SUMMARY of the ANNUAL REPORT * OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1917. To the Right Honourable the Lord Mayor, Aldermen and Commons of the City of London. Public Health Department, Guildhall, E.C. 2, May, 1918. 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 1917. STATISTICAL DETAILS. Population.—The population is estimated to number 14,720. *Note.—The Reports of the Medical Officer of Health for the City of London are continuous since the year 1818. The complete Report for the year 1917 will be printed at the termination of the War, H.K. 46.1* 2 Birth Rate.— The Birth rate was 7.9 per 1,000 persons, based on a nett number of 115 births. Vaccination.—100 out of 254 births notified to the Public Vaccinator had been successfully vaccinated at the end of the year. Death Rate.—The Death rate was 15.6 per 1,000, compared with 15.0 in the previous year. Infantile Mortality.—The deaths of children under one year were at the rate of 69 per 1,000 births. Infant Visitations.—213 visits were made to the homes of newly-born children, and 147 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 229 deaths registered 30 were due to Phthisis, 16 to Cancer, 24 to Heart Disease, 20 to Bronchitis, and 13 to Violence. Notification of Infectious Diseases.—The nett number of cases was as follows:— Small-pox. 0 Diphtheria 31 Scarlet Fever 17 Enteric Fever 0 Erysipelas 3 Cerebro-Spinal Meningitis 0 Measles and German Measles 256 Chicken-pox 20 * The City Shelter was closed for purp ses of the Mothers' Class during 1917. Other arrangements will be made to accommodate the class. 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 25l, 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 195 235 430 Non-residents 1,144 379 1,523 Totals 1.339 614 1,953 The new patients include the following :— ###] Diagnosed as suffering from Tuberculosis. Diagnosed as not suffering from Tuberculosis. U ndiagnosed. Total number examined. Still under observation. Not Maunder observation. Insured. Uninsured./###] Residents 19 32 2 0 21 32 Non-residents 33 73 10 5 91 30 52 105 12 5 112 62 Cremations.—68 persons were cremated at the City of London Crematorium, as compared with 44 of the previous year. 4 PREVENTION AND TREATMENT OF VENEREAL DISEASES. The City Shelter at Golden Lane was remodelled and equipped for use as a special Centre for the treatment of Venereal Diseases. Beds for in-patient treatment are provided. The staffing and maintenance are the responsibility of St. Bartholomew's Hospital. The following summary represents the work done from the opening of the Dispensary on August 13th to December 31st, 1917 :— Number of persons dealt with. Total Aggergate days of in-patients treatment. M. F. M. F. M. F. Syphilis 77 49 735 353 60 138 Gonorrhoea 71 29 600 226 162 343 Not suffering from Venereal Disease 14 3 — — — — Total 162 81 1,335 579 222 481 243 1,914 703 Number of doses of Salvarsan substitutes administered:— Novarsenobillon 866 Galyl 103 Total 969 5 Examination of Pathological Material : Examined at the Shelter 177 Examined at the Hospital Laboratory 19 Total 196 The following indicates the number of attendances -of patients from the various areas:— Administrative County Middlesex 106 of London 1,914 Surrey 44 Essex 38 Kent 35 Herts 6 Dorset 34 Scotland 3 Wales 40 Birmingham 1 EXAMINATION OF MILK FOR TUBERCULOSIS AND CONDITION AS TO CLEANLINESS. During the month of February 24 samples of Milk were collected for bacteriological examination. They included supplies from Norfolk 5, Cambridgeshire 2, Essex 8, and Suffolk 9. Of the total, 75 per cent, were classified as clean and 25 per cent, as unclean, but of this latter only 2, or 8*5 per cent, of the whole, could be termed really dirty milks. In one instance the tubercle bacillus was found. 6 GENERAL SANITARY WORK. Disinfections.—295,144 articles of bedding, clothing, &c., were disinfected at the Disinfection Station, as well as 5 public conveyances. Work at the Mortuary.— 234 bodies were received, 213 inquests on bodies and 1 fire inquest were held. Sanitary Inspections.—8,951 inspections were made of premises; 225 orders were issued ; 714 notices were served ; and improvements were effected in 1,800 instances without the issue of notices. Registered Lodging-houses.—There were 191 houses on the register which provided accommodation for 1,234 lodgers in 503 tenements. This equals an average of 2'4 persons per tenement. 198 cleansing notices were served. Drainage Plans.—197 plans were submitted to the Medical Officer of Health with regard to proposed reconstruction of water-closets or drains in the City. Of these 173 were approved, 15 revised and improved, and 9 not approved. In addition to these, 5 water-closets which did not comply with the Rye-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. 7 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 oE courts, limewashing of courts, and the supervision of hairdressers' and barbers' shops, as well as observations of smoke and atmospheric pollution have been continued. FACTORY AND WORKSHOP ACT. 1901. The premises at present upon the Register number 3,700, in which are included 7,769 workrooms, &c. Inspections of Factories numbered 1,735. „ „ Workshops „ 1,655. „ „ Workplaces „ 884. There were 370 notices served during the year for various purposes under the Act. The total number of defects discovered was 843. 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.—1,550 lists were received which included the addresses of 13,319 Outworkers employed outside the City, and 602 employed within the City. No new businesses in which Outworkers were employed were observed. 8 FOOD CONTROL. The administration of the various Orders, other than the Rationing Orders, devolved mainly upon the Medical Officer of Health and his Staff. Full particulars of the work are given in the manuscript Report which has been laid before your Committee. In addition to the routine work of inspection, III. special investigations were made, and proceedings were taken in 15 cases, fines ranging from 1l. Is, costs to 10l. 10s. and 21. 2s. costs were inflicted. 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. MEAT INSPECTION. Special reports referring to the condemnation o Bacon from the Netherlands, American Imported Meat and Australian Briskets were presented during the year. Supplies.—282,936 tons were delivered at the Market during the year, being a decrease of 42,225 tons as compared with the present year. * A five p£r cent, examination of all consignments of Argentine Ox Tongues is still being continued. Out of 251,090 tongues examined for this reason 3,189 were rejected. Information supplied by Mr. H. W. G. Millrn.in, Superintendent of the Central Markets. 9 No hind-quarters of South American Beef were condemned on account of Tuberculosis. This is an exceptional occurrence, and is due to the fact that very little cutting-up of carcasses is now practised at Smithfield. Tuberculous Meat.—The general condemnations on account of Tuberculosis in the Central Meat Markets were as follows :— Beef - 17 carcasses. 37 quarters. 50 pieces. Pork - 386 „ 2 „ 27 „ Veal 3 „ — — In addition, a considerable amount of oflal was seized. Poultry, Game, &c.—The Inspections at Leadenhall Market and the City Shops were continued during the year, and 26 tons of unsound food were condemned. Cold Stores.—A slight decline in the amount of unsound food destroyed from the Cold Stores was reported. The increase of last year was attributed to the difficulties in transport under existing circumstances, and this factor has operated during the present year. Increased inspection work has taken up much time, since it has been necessary to place many cargoes under " stop." Aldgate Market and Slaughterhouses.—53,514 animals were slaughtered during the year. This is a slight decrease compared with tho previous year which is most noticeable in the case of calves 10 Out of 21,778 bovine animals slaughtered at Aldgate, 657 were affected with Tuberculosis in varying degrees. Unsound Food.—The total quantity of unsound food destroyed during the year was 1,386 tons. FISH SUPPLIES. 115,169 tons of fish, of which 111,516 tons were land-borne, and 3,623 tons water-borne, were delivered at or near Billingsgate Market during the year. This is a decrease of 2,722 tons of the land deliveries, and 906 tons in the deliveries by water, Of this, 1,750 tons were condemned as unfit for food. 17 cwts. 1 qr. 4 lbs. were seized as unsound at or near the London Central Markets. DAIRIES. COWSHEDS AN1) MILKSHOPS OHDEKS. 580 Dairymen and Purveyors of Milk were on the register at the end of the year. SALE OF FOOD AND DRUGS ACT. 458 formal samples and 534 informal samples were purchased under these Acts. Of the formal samples 51 or 11.1 per cent, were found to be adulterated, and of the informal 69 out of 534. 11 Of the formal samples the adulterated articles were: milk, 24 out of 208 ; butter, 24 out of 229 ; drugs, 3 out of 3 purchased. Of the informal samples : milk, 42 out of 196 were found to be adulterated ; 22 of butter out of 197 ; 3 of drugs out of 66 ; 2 of vinegar out of 6. Milk.—The extent of sophistication is given in the preceding paragraph. Drugs.—6 out of 69 samples were reported against, viz. : 4 of Boric Acid, and 2 of Camphorated Oil. Butter.—24 samples out of 229 purchased formally, and 22 out of 197 purchased informally were found to be adulterated. MEDICAL EXAMINATIONS. Your Medical Officer of Health examined 11 persons as to their fitness to hold office under the Corporation. All were approved. 13 officers were also medically examined with a view to their retirement, and of these 12 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. 12 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 distinctly 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 of the City of London. Ohurleo Skipper & East, Printers, 49, Great Tower Street, R G. 3.