LON 92 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1966 To be presented 19th October, 1967. STAFF (as at 31st December, 1966) Date of Appointment MEDICAL OFFICER OF HEALTH (for the Port and City of London) SWANN, William George, M.D., B.Ch., B.A.O., D(Obst.) R.C.O.G.. D.P.H., Jan. 1964 B.Sc., D.P.A., F.R.I.P.H.H. DEPUTY MEDICAL OFFICER OF HEALTH (for the Port and City of London) JONES, Dilwyn Treharne, B.Sc., M.B., B.Ch., D.C.H., D.P.H., D.C.T June 1963 ASSISTANT MEDICAL OFFICERS STOTT. William, M.B., B.S., D.P.H., F.R.I.P.H.H. (Part-time) .. Aug. 1958 WHITE-FRANKLIN, Alfred, M.A., M.B., B.Ch., F.R.C.P., M.R.C.S., Child Welfare Clinic .. (Part-time) .. Apr. 1965 DENTAL OFFICER WALLACE, Leonard John, L.D.S., R.C.S. June 1965 ADMINISTRATIVE STAFF (Port and City of London) RATLIFF, R.C. Chief Clerk .. Mar. 1930 SMITH, E.V. Deputy Chief Clerk Oct. 1938 BETTS, C.W.R. First Assistant Clerk April 1926 OSBORN, F.B. Senior Assistant .. May 1952 LOTT, R.H. Senior Assistant May 1947 COLLINS, R.H. Senior Assistant Jan. 1963 FLOOD, D.J. Senior Assistant .. March 1963 SHEPHERD, Mrs. D. First Class Assistant April 1965 BALL, F.E. First Class Assistant April 1961 DARLISON, S.C. First Class Assistant April 1964 GURNEY, Miss M.L. First Class Assistant May 1939 MOORE, A.J.G. First Class Assistant April 1964 BROWN, K.B. First Class Assistant April 1964 PEDWELL, R.L. First Class Assistant July 1966 HAMBLIN, Miss I.H. General Grade Assistant.. Oct. 1957 HEMING, R.G. General Grade Assistant Aug. 1965 MORRIS, T.K. General Grade Assistant Oct. 1965 FARRELL, R.G. General Grade Assistant July 1965 MILLER, Miss J.E. Shorthand Typist April 1963 SARBUTT, Miss B.K. Shorthand Typist Jan. 1965 NEWSON, Miss J.E. Shorthand Typist June 1966 THREADGOLD, A.W. Senior Assistant (Meat Inspector's Office) .. Nov. 1923 PETERS, E.J. Clerical Assistant (Meat Inspector's Office) Nov. 1935 CASH, J.E. Clerical Assistant (Meat Inspector's Office) March 1954 KILBY, E.H. Senior Assistant (Diseases of Animals Act) April 1965 HADLEY, J.T. Clerical Assistant (Diseases of Animals Act) June 1965 EASTMAN, C.E.W. Clerical Assistant (Royal Docks Office) July 1965 LYONS, Mrs. J. Clinic Clerk (Part-time) April 1965 WOODS, T.A. Messenger Nov. 1955 HOLDAWAY, H.C. Messenger/Driver May 1966 STALLEY, J. Messenger/Driver Nov. 1966 PUBLIC HEALTH INSPECTION STAFF CAMPBELL, J.W. Chief Public Health Inspector Sept. 1946 THOMPSON, E. Dep. Chief Public Health Inspector Sept. 1948 FLYNN, M.J. Senior Public Health Inspector July 1951 RILEY, J.h. Senior Public Health Inspector Aug. 1962 WELLDON, J.B. Senior Public Health Inspector Aug. 1962 SIIEPLEY, H.L. Senior Public Health Inspector May 1964 HUDSON, L.A. Public Health Inspector April 1934 BAXENDALE, W.J. Public Health Inspector Jan. 1964 HOARE, J.A. Public Health Inspector May 1964 CORFIELD, D.F. Public Health Inspector June 1964 RENDELL, J.H. Public Health Inspector June 1965 GILKES, D.H. Public Health Inspector June 1966 MEAT INSPECTION STAFF THOMPSON, F.E., M.B.E chief meat inspector July 1924 LEE, W.R. deputy chief meat inspector July 1930 GARRARD, S.S. senior meat inspector Sept. 1946 MORRIS, W.L. senior meat inspector Sept. 1946 SEYMOUR, K.S. senior meat inspector July 1935 WILSON, J.C. senior meat inspector Jan. 1936 COX, J.T. meat inspector Aug. 1954 FIELD, H. meat inspector Aug. 1954 GINGELL, G. meat inspector Aug. 1954 PAYNE, B.G., D.F.C. meat inspector Dec. 1960 ELSEY, F.E. meat inspector Jan. 1964 BERNHARDT, D.R. 'Authorised officer'under Food Hygiene Regulations, 1955 May 1931 PREVOST, A.E. senior porter Feb. 1926 1 HEALTH AND WELFARE SECTION BENFIELD, Miss G.L. Health and Welfare Officer April 1965 PRESTON, Miss S. Health Visitor April 1965 MIMMS, Mrs. P.A. Dental Surgery Assistant Sept. 1965 WODZICKA, Miss A.M. Chiropodist (part-time) Nov. 1966 S. HOME HELPS — DISEASES OF ANIMALS ACT WIGGINS, G.S., M.RC.V.S. Veterinary Officer Oct. 1964 HAYHURST, R.J. D.F.C. Inspector Oct. 1964 GUBBINS, V.O. Inspector April 1965 RODENT STAFF CARTER, J. Rodent Officer Sept. 1944 MASON, G.A. Foreman Rodent Operative Dec. 1946 TREMAYNE, L.R. Rodent Operative Nov. 1943 BEECHAM, C.G. Rodent Operative Jan. 1966 PEACHEY, S.A. Rodent Operative Aug. 1966 MORTUARY AND DISINFECTING STATION LAWRENCE, F.HI. Superintendent of the City Mortuary and Disinfecting Station May 1936 SUNNICK, J.W.T. Disinfecting Apparatus Attendant May 1950 MANUAL WORKERS TIMONEY, J.M. (General Duties at Smithfield Market) Oct. 1966 HUDSON, R.H. (General Duties at Smithfield Market) March 1963 I'ANSON, R.H. (General Duties at Smithfield Market) Feb. 1964 STEELE, W.T. (General Duties at Mortuary) Aug. 1958 IIADLEY, J.H. (General Duties at Mortuary) Sept. 1962 PEARCE, C.E. (General Duties at Smithfield Market) June 1964 PEARCE, G.R. (General Duties at Smithfield Market) Feb. 1965 SHEEHAN, Mrs.M.M. (Bath Attendant and Cleaner) Oct. 1962 JACOBS, G.W. (General Duties at Mortuary) Dec. 1966 PUBLIC ANALYST WILLIAMS, H.A., Ph.D. (Lond), A.C.G.F.C., F.R.I.C., F.R.S.H. Jan. 1958 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1966 To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. Guildhall. e.c.2. Telephone: 01-606 3030. My Lord Mayor and Gentlemen, I have the honour to submit the following report on the work of my Department during the year 1966. In my previous Annual Report mention was made of the legislation imposing upon the Corporation of London new responsibilities and duties in connection with Personal Health and Welfare Services. When these services were first transferred it was realised that in view of the small residential population of the City of London, the quantity of work would not be great, but though the small population makes it difficult to provide and administer certain services this has proved an advantage in other ways. The organisation set up by the Corporation in April, 1965 allowed for actual search for people in need by questionnaire, visiting and neighbourhood enquiry. This has been successful as demonstrated by the increase in the numbers in the General Registers. The people so discovered were not all seriously disabled and it was necessary to ascertain that they were really in need. This is, however, very rewarding work and very much more can be done with those cases which are discovered before they develop into insoluble problems. All preventive and social medicine work is time-consuming and sometimes very little is seen for all the work. Very often all that can be hoped for is that the most unremitting efforts will prevent the patient becoming worse. The success of the scheme reflects both the professional skill of the staff and their willingness and efficiency. Finally, I should like to express my appreciation of the courtesy and consideration which the Chairman and members of the Port and City of London Health Committee and Welfare Committee have extended to me during the year. I have the honour to be, Gentlemen, Your obedient Servant, W.G. SWANN, M.D., B.Sc. Medical Officer of Health, Port and City of London. 3 HOUSING Housing Act, 1957 1. Number of houses which on inspection were considered to be unfit for human habitation:— Nil 2. Number of houses in which defects were remedied in consequence of informal action by the Local Authority or their Officers:— Nil 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) Nil (b) Nil 4. Number of notices served during the execution of works:— Nil 5. Number of houses which were rendered fit after service of formal notices:— Nil 6. Number of demolition or closing orders made: — Nil 7. Number of houses in respect of which an undertaking was accepted under subsection (4) of section 16 of the Housing Act, 1957 :— Nil 8. Number of houses demolished:- Nil During the year 76 families were rehoused leaving 419 families on the Housing Register at the end of December 1966. Two of the old tenement blocks were being prepared for demolition in preparation for the redevelopment of the Middlesex Street Estate. Further progress with the redevelopment of the Barbican area has been made. Of the 2,120 flats to be built 1,877 are now under construction. WATER SUPPLY During the year 187 water samples were taken from City premises for the purposes of bacteriological examination. These were taken from deep wells, office drinking points and swimming pools. There are 124 deep wells at present in use in the City, which supply a constant source of potable water for domestic and drinking purposes, and are operated by the respective owners or occupiers of the premises in which they are located. The Offices, Shops and Railway Premises Act, 1963 requires that an adequate supply of wholesome drinking water be provided and maintained for the use of persons employed in office premises, for this purpose a random check of office drinking points is carried out. There are two swimming pools within the City boundary where water samples were regularly taken. A third pool belonging to the Corporation was also sampled, at the request of the Housing Manager. Chlorine has a powerful bactericidal action and is therefore added to water as a sterilising safeguard. The residual content of this chlorine was determined in all bacteriological samples taken. Samples were drawn from the following sources:— Source No. of Samples Deep Wells 74 Offices, Shops and Railway Premises Act Drinking Points 93 Swimming Pools 20 Total 187 4 As a result of the bacteriological examinations three adverse reports on drinking water were received. These were thoroughly investigated and as a result of action taken the subsequent sampling showed the water from these particular drinking points to be pure and potable. Chemical analysis of water supplies was carried out by Dr. Amphlett Williams, the Corporation's Public Analyst. Fourteen such samples were taken, all of which were satisfactory. The Metropolitan Water Board have supplied the following Report:— "(a) The supply was satisfactory both as to quality and quantity throughout 1966. (b) (i) The supply was derived from the following works and pumping stations:- River Thames (Southern) New River via Stoke Newington No new sources of supply were instituted. (ii) The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. No fluoride was added, and where the fluoride content is indicated it represents the naturally occurring fluoride in the water. (c) The supply being hard in character is not liable to be plumbo-solvent. (d) All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, through the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (e) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1966, was 4,469. (ii) No houses were permanently supplied by standpipe. Other Observations (f) There were no changes to the general scheme of supply in your area. (g) There were no additions to the total yardage of mains in the Borough." 5 6 METROPOLITAN WATER BOARD — Water Examination Department BACTERIOLOGICAL RESULTS- YEARLY AVERAGES, 1966 Water supplied to the City of London Source of Supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37 °C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Stoke Newington 256 12.9 100.0 100.0 Thames-derived, South of River 1,825 10.8 99.18 99.95 METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE CITY OF LONDON "Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27°C. B.O.D. 5 days •t 20° c. Hardness (total) CaC03 Hardness (noncarbonate CaC03) Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as P04 Silicate as S102 Sulphate as S04 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) <D (2) (3) (4) (5) (6) (7) (8) (9) (10) (»D (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Stoke-Newington 52 0.038 0.069 5.4 0.74 315 82 4 27.8 4.7 36 1.4 10 64 0.20 0.01 0.1 9 7.8 630 Thames-derived South of River 156 0.029 0.090 4.4 1.27 279 77 5 24.2 5.0 32 1.8 9 62 0.20 0.01 0.1 15 7.8 560 SEWERAGE AND SEWAGE DISPOSAL Sewerage and sewage disposal in the City of London are the responsibility of the City Engineer who has supplied the following information:— "The sewerage system in the City is comprised mainly of ovoid shaped brie k sewers, the average internal dimensions being 4 feet high x 2 feet 8 inches wide, this size being adopted only to provide access for sewermen, as the normal dry weather flow depth of effluent is only about 9 inches at an average velocity of 2 to 3 feet per second. The Corporation sewers discharge into the Greater London Council intercepting sewers which flow eastwards across the City at a much lower depth to their Beckton Sewage Treatment Works. In my opinion, the system of sewerage in the City is adequate, with ample margin for diverting flows from sewers during reconstruction and maintenance works." SMOKE NUISANCES City of London (Various Powers) Act, 1954. Clean Air Act, 1956. 74 complaints were investigated by Public Health Inspectors during the year and nuisances were found to emanate from the following sources:— 1. Oil fired furnaces 48 2. Solid fuel furnaces 13 3. Bonfires 8 The main cause of nuisances in 1 and 2 was inadequate maintenance of equipment and the required improvement was effected informally in all cases. Bonfire nuisances arose from the burning of debris on demolition sites and were dealt with informally under Section 16 of the Clean Air Act, 1956. The reduction in the number of complaints is significant and affords an encouraging recognition of the attempts which have been made within the City to reach the goal of a smokeless atmosphere. NOISE Noise was one of the main causes of complaint during the year. It emanated mainly from building sites and demolition projects. The individual sources were pneumatic drills, pile drivers, compressors and other contract machinery. When investigating the cause of these complaints it was found necessary to judge each case on its merits and assess various levels for various types of complaint. These ranged from interruptions of telephone messages during the day to sleepless nights experienced by housekeepers of a number of office premises. Numerous visits were made during the year during the hours of darkness and in some cases extended to the "early hours". In all cases it was possible to abate the nuisance by negotiation. The method of abatement included confining the period of noise emission to reasonable working hours and generally lessening intensity by means of baffles and shielding. Fifty-three complaints were received, mostly involving the larger building projects. Demolition was the chief source of complaint. COMMON LODGING HOUSES The only common lodging house in the City is situated at 116 Middlesex Street and is owned and managed by the Salvation Army. The premises consist of six floors which house four hundred and twenty men and a basement supplying canteen facilities for the residents. A keeper and deputy keeper are resident. Repair, maintenance and decoration are carried out as continuous operations, the standard of which is high. Bedding is changed after every user or weekly. Insect infestation of the inmates is kept to a minimum by frequent 'spot' checks, and cleansing is carried out at the City's Mortuary and Disinfecting Station, Milton Court. An added problem in this respect is that no proper transport is provided to collect and deliver infested find clean articles and personnel. 7 A statutory inspection is carried out every thirteen months and registration is renewed subject to satisfactory conditions prevailing at the time of inspection. No cause has so far been found to recommend withdrawal of this registration. During the year ten visits were carried out, including early morning bed inspection and late night visits to interview suspected verminous persons. EXHUMATION OF HUMAN REMAINS IN DISUSED CHURCHYARDS At St. Giles Church, Cripplegate, in connection with the Barbican Development, 34 boxes of human remains were removed by the London Necropolis Co. Ltd., and reinterred at Brookwood Cemetery necessitating 4 early morning visits by the Public Health Inspectors concerned. Subsequently, the Faculty authorising removal was amended to permit reinterment of any human remains found later in a specially constructed vault to be built in the churchyard. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Offices During the year the number of visits by Inspectors was 4,831, showing an increase over the previous year (3,280) and reflecting the number of general inspections made which reached 1,003 (447). As in the past a large part of the Inspectors' time has been taken up answering requests for advice and assistance from office and personnel management departments, compared with which, complaints from office employees have been minimal. Here it is pleasing to note that whilst the Act does not require the provision of rest and recreation facilities for staff, these are increasingly being made available. The standard of cleanliness is generally found to be satisfactory but in certain instances where both internal cleaning staff and external contractors have been used, improvements have been found to be necessary, and in these cases contractors have been found the more difficult to deal with. With regard to heating and ventilation in offices, it would seem that ventilation is the greater problem, it being difficult in many instances to use windows for this purpose owing to traffic noise and inclement weather. Mechanical ventilation is very often the only method whereby satisfactory ventilation can be obtained and this usually involves a substantial capital outlay. In new offices a high standard of lighting is usually provided. However, in older premises the standard provided borders on being barely adequate for the task involved. When these older installations are being renewed in offices a standard of between 45 and 60 lumens per square foot is being recommended. Where the provision of sanitary conveniences is inadequate, difficulty is often found in providing floor space for the additional facilities required; most instances being limited by the internal arrangements of the buildings. The British Red Cross Society at Finsbury Barracks, City Road, E.C.1, carry out training in First Aid to qualify persons under the Act and during the year under review 871 persons were trained, the majority of these being from firms within the City. Of the accidents reported during the year the greatest number were due to persons slippin g on staircases and in passageways. These generally were due to slippery surfaces, but in many instances the cause was probably unnecessary haste by the person involved. Generally upon inspection it has been found that it is in the minor requirements of the Act that premises are deficient, i.e. no provision of thermometers and abstracts of the Act not being posted. With the co-operation of everyone concerned it has not been found necessary to institute any proceedings under the Act this year. It is worth noting that the amount of work involved in a general inspection varies considerably e.g. one general inspection may concern a firm occupying one room whereas another may concern a large office consisting of hundreds of rooms. Therefore, any comparison between one local authority and another on the basis of the yearly number of inspections is invalid. It has been the policy of this department to deploy the available inspectors in a way considered to be of the best advantage to all concerned in preference to the achievement of a statistical target of general inspections. This policy involves immediate attention to requests from occupiers for advice and help, investigation of causes of accidents (332 in 1965 and 320 in 1966) and consultations with architects and builders regarding new developments. In this connection there are, in the City, the headquarters of many large firms, insurance companies, and banks and questions posed by branches of these establishments to their headquarters on the implementation 8 of the Act are frequently put to the inspectors of this Department who give advice and guidance where indicated. Shops During the year, whilst continuing with the first-time general inspection of premises, greater attention has been paid to revisiting those premises already inspected to discover whether the deficiences previously found had been remedied. Compliance with some provisions of the Act can be expected to take some time, particularly where the necessary works, for instance, in respect of ventilation, sanitary conveniences and washing facilities, involve structural alterations, as these may well be expensive and have to be tied in to a financial programme. TABLE A REGISTRATIONS AND GENERAL INSPECTIONS TOTALS Offices 87 6,272 415 Retail shops 80 991 250 Wholesale shops, warehouses 70 806 106 Catering establishments open to the public,canteens 18 513 232 Fuel storage depots Nil Nil Nil 355 8.582 1.003 (1) (2) (3) (4) Class of premises Numbe r of premises registered during the year Total number of registered premises at end of year Number of registered premises receiving a general inspection during the year. TABLE B NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES 4,831 TABLE C ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of Workplace Number of persons employed (1) (2) Offices 237,587 Retail Shops 4,714 Wholesale departments, warehouses 7,320 Catering establishments open to the public 6,557 Canteens 4,073 Fuel storage depots 12 Total 260,263 Total Males 155,656 Total Females 104,607 9 10 HYGIENE IN HAIRDRESSERS' AND BARBERS' SHOPS The former powers dealing with hygienic conditions in hairdressers and barbers shops contained in the London County Council (General Powers) Act, 1954 have been repealed and these powers are replaced by legislation in the Public Health Act 1961 Section 77. There is no power, at present, to require registration of these premises. During the year 27 inspections were made showing that byelaw requirements are generally being maintained. FACTORIES ACT, 1961 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 1,134 (incl. 2 bakehouses and 974 kitchens) 1,805 (incl. 7 bakehouses and 1,738 kitchens) 164 – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 408 194 19 – (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 6 6 1 – TOTAL 1,548 (incl. 2 bakehouses and 974 kitchens) 2,005 (incl. 7 bakehouses and 1,738 kitchens) 184 – 2.-CASES IN WHICH DEFECTS WERE FOUND (If defects are discovered at the premises on two, three or more separate occasions they are reckoned as two, three or more "cases"). PARTICULARS No. of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) 770 *847 – – – Overcrowding (S.2.) – – – – – Unreasonable temperature (S.3.) – – – – – Inadequate ventilation (S.4) 46 * 56 – – – Ineffective drainage of floors (S.6.) 2 – – – – Sanitary Conveniences (S.7.) (a) insufficient 9 5 – – – (b) unsuitable or defective 208 *219 – – – (c) not separate for sexes 11 4 – – – Other offences against the Act (not including offences relating to Outwork) – – 1 – – TOTAL 1,046 1,131 1 – – *The number of defects remedied is higher than the number of defects found due to a 'carry over' from previous years. 11 PART VIII OF THE ACT Outwork (Sections 133 and 134) Section 133 Section 134 Nature of Work No. of outworkers in August list required by Section 133 (1)(c) No. of cases of default in sending lists to the Council No.of prosecutions for failure to supply lists No.of instances of work in unwholesome premises Notices served Prosecutions 1 2 3 4 5 6 7 Wearing apparel (Making, etc.) 249 – – – – – TOTAL 249 – – – – – OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms employing outworkers 36 Names and addresses of outworkers resident in the City received from other Authorities 15 Names and addresses of outworkers resident outside the City, employed by City firms, transmitted to other Authorities 249 No case of infectious disease was reported in connection with outworkers' premises in the City. SANITARY CIRCUMSTANCES The general sanitary supervision has been maintained and in this connection 5,671 inspections have been made. As a consequence of these inspections, it was necessary to serve 3 Intimation Notices. Tenement Houses were inspected ana tne only common lodging house in the City was kept under regular supervision. ATMOSPHERIC POLLUTION The measurement of atmospheric pollution has continued during 1966. The volumetric apparatus which was taken out of service at Golden Lane in June 1965 was installed and put into operation in the Public Services Building, Milton Court at the beginning of this year. The past five years figures at Golden Lane are quoted in Tables II and III for comparison with the new station at the Public Services Building which i s situated approximately 200 yards away from Golden Lane. Daily readings are taken at the volumetric stations and the information is collated at the central office in Guildhall where the smoke stains are 'read' on a photo-electric reflectometer and forms are completed and returned to the Ministry of Technology, Warren Spring Laboratory at Stevenage where similar information is received from all over the country. The results of the atmospheric pollution investigations carried out by this department are set out in the following tables:— 12 TABLE I - Deposit Gauge The rainwater collected at Guildhall during the year was more than the average for the past five years. The insoluble deposits were also more than the average for the past five years but showed a decrease of 1.17 tons per square mile as compared with 1965. TABLE II — Smoke concentration by volumetric method. The concentration of smoke recorded during 1966 is once again less than the average for the past five years. TABLE III — Sulphur measurement — by volumetric and lead peroxide methods. The concentration of sulphur in 1966 was approximately the same as the average for the past five years. TABLE 1— Results obtained in 1966 of the monthly observations of rainfall and deposited matter by means of the deposit gauge. [####]MONTH Rainfall collected in deposit gauge at Guildhall DEPOSITS Equivalent to Insoluble Soluble Total Millimetres Inches of rain Tons per square mile January 39 1.52 22.50 12.98 35.49 February 65 2.55 20.26 11.49 31.75 March 10 0.39 46.63 6 08 52.72 April 89 3.51 5.20 13.63 18.83 May 29 1.15 0.65 4 25 4.89 June 51 2.01 26.82 11.42 38.24 July 26 1.04 8.60 10.74 19.34 August 78 3.08 21.62 11.01 32.63 September 3 0.12 14.38 3.53 17.91 October 82 3.22 10.98 10.67 21.65 November – – – – – December 69 2.72 18.66 15.40 34.06 Averages: 1966 49 1.94 17.85 10.11 27.96 1965 54 2.12 19.02 9.96 28.98 1964 44 1.71 15.13 12.49 27.63 1963 41 1.63 12.48 10.07 22.55 1962 40 1.58 14.21 8.49 22.69 1961 44 1.71 15.08 7.80 22.88 1961-1965 45 1.75 15.18 9.76 24.95 13 TABLE II — Results obtained in 1966 of the daily observations of the concentration of SMOKE by the volumetric method MONTH Rainfall collected in deposit gauge at Guildhall Public Services Building Snow Hill Police Station Equivalent to Monthly Average Monthly Average Millimetres Inches of Rain Microgrammes per cu. metre Microgrammes per cu. metre January 29 1.52 59 60 February 65 2.55 117 99 March 10 0.39 66 58 April 89 3.51 57 48 May 29 1.15 35 33 June 51 2.01 34 35 July 26 1.04 29 28 August 78 3.08 34 31 September 3 0.12 60 50 October 82 3.22 66 64 November – – 83 88 December 69 2.72 79 75 Averages: 1966 49 1.94 59 56 (Golden Lane) 1965 54 2.12 70 64 1964 44 1.71 88 77 1963 41 1.63 100 87 1962 40 1.58 84 77 1961 44 1.71 90 80 1961-1965 45 1.75 86 77 TABLE III— Results obtained in 1966 of the measurement of SULPHUR DIOXIDE by the volumetric and lead peroxide methods MONTH Rainfall collected in deposit gauge at Guildhall Public Services Building Snow Hill Police Station LEAD PEROXIDE METHOD Equivalent to Monthly Average Finsbury Circus Millimetres Inches of Rain Microgrammes per cu. metre Mgs (SO3) per day per 100 sq.cm. January 39 1.52 360 505 3.27 February 65 2.55 533 561 2.74 March 10 0.39 359 442 2.39 April 89 3.51 326 366 1.72 May 29 1.15 170 189 1.11 June 51 2.01 152 159 0.94 July 26 1.04 122 126 0.67 August 78 3.08 181 136 0.85 September 3 0.12 213 227 0.76 October 82 3.22 252 289 1.41 November – – 361 449 2.47 December 69 2.72 384 482 2.25 Averages 1966 49 1.94 284 328 1.72 (Golden Lane) 1965 54 2.12 286 341 2.06 1964 44 1.71 316 383 2.27 1963 41 1.63 300 345 2.29 1962 40 1.58 284 340 2.15 1961 44 1.71 257 286 2.10 1961 -1965 45 1.75 289 339 2.15 14 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 may be practicable that its district is kept free from rats and mice and in particular:— (a) from time to time carry out such inspections as may be necessary for the purpose aforesaid. (b) to destroy rats and mice on land of which it is the occupier and otherwise to keep such land free from rats and mice. (c) to enforce the duties of owners and occupiers of land under Part I of this Act and to carry out such operations as are authorised by these provisions. (d) to keep such records and make such reports as may be required by any directions given by the Minister of Agriculture, Fisheries and Food. Compliance with the requirements of the Act comprised inspection of properties to ascertain the presence of rats and/or mice, treatment where necessary, recommendation of preventive measures such as structural and incidental proofing, and three-monthly treatments for the destruction of rats in the City sewers. A total of 2,641 properties were inspected ranging from comprehensive re-development sites in the course of construction, multi-occupied blocks of offices, riverside wharves and warehouses, public and private catering establishments, shops and factories to domestic dwellings. Although 559 complaints were received either by notification or as a result of inspection, and of this number 510 infestations were subject to control measures. In 49 instances no action other than advice was necessary. The total of 510 infestations requiring remedial measures comprised 5 major and 53 minor infestations of rats, and 5 major and 447 minor infestations of mice. Of the rat infestations 5 major (21-200) and 52 minor (1-20) were of common rat (Rattus Norvegicus) nature, and the remainder, 1 minor infestation, came under the Ship (Black) rat or Rattus Rattus classification. The rat infestations were mainly on building sites and those in the major category (21-200) were of sufficient numerical density as to be excluded from the minor scale (1-20) although low in the former scale. Treatment of these infestations entailed 4,669 visits for operational purposes, and in the application of control measures 10,829 initial baiting sites were selected for both rats and mice. For the control of rats 3,393 pre-baits were laid which necessitated the use of 466 poison baits to finalise the treatments. These measures resulted in a minimum estimated kill of 529 rats and of this number 246 bodies were recovered and removed from the sites of the operations. Others not included in this figure were found on elimination of structural or removal of incidental harbourage providing nesting and breeding facilities. Treatment of mice infestations entailed the application of 8,015 anti-coagulant poison baits and 688 bodies were recovered. In 13 instances structural rat proofing was carried out by owners or occupiers and in 8 cases defective drainage resulting in infestation of surface properties was remedied. Incidental rat and mouse proofing in the nature of removal of harbourage provided by unnecessary and undisturbed accumulations or restowing of badly stacked commodities has again received unremitting attention. Periodical treatment at 3 monthly intervals for the control of common rats in sewers is of primary importance in relation to the control of this species in surface properties. It is the purpose of these measures to ensure that the rat population of the sewers is kept down to the lowest possible level, thereby preventing infestation of surface properties via defective drainage. During the period under review, four direct poison treatments with Fluoracetamide ("1081") were applied in March, June, September and December, and an average of 385 sewer manholes distributed over 34 miles of traversable sewers were direct poison baited on each occasion, except in June. In this instance the annual overall test baiting which provides an indication of the results of the previous direct poison controls was applied prior to poison baiting and a total of 381 manholes were non-poison test baited, the test baits being left down for two days. These baits, which in effect act as pre-baits were then examined and where taken replaced by poison baits. 15 The overall result was 8.1% complete "takes" and the comparable result of the five previous years was 17.6%, 11.6%, 8.9%, 6.7% and 7.5% respectively. Taking into account the varying weather conditions at the time of these tests and the thirteen week interval from the 3rd poison control, the test result was again satisfactory. The combination of the "Direct" poison method and '1080' or '1081', applied for the first time in this country in the City sewers in 1951, has been standard practice for several years and this technique has since been adopted by an increasing number of Authorities throughout the country and commercial Pest Control firms offering their services. To summarize, the diminished status of rat infestation in the City achieved in recent years has been maintained particularly with regard to Ship (black) rat which until a few years past was the dominant infestation. PIGEON NUISANCE In accordance with Part 3, Section 121, Public Health Act, 1936 and Section 10 (1) D Protection of Birds Act, 1954, action was taken from time to time during the year in an endeavour to keep the pigeon population of the City within reasonable limits and a firm of specialists in this work, licenced by the Ministry of Agriculture, Fisheries and Food under the latter Act to use narcotics, is employed under contract by the Corporation to carry this out at sites after prior inspection and official written approval. During the year 2,940 pigeons were removed from various sites as compared with 4,300 in 1965. Several complaints were received during the year of excessive congregations centred mainly around the older properties such as churches, and also of damage to plants in the increasing number of open spaces and gardens provided for the public use and pleasure by the Corporation. It is the general opinion that the number of pigeons throughout London is increasing but observation of this problem in the City tends to show that whereas, before redevelopment, roosting facilities were available over the entire area, these are no longer available on the modern structures, thus creating concentrations of excessive numbers on and around the old types of properties. Extermination measures alone, however, will not solve this problem. On the contrary, reduction of congregations tends to assist the residual breeding potential by solving overcrowded roosting facilities and making available the food supply which previously catered for larger numbers, thus eliminating competition. Of the dual problem of housing and feeding, the latter is by far the most important, as the survival and multiplication of large congregations is relative to the food supply. It is a common sight to see well intentioned members of the public feeding large quantities of scraps to the birds particularly in laid out gardens despite the notices displayed requesting them to refrain from doing so. This is also prevelant among office staffs attracting and feeding pigeons on window ledges, and in both cases polite remonstrance has on occasions been met with mild abuse. It is the policy of the City Corporation to endeavour to control the numbers of pigeons to such proportions as will ensure that the pleasure they afford to some members of the public is not outweighed by the nuisance and damage they cause generally. It will be realised, therefore, that the pigeon problem cannot be really satisfactorily dealt with without the intelligent co-operation of the general public. In short the answer to the problem is in the hands of the public and Parliament. CITY MORTUARY Bodies received 207 Post Mortem Examinations made 207 Inquests on bodies 39 Inquests held at Holloway Prison NIL Inquests on fires NIL Inquests on Treasure Trove 1 16 DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, etc. Articles, by weight 24 tons. 11 cwt. No. of articles disinfected 453,499 Cases of horsehair 165 Fees received £2,040 General Disinfection, Infectious Diseases, etc. Premises disinfected after cases of infectious disease NIL Lockers at Post Offices disinfected 25 Verminous premises disinfected 8 Beds and bedding disinfected 72 Cells 17 Cleansing of Persons:— No. of verminous persons bathed 908 No. of scabious persons bathed 2 No. of articles disinfected 9,110 TREASURE TROVE In February, 1966, a group of volunteers excavating a rubbish pit on the site of the Dyers Arms found a Henry IV Gold Noble. The coin, measuring 1. 7/16" and weighing 119.3 grains, was struck between the years of 1399 - 1412 It is valued at £2,000. An Inquest ruled that the coin was not Treasure Trove and therefore belonged to the owners of the site, Messrs. Charringtons, who have presented it to the Guildhall Museum. OBSERVATIONS ON CATERING ESTABLISHMENTS IN THE CITY During the year under review two Public Health Inspectors have continued to devote most of their time to the control of restaurants, public houses, staff canteens, licensed clubs and other catering establishments, but it has again been a year of disappointment. Few major schemes of improvement and reconstruction have been initiated and caterers generally have been unwilling to undertake other than essential works of repair, maintenance and re-decoration. It has been found that hygienic standards in City restaurants tend to rise or fall roughly in the same ratio as the variation in the prosperity of the industry. At the present time the catering trade is passing through a very difficult period; business is static, costs are continually rising and there has recently been the additional burden of the Selective Employment Tax. Many catering businesses have ceased to show even a minimum return for the capital and effort put into them and it is not surprising, therefore, that in many cases the standards of hygiene and cleanliness have not been maintained. Legal proceedings were instituted in one instance only, when fines totalling £80. 0s. 0d. were imposed. Conditions may have justified legal action in other cases but hitherto the policy has been to draw the attention of caterers to unsatisfactory conditions as and when they are found as the result of continuous routine inspections and to give restaurant proprietors an opportunity of rectifying such conditions. It would seem, however, that if unsatisfactory conditions cannot be remedied by the present methods a more rigorous approach may have to be adopted to emphasize and impress upon the more dilatory caterers that it is a specific and definite contravention of the Food Hygiene Regulations to conduct a restaurant in dirty premises. At the present time many caterers seem to think that an offence has not been committed until they fail to comply with a notice from this Department. Apart from economic considerations, staff shortages and particularly the difficulty of recruiting interested and competent staff, continue to present caterers with an apparently insoluble problem. There have, however, been cases where because of financial difficulties caterers have been operating deliberately without a full complement of staff and in such instances it has been found that essential daily cleaning is often neglected. Much time and energy has been devoted to the consideration of all proposed new catering units and every effort has been made to ensure that each new restaurant established in the City complies with minimum standards. It must be realised, of course, that there is no compulsion on any caterer to accept the advice of officers of this Department and in the absence of any statutory enactment giving local authorities the power of "prior approval", a local authority's ability to prevent the establishment of new catering businesses in premises which are basically unsuitable or unsatisfactory is very limited. Difficulty has been experienced in several instances of new catering units being put into commission in badly designed or badly constructed premises 17 and in premises which are too small to provide for all the necessary ancilliary services such as adequate food storage and staff amenities. Experience has shown that once a restaurant becomes established it is extremely difficult to remedy deficiencies of planning and design. It is of interest to note that in the case of the legal proceedings mentioned earlier this was one of the premises where strenuous efforts were made to deter the proprietor from trying to establish a business under such adverse conditions. Even the minimum standards he achieved in the beginning could not be maintained and the legal proceedings were the inevitable result. Continuous attention has been paid to the provisions of the Offices, Shops and Railway Premises Act, 1963 and a special effort has been made to improve necessary staff amenities such as sanitary accommodation, washing facilities and changing rooms. The predominant function of most City restaurants is to provide cheap meals for vast numbers of City workers but during the year an additional top grade restaurant has opened and another is approaching completion. In this latest venture it is intended to open in the evening as well as at lunch time and entertainment, music and dancing will be provided. Application has been made for a late night licence which would enable this restaurant to remain open until 2.30 a.m. Recently preliminary discussions have taken place regarding yet another similar development in one of the new large office blocks so it would seem that soon, the City in the evening, as well as at lunch time, will be able to offer facilities comparable with the best in the West End. CATERING ESTABLISHMENTS Before establishing a catering business, application is made for planning approval and applications are referred by the City Architect to the Medical Officer of Health, with a view to advising the developers on whether the premises will be suitable from a public health aspect. Although this is purely an advisory service, it is useful to both caterers and the Health Department, in that future difficulties can be avoided by co-operative effort. During the year, fifty-two intending caterers obtained the advice of this Department before deciding to proceed with their ventures. FOOD AND DRUGS ACT, 1955 Samples purchased by the Sampling Officer during the year constituted a representative cross section of all articles of food in regular use. Of the 356 samples purchased, only 4 or 1.1% were the subject of an adverse report by the Public Analyst. Particular attention was paid to the purchase of made-up foods such as minced fresh meat, pies of all description, sausages and other meat products. Samples of these particular commodities were purchased on Monday mornings as most of the retail food premises in the City are closed on Saturday morning and it was felt that by purchasing these types of food at the beginning of the week, an examination by the Public Analyst would indicate whether or not stocks were in a fresh condition. A sample of Scotch Egg was adversely reported on by the Public Analyst, his report indicating that the commodity had a sour, stale smell and was unpalatable, but generally it was found that perishable foods offered for sale at the beginning of the week were fresh and in good condition. Of formal samples of hot milk purchased from restaurants in the City area, two were reported on adversely by the Public Analyst, his report indicating the presence of added water. On investigation it was found that in both cases the milk in question had been heated by steam injection. On being informed of the Analyst's adverse report, one restaurant proprietor ceased selling hot milk and the other agreed not to use the steam injector but to heat the milk in a pan over a gas ring. All the remaining formal samples of milk were satisfactory. There were several minor infringements of the Labelling of Food Order but these irregularities were resolved after consultation with the firms concerned. As usual, a number of complaints were investigated from members of the public regarding various articles of food purchased from retail shops or restaurants within the City. One such complaint referred to sausage rolls which were bought at a City restaurant and found to be mouldy. Legal proceedings were instituted against the catering firm but because of their excellent record they were given an absolute discharge and merely ordered to pay £10.10s.0d. costs. 18 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY Article Informal or Formal Sample Nature of adulteration or irregularity Action * Chocolate Regent Cake Informal The cake was stale and contained a large growth of mould in the chocolate icing. A thorough investigation of this matter indicated that there had been inefficient stock rotation. Following representations by this Department the manufacturers, who were also the retailers, reduced the recommended shelf life of a number of their commodities. * Crumpets Informal Mouldy and unfit for consumption. An investigation indicated that inefficient stock rotation was the cause of this commodity having been sold. Appropriate representations to the retailer concerned were made. Evaporated Fruit Salad Informal Contained sulphur dioxide, 470 parts per million. the presence of which was not disclosed in the statement of ingredients on the label. The Retailer has withdrawn this product until new labels are printed. * Foreign body from Sausage Informal The specimen consisted of a rusted and damaged piece of iron which in shape and chemical composition matched one end of a pig's nose ring submitted separately. Investigations in the factory failed to reveal any neglect on the part of the manufacturers. It was decided therefore not to take any further action. * Foreien matter from Pork Sausage Informal The specimen consisted of a small piece of iron coated with dried meat and cereal. Appropriate representations were made to the manufacturers of the sausages. It was not possible to institute legal proceedings as the complainant did not wish to give evidence on behalf of the City Corporation. * Foreign matter from Carton of Hot Chocolate Informal The specimen consisted of the dried up dregs of a chocolate drink, and included several particles of a coarse brown sediment comprising jute fibres matted together with cocoa powder. In this case the complainant was of the opinion that the chocolate drink had been served in a dirty carton. As the report of the Public Analyst confirmed that the caterer was not in default, further action was not necessary. Fruit Salad Canned Informal The proportions of component fruits did not conform with the statements of the ingredients on the label nor with the standard specified in the code of practice for canned fruit and vegetables. Explanation received that a mistake by a packer caused extra pieces of apricot to be added instead of peaches. Further action was not therefore considered necessary. Guava Shells in Heavy Syrup, Canned Informal Inadequately labelled. The label claimed a high Vitamin C content but did not include quantitive particulars as required by the Labelling of Food Order. 1953. The wholesaler concerned was requested to arrange for the label to be amended. Hot Milk Formal Contained Fat—3.50% Solids-notFat —8.32% corresponding to the presence of 2% added water This sample was obtained from a City Restaurant. Written representations were made to the caterer concerned. A subsequent sample proved to be satisfactory. Hot Milk Formal Contained Fat—3.19%. Solids-notFat —7.61% corresponding to the presence of 10% of added water. This sample was obtained from a City Restaurant. Written representations were made to the caterer concerned. An investigation indicated that the milk was being heated by means of steam injection The sale of hot milk from these premises has now been discontinued as suitable arrangements are not available for the heating of milk. Cold Milk Formal Contained fat —2.68%. Solids-notfat—8.80% corresponding to the abstraction of 10 per cent of the fat. A letter was sent to the firm concerned drawing their attention to the Public Analyst's adverse report. Further samples which were drawn and submitted to the Public Analyst for examination proved satisfactory. 19 Article. Informal or Formal Sample Nature of adulteration or irregularity Action * Piece of Toast with fragment of glass Informal Consisted of part of a slice of toast, together with a mass of masticated material containing visible fragments of glass. These fragments consisted of annealed non-splintering optical glass. The piece of toast was also found to contain a few fragments of glass of similar character. Appropriate representations were made to the caterer concerned. It was not possible to institute legal proceedings as the complainant did not wish to give evidence on behalf of the City Corporation. Potted Veal. Ham and Tongue Galantine with Pistachio Informal Contained wheat flour, 10 per cent, the presence of which was not disclosed in the statement of ingredients on the label. The attention of the firm concerned was drawn to the Public Analyst's report and a new label was subsequently produced which satisfied the requirements of the Labelling of Food Order, 1953. Prawn and Scallop Newburg Informal The ingredients included a packet of rice which was found to be coated with talc and hydrolised starch The presence of the latter ingredients was not disclosed and the labelling of the product did not appear to comply with the requirements of the Labelling of Food Order, 1953. Appropriate representations were made to the packers of this commodity. * Sausage Roll Informal The filling of the sausage roll bore several small dark green patches containing mould and bacteria and was unfit for human consumption. This was one of two sausage rolls purchased on the same day from a retail shop in the City. Legal proceedings under section 2 of the the Food & Drugs Act 1955 were instituted against the retailer as the trouble appeared to have been caused by inefficient stock rotation. The defendants pleaded guilty, but because of their excellent record were given an absolute discharge and ordered to pay £ 10.10s. 0d. costs. Savoidelice Pate Informal Consisted of a whole round cheese covered with a thick coating of grape seeds and wax. the inedible coating amounting to 30 per cent of the whole sample. The edible part contained 22 per cent fat. The Article was pre-packed but did not bear an English name or statement of ingredients on the label. The following claim on the label might be misleading—"45% de Matieres grasses" The attention of the importer of this commodity was drawn to the observations of the Public Analyst together with a request that the label be amended. Scotch Eggs Informal The Scotch eggs had a sour stale smell when received and were unpalatable. An investigation indicated inefficient stock rotation. Appropriate representations were made to the retailer concerned. Smoked Cod Roe Informal Contained salt 3.3 per cent the presence of which was not disclosed on the label. The suppliers of this product have been requested to state the presence of salt in the commodity when they print new labels. Streaky Bacon Informal The sample was pre-packed but the label did not include the appropriate designation of each of the ingredients. When asked for his opinion on a similar case last year, the Comptroller and City Solicitor stated that he would not be prepared to advise the Corporation to take any action under the Labelling of Food Order 1953. In view of this, no further action was taken. * These samples were examined as a result of complaint by members of the Public. 20 FOOD AND DRUGS ACT 1955, AND FOOD REGULATIONS Samples purchased and submitted for Analysis. Article Informal Formal Article Informal Formal Bacon 1 Lard 1 Beetroot (Jar) 1 Lemon Pie Filling 1 Biscuits 14 Liver Sausage 1 Black Pudding 1 Margarine 1 Blancmange Powder 1 Meat & Meat Products 69 Brandy 1 Milk 36 Brawn 2 Milk, Canned 1 Bread 7 Mincemeat 1 Brown Ale 1 Mussels 1 Butter 6 Mustard 1 Cakes & Pastries 22 Nutmeat 1 Cereal 1 Nutmeg, whole 1 Cheese 5 Parmesan, Cheese, canned 1 Cheese Spread 2 Pastes: Liver Pate 1 Chicken Croquettes 3 Pate Truffe 3 Chicken Fritters 1 Meat 1 Christmas Plum Pudding 1 Pastry 2 Cocktail Sausages in Brine 1 Peanut Butter 1 Coffee 1 Pepsi Cola 1 Coffee Concentrate 1 Prawn and Scallop 2 Coffee Instant 4 Rice 1 Condiments 1 Rolls & Sandwiches 6 Confectionery 15 Rum 4 Cornflour 2 Salami 2 Cream Cheese 1 Sandwich Spread 1 Cream, Dairy 2 Sauces 5 Cream, Tinned 1 Sausages 7 Custard Powder 1 Sausage Meat 2 Curry Powder 1 Sausage Rolls 6 Drinking Chocolate 3 Scotch Eggs 2 Drinks, Fruit 2 Smoked Cod Roe 1 Fat, pure 1 Soups 3 Fish Cakes 1 Spaghetti Bolognese 1 Fish, Potted 1 Spanish Rose 1 Fish, Canned 5 Sponge Mix 1 Flan Case 1 Starch Reduced Bread • Flour 1 and Rolls 2 Frankfurters 3 Stout 1 Fruite Fort 1 Suet Pudding Mix 2 Fruit Pie 2 Strained Foods 3 Fruit, Dried 4 Tea 9 Fruit, Fresh 2 Tomato Juice 1 Fruit, Canned 10 Tuna Steak 1 Gelatine 1 Whisky 4 Gin 4 Veal Croquettes 1 Ground Ginger 1 Vegetables, canned 4 Honey 5 Vodka 2 Instant Whip 1 Yoghurt 4 Jam 1 Jelly 1 TOTALS 305 51 Other samples submitted for \nalysis. Albumen 7 Mushrooms 1 Bar Toffee Crisp 1 Peppers 2 Candied Peel 1 Pork Sausage 1 Canned Bacon Rinds 1 Rice 1 Canned Bread Fruit 1 Sandwiches 1 Canned Fish 5 Sauce 1 Canned Fruit 12 Sausage Roll 1 Canned Fruit Juice 4 Sausage 1 Canned Meat 14 Shelled Almonds 1 Canned Oysters 1 Smoked Oysters 2 Canned Tomatoes 4 Steak & Kidney Pie 1 Canned Vegetables 7 Tea 1,381 Chocolate Cake 1 Toast 1 Coffee Cup 1 Water, Drinking 14 Crumpets 1 Water, Swimming Bath 1 Fertilizers 1 Water, Gutter 1 Fruit, dried 19 Ground Roasted Coffee 1 Hot Chocolate 1 Meat Extract 1 TOTAL 1,495 21 BACTERIOLOGICAL EXAMINATIONS Albumen, Granular or Flake 33 Albumen, Powdered 43 Canned Whole Oysters 1 Cheese 1 Chicken, Leg 1 Cottage Pie 1 Faeces 18 Liver Sausage 1 Meat 6 Mushrooms 1 Pancakes 1 Preserved Duck Eggs 10 Sandwiches 3 Soup 1 Stock Pot 1 Water (including 20 from Swimming Baths) 187 Whole Egg Powder 1 Total 310 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. The following table shows the types of business carried on:- Nature of Business for which registered Sale and storage of pre-packed ice cream 76 Manufacture, sale and storage of ice cream 3 Selecting and sorting of sausage casings 8 Preparation and cooking of jellied eels and shellfish 14 Cooking of Hams 1 Manufacture of sausages, dripping and cooked meats and brining of meat 32 Manufacture of pies 1 Sale of cooked meats 3 Total 138 This has required the registration of 126 premises. 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. 67 firms were registered under this Act, 59 of which were re-registrations. 1 infringement was noted.. 98 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 advertisements or by labels on medicine bottles. 38 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. 32 inspections were made. No contraventions were noted. 22 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. AGRICULTURE 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. FISH INSPECTION Inspection of fish in the City of London is carried out by officers of the Worshipful the Fishmongers' Company. The Fishmeters returns indicated as follows:- Deliveries at or near Billingsgate Market Weight of Condemnation (including shellfish) Fish condemned Rate 80,101 tons 272 tons 0.33% MEAT AND FOOD INSPECTION-SMITHFIELDS MARKET During the year 338,768 tons of meat and poultry etc. were delivered into Smithfield Market, a slight decrease compared with 1965. Total condemnations amounted to approximately 544 tons, an increase of 68 tons over 1965. This increase was due, in the main, to 163 tons of beef taken from consignments of South American beef arriving in this country grossly contaminated by bacterial spoilage and mould fungi. The Meat Inspection Regulations, 1963, as amended by the Meat Inspection (Amendment) Regulations, 1966, require that from 31st October, 1966 all carcases of meat be inspected and stamped by the Local Authority before leaving the slaughterhouse. Of the carcases, in Smithfield, found to be diseased from January 1st to October 31st, 1966, 17% did not appear to bear any Local Authority stamp. For November and December, 1966, the period when this regulation came into full effect, this figure dropped to 5%. In 1965, 35% of the stamp marks on diseased items were illegible, but during 1966 this figure dropped to 23%. In accordance with the Circular FSH 9/63, accompanying the 1963 Regulations, Local Authorities continue to be notified of any condemnation of diseased items bearing their legible inspection stamps. In March 1966 the department produced a Handbook of Poultry Inspection, containing twenty four coloured pictures of the most common diseases found in poultry on sale in the market. This handbook, which is being distributed by the Meat Trades Journal on behalf of the Corporation, is having a good sale, copies having gone all over the world. It is the first Handbook of its kind ever to be published. The department has been requested on several occasions to assist student inspectors of the R.S.PiC.A. Visits to the condemned meat room and laboratory have been most helpful to them and the Society is most grateful for this assistance. In March, Mr. F.E. Thompson, M.B.E. was invited to give a talk on meat and poultry diseases and conditions to the Society of Medical Officers of Health, East Midlands Branch at Nottingham. In July, Messrs. W.R. Lee and K.S. Seymour were invited to give a lecture on poultry diseases to the Surrey Branch of the Association of Public Health Inspectors at Reigate 50 Inspectors attended. 23 24 Table showing the amount of meat surrendered to or seized by Meat Inspectors in the City of London for DISEASED Condition, 1966 Country January February March April May June July August September October November December TOTAL 1966 TOTAL 1965 lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs Argentine 120 399 180 12 116 27 77 87 50 120 96 1,284 1,704 Australia 6 6 106 Eire 126 105 57 52 67 218 15 80 415 16 1,151 6,017 Great Britain 10,374 13,116 12,406 12,474 8,836 12,240 9,716 13,286 13,697 10,357 17,122 8,910 142,534 130,983 Holland 89 New Zealand 6 9 52 32 4 103 216 Poland 40 40 Rhodesia 758 S. Africa 10 10 25 Sweden 15 20 210 16 261 114 Uruguay 48 23 123 194 Yugoslavia 8 30 36 74 110 1966 10,641 13,688 12,676 12,788 9,035 12,254 10,114 13,387 13,916 10,475 17,661 9,022 145,657 - 1965 10,738 12,614 15,900 8,406 8,785 10,458 11,543 10,202 13,346 10,469 10,406 17,255 - 140,122 25 Table showing the amount of meat surrendered to or seized by Meat Inspectors in the City of London for UNSOUND condition, 1966 Country January February March April May June July August September October November December TOTAL 1966 TOTAL 1965 lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs Argentine 13 679 29 716 21 037 29,300 11,656 4,975 9 861 5,311 10,548 96,694 38,126 64,083 334,986 182,927 Australia 75 311 202 67 463 20 63 209 478 69 1,957 12,297 Bechuanaland 58 58 240 Belgium 10 10 Brazil 1,142 4,881 5 6,028 22 Canada 292 Denmark 22 23 30 1,488 46 16 19 1,644 152 Eire 798 752 808 841 91 360 3,669 2,424 2,732 527 234 305 13,541 10,866 Finland 22 22 France 32 Great Britain 17,443 13,361 8,774 17,124 11,000 42,769 21,304 38,940 32,624 16,925 8,664 11,667 240,595 182,739 Holland 788 7 795 2,694 Hungary 12 12 54 New Zealand 620 3,717 71 1,413 263 512 36 22,152 3,640 5,195 1,581 22 39,222 66,913 Poland 148 18 31 162 805 1,212 793 20 461 165 3,815 15,676 Rhodesia 14 14 1,782 S. Africa 4 18 822 379 16 1,239 Swaziland 94 94 Sweden 40 1,090 18 1,148 136 Uruguay 100 10,100 6,869 1,178 3,436 640 97 1,185 845 319 24,769 12,119 Various 1,120 448 1,568 340 Yugoslavia 127 912 2,867 16,532 19,110 49,323 5,376 1,928 52 96,227 111,389 1966 32,877 58,894 37,832 50,835 31,759 71,173 56,897 122,107 57,494 121,927 49,619 76,330 767,744 - 1965 25,087 28,299 41,162 55,577 48,559 101,206 66,539 55,086 69,646 46,478 27,906 35,125 - 600,670 26 Table showing the amount of various food products (excluding meat) surrendered to or seized by Meat Inspectors in the City of London for UNSOUND Condition 1966 Commodity January lbs February lbs March lbs April lbs May lbs June lbs July lbs August lbs September lbs October lbs November lbs December lbs TOTAL 1966 lbs TOTAL 1965 lbs Tinned Meat 1,277 1,112 481 348 237 1,875 2,181 2,086 1,134 1,350 351 229 12,661 18,257 Other Tinned Goods 725 791 1,061 417 861 2,819 1,045 734 801 1,618 586 106 11,564 15,847 Poultry and Feathered Game 10,533 10,776 8,744 8,284 10,554 18,662 8,582 14,961 10,167 12,442 5,624 15,138 134,467 151,447 Rabbits and Hares 349 417 526 154 472 392 124 338 574 313 172 639 4,470 6,579 Offal 7.720 8,676 6,587 4,336 6,042 13,204 13,674 21,114 24,469 16,391 10,685 9,257 142,155 131,087 Cheese 6 80 86 48 Frozen Foods (Various) 210 350 560 4,245 1966 20,814 21,772 17,749 13,539 18,166 36,958 25,606 39,233 37,225 32,114 17,418 25,369 305,963 — 1965 22,731 18,629 21,324 12,466 24,846 27,119 39,141 31,441 38,952 28,728 23,093 39,089 — 327,559 27 Total number of items stamped and passed by local authorities but condemned for diseased condition on arrival at Smithfield Market. Total number of items NOT STAMPED by local authorities but condemned for diseased condition on arrival at Smithfield Market. Number of items (included in the above table) on which local authority stamp was illegible. MEAT INSPECTION REGULATIONS, 1963 (MARKING OF MEAT) Beef Mutton Pork Veal Offal Bodies Qrs. Pes. Car. Pes. Car. Pes. Car. Pes. 1 Sheep V. N. V. N. V. N. V. N. V. N. V. N. V. N. V. N. V. N. V. N. 4 2 5 1 226 1 7 4 221 47 467 1193 114 6 2 3 3 2 3 70 6 3 50 3 82 93 11 1 3 7 2 2 8 1 296 1 13 7 271 50 549 1286 125 6 2 1 6* 2 2 3 1 154 3 42 7 97 421 71 4 1 * Part of six consignments Key to Headings:— Qrs. = Quarters Pes. = Pieces Car. = Carcases V. = Visible (i.e. Diseased condition could have been detected visually at time of slaughter). N. = Not visible (i.e. Diseased condition could not have been detected until meat was cut into smaller portions). United Kingdom Meat pitched at Smithfield Market: United Kingdom Meat condemned for diseased conditions at Smithfield Market: 1965 130,432 tons 61 tons 17 cwts. 0 qrs. 18 lbs. = 0.05% 1966 135,003 tons 64 tons 0 cwts.O qrs. 7 lbs. = 0.05% MEAT INSPECTION Tons Cwts Qrs. Lbs Meat etc., delivered at Smithfield Market 338,768 0 0 0 Meat etc., surrendered to Inspectors at Smithfield Market 534 15 3 8 Meat etc., surrendered to Inspectors at Leadenhall Market & City Shops 4 16 3 18 Meat etc., surrendered to Inspectors at Cold Stores 4 14 1 22 Number of Exportation Certificates issued 38 Number of demonstrations and lectures given 133 Number of attendances by students 1,454 Number of samples taken for Medical Research 17 Number of samples taken for Ophthalmic Research 24 Number of samples taken for Government Chemist investigation (pesticides) 66 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 254 tons, 11 cwts, 0 qrs., 13 lbs., which was disposed of as follows:— Tons Cwts Qrs Lbs Destroyed 236 9 1 18 Disposed of to Contractors 5 8 1 18 Released for Manufacture 5 0 0 4 Released for Fertiliser Manufacture 4 0 2 10 Re-exported 3 12 2 19 21 tons, 7 cwts, 1 qr. 7 lbs., of food were placed under stop and subsequently dealt with under supervision of other local authorities. FOOD HYGIENE (General) REGULATIONS, I960 and 1962. The stalls in Smithfield Market still maintain a good standard of cleanliness. Seven warning letters were sent for contraventions of the regulations during the year and the defects were remedied. The carrier company vans have been maintained to a good standard of cleanliness throughout the year and any suggested improvements received immediate attention. On 1st November, 1966, British Railways introduced their new Freightliner Service from Aberdeen to London. These insulated containers are refrigerated by dry ice from roof bunkers. The meat has arrived at Smithfield Market in very good condition and no complaints have been received. The old containers still in use need constant supervision to ensure that they are clean as there are still cases of dirty sides of beef (Albuminium Rub) arriving in these containers. The general standard of cleanliness of private butchers' vans is good, but sixty-five warning letters have been sent for dirty vehicles and private cars. In January a new floor was opened at the Fish and Vegetable Market. This floor incorporates a truck cleansing machine enabling trucks in the Market to be cleansed regularly and efficiently and space is provided for the trucks so that they can be stored under cover. During the year only two warning letters were sent regarding dirty trucks. Facilities are also provided on this floor for the self-employed Porters. These facilities include shower-baths, washing facilities, electric points for razors and changing rooms with heated lockers. During the year 463 infringements were noted and suitable warnings were given including 252 in writing as listed below. Infringements Warning Letters Prosecutions 86 in connection with clothing 72 — 38 in connection with containers 32 — 33 in connection with head covering 31 1 (a) 37 in connection with meat contami nation 18 — 128 in connection with premises and equipment 7 — 25 were incidents of smoking whilst handling food 25 — 28 regarding trucks 2 — 87 regarding vans and cars 65 1 (b) 1 in respect of a wound dressing — — (a) Defendant fined £5 and ordered to pay 2 gns, costs. (b) Defendant fined £100 and ordered to pay 5 gns. costs. 28 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 357 stalls on the Market occupied by approximately 110 tenants. DISEASES OF ANIMALS ACT, 1963 AND ASSOCIATED ACTS Mr. G.S. Wiggins, M.R.C.V.S., Veterinary Officer for the City of London, has submitted the following report:— "With the administration of the Diseases of Animals Act in regard to the importation of animals the responsibility of the Corporation for the whole of Greater London under the terms of the London Government Act 1963 and the fact that the Corporation has acted for a number of London Boroughs for the remainder of the functions of the Diseases of Animals Act on an Agency basis, the first full year of working has been one of "feeling the way". From the 1st December the Borough of Bromley (a Borough of some 61 square miles) joined the Corporation agency scheme and with the Boroughs already in the scheme, make a total of 16 Boroughs for whom the Corporation is acting on an agency basis. Apart from your Veterinary Officer, the staff has comprised two Diseases of Animals Act Inspectors, two clerical Officers plus Mr. J.A. Morris, M.R,C.V.S. as part time Veterinary Officer. The following is a resume of the work carried out during the year: — Some 2,360 routine visits have been made to various premises which include Riding Establishments, Animal Boarding Establishments, Pet Animals Shops, Theatres. Kosher Butchers, Poulterers, Abattoirs, Farms, Piggeries, Street Markets etc. and action taken as found necessary under the various Acts and Orders. Riding Establishments Act 1964 Under the provisions of this Act visits of inspection have been made to 35 riding establishments with a view to suitability for licencing and reports submitted to the appropriate London Boroughs. Animal Boarding Establishments Act 1963 Thirteen animal boarding establishments have been visited regularly on behalf of four London Boroughs, whilst in accordance with the terms of individual agency agreements other Boroughs only require the services of the Corporation Veterinary Officer under this Act in a consultative or advisory capacity. Pet Animals Act 1951 The position here is similar to the Animal Boarding Establishments Act, routine visits only being carried out on behalf of the London Boroughs of Tower Hamlets (which includes Club Row, the popular Sunday morning market), Wandsworth and Sutton. Performing Animals (Regulations) Act 1925 Seventeen certificates of registration were issued to applicants having performing animals in their productions. This included theatres, circuses etc. Live Poultry (Restrictions) Order 1957 To enable the holding of live poultry shows and to conform to the terms of the above Order, seven licences were issued on behalf of the Boroughs of Barking, Tower Hamlets, Sutton and Hammersmith. Animals (Sea Transport) Order 1930 In connection with the exportation of animals visits were made to docks within the area of Tower Hamlets, for whom the Corporation act, to ensure that the terms of the above Order were complied with. The animals comprised Hereford and Jersey Cattle and several consignments of pigs being exported for breeding purposes. Diseases of Animals Act — Importations During the year numerous visits were made to London Airport (Heathrow) in connection with the illegal entry of animals into this country. In all 96 notices were served on owners directing them to place their animals into quarantine kennels. Apart from the above a number of irregularities were dealt with in which animals escaped whilst in transhipment, being carried in unsatisfactory containers etc. Incidents also occurred of dogs escaping whilst in transit at two of London's main line termini. 29 A number of animals were found to be dead on arrival at the airport and post-mortem examinations were carried out on a number of coypu, a Baboon, Manatee, Greyhound, Rhesus Monkeys, Chinchillas and a Himalayan Bear on behalf of the airlines involved. Importation of Dogs and Cats Order 1928 Several instances-occurred of offences against the terms of the above Order. In March the Master of the s.s. "Dunedin Star" illegally brought into this country a cat which he stated had wandered onto his vessel at a port in New South Wales. As the offence was committed at the Port of Liverpool, where the vessel first docked, proceedings were instituted against the Master in that City. The defendant was proved guilty and conditionally discharged for twelve months. In May an alsatian dog was reported missing from the Danish vessel "Iberian" when it berthed at the London Dock. After intensive enquiries the dog was later found in the Battersea Dogs Home. In this instance, on the advice of Mr. Comptroller and City Solicitor warning letters were addressed both to the Master and the Shipping Agents concerned. A report was received from the Port of London Authority Police in July that a dog had escaped from the m.v. "Octavia", a Swedish vessel berthed at Millwall Dock. Fortunately the dog returned to the vessel of its own accord the following day. In this case also it was deemed expedient to address a warning letter to the Master of the "Octavia". Rabies Order 1938 An incident occurred in October in which a woman visited quarantine kennels at Mill Hill to see her dog which was being held there. Unfortunately she also took with her into the kennels a miniature poodle. Form "A" was served on this person to ensure the detention and isolation of the poodle pending further enquiries being made, in accordance with Article 2 of the above Order. Issue of Export Certificates Requests were made from time to time for health certificates to enable firms to export all kinds of meat products, game etc. and during the period under review 92 such certificates were issued in respect of wood pigeons, hares, pheasants, partridges, guinea fowl, turkeys, grouse, wild geese, ox tongues, steakburgers, sirloins of beef, smoked salmon, fox and lambskins and hatters' fur. A total revenue of £351. 8s. 5d. was received for this service. It can be fairly said, I think, that 1966 was a promising and successful year and, augurs well for the future with the possibility of more London Boroughs joining the scheme". PERSONAL HEALTH AND WELFARE SERVICES IN THE CITY (figures in brackets are for period 1965) NOTIFICATION OF BIRTHS PUBLIC HEALTH ACT, 1936 and PUBLIC HEALTH (Notification of Births) ACT, 1965 Total number of births occitf-ing in the City was 973 (684) From records the notifications of births to women whose home address indicated that they were resident or said to be resident in the City at the time of birth were as follows:- Domiciliary Hospitals & Nursing Homes Total Live births 3 (1) 23 (17) 26 (18) Still births Nil (Nil) 2 (2) 2 (2) NATIONAL HEALTH SERVICE ACT, 1946 Local health authorities, which are County Councils, County Borough Councils, London Borough Councils and the Common Council of the City of London are responsible for services as set out in sections 21 to 29 of the National Health Service Act, 1946. In London the Greater London Council is responsible for the administration of all ambulance services under section 27 of the Act. SECTION 21 - HEALTH CENTRES There are no such Centres in the City of London. SECTION 22 - CARE OF MOTHERS, AND YOUNG CHILDREN Congenital defects apparent at birth (Circular 1/67) continue to be notified on forms issued for the purpose and the arrangement continues whereby a monthly return is sent to the Registrar General giving details of congenital malformations which occur at birth to children resident in the City. During the year one such case occurred — a stillborn anencephalic child. 30 One death of a child under 5 years of age occurred in the City during the year. In such circumstances details of the name and home address are forwarded to the Education Authority. There have been no deaths of expectant or nursing mothers during the period. During the year the Metropolitan District Nursing Association provided a district nursing and domiciliary midwifery service to the City. Child Welfare Clinic The Child Welfare Clinic is held twice weekly at St. Bartholomew's Hospital. The staff consists of a part-time clinic clerk who also issues welfare foods and a health visitor whose work includes health education, mothercraft classes and tests for phenylketonuria and early signs of deafness. The Senior Paediatrician of the hospital, is Clinic Medical Officer. During the year there were 754 (543) attendances at the Clinic and 286 (196) medical examinations were carried out. An 'at risk' register is maintained for children under 5 years of age and at the end of the year there were 4 (2) names on it. Day Nurseries There is no nursery or creche in the City where mothers can leave children under proper supervision. Enquiries were received during the period for places in day nurseries and arrangements were made with a voluntary nursery in an adjacent borough for the children of working mothers to be placed therein. The cost of maintenance was guaranteed by the Corporation. At the end of the year one child was still attending. It is appropriate here to mention the Nurseries and Child Minders Regulations Act, 1948. During the period there were no enquiries for services or registration under this Act and very few are expected. However, advertisements were inserted in appropriate newspapers to draw the attention of persons to the requirements of the Act. Unmarried Mothers and their Children Two cases were referred to the department although Moral Welfare bodies dealt with 28 (17) City worker cases. The Corporation deal with such cases either under the National Health Service Act, 1946 or the National Assistance Act, 1948, whichever is more appropriate to the circumstances. Fire gu ards Where necessary, fireguards were lent to families with children under 12 years of age and also to elderly, handicapped or blind persons. Welfare Foods In addition to those sold at the Child Welfare Clinic held at St. Bartholomew's Hospital, supplies were sold from the Guildhall office during the lunch period. Dental Services - See Dental Officer's report. SECTION 23 - MIDWIVES SERVICE As mentioned previously the Metropolitan District Nursing Association provide these services in the City. Emergency services for night and weekend calls are organised on a rota basis, but by agreement the Whittington Hospital takes all such calls from patients and passes them on to the midwife on duty. Living accommodation for staff is provided where necessary in Corporation property in the City's Golden Lane Estate. The authorities of the Inner and Middle Temples have requested the Corporation to provide midwifery services in their areas and this has been agreed. At the end of the year no Order had been made regulating the provision of services in the Temples. During the period under review the Metropolitan District Nursing Association dealt with 2 (1) domiciliary confinements and 1 (1) early discharge of mother and baby from hospital. Midwives \ct, 1951 The Corporation is the Supervising Authority for the City of London which includes St. Bartholomew's Hospital. 27 (13) midwives notified their intention to practice. 31 SECTION 24 - HEALTH VISITING During the year the health visitors made 190 (190) effective and 59 (65) unsuccessful home visits. Of the 190 effective visits, 26 were primary visits to children under 1 year of age. SECTION 25 - HOME NURSING The home nursing service is undertaken by the Metropolitan District Nursing Association. It is proposed to continue this arrangement. The functions of the home nurse will be not only to carry out treatments as instructed by the General Practitioner but also to instruct the patient and relatives in the best method of nursing and feeding and in general to see that the most efficient methods are employed to make the patient as mobile as possible, and as comfortable as possible and to reduce to a minimum the inevitable loneliness of the home-bound patient living alone. Work during the year was as follows:— (figures cannot be given for previous year as the Association commenced full time in the City only from 1st October, 1965). General Nursing No. of general nursing visits paid 2,668 To persons under five years 10 To persons aged 5 to 64 years 232 To persons over 65 years 2,426 For injections only 360 For other treatments only 2,308 No. of patients 1st January 17 No. of new medical patients 34 No. of new surgical patients 9 No. of early discharges of maternity patients from hospital 1 No. of patients discharged 42 No. of patients 31st December 19 The number of patients being visited at any one time during this period has remainded fairly constant at 20. About 90% of those receiving treatment were over 65 years, mainly suffering from long term illnesses. Only one child under 5 years was visited during the year. A small clinic, attended by one of the district nurse/midwives has been started at the surgery of one general-practitioner partnership with the purpose of giving health education and general nursing advice. This clinic takes place once per month and 41 attendances by patients have been made. 40 domiciliary visits were made during the year to follow up questionnaires and to inform residents of the Local health authority services available. One district nurse/midwife resigned on 30th September. Owing to difficulty in recruiting a suitable full-time member of staff, a !»rt-time district nurse commenced work on 3rd December on a temporary basis. A midwifery refresher course was attended by one of the district nurse/midwifes and a general nursing refresher course by another. The Authorities of the Inner and Middle Temples have requested the Corporation to provide home nursing services within their areas on the same basis as the midwifery service and this has been agreed. SECTION 26 - VACCINATION AND IMMUNISATION The number of children immunised against Diphtheria, whooping cough and Tetanus at the Child Welfare Clinic was as follows:— Year of Birth 1966 1965 1964 1963 1962 1961/59 1958/51 Total No. who had completed primary immunisation at 31.12.66 7 11 3 — — — — 21 No. who had received booster doses at 31.12.66. — — — — 1 9 2 12 32 The number of children similarly immunised at Sir John Cass's Foundation School was as follows:— Year of birth 1961/59 1958/51 Total No. who had completed primary immunisation at 31. 12. 66. 3 2 5 No. who had received booster doses at 31.12.66. 24 43 67 15 (13) children were vaccinated against smallpox as were 143 (33) adult travellers and 52 (250) trainee ambulance drivers of the London Ambulance Service. During the year arrangements were made for a Medical Officer from the Medical Adviser's Department of the Greater London Council to take over the vaccination of their own staff. In accordance with Ministry requirements, poliomyelitis vaccine was supplied to the Medical Department of Unilever Ltd., St. Bartholomew's Hospital, The Church Missionary Society and to medical practitioners within the City who requested it. 25 (16) children received the primary course at the Child Welfare Clinic and 10 children received booster doses. 52 pupils at Sir John Cass's School had the primary course or received booster doses, and in all some 2,580 ( 2,700) doses were distributed. SECTION 27. - AMBULANCE SERVICE The Greater London Council are responsible for the ambulance service in the Greater London area. SECTION 28. - PREVENTION OF ILLNESS, CARE AND \FTERCARE Tuberculosis A recent trend in the care of patients suffering from pulmonary disease is towards their treatment and supervision at specialist Out-patient Clinics in General Hospitals. The Chest Clinic at St. Bartholomews Hospital has been reorganised along these lines. There are twenty four patients on the Register, of whom twenty are males. There is occasional difficulty in tracing these patients because some give a Hostel as their address, while living there only for a few days and others use a City Bank or Shipping Company as an accommodation address. Men from the Hostel present an intractaole problem and constant visiting and education is essential. Some of the men refuse treatment or stop it too early, so rendering themselves liable to become drug resistant. A large part of the work concerns the examination of people who have been in contact with cases of tuberculosis whilst working in the City. The City of London Chest Clinic is situated in St. Bartholomew's Hospital. The medical and clinical nursing staff is supplied by the hospital, whilst the Corporation supplies the Tuberculosis Health Visitor. During the period under review she made 27 (31) effective and 5 (9) unsuccessful home visits. Mass Miniature Radiography A Mass Miniature Radiography Unit of the North East Metropolitan Regional Hospital Board is now well established at Milton Court. Dr. W.D.R. Thompson, the Director of the Unit reports as follows:— "During the year under review the Unit operated for the greater part at the Public Services Building, Milton Court, Milton Street, E.C.2., where 45,511 persons were X-rayed. The Unit also visited seven firms, and 16,467 examinations were made on these visits. Unit Results During 1966 the Unit examined 38,071 males and 23,907 females, making a total of 61,978 a drop of 221 compared with the previous year. Since the Unit commenced operations in May 1950 over one million persons have been X-rayed. Up to the end of 1966 the totals examined are as follows:— 614,783 males and 401,390 females, making a grand total of 1,016,173. During 1966, forty-nine cases (34 male and 15 female) with significant tuberculous,lesions have been discovered, which gives an overfill rate of .791 per 1,000 examinees. The rate of significant cases for men was .893 and for women .627 showing only slight variation with the rate for 1965 (males .852 and for women .654). The highest incidence of tubercle was again in the "65 plus" age groups. 33 It is again noted that the incidence of significant cases of tuberculosis in persons not previously examined by Mass X-ray is considerably higher than in those who had previously been examined i.e. 1.66 per 1,000 compared with .465 per 1,000 (see Table V). Every effort should be made to attract the proportion of the population who have never been X-rayed before. Fifteen cases of carcinoma of the lung (all males) were discovered during the year — five less than in the previous year. Doctors' Referrals Doctors in our zone have been kept aware of the services of the Unit, and although only 241 patients were directly referred to the Unit these produced one active case of tubercle, giving an incidence rate of 4.15 per 1,000. Medical Procedure As in former years, abnormal cases were referred to the appropriate Chest Clinic through the examinee's own doctor. Cases outside the purview of a chest clinic have been referred to St. Bartholomew's Hospital, and the ready co-operation of Dr. N.C. Oswald and Dr. Graham Hayward is gratefully acknowledged. Conclusion This will be my last Annual Report for the Unit, as I am to retire at the end of June 1967 — and I must record my appreciation of the friendly and helpful relationships which have been maintained with Dr. W.G. Swann, Medical Officer of Health for the City of London, and the services rendered by the Regional Hospital Board and the East London Group Hospital Management Committee. The end of 1966 saw the retirement of Mr. ELG. Crowsley — the Organising Secretary of the Unit since 1950. I would like to take this opportunity of expressing my appreciation for the excellent way in which he served the Unit throughout his years of Office. All the members of the Unit Staff have carried out their respective duties conscientiously and my sincere thanks are due to them. Future Plans for the Unit 1967 will see changes for the Unit, as it will become necessary to vacate the Administrative Office at the Fins bury Health Centre. The Regional Hospital Board have decided to amalgamate this Unit with Unit 6B at Plaistow and Mr. T»H.S. Addison is to take on the responsibility of Organising Secretary of the combined Units as from 1st January 1967. We welcome Mr. Addison and know that happy relationships will be established all round. As from 1st April 1967 the Thames Group Hospital Management Committee will be responsible for the Unit. Dr. D.J. Lawless the Medical Director of Unit 6B will assume the Medical responsibilities of the Unit when I retire." Hostels for Ambulant Tuberculous Men Two (3) men were in such hostels at 31st December, 1966 and maintenance costs were guaranteed by the Corporation. Meals for invalid and sick persons Arrangements have been made with the Luncheon Room Committee of the Corporation of London Staff Association for individual diet meals to be available for delivery by departmental transport. Further details will be found in the section dealing with Welfare. Recuperative Holidays Two (3) recuperative holidays for adults were arranged during this period. Chiropody There is a growing and continuous demand for this service, and considerable efforts were made throughout the year to maintain it at an efficient level. Three different chiropodists were employed at various times and a new clinic fitted out at Milton Court. Figures for the period are as follows:— No. of domiciliary treatments by chiropodists on sessional basis 122 (92) No. of clinic treatments by chiropodists on sessional basis 18 (6) Loan of Home Nursing Equipment Items of Equipment owned by Oa Loan at 1. 1. 66 Loaned during 1966 Returned during 1966 On Loan at 31. 12. 66 Corporation 26 14 15 25 British Red Cross Society (City of London Branch) 1 10 3 8 Totals 27 2£ 18 33 34 In general small items are loaned from the British Red Cross Society whilst the larger items of equipment such as wheelchairs, hoists and pulleys have been purchased and issued by the department There is no charge for this service. Pads for Incontinent Persons Full use is made of the general encouragement from the Ministry of Health to issue such pads where they are needed. No charge is made for this service which greatly helps not only the person in need of them but also his family and those nursing him. At the end of the year 3 persons were in receipt of the service. Pads are delivered fortnightly. Yellow Fever Vaccine The Corporation supplied Yellow Fever vaccine to the designated Centre at Unilever House and also, as the Corporation is the Port of London Health Authority, to the Shipping Federation Medical Centres at King George V Dock and Tilbury Docks. During the year 3,166 (3,978) doses of vaccine were issued and 2,961 (2,654) persons were vaccinated. Venereal Disease Contact Tracing Arrangements have been made with the consultant venereologist at St. Bartholomew's Hospital Treatment Centre for the Health and Welfare Officer to act as intermediary in respect of contact tracing in other local authority areas and to help with any contact tracing in the City. A male Public Health Inspector is also available if necessary. Health Education The fact that the daytime population of the City is so huge makes for a unique opportunity to offer health education to a vast variety of people. Regular supplies of Health Education material were sent to nearly two dozen interested bodies in the City and it is hoped to expand this steadily in addition to giving talks and showing films. Regular lectures were given by the Health Visitor and the Health and Welfare Officer to students of the City Day College and nurses at London Hospital. Numbers of lectures given were as follows:— Medical Staff 4 Chief Public Health Inspector 7 Health & Welfare Officer 2 Health Visitor 11 Total 24 Family Planning Rent free premises are provided for the Family Planning Association at Milton Court where one lunch time and one evening session are held each week for City workers and residents. The Corporation met the cost of supplies and treatment for City residents referred on medical grounds. The following report has been received from the Central London Branch of the Family Planning Association in respect of the City of London Family Planning Centre at Milton Court:— "During the year the family planning clinic held at the Public Services Building, Milton Court, 2 sessions every Tuesday, one at lunch time and one in the evening. Both are staffed by a doctor and nurse specially trained in family planning techniques and two layworkers. A total of 89 sessions were held during the year at which 443 patients made 1,407 visits. Of the 443 patients attending 271 were new to the Family Planning Association; 60 transferred from other clinics and 112 were old patients attending for check visits. 28 were City residents. As the clinic serves a very large daytime working population as well as those resident in the City many patients attend for advice prior to marriage and of the 271 new patients 152 were in this category. Advice on all methods of birth control was available and it was found that most patients were anxious to discuss all methods and take expert advice on the method most suitable for them. Of the new patients 155 chose the cap method, 105 were prescribed oral contraceptives and 11 other methods. The Family Planning Association clinics do not fit nulliparous women. The IUD (intra uterine device) is not fitted at this clinic as the number of patients for whom the method is suitable is small at this particular clinic. However 3 patients were referred to Islington Family Planning Centre for fitting. 120 cervical smears were taken of which 2 were doubtful and these patients were referred for follow up treatment. 35 2 patients were referred to the Special Session for marital problems held at Islington Family Planning Clinic. Patients were referred to the clinic from many sources but the largest single source of referral was other patients and from this we gather that the clinic is meeting a real need and offering a welcome service in the City". Well-Women's Clinic The clinic, set up with City Corporation funds in 1958, is now well established at St. Bartholomew's Hospital. The following reporthas been received from the hospital on the work of the clinic during 1966:— 649 (582) patients were seen and none of them had a positive smear. There were, however, a number of abnormalities discovered on clinical examination; 22 patients, for example, had fibroids and hysterectomy was performed in 5 of these. 5 patients were found to have symptomless ovarian cysts which were treated surgically. Cervical polyps were treated in 16 and 2 patients had repair of prolapses. SECTION 28 - AND MENTAL HEALTH ACT, 1959 The Medical Officer of Health for the London Borough of Tower Hamlets provides mental health services in the City on an Agency basis. In all 45 (25) persons were admitted to hospital under the provisions of the Act. Whenever necessary, Mental Welfare Officers attended Courts at the Mansion House, Old Bailey and at Guildhall, and assisted with cases for whom a court order for hospital admission is being sought, and also with cases who are at court, for other purposes when the need for possible hospital admission under the Act arises. Nine (6) patients have been seen at these courts. The assistance of a Mental Welfare Officer was sought by the City Police on 8 (3) occasions, to deal with mentally disordered persons who were found in public places, and a similar case was dealt with at the request of the British Railway police. Ten (8) domiciliary and office visits were made at the request of the Medical Officer of Health, general practitioners and the police, with a view to possi ble compulsory action, or to assess a patient's mental state. 18 (11) patients in St. Bartholomew's Hospital who are residents of other areas have been attended, and arrangements made for transfer to hospital more appropriate to their home address. Visits have been made by the Mental Welfare Officers to the Salvation Army Hostel in Middlesex Street, with a view to providing community care, and 32 patients were seen. It often happens that patients referred by hospitals and other agencies cannot be contacted, because they fail to arrive at the Hostel. Seven of these patients were admitted informally to Hospital, one was seen at the hostel by a psychiatrist and one went on a recuperative holiday. Three patients attend a a day centre. Thirteen patients are in receipt of community care. Regarding community care for the mentally subnormal 1 (1) young City resident attends a junior training centre, whilst she and another young person tire visited regularly at home. At the end of the year 2 (3) patients were being maintained in residential hostels at the Corporation's expense. Salvation Army Hostel, 116 Middlesex Street, E.l. — Weekly Clinic. On one afternoon a week, the funeral Practitioner Surgery at the Salvation Army Hostel was attended by the Health and Welfare Officer, and Mental Welfare Officer and a volunteer from the British Red Cross Society (City Branch) to carry out clerical duties. During the year 47 persons (including one member of the Hostel staff) were seen by Corporation officers, and these patients made a total of 140 visits during the 43 sessions. This surgery has been extended from its original intention, which was to facilitate the assessment of applicants for residential accommodation in a Home. It has developed into an essential part of the service to hostel residents, many of whom have personality problems which they would probably not reveal in the more usual clinic surroundings, even if they could or would attend. This is an entirely new venture in this field, and its further development, will be of the greatest possible interest to workers in preventive medicine and social rehabilitation. 36 SECTION 29 - DOMESTIC HELP No. of persons receiving this service on 1st January 56 No. of new persons receiving this service during the year By type:- Chronic sick 11 By age:- Under 65 years 1 Over 65 years 10 No. of persons receiving this service on 31st December 56 (56) No. of home helps employed on 31st December Full time 2(1) Part time 6(8) Applications for this service came only from the elderly and physically handicapped during this year. All known needs were supplied adequately, although fluctuations in the number of home helps, due to illness and resignations caused some periods to be much busier than others. Recruitment of new home helps was reasonably satisfactory. In order to carry out assessments of need and to ensure that the service was running smoothly 452 visits were paid by the Metropolitan District Nursing Association Superintendent and Nursing Staff. The Superintendent attended a week's course run by NALGO in association with the Institute of Home Help Organisers. PUBLIC HEALTH ACT, 1936 SECTION 84 - LAUNDRY SERVICE Arrangements have been made with the London Borough of Tower Hamlets whereby the soiled linen of incontinent persons can be laundered. Corporation transport is used to make twice weekly collections and deliveries. At the end of the year 10 (5) persons were in receipt of the service and throughout the year 99 collections were made and 4,395 items launaered at no cost to the individual. EDUCATION ACT, 1944 SCHOOL HEALTH SERVICE The School Health Service is operated on behalf of the Inner London Education Authority in so far as the one local education authority School in the City is concerned (Sir John Cass Foundation). During the year the senior school moved into new premises in Tower Hamlets, thus reducing the school population to 300 from approx. 600. During the year the following school medical inspections were carried out:— Routine 146 (202) children inspected Special 73 (73) children inspected Rei inspections 119 (156) children inspected Comprehensive Health Survey 743 (539) children inspected School Denial Service (The statistics given here complMnent the Dental Officer's report). Sessions at Dental Centre 118 (44) New cases given appointments 270 (151) New cases attended by appointment 158(40) On treatment cases given appointments 230 (40) Emergency attendances - (1) Total attendances 372 (74) 1st Inspections carried out at school 306 (277) 1st Inspections carried out at clinic 4(1) Percentage requiring treatment 59.7% (46.8%) Dental Officer — whole-time equivalent 0.17 Special Clinics A school clinic is now held at the Milton Court Clinic from time to time for those pupils who have been seen at school medical inspection and for whom further investigation is felt to be necessary. During 1966 4 such clinics were held, and 9 children examined. Audiometry During the year tests were held at the School with the following results:- Sweep Tests Boys Girls Total No. tested 16 38 54 No. passed 15 36 51 No. failed 1 2 3 37 Pure Tone Test of Sweep Test Failures Boys Girls Total No. tested 2 2 No. failed (referred to otologist) — 2 2 Infectious disease in schools During the year the following cases were notified by the Head Master of Sir John Cass's School:- Chickenpox 3 Measles 3 Mumps _5 Total 11 REPORT OF THE DENTAL OFFICER, CITY OF LONDON The last report on the work of the Dental Section related only to a short period, following the appointment by the Corporation of a Full-time Dental Officer and Dental Surgery Assistant. In reviewing the following full twelve-months period the impressions I gained during the initial period have largely been confirmed and may be briefly repeated here as they reflect the day to day pattern of treatment. The amount of decay seen in 5 year old children attending school for the first time still gives cause for concern as of those inspected 50% needed treatment and of the other 50%, 76% had already received treatment. In pre-school children, that is to say children under the age of 5, the picture is, as one might suppose, relatively as grim and to see a child of 3 yrs of age with 4 cavities is not unusual. 15 was the greatest number of cavities seen in the teeth of a child of this age. The Main Causes are: — (1) The vast consumption of sweetstuffs and refined carbohydrates. (2) Eating biscuits find sweets in bed at night without cleaning the teeth afterwards. (3) In babies and very small children the improper use of undiluted vitamin syrups. Remedies. Dental decay could be enormously reduced if:— (a) Sweets, biscuits, etc. were reasonably restricted between meals at home and not sold in school tuck shops, although fruit, nuts etc. might well be available. (b) The teeth are cleaned after food. If water can be provided, swishing it round the teeth and swallowing is an extremely effective way of removing sticky debris without having tooth cleaning equipment. (c) Awareness of oral hygiene were increased by, bringing children up to realise that tooth cleaning is a desirable social habit like washing the hands and brushing the hair. (d) A water supply were provided which has been fluoridated to the ideal level. Dental Health Education This involves basically the constant reiteration of (a), (b), and (c), above, find instruction is given when attending for treatment, and at school, by means of talks, demonstrations, films and any audio-visual method which would appeal to children. More of this needs to be done and plans are in hand for so doing. It is felt that a dental health campaign (perhaps for a week) might, with considerable advantage be mounted, to be aimed at the large number of people working in the City as well as residents. Fluoridation As time goes on, more and more millions of people throughout the world are drinking water supplies where the fluoride content h^s been adjusted to the ideal level. This is happening because communities are realising that the only really effective way known at present to halt the increasing ravages of dental decay, the most widespread disease in the world, is by means of adjusting the natural fluoride content of the water to a level which produces a resistance in the enamel to dental decay. In some communities in North America this has now been done for over 20 years. There are, however, people who believe that this artificial adjustment of the fluoride level of the water, although beneficial to teeth, may, over a period of years, be injurious to other tissues of the body and that those who hold these views should not be subjected to drinking water so adjusted, when they have no easy method of avoiding it. The Corporation at the present time (December 1966) is alone among Inner London Boroughs in voting against increasing the fluoride level of the water supply. The natural content of the water supplied to the City averages .25 parts per million. 38 The Ministry of Health and Authorities throughout the world consider that 1 part per million is an ideal level. Orthodontics Every effort is made to correct irregularities of the teeth, from gross disfigurement to the lone misplaced tooth, because should the condition remain untreated beyond the age of 14 years it is extremely difficult to get a satisfactory result either functionally or aesthetically, Hiere appears to be a certain lack of awareness on the part of parents (a), that the teeth are in fact misplaced (b). that this can generally be improved (c). that having started treatment the utmost diligence and patience on their part is required to secure the necessary co-operation from the child in order to obtain a successful result. This would appear to be a subject for inclusion in Dental Health Education for children and adults. St. Bartholomews Hospital From time to time cases occur when specialised treatment is required which cannot be provided in the Corporation's Dental Surgery, generally through lack of space for the appropriate equipment. These are mainly General Anaesthetics and Extra-Oral radiographs. The Staff of the Dental Department are always most kind, co-operative and helpful in every way in offering their expertise and equipment to the great benefit of patients referred there. I am indeed most grateful to them. Sir John Cass foundation School In September the Senior half of the school was transferred to a newly-built school in Tower Hamlets with the result that the City does not now have a Local Authority school for all ages. Children from 5-11 will continue to attend the Foundation School in Dukes Place. It is understood that re-building will shortly take place here and it is hoped that there will be provision of an adequate room and facilities for medical and dental examinations. Inner London Education Authority A good deal of my time has been spent with the Chief Dental Officers of other Inner London Boroughs on committees in collaboration with the Authority's Dental Adviser in a really big effort to build up the Dental Service offered to children who attend Inner London Education Authority Schools, which it is hoped will be second to none in this country, in due course. National Health Service Those who attend for treatment from the City of London School, City of London School for Girls, Guildhall School of Music and Drama, and Corporation Staff are all seen under the National Health Service. There is nothing to be noted here which has any especial significance, and the pattern of treatment is much the same as that seen in the average dental practice. INTERN ATIONAL CERTIFICATES OF VACCINATION Some 2,661 certificates were authenticated during the half year commencing 1st July, 1966 and in addition 70 certificates were returned unstamped as the doctors who had performed the vaccinations did not practice in the City of London. WELFARE SERVICES NATIONAL ASSISTANCE ACT 1948, PART III SECTION 21 (i) (a) - RESIDENTIAL ACCOMMODATION This section relates to the provision of Residential Accommodation for persons who by reason of age, infirmity or other circumstances are in need of care and attention which is not otherwise available to thepi. The Corporation has 15 beds at "Hillside", 129 St. Johns Way, N.19. on a "sharing" basis with other boroughs; the owning borough is the London Borough of Islington. Use is also made of beds in homes managed by voluntary societies. The work by the Health and Welfare Officer has, however, shown that this provision is inadequate. "Hillside" is scheduled for run down and closure in 1973, the allocation of beds to the City reducing annually until that time. The Corporation is accordingly making arrangements to provide residential accommodation in its own premises. One of the associated problems is the fact that there is a Salvation Army Hostel in the City from which many applications are received from residents for admission to residential accommodation. 39 Many of the men have inadequate personalities and would not easily fit into the normal small home whereas a large home, such as "Hillside" can absorb a high proportion qf them without undue interference with the other residents. Active consideration is now being given to the proision of accommodation solely for such men. It is realised that not all of the residents of the Hostel come into this category and arrangements have been made for admission to voluntary homes more suited to the needs of these other residents. At 31st December, 1966 the position was as follows:— Males Females Persons in "Hillside" 8 (5) 7 (8) Persons in voluntary homes 6 (7) 5(4) During the year one man was discharged and 6 persons died. SECTION 21 (i) (b) - TEMPORARY ACCOMMODATION FOR HOMELESS FAMILIES The need continues for the Corporation to have available temporary accommodation for homeless persons. Temporary accommodation is provided under agency arrangements with the London Borough of Hackney at Morning Lane Reception Centre and Lambert Road Hostel. During the year the following cases were dealt with:— 8 (6) families (totalling 32 (19) persons) 4 (3) other persons Total: 32 (22) persons (20 (12) of whom were children) Of the families mentioned above none (1) was accepted as a City case and subsequently rehoused. All were found to be the responsibility of other welfare authorities and arrangements made to return them to their home area. Every such local authority was notified of the circumstances. There are several rail termini in the City at which cases will always arise. Vagrants present a further problem but these are normally referred'to appropriate hostels, or the Ministry of Social Security Reception Centre in Camberwell. Temporary Accommodation for Persons arising from a Peace-time Emergency Arrangements have been made with Talbot House for their premises at Trinity Square to be used and a scheme for emergency action drawn up in conjunction with City Police, Talbot House, St . Bartholomew's Hospital, British Red Cross Society (City Branch), Women's Royal Voluntary Service and the Corporation Housing Department. SECTIONS 29 and 30 Welfare Services for the Handicapped On the 1st April 1965 there were 3 physically handicapped, 5 blind and 1 partially sighted persons on the register. On the 31st December 1966 there were 117 (102) persons on the register. This rise illustrates the advantage of the more personal service possible in a small area and the problems which the London County Council must have faced in trying to cover the whole of what is now the Inner London area. 19 names have been removed from the Register due to removal or death. Home visiting of the blind and partially sighted is effected by agency arrangements made with Tower Hamlets Welfare Department but these cases are known to the Health and Welfare Officer and, where appropriate, they are also visited. At 31st December, 1966 there were 3 (4) registered blind persons and one (nil) registered partially sighted persons in the City of London. Periodic visits have been made to all these people and services which are especially applicable to them, for example pastimes, clubs and summer holidays for the blind, have been discussed with them to see if they were interested in these schemes. All registered blind persons are entitled to certain concessions; these include a special bus pass entitling the blind person and guide to travel on (red) London buses for one fare only, a free wireless set which, in this area, is supplied by the Metropolitan Society for the Blind, and a wireless licence exemption certificate, supplied by the Corporation, entitling a blind person to obtain a free wireless licence from the Post Office. A blind person may, subject to income, be entitled to a supplementary blind pension payable through the Ministry of Social Security. Other schemes exist for younger people to enable them to undertake social and industrial rehabilitation and training for further employment, but during 1966 there were no registered blind persons in the City to whom this applied. 40 Three (4) applications were completed for blind or partially sighted registration and results of examinations were awaited at the end of the year. The purpose of registration is to allow a person with sight difficulties to have the welfare services available under the National Assistance Act, 1948 (Section 29), if he so requires. The number of persons on the general register at the end of the year can be analysed as follows:- Age - 16 Age — 16—64 Age 65 & over Total Males Nil (Nil) 7 (10) 18 (20) 25 (30) Females Nil (Nil) 20 (10) 72 (62) 92 (72) The primary work of assessing and sorting cases to determine need and which, if any, specialist services should be brought into use is the responsibility of the Health and Welfare Officer. Holidays for the Physically Handicapped The finding of places in holiday homes for such persons is undertaken by the Health and Welfare Officer. In practice such cases as have arisen have been found to be more suitably dealt with as "recuperative holidays" on medical recommendation but it is realised that this will not always be so and use will be made of the provisions of the Scheme for services for the Physically Handicapped should the need arise. Sheltered Employnent for the "Handicapped and Elderly" There is very little demand for this at present but further follow-up visits to the elderly and handicapped may reveal a need in which case use will be made of the provisions of the various Handicapped Persons Schemes and arrangements made with other authorities or voluntary bodies. Day'Centres and Clubs The City of London Old Peoples Welfare Association provide club facilities for elderly residents of the Corporation's Middlesex Street Estate but it is difficult for other elderly City residents to reach. The facilities are intended primarily for use of Corporation tenants and are provided under the Housing Acts. Arrangements have been made for elderly and handicapped persons to be taken to the Social Club at St. Matthew's Hospital. Library Service for Homebound Persons In conjunction with the Principal Lending Librarian of the G"uildhall Library arrangements have been made for such a service and the Principal Lending Librarian reports as follows:— "The service is intended to supply books to readers who through old age or incapacity are unable to visit their local library. It was inaugurated on 13th July, 1966 and operates from Bishopsgate Library. A senior member of the library staff takes a selection of books at three weekly intervals by means of the Health and Welfare van to a number of residents most of whom live in the Bishopsgate area. When the service commenced, 9 readers were visited, but this has now grown to 12. The service is a small one and is unlikely to grow to any great extent, but it is greatly appreciated by the recipients. In all, since 13th July, 299 books have been issued. A number of the readers, being elderly, find it difficult to read books printed in average sized print and they are specially provided with a series of large-print books. The City Lending Library Service acquires a copy of every large-print book published in the Ulverscroft series and while these provide reading of a popular, nature, more serious volumes can be supplied through the National Library for the Blind". SECTION 31 - MEALS-ON-WHEELS SERVICE This service operates from the Guildhall Office with individual diet meals served by arrangement with the Staff Association Luncheon Room Committee to whom thanks are due. At the end of the year 1,615 (312 from July to December 1965) had been served. Bank Holidays and weekends remain a problem in that no meals can be served but in the former case this is to a certain extent overcome by the provision of cans of soup and foodstuffs which the individual can heat and serve. Where appropriate arrangements have been made for people to receive meals from the Kosher Meals-on-Wheels Service find 274 meals were served during the year. CORPORATION STAFF 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 implemented once during the year. 41 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. 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 156 members of the staff had their eyes tested, 69 of these had not previously had an eye test under the National Health Service, and 53 were found to have visual defects which required correction and were supplied with spectacles. 87 had been examined previously and were already using spectacles. Of these 73 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 678 persons were medically examined. The reasons for medical examinations are shown in Table 2. 429 persons were medically examined for admission to the Superannuation Scheme; 7 were rejected as unfit and 4 were deferred. The clinical conditions causing rejection are shown in Table 1. 49 persons were medically examined owing to prolonged absence on sick leave. At the time of examination, 16 were reported as fit for duty, 22 were reported unfit for duty, and 11 were reported unfit for further service. 94 persons who had reached retirement age were medically examined and 93 were reported as fit to continue in the Corporation's service for a further 12 months. 36 persons were medically examined for temporary appointments, and 6 medical examinations were carried out in respect of employees at the Monument who are examined bi-annually. In addition 64 persons were examined in connection with applications for exemption from parking fees. 12 candidates for teaching, canteen and other posts were X-rayed and all were reported as showing no abnormality of the lungs. 42 TABLE 1 Conditions excluding candidates from the Superannuation Scheme Disease Males Females Bronchitis 1 — Disease of central nervous system 1 — Epilepsy 1 General debility 1 Heart and kidney disease 1 Hypertension 1 Mentally unstable 1 — Totals 5 2 TABLE 2 Medical Examinations Reason for Examination Result Male Female Total Admission to Superannuation Fit 256 162 418 Scheme Unfit 5 2 7 Deferred 2 2 4 Referred for Excessive sick Fit for Duty 14 2 16 Absenteeism or retirement Still Unfit 19 3 22 Unfit for further service 10 1 11 Over 65 years of age Fit 64 29 93 Unfit 0 1 1 Special 87 19 106 TOTALS 457 221 678 STATISTICAL INFORMATION Area - 678 acres (including the Temple and foreshore) Population - Census 1961, 4,711. Estimated mid-year 1966, 4,600 Annual Rateable Value - As at 31st March, 1966, £44,274,488 Annual Sum received from Penny General Rate — £177,500 VITAL STATISTICS COMPILED FROM REGISTRAR GENERAL'S RETURN Live Births 1965 1966 Number 32 30 Rate per 1,000 population 6.96 6.52 Illegitimate Live Births per cent of total live births 21.88 13.33 Illegitimate Live Births 7 4 Stillbirths Number 4 2 Rate per 1,000 total live and still births 111.11 62.50 Total Live and Still Births 36 32 Infant Deaths (deaths under 1 year) 1 1 Infant Mortality Rates Total infant deaths per 1,000 total live births 31.25 33.33 Legitimate infant deaths per 1,000 legitimate live births Nil 38.46 Illegitimate infant deaths per 1,000 illegitimate live births 142.86 Nil Neo-notal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 31.25 33.33 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 31.25 33.33 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births) 138.88 93.75 Maternal Mortality (including abortion) Number of deaths Nil Nil Rate per 1,000 total live and still births Nil Nil Deaths, all ages 53 42 Death rate per 1,000 resident population 11.5 2 9.13 43 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1966 CAUSES OF DEATH NETT DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT ALL AGES Under 4 weeks 4 weeks and under 1 year 1 and under 5 years 5 and under 15 years 1 5 and under 25 years 25 and under 35 years 35 and under 45 years 4 5 and under 55 years 55 and under 65 years 65 and under 75 years 75 and upward 8 1 2 3 4 5 6 7 8 9 10 11 12 13 All Causes 42 1 _ _ — 2 1 2 6 16 5 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 — — — — — — — — — — — — F — — — — — — — — — — — — 11. Malignant neoplasm-lung, Bronchus M 4 _ _ _ — — _ — 1 3 — F — — — — — — — — — — — — 12. Malignant neoplasm-breast M 1 — — — — — — — — — 1 — F 1 —- — — — — — 1 — — — 13. Malignant neoplasm-uterus F — — — — — — — — _ —• — — 14. Other malignant and lymphatic neoplasms M 4 — — — — — 1 — — 2 1 — F — — — — — — — — — — — 15. Leukaemia, aleukaemia M 1 — — — — . — — — — 1 — — F — — — — — — — — — — — — 16. Diabetes M _ — — _ — _ — _ — — _ — F — — — 17. Vascular lesions of nervous system M 2 — — — 1 — — — 1 — — F — _ _ — _ _ — — 18. Coronary disease, angina M 10 — — — — — — — 3 6 1 — F 3 —- — — — — — — — — 3 19. Hypertension with heart disease M — — — — — — — — — — — — F — — — — — — — — — — — — 20. Other heart disease M — _ _ _ _ _ _ _ — F 1 — — — — — — — — — — 1 21. Other circulatory disease M 2 — — — — — — — — — — 2 F — — — — — — — — — — — — 22. Influenza M — — — — — — — — — — — — F — — — — — — — — — — — — 23. Pneumonia M 6 — — — 1 2 2 1 F 1 — — — — — — — — — — 1 24. Bronchitis M — — — — — — — — _ _ F — — — — — — — — — — 25. Other diseases of respiratory system M — — — — — — — — — — — — F — — — — — — — — — — — — 26. Ulcer of Stomach and duodenum M — — — — — — — — — — — — F — — — — — — — — — — — — 27. Gastritis, enteritis and diarrhœa M — — — — — — — — — — — — F — — — — — — — — — — — — 28. Nephritis and nephrosis M — — — — — — — — — — — — F — — — — — — — — — — — — 29. Hyperplasia of prostate M — — — — — — — — — — — — F — — — — — — — — — — — — 30. Pregnancy, childbirth, abortion F — — — — — — — — — — — — 31. Congenital malformations M — — — — _ _ F 1 — — — — — — 1 — — — — 32. Other defined and ill-defined diseases M — — — — — — — — — — F 3 1 — — — 1 — — — — — 1 33. Motor Vehicle Accidents M — — _ — — — — — _ — — — F — — — — — — — — — — — — 34. All other accidents M 1 _ _ _ _ — — _ 1 — — F 1 — — — — — — 1 — — — — 35. Suicide M — — — — — — — — — — — — F — _ _ _ _ _ — _ _ — — 36. Homicide and operations of war M — — — — — — — — — — — — F — — — — — — — — — — — — TOTALS M 31 — — — 1 1 — 5 16 5 3 F 11 1 — — — 1 — — 1 — — 6 44 INFECTIOUS DISEASE Notifications Received:— City Residents Non-Residents Total Dysentery 3 5 8 Food Poisoning — 1 1 Measles 4 4 8 Puerperal Pyrexia — 7 7 Pulmonary Tuberculosis 4 — 4 Tuberculous Pyelonephritis — 1 1 Total 11 18 29 NEW LEGISLATION DURING THE YEAR The following enactments, which affect the work of the department, were made during the year:- The Antioxidant in Food Regulations, 1966. The Butter Regulations, 1966. The Cheese (Amendment) Regulations, 1966. The Colouring Matter in Food Regulations, 1966. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966. The Food Hygiene (Market, Stalls and Delivery Vehicles) (Amendment) Regulations, 1966. The Meat Inspection (Amendment) Regulations, 1966. The Mineral Hydrocarbons in Food Regulations, 1966. The Public Health (Leprosy) Regulations, 1966. The Salad Cream Regulations, 1966. The School Health Service Amending Regulations, 1966. The Skimmed Milk with Non-Milk Fat (Amendment) Regulations, 1966. FOOD HYGIENE The Annual Conference of the Central Council for Health Education was held at Church House, Westminster, S.W.I, on 26th January, 1966. The theme of the Conference was "Food Hygiene". Four papers were read on various aspects of this subject including the following one contributed by the Medical Officer of Health. "THE PROBLEMS OF A MEDICAL OFFICER OF HEALTH" by W.G. Swann, M.D., B.Sc., D.P.H., D.R.C.O.G., D.P.A., Medical Officer of Health Port and City of London When it is suggested to a Medical Officer of Health that he should discuss problems associated with one facet of his work, in this case Food Hygiene, it must at least make him pause and consider what, over a considerable period of time, he has been trying to achieve. It is inevitable that his problems are conditioned by the surroundings in which he finds himself, the nature of his appointment and, I venture to suggest, his own philosophy regarding the importance of particular aspects of a problem. No apologies are offered therefore if some of the matters I raise appear to be of little importance to some people while I may ignore difficulties which trouble others. Legislation In food hygiene, legislation presents a problem in itself. I make no excuse for raising once once more the question of registration and prior approval of catering premises. On many occasions in an area such as the City of London, and this must apply to many of our major towns, where accommodation is at a premium and rents are high, the Medical Officer of Health and his staff are asked to comment on the suitability of accommodation for catering. Prospective caterers do not always heed the advice offered and this often results in food preparation being carried on in indifferent surroundings thereby presenting difficulties in achieving the standards we have set ourselves. This problem of persuading Parliament to give further but favourable consideration to this matter has not been resolved and while it can be maintained that there are adequate powers available to solve any problem that may arise in food preparing establishments, I feel 45 less there is an urgent necessity to prevent a food business being started in inherently unsatisfactory conditions. While the idea of effective legislation has been put forward it is in no way required for its own sake. On the contrary, the problem of the Medical Officer of Health and the Authority he represents is the extent to which persuasion and co-operation can be used when some people — no doubt a minority — prefer punitive measures. Premises and Types of Business In areas where there is a large movement of population each day from dormitory suburbs to extensive office and shop accommodation there is the problem of feeding many people in a comparatively short lunch period. This inevitably leads to the establishment of catering establishments of all types — from small sandwich bars to large canteens - which in itself creates problems for the health department of any Corporation. First a decision has to be made as to whether or not staff should specialize in taking care of catering in general, and the standards which can be achieved under these specialized conditions. There appears to be no royal road to success and it is suggested that each Medical Officer must consider his area on its merits. The feeding of large numbers of people in a short period always raised the problem of the reheating of certain items of food, as this practice is common especially in staff catering establishments. Most of the outbreaks of food poisoning which we have been called upon to investigate are directly attributable to this practice and to the lack of personal hygiene. When called upon to advise about ways and means of overcoming this problem there remains the difficulty of differentiating between what we know to be perfection and what is feasible from a practical point of view. We know that this is a problem of education, but this difficult subject is being discussed by other speakers. Staff Problems Probably the biggest problem facing a Medical Officer of Health today in his efforts to improve and maintain standards of hygiene in food premises is the persistent staff shortage, coupled with the fact that the only labour available in many cases is low grade. The mobility of this low grade labour furthermore accentuates the difficulty. Whilst most responsible traders appreciate the importance of hygiene and cleanliness, standards cannot be maintained without the co-operation of their workers. In the catering industry particularly, discipline must be either accepted or imposed if meals, safe to eat, are to be provided for customers. In the present state of the labour market where the ultimate sanction of dismissal means nothing, it verges upon the impossible for management to exercise that measure of control over their staff which is so essential if a satisfactory standard of cleanliness is to be maintained. Unfortunately, management today is often actuated by the reasoning that any pair of hands is better than none and few firms can afford to be selective in their choice of personnel. The more menial tasks in the catering business have tended to be offered to the lowest grade workers especially in an economy of practically full employment. If there were any severe competition for work many of these would not obtain employment. Nevertheless, the use of this low grade labour adds to the difficulty of the caterer who, in any case, cannot escape from his constant day to day struggle to prepare food in quantity, palatable and acceptable to his customers, at prices which are keenly competitive and, at the same time, ensure that proper safeguards are maintained in the handling and serving of food. Unless the catering trade is able to attract labour of a better quality for certain of the less attractive occupations, any further progress in the raising of standards of hygiene must, inevitably, be a slow and laborious struggle. Public Houses For a number of years, now, the brewers and their tenants have been turning their attention to providing food —snacks to elaborate meals — in their public houses. They have in common with other caterers shown their artistry in the amount and arrangement of food which they display, and perhaps to tempt their client have, literally, put their wares under his nose. The protection of food from the risk of contamination under these conditions is still a problem as it is in many retail shops. There is still ample scope in this direction for both the industry and individual caterers to exercise their ingenuity but it cannot be pretended that we have the final answer to this problem. Unfortunately, there is still widespread ignorance about the proper use of refrigerators and and refrigerated show counters. No doubt all of you have seen pies, sausages, cooked chicken and the like, stacked layers thick on a refrigerated window shelf and it is remarkable the blind faith the proprietors put into these misused pieces of equipment. The effort required to convince some sections of the retail trade that this practice nullifies the usefulness of the equipment is a constant problem and this is one which can only be resolved by constant "nagging". 46 While on the subject of problems associated with retail trade and particularly the products just mentioned, the price tabs which can be thrust deep into the substance of the food seem to have a fatal fascination for the retailers. Enquiries made by my staff seem to indicate that little attention is paid to any method of cleaning and sterilizing this type of label and yet there seems to be great reluctance to abandon them even when it has been proved that the mould growth in their produce arises as a direct result of these practices. Problems associated with Food Hygiene do not arise solely at the consumer stage. The manner in which commodities are handled in self-service stores, open markets and under street trading conditions all give rise to their own peculiar difficulties. Such a simple process as stock rotation and the careless or thoughtless way in which this is approached lead to many complaints but this is a problem which can be easily resolved. The specialised markets, wholesale meat, fish, fruit and vegetables have been the subject of much criticism in recent years. They have evolved from traditional markets of another age; the buildings and road systems around them are far from ideal in the modern context and the colourful characters who handle the food, while lending much to the atmosphere of the surroundings, are sometimes difficult to convince that Food Hygiene is an essential part of their "profession". These markets, in spite of the general public being under the impression that little or nothing is being done to improve and adapt them to present Food Hygiene standards, are changing. The Medical Officer's Department have been asked in the past to comment on suggested changes; the process is still going on, but in the background there is a desire to retain the character of these places, and it is at this point that the Medical Officer is confronted with what might be irreconcilable points of view. It is easy to destroy our past and replace it by a soulless desert of concrete find glass, but it may be possible to serve the ends of both Food Hygiene and tradition if we take care. There is, as you are well aware, an extensive catering trade carried out on a contract basis for the purposes of banqueting and individual celebrations. This often involves the preparation of food some distance from the premises in which the "occasion" is being held, with all the consequent difficulties of transport, pre-cooking, and the ultimate protection of the food from contamination. The vehicles used for the transport of food for these functions, in many instances, are far from suitable for this purpose and many of them are very shoddy makeshifts of some existing design of vehicle. The food, particularly such items as soups and sauces, are always potentially "witches brews." Close attention requires to be paid to this type of catering. It seems impracticable, under present day conditions, to eliminate contract catering but if everyone concerned is made well aware of the risks involved there need not be undue risks in this direction. The hygiene of raw foods and those which have been subject to some processing and which will receive no further treatment create special problems. Many of these problems rest fairly and squarely on the Agricultural Industry but, as a result of their various activities additional problems have been created for the Medical Officers. Residues from poisonous sprays, the treatment of animal diseases by antibiotics, and modern intensive husbandry of farm animals cause anxiety in many quarters, and while the Medical Officer has the help of his professional colleagues such as the Public Analyst and the Bacteriologist, he must ultimately bear the responsibility for the decisions taken with regard to the food in question. You will appreciate from what has been stated above, and it is inevitable that many problems have not been raised, that no suggestions or rules of thumb have been put forward as the solution of these problems. This must be the case because the answers are likely to be different in varying circumstances and it is this variety that is the challenge to us. It has been said before and probably worth repeating that Food Hygiene like other Public Health problems is a social problem. The creation of a climate among the public that many of our social ills are capable of solution provided they wish for and are prepared to pay for this type of improvement, may be one of the major problems that the Medical Officer has to face. 47 JR2/68