434 LON 83 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR the CITY OF LONDON FOR THE YEAR 1957. Printed by the Authority of Common Council 17th December 1953. STAFF. MEDICAL OFFICER OF HEALTH Date of (For the Port and City of London) Appointment Wilson, John Greenwood, M.D., F.R.c.P., D.P.H., F.A.P.H.A. (Hon.) April 1956 CLERICAL STAFF Blunt, Harold F. Chief Cleric (Food Administrative Officer for the May 1924 Port and City of London as from 1st April 1957) Stout, James Erl. 1st Assistant Cleric July 1930 Betts, Charles W.R. 2nd Assistant Cleric April 1926 Threadgold, Arthur W. Senior Cleric, Meat Inspector's Office Nov. 1923 Peters. E.J., General Grade Cleric, Meat Inspector's Office Nov. 1935 cash, J.E. General Grade Cleric, Meat Inspector's Office March 1954 Gurney, Miss M.L. Clerical Assistant May, 1939 West, Mrs. I.R. Clerical Assistant Sep. 1956 PUBLIC HEALTH INSPECTORS McGrath, William Richard March, 1922 Harrington, George Edwin Dec. 1925 Sillett, David Ernest April 1926 Neale, William G.C. July 1928 Thorpe, Robert C. March 1930 Hudson, Leslie A. April 1934 Campbell, J.W. Sep. 1946 Thompson, E. Sep. 1948 Flynn, J. July 1951 MEAT INSPECTION STAFF Thompson, Frank, E. Chief Meat Inspector July 1924 Lke, W.R. Deputy Chief Meat Inspector July 1930 Garrard, S.S.Meat Inspector Sep.1946 Morris, W.L.Meat Inspector Sep. 1946 Seymour, K.S.Meat Inspector July 1935 Wilson, J.C.Meat Inspector Jan.1936 LeACH, R.A.Meat Inspector Sep. 1952 Cox, J.T. Meat Inspector Aug. 1954 Field, H. Meat Inspector Aug. 1954 Gingell, G.Meat Inspector Aug. 1954 Giles, H.W. Meat Inspector Aug. 1956 Bernhardt, D.R. 'Authorised Officer' under Food Hygiene Regulations, 1955 May 1931 RODENT OFFICER Carter, J. Sep. 1944 RODENT OPERATIVES Cooper, J.S. (Foreman Rodent Operative) Aug. 1943(Retired Sept. 1957) Mason, G.A. (Foreman Rodent Operative from Oct. 1957) Dec.1946 Tremayne, L.r. Nov. 1943 Cardy, E.G. June 1950 Brown, G.J. Aug. 1950 Clayton, J.G Nov. 1951 KEEPER OF THE MORTUARY Lawrence, F.H. May 1936 DISINFECTING APPARATUS ATTENDANT Burton, J.H. March 1936 MESSENGERS Bourne, A.W. March 1956 SENIOR PORTER AT SMITHFIELD MARKET Prevost, A.E. Feb. 1926 PUBLIC ANALYST Lickorish, A.J.C.. F.I.C. April 1930 Williams, H.A., Ph.D. (Lond.) A.C.G.F.C., F.R.I.C. Jan.1958 (Died Sept.1957) MANUAL WORKERS Carmody, J. (General Duties at Mortuary) Feb. 1950 Sunnick, J.W.T. (General Duties at Mortuary) May 1950 Mann, Ernest V. (General Duties at Smithfield Market) Jan. 1928 Lawrence, Charles J. (General Duties at Smithfield Market) Feb. 1928 Portbury, T. (General Duties at Smithfield Market) July 1953 Wright. J. (General Duties at Smithfield Market) Oct. 1953 Wright, T.W. (General Duties at Smithfield Market) Oct. 1956 Lawrence, E.E. (General Duties at Mortuary) Aug. 1954 Jollie, Mrs. F.G. (Bath Attendant and Cleaner) Sept. 1955 Beach, Mrs. E. (Office Cleaner) Feb. 1945 Nathan, Mrs. A. (Office Cleaner) Sept. 1940 1. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1957. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. Guildhall, e.c.2. April. 1958. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1957. Vital Statistics The resident population of the City according to the Registrar General's estimate at midyear 1957 was 5,100. The birth rate dropped to 5.93 per thousand resident population and the death rate to 10.60 per thousand resident population, as compared with 7.56 and 13.19 per thousand respectively in 1956. As I have observed year by year the vital statistics of the City cannot be usefully compared either with those of other areas or even with those of previous years because the numbers on which the rates are calculated are so small. There were 34 live births, two of which were of female twins born prematurely, both of whom died a few hours after birth. One male child died four weeks after birth from pneumonia consequent upon fibro-cystic disease of the pancreas. There were no deaths attributable to pregnancy or childbirth. The total number of deaths was 53, 37 male and 16 female. Only the deaths of the 3 infants, 1 male child between 1 and 5 years of age and 1 female between 15 and 25 years old occurred in the age groups 0—25 years old. 5 were between 25 — 45; 17 between 45 — 65; 18 between 65 — 75; and 8 were 75 years old or more. One death was due to syphilitic disease; 9 were due to cancer, two of which were cancer of the lung. There were 20 deaths due to disease of the heart or blood vessels, 4 to pneumonia and 3 to bronchitis. One man, aged between 25 and 45, was killed in a motor accident. One man, aged 70, died as a result of a fall whilst going upstairs, and another, aged 75, was found drowned in the River Thames. One woman, aged 40, committed suicide by means of domestic coal gas. Infectious Diseases One case of paralytic poliomyelitis and 2 cases of non-paralytic poliomyelitis were notified. The paralytic patient was a boy aged 2½ years, and the non-paralytic patients were boys aged 6 and 2 years respectively. One case of malaria was notified in the person of a man who normally travels from country to country and was temporarily visiting England. There were 6 cases of Sonne dysentery and 8 cases of puerperal pyrexia. 5 notifications of pulmonary tuberculosis, 19 of measles and 2 of scarlet fever were received. No cases of whooping cough or pneumonia were notified during the year. Food Poisoning Appended is a copy of the annual return made to the Minister of Health on food poisoning in the City of London during the year ended 31st December, 1957. The most serious outbreak — due to staphylococcal poisoning — occurred among the staff of a Government department in the City. The number of persons at risk was approximately 400. Of this number, 23 suffered severely from vomiting, stomach pains and diarrhoea, and 13 were detained in hospital. The enquiries made and the results obtained from bacteriological examinations furnished strong evidence that the cause of the illness was restricted to one large tin of processed peas. The source of supply of the peas was traced through the distributors to a cannery in the provinces, but although a number of unopened tins were examined, physically and bacteriologically, the results were negative. No evidence was obtained to suggest that either the kitchen staff or the hygienic arrangements of the kitchen were at fault. 2. ANNUAL RETURN OF FOOD POISONING IN THE CITY OF LONDON 1. YEAR ENDED 31st DECEMBER, 1957 2. (a) FOOD POISONING NOTIFICATIONS (Corrected) as returned to Registrar General:— 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil 1 Nil. 13 14 (Note: None of these cases were City residents — all were in patients of St. Bartholomew's Hospital.) (b) Cases otherwise ascertained:— 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil 46 1 0 47 103 (c) Fatal Cases:— 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil Nil Nil Nil NU 3. PARTICULARS OF OUTBREAKS:- Agent No. of outbreaks No. of Cases Total No. of Cases Family Outbreaks Other Outbreaks Notified Otherwise ascertained Chemical Poisons Nil Nil Nil Nil Nil Salmonella Typhimurium Nil 1 Nil 3 3 Staphylococci Nil 1 13 10 23 CI. Botulinum Nil Nil Nil Nil Nil CI. Welchii Nil 3 Nil 27 27 Other bacteria Nil Nil Nil Nil Nil Not identified Nil 5 Nil 63 63 Totals Nil 10 13 103 116 4. SINGLE CASES:- Agent No. of Cases Total No. of Cases Notified Otherwise ascertained Salmonella Group C 1 Nil 1 Not identified Nil Nil Nil 5. SALMONELLA INFECTION, NOT FOODBORNE:- Salmonella Type Outbreaks No. of Cases Outbreaks Single Cases Total No. of Cases (Outbreaks and single cases) Family Other Nil Nil Nil Nil Nil Nil FOOD POISONING-PREVENTIVE MEASURES Consideration has been given by the Port and City of London Health Committee as to what further measures could be taken in the City of London to minimize outbreaks of food poisoning either by strengthening existing legislation or by an extension of the educational programme to secure the co-operation of those engaged in the catering industry. Undoubtedly one of the principal causes of food poisoning is the fairly common practice of preparing and cooking such dishes as meat, gravies, meat pie dishes, trifles and custards, on the day before they are to be eaten. If this must be done the conditions of storage are of great importance. If they are unsatisfactory, the food remains for many hours at temperatures favourable for the growth and multiplication of organisms which have escaped destruction by the heat of cooking, with the result that a poisonous dose of organisms and their products may be served with the meal next day. It is essential that the cooked food should be cooled rapidly and kept cool until it is re-heated shortly before it is to be eaten. It would be very difficult, if not impossible, to justify a Regulation or Bye-law to prohibit re-heated food being served. To be effective such a regulation or bye-law must have general support and be capable of enforcement. Minces, shepherds pies, stews etc. are made largely from die remainder of a joint and are very wholesome and nutritious. Such dishes are common to most homes and, on economic grounds alone, it would be quite impracticable to attempt their prohibition. In such circumstances it is suggested it would be better to seek still further to educate the management and staffs of catering establishments by drawing attention to measures which would do much to prevent causes of food poisoning. Special emphasis is placed on the 3. encouragement of better refrigeration arrangements and the use of an approved sterilizing agent to supplement normal cleansing of kitchen surfaces on which food is prepared or stored. The use of approved chemical agents is recognised under the Milk and Dairies Regulations in cowsheds, dairies, etc., and it seems logical to extend these requirements as a recommendation to those engaged in the catering industry. In accordance with the decision of the Health Committee a notice, a copy of which follows, has been printed and will be circulated to the owners or occupiers of all kitchens of restaurants in the City of London early in 1958. CORPORATION OF LONDON FOOD POISONING (1) Illness through food poisoning is increasing year by year. (2) Many cases of food poisoning result from a failure properly to wash and sterilize kitchen utensils and equipment, and from the practice of preparing and cooking meat, gravies, made-up dishes, trifles and custards on the day before they are to be epten. (3) If it is practicable all food should be cooked and served the same day. (4) The following measures for preventing the possible outbreak of food poisoning should be strictly observed: (a) All surfaces in the kitchen and the refrigerator on which food is prepared or stored should be properly washed at least once daily and sterilized by an approved chemical agent. (b) Meat or made-up dishes must be well cooked. (c) To prevent harmful genns from multiplying, all food after cooking; unless it is for immediate consumption, must be rapidly cooled in a well ventilated room or larder outside the kitchen. (d) The food should then be stored in a refrigerator maintained at a temperature between 32 deg. F. and 40 deg. F. at all times. (Every refrigerator should be fitted with a thermometer). (e) The food must be served as quickly as possible after re-heating. (5) Further information on this or any other aspect of hygiene in catering establishments is obtainable from the Medical Officer of Health, Guildhall, City of London, E.C.2. February, 1958 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 52,865, in addition to 9,242 City workers when the Unit was mobile, i.e. when operating at the premises of three large City firms, where employees were X-rayed at their place of work. The Unit is also available to the boroughs of Finsbury, Stepney and Shoreditch, although the majority of examinees are employed in the City. The following is an extract from the Annual Report for 1957 of the Medical Director of the Unit, Dr. W.D.R. Thompson. Introduction "During 1957 the Unit examined 40,097 males and 25,295 females, making a total of 65,392 which is a slight increase on the previous year's figure. The final total would have been higher but for the wave of illness which struck the City of London during the latter months of the year, and which greatly affected the attendances at the Unit. Up to the end of 1957 the Unit has examined 248,470 males and 177,569 females making a grand total of 426,039. "Eighty-four active cases of tuberculosis have been discovered, which is a 35% increase on last year's results, and gives a rate of 1.28 per 1,000 examined. Of these eighty-four cases it is interesting to note that seventy-nine were discovered from firms which have been previously examined by the Unit and only five from new firms, although the ratio of new to old firms was one to seven. This would appear to indicate that it is not a wasted effort re-examining firms after a suitable lapse of time. "The Unit functioned at the Mass Radiography Centre, 20, Golden Lane, E.C.I, from 1st January to 30th April and from 8th August to 31st December, during which periods there was a continuous flow of examinees from the City of London, the Metropolitan Boroughs of Finsbury and Shoreditch,Health and Teaching Staffs of the London County Council, Doctor's referrals and the General Public. All volunteers attended as a result of prior appointments which has proved to be the most acceptable method to all concerned. 4. "During the mobile period the Unit visited several firms in the City who could either themselves or in collaboration with other firms in the vicinity, provide a sufficient number of "bodied1 to render the Unit's visit economical. The Unit also spent several weeks in Shoreditch, operating from the Haggerston Library, 236, Kingsland Road, E.2. by kind permission of the Libraries Committee. Firms were circulated by the Public Health Department of Shoreditch and staffs attended the Unit in a series of appointments. Public Sessions were held but these were not so well attended as the planned sessions, notwithstanding the display of posters, distribution of handbills and announcements in the local Press. We would take this opportunity of recording our grateful appreciation to the Medical Officer of Health for Shoreditch (Dr. B. Broadbent) and his staff for their helpful co-operation. Zone of Unit "The zone of Unit 6D covers the City of London and the Metropolitan Boroughs of Finsbury and Shoreditch, with the administrative offices at the Finsbury Health Centre, Pine Street, London, E.C.I. There is no dearth of volunteers for examination and the Unit is continuously adding new firms to its already extensive card index. Method of Operation "While operating at the Mass Radiography Centre "miniature" sessions were held on Mondays, Wednesdays and Fridays with sessions from 9.15 a.m. to 12.30 p.m. and from 2.00 p.m. to 4.30 p.m. Throughout the year separate sessions were arranged for men and women, although early in 1958 the Unit discontinued this practice and now examines both sexes during the same sessions. Tuesdays and Thursdays were allocated for the reading of miniature films taking and reading large films, interviews by the Medical Director, and the dispatch of results to examinees who provide a stamped addressed envelope for this purpose. "During the mobile periods sessions were arranged to meet particular requirements. Whenever possible a firm's internal postal system was used for the dissemination of results and recalls for large films. Further time was saved by the daily reading of miniature films. Except for large films examinees are X-rayed over their clothes; ladies being advised what to avoid wearing on the day of examination. No expense has been incurred for hiring accommodation when the Unit was mobile, and it is only right and proper that we should record our appreciation of the services rendered by firms, etc. "Many City firms insist on a Chest X-ray when new staff is undergoing a medical examination. The result of such an examination is, of course, sent to the examinee. Medical Procedure "Abnormal cases (after an interview with the Medical Director) are referred, through the examinee's own doctor, to the appropriate Chest Clinic. The ultimate diagnosis is secured from the latter through the medium of the fonn designed for this purpose. We express our grateful thanks to the many Chest Clinics, to which we have referred cases, for their helpful co-operation. "All clinics have recorded their sputum findings, and thirty-one cases with a positive sputum have been reported, of which twenty-seven were male and four female. This denotes an increase of 50% on the 1956 returns. "The Unit classifies its abnormal miniatures and appropriate notification is passed to the examinee. Thus when an examinee's film shows scars of old, and now healed, lesions he (or she) does not receive the normal notification card but a specially worded letter. Where an investigation is outside the purview of a Chest Clinic, the co-operation of St. Bartholomew's Hospital is secured, and with appreciation I acknowledge the help rendered by Dr. N.C. Oswald and his colleagues. "Increasing use is made of the re-examination of previous miniatures for comparison purposes to clear up doubtful abnormalities. Such an investigation may go back eight years. Suspected malignant disease and most of the sarcoidosis cases have been brought to light by these reviews. "The recall rate for large films is thereby lowered to the advantage of the examinee who is spared an unnecessary journey and anxiety, without impairment to the efficiency and accuracy of the Unit. There is a corresponding saving of time and materials. Carcinoma of the Lung "Deaths from broncho-genic carcinoma are reported to have increased 500% since 1930. Figures for this Unit show the number of cases discovered. 1951-2 1954-12 1952-6 1955-10 1953-7 1956-11 1957-13 "Compared with other Units, the above figures are on the low side which may be explained by the fact that apart from some pollution of the atmosphere by the internal combustion engine and cigarette smoking there are no added industrial hazards in the City of London. 5. "Most of the cancers picked up by Mass Radiography Units were cases referred by general practitioners on account of symptoms. Up to the end of 1957 general practitioners have not utilised the services of our Unit so fully as might have been expected, but a revised procedure introduced early in 1958 has produced a greater response. Conditions of interest other than Tuberculosis "The following cases of interest, other than tuberculosis, have been found during 1957. 1. Tumors of the Bony Thorax Sarcoma Rib (1) Lipoid Granuloma Rib (1) 2. Cardio-vascular lesions (a) Congenital Dextro-cardia (8) Ventricular Septal Defect (4) Atrial Septal Defect (7) Dilated Pulmonary Artery (5) Right Aortic Arch (1) (b) Acquired Pulmonary Hypertension (1) Bundle Branch Block (1) 3. Abnormalities of Diaphragm Diaphragmatic Hiatus Hemia (2) 4. Pulmonary Conditions Dermoid (1) Adenoma Bronchi (1) Substernal Thyroid (2) Neuro-fibroma (4) Sarcoidosis (13) Hodgkins Lymphoma (1) Congenital Aortic Stenosis (1) Congenital Pulmonary Stenosis (2) Aortic Co-arctation (3) Marfans Syndrome (2) (Twins) Aortic Aneurysm (1) Cardiac Infarction (2) Haematoma (4) Sequestrated Segment of Lung (2) Cysticercosis (1) Spring Water Cyst (1) Fibroma Lung (1) Propaganda "Propaganda in the form of posters and leaflets is only occasionally employed as approach to firms, etc., is made either by personal contact or by special letters, of which the Unit now has a series. Conclusion "During 1958 the Unit received visits from several medical students from overseas who were in this country under the auspices of the National Association for the Prevention of Tuberculosis. "Friendly relationships have existed between the Unit and Dr. J. Greenwood Wilson, Medical Officer of Health for the City of London, and with the Medical Officers of Health for the Boroughs of Finsbury and Shoreditch. Helpful co-operation has been shown by the London County Council and the Divisional Medical Officers in Health Divisions 3, 4 and 5. Our gratitude must be accorded to the Central Group, Hospital Management Committee and to the Regional Hospital Board for the many services rendered to the Unit during the year." FOOD AND MEAT INSPECTION There are no slaughterhouses in the City of London. The Metropolitan Cattle Market in Islington is owned and administered by the Corporation of the City but the Medical Officer of Health of the City is not responsible for meat inspection at the abattoir. The meat arriving at Smithfield Meat Market has presumably been inspected at the time of slaughter in this country or abroad. Evidence of disease which has escaped notice at the primary inspection is nevertheless found; in some cases it has been overlooked, in others it has only become apparent when the carcase is cup up. Condemnations of meat at Smithfield are to a considerable extent due not to disease but to deterioration during transport, decomposition, bone-taint, brine-staining, etc. The total amount of meat delivered at Smithfield Market was 422,607 tons of which 497 tons were found to be diseased or unsound and were voluntarily surrendered. At Leadenhall Market and in City shops 4 tons and at Cold Stores 7 tons were condemned. Of other foodstuffs in Market's and Shops 8 tons, and at Riverside Wharves 118 tons were condemned. The total amount of foodstuffs found by your Inspectors to be unfit for human consumption was therefore 639 tons. 6. FOOD AND DRUGS ACT, 1955, SECTION 9, AND PUBLIC HEALTH (MEAT) REGULATIONS, 1924, SECTIONS 8, 9 & 10 On 19th July a sow carcase minus head was inspected at a stall at Smithfield Market. The carcase had been split into two sides to facilitate inspection. A detailed examination showed that the carcase was affected with generalised tuberculosis and was unfit for human consumption. This opinion was confirmed by the Chief Meat Inspector. Further enquiries were made, and a set of sow offal was found also to be affected with generalised tuberculosis. A laboratory test was made on specimens from the carcase and this again confirmed the diagnosis. It was stated that the carcase and offal had been consigned to Smithfield by a Penzance wholesale meat supplier, who was informed that it was my intention to seize the carcase and offal and that both would be taken before a magistrate with a view to requesting the issue of a Condemnation Order. On 31st July, 1957, the sow carcase minus head and set of sow offal were taken before Alderman Sir Noel Vansittart Bowater, Bt., G.B.E., M.C., and a condemnation order was signed by him. The circumstances were reported to the Port and City of London Health Committee who authorised the institution of legal proceedings against the consignor of the meat "for having deposited or consigned for the purpose of sale or of preparation for sale food intended for but unfit for human consumption". The summons was heard on 15th November at the Guildhall Justice Room before His Honour Judge Block, D.S.C. On behalf of the Defendants evidence was given that the local Meat Inspector when asked to inspect meat slaughtered by the Company had declined to inspect any meat not intended for consumption within his area unless he was expressly informed that there was diseased meat in the slaughterhouse for his inspection. The summons was found proved but having regard to the circumstances an absolute discharge was granted upon payment of 25 guineas costs. The Judge remarked that he was surprised to hear that the local authority does not carry out its moral if not its legal duty. This is not an isolated instance of the deliberate intention of a local authority not to inspect meat for Smithfield Market, in fact many local authorities have similarly declined to inspect prior to despatch. The Public Health (Meat) Regulations, 1924 require notice to be given to the local authority of intention to slaughter but there is no obligation on the local authority to examine the meat, even if it appears to be diseased or unsound at the time of slaughter and notice of the fact is given. It would seem there is little purpose in the requirement to give notice of slaughter other than to give to the local authority the opportunity to inspect The delivery of meat to Smithfield Market during 1957 was 422,607 tons and it is obviously impossible for your meat inspectors to inspect each carcase, and the refusal or inability of local meat inspectors to inspect at time of slaughter or despatch to Smithfield exacerbates the position. The Port and City of London Health Committee takes a serious view of the position whereby increasing quantities of uninspected meat are consigned to Smithfield Market, and gave instructions that representations be made to the Ministry of Agriculture, Fisheries and Food. On 6th January, 1958, a delegation was received at the Ministry of Agriculture, Fisheries and Food, at which the Corporation's views were explained. The Officer of the Ministry informed the delegation that they had the matter under consideration, and expressed his appreciation of the Corporation's having sent a delegation to express their point of view. IMPORTED MEAT AND OFFAL NOT FOR HUMAN CONSUMPTION The desirability of requiring the sterilization and staining of meat and offal unfit for human consumption has been apparent for some time. The importation into this country of consignments of offals, especially livers, marked "Not for human consumption" or "For animal food only", a high percentage of which have been found to be affected with hydatid cyst has accentuated the need for control. The Public Health (Imported Food) Regulations, 1937 and 1948, give powers for inspection and movement control, if necessary, of meat or meat products intended for human consumption, but meat and offal if marked "Not for human consumption" are outside the scope of the Regulations and local authorities have no powers of control. The trade in this class of meat has grown from imports to an animal food processing plant — in respect of which no complaint is made, as delivery of consignments is effected under proper control — to the importation on a growing scale for chance sale. It is this kind of importation to which there is objection, and evidence tends to suggest that the uncontrolled entry and sale of this type of meat may lead to its appearance as meat for human consumption. 7. The importation of pharmaceutical livers is free from criticism because these are usually dyed and no difficulties are experienced in exercising proper control. Control difficulties arise in the first instance from the fact that on the ships' manifest meat "not for human consumption" is not usually shown separately from meat for human consumption, and thus the Port Health Inspector is not warned of its entry. Agreement has been reached between Riparian Medical Officers of Health that movement from the area of one authority to another be notified but this is of course only possible upon knowledge of entry in the first instance. Apart from the matter of imported meat and offals, it is, I consider, a necessary precaution on public health grounds that all meat, offals, etc. condemned as unfit for human consumption as a result of slaughter or inspection should be sterilized and stained. It has always been the practice at Smithfield Market that condemned meat and offals are stained before removal by the Corporation's contractors for processing. Bearing in mind the possibility of communication of disease from animal to man it would appear that sterilization and staining is preferable to sterilization or staining as an alternative. Representations on this matter have been made to the Ministry concerned and it is hoped that Regulations giving the control considered to be necessary will be made in the near future. Transport and Handling of Meat The Food Hygiene Regulations as from the 1st July, 1956 replaced the Sections of the Public Health (Meat) Regulations, 1924, which enforced hygienic transport and handling of meat. In addition, they prohibit spitting, smoking, or the use of snuff, by persons engaged in the handling of open food. They also stipulate that any cuts or abrasions on an exposed part of a food handler's body should be covered with a suitable waterproof dressing. Very little difficulty was experienced in the enforcement of these Regulations in this connection, the no doubt irksome requirement in regard to smoking being accepted philosophically in the shops and markets by employees,but it is hard on them to see customers setting them such a bad example in so many instances, especially as the customers are not liable to prosecution under the regulations. FOOD HYGIENE REGULATIONS, 1955 (CATERING ESTABLISHMENTS) Messrs. Thompson and Flynn, the two public health inspectors who specialise in the hygiene of catering establishments, report to the following effect During the year under review, steady if at times slow, progress has been made in securing structural improvements and better facilities and amenities in catering establishments throughout the City. It should always be remembered, however, that the provision of satisfactorily designed and constructed kitchen and ancillary rooms is merely a necessary preliminary to the maintenance of hygienic conditions. Education in hygienic practices and habits is a continuous process of which it is difficult to see the end. The attitude of the catering industry has on the whole been co-operative, but because of a variety of circumstances, the progress and completion of essential improvements has been slower than we should have liked. Continuing the department's tradition of "peaceful persuasion" no legal proceedings were instituted during the year under review. As indicated in previous reports, it is impossible to attempt to measure the progress made in any one year because so much work is in hand at any one time and there is so much overlap from year to year. It may not always be appreciated that some of the transformations effected in catering establishments in order to raise hygienic standards are so considerable that from the date of the initial inspection of the premises to the completion of all the necessary works, an interval of two years may elapse, involving a comparatively large capital outlay which cannot be made until there has been a very careful and thorough appraisal of the economics of each and every proposal. Since the end of the war and after the enforced neglect of the war years, continuous and strenuous efforts have been made to bring all City catering premises up to an acceptable standard and it is sometimes asked when this objective will be finally reached. To this question it is impossible to give a satisfactory answer because conditions and standards are always changing. For example, a restaurant or cafe or snack-bar maybe quite satisfactory today but, in say six months' time, because pf a change of tenant, alteration in the type of trade, increased business, or some other incalculable or unforeseen circumstances, the same premises may have deteriorated to such a degree as to be unrecognisable This continuous process of change makes it impossible to state at any given time exactly how many premises are considered to be in a satisfactory condition and how many are unsatisfactory. What can be said is that there has been a great improvement in structural conditions and in the provision of necessary facilities such as adequate washing-up sinks and machines, hot water installations, mechanical ventilating plants, essential staff amenities, etc. Undoubtedly conditions in City catering premises are to-day better than they have ever been before. At the same time, it would be unwise to suggest 8. that there is no room for improvement. It is also true that much of the time and effort of everyone concerned is nullified in too many instances by the "couldn't care less attitude of catering staffs. They seem incapable of realizing that by their shoddy practices they are endangering the health of their fellow workers. Whilst there are within the City over a thousand catering establishments, the number operating on any given day is never precisely known. Premises, for some reason or another, are being constantly closed down, whilst new ones are always being opened. Perhaps it may be fairly said that whilst progress and improvement have been substantial and continuous and to a degree encouraging, it is difficult to visualize that a state of affairs will ever be achieved when it will be possible to relax vigilance. Nor is it likely that we will ever be able to assess the position numerically and say that a precise number of City restaurants still require attention. In any case, what is accepted as being satisfactory in design and construction to-day may be considered sub-standard a few years hence. In other words, there will always be scope for further achievement and improvement in a field of activity such as food hygiene where one is always striving for, but seldom achieving the ideal. In endeavouring to secure more hygienic conditions in the preparation and handling of food during the past year, it has again been our impression that the general public could play a much more effective part than they do at present. Undoubtedly they are long-suffering in many directions; they are exhorted to do this and not to do that, but at the risk of being dubbed as arbiters of public behaviour, we do ask that they object to obvious malpractices and dirty habits as they occur and when they observe them. Invariably during the course of daily inspections some deficiency is seen on the part of individuals which is corrected forthwith when the obvious is pointed out to them. It is also fairly certain that managements at least would take action on their own initiative as and when their customers complain justifiably. In many cases of customers complaints they are concerned with bad service and poor quality and while we, as officers, may deplore these causes of complaint we can only work within the limits imposed by the sometimes arbitrary boundaries of hygiene. The remedy for this type of complaint is solely in the hands of the customers themselves — i.e. not to patronise those catering establishments where they receive the service about which they complain. Lack of customers can effectively close unsatisfactory businesses far quicker than the sometimes ponderous procedure of the law. The efficient and adequate ventilation of kitchens, and indeed of restaurants themselves, especially those situated in basements or lower floors, still gives rise to serious difficulties. Many proprietors of old premises, and some in the case of new buildings, are unpleasantly surprised at the cost of resolving many of the problems posed. Since the end of the last war when our attention was again turned to improving the hygiene in kitchens and the conditions under which the staff work, we have had constantly to re-appraise the results of many plants which were installed at our instigation. Unfortunately, all too large a number of these new installations have been far from successful. Perhaps in some measure the failure is ours for not appreciating the magnitude and complexity of some of the difficulties, but obscuring the whole picture has been the underlying fact that there is very little information available which can be brought directly to bear in each case. Every kitchen is an individual problem for the ventilating engineer and each one must be treated on its merits. There is no easy way to success and it certainly will not be achieved by assuming that the minimum requirements suggested by the local authority are sufficient in every case. We are also faced with another problem which has made itself apparent in recent years. Architects in designing their structures — probably two, three or even more years in advance of the settlement of final kitchen details — make every endeavour to anticipate the position and sizes of vertical ducts to roof level for purposes of exhaust ventilation. Because of lack of information as to the ultimate intention of caterers of their requirements and also the installation of kitchens never envisaged in the original design, no effective measures can apparently be taken to provide integral horizontal trunking and duct work in the majority of cases. We are then presented with long tortuous ducts, hung on ceilings, twisting and wending their way around structural members to the fan rooms and vertical shafts. The problems of routine cleansing are immense and a paradise is created for the harbourage of various species of vermin. All too often there is a tendency to think of kitchen ventilation in terms of extract systems only, allowing the inlets to be taken care of by means of window openings and similar arrangements. Unfortunately uncontrolled openings such as windows do not always act as fresh air inlets but allow smells and odours to disperse and permeate into adjacent offices with the consequent complaints which follow. It seems sooner or later that all kitchens in congested areas such as the City of London must be regarded as "enclosed or sealed" units with motorised inlet systems for effective distribution of clean fresh air. It seems inevitable in a mechanical age where machine or mechanical contraptions perform highly complicated and precise engineering work that people should turn to a machine to relieve them of the monotonous but essential task of washing up. Unfortunately, they have imagined 9. that by the installation of a machine, their washing up troubles were over. Because the machine is there, they fondly imagine that anyone must be capable of producing clean utensils and that no skill or intelligence is needed to achieve satisfactory results. Our experience is otherwise. There is no doubt that to achieve good results with machinery a better type of individual must be employed who must be taught to handle the apparatus properly. All too often the manufacturers of the machine and the proprietor of the firms using them have paid scant attention to properly training staff to use the machine and there has been no subsequent follow up to see that good results are being secured. Sometimes staff do not even trouble to use the machines because "they don't know how" or "can't be bothered with the gadgets, etc.". Such an attitude on the part of the staff indicates a deplorable failure by all concerned. We have continued to pay particular attention to the washing of cutlery. Apart from some of the more recently established kitchens, the efficient washing of these items has been a rather neglected part of the cleansing procedure in some restaurants. In all branches of the catering trade — and presumably in all business activities — the quality of the management varies considerably. It is only with the active support of efficient management that we can ever hope to achieve the objectives which have been set for us. It is useless to indulge in the upheaval of reconstruction, re-equipping and the consequent heavy capital cost and then take no further interest in the running and maintenance of the place apart from securing the maximum return for the outlay involved. No amount of time which a local official can spend in any one restaurant or eating place can replace effective management. The whole tone and manner in which a business is run must be a reflection of the management of that business. All too often, in a restaurant of any size, there appear to be two worlds — the world of the chef and that of the manager with a no man's land between. The problems of one fail to interest the other and we are sure that it is this apparent lack of co-operation which gives rise to many of the unsatisfactory conditions observed during the course of routine inspections. During the year, as always, we have had a number of enquiries regarding the establishment of new catering premises. Unfortunately so far as hygiene considerations are concerned, many of these are connected with old and quite often basically unsuitable premises. Because of prevailing very high rents within the City, it is inevitable that the property unacceptable for other business purposes will attract caterers because of the lower rents asked. It is also inevitable that some of these premises are used for catering without our being in a position to prevent such occurrences. As we have said many times before, prior approval of new catering premises is a "must" nnder modern conditions. There must be few countries in the world where this procedure is not the normal routine and quite a number of our official foreign visitors are amazed and somewhat cynically amused at the retention of this particular archaic form of freedom. In conclusion, we would like to express our thanks to the other departments of the Corporation affected, sometimes in no small measure by the activities of this department. We have received every assistance from them in carrying out our duties. THE FOOD AND DRUGS ACT, 1955 Mr. G.E. Harrington, Sampling Officer under the Food and Drugs Act, reports as follows:— "Three hundred and twenty-five samples have been submitted to the Public Analyst, twentythree of which were formal and three hundred and two were informal samples. Adverse reports were received on eleven samples ; in four cases legal prodeedings were instituted and in the other instances appropriate cautions were administered. Milk The average composition of genuine milk samples taken during the year was:— milk fat: 3.62 per cent; solids (not fat); 8.83 per cent: total solids 12.45 per cent. Thirteen samples of pasteurised milk were submitted to the phosphatase and methylene blue tests and satisfactory reports were received thereon. The phosphatase test is a check on the efficiency of the heat treatment applied to the milk., and the methylene blue test on its keeping quality which bears relation to cleanliness and care in handling. Eighty Supplementary Licences in respect of twenty-two firms and individuals, and thirtynine Dealer's Licences in respect of fifteen firms and individuals, were issued under the Milk (Special Designation) (Raw Milk) Regulations 1949/54 and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949/53. Dairy Cream All the samples of cream submitted to the Public Analyst complied with the standards laid down by the Food Standards (Cream Order) 1951. Four samples of double, one of single and one of clotted cream were submitted for examination by the Bacteriologist. An adverse report was received on the sample of clotted cream and the details were communicated to the Medical Officer of Health for the district where the cream was prepared and packed. 10. Ice Cream None of the samples submitted to the Public Analyst failed to comply with the requirements of the Food Standards (Ice Cream) Order, 1953, the average composition of the samples analysed being, fat: 10.9 per cent; milk solids (not fat) ; 11.2 per cent; sucrose: 15.8 per cent. Food Labelling No administrative action has been required. Enquiries however, continue to be received from time to time and advice and assistance have been given wherever possible to help ensure compliance with the requirements of the Labelling of Food Order, 1953 and also with the Merchandise Marks Acts, 1887/1953. Administration Generally Details of the formal and informal samples taken and submitted for analysis and of action taken with regard to adulteration or other irregularities, appear later in this Report. IMPORTED EGG PRODUCTS During the year 456,994 cases, cartons and tins of imported egg products were landed at City Wharves, a total of approximately 5,238 tons. All shipments were immediately held under detention either for sampling for bacteriological examination for pathogenic organisms of the Salmonella group capable of causing food poisoning, or for arrangements to be made for undergoing an approved process of heat treatment. Experiments had shown that crystal albumen could be sterilized by heating at a temperature of 127° for 6% days, and a number of processing centres were established under the supervision of the local Medical Officers of Health. Consignments of crystal albumen were immediately released for submission to heat treatment at an approved centre, and check sampling only was necessary, thus to some extent relieving the pressure on the Public Health Laboratory Service. No satisfactory method of sterilization of the powdered and frozen product has been evolved, although pasteurization appears to be a possible solution if the bakery and confectionery trade can be persuaded to accept this as an alternative. Indications are that at present the pasteurised product is not willingly acceptable, and it may well be that an educational campaign sponsored by the producers will in time secure the acceptance by the trade of the safer pasteurised product. Early in the year the Ministry of Health circulated to Medical Officers of Health a suggested 'modus vivendi' regarding the sampling of these egg products. (1) All imported egg products should be detained for bacteriological examination. (2) Powdered whole egg and yolk. 5% initial sampling. If any are found positive, a further 5-10% should be sampled. If further positives are found detain the whole batch, but if second sampling is negative, batch could be released and only the known positive cases detained. (3) Frozen egg. 2% initial sampling of each batch. Any positive batches should undergo a second 5% examination. Release or condemnation would be the same as for powdered egg. This procedure had been the practice in the City since sampling of this product became necessary as mentioned in my Annual Report for 1956, and in my opinion was securing the best practical results having regard to the difficulties of the problem. As imports of this commodity arriving at City wharves steadily increased in volume it became necessary for Mr. Sillett, the City Food Inspector, to have assistance for the taking of samples, and arrangements were made for Mr. Marshall, Port Health Inspector, to co-operate with Mr. Sillett when necessary. A further problem was the inability of the Public Health Laboratory Service at Colindale to cope with the increasing number of samples, and the Director of the County Hall Laboratory of the service kindly offered to assist so far as possible. Eventually, in order that difficulties of storage at the wharves might be avoided, the importers agreed to undertake some of the sampling under the supervision of my officers, and to meet the cost of the bacteriological examinations themselves. A recent development has been the routing of shipments via the Free Port of Hamburg, and their subsequent arrival in the Port of London accompanied by a certificate issued by the Hamburg authorities that sampling had been carried out on the results of which the consignment was passed as fit for human consumption. After correspondence with the Health Authorities at Hamburg, who were as mystified as I was as to the object of this manoeuvre, sampling was carried out on these shipments in the usual way. The second of such cargoes - Chinese pasteurised dried whole hen egg — yielded three positive results from eight samples, thus confirming the inadvisability of reliance upon such certificates when dealing with this product. 11. In all 5,996 samples were taken during the year for bacteriological examination, a summary of the results of which are given below :— Initial Sampling Resampling of positive batches Country of Origin No. of pkgs. No. of samples taken Pathogenic organisms of Salmonella group Positive % No. of samples taken Pathogenic organisms of Salmonella group Positive % Australia 354,712 3,102 109 3.5 784 277 35.3 S. Africa 69,312 771 76 9.9 355 48 13.5 N. Zealand 23,371 214 5 2.3 37 3 8.1 Japan 20 4 1 25.0 — — — China 9,579 711 44 6.2 18 5 27.8 TOTALS 456,994 4,802 235 4.9% 1,194 333 27.9% It is interesting to note the comparatively wide variation in the degree of contamination of egg products imported from the countries concerned, also the much wider variation of the degree of contamination of those batches re-sampled as a result of positive samples having been found on the initial examination. The average figure of degree of infection of the positive batches of 27.9% in my opinion amply justifies the treatment of these batches as being 100% infected and being unfitfor human consumption unless subjected tosome approved high temperature processing. HYGIENE IN HAIRDRESSERS' AND BARBERS' SHOPS In accordance with Section 18 of the London County Council (General Powers) Act, 1954, the Corporation made Bye-laws for securing the cleanliness of premises registered under this Section also of instruments used and persons employed therein. 77 hairdressers' establishments are now registered in the City. Inspections throughout the year have shown that the standards required by the Bye-laws are being maintained. HOUSING The Housing Act, 1957 came into operation on the 1st September, 1957. It repeals and reenacts in consolidated form the provisions of the earlier Housing Acts with the exception of financial provisions, which will be consolidated in a future bill. Sec. 191 of the Act constitutes a comprehensive saving provision which secures continuity of action by enacting, inter alia, that anything done under a repealed enactment shall have effect as if done under the corresponding provisions of the new Act and that documents referring to a repealed enactment shall be construed as referring to the corresponding provision of the new Act. The Housing (Prescribed Forms) Regulations, 1957 came into operation on the 1st December, 1957. These Regulations set out in the second schedule thereto forms which shall be used for the purpose of the Housing Act, 1957. The Housing (Form of Orders and Notices) Regulations, 1937-1956 are revoked by these Regulations, but this revocation shall not affect the validity of any order, notice, advertisement, or any other document made or used in the form prescribed by the said Regulations before the coming into operation of these Regulations. 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:— 4 2. Number of houses in which the defects were remedied in consequence of informal action by the Local Authority or their Officers:— 4 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. 12. 7. Number of houses in respect of which an undertaking was accepted under subsection (4) of section 16 of the Housing Act, 1957:— None. 8. No. of houses demolished:— None. During the year 251 families were rehoused, leaving 446 families for whom accommodation was required at the end of December, 1957. This reduction was due to the completion of the main part of the Golden Lane Estate on the borders of the City and Finsbury and the Lammas Green Estate at Sydenham. The modernisation of the flats at Dron House, Stepney is in progress and it is anticipated that improvement schemes will be carried out at the remainder of the pre-war housing estates administered by the Corporation as a Local Authority. Isleden House continues to stimulate interest amongst those who are concerned with the housing and welfare of the elderly. Many of the elderly residents would be unable to maintain a flat if they had to prepare their own meals and if they were required to do all the work of a normal householder and it is evident that the provision of a mid-day meal and of the other services assist the old people to remain in their homes and retain their independence. The Sick Bay under the supervision of an understanding Matron and her sympathetic Assistant has continued to work smoothly. Nearly 400 patients from St. Bartholomew's Hospital have been admitted since 1954 and this has made a very useful contribution in reducing the waiting list for beds at the hospital. Patients from the Corporation's housing estates have also been admitted for short periods and results have been most satisfactory. The redevelopment of the Corporation's housing estates in Holloway and adjoining the Metropolitan Cattle Market in Islington has had to be suspended, but with the use of the vacant site of the sheep lairs to the west of the market for the purpose of erecting an initial block of flats it is hoped that the scheme may proceed. The Almshouses in Ferndale Road, Brixton are being individually brought up to date as they fall vacant. The City of London Old People's Welfare Association continues to look after the 1,350 over-60's for whom the City as a Housing Authority has a responsibility. No effort is spared to ensure that these old people have the services they require. A Mid-day Meals Service has been established at the Three Score Club adjoining the Corporation's flats in Gravel Lane, Stepney, and it is hoped that a similar service will be provided within the Corporation's estates where accommodation has been allocated to elderly people. RODENT CONTROL In compliance with the provisions of the Prevention of Damage by Pests Act, 1949, it is the duty of every Local Authority to take such steps as may be necessary to secure as far as practicable that their district is kept free from rats and mice and in particular:— (a) from time to time to carry out such inspections as may be necessary for the purpose of the aforesaid ; (b) to destroy rats and mice on land of which they are the occupier and otherwise to keep such land so far as practicable free from rats and mice; (c) to enforce the duties of owners and occupiers of land under Part 1 of this Act, and to carry out such operations as are authorised by those provisions;' (d) to keep such records and make such reports relating to their functions under this part of this Act as may be required by any directions given by the Minister of Agriculture, Fisheries and Food. For the purpose of implementing the aforementioned provisions, organisation and procedure of the Rodent Control Department was similar to that of previous years, comprising inspection of properties to ascertain the presence of infestation by rats or mice, treatment of any such properties found to be infested, recommendation of structural and incidental proofing and periodical maintenance control measures for the destruction of rats in the City sewers. No difficulty has arisen necessitating statutory action to resolve the problem, and the response to the policy of seeking the co-operation of owners and occupiers has been most satisfactory. Altogether 4,191 occupancies and properties were inspected, these properties ranging from new buildings in varying stages of construction, riverside food warehouses, public and private catering establishments, blocks of offices, shops and factories, to domestic dwellings. A total of 575 infestations of rats or mice were subject of control measures, and of this number 306 infestations were notified by owners or occupiers, and 269 infestations were found on inspection. 13 This total comprised 7 major and 105 minor infestations of rats, and 84 major and 3.9 minor infestations of mice. Treatment of these infestations entailed 4,996 visits for operational purposes. In the application of control measures for rat infestation, 9,769 pre-baits and 679 poison baits were laid. These measures resulted in a minimum estimated kill of 902 rats, and of this number 506 bodies were removed from premises. In addition 62 rats were destroyed by trapping. The use of Warfarin anti-coagulant rodenticide for the control of mice resulted in 1,296 bodies being found, no records are available of the results obtained by Pest Control undertakings servicing premises periodically. In 35 instances structural rat proofing was carried out by owners or occupiers and in 3 instances defective drainage resulting in rat infestation was remedied. Incidental rat and mouse proofing in the nature of removal of harbourage provided by unnecessary accumulations has received detailed attention, and in this respect the assistance received from the Director of Public Cleansing and his Inspectors has been invaluable. As in the past, rat infestation was in the main of Ship rat (Rattus Rattus) character. Infestation of Common rat (Rattus Norvegicus) in surface properties showed a slight increase and 15 infestations were the subject of control measures. The downward trend of rat infestation manifest in recent years continued and a further decline in the number of infestations treated, and the numerical quality of the same has been experienced. The number of major infestations (20 rats or over) was the same as for the previous year (7) but of this number 5 were borderline infestations, just qualifying for this category. In the minor classification there was a 25% reduction. The Common rat infestations were mainly confined to re-building sites which offer every facility and are in every way conducive to infestation, but taking into consideration the vast reconstruction carried out in recent years, the size of the sites, and wide distribution of the same, rat infestation has not in any way reached the degree visualized at the onset of rebuilding. From the moment the contractors occupy a site, the inducement to infestation is provided. Huts are erected, slightly raised from the ground thereby offering harbourage, obsolete drainage is removed, and as the site progresses structural harbourage, although temporary, is available, and to this must be added the incidental nesting facilities provided by the vast quantities of materials and accumulations common to these sites. The temporary canteens provided for the workmen are in the main well maintained but nevertheless are conducive to rats and mice. The principal food supply is, however, offered by the numerous workmen employed on the sites who, preferring to eat their meals other than in the dining room provided, distribute food over the entire site by haphazard disposal of remains and with utter disregard to the fact that they are encouraging infestation. All building sites were inspected periodically and when such conditions were found to exist the necessary action was taken by the contractors as far as practicable having regard to the conditions and labour involved. Summarising the position of rat infestation in relation to surface premises, and the decline in recent years, there are several contributory factors. Among the foremost of these are effective control measures, a higher standard of hygiene generally and a steady improvement in structural conditions. In addition owners and occupiers have become rat conscious and readily seek advice and assistance. The majority of catering establishments, public and private, numbering approximately 1,000 have been inspected during the period under review, and the improving standards of hygiene and structural conditions have made a contribution to the present position. The importance of hygiene in the field of rodent control, embracing proper garbage disposal, food storage and elimination of structural and incidental harbourage must be emphasised. This is essential to the permanent control of commensal rats and mice and the application of control measures should be regarded as supplementary to hygiene. The gradual increase and wider distribution of mice infestation apparent in recent years and coinciding with the decrease of rats has not been quite so noticeable, there being a reduction of 32% in major infestations treated, while the number of infestations in the minor category remained constant. In reviewing this problem there appears to be a connection with the comparable decrease in cat infestation, and when allied to other factors which must be considered, such as the pattern of behaviour, embracing the ability of mice to accept harbourage and food supply which would be insufficient for rats, general feeding hfibite, and ability to live without water, it might well be that the balance of nature has been upset, and that the absence of rats has left the Way clear for mice. Mice, unlike both species of rats which are fairly stable in behaviour, are best described as mercurial. They are on average about 25 grammes in weight and the food intake in 24 hours is consequently very small — between 3 and 5 grammes, so that very small quantities of food are 14. sufficient for their welfare. They are erratic in their feeding habits and may eat a very small amount at a number of places — not necessarily the same each day. This means that very many small baiting points are necessary in applying control measures with poison. This also tends to rule out the use of the more acute poisons. Where there is unlimited harbourage, both structural and incidental as found in warehouses with large bulk stowages of varying commodities, plus a reasonable food supply, there appears to be a very diminished range of activity from the nesting quarters. Therefore, a high percentage of an infestation living and breeding therein do not come out to accept the baits at the baiting sites which are limited by the size of the stowages, or by congestion often found in other types of premises. Many of the complaints of mice infestation are received from offices, and the cause can usually be traced to the careless or thoughtless disposal by the staff of food scraps. It is a common occurrence to find food wrappers, fruit parings, odd uneaten scraps, and milk bottle tops with cream adhering, thrown down in inaccessible places behind fittings and machines. Alternatively, it is put into waste paper baskets where, as a rule, it remains all night to attract and provide the necessary food for the existence of mice. The popular belief prevalent that rats and mice do not live together in the same premises is not strictly true. If the environmental conditions provide suitable harbourage and a sufficient supply of food, both species will accept the conditions offered, though as a rule they will live away from each other in separate sections. If, however, the facilities for their welfare are diminished, it appears to be a question of the survival of the larger species, and the mice disappear. The nucleus of mice infestation is often imported into premises, and in the case of catering establishments many instances have been seen where this has occurred via sacks of vegetables and crates of eggs. To illustrate further the decline in rat infestation and the comparable rise in mice infestation the following summary and graph is included as a useful record. The estimation of the number of rats killed is based on the amount of poison bait consumed. The calculation is however based on Common rat extermination, and as 90% of surface infestations were of Ship rat character the estimate is conservative, and could reasonably be increased by 25%. The latter being a smaller and finer built creature, it consequently consumes less food, and a smaller quantity of poison bait constitutes a lethal dose. The total in the bodies found columns is the sum of those removed from premises by the operators, and does not include any subsequently found by occupiers on elimination of structural or incidental harbourage. SURFACE PROPERTIES Year Infestations Treated Rats Mice found Initial baiting points PreBaits laid Poison baits laid Mice Warfarin Baits No. Rats Mice Poison Traps Major Minor Major Minor Estd. kill Bodies found 1944 320 261 39 13 7 11,388 2,558 423 95 12,784 62,336 8,542 1945 417 241 158 6 12 10,038 2,410 217 164 11,321 60,444 7,926 1946 373 232 101 12 28 8,658 2,767 480 207 14,991 63,244 8,672 1947 705 313 330 19 43 6,969 2,081 454 311 18,226 88,980 11,123 1948 751 260 438 22 31 5,637 1,822 552 263 18,720 98,506 12,066 1949 631 149 395 30 57 5,046 2,113 761 557 23,684 91,792 16,242 1950 846 186 391 109 160 4,369 1,632 605 710 23,737 129,295 17,719 1951 651 82 266 182 121 3,436 1,308 775 833 33,712 124,789 25,291 7,012 1952 616 50 278 152 136 2,877 1,237 514 852 11,320 48,783 5,149 16,800 1953 647 25 238 111 273 1,527 725 241 853 16,045 28,672 2,313 11,634 1954 675 20 219 116 320 1,630 955 91 1,181 16,508 25,339 1,982 16,508 1955 677 10 169 139 359 1,070 595 60 1,540 16,407 19,024 1,222 12,706 1956 661 7 141 124 389 782 459 63 1,644 16,033 10,519 823 12,829 1957 575 7 105 84 379 902 506 45 1,296 11,919 9,769 679 9,895 8,545 1,843 3,278 1,119 2,315 64,329 21,168 5,581 10,506 255,312 861,492 123,759 87,384 The low level of Common rat infestation is in no small measure due to the systematic periodical control measures applied in the City sewers at quarterly intervals. It is the purpose of these treatments to check the build-up of the rat population in the sewers and thereby assist in preventing infestation of surface properties from this source via defective drainage. Having carried out 21 treatments over a period of five years, principally with Sodium Fluoroacetate '1080', it was suggested that Fluoracetamide, technically known as '1081', might prove advantageous as an alternative to '1080', and after discussion with the Scientific Officers, Ministry of Agriculture, Fisheries and Food, it was agreed that four direct controls be applied in a similar manner to the '1080' treatments. 15. Chemically, this poison is similar to '1080', but unlike the latter which is an extremely fine powder, is in crystal form, which increases the safety factor in dispensing. It is readily soluble in water, odourless and said to be tasteless. The median lethal dose (LD50) for Common rat is about 15 MG/KG of body weight as against 1 MG/KG for'1080' and is therefore about 15 times less lethal to rats. After a lethal dose the speed of onset of warning symptoms is said to be slower than Zinc Phosphide for which the LD50 is 40 MG/KG. It was considered desirable to obtain by over all test baiting a basis on which the effectiveness of '1081' could be assessed after four "direct" controls, and this was carried out during the period 10th - 13th September, 1956, three months after the final '1080' control, and repeated the 19th - 22nd November, 1956, ten weeks later, being three weeks prior to the institution of the first '1081' control. For the first test, 402 sewer entrances were baited and the baits, each 4 ozs of damp sausage rusk, were left down for three days, and on examination 103 "takes" (84 complete, 6x¼, 8x½ and 5x¼) were recorded. The weather, an important factor in sewer control, was favourable, and the 299 test baits recorded as negative were in good condition after three days. For the purpose of the second overall test ten weeks later, 403 entrances were baited, and on examination 174 "takes" (165 complete and 9x¼) were recorded. The weather was again favourable, the sewer entrances being dry and the conditions ideal for the test. The significant feature of the test baiting results was the formidable increase in the number and the quality of the takes, indicating the rapid build-up and distribution in the intervening period of nearly six months from the final '1080' control. These results did provide a sound basis on which to judge, and the first '1081' control of such a nature to be applied in this country was carried out in December, 1956, two weeks after the second test, the procedure being similar to the '1080' control, in dispensing and distribution. A total of 394 sewer entrances were treated, each bait being 4 ozs comprising sausage rusk and water at equal parts by weight, evenly mixed with '1081' at a concentration of 1%. The baits were left down from 3-4 days before clearance and on examination 87 "takes" (8 complete, 7 x 39 x Yt and 33 x *4) were recorded. K total of 57 bodies were recovered, and no doubt a number were washed away in fast flows, as during the course of the work heavy and prolonged rain was experienced on several occasions. The majority of the bodies were found in shallow flows a considerable distance from the baits. The second treatment was applied in March, 1957, when 401 entrances were baited, and the recorded result on examination was 60 "takes" (11 complete, 7x¼, 18x½ and 24x¼ or less). In this instance 39 bodies were found in shallow and slow streams. The procedure for this and subsequent controls was altered to allow the baits to remain down longer, the timing to include a week-end when the discharge of waste from the many catering premises into the sewers from Friday night to Monday morning is at its minimum. The third treatment applied in May - June embraced 396 entrances, and the baits were down 4-5 days. The recorded result was 18 "takes" (4 complete, 4x¼, 8x½ and 2x¼) and 4 bodies were found. The weather prior to, and including the treatment was good, and the baits when cleared were in good condition. The fourth and final control of the series was carried out in September, when 398 entrances were baited. The recorded result on examination was 17 "takes" (4x¼ and 13x½) and 10 bodies were found making a total of 110 for the series. On completion of the '1081' series, it was again considered desirable to obtain by overall test baiting similar information to that supplied by the tests carried out on completion of the Sodium Fluoroacetate '1080' direct controls, June, 1956, and preceding the institution of the '1081' series. Three tests were applied on the 10th October, 1957, 5th December, 1957, and the 6th March, 1958, thus covering a period of six months from the final '1081' control, September, 1957. For the first overall test three weeks after the poison control, 400 entrances were each baited with 4 ozs of soaked wheat and the baits were left down 5 days. On examination 27 "takes" (15 complete, 9x¼ 1x ½ and 2x¼) were recorded. This was followed by the second test 8 weeks later when 406 entrances were baited, each bait being 4 ozs of damp sausage rusk. The recorded result in this instance was 69 "takes" (58 complete, 3x¼ and 8 x½). For the final test 13 weeks later, and 6 months after completion of the '1081' series of poison controls, 394 entrances were baited, and the baits, each 4 ozs of soaked wheat, were left down 7 days. The recorded result was 194 complete "takes". In this instance, bad weather was experienced. There was heavy rain on the 2nd day when baiting was completed, and this was 16. followed by very heavy snow. It was impossible to say how many of the "takes" recorded as such were possibly washed away, but from a wide experience of sewer control under all weather conditions it is reasonable to assume that approximately 15% were in fact washed away. Accepting the recorded "takes" of the final test as all taken by rats, and not washed away, the progressive rate of the complete "takes" of bait is 15, 58 and 194. The comparable results of the tests applied prior to the series was 36, 81 and 165 complete "takes". It is too early to express definite views on the efficacy of '1081' and similar controls will continue throughout 1958 and 1959 but, from observations of the controls already carried out, and comparison of the detailed information collated, the indications are that it might well prove comparable to '1080'. Bait acceptance of '1081' is extremely good and this is probably due to the slowness of the onset of warning symptoms. It also has the advantage by reason of its coarser division of being safer to dispense, and owing to lower toxicity to rats, and presumably to man, is less hazardous in distribution. The information gained from the test bait controls illustrates the rapid build-up and distribution that occurs in a period of 6 months, and tends to emphasise the necessity of quarterly poison controls, at least as far as a built-up area such as the City is concerned. ATMOSPHERIC POLLUTION The year 1957 was the second complete year of the coming into operation of the smoke abatement provisions of the City of London (Various Powers) Act, 1954 and the first complete year of certain of the provisions of the Clean Air Act, 1956. This Act will not become fully operative until 1958 when railway locomotives — which were exempt from the provisions of the City's Act — will become subject to Regulations to be made under the Clean Air Act specifying the periods when emissions of smoke of prescribed densities, determined by reference to the Ringelmann Chart, will be permitted. No application under the Various Powers Act for approval of installations in existing buildings burning a fuel other than an authorised fuel was received during the year. In compliance with the Clean Air Act three notices of intention were given that furnaces in existing buildings were to be installed or converted. The number of registered complaints of smoke emissions was 27. These were mainly of a temporary character due to mechanical faults, the burning of refuse — particularly on building sites — and initial difficulties associated with the first lighting up of installations in new buildings. In no case was it necessary to take formal action under the City's Act. Instances were found in recently built and occupied premises where the conditions of approval laid down by the Corporation were not fully complied with. These conditions are not obligatory but where the opportunity presented itself occupiers were recommended voluntarily to comply with the conditions in order to avoid the possibility of contravening the smoke legislation. MEASUREMENT OF ATMOSPHERIC POLLUTION The results obtained in 1957 of the measurement of rainfall and deposited matter by means of the deposit gauge, and the determination of sulphur dioxide by the lead peroxide method are set out in Table I below. Tables II and III record the monthly averages of the daily recordings of the concentrations of smoke and sulphur dioxide with the volumetric apparatus installed at four stations in the City. The measurements at the three Police Stations are undertaken by personnel of the City Police and indebtedness is expressed to them for their continued valuable assistance. Deposit Gauge It is known that when a deposit gauge is exposed for a number of consecutive months on the same site it is often found that the successive results vary considerably. This variation is due partly to changes in the rate of emission from chimneys, but mostly to fluctuations in meteorological factors such as rainfall, speed and direction of wind and the turbulence of the atmosphere. Another important factor which applies, particularly in the City of London at the present time, is the effect of the wide scale redevelopment of war damaged sites involving the demolition of old, and the construction of new, buildings. It will be observed that, compared with the average of the previous five years, there is an increase of total matter deposited in the gauge. This is partly accounted for by the unusually high proportion of insoluble matter deposited in March, namely 36.18 tons per square mile, compared with the yearly average of 14.56 tons per square mile, despite the low rainfall in that month. In his analysis of the water collected in March the Public Analyst commented that "the ash of the water insoluble matter contained a considerable amount of iron rust". This was undoubtedly due to redevelopment of war damaged sites adjacent to the deposit gauge. On the other hand it is satisfactory to be able to report that the weight of "tarry matter" — a water insoluble constituent which is closely connected with the emission of chimney smoke — is much less than in preceding years. In 1957 it was 2.64 tons per square mile compared with 3.28 in 17 1956 and 3.45 — the average of the years 1952-1956. The principal soluble constituent of the rainwater collected by the deposit gauge is sulphur dioxide. In 1957 the monthly average was 30.16 tons per square mile compared with 34.69 tons for 1956 and 32.39 tons — the average for the years 1952-1956. Sulphur determination by the lead-peroxide method. This method is designed to provide a useful index of the activity of sulphur pollution on the fabric of buildings by ensuring that no major change in such pollution shall go undetected. The results in Table I show that no such major change took place in 1957 when compared with the average of the previous five years. Volumetric determination of smoke and sulphur dioxide. This method gives the approximate concentration of sulphur dioxide and smoke. Unlike the deposit gauge and the lead peroxide cylinder this method of determination is not unduly influenced by weather conditions. The deposit gauge gives no information about pollution by smoke hence the necessity of the smoke filter to provide a means of assessing local and national smoke problems and the rate of progress towards a cleaner air. Sulphur. The concentrations of sulphur dioxide, as shown by the results set out in Table III, were less in 1957 when compared with 1956. At Golden Lane the monthly average of the daily readings in 1957 was 9 parts per 100 million parts of air. The average for the five previous years was 11. Smoke. There was a marked decrease at Golden Lane — 9 milligrams per 100 cubic metres of air compared with the average of 13 for the previous five years. No reliable comparisons can be made for the other three stations since they have not been established for a sufficiently long period. TABLE I.—Results obtained in 1957 of the monthly observations of rainfall and deposited matter bj means of the deposit gauge, and the monthly observations of sulphur by the lead peroxide method Month Rainfall collected in deposit gauge DEPOSIT GAUGE LEAD PEROXIDE METHOD Golden Lane Golden Lane Finsbury Circus Insoluble Deposit Soluble Deposit Total Solids Equivalent to Millimetres inches of rain Tons per. square mile Mgs. (S.O.3) per day per 100 sq. cm. January 33 1.30 13.41 9.26 22.67 3.66 4.03 February 73 2.88 11.81 6.07 17.88 3.76 3.28 March 25 0.97 36.18 9.42 45.60 3.72 3.16 April 3 0.13 14.74 5.31 20.05 2.21 2.15 May 34 1.33 12.01 6.47 18.48 1.74 1.62 June 19 0.74 9.59 6.94 16.53 1.32 1.16 July 80 3.17 10.76 7.17 17.93 1.49 1.50 August 45 1.79 12.35 8.10 20.45 1.32 1.22 September 58 2.28 13.31 5.90 19.21 1.65 1.56 October 48 1.87 18.82 7.27 26.09 3.30 2.71 November 49 1.95 7.60 5.04 12.64 3.28 3.17 December 37 1.48 14.17 9.09 23.27 5.07 4.09 Averages : 1957 42 1.66 14.56 7.17 21.73 2.71 2.47 1956 44 1.74 13.31 7.80 21.08 2.69 2.42 1955 43 1.71 13.73 7.99 21.71 2.85 2.57 1954 47 1.80 12.40 9.04 21.35 2.54 2.60 1953 36 1.40 11.99 8.22 20.21 2.30 2.47 1952 40 1.50 11.02 9.17 20.19 2.26 2.19 1952-1956 42 1.63 12.49 8.44 20.91 2.53 2.45 18. TABLE II—Results obtained in 1957 of the daily observations of the concentration of SMOKE by the volumetric method. Month Rainfall collected in deposit gauge at Golden Lane Golden Lane POLICE STATIONS Bishopsgate Cloak Lane Snow Hill Monthly Average Monthly Average Monthly Average Monthly Average Equivalent to Millimetres inches of rain Milligrams per 100 cubic metres Milligrams per 100 cubic metres Milligrams per 100 cubic metres Milligrams per 100 cubic metres January 33 1.30 10 26 16 9 F ebruary 73 2.88 12 29 20 11 March 25 0.97 9 30 17 10 April 3 0.13 5 17 11 6 May 34 1.33 3 17 9 4 June 19 0.74 2 20 7 4 July 80 3.17 2 18 7 3 August 45 1.79 2 18 9 4 September 58 2.28 3 18 11 4 October 48 1.87 11 32 19 11 November 4^ 1.95 15 26 21 9 December 37 1.48 30 45 28 14 Averages: 1957 42 1.66 9 25 15 7 1956 44 1.74 14 15(a) 12 13 1955 43 1.71 14 13(a) 10(a) 12(a) 1954 47 1.80 14 — — — 1953 36 1.40 13 — — — 1952 40 1.50 12 — — — 1952-1956 42 1.63 13 — — — (a) Measurement for 9 months of the year. TABLE III.—Results obtained in 1957 of the daily observations of concentrations of SULPHUR DIOXIDE by the volumetric method. Month Rainfall collected in deposit gauge at Golden Lane Golden Lane Police Stations Bishopsgate Clonic Lane Snow Hill Equivalent to Monthly Average Monthly Average Monthly Average Monthly Average Millimetres inches of rain Parts per 100 million parts of air Parts per 100 million parts of air Parts per 100 million parts of air Parts per 100 million parts of air January 33 1.30 11 9 14 14 February 73 2.88 12 16 15 16 March 25 0.97 10 15 15 16 April 3 0.13 6 9 11 10 May 34 1.33 4 8 8 7 June 19 0.74 4 8 6 7 July 80 3.17 4 7 7 6 August 45 1.79 4 8 6 6 September 58 2.28 5 9 6 7 October 48 1.87 11 16 13 13 November 49 1.95 12 15 14 13 December 37 1.48 21 25 22 18 Averages: 1957 42 1.66 9 12 11 11 1956 44 1.74 10 15(a) 12 13 1955 43 1.71 10 13(a) 10(a) 12(a) 1954 47 1.80 11 — — — 1953 36 1.40 11 — — — 1952 40 1.50 13 — — — 1952-1956 42 1.63 11 — — — (a) Measurements for 9 months of the year. 19. PIGEON NUISANCE For ma ny years various persons or firms have been authorised to catch pigeons in the City in places where there congregation becomes excessive. No charge has been made for this work but the carcases of the birds have remained the property of the catchers. Early in the year evidence showed that the number of pigeons in the City was increasing and I received complaints of an urgent nature of the damage caused by the birds, particularly in St. Paul's Gardens, St. Paul's Churchyard and Finsbury Circus. I was informed, however, by the firm who have carried out the work of reducing the number of pigeons in the City for some years, that they could not in future undertake this service without charge as the carcases of the birds were no longer saleable. The firm submitted a quotation, which was accepted by the City Corporation, to maintain the pigeon population at reasonable proportions and to deal with specific complaints for an annual fee. As a consequence of this arrangement, 1,121 pigeons were caught during the year and cause for complaint appears to have decreased.. EXCAVATION OF HUMAN REMAINS The destruction caused by the late war and consequent rebuilding of the City have rendered it necessary to cut roads through or erect buildings on the sites of the burial grounds of several old City Churches. In such circumstances, human remains which are unearthed in the course of excavations are, with the sanction of the Home Office, Ecclesiastical Authorities, City Coroner and City Police, taken to an approved burial ground where they are reverently re-interred. During the year excavations were carried out at the disused burial ground of St. Martin in the Vintry, Upper Thames Street, and 152 cases of human remains were re-enterred at the City of London Cemetery. Excavations at the site of St. Stephen's, Walbrook, resulted in 67 lead coffins and 307 boxes of human remains being subsequently re-buried at a cemetery in Woking. On every occasion, always early in the morning, when remains were placed in the vehicles which were to take them from the City to the cemetery, one of my officers was present to ensure that due reverence was observed and that no nuisance was caused. DISPOSAL OF BROKEN FISH BOXES - BILLINGSGATE MARKET Every day approximately 1% tons of broken fish boxes are left in Billingsgate Market and the sites surrounding it. Despite extensive enquiries it has been found impossible to ascertain who is responsible for the dumping of these boxes. Normally they are collected and despatched for burning in the destructor and salvage plant operated by one of the North London Borough Councils. Occasionally, however, it is impossible for the Borough Council to accept the boxes, at which times serious nuisance might be caused from smells and flies were the boxes to be left around the Market. It was decided that in cases of necessity the most hygienic and economic disposal of these broken fish boxes would be to burn them on suitable sites near Billingsgate Market on Saturday afternoons or Sundays, subject to the operations being strictly controlled and supervised, after due notification to the Fire Service and the City of London Police. As an experiment, 3 tons of boxes were burnt on a Sunday in July. The site chosen was deep in the foundations of a bombed out building. There was no nuisance from smoke. Indeed, the visibility of the smoke was so negligible that the provisions of the City of London (Various Powers) Act, 1954, which declared the City a "smokeless zone", were not contravened neither was there any "fishy" smell. In future, therefore, should necessity arise, broken fish boxes will be burnt in the manner outlined above. LONDON COUNTY COUNCIL CLEANSING STATION AT 20, GOLDEN LANE In 1911, by Section 122 of the Children Act, 1908, the Corporation as the Local Sanitary Authority and the London Counci Council as the Local Education Authority entered into an Agreement whereby the Corporation provided and equipped part of the premises of the City Mortuary, Golden Lane, as a Children's Cleansing Station "to effect the cleansing of the person and clothing of any child attending a public elementary school provided or maintained by the Council who or whose clothing may be found to be infested with vermin or in a foul or filthy condition". This was originally limited to children resident in the City, but was later extended to include all children attending public elementary schools in the City, and a London County Council Nurse was appointed in charge. Since the War the use made of the Centre for the Cleansing of children has steadily declined to negligible proportions.lt has functioned mainly as a centre for the treatment of minor ailments, and only some 15% of the patients were City children. The London County Council Divisional Medical Officer suggested that as the functions of the Centre, as originally intended, had practically ceased, and that as alternative accommodation could be arranged for City children at the Hopetown Street Centre near Brick Lane, the agreement referred to above might well be discontinued at the termination of the school summer term. This suggestion was agreed to and the Centre was closed at the end of July. I should like to thank the Chairman and members of the Port and City of London Health Committee for their help and encouragement in the work of the City Health Services as well as all those, for example traders, business firms and members of the public, who have co-operated in the promotion of health. 21. I have the honour to be, Your obedient Servant, J.GREENWOOD WILSON, Medical Officer of Health, Port and City of London. STATISTICAL INFORMATION Area,—678 acres (including the Temple and foreshore). Population.— Census 1951, 5,268. Estimated mid-year 5,100. Annual Rateable Value.—As at 1st April, 1957, £11,412,538. Annual Sum received from Penny General Rate.—£46,800. Births Total M. F. Legitimate 32 11 21 Birth Rate per 1,000 resident population, 1957 5.93 Live Birth, Illegitimate 2 1 1 Still Births — — — Rate per 1,000 total (live and still) births — Deaths Deaths, Infants under 4 weeks of age Legitimate 2 — 2 Illegitimate — — — Legitimate 3 1 2 Death Rate per 1,000 resident population 10.60 Deaths under 1 year Illegitimate — — — Deaths (all ages) 53 37 16 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 88.24 Legitimate Infants per 1,000 legitimate live births 93.75 Illegitimate Infants per 1,000 illegitimate live births — INFECTIOUS DISEASE Notifications received Total cases notified Sonne Dysentery 6 Poliomyelitis (Paralytic) 1 Poliomyelitis, Acute (Non-Paralytic) 2 Puerperal Pyrexia 8 Measles 19 Malaria (contracted Abroad) 1 Food Poisoning 14 Food Poisoning (suspected) 1 Scarlet Fever 2 Tuberculosis (Pulmonary) 5 ANALYTICAL EXAMINATIONS (Other than under Food and Drugs Act) Apricots (tinned) 2 Pilchards (tinned) 1 Asparagus Lettuce (Chinese) 1 Pineapple (tinned) 1 Bread 1 Plums (tinned) 1 Cheese Sauce 1 Poppadums (Indian) 2 Chestnuts in Water (Chinese) 1 Prawns (steamed) 1 Cream 2 Rainwater 12 Fertiliser 4 Raisins 1 Goose spiced (Chinese) 1 Sausages 1 Jam 1 Sausage Casings 1 Lungngan in Syrup (Chinese) 1 Shrimps peeled 1 Mackerel in oil 1 Sultanas 1 Mayonnaise 2 Tomato Juice 1 Meat (tinned) 4 Tomato Sauce 1 Mushrooms (tinned) 1 Walnut Halves 1 BACTERIOLOGICAL EXAMINATIONS The following specimens were examined during the year Cream 1 Meat (cooked) 4 Custard 1 Meat (tinned) 3 Egg Products 5,996 Mushroom Dumpling 1 Faeces 21 Ox Heart (cooked) 1 Fat (cooking) 1 Peas 5 Figs (dried) 1 Sandwich (Meat) 1 Ham (tinned) 2 Sputa 2 Meat (carcase) 2 Water 2 22. CAUSES OF. AND AGES AT, DEATH DUKING THE YEAR 1957 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 53 3 1 — 1 5 17 18 8 1. Tuberculosis, respiratory M — — — — — — — — — 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 1 — 1 — — — — — — F — — — — — — — — — 10. Malignant neoplasm-stomach M 2 — — — — — 1 1 — F — — — — — — — — — 11. Malignant neoplasm-lung, Bronchus M 2 — — — — — 2 — — F — — — — — — — — — 12. Malignant neoplasm-breast M — — — — — — — — — F — — — — — — — — — 13. Malignant neoplasm-uterus F — — — — — — — — — 14. Other malignant and lymphatic neoplasms M 1 — — — — — — — 1 F 4 — — — — 1 1 1 1 15. Leukæmia, aleukæmia M 1 — — — 1 — — — — F — — — — — — — — — 16. Diabetes M — — — — — — — — — F — — — — — — — — — 17. Vascular lesions of nervous system M 3 — — — — — 1 1 1 F — — — — — — — — — 18. Coronary disease, angina M 3 — — — — — 1 2 — F 1 — — — — — — 1 — 19. Hypertension with heart disease M 2 — — — — — 1 1 — F — — — — — — — — — 20. Other heart disease M 3 — — — — — — 2 1 F 2 — — — — — 2 — — 21. Other circulatory disease M 4 — — — — — — 3 1 F 5 — — — — 1 1 1 2 22. Influenza M — — — — — — — — — F — — — — — — — — — 23. Pneumonia M 4- 1 — — — — 2 1 — F — — — — — — — — — 24. Bronchitis M 3 — — — — — 2 1 — F — — — — — — — — — 25. Other diseases of respiratory system M 1 — — — — — — 1 — F — — — — — — — — — 26. Ulcer of Stomach and duodenum M 1 — — — — — 1 — — F — — — — — — — — — 27. Gastritis, enteritis and diarrhœa M — — — — — — — — — F — — — — — — — — — 28. Nephritis and nephrosis M 2 — — — — — 1 1 — F — — — — — — — — — 29. Hyperplasia of prostate M — — — — — — — — — F — — — — — — — — — Carried forward M 34 1 1 — 1 — 13 14 4 F 12 — — — — 2 4 3 3 23. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1951-continued 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 Brought forward M 34 1 1 — 1 — 13 14 4 F 12 — — — — 2 4 3 3 30. Pregnancy, childbirth, abortion F — — — — — — — — — 31. Congenital malformations M — — — — — — — — — F — — — — — — — — — 32. Other defined and ill-defined diseases M — — — — — — — — — F 3 2 — — — 1 — — — 33. Motor vehicle accidents M 1 — — — — 1 — — — F — — — — — — — — — 34. All other accidents M 2 — — — — — — 1 1 F — — — — — — — — — 35. Suicide M — — — — — — — — — F 1 — — — — 1 — — — 36. Homicide and operations of war M — — — — — — — — — F — — — — — — — — — Totals M 37 1 1 — 1 1 13 15 5 F 16 2 — — — 4 4 3 3 MATERNITY AND CHILD WELFARE The following details have been received from the Divisional Medical Officer of the London County Council with regard to work carried out in connection with Maternity and Child Welfare in the City. Infant Welfare Centre Total No. of children who first attended during the year and who on the date of their first attendance were :— Under 1 year of age 36 1—5 years of age 2 Total No. of children who attended during the year, and who were born in:— 1957 32 1956 33 1955-1952 34 Total attendances by children Under 1 year of age 706 1—5 years of age 507 Health Visitors No. of infants under 1 year of age visited for first time 34 Total visits to infants under 1 year of age 157 Total visits to children aged 1 year but under 2 years 88 Total visits to children aged 2 years but under 5 years 128 No. of expectant mothers visited 7 Total visits to expectant mothers 21 Care of Premature Infants No. of premature births during the year 2 No. of deaths under 1 month 2 Diphtheria Immunisation No. of children who completed a full course of primary immunisation:— Under 5 years of age 66 5—15 years of age 14 No. of children who were given a secondary or reinforcing injection 49 Vaccination No. of children successfully vaccinated or revaccinated 45 24. MEAT INSPECTION Tons. Cwts. Qrs- Lbs. Meat, etc., delivered at Smithfield Market 422,607 0 0 0 Meat, etc., seized by Inspectors at Smithfield Market 496 11 2 9 Meat, etc., seized by Inspectors at Leadenhall Market and City shops 8 15 2 3 Meat, etc., seized by Inspectors at Cold Stores 7 4 2 11 Various commodities seized by Inspectors and sent to Lett's Wharf 7 15 0 21 Number of Exportation Certificates Issued, 84. Number of demonstrations and lectures given, 18. Number of Students attending, 70. Prosecution Food and Drugs Act, 1955. Sec. 9 and Public Health (Meat) Regulations, 1924, Sec. 8, 9 and 10. Offence Result Having deposited or consigned for the purpose of sale or of preparation for sale food (namely a sow carcase diseased by general tuberculosis) intended for but unfit for human consumption. Defendant granted an absolute discharge on payment of 25 guineas costs. 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 Foodstuffs, in addition to meat, condemned as unfit for human consumption as a result of the inspection of meat landed at Riverside Wharves and in grocers shops, cafes, restaurants etc. amounted to 117 tons 15 cwt. 0 qrs. 17 lbs., which was disposed of as follows:— Released for stock feeding Disposed of to contractors Destroyed 2 tons 1 cwt. 1 qr. 17 lbs. 35 tons 6 cwt. 3 qr. 13 lbs. 80 tons 6 cwt. 3 qr. 15 lbs. 43 tons 7 cwts. 2 qrs. 18 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 inthis connection 4,150 inspections have been made. As a consequence of these inspections, it was necessary to serve 20 Intimation Notices. 6 Statutory Orders were served. No Legal proceedings were necessary. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. 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 the purposes of provisions as to health. Premises Number on Register Number of Inspections Written notices 0ccupiers prosecuted (i) Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 1,179 (including 1,000 kitchens) 1£75 (including 1,933 kitchens) 175 (including 173 kitchens) — (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 89 80 11 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — TOTAL 1,268 2,055 186 — 25. 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 No. of cases in which defects were found Number of cases in which prosecutions were instituted F ound Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1.) 669 496 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 — — — — Inadequate ventilation (S.4) 67 65 — — — Ineffective drainage of floors (S.6) 3 1 — — — Sanitary Conveniences (S.7) (a) insufficient 9 12 — — — (b) unsuitable or defective 118 135 — 5 — (c) not separate for sexes — 6 — — — Other offences against the Act (not including offences relating to Outwork) 441 393 — — — TOTAL 1,308 1,108 — 5 — OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms 86 Names and Addresses, etc..received from other Authorities 161 Names and Addresses transmitted to other Authorities 540 No case of infectious disease was reported in connection with outworkers' premises in the City. SHOPS ACT, 1950 43 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 ESTABLISHMENTS Before establishing a new catering business planning approval must be obtained before premises, new or existing, are adapted for this purpose. In order that the applicants for such approval can be satisfied that the premises are suitable from a public health point of view and that the various statutory requirements can be met, they are referred by the City Planning Officer to your Medical Officer of Health. 57 such applications were received during the year as a consequence of which 126 inspections were made. PHARMACY AND POISONS ACT, 1933 This Act provides for registration by the Local Authority of persons not already registered I in respect of poisons in Part I of the Poisons List who desire to sell poisons included in Part II. Part I of the Poisons List includes the more dangerous poisons such as Strychnine — which may be sold only by Pharmacists Registered by the Pharmaceutical Society of Great Britain, whereas Part II includes the less dangerous poisons such as Phenols, hair dyes, etc. 70 firms were registered under this Act, 67 of which were re-registrations. Three infringements were noted. 89 inspections were made in connection with the administration of the Act. PHARMACY AND MEDICINES ACT, 1941 This Act has continued to have the attention of the Inspector. It aims to protect the public from misleading claims by advertisement or by labels on medicine bottles. 25 inspections were made and no contravention came under the notice of the Inspector. FERTILISERS AND FEEDING STUFFS ACT, 1926 This Act requires sellers of certain specified fertilisers and feeding stuffs for cattle or poultry to furnish purchasers with a statutory statement indicating the name under which the article is sold and the amount, if any, of certain scheduled ingredients. 32 inspections were made; three contraventions were noted. 26. FOOD AND DRUGS ACT, 1955, AND FOOD REGULATIONS Informal and Formal Samples submitted for Analysis Article Informal Formal Article Informal Formal Almonds (ground) 4 — Brought forward 165 23 Angelica 2 — Pepper 2 — Aspic Jelly Powder 1 — Pies 6 — Baking Powder 1 — Pimento 1 — Butter 7 Pudding Mixtures 1 — Butter (on rolls) 2 2 Raisins 1 — Cake Decorations 2 — Rennet, Essence of 2 — Cake Mix 1 — Rice 2 — Caraway Seed 1 — Rum Butter 1 — Celery Seed 1 — Sauce 1 — Cereal 1 — Sausages 24 — Cheese (processed) 10 — Soft Drinks 3 — Cherries (Cocktail) 1 — Spices 3 — Christmas Pudding 2 — Spreads 2 — Cinnamon (ground) 3 — Stewed Steak (Tinned) 2 — Cloves 4 — Stuffing 2 — Coffee 2 — Suet 2 — Coffee essence 3 — Sugar 4 — Colourings 3 — Sultanas 1 — Crab (dressed) 1 — Sweets 4 — Cream (Dairy) 9 2 Syrup 1 — Curry Powder 7 — Tea 8 — Custard Powder 1 — Tomato Juice 2 — Dessicated Coconut 5 — Tomato Ketchup 2 — Dessert Powder 2 — Tomato Puree 2 — Dripping 3 — Tomatoes (Tinned) 1 — Fish 3 — Vinegar 2 — Fish Cakes 3 — Whisky 2 — Fish Paste 3 — DRUGS Flavourings 4 — Flour 6 — Fruit (Dried) 3 — Almond Oil 2 — Fruit (Tinned) 2 — Arnica, Tincture of 3 — Gelatin 3 — Arrowroot (Ground) 2 — Ginger (ground) 1 — Calamine Lotion 2 — Glace Fruits 2 1 Camphorated Oil 3 — Gravy Browning 2 — Cascara Sagrada 1 — Herbs 2 — Castor Oil 2 — Honey 1 — Citrate of Magnesia 1 — Horseradish Relish 1 — Cough Linctus 3 — Ice Cream 5 — Eucalyptus, Oil of 2 — Ice Cream Powder 2 — Flowers of Sulphur 1 — Jam 1 — Friars Balsam 2 — Jellies 3 — Fullers Earth 1 — Lard 3 — Glaubers Salt 1 — Lemon Curd 3 — Glycerin, Lemon & Honey 1 — Lemonade Powder 1 — Glycerin of Thymol 1 — Mace (ground) 2 — Hypophosphites, Compound Margarine 1 — Syrup of 1 — Marzipan 3 — Indigestion Mixture 1 — Mayonnaise 4 — Juniper, Oil of 3 — Milk 1 18 Liniment of Turpentine 1 — Milk (Condensed) 1 — Liquid Paraffin 1 — Milk Shake Powder 1 — Liquorice Powder 2 — Mincemeat 2 — Medicated Tablets 4 — Mint (Dried) 4 — Ointments 4 — Mussels 1 — Myrhh, Tincture of 1 — Mustard 1 — Rose Hip Syrup 1 — Nutmeg (ground) 1 — Saccharin Tablets 1 — Olive Oil 2 — Wintergreen Liniment 2 — Orange Juice 1 — Wintergreen, Oil of 1 — Orangeade Powder 2 — Witch Hazel 1 — Pastry Mix 1 — Zinc & Castor Oil Cream 1 — Peas (tinned) 2 — Peel (Candied) 2 — TOTALS 302 23 Carried forward 165 23 27. ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY Article Informal or Formal Sample Nature of adulteration or irregularity Action Hot milk Formal 29% extraneous water Prosecution Hot milk Formal 9.6% extraneous water Caution — City Solicitor Hot milk Formal 17.7% extraneous water Prosecution Glace Fruits Glace Fruits Informal Formal Artificial Glace Fruits ) Artificial Glace Fruits ) Formal sample taken. Cautions by City Solicitor to Vendors under Sec. 2 and to Suppliers under Sec. 116(2) (false warranty) Food & Drugs Act 1955. Butter (on roll) Butter (on roll) Informal F ormal Margarine (on roll) ) Margarine (on roll) ) Formal sample taken. Prosecution. Butter (on rolls) Butter (on buns) Informal Formal Margarine (on rolls) ) Margarine (on buns) ) Formal sample taken. Prosecution. Cream Cream Formal F ormal Imitation Cream ) Imitation Cream ) Caution by City Solicitor under Sec. 47 of the Food & Drugs Act 1955. PROSECUTIONS Food and Drugs Act, 1955 Offence Result Sec. 32(3) Selling a glass of hot milk having extraneous water to the extent d 29%. Absolute discharge. Two guineas costs. Sec. 32(3) Selling a glass of hot milk having extraneous water to the extent of 17.7% Fined Five pounds. Two guineas costs. Sec. 2 Selling margarine on rolls when "buttered rolls" were asked for. Conditional discharge. Two guineas costs. Sec. 2 Selling margarine on buns when "buttered buns" were asked for. Conditional discharge. Two guineas costs. FOOD AND DRUGS ACT, 1955 (Section 16) This Section provides for registration of premises for the sale, manufacture for sale or storage of ice cream, or the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale. 135 such premises had been registered by the end of the year. The following table shows the type of business carried on Nature of Business No. of premises registred Sale and storage of pre-packed ice cream 69 Sale and storage of ice cream 4 Selecting and sorting of sausage casings 9 Preparation and cooking of jellied eels and shellfish 13 Cooking of hams 1 Cooking of Beetroot 1 Manufacture of sausages, dripping and cooked meats. Brining of meat 34 Cooking, smoking and canning of meat products 1 Manufacture of pies 1 Smoking of bacon 1 Sale of cooked meats 1 135 AGRICULTURAL PRODUCE (GRADING & MARKETING) ACTS, 1928-1931 Regulations made under these Acts prescribe designations referred to as "Grade designations" indicating the quality of certain articles of agricultural or fishery produce. Such regulations contain definitions of the quality indicated by every "grade designation" thereby prescribed and specify a "grade designation mark" to represent each "grade designation". The Acts also stipulate that all "preserved" eggs shall be so marked before being offered for sale and that all premises used for the cold storage or chemical storage of eggs shall be registered with the local authority. The premises of one firm are so registered in the City of London. No difficulty was experienced in the administration of these Acts. 28. Merchandise Marks Act, 1926 This Act prohibits the importation of certain foodstuffs unless they bear marks indicating the "country of origin" or whether they are of "foreign" or "empire" origin. No difficulty has been experienced in the administration of this Act. CITY MORTUARY Bodies received 164 Post Mortem Examinations made 164 Inquests on bodies 36 Inquest held at Holloway Prison 1 Inquest on fires — DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, etc.:— No. of articles disinfected 1,289,646 Cases of horsehair 453 Clothing by weight 3 tons 12 cwt. Fees received £4,605. 3. 0. General Disinfection. Infectious Diseases, etc.:— Articles of bedding disinfected 539 Premises disinfected after cases of infectious disease 2 Lockers at Post Offices disinfected 10 Verminous premises disinfected Ambulances, vans, etc., disinfected 25 Police Cells disinfected — Cleansing of Persons :— No. of verminous persons bathed 482 No. of Scabious Persons bathed 5 No. of verminous articles disinfected 5,086 Cleansing of Schoolchildren:— No. of children cleansed 96 No. of articles disinfected 734 No. of children treated for Minor ailments 1,227