LON76 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1950 STAFF. Date nf MEDICAL OFFICER OF HEALTH. Appoint™',,.. 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 Threadgold, Arthur W. Senior Clerk, Meat Inspector's Office Nov., 1923 Betts. C. I April, 1920 Peters, E. J| General Grade Clerks Nov., 1935 Wilson, J. C Jan., 1936 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., B.Sc. (Estate Management) April, 1935 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 (Resigned) Slatter, Charles Senior Meat Inspector May, 1908 30/7/30 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 Seymour, K. D July, 1935 Bernhardt, D. R. Probstionary Meat Inspector May, 1931 RODENT OFFICER. Carter, J Sept., 1944 Rodent Operatives. Cooper, J. S. (Senior Rodent Operative)Aug., 1943 Tremayne, L. R Nov., 1943 Tanner, H. W Nov., 1943 ( ) Pennycook, J Nov., 1943 ( Resigned) Mason, G. A. Dec., 1946 Brown, R. J May, 1949 ( Resigned) Cardy, E. G June, 1950 Brown, G. JAug., 1950 Rowbottom, C. A Sept., 1950 KEEPER OF THE MORTUARY. Steggles, T Dec., 1918 ( Retired ) Lawrence, F. H May, 1936 DISINFECTING APPARATUS ATTENDANT. Berry, E. F July, 1946 MESSENGERS. Tierney, T. E. (temporary) Dec., 1926 Ascott, J. J. (temporary) Mar., 1947 (Resigned ) Powell, W. F Dec., 1947 MANUAL WORKERS. Burton, John H. (General Duties at Mortuary) Mar., 1936 Carmody, J. (General Duties at Mortuary) Feb., 1950 Sunnick, J. W. T. (General Duties at Mortuary)May, 1950 Ludgate, G. (Senior Porter at Smith field Market) Oct., 1906 Morris, W. F. (General Duties at Smith field Market) Mar., 1925 Prevost, A. C. (General Duties at Smith field Market) Feb., 1926 Mann, Ernest V. (General Duties at Smith field Market) Jan., 1928 Lawrence, Charles J. (General Duties at Smith field Market) Feb., 1928 Graham, Mrs. (Bath Attendant and Cleaner) June, 1927 Scrivener, H. J. A. (General Duties at Smith field Market) Aug., 1950 1 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1950. To the Right Honourable The Lord Mayor. Aldermen and Commoners of the Corporation of London. 55/61, Moorgate, London, E.C. 2. July, 1951. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1950. Vital Statistics. I have repeatedly stated in my Annual Report that owing to the small resident population of the City, the vital statistics are of little value. It so happens that the figures for 1950 work out reasonably, but for 1949 the still birth rate (121.21) and the infant mortality rate (10345) were grotesque. In an endeavour to obtain a more accurate picture, I have added together the estimated population in each of the last 10 years, which gives a population of 50,150, I have then added respectively the births, still births, deaths and infant deaths in each of these ten years, and have calculated the rates as if the population were the sum of the estimates for each of ten years. This gives an average birth rate for the City of 6'37 as opposed to an average rate of England and Wales of 17.0. The birth rate in the City is understandably low because of the nature of the population. The still birth rate is 32.52 as compared with 27.3; the death rate is 12.96 as compared with l1.7: and the infant mortality rate is 39.22 as compared with 43.0. I think that these figures give a more accurate comparison between the vital statistics for the City and for England and Wales than do those for any one year. Infectious Diseases. The incidence of infectious disease in the City during the year calls for no special comment. There was only one case of Poliomyelitis. The number of cases of Tuberculosis notified during the year was 13, which would give a high incidence in relation to the population, but only three were true City residents. Three were members of the staff of a hospital ; three were living in the Salvation Army Shelter in Middlesex Street ; and four gave addresses in the City but were not normally resident. Mass Miniature Radiography. Both employers and employees in the City have recognised the value of Mass Radiography for the early detection of pulmonary tuberculosis, and at each visit of a Mass Radiography Unit the number of requests for examination has been greater than could be dealt with in the time the Unit could stay in the City. At the first visit 15,000 were examined ; at the second 20,000 and at the third 27,000. It became difficult to find suitable accommodation for the Unit, and having heard that the North East Metropolitan Regional Hospital Board were looking for a home for a Mass Radiography Unit, it occurred to me that the ground floor of your premises at 20, Golden Lane, which were not used to capacity, might be suitable. The Public Health Committee agreed, and after discussions with the Regional Hospital Board, rooms were fitted up for undressing, registration, X-ray and dressing, together with a small room for developing and drying films. The part-time use of a room on the first floor for the reading of films was also arranged. The Corporation met the expense of the structural work and decoration, and the Regional Hospital Board provided all the special equipment. The Board pays a nominal rent, and the cost of cleaning and of electricity used for X-ray, heating and lighting. The centre started work on 1st November and has been fully employed ever since. Every occupier of premises in the City is being notified of the existence of the service, but these notices were not sent out all at once, as this would have resulted in long delays between the receipt of requests and the actual examination of volunteers. Close contact is maintained between my department and the Medical Director and Organising Secretary of the Unit, and we send out notices according to the state of the waiting list. Thus a steady flow of examinees is maintained. The Unit also dealt with requests for examination from the Metropolitan Boroughs of Finsbury, Shoreditch, Stoke Newington and Hackney. The results of the examinations carried out by the Mobile Unit which visited the City from September 5th, 1949, to March 22nd, 1950, were as follows:— The total number of persons examined was 26,633 (16,103 males and 10.530 females). In 1,402 (5.36 per cent.) some abnormality was detected in the chest. 1,190 (4-7 per cent.) were recalled for a large-scale film to be taken. 236 (0 89 per cent.) were interviewed by the Medical Director. Active tuberculous disease was found in 101 cases (0.38 per cent.). Inactive tuberculous disease was discovered in 583 cases (2.2 per cent.). A variety of other conditions were found including Bronchitis. Bronchiectasis, Pneumonia, Pulmonary Fibrosis, Tumours, Heart Disease, &c. Food Inspection. The total amount of meat delivered at Smithfield Market was 347,457 tons, of which 230 tons was found by the meat inspectors to be unfit for human consumption and was voluntarily surrendered. In Leadenhall Market and City Shops 68 tons of meat were condemned. 2 At riverside wharves, 508 tons of various foodstuffs were condemned, of which 121 tons were utilised for stock feeding and industrial purposes, and 387 tons were destroyed, being quite useless for any purpose. Every effort is made to ensure that food which is unfit for human consumption is utilised in some other way, but there is always a quantity, particularly of vegetables and fruit, for which no use can be found. Whale Meat. In May a very large consignment of whalemeat arrived in the Port of London bearing a certificate of unfitness for human consumption. The whalemeat was transferred to cold stores in the City and was released, under the supervision of your officers, for animal feeding or industrial purpose. The meat was hard frozen and it was quite impossible to examine it without thawing out. One bag was so treated, but there was no detectable abnormality. The reason for the meat being certified as unfit for human consumption was not ascertained. The Ministry of Food's memorandum on the inspection and hygiene of whalemeat production sets out the criteria of inspection by the veterinary officer in the floating factories and shore stations where whalemeat or whalemeat products are produced. These criteria include in addition to the disease of the whale, maximum times which may elapse between the various processes, killing, bleeding, butchering, cooling and refrigeration. It may be that this large consignment came from whales in regard to which this time schedule had been, for some reason, exceeded. Horsemeat. In November at the request of a Regional Inspector of the Ministry of Food, one of your meat inspectors visited a restaurant in the City and found 10 pieces of meat, weighing about 49 lbs. in a refrigerated cabinet in the kitchen. The proprietor admitted that this was horsemeat. but stated that it was for consumption by himself and his staff. No notice to the effect that horsemeat was served in the restaurant was displayed and there was no mention of horsemeat on the menu cards. The circumstances were referred to the City Solicitor, who decided that the evidence of sale was insufficient to justify legal proceedings being taken against the proprietor. Food Poisoning. There was no outbreak of food poisoning in the City during the year, and only two cases of food poisoning were notified. Both these cases were children in a hospital. One child had been in the hospital for a month, but the source of infection was probably the other child who had been admitted from Winchester and was discovered four days later to have a Salmonella typhi murium infection. There was no further spread. The Medical Officer of Health of Winchester was informed of the circumstances. Food Hygiene. I dealt at some length with this subject in my last Annual Report. Two of your inspectors devote their whole time to the inspection of catering establishments, and at the time of their visits give advice and instructions to the staffs on the principles and practice of food hygiene. I have given careful consideration to the possibility of adopting methods of encouraging food hygiene, such as the establishment of Clean Food Guilds, popular lectures and clean food exhibitions, one or more of which have been tried in various other areas, and which have received a good deal of publicity. I have not been able to evolve any scheme which I feel would give results of real practical value in the City. With few exceptions neither the proprietors nor the employees of the catering establishments live in the City, they arrive in time to prepare for the lunch-time rush, and when it is over, they clear up and go home. The only time to put over to them any propaganda in relation to food hygiene is while they are at work. This is not such a serious disadvantage as it may seem. I believe that health propaganda has to be administered in homeopathic doses at frequent intervals ; too large a dose either causes nausea, or at least is not assimilated, and consequently has no therapeutic value. I therefore feel that the inspectors, by their personal conversations with the staff, achieve better results than would result from formal lectures or films, even if an audience of those most needing instruction could be assembled under conditions in the City. For much the same reason I find it impracticable to start a Clean Food Guild in the City, and moreover I always have the fear that, by ill-chance, an outbreak of food-poisoning would occur in one of the catering establishments to which a certificate had been granted. Not during the year to which this Report refers but during the current year (1951) an outbreak of mild food poisoning, involving over 300 persons, has occurred in a modern well-equipped and well-administered industrial canteen, to which I should have confidently granted a certificate, if such a scheme had been in operation in the City. Neither the type nor the source of infection could be discovered. Unfortunate incidents of this kind will inevitably occur from time to time, despite the best efforts of the officers of a local authority. I have wondered why we have, so far, escaped serious outbreaks of food poisoning, seeing that there are over 1,000 catering establishments in the City, and well over a quarter of a million main meals are served daily. The most probable reason seems to me to be that for the most part food, particularly of the types most commonly associated with food poisoning, is eaten on the day, indeed within a few hours, of its preparation. Consequently, even if the food is contaminated with food poisoning organisms during preparation, there is not time for very considerable multiplication of such organisms and for the elaboration of their toxins in harmful concentrations. Under the conditions which have obtained in the last ten years, food supplies have only been sufficient for the day, so there is perhaps something to be said for a hand to mouth existence. 3 Food and Drugs Act, 1938, and Food Regulations. Mr. Harrington, the Sampling Officer under the Food and Drugs Acts, reports as follows:— 432 samples have been submitted to the Public Analyst; 31 of these were formal samples and 401 were informal samples. Eleven samples were reported against. The percentage of adulterated samples was 2.5. Legal proceedings were instituted in three cases and in four other cases cautions were administered. Thirty samples of milk were examined by the Phosphatase and Methylene Blue Tests, one of them being examined bacteriologically also. Three other samples were examined bacteriologically, and one in addition was especially examined for the presence of æ hæ hæmolytic streptococci. A sample of sterilised milk was examined by the Turbidity Test. The Methylene Blue test gives an indication of the keeping quality of the milk which, among other things, is dependent upon cleanliness. The especial examination for the presence of hæmolytic Streptococci was made on a sample taken from milk supplied for consumption by children at a kindergarten school. The sample was taken at the request of the visiting nurse on account of some throat infection occurring. The Bacteriologist reported, however, that no hæmolytic streptococci were found in the sample. A further sample taken at the same time and from the same consignment and submitted to the Phosphatase and Methylene Blue tests was found to be quite satisfactory on both tests. The Turbidity Test is peculiar to sterilised milk and the method of applying the test is set out in Part IV of the Third Schedule of the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, which Regulations for the first time brought sterilised milk under the heading of a specially designated milk. Ice Cream. During the year, 16 samples of ice cream were submitted to the Bacteriologist for examination by the Methylene Blue test, two of them being examined bacteriologically also. Three were placed in Grade 1, nine in Grade 2, two in Grade 3, and two in Grade 4. In the cases of Grade 3 and Grade 4 samples, the results of our examination were communicated to the Medical Officers of Health of the Districts in which the ice cream was manufactured. In one case it was stated that the premises where the ice cream was manufactured were satisfactory, with modern machinery but some congestion. The manufacturers obtained additional premises and subsequent samples showed an improvement. Ten new registrations of premises for the sale and storage of ice cream were granted during the year. Artificial Creme. This is a product used by the confectionery trade for the filling of pastries, meringues, &c., and the term is so used to distinguish it from "artificial cream" as defined in the Food and Drugs Act, 1938. There are two types in general use: viz., "butter creme" and "synthetic creme." These are purely trade terms. The finished butter creme cannot be subjected to heat treatment, but the synthetic creme can, and in view of the ever increasing consumption by the public of both these substances, a small number of samples was taken in the City and submitted to the Bacteriologist for examination. These samples were taken at the close of the year, and insufficient data has yet been obtained to form definite conclusions, but from the adverse reports of the Bacteriologist it was considered necessary to continue the sampling. Housing. The total number of housing applications outstanding on December 31st, 1950, was 402, comprising 1,008 persons. The number of families rehoused during the year was 35, comprising 77 persons. This figure includes 21 families (57½ persons) transferred within property under the Corporation's control. Progress was made with the scheme for the erection of 45 flats to accommodate a maximum of 197 persons on a site in the Old Kent Road. Further progress was also made in regard to the acquisition of a site in Golden Lane, partly in the City and partly in the Metropolitan Borough of Finsbury, for the erection of some 300 separate du ellings. Atmospheric Pollution. In my last Annual Report a detailed description was given of the apparatus for the measurement of atmospheric pollution installed at Golden Lane and Finsbury Circus Gardens, together with an explanation of the purpose and meaning of the various observations made. I am indebted to Mr. W. R. McGrath, the member of my staff in charge of the instruments for measuring atmospheric pollution, for the following report. The results of the observations for 1950 are given in the Tables overleaf. In Table 1 the mean monthly rate of deposit in the deposit gauge at Golden Lane are compared with the previous year and the year 1939. It will be found there is a significant increase in the total solids deposited. 1950 was the second complete year of the re-commencement of observations since the original deposit gauge was destroyed by enemy action in 1940. In the absence of the figures used for a "general average " (normally a period of five complete years) it is not possible by comparison to indicate to what extent the deterioration may be due either to variations in rainfall and other factors connected with the weather, or to an unusual occurrence of local or other pollution. It is known that the amount of rainfall influences the amount of soluble matter deposited, and the rainfall during the year was very high. The monthly average of the rain collected in the gauge in 1950 was 38 millimetres (1.5 inches) compared with 28 millimetres (11 inches) in 1949. The increase in the undissolved matters, a high proportion of which is deposited near its source, may be partly due to the dust from the demolition of near-by war-damaged buildings, and an acceleration of the clearance of a large 4 dump on neighbouring land of the hard-core of demolished street air raid shelters. Having regard to Table 2, which compares the results obtained in Golden Lane with stations in other areas, the main reason for the upward general trend of deposit is probably the prolonged inclement weather experienced in most parts of the country during the year. In Table 3 the results indicate a general decrease in the concentration of suspended impurity in the air. Since the main source of this soot and tar pollution is the domestic fire, burning raw coal, the shortage of adequate supplies of this fuel may account for the reduction in the concentration. Table 4 is a comparison with other stations of the mean monthly concentration of sulphur dioxide observed by the volumetric method. There is an increase of 0.0l parts per million of sulphur dioxide in the City. In two of the other three stations for which results are given, the figures are the same as for 1949. The third shows a decrease. The concentration of sulphur dioxide varies considerably from day to day and from hour to hour. In the month of November, 1950, when all kinds of weather were experienced, varying from dense fog to gales with heavy rain, the daily mean concentration was 0.154 parts per million. The highest daily figure recorded during the month was 0.326 and the lowest 0.052. Table 5 records the results of observations by the lead peroxide method for determining the concentration of sulphur dioxide. This method is designed to give a measure of the activity of attack of the sulphur upon buildings, building stones and materials. The results are not strictly comparable with the volumetric method as other factors besides the concentration have an effect in influencing the activity of attack, e.g., in winter the surface of lead peroxide is usually moister, and consequently more reactive, than in summer, and for the same reason the exterior surface of buildings are also more liable in winter than in summer to attack by sulphur dioxide. The results in Table 5 indicate a reduction of the concentration in the City and the other places chosen for comparison. DEPOSITED MATTER. Table 1. Mean Monthly Rates of Deposit at Golden Lane. Tons per square mile. 1949 1950 Total Solids 18.72 27.15 Total undissolved matter 8.74 10.19 Tarry matter 0.68 0.52 Other combustible matter 1.90 2.75 Ash 6.16 6.85 Total dissolved matter 9.99 16.96 Calcium 1.56 3.35 Chloride 1.92 2.17 Sulphate 3.13 3.63 Table 2. Comparison of Total Solids deposited during 1938/39, 1949 and 1950 at Golden Lane Godalming, Walsall and Westminster. Tons per sq. mile per month. Year ended 31 3 1939 31/12 1949 31 12/1950 London— Golden Lane 21.83 18.72 27.15 Westminster 22.30 21.32 37.59 Godalming 4.61 5.97 6.37 Walsall 19.28 15.25 22.34 SUSPENDED IMPURITY. Table 3. Comparison of the Mean Monthly Concentration of Suspended Impurity by the Volumetric Method. M illiqrams per 100 cubic metres. 1949 1950 Golden Lane 10.15 9.98 Birmingham 30.30 23.10 County Hall, London 31.50 25.53 Rye 0.018 1.40 Salford 64.83 53.75 SULPHUR DIOXIDE. Table 4. Comparison of the Mean Monthly Concentration of Sulphur Dioxide by the Volumetric Method. Parts per million of Sulphur Dioxide. 1949 1950 Golden Lane 0.09 0.10 Westminster 0.09 0.09 Bilston 0.10 0.07 Crossness 0.03 0.03 Table 5. Comparison of the Mean Monthly Concentration of Sulphur Dioxide by the Lead Peroxide Method. Milligrams of S03 per 100 cm2 1949 1950 City of London. Golden Lane 2.74 2.66 Finsbury Circus Gardens 2.53 2.32 Godalming 0.42 0.27 Walsall 2.83 2.74 Westminster 2.95 2.75 5 Rat Repression. Mr. J. Carter, your Rodent Officer, reports as follows:— Organisation and procedure during 1950 have been similar to those of previous years, and in compliance with the requirements of the Prevention of Damage by Pests Act, 1949, 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 3,217 premises were inspected, comprising blocks of offices, riverside wharves, markets, restaurant kitchens, workshops and domestic dwellings. During the year, 846 infestations of rats and / or mice were treated; 9,280 operational visits were made ; 129,295 pre.baits and 1,719 poison baits were laid. These measures resulted in an estimated minimum kill of 4,370 rats, and of this number 1,632 bodies or 37 per cent, were found. Trapping was the means of destroying 605 rats, and added to those found as the result of poison, a total of 2,237 bodies were removed from the premises. In addition, the bodies of 710 mice, killed by poisoning, were found. No records are available of the number of rats destroyed by Pest Control firms servicing premises periodically 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 1,448 rats and in December 1,450 rats. Rat proofing has been advised and carried out where practicable, and in several instances has entailed extensive repair work and structural alteration. Equal attention has also been given to incidental rat-proofing. Pre-baiting and poisoning has been the principal means of control, and trapping a secondary measure. The technique advised by the Infestation Division of the Ministry of Agriculture and Fisheries has been strictly adhered to with satisfactory results. Disposal of the Dead. The Corporation of London established a Crematorium in their Cemetery at Manor Park in 1905 and in that year nine cremations were carried out there. Progress in the adoption of cremation as an alternative to earth burial was slow. In 1910 there were 22 cremations at Manor Park; in 1920 58; in 1930, 112; and in 1940, 574. Since the war progress has been very rapid, and in 1950 the number of cremations was 1,857. Experience in crematoria throughout the country is similar. Many local authorities plan to build crematoria, but because of the shortage of building materials and labour, have not been able to obtain authority to proceed. There is little doubt that when it is possible to provide crematoria reasonably accessible from any part of the country, cremation will replace earth burial as the usual method of disposal of the dead. There are still only two furnaces (coke fired) at Manor Park, but two new electric furnaces and a new chapel are in course of construction and will be in operation before the end of 1951. Your Medical Officer of Health is firmly of the opinion that from every point of view cremation is the best method of disposal of the dead. At the request of the Cremation Society he wrote the following for the Society's series of propaganda pamphlets entitled " Why I support Cremation":— A Medical Officer of Health considers cremation from three points of view; as an individual: as a member of the medical profession ; and as an administrator concerned with the health and welfare of the community. As individuals we may prefer not to contemplate what happens to the body after death, but to think only of the dead as we knew them in life and of the spirit which has departed from its earthly habitation. But some of us, particularly in time of war, have our attention forcibly directed to the fate of the human body after death. It is then that many of us receive a shock and determine that for ourselves and for those whom we can influence, there shall not be, after death, the slow decay of that body, which in life we have endeavoured to preserve at least in dignity and grace, if not in beauty. So we become advocates of the only means of disposal which, in minutes rather than years, converts the body into the simple elements of which it is composed. As members of the medical profession we have seen death at every age ; before the mind is conscious of the body ; when the mind is still rejoicing in the strength and beauty of the human form; and finally when the mind is weary of the body and wishes only for the release of the spirit from it. We have seen death when the body has been sadly mutilated by violence or disease and. though we preserve life by every means in our power, we feel that, when death comes and the spirit has returned to God who gave it, the body should be disposed of with all reverence, but with all speed. As Medical Officers of Health we are concerned with the community rather than the individual; but a community is the sum of the individuals composing it, and therefore we, must consider the effect of individual action on the welfare of the community. We must ask ourselves whether the method of disposal of the dead may adversely affect the living. First of all, does burial of bodies in the earth endanger the public health. It is obvious that pollution of the soil occurs in graveyards and cemeteries, but is such pollution likely to spread disease, particularly in relation to the interment of persons who have died from infectious illness? If such were the fact, it might be necessary in the interests of the public health, to make cremation compulsory, at least in cases of death from certain diseases. Fortunately the germs of disease do not long survive in the dead body, and the bodies of those who have died of infectious disease are treated in such way as is necessary to protect those who may be called upon to perform the last rites. There is therefore no evidence that, in a community highly organised for the protection of the public health, the interment of the dead is a direct menace to the living. But there are indirect influences, both physical and psychological, which should not be ignored. As regards the physical influences : in this crowded island, and particularly near the populous towns, open spaces for out-door recreation for both old and young are difficult to find, since all available land is needed for housing, for factories and business premises, or for agriculture, in order that by our industry and agriculture we may at least maintain the standard of living of our vast 6 population. It is not generally realised that, taking the average for the country as a whole, one acre of ground is required for every thousand interments. The annual number of deaths is approximately half a million, so that every year some 500 acres of precious land is occupied anew by the dead, and the land available for the living is by so much reduced. Five hundred acres a year, ten thousand acres in twenty years rendered useless, unproductive, unenjoyable ! Surely this land would be better utilised as parks, as playing fields, as sites for houses and gardens, or even as factories and offices, to increase the amenities and the standard of living of our growing population. If cremation were to be generally adopted, small gardens of rest in themselves beautiful and quiet, and as such, places of recreation for older people, would require only a small proportion of this land, and annual increase would not be necessary. More land would then be available for open spaces or such other purpose as local planning might require in the interests of the community. Secondly, in the matter of the physical influences of the practice of interment of the dead, is the fact that relatives and friends attending the ceremony are exposed at the grave-side to inclement weather in winter, when the majority of deaths take place. Unnecessary illness and even deaths result and respiratory infections are disseminated. As regards the psychological influences of interment; "let's talk of graves, of worms and epitaphs." Is it good for the living that they should wander among the tombs where everything speaks of death and decay and in a generation or two, of forgetfulness and neglect ? Would it not be better for those who wish to commune with their dead to visit a lovely, well-tended garden of rest, where they may recall the happy days of their companionship and from pleasant memories in peaceful, beautiful surroundings, draw new strength to carry on alone? Surely, all who love simplicity, peace and beauty; all who have faith in, hope for, and charity towards the generations that are following on, will feel, or on reflection will come to feel, that disposal of the dead should be by cremation." Medical Examinations. Your Medical Officer carries out the medical examination of all new entrants to the staff of the Corporation; of those who appear to be medically unfit to continue in employment and of those who have had prolonged or repeated absence on account of illness. In connection with the two last mentioned categories, it is frequently necessary to correspond with medical and surgical specialists on the staffs of hospitals and with general medical practitioners, and I have pleasure in recording that I have always received from them the greatest assistance and courtesy. The total number of medical examinations during the year was 213. Staif. The members of your staff in this department 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 three occasions. Mr. L. B. A. Grace, who was appointed Veterinary Officer and Chief Meat Inspector in 1934, was seconded to the Ministry of Food in the early days of the war. Mr. Grace remained with the Ministry after the war, and on 30th July resigned from his position in the City, having been appointed to the permanent staff of the Ministry of Food. The Public Health Committee decided to recommend that the appointment of Veterinary Officer at Smithfield Meat Market should be discontinued, and that the Senior Meat Inspector, Mr. C. Slatter, who has 43 years' experience in meat inspection, should be appointed Chief Meat Inspector, and Mr. S. B. Murray, who has 39 years' experience, should be appointed Deputy Chief Meat Inspector. The recommendations were approved by the Court of Common Council and subsequently by the Ministry of Health. On account of the increase in the work at Smithfield Market, the number of Meat Inspectors on the Establishment was increased, and Mr. K. Seymour, one of the Probationary Inspectors who had obtained his full qualifications, was appointed as a Meat Inspector. During the year three of the Rodent Operatives resigned, and I regret to report that one of them, Mr. J. Pennycock, has since died. One of the Messengers, who was over 70 years of age, resigned on account of ill-health, and one of the porters at the Meat Inspector's Office was appointed in his place. I have the honour to be, Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health. 7 STATISTICAL INFORMATION. Area.--661 acres (including the Temple and Tidal Water and foreshore). Population.—Registrar-General's estimate for 1950, 4,870. Annual Rateable Value.—As at October, 1950, £6,428,103. Annual Sum received from Penny General Rate.—Estimated £26,500. Births:— Total. M. F. Legitimate 37 18 19 Live Births, Illegitimate 1 1 — Still Births 1 — 1 Birth Rate per 1,000 estimated resident population, 1950 6.87 Rate per 1,000 total (live and still) births 25 64 Deaths:— Deaths under 1 year 1 1 — Deaths (all ages) 62 38 24 Death Rate per 1 ,000 estimated resident population. 12.73 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 26 32 Legitimate Infants per 1,000 legitimate live births 27.03 Illegitimate Infants per 1,000 illegitimate live births INFECTIOUS DISEASE. Notifications received — Total cases notified. Poliomyelitis 1 Scabies 1 Measles 2 Scarlet Fever 9 Tuberculosis 13 Erysipelas 1 Whooping Cough 2 Food Poisoning 1 Puerperal Pyrexia 1 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 6 contacts and appropriate action taken. ANALYTICAL EXAMINATIONS. (Other than under Food and Drugs Act). Atmospheric Pollution 32 Bread (with fat) 2 Coffee Berries 2 Confectionery 11 Cake filling 1 Crystallised Fruit 1 Fish (tinned) 1 Fruit (tinned) 6 Molasses 1 Nuts 1 Meat (ti0nned) 5 Pickles 8 Rainwater 1 Sausages 1 Soup (tinned) 1 Tomato Paste 1 Vegetables (tinned) 10 Water 1 BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year:— Throat swabs 2 Sputa 4 Ham Sandwich 1 Fish (tinned) 2 Fruit (dried) 2 Meat (tinned) 9 Poultry 1 Rabbits 1 Sausages 3 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. 8 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1950. Nett Deaths at the subjoined ages of Residents whether occuring within or without the district. Causes of Death All Ages Under 1 year 1 and under 5 years 5 and under 15 yea rs 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 and upwards 1 2 3 4 5 6 7 8 9 10 All Causes 62 1 — — 1 2 22 17 19 1. Tuberculosis, respiratory M 3 — — — — — 3 — — F 2. Tuberculosis, other forms M 1 — — — — — 1 — — F — — — — — — — — — 3. Syphilitic disease M — — — — — — — — — F 1 — — — — — 1 — — 4. Diphtheria M — — — — — — — — — F — — — — — — — — — 5. Whooping Cough M — — — — — — — — — F — — — — — — — — — 6. Meningococcal infections M — — — — — — — — — F — — — — — — — — — 7. Acute poliomyelitis M — — — — — — — — — F — — — — — — — — — 8. Measles M — — — — — — — — — F — — — — — — — — — 9. Other infective and parasitic disease M — — — — — — — — — F 1 — — — — — 1 — — 10. Malignant neoplasm—stomach M 4 — — — — — 1 2 1 F 1 — — — — — — — 1 11. Malignant neoplasm—lung, Bronchus M 1 — — — — — — — 1 F — — — — — — — — — 12. Malignant neoplasm—breast M — — — — — — — — — F 1 — — — — — 1 — — 13. Malignant neoplasm—uterus M — — — — — — — — — F 1 — — — — — 1 — — 14. Other malignant and lymphatic neoplasms M 5 — — — — — 2 1 2 F 3 — — — — — 1 2 — 15. Leukaemia, aleukæmia M 1 1 — V — — — — — — — — — 16. Diabetes M 1 — — — — — 1 — — F — — — — — — — — — 17. Vascular lesions of nervous system M 1 — — — — — — 2 — F 1 — — — — — — — 1 18. Coronary disease, angina M 5 — — — — — 2 2 1 F 6 — — — — — 2 2 2 19. Hypertension with heart disease M 3 — — — — — — 2 1 F 1 — — — — — 1 — — 20. Other heart disease M 4 — — — — — 1 1 2 F 4 — — — — — — 1 3 21. Other circulatory disease M — — — — — — .— — — F — — — — — — — — — 22. Influenza M — — — — — — — — — F — — — — — — — — — 23. Pneumonia M 1 — — — — — —_ 1 — F 1 — — — — — — — 1 24. Bronchitis M 3 — — — — — — 1 2 F 1 — — — — — I — — 25. Other diseases of respiratory system M 1 — — — — — 1 — — F — — — — — — — — — 26. Ulcer of Stomach and duodenum M — — — — — — — — — F — — — — — — — — — 27. Gastritis, enteritis and diarrhoea M — — — — — — — — — F — — — — — — — — — 28. Nephritis and nephrosis M 1 — — — — 1 — — — F 1 — — — 1 — — — — 29. Hyperplasia of prostate M — — — — — — — — — F — — — — — — — — — 30. Pregnancy, childbirth, abortion M — — — — — — — — — F — — — — — — — — — 31. Congenital malformations M — — — — — — — — — F — — — — — — — — — Carried forward M 35 — — — — 1 12 12 10 F 23 — — — 1 — 9 5 8 9 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1950—continued, Nett Deaths at the subjoined ages of Residents whether occuring within or without the district. Causes op Death All Ages Under 1 year 1 and under 5 years 5 and under 15 years 15 and : under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 and upwards 1 2 3 4 5 6 7 8 9 10 Brought forward M 35 — — — — 1 12 12 10 F 23 — — — 1 — 9 5 8 32. Other defined and ill-defined diseases M 3 1 — — — — 1 — 1 F 1 — — — — 1 — — — 33. Motor vehicle accidents M — — — — — — — — — F — — — — — — — — — 34. All other accidents M — — — — — — — — — F — — — — — — — — — 35. Suicide M — — — — — — — — — F — — — — — — — — — 36. Homicide and operations of war M — — — — — — — — — F — — — — — — — — — M 38 1 — — — 1 13 12 11 F 24 — — — 1 1 9 5 8 MEAT INSPECTION. Tons. Cwts. Qrs. Lbs. Meat, &c., delivered at Smithfield Market 347,457 0 0 0 Meat, &c., seized by Inspectors at Smithfield Market 230 5 3 23 Meat, &c., seized by Inspectors at Leadenhall Market and City shops 68 12 1 0 Meat, &c., seized by Inspectors at Cold Stores 28 3 0 27 Various commodities seized by Inspectors and sent to Lett's Wharf 15 17 2 22 Number of eggs seized bv Inspectors and sent to Lett's Wharf, 19,361 Number of demonstrations and lectures given, 40. PUBLIC HEALTH (MEAT) REGULATIONS, 1924-1948. 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. 12 infringements were noted, the fault being 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. 508 tons 11 cwts. 2 qrs. 6 lbs. were condemned as unfit for human consumption. 120 tons 19 cwts. 3 qrs. 2 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 387 tons 11 cwts. 3 qrs. 4 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. 162 tons 11 cwts. 0 qrs. 12 lbs. of food were placed under stop and subsequeutly released to be dealt with under the supervision of other local authorities. SANITARY CIRCUMSTANCES. The general sanitary supervision has been maintained and in this connection 4.347 inspections have been made. As a consequence of these inspections, it was necessary to serve 19 Intimation Notices. Three 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 34, in 18 of which 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 three of these houses. 10 FACTORIES ACTS, 1937 and 1948 Factory premises have been under such supervision as is necessary, and the following gives details of the work carried out:— PART I. OF THE ACT. 1.—INSPECTIONS for purposes of provisions as to health. Premises Number on Register Inspections Number of Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 1,109 (including 601 kitchens) 1,898 (including 1,218 kitchens) 277 (including 203 kitchens) — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 441 386 60 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — TOTAL 1,550 2,284 337 — 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.) 423 484 — — — Overcrowding (S.2) — 2 — — — Unreasonable temperature (S.3) 8 6 — — — Inadequate ventilation (S.4) 03 43 — — — Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7) 18 8 — — — (a) insufficient 3 1 — 3 I (b) Unsuitable or defective 221 140 — 7 — (c) Not separate for sexes 12 3 — 3 Other offences against the Act (not including offences relating to Outwork) 601 313 5 — — TOTAL 1,349 1,000 5 13 1 SHOPS ACT, 1950. 137 inspections of shops and warehouses have been carried out. The 36 defects found have been remedied after the service of 15 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 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 1950, 169 inspections were made in this connection and reports forwarded to the City Food Controller. PHARMACY AND POISONS ACT, 1933. 68 firms were registered under this Act, 62 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. 102 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. 14 inspections were made and one contravention 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. 31 inspections were made, and 18 contraventions discovered. 11 MERCHANDISE MARKS ACT, 1926. AGRICULTURAL PRODUCE (GRADING AND MARKING) ACTS, 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 1950, 1,730 pigeons were destroyed by this means. CITY MORTUARY. Bodies received 65 Post Mortem Examinations made 60 Inquest on bodies 25 Inquests held at Holloway Prison — Inquest on fires DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, &c.:— No. of articles disinfected 631,622 Cases of horsehair 17 Fees received £2,153 7s. 0d. General Disinfection. Infectious Diseases, &c.:— Articles of clothing and bedding disinfected 384 Rooms disinfected after cases of infectious disease 46 Lockers at Post Offices disinfected 39 Verminous rooms disinfected 128 Ambulances, vans, &c., disinfected 1 Cleansing of Persons:— No. of scabeous persons bathed 2 No. of verminous persons bathed 272 No. of scabeous and verminous articles disinfected 2,847 Cleansing of Schoolchildren:— No. of children cleansed 2,237 No. of articles disinfected 1.393 LONDON : Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenuf, E.C. I. 1951. 100—7/51