AZ 134 LON 54 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON FOR THE YEAR 1928 LONDON. Printed by Drake, Driver & Leaver Ltd., Rosebery Avenue, E.C.I. 1929 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON For the Year 1928. LONDON. Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C.I. 1929. INDEX. A. PAGE. ANNUAL RATEABLE VALUE 7 APPENDICES 79 AREA 7 ARTIZANS' DWELLINGS, STONEY LANE 57 ATMOSPHERIC POLLUTION 26 B. BAKERS' DERMATITIS 16 BIRTHS 8 INFANT WELFARE 11 „ NOTIFICATION 11 c. CONGRESSES—R.S.I. CONGRESS. PLYMOUTH 25 „— ROYAL INSTITUTE OF PUBLIC HEALTH. DUBLIN 25 „— ATERNITY AND INFANT WELFARE, LONDON 25 „—NATIONAL ASSOCIATION FOR PREVENTION OF TUBERCULOSIS, LONDON 25 „—PUBLIC HEALTH CONGRESS AND EXHIBITION, LONDON 25 „—SANITARY INSPECTORS' ASSOCIATION, LEICESTER 25 „—WORLD'S DAIRY CONGRESS, LONDON 25 COURTS AND ALLEYS, FLUSHING 62 LIMEWASHING 62 CREAM—RECONSTITUTED AND SYNTHETIC—(ARTIFICIAL) BILL 42 CREMATIONS 28 D. DENSITY 7 DIPHTHERIA—ANTI-TOXIN 16 DISINFECTANTS 73 „—DISTRIBUTION OF—POISON 73 DISINFECTION OF SECOND HAND CLOTHING 72 DRAINAGE PLANS 62 E. EXHUMATION AND REINTERMENT OF HUMAN REMAINS AT— CITY OF LONDON CEMETERY 64 ST. OLAVE'S BURIAL GROUND 63 F. FACTORY AND WORKSHOPS ACT, 1901—ABOVEGROUND BAKEHOUSES) 65 „ „ „—FACTORIES, WORKSHOPS, WORKPLACES AND KITCHENS 64 „ „ „ —OUTWORKERS 65 „ „ „ —SUMMARY OF WORK DONE 66 „ „ „ —UNDERGROUND BAKEHOUSES 65 FERTILIZERS AND FEEDING STUFFS ACT, 1926 72 FISH—SUPPLIES AND SEIZURES 52 FLY NUISANCE 63 FOOD AND DRUGS, SUPERVISION OF 30 FOOD AT RIVERSIDE WHARVES—INSPECTIONS AND CONDEMNATIONS 57 H. HAIRDRESSERS' AND BARBERS' SHOPS 26 HEALTH VISITORS—TRAINING OF—TUBERCULOSIS 22 HOUSE AND TRADE REFUSE REMOVAL 62 HOUSING 60 HUMAN REMAINS—ST. OLAVE'S BURIAL GROUND 63 I. ICE CREAM 72 INFANTILE MORTALITY 8 INFANT WELFARE 11 INFECTIOUS DISEASE 11 „ „—BACTERIOLOGICAL AND PATHOLOGICAL EXAMINATIONS 11 „ „ —DIPHTHERIA ANTI-TOXIN 15 „ „ —INFECTIOUS DISEASE (LONDON) REGULATIONS, 1927 16 „ „ —NOTIFICATION OF 11 „ „ —NOTIFICATION OF ACUTE RHEUMATISM 16 „ „ —NURSING PROVISION—MEASLES, ENCEPHALITIS LETHARGICA, CEREBROSPINAL FEVER AND INFLUENZA 16 „ „ —PUBLIC HEALTH (NOTIFICATION OF PUERPERAL FEVER AND PUERPERAL PYREZIA) AMENDMENT REGULATIONS, 1928, AND THE PUBLIC HEALTH (OPHTHALMIA NEONATORUM) AMENDMENT REGULATIONS, 1928 15 „ „ —SMALLPOX 15 „ „ —TEMPORARY ISOLATION ACCOMMODATION, 29. MIDDLESEX STREET 16 „ „ —TUBERCULOSIS 14,17 „ „ —VENEREAL DISEASES 22 INFLUENZA—VACCINE 15 INTRODUCTION 7 INDEX (continued). L. paGE. LEGAL PROCEEDINGS—SANITARY 62 LIMEWASHING OF COURTS 62 LODGING HOUSES, COMMON—116, MIDDLESEX STREET 61 „ „ REGISTERED 59 M. MARGARINE, REGISTRATION OF DEALERS IN MARGARINE AND MARGARINE CHEESE 31 MEASLES 16 MEAT INSPECTIONS 43 „ „ —DELIVERIES AT CENTRAL MARKETS 44 „ „ —DISEASED MEAT FROM VARIOUS COUNTRIES 46 „ „ —EXPORT OF MEAT 51 „ „ —HOME KILLED MEAT SEIZED 45 „ „ —LEADENHALL MARKET AND CITY SHOPS 60 „ „ —MEAT IMPORTED 43 „ „ —PROSECUTIONS 61 „ „ —PUBLIC HEALTH (MEAT) REGULATIONS, 1924 53 „ „ —UNSOUND MEAT REMOVED FROM COLD STORES 49 MEDICAL EXAMINATIONS 77 MIDDLESEX STREET NO 29. TEMPORARY ACCOMMODATION 16 MILK—BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS FOR TUBERCULOSIS AND DIRT (RAILWAY STATIONS) 29 „ —CHEMICAL EXAMINATION OF 32 „ —PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 33 „ —MILK AND CREAM REGULATIONS P.H. (CONDENSED MILK) REGULATIONS 33 ,, —MILK AND DAIRIES (AMENDMENT) ACT, 1922 31 „ —MILK AND DAIRIES ORDER, 1926 31 „ —PRODUCTION AND DISTRIBUTION—COURSE OF INSTRUCTION 43 „ —TUBERCULOSIS REGULATIONS 22 MORTALITY 8 „ —INFANTILE 8 „ —VIOLENCE 8 „—PHITHISIS 8 „—ZYMOTICS 8 MORTUARY—DISINFECTION OF CLOTHING FOR EXPORT, INQUESTS, Etc 72 „ —PRESERVATION OF BODIES OF UNKNOWN DEAD 73 N. NOTIFICATION OF BIRTHS ACT, 1907, AND INFANT WELFARE WORK 11 O. OVERCROWDING 62 P. PIGEONS—L.C.C. (GENERAL POWERS) ACT, 1927 63 POPULATION 7 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 33 „ „ —(DRIED MILK) REGULATIONS, 1923 33 „ „ —(IMPORTED MILK) REGULATIONS. 1926 42 „ „ —(MEAT) REGULATIONS, 1924 53 „ „ (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925 22 „ „ —(NOTIFICATION OF PUERPERAL FEVER AND PUERPERAL PYREXIA) AMENDMENT REGULATIONS, 1928, AND (OPHTHALMIA NEONATORUM) AMENDMENT REGULATIONS, 1928 15 „ „ —(PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 27 31 „ „ —(TUBERCULOSIS) REGULATIONS, 1912 1924 16 R. RAILWAY STATIONS—SAMPLES OF MILK 29 RATEABLE VALUE 7 RAT REPRESSION 73 REFUSE REMOVAL 62 RHEUMATISM—NOTIFICATION OF 16 s. SALE OF FOOD AND DRUGS ACTS—ADMINISTRATIVE ACTION REGARDING SAMPLES REPORTED TO BE NOT GENUINE 34 „ „ „ —PROSECUTIONS 42 „ „ „ —SUMMARY OF ARTICLES EXAMINED UNDER SALE OF FOOD AND DRUGS ACTS 36 SANITARY DEFECTS AND INFECTIOUS DISEASE 62 SANITARY INSPECTIONS 68 SEWER, DEFECTIVE CONNECTIONS 63 SHELTER FOR TEMPORARY ACCOMMODATION, 29, MIDDLESEX STREET 16 SMALLPOX 15 SMOKE AND ATMOSPHERIC SOLUTION 26 STAFF 6 STATISTICAL INFORMATION 7 STREET GULLIES 62 T. TUBERCULOSIS 14,17 „ —PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925 22 „ —PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1925 22 „ —TRAINING OF HEALTH VISITORS 22 V. VACCINATION 10 VENEREAL DISEASES 22 VIOLENT DEATHS 8 VITAL STATISTICS 10 SANITARY STAFF. MEDICAL OFFICER OF HEALTH. Date of Appointment. Howarth, Wm. J., C.B.E., M.D., D.P.H. (Retired April, 1928) Dec., 1912 Willoughby, Willoughby Mason, B.A., M.D., B.C. (Cantab.), D.P.H. (Camb.) May, 1928 VETERINARY SURGEON. Young, T. Dunlop, O.B.E., M.R.C.V.S., D.V.S.M. Nov., 1909 CLERICAL STAFF. Lowe, George Principal Assistant Nov., 1902 Gray, Charles M. 1st Class Assistant March, 1911 Blunt, Harold F 2nd Class Assistant May, 1924 Lee, Wm. J. Oct., 1915 Spalding, C. A. 3rd Class Assistants March, 1918 Threadgold, Arthur W. Nov., 1923 Cole, Ernest May, 1924 Cann, S. W. Unclassified May, 1927 Tunbridge, Mrs. Jan., 1917 Jarvis, Miss E. S., M.B.E. May, 1921 SANITARY INSPECTORS. Hills, Arthur Reginald (Retired 30th June, 1928) April, 1888 Simmons, Edward John (Retired 30th June, 1928) June, 1892 Robbins, Francis Joseph Sept., 1892 Ralph, William Holden grade I. June, 1898 Davies, Thos. L. (Retired 30th June, 1928) Dec., 1903 Robinson, Ernest S Grade I. Feb., 1913 Fowler, George Henry Oct., 1920 McGrath, William Richard Mar., 1922 Harrington, George Edwin Dec., 1925 Sillet, David Ernest . Grade II April, 1926 Fisher, Stanley G. July, 1928 Neale, William G. C July, 1928 Tyler, Albert July, 1928 Mayne, John W., Temporary Rat Officer Oct.,.1916 SANITARY INSPECTORS AND MEAT INSPECTORS. Sharp, J. Owen, Senior Inspector May, 1892 Mettam, Harry Dec., 1903 Bintcliffe, Charles E. March, 1907 Matson, William S Grade I. Dec., 1910 Mitchener, William E. Dec., 1910 Jones, John April, 1914 Slatter, Charles . May, 1908 King, George G. Grade II April, 1910 Murray, Samuel B. Sept., 1911 Mellish, Cyril E Jan., 1912 Thompson, Frederick. Grade III July, 1924 Perris, G. A. Grade III. Dec., 1923 WOMAN SANITARY INSPECTOR. Wilkinson, Miss Annie M. July, 1909 KEEPER OF THE MORTUARY. Oakley, J. E. Feb., 1909 DISINFECTOR. Steggles, T Dec., 1918 MESSENGERS. Tierney, T. E. (Temporary) Dec., 1926 Betts, Charles (Temporary) April, 1926 LABOURERS. McDonnell, R. J. (General Duties at Mortuary) April, 1903 Powis, B. (Do. do.) Feb., 1920 Hastings, T. Do. do.) June, 1920 Collins, W. (Gatekeeper at City Mortuary) Nov., 1920 Ludgate, G. (Meat Shed) Oct., 1906 Morris, W. F. (Meat Shed) March, 1925 Strong, S. R. March, 1914 Prevost, A. C Feb., 1926 Mann, Ernest V. Jan., 1928 Lawrence, Charles J Feb., 1928 b . annual report of the medical officer of health for the year 1928. To the Right Honourable the Lord Mayor, Aldermen and Commons of the Corporation of London. Public Health Department, Guildhall, E.C. lst June, 1929. My Lord Mayor and Gentlemen, I have the honour of presenting my Annual Report on the work of this Department for 1928. On the retirement of Inspectors A. R. Hills, E. J. Simmons, and T. L. Davies, who, in 40, 36, and 25 years of service respectively, had admirably combined the qualities of official with those of public servant, I would express my appreciation of the services they rendered. STATISTICAL INFORMATION. Area.—The City of London (excluding The Temple) comprises an area of 661 acres (excluding tidal water and foreshore), or 1.032 square miles, equal to a square of 1.016 miles to a side. The area of "Registration London" is 74,817 acres (excluding tidal water and foreshore), or 116.9 square miles, equal to a square of 10.81 miles to a side. Density (1928).—City of London, Registration District, at night, 17.3 persons to an acre; City of London, Registration District, during the day, *644.1 persons to an acre; Registration London, at night, 59 .5 persons to an acre. Annual Rateable Value.—The rateable value of property within the administrative county of London (including the City) was £56,945,446 on 6th April, 1928, whilst on the same date the corresponding rateable value of property in the City of London was £8,163,691 or about one-seventh of the whole County. The sum receivable from a penny rate is £34,201. Population.—The undermentioned figures are extracted from the Report of the Registrar-General on the Census of England and Wales, 1921:— Area, Inhabited Houses. Population. Private Statute Families. Acres. 1911. 1921. 1911. 1921. 1921. City of London (Not including the Temple) 661 2,784 2,398 19,657 13,709 3,174 These figures represent the population on the nights of the 3rd April, 1911, and the 19th Tune. 1921. The following table shows the progressive decline which has taken place since 1861 in the number of inhabitants who reside within the City boundaries, and the progressive increase in the number of workers who are daily employed in the City :— Year. Imperial Census. Night Population. City Census. Day Population. 1861 112,063 — 1866 — 170,133 1871 75,983 — 1881 51,405 261,061 1891 37,705 301,384 1901 26,923 — 1911 19,657 364,061 1921 13,709 436,721 (Imperial Census). There is only one registration district in the City. The estimated population of the City for the year 1928 is 11,430. The day Census taken in 1911 showed that the day population was 364,061 persons, and also that 1,077,155 persons and 94,095 vehicles entered and left the City on the day the count was taken. * This figure refers only to persons " actively engaged in the City during the daytime," and is based upon the Imperial Census taken in June, 1921. B 2 8 Births.—During the year 1928, 427 births were registered in the City, 376 of which, however, did not belong thereto. To the remaining 51 must be added the births of 31 children born to citizens temporarily residing outside the City boundary. The number of births, therefore, on which the rate should be calculated is 82. The annual birth-rate was 7.2 per 1,000 persons of all ages, compared with a quinquennial mean rate of 7.7 per 1,000. In the Metropolis the birth-rate in 1928 was 15.9 per 1,000. Mortality.—During the year under review, 735 deaths were registered in the District, including 665 persons dying in the City, but not belonging thereto. See table, p. 9, for details. Deducting these latter, 70 deaths remain, to which must be added those of 70 persons who died in institutions in outside districts, where they were registered; the total, therefore, on which the City death-rate is calculated is 140. The death-rate for 1928 was 12.2 per 1,000 per annum of the population (the previous year being 11.5), whilst that for the whole of the Metropolis was 11.6. Deaths from Violence.—Of the City deaths, 2.8 per cent. were caused by injuries or violence, as compared with 7.2 in 1926 and 2.7 in 1927. This is 2.3 below the average for the previous five years. PERCENTAGE OF REGISTERED DEATHS FROM VIOLENCE. Year. City of London. Metropolis. Per cent. Per cent. 1923 5.8 4.5 1924 5.3 4.4 1925 4.4 4.6 1926 7.2 4.8 1927 2.7 51 Average previous five years 5.1 4.7 1928 2.8 5.5 DEATH RATES, PER 1,000 PER ANNUM. Year. City of London. 107 Great Towns of England and Wales. polis. 1923 11.5 11.6 11.2 1924 11.3 12.3 12.1 1925 11.7 12.2 11.7 1926 10.4 11.6 11.6 1927 11.5 12.2 11.9 Average previous five years 11.3 12.0 11.7 1928 12.2 11.6 11.6 The death rate from zymotic disease per 1,000 of the population was 0.17. The deaths from Phthisis correspond to a rate of 0.80 per 1,000 of the population, as compared with 0.89 in the Metropolis. Infantile Mortality.—The deaths of children under one year of age were at the rate of 60 per 1,000 births, as against 67 for the whole of London. 9 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1928. Causes of Death. Nett Deaths at the subjoined ages of "Residents " whether occurring within or without the district. Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. 1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. All Causes. 140 5 1 2 1 3 14 62 25 27 631 1. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... 2. Small-pox . ... ... ... ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... ... 1 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 6. Diphtheria 1 ... ... ... ... ... ... ... ... ... 2 7. Influenza ... ... ... ... ... ... ... ... ... ... ... 8. Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... 9. Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... 3 10. Tuberculosis of respiratory system 13 ... ... ... ... 1 2 9 1 ... 3 11. Other Tuberculous Diseases 5 ... ... 2 ... ... 1 2 ... ... 23 12. Cancer, malignant disease 16 ... ... ... ... ... 3 12 1 ... 49 13. Rheumatic Fever ... ... ... ... ... ... ... ... ... ... 1 14. Diabetes ... ... ... ... ... ... ... ... ... ... 7 15. Cerebral Haemorrhage, &c. 3 ... ... ... ... ... ... 2 1 ... 20 16. Heart Disease 31 ... ... ... ... 1 ... 12 8 10 53 17. Arterio-sclerosis 9 ... ... ... ... ... ... 3 2 4 1 18. Bronchitis 6 ... ... ... ... ... 1 ... 1 4 11 19. Pneumonia (all forms) 7 1 ... ... ... ... 1 3 2 ... 105 20. Other respiratory diseases 6 ... ... ... ... 1 2 1 ... 2 15 21. Ulcer of Stomach or Duodenum. 1 ... ... ... ... ... 1 ... ... ... 4 22. Diarrhœa, &c. 1 ... ... ... ... ... ... ... 1 ... 1 23. Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... ... 3 24. Cirrhosis of Liver 2 ... ... ... ... ... 1 1 ... ... 1 25. Acute and Chronic Nephritis 9 ... ... ... ... ... ... 6 1 2 34 26. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... 27. Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... ... ... ... ... ... ... 28. Congenital Debility and Malformation, Premature Birth 2 1 ... ... ... ... 1 ... ... ... 14 29. Suicide 2 ... ... ... ... ... ... 2 ... ... 5 30. Other deaths from Violence 2 ... ... ... ... ... ... ... 1 1 43 31. Other Defined Diseases 24 3 ... ... 1 ... 1 9 6 4 214 32. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... 18 Totals 140 5 1 2 1 3 14 62 25 27 631 10 VITAL STATISTICS OF WHOLE DISTRICT DURING 1928 AND PREVIOUS YEARS. Name of District: CITY OF LONDON. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected number. Nett. Under 1 Year of Age. At all Ages. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate. Number. Rate per 1,000 nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1923 13,480 381 11l 8.2 714 52.96 641 82 9 81 155 11.5 1924 13,330 413 94 7.1 719 53.93 656 88 11 117 151 11.3 1925 13,340 360 100 7.5 705 52.92 633 84 6 60 156 11.7 1926 13,230 383 106 7.1 703 53.14 644 79 7 66 138 10.4 1927 13,010 417 114 8.7 762 58.51 688 76 12 105 150 11.5 Average previous 5 years 13,278 391 105 7.7 721 54.29 652 82 9 86 150 11.3 1928 11,430 427 82 7.2 735 64.30 665 70 5 60 140 12.2 Area of City of London in acres (land and inland water) 661 Total population at all ages Number of inhabited houses Average number of persons per house 13,706 2,922 4.6 At Census 1921. Vaccination.—Of the 432 births notified to the Vaccination Officer during 1928, 134 had been successfully vaccinated by the end of the year, 19 had died before the age for vaccination. Vaccination was postponed by medical certificate in no cases, 166 had removed into other districts, or the vaccinations were pending at the end of the year. There were 113 instances of conscientious objection. The Public Vaccinator performed 13 re-vaccinations during the year, and in addition to the 134 successful vaccinations referred to above, 7 adult persons were vaccinated for the first time. VACCINATION STATISTICS IN THE CITY OF LONDON. Year. Number of Births notified to Vaccination Officer. Successfully Vaccinated. Insusceptible. Had Small-pox. Died before Vaccination. Vaccination postponed. Cases pending or removed at the end of the year. Conscientious objections 1923 per cent. per cent. per cent. per cent. per cent. per cent. per cent. 387 26.4 Nil. Nil. 4.4 1.1 55.5 12.6 1924 418 27.3 0.2 „ 3.3 0.5 50.3 18.4 1925 330 26.9 Nil. „ 4.3 1.8 43.4 23.6 1926 390 26.4 „ „ 4.6 — 49.2 19.7 1927 421 25.9 „ „ 4.7 — 44.9 24.5 Average previous 5 years. 389 26.6 0.04 „ 4.3 0.7 48.7 20.0 1928 432 31.1 Nil. Nil. 4.4 Nil. 38.4 26.1 11 INFANT WELFARE WORK. No new work has been undertaken in connection with Infant Welfare Work, as it is found that the needs of the City are amply filled by the arrangements already in operation. The small resident population of the City and the consequent few births enables a close personal touch to be maintained between my staff and the City mothers. The Infant Welfare Centre administered by the Corporation at St. Bartholomew's Hospital has had a satisfactory attendance at the weekly Wednesday session, and supplies of milk and dried milk, at cost price, under cost price, and free, according to circumstances, have been provided in accordance with the practice which has been in operation for some years. Cod Liver Oil Emulsion is also given where its administration appears to be advisable. 418 notifications of birth, made in accordance with the requirements of the Notification of Births Act, were received. Of these, 78 referred to City mothers, and the balance were transferred to the appropriate authorities. The Woman Inspector, who undertakes the work arising from these notifications, reports that 291 visits were made as a consequence of notifications received, and also that 327 special visits were made in connection with infant welfare. Seven visits were also made in respect of cases coming within the scope of the Children Act, 1908, all in relation to nurse children and six in connection with verminous school children notified under the London County Council (General Powers) Act, 1904. INFECTIOUS DISEASES. Few comments are necessary with reference to the incidence of infectious disease during the year 1928. Diphtheria was prevalent to the extent of 23 cases compared with 16 in 1927. The number of Scarlet Fever cases was 25 compared with 37 in 1927. There were 3 cases of Erysipelas. Measles and German Measles are not notifiable diseases and only 7 cases of the former illness were brought to my notice by medical practitioners and through the medium of the school medical service. Twelve cases of Chicken-pox were notified, one of Ophthalmia Neonatorum, and 5 of Acute Primary Pneumonia. The percentage of cases removed to hospital for treatment continues satisfactory. In each instance of notified disease a detailed examination is made of the sanitary condition of the premises where the case occurred and a summary of defects found by the District Inspector is given on page 62. Notification of Infectious Diseases.—In the following tables will be found particulars of certificates relating to cases of infectious disease, and information as to the removal of patients to hospitals, infirmaries, etc. Examination for Pathogenic Bacteria.—During the year the following specimens were so dealt with. It will be seen that positive results were obtained in 30.2 per cent. of these cases. Result. Specimen. Disease suspected. Positive. Negative. 43 Swabbings from throats Diphtheria 7 36 13 Sputa Tuberculosis 6 7 Of the 43 swabbings from throats, 10 were received from the Central Foundation School for Girls, Spital Square, E.C. 12 STATISTICS OF NOTIFICATIONS AND REMOVALS TO HOSPITAL. NAME OF DISEASE. Number of Certificates received. Treated at Home. Removed to the Metropolitan Asylums Board Hospitals. Removed to the London Fever Hospital. Treated at other Hospitals and Infirmaries. Duplicate Certificates received. Diagnosis subsequently found to be incorrect. Net number of Cases. Small-pox ... ... ... ... ... ... ... ... Diphtheria 24 ... 23 l ... ... l 23 Scarlet Fever 27 l 22 2 ... 2 ... 25 Enteric Fever (including Para-typhoid) ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... ... Erysipelas 5 l ... ... 2 2 ... 3 Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... Acute Polio-myelitis ... ... ... ... ... ... ... ... *Ophthalmia Neonatorum 1 l ... ... ... ... ... 1 Malaria contracted abroad abroad ... ... ... ... ... ... ... ... Acute Primary monia 5 1 ... ... 4 ... ... 5 Acute Influenzal monia ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... Totals 62 4 45 3 6 4 l 57 Chicken-pox 12 12 ... ... ... ... ... 12 Measles 3 4 2 1 ... ... ... 7 German Measles ... ... ... ... ... ... ... ... Totals 77 16 47 4 6 4 l 76 The following is a return of infectious diseases which have occurred in the City of London, exclusive of Tuberculosis, Measles, Rubella, Malaria, Pneumonia, Ophthalmia Neonatorum and Chicken-Pox, with the percentages of such cases removed to hospitals for treatment or nursed at home during 1928 compared with the figures for the previous five years:- Year. Number of cases reported. Per cent, of cases reported. Removed to Hospital. Treated at home. 1923 64 95.3 4.7 1924 22 95.5 4.5 1925 49 89.8 10.2 1926 91 97.8 2.2 1927 61 90.2 9.8 Average for the five years 57 93.7 6.3 1928 51 96.0 4.0 This was a prematurely born child (6½ months). Vision unimpaired, but child died. 13 CASES of INFECTIOUS DISEASE AND TUBERCULOSIS NOTIFIED DURING THE YEAR 1928. NUMBER OF CASES NOTIFIED. DISEASES. At Ages—Years. No. of Cases Removed toHospital. At all ages. Under 1 year. 1 year and under 2 years. 2 years and under 3 years. 3 years and under 4 years. 4 years and under 5 years. $ years and under 10 years. 10 years and under 15 years. 15 years and under 20 years. 20 years and under 35 years. 35 years and under 45 years. 45 years and under 65 years. 65 years and over Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 23 ... ... ... l l 5 1 ... 13 2 ... ... 23 Erysipelas 3 ... ... ... ... ... ... ... ... 1 ... l l 2 Scarlet Fever 25 ... ... ... ... 2 8 4 l 10 ... ... ... 24 Typhus „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric „ (including Para-typhoid) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polio-myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 24 ... ... 1 ... ... ... ... 2 8 2 11 ... 17 Other forms of Tuberculosis. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 1 l ... ... ... ... ... ... ... ... ... ... ... ... Measles 7 l ... ... 2 ... 2 ... 1 1 ... ... ... 3 Rubella ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria (contracted abroad). ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia . 5 ... ... ... ... ... ... ... ... 1 ... 4 2 4 Acute Influenzal Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 88 2 ... 1 3 3 15 5 4 34 4 16 3 73 * Metropolitan Asylums Board Hospitals, London Fever Hospital, City of London Infirmary, St. Bartholomew's Hospital, City Police Hospital, Sanatoria, &c. c 14 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January to the 29th December, 1928, in the City of London AGE-PERIODS Notifications on Form A. Notifications on Form B.† Number of Notifications on Form C Number of Primary Notifications.* Total Number of Primary Notifications.* Total Notifications on Form B. Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Primary Notifications. Notifications on Form A. Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males ... ... ... ... 2 3 2 1 3 1 ... 12 19 ... ... ... Nil. Nil. ... 5 „ Females. ... ... ... ... ... ... 3 1 4 3 ... 11 13 ... ... ... „ ... 4 4 Non-pulmonary Males ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ „ „ „ „ „ Females ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ „ ... 1 Col. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Patients notified as suffering from both pulmonary and non-pulmonary disease have been included among the “pulmonary " returns only. All notifications on Form D have been disregarded in preparing this return. * Primary notifications relate to patients who have not previously been notified in this or former years, either on Form A or on Form B, in the area to which the return relates. Any additional notification of a case which has been previously notified in the area is regarded as duplicate. (Note.—No primary notifications should be made on Form C ) † A School Medical Inspector, or the Medical Officer of Health of a county, county borough, or other district, if acting as a School Medical Inspector, is required to notify on Form B all cases of tuberculosis discovered in the course of inspection of children attending public elementary schools whether or not these have previously been notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, have been included in these columns. Col. 14. The object of this column is to show the extent to which duplicate notification of the same case occurs on Form A, and all notifications on Form A, whether duplicate or not, are included in this column. Cols. 15-18. Only those cases which have been notified for the first time during the year on Form B in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B. have been included in these columns. Col. 19. All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B, have been included in this column. (These figures agree with those furnished to the Ministry of Health for the period 1st January, 1928, to 29th December, 1928.) 15 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912 & 1924. New cases of Tuberculosis which have come to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during the period from 1st January, 1928, to 29th December, 1928, otherwise than by notification on Form A or Form B. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Cases. Pulmonary Males ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Females ... ... ... ... ... ... ... ... ... ... ... ... Non-pulmonary Males ... ... ... ... ... ... ... ... ... ... ... N on-pulmonary Females ... 1 ... ... .... ... ... ... ... ... ... l The source or sources from which information as to the above-mentioned case was obtained is stated below:— Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death Returns (i.e., from local Registrars, or transferable deaths from Registrar General) ... 1 "Transfers" from other areas (other than transferable deaths) ... ... Forms C and D (in respect of cases not previously known to the M.O.H.) ... ... Other Sources, e.g., posthumous notifications ... ... Number of cases of Tuberculosis remaining on the Register of Notifications on 31st December, 1928. PULMONARY. NON-PULMONARY. Males. Females. Total. Males. Females. Total. Total Cases. 25 20 45 2 2 4 49 SMALL-POX. In view of the increasing prevalence of Small-pox, one of the provincial cities expressed the view that the law should be amended so as to provide for compulsory vaccination or re-vaccination, and in cases where persons had been in contact with, or were suspected of suffering from Small-pox or other infectious disease, especially in casual wards of Poor Law Institutions, they should be isolated by order of the Medical Officer of Health for such period as he deemed necessary. One does, of course, feel sympathy with the general trend of such a view, but it does not seem probable that so wide a power as that sought is attainable, and it was with regret that I felt compelled to advise my committee not to support a recommendation on these lines. THE PUBLIC HEALTH (NOTIFICATION OF PUERPERAL FEVER AND PUERPERAL PYREXIA) AMENDMENT REGULATIONS, 1928, AND THE PUBLIC HEALTH (OPHTHALMIA NEONATORUM) AMENDMENT REGULATIONS, 1928. The above-mentioned regulations, which became operative on the 1st July, 1928, amend the previous legislations affecting these diseases, and it is now necessary that the notification be sent to the Medical Officer of Health for the district in which the patient is actually residing at the time of notification. Notification of cases occurring in hospitals are to be sent to the Medical Officer of the district in which the place from which the patient was brought to the hospital is situated. These new regulations were brought to the notice of medical men practising in the City in accordance with the suggestion made by the Ministry of Health. DISTRIBUTION OF DIPHTHERIA ANTI-TOXIN AND ANTI-INFLUENZA VACCINE. Although City medical practitioners are well aware of the facilities available, no applications for supplies of diphtheria anti-toxin or anti-influenza vaccine were received during 1928. c 2 16 NURSING PROVISION. Measles, etc.—The Corporation has approved of the expenditure of £25 per annum in respect of the nursing of complicated cases of Measles, Encephalitis Lethargica and Cerebrospinal Fever, and have also agreed to expend the sum of £30 on provision of medical assistance and nursing attendance in necessitous cases of Influenza. No action was necessary under this heading during 1928. TEMPORARY ISOLATION ACCOMMODATION, 29, MIDDLESEX STREET, Suitable accommodation for isolation and observation of Small-pox Contacts is provided by the Corporation at 29, Middlesex Street, but it has not been found necessary to use the accommodation during the year. NOTIFICATION OF ACUTE RHEUMATISM. In view of the crippling and ultimately deadly results of acute rheumatism in children and the desirability of obtaining the fullest information as to its incidence and prevalence, I am in complete accord with the endeavour which is being made by the Metropolitan Boards Standing Joint Committee to secure the notification of acute rheumatism in children under 16 years of age and of the establishment of supervisory centres in London. THE INFECTIOUS DISEASES (LONDON) REGULATIONS, 1927. The above-mentioned regulations, which came into operation on the 1st January, 1928, revoke the Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919, which were issued to make provision against the number of infectious diseases, such as Dysentery, Malaria, and Trench-Fever, which, it was feared, might be introduced into this country by soldiers returning to London from overseas, and the precautions possible under the regulations doubtless contributed to the low incidence of these diseases. Their provisions, after review and amendment, have been issued as a fresh set of regulations under the title of "Infectious Diseases (London) Regulations, 1927." One of the most apparent alterations is the removal of Trench-Fever from the list of diseases which are notifiable. An important addition has been made with regard to Malaria. There had previously been no legal obligation to report cases of Malaria induced in an Institution as a method of treatment for other conditions, and although such cases are still not required to be notified, the practitioner in charge of the case, if of the opinion that the patient is liable to relapses of Malaria, shall notify the Medical Officer of Health of the district in which the patient proposes to reside at least four days before his discharge from the Institution. Upon receipt of a notification, the Medical Officer of Health is required, amongst other things, to take such steps as are necessary or desirable to investigate the source of infection, for preventing its spread by removing conditions favourable to infection, and if no medical practitioner is in attendance on the patient, shall take such steps as are necessary or desirable for ascertaining the nature of the case. In Malaria endeavours are to be made to obtain material for microscopic examination, and also to ensure that the patient is supplied with the necessary quinine, etc. In Typhus and Relapsing Fever provision is made for the destruction of lice. In Enteric Fever and Dysentery steps must be taken to protect food against contamination by the patient or by a carrier of the infection who may be concerned with the preparation or handling of food or drink for human consumption. In this connection the affected person may be prevented from following his occupation, and provision is made for appropriate compensation. All medical practitioners resident or practising within the City area were made aware of the operation of the new regulations and were supplied with a copy. The number of notifications received by me during 1928, in accordance with the requirements of the regulation, were 5. BAKER'S DERMATITIS. Some consideration was given during the year to a suggestion made by one of the Metropolitan Borough Councils that powers should be sought to enable a Medical Officer of Health to enter a bakehouse and examine the staff employed, with a view to detecting the existence of skin diseases such as Baker's Dermatitis (Baker's Itch). Other cases are due to direct irritation of skins which are sensitive to some constituent of flour. These come into the category of idiosyncracies homologous with nettle rashes occurring on ingestion of certain food by certain individuals. This affection is an Eczema, particularly of the hands and arms, due to the lodgment of a mite. The irritation induced causes scratching and a consequent exematous inflammation of the hands and arms, which is protracted by the contact of glutinous matter such as flour. 17 In a certain stage of metamorphosis of members of the group of mites to which Baker's Itch belong, the mites attach themselves to associated flies and other insects (e.g., meal moth), either parasitically or non-parasitically, as a means of dissemination. The problem, therefore, becomes one of insect-free food rather than the removal of a chance sufferer from itch, which really does not touch the root of the matter. Since Baker's Itch is an indication of the excessive presence of worm and insect-infested flour at the source of supply or at a bakehouse, it would seem that modern methods of disinfestation of infested premises would be the appropriate Public Health approach to the subject. The idea that a baker in any degree of this state should be mixing dough or engaged in the manufacture of foodstuffs in any form is, of course, unpleasant, but I felt compelled to advise the Sanitary Committee against the support of piecemeal legislation, as I am of opinion that the subject of Baker's Itch, when the time is ripe for legislation, should be merged in the larger subject of disease and cleanliness in relation to all foodstuffs, which the introduction of legislation dealing with one section of the matter only might retard. This subject of the cleanly handling and manufacture of foods is, I believe, before the Ministry of Health at the present moment, and Baker's Itch will, doubtless, receive consideration in connection with any projected statutory methods of control. TUBERCULOSIS. For some few years, facts have gradually been accumulating which suggested that the hours during which the Tuberculosis Dispensary, which is established at St. Bartholomew's Hospital by the City Corporation, was open to receive patients needed revision. With the approval of the Ministry of Health and the authorities of St. Bartholomew's Hospital, the following sessions have been arranged in lieu of those previously operating:— Tuesdays 12.30 p.m.—2.30 p.m. 2.30 p.m.—4.30 p.m. For the Artificial Pneumothorax Clinic. Wednesdays 5.0 p.m.—7.0 p.m. Thursdays 11.30 a.m. (New cases only). Fridays 2.0 p.m.—3.0 p.m. Appropriate notice of the change was given to City Medical Practitioners, residents and employers of labour, and I am pleased to be able to report that the advantage anticipated has, in fact, been experienced. In all, 252 sessions have been held, and, in addition, the Tuberculosis Officer has visited cases at their homes when necessary. New Patients.—The number of new patients examined was 403, as compared with 435 last year. Patients Referred to the Hospital.—The following is the summary of patients referred to the various departments of St. Bartholomew's Hospital for help in diagnosis or treatment:— Resident. Non-Resident. Total. Referred to X-Ray Department 11 75 86 ,, Surgical ,, l 1 2 ,, Dental ,, 4 1 5 ,, Throat „ 3 15 18 „ Pathological „ ... 2 2 „ Other „ 3 7 10 22 101 123 Patients Admitted to the Hospital for Diagnosis.—The wards of the Hospital are available for the reception of cases presenting difficulties of diagnosis, which can only be overcome by observation as In-patients. Five resident and two non-resident patients were admitted for this purpose. Examination of Sputum.—The following is a summary:— City Residents. Non-Residents. Total. Positive 4 15 19 Negative 18 127 145 Residential Treatment.-—The number of patients for whom residential treatment was arranged was 70. Admitted to Poor Law Other St. Columbas Hosp. L.C.C. Institutions. Institutions. Institutions. Corpn. Expense. Total. Patients resident in the City 9 3 3 2 17 Patients non-resident 42 2 9 — 53 51 5 12 2 70 18 Persons neither resident nor working in the City are usually transferred immediately to their own Tuberculosis Officer, and subsequent arrangements are made by him. This system has worked satisfactorily. Persons Treated and Supervised at the Dispensary:—(A) Patients resident in the City. All persons suffering from Tuberculosis who are resident in the City may be supervised and treated at the Dispensary. The total number of cases so treated was 79. In addition, a large number of contacts are kept under observation. (B) Patients non-resident in the City. (a) Who work in the City. On diagnosis these patients are informed that they can be treated and advised at the Dispensary or transferred to the Tuberculosis Officer of their own Borough. The majority decide to remain patients at the Dispensary. (b) Who do not work in the City. On diagnosis, these patients are usually transferred to the Tuberculosis Officer of their own Borough. The total number of cases so transferred was 141. Total Attendances:- Insured. Non-Insured. Total. Residents 185 177 362 Non-Residents 567 607 1,174 1,536 This number shows a decrease as compared with last year. This is owing to the fact that a number of chronic cases had to visit the Dispensary frequently, and now have moved outside the City area, owing to the demolition of the Hutchison Avenue area property. In view of the fact that the cases in the last stages of the disease are extremely infectious, especially in crowded houses, the Corporation have made arrangements to pay for the maintenance of selected City cases at St. Columba's Hospital, Swiss Cottage. Two such cases were admitted in 1928. Artificial Pneumothorax.—Artificial pneumothorax treatment has been used to a larger extent during the year. Artificial pneumothorax was induced in one case, and 230 Refills done in connection with the Dispensary. The Tuberculosis Nurse.—As an adjunct to the work at the Tuberculosis Clinic, the outside work of the Tuberculosis Nurse has been continued on the same lines as former years. Fifty-one homes have been visited, and 233 visits made in connection with after-care and following up. In addition to the above, patients, some of whom were in an advanced stage of the disease, have been nursed in their own homes. One of these cases terminated fatally. For nursing purposes, 53 visits were paid. The number of visits in connection with aftercare has diminished in a similar way to the attendances. The Hutchison Avenue Area contained a number of houses of a very bad type, tenanted by people who, by only constant visiting, would be persuaded to obey the ordinary rules of hygiene. General.—The following information is supplied in accordance with the requirements of the Ministry of Health:— (i.) The Tuberculosis Dispensary is at St. Bartholomew's Hospital; the Tuberculosis Officer is Dr. F. H. Young, O.B.E.; one Tuberculosis Nurse is engaged in the work. Treatment in residential institutions is provided for insured and uninsured persons by the London County Council. (ii.) Patients are referred to the Tuberculosis Dispensary from hospitals, school clinics and other institutions, with all of which there is close co-operation. The services of the Staff and all the resources of St. Bartholomew's Hospital are available for diagnosis and treatment. Many patients are referred to departments of the Hospital for these purposes. (iii.) The Tuberculosis Officer is in constant consultation and communication with general practitioners, so that there is close co-operation between them and the Dispensary. He reminds them when reports are due on insured patients under domiciliary treatment and provides them with copies of the form with names and addresses inserted. (iv.) When the diagnosis is in doubt and the patient is under the care of a practitioner, arrangements are made with him for re-examination ; in other cases arrangements are made with the patient, but should he fail to attend, either the Tuberculosis Nurse calls upon him or he is reminded of the appointment in writing. 19 (v.) The Tuberculosis Officer explains to the patients the importance of the examination of home contacts, and in addition to the necessary visits of the Sanitary Inspectors, the Tuberculosis Nurse visits the homes of City residents periodically for the same purpose, and arranges for the attendance of the contacts at the Dispensary at times convenient to them. The supervision of these contacts and the re-examination of suspects among them is secured by the home visits periodically made by the Nurse. (vi.) Considerable use is made of X-rays from the point of view of diagnosis and decision as to method of treatment to be recommended. The usual methods of treatment have been continued in the Dispensary. Tuberculin has been used in a few cases. In addition, 14 cases of pulmonary tuberculosis are attending for the continuation of their treatment by artificial pneumo-thorax and inductions of the treatment have been performed in several cases in the wards of the Hospital. (vii.) Experience shows that when the disease is active, residence in an institution more quickly and certainly brings about arrest than when treatment is attempted at home on sanatorium lines, and that the lessons learnt in the sanatorium are sometimes put into practice by the patient on his return home to his permanent advantage. (viii.) Dental treatment is provided by the Dental Department of St. Bartholomew's Hospital, and the Corporation defrays the whole or part of the cost of artificial dentures for necessitous cases. (ix.) Nursing in their own homes of patients resident in the City is one of the duties of the Tuberculosis Nurse. Milk has been provided for necessitous persons requiring extra nourishment and in this connection the sum of about £40 has been expended. (x.) Patients suffering from Non-pulmonary Tuberculosis receive advice and treatment from the Surgeons of St. Bartholomew's Hospital, to whom they are referred from the Dispensary. Treatment in residential institutions is provided for as pulmonary cases. The Corporation supplies surgical apparatus free of cost for necessitous residents in the City. (xi.) The arrangements for "care" and "after-care" are carried out by a subcommittee of the Sanitary Committee, on which two ladies are co-opted as members.* It receives detailed reports on all cases of Tuberculosis occurring among City residents. (xii.) No local arrangements exist for providing employment for patients. (xiii.) No opportunity has arisen for the use of a shelter, but arrangements would be made for any suitable case if a site was available. (xiv.) No special points have been noted as to the incidence of Tuberculosis; the records do not show that the disease is specially prevalent among any class of workers in the City. (xv.) The usual method for preventing the spread of infection is adopted, and pocket sputum flasks are provided free of cost. (xvi.) The principal difficulty encountered occurs on the discharge of a patient from a sanatorium with the disease quiescent. The home environment to which he returns is often unsatisfactory; suitable occupation near his home may be practically unobtainable, even when remuneration is not the main consideration, and the very considerable benefit gained is in some cases soon lost and the treatment in the sanatorium largely wasted. (xvii.) Difficulties also arise with regard to advanced cases. These are usually very infectious and do not care to go to the Infirmary. This has been largely remedied by the arrangement made by the Corporation already referred to. The following table sets out the number of cases both of Pulmonary and Non-Pulmonary Tuberculosis, which were brought to my notice during the year 1928, and also the total number of deaths from Tuberculosis among City residents during the same period :— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 ... ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... 10 ... ... ... ... ... ... ... ... 15-20 2 ... ... ... ... ... ... ... 20-25 3 ... ... ... 1 ... ... ... 25-35 3 3 ... ... ... ... ... ... 35-45 1 2 ... ... 1 ... ... ... 45-55 1 1 ... ... 2 ... ... 1 55-65 ... ... ... ... ... ... ... ... 65 and upwards ... ... ... ... ... ... ... ... Totals 10 6 ... ... 4 ... ... 1 * The present lady members of the Committee are Lady Cooper, O.B.E., and Miss Crosby, M.B.E. At the beginning of 1929 Lady Smith was added to this Committee. 20 RETURN SHOWING THE WORK OF THE DISPENSARY DURING THE YEAR 1928. CITY RESIDENTS. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—NEW CASES examined during the year (excluding contacts):— (a) Definitely tuberculous 10 5 ... ... ... ... ... ... 10 5* ... ... (b) Doubtfully tuberculous ... ... ... ... ... ... ... ... ... ... ... ... (c) Non-tuberculous ... ... ... ... ... ... ... ... 9 3 ... 1 B.—CONTACTS examined during the year:- (a) Definitely tuberculous ... ... ... ... ... ... ... ... ... ... ... ... (b) Doubtfully tuberculous ... ... ... ... ... ... ... ... ... ... ... ... (c) Non-tuberculous ... ... ... ... ... ... ... ... 10 11 7 9 C.—CASES written off the Dispensary Register as— (a) Cured ... ... ... ... ... ... ... ... ... ... ... ... (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) ... ... ... ... ... ... ... ... 19 15 7 10 D.—NUMBER OF PERSONS on pensary Register on Dec. 31st, 1928:— (a) Diagnosis completed 22 15 2 1 3 1 ... 1 25 16 2 2 (b) Diagnosis not completed ... ... ... ... ... ... ... ... ... ... ... ... 1. Number of persons on Dispensary Register on January 1st, 1928:— 52 2. Number of patients transferred from other areas and of "lost sight of" cases returned 1 3. Number of patients transferred to other areas and cases "lost sight of " 17 4. Died during the year 5 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded two months 2 6. Number of attendances at the pensary (including Contacts) 362 7. Number of attendances of monary cases at Orthopaedic Outstations for treatment or supervision 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light " treatment (b) Other special forms of treatment 39 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 4 10.—Number of consultations with medical practitioners:— (a) At Homes of Applicants 2 (b) Otherwise — 11. Number of other visits by culosis Officers to Homes 2 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes and Nursing 233 Nursing visits for Tuberculous Patients 53 13. Number of (a) Specimens of sputum, &c., examined 22 (b) X-ray examinations made in connection with Dispensary work 11 14. Number of Insured Persons on pensary Register on the 31st December 25 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 2 16. Number of reports received during the year in respect of Insured Persons (a) Form G.P. 17 — (b) Form G.P. 36 — NON-RESIDENTS. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. m. F. A.—NEW CASES examined during the year (excluding contacts) :— (a) Definitely tuberculous 108 51 3 6 15 6 3 6 123 57 6 12 (b) Doubtfully tuberculous ... ... ... ... ... ... ... ... 8 9 ... 1 (c) Non-tuberculous ... ... ... ... ... ... ... ... 51 64 7 4 B.—Number of City workers attending Dispensary for treatment on Dec. 31st, 1928 49 C.—Number of Non-Resident and Non-Workers attending Dispensary for treatment on Dec. 31st, 1928 88 * One case previously shown as cured now shown as active on the grounds that she was sent to Sanatorium. In my opinion, however, the disease from which she is suffering is Chronic Bronchitis and not Tuberculosis. 21 return showing in summary form the condition of all patients whose case records are in the possession of the dispensary at the end of 1928, arranged according to the years in which the patients first came under public medical treatment for pulmonary tuberculosis, and their classification as shown on form a. a.—pulmonary tuberculosis. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 1927. 1928. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Alive. Discharged as cured. Adults. M 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Disease arrested. Adults. M 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F 2 .... 1 .... 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. M 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Disease not arrested. Adults. M 2 2 4 1 7 1 .... .... .... .... .... .... 2 .... 2 2 1 1 .... 2 F 1 .... 3 .... 3 1 .... .... 1 1 1 .... 1 1 2 2 .... .... .... .... Children. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... Condition not ascertained during the year 2 .... .... .... .... .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... Lost sight of or otherwise removed from Dispensary Register 14 2 11 4 17 2 .... 2 2 4 1 .... 2 2 4 5 .... .... 1 1 Dead. Adults. M 1 .... 2 5 7 .... .... 1 3 4 .... .... .... 3 3 .... .... .... 2 2 F .... .... .... 3 3 .... .... .... .... .... .... .... .... 1 1 .... .... .... 1 1 Children. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... f .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... Totals 29 4 21 13 38 6 .... 3 7 10 3 .... 5 7 12 9 1 1 4 6 B.—NON-PULMONARY TUBERCULOSIS. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 1927. 1928. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Alive. Discharged as cured. Adults. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F l .... .... .... l .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Disease arrested. Adults. M l .... .... .... l .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Disease not arrested. Adults. M .... .... .... .... .... .... .... .... .... .... 1 .... .... l 2 .... .... .... .... .... F l .... .... .... l .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... 1 l .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Transferred to Pulmonary .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Condition not ascertained during the year .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Lost sight of or otherwise removed from Dispensary Register 4 l l 2 8 2 .... .... .... 2 l .... .... .... 1 .... .... .... .... .... Dead. Adults. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... l .... .... .... 1 .... .... .... .... .... Children. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Totals 7 l 1 3 12 2 .... .... .... 2 3 .... .... l 4 .... .... .... .... 0 d 22 TUBERCULOSIS DISPENSARY.—TRAINING OF HEALTH VISITORS. Arrangements have been made that the facilities available at the Tuberculosis Dispensary shall be placed at the disposal of the College of Nursing, in order that that body can give to their Health Visitor Students a short course of practical experience in Tuberculosis work as undertaken by a Tuberculosis nurse. These courses are to start during 1929, and will doubtless prove of considerable value in the future training of Health Visitors. public health (prevention of tuberculosis) regulations, 1925. It has not been necessary during the year to take any action in regard to the abovementioned Regulations, which provide for the exercise of some control over persons suffering from Tuberculous affections and who are engaged in certain occupations associated with the milk trade. VENEREAL DISEASES. The following is a brief summary of the work carried out at the Special Treatment Centre for Venereal Diseases during the year 1928 :— At the beginning of the year 392 males and 82 females were registered on the books as being under treatment or observation, which compares with 399 males and 115 females at the beginning of the previous year. Of these patients 224 males and 62 females were under treatment for syphilis and 168 and 20 females for gonorrhoea. No patients were under treatment for conditions other than venereal disease. New patients admitted totalled 476 as compared with 425 in the previous year, and 485 in 1926 and 402 in 1925. 50 males and 10 females suffering from syphilis discharged themselves before completing the first course, and 44 males and 13 females after completing the first course, but before completion of treatment. 32 males and 15 females completed treatment, but failed to submit themselves to final test; 20 males and 1 female were transferred to other centres, whilst 7 males and 1 female were discharged after completion of treatment and observation. In the case of gonorrhoea, 140 males and 13 females, out of the total of 230 and 35 of the respective sexes coming under treatment during the year for the first time, discharged themselves before completion of the first course of treatment. The total number of attendances of all persons at the clinic was 13,051, which total is made up as follows :— Syphilis. Soft Chancre. Gonorrhœa. Non-Veneral Conditions. Total Attendances. Male. Female. Male. Female. Male. Female. *Male. Female. Male. Female. 4,221 1,946 — — 6,027 857 — — 10,248 2,803 In the interests of economy, In-patient treatment has been discontinued. In the laboratories associated with the Centre 6,932 specimens were examined, 27 for the detection of spirochetes, 1,029 for gonococci, 5,664 examinations for the Wassermann or Sigma test, and 212 other examinations. The following tabulation indicates the number of patients coming under treatment for the first time from the Counties stated, and also the examinations which were made for the detection of Spirochetes, of Gonococci and for the Wassermann or Sigma test in respect of these patients:— For Syphilis. No. of patients treated. For Spirochetes. Examinations. For Gonococci. For Wassermann or For Gonorrhœa. For Non-Venereal Conditions. Sigma Test. Reactions. For Non-Venereal Conditions. London 146 240 59 27 977 5,640 212 Essex 1 4 — — 4 4 — Herts 2 2 — — 3 2 — Surrey 1 9 1 — 25 8 — Kent 1 10 — — 19 10 — Sussex — — — — 1 — — Totals 151 265 60 27 1,029 5,664 212 Included in the above total were *4,608 examinations for the Wassermann or Sigma test at the request of general practitioners. Sixteen specimens were submitted by general practitioners for examination for gonococci. No specimens were submitted by general practitioners for examination for spirochetes. Includes tests made for St. Bartholomew's Hospital and the Metropolitan Asylums Board. 23 RETURN RELATING TO ALL PERSONS WHO WERE TREATED AT THE TREATMENT CENTRE AT ST. BARTHOLOMEW'S HOSPITAL TREATMENT CENTRE, 20, GOLDEN LANE, E.C.1, DURING THE YEAR ENDED THE 31st DECEMBER, 1928. Syphilis. Soft Chancre. Gonorrhœa. Conditions other than Venereal. Total. Males Females Males Females Males Females Males Females Males Females 1. Number of cases which— (a) at the beginning of the year under report were under treatment or observation for 224 62 .... .... 168 20 .... .... 392 82 (b) had been marked off in a previous year as having ceased to attend or as transferred to other Centres, and which returned to the Treatment Centre during the year under report suffering from the same infection 19 8 .... .... 17 4 .... .... 36 12 Total—Items 1 (a) and 1 (b) 243 70 .... .... 185 24 .... .... 428 94 2(a). Number of cases dealt with at the Treatment Centre during the year for the first time 111 40 .... .... 230 35 54 6 395 81 Total*—Items 1 (a), 1 (b) and 2 (a) 354 110 .... .... 415 59 54 6 823 175 2(b). Number of cases included in Item 2 (a) known to have received previous treatment at other Centres for the same infection 12 6 .... .... 13 .... .... .... 25 6 3. Number of cases which ceased to attend— (a) before completing the first course of treatment for 50 10 .... .... 140 13 .... .... 190 23 (b) after one or more courses but before completion of treatment for 44 13 .... .... .... .... .... .... 44 13 (c) after completion of treatment, but before final tests as to cure of 32 15 .... .... 95 8 .... .... 127 23 4. Number of cases transferred to other Treatment Centres after treatment for 20 1 .... .... 15 6 .... .... 35 7 5. Number of cases discharged after completion of treatment and observation for 7 1 .... .... 42 4 .... .... 49 5 6. Number of cases which, at the end of the year under report, were under treatment or observation for 201 70 .... .... 123 28 .... .... 324 98 54 6 Total*—Items 3, 4, 5, & 6 354 110 .... .... 415 59 .... .... 823 175 7. Out-patient attendances:- (a) For individual attention by the Medical Officer 4,221 1,946 .... .... 1,521 752 .... .... 5,742 2,698 (b) For intermediate treatment, e.g., irrigation, dressings, etc. .... .... .... .... 4,506 105 .... .... 4,506 105 Total Attendances 4,221 1,946 .... .... 6,027 857 .... .... 10,248 2,803 8. Aggregate number of "In-patient days" of treatment given to persons who were suffering from .... .... .... .... .... .... .... .... .... .... For detection of For Wassermann Reaction. Spirochetes. Gonococci. Other Organisms. 9. Examinations of Pathological material:— (a) Specimens which were examined at, and by the Medical Officer of, the Treatment Centre .... 16 (b) Specimens from persons attending at the Treatment Centre which were sent for examination to an approved laboratory 27 1,013 C.S.F. W.R. 106 Sig. 106 W.R. 2,902 Sig. 2,762 *The total of Items 1 (a), 1 (b) and 2 (a) in the vertical columns headed Syphilis, Soft Chancre and Gonorrhœa should agree with the corresponding total of Items 3, 4, 5, and 6. d 2 24 Statement showing the services rendered at the Treatment Centre during the year, classified according to the areas in which the patients resided. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings. London. Essex. Herts. Surrey. Kent. Total. A.* Number of cases from each area dealt with during the year for the first time and found to be suffering from:— Syphilis 146 1 2 1 1 151 Soft chancre .... .... .... .... .... Gonorrhœa 240 4 2 9 10 265 Conditions other than venereal 59 .... .... 1 .... 60 Total 445 5 4 11 11 476 B* Total number of attendances of all patients residing in each area 12,570 87 28 183 183 13,051 C.* Aggregate number of "Inpatient days" of all patients residing in each area .... .... .... .... .... .... D. Number of doses of Arsenobenzol compounds given in the:— 1. Out-patient Clinic 1,761 10 8 6 .... 1,785 2. In-patient Dept. to patients residing in each area. .... .... .... .... .... .... E. Give the names of Arsenobenzol compounds used in the treatment of syphilis and the usual initial and final doses. Neo.- Salvarsan. Nov-Arsenobillon. Neo.-Kharsavan. Stabilarsen. Silver Salvarsan. Sulfarsenol. MALE. Initial dose, .6 to .9. FEMALE. „ .45 to .75. F. State the amount and kind of treatment usually administered to a case of Syphilis of each of the types usually dealt with at the Treatment Centre. Usual course, 9 to 10 injections of Arsenical compounds, with 10 to 20 Mercurial or Bismuth injections. 3 to 4 courses in the 1st year, 2 to 3 courses in the 2nd year, according to Wassermann Reaction. Hydrag. Perchlor. c Pot. Iod. between the courses. Mercury Cream, Mercurosal, or Bismuth, in conjunction with or without Arsenical compounds. G. State the nature of tests applied in deciding as to discharge of patients referred to in Item 5 on previous page. MALE. Urethroscopy. Cessation of treatment. Alcohol. Films and cultures from urethral discharge, and from threads, if any, and from prostatic and vesicular secretions on three occasions at weekly intervals. FEMALE. Films and sometimes cultures from cervix, urethra and Bartholin's glands (if necessary) after at least three successive menstrual periods, after cessation of treatment. 18/1/29. (Signed) KENNETH M. WALKER, Medical Officer of the Treatment Centre. *The totals in Item A should agree with the corresponding totals In Item 2 (a) on the previous page, and the totals in Items B and C should agree with the respective totals in Items 7 and 8 on the previous page. 25 CONGRESSES. The Corporation were represented at the following Congresses, which took place in 1928: The World's Dairy Congress, London—26th June to 12th July. The National Conference on Maternity and Infant Welfare, London—4th July to 6th July. The Royal Sanitary Institute Congress, Plymouth—16th to 21st July. The Royal Institute of Public Health Congress, Dublin—15th to 20th August. The Sanitary Inspectors' Association Conference, Leicester—September. The National Association for the Prevention of Tuberculosis Congress, London— 15th to 16th October. The Public Health Congress and Exhibition, London—November 19th to 24th. At each of these Congresses interesting papers were read, and the discussions which ensued undoubtedly have contributed to Public Health knowledge. Your Medical Officer of Health had the honour of reading a paper on "Food Protection" at the Public Health Congress and Exhibition in London during November, and as this paper was printed and circulated to the members of the Sanitary Committee, I am appending it to this report for the information of the Members of the Court of Common Council. (Appendix E.) The following two brief reports oh Congresses attended have also been presented to the Sanitary Committee. The Congress of the Royal Institute of Public Health was held at Dublin in mid-August week. Delegates attending to represent the Corporation of the City of London were Mr. Cyril Gamon, Colonel R. J. Blackham, and your Medical Officer of Health. Despite the somewhat inconvenient date of this meeting, General Mulcahy's expectation, as expressed in his presidential address, of a resultant momentum in Public Health improvement, was quite justified. The number of Medical Officers who have received their preliminary public health training at the Royal Institute of Public Health, or have other connection therewith, always ensures at these gatherings a critical and interested audience at the reading of the papers, as also those exchanges of views, then and afterwards, which are a consolidation of public health opinion and a diffusion of stimulating thought. These benefits to public health are achieved without of necessity, any particular outstanding treatment of the subjects under discussion ; they flow from viva voce and personal contact as refreshment of, and from, the cold written Page. General Mulcahy showed in his review of progress in public health that, since the former visit of the Institute in 1911, the death rate from tuberculosis had dropped 50 per cent. Dr. Varrier-Jones, Medical Director at Papworth Village Settlement, frankly stated the disappointing eventual results in Sanatorium and Dispensary treatment, urging the study of a patient's environmental condition ; a clue to his authoritative paper lies in his definition of a tuberculosis colony as a community of consumptives in which the hygienic and economical factors have been readjusted to suit the abnormal physical and mental state of its members. The aim of the Papworth Settlement was that the consumptive learns to live within the limitations imposed on his life, and to enjoy that life. Dr. Gerald Leighton, of the Scottish Board of Health, traced the history of the supervision of food supplies through the rules of antiquity which were largely ethical, to the severally practical methods of to-day, and amongst other points, focussed the view, universally held in public health circles, that preservatives in food can only be allowed under the most stringent regulations. Sufficient attention had not yet been paid to cold storage as the correct line in preservation of fresh food. These speakers are just cited in illustration, on the public health side, of the calibre and type of papers put forward at a congress of which the solid worth and success were no less illustrated in the visits to local industries and places of interest arranged, and in the social functions organised in welcome. SANITARY INSPECTORS' ASSOCIATION CONFERENCE- LEICESTER. The Conference held by the Sanitary Inspectors' Association in Leicester, in September, was attended by one of the Sanitary Inspectors attached to my staff, who reported that the following papers were read and that the discussions which arose out of them were interesting and instructive:— (1) Food Inspection and the Sanitary Inspector. (2) Milk Designations and Regulations. (3) The Problem of the Slums. (4) Factory and Workshop Inspection. (5) Industrial Hygiene. (6) Refuse disposal. (7) Slaughter-houses—Public and Private. A number of resolutions arising out of the discussions were passed, and will, doubtless, receive due consideration at the hands of the appropriate authorities. 26 HYGIENE OF HAIRDRESSERS' AND BARBERS' SHOPS. A system of voluntary registration of hairdressers' establishments with the Department of the Medical Officer of Health was instituted in 1904. The following is a list of establishments at present on the register:— Alfred Kingston, 8 and 10, Ludgate Arcade. Charles Lehman, 8 and 9, Aldermanbury Postern. Thos. W. Monk, 5, Angel Court. Ed. Hy. Price, 69, Fore Street. Samuel & Harry Cohen, trading as Cohen & Co., 120, Newgate Street. SMOKE AND ATMOSPHERIC POLLUTION. Fourteen instances of smoke nuisance or annoyance from chimneys were dealt with during the year. Some of these were of a temporary character and did not recur. There has been no occasion to take further action. A critical examination of the air in the City was commenced in the year 1914, in conjunction with the Committee for the Investigation of Atmospheric Pollution, appointed by the International Exhibition and Conference in London, 1912. A large rain gauge is mounted upon the roof of one of the Corporation's buildings in Golden Lane, and the rain-water from a known area of surface is collected monthly. This rain-water, containing the soot, grit and dust washed from the air, has been submitted for examination to the Public Analyst and the results tabulated. For comparison the results obtained from similar observations made at the Metereological Office, South Kensington, on the west, and Victoria Park, on the east of the rain gauge at Golden Lane, are shown in the attached table. The table also shows the rainfall for the months of January to December of the year 1928, and the amounts found of insoluble matter, tar, soot, and dust, also the soluble matter, together with the sulphates, ammonia and chlorine in the volume collected. The results as given by the Public Analyst have been re-calculated into metric tons per square kilometre during each month. In addition to the foregoing, a daily observation has been made at mid-day at the Guildhall of the purity of the air by a modern dry method, by which the suspended matter can be readily demonstrated. From the 1st January until the 31st December the amount of the impurity at noon has varied from half a milligramme to five milligrammes per cubic metre of air ; this latter figure includes times when there has been a fog. smoke. Although much is done to control the emission of smoke from the chimneys of factories and business premises, the domestic chimney still remains uncontrolled and continues to contribute very largely to the fogs to which London and other large cities are from time to time subjected. No really satisfactory reduction of this smoke nuisance is likely to be effected until the domestic source is attacked, and this does not seem to be within practical reach until some smokeless fuel is produced which can be used in the open ventilated grate, and which will burn with that "Fire-light" effect so precious to the average English housewife. That these fuels are available, I am aware, as I attended a demonstration of two of them. In each instance the results were extremely satisfactory, and suggest that the time may not be far distant when we may enjoy the open grate conscious that we are no longer contributing to the atmospheric impurities which are undoubtedly responsible in a wide measure for pulmonary affections. Some considerable period of time will, however, doubtless elapse before general education on this subject overcomes the conservative habits of the domestic sphere. 27 summary of monthly observations and reports during the year 1928. Month of the Year 1928. Place. 3 4 5 6 7 8 9 10 11 12 Rainfall mm. Metric tons per square kilometre. Insoluble matter. Soluble matter. Total solids. Included in soluble matter. Tar. Carbonaceous other than tar. Ash. Loss on ignition. Ash. Sulphates (SO3). Chlorine (Cl). Ammonia (NH3). January Meteorological Office 84 0.22 2.06 4.50 1.51 3.82 12.11 1.42 0.82 0.08 Golden Lane 78 0.09 5.33 7.11 4.33 7.47 24.33 3.40 1.54 0.27 Victoria Park 85 0.14 2.30 2.55 1.18 2.77 8.94 1.18 0.54 0.09 February Meteorological Office 21 0.17 2.06 5.46 0.81 2.73 11.23 1.11 0.35 0.02 Golden Lane 38 0.04 2.81 4.27 2.29 2.60 12.02 1.15 0.98 0.07 Victoria Park 35 0.14 1.90 2.89 0.79 2.40 8.09 0.94 0.56 0.06 March Meteorological Office 27 0.21 2.75 6.64 0.69 2.56 12.85 0.94 0.56 0.04 Golden Lane 31 0.22 4.66 6.60 3.45 6.04 20.99 2.23 1.16 0.16 Victoria Park 35 0.07 1.59 2.86 0.83 2.31 7.66 1.04 0.32 0.07 April Meteorological Office 25 0.15 1.12 3.43 0.89 1.96 7.55 0.67 0.50 0.03 Golden Lane 31 0.08 2.20 3.81 1.83 2.68 10.60 1.00 0.81 0.13 Victoria Park 25 0.05 1.09 1.94 0.84 1.16 5.08 0.51 0.28 0.05 May Meteorological Office 46 0.12 1.39 2.60 1.10 2.47 7.68 0.92 0.47 0.05 Golden Lane 51 0.08 3.18 4.31 1.95 3.39 12.91 1.62 0.76 0.25 Victoria Park 58 0.06 1.27 2.91 0.70 2.25 7.19 0.93 0.36 0.15 June Meteorological Office 50 0.09 1.32 3.10 0.90 2.18 7.59 0.85 0.36 0.03 Golden Lane 56 0.09 2.87 5.10 1.54 5.58 13.19 1.46 1.04 0.29 Victoria Park 50 0.04 0.55 1.06 0.30 1.56 3.51 0.66 0.19 0.06 July Meteorological Office 40 0.07 0.62 1.60 1.03 1.24 4.56 0.61 0.29 0.05 Golden Lane 52 0.02 1.29 2.10 1.24 2.70 7.36 1.06 0.76 0.24 Victoria Park 57 0.09 1.89 5.06 0.84 1.59 9.47 0.66 0.26 0.09 August Meteorological Office 66 0.11 1.26 2.39 1.05 2.96 7.76 1.21 0.35 0.07 Golden Lane 57 0.07 3.00 5.03 1.59 4.99 14.68 1.71 0.68 0.23 Victoria Park 54 0.11 1.22 2.30 0.82 1.55 6.00 0.85 0.30 0.11 September Meteorological Office 16 0.08 0.60 1.56 0.48 1.10 3.82 0.44 0.13 0.02 Golden Lane 9 0.03 1.14 1.70 0.17 16.28 19.33 0.43 0.17 0.03 Victoria Park 16 0.11 0.77 1.89 0.45 1.11 4.33 0.55 0.14 0.06 October Meteorological Office 70 0.19 2.23 4.28 1.97 3.44 12.11 1.72 0.59 0.12 Golden Lane 79 0.09 2.53 4.40 4.43 3.79 15.24 1.73 1.12 0.35 Victoria Park 78 0.10 1.88 3.40 1.40 2.03 8.81 1.16 0.42 0.13 November Meteorological Office 39 0.17 1.20 2.65 1.09 3.12 8.23 1.24 0.64 0.06 Golden Lane 55 0.12 2.23 4.21 2.38 3.24 12.18 1.74 1.17 0.24 Victoria Park 48 0.10 1.73 2.39 0.76 1.66 6.64 0.87 0.38 0.08 December Meteorological Office 53 0.31 3.03 5.94 1.43 3.34 14.05 1.49 0.57 0.09 Golden Lane 62 0.12 2.98 4.85 3.74 3.99 13.67 1.79 1.12 0.22 Victoria Park 61 0.10 1.41 2.37 0.79 2.33 7.00 1.03 0.40 0.09 28 CREMATION. Although cremation is not gaining ground so rapidly as in the case of Continental countries like Czecho-Slovakia, Scandinavia, Switzerland or Germany, the figures inserted in the following table of cremations carried out in Great Britain indicate that this method of disposal of the dead is gradually appealing to a wider circle, and I am sure that it is only a question of appropriate educative action before it will be very much more largely adopted. CREMATIONS IN THE UNITED KINGDOM. 44 Years—1885-1928. YEAR. Woking.* Manchester. Glasgow. Liverpool. Hull. Darlington. Leicester. Golder's Green. Birmingham. Leeds. City of London. Sheffield. Bradford W. Norwood. Hendon Park. Pontypridd. Bristol. (opened 2/3/28.) Ipswich. (opened 6/12/28.) No of Cremations each year. 1885 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 1886 10 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 10 1887 13 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 13 1888 28 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 28 1889 46 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 46 1890 54 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 54 1891 99 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 99 1892 104 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 107 1893 101 30 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 131 1894 125 47 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 172 1895 150 58 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 209 1896 137 52 10 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 201 1897 173 51 16 10 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 250 1898 240 62 12 27 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 341 1899 240 88 16 23 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 367 1900 301 83 20 40 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 444 1901 273 96 18 40 17 1 .... .... .... .... .... .... .... .... .... .... .... .... 445 1902 275 81 20 54 13 2 1 5 .... .... .... .... .... .... .... .... .... .... 451 1903 143 92 24 35 18 1 5 158 1 .... .... .... .... .... .... .... .... .... 477 1904 138 98 19 40 20 7 8 220 19 .... .... .... .... .... .... .... .... .... 569 1905 95 97 35 35 15 4 16 252 22 16 9 7 1 .... .... .... .... .... 604 1906 140 90 44 46 17 13 12 298 25 15 23 6 14 .... .... .... .... .... 743 1907 108 98 30 34 29 8 12 290 33 16 18 18 13 .... .... .... .... .... 707 1908 119 116 28 32 37 6 14 364 18 24 19 12 6 .... .... .... .... .... 795 1909 105 106 30 46 15 9 19 421 30 19 24 18 13 .... .... .... .... .... 855 1910 106 114 28 37 21 9 16 415 38 12 22 8 14 .... .... .... 840 1911 114 124 39 50 25 12 13 542 44 17 20 10 13 .... .... .... .... .... 1,023 1912 125 149 44 52 27 15 14 591 40 24 32 12 9 .... .... .... .... .... 1,134 1913 128 172 49 66 23 11 11 602 59 16 21 15 15 .... .... .... .... .... 1,188 1914 124 184 57 48 16 11 7† 671 53 28 42 20 18 .... .... .... .... .... 1,279 1915 153 165 63 54 34 16 22 730 45 20 45 21 12 30 .... .... .... .... 1,410 1916 125 179 71 58 25 10 23 633 63 22 43 14 11 89 .... .... .... .... 1,366 1917 129 178 67 62 24 15 34 719 49 17 68 25 10 118 .... .... .... .... 1,515 1918 142 197 74 69 43 17 42 820 64 34 70 50 20 153 .... .... .... .... 1,795 1919 181 235 84 89 46 26 36 919 76 30 68 41 31 169 .... .... .... .... 2,031 1920 149 203 80 69 30 18 32 851 72 26 58 32 20 156 .... .... .... .... 1,796 1921 159 228 87 75 43 20 36 893 78 31 57 29 24 162 .... .... .... .... 1,922 1922 193 189 75 74 45 17 23 939 98 31 70 38 25 186 6 .... .... .... 2,009 1923 170 227 90 62 45 21 36 920 75 27 69 37 23 178 6 .... .... .... 1,986 1924 235 251 82 74 47 28 40 1,114 97 47 68 32 24 240 7 4 .... .... 2,390 1925 271 287 116 75 41 32 57 1,214 126 48 66 48 32 266 7 14 .... .... 2,700 1926 305 303 98 96 55 33 70 1,270 128 40 84 43 32 299 8 13 .... .... 2,877 1927 320 357 129 101 70 38 68 1,459 150 59 95 57 50 279 11 22 .... .... 3,265 1928 344 367 141 103 72 39 61 1,483 157 60 103 51 45 306 11 20 71 2 3,436 Totals 6,693 5,457 1,795 1,778 914 442 725 18793 1,660 679 1,195 644 473 2,632 58 73 71 2 44084 * "Viscount Cross in the year 1879 forbade the practice of cremation there (Woking) under the threat of passing an Act to make it "illegal....But in 1884 appeared the well-known judgment of Mr. Justice Stephen, which, in the case of a child's body having been "burned by its father contrary to the order of the coroner, determined cremation to be a legal act, provided no nuisance be caused there"by to others."—Extract from speech made by the late Sir Henry Thompson at the opening of Golder's Green Crematorium, 22nd Nov"ember, 1902. Vide "Transactions of Cremation Society of England, 1903." p. 31. † Closed for reconstruction from August, 1913, to July, 1914. 29 BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS OF MILK. Samples Collected at Railway Stations. As has been customary for some years past, a series of samples of milk arriving in the City of London from the country was collected in September and October at Liverpool Street Station, and submitted to Sir Frederick Andrewes, K.B.E., the City Bacteriologist, for bacteriological examination and investigation as to the presence of dirt. A duplicate of each sample was also submitted to Mr. E. A. Pinchin, B.Sc., the Public Analyst for the City of Lodnon, for chemical examination. The samples were collected with particular regard to cleanliness. In all, 48 samples were collected, and these were sent from different farms situated in the following Counties:— Cambridge 7 Suffolk 18 Essex 8 Norfolk 11 Shropshire 2 N. Wales 1 Leicester 1 48 The following is a summary of Sir Frederick Andrewes' report on the result of the bacteriological examinations:— "As regards Dirt.—The milks as a whole more remarkably clean as compared with what used to be the case 10 years ago. Of the 48 samples, I have noted 31 as clean and 17 as containing a trace of dirt—i.e., a few blackish specks in the sediment. No specimen deserved to be called dirty." "As regards Tubercle.—The results have been quite unequivocal. 44 specimens were undoubtedly free from tubercle bacilli; 4 specimens certainly contained them—i.e., 8.3%, or 1 in 12, of the milks delivered at railway stations in the City of London were tuberculous." These results, considering the few examinations, are not of great statistical import, but suggest that past records, such as those of the year 1926, turned on the toss of a coin. The details in connection with the four cases in which the Tubercle bacillus was present were forwarded to the appropriate Medical Officers of Health. The following are extracts from reports which have been received, indicating the conditions on the farms of origin:— Sample No. 11.—"We examined 64 cows, none of which showed definite signs of tuberculosis, and seven specimens were taken and examined microscopically and found to be negative. One cow was in an unhealthy condition and milk had apparently been taken from it at the time of your complaint, but the cow will not be used to supply milk in future." "Subsequent animal inoculations indicated the presence of tubercle in the milk from this farm, and I am informed that the matter has been referred to the Diseases of Animals Act Committee." Sample No. 12.—"The Veterinary Inspector found that one red shorthorn cow named 'Buff' had induration of the udder and enlarged supramammary glands, and he was of the opinion that this cow was suffering from Tuberculosis. "The milk from this cow was examined microscopically and acid-fast bacilli were found. The cow was then immediately slaughtered under the Tuberculosis Order, 1925, and the post mortem examination revealed that the animal was affected with Tuberculosis of the lungs, udder and supramammary, bronchial and mesenteric lymphatic glands. "In addition, the Veterinary Inspector found a red shorthorn cow named 'Brandy' with induration of the udder and enlarged supramammary glands, a black and white shorthorn cow 'Mabel' with enlarged lymphatic gland of the right forequarter, a brindled shorthorn cow ' Paggy' with enlarged supramammary lymphatic gland, and a black and white shorthorn cow ' Susan' with induration of the udder. "A separate sample of milk was taken from all these cows and examined microscopically with negative results. Guinea-pigs have been inoculated with each of these milks and I will communicate with you later when the results are known. "The milks of the 42 cows which constituted the rest of the herd were mixed, and a sample taken and examined microscopically with a negative result. An animal inoculation test is also being made with this sample of mixed milk, and I will let you have the final result when the investigation has been completed." The following is an extract from a subsequent letter:— "The mixed milk of the other 42 cows, which was considered to be sound, has proved to contain tubercle." The circumstances are being investigated at the farm. * e 30 Sample No. 17.—"Twenty-four cows in milk were examined, and microscopical examination of the samples of milk from the following cows, which, in the opinion of the Veterinary Surgeon, might be suspected of giving tuberculous milk, has failed to reveal the presence of acid-fast bacilli in all three instances:— 1. Red and white shorthorn cow: coughing. 2. Red shorthorn cow: induration of udder on right side. 3. White and red polled cow: coughing and thin. Of the remainder of the herd, none showed clinical signs of tuberculosis. The fourth case, Sample No. 48, is still the subject of investigation. For purposes of comparison the following summary of results, obtained since the examination of milk on arrival in the City was first commenced in 1904, is here inserted. Year. Percentage showing Tuberculous Infection. Year. Percentage showing Tuberculous Infection. 1904 7.7 per cent. 1919 14.8 per cent. 1905 9.1 „ „ 1921 24.2 „ „ (1st series) 1906 8.0 „ „ 26.3 „ „ (2nd „ ) 1907 8.3 „ „ 12.5 „ „ (3rd „ ) 1909 12.5 ,, ,, (1st series) 1922 9.5 „ „ 4.7 „ „ (2nd „ ) 1923 2.6 „ „ 1910 6.25 „ „ 1924 12.8 „ „ 1912 6.6 „ „ 1925 2.4 „ „ (1st series) 1913 10.4 „ „ 2.4 „ „ (2nd „ ) 1914 10.2 „ „ 1926 „ „ 1915 8.5 „ „ 1927 4.88 ,, „ 1917 4.2 „ „ 1928 8.3 ,, ,, The chemical examination showed that, with one exception, all the samples were samples of genuine milk. The exception was found to be adulterated to the extent of 2% added water. Further samples were taken from the same consignor, and in consequence of sophistication, legal proceedings were instituted. According to the most recent research work, the reliability of the intradermal inoculation test for tuberculosis in cattle, as compared with the subcutaneous, is such that, out of 835 non-reactors to the subcutaneous, 122 reacted positively to the intradermal test ; autopsy performed in 94 animals confirmed the diagnosis in every case. The advantages of the new test are reduction of the Veterinary Surgeon's visits to three instead of eight, the animal need not be kept indoors, milk yield is unaffected, and the test is without risk to pregnant or young animals. Doping by tuberculin does not nullify the test, and the test can successfully be repeated at intervals of three weeks. The ease of performance and comparative certainty of the intradermal test should make for rapid and effective working at that end of the field—the milch herd—at which prevention is most possible and logical. SUPERVISION OF FOOD AND DRUGS. During the year 1928, 1,000 samples of Food and Drugs were submitted to the Public Analyst for examination. Of this number, 706 were taken as test samples without the formalities of the Acts being observed, of these, 8, which comprise the following, were reported against:— 1 of Butter, out of 71 samples taken. 1 of Condensed Full Cream Milk—Sweetened, out of 2 samples taken. 1 of Liniment of Turpentine, out of 4 samples taken. 1 of Orange and Quinine Wine, out of 5 samples taken. 1 of Sausages (Not Preserved), out of 29 samples taken. 1 of Sausage Preservative Powder, out of 6 samples taken. 1 of Sweet Spirit of Nitre, out of 2 samples taken. 1 of White Precipitate Ointment, out of 9 samples taken. Of the formal samples, 16, out of 294, were found to be adulterated, as follows:— 13 of Milk, out of 252 samples taken. 1 of Sweet Spirit of Nitre, out of 1 sample taken. 1 of Whisky, out of 14 samples taken. 1 of White Precipitate Ointment, out of 1 sample taken. The above-mentioned samples, with the exception of Milk and Whisky, were taken as the result of informal samples having been certified as adulterated. 31 General Observations.—The percentage rate of adulteration of all foods and drugs sampled in the City was 2.4, as compared with 4.2 in 1927. Drugs.—A total of 128 samples of drugs were procured during the year under review. Six samples were found not to comply with the standards of the British Pharmacopoeia. There were two prosecutions (informal samples having been previously reported against), and in each case the vendors were fined. In two other cases, when the formal sample was procured, the article was served in accordance with the British Pharmacopoeia requirements. Butter.—During the year, 78 samples of butter (33 of which were served with bread or scone) were taken and, with one exception, all were certified genuine. The Public Health (Preservatives, etc., in Food) Regulations came into force on the 1st January, 1928, so far as they relate to butter, not including preserved butter contained in another article of food. The sample reported against, and which was certified to contain 0.07 per cent. Boric Acid, was purchased informally shortly after this date. A formal sample was immediately pur chased from the same vendor and certified to be genuine. Enquiries made at the time of sampling showed that the informal sample had been served from a small balance of stock of butter containing preservative which had not been disposed of before the Regulations came into force. Spirits.—Of the 29 samples of Spirits taken, only one was found to be below the statutory minimum strength of 35 degrees under proof. The vendor was prosecuted and a fine inflicted. Sausages.—Twenty-nine samples of Sausages and two of Sausages labelled as containing preservative were taken, and, with one exception, were found to be genuine. In this case the informal sample was certified to contain 200 parts per million Sulphur Dioxide, although the sausages were not labelled or a notice exhibited in the shop as required by the Public Health (Preservatives, etc., in Food) Regulations. A formal sample was immediately procured from the same vendor, and also one from the manufacturers, but neither sample disclosed preservative to be present. Four colourings and six preservative powders for sausages were obtained for examination. One of the latter was reported not to contain the amount mentioned in the statutory declaration on the tin, and the printing also was not in accordance with the requirements of the Regulations. The vendors were communicated with and cautioned. Cream.—Twenty samples of Cream were procured and all were certified to be genuine, thickeners, Boric Acid and other preservatives being absent. Sixteen of these samples were ordinary cream and four were clotted cream, the fat contents of the former ranging from 23.6 per cent. to 54.0 per cent., giving an average content of 43.0 per cent. The average fat content of the clotted cream samples was 60.7 per cent. supervised and registered premises. Wholesale Dealers in Margarine and Margarine Cheese.—No new applications for registrations were received during the year. the milk and dairies order, 1926, and the milk and dairies (amendment) act, 1922. Sixteen new applications for registration as retail purveyors of milk were received during the year, fifteen of which were approved. One application was refused registration, after the applicant had appeared before the Sanitary Committee, as the conditions existing at the premises were very unsatisfactory. No appeal was made from this decision. During the year it was decided that, by the Milk and Dairies Order, 1926, a person, even though he occupies no premises within the district of the Sanitary Authority, must yet be registered if he wishes to carry on in the district the trade of purveyor of milk. Accordingly, all such persons, when found to be distributing milk within the City area, have been required to be registered with this Authority. E 2 32 Registration Statistics. Number of Retail Purveyors of Milk on the Register at end of 1927 271 New Applications for Registration received 16 Applications granted 15 Applications refused 1 Names of Retailers removed from the Register 9 Number of Retail Purveyors of Milk on the Register at the end of 1928 277 Number of Milksellers (other than Retail Purveyors of Milk) on the Register at the end of 1927 7 Licenses issued under the Milk (Special Designations) Order, 1923 Nil Inspections of Premises where Milk is Retailed.—During the year 274 inspections were made in connection with the supervision of the sale of milk. Suggestions made in the course of inspections with a view to improvement in the handling of milk, methods of storage, cleansing of vessels, etc., have generally been adopted. In one case a complete sterilizing plant was installed and considerable improvement effected in the distributing part of the business. A copy of the Milk and Dairies Order, 1926, was supplied to each person newly registered during the year. Methods of distribution by hand barrows has received due attention. Article 29 of the Milk and Dairies Order, 1926, became operative on the 1st October, 1928, by which every person shall cause every churn or vessel in which he dispatches milk by rail or road to (1) have the name and address of the owner permanently marked thereon, and (2) to provide it with a lid without openings, and so constructed and fitted as effectively to prevent the access to the milk of dirt, etc., and the return to the interior of the receptacle of any milk which may have been splashed above the lid. Observations have consequently been made at the City railway stations, and, where necessary, a communication has been sent to the consignors of churns which did not comply with these requirements, drawing their attention to the matter. This action has resulted in considerable numbers of churns being replaced or refitted. Time will be necessary to allow of the complete removal from use of types of churns which are not desirable, but up to the present some progress has been made in this direction. examination of milk. Chemical.—Thirteen samples, all of which were procured formally, were certified as adulterated, giving a percentage of milk adulteration of 5.1, as compared with 6.3 for 1927. There were eleven prosecutions and penalties were imposed in five cases; in two others, the Magistrate was satisfied that the milk had been delivered as given by the cow, and accordingly dismissed them; and the remaining four cases were dismissed under the Probation of Offenders Act, with costs. One vendor was cautioned, as legal proceedings were not considered advisable, and in another instance a further sample was procured and legal proceedings successfully instituted. None of the samples taken on Sunday mornings was reported against. The following table shows the percentage of fat contained in each of the 252 samples of milk examined. Six of this number contained fat in amounts below the point which presumes adulteration, i.e., 3 per cent. The highest amount of fat contained in any sample was 5.3 per cent. The average percentage of fat was 3.5. Percentage of Fat. No. of Samples. Percentage of Fat. No. of Samples. * 2.2 1 3.7 16 2.5 1 3.8 19 2.6 1 3.9 15 2.7 1 4.0 9 2.8 1 41 9 2.9 1 4.2 5 3.0 17 4.3 3 3.1 19 4.4 3 3.2 21 4.5 1 3.3 26 4.7 3 3.4 33 5.3 1 3.5 26 3.6 20 Total 252 33 In the eleven cases where the percentage of fat exceeded 4.2 it was observed that seven of these samples were taken from churns in course of delivery at railway stations, which were thoroughly plunged previous to the samples being taken; three were taken from vessels in shops where the neglect to plunge the milk would account for the high amount of fat; and another was taken from a churn carried on a milk barrow. Twenty-five requests were received from purveyors of milk, from whom samples of milk had been taken, asking for samples to be procured in course of transit or delivery from the respective suppliers, in accordance with the Milk and Dairies (Consolidation) Act, 1915. On one occasion it was necessary to ask another Authority to procure such samples at a railway terminus outside the area of the City of London, and six samples were accordingly obtained and dealt with. These samples were certified to be genuine. THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. Five samples of different brands of condensed milk were taken and submitted to the Public Analyst, as follows:— Condensed Full Cream Milk, Sweetened 2 Condensed Skimmed or Machine Skimmed Milk, Sweetened 2 Condensed Skimmed Milk, Unsweetened - Condensed Full Cream Milk, Unsweetened 1 Total 5 These samples were certified genuine as regards equivalent contents and composition. In one instance there was a minor defect in the printing of the statutory declaration on the label, and the attention of the manufacturers was called to the matter. THE PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. Two samples of dried milk were taken and submitted to the Public Analyst, as follows :— Dried Full Cream Milk 1 Dried Machine Skimmed Milk 1 These were found to be satisfactory in all respects except that the attention of the manufacturers of the sample of Dried Full Cream Milk was called to the fact that part of the statutory declaration was not printed in block type as required by the Regulations. 34 35 ADMINISTRATIVE ACTION REGARDING SAMPLES NOT REPORTED TO BE GENUINE. Name of Article. Identification No. given to the sample in the Quarterly Report. Result of Analysis. If any legal proceedings were instituted under the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were instituted under Acts other than the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. Quarter ending 31st March, 1928. Butter 19 Boric Acid present to the extent of 0.07% .... .... Informal sample. Subsequent formal sample genuine. .... .... Dried Full Cream Milk 150 Defective label on tin .... .... Attention of Manufacturers drawn to the breach of the Regulations. .... .... Milk 163 17% fat abstracted Fined £3 and £2 2s. costs. .... .... Fined £2 and £2 12s. 6d. Costs, 16th Dec., 1927, for selling Milk containing 11% added water. .... Sweet Spirit of Nitre 183 59% deficient in Ethyl Nitrite .... .... Informal sample. Resampled formally. .... .... Sweet Spirit of Nitre 236 58% deficient in Ethyl Nitrite Fined £5 5s. & £2 2s. Costs. .... .... .... Same Vendor as No. 183. Whisky 281 39.7 degrees under proof Fined £2 2s. & £2 2s. Costs. .... .... .... .... Milk 352 6% fat abstracted .... .... Consignor communicated with and cautioned. .... .... Milk 453 12% added water Fined £1 and £2 2s. Costs. .... .... .... .... Orange and Quinine Wine. 466 80% deficient in Quinine Hydrochloride. .... .... Informal sample. Subsequent formal sample genuine. .... Similar bottle as that containing the informal sample served at the time formal sample taken, but declared to be "Not B.P. standard." Milk 470 6% added water Fined £2 and £2 2s. Costs. .... .... .... Taken in course of delivery to Vendor of Sample No. 453. Milk 530 13% fat abstracted Dismissed. .... .... .... Magistrate satisfied milk delivered as given by the cow. Milk 533 26% fat abstracted Dismissed. .... .... .... Magistrate satisfied milk delivered as given by the cow. Same Consignor as Sample No. 530. Milk 551 6% added water Dismissed under Probation of Offenders Act with £5 5s. Costs. .... .... .... Same Consignor as Sample No. 352. Milk 552 2% added water Dismissed under Probation of fenders Act. .... .... .... Same Consignor as No. 551. Milk 553 6% added water Dismissed under Probation of Offenders Act with £5 5s. .... .... .... Same Consignor as Samples No. 551 and 552. Liniment of Turpentine 629 56% deficient in Rectified Oil of Turpentine. .... .... Informal sample. Subsequent formal sample genuine. .... .... Pork Sausages 670 Sulphur Dioxide, 200 parts per million. .... .... Informal sample. Subsequent formal sample genuine. .... Formal sample taken also from Wholesale Supplier of these Sausages proved genuine. White Precipitate Ointment. 721 38% deficient in Ammoniated Mercury. .... .... Informal sample. Resampled formally. .... .... Milk 743 2% added water .... .... Resampled .... .... White Precipitate Ointment. 764 64% deficient in Ammoniated Mercury. Fined £5 and £2 2s. Costs. .... .... .... Same Vendor as Sample No. 721. Milk 773 7% added water Fined £5 and £2 2s. Costs. .... .... .... .... Condensed Full Cream Milk—Sweetened 863 Defective label on tin .... .... Attention of Manufacturers drawn to the breach of the Regulations. .... .... Milk 871 3% added water Dismissed under Probation of fenders Act. .... .... .... Same Consignor as No. 743. Milk 872 16% added water Fined £5 and £3 3s. Costs. .... .... .... Same Consignor as Samples Nos. 743 and 871. Preservative Powder for Sausages. 1000 Genuine as to absence of prohil ited preservatives, but 39% deficient in Sulphur Dioxide and labelling of tin defective. .... .... Vendors communicated with and cautioned. Fined £1 and 2s. Costs, 15th Nov., 1927, for selling Sausage Preservative Powder containing 0.30% Boric Acid. .... 36 37 SALE OF FOOD AND DRUGS ACTS, THE PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS AND THE PUBLIC HEALTH (DRIED MILK) REGULATIONS. Articles Examined during each Quarter of the Year 1928. Articles submitted for Analysis. Quarter ending 31st March. Quarter ending 30th June. Quarter ending 30th September. Quarter ending 31st December. Total for 1928. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. Formal:— Brandy .... .... .... .... .... .... .... .... 4 4 .... .... 3 3 .... .... 7 7 .... .... Butter 4 4 .... .... .... .... .... .... 3 3 .... .... .... .... .... .... 7 7 .... .... Liniment of Turpentine .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... Milk 58 57 1 1.7 81 73 8 9.8 70 68 2 2.8 43 41 2 4.6 252 239 13 5.1 Orange and Quinine Wine .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Rum .... .... .... .... .... .... .... .... .... .... .... .... 8 8 .... .... 8 8 .... .... Sausages .... .... .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 2 2 .... .... Sweet Spirit of Nitre 1 .... l 100.0 .... .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 100.0 Whisky 7 6 l 14.2 5 5 .... .... .... .... .... .... 2 2 .... .... 14 13 1 7.1 White Precipitate Ointment .... .... .... .... .... .... .... .... 1 .... 1 100.0 .... .... .... .... 1 .... 1 100.0 Total formal samples 70 67 3 4.2 87 79 8 9.1 81 78 3 3.7 56 54 2 3.7 294 278 16 5.4 Informal:— Acetic Acid (Glacial) .... .... .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Almond Oil 2 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Ammoniated Tincture of Quinine 3 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Arrowroot 2 2 .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 3 3 .... .... Bacon 7 7 .... .... 1 1 .... .... 2 2 .... .... .... .... .... .... 10 10 .... .... Baking Powder 1 1 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Bicarbonate of Soda 1 1 .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Biscuits .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... 2 2 .... .... Blanc-mange Powder .... .... .... .... 1 1 .... .... 1 1 .... .... .... .... .... .... 2 2 .... .... Borax (Purified) 2 2 4 4 .... .... 1 1 .... .... 2 2 .... .... 9 9 .... .... Brawn and Collared Head 6 6 .... .... 6 6 .... .... 1 1 .... .... 1 1 .... .... 14 14 .... .... Bread .... .... .... .... .... .... .... .... 3 3 .... .... .... .... .... .... 3 3 .... .... Butter 26 25 l 3.8 20 20 .... .... 12 12 .... .... 13 13 .... .... 71 70 1 1.4 Cakes and Pastries 2 2 .... .... 4 4 .... .... 10 10 .... .... 6 6 .... .... 22 22 .... .... Calves' Feet Jelly 1 1 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Camphorated Oil 5 5 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 6 6 .... .... Castor Oil 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Cayenne Pepper 1 1 .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... 3 3 .... .... Chicory 1 1 .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 2 2 .... .... Chocolate Powder 1 1 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 2 2 .... .... Chutney 3 3 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 4 4 .... .... Cider .... .... .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Cocoa 1 1 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 2 2 .... .... Cocoa Essence 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Cod Liver Oil 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Coffee 3 3 .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... 5 5 .... .... Coffee Essence and Coffee Extract .... .... .... .... 4 4 .... .... 1 1 .... .... .... .... .... .... 5 5 .... .... Colchicum Wine .... .... .... .... 3 3 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Colourings .... .... .... .... 3 3 .... .... .... .... .... .... 1 1 .... .... 4 4 .... .... Compound Liquorice Powder 2 2 .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... 4 4 .... .... Compound Tincture of Rhubarb .... .... .... .... .... .... .... .... .... .... .... .... 1 1 1 1 .... .... Condensed Full Cream MilkUnsweetened .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Carried forward 73 72 l .... 58 58 .... .... 36 36 .... .... 30 30 .... .... 197 196 1 .... f 38 39 SALE OF FOOD AND DRUGS ACTS, THE PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS AND THE PUBLIC HEALTH (DRIED MILK) REGULATIONS.—Continued. Articles submitted for Analysis. Quarter ending 31st March. Quarter ending 30th June. Quarter ending 30th September. Quarter ending 31st December. Total for 1928. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. Informal.—Continued. Brought forward 73 72 1 .... 58 58 .... .... 36 36 .... .... 30 30 .... .... 197 196 1 .... Condensed Full Cream Milk— Sweetened .... .... .... .... .... .... .... .... 1 1 .... .... 1 .... 1 100.0 2 1 1 50.0 Condensed Machine Skimmed Milk—Sweetened 1 1 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Cornflour 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Cream 4 4 .... .... 12 12 .... .... 3 3 .... .... 1 1 .... .... 20 20 .... .... Cream of Tartar (Purified) 4 4 .... .... 3 3 .... .... .... .... .... .... 2 2 .... .... 9 9 .... .... Crushed Linseed .... .... .... .... .... .... .... .... .... 1 .... .... 3 3 .... .... 4 4 .... .... Crystallized Glace or Cured Fruit (including Candied Peel) 3 3 .... .... 1 1 .... .... 1 1 .... .... 5 5 .... .... 10 10 .... .... Curry Powder 1 1 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 3 3 .... .... Custard Powder 4 4 .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 5 5 .... .... Desiccated Cocoanut .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... Dover's Powder .... .... .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Dried Fruit:— .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Apricots, Peaches, Nectarines, Apples and Pears 2 2 .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 4 4 .... .... Raisins and Sultanas .... .... .... .... 2 2 .... .... .... .... .... .... 8 8 .... .... 10 10 .... .... Currants, etc 1 1 .... .... 2 2 .... .... .... .... .... .... 3 3 .... .... 6 6 .... .... Dried Milk—Full Cream 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Dried Milk—Machine Skimmed .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... Dripping 2 2 .... .... 2 2 .... .... 2 2 .... .... .... .... .... .... 6 6 .... .... Egg-substitute Powder 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Eucalyptus Oil 4 4 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 4 4 .... .... Fish Paste 3 3 .... .... 2 2 .... .... .... .... .... .... 1 1 .... .... 6 6 .... .... Flour (Self-raising) 3 3 .... .... 1 1 .... .... 2 2 .... .... .... .... .... .... 6 6 .... .... Flowers of Sulphur .... .... .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... 2 2 .... .... Foie Gras .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... Friars' Balsam 5 5 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 7 7 .... .... Gelatine .... .... .... .... 2 2 .... .... 1 1 .... .... .... .... .... .... 3 3 .... .... Glauber's Salt .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 2 2 .... .... Glycerine 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Glycerine of Borax 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Golden Syrup and Treacle 2 2 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 4 4 .... .... Grape Juice .... .... .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Gregory's Powder 1 1 .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Ground Rice 3 3 .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 4 4 .... .... Ham 2 2 .... .... .... .... .... .... 2 2 .... .... 3 3 .... .... 7 7 .... .... Herbs .... .... .... .... .... .... .... .... 2 2 .... .... 4 4 .... .... 6 6 .... .... Honey 1 1 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Ice Cream .... .... .... .... .... .... .... .... 5 5 .... .... .... .... .... .... 5 5 .... .... Ipecacuanha Wine .... .... .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Jam and Marmalade 5 5 .... .... 1 1 .... .... 1 1 .... .... 1 1 .... .... 8 8 .... .... Jelly Crystals 2 2 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Lard 2 2 .... .... 2 2 .... .... .... .... .... .... 3 3 .... .... 7 7 .... .... Lemonade Powder .... .... .... .... 1 1 .... .... 4 4 .... .... .... .... .... .... 5 5 .... .... Liniment of Turpentine 2 2 .... .... .... .... .... .... 2 1 1 50.0 .... .... .... .... 4 3 .... 25.0 Linseed Oil 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Liquid Paraffin .... .... .... .... .... .... .... .... 4 4 .... .... .... .... .... .... 4 4 .... .... Malt Vinegar 1 1 .... .... 7 7 .... .... 4 4 .... .... 3 3 .... .... 15 15 .... .... Margarine 1 1 .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Carried forward 138 137 1 .... 112 112 .... .... 75 74 1 .... 78 77 1 .... 403 400 3 .... f 2 40 41 SALE OF FOOD AND DRUGS ACTS, THE PUBLIC HEALTH PRESERVATIVES, ETC., IN FOOD) REGULATIONS, THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS AND THE PUBLIC HEALTH (DRIED MILK) REGULATIONS.—Continued. Articles submitted for Analysis. Quarter ending 31st March. Quarter ending 30th June. Quarter ending 30th September. Quarter ending 31st December. Total for 1928. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. Informal.—Continued. Brought forward 138 137 1 .... 112 112 .... .... 75 74 1 .... 78 77 1 .... 403 400 3 .... Meat Paste 1 1 .... .... 1 1 .... .... 2 2 .... .... .... .... .... .... 4 4 .... .... Meat Pies and Rolls .... .... .... .... 2 2 .... .... 13 13 .... .... 7 7 .... .... 22 22 .... .... Medicated Lozenges 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Mincemeat .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... 3 3 .... .... Mineral Waters 1 1 .... .... 5 5 .... .... .... .... .... .... .... .... .... .... 6 6 .... .... Mustard 1 1 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Oatmeal 1 1 .... .... 2 2 .... .... 1 1 .... .... .... .... .... .... 4 4 .... .... Ointment, Boracic 2 2 .... .... 1 1 .... .... .... .... .... .... 4 4 .... .... 7 7 .... .... Ointment, Calomel .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 2 2 .... .... Ointment, Gall and Opium 1 1 .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Ointment, Sulphur 2 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Ointment, White Precipitate 5 5 .... .... 2 2 .... .... 1 .... 1 100.0 1 1 .... .... 9 8 1 11.1 Ointment, Zinc 1 1 .... .... 1 1 .... .... 4 4 .... .... 2 2 .... .... 8 8 .... .... Olive Oil 3 3 .... .... 3 3 .... .... 1 1 .... .... 1 1 .... .... 8 8 .... .... Orange and Quinine Wine .... .... .... .... 4 3 1 25.0 1 1 .... .... .... .... .... .... 5 4 1 20.0 Pea Flour 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Pearl Barley 9 9 .... .... 5 5 .... .... 1 1 .... .... 1 1 .... .... 16 16 .... .... Pepper 1 1 .... .... 6 6 .... .... .... .... .... .... .... .... .... .... 7 7 .... .... Peroxide of Hydrogen J 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Pickles and Sauces 11 11 .... .... 7 7 .... .... 2 2 .... .... .... .... .... .... 20 20 .... .... Rice 3 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Sausages (Not Preserved) 3 3 .... .... 15 15 .... .... 8 7 1 12.5 3 3 .... .... 29 28 1 3.4 Sausages (Preserved) .... .... .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... 2 2 .... .... Sausage Preservative Powder .... .... .... .... 4 4 .... .... 1 1 .... .... 1 .... 1 100.0 6 5 1 16.6 Sausage Seasoning .... .... .... .... 1 1 .... .... 1 l .... .... 2 2 .... .... 3 3 .... .... Sherbet .... .... .... .... .... .... .... .... 4 4 .... .... .... .... .... .... 4 4 .... .... Shredded Suet 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Shrimps .... .... .... .... .... .... .... .... .... .... .... .... 4 4 .... .... 4 4 .... .... Spices 4 4 .... .... 1 1 .... .... 2 2 .... .... 5 5 .... .... 12 12 .... .... Sponge Mixture 1 1 .... .... l 1 .... .... .... .... .... .... .... .... .... 2 2 .... .... Sugar 4 4 .... .... 1 1 .... .... 4 4 .... .... 3 3 .... .... 12 12 .... .... Sugar and Cane Syrup .... .... .... .... l 1 .... .... 4 4 .... .... .... .... .... .... 1 1 .... .... Sweet Spirit of Nitre 2 1 1 50.0 .... .... .... .... .... .... .... .... .... .... .... .... 2 1 1 50.0 Sweets 2 2 .... .... 3 3 .... .... 3 3 .... .... 3 3 .... .... 11 11 .... .... Table Jellies 5 5 .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 7 7 .... .... Tapioca 3 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Tartaric Acid 1 1 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 2 2 .... .... Tea and Tea Sittings 2 2 .... .... 3 3 .... .... 1 1 .... .... 2 2 .... .... 8 8 .... .... Tincture of Orange .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... Tinned Soft Roes .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... Tinned Fruit 1 1 .... .... 2 2 .... .... .... .... .... .... 2 2 .... .... 5 5 .... .... Tinned Vegetables 4 4 .... .... 7 7 .... .... 1 1 .... .... .... .... .... .... 12 12 .... .... Vinegar 1 1 .... .... 3 3 .... .... 4 4 .... .... 1 1 .... .... 9 9 .... .... Wines (Alcoholic) 3 3 .... .... 5 5 .... .... 1 1 .... .... 13 13 .... .... 22 22 .... .... Wines (Non-Alcoholic), Cordials and Fruit Juices 1 1 .... .... 5 5 .... .... .... l .... .... 2 2 .... .... 8 8 .... .... Wine Essence .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... Yellow Crystals 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Total informal samples 222 220 2 0.9 207 206 1 0.4 132 129 3 2.2 145 143 2 1.3 706 698 8 1.1 Totals 292 287 5 1.7 294 285 9 30 213 207 6 2.8 201 197 4 1.9 1000 976 24 2.4 42 SALE OF FOOD AND DRUGS ACTS, PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, PUBLIC HEALTH (CONDENSED MILK) REGULATIONS AND PUBLIC HEALTH (DRIED MILK) REGULATIONS. RESULTS OF PROSECUTIONS. Sample. First Quarter. Nature and Extent of Adulteration. Result. 163 Milk 17 per cent. of original fat abstracted £3 and £2 2s. Costs. 236 Sweet Spirit of Nitre 58 per cent. deficient in Ethyl Nitrite £5 5s. and £2 2s. Costs. 281 Whisky 39.7 degrees under proof £2 2s. and £2 2s. Costs. Second Quarter. 453 Milk 12 per cent. added water £1 and £2 2s. Costs. 470 Milk 6 per cent. added water £2 and £2 2s. Costs. 530 Milk 13 per cent. deficient in fat Dismissed. Magistrate satisfied milk delivered as given by the cow. 533 Milk 26 per cent. deficient in fat Dismissed. Magistrate satisfied milk delivered as given by the cow. 551 Milk 6 per cent. added water Dismissed under Probation of Offenders Act, with £5 5s. Costs. 552 Milk 2 per cent. added water Dismissed under Probation of Offenders Act. 553 Milk 6 per cent. added water Dismissed under Probation of Offenders Act, with £5 5s. Costs. Third Quarter. 764 White Precipitate 64 per cent. deficient in Ammoniated £5 and £2 2s. Costs. Ointment. Mercury. 773 Milk 7 per cent. added water £5 and £2 2s. Costs. Fourth Quarter. 871 Milk 3 per cent. added water Dismissed under Probation of Offenders Act. 872 Milk 16 per cent. added water £5 and £3 3s. Costs. SUMMARY. £ s. d. £ s. d. First Quarter, Fines 10 7 0 Costs 6 6 0 Second Quarter „ 13 10 0 „ 14 14 0 Third Quarter „ 10 0 0 „ 4 4 0 Fourth Quarter „ 5 0 0 „ 3 3 0 Total Fines 38 17 0 Total Costs 28 7 0 PUBLIC HEALTH (IMPORTED MILK) REGULATIONS, 1926. Only one application has been received for registration in accordance with the provisions of the above-mentioned regulations, which provide that no person shall receive milk from outside the British Isles unless he is registered by the Sanitary Authority into whose district the milk is imported. The applicants were duly registered, and subsequently samples from the first consignment arriving in the City were examined in order to ascertain whether they complied with the regulations as far as bacterial content and freedom from tubercle bacilli were concerned. It was found that the bacterial content was in excess of the number permitted, and the attention of the importers was accordingly directed to the circumstances. It was learnt that the importation was an emergency measure only, necessitated by the low production of milk in this country at the time, and that such importation had been confined to a few consignments only. An undertaking was given by the importers that, in the event of their again importing fresh milk, every possible endeavour will be made to ensure that it conforms with the requirements of the regulations. *RECONSTITUTED AND SYNTHETIC CREAM BILL. The Reconstituted and Synthetic Cream Bill, which was introduced into the House of Commons in the early part of the year, had, as its object, the control of the production, disposal and sale of reconstituted and synthetic cream. "Reconstituted Cream" was defined as a preparation which contains no fat other than milk fat, and is as nearly as possible identical in composition with natural cream. "Synthetic Cream" was defined as a similar *Since this Report was drafted, the Artificial Cream Act, 1929, has been placed on the Statute Book, and powers somewhat similar to those under the Reconstituted and Synthetic Cream Bill are now available in this connection. Observations on this Act will be included in my next Report. 43 preparation to reconstituted cream, in which fat other than milk fat is used. The Bill proposed to empower the Minister of Health to make orders, amongst other things, for:— (1) The registration of all persons manufacturing these substances for human consumption and of all persons selling them or products in which they are used. (2) Requiring all premises used for the sale of either of these substances to bear a prominent mark to that effect. (3) The inspection of premises and persons used or engaged in the business ; and (4) Regulating, lighting, sanitation, cleansing, drainage, protection from infection, labelling, marking and other details. The Bill was a sound one, and if the orders or regulations which were to be made under it were well-framed, it would have constituted a welcome addition to Public Health legislation. Unfortunately, however, pressure of other business prevented the Bill from reaching the final stage. PRODUCTION OR DISTRIBUTION OF MILK—COURSE OF INSTRUCTION. In addition to congresses which the Corporation and its Officers were privileged to attend, one of my Inspectors was authorised to take a short course of instruction in the production and distribution of milk, organised by the National Institute for Research in Dairying, at Shinfield, near Reading, towards the end of March, 1928. The course included lectures and demonstrations in the various branches of dairying research work, and it is evident from the report which was made to me on the subject that the course was comprehensive, practical, and educational, and cannot fail to be of considerable assistance to the member of my staff authorised to attend. MEAT INSPECTION. The following tabulated statement has been prepared by Mr. T. D. Young, O.B.E., Veterinary Inspector:— IMPORTATION OF MEAT INTO GREAT BRITAIN. According to the Board of Trade Returns, the imports of meat and bacon for the year ending 31st December, 1928, were as follows:— Country of Origin. Beef. Tons. Mutton and Lamb. Tons. Pork. Tons. Bacon. Tons. Argentina 470,615 75,570 2,890 - Australia 50,791 27,411 — - Canada — — — 15,340 Denmark — — — 268,369 Irish Free State — — 19,375 27,733 Netherlands — — — 52,788 New Zealand 22,936 139,754 6,083 — Other Countries 28,936 19,415 464 28,710 Sweden — — — 22,053 United States of America 2,038 — 2,904 26,887 Uruguay 38,660 20,141 — — Totals 613,348 281,891 31,716 441,880 The above figures show a total decrease of 58,448 tons, compared with those for 1927. Of the beef, 77 per cent. is given as chilled and 21 per cent. frozen; the remainder was fresh. The amount shows a decrease of nearly 42,000 tons chilled and over 17,000 tons frozen. Argentina heads the list of the countries from which we obtain our meat, having sent 76 per cent. of the total, but over 100,000 tons less than the previous year. Australia sent 8 per cent. and Uruguay 6 per cent. Other Countries 4 per cent., New Zealand 3 per cent., and the United States a small amount. The imports of canned beef, beef extract, etc., amounted to 50,000 tons. Mutton and Lamb.—These increased by 6,150 tons compared with 1927. New Zealand sent nearly 50 per cent. of the total, Argentina sent 27 per cent., Australia 9 per cent., and Uruguay 7 per cent. Sheep and lamb offal, i.e., tongues, hearts, livers, kidneys, etc., amounted to 3,548 tons, canned mutton and lamb 2,439 tons. Frozen Pork.—This class of food increased by 3,000 tons. New Zealand sent nearly half of the total supply; the United States of America and Argentina increased their supplies. 44 Imported Fresh Pork.—The Irish Free State has a field to itself in this class of food and increased her shipments by 3,500 tons. Bacon.—The importation of bacon increased by 17,750 tons. Denmark supplied 60 per cent. of the total. Holland sent an increased supply amounting to 11 per cent. of the total. Other countries also increased their supplies, but the United States of America, Canada and Sweden sent smaller supplies ; the United States sent most of the hams imported. Live Stock.—It was hoped that when the embargo was removed against Canadian cattle, we should receive large supplies of fat and store cattle from that country, but due to the scarcity of beef and the high prices paid for cattle in the United States, only 405 cattle arrived from Canada, and the shippers state they could have obtained more money for the animals in Chicago. The Irish Free State sent 724,372 cattle, 591,691 sheep and lambs, and 318,286 pigs. South Africa sent one small consignment of 140 cattle. smithfield markets. The total quantity of food which passed through the Central Markets, Smithfield, during the year ending March 31st, 1928, aggregated 470,161 tons, a decrease of 19,129 tons compared with the year 1927. Of the total quantity, the percentage supplied from the various countries were as follows, viz.:— Countries. Per cent. Argentina 43.70 British and Irish 27.70 Dominions 18.80 Other Countries 9.80 100.00 Analysis. Beef and Veal. Countries. Tons. Per Cent. Argentina 177,738 or 72.2 Britain and Ireland 43,144 or 17.5 Dominions 8,549 or 3.5 Other Countries 16,630 or 6.8 246,061 or 100.00 Mutton and Lamb. Countries. Tons. Per cent. Argentina 26,357 or 18.9 Australia 6,949 or 5.0 British and Irish 35,660 or 25.6 New Zealand 66,430 or 47.7 Other Countries 3,949 or 2.8 139,345 or 100.00 Pork and Bacon. Countries. Tons. Per cent. British and Irish 36,638 75.80 Dominions 1,724 3.60 Other Countries 9,985 20.60 48,347 100.00 Poultry and Game. Countries. Tons. Per cent. British and Irish 15,286 42.00 Dominions 4,515 12.40 Other Countries 16,607 45.60 36,408 100.00 The Total supplies consisted of:— Beef and Veal 52.30 per cent. Mutton and Lamb 29.60 „ Pork 10.30 „ Poultry and Game 7.80 „ 100.00 45 Over 33 per cent. of all the beef and veal and 37 per cent. of the mutton and lamb imported, passed through the Central Markets, Smithfield; in addition, a very large percentage passed through the twelve City Cold Stores and other markets, i.e., Aldgate and Leadenhall. The above figures will give some idea of the large amount of work performed by the Meat Inspection Staff of the City Corporation. British and Irish supplies, compared with the figures for 1927, show a decrease in Beef, Veal, Mutton and Lamb, and an increase in Pork, Bacon, Poultry and Game. 1927. 1928. Difference. Beef and Veal 47,558 43,144 — 4,414 Mutton and Lamb 39,921 35,660 — 4,261 Pork and Bacon 30,268 36,638 + 6,370 Poultry and Game 12,836 15,286 + 2,450 The feature mentioned in last year's report—of sending beef from Drogheda—has been unsuccessful financially. The quantity of fresh pork and bacon from Ireland has again increased by 6,370 tons over 1927, and 20,915 tons over the figures for 1926. Those are important increases and show how great an industry the pork trade is becoming in Ireland. A considerable amount of disease has been observed in Irish consignments, but the Irish Government is, we are informed, about to pass a new meat inspection law in 1929, and we hope to see good results from the appointment of meat inspectors in all places in Ireland from which meat is exported to Smithfield. Tuberculosis continues to be the most important disease in home-killed meat, and there is shown a considerable increase in the amount of tuberculous beef and pork surrendered in the Markets. Reference has previously been made to lack of inspection in districts from which meat is consigned to Smithfield Markets. While very stringent regulations are in operation in dealing with imported foods, we must admit that meat inspection throughout Rural England is generally far from being satisfactory, and is often referred to by inspection authorities abroad. It is interesting and encouraging to know that several cities and towns are building, have just finished building or considering the establishment of public abattoirs. Amongst those may be included the Corporation of the City of London, who propose to re-model and enlarge their public abattoir at Islington. It is hoped that those new places in which no doubt meat inspection will be conducted on modern principles may stimulate other Local Authorities to take more interest in the purity and freedom from disease of our meat supply. Your Veterinary Officer had the honour of being invited by the Governments of Australia and New Zealand to visit the Dominions and view the meat industry there ; he returned via Canada and the U.S.A., to observe how meat inspection is conducted in those countries. His observations will form the subject of a special report. AMOUNTS OF HOME-KILLED MEAT SEIZED AT SMITHFIELD ON ACCOUNT OF DISEASE, AND THE NATURE OF THE DISEASE. CAUSE OF SEIZURE. Carcases of Beef. Quarters of Beef. Carcases of Mutton. Quarters of Mutton. Carcases of Pork. Quarters of Pork. Carcases of Veal. Quarters of Veal. Heads. Tongues. Lungs. Livers. Mesenteries Plucks. Abscess - 2 14 4 28 4 4 - - - - - - - Asphyxia - - 1 - - - - - - - - - - - Blackquarter - - - - - - 1 - - - - - - - Cachixia 3 — — — 4 — — - - - — - - - Caseous Lymphadenitis - - 1 - - - - - - - - - - - Distomatosis — — 39 — — — — - - - - - - - Dropsy - - 1 - - - - - - - - - - - Emaciation and Hydræmia 6 7 64 - 18 - 4 - - - - - - - Haemorrhages (Musculature) - - - - 4 - - - - - - - - - Jaundice — — — — 3 — 1 - - - - - - - Injury — — 2 — 1 — 1 - - - - - - - Joint Ill - - - - - - 1 - - - - - - - Killed in Extremis — — 2 — 14 — 4 - - - - - - - Manmitis - - 1 - - - - - - - - - - - Myositis - - - - - - 1 - - - - - - - Nephritis — 3 4 — 2 — 1 - - - - - - - Carried forward 9 12 129 4 74 4 18 - - - - - - - G 46 CAUSE OF SEIZURE. Carcases of Beef. Quarters of Beef. Carcases of Mutton. Quarters of Mutton. Carcases of Pork. Quarters of Pork. Carcases of Veal. Quarters of Veal. Heads. Tongues. Lungs. Livers. Mesenteries. Plucks. Brought forward 9 12 129 4 74 4 18 - - - - - - - Ochronosis - - - - - - 1 - - - - - - - Peritonitis — — 3 — 10 — — — - - - - - — Pleurisy and Peritonitis 1 - 1 - 102 - - - - - - - - - Pleurisy — 3 9 - 90 — 2 — - - - - - — Pseudo-leukæmia - - 1 - - - 1 - - - - - - - Pyæmia — — 2 - 1 — — — - - - - - - Rachitis - - 7 - 8 - - - - - - - - - Sarcoma - - 1 - - - - - - - - - - - Sarcosporidia — — 4 - 1 — — — - - - - - — Septicæmia - - - - - - 1 - - - - - - - Tuberculosis Bov. 17 105 — - — — 7 4 34 29 10 7 - — Tuberculosis Porc. — — — - 730 7 — — 5,043 — — — 55 2,090 Totals, 1928 27 120 157 4 1,016 11 30 4 5,077 29 10 7 55 2,090 Totals, 1927 21 22 97 4 642 16 21 8 4,367 65 4 22 — 2,101 Argentina.—This country exported to Great Britain during the year 1928 470,615 tons of beef, 75,570 tons of mutton and lamb, and 2,890 tons of pork (77 per cent. of the beef was chilled). Those figures show a decrease of 107,301 tons of beef, 1,254 tons of mutton and lamb, and an increase of 657 tons of pork. Of those quantities, 177,738 tons of beef and 26,357 tons of mutton and lamb passed through the Smithfield Markets. As occurred during the previous year for a considerable period, the quality and finish of the beef was below the usual Argentine standard, due no doubt to a period of very dry weather in that country. The number of tubercular quarters of beef discovered shows a very considerable reduction, apparently the result of more careful inspection at the place of slaughter, but in conjunction with the other countries from which we obtain mutton and lamb supplies, there is shown a very large increase in the number of sheep carcases found affected with Caseous Lymphadenitis; this has in a great measure been due to the method of examination in the Frigorificos. A new method is being put into operation, from which satisfactory results are expected; hitherto all carcases of mutton and lamb have been imported in the frozen condition. During the year several small consignments of chilled mutton have been received from Argentina. The appearance of those carcases during the weather of autumn and winter has been so good that it was very difficult to detect them from homekilled mutton. The carcases may not appear so good during summer weather, but this new method of transport is important, being a keener competition with home-killed mutton. Whether due to cost of transport it will prove economically a success remains to be proved ; it would appear that it may be so chiefly when home-killed mutton is scarce and high priced. From information supplied, the Government of Argentina appear to be taking careful measures to ensure that no carcases or offal from animals which are affected with Foot and Mouth Disease are exported to Great Britain. Over 70 veterinary officers have been appointed to inspect cattle and sheep on the Estancios prior to their being sent to Frigorificos, and no animals are accepted there unless accompanied by a certificate. If disease is found in a consignment at the Frigorificos, no meat or offal from that consignment is exported to Great Britain. The following table shows comparative figures of diseased meat of Argentine origin for the year 1928 with those for 1927:— Quarters of Beef. Carcases of Mutton. Quarters of Mutton. Pig Carcases. Pieces. 1927. 1928. 1927. 192S 1927. 1928. 1927. 1928. 1928. Abscess 15 24 3 7 - 1 95 63 3 Actinomycosis — 1 — — - - — — — Caseous Lymphadenitis — — 475 1,624 48 56 — — 9 Injury 1 - - - - - - - - Malignant Growth — 1 - - - - - - - Nephritis — — — — — — 1 — — Osteomalacia — 2 - - - - - - - Parasitic Disease — 1 — — — — — — — Pleurisy — 1 — 4 — — 1 — — Pseudo Leukæmia — — 2 1 - - - - - Pyæmia — 2 - - - - - - - Tuberculosis (Hinds) 172 54 - - - - - - - Tuberculosis (Fores) 41 17 - - - - - - 9 Totals 229 103 480 1,636 48 57 97 63 21 47 Australia.—This Dominion exported to Great Britain during the year 1928 50,791 tons of beef and 27,411 tons of mutton and lamb, being 8 per cent. of all the beef and 9 per cent, of all mutton imported from the various countries. In a previous report mention was made of the Alcock electrical defrosting apparatus, which seemed to be a success, but the trade has not taken the process into operation. During 1928, Mr. Rayson, from Australia, introduced another system of defrosting by washing the quarters under an atomised spray, increasing the temperature gradually, and after washing and drying the quarters in a suitable air current, the external appearance of the test quarters was good, as also the sectioned joints. More extensive trials are required before any definite opinion can be given ; all that can be said at present is that the process seems a hopeful one. In all new processes the deciding factor is the demand for the defrosted meat by the retail butcher ; as yet that has not been great. It will be observed from the following table that there has been a considerable increase in the number of sheep carcases found affected with Caseous Lymphadenitis, the reason being as stated in the above remarks on Argentine meat. It is hoped that the suggestions made as to an alteration in the method of examination of carcases and offal at the place • of slaughter will eliminate all imported carcases containing lesion of this ubiquitous disease. Quarters of Beef. Carcases of Mutton. Quarters of Mutton. Pig Carcases. Sides of Mutton. Pieces 1927. 1928. 1927. 1928. 1927. 1928. 1927. 1928. 1928. 1928. Abscess — 2 1 3 — — 2 — — — Caseous — — 71 4,080 10 67 — — 1 5 Lymphadenitis. Tuberculosis — 3 - - - - - - - Total —5 72 4,080 10 67 2 — 1 5 New Zealand.—This Dominion exported to Great Britain 22,936 tons of beef, 139,754 tons of mutton and lamb, and 6,083 tons of frozen pork, or 3 per cent. of all beef, 50 per cent. of all mutton and lamb, and 50 per cent. of the pork. The quality of the lamb and pork exposed for sale in the Central Markets was, as usual, of a high standard. It will be observed by the following table that the number of sheep carcases found containing lesions of Caseous Lymphadenitis, compared with 1927, has increased. Careful tests have been made of sheep carcases in order to find out the percentage of infection; the result has shown that, while not absolutely free from disease, the percentage found affected was such that no hold up of consignments was necessary and that check percentage examination is sufficient. Recommendations similar to those sent to the other countries were sent to this Dominion. Legs Quarters of Beef. Carcases of Mutton. Quarters of Mutton. Pig Carcases. of Pork. 1927. 1928. 1927. 1928. 1927. 1928. 1927. 1928. 1928. Abscess — — 2 — — — 20 78 6 Caseous Lymphadenitis — — 94 102 27 22 — — — Pleurisy — — — — — — — 2 — Pseudo Leukaemia — — 1 — — — — — — Sarcoma — — 1 — — — — — — Tuberculosis — 1 — — — — — — — Total — 1 98 102 27 22 20 80 6 Chili.—In the report for 1927 mention was made as to the number of sheep carcases found to contain lesions of the disease Caseous Lymphadenitis and the steps taken by the importers to have carcases examined at the place of slaughter in Chili. When the new season's consignments arrived a careful examination was made of a number of the carcases, in order to check the value of the inspection in the country of origin; this showed that the whole of the carcases were not free from lesions, and it was necessary to hold the consignments in cold storage until they had been examined; the result will be seen in the following table. Investigation into the reason for carcases which contained lesions having been passed showed conclusively that it was due to the method of examination at the places of slaughter, and this applies to all the countries from which mutton and lamb is imported, viz., that reliance had previously been placed on the palpation of the regions in which are situated the superficial inguinal (or supra-mammary, in females), precrural and prescapular lymph glands. If lesions firm and chronic were present, they could be detected by this method of examination, but if the contents of the lesions were soft or purulent, and surrounded by a considerable amount of fatty tissue, then such lesions were not discovered. The remedy is obvious : all the six lymph glands must be incised at the places and time of slaughter, and a further weakness in the method of inspection strengthened, viz., the retention of the viscera identifiable with each carcase until the examination has been completed. Recommendations to g 2 48 that effect have been submitted through the proper official channels, and it is to be hoped that, in the interests of all concerned, next season's consignments from every country will be free from lesions of Caseous Lymphadenitis. Carcases of Mutton. Sides of Mutton. 1927. 1928. 1927. 1928. Caseous Lymphadenitis 1,535 3,990 402 42 Uruguay.—This country exported to Great Britain 38,660 tons of beef and 20,141 tons of mutton. The chilled beef from Uruguay has improved in type and quality. The breeders and feeders apparently follow the lines adopted by those in Argentina. The inspection of the beef at the place of slaughter has been good, but the inspection of sheep carcases is apparently imperfect, due no doubt to the same method being adopted by the inspectors there as in other countries from which mutton and lamb are imported. The following table shows a very marked increase in the number of sheep carcases found to contain lesions of Caseous Lymphadenitis. Recommendations as to the new method of examination were sent to this country also. Carcases of Mutton. Quarters of Mutton. 1927. 1928. 1927. 1928. Abscess — 2 — — Caseous Lymphadenitis 110 1,866 2 7 Total 110 1,868 2 7 Brazil.—Only small quantities of meat were imported from this country. Some of the beef showed a considerable improvement in type and quality. The following table shows the amount of diseased meat discovered. 1927. 1928. 1927. 1928. 1827. 1928. 1928. Abscess — 11 — — 1 3 1 Caseous Lymphadenitis — — 3 — — — — Parasitic Disease — — — — — 2 — Pleurisy — — — — 1 — — Tuberculosis — 7 — — — — — Total — 18 3 — 2 5 1 Sweden. Gammon of Bacon. Abscess 1 Denmark. Sides of Bacon. Gammon of Bacon. Abscess 2 1 Pleurisy 1 — U.S.A. Pig Carcases. Loin of Pork. 1927. 1928. Abscess 4 1 1 49 UNSOUND MEAT, Etc., REMOVED FROM COLD STORES. Article. No. How Packed. Origin. Cause for Destruction. Tons. Cwts. Qrs. lbs. Beef (Pieces) .... Barrels Argentina Decomposed 0 5 1 12 „ „ 172 Bags Australia Onchocerciasis 5 3 1 14 „ „ 3 „ „ Decomposed 0 3 0 24 „ „ .... .... ” Bone Taint 0 1 3 4 „ (Tins) 2 Cases Argentina Vermin Damg. 0 0 3 11 „ „ 5 „ Australia Decomposed 0 3 0 6 Fish (Various) 31 Cases G.B „ 0 12 3 18 Glands 72 „ Argentina Mould Fungi 1 16 2 14 Lambs 17 .... „ Mould 0 2 4 24 „ 2 .... „ Store Damage 0 0 2 24 „ 1 .... „ Brine Stained 0 0 1 1 „ 18 .... „ Vermin Damg. 0 3 1 16 „ 5 .... New Zealand Brine Stained 0 2 2 0 „ 83 .... „ Mould Fungi 1 2 0 20 „ 1 .... Chili Decomposed 0 0 0 24 „ 7 .... Australia Brine Stained 0 2 2 2 „ 15 .... „ *C.L.A. 0 6 1 4 Mutton (Carcases) 3,042 .... Chili „ 67 12 0 25 „ „ 24 .... New Zealand „ 0 13 0 6 „ „ 1 .... „ Mould Fungi 0 0 1 17 „ „ 90 .... Uruguay Ex. Glands 2 1 3 24 „ „ 1,483 .... „ *C.L.A 42 9 1 17 „ „ 69 .... Argentina .... Ex. Glands .... 1 15 1 22 tt tt •••• .... 485 .... „ *C.L.A. 25 13 0 6 „ „ 2,623 .... Australia „ 54 19 2 21 „ „ 6 .... „ Ex. Glands 0 2 2 20 „ (Pieces) .... .... „ Brine Stained 0 0 0 15 „ „ .... .... „ *C.L.A. 0 0 0 26 „ „ .... .... Argentina Brine Stained 0 0 1 15 „ „ .... .... „ *C.L.A. 0 0 1 2 „ „ .... .... New Zealand Store Damage 0 3 2 8 „ „ .... .... „ Brine Stained 0 1 1 10 „ „ .... .... „ Transit Damg. 0 0 0 20 „ „ .... .... „ Mould Fungi 8 14 3 16 Pork (Carcases) 1 .... Argentina „ „ 0 1 2 2 „ (Pieces) .... .... New Zealand Fire Damaged 0 16 0 8 Poultry (Various) 16 Cases G.B. Water Damg. 0 9 2 20 Rabbits .... .... Australia „ „ 0 0 3 16 Sausages 2 Cases .... G.B. Decomposed 0 0 3 16 Sheep (Hearts) 10 „ Argentina „ 0 1 2 22 „ „ 10 .... Australia Mould Fungi 0 1 2 22 Veal (Pieces) 6 Bags Argentina Decomposed 0 2 0 26 Venison (Carcases) 1 G.B „ 0 0 2 24 216 12 3 0 Total for the Year 1928 = 216 tons 12 cwts. 3 qrs. 0 lbs. „ „ 1927 = 72 „ 4 „ 1 „ 10 „ Increase 144 „ 8 „ 1 „ 9 „ *Caseous Lymphadenitis. 50 LEADENHALL MARKET AND CITY SHOPS. The Leadenhall Market and City Shops have been systematically inspected during the year, and the following table shows the amount and variety of unsound food dealt with:— Bacon (Pieces) 19 Milk (Tins) 250 Beef „ 28 Mutton (Carcases) 15 „ (Tins) 173 „ (Pieces) 25 „ (Sides) 1 Oysters (Bags) 2 Brawn (Cases) 3 Partridges 2,281 Capercailzies 21 Pheasants 717 Cheese (lbs.) 4 Pigeons 2,337 Chickens and Pouissins 255 Plovers 808 Cream (Tins) 118 Ptarmigan 157 Curlew 14 Pork (Carcases) 4 Ducks 1,442 „ (Pieces) 2 Eggs 1,414 Quail 659 Fowls 3,788 Rabbits 6,229 Fruit (Tins) 458 Salmon (Tins) 92 Game (Black) 50 Snipe 632 „ (Unclassified) 798 Spleens 45 Geese 142 Teal 93 Grouse 170 Tongues (Beef) 30 Guinea Fowl 41 „ (Sheep) 24 Hares 786 „ (Tins) 9 Hazelhens 180 „ (Cases) 2 Ham, Green (Cases) 3 Turkeys 506 Heads (Beef) 47 Veal (Cases) 3 „ (Pigs) 14 ,, (Pieces) 5 Herrings (Tins) 2 Venison (Carcases) 8 Kidneys (Boxes) 41 „ (Pieces) 25 Livers (Pigs) 5 Widgeon 128 „ (Ox) 194 Woodcock 120 Lobster (Cases) 16 Total weight for the year 1928 = 27 tons 4 cwts. 2 qrs. 21 lbs. „ „ „ „ 1927 = 25 „ 18 „ 2 „ 25 „ Increase 1 „ 5 „ 3 „ 24 „ SHOWING THE AMOUNT OF VARIOUS FOOD PRODUCTS SURRENDERED TO OR SEIZED BY MEAT INSPECTORS IN THE CITY OF LONDON FOR UNSOUNDNESS, 1928. Countries. Beef in lbs. Mutton in lbs. Pork in lbs. Veal in lbs. Venison in lbs. Goat in lbs. Offal in lbs. Bacon in lbs. Cheese in lbs. Furred Game. No. Feathered Game. No. Tinned Fish in lbs. Butter in lbs. Eggs. No. Milk. No. Meat. No. Argentina 626,235 77,870 2,933 881 – – 32,108 – – – 156 1,176 – – – Australia 29,533 54,886 801 555 — — 1,653 — — 1,769 — — — — — – Austria — — — — — — — — — — 1,821 — — — – – Belgium – – – – – – – – – 6,985 1,099 – – – – – Brazil 170,329 54 — — — — 30 — — — — — – — – – Britain 23,878 43,780 77,673 10,733 2,317 476 71,528 9,900 20 9,985 33,674 1,764 453 1,426 56 – Canada – – – – – – – 13 – – – – – – – – Chili – 16,518 – – – – 439 – – – – – – – – – Denmark — — — — – — — 4,476 — — — – – — – – France — — – —- — — — 1,200 — 2,653 9,164 84 20 — — – Holland — — — — — — — 16,455 — 37 798 1,802 935 — — – Hungary — — — — — — —- — — — 534 — — — – – Italy – – – – – – – – – – 494 – – – – Ireland 4,441 2,655 16,967 5,285 – — 25,395 543 – 5,283 2,842 345 8 – – – New Zealand 52,208 154,095 9,282 640 — — 18,821 — — 75 — — – — – – Russia – – – – – – – – – 15 3,198 – – – – – South Africa – – – – – – 29 – – – – – – – – – Sweden — — — — – — — 882 – — — — – — – – U.S.A. — — 225 — – — 761 48 – — — 758 445 – – – Uruguay 2,357 4,499 — — – — 251 – – — – – – — – — Totals, 1928 908,981 354,357 107,881 18,094 2,317 476 151,015 33,517 20 26,802 53,624 4,909 3,037 1,426 56 Totals, 1927 1,249,681 267,216 122,871 11,017 3,543 329 177,220 32,233 2,007 42,008 41,575 7,899 3,647 8,212 50 13,375 51 SHOWING THE AMOUNT OF VARIOUS FOOD PRODUCTS SURRENDERED TO OR SEIZED BY THE MEAT INSPECTORS IN THE CITY OF LONDON, FOR DISEASED CONDITIONS. 1928. Countries. Beef in lbs. Mutton in lbs. Pork in lbs. Veal in lbs. Goat in lbs. Offal in lbs. Bacon in lbs. Totals in lbs. Argentina 31,491 191,365 6,491 170 .... 4,525 .... 234,042 Australia 6,783 209,972 819 .... .... .... .... 217,574 Brazil 2,004 .... 235 .... .... .... .... 2,239 Britain 12,131 17,653 162,851 2,825 .... 130,964 40 326,464 Chili .... 198,665 .... .... .... 40 .... 198,705 Denmark .... .... .... .... .... 20 20 Holland .... .... .... .... .... 90 90 Ireland 12,461 901 42,805 629 .... 45,484 25 102,305 New Zealand 462 5,926 7,627 .... .... 380 .... 14,395 Uruguay .... 11,534 .... .... .... .... .... 11,534 Totals, 1928 65,332 636,016 220,828 3,624 .... 181,393 175 1,107,368 Totals, 1927 .... 54,372 142,160 142,049 1,583 57 112,070 791 453,212 SUMMARY OF UNSOUND FOOD DESTROYED. Tons Cwts. Qrs. lbs. Central Markets, Smithfield 1,009 0 l 7 Cold Stores 216 12 3 0 Leadenhall Market and City Shops 27 4 2 21 Total for the year 1928 1,252 17 3 0 Total for the year 1928 1,252 17 3 0 Total for the year 1927 1,140 13 1 14 Increase 112 4 1 14 Twenty-six Naval Officers received training in meat inspection at the Central Markets, Smithfield, during the year. EXPORT OF MEAT. During the year 87 certificates were issued at the request of merchants in connection with meat which it was proposed to export to other countries. PUBLIC HEALTH (LONDON) ACT, 1891 .—UNSOUND MEAT—PROSECUTION. Date. Name. Business. Address. Where heard. Before whom. Offence. Result. 21/3/28 Pointer, George Howard Wholes a 1 e Pork Butcher The Red House, Alysham Road, Norwich Guildhall. Ald. Sir T. V. Bowater, Bart., M.P. Under the City of London (Various Powers) Act, 1911, Sec. 39, being the person who consigned the diseased carcase of a pig for sale for human consumption. No Fine, £13 13 0 Costs. CENTRAL MARKETS, SMITHFIELD. *Table showing the average deliveries at the Central Meat Market, and other details for successive quinquennial periods during the past 55 years:— Quinquennium. Annual Average General Supply Seizures by Inspectors % of Unsound Meat. Tons. :wts. qrs. Tons. cwts. qrs. 1874-1878 178,373 10 0 192 18 2 .108 1879-1883 218,200 12 3 282 11 2 .129 1884-1888 249,580 19 2 248 1 2 .099 1889-1893 304,986 5 1 461 15 1 .151 1894-1898 372,440 12 2 749 3 3 .201 1899-1903 410,456 18 1 1,082 13 2 .263 1904-1908 414,906 11 1 1,584 19 3 .382 1909-1913 427,146 0 0 1,520 2 3 .356 1914-1918 324,715 0 0 1.370 11 2 .422 1919-1923 403,364 10 0 1,849 19 0 .459 1924-1928 477,405 0 0 1,210 2 0 .253 * I am indebted to the Clerk and Superintendent of the Central Markets for the figures relating to the market supplies, sources of origin, &c. 52 *The sources of origin of the Central Markets Supplies during the past five years are here expressed in terms per cent. of the total annual deliveries. British. † Foreign Killed. American. Australian and New Zealand. Country Killed. Town Killed. Home Killed. American Killed.1 Per cent. Per cent. Per cent. Per cent. Per cent. Per cent. 1924 16.6 5.2 10.6 0.3 48.4 18.9 1925 14.4 4.9 13.7 10 47.5 18.5 1926 16.1 5.4 8.4 0.9 49.1 20.1 1927 21.1 6.6 4.1 0.2 48.8 19.2 1928 22.1 5.7 4.9 — 48.6 18.7 The following figures supplied by the Superintendent of the Market are of interest:— 1924. 1925. 1926. 1927. 1928. Tons. Tons. Tons. Tons. Tons. Average daily delivery into the Markets 1,560 1,517 1,564 1,594 1,478 **Minimum delivery on any one day 181 147 144 286 256 Maximum delivery on any one day 4,775 5,160 5,259 4,278 3,699 The heaviest weight previously recorded on any one day (20th December, 1926) was .... .... ....5,259 tons. Table showing Weight of Meat delivered, and Meat delivered to Contractors as unsound, during each Month of the Years 1927 and 1928. Month. Meat delivered at the Market, 1927. Unsound Meat delivered to Contractors, 1927. Meat delivered at the Market, 1928. Unsound Meat delivered to Contractors, 1928. Tons. cwts. qrs. Tons. cwts. qrs. Tons. cwts. qrs. Tons. cwts. qrs. January 42,719 0 0 108 6 3 42,535 0 0 68 9 0 February 38,456 0 0 91 14 2 39,256 0 0 98 7 2 March 44,395 0 0 174 13 2 41,207 0 0 54 0 1 April 39,564 0 0 67 14 0 38,686 0 0 57 3 3 May 46,191 0 0 90 17 2 38,503 0 0 100 10 3 June 39,227 0 0 112 16 0 35,200 0 0 151 14 2 July 36,756 0 0 81 12 2 34,736 0 0 100 11 0 August 38,875 0 0 114 15 3 37,457 0 0 108 0 1 September 40,258 0 0 95 12 1 35,413 0 0 71 13 0 October 41,819 0 0 85 13 1 43,046 0 0 139 15 3 November 42,147 0 0 135 12 2 41,944 0 0 142 11 3 December 42,885 0 0 59 14 1 42,174 0 0 160 0 1 Totals 493,292 0 0 1,219 2 3 470,157 0 0 1,252 17 3 One ton in every 375 tons of meat paying toll in the Central Markets, Smithfield, was condemned last year, as compared with one ton in 404 in 1927. *1 am indebted to the Clerk and Superintendent of the Central Markets for the figures relating to the market supplies, sources of origin, &c. ** The minimum deliveries relate to Saturdays when practically no wholesale business at the Market is carried out. † Includes " General Foreign Meat and Produce." ‡ Includes South American Imports. FISH SUPPLIES. 239,024 tons of fish, of which 214,426 were land-borne and 24,598 water-borne, were received at or near Billingsgate Market during the year. This was an increase of 7,370 tons in the land deliveries, and an increase of 1,694 tons in the deliveries by water. MONTHLY FISH RETURNS. * Table showing Weight of Fish Delivered, Fish seized as Unsound, and Percentage of Fish Condemned to that Delivered, at or near Billingsgate Market, and on board boats lying off that place, during each month of the year 1928. Month. Weight of Fish Delivered. Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered. By Land. By Water. Tons. cwts qrs. Tons. cwts qrs. Tons. cwts. qrs. Tons. cwts. qrs. January 15,973 11 3 1,346 10 0 17,320 1 3 50 5 3 1 ton in 344.421 tons, or 0 290% February 16,211 19 2 2,210 0 0 18,421 19 2 145 18 2 „ 126.242 „ „ 0.792 March 18,115 19 2 2,057 15 3 20,173 15 1 125 18 3 „ 160.188 ,, ,, 0.624 April 16,917 12 2 1,896 13 0 18,814 5 2 183 18 1 „ 102.3 „ ,, 0.977 May 19,546 7 0 1,682 14 1 21,229 1 1 268 6 2 „ 79.117 ,, ,, 1.264 June 18,706 19 3 1,697 9 0 20,404 8 3 197 19 0 103.078 ,, ,, 0.970 July 17,483 17 1 2,009 8 2 19,493 5 3 324 16 3 „ 60.009 „ ,, 1.666 August 18,740 13 1 2,519 2 2 21,259 15 3 248 7 1 85.599 ,, ,, 1.168 September 17,641 9 0 2,740 10 2 20,381 19 2 317 0 0 „ 64.296 „ „ 1.555 October 19,210 18 3 2,711 19 2 21,922 18 1 173 15 2 „ 126.157 ,, ,, 0.792 November 18,530 18 3 2,110 17 2 20,641 16 1 113 0 3 „ 182.610 ,, „ 0.547 December 17,345 12 1 1,615 4 0 18,960 16 1 92 5 1 „ 205.509 „ „ 0.480 Totals 214,425 19 1 24,598 4 2 239,024 3 3 2,241 12 1 „ 106.163 „ „ 0.903 * Compiled from the Monthly Returns received from the Fishmongers' Company. 53 Weight of Fish Delivered, Fish seized as Unsound, and percentage of Fish Condemned to that Delivered, at or near Billingsgate Market during 1928 and the five years 1923—1927. Year. Weight of Fish Delivered. Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered. By Land. By Water. Tons. Tons. Tons. Tons. cwts. qrs. 1923 211,736 27,479 239,215 2,007 3 3 1 ton in 119 .178 tons or 0.839% 1924 190,088 21,634 211,722 1,617 7 2 1 „ 130.933 „ 0.763 „ 1925 193,782 25,702 219,484 1,822 0 3 1 „ 113.601 „ 0.832 „ 1926 199,540 23,959 223,499 1,938 9 0 1 „ 115.295 „ 0.867 „ 1927 207,056 22,904 229,960 2,070 1 0 1 „ 111.028 „ 0.900 „ Average (5 years) 200,439 24.337 224,776 1,891 0 2 1 ton in 118.866 tons or 0.841% 1928 214.426 24,598 239,024 2,241 12 1 1 ton in 106.163 tons or 0.903% PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Smithfield Market.—Transport (a) Carriers.—The condition of the vehicles owned by the carriers at Smithfield Market is more satisfactory, but there is still room for improvement. The use of back sheets is gradually being discontinued in favour of the more satisfactory doors. A few carriers still use straw on the floor of their vehicles; this practice must always be viewed with disfavour, owing to the risk that the straw is dirty or infected in the uncertainty as to its previous history. In August a representative from the Ministry of Agriculture visited Smithfield Market to enquire into the risk of infection of meat by Foot and Mouth Disease during transport or handling, and expressed his thorough satisfaction with the methods employed for protection of the meat from infection. (b) Butchers.—During the year several butchers have purchased new vehicles of a high standard of efficiency, but some, far from the ideal, are in use; constant supervision will gradually overcome this difficulty. The use of private cars for transport is increasing, but is discouraged in view of the very unsatisfactory conditions under which the meat is handled and packed, often without any protection against the many sources of contamination which are likely to be met with in this method of transport. A special cautionary letter is sent to offenders. The small carrier cycle used by butchers needs supervision because of the negligence displayed by both the butchers and employees in not covering baskets of meat with clean cloths. Handling.—(a) Licensed Porters.—The matter of the use of overalls and head coverings by licensed porters whilst handling meat is somewhat satisfactory; cases of infringement are usually those of forgetfulness and not wilful intention of ignoring the Regulations. The licensed porters still resent that the employees of inside stall-holders do not wear a head covering when carrying meat. (b) Retail Butchers and their Employees.—With these much supervision is still necessary; although a plea of ignorance is often made, upon investigation it is found to be negligence on the part of the employer in not acquainting his employees of the requirements under the Regulations. This condition is difficult to meet, except by drastic measures. A matter which is still causing dissatisfaction is the watering or washing down of the footways during the loading of meat into vehicles; this places the owner of the vehicle at a disadvantage, in the amount of mud almost inevitably carried into the van by the porter from the wet pavements. The question of urination in the roadway alongside meat vehicles is one which would call for action, but at present we have no power to deal with this evil. The new refuse-collecting vehicles now in use are a great improvement upon the old type and have had a good effect upon the general feeling as to cleanliness in and around the Market. Aldgate Market.—The conditions at Aldgate Market have greatly improved in respect of the shops and transport, but the careless handling of meat by persons not attired in overalls and head coverings is met with in spite of repeated cautioning and the exhibition of notices. H 54 Retail Shops.—The retail butchers and bacon shops are gradually reaching the hygienic standard set under the Regulations, and in practically every case where requirement has been made the alterations and improvements have been carried out with satisfaction to both sides. Difficulty is still experienced in the use of sawdust on floors of shops, owing to excessive and unnecessary quantity. Cold storage chambers have attained a high level of cleanliness, which is being maintained by means of periodical inspections. A few shops have been entirely refitted on the most modern lines, and further advance in this direction is expected in the near future. Premises Used for Manufacture of Meat Foods.-—Many alterations and improvements have been carried out in the above premises, and it can be said that the foodstuffs manufactured in the City are prepared at a high hygienic level. In certain cases of limited space and the age of building, this condition is being maintained by constant supervision. The chief difficulty is the personal cleanliness of the employees. This can only be dealt with by stricter supervision on the part of the persons responsible During the year a bacterial infection occurred in one of the food factories, which necessitated the thorough cleansing and disinfection of all utensils and apparatus used in connection with the particular process of manufacture. The necessary work has been carried out; operations have again been started and continue satisfactorily. Transport by Railway Companies' Road Vehicles.—This method of transport is now much improved, and the undertakings given by the various Railway Companies at the Conference last year have been carried out satisfactorily. Transport and Handling of Irish Meat.—Fresh meat imported from Ireland is variously packed, the packings which require most attention being carcases in wooden or galvanised crates or those wrapped in muslin cloths. Owing to the necessary steamer, railway and road transport, and consequent many occasions on which the meat is handled, care is necessary to ensure that the meat is adequately protected from the several sources of contamination, and in this more supervision is necessary by the responsible persons at the ports of exportation. Several of the crates arriving at Smithfield recently have shown defects, especially as regards the canvas used for lining and cleanliness of the crates. An unsatisfactory condition met with in the trade is contaminations of the head and neck in the carcases where these have come in contact with the floor of the railway waggons and road vehicles in protruding through the crate. The carcase is either too long for the crate or, through careless hanging or handling, the carcase has slipped to the bottom of the crate. A new type of crate is now in use, which, although similar to the wooden crate in construction, is more easily cleansed, being constructed of galvanised iron. Provided the canvas used is renewed when necessary, this is the most efficient crating yet devised. General Observations.—Generally, the conditions under which meat has been handled and transported to and from the City Markets has greatly improved during the past year. Many contraventions of the Regulations due to lack of thought occur, and verbal caution has had the desired effect. A typical example on the part of a person responsible for the managing of transport may be of interest. A large firm owning several depots and butchers' shops had built a fleet of new vans, which had been designed to reduce the risk of contamination. The vehicles attended Smithfield Market daily for supplies, and it was noticed that straw was being used on the floor of the van. This matter was mentioned to an official of the firm. He replied that straw had always been used and that the vans were thoroughly cleansed every night. When it was pointed out that the floor was of teak and therefore easily cleansed, he issued instructions prohibiting the use of straw in meat vehicles owned by the firm. Are muslin cloths an adequate protection against contamination? This matter has arisen owing to the increasing use of sheep muslin shirts as containers for various kinds of small joints and offal. It is generally an unsatisfactory method of protection, owing to the bad condition of the muslin. It is found that discussion of the reasons for absolute cleanliness and its effect in increased trade do good and enable your officers to carry out their duties without friction with those with whom they come in contact. This is preferable to drastic methods. During the year many verbal cautions have been given, 843 cautionary letters have been written, and 21 summonses issued for offences under the Regulations. Fines totalling £90 14s. and costs amounting to £2 18s. 6d. have been imposed. 55 INSPECTION OF FOOD AT CITY WHARVES. The duty of supervision of food at the Wharves is undertaken by Mr. D. E. Sillett, and the following; is a summary of the chief products coming under observation:— SUMMARY OF FOOD DISCHARGED AT CITY WHARVES. Article. Where from. Description of Packages. Total Number of Packages. General Range of Weight of Packages. Butter Holland Packages 126,509 6 lbs.—1 cwt. Bacon „ Bales and Cases 89,309 1 cwt. 2 qrs.—3 cwts. Cheese (loose) „ 461 4 lbs.—56 lbs. „ „ Packages 368,279 24 lbs.—1 cwt. Eggs „ Cases 50,906 84 lbs.—1 cwt. 2 qrs. Lard „ & U.S.A. Packages 4,064 28 lbs.—56 lbs. Compound „ „ 33,743 56 lbs. Margarine „ „ 1,028,193 12 lbs.—56 lbs. Cereals— Barley „ Bags 2,684 100 lbs.—1 cwt. 2 qrs. Beans „ „ 1,635 1 cwt.—2 cwts. Peas „ „ 19,901 1 cwt.—1 cwt. 3 qrs. Cornflour „ „ 288 2 cwts. Semolina „ „ 30 1 cwt.—1 cwt. 2 qrs. Rice Japan „ 1,061 1 cwt.—1 cwt. 2 qrs. Tapioca E. Africa „ 121 1 cwt.—1 cwt. 3 qrs. Coffee E. Africa, Costa Rica and Santos. „ 80,500 1 cwt. 2 qrs. Cocoa and Chocolate E. Africa, Ceylon and Holland. Bags, Cases or Casks. 24,661 28 lbs.—2 cwts. Fruit (Soft):— Apples Australia, New Zealand, Canada, U.S.A. and Holland. Packages 308,454 40 lbs.—2 cwts. Peaches Holland „ 1,328 10 lbs. Plums Holland and Germany „ 3,058 7 lbs.—12 lbs. Pears Australia, Italy and U.S.A. „ 12,299 6 lbs.—28 lbs. Cranberries Holland Boxes 6,984 28 lbs. Currants „ Packages 7,795 6 lbs.—12 lbs. Gooseberries „ „ 3,036 40 lbs.—100 lbs. Strawberries „ „ 33,033 7 lbs.—12. lbs. Cherries „ Baskets 8,765 12 lbs.—40 lbs. Rhubarb „ Bundles 2,919 28 lbs. Fruit (Dried):— Currants Australia and Greece Australia, S. Africa, Greece, California and Spain. Bags and boxes Packages 483,138 28 lbs.—56 lbs. Raisins 880,977 8 lbs.—56 lbs. Sultanas Australia, California, Greece and Smyrna. „ 396,366 24 lbs.—56 lbs. Citrons Spain and Italy „ 947 28 lbs.—56 lbs. Plums California „ 90,396 24 lbs. Dates Persia „ 786 3 qrs. Apricots California „ 8,252 24 lbs. Evaporated Apples „ Cases 1,770 56 lbs. Pears „ „ 14,319 24 lbs. Peaches „ „ 4,200 24 lbs. Figs Greece, Spain and Smyrna. Cases and Bags 82,767 28 lbs.—4 cwts. Fruit Salad California Packages 550 28 lbs.—56 lbs. Fruit (Green):— Oranges Italy and Spain „ 273,740 3 qrs.—1 cwt. 1 qr. Lemons „ „ 302,262 1 cwt. Grapes Holland and Spain „ 143,959 12 lbs.—40 lbs. Melons „ „ 16,949 12 lbs.—1 cwt. 1 qr. Pomegranates Spain „ 682 28 lbs.—1 cwt. 1 qr. Grape Fruit W. Indies and California. 1,550 3 qrs. Vegetables:— Cauliflowers Holland „ 24,302 24 lbs.—40 lbs. Cabbages „ „ 2,753 1 cwt. Carrots „ „ 49,675 40 lbs.—1 cwt. 1 qr. h 2 56 Article. Where from. Description of Packages. Total Number of Packages. General Range of Weight of Packages. Vegetables—contd.:— Lettuce Holland Packages 100,753 12 lbs.—28 lbs. Parsnips „ Bags 3,422 1 cwt. Potatoes Holland, Spain, St. Malo and Algiers. Packages 351,521 56 lbs.—1 cwt. 1 qr. Onions Holland, Spain and Egypt. Bags and Cases 224,446 1 cwt.—1 cwt. 1 qr. Beetroots Holland Bags 336 1 cwt. Tomatoes Holland and Spain Packages 497,168 12 lbs.—56 lbs. Beans Holland „ 2,151 28 lbs.—1 cwt. 2 qrs Radishes „ „ 3,102 28 lbs.—1 cwt. Sprouts „ „ 1,817 100 lbs. Cucumbers „ „ 21,256 12 lbs.—40 lbs. Turnips „ „ 125 28 lbs.—1 cwt. Peas „ Bags 2,113 56 lbs.—1 cwt. Sugar „ „ 113,057 1 cwt.—2 cwts. Tinned Goods:— Vegetables Italy and Spain Cases 14,776 50 lbs.—100 lbs. Tomatoes „ „ 131,196 50 lbs.—100 lbs. Pines Singapore „ 124,669 48 lbs. Pears California „ 39,439 48 lbs. Peaches „ „ 107,444 48 lbs. Apricots „ „ 23,411 48 lbs. Cherries Italy „ 51,928 24 lbs.—48 lbs. Fruit Pulp Australia, Holland and Spain. „ 4,835 72 lbs.—100 lbs. Fruit Salad California „ 10,988 48 lbs. Condensed Milk Ireland and Holland Cases and Casks 1,088,708 48 lbs.—3 cwts. Grape Fruit California Cases 722 50 lbs. Loganberries „ „ 18,105 48 lbs. Corned Beef Argentine and Holland „ 8,343 72 lbs. Salmon Canada and U.S.A. „ 19,302 48 lbs. Sardines Portugal „ 5,820 56 lbs.—1 cwt. Brawn Holland „ 7,804 36 lbs. Tongues „ „ 1,911 48 lbs. Veal „ „ 2,532 36 lbs. Hams „ „ 1,684 12 lbs.—20 lbs. Blackberries Italy „ 200 28 lbs.—1 cwt. Greengages „ „ 760 14 lbs.—1 cwt. Pilchards Portugal „ 4,844 1 cwt.—1 cwt. 3 qrs. Asparagus California „ 1,227 56 lbs.—1 cwt. Pork and Beans America „ 5,850 56 lbs. Sterilized Cream Holland Drums 5,123 14 lbs.—56 lbs. Other Tinned Goods Italy and Spain Cases 1,632 48 lbs.—1 cwt. Sausages Germany and Holland 174 56 lbs.—1 cwt. Macaroni Italy Packages 116,586 28 lbs. Nuts (Various) Italy, Spain, Turkey ,, 37,691 28 lbs.—2 cwts. Milk Powder Holland ,, 23,164 50 lbs.—1 cwt. Milk Sugar ,, ,, 30 100 lbs. Ginger (Preserved) China Casks or Cases 5,492 30 lbs.—3 cwts. Vegetables in Brine Holland Casks 5,925 3 cwts.—4 cwts. Miscellaneous:— Carraway Seeds ,, Bags 933 1 cwt. 1 qr. Confectionery Holland and Turkey Packages 5,650 28 lbs.—1 cwt. Liquorice Italy „ 513 1 cwt.—2 cwts. Biscuits Holland „ 7,697 1 cwt.—1 cwt. 2 qrs. Sugar Candy „ „ 3,331 28 lbs.—56 lbs. Fruit Pulp Holland and Australia Casks 7,035 4 cwts. Cocoa Butter Holland Packages 2,515 1 cwt.—2 cwts. Drained Citrons Spain and Italy „ 610 I cwt.—3 cwts. Cream (Fresh) Holland Churns and Drums 2,020 50 lbs—120 lbs. Milk (Fresh) „ Churns 1,810 170 lbs. Drained Cherries Italy and Canada Packages 258 28 lbs.—1 cwt. Anchovies Portugal Barrels 346 2 cwts.—3 cwts. Shellfish Holland Bags 1,536 1 cwt.—2 cwts. Rabbits „ Cases 2,461 1 cwt. 2 qrs. Casings Holland and America ,, 5 56 lbs.—1 cwt. 1 qr. 57 UNSOUND FOOD SURRENDERED AT RIVERSIDE WHARVES. As a result of the daily inspection of City wharves, 87 loads of unsound food were removed from these places during the year by the Cleansing Department. The material so disposed of comprised :— Tons. Cwts. Qrs. Tinned Vegetables and Fish 34 5 3 Condensed Milk (removed at request of owners) 2 19 2 Dried Fruit 18 2 Fruit Pulp 9 8 0 Fruit (various) 15 1 0 Vegetables (various) 18 5 2 Vegetables in Brine 17 9 2 Miscellaneous 10 1 3 Total 108 9 2 GENERAL SANITARY WORK. Artizans' Dwellings, Stoney Lane, Houndsditch.—These Buildings, erected by the late Commissioners of Sewers and opened in January, 1885, stand upon ground formerly the site of several courts and alleys in the Ward of Portsoken. There are five "blocks" of Dwellings, severally named King's, Queen's, Prince's, North, and South, designed for occupation by persons of the artizan class, some of the ground floors being let as shops. The Buildings contain 501 rooms, arranged in 241 tenements, and are occupied by 751 persons, compared with 773 in 1927. 79 per cent. are adults and 21 per cent. children (under 14 years). The number of births was 5, viz.: 1 male and 4 females. The birth-rate was 6.6 per 1,000, which is 2.3 per 1,000 below the average for the previous five years. The death rate for 1928 was 9.3 per 1,000 per annum. In addition to these Artizans' Dwellings, the Corporation have erected in Hutchison Street, in connection with a slum clearance scheme, a block of buildings—Bearsted House— which, at the end of 1928 were occupied by 109 persons, of whom 83 per cent. were adults and 17 per cent. children. The building contains 88 rooms arranged in 24 tenements and, as in the case of the Artizans' Dwellings, shops—7 in number—are provided on the ground floor. No births or deaths were recorded during the year. TABLE OF BIRTHS AND DEATHS OCCURRING AT THE ARTIZANS' DWELLINGS, STONEY LANE, HOUNDSDITCH, AND BEARSTED HOUSE, HUTCHISON STREET, DURING THE YEAR 1928. Name of Block. Births. Mortality from all Causes at subjoined ages. Male. Female. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. NORTH BLOCK .... .... 2 .... .... .... .... .... 2 SOUTH „ .... 2 2 .... .... .... .... 2 .... KING'S „ .... 2 2 .... .... .... .... 2 .... QUEEN'S „ .... .... 1 .... .... .... .... .... 1 PRINCE'S „ l .... .... .... .... .... .... .... .... BEARSTED HOUSE .... .... .... .... .... .... .... .... .... Totals l 4 7 .... .... .... .... 4 3 The birth-rate in these Dwellings reached a maximum of 46.9 per 1,000 in 1896, and has since been falling irregularly, but almost progressively. The present rate is 6.6. The rate last year was 7.8. The baths, provided for the use of tenants of these Buildings, which were opened in May, 1904, continue to be extensively used, the number of persons bathing during 1928 being 11,150, of whom 4,173 were males and 6,977 were females. 58 The accompanying table is compiled from the monthly records of attendances at the baths:— RECORD OF ATTENDANCES AT THE BATHS, ARTIZANS' DWELLINGS. Month. Sex. Total. Males. Females. Children. Adults. Children. Adults. January 66 239 113 374 792 February 54 227 115 391 787 March 81 273 118 449 921 April 49 202 113 386 750 May 87 220 141 457 905 June 86 272 180 514 1,052 July 97 313 145 534 1,089 August 109 301 159 462 1,031 September 94 270 124 505 993 October 101 267 91 460 919 November 128 284 121 498 1,031 December 95 258 77 450 880 Totals 1,047 3,126 1,497 5,480 11,150 SANITARY INSPECTIONS. The following is a statement of the work of the Sanitary Inspectors in their several Districts during each month of the year:— WEST DISTRICT—Inspector F. J. Robbins. Month. Premises Inspected. Orders issued. Notices served. Improvements effected. January 300 6 11 20 February 137 5 7 14 March 211 5 7 14 April 216 6 55 19 May 276 6 25 34 June 435 30 52 58 July 135 — 5 10 August 210 5 6 20 September 57 — 4 16 October 160 6 8 18 November 262 5 7 21 December 270 4 3 25 Totals 2,669 78 190 269 MIDDLE DISTRICT—Inspector E. J. Simmons (1/1/28-30/6/28). Inspector G. H. Fowler (1/7/28-31/12/28). Month. Premises Inspected. Orders issued. Notices served. Improvement effected. January 215 3 11 20 February 199 7 16 17 March 216 4 5 24 April 186 5 11 17 May 241 3 4 33 June 238 7 11 37 July 107 3 10 7 August 135 3 — 13 September 121 4 22 10 October 165 7 7 20 November 287 6 8 21 December 339 5 4 23 Totals 2,449 57 109 242 59 EAST DISTRICT—Inspector W. H. Ralph. Month. Premises Inspected. Orders issued. Notices served. Improvements effected. January 184 1 5 15 February 243 3 8 25 March 235 4 7 29 April 177 4 7 24 May 273 4 8 29 June 415 11 15 38 July 75 1 2 10 August 113 2 5 23 September 205 5 8 40 October 215 7 11 23 November 243 4 7 29 December 363 6 13 33 Totals 2,741 52 96 318 THE FOREGOING ARE SUMMARISED AS UNDER:— District. Number of inspections made. Orders issued. Notices served. Improvements effected. West 2,669 78 190 269 Middle 2,449 57 109 242 East 2,741 52 96 318 Totals 7,859 187 395 829 REGISTERED LODGING HOUSES. Public Health (London) Act, 1891, Sec. 94; and Housing Act, 1925, Sec. 6. The Corporation, as the Sanitary Authority in the City, are required, under the provisions of Sec. 94 of the Public Health (London) Act, 1891, and Section 6 of the Housing Act, 1925, to make and enforce Bye-laws with respect to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family for the following purposes:— For regulating the number of persons and separation of the sexes, For the registration and inspection of such houses. For enforcing drainage and promoting cleanliness and ventilation. For requiring adequate and accessible and, where necessary, separate provision of closet accommodation, washing accommodation, and accommodation for the storage, preparation and cooking of food. For the keeping in repair and adequate lighting of any common staircase. For the cleansing and redecorating of the premises, and for the paving of the courts and courtyards. For the provision of handrails for staircases. For securing adequate lighting. For the taking of precautions in any case of infectious disease. Particulars relating to the registered Lodging-houses in the City now on the Register are given in the accompanying table :— District. Number of Houses on Register. Number of Lodgers. Number of Tenements. Average Number of Persons per Tenement. Cleansing Notices Served. West 43 338 136 2.4 65 Middle 3 15 10 1.5 3 East 17 119 67 1.7 25 Total 63 472 213 2.0 93 These houses are periodically inspected, and in April of each year the owners or tenants are called upon to carry out a thorough cleansing of them, in accordance with the provisions of the Bye-laws. This necessitated the service of 93 notices during 1928. In addition to the foregoing, there are eleven blocks of Dwellings let out in tenements, but not placed on the Register for the reason that each holding is "self-contained," it having 60 been decided in a Court of Law that in these circumstances they are not subject to the Byelaws for houses let in lodgings, or occupied by members of more than one family:— Name and situation of Artizans* Block Dwellings. No. of Tenements. One Room. Two Rooms. Three Rooms. Four Rooms Five Rooms or more. No. of Inhabitants. WEST DISTRICT. Albion Buildings, No. 21, Bartholomew Close .... 10 .... .... .... 22 Albion Buildings, No. 22, Bartholomew Close .... 10 .... .... .... 14 Bartholomew House, Bartholomew Close 14 3 34 Dean Street Blocks, Fetter Lane— Block A 5 2 .... .... ....16 „ B 2 3 .... 1 .... 15 „ C 4 2 .... 1 ....18 „ D 6 1 .... 1 .... 17 „ E 7 1 1 .... .... 15 „ F 4 3 .... .... .... 13 St. Ann's Chambers, Ludgate Hill 3 15 .... 1 .... 36 Bloomfield House, Snow Hill .... 16 .... 4 .... 42 Total (Six "Blocks") 45 66 1 8 – 242 MIDDLE DISTRICT. Bridgewater House, Fann Street 7 .... 1 1 14 City Buildings, Moor Lane 1 21 11 .... .... 76 Total (Two "Blocks") 1 28 11 1 1 90 EAST DISTRICT. Harrow Alley and Stoney Lane— North Block .... 48 8 .... .... 181 South „ 5 22 13 134 Prince's 5 50 .... .... .... 158 Queen's „ 5 40 5 .... .... 137 King's „ 8 16 16 121 Barker's Buildings, Catherine Wheel Alley, Bishopsgate 9 5 2 1 .... 43 Bearsted House, Hutchison Street .... .... 8 16 .... 109 Total (Three "Blocks") 32 181 52 17 .... 903 These eleven blocks contain 444 tenements, and are inhabited by 1,235 persons—an average of 2.7 persons to each tenement. HOUSING SCHEME. The housing schemes which have been undertaken by the City Corporation during recent years, and which were necessitated by the demolition of certain insanitary areas in the City, are now practically completed, and in order to determine whether any extension of these, or the promotion of any new schemes are necessary, I have, personally, during the past year, made a special point of conducting an inspection of the residential property still remaining in the City which might be regarded as coming within that class, demolition of which was possibly desirable. As a result of this inspection I formed very definite conclusions, based on the examination of these houses, primarily from a sanitary point of view, but not neglecting an examination of the type of persons who inhabit them. I found that:— (1) The large majority of the houses inspected could not be closed. (2) The few remaining for consideration are obviously only awaiting the removal of the Rent Restriction Act or cessation of tenancy before demolition is effected on economic grounds. (3) The majority of persons inhabiting the few houses on which a closing order would be within the range of possibility are not of the class and type who would, or could, be housed comfortably in such accommodation as was available at the time of my inspection, in the property erected by the Corporation under the housing scheme in the neighbourhood of Middlesex Street, due regard being paid to environment and enhanced rent. One of the difficulties in determining that a house was unfit for occupation results from the rigid attention which has been given to the Corporation Bye-laws under the system of sanitary supervision in vogue in the City, as none of the houses were uninhabitable as a result 61 of sanitary defect. Such bad qualities as were found were associated with want of through ventilation and sunlight, and with the difficulty of preserving amenities in consequence of the awkward position of the sanitary accommodation or the water-supply. These latter, however, were in no case insufficient or inefficient. I have formed the very definite opinion that the housing question in the City is not now one which would justify the City Corporation in embarking upon any further housing schemes. The following table is included in this Report in accordance with the request contained in the letter from the Ministry of Health, dated 13th December, 1928, and relating to contents of annual reports of Medical Officers of Health:— Number of New Houses erected during the year— (a) Total (including numbers given separately under (b) ) .... In City 40 Outside City Nil. (b) With State Assistance under the Housing Acts: (i.) By the Local Authority Nil. (ii.) By other bodies or persons Nil. 1. Inspection of Dwelling Houses during the Year: (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 814 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,080 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 32 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 145 3. Action under Statutory Powers during the Year: A.—Proceedings under Section 3 of the Housing Act, 1925: (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners Nil. (b) By Local Authority in default of owners Nil. 3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B.—Proceedings under Public Health Acts : (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 116 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By owners 112 (b) By Local Authority in default of owners Nil. C.—Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925: (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling houses in respect of which Closing Orders were made Nil. (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. (4) Number of dwelling houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. Common Lodging-House, 116, Middlesex Street.—The above premises, which are known as the "Salvation Army Working Men's Hotel and Shelter," and is the only common lodginghouse in the City, was opened on the 7th February, 1906. It was utilised during the War as I 62 a Soldiers' Hostel, but is now again in use as a common lodging-house. The premises are periodically inspected, and always found to be well kept and in a generally satisfactory condition. Neglect to comply with Water-closet Bye-laws.—No instance of neglect in this respect has occurred during the year under review. Drainage Plans.—In the course of the year 231 plans were submitted with regard to proposed reconstruction of water-closets or drains in the City. Of these, 216 were approved; 9 revised and, approved; and 6 not approved. Street Gullies.—The gradual substitution of properly trapped gullies for those formerly existing has greatly reduced the number of complaints received of offensive smells arising from those appliances, especially in warm weather. In some cases this nuisance was doubtless due to want of flushing, but in the majority faulty construction was the cause of the trouble. The City Engineer has given special attention to this matter for several years past, and his action in replacing the old pattern gullies with those of a more up-to-date design will, I hope, eventually lead to a complete abatement of the evil. Overcrowding.—Overcrowding is a nuisance to be dealt with summarily under Section 2, Sub-section 1 (e) of the Public Health (London) Act, 1891, and during the year no case was reported by your officers. Sanitary Defects and Infectious Disease.—In every case of notification of infectious disease, the premises involved were inspected with regard to the drainage system, water supply, ventilation, &c.; and of the 81 cases so investigated in 1928, it was found necessary to make amendments to soil and waste pipes, water-closets, &c., in 49 instances. House, Trade, and other Refuse Removal.—The City Engineer informs me that the refuse removed from the City in 1928 consisted of 24,085 cartloads of street sweepings and slops, and 47,830 loads of house and trade refuse, a total of 71,915 loads. The total for the year 1927 was 67,964. The use of the Destructor was discontinued in September, 1905, since which date all refuse has been removed by barge from Lett's Wharf to the Corporation land on Hornchurch Marshes, where it is dealt with. The horse manure collected from the street orderly bins is not included in the above, but is dealt with by a contractor, who sells it to market gardeners and others. Legal Proceedings.—During the year, 395 notices have been served by the District Inspectors at the order of the Sanitary Committee, and in one case it was found necessary, in consequence of non-compliance therewith, to refer the matter to the City Solicitor. The matter is still under consideration. Summer Flushing of Courts.—There are 161 courts and narrow passages throughout the City, which were regularly flushed during the summer months, under the direction of the City Engineer, who informs me that in this service, and the flushing of the main streets, no less than 20,566,042 gallons of water were used. Of these courts and alleys, seven were flushed four times a week, six three times a week, three twice a week, 21 once a week, five once a month, and 119 every two months. Disinfectants are also freely applied where desirable. I he condition of the approaches to Billingsgate Market and the Customs House, as heretofore, required special attention. There has always been a difficulty in keeping the thoroughfares in the immediate vicinity of these places free from nuisance caused by the drippings from the fish carts, especially during hot weather. Limewashing of Courts.—There are 60 courts and narrow passages situated in various parts of the City, the walls of which, unless cleansed frequently become dirty and unsightly through the constant traffic of passengers or vehicles, together with the action of the smokeladen atmosphere. These are cleansed or limewashed twice a year under the direction of the City Engineer. Of the places so dealt with during 1928, 19 were situated in the East District, 24 in the Middle District, and 17 in the West District. 63 Defective Connections to Sewer.—During the year, 24 reports were received from the City Engineer respecting the condition of connections between the drains of certain City houses and the public sewer. Investigations showed that it was necessary to reconstruct all of the connections referred to. Of these, 20 have been completed and the remainder are, at the time of writing this Report, in process of reconstruction. As a result of the inspection of the internal drainage system of these premises, reconstruction or alteration was found necessary in eleven instances. In the majority of cases these external drains were brick-barrel drains, in which rats had their breeding-places, and were, undoubtedly, a source of much annoyance to the occupiers of the houses to which they were connected. PIGEONS. In the Annual Report for the year 1927, reference was'made to the steps which were being taken to reduce the number of pigeons infesting the City of London. Powers authorising action in this matter were conferred by the London County Council (General Powers) Act, 1927. During 1928, of 2,004 birds captured, 2,000 were killed under the supervision of my officers (by dislocation of the vertebrae), and four "ringed" birds were forwarded to the Homing Union in accordance with an arrangement entered into with that Union, who were naturally desirous that private and perhaps valuable homing pigeons would not be destroyed in the general round-up. The birds were caught mainly by hand, the rather more elaborate trapping methods at first attempted not proving as successful as was hoped. They were captured in the vicinity of St. Paul's Cathedral, Guildhall, Mansion House, the Royal Exchange and certain other centres of congregation. It will, of course, be necessary to embark again upon the trapping from time to time, but care will always be exercised to ensure that the birds are not entirely cleared from the City, as the sentimental and aesthetic association with such historic structures as St. Paul's Cathedral and the Guildhall justify their retention in, at any rate, small numbers. FLY NUISANCE. The attention which it has been customary to give to the possibility of the spread of infection by flies during the summer months has been continued. Leaflets were distributed throughout the City calling attention to the nuisance which is created by the fly and indicating certain precautionary measures which should be taken in order to minimise the danger and nuisance so far as practicable. Your officers, where opportunity offered, made a special point of directing attention of residents and others to the necessity for the strict observance of cleanliness, frequent removal of dust and other refuse, and particularly of waste foodstuffs. Special attention was given to the conditions existing at the several stables situated in the City, where it was found that the necessity of maintaining these in such a condition as to obviate nuisance, was generally appreciated. The services of the several Ward Beadles were utilised in directing attention to the subject by the exhibition of posters in their wards, and I wish to acknowledge the assistance they have rendered which, by reason of their intimate knowledge of their districts, was of considerable value. EXHUMATION OF HUMAN REMAINS. (ST. OLAVE'S BURIAL GROUND.) During excavations for building on the site of St. Olave's Church Burial Ground, situate at the corner of Seething Lane and Crutched Friars, a quantity of human remains were discovered during the year. The site was vested in the Port of London Authority by the Port of London Act, 1912, but was originally a churchyard, consecrated, so I am informed, in 1680 as an additional burial ground for the Parish of St. Olave, and burials are reported to have taken place there until it was closed in 1780. I 2 64 The remains discovered represented probably 150-200 bodies, but they did not present any indication of orderly interment, and if the site was used for burials in the customary reverent manner the remains must since have been disturbed. The Port of London Authority, desirous of affording decent re-burial in consecrated ground, purchased a grave in the City of London Cemetery at Ilford, to which the remains were transferred, with due regard to reverence, on the 18th October, 1928. EXHUMATION AND REINTERMENT OF BODIES. City of London Cemetery.—During the year the bodies of five persons buried at the City of London Cemetery at Ilford have been exhumed and subsequently re-interred in the same Cemetery. In accordance with the terms of the licences issued by the Home Secretary in respect of these cases, the work of removal and re-interment was carried out in the early morning under the supervision of your Medical Officer of Health. FACTORY AND WORKSHOP ACT, 1901, &.c. Factories, Workshops and Workplaces.—The premises upon the Register number 3,822, in which are included 8,269 workrooms, &c. There were served 1,879 notices during the year for various purposes under the Acts. The number of Factories, Workshops and Workplaces at present Registered is as follows:— Registered Places.Workrooms, &c. in, Registered Places. FACTORIES 1,174 3,688 WORKSHOPS 1,550 2,354 WORKPLACES:- Kitchens of Restaurants and Tea Rooms 626 1,177 Kitchens of Licensed Premises 231 613 Stables 15 15 Other places 226 422 3,822 8,269 The following is a Summary of Inspections of separate workrooms, &c., during the year:- Workshop Inspectors. Woman Inspector. Totals. FACTORIES 1,383 — 1,383 WORKSHOPS 1,093 1 1,094 WORKPLACES 845 1 846 The following is a Summary of Inspections of separate workrooms, since 1919:— FACTORIES. Workshop Inspectors.Woman Inspector. Totals. 1919 995 7 1,002 1920 866 — 866 1921 1,956 2 1,958 1922 1,763 — 1,763 1923 1,517 — 1,517 1924 1,050 — 1,050 1925 1,119 — 1,119 1926 1,419 — 1,419 1927 1,298 — 1,298 1928 1,383 — 1,383 WORKSHOPS. Workshop Inspectors. Woman Inspector. Totals. 1919 1,069 18 1,087 1920 731 — 731 1921 1,958 — 1,958 1922 1,598 — 1,598 1923 1,387 — 1,387 1924 1,159 — 1,159 1925 1,219 — 1,219 1926 1,242 7 1,249 1927 1,259 — 1,259 1928 1,093 1 1,094 65 WORKPLACES. Workshop Inspectors. Woman Inspector. Totals. 1919 445 41 486 1920 618 — 618 1921 979 38 1,017 1922 957 1 958 1923 675 33 708 1924 730 2 732 1925 613 — 613 1926 821 42 863 1927 1,041 1 1,042 1928 845 1 846 Bakehouses.—Bakehouses are scheduled as Workshops (Part 2, Sixth Schedule), and are required to be registered by the Local Authority (Section 131). The following is a list of Bakehouses registered in the City :— ABOVEGROUND BAKEHOUSES. † 280, Bishopsgate. † Great Eastern Railway Hotel. UNDERGROUND † 188, Aldersgate Street. 262, Bishopsgate. 8, Copthall Avenue. †*67, Farringdon Street. *93, Fetter Lane. 48, Knightrider Street. †* 85, Middlesex Street. †12 and 13, Widegate Street. BAKEHOUSES. †* 37, Middlesex Street. †* 122, Middlesex Street, † 3, Pancras Lane, † 21, Stoney Lane. 68, St. Mary Axe. 194, Upper Thames Street. SUMMARY. Aboveground Bakehouses 4 Underground Bakehouses 12 16 * These have been established at least 42 years. † Factory Bakehouses (power is used). Outworkers and, Home-workers.—The provisions of the Act relating to "Outworkers" were carried out as heretofore, and the lists of the names and addresses of workers receiving work from the City firms were duly received without the necessity for legal proceedings. In 15 cases employers neglected to keep lists at their premises and to send copies of the same to the Corporation as required by the Act. Notice in each case was served upon the offender and in all cases complied with. No case of infectious disease was reported in connection with premises occupied by outworkers in the City. The following figures show the number of Outworkers notified since 1902:— Year. Number of Lists received. Outworkers Employed in City Outworkers Employed outside City. Total number of Outworkers. 1902 17 3,752 3,769 (Note.—First Notice issued to all employers at the end of 1904.) 1905 576 236 7,891 8,127 1908 1,506 624 16,909 17,533 1911 1,515 656 16,405 17,061 1912 1,481 709 15,777 16,486 1913 1,523 718 16,025 16,743 1914 1,581 739 15,941 16,680 1915 1,589 807 15,444 16,251 1916 1,481 661 14,766 15,427 1917 1,366 602 13,319 13,921 1918 1,395 607 12,802 13,409 1919 1,379 688 12,581 13,269 1920 1,359 802 13,102 13,904 1921 1,411 717 11,035 11,752 1922 1,493 783 11,956 12,739 1923 1,406 701 12,114 12,815 1924 1,426 848 12,234 13,082 1925 1,391 874 12,061 12,935 1926 1,352 889 11,514 12,403 1927 1,338 846 11,230 12,076 1928 1,307 879 10,897 11,776 66 SUMMARY OF WORK DONE UNDER THE FACTORY AND WORKSHOP ACT, 1901, AND THE PUBLIC HEALTH (LONDON) ACT, 1891, &c. INSPECTIONS. East District. Middle District. West District. Totals. Factories, Initial Inspections (Tenancies) 38 69 47 154 Do. Initial Inspections (Workrooms) 71 110 105 286 Do. Periodical Inspections (Tenancies) 86 109 180 375 Do. Periodical Inspections (Workrooms) 221 231 645 1,097 Do. Re-inspections (Sanitary Works, &c., in hand) 126 133 145 404 Workshops, Initial Inspections (Tenancies) 24 49 35 108 Do. Initial Inspections (Workrooms) 34 63 47 144 Do. Periodical Inspections (Tenancies) 223 238 162 623 Do. Periodical Inspections (Workrooms) 330 333 242 905 Do. Re-inspections (Sanitary Works, &c., in hand) 305 230 124 659 Workplaces, Initial Inspections (Tenancies) 5 5 14 24 Do. Initial Inspections (Workrooms) 9 8 24 41 Do. Periodical Inspections (Tenancies) 14 14 26 54 Do. Periodical Inspections (Workrooms) 31 25 49 105 Do. Re-inspections (Sanitary Works, &c., in hand) 33 30 47 110 Bakehouses, Periodical Inspections (Tenancies) 16 10 8 34 Do. Periodical Inspections (Workrooms) 20 14 10 44 Do. Re-inspections (Sanitary Works, &c., in hand) 20 7 7 34 Kitchens of Restaurants, &c.— Initial Inspections (Tenancies) 9 17 19 45 Initial Inspections (Workrooms) 21 36 37 94 Periodical Inspections (Tenancies) 62 62 62 186 Periodical Inspections (Workrooms) 168 140 112 420 Re-inspections (Sanitary Works, &c., in hand) 141 177 162 480 Kitchens of Licensed Premises— Initial Inspections (Tenancies) 1 — 1 2 Initial Inspections (Workrooms) 3 — 3 6 Periodical Inspections (Tenancies) 28 24 46 98 Periodical Inspections (Workrooms) 85 71 123 179 Re-inspections (Sanitary Works, &c., in hand) 21 51 77 149 Workshops notified by H.M. Inspector — — — — General Complaints received 10 9 7 26 Miscellaneous visits 102 156 186 444 DEFECTS FOUND. FACTORIES, WORKSHOPS, WORKPLACES. KITCHENS OF RESTAURANTS, &c. KITCHENS OF LICENSED PREMISES. East District. Middle District. West District. East District. Middle District. West District. East District. Middle District. West District. Totals. Want of Cleanliness 104 28 16 40 22 15 9 5 7 246 Want of Ventilation 1 11 1 12 12 2 — — — 39 Overcrowding 1 1 — — — — — — — 2 Want of Drainage of Floors 2 — — 14 1 — — — — 17 Want of Lavatory Accommodation — — — — — — — — — Food improperly stored — — — 7 8 4 — 1 — 20 Storage Cistern defective 2 2 10 3 2 8 1 3 6 37 Accommodation for Refuse 1 2 3 1 6 1 — 1 — 15 Accumulation of Refuse 5 6 8 5 1 — — 1 — 26 Sanitary Accommodation. Insufficient (Tenancies) 1 1 1 — 2 3 — — 2 10 Unsuitable (Do.) 2 — 9 — — — — — — 11 Defective (Do.) 87 74 58 18 9 13 2 5 10 276 Do. (No. of Conveniences)* 92 75 69 18 9 15 2 5 13 298 Not separate for Sexes (Tenancies) 6 19 6 1 1 — — — — 33 Other Nuisances 88 17 16 34 31 12 5 10 7 220 Total Defects found 300 161 128 135 95 58 17 26 32 952 * Figures not included in total defects found or remedied. 67 DEFECTS REMEDIED. FACTORIES, WORKSHOPS, WORKPLACES. KITCHENS OF RESTAURANTS, &c. KITCHENS OF LICENSED PREMISES. East District. Middle District. West District. East District. Middle District. West District. East District. Middle District. West District. Totals. Want of Cleanliness 74 21 21 28 17 22 4 4 8 199 Want of Ventilation 3 8 — 9 8 3 — 1 1 33 Overcrowding — — — — — — — — — — Want of Drainage of Floors 7 — — 10 1 — — — — 18 Want of Lavatory Accommodation — — — — — — — — — — Food improperly stored — — — 4 6 6 — — — 16 Storage Cistern defective 2 4 9 2 2 14 — 1 3 37 Accommodation for Refuse 1 5 2 — 8 3 — — — 19 Accumulation of Refuse 6 10 7 2 1 2 — — — 28 Sanitary Accommodation. Insufficient (Tenancies) 1 1 1 — 2 5 — — — 10 Unsuitable (Do.) — — 7 — — 3 — — — 10 Defective (Do.) 64 69 68 14 11 16 2 4 9 257 Do. (No. of Conveniences)* 80 70 130 14 11 26 2 4 11 348 Not separate for Sexes (Tenancies) 6 12 6 — 1 1 — — — 26 Other Nuisances 71 14 19 26 28 14 2 9 7 190 Total Defects remedied 235 144 140 95 85 89 8 19 28 843 ACTION TAKEN. East District. Middle District. West District. Totals. Matters referred to H.M. Inspector— Nuisances remediable by H.M. Inspector 3 2 l 6 Failure to affix Abstract 14 7 5 26 Matters referred by H.M. Inspector— Notified by H.M. Inspector 28 20 15 63 Reports sent to H.M. Inspector 20 20 15 55 Notices served— Factories—Intimation 12 12 8 32 Statutory — 1 7 8 Workshops—Intimation 30 9 12 51 Statutory 1 6 7 14 Workplaces, &c.—Intimation 1 1 6 8 Statutory — — 4 4 Kitchens of Restaurants— Intimation 7 15 18 40 Statutory — 1 13 14 Kitchens of Licensed Premises— Intimation 3 — 4 7 Statutory — 1 5 6 Orders required from Sanitary Committee 28 28 33 89 Certificates for Cleansing issued by Medical Officer of Health 8 7 10 25 Matters referred to District Inspectors 5 4 2 11 Matters referred to Woman Inspector — — 1 1 Matters referred to Workshop Inspectors — — — — Cases reported for Legal Proceedings — — — — Legal Proceedings taken — — — — OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, &c. Lists received from City Firms — — — 1,387 Names and Addresses, &c., received from other Authorities — — — 352 Names and Addresses transmitted to other Authorities — — — 10,276 Notices served on Employers — — — 1,695 Letters written, &c. — — — 17 Firms visited 12 54 25 91 Outworkers Lists not kept 1 12 2 15 Do. not sent 1 12 2 15 Infectious Disease occurring in Outworkers' Premises — — — — Registered Factories and Workshops at which Outwork is received— Inspections 67 71 31 169 Defects found 98 24 9 131 Defects remedied 90 20 3 113 "Places from which work is given out"— Inspections 1 6 7 14 Defects found — 1 1 2 Defects remedied — 1 2 3 * Figures not included in total defects found or remedied 68 WOMAN INSPECTOR. Total. Domestic Workshops at which Outwork is received Inspections – Defects reported and appropriate action taken – Domestic Workshops which do not receive Outwork Inspections 1 Defects reported and appropriate action taken – Domestic Premises receiving Outwork (not registerable as Workshops). Inspections 1 Defects reported and appropriate action taken – Underground Conveniences for Women Inspections 30 Defects reported and appropriate action taken 6 Railway Stations (Ladies' Rooms) Inspections 34 Defects reported and appropriate action taken 9 Kitchens Inspections – Defects reported and attended to or referred to appropriate Inspector – L.C.C. (G.P.) Act, 1904. Inspection of premises after cleansing of children Notifications received 8 Visits 6 Defects reported and appropriate action taken 2 Children Act, 1908 (Nurse Children) Notifications received 5 Visits 7 Defects reported and appropriate action taken – Births notified 78 Notification of Births Act, 1907 Home visits to infants 291 Home visits to children between 1 and 5 years of age 178 Visits re Still Births 1 Deaths of Infants under 1 year of age Number Notified 5 Visits 2 Expectant Mothers 17 Distribution of Milk (Free) Nursing Mothers 62 Children under 6 months – Children over 6 months 37 Number of children in receipt of:— Distribution of Dried Milk Free — Reduced or Cost Price 19 Number of Mothers attending Infant Welfare Centre 101 Total Attendances of Mothers at Infant Welfare Centre 1,056 Expectant Mothers visited at home 79 Special Visits 67 69 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Number of Inspections. Written Notices. Occupiers Prosecuted (1) (2) (3) (4) Factories (including Factory Laundries) 529 40 – Workshops (including Workshop Laundries) 765 65 – Workplaces (other than Outworkers' premises) 409 79 — Total 1,703 184 – 2.—Defects Found, in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspectors (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 246 199 6 — Want of ventilation 39 33 — — Overcrowding 2 — — — Want of drainage of floors 17 18 — — Other nuisances 318 290 — — Sanitary accommodation insufficient 10 10 — — unsuitable or defective 287 267 — — not separate for sexes 33 26 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Other offences (excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) — — — — Total 952 843 6 — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts, No instance of outwork in unwholesome premises under Section 108 of the Factory and Workshop Act was reported. K 70 71 3.—Home Work. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists.f Outworkers.f Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— making, &c. 1,108 4,071 6,223 19 26 48 cleaning and washing 1,695 Household Linen Lace, Lace Curtains and Nets Curtains and Furniture Hangings Furniture and Upholstery Electro Plate File making Brass and brass articles Fur pulling (Furriers) 98 190 244 2 8 – Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, &c. 52 16 412 2 1 11 Artificial Flowers 22 — 154 — — Nets, other than Wire Nets Tents Sacks Racquet and Tennis Balls Paper, &c., Boxes, Paper Bags 4 10 5 — — — Brush making Pea picking Feather sorting Carding, &c., of Buttons, &c. Stuffed Toys Basket making Chocolates and sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, &c. Textile Weaving Total 1,284 4,287 7,038 23 35 59 1,695 Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. * If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 4.—Registered Workshops. 5.—Other Matters. Workshops on the Register (S. 131) at the end of the year. Number. Class. Number. (1) (2) (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133, 1901) 26 General Workshops 1,534 Action taken in matters referred by H.M. Inspector Notified by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5, Reports (of action taken) sent to 1901). H.M. Inspector 63 55 Bakehouses (including Factory Bakehouses) 16 Other – Total number of Workshops on Register *1,550 Underground Bakehouses (S. 101):— Certificates granted during the year Nil. In use at the end of the year 12 Date, 31st December, 1928. (Signature) W. M. WILLOUGHBY, Medical Officer of Health. * These were found to be 2,354 Workrooms, &c., in places Registered. Note.—The Factory and Workshop Act, 1901 (S. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). If the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office, the portions which do not relate to factories, workshops, workplaces, or homework. The duties of Local Authorities, and the Medical Officer of Health under the Act of 1901 are detailed in the Home Office Memorandum of March, 1912. K 2 72 SUPERVISION OF THE ICE CREAM TRADE. Inspections in connection with the manufacture or sale of Ice Cream within the City have been carried out. In cases where the manufacture took place in other areas, the appropriate Local Authorities were informed of the circumstances and requested to state if the premises and process of manufacture were satisfactory. Replies to these enquiries showed, with one exception, the conditions to be satisfactory. In the case mentioned steps were taken by the Authority concerned to stop the manufacture at the premises, and the sale ceased within the City. The barrows or stalls of itinerant vendors were visited from time to time during the Summer season, and in several instances, where lack of cleanliness was observed, the issue of a caution resulted in an improvement being effected. The London County Council (General Powers) Act, 1928, became operative during the year, and requires the registration of certain premises where ice cream is stored, sold, or manufactured. FERTILISER AND FEEDING STUFFS ACT, 1926. The Fertiliser and Feeding Stuffs Act, 1926, which came into operation on tne 1st July, 1928, has thrown upon the Corporation additional responsibilities in regard to the supervision of fertilisers and feeding stuffs. The Act requires, among other things, that the Corporation shall appoint an official agricultural analyst and such inspectors and samplers as may be neceesary to ensure the proper carrying out of the requirements. It is anticipated that in the City the work involved will not be large, but it is essential that these appointments be made to meet possibilities, and the City Analyst, Mr. E. A. Pinchin, B.Sc., has been accordingly appointed Agricultural Analyst, and three of my present sanitary inspectors, Messrs. Harrington, Neale and Tyler, have been provisonally appointed as official samplers and inspectors. If developments should exceed my anticipations, a revision of these appointments and a more elaborate organisation may be necessary. The quarterly reports to the Ministry of Agriculture and Fisheries have been dispatched as a matter of routine. CITY MORTUARY. Bodies Received—Post-Mortems and Inquests:— Bodies received at the Mortuary to await burial 159 Post-Mortem examinations made 93 Inquests held on bodies 147 Inquests held on fires 2 The following tabulation shows the work carried out at the Mortuary and Coroner's Court during the past five years:— Year. Articles disinfected. Bodies received at the Mortuary. Inquests held on bodies. Inquests held on Fires. 1923 355,657 149 128 l 1924 481,391 160 145 0 1925 493,813 150 145 0 1926 305,970 155 139 4 1927 227,037 178 169 1 Average for previous 5 years 372,774 158 145 1 1928 180,530 159 147 2 Disinfection—Trade.—In accordance with the requirements of the South African Government, the disinfection of second-hand clothing, prior to export to that country, has been carried on as usual. The following table gives the details of the work of disinfection carried out at the Disinfection Station during the year in connection with the export trade :— Number of Certificates issued. 620 Number of articles disinfected. 175,782 Fees received by the Corporation. £535 Disinfection—Infectious Disease:— Articles disinfected after cases of infectious disease 4,744 Public Vehicles—Electric Ambulance 2 Police Litter 2 Cleansing of Persons Act, 1897:— Number of verminous persons bathed 68 Cleansing of School Children:— Total number of children cleansed 1,044 379 articles were destroyed at request of owners. In addition to the foregoing, some assistance was rendered to the Metropolitan Borough of Finsbury during a period when the disinfection apparatus operated by that authority was out of use. 73 Preservation of Bodies of Unknown Dead.—The De Rechter apparatus for the preservation of the dead, installed at the City Mortuary, in March, 1909, was fully described in the Annual Report of that year. It has proved of considerable assistance in connection with the identification of persons found drowned in the River Thames. During the year, four bodies were placed in the apparatus, and of these two were subsequently identified. Fire Inquests.—Dr. F. J. Waldo, J.P., Coroner for the City of London and Southwark, has kindly furnished me with the following list of places in the City which were the subject of Fire Inquests held by him during 1928 :— INQUESTS HELD UNDER THE CITY OF LONDON FIRE INQUESTS ACT, 1888. Date of Inquest. Premises Burnt. 24th and 27th September, 1928 1st and 10th Oct., 1928 Subway, Victoria Embankment. 10th Oct., 1928 Do. do. do. In addition to the above, the City Coroner personally inquired into 190 "non-fatal" City fires reported to him during the year. DISINFECTANTS. The disinfectants and other chemicals in use in the Public Health Department and in other branches of the Corporation's service, have, as in the past, been supplied under a contract prepared by your Medical Officer of Health. They are used for deodorising and denaturising unsound meat, disinfecting public conveniences, streets and roadways, premises after infectious diseases, etc. Special attention was given to the thoroughfares in the vicinity of the Billingsgate and Smithfield Markets, the former of which presents certain difficulties in the matter of deodorisation in the summer months. Very few complaints were, however, received of offensive odours necessarily associated with the fish trade. DISINFECTANTS (POISONOUS LIQUIDS)—DISTRIBUTION OF. In view of the danger attending the distribution of poisonous liquid disinfectants in receptacles such as beer bottles, the Ministry of Health have suggested that all such fluids distributed by local authorities should be supplied only in containers distinguishable by touch from ordinary bottles, and that the containers should be labelled boldy in red with the words "Disinfectant—Poison-—not to be taken." Although it is not the practice of my department to distribute disinfectants to the City residents in the way suggested by the circular letter from the Ministry, on such rare occasions that fluids of this nature have been distributed, the precautions suggested by the Ministry have always been adopted, and no instances of illness or any untoward event has ever been reported to me in connection with this distribution. RAT REPRESSION. The table set out on page 76 indicates the number of investigations made and details of work carried out under the Rats and Mice (Destruction) Act, 1919, during the year ended December 31st, 1928. 1,148 buildings, occupied by 2,585 firms, were inspected. Of these, 464 were found to be rat infested. One or other of the rat-catchers working in the City was engaged by business firms in 166 instances, poisons were laid down and traps of the breakback variety used in 639 and mouse traps in 118. Varnish traps were relied on in 228 buildings. Cats or dogs were kept bv 229 firms. Complaints or applications for advice numbered 144. In addition to the above palliative measures, preventive rat-proofing was carried out in 399 instances, and repair of drainage defects in 988. Rat-proofing cannot be relied upon to exclude rodents from buildings. They are brought in in boxes and crates from the docks and enter open doors and windows, especially through roof doors provided for exit in case of fire, yet rat-proofing is extremely important, protecting food and the domestic water supply, lessening fire risk, and disclosing sanitary defects which might otherwise remain undiscovered. Hiding places are eliminated and the decrease of nesting facilities results. In many City buildings rat-proofing is practically impossible, and, further, the owners, who are the only persons competent to deal structurally with the buildings, are not responsible under the Act. Owners should certainly be associated with occupiers in any rat repression work. 74 Throughout the year, in the course of demolition of many old buildings, rats which were disturbed found harbourage in neighbouring buildings, many of which had not been previously infested. In some cases poison baits were laid before demolition began and resulted in the destruction of large numbers of rats. Messrs. William Dalton & Sons, rat-catchers, inform me that they caught 25,748 rats in the City during 1928. Even approximate figures of rat destruction cannot be given, but it can be said that there is a great decrease in the number of rats infesting the City. Owing to constant attention to drains and sewers, the brown rat is fast disappearing, and as new buildings replace the old, a lessening of the smaller black rat will be apparent. Mr. Engineer informs me that, during the year, the following sewerage and drainage works, which reduced the breeding places for rats, were carried out by his department:— Brick sewers reconstructed 7 Brick sewers constructed 7 Brick sewers in course of construction 3 Disued sewers filled in and abolished 6 Miscellaneous repairs to sewers 14 Various drains damaged by rats repaired in sewer 8 Sewers repaired and inverts rendered 3 Branch sewer bricked off 1 Brickwork repaired in manhole 1 Headwall of sewer relined 1 Sewer repaired 1 Disused brick shoot filled in 1 Hydrant pit repaired (Rats) 1 Disused barrel drain abolished 1 Side entrances filled in 2 Sewer connection repaired 1 New drains constructed in connection with new buildings 20 Drains of existing buildings reconstructed 26 House drains constructed and reconstructed in Cavendish Court, Middlesex Street, Cornhill, and New Street and Button Street sewers 66 Gulley drains constructed and reconstructed in connection with the above 40 New gulleys constructed 6 Gulley drains reconstructed 52 House and gulley drains repaired 145 Disused drains bricked up 344 Rats killed by sewer foreman and his men 739 The number of drain reconstructions carried out under the supervision of the Inspectors attached to this department is set out on page 76. Rat-catchers and poisoners are engaged on contract in many of the tea-shops, restaurants, hotels and business premises; several vacant building sites in the City were dealt with under the supervision of this department, and all necessary information was given to representatives who called for advice, and rat-proofing was carried out in 399 buildings. This last consisted of wiring area gratings, ventilators and roof openings, and the stopping of rat holes in walls and floors, the removal of wooden floors from basements, with substitution of concrete and/or the stripping of internal walls of woodwork, which affords breeding places. The cementing of walls and removal of ceilings was done in a few cases-a major proceeding which can hardly be asked of the legally responsible occupier, who would naturally hesitate to report his rat difficulties in face of possible requirements. The Rats and Mice (Destruction) Act is, perhaps, more adapted to rural areas than to larger towns, in that the onus falls on occupier rather than on owner. Observations and records in the City suggest that the brown rat is outnumbered by the black rat by about three to one. The black rat, a climbing rat by habit, is more difficult to deal with, especially where large and high buildings are his field. The number of individual occupiers in any given building or block, and the incidence of defestation, prevents the dealing with a block as a whole, especially where structural work is required. The construction of sound drainage is an important feature, and where the entry of rats is sought, smoke or chemical testing of drains may be misleading. Recently, in Bush Lane, sewer rats were found to be infesting a basement; the drains were water-tested and were sound. Holes in the floor were opened and traced to an outside wall (through which rats had gnawed a run), and thence to a defective sewer. Repair of the sewer and filling in of 75 the runs removed the rat difficulty. In Cullum Street a restaurant was infested by the brown rat. Rats had gained access to the drain from the sewer through the cleaning arm of the intercepting trap, the cap of which was missing ; the rats worked their way through broken drain pipes and burrowed through the basement floor and established themselves behind the matchboarding on the walls. The old drains were properly substituted, and the premises rat-freed. In all cases of drain defects it is the owner, and not the occupier, who is called to remedy the defects under the Public Health (London) Act, 1891. In the presence of the black rat, with its greater climbing capacity, preventive measures against entry must extend to all parts of a building, including the roof. No single occupier of a building can be made responsible for rat riddance in the roof, where ample harbourage for rats often exists under water cisterns, etc. The large areas of continuous roofs give ample scope to evade capture. From the roofs they gain access by rainwater pipes to open windows by way of the chimneys. Occasionally they have gnawed through the frame of a window. Fire-exit doors and roof ventilators also afford entry. The following are the details of a rat-proofing work recently carried out in a City building under the Rat-Officer's advice. Black rats infested this building, entry being through basement windows and other windows, unguarded pipe holes through the walls, and pipe casings leading to all parts of the building. " Make good holes in coal cellar and outside meter room. Make good around hot-water pipes and brickwork in boiler house. Fill in between iron girder in vaults, also stop holes in brickwork in meter house and vaults. " Fix expanded metal and make good in men's lavatory and carpet room. Take down casings in corridor and boiler house, also casings, skirtings, etc., generally for examination, and re-fix after making good as required. Make good holes in passage behind casings and holes in floors. " Hack out broken glass in boiler house and reglaze with wired roll plate glass. Remove broken flaps to fresh-air inlet, supply and fix new, and make good. " Supply and fix 3-inch brass gratings to rainwater pipes. Fix ½-inch mesh wire over hole under stage. Make good brickwork in Reference Library. Remove rat-gnawed felt round pipes in vaults and rebind with new. Cut and fix sheet iron over holes in Reference Library, also over roof of first-floor lavatory. Make good holes in supper room in basement, and also in photographic dark room. Fix expanded metal in passsage where shown. Fix metal plate to foot of door in boiler room. Clear away all rubbish in the basement. Supply twelve galvanised wire-work frames to correct sizes and fix to meter room, store room, area, all basement windows, and also to gentlemen's lavatory in basement, in place of defective wire netting. Make good holes in serving room and refreshment room, and also at back of stage balcony. Engage rat-catcher to rid building of all rats that are shut in after the wiring is completed." Another instance: A building where black rats had entered by way of windows, basement ventilators and chimneys. In this case it was found necessary to wire chimney flues, and fix metal baffle plates to rainwater pipes and wire basement ventilators, etc. The heavy kitchen range was taken out to stop holes in the flue, repair work was done to the lift and cellar entrances, and holes stopped in various parts of the building, where many meals are served to the public daily. Food, again, was the attraction in this building. The rat proofing was effective, but it shut in a large number of rats, which found concealment under floors. A rat-catcher was engaged, and 97 rats were caught in two nights. Break-back and varnish traps will account for the few remaining rats in the building. I wish to point out that these cases were not dealt with under the Act, but, as in several other cases, at the owner's requests for advice. Expense thus incurred in the case of old City buildings approaching demolition is not justifiable—minor rat-proofing work and constant capture and destruction of rodents is all that can be asked for. New buildings, however, should afford a reasonably rat-proof condition from the first; this might well be made a part of every plan, and the additional cost would be infinitesimal. Virus and Poisons.—It has not been the practice of this department to encourage the use of bacterial preparations in City premises. Business firms generally prefer trapping to the use of virus and other poisons. No poison is advised which is not on the official list of the Ministry of Agriculture. Traps.—Various kinds of traps have been used—the ordinary cage trap, the eel-pot, the round wire and other types of wire traps. Norte of them are very successful, and some are constructed of wire so fine that captured rats are able to force the wires apart and escape. The traps which are found to give the best results are the "break-back" and varnish traps, the latter being now in general use and the most successful of all. 76 RATS AND MICE (DESTRUCTION) ACT, 1919. Summary Showing Investigations and Inspections Made and Details of Work Carried Out under the Above Act, for the Year ended December 31st, 1928. Months. No. of Buildings Inspected. Average No. of Firms in building. No. of premises Rat Infested. Total No. of Firms interested. Steps taken to destroy Rats. Rat Proofing done, Rat-holes stopped, &c. Drainage and Sewerage Work carried out during the year. Special Observations. Complaints or Applications for Advice.[/##] Rat-Catcher Employed. Poison Used. Wire Traps. Breakbacks. Varnish Traps. Other Traps. Cats or Dogs kept. By City Engineer's Department. By M.O.H Department. January 105 1.4 35 157 12 24 14 23 18 1 14 30 757 231 16 February 109 1.8 35 203 14 26 5 25 18 2 14 33 12 March 98 2.3 31 232 10 22 8 26 18 1 11 28 9 April 103 3.7 40 377 19 29 8 30 21 2 23 39 11 May 110 1.7 47 195 23 32 18 30 33 3 29 43 9 June July 109 2.2 46 250 18 31 16 32 24 - 16 40 14 August 115 3.5 51 413 20 35 11 39 22 1 38 44 13 September 109 2.4 59 263 12 41 16 37 19 2 38 40 15 October 96 2.5 40 245 22 27 6 26 12 - 18 39 17 November 109 1.2 40 132 8 33 9 26 20 2 16 40 15 December 85 1.3 29 118 8 17 7 31 23 3 12 23 13 Totals * 1,148 2.2 464 2,585 166 314 118 325 228 17 229 399 988 144 *Buildings systematically inspected 1,004 ,, inspected in consequence of complaints 144 Totals 1,148 77 MEDICAL EXAMINATIONS. In accordance with the Standing Order of the Court that no person shall enter the employ of the Corporation or of any of its Committees without previously passing a medical examination to the satisfaction of the Committee having cognizance of the appointment, 63 persons were examined by the Medical Officer of Health during 1928. Three of these persons were reported as physically unfit for office. Twenty-one officers were also medically examined with a view to their retirement. With four exceptions, all were reported to be unfit for duty. I have the honour to be, Gentlemen, Your obedient Servant, W. M. WILLOUGHBY, Medical Officer of Health for the City of London. Public Health Department, Guildhall, E.C. APPENDICES. page Appendix A—Street Lists of Mortality 80 „ B— „ „ Infectious Diseases 85 „ C—Register of Houses let in lodgings or occupied by members of more than one family 86 „ D—List of Adoptive Acts, Orders, Bye-laws and Regulations in operation in the City 88 „ E—Food Protection, Public Health Congress. By W. M. Willoughby, M.D., D.P.H 89 80 APPENDIX A.—STREET LISTS OF MORTALITY. street or place. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Aldersgate Street, Manchester Hotel. - F 46 16th Jan. la. Myocardial Degeneration b. Aortic Regurgitation Resided at Ladbrook Grove. " " 133 F 26 15th June la. Malignant Tumour of Neck (Sarcoma) b. Secondary Deposits, Lungs Aldgate High St 37 M 48 6th March la. liens Paralyticus b. Strangulated Inguinal Hernia c. Resection Anastains of Small Gut Died in Poplar Hospital. Arthur Street 2 F 82 29th March la. Arterio Sclerosis b. Heart Failure c. Senile Decay Artillery Lane 7 9 M M 15 months. 59 19th Jan. 21st Feb. la. Laryngeal Diphtheria, la. Lobar Pneumonia P.M.—Died in London Hospital. Austin Friars - M 58 21st Feb. Shock—Fell from window Resided at Hyde Park—P.M.- Inquest - Accidental. Barker's Buildings 9 M 8 mos. 10th Jan. la. Broncho-pneumonia b. Bronchitis c. Infantile Debility " 11 M 79 27th April 2. Syncope la. Cerebral Haemorrhage b. Arterio Sclerosis Died in City of London Infirmary, Bow Road. " 22 F 74 7th Jan. Lobar Pneumonia Died in City of London Infirmary, Bow Road— P.M.—Inq.—Natural. Bank Station, Central London Railway. - M 62 13th April Shock due to crushing, with injuries to Chest caused by fall before train. Suicide—Unsound Mind Resided at Heme Hill— P.M.—Inquest. Bartholomew Close 12 F 77 23rd Dec. la. Myocardial Degeneration b. Chronic Bronchitis Died in City of London Infirmary, Bow Road. Bartholomew House 4 M 58 13th July la. Cardiac Failure b. Myocardial Degeneration c. Chronic Bronchitis Bartholomew House, Cloth Fair. Bartholomew Lane 20 1 F F 60 54 2nd Jan. 5th March Syncope due to Chronic Disease of Heart Muscle, with Mitral Stenosis la. Myocardial Degeneration b. Chronic Bronchitis Beech Street 40 M 61 5th April la. Meningitis b. Acute Frontal Sinusitis Died in St. Bartholomew's Hospital. Bishopsgate 110 F 59 17th May la. Cardiac Failure b. Carcinoma of Tongue c. Secondary Glands in Neck Died in Middlesex Hospital. Bloomfield House, King Street. 12 F 74 13th Nov. la. Cerebral Haemorrhage b Myocardial Degeneration Died in City of London Infirmary, Bow Road. 15 F 73 13th Nov. la. Lobar Pneumonia b. Chronic Bronchitis c. Chronic Myocarditis Died in City of London Infirmary, Bow Road. Bridge water Square 16 F 76 26th Feb. Senile Decay. Died in Metropolitan Mental Hospital. Broad Street Buildings 3 M 57 1st Sept. la. Cellulitis of Thigh (L.) b. Septicœmia c. Broncho-pneumonia Died in City of London Infirmary, Bow Road. 3 M 24 8th Dec. la. Pulmonary Tuberculosis Died in Colindale Hospital Brushfield Street 8 F 74 26th March Syncope due to Single Lobular Pneumonia, accelerated by Burns and Scalds of Body P.M.—Inq.—Accidental. 36 M 29 7th Dec. la. Acute Intestinal Obstruction 2b. Exclusive Peritoneal Adhesions 3c. Following on Abdominal Operation—Recurrent Stalecystitis Bury Court 3-4 M 65 10th Jan. la. Acute Bronchitis 2. Asthma Cannon Street 56 M 58 14th April la. Valvular Disease of Heart " 110 M 77 12th April Syncope due to Occluded Left Coronary Artery of Heart and Myocarditis Resided at Dulwich—Inq. —P.M. " 147 M 76 7 th May la. Bronchitis b. Old Age 2. Decubitis—Exhaustion Cheapside 102 M 39 9th April la. Broncho-pneumonia 2. Operation for Intestinal Obstruction (Strangulated Ventral Hernia) Died in St. Batholomew's Hospital. Circus, Minories 5 F 37 22nd Sept. 1b. Cirrhosis of Liver Died in St. Peter's Hospital Crown Place, Aldgate 7 M 62 4th Nov. la. Uraemia Coma b. Cystitis c. Enlarged Prostate Cutler St. Warehouse - M 52 24th Feb. Syncope—Disease of Coronary Arteries of Heart Resided at Berlin. Dean Street 5 F Bik F 70 14th Jan. la. Gastro-enteritis Devonshire Square 3 F 88 5th Sept. la. Syncope b. Fatty Degeneration Heart Muscle " 4 F 51 30th Jan. la. Asthma b. Carcinoma of Rectum 81 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Dyer's Buildings 7 M 62 16th Oct. 1a. Carcinoma of Larynx b. Chronic Nephritis c. Chronic Myocarditis Died in City of London Infirmary, Bow Road. Eastcheap 10 M 49 17th Aug. 1a. Carcinoma of Liver ,, 59 M 51 13th May la. Carcinoma of Upper End of Æsophagus Died in City of London Infirmary, Bow Road. Eldon Street 15 F 23 14th Feb. Injuries to Head and Laceration of Brain, caused by overturned van Resided in Walthamstow— P.M.—Inq.—Accidental. Essex Court 5 F 72 4th June la. Pulmonary Embolism b. Septic Thrombosis of Veins of Leg Resided at Shrewsbury. Farringdon Street - M Newly born. 18th April Haemorrhage from Cord Found dead on steps leading to Holborn Viaduct. ,, 60 M 54 12th Oct. la. Lobar Pneumonia No P.M. Fenchurch Street 124 F 44 1st July Syncope due to Haemorrhage from Cancer of Uterus P.M.—Natural—Died in St. Bartholomew's Hospital. Finsbury Circus 25 M 65 14th April Syncope due to Chronic Fatty Disease of Heart Muscle, with Disease of Coronary Arteries. Resided at Wallington, Surrey — Inq.—P.M. Fish Street Hill 36 F 28 25th Nov. Syncope due to Congenital Narrowing of Aorta, with Mitral Stenosis and Congenitally Small Heart of a child of 12 years of age. P.M.—Inq. Fleet Street, Anderton's Hotel. - F 54 11th Dec. la. Pulmonary Tuberculosis Died in St. Luke's Hospital. Fleet Street 14 F 57 11th Jan. la. Carcinoma of Stomach ,, 92 M 52 10th Sept. Syncope—Tuberculous Broncho-Pneumonia and Infraction of Brain Died in Bethem Royal Hospital. Foster Lane, - M 81 29th Jan. la. Pleurisy with Effusion (acute) Goldsmiths' Hall. Garden Place 5 F 63 9th Jan. la. Myocardial Degeneration b. Arterio Sclerosis c. Cerebral Thrombosis Died in City of London Infirmary, Bow Road. Great New Street 13 M 43 15th Jan. la. Dilatation of Heart b. Chronic Bronchitis c. Emphysema Died in Dartford district. ,, 27 M 34 1 Aug. la. Pulmonary Tuberculosis Died in Colindale Hospital. Great Tower Street 74 M 57 17th June la. Cardio Vascular Degeneration b. Broncho-pneumonia Died in City of London Mental Hospital, Stone. Godliman Street 10 M 64 3rd Jan. la. Chronic Nephritis b. Valvular Disease of Heart Died in ambulance on way to Hospital. Goodman's Yard 18 F 61 31st May la. Coma b. Cerebral Haemorrhage Greystoke Place 8 M 49 15th Jan. la. Lobar Pneumonia b. Erysipelas of Face Gunpowder Alley 8 F 74 23rd May la. Myocardial Degeneration b. Chronic Bronchitis Died in City of London Infirmary, Bow Road. Houndsditch 21 M 24 9th April la. Morbus Cordis ,, 24 M 65 3rd Feb. Syncope, due to Ruptured Diseased Aorta, with Hæmorrhage Resided at Leigh, Essex— Inq.—P.M. Huggin Court 2 F 75 3rd July la. Myocardial Degeneration &Syncope c. AdvancedArterioSclerosis&Nephritis Died in City of London Infirmary, Bow Road. Huggin Lane 9 M 47 11th Feb. la. Hæmatemesis b. Cirrhosis of Liver Died in Royal Free Hospital—P.M. Hutchison Street 6 F 68 23rd May Cerebral Thrombosis Hypostatic Pneumonia Died in St. Peter's Hospital, Stepney. ,, 6 F 79 26th Aug. la. Acute Valvular Disease of Heart b. Acute Bronchitis Died in Hospital for Jews Hutton Street 37 M 50 14th March Asphyxia due to hanging whilst of unsound mind. Deceased killed himself P.M.—Inq. Idol Lane 10 F 87 20th May la. Asthma b. Pleurisy India Street 6 M 81 3rd Oct. la. Senile Decay King's Block, Stoney Lane 24 F 52 2nd Nov. Acute poisoning by carbon monoxide gas contained in coal; self-inhaled by turning on tap and placing head in gas stove. Accelerated by poisoning by Lysol antiseptic and poison Whilst of unsound mind, deceased killed herself Died in ambulance on way to Hospital. ,, 32 F 62 1st April la. Cerebral Haemorrhage b. Arterio Sclerosis Died in City of London Infirmary, Bow Road. King William Street 41-2 F 62 1st Feb. Renal insufficiency Bilateral Pyonephrosis Died in London Hospital —P.M. Leadenhall Street, Bury St. Chambers. M 63 29th July la. Toxcemia, following b. Abscess of Lungs c. Abscess of Liver Died in St. Bartholomew's Hospital. Leadenhall Street 12 20 M 60 26th March Syncope due to Chronic Bronchitis and Emphysema P.M.—Inq.—Natural. ,, 89 & 89a F 3 22nd Jan. la. Meningitis Tuberculosis Died in St. Bartholomew's Hospital. ,, 93 F 57 25th Oct. la. Pulmonary Tuberculosis b. Exhaustion ,, 144 M 58 20th Jan. Asphyxia due to Haemorrhage from lung into air bubbles consequent upon Pulmonary Tuberculosis Resided at Regent's Park. 82 STREET LISTS OF MORTAL ITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Liverpool Street Station (L.N.E.R.) - M Newly born, few minutes. 16th March Suffocation due to want of attention at birth P.M.—Inq. ,, - M 34 19th Feb. Shock and severance of spinal cord and fracture of skull. Knocked down by engine Resided at Walthamstow — Inq. — P.M. — Accidental. London Wall, Carpenters' Hall. - M 52 12th Jan. 1 a. Heart weak and irregular b. Albuminuria, Kidney Disease c. Congestion of Lungs 2. Ascetes Pleural Effusion Lower Thames Street 55 F 75 3rd June Syncope—Disease of Heart Muscle and Chronic Nephritis Mark Lane 50 F 2 25th April la. Meningitis—Acute Tuberculosis Martin Lane 22 M 68 26th June Syncope due to rupture of Left Ventricle of Heart, consequent upon brown wasting and fatty disease of heart muscle Resided at Horley, Surrey Middlesex Street 116 M 45 31st Jan. la. Pulmonary Tuberculosis ,, 116 M 54 2nd Feb. la. Chronic Bronchitis b. Chronic Myocarditis Died in City of London Infirmary, Bow Road. ,, 116 M 67 8th Feb. la. Chronic Bronchitis and Chronic Myocarditis ,, ,, ,, 116 M 60 11th Feb. la. Pulmonary Tuberculosis b. Locomoter Ataxy ,, ,, ,, 116 M 79 4th March la. Chronic Endocarditis b. Chronic Bronchitis ,, ,, ,, 116 M 62 29th March Sycnope due to Tubercular Disease, with cavities in lungs and serious effusion in both pleura P.M.—Natural. ,, 116 M 61 24th April la. Epilepsy b. Myocardial Degeneration c. Arterio Sclerosis Died in City of London Infirmary, Bow Road. ,, 116 M 30 10th May Psoas Abscess—Pericarditis Died in St. Peter's Hospital,Stepney-P.M.-Inq. ,, 116 M 58 5th June la. Ch. Nephritis b. Uraemia Died in City of London Infirmary, Bow Road. ,, 116 M 65 1st Aug. la. Erysipelas of Face b. Broncho-pneumonia ,, ,, ,, 116 M 64 1st Aug. la. Chronic Nephritis b. Uraemia Died in Hackney. ,, 116 M 68 12th Sept. la. Locomoter Ataxy b. Myocardial Degeneration Died in City of London Infirmary, Bow Road. ,, 116 M 73 7th Sept. la. Chronic Bronchitis b. Chronic Mvocarditis ,, ,, ,, 116 M 75 31st Oct. la. Chronic Nephritis b. Chronic Cystitis c. Myocardial Degeneration ,, ,, ,, 116 M 66 4th Dec. la. Pulmonary Tuberculosis b. Arterio Sclerosis ,, ,, ,, 116 M 48 19th Dec. la. Pulmonary Tuberculosis b. Chronic Endocarditis ,, ,, ,, 116 M 51 16th Dec. la. Lobar Pneumonia b. Pulmonary Tuberculosis ,, ,, ,, 116 M 36 26th Nov. la. Bronchial Asthma b. Emphysema c. Cardiac Failure—Duration indefinite Died at Billericay—P.M. Minories " Section House." - M 25 22nd April la. Spontaneous Pneumothorax b. Pulmonary Tuberculosis Minories 97 M 50 3rd Nov. la. Tub. Caries of Lumbar Vertebrae b. Chronic Nephritis c. Myocardial Degeneration Died in City of London Infirmary, Bow Road. ,, 98 M 83 15th April la. Asthma—Coma b. Hypostatic Congestion of Lungs c. Acute Bronchitis ,, ,, Montague Court 1 F 80 24th July la. Cerebral Haemorrhage b. Hemiplegia c. Cardiac Vascular Degeneration " " ,, 2 F 61 1st Jan. la. Asthma b. Chronic Bronchitis c. Chronic Nephritis ,, ,, Mitre Street 8 M 76 16th Nov. la. Myocardial Degeneration 2. Prostatic Hypertrophy and suprabubic drainage for retention Moor Lane Chambers 4 F 61 22nd June la. Tuberculosis Pulmonatis b. Exhaustion ,, 16 F 64 3rd Jan. la. Cardiac Failure b. Hemiplegia ,, 32 F 47 28th Aug. la. Carcinoma of Ovary b. Cardiac Syncope Died in St. Luke's Hospital. Nevill's Court, Fetter Lane. 11 F 91 5th Jan. la. Bronchial Catarrh b. Senile Decay Died at 18, Thavies Inn. ,, 11 F 67 27th Feb. la. Cerebral Haemorrhage b. Arterio Sclerosis 2. Albuminuris ,, ,, 83 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. North Block, Stoney Lane 15 M 78 13th Sept. la. Myocardial Failure b. Myocardial Degeneration ,, ,, 24 M 84 22nd June la. Coma (Uraemia) b. Enlarged Prostate Old Broad Street 42 M 44 17th July la. Pneumococcal Septicaemia b. Broncho-pneumonia c. Deflected Nasal Septum Died in Throat Hospital, Westminster. Pancras Lane 11 F 65 11th Dec. la. Cerebral Softening b. Syncope Paper Buildings, Temple - M About 68 3rd July Shock and Syncope due to poisoning by swallowing Lysol. Killed himself P.M.— Inquest— No evidence as to state of mind. Resided in Clerkenwell. Paternoster Row 33 M 57 24th Feb. la. Hypertrophy and Dilatation of Heart b. Chronic Nephritis Resided at Highgate. Princes Street, Grocers' Hall. - M 73 21st June la. Cardiac Failure b. Senile Myocardial Degeneration c. Chronic Intestinal Nephritis Died in Carshalton. Queen's Block, Stoney Lane 17 F 68 15th March Syncope due to Chronic Disease of Heart Muscle and Nephritis P.M.—Inquest. Queen Street 22 F 58 26th April la. Carcinoma of Liver b. Exhaustion c. Cardiac Failure ,, 70 F 43 29th Jan. la. Cardiac Failure b. Pneumonia Queen Street Place, Thames House. - M 54 27th Aug. Syncope—Enlarged Heart—Disease of Coronary Arteries River Thames - M 62 18th March Asphyxia from drowning Resided at Battersea— P.M.—Inquest. ,, - M 68 27th April Asphyxiation by drowning P.M.—Inquest—Suicide—Unsound Mind. ,, - M 77 17th Aug. Asphyxia—Drowned in Thames P.M.— Inq. — Insufficient evidence — Misadventure. St. Anne's Chambers, Broadway. 36 M 71 25th July la. Heart Failure b. Myocardial Degeneration c. Hemiplegia (Cerebral Embolism) Died in City of London Infirmary, Bow Road. St. Dunstan's Hill 20 F 74 7th April la. Carcinoma Resided in Holloway. St. Martin-le-Grand 61 F 55 22nd Jan. la. Pyo-Nephrosis b. Renal Calculi c. Nephrectomy for Calculi, 1. side,1925 Died in Freemason's Hospital. St. Mary-at-Hill 9 F 7 20th Feb. la. Cerebellar Abscess b. Operation c. Bilateral Otitis Media 2. Lateral Sinus Thrombosis Died in St. Bartholomew's Hospital. Seething Lane 34 M 72 30th Dec., 1927. Senile Decay Died in Tooting BeC Hospital. Snow Hill 5 M 53 14th July la. Hyper-nephroma b. Secondary Growth in Chest Died in City Police Hospital. South Block, Stoney Lane. 38 F 45 19th April la. Renal Insufficiency b. Chronic Toxic Nephritis Died in London Hospital. ,, 39 F 53 12th July la. Uraemia b. Tuberculosis of Kidneys Sugar Loaf Court 3 M 82 26th May la. Chronic Bronchitis Died in St. Peter's Hospital, Stepney. Swan Lane 8 M 4 mos. 19th June la. Congenital Hydrocephalus b. Murasmus Died in City of London Infirmary, Bow Road. ,, 15 M 57 5th Aug. la. Myocarditis and Endocarditis Temple Chambers, Temple Avenue. 231 M 84 19th Dec. la. Cerebral Haemorrhage b. Arterio Sclerosis ,, 256 M 39 12th Nov. la. Hæmorrhage and Shock following operation. b. Duodenal Ulcer Died in Cookham Rural District—No P.M. Thavies Inn 18 F 91 5th Jan. la. Bronchial Catarrh b. Senile Decay Resided at 11, Neville's Court, E.C. ,, 18 F 20 days. 23rd Jan. la. Syphilis Congenital b. Premature Birth Parent resided at Southwark. Throgmorton Avenue 5 M 2 mos. 15 April la. Malnutrition b. Pylorospasm Died in Belgrave Hospital. Tudor Street 12 M 59 18th May la. Pneumonia Lobar, multiple Died in St. Bartholomew's Hospital—P.M. Upper Thames Street 89 F 73 28th Nov. la. Cerebral Thrombosis b. Arterio Sclerosis Died in Invalids' Home in Islington. Vine Street 3 F 79 30th Jan. Syncope due to starvation and Chronic Bronchitis Walbrook 4 F 80 1st March la. Old Age b. Heart Failure ,, 35 F 62 13th June la. Mitral Stenosis b. Myocardial Degeneration 2. Chronic Interstitial Nephritis Water Lane 5 F 73 29th Dec., 1927 la. Senile Decay. Died in City of London Mental Hospital, Stone. ,, 16 F 72 30th July la. Syncope b. (Morbus Cordis) c. Mitral Stenosis ,, 21 M 61 18th Aug. la. Asthenia b. Carcinoma of Rectum (inoperable Colotomy) 84 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Watling Street 67 M 61 20th July la. Uraemia—Coma b. Hyperpiesis c. Adornea Myocardial Degeneration Died in City of London Infirmary, Bow Road. Widegate Street 13 F 62 22nd Oct. la. V.D.H. Died in City of London Mental Hospital, Stone. ,, 14 M 56 25th Jan. la. Cancer of Transverse Colon b. Exhaustion ,, 22 M 86 29th Oct. Failure of Respiration, due to Acute Bronchitis, with Hypertrophy of Heart and Chronic Nephritis Wine Office Court 16 F 62 13th March la. Sarcoma of Thyroid b. Cardiac Failure Died in General Hospital, Hampstead. ,, 16 M 66 14th Dec. la. Cardiac Failure b. Aortic Regurgitation Wood Street 1 F 65 10th June la. Carcinoma Mammal Wrestlers' Court 5 F 67 14th July la. Secondary Haemorrhage b. Septic Phlebitis c. Ulcerated Eigo 2. Cerebral Thrombosis Died in City of London Infirmary, Bow Road. 85 APPENDIX B.—LIST OF CASES OF INFECTIOUS DISEASE OTHER THAN TUBERCULOSIS, 1928. STREET LISTS.—COMPILED FROM NOTIFICATIONS RECEIVED. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. 1928 Aldgate High Street 27 F 4 Diphtheria 29th February. Ditto 47 M 10½ Scarlet Fever 19th November. Amen Court 2 M 18 Diphtheria 27th December. Artillery Lane 20 F _8/12 Chicken Pox 22nd October. Botolph Lane 9 M 58 Acute Primary Pneumonia 1st June. Carter Lane 59 F 12 Scarlet Fever 12th October. Carthusian Street 13 F 5 Diphtheria 8th May. Circus, Minories 4 M 8 Scarlet Fever 23rd November. City of London Union - M 46 Acute Primary Pneumonia 14th January. Ditto - M 58 Ditto 15th December. Ditto - M 51 Ditto 3rd December. Coleman Street 25 M 6 10/12 Scarlet Fever 23rd January. Crosby Square 2/3 F 13 Chicken Pox 1st May. Crutched Friars 41 F 6 Scarlet Fever 26th October. Dean Street, Fetter Lane 4d M 8 Diphtheria 27 th September. Devonshire Square 16-17 M 5 Scarlet Fever 31st October. Ditto 16-17 M 9 Diphtheria 7th November. Dyer's Buildings 7-8 F 11/12 Measles 29th June. George Yard, Lombard Street 12 F 14 Diphtheria 31st June. Golden Lane 20 F 3 4/12 Scarlet Fever 25th May. Gracechurch Street 3 M 20 Ditto 12th November. Great New Street 10 F 9 Scarlet Fever 7th May. Ditto 23 F 74 Erysipelas 2nd January. Great St. Helens 12 M 13 Scarlet Fever 19th December. Greystoke Place 8 M 48 Erysipelas 9th January. John Street 14 F 6 Diphtheria 15th August. Knightrider Street 61 M 10 Chicken Pox 26th March. Lombard Street 80 M 6 Scarlet Fever 19th September. Long Lane 83 F 4 Chicken Pox 10th February. Mincing Lane 21 F 7 Chicken Pox 11th April. Ditto 21 M 6 Ditto 28th March. Minories 81 M 4 Scarlet Fever 31st December. New Street Square 9 F 2 8/12 Diphtheria 21st January. North Block 6 M 8 Scarlet Fever 20th April. Ditto 53 F 3 Measles 5th July. Old Broad Street 11 M 4 3/12 Chicken Pox 3rd April. Paper Street 1 M .10.. 3 6 5 Ophthalmia Neonatorum 7th November. Paternoster Row 23 M 18 Measles - Ditto 23 M 25 Ditto - Police Buildings, Rose Alley 56 M 5 Chicken Pox 16th March. Prince's Block 40 F 3 Measles 5th July. Ditto 53 F 6 Scarlet Fever 5th December. Queen Street 1 M 9 Diphtheria 24th January. Queen's Block 42 M 20 Acute Primary Pneumonia 30th April. Rose Alley 1 M 2½ Chicken Pox 13th April. Ditto 1 F 5 Ditto 29th March. Ditto 23 M 6 Measles 11th July. Ditto 23 M 6 Ditto 11th July. Ditto 43 F 3 Chicken Pox 30th March. St. Mary Axe 43 M 11 Chicken Pox 29th March. St. Bartholomew's Hospital - - - Diphtheria, 14 cases Various dates. Ditto - - - Erysipelas, 1 case 29th June. Ditto - - - Scarlet Fever, 8 cases Various dates. South Block 11 M 11 Scarlet Fever 8th October. Wood Street 18 M 19 Ditto 6th September. Ditto 47 M 25 Ditto 2nd April. Ditto 47 M 20 Diphtheria 26th November. M 86 APPENDIX C.—REGISTER OF HOUSES LET IN LODGINGS OR OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. WEST DISTRICT. Situation of Premises. Name and Address of Owner or Tenant Tenements. Lodgers. 20, Bride Lane E. Sharpe, 20, Bride Lane (o) 2 4 5, Britton's Court Mrs. Hurrel, 5, Britton's Court (t) 2 7 43, Cloth Fair Mr. C. Taylor, 6, Finsbury Square, E.C. 2 (o) 2 5 45, do. W. F. Masters, 45, Cloth Fair (o) 3 10 13, do. W. G. Gallomel, 13, Currier's Row (t) 2 5 10, East Harding Street Eyre and Spottiswoode, East Harding Street (o) 2 8 11, do. Do. do. (o) 3 8 12, do. Do. do. (o) 4 9 2, Evangelist Court Morris & Co., 37, East Road, City Road (t) 1 2 93, Fetter Lane Friern Manor Dairy Co., 93, Fetter Lane (o) 3 10 29, Fleet Lane Messrs. Watney, Combe & Reid, Stag Brewery, Pimlico (o) 4 12 30, do. Do. do. do. (o) 3 9 31, do. Do. do. do. (o) 4 10 10, Great New Street Mr. Lee, 10, Great New Street (t) 2 6 11, do, M. Quilty, 11, Great New Street (t) 2 7 12, do. Mr. A. E. Walker, 12, Great New Street (t) 2 9 13, do. F. Wilson, 51, Frankfort Road, Heme Hill (t) 9 20 14, do. Mrs. A. E. Jackson, 14, Great New Street (t) 4 9 16, do. J. Day, 16, Great New Street (t) 3 5 21, do. Goldsmiths' Company, Goldsmiths' Hall (o) 3 8 23, do. Mrs. J. Barnsley, 1, Great New Street (t) 5 9 25, do. Do. do. (t) 6 10 27, do. Do. do. (t) 3 9 7i, Gunpowder Alley T. Townsend, 259, Essex Road, N. (o) 2 6 8, do. Do. do. (o) 4 8 25, Little Britain Mr. Turner, 25, Little Britain (t) 2 4 79, Long Lane Robert Dyas & Sons, 63, Fore Street (o) 2 6 4 & 5, Middle Street J. Hull & Sons, Bartholomew Close (o) 5 10 1, Montague Court H. Tenant, 1, Montague Court (t) 2 9 2, do. R. Hutchins, 2, do. (t) 2 7 3, do. Mrs. Vincent, 3, do. (t) 3 5 4, do. Mrs. F. Smith, 4, do. (t) 3 3 5, do. Miss Saunders, 5, do. (t) 2 4 6, do. E. Jones, 6, do. (t) 2 6 8, Nevill's Court Moravian Mission, 32, Fetter Lane (o) 3 6 9, do. Do. do. (o) 3 8 10, do. Do. do. (o) 7 12 11, do. Goldsmiths' Company, Goldsmiths' Hall (o) 4 12 12, do. Do. do. (o) 6 14 14, Newbury Street J. W. Neighbour, 2, Ironmonger Row (o) 4 13 14, Wine Office Court Messrs. Reynolds & Eason, 192, Bishopsgate (o) 2 5 16, do. Do. do. (o) 2 4 17, do. Do. do. (o) 2 2 Total 136 338 Average number of lodgers to each occupied tenement: 2.4 Houses demolished or closed as dwelling-houses 4 Tenement houses on Register 43 Cleansing Notices served 65 MIDDLE DISTRICT. 1 and 2, Huggin Court Fred. Whittingham, 10/12, Lt. Trinity Lane, E.C. (o) 4 9 9, Huggin Lane George F. Cant, 9, Huggin Lane (t) 3 3 10, do. Fred. Whittingham, 10 '12, Lt. Trinity Lane, E.C. (o) 3 3 Total 10 15 Average number of lodgers to each occupied tenement: 1.5 Houses demolished or closed as dwelling-houses - Tenement houses on Register 3 Cleansing Notices served 3 (O) Owner. (T) Tenant. 87 EAST DISTRICT. Situation of Premises. Name and Address of Owner or Tenant. Tenements. Lodgers. 7, Artillery Lane Clerk to Bishopsgate Institute, Bishopsgate (o) 3 9 9, do. Claude M. Leigh, 268, Bishopsgate (o) 3 6 21, do. Clerk to Bishopsgate Institute, Bishopsgate (o) 3 7 10, Brushfield Street Reynolds & Eason, 192, Bishopsgate (o) 6 7 12, do. Luke Cohen, 12, Brushfield Street (t) 2 3 14, do. Clerk to Bishopsgate Institute, Bishopsgate (o) 7 9 1, Circus, Minories S. Moses, 65, Mansell Street (o) 6 21 3, do. W. Lewis, 3, Circus, Minories (t) 3 7 4, do. W. Wisdom, 4, do. (t) 4 8 5, do. T. Groves, 5, do. (t) 4 4 3, Three Crown Court, Mr. Martin, 14, Seething Lane (o) 3 5 Jewry Place. 18, Widegate Street S. Franks, 18, Widegate Street (t) 2 5 21, do. A. & A. Field, 95, Whitechapel Road (o) 6 6 24, do. W. I. Crane, 25, Widegate Street (t) 3 6 25, do. Do. do. (t) 3 4 2, Goodman's Yard Charrington, Brewers, Mile End Road (o) 3 3 5, Artillery Lane Clerk to Bishopsgate Institute, Bishopsgate (o) 6 9 Total 67 119 Average number of persons to each occupied tenement: 1.7 Houses demolished or closed as dwelling-houses 6 Tenement houses on Register 17 Cleansing Notices served 25 (O) Owner. (T) Tenant. 88 APPENDIX D.—LIST OF ADOPTIVE ACTS, BYE-LAWS AND LOCAL REGULATIONS, RELATING TO PUBLIC HEALTH, IN FORCE IN THE CITY OF LONDON. ADOPTIVE ACTS.—Nil. ADOPTIVE ORDERS. Subject. Date adopted. Sanitary Accommodation Sanitary Accommodation Order, 1903 Sept., 1904. BYE-LAWS. Vendors of Fried Fish London County Council (General Powers) Act, 1908, Sec. 9 Jan., 1914. Fish Curers ditto ditto ditto. Slaughtering of Cattle Public Health (London) Act, 1891, Sec. 19 May, 1911. Prevention of Nuisances arising from Snow, Ice, Salt, Dust, Ashes, Rubbish, Offal, Carrion, Fish or Filth, or other matter or thing in any street City of London Sewers Act, 1897 ; Public Health (London) Act, 1891, Sec. 16 Feb., 1894. Prevention of nuisance arising from offensive matters running out of any manufactories, breweries, slaughterhouses, knackers' yard, butchers, or fishmongers' shop, or dunghill ditto ditto ditto. Prevention of keeping of animals on any premises in such a manner as to be a nuisance ditto ditto ditto. As to the paving of yards or open spaces in connection with dwelling houses ditto ditto ditto. Keeping W.C.'s supplied with a sufficient supply of water ditto ditto Sec. 37 .... Feb., 1894. Cleansing of Cisterns ditto ditto Sec. 50 ditto. Water Closet, Earth Closet, &c City of London (Various Powers) Act, 1900 Sept., 1909. Houses Let in Lodgings Public Health (London) Act, 1891, Sec. 94 and Housing Act, 1925, Sec. 6 Sept., 1926. Demolition of Buildings City of London (Public Health) Act, 1902, Sec. 5 July, 1904. Ash Pits City of London (Various Powers) Act, 1900, Sec. 54 June, 1925. Business of Slaughterer of Poultry Public Health (London) Act, 1891 July, 1925. Rag and Bone Dealer London County Council (General Powers) Act, 1908, Sec. 9 Jan., 1927. REGULATIONS. Soda Water Agreed regulations to control trade 1908. Hairdressers ditto ditto ditto Nov., 1904. Kitchens of Restaurants and above- ground Bakehouses ditto ditto ditto Jan., 1904. Milk Stores and Milk Shops Dairies, Cowsheds & Milkshops Order, 1885 July, 1903. *Ice Cream Regulations adopted by the Corporation Nov., 1902. Common Lodging Houses City of London Sewers Act, 1851 & 1897 Oct., 1902. House Drainage Regulations adopted by the Corporation Sept. 1898. * This Trade was subsequently regulated by Acts of Parliament (L.C.C. (G.P.) Act, 1902 and 1928). 89 APPENDIX E. PUBLIC HEALTH CONGRESS (1928.) FRIDAY, NOVEMBER 23rd, at 11 a.m. FOOD PROTECTION, by W. M. WILLOUGHBY, M.D., D.P.H., Medical Officer of Health of the City of London. For any community in which for the living unit the largest possible chance of healthy life is sought the most desirable attribute of foodstuffs is abundance. This is among the prime necessities for increase and multiplication within that community, and for absence of complaints, bodily or expres sional Home Manufacture A Lost Art. To procure abundance in large cities, and indeed in large countries, which as a whole are crowded beyond the limit of self-support, masses of foodstuffs must be conveyed over long distances either in the natural or manufactured state, and if in the natural state, manufactured in massive amounts on arrival. General manufacture in the home, such as was known to former generations as a necessity, with the sociological division of labour necessarily following on urbanisation is becoming a lost art. The brewer brews for us our ale, the baker makes our cakes and bread. We are the losers to the extent of the mud in our ale and the yeast in our cakes ; moreover, the substitution of baking powder in the latter and addition of finings and preservatives in the former, are taking us far away from the natural product of the home manufacture to which our forebears were accustomed and to which they responded, as we now perceive, in subtle bodily reactions. There is a balance between gain and loss in changing over from muddy beer to the fined product, and from the old stone-milled flour raised with yeast to white luxury, and the loss is none the less that it has not been immediately visible and straightway brought into account. The eye is delighted by the clarity of beer, but it is the foaming stout, having no thought for clarity, which was, in times past, recommended to the nursing mother as beyond cavil clinically superior to beer. Instinct and taste are protective in some degree, but these faculties are lost in the individual who has never had the opportunity to exercise them on the unfactored article. Meanwhile, massive manufacture of food comes, and must come, under close scrutiny of the expert, whether of the factory or of the organisation which looks after the public health, to ascertain the limits to which any devitalising result of manufacture may still be compatible with public health or balanced by advantage. Special research with and without the grants made thereto is an essential to food protection, though not on the spectacular side. For food protection the possible devitalising influences on food must be considered, no less than the addition of positively harmful substances. Devitalising Influences. As a further illustration of this possibility from among fundamental foodstuffs, one may consider factored milk. A very commendable food of good keeping quality is now presented to the public ; one of the first processes to which the natural article is subjected is centrifugalisation for the removal of dirt, and therewith much of the bacterial content. The discard is unprepossessing "slimes" ; but this prejudicial word is not quite fair to the material, which must consist largely of plasm particles thrown off in the essential function of milk excretion by the epithelium and of whole cell elements not only natural to milk but its most living constituent. No one can at present definitely say what is the balance of gain and loss to the food value in centrifugalising, though the keeping properties of the milk thus factored are very undeniably enhanced, and of great importance to the housewife harassed by thunder weather. Again, the known vitamins are not very noticeably interfered with in the pasteurising process, but something has been done to many constituents which may be grouped as x in order. The important thing to recognise is that the value of these bodies is unknown. Preferring bottled milk (not the street bottled variety) for personal consumption, I make the above criticisms, while realizing to the full that civilisation has to face necessities—one of which is distribution of this highly changeable fluid with the retention of some of the flavour and properties recognisable as those customary to fresh milk. This side of the subject of "food protection," which concerns the vitamines and enzymes, is only in its infancy, though already very effective conclusions have been drawn from the difficult biological experiments carried through in scientific support of the lad of the past generation who fed his pet 90 rabbits, with good results, on bran, milk and "milky dysels." We are becoming conscious, scientifically, of the great qualities of unfactored food, the limits urbanisation and distribution impose on its procurement, and some of the rational procedures corrective to these limitations. The necessary exact knowledge is one result of the defects following on crowding and urbanisation ; dwindling instinc ts must be revived or replaced by conscious knowledge supplied by research workers whose labour deserves unstinted recognition from the community they so well serve. Superfluity of Added Material. Alteration in factored foods on the deficiency side is in chain with superfluity of added material. In this, of highest consideration are the recent regulations as to preservatives. The principle which had too long held sway, and was leading us down a blind evolutional path, from which return to a line of lasting progress is difficult but not impossible, was a requirement of proof that any given preservative was harmful to the human organism. Clear indications are given in modern medicine that the early stages of disease are insidious and almost unobservable. The guiding principles therefore should have been based on the question whether the added materials were natural to the human body and its physiological processes or not. Is its elimination easy ? Is it a possible cause of delayed digestion ? And is its quantity or, indeed, its presence superfluous to the object in view ? It once seemed that the boric compounds had acquired squatters' rights and were unassailable in them, so that the members of an urbanised community were for ever doomed to expend gastric energy in diluting boracic salts to beyond that point at which either bacillus or cell of the enteron could make tardy use of the doped foodstuff. And the factor using methods of unscrupulous want of cleanliness could cloak them with this antiseptic which is quite foreign, even inimical to the vegetable and animal economy—that is, to life in. general. A misguided use of one of the two preservatives at present permitted has been the addition of sulphurous acid in tinned fruit. This unscientific experiment could but announce itself to the recipient of the material by the flavour of sulphurated hvdrogen, inevitable to chemical reaction between acid and tin. These wasteful experiments can easily be avoided by the employment of a scientific staff in connection with food manufacture. It is noticeable that the large firms of caterers have such a staff. Their use is a large guarantee of at least the harmlessness of the manufactured foods such firms supply, as well as of the attractive state in which they are delivered to the public, and should be looked on as an economical essential. The method of trial and error in manufacture is wasteful in ways to be easily foreseen by a capable chemist, physicist or biologist, and waste is in conflict with our premises as to abundance. Food Lost by Keeping. In connection with waste and abundance should be mentioned the masses of material, such as dried fruit, which steadily deteriorate, even to eventual destruction, while awaiting their market ; their eventual monetary value often does not cover the customs duty on import, so that not even the doubtful consideration that what is no good for the human being is good for other animals can be brought into economic play, and the deteriorated food turned into flesh. The food is lost by keeping. On looking back over the outstanding and peculiar food poisonings, arsenical neuritis due to beer and lead poisoning to cider manufacture, were due to want of knowledge, not deliberate sophistication. Regulations now fully cover such possibilities in metallic poisonings. Cider has retaken its place as a beneficent drink; beer was easily freed from a stigma which had extended therefrom to alcoholic liquors in general. But a far less subtle sophistication than either deficiency due to facture or added deleterious material is in vogue ; it is the abstraction of one material and addition of another in substitution, this often being of such a nature as to be in itself beneficial, and at the same time difficult of detection. Synthetic cream is a case in point; in this, there is none of the salts of the lower members of the fatty acid series which distinguish what has hitherto been known as cream from fat in general. The synthesis by using other fats for milk fat may lead to ready fraud as obtained at the time of the introduction of butter substitutes ; against this kind of substitution the public has need of protection, supplied by a constant watch only afforded by the chemical expert in the laboratory acting with the administrative health officer, and by responsibility in law which shall bind manufacturer and vendor in declaring the " erzatz " nature of the food tendered under a possibly misleading name. Imported Commodities. It is a distinct protection to our food supply from abroad that any material imported should be by the very fact deemed to be food deposited for sale, and as such, if unsound, seizable and liable to such procedure as would apply to the home supply. It is often urged that such material could be made use of abroad, and should be exported where a case for this can be made out. Such a procedure would mean that the unscrupulous importer would have a double market ; either his bad goods might slide into consumption in England or stand an equal or better chance in a less particular if less paying market abroad. The net result of permitting re-export would be the hopeful bandying about of unsound food. Re-export of seizable material should in no case be permitted ; the precedent once set up breeds bad importations or, what is more difficult to cope with, doubtful importations. The refusal of re-export literally carries the war of unsound food into the enemy's country in a way that calls for international understanding. The foundation for this has been truly laid in the agreements which quickly followed on the Foreign Meat Regulations ; the principle is that meat so packed as to be readily inspected, and certified to have been inspected according to an approved scheme before export from abroad, is naturally raised in standard of excellence and finds a readier acceptance 91 at the hands of the authorities on importation. The inspection of food in general and its cleanly production and preparation at the place of packing for export, and an acceptable guarantee that it is suitably supervised throughout its history, would seem to be a direction in which protection can be afforded, as and when the nations get further together. Indications are by no means wanting that the importers as a whole are as eager to have regulations which can lead to imports of sound food as are those invested with the powers which must in cases of necessary enforcement be a nuisance to all concerned. But over and above the incentive due to trouble and loss caused by enforcement of regulations, in the methods of importers and manufacturers, can be seen the underlying consciousness of that sacro-sanctity of food which must in itself be a great protection to a people gregarious and therefore undergoing civilisation. Protection by Regulation. Tuberculosis in food is now as fully under regulation as the subject is vast. The agricultural community, which is fairly conservative in method, was originally bewildered by the findings on tuberculosis in cattle, and especially in milch herds, and had not yet recovered before Koch's dicta occasioned very considerable modification and confusion of the then current thought which identified all strains of the bacillus. The idea and fact of drinking tuberculosis in milk, no less than that of eating tuberculosis in beef and pork, is repugnant, whatever the danger. The danger to children is grave. The best place of solution of difficulty, whether in milk or meat, would seem to lie at the source and require time for its compassing. As regards milk, through exercise of the regulations, the cow supplying tuberculous milk can be sought out and removed from the milch herds. But mere removal of the animal producing the bacillus, or even the removal of reactors to the tuberculin test, may not be the correct line in production of a tubercle-free herd. It may be that calving confined to animals of a resistance to tuberculosis, which is proven by their arrival at age without infection, might yield a tuberculo-resistant and therefore truly tubercle-free herd. Artificial selection in herds, for colour, milk yield and a whole series of other points less or more valuable is constantly made ; why not artificial selection for the production of a tubercle-resistant race of milch cattle, and thus the building up of herds which are truly tubercle free because resistant to the infection ? If tuberculosis is hereditary in the sense that some breeds or types or even members of the same herd are more prone to the disease than others, surely resistance is obviously more hereditary in that its possessors live to breed their kind. For the elimination of the tubercle bacillus from the milk supply, reactors to the tuberculin test should not be calved for milch or breeding stock. It is to the veterinary surgeon and the cattle breeder, the mcdical officer must look for help in the protection of infant life, whatever the ultimate or intermediate plan of campaign may be. Meanwhile the mere separation of the bacillus-producing animal from the herd for marketing as meat is a means of accentuating nature's impetus in the production of a tuberculous-free species. Infection through Foodstuff. With regard to the commoner forms of food poisoning, there is no form of human bacillary dysentery or enteritis which does not find easy transfer in food ; it is naturally food which bears the agents to their seat of election for mischief ; hence the first principle of hygiene, the separation of ingesta from excreta. With the exception of Botulism, the known bacterial food poisonings are all derived from a previous case of the disease in the intestine of man or, much more rarely, animal. Hence the need for search for a former human case of the disease and the line of contamination of the food which may be the vehicle. There lingers to-day the tradition that zymotic diseases are dirt bred and that general sanitation (refuse removal, good drainage and so on) will eliminate them. This is more true of the intestinal infectious diseases than others, and in 1850 was practically of paramount truth for them. Cleansing now, however, has to be translated in different terms and narrowed to a very fine point. With the most elaborate arrangements for removal of human excreta from ingesta, and the elimination of general infection spread over the community, there has come into prominence an ultimate fortress of intestinal poisons in the carrier, temporary or otherwise, who can start a series of chains of infection through foodstuff, even where the general standard of cleanliness is high. Sanitation of Food Factories. The food factories in which the sanitary arrangements include such minutiae as manicure and such weighty measures as medical supervision of the workers, are setting a high standard of public health in food protection. Not all prepared or manufactured foods, however, are culture media of election for organisms of the baneful type, and it is natural that in the fancy bakery and among sugary delicacies at present these protections have their highest development and aesthetic value and their lowest public health value, except for excellent spread by example of cleanly principles in connection with food. The handling of raw milk and its products and manufactories of meat foods—especially those in which scraps for some reason or another otherwise unsaleable are utilised—are those points at which supervision of staff, stock and means to cleanliness are more necessary since these substances handled, and thus infected, are good culture media. Unbroken fruits do not give rise to these poisonings unless their surface is very newly infected, obviously because the surfaces of fruits are always protected by some natural device against perforative growth of living contaminations. Bloom persistent on raisins is a fair guarantee of their hygienic conditions, though not always of their hygienic treatment before packing. 92 The Doctor as Missionary. The multiplication of bacteria and profusion of polluting material accompanying any one case of bacterial enteritis suggests at once that, in prevention, nothing succeeds like success. With multiplication of cases (especially when some of these are mild) and multiplication of carriers, the conditions for epidemic food poisoning may be soon established, the chances growing with successive cases. This is easily seen in epidemic diarrhoea amongst children. The physician in the house has the best opportunity of pointing the necessity of protection of the domestic food from flies, of rendering the excreta safe, and inculcating those small matters of commonsense which should follow on a general recognition of the infectious nature of the disease were they laid before the people. The full co-operation of the branches of the medical profession, preventive and curative, would be an immense safeguard in this, as in food poisonings in general. The unconscious agencies in food protection, of which, I suppose, the sacro-sanctity of food previously mentioned is the greatest, are entirely unable to cope with the narrowed meaning of dirt in relation to intestinal disease in the present state of education of the public. Even the public health authorities are only within recent years fully alive to the danger of the mild case of enteritis and dysentery, and to the carrier as formidable in food poisonings. Nor has the preventive machinery which can deal with these factors been yet fully invented. This machinery would need to include the complete supervision of foodstuffs and of the whole personnel handling it, whether in production, manufacture or distribution. With necessity will come the necessary invention. Meanwhile, one can look with satisfaction on a rising tide of knowledge very generally distributed, which will create a demand for the more obvious details of cleanliness in relation to food, and on the regulations which are the largest specific driving power in education.