AC 434 Lon 63 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON FOR THE YEAR 1937 LONDON. Printed by Drake, Driver & Leaver. Ltd.. Rosebery Avenue, E.C.I. 1938 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON For the Year 1937. LONDON. Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C.I. 1938. INDEX. A. page. ANNUAL RATEABLE VALUE 7 APPENDICES 80-88 AREA 7 ARTIFICIAL CREAM ACT, 1929 51 ARTIZANS' DWELLINGS, STDNEY LANE 57, 58 AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1923 & 1931 47 B. BACON, SMOKED 49 BACTERIOLOGICAL EXAMINATIONS 18 BIRTHS 8 INFANT WELFARE 11, 12 NOTIFICATION 11, 12 BUTTER FACTORIES 51 c. CLEANSING OF PERSONS ACT, 1897 74 CLEANSING OF SCHOOL CHILDREN 75 CREMATION 30, 31 COMMON LODGING HOUSES 61 CONGRESSES—BRITISH SOCIAL HYGIENE COUNCIL 30 —ROYAL INSTITUTE OF PUBLIC HEALTH 30 —ROYAL SANITARY INSTITUTE 30 —SANITARY INSPECTORS' ASSOCIATION 30 D. DEATHS—CAUSES OF 9 DENSITY 7 DENTURES FOR MOTHERS AND EXPECTANT MOTHERS 13 DIPHTHERIA—ANTI-TOXIN 17, 18 DISINFECTANTS, SUPPLY OF 74 DISINFECTION—INFECTIOUS DISEASES 74 DISINFECTION OF SECOND-HAND CLOTHING 73 DRAINAGE PLANS 62 E. ERYSIPELAS 18 EXHUMATION AND REINTERMENT OF BODIES AT CITY OF LONDON CEMETERY 64 „ „ HUMAN REMAINS AT 56/57, FARRINGDON STREET 64 „ „ „ „ 28, ST. BRIDE STREET 66 F. FACTORIES ACT, 1937 73 FACTORY AND WORKSHOP ACT, 1901—ABOVEGROUND BAKEHOUSES 66 „ „ ,, -FACTORIES. WORKSHOPS AND WORKPLACES 65 „ „ „ —OUTWORKERS 69, 71 „ „ —SUMMARY OF INSPECTIONS 7-70 „ —UNDERGROUND BAKEHOUSES 66 FERTILISERS AND FEEDING STUFFS ACT, 1921'. 47 FISH SUPPLIES AND SEIZURES 41 FLEAS AND PLAGUE 32 FOOD AT RIVERSIDE WHARVES, INSPECTION AND CONDEMNATION 43-46 FOOD AND DRUGS—ADMINISTRATIVE ACTION REGARDING ADULTERATION, &c52, 53 —PROSECUTIONS 56 —SUMMARY OF ARTICLES EXAMINED 54, 55 —SUPERVISION OF 48 G. GULLIES, STREET 63 H. HOUSES LET IN LODGINGS 80 HOUSE, TRADE AND OTHER REFUSE REMOVAL 62 HOUSING 61 HOUSING ACT, 1936 63 HUMAN REMAINS—EXHUMATION AND REINTERMENT AT CITY OF LONDON CEMETERY 64 „ „ „ 36/57, FARRINGDON STREET 64 „ „ „ 28, ST. BRIDE STREET 65 I. ICE CREAM 42, 43 INFANTILE MORTALITY 8 INFANT WELFARE 11, 12 INFECTIOUS DISEASE 14-16 „ „ —BACTERIOLOGICAL AND PATHOLOGICAL EXAMINATIONS 18 „ „—DIPHTHERIA ANTI TOXIN 17,18 „ „ —NOTIFICATION OF 18 „ „ —NURSING PROVISION—MEASLES, ENCEPHALITIS LETHARGICA, CEREBROSPINAL FEVER AND INFLUENZA 18 -SMALLPOX 18 INFLUENZA -ANTI-INFLUENZA VACCINE 18 INQUESTS 73 INSULIN, PROVISION OF 18 INSURANCE 11 INTRODUCTION 7 ITINERANT VENDORS OF FOOD 43 INDEX (continued). L. page LEGAL PROCEEDINGS—SANITARY 62 LEPTOSPIRAL JAUNDICE 17 LIMEWASHING OF COURTS 82 LODGING HOUSES, COMMON—116, MIDDLESEX STREET 61 „ REGISTERED 60 M. MARGARINE, REGISTRATION OF DEALERS IN MARGARINE AND MARGARINE CHEESE 51 MATERNITY AND CHILD WELFARE 11, 12 MEAT INSPECTION 32-41 „ „ —CASEOUS LYMPHADENITIS 38 „ „ —DELIVERY AT CENTRAL MARKETS 41 „ „ —DEMONSTRATIONS AND INSTRUCTION 41 „ „ —EXPORT OF MEAT 40 „ „ HOME-KILLED MEAT SEIZED 35 „ „ —LEADENHALL MARKET AND CITY SHOPS 38 „ „ —LIVESTOCK IMPORTED 32 ,„ „ —PROSECUTIONS 40 „ „—PUBLIC HEALTH (MEAT) REGULATIONS, 1924 42 „ „—SEIZURES OF IMPORTED MEAT 39 ,, „ —SUPPLIES 33, 41 „ „—UNSOUND MEAT REMOVED FROM COLD STORES 38 MEDICAL EXAMINATIONS 77 MERCHANDISE MARKS ACT 1926 47 MIDWIVES ACT, 1936 13 MILK—BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS FOR TUBERCULOSIS AND DIRT (RAILWAY STATIONS) 56, 57 „ —CHEMICAL EXAMINATION OF 49 „ —PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 & 1927 51 ,, —PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 & 1927 51 „ —MILK AND DAIRIES (AMENDMENT) ACT, 1922 51 „ —MILK AND DAIRIES ORDER, 1926 51 MILK IN SCHOOLS SCHEME 50 MORTALITY 8 „ —INFANTILE 8 „ —VIOLENCE 8 „ —PHTHISIS 8 „ —ZYMOTICS 8 „ —MATERNAL 13 MORTUARY—DISINFECTION OF CLOTHING FOR EXPORT, INQUESTS, &c. 73 „ —PRESERVATION OF BODIES OF UNKNOWN DEAD 74 N. NATIONAL HEALTH CAMPAIGN 11 NURSING PROVISIONS 18 O. OPEN-AIR DAY NURSERIES 13 OUTWORKERS 69, 71 P. PHARMACY AND POISONS ACT, 1933 47 PIGFONS—L.C.C. (GENERAL POWERS) ACT, 1927 64 POPULATION 7 POST-GRADUATE NURSING COURSE 14 PRESERVED MEAT, &c., PREPARATION OF 42 PUBLIC HEALTH—(CONDENSED MILK) REGULATIONS, 1923 & 1927 51 „ „ —(DRIED MILK) REGULATIONS, 1923 & 1927 51 „ „ —(MEAT) REGULATIONS, 1924 42 „ „ —OPHTHALMIA NEONATORUM (AMENDMENT) REGULATIONS, 1937 17 „ „ —(PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925 18 „ „ —(TUBERCULOSIS) REGULATIONS, 1930 29 R RAILWAY STATIONS—SAMPLES OF MILK 56,57 RATEABLE VALUE 7 RAT REPRESSION 74-76 REFUSE—COLLECTION AND DISPOSAL 62 s. SANITARY DEFECTS AND INFECTIOUS DISEASE 62 SANITARY INSPECTIONS 59 SCABIES AND IMPETIGO 17, 88 SCHOOL CHILDREN, MILK FOR 13 SEWER, DEFECTIVE CONNECTIONS 62 SHOPS ACT, 1931 72 SMALLPOX 18 STAFF 5 STREET CLEANSING 63 STREET GULLIES 62 T. TUBERCULOSIS 22-29 „ —ARTIFICAL PNEUMOTHORAX TREATMENT 23-29 „ —OFFICE ACCOMMODATION AT DISPENSARY 14 „ —PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925 18 „ —PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930 29 „ —TRAINING OF HEALTH VISITORS 29 V. VACCINATION 10 VENEREAL DISEASES 19, 20, 21 VERMIN, D1SINFESTATION OF PREMISES 64 VITAL STATISTICS 10 w. WHARVES—INSPECTION OF FOOD AT 43-46 STAFF. MEDICAL OFFICER OF HEALTH. Date of Appointment. White, Charles Francis, M.D., Ch.B., D.P.H., D.T.M Dec., 1937 CLERICAL STAFF. Lowe, George Principal Assistant and Vaccination Officer Nov., 1902 Gray, Charles M. 1st Class Assistant March, 1911 Blunt, Harold F. 2nd Class Assistant May, 1924 Stout, James Erl July, 1930 Threadgold, Arthur W 3rd Class Assistants Nov., 1923 Pettit, Richard G. (Resigned Oct., 1936) Jan., 1934 Tunbridge, Mrs. Jan., 1917 Peters, E. Nov., 1935 Wilson, C. Unclassified Jan., 1936 Clements, K. N. H Nov., 1936 Stevens, F. W Nov., 1937 SANITARY INSPECTORS. Robinson, Ernest S Feb., 1913 Fowler, George Henry Oct., 1920 McGrath, William Richard Senior Inspectors Mar., 1922 Harrington, George Edwin Dec., 1925 Sillet, David Ernest April, 1926 Neale, William G. C July, 1928 Thorpe, Robert C March, 1930 Webber, G. A. (Rat Officer) Junior Inspectors July, 1932 Hudson, Leslie A April, 1934 Aldhous, H. J April, 1935 Holloway, A. B. May, 1937 Johnson, E. A., M.B.E., Inspector and Official Sampler under Fertilizers and Feeding Stuffs Act, 1926 ; and Officer under Agricultural Produce (Grading and Marking) Act, 1928, etc March, 1931 MEAT INSPECTION STAFF. Grace, L. B. A., M.R.C.V.S., Veterinary Officer and Chief Meat Inspector June, 1934 Mitchener, William E., Senior Inspector Dec., 1910 Matson, William S Dec., 1910 Jones, John April, 1914 Slatter, Charles Senior Inspectors May, 1908 Murray, Samuel B Sept., 1911 Mellish, Cyril E Jan., 1912 Thompson, Frank E July, 1924 Perris, G. A Junior Inspectors Dec., 1923 Cann, S. W May, 1927 Peyton, H. R Sept., 1932 Bernhardt, D. R Probationary Meat Inspectors May, 1931 Lee, W. R July, 1930 Seymour, K. D July, 1935 WOMAN SANITARY INSPECTOR. Wilkinson, Miss Annie M. July, 1909 TUBERCULOSIS SISTER AND HEALTH VISITOR. Backhouse, Miss S. A June, 1931 TUBERCULOSIS NURSE AND ASST. HEALTH VISITOR. Cook, Miss M. H. April, 1935 KEEPER OF THE MORTUARY. steggles, T. DISINFECTOR. Dec., 1918 McDonnell, R. J. MESSENGERS. April, 1903 Tierney, T. E. (Temporary) Dec., 1926 Betts, Charles LABOURERS. April, 1926 Hastings, T. (C (General Duties at Mortuary) June, 1920 Burton, John Henry Do. do. March, 1936 Lawrence, F. H. Do. do. May, 1936 Ludgate, G. General Duties at Smithfield Market) Oct., 1906 Strong, S. R Do. do. March, 1914 Morris, W. F Do. do. March, 1925 Prevost, A. C Do. do. Feb., 1926 Mann, Ernest V. Do. do. Jan., 1928 Lawrence, Charles J. Do. do. Feb., 1928 Graham, Mrs. (Bath Attendant and Cleaner) June, 1927 annual report of the medical officer of health for the year 1937. To the Right Honourable The Lord Mayor, Aldermen and Commons of the Corporation of London. Public Health Department, Guildhall, E.C. June, 1938. My Lord Mayor and Gentlemen, I have the honour to present my Annual Report on the work of the Medical Officer of Health's Department of the Corporation of the City of London for the year 1937. During the year, Mr. J. O. Sharp, Senior Inspector of Meat for the City, retired after 45 years' loyal and capable service, and I should like to place on record my appreciation of the assistance which I received from him during the short time we were associated in this Department. I know also that my predecessor, the late Dr. Willoughby, valued very highly the special knowledge of every aspect of meat inspection possessed by Mr. Sharp, who, before he became a meat inspector, had the benefit, in his early youth, of a practical training in the hutching trade. 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. The area of "Registration London" is 74,817 acres (excluding tidal water and foreshore), or 116-9 square miles. Density.—City of London Registration District, at night, 17.3 persons to an acre; City of London Registration District, during the day, *664.1 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 £60,648,605, on April 6th, 1937, whilst on the same date the corresponding rateable value of property in the City of London was £8,203,193, or about one-seventh of the whole County. The annual sum receivable from a penny rate is £31,500. Population.—The undermentioned figures are extracted from the Report of the Registrar-General on the Census of England and Wales, 1921 :— Area, Statute Acres. Inhabited Houses. Population. Private Families. 1921. 1911. 1921. 1911. 1921. City of London (Not including the Temple) 661 2,784 2,398 19,657 13,709 3,174 Ihese figures represent the population on the nights of the 3rd April, 1911, and the 19th lune, 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 1931 10,808 — Census.) "This figure refers only to persons "actively engaged in the City during the daytime," and is based upon the Imperial Census taken in lune, 1921. b 2 8 There is only one registration district in the City. The estimated population of the City, for the year 1937, is 8,980. 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. Births.—During the year 1937, 377 live births were registered in the City, 362 of which, however, did not belong thereto. To the remaining 15 must be added the births of 40 children born to citizens temporarily residing outside the City boundary. The number of births, therefore, on which the rate should be calculated is 55. There were three still births. The annual birth-rate was 6.1 per 1,000 persons of all ages, compared with a quinquennial mean rate of 7.4 per 1,000. In the Metropolis the birth-rate in 1937 was 13.3 per 1,000. Mortality.—During the year under review, 551 deaths were registered in the District, including 506 persons dying in the City, but not belonging thereto. Deducting these latter, 45 deaths remain, to which must be added those of 56 persons who died in outside districts, where they were registered ; the total, therefore, on which the City death-rate is calculated is 101. See table, p. 9, for details. The death-rate for 1937 was 11.2 per 1,000 per annum of the population (the previous year being 11.4), whilst that for the whole of the Metropolis was 12-3. Deaths from Violence.—Of the City deaths, 3.0 per cent. were caused by injuries or violence, as compared with 9.7 in 1935 and 6.7 in 1936. This is 3.8 below the average for the previous five years. PERCENTAGE OF REGISTERED DEATHS FROM VIOLENCE. Year. City of London. Per cent. Metropolis Per cent. 1932 10.2 4.6 1933 4.6 4.7 1934 3.9 5.6 1935 9.7 4.5 1936 6.7 4.2 Average previous five years 6.8 4.7 1937 30 0.5 DEATH RATES, PER 1,000 PER ANNUM. Year. City of London. 125 Great Towns of England and Wales. polis 1932 12.8 12.2 12.3 1933 10.9 12.2 12.2 1934 10.5 11.8 11.9 1935 110 11.8 11.4 1936 11.4 12.3 12.5 Average previous five years 11 3 121 121 1937 11.2 12.5 12.3 The death.rate from zymotic disease per 1,000 of the population was 0.1. The deaths from Phthisis correspond to a rate of 0.8 per 1,000 of the population, as compared with .80 in the Metropolis. Infantile Mortality.—The deaths of children under one year of age were at the rate of 18 per 1,000 births, as against 60 for the whole of London. 9 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1937. 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. 6 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and upwards. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. All Causes. 101 2 l .... 2 2 2 6 13 24 24 25 463 1. Typhoid and Paratyphoid Fevers .... .... .... .... .... .... .... .... .... .... .... .... 1 2. Measles .... .... .... .... .... .... .... .... .... .... .... .... .... 3. Scarlet Fever .... .... .... .... .... .... .... .... .... .... .... .... .... 4. Whooping Cough .... .... .... .... .... .... .... .... .... .... .... .... .... 5. Diphtheria 1 .... .... .... 1 .... .... .... .... .... .... .... .... 6. Influenza 4 .... .... .... .... .... 1 .... .... 1 .... 2 .... 7. Encephalitis Lethargica .... .... .... .... .... .... .... .... .... .... .... .... 1 8. Cerebro-spinal Fever .... .... .... .... .... .... .... .... .... .... .... .... .... 9. Tuberculosis of Respiratory System 7 .... .... .... .... .... .... .... l 3 1 .... .... 10. Other Tuberculous Diseases .... .... .... .... .... .... .... .... .... .... .... .... 12 11. Syphilis 1 1 .... .... .... .... .... .... .... .... .... .... 3 12. General Paralysis of the Insane, Tabes Dorsalis 1 .... .... .... .... .... .... .... .... 1 .... .... .... 13. Cancer, Malignant Disease 13 .... .... .... .... .... .... .... 4 2 4 3 84 14. Diabetes 1 .... .... .... .... .... .... .... .... .... .... 1 5 15. Cerebral Haemorrhage, &c. 4 .... .... .... .... .... .... 1 1 .... 1 1 12 16. Heart Disease 32 .... .... .... .... .... .... 1 .... 9 8 14 43 17. Aneurysm 1 .... .... .... .... .... .... .... .... 1 .... .... 3 18. Other Circulatory Diseases 7 .... .... .... .... .... .... .... 2 .... 3 2 6 19. Bronchitis 3 .... .... .... .... .... .... .... 1 1 .... 1 4 20. Pneumonia (all forms) 9 .... 1 .... .... .... .... .... 2 2 3 1 55 21. Other Respiratory Diseases 1 .... .... .... .... .... .... .... 1 .... .... .... 7 22. Peptic Ulcer 3 .... .... .... .... .... .... .... 1 .... 1 .... 16 23. Diarrhoea, &c. .... .... .... .... .... .... .... .... .... .... .... .... 9 24. Appendicitis .... .... .... .... .... .... .... .... .... .... .... .... 9 25. Cirrhosis of Liver .... .... .... .... .... .... .... .... .... .... .... .... 3 26. Other Diseases of Liver, &c .... .... .... .... .... .... .... .... .... .... .... .... 3 27. Other Digestive Diseases 1 .... .... .... .... .... 1 .... .... .... .... .... 1 28. Acute and Chronic Nephritis 2 .... .... .... .... .... .... .... .... 1 .... .... 35 29. Puerperal Sepsis .... .... .... .... .... .... .... .... .... .... .... .... 1 30. Other Puerperal Causes .... .... .... .... .... .... .... .... .... .... .... .... .... 31. Congenital Debility, Premature Birth, Malformations, &c 1 1 .... .... .... .... .... .... .... .... .... .... 14 32. Senility .... .... .... .... .... .... .... .... .... .... .... .... .... 33. Suicide .... .... .... .... .... .... .... .... .... .... .... .... 5 34. Other Violence 3 .... .... .... .... .... .... .... .... 1 .... .... 33 35. Other Defined Causes 6 .... .... .... 1 1 .... .... .... 2 2 .... 90 36. Causes ill-defined or unknown .... .... .... .... .... .... .... .... .... .... .... .... .... Totals 101 2 l .... 2 2 2 6 13 24 24 25 463 10 VITAL STATISTICS OF WHOLE DISTRICT DURING 1937 AND PREVIOUS FIVE 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. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1932 9,990 397 65 6.5 650 65 06 593 71 3 46 128 12.8 1933 9,830 396 83 8.4 572 58.18 521 57 5 60 108 10.9 1934 9,660 382 66 6.8 670 69.36 628 59 8 121 101 10 5 1935 9,360 378 71 7.6 572 6111 525 56 8 113 103 11.0 1936 9,100 417 68 7.5 546 60 00 501 59 10 147 104 114 Average previous 5 years 9,588 394 71 7.4 602 62.74 554 60 7 97 109 11.3 1937 8,980 377 55 61 551 61.35 506 56 2 18 101 11.2 Area of City of London in acres (land and inland water) 661 Total population at all ages 13,709 Number of inhabited houses 2,922 Average number of persons per house 4.6 At Census 1921. Vaccination.—Of the 398 births notified to the Vaccination Officer during 1936, 131 had been successfully vaccinated by the end of 1937, 21 had died before the age for vaccination and 1 was reported as insusceptible. Vaccination was postponed by medical certificate in 0 cases, and 151 had removed into other districts. No case was pending. There were 94 instances of conscientious objection. The Public Vaccinator performed 9 re.vaccinations during the year, and in addition to the 131 successful vaccinations referred to above, 2 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.[/##] 1932 413 per cent. 41.7 per cent. 0.7 per cent. Nil. per cent. 3.4 per cent. 0.3 per cent. 33.1 per cent. 21.3 1933 396 36.7 0.7 „ 4.5 0.2 35.4 22.5 1934 371 31.5 Nil. „ 4.0 1.1 41.6 21.8 1935 370 36.9 „ „ 45 0.2 365 21.9 1936 398 27.2 0.4 „ 4.9 Nil. 43.7 23.8 Average previous 5 years 389 34.8 0.4 „ 4.3 0.4 38.1 22.3 1937 398 32.9 0.2 „ 5.3 .... 37.9 23.7 11 NATIONAL HEALTH CAMPAIGN. The City Corporation took part in the National Health Campaign which was organised during 1937. Posters and display cards were exhibited and the larger employers of labour were communicated with in an appropriate manner. The City medical practitioners were also asked to co-operate, and were supplied with all the information available as to the various health services administered by the Public Health Committee. A special leaflet was prepared for distribution from post offices, where an additional small notice was exhibited on the public notice boards drawing attention to the fact that such leaflets were available at the counter. INSURANCE. A matter of some considerable domestic importance was reviewed during the year, and the Public Health Committee have now arranged for an insurance policy to be effected which covers any legal liability in respect of injuries to persons and damage to property arising in connection with the conduct and services of the various clinics administered by them. maternity and child welfare. Four hundred and twenty-seven notifications of births, including 24 still births, made in accordance with the requirements of the Notification of Births Act, were received. Of these, 48 only referred to City births; and the balance were transferred to the appropriate authorities. There were 3 still births to City parents. Forty-eight initial visits were made as a consequence of these notifications, and 1,161 subsequent visits in connection with infant welfare and ante-natal work. Three visits were necessary in connection with cases which came within the scope of the Children Act, 1908, or in respect of a nurse child. Supplies of milk (2,664 galls.) and 424 lbs. of dried milk, at cost price or free, according to circumstances, have been provided, according to the practice which has been in operation for some years. Cod Liver Oil is also given if its administration appears to be desirable. One home help was provided during 1937. There was one notification of a verminous school child under the London County Council (General Powers) Act, 1904. Three visits were made in connection with infant life protection. There were no cases of Ophthalmia. The lying-in accommodation provided by the City Corporation at St. Bartholomew's Hospital, in accordance with the provisions of the Local Government Act, 1929, was not utilized during 1937. THE CITY OF LONDON WELFARE CENTRE, HELD AT ST. BARTHOLOMEW'S HOSPITAL. The City of London Infant Welfare Centre continued actively during 1937. It was found necessary during the year to alter the dates of the two weekly sessions, and these now take place at 2.30 p.m., on Wednesdays and Thursdays. There were 99 sessions held of the Welfare Centre, 8 special sessions for the immunisation of children against diphtheria, and 2 for Schick tests. One thousand one hundred and sixty-one home visits were paid by the Health Visitors. It will be seen that, with an annual birth registration of about 48, this activity effectively covers the babies and young children living in the City and provides a satisfactory health service. 1 hope, however, to develop an ante- and post-natal and a convalescent service during the coming year. During this year the immunisation of children against diphtheria has continued. Altogether, 25 have been immunised in 1937, which may be counted a fairly satisfactory figure. Seventy-one children have now been immunised. It has proved necessary to hold special sessions for purposes of immunisation and for Schick testing ; the technique cannot be satisfactorily carried out and the cases properly supervised at the regular sessions without causing much waiting and delay for the mothers normally attending. 12 There has been a decrease of 91 in the number of attendances at the Infant Welfare Centre, during 1937, probably accounted for by the decrease from 68 to 48 births. Visits decreased by 550. It has been possible to arrange that toddlers attending the Centre receive dental treatment at Eastman's Dental Clinic, in Gray's Inn Road. Sunlight treatment, when recommended by the Medical Officer in charge of the clinic, is available through the kind offices of the Skin Department of St. Bartholomew's Hospital. Both these arrangements are informal, and the assistance rendered by the two institutions in question is gratefully acknowledged. Through the kind offices of the Lady Almoner at St. Bartholomew's Hospital, eight of the children attending the Infant Welfare Clinic and five mothers were accommodated in the Convalescent Home. During the year, the gift of Coronation mugs to all children attending the Centre was approved by the Public Health Committee, and these mugs seemed to give considerable satisfaction to the parents of the recipients. Dr. Charles F. Harris, who is in charge of the Corporation Clinic held at St. Bartholomew's Hospital, has kindly prepared the following brief report on the working of the Clinic during 1937. " The Infant Welfare Centre of the Corporation of the City of London, which holds " sessions at St. Bartholomew's Hospital on two days in each week, continued its activity " during the year 1937. One extension was made in the work, and that was in the direction " of increasing the supply of milk and vitamins to expectant mothers during the ante-natal *' period. This involved home visits to 157 expectant mothers and is part of the work which " will presumably be transferred to the City's Ante-natal and Maternity Service when this is "established. There were 2,153 attendances at the Welfare Centre, and 1,115 home visits "were made by the Health Visitors. Forty-eight births were notified in the City during " the year and two infants died. This is a remarkably low figure, the importance of which " is increased when it is realised that the death of one of these infants was due to causes for " which there is no prevention, and the other death took place when the child was a week old, " of a disease which could not be treated after the child was born. " Twenty-five infants were immunised against diphtheria. " The very successful working during the year has depended, as in the past, on the energy " and enthusiasm of the Medical Officer attending the Centre, Dr. Franklin, and of the Health " Visitors, Miss Backhouse and Miss Cook." The following is a tabulated statement of the work carried out by the Health Visiting Staff in the above connection :— MATERNITY AND CHILD WELFARE, 1937. Birth Notifications received, 48. Infant Welfare Centre, 99 Sessions :— (There were also 10 Sessions for Diphtheria Immunisation and Schick testing.) Under 1 year 863 ) Total 2,153 Over 1 year 1,290 J attendances. Mothers attending during year 116 „ left City „ „ 37 No. Children becoming 5 during year 17 Total visits, 1,161 : Under 1 year 281 Over 1 to 5 years 668 Ante-Natal 157 Ophthalmia 0 Deaths under 1 year 2 Still Births 2 Infant Life Protection 3 L.C.C. Reports for schools 0 Scabies 1 Puerperal Pyrexia 1 Diphtheria Immunisation 46 13 maternal mortality. The enquiries into maternal deaths, which the Ministry of Health has required to be conducted, have not called for any particular organisation in my Department. With a small City resident population, few deaths in this category are reported. Where such cases do occur, investigations are conducted by me. No case was reported during 1937. It may be of interest to note that, from 1900 to 1937 inclusive, only 17 maternal deaths have occurred amongst City residents. PROVISION OF DENTURES FOR MOTHERS AND EXPECTANT MOTHERS. During 1935 it was felt that the Maternity and Child Welfare activities of the Corporation were somewhat stultified by the fact that some of the City mothers in urgent need of dental treatment were not in the position to meet the cost, and the Public Health Committee decided to make free provision in such cases as the Medical Officer in charge thought necessary and where the financial conditions justified it. Some contribution is obtained when possible. Two mothers were supplied with complete dentures and one mother was supplied with new upper set in 1937. PROVISION OF MILK FOR SCHOOL CHILDREN. The Milk Act, 1934, authorised a scheme for the provision of milk for school children and has as its object the increase in the demand for milk in schools by lowering the price to scholars who are young children and young persons attending schools or courses for unemployed boys or girls recognised for grant by the Board of Education. The special price to these consumers is ½d. per ⅓ pint and the milk is supplied in ⅓-pint bottles. Free milk is also provided in cases where children are unable to pay and where necessity is certified by the Education Authority's Medical Officer. A scheme for the detailed and administrative control has been put into operation and, so far as London is concerned, it has been agreed that milk supplied under the scheme shall be pasteurised milk and comply with the Milk (Special Designations) Order, 1936. Details of the supervision of this milk appears on p. 56. MIDWIVES ACT, 1936. The above-mentioned Act provides a domiciliary service of midwives in London, and for the purposes of its administration the City has been included by the London County Council in Area B, which embraces the City and the Metropolitan Boroughs of Holborn, Finsbury, Islington and St. Pancras. The total population of this area is estimated to be nearly 600,000 people and the number of births in the year was about 10,000. Of these births, nearly 7,000 took place in institutions and about 3,500 in private homes. Arrangements have now been made as a consequence of this Act whereby every woman living in London, who wishes her baby to be born in her own home, may have the services of one of the London County Council midwives, and appropriate fees have been agreed in connection therewith. Expectant mothers should apply at once to the midwife of their choice, and the list of midwives can be obtained on application at the local council offices. Arrangements have also been made for the advice of expert consultants when circumstances suggest this to be desirable. OPEN-AIR DAY NURSERIES. During the summer months of 1935, 1936 and 1937, the London County Council granted to the National Society of Day Nurseries permission to use a site in Battersea Park for the erection of a marquee in which very young children might be looked after by the Society in order that their parents might have some leisure. A small charge was made for the accommodation, and light refreshment and simple games apparatus were provided, together with, of course, necessary supervision. Such success has attended the experiment that the General Purposes Committee of the London County Council felt that the scheme might c 14 form the basis of a valuable social service, and I understand that they are prepared to consider recommending to the Council that power be sought to allocate portions of open spaces in parks under their control, where the borough councils who are responsible for the administration of the Maternity and Child Welfare Act could provide these nurseries under properlycontrolled conditions. So far as the City is concerned, it is difficult to see where advantage could be taken of any of the sites which it would be possible for the County Council to allocate, as there are practically no parks or open spaces under their control situate within what I regard as reasonably accessible distance of the City. The scheme, however, in general is a very desirable one, and although the City is hardly likely to be able to take advantage of any provision of this nature, it is one with which it would naturally be in sympathy. OFFICE ACCOMMODATION.—TUBERCULOSIS DISPENSARY AND MATERNITY AND CHILD WELFARE CENTRE. It has been necessary to arrange with the Authorities of St. Bartholomew's Hospital for increased office accommodation in connection with the above-mentioned activities, and I am pleased to say that this provision has very largely increased the ease of working and efficiency of this section of the Department's activities. POST-GRADUATE NURSING COURSE. With the approval of the Public Health Committee, the Tuberculosis Sister and Health Visitor and the Assistant Health Visitor attended a special post-graduate course organised by the College of Nursing during the early part of the summer. These courses are particularly valuable to officers in the public health nursing service, as it enables them to keep in touch with modern developments in their profession. infectious diseases. Thirty-eight cases of infectious disease were notified during the year 1937. An examination is made of the sanitary condition of the premises where the cases occurred, and a summary of defects found by the District Inspectors is given on p. 62. Chicken-pox is not now notifiable in London. In the following tables will be found particulars relating to cases of infectious diseases and information as to the removal of patients to hospital. 15 STATISTICS OF NOTIFICATIONS AND REMOVALS TO HOSPITAL. NAME OF DISEASE. Number of Notifications received. Treated at Home. Removed to the L.C.C. Special Hospitals. Removed to the London Fever Hospital. Treated at other Hospitals and Institutions. Duplicate Certificates received. Diagnosis subsequently found to be incorrect. Net number of Cases. Small-pox .... .... .... .... .... .... .... .... Diphtheria 6 .... 5 .... .... .... l 5 Scarlet Fever 12 3 9 .... .... .... .... 12 Enteric Fever (including Para-typhoid) 1 .... .... .... l .... .... 1 Puerperal Fever 2 .... .... .... l l .... 1 Puerperal Pyrexia .... .... .... .... .... .... .... .... Erysipelas 2 .... 1 .... l .... .... 2 Cerebro-spinal Meningitis .... .... .... .... .... .... .... .... Acute Polio-myelitis .... .... .... .... .... .... .... .... Ophthalmia Neonatorum .... .... .... .... .... .... .... .... Malaria contracted abroad .... .... .... .... .... .... .... .... Acute Primary Pneumonia 3 .... .... .... 3 .... .... 3 Acute Influenzal Pneumonia 1 l .... .... .... .... .... 1 Encephalitis Lethargica .... .... .... .... .... .... .... .... Food poisoning or suspected food poisoning 9 8 .... .... 1 .... .... 9 Dysentery .... .... .... .... .... .... .... .... Totals 36 12 15 .... 7 l l 34 Measles 2 1 1 .... .... .... .... 2 Totals 38 13 16 .... 7 l 1 36 The following is a return of infectious diseases which have occurred in the City of London, exclusive of Tuberculosis, Measles, Pneumonia and Food Poisoning, with the percentages of such cases removed to hospitals for treatment or nursed at home during 1937 compared with the figures for the previous five years :— In no case was it necessary to apply for an order for compulsory removal to hospital. Number of actual cases. Per cent, of actual cases reported. Year. Removed to Hospital. Treated at home. 1932 57 91.2 8.8 1933 56 87.5 12.3 1934 61 90.2 9.8 1935 52 90.3 9.7 1936 35 97.1 2.9 Average for the five years 52 91.3 8.7 1937 21 85.7 14.3 C2 16 cases of infectious disease (exclusive of tuberculosis) notified during the year 1937. NUMBER OF ACTUAL 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. 5 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 5 .... .... .... .... .... 1 2 1 .... 1 .... .... 5 Erysipelas 2 .... .... .... .... .... .... .... .... 1 .... l .... 2 Scarlet Fever 12 .... .... .... .... l 3 1 .... 7 .... .... .... 9 Typhus „ .... .... .... .... .... .... .... .... .... .... .... .... .... .... Enteric „ (includin Para-typhoid) 1 .... .... .... .... .... .... .... .... .... .... l .... 1 Relapsing „ .... .... .... .... .... .... .... .... .... .... .... .... .... .... Continued „ .... .... .... .... .... .... .... .... .... .... .... .... .... .... Puerperal „ 1 .... .... .... .... .... .... .... .... 1 .... .... .... 1 Puerperal Pyrexia .... .... .... .... .... .... .... .... .... .... .... .... .... .... Polio-myelitis .... .... .... .... .... .... .... .... .... .... .... .... .... .... Cerebro-spinal Meningitis .... .... .... .... .... .... .... .... .... .... .... .... .... .... Ophthalmia Neonatorum .... .... .... .... .... .... .... .... .... .... .... .... .... .... Measles 2 .... .... .... 1 .... .... .... .... 1 .... .... .... 1 Malaria (contracted abroad) .... .... .... .... .... .... .... .... .... .... .... .... .... .... Acute Primary Pneumonia 3 .... .... .... .... .... .... 1 .... 1 .... l .... 3 Acute Influenzal Pneumonia 1 .... .... .... .... .... .... .... .... .... .... .... 1 1 Encephalitis Lethargica .... .... .... .... .... .... .... .... .... .... .... .... .... .... Dysentery .... .... .... .... .... .... .... .... .... .... .... .... .... .... Food Poisoning 9 .... .... .... .... .... .... .... l 4 2 2 .... 1 Totals 36 .... .... .... 1 l 4 4 2 15 3 5 1 23 * L.C.C. Hospitals, St. Bartholomew's Hospital. City Police Hospital, &c. 17 ANTI-TOXIN IN DIPHTHERIA. Although the administration of anti-toxin to practically every recognised case of diphtheria has resulted in a great reduction in the mortality from that disease, it was apparent that there was need for authoritative advice as to dosage. The London County Council appointed a committee of experts to consider this question, and their valuable report has been circulated to all medical practitioners in the City and also to St. Bartholomew's Hospital. PUBLIC HEALTH OPHTHALMIA NEONATORUM (AMENDMENT) REGULATIONS, 1937. Ophthalmia Neonatorum is a purulent discharge from the eyes of an infant, commencing within 21 days from the date of its birth. It is usually a gonorrhœal affection, and if not treated promptly and efficiently, is very likely to result in blindness. Regulations for the notification of this disease were first made in 1914, when notification had to be sent to the Medical Officer of Health of the district in which the parents or guardians of the child were living by either the certified midwife or the medical practitioner in attendance. This dual notification by midwife or doctor led to confusion and in some cases to failure to notify at all. Therefore new regulations were introduced in 1926, placing the obligation to notify on the medical practitioner only. Notification had, however, to be sent to the Medical Officer of Health of the district in which the parents or guardians of the child were living, and the local medical officer of health was required to send a copy of the notification to the county medical officer of health within 24 hours. In 1928, amendment regulations were issued requiring that notification should be to the medical officer of health of the district in which the doctor was attending the child. In the administrative County of London cases occurring in Hospital must be notified to the medical officer of health of the district from which the child or mother was brought to the hospital. It has now been agreed that it is essential that notification should be received at the earliest possible moment by the maternity and child welfare authorities, who are in a position to give assistance by home visiting and nursing or by hospital treatment. Further amendment regulations, styled the Public Health (Ophthalmia Neonatorum) Regulations, 1937, have therefore been issued, and came into operation on the 1st April, 1937. These require that notification shall be direct to the Medical Officer of Health of the local authority for the purposes of the Notification of Births Acts, which is in all districts the Maternity and Child Welfare Authority. The Regulations also provide that the medical officer of health for the district which is not a maternity and child welfare authority will receive a notification of any case of Ophthalmia Neonatorum occurring in his district from the County Medical Officer of Health, and that the County Medical Officer of Health will receive prompt information of all cases occurring in the County. Thus notification will be direct to the authorities able to act on the information for the benefit of the patient, but provision is made for copies of the notifications to be sent promptly to authorities indirectly concerned. LEPTOSPIRAL JAUNDICE. Leptospiral Jaundice is an uncommon disease in this country and is difficult to diagnose, particularly in mild cases. I have therefore made arrangements for blood tests to be taken of all suspected cases amongst City sewer workers, and have also arranged that, in the case of any of these men who are away from duty suffering from any ailment which even remotely suggests the possibility of leptospiral infection, a letter be sent to the medical practitioner in attendance, reminding him that this disease is an occupational risk amongst sewer workers and informing him of the facilities for diagnosis. SCABIES AND IMPETIGO. In consequence of the increase during recent years in the number of cases of Scabies and Impetigo reported by head teachers of the London County Council day schools, as well as in the number attending the bathing centre provided by the Council, the London County Council prepared a circular letter for distribution to medical practitioners, indicating the facilities available for the treatment of Scabies and Impetigo, and at the request of that Authority I have circulated this letter to the medical men practising within the City area. See Appendix F. 18 conditions of admission of patients to smallpox hospitals. The London County Council, who are responsible for hospital accommodation for Small-pox cases in London, decided that every precaution should be taken to ensure that a diagnosis of Small-pox is established before a patient is admitted to a receiving station, and with this object in view, the Council maintains a panel of Small-pox consultants, whose services are available at any time for the assistance of the medical officer of health of the area in which the patient resides. In the past it has occurred that application is received for admission of a case without reference to the borough medical officer of health, and, on occasions, the diagnosis of Small-pox has not been confirmed. Consequently, unnecessary expense and inconvenience has been incurred which might have been avoided had a consultant been called in. In the hope of avoiding such cases as this, the County Council have given instructions that application for the admission of a Small-pox case shall only be considered after the services of a consultant have been obtained. In these circumstances I deemed it advisable to communicate appropriate information on this subject to medical men practising within the City of London. admission of cases of erysipelas into infectious disease hospitals. In view of the fact that the London County Council decided to admit cases of Erysipelas into their infectious disease hospitals instead of, as hitherto, into their general hospitals, City medical practitioners were acquainted of the alteration in the arrangements. small-pox. No case of Small-pox occurred during the year in persons resident or employed in the City. distribution of diphtheria anti-toxin and anti-influ enza vaccine. Provision was made some years ago for the distribution of Diphtheria anti-toxin free of charge to medical practitioners who apply for it. Only two applications were received during 1937. Similar provision is made in regard to anti-Influenza vaccine, but no application was received during the year. 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 engaged in certain occupations associated with the milk trade. provision of insulin. Under the powers provided by Section 227 of the Public Health (London) Act, 1936, the Corporation have, at the request of the authorities of the University College Hospital, supplied, at regular intervals, insulin to one patient resident in the City and in attendance at that hospital. This is the first patient, so far as I am aware, in regard to whom such powers have been put into operation in the City, and the provision has been continuous since 1930. nursing provisions. measles, encephalitis lethargica, cerebro-spinal fever and influenza. No application has been received during 1937 in connection with the scheme which has been approved in connection with the provision of nursing accommodation for the above-mentioned affections. An expenditure of £25 per annum in connection with complicated cases of measles, encephalitis lethargica and cerebro-spinal fever, and of £30 per annum on provision of medical assistance and nursing attendance in necessitous cases of influenza, has been approved by the Corporation. examination of pathogenic bacteria. Arrangements have been made for free bacteriological examination by Dr. L. P. Garrod, who is in charge of the Bacteriological Department at St. Bartholomew's Hospital, at the request of medical, practitioners, in cases of suspected infectious disease or food poisoning occurring amongst patients residing in the City. City practitioners have been informed of these facilities, and the result is communicated to them immediately it has been ascertained. During the year the following specimens were dealt with, and it will be seen that positive results were obtained in 14 per cent. of these cases. Specimens. Disease Suspected. Result. Positive. Negative. 13 Sputa Tuberculosis 2 11 15 Swabbings from Throats Diphtheria 2 13 19 venereal diseases. The Special Centre for the Treatment of Venereal Diseases, which, in accordance with the powers under the Public Health (Venereal Diseases) Regulations, 1916, the City Corporation established at 20/21, Golden Lane—previously occupied as a shelter, and specially altered to meet the requirements—was transferred to St. Bartholomew's Hospital on the 17th February, 1-930. This step was deemed expedient for economic and other reasons, and it is satisfactory to note that the number of persons availing themselves of the opportunity afforded has since that date shown steady average increase, the total number of new cases in the year being 1,075. The following is a brief summary of the work carried out during 1937. At the beginning of the year 452 males and 194 females were registered on the books as being under treatment or observation, which compares with 436 males and 192 females at the beginning of the previous year. Of these patients, 284 males and 177 females were under treatment for syphilis, 161 males and 17 females for gonorrhoea, and 7 males and no females for soft chancre. No males and no females were under treatment for conditions other than venereal disease. New patients admitted totalled 1,075, as compared with 1,060 in the previous year ; the total attendances were 32,880. Unfortunately, 291 cases discharged themselves before completion of treatment, and 105, although completing treatment, failed to submit themselves to final test. Seventy-one males and 25 females were transferred to other centres after treatment, whilst 451 males and 126 females were discharged after completion of treatment and observation. There were 8 in-patients. The total number of attendances is made up as follows :— Syphilis. Soft Chancre. Gonorrhoea. Non-Venereal Conditions. Total Attendances. Male. Female Male. Female. Male. Female. Male. Female. Male. Female. 12,989 7,407 32 - 10,158 1,575 412 307 23,591 9,289 In the laboratories associated with the Centre, 12,557 specimens were examined, 27 for the detection of spirochetes, 2,035 for gonococci, 9,916 examinations for the Wassermann or Serum test, and 579 for 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 Serum test in respect of these patients:- For Syphilis. No. of patients treated. For Non-Venereal For Soft Chancre. For Gonorrhoea. Conditions. London 185 8 307 425 Essex 2 — 5 4 Middlesex 2 1 — 2 Surrey 0 — 6 4 Kent 1 — 4 3 Herts 1 — 1 4 Sussex — — — 1 Totals 191 9 323 443 The following summary shows the work carried out during each year that the Centre has been in operation. New Patients. Year. Men. Women. Total. lotai Attendances. " 606." Bismuth. Mercury. In-Pts. Path. Ex. 1917 207 87 294 2,340 1,193 .... 339 22 372 1918 304 176 480 8,353 1,406 .... 1,391 71 421 1919 606 201 807 15,269 1,763 .... 1,782 45 2,485 1920 799 254 1,053 21,689 3,690 .... 2,800 41 6,005 1921 570 188 758 18,216 3,584 .... 2,859 52 5,241 1922 469 117 586 16,702 2,637 .... 2,851 23 4,774 1923 367 98 465 14,710 2,049 .... 2,130 9 6,832 1924 301 116 417 10,890 1,510 1,368 1,503 1 7,040 1925 314 88 402 10,541 1,782 1,198 1,192 1 5,835 1926 399 86 485 11,656 1,869 1,539 764 3 6,351 1927 340 80 420 12,501 1,723 2,124 362 2 6,266 1928 395 81 476 13,051 1,785 2,781 2 0 6,932 1929 396 102 498 14,095 1,580 3,042 .... 0 6,822 1930 816 257 1,073 20,694 2,601 5,509 .... 11 8,212 1931 853 209 1,062 26,378 4,175 6,860 .... 24 8,555 1932 785 196 981 26,069 4,916 7,021 .... 5 8,282 1933 845 178 1,023 30,377 4,155 8,532 .... 6 8,314 1934 866 207 1,073 32,130 3,997 9,314 .... 5 8,764 1935 725 202 927 31,214 2,967 6,448 3,229 6 8,709 1936 868 192 1,060 31,565 3,132 6,264 1,501 8 11,256 1937 840 235 1,075 32,880 3,419 6,964 520 8 12,557 Totals 11,055 3,350 14,405 401,320 56,933 66,964 23,207 343 150,025 20 RETURN RELATING TO ALL PERSONS WHO WERE TREATED AT THE TREATMENT CENTRE AT ST. BARTHOLOMEW'S HOSPITAL DURING THE YEAR ENDED THE 31st DECEMBER, 1937. Syphilis. Soft Chancre. Gonorrhoea. Conditions other than Venereal. Totals. M. f. M. 1 f. M. f- M. r. M. F. Totals. 1. Number of cases on 1st January under treatment or observation 284 177 7 .... 161 17 .... .... 452 194 646 2. Number of cases removed from the register during any previous year which returned during the year under report for treatment or observation of the same infection .... 32 19 .... .... 38 .... .... .... 70 19 89 3. Number of cases dealt with for the first time during the year under report (exclusive of cases under Item 4) suffering from :— Syphilis, primary 21 2 .... .... .... .... .... .... 21 2 23 „ secondary 40 29 .... .... .... .... .... .... 40 29 69 „ latent in 1st year of infection .... 7 .... .... .... .... .... .... .... 7 7 „ all later stages 54 24 .... .... .... .... .... .... 54 24 78 congenital 6 8 .... .... .... .... .... .... 6 8 14 Soft Chancre .... .... 9 .... .... .... .... .... 9 .... 9 Gonorrhoea, 1st year of infection .... .... .... .... 251 34 .... .... 251 34 285 later .... .... .... .... 38 .... .... .... 38 .... 38 Conditions other than venereal .... .... .... .... .... .... 332 Ill 332 111 443 4. Number of cases dealt with for the first time during the year under report known to have received treatment for the same infection, or to have been under observation, at other Centres 9 1 .... .... 10 .... .... .... 19 1 20 Totals of Items 1, 2, 3 and 4 446 267 16 .... 498 51 332 111 1,292 429 1,721 5. Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 11 6 8 .... 100 14 332 106 451 126 577 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from :— Syphilis, primary 7 1 .... .... .... .... .... .... 7 1 8 „ secondary 11 39 .... .... .... .... .... .... 11 39 50 latent in 1st year of tion .... 6 .... .... .... .... .... .... .... 6 6 ,, all later stages 45 24 .... .... .... .... .... .... 45 24 69 „ congenital .... 6 .... .... .... .... .... .... .... 6 6 Soft Chancre .... .... .... .... .... .... .... .... .... .... .... Gonorrhoea, 1st year of infection .... .... .... .... .... 109 13 .... .... 109 13 122 „ later .... .... .... .... 30 .... .... .... 30 .... 30 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure 38 13 6 .... 48 .... .... .... 92 13 105 8. Number of cases transferred to other Centres or to institutions, or to care of private practitioners 41 16 .... .... 30 9 .... .... 71 25 96 9. Number of cases remaining under treatment or observation on 31st December 293 156 2 .... 181 15 .... 5 476 176 652 Totals of Items 5, 6, 7, 8 and 9 (These totals should agree with those of Items 1, 2, 3 and 4.) 446 267 16 .... 498 51 332 111 1,292 429 1,721 10. Number of cases in the following stages of syphilis included in Item 6 which failed to complete one course of treatment :— Syphilis, primary 5 .... .... .... .... .... .... .... 5 .... 5 ,, secondary 6 23 .... .... .... .... .... .... 6 23 29 „ latent in 1st year of infection .... 4 .... .... .... .... .... .... .... 4 4 „ all later stages 11 10 .... .... .... .... .... .... 11 10 21 „ congenital... .... 4 .... .... .... .... .... .... .... 4 4 11. Number of attendances :— (a) for individual attention of the medical officer (s) 12,989 7,407 32 .... 4,520 773 412 307 17,953 8,487 26,440 (b) for intermediate treatment, e.g., irrigation, dressing .... .... .... .... 5.638 802 .... .... 5,638 802 6,440 Total Attendances 12,989 7,407 32 .... 10,158 1,575 412 307 23,591 9,289 32,880 12. In-patients (a) Total number of persons admitted for treatment during the year 2 2 .... .... 4 .... .... .... 6 2 8 (6) Aggregate number of " inpatient days " of treatment given 2 2 .... .... 152 .... .... .... 154 2 156 Return relating to all persons who were treated at the Treatment Centre at St. Bartholomew's Hospital during the year ended the 31st December, 1937.—continued. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 years and over. Totals. M. F- M. F- M. F- M. M. F. 13. Number of cases of congenital syphilis in Item 3 above classified according to age periods 1 .... .... .... 1 2 4 6 6 8 14. Chief preparations used in treatment of Syphilis :— (a) Names of preparations Arsenical. Mercury. Bismuth. Approved Arsenobenzene 1 Compounds. Others. Neosalvarsan. Neokharsavan. N o varsenobillon. SiJsalvarsan. Collosal Mercury Sulp. Oxychloride & Collosal Metal. (b) Total number of injections given (out-patients and in-patients) 3,419 520 6,964 15 Pathological Work :— (a) Number of specimens examined at, and by the medical officer of, the Treatment Centre Microscopical Cultural for Gonorrhoea. Serum Cerebrospinal fluid. Others for diagnosis of Venereal Disease. for Syphilis. for Gonorrhoea. for Syphilis. for Gonorrhoea. .... .... .... .... .... .... .... (6) Number of specimens from patients attending at the Treatment Centre sent for examination to an approved laboratory 27 2,035 18 1,243 63 .... .... 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. Middlesex. Essex. Surrey. Sussex. Kent. Herts. Total. a. Number of cases from each area included under the following headings in Item 3:— Syphilis 185 2 2 .... .... 1 1 .... 191 Soft Chancre 8 1 .... .... .... .... .... .... 9 Gonorrhoea 307 5 6 4 1 323 Conditions other than venereal 425 2 4 4 1 3 4 443 Total 925 5 11 10 1 8 6 .... 966 B. Total number of attendances of all patients residing in each area 32,402 97 70 1.41 79 2 29 .... 32,880 C. Aggregate number of " In-patient days " of all patients residing in each area 156 .... .... .... .... .... .... .... 156 17th Jan., 1938. 21 (Signed) KENNETH M. WALKER, Medical Officer of the Treatment Centre. d 22 The hours at which the Dispensary was open for diagnosis and treatment of Tuberculosis were :— Tuesdays 12.30 p.m.—2.30 p.m. 2.30 p.m.—4.30 p.m. For the Artificial Pneumothorax Clinic. 5.0 p.m.—7.0 p.m. Fridays 12.30 p.m. (New cases only.) 3.30 p.m.—4.30 p.m. In all, 260 sessions have been held. New Patients.—The number of new patients examined was 303, as compared with 265 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 118 154 272 „ Dental „ 0 4 4 ,, Throat ,, 4 26 30 ,, Other ,, 1 14 15 123 198 321 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. One resident and 4 non-resident patients were admitted for this and other purposes. Examination of Sputum.—The following is a summary :— City Residents. Non-Residents. Total. Positive 8 27 35 Negative 20 127 147 Residential Treatment.—The number of patients for whom residential treatment was arranged was 28. Admitted to L.C.C. Institutions. Other Institutions. St. Colurabas Hospital. Corpn. Expense. St. Joseph's Hospice. Corpn. Expense. Brompton Corpn. Expense. Total. Patients resident in the City 4 2 - l - 7 Patients non-resident 4 6 - — - 10 8 8 l - 17 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.—(i.) 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 63. In addition, 42 contacts were kept under observation. (ii.) 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. (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 150. Total Attendances :— Residents 358 Non-Residents 1,037 1,395 23 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, and at St. Joseph's Hospice, Hackney. One case was admitted in 1937 to the latter institution. During past years a certain amount of difficulty has arisen in connection with the residential treatment of cases who were residing at the place at which they were employed, when diagnosed as having pulmonary tuberculosis. In order to meet this, the Corporation have made an arrangement with the Brompton Hospital whereby urgent cases can be admitted within 48 hours under Dr. Young's personal care, under a Certificate from the Medical Officer of Health. It was not necessary to utilise this facility during the year. Blood Examinations.—During the past three years a new method of examination by means of the estimation of the Red Cell Sedimentation Rate has become a routine at the Dispensary. This examination has been performed on 286 occasions. Seventy-six were performed on patients resident in the City. The examinations were extremely helpful in estimating the activity and progress of the disease. Artificial Pneumothorax.—This method of treatment is being increasingly employed, and its value is beyond doubt. The conduct of the cases should be controlled accurately by floroscopic examinations made prior to the introduction of air into the patient's chest. Many failures which have occurred when this treatment has been used are due to lack of floroscopic control. At the City Dispensary this examination has been carried out on every occasion prior to a refill. During the year 382 refills were performed on 19 cases— 4 resident in the City and 15 non-resident. A number of patients who are not resident in the City have been treated on behalf of other Local Authorities and payment made to the City Corporation for the work done. The Tuberculosis Sister and, Nurse.—As an adjunct to the work at the Tuberculosis Clinic, the outside work of the Tuberculosis Sister and Nurse has been continued on the same lines as former years. Thirty-nine homes have been visited, and 144 visits made in connection with after-care and following up, and four in connection with City deaths. The Clerical work in connection with the Dispensary, which is increasing every year, is carried out by these Officials. A somewhat complicated system of records has to be kept during the year to provide material for the detailed returns furnished for the Ministry of Health at the end of each year. Reports are furnished each month to the City Medical Officer of Health, and progress reports of all patients who have been treated in a London County Council Institution are sent annually. Great care has been taken that a full detailed clinical report is sent to every doctor who sends up cases to the Dispensary. To facilitate this work, arrangements have been made by the City Corporation with St. Bartholomew's Hospital, by which a small office has been provided adjacent to the Dispensary. 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 Sister and one Tuberculosis Nurse are 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 doctors, 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, the Tuberculosis Nurse calls upon him or he is reminded of the appointment in writing. d2 24 (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 Sister or Nurse. (vi.) Every patient attending the Dispensary as a new case has had an X-ray taken, and all patients who attend for further treatment have at least one additional film taken during the year. The usual methods of treatment have been continued in the Dispensary. Four City and 15 non-City cases of pulmonarv tuberculosis attended for the continuation of their treatment by artificial pneumothorax. Collapse therapy, by means of Artificial Pneumothorax intra and extra pleural, Thorocoplasty and Phrenic interruption have been used on an increasing scale. (vii.) Experience shows that when the disease is active, residence in an institution more quicklv and certainly brings about arrest than when the 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. (No patient was so provided during 1937.) (ix.) Nursing in their own homes of patients resident in the City is one of the duties of the Tuberculosis Sister, but this year no visits in this connection were necessary. Milk has been provided for necessitous persons requiring extra nourishment, and in this connection the sum of about £00 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 in 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 Public Health 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 were 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 diffculty 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. Screening.-—A floroscopic screening examination is made on every patient prior to the Artificial Pneumothorax refills. For some time past the Tuberculous Officer has been dissatisfied with the method in use in dealing with adult "contacts" of cases of pulmonary tuberculosis, and a new scheme has been used. The method previously used has been to examine each contact fully with X-rays at the time when the original case was discovered; if no evidence of tuberculous disease was discovered, the contact was seen periodically as long as contact was maintained with the original case and for two years after this had ceased. The objection to this system was mainly psychological; either the contact attended regularly and worried about the possibility of contracting tuberculous disease, or failed to attend after the first time owing †The present lady members of the Committee are Miss Crosby, and Lady Smith, J.P 25 to carelessness or fear that something would be discovered. In addition, there is a considerable change of population in and out of the City. Further, owing to the fact that they had been examined and told originally that there was no evidence of tuberculosis, they were likely to be more negligent about symptoms than they normally would be. The number of people who subsequently develop pulmonary tuberculosis as a result of contact during adult life, provided they show no evidence of heavy tuberculous infection when they are X-rayed, is very small, and it seemed possible that a considerable amount of psychological damage was being done by the system in operation. The new system is to examine each contact case thoroughly at the time when the original case is discovered. If no evidence of tuberculous disease or heavy tuberculous infection is discovered, they are informed of this and given a pamphlet telling them that there is no need to worry unless they develop any of the common symptoms which occur as a result of the onset of tuberculosis, and advising them of the course to take if symptoms do develop. The pamphlet which is given to them is shown in Appendix E. The method of dealing with non-adult contacts has not been changed, as most of the considerations noted above do not apply. Of course, this alteration of method does not mean that any abatement has been allowed in the hygienic measures which are applied to infectious cases. * 26 27 PULMONARY I TUBERCULOSIS. SUPPLEMENTARY ANNUAL RETURN SHOWING IN SUMMARY FORM (A) THE CONDITION AT THE END OF 1937 OF ALL PATIENTS REMAINING ON THE DISPENSARY REGISTER ; AND (B) THE REASONS FOR THE REMOVAL OF ALL CASES WRITTEN OFF THE REGISTER. THE TABLE IS ARRANGED ACCORDING TO THE YEARS IN WHICH THE PATIENTS WERE FIRST ENTERED ON THE | DISPENSARY REGISTER AS DEFINITE CASES OF PULMONARY TUBERCULOSIS, AND THEIR CLASSIFICATION AT THAT TIME. Condition at the time of the last record made during the year to which the Return relates. Previous to 1927. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 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. , 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. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus, j 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). 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). 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). (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults. M .... .... 1 .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Disease not Arrested. Adults. M .... .... 1 .... 1 .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... .... 2 1 3 .... .... .... .... .... .... 1 .... .... 1 1 2 2 .... 3 5 1 .... .... 1 1 F 1 .... 1 .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 .... 1 .... .... 1 .... 1 .... 1 .... 2 .... .... .... .... 1 .... .... l 1 1 .... 1 .... 1 .... .... 1 .... 1 Children. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 .... .... .... .... Condition not ascertained during the year 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Total on Dispensary Register at 31st December 3 .... 3 .... 3 .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... 1 .... .... 1 1 l .... 1 .... 1 .... 1 .... .... 1 .... 3 1 .... 4 2 .... .... .... .... 2 .... .... .... 2 3 2 1 3 6 3 .... 1 1 2 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults. M 2 .... .... .... .... 1 .... 1 .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Lost sight of, or otherwise removed from Dispensary Register 26 3 19 6 28 3 .... 3 2 5 8 1 .... 1 2 3 3 3 .... 6 3 1 3 2 6 5 1 1 3 5 5 2 .... 2 4 5 1 2 1 4 6 3 1 .... 4 2 .... .... 1 1 1 .... .... .... .... 2 .... .... .... .... Adults. M 2 1 3 10 14 .... .... 1 3 4 1 .... 1 2 3 1 .... .... 1 1 .... .... .... 1 1 .... .... 1 2 3 1 .... 1 2 3 .... .... .... 1 1 .... .... .... .... .... 1 .... .... 1 1 1 .... .... 2 2 .... .... .... .... .... Dead. F .... .... .... 3 3 .... .... .... 2 2 .... .... .... 1 1 .... .... .... .... .... .... .... .... 1 1 .... .... .... 1 1 1 .... .... .... .... .... .... .... 2 2 .... 1 .... 2 3 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... Children. 1 .... .... 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Total written off Dispensary Register 32 4 22 20 46 3 .... 5 7 12 9 1 1 4 6 4 3 3 1 7 3 1 3 4 8 5 1 2 6 9 7 2 1 4 7 5 1 2 4 7 6 4 1 2 7 3 .... .... 3 3 2 .... .... 2 2 2 .... .... .... .... GRAND TOTALS .... .... 35 4 25 20 49 6 .... 5 7 12 10 1 1 4 6 4 3 3 1 7 4 1 3 5 9 6 1 3 6 10 7 3 1 4 8 5 4 3 4 11 8 4 1 2 7 5 .... .... 5 5 5 2 1 5 8 5 .... 1 1 2 NON-PULMONARY TUBERCULOSIS. SUPPLEMENTARY ANNUAL RETURN SHOWING IN SUMMARY FORM (A) THE CONDITION AT THE END OF 1937 OF ALL PATIENTS REMAINING ON THE DISPENSARY REGISTER ; AND (B) THE REASONS FOR THE REMOVAL OF ALL CASES WRITTEN OFF THE REGISTER. Condition at the time of the last record made during the year to which the Return relates. Previous to 1927. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 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. 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. 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. (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M .... .... .... .... .... .... .... .... ...... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... Children. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Disease not Arrested. Adults. M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... .... 1 .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 Children. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 1 Condition not ascertained during the year .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Total on Dispensary Register at 31st December .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... .... .... 1 .... .... .... .... .... .... .... 1 .... 1 .... .... .... 2 2 .... .... .... .... .... 1 .... .... .... 1 .... .... .... 1 1 .... .... 1 1 2 Transferred to Pulmonary. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults M .... .... .... .... .... 1 .... .... .... 1 .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. 1 .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Lost sight of, or otherwise removed from Dispensary Register 8 1 1 3 13 1 .... .... 1 2 .... .... .... .... .... .... .... .... 1 1 1 .... .... .... 1 .... .... .... .... .... .... .... .... 1 1 .... .... .... 1 1 .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... Dead. AduJts M .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... F .... .... .... .... .... 1 .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Children. .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Total written off Dispensary Register 9 1 1 3 14 3 .... .... 1 4 .... .... .... .... .... .... .... .... 1 2 1 .... 1 .... 2 .... .... .... .... .... .... .... .... 1 1 .... .... .... 1 1 .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... grand totals of (a) and (b) (excluding those transferred to Pulmonarv. 9 1 1 3 14 3 .... .... 1 4 .... .... .... .... .... 1 .... .... 1 2 2 .... 1 .... 3 .... .... .... .... .... .... .... 1 1 2 .... .... .... 3 3 .... .... .... .... .... 1 .... .... 1 2 .... .... .... 1 1 .... .... 1 1 2 (Signed) CHARLES F. WHITE, Chief Tuberculosis Officer. 28 RETURN SHOWING THE WORK OF THE DISPENSARY DURING THE YEAR 1937. CITY RESIDENTS. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 4 1 1 l 4 2 l 7) (.b) Diagnosis not completed 15 (c) Non-tuberculous 3 5 si B.—CONTACTS examined during the year:— (a) Definitely tuberculous 2 2 2) (b) Diagnosis not completed >42 (c) Non-tuberculous 5 18 10 7 40 | C.—CASES written off the Dispensary Register as:— (a) Recovered 1 1 1 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) .49 8 23 10 7 48 D.—NUMBER OF CASES on Dispensary Register on December 31st:— (a) Definitely tuberculous 18 13 3 3 2 l 1 21 15 4 1 41 (b) Diagnosis not completed 1. Number of cases on Dispensary Register on January 1st 46 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 2 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases " lost sight of " 11 4. Cases written off during the year as Dead (all causes) 4 5. Number of attendances at the Dispensary (including Contacts) 358 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 38 7. Number of consultations with medical practitioners :— (a) Personal (b) Other 15 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 0 9 Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 144 10. Number of:— (a) Specimens of sputum, etc., examined 28 (b) X-ray examinations made in connection with Dispensary work. 194 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above 0 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 20 NON-RESIDENTS. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 96 57 4 6 4 102 61 4 167 (b) Doubtfully tuberculous 6 6 245 (c) Non-tuberculous 39 30 2 1 72 B.—Number of Tuberculous City workers attending Dispensary for treatment on Dec. 31st,192 30 C.—Number of Non-Resident and Non-Workers attending Dispensary for treatment on Dec. 31st, 1937 35 D.—Number of cases transferred to other areas or lost sight of 150 E.—Number of attendances at the Dispensary 1,037 F.—Number of consultations with Medical Practitioner 247 G —Number of:—(a) Specimens of sputum, &c., examined 154 (b) X-ray examinations made 597 29 TUBERCULOSIS DISPENSARY. TRAINING OF HEALTH VISITORS. The Corporation have placed at the disposal of the College of Nursing the facilities available at their Tuberculosis Dispensary, 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. Appreciation has been expressed on every occasion when advantage has been taken of these opportunities, although during 1937 the facilities were not used. ARTIFICIAL PNEUMOTHORAX TREATMENT. At the request of the Authorities of five of the Home Counties, artificial pneumothorax has been administered to patients under their control, and an appropriate fee charged. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. PART I. Summary of Notifications during the period from the 1st January, 1937, to the 31st December, 1937. Age Periods Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary Males .... 2 .... .... .... 1 1 .... 1 3 1 9 12 ,, Females .... .... .... .... .... 1 .... 2 .... .... .... 3 3 Non-Pulmonary Males .... .... .... 1 .... .... .... .... .... .... .... 1 2 „ „ Females .... .... .... .... .... .... .... 1 .... .... .... 1 1 Col. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) PART II. SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period otherwise than by formal notification. Age Periods 0- l- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males .... .... .... .... .... .... .... 1 1 .... .... 2 Females .... .... .... .... .... .... .... .... .... .... 1 1 Non-Pulmonary Males .... .... .... .... .... .... .... .... .... .... .... .... ,, ,, Females .... .... .... .... .... .... .... .... .... .... .... .... The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. No. of Cases. Pulmonary. NonPulmonary. Death Returns from local Registrars l .... transferable deaths from Registrar General .... .... Posthumous notifications l .... " Transfers " from other areas (other than transferable deaths) .... .... Other sources, if any (specify) .... .... PART III. NOTIFICATION REGISTER. Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. Number of cases of Tuberculosis remaining at the 31st December, 1937, on the Registers of Notifications kept District Medical Officers of Health in the County By The Medical Officer of Health of the County Borough or Metropolitan Borough 24 15 39 4 4 8 47 Number of cases removed from the Register(s) during the year by reason of:— 1. Withdrawal of notification .... .... .... .... .... .... .... 2. Recovery from the disease 1 1 1 .... 1 2 3. Death (all causes) 6 3 9 .... .... .... 9 4. Otherwise 14 1 15 1 1 2 1.7 E 30 CONGRESSES. The Congress of the Royal Sanitary Institute, at Birmingham, from the 12th to 17th july; the Congress of the Royal Institute of Public Health, at Margate, from 25th to 29th May; the Congress of the British Social Hygiene Council, in London, from 5th to 9th July, were all attended by representatives of the City Corporation. CONGRESS OF SANITARY INSPECTORS ASSOCIATION OF ENGLAND AND WALES. The Public Health Committee authorised the attendance of one of the Sanitary Inspectors at the Fiftieth Annual Conference of the Sanitary Inspectors Association of England and Wales, which was held at Brighton at the end of August. The permission of the Public Health Committee for one of the staff to attend at this Congress was very much appreciated, and the report I have received from the representative of the staff indicates that these opportunities for the interchange of views and experiences are undoubtedly of great value. CREMATION. The number of cremations taking place in Great Britain during 1937 advanced from 11,289 in 1936 to 14,129. To those who maintain that this method of the disposal of the dead is the only one that should be permitted in the vicinity of residential and industrial areas, these figures are encouraging, and the opening of crematoria during 1937 at Norwich, Croydon, Birmingham, Islington and St. Marylebone, which brings the total in operation to 38, leads one to anticipate that the rate of advance in hygienic disposal will be accelerated in the near future. The old prejudice and belief that this is but a relic of a pagan age and practice is, happily, fast dying, and the observations of The Right Rev. F. L. Dean, D.D., the Bishop of Aberdeen and Orkney, at the placing of the Dedication stone at Aberdeen Crematorium last April is illustrative of the enlightened view-point of many present-day clergy. After affirming that his own remains are to be disposed of in this " reverent and seemly manner," he proceeds: " This representative gathering of ministers of religion this afternoon bear witness to the fact that there is no principle in the Christian Religion on which could be based any condemnation of the practice of cremation." The following summary of cremations at all the Crematoria in Great Britain since 1885, when the first Crematorium was established at Woking, shows that, with only two exceptions, each Crematorium has shown, during 1937, an increase on the 1936 figure: the percentage increase being approximately 25. 31 CREMATIONS IN THE UNITED KINGDOM. 53 Years—1885-1937. YEAR. Woking Manchester. Glasgow. Liverpool. Hull. Darlington. Leicester. Golders Green. Birmingham. (Perry Bar). Leeds. City of London. Sheffield. Bradford. W. Norwood. Hendon Park Pontypridd. Bristol. Ipswich. Edinburgh. Brighton. Guernsey. Nottingham. Reading. Southampton. Birkenhead. Newcas tie-onTyne. Plymouth. Stockport. Blackpool. Dundee. Kent County. (Chariing) S. London. (Streatham). Harrowgate. Norwich. Croydon. Birmingham. (Lodge Hill)- Islington. St. Marylebone. 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 i ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 445 1902 275 81 20 54 13 2 I 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 t 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 1929 426 443 185 103 97 55 124 1,797 205 66 99 81 47 410 14 28 116 37 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4,353 1930 446 442 121 160 84 52 119 1,787 180 73 112 59 49 390 12 40 143 55 125 78 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4,533 1931 476 508 158 163 128 62 89 1,866 257 109 112 87 77 415 13 43 177 68 169 144 4 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5,195 1932 446 626 165 171 126 77 94 2,245 307 116 158 84 123 480 13 51 237 94 266 263 9 74 13 77 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6,315 1933 447 674 202 247 148 119 122 2,396 395 153 192 108 101 624 10 84 300 120 359 300 20 90 67 193 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7,480 1934 430 717 255 240 183 100 129 2.553 386 165 237 120 135 653 11 105 329 132 474 348 15 136 81 299 20 26 10 48 ... ... ... ... ... ... ... ... ... ... 8,337 1935 464 790 307 207 194 74 149 2,855 459 200 215 129 158 726 13 95 312 167 541 449 20 125 95 359 78 188 122 94 29 ... ... ... ... ... ... ... ... ... 9,614 1936 480 892 341 222 195 86 198 3,126 486 206 295 146 188 680 15 139 350 201 730 516 17 184 118 416 112 270 153 109 110 13 104 191 ... ... ... ... ... ... 11,289 1937 556 1,075 430 286 249 106 214 3,467 607 226 364 155 216 455 17 194 475 175 899 601 25 239 162 493 125 377 251 149 212 134 238 686 50 59 110 42 7 3 14,129 Totals ec go ©~ 11,624 3,946 3.577 2.318 1.173 1.963 40.885 4.942 1.993 2.979 1.613 1.567 7.465 176 852 2,510 1,051 3,583 2,699 116 918 536 1,837 335 861 536 400 322 147 342 877 50 59 110 42 7 3 115.307 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 or 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 thereby to others."—Extract from speech made by the late Sir Henry Thompson at the opening of "Golders Green Crematorium. 2?nd November. 1902. Vide " Transactions of Cremation Society of England, 1903. p. 31. †Closed for reconstruction from August, 1913, to July, 1914. 32 FLEAS AND PLAGUE. Investigation into the question of plague-carrying fleas on rats caught in kitchens in the City of London was attempted during the year. It was felt that, under the constantly warm conditions in restaurant kitchens, the Indian plague fleas, Xenopsylla Cheopsis, might survive and multiply. Unfortunately, the experiment had to be abandoned because of the difficulties experienced in carrying out the special requirements of a really scientific investigation. This is to be regretted, as investigation would have been of definite scientific value, as if no Cheopsis fleas were found on rats in the most likely places in the City, it could be assumed that, in spite of the prevalence of the black rat, there would be no great danger of the spread of plague, even if it were introduced. On the other hand, if not only the black rats but the plague-carrying flea are common in London, this danger could not be regarded as altogether absent. MEAT INSPECTION. According to the Board of Trade returns the imports of fresh meat and bacon for the twelve months, 1937, were :— BEEF AND VEAL. Cwts. MUTTON AND LAMB. Cwts. PORK. Cwts. BACON. Cwts. 1937. 1936. 1937. 1936. 1937. 1936. 1937. 1936. Argentine 7,124,885 7,252,004 889,932 900,083 194,001 190,371 — — Australia 2,190,301 1,666,219 1,882,962 1,499,264 233,892 232,510 — — Brazil 527,844 526,514 — — — — — — Canada — — — — — — 1,387,006 1,092,401 Chile — — 210,390 206,968 — — — — Denmark — — — — — — 3,429,427 3,373,415 Estonia — — — — — — 40,506 — Irish Free State 4,223 5,382 15,620 21,324 54,010 115,973 509,809 505,162 Latvia — — — — — — 37,096 — Lithuania — — — — — — 187,949 193,533 Netherlands — — — — — — 481,067 484,708 New Zealand 830,219 824,177 3,603,036 3,530,744 592,648 579,086 — — Poland — — — — — — 442,382 408,415 Sweden — — — — — 250,046 241,604 United States — — — 21,706 — 6,969 16,935 Uruguay Other Countries 654,994 280,473 590,348 268,262 164,961 51,633 126,128 40,027 15,634 10,731 12,514 153,128 217,094 Totals 11,612,939 11,132,906 6,818,534 6,324,718 1,111,891 1,141,185 6,925,385 6,569,632 Live stock for twelve months, 1937:— Cattle. Sheep. Pigs. Canada 9,053 — — Irish Free State 640,996 311,752 42,524 Value of Live Stock:— Canada £158,623 — — Irish Free State £6,114,699 £551,090 £179,944 LONDON CENTRAL MARKETS. Analysis and Comparisons of Supplies in Tons. Description and Country of Origin. Twelve Months. Difference. Beef and Veal: 1937. 1936. England and Wales 22,719 23,732 — 1,013 Scotland 16,768 18,234 — 1,466 Ireland 1,419 1,591 — 172 Australia 24,083 19,091 + 4,992 New Zealand 13,478 11,833 + 1,645 Canada 1,481 2,648 — 1,167 Union of South Africa 1,082 1,058 + 24 S. Rhodesia 2,928 1,899 + 1,029 U.S. of America 1,281 1,468 — 187 Argentina 149,946 152,973 — 3,027 Uruguay 6,408 6,941 — 533 Brazil, etc. 7,227 7,267 — 40 Netherlands — — — Denmark — — — Other Countries 3 3 Totals : Beef and Veal 248,820 248,738 + 82 Mutton and Lamb: England and Wales 10,654 11,410 — 756 Scotland 17,009 18,978 — 1,969 Ireland 1,285 1,796 — 511 Australia 26,948 23,255 + 3,693 New Zealand 62,234 62,369 — 135 Canada 33 11 + 22 Union of South Africa 56 10 + 46 U.S. of America 65 75 — ID Argentina 17,240 15,159 + 2,081 Uruguay 833 882 — 4£ Chile, etc 605 656 — 51 Netherlands — — — Denmark — — — Other Countries 424 326 + 98 Totals : Mutton and Lamb 137,386 134,927 + 2,459 Pork and Bacon : England and Wales 28,276 27,695 + 581 Scotland 53 112 — 5» Ireland 3,887 6,886 — 2,999 Australia 2,540 2,914 — 374 New Zealand 7,213 8,668 — 1,455 Canada 1,025 729 + 296 Union of South Africa — — — U.S. of America 536 571 — 35 Argentina 728 842 — 114 Uruguay 2 5 — 3 Brazil, etc. 136 164 — 28 Netherlands *636 *601 + 35 Denmark Bacon *290 *263 + 27 Other Countries *516 *638 — 122 Totals: Pork and Bacon 45,838 50,088 4,250 Poultry and Game: England and Wales 10,934 12,338 — 1,404 Scotland 1,016 961 + 55 Ireland 2,465 2,240 + 225 Australia 36 45 — 9 New Zealand 43 27 + 16 Canada 969 233 + 736 Union of South Africa — — U.S. of America 5 11 — 6 Argentina 273 276 — 3 Uruguay 17 21 — 4 Brazil, etc. — — — Netherlands 599 470 + 129 Denmark 23 44 — 21 Other Countries 8,314 6,503 + 1,811 Totals : Poultry and Game 24,694 23,169 + 1,525 Totals: Carried forward .... Tons 456,738 456,922 — 184 33 34 Description and Country of Origin. Totals: Brought forward Tons Twelve 1937. 456,738 Months. 1936. 456,922 Difference. 184 Rabbits : England and Wales 3,077 3,245 — 168 Scotland 114 37 + 77 Ireland 2,930 977 + 1,953 Australia 1,965 2,558 — 593 New Zealand 102 291 — 189 Canada — — — Union of South Africa — — — U.S. of America — — — Argentina — — — Uruguay — — — Brazil, etc — — — Netherlands 15 93 — 78 Denmark — — — Other Countries 561 523 + 38 Totals: Rabbits 8,764 7,724 + 1,040 Eggs : England and Wales 1,380 1,397 — 17 Scotland — — — Ireland 129 103 + 26 Australia 62 106 — 44 New Zealand 1 4 — 3 Canada — — — Union of South Africa 29 19 + 10 U.S. of America 1 — + 1 Argentina 46 67 — 21 Uruguay — — — Brazil, etc — 1 — 1 Netherlands 497 477 + 20 Denmark 117 59 + 58 Other Countries 386 386 Totals: Eggs 2,648 2,619 — 29 Butter and Cheese: England and Wales 251 322 — 71 Scotland — 1 — 1 Ireland — 1 — 1 Australia 129 178 — 49 New Zealand 246 295 — 49 Canada 8 12 — 4 Union of South Africa 4 5 — 1 U.S. of America — — — Argentina 65 100 — 35 Uruguay — — — Brazil, etc — — — Netherlands 5 19 — 14 Denmark 2 2 — Other Countries 27 39 12 Totals: Butter and Cheese Tons 737 974 — 237 Sundries : England and Wales 794 738 + 5t> Scotland — — — Ireland — — — Australia 14 — + 14 New Zealand 4 — + 4 Canada 15 2 + 13 Union of South Africa — — U.S. of America 3 3 — Argentina 1 1 — Uruguay — — — Brazil, etc — — — Netherlands 18 7 + 11 Denmark 54 41 + 13 Other Countries 127 211 84 Totals: Sundries 1,030 1,003 + 27 Grand Totals Tons 469,917 469,242 + 675 35 The following table shows the amount of British diseased meat discovered in the Markets :— GREAT BRITAIN.—1937. Beef. Mutton. Pork. Veal. Goat. Lungs. Mesenteries. Plucks. Heads. Disease. Carcases. Quarters. Carcases. Quarters. Carcases. Quarters. Carcases. Quarters. Carcases. Tongues. Actinomycosis — — — — — — — — — 19 — — — 1 Abscess — 1 70 — 87 — 10 — — — — — — — Abnormal Odour 1 — 1 — 1 — — — — — — — — Anaemia — — — 3 — — — — — — — — Caseous Lymphadenitis — — 14 — — — — — — — — — — — Congestion of Lungs — — 2 — — — — — — — — — Cutaneous Rash — — — — 40 — — — — — — — — — Cysticercus Ovis — — 4 — — — — — — — — — — — Distomatosis — — 1 — — — — — — — — — — Emaciation 4 — 499 1 113 — 10 — 1 — — — 1 — Fevered Condition — — — — 23 — — — — — — — — — Hemorrhagic — — — — 130 — 1 — — — — — — — Hydraemia — — 4 — 1 — — — — — — — 1 — Immature 53 — — — — In Extremis — — 74 — 17 — 7 — — — — — 1 — Injuries 1 — 11 — 4 — 1 2 — — — — — — Jaundice — — 1 — 14 — 20 — — — — — — — Joint-ill — — — — — — 4 — — — — — 1 — Lymphadenoma — — — — 1 — — — — — — — — — Necrosis — — — — 1 — — — — — Nephritis 5 5 5 — — — — — 1 — Osteomalacia — — — 1 — 4 2 — — — — — — Osteoporosis — — — — — — 1 — — — — — — — Osteomyelitis — — — — — — 1 — — — — — — — Parasitic — — 1 — — — — — — — — — — — Pyaemia — — 2 — 5 — — — — — — — — — Pleurisy and Peritonitis — 1 77 — 306 — 13 — — — — — 3 — Rachitis 3 — 39 — 1 — — — 2 — Rheumatoid Arthritis — — 41 — 81 — 4 — — — — — 1 — Septicaemia — — — — — — 1 — — — — — — — Tuberculosis (Bovine) 9 24 — — 15 2 — 38 5 — 7 10 Tuberculosis (Porcine) — — 638 — — 449 8 407 4,249 Uraemia — — 2 — 1 — — — — — — — — — Urticaria — — — — I — — — — — — — — Totals for 1937 15 26 812 1 1,512 — 151 6 1 57 454 8 425 4,260 Totals for 1936 13 15 317 — 1,250 — 138 4 2 36 12 25 651 4,227 Ireland.—The consignments of food, in tons, received from this country, compared with those of 1936, were as follows:— Beef and Veal. Mutton and Lamb. Pork and Bacon. Poultry and Game. Rabbits. Butter and Cheese. Eggs. 1937 1,419 1,285 3,887 2,465 2,930 — 129 1936 1,591 1,796 6,886 2,240 977 l 103 The amount of unsound food surrendered is shown in tables Nos. 14 and 15, and the diseased meat surrendered as follows :— Mutton and Lamb Carcases. Quarters. Pork Carcases. Veal Carcases. Abscess 4 — 11 — Caseous Lymphadenitis 1 — — — Emaciation 12 — 4 3 Haemorrhagic — — 1 — In Extremis — — 3 — Jaundice — — 1 — Lymphadenoma — — 2 — Nephritis 1 — — — Parasitic — 2 — — Pleurisy 4 — 23 — Pyaemia — — 1 — Rachitis — — 6 — Rheumatoid Arthritis — — 3 — Tuberculosis — — 24 Totals for 1937 22 2 79 3 Totals for 1936 1 — 74 — 36 Argentine.—During the year this country sent the following amount of foot compared with those for 1936 :— 1, in tons, Beef and Veal. Mutton and Lamb. Pork and Bacon. Poultry and Game. Eggs. Butter. Sundries. 1937 149,946 17,240 728 273 46 65 l 1936 152,973 15,159 842 276 67 100 l Lamb and Mutton Carcases. Lamb and Mutton Pieces. Pork Carcases. Beef Quarters. 1936. 1937. 1936. 1937. 1936. 1937. 1936. 1937. Abscess 27 21 45 13 l — 3 3 Caseous Lymphadenitis — — 105 84 103 380 — — Cysticercus bovis 11 25 — — — — — — Cysticercus ovis — — 3 51 — — — — Calcified Cysts — — — 1 — — — — Actinomycosis — 1 — — — — — — Abnormal Glands — 1 — 1 — — — — Emaciation — \— — 1 — — — — Hemorrhagic — 2 — — — — — — Tuberculosis 54 58 — — — — — — Tumour — 1 — — — — — — Totals 92 109 153 151 104 380 3 3 The amount of diseased meats surrendered from this year's consignments are shown in the above, and the amount of unsound food surrendered in tables Nos. 14 & 15. Australia.—During the year this country sent the following amounts of food, in tons, compared with those for 1936 :— Beef and Veal. Mutton and Lamb. Pork. Poultry and Game. Rabbits. Eggs. Butter. Sundries. 1937 24,083 26,948 2,540 36 1,965 62 129 14 1936 19,091 23,255 2,914 45 2,558 106 178 [ Beef Carcases. Lamb and Mutton Carcases. Lamb and Mutton Pieces. Pork Carcases. 1936. 1937. 1936. 1P37. 1936. 1937. 1936. 1937. Abscess 17 11 48 47 — — 3 20 Actinomycosis — 2 — — — — — — Caseous lymphadenitis — — 103 143 18 42 — — Cysticercus ovis — — 8 109 — — — — Parasitic Disease — — — 3 — — — — Tuberculosis 19 7 — — — — — — Totals 36 20 159 302 18 42 3 20 The amount of diseased meat surrendered from this year's consignments are shown in the above, and the amount of unsound food surrendered in tables Nos. 14 and 15. New Zealand.—The total amount of food, in tons, for 1937 which was deposited in the markets, compared with that for 1936, is as follows :— Butter and Cheese. Sundries Beef and Veal. Mutton and Lamb. Pork. Poultry and Lamb. Rabbits Eggs. 1937 13,478 62,234 7,213 43 102 1 246 4 1936 11,833 62,369 8,668 27 291 4 295 — The amount of unsound food discovered in these consignments is given in tables Nos. 14 and 15, and the diseased meat figures in the following tables :— Beef Quarters. Mutton and Lamb Carcases. Mutton and Lamb Pieces. Pork Carcases. 1937. 1936. 1937. 1936. 1937. 1936. 1937. 1936. Abscess 3 2 34 63 — — 59 — Abnormal Glands 1 — 2 — — — — — Actinomycosis 1 — — — — — — — Caseous lymphadenitis — — 137 147 20 4 — — Cysticercus ovis — — 119 15 — — — — Haemorrhagic 1 — — — — — — — Pleurisy — — 1 1 — — — — Tuberculosis 4 4 — — — — 2 — Tumour — — 1 1 — — — — Totals 10 6 294 227 20 4 61 — 37 Brazil.—The following table shows the amount of diseased meat surrendered from the consignments from this country during the year 1937 :— Beef Quarters. Mutton and Lamb Carcases. Mutton and Lamb Pieces. 1936. ] 937. 1986. 1037. 1936. 1937. Abscess 4 8 — 1 — — Cysticercus bovis 3 1 — — — Caseous lymphadenitis — — — 24 — 50 Tuberculosis 1 2 — — — — Totals 8 11 25 50 South Africa, including Southern Rhodesia.—The consignments for the year 1937 were made up as follows :— Beef and Veal. Tons. 4,010 Mutton and Lamb. Tons. 121 Eggs. Tons. 29 Butter and Cheese. Tons. 4 The following table shows the amount of diseased meat for the respective countries :— South Africa. Beef Quarters. Mutton and Lamb Carcases. 1936. 1937. 1936. 1937. Abscess 2 8 — 1 Caseous lymphadenitis — — — 1 Cysticercus ovis — — 1 Tuberculosis — 2 — — Totals 2 10 — 3 Southern Rhodesia. Beef Quarters. 1936. 1937. Abscess 4 16 Growth — 1 Tuberculosis Totals 1 5 2 19 Uruguay.—This country sent the following amount of food, in tons, during the year 1937 Beef and Veal. Mutton and Lamb. Pork. Poultry and Game. 6,408 833 2 17 The amounts of unsound food is shown in tables Nos. 14 and 15, and the diseased isshown in the following tables:— Beef Quarters. Mutton and Lamb Carcases. 1936. 1937. 1936. 1937. Abscess — — — 3 Caseous lymphadenitis — — 2 5 Emaciation — — — 1 Tuberculosis — 1 — — Totals — 1 2 9 Chile.-—This country sends only Mutton and Lamb to the markets, and the amounts of diseased meat are given herewith :— Mutton and Lamb Carcases. Mutton and Lamb Pieces. 1936. 1937. 1936. 1937. Abscess 3 1 — — Caseous lymphadenitis 12 14 32 133 Cyst, ovis — 6 — — Totals 15 21 32 133 Other Countries.—The following table shows the amount of food surrendered due to disease :— Beef Quarters. Bacon Sides. 1936. 1937. 1936. 1937. Belgium.—Abscess — — — 2 Myositis 2 — — — Canada.—Abscess 1 1 2 4 Denmark.—Abscess — — 4 8 Holland.—Abscess — — 1 Lithuania.—Abscess — — 2 1 Poland.—Abscess — — 1 5 Russia.—Abscess — — — 1 Sweden.—Abscess — — — 1 F 38 CASEOUS LYMPHADENITIS. The following table shows the amount of Mutton taken on account of Caseous Lymphadenitis during the past three years:— Country. Carcases. Pieces. 1936. 1936. 1937. 1936. 1936. 1937. Argentine 107 104 84 95 92 380 Australia 101 103 143 144 18 42 Brazil 1 — 24 50 Chile 15 12 14 32 133 New Zealand 127 147 113 3 4 18 South Africa 1 Uruguay 1 2 5 — 1 — Total 352 368 384 242 147 623 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) 52 Mutton (Pieces) 23 Beef (Livers) 42 Offal (lbs.) 469 „ (Pieces) 49 Partridges 1,441 „ (Tails) — Pheasants 935 „ (Tongues) 17 Pigeons 999 Butter (lbs.) 9 Plover 155 Cheese (Boxes) 1,313 Pork (Pieces) 12 Chickens and Poussins 1,529 „ (Heads and Collars) 2 Curlew 4 ,, (Plucks) 26 Ducks 731 Ptarmigan 11 Eggs 8,248 Quail 110 Gulls' Eggs (Boxes) 226 Rabbits 10,685 Fish (Tins) 9 Sausages (Tins) 135 Fowls 3,986 Snipe 112 Fruit (Tins) 1,604 Teal 53 Game (Black) 2 T urkeys 283 „ (Unclassified) 92 Veal (Carcases) 10 Geese 42 „ (Heads) 12 Grouse 419 „ (Pieces) 15 Guinea Fowls 114 „ (Plucks) 8 Hares 234 Vegetables (Tins) 63 Hazelhens 11 Venison (Carcases) 1 Kids — (Pieces) 10 Meat (Tins) 35 Widgeon 185 Milk (Tins) 932 Woodcock 27 Mutton (Carcases) 8 Tons. Cwts. Qrs. Lbs. Total for 1936 39 5 3 23 1937 38 15 0 15 Decrease 0 10 3 8 UNSOUND MEAT, ETC., REMOVED FROM COLD STORES. Article. No. How Packed. Origin. Cause of Destruction. Tons. Cwts. Qrs. Lbs. Beef (Boneless) .... .... Argentine Perished 0 0 l 20 „ (Kidneys) .... .... ,, Decomposed 0 2 0 24 .... .... .... S. Rhodesia .... 0 0 0 6 „ 1 Case New Zealand .... 0 0 0 20 „ (Livers) .... .... Argentine .... 0 6 3 17 „ 264 Tins New Zealand .... 1 8 0 27 „ 1 Case Australia .... 0 0 2 6 „ (Tongue) 50 .... Argentine .... 0 1 1 20 „ (Pieces) .... .... .... Mould Fungi 0 0 3 20 „ .... .... Decomposed 0 0 3 25 Ducks 6 .... United „ 0 0 0 24 Fish (Prawns) .... .... Kingdom. New Zealand „ 0 1 2 4 „ (Lobster) 7 Boxes. Japan „ 0 0 2 14 .... .... .... Carried forward 2 4 1 3 39 Unsound Meat, Etc., Removed from Cold Stores.—continued. Article. No. How Packed. Origin. Cause of Destruction. Tons. Cwts. Qrs. Lbs. Brought forward 2 4 1 3 Game (Mixed) 1 Bag Hungary Decomposed 0 0 1 22 Mutton (Carcases) 33 .... Argentine Caseous lymph. 0 13 3 18 „ 2 .... „ Damage in transit. 0 0 1 14 „ 1 .... „ Brine Stain 0 0 1 4 „ 7 .... Mould Fungi 0 1 0 15 „ 18 .... Australia Caseous lymph. 0 9 2 12 „ 1 .... „ Damage in transit. 0 0 1 10 „ 1 .... ,, Brine Stain 0 0 1 22 „ 18 .... New Zealand Caseous lymph. 0 7 2 27 „ 19 .... „ Mould Fungi 0 11 0 16 „ 58 .... „ Store Perished 1 1 2 8 „ 1 .... „ Brine Stain 0 0 2 2 „ (Sides) 5 .... Argentine Caseous lymph. 0 1 0 0 „ 1 .... New Zealand „ 0 0 0 26 „ 11 .... Brazil „ 0 1 3 6 (Carcases) 1 .... Uruguay „ 0 0 1 24 „ 23 .... Brazil „ 0 8 1 8 „ 2 .... Chile „ 0 0 3 7 „ 1 .... S. Africa „ 0 0 1 8 „ (Quarters) 10 .... Argentine „ 0 0 2 22 „ 1 .... „ Cyst, ovis 0 0 0 8 „ 1 .... Australia Caseous lymph. „ 0 0 0 6 „ 39 .... Brazil 0 4 0 11 „(Legs) 27 .... Argentine „ 0 1 3 6 „ 8 .... Australia „ 0 0 1 15 „ 54 .... Chile „ 0 3 0 24 „ (Shoulders) 144 .... Argentine „ 0 4 3 20 „ 1 .... Australia „ 0 0 0 4 „ (Pieces) .... .... Argentine „ 0 0 1 26 „ .... .... Australia „ 0 0 0 14 .... .... „ Brine Stain 0 3 0 26 „ .... .... New Zealand Perished 0 1 3 26 ,, (Glands) 1 Case Argentine „ 0 0 2 18 „ (Kidneys) .... .... Chile Decomposed 0 4 0 19 Pork (Pieces) .... .... Argentine „ 0 0 2 3 „ .... .... New Zealand Perished 0 3 0 24 Sausages 10 Case Argentine Unsound 0 5 3 6 Rabbits 1 „ Holland Decomposed 0 0 1 22 „ 1 „ Ireland „ 0 0 2 12 Tripe 2 Bags Argentine Perished 0 1 0 4 Veal (Side) 1 Australia Immature 0 0 0 7 Total for 1937 „ 8 2 1 15 SHOWING THE AMOUNT OF VARIOUS FOOD PRODUCTS SURRENDERED TO OR SEIZED BY MEAT INSPECTORS IN THE CITY OF LONDON FOR UNSOUND CONDITIONS, 1937. Country. Beef in lbs. Mutton & Lamb in lbs. Pork in lbs. Veal in lbs. Venison in lbs. Goat in lbs. Bacon in lbs. Offal in lbs. Furred Game. Feathered Game. Tinned Meat. Tinned Milk. Fish in lbs. Cheese in lbs. Alaska — — — — — — — — — — 50 24 — Argentine 491,081 31,405 1,964 172 — — 11 19,914 702 317 5,032 44 20 — Australia 137,644 23,517 2,494 — — — 23 13,095 741 107 75 26 — — Austria — — — — — — — — 63 498 — — — — Belgium — — — — — — 180 65 2,465 56 439 — — — Brazil 3,273 — '20 — — — — 250, — — 3 — — — Britain 29,571 46,572 71,450 15,160 1,189 57 4,261 112,057 73,695 51,268 4,564 1,132 58 424 Canada 200 — — — — — 745 96 103 473 69 — 4 — Chile — 3,012 — — — — — 2,555 — — — — — China — — 10 Denmark — — — — — 1,101 — — 10 345 — — — Estonia — — — — — 12 122 — Finland — — — — — — — — 84 — France — — — — — — — — 286 179 — 2 — — Germany — — — — — — — — — — 401 — — — Holland 42 — — — — — 1,225 — 353 974 788 408 — — Hungary — — — — — — — — 114 5,272 — — — — Iceland — 127 — — — — — 12 154 — — — — — Ireland 738 1,374 9,131 66 — — 1,596 43,988 25,158 3,009 82 17 — — Italy — — — — — — — — — 60 — — — — Japan — — — — — — — — — — — — 150 — Lithuania — — — — — — 24 — 1,547 1,186 — — — — New Zealand 37,611 73,824 6,688 172 — — 153 26,114 3,246 29 422 204 172 — Norway — — — — — — — — 16 — — -i- Poland — — — — — — 776 445 211 4.976 887 7 — — South Africa 23,401 36 42 — — — — 326 — 5 9 — — — S. Rhodesia 43,768 — — — — — — 1,030 — — — — — — Sweden — — — — — — — 21 307 — — — — 28 U.S.A 97 — 72 — — — — 942 — — 257 54 — — Uruguay 12,558 58 64 — — — — 420 — 14 24 — — — Various — 27 — — — — — 5 — — 187 7 80 Totals for 1937 779,874 179,952 91,925 15,570 1,189 57 10,095 220,335 109,145 68,555 13,746 1,901 508 452 Totals for 1936 393,670 161,886 106,903 16,903 1,036 116 10,355 242,635 122,471 76,177 17,685 3,018 502 848 f2 40 SHOWING THE AMOUNT OF VARIOUS FOOD PRODUCTS SURRENDERED TO OR SEIZED BY MEAT INSPECTORS IN THE CITY OF LONDON FOR DISEASED CONDITIONS, 1937. Country. Beef in lbs. Mutton and Lamb in lbs. Pork in lbs. Veal in lbs. Bacon in lbs. Offal in lbs. Furred Game in lbs. Feathered Game in lbs. Argentine 25,423 9,249 3,859 — — 1,916 — 50 Australia 2,459 9,172 1,435 — — 30 60 18 Austria — — — — — — — 2 Belgium — — — — 110 — 229 101 Brazil 1,062 1,580 — — — 6 — — Britain 17,375 33,808 197,755 12,472 681 55,086 6,061 24,826 Canada — — — — 413 14 19 — Chile — 1,219 — — — 14,652 — — Denmark — — — — 367 — — — France — — — — — — — 190 Holland — — — — 143 — 30 6 Hungary — — — — — — — 40 Ireland — 372 7,104 — 75 — 342 690 Lithuania — — — — 38 — 4 — New Zealand 1,646 14,137 3,977 100 112 594 — — Poland — — — — 178 — 4 48 South Africa 1,607 186 — — — — — — Southern Rhodesia 3,625 — — — — — — — Sweden — — — — 56 — — — U.S.A. — 51 — — — — — — Uruguay 2,002 13 — — — — — — Totals for 1937 55,199 69,787 214,130 12,572 2,173 72,298 6,749 25,971 Totals for 1936 50,578 61,068 176,204 12,982 825 95,214 7,647 34,540 PROSECUTION UNDER SEC. 180 (2), PUBLIC HEALTH (LONDON) ACT, 1936. Serial No. Date. Business. Where heard. Before whom. Offence. Result. 2 12/11/37 Farmer & Butcher. Guildhall Aid. Godfrey Warr. Being the owner and consignor of two sides of pork, minus head, which were diseased and unfit for human consumption. Fined £10. Costs, £10. Table showing Weight of Meat delivered to the market and to the Contractors during each month for the years 1936 and 1937 :— Month, Meat delivered at the Market, 1936. Unsound Meat delivered to Contractors, 1930. Meat delivered at the Market, 1937. Unsound Meat delivered to Contractors, 1937. January Tons. cwts. qrs. Tons. cwts. qrs. Tons. cwts. qrs. Tons. cwts. qrs. 42,656 0 0 64 8 2 41,216 0 0 58 8 0 February 29,417 0 0 39 9 3 37,668 0 0 61 18 2 March 41,032 0 0 64 5 2 41,496 0 0 66 16 1 April 39,729 0 0 76 16 1 41,810 0 0 84 1 2 May 36,431 0 0 43 16 1 36,561 0 0 71 0 0 June 35,567 0 0 52 8 2 36,192 0 0 93 12 3 July 40,452 0 0 71 6 2 36,049 0 0 85 16 2 August 34,800 0 0 72 11 1 34,468 0 0 69 17 2 September 40,516 0 0 115 15 2 39,621 0 0 140 6 1 October 42,579 0 0 91 11 3 39,424 0 0 91 18 0 November. 42,074 0 0 61 13 1 41,689 0 0 66 12 3 December 43,985 0 0 76 11 2 43,731 0 0 74 1 0 Totals 469,238 0 0 830 14 2 469,925 0 0 964 9 0 SUMMARY OF UNSOUND FOOD DESTROYED. Tons. Cwts. Qrs. Lbs. Central Markets (Smithfield) 730 7 0 23 Cold Stores 8 2 1 15 Leadenhall Market and City Shops 25 0 3 17 Total for the year 1937 763 10 1 27 Total for the year 1936 717 11 0 16 Increase 45 19 1 11 EXPORT OF MEAT. One hundred and thirty-five certificates were issued during the year. 41 One ton in every 487 tons of meat paying toll in the Central Markets, Smithfield, was condemned last year, as compared with one ton in 564 in 1936. *Table showing the average deliveries at the Central Meat Market, and other details for successive quinquennial periods during the past 65 years:— Quinquennium. Annual Average General Supply. Seizure by Inspectors. % of Unsound Meat. Tons. cwts. 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 1929-1933 464,847 0 0 946 6 0 •203 1934-1937 470,193 0 0 915 9 1 •194 *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. Year. British. Canadian. Australian and New Zealand. South African and South Rhodesian. U.S.A. Argentine, etc. Continental. Country Killed Town Killed. 1933 22.3 3.5 0.7 26.5 0.8 0.6 41.8 3.8 1934 22.3 3.0 1.0 29.4 0.5 0.9 40.0 2.9 1935 24.5 3.4 0.5 28.8 0.8 0.6 38.9 2.5 1936 24.4 3.9 0.8 28.1 0.6 0.4 39.5 2.3 1937 22.8 3.8 0.8 29.6 0.8 0.4 39.1 2.7 The following figures supplied by the Superintendent of the Market are of interest :— 1933. Tons. 1934. Tons. 1935. Tons. 1936. Tons. 1937. Tons. Average daily delivery into the Markets 1,491 1,514 1,558 1,528 1,536 **Minimum delivery on any one day 627 544 191 84 129 Maximum delivery on any one day 4,061 3,704 3,386 4,554 4,034 The heaviest weight previously recorded on any one day (20th December, 1926) was— 5,259 tons. DEMONSTRATIONS AND INSTRUCTIONS IN MEAT INSPECTION. Two hundred and seventy-three (273) persons from various training centres received instructions. Thirteen naval officers received training in meat inspection at Central Markets, Smithfield. FISH SUPPLIES. 203,803 tons of fish, of which 201,945 were land-borne and 1,858 water-borne, were received at or near Billingsgate Market during the year. This was an increase of 175 tons in the land deliveries and a decrease of 1,118 tons in 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 1937. Month. Weight of Fish Delivered. Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered By Land. | By Water. January Tons. cwts. qrs. Tons. cwts. qrs. Tons. cwts. qrs. Tons. cwts. qrs. 15,019 16 3 133 8 2 15,153 5 1 40 3 1 265% or 1 ton in 377.298 February 15,296 14 2 95 8 0 15,392 2 2 54 6 3 .353% „ „ 283.268 March 17,481 3 2 120 13 0 17,601 16 2 49 16 0 .282% „ „ 353.450 April 15,643 15 3 139 16 2 15,783 12 1 69 0 3 .437% „ „ 228.623 May 16,212 4 1 59 15 2 16,271 19 3 117 15 1 .723% ,, „ 138.176 June 17,570 7 0 92 8 2 17,662 15 2 112 8 3 .636% „ „ 157.089 July 18,578 3 2 19 2 3 18,597 6 1 82 12 0 .444% „ „ 225.149 August 16,833 18 3 1 11 16 2 16,975 15 1 80 5 1 .472% „ „ 211.503 September 17,199 18 3 300 16 2 17,300 15 1 52 16 1 .301% „ 331.375 October 17,697 8 3 432 16 2 18,130 5 1 110 7 1 .608% „ ,, 164.279 November 17,984 16 2 221 9 0 18,206 5 2 48 15 3 .267% „ ,, 373 174 December 16,426 14 2 100 18 2 16,527 13 0 48 15 3 .295% „ ,, 338.768 Totals 201,945 2 2 1,858 9 3 203,803 12 1 867 3 0 .425% „ „ 235.055 *I 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. 42 Weight of Fish Delivered, Fish Seized as Unsound, and percentage of Fish Condemned to that Delivered, ator near Billingsgate Market during 1937 and the five years 1932—1936. 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. 1932 176,494 15,991 192,485 1,558 1 0 1 ton in 123.546 tons or 0 809% 1933 181,888 14,999 196,887 1,168 6 2 1 „ 155.726 „ 0.642% 1934 186,775 13,186 199,961 1,030 5 0 1 „ 194.137 „ 0.515% 1935 193,719 12,341 206,060 965 0 3 1 „ 213.533 „ 0.467% 1936 201,770 2,976 204,746 1,027 6 1 1 „ 199.363 „ 0.501% Average (5 years) 188,131 11,896 200,027 1,150 0 0 1 ton in 173.936 tons or 0.574% 1937 201,945 1,858 203,803 867 3 0 1 ton in 235.055 tons or 0.425% PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Much improvement is reported, and the number of persons who knowingly evade the Regulations is now negligible. The market carriers know the Regulations and the advantage of maintaining their vehicles in clean and proper condition. They are always pleased and willing to put right any unsatisfactory condition brought to their notice which they have overlooked. The market porters generally also carry out the Regulations, although some of the pitchers appear to resent the enforcement of the wearing of washable head-coverings. The number of private cars used for the conveyance of meat appears to be increasing, but the owners are willing to take such precautions as are reasonably necessary to avoid contamination when using this class of vehicle for the transport of meat. Many of them have fitted an adjustable boxed inner lining, which is easily detached and cleansed. I have, therefore, no reason to stop this practice. During the year 1937 no prosecutions were taken, the 446 contraventions recorded being of a minor character, and the forwarding of cautionary letters, where necessary, has produced the desired improvement. Butchers' shops and depots used as distribution centres by multiple restaurants are the subject of constant supervision, and whilst the standard of cleanliness in these premises is generally good, many improvements have been made. The premises used for the manufacture of sausages and meat products within the City are conducted in a satisfactory manner, and the installation of modern machinery and fittings shows a genuine effort to produce these foods in as hygienic and cleanly a manner as possible. The general improvements noted during the past year are the result of co-operation between the meat traders and transporters and the officers of mv deDartment. PUBLIC HEALTH (LONDON) ACT, 1936.—SECTION 187. ICE CREAM AND PRESERVED FOOD. Summary of types of premises registered during 1937. Sausages and Cooked Meat 4 Pickling of Meat 2 Manufacture of Ice Cream 1 Sale of Ice Cream 16 Rendering of Dripping 1 Note.—Some of these premises are registered for more than one of the above processes. The action taken under this Act has improved the standard of cleanliness in many businesses. 43 Before premises are registered, a schedule of alterations and improvements is submitted, where necessary, to the applicant. When the improvements have been carried out, a standard capable of maintenance results. The number of premises registered since the inception of the L.C.C. General Powers Act, 1932, now repealed by the Public Health (London) Act, 1936, is 174. In all, 47 premises have been removed from the register, the occupier having removed or discontinued in business, and 9 premises were considered unsuitable for satisfactorily conducting the type of business for which application for registration was made, thus leaving a total number of 129 premises now on the register. SUPERVISION OF THE ICE CREAM TRADE. During the summer season 64 inspections have been made in connection with the manufacture or sale of ice cream at the 57 premises now registered in the City, and 40 inspections have been made of the barrows or stalls of itinerant vendors, who this season numbered 20. In all instances where lack of cleanliness or other breach of the requirements of the Act were observed, the issue of a caution has resulted in appropriate steps being taken to remedy the defect. Additional premises registered during the year in accordance with the requirements of the Public Health (London) Act, 1936, Section 187, numbered 17, and two premises have been removed from the register, the occupants having gone elsewhere or discontinued in business. INSPECTION OF BARROWS, ETC., OF ITINERANT VENDORS OF FOOD. During the year 67 inspections have been made of the barrows, etc., of itinerant vendors of fruit and confectionery, and 13 of these were found to be in an unsatisfactory condition. The issue of cautions and warning letters, however, resulted in a general improvement being made by all the offenders, with the exception of one, who has now given up the selling of fruit in the City. INSPECTION OF FOOD AT RIVERSIDE WHARVES. The following is a summary of the chief products coming under the observation of the Inspector charged with the supervision of foods delivered at City wharves:— SUMMARY OF FOOD DISCHARGED AT CITY WHARVES. Article. Description of Packages. Where from. General Range of Weight of Packages. Quantity. Butter Packages Holland 6 lbs.—1 cwt 337,693 Bacon Bags, Cases ,, 1 cwt. 2 qrs.—3 cwts. 58,323 Cheese (Loose) Single ,, 1 lb.—8 lbs. 158,028 Cheese Packages ,, 28 lbs.—1 cwt. 474,669 Eggs (Fresh) Cases ,, 84 lbs.—I cwt. 2 qrs. 350,185 Egg Yolk Casks ,, 56 lbs.—4 cwts. 172 Albumen China 2 cwts. 1 qr 501 Compound Packages Holland 56 lbs. 5 Lard ,, Holland, America and 28 lbs.—4 cwts. 17,501 ,, Canada. Margarine ,, Holland 12 lbs.—56 lbs 200,427 Cereals— ,, Barley Bags ,, 100 lbs.—1 cwt. 2 qrs. 1,498 Beans ,, Holland, Japan and 1 cwt.—2 cwts. 3,279 ,, Madagascar. Cornflour ,, Holland 1 cwt. 10 Peas ,, Holland and Japan 1 cwt.—1 cwt. 3 qrs. 20,539 Rice ,, Holland, Spain, Italy 1 cwt.—1 cwt. 2 qrs. 6,507 ,, and Japan. Semolina ,, Italy and Argentine 1 cwt 200 Tapioca ,, Holland and Ceylon 1 cwt.—1 cwt. 2 qrs. 381 Ground Rice ,, Holland 1 cwt.—2 cwts 288 Lentils ,, 1 cwt.—2 cwts. 5 Cocoa Bags, Packages Holland, Ceylon, E. 28 lbs.—2 cwts. 12,357 ,, Africa and Brazil. Coffee Bags Holland, Ceylon, E. 1 cwt. 2 qrs 54,329 ,, Africa and Costa Rica. 44 Article. Fruit (Soft)— Description of Packages. Where from. General Range of Weight of Packages. ity. Black Currants Packages Holland 6 lbs.—12 lbs 292 Apples ,, Holland, America, Australia and N ew Zealanc 28 lbs.—1 cwt. 2 qrs 1. 2,240 Cranberries ,, Holland 28 lbs. 34,930 Juniper Berries ,, ,, 56 lbs. 135 Gooseberries ,, ,, 40 lbs.—100 lbs. 857 Peaches ,, ,, 56 lbs. 123 Pears ,, Holland, America and Australia. 6 lbs.—28 lbs. 11,848 Red Currants ,, Holland 6 lbs.—12 lbs. 39 Rhubarb ,, ,, 6 lbs.—28 lbs. 477 Strawberries ,, ,, 7 lbs.—28 lbs 340 Fruit (Dried)— ,, ,, Apricots ,, America, Canada, S. Africa and Australia. 24 lbs. 38,029 Currants ,, Greece, Turkey and S. Africa. 28 lbs.—56 lbs. 212,976 Dates ,, Erypt, Turkey and Persia. 3 qrs. 22,304 Evaporated Apples ,, America, Canada and S. Africa. 56 lbs. 9,144 Figs ,, Greece and Turkey 28 lbs.—4 cwts. 71,216 Fruit Salad ,, America 28 lbs.—56 lbs. 870 Peaches ,, America, S. Africa and Australia. 24 lbs.—56 lbs. 6,483 Pears ,, America and Australia 24 lbs.—56 lbs 17,397 Plums ,, ,, 24 lbs.—-1 cwt 133,282 Preserved Fruit ,, Holland 10 lbs.—56 lbs. 183 Raisins ,, America, Spain, Greece and Turkey. 6 lbs.—56 lbs. 186,012 Sultanas ,, America, Greece, Turkey, Persia and S. Africa. 24 lbs.—56 lbs 580,591 Nectarines ,, America 28 lbs.—56 lbs. 100 Fruit (Green)— Grape Fruit ,, Trinidad, Florida and Jaffa. 56 lbs.—1 cwt. 108,067 Grapes ,, Spain, Holland, Turkey and Cyprus. 12 lbs.—1 cwt. 156,579 Lemons ,, Italy, Spain, Cyprus, Trinidad and Jaffa. 1 cwt. 97,708 Mandarines ,, Spain and Egypt 3 qrs.—1 cwt. 1 qr. 13,409 Melons ,, Holland, Spain and jaffa 12 lbs.—1 cwt. 1 qr. 113,703 Oranges ,, Spain, Cyprus, Egypt, Brazil and Jaffa. 3 qrs.—1 cwt. 1 qr. 413,117 Pomegranates ,, Spain 28 lbs.—1 cwt. 1 qr. 784 Limes Vegetables— ,, Trinidad 14 lbs.—24 lbs. 493 Beans ,, Holland 40 lbs. 130,889 Beetroots ,, ,, 1 cwt. 3,934 Cabbages ,, ,, 1 cwt. 6,973 Carrots ,, ,, 40 lbs.—1 cwt. 1 qr. 105,873 Cauliflower ,, ,, 12 lbs.—40 lbs. 36,681 Cucumbers ,, ,, 12 lbs.—40 lbs. 22,135 Lettuce ,, 12 lbs.—40 lbs. 399,531 Onions ,, Holland, Spain, Cyprus, Egypt and CzeckoSlovakia. 1 cwt. 1 qr. 404,804 Parsnips ,, Holland 1 cwt. 7,788 Peas ,, 40 lbs. 183 Potatoes ,, Spain, Holland, St. Malo and Cyprus. 56 lbs.—1 cwt. 1 qr. 330,375 Radishes ,, Holland 28 lbs.—1 cwt 23,722 Spinach ,, ,, 14 lbs.—56 lbs. 129 Sprouts ,, 100 lbs. 1,037 Tomatoes ,, Holland, Cyprus and Jaffa. 12 lbs.—56 lbs. 580,060 Marrows ,, Holland 14 lbs.—18 lbs 81 Sugar Bags, Cases ,, 1 cwt.—2 cwts. 2,126 Tea Packages India, Ceylon, Java, China and Japan. 1 cwt. 123,428 45 Article. Description of Packages. Where from. General Range of Weight of Packages. Quantity. Tinned Goods— Marmalade ,, Australia 56 lbs.—1 cwt. 1,501 Jam ,, ,, 14 lbs.—1 cwt. 10,064 Mangoes ,, India 60 lbs. 127 Anchovies Cases Portugal and Spain 1 cwt. 2,502 Apples ,, America and Canada 50 lbs.—1 cwt. 10,556 Apricots ,, America, Canada and Australia. 48 lbs. 21,110 Asparagus ,, America and Canada 56 lbs.—1 cwt. . 2,832 Beans ,, Spain and America 1 cwt. 2,150 Beef Brisket ,, South America 90 lbs. 425 Black Currants ,, Latvia and France 1 cwt. 464 Brawn ,, Holland 36 lbs. 295 Cherries ,, Canada and Italy 28 lbs.—48 lbs 31,774 Condensed Milk ,, Holland 48 lbs. 888,447 Corned Beef ,, South America 72 lbs. 71,231 Crab ,, America, Japan and Norway. 56 lbs. 2,074 Figs ,, America 1 cwt. 540 Fish ,, Holland, Norway, Spain and Portugal. 1 cwt. 10,175 Fruit Pulp ,, America, Spain and Holland. 72 lbs.—100 lbs 6,808 Fruit Salad ,, America 56 lbs.—100 lbs. 15,996 Grape Fruit ,, Florida 50 lbs. 33,623 Fruit Juice ,, America 56 lbs. 516 Hams ,, Holland, Denmark and Poland 20 lbs.—1 cwt. 1 qr. 1,609 Kidneys ,, ,, 56 lbs. 3 Loganberries ,, America 56 lbs.—1 cwt 3,066 Lobster ,, ,, 50 lbs. 4,614 Herring Roes ,, Norway 56 lbs. 198 Blackberries ,, America 56 lbs. 300 Meat Cases Holland and South America. 56 lbs.—1 cwt 5,410 Meat Roll ,, Holland and South America. 56 lbs.—1 cwt 3,846 Oranges ,, Japan 56 lbs.—1 cwt. 69,929 Peaches ,, America, Canada and Australia. 48 lbs. 91,438 Peas ,, America and Belgium 48 lbs. 26,081 Pears ,, America, Canada and Australia. 48 lbs. 93,519 Rolled Beef ,, South America 56 lbs.—1 cwt 5,395 Pines ,, Singapore, Hawaii, South Africa and Australia. 60 lbs. 242,612 Pilchards ,, America 60 lbs. 2,150 Plums ,, Canada 60 lbs. 2,173 Pork and Beans ,, America 60 lbs. 2,022 Prawns ,, ,, 56 lbs. 2,120 Salmon ,, America, Canada and Japan. 56 lbs.—1 cwt 59,380 Sardines ,, Portugal 56 lbs.—1 cwt 81,936 Sausages ,, Holland 56 lbs.—1 cwt 163 Soup ,, Canada 56 lbs. 2,903 Sterilised Cream Holland 48 lbs. 2,836 Strawberries ,, America 48 lbs. 619 Sugar Corn ,, America and Canada 56 lbs. 3,745 Tomatoes ,, Italy, Spain, Hungary, Bulgaria and Argentir 56 lbs.—1 cwt. le. 149,423 Tongues ,, Holland and South America. 48 lbs.—1 cwt 6,107 Veal ,, Holland and New Zealand. 36 lbs.—100 lbs 2,326 Vegetables ,, Holland and Spain 50 lbs—100 lbs 14,238 Macaroni Packages Canada, Italy, Belgium and Hungary. 40 lbs. 11,834 Milk Powder ,, Holland, Canada, America and Australis 50 lbs.—1 cwt i. 57,671 Nuts (Various) ,, Spain, China, America, Italy and Persia. 50 lbs.—1 cwt. 1 qr 43,865 (Apricot Kernels) 258 G 46 Article. Description of Packages. Where from General Range of Weight of Packages. Quantity. I inked Goods—(continued). Vegetables in Brine Casks Holland and Spain 3 cwts.—5 cwts. 7,724 Vegetables (Dried) Packages Holland 3 qrs. 14 Ginger (Preserved) Cases, Casks China 30 lbs.—3 cwts. 12,584 Miscellaneous— Block Condensed Milk. Casks Holland 56 lbs. 670 Biscuits Packages 1 cwt.-—1 cwt. 1 qr. 86 Curry Powder India 1 cwt. 622 Carrawav Seeds Bags Holland 1 cwt. 1 qr. 1,443 Cherries (in Brine Casks Italy 2 cwts.—4 cwts. 252 Chocolate Packages Holland 50 lbs.—1 cwt. 1 qr. 394 Citrons (in Brine) Casks Spain 4 cwts. 187 Cocoa Butter Packages Holland and America 1 cwt.—2 cwts. 6,059 Condensed Milk Casks Holland 4 cwts.—5 cwts. 4,992 Confectionery Packages Holland 28 lbs.—1 cwt. 1 qr. 748 Chicory Dutch East Indies 1 cwt. 1 qr. 300 Chutney India 1 cwt.—3 cwts. 598 Catsup .... 55 Jam Casks .... 63 Fish Cases Greenland and Iceland 6 lbs.—3 cwts 50 Fruit and Lemon Juice. Casks Spain, Italy and America. 3 cwts.—15 cwts. 2,561 Fruit Pulp ,, Holland, Spain and Latvia. 4 cwts.—6 cwts. 6,357 Honey Casks, Cases America, Bulgaria and Holland. 1 cwt.—2 cwts. 847 Liquorice Packages Italy and America 1 cwt.—2 cwts. 759 Desiccated Cocoa nut Ceylon 28 lbs.—1 cwt. 18 lbs. 10,790 Corn Flakes Canada 18 lbs. 15,100 Shellfish Holland 1 cwt. 7,780 Sterilized Cream Drums ,, 56 lbs. 560 Pepper Packages Dutch East Indies, Holland and Sarawak 1 cwt. 1 qr.—1 cwt. 2 16 lbs. qrs. 2,427 Peel (in Brine) Casks Spain and Italy 4 cwts.—5 cwts. 148 Poultry Holland 12 lbs.—56 lbs 2,123 Sugar Candy Packages ,, 28 lbs.—56 lbs 200 Casings Casks, Cases Holland and South America. 56 lbs.—4 cwts. 1,838 Rabbits Cases Holland 1 cwt. 114 Vegetable Powde Packages ,, 1 cwt. 2 qrs. 1,175 Yeast ,, 28 lbs.—56 lbs 12,084 Wild Fowl Cases ,, 40 lbs.—56 lbs 253 Shrimps ,, ,, 1 cwt. 34 Malted Milk ,, ,, 56 lbs.—2 cwts. 128 Spaghetti ,, Italy 40 lbs. 500 Orange Skins ,, Spain 4 cwts.—5 cwts. 37 Vegetable Extrac — Holland 56 lbs. 130 Removed by Cleansing Department. Article. Reason for Destruction. Tons. cwts. qrs. lbs. Condensed Milk Old and unsound stock 2 13 2 0 Dried Fruit Mouldy and fermented. 1 1 1 7 Eggs Decomposed 2 15 2 0 Fresh Fruit ,, 5 1 1 0 Fresh Vegetables ,, 11 8 0 0 Fruit Juice and Pulp (casks) Fermented and mouldy 14 1 3 0 Tinned Fruit, Vegetables and Fish Blown and leaky 65 3 2 17 Tinned Meat Blown and pierced 2 17 3 9 Vegetables in Brine (casks) Mouldy 1 3 2 0 Miscellaneous Old and unsound stock 2 18 3 12 Total 109 5 0 17 Destroyed at Wharf under Supervision. Article. Reason for Destruction. Tons. cwts. qrs. lbs. 1,390 Boxes Oranges Decomposed 69 0 0 0 11 Boxes Grapefruit 0 9 0 0 162 Boxes Lemons 8 0 0 0 1 Bag Almonds Mouldy 0 2 0 6 21 Casks Fruit Juice and Pulp Fermented and mouldy 3 19 0 0 25 Boxes Dried Apricots 0 5 2 9 4 Bags Gooseberries Bilge water damage 0 3 2 0 Total 81 19 0 15 47 Removal by Private Contractor. Article. Reason for Destruction. Tons. cwts. qrs. lbs. 984£ Boxes Oranges Decomposed 49 0 0 0 595 Boxes Melons ,, 29 15 0 0 1 Cask Lemon Skins Mouldy 0 6 0 0 Total 79 1 0 0 Removed by Smithfield Animal Products. Article. Reason for Destruction. Tons. cwts. qrs. lbs. 37 Boxes Margarine Rancid 0 9 0 0 Total 0 9 0 0 Grand Total 270 14 1 4 BYE-LAWS FOR THE PROTECTION OF FOOD. In accordance with the powers contained in the Public Health (London) Act, 1936, Section 183, the Corporation have made byelaws for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport or exposure for sale of any article intended to be sold for human consumption. These byelaws came into operation on the 1st February, 1938, and will be of considerable assistance to this department in securing greater control in connection with this branch of public health work. PHARMACY AND POISONS ACT, 1933. This Act came into operation on the 1st May, 1936. The greater part of the Act concerns the Pharmaceutical Society, members of which alone may sell poisons detailed in Part 1 of the Poisons List. Part 2 of the list is a concern of the Common Council of the City of London as Registering Authority for persons selling the poisons there listed in the City. The duties of the Authority are to list these persons, to inspect their premises and to secure compliance with the provisions of Part 2 of the Act. A shopkeeper may not sell listed poisons unless he is on the I.ocal Authority's list, and the application to be listed must be on a schedule form. Provision is made for a charge of 7s. 6d. for first listing, Is. for any subsequent alteration of. address, and 5s. for annual renewal. In regard to multiple premises, the fee is 7s. 6d. for each of the listed premises and 5s. for each year of renewal. Appropriate forms of application for listing have been prepared, and have been circulated by me to grocers, ironmongers, oilmen, garage keepers, seedsmen, etc., likely to be affected by the Act. At the 31st December, 1937, 107 persons were registered, of which nine were new registrations during the year. FERTILISERS AND FEEDING STUFFS ACT, 1926. The work in connection with the above Act has been carried on as usual, and 67 visits to firms dealing with material controlled by the Act made by your Officer. Five special enquiries on behalf of other Authorities in connection with delivering samples and obtaining statutory statements from registers were made. The quarterly returns to the Ministry of Agriculture and Fisheries have been made at the end of each quarter. MERCHANDISE MARKS ACT, 1926. AGRICULTURAL PRODUCE (GRADING AND MARKING) ACTS, 1928 AND 1931. The above-mentioned Acts have been administered during the year with little real difficulty beyond that of persuading affected parties to conform to the requirements. This is readily understandable in areas like the City of London, where there are so many casual street vendors with little or no knowledge of the requirements of the law. Those regularly engaged in the work associated with these Acts of Parliament, having once been acquainted by the Inspector of their obligations, readily remedy any omission; defect is almost invariably due to the failure of assistants to carry out the instructions of the proprietor. During the year 1,182 shops and stores and 36.1 street traders were interviewed. There were, in all, 17 minor offences. Ten new orders were issued under the Agricultural Produce (Grading and Marking) Acts, 1928 and 1931. g2 48 SUPERVISION OF FOOD AND DRUGS. During the year 1937, 1,007 samples of food and drugs were submitted to the Public Analyst for examination, 759 of which were taken as informal or test samples without the formalities of the Food and Drugs (Adulteration) Act, 1928, being observed. Eight of these informal samples were reported against, as follows :— 2 of Cheese, out of 32 samples. 2 of Sausages, out of 30. 1 of Butter (with scone), out of 58. 1 of Tincture of Iodine, out of 12. 1 of Boric Eye Ointment, out of 2. 1 of Salicylic Ointment, out of 3. Of the formal samples, 17 out of 248 were reported against, as follows :— 12 of Milk, out of 215 samples. 2 of Cheese, out of 2. 1 of Sausages, out of 1. 1 of Butter (with scone), out of 1. 1 of Tincture of Iodine, out of 1. The above-mentioned samples, with the exception of milk, were taken as a result of informal samples having been reported against. General Observations.—The percentage rate of adulteration of all food and drugs sampled in the City was 2-4, as compared with 2-6 in 1936. Butter, Cream and Cheese.—At one period of the year there was a considerable rise in the price of butter, and 58 informal samples of butter, served with bread or scone in refreshment rooms, were purchased. One sample only was reported against. In consequence, a formal sample was taken in connection with this sale, and it was found that the "butter" consisted of 80 per cent, margarine, the vendor admitting that butter was mixed with margarine on the premises. Legal proceedings were taken against him and a fine of 20s. was imposed, with 2 gns. costs. None of the 13 samples of cream taken was reported against. Of the two samples of cheese reported against, one referred to Caerphilly full-cream cheese, which was found to be 66 per cent, deficient in milk fat. The vendor was prosecuted and fined £2 with £1 costs, the defendant admitting that the article had been wrongly described. The other cheese sample referred to was a biscuit stick, with the centre filled with "cheese." The retailer was summoned for selling " cheese sticks " which were not of the nature, substance or quality of the article demanded. His supplier was also summoned for wilfully giving a label which falsely described the article sold. There was no complaint that the article was not wholesome, but it was submitted that it did not comply with the Food and Drugs Act as to description. The substance forming the interior of the sticks was called cheese, but was made up in the following proportions : Water, 5.4 per cent.; solids, not fat, 50 -4 per cent. ; and fat, 44 -2 per cent. Of this fat, 70 per cent, was not milk fat, and, therefore, the substance was not strictly within the provisions of the Act. It was shown that these cheese sticks had a filling resembling cheese and a purchaser would undoubtedly expect such filling to be wholly cheese. For the defence, it was stated that the filling could not be made wholly of pure cheese as it would not keep, and a certain amount of fat other than milk fat was necessary to make it a marketable article. The summonses against both defendants were dismissed under the Probation of Offenders Act on payment of 1 guinea and 4 guineas costs respectively, the magistrate expressing the hope that all parties concerned with the manufacture and distribution of this article would very carefully consider their position. Sausages.—Two of the 30 samples of sausages purchased were certified to contain sulphur dioxide, the only preservative allowed in sausages, but no declaration of its presence was made, as required by the Public Health (Preservatives, etc., in Food) Regulations. In one instance the amount of preservative was very small and enquiries failed to disclose its origin, as the vendor did not use preservative in his business. No further action was justified. In the other case, where the attention of the manager of the shop was called on a previous occasion to similar neglect, legal proceedings were instituted, when a fine of £5 5s. was imposed, with £3 3s. costs. 49 Spirits.—None of the 26 samples of spirits was found to be below the legal limit of 35 degrees under proof. Drugs.—Of the 105 samples of drugs procured for analysis, four were reported against, and in two instances, where legal action was not justified, the vendors were communicated with. Legal proceedings, however, were taken in one case, regarding tincture of iodine purchased at a shop where hygienic and toilet goods were sold, and where an informal sample previously purchased had been reported against. The sample was deficient in iodine to the extent of 22 -4 per cent, and potassium iodide to 24 -8 per cent, of the amount that it should contain by the requirements of the British Pharmacoepia. The retailer, who was summoned for selling tincture of iodine which was not of the nature, substance or quality of the article demanded, successfully proved a warranty given by his supplier. The latter was summoned for wilfully giving a label which falsely described the article, and was fined £2, with £5 5s. costs. Smoked Bacon.—Early in the year a communication was received from the Medical Officer of Health of another Local Authority to the effect that samples of smoked bacon, taken and submitted to the Public Analyst of that district, had shown the existence of from 25 to 35 parts per million of the preservative formalin, and that some of the samples were from bacon which originated from a City bacon factory. " Preservative," which is defined by the Public Health (Preservatives, etc., in Food) Regulations, does not include " any substance added to food by the process of curing known as smoking." Enquiries were instituted at the premises of the City firm in question, where it was ascertained that no bacon wash, smoke compound or smoke flavouring powder was used, but the inner surfaces of the sides of bacon are scraped, pea flour sifted over them and the bacon immediately hung in the smoke-chamber and wood-smoked for about 48 hours or longer. Danish, Canadian, Dutch, Swedish, Polish, Irish and English bacon was treated in this manner. It was felt desirable that an experiment should be made to ascertain the effect of smoking bacon. Accordingly, a gammon rasher was cut from a side of bacon before smoking, and the remainder of the side then smoked in the usual manner. After removal from the chamber, two rashers were cut from the exposed end and the side then divided, and another rasher was taken from one of the freshly-cut ends. These rashers were all submitted for analysis, with the following results :— Parts per Million Sample. Formaldehyde. Rasher, cut before smoking Nil Rashers, cut from exposed end after smoking :— (a) Outside and exposed rasher16 (b) Next rasher adjoining10 Rasher taken, after smoking, from freshly-cut surface of divided side 2 Four samples of smoked bacon purchased ordinarily in City shops, showed similar smaller amounts of formaldehyde upon analysis. In connection with this subject, it is interesting to note extracts from an article, published in the Analyst for July, 1927, by Dr. E. H. Callow, of the Food Investigation Board of the Department of Scientific and Industrial Research, Cambridge, on the presence of Formaldehyde in Wood Smoke and in Smoked Foodstuffs :— "A search of the literature on wood distillation failed to reveal any record of formaldehyde having been detected in wood distillates. This is not surprising when it is remembered that the distillation of wood is carried out in the absence of air, whilst for the production of smoke, air is essential. In wood distillation methyl alcohol is produced, and this, on oxidation, gives rise to formaldehyde. This substance, therefore, is likely to be a component of wood smoke." Mention is also made of various foodstuffs, purchased ordinarily in shops of a provincial town, which were submitted to analysis, with the result that formaldehyde was found to be present to the extent of from 05 to 1,000 parts per million in various kinds of smoked fish, 30 to 50 parts per million in smoked bacon, whereas it was absent in unsmoked bacon. EXAMINATION OF MILK. Chemical.—Twelve of the 215 samples of milk, all of which were taken formally, were reported as being below the legal limits which presume adulteration, equal to a percentage figure of 5 -5, as compared with 6 -3 in J 936. It was found necessary to take legal proceedings in regard to one sample for fat deficiency, it being shown that the milk which had been served 50 from a counter pan in the shop had not been efficiently plunged, the plunger being defective, and the previous sample from the same premises also had shown a fat deficiency. The vendor was fined £1, with £2 2s. costs. Other samples were reported against, but similar action was not considered necessary, as repeat samples were found genuine. A factor which, in future, will probably affect and lower the percentage figure of fatdeficient samples is the increased sale of homogenised milk, the fat particles of which are broken up under pressure. The fat or cream of homogenised milk does not separate out on standing, and consequently there is not the necessity for plunging, as in the case of ordinary milk. Some large distributors favour the supply of this milk, and thus eliminate the possible failure of employees to plunge milk before sale. In milk bars it is customary for milk to be served from pumps which pump milk from containers in refrigerating cabinets. These pumps are fitted with flanges, or plungers, on the pistons intended to assist in agitating the milk, to keep its constituents as evenly distributed as possible, as it is served to the customer. The complete effectiveness of these plungers is doubtful, and many proprietors of milk bars are now serving homogenised milk. Consequently, when a sample is taken, it is unlikely to be deficient in milk fat, and therefore they are not exposed to the resultant consequences of serving milk below the legal limit as regards fat-content. Incidentally, the customer is receiving the benefit of purchasing milk with its proper proportion of fat. Of the 215 samples of milk procured during the year, 105 were purchased from roundsmen in the streets. The following table shows the percentage fat-content in each of the 215 samples, the average fat-content being 3 -5 per cent. :— Percentage of Fat. No. of Samples. Percentage of Fat. No. of Samples. 2-4 l 3-8 21 2-6 l 3-9 15 2-8 2 40 6 2-9 2 41 5 30 4 4-2 2 31 7 4-3 4 3-2 13 4-4 1 3-3 21 4-5 1 3-4 25 5-3 1 3-5 38 5-5 1 3-6 22 5-6 1 3-7 21 Total 215 It will be noticed that three samples had a fat-content exceeding 5 per cent. These were taken in course of delivery at a railway terminus from churns containing milk from Jersey cows. Five purveyors of milk from whom samples had been taken availed themselves of the provisions of the Food and Drugs (Adulteration) Act, 1928, and served notices upon the Authority requesting samples of milk to be procured in course of delivery from their suppliers. MILK-IN-SCHOOLS SCHEME. Samples, both for chemical analysis and bacteriological examination, were taken quarterly from each of the contractors supplying milk under this scheme, upon delivery to the schools. Milk that has been pasteurised in accordance with the requirements of the Milk (Special Designations) Order, 1936, only is supplied, and this Order requires that, on a sample being taken, it shall not contain more than 100,000 bacteria per millilitre. An improved technique for the bacteriological examination of such milk was introduced in January and, as was expected, individual higher bacterial counts generally were recorded than previously. All the samples taken for chemical analysis were certified genuine, but of the bacteriological samples, eight were found to exceed the bacterial limit mentioned. In each case the circumstances were communicated to the contractors concerned and also the Medical Officer of Health of the London County Council. The contractors investigated the complaints and conferred with the bacteriologist and myself on the matter. A possible cause of these excessive counts may have been connected with long runs of the pasteurising plants, which would have the effect of encouraging the growth of thermophilic organisms. Repeat samples proved satisfactory. 51 THE MILK AND DAIRIES ORDER, 1926, AND THE MILK AND DAIRIES (AMENDMENT) ACT, 1922. Twenty-four new applications for registration as purveyors of milk within the City were received. One application from a person having no City premises was refused. The Authority in whose district the premises from which this person proposed to purvey milk was situated was communicated with, as is the usual practice before the application is considered. The Authority referred to replied that his application had been refused for the particular premises, which were unsuitable; consequently, the application was not granted by the City Corporation. Registration Statistics. New Applications for Registration received 24 New Applications granted 23 New Applications refused 1 Number of Retail Purveyors of Milk (with City premises) on the Register at end of 1937 110 Number of Retail Purveyors of Milk (without City premises) on the Register at end of 1937 39 Number of Milk Sellers (other than Retail Purveyors of Milk) on the Register at end of 193730 Licenses issued under Milk (Special Designations) Order 14 During the year, 127 inspections were made in connection with the sale of milk in order to ascertain that the statutory requirements were complied with. In addition, observations, which require a considerable amount of time, were made in connection with milk distribution from barrows and vehicles. Legal proceedings were taken in two instances against purveyors who were seen to bottle milk in the street, and each were fined £1. It is unnecessary to stress the danger of such a breach of the Milk and Dairies Order, 1926. By Article 31 (2) of this Order it is provided that "where a person delivers milk in bottles he shall cause every such bottle to be filled and closed on registered premises." These words are often construed and argued by a defence in court to mean that the particular bottle which has been filled in the street or away from registered premises must be proved to have been "delivered" to a person. It will be readily realised that this is extremely difficult, if not impossible, to prove in most cases, and it is to be hoped that this position will be remedied in future legislation. Further, by the Order, "milk" means milk intended for sale for human consumption. In proceedings against a purveyor who has put milk into bottles in the street and gives an excuse that it is intended for a domestic animal, it is necessary for the prosecution to prove that it was intended for human consumption, which is extremely difficult. If the position was such that it is to be presumed until the contrary is proved that milk exposed for sale is intended for human consumption, it would then devolve upon the defence to prove that such milk was not so intended. THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 AND 1927. THE PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 AND 1927. Twelve samples of different brands of Condensed J^ilk were purchased for analysis and all found to conform to the requirements of the Regulations in all respects. REGISTERED PREMISES. Butter Factories.—One butter factory is registered in the City and samples taken at these premises were all certified to be genuine. Wholesale Dealers in Margarine and Margarine Cheese.—One new application for registration was received during the year. Artificial Cream Act, 1929.—No additions have been made to the register. 52 ADMINISTRATIVE ACTION REGARDI NG Serial No. Article. Whether Formal or Informal. Nature of Adulteration or Irregularity. 43 Milk Formal Extraneous water, 2%. 100 Caerphilly Cheese Informal Fat deficient, 75.7%. 118 Milk Formal Extraneous water, 2.6%. 129 172 Full Cream Caerphilly Cheese. Tincture of Iodine Formal Informal Fat deficient, 66%. Iodine deficient, 22%, and Potassium Iodide deficient, 29.6%. 206 Tincture of Iodine Formal Iodine deficient, 22.4%, and Potassium Iodide deficient, 24.8%. 358 Salicylic Acid Ointment Informal 100% Pasta Zinci Oxidi Salicylico supplied. 484 Boric Acid Eye Ointment Informal 100% Boric Acid Ointment supplied. 486 Milk Formal Extraneous water, 3.2%. 490 Milk Formal Fat deficient, 19.3%. 518 Beef Sausages Informal Sulphur Dioxide preservative, 60 parts per million, without declaration. 528 Milk Formal Fat deficient, 4.7%. 532 Milk Formal Extraneous water, 4%. 572 Cheese Sticks Informal Foreign fat, 26%. 583 Cheese Sticks Formal The fat contained 70% of foreign fat. 584 Pork Sausages Informal Sulphur Dioxide preservative, 285 parts per million, without declaration. 599 Pork Sausages Formal Sulphur Dioxide preservative, 230 parts per million, without declaration. 643 Milk Formal Fat deficient, 5%. 645 Milk Formal Extraneous water, 1.6%. 646 Milk Formal Extraneous water, 4%. 664 Milk Formal Fat deficient, 12%. 665 Milk Formal Extraneous water, 2%. 819 Butter (with scone) Informal Margarine, 75%. 841 Milk Formal Fat deficient, 6%. 843 Butter (with scone) Formal Margarine, 80%. 53 ADULTERATION OR OTHER IRREGULARITY. Observations. Results of Proceedings or other Action taken. Further samples not procurable. Vendor deceased. Re-sampled formally—No. 129 Re-sampled—genuine Taken in connection with sample No. 100 Vendor prosecuted. Fined £2, with £1 Costs. Re-sampled formally—No. 206 Taken in connection with sample No. 172 Retailer prosecuted. Summons dismissed. Warranty proved. Manufacturer prosecuted. Fined £2, with £5 5s. 0d. Costs. Vendor communicated with Vendor communicated with Vendor communicated with. Re-sampled— genuine. Sample supplied from bottle—not mixed. Vendor communicated with. Vendor communicated with Sample supplied from bottle—not mixed. Vendor communicated with. Re-sampled—genuine Re-sampled formally—No. 583 Taken in connection with sample No. 572 Retailer prosecuted. Summons dismissed under the Probation of Offenders Act, with £1 Is. 0d. Costs. Wholesaler prosecuted. Summons dismissed under Probation of Offenders Act, with £4 4s. 0d. Costs. Re-sampled formally—No. 599 Taken in connection with sample No. 584 Vendor prosecuted. Fined £5 5s. 0d., with £3 3s. 0d. Costs. Re-sampled—No. 664 Re-sampled—No. 665 •» " Re-sampled—No. 665 Taken in connection with sample No. 643 Vendor prosecuted. Fined £1, with £2 2s. 0d. Costs. Re-sampled—genuine Re-sampled formally—No. 843 . Vendor communicated with Taken in connection with sample No. 819 Vendor prosecuted. Fined £1, with £2 2s. 0d. Costs. 54 THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, THE PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 AND 1927, THE PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 AND 1927, AND THE ARTIFICIAL CREAM ACT, 1929. Formal and Informal Samples Submitted for Analysis. Article. Number Examined. Number Adulterated, etc. Percentage of Adulteration. Formal. Informal. Total. Formal. Informal. Total. Formal. Informal. Total. Bread - 2 2 - - - - - - Butter 2 8 10 - - - - - - Butter (on bread) 1 58 59 1 1 2 100.0 1.7 3.3 Cheese 2 32 34 2 2 4 100.0 6.2 11.7 Cocoa 6 6 - Coffee 3 3 Confectionery 51 51 — Jam and Marmalade 14 14 Cream 13 13 Flour (Self.raising) 4 4 — Lard 6 6 Margarine 10 10 — Milk 215 — 215 12 12 5.5 5.5 Milk, Condensed — 12 12 — Mustard — 13 13 — Sugar — 7 7 — Tea — 21 21 — Vinegar — 9 9 — Spirits 26 — 26 — Drugs 1 104 105 1 3 4 100.0 2.8 3.8 Other Articles 1 386 387 1 2 3 100.0 0.5 0.7 Totals 248 759 1,007 17 8 25 6.8 10 2.4 Spirits— Gin 9 9 — Whisky 17 17 — — — Totals 26 — 26 — — — — — Drugs— Black Draught — 3 3 — — — Borax (Purified) — 2 2 — — — Camphorated Oil — 3 3 — — — Cascara Sagrada — 1 1 — — — Citrate, Quinine — 2 2 — — — Cream of Tartar 1 1 Easton's Syrup — 1 1 Friar's Balsam 2 2 Glycerine of Thymol — 1 1 — — — Ground Ginger — 2 2 — — — Hypophosphites — 1 1 — — — I.ozenges and Tablets — 20 20 — — — — — — Magnesia Preparation — 2 2 — — — — — — Oil, Castor — 2 2 — Oil, Eucalyptus — 4 4 — — — Ointment, Boric Eye — 2 2 — 1 1 o o 50-0 Ointment, Calomel — 2 2 Ointment, Iodine 1 1 __ Ointment, Mercuric 3 3 Ointment, Salicylic — 3 3 — 1 1 33-3 33 3 Ointment, White Precipitate — 2 2 - - - - - - Ointment, Zinc — 4 4 - - - - - - Parafin, Liquid — 3 3 - - - - - Parrish's Food — 3 3 - - - - - - Carried forward — 70 70 — 2 2 - 2-8 2-8 55 THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, THE PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 AND 1927, THE PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 AND 1927, AND THE ARTIFICIAL CREAM ACT, 1929.—Continued. Formal and Informal Samples Submitted for Analysis. Number Examined. Number Adulterated, etc. Percentage of Adulteration. Article. Formal. Informal. Total. Formal. Informal. Total. Formal. Informal. Total. Drugs (continued,)— Brought forward - 70 70 - 2 2 2-8 2-8 5owder, Gregory's 3 3 - - - - - - Jowder, Grev 1 1 - - - - - - \iwder, Liquorice — 4 4 - - - - - -- Jowder, Seidlitz 3 3 Sal Volatile 1 1 — — slippery Elm Bark 1 1 - - - - - - svrup of Rhubarb 2 2 Tincture, Iodine 1 12 13 l 1 2 1000 8-3 15-3 rincture, Quinine 5 5 - - - - - - Tincture, Rhubarb 2 2 - - - - - - Totals 1 104 105 l 3 4 100.0 2-8 3-8 Other Articles— Arrowroot 4 4 — — — — — — 3aking Powder 1 1 Barley, Pearl 2 2 — — — Beverages 16 16 3ake and Biscuits 13 13 — — — — Chocolate Powder 2 2 Coffee Essence 3 3 — — — — — — Cornflour 5 5 — — — — — — Dripping 4 4 — — — — Fish 2 2 — — — Fish, Canned 10 10 Fish Paste 10 10 — — — Fruit, Canned 6 6 — — — Fruit, Dried 48 48 Honev 4 4 — — Ice Cream 2 2 Jellies 4 4 — — — — Lemonade Powder 7 7 — — — — Leraon Curd 2 2 Meat 33 33 Meat, Canned 1 1 Meat Pies and Rolls 9 9 — — — — — — Meat, Paste 3 3 — — — — — — Milk Preparations 4 4 — — — — — — Mincemeat 4 4 Datmeal Dlive Oil 1 5 1 5 — — — — Pea Flour 2 2 — — — — — — Pepper 14 14 — — — — — — Pickles and Sauces 25 25 — — — — — — Powder, Custard 4 4 — — — — — — Preserved Vegetables 32 32 — — — — — — Rice 4 4 — — — — — — Sago 2 2 Sausages, etc 1 30 31 1 2 3 100 0 6-6 9*6 Semolina — 1 1 — — _____ — Soup 3 3 — — — — — — Spices and Condiments 60 60 — — — — — — Suet 3 3 — — — — — — Treacle and Syrup 1 1 — — — — — — Totals 1 386 387 l 2 3 100-0 0-5 0-7 56 Sample. Nature and extent of Adulteration. Result. 129 Full Cream Caerphilly Cheese. 66% deficient in Milk fat £2, with £1 Costs. 206 Tincture of Iodine 22-4% deficient in Iodine and 24-8% deficient in Potassium Iodide. Summons dismissed. Warranty proved. 206 Tincture of Iodine Wilfully giving a label which falsely described the article, being 22-4% deficient in Iodine and 24-8% deficient in Potassium Iodide. £2, with £5 5s. 0d. Costs. 583 Cheese Sticks 70% of the fat of the Cheese being foreign fat, or fat not derived from Milk. Dismissed under Probation of Offenders Act, with £1 Is. 0d. Costs. 583 Cheese Sticks Wilfully giving a label which falsely described the article, the fat of the Cheese containing 70% of foreign fat, or fat not derived from Milk. Dismissed under Probation of Offenders Act, with £4 4s. 0d. Costs. 599 Sausages 230 parts per million Sulphur Dioxide Preservative without declaration. £5 5s. 0d., with £3 3s. 0d. Costs. 664 Milk 12% deficient in Milk fat £1, with £2 2s. 0d. Costs. 843 Butter (on bread) 80% Margarine SUMMARY. £1, with £2 2s. 0d. Costs. Total Fines £11 5s. 0d. Total Costs £18 17s. 0d. BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF MILK ON ARRIVAL FROM THE COUNTRY INTO THE CITY. Since 1904, when the practice was first instituted, series of samples of milk arriving in the City of London from the country have been collected at the several termini within the City and have been the subject of report. In April, 1937, in continuation of this practice, 24 samples were collected ; some at Liverpool Street on arrival by train, and others at places of delivery by motor lorry in the City. These samples were submitted to Dr. Garrod, the City Bacteriologist, for bacteriological examination and investigation as to the presence of dirt, and a duplicate of each sample was submitted to Mr. A. J. C. Lickorish, the Public Analyst, for chemical examination. The samples were sent from different farms situate in the following counties :— Suffolk 14 Essex 4 Hertfordshire 3 Norfolk 3 The following is a copy of a report which Dr. Garrod has submitted on the results of his investigations :— No. 1 Date. 15th April Dirt. Trace Result of Guinea Pig Inoculation. Negative. 2 15th April Small trace Negative. 3 15th April Trace Negative. 4 15th April Trace Negative. 5 15th April Small trace Negative. 6 15th April Clean Negative. 7 19th April Small trace Negative. 8 19th April Small trace Died prematurely (no result). 9 19th April T race Negative. 10 19th April Clean Negative. 11 19th April Clean Negative. 12 19th April Trace Negative. 13 22nd April Small trace Negative. 14 22nd April Trace Negative. 15 22nd April Trace Negative. 16 22nd April Small trace Negative. 17 22nd April Trace Negative. 18 22nd April Small trace Negative. 19 27th April Clean Negative. 20 27 th April Clean Negative. 21 27th April Clean Negative. 22 27th April Clean Tuberculosis. 23 27th April Small trace Negative. 24 27th April Clean Negative. 57 From the foregoing it will be seen that, in one instance, the sample of milk suggested the possibility of the presence of tuberculosis at the farm of production, and the Medical Officer of Health of the area in which the farm was situated was accordingly informed of the circumstances, and although, on first examination, no clinical evidence of disease was found on the farm, milk sampling and subsequent post-mortem examination of a roan cow revealed lesions of tuberculosis in the udder. So far as the presence of dirt was concerned, the samples examined proved to be satisfactory. For the purposes of comparison, the following summary of results since 1904 is here inserted :— Year. Percentage showing Tuberculous Infection. Year. Percentage showing Tuberculous Infection. 1904 7.7% 1922 9-5% 1905 9.1% 1923 2.6% 1906 8.0% 1924 12.8% 1907 8.3% 1925 2.4% 1st Series. 1909 12.5% 1st Series. 2 .4% 2nd Series. 4.7% 2nd Series. 1927 4.88% 1910 6.25% 1928 8.3% 1912 6.6% 1929 5.1% 1913 10.4% 1930 4.2% 1914 10.2% 1931 9.5% 1915 8.5% 1932 9.1% 1917 4.2% 1933 11.1% 1919 14.8% 1934 8.3% 1921 24.2% 1st Series. 1935 0.0% 26.3% 2nd Series. 1936 8.3% 12.5% 3rd Series. 1937 4.2% The chemical examinations undertaken by the Public Analyst showed that every sample conformed to the required standard. 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 557 persons, compared with 589 in 1936. 91 per cent, are adults and 9 per cent, children (under 14 years). In addition to these Artizans' Dwellings, the Corporation, in connection with a slum clearance scheme, erected in the City :— (1) In December, 1927, a block of buildings, Bearsted House, in Hutchison Street, which contains 88 rooms, arranged in 24 tenements, and housing at the end of 1937, 96 persons (97 per cent, adults and 3 per cent, children). (2) In January, 1929, a similar block of buildings, Dutton House, in New Street, containing 52 rooms, arranged in 16 tenements, and housing at the end of 1937, 69 persons (74 per cent, adults and 26 per cent, children). There are 7 shops, each with a large and well-lighted basement, in Bearsted House, and 8 shops, similarly provided with a basement, in Dutton House. The total population of these dwellings is 722. 58 The number of births was 3*, viz.: 1 male and 2 females. The birth-rate was 4-1 per 1,000, which is 7 -3 per 1,000 below the average for the previous five years. The birthrate in these Dwellings reached a maximum of 46-9 per 1,000 in 1896, and has since been falling irregularly, but almost progressively. The death rate for 1937 was 13-8 per 1,000 per annum. For the purposes of comparison of birth and death rates, the population in the whole of these dwellings has been included in the calculation, as probably representing a class homogeneity. TABLE OF BIRTHS AND DEATHS OCCURRING AT THE ARTIZANS' DWELLINGS, STONEY LANE, HOUNDSDITCH, BEARSTED HOUSE, HUTCHISON STREET, AND DUTTON HOUSE, NEW STREET, DURING THE YEAR 1937. Name of Block. Births. Mortality from all Causes at subjoined ages. Males. Females. At all ages. Under 1 year. 1 and under 5 and under 15 16„ and under 25 25 and under 65 66 and upwards. NORTH BLOCK — — 2 — — — — 2 — SOUTH „ — 1 1 1 — — — — — KING'S „ 2 1 l QUEEN'S „ 1 — — — — — — — PRINCE'S „ 1 4 l 1 2 BEARSTED HOUSE — 1 — — 1 DUTTON „ — — — — — — — — — Totals 1 2 10 1 l 4 4 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 1937 being 14,504, of whom 5,871 were males and 8,633 were females. The accompanying table is compiled from the monthly records of attendances at the baths :— RECORD OF ATTENDANCES AT THE BATHS, ARTIZANS' DWELLINGS. Month. Skx. Males. Females. Total. Children. Adults. Children. Adults. January in 420 139 623 1,293 February 99 362 120 502 1,083 March 108 371 106 513 1,098 April 109 400 142 624 1,275 May 96 429 140 631 1,296 June 111 381 119 666 1,277 July 115 455 127 787 1,484 August 68 355 70 564 1,057 September 104 351 118 527 1,100 October 100 370 127 570 1,167 November 108 407 140 647 1,302 December 94 347 108 523 1,072 Totals 1,223 4,648 1,456 7,177 14,504 * No still births. 59 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 W. G. C. Neale. Month. Premises Inspected. Orders issued. Notices served. Improvements eflected. January 164 1 12 February 150 7 March 147 1 4 April 183 21 9 May 128 — 14 June 119 — 8 July 114 i — 11 August 142 — — 9 September 122 — — 7 October 119 — — 9 November 119 — — 6 December 111 — — 11 Totals 1,618 i 23 107 MIDDLE DISTRICT—Inspector G. H. Fowler. Month. Premises Inspected. Orders issued. Notices served. Improvements effected. January 168 8 February 176 19 March 174 22 April 103 16 May 160 16 June 163 l l 22 July 176 — — 20 August 100 — — 11 September 221 l 2 16 October 169 — — 10 November 158 l 1 12 December 162 5 2 19 Totals 1,930 8 6 191 EAST DISTRICT—Inspector G. E. Harrington. Month. Premises Inspected. Orders issued. Notices served. Improvements effected. January 165 2 11 February 159 3 3 14 March 194 1 2 13 April 154 — 19 12 May 164 6 5 16 June 151 3 4 13 July 136 — 1 14 August 116 — 7 10 September 154 , 2 7 12 October 161 — — 13 November 177 2 3 15 December 186 6 9 17 Totals 1,917 23 62 160 THE FOREGOING ARE SUMMARISED AS UNDER District. Number of Inspections made. Orders issued. Notices served. Improvements effected. West 1,618 l 23 107 Middle 1,930 8 6 191 East 1,917 23 62 160 Totals 5.465 32 91 458 60 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, was 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 24 151 85 1-8 21 Middle — — — — — East 16 114 62 1-8 17 Total 40 265 147 1-8 38 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 38 notices during 1937. In addition to the foregoing, there are twelve blocks of Dwellings let out in tenements, but not placed on the Register for the reason that each holding is "self-contained," it having 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. No. of Inhabitants. One Room. Two Rooms. Three j Rooms, i Four Rooms. Five Rooms or over. WEST DISTRICT. Albion Buildings, No. 21, Bartholomew Close ... 10 ... ... ... 16 Albion Buildings, No. 22, Bartholomew Close ... 10 ... ... ... 13 Bartholomew House, Bartholomew Close 20 ... ... ... ... 15 Dean Street Blocks, Fetter Lane— Block A 5 2 l ... ... 13 „ B 2 3 ... 4 ... 11 „ c 4 4 ... ... ... 13 „ D 4 4 ... ... ... 14 „ E 6 3 ... ... ... 11 „ F 6 3 ... ... ... 16 St. Ann's Chambers, Ludgate Hill 3 8 1 1 l 26 Bloomfield House, Snow Hill ... 15 ... 2 l 52 Total (Six " Blocks ") 47 62 2 7 2 200 MIDDLE DISTRICT. Bridgewater House, Fann Street ... 9 ... ... 1 13 City Buildings, Moor Lane 1 21 11 ... ... 57 Total (Two " Blocks ") 1 30 l ... 1 70 EAST DISTRICT. Harrow Place and Stoney Lane— North Block 2 48 8 ... ... 155 South ,, 5 22 13 ... ... 85 Prince's ,, 6 48 1 ... ... 127 Queen's ,, 5 41 4 ... ... 112 King's „ 11 17 16 ... ... 92 Barker's Buildings, Catherine Wheel Alley, Bishopsgate 1 4 1 1 ... 16 Bearsted House, Hutchison Street ... ... 7 15 1 102 Dutton House, New Street ... ... 13 2 1 66 Total (Four " Blocks ") I 30 180 | 63 18 2 755 These twelve blocks contain 449 tenements, and are inhabited by 1,019 persons—an average of 2 -3 persons to each tenement. 61 The following table is included in this Report in accordance with the request contained in the letter from the Ministry of Health, dated 24th June, 1932, and relating to contents of annual reports of Medical Officers of Health : — 1. Inspection of Dwelling-houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 514 (b) Number of inspections made for the purpose 630 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 54 (b) Number of inspections made for the purpose 84 (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 Nil. 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 25 3. Action under Statutory Powers during the Year :— A.—Proceedings under sections 9, 10, and 16 of the Housing Act, 1936 : (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. B.—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 42 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 1 (b) By Local Authority in default of owners Nil. C.—Proceedings under sections 11 and 13 of the Housing Act, 1936 : (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. D.—Proceedings under section 12 of the Housing Act, 1936 : (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit . Nil. 4. Housing Act, 1936.—Part IV.—Overcrowding : A.— (i) Number of dwellings overcrowded at the end of the year 34 (ii) Number of families dwelling therein 34 (iii) Number of persons dwelling therein 170 B.—Number of new cases of overcrowding reported during the year 11 C-— (i) Number of cases of overcrowding relieved during the year44 (ii) Number of persons concerned in such cases 233 D.—Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding. E.—Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report. Common Lodging House, 116, Middlesex Street.—This is the only common lodging house in the City. It was opened on the 7th February, 1906, and is known as the " Salvation Army Working Men's Hotel and Shelter." Periodical inspections were made during the year. The premises are registered in the name of the Salvation Army Trustee Co. I 62 Neglect to comply with Water Closet Bye-laws.—One instance of neglect in this respect has occurred during the year under review. The construction of water closets was commenced before plans had been deposited for approval. The situation of the conveniences was not in accordance with the Bye-laws and they were dismantled before they had been brought into use. Drainage Plans.—In the course of the year 294 plans were submitted with regard to proposed reconstruction of water-closets or drains in the City. Of these, 235 were approved, 38 revised and approved, and 21 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 these 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. Sanitary Defects and Infectious Diseases— In cases of notification of infectious disease, the premises involved were inspected with regard to the drainage system, water supply, ventilation, etc., and of the 38 cases investigated in 1937, defects were found in six instances. Legal Proceedings.—During the year, 32 notices have been issued by the Sanitary Committee, and in no case was it found necessary, in consequence of non-compliance therewith, to refer the matter to the City Solicitor. The condition of the approaches to Billingsgate Market and the Custom 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 1937, 19 were situated in the East District, 24 in the Middle District, and 17 in the West District. Defective Conditions to Sewer.—During the year, 14 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 seven of the connections referred to. As a result of the inspection of the internal drainage system of these premises, reconstruction or alteration was found necessary in four instances. COLLECTION AND DISPOSAL OF REFUSE AND CLEANSING OF STREETS, COURTS AND GULLIES. The following observations are included in this Report by the courtesy of Mr. E. J. Eager, the Director of Public Cleansing :— Collection and Disposal of Refuse. House and trade refuse is collected by 10 a.m. from receptacles placed on the kerb in streets scheduled by the Ministry of Transport, and after 10 a.m. from the interior of premises in other streets. Special arrangements are made for the collection of large quantities of trade refuse in scheduled streets. The contents of street orderly bins and market refuse are collected at any time during the day or night. All refuse is conveyed by horse-drawn vans or motor waggons to Lett's Wharf. It is there shot into the contractors' barges ; house, trade and market refuse being taken down the river to Hornchurch, where it is deposited on land belonging to the Corporation. Manure and contents of street orderly bins are separately barged where required by the contractors. At Hornchurch, the refuse is disposed of under the system of controlled tipping, as recommended by the Ministry of Health— i.e., the crude refuse is sealed off from the air by layers of earth excavated from the maiden ground of the tip and from other sources. 63 Fires at the tip occur but seldom, and, as a precaution, iron water pipes are laid across the top of the tip, with joints at intervals to allow for the fixing of fire hose. No rats have been seen at the tip for several years, and this result may reasonably be attributed to the system of controlled tipping. Arrangements have been made for dealing with these vermin should their presence be suspected at any time. During the year ended 31st December, 1937, the tonnage of refuse collected was as follows :— House, trade and market refuse 44,751 Street and gully refuse 14,075 Total tons 58,826 Seventy-three per cent, of the refuse was collected by horse vans and 27 per cent, by motor waggons. It is estimated that the above total tonnage is equal to over 200,000 cubic yards. Cleansing of Streets, Courts and Gullies. The major part of the work of street cleansing is done during the night, when the whole of the City is cleansed either by motor brooms, motor water waggons or jet and hose. The condition of the centres of the carriageways in main thoroughfares during dry weather, except in market areas, is clean enough to render a nightly washing of the whole surface unnecessary, and such carriageways are therefore completely washed once a week only. On the other five nights of the week the channels are washed. In wet weather, however, the whole of the carriageways are washed every night if necessary. Certain secondary streets, including those in the vicinity of Billingsgate and Leadenhall Markets, are washed every night, and streets in the vicinity of Smithfield Market three times per week. Most of the street gullies are emptied as often as required by mechanical means, two machines being employed for this purpose every night. After the gullies have been emptied, they are re-sealed with clean water from the machines and the contents of the gullies removed to Lett's Wharf. Gullies in courts and narrow thoroughfares, which are inaccessible to the machines, are emptied by hand or flushed, as required. During the year 1937, 64,973 gullies were cleansed and 25,290,000 gallons of water used for cleansing streets, courts and gullies. HOUSING ACT, 1936. The Housing Act, 1936, which came into operation on the 1st January, 1937, repeals and re-enacts in consolidated form the provisions of the Housing Acts of 1925, 1930 and 1935. The Housing Act, 1936, is divided into seven parts. Part I contains general definitions of the local authority for the purposes of the Act. Part II relates to the repair, sanitary condition, etc., of small houses. Part III relates to clearance, improvement and redevelopment. Part IV relates to overcrowding. Part V relates generally to the provision of houses by local authorities. Part VI collects together the subsidy provisions of the Acts of 1930 and 1935. Part VII contains a number of miscellaneous and general provisions taken from all three earlier Acts. Section 62 of Part IV of the Act provides that six months after the appointed day, which was fixed as 1st July, 1936, for the City of London, all rent books or similar documents used in relation to a dwelling house shall contain a statement of the permitted number of persons in relation thereto, based on the floor area and number of rooms, and a summary in the prescribed form of the provisions of Sections 58, 59 and 61 of the Act. The date after which new cases of overcrowding constitute an offence under the Act was fixed by the Minister of Health as 1st January, 1937. Although explanatory leaflets were addressed to all persons and firms early in 1936, further reminders have been sent to landlords and employers of resident housekeepers in the City, and 1,007 applications have been received for the " permitted number of persons." This necessitated the measuring of 364 dwellings. For the purposes of the City, it has been found convenient to divide dwellings into three groups : (1) Private dwelling houses, (2) Dwellings provided by the Corporation, and (3) Dwellings occupied by housekeepers and caretakers, each group presenting its own particular problems. i 2 64 In view of the difficulty of obtaining a suitable site in the City of London for the erection of buildings to re-house overcrowded families, it has not been found possible for the Corporation to provide re-housing on any large scale. So far as is possible in the dwellings provided by the Corporation, any available accommodation has been placed at the disposal of overcrowded families, and where possible they have been entirely re-housed if accommodation permitted. During the year all families occupying private dwelling houses, whose accommodation was just sufficient at the time of the Housing Survey to comply with the standard laid down by the Act, were re-visited. Seventeen underground rooms which were being used for living accommodation were discovered, and action is being taken to prevent their use for human habitation. DISINFESTATION FROM VERMIN AND ACCOMMODATION FOR PERSONS TEMPORARILY DISPLACED. Consideration has been given to the introduction of legislation enabling local sanitary authorities to provide temporary accommodation for occupiers of houses which are undergoing disinfestation from vermin. At the present time there is no statutory power to provide this accommodation, though such does exist in connection with persons temporarily displaced during disinfection of their premises after infectious disease in the City. A shelter has been established for this purpose, and should occasion demand, it would be used in connection with disinfestation after vermin. Legal powers, however, would be a desirable addition to the Statute Book. PIGEONS. The congregation of pigeons within the City area continues to be a source of nuisance and damage, and it is essential that continual efforts be made in order that the number of these birds may be kept within reasonable limits. One of the difficulties in the City is the large number of nesting places which are more or less inaccessible to the trappers engaged, and the tendency on the part of visitors to the City to feed the birds. In this latter connection the Public Health Committee sought the views of the Home Secretary on the possibility of legislation prohibiting feeding by the public, and an interview was arranged with the responsible official of the Home Office. The fullest consideration was given to the matter, but it was clearly felt that legislation was not practicable in the circumstances. In order to meet the expressed wish of the Public Health Committee that a greater number of birds should be caught, not only has the contractor been urged to greater efforts, but certain members of the Corporation Staff, who expressed their willingness to assist in this matter, were detailed to catch and destroy on the same terms as apply to the official contractor. In all, 877 birds were caught and destroyed during 1937. EXHUMATION AND RE-INTERM ENT OF BODIES AT THE CITY OF LONDON CEMETERY. During the year, the bodies of five persons buried at the City of London Cemetery, Little Ilford, were exhumed under Home Office Licences and subsequently reinterred in the same cemetery. In accordance with the terms of the licences, the work of exhumation and re-interment in each case was carried out in the early morning and under the supervision of the Medical Officer of Health. DISCOVERY OF HUMAN REMAINS. 56/57, Farringdon Street. In September a quantity of human remains was discovered in connection with excavation work at the above-mentioned premises. In accordance with the usual custom, the contractors engaged on the work were advised to ask the Home Office for a licence authorising the re-interment of the remains in some suitable burial ground. The circumstances were also communicated direct by me to the Home Office. In due course the Home Secretary issued a licence authorising the removal and re-interment in Ilford Cemetery ; the licence 65 also acceded to a request which had been received from the Royal College of Surgeons for permission to take such of the remains as they desired for scientific purposes and for their subsequent retention in their Museum. Ultimately, two cases of remains were removed and re-interred in Ilford Cemetery, one of my officers supervising the work, which was carried out with due and proper reverence. Twenty-three craniums were removed by the representatives of the Royal College of Surgeons. From the manner in which these bones were found, it would appear that they had been previously disturbed, unless the site was—which is quite probable—one used as a pit during the period of the Great Plague. 28, St. Bride Street. During excavation work at above, a very small quantity of human remains, consisting of two skulls and a femur, were discovered. These were very old and obviously the remains of some previous disturbance. With the approval of H.M. Coroner, they were re-interred on the site with due reverence. FACTORY AND WORKSHOP ACT, 1901, &c. Factories, Workshops and Workplaces.—The premises upon the Register number 4,036, in which are included 8,566 workrooms, &c. There were served 1,552 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 1,675 4,104 WORKSHOPS 1,099 1,536 WORKPLACES Kitchens of Restaurants and Tea Rooms 742 1,652 Kitchens of Licensed Premises 287 857 Stables 6 71 Other places 227 346 4,036 8,566 The following is a Summary of Inspections of separate workrooms, &c., during the year:— Workshop Inspectors. Woman Inspector. Totals. FACTORIES 1,100 — 1,100 WORKSHOPS 321 321 WORKPLACES 897 496 1,393 The following is a Summary of Inspections of separate workrooms, since 1928:— Workshop Inspectors. Woman Inspector. Totals. FACTORIES. 1928 1,383 — 1,383 1929 1,902 — 1,902 1930 1,649 — 1,649 1931 2,144 — 2,144 1932 1,872 — 1,872 1933 2,121 — 2,121 1934 2,965 — 2,965 1935 1,825 — 1,825 1936 1,119 — 1,119 1937 1,100 — 1,100 66 WORKSHOPS. Workshop Inspectors. Woman Inspector. Totals. 1928 1,093 1 1,094 1929 1,247 — 1,247 1930 855 — 855 1931 1,044 — 1,044 1932 878 — 878 1933 1,051 — 1,051 1934 1,194 — 1,194 1935 733 — 733 1936 402 — 402 1937 321 — 321 WORKPLACES. Workshop Inspectors. Woman Inspector. Totals. 1928 845 l 846 1929 1,178 li 1,189 1930 704 48 752 1931 1,248 95 1,343 1932 1,079 77 1,156 1933 1,350 514 1,864 1934 2,109 885 2,994 1935 1,237 802 2,039 1936 808 812 1,620 1937 897 496 1,393 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. t 15/19, Artillery Lane, j 280, Bishopsgate. f*85, Middlesex Street, f 12 and 13, Widegate Street. UNDERGROUND BAKEHOUSES t 188, Aldersgate Street, f 262, Bishopsgate. 8, Copthall Avenue. |*67, Farringdon Street. 48, Knightrider Street. f*Great Eastern Railway Hotel. f* 122, Middlesex Street, t 3, Pancras Lane f 21, Stoney Lane, f 68, St. Mary Axe. 194, Upper Thames Street. SUMMARY. Aboveground Bakehouses 4 Underground Bakehouses 11 15 * These have been established at least 50 years. f ractory Bakehouses (power is used). Outworkers and Homeworkers.—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 17 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 cases of infectious disease were reported in connection with outworkers' premises in the City. 67 SUMMARY OF WORK DONE UNDER THE FACTORY AND WORKSHOP ACT, 1901, AND THE PUBLIC HEALTH (LONDON) ACT, 1936, &c. INSPECTIONS. East District. Middle District. West District. Totals. Factories, Initial Inspections (Tenancies) 26 75 64 165 Do. Initial Inspections (Workrooms) 37 92 115 244 Do. Periodical Inspections (Tenancies) 30 140 201 371 Do. Periodical Inspections (Workrooms) 72 216 556 844 Do. Re-inspections (Sanitary Works, &c., in hand) 39 175 104 318 Workshops, Initial Inspections (Tenancies) 10 21 25 56 Do. Initial Inspections (Workrooms) 13 25 29 67 Do. Periodical Inspections (Tenancies) 22 64 108 194 Do. Periodical Inspections (Workrooms) 27 81 142 250 Do. Re-inspections (Sanitary Works, &c., in hand) 11 68 43 122 Workplaces, Initial Inspections (Tenancies) 10 3 7 20 Do. Initial Inspections (Workrooms) 11 9 16 36 Do. Periodical Inspections (Tenancies) 17 8 12 37 Do. Periodical Inspections (Workrooms) 29 8 22 59 Do. Re-inspections (Sanitary Works, &c., in hand) 9 7 5 21 Bakehouses, Periodical Inspections (Tenancies) 14 10 4 28 Do. Periodical Inspections (Workrooms) 22 10 4 36 Do. Re-inspections (Sanitary Works, &c., in hand) 27 12 5 44 Kitchens of Restaurants, &c.— Initial Inspections (Tenancies) 8 13 10 31 Initial Inspections (Workrooms) 12 29 13 54 Periodical Inspections (Tenancies) 34 115 60 209 Periodical Inspections (Workrooms) 84 262 110 456 Re-inspections (Sanitary Works, &c., in hand) 53 250 92 395 Kitchens of Licensed Premises— Initial Inspections (Tenancies) 2 3 3 8 Initial Inspections (Workrooms) 4 7 3 14 Periodical Inspections (Tenancies) 18 53 23 94 Periodical Inspections (Workrooms) 57 167 54 278 Re-inspections (Sanitary Works, &c., in hand) 12 70 57 139 Workshops notified by H.M. Inspector 6 9 4 19 General complaints received 13 24 10 47 Miscellaneous visits 63 133 101 297 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 77 58 63 42 58 50 9 20 13 390 Want of Ventilation 8 1 1 9 9 3 3 1 1 36 Overcrowding Want of Drainage of Floors 3 3 Want of Lavatory Accommodation 4 2 1 7 Food improperly stored — — — 3 5 1 — 9 Storage Cistern defective 6 9 18 3 3 2 2 5 2 50 Accommodation for Refuse 5 — 2 5 5 4 — 2 1 24 Accumulation of Refuse 3 11 9 8 9 9 3 1 — 53 Sanitary Accommodation. I Insufficient (Tenancies) 2 2 4 Unsuitable (Do.) 2 21 10 1 3 37 Defective (Do.) 15 90 21 4 13 3 3 1 150 Do. (No. of Conveniences)* 15 90 21 4 13 3 3 1 150 Not separate for Sexes (Tenancies) — 5 3 1 2 1 — 1 13 Other Nuisances 43 6 21 44 7 34 4 7 3 169 Total Defects found 168 203 148 121 112 110 22 39 22 945 * Figures not included in total defects found or remedied. 68 FACTORIES, WORKSHOPS, WORKPLACES. KITCHENS OF RESTAURANTS, &c. KITCHENS OF LICENSED PREMISES. DEFECTS REMEDIED. East District Middl e District West District East District Middle District West District East District Middle District West District s. Want of Cleanliness 25 54 55 26 51 44 4 22 15 296 Want of Ventilation 1 — 1 5 5 3 2 — — 17 Overcrowding 1 — — — — — — — — 1 Want of Drainage of Floors 2 — — — — — — — — 2 Want of Lavatory Accommodation — — — 2 1 — 1 — — 4 Food improperly stored — 1 — — 5 1 — — — 7 Storage Cistern defective — 9 14 — 4 2 1 3 3 36 Accommodation for Refuse — 1 1 1 8 3 — 2 1 17 Accumulation of Refuse 2 11 7 2 7 10 1 1 — 41 Insufficient (Tenancies) 3 2 — — — 1 — — 1 7 Sanitary Unsuitable (Do.) — 7 10 1 — 2 — — — 20 Accommoda- - Defective (Do.) 19 98 21 2 17 3 1 5 2 168 tion. Do. (No. of Conveniences)* 19 98 21 2 17 3 1 5 2 168 Not separate for Sexes (Tenancies) 1 4 3 1 1 1 — — — 11 Other Nuisances 15 5 19 6 11 25 2 7 9 99 Total Defects remedied 69 192 131 46 110 95 12 40 31 726 ACTION TAKEN. East District. Middle District. West District. Totals. Matters referred to H.M. Inspector- Nuisances remediable by H.M. Inspector — 7 2 9 Failure to affix Abstract 7 24 10 41 Matters referred by H.M. Inspector— Notified by H.M. Inspector 2 6 1 9 Reports sent to H.M. Inspector 2 6 1 9 Notices served— Factories—Intimation 14 41 16 71 Statutory — 1 1 2 Workshops—Intimation 6 10 5 21 Statutory — 3 3 Workplaces, &c.—Intimation 6 — 6 Statutory — — — — Kitchens of Restauran's— Intimation 13 13 5 31 Statutory — 1 — 1 Kitchens of Licensed Premises— Intimation 6 2 3 11 Statutory — — — — Orders required from Sanitary Committee — 3 3 6 Certificates for Cleansing issued by Medical Officer of Health — — — — Matters referred to District Inspectors 1 7 2 10 Matters referred to Women Inspectors 1 — — 1 Matters referred to Workshop Inspectors — — — — Cases reported for Legal Proceedings — — — Legal Proceedings taken — — — OUTWORK, AND THE INSPECTION OF OUTWORKERSPREMISES, &c. Lists received from City Firms 1,158 Names and Addresses, &c., received from other Authorities — — — 543 Names and Addresses transmitted to other Authorities — — — 8,175 Notices served on Employers — — — 1,406 Lettere written, &c — — — 25 Firms visited 19 61 16 96 Outworkers' Lists not kept 3 11 3 17 Do. not sent 3 11 3 17 Infectious Disease occurring in Outworkers' Premises — — — — Registered Factories and Workshops at which Outwork is received— Inspections 28 56 24 108 Defects found 12 30 13 55 Defects remedied 12 30 13 55 " Places from which work is given out "— Inspections 13 41 19 73 Defects found 11 22 3 36 Defects remedied 11 22 3 36 •Figures not included in total defects found or remedied 69 In addition to the foregoing inspections, the Sanitary Inspectors associated with the Factory and Workshop section of my Department assisted in the general inspection work of working-class houses which was carried out during 1937, and in this connection made 26 inspections in the West District, 58 in the Middle District and 320 in the East District. WOMAN INSPECTOR. Total. Domestic Workshops at which Outwork is received Inspections 1 Defects reported and appropriate action taken l Domestic Workshops which do not receive Outwork Inspections — Defects reported and appropriate action taken — Domestic Premises receiving Outwork (not registerable as Workshops). Inspections 7 Defects reported and appropriate action taken — Underground Conveniences for Women 1 Inspections 108 Defects reported and appropriate action taken 4 Railway Stations (Ladies' Rooms) Inspections 41 Defects reported and appropriate action taken 2 Kitchens of Restaurants, &c. Initial Inspections (Tenancies) 2 Initial Inspections (Workrooms) 13 Periodical Inspections (Tenancies) 227 Periodical Inspections (Workrooms) 483 Re-inspections (Sanitary Works, &c., in hand) 196 Defects found 66 Notices Intimation (Verbal) 89 Statutory — Matters referred to District Inspectors 22 Matters referred to Workshop Inspectors — Certificates for Cleansing issued by Medical Officer of Health — Orders required from Sanitary Committee — Cases reported for Legal Proceedings — Legal Proceedings taken 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 1929 1,263 861 10,478 11,339 1930 1,229 1,019 9,603 10,622 1931 1,202 996 9,105 10,101 1932 1,182 1,006 8,758 9,764 1933 1,189 1,069 8,495 9,564 1934 1,182 1,196 8,702 9,898 1935 1,171 1,246 8,975 10,221 1936 1,140 1,294 8,551 9,845 1937 1,113 1,254 8,187 9.441 k 70 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of (1) Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (including Factory Laundries) 558 73 Workshops (including Workshop Laundries) 258 24 Workplaces (other than Outworkers' premises) 628 49 Total 1,444 146 2.—Defects Found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspectors. in (2) (3) (4) (5) Nuisances under the Public Health Act:—* Want of cleanliness 427 334 8 — Want of ventilation 46 24 1 Overcrowding — 1 — Want of drainage of floors 3 2 — Other nuisances 415 295 — Sanitary accommodation insufficient 4 7 — unsuitable or defective 211 211 — — not separate for sexes 13 11 — — 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 1,119 885 9 •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. 71 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. 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. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Lists.t Outworkers, f Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (•») (5) (6) (7) (8) (9) (10) an (12) (13) (14) (16) (16) Wearing Apparel— making, &c 950 3,278 4,644 20 59 37 1,406 cleaning and washing 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) 84 264 166 5 10 16 Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, &c 38 16 233 — — — Artificial Flowers 10 — 118 — — — Nets, other than Wire Nets Tents Sacks Racquet and Tennis Balls Paper, &c., Boxes, Paper Bags 2 — 9 — — — Brush making 2 — 24 — — — Pea picking Feather sorting Carding, &c., of Buttons, &c Stuffed Toys 2 — 16 — — — Basket making Chocolates and sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, &c Textile Weaving Total 1,088 3,558 5,210 25 69 53 1,406 Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. k2 * 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 6 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. f 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. 72 4.—Registered Workshops. Workshops on the Register (S. 131) at the end of the year, (i) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. r General Workshops 1,095 Bakehouses (including Factory Bakehouses) 15 Total number of Workshops on Register *1,110 * These were found to be 1,552 Workrooms, &c., in places Registered. 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133, 1901) 41 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5, 1901). Notified by H.M. Inspector 9 Reports (of action taken) sent to H.M. Inspector . 9 Other — Underground Bakehouses (S. 101) :— Certificates granted during the year Nil. In use at the end of the year 9 Date, 31s/ December, 1937. (Signature) C. F. WHITE, Medical Officer of Health. 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. SHOPS ACTS, 1934. The provisions of the above-mentioned Act have been carried out, and it has not so far been necessary to appoint any additional members to the inspectorial staff in connection therewith. As a consequence, however, of a memorandum which was issued by the Minister of Health dealing with this Act in general, each of the existing inspectors has been formally appointed and provided with a certificate of such appointment, in order that it may be produced to any appropriately responsible person on request. During the year 723 shops and warehouses were inspected and re-inspected, 343 defects found, all of which were remedied without recourse to legal proceedings. Applications for exemption certificates were received, and as satisfactory alternative accommodation was available in each case, all were granted. The following is a summary of the work done :— WEST. MIDDLE. EAST. TOTALS. Number of shops inspected 248 218 77 543 Number of shops re-inspected 55 92 33 180 Number of shops re-visited 191 280 73 544 Number of defects found 116 133 94 343 Number of defects remedied 100 116 49 265 Number of intimations served 10 32 23 56 Number of statutory notices served — 2 3 5 73 FACTORIES ACT, 1937. The above-mentioned Act, which comes into operation on the 1st July, 1938, is a consolidating and revising measure. The principal act of the existing law in this matter is styled the Factory and Workshop Act, 1901, and although this has been amended by later enactments, it has not been the subject of any general revision, and it has been felt that, after 35 years or so, it is to a large extent out of date. The new Act provides greatly improved arrangements for securing the further safety and welfare of factory workers, and is the outcome of a careful review of the results of the administration of the 1901 Act, and by enquiries of numerous committees which have considered definite parts and aspects of the wide field of industrial regulations ; also research carried out by scientific bodies, and experiments and investigations conducted by the industries themselves. The Act abolishes the distinctions which exist in the present law between factories and workshops and between textile and non-textile factories, and employs only the one term " Factories." Some slight additional responsibility has been thrown upon the local authority in regard to sanitary conditions of factories by adding the control of temperatures to those duties which they already performed. The Act strengthens the existing provisions in regard to health, safety and welfare and revises the hours of employment. The requirements relating to Home Work vary slightly from those in the Factory and Workshop Act, 1901. Lists of outworkers must now be forwarded to the District Council during the month of February and the month of August, instead of on or before the 1st February and 1st August ; must now contain names and addresses of all outworkers so employed during the preceding six months. It is made clear that the section applies to outwork, irrespective of whether the materials for the work are supplied by the occupier or not. The penalty for a contravention of this section is a fine not exceeding ten pounds. The penalty under the 1901 Act was a fine not exceeding forty shillings, and in the case of a second or subsequent offence, not exceeding five pounds. The period for compliance with a notice under the section relating to employment of persons in unwholesome premises is reduced from one month to ten days; and the notice must indicate the Council's reasons for regarding the place as dangerous. CITY MORTUARY. Rodies Received.—Post-Mortems and Inquests :— Bodies received at the Mortuary to await burial 75 Post-Mortem examinations made 20 Inquests held on bodies 65 Inquests held on fires o 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. PostMortem Examinations. Inquests held on Fires. 1932 234,170 142 90 91 2 1933 233,821 114 71 77 2 1934 243,939 121 81 69 2 1935 248,031 111 74 65 4 1936 170,726 103 62 55 3 Average for previous 5 years 226,337 118 75 71 3 1937 283,626 75 65 20 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. 74 The following table gives the details of the work of disinfection carried out at the Disinfecting Station during the year in connection with the export trade Number of Certificates issued. Number of articles disinfected. Fees received by the Corporation. 544 270,780 £371 Other disinfection and cleansing work carried out during the year is as follows :— Disinfection.—Infectious Disease :— Articles disinfected after cases of infectious disease, &c 8,351 Library Books disinfected 113 Public Vehicles—Electric Ambulance 3 Cells at Police Stations 1 Premises disinfected (including offices) 111 Lockers disinfected at request of General Post Office Authorities 105 Horsehair and Bristles (cases) 27 Cleansing of Persons Act, 1897 :— Number of verminous persons bathed 123 Number of articles of clothing disinfected 1,480 Cleansing of School Children :— Total number of children cleansed 1,031 Number of articles of clothing disinfected 2,902 Books, &c., destroyed at request of owners 1,201 Beds destroyed at request of owners 80 Paper 5cwt. Pigeons destroyed 877 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 1937 six bodies were placed in the apparatus, all of which were subsequently identified. 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, street gulleys, 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. In the interests of economy the practice of using a disinfectant fluid in conjunction with general street watering has been discontinued. RAT REPRESSION. Special investigation of complaints of rat infestation in City buildings was continued throughout the year. Individual cases of lasting improvement, following severe rat infestation over a lengthy period, can be reported, mainly in those cases where co-operation between owner and tenant had been obtained in the employment of skilled catchers for extermination and the introduction of structural rat-proofing for repression. 75 Live rat catching by skilled workers is still considered to be the most suitable and hygienic method of extermination for use in the City area, and for this reason is recommended in the majority of instances. Rat-proofing is suggested in every case of rat infestation. The value of this method of repression cannot be over-emphasized, particularly where, as in an area like the City, the chief problem is provided by the Black Rat. The guarding and removal of waste food, water, and nesting facilities, which must form part of any rat-proofing campaign, is obviously the duty of occupiers of property, and its introduction is continually recommended and demanded by the Officers of this Department. Structural rat-proofing, which mainly entails the blocking of internal pipe runs, and the repair of defective doors, windows, and roofs, cannot reasonably be asked of occupiers or legally demanded of owners. For this reason this particular aspect of repression is not receiving the attention it should. In previous reports emphasis has been laid on the need for the closing of windows and doors in properties. The rat is quick to take advantage of every human failing in this way. This is amply illustrated in the accompanying photograph. This shows a fanlight over a door leading from a landing. This fanlight had never been closed. Rats nested in the ceiling over the landing, made their exit through a hole made for a pipe, ran down the framework of the window (shown by the black marking on the wood), across the bottom of the window, and through the open frame on to the top of a cupboard which stands behind the door. The frequency with which the rats used this run is illustrated by the accentuated black marking on the window framework. Incidentally, the occupiers had no idea of this happening, and though aware of the presence of this black marking, never associated it with the rat. It is not possible to give the number of rats destroyed in the City during the year 1937. Messrs. William Dalton & Sons inform me that they caught 19,561 in the area during that period, whilst one of the big catering firms state that nearly 5,000 were caught in their City shops. 76 RATS AND MICE (DESTRUCTION) ACT, 1919. Details of Work Carried Out under the above Act for the Year ended 31st December, 1937. Month. Initial Inspections. Number of Buildings found to be Infested. Number of cases of Black Rat Infestation. Number of cases of Brown Rat Infestation. Methods Employed to Destroy Rats. Drainage and Sewerage carried out during the year. Rat Catcher Employed. Poison Used. Traps. By City Engineer's Department. By M.O.H. Department. January 36 35 26 9 15 10 13 February 34 32 30 2 4 9 20 March 31 24 19 5 12 3 12 April 41 36 32 3 16 1 18 May 33 33 25 8 — 7 26 June 46 41 35 7 10 3 25 592 112 July 61 55 50 5 12 5 34 August September 41 31 31 — 8 10 16 October 34 25 22 3 5 8 12 November 53 49 42 7 16 10 24 December Totals 410 361 312 49 98 66 200 704 77 The following figures have been supplied to me by the City Engineer:— Brick sewers reconstructed and in course of reconstructing 5 Disused sewers filled in and abolished 3 Brick sewers reinverted, pointed and repaired 9 Pipe sewers constructed, reconstructed and repaired 1 Miscellaneous repairs to sewers, drains, &c. 16 House drains constructed in connection with new buildings 23 Drains of existing buildings reconstructed 29 House drains partially reconstructed in connection with the part reconstruction and reinverting of certain sewers 48 New gullies and drains constructed 6 Gullies reconstructed 40 Gully drains reconstructed 54 Gully and house drains repaired 64 Disused gully and house drains bricked off 25 Number of rats destroyed by sewermen during year 592 Eighty-four pounds of rat poison were used in the sewers. A large number of dead rats were, doubtless, carried away by the flow of water in the various sewers. 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, 82 persons were examined by your Medical Officer of Health during 1937. Eighty of these persons were reported as physically fit for office. Seventeen officers were also medically examined with a view to their retirement. With five exceptions, all were reported to be unfit for duty. I have the honour to be, Gentlemen, Your obedient Servant, CHARLES F. WHITE, Medical Officer of Health for the City of London. Public Health Department, Guildhall, E.C. L APPENDICES. page Appendix A—Street Lists of Mortality 80 „ B— „ „ Infectious Diseases 84 „ C—Register of Houses let in lodgings or occupied by members of more than one family 85 „ D—List of Adoptive Acts, Orders, Bye-laws and Regulations in operation in the City 86 ,, E—Tuberculosis Dispensary, St. Bartholomew's Hospital, E.C. 1 (Leaflet) . 87 „ F—Scabies and Impetigo 88 l2 80 APPENDIX A.—STREET LISTS OF MORTALITY. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Aldgate Avenue 27 M 52 5th Jan. Acute Heart failure, due to Stenosis by Atheroma of Coronary Artery. P.M. Resided at West Ham. Amen Court 1 M 57 31st Oct. Syncope. Coronary Artery disease and Fibrosis of the Heart muscle. P.M. 2 F 69 17th Dec. without Inquest 1a. Lobar Pneumonia b. Acute Otitis Media Barnett's Mansions, Stoney Lane. 4 F 51 22nd April la. Cancer of Uterus, with Pelvic Infiltration Baltic Chambers, 19, Bishopsgate — M 59 22nd Jan. b. Secondary Cancerous Consolidation of rt. lung c. Heart failure la. Influenza b. Cardial Vascular degeneration Died in Stone House, Dartford. Bartholomew Close 87 M 63 3rd July la. Uraemia b. Operation Died in Royal Northern Hospital. Bartholomew House, Cloth Fair 3 M 70 1st Feb. c. Adenoma of Prostate Cerebral Haemorrhage. Atheromatous Arteries. P.M. Natural ,, ,, 13 F 77 16th Jan. la. Myocardial Fibrosis b. Arterio-sclerosis Died in St. Peter's Hospital, Stepney. Bearsted House, New Street. — M 75 7th April 2. Chronic Bronchitis la. Cerebral Haemorrhage 2. Myocardial failure and Bronchitis Billiter Street 6 F 69 12th Feb. (progressive) la. Chr. Interstitial Nephritis Died in Leavesden Bishopsgate 69 M 67 18th July 16. Carcinoma of Oesophagus pital . Died in St. Peter's Hospital. Cannon Street 89 F 42 20th Aug. Septic Endocarditis (sub-acute) Died in St. Bartholomew's ,, 84 M 61 1st April la. Bronchitis Hospital. ,, 123 F 61 12th April 2. Myocardial degeneration la. Uraemia b. Cirrhosis of Kidneys Died in National Temperance Hospital, St. Pan- ,, 139 M 57 17th Jan. 2. Cirrhosis of Liver la. Pulmonary Tuberculosis eras. Charles Street, 2, Bridgwater House. M 40 18th Aug. Asphyxia from drowning. Insufficient evidence to show how he came into Died in River Thames, Stepney area. Clifford's Inn 68 F 65 13th Dec. water. P.M. la. Cerebral Haemorrhage Resided at Chelsea. Cloth Fair 39 M 83 26th April b. Arterio-sclerosis la. Broncho-pneumonia b. Cerebral Thrombosis Died in Bournemouth. Coleman Street 12 F 53 16th Dec. 2. Degenerative Myocarditis la. Arterio-sclerosis b. Broncho-pneumonia Resided at Dartford. Crown Place, Aldgate 3 F 76 27th Feb. la. Broncho-pneumonia b. Influenza 2. Old age Dean Street, Fetter Lane 7a M 2 weeks 26th April la. Infective Meningitis b. Cerebral Compression c. Meningocele 2. Encephalocele Died in St. Peter's Hospital. ,, 4b M 83 9th Nov. la. Myocarditis ,, 4d M 65 2nd Nov. b. Sub-acute Bronchitis la. Broncho-pneumonia Died in St. Peter's Devonshire Square 5 M 60 12th Dec. la. Pulmonary Oedema b. Acute Bronchitis pital. Died in St. Peter's Hospital. Evangelist Court 2 M 92 23rd Feb. la. Myocardial degeneration b. Senility Died in St. Peter's Hospital. Fenchurch Avenue 10 F 67 18th Mar. Cerebral Thrombosis Died in St. Peter's Fetter Lane 108 F 48 24th Dec. la. Primary Lobar Pneumonia pital. Fleet Street, Anderton's Hotel. - M 76 17th Oct. la. Broncho-pneumonia b. Liver Abscess and Growth c. Secondary Carcinoma of Pancreas 2. Acute Septic Endocarditis Thrombosis of post tibial vein Died in St. Peter's Hospital. Fore Street 120 F 84 18th Aug. la. Myocardial degeneration b. Senile Arterio-sclerosis Died in Poplar. Founders Court — M 75 3rd Oct. la. Chronic Myocarditis b. Arterio-sclerosis Died in Poplar. Frederick's Place 8 M 56 17th Jan. la. Pulmonary Tuberculosis Died in Hackney. Garden Court, Temple 2 M 76 9th Mar. Syncope. Enlarged Heart. Emphysema of Lung. Senile decay. P.M. Inq. 81 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Great New Street 9 F 23 1st April la. Laryngeal Tuberculosis b. Pulmonary Tuberculosis Died in Hackney Institution. ,, 11 F 69 14th Jan. la. Cardiac failure b. Myocardial degeneration Gresham Street 32 F 44 3rd Oct. 2. Chronic Bronchitis Cerebral Haemorrhage. P.M. Natural Died in St. Bartholomew's Hospital. Gutter Lane 17 F 65 16th Feb. la. Cardiac failure b. Auricular Fibrillation Died in St. Peter's Hospital. Hare Court, Temple 2 M 59 26th May la. Hypostatic Pneumonia b. Myocardial failure Holborn 24 M 25 25th Jan. c. Arterio-sclerosis Asphyxia. Pulmonary collapse. Hypertrophic Heart Resided at Wandsworth. Houndsditch 56 M 86 30th Sept. la. Cachexia and Exhaustion b. Osteoma of rt. Shoulder and It. Ribs (probably malignant) Inner Temple 6, Dr. Johnson's Bldgs. — F 58 9th Sept. la. Thrombosis (Cerebral) b. Chronic Arterio-sclerosis c. Chronic Nephritis and Glycosuria Died in Lancaster Grove. Ironmonger Lane 11 F 49 14th July la. Peritonitis b. Parametritis c. Carcinoma of Cervicuteri, treated by radium Died in Mount Vernon Hospital. King Edward Street, G.P.O. — M 45 2nd Nov. Syncope. Valvular Heart disease. Myocardial degeneration. P.M. without Resided at Islington. King's Block, Stoney Lane 2 F 86 24th Jan. Inquest la. Myocardial degeneration b. Chronic Bronchitis P.M. " " 27 F 59 16th Jan. Syncope. Chronic Valvular and Myocardial degeneration of Heart Lime Street 23 M 61 4th July la. Cardiac failure b. Mitral and Aortic incompetence ,, 37 F 65 27th Nov. 2. Alcoholic Neuritis la. Endocarditis b. Pulmonary Tuberculosis Little Somerset Street . 4 F 83 10th April la. Cardio-vascular degeneration Died in City of London Mental Hospital, Dartford. Liverpool Street Station — M 64 29th Mar. Syncope. Ruptured Aneurysm of the Aorta Resided at Islington. „ ,, — M 74 23rd Sept. la. Angina Pectoris Resided at Woodford. Long Lane .... 59 M 75 16th July la. Anascarca b. Heart failure c. Hypertension Died in St. Peter's Hospital. ,, 75 M 69 5th April 2. Anaemia la. Myocardial degeneration b. Paralysis agitans Died in Jewish Home for Incurables, Tottenham. Lombard Street 54 M 52 14th Dec. 2. Chronic Bronchitis Syncope. Coronary Thrombosis. Resided at Romford. Lower Thames Street 90 F 11 22nd April cardial degeneration. P.M. Diphtheria Died in Eastern Hospital, Hackney. Ludgate Hill 65 M 68 27th Dec. Perforation of Gastric Ulcer. P.M. Died in Hospital in St. Pancras. Martin Lane 8/ 9 M 68 21st May la. Heart failure 2. Auricular Fibrillation Cardio-vascular degeneration Died in St. Bartholomew's Hospital. Middlesex Street 116 M 91 16 Jan. la. Myocardial degeneration b. Arterio-sclerosis Died in City of London Institution, Bow Road. ,, 116 M 45 21st Jan. la. Lobar Pneumonia Died in St. Peter's Hospital. ,, 116 M 50 28th Jan. Syncope. AtheroVna of Aorta and Dilation. P.M. Natural Died in ambulance on way to Hospital. ,, 116 M 64 17th Feb. la. Cerebral Thrombosis b. Chronic Myocarditis Died in City of London Institution, Bow Road. ,, 116 M 82 16th Feb. la. Myocardial degeneration b. Arterio-sclerosis Died in City of London Institution, Bow Road. ,, 116 M 70 22nd Mar. la. Senility b. Arterio-sclerosis Died in St. Peter's Hospital. ,, 116 M 73 30th Mar. la. Broncho-pneumonia b. Cardio-vascular degeneration Died in Bancroft Lodge, Stepney. ,, 116 M 54 31st Mar. la. Cerebral Tumour Died in St. Bartholomew's Hospital. ,, 116 M 62 11th April Asphyxia from drowning in Grand Union Canal Died in Shoreditch. ,, 116 M 64 22nd May la. Carcinoma of Oesophagus 2. Senility Died in St. Peter's Hospital, Stepney. 82 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Middlesex Street 116 M 50 5th April la. Pulmonary Tuberculosis Died in Bancroft Lodge, Stepney. ,, 116 M 72 24th Nov. la. Myocardial degeneration 6. Arterio-sclerosis Died in Poplar. ,, ,, 116 123 M M 74 48 21st Nov. 27th Feb. Asthenia due to fecial Fistula, due to rupture of rt. Inguinal Hernia. Gangrenous Cellulitis of Scrotum la. Sub-arachnoid Hemorrhage Died in St. Peter's Hospital. Died in Jewish Hospital, Stepney. ,, 93 F 75 26th Aug. la. Coronary Thrombosis b. L. Pulmonary Thrombosis 2. Diabetes Minories 97 M 66 2nd May la. Myocardial degeneration b. Auricular Fibrillation Milk Street 35 F 68 22nd April la. Bronchitis b. Cardio-vascular degeneration Died in Archway Hospital, Islington. Minories, City of London Police Hospital. 63 M 32 2nd June la. Heart failure b. Pneumonia Resided at Deptford. Minories 97 F 70 2nd June la. Coma b. Arterio-sclerosis Mincing Lane 14 M 61 6th July la. Syncope ft. Auricular Fibrillation c. Myocarditis (chronic) 2. Phlebitis Resided at Lingfield, Surrey. ,, Clothworkers' Hall. 41 M 60 28th July la. Septic Pneumonia, following Carbuncle Mitre Court Buildings, Temple. Monument Street Moorgate Sation, C. & S.L. Rly. 1 9 F M M 77 13 mos. 49 7th Jan. 16th Dec. 12th Jan. la. Broncho-pneumonia 6. Influenza la. Broncho-pneumonia Shock and multiple injuries. Run over by electric train. P.M. Inq. Suicide— unsound mind Resided at Southport. Nevill's Court 11 F 55 8th Nov. la. Pneumococcal Emphysema (operation, 6/11/37) 6. Acute Lobar Pneumonia Died in St. Pancras Hospital. Newgate Street 41 F 56 13th Jan. la. Heart failure 6. Thrombosis Iliac Vein c. Cancer of Glands (secondary) 2. Following Cancer of Uterus five years ago (operation) North Block, Stoney Lane 6 M 60 3rd Sept. Syncope due to Coronary Thrombosis. P.M. Natural " 51 F 57 25th July la. Angina Pectoris 6. Myocardial degeneration Old Change 21a M 80 18th Nov. Lobar Pneumonia Died in Archway Hospital. Pemberton Row 2 F 78 19th Oct. la. Myocarditis b. Senile decay Prince's Block, Stoney Lane. l F 83 12th Feb. la. Myocardial failure b. Bronchitis Died in Croydon. ,, 11 M 77 24th Oct. la. Gangrene of Leg. b. Arterio-sclerosis 2. Bronchitis Died in St. Peter's Hospital. ,, 25 F 13 6th Jan. la. Pericarditis, with effusion b. Rheumatic Fever Died in Jewish Hospital, Stepney. ,, 42 F 30 15th Jan. la. Broncho-pneumonia 6. Influenza Died in London Hospital. Purfleet Wharf, Blackfriars Cold Stores. - M 62 20th Oct. la. Angina Pectoris ft. Myocardial degeneration c. Chronic Bronchitis Resided at Lambeth. 2. Emphysema. Queen Victoria Street 49 M 67 4th Mar. la. Cardiac failure b. Carcinoma of Colon c Oedema of left Lung ,, 63 M 60 3rd Aug. la. Bilateral Pulmonary Tuberculosis 2. Recent Haemophysis Died in Bancroft Lodge. ,, 146 A M 45 28th April la. Pericarditis and Bilateral Empyema 6. Retropharyngeal Abscess c. Mediastinitis 2. Tracheotomy. P.M. River Thames — M 30 10th July Asphyxia by drowning. No evidence to show how he came in water. P.M. Inq. Resided in Sheffield. St. Anne's Mansions, Ludgate Hill. 17 M 77 23rd Feb. la. Congested Heart failure 6. Myocarditis St. Anne's Chambers, Ludgate Hill. 10 M 47 18th Sept. la. Peritonitis 6. Perforated Duodenal LHcer Died in St. Bartholomew's Hospital. St. Bartholomew's Hospital (Sta.ff) F 46 26th Feb. la. Acute Bronchitis and Asthma 83 STREET LISTS OF MORTALITY—conti nued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. St. Bartholomew's Hospital. — M 31 25th Nov. Heart failure following Empyema and Abscess of Lung, due to Aspiration of Blood after dental extraction. Misadventure. P.M. Inq. No fixed abode. St. Bride Street 7/ 9 M 71 10th June la. Acute Heart failure b. Chronic Fibroid Myocarditis c. Pulmonary Fibrosis and Bronchiec- tasis Resided in Islington. St. Mary Axe 24 M 48 18th Dec. la. Heart failure b. Toxaemia c. Carcinoma of Bronchus Died in Wandsworth. " 31 M 62 17th Feb. la. Empyema b. Right Lobar Pneumonia c. Pneumocoecus Died in St. Bartholomew's Hospital. St. Swithin's Lane, Salters' Hall. F 65 28th Dec. Syncope. Ruptured Aortic Aneurism Serjeants' Inn 17 F 78 10th Jan. la. Broncho-pneumonia b. Influenza Snow Hill 5 M 22 12th Dec. Syncope. Acute Bronchitis. Acute Leukaemia. Enlargement of Lymphoid tissue throughout the body. P.M. Died in ambulance. South Block, Stoney Lane 25 F 1 week 28th Dec. la. Congenital Syphilis Died in Queen's Hospital. Stoney Lane 43 F 79 2nd Oct. la. Chronic Myocardial degeneration 2. Senile Atheroma Temple Chambers, Temple Avenue. 259 M 70 13th Sept. la. Toxaemia b. Empyema c. Lobar Pneumonia Died at Billericay. Watling Street 64 M 63 7th Jan. Syncope. Rupture of a Dissecting Aneurism of the Aorta into the Pericardial Cavity West Smithfield 57 F 82 7th Nov. la. Carcinoma of Liver Widegate Street 12 F 38 23rd June la. Pulmonary Tuberculosis Died in Middlesex Hospital. ,, 19 M 74 28th Mar. la. Myocardial degeneration b. Chronic Bronchitis ,, 22 M 56 28th Feb. la. General Paralysis of the Insane Died in City of London Mental Hospital. ,, 24 F 75 1st April la. Broncho-pneumonia 2. Myocardial degeneration Old age Wren's View, St. Paul's Churchyard. 20 M 64 1st Feb. la. Myocardial degeneration 2. Chronic Bronchitis and Emphysema Died in Hampstead. 84 APPENDIX B.—LIST OF CASES OF INFECTIOUS DISEASE OTHER THAN TUBERCULOSIS, 1937. STREET LISTS.—COMPILED FROM NOTIFICATIONS RECEIVED. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. Artillery Lane 9 F 1½ Diphtheria 24th February. Billiter Square 10 M 8 Scarlet Fever 24th January. Bishopsgate 86 M 18 Diphtheria 11th June. Ditto 194 F 53 Erysipelas 24th September. Brackley Street 5 M 20 Measles 14th May. Cannon Street 89 M 23 Acute Primary Pneumonia. 18th May. Coleman Street 30 M 7 Diphtheria 11th December. Cross Lane 6 F 11 Ditto 9th April. Cullum Street 15 F 12 Ditto 13th July. Gracechurch Street 2 M 27 Scarlet Fever 30th July. India Street 6 F 5 Ditto 18th December. Leadenhall Street 122 F 12 Ditto 12th December. Long Lane 64 F 7 Diphtheria 21st December. Ludgate Circus 4 F 5 Scarlet Fever 17th March. Minories 60 M 34 Erysipelas 23rd November. Do. 96 F 27 Scarlet Fever 25th February. Mitre Court Buildings 1 F 75 Acute Primary Pneumonia. 2nd January. Moorgate 84 M 18 Food Poisoning 18th February. Ditto 84 M 23 Ditto Ditto. Ditto 84 M 24 Ditto Ditto. Ditto 84 M 21 Ditto Ditto. Ditto 84 M 38 Ditto Ditto. Ditto 84 M 48 Ditto Ditto. Ditto 84 M 42 Ditto Ditto. Ditto 84 M 25 Ditto Ditto. Ditto 84 M 61 Ditto 14th September. Nevill's Court 11 F 55 Acute Primary Pneumonia. 19th October. St. Bartholomew's Hospital F 21 Scarlet Fever 26th May. Ditto - F 22 Ditto 16th May. Ditto - F 24 Ditto 8th February. Ditto F 22 Ditto 5th February. St. Mary Axe 59 M 3 Measles 20th May. Snow Hill Police Station — M 30 Scarlet Fever 18th June. South Block 7 F 29 Puerperal Fever 25th January. Watergate House 2 F 10 Scarlet Fever 10th April. Well Street — M 56 Typhoid Fever 8th December. Widegate Street 12 M 12 Acute Primary Pneumonia. 16th April. 85 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. 43, Cloth Fair Messrs. J. Seeley & P. Paget, 41, Cloth Fair, E.C. (o) 2 2 *10, East Harding Street Goldsmiths' Company, Goldsmiths' Hall (o) 2 7 12. do Do. do. (o) 5 8 93, Fetter Lane Friern Manor Dairy Co., 3, Charles Street, Hatton Garden (o) 3 5 29, Fleet Lane Messrs. Watney, Combe & Reid, Stag Brewery, Pimlico (o) 5 13 30, do Do. do. do. (o) 2 7 31, do Do. do. do. (o) 3 5 11, Great New Street M. Quilty, 11, Great New Street (t) 4 7 13, do F. Wilson, 39, Holmedene Avenue, Heme Hill(o) 9 14 14, do Mrs. A. E. Jackson, 14, Great New Street (t) 6 8 16, do J. Day, 16, Great New Street (t) 3 5 21, do Goldsmiths' Company, Goldsmiths' Hall (o) 4 Empty 23, do Mrs. J. Barnsley, 27, Great New Street (o) 4 9 25, do Do. do. (o) 7 9 27, do Do. do. (t) 6 8 7a, Gunpowder Alley Brookes (Cannon) & Odgers, Norfolk House, Norfolk Street, Strand, W.C. 2 (o) 1 2 8, do Brookes (Cannon) & Odgers, Norfolk House, Norfolk Street, Strand, W.C. 2 (o) 2 7 4 & 5, Middle Street J. Hull & Sons, Bartholomew Close (o) 7 7 10, Nevill's Court Moravian Mission, 32, Fetter Lane (o) 2 3 11, do. Goldsmiths' Company, Goldsmiths' Hall (o) 2 ]4 12, do Do. do. (o) 1 3 *14, Wine Office Court Messrs. Reynolds & Eason, 192, Bishopsgate (o) 2 2 *16, do Do. do. (o) 2 2 * 2, Pemberton Row Mr. J. O'Shea, 2, Pemberton Row (t) 1 4 24 Total 85 151 Average number of lodgers to each occupied tenement: 1.8 Houses demolished or closed as dwelling-houses 0 T enement housesonRegister 24 Cleansing Notices served 21 * Retained on Register though temporarily not subject to the Bye-laws. MIDDLE DISTRICT. Nil. EAST DISTRICT. Situation of Premises. Name and Address of Owner or Tenant. Tenements. Lodgers. 5, Artillery Lane Clerk to Bishopsgate Institute, Bishopsgate (o) 4 7 7, do. Do. do. (o) 4 7 9, do. I. J. & J. Mendes, Ltd., 113-125, Grove Street, E. 1 (o) 2 12 21, do. Clerk to Bishopsgate Institute, Bishopsgate (o) 2 5 10, Brushfield Street Reynolds & Eason, 192, Bishopsgate (o) 5 5 12, do. N. J. Bliss & Son, 164, Bethnal Green Road, E.(o) 2 9 14, do. Clerk to Bishopsgate Institute, Bishopsgate (o) 6 7 3, The Circus, Minories H. Lewis, 3, Circus, Minories (t) 5 8 4, do. T. Davis, 4, do. (t) 5 12 5, do. T. Groves, 5, do. (t) 9 9 3, Three Crown Court, Jewry Street. Mr. Martin, 14, Seething Lane (o) 3 3 18, Widegate Street S. Sonenfeld, 26, White Lion Street (o) 2 9 21, do. A. & A. Field, 95, Whitechapel Road (o) 4 5 24, do. W. I. Crane, 25, Widegate Street (t) 4 5 25, do. Do. do. (t) 2 8 2, Goodman's Yard Charrington, Brewers, Mile End Road (o) 3 3 Total 62 114 Average number of persons to each occupied tenement: 1.8 Houses demolished or closed as dwelling-houses - Tenement houses on Register 16 Cleansing Notices served 17 (O) Owner. (T) Tenant. m 86 APPENDIX D.—LIST OF ADOPTIVE ACTS, LOCAL BYE-LAWS AND 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, brewers, 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. 39 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. Kitchens of Restaurants and aboveground Bakehouses ditto ditto ditto Jan., 1904. Common Lodging Houses City of London Sewers Act, 1851 and 1897 Oct., 1902. House Drainage Regulations adopted by the Corporation Sept., 1898. 87 APPENDIX E. Corporation of Lonbon. PUBLIC HEALTH DEPARTMENT. TUBERCULOSIS DISPENSARY, ST BARTHOLOMEWS HOSPITAL, E.C.I. When you were examined here to-day, there was no evidence that you were suffering from Tuberculosis Disease of the Lungs. You need not worry any further about yourself from this point of view UNLESS 1. You have more than one attack of 'flu in three months, or have 'flu when there is no epidemic, or from which you do not recover in three weeks. 2. You feel tired for no apparent reason for one month. 3. You lose weight persistently. 4. You develop a cough which does not clear in six weeks. 5. You bring up blood in the mouth. 6. Your doctor tells you that you have pleurisy. If you develop any of these symptoms it does not mean that you have Tuberculosis, but it does mean that you should seek advice from a doctor. If he cannot find any definite cause you should arrange through him to consult a Lung Specialist privately, or your local Tuberculosis Officer. Date 88 APPENDIX F. The County Hall, Westminster Bridge, S^E.I September, 1937. Dear Sir or Madam, SCABIES AND IMPETIGO. It has been noted with concern that there has been an increase in recent years in the number of cases of scabies and impetigo reported by head teachers of the Council's day schools, as well as in the number attending the Council's bathing centres. Consideration has consequently been given, in collaboration with the Borough Medical Officers of Health, to various measures which, it is hoped, will reduce the incidence of these diseases. There is reason to believe that in some instances the treatment prescribed at hospitals and by general practitioners is not carried out in a satisfactory manner, owing to lack of facilities in the homes and that, as a result, prolonged absence from school ensues. As you are probably aware, the Council provides treatment for scabies and impetigo occurring amongst children of school age, at a number of bathing centres in various parts of London. The children's clothing can also be disinfected at these centres. No charge is made. I enclose for your information a list of these bathing centres. It would facilitate the working of the bathing centres if you would be so good as to advise the parents of any cases referred thereto by you, to make appointments with the sisters-in-charge of the bathing centres. Your co-operation with the Council in the arrangements above referred to will be much appreciated. Yours faithfully, FREDERICK MENZIES, School Medical Officer. BATHING CENTRES. North, North-East and North-West London. 131, Seven Sisters Road, Islington, N.7 .... . (Islington Borough Council). Milton Road, Stoke Newington, N.16 .... (Stoke Newington Borough Council). St. Pancras Gardens, Pancras Road, N.W.I (St. Pancras Borough Council). Lithos Road, Hampstead, N.W.3 .... .... .... .... (Hampstead Borough Council). East and East-Central London. Finch Street School, Chicksand Street, Whitechapel, E.I.... Trafalgar Square School, Whitehorse Lane, Stepney, E.l.... 5a, Russia Lane, Bethnal Green, E.2 92, Lefevre Road, Bow, E.3 ... .... Glaucus Street, Poplar, E.3 .... .... (Poplar Borough Council). Millfields Road, Hackney, E.5 (Hackney Borough Council). Central Street, E.C.I .... .... Sun Court, Golden Lane, E.C.I .... .... .... .... (City Corporation). South-East and South-West London. The Neckinger, Spa Road, Bermondsey, S.E.I .... .... (Bermondsev Borough Council). King James Street, Lancaster Street, Southwark, S.E.I (Southwark Borough Council). Watson Street, Deptford, S.E.8 (Deptford Borough Council). Blackwall Lane, Greenwich, S.E.10 (Greenwich Borough Council). Wearside Road, Lewisham, S.E.13 (Lewisham Borough Council). Frensham Street, Peckham Park Road, Camberwell, S.E.15 (Camberwell Borough Council). White Hart Lane, Woolwich, S.E.18 (Woolwich Borough Council). Grosvenor Lock, Grosvenor Road, S.W.I (Westminster City Council). 32, Paradise Road, Clapham, S.W.4 .... .... 44, Sedlescombe Road, Fulham, S.W.6 .... 196, Sheepcote Lane, Battersea, S.W.I 1 .... (Battersea Borough Council). Gatton Road, Tooting, S.W.17 West London. Harrow Road, W.2 (opposite Royal Oak Station) Blechvnden Mews, Lancaster Road, Kensington, W.2 .... (Royal Borough of Kensington). Scotts Road, Hammersmith, W.6 .... .... (Hammersmith Borough Council).