434 LON 71 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1945 LONDON: Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C. I. 1946. STAFF. MEDICAL OFFICER OF HEALTH. Date of Appointment. 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 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., 1937 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 Hudson, Leslie A Aldhous, H. J. (on Active Service) Holloway, A. B., O.B.E., (on Active Service) Senior Inspectors Mar., 1922 Dec., 1925 April, 1926 July, 1928 Mar., 1930 April, 1934 April, 1935 May, 1937 Cox, C. R. (on Active Service) Scott, A. E. R. (on Active Service) Junior Inspectors 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) Peyton, H. R. (on Active Service) Senior Inspectors May, 1908 Sept., 1911 Jan., 1912 July, 1924 May, 1927 (Resigned 30/11 /45) Sept., 1932 Lee. W. R. (on Active Serviced Junior Inspector July. 1930 Bernhardt, D. R. (on Active Service) May, 1931 Seymour, K. D. (on Active Service) Probationary Meat Inspectors July, 1935 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 (Died Mar., 1945) TUBERCULOSIS SISTER AND HEALTH VISITOR. Backhouse, Miss S. A June, 1931 TUBERCULOSIS NURSES AND ASSISTANT HEALTH VISITORS. Matthews, Mrs. J. V. (temporary) Mar., 1945 Chandler, Miss B. N. (temporary) Dec., 1945 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 1945. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. Public Health Department, Guildhall, E.C. 2. July, 1946. My Lord Mayor and Gentlemen, I have the honour to submit a report on the work of my Department for the year 1945. 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. When the year began the City was still under threat from hostile attack and in fact a long-range rocket (V2) fell in the City in March. It exploded in the retail Market at the junction of Charterhouse Street and Farringdon Street, at a busy hour of the morning, causing a large number of casualties, over a hundred of which were fatal. The end of active hostilities in Europe came in May and your staff were relieved of most of the Civil Defence duties which had been such an important part of their work for more than seven years. There remained only the demobilisation of the Civil Defence Casualty services and the collection, checking and storage, pending disposal, of Civil Defence equipment. But the destruction and disorganisation resulting from 6½ years of war has been such that the department can only gradually return to normal working and to pre-war standards. Labour and materials and food have remained in short supply and in many ways requirements have had to be adjusted to what is practicable rather than to what is desirable. Your staff have had many new problems and difficulties, but they have used common sense and tact and have endeavoured to be helpful, while at the same time taking care to safeguard everything essential for the protection of the public health and the prevention of nuisance. They look forward to the day when conditions are such that they may return to the principle that only the highest standards should be acceptable in the City of London. STATISTICAL INFORMATION. Area.—661 acres (including the Temple and Tidal Water and foreshore). Population.—Registrar-General's estimate for 1945, 4,270. Annual Rateable Value.—As at October, 1945, £6,840,516. Annual Sum received from Penny General Rate.—Estimated £24,329. Births:— Total. M. F. Legitimate 32 11 21 Birth Rate per 1,000 estimated resident population, 1945 8.90 Live Births, Illegitimate 6 5 1 Still Births 2 1 1 Rate per 1,000 total (live and stillbirths 50.00 See the paragraph on Maternity and Child Welfare on page 2. Deaths :— Deaths under 1 year Nil Nil Nil Death Rate per 1,000 estimated average population 13 82 Deaths (all ages) 59 34 25 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 0 Legitimate Infants per 1,000 legitimate live births 0 Illegitimate Infants per 1,000 illegitimate live births 0 Deaths from Cancer (all ages) 9 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 413 births notified to the Vaccination Officer during 1944, 143 had been successfully vaccinated by the end of 1945. 9 had died before the age for vaccination and 0 was insusceptible. Vaccination was postponed in no case, and 207 had removed into other districts. One case was pending. There were 53 cases of conscientious objection. The Public Vaccinator performed 4 revaccinations during 1945, and in addition to the successful vaccinations referred to above, 1 adult person was vaccinated for the first time. 2 MATERNITY AND CHILD WELFARE. No. of City Births notified (including still births) 29 Visits by Health Visitors:— Under one year 269 Over one year and under 5 years 377 Ante Natal 156 Ophthalmia 0 Still Births 1 Home Helps 0 Infant Life Protection ... 0 Scabies 2 599 lbs. of Dried Milk were supplied to children under one year ; also 115 lbs. Farex and 306 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. One visit was made in connection with the one still birth notified. The figure of 6 illegitimate live births referred to in the paragraph on Statistical Information on page 1 relates to 5 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. There were no premature births to City mothers during the year. No evidence of infestation by head lice was observed in any City child. INFANT WELFARE CENTRE. No. of Sessions (including sessions for Diphtheria Immunisation and Schick Testing) 102 Attendances:— Under one year 547 Over one year and under five years 714 Mothers 57 Dentures provided 0 Home Helps provided 0 No. of children, under five years, immunised against Diphtheria 29 No. of children, over five years and under 15, immunised against Diphtheria 0 No. of injections 32 No. of Post Schick Tests and Readings 20 INFECTIOUS DISEASE. Notifications received Total cases notified. Cases admitted to Hospital. These consisted of the following:— Cerebro-Spinal Meningitis 1 0 Dysentery 8 8 Scabies 11 0 Measles 21 2 Scarlet Fever 3 3 ' Tuberculosis 13 6 Erysipelas 2 1 Diphtheria 2 2 PROVISION OF HEALTH SERVICES -TUBERCULOSIS. Tuberculosis Dispensary:— No. of Sessions held 208 No. of Patients attending :— Residents 260 1159 Non-Residents 899 No. of New Patients 283 No. of Resident Patients admitted to Sanatoria, Hospices, etc. 6 No. of Artificial Pneumothorax Refills given 291 No. of Visits made to Homes 132 No. of Contacts kept under observation 16 Milk was supplied to two patients during the year. The Minister of Health, during 1943, made available to local authorites 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 three patients, in accordance with the above-mentioned scale. 3 PULMONARY TUBERCULOSIS. Mass Radiography. During the year it was arranged that the Mass Miniature Radiography Unit operated by the London County Council should visit the City. Your Medical Officer was responsible for finding suitable premises in which the Unit could be set up and for bringing to the notice of the business firms in the City the facilities for examinations which were offered. The Governors and Staff of St. Bartholomew's Hospital were most helpful and despite the fact that the rooms first selected were shortly afterwards damaged by a flying bomb, other and even more convenient accommodation was found. There was no guide as to the response to propaganda. Naturally, therefore, the firms with large and highly organised staffs were first approached. A statement in simple language of the objects of mass radiography and the procedure and the advantage of such examination to the individual together with an assurance that the results would be regarded as strictly confidential, was circulated to such firms. Since only one Mass Radiography Unit was available for the whole county, it had to be moved from centre to centre, so that the whole area could be covered, and the intention was that the Unit should deal in each centre with about 5,000 examinees and then move on. The response to propaganda in the City exceeded all expectations, and floods of applications poured in, a tribute to the interest of employers in the health of their staffs, to the work of the liaison officers whom they appointed, and to the enlightened outlook of their employees. The London County Council kindly undertook to extend the number to be dealt with from 5,000 to 10,000 and then to 15,000, but there a halt had to be called to the disappointment of many of the later applicants. Moreover, it was not possible to extend the facilities to the smaller firms as had been intended. The majority of the examinees were, therefore, men and women who worked under the best conditions in large modern office buildings, and who probably also enjoyed good home conditions. When the Unit visits the City again effort will be made to give priority to those who work in smaller, older offices and whose home conditions are perhaps less satisfactory. Administratively this will obviously be more difficult, but the experience gained in dealing with the larger firms will be valuable and their example may be stimulating. The arrangements worked smoothly and the Medical Officer and Operating Staff of the Mass Radiography Unit were well pleased with the accommodation and with the working conditions, for which credit and thanks are due to St. Bartholomew's Hospital. The London County Council have kindly informed your Medical Officer of the results of the examinations, which are as follows:— The total number of persons who attended for examination was 14,446, of whom 7,158 were men and 7,288 were women. Four hundred and sixty-seven (3.2 per cent.) were asked to attend for a full-sized X-ray film to be taken, six failed to attend. In 120 cases the large X-ray revealed no abnormality. In 150 cases (1 per cent. of the total examined) of whom 114 (1.3 per cent.) were men, and 36 (0.5 per cent.) were women, the large X-ray revealed old healed tubercular lesions, in regard to which no further action was indicated. One hundred and sixty-six cases (11 per cent. of the total) comprising 93 men (1.3 per cent.) and 73 women (1 per cent.) were found to have lesions in the lungs which were probably tuberculous and were referred for treatment. In twenty-five cases (15 men and 10 women) disease of the heart or blood vessels was detected. In January, 1945, your Medical Officer obtained from the Medical Research Council statistics of the results up to that time of Miniature Radiography examinations of civilians in the country generally. Those figures were not given in exactly the same form as those supplied by the London County Council. The Medical Research Council stated that 0 3 to 0 5 per cent. of persons examined for the first time were found to have tuberculosis of the lungs of such degree as to require treatment, and 0.8 to 1 per cent. were found to have small foci of tubercle requiring general advice and observation only. It seems that these two classes would together be represented by the category of " probably tuberculous " in the L.C.C. returns. On this assumption, the comparison is as follows:— Country generally 11 per cent. to 1.5 per cent. City 1.1 per cent. The figures for the City are, therefore, amongst the best so far, but it should be repeated that the examinees were on this occasion taken from the largest business houses, and that both their home and working conditions were probably better than those of many workers in the City. VENEREAL DISEASE CENTRE. Sessions held daily except Sunday. During the year a total of 1,007 persons attended the V.D. Treatment Centre at St. Bartholomew's Hospital. Cases of Syphilis numbered 370 (213 males and 157 females). Cases of Gonorrhoea numbered 222 (212 males and 10 females). Cases of Soft Chancre numbered 1 (male). 414 cases (289 males and 125 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 2 Service cases, were in the primary stage. 16 were in the secondary stage and 47 in later stages. 6 were cases of congenital syphilis. 210 cases of syphilis were still under treatment or observation from the previous year. 47 who had been removed from the register, returned suffering from a relapse. 31 cases attended Bart's for the first time but had commenced their treatment elsewhere. 4 Of the cases of Gonorrhoea, 120 attended in the first year of infection and 26 in later stages. 32 were continuing treatment or observation from the previous year ; 15 were cases which had relapsed and 29 attended Bart's for the first time having commenced their treatment elsewhere. 43 cases of Syphilis ceased to attend before completion of treatment, and 8 after completion of treatment but before final tests of cure. 46 cases of Gonorrhoea ceased to attend before completion of treatment, and 10 after completion of treatment but before final tests of cure. The one case of Soft Chancre, dealt with for the first time during the year, ceased to attend before completion of treatment. The total number of attendances of all cases was 16,248, of which 12,320 were for the individual attention of the Medical Officer and 3,928 were for intermediate treatment. 15 cases of Syphilis, 6 of Gonorrhoea, and 1 of Soft Chancre received in-patient treatment involving a total of 376 in-patient days of treatment. The Laboratory work included 20 microscopical examinations for Syphilis, 444 microscopical examinations for Gonorrhoea, and 6 examinations of Cerebro-Spinal Fluid. Of the cases attending the Treatment Centre for the first time during the year, 611 were from the County of London, 7 from Surrey, 13 from Kent, 3 from Middlesex, 8 from Essex, and 1 from Bucks. The London cases were responsible for 16,090 of the total attendances. The number of Service cases attending was 8 Syphilis, 34 Gonorrhoea and 89 non-venereal. No case was reported under Regulation 33b. BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year:— Specimen. Disease Suspected. Result. Positive. Negative. Sputum Tuberculosis 0 1 Throat Swabbing Diphtheria 0 1 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. MEAT INSPECTION. Amount of meat delivered at Smithfield Market, 35,715 tons. Amount of diseased or unsound meat surrendered to Meat Inspectors at Smithfield Market, 27 tons 19 cwts. 3 qrs. 22 lbs. Amount of meat surrendered to Meat Inspectors at Leadenhall Market and City shops, 9 tons 15 cwts. 2 qrs. 20 lbs. Amount of meat surrendered to Meat Inspectors at Cold Stores, 4 cwts. 3 qrs. 2 lbs. No. of Prosecutions instituted, Nil. No. of Examinations (Diploma in Public Health), 15. No. of unsound eggs surrendered at Smithfield Market and collected by Lett's Wharf, 2,190. 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. Six 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 and premises in the City has consisted of the customary varieties, and has been the subject of constant inspection. 86 tons 1 cwt. 0 qr. 16 lbs. were condemned as unfit for human consumption. 79 tons 2 cwts. 1 qr. 13 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 6 tons 18 cwts. 3 qrs. 3 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 ACT, 1938, AND FOOD REGULATIONS. 377 samples have been submitted to the Public Analyst, 19 of these were formal samples and 358 were informal samples. 12 samples were reported against. The percentage of adulterated samples was 3 2. Legal proceedings were necessary in 7 cases and in 3 cases cautions were administered. 5 applications were received for registration as dairymen and purveyors of milk, which were granted. 5 Supplementary Licences were issued under the Milk (Special Designations) Order, 1936-1941. SANITARY CIRCUMSTANCES. The general sanitary supervision has been maintained and in this connection 2,274 inspections have been made. As a consequence of these inspections, it was necessary to serve 33 Intimation Notices. No Statutory Orders were served. No legal proceedings were necessary. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. 5 HOUSING. The total number of dwelling houses inspected for housing defects was 70. 40 were found not to be in all respects reasonably fit for human habitation ; 22 of these were rendered fit, in 12 cases as a result of informal action by the inspectors, and in 10 cases subsequent to the service of notices requesting the defects to be remedied. Before the war, though the day-time population of the City was estimated at over half-a-million, the resident population was small, being 8,720. Apart from the occupants of the Corporation's dwellings on the Eastern boundary of the City, some 280 families ; a few groups of old dwellinghouses, and the staff of St. Bartholomew's Hospital, the residents were mainly caretakers of blocks of offices and the licensees and staffs of public houses. The blocks of dwellings all survived the " blitz," but most of the groups of old dwellings houses and a great many caretakers' flats were destroyed. Moreover, the children of residents have grown up during the war, married and had children of their own. Overcrowding has, therefore, developed in the City dwellings, and though conditions were tolerated during the war, they have become intolerable as demobilisation has proceeded. A re-housing problem has consequently arisen which, though small in comparison with that in many residential areas, presents special problems by reason of the difficulty of finding premises any part of which can be converted into housing accommodation, or any space on which temporary houses can be erected. In much of the devastated area of the City the wrecked buildings have been demolished and rubble excavated from the basements. The levelling and consolidation of the ground in these areas preparatory to erecting temporary dwellings would make the cost of such houses prohibitive. The areas where the ground is level have all been considered, but it has not been possible to reach agreement that any area is really suitable as a site for temporary dwellings. The question of the provision of permanent housing accommodation in blocks of flats in the City is still under consideration. Meanwhile, a Special Housing Department has been set up and every effort has been made to find accommodation either in the City or in flats belonging to the Corporation but situated outside the City. By repair of damaged property, reinstatement of flats used as Wardens' Posts, requisition and conversion of all empty properties suitable for housing, it has been possible to re-house 69 families of whom 21 were homeless and 48 overcrowded. There remain some 250 families who have a claim to be re-housed in the City. The provision of temporary housing seems to be out of the question. A small number will be re-housed as vacancies occur in dwellings under the control of the Corporation. Nearly half of the 250 families are newly married couples or young married couples with one child. Many of these are mobile and may find work and accommodation elsewhere. For the remainder there appears to be little chance of re-housing until the plan for the redevelopment of the City and the policy in regard to the provision of permanent housing within the City are agreed. 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. 9 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, 64 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 special 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. 814 cremations were carried out at the City of London Crematorium at Ilford. CITY MORTUARY. Bodies received *88 Post Mortem Examinations made 36 Inquest on bodies 30 Inquest on fires 0 *47 of these deaths resulted from enemy action. 6 DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing:— No. of articles disinfected 61,878 Fees received £124 General Disinfection. Infectious Diseases, etc.:— Articles of clothing and bedding disinfected 7,214 Articles of bedding and clothing destroyed 181 Rooms disinfected after cases of infectious disease 27 Lockers at Post Offices disinfected 56 Bunks in Air Raid Shelters disinfected 61 Ambulances disinfected 1 Cleansing of Persons:— No. of scabeous persons bathed 9 No. of verminous persons bathe 359 No. of scabeous and verminous articles disinfected 3,697 Verminous rooms disinfected 67 Cleansing of Schoolchildren:— No. of children cleansed 2,206 No. of articles disinfected 611 Destruction of Pigeons:— Pigeons destroyed by Staff 0 Pigeons destroyed by one private individual duly authorised by the Corporation 460 RAT REPRESSION. Rat repression has been carried out under the Rats and Mice (Destruction) Act, 1919, and in compliance with the terms of the general " Direction " issued to all Local Authorities by the Minister of Food, in exercise of his powers by virtue of the Infestation Order, S.R. & 0.680, 1943. The staff engaged on the work during the year comprised a Chief Rodent Officer, and 5 assistants, and their main duty was operational. When not engaged on operations they were employed surveying defined areas for the purpose of instituting collective action. The policy has again been to seek the co-operation of occupiers and owners of premises rather than the forceful method of serving Statutory Notices under the Act, and the response has justified this procedure. In the few instances where difficulty was encountered with occupiers, this was quickly surmounted by explanation of responsibilities under the Act and the benefit to be gained by collective action. On the operational side of the problem, the work was divided into two parts, Sewer maintenance treatment, and overground treatment. In assessing the value of Sewer treatment, the effect on surface infestations by the common rat must be considered, as there is undoubtedly a connection between the two. For example, rats poisoned in the sewers have been found dead in untreated surface premises, and one large area which was the subject of block treatment, was subsequently found to be less infested than expected. It was ascertained from occupiers and maintenance staff that there had been a noticeable decrease of the rat population over the past 18 months, and it is reasonable to assume that this condition is in some measure attributable to the periodical treatment of the sewers. Two maintenance treatments were carried out in the past year, and the following figures indicate the results obtained. Of 427 entrances baited during the initial treatment in December, 1943, 355 entrances or 77 per cent. were found to be infested. The estimated kill was 3,290 rats. Subsequently the Director of the Infestation Branch, Ministry of Food. advised the City and the Metropolitan Boroughs to conduct periodical maintenance treatments at intervals of six months. The first of these maintenance treatments was applied in January, 1945. 267 entrances or 64 per cent. of the total number were found to be infested, and the estimated kill was 3,096 rats. The second treatment conducted in June showed 165 entrances or 39 per cent. infested, a reduction of 38 per cent. from the original infestation and the estimated kill was 1,822 rats. Unfortunately the work on the sewers does not affect Ship (Black) rat infestation above ground, and 80 per cent. of infestations treated were of this character. On the Survey side of the work, 2,457 premises were inspected and of this number 330 received treatment. 275 premises received one course of treatment during the year, 39 premises received two courses and 16 were the subject of three or more at intervals, making a total of 417. This entailed 5,298 revisits for operational purposes and 11,321 initial baiting points were selected. Altogether 60,444 pre-baits were put down, and 7,926 poison baits laid. These measures resulted in an estimated kill of 10,038 rats, and of this number 1,410 bodies were recovered. The latter number does not include any subsequently found by occupiers when harbourage was removed. Trapping, as a secondary control measure, was the means of destroying 217 rats, giving a total of 1,627 bodies actually taken from premises. The subsequent absence of live rats from premises rather than the estimated kill or the number of bodies found, is the best indication of the efficacy of the work. Where practicable, structural and incidental proofing was advised, but under present conditions the amount of structural rat-proofing that can be carried out is very limited. The terms of the General Direction issued under the Infestation Order of the Ministry of Food have been complied with as far as practicable, having regard to conditions in the City, and the operation staff have maintained a keen and intelligent interest in their work. I have the honour to be, Gentlemen, Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health, City of London.