AC 434 * • • LON 78 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1952 STAFF. MEDICAL OFFICER OF HEALTH. Date of Appointment. White, Charles Francis, O.B.E., M.D., Ch.B., D.P.H., D.T.M. Dec., 1937 CLERICAL STAFF. Gray, Charles M. 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. General Grade Clerks April. 1920 Peters, E. J. Nov., 1935 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 Campbell, J. W. Sep., 1946 Thompson. E. Sept1948 Flynn, J. July, 1951 MEAT INSPECTION STAFF. Mellish, Cyril E. Chief Meat Inspector Jan., 1912 Thompson, Frank E. Deputy Chief Meat Inspector July, 1924 Lee, W. R. Meat Inspectors July, 1930 Garrard, S. S. Sept., 1946 Morris, W. L.. Sept., 1946 Seymour, K. D. July, 1935 Wilson, J. C. Jan., 1936 Leach, R. A. Sept., 1952 Bernhardt, D. R. Probationary 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 Mason, G. A. Dec., 1946 Cardy, E. G. June, 1950 Brown, G. J. Aug., 1950 Clayton, G. Nov., 1951 KEEPER OF THE MORTUARY. Lawrence, F. H. May, 1936 DISINFECTING APPARATUS ATTENDANT. Berry, E. F. July, 1946 MESSENGERS. Tierney, T. E. (temporary) Dec., 1926 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 Smithfield Market) Oct., 1906 Morris, W. F. (General Duties at Smithfield Market) Mar., 1925 Prevost, A. C (General Duties at Smithfield Market) Feb., 1926 Mann, Ernest V. (General Duties at Smithfield Market) Jan., 1928 Lawrence, Charles J. (General Duties at Smithfield Market) Feb., 1928 Scrivener, H. J. A. (General Duties at Smithfield Market) Aug., 1950 Rowe, Mrs. L. E. (Bath Attendant and Cleaner) June, 1951 1 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1952. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. 55/61, Moorgate, London, E.C. 2. September, 1953. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1952. Vital Statistics. Between the Census of 1931 and that of 1951 the resident population of the City declined from 10,999 to 5,268, a decrease of 52.1 per cent., and it is still slowly decreasing. On the other hand the day-time population is estimated to be about half a million and is increasing pari passu with the rebuilding of the City. There are many people who would be glad to live in the City. First of all those who have to get the City ready for the influx of daily workers and those who have to clean up after the evening exodus; then there are those connected with the press and with the markets, who are at work very late or very early. There must be many others who would appreciate the peace of the City at night and at week-ends with, at the same time, easy access to the social amenities of the West End. But land values appear to make the cost of housing prohibitive, certainly for the lower income groups, much as the Corporation would like to provide for them within its own boundaries; and presumably, since no developers have come forward with schemes for blocks of flats, it is considered that building costs would be too high to make the housing of the higher income groups remunerative. It may be that ultimately there will prove to be areas within the square mile which are surplus to the requirements of commercial development and which would still be quiet backwaters in which attractive residential accommodation might be built, but there can be no decision on this point until the demands of commerce have been satisfied. On the one hand is pride in the status of the City as a centre of commerce, on the other a feeling that a city cannot continue to be a living entity without citizens. With such a small residential population the vital statistics, birth rate, death rate, infant mortality rate, etc., are, as I have said year by year, of little value for comparison with the country as a whole or other areas or indeed with the figures for the City in previous years. For example, with only 37 births the death of a single infant makes a difference of 27 in the death rate per 1,000 births. In 1951 the infant mortality rate for England and Wales was 29.7, so that with only two infant deaths in the City the infant mortality rate of 54.05 appears as nearly double that for the country as a whole. Infectious Diseases. The incidence of infectious diseases in the City during the year calls for no special comment. Many enquiries are received from business houses in regard to the action to be taken in regard to employees who are contacts with infectious diseases. The number of cases of Tuberculosis notified was 11 as compared with 17 in the previous year. Mass Radiography. The Mass Radiography Unit of the North East Metropolitan Regional Hospital Board continued to operate from your premises at 20, Golden Lane and your Medical Officer continued to notify firms in the City of the facilities, at such a rate as was necessary to ensure a steady flow of examinees to the Unit. During the year the Unit examined 50,908 persons. Some 26,000 of these were referred through my Department. The remainder came from the Metropolitan Boroughs of Finsbury, Shoreditch and Stepney or from firms in the City who had previously sent members of their staff for examination and made subsequent arrangements direct with the Unit. The Medical Director of the Unit has sent me a copy of his Annual Report for the year 1952, from which I have extracted the following table:— TUBERCULOUS LESIONS CLASSIFIED IN AGE GROUPS. Male. Type of Disease. Age Group 14 Age Group 15-24 Age Group 25-34 Age Group 35-44 Age Group 45-59 Age Group 60 + Active Primary 1 1 1 — — — Inactive Primary 2 81 174 191 175 26 Active Post-Primary unilateral including T.B. Pleural Effusion — 11 14 8 5 1 Active Post-Primary bilateral — 1 6 5 5 1 Inactive Post-Primary 29 | 140 171 279 43 Total Male Examinees 29,794 Total Male cases of Active T.B. 60 Ratio per 1,000 Active T.B. 2.01 2 TUBERCULOUS LESIONS CLASSIFIED IN AGE GROUPS—continued Female. Type of Disease. Age Group 14 Age Group 15-24 Age Group 25-34 Age Group 35-44 Age Group 45-59 Age Group 60 + Active Primary — — — — — — Inactive Primary 1 126 88 44 41 2 Active Post-Primary unilateral including T.B. Pleural Effusion — 23 9 — — — Active Post-Primary bilateral 1 13 3 4 — — Inactive Post-Primary — 52 48 47 51 5 Total Female Examinees 21,114 Total Female cases of Active T.B. 53 Ratio per 1,000 Active T.B. 2.51 A large number of other diseases of the heart and blood vessels, lung and diaphragm, were disclosed by the examinations. It is a very great convenience to have a Mass Radiography Unit so readily accessible and full use is made of it; indeed the demand for examinations taxes the resources of the Unit to the utmost. The Medical Director and the Organising Secretary have co-operated closely with my Department, and have been most helpful, particularly when cases of pulmonary tuberculosis amongst City workers have been notified and it has been desirable to examine other persons who have worked in close contact with them. Food Inspection. The total amount of meat delivered at Smithfield Market was 300,244 tons. Two hundred and sixty five tons were found by the inspectors to be unfit for human consumption and werevoluntarily surrendered. In cold stores 16 tons of meat, and in Leadenhall Market and City shops 14 tons of foodstuffs were condemned. A great variety of foodstuffs is delivered at riverside wharves in the City, and 329 tons were found to be unfit for human consumption. Whenever foodstuffs which are unfit for human consumption can be used for other purposes, such as feeding stuffs for animals, the manufacture of fertilisers, or the extraction of fat for industrial purposes, they are so disposed of, subject to proper safeguards, but 158 tons were useless and were destroyed by the Cleansing Department. Food Poisoning. Only two cases of Food Poisoning were notified amongst residents in the City, but in addition two outbreaks in canteens where non-residents were involved, were investigated. Both the notified cases were isolated cases, both died in St. Bartholomew's Hospital and both were the subject of a Coroner's inquest. The first actually died on December 7th, 1951, but was not notified by the hospital till 2nd January, 1952, though I was informed of the death and the suspected cause immediately by the Mortuary Superintendent. The Coroner found that death was due to acute Gastro-enteritis of food poisoning type. I have already reported this case in detail to the Public Health Committee and to the Ministry of Health. If it was a case of food poisoning it could, so far as I could ascertain, only be due to the consumption of canned salmon. The few scraps of fish remaining in the particular can and samples from similar cans were found to be bacteriologically sterile and chemically free from significant metallic contamination. Over 9,000 cans of the same consignment had been distributed and no reports of any illness amongst other consumers had been reported. In my experience, food poisoning from canned salmon is uncommon, and in this case the can was from a first class pack. The cause of the acute Gastro-enteritis remains a mystery, but may have been individual idiosyncrasy. The second notified case was indisputably one of bacterial food-poisoning. The patient suffered from severe and persistent diarrhoea, and after some 60 hours was transferred to St. Bartholomew's Hospital. Eight hours later he died. Bacteriological examination of faeces revealed an infection with Salmonella montevideo, and the finding at the Coroner's inquest was " death from misadventure due to enteritis caused by Salmonella montevideo." Again I received the first intimation of the case from the Mortuary Superintendent, and consequently it was impossible to ascertain what the deceased had eaten at the significant time, and careful enquiry at the restaurant where he normally took his meals did not reveal anything suspicious. There had been no other complaints, no illness amongst the staff, and the hygienic conditions were satisfactory. The deceased had suffered from duodenal ulcer, and in 1951 had undergone the operation of partial gastrectomy. It seems possible that he had lost the degree of protection that the acidity of the stomach contents affords, and that he may have fallen a victim to a mild infection which would produce no symptoms in a normal healthy person. Of the two outbreaks of food-poisoning, one was in a school canteen and the other in a commercial canteen ; both were mild in type. In the school canteen, the meal was delivered from a central kitchen and was consumed within an hour or so. No other school was affected though many received a similar meal. It seems probable that the outbreak may have been due to one of the containers, probably that in which custard was delivered, not having been adequately cleansed after a previous use, because the infants who were 3 served first escaped unscathed, while those children and members of the staff who were served later with custard which had stood in contact with the sides and bottom of the container were affected. No samples of the suspected food were available for examination. The outbreak in a commercial canteen appears definitely to have been due to heat resistant Clostridium welchii, and this organism was recovered from two samples of faeces submitted to the Food Hygiene Laboratory at Colindale. The food responsible was imported pigs hearts. These were received in a hard frozen condition on a Friday and were put in a refrigerator in the canteen. After lunch on the following Monday, the chef cleaned the pigs' hearts and put them into cold water in two large boilers. They were then boiled for about an hour and a half, but the chef admitted that it would take at least three-quarters of an hour for the large quantity of cold water plus the frozen hearts to come to the boil. The hearts were therefore actually boiled for half-an-hour or less. They were then taken off the cooking range and left to stand in the warm water in the kitchen till about 10 o'clock next morning, some 17 or 18 hours. They were then heated again for one hour, which means that they were at boiling point for less than half-an-hour. The conditions for survival and multiplication of a heat resistant strain of Clostridium welchii were therefore ideal ; some 17 hours in warm water from which the air had been driven out during the short period of boiling. The pigs hearts in question were only a small part of a consignment of 1,000 lbs. distributed by an Acton butcher, and at my request the Medical Officer of Health of Acton kindly enquired as to the distribution of the remainder; whether they had given rise to any cases of food-poisoning, and whether they had been cooked and eaten the same day. It was ascertained that the remainder of the consignment had been distributed to a hospital and six staff canteens in the Acton area. The hearts had been cooked and eaten on the same day in six instances, and in the seventh instance, though they had been eaten the day after cooking they had been kept overnight in a refrigerator. Though I reported in detail on this occurrence at the time to the Public Health Committee and to the Ministry of Health, I have thought it worth while including a full summary in my annual report because it is a classical example of an outbreak of food-poisoning due to heat resistant Clostridium welchii, and demonstrates clearly the danger of insufficient cooking, followed by a number of hours of storage at room temperature or higher and then merely warming up just before serving. Pigs hearts from the same consignment were dealt with in eight different kitchens. In six they were cooked and eaten on the same day and no food-poisoning occurred. In one instance they were cooked one day and eaten the next but were placed in a refrigerator overnight, again no food-poisoning occurred. In the eighth case they were cooked one day, stored in the water in which they had been boiled in a warm kitchen overnight, raised to the boil next day and served, and about 60 cases of food-poisoning resulted. The symptoms were abdominal pain and diarrhoea coming on from 6 to 18 hours after the meal. There was no vomiting. Most of the patients were at work the next day, though some still complained of looseness of the bowels. I believe that all had recovered in 48 hours, except one who had a relapse and was ill for a week. The cooking of meat in the afternoon of one day for consumption at luncheon the next day is quite a common practice in canteens, because there often is not time to prepare large quantities of food between the time of arrival of the kitchen staff in the morning and noon, when the service of lunch commences. This practice is not dangerous if the food is rapidly cooled after cooking and kept cool overnight. The danger is greater in restaurants and canteens than in domestic kitchens because the bulk of the food is greater, consequently the penetration of heat in cooking is slower and subsequent cooling is also slower. There is therefore more chance of organisms surviving and more time at a suitable temperature for survivors to multiply than is the case with the smaller quantities dealt with in ordinary home-cooking. It is, however, quite probable that many cases of mild food-poisoning of this type occur in the home but are never heard of. Recovery is usually rapid and complete, no doctor is called in, and the patients are content to say that they must have eaten something which upset them and leave it at that. They try to recollect whether anything they have eaten tasted "a bit off," not realising that foodpoisoning is not due to the decomposition of food, but to specific organisms which do not usually affect the smell or the taste of the food. The human body can probably deal even with these specific organisms in relatively small numbers, but at anything approaching the temperature of the body, they multiply very rapidly and in a few hours may be present in such numbers as to overcome the consumer's powers of resistance. It is difficult, if not impossible, to protect all food during distribution and preparation from contamination with one or other of the organisms capable of producing the symptoms of food poisoning, but it is numbers that count, and for that reason not only is it necessary to reduce contamination to a minimum by strict attention to cleanliness at every stage of the distribution and preparation of food, but food must be kept cool to prevent multiplication of organisms ; should be well cooked to kill as many organisms as practicable without spoiling the food, and should then be eaten promptly. If it is not possible or desirable to eat it at once, or if any is left for consumption at a later date, it must be cooled rapidly and kept cool, in order to prevent the multiplication of any organisms which have escaped destruction during cooking or which have gained access to the food during handling subsequent to cooking. If these simple facts were appreciated by all who are responsible for the handling and preparation of food, there would be few outbreaks and indeed few individual cases of bacterial food poisoning. I am indebted to the Medical Officer of Health of Acton for investigating the distribution and method of preparation of the remainder of the large consignment of pigs hearts, and to the Medical Officer of Health of Watford for obtaining and sending to the Central Public Health Laboratory samples of faeces from patients ill at home in his district. Hygiene of Catering Establishments. Two of your Sanitary Inspectors, Mr. Thompson and Mr. Flynn, devote their whole time to the inspection of catering establishments, and over a number of years have accumulated a wide and varied experience in the City of London, and one of them, Mr. Flynn, in the City of Westminster also. They have jointly submitted the following report:— "During the twelve months under review there have been no startling departures from the normal routine work of the department. However, the opportunity has arisen to go back over some 4 ground which has been covered in the past during what might be called the 'hey day' of the catering world; the time of the establishing of many new businesses, the fitting out of many premises and dealing with new names to the trade. During that period, i.e., just after the war, materials and skilled labour were in short supply or unobtainable, and with a view to being as co-operative as possible, substitutes for some of the essential materials in catering establishments were accepted in all good faith. Experience has shown, some might even call it bitter experience, that some of these are quite unsatisfactory. We feel that nothing less than the following standards should be the acceptable basis when considering catering licences or the re-conditioning of existing premises. (1) Floors. It is considered that a quarry tile properly laid is the only satisfactory floor finish for kitchens. We have seen many compositions or substitute floorings during the past year, which comparatively speaking, have had only nominal wear and tear, i.e., they were laid with our approval three or four years ago, but which could not now be accepted as satisfactory. Cleaning difficulties, porosity and troubles with grease penetration are present in all of them to a greater or lesser degree. No doubt it will be argued that certain upper floors cannot be regarded as suitable for tiles on account of the additional weight involved, but we feel that in such a case the floor in question should not be used as a kitchen. Some objections are raised by the staff employed about slipperiness of tiles, but this alleged disadvantage can be discounted if the floors are kept clean. (2) Walls. Here again, we have in the past accepted walls which have been patched and painted, but experience has shown there is no real substitute for tiles, at least up to five or six feet from the floor. (3) Ventilation. For some time at the beginning of the 'expansion' of the catering trade in the City, we were prepared, in spite of some misgivings, to accept in basement kitchens, and in kitchens above ground in which natural ventilation was poor, a standard of mechanical ventilation to give twenty changes per hour. We found that systems designed to effect twenty changes very often fell considerably short of the designed performance. When this fault became apparent, we increased our demands to thirty changes an hour— hoping at least to achieve something over 20. This did in fact occur, but we feel that to have to base our ventilation requirements on the number of air changes alone, does not necessarily fulfil the basic requirement of securing good working conditions. We have been forced to accept a numerical basis in order to give at least some guidance to the person asking our requirements; but this does not ensure satisfactory ventilation as many other factors impinge, such as the amount of equipment in a given space, type of heat used for cooking, etc. Basements obviously give rise to the most difficulties in this direction and the time may occur when it will be necessary for serious consideration to be given to the whole question of basement kitchens. Why should they in fact be considered less harmful to the kitchen staff, than bakehouses which cannot now be established anew in basements? (4) Equipment and Design. Under this heading most of the features in the kitchens with which we have difficulties both as regards suitability and use, can be considered. Sinks. It is quite apparent now that we should insist on stainless steel sinks with no alternatives. This may seem somewhat arbitrary, but we have seen the results of the alternatives, i.e., glazed stoneware which in a comparatively short time looks like an old sandstone trough; hardwood washing-up sinks which are grease soaked and quite objectionable, and galvanized steel which by the nature of the cold-dip zinc coating does not give a good surface even when new. We feel that we should accept no other material than stainless steel. Hot Water Supplies. During the post-war rush to get food preparing businesses going, hot water to sinks was often provided by gas geysers. Having seen these in operation for a number of years we are convinced that they fall a long way short of providing an adequate constant hot water supply.' With our insistence on the provision of multiple sinks wherever possible, the deficiency of the gas geyser is most marked. Hot water supply, by whatever means must involve ample storage capacity capable of meeting peak loads, and we have during the past year endeavoured to reach this target wherever possible. We have been compelled on a number of occasions, to give approval to kitchens which in our experience are likely to prove unsatisfactory owing to their small size. The occupiers are often willing to provide the equipment and surfaces required, but we find difficulty in dissuading them from continuing with their schemes on account of lack of space generally. At present, except in the case of schools there is no minimum size which can be enforced, but we feel, in view of our past experience, applications for new catering licences should be rejected if there is insufficient space for the efficient running of a kitchen. Naturally it would be easier if there was a ' yardstick ' whereby we could assess an applicant's proposals, but the lack of specific regulation should not allow him to proceed against our known experience. The design and lay-out of kitchens for whatever purpose, should comply with the following simple requirements:— Central siting of cooking equipment, sinks in units with sufficient space about them in which to work ; tables, preparing benches, etc., not to be fixed and of a size and weight whereby they can easily be upturned and moved for washing purposes. Almost any space in which it is proposed to start a kitchen can be arranged to meet these requirements if the minimum floor area is available. 5 (5) General Observations. During the past year we have been consulted by a number of firms prior to their commencing work on their various projects, and we have, it is thought, been of some use in suggesting and obtaining various amendments. Difficulty has arisen in regard to premises, including some under Local Authority control, where the carrying out of our recommendations would have involved expenditure in excess of the estimates for the year. We appreciate the reluctance of officers to incur such expenditure, but it is our duty to represent what is in our opinion necessary to secure satisfactory standards of hygiene and what our experience leads us to believe will ultimately prove most economical. In response to our request the City Engineer's Department have informed us when they are considering plans for new buildings in which a kitchen or canteen is to be provided. A number of firms in the City have established excellent kitchens and dining facilities for their staffs. They have allocated ample space for the purpose and have not grudged expenditure on adequate equipment of first class quality. On several occasions allegations have been made that horseflesh has been served in restaurants. Each complaint has been carefully investigated with the help of the meat inspectors from Smithfield, but in no case was horseflesh found on the premises. In some cases it would appear that the customers had concluded that extremely poor quality beef was horseflesh and had felt that it was in the public interest that they should lodge a complaint. In others it would seem that they acted from less worthy motives. We understand that there is little inducement to serve horseflesh at the present time, as most catering establishments have an adequate allocation of butchers' meat which is not much more expensive than horseflesh. Complaints of dirty utensils have been few. In each case the arrangements for washing-up have been inspected, the faults have been pointed out and the necessary adjustments have been made." FOOD AND DRUGS ACT, 1938, AND FOOD REGULATIONS. Mr. Harrington, the Inspector under the Food and Drugs Act, reports as follows:— "304 samples have been submitted to the Public Analyst; 28 of these were formal and 276 were informal samples. Six samples were reported against. The percentage of adulterated samples was 1.3. Legal proceedings were instituted in three cases and in three other cases cautions were administered. Milk. Thirty samples of milk were examined by both the Phosphatase and the Methylene Blue Tests. These tests are designed respectively to check the efficiency of the heat treatment applied to the milk and to give an indication of the keeping quality which bears relation to general cleanliness. In one sample the report on the Phosphatase Test indicated a standard slightly lower than that required by the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, and the Local Authority within whose district the pasteurising plant was situated, was notified accordingly. Four adverse reports were received on the Methylene Blue Test. Two cases were due to lack of cleanliness in handling, etc., and in one case old milk had been mixed with new. Cautions were duly administered to those responsible. In the other instance, the milk had soured and analysis showed adulteration with a fat deficiency of twenty-six per cent. The vendor was accordingly prosecuted. The average composition of genuine milk samples taken during the year was : Milk fat 3.60 per cent.; solids-not-fat 8.80 per cent ;.water 87.60 per cent. Ice Cream. Unfortunately in July, 1952, the Minister of Food found it necessary in order to avoid a reduction in the supply of ice cream, to modify the standards laid down in the Food Standards (Ice Cream) Order which came into operation on 1st March, 1951. By the Food Standards (Ice Cream) (Amendment) Order, 1952, the required minimum fat content of ice cream was lowered from 5 per cent. to 4 per cent. and the non-fat milk solids content from 7½ per cent. to 5 per cent. It will be remembered that it was the wish of the Minister that the original standard should have been an interim one and that he had hoped progressively to improve the standard as supplies of ingredients became more plentiful. Circumstances during the year under review have not allowed of this. The average composition of samples of ice cream taken in the City was, however, fat 10.'7per cent. ; non-fatty solids 11.8 per cent. and sucrose 13.4 per cent. Nine samples were examine.d by the Methylene Blue Test. Three were placed in Grade 1, five in Grade II and one in Grade III. Particulars regarding this last-mentioned sample were communicated to the Local Authority for the district wherein the ice cream was manufactured. Seven new registrations of premises for the sale and storage of ice cream were granted during the year. Details of the formal and informal samples submitted for analysis and of the action taken in regard to adulteration or other irregularity appear later in this report." 6 ATMOSPHERIC POLLUTION. The outstanding event was the disastrous fog from 5th to 9th December, 1952. Though more detailed reports relating to the cause of this fog, the conditions which developed, and their effects over a much wider area have been and will be published by others with more expert knowledge than I possess, I think that the observations recorded in the City should be readily available for reference, and I therefore repeat below the report which I made to the Public Health Committee in February, 1953. The fog which formed over the country during the period from the 5th to the 9th December, 1952, resulted in abnormal concentrations of suspended impurities and sulphur dioxide. The concentration of sulphur dioxide was exceptionally high. This was due to the persistence for several days of weather conditions which favour the formation of inland fogs, namely, low temperatures and lack of air movement. Normally the air at ground level in towns is slightly warmed and rises high above the level of buildings, carrying smoke and other impurities with it. Lateral air currents also disperse and dilute the atmospheric pollution. But in conditions of intense cold and complete absence of wind the upward moving air is quickly cooled and falls again. The normal convection currents, of warm air rising and cold air falling, consequently take place within an unusually limited height above ground. Thus, since there is no lateral movement, the polluted air rises only a short distance, is cooled and falls again to ground level and an unusually high concentration of the products of combustion of fuel is built up. Early in 1948 daily measurements of smoke and sulphur dioxide were commenced at Golden Lane by the volumetric method. In this method a measured volume of air from outside the building is drawn, by means of a small electric motor, through a white filter paper, and then through a measured volume of dilute hydrogen peroxide. The solid particles from the air remain in the filter paper as a stain and their weight is estimated by matching with a scale of shades which has been calibrated against weighted stains. The sulphur dioxide is removed by the hydrogen peroxide to form sulphuric acid and the concentration of sulphur dioxide is calculated by a formula. When the deposit of smoke particles on a filter paper is very high the method of comparison with the standard scale of shades fails to estimate fully the weight of the material deposited. There is no doubt that during the period from the 5th-9th December the weight of material deposited was much in excess of the recorded figures. This is shown by comparing the results obtained by another method of determining the weight of the stain on the filter paper, namely, the reflectometer. I am indebted to the Department of Scientific and Industrial Research for undertaking the examination of the filter papers from Golden Lane by this method, and for furnishing the following results:— SMOKE. (Miligrams per cubic metre of air) Date. By the Volumetric Method. By the Reflector Method. 5th December 625 1.000 6th ,, 637 1.020 7th „ 613 1.063 8th „ 625 1.056 9th „ 630 1.098 The daily mean concentrations for December, 1952, for suspended impurities and sulphur dioxide are set out in the attached tables. As a basis for comparison details are also given of the concentrations which occurred in the months of December in the years 1951/1948. The figures for November, 1948, are also included as this was a bad month for fog and the figures for June, 1952, are given for comparison between summer and winter conditions. Concentrations of sulphur dioxide up to one part per million are believed not to be harmful to normally healthy persons, but there is no doubt of their ill effects on those who are already suffering from respiratory diseases or have failing hearts. The Medical Officer of Health for the County of London reports that, compared with the average per week in the previous three weeks, deaths from bronchitis in the week ending 13th December were ten times as many, from influenza seven times, from pneumonia five times, from pulmonary tuberculosis four and a half times and from other respiratory diseases nearly six times as many. Deaths from heart disease were nearly three times as many, but there was no significant increase in deaths from other causes, except gastro-enteritis in infants, which may have been secondary to respiratory infection. The effects on healthy animals exhibited at the Smithfield Show received wide publicity in the Press. Such disastrous incidents as the fog in December, 1952, are fortunately rare simply because the special atmospheric conditions necessary to draw attention so dramatically to the results of atmospheric pollution only occur occasionally. Atmospheric conditions are act of God, but atmospheric pollution is act of man. For a time there is public interest and even alarm and everybody says that something must be done about it, but the public memory is short and some other disaster steals the head-lines. So we relapse into toleration of a normal degree of atmospheric pollution which year after year costs the nation millions of pounds in ill-health and in deterioration of materials of all kinds. 7 Daily Mean Concentrations of Smoke at Golden Lane measured by the Volumetric Method SMOKE (Miligrams per cubic metre of air) Date. December November June 1952 1951 1950 .1949 1948 1948 1952 1st .207 .158 .085 .086 .691 .392 .019 2nd .207 .158 .118 .086 .203 .441 .019 3rd .265 .202 .118 .106 .079 .174 .021 4th .265 .202 .157 .040 .172 .130 .021 5th .625 085 .157 086 .172 .094 .021 6th .637 .085 .269 .130 .085 .195 .021 7th .613 .159 .170 .085 .085 .195 .028 8th .625 .159 .173 .076 .127 .130 .071 9th .630 .064 .173 .181 .174 .317 .071 10th .215 .064 .118 .181 .079 .538 .070 11th .236 .535 .118 .125 .079 .518 .070 12th .114 .524 .123 .241 .079 .625 .092 13th .156 .650 .305 .167 .104 .115 .092 14th .156 .637 .318 .106 .037 .115 .043 15th .179 .306 .167 .106 .111 .085 .043 16th .179 .123 .122 .142 .127 .167 .064 17th .122 .123 .122 .142 .215 .153 .064 18th .122 .118 .200 .077 .164 .153 .021 19th .228 .118 .200 .077 .164 .127 .021 20th .137 .262 .265 .125 .119 .085 .021 21st .137 .262 .265 .269 .119 .123 .021 22nd .158 .120 .177 .218 .120 .239 .021 23rd .158 .120 . 177 .074 .120 .369 .021 24th .195 .122 .196 .074 .085 .306 .043 25th .195 .122 .196 .074 .085 .317 .043 26th .181 .123 .157 .078 .193 .524 .082 27th .181 .123 . 157 .056 .193 .461 .065 28th .561 .123 .122 .056 .164 .419 .065 29th .161 .123 .122 .223 .118 .625 .020 30th .269 .120 .157 .308 .116 .388 .020 31st .241 .120 .157 .123 .125 Monthly Average .268 .200 .173 126 .145 .284 .043 Daily Mean Concentrations of Sulphur Dioxide at Golden Lane measured by the Volumetric Method. SULPHUR DIOXIDE (Parts per Million by volume) Date December November June 1952 1951 1950 1949 1948 1948 1952 1st .119 .104 .122 .020 .632 .226 .027 2nd .119 .104 .089 .020 .111 .123 .027 3rd .190 .165 .089 .081 .138 .101 .030 4th .190 . 165 .153 .044 .070 .085 .030 5th .618 .103 .153 .076 .070 .069 .032 6th .720 .103 .237 .136 .077 .102 .032 7th .800 .141 .152 .112 .077 .102 .031 8th 1.225 .141 .142 .091 .114 .056 .045 9th 1.209 .067 .190 .145 .120 .130 .045 10th .215 .067 .134 .145 .032 .335 .049 11th .198 .341 .134 .059 .055 .167 .049 12th .144 .279 .137 .167 .055 .359 .081 13th .200 443 .215 .143 .088 .067 .081 14th .200 .636 .357 .100 .066 .067 .048 15th .163 .213 .325 .100 .097 .062 .048 16th .163 .133 .191 .147 .074 .121 .043 17 th .121 .133 .191 .147 .222 .113 .043 18th .121 .129 .219 .066 .102 .113 .038 19th .161 .129 .219 .066 .102 .102 .038 20th .158 .172 .327 .183 .098 .223 .025 21st .158 .172 .327 .161 .098 .113 .025 22nd .103 .220 .194 .202 .121 .103 .025 23rd .103 .220 .194 .092 .121 .687 .025 24th .195 .122 .240 .092 .116 .319 .049 25th .195 .122 .240 .083 .116 .239 .049 26th .130 .081 .185 .083 .204 .391 .086 27th .130 .081 .185 .060 .204 .254 .094 28th .295 .123 .221 .060 .143 .417 .094 29th .094 .123 .221 .161 .115 .593 .052 30th .161 .138 .261 .242 .206 .424 .052 31st .204 .138 .261 .123 .120 Monthly Average .285 .171 .203 .110 .128 .210 .046 8 On atmospheric pollution in the City over the whole year 1952, Mr. McGrath, who is responsible for taking the daily observations, reports as follows:— "Table I is a summary of the observations for the year 1952 of rainfall, deposited matter and sulphur dioxide. The deposited matter, expressed in tons per square mile, is divided into total insoluble deposit and total soluble deposit. The sulphur dioxide figures give a rate of sulphation as measured by the lead peroxide instrument and are expressed in milligrams of sulphur trioxide per day per 100 square centimetres. The table also contains the concentration of smoke and sulphur dioxide by the volumetric method, the smoke being expressed as milligrams per 100 cubic metres, and the sulphur dioxide as parts per 100 million parts of air. For purposes of comparison there is set out at the foot of the Table the average figures for each of the four complete years since 1948, the year when atmospheric pollution measurements were recommenced in the City after the war. It will be seen that the rainfall for 1952 was much less than that of the previous year, and, as a consequence, the total solids deposited was less— 20.19 tons per square mile compared with 26.75 tons. Although this solid soot, grit and dust is a nuisance, and indicates a considerable loss of fuel due to its incomplete combustion, the acid pollution is probably much more serious. Therefore, it is of some satisfaction to note from the Table that the average sulphur pollution for the year measured by the lead peroxide instruments in Finsbury Circus Gardens and Golden Lane is the lowest recorded in the last four years. An examination of the figures of the concentration of smoke in the air, measured by the volumetric method at Golden Lane, shows that during the year the City had more than its usual share of foggy days and nights. Whilst fog is made up almost entirely of water droplets, smoke pollution has important indirect effects in reducing visibility by providing an abundance of nuclei for the formation of smaller droplets, thus providing a denser and less easily cleared fog. In 1952 the figure of suspended impurities was the highest recorded during the past four years. The volumetric method also measures the average daily concentration of sulphur dioxide. Notwithstanding the high concentrations recorded during the heavy fog in December the average for the year is below that of 1952. Reference has already been made to the improvement in sulphur pollution as indicated by the lead peroxide method." TABLE I.—Results obtained in 1952 of the monthly observations of rainfall and solid deposited matter ; the monthly observations of sulphur dioxide by the lead peroxide method; and the daily observations of the concentration of smoke and sulphur dioxide by the volumetric method. Month Rainfall Deposit Gauge, Golden Lane Lead Peroxide Method Volumetric Method, Golden Lane Golden Lane Finsbury Circus Insoluble Deposit Soluble Deposit Total Solids Smoke Sulphur Dioxide Monthly average Highest daily average Monthly average Highest daily average MM Inches Tons per sq. mile mgs (SO3) per day per 100 sq. cm. mg. per 100 cu. metres Parts per 100 million parts of air January 27 1.0 12.68 11.92 24.60 3.74 3.05 14.4 31.9 12.6 28.5 February 17 0.7 5.87 4.88 10.75 3.03 3.34 20.1 26.9 15.2 24.7 March 47 1.8 1.13 11.88 13.01 3.65 2.07 15.1 30.7 11.9 20.0 April 14 0.6 7.57 7.10 14.67 2.45 2.21 11.4 20.5 10.6 19.5 May 15 0.6 11.45 9.46 20.91 1.54 1.16 6.7 10.8 6.7 9.8 June 29 1.1 6.70 2.22 8.92 1.00 0.77 4.3 9.2 4.6 9.4 July 0 0.0 9.86 4.48 14.34 1.10 0.81 4.0 6.4 3.7 5.4 August 68 2.5 11.45 9.66 21.11 1.08 1.00 5.5 11.1 4.5 8.1 September 60 2.2 10.62 7.70 18.32 1.33 1.84 9.5 17.0 5.6 14.0 October 66 2.4 15.00 12.55 27.55 2.49 2.52 14.8 53.5 10. 1 37.9 November 85 3.3 17.86 17.26 35.12 2.38 2.59 19.1 65.0 13.3 42.1 December 53 2.0 22.04 10.89 32.93 3.29 4.96 33.7 109.8 28.5 122.5 Average 1952 40 1.5 11.02 9.17 20.19 2.26 2.19 13.2 — 10.6 — 1951 54 2.1 11.50 15.25 26.75 2.84 2.56 11.80 — 13.4 — 1950 38 1.5 10.19 16.96 27. 15 2.66 2.32 9.98 — 10.0 — 1949 28 1.1 8.74 9.99 18.72 2.74 2.53 10.15 — 9.0 — HOUSING. The number of housing applications outstanding on 31st December, 1952, was 417 comprising 1,046 persons. The number of families rehoused during the year was 108. This figure includes 37 families transferred within property under the Corporation's control. On 26th September, 1952, the Right Honourable the Lord Mayor formally opened two new blocks of flats built by the Corporation of the City of London in Old Kent Road in the Metropolitan Borough of Camberwell. Both blocks are five storeys in height. George Elliston House, which has an inverted "U" formation, provides 45 self-contained flats served by two public staircases with a four person pushbutton controlled lift at each staircase. Access to upper floor flats is by balconies on the north, west and east elevations. The internal courtyard which is open to the south has been developed as a garden which is overlooked by all the principal habitable rooms. Eric Wilkins House provides 20 flats and is "L" shaped. It is served by one staircase and one lift with balcony access to the upper flats. Of the total of 65 flats, five are of one room, ten of two rooms, thirty-five of three rooms, and fifteen of four rooms. 9 Each flat has an entrance lobby, W.C., bathroom, fuel store and cloak cupboard. The living rooms are heated by an all-night-burning stove with back boiler for the supply of hot water to the bath, basin and kitchen sink. In addition an electric immersion heater is fitted in the hot water cylinder in the airing cupboard. The kitchenette is fitted with an enclosed combination kitchen fitment, broom cupboard, etc., a deep white sink and draining boards. A ventilated larder opens out of this room. Cooking is by gas or electricity at the option of the tenant. The bedrooms are fitted with deep hanging cupboards. Communal laundries fitted with washing machines, wash tubs and gas-heated drying cabinets are provided. There are also lock-up pram sheds and a children's playground. The flats are set well back from Old Kent Road, and the main entrance to the estate is from a side street on the west side. The Corporation have two other housing schemes in progress, one in Golden Lane on the borders of the City and the Metropolitan Borough of Finsbury, and the other on Sydenham Hill in the Borough of Lewisham. Plans for the development of both these sites are still under consideration, and in my next annual report I expect to be able to record that building has commenced. WELFARE OF OLD PEOPLE. In my last annual report I recorded the formation of the City of London Old People's Welfare Association, and described the various ways in which the old people living not only in the City but in the Corporation's housing estates outside the City, were being helped in their difficulties and perplexities and their lives made brighter and more interesting. The Hon. Secretary of the Association, Mrs. R. H. Cohen, has a flair for this type of work and boundless energy and enthusiasm, consequently Old People's Welfare in the City has gone ahead, though the response to appeals for financial assistance has been disappointing. High taxation and the high cost of living must obviously diminish the amount of money available for charitable purposes. There is no reason to suppose that the desire to help those in misfortune, sickness or age and infirmity is less widespread than formerly, but in the first place many people have been obliged to reduce or even discontinue their donations to charity because they have suffered a serious decline in relative income, and in the second place, many take the view that in the Welfare State everything is provided by Central or Local Government from taxes or rates which come out of their pockets, and that therefore the work of voluntary welfare associations is either redundant or is only saving the State from bearing the full financial burden of discharging the obligations which it has assumed. But no Central or Local Government Authority spending public funds can fully replace the voluntary organisations. It may be necessary for the State or the Local Authority to take over welfare work which has been initiated by voluntary organisations but which has developed beyond the financial resources of such organisations; but they can only do so on broad, general lines which are universally applicable. Once the State takes over, what cannot be done for all must not be done for the few, lest a precedent, which will ultimately become vastly expensive, be established. "Fair shares for all," but if there is not enough to go round shall nobody have any ? The voluntary organisation is not restricted in the same way. It has the local knowledge and the interest in the individual which enables it to assess relative need and to allot priority in help which can be promptly given on a worth-while scale and adapted to specific requirements. The voluntary organisation does not have to fear precedent; it is recognised that its resources are limited, and though there may be some grumbling from those who are left out, they have no real sense of grievance, they are open to conviction that others were in greater need and they hope that their turn may come. The voluntary organisation need not fear exploitation, for it has local and personal knowledge to guide it, but for this same reason it is open to allegations of favouritism, though seldom with any justification. Finally the voluntary association does not have to consider whether the alleviation of any particular need by any particular means is authorised by legislation, and it can therefore help in many ways for which no statutory provision is made. However highly developed the welfare activities of the Central and Local Government Authorities may become, there will always be scope for valuable work by voluntary associations; not overlapping, but filling in gaps, extending boundaries and pioneering. Let us hope that this will be generally recognised and that those who are giving service will be supported by those who are able to give financial assistance before it is too late. RODENT CONTROL. I think it is true to say that the rat population in the City, both above ground and in the sewers is smaller than it has ever been. This is largely due to the application year by year since the war of more scientific methods of rat destruction, including the use of new poisons. Your Chief Rodent Officer, Mr. Carter, who is in charge of this work, reports as follows:— "Organisation and procedure during the year was similar to that of previous years, and in compliance with the requirements of the Prevention of Damage by Pests Act, 1949, comprised inspections of properties to ascertain the presence of rats and mice; treatment of any such properties found to be infested, and periodical maintenance treatments for the destruction of rats in sewers. Owners and occupiers have readily co-operated, and in only one instance was it necessary to serve a Statutory Notice to obtain compliance with the provisions of the Act. During the period under review 5,425 properties were inspected, and these comprised blocks of offices, riverside warehouses, markets, restaurants, workshops and domestic dwellings. 10 A total of 616 infestations were treated, and these consisted of 50 major and 278 minor infestations of rats, and 152 major and 136 minor infestations of mice. The work entailed 8,214 re-visits for operational purposes. In the process of the treatments, 11,320 initial baiting points were selected, 48,783 prebaits, and 5,149 poison baits were laid. These measures resulted in a minimum estimated kill of 2,877 rats and of this number, 1,237 bodies were recovered. Trapping was the means of destroying 514 rats, and added to those found as the result of poison, a total of 1,751 bodies were removed from premises. The use of the anti-coagulant Warfarin in the treatment of mice infestations appears to be generally successful, and many difficult infestations of this nature were treated satisfactorily. Altogether, 852 dead mice were found as the result of such treatment. In 29 instances structural rat-proofing was carried out by the occupiers and in three instances defective drainage resulting in rat infestation was remedied. In assessing the results of this systematic work over a period of several years, a retrospect of detailed records show that since January, 1944, a minimum of 58,720 rats are estimated to have been destroyed, of which 20,154 bodies were recovered. The yearly figures show a steady decline in the severity of infestations, and the numbers destroyed, and to the figures quoted must also be added the results obtained by Pest Control undertakings, servicing premises periodically. Many of the infestations treated during the year were of a minor nature, but nevertheless important, and such infestations of Ship-rats character often entail more work than those of severer nature. It does appear, however, that while the distribution remains the same the rat population numerically is greatly reduced compared with several years ago. Owners and occupiers have become more rat and mouse conscious, and generally welcome advice, and treatment of infestations that would have been accepted as inevitable in the past. Infestations of common rats were particularly few, and during the year only five such infestations were found and treated. This is possibly due in no small measure to the systematic periodical maintenance treatments carried out for the destruction of common rats in sewers. Four treatments were applied during the year in the manner described at length in the Annual Report, 1951. These were carried out in March, May, September and December. The March treatment was the fourth and final in the series of direct poison controls with Sodium Fluro-acetate "1080," and following discussions held with the Technical Officers, Infestation Division, Ministry of Agriculture and Fisheries on the excellent results which appeared to have been obtained, it was agreed to continue the treatments until March, 1954, when twelve controls will have been completed. In the case of the four treatments May, 1951—March, 1952, approximately 306 entrances of a total of 427 were selected for baiting. This number comprised 225 entrances where prebait "takes" were recorded during the December, 1950, treatment plus 81 entrances which showed a negative result at that time, but where "takes" were recorded on either of the two previous six-monthly treatments. In the March control only 53 "takes" were recorded (1 complete 2X¾ , 6X½ and 44 X¼ or less). Of the 44 x ¼ or less "takes" 20 were so small as to be hardly perceptable. For the purposes of the fifth treatment in May it was decided to bait also the entrances not previously treated. The inclusion of the additional entrances would, it was believed, supply some information on the build-up or otherwise of rats in lengths of sewers not treated for 18 months. Altogether 424 entrances were baited and examination showed 3 X½, and 17 X¼ "takes" a total of 20 only. This result was again satisfactory being a reduction of 33 "takes" on the March control. An interesting feature of the treatment was that only 3 "takes" were obtained from the additional 129 entrances baited. The possibility of poison prejudice was visualised and in order to be reasonably satisfied on this point, a test baiting of all entrances was applied after a lapse of three weeks. In the poison controls, sausage rusk was used as the bait base, and to ensure there would not be bait prejudice also, bread rusk moistened with water at equal parts by weight was used, each bait being 4 ozs. A total of 417 entrances were test baited and the baits were left down for two days, when examination showed 35 "takes" (7 full, 3 X ¾, 10 X ½ and 15 X ¼). As in the case of the poison baits some of the ¼ "takes" were mere nibbles. Altogether 104 lbs. 4 ozs. of unpoisoned test bait was put down and the amount taken was estimated to be 72 ozs. only. This result is a very great reduction on the pre-bait recording of December, 1950, when 225 "takes" (185 full, 29 X ½ and 11 X ¼) were obtained. The amount then taken was 67 lbs. The result of the September treatment was 13 "takes" only (1 X ½ and 12 X ¼ or less), and that of the December treatment 14 "takes" (2 x ½ and 12 X ¼ or less). The graph illustrates the breakdown of the pre-bait "takes" from December, 1943, to May, 1948, and then the rise in December, 1948, which was maintained for the next two years. In May, 1951, the method of treatment was changed, direct poisoning with "1080" being introduced. The result has been a rapid decline in the rat population of the sewers to a lower level than we thought possible, and it seems probable that if we are permitted to continue to use "1080" this low level can be maintained." 11 12 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 staff 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 216. STAFF. I desire to express my gratitude to my staff for the efficiency with which they have discharged their duties, for their loyalty and for the way they have worked together as a team. I have never found myself in the position of having to resolve a difficult situation of their making either inside or outside the office. Only two changes took place during the year. Two vacancies had occurred at the end of 1950 in the staff of meat inspectors at Smithfield Market. One was filled by the promotion of Mr. J. C. Wilson who, while employed in clerical duties at the Market, had qualified as a meat inspector, and the other by the appointment of Mr. R. A. Leach. I should also like to express my appreciation of the courtesy and consideration which the Chairman and Members of the Public Health Committee have constantly extended to me in my official capacity and of their personal kindness and friendship at all times. I have the honour to be, Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health. 13 STATISTICAL INFORMATION. Area--661 acres (including the Temple and Tidal Water and foreshore). Population.—Census 1951, 5,268. Estimated Mid-year 1952, 5220. Annual Rateable Value.—As at 1st April, 1952, £6,589,862. Annual Sum received from Penny General Rate.—Estimated £27,100. Births:— Total. M. F. Legitimate 34 13 21 Birth Rate per 1,000 resident population, 1952 . 617 Live Births, Illegitimate 3 2 1 Still Births - - - Rate per 1,000 total (live and still) births - Deaths:— Deaths, Infants under 4 weeks of age 2 2 - Deaths under 1 year Legitimate 1 1 - Death Rate per 1,000 resident population 11.76 Illegitimate 1 1 - Deaths (all ages) 62 47 15 Death Rate of Infants under one year of age:— All Infants per 1,000 live births ... 5405 Legitimate Infants per 1,000 legitimate live births 29.41 Illegitimate Infants per 1,000 illegitimate live births 333.33 INFECTIOUS DISEASE. Notifications received:— Total cases notified. Food Poisoning 2 Measles 13 Puerperal Pyrexia 4 Scabies 1 Scarlet Fever 3 Sonne Dysentery 2 Tuberculosis 11 ANALYTICAL EXAMINATIONS. (Other than under Food and Drugs Act). Fruit (tinned) 6 Tomato Paste 5 Vegetables (tinned) 4 Shrimps (tinned) 1 Ham (tinned) 1 Pork Brawn 1 Mincemeat 1 Bone Meal 2 Cheese 1 Concentrated Tomato 3 Chutney 1 Water 2 Crab Paste 1 Ham 1 Luncheon Meat 2 Gummed Labels 1 Coffee Essence 1 Concentrated Tomato Soup 4 Sausages 4 Rainwater 12 Apple Rings 1 Atmospheric Pollution 24 BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year:— Luncheon Meat 2 Ham 2 Swabs 4 Water 2 Ham (tinned) 2 Faeces 1 Chocolate 2 Wine 1 Pork Brawn 2 Pressed Pork 1 Ox Pork 1 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. 14 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1952. Causes of Death Nett Deaths at the subjoined ages of Residents whether occuring within or without the district. 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 All Causes 62 2 - - - 4 24 17 15 1. Tuberculosis, respiratory M 5 - - - - - 3 2 - F - - - - - - - - - 2. Tuberculosis, other forms M - - - - - - - - - F - - - - - - - - - 3. Syphilitic disease M 1 - - - - - 1 - - F - - - - - - - - - 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 - - - - - - - - - 10. Malignant neoplasm-stomach M 1 - - - - - 1 - - F - - - - - - - - - 11. Malignant neoplasm-lung, Bronchus M 1 - - - - - 1 - - F - - - - - - - - - 12. Malignant neoplasm-breast M - - - - - - - - - F 1 - - - - - 1 - - 13. Malignant neoplasm-uterus F 1 - - - - - - - - 14. Other malignant and lymphatic neoplasms M 4 - - - - - 2 1 1 F 3 - - - - - - 2 1 15. Leukaemia, aleukæmia M - - - - - - - - - F - - - - - - - - - 16. Diabetes M - - - - - - - - - F - - - - - - - - - 17. Vascular lesions of nervous system M 5 - - - - - 1 2 2 F 2 - - - - - 2 - - 18. Coronary disease, angina M 5 - - - - - 3 1 1 F 2 - - - - - - 1 1 19. Hypertension with heart disease M - - - - - - - - - F 1 - - - - - - 1 - 20. Other heart disease M 6 - - - - 1 2 1 2 F 2 - - - - - - - 2 21. Other circulatory disease M 5 - - - - - 2 2 1 F 1 - - - - - - - 1 22. Influenza M - - - - - - - - F - - - - - - - - - 23. Pneumonia M 5 - - - - 1 2 1 1 F - - - - - - - - - 24. Bronchitis M 2 - - - - - 2 - - F - - - - - - - - - 25. Other diseases of respiratory system M - - - - - - - - - F - - - - - - - - - 26. Ulcer of Stomach and duodenum M - - - - - - - - - F - - - - - - - - - 27. Gastritis, enteritis and diarrhoea M - - - - - - - - - F - - - - - - - - - 28. Nephritis and nephrosis M - - - - - - - - - F - - - - - - - - - 29. Hyperplasia of prostate M 1 - - - - - - - 1 F - - - - - - - - - 30. Pregnancy, childbirth, abortion F - - - - - - - - - 31. Congenital malformations M - - - - - - - - F Carried forward M 41 ___ 2 20 10 9 F 13 3 5 5 15 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1952—continued. Causes or Death Nett Deaths at the subjoined ages of Residents whether occuring within or without the district. 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 41 — — — — 2 20 10 9 F 13 — — — — — 3 5 5 32. Other defined and ill-defined diseases M 3 1 — — — 1 1 — — F 2 — — — — — — 2 — 33. Motor vehicle accidents M — — — — — — — — F — — — — — — — — — 34. All other accidents M 3 1 — — — 1 — — 1 F — — — — — — — — — 35. Suicide M — — — — — — — — — F — — — — — — — — — 36. Homicide and operations of war M — — — — — — — — — F — — — — — — — — — M 47 2 — — — 4 21 10 10 F 15 — — — — — 3 7 5 MATERNITY AND CHILD WELFARE. The following details have been received from the Divisional Medical Officer of the London County Council, with regard to work carried out in connection with Maternity and Child Welfare in the City. Infant Welfare Centre. Total No. of children who first attended during the year and who on the date of their first attendance were— Under 1 year of age 32 1-5 years of age 4 Total No. of children who attended and who at the end of the year were— Under 1 year of age 30 1-5 years of age 107 Total attendances by children— Under 1 year of age 543 1-5 years of age 624 Health Visitors. No. of infants under 1 year of age visited for first time 37 Total visits to infants under 1 year of age 211 Total visits to children 1-5 years of age 326 No. of expectant mothers visited 16 Total visits to expectant mothers 53 Care of Premature Infants. No. of premature births during the year 1 No. of deaths under 1 month — Diphtheria Immunisation. No. of children who completed a full course of primary immunisation— Under 5 years of age 33 5-14 years of age 7 No. of children who were given a secondary or reinforcing injection 58 Vaccination. No. of children successfully vaccinated or revaccinated 23 No. found to be insusceptible to vaccination — 16 MEAT INSPECTION. Tons. Cwts. Qrs. Lbs. Meat, &c., delivered at Smithfield Market 300,244 0 0 0 Meat, &c., seized by Inspectors at Smithfield Market 265 4 3 5 Meat, &c., seized by Inspectors at Leadenhall Market and City shops 14 5 2 14 Meat, &c., seized by Inspectors at Cold Stores 16 1 1 5 Various commodities seized by Inspectors and sent to Lett's Wharf 81 9 1 0 Number of eggs seized by Inspectors and sent to Lett's Wharf, 4,729 Number of demonstrations and lectures given, 17. Number of Students attending, 110. 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. 13 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. 329 tons 7 cwts. 1 qr. 22 lbs. were condemned as unfit for human consumption. 170 tons 13 cwts. 3 qrs. 6 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 158 tons 13 cwts. 2 qrs. 16 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. 42 tons 7 cwts. 0 qr. 27 lbs. of food were placed under stop and subsequently 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 3,111 inspections have been made. As a consequence of these inspections, it was necessary to serve 25 Intimation Notices. Five 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 37, defects found have been, or are in course of being remedied. There are three houses on which it is intended to place a Closing Order as soon as there is reasonable prospect of the occupants being able to obtain suitable alternative accommodation. No Closing Orders have been made. 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 Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and (5 are to be enforced by Local Authorities 1,047 (including 671 kitchens) 2,118 (including 1,937 kitchens) 248 (including 218 kitchens) — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 403 71 16 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 4 4 — — TOTAL 1,454 2,193 264 — 17 PART I. OF THE ACT—continued 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.1.) 722 663 4 Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 — — — — Inadequate ventilation (S.4) 94 64 — — — Ineffective drainage of floors (S.6) 10 2 — — — Sanitary Conveniences (S.7) (a) insufficient 3 6 — 3 — (b) Unsuitable or defective 159 186 — 7 — (c) Not separate for sexes 4 4 — 3 — Other offences against the Act (not including offences relating to Outwork) 843 578 — — — TOTAL 1,836 1,503 4 13 — OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms 110 Names and Addresses, etc., received from other Authorities 154 Names and Addresses transmitted to other Authorities 732 No case of infectious disease was reported in connection with outworkers' premises in the City. SHOPS ACT, 1950. 41 inspections of shops and warehouses have been carried out. The 27 defects found have been remedied after the service of 3 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 1952, 111 inspections were made in this connection and reports forwarded to the City Food Controller. PHARMACY AND POISONS ACT, 1933. 75 firms were registered under this Act, 69 of which were re-registrations. One infringement was noted. 108 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. 23 inspections were made and no contravention came under the notice of the Inspector. FERTILIZERS AND FEEDING STUFFS ACT, 1926. The provisions of the above Act were carried out without recourse to legal proceedings and without special difficulty. 48 inspections were made, and no contravention was discovered. FOOD AND DRUGS ACT, 1938, AND FOOD REGULATIONS. Informal and Formal Samples submitted for Analysis. Article Informal Formal Total Article Informal Formal Total FOOD. Brought forward 23 - 23 Almonds (ground) 1 - l Curry Powder 7 - 7 Aspic Jelly Powder 1 - 1 Custard Powder 1 - 1 Baking Powder 1 - l Dessert Powders 2 - 2 Brawn 1 - l Faggots 1 - 1 Cake Decorations 2 - 2 Fish Cakes 3 - 3 Cheese (processed) 2 - 2 Fish Paste 5 - 5 Chocolates 2 - 2 Flavouring 1 - 1 Christmas Puddings 2 - 2 Flour 3 - 3 Cinnamon (ground) 3 - 3 Fruit Salad 1 - 1 Coconut (desiccated) 2 - 2 Gelatin 4 - 4 Coffee 2 - 2 Ginger (ground) 2 - 2 Coffee extract 1 - 1 Gravy Powder 1 - 1 Coriander Seed 1 - 1 Herbal Tea 1 - 1 Colouring 1 - 1 Herbs 4 - 4 Cloves 1 - 1 Honey 2 - 2 Carried forward 23 ... 23 Carried forward 61 ... 61 18 FOOD AND DRUGS ACT, 1938, AND FOOD REGULATIONS —continued Informal and Formal Samples submitted for Analysis. Article Informal Formal Total Article Informal Formal Total Brought forward 61 - 61 Brought forward 206 28 234 Ice Cream 9 - 9 DRUGS. Ice Cream Powder 2 - 2 Jam 1 - 1 Ammoniated Tincture of Jellies 3 - 3 Quinine 2 - 2 Jelly Crystals 1 - 1 Arrowroot 1 - 1 Lemon Barley Water 1 - 1 Arnica, Tincture of 1 - 1 Lemonade Powder 4 - 4 Balsams 4 - 4 Luncheon Meat 4 - 4 Bismuth Mixture 1 - 1 Macaroni 1 - 1 Borax and Honey 1 - 1 Marzipan 3 - 3 Calamine Lotion 1 - 1 Meat Paste 3 - 3 Camphor and Aconite Mixture 1 - 1 Meringue Mixture 2 - 2 Milk - 28 28 Milk (condensed) 1 - 1 Camphorated Oil 3 - 3 Milk Whipping Compound 1 - 1 Cascara Sagrada 1 - 1 Mincemeat 4 - 4 Castor Oil 1 - 1 Mint (dried) 3 - 3 Cough Mixtures 5 - 5 Mustard 2 - 2 Embrocation 1 - 1 Nutmeg (ground) 1 - 1 Eucalyptus Oil 3 - 3 Nuts (ground) 1 - 1 Emulsion 1 - 1 Pastry Mixture 1 - 1 Glycerin of Thymol 1 - 1 Pudding Mixture 1 - 1 Hypophosphites, Comp. Syrup of 1 - 1 Pepper 6 - 6 Peel 1 - 1 Iodine, Tincture of 1 - 1 Pickles 1 - 1 Juniper, Oil of 2 - 2 Pies and Puddings 7 - 7 Lemon, Glycerin and Honey 1 - 1 Rennet, Essence of 2 - 2 Liniment of Turpentine 2 - 2 Saccharin Tablets 4 - 4 Liquorice Powder 1 - 1 Salad Cream 2 - 2 Liquid Paraffin 1 - 1 Sauces 7 - 7 Myrrh, Tincture of 1 - 1 Sausages 30 - 30 Medicated Tablets 6 - 6 Seasoning 1 - 1 Ointments 6 - 6 Soft Drinks 4 - 4 Parrish's Chemical Food 1 - 1 Soups 5 - 5 Menthol and Wintergreen Cream 2 - 2 Spices 4 4 Spaghetti 1 - 1 Patent Medicines 1 - 1 Spreads 1 - 1 Peppermint, Solution of 1 - 1 Stuffing 1 - 1 Pills 1 - 1 Suet 2 - 2 Rose Hip Syrup 1 - 1 Sweetmeats 2 - 2 Salines 1 - 1 Sweets 6 - 6 Senna Pods 1 - 1 Tea 2 - 2 Sodium Bicarbonate 1 - 1 Tomato Puree 2 - 2 Stomach Powders 2 - 2 Tomato Paste 1 - 1 Syrup of Figs 1 - 1 Vinegar 3 - 3 Wintergreen Oil 5 - 5 Welsh Rarebit Mixture 1 - 1 Witch Hazel 2 - 2 Carried forward 206 28 234 Totals 276 28 304 19 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY. Sample No. Article. Informal or Formal. Nature of adulteration or irregularity. Observations. n. 31 Pork Sausages Informal Contained preservative although not labelled accordingly or statutory notice displayed at time of sale. Vendor cautioned and statutory notice subsequently displayed. 101 Chocolates (liquid centres) Informal Misleading labelling and sale display. Bottle-shaped chocolates separately labelled and displayed for sale in a manner which would suggest that they were liqueur chocolates. On analysis no alcohol was found. The matter was taken up with the manufacturers, the suppliers and vendors, with the Local Authority where manufactured and subsequently with the Ministry of Food. 135 Tomato Paste Informal Contained tin and tin compounds equivalent to 4.4 grs. tin per pound. Two further tins sampled . Analysis of contents revealed 3.25 and 4.21 grs. tin per lb. Balance of stock in shop and at wharf surrendered and destroyed. 178 Milk Formal Deficient in fat to extent of 26 per cent. — Prosecution (see below). 227 Pork Sausages Informal Labelling regarding preservative not in compliance with Public Health (Preservatives, etc., in Food) Regulations, 1925/27. — Notification to Local Authority where sausages manufactured. 272 Milk Formal 18.4 per cent. extraneous water. — Prosecution (see below). 290 Condensed Full Cream Milk. Informal Genuine but unwholesome — Stock surrendered. PROSECUTIONS. Article. Offence. Result. Milk Section 3, Food and Drugs Act, 1938. Selling a glass of milk deficient in fat to the extent of 26 per cent. Vendor discharged conditionally for twelve months upon payment of Two Guineas costs. Milk Section 9, Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950. Having in possession for sale for human consumption, milk certified on analysis to contain extraneous water to the extent of 18.4 per cent. Company owning fined One Pound. Costs—Two Guineas. Ham Roll Section 9, Food and Drugs Act, 1938. Unlawfully selling an article of food intended but unfit for human consumption, i.e., a ham roll containing a cigarette end. Joint proprietors of business both fined Two Pounds and One Guinea costs. 20 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. EXHUMATIONS AT CITY OF LONDON CEMETERY. During the year the remains of seven persons were exhumed from common graves and reinterred in private graves, at the City of London Cemetery. In accordance with the licences issued by the Home Office, a representative of the Medical Officer of Health was present on each occasion. 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 1952, 581 pigeons were destroyed by this means. CITY MORTUARY. Bodies received 20 Post Mortem Examinations made 118 Inquest on bodies 19 Inquests held at Holloway Prison - Inquest on fires 1 DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, &c.:— No. of articles disinfected 628,522 Cases of horsehair 33 Fees received £1,799 10s. 0d. General Disinfection. Infectious Diseases, &c.:— Articles of bedding disinfected 75 Rooms disinfected after cases of infectious disease 71 Lockers at Post Offices disinfected 42 Verminous rooms disinfected 133 Ambulances, vans, &c., disinfected — Police Cells disinfected 2 Cleansing of Persons No. of verminous persons bathed 467 No. of verminous articles disinfected 4,656 Cleansing of Schoolchildren:— No. of children cleansed 3,003 No. of articles disinfected 2,730 LONDON: Printed by Drake, Driver & Leaver Ltd., Rosebery Avenue, E.C. l. 1953.