LIBRARY LON 75 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1949 STAFF. MEDICAL OFFICER OF HEALTH. Date Appointment. White, Charles Francis, O.B.E., M.D., Ch.B., D.P.H., D.T.M Dec., 1937 CLERICAL STAFF. Gray, Charles M Chief Clerk Mar., 1911 Blunt, Harold F. 1st Assistant Clerk May, 1924 Stout, James Erl 2nd „ „ July, 1930 Betts, C April, 1926 Threadgold, Arthur W. General Grade Clerk Nov.. 1923 Peters, E. J Nov., 1935 Wilson, J. C Jan., 1930 Gurney, Miss M. L. Clerical Assistant May,1939 SANITARY INSPECTORS. McGrath, William Richard Mar., 1922 Harrington, George Edwin Dec., 1925 Sillett, David Ernest April, 1920 Neale, William G. C. July, 1928 Thorpe, Rouert C. Mar., 1930 Hudson, Leslie A. April, 1934 Aldhous, H. J. April, 1935 Campbell, J. W Sep ., 1940 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 Senior Meat Inspector May, 1908 Murray, Samuel B. Sept., 1911 Mellish, Cyril E Jan., 1912 Thompson, Frank E. July. 1924 Lee, W. 11 Meat Inspector July, 1930 Garrard, S. S. Sept. 1940 Morris, W. L. Sept. 1940 Bernhardt, D. R Probationary Meat Inspector May 1931 Seymour, K. D July 1935 RODENT OFFICER. Carter, J Sept., 1944 Rodent Operatives. Cooper, J. S. (Senior Rodent Operative) Aug., 1943 Tremayne, L. R Nov., 1943 Hayes, H. Nov .1943 (Retired 30/4/9) Tanner, H. W Nov., 1943 Pennycook, J. Nov., 1943 Mason, G. A. Dec., 1946 Brown, R. J. May, 1949 KEEPER OF THE MORTUARY. Steggles, T. Dec., 1918 DISINFECTING APPARATUS ATTENDANT. Lawrence, F. H May, 1930 MESSENGERS. Tierney, T. E. (temporary) Dec., 1920 Ascott, J. J. (temporary) Mar., 1947 MANUAL WORKERS. Burton, John H. (General Duties at Mortuary) Mar., 1930 Berry, E. F. (General Duties at Mortuary) July 1940 Kingshott, W. A. (General Duties at Mortuary) Feb., 1948 (Retired 13/11/49) Ludgate, G. (Senior Porter at Smithfield Market) Oct., 1900 Morris, W. F. (General Duties at Smithfield Market) Mar., 1925 Prevost, A. C. (General Duties at Smithfield Market) Feb., 192(5 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 1949. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. 55/01, Moorgate, London, E.C. 2. July, 1950. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1949. Vital Statistics. Though the population of the City during working hours is considered to approach half a million, the resident population is very small, the Registrar-General's estimate for 1949 being only 4,670. Vital statistics are consequently of little value for purposes of comparison with those of other areas or the whole country. The birth rate per 1,000 works out at 6.21 and the death rate at 8.57. The infant mortality rate appears as 103.45, though the number of deaths under 1 year of age was only 3. The death rate for illegitimate infants appears as 333.33 per thousand because there were only three illegitimate births and one died. Rates calculated on one year's figures are therefore of no value at all. There were again no maternal deaths during the year. National Health Service Act. Although under the above Act administrative responsibility for the personal health services has passed to other authorities, no significant changes have been made and your Medical Officer remains in close touch with the Executive Officers concerned. Infectious Disease. There was no outbreak of or any incident in relation to any infectious disease calling for special comment during the year. Your Medical Officer receives many enquiries from business firms in the City as to what action they should take in regard to cases or contacts of infectious disease amongst their staffs. Food Inspection. The total amount of meat delivered at Smithfield Market was 295,103 tons, some 8,800 tons more than in the previous year. The amount of diseased or unsound meat surrendered at the Market was 218 tons, about 100 tons more than in the previous year, but about the same as in 1947. In addition nearly 40 tons of meat were condemned in Leadenhall Market and City Shops, and 2i tons in Cold Stores. Of the foodstuffs delivered at Riverside Wharves or at premises in the City, 1,051 tons were condemned. This high figure is mainly due to a tidal flood in March, when the basements of several riverside warehouses were flooded. Food and Drugs Act, 1938, and Food Regulations. Of 470 samples submitted to the Public Analyst, four were found to be adulterated or below the required standard of composition, the percentage of adulterated samples being 0'85. Milk. I am indebted to Mr. G. E. Harrington for the following summary of the new legislation in regard to milk :— Food & Drugs (Milk and Dairies) Act, 1944. Milk (Special Designations) Act, 1949. The Milk (Special Designation) (Raw Milk) Regulations, 1949. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The Milk and Dairies Regulations, 1949. The above-mentioned legislation came into operation in whole or part on 1st October, 1949. In brief review the effect of these Acts and Regulations is as follows :— Food and Drugs (Milk and Dairies) Act, 1944:—Transfers control of dairy farms and dairy farmers (producers) to the Minister of Agriculture and Fisheries, including the power of registration, refusing registration or cancelling registration of such: amends Section 20 of the Food and Drugs Act, 1938, so that the power of making Regulations under that Section shall be exercised jointly by the Minister of Health and the Minister of Agriculture-and Fisheries, with added powers to provide for the inspection of cattle on dairy farms and for regulating the storage of milk: and also amends Section 21 of the Food and Drugs Act, 1938, to allow for the making of separate Milk (Special Designation) Regulations, jointly by the Minister of Health and the Minister of Agriculture and Fisheries. Milk (Special Designations) Act, 1949 :—Empowers the Minister of Food at any time, after consultation with representative organisations, by Statutory Instrument (the draft of which has previously been laid before Parliament), to order to come into operation or to cease from operation in a specified area, the obligatory use of a special designation for the purpose of all sales of milk by 2 retail for human consumption, with special provisions relating to catering sales. The Minister is empowered to provide facilities for the treatment of milk so as to comply with special designations and he may make arrangements with local authorities or others for doing this on his behalf and at his expense. After the expiration of five years from 1st October, 1949, the designation "Accredited" is to bo excluded as an obligatory designation. "Accredited" milk under the old Milk and Dairies Order, 1936, was "raw" milk from cows which had passed veterinary examination and it had to satisfy the methylene blue test and not contain any coliform bacilli in one-hundredth of a millilitre. It is now forbidden to use the special designation "Accredited" for a purpose for which the use of a special designation is obligatory by virtue of the Milk (Special Designations) Act, 1949, unless such milk is all from a single herd. (a) The Milk (Special Designation) (Raw Milk) Regulations, 1949. (b) The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The old Milk (Special Designations) Order, 1936, and amending Regulations to 1948 are now revoked. There is no longer any provision for fees to be charged for licences to be issued under either of these new Regulations, (a) The Milk (Special Designations) (Raw Milk) Regulations, 1949:—Define "raw milk" as that which has not been subjected to heat treatment and authorise the use of the designations "Tuberculin Tested" and "Accredited" with the special provisions that after 1st October, 1954, the use of the special designation "Accredited" will no longer be permitted and no new application to use that designation will be granted after 30th September, 1952. After 1st October, 1957, the special designation "Tuberculin Tested" may only be used in respect of milk from a herd on the Register of Attested Herds of the Minister of Agriculture and Fisheries and no application to use that designation will be granted after 30th September, 1954, unless the herd is registered as an Attested Herd. (b) The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949:— Authorise the use of the designations "Pasteurised" and "Sterilised." The last-mentioned is a new designation and the Regulations specify that milk to which it is applied shall be filtered or clarified, homogenised and heated to and maintained at, such a temperature, not less than 212 deg. Fall, for such a period as to ensure that it will comply with the Turbidity Test, the technique of which is prescribed. The milk is to be treated in bottles and on completion of treatment the bottles are to be sealed with an airtight seal. Every bottle is to be conspicuously and legibly marked "Sterilised Milk" or " Tuberculin Tested Milk (Sterilised) " as the case may be. From 1st October, 1950, until 1st October, 1954, milk which is pasteurised in bottles must be delivered to the consumer in such bottles, and milk which is pasteurised by the usual method in other containers must be put into bottles, or other containers in which it is to be delivered to consumers, only by the person holding a licence to use the designation "Pasteurised" in relation to such milk, and on the registered premises named in that person's licence. From 1st October, 1954, all pasteurised milk must be put into bottles, or other containers in which it is to be delivered by retail, on the premises on which it is pasteurised. 37 Supplementary Licences and 13 Dealers Licences have been issued in connection with the above-mentioned Regulations. The Milk and Dairies Regulations, 1949:—Whilst re-enacting in general principles most of the requirements of the old Milk and Dairies Regulations, 1926, which are revoked, these new Regulations are stronger and more precise, particularly as they relate to powers in connection both with cases of infected persons handling milk and of persons suffering from disease caused by eonsumpton of milk. There are also some important and useful added requirements in connection with the protection of milk against contamination. It is not permitted to leave or cause to be left any bottles or cartons containing milk on a public highway except upon final delivery on a retail sale and every person who habitually uses any particular place for the deposit of milk to await collection or further conveyance is required to afford such place protection from the direct rays of the sun. There is a further prohibition against the opening of any milk receptacle in the course of conveyance or distribution of the milk and against transferring milk from one receptacle to another at any place other than registered premises. There are certain exceptions particularly with regard to the opening of a receptacle containing milk on final delivery on a retail sale. Bottle caps and discs before use, are required to be stored in a clean place and protected from dust and dirt. It was found necessary to administer cautions, two by letter and two verbally, with regard to the placing of filled bottles of milk in crates on the public footways. Fcod Hygiene. The hygiene of the preparation and handling of food continues to receive close attention. The Corporation of the City of London were invited to submit evidence to the Inter-departmental Committee on Meat Inspection, and I collaborated with the Medical Officer of Health of the Port of London and the Superintendent anil Chief Veterinary Officer of the Metropolitan Cattle Market, in the preparation of a memorandum, and attended before the Committee. I also gave evidence oh behalf of the Society of Medical Officers of Health before the Catering Trades Working'Party and the Meat Products Working Party appointed by the Ministry of Food. Having so recently had the opportunity of expressing, both in writing and verbally, my views on the problem of food hygiene as they affect the City of London, I do not propose to discuss the subject in detail here, but await with great interest the reports of the three Committees referred to above, which will doubtless provide a well-balanced view based on opinions and experience, not only of medical officers of health, veterinary officers and sanitary inspectors, but of representatives of the industries concerned and of consumers. While fully appreciating the importance of food hygiene, I sometimes think that the publicity recently given to this subject has been rather one sided and has tended to' create the impression that we in this country are at least careless, if not actually dirty, in our methods of handling, preparing 3 and serving of food. Some experience of various nationalities engaged in various capacities in the catering trade, leads me to believe, that the standards of hygiene in some countries more esteemed for their mastery of the theory and practice of the culinary art than we are, are distinctly lower than ours. I suggest that many people who criticize adversely both English cooking and English food hygiene, never think whether they would always enjoy what on holiday is a delightful change, and when abroad, give their critical faculties in matters of hygiene, a holiday too. In fact I do not believe that we arc as bad as we represent ourselves to be, and no visitor need feel that by coming to England he is really in danger of suffering illness or even temporary inconvenience from an attack of food poisoning. In support of this point of view I would point out that whereas there are over a thousand catering establishments in the City, and well over a quarter of a million main meals are served daily, only three outbreaks of food poisoning were reported during the year, none of which were connected with catering establishments open to the general public, and the worst of which was not due to a defect in food hygiene. It may of course be contended that people who eat in the City may not be taken ill till they arrive home, but I only received two complaints of this nature during the year, both of which referred to industrial canteens. Only three persons were involved, and on investigation it appeared highly improbable that the infection had been contracted in the City, since in each canteen hundreds of exactly similar meals had been served at the same time and no other complaints had been received. In only one case was a complaint received that food poisoning was due to food purchased in the City, and in this instance it did appear that the allegation was justified, since samples of the food concerned (sausages) were obtained in the City and on bacteriological examination were found to contain a variety of bacteria including coliform organisms, streptococcus faecalis and a coagulase positive staphylococcus. The sausages, though sold in the City, were manufactured elsewhere and the Medical Officer of Health of the district concerned was informed. It is not intended to convey the impression that all is well with food hygiene in the City. Indeed there is much still to be done even in the matter of premises, many of which are old and cramped, and still more to be done in the very difficult problem of educating and training food handlers in the routine observance of high standards. But it is suggested that more harm than good may result from overstatement. The medical profession is trained up to the standard of the modern surgical operating theatre and expects employees in the catering trade to understand and approach this standard. Those who are brought into close contact with the employees and know the conditions under which many of them live and often work, appreciate that, while visible dirt may be understood to be a potential sources of danger, it is extremely difficult, if not impossible, to convey a degree of understanding of the dangers of bacterial contamination sufficient to, result in strict observance of all the desirable precautions. We are making and shall continue to make progress, but meanwhile we need not and should not cry to the world "stinking fish" where our catering trade is concerned. I submit that we are rather inclined to compare the worst in this country with the best in other countries. Food Poisoning. An extensive outbreak of food poisoning occurred in St. Bartholomew's Hospital. The source of infection was ducks' eggs. On Thursday, July 7th, I was informed by the Medical Officer of Health of Islington that a woman who worked in the kitchen at Bart's had brought home some trifle on July 5th, and had given some to her son and daughter. The woman and her son were subsequently admitted to St. Mary's Hospital, Islington, suffering from food poisoning. The daughter was also affected and was removed to the North-Western Hospital on July 12th. I rang up the Bacteriology Department at Bart's, who said they were investigating an outbreak of food poisoning in the Hospital, and that these Islington cases confirmed their suspicions that the source of infection was a pudding with a meringue top made from 200 ducks' eggs, on Tuesday, July 5th. It is, of course, well known that ducks' eggs are occasionally infected with food poisoning organisms by reason of the dirty conditions in which some farm-yard ducks live and feed and lay their eggs. A meringue is not heated to the point of sterilisation, and therefore any infection in the eggs would survive the cooking. Symptoms developed from 24 to 48 hours after the meal at which the sweet was served. Nurses and other members of the staff and patients were affected, and all had eaten the suspected food. The illness was an actual infection with food poisoning organisms and not due simply to the ingestion of bacterial toxins. Salmonella typhi-murium was recovered from the stools in a number of cases, but no pudding or ducks' eggs remained for bacteriological examination. It is because the illness was due to the consumption of living organisms as opposed to toxins, that the incubation period was so long (24-48 hours). A total of 144 persons were affected (72 nurses, 18 maids, secretaries and other employees, 2 kitchen staff, 2 relatives of one of the kitchen staff and 50 patients). In most of those attacked the illness was brief and did not endanger life, but in some patients already ill from other causes, its effects were serious. Several of these were treated with streptomycin given orally with good effect. In one elderly patient suffering from arthritis and nephritis the illness was fatal. I visited the Hospital and discussed the outbreak with the bacteriologist, Professor Garrod, with whom I subsequently visited the kitchens, which are clean and well run. Certain members of the staff had gone on short leave from the Hospital after July 5th and had informed the Matron that they were ill. I notified the Medical Officers of Health of the districts in which these persons lived. I also wrote to the Medical Officers of Health of the districts from which the ducks' eggs were delivered. They had been collected from a number of farms, and these were investigated as to the conditions under which the ducks were kept. In three farms the ducks had access to polluted ponds and ditches. 4 I notified the Ministry of Health and the London County Council. The latter sent a note of the occurrence to all Medical Officers of Health in the County, so that persons discharged from the Hospital between July 5th and July 8th, who developed symptoms, would be promptly recognised as bacterial food poisoning and be controlled and treated accordingly. (2) In January, 1949, a business house in the City who had an arrangement with a large catering company to provide a mid-day meal for some 1,350 members of their staff, reported to me that on three occasions during the month a large number of cases of diarrhoea had occurred. On investigation no particular item of food could be incriminated and there was no history of illness nor any evidence on examination to indicate that any member of the catering staff might be the source of infection, although enquiries were pursued to a point at which the caterers began to fear that their staff would resign. The premises were generally satisfactory, but it was possible to arrange that conditions were improved in a few minor respects. It seems probable that some transient illness in some member of the catering staff, which numbered 22 men and 16 women, was responsible, though this was not confirmed. The large staff of the business house have continued to have their mid-day meal in the same restaurant, and no other complaints have been received. (3) In December, 1949, I received information that 35 members of the staff of a business house in the City had complained of illness after lunch in their own canteen. I made a very close personal enquiry into this outbreak, inspected the canteen, interviewed every member of the catering staff, and arranged for the examination of specimens of fæces from nine of them. Neither samples of food nor the specimens of faeces gave anything of bacteriological significance, and I found it quite impossible to account for the outbreak. Fortunately the illness was in every case quite transient and nobody was away more than 48 hours. The canteen has continued and there has been no further trouble. The most that could be claimed is that my personal interview with each member of the catering staff, may have had some educational value in the matter of food hygiene. Rat Repression. I am indebted to Mr. J. Carter for the following report:— Organisation and procedure during 1949 have been similar to that of previous years, and consisted of inspections of blocks of premises to ascertain the presence of rats and mice,-treatment of any such premises found to be infested, and periodical treatment for the destruction of rats in sewers. A total of 2,491 premises were inspected, including blocks of offices, riverside wharves, markets, restaurant kitchens, workshops and domestic dwellings. During the year, 751 cases of infestation were dealt with; 7,678 operational visits were made; 91,792 pre-baits and 16,242 poison baits were laid. These measures resulted in an estimated minimum kill of 5,046 rats, and of this number 2,113 bodies or 42 per cent. were found. The figure of 5,046 rats could reasonably be increased by 30 per cent. as the estimated kill is calculated for the Common or Brown rat, a much bigger and heavier animal than the Black rat, which comprises about 90 per cent. of the rat population in the City. Trapping was the means of destroying 761 rats, and added to those found as the result of poison, a total of 2,874 bodies were removed from premises. In addition 557 mice were found. No records are available of the number of rats destroyed by commercial firms servicing premises under contract. In collaboration with the Metropolitan Boroughs contiguous to the City. two maintenance treatments of the sewers were carried out in May and December respectively. In May the estimated kill was 1,254 rats, and in December 1,507 rats. Since December, 1943, twelve treatments have been applied and a total estimated kill of 17,178 rats has resulted, and of this total 476 bodies were recovered from the bases of sewer entrances. It is the purpose of these periodical treatments to check the build-up of the common rat population in the sewers and thereby assist in preventing infestation of surface properties from this source. Assessing the results of this work for the period of five years since January, 1944, a retrospect of detailed records show that in surface premises a minimum of 42,000 rats are estimated to have been destroyed, of which 11,800 bodies were recovered. The yearly figures show a steady decline in 'the severity of infestations treated and the number of rats destroyed. The value of rat proofing cannot be over-emphasized, particularly against Black rats in built-up areas such as the City. The term is a wide one, and often entails extensive repair work and structural alteration. Equally important is incidental rat proofing. This particularly applies to food premises and kitchens. It embraces the proper storage of food and disposal of waste, avoidance of accumulations, and general hygiene of the premises. Lack of attention to such details has, in many instances, been responsible for infestation. This also applies to staffs of business houses and factories, who throw away indiscriminately waste food and food wrappings into waste-paper baskets, behind office fittings and machines, or in out of the way corners which are nevertheless easily accessible to rats. In such cases the occupiers are advised to obtain metal bins in which such rat-attractive materials can be placed. As regards method and procedure, pre-baiting and poisoning has been the principle means of extermination, and trapping a secondary measure. The technique advised by the Infestation Branch of the Ministry of Agriculture and Fisheries has been strictly adhered to, and the results obtained have fully justified the time and labour spent in putting such procedure into practice. Housing. The total number of housing applications outstanding on December 31st, 1949, was 341, representing 856 persons. The number of families rehoused during the year was 37, representing 81½ persons. This figure includes 21 families, representing 57½ persons transferred within property under the Corporation's control. The Corporation approved a scheme for the erection of 45 flats, to accommodate a maximum of 197 persons, on a site in Old Kent Road, part of the Bridge House Estates. 5 Atmospheric Pollution. For many years before the war your Worshipful Committee maintained a Deposit Gauge on the roof of your premises at 20, Golden Lane. This was destroyed by enemy action and no further observations were practicable till 1948. when you authorised the replacement of this gauge and the installation of additional apparatus at Golden Lane and in Finsbury Circus for the more exact measurement of atmospheric pollution. At the end of the first complete year of observations I have considered how I may present some results to you. In future years I shall be able to show comparisons with previous years, though so many factors, particularly of wind and weather, influence the monthly readings in stations in the very centre of London, that only over a period of years can sound deductions be drawn as to the upward or downward trend of atmospheric pollution. Meanwhile I have thought it justifiable to endeavour to compare atmospheric pollution in the City with other areas in London; a busy manufacturing area and a rural area. Again I must enter the caveat that over a period of one year only wide variations are of significance for the purpose of comparison. I am indebted to Mr. W. R. McGrath, who is in charge of the various instruments for compiling the following report, and to Mr. S. H. Richards, Superintendent of Observations (Atmospheric Pollution), Department of Scientific and Industrial Research, for kindly reading the draft and making numerous valuable suggestions. I am indebted to Mr. W. G. C. Neale, a Sanitary Inspector in the Department, for the photographs of the various instrument*. The Measurement of Atmospheric Pollution. The deposit gauge was the earliest instrument used by local authorities in this country for measuring atmospheric pollution. The one positioned at Golden Lane in the City of London for many years prior to the war was destroyed by enemy action in September, 1940. In 1948, to enable observations to be restarted, the following instruments were installed:— At Golden Lane—(1) A deposit gauge. (2) A smoke filter and volumetric sulphur dioxide apparatus. (3) A lead-peroxide apparatus. At Finsbury Circus Gardens—(4) A lead-peroxide apparatus. The main purpose of (1) is to keep a check on deposited pollution during the reconstruction period, of (2) to do the same for smoke anti for sulphur-dioxide. (3) and (4) will enable a comparison to be made-of sulphur-dioxide pollution in two different areas of the City. Observations with similar instruments are being made by other local authorities in many districts, including the London area. Impurity in the atmosphere can take the form of (a) solid or liquid particles which may be so large that they settle out rapidly, or so small that they remain suspended for a very long time; and (4) gaseous impurity, such as sulphur-dioxide produced by the combustion of the sulphur present in fuels, which is dispersed and remains in the air until it is absorbed by rain, or by substances with which it comes into contact. It is of interest to note that, according to an estimate made by the Director of Fuel Research, of the Department of Scientific and Industrial Research, in 1945, from about 180 million tons of coal burnt per annum in Great Britain, there are emitted annually 2.3 million tons of smoke, 0.5 million tons of ash, and 5.0 million tons of sulphur dioxide. Nearly half of the smoke is produced in domestic grates, although these consume less than one quarter of the coal. Some four-fifths of the ash and sulphur dioxide come from industrial undertakings. Deposited Matter. The deposit gauge collects, by means of a funnel-shaped glass bowl, solid and liquid material deposited from the air. The material passes down a connecting pipe into a glass bottle. At the end of each month the contents of the bottle are analysed by the Public Analyst into the following components : Water, undissolved matter, and dissolved impurities. The undissolved matter includes soot and ash ; among the dissolved impurities arc found sulphur, chlorine and lime. The results from the deposit gauge are normally expressed as tons deposited per square mile per month. Most types of atmospheric pollution are collected by the deposit gauge. Thus, the ash of the insoluble matter, sometimes with the addition of small quantities of wind-blown dust, is the ash emitted from chimneys. Similarly, the sulphate in solution is mainly derived from the sulphur-dioxide emitted from chimneys. There is also a connection between deposits of combustible matter (including tar) and the smoke emitted from chimneys; though the combustible matter in the deposit gauge may include particles of grit including unburnt coal and coke. Table 1 shows the mean monthly rates of deposit during 1949, of the materials collected in the deposit gauge at Golden Lane. Table 1. Mean Monthly Rates of Deposit at Golden Lane. Tons pet square mile. Total solids 18.72 Total undissolved matter 8.74 Tarry matter 0.08 Other combustible matters 1.90 Ash 6.16 Total dissolved matter 9.99 Calcium 1.56 Chloride 1.92 Sulphate 3.13 The monthly variation in the total solids deposited at Golden Lane is shown graphically in Figure 1. On the graph the corresponding figures for Godalming, Walsall and Westminster have also been plotted for comparison purposes. 1949 FIG.f. COMPARISON OF TOTAL SOLID DEPOSITED MATTER. The mean monthly total deposit for the City for 1949 was slightly less than that recorded immediately before the War. The respective values for these deposits, together with the corresponding values at the three other places chosen for comparison purposes, are shown in Table 2. Table 2. Comparison of Total Solids deposited during 1938-9 and 1949 at Golden Lane, Godalming, Walsall and Westminster. Tons per square mile per month. Station. Year ended Year ended 31/3/39 31/12/49 London— Golden Lane 21.83 18.72 Westminster 22.30 21.32 Godalming 4.61 5.97 Walsall 19.28 15.25 Although the results of the first complete year's observations with the deposit gauge since the end of the War suggest that there has been some improvement compared with 1939, it would be unwise to base too definite a conclusion on the results of a single year's observations. A truer picture will be obtained when the mean results for the next two or three years become available. The improvement noted may be due to the decrease in fuel consumption in the neighbourhood consequent upon the great loss of property in the City of London during the War, and the reduction in the amount of coal available as a result of fuel rationing. Suspended Impurity. Suspended impurity is composed largely of smoke which is produced when coal is incompletely burned. It is a particularly objectionable form of pollution since it reduces visibility and daylight, it adheres to vegetation and many outdoor surfaces without being removed by rain and it easily penetrates indoors causing dirt and probably affecting health. The domestic fire burning raw coal is the main source of soot and tar pollution and these constituents form the major part of the visible grimy 7 pollution. This pollution consisting mainly of very fine particles, remains suspended in the air for a long time and is often carried down wind for several miles. The inference is clearly that atmospheric pollution is more than a local or even a regional problem, but a national one. A single community, be it town or city, cannot obtain for itself a truly clean atmosphere since it is at the mercy of other communities some of which may be quite remote from it. This does not mean that no benefit will come from abatement of local pollution. The high concentration of pollution in an urban centre before its own smokes becomes disseminated is, of course, far worse than the widely .distributed general pollution. The apparatus in use at Golden Lane is the standard equipment adopted by the Department of Scientific and Industrial Research for measuring the concentration of suspended matter in the air. With the aid of a small electrically driven pump, air from outside the building is drawn through a filter paper at the rate of about 50 cubic feet per day, the volume being measured by a gas meter. Each period of collection lasts 24 hours. The solid particles from the air are collected on the filter paper and form a uniform circular stain one inch in diameter. The weight of pollution is estimated by visual comparison of the stain with a standard scale of shades. By this means the shade intensity is determined and then converted to an estimate of smoke concentration measured in milligrams per cubic metre of air. The mean monthly concentration of suspended matter in the air at Golden Lane during 1949 was 10.15 milligrams per cubic metre. Corresponding figures for other places in Great Britain where similar observations are made are as follows: Birmingham 30.30, County Hall, London, 31.50, Rye 0.018, Salford 64.83. The station at Salford is situated in a densely populated district in which there is also a considerable amount of manufacturing being carried on. At the other extreme the instrument at Rye is situated at a R.A.F. Station in oper. country. The mean monthly variation in suspended matter at Golden Lane and the other stations used for comparison purposes is shown graphically in Figure 2. FIG.2. MONTHLY VARIATION OF SUSPENDED IMPURITY. 1949. SMOKE FILTER METHOD Sulphur Dioxide. The extent of atmospheric pollution due to sulphur dioxide may be measured in two ways. In one method the absolute concentration of sulphur dioxide in the air, in parts per million or other, convenient, unit, is obtained, whereas the second method provides arbitrary comparative values which can be used for comparing the relative concentrations of sulphur dioxide in different areas. Both methods are used in the City of London. 8 Volumetric, method.—In this method the apparatus measures the average daily concentration of sulphur dioxide. Air from outside a building is drawn at the rate of about 50 cubic feet per day through a bubbler. The bubbler contains a dilute solution of hydrogen peroxide, and sulphur dioxide from the air is absorbed in the solution to form sulphuric acid. At the end of the day's run the volume of the standard alkali needed to neutralize the sulphuric acid is determined and hence the mean concentration of sulphur dioxide is calculated. The mean concentration of sulphur dioxide at Golden Lane during 1949 was 0.09 parts of sulphur dioxide per million parts of air. Corresponding values for other stations in Great Britain making this type of observation are as follows : Westminster 0.09, Bilston 0.10, Crossness 0.03. Figure 3 records the average monthly concentrations of sulphur dioxide during 1949 at these four stations. Fig.3 Monthly variation of sulphur dioxide, 1949. (Volumetric method). The instrument at Crossness is in open country about eleven miles east of Charing Cross, Barking Power Station being 1½ miles to the W.N.W. The instrument at Bilston (in the "Black Country" area) is surrounded by a district which is residential and industrial. In the winter of 1938-39 the average concentration of sulphur dioxide in eight London Districts was 0.13 parts per million by volume. It will be noticed that marked variations occur in the concentration of sulphur dioxide. This concentration is affected to a considerable extent by meteorological factors such as turbulence and rain as a result of which the variations observed are considerably greater than the changes in the rate of emission of sulphur dioxide. There is also a marked seasonal variation of a type to be expected, i.e., a peak in the winter months, and a minimum in the summer. The maxima and minima are high for central London. This is probably due to the large number of office and domestic fires in the neighbourhood. Comparing the City with the manufacturing district of Bilston it will be seen that although the summer concentration in Bilston is higher, the winter peak is lower than in the City. This suggests that it is the domestic, rather than the industrial, chimneys which are responsible for the large seasonal variation. Lead Peroxide Method.—This method of estimating atmospheric sulphur dioxide was designed primarily to provide a measure of the "activity" of attack of sulphur pollution on the fabric of buildings. It is based on the facility with which gaseous sulphur dioxide combines with lead peroxide to form lead sulphate. 9 A prepared surface of lead peroxide, desposited on a 10 em. square of cotton fabric wrapped round a porcelain cylinder, is exposed to the atmosphere for one month. To protect the lead peroxide from the direct action of rain while still permitting the free access of air, the instrument is housed in a louvred box. The quantity of lead sulphate formed during the month's exposure is determined by chemical analysis, and provides a measure of the average concentration of sulphur dioxide at the station during the month. The results are usually expressed as milligrams S03 per 100 sq. cm. per month. The mean values recorded during 1941 at the stations at Golden Lane and Finsbury Circus Gardens were respectively 2.74 and 2.53 mg. SO3 per 100 sq. cm. per month. Comparative values at other places are as follows: Godalming 0.42, Walsall 2.83, Westminster (City Hall) 2.95. The annual variation in the monthly values at these stations is shown graphically in Figure 4. It will be seen that the individual observations for each month vary considerably, the highest of the four stations in any month being 5.60 in February at Golden Lane and the lowest (excluding Godalming) being 1.08 in June and August at Finsbury Circus Gardens. The results at Godalming (a maximum of 1.26 and a minimum of 0.05, with an average of 0.42) indicate a negligible sulphur activity. This was to be expected since the instrument is situated two miles out of the town in open country. Fig.4 Monthly variation of sulphur dioxide. 1949. (Lead peroxide method). The extent of atmospheric pollution due to sulphur dioxide in the area of the City is roughly what would be expected in a district of its type. It is less than that found in certain other parts of London and is generally lower than that associated with the heavy industrial areas. 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. I have pleasure in reporting that Mr. J. C. Wilson, one of the General Grade Assistants in the Meat Inspector's Office, was successful in passing the Royal Sanitary Institute's Examination, qualifying him to become a Sanitary Inspector. He is continuing his studies in order to obtain his qualification as a Meat Inspector. Mr. T. Steggles, the Keeper of the Mortuary and Cleansing and Disinfection Station retired on pension after serving the Corporation for over 31 years. He was 70 years of age and had previously been employed by the Finsbury Borough Council for 16 years. During the war years he rose splendidly to the unforeseen difficulties and responsibilities of his positions, in regard to fatal casualties resulting from the bombing of the City. I was very sorry indeed to lose the services of such an experienced and dependable member of my staff. I was also sorry to lose the services, through ill-health, of Mr. W. F. Kingshott, one of the staff of the Mortuary. I have the honour to be Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health. 10 STATISTICAL INFORMATION. Area.- 601 acres (including the Temple and Tidal Water and foreshore). Population.—Registrar-General's estimate for 1949, 4,070. Annual Rateable Value.—As at October, 1949, £0,344,040. Annual Sum received from Penny General Rate.—Estimated £20,000. Births:- Total. M. F. Legitimate 20 14 12 Birth Rate per 1,000 estimated Live Births, Illegitimate 3 — 3 resident population, 1949 6.21 Still Births 4 2 2 Rate per 1,000 total (live and still) births 121.21 Deaths :— Deaths under 1 year 3 2 1 Death Rate per 1,000 estimated Deaths (all ages) 40 26 14 resident population 8.57 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 103 45 Legitimate Infants per 1,000 legitimate live births 76'92 Illegitimate Infants per 1,000 illegitimate live births 333 33 Deaths from Cancer (all ages) 7 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years of age) 0 INFECTIOUS DISEASE. Notifications received :— Total cases notified. Acute Anterior Poliomyelitis 1 Scabies 2 Measles 7 Scarlet Fever 5 Tuberculosis 13 Erysipelas 3 Whooping Cough 1 . Food Poisoning 75 SMALLPOX AND TYPHUS FEVER CONTACTS. Cases of Smallpox occurred on a ship arriving at London. Contacts were allowed to leave the ship 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 7 contacts and appropriate action taken. ANALYTICAL EXAMINATIONS. (Other than under Food and Drugs Act). Atmospheric Pollution 48 Bread 1 Air 3 Fish (tinned) 3 Confectionery 4 Fruit (preserved) 1 Fruit (tinned) 8 Sauces and Pickles 12 Jam 1 Shellfish (tinned) 1 Spirits 2 Rainwater 12 Vegetables (tinned) 2 BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year :— Throat swabs 42 Articles of Food 28 Sputa 3 Well water 1 Blood 1 Faeces 2 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. 11 MEAT INSPECTION. Tons. Cwts. Qrs. Lbs. Meat, &e., delivered at Smithfield Market 295,103 0 0 0 Meat, &c., condemned by Inspectors at Smithfield Market 218 5 1 10 Meat, &c., condemned by Inspectors at Leadenhall Market ami City shops 39 6 1 18 Meat, &c., condemned by Inspectors at Cold Stores 2 10 2 15 Various commodities condemned by Inspectors and sent to Lett's Wharf 2 4 16 Number of eggs condemned by Inspectors and sent to Lett's Wharf, 644. Number of examinations.—One D.P.H. Two R.S.I. Meat and other Foods. 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 still less than in pre-war years. 33 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. 1,051 tons 3 cwts. 0 qrs. 25 lbs. were condemned as unfit for human consumption. 313 tons 18 cwts. 2 qrs. 3 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 737 tons 4 cwts. 2 qrs. 22 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. 282 tons 19 cwts. 3 qrs. 19 lbs. of food were placed under stop and subsequently released to be dealt with under the supervision of other local authorities. FOOD AND DRUGS ACT, 1938. AND FOOD REGULATIONS. 470 samples have been submitted to the Public Analyst; 31 of these were formal samples and 439 were informal samples. Four samples were reported against. The percentage of adulterated samples was 0.85. No legal proceedings were necessary but in two cases cautions were administered. Twenty-seven samples of milk were examined by the Phosphatase and Methylene Blue Tests, three of them being examined bacteriologically also. The Phosphatase and Methylene Blue Tests give respectively an indication of the efficacy of the heat treatment applied and of the keeping quality of the milk. Three of the samples failed to stand up to the Methylene Blue Test, but with these exceptions the samples were satisfactory. ICE CREAM. During the year 17 samples of ice cream were submitted to the Bacteriologist for examination by the Methylene Blue Test. 9 were placed in Grade 1, 3 in Grade 2, 2 in Grade 3 and 3 in Grade 4. In the case of Grade 3 and Grade 4 samples, the results of our examination were communicated to the Medical Officers of Health of the district in which the ice cream was manufactured. In one instance it was reported that the manufacturers were in process of replacing hand-wrapping by machine-wrapping, and in two cases it was reported that the Medical Officer of Health was already aware of the existence of unsatisfactory conditions, and was taking the necessary steps. 17 new registrations of premises for the sale and storage of ice cream were granted during the year and one application was withdrawn. SANITARY CIRCUMSTANCES. The general sanitary supervision has been maintained and in this connection 4,406 inspections have been made. As a consequence of these inspections, it was necessary to serve 21 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 32. 67 defects were found which have been, or are in course of being remedied. There are four 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. Partial Closing Orders have been made in respect of two of these houses. 12 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. Number of Number Premises on Inspections Written Occupiers Register notices prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 1,145 (including 1,845 (including 158 (including — 576 kitchens) 1,055 kitchens) 131 kitchens) (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 429 316 26 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — TOTAL 1,574 2,161 184 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 wore 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.) 634 009 — — — Overcrowding (S.2) 2 — — — — Unreasonable temperature (S.3) 32 2 — — — Inadequate ventilation (S.4) 94 45 — — — Ineffective drainage of floors (S.6) 20 11 — — — Sanitary Conveniences (S.7) (a) insufficient 27 9 — 5 — (b) Unsuitable or defective 150 67 — 6 — (c) Not separate for sexes 2 — — 1 — Other offences against the Act (not including offences relating to Outwork) 557 440 3 — — TOTAL 1,518 1,183 3 12 Nil SHOPS ACT, 1934. 216 inspections of shops and warehouses have been carried out. The 16 defects found have been remedied after the service of 9 Intimation Notices and without recourse to legal proceedings. CATERING LICENCES. Before issuing licences for the establishment of catering businesses, the Local Food Control Officer refers eases 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 1949, 302 inspections were made in this connection. PHARMACY AND POISONS ACT, 1933. 71 firms were registered under this Act, 65 of which were re-registrations. The two infringements which were noted were all remedied without difficulty on the request of the Medical Officer of Health. 165 inspections were made in connection with the administration of the Act. PHARMACY AND MEDICINES ACT, 1941. The provisions of the above Act were carried out without recourse to legal proceedings and without special difficulty. 60 inspections were made and two contraventions discovered. FERTILIZERS AND FEEDING STUFFS ACT, 1926. The provisions of the above Act were carried out without recourse to legal proceedings and without special difficulty. 73 inspections were made, and eight contraventions discovered. 13 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. Certain pigeon-catchers are authorised by the Corporation to carry out the necessary trapping, and during 1949, 1929 pigeons were destroyed by this means. CITY MORTUARY. Bodies received 71 Post Mortem Examinations made 59 Inquest on bodies 31 Inquests held at Holloway Prison 2 Inquest on fires 3 DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, &c:— No. of articles disinfected 111,824 Cases of horsehair 44 Fees received £519 5s. Od. General Disinfection. Infectious Diseases, &c:— Articles of clothing and bedding disinfected 177 Rooms disinfected after cases of infectious d'sease 41 Lockers at Post Offices disinfected 40 Verminous rooms disinfected 100 Ambulances, vans, &c., disinfected 2 Cleansing of Persons :— No. of scabeous persons bathed 4 No. of verminous persons bathed 200 No. of scabeous and verminous articles disinfected 2,391 Cleansing of Schoolchildren :— No. of children cleansed 2,528 No. of articles disinfected 1,819 LONDON: Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C.I. 1950.