AC 43331 acb'''d PUBLIC HEALTH IN CROYDON 1971 CRO 73 PUBLIC HEALTH IN CROYDON 1971 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 S.L. WRIGHT, M.D., F.R.C.P., D.P.H. PUBLIC HEALTH DEPARTMENT, TABERNER HOUSE, PARK LANE, CROYDON. CR9 3BT Telephone:— 01-686 4433 3 HEALTH AND PUBLIC SERVICES CONTROL COMMITTEE 1971 Alderman B.C. Sparrowe (Chairman); Councillor Mrs. N.B. Booth (Vice-Chairman); Alderman K.A. Edwards, J.P. Councillor Mrs. J.M.C. Baker; Councillor R.T. Bishop; Councillor A.E. Buddie; Councillor V. Burgos; Councillor P. Byrne; Councillor L.E. Deane; Councillor Mrs. M.M.H. Horden; CounciNor C.E. Kelly; Councillor Mrs. P.A.M. Little; Councillor Mrs. S.E. Lord, S.R.N. Councillor K.M.B. Munro; Councillor B.H. Rawling; Councillor N.A. Tully; Councillor Mrs. A.M. Watson, J.P. Councillor H.G. Whitwell; Doctor Maureen Adams, M.B., B.S., M.R.C.S., M.R.C.P., P.S. Boffa, Esq., M.D. P. Brightwell, Esq., M.B., B.S.; J.C. Miller, Esq., F.R.C.S., F.R.C.O.G. ' 5 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 To the Chairman and Members of the Health and Public Services Control Committee. LADIES AND GENTLEMEN. The following report for the year 1971 complies with a statutory duty and provides statistical details of the health aspects of the Committee's work. I comment on some trends and unusual items. Statistics The birth rate showed a further fall. This decline followed the pattern which began in 1967 and the rate of fall has not varied significantly over this five year period. [ lt is interesting that the birth rate of the former County Borough fell in 1933 and 1934 to a record low figure of 13.2 per 1,000, despite the paucity of family planning advice presumably as a reaction to economic recession. ] The rise in the percentage of illegitimate births in 1971 may be connected with the fall in the number of marriages. The death rate for illegitimate infants rose again to nearly three times the rate for legitimate births. There were no deaths from abortion or childbirth. There were fewer deaths from lung cancer, but it was still the commonest site for cancer in men (40% of all cancers). 6 Health Centres After many delays the Parkway Health Centre in New Addington was finally opened and began a successful service which should benefit the residents of this outlying estate. The Domiciliary Nursing Team The structure and deployment of services to link hospital and family doctor care with Local Authority functions were kept under constant review, both to improve present facilities and to provide maximum opportunity to gain from future integration. Care of Pre-School Children The transfer of duties to the Social Services Department gave some administrative problems but at all stages the staff involved were motivated by the mutual wish to promote the welfare of the children. There was a refreshing willingness to continue helping and to seek advice. A new pattern of co-operation was fashioned to cope with the continued need for supervision of health and for social support for large sections of the population. Health Education Because the service in Croydon was amongst the first to be established and has developed under the inspired leadership of Miss Elliott, subordinate staff have departed for promotion elsewhere with flattering but crippling rapidity. No solution to this problem was forthcoming in 1971, but clearly it must be remedied if the vital and growing work of the section is even to be maintained. Authority to increase the establishment was given specifically to expand the programme to prevent sexually transmitted diseases, but recruitment of suitable personnel proved very difficult. Family Planning Full re-imbursement to the Family Planning Association was approved for all women with medical/social needs. Dental Services Mr. B.J. West presents his first report which details increases in the services to pre-school children and plans to extend this throughout the Borough. Environmental Hygiene The Chief Public Health Inspector records the decision to extend the Clean Air Act to the former urban district areas of the Borough. He also mentions the growing concern with noise nuisances. The problem of 7 metallic residues in former sewage farm land occasioned much enquiry. No evidence of ill effects was obtained from blood examinations of individuals who had worked at and cultivated allotments on the site, nor dia samples of their edible crops give figures for lead in excess of recommended international limits. Nevertheless with soil samples showing over 6,000 parts per million of lead, it was thought prudent to recommend only developments which covered the site entirely by buildings, paving or Corporation mainrained grassed areas. Health Services Co-ordination The advent of the Social Services Department increased this problem but the new Director was already known to the hospital and family doctor services and made personal efforts to enhance the existing co-operation. The combined hospital and Local Authority mental social work team was maintained despite many staffing changes inevitable with re-structuring. If the proposed area health board coincides with the London Borough, it seems likely that the divisive effects of the Social Services Act will be overcome in Croydon. Impending Changes Hopes that 1971 would reveal the new health service structure were not realised with resulting discouragement to staff retention and recruitment. Nevertheless all services were fully maintained and further developed and my thanks are due for the sustained efforts of members of the department. Finally I express appreciation for the unabated interest, support and encouragement of the Chairman and members of the Committee. I am Yours faithfully, S.L. WRIGHT, Medical Officer of Health and Principal School Medical Officer. STATISTICS » 11 SUMMARY OF STATISTICS FOR 1971 Area, 21,395 acres Population (Census 1971) 332,840 Total population (estimate of Registrar General) 333,840 (Midsummer, 1971) Number of Domestic Dwellings; 108,357 Rateable Value of Borough 1971 as from 1.4.71 £22,705,525 Product of a Penny Rate, for London Borough of Croydon purposes, ₤232,800 Mixed Rate in the £. 67p (for the year from 1.4.71) Live Births Males Females Total Legitimate 2,460 2,342 4,802 Illegitimate 275 247 522 5,324 Illegitimate Live Births per cent. of total live births 10 Live Birth Rate (as adjusted by comparability factor 1.02) 16.2 (England and Wales) 16.0 Stillbirths 68 Stillbirth rate per 1,000 total (live and still) births 13 (England and Wales) 12 Total Births (Live and Still) 5,392 Infant Deaths 81 Infant Mortality rate per 1,000 live births 15 (England and Wales) 18 Infant Mortality rate per 1,000 legitimate live births 13 Infant Mortality rate per 1,000 illegitimate live births 38 Neo-natal Mortality rate (First four weeks) per 1,000 total live births 10 (England and Wales) 12 Early neo-natal Mortality rate (First week) per 1,000 total live births 8 (England and Wales) 10 Perinatal Mortality rate (stillbirths + deaths during the first week) per 1,000 total live and still births 21 (England and Wales) 22 Maternal Deaths (excluding abortion) - Maternal Mortality rate (including abortion) per 1,000 total live and still births - Deaths, 3,742 Death-rate per 1,000 of the estimated population 11.2 (England and Wales) 11.6 Death-rate (as adjusted by comparability factor 0.87) 10.1 12 Marriages The number of marriages solemnised in 1971 in the Croydon Registration District was as follows:— Church of England 932 Non-conformist places of worship 533 The Register Office 1,305 When supplying these figures Mr. Davies, the Croydon Superintendent Registrar, kindly analysed recent trends and commented:- "Of the total numbers of persons giving notice of marriage during the year 6.01 per cent were minors, compared with 6.4 per cent in 1970 which was the first year for comparison since the reduction of the age of majority from twenty-one years to eighteen years, under the Family Law Reform Act 1969. There has been a gradual increase in the number of marriages at the Register Office since 1960 which it will be seen has been maintained in 1971." Notification of Births Notifications were received in respect of confinements conducted by:- Live Births Still Births Total Midwives 3,792 39 3,831 Doctors 846 22 868 4,638 61 4,699 Accommodation for Confinements The following table shows where babies were born in the Borough of Croydon during the whole of 1971. 697 residents had babies outside Croydon and 152 non-residents were confined in Croydon. Number Percentage In Private Houses 839 17.9 In Public Institutions 3,830 81.5 In registered Maternity Homes 30 .6 Total 4,699 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 1971 may be regarded as satisfactory. Incidence 62 cases of Respiratory Tuberculosis and 20 cases of Non-Respiratory Tuberculosis were notified on Form A during 1971 (Table 1 - Formal Notifications). Of these 38 males and 24 females were Respiratory cases and 11 males and 9 females were Non-Respiratory. In addition 21 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 1971 by notification or otherwise was 105. 83 of these were cases of Respiratory Tuberculosis; 55 in males and 28 in females. There was one case of Non-Respiratory Tuberculosis among children under 15 years. The number of cases in adults was 21. The incidence rate of Tuberculosis, all forms, was 0.30 per 1,000 of the population, for Respiratory Tuberculosis 0.24 and for Non-Respiratory Tuberculosis 0.06 per 1,000 population. The notification rate was 0.24 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31 st December, 1971. RESPIRATORY N ON- RESPIRATORY Males Females Total Males Females Total Total Cases 527 408 935 67 86 153 1,088 In 1971 the death-rate from all forms of Tuberculosis was 0.03 per 1,000 population. The rate from Respiratory Tuberculosis was 0.03 and the rate for NonRespiratory 0.00 In 1971 the total number of deaths was 12. 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 117. 16 Deaths from Non-Respiratory Tuberculosis During 1971 one death was certified to be due to Non-Respiratory Tuberculosis Co-ordination with the Health Department During the year 10 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 33 selected cases for varying periods during the year and 28 cases were in receipt of extra nourishment at the end of the year. The Chest Clinic and Home Visiting 1,707 new cases were examined during the year. 55 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 14,045. The Clinic doctors paid 203 home visits and the Tuberculosis Visitors 3,620 visits for Clinic purposes. In addition the Tuberculosis Visitors made 110 primary visits for the purposes of the Notification Register. There were also 1,016 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 4,287 Number of patients recalled for examination and large film 399 Number of active cases of Pulmonary Tuberculosis found 11 Number of cases of lung cancer found 32 Contact Examination During 1971, 496 persons were examined for the first time as contacts of notified cases of Tuberculosis. Of these contacts, 6 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 12 compared with 0.30 per 1,000 of the general population. In addition one was 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 1971 and regular sessions were held at the Clinic for this purpose. 487 17 contacts were successfully vaccinated during the year. In addition 22 nurses and domestics were successfully vaccinated, and 29 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 3,858 Number found to be negative 3,181 Number vaccinated with B.C.G 3,181 For detailed figures see Appendix page 117. 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 114. 18 COMMUNICABLE DISEASES The single case of typhoid fever gave some concern. The patient was a school boy who had been on holiday abroad and returned to a large voluntary home in which children eat in a dining hall, and sleep in dormitories. They attend various day schools in Croydon. In this boy's dormitory there was an outbreak of mild epidemic vomiting shortly after re-assembly in which the patient was involved. He was so obviously more seriously ill that within 24 hours he was admitted to the sanatorium and transferred four days later to hospital where a diagnosis of typhoid fever was made. From the date of onset it was clear that he had been infected whilst abroad but there had been many contacts after he fell ill. A careful balance was maintained between measures to prevent the spreading of infection and disrupting the education of the children, As usual Dr. Thomas, the Public Health Bacteriologist gave invaluable help, and the Medical Officer, Matron and other staff at the home were co-operative, cautious and diligent. No subsequent case of typhoid infection arose, confirming that with care it is not a disease spread easily to contacts. The danger lies in infected water or food. Measles was only slightly less prevalent that in 1970. Evidence elsewhere suggests that vaccination must involve over 90% of susceptible children to eliminate this infection and this has so far not been achieved in Croydon. Immunisation With no cases of poliomyelitis or diphtheria reported, the numbers receiving protection against these diseases were disappointingly low. It was a reflection of the diminished use of Child Health centres and new techniques will be needed to overcome this trend. Vaccination against rubella proceeded without difficulties. Sexually Transmitted Diseases There was little change in the incidence of syphilis, but the number of cases of gonorrhoea and "other conditions" reach new record high figures. To enable health education courses in schools, which include the prevention of such infections, to cover all older pupils an increase in the establishment of health education officers was approved. There were delays in the re-building of the special clinic at the Croydon General Hospital, and no request was forthcoming for contact tracing staff. Posters, and leaflets regarding risks and treatment facilities were circulated but it seems doubtful if the knowledge of dangers will prevent indulgence. Research on possible vaccines is now being undertaken and results are awaited. For other figures see Appendix page 120. PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT ANTE AND POST NATAL CLINICS 21 The unified service of hospital and local authority clinics continued. The Lodge Road premises despite repeated extensions and alterations are still of insufficient size for non-clinical functions, which so far have been subordinated to the needs of patients. It became clear that inability to retain clerical staff leads to annoying increased waiting times for mothers at busy clinic sessions. Improvements were being sought, but site limitations imposed insuperable problems. Attendances during the year were:- Ante-Natal 5,486 Post-Natal 986 Patients seen for first blood test 3,917 Patients found to have antibodies 37 Patients sent to Special Clinic 9 The numbers attending the Relaxation and Mothercraft classes increased again in 1971 - Midwives, Health Visitors and Physiotherapists continue to work together and combine to provide this service. In all 1,458 mothers attended these classes and made 6,391 attendances. 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 117. 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 99 babies with congenital conditions was notified in 1971. For details see Appendix, page 95. PAEDIATRIC ASSESSMENTS The experiment of a Corporation medical officer attending the hospital maternity unit to examine new bom infants was established as a permanent scheme. The Regional Hospital Board agreed to give the Senior Medical Officer concerned, a contract for three sessions a week, reimbursing her salary to the Corporation. She dealt with 1,580 babies during 1971. 22 Child Health Centres The demand for this service which combines the education of parents, developmental assessment and immunisation of children has again fallen this year. On the other hand the number of children attending Well Baby clinics run by general practitioners and health visitors has increased, so that the total number of children using the service has increased overall. For detailed figures see Appendix page 99. Welfare Foods and Medicaments From the 4th April, 1971 the provision of cheap National Dried Milk for children ceased andthe price per carton is now 20p. instead of 12½p. This increase in price has resulted in a large decrease in sales of National Dried Milk during 1971. Cod Liver Oil was discontinued and was replaced by Vitamin A.D. & C Drops which were available from the 24th May 1971. The cost of these new Drops is 5p. per bottle, each bottle contains sufficient drops for seven weeks. For detailed figures see Appendix, page 95. HEALTH CENTRES The adaptations to the existing Child and School Health Clinic at New Addington were completed and the building opened as a Health Centre in October. It provided 6 surgeries for general practitioners in addition to accommodation for local authority and hospital staff. The treatment room was kept open throughout the day by local authority nurses so that it served as a minor casualty unit for this outlying housing estate. No major difficulties arose and the first health centre in Croydon was an encouraging start for this type of unified service. The site for the South Norwood building was acquired and detailed plans agreed with the general practitioners. It is contemplated that building will begin in 1972. The negotiations for a Centre in Coulsdon broke down with the retirement from practice in the area of two general practitioners mainly concerned. No other group of doctors in Croydon came forward during the year despite an offer of the Health Committee to consider sympathetically requests for health centre facilities. 23 THE WORK OF THE PUBLIC HEALTH NURSING SERVICE 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, provided an opportunity for decisions taken earlier to be consolidated. Four members of the Asa Briggs Committee on Nursing set up by the Department of Health and Social Security to review the education and training of nurses and midwives, spent a day in the Borough meeting the Medical Officer of Health and Senior Nursing staff in the morning, and a wide selection of field staff during the afternoon. The discussion on both occasions was free and lively. Preparing for the visit involved critical appraisal of past achievements and a re-examination of plans for the development of the community nursing services. We will never know whether the team came with preconceived ideas, or what influence Croydon had on their deliberation, but we were pleased to have been consulted. Managers in the local authority nursing services have been at a disadvantage to their colleagues in the hospital service where the provision of suitable management courses is well established. It was largely due to the efforts of the Borough Training Officer that Thames Polytechnic were persuaded to provide management courses designed for middle and first line managers in the community nursing services. Neighbouring Boroughs were invited to join what became a useful steering Committee. Involvement of the local government training board meant that the courses were recognised tor grant purposes. The advice and help given by the Training Officer and Nursing Officer from the South West Regional Hospital Board was greatly appreciated. The projects undertaken as part of the course were relevant to the work and it is hoped that all Boroughs participating will eventually have access to this useful material. Home Nursing Service In February 1971 about 70 per cent of the registered nurses were working in attachment schemes and it was becoming increasingly difficult to have staff deployed on a practice and geographical basis. Where doctors are working alone, or where for other reasons there are few patients, a meaningful attachment is not possible. Inevitably, a few members of staff find it difficult to adjust to an entirely new way of working. To meet the situation a nurse was made responsible for all the patients registered with a group of doctors. These nurses are said to be working in alignment with general practice. The increase in the number of patients treated in the home is no doubt due to the attachment of staff to general practice, but the greatest increase has occurred in the amount of work carried out in practice premises. The 24 nurses have found that the variety of work brought about by this change rewarding and stimulating. About 90 per cent of the registered nurses are district trained and it is desirable that the enrolled nurse should also have the extra qualification. The enrolled nurse, taught in her training to observe and report, is able when working in hospital to summon aid quickly. It is also much easier to monitor and control her performance in the ward situation. There were several vacancies in this grade at the beginning of 1971 and recruitment was slow, but by the end of the year the service was fully staffed, and work was beginning to outstrip the approved staff establishment. Domiciliary Midwifery The number of home confinements fell again in 1971 but early discharges from hospital increased by about 11 per cent over 1970. All the midwives have now been taught the techniques of perineal infiltration and episiotomy and the Corporation is indebted to the medical and nursing staff of Mayday Hospital for making the training available. Health Visiting Service For the first time for some years a full establishment of Health Visitors was achieved in September when 10 sponsored Health Visitor students successfully completed the training course and joined the staff. Sponsored students remain the main source of recruitment to the service and it is regrettable that it was only possible to recruit six students for current training. During the year the number of Health Visitors working in general practitioner attachment and liaison schemes increased to the point where more than 50 per cent Health Visitors were working in this way. The opening of the Parkway Health Centre provided a welcome opportunity to place all the New Addington Health Visitors on a general practice basis with the general practitioners who serve the area . The advantage of Health Visitors working more closely with the general practitioners is to extend their health education, counselling and supportive roles to "at risk" groups in the community other than families with young children. This is clearly demonstrated in the increased number of visits paid to old people, the mentally sick and to other age groups. It was with some regret that the Health Visitors passed over their work in relation to the day care of children to the Social Services Department at the end of the year. Nevertheless, the Health Visitors welcome the opportunity to use their skills with other priority groups in the community. See Appendix page 98. 25 HEALTH EDUCATION AND HOME SAFETY Miss D.S. Elliott, S.R.N., H.V.Cert., Dip.H.E. Principal Health Education Officer The Health Education Section, working within the framework of the Health Department, is reaching a critical point in its development. The earlier years of enthusiasm and enterprise have resulted in increased demands on the Section. The complexity and volume of work has led to the inevitable growth of staff and differentiation of duties. The easier, more intuitive approach is now looked at critically and is changing in character. Modification of attitudes, values and behaviour are components in the prevention of illness and rehabilitation, and staff helping with this through health education must be professionally trained, imaginative and humane in their approach and willing to relinquish earlier cherished shibboleths. While continuing with established routine work and in-service training courses during the year, the staff have always been aware of current public health problems and of social pressures which inevitably influence their work. The demand for contraceptive information from organised groups and older school children has increased. The number attending the Family Planning Youth Advisory Centre also continued to rise. A sense of responsibility is now motivitating some young people to seek this information. However, a combination of ignorance, carelessness and lack of consideration for their partners makes the control of sexually transmitted diseases increasingly difficult. One hopes that better publicity and the growth of health education in schools' programmes accounts in some measure for the greater number of people being unafraid to attend the special clinic for treatment and advice. Motivation among certain groups of the population is low with regard to undergoing the simple cervical cytology test. Discussions with small groups show that embarrassment as well as ignorance and apathy accounts for the low acceptance rate. Motivation in adults is high with regard to combatting their own obesity, but still comparatively low among parents with obese children. Health Education staff try to form and maintain as many links as possible with different sections of the community, always monitoring and encouraging their health education work, e.g.:— Links with Hospital and General Practitioner Services All work undertaken with nursing staffs is important. The greater content and experience of community services included in the present syllabus, should enable them to deal with patients with greater understanding. Throughout the year lectures were given on the National Health and 26 Local Authority Health Services to nurses at Mayday Hospital. Those undertaking projects also received help and material from the Section. Pupil nurses from Croydon General Hospital visited the Health Education Section as part of their Introductory Courses. Posters, leaflets and other health education material from the Health Education Council and other sources, are now available for hospitals through this Health Education Section. The Principal Health Education Officer attended a one-day conference at the Royal College of Nursing on "Health Education and the Nurse in the 1970's" and read a paper from the point of view of the hospital nurse. It was a pleasure to work with Dr. A. Oliver, Clinical Tutor at Croydon Medical Centre, in the running of a 10-session course on "Community Care and the General Practitioner" and to devote one session to "Health Education and General Practice". Programmes of observation visits of community health services were also arranged for General Practitioner Assistants and Medical Students. Health Visitors are encouraging general practitioners with whom they work to view and discuss professional films and other educational material. Vital work is being done with hospital kitchen staff and ward orderlies. Help with ideas and materials about the approach to food hygiene has been given to the Domestic Administrator at Croydon General Hospital. 2. Links with Occupational Health Nurses. Early in the year 36 occupational health nurses, personnel officers and first aiders in industry attended a lecture - demonstration - discussion on "Health Education in Industry", in the Health Education Section. As a result of this they formed themselves into a Royal College of Nursing Occupational Health Nurse Group. The Principal Health Education Officer now attends their meetings and encourages them to make the maximum use of the facilities of the Section. These nurses are in daily contact with a large section of the working population between the ages of 15 and 65+ and make a great contribution to their well-being. 3. Links with the Social Services Department. Close liaison has been maintained with the Social Services Department. Health Education staff continued to help with in-service training of home helps, covering topics such as "Services available for the Family", "Food Hygiene" and "Accident Prevention". Talks have also been given to foster parents on "Children Growing Up" and the resources of the Section have been available to the Senior Training Officer at all times. 27 4. Links with the Training Officer - Taberner House. Regular events are the lectures to new entrants and new senior officers to Local Government on the "Local Authority Health Services seen in the context of the National Health Service", and co-operation in the running of First Aid courses in the Section for local Government staff. 5. Other Links and Activities. Public Health Inspectors have again played an important part in the education of the public, nurses and school children in all aspects of environmental health and their help is greatly appreciated. The theme of the exhibition held in the 40' marquee at the Ashburton Flower Show was "Gambling with Health?" and as usual all stands were devised to encourage the maximum participation of the public. Advice and some help was given to the Central Office of Information on the making of a short film on "Smoking" for overseas distribution. The Principal Health Education Officer was also a member ofthe Royal College of Nursing Working Party discussing the future role of the Health Visitor, the report of which was published in September. Future changes will transform the nature of the Health Education Section's work but the staff will see these changes as opportunities for co-operative and questing endeavours in which all are involved. 28 DENTAL SERVICE (MATERNITY AND CHILD WELFARE) B.J. West, Esq., L.D.S., B.C.S.(Eng.) - Chief Dental Officer It is important that these services should be included as part of the general report of the Dental Service in Croydon, as they play an ever increasing role in the provision by the Borough of a community dental service; a service which is likely to become more important as the plans to reorganise the health services become apparent. The treatment of the pre-school child increases yearly. That this is so augers well for the long term effort to control dental disease, for it is only by establishing correct methods of oral hygiene and dietary control at the earliest possible age, that the hold of dental decay can be broken. In addition a young child will more readily accept treatment if he has become accustomed to the dental surgeon and the surgery by frequent visits before any treatment is necessary. Ideally, children should have a dental inspection as soon as possible after their third birthday. Unfortunately, this service is only available on a routine basis at our Sanderstead Clinic and to a more limited extent at Waddon. It has been possible to extend the service to these two centres because of the active co-operation of the Health Visitors concerned, and it is hoped to cover the remaining parts of the Borough as soon as possible. In the meantime inspections and treatment are readily available for pre-school children at all the Croydon dental clinics on demand. The amount of dental treatment for the under five year olds again in creased during the year with a 31.6% increase in the total number of visits, a 5.4% increase in the number of teeth filled and a 33% increase in the number of courses of treatment completed, compared with 1970. The number of expectant and nursing mothers seen during the year remained about the same as the previous year, though there was an increase of 22.1% in the number of teeth filled and a similar drop in the number of teeth extracted for these patients. The proportion of mothers to pre-school children has been decreasing during the last few years. For example: In 1951 60.1 mothers were seen for every 100 pre-school children „ 1961 91 „ „ „ „ „ 1969 23.9 „ „ „ „ „ 1970 19.8 „ „ „ „ „ 1971 15.2 „ „ „ „ This is an indication that more pre-school children are being brought to the Borough's clinics for treatment and that more mothers are being treated in general practice. This trend should be encouraged as it allows for a much better continuation of treatment in the future for each type of patient. The figures for the treatment of the priority groups will be found on page 106. 29 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 97. 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 3 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 December31st 1971, 29 chiropodists were operating this scheme. During the period January 1st to December 31st 1971, they gave 24,182 treatments at their surgeries and 8,298 by domiciliary visits. 723 treatments were given at Parkway Clinic, New Addington and 237 at "Waylands". 30 CERVICAL CYTOLOGY The number of new cases fell sharply this year due partly to the postal strike. More repeat smears were taken and the number coming forward is expected to increase each year. The main source of new referrals continues to be from a system of printed post cards. 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 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. COLOUR USE NUMBER RETURNED White Cytology Sessions 959 Green Health Visitors 111 Pink School Medical Inspection! 5 278 For detailed figures see page 108. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 33 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 1971. The year in question has been marked by increased activity in almost all spheres of work coming within the province of the Section. This is indicated to some extent by the increased number of visits overall, including an increase of nearly 3,000 visits under the provisions of the Housing Acts as compared with 1970. An increase in the number of letters and other communications received is a further token of the demands made on the inspectorate. During the year on a report of the Borough Valuer the Housing (Emergency) Sub-Committee approved a number of changes in the procedures for dealing with Improvement Grant applications and the issue of Qualification Certificates. The position now is that all schedules of repairs required in connection with Improvement Grants and Certificates of Provisional Approval are dealt with by the Borough Valuer and the Chief Public Health Inspector is solely responsible for specifying repairs required in connection with Qualification Certificates where no Improvement Grant is involved, together with the administrative work in connection with the issue of the Certificates. By so doing it is hoped that duplication will be avoided and the process expedited. The indications are that this will be so. At the same time an internal re-appraisal of clerical procedures has been carried out with the object of speeding up so far as possible the compliance with notices served under the Housing and other Acts. The benefits that will accrue will I am sure become apparent in due course. During the year five houses in Southbridge Road were the subject of Clearance Order procedure and the Council subsequently purchased the properties for demolition. Demolition or Closing Orders were made in respect of ten houses and nine basements or other parts of houses were closed. Continued expansion of the Town Centre and office concept has resulted in a corresponding increase in food premises, catering forthe needs of office workers and shoppers. Maintenance of a satisfactory standard of food hygiene in many of these premises is only achieved by regular routine inspections. Similar comments are applicable to vehicles used for transport of food. During the past 12 months also, there has been a considerable increase in the deliveries of carcass and other meat in containers from Southern Ireland to the Meat Depots in the town. This entails more detailed inspection work formerly carried out at the port of entry. 34 In view of these increased responsibilities, the Council has approved the appointment of a second Specialist Food Inspector for this work. Similarly, the staff employed on the inspection of Offices, Shops and Railway premises is to be strengthened by the transfer of a Technical Assistant from Clean Air, primarily for the purpose of concentrating on the provisions of the Hoists and Lifts Regulations as to maintenance and safety of hoists and lifts and associated lift motor rooms. It is estimated that there are 600/700 hoists and lifts in the Borough In spite of various setbacks the Borough's smoke control programme has continued and in anticipation of an early completion of the former County Borough programme, the Council has agreed in principle that smoke control should be extended to include the southern part of the Borough, formerly the area of the Coulsdon and Purley Urban District Council. During the year three student Public Health Inspectors were successful in obtaining their final qualification, one of whom was awarded the Bronze Medal presented by the Municipal Journal Group of Companies. The Council's policy of training inspectors in this way has been amply rewarded and is the only means of maintaining the inspectorate at a reasonable level. In concluding this introduction to the report, I should like to express my appreciation for the support and encouragement of the Chairman, ViceChairman and the members ofthe Health and Public Services Control Committee, the guidance and confidence of Doctor S.L. Wright, Medical Officer of Health, and the very willing help and loyalty of the whole of my staff. 35 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) 5,995 (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 5 (b) Other than in Clearance Areas 10 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 545 3. Action under Statutory Powers during the year (a) Proceedings under Sections 9 (1), 10, 12, and 170 of the Housing Act, 1957:— (i) Requisitions for information as to ownership 934 (ii) Number of dwelling houses in respect of which notices were served requiring repairs 373 (iii)Number of dwelling houses which were rendered fit after service of formal notices (a) By owners 236 (b) By Local Authority in default of owners 44 (b) Proceedings under Section 9 (1 A) of the Housing Act, 1957:— (i) Number of dwelling houses in respect of which Notices were served requiring repairs 81 (ii) Number of dwelling houses brought up to a reasonable standard after service of formal Notices (a) By owners 22 (b) By Local Authority in default of owners 2 (c) Proceedings under the Public Health Acts - (i) Requisitions for information as to ownership - 398 (ii) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 600 36 (iii) Number of dwelling houses in which defects were remedied after service of formal notices (a) By owners 326 (b) By Local Authority in default of owners 217 (d) Proceedings under Sections 17 and 23 of the Housing Act 1957 - (i) Number of dwelling houses in respect of which Demolition Orders were made 5 (ii) Number of dwelling houses demolished in pursuance of Demolition Orders 12 (iii) Number of dwelling houses in respect of which Closing Orders were made 5 (iv) Number of houses in respect of which Closing Orders were determined following repairs and renovations 5 (e) Proceedings under Section 18 of the Housing Act, 1957 (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made 9 (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 4. Houses in Multiple Occupation - (i) Number of Houses in multiple occupation inspected during the year 294 (ii) Number of houses in which defects were remedied following service of formal or informal notice under Sections 9(i) and 9(iA) Housing Act 1957 135 (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 118 (iv) Number of houses in which fire prevention works were completed following service of formal or informal notices under Section 16, Housing Act 1961 164 37 5. Housing Act, 1969 During the year 1,289 applications for Improvement Grants and/or Qualification Certificates were considered, in conjunction with the Borough Valuer, and 5,716 visits of inspection were made to the Houses concerned. On 1st October, 1971 the Chief Public Health Inspector was delegated to deal with applications for Qualification Certificates under this Act and more than 600 outstanding applications were transferred from the Borough Valuer. By the end of the year 244 of these applications had been resolved whereby 167 Qualification Certificates were formally Issued and 57 Refused. New applications received during the period 1st October to 31st December, 1971 were also dealt with as follows:— Applications received 95 Qualification Certificates Issued 13 Qualification Certificates Refused 22 Applications awaiting expiry of appeal period 25 6. Rent Act, 1957 - Certificate of Disrepair - (i) Number of applications for certificates 3 (ii) Number of certificates issued 3 (iii) Number of applications by landlords for cancellation of certificates 1 (iv) Certificates cancelled 1 DRAINAGE 2,075 visits of inspection were made to premises where underground drains were in course of repair. There are now 26 cesspools serving premises without main drainage. POLLUTION OF RIVERS AND STREAMS During the year 8 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 The activities of the field staff employed on pest control have expanded during the year to establish an effective control on the increasing number of 38 foxes in the area and to diminish the number of ferral pigeons which become a nuisance in various parts of the Borough. More than 150 complaints were received concerning foxes with the result that approximately 270 were destroyed by shooting or gassing. Some 84 complaints were received regarding ferral pigeons and, in this connection, 803 visits to premises were made and 3,170 birds destroyed by shooting or trapping. The control of rat and mice infestations has again required the constant efforts of the field staff and during the year the three full time Rodent Operators made 15,264 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. 2,869 such notifications were received during the year and 2,450 infestations were confirmed and treated. Mice infestations have again proved difficult to control in some instances since this rodent has developed a degree of resistance to the poison "Warfarin" and it is hoped that the Ministry of Agriculture will produce an effective alternative to this poison in the near future. 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. No serious infestation of the sewer system has been detected. IMOISE ABATEMENT There is an increasing awareness of the pollution of the environment by noise and a significant proportion of the work of the Inspectorate is now directed towards the prevention and reduction of noise nuisances. Preventative measures include the scrutiny of all planning applications for industrial premises or processes and advice is given on necessary safeguards to prevent noise. During the year 144 complaints were received regarding noise and in 124 cases action was taken to abate or reduce the noise complained of, in 7 cases no action was warranted and 13 cases are still under investigation. Of the cases dealt with some 50% concerned mechanical noise from factories, demolition and constructional work, ventilation and air conditioning plants, refrigerator units, all night launderettes and noisy parties. It is to this type of complaint that the statutory powers contained in the Noise Abatement Act, 1960 may be applied. The remainder of the complaints received concerned domestic amplifying equipment, slamming of house and car doors etc., and in these cases the Inspectors seek to persuade the individuals reaponsible to have consideration for their neighbours. 39 There are understandably many more complaints about noise nuisances which occur at night, as opposed to daytime, and a large proportion of the 575 visits made by Inspectors were during evenings and weekends. It is anticipated that stronger statutory powers to deal with noise nuisances will be introduced in the near future. CLEAN AIR ACT, 1956 The Council has implemented the relevant provisions of this Act in making Smoke Control Orders covering the South, West and Northern areas of the Borough and it is the intention that one Smoke Control Order shall be made each year. The progress of these Orders is shown below:- Smoke Control Order No. of premises (incl. Factories and Commercial) No. of dwellings Acreage Date of Order Date of Operation No. 1 2,076 1,916 620 22.12.58 1. 4.61 No. 2 3,042 2,686 265 26. 2.60 1. 10. 61 No. 3 4,501 3,915 332 22.11.60 1. 10. 62 No. 4 5,547 4,112 710 24.11.61 1. 7.63 No. 5 7,042 6,651 570 17.12.62 1. 7.64 No. 6 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 No. 14 7,042 6,905 2,200 10. 3.72 1. 7. 73 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 49 plans showing the construction and heights of new chimneys were examined and in 21 cases additional height was requested and agreed. 48 notices of the installation of new furnaces were received. 29 of these being oil fired plants. 40 LOCAL LAND CHARGES During the year 12,801 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 orthe 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 3,284 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 6,092 articles By Formalin Gas 79 articles Total 6,171 articles Disinfection of bedding and upholstered articles is carried out lor 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:— 65 rooms, hospital wards, clinics etc. On request disinfection was also carried out for conditions other than notifiable infectious diseases and for which a charge is made. During the year £77 was paid for such services. 1,547 items of home nursing equipment were disinfected. 41 DISINFESTATION OF PREMISES Modern insecticides provide a ready and easily applied remedy for vermin and pest infestation of premises, etc. and occupiers are advised and instructed in their use by the Inspectors. The department assisted in the more difficult cases numbering 141, 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 5 adults and 13 children were cleansed of verminous conditions and 22 adults and 32 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. At the request of the Ministry of Agriculture an investigation was carried out after a member of the public obtained a parrot which died shortly after purchase and the purchaser developed symptoms which might have been those of Psittacosis, a disease which affects foreign birds of the parrot family and may be transmitted to humans. In conjunction with the appropriate medical and veterinary officers precautionary measures were taken, the origin of the parrot was traced through the retailer and the Ministry informed. Subsequent laboratory tests fortunately disclosed that the parrot had not been suffering from Psittacosis. LECTURES During the year 61 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. 42 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. Two site licences were in force during the year. Site licence conditions require a water carriage system of drainage, main water supply and fire precautions. The Caravan Sites Act, 1968 imposes a duty upon local authorities to provide caravan sites for gipsies residing in or resorting to their areas. The provision of a suitable site in Croydon is under consideration. 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. 43 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 Housing Acts 5,995 Houses Inspected following applications for certificates of disrepair 23 Inspections of underground rooms 128 Special inspections in connection with the Housing Survey 1,106 Houses inspected for overcrowding conditions 52 Re-inspect ions of work outstanding on housing notices 14,705 Number of visits regarding infectious diseases 813 Number of visits regarding food poisoning 193 Inspections of drainage work during repair 2,223 Drainage systems inspected, surveyed or traced 4,014 Drains tested 295 Inspections of cesspools and earth closets 47 schools and school sanitary conveniences 6 public conveniences 53 verminous premises 101 ponds and ditches 9 premises in course of demolition 644 tents, vans and similar structures 80 premises in connection with improvement grants 393 Inspection and re-inspection of houses in multiple occupation 8,168 Inspection and re-inspection in connection with Smoke Control Orders 16,309 Smoke observations 137 Visits regarding exhumation 5 Visits in connection with miscellaneous public health nuisances 3,372 Visits to immigrants 98 Unsuccessful calls 7,865 Appointments kept with owners, builders, etc 8,581 Investigations of complaints other than housing matters 950 Inspections under Noise Abatement Act 575 Visits regarding rats and mice infestation by rodent operators 15,264 Visits regarding rats and mice infestation by district inspectors 1,187 Visits in connection with destruction of foxes 511 Visits in connection with destruction of pigeons 803 Informal Notices served 818 Informal Notices complied with 545 Statutory Notices outstanding 31.12.70 1,500 Statutory Notices served 2,656 Statutory Notices complied with 2,317 Statutory Notices outstanding 31.12.71 1,839 Total number of callers at the office 3,269 Total number of letters received at the office 16,706 Total number of complaints received 3,966 Attendances at Court 10 44 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 Number of on Register Inspections Written notices Occupiers prosecuted It) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 56 6 6 - (ii) Factories not included in (!) in which Section 7 is enforced by Local Authority 1.333 343 17 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers premises) 79 83 - - TOTAL 1,468 432 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 ID (2) (3) (4) (5) (6) Want of cleanliness (S.1) 16 16 - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 3 3 - - - Ineffective drainage of floors (S.6) 2 2 - - - Sanitary conveniences (S.7) - - - (a) Insufficient 3 3 - - - (b) Unsuitable or defective 12 12 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 14 14 TOTAL 50 50 • 3 - 45 PART VIII OF THE ACT Outwork Section 110 Section 111 Nature of Work 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 21 _ _ _ _ _ Paper bags and Cardboard boxes 7 _ _ _ _ _ Christmas cards, Christmas crackers and stockings 17 _ _ _ _ _ Tool assembly 13 _ _ _ _ _ Wearing apparel 77 _ _ _ _ _ Perfumery, Toiletries, etc 26 _ _ _ _ _ Curtain and furniture hangings 13 _ _ _ _ _ Making up of Cotton Articles 29 _ _ _ _ _ TOTAL 203 - - - - - OFFICES, SHOPS AMD RAILWAY PREMISES ACT. 1963 TABLE A - Registrations and General Inspections Class of Premises Number of Premises Registered during the year Total Number of Registered Premises at end of year Number of Registered Premises receiving a general inspection during the year (1) (2) (3) (4) Offices 152 1,502 334 Retail Shops 106 1.880 335 Wholesale Shops Warehouses 9 114 14 Catering Establishments open to the public, Canteens 16 239 51 Fuel Storage Depot 1 4 - TOTALS 284 3,739 734 TABLE B - Number of Visits of all kinds by Inspectors to Registered Premises 3,083 46 TABLE C - Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace Number of Persons Employed (1) (2) Offices 38,872 Retail Shops 13.038 Wholesale Departments, Warehouses 2,362 Catering Establishments open to the public 3,027 Canteens 698 Fuel Storage Depots 36 TOTAL 58.033 Total Males 28.714 Total Females 29.319 TABLE D - Exemptions No exemptions were granted under the Act during the year. TABLE E - Prosecutions There were two 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 district public health inspectorate (establishment - 20) carry out inspections at food premises to avoid duplication of visits. Four members of the clerical staff are employed part time on work in connection with the Act. 47 REMEDIAL WORKS ETC. CARRIED OUT Accident Prevention Measures 9 Abstract of Act Provided 178 Clothing Accommodation Provided 20 Drainage Defects Repaired 1 Lack of Cleanliness Remedied 2 Drinking Water/Vessels Provided 3 Eating Facilities Provided - First Aid Equipment Provided 132 Floors, Stairs, Passages Repaired etc 75 Heating Provided 1 Lighting Provided 25 Machines Guarded 10 Overcrowding abated 3 Premises registered 284 Sanitary Accommodation Provided 7 Intervening Ventilated Space Provided 7 Defective Sanitary Accommodation Repaired 43 Labelling of Sanitary Accommodation 11 Staff seating facilities Provided 7 Thermometers Provided 106 Ventilation Provided 43 Walls, Ceilings etc. Repaired 82 Washing Facilities - Wash Basins Renewed/Provided 31 „ „ „ Hot Water Provided 24 „ „ „ Nail Brushes, Soap and Towels Provided 8 Provision of Disposal for Sanitary Dressings 2 Defective Electrical Wiring Remedied 4 Accumulations of Rubbish Removed 21 Hoists and Lifts Repaired 13 More detailed comment in relation to Offices, Shops and Railway Premises is contained in the Appendix to this Report. 48 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 90 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. 1,029 inspections were made under the Shops Acts; infringements remedied were as follows:— Hours of closing 46 Notices to be exhibited or amended 28 Meal Intervals not granted to Staff 4 Opening Hours of Launderettes 3 An increasing number of enquiries and complaints have been received from shop assistants concerning their hours and conditions of employment. Most of the complaints were made anonymously and the persons concerned were advised of the provisions of the Shops Acts. In other cases warnings were given to employers regarding contraventions. Circular letters were sent to all motor traders in the Borough advising them on all the requirements of the Shops Acts, 1950/65, applicable to their business, e.g., prohibition of sale of new and second-hand motor vehicles on a Sunday: employment of staff, with special emphasis to Sunday employment in the sale of petrol and motor accessories: and to statutory compensatory holidays in lieu of Sunday employment, in addition to the weekly half-holiday: and statutory meal intervals and the control of hours of employees under the age of 18. PROSECUTIONS There were no prosecutions under the Acts during the year. The management of an entertainment centre conducted a sale of antiques after the general closing hour contrary to Sections 2 and 12 of the Shops Act, 1950. The Town Clerk sent a letter of warning to the solicitors acting for the management who gave an undertaking not to conduct such ssles after the general closing hours. A complaint was dealt with concerning a D.I.Y. shop trading on a Sunday contrary to the Shops Act 1950. Action taken by the Department secured compliance with the Act. 49 HAIRDRESSING ESTABLISHMENTS Legislation calls for the registration of hairdressers' and barbers' premises. During the year 279 inspections were made of registered premises to check that the Byelaws in force were being observed. Generally little cause for complaint was found. 13 new Registration Certificates were issued. CONSUMER PROTECTION ACTS. 1961 & 1971 The provisions of the Heating Appliances (Fireguards) Act, 1952 and Regulations made thereunder were 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 following Regulations are in operation and shops trading in the articles concerned are visited to ensure that the Regulations are complied with:- The Children's Nightdresses Regulations, 1964 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. The Nightdresses (Safety) Regulations, 1967 also impose conditions on the sale of nightdresses which are described as being of low flammability. The Stands for Carry-Cots (Safety) Regulations, 1966 prescribe certain safety features which must be incorporated in the construction of such stands. During the year two stands which did not comply with the Regulations were surrendered by a retailer and subsequently destroyed. The Oil Heaters Regulations, 1962 and 1966 impose requirements as to the construction, design and performance of domestic oil space heaters. Modern oil heaters generally comply with the Regulations but older type heaters are sometimes offered for sale in second-hand shops and at jumble sales and during the year nine unsatisfactory heaters found on retailers' premises were surrendered and destroyed. Heaters which are "suspect" are submitted to the British Standards Institute for examination and testing and one heater examined by the Institute during the year was found to be satisfactory. The Electrical Appliances (Colour Code) Regulations, 1969 specify the colours to be used in electric cables designed for domestic use in order to conform with the international colour code already in force in the Common Market countries. The Electric Blankets (Safety) Regulations, 1971 will come into operation on 1st January, 1972 and will require that all electric blankets comply with the technical and constructional requirements of a British Standard Specification and that warnings as to their correct and safe use be given on the container or package when the article is offered for sale. 50 The Toys (Safety) Regulations, 1967 govern the use of certain materials in the manufacture of toys. In particular, the use of celluloid, other than for table tennis balls, is forbidden and restrictions are also imposed on certain types of paint. During the year a firm of Importers requested an examination of the paint film on two kinds of toys imported from Italy. The Public Analyst reported that the paint on one toy contained 125,000 parts of lead per million and on the other 73,000 parts per million. The Regulations require that the proportion of lead in the paint shall not exceed 5,000 parts per million and in view of the results obtained from the samples the Importers immediately recalled all similar toys from some 90 retailers throughout England, Scotland and Wales and induced the Italian manufacturers to take back all similar goods supplied to them. A total of 2,668 toys were assembled, cleared by H.M. Customs and re-shipped to Italy. 10 samples were purchased from local retailers and submitted to the Public Analyst for examination of the paint film, and, of these, 2 proved to be unsatisfactory. In one case yellow paint on wooden skittles contained 19,000 parts of lead per million. The skittles were of Greek manufacture and the Home Office and the Greek Authorities were informed of the Analyst's findings and the Importers surrendered the remaining skittles which were destroyed. The second unsatisfactory sample consisted of dominoes of Japanese origin and a sample of the paint film on this article contained 27,100 parts of lead per million. The retailers concerned purchased the dominoes from a wholesale firm which had since gone into liquidation, and since several boxes had already been sold the Local Press and Radio London were informed of the dangerous condition of this article. The unsold stock from, two local retailers, comprising 25 boxes were surrendered and destroyed. As the result of Press, Television and Radio publicity numerous enquiries concerning suspect toys were received and dealt with during the year. THE FABRICS (MISDESCRIPTION) ACT, 1913 THE FABRICS (MISDESCRIPTION) REGULATIONS, 1959 The above mentioned Regulations prescribe standards of non-flammability for textile fabrics which claim to be non-flammable. ANIMAL BOARDING ESTABLISHMENTS ACT. 1963 The above Act, prohibits the keeping of a boarding establishment for animals (defined by the Act as cats and dogs) except under licence granted by the local authority. 51 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. One licence has been granted to a local establishment. PHARMACY AND POISONS ACT, 1933 The object is to regulate the sale of certain poisonous substances. During the year the number of applications granted for entry of names on the list of persons entitled to sell poisons under Part 2 of the Act was 15. In addition, 161 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. PET ANIMALS ACT. 1951 This Act governs the sale of pet animals and during the year 18 licences were renewed and one new licence issued. During the year 103 inspections were made and little cause for complaint relating to conditions specified in the licences was found. 52 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, 942 are registered under Section 16 of the Food and Drugs Act, as follows:— Retail sale of ice-cream 665 Manufacture of ice-cream 1 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 276 During the year 5,447 inspections and re-inspections were made of food businesses. FOOD HYGIENE (GENERAL) REGULATIONS, 1960 The following table shows the premises in the Borough at which food is sold, manufactured or stored. 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 1971 No. to which Sec. 19 applies No. of sinks fitted to comply with Sec. 19 during 1971 Bakehouses and Bakers Shops 114 4 114 2 Sugar Confectioners 360 3 340 1 Cafes, Restaurants, Snack Bars, etc. 291 11 291 8 Works & Club Canteens 497 10 497 9 Licensed Premises 158 6 158 2 Off Licences 112 - 24 - Grocers & General Shops 309 3 297 1 Butchers 180 3 180 1 Wholesale Meat Markets 12 - 12 - Chemists 85 - 85 - Greengrocers 209 9 209 2 Fishmongers 43 1 43 1 Fried Fish Shops 46 1 46 1 Milk Distributors and Dairies 300 7 279 - Premises from which Roundsmen & Mobile Shops operate 122 - 122 - Food Manufacturers 21 2 21 - Supermarkets 55 4 55 2 53 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 222 Defective condition of floors, utensils, fixtures, etc. remedied 104 Defective or insufficient drainage repaired 5 Lighting, heating or ventilation provided 37 W.C. accommodation - repair or cleansing 65 - artificial lighting provided 2 - intervening ventilated space provided 8 Food - now stored 18 ins. off floor 22 - means to prevent risk of contamination provided 13 - store provided or repaired 12 Accumulations in yard or stores removed 35 Offal and refuse bins provided 12 Yard paving repaired 2 Hand washing notices exhibited 35 Ablutions - Wash basins provided 64 - Hot water supplies provided 52 - Nail brushes, soap and towels provided 55 Clothing accommodation provided 9 Sinks installed 30 Smoking offences abated 9 Defective or unsuitable table tops replaced 29 First Aid kits provided 36 Cleanliness - advice given 15 Rats/Mice Infestation abated 13 Repair/Cleansing of Machinery/Refrigators 31 Leaflets on Food Hygiene supplied 92 Stalls and Delivery Vehicles Wash hand basins/Sinks with hot water provided 24 Nail brushes, soap, towels provided 6 First Aid kits provided 17 Washable overclothing provided 16 Name and address boards supplied 15 Food now stored 18 ins. off floor 4 Accumulation of refuse etc 5 Receptacles for waste food provided 16 Screening for stalls provided 17 Cleanliness of stalls and vehicles remedied 40 54 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 20,485 Offal 1,899 Sundry Foodstuffs 7,764 Canned, Bottled and Packet Foods 53,213 Total 83,361 Disposal of Condemned Foodstuffs Meat, 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 97 such inspections were made. MEAT INSPECTION District inspectors examine home killed and imported carcase meat and offal at the 12 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. 55 MILK SUPPLY During the year 71 inspections were made of dairies and premises from which milk is sold. The Milk (Special Designation) Regulations 1963 The following licences have been granted, or renewed during the year to dealers distributing milk from premises in Croydon. Licences to use the designation "Pasteurised" — (a) Dealer's (Pre-packed Milk) Licences 258 Licences to use the designation "Sterilised" — (a) Dealer's (Pre-packed Milk) Licences 134 Licences to use the designation "Untreated" — (a) Dealer's (Pre-packed Milk) Licences 35 Licences to use the Designation "Ultra Heat Treated" - (a) Dealer's (Pre-packed Milk) Licences 114 Pasteurisers Licences Renewed 2 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 115 Sterilised Milk 24 Untreated Milk 3 Ultra Heat Treated 5 The following tables summarise the results of bacteriological examinations of pasteurised, sterilised and untreated milk samples during the year: Untreated Milk Methylene Blue Test No. Samples Taken Not Satisfied Satisfied 3 - 3 The above samples of raw milk were also examined forthe presence of brucella abortus and antibiotics. In all cases the results of the tests were negative 56 Pasteurised Milk Methylene Blue Test No. Samples Taken Not Satisfied Satisfied 116 - 115 Sterilised Milk Turbidity Test No. Samples Taken Not Satisfied Satisfied 24 - 24 Ultra Heat Treated Milk Colony Count No. Samples Taken Not Satisfied Satisfied 5 - 5 Bacteriological Examination of Milk Bottle Rinses Satisfactory - 23 Bottle Rinse Samples - 24 Unsatisfactory - 1 BACTERIOLOGICAL EXAMINATION OF CREAM Thirteen samples of fresh cream were examined with the following results:— Grade No. of Samples 1 2 2 2 3 3 4 6 BACTERIOLOGICAL EXAMINATION OF ICE CREAM 144 samples were taken, the results being:— Grade No. of Samples 1 44 2 25 3 22 4 53 The majority of the unsatisfactory samples consisted of "soft" icecream which is dispensed from machines located in cafes and restaurants. 57 An intensive investigation was carried out in each case and, in conjunction with the manufacturers and retailers concerned, the cleaning, maintenance and operation of the machines was examined and, where appropriate samples of the ingredients taken to establish the cause of contamination of the final product. The sale of ice cream was, in a number of cases suspended voluntarily until satisfactory samples were obtained and the retailers involved were fully instructed on preventative measures to avoid as far as possible further unsatisfactory samples. The introduction, in recent years, of "soft" ice-cream machines and the increase in ice-cream sold from bulk supplies by retailers has proved retrograde from a hygiene point of view since, unlike ice-cream which is wrapped by the manufacturer and sold unopened, these products are susceptible to contamination on the retailers premises. CHEMICAL EXAMINATION OF ICE CREAM Seven samples were taken from local shops and five were found to comply with the standard. Action taken on the unsatisfactory samples is reported in the following paragraph. FOOD AND DRUGS ACT, 1955 During the year, 147 samples of milk and cream, and 367 other samples were taken, of which number, 20 were found to be "Not Genuine", details of which are set out below:- Article Nature of Adulteration or Deficiency Remarks Two samples of Ice cream Two samples of Ice-cream powder These samples were deficient in fat. The Ice-cream produced from the samples following the instructions did not comply with the Ice-cream Regulations. The manufacturers have altered the ingredients which now comply with the Regulations. Milk Bread The sample had been made with skimmed milk. Recipe changed and repeat sample proved satisfactory. Sweets (Fizzers) The name implied the presence of an effervescent mixture but only acid was present. The recipe has been altered. Sterilised Milk. The sample was deficient in milk solids other than milk fat. Precautions were taken by firm concerned to avoid any recurrence and subsequent samples taken have proved satisfactory. Beef Chow Mein The sample was deficient in meat, revealing a contravention of the Sausage and Other Meat Product Regulations 1967. Representations have been made to the Ministry as it was thought the article may not have been intended to be included in these Regulations. In the meantime the firm concerned has amended the description to comply with Regulations as they exist at present. 58 Article Nature of Adulteration or Deficiency Remarks Prawn Cocktail The sample was found to be deficient in prawn content. A new label has been introduced to comply with the labelling of Food Order 1953. Hot Gram As this article of food contains more than two ingredients the label should bear the list of ingredients. New Label introduced. Chestnuts The sample contained 43% of mouldy nuts. Legal proceedings being considered. Brazil Nuts The samples contained 21% and 16% of mouldy nute respectively. Retailers warned. The Public Analyst reported that seven other samples were not labelled in accordance with the labelling of Food Order 1953. In each case the manufacturers 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 40 Taken at Dairies 84 Taken at Institutions 23 Total 147 Average composition of samples:— Milk (excluding South Devon and Channel Islands Milks) Solids not Fat 8.64 (Legal standard is 8.5%) Milk Fat 3.81 (Legal standard is 3%) South Devon and Channel Island Milk Solids not fat 8.93 (Legal standard is 8.5%) Milk Fat 4.52 (Legal standard is 4%) ANALYSIS OF PROSECUTIONS UNDER:- Food and Drugs Act, 1955 Food Hygiene (General) Regulations 1960 Food (Markets, Stalls and Delivery Vehicles) Regulations 1966 59 OFFENCE RESULT Carton of dessert containing mould growth Fined £10 Loaf of bread with mouse droppings on base Fined £20 Carton of cream out of condition Fined £5 Peanut kernels containing mouse droppings Fined £35 Bag of chips containing a cigarette end Fined £15 Loaf of bread containing silver foil and strands of tobacco Fined £10 Steak and kidney pie containing piece of metal Fined £30 Fly eggs in packet of chipolato sausages Fined £20 Hot dog stall not complying with Regulations Fines totalling £12 were imposed. Three contraventions against a stallholder Fined £3 on one Count under appropriate Regulations 2nd Count Conditional discharge for one year. Found not guilty on 3rd Count. Eleven contraventions under Food Fines totalling £46 Hygiene Regulations in a Restaurant were imposed. FOOD COMPLAINTS During the year 385 food complaints of various types were received, fully investigated and appropriate action taken where necessary. Eight prosecutions were taken against firms concerned as reported above. 60 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 8 Visits to premises for food condemnation 1,005 Inspections of wells and gathering grounds of water supply 37 do scrap metal dealer's premises 14 do rivers and streams for pollutions 11 do hairdressers 278 Food and Drugs Acts; Food and drugs samples taken 514 Food and Drugs Acts; Milk samples taken (special designation) 141 Ice Cream samples taken (bacteriological) 144 Samples taken of Fertilizers and Feeding Stuffs 18 do swimming baths water 340 do drinking water, bacteriological and chemical 652 do private wells 249 do rag flock and other filling materials do sundry specimens (food poisoning etc.) 41 Visits in connection with Food Complaints 663 Inspections of butchers' premises 446 do meat premises (wholesale) 164 do poultry and game dealers' premises 18 do fishmongers' premises 79 do fried fish premises 107 do grocers' premises 621 do fruiterers' and greengrocers' premises 246 do bakers' premises - including bakehouses 219 do dairies 18 do milk shops 53 do general shops and supermarkets 263 Visits in connection with Animal Boarding Establishments Act 12 do do Rag Flock Act 2 do do Mines and Quarries 13 do do Croydon Corporation Act 1 Inspection of Employment Agencies 112 Examination of Imported Food 866 Inspections of premises where cooked meats etc. are prepared or sold 28 Inspections of confectioners' premises 334 do confectionery manufacturers' premises 13 do cafes, snack bars, canteens, hotels and their kitchens 1,557 do school kitchens and serveries 97 do hospital kitchens 20 do ice cream vendors' premises 12 do ice cream barrows and carts 176 do market and barrows 625 do other food premises not enumerated above 102 Licenced premises 249 Inspections of factories with mechanical power 343 do factories without mechanical power 6 do works of building and engineering 83 do shops (under Shops Acts) 1,029 do outworkers' premises 228 61 Inspections under Fertilizers and Feeding Stuffs Act 4 do Diseases of Animals Act 131 do Pets Act 103 do Pharmacy and Poisons Act 19 do Consumer Protection Act 214 do Offices, Shops and Railway Premises Act 4,104 do Performing Animals Act 16 62 APPENDIX OFFICES, SHOPS AND RAILWAY PREMISES ACT. 1963 The Act came into force in the latter part of 1964, and, since then, has been strengthened by Regulations made thereunder and will no doubt continue to grow in scope by additional Regulations from time to time. The occupancy of offices and shops is ever changing, and with the present limited personnel, the Specialist Section cannot keep pace with the reinspection of offices and shops consequent upon such changes in a large Borough like Croydon. Again in 1971, the fact that no fewer than 1,100 plans were inspected in the Section to ensure compliance with the Act is indicative of the continuous changes taking place. Overcrowding of offices, particularly newer buildings, is not uncommon. Offices which have been constructed for mechanical ventilation or air-conditioned as open plan offices, are often partitioned without the knowledge of the Local Authority or of the owners. Unforeseen conditions then arise and the ventilation is restricted, or in some cases virtually non-existent. The impression seems to be general that doors are a means of ventilation and this cannot be accepted. Even offices constructed with natural ventilation often contain unventilated internal offices due to partitioning. Site interviews with architects and ventilation engineers have been necessary to remedy these unsatisfactory conditions. Similar difficulties have arisen in Banks, Post Offices, Betting Shops and Self-Service Petrol Control Offices when bandit-proof screens have been installed. In one instance where a Self-Service Petrol Station had been constructed during 1971 the room containing a sink, indicated on the plan as a "Staff Room" was found to be occupied as an office into which the water closet opened. A ventilated lobby between the water closet and the newly formed office has been constructed to comply with the Regulations. Repeatedly one finds Receptionists' areas totally unventilated due to their internal location. Continuously working in such areas is likely to cause fatigue and the atmosphere is felt to be oppressive. Although less frequently, premises are still being found with insufficient sanitary accommodation, washing facilities and lack of hot water supplies. Occasionally even standpipe taps are found as the sole means of washing facilities for the staff. Premises which can only be described as dirty, continue to be found. Although the requirements of the Act are quite clear as to the cleansing of premises, numbers of premises are being inspected where no arrangements are made for regular cleansing. 63 Complaints respecting lack of a reasonable temperature or overheating have been reported and received attention. The inspection of hoists and lifts under the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations, 1968, has continued. All adverse reports on hoists and lifts made by specialised Inspectors are investigated. During the year 50 adverse reports were received on manually operated lifts and 39 on electrically operated lifts. In connection with these reports, visits were made to the premises concerned and notices subsequently served upon the persons responsible for the maintenance of the lifts. On reinspection 46 notices have been complied with and in the remaining cases the most urgent defects had received attention to enable the hoists and lifts to operate in a safe condition. In bank premises of recent construction the means of access to the lift motor room was so dangerous that the lift mechanics refused to enter the lift motor room until improvements were made. Notice was served on the Company to provide a fixed wall ladder, with divided lightweight flaps in the ceiling access, the flaps to be fenced when in the open position. Two dangerous lifts have been withdrawn from use and sealed up by the persons responsible. In a large motor room of a multiple store, space was being used for the storage of goods. There seemed to be no control over staff to prevent the access of unauthorised persons with consequent grave risk to them. Stringent action has been taken forbidding its use as a store, and entry to the room, except by persons authorised specifically in connection with the lift maintenance. In an endeavour to ascertain the number of hoists and lifts in the Borough to which the Act applied, a circular letter was addressed to appropriate companies and others whom it was thought to concern. Replies were received that indicated that a minimum of 600 hoists and lifts exist to which the Regulations apply. It is hoped, that the appointment of an additional Inspector will facilitate the administration and enforcement of the Hoists and Lifts Regulations, and also the safety requirements of the Act relating to the ingress and egress of lift motor rooms. The Regulations require that reports on lifts made by competent persons must be preserved and kept readily available for inspection for at least 2 years after the date of the report. It would seem that this requirement was made with intent to require the reports to be kept on premises in which the lift is operating, but dispute has arisen at some local offices where it is contended that the reports must be kept at their principal or registered office only. In most cases the Company concerned has co-operated by forwarding to the Department copies of the lift reports In its possession. In other cases co-operation is less satisfactory and it may be necessary to seek legal enforcement to secure a sight of such reports. 64 The number of accidents in offices shops, canteens and warehouses reported to this Department during 1971 was 148. This compares with 155 reported in 1970. All the accidents reported were investigated. Of the 148 accidents investigated the following action was taken:- Prosecution 1 Formal warning 15 Informal advice 47 No action was found necessary in 85 cases, but information supplied by the employers in each case was checked and, in a large number of cases, found inaccurate. Had the information reported been accepted without enquiry, an erroneous view of the type of accident would have been given in the returns. Examples of accidents reported are described as follows:— An open drawer to a filing cabinet caused a female employee, hurrying to answer the telephone, to fall, fracturing both elbows and bruising the left leg. The filing cabinet was subsequently re-sited. The floor of a boiler house had become flooded due to long-standing neglect of repair to a water supply pipe. An employee walking across the flooded floor slipped on the oily surface and sustained a fractured ankle. An employee, wishing to reach a shelf at a high level stood on a cardboard box which collapsed under his weight causing him to fall and sustain a slipped disc. Asked why he did not use the steps provided, he said it was easier to stand on the nearest object than to use the steps, which were well constructed and easily portable. An employee in a multiple food warehouse was standing on the top deck of a defective and insecure step ladder, holding a case of goods taken from a high shelf. He overbalanced, and the Manager, standing nearby, endeavoured to catch the falling box to prevent it striking another assistant, and sustained a fracture of the left wrist. Strong representation was made to the Head Office of the company, who caused instructions to be circulated to all branches in the country to ensure that all steps and ladders in their respective shops and warehouses were in good condition. In a food warehouse an accident occurred due to an overloaded trolley being pushed by an employee who could not see where he was going. An Assistant was struck and sustained a broken knee cap. A yardman, age 60, employed in a milk distribution depot, was killed, being crushed between a trailer and a crash barrier at the identical moment when the stationary trailer, loaded with crates of empty milk bottles, was struck by a tractor during the coupling operation. The trailer was apparently forced backward by the impact and pinned the yardman against the barrier. How the employee was in such a position is not known as there were no witnesses. It is thought that he was in the act of transferring a number plate to 65 the trailer although it was not his duty to do so. The Coroner at the inquest recorded a Verdict of "Death by Misadventure". Braking, reversing, and skid resistance tests carried out by the Police were satisfactory. A letter was sent to the Company concerned requesting warning notices to be conspicuously displayed forbidding all persons to move behind trailers or protecting barriers when trailers are being parked or removed; also limiting the duty of transferring registration plates from one trailer to another to that of the tractor driver, to be carried out only when the tractor and trailer are connected. The Company agreed to the recommendations and warning notices have been exhibited as requested. In a multiple store a male young person (age 15) lacerated the fingers of his left hand in cleansing an unguarded bacon slicing machine which was in motion. The firm was duly prosecuted - (See end of report). The leaflet "The safe Handling of Food Slicing Machines" is issued by the department where considered advisable, and it is hoped that there will be a resultant improvement in imparting the information to staff. Apart from defects found in the course of routine inspections 32 complaints were received during the year compared with a similar number received during 1970. These included inadequate ventilation of offices,low temperature, insufficient and defective sanitary accommodation, dirty premises, defects to floors, steps and stairs etc. No problems have arisen during the year in connection with the mechanical handling of goods. The means of access to loading docks merit special attention. Insecure wooden steps, or absence of steps, fixed steps without handrails or handholds have been found and such defects remedied. During the year two cases were reported to the Town Clerk with a view to legal action being taken. In the first case a firm retailing electrical accessories was prosecuted for— (a) Dirty walls and ceiling of premises contrary to Section 4(1). A fine of £20 was imposed. (b) Failing to provide a handrail of durable material contrary to Section 16(2). A fine of £30 was imposed. (c) Dirty wash basin and washing compartment, walls, floor, ceiling and woodwork contrary to Section 10(2). A fine of £30 was imposed. (d) Dirty condition of water closet pedestal and water closet compartment contrary to Section 9(2). A fine of £30 was imposed. Fines totalling £110 Costs £20 66 In the second case a multiple grocery firm was prosecuted for:— (a) Permitting a young person to be employed to clean machinery (an electric powered bacon slicing machine) and esposing him to risk of injury contrary to Section 18(1). A fine of £100 was imposed. (b) Failure to exhibit Abstract of Act contrary to Section 50 andthe Information for Employees Regulations, 1965. A fine of £10 was imposed. (c) Person employed on bacon slicing machine without sufficient training or adequate supervision contrary to Section 19. A fine of £150 was imposed. Fines totalling £260 Costs £25 PUBLIC HEALTH SERVICES 69 WATER SUPPLY The London Borough is served by four statutory supply authorities, as undermentioned:— Supply Authority Square Miles Estimated Population for 1970 Croydon Corporation (Central and northern part of the Borough) 17.0 216,210 Metropolitan Water Board (Spring Park Estate and New Addington) 2.8 41,080 East Surrey Water Company (Sanderstead, Selsdon, Kenley, Purley and Coulsdon East) 11.7 56,100 Sutton District Water Company (Woodcote and Coulsdon West) 1.9 13,790 33.4 327,180 The waters in supply are of good organic quality and moderately hard in character. They have no plumbo-solvent characteristics and the fluoride content averages about one-sixth of a part per million. All houses are supplied from mains and there are no standpipes for this purpose. In the Croydon Undertaking's area 92 Chemical and 608 Bacteriological samples of raw water were tested, also 138 chemical and 1,642 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 114. SEWAGE DISPOSAL This is now a function of the Greater London Council. It is understood that the Beddington Works presented some problems and the building of new sludge digestion tanks and other improvements were planned for 1972. OTHER SERVICES 73 FAMILY PLANNING The assistance given to the Croydon Family Planning Association of a financial grant and free facilities at Corporation clinics was continued. Domiciliary Family Planning by Specialist Midwife The specialist midwife undertaking this work was employed part-time (approx. 60%) until 1st August 1971, after which she became a full-time member of staff devoting all her time to this service. Although the numbers are small the results are encouraging as shown by the breakdown of the 1970 statistics. 1970 New patients seen 68 Patients where no advice was appropriate for various reasons e.g. already pregnant 12 Of the remaining 56, at the end of 1971:- 3 had subsequently become pregnant 1 I.U.D. failure - cause unknown 1 I.U.D. extruded 1 failure to persist with contraceptive pill 4 cases were referred by social workers and the rest by health visitors. 1971 New patients seen 177 Number of visits 1,065 Patients prescribed the 'pill' 42 fitted with I.U.D. 50 " cap 10 using other methods 43 where no method was advised 35 Vasectomy 15 74 NATIONAL ASSISTANCE ACT. 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 No order for compulsory removal was required during 1971. HOME DIALYSIS Three patients commenced home dialysis during 1971, and no patient was awaiting the adaptation of premises in order to begin home dialysis at the close of the year. 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 1971, see Appendix page 109. REHOUSING ON MEDICAL GROUNDS Dr. C.G. Nicol, Principal Medical Officer inquired into 828 new applications and 101 re-applications for rehousing on medical grounds in 1971 making 22 personal visits, usually jointly with a public health inspector, health visitor, or welfare officer. A further 32 applicants were interviewed at this office. 75 Sub-division of applications recommended to the Housing and Lettings Sub-Committee showed the following approximate frequencies:- (a) Rehoused from Non-Council property fb) Transferred from one Council property to another Total Moved = fa) & (b) Combined Heart disease 33% 17% 26% Lung disease 7% 9% 7% Strokes 9% 2% 6% Crippling conditions 16% 13% 14% Illnesses of children 6% 2% 4% Cancer 5% 2% 4% Tuberculosis 2% 6% 3% Mental disorders 20% 40% 30% Other conditions 2% 9% 6% MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDREN'S DEPARTMENT During the year 277 children were medically examined prior to admission to a children's home or private foster home. 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 1,146 Considered not fit for inclusion in sickness pay scheme 15 Deferred for review 62 Unfit for employment 7 76 STAFF MEDICAL EXAMINATION The Medical supervision of all Corporation staff provided by the health department includes:— Scrutiny of health statements made by successful applicants for officer grades and any follow-up or medical examination deemed necessary. Medical examination of prospective student teachers. Examination for freedom from intestinal infection:- (i) All employees of the water undertaking. (ii) All school meal service and canteen personnel. Arrangements for re-checks. Vision tests on all Corporation drivers and again at specified intervals over the age of 50. Scrutiny of records of all staff who have been absent for an aggregate of more than 8 weeks during the preceding 12 months or who are exhausting entitlement to sick pay. Follow-up for cause and anticipated date of return to duty. Report on financial circumstances by an Almoner of the Health Department, in order that a special Establishment Sub-Committee may decide on extension of sick-pay. Arrangements for radiological examination of staff who work in contact with children. Special examination of any member of staff referred by the department concerned. Enquiries into excessive sickness in any section of the Corporation staff. 918 examinations were made during the year by the medical staff of the department including 152 vision tests for drivers. Of these 178 were in respect of manual workers, who were classified as follows:— Fit for employment and sick pay scheme 93 Deferred for review 70 Unfit for sick pay scheme 11 Fit for light employment only (Not fit for sick pay scheme) - Unfit for employment 4 178 77 DRUG DEPENDENCY The informal advisory Committee established in 1967 of representatives of statutory and voluntary organisations concerned with this problem met on two occasions. The general position in Croydon was deemed unchanged, with no special prevalence but with the continued danger common to all urban areas. An in-service tr ining session for professional staff was held at the Denning Hall under the Chairmanship of the Chief Education Officer, when Dr. Dale-Beckett and Police Sergeant D. Shearon (with dogs) covered the theory and practice of drug taking and drug traffic control. Information about books, leaflets and films was provided by Miss Elliott. A pamphlet for all school leavers covering services available for adolescents was issued at Easter and was well received. With minor alterations it will be given to school leavers in 1972. A meeting for parents was held in the northern part of the Borough, covering 3 senior schools, when Dr. Dale-Beckett spoke on "Prevention from Drug Addiction"; a similar meeting for the south of the Borough was planned for early 1972. The Social Services Department continued their Drug Advisory Centre at Rees House, where a senior social worker is available by appointment or at "walk in" sessions on Tuesday evenings. The number of enquiries slightly increased especially concerning those under 20 years of age who turned to soft drugs as part of their adolescent rebellion. All referrals except one came from an intermediate source. APPENDIX TABLES 81 VITAL STATISTICS 1965 - 1971 82 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE. AGE AND SEX CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks and under 1 year AGE IN YEARS 1-4 5 14 1524 25 34 35 44 45 54 5564 65 74 75 & over B4 Enteritis and other Diarrhoeal Diseases M 2 _ _ _ 1 _ _ _ _ 1 _ _ F 1 _ _ _ _ _ _ _ _ - _ 1 B5 Tuberculosis of Respiratory System M 6 _ _ _ _ _ _ _ 1 1 _ _ F 3 _ _ _ _ _ _ _ 1 1 _ 1 B6(1) Late effects of Respiratory T.B. M 1 _ _ _ _ _ _ _ _ _ 1 _ F 1 _ _ _ _ _ _ _ _ - 1 _ B6(2) Other Tuberculosis M . _ _ _ _ _ _ _ _ _ _ _ F 1 _ _ _ _ _ _ _ _ _ 1 _ B17 Syphilis and its Sequelae M 4 _ _ _ _ _ _ _ 1 1 1 1 F 6 _ _ _ _ _ _ _ _ 1 _ B18 Other Infective and Parasitic Diseases M 7 _ 1 1 _ _ _ 2 1 _ 1 1 F 2 _ 1 - _ _ _ - _ _ 1 _ TOTAL 34 _ 2 1 1 _ _ 2 _ 5 10 9 B19(1) Malignant Neoplasm Buccal Cavity etc. M 8 _ _ _ _ _ _ - 1 - 2 5 F 4 _ _ _ _ _ _ _ _ _ 1 3 B19(2) Malignant Neoplasm Oesophagus M 9 _ _ _ _ _ _ _ _ 2 2 5 F 8 _ _ _ _ _ _ _ 1 1 3 3 B19(3) Malignant Neoplasm Stomach M 35 _ _ _ _ _ _ 1 _ 6 16 10 F 30 _ _ _ _ _ _ 1 _ 6 8 12 B19(4) Malignant Neoplasm Intestine M 42 _ _ _ _ _ _ 2 1 9 9 21 F 66 _ _ _ _ _ _ 1 1 15 13 36 B19(5) Malignant Neoplasm Larynx M 3 _ _ _ _ _ _ - _ 1 1 1 F 1 _ _ _ _ _ _ - 1 - - _ B19(6) Malignant Neoplasm Lung, Bronchus M 166 _ _ _ _ _ _ _ 8 51 71 36 F 40 _ _ _ _ _ _ 2 4 12 11 11 B19(7) Malignant Neoplasm Breast M 1 _ _ _ _ _ _ - - - 1 - F 85 _ _ _ _ _ 4 5 16 22 23 15 B19(8) Malignant Neoplasm Uterus F 21 _ _ _ _ _ 1 1 3 7 6 3 B19(9) Malignant Neoplasm Prostate M 31 _ _ _ _ _ - - - 2 8 21 B19(10) Leukaemia M 10 _ _ _ _ _ - - 1 - 3 3 F 11 _ _ _ _ _ 1 - 1 2 4 3 B19(11) Other Malignant Neoplasms M 98 _ _ _ 2 _ 1 2 13 23 34 23 F 111 _ _ _ _ _ 1 2 15 22 30 40 B20 Benign and Unspecified Neoplasms M 3 _ _ _ _ _ - 1 - 1 1 _ F 4 _ _ _ _ _ _ _ _ _ 2 2 TOTAL 787 _ _ _ 5 1 8 18 71 182 249 253 B21 Diabetes Mellitus M 8 _ _ _ _ _ _ _ 1 2 3 2 F 21 _ _ _ _ 1 _ _ 2 1 7 10 B46(1) Other Endocrine etc. Diseases M 1 _ _ _ _ _ _ _ - - - - F 11 _ _ _ _ _ _ _ 2 1 2 6 B23 Anaemias M 3 _ _ _ _ _ _ _ - - - 1 F 6 _ _ _ _ 1 _ _ - 1 - 4 B46(2) Other Diseases of Blood, etc. M 1 _ _ _ _ _ _ _ - 1 - _ F 2 _ _ _ _ - _ _ 1 1 _ _ B46(3) Mental Disorders M 4 _ _ _ _ _ _ _ 2 - 1 1 F 25 _ _ _ _ _ _ _ _ 2 4 19 83 CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks and under 1 year AGE IN YEARS 1-4 5 14 1524 25 34 35 44 45 54 55 64 65 74 75 & over B24 Meningitis M 1 - 1 - - - - - - - - - F - - - - - - - - - - . B46(4) Multiple Sclerosis M. 2 - . - - - - 1 - - 1 - F 3 - - - - - - - - 1 1 1 B46(5) Other Diseases of Nervous System M. 12 - 2 1 - 1 1 - 3 2 2 - F 20 - 4 1 - - - - 1 4 3 7 B26Chronic Rheumatic Heart Disease M. 8 - - - - - - - 1 2 2 3 F 34 - - - - - 1 2 3 7 5 16 TOTAL 162 - 7 3 1 3 3 3 16 25 31 70 B27 Hypertensive Disease M. 18 - - - - - - 1 1 4 7 5 F 31 - - - - 1 - - 1 - 10 19 B28 Ischaemic Heart Disease M 439 - - - - 1 2 - 34 120 135 135 F 327 - - - - - - - 7 25 69 224 B29 Other Forms of Heart Disease M. 85 - - - 1 - 1 1 3 8 17 54 F 144 - - - - 2 - - 4 1 17 120 B30 Cerebrovascular Disease M. 185 - - - - - - - 8 20 46 107 F 433 - - - - - 1 - 4 27 76 325 B46(6) Other Diseases of Circulatory System M. 77 - - - - 1 - 1 5 11 26 33 F 97 - - - - - - - - 6 20 71 TOTAL 1836 - - - 1 5 4 21 67 222 423 1093 B31 Influenza M 3 - - - - _ - 1 1 - - 1 F 3 - - - - - - - - 1 1 1 B32 Pneumonia M. 127 1 3 1 - 2 - - 2 11 34 72 F 233 - 2 1 1 - - - - 8 34 187 B33(1) Bronchitis and Emphysema M. 117 - - - - - - - 2 16 31 68 F 48 - - - - - - - 2 12 10 23 B33(2) Asthma M. - - - - - - - - - - - - F 4 - - - - - - - - 2 1 - B46(7) Other Diseases of Respiratory System M. 10 - 2 - - - - - - 1 2 5 F 9 - 1 - - - - - 2 1 - 5 TOTAL 554 1 8 2 1 2 3 1 9 52 113 362 B34 Peptic Ulcer M. 15 - - - - - - - 1 5 7 2 F 9 - - - - - - - - 1 2 6 B35 Appendicitis M. - - - - - - - - - - - - F 1 - - - - - - - - - - 1 B36 Intestinal Obstruction and Hernia M. 7 - 1 - - - - - - - 1 5 F 14 - 1 - - - - - 1 - 6 6 B37 Cirrhosis of Liver M. 5 - - - - _ - - - - 2 - F 10 - - - 1 - 1 - 1 4 1 - B46(8) Other Diseases of Digestive System M. 13 2 - - - - - - - 2 4 3 F 19 - - - - - - 1 - 2 7 9 B38 Nephritis and Nephrosis M. 6 - - - - 1 - 1 - - - 3 F 5 - - - - - - - - 1 1 3 B39 Hyperplasia of Prostate M 11 - - - - - - - - 1 4 6 B46(9) Other Diseases, Genito-urinary System M 14 - 1 - - - - 1 1 2 3 6 F 25 - - - - - - - 1 1 3 19 B46(10) Diseases of Skin, Subcutaneous Tissue M 1 - - - - - - - - - - 1 F 2 - - - - - - - 1 - - 1 84 CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks and under 1 year AGE IN YEARS 1-4 5 14 1524 25 34 3544 45 54 55 64 65 74 75 & over B46(11) Diseases of Musculoskeletal System M 3 - - - - - - 1 1 1 - F 18 - - - - - - - 1 3 4 10 B42 Congenital Anomalies M 17 8 5 - 2 - - - 1 1 - - F 8 2 2 - - 2 1 - - - - - B43 Birth Injury, Difficult Labour, etc. M 6 6 - - - - - - - - - - F 4 4 - - - - - - - - - - B44 Other Causes of Perinatal Mortality M 13 13 - - - - - - - - - - F 13 13 - - - - - - - - - - B45 Symptoms and III Defined Conditions M 6 - - - - - - - - 1 1 4 F 1 - - - - - - - - - - 1 TOTAL 246 48 10 1 3 3 4 6 14 24 47 86 BE47 Motor Vehicle Accidents M 24 - - _ 3 7 4 2 2 3 1 2 F 13 - - 2 - - - 2 - 3 2 4 BE48 All Other Accidents M 16 1 2 1 - 1 1 1 2 2 1 4 F 33 1 1 - - 1 2 - - 2 7 19 BE49 Suicide and Selfinflicted injuries M 15 - - - - - 2 5 3 4 1 - F 17 - - - - 1 2 1 2 7 4 - BE50 All Other External Causes M 4 - - - - 2 - 1 - - - 1 F 1 - - - - - - - - - 1 - TOTAL 123 2 3 3 3 12 11 12 9 21 17 30 TOTAL ALL CAUSES M 1703 31 18 5 13 16 15 41 108 317 488 651 F 2039 20 12 5 2 10 18 22 82 214 402 1252 3742 61 30 10 15 26 33 63 190 531 890 1903 85 CANCER Deaths from Cancer occurred at the following ages — Age Period Male Female Total Under 25 years 5 1 6 25 and under 35 years 1 7 8 35 and under 45 years 6 12 18 45 and under 55 years 26 45 71 55 and under 65 years 95 87 182 65 and under 75 years 148 101 249 75 and over 125 128 253 Total 406 381 787 Site Male Female Total Percentage of Total Bowel and Rectum 42 66 108 13.7 Brain 8 6 14 1.8 Breast 1 85 86 10.9 Buccal Cavity 8 4 12 1.5 Cervix - 16 16 4.2 Gallbladder & Duct 3 3 6 0.8 Hodgkins 4 3 7 0.9 Larynx & Pharynx 5 3 8 1.0 Leukaemia 10 11 21 2.7 Lungs and Bronchus 166 40 206 26.1 Oesophagus 9 8 17 2.2 Ovary - 26 26 6.8 Pancreas 17 11 28 3.6 Prostate 31 - 31 7.7 Stomach 35 30 65 8.3 Uterus - 5 5 1.3 Other Malignant Neoplasms 67 64 131 16.6 TOTAL 406 381 787 86 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) Foetal States - Congenital Malformations 10 Atelectasis and Marasmus 9 Haemorrhagic Diseases of Newborn 2 (3) Prematurity 21 (4) Post-Natal Causes 3 Total 51  Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1.000 Births 1970 1971 1970 1971 Injury at Birth and Congenital 19.6 29.4 3.4 4.3 Premature Births 43.5 27.0 7.5 3.9 Respiratory Diseases 11.9 12.8 2.0 1.9 Atelectasis, Debility and Marasmus 3.3 11.5 0.6 1.7 Diseases of Digestion * 1.1 1.3 0.2 0.2 Other causes 20.6 18.0 3.5 2.6 * These from Gastro-Enteritis Perinatal Deaths Stillbirths 68 Deaths in first week 43 Causes of Death in first week Prematurity 20 Congenital conditions- 6 Atelextasis 9 Birth Trauma 6 Perinatal Rate 21 per 1,000 Total (live and still) births Pneumonia - Haemorrhagic disease 2 Other causes 87 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS, WEEKS AND MONTHS CA USES OF DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th 14th day 15th - 21st day 22 nd-28th day Total Under 1 month 1 + months 2 + months 3 + months 4 + months 5 + months 6 + months 7 + months 8 + months 9 + months 10 + months 11 + months TOTAL All Causes 37 1 2 1 2 2 4 2 51 3 14 4 2 3 • 2 2 81 Meningo-Encephal itis - - - - - - - - - - - - 1 - - - - - - - - - 1 Chickenpox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - - - - - - - - - - - - - - - - - 1 Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - 1 1 - - - - - - - - - 3 Pneumonia (all forms) - - - - - - - - - - - 1 3 - - - - - - - - - 7 Diarrhoea and enteritis - - - - - - - - - - - - 1 - - - - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 2 1 - 1 - - 2 1 1 2 10 1 5 - - - - - - 1 - - 17 Premature Births 20 - - - - - - 1 - - 21 - - - - - - - - - - - 21 Atrophy, Atelectasis, Debility and Marasmus 8 - - - 1 - - - - - 9 - - - - - - - - - - - 9 Injury at Birth 5 - - - - - - - - - 6 - - - - - - - - - - - 6 Haemorrhagic disease of newborn 2 - - - - - - - - - 2 - - - - - - - - - - - 2 Other Causes - - - - - - - - 2 - 2 - 4 - 2 1 - - - - - 2 14 TOTALS 37 1 - 2 1 - 2 2 4 2 51 3 15 4 2 3 - - - 2 - 2 81 88 MIDWIFERY SERVICE Municipal midwives attended:— 1. Bookings for home confinement 955 2. Bookings for planned early discharge from hospital 696 3. Patients delivered at home 815 4. Primipara delivered at home 30 Multipara delivered at home 785 5. Live births delivered at home 813 6. Stillbirths delivered at home 2 (1) Prolapsed cord (1) Asphyxia 7. Neonatal deaths at home 0 8. Premature Infants born at home 13 39 weeks by dates 5lb. 4oz. 39 weeks by dates 5lb. 8pz. 39 " " " 5lb. 4oz. Uncertain of dates 4lb. 10oz. 37 " 5lb. 8oz. 36 weeks by dates 5lb. 10oz. 38 " " 5lb. 4oz. Term " " 5lb. 2oz. Postmature " " 5lb. Term " " 5lb. 2oz. 37 weeks " 51 b. 8oz. 37 weeks " " 5lbs. 39 " " 5lb. 8oz. 9. Inhalational Analgesia given "Entonox" 627 "Trilene" 36 10. Patients given Pethidine or Pethilorfan 462 11. Postpartum Haemorrhages (including 3 secondary P.P.H.) 16 Treated at home 9 Admitted to Hospital 7 12. Retained Placentae 9 Treated at home 4 Admitted to Hospital 5 13. Flying Squad calls 10 14. Manual removal of placenta at home 1 15. Blood transfusions at home 16. Prolonged labours over 24 hours delivered at home 0 17. Forceps deliveries at home 0 18. Ventouse vacuum extraction at home 19. General anaesthetics given at home 3 20. Breech deliveries 3 21. Sets of twins delivered at home (undiagnosed) 22. Anaemia of Pregnancy treated at home 68 23. Pre-eclamptic toxaemia of pregnancy treated at home 13 89 24. Puerperal pyrexia 22 Genital 7 Extra Genital 15 25. Congenital abnormalities delivered at home 12 Heart Murmur Talipes Left Foot Deformed Left Arm Bilateral Talipes Hypospadios Right Hand - 3 fingers only Spina Bifida Bilateral Congenital Cataract Deformity of the right foot Webbed Toes right foot Deformity of upper lip Oesophegeal Atresia 26. Artificial rupture of membranes at home 26 27. Buccal pitocin induction of labour at home 20 28. Rhesus negative mothers delivered at home 125 29. Anti-D Immunoglobul in treatment given 32 30. Guthrie tests for phenylketonuria sent to laboratory 4,862 Including 106 repeat tests sent to laboratory 31. Patients admitted to hospital 416 Antenatal 311 During labour 72 After delivery 33 (including 6 early discharges readmitted) 32. Infants admitted to hospital (including 10 readmissions) 31 Rhesus Incompatibility 2 Green Stools 2 Fretful - for investigation 1 Blood in Stools 2 Projectile Vomiting 3 Twitching 1 Cyanotic attack 3 Persistent Grunting Unbooked B.B.A.- Chilled 2 Respirations 1 Undiagnosed Twins 2 Urinary Infection 1 Spina Bifida 1 Jaundice 1 Respiratory Distress 5 Umbilical Harmorrhage 1 Weight loss and Chesty 2 Oesophogeal 1 33. Patients received for Home Nursing 1,661 Booked for Home Confinement 134 Booked for Hospital Confinement 1,527 (including 557 booked for planned early discharge) 34. Pupil Midwives trained 38 35. District visits of Obstetric Course student nurses 29 36. Visits made by Specialist Midwife for family planning advice 1,065 37. Talks in hospitals 39 90 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1965 - 1971 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 1971 5,392 - - 15.0 91 Midwife Miles Deliveries Midwifery Maternity Analgesia Ante-Natal Visits Post-Natal Visits Home Confinement Bookings 48 hour bookings Home Visits Clinic Session A.N. Clinic Session G.P. Clinic Session Cytology Family Planning Visits Normal Abnormel Normal Abnormal Entonox Trilene Midwife Pupil Midwife Pupil 1. © 4.957 40 + 6 40 33 954 716 942 650 86 80 68 2. ® 2,287 42 + 4 40 2 36 1.224 679 65 37 60 3. 4.113 34+4 34 33 526 921 37 23 31 4. x 4,608 52 + 2 48 4 43 263 68 844 68 43 22 38 5. x 3,880 40 + 3 38 2 36 1,494 791 51 64 56 6. © 2,735 69 + 7 62 7 57 1,238 743 769 571 86 32 43 7. © 5,732 52+4 51 1 42 856 89 859 126 72 24 35 8. © 6,639 63+6 58 5 57 996 747 818 761 67 22 29 9. 2,958 61 + 4 60 1 58 527 458 709 754 69 28 56 10. 1 1 2 11. X 5,784 53 + 7 52 1 40 1,111 638 656 587 59 13 12 12. © 5,798 68 + 6 67 1 49 434 294 844 743 103 40 67 13r 2,709 21 + 0 21 20 173 385 11 16 48 14. x 4,966 49 + 4 48 1 43 846 488 864 577 65 33 42 15. x 6.909 26+2 26 17 476 790 28 43 95 16. © 4,981 51 + 6 48 3 38 922 935 746 528 62 33 91 17. © 888 14 + 3 14 8 192 148 215 171 23 7 18. © 2.986 56+2 54 2 54 1,384 859 57 39 50 19. © 3,743 20+6 20 17 994 531 773 645 67 38 54 92 Midwife Miles Deliveries Midwifery Maternity Analgesia Ante-Natal Visits Post'Natal Visits Home Confinement Bookings 48 hour bookings Home Visits Clinic Session A.N. Clinic Session G.P. Clinic Session Cytology Family Planning Visits Normal Abnormal Normal Abnormal Entonox Trilene Midwife Pupil Midwife Pupil PART-TIME STAFF 1. * 5,774 1 1 6 681 16 102 24 49 2. 5,520 62 832 55 125 37 52 3. * 5,426 1 1 1 46 769 30 114 21 62 4. * 3,953 1 1 1 1.144 865 36 98 54 10 5. 4.253 11 840 52 121 49 11 6. 5.758 41 265 42 21 15 7 Totals 99.912 815+ 72 1 0 784 30 627 36 12,909 5,855 9.698 6,181 951 567 903 581 160 191 1,065 93 X Denotes Midwives working in attachment schemes but who also undertake a percentage of normal duties. ©Denotes Midwives working in liaison with General Practitioner Obstetricians. The Midwifery staff in full have assisted 35 doctors at their Antenatal sessions in the year. * Part-time Midwives 1,3,4, undertook deliveries in emergency while on duty. Staff Changes - Full-time Midwives No. 11 left service October 1971 - Not yet replaced No. 17 left service April 1971 - Replaced by No. 13 No. 4 Commenced duties January 1971 to replace 1970 vacancy No. 13 Commenced duties June 1971 - Part-time midwives No. 6 Seconded to Health Visitors Full-time Domiciliary Family Planning October 1971 - Not yet replaced. 94 CARE OF PREMATURE INFANTS (1) Number of live premature infants notified during 1971 who were born* - (i) at home or in a nursing home 20 f/'/') in hospital* 273 (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 - who died during the first 24 hours 1 who died in 1 and under 7 days - who died in 7 and under 28 days - who survived at the end of one month 19 (3) Number of those born in hospital - who died during the first 24 hours 24 who died in 1 and under 7 days 1 who died in 7 and under 28 days 2 who survived at the end of one month 246 (4) Number of premature still births who were born (i) at home or in a nursing home 1 (ii) in hospital 37 95 CONGENITAL ABNORMALITIES No. registered in 1971 - 126 of these 99 were live-births 13 were still-births 14 died (1) (2) (31 (4) (5) (6) (71 (8) (9) (10) TOTALS OVERALL TOTALS Central Nervous System Eye, Ear Alimentary System Heart and Greet Vessels Respiratory System Uro-genital System Limbs Other Skeletal Other SystemS Other Maiformations M F M F M F M F M F M F M F M F M F M F M F LIVE 1 4 3 6 6 7 1 4 - - 19 - 17 20 1 3 1 4 1 1 50 49 99 STILLBIRTHS 8 5 - - - - - - - - - - - - - - - - - - 8 5 13 DEATHS 3 1 - • 1 - 3 1 1 - - 2 - 1 - - - - - 1 8 6 14 TOTALS 12 10 3 6 7 7 4 5 1 - 19 2 17 21 1 3 1 4 1 2 66 60 126 CAUSES OF DEATH OR STILL-BIRTH Col. 1. Anencephalus 9 Spina Bifida 4 Hydrocephalus 4 Col. 2. Nil Col. 3. Malformations of Alimentary System 1 Col. 4. Malformation of Circulatory System 5 Col. 6. Malformations of uro-genital organs 2 Col. 7/8/9. Nil Col. 10. 2 ISSUE OF WELFARE FOODS FOR 1971 National Dried Milk 19,657 Cod Liver Oil 1,865 (Discontinued) Vitamin A.D & C Drops 11,894 Vitamin A & D Tablets 5,322 Orange Juice 115,312 96 AT RISK REGISTER YEAR ENDING 31st DECEMBER, 1971 Number added to Register during 1971 905 Number on Register at 31.12.71 1,964 Number of 8 month checks carried out during 1971 910 Number of 2 year checks carried out during 1971 406 REFERRALS and RETESTS 1971 Born 1971 No. to be seen again at Child Health Centre 3 No. referred to Stycar Hearing Clinic, Dr. Morgan 2 Bom 1970 No. to be seen again at Child Health Centre 12 No. referred to Stycar Hearing Clinic, Dr. Morgan 15 No. referred to hospital for Specialist opinion 1 Born 1969 No. to be seen again at Child Health Centre 35 No. referred to Stycar Hearing Clinic, Dr. Morgan Nil No. referred to Observation Register and to be seen again at Child Health Centre 27 No. referred to Observation/Handicapped Register 34 No. referred to Hospital for Specialist opinion 1 No. in abeyance awaiting report from Hospital 6 Born 1968 and 1967 No. to be seen again at Child Health Centre 11 No. referred to Observation Register and to be seen again at Child Health Centre 6 No. referred to hospital for Specialist opinion 1 No. referred to Observation/Handicapped Register 8 97 STYCAR HEARING TESTS There were 1,964 children on the At Risk Register at the end of 1971. Number of Clinics held in 1971 24 Number of Appointments made during year 221 Number of Non-attenders 72 SOURCE OF REFERRAL AND RESULT source hearing satisfactory hearing unsatisfactory total Referred Speech Clinic For Obser' vat ion Discharged Referred E. N. J. For Observation Already under observation Child Health Centre 28 7 56 8 1 1 101 L A. Doctor 3 3 Health Visitor 4 2 5 1 12 Speech Clinic 5 1 6 General Practitioner 4 11 1 1 17 Other Sources 1 2 3 REASON AND SOURCE OF REFERRAL reason for referral source of referral total Child Health Centres L.A. Doctor Health Visitor Speech Clinic General Practitioner Other Sources 1. Failed Stycar Test 53 53 2. Poor Speech 32 5 37 3. Suspected Hearing Loss 2 12 6 12 2 34 4. Parent's Request 7 7 5. Other Reasons 9 1 1 11 RETESTS reason for retest hearing satisfactory hearing unsatisfactory total Referred Speech Clinic Discharged Referred E. N. T. For Further Retest Referred from previous Stycar Session 1 3 1 5 Poor Speech 1 1 2 98 TOTAL HOME VISITS BY HEALTH VISITORS 1971 1970 Children under 1 year 6,382 6,061 Children 1-2 years 6,589 6,486 Other Children under 5 years 12,435 11,312 Re-visits to Children 0-5 years 30,674 27,206 Persons aged 65 or over 1,395 874 Mentally disordered persons 351 264 Persons discharged from hospitals 94 115 Households visited re infectious diseases (including T.B.) 47 93 Other home visits 7,763 7,212 GRAND TOTAL OF VISITS 65,730 59,623 99 ATTENDANCES AT CHILD HEALTH CENTRES - 1971 Addiscombe Grove Monday P.M. All Saints Monday P.M. Bensham 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.) Mon. P.M. (Jan.-July) Lodge Road Thursday A.M. & P.M. Lodge Road Friday P.M. Monks Hill Thursday P.M. Monks Orchard Monday P.M. New Addington Mon. P.M. (Jan.-July)Fri.A.M New Addington Wed. A.M.(Jan. -July) & P.M. New Addington Thursday P.M. Norbury Wednesday A.M. & P.M. Old Coulsdon Tuesday P.M. Parish Church Monday P.M. Purley Tuesday A.M. Infants born 1971 77 94 167 76 72 99 24 114 261 67 71 30 78 20 212 84 42 103 104 247 143 131 60 88 98 No. of re-attendances 455 774 1,054 539 295 759 263 935 1,343 387 458 148 422 18 964 291 192 589 375 1,176 596 1,364 373 408 639 Children 1-5 years 135 242 299 226 191 197 94 262 263 116 110 92 243 52 298 105 154 368 230 719 288 587 173 217 213 No. of re-attendances 572 962 1,098 941 588 710 681 1,462 1,562 440 586 391 889 82 1,293 493 405 996 801 1,918 1,305 1,902 1,423 469 712 Total attendances 1,239 2,072 2,618 1,782 1,146 1,765 1,062 2,773 3,432 1,010 1,225 661 1,632 172 2,767 973 793 2,056 1.510 4.060 2,332 3,984 2,029 1,182 1,662 Consultation with doctors 378 647 858 522 526 565 - 695 1,352 305 272 97 585 112 1,444 619 374 609 605 1,365 805 1,386 421 588 716 No. of sessions 48 48 96 50 52 52 50 48 104 27 24 52 51 11 99 51 46 48 50 82 52 104 50 48 48 Average per session 1971 25.8 43.2 27.3 35.6 22.0 33.9 21.2 57.8 33.0 37.4 51.0 12.7 32.0 15.6 27.9 19.1 17.2 42.8 30.2 49.5 44.8 38.3 40.6 24.6 34.6 Average per session 1970 20.3 31.5 29.9 44.1 24.5 35.5 18.5 49.1 38.7 34.8 31.4 12.2 37.8 16.6 24.4 20.9 19.4 38.2 30.2 44.6 43.7 35.4 42.3 29.1 32.9 Continued on next page. 100 ATTENDANCES AT CHILD HEALTH CENTRES - 1971 (Continued) Rectory Park Tuesday P.M. Rectory Park Thursday P.M. Reedham Park Avenue (Alt.) Wednesday 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 (St.John's) Wednesday P.M. Upper Norwood (St. Aubyn's) Thursday P.M. Waddon Wednesday P.M. Wood side Friday P.M. TOTAL - 1971 TOTAL - 1970 - Clinics held at General Practitioners' Surgeries in 1971 Infants born 1971 66 90 15 97 142 93 115 63 93 75 62 48 117 64 70 107 186 78 103 4,246 4,206 710 No. of re-attendances 466 655 81 683 1,137 493 762 325 808 399 399 326 760 396 424 436 976 400 403 25,148 23,952 3,833 Children 1- 5 years 107 333 81 29C 293 177 213 122 259 214 204 157 156 120 103 235 262 206 210 9,616 9,859 1,522 No. of re-attendances 486 1,100 244 1,027 1,199 792 814 799 1,05S 684 763 497 645 652 698 442 1,268 579 528 36,957 39.723 6,525 Total attendances 1,125 2,178 421 2,097 2,771 1,555 1,904 1,309 2,21S 1,372 1,428 1,027 1,678 1,232 1,295 1,220 2,692 1,263 1,244 75,967 77,740 12,590 Consultations with doctors 290 724 230 693 949 653 681 434 591 530 750 477 651 437 533 362 870 488 640 26,829 28,128 5,186 No. of sessions 61 52 24 52 102 52 51 48 48 50 48 51 52 50 51 52 52 52 50 2,379 2,418 570 Average per session 1971 22.1 41.9 17.5 40.3 27.2 29.9 37.3 27.3 46.2 27.4 29.8 20.1 32.3 24.6 25.4 23.5 51.8 24.3 24.9 31.9 - 22.1 Average per session 1970 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 23.3 101 HOME NURSING Staff at 31.12.71 1 Principal Nursing Officer (Home Nursing) 3 Assistant Nursing Officers 1 Senior District Nurse 50 Nurses S.R.N. (4 Part-time) 8 Nurses S.E.N. (1 Part-time) 12 Nursing Auxiliaries (1 Part-time) Summary of Work carried out during 1971 (1970 figures in brackets) Patients remaining on books 31st December 1970 1,629 New Patients 5,361 Total 6,990 (6,528) Specially Classified Cases Visits Tuberculosis 48 (59) 731 (839) Children 0-5 *96 *376 Patients over 65 4,493 (4,354) 124,949 (124,535) Termination of Cases Convalescent 3,019 (2,909) Hospital 1,058 (1,031) Died 391 (418) Removed - other causes 725 (541) Remaining on books 31.12.71 1,697 (1,629) Total 6,990 (6,528) Number of treatments carried out by Home Nurses in General Practitioner Surgeries 11,338 (8,195) Home Visits Surgery Treatments * January 15,644 (13,637) 761 February 13,973 (12,615) 881 March 16,472 (14,242) 1,097 April 14,093 (13,608) 936 May 15,212 (14,197) 897 June 14,517 (14,064) 822 July 15,039 (15,034) 879 August 14,753 (13,870) 784 September 14,952 (14,364) 1,188 October 15,543 (15,702) 923 November 14,983 (15,364) 994 December 15,198 (15,605) 1,176 Total 179,379 (172,302) 11,338 102 REHABILITATION OF ELDERLY PERSONS Patients visited during 1971 Female 81 (64) Male 57 (30) 138 (94) Patients not suitable Hospital 18 (7) Rehabilitation 43 (43) Limited or no success 42 (40) Died 7 (4) Remaining on books 29 (24) *1970 figures not available 103 GENERAL PRACTITIONER ATTACHMENT SCHEMES Attachment Health Visitors, domiciliary midwives or home nurses are responsible for all patients on the lists of specified general practitioners within the local authority boundaries without a traditional geographical district. Liaison Health visitors, domiciliary midwives or home nurses are responsible both for geographical districts and for the patients on the lists of specified general practitioners. Where patients live outside the nures'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 1971 (1970 FIGURES IN BRACKETS) STAFF STAFF ATTACHED STAFF IN LIAISON TOTAL Health Visitors 28 (16) 3 (4) 31 (20) Home Nurses 38 (25) 8 (2) 46 (27) Midwives 4 (5) 9*(23) 13 (28) TOTAL 70 (46) 20 (29) 90 (75) * Liaising with 23 General Practitioner Obstetricians. 104 LOAN OF NURSING EQUIPMENT The Corporation lends equipment and makes a small weekly charge, with exemption for incomes below a certain figure. 1971 HEALTH DEPT. BRITISH RED CROSS SOCIETY Croydon Purley Selsdon Shirley Coulsdon Air beds . - - - - 1 Air cushion - - - - - - Air rings 64 26 17 7 4 11 Bath mat - - - - 1 - Bath seat - 5 - - 1 - Bed blocks 57 2 - 6 - - Bed pans 160 50 35 6 7 18 Bed rests 179 39 23 6 9 22 Bedsteads 27 - - - - - Bed tables 15 3 3 - 1 2 Commodes 492 80 55 8 2 16 Cradles 177 49 29 8 6 - Crutches (Pairs) 28 24 9 - 2 9 Diapers - - - - - - Dunlopillo mattresses 13 - - - - - Enuresis machines 201 - - - - - Feeding cups 11 1 1 3 - - Foam squares and rings 99 2 - - 2 - Foot suction pumps 9 - - - - - Fracture boards (Sets) 96 - - - - - Hydraulic hoists 31 - - - - - Incontinence pads 52.165 - - - - - Kidney bowls - 1 - - - - Mackintosh sheets 111 6 19 5 3 8 North pads 51 - - - - - Paddi pads - - - - - - Paddi rolls 6,540 - - - - - Pick-up-stick - - - - - - Plastic sheet 36 - - - - - Protective undergarments 218 - - - - - Pulleys 39 - - - - - Ripple beds 82 - - - - - Toilet extension - - - - - - Urinals 110 20 14 9 3 16 Walking aids 312 31 - 3 3 - Walking sticks 38 6 - 2 1 - Wheelchairs 171 152 27 8 10 24 105 DEATHS FROM ACCIDENTS IN THE HOME Cause No. Details Falls 16 There were 15 women and 1 man between the ages of 59 and 95 years of age. Asphyxia 11 1 boy aged 11 months - drowned in his bath 1 boy aged 11 months - carbon monoxide poisoning when house cought fire. 1 boy - aged 12 - asphyxia - inhalation of stomach contents. 1 woman aged 24 - carbon monoxide poisoning from inhalation of fumes - faulty flue pipe on on gas water heater. 1 woman - aged 24 - inhalation of stomach contents following largactil ingestion. 1 man - aged 30 - carbon monoxide poisoning fumes from gas water heater. 1 man aged 59 - asphyxia from inhalation of food. 1 woman - aged 71 - carbon monoxide poisoning fumes from solid fuel stove. 1 woman - aged 72 - carbon monoxide poisoning fire caused by cigarette. 1 man - aged 84 - carbon monoxide poisoning fire caused by faulty electric blanket. 1 woman - aged 86 - carbon monoxide poisoning from smoke and fumes. Burns and Scalds 2 1 woman - aged 77 - multiple burns. 1 woman - aged 86 - multiple burns from electric blanket fire. Poisoning 6 1 girl - aged 2 months - Toxaemia from contaminated food. 1 woman - aged 31 - Welldorm. 1 woman - aged 31 - Barbiturate. 1 man - aged 37 - Barbiturate 1 man - aged 51 - overdose of sleeping tablets 1 woman - aged 72 - Aspirin TOTAL 35 106 Dental Services for Expectant and Nursing Mothers and Children under 5 years Part A. Attendances and Treatment Number of visits for treatment during year Children 0-4 (inc.) Expectant and Nursing Mothers First visit 952 110 Subsequent visits 1,416 252 Total visits 2,368 362 Number of additional courses of treatment other than the first course commenced during the year 148 12 Treatment provided during the year - Number of fillings 1,904 234 Teeth filled 1,647 232 Teeth extracted 370 80 General anaesthetics given 111 15 Emergency visits by patients 150 29 Patients X-rayed 17 39 Patients treated by scaling and/or removal of stains from the teeth (prophylaxis) 56 44 Teeth otherwise conserved 177 - Teeth root filled - 4 Inlays - 1 Crowns - 1 Number of courses of treatment completed during the year 736 73 Part B. Prosthetics Patients supplied with F.U. or F.L. (First time) 7 Patients supplied with other dentures 9 Number of dentures supplied 16 Part C. Anaesthetics General anaesthetics administered by dental officers Nil 107 Part D. Inspections Children 0-4 (inc.) Expectant and Nursing Mothers Number of patients given first inspections during year 1,093 111 Number of patients in A and D above who require treatment 797 103 Number of patients in B and E who were offered treatment 790 102 Part E. Sessions Number of sessions (i.e. equivalent complete half-days) devoted to Maternity and Child Welfare patients: For treatment 390 For health education 9 DOMICILIARY FAMILY PLANNING SERVICE 1971 Table 1 Number of new patients seen during the year (see note 2) Married (including the widowed separated or divorced) Unmarried Total Male 23 - 23 Female 131 23 154 Total 154 23 177 Table 2 Number of new patients seen during the year who were:— Medical cases 89 Non-medical but needy 86 Other non-medical cases 2 Total 177 Table 3 Number of new patients seen during the year who were initially advised to use (see note 3):— Sheath 20 Pill 42 Diaphragm 10 I.U.D. 50 Other methods 43 No method advised 35 108 CERVICAL CYTOLOGY Number of women tested during 1971 MONTH No. of Clinics Class / Class II Class III Class IV Class V TOTALS TOTAL New Cases Repeats New Cases Repeats New Cases Repeats New Cases Repeats New Cases Repeats New Repeats January 12 144 39 75 46 1 - 1 - - - 221 85 306 February 14 146 33 96 52 4 - - - - - 246 85 331 March 19 165 61 87 69 1 3 - - - - 253 133 386 April 12 131 55 70 44 1 - - - - - 202 99 301 May 13 128 72 68 46 4 1 - - - - 200 119 319 June 13 125 84 62 57 1 2 - - - - 188 143 331 July 14 126 110 90 69 3 1 - - - - 219 180 399 August 14 161 87 66 59 1 1 1 - - - 229 147 376 September 14 163 70 64 30 3 - - - - - 230 100 330 October 15 170 76 89 64 3 1 - - - - 262 141 403 November 18 168 76 94 70 - 2 - - - - 262 148 410 December 10 114 53 50 44 - 3 - - - - 164 100 264 TOTAL 168 1,741 816 911 650 22 14 2 - - 2,676 1,480 4,156 Numbers referred to Family Doctors for Treatment January 31 February 34 March 31 April 13 May 18 June 24 July 40 August 35 September 23 October 41 November 18 December 23 TOTAL REFERRALS - 331 AGE GROUPS 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Total Class I 21 197 442 419 412 334 284 228 136 48 19 7 2,547 Class II 13 103 199 230 203 198 217 190 143 51 17 6 1,570 Class III - 7 6 7 8 3 2 2 1 1 - - 37 Class IV - - - - 1 - - 1 - - - - 2 Class V - - - - - - - - - - - - - TOTAL 34 307 647 656 624 535 503 421 280 100 36 13 4,156 Class I - NORMAL SMEAR PATTERN according to age and physiological state (including pregnancy). Class II - "INFLAMATORY" PATTERN - may be due to erosion, bacterial or Monilial 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 SV - ISOLATED CELLS SUGGEST MALIGNANCY - Early gynaecological review essential. Class V - MALIGNANCY PROBABLE - Early gynaecological review essential. 109 LONG STAY IMMIGRANTS 1971 Country Issuing Passport Notifications Received Successful Visits (Contacted) Unsuccessful Visits (Not Contacted) Commonwealth Countries Caribbean 81 77 4 India 119 91 28 Pakistan 51 35 16 Other Asian 62 31 31 African 181 133 48 Others 61 54 7 Non-Commonwealth Countries European 25 25 - Others 33 24 9 TOTAL 613 470 143 MALES 173 FEMALES 224 CHILDREN 216 110 Nursing Homes - Nursing Homes Act, 1964 Number of Homes Number of beds provided for Maternity Other Total Homes registered during the year Nil Nil Nil Nil Homes closed during the year 1 Nil 26 26 Homes on the Register at the end of the year 13 18 402 420 One general nursing home was closed during the year under review. NURSES AGENCIES ACT, 1957 There are three agencies on the Register which supply nurses for home nursing on a private patient paying basis. A fourth was licenced but did not operate during 1971. CREMATION ACTS, 1902 and 1952 During the year 2,808 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 1971 Total number of Bodies received 1,092 Post-Mortem Examination for M.O.H 1 Post-Mortem Examinations for H.M. Coroner 1,087 Still-Bom (M) No P.M 2 Adults (M) No P.M 2 111 COMMUNICABLE DISEASES NOTIFIED DURING 1971 Notifiable Disease At all ages Cases notified Total cases notified in wards At ages - years U. Norwood Norbury W. Thornton Ben. Manor Thornton Heath S. Norwood Wood side East Addiscombe Whitehorse M. Broad Green Central Waddon A ddington Shirley Sanderstead North Sanderstead and Selsdon Woodcote and Coulsdon Wesf Coulsdon East Purley M F TOTAL Under 1 1 - 4 5 - 14 16 - 24 25 - 44 45 - 64 65 & over Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 109 - 28 78 2 1 - - 5 2 3 8 7 8 7 8 - 4 2 1 - 19 13 1 5 8 2 6 56 53 109 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Meningitis 6 1 3 2 - - - - 1 - - - - - 1 - - 1 - - - - 2 - 1 - - - 4 2 6 Typhoid and Para- Typhoid 2 - - -1 - - 1 - - - - - - - - - - - - - - - - - - - 1 1 1 1 2 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 3 3 - - - - - - - - - - - 2 - - - - - - - 1 - - - - - - 1 2 3 Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 13 - 3 4 3 1 2 - - 2 3 1 - - - 1 - - 1 - 1 - 1 - - - 1 2 6 7 13 Malaria 2 - - 1 - - 1 - - - - - - - - - - - - 1 - - - - - - - 1 1 1 2 Infective Jaundice 30 - 2 5 8 7 6 2 1 - 2 - - - 3 4 - - 4 2 1 4 - 2 3 - 4 18 12 30 Food Poisoning 21 2 4 5 2 7 1 - - - - 4 - - 1 6 3 - - - - 1 - 1 1 2 1 1 13 8 21 Acute Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 979 33 535 400 9 2 - - 49 33 24 19 26 45 65 53 67 50 30 19 30 174 99 19 50 37 31 59 510 469 979 Whooping Cough 207 37 83 78 3 6 - - 5 - 5 2 17 4 15 9 5 10 3 3 11 69 22 2 - 15 6 4 117 90 207 Leptospirosis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Tetanus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Yellow Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1372 76 658 574 27 24 11 2 61 37 37 34 50 59 89 80 79 65 36 28 44 265 141 23 59 65 42 78 727 645 1372 Tubersulosis notifications are shown in the section relating to that disease 112 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1971 Notifiable Diseases Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 5 7 8 8 1 2 5 9 6 2 4 5 62 Non-Respiratory Tuberculosis 1 - 2 2 3 - 3 2 3 2 - 2 20 Anthrax - - - - - - - - - - - - - Scarlet Fever 4 17 14 6 7 14 4 5 5 7 9 17 109 Diphtheria - - - - - - - - - - - - - Acute Meningitis 1 - 1 2 - 1 1 - - 2 1 1 6 Typhoid & Paratyphoid - - - - - - - 1 1 - - - 2 Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Ophthalmia Neonatorum - - 1 - 1 - - - - - - 1 3 Acute Poliomyelitis - - - - - - - - - - - - - Dysentery 3 - 1 - - 3 3 1 - - - 2 13 Malaria - - - - 1 - - 1 - - - - 2 Infective Jaundice 1 3 2 8 - 3 1 4 4 2 - 2 30 Food Poisoning - - 9 - 1 2 2 2 3 - - 2 21 Acute Encephalitis - - - - - - - - - - - - - Measles 92 128 282 158 85 117 37 26 12 3 26 13 979 Whooping Cough 21 12 77 22 16 21 10 6 2 11 7 2 207 Leptospirosis - - - - - - - - - - - - - Tetanus - - - - - - - - - - - - - Yellow Fever - - - - - - - - - - - - - 1454 113 FOOD POISONING Corrected food poisoning notifications and cases ascertained in 1971 numbered:- 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 11 5 15 2 33 Outbreaks due to identified agents:- Total Outbreaks Total Cases 6 17 Outbreaks due to:— fa) Chemical poisons Nil (b) Salmonella organisms 3 (c) Staphylococci (including toxin) Nil (d) botulinum Nil (e) welchii 3 (f) other bacteria Nil Outbreaks of undiscovered cause:— Total Outbreaks Total Cases Nil Nil Single Cases:— Agent identified Unknown Cause Total 14 2 16 Cases due to:— CI. welchii Salm. blockley Salm. enteritidis Salm. heidelberg 2 1 2 1 Unknown Cause Salm. Chester Salm. agona Salm. typhii murium 2 1 1 6 Salmonella infection not food-borne:— Nil 114 SAMPLES SUBMITTED TO THE PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION - 1971 Faeces outfits 1,389 Drinking Water samples 640 Public Swimming Bath Water samples 131 Private Swimming Bath Water samples 209 Private WelIs 249 Milk samples 147 Cream samples 13 Ice Cream samples 144 Sundry Food specimens 30 Blood 15 Urine 444 Nose and Throat Swabs 24 Total 3,435 Samples of Drinking Water During the year under review the total number of examinations performed were:- Bacteriological 640 Chemical 12 Unsatisfactory Samples The Health Department is warned by telephone whenever preliminary results of bacteriological tests show presumptive coli. The Water Engineer is immediately notified. If there is no apparent cause, simultaneous resampling by the Water and Health Departments is performed. Further action depends on the findings of these re-tests. 115 IMMUNISATION AGAINST WHOOPING COUGH A total of 4,912 children were immunised against whooping cough, comprising 4,742 under school age and 170 school children. In addition 1,038 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 5,740 children were immunised against tetanus, comprising 4,892 under school age and 938 school children. In addition 7,367 children were given reinforcing injections. VACCINATION AGAINST SMALLPOX A total of 4,322 persons were vaccinated against smallpox. Under 1 year of age 1 2 - 4 5 - 15 16 or over Total Successful Vaccinations 8 659 1.747 249 185 2,848 Successful Re-Vaccinations - - 32 362 1,080 1,474 Insusceptible to Vaccination - - - - - - 4,322 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1971 who completed a course of mmunisation during the year. Age at 31.12.71. i.e. born in year Under 1 1971 1968-1970 1967-1964 1963-1955 Total Completed course of injections 298 4,504 336 373 5,511 Reinforcing injections - 395 4,865 1,577 6,837 TOTAL 298 4,899 5,201 1,950 12,348 Under 1 1-4 Total under 5 5-14 Total under 15 Estimated mid year Child population 5,380 20,120 25,500 54.300 79,800 VACCINATION AGAINST MEASLES A total of 4,408 children were vaccinated against measles. VACCINATION AGAINST RUBELLA A total of 2,094 girls in their fourteenth year were vaccinated against rubella. 116 VACCINATED AGAINST POLIOMYELITIS The following table gives the number of persons who received a course of primary vaccination during the year. VACCINATED Children born 1971 Children born 1970 Children born 1969 Children born 1968 Young persons born 1967-64 Young persons born 1963-65 Persons over 16 years of age With Oral Vaccine 302 2,942 1,335 212 224 290 24 Number of persons who received a reinforcing vaccination as at 31st December, 1971. VACCINATED Persons given a first reinforcing Vaccination during 1971 With Oral Vaccine 8,536 Annual Total 8,536 Total since Vaccination began 1957 155,046 INTERNATIONAL VACCINATION CERTIFICATES During the year 11,159 certificates were authenticated, 6,499 Smallpox, 4,110 Cholera, 550 T.A.B. IMMUNISATION OF CHILDREN BORN IN 1970 Poliomyelitis Diphtheria 1970 Live Births 311 - (Immunised 1970) 311 2,942 - (Immunised 1971) 2,905 5,358 3,253 3,216 (61%) (60%) MEASLES VACCINATION FROM APRIL 1968 Year Children Vaccinated 1968 6,035 1969 3,546 1970 4,663 1971 4,408 117 118 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Summary of notifications during the period from 1st January, 1971 to 31st December, 1971. Formal Notification Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total all ages) Respiratory, Males - - - 1 - 2 2 6 - 8 9 5 5 38 Respiratory, Females - - - 3 - 1 2 3 2 S 3 2 3 24 Non-Respiratory Males - - - - - 1 2 1 4 2 • 1 - 11 Non-Respiratory, Females - - - 1 - - - 1 3 3 - 1 - 9 Rehousing of Tuberculous Patients 3 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. CLASSIFICATION OF NEW PATIENTS Respiratory During 1971, 44 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) 31 70.5 B, or T.B. plus, 1 (early cases, sputum positive) 2 4.5 B, or T.B. plus, 2 (intermediate cases, sputum positive) 9 20.5 B, or T.B. plus, 3 (advanced cases, sputum positive) 2 4.5 44 100.0% Non-Respiratory Tuberculosis There were 11 cases examined at the Clinic and found to have NonRespiratory Tuberculosis in the following forms:— Bones and Joints - Abdominal - Other Organs 2 Peripheral Glands 9 11 119 Ages at Death from Respiratory Tuberculosis Year 0-5 6 - 15 15-25 25- 45 45-65 over 65 TOTAL 1971 - - - - 4 7 11 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January, 1971 830 Transfers in from other areas 11 New cases confirmed during the year 55 896 Number of cases written off the Chest Clinic Register during the year as:— Recovered 173 Died 16 Removed to other areas 15 "Lost sight of" and other reasons 12 216 Remaining on Register as at 31st December 680 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 1,935 Number of visits paid by Clinic doctors to homes of patients 203 Number of visits paid to homes of patients by Tuberculosis Health Visitora 3,730 Attendances of patients at the Clinic - At ordinary sessions *14,045 Number of X-Ray films taken *16,012 * Includes 4,287 miniature film attendances 120 121 SEXUALLY TRANSMITTED DISEASES Croydon General Hospital Centre PART A New Cases of Syphilis Total Male Female A1 Primary 7 6 1 A2 Secondary 4 2 2 A3 Latent in the first two years of infection 3 3 - A4 Cardio vascular - - - A5 Of the nervous system - - - A6 All other late and latent stages 15 10 5 A7 Congenital aged under 2 years - - - A8 Congenital aged 2 years and over 4 2 2 TOTAL OF LINES A1 TO A8 33 23 10 PART B New Cases of Gonorrhoea B1 Post-pubertal infections 308 199 109 B2 Pre-pubertal infections 1 - 1 B3 Ophthalmia neonatorum - - - TOTAL OF LINES B1 TO B3 309 199 110 PART C New Cases of Other Genital Infections C1 Chancroid - - - C2 Lymphogranuloma Venereum - - - C3 Granuloma Inguinale - - - C4 Non-specific genital infection 668 505 163 C5 Non-specific genital infection with arthritis 6 5 1 C6 Trichomoniasis 143 6 137 C7 Candidiasis 358 137 221 C8 Scabies 37 29 8 C9 Pubic lice (pediculosis pubis) 51 37 14 C10 Herpes simplex 41 33 8 C11 Warts (condylomata acuminata) 114 73 41 C12 Molluscum Contagiosum 5 5 - TOTAL OF LINES C1 TO C12 1423 820 603 PART D New Cases of Other Conditions D1 Other treponemal diseases 16 10 6 D2 Other conditions requiring treatment in the centre 121 61 60 D3 Other conditions not requiring treatment in the centre 557 322 235 TOTAL OF LINES D1 TO D3 694 393 301 GRAND TOTAL OF PARTS A, B, C & D 2439 1435 1004 122 PART E AGE GROUPS OF NEW CASES SYPHILIS (lines A1 &A2) GONORRHOEA (line B1) AGE GROUP Total Male Female Total Male Female 1 Under 16 - - - 7 - 7 2 16 and 17 - - - 16 5 11 3 18 and 19 1 1 - 43 20 23 4 20 to 24 3 2 1 83 52 31 5 25 and over 7 5 2 159 122 37 TOTAL LINES 1 TO 5 11 8 3 308 199 109 PART F LOCALITIES IN WHICH INFECTIONS TOOK PLACE PRIMARY & SECONDARY SYPHILIS (Lines A1 and A2) Total Male Female 1 In locality of centre 9 7 2 2 Elsewhere in Great Britain and Northern Ireland 1 - 1 3 Outside Great Britain and Northern Ireland 1 1 • 4 Not known - - - TOTAL OF LINES 1 TO 4 11 8 3 POST PUBERTAL GONORRHOEA (line B1) 5 In locality of centre 250 168 82 6 Elsewhere in Great Britain and Northern Ireland 46 19 27 7 Outside Great Britain and Northern Ireland 12 12 - 8 Not known - - - TOTAL LINES 5 TO 8 308 199 109 PART G CONTACT ACTION AND DIAGNOSIS SYPHILIS Total Male Female 1 Contact action taken 23 23 - 2 Contacts attending with syphilis 1 1 - 3 Contacts attending, syphilis not diagnosed 4 2 2 GONORRHOEA 4 Contact action taken 204 163 41 5 Contacts attending with gonorrhoea 45 5 40 6 Contacts attending, gonorrhoea not diagnosed 11 4 7 123 Local Health Authority area of residence of patient Totals all conditions Number of New Cases in the Year Syphilis Gonorrhoea (B1 to B3) Other Genital Infections (C1 to C12) Other Conditions (D1 to D3)[] Primary and Secondary (A1 - A2) Other (A3 to A8) CROYDON 1616 8 24 223 789 572 BROMLEY 176 1 - 27 122 26 KENT 31 - - - 14 17 KINGSTON 7 - - 1 4 2 LAMBETH 100 - - 18 72 10 LEWISHAM 14 - 1 2 7 4 MERTON 42 - - 6 29 7 SURREY 207 - - 20 145 42 SUSSEX 27 1 - 3 17 6 SUTTON 79 1 1 6 57 14 WANDSWORTH 18 - - 1 11 6 ALL OTHERS 35 - - 2 20 13 TOTALS 2352 11 26 309 1287 719 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 To the Chairman and Members of the Education Committee: LADIES AND GENTLEMEN, This is the seventh Annual Report of the School Health Service of the London Borough of Croydon, and covers a year in which the number of school children reached a record high figure of 55,886. School Medical Inspections The pattern of routine inspections was unchanged, but due to re-organisation of secondary schooling the number seen was less than last year. Special inspections requested by Head Teachers or parents, showed a marked, and probably compensatory, increase. Personal Hygiene More children were examined, explanatory leaflets about infestation were distributed to parents, and a new treatment preparation introduced. These efforts were successful in reducing infestation, and are, of course, being continued. There were fewer cases of scabies, but less success in coping with plantar warts. Proof of any effective preventive treatment for this latter condition is still awaited. Meanwhile detection and effective treatment are the only methods of control. 2 Vision Defects The problem of long waiting lists for hospital eye clinics necessitated parents being offered the alternative of treatment by opticians. A survey after 6 months showed that most parents had accepted the offer and the children had been treated. Audiology Co-ordination with the Child Health Service for the earliest possible ascertainment and treatment of hearing defects was vigorously pursued. Re-organisation of school facilities to meet the needs of profoundly hard of hearing children made good progress. The department co-operated in a research project to determine the importance of rubella as a cause of deafness. Results are awaited. Educationally Subnormal Children A new school (St. Nicholas) serving the southern half of the Borough was opened. The long waiting list of children for intelligence tests was, thanks to the help of the Educational Psychologists, almost eliminated. Despite the virtual doubling of school places for E.S.N. pupils a waiting list of children still remained at the close of the year. The Education (Handicapped Children's) Act 1970 This Act was effective from April 1st 1971. The Junior Training Centre which the Health Committee had called "Coldharbour School" became a responsibility of the Education Committee and entitled to its name. The need to exclude these children from the educational system as "unsuitable" ceased. The remedial services available at the school were increased by the provision of physiotherapy. Maladjusted Children A threefold increase in the number ascertained in comparison with previous years was in anticipation of the opening in September of the Sir Cyril Burt School for maladjusted and autistic pupils. The intake of scholars proceeded satisfactorily, but the report on the school for 1971 is obviously limited. The Reception Centre for Immigrant Children In common with many other areas of the country, a skin test to show exposure to tuberculosis was introduced into the routine medical examinations, with follow-up chest x-rays of the families of those found to be positive. It is too early to comment on results. 3 Nutrition The Education (Milk) Act 1971 occasioned special medical examinations for children put forward as possibly needing the extra one-third pint of milk a day. Requests for examinations were received from 10% of parents whose children were eligible, and 16% of the children examined were recommended for free milk (330). The number graded as "General physical condition unsatisfactory" in the quoted statutory table for 1971 is 10 out of 18,180 children examined. The percentages of such "unsatisfactory" children have varied in the 7 years of the London Borough of Croydon tables from 0.06% to 0.15%. It therefore seems that a generous interpretation was given by examining medical officers to the directive to recommend any child who might benefit from additional milk. Dental Service Mr. West, the Principal School Dental Officer, gives his first report having succeeded Mr. Palmer in December 1971. It is clear that he brings to his duties the enthusiasm and foresight of his predecessor. Health Education Miss Elliott indicates how co-operation with schools continued to develop. The aim is to have an appropriate course given by the teaching staff in every school. Our role is to initiate action, suggest content, display supporting material and give occasional teaching help for special aspects. Even for schools not accepting the general programmes specific requests for sex education were met with routines adapted to the age range concerned. The method of parent involvement in the junior school programme on "growing up" is mentioned. The difficulties of recruiting and retaining staff in this section unfortunately continued, and the volume of work achieved reflects the outstanding efforts of Miss Elliott and her supporting officers. Handicapped Pupils The physically handicapped group continued to decline in number as the great crippling infections no longer afflict chiIdren in this country. At St. Giles' School for Physically Handicapped pupils Spina Bifida is the most prevalent condition (24%). Before the advent of modern surgical treatment for spina bifida 95% of affected babies died whereas now upwards of 75% survive. One survey has shown that of these survivors 71% are mentally normal and 27% without other physical handicap and able to attend an ordinary school. However, 19% were educationally subnormal and 10% ineducable. At present no diagnostic technique can show the group unlikely to respond to surqical intervention. Unless all are to be abandoned, as before, to natural elimination, we must face an increasing number of severely handicapped spina bifida children requiring special services. Agreement to provide a nursery class at St. Giles' School was very welcome to cope with this and similar problems. 4 Staff It was a difficult year for all health departments. The impact of Social Service Act changes was felt least by the School Health Section, but impending re-organisation of the National Health Service without a decision on the future control or function of the School Health Service was disturbing. Nevertheless routine duties were fully discharged, and improvements discussed at training sessions and implemented. There was a fundamental conviction that the service remained dynamic and essential and would continue with very minimal changes. My thanks are due to the Chief Education Officer and other members of his department, and to Head Teachers and their staffs for help and co-operation at all times, and to the Education Committee for continued interest, encouragement and sustained support. Yours faithfully, S.L. WRIGHT, Principal School Medical Officer. 5 PARTICULARS OF SCHOOL CLINICS as at 31.12.1971 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:— Cllnlc Address minor AILMENTS (including verrucae) 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.) OTHERS Norbury Manor Junior School (Wed. a.m. in term) Purley Clinic, Whytecliffe Road, Purley. (Wed. p.m.) Sanderstead Clinic, Rectory Park. (Mon, & Fri. p.m.) Dr. Heber's (Verruca) Surgery (Thurs. p.m.) dental Lodge Road, Broad Green, Croydon. 206, Selhurst Road, South Norwood. Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. Shirley Road, Shirley, Croydon. Waddon Clinic, Coldharbour Road, Croydon. inspection ONE CLINIC APPROX. WEEKLY IN P.M. Lodge Road, Broad Green, Croydon. Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. AS REQUIRED Ashburton School, Shirley Road. Croydon. Rockmount School, Rockmount Road, Upper Norwood. Sanderstead Clinic, Rectory Park, Sanderstead. Waddon Clinic, Coldharbour Road, Croydon. physiotherapy Lodge Road Clinic Annexe, Lodge Road, Croydon. 47, St. James's Road, Broad Green, Croydon. Old Coulsdon Clinic, Coulsdon Road. Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. Waddon Clinic, Coldharbour Road, Croydon. 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) Parkway Clinic, New Addington, (Monday p.m.)(fortnightly) Purley Clinic, Whytecliffe Road, Purley. (Friday p.m.) (monthly) 6 EYE Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. 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 9 (part-time) Consultants and Specialists 6 (part-time) *Dental Officers 15 (including 5 part-time and 2 Dental Auxiliaries) (80%) *Physiotherapists 12 (including 8 part-time) Speech Therapists 6 *School Nurses and Nurse/Assistants 79 (including S.H.V. and Deputy and 16 part-time) (52%) *Dental Surgery Assistants 16 (including 5 part-time) (80%) *Also performing duties in other sections of Public Health Department. Percentages in brackets show proportion of time given to school work. COST OF THE SCHOOL HEALTH SERVICE The cost of the Medical, dental and nursing services was £210,077 Cost of Special Schools Schools maintained by the Council £215,005 Other Schools (not maintained by local Education Authorities £85,181 Adjustments with other authorities in respect of Special Schools £47,122 £347,308 7 PART 1. MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspections in school as set out below has served the cause of school health in the Borough well. No major change is contemplated prior to the reorganisation of the Health Services in 1974. These inspections are as follows:— (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 carried out during the year shows a drop of 3½% from last year. This is due to the reorganisation of secondary schooling which caused the examinations of some children to be postponed. The situation should correct itself during the coming year, and every child at a Local Authority school will be offered routine examination in accordance with the above schedule. Table 1. Numbers seen at Medical Inspections 1971 Routine Inspections- 18,180 Special Inspections- at school medical sessions 1,110 at inspection clinics 49 1,159 Reinspections- at school medical sessions 3,580 at inspection clinics 517 4,097 8 Special Inspections have again shown a marked increase of 12½% which has been the pattern, except for last year, for some years. This indicates that Head Teachers and parents, who ask for most of these inspections, remain convinced of the help the School Health Service can provide, and underlines the need for its retention under the proposed reorganisation of the Health Services. Most of these special examinations (95%) are also conducted in school so that if necessary the Medical Officer and Teacher can discuss the problem as it relates to the child's school life. The proportion of parents attending the school medical examination has increased but only significantly in the group of school leavers. Here the figures tell a surprising story. Twice as many parents have attended with their teen-age children as in previous years. It is true that this still only represents about 10% of the children in the group but it is an unexpected though very welcome finding, and it will be most interesting to see if this pattern continues in future years. Table 2. Attendance of Parents at School Medical Inspections 1971 1970 Boys Girls Boys Girls Entrants 84.0% 84.0% 84.3% 83.8% Leavers 9.3% 10.9% 4.4% 5.8% Others 57.3% 56.1% 58.0% 58.7% Total Nos. of Children examined 9,346 8,834 9,491 9,339 Total Attendance of Parents 57.0% 54.4% The total number of defects discovered which appeared to need treatment was 6,411, and the number requiring observation 7,168; both show a decrease from last year but no more than can be accounted for by the lower number of medical inspections carried out. Full details are given in Table 3. The number of visits to non-maintained schools is much the same as in the previous year, details being given in Appendix C, Page 62. Personal Hygiene The previous year's problem of head infestation was still very much present at the beginning of the year under review. During the period the number of children inspected for cleanliness rose by 11% in an effort to overcome a condition which causes a great deal of worry to many mothers. Leaflets were also issued to schools for distribution to increase parent's awareness of the possibility of infestation and to indicate how it can be recognised. In the Winter Term a new preparation based on malathion, an insecticide formerly used in agriculture, came into general use. It has been 9 Table 3 RETURN OF DEFECTS FOUND AT ROUTINE MEDICAL INSPECTIONS 1971 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 6 12 0.2 11 9 0.3 Teeth 637 118 10.2 665 107 12.4 Skin 777 208 13.3 340 191 8.6 Eyes - Defective Vision 766 854 22.0 857 884 28.0 Squint 132 21 2.1 124 26 2.4 External Eye Trouble 23 24 0.6 27 27 9 Ears - Deafness 102 265 4.9 104 179 4.6 Otitis Media 53 132 2.5 54 125 2.9 Other Defects 8 30 0.5 8 20 0.5 Nose and Throat 176 497 9.1 164 369 8.6 Enlarged Cervical Glands 6 125 1.8 8 59 1.1 Speech 89 80 2.3 38 54 1.5 Heart and Circulation 71 75 2.0 58 92 2.4 Lungs 150 153 4.1 57 107 2.6 Developmental- Hernia 24 31 0.7 8 26 0.5 Other Defects 175 331 6.8 64 200 4.3 Deformities- Posture 10 34 0.6 11 69 1.3 Flat Feet 47 203 3.4 38 98 2.2 Other 67 152 3.0 66 156 3.6 Nervous System- Epilepsy 17 25 0.6 18 17 0.6 Other 82 123 2.8 44 82 2.0 Psychological- Development 17 68 1.1 5 49 0.9 Stability 36 163 2.7 32 138 2.8 Abdomen 22 40 0.8 23 47 1.2 Other Defects 38 98 1.9 56 175 3.8 TOTAL DEFECTS 3,531 3,862 2,880 3,306 Total Children Examined- 9,346 Boys 8,834 Girls 10 Table 4 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1971 (Percentages of Children Examined) Defects Entrants Intermediates Entrants to High Schools Final Leavers All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Teeth 10.3 9.6 9.7 10.5 6.5 7.7 3.7 6.0 8.0 8.7 Skin 5.2 5.1 7.9 6.3 13.5 6.5 19.9 6.3 10.4 6.0 Eyes- Vision 15.2 14.6 19.3 20.1 17.5 23.8 17.9 20.9 17.1 19.7 Squint 2.6 2.9 1.9 1.8 1.0 1.0 0.4 0.6 1.6 1.7 Other 0.6 0.7 0.6 0.9 0.4 0.3 0.4 0.6 0.5 0.6 Ears- Hearing 7.2 5.9 3.3 3.1 2.6 1.7 1.0 1.2 3.9 3.2 Otitis Media 4.1 3.9 2.1 1.9 0.5 1.1 0.2 0.7 2.0 2.0 Other 0.5 0.3 0.6 0.2 0.3 0.5 0.2 0.2 0.4 0.3 Nose and Throat 12.0 10.0 6.8 6.6 4.6 3.6 3.0 2.4 7.2 6.1 Speech 3.8 2.2 1.8 0.8 0.5 0.4 0.2 0.6 1.8 1.0 Cervical Glands 2.2 1.6 1.2 0.6 0.9 0.5 1.0 0.1 1.4 0.8 Heart and Circulation 1.9 1.3 1.3 1.4 1.6 2.0 1.3 2.4 1.6 1.7 Lungs 4.2 2.6 3.4 1.8 2.3 1.6 2.6 1.0 3.2 1.9 Developmental- Hernia 0.7 0.7 0.7 0.6 0.6 0.1 0.2 0.1 0.6 0.4 Other 5.0 1.0 4.9 2.2 7.4 5.4 3.7 3.8 5.4 3.0 Orthopaedic- Posture 0.5 0.4 0.5 0.6 0.3 1.6 0.7 1.1 0.5 0.9 Flat Feet 2.7 1.4 1.7 1.6 2.8 1.6 4.0 1.6 2.7 1.5 Other 2.9 2.4 1.7 2.3 2.1 2.3 2.6 3.5 2.3 2.5 Nervous System- Epilepsy 1.0 0.5 0.3 0.2 0.1 0.4 0.2 0.6 0.5 0.4 Other 4.0 2.6 2.3 1.4 0.8 0.9 0.9 0.3 2.2 1.4 Psychological- Development 1.6 0.8 1.3 0.6 0.3 0.5 0.4 0.9 0.6 Stability 2.4 2.5 2.9 2.1 1.7 1.9 1.0 0.7 2.1 1.9 Abdomen 0.8 0.4 0.6 0.8 0.7 1.4 0.3 0.5 0.7 0.8 Other Defects 2.1 1.8 2.8 3.1 1.1 2.7 0.9 0.3 1.5 2.6 11 felt for some time that the preparations in common use were no longer as efficient as they had been as lice were becoming resistant. The new preparation appears to be very successful and will be used in all cases within a few months of the end of the year under review as stocks of the older remedies are exhausted. Our efforts appear to be meeting with some success as 5% fewer children were found unclean for the first time, and 23% fewer at follow-up visits. Thirteen children compared to twenty-two last year were treated for head vermin at the Cleansing Station. A continuing pressure will be kept up towards eradication of the problem, and it is hoped that next year will show a much more encouraging picture. Scabies appears also to have reached its peak and the number of children (21) attending the cleansing centre for this condition was markedly down on last year's figure (37). However, many general practitioners are now treating the disease, which is not notifiable, so we may not be aware of the full extent of infection. It is too early yet to celebrate victory. Table 5. Cleanliness Inspections Number of pupils inspected for cleanliness 50,555 Number of pupils inspected at follow-up visits 1,564 Number found unclean for first time in 1971 382 Number of occasions in which pupils were found unclean at follow-up visits 104 Skin Defects Verrucae are still a cause of concern as unfortunately the picture here is not quite so hopeful. The number of children treated at Minor Ailment Clinics for the condition increased by 12% to 1,403. This represents a very great proportion of the Nurses' work at these clinics. There were 10,066 attendances by children, an average of just over 7 attendances per child, which demonstrates how recalcitrant to treatment are these warts on the feet. However, an extra clinic was begun during the year in a general practitioner's surgery to cover a further area of the Borough. The increase may be partly accounted for by the children treated there. Continuing effort in prevention through health education of children, parents and teachers is being made in addition to the provision of treatment. Apart from scabies, which has been referred to under the section on Personal Hygiene above, there have been no other skin infections of particular note during the year. 12 Table 6.-Summary of Findings at Routine Inspections of Vision Boys Girls Number Examined Number of defects % Number Examined Number of defects % Entrants 2,887 437 15.1 2,529 368 14.5 8 year old group 2,412 466 19.3 2,368 477 20.2 Entrants to High Schools 2,516 443 17.6 2,524 601 23.8 13 year old group 1,872 488 26.1 1,876 489 26.1 Final Leavers 1,531 274 18.0 1,413 295 20.9 Totals (All age Groups) 11,218 2,108 18.8 10,710 2,230 20.8 Vision Defects These are the commonest defects found at medical inspections constituting 28% of the total, slightly up from the previous year. During most of the year under review children living in the Mayday catchment area who appeared to have refractive errors only were issued with a Form referring them to the optician of their choice if they so desired, rather than to a hospital ophthalmologist. This procedure was agreed as the waiting list for the Mayday Eye Unit had become unacceptably long for simple refractive errors. It has been very successful. Each child who accepted this method of referral has been followed up after six months and the great majority had visited an optician. Those who had not were again reminded to do so and where the original referral form had been lost a further form was provided. The end result has been that eye defects other than refractive errors are seen very quickly at Mayday Eye Unit and the waiting list there for refraction has been reduced to four months, which of course is still too long to be satisfactory. The waiting time for our own Eye Clinics in the South of the Borough remains at one to two months. Defects of Ear, Nose and Throat The incidence of middle ear disease (otitis media) remained static in the year under review, and there was a slight decrease in other ear diseases and in nose and throat conditions. The work of the Audiology Clinic continues to increase as will be seen in the detailed account in Part II of this Report. An increase of 6% in the number of children sweep tested for hearing defect produced an increase of 13% in the number finally discovered to have hearing loss. Most of this increase was made up of children with moderate hearing loss who will not need special schooling, but whose educational performance should be improved by ensuring that Head Teachers know of the defects and can ensure that appropriate steps are taken in school to minimise their effects. 13 Defects of Heart and Circulation There is nothing significant to report. Defects of the Lungs There was one more case of Pulmonary Tuberculosis in a school child than in the previous year but the numbers remained small. Pulmonary 4 Non-Pulmonary 1 This represents a rate of 7.3 per 100,000 children which is half-way between last year's figure of 5.7 and that of 1969, 9.8. There were no deaths and, indeed, the cases discovered were primary infections which the child in most cases would probably have overcome without treatment. During the year under review Tuberculin Tine testing as part of the medical inspection of all immigrant children was instituted. This test tells if a child has been exposed to tuberculosis. Chest x-rays are then carried out to decide if actual disease is present and treatment needed. If so this is instituted and relatives are followed up at the Chest Clinic to discover any possible source of infection. The results of the test are given in detail later in this report under the heading Immigrant Pupils on Page 52. It is too soon yet to evaluate this procedure. Developmental, Abdominal and Orthopaedic Defects The number of these defects does not differ significantly from previous years. Defects of the Nervous System The number of children referred for intelligence assessment was markedly lower than in the previous year which enabled the waiting list to be reduced from 235 at the beginning of the year to 29 at the end. The Educational Psychologist carried out the actual I.Q. Test in some of the children, while the Medical Officer carried out the medical examination. This avoided, to some extent, referral of children not needing special schooling for full scale assessment by doctors and, it is hoped, will continue to be the procedure in appropriate cases. Psychological Defects The number of children reported as suffering from these defects in school medical returns remained much the same as last year. However, the numbers referred to the Child Guidance Clinic has again shown an increase of between six and seven pe ccent but in spite of this increase the waiting list still remains within reasonable bounds. A fuller account of the Clinic's work is included in Part II. The Sir Cyril Burt School with day and boarding places for 14 maladjusted children and a Day Unit for children in the autistic group opened in the Autumn Term ofthe year under review. This will be an extremely valuable addition to the provision for handicapped children in the Borough. The maladjusted children can be kept under constant review by the Child Guidance Psychiatrist and the Educational Psychologist while return to ordinary school can be quickly and easily effected where children have responded to the therapeutic environment of the special school. Those children in the autistic group who may benefit from the type of education that can be provided in such a Unit will no longer have to go to residential schools provided they can be looked after within their family. They will also be under constant review by the Consultant Psychiatrist and rapid response can be made to their changing needs. The autistic syndrome varies markedly from child to child and only long term observation in a Unit of this kind can ensure in many cases just what kind of educational provision is best for any particular child. The number of children with autism is small, being estimated at two to four per ten thousand school children but they cause a great deal of distress to their parents and nationwide provision is still not sufficient. It is a source of satisfaction to have such a Unit in the Borough. Nutrition Average heights of fourteen to seventeen year old boys and girls seem to have reached a plateau over the previous few years. There is some slight indication that height may still be increasing in the five and six year old groups which may indicate a continuing tendency to earlier maturing. Average weight also remains fairly constant. Dr. Simmonds and Miss Hunt, a Health Visitor, have conducted Clinics for overweight children throughout the year and reports will be found in Part II. The Education (Milk) Act, 1971, abolishing free school milk for children over seven years in ordinary junior schools, except on medical grounds, came into operation on 1st September, 1971. Though all School Medical Officers, Head Teachers of junior schools, School Nurses and Education Welfare Officers had been circulated in the preceding April, asking for names of children who might qualify for free school milk, very few names were put forward. The Education Committee decided to send a letter to all parents of children in the affected age group at ordinary primary and junior schools in the Borough inviting them to put their children forward for medical inspection if they wished them to be considered for free milk. The parents of 20,154 children were circulated and applications were received from parents of about 2,100 children who had medical examinations. Of these, 330 children (15.7%) were recommended for free milk. Eight year old children will be routinely examined in 1972 and School Doctors have been advised to be on the look-out for any further children who may qualify for free milk. At the initial routine school medical inspection at five years and at any special medical inspection in the future the possibility of a need for school milk in the future will be kept in mind. These examinations required seventy four sessions of doctors' time. 15 Table 7. Average Heights and Weights in 1971 and Previous Years Ages Number Examined in 1971 Average Height in inches Average Weight in lbs 1971 1970 1969 1968 1939 1971 1970 1969 1968 1939 BOYS 5 years 1,466 43.5 43.4 43.2 43.2 41.8 43.4 43.1 42.9 43.1 41.5 6 years 883 44.6 43.9 43.9 44.2 43.8 44.9 44.4 44.0 44.6 43.4 14 years 315 64.1 64.2 64.0 65.7 59.0 113.5 116.9 112.9 114.2 90.8 15 years 396 65.9 67.0 66.3 65.8 - 122.7 123.7 125.9 123.3 - 16 years 177 66.7 67.5 67.7 67.1 - 129.3 133.4 133.6 129.5 - 17 years 30 68.6* 69.0* 68.8 67.5 - 149.3# 141.4* 134.9 134.9 - girls 5 years 1.255 43.1 43.2 43.1 43.2 41.2 42.2 42.5 41.9 42.8 39.7 6 years 792 43.9 43.9 43.5 44.2 42.7 43.4 43.9 43.4 44.0 41.4 14 years 375 62.6 62.4 62.3 62.6 60.3 114.5 112.5 114.4 115.0 97.9 15 years 491 63.8 63.2 63.5 63.5 62.0 119.6 120.1 120.6 118.5 105.5 16 years 177 64.1 64.1 64.7 64.0 - 122.3 121.0 120. 7 122.2 - 17 years 14 63.9* 63.7* 63.1 64.8 - 119.6* 119.3* 121.0 127.8 - * not representative owing to very low numbers 16 PART II SPECIALIST SERVICES AUDIOLOGY SERVICE Mr. J.C. Oakley, Peripatetic Teacher of the Deaf 1971 was a very busy year for the Audiology Clinic, 1,391 children were tested by pure tone audiometry, this included routine follow-up cases, cases referred by School Medical Officers and 642 Sweep Test Failures. Regular clinics were held at Lodge Road, Croydon, Park Way New Addington and Whytecliffe Road, Purley. The pre-school children requiring auditory training were seen regularly in the Lodge Road Clinic or at home, where parent guidance was given and in some cases, speech training was given by the Speech Therapists. In addition, Speech Training Machines were loaned to parents, for use at home. 94 children were seen by either Mr. Parsons or Mr. Stewart, the Corporation's Consultant Otologists, who held regular sessions at Lodge Road and the Partially Hearing Units. 20 hearing aids were recommended during the year, 7 of these were National Health Service 'Medresco' aids and the other 13, 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 is often normal for the lower frequencies and a general amplification of sound causes a considerable amount of distortion and may become painful. 118 babies were seen at the special clinic held in conjunction with Dr. Morgan for the early assessment of deafness in young babies, 13 of these were referred to Mr. Parsons for further assessment. Blood tests on the failures were also carried out as part of a survey held in conjunction with Great Ormond Street Hospital for Sick Children, to investigate the question of rubella as a possible cause of the deafness. It was necessary to increase the number of sessions to cope with the list of babies waiting to be assessed. During the year, all infant schools were visited at least once and apart from absentees and unco-operative children (482), all children newly admitted to school during the year were tested. Tests were also carried out in the Special Schools. Of the 8,217 children tested, 722 (approx. 8.7%) failed the test and were referred to the Audiology Clinic for further assessment. We were sorry to lose Mrs. Marshall at the end of the Summer term, her place was taken by Mrs. Godderhan. For additional statistical details, see Appendix B , Page 58. 17 CHILD GUIDANCE CLINIC I am grateful to Dr. G. Crosse, Consultant Psychiatrist, South West Metropolitan Regional Hospital Board, for the following report:— It is a pleasure to begin this review of the year's work with a report that the waiting list of new patients has been kept well under control and that the time lag between referral and first consultation has been considerably reduced. This was achieved through the co-ordinated effort of all members of the clinic staff who were sustained by the knowledge that resources for maladjusted children in the borough were soon to be substantially reinforced by the opening of the Sir Cyril Burt School for day and residential maladjusted pupils. The documentation required for admission to this school was completed for a number of children and one should record that the year closed with the opening of a bright new chapter in the borough services for maladjusted children - the actual admission of such children to a school on the door-step of their homes. The untold benefits of these facilities have yet to be seen but any institution which can bring the whole family into the treatment setting has an immeasurable advantage over schools far removed from the homes of its pupils. A formal arrangement for the clinic team to consult with the teaching staff of the Sir Cyril Burt School is now in force and the opportunities for such personal contact have paved the way for communication of vital information gathered from ongoing casework. In many ways it has been a memorable year. Discussions and plans for the new purpose built premises to house the School Psychological Service, the Tutorial Class, the Child Guidance Clinic and Day unit, have borne fruit in the shape of an acceptable design for such a building, and we look forward to the day when the new centre will finally put the seal on the present close functional links between all disciplines serving the needs of maladjusted children in Croydon. An expansion of our pre-school children and parent's group necessitated its transfer from the Lodge Road clinic to our central premises, and the children's group is now supervised by a full complement of day unit staff. The parent's group is seen separately by Dr. S.M. Ring and Mrs. V. Jackson, and the success of this venture illustrates the considerable economics in professional time that can be gained by group techniques. Mrs. Jackson and Mrs. P. Ollerenshaw are now attending an Institute of Group-Analysis Training Course and it is envisaged there will be a much greater clinic emphasis on group treatment projects in the future. Patients referred from the New Addington area find the journey to the main clinic expensive and time consuming and it is worth recording that the New Addington clinic, inaugurated a few years ago, is now housed in the new comprehensive Parkway Health Centre. Dr. M. Wright and Miss M. Gradwell attend the clinic once a week and between them they have organised a session which provides both diagnostic and treatment facilities for local referrals. 18 The creation of another social worker post this year has facilitated the division of the clinic service into four geographical areas, and when the appointment is made each of our four social workers will liaise with the corresponding quadrants of the new Croydon Social Service organisation. This refinement in co-ordination should promote a rationalised link with all other statutory social agencies in the borough. In fact 1971 may be seen as the beginning of a new era in the history of the Croydon Child Guidance service, a year in which fundamental administrative developments have been accompanied by the promise of considerable concrete resources. 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 81 50 131 General Practitioners 89 37 126 Social Services Department 2 1 3 School Psychological Service 22 13 35 Juvenile Court 8 3 11 Hospitals 3 5 8 Other Agencies 4 3 7 Milton House Remand Home 79 79 209 191 400 Action Diagnostic 20 98 118 Current Treatment 155 78 233 Closed - Improved 24 11 35 Unco-operative 4 3 7 Transferred 5 1 6 No change 1 — 1 209 191 400 DENTAL SERVICE Mr. B.J. West, Principal School Dental Officer Dental decay is a viral disease which, on a national scale, has got completely out of control. Every survey published points to the fact that the average number of teeth with caries present becomes greater year by 19 year. A survey which I carried out in another area showed that on average every child had three teeth affected by dental decay. The situation is extremely serious. If it existed with almost any other disease it would be classed as a national disaster, but as dental caries does not result in death its crippling, disfiguring effects and its accompanying extreme discomfort are ignored, except by the millions of people who have experienced them. The fact is that no effective cure has been found as yet, though the researchers feel they may be on the verge of a breakthrough. We are left therefore with prevention and repair as our only weapons to deal with the immense suffering engendered by this disease, and yet even here we are having to fight with one hand tied behind our backs. The best way of preventing the caries virus from attacking the teeth is to strengthen the tooth structure, thus making it more resistant. This, it has proved, can easily and effectively be done by ensuring one part per mill ion of fluoride in the water supplies. This weapon, in most parts of the country, is denied to us. Repair then, though the most expensive and wasteful method, is all we have at our disposal, and yet despite the great advance in techniques and productivity, and the ever increasing awareness and demand by the public for dental treatment which has resulted to a great extent in the elimination of grossly carious mouths, dental disease continues to advance unabated. Until more time, money and effort are devoted to finding a cure for the disease, and until we are allowed to use effectively every weapon in our armoury, it will be difficult to even maintain the present situation. The dental service in Croydon has in the past and will continue in the future to play its full part in the fight. As a community service it is well equipped to foster dental knowledge and to promote co-operation between the various branches of the profession to obtain for the public the best treatment available. This we have continued to do and the liaison between the Public and the General Dental Services in Croydon has been increased during the year. There have been several changes in the staff, not the least being the resignation of the Chief Dental Officer, Mr. Palmer, who left to take up his new post of Chief Dental Officer to the County of Somerset. This inevitably has had a somewhat unsettling effect on the smooth running of the dental service, but with the continued efforts of the existing and new staff, and the good co-operation from the teachers, health educators and public health personnel, these difficulties have been kept to a minimum. Miss Hathorn retired after over 30 years of devoted service, and Mr. Sleeman retired in October through ill health after 17 years with the Corporation. Two part-time Dental Officers left, the second Auxiliary and several Dental Surgery Assistants also resigned during the year. We have been fortunate in filling these vacancies. The number of Senior Dental Officer posts in Croydon was increased to two with the promotion of Mr. Van den Berg to this grade in August. 20 The programme of modernising the equipment and facilities in the various surgeries was continued. The clinics generally are of a good standard and are entirely adequate for the provision of a fully comprehensive service which is now up to full strength in terms of establishment. A further increase would be desirable to cope with the increasing demand, but is prevented by shortage of suitable surgery premises pending the replacement of the Selhurst Road Clinic by a twin surgery unit in the Health Centre proposed for this area. The School Dental Services The movement towards the maintenance of good, clean, healthy mouths among Croydon's schoolchildren continued during the year. The grossly neglected mouth is only occasionally seen, although many parents appear to need constant reminders, through school inspections, to seek dental treatment for their children. With the many changes in staff the rapid advance in the amount of treatment provided, which has been the feature of recent years, slowed down during the early part of the year but began to pick up again during the latter part of 1971, and the work done was on a par with that of the previous year. The number of children who received at least one course of treatment during the year fell slightlv although the number of total visits increased. The number of teeth filled also was marginally down on the previous year. The number of the more advanced operative procedures such as the provision of crowns and inlays showed a marked increase. The preparation of these restorations is time consuming and requires more than one visit to complete, but they are one more sign of the trend towards the provision of a more complete and varied service. The trend towards the preservation of teeth is illustrated by the following table showing the number of teeth extracted compared with the number of teeth filled. In 1951 111.2 teeth were extracted for every 100 filled In 1961 65.5 „ „ „ „ In 1966 34.5 „ „ „ „ In 1970 23.0 „ „ „ „ In 1971 21.6 „ „ „ „ Altogether 5,590 teeth were extracted, but this includes many that were removed to help straighten the remaining teeth and also 289 teeth that were extracted at the request of General Practitioners. In July it was decided to centre the clinics at which general anaesthetic was administered at Lodge Road and Parkway (New Addington). This experiment has been well received and has resulted in a more efficient use of time and manpower. 21 There are unhappily a few patients who cannot be treated by conventional methods, and therefore one session is held at Lodge Road every four weeks to conserve under general anaesthesia the teeth of such patients. This extension of the service enables a wider range of patients to receive proper dental care. All except 25 school departments (18.4% of the total) were inspected during the year, resulting in 35,787 children (64.7%) being examined at school. Moreover a further 7,179 were examined in the various clinics, bringing the total percentage of the school population examined during the year to 80%. There was a further increase in the number of children requiring some form of treatment, 54.7% compared with 48.9% last year and 45.6% in 1969, again underlining the problems facing the treatment services. Another serious problem facing Croydon, in common with all other Authorities, is that of the high numbers of failed appointments. This year the position is a little better, 22.7% of all appointments not kept, compared with 24.4% last year and 24.2% in 1969. Over one third were last minute cancellations and many of those who failed made fresh appointments, but a failure rate of these proportions cannot be tolerated and represents a severe drain both in terms of time and money, especially when the demand for treatment is so high. Dental Health Education Much work has been done in this field during the year especially by the Dental Auxiliaries. We have had the active co-operation of Miss Elliott and her staff in the Health Education Department, and the student Hygienists from the Royal Dental Hospital have continued their visits to junior and infant classes to the benefit of all concerned. Dental health education is difficult to assess in terms of firm results, but any method of bringing home to children and their parents the damage that is done to the dentition by neglect and incorrect diet, and advice on the proper care and maintenance of the teeth is bound to have beneficial long term effects. Dental statistics will be found on Page 59. ENURESIS CLINICS I am grateful to Dr. Margaret White for the following report:— During 1971 the three Enuresis Clinics in the Borough have treated 271 children, their ages varying from 5 to 15. This year, as has been usual until 'ast year, the largest number belonged to the six year old age group. The fact that buzzers are now readily available has made the work of the Clinic much smoother, and the effect of this can be seen in the figures - 133 children using the buzzer in 1971, compared with 90 in 1970. The numbers attending at the Purley Clinic were slightly down but those attending at New Addington were slightly up. 22 Total Attendance 271 Boys - 176 Girls - 95 Still Attending 109 Discharged Dry 81 Discharged for Non-Attendance 45 Left District 1 Lodge Road Clinic 150 New Addington 78 Purley 43 Referred to Urologist 6 Referred to Child Guidance Clinic 2 Used Buzzer 133 Age 5 6 7 8 9 10 11 12 13 14 15 No. 15 67 48 36 38 27 16 10 8 2 4 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 treatment of those eye defects detected on routine school medical examination, and of children referred to the Clinics by Local Authority staff and general practitioners. These Clinics are especially geared to the requirements of children of school age, and the service which they provide is reinforced by the followup facilities, referral system from school inspections, and the reciprocal arrangements which exist with the Hospital Eye Service and with other facilities in the School Medical Service. Children of pre-school age are also seen at these Clinics. Statistics are to be found on Page 60. HEALTH EDUCATION IN SCHOOLS Miss D.S. Elliott, S.R.N., H.V. Cert., D.H.E. Principal Health Education Officer Awareness of the importance of discussion or 'Health education' on the concepts of health and health behaviour and its interdisciplinary nature continued to grow in Croydon schools during 1971. In a society of changing values and attitudes, personal choices and the influences which effect them are not always easy to identify. Therefore, new ideas, materials and methods were constantly tried and monitored and Health Education Officers attempted to anticipate the needs of teachers in this area of their work. The lecture room and workshop were widely used by teachers and others and its resources fully extended. 23 As the interdisciplinary nature of health education is recognised extra care will have to be taken to prevent it becoming so diffuse that it is lost again. The need for health education 'co-ordination' in each school is emerging and a few schools have designated this task to one teacher. Inservice Training (a) Primary Schools Four meetings with Primary School Teachers and supported by the Education Inspectorate were held in the Health Education Section. The Principal Health Education Officer gave several lecture-demonstrations for staff from small groups of schools who met in one central school and an eight-week inservice training course is arranged for the Spring Term 1972. These activities were designed to encourage teachers to see health education as an essential part of the curriculum and to provide them with up-to-date background information. Teachers from 47 schools have applied to attend the Spring Course. (b) Secondary Schools A total of 87 teachers from 33 maintained Secondary Schools attended some form of in-service training in health education during the last two years. Two programmes for typical Junior and Senior Courses are given at the end of this report. Survey of Sex Education in Schools A Survey was undertaken by the Education Inspectorate to assess the extent of sex education in Croydon Schools. The topic is not commonly viewed as a subject in isolation but is more usually incorporated in programmes of community health and/or incorporated in some such specific area of study as one or other of the sciences, social studies or home economics. Some pupils may miss sex education opportunities through not taking these particular subjects. The work of the Health Education Staff was supplemented by six Health Visitors and occasional informal series were given by school nurses as appropriate. The Health Education Staff continue to carry out for Junior Schools a programme of pairs of lectures about growing up. The first is given in the evening to parents of fourth year juniors and the second in the evening or the afternoon to those same parents and their 10-11 year old children. 23 pairs of lectures were booked between September and December 1971. The following tables illustrate the extent of health education in schools:- 24 Table I Primary Schools (Total 63) Percentage including health education in the curriculum 1. Aware of facts of reproduction before leaving school. 2. Including health education in the curriculum. 3. Dealing with health questions as they arise. 4. Using supporting visual aids. 5. Taking the B.B.C. television series "Merry-go-Round". 25 Table II Secondary Schools "Community Health Course" as a subject on the time-table Table III Secondary Schools "Health Education" included within a specific subject area Total schools taking course. 2. Course taken by health education staff. (Teacher present) 3. Course now run by teacher. 4. Course shared between health education staff and teacher. (Nos. 2 & 4 occur in 2 schools) 1. Total schools including health education. 2. Health education staff taking the community health section. 3. Course begun by health education staff. Now run by teachers. 4. Work covered by teachers. Other routine work continued as usual throughout the year. Help was given with fifth and sixth form school leavers' conferences at Purley Girls' John Newnham and Riddlesdown Schools. These conferences were considered to be very successful and worthwhile by both staff and pupils. The topics most often requested from Youth Clubs were drug dependency, family planning and sexually transmitted diseases. 26 Health Education Staff and one Health Visitor spoke at ten ParentTeacher Meetings. The involvement of parents is stimulating and vital to the success of Health Education in schools. Students from the Royal Dental Hospital School of Hygiene continued with their health education training in the Health Education Section and with teaching practice in eight Infant and Junior Schools. The now regular annual Inservice Training Session for Professional Staffs on "Drug Dependency" was held again in the Denning Hall and conducted by Dr. Dale Beckett, Consultant Psychiatrist at Cane Hill Hospital. There is now a considerable amount of information available about health education but much remains to be done so that, for teachers, the subject enjoys parity of concern and esteem. IN-SERVICE TRAINING COURSE FOR JUNIOR SCHOOL TEACHERS MONDAYS JANUARY 17th - MARCH 13th, 1972. 3.30 P.M. - 5.00 P.M. Monday - January 17th "The Growing Child" Miss D.S. Elliott Principal Health Education Officer Monday - January 24th "The Body's Framework and Movement" Dr. W.B.G. Simmonds Departmental Medical Officer. Monday - January 31st "The Body's Natural Defences" Dr. W.B.G. Simmonds Departmental Medical Officer Monday - February 7th "Getting the MostOut of Food" Dr. W.B.G. Simmonds Departmental Medical Officer. Monday - February 21st "Sights, Sounds and Other Senses" Dr. W.B.G. Simmonds Departmental Medical Officer Monday - February 28th "The Family Group" Dr. G. Crosse. Consultant Child Psychiatrist Child Guidance Clinic. Monday - March 6th "Talking to Strangers" Dr. G. Crosse Consultant Child Psychiatrist Child Guidance Clinic. Monday - March 13th "How Life Begins". Miss D.S. Elliott Principal Health Education Officer. HALF TERM 27 HEALTH EDUCATION INSERVICE TRAINING FOR TEACHERS (SECONDARY) SEPTEMBER 15th - DECEMBER 1st. 1971 Sept. - The Formative Years - Before Birth 15th Miss D.S. Elliott Principal Health Education Officer Sept. - The Formative Years - The Child 22nd the Family Miss D.S. Elliott, and Miss E.T. May, Senior Woman Inspector in Schools, Croydon Education Department. Sept. - The Formative Years - Towards 29th Physical Maturity Miss D.S. Elliott. Oct. - The Formative Years - Towards 6th Emotional Maturity Dr. G. Crosse, Consultant Child Psychiatrist, Child Guidance Clinic. Oct. - From Generation to Generation 13th Dr. M.K. Thompson, M.B., Ch.B., General Practitioner. Oct. - Helping the Handicapped 20th Mr. D.B. Pettman, Headmaster, St. Giles School for Physically Handicapped and Delicate. HALF TERM Nov. - Environmental Health - By Law and 3rd Education Miss R.M.C. Stock, Dip.H. Ed., Senior Health Education Officer, Nov. - Smoking and Health 10th Dr. R.H.J. Fanthorpe, M.D., C.R.C.P., Chest Physician, Mayday Hospital. Nov. - The Sexually Transmitted Diseases 17th Today Dr. J. Barrow, M.R.C.S., L.R.C.P., Consultant Venereologist, Croydon General Hospital. Nov. - Pregnancy - Planned or Unplanned 24th Mrs. M. McDaniel, S.R.N., S.C.M., Health Education Officer. Dec. - Avoiding Reality - Alcohol, Drugs or ? 1st Dr. H. Dale Beckett, M.R.C.S., L.R.C.P. Consultant Psychiatrist, Cane Hill Hospital. INTELLIGENCE ASSESSMENTS Children who are not making progress at school are referred for Tests of Intelligence to a doctor with special training in the School Health Service or to the School Psychological Service. All children recommended for special school because of learning difficulty and other children where medical factors may be playing a part receive a medical examination. A test of intelligence may also be carried out during the investigation of a large number of other medical problems. 28 252 children were examined by School Health Service Doctors and had intelligence tests during 1971. The classifications arrived at and recommendations made were as follows:— (1) Found to be educationally subnormal: (a) Recommended for St. Christopher's or St. Nicholas Day School for E.S.N, pupils 102 (b) Recommended for Coldharbour School for E.S.N. pupils 10 (c) Recommended for Residential School for E.S.N. pupils 2 (2) Found to be unsuitable for education in school 5 (3) Other Recommendations: (a) Referred back to an ordinary school 64 (b) Referred for further investigation by the School Psychological Service 11 (c) Recommended for Day Special Schools for other handicaps 6 (d) Referred for Speech Therapy 8 (e) Referred for Medical Treatment 18 (f) Referred for further assessment 17 (g) Other investigations 9 It is pleasant to be able to report that the number of children on the waiting list for assessment at the end of 1971 was only 29, compared with 235 at the end of 1970. This marked improvement was due in the first place to fewer children being put forward for assessment after the large number referred by Head Teachers in anticipation of the opening of St. Nicholas School. Also many of the children on last year's waiting list were tested by the School Psychological Service and where there was no question of any medical factors being involved and the child did not need transfer to special school, the School Health Doctors were not involved. This help given by the Educational Psychologist in reducing the waiting list was much appreciated. In addition to the above assessments, children attending special schools are under constant observation to ensure that they are still correctly placed. As part of this observation routine intelligence tests were carried out at the following schools. St. Christopher's School 16 St. Nicholas School 13 Coldharbour School 4 St. Giles' School 15 St. Luke's School 7 During the year under review the Education (Handicapped Children) Act, 1970 came into operation, and from April 1st in that year Coldharbour School came under the Education Department and no longer under the Health Department. This was a further step forward in the recognition of severely mentally 29 handicapped children as part of the ordinary child population with the need to be educated within the range of their abilities. In practice such education had been provided by Health Departments for a good many years but the change did put an end to the classification of such children as "unsuitable for education in school" and this in itself is less traumatic for parents. These children are now classified as educationally subnormal in the same way that other children are who have learning difficulties, needing education in a special school of the Coldharbour type, geared to their needs. Further benefits will undoubtedly flow from the change as teachers in the former training centres are upgraded and more of therti take the training courses which are available. The stimulus that the staff will receive by coming into the mainstream of education, and ihe extra funds which it is hoped will be available for buildings and equipment for these children should mark a new watershed in our approach to their difficulties. PHYSIOTHERAPY SERVICE Miss J. McBride, M.C.S.P., A.P.T.A. (Superintendent Physiotherapist) In April 1971 when the Junior Training Centre was transferred to the Education Department, our Service expanded its facilities to include mentally handicapped children. There is now a part-time therapist working in the classrooms treating children, instructing teachers in physical management, and giving support to parents. Whether we talk of treating or teaching or training, it is hoped that all the involved personnel are speaking the same language for physiotherapy, as always, stands astride the dichotomy of medicine and education. In spite of the lack of space, equipment and specialised furniture, the therapists' presence has undoubtedly proved to be effective. It is impossible, and also undesirable, to isolate the child's physical progress from development in other ways because it is inter-related with learning, speech and expression. Our job therefore is to help their development and to recognise the limitations imposed by the varying maturity of each child. Further interest must be stimulated and existing facilities expanded to include the under five period if we are really to succeed in a total appraisal of these children. At St. Giles' School there are now 24 children with spina bifida and an effective link has been established between them and Queen Mary's Hospital. The "helping, caring, educating" approach is now fully established between teachers and tnerapists, and it is generally agreed that looking at "the child in the round" is the only solution to integrating these children with disabilities into Society. I must thank Miss Gillian Smith, M.C.S.P., for the credit which she brought to the Department by a distinguished lecture to the Annual Spina Bifida Conference in October. Physiotherapy statistics will be found in Appendix B, on Page 61. 30 SPEECH THERAPY SERVICE Mr. J.R. Brook, Principal Speech Therapist The work of the Speech Therapy Section was maintained at a high level during 1971 although a little below the exceptional year of 1970; 1,183 cases seen against 1,342 in 1970. Staffing was reduced a little to 82% fully staffed and this accounts in part for the reduction in cases treated. Another factor is the exceptionally high level of treatments and discharges in the previous year. Speech therapy is often a long term treatment and events of one year may affect subsequent years. The waiting list for treatment at the Central Clinic at the end of 1971 was down to 27, for first appointments. This is the lowest level recorded over the 5 years since my appointment and is the effect of 1970's high work level. The reduction in staff to 82% of full staff still leaves Croydon the best staffed Speech Therapy Section of comparable size in the country; there is no doubt that this is connected with the progressive attitude maintained by the School Health Service to the treatment of speech and language disorders. It is unfortunate that the gaps in the service have become concentrated in the Special Schools area. This is a chance occurrence and the therapists who have left the Special Schools will certainly be replaced as soon as staff become available. During the year we were joined by Miss Simpson and Miss Pam Grasso who has taken responsibility for the Speech Unit. Miss Simpson had to leave during 1971 as did Miss Scrimshaw and Mrs. Moffett. Miss Scrimshaw and Miss Simpson both left to be married and Mrs. Moffett was a particularly severe loss after working in the Section for 4 years since her qualification. The work of the Section during the year included 31 school visits in which 274 children were assessed. The school visiting programme is resulting in closer contact with teachers and increased awareness, especially on the part of headteachers of Primary Schools, of the help that can be given by Speech Therapists. There have been more requests for therapy in schools. This is a very promising line of approach to Language problems, but the practical obstacles can only be removed gradually. Regular Speech Therapy in Schools cannot yet be seen as a workable proposition despite the many attractions. Mrs. Robertson continues to co-ordinate Speech Therapy in the Special Schools. Case Conferences have been attended together with Parents' Evenings and other School Functions. This work often takes place in the evening and is essential in the effort to view and treat the whole child in his family. Students from 3 London Training Schools have attended clinics in Croydon over the year as part of their practical training for Speech Therapy. This work is time consuming, but obviously necessary if the flow of 31 therapists is to be maintained. The limit on numbers trained in London is the number of suitable clinics available for students' practical training within reasonable distance of the Training Schools. 1971 has been a year of steady work despite some unexpected staff changes. It is hoped that 1972 will see the continuance of the Service to school children and an improvement of the situation of Speech Therapy in Special Schools. Statistics are in Appendix B, Page 61. WEIGHT CONTROL CLINICS Dr. W. Simmonds, Departmental Medical Officer In the year under review a Clinic for boys was conducted by Dr.Simmonds, while Miss Hunt, a Health Visitor, conducted a Clinic for girls. The boys' Clinics have continued very much as before. There is a general improvement overall, with the few resistant exceptions and the occasional startling return to normality. It seems that starting at the age of eleven gives the most satisfactory results in the time available, and once more, as is to be expected, the prospects of success are better if one or other parent is able to attend in the early stages, and if the group is seen in school rather than a Central Clinic which causes greater loss of school time. The girls' Clinic has been held monthly in Taberner House and has aimed to encourage a group of girls to lose weight when this has been considered necessary, usually following a school medical examination. The aim is to supply the girls and their mothers with enough nutritional knowledge to guide them in their choice of "fattening" and non fattening foods, and films and slides are used to illustrate this. The recommended diet is discussed with mothers and the girls and comments on this vary - from it being too fattening to starvation - neither have been proved accurate. The girls' initial interest is often lost, motivation is not very high. Family support varies but it appears that some of the girls face much disapproval at home whether they stick to the diet or give it up. The clinic seems to have achieved some success in terms of weight control but unfortunately rather less in terms of weight loss. In view of these difficulties, and to prevent waste of time and manpower, 't is suggested that the boys' and girls' groups should be merged and centres started in various parts of the Borough, so that boys and girls can be seen together and will have shorter distances to come to the various clinics. 32 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 47 such children during the year. Convalescent Treatment 15 children received a convalescent holiday on the recommendation of the school medical officer. These arrangements are not intended to provide annual holidays for children whose parents are unable to provide them; they are an essential part of the recuperative treatment provided for a child who has been found to be in poor general health or a child suffering from a particular disability. Details of the diagnosis and periods of stay are shown in the accompanying table. Diagnosis No. of Children Period of Stay Cerebral Palsy 2 2 weeks General Debility 3 (2 - 1 week (1 - 2 weeks Maladjusted 2 2 weeks Diabetic 1 2 weeks Epilepsy 1 8 days Difficult home conditions 1 2 weeks Asthma, Hay fever and Rhinitis 1 2 weeks Hemiplegia 2 weeks Mental Subnormal ity 3 (1-1 week (2-2 weeks Total 15 Juvenile Employment Return The following numbers of children were examined by the medical officers during 1971 as to their fitness to undertake the part-time employment indicated:— 33 1971 1970 Delivery of Goods for Shopkeepers 3 11 Delivery of Newspapers 152 166 Delivery of Milk 3 - Shop Assistants 57 85 Others 20 38 Total 235 300 Provision of Milk and Meals From September, 1971, free milk was supplied only to pupils in Special Schools, to pupils in maintained schools to the end of the Summer Term after attaining the age of seven and to other maintained pupils in the 7 to 11 age group recommended by the Medical Officer of Health. Approximately 12,900 pupils received one third of a pint each day. All milk supplied is pasteurised andthe 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 1971, following the price increase of the meal, was approximately 27,050. Cost of Milk and Meals Milk and Meals cost £1,278,214. Income from payment for meals was £465,053, making a net cost of £813,161. Causes of Death in School Children 1971 (Corrected) Accidental (Motor) 3 Cancer(Leukaemia) 3 Cancer (Other) 2 Cirrhosis of liver - non-alcoholic 1 Congenital (a) Spina bifida and hydrocephalus 1 (b) Downs syndrome 1 Gastro-enteritis 1 Heart disease 1 Peritonitis 1 Pneumonia 1 15 34 PART III HANDICAPPED PUPILS The result of the Ministry of Education and Science Survey of physically handicapped children in ordinary schools was published just after the end of the year under review. It included only those physically handicapped children for whom special additional attention is required in the school or who are unable for long periods to take a full part in all normal activities of children of their own age. Thus it ignored many minor handicaps from which probably the greatest number of physically impaired children at ordinary school suffer. However, even within this criterion of at least moderate handicap there were found to be 10,200 physically handicapped children in ordinary schools in England, compared with 8,545 physically handicapped children in special schools. These children who are coping in ordinary schools with the understanding and help of the staff and the encouragement of their parents, should not be forgotten, though the following report deals only with children in special schools. This group of children includes those with handicaps of the psyche such as maladjustment and educational retardation, a group accounting for just over half the children needing special provision. It is possible, even likely that a further survey of ordinary schools would discover many pupils there who differ only to a slight degree from children so handicapped in special schools. Such pupils may provide even more problems for their teachers than the physically handicapped. It is therefore all the more welcome that two new special schools opened in the Borough in 1971 to provide for these children. St. Nicholas Day School for educationally subnormal pupils opened in January, and Sir Cyril Burt Day and Residential School for Maladjusted pupils with a Unit for children suffering from the autistic syndrome opened in October. The hope last year that the waiting lists for these two groups would almost disappear has not, however, yet materialised. More children needing special provision for educational subnormality are still being discovered during assessments by educational psychologists and school medical officers, and Table 10 shows that there is a sizeable waiting list even now. When the new school for maladjusted children has its full quota that particular waiting list should be small, but there is a certain number of such children for whom a school in Croydon is not particularly suitable for various reasons, and some of these children are difficult to place in residential schools not under our control and may have to wait longer for the type of provision they need than can be considered satisfactory. Both these problems are receiving further consideration from the Officers in the Health and Education Departments. The number of pre-school children already known as likely to need special education has risen from 193 last year to 225 this year, but this is possibly due in part to earlier identification by the child health service and is not entirely a true increase in handicap. 35 TABLE 10 Children requiring Special Education, 1971 CATEGORY New Cases Ascer' tained by Committee * New Admiss ions Number of Children receiving Special Educational Treatment 20.1.72 No. of children awaiting placement on 20.1. 72 Special Schools Independent Schools hospitals Day Units Home Tuition Total Day Residential Day Resi' dential BUND - - - 8 - - - - 8 - - PARTIALLY SIGHTED 2 2 26 1 1 - - - 28 - - DEAF - 2 10 19 1 - 13 - 43 - - PARTIALLY HEARING 6 5 2 4 - - 24 - 30 1 - EDUCATIONALLY SUBNORMAL 120 137 479 12 9 58 - - 458 82 2 EPILEPTIC - - 9 8 - - _ - 17 . MALADJUSTED 59 45 19 39 52 - 35 - 145 - IS PHYSICALLY HANDICAPPED 12 12 83 12 - - - - 95 - - SPEECH 5 5 - - - - 9 - 9 - - DELICATE 3 3 18 8 2 - - - 28 - . TOTAL 207 211 646 111 65 58 81 - 961 83 17 * Including cases ascertained in previous years. TABLE 11 PRE-SCHOOL HANDICAPPED CHILDREN Category Age on the 31st December, 1971 5 years 4 years 3 years 2 years Vision Defect - - 2 1 Hearing Defect - - - 4 Speech Defect - 4 12 14 Mental Disorder - 21 33 15 Epileptic - 4 3 o O Physically Handicapped 1 25 48 35 Total 1 54 98 72 36 BLIND AND PARTIALLY SIGHTED PUPILS Blind Partially Sighted In Residential Schools In Day Schools 8 – 2 26 Blind No blind children were ascertained during the year under review. Partially Sighted Two Croydon children were ascertained in this category and admitted to St. Luke's School during the year, and another two pupils from outside the Borough began attendance there. At present no child is waiting placement. 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 1971 was a year of steady progress and improvement. The building was re-wired and there are now power sockets in all the rooms and corridors. The lighting is very much better and is a great help to the children on dull days. The school was re-decorated and is now much brighter and more attractive. During the Spring Term the second classroom used by St. Christopher's School for four years became available for the younger children. It was equipped and furnished as an attractive infants' room. The teacher and children have benefited from having their own room and equipment. New desks were provided for the junior children. These were made to suit the needs of the children and are proving very satisfactory. An additional full-time teacher was appoi nted during the Autumn Term, this increased teaching assistance has enabled the less able, also the more intelligent children to have further individual attention which is so essential for visually handicapped children. One boy began attending Winterbourne Junior Boys' School. He has settled down well and at present is able to cope in the ordinary school.The Headmaster's help and interest is much appreciated and we are also grateful to him for including the children in some of the activities of his school. In the Autumn Term a group of junior children began French lessons at the Winterbourne Language Centre. I am grateful to the Inspector, Miss M. Samuel for arranging this; the children are very enthusiastic and have made good progress. 37 Many educational visits were made and regular attendance at the Swimming Baths continued. Several children gained swimming certificates. The ophthalmologist visited the school twice during the year. The routine Medical Examinations were carried out by Dr. Wield and the School Dental Officer examined the children's teeth. I wish to thank all these people for their help and interest in the children. The year ended with a Nativity Play in which all the children took part. At the Christmas Party the children received presents kindly provided by the Education Committee. Children on Roll 31.12.71 18 Children admitted during the year 4 Transferred to Normal Secondary School 1 During the year no child was categorised as deaf, while six children were assessed as partially hearing. Five of these were admitted to the Kingsley School Day Unit and one child was on the waiting list at the end of the year. Dr. Morgan, Senior Medical Officer responsible for the Day Units, visited frequently, and Mr. Parsons (Consultant Otologist) attended at each Unit to review all the children. Parents are invited to this review and teachers are also present, together with Dr. Morgan and Mr. Oakley, the Borough Teacher of the Deaf. The reorganisation of the Units into a Nursery and Infant Partially Hearing Unit and a Nursery and Infant Deaf Unit in the Infant School and Junior Deaf and Partially Hearing Units attached to the Junior School, which was mainly carried out in the previous year, has proved quite successful. This will continue to be the pattern of provision and early next year an extra classroom attached to the Senior School will be provided for the Junior Deaf Unit so that these children who are at present in a classroom in the Infant School may move bodily as well as administratively to that School. Details of the Senior Partially Hearing Unit are given later in the report. I am grateful to the Chief Education Officer for the following reports. DEAF AND PARTIALLY HEARING PUPILS Deaf Partially Hearing In Residential Schools 17 4 In Day Schools 7 2 In Day Units 16 21 38 Nursery and Infant, Deaf and Partially Hearing Units, Kingsley Infants' School There are 16 children attending the Units at Kingsley Infants' School, 15 who have a hearing handicap, and 1 who is also spastic/deaf. The Organisation remains as last year. There are two Nursery/Infant Units with 8 children in each Unit, both Units have a qualified teacher for Deaf and Partially Hearing children. Two assistants are available to tfie Units, and on one day a week a technician/ assistant comes to work in the Units. It is proposed that next year, a qualified teacher will come every morning to take individual or small groups of children. The Units are organised so that one caters for the needs of the children who have partial/severe loss of hearing, and the other caters for those children who have severe/very severe hearing loss. There are 8 children in each Unit whose ages range from 3-7 years. 2 children were recommended for transfer to other schools, and one other child was sent to Margate. It is hoped that the 2 others who have been recommended can soon be suitably placed. Severe/very severe hearing loss - 8 Children In this class the children are basically divided into two groups, the 3 older children and the 5 younger ones. However (especially in the younger group) emphasis is placed upon individual work and attention because of the varying characteristics of each child (intelligence - hearing loss, age, concentration span etc.) Every child has made progress in the unit, in language development and comprehension and in their general education. The children join the main school at lunch time and play time. Partial/severe hearing loss - 8 children. This Unit is chiefly composed of partially hearing children; the hearing loss of the children ranges between the 'true partially hearing' to the 'severely partially hearing'. There are nine children in the Unit including a severely spastic child. The Unit caters for children whose ages range from three to seven years. The class is divided into two main groups:— The Nursery Children (3 - 5 years) The Infant Children (5-7 years) The younger children benefit from individual attention and speech training. The chief aim is to encourage the children to use speech as their means of communication. Pre reading, writing skills - as well as pre number skills help to reinforce vocabulary acquired. 39 The Infants group cope with much more formal work; the schemes of work and reading scheme are the same as the hearing children in the school. One six year old integrates with a hearing class for part of the day. Also at break and lunch-time the class integrate with the hearing children in the school. Junior Deaf and Partially Hearing Units, Kingsley Junior School In the Partially Hearing Unit there are eight full-time pupils at present. Of the five boys, four are about 10 years and one boy 9 years. The three girls are 9 years old. The most recent admission is a 10 year old boy recently arrived from Guiana who speaks very little English, having scant understanding of language. His parents have been residing in England for the last ten years. The children of the Deaf Unit were admitted on the roll of this school from the Kingsley Infant School in September. Accommodation is being arranged in a playground sited classroom specially constructed and fu.iy furnished and Peters equipment will be installed in individual specially designed desks. It is hoped to occupy the room early next year. In the meantime the same room in the Infants' School is being used as has been in the past. There are six children in this Unit, the three boys are all 8 years old and the three girls are rising 9 years. The transport arrangements to and from school and home appear to be very satisfactory. Group and individual work is carried out, children working at their own level because of theirwidely differing abilities, needs and attainment. In the P.H.U. a recently qualified teacher was appointed in September, Miss Middlemiss. She is pursuing an interesting varied and lively curriculum using Connevans group aid and an Amplivox Speech trainer as well as all the school facilities, (T.V. Library etc,), having a wide timetable of integration with many classes in the school. The class also has a part-time teacher attending for two mornings a week. A student, a qualified teacher, from the diploma course at London University is spending several weeks on a teaching practice in this Unit. Visits have been made during the year by the children to the Science Museum, the London Museum and Crystal Palace using transport provided by the Education Authority. Some visited the Grand Union Canal at Brentford with a normal class. Mr. Brozel and Miss Lucas are at present in the Deaf Unit. In addition to the usual activities the children have a regular weekly expedition around the locality and usually include practical shopping. 40 All the children integrate at morning assembly, playtimes and dinner times. Together they have occasionally led the worship at assembly with their teachers. They produced a Nativity programme to which all their parents were invited and attended. A meeting was held in the Autumn Term of parents with the Local Authority Officers and Staffs of all schools dealing with partially hearing children. Senior Partially Hearing Unit, Riddlesdown High School During the year many changes occurred in the Unit. In June, a 3rd year boy moved to Bridlington. In July a 2nd year girl moved to Stevenage and in December a 3rd year girl was given permission to attend Norwood High School at the request of parents who did not wish her to travel so far to school during winter weather by train. Mrs. Littlejohn who had been assistant teacher in the Unit for 2 mornings a week moved to Aberdeen in July. There were 3 arrivals. In September a 12 year old girl came to the Unit from another local High School - she was reported to be handicapped by executive and receptive aphesia. Towards the end of the year she was fitted with a post aural hearing aid. Two very deaf sisters - 12 years old and 13 years old - were placed in the Unit to await admission in a School for Deaf. Their family had recently moved into Croydon from London. Their admission inevitably created problems in a Unit for partially hearing children. 1971 ended with 7 pupils as follows: 5th Year Girl - integrating ￼Studying for C.S.E. exams in English, Accounts, Typing, Social Studies, Needlework and Domestic Science. 4th Year Boy - integrating ￼following Option Courses in Woodwork, History, Geography, Social Studies, Metalwork and a basic course in English, Maths and P.E. 3rd Year Girl - integrating ￼ Much improvement made in the behavioural difficulties which initially brought her to the Unit. 3rd Year Girl - integrating ￼ and progressing satisfactorily. She began travelling by public transport in April. 2nd Year Girl - integrating ￼ and has settled down quite well in the first 3 months here. The two deaf pupils 3rd ear Girl - integrating￼mostly "practical" subjects and placed in the same class as another Unit girl. 2nd Year Girl - integrating￼mostly "practical" subjects and placed in the same class as the other 2nd year girl. 41 All the Unit pupils appear to have quite a number of friends among the hearing children in the school. They have had a good share of various awards - Bronze Medal for Personal Survival, 25 words per minute R.S.A. Typing, vouchers for fund raising efforts. We issued our 2nd magazine in the Spring. All the pupils continue to have very patient and interested concern from the staff members in whose classes they work or register. Only the two (temporary) deaf children use a taxi service now. In October an induction loop was installed in the Assembly Hall. At New Cross Hospital in the same month, aids were checked and ear moulds renewed. The School Medical Officer came twice during 1971, and in November Mr. Parsons interviewed all the children - but only 2 parents. Many visitors have included local head teachers, teachers, students and a local primary teacher who started in October a course for the Diploma in Deaf Education at London University. Parents did not attend the various year interviews with staff. In March however, we had a fair response from parents of all Croydon Unit pupils at a meeting to get proposals made to put to Sir Keith Joseph by the R.N.I.D. April Conference. The Unit pupils appear very happy and progress satisfactorily both academically and socially. All our ex-pupils keep in touch with us and occasionally visit the school. EDUCATIONALLY SUBNORMAL PUPILS In Day Special Schools - 479 In Residential Special Schools - 21 In Hospitals - 58 Awaiting Placement - 84 The category of E.S.N, children was broadened by the Education (Handicapped Children) Act, 1970, which came into effect on 1st April, 1971. Children who previously had been designated as unsuitable for education in school are now included in the educationally subnormal classification, and this accounts for part of the increase in this group and also for the large number of E.S.N, children in hospital. The latter are children needing nursing care, many with gross physical as well as mental handicaps, or too disturbed to be contained in the community. Another effect of this Act was to bring Coldharbour School into the mainstream of education and under the control of the Chief Education Officer. The pioneer work carried out there when these severely handicapped children were the responsibility of the Health Department will, it is hoped, be built upon under the new regime. A further chapter in the educational approach to fitting these children to take their place in society to the full extent that their ability allows has now opened. 42 I have earlier referred to the waiting list for educationally subnormal pupils. The 84 children referred to above include many severely handicapped pupils and the building of a new school which had been allowed for in estimates when the Health Department was responsible forthese children will be put in hand soon after the end of the year. During 1971 Mr. R.G. Grice, who had been Head Master of St. Christopher's School since 1st September, 1959, and was an authority in this special field of education, retired, and I am grateful to Mr. D.D. Abraham, his successor, for the following report on the work of the school in 1971. St. Christopher's Special School for Educationally Subnormal Children 1. Statistics Boys Girls Total Number on Roll 31.12.70. 134 92 226 Admitted during 1971. 51 35 86 Left for work at 16 years. 7 6 13 Transferred to other areas 4 5 9 Transferred to Residential Schools. 5 1 6 Transferred to Waylands. 2 3 5 Transferred to Coldharbour. 1 1 2 Transferred to Normal School. 1 0 1 Transferred to St. Nicholas. 39 35 74 Number on Roll 31.12.71. 125 77 202 2. Staffing Mr. R. Grice retired as Headmaster of the School during the year. His successor, Mr. D.D. Abraham, took up duties in September. The School is indebted to Mr. F. Hutt, the Deputy Headmaster, for so effectively taking over the role of Acting Headmaster throughout the Summer Term. 3. Various Activities The School has continued its policy of developing social contact with various other schools, both Special Schools as well as Primary and Secondary Schools. These contacts have largely been established through various sporting activities and, more recently, through camping expeditions based at the camping sites of other schools. An extension of these activities has been facilitated by the School's acquisition of a Mini-bus, presented by the Variety Club of Great Britain (in conjunction with the Golfing Association of the Play Boy Club). 43 4. Medical Speech Therapy, a vital aspect in the education of many pupils at the School, has continued most effectively through Mrs. J. Robertson and Mrs. I. Siddons. The excellent relationship which exists between School and the Principal School Medical Officer's Department have continued and are manifest in the invaluable contribution to the total life of the School which is made by the School's Medical Officer. We are indebted to the staffs of both Medical and Educational Departments for their ever willing co-operation in matters relating to the benefit of the pupils of St. Christopher's. St. Nicholas Special School for Educationally Subnormal Children I am grateful for the first report on St. Nicholas School which has been supplied by the Head Master, Mr. D.A. Bartram. After suffering a minor delay in the building programme St. Nicholas opened on 7th January, 1971 for the Spring Term. The opening of this purposebuilt school almost doubled the day places available for educationally subnormal children in the Borough, as the accommodation provides for 200 boys and girls aged 4 - 16 years. The school being organised as an all-age school points to the unbroken years under the same staff and the provision of security and continuity of treatment that the educationally subnormal child needs. The number of children admitted to the school during the year was 164, their age groupings as follows:- Age in years Boys Girls Total 4- 5 1 - 1 5- 6 3 4 7 6- 7 10 1 11 7- 8 7 4 11 8- 9 9 8 17 9- 10 15 8 23 10 - 11 10 12 22 11 - 12 12 7 19 12 - 13 12 10 22 13- 14 10 8 18 14 - 15 6 4 10 15 - 16 1 2 3 96 68 164 The average age of entry to the school varied throughout the year, but the peak age was about - 10 years with some children continuing to be admitted up to the age of thirteen or fourteen. These figures pointed to the urgent need for earlier ascertainment of children for Special Educational 44 Treatment since their lingering without special help in the ordinary schools affords them the experience of continual failure, sets up unfavourable attitudes, creates emotional difficulties and intensifies the learning problem to a point at which it may be difficult to treat. The school has enjoyed much support and assistance from other agencies and disciplines. Dr. A. Letts assisted by Nurse Darling saw - 64 children for Routine Medical Inspections and - 13 children for re-assessments. An audiometrician, Mrs. Goad has continued to screen the whole school population for deficiences of hearing. A full-scale Dental Inspection took place; the children either having the opportunity to continue with treatment at the local Purley Clinic or under the own practitioners. A number of pupils were referred for child guidance and we have been grateful for their advice and assistance on many matters. Many of the pupils were found to be suffering from secondary handicaps, the greater being those of speech defects. The devoted and conscientious work of the two visiting Speech Therapists, Mrs. Julia Robertson and Miss Sue Simpson (between them attending for four full-day sessions each week) has afforded the children much individual and specific help. We have observed much improvement in general language development which has in turn assisted the childrens' reading progress. For the latter part of the year we have been fortunate in having the support of Mrs. Freud (an Education Welfare Officer) who has been able, through her home visits, to foster good home/school relationships and provide a two-way channel for communications. I am grateful for the first report from Coldharbour School which is supplied by Mrs. L.B. Mouatt, the Head Teacher. Mrs. Mouatt was in charge of the school when the Health Department was responsible and is thus no stranger. Coldharbour School for Educationally Subnormal Pupils Coldharbour School transferred to the Education Department in April 1971, and Staff are making good use of training courses available to them. Children on roll - December 1971: Total: Children left: Residential School Permanent Care Removed from Area Transferred to Waylands New Admissions: 39 girls (age range 31/2 yrs./18 plus 64 boys (age range 41/2 yrs./17 plus 103 1 1 3 2 7 45 There are six classes plus three special groups, one of which is a reception class to introduce these handicapped children to the new world of school. The other two groups are made up of the more handicapped children who at their present stage are not able to benefit from the more formal classes. The school activities include:— Music and Drama Arts and Crafts Physical Education Home Economics Gardening Visual Aids Outings to the Zoo and to recreation grounds, etc., stimulate the children and are intended for use in social training. Swimming has been introduced and is much enjoyed by all participants. Speech Therapists and Physiotherapists visit the school routinely and an Assistant Medical Officer of Health is in attendance each Friday morning. The overall improvement of children seen by the Physiotherapist has been really remarkable, and staff are most grateful for the help and guidance they have received. Parents are encouraged to visit for progress discussions and classes are open to them. There is a flourishing Parent/Teacher Association, and although meetings are not always as well attended as one would hope, the Association has provided the school with four record players. St. Jude's Young Communicants raised £50 and purchased two tape recorders for us and I would like to record my thanks to both these groups for this practical way of helping the children. The Christmas entertainment given by the children was well attended by parents and friends, and an enjoyable party was made possible with the generous grant allocated by the Education Committee. EPILEPTIC PUPILS In Day Special Schools - 9 In Residential Special Schools - 8 No children were ascertained as epileptic during 1970. This does not mean however that no new cases of epilepsy were discovered among school children during the year. Most epileptic children can manage quite well at ordinary school and some may never require any help from the School Health Service beyond possibly advice to Head Teachers. Only children with severe epilepsy requiring special schooling on that account are ascertained as epileptic and some other children with epilepsy may be ascertained maladjusted or educationally subnormal where the type of schooling provided for these categories would best meet their need. 46 MALADJUSTED PUPILS In Day Unit - 35 In Day Special Schools - 19 In Residential Special Schools - 91 Awaiting Placement - 15 There was a very marked increase over the previous year in the number of pupils ascertained as maladjusted; 59 in the year under review compared with 19 in 1970, and an average of 15 to 20 in previous years. The reason for such an increase is not immediately apparent. It is probably mainly accounted for by the fact that the new special school. Sir Cyril Burt,opened in the Borough in September of the year under review. For the first time in the Borough there were day places for maladjusted pupils. Children were therefore ascertained more quickly than might otherwise have been the case as places acceptable to the parents would be available forthem. A fairly rapid turnover of day pupils in the new school is hoped for. It will be most gratifying if these children can be returned to their ordinary schools after a reasonably brief stay at Sir Cyril Burt School. This ideal will be much easier to achieve from day school back to day school within the Borough than from a residential setting where the child has to re-adapt to the family situation again as well as to a change of school. The increase in numbers ascertained is probably also partly fortuitous due to the waiting list for children at the Child Guidance Clinic having been much reduced during the year. Also a few children with the autistic syndrome are included under this heading. It is expected that the number ascertained will show a fall during 1972. However, the hoped for turnover from Sir Cyril Burt School may mean that the number ascertained maladjusted in future years will remain at a higher level than in the past. The waiting list for places for these children has fallen slightly to 15 from 18 at the end of the previous year, and as Sir Cyril Burt School gradually takes up its full complement of pupils, this may be expected to fall further. I am grateful to Mr. A.T. Hughes, the Head Master of Sir Cyril Burt School, for the following report:— Sir Cyril Burt School for Maladjusted Children including the Unit for Autistic Children The School opened for 3 day children on 7th September, 1971. By 27th. September other pupils could be admitted, and a further seven children came into residence on that date. Since then intake has been carefully phased with the aim of establishing and maintaining a beneficial therapeutic climate within this community of maladjusted children. The Autistic Unit will open in January, 1972. 47 Total numbers for the whole School as at 31.12.71 are:— Resident girls 3 Resident boys 8 Day pupils - girls 4 Day pupils - boys 7 Total 22 The School is planned to take 30 Resident and 20 Day maladjusted pupils and I anticipate filling available vacancies by the end of July, 1972. Staffing Teaching staff for the Main School numbers seven (including the Deputy Headmaster), an advisable ratio for the maladjusted children expected. The Autistic Unit will have two teachers. Two teachers have taken the 1 year course in Teaching Maladjusted Children. Another has nine years teaching experience in co-educational residential schools for maladjusted chiluren, and another has both an Advanced Certificate in the Residential Care of Children and the Central Training Council Senior Certificate in Child Care. Teachers assist in the residential work of the School by performing extraneous duties. Two women Child Care Officers Grade 2 (Matrons) are employed. One is resident and has a Housemother role with particular responsibilities for the resident girls. The other is non-resident, and has a Housekeeper/Matron type role. All the Child Care staff are experienced in work with resident maladjusted children, and, in addition, the Housekeeper/Matron has worked with autistic children, and is familiar with residential catering. The School also has a Nursery Assistant who is a State Registered Nurse. Medical Provision Doctor Boffa, or his assistant Doctor Butts, visits the School weekly. Doctor Crosse is the School's consultant Psychiatrist. He and Doctor Mills make one morning visit each fortnight, seeing new pupils, and providing a "follow-up" in other cases. Both attend our case review conferences together with specialists of other aqencies. The conferences are intended to have diagnostic, prognostic and integrating functions to ensure pupils'needs are met, but also have great value as staff training sessions, helping staff increase their awareness of the underlying causes of childrens' anxieties and emotional disturbance. Other Specialist Assistance A close liaison exists with the School Psychological service. Mr. Reid and Mr. Edwards attend the case conferences, whilst Mrs. Pearn of that department spends two days per week assisting and testing in the School. 48 Mrs. Julia Robertson, Speech Therapist, visits the School monthly. She has reviewed the requirements of the existing autistic pupils, and finds their speech needs are being met satisfactorily by the School staff. As autistic pupils are admitted more frequent speech therapy will be required. Dental Provision Resident pupils have visited a dentist. Some had not visited a dentist for some time, and the consideration they received has caused many children to reverse previous unhelpful attitudes toward dental care. General Health There have been virtually no illnesses amongst resident pupils. We have not yet had cause to use the sick bay. PHYSICALLY HANDICAPPED PUPILS Twelve children were ascertained in this category, rather fewer than in the previous year. All these children were placed in special schools, chiefly at St. Giles' Day School, and there was no waiting list at the end of the year under review. The policy of placing only the more severely handicapped children at St. Giles' School continues and the total number of pupils there is 110, of which the spina bifida children (26) now form the largest group. The Ministry Survey on Physically Handicapped Children at ordinary school found that in 1970 there were 46 ofthese pupils at normal school in Croydon, and this number will probably tend to increase somewhat overthe next few years. However, though it is generally considered advantageous for physically handicapped children to attend normal school, the facilities, equipment and specialist ancillary staff providing physiotherapy, occupational therapy, speech therapy and nursing attention necessary for many of these children are not available there. Few Teachers in normal school have special training in dealing with the handicapped, and the philosophy of educating towards independence may often, particularly for the severely handicapped, be better put into practice by teachers with special training. There will be a place for a school of the St. Giles' type in the educational provision for the foreseeable future. The fall in numbers at the school has made it possible to consider a nursery class there for the younger physically handicapped, and this will be provided next year. A small Unit for children with hearing defect and physical handicap is also to be opened next year. I am grateful to Mr. D.B. Pettman for the report on the School for 1971. St. Giles' Special School for Physically Handicapped Children This year has seen a marked change in the pupil population of the school. During the period under survey there were 38 leavers to other schools or employment and 2 children died. Of the leavers, 9 were cerebral palsy cases. 49 There were 21 new admissions, of which 6 were spina bifida cases, so that the spina bifida are now the major handicapped group. The main handicapped groups are as follows:— Boys Girls Total Spina Bifda 15 11 26 Cerebral Palsy 15 7 22 Speech Defect 11 7 18 Asthma 9 3 12 Congenital Heart 7 3 10 Epilepsy 3 6 9 Muscular Dystrophy 5 0 5 Fibrocystic 1 3 4 Accident cases 2 2 4 The marked decline in the number of asthma cases has done little to ease the burden on the medical staff, indeed the steady increase in multiple handicapped children is stretching resources to their limits. The problem of transport has again been a cause of concern, mainly because of the length of the journey between home and school; this is particularly unfortunate for the growing number of incontinent children. However, I understand that the Authority is aware of the difficulties affecting all special school transport and have asked the Management Services Officer to carry out a pilot study at St. Giles' School. Children in wheelchairs pose a separate problem and require specially adapted vehicles; there is an increasing number of such children (now over twenty) and the one existing mini-bus can only carry four at a time. The School Medical Officer, Dr. Thelma Wield, saw 258 children at routine medicals, 120 parents being present. At specialist medicals 48 children were seen by Dr. Fanthorpe or Mr. McQueen and 44 parents were present. Sister Jordan and her staff were responsible for arrangements and keeping records in addition to dealing with routine medical matters, 26 major epileptic fits and the toilet training of 22 incontinent children 4 times per day. The Speech Therapy Department, despite a reduction in staff, gave 889 treatment sessions, 54 review sessions and 25 informal sessions. During the year 22 new cases were assessed and 19 cases closed. There were 22 children having therapy and 15 under supervision. The Physiotherapy Department has continued to work most efficiently although cramped for lack of storage space for equipment and apparatus. During the year chest cases were given 4,155 treatments, cerebral palsy cases 3,529 treatments, spina bifida 4,467 treatments, and there were 2,196 miscellaneous cases treated, making a grand total of 14,347 treatments. Without the close cooperation of the Principal School Medical Officer and his staff it would be impossible for the school to function satisfactorily and I wish to express my thanks for the support given to St. Giles' throughout the year. 50 PUPILS SUFFERING FROM A SPEECH DEFECT In Day Special School In Day Unit 9 There are many pupils with some degree of defective speech in ordinary schools and various special schools. Under the above heading only those children where the use of words is the child's major problem are considered. Most of the children at the West Thornton Unit for Speech Disordered Children have difficulty not only with the spoken word but also with the written word. Careful assessment by Dr. Hierons, the Consultant Neurologist Adviser to the Unit, the Local Authority doctor with special responsibility for children with speech problems, as well as the Principal Speech Therapist, is needed before children are admitted. On-going assessment as well as remedial teaching is an important function of the Unit, and the fact that all the children do not necessarily return to normal school does not detract from the value of the work done there. I am grateful to Mr. John Brook, Principal Speech Therapist, for the following report. West Thornton Unit for Speech Disordered Children The year started with only six children in the Unit. Since then seven have been admitted and four have left. Of these four, two returned to ordinary schools where they are managing successfully. Two went to schools for the deaf, one to a boarding school and one to a day school in Essex. At present there are nine children in the Unit, and of these four spend part of each day in a normal class. One boy came back to the Unit saying: "The boys in that class can write stories. Will you help me to write one?" This kind of motivation to use creative language is of very great value, and is an important factor in the children's progress. A second classroom has now been provided. This enables us to work in small groups and helps to ensure that this very diverse group of highly distractible children is really being fully extended, not just happily occupied. We are grateful to the Headmaster, Staff and children of West Thornton School for the help, encouragement and friendliness which they always give to the children in the Unit. One boy plays in the School football team and all the children have a great sense of being included in the life of the school. DELICATE PUPILS In Day Special Schools 18 In Residential Special Schools 10 During the year three pupils were ascertained as delicate and admitted to residential special school. Eighteen pupils listed as delicate attend St. Giles' School but they are not delicate in the lay sense of the term, all having recognised disabilities such as asthma or moderate heart disease. 51 HOME TUITION If a child is not fit to attend any school, usually due to a temporary medical condition, tuition is provided at home. Such children are returned to school as quickly as possible, since children need social contact for normal development, During the year 27 children were recommended for home tuition and 8 were still receiving this at the end of the year. UNSUITABLE FOR EDUCATION IN SCHOOL This will be the last year in which children are classified under the above heading. As referred to earlier the Education (Handicapped Children) Act, 1970, came into effect on 1st April, 1971, and from that date all retarded children were similarly classified as educationally subnormal. Before the operation of the Act five 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). Two of these children were already attending Coldharbour School, the former Junior Training Centre, two were not yet in school, and one child had had a trial at the Day School for Physically Handicapped Children. All were referred tothe Health Committee, and the three children not attending Coldharbour School were offered places there. IMMIGRANT PUPILS - RECEPTION CENTRE Dr. P. Goberdhan, Departmental Medical Officer During 1971, a total of 502 children were medically examined at Taberner House. A summary of the findings is given in the Table below:— Percentage of Defects in Children Examined ALL AGE GROUPS EUROPEAN ASIAN BRITISH OTHER India • Pakistan WEST INDIES COUNTRIES DEFECTS 51 55 104 79 42 33 70 68 Boys Girls Boys Girls Boys Girls Boys Girls SKIN 5.9 5.5 3.9 5.1 7.1 - 8.6 8.8 VISION 19.6 32.8 22.1 41.5 21.4 12.2 14.3 16.4 HEARING - 1.8 - - - - 1.4 1.5 NOSE AND THROAT 2.0 - 1.9 2.5 - - 2.9 1.5 HEART AND CIRCULATION 2.0 3.6 - 1.3 2.4 - 1.4 - LUNGS 2.0 3.6 - 1.3 7.1 - 2.9 1.5 STABILITY 5.9 1.8 1.0 - 4.8 - - - 52 Height and weight measurements were taken of all children. As in the 1969 and 1970 figures, this shows that Asian children are less heavy and smaller than those of other groups. This is especially apparent between the ages of five to twelve years. Average Heights and Weights Table 1971 Boys and Girls European Asian B.W.I. Others Ages In Years Height Weight Height Weight Height Weight Height Weight 5 & 6 years 44.3 In. 44.3 lb. 43.3 in. 38.9 lb. 44.8 In. 45.4 lb. 43.1 in. 41.5 lb. 7 & 8 years 47.9 In. 51.9 lb. 47.6 In. 48.1 lb. 49.0 In. 52.2 lb. 48.7 In. 51.5 lb. 9 & 10 years 52.4 in. 63.7 lb. 51.5 In. 54.8 lb. 52.5 In. 59.7 lb. 51.3 in. 62.2 lb. 11 & 12 years 57.7 In. 80.4 lb. 55.7 in. 69.3 lb. 56.9 In. 77.2 lb. 56.6 in. 79.6 lb. 13 & 14 years 61.6 In. 98.8 lb. 60.4 In. 92.3 lb. 58.4 in. 90.1 lb. 59.9 in. 93.9 lb. 15 & 16 years 63.6 In. 122.7 lb. 62.9 In. 107.6 lb. 63.8 in. 126.1 lb. 63.3 in. 104.7 lb. From the 4th May, 1971, the use of the Tine Test for Tuberculosis on all the children being examined was introduced. The figures for the Tine Tests though small are as follows:— Total number of children tested 383 Total number positive (i.e. those who had been exposed to tuberculosis) 43 The results of further investigation at the Chest Clinic of these children were:— Cleared 17 For further observation 21 Treatment given 1 No reports available 4 53 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 1972 as in Forms 7, 7M, and 11 Schools 55,886 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 No. of Pupils 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) 1967 and later 349 349 - 7 47 53 1966 3.252 3,244 8 140 451 551 1965 1.815 1.815 - 88 334 386 1964 250 250 - 8 45 50 1963 2.548 2.547 1 202 421 569 1962 1.982 1.982 - 180 318 456 1961 760 759 1 78 108 165 1960 615 615 - 82 122 184 1959 2.139 2.139 - 235 362 548 1958 1,526 1.526 - 176 239 384 1957 1,209 1.209 - 146 234 345 1956 and earlier 1,735 1.735 - 281 335 564 TOTAL 18,180 18,170 10 1,623 3.016 4.255 Column (3) total as a Column (4) total as a percentage of Column (2) percentage of Column (2) total 99.94% total 0.06% 54 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 1,159 Number of Re-inspections 4,097 Total 5,256 TABLE C - INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 52,119 (b) Total number of individual pupils found to be infested 399 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) Nil (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Nil 55 PART 2 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS DURING THE YEAR 1971 T = requiring Treatment 0 = requiring Observation Defect or Disease PERIODIC INSPECTIONS SPECIAL INSPECTIONS ENTRANTS LEA VERS OTHERS TOTAL SKIN T 139 327 651 1117 33 U 141 67 191 399 26 EYES - (a) Vision T 235 427 961 1623 83 0 570 142 1026 1738 103 (b) Squint T 126 13 117 256 16 0 23 1 23 47 10 (c) Other T 17 9 24 50 5 U 17 6 28 51 3 EARS - (a) Hearing T 62 23 121 206 21 0 295 10 139 444 12 (b) Otitis Media T 60 8 39 107 4 0 157 5 95 257 (c) Other T 3 4 9 16 3 0 18 4 28 50 2 NOSE AND THROAT T 150 29 161 340 11 0 449 51 366 866 48 SPEECH T 76 9 42 127 22 0 88 2 44 134 22 LYMPHATIC GLANDS T 9 2 3 14 1 0 96 14 74 184 5 HEART T 39 28 62 129 3 0 49 26 92 167 17 LUNGS T 69 36 102 207 5 0 120 18 122 260 20 DEVELOPMENTAL - (a) Hernia T 6 2 24 32 2 0 32 3 22 57 12 (b) Other T 36 39 164 239 11 0 134 70 327 531 36 ORTHOPAEDIC - (a) Posture T 7 5 9 21 2 0 13 21 206 103 17 (b) Feet T 30 ' 7 48 85 4 0 82 76 143 301 10 (c) Other T 35 40 58 133 4 0 110 50 148 308 18 NERVOUS - (a) Epilepsy SYSTEM T 14 6 15 35 6 0 26 5 11 42 6 (b) Other T 58 9 59 126 7 0 124 8 73 205 30 PSYCHO- (a) Devlopment LOGICAL T 13 _ 9 22 13 0 53 6 58 117 10 (b) Stability T 15 7 46 68 13 0 116 19 166 301 27 ABDOMEN T 9 7 29 45 3 0 24 5 58 87 8 OTHER T 22 15 57 94 12 O 83 43 147 273 12 56 PART 3 TABLE A EYE DISEASES. DEFECTIVE VISION AND SQUINT External and other, excluding errors of refraction and squint Number of cases known to have been dealt with 4 Errors of refraction (including squint) 1363 Total 1367 Number of pupils for whom spectacles were prescribed 472 TABLE B - DISEASES AND DEFECTS OF EAR. NOSE AND THROAT Received operative Number of cases known to have been dealt with 68 (a) for diseases of the ear (b) for adenoids and chronic tonsillitis 567 (c) for other nose and throat conditions - Received other forms of treatment 35 Total 670 Total number of pupils still on the register of schools at 31st December 1971, known to have been provided with hearing aids:— (a) during the calendar year 1971 9 lb) in previous years 79 TABLE C - ORTHOPAEDIC AND POSTURAL DEFECTS la) Pupils treated at clinics or out-patients depts. Number known to have been treated 258 lb) Pupils treated at school for postural defects 24 Total 282 TABLE D - DISEASES OF THE SKIN Ringworm - (a) Scalp Number of pupils known to have been treated - (b) Body 2 Scabies 21 Impetigo 4 Other skin diseases 36 Total 63 TABLE E - CHILD GUIDANCE TREATMENT Pupils treated at Child Guidance clinics Number known to have been treated 321 57 TABLE F • SPEECH THERAPY Number known to have been treated Pupils treated by speech therapists 1183 TABLE G - OTHER TREATMENT GIVEN Number known to have been treated la) Pupils with minor ailments 1875 (b) Pupils who received convalescent treatment under School Health Service arrangements 15 (c) Pupils who received B.C.G. vaccination 3181 Id) Other than (a), (b) and (c) above. Please specify (1) Enuresis 271 (21 Overweight Clinics 216 (3) Consultant for Speech Disorders 39 Total l(a)(d) 5597 APPENDIX B - TREATMENT CLINICS Summary of Attendances 1971 1970 Increase or Decrease Audiology Clinic 961 890 + 71 Dental Clinics 30.280 29.920 + 360 Enuresis Clinics 963 888 + 75 Eye Clinics 1.371 1,195 + 176 Inspection Clinics 753 861 - 108 Minor Ailments and Verruca Clinics 12,159 11,363 + 796 Physiotherapy Clinics 2,256 3,162 - 906 Weight Control Clinics 353 500 + 147 49,096 48.779 + 317 58 AUDIOLOGY CLINIC Numbers attending Croydon Day Schools and Pre-School Children (a) With hearing sufficiently impaired to require regular supervision: Pre-School Pupils 7 Primary School Pupils 25 Secondary School Pupils 2 34 (b) With a hearing loss requiring occasional supervision. Pre-School Pupils Nil Primary School Pupils 12 Secondary School Pupils 24 Pure Tone Audiometer Tests (Excluding Sweep Test Failures). (a) Tested for the first time 386 (b) Tested as a review case 363 749 Sweep Testing of Five Year Old School Entrants Number of schools visited 70 Number of children tested 8,217 Number of children passed 6,877 Number of children failed 722 Number of children to be re-tested 618 Number of children not tested 482 (absent or unco-operative). The failures were re-assessed as follows: No hearing loss 103 Slight hearing loss 276 Moderate hearing loss 206 Moderately severe hearing loss 53 Severe hearing loss 5 Failed to keep appointments 35 Left district 18 Waiting to be tested 26 Issue of Hearing Aids (a) National Health Service 'Medresco' aids 7 (b) Commercial aids bought by Croydon L.E.A 13 20 7 children under school age are using hearing aids. 59 DENTAL SERVICE Items of Treatment 1971 1970 (1) Number of children first inspected at school 35,787 43,344 (2) Number of children first inspected at clinic 7,179 5,955 (3) Number of (1) and (2) found to require treatment 23,458 24,202 (4) Number of (1) and (2) offered treatment 23,260 24,202 (5) Number re-inspected at school or clinic 5,489 8,772 (6) Number of (5) requiring treatment 3,059 4,279 (7) Visits - First 9,109 9,696 Subsequent 21,171 20,224 30,280 29,920 (8) Additional courses commenced 1,397 1,071 (9) Fillings - Permanent 16,696 17,210 Deciduous 11,841 11,172 28,537 28,382 (10) Teeth filled - Permanent 14,171 14,261 Deciduous 10,479 10,111 24,650 24,372 (11) Extractions - Permanent 1,545 1,604 Deciduous 4,045 4,044 5,590 5,648 (12) General Anaesthetics 1,488 1,704 (13) Emergencies 1,355 1,293 (14) X-rays (Number of patients) 1,400 1,326 (15) Prophylaxis 744 1,077 (16) Teeth otherwise conserved 591 967 (17) Teeth root filled 188 108 (18) Inlays 4 15 (19) Crowns 117 73 (20) Other operations 3,756 4,184 (21) Advice 1,636 1,185 (22) Appointments not kept 8,884 9,651 (23) Courses of treatment completed 8,012 8,684 60 (24) Orthodontics - 1971 1970 Cases remaining from previous year 145 245 New cases commenced during year 229 265 Cases completed during year 162 165 Appliances - Removable 477 447 Fixed 85 31 (25) Number of dentures supplied 25 19 (26) Number of sessions - Treatment 4,189 4,017 Inspection 285 444 Dental Health Education 35 39 EYE CLINICS PURLEY, SANDERSTEAD AND ADDINGTON 1971 1970 No. of New cases examined 994 706 No. of Re-examinations 377 489 Total number of examinations 1,371 1,195 No. of children for whom spectacles were prescribed 374 309 On 31st December 1971 the number of:— (1) New Cases referred but not yet examined was 49 (2) Children due for review in 1971 and still awaiting re-examination was 93 MINOR AILMENTS CLINICS Clinic Defects Attendances Ashburton School 283 1,420 Lodge Road 283 2,318 New Addi ngton 542 2,758 Norbury Manor School 56 488 Old Coulsdon 60 325 Purley 165 1,284 Rectory Park 203 1,630 Rockmount School 70 702 Waddon 213 1,234 61 MINOR AILMENTS CLINICS (continued, 1971 1970 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm - - - - - - Scabies - - - 4 4 1.0 Impetigo 4 4 1.0 6 13 2.2 Other Skin Defects 36 64 1.8 64 97 1.5 Otorrhœa and other Ear defects - . . 9 16 1.8 External Eye Defects 4 15 3.8 10 19 1.9 Verrucae 1.403 10,066 7.2 1,250 8,391 6.7 Miscellaneous 428 2.010 4.7 562 2.823 5.0 TOTALS 1.875 12.159 6.5 1.905 11.363 6.0 PHYSIOTHERAPY CLINICS 1971 1970 Total number of pupils treated 376 527 Total number of new cases 125 199 Total number of Orthopaedic conditions 200 343 Total number of Respiratory conditions 176 184 Individual treatments 319 387 Number of classes 109 162 SPEECH CLINICS 1971 1970 Total number of cases treated 1,183 1,342 Number of new cases 233 266 Number of cases discharged 392 429 Number of reviews 856 995 Treatment sessions 9,369 11,668 62 APPENDIX C RETURN OF MEDICAL INSPECTIONS - NON MAINTAINED SCHOOLS A. Routine Medical Inspections:- Year Year 1971 1970 Aged 11 and under 27 41 12 135 111 13 57 65 14 88 61 15 and over 145 183 Total Pupils 452 461 Visits to non-maintained schools 26 28 B. The following defects were found:- Requiring Treatment Observation Skin 38 5 Vision 109 32 Squint 2 - Hearing 5 1 Otitis Media 1 - Nose and Throat 4 5 Speech - - Cervical Glands - - Heart and Circulation 4 1 Lungs 7 - Development (Other) 5 12 Posture 10 9 Flat Foot 2 8 Orthopaedic (Other) 6 9 Nervous System (Other) 1 1 Psychological 3 1 Other Defects 11 4 C. Other Inspections:- There were 61 Re-inspections, and 2 Special Medical Inspections. 63 APPENDIX D NUMBERS OF PUPILS ON SCHOOL REGISTERS, AND NUMBERS OF CHILDREN EXAMINED AT ROUTINE MEDICAL INSPECTIONS IN MAINTAINED SCHOOLS DURING THE YEAR 1971 Primary Schools Numbers on No. of Children Examined Registers Boys Girls Total All Saints' (C. of E.) J.M 308 42 35 77 All Saints' (C. of E.) I 206 17 16 33 Applegarth J.M 477 62 59 121 Applegarth I. 342 56 60 116 Ashburton J.M 635 86 83 169 Ashburton I 354 78 50 128 Atwood J.M. & I 372 65 73 138 Beaumont J.M. & I 164 30 21 51 Benson J.M. & I. 578 92 77 169 Beulah J.M 604 62 84 146 Beulah I 363 83 68 151 Broadmead I 227 52 42 "4 Byron J.M. & I 350 72 55 Castle Hill J.M 593 132 115 247 Castle Hill I 464 88 58 146 Chipstead Valley J.M. & .I. 577 101 77 178 Christ Church (C. of E.) J.M.&.I. 246 44 37 81 Coulsdon J.M. & I. 130 19 15 34 Courtwood J.M. & I. 214 42 46 88 Cypress J.M. 337 39 31 70 Cypress I 239 66 52 118 David Livingstone J.M. & I. 268 36 41 77 Davidson I. 153 20 27 47 Duppas J.M 354 49 40 89 Ecclesbourne I. 212 52 61 113 Elmwood J.M 663 75 79 154 Elmwood I 356 46 47 93 Fatrchildes J.M 438 64 59 123 Fairchildes 1 323 74 90 164 Fieldway J.M. & I. 361 70 49 119 Forestdale J.M. & I 173 38 33 71 Gilbert Scott J.M 625 86 72 158 Gilbert Scott I. 342 92 57 149 Gonville J.M. & I 489 55 76 131 Good Shepherd (R.C.) J.M 281 46 56 102 Good Shepherd (R.C) I. 190 37 31 68 Gresham J.M. & I. 335 51 47 98 Hayes J.M. ft I 388 67 40 107 Howard J.M. & I. 307 54 53 107 Kenley J.M. & I. 333 54 48 102 Kensington Avenue J.M. 521 60 64 124 Kensington Avenue I. 289 46 31 77 Keston J.M 362 37 43 80 Keston I. 246 90 71 161 Kingsley J.M 502 89 71 160 Kingsley I. 374 81 92 173 Margaret Roper (R.C.) J.M. & I. 274 33 41 74 Monks Orchard J.M. &. I. 473 72 69 141 Norbury Manor J.M 461 56 71 126 Norbury Manor I. 310 63 55 118 Orchard Way J.M. & I. 163 23 25 48 Oval J.M 344 39 29 68 Oval I. 222 28 26 54 Parish Church (C. of E.) J.M 301 36 42 78 Parish Church (C. of E.) I. 215 40 47 87 64 Primary Schools Numbers on Registers No. of Children Examined Boys Girls Total Park Hill J.M 305 57 38 95 Purley Oaks J.M 348 44 38 82 Purley Oaks I. 211 15 13 28 Regina Coell (R.C.) J.M. & I. 395 59 47 106 Ridgeway J.M 382 40 55 95 Ridgeway I. 224 49 40 89 Rockmount J.M 364 108 89 197 Rockmount I. 263 54 44 98 Roke J.M. &.I. 493 86 61 147 Rowdown J.M 443 47 57 104 Rowdown I 393 86 75 161 Ryelands I. 129 24 24 48 St. John's (C. of E.) J.M. & I. 304 50 36 86 St. Joseph's (R.C.) J.M. & I. 492 84 81 165 St. Mark's (C. of E.) J.M. & 1. 243 39 34 73 St. Mary's (R.C.) J.M 331 50 37 87 St. Mary's (R.C.) I. 225 48 45 93 St. Michael's (C. of E.) I. 78 10 12 22 St. Peter's J.M. & I. 238 36 41 77 Selsdon J.M. & I. 628 115 120 235 Smitham J.M. & I. 481 61 77 138 South Norwood J.M 565 75 85 160 South Norwood I. 354 94 70 164 Spring Park J.M. 477 61 43 104 Spring Park I. 302 30 35 65 Sydenham J.M 289 55 44 99 Thomas Becket (R.C.) J.M. & I. 308 33 41 74 Toldene J.M. & I. 252 42 35 77 Waddon I. 247 52 46 98 Wattenden J.M. & I. 194 41 26 67 West Thornton J.M. &I. 451 83 62 145 Whitehorse Manor J.M 555 67 56 123 Whitehorse Manor I. 401 100 98 198 Winterbourne J. Boys 454 107 - 107 Winterbourne J. Girls 444 - 128 128 Winterbourne I. 456 114 91 205 Wolsey J.M 567 143 136 279 Wolsey I. 413 89 69 158 Woodcote J.M 380 37 47 84 Woodcote I. 254 50 44 94 Woodside J.M 602 80 78 158 Woodside I. 315 85 75 160 TOTAL 34,678 5.786 5.310 11.096 SPECIAL SCHOOLS Coldharbour (E.S.N.) Mixed 98 57 35 92 St. Christopher's (E.S.N.) Mixed 210 63 55 118 St. Giles( (P.H. & Del.) Mixed 138 83 55 138 St. Luke's (Partially Sighted) Mixed 18 10 8 18 St. Nicholas (E.S.N.) Mixed 164 48 27 75 Sir Cyril Burt (Maladjusted) Mixed ... 28 - • • TOTAL 656 261 180 441 NURSERY SCHOOLS Coulsdon 31 16 15 31 Crosfield 42 16 26 42 Purley 47 21 15 36 Tunstall 72 5 4 9 TOTAL 192 58 60 118 65 Secondary Schools Numbers on Registers No. of Children Examined Boys Girls Total Archbishop Tenlson (C. of E.) Mixed 373 85 60 145 Ashburton Mixed 1,266 219 159 378 Coloma (R.C.) Girls 655 - 195 195 Davidson Mixed 440 79 52 131 Ecclesbourne Girls 413 - 117 117 Fairchildes Mixed 1,124 238 233 471 Haling Manor Mixed 978 219 167 386 Heath Clerk Mixed 822 60 61 121 Ingram Boys 526 145 - 145 John Newnham Mixed 533 104 86 190 John Ruskin Mixed 625 182 53 235 Lady Edridge Girls 542 - 164 164 Lanfranc Mixed 1.110 266 225 491 Monks Hill Mixed 569 128 129 257 Norbury Manor Boys 473 128 - 128 Norbury Manor Girls 474 - 134 134 Our Lady's (R.C.) Girls 161 - 66 66 Overbury Mixed 651 139 150 289 Purley Boys 666 193 - 193 Purley Girls 639 - 168 168 Rlddlesdown Mixed 990 154 181 335 St. Andrew's (C. of E.) Mixed 271 72 69 141 St. Mary's (R.C.) Mixed 509 117 91 208 Selhurst Boys 634 163 - 163 Selhurst Girls 567 - 150 150 Shirley Mixed 647 130 134 264 South Norwood Mixed 466 176 128 304 Stanley Technical Boys 359 129 - 129 Taunton Manor Mixed 570 66 68 134 Tavistock Mixed 551 96 45 141 Thomas More (R.C.) Mixed 614 142 93 235 Westwood Girls 453 - 125 125 Woodcote Mixed 680 85 79 164 TOTAL 20,351 3,515 3.382 6.897 66 CASES OF INFECTIOUS DISEASES AS NOTIFIED BY HEAD TEACHERS Disease 1971 1970 1969 Chicken Pox 684 579 721 Conjunctivitis 12 27 14 Diphtheria - - - Gastro-Enteritis 3 22 9 German Measles 368 267 485 Impetigo 30 34 46 Jaundice 1 2 22 Measles 310 388 506 Mumps 47 878 1,295 Non-Specific Diarrhoea including Dysentery 247 325 551 Non-Specific Vomiting 74 10 43 Other Diseases 47 342 553 Poliomyelitis - - - Ringworm or Vermin Body 2 3 1 Scalp - - - Scabies 14 10 13 Scarlet Fever 66 78 87 Sore Throar including Tonsillitis 72 111 112 Whooping Cough 50 55 19 TOTALS 2,027 3,131 4,477 WORK OF THE SCHOOL HEALTH VISITORS AND NURSES 1971 1970 Home Visits re pupils 3,665 3,787 visits Social Welfare visits to Schools 451 421 " Minor Ailments 1,330 1,262 sessions Hygiene 822 647 " Pre-Medicals 1,290 1,226 " Routine Medical Inspections 1,304 1,405 " Follow-up 39 17 " Immunisation 137 64 " Health Survey 119 61 " Health Education 578 404 " Enuresis Clinics 87 78 " Eye Clinics 115 120 " Inspection Clinics 89 72 " CONTENTS A. - PUBLIC HEALTH REPORT Page Accommodation for confinements 12 Animal Boarding Establishments Ac 50 Animals, diseases of 41 Ante-natal clinics 21 At risk register 96 Bacteriological examination 55, 114 Births 11,12 Caravan sites 42 Cancer 85 Census 11 Cervical cytology 30, 108 Chest clinic, work of 15 Child health centres 22, 99 Chiropody 29, 108 Clean air act 39 Committee, health and public services 3 Communicable diseases 18,111, 112 Congenital malformations 21,95 Consumer protection act 49 Cremation 110 Deafness 29, 97 Deaths 11,82 Dental treatment 6, 28, 106 Dialysis, home 74 Disinfection 40 Disinfestation of premises 41 Domiciliary nursing team 6 Drainage 37 Drug dependency 77 Elderly persons, rehabilitation of 102 Employment agencies 48 Environmental hygiene 6 Fabrics (misdescription) act, 1913 50 Factories and workshops 44 Family planning 6, 73, 107 Food and drugs act, 1955 53, 57 Food hygiene regulations, 1960 52 Food poisoning 113 Foodstuffs, condemned 54 Food supply 52 General practitioner attachment schemes 103 Hairdressing 49 Health centres 6, 22 Health education 41,6, 25 Health visitors, work of 24, 98 Home dialysis 74 Home nursing 23, 101 Home safety 27, 105 Housing 35 Health Services co-ordination 7, 25 Ice-cream - bacteriological examination of 56 Illegitimacy 11 Page Immigrants, longstay 74, 109 Immunisation 18, 115 Infant mortality 1, 86, 87 Inspection - public health inspectors 43, 60 Local land charges 40 Marriages 12 Maternal mortality 11, 90 Maternity homes 110 Meat inspection 54 Medical examinations 75, 76 Midwifery 24 Midwives act 21 Midwives, work of 88, 91 Milk supply 55 Mines and quarries act, 1954 42 Mortuary 110 Mothercraft classes 21 National assistance acts 74 Neonatal deaths 11 Noise abatement 38 Notification of births acts 11, 12 Nursing equipment, loan of 104 Nursing homes 110 Nurses agencies 110 Occupational health nurses 26 Offices, shops and railway premises act 45, 48, 62 Outwork 45 Paediatric assessment 21 Perinatal deaths 11, 86 Pest control 37 Pet animals act 51 Phenylketonuria 89 Pharmacy and poisons act 51 Planning applications 40 Poliomyelitis, vaccination 116 Population 11 Post-natal clinics 21 Post-mortems 110 Premature infants 94 Prosecutions 46, 48, 59 Public health inspectors, work of 33 Public health laboratory, service 17, 114 Public health nursing services 23 Rag flock act 51 Rats and mice (destruction) act 38 Rehousing on medical grounds 74 Relaxation classes 21 Remedial works carried out 47 Riding establishment act, 1964 51 Rivers and streams, pollution of 37 Schools 54 Scrap metal dealers act, 1964 51 Sexually transmitted diseases 19,120 Sewage Disposal 69 Page Shops act 48 Social Services department 3, 26 Statistics, summary of 11. 81 Stillbirths 11 Tuberculosis, contacta 16 home visits 16 mortality 16,117 notifications 15, 117 prevention and control 15 vaccination 16,17 Page Vaccinations (smallpox 116 Verminous persons 41 Vital statistics 11, 81, 82 Water supply 69 Welfare foods 22. 95 X-ray 16 B. - SCHOOL MEDICAL REPORT Page Audiology 2,12, 16, 58 Child Guidance 2, 17, 46 Cleansing of Pupils 1, 11, 54 Clinics 5, 57 Coldharbour School 44 Convalescent treatment 32 Costs 6, 33 Deaf children 16, 37 Deaths 33 Defects found 9, 10, 55 Delicate children 34, 48 Dental services 18, 59 Developmental defects 13 Enuresis clinics 21 Epileptic children 34, 45 Eye clinics 12, 22, 56 Handicapped children 3, 34 Health Education 3, 22 Heart and circulation 13 Heights and Weights 14, 15, 31 Home tuition 51 Immigrant pupils 51 Infectious diseases 66 Intelligence assessments 27 Juvenile employment 32 Maladjusted pupils 2, 17, 46 Meals and Milk 3, 33 Medical inspections 1,7, 53, 63 Minor ailments tables 60, 61 Page Non-maintained schools 8, 62 Nutrition 3, 14, 15, 31 Orthodontic service 60 Orthopaedic defects 13, 29 Overweight pupils 14, 15, 31 Parents, attendances of 8 Partially hearing units 37 Physiotherapy 29, 61 Populations of schools 53, 63 Psychological defects 13, 17, 46 School nurses, work of 66 Special inspections 7, 54, 55 Speech 30, 50, 55 Staff 4, 6 Statutory tables 53 Sub-normal pupils 41 Sir Cyril Burt School 46 St. Christopher's School 42 St. Giles School 48 St. Luke's School 36 St. Nicholas School 43 Transport of pupils 32 Tuberculosis 13 Uncleanliness 1, 11, 54 Verrucae 1,11,61 Vision defects 2, 12, 22