go into 1970 it is pleasing to report that the dental section appears more settled with a full establishment of staff. On taking up his appointment in January the Chief Dental Officer was appointed an honorary senior demonstrator in children's dentistry at the Royal Dental Hospital, thus continuing his connection with this teaching hospital. Mr. Bell was appointed as Senior Dental Officer in February and continues his appointment in the children's dental department at King's College Hospital. For the first time a Dental Auxiliary was appointed; these girls are qualified by a special two year course and work under the supervision of a registered dentist. They are trained and skilled in the routine treatment needs of children's dentistry, and the addition of an auxiliary to the staff at the New Addington clinic will help to meet the demand for treatment in this area. Four dental officers attended post graduate courses on different aspects of dentistry, which were of value not only to the officers themselves but to the section generally; whilst the Chief Dental Officer attended two useful conferences. Attendance at these courses and conferences enables the maintenance of an efficient and up to date dental service. Quarterly staff meetings of dental officers have been started this year, at which any problems arising from dental treatment or the service can be discussed with advantage. The dental staff have worked well and efficiently and I would like to thank them all, and particularly Miss Jager, for their help and co-operation in my first year at Croydon. My thanks also go to the administrative staff of the Public Health Department for their advice and guidance during my initiation into the local government service. Dental statistics will be found on Page 62. 25 ENURESIS CLINIC I am grateful to Dr. Margaret White for the following report:- During 1969, 289 children attended the three Enuresis Clinics in the London Borough of Croydon. This was ten more than in 1968. The numbers were up at both the New Addington and Purley Clinics, and slightly down at Lodge Road Clinic. We are fortunate that with the increasing availability of the electric buzzers, 113 children were able to benefit from their use, compared with 90 last year. Though the relapse rate on the buzzer is slightly higher, it is a quicker method than the use of tablets, and the most valuable method . for the older children. Eight children were referred to the Urologist but in no case was anything found. Four children were referred to the Child Guidance Clinic because they and their parents needed psychiatric help. In these cases the enuresis was accompanied by other symptoms, such as stealing, encopresis, temper tantrums, etc. SCHOOL EYE CLINICS I am grateful to Dr. Derek Clarke for the following report:- The School Eye Clinics at Purley, Sanderstead and New Addington are held regularly for examination and treatment of children from infancy to school leaving age, and receive referrals from general practitioners and Local Authority Staff. Statistics are shown on page 63. When necessary (e.g. cases requiring surgical treatment) children can be referred onwards from the School Eye Clinics to the Hospital Eye Service, and in many cases the treatment is shared. The type and number of eye defects referred from Routine Medical Inspections at School reflect the value of the latter in this respect alone. The number of boys attending was, as always, about double the number of girls. Total Attendance 289 Boys-185 Girls-104 Still Attending 110 Discharged Dry 95 Discharged for Non-Attendance 33 Left District 4 Lodge Road Clinic 155 New Addington 74 Purley Clinic 60 Referred to Urologist 8 Referred to Child Guidance Clinic 4 Used Buzzer 113 Age (Years) 4 5 6 7 8 9 10 11 12 13 14 15 16 Number in Group 3 21 62 48 58 35 26 9 13 5 5 3 1 26 HEALTH EDUCATION IN SCHOOLS Miss D.S. Elliott, S.R.N., H.V. Cert., D.H.E. Principal Health Education Officer Secondary Schools Health Education in school programmes increases in volume, variety and flexibility. The Community Health Course, now established in over half the Secondary and Grammar Schools was revised again bearing in mind trends in C.S.E. and '0' level courses. With the approval of Croydon School Inspectors at a meeting in April suggestions for further discussion and integration of the topics into other subjects in the curriculum were included in the Course. (See appendix P. 70 ). In July teachers with whom the Health Department's staff were working were invited to an informal meeting in the Health Education Section to look at the new outline of the course, to exchange views and information and make recommendations for the coming academic year. This was a useful meeting but they felt that help was still needed from the Health Department's staff and were anxious for the present arrangements to continue. Some Illustrations of Variation in the Community Health Course 1. Lanfranc Secondary Girls' School Fourth year girls (Newsom) completed the Community Health Course in one term. The excellent partnership between form mistress and health education officer so stimulated their interest in child growth and development that the course was extended another term so that the subject could be studied in depth. As part of this study, visits were arranged to various organisations with the generous co-operation of the staff responsible, The girls took an active part in helping in child health centres, toddlers' clinics and various infant school classes, including tne units for partially hearing children, where they helped with extra reading and with the class generally during audiology tests. Two sessions were also spent in the Health Education Section using equipment unavailable in schools. At the end of the year the class organised a health education exhibition as part of the school Open Day for parents during which the exhibits were explained with great confidence by the girls themselves. Points of interest from this course were:— a) During the longer period the pupils had grown and matured and began to see the relevance to themselves of the content of the course. Their behaviour and appearance improved. b) They were helped when teachers and public health staff involved them and regarded them as useful and necessary in the running of the class or clinic rather than allowing them to be passive observers. 27 c) It was found the greatest benefit on both sides was obtained from four to five consecutive visits to a school or clinic. Familiarity with children, staff and equipment increased confidence and interest. d) The optimum numbers of girls per visit was found to be three or four i.e. one or two able girls with one or two less able girls. e) It was important for the form mistress always to accompany them to the organisation and to explain how long they were expected to remain. f) Careful briefing was necessary with regard to observations to be made and data to be collected. 2. Lady Edridge Grammar School Sixth form girls who had received a good grounding in the theoretical aspects of community health were given an opportunity to put them into practice. They went for five consecutive weeks to spend an afternoon helping with children's activities, some at toddlers' clinics, child health centres and others at St. Giles' School for Physically Handicapped Children. 3., Coloma Grammar School Sixth form girls have started on a course aimed at developing responsible attitudes to health in the community of which they are a part. It covers:- a) Human development — The influences of heredity and environment. Development through learning. Factors influencing safety. Prevention of disease. b) Health aspects of social problems — Living in towns - pollution, housing, mental health, old people. The age of affluence — dental health, weight control, alcohol, drugs, smoking. c) The services for health - Environmental services. Personal treatment services. Personal preventative services. d) Responsibility for health • Personal. World-wide help. Primary Schools Earlier opportunities provided impetus for health education in secondary schools, but as with all aspects of education the most effective stage at which to lay the foundations is before the age of eleven years. Experimental health education work was started by health visitors in Oval Infants and Junior Schools and by the Senior Health Education Officer in Elmwood Junior Girls' School with three classes in the fourth year. There the interest of staff and girls was stimulated by introductory sessions on topics closely related to the girls' experience i.e. taking a temperature, watching and recording growth and development of children, tasting food, responding to stimuli. Teachers and girls continued to discuss these subjects during each week and evolved ways of testing their ideas and recording their results. 28 The aim of the Senior Health Education Officer was not to impart specialist knowledge but to help teachers and girls to see the significance of everyday actions and their effects upon health. Other Activities 'Growing Up Talks' — The series of two talks to fourth year primary children and their parents continued and the need to discuss the many aspects of growing up seems to be as great as it was when the series began eleven years ago. 'Dental Health Education' - Co-operation continued with the Principal School Dental Officer as new and established schemes for dental health education in schools. (See Dental Service P. 23 ). Inservice Training - Health Visitors — The help and enthusiasm of Health Visitors and Public Health Inspectors has enabled the Health Education Section to offer and sustain a wider service to schools. This is very skilled work and only those who ask to do so take part in this aspect of health education. During the latter part of July, August and September lecture demonstration and practice talks are arranged for new members of staff. Techniques of teaching and lecture demonstrations of the talks or lessons which they may give in any particular syllabus are given and all available visual aids which might be used, though not necessarily, are properly and accurately presented. Before actually teaching in a classroom, the work is so arranged that they observe one of the Health Education Officers in the classroom situation first, noting the reaction of the pupils to the new topics. Only then do they begin to give their own lessons doing everything possible to involve the teachers who have the responsibility for supervising further work or integrating the subject matter with other studies. The Future With so many changes in syllabi and organisation in the near future the preservation of the present close co-operation and frequent consultations between Health and Education Departments will be vital. 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. 231 children were examined during 1969. The classifications arrived at, together with recommendations made, were as follows:— 29 (1) Found to be educationally subnormal: (a) Recommended for Day School for E.S.N, pupils 73 (b) Recommended for Residential School for E.S.N, pupils 4 (2) Found to be unsuitable for education in School 24 (3) Other Recommendations:— (a) Referred back to an Ordinary School 61 (b) Referred for further investigation by School Psychological Service 5 (cj Recommended for Day Special Schools for other handicaps 4 (d) Referred for Speech Therapy 6 (e) Referred for Medical Treatment 9 (f) Referred for further assessment 30 (g) Other Investigations 15 231 Awaiting assessment on 31.12.69. 34 In addition,54 intelligence tests were given to children attending St. Christopher's Special School. A further 4 intelligence tests were given to children who were about to attend St. Giles' Special School, and a further 3 children already attending St. Giles'. PHYSIOTHERAPY SERVICE Miss J. McBride, M.C.S.P., A.P.T.A., Superintendent Physiotherapist 1969 proved to be a productive year in which the changes mainly occurred at St. Giles' School, with the installation of an experienced physiotherapist in charge followed by a further two full-time therapists. This is now a highly integrated active Department, with thinkers deciding the methods and doers providing the impulse, thus allowing the fruition of many long considered plans. Communication problems in the Physiotherapy Department sorely needed to be rectified, so to this end plans were made to devise new methods of assessment, to establish regular case conferences, to summarise the spina bifida survey and to increase our role as parent-educators. Through any form of communication three bases of living are attained; firstly knowledge (through reading), secondly expression (through writing), and thirdly socialization (through the interchange of ideas). It has been found that in oral communication at weekly Staff Meetings, the opportunity always occurs to 30 pursue conversation until maximum understanding is reached. In written communication this is not so easy because instant development of an idea is lost and also one does not have the advantages of interpretation through self-expression. Therefore it was decided that on the assessment sheets the written thoughts, observations and ideas must be complete, clear and factual. The new system of assessment has now been established, and comprises three main groups; chest cases, neurological cases and the spina bifida cases, and it is hoped that each child will be assessed at regular intervals. This should in no way be considered a dull mechanical task,but should be used as a tool to verify and augment the physiotherapy treatment. The multi-disciplinary case conferences have proved invaluable in demonstrating that in this specialised age, communication is as essential as the educational and medical programmes made for each child. The physiotherapists have enjoyed and appreciated the increasing co-operation of the educational and nursing staff. It has made our task of rehabilitation so much easier, and the progress achieved is outstandingly obvious. Those who have been wheel chair bound for several terms are now walking independently to lunch. These achievements do not pass unnoticed; one must pay tribute to the excellent quality of the physiotherapy and hydrotherapy now given at St. Giles' School. As a result of the spina bifida survey performed on thirteen cases at home, nothing specific materialised, but the time was not felt to have been wasted because it was found easier to plan the treatment programme having knowledge of the child's home background. Both parents and therapists felt that they had gained through an interchange of knowledge. Part of our therapists' work is the education of parents, and this has been made easier and more effective by the installation of a telephone in the Department. Parents have now become acclimatized to participating in the treatment programme and are becoming used to the more intensive care that is now given. This communication system has proved useful, too, in informing parents about other facilities for handicapped children such as riding and swimming and camp holidays. Statistics are shown on page 64. SPEECH THERAPY SERVICE Mr. J.R. Brook, Principal Speech Therapist During 1969 a total of 8,946 treatments were given by the Speech Therapy Service, although the total number of patients receiving treatment showed a slight reduction compared with the previous year. Efforts have' been made to ensure that the relatively large number of children due for a review examination were seen, and newly recruited staff were employed upon this work before the Service accepted new children for treatment. The number of review examinations has been increased with a proportionate reduction in the number of new cases accepted in 1969. The large number of 31 children who could be discharged with much improved speech has shown a marked improvement as the result of this policy, and should enable earlier attention to be given in future years to children newly admitted for treatment. The reorganisation of the structure of the Service with the appointment of three Senior Speech Therapists responsible for particular areas of the work, is already bringing significant rewards, and it is pleasing to record that the Service once again has a full complement of Speech Therapists in post. Attempts are being made to improve the proportion of children who actually receive treatment during available treatment sessions. One in every five appointments offered by the Service is not kept, and this represents a significant loss in treatment time. The improved staffing position has allowed increased attention to be given to special units. Assessment of the speech therapy needs at Coldharbour School indicated that a useful contribution could be made. Coldharbour School now has three Speech Therapists attending on the equivalent of three days a week. A policy of intelligent, continuing speech therapy has been firmly laid down. It is inherent in this policy that a slow start is made with the fullest possible assessment of the whole school situation. This will enable the Service to avoid the breakdowns which sometimes occur in this type of treatment. By arrangement with the Croydon & District Spastics Society, an assessment of the Children's Centre at Rutherford was made, and arrangements were completed for the Service to provide therapy at that Centre, subject to reimbursement, for the next two years. The West Thornton Unit continues to flourish as a successful treatment centre with four children discharged and three children admitted in 1969. Miss Fenn left after one school year as temporary teacher, and Miss Evans was welcomed back at the end of the Summer Term. Since Miss Evans' return from her year's course, it has been possible to take up a more progressive attitude to treatment methods. Existing commitments at special schools have been maintained, and the development of the Service during 1969 is providing exciting opportunities for the Service in the future. Statistics are shown on page 64. WEIGHT CONTROL CLINIC Dr. Phyllis M. Mortimer, School Medical Officer Once again two new groups of the Weight Control Clinic were started during the year, while treatment continued to be available to girls from any previous groups who still required support and advice. The general pattern of meetings remained as before: an initial weighing and discussion session, followed by some form of nutritional education activity. Experiments related to factors affecting taste sensations proved to be the most popular of these activities. 32 The results showed the same pattern as in previous years. For the first six to eight weeks there was an excellent response from nearly all the girls, this then slowed down and, while many continued with a steady weight loss until they reached their ideal weight, others remained the same or even started to put on weight again. There was a striking difference in results between the average weight loss of the 'new' groups and that of the 'old' ones, and the group discussions revealed that the majority of girls who were unsuccessful in achieving satisfactory weight loss were both low in motivation and parental support. In October it became necessary to hand over the clinic for a few months, and I am very grateful to Dr. Simmonds who kindly agreed to follow up the progress of existing patients during my absence. The girls are being offered appointments at two to three monthly intervals, and this will provide useful information about their ability to maintain progress without very frequent reinforcement of advice and encouragement. Early in the year a questionnaire was sent to all the girls wlio had attended an initial introductory session of the clinic followed by at least one further visit. It did not include any girl who was still attending the clinic, however infrequently. 84 questionnaires were sent out and, after several weeks 54 completed forms were returned plus 3 which were invalid. The questions asked and the results from these 54 replies are as follows:- QUESTION GROUP 'A' GROUP 'B' 1. Are vou still at school? Yes - 31 No-23 2. Are you keeping to a diet? Yes 25 No 6 Yes 13 No 10 3. Why did you leave our Weight Control Clinic? a) because you left school? 21 ticked (b) alone 18 ticked (a) alone b) because it was taking up too much time? 3 ticked (b) and (d) 2 ticked (a) and (d) 1 ticked (b) alone c) because your weight had got back to a satisfactory one? 1 ticked (cj alone 1 ticked (c) alone d) because you felt you could now manage on your own? 5 ticked (d) alone 1 ticked (d) alone e) because the clinic was not helping you enough? 1 ticked (e) alone 4. Do you think you still need help with your weight? Yes 15 No 16 Yes 9 No 14 33 QUESTION GROUP 'B' GROUP 'B' 5. Would you have preferred individual treatment? Yes No Yes No 4 27 2 21 6. What is your present weight? (in indoor clothes without shoes) Weight satisfactory or up to 10% above ideal calculated weight for their height and build. 7. What is your present height? (if known) 8 9 These two questions were used to calculate the present degree of obesity, using the clinic records for their build type. Weight up to 10% to 20% above ideal 10 8 Weight 20% to 30% above ideal 6 4 Estimates calculated from the Metropolitan Life Insurance Company charts (1960) Over 30% above ideal 7 2 8. Have you any suggestions about the clinic? 12 girls asked if the clinic could be held out of school hours. 5 girls also asked for an evening or weekend clinic. Also several girls in both groups who had lost weight said they felt this would have been impossible without the aid of the clinic. Finally the girls were asked their name and age. One paper was anonymous but otherwise correctly filled in and this was included, using the weight range for the upper limit of a medium frame adult. After about six months it was decided to try once again to find out the present weight situation of those who had not replied to the original questionnaire, and a new letter was sent to these girls. This stressed the importance of the information but suggested that they could reply anonymously if they preferred; a pre-paid label was enclosed to try and.encourage more replies. This time the girls were merely asked their present weight and height and whether they thought the clinic was a good idea. There were ten valid replies (none anonymously) and one form was returned with the information that the girl had emigrated. The results were as follows:- Weight now satisfactory or less than 10% above ideal - 4 Weight now 10% to 20% above ideal - 3 34 Weight now 20% to 30% above ideal - 2 weight now over 30% above ideal - 1 Without a complete follow up picture one cannot compare these results with any other long term survey. However it is interesting to see that, even if all those who did not reply are now grossly overweight, there still remain the 21 girls whose weight is reasonably satisfactory. Although this represents only a 25% "success rate" on follow up, this is still more encouraging than other investigators have found, and shows the advantages of this approach to the treatment of the overweight schoolgirl. Weight Control Clinic Dr. W. Simmonds, School Medical Officer During the past year I have discharged a number of boys from the Clinics when I found that neither they nor their parents had any interest in controlling the boys' weight. As a consequence those remaining have more incentive, and I have more time to deal with the problems of those who want to lose weight but are unsuccessful. It has been gratifying to have been able to discharge other boys from the Clinic because they had become too thin. They are always told that they can attend again if the improvement is not maintained. 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 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 34 such children during the year. 35 Convalescent Treatment 12 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. Details of the diagnosis and periods of stay are shown in the accompanying table. Diagnosis No. of Children Period of Stay Diabetes 3 2 weeks Bronchial Asthma 2 (Austria) 3 weeks Epilepsy 2 2 weeks Physically handicapped 1 2 weeks General Debility 2 2 weeks Emotional Disturbance 1 2 weeks Recurrent Tonsillitis 1 2 weeks Total: \2_ Juvenile Employment Return The following numbers of children were examined by the medical officers during 1969 as to their fitness to undertake the part-time employment indicated. 1969 1968 1967 Delivery of Goods for Shopkeepers 7 10 28 Delivery of Newspapers 463 176 213 Delivery of Milk 4 6 6 Shop Assistants 62 106 65 Others 14 - - Total 550 298 312 Provision of Milk and Meals During 1969 milk was supplied free of charge to all maintained primary schools and approximately 27,885 primary children in these schools received one third of a pint each per day. This was equal to 90% of children attending junior schools and 97% in infant 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 to children daily during 1969 was approximately 32,800. Cost of Milk and Meals Milk and Meals cost £982,150. Income from payment for meals was £392,335, making a net cost of £589,815. 36 Causes of Death in School Children 1969 (uncorrected) Accidental 5 Cancer 2 Leukaemia 1 Fibrocystic disease 1 Emphysema 1 Encephalitis 1 Meningococcal Septicaemia 1 Otitis Media 1 Total 13