AC Lon87 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1961 Printed by the Authority of Common Council 17th. December 1953. STAFF. MEDICAL OFFICER OF HEALTH (Foi 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. Chief Clerk May 1924 McLorg, W.L. General Administrative Officer . Feb. 1927 Ratliff, R.C. Deputy Chief Clerk March 1930 C Stout, J.E. First Assistant Clerk 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 Campbe ll, Miss S.H. General Grade Clerk Jan. 1960 Callow, Miss B.A. General Grade Clerk Jan. 1961 Worwood, G.J. General Glade Clerk (Temporary) Oct. 1961 PUBLIC HEALTH INSPECTION STAFF McGrath, W.R. Senior Public Health Inspector March 1922 Sillett, D.E. Senior Public Health Inspector April 1926 Neale, W.G.C., Senior Public Health Inspector July 1928 THOMPSON. E. Senior Public Health Inspector Sept. 1948 Thorpe, R.C. Public Health Inspector March 1930 Hudson, L.A. Public Health Inspector April 1934 campbell, J.W. Public Health Inspector Sept. 1946 Flynn, J. Public Health Inspector July 1951 ADMINISTRATIVE STAFF - MEAT INSPECTION Threadgold, A«W. First Class Assistant Nov. 1923 Peters, E.J. General Grade Clerk Nov. 1935 Cash, J.E. General Grade Clerk March 1954 MEAT INSPECTION STAFF Thompson, F.E. Chief Meat Inspector July 1924 Lee, W.R. Deputy Chief Meat Inspector July 1930 Garrard, S.S. Meat Inspector Sept. 1946 Morris, W.L. Meat Inspector Sept. 1946 Seymour, K.S. Meat Inspector July 1935 Wilson, J.c. Meat Inspector Jan. 1936 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.G..D.F.C. Meat Inspector Dec. I960 Bernhardt, D.R. 'Authorised Officer' under Food Hygiene Regulations, 1955 May 1931 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 Vacancy KEEPER OF THE MORTUARY Lawrence, F.H May 1936 DISINFECTING APPARATUS ATTENDANT Sunnick, J.W.T May 1950 MESSENGERS Bourne, A.W. March 1956 Woods, T.A Nov. 1955 SENIOR PORTER AT SMITHFIELD MARKET Prevost, A.E Feb. 1926 MANUAL WORKERS Mann, E.V. (General Duties at Smithfield Market) Jan. 1928 Lawrence, C.J. (General Duties at Smithfield Market) Feb. 1928 Portbury, T. (General Duties at Smithfield Market) July 1953 Wright, J. (General Duties at Smithfield Market) . Oct. 1953 Wright, T.W. (General Duties at Smithfield Market) Oct. 1956 Steele, W.T. (General Duties at Mortuary) . Aug. 1958 Harrison, T. (General Duties at Mortuary) Jan. 1961 PoLLEY, T.H. (General Duties at Mortuary) June 1961 JoLLlE, Mrs. F.G. (Bath Attendant and Cleaner) Sept. 1955 OCCASIONAL DEPUTY MEDICAL OFFICER OF HEALTH Stott, William, M.B., B.S., D.P.H., F.R.I.P.H. Aug. 1958 PUBLIC ANALYST Williams, H.A., Ph.D.(Lond.) A.C.G.F.C., F.R.I.C., F.R.S.H . Jan. 1958 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1961. 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 1961. An Index is appended to this Report. VITAL STATISTICS The resident population of the City according to the Registrar General's estimate at mid-year 1961 was 4,600. The birth rate fell to 5.80 per 1,000 resident population and the death rate rose to 10.01 per 1,000 resident population compared with 5.88 and 9.80 respectively in 1960. 29 babies were born alive , one of which died within four weeks of birth , being born prematurely. 7 births were illegitimate. There was one still-birth. The total number of deaths of all ages was 56; 41 male and 15 female. 11 deaths were due to cancer, 3 of which were cancer of the lung. 7 deaths were from pneumonia and 2 from bronchitis. One death was due to a motor accident, one to falling in front of a train and one elderly man was found drowned in the River Lea. One woman, who died from a sudden heart attack had already celebrated her 100th birthday. INFECTIOUS DISEASES NOTIFIED 39 notifications of infectious disease were received ; namely 1 of acute primary pneumonia (0), *1 diphtheria (0), 2 of dysentery (6), 2 of erysipelas (1), 23 of measles (6), 1 of poliomyelitis (paralytic) (0), 2 of scarlet fever (0), 5 of tuberculosis (pulmonary) (7), 2 of whooping cough (1). (The figures in brackets denote the comparable numbers of cases in 1960) *This case was re-diagnosed as acute tonsillitis. The paralytic poliomyelitis case was the Vicar of one of the City Churches. He made a full recovery. FOOD POISONING A number of the staff of an Insurance Company, arriving at work on Friday, 6th October, reported that they had been taken ill during the previous night. The Company notified the Deputy Medical Officer of Health and extensive enquiries were made regarding this illness. It was found that ninety-two members of the staff had been taken ill with diarrhoea and abdominal pain, but only three of them claimed to have vomited. The onset of the symptoms occurred approximately 14.22 hours after the meal was eaten and most of those affected recovered within the next 24 hours. This short but rather sharp attack of abdominal pain and diarrhoea, together with the marked absence of vomiting is typical of a food poisoning due to a heat resistant strain of Clostridium Welchii. Minced chicken and ham, and fried egg were the items on the extensive menu taken in common by these people, and a total number of 400 portions were served. Some remnants of the minced chicken were submitted to the City Bacteriologist for examination and a few people also volunteered to submit faecal specimens for this purpose. The Bacteriologist isolated heat resistant strains of Clostridium Welchi: from the faecal specimens but he was unsuccessful with the remains of the minced chicken. Nevertheless, I am confident that this particular meal was the source of the trouble and that the toxins of this strain of Clostridium Welchii were the cause of the illness. The preparation of a meal of this type inevitably means handling the food greatly in excess of normal and while no obvious errors or lapses in technique have come to light the minced chicken must be viewed with suspicion. The Deputy Medical Officer visited the kitchen where the meals were prepared. It is comparatively new and they have adequate facilities to handle and store food in a proper manner. 2 ANNUAL RETURN OF FOOD POISONING IN THE CITY OF LONDON 1. YEAR ENDED 31st DECEMBER, 1961. 2. (a) FOOD POISONING NOTIFICATIONS (Corrected) as returned to Registrar General:— 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil Nil Nil Nil Nil (b) Cases otherwise ascertained:— 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Nil 1 1 92 94 (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 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) CI. welchii Nil 1 Nil 92 92 (f) Other bacteria Nil Nil Nil Nil Nil Totals Nil 1 Nil 92 92 Agent not identified Nil Nil Nil Nil Nil 4. SINGLE CASES Agent No. of Cases Notified Otherwise ascertained Total No. of Cases Identified: (a) Chemical Poisons Nil Nil Nil (b) Salmonella Nil Nil Nil (c) Staphylococci (including toxin) Nil Nil Nil (d) CI. botulinum Nil Nil Nil (e) CI. welchii Nil Nil Nil (f) Other bacteria Nil Nil Nil Totals Nil Nil Nil Agent not identified Nil 2 2 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 3 ATMOSPHERIC POLLUTION The routine measurement of atmospheric pollution at the stations in the City of London continued during the year. The results are set out in the Tables which follow. TABLE I — Deposit gauge. The rainfall collected was much below that for 1960, and was less than the average for the previous five years. During the year the total amount of soluble and insoluble matter deposited in the collecting bowl was considerably below the average for the previous years. TABLE II — Smoke concentrations by the volumetric method. In 1961 the average concentrations of smoke at two stations— Golden Lane and Cloak Lane — were below those recorded for the average of the previous five years. At Bishopsgate there was a small increase whilst at Snow Hill the figure remained constant. TABLE HI — Sulphur measurement by the volumetric and lead peroxide methods. The average concentrations of sulphur pollution changed little from the average for the previous five years. Only at Bishopsgate was there a slight increase. By the lead peroxide method sulphur pollution at Golden Lane and Finsbury Circus showed slight decreases when compared with 1960 and with the average of the previous five years. TABLE I—Results obtained in 1961 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 belong A B A B A B A B January 45 1.76 47 1.84 16.00 16.55 8.00 10.10 24.00 26.65 February 49 1.94 52 2.05 17.99 19.83 8.56 7.65 26.55 27.49 March 2 0.07 2 0.07 27.35 7.65 3.98 4.90 31.33 12.55 April 45 1.77 43 1.71 16.50 20.07 9.16 8.83 25.66 28.90 May * __ 21 0.82 14.50 4.90 - 19.40 June * 34 1.32 8.39 5.17 — 13.56 July 31 1.21 36 1.43 7.30 11.98 4.22 5.74 11.52 17.72 August 40 1.57 49 1.92 8.80 13.83 6.31 6.95 15.10 20.77 September 54 2.12 51 2.03 14.80 12.18 7.60 7.65 22.40 19.83 October 47 1.86 58 2.29 13.44 23.63 7.70 9.50 21.14 33.12 November 58 2.28 56 2.19 14.64 16.21 16.73 11.58 31.36 27.79 December 51 2.02 73 2.89 3.38 16.11 18.19 10.64 21.57 26.75 Averages: 1961 42(b) 1.66(b) 44 1.71 14.02(b) .15.08 9.05(b) 7.80 23.05(b) 22.88 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 — — 1456 — 7.17 — 21.73 — 1956 44 1.74 — — 13.31 —- 7.80 — 21.08 — 1956-60 50 1.98 58 2.26 16.23 14.53 7.61 13.07 24.17 34.27 Note: A — Golden Lane. B — Guildhall from 1st June, 1958. (a) average for 7 months. (b) average for 10 months. * No recording at Golden Lane owing to defective apparatus. 4 TABLE D—Results obtained in 1961 or the daily observations of the concentration of SMOKE by the volumetric method. Month Rainfall collected in deposit POLICE STATIONS gauge at Golden Lane Golden Lane Bishopsgate Cloak Lane Snow Hill Equivalent to Monthly Average Monthly Average Monthly Average Monthly Average 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 45 1.76 11 25 12 11 February 49 1.94 9 24 11 9 March 2 0.07 12 24 13 11 April 45 1.77 7 26 8 6 May * — _ 5 11 7 4 June * — _ 5 8 7 5 July 31 1.21 4 11 6 5 August 40 1.57 4 11 6 4 September 54 2.12 7 14 7 6 October 47 1.86 8 20 8 8 November 58 2.28 13 30 14 12 December 51 2.02 17 40 19 16 Averages: 1961 42(a) 1.66(a) 9 20 10 8 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 1956-60 50 1.98 10 19 15 8 * No recorded rainfalls owing to defective apparatus, (a) Average for 10 months. TABLE in.— Results obtained in 1961 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,O.3) per day per 100 sq. cm. Parts per 100 m. parts of air January 45 1.76 15 19 15 16 4.60 3.73 F ebruary 49 1.94 12 19 12 14 4.32 3.17 March April 2 45 0.07 1.77 13 9 22 18 16 10 15 9 4.12 3.39 2.03 2.05 May * — — 5 10 3 5 1.93 1.38 J une * — — 5 11 6 5 1.76 1.06 July 31 1.21 3 8 4 4 1.31 0.87 August 40 1.57 4 10 5 4 1.46 1.04 September 54 2.12 7 13 8 7 1.87 1.30 October 47 1.86 10 15 9 9 2.89 2.10 November 58 2.28 13 20 15 16 3.87 2.96 December 51 2.02 16 25 19 18 4.61 3.45 Averages: 1961 42(a) 1.66(a) 9 16 10 10 3.01 2.10 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 1956-60 50 1.98 10 14 12 11 3.03 2.46 * No recorded rainfalls owing to defective apparatus, (a) Average for 10 months. 5 PIGEON NUISANCE A firm of pigeon catchers is employed under contract by the City Corporation whose policy is not 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 out-weighed by the nuisance theycause. Diring the year 2,100 pigeons were humanely trapped and killed as compared with 2,400 in 1960. EXCAVATION OF HUMAN REMAINS St. Peter's Burial Ground. Upper Thames Street, E.C.4. Rebuilding on war damaged sites abutting on and including St. Peter's Burial Ground made it necessary to remove all human remains that that Burial Ground contained. An inspection disclosed four tombs and a number of gravestones and memorials. It was necessary to lower the level of the Birial Ground to a depth of approximately 10 feet below the level of the carriageway in Upper Thames Street, thus bringing it to the general level of the surrounding sites, from which stage the contractors of the redevelopment could then commence their work. An architect was responsible for the lowering of the level of the Burial Ground and the removal of human remains. For the latter purpose he obtained a Faculty from the Bishop of London for their removal and re-interment at the City of London Cemetery, Manor Park. As excavation progressed, five complete sound coffins containing human remains, as when buried originally, were found. A record of each name, age and date of burial, which was obtained from the name plates attached to the coffins has been kept. Human bones were also found. These bones gave evidence of previous disturbance, for, though some were lying loose in the soil, others were stacked at a lower level, all well covered with soil. All were conveyed to the Cemetery by a funeral undertaker for reinterment, being contained in 87 boxes. The site was screened from public gaze diring the progress of the work which was carried out with due reverence. Meat Market, Smithfield. A complete block of the Corporation Meat Market, Smithfield was destroyed by fire in 1958. At the northern corner, i.e. Charterhouse Street, a wall had been broken down and vaults had been revealed which had apparently been sealed up since the time of construction of the meat Market, over 100 years ago. In one of these vaults a quantity of human bones was found and the way in which they were lying suggested that they were tipped in from above, that is normal basement level of the Market, through a hole resembling a coal-hole such as can be seen in the public footway. The existence of these vaults was unknown until recently revealed and so these bones have been sealed up since the time the Market was built, probably having been removed from their original place. They could have been collected from all over the site. The bones appeared to be about 300 years old. A licence was subsequently issued by the Home Office for the remains to be placed in wooden shells, conveyed to the City of London Cemetery and there cremated. 10 boxes of remains were subsequently cremated. THE NOISE ABATEMENT ACT, 1960 Very few complaints, in fact less than half-a-dozen, were received of excessive noise. With the exception of one, these were all due to the use of drills or bull-dozers in connection with demolition works and the contractors were all co-operative in endeavouring to minimise the noise after their attention had been drawn to the complaints. The one exception was repeated complaints from a number of residents who were unable to sleep owing to the noise of singing, whistling and music from loudspeakers emanating from a printing establishment where workers were employed at night. Requests to minimise the noise in the interests of those dwelling nearby were at first ignored and it was not until the owner of the firm was threatened with legal proceedings that the nuisance ceased. 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. 6 Housing Consolidation Regulations, 1925, No. 866, Part IV. Inspection of District :— 1. Number of houses which on inspection were considered to be unfit for human habitation:— Two 2. Number of houses in which the defects were remedied in consequence of informal action by the Local Authority or their Officers Two 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) One 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 112 families were rehoused, leaving 804 families for whom accommodation was required at the end of December 1961. The modernisation of North flats, Artizans Dwellings (44 flats) was completed together with similar work at 66 of the 104 flats (and commenced at the remaining 38 flats) at Windsor House, Shoreditch. 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 761 having been admitted since 1954) and to receive elderly tenants from the Corporation's housing estates in need of rest and medical attention. Of the 275 flats and maisonettes comprising the extension to the Corporation's housing estate at Golden Lane, 56 were completed last year and work on the remainder (219) is well in hand. The redevelopment of the Corporation's Avondale Square Estate (380) flats is progressing well and the first 44 flats (Colechurch House) were completed just before Christmas. Work has been started 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 the 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. 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:— 'This Association receives enumerable requests for assistance and advice from Old Age Pensioners who do not necessarily live within the 'Square Mile', but who, by virtue of previous employment or residence, retain their connection with the City. An increasing number of such requests have been from the more infirm elderly who can no longer remain in their own homes and for these over 60's, and for those for whom the City has a more direct responsibility, the Association has been actively engaged in trying to find a suitable alternative. 'During the period under review the Association has helped to obtain accommodation with care and attention for no less than 150 persons, but it is evident that the shortage of this accommodation, and the increasing demand for it, will remain not only one of the greatest problems of the elderly but for those who seek to assist them. 7 'For those who continue to remain in their own homes the Association has provided amenities including chiropody service, convalescent holidays, domestic assistance (both day and night), entertainment and outings, extra nourishment, mid-day meals, special medical requisites, Handicraft Classes for those able to attend clubs and home work for the less mobile. There are now two very active employment schemes and undoubtedly this work helps to maintain an independent spirit amongst those over 60's who, only by reason of their age, have had to retire from their previous employment. 'Visiting is one of the special services the Association offers and undoubtedly these voluntary visitors, both young and old, help to bring brightness into the homes of these old folk by their kindness and more especially by their regular visits. 'The Association is now caring for approximately 1,728 persons, but at all times is conscious that those who seek aid should receive the amenities and facilities they require when the need is most urgent. 'This is a brief summary of the activities provided for the over 60's in and of the City for the year ending December 31st, 1961, ' FACTORIES ACT, 1937 THE SANITARY ACCOMMODATION REGULATIONS, 1938 PROSECUTION H.M. Inspector of Factories, in accordance with Section 9 of the Factories Act 1937, on the 12th May reported an infringement of Section 7 of that Act in that a sanitary convenience in a clothier's factory was not provided with an intervening ventilated space as is required by the Sanitary Accommodation Regulations 1938. During the ensuing months the occupier of the factory made frequent promises to do the necessary work "within a week or so" but none of these promises was implemented. On the 1st December, the Port and City of London Health Committee authorised the institution of legal proceedings. The occupier of the factory was subsequently prosecuted when the Magistrate imposed a fine of £50 and 5 guineas costs. This is the first prosecution ever instituted by the City Corporation under the Factories Act 1937, or, indeed, so far as memory and records, some of which were destroyed by enemy action, indicate under any previous Factory Act. The fact that no prosecution has been previously brought by the City Corporation under the Factories Acts, which have been in operation for well over half a century, reflects great credit on the powers of persuasion of the Medical Officer's staff, especially in view of the fact that Section 9(3) of the Factories Act 1937 stipulates that "If within one month after notice of an act or default is given by a Factory Inspector under this section to a district council proceedings are not taken for punishing or remedying the act or default, the inspector may take the like proceedings for the punishment or remedying thereof as the district council might have taken, and shall be entitled to recover from the district council summarily as a civil debt all such expenses incurred by him in and about the proceedings as are not recovered from any other person and have not been incurred in or about any unsuccessful legal proceedings. " On no occasion has the Factory Inspector taken action in default of the "district council" in regard to a City factory. Some dozen or more reports on infringements are received annually by the Medical Officer's Department from H.M. Inspector of Factories. RODENT CONTROL In compliance with the provisions of the Prevention of Damage by Pests Act, 1949, it is the duty of every Local Authority to take such steps as may be necessary to secure as far as practicable that their district is kept free from rats and mice and in particular:— (a) from time to time to carry out such inspections as may be necessary for the purpose aforesaid; (b) to destroy rats and mice on land of which they are the occupier and otherwise to keep such land so far as practicable free from rats and mice; (c) to enforce the duties of owners and occupiers of land under Part 1 of this Act and to carry out such operations as are authorised by those provisions; (d) to keep such records and make such reports relating to their functions under this part of this Act as may be required by the Minister of Agriculture, Fisheries and Food. For the purpose of implementing these provisions, organisation and procedure of the Rodent Control Department was similar to that of previous years, comprising inspection of properties to ascertain the presence of infestation by rats and mice, treatment of any such properties found on 8 inspection to be infested, recommendation and supervision of structural and incidental proofing, and periodical maintenance control measures for the destruction of Common rats in the City sewers. No difficulty has arisen necessitating statutory action to resolve the problem, and the continued policy of seeking the co-operation of owners and occupiers has again proved most satisfactory. 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. A total of 3,743 occupancies and properties were the subject of inspection, such properties ranging from new developments in varying stages of construction, until finally occupied, riverside food warehouses and adjoining premises, food markets, public and private catering establishments, blocks of offices, shops and factories, to domestic dwellings. Altogether 592 complaints were received either by notification or as the result of inspection, and of this total 531 infestations were the subject of control measures. In 61 instances no action other than advice was found necessary. These were mainly instances where an odd stray mouse had been seen by an officer cleaner during late evening or early morning, but the often long procedure of investigation to ascertain if it was merely an isolated case or the distribution fringe of an infestation elsewhere in the premises still had to be applied. Such notifications do, however, indicate the increasing awareness of employers and employees of even very minor nuisances and their readiness to seek advice and assistance. From the rodent control aspect this is an attitude to be encouraged, as from past experience many infestations of both rats and mice, some approaching major degree, have been traced as the result of a complaint of a minor or even frivolous nature, and in some instances by an innocuous remark during routine inspection. Continued routine inspection has fostered this attitude, encouraged the public, and strengthened their co-operation. The total of 531 infestations subject of treatment comprised 2 major and 74 minor infestations of rats, and 14 major and 441 minor infestations of mice. Of the rat infestations, 2 major and 49 minor were of Common (Brown) rat character and the remaining 25 minor infestations came under the Ship (Black) rat classification. Treatment of these surface infestations entailed 4,665 visits for operational purposes, and in the process of control measures for rats, 1,447 initial baiting points were selected, 5,539 prebaits and 506 poison baits were laid. This resulted in a minimum estimated kill of 555 rats and of this number .283 bodies were removed from the various premises or sites. The use of Warfarin anti-coagulant rodenticides for the control of mice entailed the application of 9,495 initial baiting points, and 897 bodies were recovered. In 1947, for example, the comparable figures were 643 rat infestations treated, 313 major (20-200 rats) and 330 minor infestations, and control measures resulted in a minimum estimated kill of 6,969 rats, of which 2,535 bodies were recovered. In 36 instances structural ratproofing was carried out by owners or occupiers and in 30 cases defective drainage resulting in Common rat infestation was remedied. Incidental rat and mouse proofing in the nature of removal of harbourage provided by unnecessary and undisturbed accumulations has again received unremitting attention, and the assistance and co-operation of The Director of Public Cleansing and his Inspectors in this respect has been invaluable. The low level of Ship (Black) rat infestation achieved in recent years has been maintained, and the number of infestations of this nature (25 minor) was again exceeded by that of Common (Brown) rat (51). In the year 1947 already mentioned, when 643 infestations were treated, 595 infestations were Ship rat and 48 Common rat. To illustrate further the decline in rat infestation the up to date summary collated from detailed information kept since 1944, is included as a useful record. It should, however, be understood that the figures referring to rat infestation is the combined total of Ship and Common rat infestation, the former comprising until recent years 90% of infestation. It is also emphasised that the estimated number of rats destroyed is the absolute minimum. The total in the bodies found column is the sum of those removed from premises by the operators and does not include any subsequently found by occupiers on elimination of structural or incidental harbourage. 9 SURFACE PROPERTIES Year Infestations Treated Rats Mice found Initial baiting points Prebaits laid Poison baits laid Mice Warfar in baits Rats Mice Poison Traps No. Major Minor Major Minor Estd. kill Bodies found 1944 320 261 39 13 7 11,388 2,558 423 95 12,784 62,336 8,452 1945 417 241 158 6 12 10,038 2,410 217 164 11,321 60,444 7,926 1946 373 232 101 12 28 8,658 2,767 480 207 14,991 63,244 8,672 1947 705 313 330 19 43 6,969 2,081 454 311 18,226 88,980 11,123 1948 751 260 438 22 31 5,637 1,822 552 263 18,720 98,506 12,066 1949 631 149 395 30 57 5,046 2,113 761 557 23,684 91,792 16,242 1950 846 186 391 109 160 4,369 1,632 605 710 23,737 129,295 17,719 1951 651 82 266 182 121 3,436 1,308 775 833 33,712 124,789 25,291 7,012 1952 616 50 278 152 136 2,877 1,237 514 852 11,320 48,783 5,149 16,800 1953 647 25 238 111 273 1,527 7 25 241 853 16,045 28,672 2,313 11,634 1954 675 20 219 116 320 1,630 955 91 1,181 16,508 25,339 1,982 16,508 1955 677 10 169 139 359 1,070 595 60 1,540 16,407 19,024 1,222 12,706 1956 661 7 141 124 389 782 459 63 1,644 16,033 10,519 823 12,829 1957 575 7 105 84 379 902 506 45 1,296 11,919 9,769 679 9,895 1958 523 2 54 36 431 343 191 16 1,012 7,645 3,034 336 6,653 1959 545 3 50 25 467 399 162 2 886 8,643 3,835 385 8,593 1960 584 2 66 33 483 634 284 12 916 12,373 5,625 574 10,029 1961 523 2 74 14 433 555 289 - 726 10,942 5,539 506 9,495 9,720 1,852 3,522 1,227 4,129 66,260 22,084 5,611 14,046 255,115 879,525 125,550 117,154 The Common rat infestations were mainly confined to re-development sites in varying stages of construction. These sites offer every facility and are in every way conducive to this type of infestation. From the moment contractors occupy a site the inducement to infestation is provided. Huts are erected, slightly raised from the ground, thereby offering harbourage. Old and often obsolete drainage is broken into and exposed during excavation, which progresses in stages in comprehensive developments. For instance, Stage 1 of a site, the tower block can be well advanced, and surrounded by excavation of Stage 2 — 3. Structural harbourage, though temporary is provided, and to this must be added the incidental nesting facilities provided by the vast quantities of materials and accumulations common to such sites. The temporary canteens provided for the workmen are on the whole well maintained, but under such circumstances are an attraction. The principle food supply is without doubt, provided by the workmen who distribute food over the entire site by haphazard and thoughtless disposal of scraps, and with utter disregard to the fact that they are encouraging infestation. The morning and afternoon "tea breaks", much in the news last summer have increased this problem, but whereas it was the practice for the workmen to leave the various floors and adjourn to the canteen, usually sited in the basement, the tea is now taken to the workmen on the floors throughout the structure, with the inevitable result that waste and unwanted food is discarded widespread. All sites were periodically inspected ,and when frequently such conditions were found to exist, the necessary action to clean up was taken by the contractors as far as practicable having regard to the conditions and labour force involved. The gradual increase and wider distribution of mice infestation apparent in recent years and coinciding with the decrease in rat infestation has not been quite so noticeable,. there being a reduction of 42% in major infestations, while the number of infestations in the minor category remained constant. Many of the complaints of mice infestation are received from offices, and the reason can usually be traced to the thoughtless disposal of food scraps by the staff. It is a common occurrence to find food wrappings, fruit parings, odd scraps and milk bottle tops with cream adhering thrown down in inaccessible places behind furniture, fixtures and fittings. Alternately it is put into waste baskets where, as a general rule, it remains all night, to attract and provide subsistence for mice. The contents of the baskets, usually emptied in the morning are then placed in waste paper sacks and stored in basements for varying periods until collected, again providing subsistence in warm and undisturbed conditions. Prior to the institution of the Smokeless Zone and oil-fired boilers a large proportion of nondescript rubbish often found in basements, and contributary to mice infestation was disposed of by burning, but as previously stated the co-operation received from the Cleansing Department has greatly assisted occupiers and owners responsible for removal to comply when requested to do so. 10 Mice, unlike both species of rats, are unpredictable in behaviour and feeding habits. They are on average about 25 grammes when mature, and the food intake in 24 hours is consequently very small — between 3 and 5 grammes, so that very small quantities of food such as described above is sufficient for their wellbeing. They are erratic in their feeding habits and may eat a very small amount at a number of places — not necessarily the same each day. This means that very many small baiting points are required when applying control measures with poison. This factor also limits the use of acute poisons. Where there is unlimited harbourage, structural and incidental, as found in warehouses, with large bulk stowages of varying commodities and types of packaging,plus ample food,there appears to be a very diminished range of activity from the nesting quarters. Therefore a high percentage of an infestation living and breeding therein, do not emerge to accept the baits at the baiting sites, which are limited by the bulk of the stowages or congestion often found in other types of premises. The nucleus of such infestation is often imported, and in the case of catering establishments many instances have been seen where this has occurred in sacks of vegetables, and cartons of eggs- As in the past, the low level of Common rat infestation is no doubt due to the systematic control measures applied in the City sewers at quarterly intervals. Four "Direct" poison treatments and an overall test baiting were applied during the year, and the result indicates that success achieved by this technique of control has been maintained. A comprehensive and detailed report on the Direct Method of Control and the use of Sodium Fluoroacetate and Fluoracetamide as the toxic agents was compiled from extensive data collated since 1951, when first instituted in the City, and included in the 1960 Annual Report. There is no doubt that an unnecessary fear has been fostered in the past, and the hazards of using these poisons, particularly the former, unduly exaggerated. It is therefore gratifying to learn that such prejudice has lessened, insofar that many Local Authorities have now adopted this system of control as applied in the City, and now laid down in the Ministry of Agriculture, Fisheries and Food manual on the Control of Rats in Sewers. MASS RADIOGRAPHY The following is an extract from a report received from the Medical Director of the Unit, Dr. W.D.R. Thompson. "During 1961 the Mass Radiography Unit examined 43,004 males and 23,569 females — making a total of 66,573. Up to the end of 1961 the Unit has examined 692,037 persons since it corncommenced operations in May 1950. "Fifty-four cases with a significant tuberculous lesion have been discovered which gives a rate of .83 per 1,000 examinees. Seventeen cases of carcinoma of the lung (16 men and l woman) were discovered during the year. The highest incidence of tubercle was discovered in men between the ages of 45-54, with those between the ages of 25-34 and 55-59 running them very close. The greatest incidence in women was found in the 25-34 Age Group. "The zone of the Unit has remained in the City of London, and the Metropolitan Boroughs of Finsbury and Shoreditch. The Unit operated for about eight months during the year at the Mass Radiography Centre, 20,Golden Lane, E.C.I, while the remaining period (excluding three week period for annual leave) the Unit visited various firms within its zone including Associated Newspapers Ltd. (when over seventy other firms participated) Custom & Excise and General Post Office personnel. "General Practitioners continue to use the Unit's services although they are not so numerous as one would wish or expect. Doctor's cases however have produced an incident rate of 11.56 per 1,000 examined. "After an interview with the Medical Director abnormal cases are referred through the examinee's own doctor to the appropriate Chest Clinic. Clinics have recorded their sputum findings and twenty-one cases with a positive sputum have been reported of which 14 were male and 7 female. Cases outside the purview of a Chest Clinic have been referred to St. Bartholomew's Hospital and the co-operation of Dr. N.C. Oswald and Dr. Graham Hayward is gratefully acknowledged, as also the helpful assistance rendered by Dr. J. Greenwood-Wilson and his staff." 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 11 and with the co-operation of the Civil Defence Department, been at the disposal of the London County Council Divisional Medical Officer in Area 5 for the use as an anti-poliomye litis clinic. During the year 1,404 persons received initial vaccination as compared with 6,441 in 1960. CITY OF LONDON CANCER DIAGNOSTIC CLINIC AT ST. BARTHOLOMEW'S HOSPITAL An account of the first two years' work in the Clinic by Mr. Brian Measday, M.B. Lond., F.R.C.S.E., M.R.C.O.G., Resident Assistant Physician Accoucheur, St. Bartholomew's Hospital, London, E.C.I, is reproduced below by courtesy of Mr. Measday and of the St. Bartholomew's Hospital Authorities. A WELL-WOMEN'S CLINIC 1 Brian Measday M.B. Lond., F.R.C.S.E., M.R.C.O.G. RESIDENT ASSISTANT PHYSICIAN ACCOUCHEUR, ST. BARTHOLOMEW'S HOSPITAL, LONDON, E.C.I The value of exfoliative cytology in the early diagnosis of cervical carcinoma is now recognised. Unfortunately, the evolution of a service to exploit this diagnostic weapon is expensive and slow. Relatively few centres or hospitals in Great Britain are able to offer a service which is so timeconsuming, and which requires technicians specially trained to read the slides. Thus the prospect of " screening " of the population—as envisaged, and to some extent practised, in the U.S.A.—seems distant in this country. Routine examination to assure positive health is rather foreign to us, and, even if practicable, it would not be wholly uncriticised. On the other hand, prophylactic dental and antenatal care, now so well established in the structure of the health services and of such obvious benefit to the community, were in a similar position in their early days. The value of cytological investigation is now so well known that the necessity for starting a cytology service must be faced. Cytological surveys of large numbers of women are often carried out in the U.S.A. by medical and nursing aides and by trained technicians. Therefore coincidental gynaecological lesions which would not be picked up by a smear may presumably pass unrecognised. Thus benign lesions in women without symptoms who attend for cytological screening may remain unreported. The cure of such lesions will be a secondary reward of any cytology clinic where an appraisal of the patient can be made by a clinician. With this ideal in mind, I am making this preliminary report of the first two years' work in the City of London Cancer Diagnosis Clinic at St. Bartholomew's Hospital. The clinics began in January, 1960, and have been entrusted to a senior registrar or registrar from the department of gynaecology. Cytological smears have been made, and also the clinical condition of the patient and her genital tract has been reviewed. A cytological pathologist has been employed part-time. This report is not concerned with the value of exfoliative cytology in diagnosis. Indeed, it covers only 678 cases and, numerically, is insignificant. It does, however, give some idea of the gross benign lesions seen in a clinic where such smears are taken. As the overall incidence of such lesions has been in the region of 30%, a detailed analysis seems worth while. A well-women's clinic is not necessarily attended by well women. THE ROUTINE Patients attend the clinic after telephoning for an appointment; this they do in response to a leaflet which has been distributed in the rest rooms of business houses and companies in the City. This notice invites any woman over thirty-five, who works or lives within the City boundaries, to attend a clinic where, by means of a simple test, her positive health in respect of cancer of the genital tract can be assured. At the clinic, patients are invited to give their reasons for attending; this is to distinguish those with symptoms from those attending solely because it is a good idea. The menstrual history is briefly reviewed, and marital status and parity are recorded. The breasts, abdomen, and genital tract are then examined, and cytological smears are made with material scraped from the cervix and posterior fornix. Finally, if no clinical abnormality has been found, the patient is informed and told that she will hear by post within a fortnight whether her tests are satisfactory. She is also told that, with her permission, a similar letter giving the results of the smears will be dispatched to her family doctor by the same post. When some abnormality has been detected which will explain a symptom troubling the patient, the matter is explained to her and she is told that the clinic will write, on her behalf, to her doctor and discuss treatment with him. All further treatment will be at the discretion of her own doctor, although if he wishes he may refer her to a gynsecological clinic. Where operation would ordinarily be advised, the patient is told of this and asked to talk matters over with her family doctor. The general practitioner is given details by letter and told what procedure or investigation would be carried out if ABNORMALITIES ENCOUNTERED IN 678 PATIENTS Abnormality No. of patients Remarks Postmenopausal bleeding 10 Dilatation and curettage on 9; 1 cancer discovered Ovarian tumours 4 1 borderline cancer Fibromyomata 43 Surgery advised in 14 Cervical erosion 64 54 symptom-free Cervical polypus 46 36 „ „ Trichomonas vaginitis 11 9 „ „ Atrophic vaginitis 10 8 „ „ Diabetic vulvitis 1 Leukoplakic vulvitis 1 Treated by simple vulvectomy Broad-ligament cyst 1 Prolapse, and other 13 Operative repair in 2 Total 204 Surgery advised in 31 the patient were in the ordinary practice of the hospital. He is offered the hospitality of St. Bartholomew's, but it is made clear that we understand he may prefer to seek elsewhere for advice or treatment on his patient's behalf. ATTENDANCE It is difficult to know how many women have seen our leaflet and decided not to attend the clinic. Latterly, we have been willing to see 12 patients each session, although originally only 6 were given appointments each week. There is almost always a waiting-list for appointments. Considering the small amount of advertisement this scheme has had, there seems to be a genuine demand. Certainly, patients' friends who are ineligible to attend, and similar patients of doctors who have heard of the clinic, have asked for appointments. Of the 678 patients so far seen, 498 were symptomfree and attended because they regarded the clinic as a sensible service. 97 had a specific symptom, such as vaginal discharge or irritation (52), or menstrual upset (45). 38 mentioned, of their own volition, that they were concerned over a family history of cancer. 45 expressed anxiety over a symptom (other than those already mentioned) not necessarily of a gynaecological nature. PATHOLOGY The abnormalities found are shown in the table. Postmenopausal bleeding.—10 patients gave a history of postmenopausal bleeding. 1 other patient complained of irregular bleeding. Curettage was therefore advised for 11 patients, and has been carried out at St. Bartholomew's Hospital in 9 of these. No neoplasia was detected in 8, but in 1 adenocarcinoma of the endometrium was found and extended hysterectomy subsequently carried out. There was a very early growth (stage I) of the posterior uterine wall near the fundus uteri. Cytological smears, taken only once before curettage, were negative. 12 Ovarian tumours.—An ovarian tumour has been detected in 4 cases. The 1st patient had bilateral serous papillary tumours of " borderline " malignancy. She was symptom-free. In the 2nd, a single large and easily palpable pseudomucinous cystadenoma was found. This patient volunteered a family history of cancer and complained of pain in the left side since a fall six weeks earlier. The 3rd complained of menorrhagia and had a solid ovarian fibroma which was easily felt. The 4th had no complaint, but an endometrioma was removed by ovarian cystectomy. One other laparotomy was carried out on the diagnosis of ovarian cyst, but in fact this patient had a broad-ligament cyst. A further small fibroma of the ovary was removed in a case in the following section where hysterectomy was performed for fibromyomata. Fibromyomata.—Fibromyomata have been detected in 43 patients and, although giving rise to no symptoms, have been of sufficient size to warrant removal in 6. Symptoms in conjunction with tumours of more moderate size have influenced advice to undergo hysterectomy in 8 other patients. 12 operations have been carried out at St. Bartholomew's, and, of the 2 remaining patients, 1 has been put on the waiting-list of another hospital, and the other is arranging her operation privately. The largest fibromyoma so far seen in this series measures 28 x 15 x 10 cm. and caused no symptoms. Cervical erosion.—64 " erosions " have been diagnosed, 54 in the absence of symptoms. Particularly where symptoms were present, treatment has been offered after consultation with the family doctor. Cervical polypus.—46 patients have been found to have cervical polypi; 36 had no symptoms. These polypi have been removed by avulsion, and have subsequently been examined histologically. All have been benign. Vaginitis.—The vaginal flora has not been examined routinely, unless the patient complained of excessive discharge or this was noted on inspection. 11 cases of vaginitis due to Trichomonas vaginalis (9 symptom-free) and 10 of atrophic vaginitis (8 symptom-free) were found. Vulvitis.—1 case of diabetic vulvitis was noted; the diabetes was subsequently confirmed by tests of urine and blood, and the patient's own doctor referred her to a diabetic clinic. This patient complained of frequency of micturition. Another, who presented with irritation, was found to have leukoplakia vulvae; this was confirmed by biopsy, and treated by local excision. Other gynaecological conditions.—We have encountered Bartholin's cyst (1), urethral caruncle (2), and different degrees of uterovaginal prolapse (10) with and without stress incontinence of urine. Of the latter group, operative repair has been carried out in 2. Positive smears.—2 patients had smears warranting full investigation. In the 1st, subsequent smears were negative and serial sections of material removed by cone biopsy were normal. This patient is being followed up. The 2nd patient had repeated suspicious smears, and biopsy showed carcinoma in situ. She was treated by amputation of the cervix as she was thirty-six and anxious to have a child. Subsequent smears have been normal. (Although this two-year survey covers only the first 678 patients to attend the clinic, it is of interest that the 697th patient had an early clinical stage-i carcinoma of the cervix, which has now been confirmed by smear and biopsy, and has been treated.) DISCUSSION McLaren and Attwood maintain that nowadays no gynaecological or obstetrical examination is complete without cytology. In their unit in Birmingham, all gynecological patients have been screened in this manner for the past ten years. The number of cases of carcinoma in situ discovered by this means has been about 3-4 per 1000 with, in addition, 1 case per 1000 of cervical carcinoma which, but for the cytological test, would have been missed in the outpatient department. This, then, is a diagnostic test of proven value, and attention should be directed to an extension of facilities so that all gynaecological outpatients—and not only those fortunate enough to attend a pioneer centre—may have smears taken. Many of the abnormalities detected at the City of London Clinic are of minor significance; yet, ideally, they should be treated. The only invasive carcinoma (of the endometrium) so far detected, however, was found not by cytology but by the further investigation necessitated by a history of postmenopausal bleeding. True, this patient might eventually have gone to her doctor with persisting bleeding, but she may have preferred the anonymity of the clinic and thus come forward earlier. The case of papillary ovarian tumours was well worth treating and, again, was asymptomatic. In the diagnosis of malignant disease of the ovary, cytology alone has little if anything to offer. The disease is insidious, diagnosis is usually late, and surgical cure depressingly infrequent. The patient with an ovarian carcinoma, who has her condition diagnosed and treated early, is indeed fortunate. Patients with cervical polypi may be without symptoms; but whether they would remain so indefinitely is uncertain. The usual practice is to remove the polypi because they are often associated with bleeding; further, a small proportion are said to undergo malignant change. 678 patients have been seen over 2 years. 204 (30%) showed some abnormality. 498 said they attended the clinic solely because it was a sensible precaution to take; they did not admit to any symptom or menstrual abnormality, and they did not volunteer a family history of cancer. They came because they thought the clinic a good idea. They represent 73% of the 678 patients. 127 of these 498 were found to have some abnormality of which they were unaware. The condition was often worth treating, and was occasionally of considerable importance to future health. Thus, routine gynaecological examination is evidently rewarding, and is conveniently combined with the taking of cytological smears. McLaren and Attwood cite the opinion of McLennan that, with careful propaganda, many women will come to regard prophylactic cytology and routine examination as not very different from an annual visit to the dentist. summary Two years' experience in a well-women's clinic is described. Cervical cytology is valuable, but clinical examination of the patient at the same time will confer as great a benefit. Any cancer-diagnosis clinic of the future should sensibly combine both procedures. We are grateful to the Corporation of the City of London for financing the services of the cytological pathologist. I wish to thank Dr. Greenwood Wilson, Mr. John Beattie and Mr. Donald Fraser for their help and encouragement. 1 The Lancet, 1962, ii, 395. 13 OCCUPATIONAL HEALTH The City's Square Mile (Excerpt from the papers read before the Health Congress of the Royal Society of Health at Scarborough, 9-13 April 1962) THE CITY of London, although its area is a little larger than the proverbial square mile , has one of the greatest densities of working population per acre in the world. Although the night population is only 5,000, by day this swells to nearly half a million. They come not only to offices (12,000 of these), but also to railway premises, shops, restaurants, cafes, inns, livery halls, banks, printers, newspaper premises, factories and warehouses. It will surprise many to learn that there are no less than 800 premises in the City, classified as factories under the Factories Act. There is also one theatre. Altogether there are some 18,000 workplaces of various kinds within the "square mile." The workers encountered in the City look healthy enough, both mentally and physically. They walk briskly and they nearly all seem to have a zest for living— one seldom sees that expression of soulless boredom that seems characteristic of so many young men today. All this is a personal and general impression, and there is little scientific evidence as to the state of health of City workers as yet, but the City Corporation has just launched an occupational health survey with a view to obtaining it. There is no organized occupational health service for all of the City workers. Many of the larger firms have whole-time or part-time doctors (the biggest having dentists, nurses, chiropodists and radiographers as well), visiting regularly to attend to the health of their workers. There are 40 medical practitioners working in the City. Only two of these are general practitioners in the sense that they will also undertake domiciliary visitation when necessary. They are both in the National Health Service. Some National Health Service doctors also cross the borders to attend to City residents and these are included in the 40. About half the City doctors work office hours on a five-day week and they should be included in the number of City workers who may travel long distances to and from their work. These doctors, as well as undertaking a good deal of life insurance practice, may also see patients who come to them or are referred to them from neighbouring firms. None of them works in the National Health Service, but some of the few dentists in private practice in the City do sometimes take on National Health Service patients. Allowing for the 20 doctors employed whole-time or part-time by firms for ad hoc occupational health services, as well as the 20 engaged in private practice, there must be at least 130,000 City workers without any kind of organized occupational health facilities whatsoever, as well as many thousands more for whom medical and nursing attention at work is perfunctory compared with the services provided by the big firms. I am not, of course, forgetting the great teaching hospitals in or very near the City, which cope nobly all the time with emergencies. It is not their job to run a City occupational health service, even though it may be desirable to provide teaching to students in occupational health. The "forgotten" 130,000 can all, of course, use the great hospital services in appropriate cases. Nor am I forgetting the relatively small, though none the less important, contributions to the ideal of a City occupational health service for all, represented by our mass radiography service and by the cancer diagnostic service for females, started recently at St. Bartholomew's Hospital with financial help from the City Corporation, and last but not least the Billingsgate Dispensary voluntary scheme started in 1879 in premises near Billingsgate Market to provide medical and nursing care while at work for Billingsgate Market workers. Its facilities are now available to other workers in the neighbourhood as well. Some firms too, although they do not arrange any medical and nursing service for their employees, do set aside the appropriate accommodation which is then equipped by an ophthalmic optician who attends regularly to undertake eye-testing and, if necessary, prescribe spectacles for those who need them—all in the employer's time. But all these factors do not add up to a complete occupational health service for all City workers in the modern sense of the term. There are many difficulties in the way of organizing one. Some firms are so small that they may employ as few as five workers. The Private Members' Offices Bill of Mr. Marsh, and the Government legislation promised both to enlarge its scope and to supersede it, have drawn attention to the environmental working conditions of workers other than factory workers. "Environment" can be given Table I Pilot Office Survey Approximate age of Building: Built prior to 1900, 61 Built between 1901 and 1945, 31 Built since 1945, 9 Location in building of floor (front, rear, central): Basement Ground 1st 2nd 3rd Offices 33 52 46 45 39 Location in building of floor {front, rear, central): 4th 5th 6th 7th 13th Offices 28 16 10 5 1 Number of rooms: 123456789 Number of Premises 915 9 10 11 4 5 4 8 Number of rooms: 10 11 12 13 16 18 20 22 23 Number of Premises 6 2 3 1 1 4 1 1 1 Number of rooms: 27 33 50 58 72 130 240 Number of Premises 1 1 1 1 1 1 1 Number of employees: under16 years 16 and 17years 18 yearsand over Male 15 113 3,168 Female 37 378 2,263 There was also a total staff of 770 for which no details were available Is any room overcrowded or congested (400 c ft up to 14 ft height only per person)? No rooms were overcrowded; 2 rooms were congested Cleanliness (standard): are cleaners employed, and by whom? With the exception of 2 all offices were clean State of repair: walls, floors, ceiling, woodwork, windows With the exception of 8 all offices were in a satisfactory state of repair Ventilation: (a) means Mostly natural (b) satisfactory—poor 3 poor (c) mechanical?—describe 3 were completely mechanically ventilated; 25 were naturally ventilated aided by fans (d) draughts—opinion of staff There were 25 instances of staff being conscious of draught Temperature: (a) in rooms 60/65°F = 29; 66/70°F = 48; 71/75°F = 25 (b) heating equipment effective in winter All satisfactory, except in one case Lighting: (a) ft candles on desks furthest from windows Varied from zero to 50 ft candles (b) artificial lighting necessary most of the day Yes in 62 cases; no in 43 cases (c) sky visible from half-way in room Yes in 57 cases; no in 60 cases Outdoor clothing accommodation: Yes in 83 cases; no in 22 cases Rest room: Yes in 30 cases; no in 71 cases Facilities for taking meals other than at the desk where the employee works and where food brought in by him may be eaten? Yes in 16 cases; no in 84 cases Where is tea made ? In a variety of places. There were 31 instances of the canteen being used, 3 in rest rooms, 43 in offices, 3 on landings, 3 outside caterer, 3 in lobbies to water closets and 9 nondescript places Main drinking water tap—location - Same floor Next floor 2 floors away In toilet On landing 57 26 15 12 1 Washing facilities: (a) separate 46 (b) in communal toilets 58 (c) towels and soap provided Yes in 91 cases; no in 10 cases (d) hot water Yes in 92 cases; no in 9 cases Sanitary accomodation: (a) separate for tenancies Yes in 44 cases; no in 59 cases (b) separate for male and female Yes in 99 cases; no in 3 cases (c) standard Fair in 21 cases; good in 81 cases (d) sufficiency All Caretaker: Is there a caretaker (resident or otherwise)? Yes in 70 cases; no in 31 cases Basement rooms: There were 17 cases (a) depth below ground Varied at 6, 8, 9, 12, 15, 16 to 20 ft (b) dampness None observed (c) environmental observations Only one found to be unsatisfactory (d) for what purpose used? Offices and stockroom Escape from fire: Yes in 78 cases; no in 22 cases First aid provision: Yes in 67 cases; no in 33 cases 14 a broad interpretation; it can cover not only considerations like space, light, heat and noise, but also the nature and interest of the work itself, and the kind of journey to and from work. It would be interesting to obtain evidence of the relative health record of those City workers who are provided with an organized occupational health service and those who are not. Certain factors in my view must make for positive health in City workers. However long and tiring the journey to and from the City may be, there is still an irreducible amount of walking. Few people get from one point in the "square mile" to another except by walking. The nature of the terrain often makes it the quickest and most convenient method, more so than ever now that parking restrictions and parking meters have spread to the City. My own public health inspectors always walk on duty. The illustration at the head of this paper shows the workers, looking not too unhappy even on a rainy day, walking over London Bridge from the railway terminus south of the Thames. Mostly, City workers seem to walk quickly at almost any time of day. Then I think, too, that the mental health of workers is helped by the idea that they all belong to a sort of club at the "hub of the universe"; a great world centre backed by centuries of tradition, much of it of exceptional interest like that of the City Livery Companies. A "job in the City" may not carry the same status as it did in Dickens' time, but it still means something. Last but by no means least, since October 1955, City workers have been able to breathe clean air, the City now being, by private legislation, a smokeless zone. Through the energetic enforcement of the Dark Smoke (Permitted Periods) (Vessels) Regulations 1958, by the Corporation of London acting in its capacity as Port of London Health Authority, the hazards of smoke from Thames vessels have also been largely removed. At the time when the Marsh Bill was first under debate in Parliament, the Corporation of London, through its Health Committee decided to undertake a pilot survey of office enviromental conditions. This was started by City public health inspectors in March 1960. No extra staff were taken on in this earlier survey and the work had to be fitted in as and when convenient with the routine duties of the three district inspectors. Before the survey was commenced, the medical officer of health and the inspectors met a number of times to work out a standard form or schedule for use in the survey. One hundred firms were visited. The buildings inspected were chosen in the first instance according to age: (a) those built from 1900 up to the beginning of World War II and: (b) those built since the end of the War. A further subdivision was made in accordance with size—small, large and medium. The results of the pilot survey are shown on a prototype of the form of schedule that was used in the survey, and this is reproduced in Table I. The results of this small pilot survey at first sight appear to argue that the City's offices are not after all so bad an environment to work in. But a closer scrutiny of our results showed that the picture may have some distortions in it. To begin with the sample, for reasons beyond our control at that time, was not selected statistically at random, and similarly preference tended to be given by the inspectors to premises well-known to them. The sample of 100 is too small—under one per cent—to reflect very accuratelytheuniverseof City offices which number 12,000. Detailed environmental measurements, particularly of space, lighting and ventilation, proved impossible to carry out, and these three are in many ways the chief arbiters of health in the office room itself. The 400 cubic feet fixed as a minimum is both an absolute minimum and a very tiny space. It should never be regarded as a figure to be complacent about. Glare is a problem recognized long ago but not easily evaluated accurately without detailed readings of illumination and space. And how is the office worker to be persuaded to open windows? Nevertheless, certain undesirable facts emerged. Seventy-three out of 102 rooms were at temperatures above 65°F, 25 of them being over 70°F. Opinions differ, but most health specialists would agree that 70°F and above is unnecessarily warm. Though 43 offices were daylighted in the sense that they did not need artificial light during morning and most of the afternoon, the source of the light—the sky—was invisible to most of the occupants. Sixteen firms had canteens; 84 had no facilities for eating meals on the premises. It is our impression that not enough attention is paid to this absence of a place to relax in at the midpoint of the working day. Finally teamaking, by no means only a Civil Service ritual, goes on all over the place in a variety of spots often undesirable from a food-hygiene aspect. Dr. R. Owen, Her Majesty's Medical Inspector of Factories, whose division includes the City area, has supplied interesting particulars about factories in the City. They are given in Table II. Table II Factories in the City of London Size of Factory (.Persons employed) Number of Factories Numbers Employed 1—5 306 920 6—10 205 J,640 11—20 132 2,000 21—50 75 2,620 51—80 23 1,500 81—120 13 1,300 121—250 10 1,850 251—1,000 10 5,780 Over 1,000 4 6,450 All factories 778 24,060 From these factories issue an immense variety of products. Whilst heavy industry is absent, there are many examples in clothing and textiles, furnishings, food and drink, jewellery, rubber and leather and sundry products, engineering, chiefly of a light instrument nature, and, of course, a tremendous weight of printing and allied trades, including photography. There are also dozens of warehouses and a handful of curious and interesting small trades. Factory workers have the protection of legislation from environmental hazards. Because the dangers to health of the white-collared worker are more subtle, less easily discernible and therefore less dramatic, he (and she) have been denied the environmental protection which is their due. Factory workers have, in some cases at least, services to guard their health during working hours. Industrialists are convinced of the value of these services. If it were not so one would hear of surgeries being closed and staff dismissed. The logic of extending occupational health coverage to the white-collared worker has been recognized by the British Medical Association in their admirable publication The Future of Occupational Health Services: "The Association believes that there is a need for occupational health services to be extended to all types of employment. It therefore endorses the recommendation of the Dale Committee (1951) that: 'there should eventually be some comprehensive provision for occupational health, covering not only industrial establishments of all kinds, both large and small, but also the non-industrial occupations referred to in the report of the Gowers Committee.' " Do not let us ask ourselves if we can afford to establish occupational health services for the non-manual worker. Let us rather put the question—can we any longer afford to neglect the health of so many by leaving unfilled this breach in the ramparts of health? The Corporation of London appointed an Assistant Medical Officer, Dr. Alan Robinson, on 1st June 1961 to conduct a survey of occupational health conditions in the City of London before considering the setting up of an Occupational Health Service to cater for City workers mainly in small firms not already covered by their own occupational health services. Dr. Robinson will commence duties on 1st January 1962. The following photographs (a) show throngs of City workers coming over London Bridge in the rush hour (b) illustrate two types of offices that will be surveyed by Dr. Robinson, the older one is adjacent to a house formerly occupied by Dr. Samuel Johnson from 1748 to 1759, the other was first put into use in September, 1960. 15 MEAT AND FOOD INSPECTION - SMITHFIELD MARKET Although the deliveries of meat, poultry etc. into Smithfield Market increased by only 20,000 tons, compared with 1960, from 356,106 tons to 376,273 tons the tonnage of food condemned has more than doubled, from 405 tons to 860 tons. The increased rate of condemnation is partly due to the large number of broiler chickens delivered to the market, considerable quantities of which are rejected on account of disease, nearly 102 tons in 1961 compared with 67 tons in 1960. Condemnations of meat from one particular country were necessary on an unduly high scale owing to faulty handling in transporting the meat from the continent to this country. It was found that the cause originated in the transference of the meat from refrigerated containers to smaller non-refrigerated vehicles which were then conveyed by ferry to this country — an unsatisfactory procedure which is under urgent consideration by the importers concerned. The Chief Meat Inspector reports a noticeable increase in the amount of home-killed meat condemned on account of disease and unsoundness. Table showing the amount of meat surrendered to or seized by Meat Inspectors in the City of London for DISEASED condition, 1961 and 1960. Year Jan. lbs. Feb. lbs. Mar. lbs. April lbs. May lbs. June lbs. July lbs. Aug. lbs. Sept. lbs. Oct. lbs. Nov. lbs. Dec. lbs. Total lbs. 1961 12,237 14,322 16,376 13,190 12,234 12,326 8,767 10,165 10,970 8,301 9,644 10,894 139,426 1960 13,857 17,022 15,571 14,612 10,858 10,421 10,210 7,499 5,456 8,553 7,786 11,713 133,558 Table showing the amount of meat surrendered to or seized by Meat Inspectors in the City of London for UNSOUND condition, 1961 and 1960. 1961 74,051 74,523 73,719 68,585 91,389 162,844 84,295 220,079 193,924 83,786 49,936 47,432 1,224,563 1960 12,323 18,072 26,593 20,426 19,269 47,628 51,417 41,276 30,540 80,760 40,382 27,137 415,823 Table showing the amount of various food products (excluding meat) surrendered to or seized by Meat Inspectors in the City of London for DISEASED or UNSOUND condition, 1961 and 1960. 1961 22,817 27,113 29,861 28,217 20,578 60,016 57,257 74,763 113,672 74,447 45,034 51,014 604,789 1960 25,359 20,684 29, 381 25,056 24,996 31,772 37,487 44,511 39,629 56,782 31,228 40,092 406,977 FOOD HYGIENE (GENERAL) REGULATIONS, 1960 Transport and Handling of Meat The following report has been received from Mr. D.R. Bernhardt, the Officer appointed to enforce the provisions of these Regulations in regard to transport and handling of meat. "Stalls — The standard of cleanliness in the stalls has been maintained. "Meat Transport — The standard of hygiene of the vans is still being maintained. Experiments are now being carried out with a variety of materials to enable the floor to be better protected when loading and unloading. Meetings with British Railway Officials have been held to improve the transport of meat and a number of suggestions have been made to improve the standard of hygiene and facilitate better condition of the meat. "Trucks — Truck cleanliness still shows improvement in spite of the fact that a large number of trucks have to be stored in the open during the re-building of the poultry market. "Washing Facilities — All conveniences around the market have now been modernised and these have been well used by market staff. "Hats and Clothing — The general standard has improved, but ten prosecutions for not wearing head covering whilst carrying food and one prosecution for not wearing protective clothing whilst handling food have been taken. "Smoking — Since the last report ten prosecutions for smoking whilst handling food have been successful at the Guildhall Police Court, with a consequent marked improvement. "Vans — There were two prosecutions for dirty vans during the year. The standard of butchers vans has been good. Taxis and Private Cars — Towards the end of November it was apparent that a number of taxis were being hired in areas outside the City in order to transport meat from Smithfield Market. Until they arrived at Smithfield the majority of the drivers of these taxis were 16 unaware of the purpose for which they had been engaged neither had they any knowledge of the existence of regulations in respect of transport of meat. Appropriate communications were therefore sent to the Transport and General Workers' Union, the Motor cab Owner and Drivers' Association, the London Motor cab Proprietors' Association and the Taxi Fleet Operators' Federation. As a consequence of these communications and of the co-operative action of the recipients, the use of taxis for the conveyance of meat virtually ceased. As a consequence however, there has been a large increase in the use of private cars for the conveyance of meat. These are used primarily by foreign owners of cafes, namely Greeks, Cypriots, Chinese and Indians. The meat is generally placed on top of the spare wheel, tools, etc., which are carried in the boot which is usually in a dirty condition. Where such cases are found the meat is off loaded on to market transport and the owner of the vehicle warned. Every effort is made to keep observation on these vehicles but difficulty is experienced due to the extensive area of the Market and the fact that some vehicles are parked in the adjoining side streets making constant inspection very difficult." In July, the Judge by whom the majority of the prosecutions were heard remarked upon the frequency with which he had to deal with offences under the Food Hygiene Regulations at Smithfield Market and stated that if the offences continued he would consider imprisonment as an alternative to a fine. Since that month it has been necessary to prosecute only one porter for an offence in connection with the transport of meat. He was fined £10 and 2 guineas costs for smoking whilst handling meat. On a lighter note, as an illustration of the ingenuity sometimes required to bridge an administrative gap in Act or Regulation may be quoted the awareness of the Meat Inspectors at Smithfield Market that a number of meat porters were in process of growing, or had already achieved, a beard. Sec. 30 of the Food Hygiene (General) Regulations, 1960 requires every person who, in the course of a food business, carries meat while so engaged to wear a clean and washable overall, and if the meat is liable to come into contact with his neck or head, a clean and washable head covering. It was considered that if the protective clothing required by the Regulations was worn, there would still remain a risk of contamination if a beard was involved. Accordingly the Chief Meat Inspector invited all bearded meat porters to his office and explained that Regulation 8 required a person who engages in the handling of food while so occupied to take all such steps as may be reasonably necessary to protect the food from risk of contamination, and requested either the removal of beards or the wearing of a suitable beard covering whilst carrying meat. It is gratifying to note that only one beard now survives, and it is hoped the influence of his colleagues will induce the wearer to follow their example. IMPORTED FROZEN PRAWNS During the year all shipments of cartoned imported frozen prawns, irrespective of source, were placed under detention for bacteriological examination. 235 samples were taken from 33 shipments of 14 different brands from 7 different countries, Egypt, Chile, India, Norway, Persia, Spain and Japan. 15% of the total imports were rejected on account of unacceptable bacteriological condition and were either destroyed or allowed for re-export for sterilization with the knowledge of the Port Medical Officer of the country of destination. Particular brands showed a spectacular improvement in the latter part of the year, surface plate counts repeatedly being as low as 500 p.g.with absence of coagulase-positive staphylococci and B.Coli. It is understood these excellent results are obtained by further boiling after the peeling process, no chemical or antibiotic having been detected on bacteriological and chemical examinations. THE LEAD IN FOOD REGULATIONS, 1961 Imported Tea The above Regulations will come into operation on 16th April 1962, and restrict the lead content of certain specified foods, and after that date tea may not contain lead in excess of 10 p.p.m. 17 I have reported in recent Annual Reports that lead in excessive amounts has been found occasionally in teas principally of Formosan and Indonesian origins, and under the new Regulations such teas will be liable for treatment as being unfit for human consumption. During the year 1,303 samples of tea have been examined in the City, of which 26 or 2% were the subject of adverse reports on account of excessive stalky content, oil taint, or a high proportion of sand, 16 being on account of lead content, 5 of which showed lead content in excess of 10 p.p.m. CATERING AND FOOD HYGIENE Messrs. Thompson and Flynn, the two public health Inspectors who specialise in the hygiene of catering establishments report to the following effect:— What of the year 1961, when once again we come to consider and to contemplate the problem of food hygiene and the catering industry as it is known to us in the City of London? In some spheres of human activity the degree of success from a given effort may be spectacular. In contrast, advances and improvements in catering hygiene are sometimes meagre and often difficult to assess as an advance at all. However, some measure of achievement is the fact that standards have not deteriorated and that many proprietors do not now feel that a visit by the representative of the Medical Officer of Health means inevitable doom. Few people unconnected with the industry can appreciate the diversity of the troubles and difficulties with which a caterer may be faced. Many are of his own making but some spring from sources beyond his immediate control. For instance many caterers wish to modify and improve their premises without any prompting from an official. They are then faced with the problem of finding a builder able and willing to carry out the work. Because of the highly specialised nature of much of this work, few builders are prepared to give either a firm price or a definite completion date. This is not a condemnation of the builder. Obviously if he can secure his income from more attractive and less exacting spheres of building who is to blame him; but it does indicate the very real difficulty with which caterers are faced whenever they wish to carry out improvements of a structural nature. Undoubtedly the problems of the caterer are legion, but only after all his difficulties have been effectively overcome can one expect to receive good, clean wholesome food, attractively presented, and hygienically prepared and served. As officers who are constantly endeavouring to achieve the objective of getting clean, wholesome food on the table of the public restaurant and staff canteen, we are at times discouraged by the lack of interest displayed by many of the customers who use these facilities. Often there seems to be an almost eastern fatalism in the way they accept the fact that they are getting an inferior service. With perhaps a few exceptions, it would appear that canteen feeding reaches the lowest standards, both as regards the quality of the food and the efficiency of service. There is the inevitable contradiction of providing a meal as cheaply as possible on the part of the employer, and that of the staff using the canteen who literally expect first class materials and service at a cost which they consider economic. There is disappointment and disillusionment on both sides, and often an embittered relationship develops between those providing the meals and those wanting to be fed, which leads to a state of affairs where everything suffers including the standard of hygiene. When the staff — and they are not machines — feel that their efforts are in vain and that the job does not seem to matter, they cease to care, often stay away from work, and quite unwittingly adopt an attitude which leads to even greater confusion and chaos in the kitchen. A considerable amount of routine work has been carried out, particularly in checking the state of some of those premises which have been subject to considerable improvement and modification. The extent and degree of deterioration which has occurred in some instances, comes as an unpleasant reminder of the necessity of constant vigilence if a satisfactory standard of cleanliness and hygiene is to be maintained. The general accummulation of dirt and the other adverse conditions observed are invariably associated with a tale of woe regarding the poor quality of staff and the general shortage of workers. During the year we have again received complaints concerning the storage of kitchen waste in containers which are dilapidated and objectionable, and which are placed in positions for collection which are offensive to the public in general. It would seem that the time is fast approaching when the attempt to store kitchen waste for animal feeding should be abandoned. Unless there is a daily collection, a consistent and conscientious cleaning of the bins, together with a proper replacement procedure when the bins begin to show signs of deterioration, the existing normal arrangements must inevitably cause a public health nuisance. 18 In small and congested kitchens where space for even essential requirements is at a premium, serious consideration should be given to the storage and disposal of kitchen waste. Waste food disposal units are undoubtedly of great assistance in overcoming this type of problem, but their use must of necessity be governed by the initial approval of the City Engineer in order to ensure that the sewerage system in the locality is capable of dealing with the effluent from such installations. The intelligent use of the machine by the kitchen staff is also of paramount importance. However, combined with the use of paper disposable containers for the remainder of the refuse from kitchens, caterers could go a long way by using these units to establish an efficient waste disposal system, in the certain knowledge that all danger of causing a nuisance to their neighbours would be eliminated. Without attempting to enter into the economics of any particular system of providing vegetables, the actual volume of waste material which has to be stored in premises can be substantially reduced by the use of prepared vegetables. Again we must draw attention to the unsatisfactory results which are produced from many washing-up routines. It is understandable that everyone, erroneously relegates this job to the status of a chore, fit in the estimation of the more normal worker only for the occupation of a sub human species. An intelligent caterer surely would not spend good money on expensive equipment, and imagine his problems are solved by handing over such equipment to untrained and unskilled staff. He should make certain that the staff using this equipment are properly trained. The manufacturers of washing-up machines etc. should also ensure that in their organisation there are adequate facilities for providing this essential training. It is customary at the conclusion of our notes to express thanks to our colleagues in the Medical Officer's Department and the staff of the other Chief Officers of the Corporation. Because these thanks, again by custom may become a little formal over .the years, they are none the less sincere and our daily lives would be duller and more difficult without their whole hearted co-operation. 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 which has been made with a firm of medical practitioners in the City to be on call for emergencies at Guildhall was not implemented during the year. This 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, 91 members of the staff had their eyes tested, 22 of these had not previously had an eye test under the National Health Service, and 13 were found to have visual defects which required correction and were supplied with spectacles. 69 had been examined previously and were already using spectacles. Of these 54 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 444 persons were medically examined. The distribution by Departments and the reason for medical examinations are shown in Table 3. 319 persons were medically examined for admission to the Superannuation Scheme; 6 were rejected as unfit and 12 were deferred. The clinical conditions causing rejection are shown in Table 1. 19 23 persons were medically examined owing to prolonged absence on sick leave. At the time of examination, 2 were reported as fit for duty, 15 were reported unfit for duty, and 6 were reported unfit for further service. The clinical conditions causing unfitness are shown in Table 2. 87 persons who had reached retirement age were medically examined and 82 were reported as fit to continue in the Corporation's service for a further 12 months. 5 were reported as unfit, 2 were unfit owing to Bronchitis and Emphysema, 2 owing to Hypertension and 1 owing to Chronic Heart condition. 2 persons were medically examined for temporary appointments and 7 were examined to verify the nature of a disability. In addition 6 persons were examined in connection with applications for exemption from parking fees. 32 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 (444 for 1961 as compared with 365 for 1960) 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. TABLE 1 CLINICAL CONDITIONS EXCLUDING THE CANDIDATES FROM THE SUPERANNUATION SCHEME Disease Males Females Hypertension 2 — Heart Disease 1 — Diabetes 1 — Chronic Chest Condition 2 — TOTALS 6 TABLE 2 CLINICAL CONDITIONS LEADING TO PREMATURE RETIREMENT Disease Males Females Arthritis — 1 Bronchitis and Emphysema 1 — Anxiety Neurosis - 1 Raynauds Disease — 1 Disc Lesion 1 — Hypertension 1 — TOTALS 3 3 20 TABLE 3 DEPARTMENT ADMISSION TO SUPERANNUATION SCHEME REFERRED FOR EXCESSIVE SICK ABSENTEEISM OR RETIREMENT OVER 65 YEARS OF AGE Fit Unfit Deferred TOTAL Fit for Duty Still Unfit Unfit for further service TOTAL Fit Unfit TOTAL SPECIAL 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 1 1 2 Billingsgate Market 9 9 1 1 Cemetery 6 6 1 1 1 1 8 8 Central Criminal Court 8 1 8 1 Chamberlain 6 9 6 9 1 1 Civil Defence 1 1 1 1 1 Cleansing 2 2 2 12 1 15 19 4 2 1 21 5 2 Comptroller & City Solicitor 2 1 2 1 Engineer 19 1 20 9 1 10 Epping Forest 5 5 1 1 Hallkeeper 4 4 9 9 Highgate Woods 2 2 Housing 5 3 1 6 3 2 2 2 2 Justice Room, Guildhall 1 1 2 Library 10 5 2 12 5 London Central Markets 10 10 2 2 1 Mansion House 3 3 Medical Officer of Health 13 2 15 4 4 3 Metropolitan Cattle Market 18 18 Planning 13 3 2 15 3 2 2 Police 39 25 3 1 42 26 3 4 3 4 Printing & Stationery 3 3 Public Relations 1 1 1 1 Rating & Rate Accounts 4 4 1 1 6 Remembrancer 1 1 1 1 Schools: Boys 7 1 7 1 Freemen's 4 4 4 4 Girls 1 3 1 3 1 1 Music & Drama 5 4 1 5 5 2 2 Spitalfields Market 4 4 2 2 Surveyor 14 1 14 1 1 1 1 1 2 Town Clerk 1 2 1 2 1 1 Tower Bridge 9 1 3 13 Weights & Measures 1 1 1 1 West Ham Park 2 2 2 2 Works 2 2 2 1 2 1 237 64 6 10 2 253 66 2 14 1 3 3 19 4 59 23 3 2 62 25 14 1 ACKNOWLEDGEMENTS This Report is a record of many and varied activities of which the City Health Service may well be proud, including 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. Special thanks are due to the Public Health Laboratory Service and the Public Analyst, Dr. H. Amphlett Williams. This is a welcome opportunity of expressing appreciation to everyone concerned. 21 STATISTICAL INFORMATION Area.—678 acres (including the Temple and foreshore). Population.— Census 1951, 5,268. Estimated mid-year 1961, 4,600. Annual Rateable Value.— As at 1st April, 1961, £13,835,428. Annual Sum received from Penny General Rate.— £57,320. Live Births Number 29 Rate per 1,000 population 5.80 Illegitimate Live Births per cent of total live births 23.33 Stillbirths Number [late per 1,000 total live and still births 33.33 Total Live and Still Births 30 Infant Deaths (deaths under 1 year) 1 Infant Mortality Rates Total infant deaths per 1,000 total live births 34.48 Legitimate infant deaths per 1,000 legitimate live births 45.45 Illegitimate infant deaths per 1,000 illegitimate live births 0 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 34.48 Early Neo-natal Mortality Rate (deaths under L week per 1,000 total live births) 0 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per l,000total live and still births) 33.33 Maternal Mortality (including abortion) Number of deaths 0 Rate per 1,000 total live and still births 0 Deaths, all ages 56 Death rate per 1,000 resident population 10.01 INFECTIOUS DISEASE Total cases notified Notifications received Acute Primary Pneumonia 1 * Diphtheria 1 Dysentery 2 Erysipelas 2 Measles 23 Poliomyelitis (Paralytic) 1 Scarlet Fever 2 Tuberculosis (Pulmonary) 5 Whooping Cough 2 * This case was re-diagnosed as acute tonsillitis. ANALYTICAL EXAMINATIONS (Other than Food and Drugs Act) Albumen 19 Bread 3 Buttered Bun 1 Cleaning Fluid 1 Coconut Ice 1 Cooking Fat 1 Dried Fruit 46 Fruit Pie 1 Gelatine Powder 1 Bam Roll 1 Hamburger 1 Instant Coffee 1 Lamb Trimmings 1 Lime Gums 1 Lolly (in cockle shell) 1 Margarine 1 Milk 2 Mushrooms 2 Oranges 1 Pickles & Sauces 3 Pickling Spice 2 Shelled Walnuts 2 Steak Pie . . 1 Sulphate of Ammonia 1 Tea 1,303 Tinned Foods:— Ackees 1 Anchovies. 1 Apple Juice 2 Asparagus 1 Corned Beef 2 Grapefruit 1 Orange Juice 3 Oysters 1 Salmon 1 Shrimps 1 Tomato Juice 1 Tongue 1 Water 1 BACTERIOLOGICAL EXAMINATIONS The following specimens were examined during the year:— Cheese 1 Chicken 5 Confectionery 1 Corned Beef 1 Egg Products 283 Faeces 12 Haddock 1 Ice Cream Powder 1 Lymph Nodes 1 Port Luncheon Meat 1 Pork Pie 1 Prawns . 235 Roast Beef 1 Stewed Steak 1 Throat Swabs 3 Well Water 1 Vomit 1 22 CAUSES OF, AND AGES AT. DEATH DURING THE YEAR 1961 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 lyear 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 and upwards 1 2 3 4 5 6 7 8 9 10 11 12 All Causes 56 — 1 — — — 1 4 24 17 9 1. Tuberculosis, respiratory M — — — — — — — — — — — F _ — — — — — — — — — — 2. Tuberculosis, other forms M — — — — — — — — — — — F — — — — — — — — — — — 3. Syphilitic disease M — — — — — — — — — — F — — — — — — — — — — — 4. Diphtheria M — — — — — — — — — — — F — — — — — — — — — — 5. Whooping Cough M — — — — — — — — — — F — — — — — — — — — — — 6. Meningococcal infections M — — — — — — — — — — F — — — — — — — — — — — 7. Acute poliomyelitis M — — — — — — — — — — F — — — — — — — — — — 8. Measles M — — — — — — — — — _ — F — — — — — — — — — — — 9. Other infective and parasitic disease M — — — — — — — — — — — F — — — — — — — — — — — 10. Malignant neoplasm-stomach M 1 — — — — — — — 1 — — F — — — — — — — — — — — 11. Malignant neoplasm-lung, Bronchus M 3 — — — — — — — 2 1 — F — — — — — — — — — — — 12. Malignant neoplasm-breast M — — — — — — — — — — F — — — — — — — — — — — 13. Malignant neoplasm-uterus F — — — — — — — — — — — 14. Other malignant and lymphatic neoplasms M 6 — — — — — — 1 3 2 — F 1 — — — — — — 1 — — — 15. Leukaemia, aleuækmia M 1 — — — — — 1 — — — — F 1 — — — — — — — 1 — — 16. Diabetes M — — — — — — — — — — — F 1 — — — — — — — 1 — — 17. Vascular lesions of nervous system M 3 — — — — — — — 1 1 1 F — — — — — — — — — — — 18. Coronary disease, angina M 12 _ — — — — — 1 8 2 1 F 3 — — — — — — — 1 2 — 19. Hypertension with heart disease M 3 — — — — — — — 2 — 1 F 1 — — — — — — — — 1 — 20. Other heart disease M 1 — — — 1 — F 1 — — — — — — — — — 1 21. Other circulatory disease .. M 1 — — — — — — — — 1 — F 1 — — — — — — — — — 1 22. Influenza M — — — — — — — — — — — F — — — — — — — — — — — 23. Pneumonia M 4 — _ — 1 2 — F 3 — — — — — — — — — 3 24. Bronchitis M 1 — — — — — — — 1 — — F 1 — — — — — — — — 1 — 25. Other diseases of respiratory system M — — — — — — — — — — — F — — — — — — — — — — — 26. Ulcer of Stomach and duodenum M 2 — — — — — — — 2 — — F — — — — — — — — — — — 27. Gastritis, enteritis and diarrhoea M — — — — — — — — — — — F — — — — — — — — — — — 28. Nephritis and nephrosis M — — — — — — — — — — — F — — — — — — — — — — — 29. Hyperplasia of prostate M — — — — — — — — — — — F — — — — — — — — — — — Carried forward M 38 — — — — — 1 3 21 10 3 F 13 — — — — — — 1 3 4 5 23 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 wards 1 2 3 4 5 6 7 8 9 10 11 12 Brought forward M 38 — — — — — 1 3 21 10 3 F 13 — — — — — — 1 3 4 5 30. Pregnancy, childbirth, abortion F — — — — — — — — — — — 31. Congenital malformations M — — — — — — — — — — — F — — — — — — — — — — — 32. Other defined and ill-defined diseases M 1 — — — — — — — — 1 — F 1 — 1 — — — — — — — — 33. Motor vehicle accidents M — — — — — — — — — — — F 1 — — — — — — — — — 1 34. All other accidents M 2 — — — — — — — — 2 — F — — — — — — — — — — — 35. Suicide M — — — — — — — — — — — F — — — — — — — — — — — 36. Homicide and operations of war M — — — — — — — — _ _ F — — — — — — — — — — — Totals M 41 — — — — — 1 3 21 13 3 F 15 — 1 — — — — 1 3 4 6 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 anrd 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 30 Total No. of children who attended during the year, and who were born in:— 1961 14 1960 41 1959-1956 44 Total attendances by children:— Under 1 year of age . 621 1—5 years of age 570 Health Visitors Total No. of children visited 58 No. of infants under 1 year of age visited for first time 21 Total visits to infants under 1 year of age 122 Total visits to children aged 1 year but under 2 years 127 Total visits to children aged 2 years but under 5 years 140 No. of expectant mothers visited for the first time 13 Total visits to expectant mothers 26 Care of Premature Infants No. of premature births during the year 3 No. of deaths under 1 month 1 Diphtheria Immunisation No. of children who completed a full course of primary immunisation:— Under 5 years of age 28 No. of children who were given a secondary or reinforcing injection 34 Vaccination No. of children successfully vaccinated or re-vaccinated 24 Home Help Service No. of maternity cases provided with home help Nil 24 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 1,231 (incl. 2 bakehouses and 1,016 kitchens) 2,183 (incl. 2 bakehouses and 2,011 kitchens) 187 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 534 454 22 1 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — TOTAL 1,765 (incl. 2 bakehouses and 1,016 kitchens) 2,637 (incl. 2 bakehouses and 2,011 kitchens) 209 1 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 Remed ied Refeired To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1.) 438 436 Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 61 45 — — — Ineffective drainage of floors (S.6) 2 2 — — — Sanitary Conveniences (S.7) (a) insufficient 4 2 — — — (b) unsuitable or defective 189 167 — 16 1 (c) not separate (or sexes 8 3 — — — Other offences against the Act (not including offences relating to Outwork) - - 17 - - TOTAL 702 655 17 16 1 PART VIII OF THE ACT Outwork (Sections 110 and 111) Section 110 Section 111 Nature of Work No.of outworkers in August list required by Section 110(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 N otices served Prosecutions 1 2 3 4 5 6 7 Wearing apparel (Making, etc.) 212 - - - - - Household linen 14 — - ~~ — - Total 226 - - - - - 25 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 44 Names and Addresses of outworkers resident outside the City, employed by City firms, transmitted to other Authorities 252 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. 510 inspections of shops and warehouses have been made. The few defects found have been remedied as a consequence of informal action by the Inspectors. 8 intimation notices were served. No legal proceedings were instituted. No applications for certificates granting exemption from the provision of sanitary accommodation in accordance with Section 38(2) and (6) of the Act were received. 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. 83 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 376,273 0 0 0 Meat, etc., surrendered to Inspectors at Smithfield Market 859 18 1 27 Meat, etc., surrendered to Inspectors at Leadenhall Market and City shops 8 8 3 22 Meat, etc.,surrendered to Inspectors at Cold Storey 10 10 3 21 Number of Exportation Certificates Issued 92 Number of demonstrations and lectures given 63 Number of Students attending 980 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 140 tons 7cwts. Oqrs. 0 lbs., (in addition to 2,455 eggs) which was disposed, of as Tons Cwts. Qre. Lbs. Released for manufacture 13 18 0 11 Disposed of to contractors 21 10 2 14 Destroyed 104 18 1 3 49 tons 18 cwts. 1 qrs. 11 lbs. of food were placed under.stop and subsequently released to be dealt with under the supervisibn of other local authorities. 26 THE FOOD HYGIENE (General) REGULATIONS, 1960 Supervision in accordance with these Regulations has been carried out at Smithfield Market. During the year 776 infringements were noted. 208 were in connection with clothing, 65 in connection with containers, 99 in respect of meat contamination, 72 in regard to premises and equipment,and 156 were instances of smoking whilst handling food. 26 trucks and 147 vans and cars were observed to be infringing the Regulations. 3 meat handlers with cut fingers were not wearing washable dressings on the wounds. Suitable warnings were given in connection with these cases. There are estimated to be some 7,000 persons using Smithfield Market daily, which figure includes approximately 600 porters licensed by the Superintendent of the Market, including some 120 freelance porters popularly known as "bummarees". some 200 pitchers who arrive at the Market with the various meat vans, unload the vehicles and leave the Market again on the vans. tenants' staffs, buyers and their staffs. there are 349 stalls on the Market occupied by approximately 110 tenants. FISH INSPECTION Inspection of fish in the City of London is carried out by officers of the Worshipful the Fishmongers' Company. The Fishmeter's returns indicated as follows Deliveries at or near Billingsgate Market Weight of Condemnation (including shell fish) Fi sh Condemned Rate 99,634 tons 368 tons 0.37% SANITARY CIRCUMSTANCES The general sanitary supervision has been maintained and in this connection 3,678 inspections have been made. \s a consequence of these inspections, it was necessary to serve 23 Intimation Notices. No Statutory Orders were served. No Legal proceedings were necessary. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. CATERING ESTABLISHMENTS Before establishing a new catering business planning approval must be obtained before premises, new or existing, are adapted for this purpose. In order that the applicants for such approval can be satisfied that the premises are suitable from a public health point of view and that the various statutory requirements can be met, they are referred by the City Planning Officer to your Medical Officer of Health. 70 such applications were received during the year as a consequence of which 223 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. 60 firms were registered under this Act, all of which were re-registrations. One infringement was noted. 77 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. 22 inspections were made and no contraventions 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 noted. 27 FOOD AND DRUGS ACT, 1955, AND FOOD REGULATIONS Informal and Formal Samples submitted for Analysis Article Informal Formal Article Informal Formal Bacon 7 - Brought forward 145 4 Beer 1 - Margarine 12 - Brandy - 1 Marmalade 5 - Butter 10 - Meat & Meat Products . 20 - Cake Mixture 1 - Medicines 16 - Cakes & Pastries 3 - Milk 7 27 Calf's Foot Jelly 1 - Milk, tinned 3 - Cheese 15 - Mincemeat 1 - Chicken Soup Cubes 1 - Noodles 1 - Chicken, tinned 3 - Olives, bottled 1 - Chop Suey, tinned 1 - Pastry Mixture 3 - Cocktail Cherries 2 - Pate Truffle 1 - Cocktail Onions 1 - Peel, mixed 1 - Pickles & Sauces 4 - Cocoa 1 - Pies 7 - Coffee 5 - Puddings 2 - Confectionery 1 - Puddings, tinned 2 - Cooking Fat 11 - Ravioli 1 - Cooking Oil 3 - Rice, tinned 1 - Cream, tinned 6 - Rum 1 - Curry Powder 1 - Saccharin Tablets 2 - Fish, tinned 12 - Sausages 25 - Frogs Legs, tinned 1 - Soup, tinned 2 - Frozen Foods 9 - Spices 4 - Fruit, Dried 12 - Suet 1 - Fruit, fresh 8 - Sugar 5 - Fruit Juice 12 - Tea 11 - Fruit, tinned 6 - Vegetables, dried 3 - Gin - 3 Vegetables, tinned 11 - Honey 1 - Vinegar 9 - Ice Cream Powder 1 - Whisky - 4 Jam 8 - Wines 8 - Lolly Mix 1 - Yoghourt 2 - Carried forward 145 4 TOTAL 317 35 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY Article Informal or Formal Sample Nature of adulteration or irregularity Action Apple Juice Canned Vitaminized Informal Incorrectly labelled. The labelling has been taken up with the wholesaler and the stocks have been withdrawn from sale. Bread Loaf Sliced White Informal Discoloured by brown streaks which penetrated through-out the loaf. This was due to the change over from a run of brown loaves in the moulding machine to a run of white bread. The matter was taken up with the manufacturer but no further official action taken. Bread Roll Portion of Informal Contained a small quantity of black foreign matter, consisting of a mixture of fat, dust and charred flour, which had been baked in the roll. This "sample" was a complaint from a member of the public of mice dirt. Although no evidence of rodent contamination was found the baker's attention was drawn nevertheless to the general debris found in this sample. Coconut Ice Informal The sample was mouldy and rancid. This coconut ice was old stock. It was withdrawn immediately. Glace Cherries Informal Contained Sulphur dioxide, 100 parts per million, the presence of which was not disclosed on the label. The cartons will have the presence of Sulphur dioxide indicated thereon at the time of the next printing. Lolly mix Informal Incorrectly labelled. Discussions are in progress with the distributors. There are differences of opinion on the wording of the label. Milk (Hot) Formal Contained Fat, 3.24 per cent; Solids-not-fat, 7.71 per cent, corresponding to the presence of nine per cent of added water. Warning letter sent to vendor. He has since discontinued the sale of hot milk. 28 Administrative action regarding adulteration or other irregularity — continued Article Informal or Formal Sample Nature of adulteration or irregularity Action Milk Shake Syrup Informal Contained Sulphur dioxide, 250 parts per million. This article might legitimately contain 30 parts per million of sulphur dioxide, from its sugar content. (42% of 70 parts per million). There is quite a strong case for permitting preservatives in these products, to the same extent that they are permitted in "Cordials", and it has been proposed that when the Preservatives Regulations are revised "Flavouring Syrups" should be permitted to contain 350 parts per million of Sulphur dioxide. Nutmeg Informal Contaminated by insects. The vendors withdrew all stocks from sale. Cautionary letters were sent to both vendors and producers. Tea Informal Misleading label. This label of this tea is still under discussion. Wine Gums Informal Contained a large number of dark specks some of which consisted of particles of scorched gum and some of dust. Although the scorched gum was considered objectionable by the Public Analyst, after discussion with him it was agreed that it was not harmful. The manufacturers have been asked to investigate the matter and warned that they may be involved in legal proceedings. Wine (Spanish Rose) Informal The description did not appear to constitute an "appropriate designation" as required by the Labelling of Food Order. Inquiries have been made through various trade channels and there appears to be some divergence of views about the comments of the Public Analyst. Further discussions are taking place. Yoghourt Informal The sample was made from separated milk and contained only 0.3 per cent of fat. This product was labelled "Yoghourt" and although in the statement of ingredients skimmed milk was mentioned there was no indication in the general body of the label of this fact. After correspondence with the producers they have agreed on a fresh printing of the label to use the words , . . "Yoghourt (non fat, skimmed milk)". PROSECUTION Food and Drugs Act, 1955 Section Of fence Result 8 Sale on two occasions of cheese unfit for human consumption. Vendor fined £50 on each of two summonses in addition to 10 guineas costs. FOOD AND DRUGS ACT, 1955 (Section 16) This Section provides for registration of premises for the sale, manufacture for sale or storage of ice cream, or the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale. 147 such premises were registered at the end of the year. 29 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 83 Sale and storage of ice cream 4 Selecting and sorting of sausage casings 9 Preparation and cooking of jellied eels and shellfish 14 Cooking of hams I 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 2 150 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 MRTUARY Bodies received 187 Post Mortem Examinations made 187 Inquests on bodies 26 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 741,795 Cases of horsehair 90 Fees received £3,755 General Disinfection. Infectious Diseases, etc.:— Articles of bedding disinfected 222 Premises disinfected after cases of infectious disease 2 Lockers at Post Offices disinfected 17 Verminous premises disinfected 18 Cleansing of Persons :— No. of verminous persons bathed 931 No. of Scabious Persons bathed 14 No. of articles disinfected 9,460 30 ■ APPENDIX INDEX Page Vital Statistics 2 Infectious Diseases Notified 2 Food Poisoning 2 Atmospheric Pollution 4 Pige on Nuisance 6 Excavation of Human Remains 6 The Noise Abatement Act, 1960 6 Housing 6 Old Peoples' Welfare 7 Factories Act 1937 — Prosecution 8 Rodent Control 8 Mass Radiography 11 Anti Poliomyelitis Clinic 11 Cancer Diagnostic Clinic 12 Occupational Health 14 Meat and Food Inspection — Markets 16 Food Hygiene (General) Regulations, 1960 — Transport and Handling of Meat 16 Imported Frozen Prawns 17 Lead in Food Regulations — Tea 17 Catering Establishments 18 Corporation Staff 19 Acknowledgements 21 Statistical Information Vital Statistics 22 Infectious Disease 22 Analytical Examination22 Bacteriological Examination 22 Causes of, and Ages at, Death 23 Maternity and Child Welfare 24 Factories Acts, 1937 and 1948 25 Shops Act 1950 26 Hygiene in Hairdressers' and Barbers' Shops 26 Meat Inspection 26 Itinerant Food Vendors 26 Food Inspection 26 The Food Hygiene (General) Regulations 1960 — Meat Transport 27 Fish Inspection 27 Sanitary Circumstances 27 Catering Establishments27 Pharmacy and Poisons Act 1933 27 Pharmacy and Medicines Act, 194 27 Fertilisers and Feeding Stuffs Act, 1926 27 Food and Drugs Act, 1955, and Food Regulations, Informal and Formal Samples submitted for Analysis 28 Adminstrative Action regarding Adulteration or other Irregularity 28 Prosecutions — Food and Drugs Act, 1955 29 Food and Drugs Act, 1955 (Section 16) Registration of Food Premises 29 Agricultural Produce (Grading & Marketing) Acts, 1928-1931 30 Merchandise Marks Act, 1926 30 City Mortuary 30 Disinfection and Cleansing of Verminous Persons, etc. 30