434 LON 86 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1960 Printed by the Authority of Common Council 17th, December 1953. STAFF. Date of MEDICAL OFFICER OF HE ALTH (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 Hamblin, Miss, I.H. General Grade Clerk Oct. 1957 Smith, Mrs. F.I.M. General Grade Clerk (Part-time) May 1959 CAMPBELL, Miss S.H. General Grade Clerk Jan. 1960 (Resigned 23.4.60.) 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 Garr ard, 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 Le ach, R.A. Meat Inspector Sept. 1952 Cox, J.T. Meat Inspector Aug. 1954 Field, H. Meat Inspector Aug. 1954 Gingell, G. Meat Inspector Aug. 1954 Giles, H.W. Meat Inspector Aug. 1956 Payne, B.C., D.F.C. Meat Inspector Dec. 1960 Bfrnhardt D.R. 'Authorised Officer' under Food Hygiene Regulations, 1955 May 1931 (Resigned 11.9.60.) RODENT OFFICER Carter, J. Sept. 1944 RODENT OPERATIVES Mason, G.A. (Foreman Rodent Operative) Dec. 1946 Tremayne, L.R Nov. 1943 Cardy, E.G. June 1950 Brown, G.J. Aug. 1950 Clayton, J.G. Nov. 1951 (Resigned 23.1.60.) 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 Smithfielu 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 (Resigned 24.9.60.) 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 1960. To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. Guildhall, E.C.2. Telephone: MONarch 3030 My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1960. VITAL STATISTICS The resident population of the City according to the Registrar General's estimate at midyear 1960 was 4,390. The birth rate remained at 5.88 per 1,000 resident population and the death rate rose to 9.80 per 1,000 resident population compared with 9.37 per 1,000 in 1959. 32 babies were born, one of which died within four weeks of birth, being born prematurely. 4 births were illegitimate. There were no still-births. The total number of deaths of all ages was 47; 32 male and 15 female. 14 deaths were due to cancer, 3 of which were cancer of the lung. 7 deaths were from pneumonia and 1 from bronchitis. 2 deaths were due to motor accidents. One male City resident aged 56 killed himself by taking poison in his own home, and one woman aged 47 walked out into the sea off Eastbourne and drowned herself. INFECTIOUS DISEASES NOTIFIED 23 notifications of infectious disease were received; namely 6 cases of dysentery (1), 1 of erysipelas (1), 1 of malaria (0), 6 of measles (21), 1 of ophthalmia neonatorum (0), 7 of pulmonary tuberculosis (4) and 1 of whooping cough (0). (The figures in brackets denote the comparable numbers of cases in 1959). The case of ophthalmia neonatorum was gonococcal and occurred in a male child who was born in St. Bartholomew's Hospital but whose parents resided outside the City. The notification of Malaria was in regard to a student from West Africa on a conducted tour of this country, who was temporarily residing in an hotel in the City. Two days after notification he left the City for the North of England to be treated under the supervision of the local Medical Officer of Health. SMALLPOX Modified smallpox was diagnosed in a Dutch businessman from Singapore, who arrived at London Airport on 3rd October from Colombo, Ceylon, and was admitted to hospital on the evening of 5th October. The patient was found to have a sparse rash, first observed on 5th October, which was sufficiently advanced to suggest that he was probably in an infectious state at the time of his arrival in London. All persons who travelled by the same flight were regarded as having been exposed to risk of infection. On the morning of 7th October, a City Medical Practitioner telephoned the City Medical Officer of Health to the effect that an Indian, who had travelled in the same plane as the smallpox patient, had lunched at a City Inn and had dined at a Restaurant in the City. Visits were made by Public Health Inspectors to both these premises at mid-day on Friday, 7th October. The circumstances were explained to the Managers and although the possibility of the Indian's having infected any of the staff was extremely remote they were offered opportunities for vaccination, and as a consequence members of the catering staffs were vaccinated on the same day at Guildhall. The appropriate Medical Officers of Health were notified immediately of this Indian's movements in this country, although he had by then flown back to India. One or two City firms telephoned for advice in regard to individual members of their staffs who had been in contact with contacts of the patient, but not with the patient himself. They were advised that these individuals should be vaccinated but that the possibility of infection was not sufficient to warrant vaccination of their colleagues. FOOD POISONING Incident 1. On the 2nd February, I960 it was reported that a family consisting of husband, wife and son, resident in the City, had been ill with diarrhoea. As a result of enquiry it was ascertained that 2 (a) the son had been absent from his school in the City on the 19th and 20th January with diarrhoea; (b) the mother had a similar illness on the 26th January; and (c) the father had had severe attacks of diarrhoea on the 31st January necessitating medical attention. Specimens of faeces from the three were examined by the Pathological Department of St. Bartholomew's Hospital, and cultures from those of the mother and son yielded growths of Shigella Sonnei. Sensitivity tests on the Shigella Sonnei indicated that it was only moderately sensitive to Tetracycline and Sulphonamide, but was full sensitive to Streptomycin, Chloramphenicol and Neomycin. This information was conveyed to the medical practitioner concerned to assist him in the treatment of the complaint. Enquiries made at the School revealed that since the middle of January some 60 children had a history of illness which could be associated with Sonnei Dysentery. Since the greater number of these live outside the City, and to exclude the possibility that the first child was an isolated case, it was decided to enquire first into the cases of the eight children living in the City before general remedial measures were instituted. Specimens of faeces from the City children were examined when it was discovered that there were other cases of the disease. From this further evidence it was concluded that an outbreak of dysentery existed at the School. Remedial measures covering the whole School were then put into operation. These measures may be summarized as follows (1) Medical Officers of Health of all the districts where the suspected cases lived were notified of the circumstances. (2) A communication was addressed to all the parents of children attending the School. A copy of this letter follows "As Medical Officer of Health for the City of London I have been informed that a number of cases of dysentery have occurred among the children attending the above-named School. "There is no cause for undue alarm since the type of dysentery usually met with in schools is rarely a serious danger to health, but the disease is capable of causing enforced absences from school and a serious dislocation of school life. "Your co-operation is sought to assist in checking the spread of the disease. Parents are not immune from infection and instances have occurred where they have contracted the infection from children. "PREVENTION. Dysentery is spread by fingers or other things used in common which have become infected by contact with faeces. The following precautions will make a serious outbreak of the disease less likely to occur:— (a) The most important single thing that can be done is to ensure that children wash their hands thoroughly after using the water closet; the use of common towels should be avoided and, if practicable, paper towels only should be used. (b) W.C. seats, pulls, toilet paper holders, door handles and the surrounding walls and door are most likely to be contaminated — they must be kept clean, and the W.C. seat could be swabbed after use with a dilute disinfectant. (c) Toilet paper must always be available in the water closet. (d) Before meals, hands should be thoroughly washed. (e) It would be of advantage if children could be persuaded to attend to the wants of nature before leaving home. This would result in a less demand being made on the sanitary accommodation provided at the school with a less risk of contracting the disease. (f) Anyone, parent or child, who has had symptoms of dysentery, i.e. diarrhoea (loose stools which contained slime or blood and slime) within the last six weeks should be seen by his/her own doctor with the explanation that they may have been in contact with cases of the dysentery germ known as "Shigella Sonnei". For the information of your doctor the Shigella Sonnei implicated has been found to be only moderately sensitive to tetracycline and sulphonamide, but is fully sensitive to streptomycin, chloramphenicol and neomycin. "I am sure you will do all you can to assist the Headmaster and the Teaching Staff in the efforts being made at the School to prevent further cases occurring among the children who attend the School. (3) An inspection of the School premises indicated that the sanitary accommodation was ample and in a clean condition. The main criticism was the absence of hot water for washing, and roller towels used in common by the children. These towels were replaced by paper towels, and wire baskets provided for the collection and burning of the used towels. The School Authorities were communicated with indicating the urgent need for a supply of hot water over all lavatory basins. 3 (4) One of the disinfecting staff of the Corporation was posted to the School to disinfect all sanitary accommodation. It was arranged that such spraying should take place at the end of each "break" in the school curriculum, i.e. at 10.30 and 11.30 a.m. and at 2.0 and 4.30 p.m. each day. In addition all the water closet seats were swabbed with a disinfectant solution and a quantity of the latter poured into the water closet pan to overcome the effects of splashing when the children used the water closets. This routine was followed until seven days after the last case was notified —a period of three weeks. Suitable notices were posted in all water closets and lavatories to draw attention to the need for the washing of hands. (5) Absentees or cases of suspicious illness were immediately notified to enable appropriate follow-up measures to be taken. Your Medical Officer did not consider the closure of the School was warranted since not only would it have meant a severe dislocation of school life but it would also have resulted in the loss of adequate control of potential cases or carriers of the disease. All in all, not only did the measures undertaken quell the outbreak of the disease, but it provided a very useful lesson to all those attending the School on the need at all times to practice those elementary precautions so necessary to prevent the spread of diarrhoeal illnesses associated with food poisoning, dysentery, typhoid, etc. Incident 2. On Wednesday morning 17th August, 1960, your Medical Officer was notified that some members of an Office Staff had been ill overnight with symptoms which indicated that food poisoning might have been the cause. From subsequent enquiries it was ascertained that 30 people were affected in some degree and that the item of food suspected was Curried Beef eaten at mid-day on the 16th August. Everyone had similar symptoms — abdominal pain and diarrhoea — with an average time of 10.3 hours from taking their meals to the onset of the symptoms and the majority were feeling reasonably well within the next 24 hours. Although these symptoms and the time factors indicated that the food poisoning might have been due to a toxin of a heat resistant strain of Clostridium Welchii, the bacteriologist was unable to isolate these organisms from the specimens submitted to him. This was the third occurrence of food poisoning in this canteen during the past 18 months and on each occasion a thorough investigation was made to ascertain the cause. On the two previous occasions certain deficiencies in the handling of food were obvious and could have accounted for these outbreaks. This latest incident, however, was quite unresolved, but certain staff changes were subsequently made by the Caterers which may result in better supervision of the catering staff and better food handling in general. The canteen in this case was the City of London Corporation's own Staff Dining room at Guildhall, where general inspectorial advice and supervision of the personnel engaged are at an optimum. Even in these circumstances, however, food poisoning due to negligence of catering personnel does occur, which fact enhances the contention that without maximum care in matters of hygiene by those engaged in the handling of food, such outbreaks cannot be eliminated. Below is a copy of the Annual Return made to the Minister of Health on food poisoning in the City of London during I960. ANNUAL RETURN OF FOOD POISONING IN THE CITY OF LONDON 1. YEAR ENDED 31st DECEMBER, 1960. 2. (a) FOOD POISONING NOTIFICATIONS (Corrected) as returned to Registrar General:- lst 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 1 1 Nil 2 (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 4 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 2 Nil 70 70 (f) Other bacteria Nil Nil Nil Nil Nil Totals Nil 2 Nil 70 70 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 ATMOSPHERIC POLLUTION The routine measurement of atmospheric pollution at the four stations in the City of London continued during the year. The results are set out in the Tables which follow. TABLE 1 — Deposit Gauge. The rainfall collected was the highest for many years, e.g. approximately five inches fell in each of the months of September and October. During a year of heavy rainfall it is expected that the amount of soluble and insoluble matter deposited in the collecting bowl would be very much greater than normal. In fact the yearly average for 1960 was considerably below the average for the two previous years and lower for the average of the five years 1955-1959. Attention was drawn in the last annual report to the connection between the deposits of a tarry nature and the smoke emitted from chimneys. The downward trend in this deposit continued in 1960. 5 TABLE 11 — Smoke concentrations by the volumetric method. In 1960 the average concentrations of smoke at all four stations were below those recorded for the average of the previous five years. There was a marked improvement at Bishopsgate compared with|the three previous years which may well be due to the increasing use of electric and diesel locomotives at Liverpool Street Station. TABLE 111 — Sulphur measurements by the volumetric and lead peroxide methods. It will be seen from the Table that the average concentrations of sulphur pollution were less than those recorded in 1959, but there was little change from the average of the years 1955-1959. Only at the Cloak Lane station was there shown to be a slight increase. A "smog" incident is likely to occur when the mean level for London attains a daily value of 40 parts of sulphur dioxide per 100 million parts of air. This daily value was exceeded in the City on only two days in 1960 — on December 17th and January 7th at the Golden Lane, and Bishopsgate and Cloak Lane stations, when the concentrations were 41.8 at Bishopsgate on December 17th, and 43.7, 54.4 and 60.3 at Golden Lane, Bishopsgate and Cloak Lane. By the lead peroxide method sulphur pollution at Golden Lane showed a slight decrease when compared with 1959, but there was a slight increase when compared with the average of the previous five years. Similar comparisons of the measurements recorded in Finsbury Circus showed a decrease in sulphur pollution. TABLE I—Results obtained in 1960 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 Millimetres inches of rain Tons per square mile STATIONS (see note below) A B A B A B A B January 36 1.43 37 1.45 10.12 14.57 7.43 9.83 17.56 24.40 February 46 1.80 44 1.73 13.61 11.44 8.73 8.62 22.34 20.07 March 36 1.44 38 1.50 13.44 15.17 8.26 9.46 21.71 24.63 April 10 0.41 11 0.45 17.23 8.52 5.64 4.93 22.87 13.46 May 44 1.74 44 1.73 28.61 10.87 4.85 6.07 33.46 16.95 June 40 1.60 37 1.46 15.60 19.53 5.74 6.71 21.34 26.24 July 65 2.55 79 3.10 12.21 10.20 6.34 5.60 18.55 15.81 August 80 3.14 77 3.03 13.74 9.43 7.80 7.45 21.54 16.88 September 122 4.80 122 4.81 14.34 11.44 8.07 9.83 22.40 21.28 October 128 5.06 119 4.69 14.11 13.12 10.85 9.60 24.96 22.72 November 89 3.51 93 3.66 11.25 11.85 8.93 9.46 20.18 21.31 December 51 2.00 56 2.21 10.69 12.59 7.90 10.20 18.59 22.79 Averages: 1960 62 2.46 63 2.49 14.58 12.39 7.55 8.15 22.13 20.55 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 - 1955-59 46 1.83 - - 16.06 - 7.70 - 24.09 - Note: A — Golden Lane. B — Guildhall from 1st June, 1958. (a) average for 7 months. (b) average for 10 months. 6 TABLE II- Results obtained in 1960 of the daily observations of the concentration of SMOKE by the volumetric method. Month Rainfall collected in deposit gauge at Golden Lane Golden Lane POLICE STATIONS Bishopsgate Cloak Lane Snow Hill Monthly Average Monthly Average Monthly Average Monthly Average Equivalent to Millimetres inches of rain Milligrams per 100 cubic metres Milligrams per 100 cubic metres Milligrams per 100 cubic metres Milligrams per 100 cubic metres January 36 1.43 17 26 23 11 February 46 1.80 15 22 20 12 March 36 1.44 13 14 13 6 April 10 0.41 8 11 13 3 May 44 1.74 7 10 13 3 June 40 1.60 3 8 10 2 July 65 2.55 2 10 8 2 August 80 3.14 4 10 8 2 September 122 4.80 6 11 11 3 October 128 5.06 11 16 12 9 November 89 3.51 11 28 12 11 December 51 2.00 17 32 18 13 Averages: 1960 62 2.46 10 16 13 6 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) 1955-59 46 1.83 11 19 14 10 (a) Measurement for 9 months of the year. TABLE III.— Results obtained in 1960 of the measurement of SULPHUR DIOXIDE by the volumetric and lead peroxide methods. Month Rainfall collected in deposit gauge at Golden Lane Police Stations LEAD PEROXIDE METHOD Golden Lane Bishopsgate Cloak Lane Snow Hill Golden Lane Finsbury Circus Equivalent to 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 J anuary 36 1.43 13 19 19 17 4.44 3.39 February 46 1.80 13 17 17 15 4.21 2.96 March 36 1.44 14 14 18 13 4.36 2.60 April 10 0.41 7 13 11 8 2.79 2.20 May 44 1.74 8 13 10 7 2.74 1.70 June 40 1.60 5 9 8 5 2.05 1.35 July 65 2.55 3 5 8 3 1.41 1.05 August 80 3.14 4 9 6 4 1.46 0.92 September 122 4.80 6 11 8 3 2.50 1.36 October 128 5.06 12 14 13 9 3.97 1.95 November 89 3.51 13 20 14 13 4.19 3.28 December 51 2.00 14 24 19 13 4.48 3.46 Averages: 1960 62 2.46 9 14 13 9 3.22 2.19 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 1955-59 46 1.83 10 14 12 12 2.96 2.54 (a) Measurements for 9 months of the year. 7 PIGEON NUISANCE A firm of pigeon catchers is employed under contract by the City Corporation whose 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. During the year approximately 2,400 pigeons were humanely trapped and killed as opposed to 12,000 and 12,000 in 1959 and 1958 respectively. It is generally held that the number of London pigeons is growing but the contractor, by increasing his efforts, has been successful in maintaining the City pigeon population at a steady level. This claim is supported by the fact that only four complaints of nuisance caused by these birds were received during the year. In each instance intensive trapping in the area affected mitigated the nuisance. It is estimated that the daytime pigeon population of the City can be counted in thousands, but that eighty per cent of the pigeons leave the City with the home-going workers to spend the night in various metropolitan boroughs. The contractor usually operates in the evening and at week-ends when the City is quiet, largely because his work has frequently been impeded by misguided though well intentioned members of the public who shout and frighten the birds, thus preventing them from being trapped. During the latter part of the year, however, obstruction by this type of person decreased, presumably because the public are beginning to realise the necessity for controlling the numbers of these birds. It is hoped that such enlightenment will continue as in the light of the foregoing remarks more daytime trapping will obviously become necessary in order to prevent an increased City population, unless, of course efforts of other local authorities are successful in catching birds during the night. It is also considered that ninety per cent of the problem is due to office staffs feeding the birds on open spaces and even throwing scraps of food onto their own window ledges. It will be realised, therefore, that the pigeon problem cannot be really satisfactorily dealt with without the intelligent co-operation of the general public. 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 re-interred in an approved burial ground or cremated at an established crematorium. During the year all human remains interred in the churchyards of St. John Zachary, Gresham Street and St. Stephens, Coleman Street, were excavated and taken to other Cemeteries where they were reverently re-interred. In both instances, the burials had occurred many decades ago. All excavation and transport to the Cemeteries was carried out under the supervision of a representative of The Medical Officer of Health. CANCER DIAGNOSIS The City Corporation had for some years been considering the possibility and practicability of inaugurating a scheme in the City to provide, for members of the public, free examination for the purposes of diagnosing whether a 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. The Governors of St. Bartholomew's Hospital who were approached in this connection were very helpful and co-operative and as a consequence a clinic for the early laboratory diagnosis of cancer in certain organs of women has been established in that Hospital. The Corporation have no statutory powers to spend money on work of this nature out of rates but are doing so out of City's Cash. The initial report prepared by St. Bartholomew's Hospital on the work of this clinic follows "Period : 4th January — 26th September, 1960. Attendances: 221 to date. Appointments booked to 28th November — approx. 9 weeks ahead. Abnormal smears : Age distribution : Class IV: 1 (under investigation) 35—44:103 Class II: 3 45—54:91 55—64:27 Total 221 Symptomatology: Patients asymptomatic (attending solely because the Clinic is a good idea): 124 Patients asymptomatic who mention a family history of carcinoma: 20 Patients asymptomatic who mention previous gynaecological treatment: 21 Hysterectomy:— Total: 3 Sub-total 5 Undetermined 1 D. & C.: 4 Radium menopause: 1 Ovarian or Tubal: 4 Unspecified: 1 Repair: 2 8 Patients with history constituting post-menopausal bleedings: 4 No. investigated by diagnostic curettage : 2 (No abnormal findings) No. willing for investigation not yet carried out: 2 Patients complaining of vaginal discharge: 19 Abnormal findings on examination : Cervical erosion: 4 Cervical polyp: 1 No lesion: 14 Patients complaining of pruritus valvae : 6 Abnormal findings on examination : Cervical erosion: 1 Cervical polyp: 1 Leukoplakia: 1 Diabetes mellitus: 1 Benign lesions found on routine examination, with no symptoms : Probable fibromyomata, usually small: 11 Cervical erosion: 11 Cervical Polyp: 9 Atrophic vaginitis: 4 Trichomonas vaginalis vaginitis : 2 Total benign Cervical Lesions : Erosion : 15. Polypi: 10." The information and statistics given seem to indicate that whereas the original concept underlying the establishment of this Diagnostic Clinic was that it would be primarily an affair of laboratory diagnosis, the work in practice is turning out to be more like what the Americans call a "well person" clinic. Thus in the 221 cases examined so far only 1, which is under investigation, may indicate a very early case of a pre-cancerous condition. A number of other potential causes of ill health or a "feeling below par" have been discovered as a result of a fairly complete local physical examination undertaken by the doctors at Bart's Hospital, in addition to the purely mechanical taking of material for laboratory examination. The conditions shown in the report have been the subject of correspondence with the family doctors concerned, instigating action for remedy, with rapid improvement of health in the very earliest stages of deviation from normal health. In the early weeks of operation of the Clinic only the personnel of two or three large business organisations were offered facilities for examination so as to obviate the possibility of long waiting lists. In May, however, a meeting of City Doctors was held at Guildhall to hear M*. John Beattie, the Head of the Gynaecology Department of St. Bartholomew's Hospital give an explanation of the purposes of the clinic and to report on the progress made. This was followed by an interesting discussion and it was subsequently decided that the facilities of the diagnostic clinic should be made freely available (within the capacity of the clinic) to all City workers. Appropriate notices were published in the Press and a leaflet of which the following is a copy was sent to all City Doctors, who in turn, made the information available to City workers generally. CITY OF LONDON DIAGNOSTIC CLINIC ST. BARTHOLOMEW'S HOSPITAL The purpose of this notice is to draw your attention to the existence in the City of a Diagnostic Clinic in case you did not read about it in the press. The Clinic is for the benefit of women who live or work in the City and who are over the age of 35. By a simple and well-tried test, which only takes a short time, it is possible to advise you that you do not have any of the cancers peculiar to the womb. Your attendance for this examination will be treated as personal and absolutely confidential and the nature of the test will be explained to you before it is done. The examination is harmless but necessarily intimate ; should you feel at all reluctant to proceed with it you need not feel under any obligation to do so, nor will the slightest presswe be exerted on you by the hospital staff. The Clinic has been set up under the auspices of the City Corporation. If you are over the age of 35 and would like to make use of this facility, you can make an appointment to have the test at St. Bartholomew's Hospital, E.C.I, by telephoning MONarch 7777. You should ask for the Appointments Bureau and say you wish to have a test in the Womens' Outpatient Department. You will then be given a time at which you should attend the Hospital. It is not necessary for you to have a doctor's letter of introduction but your own doctor will be informed if you so wish. Your attendance at the Hospital should not take more than half an hour. It will be seen from the report quoted that at the end of September appointments had been booked until the end of November and it is confidently hoped that the Clinic's initial success will be maintained. 9 THE NOISE ABATEMENT ACT, 1960 This Act came into operation on the 27th November, 1960. It amends Section 66 of the London County Council (General Powers) Act, 1937 which makes provision for noise abatement by reference to the nuisance provisions of the Public Health (London) Act, 1936. This amendment provides that Local authorities will be able to require the abatement of a noise or vibration nuisance by the service of an abatement notice on the person causing the nuisance or on the owner or occupier of premises on which it arises and if the notice is not complied with it can be enforced by proceedings in a magistrates' court. Apart from action by a local authority, three or more occupiers of land or premises who are aggrieved by a noise or vibration nuisance may make a complaint to a magistrate. The Act does not apply to noise or vibration caused by aircraft, which are subject to other statutory controls, nor to noise or vibration caused by statutory undertakers in the exercise of their powers. In the case of noise or vibration caused in the course of a trade or business, it is a defence in any proceedings to show that the best practicable means have been used for preventing it and counteracting its effect. No reference was made to vibration prior to the passing of the Noise Abatement Act. Furthermore, Section 1(6) of the Noise Abatement Act substitutes "noise which is a nuisance" for "excessive or unreasonable or unnecessary noise which is injurious or dangerous to health" in Section 66 of the London County Council (General Powers) Act, 1937. Other sections of the Noise Abatement Act restrict the use of loud speakers in streets in certain circumstances. These instruments however, do not constitute a noise problem in the City. The only complaints of noise which have been received in the City arise from the use of compressors or drills in connection with demolition, rebuilding or street works. The majority of the works in connection with which these complaints are made are statutory undertakings and, therefore, exempted from the provision of the Act. In the remainder of the instances in which it has been found impossible to secure reduction of noise it has been because "the best practicable means have been used for preventing it and counteracting its effect" which as has been said is a defence in any proceedings. It is, however, very satisfactory to be able to report that when complaints have been brought tothe notice of those responsible for making noise to such an extent to be a nuisance, they have been most co-operative in making every endeavour to minimise the nuisance. Several contractors have as a consequence of informal representations from officers of the Medical Officer of Health's Department agreed to discontinue noisy activities during the night, possibly thereby jeopardising their contracts, although knowing full well that they could not be compelled to do so by law. The Medical Officer of Health is glad of the opportunity to place on record in this Report his appreciation of the consideration shqwn by these contractors in their voluntary practical consideration of a small minority of the City Population. RECEPTION TO DELEGATES TO THE TERCENTENARY CELEBRATIONS OF THE ROYAL SOCIETY In connection with this Reception, the Medical Officer of Health was asked to arrange "something scientific" in addition to the usual book display in the Library. With the valuable help of Mr. W.R. McGrath, Senior Public Health Inspector, and the Department of Scientific and Industrial Research, a most interesting display was arranged of smoke abatement apparatus for the measurement of atmospheric pollution. Included in the exhibit was an ordnance survey map indicating the smoke concentration in the atmosphere over the whole London Area. It demonstrated that although the City (the first Local Authority in the country to declare the whole of its area a smokeless zone) was surrounded by areas not so declared, a marked decrease in smoke concentration resulted. It clearly showed that the atmosphere over the City compared very favourably with those of suburban districts on the periphery of the London area. There was also a display of very great enlargements of microscope slides, the one showing normal, the other abnormal cells, to illustrate the working of the City of London Cancer Diagnostic Centre at St. Bartholomew's Hospital. Suitable explanations in large heavy type were put on boards in connection with both exhibits. Your Medical Officer has been thanked by the Chairman of the Reception Committee, Mr. Charles G. Hayes, who said that the leading delegates from the Royal Society who had accompanied him round the Library had expressed pleasure in these scientific exhibits and,further, the Librarian had told him that there were considerably more people than there are normally in the Library on similar occasions examining the various exhibits. Thanks are due to Mr. McGrath and to the authorities at St. Bartholomew's Hospital, particularly Mr. Beattie, the Gynaecological Surgeon who authorised the Cancer Centre display and Dr. Canti, the Medical Officer of the Laboratory, who arranged it. 10 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 8— 1. Number of houses which on inspection were considered to be unfit for human habitation Three 2. Number of houses in which the defects were remedied in consequence of informal action by the Local Authority or their Officers Three 3. Number of representations made to the Local Authority with a view to (a) the serving of notices requiring the execution of works or (b) the making of demolition or closing orders (a) None (b) None 4. Number of notices served during the execution of works None 5. Number of houses which were rendered fit after service of formal notices None 6. Number of demolition or closing orders made None 7. Number of houses in respect of which an undertaking was accepted under subsection (4) of section 16 of the Housing Act, 1957 None 8. Number of houses demolished None During the year 43 families were rehoused, leaving 732 families for whom accommodation was required at the end of December 1960. No new housing accommodation was completed during the year. The modernisation of North Flats, Artizans Dwellings (44 flats) was commenced during 1960 together with similar work at Windsor House, Shoreditch (104 flats). Smokeless fuel grates were installed in Viaduct Buildings, Holborn (40 flats). The Old People's accommodation at Isleden House (31 flats) 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. The result of living under the conditions which obtain at Isleden House is reflected in the well-being 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 approximately 685 having been admitted since 1954) and to receive elderly tenants from the Corporation's housing estates, in need of rest and medical attention. The work on the extension (275 flats) to the Corporation's housing estate at Golden Lane commenced in March 1960 but will not be completed until the end of 1961. The first stage of the redevelopment of the Corporation's Avondale Square Estate (380 flats) is now in progress and the first flats are likely to be completed in the latter part of 1961. Work will be started shortly on the first stage of the redevelopment of the Holloway Estate (24 flats). The replacement of the sub-standard houses to the north and west of the Metropolitan Cattle Market in Islington by erection of flats is still held up for want of planning permission for use of the vacant site of the sheep lairs to the west of the market. The improvements to the City of London Freemen's Houses (38) in the Ferndale Road, Brixton have been completed. 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 The City of London Old People's Welfare Association continues to try to ease the burden of the aged members of the community for whom the Association accepts responsibility, by helping them to utilise their abilities to the fullest, and to assist them to remain in their own homes by obtaining for them the Statutory benefits to which they are entitled, and by providing them with the following amenities Provision of extra domestic assistance to those who can no longer carry out their own daily chores, etc. 11 Provision of mid-day meals to those living alone, who, for one reason or another, can no longer concern themselves in shopping; preparing meals, etc. Arranging of Handicraft Classes, including Old Time Dancing, for those who are still sufficiently active enough to enjoy such amenities. Providing on loan, wireless and television sets (donated to this Association) to home-bound elderly persons, to prevent them becoming morose and from feeling entirely cut off from the outside world. Providing Chiropody Services both at Clinics or within their own homes. ANTI-POLIOMYELITIS CLINIC Since the autumn of 1958 the Civil Defence Control accommodation in the sub-basement of the office block at Guildhall, has, by courtesy of the Chairman of the Civil Defence Committee and with the co-operation of the Civil Defence Department, been at the disposal of the London County Council Divisional Medical Officer for Area 5 for use as an anti-poliomyelitis clinic. Throughout this period attendances have justified always one and sometimes two sessions a week. From early in 1960 supplies of vaccine have been sufficient to enable volunteers of up to forty years of age to be invited to avail themselves of facilities for innoculation, and during the year 6,441 persons received initial vaccinations as compared with 20,000 in 1959 when the clinic was available only to persons of less than twenty-five years of age. In comparing the figures for these two years it must be remembered that in April, 1959 a well known professional footballer died from poliomyelitis. There is no doubt that in consequence of this death many hundreds of young persons, who would not otherwise have troubled to do so, presented themselves for vaccination. It may well be, therefore, that this one death saved the lives of many young people who might but for this vaccination have died from poliomyelitis. 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 necesssry 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 so far as practicable free from rats and mice; (c) to enforce the duties of owners and occupiers of land under Part I of this Act, and to carry out such operations as are authorised by those provisions; (d) to keep such records and make such reports relating to their functions under this part of this Act as may be required by any direction given by the Minister rof Agriculture, Fisheries & Food. For the purpose of implementing the aforementioned provisions, the organisation and procedure of the Rodent Control Department was similar to that of previous years, comprising inspection of properties to ascertain the presence of infestation by rats and mice, treatment of any such properties found to be infested, recommendation and supervision of structural and incidental proofing, and periodical maintenance control measures for the destruction of rats in the City sewers. No difficulty has arisen necessitating statutory action to resolve the problem, and the response to the policy of seeking the co-operation of owners and occupiers has been most satisfactory. A total of 3,579 occupancies and properties were inspected, such properties ranging from new buildings in the course of construction, riverside food warehouses and adjoining premises, public and private catering establishments, blocks of offices, shops and factories to domestic dwellings. A major proportion of the work comprised inspection of defined areas for the purpose of instituting collective action. In instances of individual notification of infestation, or request for assistance in control measures, the remaining occupancies and adjoining properties were inspected and where necessary combined action taken. Altogether, 538 complaints were received, either by notification or as the result of inspection, and of this total 520 infestations were subject of control measures. In 68 instances no action other than advice was found necessary. These were in the main cases where an odd stray mouse had been seen, in most instances by the office cleaner, and the often long procedure of investigation still had to be applied. Such cases do, however, indicate the increasing awareness of employers and employees of even very minor nuisances, and their readiness to seek advice and 12 assistance. In nine instances complaints of very bad odours, suspected by the occupiers of being due to decomposing rats under the floors were received. Investigation revealed no sign of rat or mouse infestation, and in each case the cause of the odour which bore a very strong resemblance to dead vermin, was traced to the overloaded electrical circuit, and consequent heating of the P.V.C. cable in the plug box supplying current to electric fires. One occupier had incurred costs of fifty pounds by his builder for the lifting of floor boards and stripping of panelling in two offices. The total of 520 infestations subject of treatment comprised 2 major and 66 minor infestations of rats, and 33 major and 419 minor infestations of mice. Of the rat infestations, 2 major and 41 minor were of common rat character, and the remaining 25 minor infestations came under the Ship (Black) rat classification. Treatment of these infestations entailed 5,022 visits for operational purposes and in the process of control for rats 5,625 prebaits and 574 poisons baits were laid. This resulted in a minimum estimated kill of 634 rats, and of this number, 284 bodies were removed from premises. The use of Warfarin anti-coagulant rodenticides for the control of mice entailed the application of 10,220 initial baiting points and 986 bodies were recovered. In 1945, the comparable figures were 399 rat infestations treated, 241 major (20 - 200 rats) and 158 minor infestations, and control measures resulted in a minimum estimated kill of 10,038 rats of which 2,410 bodies were recovered. In 28 instances structural ratproofing was carried out by owners or occupiers after the application of control measures, and in 2 cases defective drainage resulting in Common rat infestation was remedied. Incidental rat and mouse proofing in the nature of the removal of harbourage provided by unnecessary and undisturbed accumulations has received detailed attention, and the assistance given in this respect by the Director of Public Cleansing and his Inspectors has been invaluable. The low level of Ship (Black) rat infestation manifest in recent years has been maintained, and the number of infestations of this nature (25), was for the second year exceeded by that of Common Rat (43). In the year 1948, when 698 rat infestations were treated, 668 infestations were Ship rat and 30 Common rat. Minor infestations of Ship rat have a high nuisance value and often entail greater assiduity in respect of inspection and control measures than major infestations distributed over a similar area. This is emphasized more especially where the odd rat or two in search of food and water traverses the long tortuous ventilation ducts, lift shafts, and service risers throughout buildings, leaving a trail of spasmodic evidence between roof and basement, and it is only by a meticulous and methodical inspection that the evidence is found and the best baiting sites selected. It is no trouble for this species of rat, with its climbing abilities, to traverse long distances via ducts and up lift shafts, ropes and guides, as unrestrictive movement is necessary for its well-being. The Common rat infestations were, in the main, confined to building sites, which offer every facility and are in every way conducive to infestation, but taking into consideration the vast amount of re-development completed since 1950 and that in progress, rat infestation has not in any way reached the degree viaualized and expected at the onset of reconstruction. The sites were regularly inspected and the fullest co-operation has been received from the various contractors. In respect of the demolition of empty premises for re-development, it has been generally accepted by occupiers of adjoining properties that they would, as the result, be subject to rat infestation, but their fears have been unfounded, and no known infestations of Ship or Common Rat have occurred from this source. The low level of Common rat infestation in surface properties is in no small measure due to the intensive and systematic periodical control measures applied in the City sewers. It is the purpose of these control measures to check the build-up of the rat population in the sewers, and thereby assist in preventing infestation of surface properties from this source via defective drainage. Such measures also lessen the possibility of incidence of Leptospiral jaundice or Weil's disease among the sewermen and others working daily in the sewers, since this disease may be contracted by man when working or living in a rat infested environment. Rats are the principal carriers of a spirochaete, Leptospira icterohaemorragiae which can be carried in the kidneys of both Common and Ship rat. The disease can be caught by handling Infected animals or coming into contact with bacterium in water or slime contaminated with infected rat urine. Leptospiro can live for a considerable time outside the rat in damp conditions, e.g. in the slime on the walls of sewers. Entry into the human body is usually by means of scratches on the hands or through the mucous membranes. The City sewer system comprises approximately 34 miles of traversable sewers, and about 5 miles of 9 inch pipe sewers, which cater for the courts and alleys. The accessible sewers are, in the main, 3 to 4 feet in diameter, but certain sections are 11 and 17 feet. The daily flow in the Greater London area is believed to be in the region of 400 million gallons. The entrances providing access vary in depth from 10 to 35 feet. 13 In an area, such as the City, with approximately 1,000 catering establishments, plus innumerable staff tea rooms, and three large markets, it is inevitable that a large quantity of food is deposited daily into the sewers to provide subsistance for rats. The increasing practice of the catering industry of installing waste food disposal units in kitchens accentuates this problem, as the chewed-up waste after passing through the machine is finally discharged into the sewers to be carried away in the flows. This method of waste food disposal does, however, eliminate the use of swill bins, and the storage thereof, which creates many difficulties. In many instances these bins have to remain in the premises overnight, and inevitably constitute an attraction for rats, mice, flies, and other insects. Where it is possible to put them out on the footway for collection next morning, they still act as an attractant and in addition often create a nuisance to the public by offensive odours, particularly in hot weather. The importance of hygiene in relation to rodent control, embracing efficient waste disposal, food storage, and elimination of incidental harbourage must be emphasized. This is essential to the permanent control of commensal rats and mice, and control measures should be regarded as supplementary to hygiene. From the rodent control aspect the disadvantage created by the discharge of additional food for rats into the sewers is far outweighed by the elimination of swill bins and their attendant problems, and any improvement which can be introduced in the field of preventive control, especially in catering premises, is to be commended. In the phase of rodent control relative to sewers, innovations in the technique of applying control measures and the use of new rodenticides have been introduced during the past ten years. This applies principally to the "Direct" poison control method of application, and the use of Monosodium Fluoroacetate and Fluoracetamide as the toxic agents. Subsequent to the initial sewer treatment in December, 1943, it was the practice in accordance with legislation, and in conjunction with the Metropolitan Boroughs contiguous to the City, to carry out six-monthly controls. These measures comprised a two-day pre-bait, followed by poison baiting in entrances where pre-bait was taken, and recording the result on the fourth day. The poisons used were Zinc Phosphide, Arsenious Oxide and Alpha-Naphthyl-Thio-Urea. The recorded result of the initial treatment was 355 pre-bait "takes" from 427 sewer entrances baited, of which 185 were complete "takes", indicating the numerical density and distribution of the rat population in the sewers at that time. Continued six-monthly controls from January, 1943 resulted in a gradual reduction of the pre-bait "takes", and the recording in the May, 1948 treatment was 118 "takes" of which 63 were complete. From then onwards an upward trend of pre-bait "takes" was experienced with a proportional increase in complete "takes" until in December, 1950 the pre-bait "takes" were 225, of which 185 were complete, thus equalling the number obtained in the initial control in December, 1943. Little was known at that time of the movement of rats in sewers, but the position obtaining at the time of the December, 1950 control appeared to indicate that the low basic level of the residual rat population attained by the maintenance controls up to May, 1948 had not been maintained, and that there was increased distribution, over a wider area plus the breeding increase during the intervening period. It was considered that in view of the time and effort expended on the maintenance controls, drastic action was necessary to effect a further reduction of the residual rat population and to this end discussions were held with the Scientific Officers of the Ministry of Agriculture, Fisheries & Food, which resulted in their approval to the proposition that a series of "Direct" poison controls with Sodium Fluoroacetate, technically known as "1080", should be applied at quarterly intervals. Thirteen controls of this nature were applied at quarterly intervals from May, 1951, and the final control of the series was carried out in June, 1954. By applying the "Direct" poisoning system the time expended previously was halved by reason of the elimination of the two days required for pre-baiting, so that four treatments annually involved approximately the same number of man hours as was needed for the six-monthly controls. The first stage of the series comprised five treatments during the period May, 1951— May, 1952. In the initial control in May, 1951, 150 poison "takes" (three complete, 12 x ¾, 32 x ½ and 103 x ¼ or less) were recorded. In the second treatment in September, 1951 142 "takes" (6 x ¾, 25 x ½ and 111 x ¼ or less) were recorded. The third treatment in December, 1951 produced 89 "takes" (one complete, 2 x ¾, 7 x ½ and 79 x ¼ or less). The fourth treatment in March, 1952 showed a continued reduction in the poison acceptance, which was 53 "takes" (one complete, 2 x ¾, 6 x ½ and 44 x ¼ or less). In the final treatment of the series in May, 1952, 424 sewer entrances were baited as against 306 entrances in the previous controls. The inclusion of the 118 additional entrances would, it was believed, supply some information on the 14 movement and build-up of rats in lengths of sewers not treated for 18 months. The result of this treatment was 20 "takes" only (3 x ½ and 17 x ¼ or less), the lowest recorded. In each instance the poison baits, which were 4 ounces each, comprised sausage rusk and water in equal parts by weight evenly mixed at a concentration of 1% Sodium Fluoroacetate. A feature of the last treatment was that only three "takes" were obtained from the 118 additional entrances baited. The decline in the number of poison "takes" and quantitive value was extremely satisfactory, but the possibility of some poison prejudice having developed could not be over-ruled, and in order to be reasonably satisfied on this point, and at the same time test the efficacy of the measures applied, a test baiting of all available sewer entrances was carried out after a lapse of three weeks. To overcome any possible bait prejudice also, bread rusk moistened with water in equal parts by weight was used, each test bait being 4 ounces. A total of 417 sewer entrances were baited and the baits left down for two days. On examination 35 "takes" (seven complete, 3 x ¾, 10 x ½ and 15 x ¼ or less) were recorded. Altogether, 104 lbs. of unpoisoned test bait was put down, and the estimated amount taken was 72 ounces only. This was a very satisfactory reduction on the pre-bait recording of December, 1950, when 225 "takes" (185 complete 29 x ½ and 11 x ¼) were obtained and the amount taken was 67 lbs. The intermediate stage of the series comprised four treatments during the period September, 1952 and June, 1953. The number of entrances baited was approximately 315 in each instance and the "takes" were consistently low. They were 13, 14, 16 and 11 respectively, and with one exception were in the half or quarter category. Subsequent to the fourth poison control of the second series, and after a lapse of three weeks, 413 sewer entrances were test baited and a total of 105 lbs. was put down and left for two days. Examination showed 23 "takes" (14 complete, 6 x ½ and 3 x ¼) and the estimated weight was 71 ounces. This test indicated that the results obtained by the first series had been maintained. The third and final stage comprised four treatments during the period September 1953 June, 1954 and as in the second series, the poison "takes" were consistently low, the recordings being 21, 4, 5, and 4 respectively. The annual test baiting was applied three weeks after the final poison control, and the recorded result was 26 "takes" (15 complete, 5x ¾, 3x ½ and 3 x ¼) out of 405 entrances baited. In this instance 101 lbs. of test bait was put down and approximately 82 ounces taken. During the course of this series of controls, 262 bodies were found at the base of the sewer shafts or in shallow flows close to the base. This number does not include those found subsequently by sewermen in their routine work along the lengths of the sewers and in dead ends. In one instance, 15 bodies were found in a group near to an entrance where a complete "take" had been recorded, and no doubt many bodies were washed away in rapid flows. The weather conditions diring such treatments can have an important bearing on the ultimate result. If there is an appreciable amount of rain prior to and during a treatment this has the effect of making the entrances very wet and sludgy, resulting in the baits becoming sodden, and in the event of prolonged and heavy rain a number of baits are inevitably washed away by the charged up flows. Fortunately the periods selected for these "direct" controls were, in the main, fine, and of the 90 days which the controls and tests occupied, only four were sufficiently wet to have an adverse effect. From an analysis of the detailed records collated, it did appear that the combination of quarterly "direct" controls and the use of Sodium Fluoroacetate had produced the results it was considered could be obtained, and that an extremely low level of infestation had been achieved, thereby justifying the use of this highly toxic poison, and the labour, care and thought taken in the dispensing and application. During the progress of these control measures, the first to be carried out by any Local Authority in this country, the closest co-operation and fullest exchange of information was maintained with the Scientific Officers of the Ministry of Agriculture, Fisheries & Food, who had carried out field trials under controlled conditions, and it was gratifying to learn some two years later that this method of control of rats in sewers had received official blessing and was embodied in the text book of Rodent Control issued by the Infestation Control Division. In view of the low level of infestation now obtained, it appeared to be an excellent opportunity to ascertain, as far as practicable, if this level could be maintained by "direct" poisoning with Zinc Phosphide at a concentration of 10%. Four such controls were applied during the period September, 1954 and June, 1955 and the poison bait "takes" were 7, 22, 15 and 3 respectively. A similar test baiting to that applied after the "1080" controls was carried out, and a total of 405 entrances were baited for three days. The subsequent recorded result was 63 "takes" (33 complete, 5 x ¾, 19 x ½ and 6 x ¼ or less). The test result after the final "1080" control was 26 "takes" (15 complete, 5 x¾, 3 x ½ and 3 x ¼ or less). In this series of controls 35 bodies were recovered. 15 Analysis of the sector recordings and overall test result indicated that the previous low level had not been maintained. The upward trend and distribution indicated by the acceptance of the non-poison test baits coincided with the observations of the sewermen who had noticed an increase in the number of rats seen during their routine duties in the sewers between these controls, and in particular the last quarter. The low poison acceptance and increase in complete test bait "takes", plus the visual evidence indicated the possibility that some poison prejudice had been produced by the continued use of Zinc Phosphide at a 10% concentration. It was therefore considered that a return to Sodium Fluoroacetate was necessary and during the period September, 1955 and June, 1956, three "direct" poison controls and one pre-bait treatment was applied. In the September control 397 entrances were poison baited, and after three days 38 "takes" (one complete, 9 x ½ and 28 x ¼ or less) were recorded and 52 bodies were recovered. In the two subsequent "direct" controls the "takes" were 12 and 10 respectively, and with two exceptions these were in the ¼ or less category. These controls produced 21 bodies. For the final "1080" control it was decided to apply a pre-bait treatment on the 1-3-5 system, the pre-bait substituting for the annual test-baiting. Unfortunately bad weather was experienced, and thunderstorms and prolonged rain made recording difficult. The pre-bait result was 49 "takes" (36 complete, 9x ¾ and 4 x ½). Some of the "takes" recorded as complete were doubtful and could have been washed away by charged up flows. The poison result was 25 "takes" (2 x ½, 23 x ¼ or less) and 10 bodies were found. Having carried out 21 treatments over a period of five years, principally with Sodium Fluoroacetate, it was suggested that a new poison, Fluoracetamide, technically known as "1081" might prove advantageous as an alternative to the former, and as the result of discussions with the Scientific Officers, Infestation Control Division, it was agreed that a series of "direct" controls be applied in a similar manner to the "1080" treatments. The median lethal dose (LD50) for Common rat is about 15MG/KG of body weight as against 1 MG/KG for "1080". Undiluted Fluoracetamide is approximately 10 - 15 times less toxic to Common rat than Sodium Fluoroacetate and about three times more toxic than Zinc Phosphide. At 2% in bait therefore it is about half as toxic to rats as bait containing 0.25% Sodium Fluoroacetate and about three times as toxic as 2.5% Zinc Phosphide. After a lethal dose the speed of onset of warning symptoms is said to be slower than Zinc Phosphide for which the LD50 is 40 MG./KG. It was considered desirable to obtain by overall test-baiting a basis on which the effectiveness of Fluoracetamide could be assessed after four "direct" controls, and this was carried out during the period 10th - 13th September, 1956, three months after the final Sodium Fluoroacetate control, and repeated the 19th - 22nd November, 1956, ten weeks later, and three weeks prior to the institution of the new series. For the first test, 402 sewer entrances were baited and the baits each 4 ounces of damp sausage rusk were left down three days, and on examination 103 "takes" (84 complete, 6 x 8 x ½ and 5 x ¼) were recorded. The weather was favourable, and 299 test baits recorded as negative were in good condition. For the purpose of the second overall test, ten weeks later, 403 entrances were baited, and on examination, 174 "takes" (165 complete and 9 x ½) were recorded. The weather was again favourable, the sewer entrances being dry and the conditions ideal for the test. The significant feature of the test baiting results was the formidable increase in the number of the "takes", indicating the rapid build-up and distribution in the intervening period of nearly six months from the final control of the former series. These did provide a sound basis on which to judge, and the first Fluoracetamide "1081" control of such a nature to be applied in this country was carried out in December, 1956 two weeks after the second test, the procedure being similar to the "1080" controls, in dispensing and distribution. A total of 394 sewer entrances were treated, each bait being 4 ounces, comprising sausage rusk and water at equal parts by weight, evenly mixed with "1081" at a concentration of 1%. The baits were left down 3-4 days before clearance and on examination 87 "takes" (8 complete, 7 x ¾, 39 x ½ and 33 x ¼ or less) were recorded. A total of 57 bodies were recovered, and no doubt a good many were washed away in fast flows, as during the treatment heavy and prolonged rain was experienced on several occasions. The majority of the dead rats were found in shallow flows a fair distance from the bait sites. The second treatment was applied in March, 1957 when 401 entrances were baited and the recorded result on examination was 60 "takes" (11 complete, 7 x ¾, 18x ½ and 24 x ¼ or less). In this instance 39 bodies were found in shallow and slow flows. At this juncture the procedure was altered to allow the baits to remain down longer, the timing to include a weekend when the discharge of waste from the many catering premises is at a minimum. 16 The third treatment applied in May - June, 1957 embraced 396 entrances, and the baits were down 4-5 days. The recorded result was 18 "takes" (4 complete, 4 x ¾, 8 x ½ and 2 x ¼) and 4 bodies were found. The weather prior to, and during the treatment was good and the baits when cleared were in good condition. The fourth control was carried out in September, 1957 when 398 entrances were baited. The recorded result was 17 "takes" (4 x ¾ and 13 x ½) and 10 bodies were found, making a total of 110 for the series. It was again considered essential to obtain by overall test-baiting comparable information to that supplied by the tests applied on completion of the Sodium Fluoroacetate "1080" direct controls June;1956 and preceding the institution of the "1081" series. Three tests were applied on the 10th October, 1957, 5th December, 1957 and the 6th March, 1958, thus covering a period of six months from the last "1081" control. For the first overall test, three weeks after the poison control, 400 entrances were baited with 4 ounce baits of soaked wheat and left down 5days. On examination 27 "takes" (15 complete, 9 x ¾, 1 x ½ and 2 x ¼) were recorded. This was followed by the second test, 8 weeks later, when 406 entrances were baited with 4 ounce baits of damp sausage rusk. The recorded result in this instance was 69 "takes" (58 complete, 3 x ¾ and 8 x ½). For the final test 13 weeks later, and 6 months after the completion of the "1081" series, 394 entrances were baited with soaked wheat and the baits left down 7 days. The recorded result was 194 complete "takes". In this instance bad weather was experienced. There was heavy rain on the second day when baiting was completed and this was followed by very heavy snowfall. It was impossible to say how many of the "takes" recorded as such were possibly washed away, but from a wide experience of this work under all weather condition3, it is reasonable to assume that approximately 15% were in fact washed away. Allowing the stated percentage of baits washed away the progressive rate of the complete "takes" of test bait is 15, 58 and 135. The comparable results of the tests applied prior to the series was 36 , 84 and 165 complete "takes". The detailed information gathered during this series of controls and tests was the subject of further discussions with the Scientific Officers, Infestation Control Division, and in light of the promising results obtained in the first series and the information gained on the build-up during the intervening period of six months before and after the control measures, it was at the request of the Ministry that the Fluoracetamide controls were continued for a further period of two years and timed for completion in March, 1960 being known as the second and third series. The first control of the second series was applied immediately after the final test of the first series. A total of 394 entrances were baited, and on examination 4-6 days later 91 "takes" (14 complete, 17 x ¾, 26 x ½ and 34 x ¼ or less) were recorded. The weather was ideal and 28 bodies were found nearby. The second control in June, 1958 resulted in 45 "takes" (25 complete, 8 x ¾ 11 x ½ and 1 x ¼) of 401 entrances treated and 14 bodies were found. The latter part of this treatment was marred by continuous heavy rain, and 27 baits were recorded as washed away. This could apply to some of the "takes" recorded as complete acceptance. For the purpose of the third control, started on the 11th September, 1958, 406 entrances were baited, the recorded result being 31 "takes" (7 complete, 5x ¾, 3 x ½ and 16 x ¼), and 6 bodies were recovered. The fourth and final control of the series in December, resulted in 29 "takes" (8 complete, 3 x ¾, 9 x ½ and 9 x ¼), 10 bodies being found. The annual test was applied as from 1st January, 1959, 22 days after completion of the previous series and a total of 400 manholes were test baited and the result on examination was 21 complete "takes". An interim period of six months was again allowed between the series, and a further overall test baiting was applied as from the 21st May, 1959. A total of 393 entrances were test baited, the baits being left down 7 days and on examination 106 "takes" (101 complete and 5 x ¾ were recorded. On the evening of the first day of the test when four sectors comprising 211 manholes had been baited, a prolonged thunderstorm occurred and 21 baits were recorded as washed away. The comparable test after a similar period before the first poison control of the second series produced 194 complete "takes". As previously mentioned, due to heavy snow and rain approximately 15% of this number were in fact washed away. On the recorded basis the build-up therefore in the six months between the last tests is from 21 - 101 complete "takes". The comparable tests prior to the second series produced a build-up from 15- 135 complete "takes". In similar tests after the completion of the Sodium Fluoroacetate ("1080") controls, 1956, the resultant build-up was 36-165 complete "takes". The first poison control of the third series was applied at the same time as the examination and recording of the test, and 400 sewer entrances were poison baited. The baits to which 17 paranitrophenal had been added as a mould inhibitor were left down 4-7 days before clearance and 38"takes" (2 complete, 7x¾, 19x½ and 10x¼) were recorded, 10 bodies being recovered. A heavy rainstorm occurred mid-day on the first day of examination after the baits had been down 4 days. The comparable poison control of the second series produced 91 "takes" (14 complete, 17 x ¾, 26x½ and 34x¼), 28 bodies being found. The similar control of the first series was 87 "takes" (8 complete, 7x¾, 39x½ and 33x¼) and 52 bodies were recovered. The build-up in the interim period prior to this series was 52% less than in the comparable period between the first and second series and the decrease in poison acceptance and the number of bodies found followed a similar pattern. The result of the second control was 25 "takes" (2 complete, 4x¾, 17x½ and 2x¼) of 411 manholes baited and 5 bodies were found. The weather was ideal and the baits were in good condition when examined. The comparable result of the similar control of the 2nd series was 45 "takes" (25 complete, 8x¾, 11x½ and 1x¾) and that of the first series 60 "takes" (11 complete, 7x¾, 18x ½ and 24x¼) and 14 and 34 bodies respectively were found. For the third control 402 entrances were baited, the recorded result being 11 "takes" (8x½ and 3x¼) and 3 bodies were found. The weather, with the exception of a few dry periods , was very wet, and 49 baits were recorded as washed away. The comparable results in the previous series was 31 "takes" (7 complete, 5x¾, 3x½ and 16x¼) and 18 "takes" (4 complete, 4x¾, 8x½ and 2x¼). The final control of the third series was applied in March, 1960, when 402 entrances were baited and the recorded result was 43 "takes" (1 complete, 23x½ and 19x¼ or less) and 5 bodies were found. The result of the comparable treatment of the second series was 29 "takes" (8 complete, 3x¾, 9x½ and 9 x ¼ or less) and that of the first series, 17 "takes" (4 x \ and 13x½). The annual overall test baiting was applied 21 days after the completion of the series and the baits comprising soaked wheat were left down four days. On examination 41 "takes" (38 complete and 3x¾) were recorded and 410 sewer entrances were baited. There was, during three nights, prolonged rain and although only four baits were recorded as washed away there is a possibility that others were similarly affected. The comparable test result on completion of the first series was 27 "takes" (15 complete, 9x¾, 1x½ and 2x¼) and that of the second series 21 complete "takes". A total of 25 dead rats were found during this' series as against 52 for the second and 110 for the first series making a total of 187 for the series comprising 12 treatments with Fluoracetamide. During the former series which comprised 17 "direct" poison treatments with Sodium Fluoroacetate 319 bodies were found, and when combined with those found as the result of the Zinc Phosphide "direct" controls, and the pre-bait treatments prior to the institution of the "direct" method the sum is 1,092. It is emphasized that this figure refers only to those found by the Rodent Operators near the baiting sites at the base of the entrance shafts or nearby in the flows, when examining the baits, and does not include any subsequently found by the sewermen during their routine work. Assessing the relative values of Mono Sodium Fluoroacetate ("1080") and Fluoracetamide ("1081") in light of the detailed information collated, close observation of the treatments carried out in the varying seasons, and making due allowance for the vagaries of the weather, during each treatment, it does appear that the results achieved with the former can in similar conditions be obtained with Fluoracetamide, thus providing an alternating control as at present carried out in the City. These conclusions, reached as the result of this work under practical conditions, are confirmed by the Scientific Officers, Infestation Control Division, as a consequence of controlled laboratory and field trials. This information is contained in the Ministry circular P.D.P./196Q/3 approving the use of Fluoracetamide and recommending the procedure of application similar to that applied in the City since 1951. 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 41,853 persons (24,836 men and 17,017 women) were X-rayed during the year. In addition 22,503 employees of business organisations in the City (13,112 men and 9,391 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 an Extract from a Report received from the Medical Director of the Unit, Dr. W.D.R. Thompson. 18 "NORTH EAST METROPOLITAN REGIONAL HOSPITAL BOARD MASS RADIOGRAPHY UNIT 6D INTRODUCTION. During 1960 the Unit examined 37,948 males and 26,408 females, making a total of 64,356 which was somewhat lower than the average for the past few years. The proportion of women to men was slightly above the yearly average. Up to the end of 1960 the Unit has examined 369,357 males and 256,107 females — making a grand total of 625,464 since it commenced operations in May 1950. Sixty-three cases with a significant tuberculous lesion have been discovered which gives a rate of .98 per 1,000 examinees. Twenty cases of carcinoma of the lung (18 men and 2 women) were discovered during the year which is an increase of about 43% on the previous year's results. The zone of the Unit has remained unaltered, viz. the City of London and the Metropolitan Boroughs of Finsbury and Shoreditch. The Unit operated for about seven months during the year at the Mass Radiography Centre, 20 Golden Lane, E.C.1, while for the remaining period (excluding three weeks annual leave) the Unit visited various firms and organisations which included a co-operative Survey at the Finsbury Health Centre by kind permission of the Public Health Committee of the Borough of Finsbury, when nearly four hundred firms participated. Public Sessions were arranged but were not well supported. The Unit also participated in the Special Campaign at Stepney when the Unit X-rayed 4,481 men and women and discovered fourteen cases (11 men and 3 women) with significant tuberculous lesions. Nearly three thousand new firms were advised of the Mass Radiography Service during the year and produced satisfactory results. DOCTOR'S REFERRALS. General practitioners in our zone have continued to use the Unit's services, and such cases have produced an incident rate of 23.08 per 1,000 examined. MEDICAL PROCEDURE. Abnormal cases (after an interview with the Medical Director) are referred through the examinee's own doctor to the appropriate Chest Clinic. All clinics have recorded their sputum findings, and twenty cases with a positive sputum have been recorded of which 14 were male and 6 were female. A number of cases — outside the purview of a Chest Clinic — have been referred to St. Bartholomew's Hospital and I gratefully acknowledge the ready co-operation offered by Dr. N.C. Oswald and his colleagues. STAFF. Throughout the year the staff have performed their duties in an efficient and courteous manner which I herewith gratefully acknowledge. CONCLUSION. Friendly relationships continue between 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 Divisions 3, 4 and 5. Our gratitude for services rendered by the Central Group Hospital Management Committee and the Regional Hospital Board is also acknowledged." 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 4 occasions during the year. 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 1959, 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 year, 80 members of the staff had their eyes tested, 19 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. 19 61 had been examined previously and were already using spectacles. Of these 48 needed further correction and appropriate lenses were fitted to existing frames or to new frames of the patient's choice. Medical Examinations During the year 365 persons were medically examined. The distribution by Departments and the reason for medical examinations are shown in Table 3. 232 persons were medically examined for admission to the Superannuation Scheme; 4 were rejected as unfit and 4 were deferred. The clinical conditions causing rejection are shown in Table 1. Of the 4 candidates deferred one has been passed fit, having been re-examined after serving a probationary period. The other candidates who were deferred have yet to be re-examined. 52 persons were medically examined owing to prolonged absence on sick leave. At the time of examination, 30 were reported as fit for duty, 11 were reported unfit for duty, and 11 were reported as unfit for further service. The clinical conditions causing unfitness are shown in Table 2. 74 persons who had reached retirement age were medically examined and 73 were reported as fit to continue in the Corporation's service for a further 12 months. One person was reported as unfit owing to senility. 3 persons were medically examined for temporary appointments and 4 were examined to verify the nature of a disability, referred to as "special" in Table 3. 13 candidates for teaching and canteen posts were x-rayed and all were reported as showing no abnormality of the lungs. There has been a considerable increase in the number of medical examinations (365 for 1960 as compared with 226 for 1959) and the investigation of cases referred owing to sickness has involved a considerable amount of documentary research, correspondence and telephone calls as well as physical examination. The liaison between the Medical staff of the Corporation and Hospitals and patients' doctors is all that can be desired. TABLE 1 CLINICAL CONDITIONS EXCLUDING THE CANDIDATES FROM THE SUPERANNUATION SCHEME Disease Males Females Hypertension 2 - Heart Disease 1 — Thyrotoxicosis 1 — TOTALS 4 - TABLE 2 CLINICAL CONDITIONS LEADING TO PREMATURE RETIREMENT Disease Males Females Osteo-Arthritis 2 1 Duodenal or Peptic Ulcer 2 - Heart Disease 2 — Prolapsed intervertebral disc 1 — Carcinoma of bronchus 1 — Bronchitis and Emphysema 1 — Anxiety Neurosis 1 — TOTALS 10 1 20 TABLE 3 DEPARTMENT ADMISSION TO SUPERANNUATION SCHEME REFERRED FOR EXCESSIVE SICK ABSENTEEISM OR RETIREMENT OVER 65 YEARS OF AGE SPECIAL Fit Unfit Deferred TOTAL Fit for Duty Still Unfit Unfit for further service TOTAL Fit Unfit TOTAL M F M F M F M F M F M F M F M F M F M F M F M F Accountant Auditor 2 2 Billingsgate Market 4 4 1 1 1 1 Cemetery 7 1 7 1 6 6 Central Criminal Court 3 3 Chamberlain's 1 3 1 3 1 1 1 Cleansing 2 2 20 7 3 1 30 1 15 4 15 4 1 Comptroller & City Solicitor 3 4 3 4 1 1 Engineer 19 1 20 13 1 14 Epping Forest 2 1 3 1 1 Hallkeeper 2 2 3 3 Housing 1 3 1 2 3 1 2 1 2 Justice Room, Guildhall 2 2 Library 6 1 6 1 1 1 2 2 London Central Markets 26 26 1 1 2 2 1 Mansion House 3 2 3 2 Mayor's Court 1 1 1 Medical Officer of Health 12 1 12 1 5 1 1 7 5 5 1 Metropolitan Cattle Market 14 14 1 1 2 Planning 5 2 5 2 1 1 Police 1 10 1 10 2 3 2 3 Printing & Stationery 4 4 Rating & Rate Accounts 2 2 1 1 Schools:-Boys . . 7 1 1 8 1 1 1 Freemen's 4 4 1 1 Girls 1 1 1 1 Music & Drama 1 3 1 3 1 1 Spitalfields Market 3 3 2 2 Surveyors 11 1 1 1 13 1 2 2 3 3 1 Town Clerk 1 4 1 4 1 Tower Bridge 29 2 31 2 1 3 1 1 Weights & Measures 1 1 1 1 West Ham Park 1 1 Works 6 6 2 1 2 1 177 47 4 4 185 47 30 11 10 1 51 1 56 17 1 57 17 7 21 Catering Establishments Messrs. Thompson and Flynn, the two public health inspectors who specialise in the hygiene of catering establishments, report to the following effect:— As we enjoy the festivities of Christmas and New Year, Time, that fleet footed robber of all our good intentions reminds us that the hour is approaching, all too quickly, when we must again account for the year that has passed beyond recall. There is at first recollection a sense of panic and frustration at the apparently superficial progress which has been made. An elegant or brash specimen of the Shop Fitter's art is no true indication of progress, but many of these new shop fronts have been the means of giving a spring look to a run down business. If shop fronts were a reliable yardstick whereby an assessment could be made of hygienic standards inside the premises, we might feel happier about our progress. However, a more critical examination indicates that a single year's work in the sphere of food hygiene is an inadequate unit of time upon which to make an accurate estimate of the extent of improvements and progress. Indeed, if we were compelled to use this parameter of progress we could think of no more unrewarding task. Inevitably this feeling of dissatisfaction must be the lot of those who endeavour to work for the public well-being. We would therefore invite the critical general public to look back over a period of say ten years and compare the standard's they knew then with those existing today. If they consider the effort involved is worth while we would suggest that they re-iterate their demand for even better standards in the future. Without question the rebuilding of the City on the scars enobled by the lowliest weeds proceeds apace. With the very able assistance of the developers and planners we see the sky lines changing and the edifices which now inspire our daily lives springing up from the beds of these lowly plants, but, with these large new buildings come the problems which are likely to be troublesome for years. Only where the small caterer struggled or the fortunate vendor of alchohol plied his trade and were rudely blasted away by the bombs or chased out of existence with indecent haste by the flames, has there been any insistence upon the re-establishment of catering facilities for the many additional people now working in the City. Where a two-storey building existed before the devastation a twenty-storey office block now stands, but no provision has been made for the feeding of the many additional day-time citizens. In the early stages of the construction of new buildings, it has been our practice to make enquiries from agents and architects as to the likelihood of a restaurant being incorporated therein. In many instances, however, no information was available as to whom the building was to be let or what the individual requirements of the new occupiers might be. Usually in such circumstances no provision has been made for catering facilities and no essential services such as drain connections etc. have been made available for a major eating establishment should one be required. With catering arrangements in the City already stretched to their limits it is suggested that an essential requirement in each large new building is the provision of adequate catering facilities for the personnel employed therein. In considering these points of view, two things become obvious. Firstly, when a caterer is working to the limit of his resources the hygienic standards of his staff are likely to go by the board. This is in no way a condemnation of the caterer as obviously he must, by and large, meet the demands for his services. Secondly, the developer is loath to provide voluntarily facilities for caterhig accommodation because the rents he could obtain for purposes other than restaurants, are far higher than a caterer can afford. Perhaps the time is rapidly approaching when under the special circumstances which are operating in the City of London a more critical look should be given to the caterer. He is of course primarily there as a business man with the object of making a profit. But does he not do something more than that? We believe that he provides a valuable service to the community, a service which would be sadly missed if the pressure of rents and other costs forced him to give up what is in many cases an arduous struggle to make a success of his business. There may be some justification for a local authority accepting the fact that he is providing an essential service to the community and consequently assist him to remain in business by more favourable rating assessment or by some other device. It may become necessary for the planning authorities to insist also upon the provision of suitable catering facilities in all new buildings, and means will have to be found to ensure that efficient caterers are available to provide these essential services. Again this is not an attempt to revive municipal catering but unless some attention is paid to the provision of adequate feeding arrangements in such areas as town centres, people may eventually refuse to work there. Repeatedly during the last year our attention has been drawn to the inadequate standard of ventilation proposed when plans have been submitted to us for our observations. It is obvious, as in the case of chimneys from furnaces, that the terminal points of exhaust ducts from ventilating plants will continue to give increasing cause for concern. In many instances it is certain that as these new buildings tower above their more lowly neighbours they will be the unwilling recipients of the waste products from these low placed outlets which can be just as offensive and objectionable as the emptying of rubbish bins on one's doorstep. Here again it may well be that the solution lies with the planners. Unless they insist upon the provision in these new giant buildings of ducts and chimneys to take waste gases from lower adjoining premises, some of the new office accommodation in the City may become almost uninhabitable. We have digressed. It seems a far cry from good planning to good catering, but it is obvious that many of the considerations mentioned above are an essential pre-requisite to good catering. 22 During the year we have again noticed the difficulties encountered by caterers generally in their endeavours to secure the execution of necessary building work. After all the preliminary energy expended endeavouring to induce everyone concerned to agree to essential improvements, we find that the anticipated benefits to be gained are subject to prolonged delay and that the work is frequently carried out in an inferior manner because of the difficulty of securing the services of a competent builder. The staffing of restaurants in the City is another intractable problem and unless this can be solved it is possible that much of the work and effort expended to secure improved standards of hygiene and better feeding arrangements generally, will be wasted. This also may be a reflection upon the economics involved, as probably the public in general have been led unwittingly to expect meals at prices, which are no longer realistic. Contrary to the state of affairs which existed immediately after the war when a large volume of building work was carried out by and on behalf of caterers without prior consultation with the local authority, we now spend much time discussing with architects and the specialists they employ, the difficulties connected with the modernisation and improvement of existing restaurants, and the problems associated with the provision of new catering premises. Whilst we welcome these opportunities of giving advice, one should not lose sight of the fact that such procedure imposes a heavy responsibility on the staff of this Department as it is essential to ensure that ultimately everyone concerned may proceed with the knowledge and confidence that, if our advice is followed, no major difficulties will arise in the fore-seeable future. Useful and beneficial as these consultations have been in securing a much improved standard of design and construction, so much time has been spent on this aspect of our work that inevitably there has been less opportunity for normal routine inspections. Nevertheless, the priority afforded to securing a satisfactory standard in new premises, has proved worthwhile and is justified, in our view, by the results generally achieved in new restaurants, canteens and public houses throughout the City. During the year under review, it has not been found necessary to institute legal proceedings in a single instance to enforce compliance with the provisions of the Food Hygiene Regulations so far as catering establishments are concerned, and the policy pursued over many years of advising and persuading rather than of enforcing and compelling has, in the majority of cases paid good dividends. Legal proceedings were instituted however, against the proprietor of a Snack Bar under the Food & Drugs Act, for selling a PORK SANDWICH which was not fit for human consumption. A conviction was secured in this instance and a fine of £75 was imposed. It is interesting to note that this was the third conviction against the same caterer for similar offences. Apparently, this was one of our failures where advice and persuasion has been of little avail. In conclusion, we should like to record our appreciation of the co-operation received during the year from the staffs of the City Engineer, the City Surveyor and City Planning Officer. FOOD HYGIENE (GENERAL) REGULATIONS, 1960 Smithfield Market The following report has been received from Mr. D.R. Bernhardt, the Officer appointed to enforce the provisions of the Food Hygiene (General) Regulations, 1960, at Smithfield Market. Stalls. The standard of cleanliness in the stalls has been maintained. P.V.C. DARBIC panelling on the walls of the stalls has now been completed. Meat Transport. The standard of hygiene of the vans is still being maintained and new materials to prevent contamination of the meat are constantly being tried out. Offal Containers. These have complied with the Regulations and a good standard of cleanliness has been maintained. A number of butchers' private vans have been found without containers but these are readily provided when the omission is pointed out. Trucks. The cleanliness of trucks still shows improvement. The Market Superintendent has now had installed a constant supply of hot water in one of the public conveniences, and for a small charge a bucket of hot water and detergent can be obtained at any time during market hours. Owing to the re-building of the Poultry Market, the covered storage of trucks still remains a problem and some trucks have to remain in the open during week-ends. Constant inspection of these trucks is being carried out to ensure that they are in a clean condition when the Market re-opens every Sunday night. Meat Contamination. There are still incidents of meat falling off trucks, mainly due to overloading and the type of open truck in use. This carelessness, when observed, is dealt with instantly and the porters warned. Experiments are going or to produce a more hygienic truck and to minimise the number of cases of meat falling off trucks, and it is hoped to have a suitable truck for use in the near future. 23 A number of cases of dirty meat arriving in the Market on British Railway transport have been found and on each occasion the help and co-operation of the railway officials in the Market has been given and much has been done to improve the standard of delivery and cleanliness of the containers. Washing Facilities. Since my last report, two of the conveniences around the Market have been modernised and increased washing facilities have been provided. A third convenience is in process of being modernised. More personnel from the Market are taking advantage of these washing facilities. Hats and Clothing. The general standard is good and a constant watch is kept to see that this is maintained. Smoking. A degree of smoking in the Market persists. Persuasive measures are still being proceeded with but should these not be successful it will be necessary for prosecutions to be recommended. I would add that the Market Superintendent and his department have given great help and co-operation in carrying out the Regulations and improving the standard of hygiene in the Market. IMPORTATION OF FROZEN PRAWNS 115 samples of prawns taken on importation were submitted for bacteriological examination, of which 31 were contaminated with coagulase-positive staphylococci of a food poisoning type. Details of the results of examination are given with the country of origin:— Country of Origin Description Total Samples Surface Plate at 37°C Count (samples containing coagulase positive staphylococci of a food poisoning type shown in brackets) * claustridium welchii. -100,000 -250,000 -500,000 -2,000,000 2,000,000 3,500,000 Japan Quick frozen peeled cooked prawns 97(28) 56(18) 16(4) 8(2) 15(3) 2(1) Chile „ 10(2) 4(1) 3 3(1) - - China „ 8(1) 8(1) (1*) (1*) — — — — 115 (31) 68 (20) 19(4) 11 (3) 15(3) 2 (1) (1*) (1*) In all cases when a significantly high plate count or the presence of coagulase-positive staphylococci of a food poisoning type is reported the importers are warned, and it may be a measure of the efficacy of steps taken for more hygienic processing at source that this year only two samples of 115 showed plate counts exceeding 2,000,000 (i.e. 2,500,000 and 3,500.000). In 1959 of 110 samples, 16 exceeded 2,000,000, one being 40 million and one 75 million. There is no statutory bacteriological standard for prawns and therefore a provisional standard is applied which must necessarily allow of some flexibility. In assessing fitness for human consumption a two-day surface plate count at 37°C. of 250,000 or less is regarded as satisfactory, a surface plate count of 2,000,000 and over being regarded as excessive. Within this range regard is had to the presence of pathogens and faecal contamination in conjunction with the surface plate count reported. Depending upon the assessment made, release, re-export or destruction is decided upon. Re-exportation is usually allowed conditionally upon a guarantee that the prawns will be processed, in which case the Medical Officer of Health of the Port of destination is informed. In no case was it necessary formally to seize any shipment, the importers voluntarily surrendering the goods upon an assessment of unfitness for human consumption. IMPORTED EGG PRODUCTS During the year 5,715 tins Australian frozen egg, 30 cartons Chinese crystallised albumen and 40 cartons powdered albumen, and 1,751 cartons and drums of U.S.A. albumen were imported into City Wharves. 167 samples were examined for the presence of Salmonella organisms, of which six or 3.6% were the subject of positive reports. — Salra. Typhimurium 3, Salm.Tennessee 2, Salm.alachua 1. 24 IMPORTED TEA Tea destined for City Wharves is allowed forward through the Port of London for examination by the City Food Inspector at the tea warehouses. During the year 1,503 samples were examined by the Public Analyst of which 5 or 0.3% were adversely reported upon for excessive lead content. Although there is no statutory limit for lead content of foods, the Food Standards Committee in their report on the subject recommended a limit of 10 parts per million of lead in tea, and this recommendation has been provisionally accepted in the absence of any other guide. The five samples referred to related to three shipments:— 260 chests Formosa 'Black Tea. lead content 55 ppm, 60 ppm, 60 ppm. 30 x ½ chests Indonesia Tea fannings. " 18 ppm. 200 chests Indonesia Tea " 13 ppm. In each instance acceptable arrangements were made for blending with lead-free teas in such proportion that the lead content of the blended tea was considerably less than the recommended limit. This Report is a record of many and varied activities of which the City Health Service may well be proud, including the newer developments like the arrangements for the diagnosis and treatment of ophthalmic conditions and of cancer diagnosis. Success in our work has been facilitated by the active encouragement of the Chairman and Members of the Committee as well as of other members of the Corporation who take a special interest and by the co-operation of business firms, trade interests, the general public and where appropriate, of other departments of the Corporation. This is a welcome opportunity of expressing thanks to everyone concerned. 25 STATISTICAL INFORMATION Area.—678 acres (including the Temple and foreshore). Population.-Census 1951, 5,268. Estimated mid-year 1960, 4,890. Annual Rateable Value.—As at 1st April, 1960, £13,425,375. Annual Sum received from Penny General Rate.—£55,000. Live Births Number32 Rate per 1,000 population5.88 Illegitimate Live Births per cent of total live births . . . . . . . . . . 12.50 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) . • • • • • 1 Infant Mortality Rates Total infant deaths per 1,000 total live births 31.25 Legitimate infant deaths per 1,000 legitimate live births 35.71 Illegitimate infant deaths per 1,000 illigitimate live births 0 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 31.25 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 31.25 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births) 31.25 Maternal Mortality (including abortion) Number of deaths 0 Rate per 1,000 total live and still births 0 Deaths, all ages 47 Death rate per 1,000 resident population 9.80 INFECTIOUS DISEASE Total cases notified Notifications received:— Dysentery 6 Erysipelas 1 Malaria 1 Measles 6 Ophthalmia Neonatorum 1 Tuberculosis (Pulmonary) 7 Whooping Cough 1 ANALYTICAL EXAMINATIONS (Other than Food and Drugs Act) Agar Agar 2 Apples 2 Apricots 16 Aerolite Adhesive 1 Fertilisers— Chrysanthemite 1 Vegerite with Aldrin 1 Basic Slag 1 Oranges 2 Prunes 1 Paper (for colouring dyes) 1 Raisins 1 Salmon Mayonnaise 1 Salmon Spread 1 Sultanas 10 Tea 1503 Tinned Foods — Breadfruit 1 Chopped Pork 1 Crawfish Tails 1 Grapefruit 2 Grapefruit Juice 1 Luncheon Meat 1 Salmon 3 Yams 2 BACTERIOLOGICAL EXAMINATIONS The following specimens were examined during the year :— Braised Ox Kidney 1 Chicken (cooked) 1 Corned Beef 3 Curry1 Curry Powder 1 Egg Products 167 Escallops 1 Faeces 45 Fowls 6 Haras, Tinned 1 Hamburger 1 Meat 56 Meat Pie 1 Minced Meat 1 Pigs Head 1 Pork, Roast 1 Prawns 84 Soup 1 Stewed Steak 1 Stuffing 1 Stuffing (cooked) 2 Turkey 1 26 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1960 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 ruths. 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 upwards 1 2 3 4 5 6 7 8 9 10 11 12 All Causes 47 1 - - - - 2 2 26 9 7 1. Tuberculosis, respiratory M - - - - - - - - - - - F - - - - - - - - - - - 2. Tuberculosis, other forms M - - - - - - - - - - - F - - - - - - - - - - - 3. Syphilitic disease M - - - - - - - - - - - F 1 — - — — — - — — 1 - 4. Diphtheria M - - - - - - - - - - - F - - - - - - - - - - - 5. Whooping Cough M - - - - - - - - - - - F - - - - - - - - - - - 6. Meningococcal infections M - - - - - - - - - - - F - - - - - - - - - - - 7. Acute poliomyelitis M - - - - - - - - - - - F - - - - - - - - - - - 8. Measles M - - - - - - - - - - - F - - - - - - - - - - - 9. Other infective and parasitic disease M - - - - - - - - - - - F - - - - - - - - - - - 10. Malignant neoplasm-stomach M - - - - - - - - - - - F - - - - - - - - - 1 - 11. Malignant neoplasm-lung, Bronchus M 2 - - - - - - - 2 - - F 1 - - - - - - - 1 - - 12. Malignant neoplasm-breast M - - - - - - - - - - - F 2 — — — — — — — 2 — — 13. Malignant neoplasm-uterus F - - - - - - - - - - - 14. Other malignant and lymphatic neoplasms M 5 - - - - - - - 4 - 1 F 3 — — — — — — — 1 1 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 4 - - F 1 - - - - - - - - - 1 19. Hypertension with heart disease M 1 - - - - - - - 1 - - F - - - - - - - - - - - 20. Other heart disease M - - - - - - - - - - - F 1 - - - - - - - - - 1 2 1. Other circulatory disease M 4 - - - - - - - 4 - - F 3 — — — — — — — 1 2 — 22. Influenza M — — — — - - - - - - - F - - - - - - - - - - - 23. Pneumonia M 6 - - - - - - - 2 3 1 F 1 — — — - - — - 1 - - 24. Bronchitis M 1 - - - - - - - 1 - - F - - - - - - - - - - - 25. Other diseases of respiratory system M - - - - - - - - - - - F - - - - - - - - - - - 26. Ulcer of Stomach and duodenum M - - - - - - - - - - - F - - - - - - - - - - - 27. Gastritis, enteritis and diarrhœa M 1 - - - - - 1 - - - - F - - - - - - - - - - - 28. Nephritis and nephrosis M - - - - - - - - - - - F - - - - - - - - - - - 29. Hyperplasia of prostate M 1 - - - - - - - - - 1 F - - - - - - - - - - - Carried forward M 27 - - - - - 1 2 18 3 3 F 14 — — — — — - - 6 5 3 27 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 1 year 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 75and wars 1 2 3 4 5 6 7 8 9 10 11 12 Brought forward M 27 - - - - - 1 2 18 3 3 F 14 - - - - - - - 6 5 3 30. Pregnancy, childbirth, abortion F - - - - - - - - - - - 31. Congenital malformations M - - - - - - - - - - - F - - - - - - - - - - - 32. Other defined and ill-defined diseases M 2 1 - - - - 1 - - - - F - - - - - - - - - - - 33. Motor vehicle accidents M 2 - - - - - - - - 1 1 F - - - - - - - - - - - 34. All other accidents M - - - - - - - - - - - F - - - - - - - - - - - 35. Suicide M 1 - - - - - - - 1 - - F 1 — — — - — — — 1 — - 36. Homicide and operations of war M - - - - - - - - - - - F - - - - - - - - - - - Totals M 32 1 - - - - 2 2 19 4 4 F 15 - - - - - - - 7 5 3 MATERNITY AND CHILD WELFARE The following details have been received from the Divisional Medical Officer of the London County Council with regard to work carried out in connection with Maternity and Child Welfare in the City. Infant Welfare Centre Total No. of children who first attended during the year and who on the date of their first attendance were:— Under 1 year of age 29 Total No. of children who attended during the year, and who were born in:— I960 44 1959 31 1958-1955 47 Total attendances by children:— Under 1 year of age 741 1—5 years of age 520 Health Visitors Total No. of children visited 69 No. of infants under 1 year of age visited for first time 36 Total visits to infants under 1 year of age 176 Total visits to children aged 1 year but under 2 years 86 Total visits to children aged 2 years but under 5 years 184 No. of expectant mothers visited for the first time 7 Total visits to expectant mothers 26 Care of Premature Infants No. of premature births during the year 5 No. of deaths under 1 month 1 Diphtheria Immunisation No. of children who completed a full course of primary immunisation:— Under 5 years of age 30 No. of children who were given a secondary or reinforcing injection 1 Vaccination No. of children successfully vaccinated or re-vaccinated 33 Home Help Service No. of maternity cases provided with home help Nil 28 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 1,145 (incl. 2 bakehouses and 1,004 kitchens) 1,806 (incl. 2 bakehouses and 1,698 kitchens) 181 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 552 400 22 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - TOTAL 1,697 (incl. 2 bakehouses and 1,004 kitchens) 2,206 (incl. 2 bakehouses and 1,698 kitchens) 203 - 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 Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) 488 426 - - - — - — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 56 44 - — — Ineffective drainage of floors (S.6) 1 18 — — — Sanitary Conveniences (S.7) (a) insufficient 1 — — — — (b) unsuitable or defective 140 124 — 21 — (c) not separate for sexes 8 1 — — Other offences against the Act (not including offences relating to Outwork) - - 15 - - TOTAL 694 613 15 21 - PART VIII OF THE ACT Outwork (Sections 110 and 111) Section 110 Section 111 Nature of Work No. of outworkers in August list required bv Section 110(1) (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.) 249 - - - - - Household linen 17 — — — - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 12 - - - - - Total 278 - - - - - 29 OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms employing outworkers 38 Names and Addresses of outworkers resident in the City received from other Authorities 48 Names and Addresses of outworkers resident outside the City, employed by City firms, transmitted to other Authorities 278 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. 421 inspections of shops and warehouses have been made. The few defects found have been remedied as a consequence of informal action by the Inspectors. 5 intimation notices were served. No legal proceedings were instituted. 4 Certificates granting exemption from the provision of sanitary accommodation in accordance with Section 38(2) 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 T ons Cwts. Qrs. Lbs. Meat, etc., delivered at Smithfield Market 356,106 0 0 0 Meat, etc., surrendered to Inspectors at Smithfield Market 404 19 2 24 Meat, etc., surrendered to Inspectors at Leadenhall Market and City shops 4 5 1 26 Meat, etc.,surrendered to Inspectors at Cold Stores 17 13 2 24 Number of Exportation Certificates Issued 60 Number of demonstrations and lectures given 55 Number of Students attending • . • • 581 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 259 tons 15 cwt. 0 qrs. 18 lbs., which was disposed of as follows T ons Cwts. Qrs. Lbs. Released for stock feeding 103 0 0 0 Released for re-export 3 13 9 Disposed of to contractors 20 4 0 11 Destroyed. 133 9 0 26 45 tons 9 cwts. 0 qrs. 25 lbs. of food were placed under stop and subsequently released to be dealt with under the supervisibn of other local authorities. 30 FOOD HYGIENE REGULATIONS 1955 (Revoked Oct. 1960) and THE FOOD HYGIENE (General) REGULATIONS, 1960 Supervision in accordance with these Regulations has been carried out at Smithfield Market. During the year 683 infringements were noted. 170 were in connection with clothing, 58 in connection with Containers, 64 in respect of meat contamination, 69 in regard to premises and equipment, and 86 were instances of smoking whilst handling food. 65 trucks and 169 vans and cars were observed to be infringing the Regulations. 2 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) Fish Condemned Rate 109,742 tons 381 tons 0.35% SANITARY CIRCUMSTANCES The general sanitary supervision has been maintained and in this connection 3,377 inspections have been made. As a consequence of these inspections, it was necessary to serve 26 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. 74 such applications were received during the year as a consequence of which 262 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. 65 firms were registered under this Act, 61 of which were re-registrations. One infringement was noted. 79 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. 18 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. 29 inspections were made ; no contraventions were npted. 31 FOOD AND DRUGS ACT, 1955, AND FOOD REGULATIONS Informal and Formal Samples submitted for Analysis Article Informal Formal Article Informal Formal Almonds, Ground 2 — Brought forward 180 1 Aspirin Tablets 1 — Meat Products, Canned 34 — Bacon 2 — Meat Products, Frozen 2 — Brandy 3 1 Milk 18 11 Butter 18 — Milk, Condensed 7 — Castor Oil 1 — Milk Pudding, Canned 1 — Cheese & Cheese Spread 14 — Mincemeat 1 — Chocolate, Drinking 1 — Oil, Cooking 4 — Cocoa 1 — Olive Oil 3 — Codeine Tablets 1 — Peel, Candied 1 — Coffee & Coffee Extract 23 — Pepper 3 — Confectionery, Flour 1 — Pickles 1 — Cooking Fat 1 — Proprietary Foods 2 — Cream 5 — Proprietary Medicines 2 — Curry Powder 1 — Rice 1 — Drinks, Soft 6 — Rum 1 — Fish, Bottled 2 — Saccharin Tablets 1 — Fish, Canned 2 — Salt 1 — Fish, Dried 1 — Sauces 4 — Flavouring Essence 1 — Sausages 41 — Flour, Self-raising 1 — Soup, Canned 2 — Fruit, bottled 4 — Spread, Sandwich 1 — Fruit, canned 4 — Spread, Rum Butter 1 — Fruit, dried 25 — Stuffing Mixture 3 — Fruit Juice 2 — Suet, Shredded 1 — Ginger in Syrup 1 — Sugar 3 — Honey 4 — Syrup, Maple 1 — Honey Comb 1 — Tea 14 — Jam 8 — Tea Extract (Dry) 1 — Juniper, Oil of 1 — Tomatoes, Canned 2 — Lard 8 — Tomato Juice, Canned 1 — Macaroni 1 - Vegetables, Canned 10 — Margarine 15 — Vegetables, Frozen 3 — Marmalade 2 — Vinegar 11 — Meat, frozen 1 — Whisky 1 2 Meat Products 15 — Wine, Alcoholic 1 — Carried forward 180 1 TOTALS 364 14 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY Article Informal or Formal Sample Nature of adulteration or irregularity A ction Hot Milk F ormal Contained Fat, 3.14% Solids-not-fat, 7.80% corresponding to the presence of 8% of added water. The added water was a result of the vendor heating the milk by steam injection. Each case was reported to Committee who instructed the Comptroller & City Solicitor to issue warning letters. Hot Milk Formal Contained Fat, 1.93% Solids-not-fat, 4.89% corresponding to the presence of 42% of added water. do. Hot Milk Formal Contained Fat, 2.68% Solids-not-fat, 7.05% corresponding to the presence of 17% added water. do. Hot Milk Informal Contained milk-fat, 1.05% milk solids other than milk-fat 2.63 %, Sugar 4.28%. This composition indicates the presence of 64% of added water, in addition to the added sugar. Served in staff canteen from a watered supply of hot milk used for coffee. The practice has been discontinued. Sterilised Milk Informal The sample w as sour and contained a large growth of Penicillium mould. Upon investigation, it was found that the organisms causing the growth of the penicillium mould must have obtained access to the milk after processing as the mould growth was still active. It was presumed therefore that some damage to the sealing arrangement had been caused after transit. 32 Administrative action regarding adulteration or other irregularity — continued Article Informal or Formal Sample Nature of adulteration or irregularity Action Chipolata Sausages Informal Contained Sulphur dioxide, 320 parts per million. Representations were made to the Vendor and a subsequent inspection indicated that the requisite notice is now being exhibited. Hamburger Informal Unfit. The sample was stale and mouldy. Proceedings authorised by the Committee which resulted in fines and costs of £18. 8s. being incurred by the offender. Pork Luncheon Meat Informal Contained meat 70%. In the opinion of the Public Analyst Luncheon Meat should contain at least 80% of meat. Written representations made to the vendors and upon investigation it was ascertained that these luncheon meats were each manufactured prior to the trade agreement making 80% meat content as the minimum. All this stock had been issued through wholesalers before the agreement became operative. Pork Luncheon Meat, Canned. Informal Contained meat 74%. do. do. Informal Contained meat 70%. do. do. Informal Contained meat 74%. do. do. Informal Contained meat 73%. do. do. Informal Contained meat 70%. do. do. Informal Contained meat 72%. do. Stuffing Informal This sample was not in good edible condition. A stale, sour smell was perceptible and significant degradation of the starch was found to have taken place indicate ing decomposition. This was an investigation into the condition of the stuffing being used in chickens now being sold at many cooked meat shops. Together with the bacteriological result approaches have been made to the manufacturers of the stuffing. Cream of Tomato Soup, Canned. Informal Unfit. The can, which had been opened, was badly corroded and the sample consisted of a shrivelled brown mass of fungal myselium, the soup having completely decomposed. This was caused by a pin hole in the metal container which resulted in the contents drying out and moulds growing. This appears to be an isolated case. The attention of the vendor and manufacturer was drawn to this defect but no further action was considered necessary. Peeled Tomatoes, Canned Informal The sample, which consisted of an opened tin of peeled tomatoes, contained a dead caterpillar and some partly rotten tomato. This was a result of a complaint. The matter was pursued through the retailer, wholesaler, importer and manufacturer in Italy. No further action considered necessary. Smoked Salmon, Canned Informal Contained added preservative viz: Benzoic acid, 1400 parts per million. The article should not contain added preservative. Representations made through wholesalers to manufacturers in Holland. Scotch Whisky Informal Alcoholic strength 38.3°U.P. Stated on the label to have been diluted with water, but the declaration did not comply with the requirements of the Labelling of Food Order. Representations were made to the vendors who withdrew the entire stock of this whisky from their retail premises. Pure American Instant Coffee Informal Consisted of Dry Coffee Extract, incorrectly labelled. Labelling taken up with distributors, who in turn have drawn the attention of the manufacturers to the incorrect statement. Instant Coffee Informal Contained Sulphur dioxide., 120 parts per million. Taken up with the manufacturers. The methods of analyses and other relevant details have been discussed and they are carrying out exhaustive investigations. The matter has not yet been finally resolved. 33 Administrative action regarding adulteration or other irregularity - continued Article Informal or Formal Sample Nature of adulteration or irregularity Action Instant Coffee Informal Contained Sulphur dioxide, 140 parts per million. Coffee extracts of this type are not permitted to contain sulphur dioxide. The manufacturers have made representations to the Ministry of Agriculture, Fisheries and Food for dry coffee extracts to be placed on a similar basis with regard to preservatives, as liquid extracts. Instant Coffee Informal Contained Sulphur dioxide, 90 parts per million. This coffee extract was imported from Israel and the sulphur dioxide apparently results from the drying process being carried out by a fuel containing sulphur. Later samples of this product were free from sulphur dioxide as a result of changing the type of fuel used for drying purposes. Butter Informal Contained water 16.2%. Butter should not contain more than 16% water. The matter was taken up with the vendors and packers. No further action was considered necessary. Cheese Informal The cheese contained embedded in it a small bent piece of rusty iron wire. There is no explanation for this small piece of wire being embedded in the Cheese. No legal action taken. Dried Fruit Salad Informal Unfit. The sample was contaminated by mites and insect excreta. The remaining stocks were examined and withdrawn from sale. Stores are being disinfested. Turkish Figs Informal Unfit. The sample had been attacked by insects, mites and mildew. 200 small beetles and 17 larvae were found. The remaining stocks were examined and withdrawn from sale. Stores are being disinfested. PROSECUTIONS Food and Drugs Act, 1955 Section Offence Result 6 & 8 Sale of Hamburger sausage meat bearing a label falsely describing the sausage meat. Sale of Hamburger Sausage Meat unfit for human consumption. Vendor fined £5 on each of the two summonses with £8. 8s. 0d. costs. 8 Sale of meat roll unfit for human consumption. Vendor fined £75 with £7. 7s. 0d. 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. 148 such premises were registered at the end of the year. 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 82 Sale and storage of ice cream 6 Selecting and sorting of sausage 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. 33 Cooking, smoking and canning of meat products 2 Manufacture of pies 1 Smoking of bacon 1 Sale of Cooked Meats 2 152 34 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 Acts also stipulate that all "preserved" eggs shall be so marked before being offered for sale and that all premises used for the cold storage or chemical storage of eggs shall be registered with the local authority. 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. CITY MORTUARY Bodies received 179 Post Mortem Examinations made 178 Inquests on bodies 40 Inquest held at Holloway Prison Nil Inquest on fires Nil DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, etc.:— No. of articles disinfected 885,700 Cases of horsehair 388 Fees received £3,659 General Disinfection. Infectious Diseases, etc.:— Articles of bedding disinfected 112 Premises disinfected after cases of infectious disease 3 Lockers at Post Offices disinfected 18 Verminous premises disinfected 22 Cleansing of Persons:— No. of verminous persons bathed 741 No. of Scabious Persons bathed 2 No. of articles disinfected 7,430 35