LON 12 SUMMARY OF THE ANNUAL REPORT * OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1918. To the Right Honourable the Lord Mayor, Aldermen and Commons of the City of London. Public Health DepaRtment, Guildhall, E.C. 2, July, 1919. 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 1918. STATISTICAL DETAILS. Population. — The population is estimated to number 13,900. * 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 1918 will doubtless be printed at a later date. 2 Birth Rate.— The Birth rate was 7.3 per 1,000 persons, based on a nett number of 101 births. Vaccination.—71 out of 312 births notified to the Public Vaccinator had been successfully vaccinated at the end of the year. Death Rate.—The Death rate was 20.9 per 1,000, compared with 15-6 in the previous year. Infantile Mortality.—The deaths of children under one year were at the rate of 148 per 1,000 births. Infant Visitations.—285 visits were made to the homes of newly-born children. The Infant Welfare Centre is now held, by arrangement with the Governors, at St. Birtholomew's Hospital. Causes of Death.—An analysis of the cause of the increased mortality compared with the previous year shows that Influenza caused 30 deaths in the year under review, as against none in 1917; Organic Heart Disease 31 as against 24; Broncho-Pneumonia and other diseases of the respiratory system, 48 as against 38; and other defined diseases, 95 as against 86. From these facts it will be noted that Influenza, which was probably a contributory cause of death in many of the other cases referred to, was the chief factor which resulted in the increased mortality. 3 As regards the increased mortality amongst infants it is difficult to draw any useful deductions owing to the fewness of the numbers which are available for consideration. The only points of interest are that there were two deaths from Measles in 1918 as against nil in 1917. There were four deaths from Diarrhoea and Enteritis compared with none in 1917. Notification of Infectious Diseases.—The nett number of cases was as follows:— Small-pox 0 Diphtheria 18 Scarlet Fever 16 Enteric Fever 0 Puerperal Fever 0 Erysipelas 7 Cerebro-Spinal Meningitis 1 Acute Poliomyelitis and Polioencephalitis 0 Ophthalmia Neonatorum 0 Measles 82 Rubella 9 Chicken-pox 44 The figures indicate that the epidemic of Measles, which was a feature of the later months of 1918, continued during the early months of 1919. Diphtheria was prevalent to a less extent than in previous years. The number of Scarlet Fever cases reported was practically the same. 4 Chicken-pox was more prevalent to the extent of 42 reported cases against 20. It was not found necessary to use any of the grant of £25 which the Sanitary Committee had allotted for the purposes of nursing urgent cases. The usual high percentage of removals to Hospitals was maintained. A detailed Report on the prevalence of Influenza and the incidence of the disease on certain specially investigated premises is set out in the full Report. A limited epidemic of Enteric Fever due to the consumption of contaminated oysters is also set out in detail, and the facts of this Report were forwarded to the Local Government Board. Two cases of Anthrax were also brought to the notice of the Medical Officer of Health. Tuberculosis Dispensary.—The total attendances are set out in the following summary:— Insured. Uninsured. Totals. Residents 263 413 676 Non-residents:— Working in the City 1,314 354 1,668 Not working in the City 27 28 55 Totals 1,604 795 2,399 5 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 23 56 3 0 29 53 Non-residents- Working in the City 33 56 3 3 64 31 Not working in the City 9 15 0 1 12 13 65 127 6 4 105 97 202 202 Cremations.—70 persons were cremated at the City of London Crematorium, as compared with 68 in the previous year. SPECIAL CENTRE FOR THE TREATMENT OF VENEREAL DISEASES. The work carried out at the Centre continues to increase, and to meet the necessary requirements additional equipment and various alterations have had to be undertaken. These cost approximately £300, and approval for all money expended has been received from the Local Government Board. 6 The number of new patients treated during the twelve months was 528. Of these 247 suffered from Syphilis, 219 from Gonorrhoea, 48 from both Syphilis and Gonorrhoea, and 14 from conditions other than venereal. Of this total 398 patients were normally resident in London, and 206 of these suffered from Syphilis; 33 were resident in Essex, 14 suffered from Syphilis; 5 in Herts, with no cases of Syphilis; 9 in Middlesex, of which 4 were cases of Syphilis; 19 in Surrey with 12 cases of Syphilis; 18 in Kent with 7 cases of Syphilis; 3 patients each came from Berks and Bucks, and 1 case each from Sussex and Northamptonshire. Total attendances of patients numbered 8,353. The number of in-patients' days of all patients was 785. In the out-patients' Clinic 1,368 doses of Salvarsan or its substitutes were administered, and in the in-patient department 38 doses. 396 examinations were made for the detection of Spirochetes, and 35 for the detection of Gonococci. Amongst the old patients under treatment two came from Dorsetshire and one from Cardiff. There were under treatment on the 1st January, 1918, 210 males and 86 females. Of the 247 patients suffering from Syphilis who came under treatment 7 for the first time in 1919, 144 were men aNd 103 were women; and of the same group who suffered from Gonorrhoea, 158 were men and 61 women. Forty men and eight women suffered also from both Syphilis and Gonorrhoea. The number of patients who ceased to attend the Clinic without completing treatment was : For Syphilis 36 males, 15 females. For Gonorrhoea - 12 males, 6 females. The number of patients discharged from the Out-patient Clinic after completion of treatment was:— For Syphilis 2 males. For Gonorrhoea - 5 males, 4 females. It is interesting to note that the two males who were discharged after treatment for Syphilis made a total of 56 attendances, and the five males discharged after Gonorrhoea 33 attendances, and the four females 43 attendances. The two males under treatment for Syphilis received altogether 12 injections of Salvarsan. In accordance with the desire of the Sanitary Committee, I have to report the occupation of 8 104 patients who were under treatment for Venereal Diseases. They are as follows:— Labourers 12 Carmen 2 Traveller 1 Student 1 Contractor 1 Surveyor 1 Waitress 1 Policemen 2 Chemist 1 Clerks 9 Engineers 5 Pressman 1 Actor 1 Watchman 1 Silver Worker 1 School Teacher 1 Greengrocer 1 Furrier 1 Bootmaker 1 Chauffeur 1 Housewives 14 Cutler 1 Motor Driver 1 Engraver 1 Soldiers 9 Carpenters 2 Sailors 9 Instrument Maker 1 Packers 2 Cook 1 Joiner 1 Tram Conductor 1 Farmer 1 Hairdresser 1 Warehousemen 10 Assistant, Provision Shop 1 Baker 1 It will be noted that in three instances the patients were engaged in an occupation which involved the handling of food, namely:— A Greengrocer, A Cook and An Assistant in a Provision Shop. The Cook suffered from Syphilis, and the Assistant from Gonorrhoea. The disease in the case of the 9 Greengrocer is not stated. In two other cases a Waitress and a Baker attended, but neither of these suffered from Venereal Disease. Two other occupations of interest are a Hairdresser and a Tram Conductor. I know of no power which will enable persons suffering from Venereal Disease, engaged in the preparation of food, to be restrained from continuing their work. I think this point should be brought to the notice of the Local Government Board, with a recommendation that it should be made illegal for persons suffering from Venereal Disease to continue in certain specified occupations. CLEANSING OF VERMINOUS SCHOOL CHILDREN. The existing arrangements between the Corporation and the London County Council whereby children who are in a verminous condition, and whose normal place of residence is in the City, and who attend any public elementary school provided or maintained by the London County Council, and in addition children not residing in the City, but attending City schools, are cleansed at the Cleansing Station in Golden Lane, were extended, owing to pressure on available accommodation, and simply as a temporary arrangement, to include a few children weekly who neither reside in the City nor attend City Schools. 10 CLEANSING OF VERMINOUS PERSONS. The arrangement entered into between the Corporation and the City of London Guardians to carry out such disinfection as may be necessary under the Cleansing of Verminous Persons Act, 1897, at a charge of 10s. 6d. each case was terminated by the Guardians in consequence of altered circumstances at the Board's Institution at Thavies' Inn. This disinfection is now carried out at the Corporation's Disinfecting Station in Golden Lane. GENERAL SANITARY WORK. Disinfections.—A considerable amount of disinfection work has been necessary during the War in connection with War Institutions. The following summary indicates the number of articles disinfected in each year, and will give some idea of the amount of work carried out under this heading:—1914, 244 articles; 1915, 1,336; 1916, 2,677; 1917, 9,294; and 1918, 7,069; it represents a total for the five years of 20,620 articles disinfected. Various billets have also been subjected to periodical disinfection, as well as certain enemy clothing on behalf of the Board of Trade. 170,670 articles were disinfected for City firms engaged in second-hand export trade to South Africa. 11 Work at the Mortuary.—158 bodies were received, 130 inquests on bodies. No fire inquests were held, although the City Coroner informs me that 134 preliminary investigations into fires were held by him. Sanitary Inspections.—8,524 inspections were made of premises; 275 orders were issued; 694 notices were served; and improvements were effected in 1,622 instances without the issue of notices. Complaints.—Complaints have been received respecting the Condemned Meat Shed in Lindsey Street, and in respect of offensive smells at Billingsgate Market. Both these matters received attention. Registered Lodging-Houses.—There were 134 houses on the register which provided accommodation for 713 lodgers in 371 tenements. This equals an average of 2.1 persons per tenement. 188 cleansing notices were served. Tenement Houses.—Tenement houses were the subject of a special Report to the Sanitary Committee, in which Report certain administrative difficulties were referred to, particularly the one which makes the landlord of the lettings the responsible party for the observance of the Bye-laws. In practice, the owner and real landlord of the premises lets a large house to 12 a person of more or less limited means. The house is too large for the person renting it, and he seeks to recover part of his rent by subdetting the rooms which are not required. The landlord of the property looks to the tenant for the rent of the house, and the landlord ot' the lettings to the sub-tenants for their share of the weekly rent. These houses rapidly deteriorate from the point of view of cleanliness and minor structural deficiencies. In due course the landlord of the lettings is served with a notice to effect an improvement, but owing to insufficient means, considerable difficulty is experienced in getting the necessary improvements attended to. Drainage Plans.—150 plans were submitted to the Medical Officer of Health with regard to proposed reconstruction of water-closets or drains in the City. Of these 139 were approved, 6 revised and improved, and 5 not approved. 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. 13 FACTORY AND WORKSHOP ACT. 1901. The premises at present upon the Register number 3,753, in which are included 7,659 workrooms, &c. Inspections of Factories numbered 907. „ „ Workshops ,, 794. „ ,, Workplaces ,, 785. There were 268 notices served during the year for various purposes under the Act. The total number of defects discovered was 513. Of these, 397 were remedied before the end of the year, and four instances were referred to H.M. Inspector of Factories. 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.—1,395 lists were received which included the addresses of 12,802 Outworkers employed outside the City, and 607 employed within the City. The chief trades employing Outworkers appear to be those engaged in making of wearing apparel, furriers, umbrella makers, artificial flower makers and paper-bag and box makers. 14 FOOD CONTROL. A considerable amount of work connected with the administration of various Orders, other than the ordinary rationing Orders, devolved upon the Medical Officer and his Staff. Full particulars of this work are included in the manuscript copy of the report. In addition to the routine work of inspection, 107 special investigations were made, and police-court proceedings were taken in 18 cases. The total amount of fines inflicted in these cases was £175 2s., and costs £28 7s. 6d. The fines ranged from £60 downwards. 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 98 tons were condemned. MEAT INSPECTION. Difficulties in connection with Meat Inspection were considerably increased owing particularly to the receipt of much meat at Smithfield which had been landed unfit for food in consequence of decomposition changes. 15 A large number of carcasses were also forwarded to the market from animals which were diseased, and the inspection in the district of slaughter had not been adequate. The method of the packing of Irish carcasses and offal left much to be desired. Difficulties were experienced also for a month or six weeks in connection with the disposal of condemned products. The contractor was unable to remove the whole of the material, and emergency arrangements had to be improvised. Dr. MacFadden of the Local Government Board drew the attention of the Army Council to the difficulties, and by his assistance Army motor lorries were placed at the disposal of the Corporation for the removal of the products. The National Salvage Council arranged for the receipt and disposal of the surplus unsound meat which could not be accepted by the contractor. Supplies.—211,090 tons were delivered at the Market during the year, being a decrease of 71,810 tons as compared with the previous year. * A five per cent, examination of all consignments of Argentine Ox Tongues is still being continued. Out of 285,276 tongues examined for this reason * Information supplied by Mr. H. W. G. Millman, Superintendent of the Central Markets. 16 501 were rejected. This proportion shews a considerable decline in the previous year. No hind-quarters of South American Beef were condemned on account of Tuberculosis. As stated last year, 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— Carcasses. Quarters. Pieces. 1918 105 548 64 1917 17 37 50 Pork— 1918 68 — 56 1917 386 2 27 Veal— 1918 — — — 1917 3 — — 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 43 tons of unsound food were condemned. 17 Cold Stokes.—A slight decline in the amount of unsound food destroyed from the Cold Stores was reported. Embargoes were placed on most of the carcasses that were admitted into the Cold Stores, and the necessary sorting entailed a considerable amount of additional work to this department. The actual amount of food condemned in the Cold Stores was 235½ tons. Aldgate Market and Slaughterhouses.—Only 15,482 animals were slaughtered during the year as compared with 53,514 of the previous year. Bulls and heifers showed a slight increase, and there was a considerable decrease in the number of cows, calves, oxen and sheep. Out of 10,184 bovine animals slaughtered at Aldgate, 109 were affected with Tuberculosis in varying degree. Unsound Food.—The total amount of unsound food delivered at the Markets' Slaughterhouses and in the Cold Stores amounted to 1,710 tons as compared with 1,385½ tons in the previous year. FISH SUPPLIES. 121,424 tons of fish, of which 121,271 tons were land-borne, and 153 tons water-borne, were delivered at or near Billingsgate Market during the year. 18 This is an increase of 9,723 tons of the land deliveries, and a decrease of 3,470 tons in the deliveries by water. Of this, 2,166 tons were condemned as unfit for food. 13 tons 17 cwts. of fish were seized as unsound at or near the London Central Markets. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS. 580 Dairymen and Purveyors of Milk were on the register at the end of the year. SALE OF FOOD AND DRUGS ACT. 254 formal samples and 541 informal samples were purchased under these Acts. Of the formal samples 28, or 11 per cent., were found to be adulterated, and of the informal 66 out of 541. Of the formal samples the adulterated articles were: milk, 23 out of 215; butter, 2 out of 16; almond oil, 2 out of 4 ; dripping, 1 out of 1 purchased. Of the informal samples: milk, 24 out of 84 were found to be adulterated; 27 of butter out of 147; 12 of drugs out of 141; 2 of dripping out of 18; 1 of almond oil out of 9. Milk,—The extent of sophistication is given in the preceding paragraph. 19 Drugs.—12 out of 141 samples were reported against, viz.; 8 of magnesia, 3 of calomel ointment and 1 of Epsom salts. Butter.—2 samples out of 16 purchased formally, and 27 out of 147 purchased informally were found to be adulterated. MEDICAL EXAMINATIONS. Your Medical Officer of Health examined 10 persons as to their fitness to hold office under the Corporation. All were approved. 18 officers were also medically examined with a view to their retirement, and of these 14 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 attached to the Report. I desire to express my indebtedness to the Members of my Staff who remained on duty for assistance in difficult circumstances. In several branches the work materially increased, but all accepted their increased responsibilities with cheerfulness. 1 have the honour to remain, Your obedient Servant, WILLIAM J. HOWARTH, Medical Officer of Health of the City of London. Oracles Skipper & East. Printers 49, Great Tower Street ,K.C. 3.