Mis. Gophi DW 5B 2.Library LoN.79 REPORT of the MEDICAL OFFICER OF HEALTH for the CITY OF LONDON for the year 1953 Printed by the Authority of Common Council 17th December 1953. STAFF. Date of Appointment MEDICAL OFFICER OF HEALTH. 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 April, 1926 Peters, E. Jf General Grade Clerks 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 Sept., 1946 Thompson, E.Sept., 1948 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 July, 1930 Garrard, S. S. Sept., 1946 Morris, W. L Meat Inspectors Sept., 1946 Seymour, K. D Meat lnsPectors 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. (Senior Porter 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 Portbury, T. (General Duties at Smithfield Market) July, 1953 Wright, J. (General Duties at Smithfield Market) Oct., 1953 Rowe, Mrs. L. E. (Bath Attendant and Cleaner) June, 1951 (Retired 30.6.53.) (Retired 10.10.53.) 1 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1953. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. 55/61, Moorgate, London, E.C. 2. July, 1954. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1953. Vital Statistics. The resident population of the City continues to decline. At the census of 1951 it was 5,268 having fallen from 10,999 at the 1931 census. The population at mid-year 1953, as estimated by the Registrar General, was 5,090. The birth rate was 5.42 per 1,000 and the death rate 10.56 per 1,000. The infant mortality rate was 32.19 per 1,000 live births. As I have observed year by year the vital statistics of the City cannot be usefully compared either with those of other areas or even with those of previous years because the numbers on which the rates are calculated are so small. Infectious Diseases. The number of notifications of Tuberculosis rose from 11 to 29, but deaths were one fewer, being 4 as compared with 5 in 1952. Twelve of the notifications were from the Salvation Army Shelter in Middlesex Street, all relating to casual workers who do not report to a doctor until they are so ill that they must be admitted to hospital and who will not submit themselves for routine examination at the mass radiography centre, believing as they do that the only result of such examination will be a restriction of their personal freedom. There were 9 notifications of puerperal pyrexia all from St. Bartholomew's Hospital; but since under the Puerperal Pyrexia Regulations, 1951. "any febrile condition occurring in a woman in whom a temperature of 100.4°F. or more has occurred within fourteen days after childbirth or miscarriage" must be notified as puerperal pyrexia, nine such notifications from amongst the 604 cases of childbirth in St. Bartholomew's Hospital, giving a rate of 14.9 per 1,000, with no deaths, is indicative of the high standard of midwifery one would expect. The Public Health (Infectious Disease) Regulations, 1953, came into force on 1st April. They amplify the precautionary measures against food poisoning by providing that a local authority may, by notice in writing, require any person to discontinue or refrain from engaging in any occupation connected with the preparation and handling of food or drink for human consumption, if such person is suffering from, or a carrier of the organisms of, typhoid fever, paratyphoid fever, dysentery or food poisoning. The local authority may also, by notice in writing, require the measures necessary to prevent the spread of infection to be taken. Delay in the issue of such notices may be dangerous and therefore the regulations state that a local authority may authorise the Medical Officer of Health generally to issue notices on their behalf, if it is in his judgment necessary for him to do so for the purpose of preventing the spread of infection. The Corporation of the City of London have by resolution authorised their Medical Officer to take such action on their behalf where necessary. It has not been necessary to issue any written notices, though in a number of cases Medical Officers of Health of other districts have notified me of persons engaged in handling food in the City who are contacts with cases of Sonne dysentery at home. It has always been possible with the co-operation of employers, to arrange for such persons to discontinue the handling of food or drink until it has been ascertained that they are neither infected nor carriers of infection. Mass Miniature Radiography. A Mass Radiography Unit of the North East Metropolitan Regional Hospital Board continued to operate during the year from your premises at 20, Golden Lane. The circulation of all firms and private residents in the City, advising them of the facilities for examination, was completed during the year. A total of 14,686 circular letters were despatched. Two thousand three hundred and sixty firms arranged for their staffs to be X-raved 1,622 of which were small firms sending 10 or fewer persons for examination. The total number of examinees from all firms was 56,642 comprising 34,135 men and 22 507 women. The number of persons making individual requests for examination was 363. The Unit is also available to the Boroughs of Finsbury, Stepney and Shoreditch, and since it commenced to operate from 20, Golden Lane, on 1st November, 1950, 147,000 persons have been X-rayed, which fully justifies the decision of the Corporation to provide a base for the Unit within the City. The annual report of the Medical Director of the Unit is not yet available, so I am unable to report the results of the examinations carried out during 1953 2 Food Poisoning. The day population of the City is estimated to be in the region of 500,000, the majority of whom take luncheon and/or tea in the City. Only two outbreaks of food poisoning, both fortunately mild and both connected with commercial canteens, came to my notice during the year. Details of these are as follows: — No. 1. On 14th May, 1953, the Medical Officer of Health of Wallington, Surrey, informed me that a bank manager employed in the City had been notified as suffering from food poisoning, and that he suspected some shepherd's pie, consumed at lunch in the bank's luncheon club on the 13th May, as the source of infection. On enquiry at the bank, it was ascertained that 24 members of the staff had developed similar symptoms on the evening of 13th May. These were all members of the staff of one branch and not all of them had had lunch at the luncheon club. It appeared, therefore, that the source of infection was at one branch and not at the club, where some 1,300 lunches had been served on the 13th May and there had been no other cases of illness. At the branch in question, tea or coffee with buns and butter and cakes are served during the morning and afternoon from a small kitchen. The food is supplied from the club but the beverages are made at the branch. It was found that milk was supplied to the branch kitchen from the club in 10 gallon churns. This milk arrived at the branch after the morning issue of tea and coffee. It was retained in the kitchen which is small and has no refrigerator, and used for the afternoon beverages and for the morning issue next day. On enquiry as to how milk was drawn from the 10 gallon churn, it was ascertained that a jug was dipped in and withdrawn; there was no ladle with a long strap-handle such as is commonly used for this purpose. Consequently the milk was contaminated by the jug and by the hand of the kitchen maid. The milk then stood in the warm kitchen overnight, providing ideal conditions for the growth and multiplication of organisms. None of the milk delivered on 13th May was of course available, but on May 15th a sample of the milk delivered on 14th May, from which milk had been drawn for tea on that day, and the remainder of which had stood over-night in the kitchen, was submitted for bacteriological examination. The report of the bacteriologist was that methylene blue was reduced in less than 30 minutes, and that on the total bacterial count the colonies of bacteria were uncountable. No specific food poisoning organisms were identified, but this was not the milk consumed on the day when the infection occurred. In my opinion the most likely cause of the outbreak was the grossly contaminated milk. Arrangements have been made for the milk to be kept under proper conditions at the Club and only supplied to the branch for immediate consumption. The Sanitary Inspectors engaged in the inspection of catering establishments have been requested to have this incident in mind and to endeavour to ensure that milk is not similarly contaminated and then incubated in other kitchens, canteens, cafes, etc. No. 2. On Friday, 23rd October, at 4 p.m., 1 was informed that an outbreak of mild foodpoisoning involving about 40 persons, had occurred amongst the staff of a commercial firm in the City. The cases had developed during the night of Wednesday, 21st October, and were attributed to the luncheon meal served in the staff canteen that day. The symptoms were abdominal pains and diarrhoea, but no vomiting, coming on from 6 to 18 hours (average 12½ hours) after the meal. Recovery was rapid and complete. The meal was served between 11.40 a.m. and 2.30 p.m. to about 200 persons, of whom only one-fifth were affected. These were not in any one batch but had eaten the meal at different times between noon and 2 p.m. The meal comprised roast beef, roast lamb, baked potatoes, brussels sprouts, tinned apricpts, tinned pineapples, custard, blue cheese and biscuits. The only items which had been consumed by all the cases were potatoes and sprouts, and the gravy served with the meat course. The beef had been cooked the previous day and stored overnight in a refrigerator. The rest of the meal had been prepared on the day it was served. The only residue of the meal available for examination was some beef and mutton bones with a little meat attached. These were sent to the City Bacteriologist who reported that he had not found any pathogenic organisms, but observed that they were not satisfactory specimens on which to express an opinion. They were, however, all that was available when we came on the scene. Samples of custard powder were examined bacteriologically but contained neither pathogenic organisms nor poisonous chemical substances. The canned apricots and pineapples appeared to be above suspicion as judged by the condition of the remaining stock of cans. Samples of faeces were obtained from the four members of the kitchen staff who prepared the meal. All were found to be free from pathogenic organisms. Conditions in the kitchen were generally good and the staff well informed on the hygiene of food preparation. They all readily co-operated in our investigations. A number of recommendations for minor repairs and improvements to equipment in the kitchen were made, and the firm have undertaken to give these prompt attention. The cause of this outbreak must remain unidentified. There is bound to be a delay of at least 24 hours between the consumption of a suspected meal and news of any ill effects reaching us, because symptoms do not develop till the late evening, and it is not till the middle of the next day that the firm concerned realise that an outbreak of food-poisonin has occurred. In this case the delay was more than 48 hours. 3 Under these circumstances it is rarely possible to obtain for examination any residue of the meal responsible, and in this case it is not even possible to say that a particular item was probably the cause, because, as had already been said, the only foods which had been eaten by all the cases were potatoes and sprouts, neither of which is likely to give rise to food-poisoning. Food Inspection. The total amount of meat delivered at Smithfield Market was 368,196 tons—62,952 tons more than in the previous year. The quantity found by the inspector to be unfit for human consumption and voluntarily surrendered was 563 tons. In cold stores 67 tons and in Leadenhall Market and City shops 13 tons were condemned. A great variety of foodstuffs is landed at riverside wharves in the City and 330 tons were condemned as unfit for consumption. Food Hygiene. Ministry of Health Circular 1/54 requires Medical Officers of Health in their Annual Reports for 1953 to give information under the heading 'Clean Food Campaigns', as follows:— (1) the number, if available, of food premises in the area, by type of business; There are 961 catering establishments in the City. It is not possible to give the number of food premises in total let alone by type, except for those which are required to be registered under Sec. 14 of the Food & Drugs Act and which are dealt with under item (2) below. There are very large numbers of food premises of all kinds from cold stores to fruit stalls. The main concentrations are in and around the three great markets, Smithfield, Billingsgate and Leadenhall, but food shops of various types are scattered all over the City. (2) the number of food premises, by type, registered under Sec. 14 of the Food & Drugs Act, or under local Acts, and the number of dairies registered under the Milk and Dairies Regulations, 1949: Premises Registered for. No. of Premises. Sale and storage of ice cream 90 Manufacture of ice cream 1 Selecting & testing sausage casings 8 Manufacture of sausages 18 Manufacture of meat pies 4 Manufacture of brawn, etc. 6 Cooking of hams 10 Preparation of chutney 1 Preparation of fish paste 1 Preparation of jellied eels 6 Preparation & bleaching of tripe 1 Boiling of shellfish 8 Brining of meat 20 Pickling & bottling of mussels 3 Pickling & bottling of vegetables 1 Smoking of bacon 2 Manufacture of processed cheese 1 The number of premises on the Register under Sec. 14 of the Food & Drugs Act, 1938, was 154. Some are registered for more than one of the above processes. Premises Removed from Register. No. of Premises. Sale of ice cream 12 Food preparations, sausages, etc. 4 There are 8 Dairies registered under the Milk and Dairies Regulations, 1949, and a considerable number of other premises from which milk is supplied only in the properly closed and unopened vessels in which it is delivered to the shop, or in which milk is sold for consumption on the premises only. (3) the number of inspections of registered food premises, with informative comment as necessary; In premises registered for the sale, manufacture and storage of ice cream, 132 inspections were made. 4 premises were found to be unsatisfactory, but the conditions are now remedied. In premises registered for the manufacture of sausages, etc., 83 inspections were made. 46 premises were found to have unsatisfactory conditions, and 207 re-inspections were made regarding these. In all but 10 of the premises the unsatisfactory conditions have now been remedied, and in these 10 the work is in hand or on order. (4) any new educational activity (e.g. inauguration of clean food guilds or of lectures on food hygiene), and the progress of established educational activity; There is no organised teaching of food hygiene in the City of London. I have from time to time carefully considered and discussed with my staff the possibility of establishing a Clean Food Guild and of arranging lectures on food hygiene, but we have always come to the conclusion that neither would be of real practical value in the City of London. The City is not a residential area, and the catering business is almost entirely a lunch time trade. The employees live some considerable distance from their work. They arrive in time to prepare for a tremendous rush between noon and 2 or 2.30 p.m., clear up and return home. 4 They certainly would not stay in the City to attend lectures, and employers could not be expected to release them during the intensely busy working hours. It seems that the only possible way to impart instruction in food hygiene in the City is for the sanitary inspectors to talk to individual food handlers during their visits to catering establishments, explaining why this and that should or should not be done, criticising equipment, lay out and methods, and giving reasons for their criticisms. This kind of instruction may be relatively slow, but I believe it to be more effective than lectures which, even if they are fully comprehended, are apt to be forgotten, and even if remembered are in many cases not related to the 'daily round the common task'. Be this as it may, I believe that standards of food hygiene are improving. There is a number of reasons for this; a wide public interest in food hygiene has been created by the Press, outbreaks of food poisoning are news, and long may they remain so, for if they do not always teach a lesson they convey a warning; sound broadcasting and television have helped; improved housing has raised general standards of hygiene, and finally, improved working conditions in kitchens are an example and an encouragement to the kitchen staff. As regards Clean Food Guilds I do not know how I could start one in the City, even if I had the courage and the confidence to try. Those of us who have administrative responsibility may realise how far a certificate awarded by a Clean Food Guild can be a guarantee of safety, we know how much depends upon the individual, and that there are dangers against which it is impossible to guard. But the public will take such a certificate as an absolute guarantee. I have experience of outbreaks of food-poisoning in canteens which are well constructed, well equipped, well staffed, well managed and not run for profit Incidents of this kind are uncommon but they do occur and we know that, though we can do a great deal to reduce the incidence of food-poisoning, we cannot give an absolute guarantee that it will not occur in relation to any particular establishment. In my opinion a more satisfactory way of hastening the improvement in standards of food hygiene would be to require the registration of all catering establishments, with powers to withdraw registration if reasonably practicable standards were not attained and maintained. Quite understandably caterers fear that such powers might be abused, but cancellation of registration would only be by authorisation of the Local Authority, before whom a caterer would be entitled to appear to show cause why the registration of his premises should not be cancelled, and in the City of London at least, where every member of the Local Authority can, in the Court of Common Council or in Committee, freely express his personal opinion on any question under consideration, caterers could certainly be confident that due attention would be given to every extenuating circumstance they could advance. (5) the method of disposal of unsound food; Unsound food which is suitable for dry rendering for conversion into animal feeding stuffs, fertilisers, etc., is removed to the condemned meat room at Smithfield Market, whence it is removed by the appointed contractors for processing. Unsound food which is unsuitable for any such purpose is removed by the Cleansing Department and disposed of with the general refuse from the City. (6) where special examination of a stock or consignment of food has been necessary, the total quantity as well as the quantity condemned; It is not clear to me what is required under this heading. Considerable quantities of imported food stuffs are condemned at Riverside wharves but this is regarded as routine. Details can be given if required. Hygiene of Catering Establishments. Each year I ask the two Inspectors, Mr. Thompson and Mr. Flynn, who devote the whole of their time to the inspection of catering premises, to contribute some observations on thenwork and their impressions of the progress that has been made. They have jointly submitted the following: — Steady, but at times irritatingly slow, progress has been made in the improvement of catering establishments of all types in the City of London. In order to secure a reasonable basis for the maintenance of cleanly and hygienic conditions, it has been necessary in many cases to gut the inside of existing premises and completely to reconstruct, re-equip and re-design the kitchen and ancillary rooms. In such instances prolonged technical discussions are inevitable before work can even commence. Some appreciation of the delays which have occurred may be gained, when it is considered that consent from each of the following authorities may be necessary, before the work of improvement required by the Medical Officer of Health may be put in hand: — 1. The Ministry of Works for a building licence. 2. The Divisional Food Office in certain cases when it is necessary for this Authority to sponsor a building licence. 3. The Licensing Justices where alterations to licensed premises are concerned. 4. The Town Planning Department of the City Corporation. 5. The Architect's Department of the L.C.C. where temporary structural licences are necessary in connection with the erection of external ducts for mechanical ventilating plant. 6. The District Surveyor regarding all matters of a structural nature. 7. The War Damage Commissioners where repairs or alterations to war damaged premises are involved. In addition, there are delays due to the usual difficulties between landlord and tenant, particularly when a new lease has to be negotiated, which is often necessary in order to extend security of tenure before embarking upon heavy capital expenditure. 5 Very large capital expenditure on improvements has been and is being incurred by catering establishments in the City, in some instances exceeding £20,000. It is not surprising, therefore, that after all preliminary difficulties have been resolved, the actual execution of the necessary works may extend over a period of 12 months or more. Sufficient has been said to indicate that there is no short and easy way to the achievement of a satisfactory standard in design and structure, even when the goodwill and co-operation of all interested parties is available. It is only fair to state that almost without exception the full co-operation of the catering trade has been forthcoming, and in no instance has it been necessary to resort to legal proceedings in order to enforce satisfactory standards. It is apparent, however, that the ever increasing cost of modernisation of premises must retard the rate at which major schemes of improvement can be launched even by the larger catering firms, and there is no doubt that the high cost of building works is proving a serious embarassment to the small caterer with limited capital resources. Considerable progress has been made during the year in the provision of additional washingup facilities and personal washing facilities for staff, but undoubtedly much remains to be done in the fitting of better hot water installations and the provision of additional sinks and/or washingup machines, before some of the more obvious bad practises are eliminated. The washing of cutlery in portable containers, a practise much to be deprecated, is almost a tradition in some sections of the catering industry and is a habit which dies slowly. It is encouraging to report that the extent and degree of rat infestation in restaurant premises has shown a remarkable decline during the last few years, this improvement undoubtedly being due in a great measure to the efficiency and effectiveness of the steps taken by the Corporation's Rodent Officer and his staff. The endeavour to improve means of ventilation in the many basement kitchens throughout the City is a constant struggle against technical difficulties and heavy expenditure, and the measures taken to improve conditions have met with varying degrees of success. A further problem which seems incapable of a satisfactory solution is that of the very tiny kitchen, sometimes nothing more than a passage or recess, where it is impossible to provide adequate floor space for essential equipment such as sinks; where suitable food storage accommodation is non-existent; outdoor clothes of the staff are deposited within the kitchen; and the congestion is such that thorough cleansing is an impossibility. In some instances these establishments have been operating for many years; in others, these conditions have gradually developed as a result of the expansion of the business to a type of catering not originally intended and for which the premises were not designed. The only logical course is for such premises, which are basically unsuitable for the preparation of food and which cannot be made suitable, to cease to function as catering establishments. Of course the initiation of any action which might deprive a trader of his living is repugnant and heretofore a radical solution has been deferred. Sooner or later, however, the difficulty of dealing with this type of premises must be resolved, and it would appear that a few at least of the City caterers should either cease trading or alternatively move to more suitable premises. Here again a further difficulty arises, because suitable premises, at rents which a small caterer could afford to pay, are not easy to obtain. FOOD & DRUGS ACT, 1938 and FOOD REGULATIONS. Mr. Harrington, Sampling Officer under the Food and Drugs Act, reports as follows: — 226 samples have been submitted to the Public Analyst; 23 of these were formal and 203 were informal samples. Two samples were reported against; in the one case legal proceedings were instituted and in the other a caution was administered. Milk. 19 samples of pasteurised milk were examined by both the Phosphatase and the Methylene Blue Tests. The Phosphatase Test is designed to check the efficiency of the heat treatment applied to the milk, whilst the Methylene Blue Test gives an indication of its keeping qualities, which has some relation to general cleanliness. Adverse reports on the Methylene Blue Test were received in respect of two of these samples and cautions were administered to the persons responsible. Two samples of sterilised milk were submitted to the Turbidity Test and were found satisfactory. The average composition of genuine milk samples taken during the year was Milk fat 3.50 per cent., Solids (not fat) 8.90 per cent., Total solids 12.4 per cent. There are now eight dairies in the City of London within the meaning of the Milk and Dairies Regulations, 1949 but a considerable number of milk bars and suchlike places where milk is sold for consumption on the premises only. 92 Supplementary Licences in respect of 28 firms and individuals and 32 Dealers' Licences in respect of 12 firms and individuals were issued under the Milk (Special Designation) (Raw Milk) Regulations, 1949/50 and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949/1953. Cream. Four samples of Double Cream were submitted to the Methylene Blue, Phosphatase and Coliform Tests. Of these, one was unsatisfactory suggesting some degree of contamination after pasteurisation. The suppliers were notified immediately. In one other case in which two samples were taken on different dates, it appeared on examination by the Phosphatase Test that the cream had not been heat treated despite the printed claim of the suppliers that it had been 'flash pasteurised'. 6 A sample of Cornish clotted cream was found to be not quite satisfactory and the containers were inadequately labelled. The supplier was interviewed and the labelling corrected. In each of these cases full details were forwarded to the Medical Officers of Health for the districts where the cream was prepared and packed. Two samples of sterilised cream were also examined and found satisfactory. It has been agreed between your Bacteriologist and the Medical Officer of Health not to continue with the application of the Methylene Blue Test to cream samples as the test is unreliable for cream, but to substitute the plate count, and this has been done in respect of later samples. The average milk fat content of samples of cream submitted for analysis was, in respect of double cream 50 per cent., and of sterilised cream 24 per cent., by weight. Ice Cream. The attention that has been paid to the production of ice-cream in recent years has resulted in a much improved product and there has been a tendency in the City for more retailers to obtain their supplies from reputable manufacturers, mostly in pre-packed form in which it is sold to the consumer. There is only one manufacturer of ice-cream in the City of London. Five samples were taken from his premises and unfortunately three were unsatisfactory. From the temperature recording charts however, it appeared that he was not holding the mix at 160 degrees for the requisite ten minutes. He was severely cautioned on this and on matters of cleanliness and the samples drawn thereafter proved satisfactory. Eight new registrations of premises for the sale and storage of ice-cream were granted during the year. Butter. Samples taken from a packing factory and submitted for analysis and for bacteriological examination were reported as satisfactory. Food Labelling. No administrative action has been required during the year but a number of enquiries have been received and advice given to enable compliance with the requirements of the Labelling of Food Order, 1953. 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. HOUSING. The number of housing applications outstanding on 31st December, 1953, was 465, comprising 1,131 persons. The number of families rehoused during the year was 29. This figure includes 13 families transferred within property under the Corporation's control. Although the Corporation have only one housing estate actually within the City boundary, they have provided a number of blocks in neighbouring Metropolitan Boroughs. The housing under the control of the Public Health Committee comprises: — 1. In the City: — 201 tenement flats in 4 blocks—King's, Queen's, Prince's and North—erected in 1884. Plans have been passed for complete interior reconstruction of these premises so as to make self-contained flats with all modern conveniences. 24 Self-contained flats, without bathrooms—Bearsted House—erected in 1926. 16 ,, ,, ,, ,, ,, —-Dutton House—erected in 1928. 24 ,, ,, ,, ,, ,, —South Block—erected in 1884 structed in 1938/9). 2. In Stepney : — 49 Self-contained flats—Whitaker Buildings—erected in 1923. 76 ,, ,, ,, —Dron Buildings—erected in 1923. Plans have been approved for modernising the flats in both these buildings. 3. In Shoreditch: — 104 self-contained flats—Windsor House—erected in 1926, which are quite good even by modern standards. 4. In Lambeth: — 48 self-contained flats—Blake House—erected in 1921/2, 5. In Camberwell: — 48 self-contained flats—Avondale House—erected in 1921/2. 65 ,, ,, ,, —George Elliston House and Wilkins House—erected in 1952, providing all modern amenities and conveniences. 6. In Islington: — 73 flats—Isleden House—-erected in 1948/9. 7. In City and Finsbury: — 340 modern self-contained flats under construction which may be extended to 580. 8. In Lewisham: — Plans for the erection of 30 flats and 27 houses on a site on Sydenham Hill have been approved. The Corporation of the City of London have already provided housing accommodation for 728 families and have started or have in contemplation provision for a further 641. 7 There are at most a dozen dwellings in the City which are so old, so lacking in light and air, and so devoid of reasonable amenities that they should be closed as opportunity offers. Except in the instance reported below there is no question of demolition, since the ground floors are already converted to commercial use, and when the tenants of the dwellings above are rehoused the remainder of the premises will no doubt be similarly converted. This has already happened in several instances and the transformation effected is remarkable. This does not mean that they could be made fit as dwellings even if an equal amount of money was spent on them. The type of tenant in these dwellings is difficult to rehouse, mainly, but not solely, because they don't want to move from the particular location. Crown Gardens is a group of five houses on either side of a court approached by a passage from Aldgate. The houses are old and have no through ventilation by reason of the fact that commercial premises have been built against the back walls. The basement kitchens are illegal underground rooms; the water-closets are under the common court and have no natural light. There are of course no bathrooms. The houses are falling into disrepair and have become damp and insanitary. No. 7 has been empty for three years and has been closed but not demolished. The tenants of the other houses were all elderly and it was intended to close the houses as they became vacant and then demolish them altogether, but it became apparent that earlier action was necessary, and notices under Section 11 of the Housing Act, 1936 were served on the owner, who readily agreed to the demolition of the houses as soon as the sitting tenants could be accommodated elsewhere. Finding alternative accommodation which the tenants will accept is proving very difficult, as they are unwilling to be rehoused outside the City. WELFARE OF OLD PEOPLE. The City of London Old People's Welfare Association, under the Presidency of the Lord Mayor and the Chairmanship of Sir Frederick Rowland, has continued to do all that its limited financial resources permit for the welfare of old people resident in the City and in the Corporation's Housing Estates outside the City. Residents in the eastern half of the City have an excellent club in Stoney Lane which is open all day. Those in the western half are very kindly granted club facilities by the City of London Residents Association. All old people on the register, which now includes 1,138 names, are visited by the Hon. Secretary or by one of the voluntary visitors, and visits are repeated regularly if needed or desired. The Association provides Convalescent holidays, additional domestic assistance and night help, invalid aids of various kinds, a chiropody service, handicraft classes, wireless sets and Christmas parcels. A number of kind friends have provided entertainments and summer outings. We are very grateful to them; to the voluntary visitors and to the Hon. Secretary Mrs. Cohen, who devotes almost all her spare time to the welfare of the aged, the infirm, and those in sickness or distress, but is essentially practical in her approach to their problems. Isleden House. Isleden House was built after the war, as "an experiment in the housing of the aged in a densely populated district", by the Trustees of the London Parochial Charities, a charitable body formed to administer the consolidated charities of most of the parishes of the City of London, under a scheme of the Charity Commissioners dated 23rd February, 1891, made under the City of London Parochial Charities Act, 1883. Having administered Isleden House most successfully for some three years, the Trustees decided that it should be transferred to Local Authority control, and appropriately offered it to the Corporation of the City of London, who agreed to purchase it for the sum of £100,000. The accommodation provided is as follows: — Ground Floor: — 22 Small flats for one person (Type "A"). Living Room, Kitchenette and Bathroom. 9 Small flats for two old persons (Type "B"). Living Room, Bedroom, Kitchenette and Bathroom. First Floor: — 9 Flats for a three-person family (Type "C"). Living Room, Two Bedrooms, Kitchen and Bathroom. 5 Flats for a 4-5 person family (Type "D"). Living Room, Three Bedrooms, Kitchen W.C. and Bathroom. Second Floor: — Ditto. Third Floor: — Ditto. In addition to the above there are separate Communal Laundries for the Old People and the Families, with a Central Boiler House in the Basement under. There is an Administration Block, consisting of the Superintending Matron's Office and Flat, a Communal Dining Room and Kitchen for the Old People and a Sick Bay with a General Ward and two private rooms, in which old People who are not ill enough to go to hospital can be looked after. Pram and Bicycle stores are also provided on the ground floor for the use of the tenants on the upper floors. Detailed Description of Flats (1) Type "A" Flat to accommodate one Old Person. Entered through a small porch leading into the Living Room, which has a curtainedoff Bed Recess and a bay window and is warmed by a combined gas and coal fire in addition to Central Heating from the Main Boiler House. Leading out of the Living Room and looking on to the Central Courtyard is a small Kitchenette, one side of which is taken up 8 with a special Kitchen Unit finished throughout in cream coloured enamel. This Unit comprises a stainless steel sink and draining board, with heated towel airer, a gas cooker with a hinged enamelled top, an electric refrigerator, an electric clock, loud speaker for wireless programmes and sundry cupboards for food, household utensils, etc. The Kitchenette has a flap table which folds against the wall. Also leading out- of the Living Room is a small back entrance with a Bathroom, containing a bath, W.C. and lavatory basin, towel airer and linen cupboard. Outside the back entrance is a fuel store and a space for a dustbin. Each flat has over the bed and bath an electric bell which rings in the Superintendent's office in the Administration Block. (2) Type "B" Flat to accommodate two Old Persons. Similar to Type "A" but with a separate Bedroom in addition to the Living Room. (3) Type "C" Flat to accommodate a family of three Persons. These flats are situated on the upper floors. The general accommodation and finishings are similar but in these flats there is "Background" Heating only and Gas Fires in all rooms. They are entered from balconies running the whole length of the Blocks and communicating with Common Staircases at each end. (4) Type "D" Flat to accommodate a family of three-four persons. These flats are situated on the upper floors. They are similar to Type "C" flats but have three Bedrooms and a separate W.C. The upper-floor flats are served with Electric Shopping Lifts and with Dust Shoots for the disposal of refuse at each of the three common staircases. There is a "Work Room" on each floor for the use of the tenants for minor household repairs and hobbies. Laundries. There are separate Communal Laundries for the Old People and for the Tenants on the upper floors. The Old People's Laundry has two washing compartments consisting of a sink, draining bench, electric washing machine and a gas copper. Leading off this is a Drying Room consisting of separated gas-heated drying racks, each of which can be locked whilst the clothes are drying. Ironing is done by individuals in their own flats. , The Tenants' Laundry is similar, except that there are four washing compartments and a larger Drying Room. All hot water, etc., is provided from the Central Boiler House below the Laundries. Dining Room. A Dining Room is provided in the Administration Block where the Old People have a mid-day meal on a Cafeteria system. There is a hot plate counter with a steel shutter opening into the Kitchen, which is equipped with gas cookers, sinks, refrigerator and food stores. Staff Cloak Rooms and a service entrance to the street are provided. There are lavatories for men and women near the Main Entrance to the Dining Room. Sick Bay. The Sick Bay for the care of the Old People is in two parts and is situated in the Administration Block. There are two private rooms (one single and one double) with a Bathroom adjoining the Superintending Matron's Quarters which is set aside for very Old People who are no longer capable of looking after themselves. On the first floor is a six-bed ward designed on hospital lines for Old People who may be temporarily ill or require special care. Adjoining the ward is a Duty Room for the use of a nurse, with Bathroom, Lavatories and Sink Room equipped on modern lines. Meals are served from the Communal Kitchen below. There is a Passenger Lift large enough to take a stretcher. Superintending Matron's Accommodation. There is an office for the Superintending Matron on the Ground Floor of the Administration Block. In this room is located the Bell Indicator serving each old person's flat, so that the Matron can be summoned in the case of emergency. On the First Floor is a flat for the Matron, comprising a Living Room with Dining Recess, Bedroom, Bathroom and Kitchenette equipped in a similar manner to the other flats. Special Features of Old People's Flats. Considerable thought has been given to the provision of special amenities, bearing in mind the particular needs of old and possibly infirm persons. The baths are sunken into the floors six inches, for easy access, and bars are fixed on the walls above them to afford support when in use. The taps of the baths, basins and sinks have large heads for easy turning: the handles of the doors are "lever type" for easy operation: the window fastenings are within easy reach: the paths are constructed to prevent them from becoming slippery. A proportion of the doors of the flats are wide enough to admit invalid chairs. Services. The Engineering Services are controlled from the Central Boiler House in the Basement under the Laundry and are in charge of a Resident Engineer. The Heating and Hot Water Boilers are oil-fired and afford supplies to all flats, the Laundry and the Administration Block. The Cold Water Tanks are located on the top of each Staircase Tower and the services controlled from the Central Boiler House. 9 The Gas Supplies are run to individual flats, but the metering of the Old People's Flats and the Administration Block are controlled from the Central Boiler House. The flats on the upper floors have "Slot" Meters. The Electrical Supply Company have installed a Sub-station in the Basement adjoining the Boiler House which controls the Electric Lighting and Power throughout the buildings. The system is so arranged that the charges for the Old People's flats, the Administration Block and the flats on the upper floors are kept separate. Time switches are installed to control the Staircase, Balcony and Courtyard lighting respectively; these can be set to switch off the lights at a given time each evening. A Central Wireless receiving set is installed in the Switch Room to provide a choice of three programmes to the loudspeaker in the Kitchen Units in each flat. The sick bay has earphone connections at each bed. Electric fans connected to ducts extract steam and cooking smells from the Laundries and Kitchens. The Corporation have every reason to take pride in having become the owners of Isleden House and to be grateful to the Trustees of the London Parochial Charities for transferring it on such generous terms. RODENT CONTROL Rodent control is a public health measure the importance of which is apt to be under-rated, and I make no apology for devoting year by year a section of my annual report to this subject. My interest in the control of rat infestation dates from my days as a port medical officer, plague being a disease of rats communicable to man, and the prevention of the spread of plague from port to port being largely a matter of the control of rat-infestation in ships. As Medical Officer of Health of the City I have retained my interest because, not only are rats and mice potential carriers of food poisoning organisms, but they cause the waste of very large quantities of food, not only by what they eat, but by what they soil and the damage they do to containers from which food consequently escapes. You have a competent team of rodent operatives under the Chief Rodent Officer, Mr. Carter, and I am pleased to record that I have received a number of spontaneous tributes to their efficiency and integrity. Mr. Carter's report of the year's work is as follows: — Organisation and procedure during the year was similar to that of previous years, and in compliance with the provisions 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 treatment for the destruction of rats in the sewers. It has always been the policy to seek the co-operation of occupiers and owners of property, and the response to this approach has been satisfactory. No difficulty has arisen in which it has been necessary to resort to statutory action to resolve the problem. A major proportion of the work consisted of inspecting defined areas for the purpose of instituting collective action. In cases of individual notification of infestation, or request for assistance in control measures, the property adjoining was also inspected and combined action taken where necessary. On the survey side of the work 5,601 occupancies and properties were inspected, and types of properties rangecl from large blocks of offices, riverside food warehouses, catering establishments, factories and shops, to domestic dwellings. The time expended on inspection of large blocks is very considerable, and although often with negative result, it is necessary for the success of collective action. A total of 637 infestations of rats and mice were treated, and of this number 295 were notifications and 342 the result of inspection. The infestations comprised 25 major and 238 minor infestations of rats, and 111 major and 273 minor infestations of mice. The rat infestations were in the main of Ship rat (Black) nature. Treatment of these infestations entailed 7,582 visits for operational purposes. A minimum of 1,572 rats were destroyed as the result of poison, and 752 bodies were recovered. Trapping resulted in the destruction of 241 rats. The use of the anti-coagulant Warfarin in the treatment of mice infestation resulted in 925 dead mice found. No records are available of the results obtained by Pest Control firms servicing premises periodically. The downward trend of rat infestation has continued and a further decline in the number of infestations, and numerical density has been experienced. There is a 50% reduction of major infestations (20 rats or over) and a 15% reduction in the minor classification. Infestation of common rat nature in surface properties was again on an extremely minor scale, and during the year only three such infestations were found and treated. There is, however, a steady increase in mice infestation, and this appears to coincide with the decrease in rat infestation. In many instances premises treated in the past for rats have remained free of that type of infestation, but have become subject to mice infestation. The increase in the number of catering establishments and the installation of staff canteens in office properties is conducive to this nuisance. The nucleus of mice infestation is often imported into these premises in sacks of vegetables and cases of eggs, etc. Many of the complaints are from offices and the cause is generally traced to the careless or thoughtless disposal of food scraps. It is a common occurrence to find food wrappers, orange and apple peelings and odd scraps behind furniture and in inaccessible places. Alternatively it is put into waste paper baskets, where it is left all night, attracts mice and provides the necessary sustenance to maintain a colony. 10 Periodical maintenance treatment for the control of common rats in the City sewers continued and direct poisoning with "1080", Sodium Fluoroacetate, was again the method of control. Four treatments were applied at quarterly intervals in March, June, September and December. The annual full scale non-poison test-baiting was carried out 3 weeks after the June control Altogether 12 controls by this method have been applied since May, 1951, and 2 treatments plus a full-scale test-baiting in 1954 will complete the series of 14 controls spread over three years. This work was undertaken in conjunction with the Technical Officers, Infestation Division, Ministry of Agriculture & Fisheries. For the March control 327 sewer entrances were poison baited, and 16 "takes" (4 x ½ and 12 x ¼ or less) were recorded, each bait being 4 ozs. The June treatment was the yearly full scale control, and 407 sewer entrances were baited. Examination showed 11 "takes" (1 full, 1 x ½ and 9 x ¼ or less). Following a lapse of three weeks, the annual complete test baiting was applied, and 413 sewer entrances were baited with unpoisoned bread rusk, each bait being 4 ozs., a total of 105 lbs. The test baits were left down for 2 days, and on examination only 23 "takes" (14 full, 6x½ and 3x¼) were recorded, the weight taken being approximately 60 ozs. The result of the test baiting appears to be very satisfactory when compared with the pre-bait "takes" of the December, 1950 treatment, prior to the present system of control. In that instance, after a twoday pre-bait, 225 "takes" (185 full, 29 x ½ and 11 x ¼) were recorded a total weight of over 60 lbs. being consumed. In the September control 315 sewer entrances were baited and 21 "takes" (1 x 3/4, 2 x½ and 18 x ¼ or less) were recorded. Of the 18 "takes" classified as ¼ or less, only 4 really came within the category of 1 oz. taken, the remainder being recorded solely by reason of a body being found near the bait. It was estimated that only 13 ozs. of the 80 lbs. of poison bait put down was consumed. The estimated amount "taken" in the first control of the series May, 1951 was 187 ozs., and during the last control by the old system, December, 1950 approximately 430 ozs. of Zinc Phosphide bait. In previous controls Sausage rusk was used as the bait base for the poison and Bread rusk for test baiting. For this treatment wheat was used, being available for the first time owing to derationing of animal feeding stuffs. The wheat was soaked in a water solution of "1080", at a concentration of 1%, for 24 hours. For the December control 311 sewer entrances were baited and 4x ¼ "takes" were recorded. The overall result, so far as it can be ascertained, shows that a low level of rat infestation in the sewers has been achieved and maintained. The sewermen who assist in these treatments state that it is rare for them to see a rat during the course of their routine duties. The graph illustrates the breakdown of the pre-bait "takes", which are indicative of the density and distribution of the rat population, from December, 1943 to May, 1948; the rise which was maintained until December, 1950; and the rapid decline following the introduction of direct poisoning with "1080" Sodium Fluoroacetate at quarterly intervals. 11 12 ATMOSPHERIC POLLUTION Immediately after the war the Corporation of the City considered the problem of atmospheric pollution, and on the recommendation of the Public Health Committee, included in their Various Powers Bill of 1946 clauses empowering them to declare smokeless zones in the City and to make bye-laws requiring, "in the case of new buildings and in the case of substantial alterations in the arrangements for heating in any existing building, the provision, to the satisfaction of the Corporation, of such arrangements for heating as are calculated to prevent or reduce to a minimum the emission of visible smoke". There was considerable opposition to the "smokeless zone clause" and it was withdrawn. The "prior approval" clause was not opposed and was included in the City of London (Various Powers) Act, 1946, but it was never found possible to frame bye-laws under the clause which the Ministry of Health would approve. We were, therefore, left with no more than the old powers, which in effect enabled us to deal only with gross nuisances from individual sources of smoke when they had occurred, and did not provide for any general preventive action. In 1953, following the disastrous "smog" incident in December, 1952, The Public Health Committee called for a report by your officers, on which, encouraged by the success of the City of Manchester in establishing a smokeless zone in the centre of that city, they decided to ask the Corporation to include again a smokeless zone clause in their next Various Powers Bill. To this the Corporation agreed, and a clause was included in the Bill then in course of preparation. It was decided to seek power to declare the whole of the City to be a smokeless zone. The experience of December, 1952, has created such widespread alarm and so much publicity has been given to the dangers of atmospheric pollution, that it appears likely that your smokeless zone clause will have a very different reception to the similar clause in your 1946 Bill, and there is every reason to hope that it will receive the approval of both Houses of Parliament. The measurement of atmospheric pollution at your two observations stations in Golden Lane and Finsbury Circus, has been continued throughout the year and the results are given below. They show no significant improvement. TABLE 1.—Results obtained in 1953 of the monthly observations of rainfall and solid deposited matter ; the monthly observations of sulpher dioxide by the lead peroxide method ; and the daily observations of the concentration of smoke and sulpher 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 (SOa) per day per 100 sq. cm. mg. per 100 cu. metres Parts per 100 million parts of air January 21 0.8 14.64 11.98 26.62 4.03 4.45 21 .7 70.7 19.9 66.1 February 12 0.5 4.78 3.92 8.70 3.36 2.71 18.3 60.2 14.9 49.8 March 12 0.5 22.93 9.26 32.19 3.34 4.78 26.3 63.0 23.4 74.4 April 57 2.2 11.91 12.31 24.22 2.10 2.26 8.6 17.3 8.2 18.6 May 26 1.0 10.12 6.87 16.99 1.41 1 .56 4.5 9.0 5.7 8.5 June 33 1.3 7.56 6.31 13.87 1.18 1.17 3.1 7.9 4.7 22.4 July 92 3.6 12.45 10.62 23.07 1.14 1.14 2.6 9.0 3.1 4.8 August 47 1 .8 7.00 5.38 12.38 1.19 1.10 3.7 6.4 4.7 8.9 September 29 1.1 12.28 5.21 17.49 1 .63 1.44 4.3 7.5 6.2 13.4 October 70 2.8 13.24 11 .48 24.72 1.56 1.84 20.1 50.1 14.0 40.6 November 24 0.9 5.58 6.11 11 .68 3.26 3.17 20.9 62.5 14.8 35.4 December 15 0.6 21.44 9.19 30.63 3.46 4.03 28.1 85.1 16.6 40.9 Average 1953 36 1 .4 11 .99 8.22 20.21 2.30 2.47 13.5 — 11 .3 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 - 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 213. 13 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. Two faithful servants of the Corporation retired during the year: — G. Ludgate, Senior Porter Meat Inspector's Office, after 47 years' service. T. E. Tierney, Senior Messenger, after 26 years' service. 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. 14 STATISTICAL INFORMATION. Area.—661 acres (including the Temple and Tidal Water and foreshore). Population.—Census 1951, 5,268. Estimated Mid-year 5,090 Annual Rateable Value.—As at 1st April, 1953, £6,732,840. Annual Sum received from Penny General Rate.—Estimated £27,650. Births:— Total. M. F. Legitimate 30 16 14 Live Births, Illegitimate 1 1 - Still Births — — — Deaths:— Deaths, Infants under 4 weeks of age Deaths under 1 year Deaths (all ages) Death Rate of Infants under one year of age :— All Infants per 1,000 live births 32.19 Legitimate Infants per 1,000 legitimate live births — Illegitimate Infants per 1,000 illegitimate live births 1000.00 INFECTIOUS DISEASE. Notifications received :— Total cases notified. Acute Influenza 1 Food Poisoning 2 Measles 8 Puerperal Pyrexia 11 Sonne Dysentery 2 Tuberculosis 29 Whooping Cough 1 ANALYTICAL EXAMINATIONS. (Other than under Food and Drugs Act). Fruit (tinned) 14 Hen Albumen Crystals 1 Vegetables (preserved) 1 Tomato Puree 2 Bacon 1 Pressed Beef 3 Fruit (Dried) 1 Cream (tinned) l Cheese (processed) 1 Custard Powder l Vegetables (Dehydrated) 2 Buttered Roll l Chemical Fertilizer 2 Water 2 Luncheon Meat 4 Corned Beef in Roll l Shellfish (tinned) 2 Rainwater 12 Sausages 3 Atmospheric Pollution 24 BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year :— Beef 1 Milk 1 Corned Beef (tinned) 3 Water 2 Ham (tinned) 7 Faeces 4 Tongues (tinned) 2 Sputum 3 Pork (tinned) 1 Veal (tinned) 1 Custard Powder 7 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. Birth Rate per 1,000 resident population, 1953 5.42 Rate per 1,000 total (live and still) births — Legitimate — — — Illegitimate 1 1 — | Legitimate — — — Illegitimate 1 1 — 56 46 10 Death Rate per 1,000 resident population 10.56 15 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1953. Causes of Death 1 Nett Deaths at the subjoined ages or Residents whether occurring! within or without the district. All Age3 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 2 3 4 5 6 7 8 9 10 All Causes 56 1 1 1 28 21 4 1. Tuberculosis, respiratory M 3 - - - - - 2 1 — F - - - - - - - - - 2. Tuberculosis, other forms M 1 — — - — — 1 — — 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 3 — — - - - 3 - — F - - - - - - - - - 12. Malignant neoplasm-breast M - - - - - - - - - F 1 - - - - - - 1 — 13. Malignant neoplasm-uterus F - - - - - - - - - 14. Other malignant and lymphatic neoplasms M 6 - - - - - 4 1 1 F - - - - - - - - - 15. Leukaemia, aleukæmia M — — — - - F - - - - - - - - - 16. Diabetes M — — — - - F - - - - - - - - - 17. Vascular lesions of nervous system M 2 - - - - - 2 - - F 1 - - - - - - - 1 18. Coronary disease, angina M 6 — — - - - 3 3 F - - - - - - - 19. Hypertension with heart disease M 1 - - - - - - 1 F - - - - - - - - - 20. Other heart disease M 3 1 2 F 2 - - - - - 1 - 1 21. Other circulatory disease M 1 — — - - 1 F - - - - - - - - - 22. Influenza M — — — - - - - F - - - - - - - - - 23. Pneumonia M 8 — — - - 4 4 F 1 - - - - - - - 1 24. Bronchitis M 2 — - 1 1 - F 1 - - - - - - 1 25. Other diseases of respiratory system M - - - - - - - - - F 1 - - - - - 1 - 26. Ulcer of Stomach and duodenum lM 1 - - - - - 1 F - - - - - - - - - 27. Gastritis, enteritis and diarrhoea M - - - - - - - - - F - - - - - - - - - 28. Nephritis and nephrosis M 1 — — - - - 1 - . F - - - - - - - - - 29. Hyperplasia of prostate M 1 1 - F - - - - - - - - - 30. Pregnancy, childbirth, abortion F - - - - - - - - - 31. Congenital malformations M - - - - - - - - - Carried forward F - - - - - - - - - M 41 - - - - - 24 16 1 F 7 - - - - - 2 2 3 16 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1953—continued. Nett Deaths at the subjoined ages of Residents whether occurring within or without the district. Causes of 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 41 - - - - - 24 16 1 F 7 - - - - - 2 2 3 32. Other defined and ill-defined diseases M 5 1 — — — 1 2 1 - F 3 — — — 1 - — 2 - 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 46 1 1 26 17 1 F 10 — — — 1 - 2 4 3 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 Centres. 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 36 1-5 years of age 15 Total No. of children who attended during the year, and who were born in:— 1953 19 1952 35 1951-48 60 Total attendances by children— Under 1 year of age 552 1-5 years of age 388 Health Visitors. No. of infants under 1 year of age visited for first time 30 Total visits to infants under 1 year of age 182 Total visits to children 1-5 years of age 401 No. of expectant mothers visited 27 Total visits to expectant mothers 62 Care of Premature Infants. No. of premature births during the year 3 No. of deaths under 1 month 1 Diphtheria Immunisation. No. of children who completed a full course of primary immunisation— Under 5 years of age 25 5-14 years of age 4 No. of children who were given a secondary or reinforcing injection 43 Vaccination. No. of children successfully vaccinated or revaccinated 21 No. found to be insusceptible to vaccination — 17 MEAT INSPECTION. Tons. Cwts. Qrs. Lbs. Meat, &c., delivered at Smithfield Market 363,196 0 0 0 Meat, &c., seized by Inspectors at Smithfield Market 563 8 2 24 Meat, &c., seized by Inspectors at Leadenhall Market and City shops 13 5 3 10 Meat, &c., seized by Inspectors at Cold Stores 66 19 3 7 Various commodities seized by Inspectors and sent to Lett's Wharf 68 12 2 0 Number of eggs seized by Inspectors and sent to Lett's Wharf, 11,156 Number of demonstrations and lectures given, 9. Number of Students attending, 87. 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. 25 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. 330 tons 0 cwts. 3 qrs. 1 lb. were condemned as unfit for human consumption. 246 tons 17 cwts. 2 qrs. 4 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 83 tons 3 cwts. 0 qrs. 25 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. 54 tons 11 cwts. 2 qrs. 12 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 3,359 inspections have been made. As a consequence of these inspections, it was necessary to serve 24 Intimation Notices. Six 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 29, defects found have been, or are in course of being remedied. Action has been taken under Section 11 of the Housing Act, 1936, in relation to 5 houses. 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 6 are to be enforced by Local Authorities 1.061 (including 711 kitchens) 1,903 (including 1,637 kitchens) 162 (including 135 kitchens) — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 392 191 27 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 4 4 - - TOTAL 1,457 2,094 189 — 18 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.l.) 520 416 2 13 - Overcrowding (S.2) 13 — — — — Unreasonable temperature (S.3) — 1 — — — Inadequate ventilation (S.4) 57 41 — — — Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7) 16 7 — — (a) insufficient 2 15 — — (b) Unsuitable or defective 150 127 — 15 (c) Not separate for sexes 4 1 — 2 — Other offences against the Act (not including offences relating to Outwork) 636 432 — — — TOTAL 1,398 1,040 2 30 — OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms 119 Names and Addresses, etc., received from other Authorities 174 Names and Addresses transmitted to other Authorities 710 No case of infectious disease was reported in connection with outworkers' premises in the City. SHOPS ACT, 1950. 61 inspections of shops and warehouses have been carried out. Defects found have been remedied after the service of 14 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 1953, 155 inspections were made in this connection and reports forwarded to the City Food Controller. PHARMACY AND POISONS ACT, 1933. 79 firms were registered under this Act, 77 of which were re-registrations. One infringement was noted. 114 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. 29 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. 52 inspections were made, and one 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 31 - 31 Almonds (ground) l — l Cream 9 — 9 Apricots in syrup 1 — 1 Curry Powder 5 - 5 Baking Powder 1 — 1 Custard Powder 1 — 1 Beef Extract 1 — 1 Faggots .., 1 — 1 Blanc-mange Powder 1 — 1 Flavourings 1 - 1 Butter l — l Fish Cakes 5 — 5 Cheese (processed) 8 - 8 Fish Paste 5 - 5 Chicken Paste 1 — 1 Gelatin 1 - 1 Coffee 3 - 3 Haddock (smoked) 4 - 4 Coffee & Chicory Mixture 1 - 1 Honey 1 - 1 Coffee Essence 2 — 2 Horseradish Cream 1 - 1 Colourings 2 - 2 Ice Cream- 1 - 1 Cinnamon (ground) 4 — 4 Ice Cream Powder 1 — 1 Coconut (desiccated) 2 - 2 Jellies 3 — 3 Crab (dressed) 2 - 2 Lemonade Powder 2 - 2 Carried forward 31 — 31 Carried forward 72 72 19 FOOD AND DRUGS ACT, 1938, AND FOOD REGULATIONS—continued Informal and Formal Samples submitted for Analysis. Article Informa Formal Total Article Informal Formal Total Brought forward 72 — 72 Brought forward 156 23 179 Mayonnaise 1 — 1 DRUGS. Meringue Powder 1 — 1 Meat Paste., 1 — 1 Ammoniated Tincture of Milk — 23 23 Quinine 1 1 Milk (condensed) 3 — 3 Aniseed, Balsam of 1 — 1 Mincemeat 1 — 1 Arnica, Tincture of 1 1 Mint (dried) 2 — 2 Aspirin Tablets 1 — 1 Mustard (ready mixed) 1 — 1 Ointments 5 — 5 Nutmeg (ground) 4 — 4 Camphorated Oil 3 — 3 Olive Oil 3 — 3 Cascara Sagrada 1 1 Pepper 5 — 5 Castor Oil 2 — 2 Pies 3 — 3 Cod Liver Oil Tablets 1 1 Pickles., 1 — 1 Cough Mixture 1 — 1 Pineapple Juice 1 — 1 Eucalyptus Oil 3 — 3 Pudding Mixture 1 — 1 Glauber's Salts 1 — 1 Sage 1 — 1 Glucose with Vitamin 'D' 1 1 Sauces 6 — 6 Indigestion Mixture 1 — 1 Sausages 20 — 20 Iodine, Tincture of 1 — 1 Spice (ground mixed) 1 — 1 Linctus 2 — 2 Sponge Mixture 1 — 1 Liniment of Turpentine 1 — 1 Spreads 6 — 6 Liquid Paraffin 1 — 1 Stuffing 2 — 2 Liquorice Powder 5 — 5 Suet 6 — 6 Medicated Sweets 1 1 Stewed Steak 1 — 1 Medicated Tablets 6 6 Tea 6 — 6 Milk of Magnesia 1 — 1 Tomato Juice 3 — 3 Pills 1 — 1 Vinegar 2 — 2 Senna Pods 1 1 Welsh Rarebit 1 — 1 Wintergreen, Oil of 4 — 4 Carried forward 156 23 179 Totals 203 23 226 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY. Article. Informal or Formal. Nature of adulteration or irregularity. Observations. Action. Milk Formal See below. Prosecution (see below). Sausages Informal Sold containing sulphite preservative equivalent to 220 parts per million sulphur dioxide without statutory declaration. Vendor cautioned and notice properly displayed. PROSECUTION. Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 Article Offence. Result. Milk Section 9. Having in possession for sale for human consumption milk certified on analysis to contain extraneous water to the extent of 38 per cent, and to be deficient in milk fat to the extent of 1 per cent. Vendor fined £2 and Five Guineas 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 four persons were exhumed from common graves and reinterred in private graves, and the remains of one person were exhumed from a private grave and reinterred in a family vault 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 1953, 114 pigeons were destroyed by this means. CITY MORTUARY. Bodies received 135 Post Mortem Examinations made 135 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 1,083,708 Cases of horsehair 153 Fees received £3,600 10s. Od. General Disinfection. Infectious Diseases,&c. :— Articles of bedding disinfected 1,168 Rooms disinfected after cases of infectious disease 7 Lockers at Post Offices disinfected 56 Verminous rooms disinfected 86 Ambulances, vans, &c., disinfected — Police Cells disinfected 11 Cleansing of Persons :— No. of verminous persons bathed 490 No. of verminous articles disinfected 4,790 Cleansing of Schoolchildren :— No. of children cleansed 288 No. of articles disinfected 1,942 No. of children treated for Minor ailments 2,040 LONDON: Printed bv Drake, Driver & Leaver Ltd., Rosebery Avenue, E.C. 1 1954.