AC43A 2 library LON 80 REPORT of the MEDICAL OFFICER OF HEALTH for the CITY OF LONDON for the year 1954 Printed by the Authority of Common Council 17th December 1953. 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 MChief 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 Peter E. J. General Grade Clerks Nov1; 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. Sept., 1946 Seymour, K. D July, 1935 Wilson, J. C. Meat Inspectors Jan. 1936 Leach, R. A. Sept., 1952 Cox, J. T Aug., 1954 Field, H Aug., 1954 Gingell, G Aug., 1954 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 Burton, John H. Mar., 1936 MESSENGERS. Powell, W. F. Dec., 1947 MANUAL WORKERS. Carmody, J. (General Duties at Mortuary) Feb., 1950 Sunnick, J. W. T. (General Duties at Mortuary) May, 1950 Morris, W. F. (General Duties at Smithfield Market) Mar., 1925 (Retired 27.3.54.) 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 (retired 20.6.53) Portbury, T. (General Duties at Smithfield Market) July, 1953 Wright, J. (General Duties at Smithfield Market) Oct., 1953 Cash, J. E. (General Duties at Smithfield Market) Mar., 1954 Lawrence, E. E. (General Duties at Mortuary) Aug., 1954 Rows, 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 1954. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. 55/61, Moorgate, London, E.C. 2. July, 1955. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1954. Vital Statistics. The resident population of the City according to the Registrar General's estimate to mid-year 1954 was 5,180. The birth rate fell to 3.78 per 1,000 and the death rate rose to 12.05 per 1,000. There were 22 live births during the year, no premature births and no deaths of infants under one year of age. There were no deaths attributable to pregnancy or childbirth. The number of deaths was 65 of which none occurred in the age group under 15 years; one in the age group 15-25 years; 6 between 25 and 45 years; 33 between 45 and 65; 7 between 65 and 75; and 18 over 75 years. Twenty-one deaths were due to disease of the heart or blood vessels, 15 were due to cancer of which 4 were cancer of the lung. There was only 1 death due to tuberculosis, 4 to pneumonia and 6 to bronchitis. So far as these statistics, recorded in relation to such a small population, are of any value at all, they indicate that though the City is quite a healthy place to live in, the resident population is ageing and dying of the diseases associated with advancing years, and is not being replaced by children born in the City or by young immigrants. I have previously drawn attention to the desirability of providing more housing accommodation within the City, and recorded my opinion that there are many people who would be glad to live in the City if accommodation was available. Infectious Diseases. The incidence of infectious diseases remained low. There was only one case of poliomyelitis. Cases of Puerperal Fever and Tuberculosis fell to 2 and 19 compared with 11 and 29 respectively in the previous year. Mass Radiography. The 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 total number of examinees was 58,471. The Unit is also available to the Boroughs of Finsbury, Stepney and Shoreditch, though the majority of examinees are persons employed in the City. Last year I did not receive the Annual Report of the Medical Director until my annual report had gone to press, I therefore reproduce here the summary of and comments on his report for the year 1953, which I submitted to the Public Health Committee on 30th September, 1954. The total number of persons examined during 1953 was 60,225, of whom 33,913 were males and 26,312 females. Amongst the males 49 cases of Active Pulmonary Tuberculosis were discovered, a rate of 1.44 per 1,000. Amongst the females 36 cases of Active Pulmonary Tuberculosis were found, a rate of 1.47 per 1,000. These rates are about half those for the country as a whole as recorded in the Annual Report of the Chief Medical Officer of the Ministry of Health for the year 1952. In addition 1,648 cases of inactive Pulmonary Tuberculosis were recorded. The number of cases found actually to have tubercle bacilli in the sputum was 15—12 men and 3 women. The Medical Director estimates that he examined about 11 per cent. of the working population of the City, and assuming that the incidence of pulmonary tuberculosis in the other 89 per cent. was about the same, he concludes that there are "at least 150 persons every day expectorating live, virulent tubercle bacilli in the square mile of the City of London". He goes on to say, "these undetected people are habitually travelling on crowded trains and buses, eating in congested restaurants, perhaps working in overcrowded offices, and the sufferer, his family and the general public are not aware of the peril to which they are subjected." I think the Medical Director's assumption and conclusion are justifiable. It might be argued that amongst those who attend for examination by mass radiography there will be a high proportion of people who have reasons for anxiety and therefore that the discovered incidence of pulmonary tuberculosis amongst the examinees is higher than amongst the 89 per cent. who do not attend for examination; but I am of the opinion that those who attend are the more enlightened, not the more anxious members of the community; that the unenlightened are more careless of their health and, if they have occasion for anxiety, are more likely 'to hide their heads 2 in the sand and not be examined lest their fears be confirmed. I therefore think that by applying the findings in 11 per cent. of the population to the whole, the Medical Director does not arrive at an over-estimate of the number of sputum positive cases of pulmonary tuberculosis working in the City. In an urban community at least it is impossible to avoid exposure to the tubercle bacillus. Whether a person falls a victim to infection depends on his natural powers of resistance, which vary according to his general health and the conditions under which he is living and working; on the dosage of infection, and on the frequency of exposure. Modern methods of treatment have greatly reduced the mortality from Pulmonary Tuberculosis, but the incidence of the disease, as judged by notifications, shows no comparable decline. This may be due, at least in part, to improved diagnosis to which mass radiography has contributed, but, though we are gratified by improved methods of treatment resulting in cure or postponement of death, our aim must be prevention, and this is dependent on the detection and control not only of the 'open' cases which are definitely infectious, but of the early cases which, by prompt treatment, may be prevented from becoming infectious. Mass Radiography can make a contribution to the prevention of pulmonary tuberculosis proportionate to the extent to which the general public avail themselves of the facilities for examination. The Mass Radiography Unit at Golden Lane discovered in the examinees a number of other thoracic diseases and abnormalities, including 18 cases of new growths, 121 cases of disease of the heart and large blood vessels, 22 cases of bronchiectasis, 20 cases of non-tuberculous pulmonary fibrosis, 19 of chronic bronchitis and emphysema, 5 of pneumonia, 2 of pneumokoniosis, and many others of less significance. Food Poisoning. There were only four cases of food-poisoning actually notified, but there were two outbreaks of food-poisoning both of which occurred in canteens of business houses in the City. Details of these are given below:— Case No. 1. On 16th July, 1954, a telephone message was received from a firm in the City asking for a tin of tomato pure to be inspected and condemned. When asked the reason for the request, the caller stated that a number of employees had been ill as the result of the use of the pure in their canteen. The canteen was visited and the following facts were elicited. On 15th July a number of employees complained that they had suffered from abdominal pain and diarrhoea during the previous night. This appeared to fix the responsibility on the lunch served in the canteen the previous day, 14th July. The menu at that meal comprised cold lamb and salad, braised lamb, meat patties made from steak and kidney remaining from the previous day's lunch, egg salad, egg moynay, potatoes, butter beans, steamed sponge roll, stewed apricots and custard, stewed rhubarb and custard, rice pudding, cheese and coffee. Both the braised lamb and the cold lamb were from a piece weighing 19 lbs. 10 ozs. which was cut into three pieces of approximately equal size and rolled and cooked the day before it was served; the braised lamb being re-heated on the day of service and served with hot gravy. On 14th July 80 meals were served and 25 persons, of whom 20 were interviewed, suffered from abdominal pain and diarrhoea during the subsequent 18 hours (extremes 5J-18J, average ll4 hours). There was no vomiting and all recovered within 24 hours, the average duration of symptoms being 10½hours. The common food factor was lamb, cold or braised. Some portions of the lamb remained and these together with a bowl of the meat patty filling and a can of tomato pure were submitted for bacteriological examination. Samples of fasces from the 5 members of the kitchen staff, four of whom had suffered from diarrhoea after the meal, but not before, were also sent for bacteriological examination. The bacteriologist reported that no organisms of the salmonella group were recovered from any of the food specimens, but anaerobic culture gave a growth of Clostridium welchii from the lamb and the stewed steak and kidney. Three of the five specimens of fæces yielded pure growths of heat-resistant Clostridium welchii identical with those obtained from the lamb. Both clinically and bacteriologically this appears to have been an outbreak of food poisoning due to heat-resistant Clostridium welchii, the infected food being lamb. It is noteworthy that the lamb was rolled and therefore part of what had been the exposed surface would be in the centre of the piece of meat when cooked. The degree and duration of heat in the centre was apparently not suffcient to kill a heat-resistant strain of Clostridium welchii. Further, the meat was not eaten till the next day and as the method of storage was unsatisfactory, conditions in the centre of the roll would be favourable for the growth and multiplication of the organisms. Where and when the surface of the meat was infected it is impossible to say; it might be anywhere between where the carcase of lamb was dressed and the kitchen of the canteen. The kitchen was carefully inspected. It is situated in a basement in rooms converted, though inherently ill-suited, to this purpose. I wrote to the occupiers to suggest that, as there is less need for canteens in the City now that food is no longer rationed, they should consider closing down their canteen. They replied that they would be vacating the premises in the near future and wished to carry on meanwhile. They are being advised as to how they may make the best use of the existing accommodation from the point of view of hygiene in the preparation and service of food, and on the change of tenancy I will endeavour to ensure that this basement is not again used as a canteen. 3 Case No. 2. On the 26th October the manager of the canteen in a Government building in the City reported that several people had complained of illness following a meal eaten in the canteen the previous day. On investigation it was ascertained that thirteen people had been affected, the symptoms being abdominal pain and diarrhoea. The number of persons served with lunch on 25th October was about 750. From a number of items on the menu the only one which had been eaten by all the affected persons was roast veal and seasoning. Some 200 portions of roast veal were served but only 13 complained of illness. About 4 lbs. of the veal remained, and this was sent for bacteriological examination. The bacteriologist reported that the meat was normal in appearance and smell, but direct films showed rather large numbers of Gram positive cocci, and cultures yielded a profuse growth of micro-cocci. The colonies were non-pigmented and coagulase tests were negative. His comment was, "it is abnormal for meat to contain as many bacteria as this of any kind, but it is not possible to say with certainty whether their presence was the cause of the intestinal disturbance". The veal was delivered to the canteen on 20th October and was immediately placed in a refrigerator. On 22nd October it was boned, cut up and cooked for about 3 hours. It was then placed by hand in four separate tins to make pressed jellied veal. It was allowed to cool in the kitchen then put in the refrigerator till 25th October, when it was cut into thin slices, which were put on individual plates, warmed up in a hot cupboard and served. This history of the treatment of the veal explains why an abnormal number of bacteria were found. Fortunately there were no specific food-poisoning organisms, but excessive contamination with non-specific bacteria will give rise to symptoms in susceptible people. In this instance only thirteen out of about 200 were affected. A thorough inspection of the canteen was made; and though a fair standard of cleanliness was maintained, there were some unsatisfactory conditions due mainly to wear and tear of fittings and equipment. A schedule of defects was forwarded to the appropriate senior officer at the request of the manager, and I have received an undertaking that they will be remedied. Year by year I report one or two outbreaks of food-poisoning of the Clostridium welchii type from canteens in the City but rarely one from a public restaurant. This might suggest that the standard of food hygiene in the commercial canteens is lower than that in the public restaurants. This is certainly not the case. I think the explanation is that if there is an outbreak of foodpoisoning, even of a mild type, in the canteen of a business house, a number of the staff are away for a day or part of a day, moreover there is an interchange of experiences and the occurrence becomes known to the management, who inform my department, and an investigation is undertaken. In a similar occurrence in a public restaurant, the affected persons would probably be widely distributed as regards their places of employment, and still more so as regards their places of residence. The attack of abdominal pain and diarrhoea usually comes on in the evening after the consumption of the infected mid-day meal and continues through the night, but by the morning the patient has begun to recover and is perhaps even well enough to go to work, so a doctor is not called in. There is consequently no notification and we hear nothing about it. I find it difficult to believe that there are not in fact proportionately as many cases of this type of food-poisoning from public restaurants as from canteens, but we only hear about the latter. An interesting outbreak which appeared not to be due to food-poisoning but possibly to a virus infection, occurred in September. The details are as follows:— Late in the evening of 15th September I received a telephone enquiry at home from a reporter of one of the daily papers, asking if there was an epidemic of gastro-enteritis in the City. I replied that so far as I was aware there was no epidemic, and asked the reason for the enquiry. The reporter then said that many of the staff of his newspaper had been affected. It occurred to me that the cases of illness might be due to food-poisoning, and I arranged for enquiries to be made next morning. These revealed that approximately 2,000 persons are employed on the day and night shifts, and that some 50 people were known to have been taken ill during the night of the 14th-15th September, though probably there were many more who had been less severely affected. The symptoms were severe frontal headache; nausea and abdominal pain followed by violent sickness which persisted through the night; and diarrhoea of varying severity. The illness lasted from 24 to 48 hours, and all the cases recovered completely in 3 or 4 days. There is a canteen which is well equipped and maintained. A mid-day meal is served, but many of the persons affected did not have the mid-day meal. The canteen is, however, open day and night for the supply of snacks, and all the affected persons had something from the canteen. No remains of the food consumed on the 14th September were available for bacteriological examination. It was found that milk in churns was stored under unsatisfactory conditions for some 24 hours. One of the women employed in the preparation of food in the canteen had suffered from diarrhoea during the week-end before the outbreak. A sample of feces was examined bacteriologically, and an organism which appeared to be serologically related to Shigella flexneri, the cause of one type of dysentery, was found, but it was atypical, and on full 4 investigation at both St. Bartholomew's Hospital and the Central Public Health Laboratories at Colindale, it was reported that the organism was not in fact of the dysentery group and was not pathogenic. In any case the symptoms of illness did not suggest dysentery, nor indeed were they typical of food poisoning. It is possible that the outbreak was a virus gastro-enteritis of a type which has recently been reported in America and which has been suspected in this country also, but there is no practicable means of proving this. The investigation has, however, enabled us to emphasise the importance of personal hygiene amongst the food handlers, and to secure that a refrigerator is provided in which to keep the bulk supply of milk, which was grossly contaminated, the bacterial count being over 10 million per millilitre, though no pathogenic organisms were present. Food Inspection. The total amount of food delivered at Smithfield Market was 354,698 tons, of which 430 tons were found to be diseased or unsound and were voluntarily surrendered. At Leadenhall Market 13 tons 16 cwt. of meat, and at Cold Stores 2 tons 16 cwt. of meat, were condemned. Of other foodstuffs in Markets and Shops 27 tons 17 cwt., and at Riverside Wharves 98 tons 16 cwt., were condemned. The total amount of foodstuffs found by your food inspectors to be unfit for human consumption was therefore 573 tons. This may appear to be a high figure, but is in fact only a very small fraction of the enormous quantity of food which is dealt with at the Markets and Wharves in the City. Those engaged in the food trade co-operate readily with your inspectors and surrender whatever is found to be unsound, unwholesome or unfit for human consumption. Formal seizure and condemnation by a justice of the peace are only resorted to where there is unwillingness to surrender or where there appears to have been a deliberate attempt to conceal or remove evidence of disease or unsoundness. Only one such case occurred during the year. A carcase of beef, two fore-quarters and two hind-quarters, were discovered in Smithfield Market to be infected with generalised tuberculosis, and as the pleura had been almost completely stripped from both forequarters, it appeared that there had been a deliberate attempt to remove obvious evidence of disease. The carcase was formally seized and carried before a justice of the peace who condemned it. Subsequently legal proceedings were taken against the consignor, who was fined £10 with £10 costs. Food Hygiene and Hygiene of Catering Establishments. I believe that steady progress is being made in the hygiene of catering establishments, certainly in the provision of the means to cleanliness, but less certainly in the intelligent and conscientious use of such means. In accordance with my usual practice, I have asked the two Inspectors, Mr. Thompson and Mr. Flynn, who devote their whole time to this work, to review the progress made during the year. They have been very outspoken, nevertheless I am of the opinion that their observations should be printed. Having worked hard to secure improvements in equipment, lay-out and working conditions in kitchens, they find their efforts defeated by ignorance and carelessness on the part of certain employees. Most of us in these days of little or no domestic help at home have experience of the uninteresting, monotonous tasks in the kitchen, which fall to the lot of those of us who are not qualified to do the cooking, and we can appreciate that in catering establishments the labour for this type of work is apt to be drawn from a section of the community whose standards of, and indeed opportunities for, personal hygiene are not of the best. As housing conditions improve so will their standards, and though they disappoint and even aggravate us at present, I feel sure that we can look forward to improvement in this most important factor in food hygiene. Mr. Thompson and Mr. Flynn report as follows:— "Each year, when endeavouring to review what has taken place and what is being done to improve the standard of food handling in City Catering Establishments, it is not always easy either to assess the extent of the improvements or to demonstrate the actual direction in which improvements have been made. However, during the year under review there have been substantial improvements of a structural nature, and some headway has been made in obtaining better design and equipment in various types of kitchens throughout the City. As pointed out in previous reports, whilst this progress is slow, sometimes frustratingly so, there is, nevertheless, a definite movement towards the higher standard which one is endeavouring to encourage in the handling of food. This slowness is not because of a lack of co-operation and goodwill on the part of the catering industry, but is occasioned by a variety of causes which seem to be beyond the control of any one person. Nevertheless the improvements effected in various premises have been substantial. In some cases there has been a complete transformation and the capital expenditure by some of the larger firms has been very heavy indeed. This does pose the question as to whether or not the small caterer without adequate financial backing can survive. Having regard to the present high cost of building works, equipment, and general overhead charges, the caterer with limited financial resources is at a grave disadvantage—both from the point of view of the size of the premises he can rent, and from the cost of meeting the requirements which must necessarily be imposed upon him. It seems possible that this type of caterer will follow the path of the small dairyman and ultimately disappear or at least that their numbers will be considerably reduced. It has been found that one of the major difficulties in securing the improvement of hygienic conditions and practices is the irresponsibility, disinterestedness, and obvious laziness displayed by some of the staff employed on the more menial tasks in the catering 5 industry. Indeed a percentage of such staff could be described as unemployable and presumably but for the present state of the labour market would not secure a job. The mobility of the labour is also a continuous source of annoyance and difficulty, and the apparent impossibility of enforcing discipline renders the task of the managerial staff unenviable. In some instances full advantage has not been taken of improved facilities and equipment because of the unwillingness or inability of staff to co-operate. For example a frequent cause of criticism has been the unsatisfactory manner in which washing-up machines are used, and for the most part it has been observed that the operators in such cases have only a very hazy idea of what they are doing, and certainly have no accurate knowledge of the limitations of the machine they are using, or what part they themselves must play if a hygienic standard of washing-up is to be secured. Undoubtedly in many instances there are sufficient grounds for the consideration of legal proceedings, not against catering firms but against individual employees. With the exception of a few isolated instances, the catering industry has been very co-operative in complying with the various notices served, and in putting into operation the improvements which have from time to time been suggested. During the year a few complaints have been received from customers regarding dirty crockery and cutlery, particularly cutlery. Invariably it was found when such complaints were investigated that existing washing-up facilities were inadequate to meet the normal demands of the business in question, and appropriate steps were taken in each case to secure the installation of additional washing-up sinks and improved hot water supplies. Unfortunately a feature in many City kitchens, much to be deplored, is the slovenly washing-up of cutlery. This is an example of the lack of responsibility, both on the part of the management which fails to provide the facilities for this purpose, and the staff who fail to use such facilities when they are available. This carelessness is the more astounding, when one realises that, apart from the cup and glass, the only equipment which goes from mouth to mouth is the cutlery. In some establishments even to-day cutlery sees only the inside of a two pound jam jar and a half pint of "sludge". The Welfare Officer of the General Post Office Region situated at St. Martins-le-Grand, approached the Medical Officer of Health with a view to him arranging a series of lectures in food handling and hygiene to be given to members of the Post Office Staff. The General Post Office has maintained that local authorities are not entitled to administer statutes on premises used for the purposes of the Crown, and for that reason any dealings with the G.P.O. up to the present time have been in a purely advisory capacity. With a view to making some improvement in their canteens, the Welfare Department considered it an essential preliminary to have a nucleus of adequately trained staff to form the basis of further training for canteen staff, and it was for this purpose that considerable time and effort was expended in making the series both comprehensive and interesting. Such an approach by the G.P.O. is welcomed by this Department, as it does indicate an awareness by at least one Government department that some of their facilities for food handling, etc., are not up to present day standards. During the year many opportunities have occurred for discussing the problem of kitchen design and equipment with different firms who have been making efforts to improve their particular premises. This was not only helpful from the caterers point of view but also from the point of view of this department. As a result of these exchanges of ideas and experience, which has of necessity brought some sharp reminders of past shortcomings, it has enabled minimum requirements to be formulated which are essential if a kitchen is to function successfully. Basement kitchens must always be examined with the utmost care—there must be an almost foolproof ventilation system if nuisances are to be avoided and at the same time satisfactory working conditions maintained. It would be an asset from an administrative point of view if such basement kitchens were subject to similar legislation as basement bakehouses, and would assist substantially in preventing the establishment of unsatisfactory new basement kitchens, which, it must be admitted, is not easy under existing law. In some cases we have been successful in persuading caterers to provide additional floor space in the kitchen, sometimes at the expense of the dining room, but here again some guidance in the appropriate statutes would be an invaluable aid in securing the necessary minimum space, which experience has shown to be essential for food preparing purposes. Undoubtedly further efforts to improve the standard of hygiene in catering establishments must be concentrated on securing radical improvements in many premises, but in addition some means must be found of ensuring that the employees in such businesses are acutely aware that they are the main obstacle to the provision of safe and assthetically eatable meals. From all points of view it would seem inevitable that progress will continue to be slow until everyone, the catering trade, the employees, and the public, co-operate towards achieving an ideal. For instance, the public could cease to patronise catering establishments where they observe carelessness, and the caterers should realise that hygiene pays dividends in the long run. We wish to record our appreciation of the assistance and co-operation received from the departments of the City Surveyor and the City Engineer during the past year. They have drawn the attention of people consulting them on other matters to the necessity of meeting the requirements of the Medical Officer, and this has resulted in substantial improvements being made in the food preparing facilities of a number of premises." FOOD & DRUGS ACT, 1938 and FOOD REGULATIONS. Mr. Harrington, Sampling Officer under the Food & Drugs Act, reports as follows:— "345 samples have been submitted to the Public Analyst; 28 of these were formal and 317 were informal samples. Five samples were reported against; in one case legal proceedings were instituted and in other instances cautions were administered. 6 Milk. 24 samples of pasteurised milk were examined by both the Phosphatase and the Methylene Blue Tests and one sample was examined bacteriologically. 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 bears some relation to general cleanliness, care in handling, etc. Adverse reports on the Methylene Blue Test were received in respect of five samples and also on the sample examined bacteriologically and cautions were administered to the persons concerned. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, required that from 1st October, 1954, milk pasteurised in bottles must be delivered to the consumer in those bottles, and milk which is pasteurised, in containers other than bottles must be put into the containers in which it is to be delivered to the consumer at the premises at which it is pasteurised, and as soon as possible after pasteurisation. The beneficial effect of this provision is that it checks the free handling of loose milk after pasteurisation. There are in the City now seven dairies within the meaning of the Milk & Dairies Regulations, 1949. In addition, there are a number of milk-bars and snack-bars, where milk is sold for consumption on the premises only. The average composition of genuine milk samples taken during the year was:—milk fat: 3.54 per cent.—solids (not fat): 8.80 per cent.—total solids 12.34 per cent. 81 Supplementary Licences in respect of 25 firms and individuals and 28 Dealers' Licences in respect of 13 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. During the year there was one new registration of a distributor of milk within the City with premises outside, two new registrations of distributors of cream with premises within the City and one new registration under Section 34(l)(b) of the Food and Drugs Act, 1938, for carrying on the business of a wholesale dealer in margarine. Cream. Five samples of sterilised cream, one of clotted cream, three samples of single and three of double cream were submitted to the Phosphatase Test and for general bacteriological examination. Reports on two of the samples of single cream which had been obtained from the same source showed them to be unsatisfactory. The manufacturers were notified immediately and a communication was sent to the Medical Officer of Health for the district in which the cream was prepared Ice Cream. The improvement effected in this product in recent years has been maintained. The average composition of the samples taken was:—fat 9.8 per cent., milk solids-not-fat: 11.35 per cent., sucrose 12.5 per cent. Adverse reports were received in respect of the Methylene Blue Test on one sample and on general bacteriological examinations of two others. These samples had a common source and accordingly a communication was sent to the Medical Officer of Health for the district where the ice cream was manufactuered. There is only one manufacturer of ice cream within the City of London: his premises have been kept under survey and samples taken therefrom have been found to be satisfactory. Three new registrations of premises for the sale and storage of ice cream were granted during the year. Food Labelling. No administrative action has been required but enquiries continue to be received and advice and assistance have been given wherever possible to assist compliance with the requirements of the Labelling of Food Order, 1953. Administration. Details of the formal and informal samples taken and submitted for analysis and of action taken in regard to adulteration or other irregularity appear later in this Report. Tinned Cream infected with Bacterium typhosum. In February there was widespread alarm because a sample of imported tinned cream examined in Birmingham had been found to contain typhoid bacteria. The Ministry of Health took prompt action by a statement in the B.B.C. News bulletin and by notices in the Press to stop the further retail sale of this cream, and it was then necessary to trace the distribution. The sole agent for the importation of this tinned cream had his offices in the City. He was visited and readily co-operated in giving the primary distribution. The majority of the importations had been to eight other firms in the City. These were also contacted and the secondary distribution was obtained from them. Names and addresses of all the dealers who had received this brand of cream from the City firms were forwarded by my Department to the Medical Officers of Health of the districts in which the addresses were situated. This involved a great deal of work for my department, since the cream had been distributed all over the country. The Ministry of Health arranged for numerous samples of the cream to be bacteriologically examined in various laboratories of the Public Health Laboratory Services. The examinations revealed that certain batches had not been adequately processed, but no samples other than the original Birmingham one were infected with Typhoid bacilli. No cases of Typhoid fever occurred. 7 The agent for the importation of the cream was most co-operative, and sent telegrams to all his customers instructing them to return any cans of this cream still in their possession. The batches which had been imperfectly sterilised were condemned locally, as were also the cans which showed external signs of unsoundness. The remainder were collected at a wharf in Bermondsey and were thence returned to the country of origin. PUBLIC HEALTH (PRESERVATIVES ETC. IN FOOD) REGULATIONS. Thiourea in Oranges. Early in the year the Minister of Food drew attention to the possible use by certain orange growers of thiourea and of fungicides containing thiourea as rot and mould suppressants, and to the fact that thiourea could penetrate the skin of citrus fruits and find its way into the juice. He advised that thiourea fell within the definition of "preservatives" in the above Regulations. Eight samples of oranges were taken at Riverside Wharves in the City and submitted to the Public Analyst. Five samples, all of Valencia oranges, were found to have been treated with thiourea which was present up to as much as 13 parts per million of the whole orange. Jaffa and Seville oranges were found to be free from thiourea. It was then the end of the season for the importation of Spanish oranges, but importers were informed that in future the importation of oranges treated with thiourea would be prohibited under the Public Health (Preservatives etc. in Food) Regulations, and were advised to communicate with the growers promptly so as to prevent them using thiourea in the next season's crop. HOUSING. Housing Consolidation Regulations, 1925, No. 866, Part IV. Inspection of District:— 1. Number of houses which on inspection were considered to be unfit for human habitation:— 52 dwellings in 17 premises. 2. Number of houses in which the defects were remedied in consequence of informal action by the Local Authority or their Officers:— 23 3. Number of representations made to the Local Authority with a view to (a) the serving of notices requiring the execution of works or (b) the making of demolition or closing orders:— (a) none. (b) none. 4. Number of notices served during the execution of works:— None. 5. Number of houses which were rendered fit after service of formal notices:— None. 6. Number of demolition or closing orders made:— None. 7. Number of houses in respect of which an undertaking was accepted under subsection (2) of section 19 of the Housing Act, 1930:— None. 8. Number of houses demolished:— None. The re-housing of the occupants of unfit dwellings is proceeding slowly as suitable accommodation becomes available. Meanwhile the dwellings are maintained in as good condition as is reasonably practicable having regard to their age. Many of the occupants are unwilling to leave, because they do not want to move out of the City and they pay very low rents. For the most parts the owners would be glad to get the houses empty, as the premises would then be converted to commercial use. It is therefore not necessary to issue closing orders and demolition orders, save in exceptional cases. I think I could safely say that, though there are a number of people in the City living under very unsatisfactory conditions, by reason of the age of the premises and the lack of amenities, which by modern standards of housing are regarded as necessities, there are no persons who are really desperately badly housed. During the year 34 families were re-housed, including 16 families transferred within the properties under the control of the Corporation. The number of housing applications outstanding on 31st December, 1954, was 625 families, representing 1,541 persons, but these are mainly families which have become overcrowded in quite good accommodation in the City, or in the Corporation's own housing estate, or who are living outside the City and yet have a claim to be housed by the Corporation of the City. In my last Annual Report I gave a list of all the housing, within and without the City, under the control of the Corporation. The new housing accommodation under construction or in prospect comprises:— 1. the Golden Lane Estate of 580 flats and 20 shops. 2. the Sydenham Hill Estate of 30 flats and 27 houses. In addition:— at Artizans Dwellings a block of flats is being cleared so that the accommodation can be modernised. This process will be continued block by block, till all the flats have been made self-contained. These improvements must inevitably result in a reduction in the number of flats: at Dron Buildings in Stepney the rebuilding of a block of 9 flats destroyed by enemy action is in progress, and plans have been passed for the modernisation of 76 flats: at Blake House, Lambeth, 47 flats are being modernised. 8 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 resources permit for the welfare of old people resident in the City and in the Corporation Housing Estates outside the City. The number on the register remains the same as last year, 1,138, the number of those who have died being exactly balanced by the number who have qualified for inclusion. The welfare provision includes:— a club in the East End of the City which is open all day, and club facilities for those in the western section kindly provided by the City of London Resident Association; domiciliary visiting; convalescent holidays; additional domestic assistance and night help; invalid aids of various kinds; chiropody; handicraft classes; wireless sets and Christmas parcels. Entertainments and summer outings have again been provided by a number of kind friends. We are very grateful to them; to the voluntary visitors and to the Hon. Secretary of the Association, who organises the services and devotes nearly all her spare time to welfare activities, which I will not refer to as work or duties, because they appear to be an absorbing interest and pleasure to her. If the funds of the Association permit, it is proposed to expand the chiropody service, which not only adds greatly to the comfort of old people but helps them to remain active, which is all important in old age. It is hoped also to expand the domestic help service. When old people really need help in their homes they often need it daily not just once or twice a week. Domestic help is expensive but is is much cheaper than institutional care, even if skilled medical and nursing attention is not required. We must keep old people in their homes if we possibly can, mainly because they are usually happier there, in familiar surroundings, with their ' household gods ' around them and free from the rules and routine which are inseparable from institutional life; but also because it is in the interest of the national economy, institutional care being so expensive. It is also proposed to establish a kitchen in the "Three Score Club" in Stoney Lane, from which a meals service for old people can be provided. Isleden House. In my last annual report I referred to the transfer of Isleden House to the Corporation by the Trustees of the London Parochial Charities on very generous terms. The high standard which the Trustees set in the administration of this model accommodation for old people has been maintained. In the experience of the Trustees it had been found that, largely by reason of the attention given to the old people by the resident matron, the sick-bay accommodation was not used to capacity and this continued to be our experience. It was desirable that such accommodation, with the services of the matron, who is a state-registered nurse, and an assistant nurse, should be used to the full; at the same time it was realised that as the residents became older and more feeble the demands on the accommodation might at any time become greater and that therefore it was imperative not to get the beds blocked with chronic cases from outside, but to be able to clear them at short notice. It was decided to admit short-term cases from amongst the old people resident in the City or the Corporation's Housing Estates, but even this yielded very few patients. Subsequently a request from St. Bartholomew's Hospital to house a female patient, who had had both legs amputated, while she was awaiting the provision of artificial limbs, led to the development of a scheme for admitting to the sick-bay at Isleden House, patients from St. Bartholomew's Hospital who were not well enough to go home but no longer needed the full resources of a great teaching hospital, thus freeing hospital beds for patients on the long waiting list. It was agreed that St. Bartholomew's Hospital should pay for such accommodation at the rate of £4 4s. per week per occupied bed. This scheme has worked smoothly. The hospital patients have been pleased with the accommodation provided and the treatment given by the matron and assistant nurse and the old people in the sick-bay and the others who meet the hospital patients in the communal dining room at the mid day meal and in the evenings have benefitted from the new and changing personal contacts. From 7th August, when the scheme came into operation, to 31st December, a total of 50 patients were accepted from St. Bartholomew's Hospital. RODENT CONTROL Until 1944, when Mr. J. Carter was appointed Chief Rodent Officer, we attempted to carry out rat repression in the City by the use of traps of various kinds, being afraid that poisoning might lead to widespread complaints of nuisance from the smell of rats dying and decomposing under floor boards and in other places difficult of access. But Mr. Carter introduced the use of poisons, particularly the new and more powerful poisons which have been made available in recent years, and our fears of complaints have been proved to have been groundless. There have been a few but we have been able to deal with them, and the occupiers of premises have always agreed that any temporary inconvenience has been more than compensated by the efficiency of the poisoning. Mr. Carter has made a long report, most of which is concerned with the control of rats in the sewers. I have printed it in full because it is a valuable record of what can be achieved by the intelligent use of the deadly poison Sodium Fluoracetate. We have used this poison for three years in the City sewers and the rat population has been reduced to insignificant proportions. We are now experimenting to ascertain whether the low level of infestation can be maintained with Zinc Phosphide, a much less dangerous poison which is in common use, but it is yet too early to draw any definite conclusion. 9 Mr. Carter reports 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 properties found to be infested, and periodical maintenance controls for the destruction of rats in the City sewers. The co-operation of occupiers and owners of properties has been satisfactory, and no difficulty has arisen which necessitated statutory action to resolve the problem. During the period under review 3,793 occupancies and properties were inspected, the varying types of properties ranging from large blocks of offices, riverside food warehouses, catering establishments, factories and shops, to domestic dwellings. A total of 675 infestations of rats and mice were treated, and of this number 310 infestations were notified, and 365 were found as the result of inspections. The total comprised 20 major and 219 minor infestations of rats, and 116 major and 320 minor infestations of mice. The rat infestations were mainly of Ship rat (Black) nature. Applied control measures entailed 6,013 visits for operational purposes, and during the course of the treatments 16,508 initial baiting points were selected, 25,339 pre-baits were put down, and 2,124 poison baits were laid. These measures resulted in a minimum estimated kill of 1,630 rats, and 955 bodies were recovered. In addition, 91 rats were destroyed by means of traps. The use of anti-coagulant rodenticides for the control of mice resulted in 1,181 dead mice found. In 36 instances structural rat-proofing was carried out by occupiers, and in ten instances incidental rat-proofing was effected by means of removal of rubbish and other accumulations providing harbourage. The downward trend of rat infestation has continued, and a further decline in the number of infestations and numerical density has been experienced. There has, however, been an increase in mice infestation, and this is due in the main to the careless or thoughtless disposal of waste scraps of food, food wrappers, etc. by the daytime population of premises. Infestation of common rat character in surface properties was again extremely low, and only two such infestations were found and treated. This is possibly due in no small measure to the systematic periodical maintenance treatments carried out for the control of common rats in the City sewers. It is the purpose of these treatments to check the build-up of the common rat population in the sewers, and thereby assist in preventing infestation of surface properties from this source via defective drainage. Subsequent to the initial sewer treatment in December, 1943, it was the practice in accordance with legislation and in conjunction with Metropolitan Boroughs contiguous to the City, to carry out six-monthly controls. These control measures comprised a two-day pre-bait, followed by poison baiting in entrances where pre-bait was taken, and recording the result on the fourth day. The poisons used were Zinc Phosphide, Arsenious Oxide, and Alpha-NaphthyThio-Urea. The recorded result of the initial treatment was 355 pre-bait "takes" of which 185 were complete "takes", this indicating the numerical density and distribution of the rat population of the sewers at that time. Continued six-monthly maintenance controls from January, 1945, resulted in a gradual reduction of the pre-bait "takes", and the recording in the May 1948, treatment was 118 "takes", of which 63 were complete. From then onwards an upward trend of the pre-bait "takes" was experienced, with a proportional increase in complete "takes", until in December 1950, the prebait "takes" were 225, of which 185 were complete, thus equalling the number of complete "takes" obtained in the initial control in December, 1943. Little is known scientifically of the movement of rats in sewers, but the position obtaining at the time of the December, 1950 control appeared to indicate that there was a distribution over a wider area, plus the breeding increase during the intervening period of six months between controls. It was considered that in view of the time and effort expended on the maintenance controls, drastic action was necessary to effect a reduction of the residual rat population, and to this end discussions were held with the Technical Officers, Infestation Division, Ministry of Agriculture and Fisheries. As a result, it was agreed that as from May, 1951 a series of treatments, comprising direct poisoning with Sodium Fluoroacetate, technically known as "1080", be carried out at quarterly intervals. This poison is in powder form, and as a precautionary measure is tinted blue with nigrosene dye. It is extremely lethal to man and animals, there being no known antidote. It should never be handled without rubber gloves being worn, and its use should be controlled by a responsible person, both in its dispensing and distribution. A total of 13 treatments at quarterly intervals, in three stages, have been applied since May, 1951, the final control of the series being carried out in June, 1954. As in the previous controls, the sewer area was divided into seven sections, each having approximately 63 sewer entrances. It was decided not to bait every entrance in each sector, and 306 of a total of 427 entrances usually pre-baited were selected. This number comprised 225 entrances where pre-bait "takes" were recorded during the December, 1950 treatment, plus 81 entrances which showed a negative result during that control, but where "takes" were recorded during either of the two previous treatments. By applying the direct poisoning system the time was halved by reason of the elimination of the two days required for pre-baiting, so that four treatments annually involved approximately the same number of man hours as was needed by the six-monthly treatments. The labour used to work a sector, comprised a sewerman to raise the entrance covers, and two operators. One operator deposited and picked up the baits, and the other recorded, lowered and raised the container when the poison was cleared up. 10 The bait was carried in large tins with lids, and the operator depositing the bait wore rubber gloves which he put on before leaving the depot. Each bait was 4 ozs., this amount being measured by means of a metal mug holding that amount. As each sector took approximately five and one-half hours, a break was necessary, and each term adjourned to a public convenience, where the recording operator who had not touched the poison bait turned on the wash basin tap to enable the depositing operator to wash his gloves before removal. Every precaution was taken during the mixing of the poison bait and rubber gloves were worn. The baits comprised sausage rusk and water in equal parts by weight, evenly mixed at a concentration of 1% by weight. The bait was mixed in batches of 100 ozs., the required amount of rusk being added to the solution and well stirred. After use every utensil was thoroughly washed under a running tap. In the treatments prior to this series it was the practice to take the poison bait recording from the top of the entrance and leave the bait to decompose, but in the instance of these treatments it was imperative that poison bait not taken be cleared up. While this entailed descent of the sewer shafts, it also enabled a reasonably correct recording to be made. The procedure of application was to bait three sectors on Monday, examine and pick up the poison on Thursday; three sectors on Tuesdays, examine and pick up on Friday; and one sector on Wednesday, examine and pick up on Saturday, thus completing the whole area in one week. The first stage of the series comprised five treatments during the period May, 1951—May, 1952. In the initial control in May, 1951, 150 "takes" (three complete, 12×¾, 32×½ nd 103×¼ or less) were recorded. In the second treatment in September, 1951, 142 "takes" (6×¾ 25×½ and lll×¼ or less) were recorded. The third treatment in December, 1951, produced 89 "takes" (one complete, 2×¾, 7×½ and 79×¼ or less). The fourth treatment in March, 1952, showed a continued reduction in the poison "takes", which were (one complete, 2×¾ 6×½ and 44×¼ or less), a total of 53. In the fifth treatment in May, 1952 424 entrances were baited as against 306 entrances in the previous controls. The inclusion of the 118 additional entrances would, it was believed, supply some information on the movement and build-up of rats in lengths of sewers not treated for 18 months. The result of this treatment was 20 "takes" only (3×½ and 17×¼ or less), the lowest yet recorded. A feature of this treatment was that only three "takes" were obtained from the 118 additional entrances baited. The fall in the number of poison "takes" was extremely satisfactory, but the possibility of some poison prejudice having developed was visualized, and in order to be reasonably satisfied on this point, and at the same time test the efficacy of the measures applied, a test baiting of all available sewer entrances was applied after a lapse of three weeks. To overcome any possible biat prejudice also, bread rusk moistened with water in equal parts by weight was used, each test bait being 4 ozs. A total of 417 sewer entrances were test baited and the bait left down for two days, when examination showed 35 "takes" (seven complete, 3×¾ 10×½ and 15×¼ or less). Altogether 104 lbs. of test bait was put down, and the estimated amount taken was 72 ozs. only. This is a very satisfactory reduction on the pre-bait recording of December, 1950, when 225 "takes" (185 complete, 29×½ and 11×¼) were obtained and the estimated amount taken was 67 lbs. The intermediate stage of the series comprised four treatments during the period September, 1952 and June, 1953. The number of entrances baited was approximately 315 in each instance and the "takes" were consistently low. They were 13, 14, 16 and 11 respectively, and with one exception were in the ½ and ¼ or less category. Subsequent to the fourth poison control and after a lapse of three weeks, 413 sewer entrances were test baited and a total of 105 lbs. was put down and left for two days. Examination showed 23 "takes" (14 complete, 6×½ and 3×¼), and the estimated weight was 71 ozs. This test result shows little change to the test of the previous year and the increase in the complete "takes" is in no way significant. The third and final stage comprised four treatments during the period September, 1953 to June, 1954, and as in the second stage the poison "takes" were consistently low, the recordings being 21, four, five and four respectively. The annual test baiting of all available entrances was applied three weeks after the final poison control, and the recorded result was 26 "takes" (15 complete, 5×¾, 3×½ and 3×¼ or less) out of 405 entrances baited. In this instance 101 lbs. of test bait was put down and approximately 82 ozs. taken. During the course of this series of treatments, 262 bodies were found at the base of the sewer shafts or in shallow flows close to the base. This number does not include those found subsequently by the sewermen during their routine work, along the lengths of sewers and in dead ends. In one instance 15 bodies were found in a group near to an entrance where a complete "take" was recorded, and no doubt many bodies were washed away in rapid flows. The weather conditions during these treatments can have an important effect on the results. If there is an appreciable amount of rain prior to, and during a treatment, this has the effect of making the entrances very wet and sludgy, resulting in the baits becoming sodden, and in the event of heavy rains the baits can be washed away by the charged up flows. Fortunately the periods selected for these direct poison controls was, in the main, fine, and of the 90 days which the treatments occupied, only four were sufficiently wet to have an adverse effect. From an analysis of the detailed records collated it does appear that the combination of quarterly treatments and the use of Sodium Fluoroacetate has produced the results it was considered could be obtained, and that an irreduceable minimum of the rat population in the sewers had been achieved, thereby justifying the use of such highly toxic poison, and the labour, care and thought taken in the dispensing and application. Subsequent to the completion of the series, discussions were again held with the Technical Officers, Infestation Division, Ministry of Agriculture & Fisheries, to decide (a) continuance with Sodium Fluoroacetate, (b) alternative control measures. The question of returning to six monthly periods as prior to May, 1951 did not arise, as it was previously agreed that the quarterly controls were preferable. 11 In view of the low level of infestation obtained, it appeared to be an excellent opportunity to ascertain, as far as possible, if this level could be maintained by direct poisoning with Zinc Phosphide at an concentration of 10%, and it was decided to apply four such treatments and a test baiting during the ensuring year. Two treatments of this nature were applied in September and December, 1954, and a similar procedure to the previous series was followed. In view of the vast rebuilding operations now in progress throughout the City, it was deemed advisable to bait all available sewer entrances, by reason that several entrances previously baited were no longer in existence and that disturbance of obsolete sewers and drainage during rebuilding could have the effect of scattering any residual rats into active lengths of sewers. In the September treatment 402 entrances were baited, each bait being 4 ozs. comprising damp sausage rusk evenly mixed with Zinc Phosphide at a concentration of 10% by weight. The baits were left down for three days and then picked up and destroyed. Examination showed seven "takes" (1×¾, 2×½ and 4×¼ or less). Of a total of 102 lbs. put down approximately 8 ozs. only was taken. Heavy rain was experienced during the treatment, and as the result 16 baits were washed away. For the second control in December, 1954, 400 sewer entrances were baited, and on examination 22 "takes" (2×¾, 7×½ and 13×¼ or less) were recorded, and of 100 lbs. of bait put down, approximately 33 ozs. was taken. Heavy rain was experienced on the first day of this treatment, and allied to the continuous rain during the previous week, had the result of the baits becoming very wet, and a reasonably true recording was difficult. From these two controls 25 bodies were recovered. The efficacy of 10% Zinc Phosphide in maintaining the low level attained by Sodium Fluoroacetate cannot be ascertained until completion of the remaining treatments, and testbaiting in July, 1955. In conclusion, the graph illustrates the breakdown of the pre-bait "takes", which are indicative of the numerical density and distribution of the rat population from December, 1943, to May, 1948; the rise which was maintained until December, 1950, and the decline following the institution of direct poison controls with Sodium Fluoroacetate at quarterly intervals." 12 13 ATMOSPHERIC POLLUTION The outstanding event of the year in regard to atmospheric pollution, so far as the City is concerned, was the passing into law of the City of London (Various Powers) Act, 1954, Section 4 of which is designed to make the whole of the City a "smokeless zone". It was obviously necessary to give owners and occupiers of premises time to make such alterations to existing fuel burning installations as might be necessary to render them smokeless, and therefore the Act prescribed that Section 4 should come into operation on such date after the 1st October, 1955 as the Common Council should resolve and, in fact, the earliest possible date 2nd October, 1955 has been fixed. I was invited to make a short statement on the City of London "Smokeless zone" powers to the Conference of the National Smoke Abatement Society held in Scarborough in September, 1954, and I think it is worthwhile reporting my statement in full as a concise record of the efforts which the Corporation have made since the war to achieve smoke abatement in the City. NATIONAL SMOKE ABATEMENT CONFERENCE, SCARBOROUGH, SEPTEMBER, 1954. Paper read by the Medical Officer of Health to the Corporation of London. I have been asked to make a short statement on the subject of the powers recently obtained by the Corporation of the City of London in the City of London (Various Powers) Act, 1954 to make the City of London a "smokeless zone", which, as you realise, means a non-smoke producing zone, because we shall continue to get smoke drifting into the City from the vast area of the County of London surrounding us. Perhaps a few words on the history of the Corporation's efforts in this direction will be of interest as showing how difficult it is to achieve substantial progress in smoke abatement. From the time the City of London was devastated by enemy action in the years 1940 and 1941, the Corporation began to consider the rebuilding of the City. The contribution of a Medical Officer of Health to planning of such magnitude is very small, but following a meeting of the National Smoke Abatement Society in London on 5th November, 1943, I reported to the Public Health Committe on "Measures for the Prevention of Smoke in relation to Initial Post-war Reconstruction", and recommended that the Corporation should seek Statutory powers to require prior approval of heating arrangements in new and reconstructed buildings and to declare smokeless zones in the City; in accordance with the resolutions passed at the meeting of the National Smoke Abatement Society. The Public Health Committee, and subsequently the Special (i.e the Policy) Committee of the Corporation, approved the recommendations, and the Corporation decided to seek such powers in their next Various Powers Bill. At the same time, the late Sir George Elliston, a former President of this Society and a member of the Corporation of the City of London, urged that a District Heating Scheme should be prepared for the rebuilt City. What was the result of these efforts? A "Smokeless zone" clause and a "prior approval" clause were, in 1945, included in a City of London (Various Powers) Bill, but there was powerful opposition to the "smokeless zone" clause, and as the Bill contained other clauses which the Corporation were anxious to get through Parliament unopposed, the "smokeless zone" clause was dropped. The "prior approval" clause, however, went through and was included in the City of London (Various Powers) Act, 1946 in the form of extended powers to make bye-laws under Section 151 of the Public Health (London) Act, 1936 requiring the approval of the Common Council to be obtained before the installation in new buildings of heating arrangements of any kind, and before substantial alterations were made in the heating arrangements of any existing building. It was never found possible to frame bye-laws which the Ministry of Health would approve. First of all the Ministry suggested that, owing to the difficult coal supply position and particularly the shortage of smokeless fuel, the time was not opportune for the making of such bye-laws When the particular circumstances of the rebuilding of the City were emphasised, the Ministry intimated that they would be prepared to consider, with a view to confirmation, a series of bye-laws which were not open to criticism on the grounds that they were unreasonable in the light of existing conditions as to fuel supplies, or that they failed to give adequate and specific guidance as to the arrangements which would satisfy their requirements. The Ministry contended that the draft bye-laws were not sufficiently specific, and we never succeeded in drafting any that were. As regards a District Heating Scheme for the City, the Corporation appointed a distinguished consulting engineer to prepare such a scheme, but again it was not found practicable to carry the scheme into effect. A supply of hot water from an electricity generating station, such as has been provided in Pimlico from the Battersea Power Station, was not available. Moreover it was obvious that the rebuilding of the City would not be progressively area by area but would be sporadic, a large building here, then another a considerable distance away; so that the Corporation would have been faced with the enormous expense of constructing a heat generating station large enough, or capable of expansion to a size, to meet an unknown future demand, and miles of pipes leading initially only to individual, widely separated buildings. So all our efforts came to nothing. Then in December, 1952, there occured the disastrous "smog" over London, which created a widespread and insistent public demand that steps should be taken to reduce the pollution of the atmosphere. The Corporation of the City of London decided that they would again seek power to declare smokeless zones in the City, and to include an appropriate clause in a general powers bill which they had in preparation in 1953. This time the proposal was accorded an entirely different reception; it had an excellent press, there was little opposition, and what there was was faint-hearted and almost apologetic. The Bill passed through all stages in both Houses of Parliament, providing, on second reading, an opportunity for a general debate on atmospheric pollution. The Act received the Royal Assent on 5th July, 1954. The City of London is a particularly favourable area in which to establish a smokeless zone. There is no heavy industry and there is comparatively little residential accommodation. The 14 majority of the buildings are blocks of offices, most of which have central heating plants using coke or oil fuel. There are, however, a considerable number of old office blocks which have no central heating but have ordinary domestic coal-burning grates in the individual offices. There are others which have central heating on the lower floors, but individual heating by coal fires on the upper floors. Even in the centrally heating blocks certain rooms have coal-burning grates, often more for appearance than for heating purposes. All these coal fires produce a domestic smoke type of nuisance, which is rendered more obvious by the fact that they are mainly in the older buildings of three or four storeys which are surrounded by more modern, much higher buildings, so that the smoke never gets away. The Corporation came to the conclusion that it would be futile to attempt to define zones within the City which should be declared smokeless zones, and decided to make the whole City of 667 acres one smokeless zone. The Act states that as from a date to be fixed by the Corporation, which shall not be before the 1st October, 1955 "no smoke shall be emitted from any premises in the City". The penalty is a fine not exceeding £10 and a daily penalty not exceeding £5. There is no general defence on the grounds that the "best practicable means" for the prevention of smoke under existing circumstances, have been used. There are provided, however, two lines of defence, one in relation to the burning of an authorised fuel, and the other to the burning of any fuel which has been approved by the Common Council as suitable for the particular appliance, and burnt in accordance with approved conditions and during such period as has been approved. In regard to the first of these lines of defence, an authorised fuel is defined as "coke, anthracite or any other fuel from time to time approved as being an authorised fuel by resolution of the Common Council", and it is a defence to prove that the smoke emitted arose solely from an appliance suitable for burning an authorised fuel and properly maintained and used, and so arose either by burning that authorised fuel therein, or by burning any other type of fuel because the authorised fuel was not available at the time and could not, by reasonable care and foresight, have been made available. It is reasonable to provide this defence, because it is the intention of the Corporation to limit the authorised fuels to those generally recognised as smokeless fuels, and they may not be available at all times; and moreover it is possible that there may be a brief emission of a little smoke even with a smokeless fuel, when lighting up or stoking up. The second of the two lines of defence is designed to provide that if an occupier has sought the advice of the Corporation in regard to the type of heating appliance he should install, the type of fuel he should use, and the precautions he should take by means of instruments or otherwise to check the emission of smoke, and if he has followed the recommendations of the Corporation, he shall not be liable to a penalty if smoke is emitted occasionally. This is an encouragement to occupiers to seek prior approval of heating installations, and accordingly the Section of the 1946 Act, under which the Corporation may make bye-laws in regard to prior approval of heating arrangements, is repealed. Even if an occupier has done everything humanly possible to ensure that the heating appliances in his premises are smokeless in operation, there may be an occasional emission of smoke through some unexpected failure in the apparatus, the fuel or the operator. The occupier has then contravened the law, but it would be unreasonable to impose the penalty which the law prescribes for such contravention. The Act enables the Corporation to exempt premises from the application of the provisions of the "smokeless zone" section, or to postpone their application to any particular premises; and to contribute the whole or part of the expense necessarily incurred in the execution of works for the purpose of complying with the section; though, so far as I am aware, there are no premises which should be exempted permanently or temporarily, and in my opinion anybody who can afford to occupy premises in the City of London should be able to afford to install smokeless methods of heating. The section also lays down the means by which disputes between occupier and owner as to responsibility for the cost of necessary works shall be settled. Raihvay locomotives are specifically exempted from the application of the Act. As regards the implementation of the powers, I am of the opinion that there should not be any serious difficulty so far as the open fires in the older offices, or what I may call the "amenity" fires in the modern offices, are concerned. The cost of conversion to gas or electric fires or to modern grates or stoves capable of burning any type of smokeless fuel will not be a serious matter, and the greater efficiency will result in lower fuel costs, so the capital outlay on conversion will soon be repaid. There will be no objection from the Corporation to the burning of smokeless fuels of the coalite type in the existing grates, but from the occupier's point of view it would be more economical to install an approved modern appliance. The burning of bituminous coal and of oil in central heating plants will need more care than it has received in the past, but the difficulties are not insurmountable. We have had quite a lot of trouble from coal-fired plants, even with automatic stoking, in modern buildings. In some cases at least this has been due to the variable quality of the coal supplied, though of course it has, since the war, become usual to blame the quality of the coal whenever there is complaint about the emission of smoke. The petitioners against the Bill pressed us to include oil as an authorised fuel but we refused to do so, because an oil-fired plant can make the most filthy smoke. I am inclined to think that the manufacturers of oil-firing plant have not yet tackled the problem of absolute smokelessness. They have felt that they could keep well within the legal limits for smoke emission, but, so far as the City of London is concerned, they will in the future have to achieve a standard of no visible smoke at any time. There seems to be a problem in relation to commercial buildings which are centrally heated by oil-fires plants. Over the week-end the buildings are unoccupied and therefore the heating is cut down. During this period there is an accumulation of oily soot in the flues, and when full heat is turned on on Monday morning this is blown out and falls in the vicinity like black snow. This is perhaps not atmospheric pollution in the strict sense and 15 the actual emission takes place in the early hours, perhaps in the dark when there is nobody about to observe it. We get the complaints about the oily deposit on flat roofs and skylights. I have also observed a relatively small automatic, thermostatically controlled, oil-fired plant which gave a short burst of smoke every time the burners lighted up. These points require attention and I should be glad to hear comments during the discussion. Quite apart from visible smoke, we get complaints of the smell from oil-fired plants. With buildings of varying height and with various excrescences on top, resulting in a completely crazy skyline, the most unpredicable wind currents are created, and it may be very difficult to decide which is the offending stack. At any rate stacks must be carried above the level of any obvious obstructions in the vicinity. Finally, what benefits do we expect from this legislation, seeing that the City is only a square mile in the centre of London? Of course the smoke from all round will be blown over the City according to the direction of the wind, but at least we expect to be free from the heavier smoke particles which fall within a comparatively short distance of the point of emission from a chimney. Moreover, in foggy weather there is usually little or no lateral movement of air, and therefore we hope that, because we are not producing smoke in the City, our fogs will not be "smogs". The reports from the smokeless zone of just over 100 acres in central Manchester are encouraging, and we are very grateful to Manchester, not only for this encouragement, but also for their help in the preparation of our Bill and during its second reading and its Committee stage. Manchester is extending its smokeless zone, the City of London has gone to its boundaries and must depend on neighbouring local authorities for any extension. They have a more difficult problem, but we sincerely hope that they will tackle it in the near future. CITY OF LONDON (VARIOUS POWERS) ACT, 1954 PART II.—SMOKB ABATEMENT. Prohibition of emission of smoke in City. 4.—(1) As from the date fixed in pursuance of subsection (5) of this section and subject to the other provisions of this section no smoke shall be emitted from any premises in the City. (2) The occupier of any premises in the City from which smoke is emitted in contravention of the provisions of this section shall on summary conviction be liable to a penalty not exceeding Ten Pounds and to a daily penalty not exceeding Five Pounds: Provided that it shall be a defence in any proceedings under this subsection to prove that the smoke emitted— (a) arose solely from a furnace stove or other appliance suitable for burning an authorised fuel and properly maintained and used and so arose either— (i) by burning that authorised fuel therein; or (ii) by burning any other type of fuel therein and that such other type of fuel was burnt therein for the reason that the authorised fuel for which the furnace stove or other appliance was suitable was not available to the defendant and could not with reasonable care and foresight on his part have been available to him at the time the smoke was emitted; or (b) arose by burning any fuel whether an authorised fuel or not which may have been approved by the Common Council as suitable for the furnace stove or other appliance in which it was burnt in accordance with such conditions and during such period as may have been approved as aforesaid in relation to such furnace stove or other appliance. In this subsection the expression "authorised fuel" means coke anthracite or any other fuel from time to time approved as being an authorised fuel by resolution of the Common Council. (3) The occupier of any premises who— (a) by reason of a restriction affecting his interest in the premises is unable to execute works for the purpose of complying with the provisions of this section; or (b) considers that the owner of the premises or any other person having an interest therein should contribute towards the cost of the execution of works as aforesaid and is unable to agree with the owner or such other person as to whether such a contribution should be made or as to the amount thereof; may apply to the Mayor's and City of London Court for an order to enable the execution of such works as may be necessary for the purpose of complying with the provisions of this section or (as the case may be) to direct the owner of the premises or any other person who appears to the Court to have an interest therein to contribute towards the cost of suoh works as aforesaid such an amount as appears to the Court in all the circumstances of the case to be fair and reasonable and the said Court may on such application make an order in respect of either or both of the matters aforesaid accordingly. (4) The Common Council may if they think fit contribute the whole or part of the expense necessarily incurred by any person in connection with the execution of works for the purpose of complying with the provisions of this section whether in compliance with an order under the last foregoing subsection or otherwise. (5) The foregoing provisions of this section shall come into operation on such date after the first day of October nineteen hundred and fifty-five as may be fixed by resolution of the Common Council of which date at least six months' notice shall be given by publishing a notice in a local newspaper circulating in the City. 16 (6) The Common Council may in any resolution passed in pursuance of this section provide in relation to any premises specified in that resolution that the provisions of this section shall not apply to such premises or that the application of the provisions of this section to such premises shall be deferred for such period as may be specified in that resolution: Provided that where in any resolution provision is made relating to any premises specified therein in pursuance of this sub-section a copy of the resolution shall as soon as practicable after the passing thereof be served on the owner and the occupier of the premises specified therein. (7) A resolution passed in pursuance of this section may be varied or revoked by another resolution passed by the Common Council in like manner and subject to like provisions. (8) A copy of a newspaper containing a notice published in pursuance of sub-section (5) of this section shall be sufficient evidence of the publication of the notice and of the date of the publication. (9) Nothing in this section shall apply to smoke emitted from a railway locomotive. (10) As from the date fixed in pursuance of sub-section (5) of this section section 14 (Further bye-laws for regulating smoke) of the City of London (Various Powers) Act 1946 is hereby repealed. (11) For the purposes of this section the execution of works includes the provision alteration or adaptation of fixtures fittings and appliances and the expression "smoke" includes soot ash grit or gritty particles. As regards the measurement of atmospheric pollution, Mr. McGrath of my department who has charge of the recording instruments reports as follows:— "The measurement of atmospheric pollution at Golden Lane and Finsbury Circus continued during the year, and the Table shows the results obtained. The methods used have been described in previous reports. They are similar to the kinds employed throughout the country to obtain exact information about the nature and extent of atmospheric pollution. Nearly 200 local authorities co-operate in the work and the total number of instruments in use exceeds 1,200. The work of co-ordinating all the results obtained is undertaken by the Department of Scientific and Industrial Research. For this purpose returns are sent monthly by each of the local authorities to the Department at the Fuel Research Station, Greenwich. Periodically the Department issues reports drawing attention to any significant changes in pollution over the country as a whole with an analysis of the possible causes of the changes. During the year three more sets of apparatus were authorised by the Public Health Committee for use in the City of London to measure smoke and sulphur pollution by the volumetric apparatus similar to the one which has been in operation since 1948. The additional instruments are sited in the Police Stations at Snow Hill, Cloak Lane and Bishopsgate. The measurements taken in the City during 1954 do not indicate any significant change. Compared with 1953 the monthly average of total solids deposited in the rainwater gauge at Golden Lane shows an increase of 1.14 tons per square mile, but compared with the average for the five years 1949/1953 there is a decrease in the average monthly deposit of 1.35 tons per square mile. The considerable month to month variation follows the pattern of previous years. This is primarily due to fluctuations in meteriological factors such as fog, rainfall and the speed and direction of wind. The results for April and June emphasize this. The lowest recorded rainfall was in April and the greatest in June. In April the rainfall was 4 millimetres, or 0.1 of an inch, with a total solids deposit of 7.63 tons per square mile, whilst in June 78 millimetres, or 3.0 inches, of rainfall resulted in a deposit of 22.30 tons per square mile. Factors contributing to the increase in the deposit for 1954, as compared with the two previous years, might well be of local origin, viz. the demolition of derelict buildings, the removal of builders refuse and the construction of new buildings in the immediate neighbourhood of the station. Sulphur pollution remained fairly constant. There is little variation in the monthly or yearly figures of the last six years as shown by either of the methods employed for determining the amount of sulphur dioxide in the atmosphere. The amounts recorded by the lead peroxide method show a slight decrease for 1954 at Golden Lane compared with the average for the previous five years and a slight increase at Finsbury Circus. By the more reliable volumetric method the monthly average of sulphur dioxide, expressed as parts per 100 million parts of air, was 9.7 in 1954, compared with 10.9, the average of the previous five years. An indication of the significance of these concentrations may be obtained by reference to the limits of safety for those employed in manufacturing processes producing sulphur dioxide. The figure quoted for the guidance of industrial firms is 100 parts per 100 million parts of air. In the Annual Report for 1951 reference was made to the large electricity generating station in course of construction on the south side of the River; to the faot that it is impracticable to remove sulphur compounds from the chimney gases of any but the very largest installations, and that even in such installations it is not possible, for economio and technical reasons, to stop entirely the pollution from sulphur. During 1954 complaint was received of inconvenience and some ill effect on health from certain occupiers of premises situate on the north bank of the River. Concern was also expressed of the effect of the pollution on the fabric of St. Paul's Cathedral. The cause was attributed to the Bankside Power Station which had commenced operations in the latter months of 1952—gas washing of the chimney flue gases being introduced in July, 1953. No positive action has been taken to reduce the emission of sulphur except at three large generating stations in London, of which Bankside "B" Station, as it is named, is one. The Bankside Station is required by Parliament to remove the greater part of the sulphur compounds from the chimney gases. This stipulation has focussed attention on electricity generating stations as a source of pollution by sulphur, and the enormous volume of water vapour emitted as a consequence of the gas-washing process has lead to the mistaken impression on the part of the general public that vast quantities of noxious gases are being discharged into the atmosphere from Bankside, whereas the emission of invisible sulphur compounds from other fuel burning installations where there is no gas washing plant is not recognised. 17 The average sulphur content of the heavy fuel oil used at the Bankside "B" Station is 3.8%. The average elimination of the sulphur compounds from the flue gases is 97.1%. The weight of the sulphur dioxide emitted to the atmosphere, calculated on the tonnage of fuel used in 1954 was 91.6 tons, or an average of approximately 5 hundredweights per day. The whole of this is ultimately washed down by rain as very dilute sulphuric acid. Much of this emission makes no contribution to the sulphur pollution of the City's atmosphere since the chimneys of the power station are of such a height as to ensure its discharge and dispersal beyond the zone of turbulence which exists downwind of buildings or high ground. In addition there are long periods of the year when winds from directions other than the south blow the gases away from the City. But with the wind from a southerly direction, coupled with a very humid atmosphere, the flue gases, cooled as a result of the washing process, sink to ground level before they have become adequately diluted, and then cause a higher local concentration than would occur if the gases were not washed and so, being hot, rise high above the level of the top of the chimney. How does the quantity of sulphur emitted from Bankside compare with that emitted from the chimneys of other premises within the City boundaries? Sulphur dioxide is discharged wherever solid or oil fuel is burnt, whether in industrial or domestic premises. The degree of efficiency of combustion does not affect the quantity of sulphur dioxide evolved, and although a relatively small proportion of the sulphur is retained in the ashes the bulk goes into the atmosphere. Gas for public supply is excluded from consideration since nearly all the sulphur compounds are removed before distribution. The approximate annual consumption, in tons, of fuel, solid and oil, in the City of London is set out below. The figures for solid fuels relate to 1953 and for oil to 1954. Bituminous Anthracite and Coke. Other smokeless Oil. coal. other Welsh coals. fuels. 23,100 7,000 41,900 300 20,000 The approximate total tonnage of solid fuels consumed is 72,300, and oil fuel 20,000. The amount of sulphur in solid fuels varies between 0.5 and 3.0%. The average is generally taken to be 1.5%. In oil the percentage varies between 3 and 4. For the purpose of the* following calculations the average taken is 3%, i.e. 0.8% less than the figure of the average sulphur content of the oil used at the Bankside Power Station. From these figures it will be seen that the quantity of sulphur emitted without any treatment at low level from premises in the City is as follows:— in tons annually. daily. Solid fuel 1084.5 2.97 Oil fuel 600.0 1.64 Hence the sulphur emitted from the Bankside Station annually 91.6 tons, and daily, approximately 5 cwts. is equal to about 5.4 per cent. of the sulphur dioxide discharged from all the chimneys in the City of London." TABLE.—Results obtained in 1954 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 (SOs) per day per 100 sq. cm. mg. per 100 cu. metres Parts per 100 million parts of air January 24 0.9 12.45 8.69 21.14 3.57 4.28 22.1 48.1 14.2 22.9 February 52 2.0 20.15 9.89 30.04 3.24 2.83 24.4 49.0 16.2 42.2 March 47 1.9 16.99 7.76 24.76 3.10 3.47 19.3 32.1 13.4 28.6 April 4 0.1 4.84 2.79 7.63 2.11 2.17 16.5 26.0 9.6 19.9 May 31 1.2 14.70 10.62 25.32 1.57 1.56 12.3 31.0 6.8 11.9 June 78 3.0 11.38 10.92 22.30 1.50 1.59 4.2 8.7 4.8 8.6 July 73 2.9 6.37 8.33 14.70 1.35 1.44 3.6 8.2 3.9 8.1 August 53 2.0 10.55 4.04 14.60 1.42 1.22 4.6 8.7 5.1 8.9 September 38 1.5 12.61 8.72 21.34 1.78 1.69 4.5 13.0 5.7 14.6 October 55 2.1 13.18 10.49 23.67 3.19 3.08 7.2 24.6 8.6 18.1 November 76 3.0 13.90 15.40 29.30 4.01 3.94 28.0 124.5 13.9 45.4 December 37 1.5 10.59 10.85 21.44 3.66 3.91 23.1 134.9 13.8 36.6 Averaqe 1954 47 1.8 12.4 9.04 21.35 2.54 2.60 14.1 9.7 - 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 11.8 - 13.4 - 1950 38 1.5 10.19 16.96 27.15 2.66 2.32 9.9 - 10.0 - 1949 28 1.1 8.74 9.99 18.72 2.74 2.53 10.2 - 9.0 - 1949/53 39 1.5 10.69 11.91 22.60 2.56 2.41 11.7 - 10.9 - 18 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 last two 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 and I have always received from them the greatest assistance and courtesy. The total number of medical examinations during the year was 219. STAFF I desire to express my gratitude to my staff for the efficiency and tact with which they have discharged their duties, for their loyalty, and for the way they have worked together as a team. Owing to the increase in the work at Smithfield Meat Market consequent on the de-rationing of meat, it became necessary to appoint three additional meat inspectors, but the staff there is still below the pre-war establishment. The new appointments were:— Mr. J. T. Cox. Mr. H. Field. Mr. G. Gingell. all of whom have proved to be capable, adaptable and congenial colleagues. The Chief Meat Inspector, Mr. C. E. Mellish, received the honour of Membership of the Most Excellent Order of the British Empire on New Year's Day. Two members of the staff retired after long years in the service of the Corporation:— Mr. W. F. Morris, Meat Porter, on reaching the age of 65 years. Mr. E. F. Berry, Disinfecting Apparatus Attendant, on account of ill health. I should like to express my appreciation of the unvarying courtesy and kindness which the Chairman and Members of the Public Health Committee have extended to me throughout the year, both on and off duty. I have the honour to be, Your obedient Servant, CHAS. F. WHITE, Medical Officer of Health. 19 STATISTICAL INFORMATION. Area.—678 acres (including the Temple and foreshore). Population.—Census 1951, 5,268. Estimated mid-year 5,180 Annual Rateable Value.—As at 1st April, 1954, £6,834,410. Annual Sum received from Penny General Rate.—Estimated £28,150. Births:— Total. M. F. Legitimate 21 13 8 Birth Rate per 1,000 resident Live Births, Illegitimate 1 1 population, 1954 3'78 Still Births Rate per 1,000 total (live and still) births Deaths:- Deaths, Infants under Legitimate 4 weeks of age Illegitimate Deaths under 1 year legitimate Death Rate per 1,000 resident Deaths (all ages) 65 43 22 Death Rate per1,000resident opulation 12.05 Death Rate of Infants under one year of age :— All Infants per 1,000 live births Legitimate Infants per 1,000 legitimate live births Illegitimate Infants per 1,000 illegitimate live births INFECTIOUS DISEASE. Notifications received:— Total cases notified. Acute Primary Pneumonia 2 Food Poisoning and suspected Food Poisoning 4 Measles 7 Puerperal Pyrexia 2 Poliomyelitis 1 Scarlet Fever 2 Sonne Dysentery 4 Tuberculosis 19 Whooping Cough 4 ANALYTICAL EXAMINATIONS. (Other than under Food and Drugs Act). Atmospheric Pollution 24 Oranges 8 Chemical Fertilizer 3 Pork Pie 1 Cocoa Beans 1 Rainwater 12 Confectionery 1 Raspberry Pressing Cask 2 Cooking Fat 1 Sauce 1 Dripping 1 Sausages 2 Egg Yolk 1 Shellfish (Tinned) 3 Fruit Tart 1 Tomato Puree 1 Gelatine 2 Vegetables (Tinned.) 2 Luncheon Meat (Tinned.) 1 BACTERIOLOGICAL EXAMINATIONS. The following specimens were examined during the year:— Bristles 3 Milk 1 Cream (Tinned) 1 Rabbit 1 Fæces 11 Shellfish (Tinned. 2 Meat 4 Steak and Kidney Filling 1 Meat Roll 1 Throat Swabbing 1 Meat (Tinned) 14 Tomato Puree 1 DIPHTHERIA ANTI-TOXIN. Quantity provided to private practitioners Nil. 20 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1954. Causes of Death Nett Deaths at the subjoined ages of Residents whether occurring 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 . 65 — — — 1 6 33 7 18 1. Tuberculosis, respiratory M 1 — — — — — 1 — — 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 — — — — — — — — — F 1 — — — — — — 1 — 11. Malignant neoplasm-lung, Bronchus M 3 — — — — — 3 — — F 1 — — — — — — — 1 12. Malignant neoplasm-breast M — — — — — — — — — F — — — — — — — — — 13. Malignant neoplasm-uterus F 1 — — — — — — — — 14. Other malignant and lymphatic neoplasms M 3 — — — — — 2 1 — F 6 — — — — 2 2 — 2 15. Leukaemia, aleukaemia M — — — — — — — — — F 1 — — — 1 — — — — 16. Diabetes M — — — — — — — — —. F — — — — — — — — — 17. Vascular lesions of nervous system M 2 — — — — — 1 — 1 F 2 — — — — — 1 — 1 18. Coronary disease, angina M 10 — — — — — 4 3 — F 1 — — — — — — — 1 19. Hypertension with heart disease M 1 — — — — — — — 1 F — — — — — — — — — 20. Other heart disease M 2 — — — — — 1 — 1 F 3 — — — — — — — — 21. Other circulatory disease M 3 — — — — — 2 — 1 F — — — — — — — — — 22. Influenza M — — — — — — — — — F — — — — — — — — — 23. Pneumonia M 4 — — — — — 3 — 1 F — — — — — — — — — 24. Bronchitis M 4 — — — — — 3 1 — F 2 — — — — — — — 2 25. Other diseases of respiratory system M 3 — — — — — 3 — — 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 — — — — — — — — — F — — — — — — — — — 30. Pregnancy, childbirth, abortion F — — — — — — — — — 31. Congenital malformations M — — — — — — — — — F — — — — — — — — — Carried forward M 37 — — — — — 23 6 8 F 18 — — — 1 2 4 1 10 21 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1954—continued. Nett Deaths at the subjoined aoes 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 37 — — — — — 23 6 8 F 18 — — — 1 2 4 1 10 32. Other defined and ill-defined diseases M 1 — — — — — 1 — — F 2 — — — — 1 1 — — 33. Motor vehicle accidents M 1 — — — — — 1 — — F — — — — — — — — — 34. All other accidents M 2 — — — — 2 — — — F 2 — — — — 1 1 — — 35. Suicide M 1 — — — — — 1 — — F — — — — — — — — — 36. Homicide and operations of war M 1 — — — — — 1 — — F — — — — — — — — — M 43 — — — — 2 27 6 8 F 22 — — — 1 4 6 1 10 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 21 1-5 years of age 6 Total No. of children who attended during the year, and who were born in:— 1954 19 1953 38 1952-49 37 Total attendances by children— Under 1 year of age 485 1-5 years of age 564 Health Visitors. No. of infants under 1 year of age visited for first time 28 Total visits to infants under 1 year of age 116 Total visits to children aged 1 year but under 2 years 93 Total visits to children aged 2 years but under 5 years 208 No. of expectant mothers visited 14 Total visits to expectant mothers 46 Care of Premature Infants. No. of premature births during the year — No. of deaths under 1 month — Diphtheria Immunisation. No. of children who completed a full course of primary immunisation— Under 5 years of age 21 5-14 years of age 16 No. of children who were given a secondary or reinforcing injection 59 Vaccination. No. of children successfully vaccinated or revaccinated 17 22 MEAT INSPECTION. Tons. Cwts. Qrs. Lbs. Meat, &c., delivered at Smithfield Market 354,698 0 0 0 Meat, &c., seized by Inspectors at Smithfield Market 430 17 0 11 Meat, &c., seized by Inspectors at Leadenhall Market and City shops 13 16 1 4 Meat, &c., seized by Inspectors at Cold Stores 2 5 3 3 Various commodities seized by Inspectors and sent to Lett's Wharf 27 17 2 0 Number of eggs seized by Inspectors and sent to Lett's Wharf, 5,946 Number of demonstrations and lectures given, 38. Number of Students attending, 372. 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. 39 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. 98 tons 16 cwts. 3 qrs. 19 lbs. were condemned as unfit for human consumption. 55 tons 13 cwts. 2 qrs. 7 lbs. of this food were utilised for stock feeding, fertilizing or manufacturing purposes. The remainder, consisting of 43 tons 3 cwts. 1 qr. 12 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. 21 tons 12 cwts. 1 qr. 6 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 3,670 inspections have been made. As a consequence of these inspections, it was necessary to serve 13 Intimation Notices. Three Statutory Orders were served. Legal proceedings were necessary in one instance. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. 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) 1,796 (including 1,744 kitchens) 179 (including 173 kitchens) — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority ... 392 108 18 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) ... 4 4 TOTAL 1,457 1,908 197 — 23 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.) 561 547 Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — 3 — — — Inadequate ventilation (S.4) 65 65 — — — Ineffective drainage of floors (S.6) 3 8 — — — Sanitary Conveniences (S.7) (a) insufficient 4 11 — — — (b) Unsuitable or defective 138 92 — 11 — (c) Not separate for sexes ... 8 3 — — — Other offences against the Act (not including offences relating to Outwork) 410 449 7 — — TOTAL 1,189 1,178 7 11 — OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms 110 Names and Addresses, etc., received from other Authorities 125 Names and Addresses transmitted to other Authorities 719 No case of infectious disease was reported in connection with outworkers' premises in the City. SHOPS ACT, 1950. 72 inspections of shops and warehouses have been carried out. Defects found have been remedied after the service of 4 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 1954, 117 inspections were made in this connection and reports forwarded to the City Food Controller. PHARMACY AND POISONS ACT, 1933. 71 firms were registered under this Act, 69 of which were re-registrations. No infringement was noted. 107 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. 31 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 one contravention was discovered. FOOD AND DRUGS ACT, 1938, AND FOOD REGULATIONS. Informal and Formal Samples submitted for Analysis. Article Informal Formal Article Informal Formal FOOD. Brought forward 35 — Almonds (ground) 4 — Cloves 1 — Apple Sauce 1 — Cocoa 1 — Baking Powder 2 — Coconut (desiccated) 2 — Butter 4 — Coffee 6 — Butter (on bread) 1 — Coffee Essence 1 — Cakes 2 — Cooking Fat 1 — Cake Decorations 2 — Crab (tinned) 3 — Cashew Nuts — Cream 12 — Celery Salt 1 — Crystallised Fruit 1 — Celery Seed 1 — Curry Powder 4 — Cheese (processed) 8 — Dessert Powders 3 — Chocolate Spread 1 — Dripping 1 — Chocolate (drinking) 1 — Egg Custard Powder 1 — Christmas Puddings 2 — Fish Cakes 1 — Cinnamon (ground) 4 — Fish Paste 3 — Carried forward 35 — Carried forward 76 — 24 FOOD AND DRUGS ACT, 1938, AND FOOD REGULATIONS—continued Informal and Formal Samples submitted for Analysis. Article Informal Formal Article Informal Formal Brought forward 76 — Brought forward 227 26 Flavourings 2 — Tripe & Onions (tinned) 1 — Flour (self-raising) 1 — Turkish Delight 1 — Foie Gras Paste 1 — Vegetables (tinned) 1 — Fruit (tinned) 4 — Vinegar 6 — Gelatin (granulated) 2 — Welsh Rarebit 1 — Gin — 1 Whisky — 2 Ginger (ground) 4 — Grapefruit (tinned) 1 — DRUGS. Honey 3 — Ammoniated Tincture of Quinine 4 Ice Cream 5 — Iced Lollies 1 — Ammoniated Tincture of Quinine with Oil of Cinnamon 1 — Jellies 6 — Lard 1 — Lemon Juice 1 — Arnica, Tincture of 1 — Lemonade Powder 1 — Arrowroot (ground) 1 — Liquid Browning 2 — Aspirins 1 — Liqueur Chocolates 1 — Bismuth Mixture 1 — Margarine 5 — Calamine Lotion 2 — Meat Paste 1 — Camphorated Oil 4 — Meat Pie 1 — Cascara Sagrada 4 — Milk — 24 Castor Oil 1 — Milk (condensed) 2 — Citrate of Magnesia 1 — Mincemeat 1 — Cough Mixture 3 — Mint (dried) 7 — Embrocation 2 — Mustard (prepared) 2 — Eucalyptus, Oil of 2 — Nutmeg (ground) 4 — Friars Balsam 2 — Olive Oil 4 — Glauber's Salt 1 — Parsley (dried) 1 — Glucose (powdered) 1 — Pastry Mix 1 — Glycerin of Thymol 1 — Peel (mixed) 2 — Halibut Oil Capsules 2 — Pepper 8 — Hydrogen Peroxide 1 — Pepper Compound 1 — Hypophosphites, Syrup of 1 — Pie Filling 1 — Iodine, Tincture of 5 — Pudding Mixture 2 — Liniment 1 — Rapeseed Oil 1 — Liniment of Turpentine 3 — Salad Oil 1 — Liquid Paraffin 7 — Sauces 6 — Liquorice Powder 2 — Sausages 27 — Lotions 2 — Shrimps (tinned) 1 — Medicated Tablts 8 — Soft Drinks 2 — Methyl Saliciate 1 — Soup (tinned) 1 — Milk of Magnesia 1 — Spice (mixed) 4 — Myrhh, Tincture of 1 — Spreads 1 — Ointments 3 — Stewed Steak (tinned) 1 — Rhubarb Pills 1 — Suet 2 — Syrup of Figs 1 — Sweets 11 1 Tonic Phosphates 1 — Tea 8 — Vitaminised Iron Jelloids 1 — Tomato Juice 1 — Wintergreen, Oil of 2 — Tomato Ketchup 1 — Witch Hazel 2 — Tomato Paste 3 — Zinc & Castor Oil Cream 1 — Carried forward 227 26 Totals 317 28 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY. Article. Informal or Formal Sample. Nature of adulteration or irregularity. Action. Glass of Hot Milk. Formal. Extraneous water 4.2%. Vendor cautioned. Milk taken from 10 gall, can. Informal. Unsatisfactory to methylene blue test and bacteriological examination, due to careless handling. Dairyman cautioned. Sausages. Informal. Sold containing sulphite preservative equivalent to 150 p.p.m. sulphur dioxide without statutory declaration. Vendor cautioned. Sweets. Formal. Sold as "Butter Selection" but containing only 0.82% fat. Prosecution (see opposite). Ammoniated Tincture of Quinine with Oil of Cinnamon. Informal. Improperly labelled. Manufacturers notified and new labels printed. 25 PROSECUTION. Food and Drugs Act, 1938 (Section 3). Article. Offence. Result. Sweets. Selling sweets described as 'Batter Selection' Plea of Guilty. containing only 0.82 per cent. fat. Absolute discharge on payment Butter Sweets should contain butter fat to the of Five Guineas costs. extent of not less than 4 per cent. 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 six persons were exhumed from common graves and re-interred in private graves, and the remains of one person were exhumed from a private grave and subsequently cremated. 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 1954, 550 pigeons were destroyed by this means. CITY MORTUARY. Bodies received 166 Post Mortem Examinations made 166 Inquest on bodies 38 Inquests held at Holloway Prison 1 Inquest on fires — DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, &c. :— No. of articles disinfected 1,131,167 Cases of horsehair 63 Fees received £3,876 General Disinfection. Infectious Diseases, &c.:— Articles of bedding disinfected 123 Rooms disinfected after cases of infectious disease 11 Lockers at Post Offices disinfected 62 Verminous rooms disinfected 110 Ambulances, vans, &c., disinfected — Police Cells disinfected 3 Cleansing of Persons :— No. of verminous persons bathed 499 No. of verminous articles disinfected 4,897 Cleansing of Schoolchildren :— No. of children cleansed 234 No. of articles disinfected 2,238 No. of children treated for Minor ailments 2,738 LONDON: Printed by Drake, Driver & Leaver Ltd., Rosebery Avenue, E.C. 1. 1955. 850—A7278—7/55.