AC 434 Lon 70 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1944 LONDON: Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C.I 1945. STAFF. Date of Appointment. MEDICAL OFFICER OF HEALTH. White, Charles Francis, O.B.E., 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. Deputy Principal Assistant Mar., 1911 Blunt, Harold F. (on Active Service) 2nd Class Assistant May, 1924 Stout, James Erl. Threadgold, Arthur W. Stevens, F. W. (on Active Service) 3rd Class Assistants July, 1930 Nov., 1923 Nov., 1937 Peters, E. J. (on Active Service) Wilson, J. C. (on Active Service) Clements, K. N. H. (on Active Service) Gurney, Miss M. L. (temporary) Unclassified Assistants Nov., 1935 Jan., 1936 Nov., 1936 May, 1939 SANITARY INSPECTORS. McGrath, William Richard Harrington, George Edwin Sillett, David Ernest Neale, William G. C. Thorpe, Robert C. Webber, G. A. (Rodent Officer) Hudson, Leslie A. Aldhous, H. J. Senior Inspectors Mar., 1922 Dec., 1925 April, 1926 July, 1928 Mar., 1930 July, 1932 (Resigned 30 /9 144) April, 1934 April, 1935 Holloway, A. B O.B.E. (on Active Service) Cox, C. R. (on Active Service) Scott, A. E. R. (on Active Service) Junior Inspectors May, 1937 Oct., 1938 Oct., 1938 MEAT INSPECTION STAFF. Grace, L. B. A., M.R.C.V.S. Veterinary Officer and Chief Meat Inspector June, 1934 Matson, William S. First Senior Inspector of Meat Dec., 1910 Slatter, Charles Murray, Samuel B. Mellish, Cyril E. Thompson, Frank E. Cann. S. W. (on Active Service) Senior Inspectors May, 1908 Sept., 1911 Jan., 1912 July, 1924 May, 1927 Peyton, H. R. (on Active Service) Lee, W. R. (on Active Service) Junior Inspectors Sept., 1932 July, 1930 Bernhardt, D. R. (on Active Service) Seymour, K. D. (on Active Service) Probationary Meat Inspectors May, 1931 July, 1935 WOMAN SANITARY INSPECTOR. Wilkinson, Miss Annie M July, 1909 (Retired Sept., 1944) RODENT OFFICERS. Carter, J. (temporary) Sept., 1944 Assistant Rodent Officers (Temporary). Cooper, J. S. (Foreman Assistant Rodent Officer) Aug., 1943 Tremayne, L. R. Nov., 1943 Hayes, H. Nov., 1943 Tanner, H. W. Nov., 1943 Pennycook, J. Nov., 1943 Lambeth, A. Nov., 1943 TUBERCULOSIS SISTER AND HEALTH VISITOR. Backhouse, Miss S. A. June, 1931 TUBERCULOSIS NURSE AND ASSISTANT HEALTH VISITOR. Gibbon, Miss E. N. (temporary) Mar., 1943 (Resigned Aug., 1944) KEEPER OF THE MORTUARY. Steggles, T. Dec., 1918 DISINFECTOR. McDonnell, R. J. April, 1903 MESSENGERS. Betts, Charles (Head Messenger) (on Active Service) April, 1926 Tierney, T. E. (temporary) Dec., 1926 LABOURERS. Hastings, T. (General Duties at Mortuary) June, 1920 Burton, John H. (General Duties at Mortuary) Mar., 1936 Lawrence, F. H. (on Active Service) (General Duties at Mortuary) May, 1936 Ludgate, G. (General Duties at Smithfield Market) Oct., 1906 Strong, S. R. (General Duties at Smithfield Market) Mar., 1914 Morris, W. F. (General Duties at Smithfield Market) Mar., 1925 Prevost, A. C. (on Active Service) (General Duties at Smithfield Market) Feb., 1926 Mann, Ernest V. (National Fire Service) (General Duties at Smithfield Market) Jan., 1928 Lawrence, Charles J. (General Duties at Smithfield Market) Feb., 1928 Graham, Mrs. (Bath Attendant and Cleaner) June, 1927 1 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1944. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. Public Health Department, Guildhall, E.C. 2. My Lord Mayor and Gentlemen, July, 1945. I have the honour to submit a report on the work of my Department for the year 1944. On the instructions of the Minister of Health, this report is again presented in an abridged form and briefly summarises the activities of the Department, the normal work of which has been restricted by war circumstances. Particular attention has been given to the rat problem and also to the supervision of food supplies. STATISTICAL INFORMATION. Area.—661 acres (including the Temple and Tidal Water and foreshore). Population.—Registrar-General's estimate for 1944. 4,170. Annual Rateable Value.—As at October, 1944, £6,218,800. Annual Sum received from Penny General Rate.—Estimated £23,800. Births:— Total. M. F. Legitimate 27 10 17 Live Births, Illegitimate *8 5 31 Still Births 1 1 0 Birth Rate per 1,000 estimated resident population, 1944 8.37 Rate per 1,000 total (live and still) births 27.27 *See the paragraph on Maternity and Child Welfare below. Deaths:— Deaths under 1 year 2 1 1 Death Rate per 1,000 estimated average population 16.79 Deaths (all ages) 70 46 24 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Rate per 1,000 total Deaths. (live and still) births. No. 29. Puerperal sepsis Nil. 0 No. 30. Other puerperal causes Nil. 0 Total Nil. 0 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 57 Legitimate Infants per 1,000 legitimate live births 0 Illegitimate Infants per 1,000 illegitimate live births 250 Deaths from Cancer (all ages) 12 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 0 Vaccination.—Of the 271 births notified to the Vaccination Officer during 1943, 111 had been successfully vaccinated by the end of 1944. 13 had died before the age for vaccination and 0 was insusceptible. Vaccination was postponed in no case, and 110 had removed into other districts. No case was pending. There were 37 cases of conscientious objection. The Public Vaccinator performed 8 revaccinations during the year, and in addition to the successful vaccinations referred to above, 24 adult persons were vaccinated for the first time. MATERNITY AND CHILD WELFARE. No. of City Births notified (including stillbirths) 36 Visits by Health Visitors:— Under one year 160 Over one year and under 5 years 308 Ante Natal 163 Ophthalmia 0 Still Births *0 Home Helps 0 Infant Life Protection 1 Scabies 0 476 lbs. of Dried Milk were supplied to children under one year; also 62 lbs. Farex and 247 bottles Radiostoleum to mothers and children. Liquid Milk, Cod Liver Oil and Fruit Juices were distributed through the Child Welfare Centre to mothers and children on behalf of the Food Office. *No visit was made in connection with the one still birth, as the body was found in a train at a station and not identified. The figure of 8 illegitimate live births referred to in the paragraph on Statistical Information above relates to 7 babies found abandoned and to only 1 born to a mother known to be resident in the City. This child remained in the care of its mother and receives regular visits from the Health Visitor. The parents of this child have since married. There were no premature births to City mothers during the year. No evidence of infestation by head lice was observed in any City child. 2 INFANT WELFARE CENTRE. No. of Sessions (including sessions for Diphtheria Immunisation and Schick Testing) 97 Attendances:— Under one year 369 864 Over one year and under five years 460 Mothers 35 Dentures provided 0 Home Helps provided 0 No. of children, under five years, immunised against Diphtheria 181 19 No. of children, over five years and under 15, immunised against Diphtheria 1 No. of injections 38 No. of Post Schick Tests and Readings 7 INFECTIOUS DISEASE. Notifications received:— Total cases Cases admitted These consisted of the following:— notified. to Hospital. Chickenpox 1 0 Dysentery 7 7 Scabies 12 0 Measles 5 2 Whooping Cough 5 1 Tuberculosis 14 10 Lobar Pneumonia 1 1 Diphtheria 1 1 Malaria 1 1 PROVISION OF HEALTH SERVICES. Tuberculosis Dispensary:— No. of Sessions held 204 No. of Patients attending:— Residents 2561 1165 Non-Residents 909 No. of New Patients 253 No. of Resident Patients admitted to Sanatoria, Hospices, etc 10 No. of Artificial Pneumothorax Refills given 296 No. of Visits made to Homes 155 No. of Contacts kept under observation 16 Milk was supplied to two patients during the year. During 1943, the Minister of Health made available to local authorities funds for the payment of allowances to persons who have to give up remunerative work in order to undergo treatment, either at home or in sanatorium. So far as the County of London is concerned the London County Council are the Assessing Authority for the payment of allowances, but the Minister has laid down a scale of payments which is as follows:— A tuberculous married man with a dependent wife or a tuberculous wife whose husband is dependent on her income, receives jointly 39s. per week while the patient is undergoing treatment at home, this sum being decreased by ten shillings should the patient be in sanatorium. A single person is entitled to 25s. per week, while away from work but not in sanatorium, such payments ceasing if the patient enters sanatorium. Additional sums are payable in respect of dependent children, or infirm persons, and allowances are made towards rent. These payments are only payable where treatment is hoped to be "curative," and are not payable to "incurables," and in the former case must only be paid for six months after discharge from sanatorium except with the approval of the Minister. The object of these allowances is to enable patients to undergo curative treatment. During the year allowances were paid to seven patients, in accordance with the above-mentioned scale. VENEREAL DISEASE CENTRE. Sessions held daily except Sunday. During the year a total of 841 persons attended the V.D. Treatment Centre at St. Bartholomew's Hospital. Cases of Syphilis numbered 374 (219 males and 155 females). Cases of Gonorrhoea numbered 164 (149 males and 15 females). 303 cases (221 males and 82 females) attending were found not to be suffering from any venereal disease. Of the cases of Syphilis attending for the first time only 13, including two Service cases, were in the primary stage. 16 were in the secondary stage and 39 in later stages. Four were cases of congenital syphilis. 141 cases of syphilis were still under treatment or observation from the previous year. 31 who had been removed from the register, returned suffering from a relapse. 30 cases attended Bart's for the first time but had commenced their treatment elsewhere. Of the cases of Gonorrhoea, 77 attended in the first year of infection and 19 in later stages. 51 were continuing treatment or observation from the previous year; 13 were cases which had relapsed and 4 attended Bart's for the first time having commenced their treatment elsewhere. 3 59 cases of Syphilis ceased to attend before completion of treatment, and 8 after completion of treatment but before final tests of cure. 43 cases of Gonorrhoea ceased to attend before completion of treatment, and 12 after completion of treatment but before final tests of cure. The total number of attendances of all cases was 14,864, of which 12,119 were for the individual attention of the Medical Officer and 2,745 were for intermediate treatment. 7 cases of Syphilis and 3 of Gonorrhoea received in-patient treatment involving a total of 186 in-patient days of treatment. The Laboratory work included 10 microscopical and 1,167 serum examinations for Syphilis and 221 cultural and 127 serum tests for Gonorrhoea. Of the cases attending the Treatment Centre for the first time during the year, 443 were from the County of London, 3 from Surrey, 12 from Kent, 8 from Middlesex, 3 from Essex, 1 from Sussex and 1 from Hertfordshire. The London cases were responsible for 14,648 of the total attendances. The number of Service cases attending was very few ; 2 Syphilis, 1 Gonorrhoea and 20 nonvenereal. This is to be expected from the situation of the Clinic, and for the same reason the figures do not reflect the increase in venereal disease which in the Country generally has resulted from war conditions. No case was reported under Regulation 33b. BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year:— Disease Result. Specimen. Suspected. Positive. Negative. Sputum Tuberculosis 0 3 Throat Swabbing Diphtheria 0 3 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. MEAT INSPECTION. Amount of meat delivered at Smithfield Market, 36,533 tons. Amount of diseased or unsound meat surrendered to Meat Inspectors at Smithfield Market, 25 tons 10 cwts. 0 qr. 12 lbs. Amount of meat surrendered to Meat Inspectors at Leadenhall Market and City shops, 13 tons 16 cwts. 3 qrs. 26 lbs. Amount of meat surrendered to Meat Inspectors at Cold Stores, 2 cwts. 0 qr. 11 lbs. No. of Prosecutions instituted, Nil. No. of Examinations (Diploma in Public Health), 2. No. of unsound eggs surrendered at Smithfield Market and collected by Lett's Wharf, 11,838. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. The improvement in carriage of meat noted in past reports has been maintained, although, of course, the quantities carried are very much less than in pre-war years. Five infringements were noted in connection with the transport of meat in private cars, but the fault was remedied on each occasion on instructions given. PREMISES WHERE FOOD IS PREPARED AND OFFERED FOR SALE. All these premises are subject to regular inspection. Without exception all criticisms have received immediate attention. ITINERANT FOOD VENDORS. Constant inspections of barrows and of itinerant food vendors have been maintained and no difficulty has been experienced in connection with this class of trade. FOOD INSPECTION. The food delivered at riverside wharves, approximately 100,000 tons, and at other premises in the City has consisted of the customary varieties, and has been the subject of constant inspection. 864 tons 14 cwts. 2 qrs. 10 lbs. were condemned as unfit for human consunption. 603 tons 7 cwts. 3 qrs. 21 lbs. of this food were utilised for stock-feeding, fertilizing or manufacturing purposes. The remainder, consisting of 261 tons 6 cwts. 2 qrs. 17 lbs. was destroyed either by the Cleansing Department of the City Corporation, being useless for stock-feeding purposes, or else on the sites on which it was condemned, the individual quantities being so small as not to warrant the use of petrol in transport. FOOD AND DRUGS ACTS. 512 samples have been submitted to the Public Analyst for examination, 24 of these were formal samples and 488 were informal samples. 11 samples were reported against. The percentage of adulterated samples was 2.15. Legal proceedings were necessary in 3 cases. 1 application was received for registration as a dairyman and purveyor of milk which was granted. 5 supplementary licences were issued under the Milk (Special Designations) Orders, 1936-1941. SANITARY CIRCUMSTANCES. The general sanitary supervision has been maintained and in this connection 2,018 inspections have been made. As a consequence of these inspections, it was necessary to serve 1 Statutory Order and 35 Intimation Notices. No legal proceedings were necessary. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. 4 HOUSING. The total number of dwelling houses inspected for housing defects was 73. 30 were found not to be in all respects reasonably fit for human habitation; 23 of these were rendered fit, in 12 cases as a result of informal action by the inspectors, and in 11 cases subsequent to the service of notices requesting the defects to be remedied. No case of overcrowding in the City was reported. FACTORY ACT, 1937. Factory premises have been under such supervision as has been possible having regard to their needs. There are 4 above-ground bakehouses and 3 underground bakehouses. The provisions of the Act relating to outworkers have been carried out as heretofore. No case of infectious disease was reported in connection with outworkers' premises in the City. SHOPS ACT, 1934. 31 shops and warehouses have been inspected and where necessary re-inspected. Any defects have been remedied without recourse to legal proceedings. PHARMACY AND POISONS ACT, 1933. 69 firms were registered under this Act, 67 of which were re-registrations. The few infringements which were noted were all remedied without difficulty on the request of the Medical Officer of Health. PHARMACY AND MEDICINES ACT, 1941. The provisions of the above Act were carried out without recourse to legal proceedings and without special difficulty. FERTILIZERS AND FEEDING STUFFS ACT, 1926. The provisions of the above Act were carried out without recourse to legal proceedings and without especial difficulty. MERCHANDISE MARKS ACT, 1926. AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1928-1931. No difficulty was experienced during the year in regard to the administration of the above Acts. CREMATIONS. 752 cremations were carried out at the City of London Crematorium at Ilford. CITY MORTUARY. Bodies received *69 Post Mortem Examinations made 36 Inquest on bodies 31 Inquest on fires 2 *17 of these deaths resulted from enemy action. DISINFECTION AND CLEANSING OF VERMINOUS PERSONS. Export of Clothing:— No. of articles disinfected 3,000 Fees received £5 General Disinfection. Infectious Diseases, etc.:— Articles of clothing and bedding disinfected 9,406 Articles of bedding and clothing destroyed 270 Disinfection of Hair:— Horsehair (cases) 1 Ox Ear Pieces (cases) 1 Goat Hair (cases) 1 Fees received £3 Cleansing of Persons:— No. of scabeous persons bathed 17 No. of verminous persons bathed 348 No. of scabeous and verminous articles disinfected 3,889 Cleansing of Schoolchildren:— No. of children cleansed 2,042 No. of articles disinfected 1,016 Destruction of Pigeons:— Pigeons destroyed by Staff 0 Pigeons destroyed by one private individual duly authorised by the Corporation 819 RAT REPRESSION. Your Rodent Officer, Mr. J. Carter, reports as follows on the progress of rat repression within the boundaries of the City. "Although my appointment as Rodent Officer is of recent months, the cordial relationship which existed over several years between my predecessor, Mr. G. A. Webber, and myself, during my service in the Rodent Control Branch of the Ministry of Food, enables me to present a comprehensive survey of the work and results obtained thereby during the past year. The work has been effected under the Rats and Mice (Destruction) Act, 1919, and the Infestation Order, S.R.O. 680, 1943. Under the Order, the Minister of Food, in exercise of his powers, issued on the 18th May, 1944, a Direction to the Corporation, requiring that ' the Common Council shall forthwith proceed to take such action as may be necessary to remedy infestation of land within the City boundaries.' A similar Direction was served at that date on all Local Authorities throughout the country. 5 The staff carrying out this work during the period under review, comprised, in addition to the Rodent Officer, 6 Assistant Rodent Officers, of whom one is foreman. Their main duty is operational. In order to carry out this work in an area such as the City, the policy has been to seek the co-operation of occupiers rather than the forceful method of issuing Statutory Notices under the Act; these being used only in recalcitrant instances, and the response of occupiers generally has justified this method. Infestations fall under two headings: complaints, which are in effect requests for advice or assistance, and those found as the result of surveys. If not engaged on operational work, your Officers are employed on surveying defined areas for the purpose of instituting 'Block Control.' A group of buildings surrounded on all sides by roads, forms a convenient block. When the extent and number of infestations, if any, is determined, an informal letter requesting the co-operation of the various occupiers is sent to each one. This letter outlines the advantages to be gained by collective action and organised control measures carried out by skilled operators simultaneously. It in no way minimizes any efforts taken by the occupier to reduce the infestation in the past. With regard to individual complaints, it is often the case that several requests for assistance are received in a week, and these are usually situated in different parts of the City. These requests cannot be neglected until such time as it is possible for your Officers to reach the site by the block method, and accordingly a survey is made around the premises which are the subject of the compliant, and a similar procedure as in the case of block survey adopted. In every instance the occupier is advised of the two courses open to him to reduce the infestation to a minimum. These are as follows:— (1) Carrying out of specified control measures, the work to be supervised by the Rodent Officer and effected by the occupier or his servant. (2) Employment of a commercial undertaking to carry out the work. If the occupier is unable or unwilling to adopt either of these methods, the Corporation may undertake the work and recover the costs. Until November 26th, 1944, this was at the rate of 2s. 6d. per hour for actual time on the premises, plus the cost of materials used. Since the date mentioned, the hourly rate has been increased by 20 per cent. to 3s. In every instance of infestation, advice on structural and incidental proofing is given, but the difficulty of obtaining labour and materials renders much of this advice abortive. The problem of conducting a survey of an area such as the City is full of complications, and the time spent in one building interviewing occupiers, of which there may be several, can be considerable, and, of course, is additional to the inspection. Also in trades such as catering establishments and licensed premises, it is not convenient from the traders aspect, to make inspections and do operational work during the peak hours. For record purposes, the degree of infestation is classified in three categories : (a) Severe ; (b) Moderate; and (c) Slight. Of the two latter headings, these can also be spasmodic or persistent, according to their proximity to a severe infestation, food supplies available, and control measures taken by the occupier. From information recorded during the past year, the type of infestation is in the ratio 4 Black (Ship) rat to 1 of Common rat. Poisoning has been the principle means of extermination, and trapping a secondary measure. The poisons used and advised by the Ministry of Food are Zinc Phosphide, Barium Carbonate, Arsenious Oxide and Red Squill. Bait bases are Sausage Rusk, bread mash, soaked wheat, and national flour, plus 10 per cent. Castor Sugar. Arsenious Oxide has only been used in non-food premises, or in instances where prejudice to the other poisons is suspected. Wheat is used only where food available renders other baits unattractive. In almost every case of poison treatment, the pre-baiting technique has preceeded poisoning, and this method has produced extremely satisfactory results. Premises known to be infested over a number of years have been freed, or the infestation reduced to a minimum and maintained at that level by periodical treatments. The underlying principle of modern Rodent Control is to kill all rodents in an infestation as quickly as possible, thus eliminating the natural increase in breeding. To do this, it is necessary to ensure that the rats eat a lethal dose of poison before the warning symptoms appear. If a sublethal dose is eaten, the animal is only ill and will recover, with the result that prejudice is obtained and further attempts by using the same poison would be a waste of labour. The pre-baiting method comprises setting unpoisoned bait for a period of four days at selected sites. The number of baits depends on the extent of the premises and distribution of the rat population. The baits are examined daily, and those taken or part taken are replaced. Any not taken after two days are removed. On the fifth day, an increased quantity of bait evenly mixed with a selected poison at a prescribed concentration is put down at all points where the unpoisoned bait was taken. This is left down for two days and examined each day. After this period the residue of the poison bait is picked up and destroyed. The second phase, termed post-baiting, is to test the efficacy of the treatment, and therefore unpoisoned bait, of a different nature from that first used, is placed at all points where poison bait was taken. This in turn is left down for two days, and if not taken, the initial treatment can he considered successful. Should, however, any of the post-bait be taken, a similar procedure as in the first instance is followed and a different poison used. Again a post-bait is carried out, and if necessary a third treatment. In most cases two treatments are sufficient to eliminate an infestation, and the second and third treatments are always greatly reduced as regards numbers of baits used and the time taken. It will be seen that a campaign may comprise one or more treatments, but by this method the infestation is cleared up quickly, and the risk of leaving a residual population to build up again in a short time is eliminated. 6 Each infestation has its own peculiarities, and the nature and number of treatments depends on the features present. The technique described above, while fundamentally the same for both species of rat, differs in respect of numbers of baits used, weight and sites of baiting points for Ship rat infestations. Four ounce pre-baits and 6 ounce poison baits are generally used in the case of Common rat and floor-baiting is usually sufficient, but for Ship rat 1 ounce pre-baits and 2 ounce poison baits in greater numbers must be placed on runways, beams, stanchions and offsets, in order to get between the living quarters and the food supply. On the survey side of the work, 2,636 premises have been inspected. Of this number, 320 have received treatment by your Officers. This entailed 4,388 revisits for operational purposes, and a further 1,112 visits by the Rodent Officer or his foreman during the course of the work or afterwards, making a total of 5,500 revisits. Poison control has resulted in an estimated kill of 11,388 rats, and of this number nearly 14 per cent. or 1,558 bodies have been recovered. The latter number does not include those found subsequently by occupiers when harbourage has been removed or goods providing nesting facilities delivered. Trapping as a secondary control was the means of destroying 423 rats, and this figure added to that of bodies found after poisoning, gives a total of 1,981 bodies taken from premises by this department. While this report is, in the main, a review of overground work, the treatment against the Common rat in the City sewers must be included in assessing the net result. A campaign which started on the 13th December, 1943. was finally concluded on the 22nd January, 1944. This work resulted in an estimated kill of 4.977 rats. The method of estimating the number of rats killed in an infestation is based on the amount of poison bait consumed, and is arrived at in accordance with a formula evolved by the Scientific Officers of the Infestation Branch, Ministry of Food. The calculation is, however, based on Common rat extermination, and as 75 per cent. of overground infestations dealt with were of Ship rat character, the estimated kill of 11,388 rats is conservative and could reasonably be increased by 20 per cent., as this rat being much smaller and finer built than the Common rat, naturally consumes less food, and consequently a smaller quantity of poison bait constitutes a lethal dose. While the estimated kill and the bodies found are a source of satisfaction to your Officers, the real value of the service lies in the number of premises freed or greatly relieved for at least a long period. To enlarge on this aspect, of 320 premises treated 270 were considered clear after one treatment. and no further action taken or complairts received from the tenants. 31 premises were the subject of two courses of treatment: the second, after a long period of freedom. The remainder received three or more courses during the year, and here the premises and nature of the businesses are conducive to re-infestation. Further, the term premises is elastic and may refer to a building of many floors and sections, or on the other hand a small shop and basement. Much of our work has been in dealing with infestations which in the past have been the subject of unorganised and haphazard control measures. In many cases, the occupier, before seeking expert advice, has expended a considerable sum and much labour on various methods, without any regard as to how the infestation will react to the control. Often several proprietary poisons are put down or a couple of traps set where dozens are necessary, and although a number of immature rats may be destroyed, the mature and productive adults often remain, and generally the net result is a poison prejudiced or trap shy population. During the year many such cases have been brought to a satisfactory conclusion by your Officers, and tenants, who after failure had become resigned to the nuisance, were given welcome relief or freedom from the pest. Your Officers are frequently asked two questions : (l)will the dead rats cause an offensive smell, and (2) is it possible to use a poison which will prevent the nuisance. As to the first question, occupiers are warned that ' corpse ' smell may develop as the result of numbers of rats dying, and should this occur it must be accepted as part of rodent control. In instances where this nuisance has resulted, assistance has been given in the appropriate action to clear it as quickly as possible. Though unpleasant while it lasts, in the majority of instances occupiers have been more than satisfied by the knowledge that there has been an entire clearance of live rats, in most cases achieved at one blow. Regarding the second question, it is doubtful if any poison suitable for rat extermination will have such action as to cause the animals to die without the possibility of smell arising. Smell is dependant on the action of the poison and where the creature dies. If atmospheric conditions are favourable and there is plenty of ventilation and air currents, the smell is often carried away and not detected by the occupier. Of the poisons used, Arsenious Oxide is least likely to cause smell by reason of its preservative properties, but even so, if the animals die near hot-water pipes, the heat accelerates the development of micro-organisms, setting up rapid decomposition. A complete recording of any treatment is available should the result, number of hours or charge at any time be challenged. A set of large-scale maps are notated with coloured inks, showing areas surveyed marked in red and sites of infestations in green. The maps are open to inspection by the Divisional Rodent Inspector, Ministry of Food, who visits periodically to ascertain progress. It is submitted that the ' Direction ' and procedure advised, although standard for all areas, is being adhered to as far as practicable, taking into consideration the problems peculiar to the City, the character of the infestations and the type of premises." I have the honour to be, Gentlemen, Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health, City of London.