LON 93 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1967 To be presented 31st October, 1968. STAFF (as at 31st December, 1967) 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., B.Sc., D.P.A., F.R.I.P.H.H. Jan. 1964 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 MEDICAL OFFICER (for the Port and City of London) De THIERRY, Albert Edwarf Lewis, M.A., M.B., B.Chir., D(Obst.) R.C.O.G. March 1967 ASSISTANT MEDICAL OFFICERS STOTT, William M.B., B.S., D.P.H., F.R.I.P.H.H., F.R.S.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, Lionel 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 Apr. 1926 OSBORN, F.B. Senior Assistant May 1952 COLLINS, R.H. Senior Assistant Jan. 1963 FLOOD, D.J. Senior Assistant Mar. 1963 MOORE, A.J.G. Senior Assistant Apr. 1964 SHEPHERD, Mrs. D. First Class Assistant Apr. 1965 BALL, F.E. First Class Assistant Apr. 1961 DARLISON, S.C. First Class Assistant Apr. 1964 GURNEY, Miss M.L. First Class Assistant May 1939 BROWN, K.B. First Class Assistant Apr. 1964 PEDWELL, R.L. First Class Assistant July 1966 MORRIS, T.K. First Class Assistant Oct. 1965 HAMBLIN, Miss I.H, First Class Assistant Oct. 1957 HEMING, R.G. General Grade Assistant Aug. 1965 FARRELL, R.G. General Grade Assistant July 1965 MILLER, Miss J.E. General Grade Assistant Apr. 1963 KILBEY, Mrs. B.A. General Grade Assistant Jan. 1967 8ARBUTT, Miss B. Shorthand Typist Jan. 1965 NEWSON, Miss J.E. Shorthand Typist June 1966 DUNN, Miss S.C. Shorthand Typist Aug. 1967 THREADGOLD, A.W. Senior Assistant (Meat Inspectors' Office) Nov. 1923 PETERS, E.J. Clerical Assistant (Meat Inspectors' Office) Nov. 1935 CASH, J.E. Clerical Assistant (Meat Inspectors' Office) Mar. 1954 KILBY, E.H. Senior Assistant (Diseases of Animals Act) Oct. 1964 HADLEY, J.T. Clerical Assistant (Diseases of Animals Act) June 1965 SCOFIELD, Mrs. W.A.A. Clerical Assistant (Diseases of Animals Act) Aug. 1967 LYONS, Mrs. J. Clinic Clerk (Part time) Apr. 1965 WOODS, T.A. Messenger Nov. 1955 HOLDAWAY, H.C. Messenger/Driver May 1966 PUBLIC HEALTH INSPECTION STAFF THOMPSON, E. Chief Public Health Inspector Sept. 1948 FLYNN, M.J. Deputy Chief Public Health Inspector July 1951 RILEY, J.H. Senior Public Health Inspector Aug. 1962 WELLDON, J.B. Senior Public Health Inspector Aug. 1962 SHEPLEY, H.L. Senior Public Health Inspector May 1964 HOARE, J.A. Senior Public Health Inspector May 1964 HUDSON, L.A. Public Health Inspector Apr. 1934 BAXENDALE. W.J. Public Health Inspector Jan. 1964 CORFIELD, D.F. Public Health Inspector June 1964 GILKES, D.H. Public Health Inspector June 1966 HITCHCOCK, D. Public Health Inspector Nov. 1967 MEAT INSPECTION STAFF LEE, W.R. Chief Meat Inspector July 1930 GARRARD, S.S. Deputy Chief 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.F., D.F..C. Meat Inspector Dec. 1960 ELSEY, F.E. Meat Inspector Jan. 1964 BERNHARDT, D.R. Technical Assistant (Authorised) May. 1931 HUDSON, R. Senior Porter Mar. 1963 HEALTH AND WELFARE SECTION BENFIELD, Miss G.L. Health and Welfare Officer Apr. 1965 DOWD, Miss M.T. Assistant Health and Welfare Officer Mar. 1967 BERGSTROM, Miss S.M. Assistant Health and Welfare Officer Apr. 1967 MIMNE, Mrs. P.A. Clerk/Dental Surgery Assistant Sept. 1965 WODZICKA, Miss A.M. Chiropodist (Part time) Nov. 1966 9 Home Helps - - DISEASES OF ANIMALS ACT WIGGINS, G.S., M.R.C.V.S. Veterinary Officer Oct. 1964 HAYHURST, R.J., D.F.C. Inspector Oct. 1964 GUBBINS, V.O. Inspector (Part time) Apr. 1965 KILBY, E.H. Inspector/Administrative Assistant Oct. 1964 RODENT STAFF CARTER, J. Rodent Officer Sept.1944 MASON, G.A. Foreman Rodent Operative Dec. 1946 BERRY, P.M. Rodent Operative Jun. 1967 PEGRAM, J. Rodent Operative Sept.1967 HARRIS, R.G. Rodent Operative .. .. Dec. 1967 MORTUARY AND DISINFECTING STATION LAWRENCE, F.H. Superintendent of the City Mortuary and Disinfecting Station May 1936 SUN NICK, J.W.T. Disinfecting Apparatus Attendant May 1950 MANUAL WORKERS TIMONEY, J.M. (General Duties at Smithfield Market) Oct. 1966 HIGLEY, E.A. (General Duties at Smithfield Market) Sept. 1968 I'ANSON, R.H. (General Duties at Smithfield Market) Feb. 1964 STEELE, W.T. (General Duties at Mortuary) Aug. 1958 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.)., F.C.G.I., 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 1967 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 1967. The question of fluoridation of water supplies is topical and of current interest in view of Ministry of Health circular No. 24/56 dated 20th June, 1968. On this account I have included as an appendix a copy of a chapter on "Responsibility in Preventive Medicine" that I contributed to the book "Ethical Responsibility in Medicine" by Edmunds & Scorer published by E. & S. Livingstone Ltd., 1967. In this contribution I used the topic of fluoridation of water supplies to illustrate the complexity of the factors which are involved and affected in executive decisions and administrative actions. 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. 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 3 During the year 143 families were rehoused leaving 395 families on the Housing Register at the end of December 1967. The first phase of the Middlesex Street Redevelopment was commenced. When completed the redevelopment will provide a shopping and residential precinct of 181 flats and 38 shops. The redevelopment of the Barbican residential area continued and the first flats due for completion reached an advanced stage of construction. A total of 2,120 flats are planned and work on 1,877 is in progress. EXAMINATION OF WATER SUPPLIES AND SWIMMING BATH WATER Regular sampling of water is carried out in the City in order to ensure its purity and potability, and of swimming bath water to see that proper standards are maintained. The City is unique in that many premises have their own private source of water obtained from wells bored deep into the strata upon which the City stands. There are still 125 of these wells in operation, all of which are kept under observation. Samples are taken for bacteriological examination, chemical analysis and the determination of chlorine content. Under normal circumstances drinking water points are sampled for bacteriological examination and include those derived from deep wells in addition to supplies from the mains of the Metropolitan Water Board. In some cases the water is supplied through storage tanks and 102 samples were obtained from these sources. Twenty eight samples were taken from the water supplies used in food preparation premises Three adverse reports were received on the water used in these premises. The reasons for such results were investigated and in addition to other work, arrangements were made for the storage tanks to be thoroughly cleaned. Further sampling showed that the water from these particular sources was then satisfactory. Tests of water for the effectiveness of chlorination are made on site and of 77 such tests all were found to be satisfactory. Samples for chemical analysis are not taken as a routine measure but only when there are some particular reasons indicating that such a test is desirable. Four samples were taken during the year and analysed by Dr. Amphlett Williams, the Corporation's Public Analyst. All were found to be satisfactory. The swimming baths situated at the City of London Boy's School, St. Bride's Institute, St. Paul's Choir School and the Golden Lane Swimming pool of the City Corporation were included in the sampling routine, 21 such samples being taken during the year. The results showed that the accepted standards were being achieved. The present situation regarding the quality of water used in the City seems a far cry from the one which existed in 1866, just 101 years ago. In the Annual Report for that year Dr. H. Letherby, M.B.. M.A., writes critically of the water being used from shallow wells in the following terms:- "In most cases too, the constituents are remarkably indicative of the source and nature of pollution. The wells of the public meat markets for example, as those of Newgate, Aldgate and Leadenhall, all charged with the peculiar filth of those localities. Indeed, the water furnished by the well in Leadenhall Market contains nearly 40 grains of common salt per gallon, besides a large quantity of nitre and organic matter, all of which is derived from the stinking serosity which runs from the hides exposed for sale and salted upon the public way." It can be said with confidence that the persistent and thorough work in this sphere by the Metropolitan Water Board and others continue to ensure a clean and wholesome supply of water to the City. The Metropolitan Water Board have supplied the following Report:— 1. (a) The supply was satisfactory both as to quality and quantity throughout 1967. (b) 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 treated 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, from the treatment works or well stations, from the distribution system, 4. and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the resident population supplied direct according to the Registrar General's estimates at 30th June, 1967, was 4,401. (ii) No houses were permanently supplied by standpipe. (d) No fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) 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 and there were no changes to the general scheme of supply in your area. 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. (b) The Board's river and well sources have not been considered to have a plumbo-solvent action on account of their hardness content and alkaline reaction. It should, however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zinc, iron and also lead. Tests for lead have been carried out in connection with chemical analyses of samples of running water collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December, 1967:— Lead content (mg/1. Pb) water from main taps in consumers' premises Number of samples Per cent Less than 0.01 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 — 0.06 1 1.0 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that the findings are applicable to individual Boroughs. The regular system of examination for lead in water in domestic premises will continue during 1968. 5. 6 METROPOLITAN WATER BOARD — Water Examination Department BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1967 OF 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. *Thames-derived, South of River 1,887 8.8 99.52 99.95 Stoke Newington 254 6.5 99.61 99.61 *Hampton, Surbiton and Walton. METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE 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 Sample's Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27 °C. B.O.D. 5 days at 20°c. Hardness (total) CaC03 Hardness (noncarbonate CaC03) Magnesium as Mg Sodium as NA Potassium as K Chloride aa CI Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) *Thames-derived South of River 156 0.021 0.088 4.2 1.12 272 69 5 22.6 5.1 30 1.9 9 64 0.30 0.01 0.1 12 7.9 580 Stoke-Newington 52 0.017 0.063 5.2 0.56 312 77 5 28.9 4.8 35 1.4 10 64 0.30 0.01 0.0 5 7.9 660 *Hampton, Surbiton & Walton 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 brick 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. 44 complaints were investigated by Public Health Inspectors during the year and nuisances were found to emanate from the following sources:— 1. Oil fired furnaces 22 2. Solid fuel furnaces 7 3. Bonfires 10 The main cause of nuisance 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 CONTROL Seventy four complaints of noise were received during the year. The subject fell firmly into the pattern of previous years, involving demolition, building operations and machinery in general, with the unique addition of one complaint of noise from low flying aircraft. Observations, investigations and assessment of noise levels required visits over long periods and, as the occasion necessitated, calls were made during both normal working hours and later, even extending into the "early hours." Within the City a great deal of noise originates from building operations which have to meet a tight time schedule. The latter in some instances inevitably means working out of normal hours. Much thought and attention is therefore given to the best practicable means of reducing noise to an acceptable level, "acceptable" in this sense being one that is practicable from the point of view of industry and reasonable to the neighbourhood. The building industry has been co-operative in trying and accepting methods which have been suggested to them by my staff. In the context of the practical approach to noise control, 1967 was notable for the issuing of Circular 22/67 by the Ministry of Housing and Local Government, dated 18th April, 1967, on the subject of noise. The circular outlines procedures designed to further implement the recommendations of the final report of the Committee on the problem of noise submitted in Parliament in July 1963 (The Wilson Report Cmnd 2056). Briefly, in the Circular the Minister asks for a determined attack on noise. Among the matters raised are the speed of legal proceedings, Town and Country Planning, aircraft noise, insulation and the education of the public about unnecessary noise and inconsiderate behaviour. Furthermore the Minister anticipates that in April 1969 he will call for a report on progress and any difficulties encountered in noise control, which should ultimately yield useful information. The technical instruction of staff engaged in noise control is recommended. During 1967 three Public Health Inspectors attended an approved course at Tottenham Technical College. This will be extended to others during 1968. 7 COMMON LODGING HOUSES The only common lodging house situated within the City is at 116 Middlesex Street. This establishment is owned and managed by the Salvation Army and consists of 6 floors and a basement. It provides canteen facilities and rudimentary accommodation for 420 men. A clothing store and laundry are also available. Maintenance is carried out by building contractors as a continuous operation and is quite good. A rise in the number of verminous persons using these premises has given rise to some concern and measures are at present being taken to obtain transport and revise the Cleansing Station procedure. It is hoped that this will deal effectively with this problem. The keeper has been made aware of this nuisance and has undertaken to give complete co-operation. Cleansing and disinfection of persons and clothing are carried out at the Corporation's Cleansing Station at Milton Court. The Public Health Inspectors have carried out 12 inspections during the year and all matters regarding environmental health therein were dealt with by consultation with the Salvation Army Authorities. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The Offices, Shops and Railway Premises Act, 1963, prescribes standards of working conditions in a similar manner to those provided for factory workers under the Factories Acts. The responsibility of enforcing this Act, for securing the health, safety and welfare of persons employed in offices and shops, is divided between the local authorities, the fire authorities and the Ministry of Labour. During the year under review, 4,960 visits were paid to offices and shops, which is a further increase in the number of visits made during the previous year. This number is made up of general inspections, i.e. initial visits, and subsequent inspections. It is known that there are some premises in the City still unregistered notwithstanding the fact that the number on the register has now reached 8,734. Unregistered premises when discovered are registered immediately. Statistics of general inspections are very misleading so far as the City is concerned and give little indication of the time and energy which has been devoted to the implementation of this Act, as offices in the City are often larger and more complex than those in other areas. For instance, one office block, which comprised a single general inspection employed 1,750 persons. Another initial survey lasted for nine days, during which time 3,583 individual items were inspected in three interconnected buildings. The time taken on this inspection did not include office work or subsequent visits to ensure that the works necessary to secure compliance with the Act had been carried out. The total number of accidents notified during the year was 320 which is approximately the same number as those reported during each of the previous two years. These were generally of a minor nature, again mainly caused by persons slipping on staircases and in passage ways. There was one fatal accident resulting from a 63 year old man falling from a set of 4' high steps and dying during a subsequent operation. All steps and ladders are examined during inspections for their suitability and state of repair. A person involved in an accident must be away from work for three days before it is necessary to report the accident. It would seem, in view of the number of workers in the City, that City workers enjoy a high safety factor, or alternatively, that employers are unaware of their responsibility to notify accidents. Several Orders and Regulations regarding standards for the provision of sanitary accommodation, washing facilities, first aid equipment and other facilities have been issued since the passing of the Act, but no regulation for standards of lighting and ventilation has yet been made. The arrangements for lighting and ventilation in both old and new offices are often found to be unsatisfactory and there is a tendency for overheating and stuffiness to become worse in deeper offices remote from external walls and in those premises built for speculative purposes in which floors have been partitioned to meet the individual needs of the occupiers. Improvement in the standard of lighting and ventilation generally involves a great deal of expense and, in the absence of official standards, much time has to be spent by the Inspectors in advising and persuading managements to improve the lighting and ventilation to an acceptable standard. During the year there was an increase in the number of enquiries from Employers, Surveyors, Architects and Estate Agents on the requirements of the Act and Regulations made thereunder. As a result of these enquiries the Inspectors visited many premises in order to advise on the measures necessary to secure compliance with the Act. It would appear that an increasing 8 number of employers in the City are becoming aware of their responsibilities and this awareness of legal requirements and the consequent spirit of co-operation which is generally found, has meant that steady progress has been made in securing satisfactory conditions and amenities without the necessity of resorting to legal proceedings. Whilst, as indicated above, steady pr ogross has been made, the rate of carrying out general inspections has been disappointingly slow, partly because of the difficulties experienced in replacing Public Health Inspectors who have either retired or left the service of the City Corporation. TABLE A REGISTRATION AND GENERAL INSPECTIONS Class of premises Number of premises newly registered during the year Total number of registered premises at end of year. Number of registered premises receiving one or more general inspections during the year Offices 166 6,370 549 Retail shops 60 1,013 161 Wholesale shops, warehouses 71 832 137 Catering establishments open to the public, canteens 20 519 201 Fuel storage depots NIL NIL NIL TOTALS 317 8,734 1,048 TABLE B NUMBER OF VISITS OF ALL KINDS (INCLUDING GENERAL INSPECTIONS) TO REGISTERED PREMISES 4960 TABLE C ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES AT END OF YEAR Class of workplace Number of persons employed Offices 241,260 Retail shops 5,327 Wholesale departments, warehouses 7,243 Catering establishments open to the public 6,505 Canteens 4,324 Fuel storage depots 12 Total 264,671 Total Males 158,289 Total Females 106,382 9 10 HYGIENE IN HAIRDRESSING AND BARBERS SHOPS Section 77 of the Public Health Act, 1961 empowers local authorities to make Byelaws dealing with hygienic conditions in hairdressers and barbers shops. During the year thirteen inspections were made and no contravention of the Byelaw requirements was observed. On 14th July, 1967 the Greater London Council (General Powers) Act, 1967 received the Royal Assent. Section 21 of this Act requires all persons who wish to carry on the business of a hairdresser or barber to be registered. The Common Council of the City of London resolved in September 1967 that the requirements of Section 21 of the Greater London Council (General Powers) Act, 1967 should apply in the City of London as from the 1st January, 1968. 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 86 (incl. 2 bakehouses) 140 (incl. 4 bakehouses) 6 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 601 504 25 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 66 6 2 — TOTAL 753 (incl. 2 bakehouses) 650 (incl. 4 bakehouses) 33 - 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.1.) 7 4 — — — Overcrowding (S.2.) — — — — — Unreasonable temperature (S.3.) — — — — — Inadequate ventilation (S.4.) _ — — _ _ Ineffective drainage of floors (S.6.) — — — — _ Sanitary Conveniences (S.7.) (a) insufficient 1 1 — _ _ (b) unsuitable or defective 35 24 — — — (c) not separate for sexes 1 — — — — Other offences against the Act (not including offences relating to Outwork) 17 16 1 3 — TOTAL 61 45 1 3 — 11 PART VIII OF THE ACT Outwork (Sections 133 and 134) Section 133 Section 134 Nature of Work 1 No. of outworkers in August list required by Section 133 (1) (c) 2 No. of cases of default in sending lists to the Council 3 No. of prosecutions for failure to supply lists 4 No. of instances of work in unwholesome premises 5 Notices served 6 Prosecutions 7 Wearing apparel (Making, etc.) 352 - - - - - TOTAL 352 - - - - - OUTWORK AND THE INSPECTION OF OUTWORKERS' PREMISES, ETC. Lists received from City Firms employing outworkers 32 Names and addresses of outworkers resident in the City received from other Authorities 16 Names and addresses of outworkers resident outside the City, employed by City firms, transmitted to other Authorities. 352 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 6,986 inspections have been made. As a consequence of these inspections, it was necessary to serve 51 Intimation Notices. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. ATMOSPHERIC POLLUTION The measurement of atmospheric pollution has continued during 1967. 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 figures for 1962/65 from the Golden Lane Station, which was taken out of service in 1965, are included in Tables II and III for comparison with the station at the Public Services Building which is situated approximately 200 yards from Golden Lane. The determination of Sulphur Dioxide by the Lead Peroxide method was discontinued in the City at the end of 1966. The results of the atmospheric pollution investigations carried out by this department are set out in the following tables:— 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 have increased once again and the average was higher than that of any of the previous five years. This was probably due to demolition and rebuilding works in the vicinity. TABLE II — Smoke concentration by the volumetric method. The concentration of smoke recorded during 1967 was less than the average for the past five years. TABLE III — Sulphur measurement by the volumetric method. The concentration of sulphur in 1967 was less than the average for the past five years. 12 TABLE 1 — Results obtained in 1967 of the monthly observations of rainfall and deposited matter by means of the deposit gauge MONTH Rainfall collected in deposit gauge at Guildha 11 DEPOSITS Equivalent to Insoluble Soluble Total Millimetres Inches of rain Tons per square mile January 37 1.46 12.07 11.76 23.83 February 44 1.74 39.73 12.58 52.31 March 31 1.21 23.45 8.06 31.51 April 58 2.30 23.32 10.47 33.79 May 85 3.35 13.15 16.66 29.81 June 60 2.37 24.00 12.75 36.74 July 29 1.13 19.95 12.20 32.15 August 56 2.21 13.66 13.49 27.16 September 54 2.11 14.85 13.94 28.79 October 98 3.85 9.28 10.16 19.44 November 37 1.46 15.98 10.94 26.92 December 60 2.36 22.57 9.76 32.32 Averages: 1967 54 2.13 19.33 11.90 31.23 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 1962 - 1966 46 1.80 15.74 10.22 25.96 TABLE II — Results obtained in 1967 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 grammes per cu. metre January 37 1.46 83 87 February 44 1.74 75 73 March 31 1.21 36 46 April 58 2.30 46 44 May 85 3.35 39 37 June 60 2.37 28 29 July 29 1.13 27 28 August 56 2.21 30 38 September 54 2.11 40 34 October 98 3.85 28 42 November 37 1.46 86 76 December 60 2.36 83 69 Averages: 1967 54 2.13 50 50 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 1962- 1966 46 1.80 80 72 13. TABLE III - Results obtained in 1967 of the measurement of SULPHUR DIOXIDE by the volumetric method MONTH Rainfall collected in deposit gauge at Guildhall Public Services Building Snow Hill Police Station Equivalent to Monthly Average Millimetres Inches of Rain Microgrammes per cu. metre January 37 1.46 444 501 February 44 1.74 387 464 March 31 1.21 279 391 April 58 2.30 291 324 May 85 3.35 202 181 June 60 2.37 124 128 July 29 1.13 137 118 August 56 2.21 173 137 September 54 2.11 142 129 October 98 3.85 217 233 November 37 1.46 463 432 December 60 2.36 397 468 Averages: 1967 54 2.13 271 292 1966 49 1.94 284 (Golden Lane) 328 1965 54 2.12 286 341 1964 44 1.71 316 383 1963 41 1.63 300 345 1962 40 1.58 284 340 1962 - 1966 46 1.80 294 347 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. For the purpose of implementing the provisions of the Act, organisation and procedure was similar to previous years, comprising inspection of properties to ascertain the presence of rats and/or mice, treatment of properties found to be infested, recommendation and supervision of structural and incidental proofing, and periodical control measures for the destruction of rats in the City sewers. A total of 2,160 properties were inspected under the Act, the properties varying from comprehensive redevelopments in the course of construction, riverside food wharves, warehouses, public and private catering establishments, blocks of offices, shops and factories to domestic dwellings. Altogether 598 complaints were received, either by notification or as the result of inspection and of this total 534 infestations were subjected to control measures. In 64 instances no action other than advice was necessary. These were mainly cases of suspicion, or where a mouse had been seen by early morning cleaners, but the often long procedure of investigation had to be carried out, not only to satisfy the occupier, who had co-operated by notifying the matter, but to ensure that the occurence was not the fringe of a heavier infestation elsewhere in the property or adjoining premises. Such complaints do, however, indicate the awareness by employers and employees of even minor nuisances, and their readiness to seek advice and assistance to resolve a problem. From the rodent aspect alone, this is an attitude to be encouraged, as, in the past, many infestations of rats and mice, some approaching a major degree, have been traced and eliminated as the result of a complaint of a minor or even frivolous nature. Continual routine inspection over the years has fostered this attitude, encouraged the public, and strengthened their co-operation. The total of 534 infestations requiring control measures comprised 4 major and 43 minor infestations of rats, and 3 major and 484 minor infestations of mice. Of the rat infestations 4 major, (21-200 rats) and 41 minor (1-20 rats) were of common rat (Rattus Norvegicus) character, and the remaining 2 minor infestations were of ship, or black rat (Rattus Rattus) nature. Treatment of these infestations entailed 3,581 visits for operational purposes and in the application of control measures 9,784 initial baiting sites were selected for both rats and mice. For the control of rats 3,160 pre-baits were laid which necessitated the use of 420 poisonbaits to finalise the treatments. These measures resulted in a minimum estimated kill of 609 rats and of this number 316 bodies were removed from the sites of the treatments. Others, not included in this figure, were found on removal of structural or incidental harbourage providing nesting and breeding facilities. The use of anti-coagulant rodenticides and other poisons entailed the application of 9,763 baiting points for the control of mice and 685 bodies were recovered. The low level of Ship (Black) rat infestation manifest in recent years has been maintained and the 2 minor infestations of this nature during the year under review is the lowest yet recorded. To illustrate the diminished status of this species within the City, the comparable figure recorded in 1948 was 698 rat infestations treated, comprising 668 ship and 30 common rat infestations, and of the ship rat figure 249 infestations were in the major classification. In reviewing the present position of this species, there are many contributory factors. Foremost of these has been advanced techniques of control, the great improvement in general hygiene, progressive demolition of old properties and redevelopment, systematic inspection and diminution of re-infestation from outside sources. The relatively low number of common rat infestation s was confined to the comprehensive re-development sites in their varying stages of construction. These offer every facility and are, in every way, conducive to infestation. All such sites were regularly inspected and the fullest cooperation of the various contractors was received at all times having regard to the conditions and labour involved. Periodical treatment at 3 monthly intervals for the control of common rats in the sewers is of primary importance in relation to the control of the same in surface properties. It is the purpose of these measures to ensure that the rat population in the sewers is kept down to the lowest possible level, thereby preventing infestation of surface properties via defective drainage. 15 During the year three "Direct" poison treatments and the annual overall test were carried out. These were applied in March, June, September and December, and an average of 370 sewer manholes were poison baited "Direct" in the 1st, 3rd and 4th treatments. The toxic agent in the two former controls was Fluoroacetamide and in the latter instance Zinc Phosphide. The annual overall test baiting of all available manholes was applied in June, and in this instance 379 manholes were non-poison test baited. The test baits, which provide some evidence of the results of the previous "Direct" poison treatments, and in effect, act as a pre-bait, were left down two days, and where, on examination, they were found to be taken, were replaced by poison bait, in this instance. Sodium Fluoroacetate (1080). The test bait result was 60 "takes" (29 complete and 31 partial), which is 7.6% complete "takes". The comparable result in 1966 was 8.1% and in 1965, 7.5% and the low level obtained by these treatments over the years has been maintained. The importance of hygiene in relation to rodent control, embracing effective food storage, proper waste disposal, and the elimination of structural and incidental harbourage cannot be over emphasized. Rats and mice are commensal creatures, dependent on man for their food and housing and, therefore, the maintenance of good general conditions, whatever the usage of the property, is essential, and control measures should be regarded as supplementary to hygiene. PIGEONS Despite the measures carried out in the past there has been a general tendency for the pigeon population in the City to increase. In view of the complaints received as a consequence of this increase, it was found necessary to make more concentrated efforts at the various trouble spots in the City where the numbers of pigeons had become inconveniently high. The reduction of the excessive numbers of birds is undertaken by the Corporation's Contractor who is licensed by the Ministry of Agriculture, Fisheries and Food and it is only after consultation with that Ministry that the necessary measures can be put in hand. It is a fact that pigeons are becoming an ever-increasing source of nuisance and unfortunately, members of the general public increase the difficulties, as well as the expense, of dealing with this problem, by their thoughtless persistence in feeding these birds. CITY MORTUARY Bodies received 155 Post Mortem Examinations made 154 Inquests on bodies 28 Inquests held at Holloway Prison Nil Inquests on fires Nil Inquests on Treasure Trove Nil DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, etc. Articles, by weight 8 Tons No. of articles disinfected 413,920 Cases of horsehair 258 Fees received £1,894. 5s. 0d. General Disinfection, Infectious Diseases, etc. Premises disinfected after cases of infectious disease 16 Lockers at Post Offices disinfected 12 Verminous premises disinfected Nil Beds and bedding disinfected 24 Cells 12 Cleansing of Persons:— No. of verminous persons bathed .. 930 No. of persons with scabies bathed 9 No. of articles disinfected 9,390 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. 16 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 coroperative effort. During the year, fifty intending caterers obtained the advice of this Department before deciding to proceed with their ventures. OBSERVATIONS ON CATERING ESTABLISHMENTS IN THE CITY OF LONDON Mr. Thompson and Mr. Flynn, who devote most of their time to catering establishments, have submitted their views on the year's work. In considering the standard of cleanliness and hygiene in City restaurants one tends to emphasise the dirty restaurant and kitchen and to give scarcely a passing thought to the clean, well run establishment. It is undoubtedly true to say that within the City of London there are more well designed, well constructed kitchens and efficiently run catering units than is likely to be found in suchasmall area elsewhere, although it must be admitted that some of these establishments are staff restaurants which are not open to the general public. There are also some top grade quality restaurants which undoubtedly compare favourably with the highest standards found in the more exclusive restaurants in other parts of London. Such premises are not a source of concern and worry to this department as a high standard of hygiene is consistently maintained. Many smaller establishments are also well run and their proprietors, notwithstanding present difficulties manage to keep up a very good standard. Unfortunately, however, such establishments are outnumbered by those which demand continuous attention and where regular monthly visits would be desirable if circumstances permitted. There are approximately one thousand premises in the City which are classified as catering establishments and whilst we have continued to devote the greater part of our time to the routine inspection of these premises it is never possible to visit them as regularly and frequently as one would wish. Generally it is not very difficult to persuade caterers to carry out essential cleaning works once their attention has been drawn to unsatisfactory conditions but it verges upon the impossible to induce many of them to carry out thorough cleaning both of premises and equipment as a routine measure. Some of the larger catering companies which are household names have also found it difficult to maintain the standards they achieved in the past. As indicated in a previous report, some restaurant proprietors either by design or perverseness, do not seem to realise that the existence of dirty and defective conditions are offences under the Food Hygiene (General) Regulations and renders them liable to prosecution WITHOUT warning. During the year under review, in two such cases, legal proceedings were instituted immediately following a routine inspection where exceptionally filthy conditions were found. Both caterers considered that they had been unfairly dealt with in not being allowed to rectify those unsatisfactory conditions before a decision was made to prosecute. It is difficult to believe thatafter many years of effort and the known awareness of the general public, caterers cannot appreciate that filth, neglect and an indifferent approach to good hygiene will not be tolerated and that where such conditions are discovered they render themselves liable to legal action. During the year three restaurant proprietors were successfully prosecuted and fines and costs totalling £83. 5s. Od. were imposed. Concurrently with inspections made to enforce compliance with the Food Hygiene Regulations, the requirements of the Offices, Shops and Railway Premises Act, 1963, are also borne in mind and every effort has been made to improve essential staff amenities. However, because of the high value of all rented accommodation in the City some catering units are so short of space that at times the allocation of 27 square feet for the construction of an additional water closet becomes for all practical purposes impossible. Apart from low profit margins, the ever increasing difficulty of retaining and recruiting suitable staff continues to be a major obstacle to the maintenance of an acceptable standard of hygiene and cleanliness in certain establishments. The extent to which washing facilities and sanitary accommodation provided exclusively for the use of the staff in such establishments are misused or damaged is a further indication of the type of staff which certain caterers have to employ to continue to keep their business operating. However, in spite of disappointment and shortcomings, a sustained effort is made by this department to maintain and improve the standard in catering establishments and the criticisms made of some premises should not be allowed to obscure the tremendous improvements which have been made during the last decade. 17 Naturally when one is dealing with Food Hygiene one can never be complacent or even pretend to be satisfied with any limited achievement. This work is a continuous struggle and it is doubtful whether a state of affairs will ever be reached when one can conscientiously and truthfully express a feeling of satisfaction. It should be pointed out that a great effort has been made by the staff of this department to ensure that all catering units which have been brought into use during the year conform to a satisfactory standard , and the amount of time and effort devoted to these new premises has considerably reduced the attention which could otherwise have been paid to restaurants already in operation. SAMPLING UNDER THE FOOD AND DRUGS ACT, 1955 Samples purchases by the Sampling Officer during the year constituted a representative cross-section of all articles of food in regular use. Of the 404 samples purchased only 30, or 7.4%, were the subject of an adverse report by the Public Analyst. Most of these irregularities referred to infringements of the Labelling of Food Order and were resolved after consultation with the manufacturers and packers concerned. Particular attention was again paid to the sampling of made-up foods such as minced fresh meat, sausage meat, sausages, fish cakes and pies of all descriptions. These commodities were purchased early on Monday morning as most retail food premises in the City are closed from Friday evening until Monday morning and it was felt that sampling at that time would give an accurate indication of the freshness or otherwise of food offered for sale during the early part of the week. Three such samples were found to be in a mouldy condition and to be unfit for human consumption. One sample, a beef croquette and the other, a turkey croquette, purchased from two separate shops, were found to contain mould growths in the substance of the food. Subsequently, successful legal proceedings were taken against both retail shops. In the third case a fishcake was also found to be in a mouldy condition, but as the mould contamination was very slight it was decided not to take legal action. However, this problem was discussed with the Manager of the premises in question who agreed that in future all stock of perishable food stuffs left over at the end of each day would be destroyed and not as had been the practice, hitherto, returned to the suppliers. All the formal samples of milk purchased from milk roundsmen in the City were up to standard but four formal samples of hot milk purchased from catering establishments were found to be adulterated. In each case the milk had been heated by steam injection and, when informed of the Analyst's Report, each caterer agreed that in future, he would heat milk in a pan or closed container if hot milk were specifically asked for by the customer. This form of adulteration is somtimes found to occur in cafes and restaurants carrying on a brisk morning trade which necessitates serving customers as speedily as possible. There does not seem any intent to defraud the public and the practice of heating milk by means of steam injection is always discontinued when the offence is pointed out to the caterer in question. One complaint regarding the adulteration of milk referred to milk sold from a staff canteen but a thorough investigation failed to indicate why or by whom the milk had been watered. A subsequent formal sample purchased from the same premises was found on analysis to be satisfactory. The number of complaints received from customers regarding articles of food unfit for human consumption or food containing extraneous materials increased sharply during the year and may be an indication of the decreasing efficiency of some firms engaged in both the catering and retail food trades. It will be noted from the table below which includes the legal proceedings instituted under the Food and Drugs Act, that all eight cases involved unfit food or food containing extraneous materials. 18 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY Article Informal or Formal Sample Nature of adulteration or irregularity Action Bacon Informal The sample, in which four ingredients were found, was prepacked but the label did not include a declaration of ingredients. In view of the opinion expressed by the City Solicitor it was decided inadvisable to institute legal proceedings. *Bread Sliced White Loaf Informal Contained a few small, dark brown particles of hard dough discoloured by iron. Appropriate representations were made to the bakers concerned. *Bread Roll Containing Cheese and Mustard Informal Contained embedded in the crust at the bottom of the roll, where it had been baked, a small dead wood-louse. Legal proceedings were instituted against the bakers of the roll, who were given an absolute discharge and ordered to pay £9. 9s.0d. costs. *Buttered Fruit Bun Informal Contained within the two halves a small crumpled circular perforated pink plastic plaster. The circumstances of this complaint were reported to the Port and City of London Health Committee who decided not to take any legal action. Cake Decorations: Silver-coated Beads Informal Consisted of aluminium-coated dragees and contained no silver. The Importer was informed that if this sample were imported into this country he would not be allowed to sell it as cake decoration. Almond Slice Informal The fruit filling of the tart contained a large colony of blue Penicillium mould. Legal proceedings were instituted against the retailer who was fined £10.0s.0d. and ordered to pay £9. 9s. 0d. costs. Cheese — soft Informal Consisted of a Full Fat Soft Cheese not labelled in accordance with the requirements of the Cheese Regulations or the Labelling of Food Order The retailer was notified of the contravention of the Cheese Regulations 1965 and the Labelling of Food Order 1953 and agreed to withdraw from sale all stock of this commodity. Cheese — brie Informal Consisted of a Full Fat Soft Cheese but was not labelled as required by the Cheese Regulations 1965. Stock withdrawn from sale until suitable labels are provided. Cheese — brie Informal Consisted of a Full Fat Soft Cheese but was not labelled as required by the Cheese Regulations 1965. Representations were made to the suppliers of this cheese and they are now preparing new labels which will comply with the Cheese Regulations 1965. Cream Slices Informal Consisted of Imitation Cream Slices. Representations were made to the retailer in question and a Cream Doughnuts Informal Consisted of Imitation Cream Doughnuts notice is now exhibited indieating that artificial cream Cream Doughnuts Informal The doughnuts were filled with an imitation cream made from emulsified fat, water and sugar. only is used in their confectionery Cream Doughnuts Informal The doughnuts were filled with an imitation cream made from emulsified fat, water and sugar. Retailer requested to display a notice when imitation cream is used. Chocolate Eclair Informal The interior of the eclair was mouldy and unfit for consumption Legal proceedings were instituted against the Retailer who was given an absolute discharge and ordered to pay £5. 5s. 0d. costs. *Coffee from Vending Machines Informal The specimen had an abnormally bittertaste. This was ascribed to incorrect dispensing, the strength of the liquor being two and a half times therecommended strength. No foreign ingredients were found. This sample was obtained from an office vending machine and the person in charge was informed of the findings of the Public Analyst. Evaporated Peaches Informal Consisted of Dried Peaches incorrectly labelled. The food was claimed on the label to be an extremely valuable source of Fruit Sugar, Vitamins and Minerals, but no particulars as to the nature or quantities of the Vitamins and Minerals were included on the label. Producers requested to relabel the tins to conform with the Labelling of Food Order. 19 Article Informal or Formal Sample Nature of adulteration or irregularity Action *Foreign matter found in Apple & Blackcurrant Pie Informal Consisted of a small splinter of bone, half an inch long. Appropriate representations were made to the Caterer concerned. *Foreign matter found in Shepherds Pie Informal The specimen consisted of a piece of heat-resistant glass weighing nearly one gramme. Legal proceedings were instituted against the Caterers who were given an absolute discharge and ordered to pay £5. 5s. 0d. costs. *Fudge Informal Contained adhering to one of the cubes a dead caterpillar (Ephestia elutella larva). A cautionary letter was sent by the Comptroller and City Solicitor to the retailer in question. Fish Cakes Informal The fish cakes bore several small surface growths of mould and were unfit for sale. The Manager of the retail shop was interviewed and informed of the Analyst's report. He agreed that in future all stock, such as fish cakes, left over at the end of the day would be destroyed and not as hitherto returned to the supplier. *Fresh Salmon Informal Consisted of a fresh salmon steak but was found on being cooked to have an objectionable taint of crude petroleum. This complaint was referred to the Fishmongers' Company who carried out an investigation. Prawns in Creole Sauce Informal The ingredients included a packet of rice which was found to be coated with talc and hydrolysed starch. The presence of these ingredients was not disclosed on the label as required by the Labelling of Food Order 1953. This product has been withdrawn from sale until a suitably amended label has been prepared Milk-Hot Formal Contained fat, 3.06%: Solids-notfat, 7.30% corresponding to the presence of 14% of added water. Added water confirmed by the freezing point, — 0.461°C. (Hortvet) In each of these cases the presence of added water in the milk was found to be the result of heating the milk by means of steam injection. Milk-Hot Formal Contained fat, 3.32%: Solids-notfat, 7.84% corresponding to the presence of 7% of added water. Added water confirmed by the freezing point, — 0.498 C. (Hortvet). Milk-Hot Formal Contained fat, 2.84%: Solids-notfat, 6.18% corresponding to the presence of 27% added water. Added water confirmed by the freezing point, — 0.373°C. (Hortvet). Appropriate representations were made to the Caterers concerned and in each case they agreed in writing to refrain from heating their milk by steam injection. Milk-Hot F ormal Contained fat, 3.63%: Solids-notfat, 7.90% corresponding to the premises of 7% of added water. Added water confirmed by the freezing point, — 0.490°C. (Hortvet). *Milk Informal Contained — Milk-fat, 2.02%: Solids-not-fat, 5.22% corresponding to the presence of 38% of added water. Added water confirmed by the freezing point — 0.319° C. (Hortvet). This complaint referred to milk sold from a staff canteen. An investigation failed to indicate how or by whom the milk had been watered. A subsequent formal sample purchased from the same premises was found on analysis to be genuine. Yoghourt Informal Contained — Milk fat, 3.3%: Milksolids other than milk fat, 7.8%: Yoghourt is normally made by the controlled souring of concentrated milk and products sold as Yoghourt in the London are a contain at least 10% of milk-solids other than milk fat. The matter of the Analyst's report was taken up with the producers of the Yoghourt, which is made from goat's milk, as originated in the Balkans. As there is no generally accepted standard for Yoghourt or legal presumptive standard for goat's milk the City Solicitor advised that the evidence available was insufficient to warrant legal proceedings. 20 Article Informal or Formal Sample Nature of Adulteration or Irregularity Action Meat Informal The meat was discoloured by blue stains caused by a pigment not permitted in food by the Colouring Matter in Food Regulations, 1966. The stain arose from the stamp indicating the country of origin. The attention of the Importer was drawn to this irregularity. Lamb Informal The stain was discoloured by blue stains caused by a colouring matter not permitted in food by the Colouring Matter in Food Regulations, 1966. *Pork Pie Informal Contained a dead wasp which had been baked in the pie. Legal proceedings were instituted against the manufacturers who were given an absolute discharge and ordered to pay £7.7s. costs. Beef Croquettes Informal One of the three croquettes comprising the sample contained a number of small growths of mould and was unfit for consumption. Legal proceedings were instituted against the Retailer who was given an absolute discharge and ordered to pay £5.5s.0d. costs. Turkey Croquettes Informal Both the croquettes bore several small growths of mould and were unfit for consumption. Legal proceedings were instituted against the Retailer who was fined £10.10s.0d. on each of two summonses and ordered to pay £10.10s.0d. costs. Pork Sausages Informal Contained sulphur dioxide 250 parts per million. Sausages may not contain preservatives unless its presence is declared. A notice is now displayed in the shop indicating that sausages contain preservatives. Pork Chipolata Sausages Informal Contained sulphur dioxide, 150 parts per million. Sausages may not contain preservatives unless its presence is declared. Both these samples consisted of unwrapped sausages and a notice indicating that the sausages contained preservatives should have been displayed in the retail shop in question. Steps were taken to ensure that suitable notices are exhibited. Sausages Informal Contained sulphur dioxide, 240 parts per million. Pork Sausage Meat Informal Contained — Fat, 36.5%, fat-free meat, 27.5% total meat, 64%. Pork Sausage Meat should contain at least 65% of meat and the proportion of fat should not exceed 50% of the total meat. Appropriate representations were made to the manufacturers. *Beef Sausages Informal The sausages were mouldy and unsuitable for human consumption An investigation indicated that the retailer was carrying out an efficient stock rotation. The cause of the sausages being in a mouldy condition was finally ascertained to have been due to a break down of the manufacturers refrigeration plant. Appropriate representations were made to the manufacturers. *Oxtail Soup Informal The specimen was considerably below normal strength, containing approximately 60% of excessive water. It would appear that, at the restaurant complained of the tinned soup was not being diluted in accordance with the manufacturer's instructions, as an excessive amount of water was being used. Following representations from this Department this practice was discontinued. Potato Croquettes Informal Contained sulphur dioxide, 80 parts per million, the presence of which was not disclosed on the label of the carton. Appropriate representations have been made to the retailer and to the packer of this commodity. Orange Juice Informal The samples had deteriorated and contained considerable amounts of a yellow sediment, which was found to consist of a form of pectin. All outstanding stocks of this commodity were withdrawn from sale. Orange Juice Informal Orange Juice Informal * These samples were examined as a result of complaint by members of the Public 21. FOOD AND DRUGS ACT 1955, AND FOOD REGULATIONS Samples Purchased and submitted for Analysis Article Informal Formal Article Informal Formal Bacon 4 Lard 2 Biscuits 8 Lime Cordial & Lager 1 Black Pudding 2 Margarine 5 Bovril 1 Corn Oil 1 Bread 7 Meat & Meat Products 76 Butter 4 Milk Shake 2 Cakes & Pastries 32 Milk, fresh 3 36 Candied Peel 1 Canned 2 Canellonia 1 Mincemeat 1 Cheese 14 Mustard 2 Cheese Spread 1 Nuts 5 Chicken Croquettes 4 Ovaltine 1 Chocolate Drink 1 Pastes, Pates 3 Coffee 2 Pickles 3 Coffee, Instant 2 Pizza Napolitana 1 Cooking Fat 2 Prawns 4 Cream, Dairy 4 Pastry 1 Confectionery 14 Potato Cakes 2 Curry 1 Ravioli 2 Drinks, Fruit 10 Rolls & Sandwiches 15 Raspberry Syrup 1 Sauces & Spices 4 Fruit Juice 1 Sausages 18 Dripping 1 Sausage Meat 1 Fish, Frozen 2 Sausage Rolls 6 Canned 2 Scotch Eggs 4 Cakes 3 Smoked Salmon 1 Shell 2 Soups, Canned 3 Fruits, Dried 7 Spirits — 11 Fresh 6 Strained Foods 1 Canned 4 Tea .11 Pies 5 Turkey Croquettes 1 Grosvenor Pie 1 Vegetables, Canned 4 Jam 4 Juice 1 Jelly 3 Dehydrated 3 Junior Egg Custard 1 Salad 1 Vinegar 2 Wine 3 Yoghurt 3 TOTALS 357 47 OTHER SAMPLES SUBMITTED FOR ANALYSIS Albumen 6 Onion Powder 6 Almonds, Shelled 1 Pork Pies 2 Bread 3 Rolls 1 Cakes 3 Rissoles 1 Chicken 1 Sauce 2 Chocolate, Milk 1 Sausages 1 Coffee 1 Shepherds Pie 1 Confectionery 4 Soup 1 Fertilisers 2 Tea 1249 Fish, Canned 6 Tomatoes, Canned 3 Fish, Fresh 2 Tomato juice 1 Fruit, dried 32 Vegetables, Canned 6 Fruit, canned 8 Water, well 1 Fruit, juice 2 Water, bath 1 Fruit, powder 3 Water, tank 1 Fruit Pie 1 Water, drinking 2 Lard 7 Meat, fresh 2 Meat, canned 2 Milk, fresh 1 Milk, canned 1 TOTAL 1,368 22 BACTERIOLOGICAL EXAMINATIONS Albumen, egg white solids, granular, or flake 65 Duck Eggs 1 Faecal Specimens 3 Lamb Tongues, canned 1 Throat Swabs 6 Water (including 21 from swimming baths) 152 TOTAL 228 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 56 tons, 4 cwts., 3 qrs., 12 lbs., which was disposed of as follows:— Tons Cwts. Qrs. Lbs. Destroyed 48 2 2 16 Disposed of to Contractors 4 1 3 22 Released for Manufacture 4 0 1 2 7 tons, 5 cwts., 1 qtr., 12 lbs., of food were placed under stop and subsequently dealt with under supervision of other local authorities. 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 57 Manufacture, sale and storage of ice cream 2 Brining of Meat 17 Boiling of Shellfish 5 Cooking of Meats and Poultry 10 Cooking of Meats and Poultry for Resale 3 Manufacture of Dripping 7 Manufacture of Pies 1 Manufacture of Sausages 9 Pickling and Bottling of Shellfish 3 Preparation and Bleaching of Tripe 1 Preparation of Jellied Eels and Shellfish 8 Preparation of Poultry 2 Selecting and testing of Sausage Casings 5 TOTAL 130 EXAMINATION OF SAMPLES Dr. H. Amphlett Williams, the Public Analyst for the City of London has contributed the following:— A total of 429 samples (including 404 samples purchased by the Corporation's sampling officers), was submitted for analysis under the Food and Drugs Act during the year, excluding samples taken on importation. 47 were taken formally, the remaining 382 being "informal" samples. Milk Samples 39 samples of milk were submitted, 36 being formal and 3 informal, and included in the formal samples were 5 of hot milk from cafes, etc. Of these, 4 were found to contain added water, the proportions being 14, 7, 7 and 27 per cent. In each instance the presence of added water was confirmed by the Freezing Point Test, but none of the samples gave a positive reaction for nitrates, which occur naturally in the London water supply. In spite of past warnings, steam injection, a method which introduces water through condensation, is evidently still being used for heating milk in cafes. 23. Other Samples Of the 390 samples other than milk 39 were found unsatisfactory. But the unsatisfactory samples included 13 articles brought in by members of the public, who had found mould, insects or other foreign bodies in their purchases. Being weighted by these samples the arithmetical "adulteration" figure of 10% should not be taken as an indication of the proportion of food on sale in the City that is of unsatisfactory quality. The number of articles of food and drink complained of by the public seems to increase year by year. This is probably due mainly to an effect of improved health education in leading to the expectation of higher standards of purity and cleanliness; but in some instances it appears to result from difficulty in obtaining satisfaction, and an apparent lack of responsibility or even of interest, when an article is complained of in the shop or restaurant where it was purchased. There is no real evidence of any increase in the proportion of contaminated food on sale in the London area. Three of the other samples consisted of fancy cheeses which would have been regarded as "genuine" in 1966 but failed to conform to the new labelling requirements introduced in the Cheese Regulations which came into force on 1st February, 1967. Two of these were labelled "Brie" but they must now be labelled "Full Fat Soft Cheese". The third was a very different French cheese made from goats' milk, which apparently should also have borne the same description. The new requirements, particularly the term "Medium Fat Soft Cheese", which was strongly criticised without avail when the Regulations were in draft form, have caused a certain amount of confusion and given rise to a large crop of adverse certificates on samples taken in the London area this year, mainly respecting the small, foil wrapped, Continental cheeses. No doubt, however, the new terminology will gradually become accepted, if not quite understood. PHARMACY AND POISONS ACT, 1933 This Act provides for registration by the Local Authority of persons not already registered in respect of poisons in Part I of the Poisons List who desire to sell poisons included in Part II. Part I of the Poisons List includes the more dangerous poisons such as strychnine — which may be sold only by Pharmacists registered by the Pharmaceutical Society of Great Britain, whereas Part II includes the less dangerous poisons such as phenols, hair dyes, etc. 70 firms were registered under this Act, 65 of which were re-registrations. No contraventions were noted. 94 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. 32 inspections were made and no contraventions came to 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. 35 inspections were made. No contraventions were noted. 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 AND 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". 24. 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. Furthermore certain imported foods sold loose, such as fresh apples, raw tomatoes etc. must bear a label indicating the country of origin or the word "Foreign" or "Empire" when offered or exposed for sale. 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 69,706 tons 286 tons 0.41% MEAT AND FOOD INSPECTION - SMITHFIELD MARKET Meat and poultry etc., delivered to Smithfield Market during 1967 exceeded the tonnage of the previous year for the first time since 1963. 1963 1964 1965 1 966 1967 tons tons tons tons tons 385,337 354,088 338,982 338,768 343,619 There was a marked drop in supplies of Argentine beef during this period and latterly a falling off in supplies of beef from Yugoslavia but increased quantities from Eire. Summary of meat and poultry etc. surrendered during 1967 (Tables 1, 2 and 3) Tons Cwts Qrs. Lbs Diseased meat 46 0 3 18 Unsound meat 385 4 3 20 Tinned meat 4 3 3 21 Other tinned goods 2 8 3 6 Poultry and feathered game 48 5 0 13 Rabbits and hares 5 12 0 10 Offal 94 9 0 11 Dried fruit 1 2 Fish 3 1 15 Frozen foods 5 1 12 TOTAL 586 13 3 16 The 1966 Amendment to the Meat Inspection Regulations provided an additional instruction that during routine inspection in slaughterhouses any pig carcase in which an abscess is found be split and examined in detail. This must in some measure account for a drop of roughly 30% in home killed meat surrendered for disease. Meat Inspection Regulations, 1963 Table 4 refers to meat from England and Wales only. Referring to these records, of the 141 pig carcases surrendered, 100 were for pyaemia or pyogenic abscesses and 13 were for acute septic, fevered and allied condition. The 1,782 pieces were taken from 1,770 carcases 1,505 of which had localised abscesses and 127 of which had lesions of avian tuberculosis, corynebacterium equi etc. in the heads. Disease found in pigs from all other sources formed much the same picture. Local Authorities have been notified of significant losses, by reason of disease, from carcases bearing legible inspection stamps. 25. Four beef carcases and five sets of beef offal, carcases in which localised infestation with cysticercus bovis had been found, were received in Smithfield, by arrangement with Local Authorities at source, and were detained in cold storage for the period prescribed in the Meat Inspection Regulations, 1963. The bulk of unsound meat is from imported chilled beef affected with bacterial slime and mould fungi. Bacterial slime and decomposition were the main causes of loss in fresh and chilled meat, particularly pork, from other sources including Great Britain. Delays in transit, consequent exhaustion of solid C02 in containers, and opening of containers en route, allowing condensation on carcases, thus promoting development of bacterial slime are factors giving rise to losses. From home sources a frequent fault is the despatch of carcases, particularly pork, before they are sufficiently cooled. Some consignments of pork carcases, are still warm on arrival at Smithfield. 26. 27. Table showing the amount of meat surrendered to or seized by Meat Inspectors in the City of London for DISEASED Condition, 1967. January February March April May June July August September October November December TOTAL 1967 TOTAL 1966 lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs Argentine 116 66 380 43 301 195 128 86 4 17 35 1,371 1,284 Australia 6 Denmark 9 9 Eire 100 171 107 113 818 489 151 1,949 1,151 F inland 95 123 192 657 87 273 73 176 562 206 2,444 Great Britain 10,304 8,670 8,860 7,618 9,123 5,999 8,274 8,404 6,796 8,265 9,392 5,171 96,876 142,534 New Zealand 9 3 32 17 1 3 4 69 103 Poland 87 87 40 S. Africa 10 Sweden 52 64 52 169 337 261 Uruguay 194 Yugoslavia 74 1967 10,520 8,745 9,335 7,831 9,390 7,026 8,791 8,913 7,071 9,276 10,512 5,732 103,142 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 28. Table showing the amount of meat surrendered to or seized by Meat inspectors in the City of London for UNSOUND condition, 1967 Country January February March April May June July August September October November December TOTAL 1967 TOTAL 1966 lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs Argentine 151,671 49,764 96,735 15,706 13,033 7,094 20,566 25,884 17,223 4,762 39,736 8,918 451,092 334,986 Australia 27 66 92 241 74 62 562 1,957 Bechuanaland 58 Belgium 10 Brazil 6,028 Denmark 17 66 29 5 14 13 144 1,644 Eire 279 193 100 411 490 1,015 5,216 19,604 4,412 1,744 3,371 2,289 39,124 13,541 Finland 16 39 42 1,228 6,468 1,345 10,443 4,966 28 45 447 1,728 26,795 22 Great Britain 6,189 10,813 8,547 13,809 9,978 17,132 51,217 57,966 24,249 17,150 14,319 16,391 247,760 240,595 Holland 1,514 1,514 795 Hungary 12 New Zealand 388 29 1,233 143 498 97 174 362 405 42 789 66 4,226 39,222 Poland 82 27 212 98 96 84 1,367 14 3,604 70 40 316 6,010 3,815 Rhodesia 80 80 14 Rumania 79 120 313 477 989 S. Africa 53 39 112 591 58 60 913 1,239 Swaziland 94 Sweden 5,333 9,929 73 15,335 1,148 U.S.A. 14 14 Uruguay 16,001 182 1,242 478 28,332 740 46,975 24,769 Various 1,568 Yugoslavia 60 333 188 1,999 4,662 5,236 5,055 3,886 21,419 96,227 1967 158,652 61,008 124,770 32,041 34,186 37,836 132,494 114,857 54,213 24,412 58,775 29,708 862,952 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 29. 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 1967 Commodity January February March April May June July August September October November December TOTAL 1967 TOTAL 1966 lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs lbs Tinned Meat 360 283 383 332 387 311 1,092 1,474 2,248 1,406 930 195 9,401 12,661 Other Tinned Goods 317 220 490 469 1,451 431 394 533 553 364 86 158 5,466 11,564 Poultry & Feathered Game 8,277 4,789 5,042 5,025 6,836 7,121 19,509 12,381 11,317 13,629 7,981 6,186 108,093 134,467 Rabbits & Hares 452 456 6,639 90 66 187 816 378 840 712 1,463 455 12,554 4,470 Offal 7,601 12,481 14,419 5,249 11,999 16,519 33,673 39,307 22,928 23,998 13,472 9,933 211,579 142,155 Dried Fruit 30 30 Fish 140 239 379 Frozen Foods (Various) 500 100 600 560 Cheese 86 1967 17,007 18,729 26,973 11,305 20,839 24,569 55,723 54,103 37,886 40,109 23,932 16,927 348,102 — 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 30. MEAT INSPECTION REGULATIONS, 1963 (MARKING OF MEAT) Beef Mutton Pork Veal Offal Bodies Qrs. Pes. Car. Pes. Car. Pes. Car. Pes. Sheep v. n. v. n. v. n. v. n. v. n. v. n v. n. v. n. v. n. v. n. 3 3 120 2 21 13 89 49 399 1351 65 5 4 1 23 3 1 2 12 20 8 1 1 4 3 143 2 24 13 90 51 411 1371 73 6 4 1 * 3 3 1 81 1 9 5 16 15 77 477 50 5 1 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. * Part consignment Key to Headings:— Qrs. = Quarters Pes. = Pieces Car. = Carcases v. = Visible (i.e. Diseased condition which could have been detected visually at time of slaughter). n. = Not Visible (i.e. Diseased condition which could not have been detected until meat was cut into smaller portions). 1966 1967 United Kingdom meat pitched at Smithfield Market: 135,003 tons 120,733 tons United Kingdom meat condemned for diseased condition at Smithfield Market: 64 tons 0 cwts. 0 qrs. 7 lbs 43 tons 4 cwts. 3 qrs. 24 lbs = 0.05% = 0.04% MEAT INSPECTION Tons Cwts. Qrs. Lbs. Meat etc., delivered at Smithfield Market 343,619 0 0 0 Meat etc., surrendered at Smithfield Market 581 2 3 7 Meat etc., surrendered at Leadenhall Market and City Shops 3 19 1 26 Meat etc., surrender at Cold Stores 1 11 2 11 Number of exportation certificates issued. 17 Number of demonstrations and lectures given 155 Number of attendances by students 1,388 Number of samples taken for medical research 10 Number of samples taken for ophthalmic research 62 Number of samples taken for bacteriological examination 8 Number of samples taken for Government Chemist investigation 86 FOOD HYGIENE (General) REGULATIONS. 1960 and 1962 During the yearthe provision of facilities for washing tools and equi pment has been completed. Delay in this project has been due to drainage difficulties. All stalls are now fitted with sinks and most have hot water supply, but the latter, which is the tenants responsibility, remains to be provided in a few stalls. The vehicles of the carrier companies have been maintained to a good standard of cleanliness. The vehicles of butchers who collect meat are generally of good standard, and where faults were found they were speedily remedied. Most infringements of the Hygiene Regulations are found among the personnel and vehicles of small cafe and restaurant owners. In these cases information has been passed to the Local Authority in whose area the business is situated. The market truck cleansing facilities installed by the Corporation of London are extremely effective, but only half the trucks in use on the market are regularly put through the machine. Private arrangements for cleansing are made for the remainder some of which have been the subject of verbal warnings. The Food Hygiene (Market, Stalls and Delivery Vehicles) Regulations, 1966, required, from 1st January, 1967, that all trucks carrying meat outside the covered area of the Market should be covered. In consultation with the Trade Union the use of Polythene sheeting was agreed upon and a convenient source of supply arranged. It was necessary to issue 35 warning letters for infringement of this particular requirement. Warnings issued include a number to senders and transport firms who deliver into the market from other parts of the country. Where for example an unhygienic vehicle is used in emergency, warnings by telephone have been given to prevent despatch of further consignments without adequate protection from risk of contamination. The supply from laundries of clean protective clothing to market personnel is often interrupted. There are three specialist laundries engaged in this service and each has been communicated with on various occasions to expedite delivery. During the year 530 infringements were noted and suitable warnings were given including 255 in writing as listed below. Infringements Warning Letters 23 in connection with clothing 20 19 in connection with containers 15 50 in connection with head covering 45 97 in connection with meat contamination 61 171 in connection with premises and equipment 10 50 were incidents of smoking whilst handling food 47 36 regarding trucks — 84 regarding vans and cars 57 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. 31 DISEASES OF ANIMALS ACT 1950 & ASSOCIATED ACTS Mr. G.S. Wiggins M.R.C.V.S. Veterinary Officer for the City of London, has submitted the following report:— In submitting my report for 1967 it is with the knowledge that two full years have elapsed since, under the terms of the London Government Act 1963, the Corporation became the Authority for the administration of the Diseases of Animals Act in regard to the importation of animals for the whole of the Greater London Area. For the remainder of the functions of the Disease of Animals Act and Associated Acts the Corporation acts for a number of the London Boroughs on an agency basis. During the year the London Boroughs of Camden and Bexley joined the scheme, making a total of 18 Boroughs for whom the City accepts responsibility for work necessary under the above Acts. Work carried out under the various Acts and Orders comprised the following:— Riding Establishments Act 1964 Riding Establishments in the London Boroughs of Lewisham, Southwark, Lambeth, Wandsworth, Kensington & Chelsea, Barking, Sutton, Richmond upon Thames, Bromley and the City of Westminster were visited, the premises inspected and reports submitted to the various Authorities concerned. 37 establishments in all were recommended for re-licencing for a further year. Pet Animals Act 1951 Although the Corporation act for the Boroughs under the above Act, in most cases it is only in a consultative capacity. Several requests were made, from those Boroughs however, for assistance in dealing with complaints from members of the public concerning animals etc. and advice was sought in three instances in dealing with cases of people suffering from psittacosis. Quarterly routine visits were carried out to pet shops in the Boroughs of Wandsworth, Sutton, Richmond upon Thames, and Tower Hamlets, the latter including Club Row, the Sunday morning street market. Animal Boarding Lstablishments Act 1963 A similar arrangement is carried out as with the Pet Animals Act, routine visits being made as required. Twenty seven such establishments were regularly visited with a view to suitability for re-licencing, an increase of fourteen over 1966. Performing Animals (Regulation) Act 1925 Four applications were received for certificates of registration, or variations of registration, from a number of organisations having performing animals in their productions. These were duly issued. A visit was made to Billy Smart's Circus, when appearing at Clapham Common. All the animals and their living quarters were inspected and a performance of the circus was witnessed. Animals (Sea Transport) Order, 1930 Under the terms of the above Order visits were made, in respect of the exportation of animals, to the South West India, London and Millwall Docks to ensure that the terms and conditions of this Order were complied with. The animals concerned comprised 34 cattle, 25 pigs, 6 sheep, 2 calves and 2 horses and were exported, mostly for breeding purposes, to destinations as varied as South Africa, Germany, Spain, Portugal, Malta and Cyprus. Issue of Export Certificates To enable firms to export all kinds of meat products, game and other merchandise, a total of 86 health certificates were issued comprising such varied commodities as pheasants, partridges, wild ducks, wood pigeon, hares,grouse,ducklings, turkeys, ox tongues, lamb tongues, steakburgers, beefburgers, boneless lamb, horse meat, sheep casings, lambskins, hatters' fur. A total of £298. 4s. lOd. was received for this service compared with £351. 8s. 5d. for the previous year mainly due to a shortage of game and restrictions on shooting imposed because of Foot and Mouth disease. In July, at the requestofHarvey's Belgravia Foods Ltd. a visit was made to their new factory in Cambridgeshire, to inspect as to its suitability for theproeessing of meat products for export. An appropriate charge was made for this service. Diseases of Animals Act — I mportations It was necessary to visit London Airport (Heathrow) on numerous occasions throughout the year in connection with the illegal entry of dogs and cats into this country, i.e. arriving without the Ministry of Agriculture's import licence. 147 notices were served on owners of such animals directing them to remove them to quarantine kennels. 32 A number of animals were found to be dead on arrival at the airport and post mortem examinations were carried out on 3 hyaenas, an African baboon. Leopard cat, pug dog, chimpanzee and a consignment of penguins. Reports were submitted to the airlines concerned. From time to time enquiries were received from the Ministry of Agriculture, Metropolitan and County Police Forces requesting the tracing of animals that had illegally entered the country through other ports or had escaped whilst in transhipment. Your office co-operated with the Authorities concerned in these enquiries at all times. In two instances assistants at the R.S.PXtA. Hostel at Heathrow received scratches and abrasions whilst handling cats in transhipment. In each case, as a precautionary measure, reports were received from the Veterinary Services of the importing countries to ensure that the animals remained healthy for the usual 10 day period. Importation of Dogs & Cats Order 1928 Several instances occurred of offences against the terms of the asove Order, resulting in prosecution in one case and letters of caution in four others. In March proceedings were instituted against Mr. Samuel Brody, agent for Miss Jayne Mansfield, for landing two chihuahua dogs, the property of the film actress, at London Airport in contravention of Article I of this Order. He was fined £25 on each of the summonses and ordered to pay 20 guineas costs. In April a dog was reported running loose alongside the Motor Vessel "Catherina W", moored off Brentford Dock. It was soon returned to the vessel and it was considered expedient in this case to address a letter of caution to the Master. Later the same month a similar instance occurred of a dog escaping ashore from the Motor Vessel "Margaret Catherina", berthed at the Surrey Commercial Docks, and was dealt with by a cautionary letter to the Master of the vessel. A further case concerned two German seamen from the Motor Vessel "Uhenfels", berthed at Tate and Lyle's Refinery Wharf, Silvertown, who had taken a dog ashore. Enquiries revealed that it had left the boat without the Captain's knowledge, was only ashore for a short time and was accompanied by the two members of the crew. Warning letters to the Captain and seamen concerned were considered appropriate in view of the circumstances. Information was received from the Kent County Constabulary at Sevenoaks to the effect that a passenger from East Africa had reported landing at London Airport with two griffon dogs as a present for friends, being unaware that they should have been declared before leaving Heathrow. hi view of the circumstances and the fact that the dogs were placed in quarantine within a few hours of arrival in this country, a cautionary letter was forwarded in this instance. Rabies Order 1938 From information received from the Police at Gerald Road Station in March it came to notice that a chihuahua dog had been illegally landed at London Airport several weeks earlier, the property of an Italian Countess staying in London. From enquiries made it was impossible to prove that the dog had been brought into this country and in the circumstances, to ensure temporary isolation, Form 2 under the above Order was served on the owner ordering the animal to be confined for 10 days. Psittacosis or Ornithosis Order 1953 Reports were received in two instances of persons suffering from psittacosis in the Boroughs of Tower Hamlets and Hammersmith. In each case the person concerned had recently purchased parrots. The necessary action was taken and the Ministry of Agriculture, Fisheries and Food advised accordingly. Slaughter of Poultry Act 1967 This Act was passed in May but will not come into operation until a date appointed by the Minister of Agriculture, Fisheries and Food. Its main provision is that poultry shall be stunned instantaneously by decapitation or some kind of approved instrument. Although no poultry slaughtering takes place within the City of London, there are a large number of premises where poultry are regularly slaughtered in the Borough of Tower Hamlets for whom the Corporation act on an agency basis. Foot and Mouth Disease In view of the epidemic of the above disease which developed in Shropshire in late October and in an effort to prevent the spread of the disease the Ministry of Agriculture, Fisheries and Food declared the whole of England and Wales to be a "Controlled" area as from the 18th November, to be followed a week later by a further Order bringing the whole of Scotland within this category. The effect of the control is that all cloven hoofed animals could only be moved by licence issued by the Local Authority into whose area the movement is made, so that in effect all movements were recorded. 33 As the Corporation act, as agents under the terras of the Diseases of Animals Act 1950 for 18 London Boroughs, your Officers have been responsible for licencing such movements. From the 18th November to the end of the year over 900 licences have been issued. Mainly these were movements to slaughterhouse premises in Bromley, Bexley, Greenwich and Islington. Other movements have been for breeding etc. and it has been necessary for your Officers to visit premises to ensure that the terms of the licences so issued have been strictly adhered to. In addition to the above the Department has dealt with many enquiries from stock owners, police, etc., and on occasions have acted for the Ministry of Agriculture, Fisheries and Food at their request checking on the movement of possible contact animals. Staff changes comprised the retirement of Mr. V.O. Gubbins as Diseases of Animals Act Inspector in May on reaching the age of 65 years, the appointment of Mr. E.H. Kilby as a part time Inspector, combining this work with office duties and the engagement of Mrs. Scofield as a clerical assistant. I should like to take this opportunity of expressing my appreciation to all the staff for the very efficient way they have carried out their duties especially in view of the Foot and Mouth disease epidemic which entailed much extra work often carried out from their homes over the weekends. PERSONAL HEALTH AND WELFARE SERVICES IN THE CITY (Comparable figures for 1966 are given in brackets (where appropriate) The total number of births occurring in the City (St. Bartholomew's Hospital and domiciliary births) was 967 (973) Bitths (to City Residents) 1966 1967 Hospital Live Births 23 21 Domiciliary Live Births 3 2 Number of these born with congenital malformations 1 Nil Stillbirths 2 1 NATIONAL HEALTH SERVICE ACT, 1946 The Common Council of the City of London is responsible for services as set out in Sections 21 to 29 of the National Health Service Act, 1946. The Greater London Council is responsible for the administration of all ambulance services within the Greater London area 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 There were no (1) notified cases of congenital defects recorded during the year. Infum Deaths 1966 1967 Stillbirths Nil Nil Neo Natal 1 Nil Perinatal Nil Nil Others under 5 years Nil Nil Details of all deaths of children under five years who are not City residents are reported to the appropriate health authority and in the case of those living in Inner London, the Inner London Education Authority is also informed. 34 Maternal Deaths 1966 1967 Nil Nil Maternal and Child Care Clinic Attendance of Children under 5 years 1966 1 967 Attendances 754 553 Medical Examinations 286 266 Hearing Tests (Not 4 Phenylketonuria Tests ( Specified 20 Child Welfare Clinic Dr. A. White Franklin, Senior Paedriatrician, St. Bartholomew's Hospital and Paedriatric Consultant to the Corporation of London, reports as follows:— "The Child Welfare Clinic continues twice weekly at St. Bartholomew's Hospital. A reallocation of rooms has provided a small suite for the use of the Health Department, which facilitates the work carried out. New furniture and equipment provided by the hospital helps to create a less formal atmosphere which is much appreciated. Routine medical examinations are made of all children attending as well as phenistix tests for phenylketonuria and tests for early signs of deafness. The routine immunization procedures are accepted by almost all families. The numbers vaccinated against smallpox are not so satisfactory." (Infants are vaccinated at 1 year to 18 months of age. Many families move out of the City before the infants are at the age when smallpox vaccination is normally undertaken). Vaccinations and Immunisations at Child Welfare Clinic 1966 1967 Diphtheria/Tetanus/Whooping Cough 33 28 Poliomyelitis 35 16 Smallpox 15 12 At Risk Register 1966 1967 Children under 5 years of age 4 4 Day Nurseries Kingway Creche 1966 1967 City children in attendance at end of year 1 2 City children on waiting list Nil 1 Although the demand for nursery placements for children living in the City is small, we are grateful for the continued arrangements made by the Kings way Creche to accept such applications as vacancies allow. Registered Child Minders 1966 1967 Applications for registration Nil Nil Fireguards No requests for the loan of fireguards have been received from families with children under 12 years of age. Unmarried Mothers and their Children The Moral Welfare Worker has advised and assisted 40 (28) cases during the year, but no (2) cases were referred to the Health Department. City Workers 36 City Residents 4 35 Other referrals from outside the City were also helped. A total of 94 cases were assisted, 32 of that number being personal applications. Welfare Foods The sale of Welfare Foods continues at the Child Welfare Centre, St. Bartholomew's Hospital and at the Guildhall Health Department. SECTION 23 - MIDWIFERY SERVICE The Melropolitan District Nursing Association continues to provide domiciliary midwifery services in the City. There were two home confinements during the year. No requests for midwifery services within the Temples has been made. Midwives Act, 1951 The Corporation as the Supervising Authority for the City of London received 25 (27) notifications of intention to practise from midwives during the year. SECTION 24 - HEALTH VISITING Home visits to Children under 5 years 1966 1967 Successful visits 190 237 Unsuccessful visits 59 55 Primary visits to children under 1 year 26 17 In April 1967 theHealth Visitor resigned to take up an appointment in another London Borough. She was replaced by the appointment of an Assistant Health and Welfare Officer. In the following month an additional appointment of another Assistant Health and Welfare Officer was made. The liaison between the Health and Welfare Officers and the doctors of the one general practice in the City continues. Regular meetings take place and patients who need the supporting care of the health and welfare services are visited by the Assistant Health and Welfare Officers. In this way the services provided to aid the sick, handicapped and the elderly infirm, can be so devised as to give fuller benefit to individuals in specific need. In the field of maternal and child care, the health of the children under five living in the City is of a high standard. Home visiting gives the Assistant Health and Welfare Officers the opportunity to advise and teach health maintenance within the home environment. It also provides social contact and this is important as many of our families are a moving rather than a settled population. Tuberculosis Health Visiting 1966 1967 Cases notified (residents) 6 3 Home visits 27 5 Workplaces (offices and shops) are also visited to follow up contacts of cases among City Workers. 64 contacts were advised and arrangements made for themtoreceive medical investigation. SECTION 25 - HOME NURSING The home nursing service is provided by the Metropolitan District Nursing Association. General Nursing 1966 1967 Nursing visits 2668 2713 Number of patients at the end of the year 19 19 As follows:- Visits to children under 5 years 10 — Visits to age group 5 years to 64 years 232 208 Visits to persons over 65 years 2426 2505 Type of Nursing Care and Treatment Injections only 360 344 Injections plus nursing treatment — 12 Nursing care and treatment 2308 2357 36 SECTION 26 - VACCINATION AND IMMUNIZATION (See School Health Section for vaccination and immunization of school children) Adults Children under five years Smallpox 41(143) 15 (12) Poliomyelitis 16 (35) (primary courses and booster doses) Diphtheria/Whooping Cough/Tetanus 28 (33) (primary courses and booster doses). In accordance with Ministry of Health instructions that smallpox vaccine should be distributed to medical practitioners by the local Authority in whose area they practice, arrangements were made, commencing in June 1967 for the vaccine to be distributed to City doctors. Since that date until the end of the year 2,657 doses have been issued to private doctors, general practitioners, St. Bartholomew's Hospital, the medical department of Unilever, and various City business houses. Vaccine is also issued for the vaccination of trainee ambulance drivers at a City centre. Poliomyelitis vaccine is also issued at the request of St. Bartholomew's Hospital, Unilever Ltd., and City medical practitioners. In all 3,260 (2,580) doses were issued. 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 AFTER CARE The City of London Chest Clinic is incorporated within the St. Bartholomew's Hospital Chest Clinic and so provides services for investigation and medical treatment for a wide range of diseases of the chest. To supplement the medical treatment and advice given to patients by the Chest Physician and his Assistant, an Assistant Health and Welfare Officer is in attendance to provide health teaching and social advice for City residents and City workers. All other patients are referred to the Hospital Medical Social Worker. Examination and screening of City workers who have been in contact with the disease in their workplaces continues to be a preventive function of the City of London Chest Clinic. 64 contacts were examined. None was found to have active Pulmonary Tuberculosis. Three new cases of the disease occurred among City residents and a further twenty five persons continued to receive treatment. Mass Miniature Radiography A Mass Miniature Radiography Unit of the North East Metropolitan Regional Hospital Board is now well established at Milton Court. Dr. D.J. Lawless, O.B.E., the Director of the Unit reports as follows:— "INTRODUCTION 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 55,056 persons were X-rayed. The unit also visited Fleetway Publications, Fleetway House, Farringdon Street, E.C.4. and 6,732 examinations were made on this visit. UNIT RESULTS During 1967 the Unit examined 38,798 males and 22,990 females, making a total of 61,788 — a drop of 190 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 1967 the totals examined are as follows:— 653,581 males and 424,380 females, making a grand total of 1,077,961. During 1967 twenty-eight cases (23 males and 5 females) with significant tuberculous lesions have been discovered, which gives an overall rate of .453 per 1,000 examinees. The rate of significant cases for men was .593 and for women .217 showing a marked drop compared with the rate for 1966 (males .893 and for women .627). The highest incidence of tubercle was in the "55-59" age group. 37 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. .898 per 1,000 compared with .317 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. Nine cases of carcinoma of the lung (seven male and two female) were discovered during the year — six 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 256 patients were directly referred to the Unit these did not produce any active cases of tubercle. 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 were referred to St. Bartholomew's Hospital, and the ready co-operation of Dr. N.C. Oswald and Dr. Graham Hayward is gratefully acknowledged. AMALGAMATION WITH UNIT 6B As from the 1st April, 1967 the amalgamated Units 6B and 6D came under the Thames Group Hospital Management Committee and the Administrative Offices are now at First Avenue, Plaistow, E. 13. The amalgamation has been accomplished very smoothly and my thanks are due to all concerned. The Regional Hospital Board have made modifications and additions to the Plaistow Headquarters to accommodate the joint clerical and administrative staff and the large amount of records. CONCLUSIONS Dr. W.D.R. Thompson, the former Medical Director of Unit 6D retired at the end of June. 1967, and in taking over the unit I have made no change as yet in the medical arrangements for disposal of cases, etc. All members of the staff have given loyal service and my thanks are due to them. I would like to 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 Thames Group Hospital Management Committee. FUTURE PLANS FOR THE UNIT There are no definite plans in view for any major alteration in policy, but consideration is being given to the provision of a regular service for men in the lung cancer age groups." Special Hostels for Tuberculous Men 1966 1967 Men resident during the year 2 2 Loan of Nursing Aids 1966 1967 Supplied by Health Department 14 33 Supplied by British Red Cross Society — City Branch 10 15 In general, small items are loaned from the British Red Cross Society, but in chronic illness many items of equipment are required over long periods. It has now been found necessary for the Health Department to purchase more general items of equipment as the demand increases. The Assistant Health and Welfare Officers check the articles on loan to patients in their own homes, to ensure that maximum advantage is obtained for the benefit of patients and relatives. The equipment is also checked to see that it remains safe and in a useable condition. Meals for Invalids and Sick Persons Meals and, in some instances, special dietetic meals are delivered five days a week by the Meals on Wheels service. Chiropody There is a continuous demand for this service and figures for the period are as follows:— 1966 1967 Domiciliary Treatments 122 151 Clinic Treatments 18 81 Salvation Army Surgery Treatments No clinics held 52 School Inspections No clinics held 135 Recuperative Holidays 1966 1967 Adults 2 2 Children Nil Nil Pads for Incontinent Persons No charge is made for this service, which greatly helps not only the person in need of them, but also the family and those providing nursing care. Incontinent I -aundry Service (Public Health Act, 1936). 1966 1967 Persons receiving service at end of the year 10 10 Items washed 4,395 4,886 Patients supplied with Incontinence Pads at end of the year 3 2 Arrangements have been made with the London Borough of Tower Hamlets for items to be laundered at their premises. A twice weekly collection and delivery service is operated by Corporation transport. Yellow Fever Vaccination The Corporation continued to supply yellow fever vaccine to the designated centre at Unilever House. As the Corporation is also the Port Health Authority for the Port of London arrangements have also been made for distribution to the Shipping Federation Medical Centres at King George V Dock and at Tilbury Dock. During the year 4,064 (3,166) doses of vaccine were distributed. International Certificate of Vaccination 1966 1967 No. authenticated 2,661 2,824 No. returned as doctor did not practice in City 70 40 V.D. Contact Tracing 1966 1967 Requests received for assistance in follow up City Cases Nil Nil Non City Cases 10 6 Health Education The field of Health Education has been extended during the year and formal and informal methods are being used. Talks to small classes of primary school children at Sir John Cass's Foundation School have been given and the children have shown much interest. These talks are given by the Assistant Health and Welfare Officer as School Nurse. Selected leaflets and posters on special aspects of health were circulated to Schools, Offices, Libraries and other organisations throughout the year. Much interest and support has been given to displays of posters and leaflets, particularly at the Citizens Advice Bureau Centre where posters are displayed in the windows and leaflets are obtainable inside the Centre itself. Many City workers visit the centre and frequent calls are made by the Organiser to replenish stocks of leaflets covering a wide range of health aspects. 39 Subject Place and Audience No. of Audience No. of Lectures Baby Care Expectant Mothers. St. Bartholomew's Hospital. 31 3 Emergency Home Care Course Corporation Staff C.D. Headquarters 83 13 Child Care Grammar Schoolgirls Duke of Edinburgh's Award Scheme. 92 6 Health and Hygiene Sir John Cass's Foundation School 107 4 The Health and Welfare Officer and her Assistants gave 51 (13) lectures during the year. I1 amily Planning Rent free premises are provided for the Family Planning Association at Milton Court where two lunch time and one evening sessions are held each week tor City Workers and residents. The Corporation met the cost of supplies and treatment for City residents referred on medical grounds. The following reporthasbeen 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 1967 there was a steady increase in the number of people using the Family Planning Clinic at Milton Court and in October a second lunch time session was started to be held on alternate Fridays. Altogether 105 sessions were held during the year and 606 patients made 1,582 visits. Many were young people coming prior to marriage or in the early stages of their marriage who attended with their partners and the clinic staff were very glad to welcome such couples. Of the 606 patients, 344 were new to the Family Planning Association (221 premaritals) 58 transferred from other clinics and 214 were old patients returning for check visits. The clinic doctors were ready to discuss with and advise patients on the most suitable method of birth control for them and of the new patients 140 were fitted with the cap, 193 prescribed oral contraceptives and 7 other methods. Four patients were referred to the Islington Family Planning Centre for the fitting of an inter uterine device. 162 cervical smears were taken during the year all of which were satisfactory. It is found that family planning clinics provide an environment in which those with difficulties are encouraged to discuss these with the clinic doctors. As much time as possible is given to patients in birth control sessions but where more help is needed with marital problems patients can be referred for consultation to the Islington Family Planning Centre where the Branch holds four sessions for psycho-physical difficulties staffed by specially trained doctors. Two such patients were referred during the year. We are pleased to present this report which shows a gradual and healthy consolidation of the clinic services throughout the year." 1966 1967 No. of sessions during the year 89 105 No. of new patients 271 344 Total visits made by new and old patients 1,407 1,582 No. of new City patients included above 28 23 No. of cervical smears taken 120 162 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 reporthasbeen received from the hospital on the work of the clinic during 1967:- "During 1967 - 591 (649) patients were seen. In one patient a positive smear was found suggesting an in situ carcinoma of the cervix and this was treated by total hysterectomy. Three patients had class 3 smears which were suspicious of malignancy. These were investigated and found to be not malignant. A number of abnormalities were discovered on clinical examination. 17 (22) patients had uterine fibroids, 3 (5) of whom required total abdominal hysterectomy and 2 (5) others had ovarian tumours which were treated surgically. 14 (16) patients had cervical polypi and 4 women were investigated for post-menopausal bleeding." The Medical Officer of one of the large Banks set up a cervical smear service for staff and in the latter three months of the year during which the scheme operated 110 examinations were carried out. One positive smear was found and the individual referred to St. Bartholomew's Hospital. MENTAL HEALTH ACT, 1959 and NATIONAL HEALTH SERVICE ACT, 1946 Mental Health Services Mental Health services in the City are provided on an agency basis by the London Borough of Tower Hamlets and the following information has been given by Dr. R.W. Watton, Medical Officer of Health of that Borough:— "City Courts Four (9) patients were seen at the Courts by the Mental Welfare Officer and escorted to mental hospitals. Police Cases One (8) patient dealt with by City Police pursuant to Section 136, Mental Health Act, 1959. 40 Two (—) patients dealt with by Metropolitan Police pursuant to Section 136, Mental Health Act, 1959. One (1) patient was seen at Liverpool Street Station at the request of the British Railway Police and returned to hospital pursuant to Section 29 Mental Health Act, 1959. St. Bartholomew's Hospital Fifteen (18) patients visited at request of hospital doctors and dealt with pursuant to Mental Health Act, 1959. Patients visited at Private Address, Office or Aboard Ship Fourteen (10 patients visited at the request of various agencies for investigation, action under the Mental Health Act, or follow-up. Psychiatric Recuperative Holidays One (1) patient enjoyed two weeks holiday at Heme Bay. Day Centre for Mentally ill and Psycho-geriatric Patients During the year, nine patients were introduced to, and started attendance at the Centre in Tower Hamlets. Length of stay ranged from one hour to one day. One patient attended from 8.9.66 to 27.6.6? leaving to return to full time employment. One patient attended from 19. 12. 66 to 10. 2. 67 of whom trace was subsequently lost. One patient attended from 25. 9. 67 to 20. 12. 67 leaving to resume full employment. One patient attended from 20. 3. 67 to 21. 7. 67 leaving to resume full employment Three patients are in regular attendance to date. A social Club operates-on Monday and Wednesday evenings for patients and their relatives or friends. Light meals and snacks are provided. The programme of entertainment and activities features Bingo, Records, Table Tennis, Darts, Billards, Film Shows, etc. A quiet room is set apart for those patients who prefer such environment. Outings are arranged when finances permit, by the organisation of Jumble Sales, etc. Persons maintained in Hostels At the end of the year one (2) patient was being maintained in a hostel at Corporation expense. Mentally subnormal in Community Care One (1) young patient was in receipt of community care and regularly seen by a mental health social worker. This child attends a Training Centre, and a Club for subnormals. Number of Mentally ill patients in Community Care Eighteen (13) such persons were in receipt of community care. Salvation Army Hostel, Middlesex Street, E.l. Twenty-eight patients were seen at the Hostel by the Mental Welfare Officer either for advice, action pursuant to Mental Health Act, 1959, for follow-up, Day centre Attendances, Psychiatric out-patient Clinics or recuperative holiday arrangements." Salvation Army Hostel — Weekly Clinic In addition to the report submitted above under the Mental Health heading, the following report is also made on the overall aspect of work with the residents of the hostel. The attendance of a Health and Welfare Officer and the Mental Welfare Officer at the Hostel continues at weekly intervals to coincide with the General Practitioner's Surgery. The number of men seeking advice regarding their health or social needs is increasing and more handicapped men are being assessed and registered. It is now easier to follow up the men requiring treatment at hospitals, particularly Chest Clinics. SECTION 29 - DOMESTIC HELP There was an increase in the total number of people receiving this service in 1967 from 56 on 1st January to 58 on 1st December. There were 12 new cases, all chronic sick, one under 65 years of age, but these were almost balanced out by the fact that 10 cases were removed for various reasons. No. of home helps employed on 31st December, 1967:— Full time 1 (2) Part time 8 (6) 41 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, 341 (452) visits were paid by the Metropolitan District Nursing Association Superintendant and Nursing Staff. 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's Foundation School). The school population is approximately 300. During the year the following school medical inspections were carried out:— Routine 86 (146) children inspected Special 75 ( 73) children inspected Re-inspections 52 (119) children inspected Comprehensive Health Survey 241 (743) children inspected Selective Survey 228 ( — ) children inspected School Dental Service (The statistics given here compliment the Dental Officer's Report). 1966 1967 Sessions at Dental Centre 118 71 New cases given appointments 270 253 New cases attended by appointments 158 212 On treatment cases given appointments 230 245 Emergency attendances — 3 Total attendances 372 452 1st inspections carried out at school 306 303 1st inspections carried out at clinic 4 4 Percentage requiring treatment 59. 7 53. 8 Dental Officer — whole time equivalent 0.17 0.25 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 1967, 5 (4) such clinics were held, and 17 (9) children examined. Audiometry During the year tests were held at the School with the following results:— Sweep Tests 1966 1967 No. tested 54 87 No. passed 51 80 No. failed 3 7 Pure Tone Tests of Sweep Test failures No. tested 2 3 No. failed (referred to Otologist) 2 3 Other Pure Tone Tests No. Tested NIL 3 No. Failed NIL 3 Vaccination and Immunisation of School Children 1966 1967 Poliomyelitis 52 63 B.C.G. School children NIL 110 B.C.G. Students NIL 112 Diphtheria, Whooping Cough and Tetanus 82 69 Infectious Diseases Reported from Schools 1966 1967 Chicken pox 3 9 Measles 3 1 Mumps 5 NIL Impetigo NIL 1 Conjunctivitis NIL 2 42 Chiropody service in School The Chiropody Clinic at Sir John Cass's Foundation School was started in April, 1967, but due to the School holidays the major part of the work was carried out in the autumn term. All the children at the school are seen individually so that their feet and footwear can be inspected—this procedure is to be repeated at regular intervals of 12-18 months to record any progress, regress or general change which might have occurred in the time elapsed since the previous inspection. Any treatment shown as necessary in the course of these examinations is carried out. The education of the children is in making them aware of their feet—they are given a general idea of the structure of the foot and its function as part of their bodies. At the same time a few of the more common conditions are dwelt upon so that they can recognize danger signals and seek further advice. Considering the number of adults suffering through sheer neglect and lack of common sense the plan seems to be working well in so far as the children are concerned. An average session consists of about 15-20 children who are seen by the Chiropodist who gives a short talk on the subject of foot health. Pictures are shown whenever possible, including some very good charts on the correct type and fitting of footwear. The need for the right shoe and sock measure is always greatly stressed. At this point questions are encouraged and although the standard varies according to the age groups, none the less there is always a great interest shown. Afterwards the children take off their shoes and socks and each one's feet and shoes are examined. A foot measure is used and details are entered on the child's record card as to the size of shoe he or she wears as opposed to what he or she ought to be wearing. Apart from any incipient deformity such as hallux valgus, clawing or burrowing of the smaller toes which can be detected on such examination, all the skin conditions come to be noticed. Thus, corns, callosities, verrucae and fungus infections can all be dealt with. It is unfortunate that even the former are met in the infant groups. The children found to be suffering from any of these complaints are treated accordingly and seen regularly until the condition is cleared. This does mean that a further 6-8 children arrive for treatment when the inspection of the "new" groups is over. There is no doubt as to the value of the project and a few points are mentioned below:— Most of the children are wearing shoes much too short (one, or often, two sizes). The inspections have resulted in parents coming forward and making enquiries as to what ought to be bought. It is not generally realized that children's feet grow at such different rates, that within 3-4 months a shoe can be completely outgrown. Also the elongation of the foot on standing and walking is stressed and parents are encouraged to go only to the shops where the foot is measured and the assistant willing to take enough trouble to find the correct fitting. The question of price does not arise, this often is paid for the style or name of manufacturer, though people still tend to think that because they have paid a lot the shoes must be satisfactory. The children themselves are really becoming more foot-conscious. This is shown by the fact that the older ones return weeks after they have been seen because they have noticed something which they have been warned about and they return for advice and treatment. Thus infections, for example, are caught early and prevented from spreading. Treatment The children are seen regularly and various conditions cleared without having to miss school to attend hospitals or private chiropodists. The children are not afraid and are interested, an attitude which it is hoped will always remain with them. By the end of the Summer term of 1968, all the children in the school will have been individually examined. Many have been treated for various conditions, advised as to other conditions and all will have benefited to some degree although this will only be shown by the state of their feet 10 or 12 years from now. None the less it is felt that they have a much better chance of good and healthy feet for having attended a chiropody clinic in their early youth. Statistics In the limited time that the scheme had to run in 1967, 7 sessions were held at the School and 135 inspections were made. 43 REPORT OF THE DENTAL OFFICER, CITY OF LONDON It would seem reasonable to hope that since the last report there might have been some improvement in the teeth of school children seen in this area, but regrettably there is none, and the position remains just as bad as it was a year ago. Inner London Education Authority Schools 52% of children in the 6-11 age groups were found, on inspection, to need treatment, and of the 5 year-olds (new entrants to school) no less than 50% needed treatment. Pre-School Children A larger number of pre-school children have been seen during the year as compared with the previous year, but again just under 50% of these children under 5 years of age needed treatment. A shattering thought that one out of every two of these babies needed treatment. This means that in spite of regular inspections and treatment, and in spite of increasing dental health education, the status quo is just about being maintained. The main answer to this very unsatisfactory situation is, alas, not difficult to find. The sale of chocolate and sugar confectionery rose from £291 million in 1961 to £340 million in 1966, an average of £7 per head of population. In 1966, 606,000 tons of chocolate and sugar confectionery was eaten or 7.6 ozs. per head. These figures do not include cakes, pastries and sweet biscuits, and consumption is still rising. To achieve these sales £7 million was spent on Television Advertising. Dental Disease is admittedly only a small facet of Man's Health problems, but it is still the world's most prevalent and widespread disorder, and is not self-curing like the common cold. Regarded economically it is the cause of millions of man-hours spent in treatment, quite apart from the pain, distress and disfigurement it causes. Prevention It is at last being realised in more and more countries that our main hope lies in prevention, and that our efforts to stem the still rising tide of dental disease can be little more than the Canute-like gestures of inadequacy. With our present state of knowledge the most effective weapons of prevention are:— (a) Dental Health Education This is the publicising by any means available, and particularly among the younger sector of the population, of the facts about oral hygiene and diet; i.e. correct methods of tooth and gum brushing, types of food to be encouraged and avoided and regular examinations of the mouth. A stepping-up of mass media publicity is what is really required to combat apathy and the £7 millions, mentioned above, spent on advertising by the sweet manufacturers. (b) Fluoridation of the water supply It has been shown repeatedly that if the fluoride content of water is maintained at the recommended level of one part per million that dental decay can be reduced significantly in children, by up to 50%, with consequent benefits in adult life. In spite of this tremendous aid to our problem, and although its introduction is slowly spreading across the world, particularly in the more socially advanced countries such as New Zealand and Holland, only a very small percentage of the water supply in this country is so treated. The factors relating to Dental Disease as set out above are a national problem, but there is no reason to suppose that the position in the City as regards both adults and children is any different from elsewhere. It will no doubt be asked what can be done locally to reduce or even contain the incidence of the disease. (1) Dental Health Education in various forms is being stepped up but its impact will inevitably be gradual. (2) Fluoridation of the water supply at an effective level is non-existent. It must be regretfully concluded that in the City the concept of preventive dentistry is simply not keeping pace with the rest of the world, and that we are in fact slipping back despite all the advances in dental science and technology since the last war. Adults, National Health Service Now that the recall system for routine checks has been operating for two years, it is encouraging to note that an increasing proportion of those seen require no treatment, and serves to emphasise that regular visits do bring rewards, apart from a sense of virtue to the visitor. 44 St. Bartholomew's Hospital Once again it is pleasant to record the excellent co-operation received from all departments, in particular the Dental Department. All patients who have been referred there for treatment for general anaesthetics, oral surgery, radiography or orthodontics have benefited tremendously from the skill, kindness and courtesy they have received. WELFARE SERVICES NATIONAL ASSISTANCE ACT, 1948 PART III Section 21 (i) (a)—Residential accommodation Residential care and accommodation is provided by the allocation of 15 beds in 'Hillside', 129 St. Johns Way, N.19. This large home owned by the London Borough of Islington is due for closure in 1973. Accommodation in small voluntary residential homes is also used for City applicants, but often it is difficult to obtain a vacancy and in some cases the urgency of admission to a home means a wide scale search for a placement. Arrangements have been made with the Salvation Army for a Home to be built in the upper floors of their new complex at Booth House, Whitechapel Road, E.l. This accommodation will be financed by the Corporation of London but organised by the Salvation Army as a voluntary home. It is planned to accommodate 40 men and some of the residents will be men from the Hostel in the City by recommendation from the Corporation of London Health and Welfare Department, while other residents may be accepted from elsewhere at the recommendation of the Salvation Army. '* Residential Accommodation for the Elderly. 'Hillside' 1966 1967 Persons accommodated at the end of the year 15 17 Voluntary Homes 1966 1967 Persons accommodated at the end of the year 11 10 Section 21 (i) (b)—Temporary Accommodation for Homeless Families During the year the following cases were helped— 1966 1967 Families referred to the Department 8 Families comprising 32 persons 7 Families comprising 22 Persons Families (of those above) accepted for rehousing Nil Nil Other Homeless Persons given advice or referred to Hostels 4 6 Temporary Accommodation for Homeless Persons arising from a Peace-time Emergency. A Peace-time Emergency Plan has been drawn up and this would be put into action if such a disaster occurred. It involves the provision of a rest centre for persons rendered homeless. Voluntary organisations and the statutory services are thus organised to provide a necessary service for people in special need in an emergency. SECTIONS 29 and 30 Welfare Services for the Handicapped. 1966 1967 Blind 3 5 Partially Sighted 1 1 No. of people in Residential Homes for the Blind 1 2 Welfare Services for the Blind By agency agreements, the London Borough of Tower Hamlets provides a Welfare Officer for the Blind to visit registered blind and partially sighted persons resident in the City and to help them obtain those services which will benefit them both physically and socially. One man receives talking books and another was aided in obtaining a portable radio which has given him much pleasure. The Deaf and Hard of Hearing 1967 Deaf without Speech 1 Deaf with Speech 3 Hard of Hearing 5 45 Welfare Services for the Deaf and Hard of Hearing It has been difficult to know how many deaf persons reside in the City and to assess their special needs. It has taken longer to make contact with deaf persons and in the main their response to the offer of services is slower. They all appear to enjoy the social visits made by the Assistant Health and Welfare Officer. Handicapped Persons General Register 1966 1967 Under 65 years of age 27 17 Over 65 years of age 90 111 Welfare Services for the Aged and Infirm and Handicapped Persons There are very few severely disabled persons living in the City. The largest group of handicapped persons are those on the general register. There is a smaller group of 33 elderly and infirm who at the present time wish to be 'independent of welfare services' and who are visited from time to time. The visits are happily accepted with the assurance that if they need help they will notify the Health and Welfare Department. The Assistant Health and Welfare Officers have left each person a card with name, address and telephone number of the Department to use in an emergency. During the winter months, home visits increased in number to help the less mobile avoid the complications of the condition known as hypothermia— two such cases occurred during December. Many elderly and handicapped persons are receiving two, three or more of the services provided to help maintain themselves in their own homes. Home Visits 1967 Handicapped—general classes 319 Blind and partially sighted 7 Deaf and Hard of Hearing 5 Aged and Infirm 106 Visits in connection with applications for residential accommodation 41 Holidays for the Physically Handicapped Up to the present time, holidays for handicapped persons have been more suitably provided as recuperative holidays on medical recommendation. Sheltered Employment for the Handicapped and Elderly No requests have been made. Day Centres and Clubs Three elderly and infirm women attend the Day Social Club at St. Matthews Hospital twice weekly. All three are not entirely home-bound but are very limited in their activities. Library Service for the Homebound Persons In conjunction with the Principal Lending Librarian of the Guildhall Library, arrangements have been made for such a service and the Principal Lending Librarian reports as follows:— "This service which was inaugurated in co-operation with the City Lending Libraries has continued throughout the year. Residents who through old age or who are incapacitated are visited at three-weekly intervals by a senior member of the lending library staff with a selection of books. 17 deliveries were made in 1967 to an average of 12 readers per visit. No limitation is placed on the number of books that can be borrowed at a time and the amount obviously varies, from reader to reader, but in all 905 books were issued during the year. There is a demand for non-fiction as well as fiction and good use continues to be made of the large-print books specially provided for readers with failing sight. This is a small service, but one which is generally appreciated by the recipients, not least from the point of view of the 'Social call'. The pleasure it affords brings its own rewards to the library staff involved and the City Lending Libraries are glad to be able to co-operate in this venture." SECTION 31-MEALS ON WHEELS SERVICE The arrangements for providing Meals on Wheels five days a week from the Staff Association Luncheon Room Continues. At the end of the year 1558 meals had been supplied and delivered. 46 On request, meals are also supplied from the Kosher Meals on Wheels Service and 364 meals were served during the year. The British Red Cross Society (City Branch) The Branch Director of the above Society has kindly provided a member of the Branch to act as escort on the journeys to and from St. Matthews Hospital Day Social Club and also to assist with the delivery of Meals on Wheels. This help has enabled our services to run more smoothly. CORPORATION STAFF 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 Health Department in 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 148 members of the staff had their eyes tested, 51 of these had not previously had an eye test under the National Health Service and 45 were found to have visual defects which required correction and were supplied with spectacles. 97 had been examined previously and were already using spectacles. Of these, 76 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 641 persons were medically examined. The reasons for medical examinations are shown in Table I. 387 persons were medically examined for admission to the Superannuation Scheme; 2 were rejected as unfit and 7 were deferred. 51 persons were medically examined owing to prolonged absence on sick leave. At the time of examination, 19 were reported as fit for duty, 28 were reported unfit for duty, and 4 were reported unfit for further service. 99 persons who had reached retirement age were medically examined and all were reported as fit to continue in the Corporation's service for a further 12 months. 42 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 56 persons were examined in connection with applications for exemption from parking fees. 13 candidates for teaching, canteen and other posts were X-rayed and all were reported as showing no abnormality of the lungs. TABLE I Medical Examinations Reason for Examination Result Male Female Total Admission to Superannuation Fit 241 137 378 Scheme Unfit 2 0 2 Deferred 3 4 7 Referred for Excessive sick Fit for Duty 18 1 19 Absenteeism or retirement Still Unfit 24 4 28 Unfit for further service 2 2 4 Over 65 years of age Fit 68 31 99 Unfit 0 0 0 Special 87 17 104 TOTALS 445 196 641 47 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1967 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 15 and under 25 years 25 and under 35 years 35 and under 45 years 4 5 and under 55 years 5 5 and under 65 years 65 and under 75 years 7 5 and upwards 1 2 3 4 5 6 7 8 9 10 11 12 13 All Causes 49 — — — — — 2 6 3 9 17 12 1. Tuberculosis,respiratory M 1 — — — — — — 1 — — — — F — — — — — — — — — — — — 2. Tuberculosis, other forms M 1 — — — — — — — 1 — — — F — — — — — — — — — — — — 3. Syphilitic disease M — — — — — — — — — — — — F — — — — — — — — — — — — 4. Diphtheria M — — — — — — — — — — — — F — — — — — — — — — — — — 5. Whooping Cough M —, — — — — — — — — — — — F — — — — — — — — — — — — 6. Meningococcal infections M — — — — — — — — — — — — F — — — — — — — — — — — — 7. Acute poliomyelitis M — — — — — — — — — — — — F — — — — — — — — — — — — 8. Measles M — — — — — — — — — — — — F — — — — — — — — — — — — 9. Other infective and parasitic disease M — — — — — — — — — — — — F — — — — — — — — — — — — 10. Malignant neoplasm-stomach M 1 — — — — — — — — — 1 — F — — — — — — — — — — — — 11. Malignant neoplasm-lung, Bronchus M 5 — — — — — — — — — 4 1 F — — — — — — — — — — — 12. Malignant neoplasm-breast M — — — — — — — — — 1 — F 2 — — — — — — — 1 — 13. Malignant neoplasm-uterus F — — — — — — — — — — — 14 Other malignant and lymphatic neoplasms M 4 — — — — — — 1 — 2 1 — F 2 — — — — — — 1 — — 1 — 15. Leukaemia, aleukaemia M — — — — — — — — — — — — F 1 — — — — — 1 — — — — — 16. Diabetes M 1 — — — — — — — — — — 1 F 2 — — — — — — — — — 1 1 17. Vascular lesions of nervous system M 1 — — — — — — — — 1 — — F 2 — — — — — — — — 1 1 18. Coronary disease, angina M 7 — — — — — — 1 — 2 2 2 F — — — — — — — — — — — — 19. Hypertension with heart disease M — — — — — — — — — — — — F — — — — — — — — — — — — 20. Other heart disease M 3 — — — — — — — — 1 — 2 F 1 — — — — — — — — — — 1 21. Other circulatory disease M 3 — — — — — — 1 — — 1 1 F — — — — — — — — — — — — 22. Influenza M — — — — — — — — — — — — F — — — — — — — — — — — — 23. Pneumonia M 4 — — — — — — — 1 — 2 1 F — — — — — — — — — — — — 24. Bronchitis M 2 — — — — — — — — 1 1 — F __ — — — — — — — _— — — — 25. Other diseases of respiratory system M — — — — — — — — — — — — F — — — — — — — — — — — — 26. Ulcer of Stomach and duodenum M 1 — — — — — — — — — 1 — 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 — — — — — — — — — — — — 32. Other defined and ill-defined diseases M 2 — — — — — 1 — — — — 1 F 1 — — — — — — — — 1 — — 33. Motor Vehicle Accidents M 1 — — — — — — — 1 — — — F — — — — — — — — — — — — 34. All other accidents M — — — — — — — — — — — — F — — — — — — — — — — — — 35. Suicide M — — — — — — — 1 — — — — F 1 — — — — — — — — — — 36. Homicide and operations of war M — — — — — — — — — — — — F — — — — — — — — — — — — TOTALS. M 37 — — — — — 1 4 3 7 13 9 F 12 — — — — — 1 2 — 2 4 3 49 INFECTIOUS DISEASE Notifications received: — City Residents Non-Residents Total 1966 1967 1966 1967 1966 1967 Dysentery 3 0 5 9 8 9 Food Poisoning 0 0 1 18 1 18 Measles 4 2 4 3 8 5 Ophthalmic Neonatorum 0 0 0 2 0 2 Puerperal Pyrexia 0 0 7 14 7 14 Pulmonary Tuberculosis 4 7 0 0 4 7 Tuberculous Pyelonephritis 0 0 1 0 1 0 Whooping Cough 0 1 1 1 1 2 Total 11 10 19 47 30 57 NEW LEGISLATION DURING THE YEAR The following enactments, which effect the work of the department, were made during the year:— The Artificial Sweetners in Food Regulations, 1967. The Canned Meat Product Regulations, 1967. (Date of Commencement — 31st May, 1969). The Coffee and Coffee Product Regulations, 1967. (Date of commencement - 4th January, 1971). The Food (Control of Irradiation) Regulations, 1967. The Ice-Cream Regulations, 1967. (Date of commencement — 4th January, 1971). The Importation of Carcases and Animal Products (Amendment) Order, 1967. The Labelling of Food Regulations, 1967. (Date of commencement-in so far as they apply to any food (other than a soft drink) containing calcium cyclamate, sodium cyclamate or cyclamic acid or any mixture of two or all of these substances on 1st January 1968; and in all other respects, 4th January, 1971). The Margarine Regulations, 1967. (Date of commencement — 4th January, 1971). The Meat Pie and Sausage Roll Regulations, 1967. (Date of Commencement — 31st May, 1968). The Merchandise Marks (Imported Goods) No. 7 Order, 1934 Amendment Order 1967. (Date of Commencement — 20th March, 1968). The National Assistance (Charges for Accommodation) Regulations, 1967. The National Health Service (Family Planning) Act, 1967. The Sausage and Other Meat Product Regulations, 1967. (Date of Commencement — 31st May, 1969). The Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day) Order, 1967. The Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day No.2) Order, 1967. The Slaughter of Poultry Act, 1967. The Slaughterhouses (Hygiene) Regulations (Appointed Day) Order, 1967. The Slaughterhouses (Hygiene) Regulations (Appointed Day No.2) Order, 1967. The Solvents in Food Regulations, 1967. (Date of Commencement - 3rd November, 1969). The Solvents in Food (Amendment) Regulations, 1967. (Date of Commencement — 3rd November, 1969). PUBLICATIONS (1) Handbook of Poultry Inspection (2) Clean Food Handling. 50 Articles by the Medical Officer of Health:— ROYAL INSTITUTE OF PUBLIC HEALTH AND HYGIENE JOURNAL VOL. 30 No. 3 THE OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 by W.G. SWANN, M.D., D.P.H., D.P.A. (Medical Officer of Health, Port and City of London) Fourteen years after the publication of the Gower Report the Offices, Shops and Railway Premises Act, 1963 was given Royal Assent. It amends the Factories Act 1961 (1) and repeals the Offices Act, 1960 (2). The enforcement of the Act is divided between Local Authorities, Fire Authorities, H.M. Inspector of Factories, H.M. Inspector of Mines and Quarries and the Overseers of the Middle and Inner Temples. The Act sets standards for the safety, health and welfare of probably eight million employees in more than a million premises; approximately more than four times the premises covered by the Factories Acts. The following is a brief summary of the sections of the Act apart from registration dealt with by a Local Authority. PART I Office Environment The factors associated with the physical environment in offices include: Space, lighting, heating, ventilation, cleanliness and seating. The act deals with each as a separate entity and lays down the following standards: 1. Space. A minimum floor area of 40 sq. ft/person (or 400 cu. ft/person if the ceiling height is below 10 ft.) no allowance being made for furniture, fittings etc. (3). Also, within the above standards no room shall be so overcrowded as to cause risk of injury to the health of persons working therein. But in determining whether or not any room is so overcrowded regard shall be taken as to numbers of persons working in the room and the space taken by such things as furniture and fittings. 2. Lighting. Effective provision shall be made to secure sufficient and suitable lighting whether natural or artificial. General lighting by natural means for offices is on occasion inadequate in Britain, so that artificial means must be used. The standards required in various countries differ, ranging from 12-150 lumens/sq. ft. (4). In the United States of America where the lighting standards are based on the analyses of the process of vision, suggested intensities are 100-150 lumens/sq. ft. (5). Comparable figures in the United Kingdom are from 30-45 lumens/sq. ft. for similar tasks (based on a figure of 90-100 per cent visual efficiency). Research has shown that people feel most comfortable with a lighting intensity of 100-150 lumens/sq. ft. (In the City of London, Health Inspectors are recommending a standard for general office work of 60 lumens/sq. ft.). 3. Heating. The legal requirement of a temperature of not less than 60.8° F within one hour of commencement of work (with certain exceptions) (7) has been regarded as a major advancement in office standards. At present it would seem that it is more difficult in new office blocks to keep summer temperatures down to an acceptable maximum. 4. Ventilation. Every room shall have provision so as to be ventilated by the circulation of adequate supplies of fresh or artifically purified air. This in normal circumstances can be provided by the use of a window which opens. Complications may arise, when, because of traffic noise, or dust, the window will be closed. Thereafter some form of air conditioning becomes necessary. It is interesting to note that more and more office blocks are being designed with an integral air conditioning system to give more acceptable working conditions. 5. Cleanliness. The premises and all furniture, furnishings and fittings shall be kept clean and floors and steps must be washed effectively at least once weekly or they may be swept if this is as effective. In practice due to the problems of staff most occupiers contract with a cleaning company or leave the responsibility to their landlords. Up to the present time little difficulty has been experienced in enforcing this section. PART II Facilities. 1. Sanitary Accommodation. The Sanitary Conveniences Regulations, 1964 S.I. 1964 No. 966. These might be said to parallel in some ways legislation found under the Factories Acts since 1938 (8) but is of a higher numerical standard requiring in the first instance one water closet per 15 persons (of the same sex) (9) and continuing further up a scale in similar fashion. Here it 51 should be noted that if the number of people does not regularly exceed five (males and females combined) or each of the regular employees normally works on the premises for two hours or less daily, one water closet is sufficient. Similarly only one wash hand basin needs to be provided. Further the Regulation (9 (i) & (ii) ) specify that where the total number of females employed and for whose use sanitary accommodation is provided exceeds ten, then suitable means for the disposal of sanitary dressings shall be provided and suitably maintained. With this regulation it would seem that a definite advance has been made towards recognition of personal hygiene and it seems surprising that no parallel regulation had been added to the similar factory legislation which however is more specific with regard to the entrance to such sanitary accommodation in that the different sexes should approach their accommodation separately. Washing Facilities. Apart from the Food Hygiene (General) Regulations, 1960 S.I. 1960 No. 1601 (10) and a few factories where specific types of work are carried on which are covered by Safety, Health and Welfare Regulations (11), the Washing Facilities, Regulations, 1964 S.I. 1964 No. 965 is the first legislation which has applied generally to all classes of premises covered by an Act specifying scales of washing facilities and requiring one wash hand basin (or unit of washing fountain) per 15 persons in the first instance and then continues through a scale. The Act (12) goes further and requires not only a supply of clean hot and cold. or warm water but also soap and towe is or other suitable means of cleaning and drying. Section 11 requires an adequate supply of wholesome drinking water to be made available and as this is usually provided within the sanitary accommodation this section can most usefully be discussed here. Referring to the previous paragraphs it will be seen that all the facilities are made available for normal bodily functions and attendant personal hygiene whether they be used or not, but it is felt that the only satisfactory drinking water supply in sanitary accommodation is by a drinking fountain and not by the almost universal means of a tap over a wash hand basin, sometimes so placed that it is impossible to fill a normal size glass. It is usually agreed that the most satisfactory drinking water supply both practically and aesthetically is by means of a separate water cooler unit away from the sanitary accommodation. It should be noted that wholesome supply does not necessarily imply mains water, or even runni ng water. 2. First Aid. Section 24 of the Act states that there shall be readily accessible a first aid box or cupboard with a range of contents specified according to the number of employees. This can be found in Statutory Instrument 1964 No. 970 (13) and it should be noted that the dressings including adhesive dressings are all of the separate and sterilised type. It would seem probable that previously first aid boxes contained aspirin, cough medicine and similar medicaments rather that true first aid materials. If the employees number over 150 then a person trained in first aid should be in charge of one of the First Aid boxes required by' the Act at all times during normal working hours and to be covered during meal times, holidays and sickness; this would seem to require at least two persons and preferably three. When there are less than 150 persons a responsible person should be in charge and not as sometimes previously the office junior. First Aid rooms, where provided, should comply with certain minimum facilities and subject to Local Authority approval exempt occupiers from the statutory provision of first aid boxes. 3. Clothing Accommodation. Section 12 states that there shall be facilities to hang clothing not worn by employees when working and where reasonable and practical means for drying clothing must be supplied (14). Thus messengers, porters and persons working outside in inclement weather should not be in the position of having to put on wet outer clothing. PART III Safety 1. Floors, passages and stairs. Must be of sound construction and properly maintained, neither should there be any obstructions so that free movement is allowed as far as possible, the Act specifically mentions substances likely to cause persons to slip should be avoided. There must be provided handrails for staircases and where there are open sides balusters or other means to prevent people falling from the stairs. 2. Machinery. Every dangerous part of any machine shall be securely guarded to make the machine safe for every person working on the premises and if no fixed guard can be fitted a device must be fitted so that the operator is prevented from coming into contact with that part. Added to this there must be adequate supervision and training for operators of "dangerous" (15) machines. 52 3. Accidents. Any accident to a person happening in premises subject to registration and preventing that person from carrying out his normal duties for three or more days must be notified. This is to help the local Authority to detect breaches of the Act but mainly to enable inspectors to offer experienced advice to prevent their recurrence under similar circumstances. Long-term investigation statistics gained from notifications will enable the Ministry to assess the need for further preventive measures (if any). With regard to shop premises all the foregoing statements apply with the additional proviso that is shop employees eat meals within the shop they must have a suitable room provided for this purpose. REFERENCES (1) 9 & 10 Eliz 2. CH 34. (2) 8 & 9 Eliz 2. CH 47. This gave the Minister powers to make regulations for securing the health, safety and welfare of employees in offices — none were made. (3) These standards are not enforceable until 1st August, 1967 if at the date of commencement the premises were in use as offices and the same circumstances apply S.I. 1964 No. 191 (c.3) The Offices, Shops and Railway Premises Act, 1963 (Commencement No. 1) Order 1964 Part III. (4) Office design: A study of environment — Pilkington Research Unit Dept. of Building Science University of Liverpool SfB (92) UDC 725:23 1965. (5) Illuminating Engineering Society (of U.S.A.): lighting handbook (3rd Ed) New York 1959. (6) Illuminating Engineering Society: The IES Code. (7) Offices, Shops and Railway Premises Act, 1963 Section 6 (3). (8) Factories Act, 1937(1 Edw 8 & Geo.6 c.67)Section 7 and Sanitary Accommodation Regulations, 1938 S.R.O. 1938 No. 611. (9) S.R.O. 1938 No. 611 requires one water closet per 25 persons initially. (10) Made under the food and Drugs Act, 1955 4 Eliz 2. CH 16. (11) Made under various Factory Acts. (12) Offices, Shops & Railway Premises Act, 1963. Eliz. 2. 1963 CH 41 Sec. 10. (13) Shops and Offices — The Offices, Shops and Railway Premises First Aid Order, 1964. (14) Under sub section 3 the Minister may make regulations. This has not yet been done. (15) Machines specified by the Minister as dangerous — Shops and Offices. The Prescribed Dangerous Machines Order, 1964 S.I. 1964 No. 971. In "Ethical Responsibility in Medicine" by Edmunds and Scorer, published by E. & S. Livingstone Ltd., 1967. Chapter on "Responsibility in Preventive Medicine" by W.G. Swann, M.D., M.O.H., Port & City of London. The road to achievement in social and preventive medicine is not hard to see; to build it is quite another matter. Not only are there entrenched vested interests bestriding the primitive tracks, there is also the natural unwillingness of human nature to have to take the extra trouble needed. In addition, at some points, political, religious, social and individual freedom may seem to be, or actually is, at stake. Some authority and ultimately some person must take responsibility for the planning and carrying out of such measures as seem desirable. Therefore, before discussing the basic problems it will be necessary to outline some of the varied and complicated tasks which concern environmental and preventive medicine in this country, and to indicate who is primarily responsible for the applications. The fundamental aim of a reformer in public health is to alter the 'environment' of the social group whom he seeks to serve. This must be done in such a way as to rid that environment of what is injurious to physical or mental health or, alternatively, to add what will work effectively for health. The varieties and complexities which these alterations may take is best appreciated by summarising the work of a Public Health Department. THE SPHERE OF PUBLIC HEALTH Local Government through its many services works to protect people against all that might cause disease. In the environmental division of the Health Department the epidemiological section deals with the notification of disease, preventive immunisation and vaccination, control by quarantine of disease at ports, food hygiene in all its aspects, health aspects of housing and factories, smoke abatement, and such like. This work was traditionally developed in connection with the control of infectious disease, but modern epidemiology is equally concerned with non-communicable diseases in an endeavour to unmask the causative factors in the aetiology of diseases such as bronchitis, cancer and coronary thrombosis. The environmental work of the Public Health Medical Officer also includes the abatement of 'statutory nuisances', which means a concern for slum clearance and other housing problems, offensive trades, rodent and insect pest control. In addition, the Medical Officer of Health has powers and duties (under the Food and Drugs Act and subsidiary regulations) to ensure that food is of the nature, substance and quality demanded by the purchaser and that it is free from contamination and fit for human consumption. This has wide ramifications in the field of food production and technology, and concerns such commodities as meat, home slaughtered and imported; production, transportation, pasteurization and distribution of milk supplies; inspection of catering establishments and, in some instances, their registration; and many other aspects of food control dealing with labelling, preservatives and other permitted additives. The history of public health discloses many instances of the way in which disease has been controlled by altering the environment. The introduction of a pure water supply and of various water-borne sewage disposal systems led to the eradication of epidemics of cholera and typhoid in this country, even before the bacterial causation of these diseases was known. In traditional Public Health the practitioner was concerned primarily with material factors in the physical environment which should be eliminated, that is those which were injurious to health. The history of the conquest of infectious diseases in this country illustrates how harmful agents, which were a menace to the health of the public, were at first controlled and later largely conquered. The various statutory provisions for the control of the spread of infectious diseases encroached on the liberty of individuals because the welfare of the community as a whole was the overriding consideration. Doctors by law were and are required to notify certain infectious diseases—a responsibility which a few forget, even in this enlightened age! The Medical Officer of Health may become aware of the outbreak of communicable diseases and he then has the responsibility to determine the source of the infection bv epidemiological investigations. He seeks to discover the mode of transmission of the disease ana takes adequate measures to prevent its spread in the community. At this point the history of preventive medicine shows how necessary it has been to give powers to local authorities to limit the freedom of individuals. This has been done by restricting the movements in public places of persons suffering from notifiable infectious disease and, if necessary, by compulsorily removing them to, and retaining them in, hospital by a magistrate's order, for their own welfare or to protect the health of the public. This compulsion was extended into the realm of preventive treatment as in the case of vaccination against smallpox. However, where the directive involves the freedom of the individual and his right to refuse medical treatment, safeguards were introduced to allow for genuine conscientious scruples as well as exemptions on medical certification of conditions considered as contra-indications to vaccination. 54 Growth of Public Health The manner in which other injurious physical factors in both the social and working environment were dealt with in the early practice of public health and preventive medicine readily come to mind, such as improvement in housing by slum clearance and the planning of redevelopment schemes and improvement of working conditions in factories. So at present it may well be that the elimination of harmful agents from the air we breathe could have a similar beneficial effect in reducing the incidence of lung cancer. Who knows but that the introduction of smoke-controlled or smoke-free areas under the new powers given to Local Authorities by the Clean Air Act may reduce considerably this scourge, even before the research workers have discovered its specific cause? The evolution of public health measures naturally involves the further encroachment of central and local government by statutory powers into the realm of freedom of the individual. This limitation of freedom has been considered equitable in certain instances for the preservation of the health of the community. In fact, in certain instances this 'police-like' action has been necessary to save the life of a community when threatened by an epidemic disease with high mortality such as cholera or smallpox. Drastic measures, even those which we would today consider barbarous, were taken in certain instances. In this tercentenary year of the great plague of London one recalls that the Lord Mayor and Magistrates attended to the cleanliness of the city and the relief of the poor so that there was little or no actual want. But the administrative measures, carried out with the best intentions to limit the spread of infection, in fact led to further dissemination of the disease. One house after another was shut up with all its occupants inside. Thus each became a focus for further spread of disease. This was followed by the marking of such houses with a red cross and the legend 'God have mercy on us !' No one would doubt the necessity for governments to have powers such as are given by the present-day International Sanitary Regulations to control by quarantine the spread to other countries of diseases such as smallpox, cholera, plague, yellow fever and typhus. Thus it is that controls which were at first introduced by individual States for self-preservation or protection have become adopted internationally. This unification of the world by rapid transport has its dangers and so legislative means to protect nations against the importation of dangerous epidemic diseases are justifiable. THE MEDICAL OFFICER OF HEALTH'S RESPONSIBILITIES The Medical Officer of Health is appointed by a local authority and he is granted certain statutory powers and given duties to perform. The terms and conditions of his appointment are even to some extent circumscribed by legal requirements. For example, he enjoys security in his tenure of office whereby he cannot be dismissed without the concurrence of the designated central government department and only then after due enquiry. The Public Health Service, in which the Medical Officer of Health holds a full-time salaried appointment, was the first sector of the medical profession to come under State authority as a 'servant'. However, subsequent to 1948 with the introduction of the National Health Service, practically all doctors in this country are engaged in, and receive remuneration to some extent from State appointments. The relationships of a doctor practising in a State-run Health Service give rise to many specific responsibilities which he did not previously encounter when he was engaged in private practice. An attempt will be made to define and illustrate some of these responsibilities in relation to the work of a Medical Officer of Health. The duties of a Medical Officer of Health are largely laid down in Acts of Parliament or subsidiary rules, orders or byelaws and they determine the functions of the employing authority. So whether it be the abatement of a statutory nuisance, control of an outbreak of smallpox or the provision of a domiciliary midwife for the home confinement of an expectant mother, all stem from statutory powers or duties. The Medical Officer of Health is not solely responsible for environmental health. Every doctor to some extent is engaged in this work. A practitioner, as he seeks to treat his patients, may become aware that there are diseases in which the patient's environment constitutes some specific adverse factor. This factor may be physical, psychological, social or spiritual in nature. He may discover an allergen in the home environment which is causing his patient's asthma. The industrial medical officer may find that the worker's dermatitis is due to the irritant effect of the material he handles in the factory. The psychiatrist may discover that the underlying complex of an anxiety neurosis consists in his patient's repressed hatred of someone. How important in our environment are the people whom we meet each day! Maladjustment in personal relationships has been shown to be one of the main causes of mental illness. The M.O.H. recommends to the local Health Committee how best to help the people in the area. These duties extend beyond the elimination of harmful agents from the environment to the attempt to contribute directly to the health of individuals. An example is the introduction of various schemes of immunisation against specific infectious diseases such as diphtheria, poliomyelitis, whooping-cough, tetanus and tuberculosis. These schemes followed compulsory vaccination against smallpox but were voluntary, both for parents and children. Those immunised obtain active immunity, and if a sufficient number of the population are protected, the disease can be eliminated from the community giving protection to all. 55 Fluoridation of Water As an illustration of another measure contributing to the health in the community, the fluoridation of water may be cited. This matter is of great topical interest at the present time. The addition of fluoride to a water supply to bring it to almost 1 ppm. will help to prevent dental caries in children. All evidence, such as it is, recommends it as a desirable measure. Some consider that once the Medical Officer of Health has satisfied himself about its value, this is the end of the matter. He must, of course, be fully convinced that it is a safe procedure. The British Medical Officer of Health is merely a professional adviser on the scientific aspects of the problem. There are other ways of looking at it. For example, a recent annotation in The Lancet stated 'passion has entered into the controversy over fluoridation because it is a measure that restricts the liberty of the individual and none can doubt that this is worth caring for deeply.' The Medical Officer of Health, who is very much aware of this, may consider that his scientific recommendation is inadequate, and feel it is his duty to incorporate other considerations in his report. At the present time the Medical Officer of Health is besieged by propaganda with such titles as 'M.O.H. morality'. In this it is stated 'it is hoped that this article will cause some M.O.s to examine their own consciences and to decide whether or not they are living up to the high standards of their profession.' So it is obvious that some consider that there is an ethical factor to be considered and that the recommendation to add fluoride to the public water supplies cannot be based on scientific evidence alone. The opponents of fluoridation complain that the process involves forcing fluoridated water upon them without respect of their personal freedom. This complaint may still be validly made even by those who are convinced that the addition of fluoride to 1 ppm. is beneficial to children's teeth and is safe as far as the general public is concerned. They argue that in principle it is wrong to add this substance to a water supply and force the whole community to drink it. By adding it to the water it makes it well nigh impossible for those who wish to refrain from drinking such water to be able to do so. This is a denial of personal freedom, they say. Worse may follow. Some have suggested that since 90 per cent of the community is receiving barbiturates or tranquillisers under the National Health Service, a trace of a suitable drug could be added to the water supply to achieve the same result, irrespective of a minority who object to this encroachment on their personal freedom! Such views are honestly held and, in so far as they are, they deserve respect and rational consideration. Is it the responsibility of the Medical Officer of Health to incorporate advice in his committee report as to what he considers the correct attitude in this matter? If so, this involves him in taking a personal position in relation to what he considers to be the liberty of the subject, and a definition of his understanding of the rights of free citizens living in a democratic community such as ours. Some are arguing that though the majority vote must rule in democracy, yet there are realms where the State has no right to intervene and to impose its will on the minority. Most of us will agree that this is so in matters of conscience and religious belief, and that the essence of democracy is the maintenance of personal liberty. There are, however, those who believe that fluoridation of the public water supply is one of those realms, and so should be resisted obstinately. They believe that a surrender in principle means opening the door to the limitation of personal freedom by the State. Water is essential to life, so they argue that no option is left for the individual but to consume it. It is practically impossible to remove fluoride completely from the public water supply by filtration. There is a great difference between being compelled in some respect and being disturbed or inconvenienced. The freedom of the individual to act as he or she chooses is limited by the interest of the rest of the community. In other words, in the exercise of his freedom he must have regard to the like liberty of others, otherwise there would be disorder and anarchy in society. Freedom is relative and qualified. The individual may do or say what he pleases, provided he does so without transgressing the law or infringing the legal rights of others. Likewise public authority can only do what is legally permitted; it cannot interfere with the subject. The subject has liberties which are not expressly defined in any code of law, and there are some matters in which he does not possess guaranteed rights. Parliament is the lawmaking authority where the view of the majority prevails. In the modern world central and local government are taking more and more responsibility in the social and public welfare of the community. This legislative encroachment curtails the action of the individual. In public health, as the knowledge of preventive medicine increases, measures are increasingly enacted which the majority considers to be for the public good. In this way freedom of action of the individual is further curtailed. In the final result only a few fundamental rights may remain as ultimately sacrosanct, such as the peaceful enjoyment of property or freedom from illegal detention. 56 In the matter of fluoridation of water supplies, some opponents have contended that it compels people to take a form of medication contrary to their religious belief, or that it deprives them of the right (as part of their personal freedom) to safeguard their health in the way they consider best. Religious freedom embraces freedom of belief and freedom to act in accordance with one's belief. Freedom of belief is absolute but the second, that is, freedom of action, can only be exercised in conformity with the law. For example, certain sects may regard polygamy as a religious duty, but the State may punish it as a crime. During prohibition in America, the Federal Government had authority to limit the quantity of wine that could be used for sacramental purposes. DIRECT AND INDIRECT COMPULSION Again, in consideration of constitutional rights of freedom it is important to distinguish between direct compulsion upon the individual as, for example, the compulsory vaccination against smallpox, with penalties for violation of the law, and those which are indirect, such as fluoridation, which is incidental to a publicly provided water supply. A citizen is free to drink whatever water he pleases, but in contrast the law takes action if he drives on the righthand side of the street. A public utility, such as a water supply, which i s provided democratically by law, does not give an individual or a minority the right to dictate how the water authority will provide the supply, so long as it acts within its statutory undertaking. Such persons are riot compelled to drink the water supply, though it would be difficult for them to obtain an alternative supply. It must, however, be remembered that it is provided as a public utility service and is not, in this sense, like the air we breathe. Individuals possess an obvious right to water as one of the essentials of life, but that is not to say that they have an equal right to receive it from a man-made system or without interruption in unlimited quantities and of the nature and quality to suit their individual requirements or tastes. If some persons in such a community combined to provide a public supply, but they were outvoted, it could not be argued that their rights were not protected because they were deprived of the water supply they wanted. Persons receiving water from a public supply system, whether the water is fluoridated or not, are in no worse position than those who receive none at all in this way. Other opponents contend that fluoridation of water supplies compels them to take a 'form of medication' or 'compulsory mass medication'—terms which have gained an emotional content often irrespective of what they mean. The argument here largely hinges on one's conception of what a medicine or medicament is. According to dosage, mode of administration and other circumstances, a substance can be a nutrient, a medicine or a poison. Amounts of vitamin D are needed as a nutrient to promote health and lack of this vitamin leads to the development of rickets. The rickets can be cured by supplying the appropriate dose of the vitamin as a medicine. This dose is in excess of the minute quantity required as an accessory food factor or nutrient to prevent the condition. In still larger doses vitamin D can be poisonous, causing abnormal calcification of bone, and even be fatal. This can be true even of pure water itself. Again, small traces of iodine are essential to health. In districts where the water supplies are deficient, goitre occurs. This deficiency can be made good by supplying iodine in minute amounts as an addition to table salt. An appropriate dose of iodine can be used as a medicine, for example, as Lugol's iodine, or as an antiseptic tincture of iodine, whereas the consumption of iodine in still larger doses causes iodine poisoning. Similarly fluoride is an essential of human teeth and bone. In areas where the water supply is naturally deficient in fluoride, dental caries in children is greater than in those with approximately 1 ppm. fluoride in the water. In an area where fluoride occurs naturally, in a higher concentration, for example 8 parts per million, the mottling of dental fluorosis is found in children's teeth. Fluoride taken in larger doses would cause acute or chronic poisoning depending on the dosage and mode of administration. Such a consideration of the matter may well lead to the conclusion that fluoride taken in a water supply of 1 ppm. is more properly described as a nutrient than a medicament. It is found in trace amounts in a number of foods. Many opponents of fluoridation of the water supply are actually drinking water which contains fluoride naturally. It can be argued with equal validity that if such individuals regard the question as an important one, they should be prepared to seek unfluoridated water rather than impose their preferences of this kind of water on a whole community. In exactly the same or similar ways the problems of the introduction of smoke control areas, accident prevention, increasing drug addiction, and many other causes of, mental and nhvsical ill Health in the community are to be analysed. The detailed problems of adjusting corporate responsibility to personal liberty are legion. They go right to the heart of the matter of how far the State, besides eliminating evils, can promote the positive good of the community. The concept of the State as the source of comprehensive welfare causes to loom large the spectre of "interference" in the family, and other 57 similar 'interferences', until the Totalitarian State takes over. Any large impersonal concept of welfare easily lends itself to one 'Big Brother' (or a number of Big Brothers) watching over you to such an extent that they eventually take over everything that matters in shaping the individual's life. It will always be in ways which seem good to themselves. Preventive and Social Medicine may well prove to be the most innocent—or innocent looking— of all forms of the roads to Totalitarianism. The question of fluoridation of water supplies is also complicated by the fact that the areas of more than one local health authority are usually supplied by one water undertaking. It will be necessary for all the local health authorities supplied by each undertaking to agree to the procedure before fluoridation is introduced. Alternatively government action by Act of Parliament may enforce fluoridation universally. A Medical Officer of Health may well find himself in a situation, such as in the City of London, where the resident population is about 5,000 and the number of children involved is comparatively small. The answer in this case may be to give fluoride tablets to the small group who will benefit. Some say that mothers cannot be expected to give tablets to young infants and children over a period of years regularly. This raises the question of motivation, a very popular one in the modern world of health education. A woman can be trusted to take contraceptive pills regularly, as she is motivated by fear of pregnancy, but not to give tablets in an endeavour to prevent caries in her child's teeth, out of consideration for her child's well-being in this respect. THE USE OF MASS MEDIA This brings us to what many consider the most important aspect of the planning of health programmes. It is true to say that opinions have largely become the facts in health education. Opinion polls are used to assess so-called needs or as measures to evaluate services provided. These opinions obtained by postal or personal questionnaires replace the older objective data of mortality or morbidity statistics of public health. Such sociological enquiries seek to discover causes of motivation. It is considered that one must seek to alter habits, but influencing motives often may be at the expense of reason. Exhortation is considered to be ineffective and the modern advertising techniques by pamphlet or television employ such other devices. Surely there is a responsibility to ensure that such brain-washing techniques are used honestly and truthfully in the service of health education, and that the means employed are as worthy as the ends to be achieved. Methods should not be used which influence action without the rational consent of the individual and his willing acceptance of the benefit offered. 'Dogooders' can be a real menace in public health or social work if they intrude upon the sanctity, right or freedom of the individual against his will. The employment of a mass medium such as television or the methods of mob psychology to sway people to do what authority considers to be for their good opens the door to the misuse of their powers, and the eventual elimination of the freedom of the individual. This is a real danger, especially in the field of mental health. SOME CRUCIAL CONSIDERATIONS This whole subject of corporate responsibility in relation to Preventive Medicine involves all the basic principles of the theory of the State, the extent to which it should interfere and the age-long uneasy association between corporate action and individual freedom. Not only so, but it involves also the difficult problem of how far the community may impinge on parental responsibility—even when it seems for their good. It involves the difficult sphere of the extent to which suggestive advertising and educative methods may be utilised to alter (against their will) the people's ways of living. In the last analysis the Christian doctor is bound to make radical judgments and choices. He believes and would argue that his experience confirms that Christianity in its ideal form offers a solution at every tum. If this be God's world, then the summum bonum is God's will for the State, the community, family, and the individual. The more we are able to approximate to the overall beneficent plan, and to extend its benefits to all concerned, the more such problems of individual liberty will be absorbed into the common good. The convinced Christian is compelled therefore to believe that he is working for the best of Medicine, the State, and the family, by seeking to conform to the Biblical Revelation. The corporate action of the State is then seen to be largely negative. It exists for the restraint of evil and the punishment of the evil-doer so that the individual can live in peace and responsible freedom. The Magistrate bears the sword for this purpose. He is responsible for the protection of persons and property in general. The ordinance of marriage preserves the sanctity of the family. Duties and mutual responsibilities are laid on parents and children, husbands and wives. The creational ordinances of work and appropriate 'Sabbath Rest' remain mandatory principles. The moral law indicates the priority of God in the life of the individual, the sanctity of human life and the right to property. It must be respected, There are other similar implications. In the Bible the Christian finds revealed to him the principles which are to guide him. In so far as these can be incorporated into modern living, he believes that the good of all will be advanced. 58 As a member of the Church, the Christian finds that he is taught an ideal which is spiritual and ethical. History demonstrates that progress comes from free voluntary institutions when they are protected by a strong State and inspired by a strong Church, which points to higher things. In so far as the members of the Church can demonstrate in their own lives something of the example of Christ, they are better able corporately to influence the moral standards and ethical ideals of the community in which they are placed. Its exceptional members, acting in the ways which a Shaftesbury or a Wilberforce would have done, may be in the vanguard of reforming movements and philanthropic progress. In this way some of the best service to the community has hitherto been assured. Political and social circles were leavened by those who proved to be the salt of the earth and the light of the world. When such private institutions have grown to strength and influence they have been replaced by the public and the corporate organisations. Hence, the best government and the most beneficent forms of progress are believed to come through gifted individuals, who have learnt the art of leading and governing. They need to be assisted and supervised by a small body of well-informed equals. Ultimately they must be controlled by an elected assembly, which adequately represents the community which is being served. 59 MINISTRY OF HEALTH LIBRARY LIBY. 15