LB I CRO 74 PUBLIC HEALTH IN CROYDON 1972 VOL. 10. PART 2. NO. 1 CRO 74 PUBLIC HEALTH IN CROYDON 1972 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1972 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 1972 Alderman B.C. Sparrowe (Chairman); Councillor Mrs. P.A.M. Little; Councillor Mrs. N.B. Booth (V ice-Chairman); Councillor Mrs. S.E. Lord, S.R.N.; Councillor K.M.B. Munro; Councillor Mrs. J.M.C. Baker; Councillor B.H. Rawling; Councillor V.W.H. Bendall; Councillor N.A. Tully; Councillor R.T. Bishop; * Councillor Anne Usher; Councillor A.E. Buddie * Councillor Mrs. A.M. Watson, J.P. Councillor V. Burgos; * Councillor H.G. Whitwell; Councillor P. Byrne; Doctor Maureen Adams, M.B.,B.S. M.R.C.S., M.R.C.P., Councillor S.L. Eaton; *Councillor A.W. Elliott; P.S. Boffa, Esq., M.D. *Councillor Mrs. W.M. Holt, J.P. J.F. Boyle, Esq., M.B.,B.Chir., D. Obst., R.C.O.G. Councillor Mrs. M.M.H. Horden; Councillor C.E. Kelly A. Tickner, Esq., B.Sc.,M.B., B.S. F.C. Path. * Councillor H.G. Whitwell resigned from the Council and Councillor A.W. Elliott was appointed to the Committee in his place on 24th July, 1972. Councillor Mrs. W.M. Holt was appointed in place of Councillor Mrs. A.M. Watson on 9th October, 1972 Councillor Anne Usher was appointed in place of Councillor Mrs. W.M. Holt on 13th November, 1972. 5 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1972 To the Chairman and Members of the Health and Public Services Control Committee LADIES AND GENTLEMEN This statutory report for the year 1972 follows the usual pattern and provides a mainly statistical record for the year under review. Statistics In comparison with the previous year the number of births fell by 8.6%, in line with the national trend. This reflects the change in public opinion and the greater availability of Family Planning services. The percentage of illegitimate births (10) was the same as last year. There were two deaths associated with childbirth, and the routine reports made to the Department of Health indicated that neither could have been anticipated or prevented. The general death rate was raised by a winter outbreak of influenza, increasing fatalities amongst the elderly and debilitated members of the community. It partly explains a considerable rise in deaths from lung cancer, which amongst men reached the highest level of recent years. 6 Health Centres The planning of the South Norwood Health Centre reached the stage of acceptance of a tender, and it was hoped that the building would be completed by mid-1973. This project has unfortunately progressed very slowly, but there have been advantages that delays have allowed the new guide lines of the Department of Health to be used. Experience at the Parkway Health Centre has shown that previous standards did not allow sufficient accommodation for certain essential functions, to the discomfort of both patients and staff using the building. Plans for South Norwood were redrawn to correct this defect. Community Nursing Care The Director of Nursing details the important changes due to national and international events, which influenced the administration of these services during the year under review. They were not allowed to disturb the advice and care given by the staff to members of the public, nor significant developments to improve the facilities which could be offered. Despite a vigorous training programme the recruitment and retention of Health Visitors remained an unsolved problem, and the target of complete integration with general medical practice could not be achieved. Care of Pre-School Children The early detection and correction of inborn defects has of recent years been an increasing responsibility of the Child Health Service. Departmental Medical Officers have been seconded to attend special courses in developmental paediatrics, which included for one member of the staff whole-time attendance for an academic year at the Institute of Child Health in London. The Paediatric Department at Mayday Hospital received a special grant from the Regional Hospital Board to build an Assessment Unit for early diagnosis, observation and treatment of handicapped children. The Health Department have co-operated in its design, and a joint appointment agreed forthe Departmental Medical Officer with special training in this subject. Health Education There was some easing of the difficulties to recruit Health Education Officers, which has continuously curtailed the full development of this service, but this did not extend to the supporting ancilliary and clerical staff. Nevertheless the Principal Health Education Officer is able to report on a year of further progress. Family Planning The Corporation agreed to increase their reimbursement of charges to the Family Planning Association as from April 1st 1972 to include free 7 advice to all as well as free supplies to medical and social cases. This applies to residents of the borough wherever they attend a Family Planning Association clinic. The Corporation also agreed to pay similar reimbursement to the Brook Advisory Clinics, and to introduce a limited vasectomy service. The domiciliary family planning service which is provided directly by Corporation staff, was also extended. More clinics were opened by the Family Planning Association, and additional sessions provided to cope with increasing demands. Health Service Reorganisation The anticipated decision not to co-ordinate health services under local authority control was received with regret, and every effort made to ensure that the new Area Health Board for Croydon would be based on the area of the London Borough. Since 1948 the Croydon Health Department has accepted the primary duty to strive for integrated local services to minimise the disadvantages of separate administrative systems. With continued goodwill and effort the success of these efforts should not be lost under the new system to be imposed. If this is the case an improved service to the public should be forthcoming. Against this background of doubts and uncertainty my thanks are due to the staff of the Department who have not been distracted from their duties, and to the Chairman and Members of the Committee, unchanged in their wish to do all that is possible to improve services available to the residents of the borough. I am Yours faithfully, S.L. WRIGHT, Medical Officer of Health and Principal School Medical Officer. STATISTICS 11 SUMMARY OF STATISTICS FOR 1972 Area, 21,395 acres Population (Census 1971) 333,870 Total population (estimate of Registrar General) 334,000 (Midsummer, 1972) Number of Domestic Dwellings; 109,561 Rateable Value of Borough 1972 as from 1.4.72 £23,504,607 Product of a Penny Rate, for London Borough of Croydon purposes, £239,000 Mixed Rate in the£. 81.5p(for the year from 1 4.72) Live Births Males Females Total Legitimate 2,271 2,123 4,394 Illegitimate 250 222 472 4,866 Illegitimate Live Births percent, of total live births 10 Live Birth Rate (as adjusted by comparability factor 0.97) 14.6 (England and Wales) 14.8 Stillbirths 61 Stillbirth rate per 1,000 total (live and still) births 12 (England and Wales) 12 Total Births (Live and Still) 4,927 Infant Deaths 69 Infant Mortality rate per 1,000 live births 14 (England and Wales) 17 Infant Mortality rate per 1,000 legitimate live births 13 Infant Mortality rate per 1,000 illegitimate live births 30 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 9 (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) 2 Maternal Mortality rate (including abortion) per 1,000 total live and still births 0.41 Deaths, 3,828 Death-rate per 1,000 of the estimated population 11.5 (England and Wales) 12.1 Death-rate (as adjusted by comparability factor 0.99) 11.4 12 Marriages The number of marriages solemnised in 1972 in the Croydon Registration District was as follows:— Church of England 918 Non-conformist places of worship 596 The Register Office 1,496 When supplying these figures Mr. Davies, the Croydon Superintendent Registrar, kindly analysed recent trends and commented:— "During the year the percentage of minors under the age of 18 years giving notice remained fairly consistent at 5.4% compared with 6.01% for 1971. By comparison with last year's figures there has been a continued increase in the number of marriages taking place at the Register Office. Notification of Births Notifications were received in respect of confinements conducted by:— Live Births Still Births Total Midwives 3,280 34 3,314 Doctors 817 20 837 4,097 54 4,151 Accommodation for Confinements The following table shows where babies were born in the Borough of Croydon during the whole of 1972. 763 residents had babies outside Croydon and 66 non-residents were confined in Croydon. Number Percentage In Private Houses 692 16.7 In Public Institutions 3,452 83.1 In registered Maternity Homes 7 .2 Total 4,151 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 1972 may be regarded as satisfactory. Incidence 68 cases of Respiratory Tuberculosis and 21 cases of Non-Respiratory Tuberculosis were notified on Form A during 1972 (Table 1 - Formal Notifications). Of these 52 males and 16 females were Respiratory cases and 9 males and 12 females were Norv-Respiratory. In addition 16 Respiratory cases and 5 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 1972 by notification or otherwise was 110. 84 of these were cases of Respiratory Tuberculosis; 60 in males and 24 in females. There were two cases of Non-Respiratory Tuberculosis among children under 15 years. The number of cases in adults was 24. The incidence rate of Tuberculosis, all forms, was 0.32 per 1,000 of the population, for Respiratory Tuberculosis 0.25 and for Non-Respiratory Tuberculosis 0.07 per 1,000 population. The notification rate was 0.26 per 1,000. Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1972 RESPIRATORY NO N~RESP!RA TORY Males Females Total Males Females Total Total Cases 522 398 920 71 96 167 1,087 In 1972 the death-rate from all forms of Tuberculosis was 0.04 per 1,000 population. The rate from Respiratory Tuberculosis was 0.04 and the rate for NonRespiratory 0.00 In 1972 the total number of deaths was 14. 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 123. 16 Deaths from Non-Respiratory Tuberculosis During 1972 no death was certified to be due to Non-Respiratory Tuberculosis. Co-ordination with the Health Department During the year 22 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 32 selected cases for varying periods during the year and 27 cases were in receipt of extra nourishment at the end of the year. The Chest Clinic and Home Visiting 1,517 new cases were examined during the year. 70 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 14,600 The Clinic doctors paid 176 home visits and the Tuberculosis Visitors 3,786 visits for Clinic purposes. In addition the Tuberculosis Visitors made 98 primary visits forthe purposes of the Notification Register. There were also 1,004 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 4,489 Number of patients recalled for examination and large film 425 Number of active cases of Pulmonary Tuberculosis found 19 Number of cases of lung cancer found 50 Contact Examination During 1972, 527 persons were examined for the first time as contacts of notified cases of Tuberculosis. Of these contacts, 7 were found to be tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 13 compared with 0.32 per 1,000 of the general population. In addition two were found to be tuberculous who had been under observation from previous years. B.C.G. Vaccination The use of B.C.G. vaccination for contacts has been continued during 1972 and regular sessions were held at the Clinic for this purpose. 559 17 contacts were successfully vaccinated during the year. In addition 22 nurses and domestics were successfully vaccinated, and 43 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 3,971 Number found to be negative 3,342 Number vaccinated with B.C.G 3,326 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 120- COMMUNICABLE DISEASES No special problems arose. The two cases of enteric fever were both due to infection acquired abroad. Notifications of measles were half as numerous as in 1971. This was due not to vaccination, but to the 2 year cycle of this infection. Meningococcal meningitis which responds readily to treatment still causes deaths in very young children who succumb too rapidly for intervention to be possible. It is a risk of infants born into large families with barely adequate accommodation, of which one or more members are healthy temporary carriers of the germ. No feasible measures are known to prevent the two fatal cases recorded in 1972. Immunisation Acceptance rates for protection cf children against poliomyelitis and diphtheria were maintained at over 75%. Measles vaccination was less popular than in 1971. Efforts to achieve a 90% acceptance which is suggested as essential to eliminate this illness seemed unjustifiable and unlikely to succeed even with an unfair diversion of scarce resources. Vaccination against rubella proceeded without difficulties, in the schools. In addition 18 Dr Thomas operated a service of offering female staff of child bearing age in such schools, blood tests to detect immunity to rubella. Results were also sent to the family doctor so that a woman found susceptible could be offered vaccination with appropriate safeguards if this was deemed advisable. Sexually Transmitted Diseases Additional treatment facilities were provided at the Special Clinic at the Croydon General Hospital. Efforts to promote preventive publicity are detailed by the Principal Health Education Officer, but no rapid improvements can be anticipated. Undoubtedly these diseases cause discomfort or chronic ill health to those infected, and economic loss to the community, but the only deaths directly attributable in 1972 were 8 due to "Syphilis and its sequelae". Since 3 of the individuals involved were over 55 and the remainder over 75 years of age, they could not have had the benefits of antibiotic treatment. Readiness to accept advice to attend the special clinics, as indicated by mounting numbers, does give hope that serious sequelae will be prevented, even if prevalence is not reduced. PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT 21 ANTE AMD POST NATAL CLINICS The unified service of hospital and local authority clinics continued. The fall in attendance eased slightly the pressure on accommodation at the Lodge Road Clinic. Nevertheless plans for possible adaptation were considered. The only feasible extension would bisect the garden of St. Mary's Hospital and against the background of possibly falling demand was not deemed a practicable proposal at the present time. No further action was taken. Attendances during the year were:- Ante-Natal 5,073 Post-Natal 893 Patients seen for first blood test 4,010 Patients found to have antibodies 27 Patients sent to Special Clinic 7 The numbers attending the Relaxation and Mothercraft classes increased again in 1972 - Midwives, Health Visitors and Physiotherapists continue to work together and combine to provide this service. In all 1,792 mothers attended these classes and made 6,907 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 147. 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 134 babies with congenital conditions was notified in 1972. For details see Appendix, page 97. PAEDIATRIC ASSESSMENTS A senior medical officer of the Corporation who holds a joint appointment with the Hospital Management Committee continued to act as a member of the paediatric team at Mayday Hospital, and examine routinely newly born infants in the Maternity unit. She dealt with 1,390 babies during 1972. 22 The Hospital with a special grant from the Regional Board built an Assessment Unit to be under the charge of the Consultant Paediatrician. Dr. Burkinshaw kindly sought our help to make this a combined Hospital and local authority service and agreed to support an application for a further joint appointment of a Corporation medical officer with special training in the subject of developmental assessment. It was anticipated that the Unit would open early in 1973. 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 overall, although the numbers of attendances at well-baby clinics run by general practitioners and health visitors has increased. The overall fall in attendances is no doubt due to the falling birth rate. For detailed figures see Appendix page 102. Welfare Foods and Medicaments The price of National Dried Milk was maintained at 20p per carton of 20 ozs. during 1972, but a steady decline in sales was recorded. The supply of Orange Juice was officially discontinued by the Department of Health and Social Security as a welfare food item on 31st December 1971, and all stock was sold by April 1972. Vitamin C was included with the Vitamin A & D tablets at a cost of 6p per container. HEALTH CENTRES The Centre at New Addington has functioned reasonably well but there have been difficulties in recruiting and retaining reception and clerical staff. The pressures on these sections have been recognised by the Department of Health, and a new building guide allows much more generous accommodation for these officers. The South Norwood Health Centre plans were altered to include these improvements and a tender was accepted in December for its construction. Doctors in the South Croydon area of the borough expressed an interest in a Health Centre and the Health Committee agreed to an official approach to the Executive CounciI. 23 THE WORK OF THE COMMUNITY NURSING SERVICE Miss A. Hayward, A.R.R.C., T.D., S.R.N., S.C.M., H.V. Cert., Director of Nursing Services During 1972, preparations were being made nationally and intenatinally to improve and safeguard professional standards of nurses. In Brussels a watching brief was kept as Britain moved nearer to joining the European Economic Community; at home, interest was building up as reorganisation of the National Health Service came closer, and in October the Committee on Nursing, under the chairmanship of Professor Asa Briggs, published their report. All three events must have long term effects on nursing, but the Asa Briggs' proposals and National Health Service reorganisation will affect the service sooner. Staff morale has remained high in spite of the original interpretation that Health Visitor training was to leave the main stream of adult education and join Nursing and Midwifery training in Colleges of Nursing. Anxiety has also been expressed by all grades of nurses about the number of levels of Management proposed for the unified service. Discussions between the Council and the Department of Health and Social Security about an appropriate management structure for the nursing service took place in the early part of the year. Final agreement was reached in July, when approval was given for functional management. (See chart on page 100).Croydon has had a Chief Nursing Officer since 1965 and the new structure required few alterations in the existing pattern. The transition was complete and all personnel were in post by the end of the year. In preparation for unification of the National Health Service at local level, the Establishment Committee agreed that:— (a) A Nursing Officer (Home Nursing) should be allocated to each of the main hospitals in the group to act as Liaison Officer, (b) the existing Health Visitor Liaison Scheme with the Paediatric Department should be extended, (c) one week's community experience should be offered to all line managers in the hospital service, (d) and one to two days community experience should be offered to ward sisters. The Hospital Establishment Committee welcomed these proposals and agreed that Nurse Managers in the Community Nursing Service should spend one week with their opposite number in the Hospital Service. Considerable progress had been made on the first two proposals by the end of the year and in November the first exchange of Nursing Officers took place. This proved to be well worthwhile. All community staff and most of the hospital staff will have participated by April 1st 1974, 24 Miss Friend, O.B.E. the Chief Nursing Officer at the Department of Health and Social Security, spent a day with the staff during July. They were pleased to welcome her to Croydon and discuss their work with her. Domiciliary Midwifery Service The falling birth rate has been reflected in the number of patients delivered at home and in the number of patients discharged early from hospital. Two midwives who resigned during the year have not been replaced. All the remaining midwives have been equipped with radio telephones. When "blind spots" have been eradicated, a more efficient service should ensue. No doubt the midwives will feel under greater pressure as they will be more readily available and a different style of management may be needed. One of the Hospital Maternity Units had to close due to infection and with the help of the Home Nurses and Health Visitors, mothers and babies were discharged for home nursing. This enabled the Unit to be re-opened in a shorter space of time. Health Visiting Service The Health Visiting Service has worked under considerable pressure this year due to the shortage of staff. The six sponsored students who successfully completed their training were insufficient in number to fill the vacancies. It is especially regrettable that it was only possible to recruit five full time and one part-time student for current training. It becomes increasingly clear that with the rising cost of living in the London area, and loss to the profession of young Health Visitors due to early marriage and pregnancy, that recruitment and retention of staff will continue to be difficult. It is, therefore, essential that work which does not require the special skills of highly trained Health Visitors is delegated to less well qualified staff. To determine more precisely how the Health Visitors are spending their time, a detailed survey of their work and that of the School/Clinic Nurse was undertaken for two weeks in September/October. The results of this survey will not be analysed until later in 1973. The attachment and alignment of Health Visitors to General Practitioners continued slowly as staffing numbers allowed. The wider range of work thus undertaken by the Health Visitors is reflected in this year's statistics. At the suggestion of one of the General Practitioners, two Health Visitors started a Slimming Club at the Parkway Health Centre one evening a week. It has proved a very successful venture. Home Nursing Service Established posts were increased during the year but this barely kept pace with the increasing work load. Considerable difficulty has been experienced in recruiting male nurses. Housing accommodation has not compensated forthe higher salaries which can be earned in the Hospital 25 Service, particularly in psychiatric hospitals. More patients were nursed at home than last year, but the significant increase is in those who require the greatest care and nursing skill, the terminally ill. Increasing involvement in surgery sessions (excluding the Health Centre) is reflected in the number of treatments which increased by nearly 100%. 26 HEALTH EDUCATION AND HOME SAFETY Miss D.S. Elliott, S.R.N., H.V.Cert., Dip.,H.E., Principal Health Education Officer. "Nature and Nature's Laws lay hid in night; God said. Let Newton be! - and all was light". Alexander Pope. If "Health Education" were substituted for "Newton" one would be voicing the opinions of those who expect changes in behaviour and reduction in manmade ill-health to occur as a direct result of educational effort. It is, however, only a part, but an essential part of the accumulation of environmental and personal experiences which continue to mould attitudes and behaviour throughout life. Offered at appropriate times Health Education can have either a catalystic or reinforcing effect. The increasing scope of the Health Education Section and the demands made upon it since tentative beginnings in 1957 bear witness to public and professional interest in health information and in opportunities for discussion with skilled staff. During the year routine work and in-service training continued as usual with the close co-operation of Health Education staff, Doctors and Health Visitors, District Nurses, Midwives, Public Health Inspectors, Social Workers, Pharmacists and Teachers. There was constant monitoring and renewal of teaching equipment, programmes and background information for staff. The first edition of "Health Education News" with a foreword written by Dr. S.L. Wright, was published and circulated to 1,000 General Practitioners, School and Education staffs, Public Health and Social Services' staffs, Hospital and Occupational Health staffs and many others. It included a description of the Health Education team and short items of practical interest for the different disciplines. Other new ventures during the year included:- (a) Health Education in General Practice In November, following enquiries and several visits to the Health Education Section to view educational materials, a General Practitioner in South Croydon began Health Education sessions in surgery premises. With the help of the Health Visitor attached to the Group Practice and a member of the Health Education staff, weekly sessions were held between 12 p.m. and 1 p.m. Topics included "home nursing", "heart disease" and "nutrition". The first audiences were small but the topics proved to be relevant. At the end of the year plans were being made to publicise sessions more effectively. It was clear that a need existed for this type of informal education. 27 (b) The Tuesday Club The Tuesday Club originated from a suggestion from the Committee of the Local Association for the Blind. It was felt that there was a need for group meetings at which partially sighted and blind elderly housebound people could participate in simple physical exercise. The aim was to encourage more confidence in their movements and to offer some mental stimulation. After discussion with a variety of interested people and a Health Education Officer, it was decided that a weekly physical exercise session to music should be tried on Tuesday mornings - hence the name "Tuesday Club". The first meeting was held in June and 15 members were transported to Bedford Hall by minibus driven by a volunteer. The ages ranged from 70 to 96 years. The group was delighted to meet and so willing to enter into the spirit of the meeting that the Health Education Officer's slight anxiety about the suitability of the activity was soon dispelled. Sessions have been held weekly ever since. They began with simple exercises for neck, hands, feet and ankles which were practised to music with the group sitting down, and have now progressed from gentle to fairly strenuous exercises involving the use of the whole body. The Health Education Officer now knows the members well and has informal discussions with them about many health problems. On their part the members of the group enjoy coming out to the sessions and look forward to them as social occasions. They have remarked that the exercises relieve muscle cramp, "pins and needles" in the neck, make them feel fitter and brighter and that the music makes the whole meeting enjoyable. The Health Education Officer on her part learnt a great deal about guiding and handling the blind, the importance of making one's speech clear and descriptive and received lessons in how the blind are taught to count, handle money and read Braille. She was most grateful throughout for the constant and vital support of the Chairman of the Local Association for the Blind, Mr. Thornton, and his wife; Mr. H. Steward a Committee member who initiated the scheme, and also his wife. (c) "Don't Hoard Medicines" Campaign - 3rd to 24th March Mrs. E.B.E. Hughes, M.P.S., P.H.C., Chairman of the Campaign Committee (of 6 Pharmacists), worked with the co-operation of the Principal Health Education Officer on a campaign to persuade the public to turn out their old unwanted medicines and take them to their Chemist for destruction. The following ia an extract from Mrs. Hughes' report on the campaign:- "Drugs Brought In:— It was possible to examine each bottle as it was emptied (at Mayday Hospital Pharmacy). Many unfinished antibiotic treatments were returned. Different kinds of tablets were frequently found in one bottle. Many drugs were extremely old (some pre-War) and in a terrible condition. Some preparations had self diagnosis on the label e.g. "Bob's tummy 28 pills", "itch pills", "shock", "nerves", "Dad's tablets” some cases large quantities of tablets were returned, but this could have been due to the death of the patient. Drugs had often been removed from their original containers to something less suitable, such as an envelope. Assessment 38% of returned medicines were Central Nervous System drugs. 19% were over-the-counter remedies. Only 3% remained unidentified. Final Results The public returned ½ ton of medicines (gross weight). Approximately ¼ million tablets and capsules were handed in weighing 247 lbs. and also 12½ gallons of liquid preparations. It is obviously necessary to encourage the public to destroy their unwanted medicines. Conclusion The weight of drugs brought in for disposal increased each week and illustrated the time required by the public firstly to become aware of the campaign and then to take action. If the campaign were to be repeated it might well be extended for another week". For detailed figures of the campaign see appendix pages 110-112. (d) Sexually Transmitted Diseases Publicity campaigns built round posters and leaflets on this topic were unsatisfactory and difficult to mount especially in large residential areas.The protection afforded by the Indecent Advertisements (Amendment) Act, 1970 as yet makes little difference to the willingness of local people to allow this sort of material to be displayed in public. Attractive circular, adhesive, non-defaceable notices, some in blue and some in pink, giving a simple reassuring message about free, confidential advice and treatment were designed in the Health Education Section. They were offered for display to the local Chamber of Commerce, Shops, Offices, Factories, Pharmacists, Railway Stations, Public Health and Cleansing Departments. The take-up of notices and other publicity material was patchy and reinforced the need for the topic to be an integral part of general health education of the public and especially of school children, when opportunities are contrived for discussion and/or counselling. Some 80% of High Schools in the Croydon area now include Health Education courses in their curriculum. These deal firstly with the normal sequence of growth, development and behaviour and continue with some of the health hazards of today including the sexually transmitted diseases. A pamphlet "The Health Services and You" is issued annually by the Health Department to all school leavers and includes information about sexually transmitted diseases and where to go for help. 29 In-service training courses for teachers are now held annually and include one session on sexually transmitted diseases given by Dr. J. Barrow, M.R.C.S., L.R.C.P., Consultant Venereologist, Croydon General Hospital. The Health Education Section has a good selection of reference books on sexually transmitted diseases in the Library and samples of current pamphlets used in connection with talks are also available. The Department also owns copies of the film "A ½ Million Teenagers" which is suitable for young people and other relevant material from different sources. The Principal Health Education Officer is also in regular contact with the Croydon Occupational Health Nurses Group of the Royal College of Nursing and is encouraging them to undertake as much health education as possible in the 16 - 25 year age group. (e) Smoking and Health No anti-smoking clinics are in operation at present. Education about smoking and health is included in all health education programmes and wide publicity of the Health Education Council's material has been given throughout the town. 30 DENTAL SERVICE (MATERNITY AND CHILD WELFARE) B.J. West, Esq., L.D.S., B.C.S.(Eng.) - Chief Dental Officer The treatment of the priority classes is an integral part of the Public Health Service in Croydon and must be viewed together with the report on the School Dental Service; thus the adverse factors prevailing will apply equally to both. The shortage of staff has had a very limiting effect upon the child welfare service in particular. The much needed expansion in this field, which is essential to the general improvement of dental health in Croydon, cannot take place until the number of dental officers employed not only reaches the present establishment figure, but exceeds it. At present the only centre which sends appointments for 3 year old children on a routine basis is the Sanderstead CIinic, though Waddon Clinic do have a scheme for inviting 3 year old children to a Christmas Party with the offer of dental inspections at a later date. The routine examination of 3 year olds and their continued attendance afterwards must be extended to other centres in the Borough as soon as possible, but a large increase in staff will be required before we are able to do so. Although only two centres have schemes for sending routine examination appointments for 3 year olds, all the remaining centres will and do treat pre-school children on request. In spite of the shortage of staff the number of pre-school children receiving at least one course of treatment again increased from 952 in 1971 to 984 in 1972, though the total number of visits and additional courses of treatment fell. There was also a reduction in all forms of treatment and in the number of sessions devoted to the priority services. A similar situation exists with the treatment of expectant and nursing mothers, though this is in line with the trend which has been prevailing for a number of years. For example:— In 1952 64.9 mothers were treated for every 100 pre-school children 1962 91 " " 1970 19.8 " " " 1971 15.2 " " " " " " 1972 1 0.1 " " This is an indication that whilst more pre-school children, whose treatment can be followed through for a number of years, are being brought to the Borough's clinics for treatment, mothers are attending the General Dental Practitioners. This trend should be encouraged for the benefit of both groups of patient. Much more, however, needs to be done to provide an adequate cover for pre-school children. There are still too many children entering school with grossly decayed teeth. 31 DEAFNESS All infants are screened for deafness during the first year of life either in the Child Health Centres or at home For detailed figures see Appendix, page 99. 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 five 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. Additional chiropody services were provided at the Sanderstead Clinic where 653 treatments were provided and a further surgery commenced at the Bensham Day Centre where 145 treatments were given. On December 31st 1972, 30 chiropodists were operating this scheme. During the period January 1st to December 31st 1972 they gave 24,841 treatments at their surgeries and 9,346 by domiciliary visits. 739 treatments were given at Parkway Clinic, New Addington and 636 at "Waylands". REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 35 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 1972. It is appropriate to state in introducing this report that environmental hygiene and protection has taken on a new importance in recent years in the light of higher standards of living, technological advances in industry, increasing road and air transport and traffic noise. From the more commonplace problems associated with the domestic environment the subject has broadened to take in the general problem of noise generation, disposal of toxic waste, air pollution in its broadest sense and sophistication of foods. Notwithstanding this development the bulk of the time of the Inspectorate has been taken up with basic problems associated with housing, food control, offices and other work places and general sanitation including infectious disease control. The year past has been no exception in the pressures that are brought to bear in an effort to achieve speedy relief from conditions that are thought to constitute a nuisance or health hazard. The biggest single factor against progress in the housing repair sector is the shortage of building labour. The attractions of new work coupled with the sheer amount of work available in the building industry results in a lack of interest in less-attractive repair work in occupied houses. This is the experience of many private owners and certainly the Council's Building Maintenance Manager who undertakes works of default on behalf of the Department. During the year 14 British Rail cottages situated on an island site in the centre of the main line railway track at Sel hurst were dealt with informally. The houses were sub-standard in character and it was found impractical to provide proper drainage. In view of the isolated nature of the site coupled with the noisy environment, the only satisfactory solution was demolition and this was carried out by the Board with some assistance from the Council in re-housing six of the families concerned. Two houses in Sydenham Road were made the subject of a clearance area and subsequently demolished. Demolition or Closing Orders were made in respect of seven houses and ten basements or other parts of houses were closed. In response to a Circular from the Department of the Environment requiring information about the condition of the housing stock of individual local authorities a 1% sample survey of the housing stock in the Borough was carried out during the year. The result of the survey could be considered reassuring and indicated that the condition of the housing stock in Croydon compares favourably with that in other London Boroughs. 36 The appointment of a Specialist Technical Assistant to carry out duties in connection with hoists and lifts in offices and shops has given an added impetus to this work and good progress has been made. The Borough's Smoke Control programme was continued with the making of Smoke Control Order number 15, this being the last within the old County Borough area. The programme will now be extended to the former Coulsdon and Purley U.D.C. area. The difficulties associated with obtaining and retaining qualified Inspectors continue to be acute. Three recently-qualified Inspectors were lost to the Department during the year and at the time of writing this report there are four vacancies from an establishment of 17 District Inspectors. This will be aggravated in 1973 by the retirement of two Inspectors and it is only by maintaining a full complement of Trainee Public Health Inspectors and thus obtaining the services of newly-qualified Inspectors for at least some time afterwards that the Department can function reasonably well. This however inevitably results in added strain on the senior inspectorate. In concluding my introduction to this my last report, should like to express my appreciation for the support and encouragement of the Chairman, Vice-Chairman and the members of the Health and Public Services Control Committee, the guidance and confidence of Dr. S.L. Wright, Medical Officer of Health, and the very willing help and loyalty of the whole of my staff. 37 HOUSING The following is a summary of work carried out in respect of the sanitary condition of dwelling houses during the year:— 7. Inspection of Dwelling Houses (i) Total number of houses inspected for housing defects (under Public Health or Housing Acts) - 6,214 (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 - 2 (b) Other than in Clearance Areas - 7 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 435 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 - 755 (ii) Number of dwelling houses in respect of which notices were served requiring repairs - 395 (iii) Number of dwelling houses which were rendered fit after service of formal notices - (a) By owners 249 (b) By Local Authority in default of owners 55 (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 - 128 (ii) Number of dwelling houses brought up to a reasonable standard after service of formal Notices (a) By owners - 70 (b) By Local Authority in default of owners - 13 (c) Proceedings under the Public Health Acts- (i) Requisitions for information as to ownership - 685 (ii) Number of dwelling houses in respect of which notices were served requiring defects to be remedied - 823 38 (iii) Number of dwelling houses in which defects were remedied after service of formal notices (a) by owners - 679 (b) By Local Authority in default of owners - 260 (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 - 3 (ii) Number of dwelling houses demolished in pursuance of Demolition Orders - 3 (iii) Number of dwelling houses demolished following informal action - 14 (iv) Number of dwelling houses in respect of which Closing Orders were made - 4 (v) Number of houses in respect of which Closing Orders were determined following repairs and renovations - 1 (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 - 10 (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 - 242 (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 - 181 (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 - 156 (iv) Number of houses in which fire prevention works were completed following service of formal or informal notices under Section 16, Housing Act . 1961 - - 227 39 5. Housing Act, 1969 During the year 641 applications for Improvement Grants were referred to the Department by the Borough Valuer, and 732 visits of inspection were made to the Houses concerned. 6. Housing Act, 1969 and Housing Finance Act, 1972. On 1st October, 1971 the Chief Public Health Inspector was delegated to deal with applications for Qualification Certificates and more than 600 outstanding applications were transferred from the Borough Valuer. By the end of this year 507 of these applications had been resolved whereby 146 Qualification Certificates were formally Issued and 117 Refused. New applications received during the year were also dealt with as follows:— Applications received - 432 Qualification Certificates Issued - 171 Qualification Certificates Refused - 182 Applications withdrawn - 19 Applications awaiting expiry of appeal period - 22 Applications stilI under consideration - 38 7. Rent Act, 1957 - Certificate of Disrepair- (i) Number of applications for certificates - - (ii) Number of certificates issued - - (iii) Number of applications by landlords for cancellation of certificates - - 1 (iv) Certificates cancelled - - COMMON LODGING HOUSES Under the provisions of the Public Health Act, 1936, Common Lodging Houses are registered by the Council providing the premises are managed by competent persons and conform with the standards prescribed. Surveys are carried out in areas where such premises are likely to exist but at the present time there is only one registered Common Lodging House within the Borough and this establishment, which is regularly inspected, is well maintained and conducted and, in providing casual accommodation for up to 20 men, is supplying a local need. DRAINAGE 1,562 visits of inspection were made to premises where underground drains were in course of repair. There are now 22 cesspools serving premises without main drainage. 40 POLLUTION OF RIVERS AND STREAMS Inspection of the water courses with in the Borough is carried out to ascertain if any obstructions or pollution exists and, when necessary, samples of the waters are taken for analysis. The Scientific Adviser to the Greater London Council refers, in his Annual Report for 1971, to the very great improvement in the quality of the River Wandle water which is due mainly to the higher quality of the sewage effluent now discharged into the River. PEST CONTROL The Prevention of Damage by Pests Act requires that the occupier of any premises notifies the Local Authority if such premises are infested by rats or mice and it is gratifying to note that there has been some reduction in the number of rodent infestations reported since the previous year. The control of infestations in domestic premises is carried out, free of charge, by three full-time Rodent Operators who, during the year, dealt with 2,737 notifications involving 2,050 infestations and they made 13,177 visits to premises to carry out treatment. The occupiers of infested business premises are required to employ private contractors to carry out this work. Mice infestations have become a matter of concern in many areas throughout the country owing to the degree of resistance which this rodent has developed against the poison "Warfarin" and during the year the Ministry of Agriculture, Fisheries and Food instituted a survey to establish the extent of this problem and the introduction of remedial measures. 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 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 local sewers. No serious infestation of the sewer system has been detected. Measures to control the increasing number of foxes in the Borough have continued and 189 complaints were received with the result that some 310 foxes were destroyed by shooting or gassing. Activities have also continued to reduce the number of feral pigeons which became a nuisance in some districts and, following more than 70 complaints, 903 visits were made by the Pest Control Staff and 4,750 birds were destroyed by shooting or trapping. 41 NOISE ABATEMENT The prevention and reduction of noise, sometimes defined as "unwanted sound", is an essential element in the campaign against the pollution of the environment, for noise, as an unfortunate bi-product is increasing with the growth of population, industry and road and air traffic. The problems are complex since although it is possible to define a noise nuisance by specialist knowledge and the use of instruments, reaction to noise is an individual characteristic and therefore infinitely variable, whereby, the roar of a sports car engine may exhilarate some persons and infuriate others. The Inspectorate are concerned not only with the resolution of current noise problems but with the prevention of potential noise, and, in this connection, special attention is given to all planning applications relating to industrial and commercial premises and the degree of noise which may emanate from such premises and, where appropriate, safeguards are prescribed to minimise noise levels and excessive vibration. Complaints received from the public largely concerned mechanical noise from factories, demolition and construction work, ventilation and refrigeration plants and domestic noise, usually amplified music. Of the 159 complaints received during the year, 99 were resolved by action resulting in the reduction or abatement of the noise complained of, in 19 cases no action was warranted and the remainder are still under investigation. The statutory powers contained in the Noise Abatement Act, 1960 are limited and complaints concerning domestic noise, such as slamming of house and car doors, must be resolved by persuading the individuals responsible to have consideration for other residents. It is understandable that many of the complaints received relate to noise nuisances which occur at night and a large proportion of the 535 visits made by Inspectors were during evenings and weekends. CLEAN AIR ACT, 1956 The Council has implemented the relevant provisions of this Act in making Smoke Control Orders coveringthe 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:— 42 Smoke Control Order No. of premises find. Factories and Commercial) No. of dwellings Acreage Date of Order Date of Operation No. 1 2,076 1,916 620 22.12.58 1 4.61 No. 2 3,042 2,686 265 26. 2.60 1 10.61 No. 3 4,501 3,915 332 22.11.60 1 10.62 No. 4 5,547 4,112 710 24.11.61 1 7.63 No. 5 7,042 6,651 570 17.12.62 1 7.64 No. 6 6,220 5,885 470 18.11.63 1 7.65 No. 7 8,198 7,788 1,060 21.12.64 1 7.66 No. 8 7,198 6,777 460 20.12.65 1 7.67 No. 9 6,158 5,605 554 19.12.66 1 7.68 No. 10 6,670 6,351 596 18.12.67 1 7.69 No. 11 7,099 6,573 588 27. 1.69 1 7.70 No. 12 6,007 5,865 439 15.12.69 1 7.71 No. 13 10,859 9,596 2,000 26. 3.71 1 7.72 No. 14 7,042 6,905 2,200 10. 3.72 1 7.73 No. 15 11,387 11,115 2,300 21.12.72 1 7.74 The District Inspectors keep observation on the various factory chimneys within their districta with a view to observing any contravention of the Clean Air Act in respect of smoke and grit emissions. During the year 96 plans showing the construction and heights of new chimneys were examined and in 36 cases additional height was requested and agreed. 45 notices of the installation of new furnaces were received. 24 of these being oil fired plants. 43 LOCAL LAND CHARGES During the year 14,791 Local Land Charge enquiries have been referred to the Department by the Town Clerk and, in each case, a detailed investigation is carried out to ensure that the prospective purchaser of any property is made aware of whatever legal requirements may have been imposed by the Department currently, or which may apply to the property at some future date. PLANNING APPLICATIONS Planning applications relating to new developments or the alteration of existing buildings are subjected to detailed scrutiny by the appropriate technical staff to ensure that the extensive and varied legislation administered by the Department is applied to the proposed development. Applicants are advised of the legal requirements applicable to the development and, during the year, the staff concerned have spent a considerable time examining and reporting upon the 4,571 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 year:- By Steam 8,699 articles By Formalin Gas 179 articles Total 8,878 articles Disinfection of bedding and upholstered articles is carried out for traders, who deliver them to, and collect them from, the station. For this service a charge is made. Disinfection was carried out after infectious or contagious diseases as follows:— 73 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 £34.50 was paid for such services. 1,700 items of home nursing equipment were disinfected. 44 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 106, 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 one adult and 8 children were cleansed of verminous conditions and 8 adults and 20 children were treated for scabies. DISEASES OF ANIMALS ACT Cases, or suspected cases, of contagious animal disease are dealt with in conjunction with Veterinary Officers of the Ministry of Agriculture, Fisheries and Food and appropriate action is taken to prevent the spread of the disease. Although no cases were reported within the Borough during the year visits to premises where animals are kept were intensified to ensure that precautionary measures were maintained against, in particular, swine vesicular disease. This disease, which was unknown in this country until the latter part of 1972, is a virulent disease of pigs and the stringent Animal Disease Orders relating to foot and mouth disease have been extended to apply to this disease. It is known that untreated swill is implicated in the spread of the disease and local pig keepers were warned that swill intended for pig food must be boiled in accordance with the provisions of the Diseases of Animals (Waste Foods) Order, 1957 and that a high standard of hygiene is essential in swill processing plants. LECTURES During the year 72 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. CARAVAN SITES 45 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 and a site, to accommodate 15 caravans, is now under construction. 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. 46 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 6,214 Houses Inspected following applications for Qualification Certificates 2,675 Houses Inspected following applications for certificates of disrepair 3 Inspections of underground rooms 235 Special inspections in connection with the Housing Survey 2,136 Houses inspected for overcrowding conditions 84 Re-inspections of work outstanding on housing notices 13,383 Number of visits regarding infectious diseases 734 Number of visits regarding food poisoning 157 Inspections of drainage work during repair 1,562 Drainage systems inspected, surveyed or traced 4,362 Drains tested 163 Inspections of cesspools and earth closets 61 schools and school sanitary conveniences 16 „ public conveniences 52 „ verminous premises 99 „ ponds and ditches 24 „ premises in course of destruction 789 „ tents, vans and similar structures 142 „ premises in connection with improvement grants 112 Inspection and re-inspection of houses in multiple occupation 6,671 Inspection and re-inspection in connection with Smoke Control Orders 18,096 Smoke observations 82 Visits regarding exhumation 3 Visits in connection with miscellaneous public health nuisances 2,870 Visits to immigrants 146 Unsuccessful calls 7,014 Appointments kept with owners, builders, etc. 6,746 Investigations of complaints other than housing matters 854 Inspections under Noise Abatement Act 535 Visits regarding rats and mice infestation by rodent operators 13,177 Visits regarding rats and mice infestation by district inspectors 954 Visits in connection with destruction of foxes 881 Visits in connection with destruction of pigeons 903 Informal Notices served 756 Informal Notices complied with 435 Statutory Notices outstanding 31.12.71 1,839 Statutory Notices served 3,159 Statutory Notices complied with 3,242 Statutory Notices outstanding 31.12.72 1,756 Total number of callers at the office 3,064 Total number of letters received at the office 17,168 Total number of complaints received 5,485 Attendances at Court 29 47 FACTORIES ACT, 1961 During the year the under-mentioned inspections have been made and defects were found as set out below. PART 1 OF THE ACT INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors PREMISES Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 1, 3, 4 and 6 are to be enforced by Local Authorities 61 16 3 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 1 ,425 205 10 - (iii) Other Premises in which Section 7 is enforced by Local Authority (excluding out-workers premises) 84 43 - - TOTAL 1.570 264 13 - Cases in which DEFE CTS were found PARTICULARS Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 2 2 - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 1 1 - - - Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7):— (a) Insufficient 1 1 - - - (b) Unsuitable or defective 2 2 - - - (c) Not separate for sexes - - - - - (d) Not labelled 2 2 - - - Other offences against the Act (not including offences relating to Outwork) 16 16 - - - TOTAL 24 24 - - - 48 PART VIII OF THE ACT Outwork Nature of Work Section 110 Section 111 No. of Outworkers in August list required by Sect. 10 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Lampshades 27 - - - - - Paper bags and Cardboard boxes 11 - - - - - Christmas cards, Christmas crackers and stockings 31 • - - - - Tool assembly 12 - - - - - Wearing apparel 76 - - - - - Perfumery, Toiletries, etc. 25 - - - - - Curtain and furniture hangings 7 - - - - - Making up of Cotton Articles 8 - - - - - TOTAL 197 - - - - - OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 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. 49 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 295 1.601 492 Retail Shops 129 1 ,842 496 Wholesale Shops Warehouses 10 104 25 Catering Establishments open to the public. Canteens 22 233 73 Fuel Storage Depot 1 5 2 TOTALS 457 3,785 1,088 TABLE B - Number of visits of all kinds by Inspectors to Registered Premises 4,354 TABLE C - Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace Number of Persons Employed (1) (2) Offices 40,933 Retai I Shops 12,810 Wholesale Departments, Warehouses 2,379 Catering Establishments open to the public 3,041 C anteens 658 Fuel Storage Depots 37 TOTAL 59,858 Total Males 29,931 Total Females 29,927 TABLE D - Exemptions No exemptions were granted under the Act during the year. TABLE E - Prosecutions There were no prosecutions under the Act during the year. 50 REMEDIAL WORKS ETC. CARRIED OUT Accident Prevention Measures 11 Abstract of Act Provided 285 Clothing Accommodation Provided 15 Drainage Defects Repaired Lack of Cleanliness Remedied 2 Drinking Water/Vessels Provided 6 Eating Facilities Provided First Aid Equipment Provided 177 Floors, Stairs, Passages Repaired etc. 63 Heating Provided 2 Lighting Provided 36 Machines Guarded 28 Overcrowding abated 12 Premises registered 518 Sanitary Accommodation Provided 9 Intervening Ventilated Space Provided 54 Defective Sanitary Accommodation Repaired 9 Labelling of Sanitary Accommodation 9 Staff seating facilities Provided 4 Thermometers Provided 151 Ventilation Provided 96 Walls, Ceilings etc. Repaired 109 Washing Facilities - Wash Basins Renewed/Provided 28 - Hot Water Provided 44 - Nail Brushes, Soap and Towels Provided 12 Provision of Disposal for Sanitary Dressings 3 Defective Electrical Wiring Remedied 16 Accumulations of Rubbish Removed 17 Hoists and Lifts Repaired 15 More detailed comment in relation to Offices, Shops and Railway Premises is contained in the Appendix to this Report. 51 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 85 agencies registered and regularly inspected in the Borough. SHOPS ACTS, 1950-65 The Shops Acts include provisions relating to the health, comfort and the working hours of persons employed in shops and also control the hours during which shops may remain open for business. During the year 487 inspections were made under the Acts and the following infringements were remedied:— Hours of Closing 46 Notices to be exhibited or amended 73 A number of complaints and enquiries were received from shop assistants concerning their hours and conditions of employment and these persons and, where appropriate, their employers were advised of the relevant provisions of the Acts. As the result of complaints, and information contained in Press advertisements, 14 cases of alleged trading outside the permitted hours, or on Sundays, were investigated and, following the necessary observations, the traders concerned were warned or, as in the cases referred to below, prosecuted under the Acts. PROSECUTIONS Both Directors of a firm retailing decorating materials were summoned following the sale of goods on Sundays and the Court imposed a fine of £15.50 and £5 costs, in respect of each summons. The proprietors of a shop selling pet animals were prosecuted for trading on Sundays and it is interesting to note that the firm pleaded that, since they were selling goods only to members of a Club they had organised, they were not invoking the Sunday trading laws. The Court set aside this plea and imposed a fine of £6 with £5 costs. 52 HAIRDRESSING ESTABLISHMENTS Legislation calls for the registration of hairdressers' and barbers' premises. During the year 224 inspections were made of registered premises to check that the Byelaws in force were being observed. Generally little cause for complaint was found. 33 new Registration Certificates were issued. CONSUMER PROTECTION ACTS, 1961 & 1971 The Secretary of State is empowered by the Consumer Protection Acts to make Regulations, in respect of any goods which he may prescribe and imposing such requirements as he may consider 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 compl ied with:— The Heating Appliances (Fireguards) Regulations prescribe that all domestic heating appliances shall be fitted with fireguards which conform to specified standards of construction. During the year an electric fire with inadequate guard was found on sale in a second-hand shop. This article was surrendered and destroyed. 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. 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 six 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. 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. 53 The Electric Blankets (Safety) Regulations, 1971 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. The Toys (Safety) Regulations, 1972 govern the use of certain materials in the manufacture of toys. In particular, the use of celluloid, other than for table tennis balls, is prohibited and restrictions are imposed upon the chemical content of paint applied to toys. During the year twelve samples of toys, mostly of foreign manufacture, were purchased from local retailers and submitted to the Public Analyst for examination of the paint film and, of these, two proved to be unsatisfactory. In one case the paint on two items of a set of small wooden toy animals contained 13,000 and 21,500 parts per million respectively of lead whereas the Regulations prescribe that the proportion of lead shall not exceed 5,000 parts per million in the dry paint film. These toys were imported from Germany but manufactured in Italy and following consultation with the Town Clerk warnings were sent to the German importer and the vendor and the Italian authorities were reminded of the British legal requirements relating to atjch toys. It was established that the vendor was the only one in this country supplied with the toys and the remaining stock was duly returned to Germany. The second unsatisfactory sample consisted of a toy tomohawk painted in various colours including a yellow paint film containing 71,000 parts per million of lead and 4,800 parts per million of soluble chromium and a red paint film containing 20,000 parts per million of lead and 2,400 parts per million of soluble chromium. In addition to the limitations on lead, the Regulations prescribe a limit of 250 parts per million of soluble chromium. This toy, which was manufactured in the Republic of China, was the only one in stock in the shop although six were original ly supplied by a wholesaler. Extensive investigations failed to reveal the actual importer of these goods and the Town Clerk advised that, owing to legal complications, a prosecution was not appropriate and a warning was therefore issued to the vendor concerned. THE FABRICS (MISDESCRIPTION) ACT, 1913 THE FABRICS (MISDESCRIPTION) REGULATIONS, 1959 The above mentioned Regulations prescribe standards of non-flammability for texti le 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. 54 Licences are granted subject to conditions attached thereto. During the year five such licences were issued. THE SCRAP METAL DEALERS ACT, 1964 This Act requires dealers in scrap metal to be licenced by the local authority. Dealers are required to maintain, in a prescribed manner, records of their business transactions. Special provision is made for "itinerant" dealers who may be exempted from the keeping of full records of their transactions and this and other provisions of the Act are administered in cooperation with the local police. THE RIDING ESTABLISHMENTS ACTS 1964 and 1970 These Acts provide for the licencing and inspection of riding establishments by the local authority. Licences are granted subject to conditions attached thereto and inspections are carried out at six-monthly intervals by authorised veterinary surgeons. Two licences have been granted to local establishments. PHARMACY AND POISONS ACT, 1933 The object is to regulate the sale of certain poisonous substances. During the year the number of applications granted for entry of names on the list of persons entitled to sell poisons under Part 2 of the Act was 9. In addition, 150 applications were made for the retention of names on the list for a further 12 months. No infringement ofthe 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. PET ANIMALS ACT, 1951 This Act governs the sale of pet animals and during the year 17 licences were renewed and 4 new licences issued. During the year 62 inspections were made and little cause for complaint relating to conditions specified in the licences was found. 55 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, 823 are registered under Section 16 of the Food and Drugs Act, as fol lows:— Retai I sale of ice-cream 571 Manufacture of ice-cream 1 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 251 During the year 6,903 inspections and re-inspections were made of food businesses. FOOD HYGIENE (GENERAL) REGULATIONS. 1960 The following table shows the premises in the Borough at which food is sold, manufactured or stored. These premises are subject to the above Regulations and special reference is made to the provision of wash hand basins (Section 16) and sinks (Section 19) at premises where unwrapped food is handled. Description No. of premises Wash hand basins provided during 1972 No. to which Sec. 19 applies No. of sinks fitted to comply with Sec. 19 during 1972 Bakehouses and Bakers Shops 1 18 3 118 2 Sugar Confectioners 422 2 402 1 Cafes, Restaurants, Snack Bars, etc. 310 10 310 6 Works & Club Canteens 528 9 528 7 Licensed Premises 166 6 166 2 Off Licences 115 - 24 - Grocers & General Shops 312 2 298 1 Butchers 179 3 179 1 Wholesale Meat Markets 11 - 11 - Chemists 85 - 85 - Greengrocers 203 8 203 2 Fishmongers 33 1 33 1 Fried Fish Shops 47 1 47 1 Milk Distributors and Dairies 317 6 281 _ Premises from which Roundsmen & Mobile Shops operate 127 - 127 - Food Manufacturers 23 2 23 - Supermarkets 62 2 62 2 56 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 4 Defective condition of walls, ceilings, doors and window glazing 244 Defective condition of floors, utensils, fixtures, etc. remedied 76 Defective or insufficient drainage repaired 6 Lighting, heating or ventilation provided 37 W.C. accommodation - repair or cleansing 43 -artificial lighting provided - - intervening ventilated space provided 3 Food - now stored 18 ins. off floor 11 - means to prevent risk of contamination provided 33 " - store provided or repaired 5 Accumulations in yard or stores removed 40 Offal and refuse bins provided 18 Yard paving repaired Hand washing notices exhibited 52 Ablutions - Wash basins provided 55 - Hot water supplies provided 46 - Nail brushes, soap and towels provided 60 Clothing accommodation provided 10 Sinks installed 26 Smoking offences abated 9 Defective or unsuitable table tops replaced 76 First Aid kits provided 44 Cleanliness - advice given 18 Rats/Mice Infestation abated 17 Repair/Cleansing of Machinery/Refrigators 26 Leaflets on Food Hygiene supplied 101 Stalls and Delivery Vehicles Wash hand basins/Sinks with hot water provided 16 Nail brushes, soap, towels provided 8 First Aid kits provided 20 Washable overclothing provided 28 Name and address boards supplied 33 Food now stored 18 ins. off floor 2 Accumulation of refuse etc. 5 Receptacles for waste food provided 18 Screening for stalls provided 11 Cleanliness of stalls and vehicles remedied 46 57 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 13,287 Offal 1,878 Sundry Foodstuffs 4,858 Canned, Bottled and Packet Foods 42,632 Total 62,655 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 161 such inspections were made. MEAT INSPECTION District inspectors examine home killed and imported carcase meat and offal at the 11 wholesale meat depots in the Borough. Meat exposed for sale is inspected in butchers' shops. The Diseases of Animals (Waste Foods) Order, 1957 The 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. 58 MILK SUPPLY During the year 49 inspections were made of dairies. The Milk (Special Designation) Regulations 1963 The following licences have been granted to dealers distributing milk from premises in Croydon. Licences to use the designation "Pasteurised" — (a) Dealer's (Pre-packed Milk) Licences 234 Licences to use the designation "Sterilised" — (a) Dealer's (Pre-packed Milk) Licences 89 Licences to use the designation "Untreated" — (a) Dealer's (Pre-packed Milk) Licences 14 Licences to use the Designation "Ultra Heat Treated" — (a) Dealer's (Pre-packed Milk) Licences 66 Pasteurisers Licences Renewed 2 Inspections of dairies and other premises where milk is sold are carried out to ensure that the conditions of the licences are observed. Bacteriological Examination of Milk During the year the following samples of milk were examined:- Pasteurised Milk 114 Sterilised Mi Ik 27 Ultra Heat Treated 5 The following tables summarise the results of bacteriological examinations of pasteurised, sterilised and untreated milk samples during the year:— Pasteurised Milk Methylene Blue Test No. Samples Taken Not Satisfied Satisfied 114 - 114 Sterilised Mi Ik Turbidity Test No. Samples Taken Not Satisfied Satisfied 27 - 27 59 Ultra Heat Treated Milk Colony Count No. Samples Taken Not Satisfied Satisfied 5 - 5 Bacteriological Examination of Milk Bottle Rinses „ Satisfactory - 16 Bottle Rinse Samples - 16 Unsatisfactory - - BACTERIOLOGICAL EXAMINATION OF CREAM 42 samples of fresh cream were examined with the following results Grade No. of Samples 1 15 2 3 3 9 4 15 BACTERIOLOGICAL EXAMINATION OF ICE CREAM 151 samples were taken, the results being:— G rade No. of Samples 1 95 2 33 3 12 4 11 The majority of these samples consisted of "soft" ice cream and the results indicate a general improvement in the standards of handling this product. CHEMICAL EXAMINATION OF ICE CREAM Eleven samples were taken from local shops and all were found to comply with the standard. FOOD AND DRUGS ACT, 1955 During the year, 141 samples of milk and cream, and 300 other samples were taken, of which number, 17 were found to be "Not Genuine", details of which are set out below:— 60 Article Nature of adulteration Remarks or Deficiency Raspberry Flavouring Label did not bear the statement The manufacturer has now required by the colouring matters amended the label to in- in Food Regulations, 1966 corporate the statement. Two samples of Brazil Contained 21%, 16% and 43% of Retailers warned nuts and one sample mouldy nuts respectively. of chestnuts. Samotea. The label stated no "tannin" The label has been but tannin was present. amended. Chicken soup. The sample was deficient in The recipe has been fat content. altered and a further sample has proved to be satisfactory. Drinking Chocolate. The sample was deficient A repeat sample has in cocoa butter content. proved satisfactory. Three samples of The samples were deficient All the recipes have Wholemeal Bread in fibre content due to the now been altered to use of other flour. comply with the Bread and Flour Regulations 1963. Milk Loaf. The sample contained Retailer warned, skimmed milk solids. Four samples of The samples all contained The retailers are now Sausages. an added preservative displaying notices to without declaration. comply with the servatives in Food Regulations, 1962. Bread. The sample contained sol id Further samples have lumps of dough in which dry proved satisfactory, flour was visible. Brazil Nuts. The sample contained a high Legal proceeding are proportion of unfit nuts. being considered. Result of Analysis of Milk Samples The samples of milk were obtained as follows:- Taken on Mi Ik Rounds 33 Taken at Dairies 108 Total 141 Average composition of samples:— Milk (excluding South Devon and Channel Islands Milks) Solids not Fat 8.57 (Legal standard is 8.5%) Milk Fat 3.82 (Legal standard is 3%) 61 South Devon and Channel Island Milk Sol ids not fat 8.83 (Legal standard is 8.5%) Milk Fat 4.75 (Legal standard is 4%) AMALYSIS OF PROSECUTIONS UNDER:— Food and Drugs Act. 1955 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 Milk and Dairy (General) Regulations, 1959 Shops Act, 1950. OFFENCE RESULT Chocolate eclair containing a dead fly Fined £25 Apricot pastry containing a dead wasp Fined £25 Mouldy cheese and pickle sandwich unfit for human consumption Fined £15 Bath bun containing a naiI Fined £25 Coffee Swiss roll containing mould Fined £25 Skinless sausages unfit for human consumption Fined £25 Skinless sausages containing mould Fined £25 Loaf of sliced wrapped bread containing a piece of metal Fined £25 Custard tart containing a screw Fined £25 Loaf of bread containing a piece of metal Fined £40 Loaf of bread containing a first aid dressing Fined £40 A packet of pork and ham containing pieces of metal Fined £25 Tray of trifles and cream cakes containing cockroaches on the tray Case dismissed Chopped ham and pork containing a part of a safety pin Fined £10 Bar of chocolate containing a piece of metal Fined £20 Five offences contrary to the Markets, Stalls and Defendant aquitted Delivery Vehicles Regulations on all 5 accounts Pizza not of the nature, substance or quality demanded Fined £25 A chocolate eclair containing a screw Fined £50 Portion of wrapped cheese containing mould Fined £20 A loaf of bread containing a piece of a needle Fined £15 62 OFFENCE RESULT A doughnut containing a washer Fined £30 A bottle of Gee's Linctus containing a piece of glass Fined £100 Sausages containing mould Fined £30 A bottle of milk containing a biro refill Fined £30 A bottle of milk containing a piece of glass Fined £40 A bottle of milk containing a piece of paper Fined £15 Four contraventions relating to staleness and insect infestation in chocolate wheatmeal biscuits Total Fine £140 Paint inside bottle of miIk Fined £25 Bottle of milk containing a conker Fined £25 Bottle of milk containing glass Fined £75 Bottle of milk containing glass Fined £75 Piece of bread pudding containing plastic Fined £25 Bottle of milk containing glass Fined £100 Stale cake with fermenting jam filling Fined £25 Loaf of bread containing plastic material Fined £50 Liquorice cuttings containing a piece of wire Fined £25 Bacon containing maggots Fined £15 Biscuit containing a dead fly Fined £20 Loaf of bread containing a piece of wire Fined £50 FOOD COMPLAINTS During the year 427 food complaints of various types were received, fully investigated and appropriate action taken where necessary. 38 prosecutions were taken against firms concerned as reported above. SUMMARY OF INSPECTIONS OF FOOD AND OTHER BUSINESS PREMISES MADi BY THE PUBLIC HEALTH INSPECTORS, AND OTHER DEPARTMENTAL WORK Inspections of theatres, cinemas, halls, etc 18 Visits to premises for food condemnation 788 Inspections of wells and gathering grounds of water supply 56 do scrap metal dealer's premises 7 do rivers and streams for pollutions 3 do hairdressers 229 Food and Drugs Acts; Food and Drugs samples taken 300 Food and Drugs Acts; Milk samples taken (special designation) 141 Ice Cream samples taken (bacteriological) 144 63 Samples taken of Fertilizers and Feeding Stuffs 18 do swimming baths water 273 do drinking water, bacteriological and chemical 646 do private wells 189 do rag flock and other filling materials 1 do sundry specimens (food poisoning etc.) 22 Visits in connection with Food Complaints 951 Inspections of butchers' premises 348 do meat premises (wholesale) 158 do poultry and game dealers' premises 3 do fishmongers' premises 84 do fried fish premises 129 do grocers' premises 438 do fruiterers' and greengrocers' premises 189 do bakers' premises - including bakehouses 200 do dairies 27 do milk shops 22 do general shops and supermarkets 297 Visits in connection with Animal Boarding Establishments Act 13 do do Rag Flock Act 2 do do Mines and Quarries 6 do do Croydon Corporation Act 3 Inspection of Employment Agencies 138 Examination of Imported Food 812 Inspections of premises where cooked meats etc. are prepared or sold 8 Inspections of confectioners' premises 300 do confectionery manufacturers' premises 25 do cafes, snack bars, canteens, hotels and their kitchens 1,828 do school kitchens and serveries 113 do hospital kitchens 50 do ice cream manufacturers' premises 12 do ice cream vendors'vehicles 123 do market and barrows 651 do other food premises not enumerated above 80 Licenced premises 256 Inspections of factories with mechanical power 205 do factories without mechanical power 16 do works of building and engineering 43 do shops (under Shops Acts) 460 do outworkers' premises 140 Inspections under Fertilizers and Feeding Stuffs Act 3 do Diseases of Animals Set 15 do Pets Act 62 do Pharmacy and Poisons Act 24 do Consumer Protection Act 287 do Offices, Shops and Railway Premises Act 4,354 do Performing Animals Act - 64 APPENDIX OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 This is the eighth report in the series since the Act came into operation, and, in retrospect, it is fair to say that in that time a lot of good work has been done, many problems met and solved, and in so doing conditions improved for many workers in shops and offices coming within the scope of the Act. The practice of inspecting plans relating to offices and shops etc. continues. Detailed examination is required to ensure, inter alia, that so far as is reasonably practicable, premises when occupied will conform to the requirements of the Act, and thus avoid the necessity for alterations after construction. Ventilation of premises and partitioned office areas present problems. Plans of proposed hoists and lifts can be inspected to ensure satisfactory and safe approach. Duri ng the year no fewer than 1,315 plans were received in the Department and reported upon. This is the highest figure since the Act came into force. The number of accidents in offices, shops and warehouses reported to the Department during the year was 143 and all were investigated. This compares with 148 accidents in 1971. Of the accidents investigated the following action was taken. Prosecutions nil. Formal warnings 15. Informal advice 49. No action was found necessary in 79 cases but the information supplied by the employer in each case was checked and in a large number of cases found inaccurate or insufficient. Too many accidents are arising from use of hand tools particularly in the food trade. There seems to be far too little supervision of young persons who are not trained in the elementary method of handling knives used in cutting foods. Accidents by untrained personnel in boning out and jointing meat have been reported. Week-end students are often employed as shop assistants. They are rarely trained, and totally unaware of the dangers and hazards which can arise in an unaccustomed environment and through lack of experience. Young persons in the 18 - 20 age group are often employed as Assistant or Trainee Managers in large food premises. This early age of responsibility has its drawbacks in achieving a high standard of supervision and discipline particularly with older staff. Numbers of accidents are due to falling on wet, slippery or greasy floors, causing fractures to limbs. Canteen and shop kitchens come under criticism in this respect where spil led fluids are not always cleansed immediately. The peak period for accidents occurs during the time the meals are being served, when the staff is under pressure of work. 65 Load lifting causes sprains and strains mainly through monotonous continuity of lifting and carrying work, few rest periods combined with a lack of physical ability of the person employed. The booklet "Lifting and Carrying" has been recommended for display in warehouses, shops and stores for the guidance of persons employed in such work. Several accidents have been reported of staff walking through clear glass doors or through collisions when meeting on each side of a solid door. In the former case demarcation colouring or bars have been fitted to the doors and in the latter small observation windows (with the approval of the Fire Authority) have been inserted. Horseplay is responsible for a few accidents. A young girl fractured her wrist as a result of falling off the balustrade of a staircase down which she had been sliding. An Inspector whilst carrying out an inspection of an office, found a youth with long hair operating a printing machine with the guards removed. Immediate representation to the management resulted in censure of the employee and the immediate reinstatement of the guard. A typist sustained a cracked vertebra through falling when the chair she was about to sit on slipped away on castors. The chair was replaced by one without castors. Defective chairs are found from time to time and removed or repaired on representation by notice. In a Supermarket a young person (under 16) sustained a cut finger whilst (iperating a mechanically operated gravity feed slicing machine. A Notice was clearly exhibited on the machine, that no person under 18 was permitted to use the machine, or to clean it. Investigation revealed that the boy had acted on his own free will. He had not been trained in the use of the machine and was not under supervision. An assurance was received that no person would be employed at the counter in question unless he had full operational knowledge of the machine. An accident occurred in connection with a similar machine in a Supermarket whereby a woman employee cut her finger whilst wiping the blade of the machine. Statements taken under caution revealed a conflict of evidence in respect of the adequacy of training, but the Company was warned, in writing, of the need for such training. As a result, the Managers of all branches of the Company were reminded of their duty to ensure that the requirements as to training were observed. A woman employee in an office suffered injury to her kneecap due to colliding with the opened drawer of a filing cabinet. The filing cabinet was subsequently re-sited. Loading bays need constant supervision. An employee, wheeling a pallet containing reams of paper from a van parked close to the loading bay, slipped on the polished steel edge of the deck and fell some 30 inches from the loading bay deck to the ground. He sustained a crushed kneecap and laceration of the 66 lower left leg and was absent from duty for 11 months. The floors of the loading bay and the steel edge of the deck have since been treated. Congestion and lack of proper cleanliness and order, present problems in many offices. Water closet compartments have been found containing shelves for storing paint tins, builders tools, ladders and even legal documents. The staircase walls of a builder's office were lined with shelves reducing the width of the staircase to 1' 6". Apart from the defects found in the course of routine inspections, 31 complaints were received during the year compared with 32 in 1971. The complaints included inadequate ventilation of offices, low temperatures, insufficient and defective sanitary accommodation, overcrowding, insufficient means for accommodating outdoor clothing, lack of hot water supply to wash hand basins, etc. Certificates of Exemption from the requirements to provide the stipulated number of first aid outfite were granted to three Companies who produced satisfactory evidence that first aid facilities in their premises, including full time nursing personnel and qualified first aiders, were provided. Since the appointment of an additional Technical Assistant primarily to enforce the provisions of the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations, more progress is being made, not only in dealing with adverse reports from Insurance Company Inspectors, but also in bringing under control by regular inspections all such apparatus in all premises to which the Act applies. During the year all adverse reports on hoists and lifts have been investigated, resulting in Notices being served for these and any additional defects found at the time of investigation. In all, as can be seen by the following table, 89 Notices were served and on re-inspection 62 Notices have been abated. Delays have occurred in carrying out remedial measures as a result of pressure of work on servicing companies. 67 OFFICES, SHOPS AIMD RAILWAY PREMISES (HOISTS, AND LIFTS) REGULATIONS, 1968 Class of Premises Number of adverse reports received Number of Lifts inspected Number of Lifts inspected Number of Notices served & abated Total Number of Inspections & Re-inspections Non-powered Powered Served Abated Offices 17 66 27 20 Retail Shops 7 23 7 5 Wholesale Shops and Warehouses 4 4 4 4 Catering Establishments open to the public. Canteens. 26 76 4 51 33 TOTAL 54 76 97 89 62 223 Almost without exception lift motor rooms inspected fell short of the requirements of the Act and Regulations in some degree. Examples of the contraventions found are as follows. Insufficient lighting and ventilation, socket outlets, steps and hand-rails, insufficient guarding of motor platforms, trip wires, chain drives and other machinery, together with lack of proper accessibility. Light switches so placed that no light is afforded until access is gained to the room, and obstructions in trap-doors and hatchways. The depositing of re-usable equipment and rubbish, machine and switch covers not replaced, keys to motor rooms not easily accessible and motor room doors not locked. It has been observed that some lift shafts are used for depositing rubbish and several shafts were found to have large accumulations of waste paper and cardboard stored therein. The only access to one lift motor room situated on a roof was by using a pair of steps of which the bottom rungs were broken and dilapidated. Whilst standing on such steps the trap door, which was large and of considerable weight, was, when pushed upwards to afford access to the roof, likely to fall about 50 ft. on to the roof of an adjoining property. 68 Two lifts were found in such an unsatisfactory condition as to demand immediate cessation of use and after informal representation, this was done Although lift reports by competent persons are rarely available at the time of the Local Authority Inspectors visit, there appears to be no delay in dealing with the Notices served except as previously mentioned. There were no prosecutions during the year. PUBLIC HEALTH SERVICES 71 WATER SUPPLY The London Borough is served by four statutory supply authorities, as undermentioned:— Supply Authority Square Estimated Miles Population for 7971 Croydon Corporation (Central and northern part of the Borough) 17.0 218,780 Metropolitan Water Board (Spring Park Estate and New Addington) 2.8 42,000 East Surrey Water Company (Sanderstead, Selsdon, Kenley, Purley and Coulsdon East) 11.7 57,700 Sutton District Water Company (Woodcote and Coulsdon West) 1.9 15,360 33.4 333,840 The waters in supply are of good organic quality and moderately hard in character. They have no plumbo-sotvent 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 Uidertaking's area 94 chemical and 603 bacteriological samples of raw water were tested, also 125 chemical and 1,547 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 P 69. SEWAGE DISPOSAL This is now a function of the Greater London Council. It is understood that the building of new sludge digestion tanks and other improvements at the Beddington works to deal with problems which arose in previous years are proceeding satisfactorily. OTHER SERVICES 75 FAMILY PLANNING The assistance given to the Croydon Family Planning Association of a financial grant and free facilities at Corporation clinics was extended this year to include free advice to all and free supplies to medical/ social cases. Domiciliary Family Planning by Specialist Midwife Two part-time specialist midwives are now employed in this service. Although the numbers of new cases seen are smaller than in 1971, the midwives have been able to extend their teaching skills to mothers in hospital following the birth of their babies. 1972 1971 New patients seen 155 177 Number of visits 1,461 1,065 Patients prescribed the 'pill' 48 42 fitted with I.U.D. 67 50 " cap 4 10 using other methods 80 43 " where no method was advised 8 35 Vasectomy 12 15 No. teaching sessions in hospital and elsewhere 68 76 NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1351 3 Orders for compulsory removal were made during 1972. HOME DIALYSIS 3 patients commenced home dialysis during 1972. 1 further case was under consideration during the year. LONGSTAY IMMIGRANTS Initial visits to longstay immigrants were made to families with children and single women by Mrs. Glucksmann,the Specialist Health Visitor and to single men by the Public Health Inspector. This work which is concerned with giving information about health and social facilities in Croydon was intensified with the arrival of the Ugandan Asian families. Most of the Ugandan families went to relatives and friends and most had some resources and spoke some English. Offers of help with clothing and temporary accommodation were received from some local residents but the families were helped mainly by their own community efforts. Medical problems were dealt with immediately under the National Health Service. For details of arrivals in 1972, see Appendix, page 107. REHOUSING ON MEDICAL GROUNDS Dr. C.G. Nicol, Principal Medical Officer enquired into 712 new applications and 148 re-applications for rehousing on medical grounds in 1972. He made 13 personal visits, usually jointly with a Public Health Inspector, Health Visitor or Welfare Officer. A further 23 applicants were interviewed at this office. 77 Sub-division of applications recommended to the Housing and Lettings Sub-Committee showed the following approximate frequencies:- (a) Rehoused from Non-Council property (b) Transferred from one Council property to another (a) and (b) Total Moved Heart disease 26% 19% 23% Lung disease 11% 14% 12% Strokes 1% 2% 1% Crippling conditions 15% 20% 17% Illnesses of children 7% 3% 5% Cancer 7% 1% 4% Tubersulosis 2% 3% 3% Mental disorders 23% 28% 26% Other conditions 8% 10% 9% MEDICAL EXAMINATION OF CHILDREN FOR THE CHILDREN'S DEPARTMENT During the year 340 children were medically examined prior to admission to a children's home or private foster home. OCCUPATIONAL HEALTH SERVICE The medical supervision of all Corporation staff provided by the health department includes:— Scrutiny of health statements made by successful applicants for employment 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 domestic and financial circumstances by a welfare officer for extension of sick-pay. 78 Arrangements for radiological examination of staff who work in contact with children. Advice for staff exposed to occupational risks. Special examination of any member of staff referred by the Department concerned. Enquiries into excessive sickness in any section of the Corporation staff. Control of First Aid services for the central offices. Health Statements Number of Health Statements received from Officers 1,451 Number of Health Statements received from Manual employees 1,290 Total 2,741 Medical Examinations 983 examinations were made during the year by the medical staff of the department including 138 vision tests for drivers. Of these 218 were in respect of manual workers, who were classified as follows:- Fit for employment and sick pay scheme 131 Deferred for review 75 Unfit for sick pay scheme 10 Fit for light employment only (Mot fit for sick pay scheme) - Unfit for employment 2 218 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 training session for professional staff was held at the Denning Hallunderthe Chairmanship of the Chief Education Officer, when Dr. Dale-Beckett and Dr. Rosenberg covered the theory and practice of drug taking as seen by a Consultant Psychiatrist and a General Practitioner. Information about books, leaflets and films was provided by Miss Elliott. 79 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 1973. A meeting for parents was held in the southern part of the Borough, covering 3 senior schools, when Dr. A.J. Wood of the Health Education Council spoke on "The problems of adolescence". 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. She reported that the number of enquiries was tending to diminish as those concerned with the groups mainly involved - the under 20 years of age - were becoming more skilled in handling soft drug takers and were not asking for help from other agencies. No cases of hard drug addiction had come forward. Nevertheless it was thought that the Centre was providing a needed service and should be continued. APPENDIX TABLES VITAL STATISTICS 1965 - 1972 83 1965 1966 1 067 1968 1969 1970 1971 1972 84 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 2534 35 44 45 54 55 64 65 74 75 & over B4 Enteritis and other Diarrhoeal Diseases M 1 - - - - - - - - - - 1 F 2 1 - - - - - - - 1 - - B5 Tuberculosis of Respiratory System M 7 - - - - - - - 1 - 3 3 F 4 - - - - - - - 1 2 - 1 B6(1) Late effects of Respiratory T.B. M 1 - - - - - - - - - - 1 F 2 - - - - - - - - 1 1 - B6(2) Other Tuberculosis M - - - - - - - - - - - - F 2 - - - - - - - - 1 1 - B11 Meningococcal Infection M 1 - 1 - - - - - - - - - F 1 1 - - - - - - - - - - B17 Syphilis and its Sequelae M 2 - - - - - - - - 1 - 1 F 6 - - - - - - - - 2 - 4 B18 Other Infective and Parasitic Diseases M 2 1 - - - - - - - - 1 - F - - - - - - - - - - - - TOTAL 31 3 1 - - - - - 2 8 6 1 1 B19(1) Malignant Neoplasm Buccal Cavity etc. M 6 - - - - - - - - 3 2 1 F 4 - - - - - - - 1 - 1 2 B19(2) Malignant Neoplasm Oesophagus M 16 - - - - - - - 2 2 7 5 F 5 - - - - - - - - 2 1 2 B19(3) Malignant Neoplasm Stomach M 33 - - - - - - 3 2 10 10 8 F 34 - - - - - 3 1 4 10 16 B19(4) Malignant Neoplasm Intestine M 42 - - - - - - - 5 7 18 12 F 55 - - - - - - 2 3 11 13 26 B19(5) Malignant Neoplasm Larynx M 6 - - - - - - 1 • 1 2 2 F 3 - - - - - - - - 1 2 • B19(6) Malignant Neoplasm Lung, Bronchus M 180 - - - - - - 2 13 53 73 39 F 46 - - - - - - 1 3 16 16 10 B19(7) Malignant Neoplasm Breast M - - - - - - - - - - . - F 75 - - - - - 3 1 12 18 14 27 B19(8) Malignant Neoplasm Uterus F 17 - - - - - 1 - 1 4 5 6 B19(9) Malignant Neoplasm Prostate M 34 - - - - - - - 2 4 8 20 B19(10) Leukaemia M 8 - - - 1 1 - - 1 1 2 2 F 17 - - 1 1 1 - 1 3 - 5 5 B19(11) Other Malignant Neoplasms M 92 - •- - 2 - 1 3 9 28 26 23 F 110 - - - - 2 2 6 6 26 29 39 B20 Benign and Unspecified Neoplasms M 2 - - - - - - - - 1 1 F 6 - - - - - - - 1 1 1 3 TOTAL 791 - - 1 4 4 7 23 65 192 246 249 B21 Diabetes Mellitis M 9 - - 1 - 1 - - - 2 3 2 F 22 - - - - - - 1 - 1 6 14 B46(1) Other Endocrine etc. Diseases M 3 1 1 - - - - - - - 1 - F 8 - - - - - - - 2 1 2 3 B23 Anaemias M 2 - - - - - - - - - 1 1 F 4 - - - - - - - - - 1 3 B46(3) Mental Disorders M 5 - - - - 1 - - 1 1 1 1 F 3 - - - - - - - - - 1 2 85 CAUSE OF DEATH Sex Total all ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1-4 5 14 15- 24 25 34 35 44 45 54 55 64 65 74 75 & over B24 Meningitis M - - - _ - - - _ - - - - F 1 1 - - - - - - - - - - B46(4) Multiple Sclerosis M 1 - - - - _ - - - 1 - - F 5 - - - - - - 1 1 2 1 - B46(5) Other Diseases of Nervous System M 14 - 1 1 1 1 - 1 - 4 3 2 F 18 - 1 - - - 1 - - 3 4 9 TOTAL 95 2 3 2 1 3 1 3 4 15 24 37 B26 Chronic Rheumatic Heart Disease M 15 - - - - - 1 1 3 5 2 3 F 30 - - - - - - 3 2 4 3 18 B27 Hypertensive Disease M 22 - - - - - - - 4 9 5 4 F 23 - - - - - - - - 2 7 14 B28 Ischaemic Heart Disease M 458 - - - - - 1 1 1 59 102 147 138 F 365 - - - - - - - 9 35 85 236 B29 Other Forms of Heart Disease M 66 - - - - - 1 1 2 8 8 46 F 127 - - - - - 1 - 1 1 17 107 B30 Cerebrovascular Disease M 195 - - - - - - 1 9 14 58 1 13 F 445 - - - - - 1 5 7 19 74 339 B46(6) Other Diseases of Circulatory System M 78 - - - - - - - 2 12 1 9 45 F 96 - - - - 1 1 - 3 7 16 68 TOTAL 1920 - - - - 1 6 22 101 216 441 1 133 B31 Influenza M 10 - - - - - 1 1 2 3 3 F 16 - 1 1 - - - 1 1 1 4 7 B32 Pneumonia M 145 2 2 2 - 1 - - 2 11 29 94 F 220 2 4 - - 1 - 1 3 4 39 166 B33(1) Bronchitis and Emphysema M 118 - - - - - - 1 2 24 36 55 F 46 - - - - - - - 1 4 8 33 B33(2) Asthma M 1 - _ - - - - 1 - - - - F 13 - - - - - - 2 3 1 4 2 B46(7) Other Diseases of Respiratory System M 17 - - - - - - 1 1 1 5 9 F 14 - - 1 - - - - 2 1 10 TOTAL 600 4 7 4 - 3 2 8 14 50 129 379 B34 Peptic Ulcer M 19 - - - - - 1 - 2 1 8 7 F 18 - - - - - - - - 2 4 12 B35 Appendicitis M 1 - - - - - - - - 1 - - F 2 - - - - - - - - - 1 B36 Intestinal Obstruction and Hernia M 9 - - - - - - - - - 3 6 F 15 - - - - - 1 - 1 1 5 6 B37 Cirrhosis of Liver M 8 - - - - - - - 1 3 3 1 F 4 - - - - - - - 1 2 - 1 B46(8) Other Diseases of Digestive System M 17 - - - - - 1 - 5 4 6 F 28 - - - - - - - 1 1 7 19 B38 Nephritis and Nephrosis M 7 - - - - - 1 2 2 2 F 11 - 1 - - 1 2 1 1 1 4 B39 Hyperplasia of Prostate M 10 - _ - - - - - - - 2 8 B46(9) Other Diseases, Genito-Urinary Systerv M 8 - - - - - - 1 1 1 1 4 F 19 - 1 - - - 1 - 2 - 5 10 B41 Other Complications of Pregnancy, etc. F 2 - - - - 1 - 1 - - - - 86 CAUSE OF DEATH Sex Total all ages Under 4 Weeks 4 weeks and under 7 year AGE IN YEARS 1-4 5 7 4 7524 25 34 3544 45 54 55 64 65 74 75 & over B46(10) Diseases of Skin, Subcutaneous Tissue M - _ _ _ _ _ _ _ _ _ _ _ F 1 - - _ _ _ _ _ _ _ _ 1 B46( 11) Diseases of Musculoskeletal System M 3 - _ _ _ _ _ _ _ _ 1 1 F 7 _ _ _ _ _ _ _ _ _ 1 6 B42 Congenital Anomalies M 10 4 4 _ _ _ _ _ 2 _ _ _ F 14 4 2 2 2 _ _ 1 _ _ 1 2 B43 Birth Injury, Difficult Labour , etc. M 11 1 1 _ _ _ _ _ _ _ _ _ _ F 7 6 1 _ _ _ _ _ _ _ _ _ B44 Other Causes of Perinatal Mortality M 8 8 - _ _ _ _ _ _ _ _ _ F 6 6 - _ _ _ _ _ _ _ _ _ B45 Symptoms and III Defined Conditions M 1 _ _ _ _ _ _ _ _ _ _ 1 F 7 - - _ _ _ _ _ 1 _ _ 6 TOTAL 253 39 9 2 3 4 6 6 15 19 48 102 BE47 Motor Vehicle Accidents M 27 _ _ . 2 4 5 3 3 3 3 4 F 16 _ _ 1 1 1 1 3 - 2 2 5 BE48 All Other Accidents M 25 _ 1 1 1 3 4 - 4 4 4 3 F 26 _ - - - 2 - 2 2 5 2 13 BE49 Suicide and Selfinflicted Injuries M 21 _ _ _ _ 4 1 3 5 3 4 1 F 17 _ - - - - 3 2 5 3 2 2 BE50 All Other External Causes M 3 _ _ 1 - 1 - - - 1 - - F 3 _ _ - • - - 1 _ 1 1 - TOTAL 138 _ 1 3 4 15 14 14 19 22 18 28 TOTAL ALL CAUSES M 1780 27 10 6 R 1 R 18 36 141 330 509 677 F 2048 21 1 1 6 4 12 18 40 79 194 403 1260 3828 48 21 12 12 30 36 76 220 524 912 1937 87 CANCER Deaths from Cancer occurred at the following ages - Age Period Male Female Total Under 25 years 4 5 9 25 and under 35 years 1 6 7 35 and under 45 years 9 14 23 45 and under 55 years 34 31 65 55 and under 65 years 109 83 192 65 and under 75 years 149 97 246 75 and over 113 136 249 Total 419 372 791 Site Male Female Total Percentage of Total Bowel and Rectum 42 55 97 12.3 Brain 6 11 17 2.2 Breast - 75 75 9.5 Buccal Cavity 6 4 10 1.3 Cervix - 9 9 2.4 Gallbladder & Duct 2 2 4 0.5 Hodgkins 1 3 4 0.5 Larynx & Pharynx 6 3 9 1.1 Leukaemia 8 17 25 3.2 Lungs and Bronchus 180 46 226 28.6 Oesophagus 16 5 21 2.6 Ovary - 21 21 5.7 Pancreas 13 11 24 3.0 Prostate 34 - 34 8.1 Stomach 33 34 67 8.5 Uterus - 8 8 2.2 Other Malignant Neoplasms 72 68 140 17.7 TOTAL 419 372 791 88 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 17 (2) Foetal States - Congenital Malformations 8 (3) Prematurity 14 (4) Post-Natal Causes 9 Total 48 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under 1 year per 1.000 Births 1971 1972 1971 1972 Injury at Birth and Congenital 29.4 46.4 4.3 6.5 Premature Births 27.0 21.8 3.9 3.1 Respiratory Diseases 12.8 15.9 1.9 2.2 Atalectasis, Debility and Marasmus 11.5 - 1.7 - Diseases of Digestion * 1.3 1.4 0.2 0.2 Other causes 18.0 14.5 2.6 2.0 * These from Gastro~Enteritis Perinatal Deaths Stillbirths - 61 Deaths in first week - 42 Causes of Death in first week Prematurity - 14 Pneumonia -2 Congenital conditions- 6 Other causes -3 Meningitis - 1 Birth Trauma - 16 Perinatal Rate 21 per 1,000 Total (live and still) births 89 DEATHS UNDER ONE YEAR, ARRANGED IN DAYS. WEEKS AND MONTHS CA USES OF DEA TH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th - 14th da y 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 Al 1 Causes 28 6 4 1 - 2 1 1 1 4 48 6 6 3 1 1 1 1 1 1 69 Meningo-Encephalitis 1 - - - - - - - - - 1 - 1 - - - - - - - - - 2 Chickenpox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - 1 - - - 1 - - - - - - - - - - - 1 Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (all forms) 1 - 1 - - - - - - 1 3 - 3 2 - 1 - - 1 - 1 - 1 1 Diarrhoea and enteritis - - - - - - - - 1 - 1 - - - - - - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - . Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 3 2 - - - 1 - - - 2 8 4 1 - - - 1 - - - - - 14 Premature Births 11 1 2 - - - - - - - 14 1 - - - - - - - - - - 15 Atrophy, Atelectasis, Debility and Marasmus - - - - - _ - - - - - - - - - - - - - - - Injury at Birth 12 3 1 - - - - - - - 17 -- - - - - - - - - - 18 Haemorrhagic disease of newborn - - - - - - - - - - - -- - - - - - - - - - Other Causes - - - 1 - 1 - - - 1 3 1 - 1 1 - - 1 - - - - 7 TOTALS 28 6 4 1 -- 2 1 1 1 4 48 6 6 3 1 1 1 1 1 -- 1 - 69 90 MIDWIFERY SERVICE Municipal midwives attended:— 1. Bookings for home confinement 826 2. Bookings for planned early discharges from hospital 627 3. Patients delivered at home 679 4. Primipara delivered at home 10 Multipara delivered at home 669 5. Live births delivered at home 678 6. Stillbirths delivered at home 1 congenital abnormalities:— Nasal passages 7. Neonatal death at home 1 congenital abnormality:- Imperforate anus 8. Premature Infants born at home 17 1.51b 37 weeks admitted 9.5.8 36 weeks 2. 5.8 Term 10. 3.12 34 weeks admitted 3.5.4 Term 11.5.8 Term 4. 5.8 39 weeks 12. 5.4 38 weeks 5. 5lb ?36 weeks 13. 5.4 38 weeks 6. 5.8 ?36 weeks 14. 5.2 37 weeks 7.5.8 34 weeks admitted 15.5.4 Term 8. 4.14 38 weeks admitted 16. 5.8 Term 17. 5lb Term 9. Inhalational Analgesia given "Entonox" 509 "Trilene" 34 10. Patients given Pethidine or Pethilorfan 347 11. Post Partum Haemorrhage including 2 secondary P.P.H. 7 Treated at home 3 Admitted to Hospital 4 12. Retained Placentae 14 Treated at home 3 Admitted to Hospital 11 13. Flying Squad calls 15 14. Manual removal of placentae at home 2 15. Blood transfusions at home 1 16. Prolonged labours over 24 hours delivered at home, - 17. Forceps del iveries at home - 18. Ventouse extraction at home 1 19. General Anaesthetics given at home 5 20. Breech deliveries 4 21. Sets of twins delivered at home - 91 22. Anaemia of pregnancy treated at home 82 23. Pre-eclamptic toxaemia of pregnancy treated at home 22 24. Puerperal pyrexia 20 Genital 7 Extra-Genital 13 25. Congenital abnormalities delivered at home 12 Spina Bifida Imperforate Anus (N.N.D. at home) Mole on index finger - Rt. hand Absence of Nasal Passages Extra digit - Left hand (Mother Rubella contact) Heart Murmur Hypospadias Small extra digit - Rt. foot Port Wine Stain Rt. leg Cystic pedicles on ears Blocked Tear Duct Fractured Humerus - Family history of fragi lity of bones 26. Artificial rupture of membranes at home 27 27. Buccal pitocin induction of Idbour at home 24 28. Rhesus negative mothers delivered at home 93 29. Anti-D Immunoglobulin treatment given 49 30. Guthrie tests for phenylketonuria sent to laboratory 4,730 including 65 repeat tests 31. Patients admitted to hospital 237 Antenatal 151 During labour 59 After delivery 27 (including 10 early discharges re-admitted) 32. Infants admitted to hospital (including 3 re-admissions) 24 Spina Bifida 1 Lethargic 1 Respiratory Distress 2 Spots on body 1 Prematurity 4 Malaena Stools 1 Vomiting 3 Jaundice 1 Cyanosis 3 Respiratory Infection 1 Collapse 1 Small for dates 3 Asphyxia 1 Fractured Humerus 1 33. Patients received for Home Nursing 1,492 Booked for Home Conf. 158 Booked for Hospital Conf. 1,334 (including 583 booked for early discharge) 34. No. of Pupil Midwives trained 45 (3 did not complete training) 35. District visits of Obstetric Course students 45 92 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1965 - 1972 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 1972 4,927 2 0.41 14.0 93 Mid\wlfe Mile 3 Deliveries Maternity Analgesia Ante-Natal Post-Natal Home Confinement 48 hour bookings Home Visits Clinic Session A.N. Clinic Session G.P. A/N Clinic Session Cervical Cytology Normal Abnormal Entonox Trilene Midwife Pupil Midwife Pupil 1. + 4.014 43 + 9 41 2 39 838 633 762 681 71 52 105 2. ® 3,019 37 + 4 37 31 898 586 45 34 69 3. x 3.202 43 + 5 42 1 39 545 98 753 207 29 33 62 4. x 4,314 44 + 7 42 2 37 1.033 403 800 644 54 29 94 5. x 4.098 35 + 1 32 3 1 33 1,440 34 885 31 45 67 96 6. + 2,478 59 + 4 56 3 46 1,246 380 772 324 72 37 98 7. 5,679 58 + 4 54 4 41 648 300 663 368 53 40 59 8. + 6,570 70 + 3 65 5 50 806 419 742 511 53 36 84 9. + 3,081 48 + 8 47 1 43 528 332 769 513 56 48 166 10. 2,218 11. + 4,471 49 + 4 48 1 41 534 209 581 635 93 80 145 12. 1,454 12 + 6 11 1 10 189 133 4 10 21 13. x 4,497 49 + 3 48 1 39 789 467 770 508 63 58 98 14. x+ 5,410 32 + 1 32 28 516 725 31 36 47 15. 4,574 43 + 8 43 27 1.257 561 874 413 43 59 118 16. + 2,817 43 + 2 43 27 1.224 584 46 41 94 17. + 3,403 10 + 2 10 10 629 172 471 353 28 27 53 18. † 1 + 0 1 1 11 94 Midwife Miles Deliveries Maternity Analgesia Ante-Natal Post-Natal Home Confinement 48 hour bookings Home Visits Clinic Session A.N. Clinic Session G.P. A/N Clinic Session Cervical Cytology Normal Abnormal Entonox Trilene Midwife Pupil Midwife Pupil 1. 5,440 193 456 26 150 33 74 2. 4,650 220 754 18 116 21 39 3. , 4.505 1,056 619 31 113 31 15 4. * 4,962 3 + 0 3 2 173 573 22 96 19 49 5. 3,772 385 682 52 100 65 23 6. 5,278 92 875 24 109 59 23 7. † 201 Totals 93,106 679 + 71 655 24 509 34 15.219 3,998 9.021 5,188 826 627 1.382 584 228 223 95 x Denotes 4 Midwives working in attachment schemes but who also undertake some other duties N.B. Attachment transferred from Midwife 14 to Midwife 3 - November 1972 + Denotes Midwives working in liaison schemes with General Practitioner Obstetricians The Midwifery Staff in full have assisted 37 doctors at the Ante-Natal sessions in the year. * Part-time Midwife 4 undertook deliveries in an emergency while on duty. † District Nurses and Health Visitors undertook these duties in connection with patients discharges from maternity unit during a period of quarantine for infection ✓ Midwives who assist with preparation for parentcraft sessions Deliveries + = No. of deliveries + No. of patients admitted to Hospital in labour. Staff Changes Full Time No. 12 Left Service Sept. 1972 Not replaced (General Relief) No. 16 Left Service Oct. 1972 Not replaced Area transferred to Midwife 14 - See Note under Attached Schemes X No. 17 Promoted 1972 Not replaced Area transferred to Midwives 8 and 9 Part-Time No. 2 Commenced duties Jan. 1972 Replacement for 1971 Vacancy 96 CARE OF PREMATURE INFANTS (1) Number of live premature infants notified during 1972 who were born* - (i) at home or in a nursing home 16 (ii) in hospital* 303 (2) The number of those born at home or in a nursing home - who were nursed entirely there 16 who were transferred to hospital on or before the 28th day 1 who died during the first 24 hours 1 who died in 1 and under 7 days who died in 7 and under 28 days who survived at the end of one month 15 (3) Number of those born in hospital - who died during the first 24 hours 16 who died in 1 and under 7 days 14 who died in 7 and under 28 days 1 who survived at the end of one month 272 (4) Number of premature still births who were born (i) at home or in a nursing home 3 (ii) in hospital 36 * The group under this heading includes cases which may be born in one hospital and transferred to another. 97 CONGENITAL ABNORMALITIES No. registered in 1972 - 134, of these125 were live-births 8 were still-births 8 died (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) TOTALS OVERALL TOTALS Central Nervous System eye, tar Alimentary System I Heart and (jreat vessels Respiratory System Uro-genital System Limbs Other Skeletal Other systems Other Ma!- formations M F M F M F M F M F M F M F M F M F M F M F LIVE 3 4 3 - 11 6 8 12 - - 14 2 12 18 9 1 5 8 3 6 68 57 125 STILL BIRTHS 1 6 - - - - - - - - - - - - - - - - 1 - 2 6 8 DEATHS 2 3 - - - - - - - - 1 - - - - - - - - 1 4 4 8 TOTALS 6 13 3 - 12 6 8 1 2 - - 15 2 12 1 8 9 1 5 8 4 7 74 67 134 CAUSES OF DEATH OR ST ILL-BIRTH Col. 1. Anencephalus 2 Spina Bifida 1 Hydrocephalus 1 Col. 2. Nil Col. 3. Malformations of alimentary system 1 Col. 4. Nil Col. 5. Nil Col. 6. Malformations of uro-genital organs (cardiac failure) 1 Col. 7/8/9. Nil Col. 10. pneumonia 1 ISSUE OF WELFARE FOODS FOR 1972 National Dried Milk 14,679 Vitamin A.D & C Drops 20,624 Vitamin A.D & C Tablets 3,367 Orange Juice 26,804 (Disco nti nued) 98 AT RISK REGISTER YEAR ENDING 31st DECEMBER, 1972 Number added to Register during 1972 747 Number on Register at 31.12.72 1,998 Number of 8 months checks carried out during 1972 563 Number of 2 year checks carried out during 1972 581 REFERRALS AND RETESTS 1972 Born 1972 No. to be seen again at Child Health Centre 5 No. referred to Stycar Hearing Clinic, Dr. Morgan 3 No. in abeyance awaiting report from Hospital 1 Born 1971 No. to be seen again at Child Health Centre 11 No. referred to Stycar Hearing Clinic, Dr. Morgan 9 No. referred to General Practitioner 1 No. referred to Handicapped Register 1 No. in abeyance awaiting report from Hospital 5 Born 1970 No. to be seen again at Child Health Centre 93 No. referred to Stycar Hearing Clinic, Dr. Morgan 2 No. referred to Speech Therapy 1 No. referred to Handicapped Register 12 No. in abeyance awaiting report from Hospital 7 ^°rn ioco anC' No. to be seen again at Child Health Centre 2 i "bo No. referred for Audiogram 1 No. referred to Speech Therapy 6 No. referred to Handicapped Register 3 99 STYCAR HEARING TESTS Number of Clinics held in 1972 19 Number of Appointments sent out during year 153 Number of Non-Attenders 44 SOURCE OF REFERRAL AND RESULT SOURCE HEARING SATISFACTORY HEARING UNSATISFACTORY TOTAL Referred Speech Clinic Referred Speech Clinic and E N. T. Refused Speech Therapy For Observation Discharged Referred E. N. T. Referred Speech Clinic & T.C.A. For Observation CHILD HEALTH CENTRE 17 5 38 2 1 3 66 HEALTH VISITOR 1 1 8 2 12 SPEECH CLINIC 9 1 10 GENERAL PRACTITIONER 2 8 10 OTHER SOURCES 2 1 1 4 REASON AND SOURCE OF REFERRAL REASON FOR REFERRAL SOURCE OF REFERRAL TOTAL Child Health Centres Health Visitor Speech C linic General Practitioner Other Sources 1. Failed stycar test 33 5 38 2. Poor Speech 22 5 1 28 3. Suspected Hearing Loss 9 10 10 3 32 4. Other reasons 2 2 4 RETESTS REASON FOR RETESTS HEARING SATISFACTORY HEARING UNSATISFACTORY TOTAL Referred Speech C linic Referred Child Guidance Discharged For Further Retest Immature Response last test 3 1 4 Mentally Retarded 1 1 Poor Speech 1 1 2 100 101 HOME VISITS BY HEALTH VISITORS AND TUBERCULOSIS VISITORS * TYPE OF CASE YEAR 1972 1 Children born in 1972 5,256 2 Other children aged under 5 years 15,657 3 Persons aged 5-16 seen as part of health visiting (not school health service) 1,245 4 Persons aged between 17 and 64 3,363 5 Persons aged 65 and over 815 6 Households visited on account of T.B. 634 7 Households visited re other infectious diseases 70 8 Households visited for any other reason 1,011 SUB-TOTAL 28,051 Subsequent visits to childrenO -5 years 29,755 Subsequent visits to persons aged 65+ 1,106 Visits to Commonwealth immigrant families 3,490 Visits to problem families 2,971 Other subsequent home visits 4,283 Home visits by Tuberculosis Visitors 3,884 GRAND TOTAL OF VISITS BY HEALTH VISITORS AND TUBERCULOSIS VISITORS 73,540 No. of persons in lines 1 - 5 above who were: — Mentally handicapped 78 Mentally ill 214 * N.B. - If a household rather than a person was visited, the case was included in line 6, 7 or 8, and not in lines 1 -5, in accordance with DOHSS Form LHS 27/3 (1972) 102 ATTENDANCES AT CHILD HEALTH CENTRES - 1972 Addlscombe 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. Hazelg len Wed. A.M. (Jan-Feb.) Kenley Friday P.M. Lodge Road Thursday A.M. & P.M. Lodge Road Friday P.M. Monks Hill Thursday P.M. Monks Orchard Monday P.M. New Addington Monday P.M. Infants born 1972 76 72 120 70 55 134 28 77 154 54 50 2 73 198 105 49 104 108 No. of re-attendances 357 432 930 481 372 782 274 556 1201 287 295 2 609 890 409 247 627 491 ChiIdren 1 -5 years 165 257 248 219 189 186 91 202 243 99 98 44 232 293 137 66 328 311 No. of re-attendances 631 1023 1347 982 503 862 553 1408 1270 457 447 40 999 1222 588 418 979 632 Total attendances 1229 1784 2645 1752 1119 1964 946 2243 2868 897 890 88 1913 2603 1239 780 2038 1542 Consultation with doctors 475 678 914 490 478 671 - 741 1148 238 230 21 598 1423 691 359 608 523 No. of sessions 44 48 96 52 50 52 52 48 94 28 22 8 50 104 50 52 47 48 Average per session 1 972 27.9 37.1 27.5 33.7 22.4 37.8 18.2 46.7 30.6 34.5 40.4 11.0 38.2 25.0 24.8 15.0 43.3 32.1 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 27.9 19.1 17.2 42.8 30.2 Continued on next page 103 ATTENDANCES AT CHILD HEALTH CENTRES - 1972 (Continued) New Addington Wednesday P.M. New Addington Thursday P.M. Norbury Wednesday A.M. & P.M. Old Coulsdon Tuesday P.M. Parish Church Mon. P.M. (Jan.-March) Purley Tuesday A.M. Rectory Park Tuesday P.M. Rectory Park Thursday P.M. Reedham Park Avenue (Alt.) Wednesday P.M. St. Albans Wednesday P.M. St. Andrews Friday P.M. (April - Dec.) St. Judes Tues. A.M. (Jan.-Sept.) & P.M. St. Oswalds Thursday P.M. St. Paul's Friday P.M. Selhurst Mon. P.M. (Jan. - Oct.) Selsdon Monday P.M. Shirley Thursday A M. Shrublands Monday P.M. Infants born 1 972 144 173 147 43 26 78 105 95 17 104 121 113 86 72 25 99 72 35 No. of re-attendances 682 653 998 390 36 448 819 788 53 563 718 660 492 417 112 762 546 248 Chi Idren 1 - 5 years 513 417 315 196 111 228 173 305 69 259 20 212 157 217 84 203 197 162 No. of re-attendances 1104 1203 1854 1005 95 708 1010 1327 163 1173 513 1103 783 629 441 1128 743 635 Total attendances 2443 2446 3314 1634 268 1462 2107 2515 302 2099 1372 2088 1518 1335 662 2192 1558 1080 Consultation with doctors 953 803 1201 354 161 620 350 811 156 631 567 784 564 539 254 550 551 587 No. of sessions 60 52 100 51 13 51 55 52 24 52 38 88 52 50 33 48 50 48 Average per session 1972 40.7 47.0 33.1 32.0 20.6 28.6 38.3 48.3 12.6 40.3 36.1 23.7 29.2 26.6 20.0 45.6 31.1 22.5 Average per session 1971 49.5 44.8 38.3 40.6 24.6 34.6 22.1 41.9 17.5 40.3 - 27.2 29.9 37.3 27.3 46.2 27.4 29.8 Continued on next page 104 ATTENDANCES AT CHILD HEALTH CENTRES - 1972 (Continued) co ^ "O S0- !2 ~o xi 'Z CO u. .c o CD C CO 3 o -£ >< 2 > o « -C CO S 3 o -C CO H- -o o . O 2 * s J_ "D to 3 a) O 3 c/) l- T3 O O £ £ 3 *a o c C/) LL CO c -C o -> o ^ O O- ! > o « CO i_ a> a) c a -a a a) CO c > -Q < ^ 35 * — 00 TJ §5 ! < Z. CO a) ^ £ = a." > (0 "O C CO O 0) -D c •a -o co a) $ $ a) . "O D- 'co > U CO 0 *a 1 £ CN Is* _J < K O r- CD < y- o 1- CO a5 c .2 cm 0) -O u ^ — CO . 0) k- 1 ■C CO 8sS c g £ - ® 3 O U (/> CO © c o <0 O) "O " - — CO . x: o- to _ a) 8 •- ® ® c c a — ® 3 U O u> Infants born 1972 43 16 67 62 66 168 82 82 3,670 4,246 841 710 No. of re-attendances 338 30 421 379 490 940 412 480 22,117 25,148 4,985 3,833 Children 1 - 5 years 157 86 106 62 178 382 182 146 8,545 9,616 1.755 1 ,522 No. of re-attendances 602 290 691 690 768 1449 431 539 35,438 36,957 6,973 6,525 Total attendances 1140 422 1285 1193 1502 2939 1107 1 247 69.770 75,967 14,554 12,590 Consultation with doctors 478 173 390 395 333 1044 455 614 24.604 26.829 5.065 5,186 Mo. of sessions 50 13 47 50 52 94 52 49 2,269 2,379 724 570 Average per session 1972 22.8 32.4 27.3 23.8 28.8 31.2 21 .3 25.4 30.7 - 20.1 Average per session 1971 20.1 32.3 24.6 25.4 23.5 51.8 24.3 24.9 • 31.9 ■ 22.1 105 HOME NURSING Staff as at 31.12.72. 1 Area Nursing Officer 4 Nursing Officers 1 Senior District Nurse 51 (46 F.T.E.) Nurses S.R.N. 11 Nurses S.E.N. 18 (15 F.T.E.) Nursing Auxiliaries Summary of work carried out during 1972 (1971 figures in brackets) Total number patients nursed at home 7,059 (6,990) Termination of Domiciliary cases Convalescent 3,038 (3,019) Hospital 971 (1,058) Died 456 (391) Removed - other causes 671 (725) Remaining on books 31.12.72 1,923 (1,697) Total 7,059 (6,990) Total number of treatments carried out by Home Nurses in General Practitioner Surgeries 22,198 (11,338) Total number of treatments carried out at Health Centre 11,880 HOME VISITS Croydon Cross Boundary Arrangements with other Local Authorities 1972 1971 January 14,745 15,644 104 February 15,240 13,973 74 March 16,100 16,472 50 April 15,083 14,093 98 May 16,082 15,212 63 June 14,962 14,517 76 July 15,434 15,039 144 August 15,301 14,753 121 September 14,696 14,952 97 October 16,384 15,543 89 November 16,596 14,983 84 December 15,060 15,198 82 TOTAL 185,683 179,379 1,082 106 REHABILITATION OF ELDERLY PERSONS Patients visited during 1972 Female 105 (81) Male 58 (57) 163 (138) Results Admitted Hospital 14 (18) Rehabilitated 45 (43) Limited or no success 73 (42) Died 3 (7) Remaining on books 28 (29) 1 Visit only 44 GENERAL PRACTITIONER ATTACHMENT SCHEMES Definitions FULL ATTACHMENT Schemes are those in which a Health Visitor or Home Nurse has regular consultations with specified general practitioners and is responsible for providing Local Health Authority services to all the patients on their lists who live within the Authority's area. PART ATTACHMENT Schemes are those where a Health Visitor or Home Nurse has regular consultations with specified general practitioners but is responsible for providing Local Health Authority services to only some of the patients on their practice lists who live in the Authority's area. ALIGNMENT Schemes are where the Health Visitor or Home Nurse is responsible for providing Local Health Authority services to all patients on specified general practitioner lists living in a Local Authority area but where no formal arrangements exist between nursing staff and the general practitioner. ATTACHMENT SCHEMES AS AT 31st DECEMBER 1972 (1971 FIGURES IN BRACKETS) STAFF FULL ATTACHMENT PART ATTACHMENT ALIGNMENT TOTAL Health Visitors 29(28) 3(3) 5 37(31) Home Nurses 41(38) 5(8) - 46(46) Midwives 4(4) 8(9) - 12(13) TOTAL 74(70) 16(20) 5 95(90) 107 CROSS BOUNDARY ARRANGEMENTS Arrangements have been made on a knock for knock basis with the under-mentioned Local Authorities for community nursing staff to nurse and advise patients registered with specified general practitioners:— London Borough of Lambeth London Borough of Bromley London Borough of Merton Surrey County Council LONG STAY IMMIGRANTS Country Issuing Passport Notifications Received Successful Visits (Contacted) Unsuccessful Visits (Not Contacted) Commonwealth Countries Caribbean 50 49 1 India 115 66 49 Pakistan 60 54 6 Other Asian 70 58 12 African 569 467 102 Others 37 35 2 Non-Commonwealth Countries European 12 12 - Others 22 19 3 TOTAL 935 760 175 MALES 293 FEMALES 341 CHILDREN 301 108 LOAN OF NURSING EQUIPMENT The Corporation lends equipment and makes a small weekly charge, with exemption for incomes below a certain figure. 1972 HEALTH DEPT. BRITISH RED CROSS SOCIETY Croydon Air rings 46 17 Bath mat - - Bath seat - 4 Bed blocks 71 2 Bed pans 165 45 Bed rests 193 40 Bedsteads 31 - Bed tables 18 4 Carry Chairs 5 - Commodes 578 109 Cradles 174 51 Crutches (Pairs) 38 20 Diapers 270 - Enuresis machines 173 - Feeding cups 8 2 Foam squares and rings 125 6 Foot suction pumps 8 - Fracture boards 122 - Hydraulic hoists 49 - Incontinence pads 75,305 - Kidney bowls - - Mackintosh sheets 82 11 Mattresses 24 - North pads 120 - Paddi rolls 10,771 - Pick-up-stick - - Plastic sheet 50 - Protective undergarments 1,508 - Pulleys 38 - Ripple beds 139 - Renal Dialysis Machines 8 - Toilet extension - 2 Urinals 116 14 Walking aids 367 24 Walking sticks 62 6 Wheelchairs 183 93 Wheelchairs (self-propelled) - 11 Toilet Aid (rail) - 2 Bath Aid (rail) ~ 4 109 DEATHS FROM ACCIDENTS IN THE HOME Cause No. Details Falls 16 There were 12 women and 4 men between the ages of 37 and 84 years of ape. Asphyxia 8 1 boy aged 2 months - carbon monoxide poisoning when house caught fire. 1 man aged 20 - inhalation of stomach contents. 1 man aged 32 - inhalation of stomach contents. 1 woman aged 58 - inhalation of stomach contents. 1 man aged 63 - carbon monoxide poisoning from inhalation of fumes - faulty flue pipe on gas water heater. 1 man aged 64 - inhalation of smoke and fire fumes. 1 woman aged 75 - drowned in her bath. 1 man aged 79 - carbon monoxide poisoning from inhalation of fumes from solid fuel stove. Burns and Scalds 1 1 woman aged 84 - multiple burns. Poisoning 4 1 boy - aged 2 months - lead poisoning - ingestion of paint flakes. 1 man - aged 52 - Barbiturate. 1 woman - aged 53 - Alcohol and Soneryl. 1 woman - aged 67 - Phenformin overdose. TOTAL 29 110 "DON'T HOARD MEDICINES" CAMPAIGN. CROYDON - MARCH 1972 Number of shops visited 74 Time taken on collection 33 hours Weighing, packing and incineration 4 pharmacists - 120 hours Assessment of 10% sample 8 pharmacists - 40 hours Distance covered 294 miles Total gross weight of drugs collected 1353 lbs. Weight of Chemists' and Doctors' stock 236 lbs. Weight returned by public 1st week 273 lbs. 2nd week 354 lbs. 3rd week 490 lbs. Total weight returned by public 1117 lbs Total nett weight of tablets etc. 247 lbs. = less than one tablet per head of the population Number of bottles returned containing Barbiturates 124 Amphetamines 8 Mandrax 11 Preludin 3 D.D.A. items 9 Assessment Result: Classified with reference to MIMS Pharmacological Index Pk % % Analgesic & Anti-inflammatory 17 Central Nervous System 38 Alimentary system 12 E.N.T. Tranquilliser & Sedative 12 Ophthalmic 15 Antibiotic & Sulphonamide 9 Dermatological Nutritional & Vitamin 9 Anaesthetic E.N.T. 6 Alimentary 12 Dermatological 6 Anti infective 9 Stimulant & Anti-Depressant 5 Nutritional 9 Cardiovascular 4 G.U. 4 Hypnotic 4 Respiratory 4 G.U. 4 Miscellaneous & Unidentified 4 Respiratory 4 Cardiovascular 4 Unidentified 3 Hormones 1 Ophthalmic 2 Hormones 1 Anaesthetic 1 Miscellaneous 1 111 Dispensed medicines 81% Over the counter 19% Estimated total number of tablets and capsules 214,180 Estimated total number of tablets and capsules in each bottle 33 Estimated total volume of liquid 21 gallons 112 ORIIG COLLECTION CAMPAIGN - SPRING 1972 Assessment of 10% samples Dispensed Medicine Over the Counter Tablets Type of Preparation % Total of Units Returned Capsules Bottles Contents Bots. Cont. Liq. Other External Alimentary System 56 48 64 2092 4 61 21 10 5 12% Cardiovascular 32 1 29 1342 2 27 2 4% Analgestics Ant i-Inflammatory 120 22 122 4569 16 528 3 1 17% TranquilIisers/Sed. 93 4 79 3099 14 721 3 1 12% Stim./Anti-Depressants 41 27 714 13 368 1 5% Hypnotic 29 1 26 804 2 146 2 4% E.N.T. 37 13 26 384 5 104 5 11 14 6% Hormones 10 9 319 1 1 1% G.U. 30 2 29 921 3 46 4% Antibiotic/ Sulphonamides 74 4 44 851 23 172 6 4 4 9% Nutritional/Vitamin 56 20 58 1539 11 140 7 9% Respiratory 9 26 13 398 4 130 17 3 4% Ophthalmic 15 2 10 18 2% DermatologicaI 42 9 15 36 1% Anaesthetic 5 4 6 65 2 3 1% Contraceptives - Miscellaneous 7 4 442 1% Unidentified 25 1 21 1313 3 123 1 1 3% TOTALS 681 157 557 18852 100 2566 6 21 39 82 100% 113 Dental Services for Expectant and Nursing Mothers and Children under 5 years Part A. Attendances and Treatment Number of visits for treatment during year Children Expectant and 0-4 (inc.) Nursing Mothers First visit 984 99 Subsequent visits 941 166 Total visits 1,925 265 Number of additional courses of treatment other than the first course commenced during the year 80 51 Treatment provided during the year - Number of fi 11 i ngs 1,337 203 Teeth filled 1,213 193 Teeth extracted 335 64 General anaesthetics given 119 14 Emergency visits by patients 123 20 Patients X-rayed 9 28 Patients treated by scaling and/or removal of stains from the teeth (prophylaxis) 50 49 Teeth otherwise conserved 129 Teeth root filled 4 Inlays Crowns P 3 Number of courses of treatment completed during the year 504 62 Part B. Prosthetics Patients supplied with F.U. or F.L. (First time) nil Patients supplied with other dentures 12 Number of dentures supplied 12 Part C. Anaesthetics General anaesthetics administered by dental officers nil 114 Part D. Inspections Children Expectant and 0-4 (inc.) Nursing Mothers Number of patients given first inspections during year 1,028 82 Number of patients in A and D above who require treatment 593 76 Number of patients in B and E who were offered treatment 591 76 Part E. Sessions Number of sessions (i.e. equivalent complete half-days) devoted to Maternity and Child Welfare patients: For treatment 312 For health education 3 DOMICILIARY FAMILY PLANNING SERVICE 1972 Table 1 Number of new patients seen during the year (see note 2) Married (including the widowed separated or divorced) Unmarried Total Male 9 1 10 Female 120 25 145 Total 129 26 155 Table 2 Number of new patients seen during the year who were:— Medical cases 44 Non-medical but needy 61 Other non-medical cases 50 Total 155 Table 3 Number of new patients seen during the year who were initially advised to use (see note 3):— Sheath 49 Pill 48 Diaphragm 4 I.U.D. 67 Other methods 80 No method advised 8 115 CERVICAL CYTOLOGY Number of women tested during 1972 MONTH No. of Clinics Class I 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 Cases Repeats January 13 114 78 73 95 2 2 - - - - 189 175 364 February 14 128 120 54 86 1 3 - - - - 183 209 392 March 20 141 153 76 94 1 2 - - - - 218 249 467 ApriI 15 126 89 60 68 4 - - - - - 190 157 347 May 21 142 114 103 127 - 3 - - 1 - 246 244 490 June 19 132 144 79 96 - 1 - - - - 211 241 452 July 17 115 101 76 88 1 - 1 - - - 193 189 382 August 20 112 109 106 98 2 1 1 - - - 221 208 429 September 23 125 114 98 141 3 2 - - - - 226 257 483 October 20 116 139 71 112 7 2 1 - 1 - 196 253 449 November 25 180 137 110 101 1 - - - - - 291 238 529 December 17 127 53 124 65 2 - - - - - 253 118 371 TOTAL 224 1,558 1,351 1,030 1,171 24 16 3 - 2 - 2,617 2,538 5,155 Numbers referred to Family Doctors for Treatment January 42 Apri 1 44 July 23 October 37 February 43 May 46 August 25 November 27 March 38 June 31 September 44 December 16 TOTAL REFERRALS - 416 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 23 207 451 420 468 446 405 277 136 56 12 8 2,909 Class II 11 111 268 296 310 286 302 313 190 94 16 4 2,201 Class III - 2 7 10 8 4 3 4 - 1 1 - 40 Class IV - - - 1 - 1 - 1 - - - - 3 Class V - - 1 - - - - - 1 - - - 2 TOTAL 34 320 727 727 786 737 710 595 327 151 29 12 5,155 Class I - NORMAL SMEAR PATTERN according to age and physiological state (including pregnancy) Class II - "INFLAMMATORY" 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 IV - ISOLATED CELLS SUGGEST MALIGNANCY - Early gynaecological review essential. Class V - MALIGNANCY PROBABLE - Early gynaecological review essential. 116 REGISTERED NURSING HOMES Sections 187-194, Public Health Act 1936, as amended by Nursing Homes Act 1963 Number of Homes Number of beds provided Maternity Other Total Homes registered during the year - - - - Homes whose registrations were withdrawn during year - - - - Homes on Register at end of year 15* 20* 399 419 *Includes 1 Mother and Baby Home. NURSES AGENCIES ACT, 1957 There are two agencies on the Register which supply nurses for home nursing on a private patient paying basis. CREMATION ACTS. 1902 and 1952 During the year 2,914 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 1972 Total number of Bodies received 1,152 Post-Mortem Examination for M.O.H 2 Post-Mortem Examinations for H.M. Coroner 1,145 StiIl-Bom (M) No P.M - Adults (M) 3 (F) 2 No P.M 5 117 COMMUNICABLE DISEASES NOTIFIED DURING 1972 Notifiable Disease <0 03 O) CD CD Cases notified Total cases notified in wards A t ages - years ■o o o S >*. o -o o c: o c w o -c: K V. 0 c 1 c 03 03 <0 03 £ c o c O -c K o o o CO 03 .■Q O O to CO Uj 03 -Q £ 0 0 to ■0 0) CO < 0 •C 03 c 03 03 *«. CD X3 CO 0 03 ~co w C 0) 0 c: 0 •Q CO c 0 Co c •5 0) .v. CO -c: £ 0 <0 0) CO V. 0) "O C CO CO T3 C CO O 03 "C3 5-2 ^ 03 c-o CO C CO CO T3 ^ c® cos 03 C 0 5 0 0 to CO Uj c 0 T3 CO O O >.03 0. M F -J 5 0 K- 03 "0 C M- ••a- io CN 2 <o 03 o to <0 Anthrax - - - - - - - . - - . - - - - - - - - - - . . . . . Scarlet Fever 100 - 28 63 9 - - 4 2 1 7 5 5 7 7 5 5 3 1 16 17 8 1 5 49 51 100 Diphtheria - - - - - - - - - - - - - Acute Meningitis ... 11 4 3 2 1 1 - 1 - - 1 - 2 1 1 - 1 - 2 . 2 7 4 11 Typhoid and Para- Typhoid 2 1 1 1 1 2 Smallpox Cholera - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - • - • - - - - Ophthalmia Neonatorum 1 1 1 1 Acute Poliomyelitis Dysentery 13 1 2 5 4 - - 3 - - - 1 1 3 1 - 2 8 5 13 Malaria 3 2 - - - - 3 3 Infective Jaundice .. 32 • - 7 5 1 1 8 1 4 2 4 - 2 2 2 2 2 3 1 1 - 20 12 3? Food Poisoning 15 - 1 4 4 4 2 1 2 - 1 1 • 1 - 1 - 1 . 5 1 9 6 15 Acute Encephalitis.. 2 - - 1 1 - - - 2 2 Measles 498 21 227 240 6 4 41 10 11 8 43 43 71 16 3 1 1 1 1 12 26 109 32 ? 31 6 4 R 255 243 498 Whooping Cough 50 7 29 13 1 _ 2 2 1 - 6 2 2 29 1 . 3 2 . 28 22 50 Leptospirosis 1 - - - - 1 1 Tetanus - - - - - - - - - - - - - - - - • - - - - - - . _ Vellow Fever " " " ■ 728 34 290 337 34 20 10 3 50 23 15 22 56 54 81 27 1 1 19 17 14 31 158 57 5 48 16 7 17 377 351 72R Tuberculosis notifications are shown in the section relating to that disease 118 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES 1972 Notifiable Diseases Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total Respiratory Tuberculosis 6 8 5 6 4 8 6 10 8 2 4 1 68 Non-Respiratory Tuberculosis 3 2 2 1 1 2 3 - 2 2 2 1 21 Anthrax - - - - - - - - - - - - - Scarlet Fever 6 11 10 15 16 14 8 4 1 7 5 3 100 Diphtheria - - - - - - - - - - - - - Acute Meningitis - - - - - 1 1 2 1 - 3 3 11 Typhoid and Paratyphoid - - - - - - 1 - 1 - - - 2 Smallpox - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - Ophthalmia Neonatorium - - - - - - - - 1 - - - 1 Acute Poliomyelitis - - - - - - - - - - - - - Dysentery 1 3 1 - 2 - 1 - 1 2 1 1 13 Malaria 1 - - - - - 1 - - 1 - - 3 Infective Jaundice 2 2 4 4 8 1 4 1 1 2 2 1 32 Food Poisoning 1 1 - 1 - 1 1 7 1 - 2 - 15 Acute Encephalitis 1 - - 1 - - - - - - - - 2 Measles 33 22 86 40 63 32 53 22 15 59 34 39 498 Whooping Cough 4 7 11 5 - 5 1 1 5 7 4 - 50 Leptospirosis - 1 - - - - - - - - - - 1 Tetanus - - - - - - - - - - - - - Yellow Fever - - - - - - - - - - - - - 817 119 FOOD POISONING Corrected food poisoning notifications and cases ascertained in 1972 numbered:— 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total 16 3 23 6 48 Outbreaks due to identified agents:- Total Outbreaks Total Cases 5 29 Outbreaks due to:— fa) Chemical poisons Nil (d) botulinum Nil (b) Salmonella organisms 4 (e) welchii 1 (c) Staphylococci (including (f) other bacteria Nil toxin) Nil Outbreaks of undiscovered cause:- Total Outbreaks Total Cases Nil Nil Single Cases:— Agent identified Unknown Cause Total 16 3 19 Cases due to:- Salm. brediney 3alm. infantis Salm. montevideo Salm. thompson Strep faecalis 2 1 1 11 Unknown Cause Salm. braenderup Salm. agona Salm. typhii murium 3 118 Salmonella infection not food-borne Nil 120 SAMPLES SUBMITTED TO THE PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION - 1972 Faeces outfits 1,360 Drinking Water samples 600 Public Swimming Bath Water samples 112 Private Swimming Bath Water samples 161 Private Wells 189 Milk samples 141 Cream samples 42 Ice Cream samples 151 Sundry Food specimens 22 Blood 18 Urine 571 Nose and Throat Swabs 40 Total 3,407 Samples of Drinking Water During the year under review the total number of examinations performed were:— Bacteriological 600 Chemical 46 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. 121 IMMUNISATION AGAINST WHOOPING COUGH A total of 6,424 children were immunised against whooping cough, comprising 6,263 under school age and 161 school children. In addition 754 children were given reinforcing injections. IMMUNISATION AGAINST TETANUS A total of 7,474 children were immunised against tetanus, comprising 6,326 under school age and 1,148 school children. In addition 8,067 children were given reinforcing injections. VACCINATION AGAINST SMALLPOX A total of 1,046 persons were vaccinated against smallpox. Under 1 year of age 1 2-4 5- 15 16 or over Total Successful Vaccinations 12 162 313 103 8 598 Successful Re-Vaccinations - - 36 309 103 448 1,046 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31 st December, 1972 who completed a course of immunisation during the year. Age at 31.12.72 i.e. born in year Under 1 1972 1969-1971 1968-1965 1964-56 Total Completed course of injections 778 5,548 402 550 7,278 Reinforcing injections - 312 4,285 1,382 5,979 TOTAL 778 5,860 4,687 1,932 13,257 Under 1 1 -4 Total under 5 5-14 Total under 15 Estimated mid yeaChild population* 5,070 21,030 26,100 54,500 80,600 * uncorrected VACCINATION AGAINST MEASLES A total of 3,767 children were vaccinated against measles. VACCINATION AGAINST RUBELLA A total of 2,586 girls were vaccinated against rubella. 122 VACCINATED AGAINST POLIOMYELITIS The following table gives the number of persons who received a course of primary vaccination during the year. Children born 1972 Children born 1971 Children born 1970 Children born 1969 Young Persons born 1968-65 Young Persons born 1964-56 TOTAL With Oral Vaccine 836 3,846 1,501 298 489 599 7,569 Number of persons who received a reinforcing vaccination as at 31st December, 1972. Persons given a V AC CI NATED first reinforcing Vaccination during 1972. With Oral Vaccine 8,357 Annual Total 15,926 Total since Vaccination began 1957 170,972 INTERNATIONAL VACCINATION CERTIFICATES During the year 12,017 certificates were authenticated; 8,245 Smallpox, 3,429 Cholera, 343 T.A.B. IMMUNISATION OF CHILDREN BORN IN 1971 Poliomyelitis Diphtheria Live Births 302 - (immunised 1971) 298 3,846 - (Immunised 1972) 3,833 5,324 4,148 4,131 (78%) (78%) MEASLES VACCINATION FROM APRIL 1968 Year Children Vaccinated 1968 6,035 1969 3,546 1970 4,663 1971 4,408 1972 3,767 123 TUBERCULOSIS (All Forms) PRIMARY NOTIFICATION AND MORTALITY - 1965 - 1972 124 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Summary of notifications during the period from 1st January, 1972 to 31st December, 1972. 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 1 1 2 6 7 4 13 4 6 7 52 Respiratory, Females 1 - 1 - 1 - 2 1 5 2 1 2 - 16 Non-Respiratory Males - - - 1 1 - 2 2 - 1 2 - - 9 Non-Respiratory, Females - - - - - - 3 1 6 1 1 - - 12 Rehousing of Tuberculous Patients 1 family was 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 1972, 58 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) 33 56.9 B, or T.B. plus, 1 (early cases, sputum positive) 9 15.6 B, or T.B. plus, 2 (intermediate cases, sputum positive) 11 18.9 B, or T.B. plus, 3 (advanced cases, sputum positive) 5 8.6 58 100.0% Non-Respiratory Tuberculosis There were 12 cases examined at the Clinic and found to have NonRespiratory Tuberculosis in the following forms:— Bones and Joints - Abdominal - Other Organs 3 Peripheral Glands 9 12 125 Chest Clinic Register of Tuberculosis Cases Number on Chest Clinic Register on 1st January 1972 680 Transfers in from other areas 11 New cases confirmed during the year 70 761 Number of cases written off the Chest Clinic Register %. during the year as:— Recovered 46 Died 16 : Removed to other areas 15 "Lost sight of" and other reasons 5 82 Remaining on Register as at 31st December 679 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 1,972 Number of visits paid by Clinic doctors to homes of patients 176 Number of visits paid to homes of patients by Tuberculosis Health Visitors 3,884 Attendances of patients at the Clinic - At ordinary sessions *14,600 Number of X-Ray fiIms taken *16,231 * Includes 4,489 miniature film attendances Ages at Death from Respiratory Tuberculosis Year 0 - 5 5 - 15 15 - 25 25 - 45 45 - 65 over 65 TOTAL 1972 - - - - 5 9 14 126 127 SEXUALLY TRANSMITTED DISEASES Croydon General Hospital Centre PART A New Cases of Syphilis Total Male Female A1 Primary 2 2 - A2 Secondary 1 1 - A3 Latent in the first two years of infection 5 4 1 A4 Cardio vascular - - - A5 Of the nervous system - - - A6 All other late and latent stages 12 4 8 A7 Congenital aged under 2 years - - - A8 Congenital aged 2 years and over 1 - 1 TOTAL OF LINES A1 TO A8 21 11 10 PART B New Cases of Gonorrhoea B1 Post-pubertal infections 336 211 125 B2 Pre-pubertal infections - - - B3 Ophthalmia neonatorum - - - TOTAL OF LINES B1 TO B3 336 211 125 PART C New Cases of Other Genital Infections C1 Chancroid - - - C2 Lymphogranuloma Venereum - - C3 Granuloma Inguinale - - • C4 Non-specific genital infection 882 652 230 C5 Non-specific genital infection with arthritis 4 4 - C6 Trichomoniasis 133 2 131 C7 Candidiasis 520 207 313 C8 Scabies 17 10 7 C9 Pubic lice (pediculosis - pubis) 32 26 6 C10 Herpes simplex 25 16 9 C11 Warts (condylomata acuminata) 147 84 63 C12 Molluscum Contagiosum 4 4 - TOTAL OF LINES C1 TO C12 1764 1005 759 PART D New Cases of Other Conditions D1 Other treponemal diseases 12 9 3 D2 Other conditions requiring treatment in the centre 113 74 39 D3 Other conditions not requiring treatment in the centre 582 296 286 TOTAL OF LINES D1 TO D3 707 379 328 GRAND TOTAL OF PARTS A, B, C & D 2828 1606 1222 128 PART E AGE GROUPS OF NEW CASES SYPHILIS (lines A1 & A2) GONORRHOEA (line B 1) AGE GROUP Total Male Female Total Male Female 1 Under 16 - - - 8 - 8 2 16 and 17 - - - 28 8 20 3 18 and 19 - - - 54 33 21 4 20 to 24 - - - 108 70 38 5 25 and over 3 3 - 138 100 38 TOTAL LINES 1 TO 5 3 3 - 336 211 125 PART F LOCALITIES IN WHICH INFECTIONS TOOK PLACE PRIMARY & SECONDARY SYPHILIS (Lines A1 and A2) Total Male Female 1 In locality of centre 2 2 - 2 Elsewhere in Great Britain and Northern Ireland - - - 3 Outside Great Britain and Northern Ireland 1 1 - 4 Not known - - - TOTAL OF LINES 1 TO 4 3 3 - POST PUBERTAL GONORRHOEA (line B1) - - - 5 In locality of centre 269 188 81 6 Elsewhere in Great Britain and Northern Ireland 51 13 38 7 Outside Great Britain and Northern Ireland 10 10 - 8 Not known - - - TOTAL LINES 5 TO 8 336 211 125 PART G CONTACT ACTION AND DIAGNOSIS SYPHILIS Total Male Female 1 Contact action taken 8 8 - 2 Contacts attending with syphilis - - - 3 Contacts attending, syphilis not diagnosed - - - GONORRHOEA 4 4 Contact action taken 235 193 42 5 Contacts attending with gonorrhoea 64 2 62 6 Contacts attending, gonorrhoea not diagnosed 35 4 31 129 Local Health Authority area of residence of patient Totals all conditions Number of New Cases in the Year Syphilis Gonorrhoea Other Genital Infections Other Conditions Primary and Secondary Other (A1 - A2) (A3 - A8) (B1 - B3) (C1 - C12) (D1 - D3) CROYDON 1959 2 12 255 1211 479 BROMLEY 227 1 3 17 146 60 KENT 36 - - 2 27 7 KINGSTON 6 - - 1 5 - LAMBETH 70 - - 10 41 19 LEWISHAM 19 - - 3 13 3 MERTON 64 - - 6 44 14 SOUTHWARK 4 - - 2 2 - SURREY 239 - 2 25 134 78 E. SUSSEX 13 - - 2 9 2 W. SUSSEX 4 - - - 3 1 SUTTON 81 - - 5 55 21 WANDSWORTH 27 _ _ 2 19 6 OTHERS 86 - 1 6 55 18 TOTALS 2828 3 18 336 1764 707 LONDON BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1972 To the Chairman and Members of the Education Committee: LADIES AND GENTLEMEN, This is the eighth Annual Report of the School Health Service of the London Borough of Croydon, and if expressed Government Policy is confirmed by legislation it will be the last to be presented by a Medical Officer wholly employed by the Corporation. When the decision was made to reject local authority control of a co-ordinated health service, it became inevitable that to prevent competition within the public sector for scarce professional staff the new Area Boards would be required to supply appropriate medical facilities to Education Authorities. Fortunately in Croydon there is a long tradition of co-operation between hospital and local authority health services, so that for parents and children changes under the new system may pass unnoticed. Routine Medical Inspections These increased in number to cope with a record school population. Findings were largely unchanged. There were five pupils whose physical condition was noted as "unsatisfactory" (0.03%), half the number recorded in the previous year. The centralization of medical record cards was 2 impeded by staff shortages, but as the future location of central office premises was uncertain, delay seemed advisable until this question was settled. Personal Hygiene The recorded numbers of skin defects were average figures, but infestation with head lice increased despite strenuous efforts to prevent, find and treat this annoying condition. There is no evidence that the latest insecticide was ineffective, but its use must finally be followed by careful washing and combing. Furthermore current hair styles demand constant care and cleanliness if infestation is to be avoided. Plantar warts maintain their troublesome prevalence, and efforts to find a shorter method of cure were pursued with some modest success. Vision Defects The system of referral to opticians begun in 1971 worked satisfactorily. Children referred in this way were reviewed in six months to ensure the examination had been carried out, and there was no evidence that any more children failed to attend the optician than would fail an appointment at an Eye Clinic. Educationally Subnormal Children There was no return to the position of previous years with a long waiting list of children needing assessment, but the same cannot be noted for the number (72) waiting entry to a day special school. Maladjusted Children Last year comment was made about a three-fold increase in the number of children ascertained as maladjusted over the previous years. This was maintained during 1972, and the Sir Cyril Burt Day School has a waiting list for most age groups in both the day and residential departments, as has the unit for non-communicating children. Dr. Crosse in his report on the Child Guidance Service comments on these facts and on the efforts made to increase facilities at the Clinic. Health Education The Principal Health Education Officer sets out in some detail the continuing development of this service in schools. From the outset our local health education efforts have been directed to influence two main groups of the population - parents concerned with the upbringing of children, and children themselves. For the latter we have sought to offer help to teachers, in the hope that health education would become part of the usual school curriculum. The effects of this long term approach are incapable of speedy evaluation and await findings when school children so educated form a new generation of parents. It was thought very important to maintain the firm 3 links established between the Health and Education Departments in this field, and measures to ensure its continuation in 1974 were being considered. Dental Services The year began with an exceptionally good staffing position, but as related by the Chief Dental Officer we finished sadly depleted. The general trend of applications for employment by dentists has been encouraging, so that there are reasons to think that this was only a temporary setback. Speech Therapy A similar position arose due to resignations for various reasons and the number of Therapists employed at the end of the year had fallen to four. The problem here is much more difficult as there is a national shortage. This had been overcome by local measures which cannot be repeated at the present time. Infectious Diseases There was a small outbreak of Sonne dysentery in a South Croydon school which responded rapidly to the usual methods of control. The Committee agreed that during their final school medical examination children should be offered booster doses of tetanus and poliomyelitis vaccines. With the co-operation of Head Teachers this is now being carriea out as a routine procedure. Research The Committee agreed that subject to the usual safeguards teaching staff could be approached by various organisations for research projects involving schoolchildren. These included blood biochemistry by University College Hospital, London, at Ashburton School, a general survey of Rubella and its connection with deafness by the Hospital for Sick Children, Great Ormond Street, a dental health study on fluoride mouth wash and toothpaste by Guy's Hospital, and a survey of dental health of school children by the Department of Education and Science. Although most of the work concerns the research teams, these projects do require some help from the staff of schools and officers of this Department, whose essential voluntary efforts are much appreciated. Acknowledgments As usual individual contributions to this report are indicated by naming the professional officer concerned and Dr. Burrowes has assembled and commented on the general findings. Professional work must be supported by efficient administration, and this has been forthcoming throughout a somewhat difficult year with unfailing courtesy and competence. It would be impossible to discharge our duties without the help of the Chief Education Officer and his staff, and especially Head and other teachers in all the Croydon schools. 4 The Members of the Education Committee have continued to exercise the interest and encouragement on which the maintenance and development of the School Health Service depend, and for which I express the collective thanks of the Department. Yours faithfully S.L. WRIGHT, Principal School Medical Officer. 5 PARTICULARS OF SCHOOL CLINICS as at 31.12.1972 The following Clinics are provided by the Education Committee; attendance, with the exception of the Minor Ailments Clinics, is by appointment arranged by the Principal School Medical Officer;- Clinic Address DAILY A.M. MINOR AILMENTS (INCLUDING VERRUCAE) 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 (Verrucae) Surgery (Thurs. p.m.) DENTAL Lodge Road, Broad Green, Croydon. 206, Selhurst Road, South Norwood. Parkway CIinic. New Addington. Purley Clinic. Whytecliffe Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. Shirley Road, Shirley, Croydon. Waddon Clinic, Coldharbour Road, Croydon. INSPECTION ONE OF THE FOLLOWING CLINICS APPROX. WEEKLY IN P.M. Lodge Road, Broad Green, Croydon. Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. AS REQUIRED Sanderstead Clinic, Rectory Park, Sanderstead. 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, CounciI Offices, Brighton Road, Purley. Sanderstead Clinic, Rectory Park, Sanderstead. AUDIOLOGY Lodge Road, Broad Green, Croydon. Parkway Clinic, New Addington. Purley Clinic, Whytecliffe Road, Purley. ENURESIS Lodge Road, Broad Green, Croydon. (Weekly) Parkway Clinic, New Addington. (Monday p.m.)(fortnightly) Purley Clinic, Whytecliffe Road, Purley. (Friday p.m.) (monthly) 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. 6 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 10 (full-time) (38%) *Medical Officers 8 (part-time) (39%) Consultants and Specialists 6 (part-time) *Dental Officers 13 (including 8 part-time and 1 Dental Auxiliary) (80%) *Physiotherapists 12 (including 9 part-time) Speech Therapists 4 *Health Visitor/School Nurses, Clinic Nurses and Nurse/Assistants 75 (including D.N. Officer, A.N. Officer and Nursing Officers, and 13 part-time) (27%) *Dental Surgery Assistants 17 (including 6 part-time) (80%) *Also performing duties in other sections of Public Health Department. Percentages in brackets show proportion of time given to school work. COST OF THE SCHOOL HEALTH SERVICE The cost of the Medical, dental and nursing services was £232,321. Cost of Special Schools Schools maintained by the Council £376,507 Other Schools (not maintained by local Education Authorities £122,490 Adjustments with other authorities in respect of Special Schools £53,391 £552,388 7 PART I. MEDICAL INSPECTION IN SCHOOLS As stated previously, no major change in the system of routine medical inspections 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 children seen at Routine Medical Inspections and Special Inspections has not varied significantly from the previous year. The number of re-inspections has, however, decreased by one-fifth after a steady rise over the previous seven years. Special Inspections have decreased by 10% after a fairly steady rise for some years and a marked increase last year. It is probable, however, that in future years the trend will continue to be for more of these special inspections requested by Head Teachers, School Nurses or parents. Table 1. Numbers seen at Medical Inspections 1972 Routine Inspections - 18,395 Special Inspections - at school medical sessions 1,016 at inspection clinics 38 1,054 Re-inspections - at school medical sessions 2,840 at inspection clinics 598 3,438 8 Last year showed an increase in the number of parents attending School Medical Inspections particularly, strangely enough, in the School Leavers Group. This pattern has not continued and the number of parents attending has reverted to under 55% which is just above the average ofthe previous five or six years. Table 2. Attendance of Parents at School Medical Inspections 1972 1971 Boys Girls Boys Girls Entrants 84.1% 83.2% 84.0% 84.0% Leavers 5.5% 6.2% 9.3% 10.9% Others 56.7% 57.4% 57.3% 56.1% Total Nos. of Children examined 9,452 8,943 9,346 8,834 Attendance of Parents (overall %) 54.8% 57.0% Total Defects T's and R's = 6,500 Total Defects O's = 6,074 No. of medical inspections at non-maintained schools = 28 (visits) The total number of defects discovered appearing to need treatment has remained much the same as in previous years but the number requiring observation has decreased. This accounts for the fall in the number of re-inspections. The number of visits made to non-maintained schools remains fairly static as shown in Appendix C, Page 55. Personal Hygiene The problem of head infestation is still very much with us. There was an increase of 7% in the number of pupils inspected in the course of the year. This number has now risen to a figure almost equivalent to the total school population, though the numbers may include the same infant and junior schools several times in a year, while many secondary schools are not inspected routinely. The number of pupils found unclean for the first time was the highest figure for many years and the number of pupils found unclean at follow-up visits was also, regrettably, at a record level. It appears to be true that in Croydon mainly infant and junior children are involved and there was a large outbreak of infestation at an Infant and Junior School which was still not under control at the end of the year. Head Inspections at Secondary Schools, where siblings of the children at the infected school might have been expected to attend, showed some cases of infestation but on nothing like the scale at the Infant and Junior Schools. 9 Table 3 RETURN OF DEFECTS FOUND AT ROUTINE MEDICAL INSPECTIONS 1972 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 2 11 0.2 10 8 0.3 Teeth 586 92 10.5 764 91 14.0 Skin 599 156 11.7 375 155 8.7 Eyes - Defective Vision 823 812 25.1 930 920 30.2 Squint 135 20 2.4 125 30 2.5 External Eye Trouble 20 28 0.7 24 29 0.9 Ears - Deafness 113 163 4.3 92 184 4.5 Otitis Media 50 70 1.9 57 95 2.5 Other Defects 7 21 0.4 8 20 0.5 Nose and Throat 164 337 7.7 154 302 7.5 Enlarged Cervical Glands 7 81 1 .4 7 71 1.3 Speech 75 90 2.5 50 46 1.6 Heart and Circulation 101 46 2.3 76 64 2.3 Lungs 149 109 3.9 69 75 2.4 Developmental - Hernia 25 22 0.7 17 16 0.5 Other Defects 186 352 8.5 56 204 4.3 Deformities - Posture 17 32 0.8 19 45 1.0 Flat Feet 49 121 2.7 32 102 2.2 Other 66 107 2.7 73 132 3.4 Nervous System - Epilepsy 23 22 0.7 14 11 0.4 Other 60 121 2.8 35 70 1.7 Psychological - Development 14 63 1.2 20 47 1.1 Stability 35 112 2.3 26 92 1.9 Abdomen 35 33 1.0 42 37 1.3 Other Defects 25 80 1.6 59 127 3.0 TOTAL DEFECTS 3,366 3,101 3,134 2,973 Total Children Examined - 9,452 Boys 8,943 Girls 10 Table 4 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS 1972 (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 9.8 10.0 10.0 11.2 4.5 9.3 3.0 7.0 7.2 9.6 Skin 4.2 3.7 6.4 6.7 1 1.4 8.2 11.4 4.9 8.0 5.9 Eyes - Vision 15.4 16.2 19.5 21.4 1 6.9 22.0 17.5 24.8 17.3 20.6 Squint 2.8 2.7 2.0 1.5 0.8 1.5 0.7 0.8 1.6 1.7 Other 0.7 0.9 0.4 0.4 0.5 0.8 0.4 0.1 0.5 0.6 Ears - Hearing 5.3 5.6 2.8 2.4 2.1 2.4 0.9 1.2 2.9 3.1 Otitis Media 3.0 3.0 1.2 1.6 0.4 1.3 0.1 0.4 1.3 1.7 Other 0.3 0.4 0.3 0.4 0.2 0.3 0.4 0.1 0.3 0.3 Nose and Throat 8.7 7.6 6.4 5.6 3.4 4.0 1 .4 1.8 5.3 5.1 Speech 3.8 2.1 1.6 1.0 0.9 0.7 0.2 0.1 1.7 1.1 Cervical Glands 0.9 1.2 1.7 1.8 0.8 0.2 0.2 0.1 0.9 0.9 Heart and Circulation 2.0 1.8 1.3 1.4 1.2 1.5 1.7 1.7 1.5 1.6 Lungs 3.5 2.1 2.7 1.5 2.6 1.7 1.9 0.9 2.7 1.6 Developmental - Hernia 0.8 0.7 0.5 0.4 0.2 0.2 0.4 - 0.5 0.4 Other 6.4 1.1 5.2 2.3 7.5 5.8 3.3 2.4 5.7 2.9 Orthopaedic - Posture 0.6 0.5 0.7 0.5 0.5 0.9 0.3 1.1 0.5 0.7 Flat Feet 2.0 1.9 1.9 1.8 1.9 1.1 1.3 1.0 1.8 1.5 Other 2.3 1.7 2.1 1.8 1.4 3.4 1.4 2.4 1.8 2.3 Nervous System - Epilepsy 0.8 0.4 0.3 0.3 0.4 0.1 0.4 0.3 0.5 0.3 Other 3.6 2.1 2.0 1.1 1.2 0.7 0.3 0.5 1.9 1.2 Psychological - Development 1.5 1.2 1.0 0.9 0.4 0.6 0.1 0.2 0.8 0.7 Stability 2.0 1.6 2.0 1.3 1.1 1.4 0.8 0.8 1.5 1.3 Abdomen 1.3 1.2 0.5 1.0 0.4 0.8 0.2 0.4 0.7 0.9 Other Defects 1.2 1.2 1.2 2.0 1.5 2.6 0.3 2.7 1.1 2.1 11 This does not support the findings in a survey carried out in Teesside in the Autumn Term 1970. There, a stratified sample of children in infant and junior schools and children in two senior schools were examined. One in seven of the primary school children was found to be infested to some degree, and one in four of the secondary school children. The need for constant vigilance by parents and older children cannot be too strongly urged to avoid the spread of this essentially curable condition. The number of children treated at the Cleansing Centre for Scabies showed another welcome reduction and it may be that the large increase of cases in recent years has reached its peak or is on the wane. Six school children were treated for head vermin at the Cleansing Centre and 16 school children were treated for scabies. Table 5. Cleanliness Inspections No. of pupils inspected for cleanliness 53,910 No. of pupils inspected at follow-up visits 4,873 No. found unclean for first time in 1972 459 No. of occasions in which pupils were found unclean at follow-up visits 300 Skin Defects There has been little decrease in the number (1,398) of children treated at Minor Ailment Clinics for verrucae and the average number of attendances per child has remained constant at seven. A trial of a different form of treatment gave no better results than those being currently used. Verrucae remain so prevalent that children with the condition should not be allowed to use public swimming baths where the wet surface encourages the survival of the wart virus and the concrete surrounds provide the minor damage to the skin of the soles allowing the virus to enter. Table 6. Summary of Findings at Routine Inspections of Vision Boys Girls Number Examined Number of defects % Number Examined Number of defects % Entrants group 2,604 397 15.2 2,567 416 16.2 8 year old group 2,612 510 19.6 2,413 514 21.3 Entrants to High Schools 2,334 395 17.0 2,357 519 22.0 13 year old group 2,499 541 21.6 2,303 508 22.1 Final leavers group 1,902 333 17.5 1,606 401 25.0 Totals (AlI Ages) 11,951 2,176 18.2 11,246 2,358 21.0 12 The percentage of children discovered with visual defects remains fairly constant. There are slight variations over the years but about 30% of total defects found at routine school medical examinations are of vision. Most parents take their children along for further investigation and treatment when a visual defect is suspected at a screening examination, but a few ignore appointments offered at Eye Clinics or do not attend opticians after receiving a form entitling them to an examination. A lot of unnecessary work is caused to the administrative staff of the Department in sending out reminders and in some cases, unfortunately, it is necessary for a Nurse to be diverted from other work to chase up the recalcitrant. In the meantime, of course, the child may be having difficulty in seeing what is written on the blackboard. Defects of Ear, Nose and Throat Otitis Media (disease of the middle ear), deafness and other defects of the ears were found in approximately the same percentage of children as in previous years. Defects of Heart and Circulation There have been no significant changes in the year under review. Defects of the Lungs Almost exactly the same number of lung defects (149) were discovered to need treatment as last year (150). The great majority of these cases consist of mild bronchitis. The Tuberculosis figures remain remarkably constant. Pulmonary - 3 Non-Pulmonary - 2 The incidence rate among the school population works out at 5.0 per 100,000. There was one case less of pulmonary tuberculosis than in 1971 and one more case of non-pulmonary tuberculosis. Developmental, Abdominal and Orthopaedic Defects There is no marked change in numbers in this group from previous years. Defects of the Nervous System The number of children found to have epilepsy was up slightly as compared to 1971, but the total numbers are so small (23) that the variation is not significant. As mentioned later in the report, none of these children was found to be in need of special education and all are still attending ordinary schools. Two hundred and fifteen children were referred for intelligence assessment in 1972 and there was no waiting list at the end ofthe year. 13 Psychological Defects The number of referrals to the Child Guidance Clinic of children with behaviour difficulties of some kind continues to increase. As will be seen from the account of the Clinic's work in Part II of the Report, the waiting list at the end of the year has unfortunately lengthened again. Nutrition Average heights and weights of all age groups of school children measured have reached a plateau over the last few years after rising steadily since the end of the last war. Table 7. Average Heights and Weights in 1972 and Previous Years Ages Number Examined In 1972 Average Height in Inches Average Weight in lbs. 1972 1971 1970 1969 1939 1972 1971 1970 1969 1939 BOYS 5 years 1,054 43.3 43.5 43.4 43.2 41.8 43.2 43.4 43.1 42.9 41.5 6 years 845 44.0 44.6 43.9 43.9 43.8 44.8 44.9 44.4 44.0 43.4 14 years 196 64.3 64.1 64.2 64.0 59.0 113.5 113.5 116.9 112.5 90.8 I5 years 450 66.1 65.9 67.0 66.3 - 122.2 122.7 123.7 125.9 - 16 years 180 67.0 66.7 67.5 67.7 - 129.7 129.3 133.4 133.6 - 17 years 19 68.7* 68.6* 69.0* 68.8 - 133.4* 149.3* 141.4* 134.9 - GIRLS 5 years 956 43.2 43.1 43.2 43.1 41.2 42.4 42.2 42.5 41.9 39.7 6 years 912 43.7 43.9 43.9 43.5 42.7 43.6 43.4 43.9 43.4 41.4 14 years 197 62.5 62.6 62.4 62.3 60.3 115.4 114.5 112.5 114.4 97.9 15 years 307 63.2 63.8 63.2 63.5 62.0 118.3 119.6 120.1 120.6 105.5 16 years 110 63.8 64.1 64.1 64.7 - 121.1 122.3 121.0 120.7 - 17 years 3 62.7* 63.9* 63.7* 63.1 - 97.7* 119.6* 119.3* 121.0 - *not representative owing to very low numbers 14 PART II SPECIALIST SERVICES AUDIOLOGY SERVICE Mr. J.C. Oakley, Peripatetic Teacher of the Deaf During 1972, 1,379 children were tested by pure tone audiometry, this included routine follow-up cases, cases referred by School Medical Officers and 688 Sweep Test Failures. Regular clinics were held at Lodge Road, Croydon, Parkway, New Addington and Whitecliffe Road, Purley. All the preschool children requiring auditory training were seen regularly at home, where parent guidance was given and in some cases, speech training was carried out by the Speech Therapists. In addition, Speech Training Machines were loaned to all parents, for use in the home. Mrs. G.O. Moreland, peripatetic teacher of the deaf was appointed in October to help with this work. She will commence her duties in January 1973. 78 children were seen by Mr. Parsons, the Corporation's Consultant Otologist, who held regular clinics at Lodge Road and visited the Partially Hearing and Deaf Units. 12 hearing aids were recommended during the year, 2 of these were National Health Service 'Medresco' aids and the other 10, Commercial aids paid for by the Corporation. Commercial aids are considered necessary if the hearing loss is greater than the range covered by the 'Medresco' aid, or if there is a sharp perceptive loss in the higher frequencies. The 'Medresco' aid has no automatic volume control and cannot be tolerated by children with such a loss, as the hearing forthe lower frequencies is often normal and a general amplification of sound causes a considerable amount of distortion and may become painful. 120 babies were seen at the special clinic held in conjunction with Dr. Morgan for the early assessment of deafness in young babies, 18 of these being referred to Mr. Parsons for further assessment. Blood tests on the failures were continued as part of a survey held in conjunction with Great Ormond Street Hospital for Sick Children, to investigate the question of rubella as a cause of deafness and as a result of this survey, we have been able to pinpoint the probable cause of deafness in two cases which might otherwise have been recorded as "no known cause". It was necessary to continue the increased number of clinics to cope with the waiting list of babies waiting to be tested. During the year, all infant schools were visited at least once and apart from absentees and unco-operative children (501), all children newly admitted to school during the year were tested. Tests were also carried out in the Special Schools. Of the 8,564 children tested, 786 (approx. 9.1%) failed the test and were referred to the Audiology Clinic for further assessment. We were sorry to lose Mrs. Godderhan at the end of the Summer term, her place was taken by Mrs. Feakins. For additional statistical details, see Appendix B, Page 51. 15 CHILD GUIDANCE CLINIC I am grateful to Dr. G. Crosse, Consultant Psychiatrist, South West Metropolitan Regional Hospital Board, forthe following report:- A steady rise in the demand for child guidance facilities over the past two years set against the reality of static resources has continued to immobilize the waiting time for new appointments at a level of fourteen weeks. All permutations of clinic practice and method have failed to make any impression on this new wave of referrals, and nothing less than an expansion of manpower will resolve this stubborn back-log of cases. The growing concern of local organizations, consumer and administrative, at the continuing existence of a child guidance waiting list has led to administrative initiatives for an increase in the medical establishment and the matter now rests in the hands ofthe Regional Hospital Board. In the appeal for such reinforcements emphasis was laid on the developing social services in the borough and how this will uncover a long felt latent demand for consultative facilities at the clinic. The hierarchy of needs which have had to be met by the clinic staff reached new heights in the year under review, and much time and thought has been spent on forward planning ofthe premises which will house both the School Psychological and Child Guidance Services. There have been other considerations such as those related to the advent of the Seebohm recommendations and the development of Area Health Boards. From a purely internal domestic point of view it should be recorded that our rationalization of the borough into four geographical areas each supported by a clinic social worker as an ongoing commitment has facilitated a more effective and coherent contribution to the borough service as a whole. At a time when there is a great deal of shift and change caused by the reorganization of the social and health services it should be underlined that the aura of permanence which surrounds our team of four social workers - Miss M.S. Gradwell, Mrs. P.E. Ollerenshaw, Mrs. V.H. Jackson and Mrs. B. Bark - has enabled the clinic to cultivate a stable division and distribution of duties and to discharge its responsibilities to the other systems of care in the borough. The Wednesday pre-school therapeutic group in which the children take part in activities on the day unit while their mothers are seen as a group by Dr. S.M. Ring and Mrs. V.H. Jackson continues to prosper, and this invaluable preventative exercise could be extended if our medical establishment were to be increased. It is some measure of present day social pressures that the Sir Cyril Burt School, opened in September 1971 forthe education of maladjusted children in the borough, is now oversubscribed, and children ascertained for special education often have to wait several months for a placement. Together with children who have been suspended from school as well as the truants and school refusals, they form a large growing uneasy collection of children who weigh heavily on all educational systems inthe borough. They form a mixed bag 16 of problems at all points of the school age spectrum and it is almost impossible to devise for them a uniform remedy. Many receive home tuition, others attend the Chats worth centre and the Child Guidance clinic on a part time basis. Nevertheless they present a growing challenge to the administrative services of the borough, and even a partial solution will not be achieved unless there is a close liaison between the educational and psychiatric services in this area. The day unit continues to provide endless opportunities for experimentation and a significant development this year has been the creation of a group of disturbed adolescent girls who have been encouraged to assume roles of "helpers" to the staff. Those who have been plagued with chronic states of inadequacy have used this opening as a means of recovering their independence and initiative. Although this project barely scratches the surface of the adolescent problems in the area, it highlights the flexibility needed in the treatment of this age group. This report would not be complete without an expression of thanks to Dr. S.L. Wright, Principal School Medical Officer, Mr. K.G. Revell, 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 65 26 91 General Practitioners 64 32 96 Social Services Department - 2 2 School Psychological Service 29 14 43 Juvenile Court 14 5 19 Hospitals 10 8 18 Other Agencies 14 3 17 Milton House Remand Home 89 89 196 179 375 Action Diagnostic 22 99 121 Current Treatment 147 73 220 Closed - Improved 15 10 25 Unco-operative 2 2 4 Transferred 5 - 5 No change - - - 191 184 375 17 DENTAL SERVICE Mr. B.J. West, Principal School Dental Officer Dentistry, along with most professions, is continually evolving and its standards improving. Originally dentistry consisted of simply extracting aching teeth, usually as a fairground spectacle. Since 1921, but especially since the introduction of the National Health Service, the emphasis has been directed to saving teeth wherever possible by the use of various filling materials. Consequently the proportion of teeth filled to teeth extracted has steadily risen year by year. This has required renewed efforts by the dental educators to change the attitude on the part of the public and promote a greater sense of dental awareness. We are now on the verge of the next logical stage in the evolution of dentistry, that of the prevention of dental disease, both dental caries and periodontal disease, and considerable effort and thought is now being devoted to find the most effective ways of achieving this. Among the proven methods of reducing the prevalence of dental caries is the adjustment of fluoride in the domestic water supply to one part per million. This, however, is being seriously hampered by social-political factors and although considered the most effective method of reducing dental caries by the vast majority ofthe medical and dental professions, it is unlikely to be introduced as a large scale public health measure for some time. Other methods of treating teeth with fluoride such as topical application, fluoride tooth pastes, fluoride in school milk and in tablet form, are being tried with varying degrees of success but cannot be as effective as the adjustment of fluoride in water, being dependent on personal effort on the part ofthe public. Despite all the efforts being made in the field of preventive dentistry, the major cause of caries and periodontal disease is the abysmal lack of oral hygiene among the public at large and until the standard of personal oral hygiene is considerably improved, even routine conservation of teeth is largely a waste of time, effort and resources. It is essential therefore to educate the mass of the general public to keep their mouths clean before any of the other preventive measures will have any worthwhile effect. The dental service in Croydon is playing its part in the education of parents and children in oral hygiene and general dental awareness by personal contact, dental education lectures and in-service training of school teachers, and by providing facilities forthe dental scientists to further their researches. The continuing improvement and development of the dental services in the Borough received a considerable setback this year through lack of staff. The year started well but the resignation of five dental officers in mid-summer and the inability to find suitable replacements has inevitably led to the accustomed service being modified. The start ofthe coming year should see an improvement in the staffing situation but the restoration of a fully staffed service will take some time. 18 The programme of modernisation and facilities in the various surgeries, however, continues and orders for the replacement of the more obsolete equipment were placed. It was decided to meet the need for additional surgery facilities, especially in the north ofthe Borough,by the introduction of an adapted caravan as a mobile surgery. The School Dental Service The shortage of dental staff resulted in a reduction of 120 in the total number of sessions worked this year. In order to treat as many children as possible, the reduction in treatment sessions was less than the reduction in sessions devoted to routine examinations at schools and in those devoted to Dental Health Education. In spite ofthe reduced number of sessions the number of children receiving at least one course of treatment during the year rose by 372 and represents 18.8% of the total school population as opposed to 18.4% in 1971. In addition the total number of teeth filled rose slightly due to a big increase in the number of permanent teeth filled - although the number of deciduous teeth conserved was less. However, the more advanced procedures showed a reduction. The number of crowns fitted was only slightly down on 1971 but the number of teeth root filled showed a reduction of nearly one-third. It is inevitable that when there is a shortage of staff the service must devote more of its time and resources to more routine treatment at the expense of the time consuming advanced techniques. The need for teeth to be extracted increased markedly during the year and the demand on the general anaesthetic sessions was very heavy, though it eased somewhat during December. As a consequence, the ratio of teeth extracted for every 100 filled, which has been falling since 1951, showed an increase this year as the following shows: 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 " " " " " In 1972 27.4 " " " " " Altogether 6,789 teeth were extracted, but this includes many that were extracted to help straighten remaining teeth and also 318 teeth that were extracted at the request of General Practitioners. The number of general anaesthetics administered showed a large increase from 1,488 in 1971 to 1,789 this year. Again 145 of these administrations were for patients referred by General Practitioners. One service which did not suffer as a result of the reduction in staff was that for patients who cannot be treated by conventional means, mainly the mentally and emotionally handicapped. One session every four weeks was set aside to conserve the teeth of these patients under general anaesthesia. Croydon's dental service is one of the very few providing this type of treatment. 19 Although there were 29 fewer sessions devoted to school inspections 99 school departments were inspected during the year (71.6% of the total) resulting in 32,260 children (57.9%) being examined at school. In addition a further 7,011 were inspected in the surgery, bringing the total percentage of the school population examined during the year to 70.5%. This was a reduction of 5% on the total number examined the previous year but compares well when it is remembered that there was a reduction of almost 50% in the dental staff for a large part of the year. Of those examined 59% required some form of dental treatment. The corresponding figure last year was 54.7%; in 1970 48.9% and in 1969 45.6%. It is therefore evident that the need for dental treatment is steadily increasing, and renewed efforts must be made not only to bring the number of dental officers up to the full establishment, but to further increase the establishment in order to cope with the increased need and demand. There has been a considerable advance in the work done by the Orthodontist, with an increase of 45 in the number of new cases and 28 in cases completed. The number of failed appointments again fell slightly this year and represented a figure of 21.1% of all appointments made. The corresponding figures for previous years were 22.7% in 1971, 24.4% in 1970 and 24.2% in 1969. It would appear that the position is slowly improving but nevertheless presents an alarming state of affairs. Dental Health Education The number of sessions devoted to Dental Health Education was drastically reduced this year in spite of the obvious need for an expansion in this field. However, the student Hygienists from the Royal Dental Hospital have continued their visits to infant and junior classes to instruct the children both in the care of their teeth and the dangers of incorrect diet. In addition, we are working closely with Miss Elliott and her staff in the Health Education Department both to encourage teachers to promote dental knowledge especially through teaching projects, and to give dental health talks in ante-natal clinics and parent/teacher associations. It was proposed that a poster campaign in schools and ante-natal clinics should be mounted, but this would be costly and not have very much effect in the absence of adequate instruction. Dental statistics will be found on Page 52. 20 ENURESIS CLINICS I am grateful to Dr. Margaret White for the following report:- The numbers attending the local authority enuresis clinics continued to rise during 1972 when 278 children were seen at the clinics at Lodge Road, Purley and New Addington. There were 176 boys and 102 girls, and their ages ranged from four to fifteen. Towards the end of the year the buzzers were breaking down at a higher rate than usual. After consultation with the manufacturers a more reliable electric mechanism is to be tried out. Four children who were incontinent by day as well as night were referred to the Urologist. It was not considered necessary to refer any child to the Child Guidance Clinic. Towards the end of 1972 the waiting list for the Purley Clinic became very long and to overcome this problem a fortnightly clinic has been started there. Total Attendance 278 (Boys - 176 Girls - 102) Still Attending 106 Discharged Dry 95 Discharged for Non-Attendance 55 Left District 2 Lodge Road Clinic 154 New Addington 81 Puriey 43 Referred to Urologist 4 Referred to Child Guidance Clinic - Used Buzzer 126 Age 4 5 6 7 8 9 10 11 12 13 14 15 No. 2 12 52 64 47 30 34 13 9 10 4 1 SCHOOL EYE CLINICS I am grateful to Dr. Derek Clarke for the following report:— School Eye Clinics are held regularly at Purley, Sanderstead and New Addington as part ofthe School Health Service. Referrals are seen from routine medical inspections of school children, and also from other examinations by Local Authority Staff (e.g. toddlers' clinics) and directly from General Practitioners. The cases include defective visual acuity and other instances where an ocular abnormality is suspected. The age range of children seen is from infancy to school leaving age. Referrals are also accepted from the Hospital Eye Service and vice versa. The facilities offered are complementary to the General Optical Services and the Hospital Eye Service, and are concentrated especially on the require- 21 merits of school children, particularly in the follow-up system and the liaison with other parts of the School Health Service. Statistics are to be found on Page 53. HEALTH EDUCATION IN SCHOOLS Miss D.S. Elliott, S.R.N., H.V.Cert., D.H.E. Principal Health Education Officer. "More years of schooling, the steady increase of urbanisation, the continuing shifts of population and the rapid changes in the types of employment available are but a few of the developments that may not only provide adolescents with new and broadening opportunities, but also contribute to their vulnerability". (WHO (1965). Expert committee on health problems of adolescence). Each year teachers show a greater interest in health education and have a greater appreciation of its relevance to pupils. With encouragement and support they are taking a more active part in courses in schoola and are using the Health Education Advisory and Resource Centre well. The Education Department is now advised by the Principal Health Education Officer on the purchase of suitable health education aids for loan to schools. The aids are kept in the Health Education Centre in Taberner House so that Health Education Officers may discuss with teachers the content of the aids chosen and the relevance for their groups. Other help for teachers included:— (1) An in-service training course for secondary school teachers of 12 weekly sessions conducted by health education staff and local hospital consultants, whose help is always very much appreciated. (2) An in-service training course for primary school teachers of 8 weekly sessions conducted by health education staff and a senior medical officer in the Health Department whose sympathetic and humorous approach clarified detail and showed how health education could be an enjoyable topic. (3) Courses conducted in schools with the appropriate teacher present. (4) Occasional sessions in schools given by health education staff supplemented work already being carried out by teachers. (5) A periodical "Health Education News" issued to all professional workers in the field which included up-to-date information about courses, teaching aids and health education trends. Other New Developments Secondary Schools 1. A special course "You And Your Body" was devised for the 11-14 high schools which as the result of reorganisation of schools, had no specific 22 health education guide for this age group. It is a simple applied physiology course which aims:— (a) To give pupils a better understanding of the growth, development and function of their own bodies. (b) To inculcate a sense of responsibility with regard to their future health. (c) To encourage an awareness of environmental influences on the health of the individual and the community. The course is divided into 10 units and includes suggestions for visual aids and themes for activities and further discussion which can be taken up in other subject areas. 2. A course "The Child and his World - study of children from 0 to 5 years" for pupils of 14+ years, of particular interest to Home Economics and Social Studies teachers, was also devised and is being tested in Monks Hill, John Ruskin and Lanfranc Schools. It is designed:- (a) To give pupils a greater understanding ofthe physical development and care of young children. (b) To enlarge their understanding of the part played by heredity and environment. (c) To emphasise the importance of family life in the rearing of children. For convenience this course is also divided into 10 units, containing suggestions for visual aids and themes for further discussion.. Pupils are encouraged to observe normal growth and development by studying one or two children in depth and completing a child development chart throughout the course. 3. The existing community health syllabus for pupils of 14+ years was also revised and re-printed. For various reasons there is often lack of carry-over of what is learned in school tp the home and community. With this in mind and the current emphasis which is being placed on parent education, other new components were included in the health education programmes in some schools:— (a) Parents were invited to evening exhibition/demonstrations of materials used during health education courses in schools. These were arranged by Health Education Officers with the co-operation of the teachers and health visitors concerned. They were very well attended, the material aroused great interest and the effort was felt to be very well worthwhile. (b) There will always be difficulty in reaching those parents who perhaps need the most help and understanding. However others, not necessarily those with social difficulties, are also often glad to be reassured about their children's development. The Principal Health Education Officer spoke at meetings held in schools on "The Growth and Development of the Primary School Child" and "The Growth and Development of Adolescents" and hopes to encourage more of these meetings in the future. 23 Junior Schools Health Visitors in Applegarth and Oval Junior Schools are developing good health education courses and teachers in Fairchildes and Beaumont Schools also carried out some very imaginative health education work. Health Visitors and health education staff at Oval and Beaumont Schools also demonstrated the material used and created by the children to parents. B.B.C. Radio - Vision programmes "Life Cycle" for 11 - 13 year old pupils. The Principal Health Education Officer acted as consultant to the above 8 programmes and teachers and pupils from Norbury Manor Boys, Norbury Manor Girls, Ecclesbourne, Taunton Manor and Davidson Schools gave good advice and took part in the pre-testing of the programmes, which were broadcast during the Summer term. Health education in Croydon schools is making steady progress and has a bright future. The Health Education team is greatly indebted to the Education Department, the Inspectorate and to Dr. S.L. Wright for their continual advice, support and encouragement without which no progress would be possible. 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. 215 children were examined by School Health Service Doctors and had intelligence tests during 1972. 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 80 (b) Recommended for Coldharbour School for E.S.N. pupils 24 (c) Recommended for Residential School for E.S.N. pupils 1 (2) Other recommendations: (a) Referred back to ordinary school 64 (b) Referred for further investigation by the School Psychological Service 1 (c) Recommended for Day Special Schools for other handicaps 13 (d) Referred for Speech Therapy 8 24 (e) Referred for Medical Treatment 9 (f) Referred for further assessment 15 It was reported last year that the waiting list for assessment had been reduced markedly from the previous year. At the end of the year under review there was no longer any waiting time beyond the few days administratively necessary to arrange appointments. This satisfactory state of affairs is due to several factors. There was a drop in the number of children brought forward by Head Teachers, the Educational Psychologist arrange psychometric testing in many instances. Also two Medical Officers completed the Course on ascertainment of mentally handicapped children while other Medical Officers trained in the technique became available for sessional work. The numbers of children in special schools who received intelligence assessments to ensure that they were properly placed or for the purpose of advising the Chief Education Officer about their educational needs showed an increase from 55 in 1971 to 63 in the year under review, made up as follows:— St. Christopher's School 19 St. Nicholas School 18 Coldharbour School 14 St. Giles' School 9 St. Luke's School 3 PHYSIOTHERAPY SERVICE Miss J. McBride, M.C.S.P., A.P.T.A., (Superintendent Physiotherapist) In August 1972 an experimental project for providing physiotherapy treatment for selected children was carried out during the school holidays. This proved to be highly satisfactory and it is hoped that this year the scheme will be repeated and run in conjunction with a play group organised by the Education Department and the Parent/Teachers' Association. The selected children were those who were likely to regress without treatment, and those who were so lonely and unstimulated at home that extra physical activities would prove to be beneficial. In planning the programme with Staff and Parents it transpired that there was a dire need for a recreational facility, so four children were accepted into the Cheyne Holiday Club in London. This provided opportunity for play in the Adventure Playground, outings to the sea and indoor games geared to the physically disabled. Fifteen children received specific physiotherapy and were brought to the School two or three times a week. These numbers are small compared to a normal working day because there was nobody available to occupy them when they were not receiving treatment. Hence this year it is essential to expand the scheme for more patients and have the treatment programme running concurrently with a play group. I am grateful for the opportunity to participate in the Case Conferences in which many professions are now represented. There is the School Medical 25 Officer, the Head Master, a Teacher, a Nurse, a Physiotherapist, a Speech Therapist, an Occupational Therapist, a Teacher of the Deaf, a Health Visitor, a Nursery Teacher, a Nursery Nurse, sometimes a Social Worker from Queen Mary's Hospital - all of whom may be called upon to plan an integrated programme for the child. None has more priority than the other in discussion, their united aim is to do their joint best for each patient. What is offered by multi-disciplinary medical care such as this is undoubtedly a wide service - a service to the grossly disabled young rooted in compassion. Physiotherapy statistics will be found in Appendix B, Page 54. SPEECH THERAPY SERVICE Mr. J.R. Brook, Principal Speech Therapist The work of the Speech Therapy Section has been hampered during 1972 by staff shortages. The Section was approximately 65% fully staffed over the year. At the end of the year there were four full-time Therapists in post out of an establishment of nine. This means that after some years of plenty Croydon's Speech Therapy staff is reduced to a level comparable to most other Authorities. In October 1972 the report of a Committee of Enquiry into Speech Therapy (Quirk Report H.M.S.O.) was published and proposed a fourfold increase in the number of Therapists to meet the demand in the country. Other recommendations in the report included the profession being independently organised under the coming Area Health Authorities and a degree course to replace the present diploma course. These and many other points are being considered by interested parties. The report drew attention to the severe shortage of Speech Therapists, and figures quoted show that new entrants into the profession hardly replace wastage. The Borough has mounted an increased advertising effort to try to attract staff, especially married Therapists, by offering attractive part-time or sessional conditions for the first time. Duri ng the year Miss Pat Blaine, an American Therapist and Mrs. S. Wasmer, an Australian, joined the staff. Miss Blaine left after only four months to be married and Mrs. Robertson and Miss P. Grasso also left. Mrs. Robertson had been with us some time and was the Senior Therapist responsible for special schools. Miss Grasso had been in charge of Speech Therapy at the West Thornton Speech Unit, and she has been replaced there by Mrs. Siddons who was already a member of staff. The gradual decline in the numbers of Therapists available has inevitably led to a reduction of the service to the special schools and in ordinary clinics at a time when the demand for speech therapy, as shown by requests especially from schools, continues to increase. It seems likely that the services of the Speech Therapist will be required even more as the Borough's school population increases, as does environmental pressure and the survival of handicapped children. 26 The school visiting programme has so far been maintained together with talks to various groups. The number of students from London Training Schools has had to be slightly reduced. It is obviously important to maintain as many students as possible to help combat the shortage of speech therapists, but also as a pool of potential applicants. 1972 has seen the end of a period of remarkably high staffing compared to other Authorities. The start of the decline can be seen in 1971 and it must be admitted that a return to full staffing as occurred in 1969 cannot be predicted in the foreseeable future. Statistics are in Appendix B, Page 54. WEIGHT CONTROL CLINICS Dr. W, Simmonds, Senior Departmental Medical Officer It is proposed to extend the weight-control clinics to cover all schoolchildren in Croydon and head teachers have been asked to submit a list of those who might be helped by attending such sessions. Meanwhile the boys' groups continued in the schools and clinics in which they were already established, with a reasonable degree of success among the "regulars" and of interest from new entrants and their parents. The girls' groups were conducted by Miss Hunt and Mrs. Gartside until July, and are now waiting to be integrated into the new system, which will provide cover in areas which had so far not been served by a special clinic. 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 plasier 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 17 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 ofthe recuperative treatment provided for a child 27 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 General Debility 1 2 weeks E.S.N. 1 2 weeks Physically Handicapped 3 (2 - 2 weeks (1 - 1 week Social Deprivation 3 2 weeks Diabetic 3 2 weeks (1-2 weeks Epileptic 4 (2 -1 week (1-10 days Asthma 1 2 weeks Head Injury 1 2 weeks Total 17 Juvenile Employment Return The following numbers of children were examined by the medical officers during 1972 as to their fitness to undertake the part-time employment indicated:— 1972 1971 Delivery of Goods for Shopkeepers 4 3 Delivery of Newspapers 121 152 Delivery of Milk 3 3 Shop Assistants 71 57 Others 26 20 Total 225 235 Provision of Milk and Meals Free milk is supplied only to pupils in Special Schools, to pupils in Maintained Schools to the end of the Summer term after attaining the age of 7, and to other Maintained pupils in the 7-11 age group recommended by the Medical Officer of Health. Approximately 13,115 pupils received one third of a pint each day. All milk supplied is pasteurised and the sources of supply are subject to the approval and constant supervision of the Medical Officer of Health. The number of meals supplied to children daily during 1972 was approximately 30,500. Cost of Milk and Meals Milk and Meals cost £1,308,363. Income from payment for meals was £526,958, making a net cost of £781,405. 28 Causes of Death in School Children 1972 (Uncorrected) Accidental 5 Cancer (Leukaemia) 2 Cancer (Other) 2 Congenital (a) Hydrocephalus secondary to birth trauma 1 (b) Meckels diverticulum 1 (c) Heart disease 1 Muscular dystrophy 1 Osteomyelitis 1 14 29 PART III HANDICAPPED PUPILS The number of handicapped pupils ascertained as needing special education continues to grow. It has risen from 681 in 1966 to 1,167 in the year under review, an increase of 86%. During that period the school population has increased by only 23%. The largest increases are in the E.S.N. group, almost doubled, from 298 to 567, after making allowance for the children at Coldharbour School who were formerly outside the provision of the Education Department and the maladjusted group, increased three and a half times from 48 to 170. On the other hand the number of physically handicapped children has only increased by one-third, while those categorised as delicate have dropped from 83 to 18. Blind and partially sighted numbers remain substantially the same, while the deaf and partially hearing group has increased from 42 to 72, reflecting, it is believed, an epidemic of rubella in 1962/63. The growing number of school children with physical defects is relatively easy to explain. The advances in medical treatment both by drugs and surgery are responsible for the survival of more children born with handicaps. The group of spina bifida children is a good example. The fall in the numbers of delicate children may reflect to some extent a healthier population but probably is explained to a much greater extent by a change in philosoohy. It is now considered that most of the children in this group should remain at ordinary school, or if they do spend a period at a special school, they return to ordinary school as soon as they appear reasonably fit to do so. There remain the two large groups mainly accounting for the increase the E.S.N. and the maladjusted. It may be noted that these two groups of children have not the same easy characteristics of diagnosis as those with physical handicaps. It is very doubtful if there has been a change among the child population sufficient to explain these increases. Probably many factors are contributing. More attention is being paid to the child with educational difficulties by school doctors and teachers, whether they are bound up with behaviour problems or appear simply to be educational retardation. Increases in the staffing of the Child Guidance and the Educational Psychology Service have allowed more children to be seen. Whatever the factors involved, the increase in the numbers of these two groups of children shows no signs of abating, and this will have increasing repercussions on the School Health and Educational Welfare Sections dealing with the administrative side of the placement of the children in special schools. The School Health Section is already under severe pressure. The need for more places for the children in Day or Residential Schools will also become increasingly a matter for concern. There is now a waiting list at the two day schools for moderately educationally retarded children and the day school for maladjusted children. 30 TABLE 10 Children requiring Special Education, 1972 CATEGORY New Cases Ascertained by Committee *New Admissions Number of Children receiving Special Educational Treatment 31.12.72 No. of children awaiting placement on 1.1.73 Special Schools Hospitals Day Units Home Tuition Total Day Residential Day Residential BLIND - - - 9 . - - 9 . . PARTIALLY SIGHTED 2 2 21 2 - - - 23 • - DEAF 3 7 9 20 • 12 1 42 - 1 PARTIALLY HEARING 5 6 2 9 - 20 - 31 - - EDUCATIONALLY SUBNORMAL 101 124 528 29 36 - 2 595 69 3 EPILEPTIC . - 1 . 8 • • 8 - - MALADJUSTED 59 50 30 105 • 1 3 139 - 34 PHYSICALLY HANDICAPPED 32 35 147 15 - - - 162 • 1 SPEECH 5 5 • 2 . 9 _ 11 - - DELICATE 7 6 7 9 - _ - 16 . 2 TOTAL 214 235 745 200 44 42 6 1.036 69 41 Including cases ascertained in previous years. TABLE 11 PRE-SCHOOL HANDICAPPED CHILDREN Category Age on the 31st December, 1972 5 years 4 years 3 years 2 years Vision Defect 1 2 2 3 Hearing Defect - - 1 2 Speech Defect - 7 9 - Mental Disorder 3 25 24 9 Epileptic - - - - Physically Handicapped 1 33 41 10 Total 5 67 77 24 31 The numbers of pre-school handicapped children do not generally reflect the increase in the preceding two groups. The moderately retarded child is not usually detected before starting school and while maladjustment for whatever reason may show before school age, there will generally be no formal ascertainment of these children until they have begun at school and shown whether or not they can adapt to the school situation. I am grateful to the Chief Education Officer for providing school reports by the Head Teachers of each of the Borough's Day Special Schools. They will be found under the appropriate heading. BLIND AND PARTIALLY SIGHTED PUPILS Blind Partially Sighted In Residential Schools 9 2 In Day Schools - 21 Blind No blind child was newly ascertained in 1972. Partially Sighted Two children were ascertained in this category during the year under review, both being admitted to St. Luke's School. St. Luke's Special School for Partially Sighted Children Steady progress was maintained throughout the year and the children had greater opportunities of widening their interests. Early in the year a colour television set was installed; this has increased the children's general knowledge and stimulated their speech and creative writing. Additional brightly coloured apparatus for Physical Education has encouraged greater activity and developed confidence in movement which is often lacking in visually handicapped children who tend to rely on others to see for them. Various educational visits were made during the year including visits to the Commonwealth Institute, the Horniman Museum and a trip on the River Thames to Greenwich followed by a tour of the Cutty Sark and Gypsy Moth IV. A group of children who attended Winterbourne Language Centre were taken to Dieppe. This was a most valuable experience for the children andthe success of the visit was due to the efforts of the teacher, Madame Barber, and her husband. There were opportunities for parents to meet and to hear some very interesting speakers. I am grateful to Dr. Clarke, ophthalmologist, Mrs. J. Kell, Special Schools Adviser to the County of Buckinghamshire, and to Mr. J. Pope, Headmaster of an I.L.E.A. School for the Partially Sighted for giving their time to talk to the parents. 32 We were very pleased to have Miss M. Sharp, Health Education Officer, to guide the junior children through the television sex education programmes during the Summer Term. The subject was most skillfully handled and the children gained much from her talks. At an evening meeting in the Autumn Term Miss Sharp explained to the parents how she had approached this subject. On the sports side good progress continued with swimming. We were very pleased to be invited to take part in the I.L.E.A's PartialIy Sighted Schools' Sports on Tooting Bec Common. During the Summer Term contact with the Lanfranc High School was made with two pupils coming one half-day a week to help the children here. This arrangement continued with other pupils during the Autumn Term. A second boy began attending Winterbourne Junior Boys' School on a parttime basis. Both boys are coping well in the normal school situation. The headmaster's help and interest is much appreciated and we are also grateful to him for inviting all the children to join his school when the opportunity arises. We very much regretted saying farewell to Mrs. L. Rebronja from Australia at the end of the Summer Term. During the short time that she had been with us she had brought many new interests to the children. In September we were very pleased to welcome Mrs. H. Harrison who has had valuable experience in one of the London Schools for the partially sighted. Eye and routine medical examinations were carried out as usual. I wish to thank Dr. T. Wield and the ophthalmologists from the Mayday Eye Unit for their interest and help. The year ended with the usual Christmas festivities and once again we wish to express our appreciation for the wonderful selection of presents kindly given by the staff of Telephone House and to the Education Committee for providing a grant for the Christmas Party and gifts for the children. DEAF AND PARTIALLY HEARING PUPILS Deaf Partially Hearing In Residential Schools 20 9 In Day Schools 9 2 In Day Units 12 20 Awaiting Placement 1 - During the year three children were ascertained as deaf, while five children were ascertained as partially hearing. All these children were admitted to Day Units and one deaf child is awaiting a residential place. 33 Nursery and Infant Deaf and Partially Hearing Units, Kingsley Infants' School At the beginning of the year, there were 19 children attending the two units. Although their hearing losses fell into 3 groups (severely partial 7085 db. severely deaf 85 - 100 db and profoundly deaf 100 + db) the children were divided into 2 classes:(1). The Partially Hearing Unit and (2) The Deaf Unit. The staffing in these units was comprised of 2 qualified teachers of the deaf each with a qualified assistant. During the year changes occurred. Two infant children were transferred to the Junior Units. A multiple handicapped child was sent to the spastic's centre and another was fully integrated into the top class of the infants' school. Three children moved from the Croydon area; one child was recommended and admitted to Margate, and a severely deaf child was accepted into Ovingdean, the Partially Hearing School. One of the qualified teachers left at the end of the year, which was a great loss, not only for the children, but the units as a whole. Throughout the year the children have gone out once a week for shopping and the local shopkeepers have been most friendly and co-operative. It is hoped that other outings and visits can be made in the future. The children's progress in these units has been satisfactory, and the work done here has been appreciated by the parents who are most co-operative. Audiometry is done within the unit as necessary. Hearing losses range from 70 db to over 100 db and can be called severe partial to profoundly deaf. However, by a combination of stimulating teaching and the best possible use and maintenance of all available auditory equipment most of the children demonstrate wonderfully improved discrimination of speech sounds by hearing alone. School staff carefully maintain the children's hearing aids with the generous help of the Public Health Department and St. Helier's Hospital who give every possible support. We also make regular checks upon our main equipment and call upon maintenance services when necessary. We make every effort to see that our older equipment is effective or improved. Recently our Amplivox trainers have had new headphones and it is now known the Technical Department of the R.N.I.D. endorse our views. New Unco and Speechmaster trainers have been in use this year while the staff have worked upon the design of a simple home trainer now approved as safe by the R.N.I.D. Ten trainers have or will be made to the basic design, and it is hoped five will be used by the Kingsley Unit. The new Health Service aid type 0166 has been withdrawn as a failure. A member of the Staff has been invited by the Minister of State concerned to contribute his views and practical proposals for a new review of hearing aid provision. It is thus hoped Croydon can help, a little, deaf people everywhere. 34 Junior Deaf and Partially Hearing Units, Kingsley Junior School There are 6 children in the Deaf Unit, accommodated in a specially built classroom with Peters equipment installed in individual specially designed desks and fully furnished for all Junior school activities. An additional teacher has been appointed for some part of the time to this class. Arrangements have been made for a regular weekly visit by this class to a learner bath for swimming instruction. In the Partially Hearing Unit there are 9 children who are continuing to progress with an interesting, varied and lively curriculum using Connevans group aid and Amplivox speech trainers as well as all the usual school facilities. There is an individual timetable for each child giving considerable integration with many classes in the school for a variety of activities. The class also has a part-time teacher attending two mornings a week. A student, a qualified teacher, from the Diploma course at the London University is on a teaching practice in the Unit. Visits to places of interest continue to be an important part of the curriculum of the Units; on these occasions the children often go-together with children from the main School. Some of the children are joining the school group visiting Belgium and Holland during the Whitsun holiday 1973. All the children join in with morning assembly, playtimes and at school dinners. Together, they occasionally lead worship at assembly with their teachers. Group and individual work is carried out, children working at their own level because of their widely differing abilities, needs and attainments. Senior Partially Hearing Unit. Riddlesdown High School There are five pupils in the unit as follows:— 5th Year 1 4th Year 2 3rd Year 1 1st Year 1 These pupils are very well integrated throughout the school, viz: 5th year boy 37/40 periods) 4th year girl 37/40 periods) 4th year girl 36/40 periods) 3rd year girl 32/40 periods) 1st year boy 17/40 periods) At the beginning of the 4th year, pupils begin their "option" courses which, where appropriate, lead to C.S.E. Examinations in the 5th year. The 5th year boy recently sat for 5 "mock" exams and it is hoped he will be entered for the C.S.E. exams in June (English, Accounts, History, Geography, 35 Social Studies). This boy has matured very much and has taken a Saturday job. He is very keen to become an apprentice as a racing car mechanic. One 4th year girl is doing quite well with Commercial Subjects: typing, accounts etc. The other 4th year girl decided on a non-examination course which includes a great deal of social and liberal studies. The 3rd year girl manages very well and has made good progress in most subjects and certainly seems to be happy here. The 1st year boy arrived half way through the Autumn term from the Junior P.H. Unit although he was only 11 years and a few days old. He integrates with 1st years for two afternoons a week and with 2nd years for Drama, P.E. and Art. He is the only 1st year child at the main school and has settled in remarkably quickly and well. He travels quite happily by bus to and from Addiscombe. In January he sat for the entrance examination for the Mary Hare Grammar School for the Deaf. Results have not yet been published. The pupils take part in very many of the activities of the school, including helping to run the tuck shop, representing their class on the school council, and joining in a wide variety of School Visits with their various groups. In July a 5th year girl started work in an insurance broker's office where she is doing very well. She passed six C.S.E. exams (Typing, Accounts, English, Needlework, Cookery and Social Studies) for which she had worked extremely hard for two years. EDUCATIONALLY SUBNORMAL PUPILS In Day Special Schools 528 In Residential Special Schools 29 In Hospitals 36 Home Tuition 2 Awaiting Placement 72 The Educationally Subnormal group now covers a large range of children. They vary from the child who is just not coping in the larger class in a normal school, and appears to need more attention than a remedial class is capable of giving, to the severely retarded child with possibly other handicaps. The first group attend St. Christopher's and St. Nicholas Day Special Schools or similar Day or Residential Schools. The latter group attend Coldharbour or a similar School or,if their handicaps do not permit them to be contained in the school situation, are admitted to hospital. Before the latter step is taken every effort is made to contain the chiId elsewhere. He or she wiII almost always have had a trial at Coldharbour School and Residential placement at a suitable school will have been obtained wherever possible. 36 I earlier referred to the increased number of this group of children being ascertained and there is still a waiting list for places at each of the three E.S.N. schools. Those children who are severely retarded should all be placed when the second school for this category opens later in 1973. St. Christopher's Special School for Educationally Subnormal Children 1. Statistics Boys G iris Total Number on roll 31.12.71 125 77 202 Admitted during 1972 42 22 64 Transferred to work at 16 15 6 21 Transferred to residential schools 1 0 1 Transferred to Way lands 0 2 2 Transferred to Coldharbour 4 2 6 Transferred to Sir CyriI Burt School 1 0 1 Transferred to Other Areas 4 2 6 Deceased 1 0 1 Number on roll 31.12.72. 141 87 228 2. Various Activities In order to broaden the experiences of our maturing pupils, a series of expeditions has been undertaken, including camping and canoeing. The School has introduced the Duke of Edinburgh Award Scheme for a group of older pupils and a number of these pupils are now working towards their Bronze Certificates. As part of this Award, 5 boys undertook a Course on First Aid, and it is pleasing to report that 4 boys were successful in obtaining their Red Cross Junior Certificate, having satisfied the requirements of an external examiner. These and others of the D. of E. Group are involved in a range of interests including canoeing and canoe-building, art and leathercraft. The girls Interest Section has involved them in Embroidery, Dressmaking and Cookery. During the Summer Term, a mixed group of our pupils took part in the Pinewood Camp organised by the Department of Social Services. This appeared to be most successful in that our pupils both enjoyed and benefitted from the experience. In September 1972, a Scout Cub Pack was introduced into School, the School Pack becoming The 30th Croydon Pack. Some 18 of our Junior Department boys have been initiated and are enthusiastic Scouters. We are indebted to a number of the Scouting fraternity for the tremendous support they have afforded us in establishing the Cub Pack and in their continued support in many practical ways since the Pack was installed. 37 In October 1972, the School obtained the support of the Road Safety Officer in organising, at the School, a Cycle Proficiency Course. The 8 pupils who undertook this Course received intensive instruction from officers of Mr. Arthur's Department and this resulted in all 8 pupils receiving their Cycling Proficiency Certificates, one boy receiving a Special Commendation. An interesting development in the life of the School has been the recent appointment of Mr. Frank Knight, who is a Music Therapist, to attend the School on one day per week. We have every hope that Mr. Knight's work will be a significant item in the School's total commitment to dealing with the behavioural and educational problems of a number of our pupils. It is a matter of some concern that the amount of Speech Therapy afforded the School in the past has, due to a number of circumstances, been curtailed. Nevertheless, we are indebted to Mrs. Robinson who left the Authority some months ago, and to Mrs. Siddons, for the excellent work they have done w ith our pupils in this vital area of education. It is my pleasure to record that we have been fortunate in receiving the full support of the Staffs of the Education Department and the School Medical Department and we receive considerable assistance in our work from our School Medical Officer, the Educational Psychological Service, and the Chi Id Guidance Clinic. Further I wish to pay tribute to the members of the Governing Body for their unstinted support throughout the year. Finally, our gratitude must be expressed to the Friends of St.Christopher's Association who, apart from realising large sums of money which they kindly donate towards the development of a wide range of school activities, are ever-ready to give moral and practical support to all School events. St. Nicholas Special School for Educationally Subnormal Children The number of chiIdren on roll to St. Nicholas School for December, 1972 had increased on the previous year to a total of 175 pupils in an age range of 4 - 17 years. During the course of the year thirty-four children were admitted to the school, whilst twenty-four children left the school for reasons as detailed below. Boys Girls Total Number on roll December 1971 96 68 164 Admissions during 1972 17 18 35 113 86 199 Transferred to Normal School 2 2 4 Transferred to Residential Schools 2 3 5 Transferred to Coldharbour School - 1 1 38  Boys Girls Total Left school to enter Open Employment 2 - 2 Left school to enter Sheltered Employment - 1 1 Removal from District 5 6 11 Number on roll December 1972 102 73 175 The School has continued to enjoy invaluable support and assistance from other agencies and disciplines. School Medical Officers examined a total of 70 children under the system of routine medical inspections at which time considerable advice was afforded the parents and the school, and treatment prompted where defects were discovered. The children of the school are under constant observation to ensure their continued correct placing and as part of this observation 20 children were re-assessed by the School Medical Officer during the course of the year. Regular cleanliness inspections were conducted for the whole school where only a small number of head infestations and skin defects were recognised. The school is indebted to the School Nurse for the regular treatment (on the school premises) of those chiIdren suffering with verrucae, as it is reasonable to assume that the defects would have other wise gone untreated. The school is also grateful for the Nurse's advice to the children and teachers in the prevention of future verrucae aspecially at a time when all the children attending the school have the opportunity of swimming instruction. All children who were admitted to the school during the course of the year were screened for deficiencies of hearing by the Audiometrician and where children failed the sweep test they were referred for re-assessment and further investigation. Throughout the year a regular case-load of 40 children received Speech Therapy, either individually or in group sessions. A further 20 children were under the supervision of the Speech Therapist for minor defects. Because of unexpected staff changes in the Speech Therapy Service the allocation of time when a Speech Therapist was able to attend the school was reduced during 1972. Despite resultant difficulties the children have continued to prosper from the treatment afforded them and the school is most grateful for the help and advice given to the teachers and the parents of the children to promote supplementary treatment in the classroom and the home. During the Summer Term 1972 two groups of children and their teachers took part in school journeys of one week's duration. A group of junior children attended a Holiday Camp on the South Coast, whilst a group of senior children attended the Municipal Camping Site at Dieppe. Both parties of children enjoyed a number of whole-day excursions during these holidays visiting places of cultural, geographical and historical interest. It was rewarding to note the considerable upsurge of vitality of all the children on their return to school and to receive reports that many of the children showed greater and more positive signs of self-reliance on holiday than had been apparent in the school setting. 39 1972 saw the inauguration of a Youth Club based on St. Nicholas School. The facility of such a club has afforded opportunities to promote good social development and to help guide the senior pupils of the school (who so often are not easy to integrate into existing Y aith Club provisions) into acceptable leisure pursuits. Coldharbour Special School for Educationally Subnormal Children Staffing problems kept numbers lower at the beginning of the year. Regretfully speech therapy ceased. The Physiotherapist continues her good work. There are additional part-time specialists i.e. language development, art and music therapy. The school now has its full complement of teaching staff but there is still a great need for more welfare assistants to support teachers. The Parent/Teacher Association continued to help in providing equipment. Each class now has a record player and the next project may well be a swimming pool. The Christmas entertainment was very well supported and the annual Christmas party was made possible by the generous grant allocated by the Education Committee. The Headmistress expressed appreciation of the support received from the Education Welfare Officer, Mr. Tyler. Movement of Children January 1972 - 40 girls 63 boys. 103 chiIdren on roll. December 1972 - 41 girls 62 boys 103 " " Transferred to Way lands 3 Taken into permanent care 2 Deceased 2 Transferred to E.S.N. 1 Removed from district 2 Transferred to residential school 2 Excluded 1 13 Children admitted during the year 13. After 27 years of service at Coldharbour School, the Head Teacher, Mrs. L.B. Mouatt, will retire at the end ofthe Spring Term 1973. EPILEPTIC PUPILS In Day Special Schools - 1 In Residential Special Schools - 8 40 No pupils were ascertained as epileptic during 1972 for the second year in succession. Some children with epilepsy were placed in special schools but in these cases epilepsy was a secondary handicap and not the main reason for special education. Epilepsy is not, generally speaking, incompatible with ordinary school placement, and wherever possible such children, with the goodwill of teachers, are encouraged to remain at a normal school. MALADJUSTED PUPILS In Day Unit for non-communicating children 10 In Day Special Schools 26 In Residential Special Schools 105 Awaiting Placement 34 The number of children ascertained as maladjusted was exactly the same as last year - 59. There is no indication of the hoped for return to the figures for 1970, and previous years, when the average was 15 to 20 children. Indeed, the position is quite a lot worse as was indicated in the opening remarks to this section of the Report, for the number of children awaiting placement has more than doubled from 15 last year to 34 this year. The latter is a very depressing statistic as the Borough Special Day School has only been open for a year and a term, and already almost twice as many disturbed children as ever before had not been found places in suitable schools at the end of the year. The Unit for Autistic Children, as the following school report points out, is also full. The desirable number of places in this Unit is not determined yet as it is not certain how many of the children will transfer to other placements eventually. It is, however, clear that there are not enough places in the Unit for the needs of the Borough. Sir Cyril Burt School for Maladjusted Children, including the Unit for Autistic Children Pupils on Roll Resident Girls 9 Resident Boys 17 26 26 Day Pupils - Girls 3 Day Pupils - Boys 15 18 18 Autistic Unit - Girls 1 Autistic Unit - Boys 9 10 10 Total on Roll - 54 41 In addition, one girl day pupil, left school and is now in full-time employment. One senior boy, day pupil, was taken off-roll, following a prolonged period of absence. A boy pupil, joining the Autistic Unit in January, 1972, had been gradually transferred to the Infant class of the Main School by Easter, 1972, and his careful phasing back to normal Infants' Day School completed by December. Another pupil from the Autistic Unit is in the process of gradual transference to the Infants class, and the Unit's only girl now attends St. Christopher's School for two days per week. The School has largely passed through the initial intake phase. All places for resident boys are filled, and no vacancies exist in the Autistic Unit. The few remaining vacancies are confined to the Infants and Senior/ Leavers age group. The latter would be best filled by a redistribution of present pupils as they mature, so that vacancies are created for younger pupils, with whom rehabilitation would be a realistic aim. Staffing Appointments have now been made, filling the Teaching Staff establishment. Ancillary staff include a Nursery Class Assistant and two Welfare Assistants. A further full-time Male Child Care Officer was appointed during this year, bringing the total Child Care Staff to four (Two men and Two women). Mrs. Pearn and Mrs. Salter of the School Psychological Service, each attend one day per week, observing, advising and testing within the School. Mr. Reid and Mr. Edwards give the School close support, and regularly attend Case Conference sessions. Medical Provision Dr. Crosse and Dr. Mills attend one morning on alternate weeks. Their support is available to pupils in need of psychiatric help, their specialist advice is widely sought, and their contributions to Case Conference Reviews are greatly appreciated. The Review Meetings have included members of the School Psychological Service, Education Welfare Officers, Social Workers, Probation Officers, Home Tutors, Child Guidance Clinic Staff, Teaching and Child Care Staff. Staff from Childrens' Homes and Hospital Staff. Such forums have great value as In-service Training sessions in addition to discussing the needs of individual pupils. Dr. Boffa or Dr. Atkinson visit the School weekly, and see resident pupils as required, at their surgery. A very few cases of accidents, involving relatively minor injuries, have been treated at the nearby Beckenham Hospital Casualty Department. 42 Twenty pupils have, so far, received general medical inspections, during two visits from the School Medical Officer. All pupils have been examined by the Audiologist and School Dental Service. Treatment has been arranged at the Dental Clinic for some pupils. In addition, resident pupils receive regular dental care and examinations at a local Dentist's surgery. Speech Therapy Mrs. Julie Robertson's resignation has left the self-evident needs of many autistic, non-communicating and emotionally disturbed pupils unfulfilled since September 1972. Parent Participation An encouraging development has been the formation of a Parents' Committee. The Parent/Pupil Socials and other events held at School have been well attended. lt is hoped that parents will be more relaxed and confident in their attitudes towards the School, and that pupils will benefit from the mutual support of parents and staff. PHYSICALLY HANDICAPPED PUPILS The number of physically handicapped pupils ascertained was 32, a large increase from the 12 of the previous year. However, fifteen of these children were under five years of age, thirteen being ascertained in preparation for attending the Nursery Unit at St. Giles' School to be opened at the beginning of the Spring Term in 1973, and two were ascertained for a small Unit for physically handicapped children with hearing defects to be opened at the same time. The spina bifida group of children continues to grow. These often severely handicapped children, requiring a lot of medical attention, will place an increasing work load on the School Nurse and her staff, as well as on the school generally. St. Giles' Special School for Physically Handicapped Children During the year under review there were 37 admissions and 29 leavers. Of the leavers 17 transferred to other schools or left the district, 10 left to employment or training and 2 died. The number on roll at present is 155 and the main handicap groups are as follows:— Boys Girls Total Spina Bifida 14 15 29 *Speech Defect 16 12 28 Cerebral Palsy 10 7 17 Asthma 9 7 16 Congenital Heart 7 3 10 Epilepsy 6 4 10 Muscular Dystrophy 6 - 6 Fibrocystics 1 3 4 43 *The numbers with speech defect include 8 boys and 5 girls also suffering from cerebral palsy. The school medical officer, Dr. Thelma Wield, saw 225 children at 22 medicals, 86 parents being present. At specialist medicals held by Dr. Fanthorpe and Mr. McQueen, a total of 40 children were seen, 22 parents being present. Sister Jordan and her staff were responsible for the arrangements and recording, in addition to dealing with 58 major epileptic fits and the toilet training of incontinent children. In the Physiotherapy Department the following treatments have been given:— 3,690 chest treatments, 6,631 Spina Bifida, 4,343 Cerebral Palsy and 2,013 miscellaneous treatments - a grand total of 16,785. The absence of speech therapy at the end of the period is a matter of grave concern in the School. PUPILS SUFFERING FROM A SPEECH DEFECT In Day Special School Nil In Day Unit 9 In Residential School 2 Under this heading only pupils where speech is the major disability are considered. Most of these children attend the Day Unit at West Thornton School untiI they are fit to transfer back to normal school or untiI they reach eleven years. Luckily most of the children, afterthe skilled attention they receive in the Unit, are able to take their places in ordinary schools. The others have been placed reasonably satisfactorily in other special schools and units in the Borough according to their needs. West Thornton Unit for Speech Disordered Children There were nine children in the Unit at the beginning of the year. Since then, five have been admitted and seven have left us. Of these seven, five are in ordinary schools, where they are progressing satisfactorily; one is in a School for Educationally Sub-normal children, and one is in a Partially Hearing Unit. Miss Grasso, Senior Speech Therapist, left in the autumn to return to Australia and we are happy to welcome Mrs. Siddons, L.C.S.T. as our new Senior Speech Therapist. Three of the older boys in the Unit spend the afternoons in classes with their own age groups, and all the children join with other classes for Assemblies, P.E., games and music. The friendly welcome which they always receive from teachers and children in the main school is a great help. Gning into other classes is something whichthe children in the Unit 44 1ook forward to very much. It cou1d so easi1y be otherwise in a 1ess to1erant atmosphere. In order that chi1dren who are not yet ready to join other c1asses shou1d make friends with chi1dren from outside the Unit, we now have sma11 groups from the Infant Schoo1 spending two afternoons each week in the Unit. The genera1 shortage of Speech Therapists has 1ed to a diminution in this side of the work and it i,s to be hoped that the steps which are being taken to a11eviate the position wi11 soon be successfu1. DE1ICATE PUPI1S In Day Specia1 Schoo1s 7 In'Residentia1 Specia1 Schoo1s 9 Seven chi1dren were ascertained as de1icate during the year. The numbers are too sma11 to compare from year to year and there wi11 remain a sma11 number of chi1dren, most1y with diseases of the chest or heart conditions who find ordinary schoo1 too much of a physica1 and menta1 strain. After a period in a day or residentia1 specia1 schoo1 most of these chi1dren find their way back to ordinary schoo1. HOME TUITION If a chi1d is not fit to attend any schoo1, usua11y due to a temporary medica1 condition, tuition is provided at home. Such chi1dren are returned to schoo1 as quick1y as possib1e since the chi1dren need socia1 contact for norma1 deve1opment. During the year 37 chi1dren were recommended for home tuition and 6 were sti11 receiving this at the end of the year. IMMIGRANT PUPI1S - RECEPTION CENTRE Dr. P. Goberdhan, Departmenta1 Medica1 Officer During 1972 a tota1 of 584 pupi1s were medica11y examined. A summary of the findings is given in the Tab1e be1ow:Percentage of Defects in Chi1dren Examined DEFECTS A11 AGE GROUPS EUROPEAN ASIAN India - Pakistan BRITISH WEST INDIES OTHER COUNTRIES 65 Boys 63 Gir1s 137 Boys 110 Giris 36 Boys 39 Gir1s 69 Boys 66 Gir1s SKIN 3.1 9.5 2.2 4.6 5.7 2.6 8.7 1.5 VISION 16.9 31.9 20.4 14.7 20.0 25.6 20.3 21.2 HEARING - 1.6 0.7 - - - - NOSE AND THROAT 3.1 3.2 - 0.9 - 2.6 1.5 - HEART AND CIRCU1ATION - 1.6 0.7 0.9 8.6 - _ 1.5 1UNGS 1.5 1.6 0.7 - .9 5.1 1.5 1.5 STABI1ITY 3.1 - 0.7 - - - 1.5 1.5 45 Height and weight measurements were taken of a11 chi1dren. As in the 1969, 1970 and 1971 figures, this shows that Asian chi1dren are 1ess heavy and sma11er than those of other groups. This is especia11y apparent between the ages of five to fourteen years. Average Heights and Weights Tab1e 1972 Boys and Gir1s European Asian B.W.I. Others Ages in Years Height Weight Height Weight Height Weight Height Weight 5 & 6 years 44.5 in. 43.1 1b. 42.6 in 38.5 1b. 44.2 in 42.6 1b. 43.3 in 40.1 |b. 7 & 8 years 49.8 in. 56.5 1b. 48.9 in 45.5 1b. 46.5 in. 48.2 1b. 47.6 i n. 48.3 1b. 9 & 10 years 54.0 in. 75.2 1b. 51.1 in 55.8 1b. 52.4 in. 62.2 1b. 52.1 in. 62.2 1b. 11 & 12 years 59.4 in. 86.9 1b. 56.0 in 73.0 1b. 59.5 i n. 69.2 1b. 56.8 in. 83.2 1b. 13 & 14 years 61.5 in. 108.3 1b. 59.7 in 89.1 1b. 61.3 in. 91.81b. 59.6 i n. 84.3 1b. 15 & 16 years 63.0 in. 111.0 1b. 63.4 in 104.8 1b. 64.9 in. 124.9 1b. 63.2 in. 107.0 1b. In 1972 the use of the Tine Test for Tubercu1osis was conti nued. The figures for the Tine Tests are as fo11ows: — Tota1 number of chi1dren tested 594 Tota1 number positive (i.e. those exposed to Tubercu1osis) 19 The resu1ts of further investigation at the Chest C1inic of these chi1dren were:- C1eared 6 For further observation 13 Treatment given Ni1 No reports avai1ab1e 0 46 PART IV STATISTICA1 RETURNS APPENDIX A STATUTORY TAB1ES Number of pupi1s on registers of maintained primary and secondary schoo1s (inc1uding nursery and specia1 schoo1s) in January 1973 as in Forms 7, 7M, and 11 Schoo1s 57,482 PART 1. - MEDICA1 INSPECTION OF PUPI1S ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOO1S (INC1UDING NURSERY AND SPECIA1 SCHOO1S) TAB1E A - PERIODIC MEDICA1 INSPECTIONS Age Groups Inspected No. of Pupi1s PHYSICA1 CONDITION OF PUPI1S INSPECTED Pupi1s found to require treatment (exc1uding denta1 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) (5I (6) (7) 1968 and 1ater 430 430 - 12 48 54 1967 2,786 2,786 - 124 442 526 1966 1,955 1,955 - 117 346 421 1965 272 271 1 17 42 53 1964 2,510 2,510 - 221 398 556 1963 2,243 2.242 1 194 353 496 1962 668 668 - 59 107 156 1961 297 296 1 28 49 70 1960 1,967 1,965 2 215 360 538 1959 1,759 1,759 - 209 328 494 1958 1,267 1,267 - 201 186 352 1957 and ear1ier 2,241 2,241 - 356 339 644 TOTA1 18,395 18,390 5 1,753 2,998 4.360 Co1umn (3) tota1 as a percentage of Co1umn (2) tota1 99.97% Co1umn (4) tota1 as a percentage of Co1umn (2) tota1 0.03% 47 TAB1E B - OTHER MEDICA1 INSPECTIONS NOTES:- A specia1 inspection is one that is carried out at the specia1 request of a parent, doctor, nurse, teacher or other person. A re-inspection is an inspection arising out of one of the periodic medica1 inspections or out of a specia1 inspection. Number of Specia1 Inspections 1,054 Number of Re-inspections 3,438 Total 4,492 TAB1E C - INFESTATION WITH VERMIN (a) Tota1 number of individua1 examinations of pupi1s in schoo1s by schoo1 nurses or other authorised persons 58,783 (b) Tota1 number of individua1 pupi1s found to be infested 459 (c) Number of individua1 pupi1s in respect of whom c1eansing notices were issued (Section 54(2), Education Act, 1944) 1 (d) Number of individua1 pupi1s in respect of whom c1eansing orders were issued (Section 54(3), Education Act, 1944) 1 48 PART 2 DEFECTS FOUND BY PERIODIC AND SPECIA1 MEDICA1 INSPECTIONS DURING THE YEAR 1972 T = requiring Treatment 0 = requiring Observation Defect or Disease PERIODIC INSPECTIONS SPECIA1 INSPECTIONS ENTRANTS 1EA VERS OTHERS TOTA1 SKIN T 123 249 602 974 24 o 79 46 186 311 15 EYES - 1a) Vision T 253 557 943 1.753 84 o 560 1 77 995 1,732 74 (b) Squint T 120 21 119 260 7 o 21 5 24 50 5 (c) Other T 23 4 17 44 3 o 18 5 34 57 6 EARS - 1a) Hearing T 53 17 135 205 10 o 228 21 98 347 5 (b) Otitis Media T 51 2 54 107 5 o 100 7 58 165 8 (c) Other T 2 4 3 15 1 o 16 5 20 41 2 NOSE AND THROAT T 140 27 151 318 7 o 282 29 328 639 12 SPEECH T 78 1 46 125 6 o 76 4 56 136 17 1YMPHATIC G1ANDS T 9 1 4 14 1 o 43 3 106 152 2 HEART T 59 43 75 177 5 o 37 17 56 110 4 1UNGS T 62 40 116 218 7 o 82 11 91 184 8 DEVE1OPMENTA1 - fa) Hernia T 21 5 16 42 3 o 18 3 17 38 7 (b) Other T 44 54 144 242 12 o 149 47 360 556 25 ORTHOPAEDIC - (a) Posture T 11 9 16 36 2 o 16 13 48 77 7 (b) Feet T 31 10 40 81 2 o 70 30 123 223 2 (c) Other T 34 33 72 139 11 o 70 32 137 239 7 NERVOUS - (a) Epi1epsy SYSTEM T 11 8 18 37 9 U 19 4 10 33 4 (b) Other T 32 8 55 95 6 o 116 6 69 191 11 PSYCHO- 1OGICA1 (a) Deve1opment T 9 3 22 34 14 o 60 1 49 110 9 (b) Stabi1ity T 15 9 37 61 13 o 80 20 104 204 13 ABDOMEN T 31 7 39 77 4 o 34 3 33 70 5 OTHER T 14 12 58 84 6 o 48 37 122 207 11 49 PART 3 TAB1E A - EYE DISEASES, DEFECTIVE VISION AND SQUINT Externa1 and other, exc1uding errors of refraction and squint Number of cases known to have been dea1t with - Errors of refraction (inc1uding squint) 1,034 Tota1 1,034 Number of pupi1s for whom spectac1es were prescribed 400 TAB1E B - DISEASES AND DEFECTS OF EAR. NOSE AND THROAT Received operative treatment - Number of cases known to have been dea1t with (a) for diseases of the ear 126 (b) for adenoids and chronic tonsi11itis 397 (c) for other nose and throat conditions - Received other forms of treatment 111 Tota1 634 Tota1 number of pupi1s sti11 on the register of schoo1s at 31st December 1972. known to have been provided with hearing aids:- (a) during the ca1endar year 9 (b) in previous years 79 TAB1E C - ORTHOPAEDIC AND POSTURA1 DEFECTS (a) Pupi1s treated at c1inics or out-patients depts. Number known to have been treated 186 (b) Pupi1s treated at schoo1 for postura1 defects 27 Tota1 213 TAB1E D - DISEASES OF THE SKIN Ringworm - (a) Sca1p Number of pupi1s known to have been treated . (b) Body 7 Scabies 16 Impetigo 32 Other skin diseases 56 Tota1 111 TAB1E E - CHI1D GUIDANCE TREATMENT Pupi1s treated at Chi1d Guidance c1inics Number known to have been treated 286 50 TAB1E F - SPEECH THERAPY Number known to have been treated Pupi1s treated by speech therapists 1,134 TAB1E G - OTHER TREATMENT GIVEN Number known to have been treated (a) Pupi1s with minor ai1ments 1,761 (b) Pupi1s who received conva1escent treatment under Schoo1 Hea1th Service arrangements 17 (c) Pupi1s who received B.C.G. vaccination 3,326 (d) Other than (a), (b) and (c) above, P1ease specify (1) Enuresis 278 (2) Overweight C1inics 113 (3) Consu1tant for Speech Disorders 36 TOTA1 (a) - (d) 5,531 APPENDIX B - TREATMENT C1INICS Summary of Attendances 1972 1971 Increase or Decrease Audio1ogy C1inic 889 961 - 72 Denta1 CIinics 30.353 30.280 + 73 Enuresis C1inics 994 963 + 31 Eye C1inics 1.225 1.371 - 146 Inspection C1inics 713 753 - 40 Minor Ai1ments and Verruca C1inics 11.926 12,159 - 233 Physiotherapy C1inics 1.680 2.256 - 576 Weight Contro1 C1inics 290 353 -63 48.070 49.096 - 1,026 51 AUDIO1OGY C1INIC Numbers attending Croydon Day Schoo1s and Pre-Schoo1 Chi1dren (a) With hearing sufficient1y impaired to require regu1ar supervision: Pre-Schoo1 Pupi1s 7 Primary Schoo1 Pupi1s 22 Secondary Schoo1 Pupi1s NI1 29 (b) With a hearing 1oss requiring occasiona1 supervision. Pre-Schoo1 Pupi1s NI1 Primary Schoo1 Pupi1s 16 Secondary Schoo1 PupiIs 16 32 Pure Tone Audiometer Tests (Exc1uding Sweep Test Fai1ures). (a) Tested for the first time 364 (b) Tested as a review case 327 691 Sweep Testing of Five Year O1d Schoo1 Entrants. Number of schoo1s visited 72 Number of chi1dren tested 8,564 Number of chi1dren passed 7,011 Number of chiIdren fai1ed 786 Number of chi1dren to be re-tested 767 Number of chi1dren not tested (absent or unco-operative) 501 The fai1ures were re-assessed as fo11ows: No hearing 1oss 116 S1ight hearing 1oss 282 Moderate hearing 1oss 241 Moderate1y severe hearing 1oss 42 Severe hearing 1oss 7 Fai1ed to keep appointments 42 1eft district 21 Waiting to be tested 35 Issue of Hearing Aids (a) Nationa1 Hea1th Service 'Medresco' aids 2 (b) Commercia1 aids bought by Croydon 1.E.A. 10 12 7 chi1dren under schoo1 age are using hearing aids. 52 DENTA1 SERVICE Items of Treatment 1972 1971 (1) Number of chi1dren first inspected at schoo1 32,260 35,787 (2) Number of chi1dren first inspected at c1inic 7,011 7,179 (3) Number of (1) and (2) found to require treatment 23,337 23,458 (4) Number of (1) and (2) offered treatment 21,859 23,260 (5) Number re-inspected at schoo1 or c1inic 4,561 5,489 (6) Number of (5) requiring treatment 2,533 3,059 (7) Visits - First 9,487 9,109 Subsequent 20,866 21,171 30,353 30,280 (8) Additiona1 courses commenced 1,402 1,397 (9) Fi11ings - Permanent 18,268 16,696 Deciduous 10,858 11,841 29,126 28,537 (10) Teeth Fi11ed - Permanent 14,920 14,171 Deciduous 9,831 10,479 24,751 24,650 (11) Extractions - Permanent 1,783 1,545 Deciduous 5,006 4,045 6,789 5,590 (12) Genera1 Anaesthetics 1,753 1,488 (13) Emergencies 1,244 1,355 (14) X-rays (Number of patients) 1,126 1,400 (15) Prophy1axis 816 744 (16) Teeth otherwise conserved 716 591 (17) Teeth root fi11ed 69 188 (18) In1ays - 4 (19) Crowns 98 117 (20) Other operations 3,020 3,756 (21) Advice 1,922 1,636 (22) Appointments not kept 8,499 8,884 (23) Courses of treatment comp1eted 7,507 8,012 53 1972 1971 (24) Orthodontics - Cases remaining from previous year 232 145 New cases commenced during year 274 229 Cases comp1eted during year 190 162 Discontinued cases 17 12 App1iances - removab1e 535 477 - fixed 42 85 (25) Number of dentures supp1ied 26 25 (26) Number of sessions - Treatment 4,128 4,189 Inspection 256 285 Denta1 Hea1th Education 5 35 EYE C1INICS PUR1EY, SANDERSTEAD AND ADDINGTON 1972 1971 No. of New cases examined 1,042 994 No. of Re-examinations 321 377 Tota1 number of examinations 1,363 1,371 No. of chi1dren for whom spectac1es were prescribed 564 374 On 31st December 1972 the number of:— (1) New Cases referred but not yet examined was 41 (2) Chi1dren due for review in 1972 and sti11 awaiting re-examination was 0 MINOR AI1MENTS C1INICS C1inic Defects Attendances Ashburton Schoo1 257 1,121 1odge Road 301 2,140 New Addington 414 2,601 Norbury Manor Schoo1 76 475 O1d Cou1sdon 61 422 Pur1ey 174 1,451 Rectory Park 194 1,542 Rockmount Schoo1 72 585 Waddon 212 1.589 54 MINOR AI1MENTS C1INICS (continued) 1972 1971 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm . _ - - - - Scabies - - - - - - Impetigo 1 2 2.0 4 4 1.0 Other Skin Defects 56 103 1.8 36 64 1.8 Otorrhoea and other Ear defects - - - - - - Externa1 Eye Defects 6 16 2.6 4 1 5 3.8 Verrucae 1,398 9,802 7 0 1,403 10,066 7.2 Misce1 1 aneous 300 2,003 6.6 428 2 010 4.7 TOTA1S 1,761 11,926 6.8 1,875 12,159 6.5 PHYSIOTHERAPY C1INICS 1972 1971 Tota1 number of pupi1s treated 280 376 Tota1 number of new cases 80 125 Tota1 number of Orthopaedic conditions 155 200 Tota1 number of Respiratory conditions 125 176 Individua1 treatments 391 319 Number of c1asses 41 109 SPEECH C1INICS 1972 1971 Tota1 number of cases treated 1,134 1,183 Number of new cases 191 233 Number of cases discharged 240 392 Number of reviews 742 856 Treatment sessions 6,436 9,369 APPENDIX C RETURN OF MEDICA1 INSPECTIONS - NON MAINTAINED SCHOO1S A. Routine Medica1 Inspections:- Year Year 1972 1971 Aged 11 and under 34 27 12 125 135 13 66 57 14 83 88 15 and over 152 145 Tota1 Pupi1s 460 452 Visits to non-maintained schoo1s 28 26 Tota1 No. of parents present 201 183 B. The fo11owing defects were found:- Requiring Treatment Observation Skin 36 3 Vision 102 40 Squint 6 - Hearing 6 3 Otitis Media . 1 Nose and Throat 8 11 Speech - - Cervica1 G1ands - . Heart and Circu1ation 2 _ 1ungs - 1 Deve1opment (Other) 4 11 Posture 9 3 F1at Foot 6 3 Orthopaedic (Other) 7 7 Nervous System (Other) 2 2 Psycho1ogica1 2 - Other Defects 8 7 C. Other Inspections:- There were 29 Re-inspections, and 1 Specia1 Medica1 Inspection. 56 APPENDIX D NUMBERS OF PUPI1S ON SCHOO1 REGISTERS, AND NUMBERS OF CHI1DREN EXAMINED AT ROUTINE MEDICA1 INSPECTIONS IN MAINTAINED SCHOO1S DURING THE YEAR 1972 Primary Schoo1s Numbers on Registers No. of Chi1dren Examined Boys Giris Tota1 A11 Saints' (C. of E.) J.M 323 36 38 74 A11 Saints' (C. of E.) I 191 32 30 62 App1egarth J.M 494 72 63 135 App1egarth I 341 82 69 151 Ashburton J.M 621 71 80 151 Ashburton I 339 63 51 114 Atwood J.M. & I 381 58 65 123 Beaumont J.M. & I. 143 21 23 44 Benson J.M. & I 531 87 78 165 Beu1ah J.M 602 91 77 168 Beu1ah I. 388 95 78 173 Broadmead I 229 57 67 124 Byron J.M. & I 337 61 44 105 Cast1e Hi11 J.M 604 50 39 89 Cast1e Hi11 I 444 120 147 267 Chipstead Va11ey J.M. & I. 526 82 92 174 Christ Church (C. of E.) J.M. & I 257 44 46 90 Cou1sdon J.M. & I. 134 23 20 43 Courtwood J.M. & I 225 43 36 79 Cypress J.M 330 103 88 191 Cypress I 245 25 25 50 David 1ivingstone J.M. & I 275 21 51 72 Davidson I 189 42 30 72 Duppas J.M 356 53 55 108 Ecc1esbourne I 220 22 26 48 E1mwood J.M. 714 90 100 190 E1mwood I 369 55 51 106 Fairchi Ides J.M 452 55 47 102 Fairchi1des I. 335 72 76 148 Fie1dway J.M. & I. 378 59 68 127 Forestda1e J.M. & I 225 34 41 75 Gi1bert Scott J.M. 597 78 71 149 Gi1bert Scott I 284 53 44 97 Gonvi1 1e J.M. & I. 501 79 47 126 Good Shepherd (R.C.) J.M 285 29 17 46 Good Shepherd (R.C.) I. 188 45 57 102 Gresham J.M. & I. 324 57 57 114 Hayes J.M. & I 365 64 60 124 Heavers Farm J.M. & I. 102 13 17 30 Howard J.M. & I 326 55 52 107 Ken1ey J.M. & I 331 56 48 104 Kensington Avenue J.M 518 66 64 130 Kensington Avenue I 283 64 69 133 Keston J.M 379 65 40 105 Keston I. 228 72 41 113 Kings1ey J.M. 475 67 63 130 K1ngs1ey I 337 45 52 97 Margaret Roper (R.C.) J.M. & I 271 40 42 82 Monks Orchard J.M. & I 458 84 74 158 Norbury Manor J.M 462 59 68 127 Norburv Manor I 264 59 52 111 Orchard Way J.M. & i. 186 29 39 68 Ova1 J.M. 335 46 27 73 Ova1 I. 230 53 53 106 Parish Church (C. of E.) J.M 298 38 40 78 Parish Church (C. of E.) I 225 40 39 79 57 Primary Schoo1s Numbers on Registers No. of Chi1dren Examined Boys Gir1s Tota1 Park Hi11 J.M. & l 338 57 80 137 Pur1ey Oaks J.M 334 55 49 104 Pur1ey Oaks l 203 47 54 101 Regina Coe1i (R.C.) J.M. & 1 395 69 54 123 Ridgeway J.M 381 66 44 1 10 Ridgeway 1 195 31 37 68 Rockmount J.M. 339 49 47 96 Rockmount 1 516 53 46 99 Roke J.M. & 1 516 97 69 166 Rowdown J.M 472 68 72 140 Rowdown 1. 405 78 83 161 Rye1ands 1. 147 29 32 61 St. John's (C. of E.) J.M. & 1. 287 35 53 88 St. Joseph's (R.C.) J.M. & 1. 477 102 61 163 St. Mark's (C. of E.) J.M. & 1. 243 25 45 70 St. Mary's (R.C.) J.M 368 41 52 93 St. Mary's (R.C.) 1 216 33 50 83 St. Michae1's (C. of E.) 1. 82 22 16 38 St. Peter's J.M. & 1 234 50 37 87 Se1sdon J.M. & 1 607 67 80 147 Smitham J.M. & 1 481 64 84 148 South Norwood J.M 509 77 65 142 South Norwood 1 369 70 69 139 Spring Park J.M. 471 54 37 91 Spring Park 1. 319 67 86 153 Sydenham J.M 304 27 30 57 Thomas Becket J.M. & 1 309 43 59 102 To1dene J.M. & 1 249 34 30 64 Waddon 1 284 44 54 98 Wattenden J.M. & 1 216 33 27 60 West Thornton J.M. & 1 456 57 66 123 Whitehorse Manor J.M 538 68 70 138 Whitehorse Manor 1 358 57 60 117 Winterbourne J. Boys 448 1 15 • 115 Winterbourne J. Gir1s 473 . 113 113 Winterbourne 1 508 63 51 114 Wo1sey J.M. 564 64 47 111 Wo1sey 1. 404 80 76 156 Woodcote J.M 385 39 65 104 Woodcote 1. 256 47 41 88 Woodside J.M 629 101 99 200 Woodside 1. 311 61 55 116 TOTA1 34.757 5.514 5.379 10.893 SPECIA1 SCHOO1S Co1dharbour (E.S.N.) Mixed 100 28 28 56 St. Christopher's (E.S.N.) Mixed 230 54 34 88 St. Gi1es (P.H. & De1.) Mixed 151 92 59 151 St. 1uke's (Partia11y Sighted) Mixed 19 8 2 10 St. Nicho1as (E.S.N.) Mixed 178 30 22 52 Sir Cyri1 Burt (Ma1adjusted) Mixed 52 14 6 20 TOTA1 730 226 151 377 NURSERY SCHOO1S Cou1sdon 48 21 14 35 Crosfie1d 49 14 18 32 Pir1ey 58 21 21 42 Tunsta11 1 12 13 14 27 TOTA1 267 69 67 136 58 Secondary Schoo1s Numbers on Registers No. of Chi1dren Examined Boys Gir1s Tota1 Archbishop Tenison (C. of E.) Mixed 360 29 68 97 Ashburton Mixed 1.243 249 234 483 Co1oma (R.C.) Gir1s 633 - 184 184 Davidson Mixed 455 88 51 139 Ecc1esbourne Gir1s 412 • 127 127 Fairchi1des Mixed 1.100 273 238 511 Ha1ing Manor Mixed 990 199 97 296 Heath C1ark Mixed 870 137 87 224 Ingram Boys 521 189 - 189 John Newnham Mixed 567 151 155 306 John Ruskin Mixed 634 162 - 162 1ady Edridge Gir1s 660 - 141 141 1anfranc Mixed 1.074 242 201 443 Monks Hi11 Mixed 809 162 154 316 Norbury Manor Boys 458 162 • 162 Norbury Manor Gir1s 473 - 163 163 Our 1ady's (R.C.) Gir1s 155 • 69 69 Overbury Mixed 667 76 74 150 Pur1ey Boys 697 201 • 201 Pur1ey Gir1s 659 - 207 207 Ridd1esdown Mixed 1.055 267 182 449 St. Andrew's (C. of E.) Mixed 272 47 46 93 St. Mary's (R.C.) Mixed 601 93 81 1 74 Se1hurst Boys 743 222 - 222 Se1 hurst Gir1s 626 - 112 112 Shir1ey Mixed 623 143 148 291 South Norwood Mixed 467 - • • Stan1ey Technica1 Boys 394 196 - 196 Taunton Manor Mixed 660 106 142 248 Tavistock Mixed 436 76 71 147 Thomas More (R.C.) Mixed 570 145 100 245 Westwood Gir1s 407 - 152 152 Woodcote Mixed 731 135 139 274 TOTA1 21,022 3.750 3.423 7,173 59 CASES OF INFECTIOUS DISEASES AS NOTIFIED BY HEAD TEACHERS Disease 1972 1971 1970 Chicken Pox 301 684 579 Conjunctivitis 3 12 27 Diphtheria - - - Gastro-Enteritis - 3 22 German Measles 273 368 267 Impetigo 32 30 34 Jaundice - 1 2 Measles 194 310 388 Mumps 887 47 878 Non-Specific Diarrhoea inc1uding Dysentery 291 247 325 Non-Specific Vomiting 107 74 10 Other Diseases 170 47 342 Po1iomye1itis - - - Ringwormor Vermin Body 7 2 3 Scalp m m Scabies 4 14 10 Scar1et Fever 84 66 78 Sore Throat inc1uding Tonsillitis 70 72 111 Whooping Cough 30 50 55 TOTA1S 2,453 2,027 3,131 WORK OF THE SCHOO1 HEA1TH VISITORS AND NURSES 1972 1971 Home Visits re pupiIs 3,286 3,665 visits Socia1 We1fare visits to Schools 576 451 ” Minor AiIments 1,413 1,330 sessions Hygiene 833 822 ” Pre-Medicals 1,224 1,290 ” Routine Medical Inspections 1,303 1,304 ” Follow-up 31 39 ” Immunisation 96 137 ” Health Survey 168 119 ” Health Education 272 578 ” Enuresis C1inics 90 87 ” Eye Clinics 165 115 ” Inspection Clinics 80 89 ” CONTENTS A. - PUB1IC HEA1TH REPORT Page Accommodation for confinements 12 Anima1s Boarding Estab1ishments Act 53 Anima1s, diseases of 44 Ante-nata1 c1inics 21 At risk register 98 Bacterio1ogica1 examination 58,120 Births 11 ,12 Caravan sites 45 Cancer 87 Census 11 Cervica1 cyto1ogy 115 Chest c1inic, work of 15 Chi1d hea1th centres 22,102 Chiropody 31 C1ean Air Act 41 Committee, Hea1th and Pub1ic Services 3 Common 1odging houses 39 Communicab1e diseases 17, 117,118 Community nursing services 23 Congenita1 ma1formations 21 ,97 Consumer Protection Act 52 Cremation 116 Deafness 31, 99 Deaths 11, 84 Denta1 treatment 6, 30, 113 Dia1ysis, home 76 Disinfection 43 Disinfestation of premises 44 Domici1iary nursing team 6 Drainage 39 Drug dependency 78 E1der1y persons, rehabi1itation of 106 Emp1oyment agencies 51 Environmenta1 hygiene 6 Fabrics (Misdescription) Act, 1913 53 Factories and workshops 47 Family p1anning 6,75,114 Food comp1aints 62 Food and Drugs Act, 1955 56, 59 Food hygiene regu1ations, 1960 55 Food poisoning 119 Foodstuffs , condemned 57 Food supply 55 Genera1 practitioner attachment schemes 106 Hairdressing 52 Hea1th centres 6 ,22 Hea1th education 6,26,43 Hea1th visitors, work of 24, 100,101 Hearing tests 99 Home dia1ysis 76 Home nursing 24, 105 Home safety 27,109,110 Housing 37 Hea1th Services co-ordination 7, 23 Page Ice-cream - bacterio1ogical examination of 59 I11egitimacy 11 Immigrants, longstay 76. 107 Immunisation 17, 121 Infant mortality 11, 88, 89 Inspection - pub1ic hea1th inspectors 46, 62 1oca1 1and charges 43 1ectures, pub1ic hea1th inspectors 44 Marriages 12 Materna1 morta1ity 11, 92 Maternity homes 116 Meat inspection 57 Medica1 examinations 77 Midwifery 24 Midwives Act 21 Midwives, work of 90, 9 1 Mi Ik supply 58 Mines and Quarries Act, 1954 45 Mortuary 116 Mothercraft classes 21 Meas1es, vaccination 121, 122 Nationa1 Assistance Acts 76 Neonata1 deaths 11 Noise abatement 41 Notification of Births Acts 11, 12 Nursing equipment, 1oan of 108 Nursing homes 116 Nurses agencies 116 Offices, Shops and Rai1way Premises Act 48, 51, 64 Outwork 48 Paediatric assessment 21 Perinata1 deaths 11,88 Pest control 40 Pet Anima1s Act 54 Phenylketonuria 91 Pharmacy and Poisons Act 54 P1anning app1ications 43 Poliomye1itis, vaccination 122 Population 11 Post-natal clinics 21 Post-mortems 116 Premature infants 96 Prosecutions 49, 51. 61 Public health inspectors, work of 35 Public hea1th laboratory, service 17, 120 Public hea1th nursing service 23 Rag F1ock Act 54 Rats and mice (desctruction) act 39 Rehousing on medica1 grounds 76 Relaxation classes 21 Remedial works carried out 50 Riding Establishment Act, 1964 54 Page Rivers and streams, pollution of 40 Rube11a, vaccination 121 Schools 57 Scrap Meta1 Dea1ers Act, 1964 54 Sexua1 ly transmitted diseases 18,126 Sewage Disposal 7 1 Shops act 51 Statistics, summary of 11, 83 Stillbirths 11 Tuberculosis, contacts 16 home visits 16 morta1ity 16, 123 Page Tubercu1osis, notifications 15,123 prevention and control 15 vaccination 16,17 Vaccinations (smallpox, cholera, T.A.B.) 121 ,122 Verminous persons, c1eaning of 44 Vita1 statistics 11,83,84 Water supply 7 1 We1fare foods 22, 97 X -ray 16 B. - SCHOO1 MEDICA1 REPORT Page Audiology 12,14,51 Child Guidance 2,15,40 C leansing of PupiIs 2,8,47 C linics 5 , 50 Coldharbour School 39 Convalescent treatment 26 Costs 6,27 Deaf children 14, 32 Deaths 28 Defects found 8, 9, 48 Delicate chiIdren 30,42,44 Dental services 17,52 Developmental defects 12 Enuresis clinics 20 Epileptic children 30,39 Eye clinics 11,20,53 Handicapped pupils 29 Health Education2,21 Heart and circulation 12 Heights and weights 13,26 Home tuition 44 Immigrant pupiIs 44 Infectious diseases 3,59 Inte1 I igence assessments 23 Juveni1e emp1oyment 27 Ma1adjusted pupi1s 2,15,40 Mea1s and mi Ik 27 Medica1 inspections 1,7,46,55 Minor ai1ments tab1es 53, 54 Page Non-maintained schools 8,55 Nutrition 13,26 Orthodontic Service 17,52 Orthopadic defects 12,24 Overweight pupiIs 13,26 Parents attendances of 8 Partially Hearing Units 32 Physiotherapy 24, 54 Populations of schools 46, 56 Psychological defects 13,15,40 School nurses, work of 59 Special inspections 7,47,48 Speech 25,43,54 Staff 6 Statutory tables 46 Sub-normal pupils 35 Sir Cyril Burt School 40 St. Christopher School 36 St. Giles School 42 St. Luke School 31 St. Nicholas School 37 Transport of pupils 26 Tuberculosis 12 Uncleanliness 2,8,47 Verrucae 1 1, 54 Vision Defects 2,11,20,53