AC-4331 ackid CR072 PUBLIC HEALTH IN CROYDON 1970 PUBLIC HEALTH IN CROYDON 1970 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1970 3 HEALTH AND PUBLIC SERVICES CONTROL COMMITTEE 1970 *Alderman Keith Edwards (Chairman) Councillor B.H.Rawling (Vice-Chairman) Alderman A.V. Dammarell Alderman B.C. Sparrowe Councillor Mrs. N.B. Booth Councillor A.E. Buddie Councillor Mrs.M.E. Campbell Councillor J.G. Davies Councillor Mrs. D.C.H. Hobbs Councillor C. Johnston, A.I.S.T..M.R.S.H. Councillor C.E. Kelly Councillor R.W. Kersey. B.Sc. Councillor G. Levy Councillor Miss I.S. Rodda Councillor W.E. Ross Gower, B.E.M. Councillor Mrs. B. Saunders *Councillor R. Tilbury, J.P. Councillor H.G. Whitwell P.S. Boffa, Esq.,M.D. G. Hirst, Esq.,M.A.,M.B.,B.Chir. J.C. Miller, Esq., F.R.C.S., F.R.C.O.G. 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 M.E. Lambert, 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. W. Patterson, Esq., M.P.S. Local Medical Committee Croydon and Warlingham Park Group Hospital Management Committee Royal College of Nursing Royal College of Midwives Family Planning Association 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) *Note: On 9th November 1970, Alderman Edwards resigned the Chairmanship and Councillor Tilbury was appointed to succeed him. 5 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1970 To the Chairman and Members of the Health and Public Services Control Committee. ladies and gentlemen. In accordance with statutory requirements I present this report for 1970 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 again slightly lower than in the preceding year. There was a small increase in the infant mortality rate, due mainly to a sharp rise in deaths of illegitimate infants. However, the percentage of illegitimate births fell from the record of 11 in 1969 to 9. There was no death of a mother in childbirth, but 1 death from abortion. In comparison with 1969 the general death rate was lower, the number of deaths from lung cancer in men unchanged, and for women fewer. In general terms 1970 was an average good health year. Health Centres The difficulties associated with the adaptation of the Parkway Clinic were not resolved until late in the year, when a revised building tender was accepted. It was hoped that the Centre would begin operating in 1971. The purchase 6 of the South Norwood site was concluded, and active planning proceeded. This very slow progress has advantages in learning from the difficulties of other areas, but raised problems for the general practitioners concerned with their existing premises and the future oftheir partnerships. Requests were also received from additional family doctors for the use of the Rectory Park Clinic, but it was not possible to suggest adaptations of the existing building within the present site which would allow its use as a Health Centre. The Domiciliary Nursing Team Attachment and liaison schemes with general practice made steady progress. Dealing only with applications from family doctors has allowed a useful comparison of work loads on which the Chief Nursing Officer . comments. She also reports the successful introduction of other grades of nursing staff within the domiciliary team, as authorised by a new establishment. After some doubts about the feasibility of attachment and liaison schemes in urban areas we are now convinced that they ensure a better service for the patient, a favourable response from the general practitioner, and a greater job satisfaction for nursing staff. It is anticipated that all District Nurses and the majority of Health Visitors will work in attachment or liaison by 1972. Care of Pre-School Children. Nursery Groups and Child Minding continued to increase. Access to mothers with children in such units for group health education is mentioned by the Principal Health Education Officer. In the discussion on the merits of pre-school provision, the benefits to mothers of some relief from the continuous responsibility of constant infant care may be overlooked. By such relief pre-school facilities can help not only the developing child, but can improve the quality of essential maternal nurture. The building of the new Corporation Day Nursery was commenced and the Play Room at the Lodge Road Clinic accepted children with social needs outside the actual hours of Clinic attendance. It has proved a most useful provision under the urban aid scheme, but unfortunately other recommendations to assist the Play Group movement could not be accepted in the year under review, for such financial help. Mental Health The scheme to establish joint hospital and local authority Mental Health Centres serving all parts of the Borough was fulfilled. As indicated later in the Report a system which allows full use of existing medical knowledge and is ready for any new discoveries in clinical care has been established in Croydon, with a full range of supporting facilities. Unfortunately there are many forms of mental illness which do not respond to known methods of treatment. Pending successful research, patients and their 7 relatives will need help and support for which demand is virtually limitless, and is finally controlled by the extent of financial resources. With such a burden to sustain it is clearly imperative to avoid any unnecessary duplication, and an integrated service which co-ordinates the efforts of all concerned is essential. Health Education There is no easy method of instant health education, and while the Principal Health Education Officer describes some new aspects of her section, it is the pattern of routine work which really achieves results. The resurgence of interest in the effect on health of environmental factors which are amenable only to action by the whole community is welcome, but does not lessen the vital need for individuals to preserve and promote their own fitness by personal efforts. Health education can seem an unrewarding task, especially since excessive zeal which results in rejection of, sometimes unpalatable advice, must be avoided. Clean Air The mild winter made unnecessary the partial suspension of orders to meet the expected shortage of smokeless fuel. It is hoped that no setbacks will prevent the completion of the scheme to apply the Act to the whole of the former County Borough area. There can be little doubt that the Clean Air Act has fulfilled all the promises made for this first stage of controlling air pollution. I trust the scheme will apply to the whole of the London Borough, and that national legislation will eventually review the possibility of reducing the invisible pollution of urban atmospheres. Home Helps Miss Heath, who developed this service in Croydon following her appointment as Supervisor in 1952, provides her final report having decided not to transfer to the new Social Services Department. Her departure is much regretted as she was a devoted and highly successful organiser. Health Services Co-ordination In many previous reports I have mentioned success in co-operative schemes in Croydon which combine the three existing branches of the Health Service. New legislation forecast during the year seeks to ensure a statutory basis for such co-ordination. However, it does seem that similar techniques will be needed in the future for co-operation with Departments of Social Service, and every effort was made in 1970 to continue and strengthen existing joint enterprises to withstand possible future disruptive changes. Ac know ledge me nts Firstly I must express to Members of the Committee, and especially to the Chairman, my appreciation of their patience and understanding during a period 8 of change divesting them of services which they have often pioneered and always supported and fostered over many years. My thanks are also due to Chief and other officers of Corporation departments, statutory and voluntary organisations, for much advice and help. Officers of the Department have throughout the year given of their best, despite the worries of yet another reorganisation, so that to their great credit services have continued and developed without any interruptions. Preventive and community medicine will be of increasing importance in the promotion of public health in future years, and it is hoped that it will remain with, or eventually return to, local authority control where it rightfully belongs. I am, Yours faithfully, S.L. WRIGHT, Medical Officer of Health and Principal School Medical Officer. STATISTICS 11 SUMMARY OF STATISTICS FOR 1970 Area, 21,395 acres. Population (Census 1961). 327,239 Total population (estimate of Registrar General) 327,180 (Midsummer, 1970) Number of Domestic Dwellings; 106,870 Rateable Value of Borough 1970 as from 1.4.70 £21,963,943 Product of a Penny Rate, for London Borough of Croydon purposes, £93,000 Mixed Rate in the £. 67p (for the year 1.4.70 to 1.4.71) Live Births Males Females Total Legitimate 2,434 2,426 4,860 Illegitimate 233 265 498 5,358 Illegitimate Live Births per cent, of total live births 9.0 Live Birth Rate (as adjusted by comparability factor 1.02) 16.7 (England and Wales) 16.0 Stillbirths 60 Stillbirth rate per 1,000 total (live and still) births 11 (England and Wales) 13 Total Births (Live and Still) 5,418 Infant Deaths 92 Infant Mortality rate per 1,000 live births 17 (England and Wales) 18 Infant Mortality rate per 1,000 legitimate live births 15 Infant Mortality rate per 1,000 illegitimate live births 36 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 12 (England and Wales) 12 Early neo-natal Mortality rate (First week) per 1,000 total live births 11 (England and Wales) 11 Perinatal Mortality rate (stillbirths + deaths during the first week) per 1,000 total live and still births 22 (England and Wales) 23 Maternal Deaths (excluding abortion) Maternal Mortality rate (including abortion) per 1,000 total live and still births 0.18 Deaths, 3,833 Death-rate per 1,000 of the estimated population 11.7 (England and Wales) 11.7 Death-rate (as adjusted by comparability factor 0.90) 10.5 12 Marriages The number of marriages solemnised in 1970 in the Croydon Registration District was as follows:- Church of England 1,030 Nonconformist Places of Worship 583 Register Office 1,285 When supplying these figures Mr. Davies, the Croydon Superintendent Registrar, kindly analysed recent trends and commented "Of the total number of persons giving notice of intention to marry during the year,6.4% were minors compared with 19.8% in 1969 and 23.72% in 1968. The dramatic drop in the number of marriages of minors was brought about by the introduction on the 1st January, 1970, of the reduction of the age of minority from 21 years to 18 years under the Family Law Reform Act of 1969. Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,735 34 3,769 Doctors 952 17 969 4,687 51 4,738 Accommodation for Confinements The following table shows where babies were born in the Borough of Croydon during the whole of 1970. 705 residents had babies outside Croydon and 75 non-residents were confined in Croydon. Number Percentage In Private Houses In Public Institutions In registered Maternity Homes 1,017 3,677 44 21.5 77.6 .9 Total 4,738 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 1970 may be regarded as satisfactory. Incidence 74 cases of Respiratory Tuberculosis and 12 cases of Non-Respiratory Tuberculosis were notified on Form A during 1970 (Table 1 - Formal Notifications). Of these 47 males and 27 females were Respiratory cases and 6 males and 6 females were Non-Respiratory. In addition 28 Respiratory cases and 2 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 1970 by notification or otherwise was 116. 102 of these were cases of Respiratory Tuberculosis; 60 in males and 42 in females. There was one case of Non-Respiratory Tuberculosis among children under 15 years. The number of cases in adults was 13. The incidence rate of Tuberculosis, all forms, was 0.35 per 1,000 of the population, for Respiratory Tuberculosis 0.31 and for Non-Respiratory Tuberculosis 0.04 per 1,000 population. The notification rate was 0.26 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31 st December, 1970 RESPIRATORY NONRESPIRATORY Males Females Total Males Females Total Total Cases 625 461 1.086 60 87 147 1 ,233 In 1970 the death-rate from all forms of Tuberculosis was 0.02 per 1,000 population. The rate from Respiratory Tuberculosis was 0.02 and the rate for NonRespiratory 0.00. In 1970 the total number of deaths was 9. 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 140. 16 Deaths from Non-Respiratory Tuberculosis During 1970 one death was certified to be due to Non-Respiratory Tuberculosis. Co-ordination with the Health Department During the year 20 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 31 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 1,705 new cases were examined during the year. 76 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 14,626. The Clinic doctors paid 214 home visits and the Tuberculosis Visitors 3,215 visits for Clinic purposes. In addition the Tuberculosis Visitors made 116 primary visits for the purposes of the Notification Register. There were also 1,010 ineffective 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 4,476 Number of patients recalled for examination and large film 426 Number of active cases of Pulmonary Tuberculosis found 14 Number of cases of lung cancer found 25 Contact Examination During 1970, 338 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 20 compared with 0.35 per 1,000 of the general population. In addition two were found to be tuberculous who had been under observation from previous years. B.C.G. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1970 and regular sessions were held at the Clinic for this purpose. 376 17 contacts were successfully vaccinated during the year. In addition 16 nurses and domestics were successfully vaccinated, and 48 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 3,726 Number found to be negative 2,988 Number vaccinated with B.C.G. 2,983 For detailed figures see Appendix page 140 AFTER-CARE OF THE TUBERCULOUS PATIENT In 1970 practical assistance, advice and support have again been given to the tuberculous patient As in previous years, guidance has been needed regarding claims for Sickness and Supplementary benefits and for Earnings Related Supplement. In addition to statutory grants some patients who are living on a low income have received help from other sources. £525 allowed by the Public Health Department for milk has been used to supply about 30 tuberculous patients with one pint of free milk daily. The Croydon Care Committee has given valuable aid particularly in the form of help with heating costs and so has eased a problem which worries many patients during the winter months. At Christmas the Care Committee issued grocery vouchers to the value of £120. for distribution amongst needy patients attending Croydon and Purley Chest Clinics. A mother of a family may refuse treatment unless adequate home arrangements can be made, and so it is important to have the co-operation of the Home Help Service and the Children's Department. In 1970, this cooperation has again been given, thus helping certain patients to accept and to continue the treatment recommended. The District Nurses, too, have given their assistance with after-care needs. When fit enough to return to work many patients can resume their previous employment. Sometimes, however, in view of the nature of their work, they have to find alternative jobs. The Disablement Resettlement Officer gives all guidance possible regarding suitable employment but, as in recent years, there is still difficulty in placing the frail man in light work. Some patients, who are unfit for work have been attending the Occupation Centre whilst others, who are housebound, are having occupational therapy at home. A patient often feels worried and bewildered when hearing that he has tuberculosis and needs help and advice, not only immediately, but in the months to come. During 1970 the after-care required by the tuberculous patient has continued. 18 OCCUPATIONAL THERAPY The Chest Clinic Occupational Therapy Department has been kept busy in 1970. Of the new patients visited some were short term but most were long term cases who find that time hangs heavily at home and look for new interests and outlets. These patients are pleased to be taught something new to do and in some cases to go to Social and Work Centres when the weather permits. Craftwork has been of a high standard and we have had a steady demand for our products throughout the year. There was no Christmas sale this.year as we did not have enough articles left to sell. The main interest has been canework which the patients enjoy doing especially since we changed to the use of plastic cane which is more pliable and does not need to be kept damp. This enables the patients to work in their warm rooms without the inconvenience of trailing wet cane backwards and forwards from the colder kitchen. This year we have also had one or two keen rug makers and stool seater but these crafts are not suitable for the more frail patients. 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 136. 19 COMMUNICABLE DISEASES Measles There were fewer cases notified than in 1969, but as it was a nonepidemic year the actual figure made it clear that vaccination was not eradicating this infection. Efforts to improve acceptance were initiated in anticipation of the increased prevalence due in 1971. The control of less serious illnesses by active immunisation is always difficult as the case for vaccination is less impressive, and it is essential not to exaggerate to parents, risks and advantages. However measles vaccination does seem to have achieved not only a significant reduction in the number of cases of measles, but it has spread them throughout the year and thus avoided the peak demands on medical services and the disruption of schools formerly occasioned by massive outbreaks concentrated during the winter months. There were no cases of Diphtheria or Poliomyelitis, despite the reappearance of the former disease elsewhere. The single case of typhoid fever was associated with infection acquired abroad, and two cases of paratyphoid fever were infected on holiday away from Croydon. Sexually Transmitted Diseases As judged by aggregate figures of the clinic at the Croydon General Hospital and returns from the major treatment centres in the London area, there was a small increase in the number of cases of gonorrhoea, and a fall in those due to syphilis. "Other conditions" which may include non specific infections difficult to cure increased sharply in comparison with former years. Contact tracing was carried out by the staff of the department in response to requests from the treatment centres. The usual posters were exhibited, stressing for those who may be infected the need for diagnosis and effective treatment, and detailing the centres where this is available. The risk of contracting such illnesses from promiscuous partners is included in our general health education programme to older school children. Following the pattern of this comment the subject comes within the general heading of communicable diseases, with the necessary emphasis that avoidance of this group of infections rests largely with the individual. For detailed table of Communicable diseases see Appendix, pages 133 and 142. Immunisation The timing and schedules remained unaltered, and programmes were unchanged. Computer facilities were still not available, but acceptance rates were slightly increased. In November vaccination of schoolgirls in their 14th year of age against Rubella was commenced. This is a new departure since protection rs not for the benefit of the individual vaccinated, but for children who may subsequently be conceived. It seems a rational procedure but confirmation must await future results. 773 girls were vaccinated against rubella in 1970, without any significant reactions being recorded. For other figures see Appendix page 137. PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 23 ANTE AND POST NATAL CLINICS The unified hospital and local authority services at the Lodge Road and New Addington Clinics continued unchanged. The former premises have been extended and altered on several occasions during the last 20 years. The latest addition of a playroom for the children of mothers attending clinics is described by the Chief Nursing Officer. It was a most successful project under the Urban Aid Scheme. Ante-natal clinics despite appointment schemes have peak attendance periods when otherwise adequate accommodation seems insufficient. No adaptations at Lodge Road will cope easily with this problem, and long term plans envisage a unified obstetric service in a new maternity wing of the district hospital. Since this should be forthcoming during the present decade it is unreasonable to propose any major development on the Lodge Road site, and the best use of existing premises is inevitable. Attendances during the year were:— Ante Natal 5,303 Post Natal 909 No. of patients seen for first blood test 3,445 No. of patients found to have antibodies 37 No. sent to Special Clinic 9 The numbers attending the Relaxation and Mothercraft classes increased again in 1970 - Midwives, Health Visitors and Physiotherapists continue to work together and combine to provide this service. In all 1,273 mothers attended these classes and made 5,872 attendances. PAEDIATRIC ASSESSMENTS The co-ordination with the Maternity units was strengthened by the successful experiment of a Corporation Senior Medical Officer attending at the hospital for 3 sessions each week for the pre-discharge assessment of newly born babies. This linkage of the Child Health and Hospital Paediatric services was placed on a permanent basis during the year under review, when 1,212 babies were so examined. Obviously appropriate action is taken forthwith if this is necessary, but routinely the results go forward to the Health Visitors and the Medical Officers of Child Health Centres concerned with the further developmental assessment of the children. 24 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 cost 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:367 cases were dealt with by the social workers. 35 girls were admitted to mother and baby homes. 35 girls were financially assisted by the Local Authority. Ages of the younger mothers when they applied for help. Age when baby was born 12 years old — 12 years old — 13 " " — 13 " " — 14 " " 4 14 " " 2 15 " " 12 15 " " 9 16 " " 3 16 " " 6 17 " " 27 17 " " 25 18 " " 57 18 " " 45 Total 103 19 " " 13 Total 100 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 102. 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 97 babies with congenital conditions was notified in 1970. For details see Appendix, page 108. 25 Child Health Centres. The demand for these services which comprise the education of parents, developmental assessment and immunisation of children has fallen again this year. No doubt this is due in part to the increase of health visitor attachment to general practitioners who are running their own well baby clinics. One new child health centre was opened to help the need of the developing Sylvan Estate and this is proving successful. For detailed figures see Appendix page 114. Welfare Foods and Medicaments There were no changes in the general arrangements to sell national dried milk. Ministry of Food vitamin preparations, and a proprietary vitamin A & D concentrate at Child Health Centres. The W.R.V.S. moved their central Croydon headquarters but maintained their service of selling these products each day from their new offices. For detailed figures see Appendix, page 108. 26 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. Chief Nursing Officer The year under review has again provided a challenge to the nursing section. In keeping with progressive trends in domiciliary care attachment of nursing teams to general practitioners has resulted in a better doctor/ nurse/patient relationship. The number of staff working in Group Attachment schemes has increased particularly in the Home Nursing Service where attachment is easier. An increasing number of nurses are holding sessions in General Practice Surgeries, treating patients they would otherwise have to visit. During the year agreement was reached with Surrey County Council for attached Nurses and Health Visitors to work either side of the Borough boundary and in the north of the Borough a Health Visitor attached to a group of Doctors in the London Borough of Lambeth crosses into Croydon. Improved liaison with the medical and nursing staff of Mayday Hospital has resulted in more planned early discharges to the Midwifery and Home Nursing services and provided for a wider use of home nursing skills. A group adviser in the Health Visiting service acting as a liaison officer with the Paediatrician, Paediatric Ward Sister and Medical Social Worker has proved a worth-while appointment. Day Nursery Service Each year there is a heavy demand for Nursery Nurse training and 1970 was no exception. Whitehorse Road Nursery has three work based students each year and selecting them from the flood of worth-while applicants is a difficult task. Because of the increasing demand for Nursery Nurses, a College based course of Nursery Nurse training was started by Croydon Technical College. Hazelglen, the day nursery in Sanderstead, was approved for training purposes and two College based students started practical training there in October. For training purposes the Nursery is linked with a nearby Nursery School. The nursery staff have found this an interesting and stimulating experience. This nursery operates in a delightful house full of nooks and crannies that children love. It has adapted well to family grouping which was introduced during 1970. The change from age grouping was made with relative ease and when it had been in operation only a few weeks it was interesting to note that a child who had a fall when playing in the garden went to her own Nursery Nurse for comfort and ignored staff near her. This change has provided useful experience for the new Day Nursery in Thornton Heath which should open next year, and is purpose built for family grouping. 27 The nurseries are indebted to the Chief Librarian for allowing them to borrow books. Quite young children use these books and treat them with respect and care. Members of Staff from the Children's Library visit the nurseries for story telling sessions. Another interesting venture was the provision of a Playroom at the AnteNatal Clinic. Six sessions a week cater for children of mothers attending this busy combined Hospital and Local Authority Clinic. The remaining four sessions will provide play facilities for physically handicapped, mentally handicapped and socially deprived children. The group which is staffed by a Nursery Nurse and Nursery Assistant is administered by the nearby Day Nursery Matron. It gives not only custodial care forthe children during Ante-Natal Clinic sessions, but helps the parents understand their children's needs. The Nursery Nurse has built up an excellent relationship with the mothers and finds time to answer questions about behaviour problems and give advice on suitable toys and their cost. The children now cry when collected rather than when left with the nursery group. Domiciliary Midwifery Service The total number of Domiciliary births dropped by only a small number this year and each midwife booked an average of 71.4 patients of whom 54.5 were delivered at home (see appendix page 101 ). Busy General Practitioner Obstetricians enjoy the help of a midwife at their Ante-Natal sessions and although many more would like this service their small number of bookings makes it uneconomic from the midwife's point of view. No doubt health centres will do much to ease this situation. Home Nursing Service A local survey of the day to day work of each home nurse was carried out in 1969 and repeated for comparison in 1970. Although not intended for general publication the results showed areas of work requiring further investigation and possible change. The survey suggested that 18% of the work being done by Registered and Enrolled Nurses could be adequately carried out by a Nursing Auxiliary working under the guidance and control of a Registered Home Nurse. During 1970 where appropriate and as Registered Nurses retired a Nursing Auxiliary was appointed in her place. It is interesting to note that in September when it was felt saturation point had been reached. Nursing Auxiliaries were in fact 18% of Registered/Enrolled Nurse Establishment. As a result of the survey and experience gained during 1970, a new approved establishment was agreed in October reducing the number of Registered Nurses from 60 to 48 and increasing Enrolled Nurses from 3 to 12 and Nursing Auxiliaries from 1 to 14. This new establishment gave an increased number of staff at minimal cost and provided for an improved service. 28 Health Visiting Service The difficulties in maintaining a full establishment of Health Visitors persisted during the year. In common with other women dominated professions the service suffers from staff losses due to early marriage and pregnancy. This shortage has meant that Health Visitors have carried case loads in excess of the number considered desirable. Sponsored students remain the chief source of recruitment. Six students successfully completed the Health Visitor training course this year and a further ten are currently in training. The support and guidance of newly qualified Health Visitors and of an increasing number of student Health Visitors in their last three months of practical training has increased the need for first line management staff. To meet this need two senior Health Visitors were appointed as Group Advisers, bringing the number in this grade to 3. The London Borough of Croydon continues to enjoy the services of a devoted but diminishing band of voluntary workers in the Child Health Centres, Their co-operation has enabled Health Visitors to introduce appointment systems for medical examinations in almost all centres, thus improving the quality of the services to the public. The Child-Minding service has been under considerable pressure this year resulting from an increased volume of requests for Registration and increased demands from the public for suitable day care for their children. It is with some regret that preparation has been made to pass over to the new Social Services Department this valuable service which has been closely tied to Health Visiting practice for so many years. Health visitors continue to be involved in group health education in Parentcraft classes, toddlers and mothers clubs and schools. This year a team approach to parentcraft classes has evolved with success, the physiotherapist, midwife and health visitor each bringing her own expertise to this training. A record number of attendances at these classes is noted for this year. For detailed figures see Appendix page 111. 29 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 38 cases were so dealt with, 27 women and 11 men. There were in addition, 21 cases where the patients cancelled their applications after the arrangements had been made. HOME HELP SERVICE Miss J.E. Heath, Principal Home Help Organiser "Progress therefore is not an accident, but a necessity it is part of nature." Herbert Spenser. Throughout 1970 the Home Help Service was somewhat overshadowed by April 1971 and the ensuing change loomea large in all progressive discussions. Since 1948 the service in Croydon has grown and developed like a large family, it was not subject to the sophisticated management techniques of the 1970's. It aimed quite simply to provide the right woman in the right place at the right time. Home Helps provided an economical, efficient and compassionate solution to many problems. The training programme for Home Helps was directed towards the policy of economy of time, effort and materials. No training can be devised for enthusiasm and good nature, these are natural attributes of a good Home Help. Observers from many parts of the country and overseas came to see and discuss the operation of the Croydon training scheme. The London Boroughs'Training Committee set aside one day of each group of seminars for Home Help Organisers for a visit to the Croydon training flat. In October 1970 the Chairman of the Health, Maternity and Welfare Sub-Committee presented certificates to Home Helps who had successfully completed training courses. Members of the staff of other Departments and Sections who had contributed to the training scheme were amongst the guests. One of the District Home Help Organisers was successful in the second part of the Institute of Home Help Organisers Certificate examination. She hopes to-complete the third and final part in 1971. Owing to the pressure of her duties she was unable to avail herself of the day release study time to which she was entitled. Apart from one week at a residential course she completed most of her studies in her own time. 30 A scheme for the production of time sheets and work programmes was developed by Management Service Officers. An experimental pilot project was put into operation in one area during the year. The process involved photographic reproduction and was designed to reduce the clerical time spent in rewriting weekly work programmes. The future of the Home Help Service will inevitably be based on a broader spectrum following complete integration with other services. Progress might inevitably change the appearance but the spirit of service will form the sure foundation on which all subsequent development can be built safely. In this my final report to the Medical Officer of Health I would like to express my appreciation to him and to my colleagues at all levels whoshould share the credits I was given when I left the service. For detailed figures see Appendix page 122. HEALTH EDUCATION AND HOME SAFETY Miss D.S. Elliott, S.R.N., H.V. Cert., Dip. H.E. Principal Health Education Officer Staff working in health and education services still face enormous problems in making health education effective. Enthusiasm was never more necessary, nor the need to experiment with different groups, methods and materials without being hampered by rigid patterns of thought and professional prerogatives. Parent Education (a) Parentcraft Classes for expectant parents improved in both quality and quantity and generally the teamwork approach by health visitor, midwife and physiotherapist is working well. "Fathers" sessions are included in all courses and are often supported by Health Education staff particularly where the health visitor is new to teaching. A specially qualified Health Education Officer also trains small groups of health staff in methods and techniques of teaching about family planning, now an important item in each course. (b) Toddlers' Clubs - Mothers' Discussion Groups Unfortunately frequent staff changes, a shortage of voluntary help and sometimes difficult premises reduced the groups to eight. The necessity for full involvement of parents in understanding the basic psychological, physical and educational needs of their children and themselves becomes more and more apparent to those dealing with problems at school and work. Maladjustment, smoking, drug-taking, venereal disease, overweight and dental disease are symptoms of insufficient involvement. 31 There is great improvement in health education in schools (See School Report P ) but because of the time gap between school leaving and adult practice much of the content is forgotten. Regular reinforcement of relevant topics and redirection of emphasis is necessary at intervals. The Health Education staff are exploring supplementary opportunities for educating young parents. A six weeks' pilot course was run for mothers with children attending the Jane Carrick Nursery Playgroup. These 'playgroup - linked' talks covered heredity, growth and development, communication and play (demonstrating methods with the children) home safety, sex education and other emotional problems. The role of each member of the family unit, the stimulation and reaction of one person to another and the chain reaction which can result from one small 'incident' formed the nucleus of the final discussion. Contact is being made with the Area Organiser of the Pre-School Playgroups Association, which now has a large following, offering similar courses to mothers with children attending the playgroups. (c) General Practice The attachment of health visitors, district nurses and midwives to general practice provides a new dimension and stimulus to health education. General practitioners are inevitably involved in health education during consultations with individual patients since their diseases cannot be treated in isolation from their social environment. One health visitor has an attractive display in the waiting room consisting of leaflets dealing with specific topics which are helpful in the personal health situation. "Health education, as an integral part of preventive medicine, shares with it a concern with populations and groups of people rather than individuals". (Baric). Three health visitors have also successfully established parentcraft courses and a weight control advisory service in practices. In-Service Training Help was given with a wide variety of in-service training sessions all of which either directly or indirectly had implications for the health and educacation of the public. Among them were:— 1. Home Helps (2 groups) "Supporting Services for the Family", "Cervical Cytology" and "Accident Prevention". 2. Home Help Organisers (London Boroughs' Training Committee) "Teaching and Training Methods*. 3. School Cooks and Kitchen Staff (Monthly Groups) "Food Hygiene" 4. Child Care Officers Film "John" and discussion on "Children in Temporary Care". 5. Foster Parents "Talking to Children about Growing Up". 32 6. Dental Officers "Resuscitation". 7. School Nurses "Health Education in Junior and Infant Schools". 8. Doctors and Health Visitors (Monthly) Lunch-time clinical discussions with Dr. G. Crosse, Consultant Child Psychiatrist. 9. Health Visitors "Hearing Test Techniques". 10. District Nursing Auxiliaries "Health Services", "Work of the Health Visitor", "Working in Clinics", "Normal Play". 11. Local Government Staff 2 full courses in First Aid (St. John) given by the Deputy Medical Officer of Health. 12. "Way/and" Staff "Mouth to Mouth Resuscitation". 13. Multidisciplinary Public Health Staff "Medical Management in a Local Health Authority". A course run by the Deputy Medical Officer of Health, 14. Newly Appointed Health Visitors "Health Education in Croydon". Professional Training Courses Future health services' staff need to regard health education as a constructive and integral part of their duties and not as a time-consuming 'extra', During the year the following groups visited the Health Education Section for one or more sessions:— Nursery nurses, pupil and student nurses, district nurses, midwives, health visitors, health visitor fieldwork instructors, health visitor community health tutors and health education students from:— London Boroughs' Training Committee A constant flow of visitors also came from as far away as Sydney, Johannesburg, Denmark and Sweden. Public Health Inspectors were a great help throughout the year covering many aspects of environmental health and food hygiene. Industrial Health Work on personal health and food hygiene was undertaken at Littlewoods, Grants, Marks and Spensers and the John Lewis Partnership. The Industrial Chaplain brought twelve engineering students to the Department for a discussion on the health services. Preparations were made for the first meeting after Christmas of local occupational health nurses. Croydon General Hospital Mayday Hospital Royal College of Nursing Royal College of Midwives Health Visitors' Association Croydon Technical College Chiswick Polytechnic Medway and Maidstone College of Technology London University Surrey University 33 Voluntary Organisations 44 talks on all aspects of health were also given by Health Education staff during the year and included 7 on drug-taking and 9 on accident prevention. Exhibitions Once again a forty foot marquee at the Ashburton Flower Show was devoted to topics such as accident prevention, smoking, cervical cytology, dental and other health services. All exhibits were new and involved the participation of the-public. A small stand was also designed for part of the Local Government Display at the Whitsun New Addington Show. Knowledge constitutes, partially at least, the foundation of health education and research has already shown that well-informed people are most likely to practice healthful living. 34 DENTAL SERVICE (MATERNITY AND CHILD WELFARE) J.D. Palmer, B.D.S.(Lond.) L.D.S., R.C.S.(Eng.) Chief Dental Officer The provision of free and fully comprehensive dental care for pre-school children, nursing and expectant mothers is all part of the local authority dental service about which some general comments are made in the Annual Report of the School Dental Service. If there is to be any hope of controlling dental disease in the community, it is essential to start with the very young in order to establish correct dietary and hygiene control, as well as the need for regular routine maintenance to achieve dental health. This, of course, involves their parents and also needs the co-operation and support of other health personnel, e.g. doctors and health visitors, who have greater contact with these parents. This liaison has been established and is developing well in the Borough. The importance of good dental care for the pre-school child is becoming well recognised as the cornerstone on which to build future dental health programmes. The three year old birthday card scheme, which has been running at Sanderstead for some three years, has been extended to Purley. The child receives a colourful birthday card enclosing an informative letter containing a realistic and simple message about dental care, for the parents to read and, one hopes, apply. At Waddon the idea of "toddlers parties" was successfully tried in conjunction with the Health Visitor. Two groups of young children and their parents were invited to the clinic on two afternoons, allowed freedom of the surgery, saw some dental health education films and provided with 'dentally acceptable foods' as a party tea. The 56 three year old children were all examined, of whom 15 required treatment at that time. They were given appointments, if required, or a check up arranged in four months time. All the children arrived for their appointments or check up subsequently and this idea of toddlers parties is being repeated. The amount of treatment provided for the pre-school child has shown a marked increase in 1970, with 34.6% more visits, 64.8% more teeth filled and 24.5% more courses of treatment completed in this group when compared with 1969 figures. Details of treatment see Appendix, page 124. 35 MENTAL HEALTH SERVICES Administration This remained unchanged with the Medical Officer of Health in administrative control and the Deputy and two Departmental Medical Officers approved for the purposes of the Mental Health Act. Dr. J.D.W. Fisher, Consultant Psychiatrist, Warlingham Park Hospital, and Dr. B.W. Richards, Consultant Psychiatrist, St. Lawrence's Hospital, continued as Medical Director and Clinical Adviser. The re-opening of the premises at Thornton Heath (The Oaks) as a combined day hospital/centre allowed all the Consultant Psychiatrists at Warlingham Park Hospital day hospital facilities. Every patient could thus be treated either as an in-patient or in the community as was thought appropriate on clinical grounds. Of the four combined Centres which were operating, three served populations of about 100,000 persons, and the fourth, a smaller unit, an outlying housing estate of about 28,000. A multi-disciplinary co-ordinating committee at officer level from the hospital and local authority met at quarterly intervals, but personal contacts and discussions were necessary to meet inevitable problems of the combined services. This minimum of administrative machinery was possible only because mutual trust of those involved had been built up over many years of cooperative efforts. It was not a system capable of precise definition or suitable for immediate application to other areas. In view of impending changes enforced by the Social Services Act no attempt was made to rationalize or codify, but efforts to retain the co-ordinated hospital and community service, despite new legislation, were initiated. When the statutory background has been established an administrative framework will need to be erected to lessen the reliance on personalities. Voluntary Associations The experimental scheme sponsored by the National Association for Mental Health with a grant from the King Edward's Hospital Fund was made a permanent part of local facilities by the hospital and the Corporation assuming responsibility. Mr. H. Muller became an officer on the staff of the Hospital Committee, with the local authority reimbursing 50% of the cost of the scheme. The most encouraging upsurge in voluntary help by individuals was complemented by the really close association the Mental Health Service of the Borough had with all voluntary organisations, particularly the Croydon and District Society for Mentally Handicapped Children and the Croydon Association for Mental Health, both of which have grown in strength during the year. There was also a continuing cordial relationship between the service and the Mental After Care Association, the Croydon Guild of Social Service and the Guardianship Society, to the benefit of Croydon patients. Patients continued to be sponsored for the local Richmond Fellowship hostel for alcoholics, and 4 were in residence at the end of the year. 36 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 to hospital under the Mental Health Act 1959 Males Females Total Admitted informally 41 55 96 Under Section 25 (for observation) 29 64 93 Under Section 26 (for treatment) 9 15 24 Under Section 29 (for observation in emergency) 76 108 184 Under Section 60 (Hospital Order through Court) — 1 1 Under Section 136 (Police Action) 6 2 8 Investigated but not admitted 35 70 105 196 315 511 In Netheme and Cane Hill Hospitals Mental Welfare Officers were concerned with 26 Section 25 procedures, 12 Section 26 procedures 2 Section 29 procedures, and 2 informal procedures. 1969 1970 Informal Admissions 92 96 i.e. rise of 4.35% Emergency Admissions 205 184 i.e. fall of 10.25% Investigated but not admitted 140 105 i.e. fall of 25% Total admissions under Sections 372 310 i.e. fall of 16.2% Total cases dealt with 604 511 i.e. fall of 15.3% Guardianship During 1970 the total number under Guardianship remains at 15. Training Centres - Coldharbour School This purpose built Centre in Purley Way had 119 pupils on the register at 31.12.70 and there was a waiting list. This will be resolved when the proposed new school in the northern part of the Borough is built, although by then the responsibility for both these schools will have devolved upon the local Education Committee. The parent teacher association which was formed last year, together with the Croydon and District Society for Mentally Handicapped Children, continued to take a keen interest in the affairs of the school and thanks are due to the Parent Teacher Association for the much appreciated gift of a record player. 37 A gift of £50 was received from Smith's Charity (Kensington Estate) through Alderman Monk and this was used for the purchase of a film strip projector and screen for use by the School. Day Hospital/Centres The former Day Hospital at The Oaks in Thornton Heath was again reopened as a Day Hospital in July as a joint scheme of the regional hospital board and the local authority, thus making Day Hospital provision in the four geographical areas of the Borough. Day Centre With the alternative use of The Oaks, Thornton Heath, as a Day Hospital and it having been proved possible to successfully operate a centre for more chronically disabled or elderly patients, premises for the continuation of these facilities were made available at Bensham Grove and this was opened as a Day Centre in November 1970. Residential Care (i) Temporary Care In 55 instances short term care for mentally handicapped patients was made through the hospital service, and convalescent holidays were arranged for 24 patients, and 30 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, and 10 were in residence at the end of the year. (ii) Long Term Care (a) Boarding Out Scheme During 1970, 63 patients were found lodgings through the scheme, 22 more than the previous year. Of these 41 were still in lodgings at the end of the year, 16 had moved on to other accommodation and 6 had been readmitted to hospital. A total of 100 patients was living in lodgings at the end of the year. Again tribute must be paid to the landladies who participate in the scheme and make it a successful aid to the rehabilitation of patients. (b) Group Homes In August of this year another group home was opened at South Croydon, making it possible to accommodate a total" of 44 residents in the 6 houses. 38 Social Work At the end of 1969 the number of active cases carried by the social workers was over 1,400 and represented a new high level in the history of the service. During 1970 the pressure of work increased still further and despite a number of staff changes the total work load ran at over 1,615 action cases throughout the year. The number of requests for social work assistance was also substantially greater than in any previous year and 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 was further developed whereby a number of persons can be helped together. Social workers were concerned with five such groups catering for about 50 persons and representing different categories of need. Students The Training Officer continued to supervise the practical work of student social workers in the service. In 1970 some 20 students attended for practical training and contributed to the life and work of the service. Visitors The mental health service in the Borough continues to prove a most popular source of interest to visitors from many countries, other local authorities and hospitals. THE UNIFIED INDUSTRIAL THERAPY SERVICE 1970 saw the further consolidation of this service, the focal point of which is the Crosfield factory, a sheltered workshop which was transferred to new premises in 1969. The benefits of the modern working conditions which it provides are indicated by the increase in the contract income from £48,785 in 1969 to over £71,000. In many ways it has not been an easy year and the uncertainties of the national economic situation have left their mark on the service. In particular, the resettlement of disabled persons into open employment has presented greater difficulties than at any time since the service started. Even so, the rehabilitation statistics show an improvement over 1969 and this may be due in some measure to the follow up section which has now been formed under the Unit's Welfare Officer to improve liaison with employers, to provide a ready channel of information and advice and generally make available an immediate counselling service to which the employer of any disabled person may turn if problems arise. The main Health Department Units in the service are:— 39 (i) Crosfield Industrial Unit (sheltered employment and assessment). (ii) Waylands Craftwork, Training & Social Centre (Health Wing). (iii) Cherry Orchard Advanced Adult Training Centre. Particulars about their operations follow, but first I once again record with appreciation the support, guidance and advice given by the local industrialists who make up the Crosfield Industrial Advisory Panel, the Croydon and District Society for Mentally Handicapped Children, and the Department of Employment whose officers at all levels have contributed so much to the development of Croydon's employment services for the disabled. 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. In addition to providing wage earning sheltered employment for severely disabled persons it now has an experimental industrial assessment and rehabilitation section for disabled persons, mainly mentally disordered, who may eventually be capable of open employment. This section was formerly housed in separate premises. See Appendix, page 129. 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, on a scale approved by the Corporation. Subject to places being available, children may be accepted at the full rate of £1. 8. 6d. as from 1st December, 1970. Whitehorse Hazleglen Road Sanderstead Road Details of attendances Capacity 50 30 Number on books at the end of year 50 30 Attendances: Under 2 4,097 755 Over 2 6,396 5,316 Total 10,493 6,071 Number of days opened 255 255 Average daily attendance 41.0 24.0 40 DEAFNESS Schemes for testing all infants during the first year of life, whose names were included on the "At Risk" register, were continued. This assessment of hearing ability is extended to all infants attending child health centres, and where staffing permits by home visits of health visitors. For detailed figures see Appendix, page 110. 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 four 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 1970, 29 chiropodists were operating this scheme. During the period January 1 st to December 31st 1970, they gave 22,811 treatments at their surgeries and 7,208 by domiciliary visits. 481 treatments were given at Parkway Clinic, New Addington and 329 at "Waylands". CERVICAL CYTOLOGY The number of new cases increased again this year, but it has not always been possible to reach the target set by the Regional Hospital Board Laboratory of 100 new cases per week. Various methods of publicity have been tried and the best results obtained by a system of printed post cards of various colours. The cards are identical on one side, requesting name, address, age etc. The reverse side varies according to the means of distribution e.g. cards given out by a Health Visitor or School nurse at a Medical Inspection remind the mother that her child has just received a health check and suggesting that she could also 41 benefit from having another type of examination. Another card is specifically designed to be issued to every woman attending a cytology session, asking her to pass the card on to a friend or neighbour. Other cards are for Health Visitors to use in homes and clinics, and another is for distribution in selected factories and offices. COLOUR USE NUMBER RETURNED White Cytology Sessions 902 Green Health Visitors 689 Pink School Medical Inspections 121 Yellow Selected Factories/Offices 50 For detailed figures see page 126. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 45 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 1970. Housing work continued to account for a large proportion of the time of the general inspectorate with special emphasis on the inspection of houses in connection with applications for Improvement Grants and/or Qualification Certificates. This latter work is carried out in close liaison with the Borough Valuer. During the year, Demolition Orders or Closing Orders were made in respect of six houses, and Closing Orders were made in respect of two basements. Two Clearance Areas, comprising thirty-one houses, were withdrawn when agreement was reached for purchase of the properties by the Council. In a town the size of Croydon, where large scale shop and office development has taken place, the significance of the Offices, Shops and Railway Premises Act, 1963, looms large in its application to such premises. With a comparatively small staff in relation to the size of the problem, a lot of good work has been done, although it will be a very long time before complete coverage has been effected over the Borough. More detailed comment is made in the body of this report. The Pest Control staff of the Department has been greatly strengthened by the appointment of a Pests Officer and the transfer of a general assistant to rodent control. By this means the staff is now able to deal with a wider range of pests including foxes, which infest certain parts of the Borough and become a hazard to small livestock.Some success has already been recorded in this direction. The increasing incidence of food poisoning cases points to the need for continued vigilance in this sphere of food hygiene, and during the year a determined effort has been made to enforce the provisions of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 in respect of itinerant food traders frequenting the vicinity of the Crystal Palace Football Ground and the Town Centre. With the willing co-operation of the Police, considerable success has been achieved. Translation of food hygiene posters into different languages has proved helpful to local immigrant traders and food handlers and enquiries in regard thereto have been received from about twenty local authorities in different parts of the country. It is satisfactory to record the continuation of the Borough's Smoke Control policy with the making of Smoke Control Order No.13. Only one more Order is necessary to complete the original programme covering the area of 46 the former County Borough. It is hoped that during 1971 a further programme will be placed before the Council for approval which will provide for similar control, over a period, of the area formerly comprising the Coulsdon and Purley Urban District. In July 1970 the Ministry of Housing and Local Government issued a circular indicating that supplies of solid smokeless fuel may be short in some parts of the country during the winter of 1970/71. The Minister stated his willingness at short notice to make orders suspending the operation of Smoke Control Orders in respect of particular smoke control areas or groups of such areas in the light of requests from local authorities. Consultation with the Solid Smokeless Fuel Federation was advised. After studying the position a working party appointed by the London Boroughs' Association advised the suspension of existing Smoke Control Orders throughout Greater London to the extent of 40% of the properties covered by such orders for the period from 1st November, 1970 to 31st March, 1971, Local Authorities were advised accordingly. In the light of this advice the Council applied to the Minister to suspend for the period mentioned Smoke Control Areas 1 to 5 plus portions of abutting Smoke Control Areas and the Orders were made in due course. Happily there appear to have been no serious repercussions from this action and little or no increase in smoke pollution has been noted due no doubt, to a large extent, to the very mild winter experienced. In concluding this introduction to the report I should like to express my appreciation for the support and encouragement of the Chairman, Vice-Chairman and the members of the General Services Sub-Committee, the guidance and confidence of Dr. S.L. Wright, Medical Officer of Health and the very willing help and loyalty of the whole of my staff. 47 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) - 5,561 (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 - 31 (b) Other than in Clearance Areas - 6 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 647 3. Action under Statutory Powers during the year (a) Proceedings under Sections 9, 10, 12 and 170 of the Housing Act, 1957:- (!) Requisitions for Information as to ownership - 712 (ii) Number of dwelling houses in respect of which notices were served requiring repairs - 347 (ii) Number of dwelling houses which were rendered fit after service of formal notices (a) By owners 223 (b) By Local Authority in default of owners 29 (b) Proceedings under the Public Health Acts - (i) Requisitions for information as to ownership 318 (ii) Number of dwelling houses in respect of which notices were served requiring defects to be remedied - 489 (iii) Number of dwelling houses in which defects were remedied after service of formal notices (a) By owners - 275 (b) By Local Authority in default of owners - 205 (c) Proceedings under Sections 17 and 23 of the Housing Act 1957 - (i) Number of dwelling houses in respect of which Demolition Orders were made - 1 48 (ii) Number of dwelling houses demolished in pursuance of Demolition Orders - 9 (iii) Number of dwelling houses in respect of which Closing Orders were made - 5 (d) Proceedings under Section 18 of the Housing Act, 1957 (i) Number of separate tenements of underground rooms in respect of which Closing Orders were made - 2 (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit - 3 4. Houses in Multiple Occupation - (i) Number of Houses in multiple occupation inspected during the year - 196 (ii) Number of houses in which defects were remedied following service of formal or informal notice under Section 9, Housing Act 1957 - 103 (iii) Number of houses in which additional amenities were provided following service of formal or informal notices under Section 15 of the Housing Act 1961 . 107 (iv) Number of houses in which fire prevention works were completed following service of formal or informal notices under Section 16, Housing Act1961- 119 5. Housing Act, 1969 During the year 1,738 applications for improvement Grants and/or Qualification Certificates were considered, in conjunction with the Borough Valuer, and 1,847 visits of inspection were made to the Houses concerned. 6. Rent Act, 1957 - Certificate of Disrepair - (i) Number of applications for certificates - 5 (ii) Number of certificates issued - 5 (iii) Number of applications by landlords for cancellation of certificates - 5 (iv) Certificates cancelled - 5 49 DRAINAGE 2,619 visits of inspection were made to premises where underground drains were in course of repair. 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. PEST CONTROL During the year the Ministry of Agriculture, Fisheries and Food ceased to undertake the destruction of foxes which have now become common in suburban areas where they have access to a varied supply of food. Opinions differ on the subject of the fox as a pest but it is generally accepted that some control is necessary to limit their numbers and such measures are now the responsibility of this Department. A Pests Officer was appointed during the year and he will undertake the destruction of Foxes and also supervise the destruction of rodents and other pests. In an area the size of Croydon the control of rat and mice infestation requires the constant efforts of field staff in order to deal effectively with known infestations and during the year the three full-time Rodent Operators made more than 13,000 visits to premises to carry out treatment. The Prevention of Damage by Pests Act requires the occupier of any premises to notify the Local Authority if such premises are infested with rats or mice and 2,871 such notifications were received during the year and in 2,516 cases the premises were found to be infested. Mice infestations have sometimes proved to be difficult to control as this rodent has developed a degree of resistance to the poison "Warfarin" thereby invoking the use of more acute poisons which are less attractive to the mouse. The Ministry of Agriculture is undertaking research which, it is hoped, will produce an effective alternative to "Warfarin* which itself is harmless to humans and domestic animals. 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 is taken if the premises are infested. Periodical testing and treatment of the sewer system is undertaken especially where a persistent surface infestation might be associated with the presence of rats in the local sewers. 50 NOISE ABATEMENT During the year 98 complaints were made regarding noise alleged to be a nuisance. In 51 cases no action was warranted. In 33 instances the noise complained of was abated, or reduced so as not to be a nuisance and 14 cases are still under investigation. 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 area of the Borough and it is the intention that one Smoke Control Order shall be made each year. The progress of these Orders is shown below:- Smoke Control Order No. of premises find. Factories and Commercial) No. of dwellings Acreage Date of Order Date of Operation No. 1 2,076 1,916 620 22.12.58 1. 4.61 No. 2 3,042 2,686 265 26. 2.60 1.10.61 No. 3 4,501 3,915 332 22.11.60 1.10.62 No. 4 5,547 4,112 710 24.11.61 1. 7.63 No. 5 7,042 6,651 570 17.12.62 1. 7.64 No. 6 6,220 5,885 470 18.11.63 1, 7.65 No. 7 8,198 7,788 1,060 21.12.64 1. 7.66 No. 8 7,198 6,777 460 20.12.65 1. 7.67 No. 9 6,158 5,605 554 19.12.66 1. 7.68 No. 10 6,670 6,351 596 18.12.67 1. 7.69 No. 11 7,099 6,573 588 27. 1.69 1. 7.70 No. 12 6,007 5,865 439 15.12.69 1. 7.71 No. 13 10,859 9,596 2,000 26. 3.71 1. 7.72 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 22 plans showing the construction and heights of new chimneys were examined and in 22 cases additional height was requested and agreed. 33 notices of the installation of new furnaces were received, 28 of these being oil fired plants. 51 LOCAL LAND CHARGES During the year 11,936 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 the Department currently, or which may apply to the property at some future date. PLANNING APPLICATIONS Planning applications relating to new developments 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 applied 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 3,080 plans submitted for approval. 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 yean- By Steam 7,171 articles By Formalin Gas 322 articles Total 7,493 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:— 90 rooms, hospital wards, clinics etc. 66 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 £16 was paid for such services. 1,333 items of home nursing equipment were disinfected. 52 DISIINIFESTATION 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 144, either by spraying or fumigation. CLEANSING OF VERMINOUS. ETC., PERSONS A cleansing station consisting of a reception room, two 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 9 adults and 23 children were cleansed of verminous conditions and 36 adults and 54 children were treated for scabies. 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. 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 Ministry of Agriculture has emphasized the need for continued vigilance against rabies, a disease which has occurred among animals imported into this country recently and appropriate action was taken in the case of a dog whose behaviour, prior to death; was unaccountable. Subsequent laboratory tests fortunately revealed no trace of the disease. The incidence of foul pest increased considerably in certain parts of the country towards the latter end of the year and local poultry keepers were advised on the precautions against the spread of this disease and, in particular, the requirement that all waste food must be boiled in accordance with the Diseases of Animals (Waste Food) Order, 1957 before being fed to poultry. LECTURES During the year 54 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 contributions to both public relations and health education. 53 CARAVAN 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, 1 Indefinite period. Magdala Road, Croydon. Site licence conditions require a water carriage system of drainage, main water supply and fire precautions. 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. 54 SUMMARY OF HOUSING AND MISCELLANEOUS INSPECTIONS MADE BY THE PUBLIC HEALTH INSPECTORS. AND OTHER DEPARTMENTAL WORK Total number of houses inspected for housing defects under Public Health or Mousing Acts 5,561 Houses Inspected following applications for certificates of disrepair 18 Inspection of underground rooms 101 Special inspections in connection with the Housing Survey 766 Houses inspected for overcrowding conditions 56 Re-inspections of work outstanding on housing notices 12,159 Number of visits regarding infectious diseases 661 Number of visits regarding food poisoning 111 Inspections of drainage work during repair 2,347 Drainage systems inspected, surveyed or traced 3,197 Drains tested 272 Inspections of cesspools and earth closets 29 do schools and school sanitary conveniences 15 do public conveniences 210 do verminous premises 48 do ponds and ditches 11 do premises in course of demolition 781 do tents vans and similar structures 194 do premises in connection with improvement grants 512 Inspection and re-inspection of houses in multiple occupation 5,966 Inspection and re-inspection in connection with Smoke Control Orders 14,706 Smoke observations 72 Visits regarding exhumation 5 Visits in connection with miscellaneous public health nuisances 3,268 Visits to immigrants 101 Unsuccessful calls 7,203 Appointments kept with owners, builders, etc 5,722 Investigations of complaints other than housing matters 1,044 Inspections under Noise Abatement Act 490 Visits regarding rats and mice infestation by rodent operators 13,106 Visits regarding rats and mice infestation by district inspectors 963 Informal Notices served 969 Informal Notices complied with 584 Statutory Notices outstanding 31.12.69 932 Statutory Notices served 1.901 Statutory Notices complied with 1,333 Statutory Notices outstanding 31.12.70 1,500 Total number of callers and complaints received at the office 2,584 Total number of letters received at the office 15,941 55 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 Inspections Written notices Occupiers prosecuted (1) (2 (3 (4 (5) (i) Factories in which Sections 1.2.3.4 and 6 are to be enforced by Local Authorities 53 6 7 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 1,226 192 16 - (III) Other Premises In which Section 7 is enforced by the Local Authority (excluding out-workers premises) 82 65 - - TOTAL 1.361 263 23 - Cases In which DEFECTS were found:— PARTICULARS Number of cases In which defects were found Number of cases in which prosecutions were Instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 5 5 - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 1 1 - - - Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7) (a) Insufficient 2 2 - - - (b) Unsuitable or defective 5 5 • 2 . (c) Not separate for sexes - - - - - Other offences against the Act (not Including offences relating to Outwork) 10 10 . . - TOTAL 23 23 - 2 • 56 PART VIII OF THE ACT Outwork Nature of work Section 110 Section 111 No. of Outworkers in August list required by Sect. 10 (1) (c) No, of cases of default In sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Lampshades 27 - - - - - Embroidery and Tapestry Printing 14 - - - - - Paper bags and Cardboard boxes 8 - - - - - Christmas cards, Christmas crackers and stockings 24 - - - - - Tool assembly - - - - - - Wearing apparel 111 - - - - - Perfumery, Toiletries, etc. 10 - - - - - Carding of buttons etc. 45 - - - - - Artificial flowers 1 - - - - - Curtain and furniture hangings 17 - - - - - TOTAL 257 - - - - - 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 Premiss at end of year Number of Registered Premises receiving a general inspection during the year (1) (2) (3) (4) Offices 138 1,387 217 Retail Shops 113 1,932 337 Wholesale Shops Warehouses 6 113 14 Catering Establishments open to the public. Canteens 33 240 31 Fuel Storage Depot 1 3 - TOTALS 291 3,675 599 TABLE B - Number of Visits of all kinds by Inspectors to Registered Premises 3,324 57 TABLE C - Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace Number of Persons Employed (1) (2) Offices 36.005 Retail Shops 12.661 Wholesale Departments, Warehouses 2.396 Catering Establishments open to the public 3.069 Canteens 655 Fuel Storage Depots 31 TOTAL 54.81 7 Total Males 26.949 Total Females 27.868 TABLE D - Exemptions No exemptions were granted under the Act during the year. TABLE E - Prosecutions There were three prosecutions under the Act during the year, as outlined in the Appendix to this Report. 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. 58 REMEDIAL WORKS ETC. CARRIED OUT Accident Prevention Measures 6 Abstract of Act Provided 201 Clothing Accommodation Provided 22 Drainage Defects Repaired Lack of Cleanliness Remedied 6 Drinking Water/Vessels Provided 8 Eating Facilities Provided First Aid Equipment Provided 161 Floors, Stairs, Passages Repaired etc 85 Heating Provided 14 Lighting Provided 36 Machines Guarded 21 Overcrowding abated 1 Premises registered 291 Sanitary Accommodation Provided 7 Intervening Ventilated Space Provided 29 Defective Sanitary Accommodation Repaired 39 Labelling of Sanitary Accommodation 12 Staff seating facilities Provided 7 Thermometers Provided 119 Ventilation Provided 59 Walls, Ceilings etc. Repaired 102 Washing Facilities - Wash Basins Renewed/Provided 26 „ - Hot Water Provided 58 „ - Nail Brushes, Soap and Towels Provided 13 Provision of Disposal for Sanitary Dressings Defective Electrical Wiring Remedied 7 Accumulations of Rubbish Removed 15 More detailed comment in relation to Offices, Shops and Railway Premises is contained in the Appendix to this Report. 59 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, 1950 - 65 The Shops Acts include the Regulation of the working hours of shop assistants. 801 inspections were made under the Shops Acts; infringements remedied were as follows:— Hours of closing 7 Notices to be exhibited or amended 149 Meal Intervals not granted to Staff 2 Opening Hours of Launderettes 3 During July the appropriate Inspectors were engaged in preparing a Register of Shops in the Central Croydon Area for the purpose of conducting a referendum as a result of a request by the Croydon Chamber of Commerce for 6 day trading in that particular Area. Apart from votes received by post, much work was entailed in obtaining as many votes from shopkeepers as possible in the defined voting area. As a result of the referendum an Order was made by the Council for a large number of traders to keep their shops open for 6 days per week. The following complaints were received during the year and investigated;— Insufficient meal intervals for shop assistants in restaurants 2. Selling goods on a Sunday not permitted by the Fifth Schedule of the Shops Act 1950 1. A complaint was received of a misleading advertisement in a magazine specialising in the sale of pet fish and aquaria. The advertisement led the reader to believe that a shop in the Borough conducted retail trade or business on a Sunday. The complaint was investigated and the advertisement amended to indicate that wholesale business only was conducted on a Sunday. Six shops - 3 booksellers and 3 secondhand furniture businesses - were found to be conducting business 6 days per week, being situated outside the Central Croydon Area. After warnings given, the shops were closed on one half day per week. One secondhand furniture shop was found open on Sundays and the occupier instructed to close his shop on that day. 60 A number of evening sales conducted in church halls and other public halls were visited and warnings given to the organisers to conform to the general closing hours. A fried fish shop was found open at 12.30 a.m. on s Sunday morning, contrary to Section 47 and the Fifth Schedule of the Shops Act 1950. The occupier was sent a warning letter. PROSECUTIONS UNDER THE SHOPS ACTS 1950 - 65 There were no prosecutions under the Acts during the year. The management of an entertainment centre was found to have conducted a sale of goods on a Sunday contrary to Sections 47 and 58 of the Shops Act 1950. The facts were confirmed and reported to the Town Clerk who sent letters of warning to the management of the premises in which the sale was conducted and to the firm who sold the goods. The management gave an undertaking not to conduct sales in future on Sundays. A firm of motor car salesmen conducted a demonstration of motor cars after the general closing hour on a Saturday and all day on a Sunday with intent to sell cars during such time and on such a day not permitted by the Shops Act 1950. The matter was reported to the Town Clerk who warned the firm in question that the demonstration would be interpreted to contravene the requirements of the Act and must not be repeated. 61 HAIRDRESSIIMG ESTABLISHMENTS Legislation calls for the registration of hairdressers and barbers premises. During the year 221 inspections were made of registered premises to check that the Byelaws in force were being observed. Generally little cause for complaint was found. 17 new Registration Certificates were issued. CONSUMER PROTECTION ACT 1961 The provisions of the Heating Appliances (Fireguards) Act, 1952 and Regulations made thereunder have now been incorporated in the Consumer Protection Act, 1961 which empowers the Secretary of State to make Regulations in respect of any goods which he may prescribe, imposing such requirements as he may think expedient, to prevent or reduce risk of death or personal injury The Oil Heaters Regulations, 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. One prosecution was taken during the year against a shopkeeper for selling an Oil Heater contrary to The Oil Heaters Regulations. A fine totalling £20 was imposed. 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. 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 complied 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. 62 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 four such licences were issued. 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. Special provision is made for "itinerant„dealers who may be exempted from the keeping of full records of their transactions and this and other provisions of the Act are administered in cooperation with the local police. THE RIDING ESTABLISHMENTS ACTS 1964 and 1970 These Acts provide 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. 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 16. In addition, 163 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 compelling the use of clean fillings. Only one firm is now engaged in this type of business within the Borough. Two samples of cotton felt were taken. These samples conformed with the requirements of the Regulations made under the Act. 63 PET ANIMALS ACT, 1951 This Act governs the sale of pet animals and during the year 22 licences were renewed and 4 new licences issued. During the year 45 inspections were made and little cause for complaint relating to conditions specified in the licences was made. 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, 1,369 are registered under Section 16 of the Food and Drugs Act, as follows:— Retail sale of ice-cream 1,068 Manufacture of ice-cream Nil Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 301 During the year 5,273 inspections and re-inspections were made of food businesses. 64 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 1970 No. to which Sec. 19 applies No. of sinks fitted to co/rplv with Sec. 19 during 1970 Bakenouses and Bakers Shops 120 4 120 2 Sugar Confectioners Cafes, Restaurants, 416 1 376 1 Snack Bars, etc. 280 23 280 7 Works & Club Canteens 485 21 485 12 Licensed Premises 155 6 155 4 Off Licences 112 1 24 Grocers & General Shops 310 4 298 2 Butchers 184 2 184 1 Wholesale Meat Markets 11 • 11 Chemists 85 . 85 . Greengrocers 200 • 200 1 Fishmongers 47 1 47 1 Fried Fish Shops 47 1 47 2 Milk Distributors and Dairies 265 . 244 - Premises from which Roundsmen & Mobile Shops operate 109 - 109 - Food Manufacturers 19 . 19 - Supermarkets 50 1 50 4 65 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 remedied Defective condition of walls. ceilings, doors and window glazing 238 Defective condition of floors, utensils, fixtures, etc. remedied 83 Defective or insufficient drainage repaired - Lighting, heating or ventilation provided 39 W.C. accommodation - repair or cleansing 48 -artificial lighting provided - - intervening ventilated space provided 19 Food - now stored 18 ins. off floor 22 „- means to prevent risk of contamination provided 21 „- store provided or repaired Accumulations in yard or stores removed 41 Offal and refuse bins provided 7 Yard paving repaired Hand washing notices exhibited 48 Ablutions - Wash basins provided 65 „- Hot water supplies provided 59 „- Nail brushes, soap and towels provided 68 Clothing accommodation provided 11 Sinks installed 37 Smoking offences abated 10 Defective or unsuitable table tops replaced 36 First Aid kits provided 45 Cleanliness - advice given 14 Rats/Mice Infestation abated 9 Repair/Cleansing of Machinery/Refrigators 35 Leaflets on Food Hygiene supplied 81 Stalls and Delivery Vehicles Wash hand basins/Sinks with hot water provided 57 Nail brushes, soap, towels provided 22 First Aid kits provided 28 Washable overclothing provided 24 Name and address boards supplied 55 Food now stored 18 ins. off floor 3 Accumulation of refuse etc 5 Receptacles for waste food provided 7 Screening for stalls provided 4 Cleanliness of Stalls and vehicles remedied 16 Advice given on Storage of Stalls 10 Lighting of Stalls/Vans improved 2 66 Condemned Foodstuffs Summary of meat and other articles of food found to be unfit and condemned by Inspectors during the year:— Articles Weight in lbs. Carcase Meat 31,042 Offal 2,543 Sundry Foodstuffs 5,422 Canned, Bottled and Packet Foods 25,294 Total 64,301 Disposal of Condemned Foodstuffs Meat condemned at wholesale meat markets or at shops, and other condemned foodstuffs, are destroyed by incineration. 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 84 such inspections were made. MEAT INSPECTION District insp11 wholesale meat depots in the Borough. Meat exposed for sale is inspected in butchers' shops. The Diseases of Animals (Waste Foods) Order, 1957 The Order 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. 67 MILK SUPPLY During the year 114 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 28 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 4 Licences to use the Designation "Ultra Heat Treated" — (a) Dealer's (Pre-packed Milk) Licences 24 Frequent inspections of these licensed premises are carried out during the year to see that the conditions of the licences are observed. Bacteriological Examination of Milk During the year the following samples of milk were examined:— Pasteurised Milk 127 Sterilised Milk 15 Untreated Milk 13 Ultra Heat Treated 3 The following tables summarise the results of bacteriological examinations of pasteurised, sterilised and untreated milk samples during the year:- Untreatd Milk Methylene Blue Test No. Samples Taken Not Satisfied Satisfied 13 1 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. 68 No. Samples Taken Pasteurised Milk Methylene Blue Test Not Satisfied Satisfied 127 1 126 Sterflisad Milk No. Samples Taken Turbidity Test Not Satisfied Satisfied 15 - 15 Ultra Heat Treated Milk No. Samples Taken Colony Count Not Satisfied Satisfied 3 - 3 Bacteriological Examination of Milk Bottle Rinses Bottle Rinse Samples - 29 Satisfactory- 25 Unsatisfactory - 4 BACTERIOLOGICAL EXAMINATION OF CREAM One sample of fresh cream was examined and gave a satisfactory result. BACTERIOLOGICAL EXAMINATION OF ICE CREAM 105 samples were taken, the results being:— Grade No. of Samples 1 65 2 18 3 16 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 Three samples were taken from local shops and were found to comply with the standard. 69 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. 10 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 391 other samples were taken, of which number, 26 were found to be "Not Genuine", details of which are set out below:— Article Nature of Adulteration or Deficiency Remarks Two samples of Pasteurised Milk These samples contained a small amount of added water. Precautions were taken by Firms concerned to avoid any recurrence and subsequent samples taken have proved satisfactory. Untreated Milk This sample was deficient in milk solids other than milk fat. • Sterilised Cream The sample was deficient in milk fat. Extensive investigations proved this to be an isolated occurrence. Two samples of Irish Stew These samples were deficient In meat. Labelling amended to conform with regulations. Canned Pork Sausages This sample was deficient in meat. Commodity has been discontinued. Lamb Tongues " A further sample proved satisfactory. Steak and Vegetable: - Investigated by Firm concerned and found to be an isolated occurrence. Pork Sausages The sample contained added preservative which was not declared. Vendor warned and notice exhibited. Melon Cubes In Syrup Sample contained 360 parts per million of tin derived from the interior lacquer of the can. In the Public Analyst's opinion the tin content should not exceed 250 parts per million. It was ascertained this can was from old stock. Remaining stock removed from sale. Escargots (Snails) Sample contained 5.1 parts per million of lead, which exceeded regulations specifying 2 parts per million. Manufacturers warned and this was considered to be an isolated occurrence. Cooking Chocolate The sample consisted of chocolate made with a high proportion of vegetable fat other than cocoa butter. The article has now been re-labelled Bakers Dark Covering. Friars Balsam Sample was deficient in total balsamic acids. A further sample proved to be satisfactory. 70 Article Nature of Adulteration or Deficiency Remarks Lemon Drink (Low Calorie) Sample contained cyclamic acid which is an artificial sweetener and not permitted by Regulations. Ascertained this was from old stock. No remaining stock left on shop premises. Lime Flavoured Pastilles Sample contained adipic acid, which is not recommended for use in foodstuffs. Information received that adipic acid can be accepted until new regulations are Introduced. The Public Analyst reported that ten 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 11 Taken at Dairies 118 Taken at Institutions 30 Total 159 Average composition of samples:— Milk (excluding South Devon and Channel Islands Milks) Solids not Fat 8.64 (Legal standard is 8.5%) Milk Fat 3.77 (Legal standard is 3%) South Devon and Channel Island Milk Solids not fat 9.02 (Legal standard is 8.5%) Milk Fat 5.32 (Legal standard is 4%) ANALYSIS OF PROSECUTIONS UNDER:- Food and Drugs Act 1955. Food Hygiene (General) Regulations 1960. Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966. OFFENCE RESULT Bottle of Milk containing insects Fined £25. Pie containing a piece of wire Fined £40. Boiled sweet containing a piece of glass Casedismissed (continued over) 71 (continued) OFFENCE RESULT Sausages unfit for human consumption Fined £25 Meat containing mouse droppings (2 cases) Fines totalling £50. were imposed. Meat unfit for human consumption Fined £30. Sausages containing piece of metal Fined £10. Date and Hazel cake containing a nail Fined £25. Carton of soup containing a sliver of metal Fined £30. Almond slice containing an insect Fined £20. Two contraventions under Food Hygiene Regulations in a Butchers shop Fines totalling £30. were imposed. Seven contraventions under Food Hygiene Regulations in a Greengrocers shop, Fines totalling £15 on three counts, remaining four dismissed. Three contraventions under Food Hygiene Regulations in a Bakehouse. Fines totalling £45. were imposed. Ten contraventions under Food Hygiene Regulations in a Restaurant. Fines totalling £60. were imposed. Mobile Food Vehicle not complying with Regulations (3 cases) Fines totalling £91. were imposed (five offences in one case were proved but an absolute discharge was granted) Hot Dog Stalls not complying with Regulations (10 cases) Fines totalling £287, were imposed. FOOD COMPLAINTS During the year 294 food complaints of various types were received, fully investigated and appropriate action taken where necessary. Eleven prosecutions were taken against firms concerned as reported above. 72 SUMMARY OF INSPECTIONS OF FOOD AND OTHER BUSINESS PREMISES MADE BY THE PUBLIC HEALTH INSPECTORS. AND OTHER DEPARTMENTAL WORK Inspections of theatres, cinemas, halls, etc 33 Visits to premises for food condemnation 859 Inspections of wells and gathering grounds of water supply 26 do scrap metal dealer's premises 7 do rivers and streams for pollutions 14 do hairdressers 221 Food and Drugs Acts; Food and drugs samples taken 521 Food and Drugs Acts; Milk samples taken (special designation) 160 Ice Cream samples taken (bacteriological) 104 Samples taken of Fertilizers and Feeding Stuffs 20 do swimming baths water 306 do drinking water, bacteriological and chemical 720 do subsoil water 6 do private wells 142 do rag flock and other filling materials 2 do sundry specimens (food poisoning etc.) 29 Visits in connection with Food Complaints 435 Inspections of butchers' premises 426 do meat premises (wholesale) 268 do poultry and game dealers' premises 11 do fishmongers' premises 88 do fried fish premises 116 do grocers' premises 669 do fruiterers' and greengrocers' premises 265 do bakers' premises - including bakehouses 249 do dairies 25 do milk shops 89 do general shops and supermarkets 104 Visits in connection with Animal Boarding Establishments Act 6 do do Rag Flock Act 1 do do Mines and Quarries 18 do do Croydon Corporation Act Inspection of Employment Agencies 99 Examination of Imported Food 1,065 Inspections of premises where cooked meats etc. are prepared or sold 26 Inspections of confectioners' premises 317 do confectionery manufacturers' premises 7 do cafes, snack bars, canteens, hotels and their kitchens 1,326 do school kitchens and serveries 84 do hospital kitchens 25 do ice cream vendors' premises 2 do ice cream barrows and carts 159 do market and barrows 659 do other food premises not enumerated above 84 Licenced premises 273 Inspections of factories with mechanical power 192 do factories without mechanical power 6 do works of building and engineering 65 do shops (under Shops Acts) 801 do outworkers' premises 297 73 Inspections under Fertilizers and Feeding Stuffs Act 9 do Diseases of Animals Act 17 do Pets Act 45 do Pharmacy and Poisons Act 22 do Noise Abatement Act 502 do Consumer Protection Act 114 do Offices, Shops and Railway Premises Act 2,923 74 APPENDIX OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 In presenting a report on the work carried out under the above-mentioned Act, one is conscious of the wide scope of the duties coming within the terms of the Offices, Shops and Railway Premises Act, 1963. Much has been accomplished, and if the staff were numerically larger, more could be done and inspections proceed at a greater speed. However, the policy of the Department is to proceed steadily and in detail giving premises a thorough inspection, thus avoiding the need for further inspection for some time to come. As mentioned in a previous report changes in occupancy of shops.and offices are frequent and the desire to use allotted areas to the best advantage by alteration of office partitions, may lead to overcrowding and upset in the ventilation system provided in the building. The Whitgift Centre shops are to a large extent occupied. The formation of this shopping centre has put stress on the work of the Department in examining plans and meeting builders, architects and heating and ventilation engineers either on the site or in the office, often at short notice. With the change in status of the General Post Office the responsibility for the inspection of all post offices, clerical offices, sorting offices and other post office properties (except factories) has been transferred to the Local Authority. During the year Forms of Registration of 31 premises in the occupation of the Post Office Corporation were received from H.M. District Inspector of Factories (who was the official formerly responsible for the inspection of General Post Office premises as Crown property). The Post Office Corporation employs in the 31 various premises in the Borough (other than factory premises) 3,175 workers, of whom 1,928 are males and 1,247 females. During the Christmas period, five premises temporarily occupied by the Post Office Corporation to deal with increased postal work were inspected for compliance with welfare provisions. The practice of inspecting plans relating to offices, shops, warehouses and factories continues. Detailed examination is required, to ensure inter alia that so far as possible no form of construction is carried out which may later result in accidents. This applies particularly to means of access to lift motor rooms, boiler houses, and means of access to loading bays. During the year no fewer than 1,100 plans have been inspected and reported upon and this is the highest number since the Act came into force in 1964. The inspection of hoists and lifts under the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations, 1968, has continued and all adverse reports made by Inspectors of Insurance Companies are pursued to a satisfactory conclusion. During the year 8 adverse reports were received on manually operated hoists and 12 on electrically operated lifts. Visits were made to the premises concerned, and notices subsequently served upon the owners of 75 the properties. On reinspection 15 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 hoists and lifts to operate in a safe condition. The total number of inspections and reinspections of lfts during the year was 87. It is essential that adequate arrangements are made for the safety of persons using lift motor rooms. The doors to the rooms should be locked, the access ladder must be safe with grab rails or handholds provided at strategic points. Adequate lighting with switches provided at easily accessible points must be provided. The trap door opening (and any dangerous machinery) must be fenced. The Local Authority Inspector is expected to envisage hazards and to recommend appropriate precautions. The dangers inherent in the handling of this type of machinery are often underestimated and the amount of work involved in the enforcement of the Regulations is considerable. Some cases dealt with during the year are as follows:— The internal approach to the lift motor room of an Insurance Company's office is so hazardous that legal action is being contemplated. One disused lift, serving three floors, was found in a food shop. The doors of the basement and ground floor means of access were found securely locked, but the first floor lift door was found wide open. The lift well served as a useful means of depositing therein disused shop equipment,cartons, boxes etc. but in addition the opened gate presented a most dangerous hazard. As a result of an urgent notice to the Company the accumulations and deposits were removed from the lift well and the lift sealed off at all entrances. So bad was the Lift Inspector's report on a butcher's goods lift that the Company decided to discontinue its use forthwith and to seal it up. The motors and lifting machinery in one office block were found to be situated on a concrete platform six feet from the floor of the motor room. Any person inspecting the motors, ropes and sheaves was in danger of falling off the platform. Action is being taken to provide guard rails around the perimeter of the platform. The number of accidents in offices, shops and warehouses reported to the Department during 1970 was 155 and all were investigated. This compares with 132 in 1969. When premises are inspected, occupiers are reminded of their obligations to notify accidents reportable within the meaning of the Act. Every endeavour is made to interview the injured person, whether in hospital, at home or in the place of employment, when frequently a different version is obtained of the accident as compared with that reported by the management. A male young person, not being under supervision, was wrongly instructed to clean a bacon slicer, and a tip of a finger was removed by the blade. Legal proceedings were instituted and the case is mentioned at the end of this report. 76 A butcher's manager stood on a chopping block to reach for goods on tcp of a refrigerator. He slipped on to the floor and lacerated his hand and sustained bruising. Well constructed step ladders had been provided by the Company and which the manager had failed to use. In a multiple store the staff used the door glazing to push open the door instead of using the push plates provided. An assistant pushed her hand through the glass, sustaining laceration of the hand and lower arm. The firm have, as a result, supplied a reinforced glass panel in an endeavour to prevent further accidents. A workman cleaning the ceiling of a warehouse from the top of a ladder fell with the ladder to the cpncrete floor, a distance of 15 ft., sustaining injuries to his back. He had failed to carry out Company instructions to secure the ladder to the crossbeam at the top before commencing work. An employee, slicing meat on a powered machine, pressed meat against the blade instead of using the last slice device. He sustained laceration of his thumb. An accident that could have had serious consequences took place in a refrigerated store of a supermarket. An employee, in stooping down to lift meat struck his head against a shelf on rising and was rendered temporarily unconscious. Fortunately, a member of the staff entered the refrigerator very shortly after the accident and found the injured person on the floor and brought him out. The firm have taken measures to ensure that the store is regularly visited and that, so far as possible, two persons ere together in the store. An electric switch, connected with an alarm bell, has also been installed in the store. An accident occurred in the offices of an Insurance Company when an electrician fell through the open flap in the floor to the cellar beneath sustaining bruises to back and ankle injury. While it is true that the electrician raised the flap himself, the Society were instructed to take all necessary measures to prevent as far as possible future accidents by providing a warning notice and also providing fencing to be used when the flap is in the open position. Accidents are common among people using knives. There seems to be a general lack in training persons how to use a knife when preparing food for sale. Too many accidents are caused by persons slipping on wet floors. Approaches have been made to managements as far as possible to ensure that floors are washed prior to staff arriving at the premises for duty. Accidents due to "horseplay„still occur. The cause is usually determined as a result of close questioning and patient enquiry. One accident on a fork lift truck occurred when the driver was conveying a worker who was standing astride on the forks of the truck. On crossing a joint in the concrete floor the man riding on the forks lost his balance and 77 was jerked off the forks on to the floor. Fortunately, the driver immediatly braked the vehicle and the "passenger„suffered bruising to his heels. 32 complaints were received during the year, compared with 30 in 1969, made up as follows:— Inadequate ventilation of office and shop premises 6 Low temperatures of offices and shops - reasonable temperature not being maintained - 4 Overheating of offices and work places - 5 Lack of thermometers - 2 No means of heating provided - 1 Office heater defective - 1 Alleged overcrowding - 1 Alleged unsafe condition of office windows - 1 Insufficient artificial lighting of office - 2 Defective covering of office floor - 1 Insufficient sanitary accommodation - 2 Unclean condition of shop - 1 Lack of seats for shop assistants - 1 General disrepair of office - 1 Unprotected prescribed dangerous machines - 1 Defective trolley used for transporting goods in warehouse 1 Lack of First Aid Box - 1 With regard to the complaints received due to overheating of offices,shops and warehouses, where mechanical ventilation of air conditioning was not provided, remedies have been found in some cases by:— (a) Checking overcrowding and redistributing the staff. (b) Whitening or shading of glass roofs and skylights. (c) Checking all means of ventilation, windows, roof lights and skylights, and ensuring that they are in proper working order. (d) Provision of electric fans in proximity to open windows. Three complaints received were unjustified. A matter of some concern is the lack of proper maintenance reported in the case of some office blocks occupied only for a short time. Defective flushing cisterns, defective and choked sanitary appliances, doors falling off hinges and accumulations and deposits of refuse have been found in modern offices. A most unsatisfactory feature was the unsafe condition of casement windows in a tall office block. The glazing appeared to be too heavy for the casement frames into which it was fitted. In a high wind the glazing of one opened casement window was blown from its frame onto the car parked below, fortunately without causing personal injury. The owners' attention has been drawn to this condition which is receiving attention. With tall buildings in close proximity, wind movement in all conditions at all times cannot be 78 known, and wind currents are caused which sometimes necessitate the total closure of some windows to avoid the pulling or drawing action of winds causing excessive strain on the window securing fitments. During the year four cases were reported to the Town Clerk with a view to legal action being taken. In the first case a multiple grocery firm was prosecuted for permitting a young person to clean a bacon cutting machine exposing him to risk of injury from a moving part of the machine, contrary to Section 18 of the Act. The young person sustained a lacerated finger. A fine of £10 plus £5.5.0d costs was imposed. In the second case a multiple firm having branch stores, selling newspapers, stationery and sugar confectionery was prosecuted for:— (a) Failing to provide a supply of clean running hot and cold or warm water, contrary to Section 10(1) of the Act. A fine of £2.0.0d. was imposed. (b) Failing to maintain in the shop a reasonable temperature contrary to Section 6(1). A fine of £20.0.0d plus £5.5.0d. was imposed. The Company appealed to Quarter Sessions when the appeal was dismissed. In the third case the occupiers of a poodle parlour were prosecuted for:— (1) Not keeping the premises in a clean state, contrary to Section 4(1), A fine of £20.0.Od. was irrposed. (2) Not maintaining the floors of the shop in a sound condition contrary to Section 16(1). A fine of £20.0.Od was imposed. (3) Not maintaining a first aid box with first aid requisities and appliances as prescribed, contrary to Section 24. A fine of £20.0.0d was imposed. (4) Permitting an accumulation of refuse in the yard contrary to Section 4(2). A fine of £15.0.0d was imposed. The fines in this case amounted altogether to £75.0.0d. plus £15.0.0d. costs. In the fourth case a mail order firm failed to keep a passageway free from obstruction, contrary to Section 16(1), and failed to maintain in the passageway sufficient and suitable lighting, contrary to Section 8(1). A woman employee sustained injury to her foot due to falling over a carton left in an unlit passageway by a person unknown. In view of the fact that the firm took immediate steps to employ a man to ensure that passageways were kept free from obstruction and that artificial lighting was maintained during such time as persons were employed in the premises, the Town Clerk sent a warning letter to the Company in lieu of legal proceedings. PUBLIC HEALTH SERVICES 81 WATER SUPPLY The London Borough is served by four statutory supply authorities, as undermentioned:— Supply Authority Square Miles Estimated Population for 1969 Croydon Corporation (Central and northern part of the Borough) 17.0 217,050 Metropolitan Water Board (Soring park Estate and New Addington) 2.8 40,280 East Surrey Water Company (Sanderstead, Selsdon, Kenley, Purley and Coulsdon East) 11.7 55,900 Sutton District Water Company (Woodcote and Coulsdon West) 1.9 13,900 33.4 327,130 The waters in supply are of good organic quality and moderately hard in character. They have no plumbo-sol vent 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 85 Chemical and 521 Bacteriological samples of raw water were tested, also 137 Chemical and 1,435 Bacteriological samples of water going into supply. For results of consumer samples of water sent by the Health Department to the Public Health Laboratory Service see Appendix page 136. 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 became fully operational in December, 1969. Under the powers of the London Government Act, 1963, the works became vested in the Greater London Council as from the 1st April, 1970. During -the first quarter of the year that the Works were the responsibility of the London Borough, a satisfactory effluent was produced at all times. OTHER SERVICES 85 FAMILY PLANNING The assistance given to the Croydon Family Planning Association of a financial grant and free facilities at Corporation clinics was continued. In addition the Corporation agreed to extend the definition of medical need to include a free service for "any woman whose general health would be caused to suffer by reason of the increased mental, physical or social burden placed upon her by by a pregnancy." An initial survey by Health Visitors suggested that some 50 cases a month would be forthcoming. The extended service was introduced in October, and against the estimated figure of 150, only 23 cases came forward during the final quarter of the year. Domiciliary Family Planning by Specialist Midwife Patients referred to this service have usually had two or more children in quick succession and it is surprising therefore to find that three patients were under 18 years of age. Language difficulties were overcome by various means; a pupil midwife acting as interpreter with one Chinese family where neither husband nor wife could speak English. The midwife makes many ineffectual visits and consideration is being given to methods by which these can be reduced. 1970 April 1st - December 31st 1969 New Patients seen 68 28 Number of visits 479 159 Patients prescribed the "Pill" 18 4 Patients fitted with I.U.D. 26 14 Patients fitted with cap 3 - Patients using other methods 3 - Patients had hysterectomy 1 - Patients already pregnant 4 3 Patients refused or changed their minds 7 4 Vasectomy 1 18 or under = 3 The rest are awaiting appointments. 86 MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDREN'S DEPARTMENT During the year 311 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 532 in number. Providing places for 1,021 children Part time Child Minders (Playgroups) 30 in minders' own homes Providing places for 352 children Playgroups on premises other than private homes 80 premises Providing places for 2,597 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 1970 22 Children placed 31 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 1,284 Considered not fit for inclusion in sickness pay scheme 11 Deferred for review 82 Unfit for employment 5 87 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. fii) 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 siclkpay. 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. 990 examinations were made during the year by the medical staff of the department including 145 vision tests for drivers. Of these 156 were in respect of manual workers, who were classified as follows:— Fit for employment and sick pay scheme 81 Deferred for review 68 Unfit for sick pay scheme 6 Fit for light employment only (Not fit for sick pay scheme) - Unfit for employment 1 156 88 BLINDNESS I am endebted to the Chief Welfare Officer for access to his records regarding blind persons registered during the year. These show that of the 78 cases registered:— 9 were due to glaucoma and 24 to cataract Of the cases where surgical treatment had been recommended, subsequent follow-up showed it had either been performed or would be carried out except:— 6 patients had died. 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 112 adult cases are registered with his department. 10 of whom are in special homes. NATIONAL ASSISTANCE ACT. 1948. SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT. 1951 During 1970 one order for compulsory removal was required:— One elderly lady, over 80 years of age, seriously ill and unable to care for herself, was admitted to Queen's Hospital. HOME DIALYSIS Since the introduction of these units into service it has been possible for hospitals to discharge patients with kidney failure to continue intermittent dialysis at home. The units are provided by the hospital service but their installation requires certain building and planning adaptations at the patient's home. Through the courtesy of the Housing and Building Maintenance Manager this work is undertaken by his department where there is now a small team with expert knowledge of the processes involved. At the time of writing adaptations have been made to five homes during the past three years and there are two further cases in prospect. 89 LONGSTAY IMMIGRANTS Visits were made to longstay immigrants so that they may be made aware of the health and social facilities available, particularly to children. The department was notified of all 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 1970, see Appendix page 127. REHOUSING ON MEDICAL GROUNDS Dr. C.G. Nicol, Principal Medical Officer inquired into 714 new applications and 86 re-applications for rehousing on medical grounds in 1970 making 15 personal visits, usually jointly with a public health inspector, health visitor, or welfare officer. A further 31 applicants were interviewed at this office. Sub-division of applications recommended to the Housing and Lettings Sub-Committee showed the following approximate frequencies:- (a) Rehoused from Non-Council property (bj Transferred from one Council property to another Total Moved = (a) & (b) Combined Heart disease 23% 23% 23% Lung disease 10% 10% 10% Strokes 4% 4% 4% Crippling conditions 14% 15% 15% Illnesses of children 8% 1% 4% Cancer 4% 4% 4% Tuberculosis 4% 3% 3% Mental disorders 23% 29% 26% Other conditions 10% 11% 11% 90 All these cases involved severe illness in circumstances which showed clearly that ill health was due to housing conditions or that effective treatment could not be attempted without prior rehousing. Medical representations were submitted from 1 in 15 of all applicants on the active housing waiting list, priority being sought on grounds of some specific illness. The list of conditions above shows that every category of sickness was represented. It is to be understood that allowance is made in the housing "points system* for overcrowding, sharing premises and for lack of/ sharing sanitary facilities before an application is referred for consideration on health grounds. It is not my purpose to comment on each type of illness for which the varying proportions of recommendations were made. The first four heart.chest, crippling conditions and strokes: relate in the main to those in later life who can no longer cope with innumerable stairs, steep hills and other physical obstacles within the home and its location. DRUG DEPENDENCY The informal advisory committee established in 1967 of representatives of statutory and voluntary organisations concerned with this problem met again under the Chairmanship of the Medical Officer of Health. The general position in Croydon was deemed unchanged, with no special prevalence but the continued dangers which threaten all urban areas. A further inter-disciplinary in-service training session for professional staffs was held in the Denning Hall when Dr. Dale-Beckett was the principal speaker with the Chief Education Officer in the Chair. As agreed by the advising committee a small group which included consumer representatives considered a pamphlet designed by the Principal Health Education Officer for issue to all school leavers. This pamphlet dealt with general health topics but mentioned the youth counselling service of the Croydon Guild of Social Service and the Corporation's Drug Advisory Centre. The project made good progress and distribution at Easter 1971 was anticipated. Support was also given to a scheme proposed by Dr. Dale-Beckett of recruiting and training young adults (18-24 years of age) to staff an advisory centre for adolescents (14-17). This was still at an early stage during the year under review. The Senior Psychiatric Social Worker concerned with the Corporation's Drug Advisory Centre reported 30 referrals during 1970 (26 in the previous 24 months). During the second half of the year, 9 out of 10 referrals were under 25 years of age, and 6 were under 21 years of age. Most referrals were from family doctors and of all who came to the centre about 25% were involved with "hard" drugs. APPENDIX TABLES 93 VITAL STATISTICS 1965 - 1970 94 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE. AGE AMD SEX CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks end under 1 year AGE IN YEARS 1-4 574 I524 2534 3544 4554 5564 5574 75 & over B4 Enteritis and other Diarrhoeal Diseases M - - - - - - - - - - - - F 3 - 1 - - - - - - - - 2 B5 Tuberculosis of Respiratory System M 2 - - - - - - - - 1 1 - F 2 - - - - - - - 1 - - 1 B6(1) Late effects of Respiratory T.B. M 2 - - - - - - - 1 1 - - F 2 - - - - - - - - 2 - - B6(2) Other Tuberculosis M - - - - - - - - - 1 - - F - - - - - - - - - - - - B11 Meningococcal Infection M 1 - 1 - - - - - - - - - F - - - - - - - - - - - - B17 Syphilis and its Sequelae M 9 - - - - - - - - 2 2 5 F 1 - - - - - - - - - 1 - B18 Other Infective and Parasitic Diseases M - - - - - - - - - - - - F 2 - - - - - - - 2 - - - TOTAL 25 - 2 - - - - - 4 7 4 8 B19(1) Malignant Neoplasm Buccal Cavity etc. M 4 - - - - - - - 1 1 1 1 F 5 - - - - - - - - - 2 3 B1 9(2) Malignant Neoplasm Oesophagus M 9 - - - - - - - 1 1 3 4 F 6 - - - - - - - 1 2 - 3 B19(3) Malignant Neoplasm Stomach M 39 - - - - - 2 - 3 10 16 8 F 32 - - - - - - - 2 4 13 12 B19(4) Malignant Neoplasm Intestine M 62 - - - - - - - 5 22 19 16 F 77 - - - - - - - 7 17 21 32 B19(6) Malignant Neoplasm Lung, Bronchus M 167 - - - - - - 2 14 49 75 27 F 60 - - - - - - 1 7 17 15 10 B19(7) Malignant Neoplasnr Breast M 1 - - - - - - - - 1 - - F 80 - - - - - - 8 8 22 22 20 B19(8) Malignant Neoplasrr Uterus F 19 - - - - - - 2 3 6 3 5 819(9) Malignant Neoplasm Prostate M 33 - - - - - - - - 3 8 22 B19(10) Leukaemia M 3 - - - - - - 1 - 1 - 1 F 14 - - - - - - 1 - 3 5 5 B19(11) Other Malignant Neoplasms M 99 - - - 1 2 3 2 6 33 24 28 F 131 - - 1 3 - 1 8 10 24 36 48 B20 Benign and Unspecified Neoplasms M 1 - - - - - 1 - - - - - F 1 - - - - - - - - - - 1 TOTAL 833 - - 1 4 2 8 26 68 216 263 245 B21 Diabetes Meilltus M 7 - - - - - - 1 - 1 3 2 F 17 - - - - - - 1 - 2 3 11 B22 Avltaminoses, etc. M - - - - - - - - - - - - F 2 - - - - - - - - - - 2 B46(1) Other Endocrine etc. Diseases M 3 - 1 - - - - - - 1 - 1 F 6 - - - 1 - - - - 2 1 2 B23 Anaemias M 4 - - - - - - - 1 1 1 1 F 4 - - - - - - - - - - 4 B46I2) Other Diseases of Blood etc. M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - B46(3) Mental Disorders M 7 - - - - - - - 1 1 1 4 F 12 - - - - - - - - 2 1 9 95 CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks and under 1 year AGE IN YEARS 1 -4 5- 14 1524 2534 3544 4554 5564 6574 75 & over 924 Meningitis M 1 1 - - - - - - - - - - F - - - - - - - - - - - - B46(4) Multiple Sclerosis M - - - - - - - - - - - - F 7 - - - - - - - 1 4 2 - B46(5) Other Diseases of Nervous System M 19 - 2 1 - 2 - - - 3 5 6 F 20 - 3 - - - - - - 1 4 12 TOTAL 110 1 6 1 1 2 - 2 3 1 9 21 54 B26 Chronic Rheumatic Heart Disease M 24 - - - - - - 5 3 9 4 3 F 28 - - - - - - - 3 6 9 10 B27 Hypertensive Disease M 10 - - - - - - - - 5 .1 3 F 24 - - - - - - 1 - 2 6 15 B28 Ischaemic Heart Disease M 461 - - - - - - 12 45 126 135 143 F 345 - - - - - - - 4 27 86 227 B29 Other Forms of Heart Disease M 79 - - - - - - - 2 9 15 53 F 158 - - - - - - - - 4 17 137 B30 Cerebrovascular Disease M 197 - - - - - - - 5 23 56 113 F 427 - - - - - - 2 15 35 80 295 B46(6) Other Diseases of Circulatory System M 58 - - - - - - - 4 10 17 27 F 92 - - - - - - - 2 3 16 71 TOTAL 1903 - - - - - 2 20 83 259 442 1097 B31 Influenza M 11 - - - - - - - - 1 5 4 F 15 - - - - - - 1 - 3 3 8 B32 Pneumonia M 125 2 8 1 - 1 - 1 1 11 25 75 F 228 - 2 - - - 1 - 2 6 36 181 B33(1) Bronchitis and Emphysema M 154 - - - - - - 2 8 27 56 61 F 33 - - - - - - - - 4 6 22 B33(2) Asthma M 1 - - - - - - - - 1 - - F 4 - - - - - - - - 2 1 1 B46(7) Other Diseases of Respiratory System M 8 - - - - - - - - 3 3 2 F 17 - 1 - - - - - - 1 3 12 TOTAL 596 2 11 2 2 1 4 11 59 138 366 B34 Peptic Ulcer M 13 - - - - - - - 2 2 4 5 F 7 - - - - - - - - 1 1 5 B35 Appendicitis M 4 - - - 1 1 - - - - 2 - F 3 - - - - - - - - - 1 2 B36 Intestinal Obstruction and Hernia M 8 - - - - - - - 1 2 1 4 F 14 - - - - - - - - 2 3 7 B37 Cirrhosis of Liver M 7 - - - - - - - 1 1 2 2 F 5 - - - - - - 1 1 1 2 - B46(8) Other Diseases of Digestive System M 9 - - - - - - - 1 - 6 2 F 19 - - - - - - 2 - 2 6 9 B38 Nephritis and Nephrosis M 10 - - - - - - - - 3 1 3 F 7 - - - - - - 1 - 1 1 4 B39 Hyperplasia of Prostate M 9 - - - - - - - - 2 - 7 B46(9) Other Diseases, Genitourinary System M 11 - - - - - - - 3 1 3 3 F 13 - - - - - - 1 - - 4 8 B40 Abortion F 1 - - - - - - 1 - - - - B46(10) Diseases of Skin, Subcutaneous Tissue M 3 - 1 1 - - - - - - - 1 F 2 - - - - - - - - 1 - 1 96 CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks and under 1 year AGE IN YEARS 1-4 5- 14 5- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75 & over B46(11) Diseases of Musculo Skeletal System M 5 - - - - - - - - - 2 3 F 11 - - - - - - 1 - 2 2 6 B42 Congenital Anomalies M 11 8 3 - - - - - - - - - F 12 5 2 - - - - - - - 3 - B43 Birth Injury, Difficult Labour, etc. M 17 17 - - - - - - - - - - F 4 4 - - - - - - - - - - B44 Other Causes of Perinatal Mortality M 14 14 - - - - - - - - - - F 13 13 - - - - - - - - - - B45 Symptoms and IllDefined Conditions M 2 - - - - - - - - - - 2 F 2 - - - - - - - - - - 2 TOTAL 236 61 7 1 1 2 - 9 14 21 44 76 BE47 Motor Vehicle Accidents M 28 - - 1 3 13 - 1 1 2 1 3 F 15 - - - 1 2 - - - 3 6 3 BE48 Other Accidents M 29 - 1 1 2 3 - 4 5 2 4 7 F 35 - - - - 3 - - 2 2 6 22 BE49 Suicide and inflicted Injuries M 9 - - - - - - 1 4 3 - 1 F 11 - - - - 1 - 2 1 3 2 2 BE50 All Other External Causes M 2 - 1 - - - - 1 - - - - F - - - - - - - - - - - TOTAL ALL CAUSES M 1794 42 19 5 7 24 12 33 122 377 502 651 F 2038 22 9 2 5 6 3 37 74 219 129 1232 3832 64 28 7 12 30 15 70 1 96 596 931 1883 97 CANCER Deaths from Cancer occurred at the following ages — Age Period Male Female Total Under 25 years 3 4 7 25 and under 35 years 1 7 8 35 and under 45 years 5 21 26 45 and under 55 years 30 38 68 55 and under 65 years 118 98 216 65 and under 75 years 146 117 263 75 and over 106 139 245 Total 409 424 833 Site Male Female Total Percentage of Total Bowel and Rectum 62 77 139 16.7 Brain 6 6 12 1.4 Breast 1 80 81 9.8 Buccal Cavity 4 5 9 1.1 Cervix • 7 7 1.7 Gallbladder & Duct 2 4 6 0.7 Hodgkins 2 1 3 0.4 Larynx & Pharynx 2 2 4 0.5 Leukaemia 3 14 17 2.0 Lungs and Bronchus 167 50 217 26.1 Oesophagus 9 6 15 1.8 Ovary 30 30 7.1 Pancreas 21 17 38 4.6 Prostate 33 33 8.1 Stomach 39 32 71 8.5 Uterus - 12 12 2.8 Other Malignant Neoplasmas 58 81 139 16.7 Total 409 424 833 98 WARD STATISTICS 1970 Estimated Population Births (live) Birth Rate Deaths *Death Kate Deaths under 1 year Deaths under 1 year per 1,000 births Deaths from Diarrhoea (under 2 years) *Death Rate from Diarrhoea (under 2 years) Deaths from Bronchitis and Pneumonia *Death Rate from Bronchitis and Pneumonia Deaths from Pulmonary Tuberculosis *Death Rate from Pulmonary Tuberculos Is Deaths from Non* Pulmonary Tuberculosis 'Death Rate from NonPulmonary Tuberculosis Deaths from Heart and Circulatory Diseases *Death Rate from Heart and Circulatory Deaths from Cancer *Death Rata from Cancer Natural Increase of Births over Deaths Addiscombe 16,180 313 20.6 206 13.6 9 29 31 2.0 1 0.07 - - 107 7.0 40 2.6 + 107 Bensham Manor 14,770 257 17.4 179 12.1 6 23 27 1.8 - - - - 100 6.8 30 2.0 + 78 Broad Green 13,000 264 20.3 167 12.1 2 8 - - 24 1.8 - - - - 76 6.9 39 3.0 + 107 Central 15.510 228 14.7 211 13.6 6 22 - - 29 1.9 1 0.06 - - 102 6.6 53 3.4 + 17 Coulsdon East 14,1 80 188 13.2 233 16.4 1 6 - - 56 3.9 - - - - 122 8.6 26 1.8 - 46 East 16,800 186 11.0 187 11.1 3 16 - - 46 2.7 - - - - 98 6.8 46 2.7 - 2 New Addlngton 27,680 628 22.8 136 4.9 9 14 - - 19 0.7 - - - - 54 2.0 26 0.9 + 493 Norbury 1 6,720 216 13.7 196 12.6 4 19 - - 18 1.1 2 0.13 - - 121 7.7 44 2.8 + 19 Purley 16,630 209 12.6 122 7.4 3 14 - - 39 2.4 - - - - 106 6.4 46 2.8 + 87 Sanderstead North 1 7,090 211 12.4 169 9.3 2 9 - - 16 0.9 - - - - 97 5.7 29 1.7 + 62 Sanderstead & Selsdon 16,490 193 11.7 168 10.2 4 21 - - 17 1.0 - - - - 86 6.2 46 2.7 + 26 Shirley 21,250 339 16.0 170 8.0 7 21 - - 17 0.8 1 0.06 - - 73 3.4 52 2.6 + 169 South Norwood 17,190 370 21.6 195 11.3 13 36 1 0.06 32 1.9 - - 1 0.6 94 5.6 42 2.6 + 176 Thornton Heath 14,580 283 19.4 177 12.1 2 7 1 0.07 22 1.6 1 0.07 - - 94 6.4 37 2.6 + 106 Upper Norwood 16,220 247 16.2 188 11.6 6 20 - - 16 0.9 - - - - 108 6.7 37 2.3 + 69 Waddon 16,500 225 13.7 127 7.7 2 9 - - 41 2.5 - - - - 141 8.6 48 2.9 + 98 West Thornton 14.300 248 17.4 199 13.9 4 16 - - 33 2.3 1 0.07 - - 93 6.6 61 3.6 + 49 Whltehorse Manor 13,960 313 22.4 187 13.4 6 16 - - 30 2.2 1 0.07 - - 102 7.3 34 2 A + 126 Woodcote & Coulsdon West 1 6,500 179 11.6 210 13.6 4 22 - 23 .1.6 - - - - 104 6.7 54 3.6 -31 Woods Ide 14,730 263 17.9 162 10.3 2 8 - 23 1.6 - - - - 77 5.2 34 2.3 + 111 The Borough 327.1 80 6,368 16.7 3,832 10.6 92 17.0 2 0.006 640 1.7 8 0.026 1 0.003 1,903 5.8 833 2.6 +1.626 •Death Rate Der 1,000 popoultation and excluding those who died in Queen's Hospital 99 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 6 (2) Foeta I States - Congenital Malformations 13 Atelectasis and Marasmus 2 Haemorrhagic Diseases of Newborn - (3) Prematurity 40 (4) Post-Natal Causes 3 Total 64 Percentage Deaths under 1 year per Tote! Infantile Deaths Deaths under 1 year per 1.000 Births 1969 1970 1969 1970 Injury at Birth and Congenital 12.0 19.6 1.84 3.4 Premature Births 42.2 43.5 6.41 7.5 Respiratory Diseases 2.4 11.9 0.37 2.0 Atalectasis, Debility and Marasmus 2.4 3.3 0.37 0.6 Diseases of Digestion * - 1.1 - 0.2 Other causes 41.0 20.6 6.25 3.5 *These from Gastro-Enterltis Perinatal Deaths Stillbirths -60 Perinatal Rate 22 per 1,000 Deaths in first week - 58 Total (live and still) births Causes of Death in first week Prematurity - 39 Pneumonia - 1 Congenital conditions 8 Haemorrhagic disease - Atelectasis - - Other causes - 4 Birth Trauma - 6 100 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 16th-21st day 22nd - 28th da y Total Under 1month 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 42 9 3 3 - 1 - 2 3 - 64 6 6 3 6 1 3 1 2 - 1 - 92 Meningo-encephalitis - 1 - - - - - - - - 1 - - - - - - - - - - - 1 Chickenpox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - - - - - - - - - - - 1 - - - - - 1 Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (all forms) - - - 1 - - - - - - 1 1 4 1 2 - 1 - 1 - - - 11 Diarrhoea and enteritis - - - - - - - - - - - - - - 1 - - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 4 1 2 - - 1 - 2 3 - 13 4 1 - - - - - - - - - 18 Premature Births 31 6 - 2 - - - - - 1 40 - - - - - - - - - - - 40 Atrophy, Atelectasis, Debility and Marasmus 2 - - - - - - - - 2 - 1 - - - - - - - - - 3 Injury at Birth 4 1 1 - - - - - - - .6 - - - - - - - - - - - 6 Haemorrhagic disease of newborn - - - - - - - - - - - - - - - - - - - - - - - Other Causes 1 - - - - - - - - - 1 1 - 2 2 1 1 1 1 - 1 - 11 TOTALS 42 9 3 3 - 1 - 2 3 - 64 6 6 3 6 1 3 1 2 - 1 - 92 101 MIDWIFERY SERVICE Municipal midwives attended:— 1. Home confinements booked 1,353 2. Planned early discharges booked 467 3. Patients delivered at home 996 Midwifery cases Nil Maternity cases 996 4. Primagravida delivered at home 42 Multigravida delivered at home 954 5. Live births At home 993 6. Still births At home 3 (1) Impacted shoulders (2) I.U.D. Placental Insufficiency (3) Macerated 7. Neonatal deaths at home (1) Cardiac (2) Meningitis 2 8. Premature births at home 21 36 weeks by dates 6lbs. 6oz. 37½ weeks 5lbs. 4oz. admitted 37 weeks 5lbs. 4oz. 35 weeks 5lbs. Breech admitted 36 weeks 4lbs. admitted 36 weeks 5lbs. 12oz. Severe Asphyxia. Admitted later Cold syndrome 38 weeks 5lbs. 4oz. Term 5lbs. 8oz. 36 weeks 4lbs. admitted Term 5lbs. 4oz. 37 weeks 4lbs. admitted 37 weeks 4lbs. Macerated S.B. breech 36 weeks 5lbs. 4oz. admitted 36 weeks by dates 6lbs. 13oz. Term 5lbs. 37 weeks 3lbs. 2oz. S.B. I.U.D. Term 5lbs. Term 5lbs. Term 5lbs. 8oz. Term 5lbs. 8oz. Not known 2lbs. admitted (NND) on arrival 9. Inhalational Analgesia given "Entonox" 684 "Trilene" 105 10. Patients given Pethidine or Pethilorfan 563 102 11. Post Partum Harmorrhages 17 + 5 (Including 5 Secondary P.P.H.) Treated at home 12 + 1 Admitted to Hospital 5 + 4 12. Retained placentae 13 Treated at home 1 Admitted to hospital 12 13. Flying Squad Calls 14 14. Manual removal of placenta at home 0 15. Blood transfusion at home 4 16. Prolonged labours over 24 hours delivered at home 3 17. Forceps delivered at home 1 18. Breech deliveries at home 3 19. Sets of twins delivered at home 0 20. Anaemia of pregnancy treated at home 66 21. Toxaemia of pregnancy treated at home 8 22. Puerperal Pyrexias 30 Genital 5 Extra Genital 25 23. Congenital abnormalities delivered at home 18 Hydrocele Double Jointed Legs Talipes Left Foot "Click" Left Hip Wide Foritanelles (2) Talipes Right Foot (3) Cardiac Nasal Defect Facial Palsy Mongol Pilonoidal Sinus Multiple Deformities Naevus Rt. Forehead Spina Bifida Naevus Both Ears 24. Patients Admitted to Hospital 411 Antenatal 250 During labour 119 After delivery 29 Early discharges re-admitted 3 25. Patients Received for Home Nursing 1,486 Booked for home confinement 197 Booked for hospital confinement 1,289 (Including 328 booked for planned early discharge 26. Jnfants admitted (including 7 re-admissions) Prem. 5lbs. 4oz. Blood in stools Severe Blue Asphyxia Vomiting (4) Prem. 5lbs. 4oz. Twitching Respiratory Distress (cont. overleaf) 103 26. Infants admitted (continued) Breech Presentation Spina Bifida Prem. 51b. Breech ? Obstruction Very Mucousy Asphyxia Pallida Convulsions Raised Bilirubin Prem. 41b. (3) Cyanotic attacks Cold Syndrome Respiratory infection Blood per Rectum (3) Prem. Multiple Abnormalities ? lmperforate Anus N.P.M, Twitching (2) Jaundice (2) Diarrhoea & Vomiting Respiratory Infection Poor Feeding 27. Guthrie Tests for Phenylketonuria sent to Laboratory 5,693 Repeat tests sent to Laboratory 130 28. Pupil Midwives Trained 41 29. District Visits of Obstetric Course Students 37 30. RH. Negative Patients Delivered at home 105 31. Anti.D Immunoglobulin Treatment given 0 32. Visits made by Specialist Midwife for Family Planning Advice 479 No. New Patients 68 MATERNAL AND iNFANT MORTALITY FOR THE YEARS 1965 - 1970 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 1970 5,358 1 0.18 17.0 104 fe Miles Deliveries Mid. wifery Mater nity Analgesia Ante-Natal Visits Post-Natal Visits Bookings Office Bookings 48 hour Bookings Home Visits Clinic Sessions Femily Pfenning Visits Normel Abnormal Normal A bnormal E ntonox Trllene Midwife Pupil Midwife Pupil 1.000 2,403 28 + 3 28 18 324 448 31 28 21 32 2.+ 4,869 62 + 11 61 1 53 795 851 858 790 120 117 24 51 3.+ 4,532 62 + 4 60 2 54 1,063 550 621 437 104 49 17 22 4.+ - 55 + 0 54 1 49 1,256 773 59 59 23 28 5. 3,685 61 + 8 59 2 47 547 951 55 64 17 24 6. X 4,316 60 + 4 69 1 54 1,680 1,125 72 81 66 55 7. 3,095 75 + 12 67 8 50 1,563 1,048 1,056 831 104 123 32 27 8. 5.347 70+6 69 1 59 910 642 694 591 97 109 14 19 9. 5,543 49 + 10 45 4 43 907 436 695 367 71 86 22 26 10. 2.963 65+5 63 2 55 763 861 815 1,003 75 62 16 23 11. 3,113 3 + 0 3 2 4 12 12. x 6,978 72 + 20 71 1 54 1,298 1 ,080 694 616 65 72 7 12 13. 2,894 28+0 28 22 67 237 25 36 - 24 14. x 4,678 63+7 61 2 55 1 780 370 748 669 80 83 15 21 15. x 7,965 40+3 38 2 26 394 787 25 24 35 55 16.+ 5,516 50+5 50 31 1,082 1,222 975 780 77 97 31 85 17.+ 3,954 56+8 55 1 48 655 919 823 988 83 83 29 39 18.+ 3,258 63 + 3 58 5 41 1.557 912 76 78 28 30 105 fe Miles Deliveries Midwlfery Mternlty Ana leesla Ante-Natal Visits Post-Netal Visits Bookings Office Bookings 48 hour Bookings Home Visits Clinic Sessions Family Planning Visits Normal Abnormal Normal Abnormal Entonox Trilene Midwife Pupil Midwife Pupil 19.+ 3,197 21+9 21 17 840 347 657 425 66 102 27 24 20. APPOINTED To COMMINCE DUTIES JANUARY 1971 PART-TIME STAFF 1.* 4,566 2 + 0 2 2 2 728 548 23 65 2. 4,412 430 405 12 32 99 3. 5,655 1,343 835 5 34 91 4. 1,129 427 248 24 22 141 5.* 3,433 3 + 0 3 3 228 411 17 34 6.* 3,969 3 + 1 2 1 1 1 .057 734 7 44 66 7. 1.838 222 324 9 13 127 8.* 4,521 5 + 0 4 1 3 544 392 3 61 56 479 9. APPOINTED T0 COMMENCE DUTIES JANUARY 1971 107,829 996 + 119 961 35 684 105 11.464 8,276 17,737 7,527 1.285 1,353 467 823 679 479 106 X Denotes 4 Midwives working in attachment schemes but who also und take a percentage of normal duties. + Denotes 10 midwives working in liaison with 23 General Practitioner Obstetricians The Midwifery staff in full have assisted 35 doctors at their Ante-n sessions in the year. * Part-time midwives 1,5,6,7 undertook deliveries in emergency while duty. No. of deliveries + = No. of deliveries + No. of patients admitted in I at Staff Changes -Full-time Midwives September 1970 No. 1 left service Replaced by No. 20 January 1971. October 1970 No. 3 left service Not yet replaced No. 20 To commence duties January 1971 to replace No. 1 In Addition-Part-time Midwives Three Vacancies exist from 1969 No. 1 Commenced duties April 1970. Replaced No. 4 No. 2 Left service September 1970. Replaced by No. 5 No. 4 Retired April 1970 Replaced by No. 1 No. 5 Commenced duties June 1970. Replaced No. 2 No. 7 Left service May 1970. Replaced by No. 9 No. 9 To commence duties January 1971 to Replace No. 7 Average number of bookings per midwife 71.4 Average number of home deliveries per midwife 54.5 Average number of 48 hour discharges per midwife 22.6 Part-time midwives delivered 13 patients and nursed 60 48 hour discharges. 107 CARE OF PREMATURE INFANTS (1) Number of live premature infants notified during 1970 who were born* - (i) at home or in a nursing home 21 (ii) in hospital* 310 (2) The number of those born at home or in a nursing home - who were nursed entirely there 20 who were transferred to hospital on or before the 28th day 1 who died during the first 24 hours 1 who died in 1 and under 7 days 3 who died in 7 and under 28 days who survived at the end of one month 17 (3) Number of those born in hospital - who died during the first 24 hours 24 who died in 1 and under 7 days 14 who died in 7 and under 28 days 3 who survived at the end of one month 269 14) Numoer of premature still births who were born (i) at home or in a nursing home 3 (ii) in hospital 29 *The group under this heading includes cases which may be born in one hospital and transferred tc another. 108 CONGENITAL ABNORMALITIES No. registered in 1970 - 97 of these 74 were live-births 9 were still-births 14 died (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Central Nervous System Eve. Far Alimentary System Heart and Greet Vessels Respiratory System Uro-genltal S ys tem Limbs Other Skeletal Other Systems Other Mal- formations TOTALS OVERALL tota ls M F M F M F M F M F M F M F M F M F M F M F LIVE 4 5 1 2 5 10 - 1 - 1 8 - 20 9 - 1 2 1 2 2 42 32 74 STILLBIRTHS 1 6 - - 1 - - - - - 1 - - - - - - - - - 3 6 9 DEATHS 2 1 - - 1 - 3 2 - - 1 - - 1 - - - 1 - 2 7 7 14 TOTALS 7 12 1 2 7 10 3 3 - 1 10 - 20 10 - 1 2 2 2 4 52 45 97 CAUSES OF DEATH OR STILL-BIRTH Col. 1. Anencephalus 7 Col. 6. Indeterminate sex 1 Spina Bifida 2 Malformation of uro- Hydrocephalus 1 genital organs 1 Col. 3. Malformations of Col. 7- Reduction deformity alimentary system 2 of leg 1 Col. 4. Malformations of Col.9. Exomphalos 1 heart and circulatory Col. 10. Potters Syndrome system 5 Multiple congenital malformations 1 ISSUE OF WELFARE FOODS FOR 1970 National Dried Milk 28,252 Cod Liver Oil 4,722 Vitamin A & D Tablets 6,934 Orange Juice 119,825 109 AT RISK REGISTER YEAR ENDING 31st DECEMBER, 1970 Number added to Register during 1970 1,157 Number on Register at 31.12.70 2,027 Number of 8 month checks carried out during 1970 512 Number of 2 year checks carried out during 1970 553 Referrals and Retests 1970 Born 1970 No. to be seen again at Child Health Centre 2 No. referred to Stycar Hearing Clinic, Dr. Morgan 2 Born 1969 No. to be seen again at Child Health Centre 8 No. referred to Stycar Hearing Clinic, Dr. Morgan 9 No. referred to hospital for Specialist opinion 4 Born 1968 No. to be seen again at Chi id Health Centre 52 No. referred to Stycar Hearing Clinic, Dr. Morgan 6 No. referred to Handicapped Register 37 Born 1967 and 1966 No. still to be kept under observation 14 No. referred to Handicapped Register 10 110 STYCAR HEARING TESTS There were 2,027 children on the At Risk Register at the end of 1970. Number of Clinics held in 1970 18 Number of appointments made during year 172 Number of Non-attenders 66 SOURCE OF REFERRAL AND RESULT SOURCE HEARING SATISFACTORY HEARING UNSATISFACTORY TOTAL Referred E.N.T Referred Speech Clinic For Observation Referred Handicapped Register Recommended Nursery School Discharged Referred Speech Clinic Referred E.N.T. For Obser ration A1ready has hearing Aid Child Health Centres 4 8 10 1 1 28 1 3 56 L.A. Doctor 1 1 9 1 12 General Practitioner 2 7 3 12 Mr. Oakley,Peripatetic Teacher of the Deaf 1 1 School Health Service 2 1 4 1 8 Other Sources 1 1 REASON AND SOURCE OF REFERRAL REASON FOR REFERRAL SOURCE OF REFERRAL TOTAL Child Health Centres L.A. Doctor General Practitioner Mr. Oakley School Haalth Service Other Sources 1. Failed Stycar Test 28 28 2. Poor Speech 18 1 1 5 1 26 3. Suspected Hearing Loss 10 10 1 21 4. Parent's Request 6 6 5. Other Reasons 4 1 1 1 2 9 RETEST5 REASON FOR RETEST HEARING SATISFACTORY HEARING UNSATISFACTORY TOTAL Referred Speech Clinic For Observation Discharged Referred E.N.T. For Further Referred from previous Stycar Session 2 4 1 2 9 No Speech 5 1 6 ? Retarded 1 1 111 HOME VISITS BY HEALTH VISITORS 1970 Comm. March Part-time Part-time Comm. Feb. Comm. Nov. Comm. June Comm. June Part-time Comm. March 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 16 17 18 19 Children born 1970 85 122 107 90 81 45 147 78 23 36 146 112 84 41 34 143 150 110 79 Children born 1969 95 83 116 102 92 62 44 141 2 57 135 82 81 26 20 113 164 80 67 Children born 1965/68 284 149 538 134 113 66 27 145 4 103 305 274 120 48 67 178 335 96 213 Re-vlslts 0-5 years 566 369 585 157 404 142 565 357 229 255 493 465 235 246 652 526 557 435 504 Persons 65 or over - 59 - 13 2 1 32 11 - 14 2 4 3 1 10 65 5 7 4 Mentally disordered persons - 2 - 1 - 2 3 8 - 9 - - - 2 1 6 4 4 8 Persons discharges from Hospitals - 2 - 1 - - - 3 - 1 1 - - 3 1 10 - 1 - Households visited reInfectlous diseases (Including T.B.) - - - - - - 1 - - - - - - - 6 2 - - - Other home visits 134 47 7 44 59 2 114 1 31 41 97 252 48 64 192 93 1 82 17 121 TOTALS 1,164 833 1,353 542 751 320 933 744 289 516 1,179 1 ,189 571 430 983 1,136 1,387 750 996 (Continued on next page) HOME VISITS BY HEALTH VISITORS (Continued) Left June Comm. July Comm. July Left November 20 21 22 23 24 26 , 26 27 28 29 30 31 32 33 34 35 36 37 38 Children born 1970 131 148 99 166 178 62 182 100 226 138 136 61 83 92 142 37 116 200 105 Children born 1969 200 110 113 147 162 65 235 85 222 95 219 95 19 215 241 2 57 193 121 Children born 1965/68 263 212 123 378 316 247 282 159 130 156 255 318 35 265 223 21 111 249 168 Re-vlslts 0-6 years 1,189 1,000 58 517 486 321 928 913 996 781 862 813 489 385 64 437 365 410 917 Persons 65 or over 27 13 2 14 16 2 15 2 49 15 3 19 6 19 22 1 66 35 33 Mentally disordered persons 17 3 - 4 2 7 1 1 3 - - 5 18 - 4 - 19 5 72 Persons discharged from Hospitals - 6 - 1 4 12 1 5 5 - - 3 2 1 2 1 5 6 4 Households visited re* infectious diseases (Including T.B.) - - - - 2 37 - - 4 - 1 - 1 - - - 2 3 8 Other home visits 112 926 85 216 120 117 328 296 338 73 195 45 65 199 125 134 185 140 134 TOTALS 1,939 2,418 480 1,433 1,286 860 1,970 1.661 1,973 1.258 1,671 1,359 718 1.176 823 633 926 1.241 1,562 (Continued on next page) to HOME VISITS BY HEALTH VISITORS (Continued) Part-time Comm. Sept. Pert-time Comm. June Comm. June Comm. tviersh Comm. June Comm. Sept. TOTALS FOR 1970 TOTALS FOR 1969 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Children born 1970 64 24 233 162 72 94 88 58 78 392 54 155 118 114 16 171 73 6,061 5,975 Children born 1969 62 8 308 92 58 92 136 20 82 527 30 178 80 140 2 402 121 6,486 6,291 Children born 1965/68 228 60 362 227 70 211 127 57 188 1,121 112 367 201 308 1 171 391 11,312 11,782 Re-vlslts 0-5 years 453 38 247 553 518 536 381 518 519 335 279 499 644 858 191 377 588 27,206 25,003 Persons 65 or over 8 11 29 33 17 8 - 12 3 22 4 88 15 11 - 17 4 874 842 Mentally disordered persons 4 1 - 4 - 2 - - - 25 - 16 - - 1 - - 264 255 Persons discharged from Hospitals - 1 11 - - 4 - 1 2 - 1 9 2 - - 3 - 115 96 Households visited reinfectious diseases (Including T.B.) 5 - 2 - - 1 - • 1 2 - 6 - - - - 9 93 131 Other home visits 101 20 123 345 2 167 32 20 55 554 16 135 77 5 14 119 50 7,212 5,955 TOTALS 925 163 1,315 1,416 737 1,115 764 686 928 2,978 496 1,453 1,137 1,436 225 1,260 1,236 59,623 56,330 -e» ATTENDANCES AT CHILD HEALTH CENTRES - 1970 Addiscombe Grove Monday P.M. All Saints Monday P.M. Bens ham Manor Monday A.M. & P.M. Boston Road Thursday P.M. Brighton Road, Coulsdon Thursday P.M. Brighton Road. S. Croydon Wednesday. P.M. Cherry Tree Green Thursday A.M. Coulsdon Youth Club Monday P.M. East Croydon Thursday A.M. & P.M. Falconwood (Alt.) Wednesday P.M. Forestdale (Alt.) Wednesday P.M. Hazelglen Wednesday A.M. Kenley Friday P.M. Lodge Road (Alt.) Monday P.M. Lodge Road Thursday A.M. Lodge Road Thursday P.M. Lodge Road Friday P.M. Monks Orchard Monday P.M. Monks Hill Thursday 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 P.M. Parish Church Monday P.M. Infants born 1970 62 69 153 95 69 101 25 82 249 67 53 30 87 37 104 82 86 88 52 291 117 91 173 91 90 No . of re-attendances 369 394 933 688 331 830 140 607 1.584 273 323 114 681 81 685 287 423 394 241 1,312 609 346 1,043 653 468 Children 1 - 5 years 89 231 416 277 213 208 109 230 371 143 77 82 230 37 193 90 82 339 157 780 375 257 325 342 188 No. of re-attendances 452 819 1,369 1,187 663 708 671 1,391 1,855 491 300 408 894 110 660 359 455 973 480 2.251 1.172 815 2,145 1,665 623 Total attendances 972 1,513 2,871 2,247 1,276 1,847 945 2,310 4,059 974 753 634 1,892 265 1,642 818 1,046 1,794 930 4,634 2,273 1,509 3,686 2,751 1,369 Consultations with doctors 302 627 950 619 586 613 - 633 1,337 329 218 104 638 164 760 470 556 699 384 1,491 723 671 1,278 636 675 No. of sessions 48 48 96 51 52 52 51 47 105 28 24 52 50 16 49 52 50 47 48 104 52 50 104 65 47 Average per session 1970 20.3 31.6 29.9 44.1 24.5 35.5 18.5 49.1 38.7 34.8 31.4 12.2 37.8 16.6 33.5 15.7 20.9 38.2 19.4 44.6 43.7 30.2 35.4 42.3 29.1 Averaoe per session 1969 20.1 35.9 27.4 42.3 30.5 32.5 24.7 35.9 40.7 36.7 23.0 16.0 37.9 16.3 31.4 22.8 17.9 33.1 27.9 47.6 55.2 31.6 40.6 34.9 32.0 Continued on next page. <J» ATTENDANCES AT CHILD HEALTH CENTRES (continued) Purley Tuesday A.M. Rectory Park Tuesday P.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. Selhurst Monday P.M. Selsdon Monday 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. Woodside Friday P.M. TOTAL - 1970 TOTAL - 1969 Clinics held at General Practitioners* Surgeries in 1970 Infants born 1970 99 13 105 26 125 163 90 112 64 95 86 64 42 132 68 91 190 80 117 4206 4422 706 No. of re-attendances 666 79 638 87 577 1048 495 827 329 767 502 369 260 710 386 474 1133 436 360 23952 27237 2893 Children 1 - 5 years 224 101 361 96 310 281 203 236 182 220 217 205 169 161 144 1 93 192 198 325 9859 9742 1398 No. of re-attendances 753 238 1559 259 1432 1225 1036 877 1078 1229 597 685 435 603 508 870 2120 596 707 39723 401 62 4630 Total attendances 1742 431 2663 468 2444 2717 1824 2052 1653 2311 1402 1323 906 1606 1106 1628 3635 1310 1509 77740 81663 9627 Consultations with doctors 824 226 735 264 685 929 862 759 542 657 560 742 470 596 535 790 1227 518 744 28128 28591 4254 No. of sessions 53 27 52 25 52 97 52 50 48 68 50 48 50 53 51 51 101 52 50 2418 2465 414 Average per session 1970 32.9 16.0 51.2 18.7 47.0 28.0 35.1 41.0 34.6 33.9 28.0 27.6 18.1 30.3 21.7 31.9 36.0 25.2 30.2 32.2 - 23.3 Average per session 1969 29.8 24.3 49.5 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 22.3 116 HEALTH VISITIIMG/SCHOOL HEALTH SERVICE Average Case Load per Health Visitor (1969 Figures in Brackets) Average number of families with children 0 - 5 years 413 (467) „ „ „children 0 - 5 years 578 ( 633) „ „ „problem families* 11 (8) „ „ „child health sessions per week 1.8 (2) " infant school children † 324 (33) *In 1969 Health Visitors made their own assessment but in 1970 a common code was developed and the assessment is the same throughout the Borough. † Health Visitors are directly responsible for all infant schools. Responsibility for Primary and Secondary school children remains with the Health Visitors but she delegates much of the work to enrolled nurses. Average Work Load of Ancillary Workers Reg. Nurses Enrolled Nurse, Average number of Junior and Secondary school children 3,265 3,253 Child Health sessions per week 4 4 School treatment sessions 3 1 117 HEALTH VISITOR GROUP ATTACHMENT The work of health visitors working full time throughout the year attached to General Practitioners was compared with health visitors working full time for the whole year in a geographical area. As the number of staff involved is small the figures can only indicate a trend. Average per Health Visitor Attached Geographically Based Children born 1965/1970 Visited during year 431.8 650.9 Re-Visits to Children 0-5 years Visited during year 653.7 601.8 Persons 65 years and over Visited during year 28 16.1 Mentally disordered persons Visited during year 12.5 4.6 Persons discharged from Hospital Visited during year 3.4 1.8 *Other Home Visits 444.5 168.1 *Home Visits related to School Health Service not included 118 HOME NURSING Staff at 31.12.70 1 Assistant Superintendent Nursing Officer - District Nursing 1 Deputy Assistant Superintendent Nursing Officer - District Nursing 2 Assistant Superintendents 42 Nurses S.R.N. (4 Part-time) 6 Nurses S.E.N. 7 Nursing Auxiliaries (Full-time) 1 Nursing Auxiliary (ParMime) Summary of Work carried out during the year 1970 Patients remaining on books at 31st December 1969 1,514 New Patients 5,014 Total 6,528 New Patients Medical 2,473 Surgical 2,626 Gynaecological 12 Maternity 3 Total 5,014 Specially Classified Cases Visits Tuberculosis 59 839 Children 0 -4 94 622 Children 5-15 87 1,148 Patients over 65 4,354 124,535 Termination of Cases Convalescent 2,909 Hospital 1,031 Died 418 Removed - other causes 541 Remaining on books 31.12.70 1,629 Total 6,528 Number of treatments carried out by Home Nurses in General Practitioner Surgeries 8,195 119 Visits January 13,637 February 12,615 March 14,242 April 13,608 May 14,197 June 14,064 July 15,034 August 13,870 September 14,364 October 15,702 November 15,364 December 15,605 Total 172,302 REHABILITATION OF ELDERLY PERSONS Patients visited during 1970 Female 64 Male 30 94 Patients not suitable Hospital 7 Rehabilitation 43 Limited or no success 40 Died 4 Remaining on Books 24 120 CASE LOADS OF HOME NURSES Case loads of Home Nurses vary according to the type of G.P. attachment and type of population served. State Registered Home Nurse paid an average of 15.6 visits per day. State Enrolled Nurse paid an average of 12.5 visits per day. Nursing Auxiliary paid an average of 9 visits per day. GENERAL PRACTITIONER ATTACHMENT SCHEMES 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. Liaison Health visitor, domiciliary midwife or home nurse is responsible both for 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. ATTACHMENT SCHEMES AS AT 31st DECEMBER 1970 (1969 FIGURES IN BRACKETS) STAFF STAFF ATTACHED STAFF IN LIAISON TOTAL Health Visitors 16 (10) 4 (5) 20 (15) Home Nurses 25 (10) 2 (7) 27 (17) Midwives 5 (4) 23(23) 28 (27) TOTAL 46 (24) 29(35) 75 (59) 121 LOAN OF NURSING EQUIPMENT The Corporation lends equipment and makes a small weekly charge, with exemption for incomes below a certain figure. 1970 Health Dept. sh Red Cross Society Air cushion - 3 Air Rings 77 34 Bed Blocks 32 6 pairs Bed Pans 138 49 Bed Rests 124 43 Bedsteads 17 - Bed Tables 6 1 Child's Chair (Wheel) - 4 Commodes 318 90 Cradles 138 41 Crutches (Pairs) 18 6 Diapers 62 - Dunlopillo Mattresses 10 - Enuresis Machines 120 - Feeding Cups 13 4 Foam Squares and Rings 65 4 Foot suction pumps 4 - Fracture boards (Sets) 36 - Hydraulic Hoists 21 1 Incontinence pads 41,725 - Kidney bowls 1 - Mackintosh sheets 83 9 North pads 17 - Paddi pads 63 - Paddi rolls 4,237 - Pick-up-stick - 4 Plastic sheets 27 - Protective Under-garments 140 - Pulleys 26 - Ripple beds 42 - Toilet extension - 2 Urinals 73 10 Walking aids 214 39 Walking Sticks 14 37 Wheelchairs 123 157 122 HOME HELP SERVICE Staff at 31.12.1970 1 Principal Home Help Organiser 1 Deputy Principal Home Help Organiser 1 Tutor Organiser 5 District Organisers 1 Assessment Officer 6 Clerical Assistants 10 Full Time Home Helps 214 Part Time Home Helps Summary of work carried out during the year under review:- Patients remaining on books from 1969 1,814 New Applicants 1,254 Patients carried forward to 1971 1,899 New Applicants (a) Maternity 195 (b) Sickness 1,059 (c) Night Service NIL Classification of Cases attended (a) Maternity 149 (b) Mental Health 20 (c) Chronic Sick including Old Age and T.B. 2,398 (d) Other - including Acute Sick and Problem Families 264 Number of Hours Service Given 206,400 Average Duration of Service given (a) Maternity 10 days (b) Acute Sick 10-21 days (c) Chronic Sick Indefinitely Amount Recovered for Service £12,270.1.10d. Rate of Remuneration of Home Helps at 31.12.1970 Home Helps 7/8d (dated from 9.11.70) per hour Washing Service 7/8d ( " " " ) per hour Disinfestation 10/- per week 123 DEATHS FROM ACCIDENTS IN THE HOME Cause No. Details Falls 14 There were 9 women and 5 men between 68 and 96 years of age. Asphyxia 6 1 man - aged 39 years - Carbon Monoxide poisoning from car exhaust fumes. 1 woman aged 45 years - drowning and carbon monoxide poisoning. 1 man aged 51 years - inhaled vomit after drinking beer, choking when asleep. 1 woman aged 81 years -impaction of food in larynx. 1 woman aged 81 years - Carbon Monoxide poisoning from inhalation of fumes - domestic boiler. 1 woman - aged 82 years - inhalation of vomit - gastro-enteritis. Bums and Scalds 7 1 man aged 17 - burns and inhalation of smoke. 1 man aged 45 - Clothing caught fire while burning rubbish in a dustbin. 1 man aged 45 - Bedding ignited from smoking materials. 1 man aged 53 - Multiple burns. 1 woman aged 83 - Clothing caught fire from gas fire. 1 woman aged 85 - Multiple scalds. 1 man aged 93 - bedding ignited by smoking materials Poisoning 5 1 man aged 22 years - Chlordiazepoxide. 1 woman - aged 20 years - Barbiturate and Methadone. 1 woman - aged 64 years - Aspirin. 1 man aged 66 years - Amylobarbetone and chlorodyne. 1 woman aged 70 years - Carbritol. TOTAL 32 124 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 Expectant and 0*4 (inc.) Nursing Mothers First visit 647 Subsequent visits 1,126 137 222 Total visits 1,800 359 Number of additional courses of treatment other than the first course commenced during the year 73 13 Treatment provided during the year - Number of fillings 1,769 196 Teeth filled 1,562 190 Teeth extracted 325 99 General anaesthetics given 142 13 Emergency visits by patients 130 32 Patients X-rayed 14 20 Patients treated by scaling and/or removal of stains from the teeth (prophylaxis) 81 41 Teeth otherwise conserved 170 • Teeth root filled 1 I nl ays 2 Crowns 1 Number of courses of treatment completed during the year 553 97 Part B. Prosthetics Patients supplied with F.U. or F.L. (First time) * Patients supplied with other dentures 10 Number of dentures supplied 10 Part C. Anaesthetics General anaesthetics administered by dental officers Nil 125 Part D. Inspections Children 0-4 (inc.) Expectant and 1 Nursing Mothers Number of patients given first inspections during year 992 134 Number of patients in A and D above who required treatment 572 114 Number of patients in B and E who were offered treatment 572 114 Part E. Sessions Number of sessions (i.e. equivalent complete half-days) devoted to Maternity and Child Welfare patients: For treatment For health education 330 16 126 CERVICAL CYTOLOGY Number of women tested during 1970 Month No. of Clinics Class ! Class II Class III Class /V Class V TOTALS TOTALS New Cases Repeats New Ceses Repeats New Ceses Repeats New Cases Repeets New Cases Repeats New Cases Repeets January 13 65 74 37 42 3 2 1 - - - 106 118 224 February 12 177 36 84 34 2 - - - - 263 70 333 March 17 280 17 111 16 3 1 1 - - - 395 34 429 April 17 234 61 81 46 3 - 1 - - - 319 107 426 May 15 211 47 100 38 5 - - - - - 317 85 402 June 15 152 50 100 61 - - - - - - 252 111 363 July 19 272 50 128 25 2 2 - - 1 - 403 77 480 August 18 231 42 121 39 3 2 - - 1 - 356 83 439 September 19 213 35 120 36 5 2 - - . - 338 73 411 October 17 207 38 129 47 5 - - - 1 - 342 85 427 November 18 207 52 111 56 2 . 1 - . - 321 1 08 429 December 13 129 34 65 46 2 1 - 2 - - 196 83 279 TOTAL 1 93 2.378 536 1.1 87 486 35 10 5 2 3 - 3.608 1 .034 4,642 Numbers referred to Family Doctors for Treatment January 13 April 29 July 29 October 28 February 7 May 43 August 33 November 31 March 30 June 24 September 39 December 23 TOTAL REFERRALS = 329 AGE GROUPS 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-69 60-64 65-69 70-74 Total Class 1 25 158 394 471 477 462 406 262 176 65 13 5 2,914 Class II 3 66 183 212 237 239 244 221 188 60 16 4 1,673 Class III 1 4 8 8 14 4 4 2 . - - - 45 Class IV . . 1 2 2 . 2 . • • • - 7 Class V . . . 1 1 . • . • • 1 3 TOTAL 29 228 586 694 731 705 656 485 364 125 30 9 4,642 Class I - NORMAL SMEAR PATTERN according to age and physiological state (including pregnancy). Class II • "INFLAMMATORY* PATTERN - may be due to erosion, bacterial or Monolial infections. Trichomonad 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 atypicality of cervical epithelium. Current opinion suggests that at this stage such a condition may be reversible. Careful follow-up and specialist management required. Class IV - ISOLATED CELLS SUGGEST MALIGNANCY - Early gynaecological review essential. Class V - MALIGNANCY PROBABLE - Early gynaecological review essential. 127 LONG STAY IMMIGRANTS 1970 Country Issuing Passport Notifications Received Successful Visits Unsuccessful Visits Commonwealth Countries Caribbean 101 89 12 India 75 61 14 Pakistan 62 55 7 Other Asian 27 24 3 African 133 90 43 Others 87 81 6 Non-Commonwealth Countries European 44 29 15 Others 39 23 16 TOTAL 568 452 116 MALES 173 FEMALES 200 CHILDREN (under 18 years of age) 195 128 Nursing Homes - Nursing Homes Act. 1964 Number of Homes Number of beds provided for Maternity Other Total Homes registered during the year - . * . Homes closed during the year 2 16 26 42 Homes on the Register at the end of the year 14 20 370 390 One general nursing home and one maternity home were 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. A fourth was licenced but did not operate during 1970. CREMATION ACTS. 1902 and 1952 During the year 2,870 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, including one nonviable foetus 1,093 One Adult no Post Mortem Examination. One Stillborn no Post Mortem Examination. Total number of Post Mortem Examinations for H.M, Coroner 1,092 129 CROSFIELD INDUSTRIAL UNIT The number of severely disabled persons employed in the sheltered workshop section on 31.12.70 was 98, made up as shown below. The comparable figures for 1969 are shown in brackets. Type of disability Male Female  Mental illness 24 (24) 18 (18) 42 (42) Subnormality 22 (16) 5 (6) 27 (22) Severe Subnormality 7 (8) 8 (7) 15 (15) Physical handicap 12 (13) 2 (2) 14 (15) 65 (61) 33 (33) 98 (94) 1 male (7) and 4 female (1) attend from Warlingham Park Hospital. Totals of employees admitted via:— Male Female Total Assessment & Rehabilitation Section 9 (11) 6 (2) 15 (13) Disablement Resettlement Officer 1 (4) 1 (-) 2 (4) Warlingham Park Hospital . (3) . (2) - (5) Waylands 2 (-) _ (-) 2 (-) Day Hospitals . (1) . (2) - (3) Social Worker 1 (-) - (•) 1 (-) 13 (19) 7 (6) 20 (25) Number of employees leaving unit: Open employment 6 (13) Waylands 1 (1) Died 1 (4) Other causes 8 (12) 16 (30) The number of non-sheltered workshop trainees as at 31.12.70 was 7 (4), there being 15 admissions during the year and 12 discharges. Remuneration 1970 1969 £ s. d. £ s. d. Total paid out as pocket money (non-sheltered workshop group) 525. 7. 0. 473. 0. 6. Total amount paid out as wages 54,448. 19. 9. 49,652. 18. 7. £54,974. 6. 9. £50,125. 19. 1. 130 Income:— 1970 1969 £ s. d. £ s. d. Industrial contracts: Packing, assembly, electrical sub-assembly 62,071. 0. 3. 39,505. 1. 9 Mobile Work Group 6,595. 8. 4. 3,521. 14. 5. Manufactured goods and Manpower section 465. 15. 7. 315. 7. 3. Manufactured breeze blocks sold 1,874. 13. 9. 5,443. 3. 1. £71,006. 17. 11. £48,785. 6. 6. Value of raw materials in stock at 31.12.70 £294. 0. .0. Average daily attendance (excluding paid and approved unpaid holidays) 89 (94) ASSESSMENT AND REHABILITATION SECTION Number of rehabilitees attending on 31.12.70 27 Type of disability Male Female Total Mental illness 11 (16) 3 (6) 14 (22) Subnormality 7 (7) 3 (6) 10 (13) Severe Subnormality 1 (-) . (-) 1 (•) Physical handicap 1 (2) 1 (-) 2 (2) 20 (25) 7 (12) 27 (37) 3 males attend daily from Warlingham Park Hospital. Referral source:— Male Female Total Warlingham Park Hospital 6 (10) 3 (2) 9 (12) Waylands - Health Wing 4 (4) 1 (4) 5 (8) Waylands -Welfare Wing 4 (•) 1 (-) 5 (-) Day Hospitals 10 (12) 4 (2) 14 (14) Department of Employment 2 (9) 1 (6) 3 (15) Social Workers 4 (7) • (2) 4 (9) Others 8 (6) 4 (-) 12 (6) 38 (48) 14 (16) 52 (64) Totals of rehabilitees discharged during the year:— Male Female Total Open employment 18 (16) 6 (6) 24 (22) Sheltered employment 9 (12) 6 (2) 15 (14) Industrial Rehabilitation Unit • (4) • (-) • (4) Cherry Orchard Centre 1 (-) 1 (-) 2 (-) (cont. overleaf) 131 Male Female Total Day Hospitals • (3) - (-) - (3) Waylands - Health Wing 1 (-) 1 (1) 2 (1) Waylands - Welfare Wing 1 (-) • (-) 1 (-) Terminated 12 (16) 4 (4) 16 (20) Non sheltered workshop 1 (-) 1 (-) 2 (-) 43 (51) 19 (13) 62 (64) Average daily attendance during the year: 21 (30) Total income from industrial work (approx.): £5,965. 16. 2. WAYLANDS CRAFTWORK, TRAINING & SOCIAL CENTRE • HEALTH WING Statistics concerning severely disabled in the Health Wing of the Waylands Craftwork, Training and Social Centre were as follows:- Numbers of severely disabled persons attending the Health Wing at 31.12.70: Type of disability Male Female Total Mental illness 1 (5) - (1) 1 (6) Subnormality 10 (11) 12 (20) 22 (31) Severe Subnormality 40 (48) 23 (30) 63 (78) Physical handicap 2 (2) 2 (1) 4 (3) 53 (66) 37 (52) 90 (118) Totals of trainees admitted to Waylands from: Male Female Total Coldharbour School 1 (1) 1 (1) 2 (2) St. Christopher's E.S.N. School 2 (2) 1 (1) 3 (3) Careers Officer 2 (1) - (2) 2 (3) Social Worker - (3) 1 (-) 1 (3) Crosfield Assessment and Rehabilitation Section 1 (-) 1 (1) 2 (1) Other Sources 7 (2) 1 (2) 8 (4) 13 (9) 5 (7) 18 (16) Total of trainees discharged to: Crosfield Assessment and Male Female Total Rehabilitation Section 4 (4) 1 (4) 5 (8) Left area - (2) 1 (1) 1 (3) Open employment 1 (-) • (1) 1 (1) Day Centre . (•) 1 (1) 1 (1) Other sources 1 (2) 3 (3) 4 (5) Cherry Orchard Centre 22 H 12 (-) 34 (-) 28 (8) 18 (10) 46 (18) 132 Remuneration 1970 1969 £ s. d. £ s. d. Total merit payments, fares, craftwork payments to whole centre. 10,798. 7. 6. 10,297. 2. 8. Total earnings for whole centre 11,635. 3. 3. 11,278. 16. 1. Average daily attendance (Health Wing only) during the year: 109 (105) The Cherry Orchard Advanced Adult Training Centre The Cherry Orchard Advanced Adult Training Centre was opened Ipte in December 1970 - its composition on 31st December being: Type of disability Male Female Total Mental illness 2 2 4 Subnormality 14 12 26 Severe Subnormality 7 2 9 23 16 39 133 COMMUNICABLE DISEASES NOTIFIED DURING 1970 Notifiable Disease At all ages Cases notified Total cases notified In wards At ages • veers U. Norwood Norburv W. Thornton Ben. Manor Thornton Heath S. Norwood Woods ide East Addlscombe Whltehorse M. Broad Green Central Waddon Addlngton * Shirley Sanderstead North Sanderstead and Selsdon Woodcote and Coulsdon West Coulsdon East Purle v M F TOTAL Under 1 1 - 4 5- 14 15 - 24 25 • 44 45 - 64 65 & over Anthrax • . • • . . . • . . . . . • . • . . . . . . . • - . • . . . . Scarlet Fever 120 • 29 86 5 - - 3 4 '1 2 9 11 8 7 1 3 3 2 23 9 4 2 4 16 8 64 66 120 Diphtheri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acute Menlnaitls 7 2 4 . 1 • . - 1 1 1 • . • 1 • . . . 1 . . 1 • • 1 • . 6 1 7 Typhoid and Para Typhoid 3 1 1 . . . . . . . . . . . . . . . . . . . 1 1 . . . . 3 3 Smallpox . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .Cholera • - • • - . . . • • • - • - . . . . - - - - • - • • • • Typhus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ophthalmia Neonatorum 8 8 . • . . . . . . . 1 . . 1 . 4 . . . . 1 1 . . . . . 5 3 8 Acute Poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dysentery 19 1 4 6 2 4 2 1 . • 3 . 1 - 2 • . . . . 2 * • - 8 1 2 8 11 19 Malaria • • • • - • • . . • . - . • - • - . . . . - • • • - • • - - • infectlve Jaundice 48 - 4 13 13 12 6 2 1 2 1 4 4 6 3 1 2 2 2 7 2 - 2 3 2 1 26 22 48 Food Poisoning 16 2 1 1 2 7 2 . 1 • 1 1 . - - - 1 . . 2 2 - 4 - 2 - 1 5 10 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Measles 1038 46 624 469 6 3 • . 29 39 98 90 46 46 54 47 37 54 68 24 42 61 109 14 2 29 86 63 506 532 1038 Whooping Cough 147 27 66 53 - 1 1 11 4 6 1 8 5 8 3 - 11 2 2 7 38 24 5 4 2 • 6 69 78 147 Leptospirosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tetanus 2 . . . . . 2 . . . . . . . . . . . . . . 1 • - - • 1 1 1 2 Yellow Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1407 87 632 617 29 28 11 3 47 49 109 99 65 67 76 65 46 69 75 33 51 134 147 28 11 49 105 82 680 727 1407 Tubersulosis notifications are shown in the section relating to that disease 134 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1970 Notifiable Diseases Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 6 3 10 6 3 4 6 7 11 9 6 4 74 Non-Respiratory Tuberculosis 1 - 2 - - 1 2 1 3 1 1 - 12 Anthrax - - • - - • • . - • • • - Scarlet Fever 6 7 22 10 - 17 12 10 6 12 5 6 120 Diphtheria - • - - - - - - • . • - - Acute Meningitis - . 1 2 - . - - - 2 1 1 7 Typhoid & Paratyphoid - - - • - - 1 1 1 • - • 3 Smallpox - - - • - - - - - - - • - Cholera - • - - - - - - - - - • * Typhus - - • - - - - - - - - - - Ophthalmia Neonatorum - - 4 1 - 1 - - - - 2 - 8 Acute Poliomyelitis - - • - - • - - - • - • Dysentery 2 5 1 4 1 1 - 5 - n - • 19 Malarla - - • • - • - • - - - • - Infective Jaundice 4 3 4 3 1 4 2 3 9 8 6 2 48 Food Poisoning 2 • - 2 - 1 2 1 6 1 • 1 15 Acute Encephalitis - - • - - - - - - - • - - Measles 12 42 34 49 91 195 213 129 40 22 73 138 1038 Whooping Cough 5 2 3 3 10 5 3 4 19 26 26 41 147 Leptospirosis • - - - - - - - - • • - - Tetanus - - - 1 - - 1 • • - - - 2 Yellow Fever • • • - - -• * • • • • • * 135 FOOD POISONING Corrected food poisoning notifications and cases ascertained in 1970 numbered:— 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total 4 3 11 6 24 Outbreaks due to identified agents:— Total Outbreaks Total Cases 6 13 Outbreaks due to:- (a) Chemical poisons Nil (d) botulinum Nil (b) Salmonella organisms 6 (e) welchii Nil (c) Staphylococci (including (f) other bacteria Nil toxin) Nil Outbreaks of undiscovered cause:— Total Outbreaks Total Cases 2 4 Single Cases:— Agent identified Unknown Cause Total 5 2 7 Cases due to:— Salm. panama Salm. enteritidis Salm. heidelberg 1 1 1 Salm. bovis morbificans Salm. ohio Salm. unidentified 1 1 2 Salmonella infection not food-borne:— Nil 136 SAMPLES SUBMITTED TO THE PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION - 1970 Faeces outfits 1,514 Drinking Water samples 711 Public Swimming Bath Water samples 130 Private Swimming Bath Water samples 176 Private Wells 142 Milk samples 158 Cream samples 1 Ice Cream samples 105 Sundry Food specimens 29 Blood 21 Urine 656 Nose and Throat Swabs 43 Total 3,686 Samples of Drinking Water During the year under review the total number of examinations performed were:— Bacteriological 709 Chemical 9 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. 137 IMMUNISATION AGAINST WHOOPING COUGH A total of 4,711 children were immunised against whooping cough, comprising 4,564 under school age and 147 school children. In addition 1,061 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 5,373 children were immunised against tetanus, comprising 4,633 under school age and 740 school children. In addition 6,277 children were given reinforcing injections. DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1970 who completed a course of immunisation during the year. Age at 31.12.70 i.e. born in year Under 1 1970 1967-1969 1966-1963 1962-1954 Total Completed course of Injections 311 4,321 289 145 5.066 Reinforcing injections - 511 3,847 1.310 5.668 TOTAL 311 4.832 4.136 1.455 1 0,734 Under 1 1 - 4 Total under 5 5-14 Total under 15 Estimated mid year Child population 1969 5.520 22,280 27.800 50.600 78,400 1970 figures not available at time of printing VACCINATION AGAINST MEASLES A total of 4,663 children were vaccinated against measles. VACCINATION AGAINST SMALLPOX A total of 6,941 persons were vaccinated against Smallpox. Under 1 veer of age 1 1 - 4 5-16 16 or over Totel Successful Vaccinations Successful Re-vaccinations Insusceptible to Vaccination 9 1.297 1,949 86 589 506 329 2,176 4,173 2,768 6,941 138 VACCINATED AGAINST POLIOMYELITIS The following table gives the number of persons who received a course of primary vaccination during the year. VACCINATED Children born 1970 Children born 1969 Children born 1968 Children born 1967 Young persons born 1966-63 Young persons born 1962-54 Persons over 16 years of age With Oral Vaccine 311 3,364 1.206 153 273 184 45 Number of persons who received a reinforcing vaccination as at 31st December, 1970. VACCINATED Persons given a first reinforcing Vaccination during 1970 With Oral Vaccine 8,386 Annual Total 8.386 Total since Vaccination began 1957 146.510 INTERNATIONAL VACCINATION CERTIFICATES During the year 9,670 certificates were authenticated, 6,792 Smallpox, 1,781 Cholera, 1,097 T.A.B. IMMUNISATION OF CHILDREN BORN IN 1969 Poliomyelitis Diphtheria 1969 Live Births 341 - (Immunised 1969) 439 3,364 - (Immunised 1970) 3,026 3,705 3,465 5,446 (68%) (64%) MEASLES VACCINATION FROM APRIL 1968 Year Children Vaccinated 1968 6,035 1969 3,546 1970 4,663 139 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATIONS AND MORTALITY - 1970 140 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS.1952 Summary of notifications during the period from 1st January, 1970 to 31st December, 1970. Formal Notification Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 26- 35- 45- 55- 65- 75- Total (aII ages Respiratory, Males - 1 4 - 2 2 2 6 6 10 8 6 - 47 Respiratory. Females 1 1 3 1 - 1 2 5 2 5 2 2 2 27 Non-Respiratory, Males - - - 1 - - 1 2 2 - - - - 6 Non-Respiratory, Females - - - - - 2 - 1 - 1 - 1 1 6 Rehousing of Tuberculous Patients 8 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. CLASSIFICATION OF NEW PATIENTS Respiratory During 1970. 76 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) 49 64.5 B, or T.B. plus, 1 (early cases, sputum positive) 5 6.6 B, or T.B. plus, 2 (intermediate cases, sputum positive) 22 28.9 B, or T.B. plus, 3 (advanced cases, sputum positive) 76 100.0% Non-Respiratory Tuberculosis There were 10 cases examined at the Clinic and found to have NonRespiratory Tuberculosis in the following forms:— Bones and Joints- Abdominal- Other Organs 1 Peripheral Glands 9 10 141 Ages at Death from Respiratory Tuberculosis Year 0-5 6 - 15 15 - 25 25 - 45 45 • 65 over 65 total 1970 - • - ' 5 3 8 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1970 939 Transfers in from other areas 16 New cases confirmed during the year 76 1.031 Number of cases written off the Chest Clinic Register during the year as:— Recovered 157 Died 17 Removed to other areas 15 "Lost sight of " and other reasons 12 201 Remaining on Register as at 31st December 830 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 1,882 Number of visits paid by Clinic doctors to homes of patients 214 Number of visits paid to homes of patients by Tuberculosis Health Visitors 3,331 Attendances of patients at the Clinic - At ordinary sessions *14,626 Number of X-Ray films taken * 17,260 * Includes 4,476 miniature film attendances 142 SEXUALLY TRANSMITTED DISEASES New cases residing in Croydon and treated at various London Clinics 143 SEXUALLY TRANSMITTED DISEASES Croydon General Hospital Centre SYPHILIS 1. New Cases of Syphilis Totals Males Females (i) Primary 4 3 1 (ii) Secondary 2 1 1 (iii) TOTAL OF LINES 1 (i) and 1 (ii) 6 4 2 (iv) Latent In the first year of Infection - - - (v) Cardio-vascular - - - (vi) Of the nervous system 3 2 1 (vii) All other late and latent stages 20 5 15 (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 15 and over 3 1 2 (xii) TOTAL OF LINES 1 (iii) to 1 (xi) 32 12 20 2. Age Groups of Cases in Item 1 (i) & (ii) Above (i) Under 16 - - - (ii) 16 and 17 - - - (iii) 18 and 19 - - - (iv) 20 - 24 2 1 1 (v) 25 and over 4 3 1 (vi) TOTAL OF LINES 2 (i) to 2 (v) 6 4 2 3. Cases Transferred from other Centres in England and Wales after Diagnosis 7 4 3 4. Cases in Which Treatment and Observation were Completed 8 4 4 GONORRHOEA 5. New Cases of Gonorrhoea (i) Post-pubertal Infections 281 188 93 (ii) Vulvovaginitis - - - (iii) Ophthalmia Neonatorum - - - TOTAL OF LINES 5 (i) to 5 (iii) 281 188 93 6. Age Groups of Cases in Item 5 (i) Above (i) Under 16 9 1 8 (ii) 16 and 17 15 5 10 (iii) 18 and 19 35 12 23 (iv) 20 - 24 82 55 27 (v) 25 and over 140 115 25 (vi) TOTAL OF LINES 6 (i) to 6 (v) 281 188 93 7. Cases Transferred from Other Centres in England and Wales after Diagnosis 4 1 3 8. Cases in which Treatment and Observation were Completed 71 36 35 144 9. New Cases of Other Conditions Totals Males Females OTHER CONDITIONS (i) Chancroid - - - (ii) Lymphogranuloma - - - (iii) Granuloma Inguinale - - - (iv) Non Gonococcal Urethritis 500 500 - (v) Non Gonococcal Urethritis with Arthritis 1 1 - (vi) Late or latent Treponemetosess presumed to be non-Syphilltic 14 3 11 (vii) Other conditions requiring treatment within the centre (a) Trichomoniasis 90 6 84 (b) All other 668 321 347 (viii) Conditions requiring no treatment within the centre 403 246 157 (ix) Undiagnosed conditions 2-2 - 22 (x) TOTAL OF LINES 9 (i) to 9 (ix) 1636 1077 621 10. Cases Transferred from Other Centres iin England and Wales after Diagnosis 8 1 7 11. Cases in which Treatment and Observation were Completed 724 309 415 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 - - - (iv) 20- 24 2 1 1 (v) 25 and over 4 3 1 (vi) TOTAL OF LINES 12 (1) (i) to 12 (1) (V) 6 4 2 (2) GONORRHOEA (Post-pubertal) Age Groups (i) Under 16 9 1 8 (ii) 16 and 17 14 4 10 (iii) 18 and 19 33 10 23 (iv) 20 - 24 78 51 27 (v) 25 and over 124 99 25 (vi) TOTAL OF LINES 12 (2) (i) to 12 (2) (v) 258 165 33 13. Localities in which Infections Took Place (1) PRIMARY OR SECONDARY SYPHILIS (i) In locality of Centre 1 1 - (ii) Elsewhere in Great Britain end Northern Ireland 3 1 2 (iii) Outside Great Britain and Northern Ireland 2 2 (iv) Not known - - - (V) TOTAL OF LINES 13 (1) (i) to 13(1) (iv) to agree with line 1 (iii) 6 4 2 (2) GONORRHOEA - - - (i) In locality of Centre 209 144 65 (ii) Elsewhere in Great Britain and Northern Ireland 56 28 28 (iii) Outside Great Britain end Northern Ireland 16 16 - (iv) Not known - - - (V) TOTAL OF LINES 13 (2) (i) to 13 (2) (iv) to agree with line B (i) 281 188 93 145 14. Attendances and Diagnoses of Contacts Totals Males Females (1) Contacts slips Issued to patients with (i) Syphilis, primary and secondary - - - (ii) Gonorrhoea 194 169 25 (2) Contacts attending with (i) Syphilis, primary and secondary 1 - 1 (ii) Gonorrhoea 52 4 48 (iii) Other conditions 211 31 180 15. Total Attendances of All Patients (i) Syphilis 439 320 119 (ii) Gonorrhoea 926 481 445 (iii) Other conditions 4281 2569 1712 (iv) ALL CONDITIONS (TOTAL OF IB (i) (ii) and (iii) 5646 3370 2276 16. Cultures for the Gonococcus 1263 19 1244 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 Cases In year Syphilis Gonorrhoea Other Vanereel Conditions Totals all Venereal Conditions Primary and Secondary Other (1) (iv) to (1) (iii) (1) (xi) (5) (iv) (9) (x) CROYDON 1 24 193 1184 1402 BROMLEY - - 7 43 50 HARINGEY - - - 3 3 KINGSTON - - 1 5 6 LAMBETH - - 9 60 69 LEWISHAM - 1 4 15 20 MERTON - - 4 18 22 SURREY 3 - 13 141 157 SUTTON - - 5 54 59 WANDSWORTH 2 - 9 16 27 OTHERS " " 17 99 116 TOTALS 1970 6 25 262 1638 1931 TOTALS 1969 14 29 314 ´1498 1857 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1970 To the Chairman and Members of the Education Committee: LADIES AND GENTLEMEN, This is the sixth Annual Report of the School Health Service of the London Borough of Croydon. It covers the usual wide range of activities, and is fortunately devoid of any major adverse episode, I comment on some aspects dealt with in detail in the Report itself. Routine School Medical Inspections These continued unchanged as the basis for supervision and ascertainment. The numbers increased in ratio with the larger school population. For several years I have mentioned national trends to modify or replace this system, and with our centralization of medical records making good progress we shall soon be able to operate any of the adaptations current in other local authority areas. However, scrutiny of their reports and local study sessions have reinforced our view that if skilled and interested doctors are covering these medical interviews, which-determine the need for more detailed medical examinations, no alternative techniques are of superior or even of equal merit. There was thus no pressing need for changes under conditions of medical staffing which prevailed last year, and this satisfactory position continues. 2 Personal Hygiene In 1969 there was recorded an 11% increase in the number of children with infested heads as compared with the previous year, and the annual increase rose in 1970 to 30%. These are increases over previous rates, and it must be remembered that less than 1% of the children inspected were unclean. Nevertheless some parents were understandably disturbed when their children were notified as verminous. Hair which is allowed to grow and is worn as intended by nature is easily infested and difficult to cleanse. Present hair styles for both girls and boys are kind to head lice, which found little shelter on the shorter locks or more denuded scalps of previous fashions. Insecticidal shampoos became less efficient and we were back to the toil and trouble of the fine tooth comb, and legal action against those unwilling to exert themselves or to allow the Authority to cleanse and.keep clean their own and their children's hair. These families are the foci of infestation, never entirely eliminated, and from which in favourable circumstances the increases stem. Plantar Warts. This minor but annoying condition is equally difficult to eradicate. Relaxation of detection, exclusion from barefoot activities, and prompt treatment are followed by a temporary increase of prevalence until the appropriate measures are reinforced. Such an increase was noted last year and the necessary action taken. Vision Defects. In the northern part of the Borough the waiting list for the hospital Eye Unit became unreasonably long. Following advice from the Consultant Ophthalmologist the Committee agreed that reference to Opticians should be offered to parents of children with refractive errors. It is too early to report on the results of this new procedure. Defects of the Nervous System The long waiting list for Intelligence Assessments resulted from an invitation to Head Teachers for the names of children who should be considered for the new school for educationally subnormal pupils. It was thus an exceptional situation and does not reflect some unexplained change in the ordinary school population. The help of the School Psychological Service was sought to cope with the problem. Audiology. Despite ascertainment during the first year of life, and the use of sophisticated electronic equipment, a few children remain deaf. This dashing of earlier hopes that every child could be assured some degree of hearing has necessitated a national review of educational facilities against the background of staff shortages. Locally the Kingsley units were 3 reorganised to cater for infant and nursery partially hearing in one class, and infant and nursery deaf in another. A similar division was made for juniors. Maladjusted Children. In connection with a welcome reduction in the waiting list for the Child Guidance Clinic, the Consultant Psychiatrist mentions especially the work of the Psychiatric Social Workers. The advent of the Social Services Act raised the future problem of these officers being excluded from the main establishment of local authority social workers, since they were to remain members of the Education Department. This was not a matter which could be pursued during the year under review. Possible pupils for the new Sir Cyril Burt day school for the maladjusted were considered in relation to the considerable number awaiting placement in residential schools. It is hoped that the local facilities of day school and hostel will be ready by mid 1971. Speech Disordered Children. Dr. Worster Drought, Consultant Neurologist, who was the adviser to the Speech Clinic and the special day school unit, retired at the end of the year. He was one of the most experienced and skilled Neurologists in this field of speech defects, and his advice and guidance were always most helpful. He took special care to pass over his current cases to Dr. Hierons who succeeds him. Infectious Diseases. No special difficulties arose. The Committee agreed that vaccination against rubella could be offered to girls in their 14th year of age, and performed in schools. We are very conscious of the interference with school routine occasioned by such procedures, but it is the most efficient method of protecting the largest number of susceptible individuals. The help of school staffs in this connection was greatly appreciated. Dental Services. Recruitment of Dental Officers was most successful, and permitted inspection of 93.7% of all children. Despite a growing programme of general and special dental health education, the Chief Dental Officer reports that the number of dentally unfit children, and the amount of dental decay observed, increased. Also that the proportion of failed appointments for treatment was almost 25%, of which two-thirds were unexplained failures to attend. Health Education. The Principal Health Education Officer describes efforts to involve all schools in the programmes on healthy living which have been tested and 4 developed over many years. The emotive subject of drug dependence was again discussed at a multi-disciplinary staff in-service study session. Participants agreed that the basis of any local authority programme should be the school health education course, which includes the problem within the general syllabus, and thus keeps it in perspective. We need to give the facts and our warnings without an emotional reaction which may raise morbid curiosity. Staff. Dr. J.S. Homer, known to the Committee as having a primary responsi* bility for the School Health Service, left to take up a Chief Officer post in another London Borough. He was succeeded by Dr. J. Burrowes. To both I am indebted for loyal support during the year under review. Other members of the section were equally helpful, especially the Chief Assistant, Mr. W.S. Wake, who was particularly hard pressed during the transition period before Dr. Burrowes took up duty. Finally, in a year concerned with far reaching educational changes the kind co-operation of the Chief Education Officer, his staff, and of teachers in all schools, was nevertheless exemplary. The problems of the Committee in dealing with basic educational systems did not prevent your usual interest and support for the school health service, and I take this opportunity to express the appreciation of all members of the Department. Yours faithfully, S.L. WRIGHT, Principal School Medical Officer. 5 PARTICULARS OF SCHOOL CLINICS as at 31.12.1970 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.) VERRUCAE Purley Clinic, Whytecllffe Road, Purley. (Wed. p.m.) Sanderstead Clinic, Rectory Park. (Mon. & Fri. p.m.) Norbury Manor Junior School (Wed.a.m. In term) DENTAL Lodge Road, Broad Green, Croydon. 206, Selhurst Road, South Norwood. Parkway Clinic, New Addington. Purley Clinic, Whytecllffe Road. Purley. Shirley Road, Shirley, Croydon. Sanderstead Clinic, Rectory Park, Sanderstead Waddon Clinic. Coldharbour 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, Rockmourrt Road, Upper Norwood. Waddon Clinic, Coldharbour Road, Croydon. Sanderstead Clinic, Rectory Park, Sanderstead. PHYSIOTHERAPY; Lodge Road Clinic Annexe, Lodge Road, Croydon. 47, St. James's Road, Broad Green. Croydon. Parkway Clinic. New Addington. Sanderstead Clinic, Rectory Park, Sanderstead. 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, Coldharbour 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, Whytecllffe Road, Purley. (Friday p.m.) 6 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) on various days by appointment. STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 11 (full-time) (36.7%) *Medical Officers 6 (part-time) Consultants and Specialists 9 (part-time) *Dental Officers 15 (including 4 part-time and 2 Dental Auxiliaries) (80%) *Physiotherapists 10 (including 6 part-time) Speech Therapists 6 *School Nurses and Nurse/Assistants 72 (including S.H.V. and Deputy and 12 part-time) (52%) *Dental Surgery Assistants 16 (including 6 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 £170,857. Cost of Special Schools Schools maintained by the Council £161,643 Other Schools (not maintained by local Education Authorities) £72,921 Adjustments with other authorities in respect of Special Schools £49,653 £284,217 7 PART 1. MEDICAL INSPECTION IN SCHOOLS Routine medical inspections in school still remain the basis of the Borough's School Health Service and are provided in maintained schools and others which have requested them. The following inspections are carried out:— (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 shows an increase of 2½% to 18,830 in line with the increase in the number of school children. The question of some change in the present system of inspections is still receiving consideration but the indication for, and the direction of, change is still far from clear cut. The emphasis in School Health is towards more.professional time being given to where it is needed most, and this concept is straightforward where the children are receiving special education because of a handicap of some kind. However, many pupils in ordinary school also have a degree of handicap requiring advice and possibly treatment, and convincing evidence that any change in our system will enable these children to be recognised at least as well as under the present regime is needed. Table 1. Numbers seen at Medical Inspections 1970 Routine Inspections - 18,830 Special Inspections - at school medical sessions 986 at inspection clinics 34 1,020 Reinspections — at school medical sessions 3,324 at inspection clinics 549 3,873 8 Special inspections have not increased this year beyond that expected with the increase in the school population though re-inspections continue to be asked for more frequently by medical officers. The proportion of parents attending the various inspections has not changed significantly in the year under review. Table 2. Attendance of Parents at School Medical Inspections 1970 1969 Boys Girls Boys Girls Entrants 84.3% 83.8% 82.3% 81.5% Leavers 4.4% 5.8% 3.9% 6.5% Others 58.0% 58.7% 55.4% 59.2% Total Numbers of Children examined 9,491 9,339 9,373 9,005 Total Attendance of Parents 54.4% 55.3% The number of visits to private schools was similar to last year but there was an increase in the number of pupils seen. Details are given in Appendix C, page 55. The total number of defects discovered was 6,825, and the number of defects noted as requiring observation, 7,353. Both showed a greater increase than the larger number of medicals should have produced. The reason is not clear as the increase is widely spread over the range of defects. Personal Hygiene Unfortunately the problem of head infestation became more prominent during the year, many more inspections were carried out and 30% more children were found unclean for the first time. A similar increase was noted in the number found infested at follow-up visits. The condition is not evenly spread throughout the Borough but is confined to a relatively small number of schools. Intensive efforts are being made by the Health Visiting staff to deal with the problem by treating some of the children in school and at home and bringing families to the Cleansing Station. A leaflet to inform parents about what to look for and how to treat infestation is being prepared, and copies will be sent to schools where cases are occurring. The question of prosecution under the Education Act, 1944, has been considered in two cases but neglect by the parents has to be proved, and it was felt that in the particular circumstances it would have been difficult to convince the Court that there had been unreasonable neglect. Twenty-two school children compared to six last year were treated for head vermin at the Cleansing Station. 9 Table 3 RETURN OF DEFECTS FOUND AT ROUTINE MEDICAL INSPECTIONS 1970 Defects Boys Girls Number requiring Treatment Number requiring Observation Percentage of total Defects Number requiring Treatment Number requiring Observation Percentage of total Defects Uncleanliness - Head/Body 8 7 0.2 11 18 0.4 Teeth 725 107 11.1 860 89 14.2 Skin 706 214 12.2 357 174 7.9 Eyes - Defective Vision 817 760 21.1 922 848 26.4 Squint 127 13 1.9 138 14 2.3 External Eye Trouble 32 34 0.9 18 29 0.7 Ears - Deafness 121 238 4.8 113 190 4.5 Otitis Media 46 160 2.7 30 142 2.6 Other Defects 10 30 0.5 22 31 0.8 Nose and Throat 161 524 9.2 155 463 9.3 Enlarged Cervical Glands 14 111 1.7 16 91 1.6 Speech 108 92 2.7 51 48 1.5 Heart and Circulation 53 113 2.2 52 128 2.7 Lungs 120 111 3.1 52 92 2.2 Developmental - Hernia 32 43 1.0 6 26 0.5 Other Defects 183 328 6.8 53 237 4.3 Deformities - Posture 16 34 0.7 31 82 1.7 Flat Feet 57 205 3.5 57 124 2.7 Other 81 173 3.4 52 179 3.4 Nervous System - Epilepsy 16 19 0.5 17 16 0.5 Other 71 105 2.3 37 58 1.4 Psychological - Development 26 64 1.2 12 35 0.7 Stability 57 182 3.2 37 156 2.9 Abdomen 37 50 1.2 24 63 1.3 Other Defects 32 109 1.9 46 194 3.5 TOTAL DEFECTS 3,656 3,826 3.169 3,527 Total Children Examined - 9,491 Boys 9,339 Girls 10 Table 4 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1970 (Percentages of Children Examined) Defects Entrents inter' mediates Entrants to Secondary Schools Fine! Leavers All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 9.6 7.7 14.3 13.7 6.2 8.7 3.1 10.9 8.7 10.2 Skin 4.8 5.0 6.6 5.9 13.0 6.5 16.7 5.4 9.7 5.7 Eyes - Vision 14.7 14.6 17.9 19.1 17.0 21.2 17.0 21.8 16.6 18.9 Squint 2.7 2.8 2.2 2.1 0.7 0.7 0.4 0.5 1 .6 1.6 Other 0.7 0.9 1.0 0.5 1.8 0.2 2.7 0.4 1.5 0.5 Ears - Hearine 7.0 6.4 3.7 3.1 2.1 1.6 1.3 0.9 3.8 3.2 Otitis Media 4.2 3.2 2.6 1.7 0.9 1.2 0.2 0.9 2.2 1.8 Other 0.8 0.7 0.3 0.6 0.3 0.3 0.2 0.7 0.4 0.6 Nose and Throat 12.9 11.0 8.3 7.7 4.0 4.3 1.5 1 .8 7.2 6.6 Speech 4.4 2.0 2.4 1.4 0.6 0.3 0.3 0.2 2.1 1.1 Cervical Glands 2.4 1.9 1 .3 1.9 1.0 0.2 0.3 0.3 1.3 1.1 Heart and Circulation 2.1 2.2 1.5 2.0 1.7 1.8 1.6 1.6 1.8 1.9 Lungs 3.4 2.1 2.3 2.1 2.4 1.1 1 .3 0.6 2.4 1.5 Developmental - Hernia 1.1 0.7 0.8 0.4 0.7 0.1 0.5 0.1 0.8 0.3 Other 6.1 1.9 4.5 2.1 7.8 4.5 2.4 4.4 5.3 3.1 Orthopaedic - Posture 0.7 0.3 0.6 0.6 0.3 2.2 0.4 2.1 0.5 1.2 Flat Feet 2.4 1.5 2.3 1.8 3.3 2.6 3.3 1.8 2.8 1.9 Other 4.0 2.6 2.2 2.2 2.0 2.4 2.1 2.7 2.7 2.5 Nervous System - Epilepsy 0.7 0.5 0.3 0.3 0.1 0.5 0.4 0.1 0.4 0.4 Other 3.3 1.4 2.2 1 .3 1.0 0.9 0.4 0.3 1 .9 1.0 Psychological Development 1.6 0.8 1.1 0.6 0.5 0.3 0.4 0.2 1.3 0.5 Stability 3.7 2.9 3.5 2.3 1.7 2.0 0.6 0.7 2.5 2.1 Abdomen 1.2 0.9 1.1 1.0 0.7 1.1 0.5 0.6 0.9 0.9 Other Defects 1.7 1.7 2.0 2.1 1.4 3.0 0.7 3.9 1.5 2.6 11 Scabies is also causing concern and thirty-seven school children attended the Cleansing Centre for treatment of this condition, an increase of twenty-one cases over last year's attendance. It should be added that these problems are not peculiar ro Croydon, and an increase in both conditions has been reported from many other areas of the Country. Table 5. Cleanliness Inspections Number of children inspected for cleanliness 45,028 Number of children inspected at follow-up visits 1,577 Number found unclean for the first time in 1970 401 Number of occasions in which children were found unclean at follow-up visits 135 Skin Defects The incidence of verrucae in the Borough has increased markedly during the year, and 1,250 children were treated at the Minor Ailments Clinic, an increase of 50% on the year before. Schools and general practitioners have been advised about the problem, and a watch will be kept to see if any further steps need to be taken. Twenty-seven children with suspected "Athlete's Foot* had skin scrapi taken for transmission to a Mycology Laboratory, but only three (11%) were reported positive. This confirms last year's findings that most cases of so called "Athlete's Foot" are not true fungal infections. Table 6. Summary of Findings at Routine Inspections of Vision Boys Girls Number Examined Number of defects % Number Examined Number of defects % Entrants 2,838 418 14.7 2,811 415 14.8 8 year old group 2,764 486 17.6 2,645 511 19.3 Entrants to Secondary Schools 1,914 336 17.6 2,046 443 21.7 13 year old group 1,544 291 18.8 1,513 325 21.5 Final Leavers 1,975 337 17.1 1,837 401 21.8 Totals (All age groups) 11,035 1,868 16.9 10,852 2,095 19.3 12 Vision Defects The number of such defects, the largest group of abnormalities found at school medical examinations, does not differ significantly from last year's total. The waiting list for children referred to the Authority's Ophthalmologist remained within reasonable bounds but that at Mayday Hospital eventually became of an unacceptable length. The position was discussed towards the end of the year with Mr. Dermot Pierse, the Consultant Ophthalmologist who advises the Authority, and it was decided to make more use of ophthalmic opticians as it appeared unlikely that the Mayday Eye Unit could reduce the waiting list to a manageable size. Parents of children living in the Mayday catchment area will now be offered the alternative of referral to an optician which will obviate delay. This will have the added benefit that eye defects, other than refractive errors which are liable to need medical treatment, will be seen at the Mayday Eye Unit even more quickly. The change has not been in operation in the year under review. Defects of Ears, Nose and Throat The incidence of otitis media (disease of the middle ear) has shown a welcome drop in cases needing treatment, though suspected cases needing observation have again increased. On the other hand, hearing defects are still being found more frequently. The account of the Audiology Service elsewhere in the Report gives more details of this aspect of the Child Health Service. Defects of Heart and Circulation There is nothing significant to report. Defects of the Lungs The incidence of pulmonary tuberculosis in school children has fallen but the figures are small and too much cannot be read into one year's cases. Nevertheless, it is a welcome trend. The number of cases of notified tuberculosis in children of school age was:— Pulmonary - 3 Non-Pulmonary - 1 The school population was 53,000 (approx.) so that the incidence rate of pulmonary tuberculosis per 100,000 was 5.7. In 1969 the rate was 9.8 per 100,000. There were no deaths. Developmental, Abdominal and Orthopaedic Defects There were rather more of these reported but the figures are within the normal year to year fluctuation. 13 Defects of the Nervous System A further marked increase is noted in the children referred to the service for intelligence assessment and almost fifty per cent more children were examined than was the case a couple of years ago. The waiting list for assessment has unfortunately grown with the number of referrals, and now contains as many cases as would normally be carried out in a full year. The reason for the great increase in referrals is partly due to the opening just after the end of the year under review of the Borough's second school for educationally retarded pupils, as Head Teachers are putting forward possible candidates but, as remarked last year, many of the referrals are of pupils within the average range with special difficulties who are more properly a responsibility of the School Psychological Service. Psychological Defects The number of psychological problems reported is similar to last year's figure. However, it is very gratifying to note that the cases seen by Dr. Crosse, the Consultant Psychiatrist, and his team at the Child Guidance Clinic, showed a marked increase and as is pointed out later in the Report (page 16) this has substantially reduced the waiting time for those needing this Clinic's services. Dr. Crosse's lunchtime seminars for medical officers and health visitors have continued throughout the year, and continue to give those able to attend a greater insight into behaviour, normal and abnormal, within the family group. This knowledge is essential in the preventive advisory role of the Child Health Service. Occasional cases of drug experimentation among small groups of school children were reported and advice given. There again was no evidence of drug dependence having become a problem in the Borough, but the Health Education Section continues to disseminate knowledge about the whole subject to parents and teachers, and School Medical Officers are very willing to advise when called upon. The subject of drugs is also included in an integrated programme of health education in most of the secondary schools in the Borough. Nutrition Average heights of boys continue to increase slowly, most noticeably in the 14 year age group, but girls'heights seem not to have changed much over the last three years. The tendency for weight to increase has not continued, in fact there is a slight but welcome average loss. Dr. Simmonds has continued to supervise the progress of children attending the Weight Control Clinics during the year. 14 Table 7. Average Heights and Weights in 1970 and Previous Years Ages Number Examined In 1970 Average Height In Inches Average Weight In lbs 1970 1969 1968 1967 1939 1970 1969 1968 1967 1939 BOYS 5 years 1,433 43.4 43.2 43.2 43.3 41.8 43.1 42.9 43.1 44.0 41.5 6 years 830 43.9 43.9 44.2 44.2 43.8 44.4 44.0 44.6 45.0 43.4 14 years 611 64.2 64.0 65.7 64.0 59.0 116.9 112.5 114.2 115.5 90.8 15 years 495 67.0 66.3 65.8 65.6 - 123.7 125.9 123.3 122.6 - 16 years 183 67.5 67.7 67.1 67.5 - 133.4 133.6 129.5 131.4 - 17 years 46* 69.0* 68.8 67.5 68.1 - 141.4* 134.9 134.9 135.3 - GIRLS 5 years 1,424 43.2 43.1 43.2 43.0 41.2 42.5 41.9 42.8 42.2 39.7 6 years 772 43.9 43.5 44.2 43.6 42.7 43.9 43.4 44.0 43.3 41.4 14 years 673 62.4 62.3 62.6 62.4 60.3 112.5 114.4 115.0 113.8 97.9 15 years 650 63.2 63.5 63.5 63.1 62.0 120.1 120.6 118.5 117.7 105.5 16 years 187 64.1 64.7 64.0 63.8 - 121.0 120.7 122.2 121.5 - 17 years 12* 63.7* 63.1 64.8 64.1 - 119.3* 121.0 127.8 126.0 - * not representative owing to very low numbers 15 PART II SPECIALIST SERVICES AUDIOLOGY SERVICE Mr. J.C. Oakley, Peripatetic Teacher of the Deaf During 1970, 1,304 children were tested in the Audiology Clinic by pure tone audiometer, this included routine follow up cases, cases referred by School Medical Officers and 619 Sweep Test Failures. Regular clinics were held at Lodge Road, Croydon; Parkway, New Addington; and Whytecliffe Road, Purley. The pre-school children requiring regular auditory training, were seen at the Lodge Road clinic, or at home. Extra speech training was given by the Speech Therapists. 4 extra Speech Training machines were received during the year.2 being provided by Croydon Corporation and the other 2 presented by Friends of Croydon High School and St. Jude's Young Communicants Guild. Speech Training machines were loaned to all parents of preschool children. 89 children were seen either by Mr. Parsons or Mr. Stewart, the Corporation's Consultant Otologist, who held regular sessions at Lodge Road, Kingsley Road Nursery, Infant and Junior Partially Hearing Units and the Riddlesdown Senior Partially Hearing Unit. 12 hearing aids were recommended during the year, 2 of these were National Health Service Medresco' aids and the other 10, Commercial aids paid for by the Corporation. Commercial aids are considered necessary if the hearing loss is greater than the range covered by the 'Medresco' aid, or if there is a sharp perceptive loss in the higher frequencies. The 'Medresco' aid has no automatic volume control and cannot be tolerated by children with such a loss, as the hearing for the lower frequencies is often normal and general amplification of sound causes a considerable amount of distortion and pain. Towards the end of 1969, the children in the Riddlesdown Partially Hearing Unit wearing 'Medresco' body worn aids, were issued with the 'Medresco' post aural version, but this proved to be disappointing, as in almost every case, the. children themselves asked to return to the body worn aid because the degree of amplification was not sufficient to meet their requirements. 116 babies were seen at the special clinic, held in conjunction with Dr. Morgan, for the early assessment of deafness in young babies. It was necessary to hold 7 extra clinics during the year to keep pace with the waiting list. This increase was attributed to the screening tests now being carried out by the Health Visitors. This special clinic, now well established, has been very successful in diagnosing deafness and E.N.T. conditions in young babies, enabling a hearing aid or hospital treatment to be prescribed and where necessary, auditory training and parent guidance commenced with a minimum of delay. During the year, all Infant schools were visited at least once and apart from absentees and unco-operative children (598), all children newly admitted to school during the year were tested. Of the 7,871 children tested,681 (approx 8.8%), failed the test and were referred to the Audiology Clinic for further assessment. For further additional statistical details, see Appendix B Page 51. 16 CHILD GUIDANCE SERVICE I am grateful to Dr. G. Crosse, Consultant Psychiatrist, South West Metropolitan Regional Hospital Board,for the following report:— For more than a decade the vigour of the service has been cramped by the weight of an ever lengthening waiting list, the ill effects of which are felt by the community and by the staff who are constantly harrassed by the urgent appeals and demands of the patients yet to be seen. The year under review has been noteworthy for a renewed attack on the back log of cases and it is pleasing to report that there has been a substantial reduction in the waiting time for consultation at the clinic. The whole operation has been consistently supported by the sustained drive of all members of the staff though it should be recognised that the brunt of the pressures has been felt mainly by our team of social workers who have been responsible for the initial work-up of all cases. It should also be seen that the cold statistics of the clinic does not truly reflect the work expended on those problems which have an abortive outcome in the sense that a fair number of cases fail to reach full clinic attendance. The sustained pressures on the day unit of the clinic has also exercised the ingenuity of the unit staff and Charge Nurse Allen has been constrained to test out the comparative values of different therapeutic situations, andthe main emphasis now is the intensive treatment of small groups. It should be remembered that children attending the day unit are severely deprived and disturbed and they make enormous emotional demands on individual members of the staff. The concept of psychiatric illness in childhood tends to be overshadowed by the prevalence of adult mental disorder in the community, and it would be easy to overlook the fact that mentally disturbed children too need nursing care. It is to be hoped that the next year will see a full nursing complement of one charge nurse and two staff nurses in the day unit to deal with acute casualties referred to the clinic. Their needs and care are of a kind far removed from that provided under remedial education, and a day unit as such cannot be equated with a remedial class. It is sad to report that Staff Nurse J. Furnish will be leaving the day unit for family reasons. Her devotion to the children under her care has been an inspiration to us all. The physical environment of the clinic, not an unimportant factor in the treatment of patients, has been greatly improved by a complete redecoration of the interior and the extension of the car park has made clinic life a little easier. There have been a few staff changes. Mrs. V. Jackson has been appointed to the post of social worker vacated by Mrs. E.M. Gee. Mrs. S. Morley has replaced Miss Boggis as assistant secretary, and Mrs. A. Smith succeeds Mrs. V. Tindle as teacher to the day unit. The use of pocket memos for dictation purposes by the social worker has helped to streamline our secretarial service and nearly all clinical data is now typed on our case sheets. 17 This report would not be complete without an expression of thanks to Dr. S.L. Wright, Principal School Medical Officer, Mr. K.G. RevelI, Chief Education Officer and Mr. C.H. Langley, Group Secretary to the Croydon and Warlingham Park Hospital Group Management. The administrative support of their respective departments has been greatly appreciated by the clinic staff. Source of Referral Boys Girls Total Principal School Medical Officer 74 36 110 General Practitioners 56 45 101 Children's Department 4 2 6 School Psychological Service 14 8 22 Juvenile Court 24 3 27 Parents 1 2 3 Other Hospitals and Social Agencies 11 10 21 Milton House Remand Home 84 84 184 190 374 Action Diagnostic 32 97 129 Current Treatment 134 68 202 Closed Cases — Improved 8 17 25 Unco-operative 7 4 11 Moved away 3 2 5 Transferred 2 2 184 190 374 DENTAL SERVICE Mr. J.D. Palmer, Principal School Dental Officer With the growing affluence of our society, and the change in the patterns of living which come in its wake, dental disease flourishes. Despite the best efforts of the dental profession over many years, providing an ever increasing volume and more sophisticated treatment - which has been made possible by technical advances and improving methods - there is more dental disease affecting more people than ever today. The public has come to accept dental disease with eventual loss of teeth as inevitable and generally looks upon the dentist purely as a provider of treatment by doing jobs in their mouths (with varying degrees of unpleasantness). But both dental decay and gum disorders are very largely preventable, and certainly controllable, by relatively simple means which are ultimately less expensive to the community. So one of the prime objectives of a public dental service must be to promote the concept of dental health by advice and provision of control services and motivate individuals to seek such care. 18 It has been said that the only hope for dentistry lies in prevention, perhaps only half the truth because treatment - and first class treatment at that - will always be necessary as an integral part of community dental care to control the disease which cannot be prevented. This involves close co-operation between the public and dental services based on mutual trust and understanding. This approach forms the basis of the dental services in Croydon. During 1970 we have been fortunate in generally having a full complement and unchanging dental staff who have worked hard and well. We have also enjoyed good co-operation from teachers, health educators and public health personnel which has meant that it has been possible to provide a good local authority dental service. Dental Inspection 49,299 (93.7%) children out of a school population of 52,633 were inspected. It was also possible to increase the number of children reinspected during the year to 8,772, an increase of over 60% on the previous year. These are easily the best results yet obtained in the school dental service. The routine inspections in schools produced an acceptance rate for treatment of 25.9%. Dental Treatment for Schoolchildren The problem of gross dental sepsis in neglected mouths and involving much surgery time in relief of pain and multiple extractions has been largely overcome in Croydon. Patients are wanting, and usually able to obtain, maintenance care to preserve their teeth. However the overall numbers found to require some treatment on inspection rose from 45.6% in 1969 to 48.9% in 1970, which suggests a continuing problem in terms of treatment services as the standard of dental health demanded improves. The trends in treatment have all been towards keeping teeth with a 33.7% increase in the number of teeth filled, increases in other restorative procedures and 16.2% more courses of treatment completed than the previous year. Extractions have also increased, but related to the greater number of patients the proportion is indeed less than last year, and the ratio to teeth filled is continuing to improve. In 1960 72 teeth were extracted for every 100 teeth filled In 1965 47 ,, ,, ,, ,, ,, In 1969 27.5 ,, ,, ,, ,, ,, In 1970 23 ,, ,, ,, ,, ,, In addition the extraction figures include some 313 extractions on 144 patients who were referred by practitioners for treatment under general anaesthesia, so that the extraction and general anaesthetic figures are relatively higher. 19 The number of appointments not kept is disappointingly high still, but the proportion is the same as last year, 24.4% compared with 24.2% of the total possible attendances. Over one-third (2,887) of these appointments not kept are cancellations for which an alternative arrangement is made so that treatment is continued in these cases. The New Addington area still lags behind the rest of the Borough in treatment and inspection services, due to the limited general dental services in the area and the high demand for treatment, but the situation is slowly improving with the existing dental facilities being fully utilised. Dental Health Education It has been possible to devote more time to the important aspect of dental health education, and to enlist the active co-operation of teachers and others, which is essential to achieve any success in this field. However it is not possible to quantify the results as these would only show up in a long term improvement in dental health. The primary schools have been encouraged to continue and develop project participation dental health education which not only creates a greater dental awareness in the children but provides good teaching situations for the educationa lists. The student hygienists from Royal Dental Hospital have continued their useful visits to infant and junior schools to demonstrate and talk about oral hygiene. A comprehensive study on children's dietary habits at bedtime in relation to their dental condition was undertaken and showed that food and drink taken at this time had an adverse effect on their dental health. This work has been written up for publication in the dental press. Staff and Services A second Dental Auxiliary was appointed and has been working at Purley and Shirley. These girls are also specially trained in dental health education and so the control side of the service has been strengthened. The quarterly staff meetings of dental officers, where matters of clinical or administrative interest can be discussed, have continued and proved very useful. The Chief Dental Officer is on a public dental health course at London University and four other dental officers have attended various postgraduate courses during the year, which helped to maintain the standard of dental services. Within the financial limits existing, much was done to modernise equipment and improve the facilities at the various clinics, which are generally of a good standard and suitable for provision of comprehensive dental care to the priority classes. Details of treatment carried out for schoolchildren.in the year will be found on Page 52. 20 ENURESIS CLINIC I am grateful to Dr. Margaret White for the following report:— During 1970, 284 children attended for treatment at the three Enuresis Clinics in the Borough, this being 5 less than in 1969. The sex ratio was similar to previous years - 179 boys to 105 girls (1969 figures 185 - 104) and has been consistent for the past sixteen years. Those children who do not attend for two consecutive appointments without any reason being given are discharged for non-attendance, and in 1970 the number of poor attenders increased, and 47 children were discharged for this reason. The age with the highest number of children attending the Clinics was 9 years; this is older than usual. In the past we have had more 6 year old children than any other age group. At the end of the year we were finally able to dispense with the waiting list for the buzzers, and now children who require this form of therapy are able to collect the apparatus from Home Nursing the same day; this is very much appreciated by the parents. Total Attendance 284 Boys - 179 Girls - 105 Still Attending 109 Discharged Dry 78 Discharged for Non-Attendance 47 Left District 2 Lodge Road Clinic 161 New Addington 73 Purley 50 Referred to Urologist 5 Referred to Child Guidance Clinic 1 Used Buzzer 90 Age 4 5 6 7 8 9 10 11 12 13 14 15 16 No. 0 24 46 52 44 54 23 13 17 5 4 2 1 SCHOOL EYE CLINICS I am grateful to Dr. Derek Clarke for the following report:— School Eye Clinics are held regularly at Purley, Sanderstead and New Addington for the examination and treatment of children found to have ocular abnormalities at routine school medical examinations. Referrals are also accepted from General Practitioners directly. The age groups covered are from infancy to school leaving age. Reciprocal arrangements exist for the transfer of children when necessary to and from the Hospital Eye Service.The allocation of time, equipment and staff is particularly suitable for the assessment and advising of patients who may have ocular abnormalities together with problems of schooling, general development and other difficulties. When suitable, cases of squint, amblyopia and other eye conditions can be treated medically.Statistics are to be found on Page 53. 21 HEALTH EDUCATION IN SCHOOLS Miss D.S. Elliott, S.R.N., H.V. Cert., D.H.E. Principal Health Education Officer. With the co-operation of the Education Department and good will of many teachers, the Health Education Section was well able to exercise its function to reinforce and extend health education activities in schools during 1970. Secondary Schools The basic framework "The Community Health Course" described in "Public Health in Croydon 1969" is now interpreted and developed widely in many schools. Certain concepts are the unifying thread and reflect the scope of health education in the curricula:— (a) That growth and development influences and is influenced by the structure and function of the individual. (b) There are reciprocal relationships involving man, disease and environment. (c) Decision making. In-Service Training 1. During the past 12 years some 80% of Croydon Secondary Schools were helped by the Health Education Section in various ways. While wishing to continue this service to the schools it was felt that the form of help given should be reappraised, particularly as many aspects of the original community health course are now included in "0" level biology, the new Combined Science courses and several C.S.E. courses. With the agreement of the steering committee for educational development four meetings were arranged in the Health Education Section at Tabemer House to cover all secondary schools, some 10 schools being represented at each meeting. Two firm recommendations emerged, the first of which was implemented during the Autumn term:— (3) A course of 10 weekly sessions on the medical content of the Community Health Syllabus was held at Coombe Cliffe Education Centre. Lectures and discussions were given by local specialists and consultants and covered such subjects as environmental health, growth and development, weight control, smoking and health, drugs and alcohol, venereal disease and family planning. Number of schools involved = 22. Number of teachers involved = 64. Average attendance per session = 29.5 A questionnaire returned by teachers showed that health education was dealt with in biology, home economics and social studies. Others found opportunities during general science, physical education and religious education. 22 The session on drugs and alcohol drew the biggest attendance and reflected teachers' anxiety and desire for more knowledge on these topics and their management (b) A regular bulletin of health education news and information was suggested. This will be compiled by the Health Education Section during 1971, and (c) The principle was established that a teacher will be present with any class taken by a Health Education Officer to ensure follow-up and integration of topics with other studies. 2. Conference on Drug Dependence Once again a debt of gratitude is due to Dr. H. Dale-Beckett, Consultant Psychiatrist at Cane Hill Hospital who spoke on "Drug Dependence - some Facts and Misconceptions" at an in-service training session held in the Denning Hall in February. The meeting was chaired by Mr.K.J. Revel I, chief Education Officer and summed up by Dr. S.L. Wright, Principal School Medical Officer. Some 200 teachers, probation officers police, medical and social work staff attended. A wide variety of work was carried out by Health Education staff, Health Visitors and Public Health Inspectors in 22 secondary schools, during the year and help and advice was given to teachers in 6 others. Work was also done with Parent-Teacher Associations on Drugs, Health Education in School, and A Closer Look at the Primary School Child. Primary Schools. "Growing-Up Talks" The series of two talks (a) to parents and (b) to parents with their children in the fourth year were repeated in 45 schools during the year. In addition extra support was given to teaching staff at meetings held in some schools to give parents the opportunity to see and discuss the three movie films on conception and birth. The films were shown to children during a general series of B.B.C. Schools Television programmes called "Merry-go-Round". The films were bought by the Education Department and are now available for use at any appropriate time during the year. This is a big step towards integrating sex education into the general school programme and keeping the subject in its proper perspective. However, it will still be necessary to have at least one meeting a year with parents to give them an opportunity to discuss content, correct language and other problems covering children growing up. Elmwood Girls' School. The Senior Health Education Officer was invited by the Headmistress to undertake three half-hour sessions weekly in the fourth year classes. The sessions were preceded by a staff meeting to discuss this experimental work and to ensure understanding, co-operation and follow-up of each starting point by the staff. Merely more courses on health education as they now exist will 23 not meet the needs of today's future adults. There exists at least a marginal concensus of opinion on content. Children need age-appropriate knowledge concerning their own bodies, their physical, social and cultural environment and the moral and physical values which will produce the kind of adult who can deal with the demands of future urban life. Public responsibility in the end means individual concern. The basic ideas covered were:— People connected with health. Growth and development (including sex education at the appropriate time). Common experiences, e.g. fainting, X-rays, injections and so forth. The same school also initiated three half-hour sessions weekly with third year classes, starting points again being followed up by the teaching staff. The basic ideas included:— How we learn about the world about us (developing understanding of the senses.) Life and its needs. Although Health Education should be integrated into general education either through traditional academic disciplines or open-ended teaching, in practice this rarely occurs unless the health education content is planned and contrived. The above work was an attempt to show this. Oval Junior School. Throughout the year an enterprising Health Visitor worked with groups of children and their teachers inthe first, third and fourth years, integrating very simple applied physiology with growth, first aid, environmental and personal health, personal hygiene, prevention of illness, junior citizenship and human relationships. Visits were arranged to a Child Health Centre and to Taberner House. Associated with this teaching and with help from the Health Education staff and equipment an excellent home safety exhibition was arranged in the school hall. Parents and all the children in the school were invited to visit this during an afternoon and evening and the attendance was most rewarding. "The facts of this inadequacy (of health education) have risen to the surface and are the popular targets of mass media and commercial interests. A great deal of sensationalism goes into public print on subject like sex and family life education, self medication, accident and safety, obesity, cigarette smoking, credit purchasing, food fads and the teenage market to name just a few of today's concern" (J.F. Keefe. 1967). We still have much to do. 24 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. 283 children were examined during 1970. The classifications arrived at, together with recommendations made, were as follows:— (1) Found to be educationally subnormal: (a) Recommended for Day School for E.S.N. pupils 95 (b) Recommended for Residential School for E.S.N. pupils 1 (2) Found to be unsuitable for education in School 20 (3) Other Recommendations:— (a) Referred back to an Ordinary School 78 (b) Referred for further investigation by School Psychological Service 22 (c) Recommended for Day Special Schools for other handicaps 6 (d) Referred for Speech Therapy 6 (e) Referred for Medical Treatment 9 (f) Referred for further assessment 25 (g) Other Investigations 21 283 Awaiting assessment on 31.12.70. 235 In addition 41 intelligence tests were given to children attending St. Christopher's Special School. A further intelligence test was given to a child who was about to attend St. Giles' Special School, and a further 6 children already attending St. Giles' were tested. Another 12 intelligence tests were routinely carried out on children attending Coldharbour School. 25 PHYSIOTHERAPY SERVICE Miss J. McBride, M.C.S.P., A.P.T.A., Superintendent Physiotherapist The existing therapeutic services at St Giles' School have recently been expanded with the employment of a part-time occupational therapist. Her job will cover the area of the child's life which hitherto has fallen between the teachers and physiotherapists. This gap involves the many aids to daily living, dressing abilities, caliper care, suitability of classroom furniture, and advice on the adaptation of bicycles and tricycles, which is of vital importance as this is sometimes the only means by which a handicapped child can be independently mobile. There is no doubt already about the significant rewards that will materialize from this new impetus in the rehabilitation team. It is fortunate that it is possible to send our staff on post-graduate courses for continuing education makes it impossible for people to stand still. The use of new drugs does have a revolutionary effect on our work; in particular the use of Intal has considerably reduced the case load of patients with chest conditions. There is now more time to devote to the severe disablement of the 21 cases of Spina Bifida who are having regular treatment and routine assessment It is comforting to find that the therapists at St. Giles' are made so welcome at the Queen Mary's Spina Bifida Unit, for these link-ups over shared patients are invaluable for providing a more scientific approach to the problems of life-long disability. SPEECH THERAPY SERVICE Mr. J.R..Brook, Principal Speech Therapist During 1970 there was a steady increase in the work of the Speech Therapy Section. Over the year the number of treatment sessions increased by more than 20%. The number of children seen and the number of discharges has also increased by well over 20%. I am quite sure that this is due not only to the good staffing over the year, but also to the continued effect of reorganisation of the structure of the Service as was mentioned in last years' report The 3 Senior Therapists responsible for particular areas of the Section's work release the Principal Therapist to concentrate on the management of the Service as a properly run, increasingly effective organisation. The provision of a clerk during the latter half of the year has also contributed to the greater amount of treatment undertaken by the Section. The work of the Speech Therapy Section in the Special Schools area is now on a much firmer foundation as Mrs. Robertson the Senior Therapist has become familiar with the Schools concerned. This post is proving very valuable as the demands on the Section as a whole increase. It is quite impossible for the Principal of this busy Section to maintain the necessary 26 personal contact required in 5 very active Special Schools. Mrs. Robertson and the therapists working with her have attended P.T.A. meetings and a number of other school functions in the evening as well as case conferences, special clinics etc. The Special Schools do appear to be an area of particularly rapid growth at the moment and during 1971 demand will again outstrip available staff. During the year the regular assessment visits to normal schools were made the responsibility of Mrs. Costerton, the Deputy Principal. Over 30 visits to schools were made during 1970 and the question of Speech Therapists working in schools has been brought up again. The possibility of a carefully regulated pilot scheme to examine the practicalities of these proposals is being considered. Work with speech defective children from normal schools is the core of the service in the Borough. The availability of staff has made it possible to reduce waiting lists to a very respectable level although two vacancies at the end of the year may cause an increase in the numbers awaiting therapy if they are not filled early in 1971. A fully staffed Speech Therapy Section is almost unknown in this country and is a sure indication of the respect with which the Profession views the Service in Croydon. Every effort is made to maintain this high standard by making the work challenging and rewarding for the staff as well as effective in fulfilling the needs of the Borough. The Deputy, together with the Principal Therapist have addressed a number of Toddlers Clubs, W.I. meetings etc. The West Thornton Unit has 10 children on the register, having discharged 7 and taken on 5 new cases during the year. Of the 7 discharged 4 have gone to normal schools, 2 to schools for the deaf or hard of hearing and one to a residential school for the maladjusted. A second teacher has been appointed to cope with the wide range of abilities and handicaps and it is hoped that the second classroom, approved earlier in the year, will become manifest during 1971. The work of the Unit has been made much easier by the starting of a trial term during which new entrants can be properly assessed and a termly case conference to consider treatment objectives, assessments and discharges etc. During the year two therapists, Miss Moses and Miss Brownlow who was responsible for the West Thornton Unit, left. Miss Enot was appointed as the Sections' first Clerk Receptionist. At the end of the year we are one Senior and one therapist short of fully staffed. I would like to thank the present staff for the steady work of treating children often long term, handicapped cases which they have maintained throughout the year. I must also note the retirement of Dr. C. Worster-Drought who first came to us as Consultant in Speech Disorders in 1961. Dr. Worster-Drought has been able to put at our disposal the great experience he has gained over many years of dealing with speech disorders in children and adults. His help and advice were particularly valuable in the setting up of the West Thornton Unit. The work of Consultant has been taken over by Dr. R. Hierons of the Brook Hospital. 27 11 Students from two of the London training schools have attended for practical work during the year. 1970 has been a much more settled year than the previous one. A nucleus of experienced staff has formed and it is hoped that this can be maintained into the future as a buffer against the inevitable staff changes. The beginnings of closer contact with the schools occurred during the year and it is hoped that we will find it possible to increase this contact for most of the work of the Section is with schoolchildren. Statistics are set out on Page 54. WEIGHT CONTROL CLINICS Dr. W. Simmonds, Departmental Medical Officer During the past year the Weight Control Clinics in the various main areas and in some schools have been continued on the same principles as before. The effect of excluding those who did not wish to participate is showing results, and the majority of those who now attend are improving, and an appreciable number are now considered to be within the normal limits. It is still interesting that the most successful group is once more that at Waylands, and the individual with the best weight loss is a pupil of St. Christopher's Special School. The girls' group has been less successful; partly because all the groups had to be combined into one in Dr. Mortimer's absence, which meant less time for each individual girl, and partly because it was only possible to meet once a term, and the effect of the group therapy tends to wear off in the four month intervals. Arrangements have been made to place this group on a more regular footing in the coming year. 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 28 such children during the year. 28 Convalescent Treatment 24 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 Door general health or a child sufferina 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 Home Conditions 4 2 weeks Emotional Deprivation 2 2 weeks Social Deprivation 3 2 weeks Emotional stress at home 3 2 weeks Maladjusted 2 (1-8 days (1-2 weeks Cerebral Palsy 1 2 weeks Epilepsy 5 (3-10 days (2-2 weeks Eczema 1 2 weeks General Debility 3 2 weeks Total 24 Juvenile Employment Return The following numbers of children were examined by the medical officers during 1970 as to their fitness to undertake the part-time employment indicated:— 1970 1969 1968 Delivery of Goods for Shopkeepers 11 7 10 Delivery of Newspapers 166 463 176 Delivery of Milk Nil 4 6 Shop Assistants 85 62 106 Others 38 14 - Total 300 550 298 Provision of Milk and Meals During 1970 milk was supplied free of charge to all maintained primary schools and approximately 29,000 primary children in these schools received one third of a pint each per day. This was equal to 92% of children attending primary 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 1970 was approximately 32,550. 29 Cost of Milk and Meals Milk and Meals cost £1,076,307. Income from payment for meals was £413,750, making a net cost of £662,557. Causes of Death in School Children 1970 (Uncorrected) Accidental 4 Acute appendicitis 1 Cancer 2 Carbon Monoxide poisoning 3 Fibrocystic Disease 1 Spastic quadriplegia (brorrchopneumonia) 1 Total 12 30 PART III HANDICAPPED PUPILS During the year under review the Ministry of Education and Science completed a countrywide survey of the number and defects of handicapped pupils in ordinary schools. The result is awaited with interest, but it does serve as a reminder of the undoubted fact that most handicapped pupils are in ordinary schools and, with the help of parents and teachers, are enabled to remain there. Admittedly these children suffer in the main from minor handicaps, but there is no doubt the survey may provide some surprises. Apart from these pupils there are 805 children in the Borough ascertained as needing special schooling. This is an increase of 87 over last year's figure, largely due to increased ascertainment of educationally subnormal children in anticipation of the opening of the second day school for this group in the Borough. The waiting list for special schools is principally made up of two groups - the educationally subnormal and the maladjusted, and when the two new schools for these groups are fully operational in 1971 the number of handicapped children having to wait for entry to special school should be small. The number of pre-school children known to the School Health Service as likely to require special education is 193 (Table 11). This is not comparable to last year's figure as children below 2 years old are not included this year. There is a marked increase in the two year old and four year old groups and though, as mentioned in last year's report, there is a tendency to over-estimate in some categories, the trend appears to be upwards. However, it may be that this is due in part to better reporting following the combination of the pre-school and school services in 1969, and it will be a few years yet before Table 11 can be interpreted with complete confidence. BLIND AND PARTIALLY SIGHTED PUPILS Blind Partially Sighted In Residential Schools 9 3 In Day Schools • 22 Blind One blind child was ascertained and admitted to a residential special in the year under review. Partially Sighted Five children were ascertained in this category and four were admitted to St. Luke's School, which at the end of the year had its full quota. However, with the opening of St. Nicholas School, a classroom in St. Luke's being used as an overflow for educationally subnormal children was emptied and will be 31 TABLE 10 Children requiring Special Education, 1970 CATEGORY New Cases Ascertained by Committee * New Admissions Number of Children receiving Specie1 Educational Treatment 23.2.71 No. of children awaiting placement on 23.2.71 Special Schools Independent Schools Hospitals Day Units Home Tuition Total Day Residential Day Residential BLIND - 1 - 8 1 - 9 - - PARTIALLY SIGHTED 5 6 22 2 1 - 25 1 - DEAF 1 4 7 17 - 16 40 1 2 PARTIALLY HEARING 8 11 2 4 - 21 27 - - EDUCATIONALLY SUBNORMAL 84 99 324 20 5 - 349 56 3 EPILEPTIC 7 7 9 5 1 - 15 - 1 MALADJUSTED 19 15 3 13 42 3 16 77 - 18 PHYSICALLY HANDICAPPED 18 25 114 15 - - 129 3 - SPEECH 2 5 1 - - 10 11 - - DELICATE 7 7 30 4 2 - 36 - 2 TOTAL 149 176 512 88 52 3 63 - 718 61 26 * Including cases ascertained in previous years. TABLE 11 PRE-SCHOOL HANDICAPPED CHILDREN Category Age on the 31st December, 1970 5 years 4 years 3 years 2 years Vision Defect - 2 1 2 Hearing Defect - - 1 2 Speech Defect - - 1 3 Mental Disorder - 29 28 26 Epileptic - 2 9 1 Physically Handicapped 1 22 26 37 Total 1 55 66 71 32 available if more children needing this category of education are discovered in the Borough. 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 Throughout 1970 steady progress was maintained in all aspects of school activities. Four children were admitted, one child of junior age and three infants. Three children have left, one transferred to a normal Secondary School and two boys transferred to residential schools for the partially sighted. A pupil who had left previously to go to Winterbourne Junior Boys' School gained a place at Dulwich College. Various educational excursions were undertaken to extend the children's knowledge and to widen their interests. Public transport is used for most journeys with the aid of gradually developing self-confidence and independence so that the children will be able to get themselves about when they are older. Teaching the basic subjects continued to be on individual lines as the children's wide range of ability and visual acuity present many problems. Good progress continued with swimming; some children were successful in gaining their 25, 50 and 100 yards certificates. The ophthalmologist visited the school twice during the year. The school Dental Officer examined the children's teeth and Dr. Wield carried out the routine medical examinations. I am grateful to these people for their help and interest in the welfare of the children. There were various school functions each term. Parents' Evenings, Open Day, the Harvest Festival Service and the Nativity Play provided opportunities for the parents, who came from a very wide area to meet and to discuss their children's progress. The year ended with many Christmas activities including two visits to St. Christopher's School. Mr. R.G. Grice kindly invited us to the Carol Service and Christmas Play and we are grateful to him. Members of Staff at Telephone House again were very generous and brought presents for each child. The children had a very happy Christmas Party with presents kindly provided by the Education Committee. Children on Roll 31.12.70 16 Transferred to Normal Secondary School 1 Transferred to Residential Schools for the Partially Sighted 2 Admissions during 1970 4 33 DEAF AND PARTIALLY HEARING PUPILS Deaf Partially Hearing In Residential Schools 17 4 In Day Schools 7 2 In Day Units 16 21 These groups are being considered together this year, as though children with a very severe hearing loss can be reasonably categorised as deaf, and those with a loss just serious enough to require special schooling as partially hearing, there is a middle group whose categorisation is largely a matter of opinion. The number of children in both categories in residential schools and in day schools, other than the Borough's own special units, remains the same. There has been a complete reorganisation of the day units in the Kings ley schools. Dr. Morgan, the Senior Medical Officer, responsible for children with hearing difficulties, reports:— "The Units for partially hearing pupils at Kingsley Infants and Junior Schools continue to provide education for partial hearing and deaf children from 3-11 years of age. Since the Autumn Term 1970, a Junior Deaf Unit (age range 7-11 years) has been established at Kingsley Infants' School, and currently there are nine pupils attending. More recently the children previously attending the Nursery and Infant Partially Hearing Units have been re-classified according to their disability rather than age. The Infant Partially Hearing Unit (3-7 year range) with six children currently attending, and the Infant Deaf Unit (3-7 year range) with eight children currently attending. Throughout the year I have made visits to the Units to supervise the general health of the children and to observe their progress, Mr. Parsons (Consultant Otologist) continues to visit each Unit annually. At these visits the teacher concerned, Mr. Oakley, and myself are also present, and the parents are invited to attend whilst each child is discussed individually. Every effort is made by the Teaching Staff to integrate the children attending the Units with the normal hearing children, both in the classroom and playground." I am grateful to the Chief Education Officer for the following reports which have been edited to show the position at the end of the year. Units for Nursery and Infant Children with Hearing Defects, Kingsley Infants' School There have been a considerable number of changes in the organisation of the Units in the last year. Until September 1970 the children were divided into two groups: Nirsery and Infants with ten children in each class. Of the 34 ten Infants children, eight reached their seventh birthday by September and therefore were educationally classed as 'Juniors'. They were all diagnosed as being deaf and therefore could not be expected to attend the partially hearing Junior Unit. A Junior Deaf Unit was therefore established in the Infants' School. The remainder of the children were divided into an Infants Class (of six deaf children) and a Nursery Class (beginning with six and rising to ten Nursery Age children of whom there were four partially hearing and six deaf children). Further reorganisation has resulted in the present system (December 1970) whereby the Junior Unit had one child removed (possibly for attendance at Larchraore School for Maladjusted Deaf Children) and has admitted two of the older Infants children making a total of nine deaf children; the partially hearing children (six children ranging in age from 3-6) are educated in one Unit and the deaf children (eight children ranging in age from 3-7) are educated in the other. Each Unit has its own qualified Teacher of the Deaf and there is another 'floating' qualified Teacher of the Deaf available for help by each of the Units. The two Units containing the younger children each have a Nursery Assistant. Junior Deaf Unit, Kingsley Infants' School This class began in September 1970 and contained eight children with hearing losses ranging from profoundly deaf into the region often called severe partial. The Peters Senior Trainer was well able to provide maximum help to these children and was extensively used together with the group aid. As well as a wide range of hearing loss type there was an extremely wide ability range. For this reason an early introduction of an integrated school day was made so that the vitally important child orientated individual and small group work could be effectually followed. Space precludes a detailed survey of the range of work followed in the first term of the new unit. In number work, decimal money was introduced and within the ability range was happily accepted by the children. Speech is rightly an important priority. Several children had excellent articulation in test situations. For them phrase/sentence work was desirable to improve speech which rapidly degenerated under the stress of communication as we understand it. This is natural and several years of steady work are needed. Other children had much more severe problems of communication, and for them the emphasis was on vocabulary revision and extension based upon home and school, speech reading and speech production. 35 Junior Partially Hearing Unit, Kingsley Junior School Miss M. Dallimore, the P.H.U. teacher resigned from the school at the end of the summer term and Miss A. Hewitt took over as teacher in charge of the Junior class in September. The class also has a part-time teacher attending for two mornings a week. There are at present six children attending the Unit, two in each of the first three years. All integrate with the hearing children for all activities outside classes, for practical lessons and, according to ability, for those subjects which they can manage without special help. During the summer term some of the children were taken on a week-end Youth Hostel educational visit. For the first time, the children performed a simple Nativity Play at Christmas which they staged at the Broad Green Old Age Pensioners Centre. Such activities form an important part of a partiallyhearing child's education since it encourages confidence in speaking and gives meaning to the daily individual speech lessons. Orders were placed in December for a new Group Hearing Aid which will ensure that each child has the opportunity to make maximum use of his residual hearing through the use of the most up-to-date equipment. Every child wears an individual hearing aid and spares are kept at school so that in the case of breakages continuity is ensured. Regular visits are made to the Hearing Aid Dept. at New Cross Hospital where impressions are taken for new earmoulds for the children. Partially Hearing Unit for Secondary Children, Riddlesdown School In May 1970 a 2nd year girl joined the unit from Ashburton School. In July one 4th year girl left Riddlesdown. She is now at Redhill Technical College on a Commercial Course which includes Audio Typewriting. One 14 year old boy left the school in the autumn term. A 13 year old boy left to join Tewin Water School for the Partially Hearing. Integration in Hearing Classes 1 14+ girl 33/40 periods (4th year) 1 14+ boy 38/40 ,, (3rd year) 1 13+ boy 22/40 ,, (2nd year) 1 13+ girl 34/40 ,, (2nd year) 1 13+ girl 38/40 ,, (2nd year) 1 13+ girl 23/40 ,, (2nd year) 1 12+ girl 20/40 ,, (2nd year) 36 These seven children are progressing satisfactorily academically and socially with perhaps two exceptions where progress is probably hampered by lack of maturity and a sense of responsibility. It would be of much help if parents of all these children manifested more interest in their school careers. The autumn meeting of parents had to be cancelled through lack of support. All pupils attended New Cross Hospital in October for renewal of ear moulds. It has been arranged that in future new ear moulds will be made locally by the Authority's own staff. It is noteworthy that there are now only 3 pupils who rely on the taxi service. These it is hoped will be travelling independently quite soon. We have been fortunate in having Mrs. Littlejohn for 2 mornings each week since September 1970. She gives extra tuition particularly in Maths and Accounts. To end on a pleasant note, it is pleasing that two of the pupils were chosen as Form Captains this year for the autumn. This seems to indicate that in these two cases integration has succeeded. EDUCATIONALLY SUBNORMAL PUPILS In Day Special Schools 324 In Residential Special Schools 20 Awaiting Placement 59 During the year 84 children were ascertained as educationally subnormal, a considerable increase on earlier years. This followed a circular letter from the Chief Education Officer to Head Teachers asking for the names of children who might require this type of special education, as the imminent opening of St. Nicholas Special School would almost double the day places available in the Borough. In the event many more names were submitted than the Medical Officers could deal with. The Educational Psychologist kindly helped out by carrying out psychometric testing, but at the end of the year a very large back log of assessments remained to be done. Though St. Nicholas School did not open in 1970, some pupils were admitted in January 1971, and Table 10 in the Report takes account of this. The waiting list of earlier years has already begun to shrink and this will be a continuing process. I am grateful to Mr. R.G. Grice for the following report on the work of St. Christopher's School in 1970:— 37 St. Christopher's Special School for Educationally Subnormal Children 1. Statistics Boys Girls Total Number on Roll 31.12.69. 151 88 239 Admitted during 1970. 23 16 39 Left to work at 16 years. 12 7 19 Transferred to other areas. 10 2 12 Transferred to P.H. School. 1 - 1 Transferred to Residential Schools. 7 2 9 Transferred to Waylands. 5 1 6 Transferred to Normal Schools. 4 - 4 Transferred as unsuitable for Education in School. 1 - 1 Number on Roll 31.12.70. 134 92 226 2. Redecoration of School This was commenced on November 11th and is nearing completion. Children helped to choose the colours for the classrooms, and the finished effects are very pleasing. 3. Sport (a) Swimming During the year the following certificates have been obtained:- Distance No. obtained 25 yards 17 50 yards 16 100 yards 19 220 yards 14 ¼ mile 5 ½ mile 4 1 mile 3 Three boys and two girls out of six entries were successful in obtaining the All Round Proficiency Certificates issued by the All England Schools Swimming Association. On December 11th the pupils undertook a sponsored swim to raise funds towards the cost of a mini-bus to solve transport problems in connection with sporting activities. Fifty-one children took part, and altogether they covered 258 lengths of the baths. The event raised £61.9.1 0d. (b) Athletics The Annual School Sports were held on the Barclays Bank Sports Ground on Wednesday, June 24th, 1970. 38 The School Athletic Team competed in the Surrey Special Schools Athletic Championships at Imber Court, and won both the Boys and Girls Trophies. Altogether 93 Certificates were obtained (41 firsts, 30 seconds, and 22 thirds). (c) Boxing Clinton McKenzie won the Surrey Championships, Class B at 8st. 3 lbs. on January 30th, 1970. (d) Football and Rounders The School Football XI came second in the Surrey Special Schools League, while the Rounders Team won its section. 4. Events (a) Visit to Pantomime Forty of our Junior Children were taken to the Ashcroft Theatre on January 20th by the Staff of Impact House. The children thoroughly enjoyed the visit and each child sent a letter of thanks. (b) New Year Party The Parents Association held a New Year Party for all the children on Saturday, February 7th. In addition to the usual tea, conjuring and Punch and Judy Shows, each child received a present of a box of chocolates. (c) Open Day The School was open to friends, parents and the general public on July 7th, 1970. (d) Outing to Littlehampton The Staff of Telephone House, Croydon, took 40 of our primary department to Littlehampton for the day on July 18th. The children, and Staff who accompanied them, had a very enjoyable time, and we are most grateful to our hosts for their kindness. (e) Harvest Festival The Harvest Festival was held in the School Hall on September 30th. The Rev. R. Lunnon, Vicar of St. Stephen's Norbury, gave the address, the rest of the service being conducted by the children. After the service, senior pupils distributed parcels of groceries to the Senior Citizens in the neighbourhood. 39 (f) The Annual Carol Service This was held on December 16th at St. Stephen's Church, Norbury. We are all very grateful to the Vicar and Churchwardens of St.Stephen's for their kindness in offering to us the use of the Church for this occasion. (g) Christmas Parties These were held on December 17th. We are also indebted to the Staff of Impact House, Croydon, who kindly gave to each child a bag of sweets and a Christmas Present. (h) Nativity Play A three act Nativity Play was performed in the School Hall for parents and friends on Monday, December 21st. 5. Parents Association The Parents Association has continued to meet during the year, and a full programme of talks and discussions has been carried out. The year's programme ended with a Christmas Party on December 18th. The Parents have agreed to attempt to raise the purchase price of a mini-bus for the School, and many fund raising activities have been planned for 1971. 6. Miss M.E. Woolverton Miss Woolverton who has served at St. Christopher's for 25 years retired on December 31st. She will be a great loss, for she was always a conscientious and. loyal colleague, and always put the interests of the school first. In addition, she did much for the children and staff socially. Everyone at St. Christopher's thank her most sincerely for her help and friendship and wish her a long and happy retirement. EPILEPTIC PUPILS In Day Special Schools 9 In Residential Special Schools 6 The number of pupils with epilepsy found to need special education during the year rose to 7, a marked increase on former years. This is one of the handicaps which is usually compatible with ordinary school life, and only when the condition is very severe or has produced associated disturbance is transfer to special school indicated. The seven children transferred were over 8 years old and the eldest was 14, so all had spent a period in ordinary school. Three had to be admitted to residential school for epileptics, and the other four entered St. Giles' School. 40 MALADJUSTED PUPILS In Day Unit 16 In Day Special Schools 3 In Residential Special Schools 55 Awaiting Placement 18 During the year nineteen pupils were ascertained as maladjusted. As Table 10 shows, there are at present 18 children awaiting placement in suitable residential schools. This is a marked increase over previous years, and it is an unfortunate fact that there is a tendency for some of these children to have to wait for a longish period before a suitable school can be found. The opening of the Sir Cyril Burt School in 1971 will, it is hoped, make marked inroads on this waiting period, but it will not solve the problem entirely. There are two reasons for this, firstly certain children of problem families would be better at residential schools at some distance from their homes, and secondly a balanced intake of pupils will be necessary for the new school to ensure that it provides the optimum therapeutic setting for the children who attend there. The difficulty of placement is to be the subject of discussion between the Health and Education Departments, and it is hoped that next year's report will show a better position. PHYSICALLY HANDICAPPED PUPILS In Day Special Schools 114 In Residential Special Schools 15 Awaiting Placement 3 There were 18 pupils ascertained as physically handicapped and virtually all of these pupils have been placed in appropriate schools, mostly in St. Giles* day special school. It will be noted from the school report which follows that the number of children suffering from spina bifida is showing the expected steady increase, and the influx of severely handicapped children into a building nor primarily designed for this type of handicap must throw an extra burden on the school staff. The total number of pupils at St. Giles' has not increased, however, as the tendency is towards the less handicapped children, those with asthma being a good example, remaining at ordinary school. How far this movement will go to counter balance the expected increase in survival of the more seriously handicapped children will be an exercise in judgement when planning the future of the St. Giles' School. I am grateful to Mr. D.B. Pettman for the following report:— St. Giles' Special School for Physically Handicapped Children The school has continued its multifarious activities on behalf of the children despite the increasing difficulties foreseen in previous reports. 41 The number on roll has dropped slightly but the work load on various departments has increased because of the greater severity of the handicaps now being admitted to St. Giles. The main handicap groups are as follows:- Boys Girls Total Cerebral Palsy 20 11 31 Spina Bifida 12 11 23 Asthma 17 4 21 Epilepsy 4 8 12 Congenital Heart 6 4 10 Muscular Dystrophy 6 - 6 Fibrocystic 2 3 5 The problem of transport for the severely handicapped children became acute and it was apparent that the existing transport arrangements were stretched to the limit. Future planning must provide for the transport of severely handicapped children from any part of the Borough. The medical departments of the school continued to work to capacity. The School Medical Officer, Dr. Thelma Wield, saw 291 children at routine medical examinations, 110 parents being present. Specialist medical examinations were held by Mr. McQueen who saw 25 children, 18 parents being present; Dr. Fanthorpe who saw 30 children, 16 parents being present and Dr. Robson who saw 21 children, 14 parents being present. All arrangements and records are kept by Sister Jordan and her staff in addition to dealing with routine medical matters and coping with 102 major epileptic fits, an increase of 120% on last year. The Physiotherapy Department has excelled itself. The total number of treatments for the year - 13,654 is a 25% increase on last year. The handicaps treated were 68 chest cases, 20 spina bifida, 31 cerebral palsy, 5 muscular dystrophy and 19 miscellaneous. Great credit is due to Miss Smith and her staff for their efficiency and efforts under difficult circumstances. The Speech Therapy Department gave 1,176 treatment sessions, together with 74 review sessions. During the year 37 new cases were assessed, 10 cases were closed. There were 25 children on treatment and 25 on supervision. I wish to thank the Principal School Medical Officer and all the school medical staff for their co-operation and efforts on behalf of St. Giles. PUPILS SUFFERING FROM A SPEECH DEFECT In Day Special School 1 In Day Unit 10 Five children were admitted to the Unit during the year including one deaf child who was awaiting a residential placement and had become a problem at his day school. This may appear peculiar but it is mentioned to emphasise that in a small Unit of this kind, almost individual programmes 42 have to be worked to as the children's speech defects do not have a common aetiology. As indicated in last year's report, it is the probability of the child's defect being remedied in the Unit which more and more has come to govern the question of admission and not a diagnosis of aphasia. Of the seven pupils who left the Unit, five returned to ordinary school where they are managing successfully, but the other two children are still giving some cause for concern and are still being followed by the Speech Therapist. Dr. Worster-Drought, who acted as Consultant to the Unit, finally retires at the end of the year. His unrivalled experience in the field of Speech Disordered Children has been of the utmost value to the Unit over the four years of its existence. The Borough has been fortunate to secure the services of Dr. Hierons, again a Consultant Neurologist, to take Dr. Worster-Drought's place. The difficulty of diagnosis these children may present makes it essential to have as adviser someone not only highly skilled but with special interest in this field, which Dr. Hierons has. I am grateful to Mr. John Brook, Principal Speech Therapist, for the following report:— During 1970 seven children have been discharged and five have been taken on. This means that at the end of 1970, ten out of the twelve available places are filled. In October 1970 Miss Brownlow, the Senior Speech Therapist responsible for the Unit, left to take up a post abroad. Applicants for the post were still being interviewed at the end of the year. As mentioned in last year's report, there is a wide range of ages and abilities in the group. To help deal with this problem a part-time teacher, Mrs. Frackiewicz, was appointed in the Summer Term in addition to the full-time teacher in charge. Permission was also given for a second classroom, but it has not been possible to bring this into being yet. The additional staff is a very great help. Children can now be grouped in various ways along team teaching principles. The teaching and therapy staff are able to work together, often usefully interchanging roles to increase the overall effectiveness of the team. Steady progress is being made in the application of programmed learning techniques, and the establishment of a firm linguistic basis for each child on which speech and education can be built The Unit functions within a normal primary and infants* school, and it is very much a class within that school. The working philosophy on which all teaching and speech therapy at the Unit is based assumes that the planned integration of the children into the everyday working of the school is the most effective technique we have in the effort to establish normal social communication. The Head Master and his staff are unstinting in their interest and practical halp with this difficult remedial task. 43 DELICATE PUPILS In Day Special Schools 30 In Residential Special Schools 6 During the year seven pupils were found to be delicate and admitted to St. Giles' School for this reason. Their disabilities varied from congenital heart disease to severe asthma, causing frequent absence from ordinary school. Some of these children may remain at St. Giles' for the rest of their school career, but it is hoped that the asthmatic children will eventually be fit to return to ordinary school. In no case was a child ascertained as delicate in the generally accepted sense of the term. They had suffered from recognised handicapping conditions. 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 16 children were recommended for home tuition, and 13 are still receiving such tuition. UNSUITABLE FOR EDUCATION IN SCHOOL Eighteen 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 14 had never previously attended a maintained school, and 4 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. Two 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 both cases it was found that the children were still unsuitable for education in school. IMMIGRANT PUPILS I am grateful to Dr. Hilary Lennox for the following report:— During 1970, 424 children were medically examined at St. James' House, the receptive and educative centre for immigrant children. A summary of findings is given overleaf:— 44 Percentage of Defects in Children Examined DEFECTS ALL AGE GROUPS EUROPEAN ASIAN India - Pakistan BRITISH WEST INDIES OTHERS 60 Boys 35 Girls 74 Boys 63 Girls 44 Boys 68 Girls 48 Boys 42 Girls Skin 4.0 - - 1.6 - 4.4 2.1 - Vision 18.0 5.7 20.2 12.7 11.7 17.7 4.2 21.4 Hearing - - 4.0 - - - - - Nose and Throat 8.0 - 6.8 3.2 4.5 4.4 - - Heart and Circulation 4.0 - 1.4 3.2 2.3 2.9 - 4.8 Lungs - - 5.4 3.2 - - 4.2 - Stability 2.0 - 1.4 1.6 4.5 5.9 - - Investigation of stool specimens was requested from all children from areas with endemic hookworm. 187 requests were made for specimens, 135 were returned for examination with 48 positive results. 72 specimens were examined from children from B.W.I, of which 32 were positive. 25 specimens were examined from Asian children of which 9 were positive. 38 specimens were examined from African children of which 7 were positive. i.e. 35.5% total positive. The positive findings were reported as:— Entamoeba coli cysts found in 4 specimens Hookworm ova found in 8 specimens Trichiniasis trichura ova found in 6 specimens Giardia Iambiia cysts found in 3 specimens Taenia ova found in 1 specimen Dwarf tapeworm found in 1 specimen Ascaris lumbricoides found in 4 specimens 21 specimens had mixed infection Height and weight measurements were taken of all the children. Although numbers in each group are small, it shows that Asian children are less heavy and smaller than those of the other groups, a finding similar to the 1969 figures. 45 Boys and Girls European Asian B.W.I. Others Ages In Years Height Weight Height Weight Height Weight Height Weight 5 & 6 years 44.0 In. 46.0 lb 42.4 In. 39.4 lb. 43.5 in, 42.91b. 43.3 in 42.4 lb 7 & 8 years 48.7 In. 52.7 lb 47.6 in. 47.1 lb. 47.7 in. 60.2 lb. 48.0 in 52.1 lb 9 & 10 years 53.4 in. 73.4 lb 51.1 In. 59.2 lb. 52.1 In, 60.1 lb. 51.0 In 61.2 lb 11 & 12 years 57.4 In. 82.2 lb 55.6 In. 69.7 lb. 54.8 in. 71.4 lb. 57.5 in 82.5 lb 13 & 14 years 61.4 In. 97.9 lb 59.2 in. 88.5 lb. 60.7 In. 94.1 lb. 61.4 In 99.0 lb 15 & 16 years 69.7 in* 147.0 lb* 61.9 in. 95.7 lb. 64.6 In. 119.6 lb. 61.9 In 107.4 lb (*Averages not representative owing to low numbers) 46 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 1971, as in Forms 7, 7M, and 11 Schools 54,339 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) 1966 and later 287 286 1 7 41 44 1965 3,244 3,236 8 115 455 532 1964 1,871 1,864 7 92 290 345 1963 247 247 - 20 50 66 1962 2,442 2,436 6 218 444 595 1961 2,306 2,301 5 205 427 575 1960 661 661 - 46 104 142 1959 365 365 - 56 69 111 1958 2,458 2,458 - 305 425 657 1957 1,137 1,136 1 119 189 291 1956 1,777 1,777 - 230 257 437 1955 and earlier 2,035 2,035 - 326 302 581 TOTAL 18,830 18,802 28 1,739 3,053 4,376 Column (3) total as a percentage of Column (2) total 09.85% Column (4) total as a percentage of Column (2) total 0.15% 47 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 1,020 Number of Re-inspections 3,873 Total 4,893 TABLE C - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 46,605 (b) Total number of individual pupils found to be infested 424 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 16 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) 7 48 PART 2 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS DURING THE YEAR 1970 T = requiring Treatment O = requiring Observation Defect or Disease PERIODIC INSPECTIONS SPECIAL INSPECTIONS ENTRANTS LEA VERS OTHERS TOTAL SKIN T 128 335 600 1063 15 O 137 94 157 388 3 EYES - (a) Vision T 214 556 969 1739 68 O 578 182 848 1608 36 (b) Squint T 123 15 127 265 9 O 13 2 12 27 2 (c) Other T 19 7 24 50 - O 25 11 27 63 3 EARS - (a) Hearing T 63 23 148 234 14 O 299 19 110 428 9 (b) Otitis Media T 33 6 37 76 4 O 169 14 119 302 4 (c) Other T 11 7 14 32 4 O 30 9 22 61 - NOSE AND THROAT T 125 26 165 316 9 O 521 38 428 987 20 SPEECH T 71 4 84 159 11 O 102 5 33 140 11 LYMPHATIC GLANDS T 20 1 9 30 2 O 97 9 96 202 3 HEART T 29 29 47 105 11 O 89 32 120 241 10 LUNGS T 48 23 101 172 14 O 101 14 88 203 4 DEVELOPMENTAL - (a) Hernia T 16 5 17 38 9 O 34 6 29 69 4 (b) Other T 36 44 156 236 14 O 179 85 301 565 14 ORTHOPAEDIC - (a) Posture T 7 8 32 47 4 O 19 38 59 116 - (b) Feet T 27 11 76 114 9 O 78 89 162 329 6 (c) Other T 39 25 69 133 8 O 140 67 145 352 11 NERVOUS - (a) Epilepsy T 10 5 18 33 4 O 23 4 8 35 2 (b) Other T 44 6 58 108 12 O 83 8 72 163 10 LOGICAL = (a) Development T 13 1 24 38 10 O 52 10 37 99 11 (b) Stability T 20 9 65 94 16 O 157 15 166 338 19 ABDOMEN T 19 5 37 61 9 O 38 16 59 113 6 OTHER T 16 13 49 78 2 O 75 72 156 303 8 49 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 10 Errors of refraction (including squint) 1016 Total 1026 Number of pupils for whom spectacles were prescribed 399 TABLE B - DISEASES AND DEFECTS OF EAR. NOSE AND THROAT Number of cases known to have been dealt with Received operative treatment- (a) for diseases of the ear - (b) for adenoids and chronic tonsillitis 576 (c) for other nose and throat conditions - Received other forms of treatment 108 Total 684 Total number of pupils still on the register of schools at 31st December 1970, known to have been provided with hearing aids:— (a) during the calendar year 1970 4 (b) in previous years 86 TABLE C - ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated (a) Pupils treated at clinics or out-patients depts. 343 (b) Pupils treated at school for postural defects 23 Total 366 TABLE D - DISEASES OF THE SKIN Number of pupils known to have been treated Ringworm - (a) Scalp - (b) Body 3 Scabies 37 Impetigo 6 Other skin diseases 64 Total 110 TABLE E - CHILD GUIDANCE TREATMENT Number known to have, been treated Pupils treated at Child Guidance clinics 290 50 TABLE F - SPEECH THERAPY Number known to have been treated Pupils treated by speech therapists 1342 TABLE G - OTHER TREATMENT GIVEN Number known to have been treated (a) Pupils with minor ailments 1905 (b) Pupils who received convalescent treatment under School Health Service arrangements 24 (c) Pupils who received B.C.G. vaccination 2983 (d) Other than (a), (b) and (c) above, Please specify (1) Audiology 28 (2) Enuresis 284 (3) Overweight Clinics 182 (4) Consultant for Speech Disorders 71 Total (a) - (d) 5477 APPENDIX B - TREATMENT CLINICS Summary of Attendances 1970 1969 Increase or Decrease Audiology Clinic 161 197 -36 Dental Clinics 29,920 25,000 +4920 Enuresis Clinics 888 1,068 -180 Eye Clinics 1,195 1,179 +16 Inspection Clinics 861 1,007 -146 Minor Ailments and Verruca Clinics 11,363 9,714 +1649 Physiotherapy Clinics 3,162 3,434 -272 Weight Control Clinics 500 920 -420 48,050 42,519 +5531 51 AUDIOLOGY CLINIC Numbers attending Croydon Day Schools and Pre-School Children (a) With hearing sufficiently impaired to require regular supervision: Pre-School Pupils 9 Primary School Pupils 21 Secondary School Pupils NIL 30 Pure Tone Audiometer Tests, (Excluding Sweep Test Failures) (a) Tested for the first time 311 (b) Tested as a review case 374 685 Auditory Training 28 children received regular auditory training during the year. Number of attendance sessions: (a) At the Audiology Clinic 161 (b) At home 111 272 Sweep Testing of Five Year Old School Entrants Number of schools visited 68 Number of children tested 7,871 Number of children passed 6,394 Number of children failed 681 Number of children to be re-tested 796 Number of children not tested 598 (absent or unco-operative). The failures were re-assessed as follows: No hearing loss 141 Slight hearing loss 263 Moderate hearing loss 156 Moderately severe hearing loss 51 Severe hearing loss 8 Failed to keep appointments 30 Left district 16 Waiting to be tested 21 Issue of Hearing Aids (a) National Health Service 'Medresco' aids 2 (b) Commercial aids bought by Croydon L.E.A. 10 12 8 children under school age are using hearing aids. 52 DENTAL SERVICE Items of Treatment 1970 1969 (1) Number of children first inspected at school 43,344 36,569 (2) Number of children first inspected at clinic 5,955 5,463 (3) Number of (1) and (2) found to require treatment 24,202 21,808 (4) Number of (1) and (2) offered treatment 24,202 21,808 (5) Number re-inspected at school or clinic 8,772 5,902 (6) Number of (5) requiring treatment 4,279 3,315 (7) Visits - First 9,696 8,328 Subsequent 20,224 16,672 29,920 25,000 (8) Additional courses commenced 1,071 894 (9) Fillings - Permanent 17,210 12,592 Deciduous 11,172 8,016 28,382 20,608 (10) Teeth Filled - Permanent 14,621 11,322 Deciduous 10,111 7,182 24,732 18,504 (11) Extractions - Permanent 1,604 1,646 Deciduous 4,044 3,467 5,648 5,113 (12) General Anaesthetics 1,704 1,702 (13) Emergencies 1,293 1,172 (14) X-Rays (Number of patients) 1,326 1,209 (15) Prophylaxis 1,077 951 (16) Teeth otherwise conserved 967 1,065 (17) Teeth root filled 108 110 (18) Inlays 15 8 (19) Crowns 73 58 (20) Other operations 4,184 4,529 (21) Advice 1,185 1,373 (22) Appointments not kept 9,651 7,982 (23) Courses of treatment completed 8,684 7,473 53 (24) Orthodontics- 1970 1969 Cases remaining from previous year 245 241 New cases commenced during year 265 240 Cases completed during year 165 157 Appliances - Removable 447 462 Fixed 31 31 (25) Number of dentures supplied 19 37 (26) Number of sessions - Treatment 4,017 3,262 Inspection 444 358 Dental Health Education 39 8 EYE CLINICS PURLEY, SANDERSTEAD AND ADDINGTON 1970 1969 No. of New cases examined 706 813 No. of Re-examinations 489 366 Total number of examinations 1,195 1,179 No. of children for whom spectacles were prescribed 309 496 On 31st December 1970 the number of:— (1) New Cases referred but not yet examined was 64 (2) Children due for review in 1970 and still awaiting re-examination was 150 MINOR AILMENTS CLINICS Clinic Defects Attendances Ashburton School 361 1,680 Lodge Road 247 2,039 New Addington 470 2,067 Norbury Manor School 44 418 Purley 126 870 Rectory Park 201 1,274 Rockmount School 93 966 Waddon 363 2,060 54 MINOR AILMENTS CLINICS (continued) Defects 1970 1969 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm - - - - - - Scabies 4 4 1.0 1 1 1.0 Impetigo 6 13 2.2 4 6 1.5 Other Skin Defects 64 97 1.5 90 240 2.7 Otorrhoea and other Ear defects 9 16 1.8 2 3 1.5 External Eye Defects 10 19 1.9 7 19 2.7 Verrucae 1.250 8,391 6.7 821 6,774 8.3 Miscellaneous 562 2,823 5.0 539 2,671 5.0 TOTALS 1.905 11,363 6.0 1.464 9.714 6.6 PHYSIOTHERAPY CLINICS 1970 1969 Total number of pupils treated 527 589 Total number of new cases 199 224 Total number of Orthopaedic conditions 343 377 Total number of Respiratory conditions 184 212 Individual treatments 387 467 Number of classes 162 187 SPEECH CLINICS 1970 1969 Total number of cases treated 1,342 1,067 Number of new cases 266 90 Number of cases discharged 429 343 Number of reviews 995 716 Treatment sessions 11,668 8,946 55 APPENDIX C RETURN OF MEDICAL INSPECTIONS - NON MAINTAINED SCHOOLS A. Routine Medical Inspections:— Year Year 1970 1969 Aged 11 and under 41 4 12 111 129 13 65 55 14 61 74 15 and over 183 169 Total Pupils 461 431 Visits to non-maintained schools 28 29 B. The following defects were found:— Requiring Treatment Observation Skin 29 8 Vision 114 37 Squint 1 2 Hearing 6 5 Otitis Media 1 2 Nose and Throat 4 7 Speech - - Cervical Glands - - Heart and Circulation 1 2 Lungs 4 1 Development(Other) 10 10 Posture 7 3 Flat Foot 16 3 Orthopaedic (Other) 10 8 Nervous System 2 1 Psychological 1 5 Other Defects 13 4 C. Other Inspections:— There were 96 Re-inspections, and no Special Medical Inspections. 56 APPENDIX D NUMBERS OF PUPILS ON SCHOOL REGISTERS. AND NUMBERS OF CHILDREN EXAMINED AT ROUTINE MEDICAL INSPECTIONS IN MAINTAINED SCHOOLS DURING THE YEAR 1970 Primary Schools Numbers on Registers No. of Children Examined Boys Girls Total All Saints (C. of E.) J.M. 294 42 43 85 All Saints County I. 235 40 59 99 Applegarth J.M. 481 67 75 142 Applegarth I. 313 62 78 140 Ashburton .M. 601 96 79 175 Ashburton I. 342 70 61 131 Atwood J.M & I. 356 50 56 106 Beaumont J.M. & I. 168 29 27 66 Benson J.M. & l. 570 124 116 240 Beulah J.M. 554 71 61 132 Beulah l. 361 80 75 155 Byron J.M. & l. 341 59 57 116 Castle Hill J.M. 551 91 59 150 Castle Hill l. 436 87 81 168 Chipstead Valley J.M. & l 574 85 66 151 Christ Church(C. of E.)J.M. & l. 251 34 33 67 Coulsdon(C. of E.) J.M. & l. 136 18 30 48 Courtwood J.M. & l. 192 34 28 62 Cypress J.M. 313 40 29 69 Cypress l. 249 52 70 122 David Livingstone J.M. & l. 260 43 46 89 Davidson l. 158 50 27 77 Duppas J.M. 335 46 37 83 Ecclesbourne l. 189 35 45 80 Elmwood J.Boys 303 152 - 152 Elmwood J.Girls 333 - 138 138 Elmwood l. 391 56 78 134 Fairchildes J.M. 438 28 77 105 Fairchildes l. 323 67 53 120 Fieldway J.M. & l. 347 72 73 145 Forestdale J.M. & I. 95 9 9 18 Gilbert Scott J.M. 634 174 137 311 Gilbert Scott l. 366 38 35 73 Gonville J.M. & l. 497 72 88 160 Good Shepherd(R.C.)J.M. 267 32 22 54 Good Shepherd(R.C.) l. 194 33 24 57 Gresham J.M. & l. 335 63 58 121 Hayes J.M. & l. 400 57 56 113 Howard J.M. & l. 293 38 43 81 Kenley J.M. & l. 318 52 43 95 Kensington Avenue J.M. 507 87 75 162 Kensington Avenue l. 297 57 58 115 Keston J.M. 360 51 53 104 Keston l. 272 79 54 133 Kingsley J.M. 496 76 74 150 Kingsley l. 367 68 69 137 Margaret Roper(R.C.)J.M. & l. 268 51 35 86 Monks Orchard J.M. & l. 430 84 55 139 Norbury Manor J.M. 461 47 57 104 Norbury Manor l. 293 51 53 104 Orchard Way J.M. & l. 151 32 40 72 Oval J.M. 336 50 48 98 Oval l. 227 53 41 94 Parish Church(C. of E.) J.M. 306 39 47 86 Parish Church (C. of E.) l. 226 22 22 44 57 Primary Schools Numbers on Registers No. of Children Examined Boys Girls Total Park Hill J.M. & I. 276 41 40 81 Portland l. 116 26 38 64 Purley Oaks J.M. 337 54 51 105 Purley Oaks l. 244 56 56 112 Regina Coeli(R.C.) J.M. & l. 391 61 71 132 Ridgeway J.M. 361 48 61 109 Ridgeway l. 234 51 37 88 Rockmount J.M. 339 31 53 84 Rockmount l. 265 27 25 52 Roke J.M. & l. 456 71 59 130 Rowdown J.M. 422 62 48 110 Rowdown l. 388 94 74 168 St. John's(C. of E.) J.M. & l. 301 73 64 137 St. Joseph's(R.C.) J.M. & l. 503 145 106 251 St. Mark's (C. of E.) J.M. & l. 239 36 39 75 St. Mary's(R.C.) J.M. 324 47 43 90 St. Mary's(R.C.) l. 240 30 40 70 St. Michael's(C. of E.) l. 89 17 13 30 St. Peter's J.M. & l. 250 37 27 64 Selsdon J.M. & l. 611 99 72 171 Smitham J.M. & l. 462 83 63 146 South Norwood J.M. 526 64 74 138 South Norwood l. 357 62 49 111 Spring Park J.M. 462 70 65 135 Spring Park l. 327 53 76 129 Sydenham J.M. 310 45 33 78 Sydenham l. 216 45 42 87 Thomas Becket(R.C.) J.M. & l. 274 34 47 81 Toldene J.M. & l. 254 36 59 95 Waddon l. 253 44 50 94 Wattenden J.M. & l. 184 23 27 50 West Thornton J.M. & l. 430 72 67 139 Whitehorse Manor J.M. 528 70 39 109 Whitehorse Manor l. 369 107 119 226 Winterbourne J. Boys 437 52 - 52 Winterbourne J. Girls 459 - 111 111 Winterbourne l. 443 76 77 153 Wolsey J.M. 564 70 57 127 Wolsy l. 404 54 48 102 Woodcote J.M. 340 38 41 79 Woodcote l. 275 57 72 129 Woodside J.M. 676 73 68 141 Woodside l. 293 34 36 70 TOTAL 33,901 5,563 5,390 10,953 SPECIAL SCHOOLS St. Christopher's(E.S.N.) Mixed 226 45 30 76 St. Giles' (Del. & P.H.) Mixed 156 96 60 166 St. Luke's(Partially Sighted) Mixed 16 7 9 16 TOTAL 398 148 99 247 NURSERY SCHOOLS Coulsdon 48 15 20 35 Crosfield 57 29 28 57 Purley 52 22 15 37 TOTAL 157 66 63 129 58 Secondary Schools Numbers on Registers No. of Children Examined Boys Girls Total Archbishop Tenison (C. of E.) Mixed 367 51 63 114 Ashburton High 1,273 238 264 502 Coloma (R.C.) Girls 636 - 190 190 Davidson High 447 94 111 206 Ecclesbourne Girls 417 - 156 156 Fairchildes High 1.184 280 283 563 Haling Manor High 962 208 109 317 Heath Clark Mixed 848 118 130 248 Ingram Boys 593 253 - 253 John Newnham Mixed 642 89 113 202 John Ruskin Boys 614 211 - 211 Lady Edridge Girls 604 - 165 165 Lanfranc High 1,110 207 176 383 Monks Hill High 310 - - - Norbury Manor Boys 439 203 - 203 Norbury Manor Girls 479 - 185 185 Our Lady's (R.C.) Girls 166 - 79 79 Overbury Mixed 677 162 165 327 Purley Boys 628 186 - 186 Purley Girls 587 - 178 178 Riddlesdown High 885 222 155 377 St. Andrew's (C. of E.) Mixed 258 62 53 116 St. Mary's (R.C.) Mixed 471 79 97 176 Selhurst Boys 595 180 - 180 Selhurst Girls 529 - 169 169 Shirley Mixed 657 111 133 244 South Norwood High 482 71 85 156 Stanley Technical Boys 331 73 - 73 Taunton Manor Mixed 504 76 94 170 Tavistock High 623 179 60 239 Thomas More (R.C.) Mixed 590 149 117 266 Westwood Girls 485 - 237 237 Woodcote Mixed 663 152 152 304 TOTAL 19,856 3,654 3,719 7,373 59 CASES OF INFECTIOUS DISEASES AS NOTIFIED BY HEAD TEACHERS Disease 1970 1969 1968 Chicken Pox 579 721 841 Conjunctivitis 27 14 3 Diphtheria - - - Gastro-Enteritis 22 9 12 German Measles 267 485 477 Impetigo 34 46 10 Jaundice 2 22 37 Measles 388 506 75 Mumps 878 1,295 135 Non-Specific Diarrhoea including Dysentery 325 551 615 Non-Specific Vomiting 10 43 98 Other Diseases 342 553 246 Poliomyelitis - - - Ringworm or Vermin Body 3 1 3 Scalp - - 2 Scabies 10 13 2 Scarlet Fever 78 87 96 Sore Throat including Tonsillitis 111 112 72 Whooping Cough 55 19 21 TOTALS 3,131 4,477 2,749 WORK OF THE SCHOOL HEALTH VISITORS AND NURSES 1970 1969 Home Visits re pupils 3,787 2,723 visits Social/Welfare visits to Schools 421 354 " Minor Ailments 1,262 1,108 sessions Hygiene 647 551 '' Pre-Medicals 1,226 1,067 '' Routine Medical Inspections 1,405 1,322 " Follow-up 17 8 " Immunisation 64 68 '' Health Survey 61 30 " Health Education 404 423 '' Enuresis Clinics 78 71 '' Eye Clinics 120 86 '' Inspection Clinics 72 69 '' CONTENTS A. - PUBLIC HEALTH REPORT Page Accommodation for confinements 12 Animal Boarding Establishments Act 62 Animals, diseases of 52, 66 Ante-natal clinics 23 At risk register 109 Bacteriological examination 67,136 Births 11,12 Blindness 88 Caravan sites 53 Cancer 97 Census 11 Cervical cytology 40,126 Chest clinic, work of 15 Child health centres 25,114 Child minders 86 Chiropody 40 Clean air act 50 Committee, health 3 Communicable diseases 19,133,142 Congenital malformations 24,108 Consumer protection act 61 Convalescence 29 Cremation 128 Day nurseries 26, 39 Deafness 40, 110 Deaths 11, 94 Dental treatment 34, 124 Dialysis, home 88 Disinfection 51 Disinfectation of premises 52 Drainage 49 Drug dependency 90 Employment agencies 59 Epileptic 88 Elderly persons, rehabilitation of 119 Fabrics (misdescription) act,1913 61 Factories and workshops 55 Family planning 85 Food and drugs act, 1955 65, 69 Food hygiene regulations, 1960 64 Food poisoning 135 Food supply 63 General practitioner attachment schemes 11 7, 120 Hairdressing 61 Health education 30 Health visitors, work of 28,111,116 Home dialysis 88 Home helps 29, 122 Home nursing 27,118 Home safety 30, 123 Housing 47 Ice-cream - bacteriological examination of 68 Illegitimacy 11,24 Page Immigrants,longstay 89,127 Immunisation 19,137 Infant mortality 11.94,99,100 Inspection - public health inspectors 54,72 Liquid egg 69 Local land charges 51 Marriages 12 Maternal mortality 11,103 Maternity homes 128 Meat inspection 66 Medical examinations 86,87 Mental health 35,129 Midwifery 25, 101 Midwives act 24 Midwives, work of 27,104 Milk supply 67 Mines and quarries act, 1954 53 Mortuary 128 Mothercraft classes 23 National assistance acts 88 Neonatal deaths 11 Noise abatement 50 Notification of births acts 11,12 Nursing equipment, loan of 121 Nursing homes 128 Nurses agencies 128 Offices, shops and railway premises act 56, 74 Outwork 56 Paediatric assessment 23 Perinatal deaths 11,99 Pest control 49 Pet animals act 63 Phenylketonuria 103 Pharmacy and poisons act 62 Planning applications 51 Poliomyelitis 138 Population 11 Post-natal clinics 23 Post-mortems 128 Premature infants 107 Prosecutions 57,60,69 Public health inspectors, work of 45 Public health laboratory, service 136 Public health nursing services 26 Rag flock act 62 Rats and mice (destruction) act 49 Rehousing on medical grounds 89 Relaxation classes 23 Remedial works carried out 58 Riding establishment act, 1964 62 Rivers and streams, pollution of 49 Schools 66 Scrap metal dealers act, 1964 62 Sewage disposal 81 Sexually transmitted diseases 19,142 Shops act 59 Page Statistics, summary of 11 Stillbirths 11 Tuberculosis, after care 17 '' allowances 17 '' contacts 16 '' home visits 16 " mortality 16 '' notifications 15,139 '' occupational therapy 18 '' prevention and control 15 '' vaccination 17 Page Unmarried mothers 24 Vaccinations (smallpox) 137 Verminous persons 52 Vital statistics 11,94,97 Ward statistics 98 Water supply 81 Welfare foods 23,108 X-Ray 16 B. - SCHOOL MEDICAL REPORT Page Audiology 2,12,19,51 Child Guidance 316,40,49 Cleansing of children 2,8,47 Clinics 5,50 Convalescent treatment 28 Costs 6,29 Deaf children 19,33 Deaths 29 Defects found 8,9,48 Delicate children 30,40,43 Dental Services 3,17,52 Developmental defects 12 Enuresis clinic 20 Epileptic children 39,40 Eye clinics 11,20,49,53 Handicapped children 30 Health Education 3,21 Heart and circulation defects 12 Heights and Weights 13,14,27 Home tuition 43 Immigrant pupils 43 Infectious diseases 3,59 Intelligence assessments 24 Juvenile employment 28 Maladjusted pupils 3,16,40 Meals and Milk 28,29 Medical inspections 1,7,46,56 Minor ailments tables 53, 54 Page Non-maintained schools 8,55 Nutrition 13,14,27 Orthodontic service 53 Orthopaedic defects 12,40 Overweight children 1314,27 Parents, attendances of 8 Partially hearing units 33 Physiotherapy 25,54 Populations of schools 46,56 Psychological defects 13,16,40 School nurses, work of 59 Special inspections 7,47,48 Speech 25,50,54 Staff 4,6,19 Statutory tables 46 Sub-normal children 36,43 St. Christopher's School 37 St. Giles' School 40 St. Luke's School 32 Transport of children 27 Tuberculosis 12 Uncleanliness 2,8,47 Verrucae 2,11,54 Vision defects 2,11,12,30