REPORT OF THE MEDICAL OFFICER OF HEALTH FOR the CITY OF LONDON for the year 1959 Printed by the, Authority of Common Council 17th. December 1953. STAFF. MEDICAL OFFICER OF HEALTH (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 ADMINISTRATIVE STAFF (Port and City of London) Blunt, H.F. Food Administrative Officer May 1924 McLorg, W.L. General Administrative Officer Feb. 1927 Ratliff. R.C. Finance & Establishment Officer March 1930 Stout, J.E. Senior Assistant July 1930 Betts, C.W.R. Senior Assistant April 1926 Smith, E.V. Senior Assistant Oct. 1938 Lott, R.H. First Class Assistant May 1947 Osborn, F.B. First Class Assistant May 1952 Gurney, Miss M.L. General Grade Clerk May 1939 West, Mrs. I.R. General Grade Clerk Sept. 1956 (Resigned 31.12.59) Hamblin, Miss, I.H. General Grade Clerk Oct. 1957 Smith, Mrs. F.I.M. General Grade Clerk (Part-time) May 1959 PUBLIC HEALTH INSPECTION STAFF McGrath. W.R. Senior Public Health Inspector March 1922 SlLLETT, D.E. Senior Public Health Inspector April 1926 Neale, W.G.C., Senior Public Health Inspector July 1928 Thompson. E., Senior Public Health Inspector Sept. 1948 Thorpe, R.C. * Public Health Inspector March 1930 Hudson, L.A. Public Health Inspector April 1934 Campbell, J.w. Public Health Inspector Sept. 1946 Flynn, J. ... Public Health Inspector July 1951 ADMINISTRATIVE STAFF - MEAT INSPECTION Threadgold, A.W. First Class Assistant Nov. 1923 Peters, E.J. General Grade Clerk Nov. 1935 Cash, J.E. General Grade Clerk March 1954 MEAT INSPECTION STAFF Thompson, F.E. Chief Meat Inspector July 1924 Lee, W.R. Deputy Chief Meat Inspector July 1930 Garrard, S.S. Meat Inspector Sept. 1946 Morris, W.L. Meat Inspector Sept. 1946 Seymour, k.S. Meat Inspector July 1935 Wilson, J.C. Meat Inspector Jan. 1936 Leach, R.A. Meat Inspector Sept. 1952 Cox, J.T. Meat Inspector Aug. 1954 Field, H. Meat Inspector Aug. 1954 Ginoell, 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. Sept. 1931 RODENT OPERATIVES Mason, G.A. (Foreman Rodent Operative) Dec. 1946 Tremaynk, Nov. 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 Woods, T.A. Nov. 1955 SENIOR PORTER AT SMITHFIELD MARKET Prevost, A.E. Feb. 1926 MANUAL WORKERS Mann, E.V. (General Duties at Smithfield Market) Jan. 1928 Lawrence, C.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 Sunnick, J.W.T. (General Duties at Mortuary) May 1950 Lawrence, E.E. (General Duties at Mortuary) Aug. 1954 Steele, W.T. (General Duties at Mortuary) Aug. 1958 Jollie, Mrs. F.G. (Bath Attendant and Cleaner) Sept. 1955 OCCASIONAL DEPUTY MEDICAL OFFICER OF HEALTH Stott, William, M.B., B.S., D.P.H., F.R.I.P.H. Aug. 1958 PUBLIC ANALYST Williams, H.A., Ph.D.(Lond.) A.C.G.F.C., F.R.I.C., F.R.S.H. Jan. 1958 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1959. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. Guildhall, E.C.2. Telephone: MONarch 3030 July. 1960. My Lord Mayor and Gentlemen. I have the honour to submit the following report on the work of my Department during the year 1959. Vital Statistics The resident population of the City according to the Registrar General's estimate at midyear 1959 was 4,900. The birth rate rose to 5.88 per 1,000 resident population and the death rate dropped to 9.37 per 1,000 resident population, as compared with 5.22 and 11.42 per 1,000 respectively in 1958. 32 babies were born, none of which died within four weeks of birth. 3 births were illegitimate. There were no still-births. The total number of deaths of all ages was 45; 34 male and 11 female. 13 deaths were due to cancer, 3 of which were cancer of the lung. 5 deaths were from pneumonia and 4 from bronchitis. One death was due to a motor accident. The only death of a person less than 45 years of age was of a Sicilian doctor on a temporary visit to this country, who died from coronary thrombosis in a City Hotel. Infectious Disease 34 notifications of infectious disease were received; namely 1 case of dysentery (3), 21 of measles (9), 4 of food poisoning (5), 1 of scarlet fever (4), 4 of pulmonary tuberculosis (6), 1 of non-pulmonary tuberculosis (0), 1 of erysipelas (0) and 1 of influenzal broncho-pneumonia (0). (The figures in brackets denote the comparable numbers of cases in 1958.) Food Poisoning Below is a copy of the Annual Return made to the Minister of Health on food poisoning in the City of London during 1959. There were three outbreaks of food poisoning. In all three cases the causative agent was a heat resistant strain of Clostridium welchii. Once again the investigations showed that the prior preparation resulted in the food being infected and that the subsequent storage before re-heating had provided suitable conditions for the proliferation of the organisms. Undoubtedly food preparation by this method involves greater risks for the consumer, and the catering trade must appreciate this fact and act accordingly. ANNUAL RETURN OF FOOD POISONING IN THE CITY OF LONDON 1. YEAR ENDED 31st DECEMBER, 1959. 2. (a) FOOD POISONING NOTIFICATIONS (Corrected) as returned to Registrar General:— 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil Nil Nil Nil Nil (b) Cases otherwise ascertained:— 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil Nil Nil 48 48 (c) Symptomless Excreters 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil Nil Nil Nil Nil (d) Fatal Cases 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil Nil Nil Nil Nil 2 3. PARTICULARS OF OUTBREAKS Agent No. of outbreaks No. of Cases Total No. of Cases Family Outbreaks Other Outbreaks Notified Otherwise ascertained Agent identified: (a) Chemical Poisons Nil Nil Nil Nil Nil (b) Salmonella Nil Nil Nil Nil Nil (c) Staphylococci (including toxin) Nil Nil Nil Nil Nil (d) Cl.botulinum Nil Nil Nil Nil Nil (e) Cl. welchii Nil 3 Nil 48 48 (f) Other bacteria Nil Nil Nil Nil Nil Totals Nil 3 Nil 48 48 Agent not identified Nil Nil Nil Nil Nil 4. SINGLE CASES Agent No. of Cases Total No. of Cases Notified Otherwise ascertained Identified: (a) Chemical Poisons Nil Nil Nil (b) Salmonella Nil Nil Nil (c) Staphylococci (including toxin) Nil Nil Nil (d) Cl. botulinum Nil Nil Nil (e) Cl. welchii Nil Nil Nil (f) Other bacteria Nil Nil Nil Totals Nil Nil Nil Agent not identified Nil Nil Nil 5. SALMONELLA INFECTIONS, NOT FOOD-BORNE Salmonella Outbreaks No. of Cases (outbreaks) Single Cases Total No. of Cases (outbreaks and single cases) Family Other Nil Nil Nil Nil Nil MASS RADIOGRAPHY The Mass Radiography Unit of the North East Metropolitan Regional Hospital Board continued to operate at the Corporation's premises at 20 Golden Lane, London, E.C.I., where 49,847 persons (30,870 men and 18,977 women) were X-rayed during the year. In addition 14,157 employees of business organisations in the City (10,471 men and 3,686 women) were screened when the Unit was "mobile", i.e. when operating at the premises of large firms where employees are X-rayed at their place of work. Although the Unit is also available to the Boroughs of Finsbury and Shoreditch, the majority of examinees are employed in the City. The following is a Report received from the Medical Director of the Unit, Dr. W.D.R. Thompson. NORTH EAST METROPOLITAN REGIONAL HOSPITAL BOARD MASS RADIOGRAPHY UNIT 6D During 1959 the Mass Radiography Unit examined 42,996 males and 24,114 females making a total of 67,110. Up to the end of 1959 the Unit has examined 561,108 persons since it commenced operations in May 1950. Sixty-six cases of active tuberculosis were discovered during the year as well as fourteen cases of carcinoma of the lung. All clinics have recorded their sputum findings and twenty-two had a positive sputum. 3 The Unit has functioned at the Mass Radiography Centre, 20 Golden Lane, E.C.I, for about nine months in the year and during the remaining period it has visited firms, etc. within its zone, viz. the City of London, and the Metropolitan Boroughs of Finsbury and Shoreditch. Of the firms examined during 1959 many were small and new firms for it has long been the practice of this Unit not to overlook the smaller firms. The practice of X-raying both sexes during the same Sessions has been continued with examinees attending the Unit by prior appointment, with the exception of doctor's referrals who attend the Unit without appointment under a special dispensation. The medical procedure adopted in previous years has continued throughout 1959. Where an investigation has been outside the province of a Chest Clinic the co-operation of St. Bartholomews Hospital is secured and our indebtedness to Dr. N.C. Oswald and his colleagues is herewith acknowledged. A number of conditions other than tuberculosis have been discovered by the Unit and some of the more interesting are listed hereunder: Tumors of the bony thorax 1 Congenital malformation of the lungs 96 Bacterial and virus infections of the lungs 25 Hydatid Cyst and Syphilis 4 Bronchiectasis 14 Pulmonary fibrosis — non-tuberculous 29 Spontaneous pneumothorax 4 Benign tumours of the lungs and mediastinum 12 Carcinoma of the lung and mediastinum 14 Metastases in the lung 1 Sarcoidosis and collagenous disease 7 Abnormalities of the diaphragm and oesophagus — congenital and acquired 31 Congenital abnormalities of heart and vessels 35 Acquired abnormalities of heart and vessels 85 Miscellaneous to include, e.g. empyema; foreign body in lung 98 Conclusion Friendly relationships have been maintained with Dr. J. Greenwood Wilson, Medical Officer of Health for the City of London, the Medical Officers of Health for the Boroughs of Finsbury and Shoreditch, and the Divisional Medical Officers in Health Divisions 3, 4 and 5. The services rendered by the Central Group Hospital Management Committee and the North East Metropolitan Regional Hospital Board are also gratefully acknowledged. THE EXAMINATION OF IMPORTED FOOD The City of London, in the sense that it has a river frontage, is one of the so called riparian authorities, i.e. it is an authority with a frontage on the River Thames which includes one or more riverside wharves where cargoes may be unloaded and these cargoes may include foodstuffs. All the riparian authorities, including the City of London acting in that capacity, have therefore been granted powers under the Public Health (Imported Food) Regulations similar to those of the Corporation of London acting in its other capacity of Port of London Health Authority and working in the five great dock groups. The other riparian authorities usually included in the list of these are — Poplar Southwark West Ham East Ham Westminster Lambeth Woolwich Greenwich Stepney Wandsworth Bermondsey Thus even before the amalgamation of the Port and City of London Health Departments, the City of London Health Services in that part of them that deal with the City's riparian activities, had to operate the Public Health (Imported Food) Regulations. The amalgamation of the Port and City of London Health Departments resulted in the setting up of an administrative section that would deal with port health administration, both for the Port of London Health Authority (in the 5 major dock groups) and for the City of London riparian Health Authority. Conferences with the other riparian authorities are now convened regularly with a view to achieving agreed standards of judgment on food imports. Another aspect of the old separate City of London Health Service also comes into this picture, namely Smithfield with its adjacent Cold Stores, because large quantities of the meat imported through the Docks, ends up at Smithfield and in the Cold Stores. 4 It has seemed appropriate, therefore, to include some notes which follow on imported food, and although these would turn the attention normally of readers to the Port Health Services, for the reasons stated in this introduction the section is included this year in the Annual Report of the City of London Health Services. Fitness for human consumption of imported food is normally determined at port of entry and before distribution by one or more of three examinations; the organoleptic, whereby a decision as to soundness relies upon the appearance, smell, taste and feel; the analytical, which determines the chemical composition and condition, and the bacteriological, which indicates the degree of sterility or the presence of contaminating micro-organisms. The volume of food imported into the Port of London of an annual value of some £m650 necessarily imposes its own limitations of examination to the physical capacity of the staff available in the ports and in the laboratories to undertake it. Staff and laboratory capacity are not readily flexible factors whereas the picture of imports may rapidly change, and within these limitations the best use of all available resources must be planned to secure the greatest return for the efforts spent. Imported food may be divided roughly into three categories, each having its own peculiarities and problems. (1) Meat is the most valuable import into the Port and City of London, with the Port as discharge centre and Smithfield Market as distribution centre. In 1959 this import was valued at £ml87. (2) Canned foods,from corned beef to chocolate coated ants, form a category of their own. (3) The remaining items consist broadly of dairy products, fish and fish preparations, cereals and cereal preparations, fruits and vegetables, sugar and sugar preparations, coffee, cocoa and cocoa preparations, tea, spices and beverages, increasing in diversity year by year. Meat inspection is an art in its own right in which experience is the most important factor when dealing with s uch huge quantities at conveyor-like rapidity. In recent years the introduction of "boned-out" meat imports has brought its own train of problems. The Imported Food Regulations permit the removal of such glands as are "necessarily removed in the preparation of the meat" and too often those glands considered to be necessarily available for inspection are removed under the protection of the clause. Bacteriological examination has indicated that the additional handling necessitated by the "boning-out" process has provided the means for salmonella and other contamination. The danger of this contamination lies not so much in the consumption of the meat which invariably undergoes a process of heating before consumption, but as a source of contamination that could be spread throughout a plant engaged in the manufacture of meat pies, sausages, etc., before the application of any heating process. For this reason sampling is now regularly carried out for bacteriological examination and where circumstances so dictate, the Authorities of the country of origin are informed and requested to deal with the matter at source. The variety of canned foods increases year by year, each new variety being subjected to a general organoleptic examination, analysis for the presence of preservative, colouring matter, metallic contamination and other adulterations where these are either prohibited or allowed in definite permissible amounts, and when considered advisable, bacteriological examination. In the case of unsound cans bacteriological or analytical examination will often indicate the cause of the breakdown and the answer may be found in improved conditions of processing or storage. There remains the endless variety of "other commodities" each required to be "fit for human consumption" by criteria laid down by Statute, Regulation or Order. Increasing use is being made of the bacteriological examination in assessing fitness of food for human consumption, and items of food hitherto accepted as free of criticismy as a result of such examination, have been found to fall short of the high standard considered necessary in an article of food. Imported egg products, boned-out meat, coconut, prawns and cheese are items which have been subjected to intensive endeavours to secure an article free from bacterial contamination, often of a food poisoning type. It is felt that even in the absence of any evidence that the consumption of a certain commodity has at any time caused food poisoning symptoms, the elimination of organisms capable of causing food poisoning is an elementary precaution that any authority charged with the duty of ensuring that a safe food supply only enters the country could not afford to ignore. It should be stressed that the objective is not bacteriological sterility, which is neither necessary nor wise, as possibly nullifying any natural immunity that may have become established. The child is affected by these organisms when the healthy adult can ingest them in his stride usually without any untoward result. 5 It is the concentration or "dose" of organisms or toxin ingested that is significant, the greater the intake the greater the bodily reaction, and here a problem is met which is not easy of solution. A particular item of food is imported in conditions of deep freeze, conditions which would inhibit the proliferation of bacteria which may be pathogenic. The concentration or plate count of the pathogenic organisms may be so low as to render unlikely that consumption of the food would be followed by symptoms of food poisoning. It must be remembered that a decision as to fitness of the food must be made at time of importation and that if necessary the goods must be seized and taken before a Justice for condemnation, in which event evidence of unfitness must be produced upon which the order as to condemnation is made or refused. The absence of unanimity of agreement amongst bacteriologists as to what degree of bacterial contamination would constitute a health hazard sufficient to warrant condemnation in regard to certain items of food has become very evident. One facet of the problem is that an item of food with bacterial contamination of such minimal proportions at time of importation in conditions of deep freeze as not to justify legal seizure as unfit for consumption, may after thawing and before consumption constitute a real health hazard by the rapid proliferation of bacteria encouraged by improper storage conditions. This possibility is not legally the concern of the Port inspecting staff, but the established business houses are well aware of the hazard inherent in the type of food they are handling and take all proper precautions for the safety of its condition, and here it cannot be too strongly stressed that the well-known brand mark or firm name is one of the strongest guarantees of wholesomeness of an article of food. An example of the problem foods is the imported prawn. Imports from certain countries have been found to be bacteriologically contaminated to an extent which might justify seizure as unfit for human consumption. These shipments have been rejected by the importers. Although it is true to say that little if any evidence has ever pointed to this article as the vehicle of food poisoning, nevertheless once organisms of a food poisoning type have been found in samples submitted to the laboratory action must follow to prevent distribution of suspected cargoes and to warn the importers. All shipments now arriving into the Port and City of London are detained for bacteriological examination. In the absence of any statutory or other bacteriological standard for prawns, advice was sought from bacteriologists specialising in food hygiene and a provisional standard was imposed on the entry of this item. Further discussions with Port Medical Officers of Health, representatives of the trade and with bacteriologists evolved a modified provisional standard which was adopted only to be superseded by yet a further provisional standard. The very responsible attitude adopted by the trade in declining to accept shipments upon which critical reports were received rendered formal seizure and administrative action unnecessary, and their representations to the suppliers have resulted in a slow but very definite improvement to the extent that it is clear that the standards required can be achieved if strict hygienic practice is observed at source. A further requirement considered necessary was the cautionary labelling of this type of food indicating the necessity for storage under refrigerated conditions and that it must be consumed within a reasonable time. Perhaps it is rather anticipating my report for 1960, but the 1960 seasons pack which is arriving at the time of writing this report bears the cautionary labelling requested. To summarise, much is being done, within the limitations of available staff and laboratory capacity to extend the investigations of the bacteriological condition of imported foods as modern techniques become increasingly available, as a further adjunct to the more usual means of examination of imported food. The increasing variety of such foods has made this necessary as physical and analytical examination give little indication of the presence of pathogenic micro-organisms. Parallel with the wider use of bacteriological examinations are the problems that follow the discovery that potentially harmful bacteria are present in the product of an entire industry, calling for the rapid overhaul of processes and handling that have been practised for years without criticism. The alarmist references to "unseen killers" and "the food of death" are quite unjustified as most of the foods have been consumed for years without unfavourable record and it is simply a wise precaution to eliminate a potential health hazard when and where discovered. 6 FOOD AND DRUGS ACT, 1955 Examinations of Imported Tea By Section 1 (1) of the Food and Drugs Act 1955 "no person shall add any substance to food, use any substance as an ingredient in the preparation of food so as (in any case) to render the food injurious to health, with intent that the food shall be sold for human consumption in that state". Section 1(5) provides that "in determining for the purpose of this Act whether an article of food is injurious to health, regard shall be had not only to the probable effect of that article on the health of a person consuming it, but also to the probable cumulative effect of articles of substantially the same composition on the health of a person consuming such articles in ordinary quantities". Tea dust, tea fannings and broken leaf teas are regularly examined on importation for the presence of extraneous matter/ i.e. sand, metal chafings, etc., and whilst such adulterants are not necessarily injurious to health, they are "not of the nature, or not of the substance, or not of the quality" of tea and therefore their presence constitutes an offence under Section 2,of the Act. "If a person sells to the prejudice of the purchaser any food or drug which is not of the nature, or not of the substance, or not of the quality of the food or drug demanded, he shall be guilty of an offence". As a Food and Drugs Authority and a Riparian Authority, the City of London is charged with the inspection of imported articles of food for fitness for human consumption when this inspection has not been carried out by the Port of London Health Inspectors upon discharge of the vessel in the Docks. This is usually due to discharge "overside" into lighters for landing at an upriver wharf, in which case it devolves upon the Riparian Authority to carry out the necessary inspection. Before 1st January, 1959 the inspection of tea on importation had been carried out by Officers of H.M. Customs & Excise, and although the Food and Drugs Act, 1955 confers powers of inspection of all food upon a Food and Drugs Authority, in order to avoid duplicity of action they generally refrained from further inspection at time of importation. On 28th November, 1958 Local Authorities were notified that from 1st January, 1959 H.M. Customs & Excise would cease to sample for analysis imported teas. With little notice it became necessary to formulate policy, provide for the analysis of approximately 5,000 samples of tea annually divided between the Port of London and the City of London, arrange for the sampling and examining techniques to be learned by the Inspectorate and provide any necessary equipment. On 1st January a conference was convened at Guildhall at which were present a representative of the Ministry of Agriculture, Fisheries and Food, Officers of H.M. Customs & Excise, Government Chemists, representatives of the Port of London Authority, the Tea Clearing House Committee, Wharfingers Association, Bonded Warehouses, Public Analyst for the Port and City of London, and Food Officers of the Port of London Health Authority and the City of London. The results of examinations during the previous four years were reviewed. The number of samples taken varied between 3,000 and 5,250 per annum, the percentage of samples reported against steadily increasing from 0.2% to 2%. Procedural difficulties were freely discussed and agreement reached. It was made very apparent that the tea trade is one extremely sensitive to the limitations of time and it was necessary to undertake that the result of chemical examination be available within 48 hours. The Public Analyst expressed himself as quite unable to undertake the examination of tea samples on the scale envisaged owing to inadequate laboratory accommodation, and the Chief Government Chemist kindly authorised his staff temporarily to continue the examinations. The procedures decided at this meeting were put into operation on 1st January 1959 and with some slight "teething troubles", have worked smoothly. A short course of instruction on the examination of tea as previously carried out for H.M. Customs & Excise was arranged, and attended by Port Health Inspectors and City Public Health Inspectors. Teas are by their nature and packing susceptible to damage by unsuitable or lengthy storage, and examination is regularly made for moulds, staleness, contamination arising from oil and water damage as a result of unsuitable storage or accident, or one of the many other possible hazards attendant upon transportation and storage. Analysis for metallic contamination revealed many instances of excessive lead contamination of Formosa Teas. Although these Teas normally are not used unblended, nevertheless they are "Articles of food, or an ingredient used in the preparation of food" and by Section 1(1) and (5) of the Food and Drugs Act 1955 quoted above, any excessive lead content renders them unfit for human consumtpion. 7 Although there is no statutory standard limiting the lead content of foods, the Food Standards Committee reported in 1954 recommending a limit of 10 parts per million in tea. The Public Analyst has reported lead contamination as high as 140 parts per million in Formosa Teas. To quote from the Food Standards Committee's Report: "Lead is one of the most widespread and serious of the metallic contaminants of food and drink. Many foods contain naturally small amounts of lead ; but the principal sources of lead contamination are the use of lead, lead alloys and lead compounds in food processing plant, in the piping by which water and other fluids are conveyed, and in agriculture insecticides. Lead, unlike most other poisons, is stored in the body, and however little is absorbed and stored, there is always the danger that this stored lead may be released and produce toxic effects, Lead poisoning may be brought to light following acute infection and certain other clinical conditions may result in release of immobilised lead. The daily amount of lead ingested is the sum of the minute quantities present in the components of the diet, each of which may contribute apparently insignificant amounts, but the total daily intake in the food may, in course of time, add up to a possible hazard to health. The only way of removing this hazard is to eliminate lead from foods and drink." These contaminated teas are detained in the Port of London or at City Warehouses until acceptable arrangements have been made for blending with other teas in such proportions that the lead content is reduced well within the recommended limit of 10 parts per million, or for reexportation to outside the United Kingdom. The source of lead contamination in Formosa teas has not been established but investigations are being carried out at source. Lead foil linings, at one time generally used for chested tea, have been replaced by aluminium foil linings as a contribution towards the elimination of this type of contamination. The circumstances arising from the control of tea imports have accentuated the anomaly of differing standards applicable by the Port and City of London. In the City of London, the Corporation are the Food and Drugs Authority and the powers of the Food and Drugs Act 1955 are exercisable by them. The Port Health Authority is not a Food and Drugs Authority and is limited to the exercise of the powers granted by the Public Health (Imported Food) Regulations 1937 and 1948. Under the Imported Food Regulations the criteria justifying condemnation are disease, unsoundness, unwholesomeness or unfitness for human consumption. These Regulations would doubtless justify action in the case of excessive lead content as being unfit for human consumption, and for mould or staleness as being unwholesome, but it is very doubtful whether action could legally be taken in the case of an adulterant such as sand, or a case of tea containing 80% stalk, although these could be dealt with under the Food and Drugs Act, 1955. The Public Analyst also finds himself in difficulties in applying differing criteria to the same commodity. Sampling in the Port of London and the City of London is complementary, any consignments destined for City warehouses being allowed forward for sampling at the warehouse. During the year, 5.364 samples were taken for analytical examination, 3,571 by Port Health Inspections and 1,793 by City Food Inspectors, of which 26 were reported as contaminated with lead in varying amounts up to 140 p.p.m., and one as chemically contaminated. This gives a rejection rate of 0.5%. In addition to rejections on account of metallic contamination 29½ tons of tea have been coudemned for reasons of unwholesomeness and unfitness for human consumption. This is invariably disposed of under guarantee for caffeine extraction. Imported Egg Products Imported egg products continue to be regularly sampled for bacteriological examination upon discharge in the Port of London and at the City riverside wharves. Of 296 samples, 57 or 19.3% were found to be contaminated with organisms of the salmonella group, the shipments originating as follows:— Salmonella organisms present Salmonella organisms not found Country of Origin "A" – 2 "B" – 6 "C" – 13 "D" 19 136 "E" 18 69 "F" 20 13 8 All contaminated hatches are subjected to sterilizing heat treatment at an approved centre before release, or released under proper supervision for trade use in instances where the processing involves sufficiently high temperatures to ensure destruction of the bacteria. FOOD HYGIENE REGULATIONS, 1955 Smithfield Market The following report has been received from Mr. D.R. Bernhardt, the Officer appointed to enforce the provisions of the Food Hygiene Regulations, 1955, at Smithfield Market. Stalls. The standard of cleanliness in the stalls is good, and the introduction of PVC Darvic panelling on the walls and partitions has proved very successful. Market Transport. There has been a great improvement in the condition of market vans and the standard of hygiene is very good. Vans are being continually improved and a high standard of repair is being maintained. Offal Containers. All vehicles now have the regulation containers to carry offal. Butchers' Vans. These have been inspected regularly and any infringements have been quickly attended to by the Owners. Trucks. Market trucks show a fair standard of cleanliness. There is no area where trucks can be cleansed and no supply of constant hot water for washing of trucks is available. Some trucks are removed in meat vans and cleansed at the garages of the meat transport companies, others are cleansed within the Market area, after Market hours, with buckets of hot water kindly supplied from various private sources, and the bummaree porter and some meat transport firms have necessarily to rely on this. A centralised cleansing area with constant hot water and a machine for cleansing is urgently required and trucks could then be checked for regular washing. Other equipment from the Market, such as offal containers, boards, etc., could also be cleansed through this machine. A charge could pay for the upkeep and working expenses for such a machine and supply of hot water. There is also no central area for storage of trucks when not in use at the end of each day and some have to be left in the open. It is understood that the provision of these facilities is under consideration. Meat Contamination. Meat is occasionally dropped from trucks in transit to the vans. There are two main reasons for this. Firstly the design of the truck, intended primarily for quarters and carcases and secondly due to overloading. Where overloading and negligence in packing is found, the porter is told and a warning letter sent. In all cases the meat is returned to the shop for reconditioning and the co-operation of the shop is gladly granted, although the meat, having once left the shop, is no longer their responsibility. Some Market carriers are experimenting to adapt the trucks to take the smaller cuts of meat. Washing Facilities. Washing facilities are now available in all conveniences around the Market (free of charge) and good use is made of this. Hats and Clothing. All porters have the necessary protective clothing and hats and these are changed as often as possible. There are inevitably delays with the laundry and some porters require more overalls than others, according to the type of meat being carried, but on the whole the standard is quite good. The two prosecutions which were recently successful at the Guildhall Court for dirty overalls have done much to improve the standard. Smoking. This has been one of the most difficult sections of the Act to enforce. The fact that this is a public market and open stalls are used, action has been taken to stop smoking when a person is engaged in handling meat. Two prosecutions have been successful at the Guildhall Court and the fines imposed have been a great deterrent to smoking. But there are still isolated cases of smoking, and letters of warning have been sent to porters and market staff. The portering staff smoke whilst waiting for orders but not when handling meat. Salesman also smoke on the front of the stall and buyers smoke whilst walking through the market. When handling, of course, they are expected to refrain from smoking but there have been cases, and warning letters have been issued. The union representatives have always given the fullest co-operation in carrying out the Regulations. Catering Establishments Messrs. Thompson and Flynn, the two public health inspectors who specialise in the hygiene of catering establishments, report to the following effect With the close of the year custom and authority demand that we go to the mirror of the past year and look at ourselves to see what we have achieved or failed to achieve in connection with food hygiene. We have failed to secure the advantage that could be gained from the registration and prior approval of new catering establishments. Our lamentations have received added volume from and we echo the sentiments expressed in, the Annual Report of the Medical Officer of Health of St. Marylebone for 1958 who states that 9 "The registration of all food premises is long overdue and it is a sad commentary on the present state of the law that while one shopkeeper selling packaged ice-cream from a refrigerator is required to register with the local authority,*his next door neighbour selling frozen foods is not required to do so. Many of these foods such as made up meat and fish dishes, some of which may be prepared as far afield as Italy, are, if not stored properly, potentially at least as dangerous as ice-cream and are much more liable to contamination during manufacture." It really does border on the ridiculous when our present law compels certain standards to be demanded before a business handling food in one form can commence operation, and yet because of alleged difficulties with the Catering Industry any one can open a restaurant without the Medical Officer of Health having any say in the matter whatsoever. A person must register for the sale of ice-cream but not for the sale of frozen foods ! To what length of dizzy fantasy will the prejudiced mind lead us ? Of course it is feasible to argue academically for non-registration on purely theoretical grounds. Our colleagues in the Planning Department can adjudicate on the necessity of the type of business which may be allowed in a particular neighbourhood or on the external appearance the business will present to the world. The City Engineer can ensure that the sanitary accommodation and plumbing arrangements in all new buildings are in accordance with the bye-laws. We ourselves must then have the temerity to approach any prospective proprietor and ask if we may be informed of the details of their catering proposals. However, should the size of the premises or the spaces allocated for the various functional purposes appear to us fraught with difficulties we find ourselves in a dilemma to which there is no logical answer. We cannot deny the person the use of premises even though he maintains before he commences trading that he can provide all the necessary adjuncts to his proposed business and still leave space for his customers. We know only too well from our experience that such premises are inherently unsatisfactory and will inevitably lead to difficulties and disappointment from everyone's point of view. It is probable that inadequate space in kitchens and inadequate and unsuitable food storage accommodation are basic difficulties which impede good hygienic practice to a greater extent in the City than elsewhere. This is a fundamental reason why we are so insistent that prior approval is the only practicable means of preventing the use of unsuitable premises. It may well be that the solution of this problem lies in the introduction of legislation on similar lines to the Clean Air Act in which a period of grace could be allowed before legislation becomes effective so far as existing premises were concerned provided registration was made compulsory forthwith for all new catering businesses. Looking back not only on the immediate past but over a number of years, some facets of the Food Hygiene problem make themselves more obvious than at the time we were trying to meet certain shortcomings. Much time and effort has been spent by the catering trade in improving the structure of their premises and replacing equipment. In addition new establishments have come into being, with everyone doing their utmost to secure the best possible basis upon which the business shall be run. Nevertheless, some of these relatively new premises are now in a state which should give us all cause for concern, officials and proprietors alike. It is obvious that at the design stage of the equipment, the layout and the adaptation of premises, we did not, and probably are not at the present time paying sufficient attention to and placing sufficient emphasis on operational techniques and maintenance practices which will have to be used in any catering premises, if the original ideals are not to be ruined by the devastation of the daily grind. It is fatal to these ideals if managements ignore or neglect maintenance and good operational methods. We make these comments knowing full well the harassing and trying conditions under which they are compelled to work in the City. It is really hoping for too much to employ anyone in a catering establishment and expect to get first-class labour capable of adopting good techniques without some tuition or training. While no doubt s logans, posters, etc. which are addressed to all and sundry in the catering trade and to no-one in particular, serve some useful purpose, there is no real substitute for definite training and education in the simpler matters of food handling. During the year most Public Health Departments, and the City is no exception, receive varying types of complaints regarding food handling in general. These complaints are investigated forthwith but it is surprising to find on enquiry that the majority of complainants have made no attempt to draw the attention of the proprietor or the manager of the premises in question to their grievances. We feel sure that many members of the catering world would receive these complaints in the right spirit and we are sure also that should the members of the public fail to get the improvements they feel are necessary there are a number of remedies available including the final sanction of taking their business elsewhere. This applies with particular force in the case of one's favourite Public House, where usually a different and more intimate relationship exists between 'mine host"and the patrons. Should direct approach to the Manager fail, again a short note to the brewer would in all probability achieve the necessary results. In making this type of approach we are asking the public to help us. After a moment's contemplation it will be obvious to everyone that greater and quicker improvements would be effected in the general standard of catering hygiene and food handling if the public took an active part by ventilating their legitimate grievances on the spot rather than leaving it all to the local authority, whose staff may be already fully stretched. 10 Inefficient and disinterested catering staff constitute a stumbling block which prevents a quick and substantial improvement in the general standard of food hygiene. In order to assist the rank and file of catering workers an illustrated booklet was prepared under the editorship of the Medical Officer of Health during the year and widely distributed in the catering industry throughout the City. This booklet was written in conjunction with the Food Hygiene Division of the Ministry of Health and with the assistance of some members of the catering industry. It is in the form of question and answer and the subject matter and language has been kept as simple and straightforward as possible in an effort to convey basic and important principles to a class of individuals who are not normally given to deep thinking or extensive reading. It is hoped that this booklet, which has been entitled "Clean Food Handling" will assist the catering worker in taking a greater interest in his or her job and will induce these workers to appreciate the importance of the most ordinary and routine duties and help them to understand the necessity of ensuring a high standard of cleanliness and hygiene at all times. "At all times" is the operative phrase. In the stresses of the lunch time rush, all too frequently everything is sacrificed to the inexorable necessity of serving lunches on time. During the year under review legal proceedings were instituted in one case only. This referred to the heavy infestation by cockroaches of a service counter in a small snack bar. The Proprietor was fined £50 and ordered to pay two guineas costs whilst the Manager was fined £5 and also ordered to pay two guineas costs. Subsequent investigation indicated that effective measures had been taken to deal with the infestation. We would like to express our appreciation of the co-operation which has been forthcoming from the other departments of the City Corporation, particularly those of the City Engineer and the City Planning Officer in informing all prospective caterers of the advisability of contacting us before opening new restaurants or cafes. HOUSING The Housing Act, 1957 repeals and re-enacts in consolidated form the provisions of the earlier Housing Acts with the exception of financial provisions. 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. 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 Five 2. Number of houses in which the defects were remedied in consequence of informal action by the Local Authority or their Officers Four 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 One 6. Number of demolition or closing orders made None 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. Number of houses demolished None During the year 48 families were rehoused leaving 499 families for whom accommodation was required at the end of December 1959. No new housing accommodation was provided during the year. The modernisation of Kings Flats, Artizans Dwellings, has been completed and work will shortly be commenced on the modernisation of North Flats, Artizans Dwellings, to be followed by further work at Windsor House, Shoreditch and on other pre-war estates. The old people's accommodation at Isleden House continues to be of great interest to people in this country and from overseas who are concerned with the housing and welfare of the elderly. 11 The result of living under the conditions which obtain at Isleden House is reflected in the wellbeing of the elderly residents and their longevity, coupled with the very infrequent use made of the Sick Bay for treatment of the residents. This allows the Sick Bay to continue to receive patients from St. Bartholomew's Hospital (a total of nearly 600 having been admitted since 1954) and also to receive elderly tenants from the Corporation's housing estates, in need of rest and medical attention. The erection of new flats on the extension to the Corporation's housing estate at Golden Lane was commenced in March 1960 and it is expected that the first of three blocks of flats will be completed by June 1960 and the whole of the extension scheme, comprising 275 flats, shops, garages and ancillary buildings, by April 1961. The redevelopment of the Corporation's Avondale Square Estate will be commenced early in 1960 but the redevelopment of the housing estates in Holloway and adjoining the Metropolitan Cattle Markets in Islington is still in abeyance pending agreement with the London County Council on the use of the vacant site of the sheep lairs to the west of the market. The improvements to the Freemens Houses at Ferndale Road, Brixton, are well forward and should be completed by June 1961. I am indebted to Mrs. Rita Cohen, Hon. Welfare Officer and Hon. Secretary of the City of London Old People's Welfare Association, for the following report :— "During 1959 the City of London Old People's Welfare Association has concentrated its activities in extending established services and in maintaining friendly contact with the over 60's in, and of, the City for whom the Association accepts responsibility. "These services include — Chiropody, Club facilities, Convalescent Holidays, Employment Schemes, Home Help and Night Attendance, Mid-day Meals and Recreational Activities. "As a voluntary organisation this Association acts as a group of good neighbours and tries to ease the burden of those who through sickness, old age, physical or mental disability, cannot provide for themselves, adequate help." RODENT CONTROL Mr. J. Carter, the Rodent Officer, reports as follows — 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 aforesaid ; (b) To destroy rats and mice on land of which they are the occupier and otherwise to keep such land as 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 totheir 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 Department was similar to that of previous years, comprising inspection of properties to ascertain the presence of rats and/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 cooperation of occupiers and owners has been most satisfactory. A total of 1,764 occupancies and properties were inspected. These properties ranged from new buildings in varying stages of construction, riverside food warehouses and other premises, public and private catering establishments, blocks of offices, shops and factories, to domestic dwellings. Altogether 545 infestations of rats and mice were the subject of control measures, and of this number 331 infestations were notified by owners or occupiers, and 242 infestations were found, by inspection. This total comprised 3 major and 50 minor infestations of rats, and 25 major and 467 minor infestations of mice. Treatment of these infestations entailed 4,186 visits for operational purposes. In the application of control measures for rat infestation, 3,835 prebaits and 385 poison baits were laid. These measures resulted in a minimum estimated kill of 399 rats, of which 162 bodies were found. The use of warfarin anticoagulant baits for mice resulted in 886 bodies being found. No records are available of the results obtained by Pest Control undertakings servicing premises periodically. 12 In 36 instances structural rat proofing was carried out by owners or occupiers. Incidental rat and mouse proofing in the nature of the removal of harbourage provided by unnecessary and undisturbed accumulations received detailed attention, and in this respect the assistance given by the Director of Public Cleansing and his Inspectors was invaluable. The downward trend of rat infestation manifest in recent years has continued and a further decline in the number of infestations found and treated, and the numerical quality of the same has been experienced. Although there was a slight increase in the major classification, (20 rats or over), 3 infestations as against 2 the previous year, they were borderline infestations just qualifying for that category. In the minor classification there was a reduction of 8%. 50 as against 54 in 1958. Of the 53 rat infestations which were the subject of control measures, only 21 were of Ship (Black rat) character, this being the lowest figure yet recorded, and in each instance the infestation was minor. In the past the Ship rat has always been the dominant infestation and 90% of infestations were of this nature. Prior to and after the war this specie was firmly established in the City, and indeed, the whole riverside of the riparian Boroughs. In 1944 it would have been true to say that very few properties in the City were free of this type of infestation. The older properties, multi-storied, centrally heated and non-residential, war damaged, and interspersed with restaurants, canteens and other sources of food, were specially conducive to ship rat infestation. Haphazard and sporadic control measures were totally ineffective and in many instances occupiers regarded such infestation in City premises as inevitable. From 1944 onwards organised control measures and systematic inspection was instituted. Many established reservoir infestations were gradually eliminated, and in succeeding years the decrease in the numerical density of ship rat and, more recently, the distribution, became apparent. To illustrate further the decline in rat infestation, the following summary collated from detailed information kept since 1944, and the graph is included as a useful record. It should, however, be understood that the figures referring to rat infestation include those of Common rat (Rattus Norvegicus), but as already stated 90% of the infestations in the past were Ship (Black) rat. It is also emphasised that the estimated number of rats killed is the minimum. The total in the bodies found column 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 Posion baits laid Mice Warfarin Baits Rats Mice Poison Traps No. 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 1958 523 2 54 36 431 343 191 16 1,012 7,645 3,034 336 6,653 1959 545 3 50 25 467 399 162 2 886 8,643 3,835 385 8,593 9,613 1,848 3,382 1,180 3,213 65,071 21,521 5,599 12,404 231,800 868,361 124,480 97,630 In reviewing the present position of Ship rat infestation in the City a general perspective is necessary, the City having boundaries with five Metropolitan Boroughs, plus a considerable riverside frontage of wharves and warehouses. It is therefore necessary to go beyond one's own boundaries or particular sphere of influence and envisage the situation as a whole when assessing the relative factors which have contributed to the position now obtained. Among the foremost of these are, the diminution of re-infestation from outside sources, the great improvement in hygiene, progressive building construction, and improved control measures. Regarding the question of re-infestation from outside sources there is little doubt that in the earlier years, established infestations of ship rat were augmented from outside, principally via shipping and river lighters, and to a much lesser degree road transport. 13 In this respect the Port Health Authority by exercise of its functions relative to rodent control in ocean going vessels, coastwise shipping, river lighters, and shore premises within the curtilage of the Port of London Authority, has made a contribution of primary importance, resulting in a greatly diminished possibility of re-infestation from these sources, which has become evident in the City and equally the riverside of the riparian Boroughs. The importance of this contribution is accentuated by the figures of shipping entering the Port during the year under review. They comprise 16,135 vessels from foreign ports and 11,139 coastwise vessels with a combined gross tonnage of 43,424,411 tons. In addition these vessels were served by 7,000 lighters receiving cargo overside for distribution to wharves and warehouses on both sides of the river. The importance of hygiene, relative to rodent control, embracing proper garbage disposal, food storage and elimination of structural and incidental harbourage must be emphasised. Maintenance of good general conditions, whatever the usage of property, is essential forthe permanent control of commensal rats and mice, and the application of control measures should be regarded as supplementary to hygiene. In the field of catering premises, both public and private, the continued improvement embracing the abovementioned provisions has been maintained, thereby contributing to the overall position of Ship rat infestation. Regarding the old types of properties used mainly as offices, many of these have been entirely reconstructed internally, resulting in the removal of structural harbourage, while others have been effectively improved. In addition occupiers have become rat conscious and do not hesitate to seek advice and assistance. To summarise the position of Ship rat infestation it will be of interest to include the conclusions of an interim summary based on a survey of the Ship rat in the United Kingdom made by Officers of the Ministry of Agriculture, Fisheries and Food, two years ago in co-operation w ith Local Authorities. The date has now been collated and the full report will be published shortly. Meanwhile, the interim summary covering the period 1951 - 1956 provides the following:— (1) In 1951 the Ship rat was reasonably well established ashore in the London area and in about 40 localities outside it, and occurred sporadically in about 30 other places. (2) By 1956 it had decreased in range and frequency in most localities and disappeared from some. (3) The main factors responsible for its loss of ground between 1951 and 1956 are thought to be the continuous reduction in the number of rats arriving in the ports in ocean-going vessels, the introduction of measures to reduce rat infestation on coastal vessels, improvements in dockside building construction and improved methods of control on land. (4) It is thought that the ship rat will lose more ground in the next few years, but can be expected to persist fora considerable time yet, at least in London, Bristol and Liverpool, and perhaps in Leith and Belfast. The 31 Common rat infestations which were the subject to control measures were mainly confined to re-building sites in varying stages of construction. These sites offer facilities, and are in every way conducive to this type of infestation, but taking into consideration the vast reconstructure carried out in recent years, the size of the sites, and wide distribution, the problem 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; old and often obsolete drainage is broken into 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 such sites. The temporary canteens provided for the workmen are in the main well maintained, but nevertheless are an attraction to rats and mice. The principal food supply is, however, provided 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 without regard 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. The gradual increase and wider distribution of mice infestation apparent in recent years, and coinciding with the decrease in rats, has not been quite so noticeable, there being a reduction of 30% in major infestations treated, while the number of infestations in the minor category remained fairly constant. In reviewing this problem there appears to be a connection with the comparable decrease in rat infestation, there being little doubt that the absence of rats has left the way clear for mice, which do not respond to control measures in the like manner of rats 14 There are many factors to be considered, such as environment and the pattern of behaviour, embracing the general feeding habits and ability to subsist without water, plus the acceptance of harbourage and food supply which would be quite inadequate for rats. 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 when mature, and the food intake in 24 hours is consequently very small - between 3 and 5 grammes, so that very small quantities of food are 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 when applying control measures with poison. This factor also limits the use of the more acute poisons. Where there is unlimited harbourage, structural and incidental, as found in warehouses with large bulk stowages of varying commodities, and 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 emerge 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. 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, crates of eggs, and cartons. 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 paringp, odd scraps, and milk bottle tops with cream adhering, thrown down in inaccessable places. Alternately, it is put into waste paper baskets where, as a rule, it remains all night, to attract and provide the subsistence for mice. During the year, three direct poison treatments for the destruction of rats in sewers were carried out. These control measures were proceeded by an overall test bait control and comprised the third series of four quarterly controls by direct poisoning with Fluoracetamide '1081'. The first of these treatments was applied in December 1956 and the final treatment of the series will be carried out in March 1960. On completion a comprehensive report will be written giving the full details of each treatment, and test controls applied between each series. These control measures, unique to the City, have been carried out in conjunction with the Scientific Officers of the Infestation Division, Ministry of Agriculture, Fisheries and Food. Prior to the institution of these control measures, a similar series of 17 treatments at quarterly intervals, interspersed with overall test bait controls was applied, the toxic agent being Mono Sodium Fluoroacetate '1080'. These treatments, the first to be carried out in this country, appeared to be very successful, and it was decided to apply the present series, now nearing completion, in an endeavour, as far as reasonably practicable, to ascertain if the low level of rat infestation believed to have been achieved, could be maintained by Fluoracetamide '1081'. From the information collated so far, and the similarity of the results obtained with these poisons, it does appear that Fluoracetamide is comparable in effect with sodium Fluoroacetate. By reason of its more granular texture, the former is safer to dispense, and owing to its lower toxicity to rats, and presumably to man, is less hazardous in distribution. 15 ATMOSPHERIC POLLUTION The results of the measurement of air pollution by the methods recommended by the Department of Scientific and Industrial Research are set out in the Tables which follow. Table 1 - Deposit Gauge Material coarse enough to settle out of the atmosphere is collected in the bowl of the gauge and washed by rain into a large bottle. Each month the contents of the bottle are measured and analysed. The Table gives the volume of water collected and its equivalent in inches of rain, and it will be seen that the rainfall in 1959 was much below that of 1958 and less than the average for the previous five years. The influence of the redevelopment of the City with its consequent demolition and reconstruction of buildings continues to be reflected in the total deposited matter which is much in excess of the average for the previous five years. In these circumstances the original intention of the gauge to measure the impurity produced by the combustion of coal and similar fuels, is of a reduced value. However, there is a connection between the deposits of combustible matter (including tar) and the smoke emitted from chimneys. This constituent is determined by estimating the weight of the matter which is insoluble in water but soluble in carbon bisulphide. Smoke pollution is at its maximum in the winter heating season, i.e. from the beginning of October to the end of March. A comparison of the weights obtained during the five heating seasons beginning in October 1955 (which approximately corresponds with the period of operation of the smoke abatement provisions of the City of London (Various Powers) Act, 1954) with the previous five years beginning in October, 1950 shows that the deposits of "Tarry matter" has decreased by some 62 per cent. This corroborates the results of the survey of air pollution in London by members of the Department of Scientific and Industrial Research, referred to in the last annual report, when it was concluded that the maximum reduction in smoke pollution in the centre of the City of London was some 58 per cent, and gives added force to the view that there is appreciable local benefit in a smokeless zone although it may be surrounded by smoky neighbours. In the latter connection it is noted that by the end of 1958, of the five local authorities bounding the City, with a total acreage of 6,507 , 305 acres in three boroughs were covered by smoke control areas under the Clean Air Act, 1956. The establishment of these areas has as its main purpose the control of smoke from domestic stoves and fireplaces burning coal, which cause about half the smoke in the atmosphere. By the end of 1959 an additional 320 acres in four of the boroughs was covered and by the end of 1960 it is estimated that a further 588 acres in five boroughs will be similarly dealt with. At this rate of process it is estimated that the target year for the completion of the phased programmes in the five areas will vary between 1965 and 1974. The area of the City of London is 678 acres. Through the good offices of the Warren Springs Laboratory of the Department of Scientific and Industrial Research, and with the permission of the Controller of Her Majesty's Stationery Office, the photograph illustrates the yearly average of smoke pollution in the County of London. It will be seen that the smoke concentration in the City of London is of the lowest order. Table II - Smoke concentrations by the volumetric method This method recognises the distinction to be drawn between the relatively coarse particles of pollution deposited by their own weight, or washed down by rain - as measured by the deposit gauge - and fine particles which remain suspended in the atmosphere. In 1959 the average concentration of smoke varied slightly from the results obtained in 1958. Short period measurements taken at Golden Lane during foggy weather between 2.0p.m. on the 18th until 2.0 p.m. on the 19th February resulted in an average concentration of 109 milligrams per 100 cubic metres. On the 12th November, similar measurements between 2 and 10 p.m. recorded a concentration of 139 milligrams. The foggy weather on the 18A9th November when further short period measurements were taken resulted in a smoke concentration of 133 parts per 100 m. parts per air. Table HI - Sulphur measurements by the volumetric and lead peroxide methods. All four stations showed increases in sulphur pollution by the volumetric method when compared with 1958 and with the previous five years at Golden Lane. The results obtained by the lead peroxide method (which determines over monthly periods the extent to which an area of 100 square centimetres is attacked by atmospheric sulphur dioxide) indicates that at both Golden Lane and Finsbury Circus there was an increase when compared with 1958 and the averages for the previous five years. Short period measurements taken at Golden Lane between 2.0 p.m. on the 18th February and 2.0 p.m. on the 19th February showed an average concentration of 105 parts per 100 million parts of air, and similar measurements between 2 and 10 p.m. on the 12th November recorded an average concentration of 72 parts of sulphur dioxide per 100 million parts of air. More foggy weather occurred on the 18/19th November when short period measurements resulted in an average concentration of 83 parts of sulphur dioxide to 100 m.p.p. air. It has been suggested that when the mean level for London attains a daily value of 200 milligrams of black suspended matter per 100 cubic metres of air and 40 parts of sulphur dioxide per 100 million parts of air a 'smog incident' is likely to occur. Fortunately, the foggy periods when high pollution figures were obtained were of comparatively short duration,and without atmospheric conditions conducive to so-called 'smog incidents'. 17 TABLE I—Results obtained in 1959 of the monthly observations of rainfall and deposited matter by means of the deposit gauges. MONTH Rainfall collected in deposit gauge DEPOSITS Equivalent to Insoluble Soluble Total Millimetres inches of rain Milli- inches metres of rain Tons per square mile STATIONS (see note below) A B A B A B A B January 49 1.93 39 1.55 12.31 14.90 7.10 9.36 19.42 24.26 February 1 0.04 – — 11.72 — 6.34 — 18.06 — March 40 1.58 – — 45.64 — 16.86 — 62.50 — April 32 1.27 39 1.54 28.51 32.72 9.69 16.41 38.20 49.13 May 20 0.79 21 0.82 22.60 12.32 4.98 4.93 27.58 17.25 June 33 1.31 32 1.28 25.46 15.00 7.47 7.22 32.92 22.22 July 38 1.51 36 1.41 9.16 11.34 5.71 5.30 14.87 16.65 August 101 3.96 98 3.84 14.34 10.24 6.97 7.85 21.31 18.09 September 2 0.09 2 0.08 7.27 6.91 4.78 3.15 12.05 10.07 October 40 1.59 40 1.57 15.57 18.99 9.33 11.14 24.89 30.14 November 59 2.31 59 2.31 12.38 10.20 9.79 12.72 22.17 22.92 December 72 2.83 71 2.82 32.76 15.44 8.93 11.88 41.69 27.32 Averages: 1959 41 1.60 44(b). 1.72(b) 19.81 14.81(b) 8.16 19.00(b) 29.64 23.80(b) 1958 62 2.44 66(a) 2.58(a) 18.88 16.39(a) 7.39 12.06(a) 26.27 28.45(a) 1957 42 1.66 — — 14.56 — 7.17 — 21.73 — 1956 44 1.74 — — 13.31 — 7.80 — 21.08 — 1955 43 1.71 — — 13.73 — 7.99 — 21.71 — 1954 47 1.80 – — 12.40 — 9.04 — 21.35 — 1954-58 48 1.87 – – 14.57 – 7.88 – 22.4 – Note: A — Golden Lane. B — Guildhall from 1st June, 1958. (a) average for 7 months. (b) average for 10 months. TABLE II—Results obtained in 1959 of the daily observations of the concentration of SMOKE by the volumetric method. Month Rainfall collected in deposit gauge at Golden Lane POLICE STATIONS Golden Lane 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 49 1.93 24 43 33 28 February 1 0.04 22 31 41 16 March 40 1.58 11 22 22 8 April 32 1.27 7 18 17 8 May 20 0.79 6 11 15 4 June 33 1.31 4 10 13 3 July 38 1.51 2 12 9 2 August 101 3.96 3 11 7 3 September 2 0.09 4 10 7 5 October 40 1.59 7 14 10 6 November 59 2.31 17 32 19 13 December 72 2.83 11 22 20 8 Averages: 1959 41 1.60 10 20 18 9 1958 62 2.44 9 20 16 7 1957 42 1.66 9 25 15 7 1956 44 1.74 14 15 12 13 1955 43 1.71 14 13(a) 10(a) 12(a) 1954 47 1.80 14 — — — 1954-1958 48 1.87 12 (a) Measurement for 9 months of the year. 19 TABLE III.—Results obtained in 1959 of the measurement of SULPHUB DIOXIDE by the volumetric and lead peroxide methods. Month Rainfall collected in deposit gauge at Golden Lane Police Stations LEAD PEROXIDE METHOD Equivalent to Golden Lane Bishopsgate Cloak Lane Snow Hill Golden Lane Finsbury Circus Millimetres inches of rain Monthly Average Monthly Average Monthly Average Monthly Average Mgs. (S.0.3) per day per 100 sq. cm. Parts per 100 m. parts of air January 49 1.93 23 28 26 24 6.34 5.24 February 1 0.04 22 26 28 25 6.06 5.19 March 40 1.58 11 15 15 14 3.56 3.26 April 32 1.27 10 42 13 13 3.16 2.38 May 20 0.79 6 10 11 8 2.14 1.38 June 33 1.31 3 9 8 6 1.85 1.24 July 38 1.51 2 7 6 4 1.73 1.08 August 101 3.96 4 8 8 4 1.99 1.00 September 2 0.09 5 9 8 6 2.13 1.24 October 40 1.59 10 14 14 11 3.76 2.36 November 59 2.31 16 20 16 15 4.70 3.37 December 72 2.83 13 18 16 13 4.10 3.09 Averages: 1959 41 1.60 11 17 14 12 3.46 2.57 1958 62 2.44 10 14 12 10 3.10 2.66 1957 42 1.66 9 12 11 11 2.71 2.47 1956 44 1.74 10 15 12 13 2.69 2.42 1955 43 1.71 10 13(a) 10(a) 12(a) 2.85 2.57 1954 47 1.80 11 – – – 2.54 2.60 1954-1958 48 1.87 10 – – – 2.78 2.54 (a) Measurements for 9 months of the year. CLEAN AIR - SULPHUR POLLUTION During the year the Port and City of London Health Committee gave considerable attention to the question of the emission of sulphurous gases into the atmosphere and received reports from the various Officers concerned. For record purposes the following report is included in the Annual Report of your Medical Officer of Health. The question was still under consideration at the end of the year. TO THE WORSHIPFUL THE PORT AND CITY OF LONDON HEALTH COMMITTEE Gentlemen, CLEAN AIR - SULPHUR POLLUTION At your meeting on the 4th March last you further considered the proposal in the Motion of Mr. Stanley E. Cohen relating to the emission of sulphurous gases into the atmosphere. You then instructed Mr. Engineer, the Medical Officer and myself to report upon the possibility of obtaining powers to control such emission, and further authorised us in our discretion to obtain advice from appropriate experts. 2. This problem has been exhaustively examined by us, and the views of a great number of scientific and medical experts have been reviewed during the course of our considerations. Mr. Engineer considered that as technical progress was fully reported to date, there appeared to be no point in engaging a further consultant in his field, but the Medical Officer submitted his conclusions to Dr. Charles Fletcher, C.B.E., (Cambridge and St. Bartholomew's) Senior Lecturer in Medicine at the British Postgraduate Medical School at Hammersmith, lately Director of the Pneumoconiosis Research Unit, Medical Research Council. Dr. Fletcher considered that the summary of the Medical Officer, in the light of present medical knowledge, was admirable, and had no further constructive comments to make. He further pointed out that Dr. Daly, working in Dr. J.N. Morris's Social Medicine Research Unit, make some studies of bronchitis mortality in county boroughs, and showed a closer correlation with domestic rather than with power station coal consumption, and since power stations are the greater producers of sulphur, it was taken as 20 evidence that smoke might be more important than sulphur. This work has never been published in full, and only briefly in the transactions of the Association of Industrial Medical Officers. He agreed that the only way of determining the effect of sulphur gas would be by prospective surveys over the next decade, during which smoke will doubtless be reduced while sulphur pollution will remain relatively constant. 3. The comments set out above summarise in effect the conclusions to be derived from the technical observations of Mr. Engineer and the Medical Officer; in short, that sulphur alone is not a proven danger. They are brought into this introduction so that Your Worshipful Committee may be aware of the inevitable scientific deduction which is to be drawn from the reviews of your Technical Officers. 4. In seeking to obtain legislative powers to control a nuisance, it is essential that it is possible clearly to define the nuisance, and to prove that such nuisance exists as a hazard to health or welfare, and finally to set out in the powers sought a practical manner of controlling such a nuisance. Mr. Remembrancer has kept these requirements in mind when reading the opinions of the experts in this field. The Medical Officer would say:— 5. The magnitude of the London Fog in December, 1952, focussed public attention upon the serious effect of atmospheric pollution on health. The Minister of Housing and Local Government appointed in July, 1953, the Committee on Air Pollution, with the following terms of reference:— "To examine the nature of causes and effects of air pollution, and the efficacy of present preventative measures; to consider what further preventative measures are practicable, and to make recommendations." Both the interim report issued in November, 1953, and the final report of the Committee indicated that the sulphur content of British fuels varies considerably. When the fuel is burnt, whether in industrial or domestic appliances, most of the sulphur is also burnt, being converted into twice its weight of sulphur dioxide, a gas of acidic properties which is discharged with the chimney gases. An estimate was given of 5 million tons of sulphur dioxide per annum from the use of solid fuels used throughout the Country in 1952. From the burning of 4.5 million tons of fuel and gas fuel oils, together with 0.6 million tons of creosote pitch mixtures in 1952, there would be little smoke given efficient combustion, but assuming an average sulphur content of 2 to 4%, the burning of 5.1 million tons would result in about 0.3 million tons of sulphur dioxide being discharged with the chimney gases. Diesel engines (road transport and others) use about 2 million tons of oil per year, and produce from 20,000 to 40,000 tons of sulphur dioxide. Some 5.3 million tons of motor spirit (including motor benzole) were used in transport in 1952. The amount of sulphur dioxide produced in this source is negligible. 6. The only recommendation of the Committee, so far as the emission of sulphur dioxide is concerned, related to the washing of gases at power stations to remove at least 90% of that pollution. The comment is made "that there remain many uses of fuel for which the more expensive refined sources of energy will be too costly. There is thus no present prospect of substantially reducing the emission of sulphur dioxide from general industry or domestic fires. An intensive research is recommended." In this connection, the standing Advisory Committee to the Medical Research Council has a Sub Committee on Atmospheric Pollution with working parties engaged on various aspects; e.g. chronic bronchitis in relation to atmospheric pollution; the constituents of atmospheric pollution and means of prevention,mortality and morbidity statistics,etc. 7. So far as the City of London is concerned, in 1953 the approximate consumption of solid fuel was 72,300 tons. The amount of sulphur in these fuels varied between 0.5% and 3%. Assuming the average sulphur content to be 1.5% by weight the sulphur dioxide emitted would have been 2,169 tons. In 1954 the annual consumption of fuel oils was 20,000 tons, and if all the oil burnt in that year had contained an average of 3% of sulphur, (light or 200 seconds oil) the total sulphur dioxide pollutant would have been 1,200 tons. If it had all contained 3.7% (medium or 950 seconds oil) the total would have been 1,480 tons, and if it had all contained 4% (heavy or 3,500 seconds oil) the total would have been 1,600 tons. Unfortunately no figures were actually available which subdivide the various grades of oil into their sulphur content, but figures have recently been obtained from one large oil company from the quantities which they are now supplying. Heating oil 35 seconds 1% sulphur 324 tons Light oil 200 " 3.0% " 2,260 " Medium oil 950 " 3.7% " 1,400 " This company does not supply any heavy grade oil in the City, and in any case, only the largest installations in buildings of many storeys would burn the heaviest grade of fuel oil, and the height of the chimneys would assist in the greater dispersal of the flue gases, with a consequent decrease of the ground level concentration of sulphur dioxide. 8. Thus it will be seen from the figures of the particular company referred to above that if the 950 seconds viscosity oil with a sulphur content of 3.7% was substituted by 200 seconds oil with a sulphur content of 3 0% the total annual sulphur dioxide would be reduced by only 0.7% of 1,400 tons; i.e., 9.8 tons, which is not a significant figure compared with the total emission. It should, however, be remembered that oil consumption for central heating in the City must have risen steeply since 1954, but the actual increase is not known. 21 9. Medical literature, especially since 1952, abounds with references to the effect of air pollution on health. Incidences of this have been given in reports to the Port and City of London Health Committee from time to time. The authoritative views of the Committee of Departmental Officers and Expert Advisers, appointed by the Ministry of Health to enquire into the mortality and morbidity during the London Fog of 1952, found that between 80% and 90% of the increase in deaths during and immediately after the fog were due to respiratory and cardiovascular diseases, mainly of a chronic nature, and that between 60% and 70% of the increased deaths were in people over the age of 65. The increase in morbidity was less than might have been expected from the excessive mortality. It was also concluded that substances in the polluted fog caused irritation of the bronchii and of the broncholes, and so accelerated death in those already suffering from diseases of the respiratory and cardiovascular systems, but that in the present state of knowledge, it was impossible to state that any one pollutant was the cause of death. The report also contained a note that no firm conclusion had been reached as to the result of the work of the Atmospheric Pollution Research Unit in the endeavour to establish some relationship between health and the constituents of the atmosphere. There was also contained in the report the conclusion of Dr. Percy Stocks, the eminent Statistician, that highly significant statistical correlations were found from bronchitis and lung cancer with undissolved deposit and smoke from the air in county boroughs of England and Wales. 10. A recent survey in London, undertaken by the London County Council Public Health Department and Scientific Division, includes many references from medical literature. It is shown how the death rate from bronchitis increases with the degree of urbanisation, and that there is some correlation between deaths from bronchitis and the amount of pollution in the atmosphere. Reference is made to the differential death rate from bronchitis in middle aged men between industrial cities and seaside resorts, although there is the reminder of the differences in social classes in this context. 11. The conclusions drawn from the survey mentioned in paragraph 10 together with all the other available information,shows that there is little doubt that living in London for a long period increases the risk of dying from respiratory disease, particularly with bronchitis, and since these diseases are often suffered over a number of years, morbidity too is associated with the length of residence. No significant relationship between mortality and the two types of atmospheric pollution so far considered, i.e., sulphur dioxide and smoke, has been demonstrated, though smoke looks more dangerous than sulphur dioxide. This conclusion does not preclude there being a critical level of one or both in combination that could be directly associated with increased mortality or morbidity, but equally there may be other types of pollutants more dangerous than either. In this respect Professor F.G. Pybus, Durham University, a cancer research worker of some 30 years, holds the opinion that benzepyrene is the most prolific source of danger and damage to the lungs. 12. In the short term, whilst it is difficult to disentangle the effects of duration and intensity of atmospheric pollution and temperature from any seasonal trend, the effect of the smog of January 1956 suggests that the threshold level above which a smog incidence is likely to occur in London is when the mean level for London attains a value of 200 milligrammes of black suspended matter per 100 cubic metres of air, and 40 parts of sulphur dioxide per 100 million parts of air; i.e. about four times the customary winter level. The differential effect on old people when pollution reaches this level, has been shown, though the overall effect was much less than the catastrophe of 1952. 13. If, as is to be anticipated, measures to diminish the amount of atmospheric pollution reduce the amount of smoke, it may be possible to assess with greater clarity the respective parts played by sulphur dioxide and smoke which have both so far been present concurrently in the atmosphere in roughly the same proportions during different episodes of fog. Mr. Engineer would say:— 14. That there is not yet any satisfactory method at reasonable cost of preventing pollution by oxides of sulphur. Confirmation of this was obtained from Dr. Charles Forrester of the Chief Scientists Division of Ministry of Power, who is particularly concerned with the subject of sulphur. Research work in progress at the British Coal Utilisation Research Association, undertaken at the request of the Minister of Power, on methods to prevent the sulphur in coal passing into flue gases, indicated that there was a promise of technical success, but that the cost might be high, and that there might be difficulties in putting the method into practice. Dr. Forrester states that it is virtually impossible to remove more than a proportion — say one-tenth to one-half — of the sulphur in coal by cleaning treatment, and quite impracticable to remove it from the heavier fuel oils. Dr. Forrester furnished the most precise table to date on the sulphur content of British fuels which are set out below:— Fuel Sulphur Petrol 0.3% to 0.16% Kerosine 0.04% to 0.15% Gas/Diesel oil 0.05% to 1.0% 22 Industrial fuels oils:— (B.S.I. Standards) 250 seconds Class E 2.5% to 3.3% 950 " Class F 3.0% to 4.0% Heavy Class G 3.5% to 4.0% Bunker Class H 4.0% to 5.0% 15. To use viscosity as a criterion for approval of any fuel oil was considered unwise by Dr. Forrester, since viscosity is not necessarily a guide to sulphur content, because some 250 seconds oil from the U.S.A. would contain very little sulphur while some 950 seconds oil from the U.S.A. might be as good as the average British 250 seconds oil in respect of sulphur content. It will be noted from the Table set out above that there is an overlap of sulphur content in the various grades of oil, and on a viscosity standard it could well be that approval would be withheld to a British oil of 950 seconds with a 3.0% sulphur content, whilst approval would be given to a 250 seconds British oil with a sulphur content of 3.3%. To see the matter in a true prospective it is necessary to make an accurate assessment of the relative sulphur release of each fuel, since it may be necessary to burn only half as much of one type of fuel to achieve the same heat release as another type. For example, the weight of fuel burned to produce a therm of heat is approximately in solid fuel 8.31 lb., of kerosine 5lb., and residual fuel oil 5lb. Dr. Forrester has explained this matter in detail, and the following Table sets out his conclusions:— Sulphur dioxide emitted into air for a therm of heat produced (Note: All considerations have been taken into account) Fuel 1 bs. S.O.2 Kerosine 0.004 to 0.016 Coal (used at gas works) 0.15 Coke (domestic) 0.15 Coke (other uses) 0.15 to 0.3 Coal (domestic) 0.28 Oil fuel (250 seconds) 0.25 to 0.33 Oil fuel (950 seconds) 0.3 to 0.4 Oil fuel (above 950 seconds) 0.35 to 0.4 British oils only are used in the table. 16. In comparing the domestic use of coal and coke with residual fuel oil, it must be remembered that low chimneys do not facilitate the dispersal of sulphur dioxide, whereas in most industrial and commercial premises dispersal is facilitated by the taller chimney stacks. The table also illustrates that fuel oil of 950 seconds might emit less sulphur dioxide per therm of heat produced than 250 seconds oil, and that a heavy fuel oil could emit less than a 950 seconds oil. 17. If it is conceded that:— (a) whatever the percentage of sulphur any liquid fuel may contain, it will on combustion become sulphur dioxide, and be emitted into the air with the products of combustion; and (b) that sulphur dioxide will ultimately become oxidised to sulphur trioxide and then to sulphuric acid,and that all three are objectionable as affecting health and materials; and (c) the removal of all the sulphur from solid fuels remains a problem to be solved because residual oil fuels are extremely intractable chemically, and no economically feasible method has so far been found to eliminate or reduce the sulphur content, all of which would be emitted as sulphur dioxide despite continued research; the problem outstanding is whether pollution can be reduced by:— (i) the judicious selection of fuels of the lowest sulphur content for use in selected areas, e.g., the central areas of large cities with buildings of varying heights, as in the City of London, or (ii) by discharging gases through high chimneys to assist their dispersal at high levels with consequent dilution to comparatively harmless concentrations at ground level? 18. On (ii) above, Mr. Comptroller and City Solicitor is reporting jointly with the Medical Officer of Health, Mr. Engineer and the Planning Officer to the Improvements and Town Planning Committee on the powers, if any, possessed by the Corporation to control the height of chimneys of new buildings, and the prevention or minimising of the nuisance on the products of combustion emitted from the chimneys of buildings at a lower level to the new and higher buildings. 19. On (i) above, so far as solid fuels are concerned, the question does not arise, since the sulphur content of such fuels is more or less constant. In the case of industrial fuel oils, apart from any quality requirements for special industries, the prospective user will wish to use a liquid fuel which his plant can handle with the greatest economy. This will often be the heaviest, and therefore cheaper grade, which has the greatest sulphur content. The exceptions to which no previous reference has been made are the coal tar fuels which consist of distillates from coal tar, free from admixture of petroleum oils. The sulphur content of such fuels vary from 0.06% to 1.0% which makes them attractive from the low sulphur content, and their use might well be 23 couraged in the City. All grades of oil are capable of operating continuously without the emission of smoke, and from the existing legal point of view the plant owner has complete freedom of choice to use any grade of oil. The co-operation of all oil distributors (a very competitive trade) might possibly be sought to minimise as far as practicable pollution from sulphur in recommending to customers the use of those residual fuels oils with a sulphur content not exceeding 3%, despite any increased cost to the customer. 20. The Air Pollution Control Regulations in Los Angeles limit the sulphur content of fuel oil to 0.5%. Conditions in that area are very different to our own however both topographically and meteorologically. No coal and very little coke is burnt, and soot and ash is thus not a problem. It is also probably true to say that were it not for an abundant supply of alternative fuel in natural gas, such a regulation could not be possible. Mr. Remembrancer would say:— 21. Having read the observations of Mr. Engineer and the Medical Officer of Health, and also of having had the advantage of many conversations with them on this subject it seems to me that the problem can be reduced to certain essentials. In my opinion they are:— (i) that most authorities accept that living in towns has a deleterious effect on health; (ii) that smoke and sulphur are probably strongly contributory causes. Smoke of course has many other evil secondary effects such as sun starvation, damage to buildings, loss of amenities etc., but for our present purpose these must be left out of account; (iii) in the present state of scientific knowledge it is not known whether smoke by itself, or sulphur by itself, or these two in combination with each other or one of them in combination with some other cause is the root cause of the trouble. It may be that there is a balance in nature, the disturbance of which has disastrous effects but the cause of this possible disturbance has yet to be isolated; (iv) the smoke nuisance has been attacked by our own legislation and by the Clean Air Act. The reduction of smoke nuisance will reduce not only the secondary effects to which I have referred in (ii) above, but also will assist those who are investigating these matters with some hope of isolating the true causes of the deleterious effect of living in towns; (v) it can be argued that an attempt to remove sulphur pollution would contribute to this investigation but our technical knowledge at this stage is wholly insufficient to enable us to attempt it. The slight reduction that might possibly be made in the City would be expensive and in the small area concerned would virtually be valueless from the point of view of research and probably from the health point of view; (vi) there are very many specialised agencies who are investigating the subject of sulphur pollution, its effects and how to stop it. While I would wish that the City should play a useful part in this work, at the present stage I cannot see that it is possible for the City to do anything useful by legislation. The form of any such legislation would be most difficult to substantiate on the evidence available. 22. I have discussed this problem informally with the Ministry of Housing and Local Government and it is clear that the Ministry are as anxious as the Corporation for some definite trend to appear in the views of the research workers. Other areas, such as Manchester and Salford, are also anxious to do something towards sulphur control as soon as possible, but the only immediate project that the Government have in mind is the possibility of washing by an ammonia producing apparatus major sources of sulphur emission. To this end they have a pilot plant at Nottingham with apparatus designed by Simon-Carves, Ltd. This apparatus, however, would not be suitable except for very large heating plants, as it is necessary to install a plant which is virtually a small chemical works. The Government's research is being centralised at the Warren Spring Laboratory, and their principal Medical Adviser is Dr. Lawther of St. Barts. The Ministry seem to be taking the view that because it is not yet certain that sulphur alone is harmful, no cause has yet been made for an all-out drive against this particular contaminant. 23. The views that we set out above are intended to summarise for the benefit of Your Worshipful Committee the results of the exhaustive review that we have given to this question. We have reluctantly come to the conclusion that the time is not yet opportune for the City to be able to take some pioneering lead as it did in the question of smoke abatement. We recommend, however, that the situation should be watched and when and if an opportunity occurs we should bring before you a further report. It should be mentioned, however, that such a report may not be possible for some time. We have the honour to be, Gentlemen, Your obedient Servants, (Sgd.) PAUL C. DAVIE, Remembrancer. (Sgd.) J. GREENWOOD WILSON, Medical Officer of Health for the Port and City of London. (Sgd.) F.J. FORTY, 24 City Engineer. PIGEON NUISANCE The firm of pigeon catchers employed under contract by the City Corporation have continued to give satisfaction. The Corporation's policy is not entirely to exterminate all pigeons but to control their numbers to such proportions as will ensure that the pleasure they give to residents and visitors is not outweighed by the nuisance they cause. The fact that only three complaints were received of nuisance caused by these birds would appear to justify the Contractor's statement that although there has been a general increase in the pigeon population in the London area he has maintained a satisfactory level within the City. During the year 1,200 pigeons were humanely trapped and killed. EXCAVATION OF HUMAN REMAINS Human remains which are unearthed in the course of excavation are with the sanction of the Home Office, the Ecclesiastical Authorities, the City Coroner and the City Police reverently reinterred in an approved burial ground or cremated at an established crematorium. Work in connection with the removal of humanremains from St. Botolph's Churchyard, Bishopsgate, to the City of London Cemetery, Manor Park for reinterment commenced in August, 1958 and was finally completed in January, 1959. The remains appeared to have been removed from the surrounding land some years ago and re-interred in St. Botolph's Churchyard. No lead or timber coffins were found. All the bones were of ancient origin. No offensive odours were experienced during the progress of the work. CANCER DIAGNOSIS The City Corporation had for some years been considering the advisability and practicability of inaugurating a Scheme in the City to provide, for members of the public, free examination for the purpose of diagnosing whether such person is suffering from cancer or not, and by publicity to encourage people to take advantage of this scheme so as to ensure that, if the disease is present, it is diagnosed and treated in its early stages. In 1958 it was therefore decided to approach the Governors of St. Bartholomew's Hospital with a view to enlisting their co-operation in establishing a clinic for the diagnosing of cancer, in that hospital. The facilities for the diagnosis and treatment of cancer are generally available in our National Health Scheme, but the Governors of St. Bartholomew's Hospital agreed to develop a system of early laboratory diagnosis of cancer which could be applied to certain organs of women in the first instance. By the end of the year arrangements had reached such an advanced stage that it is possible to state definitely that a clinic for the early laboratory diagnosis of cancer which could be applied to certain organs of women will be established at St. Bartholomew's Hospital early in 1960. These facilities will initially be offered only to certain sections of the community in order to avoid congestion at the clinic. It is hoped, however, that after the elimination of possible "teething troubles" the scheme will be extended. The Corporation have no statutory powers to spend money on work of this nature out of rates but have decided to do so out of City's Cash. RADIOACTIVITY At approximately 8.0 a.m. on Friday, 29th May, a fire occurred in the Value Offices Section of the Parcels Office at Liverpool Street Station, Bishopsgate. This section is a small wired-in part of the main office used for Customs goods and consignments of special value. The fire was contained by the Fire Brigade in this small section. One fireman was said to have collapsed after handling some small leaden tubes containing radioactive material and was taken to St. Bartholomew's Hospital. He was discharged in about an hour, after having had a bath, with the diagnosis that he had fainted. His colleagues in the fire crew were also examined for radioactivity without result. This coincidence of the fireman fainting after handling the tubes was magnified out of all proportion and resulted in Press reports which were alarming and quite irresponsible. No matter how great the radiation there is no impact on the senses and no immediate ill-effect. The isotope involved was Thorium X. Had it been Thorium, as it was first stated in the early editions of the London newspapers, it would have been a major incident with very great radiation hazards, since, for all practical purposes, it is indestructible. Two parcels, each weighing approximately 1lb., containing Thorium X had been handed in at 7.20 a.m. for despatch by the 12-24 train. Thorium X is used for the removal of birth marks in young children and for certain other skin diseases. It has a half-life of 3.65days. Half-life is the time taken for half the radioactivity of a given preparation to decay. Half-lives vary from fractions of a second to millions of years. Thorium, which was first reported by the Press, comes within the latter category. Thorium X when sent by parcels service is specially packed. In each parcel was a ½ c.c. in a small bottle. This in turn was placed in a leaden tube which is placed in an electrically sealed plastic container, then suspended in a wooden box surrounded by sawdust, to ensure that if by any mischance there is any radiation it is transmitted in all directions, which weakens its effects. 25 CORRIGENDUM Excavation of Human Remains 2nd Paragraph, Lines 1 & 4 — For 'St. Botolph's' read 'St. Benet's' Line 1 — For 'Bishopsgate' read 'Fenchurch Street' Having first made enquiries of the Station Officer of the Bishopsgate Fire Brigade Station a Senior Public Health Inspector went to Liverpool Street Station. The Civil Defence Training Officer had just arrived with a Geiger counter and was satisfied there was no radiation hazard. A Civil Defence Instructor had previously visited the Parcels Office and had found some radiation from the tubes, from which all the packing had been burnt. The Inspector enquired as to the contents of the various parcels involved. There was no foodstuff but quite a large quantity of damaged and undamaged cigarettes and tobacco. In view of this he arranged with the Officer in charge of the Parcels Office to hold all the goods until the former was completely satisfied they could be released. After consultation with Physicists at the Sir John Cass Technical Institute, who were of the opinion that more precise investigation should be undertaken in view of a possible hazard from the smoking of the cigarettes and tobacco, the Inspector telephoned the Radiological Protection Service at Clifton Avenue, Belmont, Surrey. This service is called in by the Atomic Energy Commission and the Ministry of Health for incidents of this character. An officer of the Service informed the Inspector that their information was that the tubes had remained sealed and consequently there was no hazard. This information was later found to be incorrect in that not only were the tubes not sealed but the Thorium X in one bottle had evaporated and there was only a small quantity of the liquid in the other. In view of this the area and all the parcels involved were reexamined and it was found that there was still alpha radiation of 1 count per second and beta radiations of 5 to 8 counts per second in the parcels office. Both are harmless radiations, although had they been found in open foodstuffs, the latter would have been rendered suspect warranting laboratory examination before release. The experience was of value since, although the Press may have caused some alarm to the public, it demonstrated the need for a more precise system of notification for any similar incident. Arrangements have, therefore, been made with the City Police that all such notifications shall be made in the first instance to the Medical Officer of Health, during cr after office hours, as is the case in any other matter involving public health. On the 28th September a report was received from the City Police that a fire had occurred in the laboratory of Sir John Cass College where radioactive materials were stored. A Senior Public Health Inspector at once went to the College and learned that the fire which had been caused by a defect in an electric motor had been extinguished. The radioactive materials in the laboratory were stored away from where the fire occurred and were moreover protected by a lead-lined shutter. Consequently there was no danger from radioactivity and this was confirmed by the use of Geiger counters. In the meantime however, the Inspector had informed the Radiological Protection Service of the report, consequently that Service was prepared to take immediate action if this had been necessary. ANTI-POLIOMYELITIS CLINIC In October 1958, the London County Council Divisional Medical Officer for Area 5, in which is included the City of London, approached the Corporation s Medical Officer of Health for assistance in connection with the Councils proposed anti-poliomyelitis campaign to offer inoculation to all young persons born in the years 1933-1942, such assistance to include suggestions for the establishment of a lunch hour clinic centrally situated in the City. The most convenient and suitable site for a clinic appeared to be the Civil Defence Control accommodation in the sub-basement of the Office Block at Guildhall and by courtesy of the Chairman of the Civil Defence Committee and with the co-operation of the Civil Defence Department this was made available for the purpose. This Clinic continued to operate throughout 1959, and during the year approximately 20,000 volunteers received initial inoculations. The death from Poliomyelitis of Jeff Hall, a wellknown professional footballer, was extensively reported in the Daily Press on Monday, 6th April. By 1 p.m. on the 8th April, the first day after circulation of these reports on which the Vaccination Centre in Guildhall was open, some 500 persons were waiting to be inoculated. Notices were then displayed stating that no further people should join the queue on that day, but that additional sessions would be held the next day and on Monday, Tuesday, Wednesday and Thursday of the following week. On 8th April, 942 applicants were inoculated by one L.C.C. doctor in a two hour session. This was a splendid achievement, but at subsequent sessions even greater numbers were vaccinated, the maximum number attending on any one day being 1,368, and it is considered that this doctor, and his small team of nursing and clerical staff, merit congratulation for a good job very well done. It is complimentary to the efforts of all concerned that nobody was heard to complain of comparatively long waits and in some cases temporary disappointment. It seemed to be the general opinion of the public that an unforeseen and unprecedented enthusiasm for inoculation was being dealt with efficiently. 26 CORPORATION STAFF Occupational Health Service Mass Miniature Radiography A permanent Mass Radiography Unit is operated by the North East Metropolitan Regional Hospital Board in premises in the City which are owned by the Corporation. Members of the Staff are encouraged to take voluntary advantage of the facilities thus provided for biennial X-ray of the chest. For obvious reasons no attempt is made to compile official statistics but it is known that a large percentage of Corporation employees take advantage of this opportunity for a regular "check-up". Medical Emergencies The arrangement with a firm of medical practitioners in the City to be on call for emergencies at Guildhall was used on 8 occasions during the year. One concerned a member of the public, who had an epileptic fit in the Library. The emergency service was instituted because the Medical Officer of Health from the nature of his duties may often be unavailable to answer urgent calls, and even if he were, he would not have with him the doctor's "black bag" the contents of which are essential for effective treatment of many medical emergencies. Ophthalmic Optician Service Since the beginning of March, a firm of Ophthalmic Opticians have been operating an eye testing service for members of the staff. A weekly session is held in the medical suite of the Guildhall Office Block. This service is operated under the National Health Service, and examinations are free although charges are made for the dispensing of prescriptions. During the period March -December, 139 members of the staff had their eyes tested. 26 of these had not previously had an eye test under the National Health Service, and 14 were found to have visual defects which required correction and were supplied with spectacles. 113 had been examined previously and were already using spectacles. Of these 100 needed further correction and appropriate lenses were fitted to existing frames or to new frames of the patient's choice. The fact that over 50% of the new examinees had visual defects which needed correction, and over 88% of the examinees already wearing glasses needed further correction for their vision, shows how valuable this form of occupational health service is both to members of the staff, and to the Corporation because they would be liable for sick pay of members of the staff who had gone sick through headaches and other conditions which can be caused by inadequate corrective spectacles or no spectacles when they are needed. Medical Examinations During the year 226 persons were medically examined. The distribution by department and the reason for medical examination is shown in Table 1. 184 persons were medically examined for admission to the superannuation scheme; 3 were rejected as unfit and 3 were deferred. The clinical conditions causing rejection are shown in Table 2. Of the 3 candidates deferred, 2 have been passed as fit, one having received dental treatment, the other having been re-examined after serving a probationary period. The third candidate who was deferred has yet to be re-examined. 29 persons were medically examined owing to prolonged absence on sick leave. At the time of the examinations 14 were reported as fit for duty, 9 were still unfit for duty, and 6 were reported as unfit for further service. The clinical conditions causing unfitness for further service are shown in Table 3. 7 persons who had reached retiring age were medically examined and were reported as fit to continue in the Corporation's service for a further 12 months. 3 persons were medically examined for temporary appointments, and 3 were examined to verify the nature of a disability. 20 candidates for teaching and canteen posts were X-rayed and all were reported as showing no abnormality of lungs. The investigation of cases referred owing to sickness involves a considerable amount of documentary research, correspondence and telephone calls, as well as physical examination, and it is gratifying to note that the liaison between the medical staff of the Corporation and hospitals and patients' doctors is all that can be desired. 27 TABLE 1 DEPARTMENT ADMISSION TO SUPERANNUATION SCHEME REFERRED FOR EXCESSIVE SICK ABSENTEEISM OR RETIREMENT * Fit Unfit Deferred TOTAL Fit for Duty Still Unfit Unfit for further service TOTAL Over 65 years of age SPECIAL M F M F M F M F M F M F M F M F M F M F Billingsgate Market 3 3 Burnham Beeches 2 2 Cemetery 10 1 11 1 1 1 Central Criminal Court 6 6 Chamberlain's 3 6 3 6 Cleansing 1 1 4 8 3 15 4 2 1 Comptroller & City Solicitor's 3 3 3 3 1 1 Engineer's 7 1 8 Epping Forest 2 2 Hallkeeper's 4 4 1 Housing 3 1 3 1 Justice Room, Mansion House 1 1 Library 2 3 2 3 1 1 2 London Central Market 11 11 Mansion House 3 1 3 1 Mayor's Court 1 Medical Officer of Health 6 3 1 7 3 1 1 1 Metropolitan Cattle Market 7 7 2 2 Planning 6 2 6 2 1 Police 5 6 1 1 7 6 Printing & Stationery 1 1 Public Relations 1 1 1 1 Queens Park 1 1 Records 1 1 Remembrancer's 1 1 Schools:— Boys 10 10 Freemen's 1 2 1 2 Girls 1 7 1 7 1 1 Music & Drama 3 5 3 5 2 2 Spitalfields Market 5 5 Surveyor's 16 1 17 2 2 1 Town Clerk's 1 1 1 1 Tower Bridge 5 5 1 1 2 Rating & Rate Accounts 1 1 1 1 Weights & Measures 1 1 West Ham Park 2 2 TOTALS 134 44 3 — 3 - 140 44 14 - 8 1 5 1 27 2 5 2 5 1 * Referred with a recommendation for continued service by heads of departments. All were found fit for it. TABLE 2 CLINICAL CONDITIONS EXCLUDING THE CANDIDATES FROM THE SUPERANNUATION SCHEME Disease Males Females Heart disease 1 — Diabetes Mellitus 1 - Albuminuria and High Blood Pressure 1 - TOTALS 3 — TABLE 3 CLINICAL CONDITIONS LEADING TO PREMATURE RETIREMENT Disease M ales Females Chronic Bronchitis 3 Raynauds Disease - 1 Heart Disease and Asthma 1 - Osteo-arthritis 1 - TOTALS 5 1 Attention is drawn to a new feature of this annual report, namely the section dealing with staff occupational health. Except for the emergency medical service and the eye-testing service, this important work has been carried on by the City's public health department for many years, and I consider that the value of the service makes it worthy of report. It also represents the germ of an occupational health service, the provision of which in my opinion, would be ideal for all those City workers who do not already enjoy anything of the kind in their day to day occupation. 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 those, for example members of the Civil Service, laboratory experts, traders, business firms and members of the public, who have co-operated in the promotion of health. STATISTICAL INFORMATION Area.—678 acres (including the Temple and foreshore). Population.— Census 1951, 5,268. Estimated mid-year 1959, 4,900. Annual Rateable Value.— As at 1st April, 1959, £12,885,565. Annual Sum received from Penny General Rate.—£55,000. Live Births Number 32 Rate per 1,000 population 5.88 Illegitimate Live Births per cent of total live births 9.37 Stillbirths Number 0 Rate per 1,000 total live and still births 0 Total Live and Still Births 32 Infant Deaths (deaths under 1 year) 0 Infant Mortality Rates Total infant deaths per 1,000 total live births 0 Legitimate infant deaths per 1,000 legitimate live births 0 Illegitimate infant deaths per 1,000 illigitimate live births 0 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 0 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 0 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births) 0 Maternal Mortality (including abortion) Number of deaths 0 Rate per 1,000 total live and still births 0 Deaths, all ages 45 Death rate per 1,000 resident population 9.37 INFECTIOUS DISEASE Total cases notified Notifications received:— Dysentery, Sonne 1 Measles 21 Food Poisoning 4 Scarlet Fever 1 Tuberculosis (Pulmonary 4, Non-Pulmonary 1) 5 Influenzal Broncho Pneumonia 1 Erysipelas 1 ANALYTICAL EXAMINATIONS (Other than Food and Drugs Act) Apricots, Dried 4 Sauce 1 Beef, Corned 1 Sausage, portion of 1 Butter 1 Sharks Fin Soup 1 Egg, Scotch 1 Sultanas 3 Fertilisers— Sweets, Fruitella 1 Fish Manure 1 Tea 660 Hop Manure 1 Tinned Foods- Fish Cakes 1 Crab 1 Lime Juice Cordial (Diabetic) 1 Fish Roes 1 Oranges 3 Melons 1 Orange Drink 1 Peaches 3 Pate de Canard d'Amiens aux Truffles Shrimps 4 de Pistache 1 Stewed Steak 1 Raisins 1 Tomato Puree 1 BACTERIOLOGICAL EXAMINATIONS The following specimens were examined during the year:— Bananas 2 stems Meat, tinned 4 Beef, cooked 3 Poultry 2 Coconut, desiccated 12 Prawns, frozen 53 Egg products 68 Prawns, tinned 1 Faeces 6 Sausage Rolls 1 Fruit Salad 1 Shrimps, dried 1 Ham, tinned 3 Shrimps, tinned 4 Meat Pie 3 Steakettes, frozen 1 30 CAUSES OF, AND AGES, DEATH DURING THE YEAR 1959 CAUSES OF DEATH NETT DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT All Ages Under 1 week Under 4 mths 4 mths and under lyear land 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 11 12 All Causes 45 - - - - - - 1 24 8 12 1. Tuberculosis, respiratory M - - - - - - - - - - - F - - - - - - - - - - - 2. Tuberculosis, other forms M - - - - - - - - - - - F - - - - - - - - - - - 3. Syphilitic disease M - - - - - - - - - - - F - - - - - - - - - - - 4. Diphtheria M - - - - - - - - - - - F - - - - - - - - - - - 5. Whooping Cough M - - - - - - - - - - - F - - - - - - - - - - - 6. Meningococcal infections M - — — — — — — — — — — F - - - - - - - - - - - 7. Acute poliomyelitis M - - - - - - - - - - - F - - - - - - - - - - - 8. Measles M - - - - - - - - - - - F - - - - - - - - - - — 9. Other infective and parasitic disease M - - - - - - - - - - - F - - - - - - - - - - - 10. Malignant neoplasm-stonach M - - - - - - - - - - - F - - - - - - - - - - - 11. Malignant noeplasm-lung, Bronchus M 3 - - - - - - - 2 - 1 F - - - - - - - - - - - 12. Malignant neoplasm-breast M - - - - - - - - - - - F - - - - - - - - - - - 13. Malignant neoplasm-uterus F - - - - - - - - - - - 14. Other malignant and lymphatic neoplasms M 6 - - - - - - - 3 3 - F 4 — — — — — — — 3 — 1 15. Leukaemia, aleukæmia M - - - - - - - - - - - F — — — — — — — — — — — 16. Diabetes M - - - - - - - -. - - - F - - - - - - - - - - - 17. Vascular lesions of nervous system M 1 - - - - - - - 1 - - F - - - - - - - - - - - 18. Coronary disease, angina M 5 - - - - - - 1 2 2 - F 1 - - - — — — — 1 — — 19. Hypertension with heart disease M 4 - - - - - - - 1 1 2 F 1 - - - - - - - - - 1 20. Other heart disease M 2 - - - - - - - 1 - 1 F - - - - - - - - - - - 21. Other circulatory disease M 2 - - - - - - - 1 - 1 F - - - - - - - - - - - 22. Influenza M - - - - - - - - - - - F - - - - - - - - - - - 23. Pneumonia M 4 - - - - - - - 3 - 1 F 1 - - - - - - - - - 1 24. Bronchitis M 4 - - - - - - - 1 2 1 F - - - - - - - - - - - 25. Other diseases of respiratory system M - - - - - - - - - - - F 1 - - - - - - - 1 - - 26. Ulcer of Stomach and duodenum M - - - - - - - - - - - F - - - - - - - - - - - 27. Gastritis, enteritis and diarrhœa M - - - - - - - - - - - F - - - - - - - - - - - 28. Nephritis and nephrosis M - - - - - - - - - - - F - - - - - - - - - - - 29. Hyperplasia of prostate M - - - - - - - - - - - F - - - - - - - - - - - Carried forward M 31 - - - - - - 1 15 8 7 F 8 - - — - - - - 5 - 3 31  NETT DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT CAUSES OF DEATH All Ages Under 1 week Under 4 mths 4 mths and under l year l 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 wards 1 2 3 4 5 6 7 8 9 10 11 12 Brought forward M 31 - - - - - - 1 15 8 7 F 8 - - - - - - - 5 - 3 30. Pregnancy, childbirth, abortion F - - - - - - - - - - - 31. Congenital malformations M - - - - - - - - - - — F - - - - - - - - - - — 32. Other defined and ill-defined diseases M 2 - - - - - - - 2 - - F 3 — — — — — — — 2 — 1 33. Motor vehicle accidents M 1 - - - - - - - - - 1 F - - - - - - - - - - - 34. All other accidents M - - - - - - - - - - — F - - - - - - - - - - - 35. Suicide M - - - - - - - - - - - F - - - - - - - - - - - 36. Homicide and operations of war M - - - - - - - - - - - F - - - - - - - - - - - Totals M 34 - - - - - - 1 17 8 8 F 11 - — — — — — — 7 - 4 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 26 Total No. of children who attended during the year, and who were born in:— 1959 18 1958 36 1957-1954 29 Total attendances by children:— Under 1 year of age 715 1—5 years of age 488 Health Visitors Total No. of children visited 84 No. of infants under 1 year of age visited for first time 24 Total visits to infants under 1 year of age 149 Total visits to children aged 1 year but under 2 years 103 Total visits to children aged 2 years but under 5 years 191 No. of expectant mothers visited for the first time 7 Total visits to expectant mothers 44 Care of Premature Infants No. of premature births during the year Nil No. of deaths under 1 month Nil Diphtheria Immunisation No. of children who completed a full course of primary immunisation:— Under 5 years of age 19 5 — 15 years of age 1 No. of children who were given a secondary or reinforcing injection 23 Vaccination No. of children successfully vaccinated or re-vaccinated 25 Home Help Service No. of maternity cases provided with home help 1 32 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 Occupiers prosecuted (i) Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 1,144 (incl. 1 bakehouse and 992 kitchens) 1,791 (incl. 1 bakehouse and 1,758 kitchens) 139 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 561 60 6 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises). - - - - TOTAL 1,705 (incl. 1 bakehouse and 992 kitchens) 1,851 (incl. 1 bakehouse and 1,758 kitchens) 145 - 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.l.) 339 508 - - - Overcrowding (S.2) — - - - - Unreasonable temperature (S.3) - 3 — — — Inadequate ventilation (S.4) 53 54 — — — Ineffective drainage of floors (S.6) 1 1 — — — Sanitary Conveniences (S.7) (a) insufficient 18 3 — — — (b) unsuitable or defective 109 106 — 15 — (c) not separate for sexes 14 - — — — Other offences against the Act (not including offences relating to Outwork) - - - - - TOTAL 534 675 - 15 - PART VIII OF THE ACT Outwork (Sections 110 and 111) Section 110 Section 111 Nature of Work No. of outworkers in August list required by Section 110(l)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions 1 2 3 4 5 6 7 Wearing apparel (Making, etc.) 263 - - - - - Household linen 21 — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 18 - - - - - Total 302 - - - - — 33 OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms employing outworkers 41 Names and Addresses of outworkers resident in the City received from other Authorities 53 Names and Addresses of outworkers resident outside the City, employed by City firms, transmitted to other Authorities 276 No case of infectious disease was reported in connection with outworkers' premises in the City. SHOPS ACT, 1950 Section 38 of this Act requires the provision of adequate ventilation, heating, sanitary conveniences and washing facilities for employees. 228 inspections of shops and warehouses have been made. The few defects found have been remedied as a consequence of informal action by the Inspectors. Only one intimation notice was served. No legal proceedings were instituted. No Certificates granting exemption from the provision of sanitary accommodation or washing facilities in accordance with Section 38(2)(4) and (6) of the Act were issued. 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. 82 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. MEAT INSPECTION Tons Cwts. Qrs. Lbs. Meat, etc., delivered at Smithfield Market 352,771 0 0 0 Meat, etc., surrendered to Inspectors at Smithfield Market 400 3 0 25 Meat, etc., surrendered to Inspectors at Leadenhall Market and City shops 6 6 2 22 Meat, etc.,surrendered to Inspectors at Cold Stores 2 18 2 13 Number of Exportation Certificates Issued 75 Number of demonstrations and lectures given 43 Number of Students attending 495 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 food landed at Riverside Wharves and in grocers shops, cafes, restaurants, etc., amounted to 191 tons 14 cwt. Oqrs. 17 lbs., (in addition to 2,455 eggs) which was disposed of as follows:— T ons Cwts. Qrs. Lbs. Released for stock feeding 22 14 10 Released for manufacture 49 8 0 15 Disposed of to contractors 33 1 111 Destroyed . . .... 86 10 1 19 (in addition to 2,445 eggs) 87 tons 12 cwts. Oqrs. 24 lbs. of food were placed under stop and subsequently released to be dealt with under the supervision of other local authorities. 34 FOOD HYGIENE REGULATIONS 1955 Supervision in accordance with these Regulations has been carried out at Smithfield Market. During the year 798 infringements were noted. 230 were in connection with clothing, 77 in connection with containers, 66 in respect of meat contamination, 52 in regard to premises and equipment,and 134 were instances of smoking whilst handling food. 22 trucks and 211 vans and cars were observed to be infringing the Regulations. 6 meat handlers with cut fingers were not wearing washable dressings on the wounds. Suitable warnings were given in connection with these cases. There are estimated to be some 7,000 persons using Smithfield Market Daily, which figure includes approximately 600 porters licensed by the Superintendent of the Market, including some 120 freelance porters popularly known as "bummarees". some 200 pitchers who arrive at the Market with the various meat vans, unload the vehicles and leave the Market again on the vans. tenants' staffs, buyers and their staffs. there are 349 stalls on the Market occupied by approximately 110 tenants. FISH INSPECTION Inspection of fish in the City of London is carried out by officers of the Worshipful the Fishmongers' Company. The Fishmeter's returns indicated as follows: — Deliveries at or near Billingsgate Market Weight of Condemnation (including shell fish) Fi sh Condemned Rate 112,817 tons 396 tons 0.35% SANITARY CIRCUMSTANCES The general sanitary supervision has been maintained and in this connection 3,786 inspections have been made. As a consequence of these inspections, it was necessary to serve 23 Intimation Notices. No 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. 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. 61 such applications were received during the year as a consequence of which 234 inspections were made. PHARMACY AND POISONS ACT, 1933 This Act provides for registration by the Local Authority of persons not already registered 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, 68 of which were re-registrations. One infringement was 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. 28 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. 36 inspections were made ; no contraventions were noted. 35 FOOD AND DRUGS ACT, 1955, AND FOOD REGULATIONS Informal and Formal Samples submitted for Analysis Article Informal Formal Article Informal Formal Aspirin Tablets 3 - Brought forward 164 6 Barley 1 - Linctus . . . . 1 - Biscuits 1 - Liver Tonic 1 - Brandy 2 1 Magnesia, Milk of 2 - Bread 1 - Malt, Extract of 1 - Butter 16 - Margarine 15 - Cake 1 - Marmalade 1 - Cake Decorations 1 - Meat and Meat Products 23 - Cake Mixture 1 - Milk 8 53 Cascara Tablets 1 - Milk, Dried 2 - Castor Oil 1 - Milk, Tinned 6 - Cheese 9 - Mincemeat 1 - Cheese Products 1 - Olive Oil 2 - Chicken, Tinned 3 - Peanut Butter 2 - Chocolates 1 - Peel, Candied 1 - Cocoa 3 - Pepper 3 - Coffee 7 - Pickles and Sauces 12 - Colouring, Food 1 - Pies, Meat 11 - Confectionery 3 - Pudding Mixture 1 - Cooking Fat 3 - Rice 2 - Cream, Bottled 1 Rice, Tinned 2 - Cream, Tinned 3 - Rum 1 1 Curry Powder 2 - Sago 1 - Fish, Tinned 12 - Salad Oil 1 - Fish Paste 2 - Sandwiches 1 - Fruit, Bottled 2 - Sausages 40 - Fruit, Dried 21 - Sausages, Tinned 1 - Fruit, Glace 2 - Sauternes 3 - Fruit, Tinned 3 - Sherry 1 - Fruit Drinks 18 - Soup, Dehydrated 2 - Fruit Juice, Tinned 1 - Soup, Tinned 1 - Frying Oil 1 - Soya Flour 1 - Gin 1 5 Spaghetti Bolognese, Tinned 1 - Ginger Cordial 1 - Suet 1 - Ginger 1 - Sugar 4 - Ham, Tinned 1 - Tea 4 - Honey 4 - Treacle 1 - Jam 13 - Vegetables, Tinned 5 - Jelly 1 - Vinegar 7 - Juniper, Oil of 1 - Whisky - 7 Lanoline 1 - Wine 1 - Lard 11 - Y oughourt 1 - Lemon Curd 1 - Zinc and Castor Oil Cream 1 - Carried forward 164 6 TOTALS 340 67 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY Article Informal or Formal Sample Nature of adulteration or irregularity A ction Hot Millk Formal Contained Fat, 2.83% Solids-not-fat, 8.54% corresponding to a deficiency of 5% of the milk-fat. Matter investigated and facts reported to Port & City of London Health Committee. Warning letter sent from City Solicitor. Hot Milk Formal Contained Fat, 2.72% Solids-not-fat, 7.04% corresponding to the presence of 17% of added water. do. Hot Milk F ormal Contained Fat, 2.94% Solids-not-fat, 7.51% corresponding to the presence of 11% of added water. Steam used for the heating of milk. This method now discontinued. Hot Milk Formal Contained Fat, 2.17% Solids-not-fat, 5.59% corresponding to the presence of 34% of added water. Reported to Port & City of London Health Committee. Warning letter sent from City Solicitor. Hot Milk Formal Contained Fat, 2.66% Solids-not-fat, 8.51% corresponding to the abstraction of 11% of the milk-fat. do. 36 Administrative action regarding adulteration or other irregularity — continued Article Informal or Formal Sample Nature of adulteration or irregularity Action Milk Informal The bottle containing the sample was dirty, a discoloured film of stale milk residue being noticeable at the bottom and partly floating detached in the milk. Milk bottled in the Metropolitan Borough of Paddington. Results and information passed on to M.O.H. of Paddington for appropriate action. Milk Informal Contained Fat, 1.57% Solids-not-fat, 5.69% corresponding to the presence of 33% of added water, and the abstraction of 21% of the milkfat. Matter taken up with the proprietors of the firm running the canteen and the caterers. Milk sold as such is now delivered to the staff in sealed bottles. Milk Informal Contained Fat, 2.08% Solids-not-fat, 5.56% corresponding to the presence of 34% of added water. Cold Milk (Class) Formal Contained Fat, 2.60% Solids-not-fat, 8.24% corresponding to the presence of 3% of added water, and the abstraction of 10% of the milkfat. Summons issued. Represented at Court and pleaded Guilty. Given absolute discharge on payment of £3. 3s. costs. Frying Oil Informal The label failed to satisfy the requirements of the Labelling of Food Order, owing to absence of "appropriate designation". Wrong labels on the bottles. Representations made and the entire stock was withdrawn for relabelling. Oyster Sauce Informal Contained Benzoic acid, 2400 parts per million. The importer is dealing with the manufacturer, and has stopped the sale of this article. Bread Informal Consisted of a loaf of white bread containing a quantity of black particles penetrating through the centre from end to end. These were found to consist of charred wholemeal bread with some dust. Taken up with manufacturers. The material present in this loaf arose as a result of changing from brown to white loaf production. "Sunfresh" Orange Drink Informal Consisted of an orange drink contained in an imperfectly cleansed bottle. Taken up with manufacturers and bottlers. The plant is in first class order and this occurrence cannot be explained. Pork Sausages Informal Contained Sulphur dioxide 250 parts < per million. Notices were displayed in shop but in an inconspicuous position. This has been remedied and arrangements made for the preservative to be declared on wrapping ring. do. Informal Contained Sulphur dioxide 240 parts per million. Preserved Pork Sausages Informal Contained meat, 55% The manufacturers have increased the meat content in their recipe to allow for a greater margin of error should any deficiency occur during the mixing process. do. do. Contained meat, 53% do. do. Contained meat, 62% Dehydrated Soup Informal Incorrect labelling These soups are not yet being marketed and the new label will have ingredients in correct order. do. do. Incorrect labelling Hamburgers Informal Contained Sulphur dioxide 150 parts per million. The preservative was introduced by the use of sausage meat containing preservative used in the manufacture of these hamburgers. Cooked Pork, Canned Informal Contained Pork, 72% After discussion between the manufacturers and importers the meat content has been increased. Sugarless Pastilles Informal The pastilles were pre-packed but the label bore no declaration of ingredients. This matter has not yet been resolved. Sandwiches made with Butter Informal. The sandwiches were spread with equal parts of butter and margarine. A written declaration on the menu stated that only butter was used in the sandwiches. Written representations made to the firm in question, and instructions given by the firm that margarine is not to be used. 37 PROSECUTIONS Food and Drugs Act, 1955 Section Offence Result 2 Sale of confectionery containing antiseptic dressing. Manufacturer discharged absolutely on payment of £5. 5s. costs. 2 Sale of unfit oranges to the prejudice of the purchaser. Vendor fined £5. 5s. with 10/- costs. 2 Sale of unfit strawberries to the prejudice of the purchaser. Vendor fined £5. 5s. with £3. 3s. costs. 2 Sale of glass of milk to which 3% water had been added and from which 10% milk fat had been abstracted. Vendor discharged absolutely on payment of £3. 3s. costs. Food Hygiene Regulations, 1955 Section 0ffence Result 5 & 8 Snackbar infested with cockroaches. Manager fined £5. and £2. 2s. costs, Proprietor fined £50. with £2. 2s. costs 9(e) & 30 A meat porter smoking whilst handling meat, not wearing a clean and washable head-covering and overall. Fined £15. with £2. 2s. costs. 9(e) & 30 A meat porter smoking whilst handling meat, not wearing a clean and washable head-covering and overall. Fined £20. with £3. 3s. 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. 142 such premises were registered at the end of the year. AGRICULTURAL PRODUCE (GRADING & MARKING) 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 \cts 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. There are no firms so registered in the City of London. No difficulty was experienced in the administration of these Acts. 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. 38 The following table shows the types of business carried on:— Nature of Business No. of premises registered Sale and storage of pre-packed ice cream 80 Sale and storage of ice cream 3 Selecting and sorting of sauage casings 9 Preparation and cooking of jellied eels and shellfish 14 Cooking of hams 1 Cooking of Beetroot 1 Manufacture of sausages, dripping and cooked meats, and brining of meat. 34 Cooking, smoking and canning of meat products 1 Manufacture of pies 1 Smoking of bacon 1 Sale of Cooked Meats 1 146 CITY MORTUARY Bodies received 180 Post Mortem Examinations made 180 Inquests on bodies 35 Inquest held at Holloway Prison 1 Inquest on fires - DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, etc.:— No. of articles disinfected 1,337,551 Cases of horsehair 465 Clothing by weight 1 Ton 3 cwt. Fees received £4,688 General Disinfection. Infectious Diseases, etc.:— Articles of bedding disinfected 1,257 Premises disinfected after cases of infectious disease 3 Lockers at Post Offices disinfected 11 Verminous premises disinfected 28 Cleansing of Persons:— No. of verminous persons bathed 618 No. of Scabious Persons bathed 2 No. of articles disinfected 6,200 39