REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1948 LONDON: Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C..I. 1949. 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. Gray, Charles M. Principal Assistant and Vaccination Officer Mar., 1911 Blunt, Harold F.1st Class Assistant May, 1924 Stout, James Erl July, 1930 Threadgold, Arthur W. Nov., 1923 Peters, E. J General Clencal Asslstants Nov., 1935 Wilson, J. C Jan., 1936 Betts, C. Temporary Clerical Assistant April, 1926 Gurney, Miss M. L Clerical Assistant May, 1939 SANITARY INSPECTORS. McGrath, William Richard Mar., 1922 Harrington, George Edwin Dec., 1925 Sillett, David Ernest April, 1926 Neale, William G. C. July, 1928 Thorpe, Robert C. Mar., 1930 Hudson, Leslie A. April, 1934 Aldhous, H. J. April, 1935 Scott, A. E. R. Oct., 1938 (Resigned 1/5/48) Campbell, J. W Sept., 1946 Thompson, E. Sept., 1948 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. Sept., 1911 Mellish, Cyril E. Jan., 1912 Thompson, Frank E. July, 1924 Lee, W. R. Meat Inspectors July, 1930 Garrard, S. S. Sept. 1946 Morris, W. L. Sept. 1946 Bernhardt, D. R.May, 1931 Seymour, K. D. Probationary Meat Inspectors July, 1935 RODENT OFFICER. 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. Chandler, Miss B. N. Dec., 1945 ASSISTANT HEALTH VISITOR. Davies, Miss M. (temporary part-time) May 1946 ( ditt° ) KEEPER OF THE MORTUARY. Steggles, T. Dec., 1918 DISINFECTING APPARATUS ATTENDANT. Lawrence, F. H. May, 1936 MESSENGERS. Tierney, T. E. (temporary) Dec., 1926 Ascott, J. J. (temporary) Mar., 1947 LABOURERS. Burton, John H. (General Duties at Mortuary) Mar., 1936 Berry, E. F. (General Duties at Mortuary) July 1946 Kingshott, W. A. (General Duties at Mortuary) Feb., 1948 Ludgate, G. (General Duties at Smithfield Market) Oct., 1906 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 Graham, Mrs. (Bath Attendant and Cleaner) June, 1927 Powell, W. F. (General Duties at Smithfield Market) Dec., 1947 1 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1948. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. 55/61, Moorgate, London, E.C. 2. July, 1949. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during 1948. Vital Statistics. In my annual report for the year 1947 I remarked that by reason of the small resident population in the City, vital statistics are of little value as an indication of improvement or deterioration in the public health. A single birth or a single death can make a very big difference in the birth rate or the death rate. There were only 44 births in the City, only one child died in the first year of life, and there were no maternal deaths. National Health Service Act. On July 5th the transfer of the personal health services to the London County Council was effected without any disturbance of their efficiency or the smooth running which has characterised them for so many years, thanks to the cordial relations which have always existed between St. Bartholomew's Hospital and the Corporation of the City of London. I regret the change in responsibility for the services, which in the City will not be any advantage to the citizens ; but so far there has been no change in the professional staff, nor in the time and place of clinics, and I doubt whether those attending the clinics are aware that responsibility for them has passed to another authority. For my own part I have received every courtesy from the Divisional Medical Officer of the London County Council, who has kept me fully informed in regard to all matters affecting the personal health services in the City. Nevertheless, I hope that some day the ancient City of London will be permitted to manage its own affairs. It has the experience, the ability and the means to do so. It was centuries old before County Councils and County Borough Councils were conceived, but it has not grown senile. It is not swayed by fashion or by political expediency, but it is humane, perhaps almost sentimental ; and generous ; it is progressive, but it recognises of old the will-o'-the-wisp and the mirage. Infectious Disease. There was no outbreak of, or any incident in, relation to any infectious disease calling for special comment during the year. No case of diphtheria occurred during the year, 75 per cent, of all children under five years of age and 95 per cent, of all children between two and five years having been immunised. Food Inspection. The total amount of meat delivered at Smithfield Market was 286,216 tons, some 3,500 tons less than in the previous year. The amount of diseased or unsound meat surrendered at the Market was 115 tons ; 97 tons less than in 1947. Over 21 tons of meat were surrendered at Leadenhall Market and City shops, and over 8 tons at Cold Stores. Of the foodstuffs delivered at Riverside Wharves or at premises in the City, 357 tons were condemned. Food and Drugs Act, 1938, and Food Regulations. Of 473 samples submitted to the Public Analyst, 12 were found to be adulterated or below the required standard of composition, the percentage of adulterated samples being 2.5. Handling of Food. The hygiene of catering establishments is of special importance in the City of London because of the large daytime population. Since the war several factors have tended to lower the standard. As a result of food rationing fewer City workers bring food from home, and the majority want a substantial meal in the luncheon hour at a restaurant or cafe. Many catering establishments were destroyed by enemy action, and many small catering establishments have launched out into the service of main meals when they were only designed and equipped to serve light meals or snacks. This has resulted in serious congestion in the kitchens, and moreover, since there have been queues of people waiting outside, the staffs have had to work at very high pressure. It is obvious that under these conditions of crowding and rushing, it is difficult to maintain a high standard of cleanliness, even if the staff are adequate in number and appreciate the importance of hygiene in the handling, preparation and service of food. Some large catering firms put their staffs through a course of training, and are thus able to include food hygiene in the instruction given ; in some small establishments the proprietors supervise personally every detail of the work in their establishments and attain a remarkably high standard 2 with minimum facilities ; but there are many where the standard of hygiene is the standard of the individual employee without special training or close supervision. These are days when independence is claimed regardless of personal qualities, innate or acquired, entitling persons to independence ; yet in the hygiene of the handling of food everything depends on the individual food handler, who must either be instructed or, if incapable of absorbing instruction, must be trained to automatic performance of the part he or she has to play. In regard to accommodation, the kitchen and ancillary rooms must be adquate in size in relation to the number of meals served at the busiest times. It is impossible to keep congested kitchens clean, moreover, they are ill-ventilated, hot and humid, and these conditions are not only bad for the health of the staff but lower their standards of hygiene. Equipment too must be adequate not only for cooking but also for menial tasks, such as the preparation of vegetables and washing up. There must be provision also for the personal ablutions of the staff. The old principle of one sink for all purposes is highly unsatisfactory from a food hygiene point of view. Since the war the proprietors of many catering establishments in the City have been anxious not only to make good arrears of maintenance, but to improve and extend their kitchen premises, and have sought the assistance of the Medical Officer of Health's Department in acquiring the necessary building licences from the Ministry of Works. Even with a full appreciation of the many demands on the limited supplies of labour and material, your Medical Officer has felt fully justified in supporting most of these applications. Your Inspectors have been able, by their practical commonsense outlook and tactful approach, to obtain many improvements, some involving radical, almost dramatic changes, others small and unseen by the public but nevertheless of considerable significance from the point of view of hygiene. As examples of the former, in two cases the floors of basement kitchens have been excavated so as to give adequate height, and in another case the owner decided to demolish and rebuild his restaurant, with the result that a better class of customer is attracted and his business has improved. The catering at one railway station has also been very markedly improved. In my personal visits I have been pleased to note that your inspectors are well received by the proprietors and staffs of catering establishments, and that their recommendations receive serious attention. Indeed I have the impression that interest in and appreciation of the importance of food hygiene is growing. The arrangement under which, before granting a new catering licence, the Local Food Executive Officer requires a certificate that the premises are suitable from a public health point of view has worked smoothly and is of great value in the promotion of food hygiene. On only four occasions was food-poisoning alleged to have resulted from meals actually eaten in the City. All were mild, and were probably due to infection of food with staphylococcus pyogens aureus, or to the presence of large numbers of non-pathogenic organisms. The largest outbreak involved 30 policemen, who suffered from acute diarrhoea from 4 to 14 hours after a meal in their own canteen. Bacteriological examination of food revealed no pathogens, but from a cleft between muscles in a large piece of cooked beef a profuse growth of coliform bacilli was obtained. This beef had been cooked on a Sunday and remained in the larder, not the refrigerator, in the month of June, till mid-day the next day (Monday). The opportunity was taken to obtain necessary improvements in the canteen, and to emphasize the danger of overnight storage of prepared food at room temperature in summer. Another outbreak involved 12 persons in August. Vomiting and diarrhoea developed some four hours after eating tinned brisket beef, from which a typical staphylococcus pyogens aureus (coagulase positive) was isolated by the bacteriologist. Another instance involved three or four persons who lunched regularly at a certain restaurant and who complained on two occasions of food poisoning. From the many other customers there were no complaints, no medical reports were available, and no satisfactory details of any kind. After enquiries I came to the conclusion that these were not genuine cases of food poisoning. However, a number of improvements were effected in the restaurant, particular attention being paid to ratproofing. Having regard to the fact that thousands of meals are served daily in the City, it is remarkable that so few cases of food-poisoning have occurred. The complete investigation of cases infected in the City will always require the very closest co-operation between the Medical Officers of Health of the districts in which the cases reside and your Medical Officer. In two instances reports were received of persons being taken ill after consuming food purchased in the City and consumed at home. One involving a husband and wife appeared to be typical staphylococcal food-poisoning, but bacteriological examination of poloni sausage, sausage meat, egg substitute powder and pudding mixture, revealed no pathogens and no gross contamination with non-pathogenic organisms. The other involved five persons living in Ipswich who had eaten pressed beef which had been purchased in the City. What remained of the consignment in the shop was sent for bacteriological examination and staphylococcus aureus (coagulase positive type) was found. The pressed beef was manufactured in a neighbouring Borough, the Medical Officer of Health of which had received information of other cases and was carrying out a very thorough investigation. He discovered two employees engaged in the preparation of the pressed beef to be infected and took the necessary steps to eliminate the source of infection. Rat Repression. Rat repression has gone on actively throughout the year ; occupiers of premises have been increasingly co-operative, and it appears that the rat-population in the City has been greatly reduced in recent years. A total of 3,340 premises were inspected including blocks of offices, riverside wharves, markets, kitchens, workshops and domestic dwellings. 3 Your staff only undertake rat-destruction where the occupier has failed to take the necessary action or the measures he has taken have failed; but it frequently happens that, subsequently, occupiers request us to undertake periodical treatment of their premises. During the year, 751 cases of infestation were dealt with ; 8,622 operational visits were made; 98,506 pre-baits and 12,066 poison baits were laid. The kill, estimated on the weight of poison consumed, was 5,637 rats, of which 1,822 bodies were actually recovered. In addition, 552 rats were destroyed by trapping. The figure of 5,637 rats is probably an under estimate, as the lethal dose of poison is calculated for the brown rat, a much bigger and heavier animal than the black rat. which in the City is about 90 per cent, of the rat population. The rats destroyed by your staff are only a small proportion of the total bag during the year, because a number of private rat-catching firms are operating and many occupiers do their own ratcatching. It is not practicable to ascertain with reasonable accuracy the number of rats thus destroyed. The treatment of sewers was carried out twice during the year. In May the estimated kill was 730, and in December 1,342 rats. Instances occurred in which rats poisoned in the sewers during these treatments were found dead inside premises. In such cases the means of access to the premises from the sewers were investigated and closed. The poisons mainly used have been Zinc Phosphide and Arsenious Oxide and occasionally Red Squill and Barium Carbonate. Occasional complaints of the smell of dead rats are inevitable, but it has been possible to minimise this temporary nuisance, and it has been generally agreed that it is more than compensated by the effective clearance of rats achieved. Housing. The total number of housing applications outstanding on December 31st, 1948, was 340, representing 848 persons. The number of families rehoused during the year was 48, representing 113½ persons. This figure includes 31 families representing 77 persons transferred within property under the Corporation's control. The Corporation have continued to endeavour to find a site for the erection of flats in which to re-house the persons for whom they have this responsibility. A proposal so to develop a " blitzed " site in the City failed to obtain the approval of the Ministry of Health. Sites outside the City are at present under consideration. Staff. The members of your staff in this department have carried out their duties with efficiency, tact and courtesy during the year, and have secured compliance with the sanitary legislation without recourse to the courts except on five occasions. I have pleasure in reporting that Mr. H. J. Aldhous, one of your Sanitary Inspectors, obtained the degree of Bachelor of Science (Estate Management) of the University of London, and Mr. K. S. Seymour, Probationary Meat Inspector, who on demobilisation was granted leave of absence without pay to enable him to take a Government Course of Training to qualify as a Sanitary Inspector, was successful in obtaining the Sanitary Inspector's Certificate of the Royal Sanitary Institute. I have also to report that Mr. A. E. R. Scott, one of your Sanitary Inspectors, resigned, having been accepted as a Medical Student at St. Bartholomew's Hospital Medical School. Miss B. N. Chandler, Tuberculosis Nurse and Senior Health Visitor, and Sister M. Davies, parttime assistant in the Child Welfare and the Tuberculosis Clinics, were transferred to the staff of the London County Council on the " Appointed Day," under the National Health Service Act. I have the honour to be, Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health. 4 Area.—661 acres (including the Temple and Tidal Water and foreshore). Population.—Registrar-General's estimate for 1948, 4,650. Annual Rateable Value.—As at October, 1948, £6,205,779. Annual Sum received from Penny General Rate.—Estimated £25,600. Births:— Total. M. F. Legitimate 44 26 18 Live Births, Illegitimate 3 3 — Still Births — — — Birth Kate per 1,000 estimated resident population, 1948 11 08 Rate per 1,000 total (live and still) births — Deaths :— Deaths under 1 year 1 — 1 Deaths (all ages) 77 54 23 Death Rate per 1,000 estimated resident population 16.77 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General s Short List) :— Deaths. Rate per 1,000 total (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 21.28 Legitimate Infants per 1,000 legitimate live births ... 0 Illegitimate Infants per 1,000 illegitimate live births ... 333.33 Deaths from Cancer (all ages) ... 20 Deaths from Measles (all ages) ... 0 Deaths from Whooping Cough (all ages) ... ... 0 Deaths from Diarrhoea (under 2 years of age) ... 0 Vaccination.—The Vaccination Acts were repealed by the National Health Service Act, 1946, which came into operation on 5th July, 1948 ; the Vaccination Officer's appointment was accordingly terminated on 4th July, 1948. Of the 525 births notified to the Vaccination Officer during 1947, 221 had been successfully vaccinated by the 4th July, 1948 ; 10 had died before the age for vaccination and one was insusceptible. Vaccination was postponed in two cases, and 215 had removed into other districts. Seven cases were pending. There were 69 cases of conscientious objection. The Public Vaccinator performed 13 revaccinations during the six months ending 4th July, 1948, and in addition to the successful vaccinations referred to above, 2 adults were vaccinated for the first time. MATERNITY AND CHILD WELFARE. On July 5th, 1948, the " Appointed Day " under the National Health Service Act, 1946, the functions exercised by the Corporation in connection with Maternity and Child Welfare were transferred to the London County Council, and the information given below therefore relates only to the period 1st January to 4th July. No. of City Births notified (including still births) 19 Visits by Health Visitors:—Under one year 98 Over one year and under 5 years 137 Ante Natal 3 Ophthalmia 0 Home Helps 0 510 packets of Dried Milk were supplied to children 0-2 years of age ; also 122 packets Farex and 90 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. The death under one year referred to above in the paragraph on Statistical Information relates to a newly-born infant found in a devastated area 17/19, Gravel Lane, E.C., the cause of death being lack of attention at 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) 50 Attendances :—Under one year 550 Over one year and under five years 271 Dentures provided Nil Home Helps provided Nil No. of children, under five years, immunised against Diphtheria 19 No. of children, over five years and under 15, immunised against Diphtheria Nil No. of injections 40 No. of Post Schick Tests and Readings 12 5 DOMESTIC HELP SERVICE. Owing to the small resident population of the City, it has been neither necessary nor practicable to engage whole-time domestic helps. In every case where domestic help was urgently needed ad hoc arrangements have been made through the Honorary Welfare Officer. From 1st January to 4th July, 1948, domestic help was provided in 11 cases, the total hours of work being 1,333. INFECTIOUS DISEASE. Notifications received :— Total cases notified. Cases admitted to Hospital. These consisted of the following :— Acute Primary Pneumonia 1 1 Scabies 2 1 Measles 10 2 Scarlet Fever 1 — Tuberculosis 12 3 Erysipelas 1 — Whooping Cough 2 — 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 2 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 11 passengers during 1948. PROVISION OF HEALTH SERVICES—TUBERCULOSIS. On July 5th, 1948, the " Appointed Day " under the National Health Service Act, 1946, the functions exercised by the Corporation in connection with the treatment of Tuberculosis were transferred to the North East Metropolitan Regional Hospitals Board and the information given below therefore relates only to the period 1st January to 4th July. Tuberculosis Dispensary :— No. of Sessions held 104 No. of Patients attending :— Residents 154 504 Non-Residents 350 No. of New Patients 94 No. of Resident Patients admitted to Sanatoria, Hospices, &c. 1 No. of Artificial Pneumothorax Refills given 216 No. of Visits made to Homes 42 No. of Contacts kept under observation 28 Milk was supplied to two patients during the period under review. 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 period under review allowances were paid to five patients, in accordance with the above-mentioned scale. VENEREAL DISEASE CENTRE. On July 5th, 1948 the " Appointed Day " under the National Health Service Act, 1946, the functions exercised by the Corporation in connection with the treatment of Venereal Diseases were transferred to the North East Metropolitan Regional Hospitals Board, and the information given below therefore relates only to the period 1st January to 4th July. Sessions are held daily except Sunday. During the period mentioned above 453 new cases attended for treatment of which 375 were men and 78 were women. 6 BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year :— Throat swabs 1 Articles of Food 24 Sputa 4 Well water 10 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. MEAT INSPECTION. Tons. Cwts. Qrs. Lbs. Meat, &c., delivered at Smithfield Market 286,216 0 0 0 Meat, &c., surrendered at Smithfield Market 115 6 2 4 *80 0 0 0 Meat, &c., surrendered at Leadenhall Market and City shops 21 11 1 12 Meat, &c., surrendered at Cold Stores 8 8 1 25 *7 0 0 0 Various commodities surrendered and sent to Lett's Wharf 52 7 3 24 Number of eggs surrendered and sent to Lett's Wharf, 1,161. * Approximate weights collected on behalf of the Ministry of Food. Number of examinations.—Two D.P.H. One Diploma in Sanitary Science. Number of students who attended for tuition during the year, 136. 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. 26 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 i nspection. 357 tons 0 cwts. 2 qrs. 10 lbs. were condemned as unfit for human consumption. 67 tons 5 cwts. 3 qrs. 11 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 254 tons 18 cwts. 1 qr. 9 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 DUGS ACT, 1938, AND FOOD REGULATIONS. 473 samples have been submitted to the Public Analyst; 28 of these were formal samples and 445 were informal samples. Twelve samples were reported against. The percentage of adulterated samples was 2.5. Legal proceedings were necessary in three cases and in four cases cautions were administered. Seven Supplementary Licences were issued under the Milk (Special Designations) Regulations, 1936-48. Nineteen samples of milk were submitted to the Bacteriologist for examination by the Phosphatase and Methylene Blue Tests. These Tests respectively, give indications of the adequacy of the heat treatment and of the keeping quality of the milk. ICE CREAM. 18 samples of Ice Cream were submitted to the Bacteriologist and 14 were analysed by the Public Analyst. The samples sent to the Bacteriologist were subjected to the Methylene Blue Test in accordance with the recommendations of the Ministry of Health. This Test affords an index of contamination but where adverse results were reported and especially where previous results had been bad it was considered advisable to have complete bacteriological examinations made in addition. Such were carried out in nine cases. Resulting from this sampling and examination, communications were forwarded to the Medical Officers of Health of two Districts where the Ice Cream was manufactured. In one case it was ascertained that new plant was being installed by the manufacturer and samples since taken have shown satisfactory results, and in the other the retailer has changed his source of supply. In accordance with the powers conferred by the Food and Drugs Act, 1938, and in order to see that the requirements of that Act and of the Ice Cream (Heat Treatment, &c.) Regulations, 1947, were being complied with, premises concerned with the manufacture, storage and sale of Ice Cream have been inspected. There have been nine new registrations for the sale and storage of Ice Cream, and in four cases the use of premises for such purpose has been discontinued. 7 SANITARY CIRCUMSTANCES. The general sanitary supervision has been maintained and in this connection 3,920 inspections have been made. As a consequence of these inspections, it was necessary to serve 47 Intimation Notices. Two 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. HOUSING. The total number of dwelling-houses inspected for housing defects was 21. 19 defects were found of which 14 were remedied. There are three houses on which it is intended to place a Closing Order as soon as there is reasonable prospect of the occupants being able to obtain suitable alternative accommodation. 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:— PART I OF THE ACT. 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 735 (including 579 kitchens) 905 (including 768 kitchens) 110 (including 87 kitchens) — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority ... 431 227 35 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers'premises) 1 — TOTAL 1,166 1,132 145 Nil 2.—CASES IN WHICH DEFECTS WERE FOUND. (If defects are discovered at the premises on two, three or more separate occasions they are reckoned as two, three or more "cases ") Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) 765 774 — 10 — Overcrowding (S.2) 5 5 — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 48 36 — 1 — Ineffective drainage of floors (S.6) 12 o — — — Sanitary Conveniences (S.7) (a) insufficient 5 6 — 4 — (b) Unsuitable or defective 54 44 — 15 — (c) Not separate for sexes 4 4 — 2 — Other offences against the Act (not including offences relating to Outwork) 768 773 2 — — TOTAL 1,661 1,647 2 32 Nil SHOPS ACT, 1934. 171 inspections of shops and warehouses have been carried out. Any defects have been remedied without recourse to legal proceedings. 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 1948, 224 inspections were made in this connection. PHARMACY AND POISONS ACT, 1933. 68 firms were registered under this Act, 63 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. 8 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. 52 inspections were made. 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. PIGEON NUISANCE. The Corporation, in exercise of their powers under Sec. 121 of the Public Health (London) Act, 1936, from time to time cause the number of pigeons in the City to be reduced when it appears to them either that their number is excessive, or that complaints of their congregation in certain areas are justified. A pigeon-catcher is authorised by the Corporation to carry out the necessary trapping, and during 1948, 1,300 pigeons were destroyed by this means. CITY MORTUARY. Bodies received 54 Post Mortem Examinations made 46 Inquest on bodies 26 Inquests held at Holloway Prison Nil Inquest on fires Nil DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, &c.:— No. of articles disinfected 139,191 Cases of horsehair 16 Fees received £542 General Disinfection. Infectious Diseases, &c.:— Articles of clothing and bedding disinfected 499 Rooms disinfected after cases of infectious disease 35 Lockers at Post Offices disinfected 99 Verminous rooms disinfected 78 Ambulances, vans, &c., disinfected 4 Cleansing of Persons :— No. of scabeous persons bathed 1 No. of verminous persons bathed 144 No. of scabeous and verminous articles disinfected 1,803 Cleansing of Schoolchildren:— No. of children cleansed 2,477 No. of articles disinfected 2,765