LON 11 SUMMARY OF THE ANNUAL REPORT * 0F THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1916 To the Right Honourable the Lord Mayor, Aldermen and Commons of the City of London. Public Health Department, Guildhall, E.G. 2, July, 1917. Gentlemen, In accordance with your instructions I have the honour to submit herewith a summary of my Report as Medical Officer of Health of the City of London for the year 1916. STATISTICAL DETAILS. Population.— The population is estimated to number 15,531. * Note.—The Reports of the Medical Officer of Health for the City of London are continuous since the year 1848. The complete Report for the year 1916 will be printed at the termination of the War. 2 Birth Rate.—The Birth rate was 8T per 1,000 persons, based on a nett number of 125 births. Vaccination.—123 out of 415 births notified to the Public Vaccinator had been successfully vaccinated at the end of the year. Death Rate.—The Death rate was 15.0 per 1,000, compared with 17.4 in the previous year. Infantile Mortality.—The deaths of children under one year were at the rate of 128 per 1,000 births. Infant Visitations.—178 visits were made to the homes of newly-born children, and 332 attendances of mothers with infants were made at the City Shelter. Causes of Death.—No special observations are necessary beyond the fact that out of 233 deaths registered 26 were due to Phthisis, 24 to Cancer, 29 to Heart Disease, 30 to Bronchitis, and 20 to Violence. Notification of Infectious Diseases.—The nett number of cases was as follows:— Diphtheria 25 Scarlet Fever 33 Enteric Fever 2 Erysipelas 7 Cerebro- Spinal Meningitis 2 Measles and German Measles 145 Chicken-pox 15 3 The figures indicate that there was an epidemic of Measles during the year. It was not found necessary to use any of the grant of 251, which the Sanitary Committee had allotted for the purposes of nursing urgent cases. The usual high percentage of removals to Hospitals was maintained. Tuberculosis Dispensary.—The total attendances are set out in the following summary:— Insured. Uninsured. Totals. Residents 167 215 382 Non-residents 1,407 314 1,721 Totals 1.574 529 2,103 The new patients include the following:— Diagnosed as suffering from Tuberculosis. Diagnosed as not suffering from Tuberculosis. Undiagnosed. Total number examined. Still under observation. Not now under observation. Insured. Uninsured. Residents 15 28 4 2 20 29 Non-residents 52 91 14 5 129 33 67 119 18 7 149 62 Cremations.—44 persons were cremated at the City of London Crematorium, as compared with 45 of the previous year. 4 GENERAL SANITARY WORK. Disinfections.—438,426 articles of bedding, clothing, &c., were disinfected at the Disinfection Station. Work at the Mortuary.—169 bodies were received, 151 inquests on bodies, and 2 fire inquests were held. Sanitary Inspections.—8,685 inspections were made of premises; 290 orders were issued; 736 notices were served; and improvements were effected in 1,368 instances without the issue of notices. Registered Lodging-houses.—There were 197 houses on the register which provided accommodation for 1,278 lodgers in 518 tenements. This equals an average of 2.3 persons per tenement. 222 cleansing notices were served. Drainage Plans.—302 plans were submitted to the Medical Officer of Health with regard to proposed reconstruction of water-closets or drains in the City. Of these 277 were approved, 18 revised and improved, and 7 not approved. In addition to these, 6 water-closets which did not comply with the Bye laws, have been constructed. They have been sanctioned merely as temporary measures, and in each case a written undertaking has been received that the closets shall be removed within six months of the termination of the War. 5 OTHER DETAILS. The substitution of street gullies has been continued. The supervision of over-crowding has been maintained. Notification of Sanitary defects in association with outbreaks of infectious disease, supervision of sanitary conveniences provided at railway stations, summer flushing of courts, limewashing of courts, and the supervision of hairdressers' and barbers' shops, as well as observations of smoke and atmospheric pollution have been continued. Y.M.C.A. HOSTEL, LONDON BRIDGE. A new Soldiers' Hostel was established in November by the Y.M.C.A. on the Approach to London Bridge. Certain sanitary alterations were necessary to render the building suitable for the purpose. These were carried out under supervision. REMOVAL OF HUMAN REMAINS. Removals were supervised at the Church of St. Vedast, Foster Lane, and the Church of St. Dunstan's, Fleet Street. BORIC ACID IN SHRIMPS. During the early part of the year the presence of Boric Acid in picked and potted shrimps was reported upon and suitable preventive action taken. 6 FACTORY AND WORKSHIP ACT, 1901 The premises at present upon the Register number 3,800, in which are included 7,917 workrooms, &c. Inspections of Factories total 1,670. ,, „ Workshops ,, 1,960. „ ,, Workplaces,, 642. There were 211 notices served during the year for various purposes under the Act. The total number of defects discovered was 772. Bakehouses were as in previous years. The details of the work done in Factories and Workshops does not admit of a satisfactory summary. "Home" Workers.—1,481 lists were received which included the addresses of 14,766 Outworkers employed outside the City, and 661 employed within the City. No new businesses in which Outworkers were employed were observed. INSPECTION OF FOOD AT RIVERSIDE WHARVES. Again it is impossible to summarise the work done under this heading. Enormous quantities of food were inspected, of which over 200 tons were condemned. 7 MEAT INSPECTION. Special reports referring to the condemnation of Irish Pig Carcases, and the Handling of Meat were presented during the year. Supplies.—331,161 tons were delivered at the Market during the year, being a decrease of 42,170 tons. * A five per cent, examination of all consignments of Argentine Ox Tongues is still being continued. Out of 308,930 tongues examined for this reason 6,309 were rejected. Only 13 hind-quarters of South American Beef were condemned on account of Tuberculosis. Tuberculous Meat.—The general condemnations on account of Tuberculosis in the Central Meat Markets were as follows:— Beef 16 carcases. 41 quarters. 78 pieces. Pork 685 ,, 7 „ 98 „ Veal 4 „ — — In addition, a considerable amount of offal was seized. Poultry, Game, &c.—The Inspections at Leadenhall Market and the City Shops were continued during the year, and 18 tons of unsound food were condemned. * Information supplied by Mr. H W. G.. Millman, Superintendent of the Central Markets. 8 Cold Stores.—A considerable increase in the amount of unsound food destroyed from the Cold Stores was reported. This must be attributed to the difficulties in transport under existing circumstances. This increased inspection work has taken up much time, since it has been necessary to place many cargoes under "stop." Alugate Market and Slaughterhouses.—51,000 animals were slaughtered during the year. This is a slight decrease compared with the previous year, which is most noticeable in the case of calves, Out of 24,805 bovine animals slaughtered at Aldgate, 1,163 were affected with Tuberculosis in varying degrees. Unsound Food.—The total quantity of unsound food destroyed during the year was 1,256 tons. Lectures.—During the year about 300 officers and men of the 2nd London Sanitary Company attended the Central Markets for practical demonstrations in meat inspection. FISH SUPPLIES. 118,797 tons of fish, of which 114,268 tons were land-borne, and 4,529 tons water-borne, were delivered at or near Billingsgate Market during the year. This is a decrease of 10,763 tons of the land deliveries, and 13,413 tons in the deliveries by water. Of this 1,183 tons were condemned as unfit for food. 9 19 tons 6 cwts. 6 qrs. 27 lbs. were seized as unsound at or near the London Central Markets. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS. 561 Dairymen and Purveyors of Milk were on the register at the end of the year. SALE OF FOOD AND DRUGS ACT. 447 formal samples and 531 informal samples were purchased under these Acts, and also 11 informal samples under the Milk and Cream Regulations. Of the formal samples 26 or 5.8 per cent, were found to be adulterated, and of the informal 25 out of 531. Of the formal samples the adulterated articles were: milk, 24 out of 262; butter, 1 out of 140; drugs, 1 of 7 purchased. Of the informal samples : milk, 11 out of 246 were found to be adulterated. Milk.—The extent of sophistication is given in the preceding paragraph. Drugs.—4 out of 46 samples were reported against, viz.: 2 of Boric Acid, and 2 of Acid Phosphate. Butter.—One sample of 140 purchased formally, and 7 out of 152 purchased informally were found to be adulterated. 10 MEDICAL EXAMINATIONS. Your Medical Officer of Health examined 20 persons as to their fitness to hold office under the Corporation. All were approved, with two exceptions. Eleven officers were also medically examined with a view to their retirement, and of these ten were reported to be unfit for duty. GENERAL. The usual appendices setting out particulars of causes of deaths, the location of infectious diseases, and the lists of the various registered premises, are appended to the Report. I desire to express my indebtedness to the Members of my Staff who still remain on duty for assistance in these troublous times. They have continued their work under somewhat trying circumstances, and in several branches the work has materially increased. All have accepted their increased responsibilities with cheerfulness. I have the honour to remain, Your obedient Servant, WILLIAM J. HOWARTH, Medical Officer of Health for the City of London. Obarles Skipper & East, Printers, 49, Great Tower Street, E.C. 3.