LON 72 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1946 LONDON: Printed by Drake, Driver & Leaver. Ltd., Rosebery Avenue, E.C. I. 1947. 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 (Retired 31/5/46) Gray, Charles M as above) Mar., 1911 Blunt, Harold F. 1st Class Assistant May. 1924 Stout, James Erl Threadgold, Arthur W. Stevens, F. W. Peters, E. J. Wilson, J. C. Clements, K. N. H. General Clerical Assistants July, 1930 Nov., 1923 Nov., 1937 (Resigned 20/4/46) Nov., 1935 Jan., 1936 Nov., 1936 (Resigned 31/1/46) Gurney, Miss M. L. Clerical Assistant 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. 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 (Resigned 12/3/46) Cox, C. R. Scott, A. E. R. Campbell, J. W Junior Inspectors Oct., 1938 (Resigned 25/4/46) Oct., 1938 Sept., 1946 MEAT INSPECTION STAFF. Grace, L. B. A., M.R.C.V.S. Veterinary Officer and Chief Meat Inspector June, 1934 Slatter, Charles First Senior Inspector of Meat May, 1908 Murray. Samuel B. Senp, 1911 Mellish, Cyril E. Thompson, Frank E. Peyton, H. R. Senior Inspectors Jan., 1912 July, 1924 Sept., 1932 (Resigned 20/4/46) Lee, W. R Garrard, S. S. Morris, W. L. Junior Inspectors July 1930 Sept. 1946 Sept. 1946 Bernhardt, D. R. Seymour, K. D. (on Active Service) j Probationary Meat Inspectors May, 1931 July, 1935 RODENT OFFICERS. Carter, J .Sept., 1944 Assistant Rodent Officers. 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 Mason, G. A. Dec., 1946 TUBERCULOSIS SISTER AND HEALTH VISITOR. Backhouse, Miss S. A. June, 1931 TUBERCULOSIS NURSES AND ASSISTANT HEALTH VISITORS. Matthews, Mrs. J. V. (temporary) Mar., 1945 (Resigned 31/3/46) Chandler, Miss B. N.Dec., 1945 Davies, Miss M. (temporary part-time) May 1946 KEEPER OF THE MORTUARY. Steggles, T. Dec., 1918 DISINFECTOR. McDonnell, R. J. April, 1903 Hastings, T. June, 1920 MESSENGERS. Betts, Charles (Head Messenger) April, 1926 Tierney, T. E. (temporary) Dec., 1926 LABOURERS. Burton, John H. (General Duties at Mortuary) Mar., 1936 Lawrence, F. H. (General Duties at Mortuary) May, 1936 Berry, E. F. (General Duties at Mortuary) July 1946 Ludgate, G. (General Duties at Smithfield Market) Oct., 1906 Strong, S. R. (General Duties at Smithfield Market) Mar., 1914 Retired 28/7/46) Morris, W. F. (General Duties at Smithfield Market) Mar., 1925 Prevost, A. C. (General Duties at Smithfield Market) Feb., 1926 Mann, Ernest V. (General Duties at Smithfield Market) Jan., 1928 Lawrence, Charles J. (General Duties at Smithfield Market) Feb., 1928 Tapper, T. J. (General Duties at Smithfield Market) Aug., 1946 Graham, Mrs. (Bath Attendant and Cleaner) June, 1927 1 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1946. To the Right Honourable The Lord, Mayor, Aldermen and Commoners of the Corporation of London. Public Health Department, Guildhall, E.C. 2. September, 1947. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my department during 1946. This has been the first year of peace and we have begun to realise how painfully slow will be our recovery from the effects of the war. The shortage of labour and materials and the concentration on the production of goods for export to enable us to import essential raw materials and food, has imposed at home a continuation of the policy of " make do and mend." We find ourselves struggling hard to prevent further deterioration rather than advancing to higher standards. Scarcity results in controls designed to achieve fair distribution of what is available, but controls are at best a necessary evil; they mean the filling up of endless forms ; long periods of delay and uncertainty with consequent discouragement; and the destruction of the sense of personal responsibibity and therefore of interest and enthusiasm. Meanwhile we plan for the days of plenty as well as peace; but Cornucopia is not within mortal sight. The National Health Service Act. During the year your Worshipful Committee gave very careful consideration to Part III of the National Health Service Bill, under which it appeared that the personal health services administered by the Corporation would be transferred to the London County Council as the " local health authority " for the County. Every practicable step was taken by the Corporation to obtain amendment of the Bill so that the City of London should, for the purposes of Part III, be deemed to be a County Borough and thus the local health authority for the City, but without avail. After the appointed day therefore, the Maternity and Child Welfare services in the City will be administered by the County Council, as will also the vaccination and immunisation and the ambulance service; and the Corporation will not be responsible for the institution of the new personal health services; health centres, extended health visiting and home nursing. The Maternity and Child Welfare Clinics, as also the Tuberculosis and the Venereal Diseases Clinics in the City, though administered directly by the Corporation, have been held in St. Bartholomew's Hospital; the Medical Officers in Clinical Charge have been Consultants on the Staff of the hospital and all the hospital's facilities for diagnosis and treatment have been freely available to the Clinics, which have therefore been both highly efficient and economical. The resident population of the City is small and it has consequently been possible to give individual attention to those who avail themselves of the personal health services provided by the Corporation. There is no doubt that the technical efficiency of the services will be fully maintained by the London County Council. The loss will be in the art, not the science of medicine ; which is only part of a general trend that has been obvious for a good many years by reason of the rapid advance of scientific knowledge, but which is now being accelerated by the administrative changes imposed by post-war legislation. Committee of Enquiry into the Closing Hours of Shops, etc. During the year Your Worshipful Committee submitted written evidence to the Committee of Enquiry into the Closing Hours of Shops ; Health Welfare and Safety in Places not regulated under the Factories and Quarries Acts ; and the Hours of Employment of Young People. Your Medical Officer subsequently attended to give oral evidence before the Committee. Though the resident population of the City is small, nearly half a million people spend their working day within the square mile. The main part of the work of your staff has therefore been for many years, in the field of environmental hygiene. These are days of scarcity of accommodation, of materials, of labour and of food ; and much that we would wish to do and that many employers of labour and owners and occupiers of property are anxious to do, to improve environmental conditions, cannot be done. It is a question of making the best of what is available. There is a danger that as the years pass,we shall become tolerant of lower standards, that they will cease to disturb us Just as we have ceased to be shocked by the sight of the devastated areas in the City. It is therefore desirable that a Committee with such wide terms of reference in regard to environmental conditions should be sitting now. Their work must be long and difficult and must demand very careful consideration of what is practicable under present circumstances,as well as in the future when the erection of new, or even extensive improvements to, existing commercial buildings can be undertaken. Though we await the recommendations of the Committee with great interest we need not be impatient because it certainly appears that it will be some years before they can be implemented. Housing. By comparison with the housing problems in residential areas the City's housing problem is small, but it exists and presents difficulties out of proportion to its size because there are very few premises which are suitable for conversion into dwellings ; satisfactory sites for temporary houses cannot be found even in the devastated areas; and the provision of permanent housing in the City can, on economic grounds alone, only be on a very limited scale. 2 Nevertheless a small Re-housing Department has been set up under the direction of the Town Clerk, which works in close co-operation with the City Engineer and the Medical Officer of Health. Consideration was given by the three departments concerned to about a hundred properties ,and by requisition and conversion it has been possible to rehouse 75 families of whom 34 were homeless and 37 overcrowded and four had other urgent claims to accommodation in the City. There remained at the end of the year some 310 families entitled to rehousing. Very full consideration was given to the question of sites for temporary houses. Your Medical Officer was very anxious to adopt this, the speediest method of alleviating overcrowding. Numerous sites in the bombed areas were visited, the Ministry of Health was consulted and the Ministry's Officers paid several visits, but ultimately it was reluctantly concluded that there were no sites in the City suitable for temporary housing. In the majority of cases the basements of blitzed buildings have been excavated and the expense of filling in and consolidating these basements would have made the cost of temporary houses prohibitive. Even where the ground was level the areas were too small or there were other difficulties or dangers which made the sites unsuitable. There are still over 300 families who have a claim to be rehoused in the City. A small number of these will be rehoused as vacancies occur in the dwellings under the control of the Corporation. Nearly half the families are newly-married couples or young married couples with one child. Many of these are mobile and may find work and accommodation elsewhere. But the Corporation desires to make such contribution as is practicable to the permanent solution of the housing problem and has approved in principle a proposal to erect in the Bridgewater Square area, a block of some 250 flats. Numerous problems arise in connection with such a scheme and these are under consideration by the Ministry of Health and the Improvements and Town Planning Committee of the Corporation. Food Inspection. During January and February of 1946, the Meat Depots returned to the City and were installed in the East and West sections of Smithfield Market. The work of your staff of meat inspectors increased with the activity of the Market. Before the war the staff numbered 14, during the war it fell to five ; since no new appointments were made. With the return of the Meat Depots to Smithfield it became necessary to increase the staff and two new appointments were made bringing the total staff of inspectors to seven, exclusive of the Veterinary Officer and the Chief Meat Inspector, Mr. Grace, who is still seconded to the Ministry of Food. The total amount of Meat delivered at Smithfield Market during the year was 237,764 tons. The amount condemned as diseased or unsound was about 173 tons. The two unofficial strikes in the market caused some 30 tons of meat to become unfit for human consumption. The quantity of other foods condemned at riverside wharves and at premises in the City was some 338 tons. Your officers realise fully the present difficulties in maintaining the nation's food supply and do their best to prevent waste of any description. Nearly 322 tons of this condemned food was utilised for stock feeding and for various industrial purposes, only some 16 tons being actually destroyed. But from time to time it happens that consignments of food,showing signs of deterioration on arrival, would in large part be fit for human food if they could be put into consumption rapidly. The longer they are delayed the further the deterioration spreads. In normal times the owner will take immediate steps to find a suitable market for the food,to save himself serious financial loss. Under the present conditions of central control and the absence of the incentive of personal financial interest, the wheels move too slowly, there is delay in marketing the food and thereby much is lost that might have been saved. Sampling of Food and Drugs. The various orders of the Ministry of Food in regard to standards and to declarations of composition and labelling of articles of food, have had a salutary effect in preventing the public from being exploited. At the same time it is to be remembered that though the same, or perhaps greater, nutritive value could be obtained for less expenditure of money from ordinary foods than from proprietary articles, the public is prepared to pay for convenience and appearance. There is therefore a legitimate field for prepared and manufactured articles of food attractively presented and quickly and easily served. Nutrition is not simply a question of chemistry and physiology. Ice Cream. The sampling of ice cream was commenced on May 9th, before the scare created by the outbreak of ice-cream-borne typhoid fever in Aberystwyth. Ice cream is only one of the many articles of food and drink which may be vehicles of infection if standards of hygiene in the manufacture, storage and preparation for sale of such articles are low. Unfortunately, owing to the many difficulties of the present time,standards have declined. In the general rush and scramble for such food and drink as is available the stimulus of competition for custom no longer operates. No one sings " come where the beer is cheaper, come where the pots hold more." and the customer is glad to accept sorry beer rather than " Sorry ! No Beer." Without an enlightened public opinion free to express itself by the withdrawal of custom ; good management; and employees sufficiently interested and willing to take trouble in matters of detail, a high standard of food hygiene will not be achieved. Legislation and inspection alone cannot do more than ensure that the practical means for maintaining cleanliness are available. The strict observance of the simple rules of food hygiene depends on the individual. The extent to which the public eat away from home, in canteens, restaurants and hotels means that one source of infection may affect a large number of people and outbreaks of food poisoning, even of a mild degree, are sufficiently extensive to attract attention and have news value. It is good that the Press should report these outbreaks because public appreciation of the importance of hygiene in the preparation and handling of food will thereby be increased. 3 Water Supply. The Ministry of Health have requested special reference in the Annual Reports of Medical Officers of Health for 1946, to the water supply of the area. The City of London is mainly supplied by the Metropolitan Water Board, but there is a number of deep bore wells. On January 31st, 1939, the Ministry of Health issued a circular letter stating that attention had been drawn " to the possibility of pollution from disused wells or borings of water obtained from the chalk under London." At that time samples of water were taken from wells in the City for bacteriological examination and though all were satisfactory, the owners of properties drawing a supply of water from deep bore wells were informed that they should not continue to have absolute faith in the purity of such water, but should have samples examined bacteriologically at intervals of not more than one year, and more frequently if comparison of the reports indicated even the slightest deterioration in the quality of the water. The outbreak of war diverted attention from the matter until the commencement of air raids. It was then realised that, not only were some well heads buried under blitzed buildings, but that also the bore tubes of some wells still in use might be cracked or broken as the result of bombs falling in the vicinity. Owners of property supplied from wells were informed of the risk and were advised to instal chlorination plants. The majority took this advice and at the present time there are 52 premises with a total of 92 bores in daily use where automatic chlorination is in operation. There are 28 premises with 44 bores in daily use without chlorination and there are eight premises with 15 bores where the wells are maintained as a reserve supply only. So far as is known there are about 100 disused bores in the City? 27 are in occupied premises which have turned over to the Metropolitan Water Board supply,usually because the yield of water from the wells became insufficient. Fifteen bores are in unoccupied, damaged or destroyed premises and there is no record of the sealing of these bores. There are a number of other bores in regard to which further information is sought. In the case of 37 disused bores there are records of sealing above the impermeable stratum of clay, but if the water in the chalk is to be protected from the percolation down the bore of impure water from the gravel, it would appear that sealing should be at the level of the clay, a much more difficult and expensive business than just capping the bore. Section 21 (1) of the Water Act, 1945, states that If any person is guilty of any act or neglect whereby any spring, well or adit the water from which is used or likely to be used for human consumption, is polluted or likely to be polluted, he shall be guilty of an offence against this Act. Whether failure to seal a disused bore at the level of the impermeable stratum would be deemed to be neglect under the above section I am not prepared to say, but I doubt whether it would now be practicable to seal all the disused wells in the City and probably the best course would be to require owners to submit periodical bacteriological reports on the water from their wells and,if evidence of pollution became apparent, require them to chlorinate the water, or close the well and take the Metropolitan Water Board supply. Factories Act 1937. Particulars of the work done under Parts I and VIII of the Factories Act, 1937, are given in the body of the Report. General Sanitary Administration. The general sanitary supervision of the City has been maintained but the work of the Sanitary Inspectors has been rendered more difficult, not by reason of any unwillingness on the part of owners or occupiers to carry out works of repair and maintenance but because of the shortages of labour and materials. Rat Repression. The report of your Rodent Officer appears in the following pages. I should like to pay a special tribute to Mr. Carter for having had the courage to introduce poisoning as the principal means of rat destruction in the City. Before he joined the staff we were disinclined to use poison because we feared that rats would die under floors and in out of the way places, would decompose and give rise to serious nuisance from smell. But Mr. Carter has used poison with much greater success than ever attended the use of traps, and complaints of smell have been very few and have been satisfactorily dealt with. We are always in difficulty in describing the type of rat infestation. The terms " Black " and " Brown " rats are unsatisfactory, for the "black" rat is often brown and the " brown " rat may be almost black. Mr. Carter uses the terms " Ship rat " and " Common rat," but these are not really good because, while the " Black rat" is practically the only type found in ships, it is now well established ashore and indeed in the City it is commoner than the " Brown " or " Common " rat. I would suggest " Climbing " rat and " Burrowing " rat which at least indicates in each case an important characteristic from the point of view of rat destruction and rat-proofing. There may be better suggestions, but it is important to have a popular name for each type which is generally accepted and used,so that everybody knows what we mean. Cremation. The Public Health Committee is also the Burial Board for the City of London, Cemetery and Crematorium at Manor Park and your Medical Officer is the Medical Referee to the Crematorium. It is satisfactory to note that Cremation,as a means of ultimate disposal of the dead,is growmg in public favour as is evidenced by the following figures:— No. of Cremations at Year. City of London Crematorium. 1936 295 1946 1,011 Staff. Your staff, which is still below pre-war strength, has worked very satisfactorily during the year despite the many difficulties and irritations which present conditions impose. 4 I should like to make special reference to the retirement of Mr. George Lowe, after 43 years' service. Mr. Lowe had been for 20 years the Principal Assistant in this office and had served under four Medical Officers of Health. He is a man of exceptional ability, vitality and personality and his knowledge, experience and tact have been of the greatest service to the Corporation and to the Medical Officers of Health whose right-hand man he has been. I worked with him for ten years, including the war period, and shall always remember our association with gratitude for the invaluable help he gave me day by day and for his infectious cheerfulness and optimism in the darkest hours. I have the honour to be, Gentlemen, Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health, City of London. STATISTICAL INFORMATION. Area.—661 acres (including the Temple and Tidal Water and foreshore). Population.—Registrar-General's estimate for 1946, 4,930. Annual Rateable Value.—As at October, 1946, £6,176,494. Annual Sum received from, Penny General Rate.—Estimated £25,600. Births :— Total. M. F. Legitimate 29 18 11 Birth Rate per 1,000 estimated resident population, 1946 6.69 Live Births, Illegitimate 4 4 — Still Births — — — Rate per 1,000 total (live and still) births 0 Deaths :— Deaths under 1 year 1 1 Nil Death Rate per 1,000 estimated average population 14 20 Deaths (all ages) 70 41 29 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 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 30.30 Legitimate Infants per 1,000 legitimate live births 34.48 Illegitimate Infants per 1,000 illegitimate live births 0 Deaths from Cancer (all ages) 8 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 476 births notified to the Vaccination Officer during 1945, 216 had been successfully vaccinated by the end of 1946; 17 had died before the age for vaccination and 2 were insusceptible. Vaccination was postponed in 3 cases, and 157 had removed into other districts. One case was pending. There were 74 cases of conscientious objection. The Public Vaccinator performed one revaccination during 1946. MATERNITY AND CHILD WELFARE. No. of City Births notified (including still births) 28 Visits by Health Visitors :—Under one year 164 Over one year and under 5 years 300 Ante Natal 80 Ophthalmia 1 Home Helps 6 735 packets of Dried Milk were supplied to children under one year ; also 111 packets Farex and 264 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. Of the four illegitimate births referred to in the paragraph on Statistical Information on this page, one relates to a baby found abandoned in the City. This child is in the care of an L.C.C. Institution. There were three premature births to City mothers during the year, one of whom died shortly after birth. 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) 107 Attendances :—Under one year 664 Over one year and under five years 752 Mothers 42 Dentures provided Nil Home Helps provided Nil No. of children, under five years, immunised against Diphtheria 21 No. of children, over five years and under 15, immunised against Diphtheria Nil No. of injections 45 No. of Post Schick Tests and Readings 17 5 INFECTIOUS DISEASE. Notifications received :— Total cases notified. Cases admitted to Hospital. These consisted of the following :— Opthalmia Neonatorum 1 1 Paratyphoid 1 1 Scabies 12 1 Measles 9 3 Scarlet Fever 3 2 Tuberculosis 10 2 Erysipelas 1 — Diphtheria 1 — Whooping Cough 2 — Chicken Pox 1 — SMALLPOX AND TYPHUS FEVER CONTACTS. Cases of Smallpox occurred on ships arriving at Liverpool and Southampton. Contacts were allowed to leave the ships on condition that they gave to the Port Health Authorities their names and the addresses of their destination. These names and addresses were communicated to the Medical Officers of Health of the districts to which the contacts were proceeding, who were responsible for surveillance of the contacts. In the City enquiries were made in regard to 53 contacts and appropriate action taken. Under the Public Health (Aircraft) Regulations, 1938, notifications are received of passengers arriving in this country by air from areas infected with Typhus or Smallpox. Enquiries were made in connection with 108 passengers during 1946. PROVISION OF HEALTH SERVICES—TUBERCULOSIS. Tuberculosis Dispensary:— No. of Sessions held 205 No. of Patients attending :— Residents 222 665 Non-Residents 443 No. of New Patients 171 No. of Resident Patients admitted to Sanatoria, Hospices, etc. 3 No. of Artificial Pneumothorax Refills given 184 No. of Visits made to Homes 61 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 childrer, 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 five patients, in accordance with the above-mentioned scale. VENEREAL DISEASE CENTRE. Sessions held daily except Sunday. During the year a total of 1,461 persons attended the V.D. Treatment Centre at St. Bartholomew's Hospital. Cases of Syphilis numbered 430 (258 males and 172 females). Cases of Gonorrhoea numbered 352 (342 males and 10 females). Cases of Soft Chancre numbered 1 (male). 678 cases (593 males and 85 females) attending were found not to be suffering from any venereal disease. Of the cases of Syphilis attending for the first time only 26 were in the primary stage. 42 including 2 service cases, were in the secondary stage and 31 in later stages. 9 were cases of congenital syphilis. 246 cases of syphilis were still under treatment or observation from the previous year. 32 who had been removed from the register, returned suffering from a relapse. 43 cases, including 15 Service cases, attended Bart's for the first time but had commenced their treatment elsewhere. Of the cases of Gonorrhoea, 140 attended in the first year of infection and 36 in later stages. 81 were continuing treatment or observation from the previous year ; 6 were cases which had relapsed and 89 attended Bart's for the first time having commenced their treatment elsewhere. 8 cases of Syphilis ceased to attend before completion of treatment, and 17 after completion of treatment but before final tests of cure. 6 67 cases of Gonorrhoea ceased to attend before completion of treatment, and 24 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, completed treatment. The total number of attendances of all cases was 19,178, of which 15,664 were for the individual attention of the Medical Officer and 3,514 were for intermediate treatment. 16 cases of Syphilis, and 8 of Gonorrhoea received in-patient treatment involving a total of 157 in-patient days of treatment. The Laboratory work included 47 microscopical examinations for Syphilis, and 625 microscopical examinations for Gonorrhoea. Of the cases attending the Treatment Centre for the first time during the year, 898 were from the County of London, 17 from Surrey, 17 from Kent, 8 from Middlesex, 15 from Essex, 8 from Herts, and 1 from Bucks. The London cases were responsible for 18,687 of the total attendances. The number of Service cases attending was 17 Syphilis, 67 Gonorrhoea and 83 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 3 Throat Swabbing Diphtheria 0 9 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. MEAT INSPECTION. Amount of meat delivered at Smithfield Market, 237,764 tons. Amount of diseased or unsound meat surrendered to Meat Inspectors at Smithfield Market, 152 tons 7 cwts. 1 qr. 22 lbs. Amount of meat surrendered to Meat Inspectors at Leadenhall Market and City shops, 15 tons 5 cwts. 1 qr. 25 lbs. Amount of meat surrendered to Meat Inspectors at Cold Stores, 5 tons 8 cwts. 1 qr. 7 lbs. No. of Prosecutions instituted, Nil. No. of Examinations (Diploma in Public Health), 3. No. of unsound eggs surrendered at Smithfield Market and collected by Lett's Wharf, 980. 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. 51 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. 338 tons 3 cwts. 2 qrs. 2 lbs. were condemned as unfit for human consumption. 321 tons 17 cwts. 1 qr. 19 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 16 tons 6 cwts. 0 qrs. 11 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. FOOD AND DRUGS ACT, 1938, AND FOOD REGULATIONS. 386 samples have been submitted to the Public Analyst, 35 of these were formal samples and 351 were informal samples. Five samples were reported against. The percentage of adulterated samples was 13. Legal proceedings were necessary in one case and in four cases cautions were administered. Four applications were received for registration as dairymen and purveyors of milk, which were granted. Eight Supplementary Licences were issued under the Milk (Special Designations) Regulations, 1936-1946. MILK SAMPLES—PHOSPHATASE AND METHYLENE BLUE TESTS. 26 samples of milk were submitted to the Bacteriologist for examination by the Phosphatase and Methylene Blue Tests. These tests give indications of the adequacy of the heat treatment and of the keeping quality of the milk respectively. The technique to be employed in applying the Phosphatase Test is set out in the Heat Treated Milk (Prescribed Tests) Order and the Test is based on the principle that the phosphatase enzyme occurring in milk is destroyed by heat under conditions of time and temperature slightly in excess of those adequate to destroy the tubercle bacillus. All samples submitted gave satisfactory results to this test. 7 The basis of the Methylene Blue Test is that living micro-organisms use up dissolved oxygen and the rate of removal of oxygen is roughly proportional to the number of organisms present. As the concentration of oxygen is reduced the Methylene Blue loses its colour. The method of applying this Test has also been prescribed in the above-mentioned Order. There were eight unsatisfactory results to this test. The dairymen concerned were interviewed and particular attention paid to the premises through which the milk had passed and the method of transport and handling. The results of these tests have been forwarded in monthly returns to the Ministry of Food, Milk Division (Quality Branch). ICE CREAM. Sampling of Ice Cream was commenced on May 9th and continued during the Summer months. 18 samples were submitted for bacteriological examination and 16 for analysis by the Public Analyst. Of the 18 samples submitted for bacteriological examination four were satisfactory, three were fairly satisfactory, four were of poor quality, six had low standards of cleanliness, and one was quite unfit. Two of the samples were taken from itinerant vendors and these were almost the worst, both bacteriologically and chemically. There are no standards for Ice Cream but the Ministry of Health had in draft the Ice Cream (Heat Treatment, etc.) Regulations to require the pasteurisation of ice cream mixtures and their subsequent retention, until sale by retail, at a temperature not exceeding 28° Fahrenheit. Acting within the legal requirements provided by the Food and Drugs Act, 1938, premises where ice cream has been manufactured, sold or stored for sale have been inspected. Requirements have included cleansing and the provisions of a supply of hot water, soap and towels and some means of sterilising appliances. In one case the manufacture, and in another the sale, of ice cream were discontinued. When the original source of ice cream, which on sampling has proved unsatisfactory, is outside the City, the Medical Officer of Health of the district of origin is informed. SANITARY CIRCUMSTANCES. The general sanitary supervision has been maintained and in this connection 3,076 inspections have been made. As a consequence of these inspections, it was necessary to serve 53 Intimation Notices. One Statutory Order was served. No legal proceedings were necessary. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. HOUSING. The total number of dwelling-houses inspected for housing defects was 31. 15 were found not to be in all respects reasonably fit for human habitation. Two of these were rendered fit as a result of informal action by the Inspectors and one has ceased to be used as a dwelling-house. FACTORY ACT, 1937. Factory premises have been under such supervision as has been possible having regard to their needs, and the following gives details of the work carried out :— Mechanical Factories. Number on register 366 Inspections 57 N on-Mechanical Factories. Number on register 470 Inspections 154 Defects. Found. Remedied. Want of cleanliness 82 18 Want of ventilation 1 1 Food improperly stored ... 5 1 Accommodation for refuse 2 1 Sanitary accommodation:— Insufficient (Tenancies) 3 3 Defective (Tenancies) ... 24 5 Defective (No. of conveniences) 17 1 Not separate for Sexes (Tenancies) 1 — Other Nuisances 73 10 Total defects 210 40 Matters referred to H.M. Inspector:— Notified by H.M. Inspector 16 Reports sent to H.M. Inspector 16 Notices served:— Mechanical Factories—Intimation 19 Kitchens of Restaurants—Intimation 14 Kitchens of Licensed Premises—Intimation 3 There are four above-ground bakehouses and three underground bakehouses in the City. Outivork and the inspection of Outworkers' Premises, etc. Lists received from City Firms 103 Names and Addresses, etc., received from other Authorities 47 Names and Addresses transmitted to other Authorities 440 Registered Factories at which Outwork is received:— Defects found 2 Defects remedied 2 No case of infectious disease was reported in connection with outworkers premises in the City. 8 SHOPS ACT, 1934. 28 inspections of shops and warehouses have been carried out. Any defects have been remedied without recourse to legal proceedings. One Notice was issued. CATERING LICENCES. Before issuing licences for the establishment of catering businesses, the Local Food Control Officer refers cases to your Medical Officer of Health in order that licences may only be issued in respect of premises which are suitable from a public health point of view. During 1946, 98 premises were inspected and reports forwarded to the Food Controller. PHARMACY AND POISONS ACT, 1933. 72 firms were registered under this Act, 70 of which were re-registrations. The few infringementa 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. CITY MORTUARY. Bodies received 63 Post Mortem Examinations made 49 Inquest on bodies 32 Inquests held at Holloway Prison 2 Inquest on fires 4 DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing :— No. of articles disinfected 109,905 Fees received £311 General Disinfection. Infectious Diseases, etc.:— Articles of clothing and bedding disinfected 481 Articles of bedding and clothing destroyed 22 Rooms disinfected after cases of infectious disease 24 Lockers at Post Offices disinfected 209 Verminous rooms disinfected 30 Ambulances disinfected 2 Cleansing of Persons:— No. of scabeous persons bathed 23 No. of verminous persons bathed 241 No. of scabeous and verminous articles disinfected 2,701 Cleansing of Schoolchildren:— No. of children cleansed 2,624 No. of articles disinfected 1,871 Destruction of Pigeons:— Pigeons destroyed by Staff 0 Pigeons destroyed by two private individuals duly authorised by the Corporation 1,238 RAT REPRESSION. The following report is submitted on the progress of rat repression within the boundaries of the City for the year ending 31st December, 1946. The work has been carried out under the Rats and Mice (Destruction) Act, 1919, and in compliance with 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. & O, 680, 1943. The staff engaged on this work comprised the Rodent Officer and five assistants or operators, and their main duty was operational. When not so employed they were engaged in surveying defined areas for the purpose of instituting collective action. As in the previous years the policy has been to seek the co-operation of occupiers and owners of property The response has been very satisfactory, and it has not been necessary to serve notices under the Act. In all instances of infestation the occupiers were advised of methods proved to be most satisfactory in clearing or reducing expeditiously an infestation of rats or mice. It was generally realised that the primary factor was the application and co-ordination of the work, and that to ensure that the best results would be achieved, the work should be carried out by experienced operators whose sole concern is the destruction of these pests. In the case of individual complaint or request for assistance the property adjoining the premises subject to complaint is inspected and if necessary collective action is taken. 9 On the survey side of the work, 2,636 properties were surveyed. This embraced all types of property, ranging from large blocks of offices, riverside food warehouses, factories, kitchens and workshops to domestic dwellings. The time spent on inspection of large blocks is very considerable, and although often with negative results, it is necessary for the success of collective action. Indirect poisoning has again been the principle means of extermination and in every instance pre-baiting has preceeded poisoning. While it may appear to be a long and tedious procedure to pre-bait for four to five days before poisoning, the results obtained have fully justified the time so spent. This applies to minor as well as heavy infestations. While it is not claimed that complete clearance is obtained in all cases, it can be said that a high proportion of a rat population is destroyed in one blow. Much of our work has been in dealing with infestations which in the past have been the subject of unorganised and haphazard control measures. Often the occupier has used several proprietary poisons and expended much labour before seeking advice, and although a few immature rats may have been destroyed, the mature and productive adults often remain and the net result is a poison prejudiced population. Of the number of premises inspected, 412 were found to be infested in varying degrees and in each instance control measures were applied. In 315 properties one course of treatment was sufficient to abate the nuisance, and of the remainder, 63 received two periodical treatments, and 34 needed three or more during the year, making a total of 512 operations completed. This entailed 6,543 re-visits for operational purposes, and to provide some indication of the amount of work this involved, 14,991 initial baiting points were selected. A total of 63,224 pre-baits were put down, and 8,672 poison baits were laid. These measures resulted in an estimated kill of 8,658 rats and of this number, 25 per cent, or 2,087 bodies were recovered on completion of the work. This figure does not include dead rats found subsequently by occupiers when harbourage was removed, unless they were actually seen by an operator. Trapping, as a secondary control measure was the means of destroying 480 rats, and added to those found after poisoning, a total of 2,560 bodies were taken from premises by this department. The number of bodies recovered in relation to the estimated kill appears to be high, but the estimate is very conservative, and could reasonably be increased by at least 25 per cent. The calculation is based on common rat extermination and 80 per cent. of infestations were of Ship (Black) rat character. The latter animal being much smaller than the common rat, naturally consumes less food and consequently a smaller quantity of poison-bait constitutes a lethal dose. For example, in one property subject of Ship (Black) rat infestation, 42 bodies were recovered, and 10 ozs. of poison bait had been consumed. On the common rat basis of calculation this amount of poison taken would give an estimated kill of 25 rats, and it is this figure which is recorded. While these figures are a source of satisfaction to the operators and provide some evidence of the results of their work, the real test of the efficacy of the treatment is the absence of live rats in premises. Taking into consideration the nature of the property in the City and the character of the rat infestations treated, very few complaints of corpse smell have been received. In instances where this nuisance has resulted, assistance has been given in the appropriate action to clear it as quickly as possible. A considerable number of mice infestations have been treated with satisfactory results in all types of property. It is not possible to give an estimated kill, as the amount of poison bait consumed is so very small. Altogether 207 bodies were recovered after various treatments and as in the case of rats, their absence, at least for a reasonable period is the main object. An important part of rat repression is the periodical Sewer Maintenance Treatment against common rat, and during the year three treatments were carried out. These took place in January, May and December. This work resulted in an estimated kill of 2,910 rats of which 105 bodies were found at the base of entrances. The effect of these treatments must be considered in relation to surface infestations of common rat as there is always a possibility of a connection between the two. Figures as accurate as it is possible to obtain are kept of these treatments, and by analysis of sector recordings it is possible to define the centres of residual populations where conditions are most favourable for infestation and from which the population, if allowed to build up is distributed over sections found to be free as the result of the last treatment. It is the purpose of these maintenance treatments to check the build-up at these centres. The value of preventive measures is fully realised, and where practicable, structural and incidental rat proofing was advised and combined with extermination measures. Unfortunately many of the premises treated were beyond structural proofing against ship rat or alternately it entailed work which could not be undertaken at the present time. In assessing the overall results of the work for the last three years, it can be said that the density of the rat population is in no measure comparable with that of several years ago. This is widened by our surveys and remarks made by occupiers of premises. In conclusion, the terms of the " Direction " have been complied with as far as practicable, having regard to problems peculiar to the City, the character of infestations, and the types of property.