2nd Copy LON 94 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1968 To be presented 19th February, 1970 STAFF (As at 31st December, 1968) Date of Appointment MEDICAL OFFICER OF HEALTH (for the Port and City of London) PRINCIPAL SCHOOL MEDICAL OFFICER AND ACTING CHIEF WELFARE OFFICER (City of London) SWANN, William George, M.D.,B.Ch., B.A.O., D.(Obst.) R.C.O.G.,, D.P.H., B.Sc., Jan. 1964 D.P.A., F.R.I.P.H.H. DEPUTY MEDICAL OFFICER OF HEALTH (for the Port and City of London) JONES, Dilwyn Treharne, B.S.c., 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 Edward 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.P., (Child Welfare Clinic) (Part time) Apr. 1965 DENTAL OFFICER WALLACE, Lionel John, L.D.S.,R.C.S. June 1965 ADMINISTRATIVE STAFF (for the 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., A.M.R.S.H. Senior Assistant May 1952 COLLINS, R.H., L.M.R.S.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 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 HEMING, R.G. First Class Assistant Aug. 1965 RUTTER, R.G. First Class Assistant July 1968 HADDON, D.M. First Class Assistant Nov. 1968 HAMBLIN, Mrs. I.H. General Grade Assistant Oct. 1957 FARRELL, R.G. General Grade Assistant July 1965 DOVE, Miss J.M. General Grade Assistant Mar. 1968 MORROW, Mrs. E.J.A. General Grade Assistant Mar. 1968 NEWSON, Miss J.E. General Grade Assistant June 1966 DUNN, Miss SwC. Shorthand Typist Aug. 1967 DUFFY, Miss A.M. Shorthand Typist Aug. 1968 PERKINS, Miss G.L. Shorthand Typist Aug. 1968 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 HADLEY, J.T. Senior Assistant (Diseases of Animals Act) June 1965 SCHOFIELD, Mrs, W.A.A. Clerical Assistant (Diseases of Animals Act) Aug. 1967 LYONS, Mrs. J. Clinic Clerk (Part time) Apr. 1965 HAMMOND, G. Senior Messenger Mar, 1968 LLOYD, H.T. Messenger/Driver Nov. 1968 LAMBERT, J.A. Messenger/Driver Nov. 1968 PLRLIC HEALTH INSPECTION STAFF THOMPSON, E., M.A.P.H.I. Chief Public Health Inspector Sept. 1948 FLYNN, M.J., M.A.P.H.L Deputy Chief Public Health Inspector July 1951 RILEY, J.H., M.A.P.H.I. Senior Public Health Inspector Aug. 1962 WELLDON, J.B., M.A.P.H.I., Senior Public Health Inspector Aug. 1962 A.R.S.H. SHEPLEY, H.L., M.A.P.H.I. Senior Public Health Inspector May 1964 HOARE, J.A., M.A.P.H.I. Senior Public Health Inspector May 1964 HUDSON, L.A., M.A.P.H.I. Public Health Inspector Apr. 1934 BAXENDALE, W.J., M.A.P.H.I. Public Health Inspector Jan. 1964 CORFIELD, D.F. Public Health Inspector June 1964 HITCHCOCK, D., M.A.P.H.I., Public Health Inspector Nov. 1967 M.R.S.H. MEANEY, T.B., M.A.P.H.I., Public Health Inspector Mar. 1968 F.R.S.H. PLUMMER, R.J.W., M.A.P.ILI. Public Health Inspector Apr. 1968 NUNN, B.L., M.A.P.H.I. Public Health Inspector Apr. 1968 WILLIAMS, A.G., M.A.P.H.I. Public Health Inspector May 1968 PAGE, G.L., M.A.P.H.I., Public Health Inspector July 1968 A.M.R.S.H. LINARD, W.E. Technical Assistant Mar.1968 FREEMAN, D.T.W. Technical Assistant Mar. 1968 2 MEAT INSPECTION STAFF LEE, W.R., M.Inst,M. Chief Meat Inspector July 1930 GARRARD, S.S., M.A.P.H.I. Deputy Chief Meat Inspector Sept. 1946 MORRIS, W.L. Senior Meat Inspector Sept. 1946 SEYMOUR, K.S., M.Inst.M., Senior Meat Inspector July 1935 M.A.P.H.I. WILSON, J.C., M.Inst.M. Senior Meat Inspector Jan. 1936 COX, J.T. Meat Inspector Aug. 1954 FIELD, H., M.A.P.H.I. Meat Inspector Aug. 1954 GINGELL, G., A.R.S.H. Meat Inspector Aug. 1954 PAYNE, B.G.F., D.F.C., Meat Inspector Dec. 1960 M.A.P.H.I. ELSEY, F.E., M.A.P.H.I., M.R.S.H. Meat Inspector Jan. 1964 BERNHARDT, D.R. Technical Assistant(Authorised) May 1931 HUDSON, R. Senior Porter May 1963 HEALTH AND WELFARE SECTION BENFIELD, Miss G.L.,S.R.N., Health and Welfare Officer Apr.1965 S.C.M., H.V., Nursing Admin. P.H. Cert., M.R.S.H. DOWD, Miss M.T.,R.F.N.,S.R.N., Assistant Health and Welfare Officer Mar. 1967 C.M.B., Part I, H.V. BERGSTROM, Miss S.M., S.R.N., Assistant Health and Welfare Officer Apr. 1967 S.C.M., H.V. MIMMS, 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 F.R.S.H. HAYHURST. R.J., D.F.C. Inspector Oct. 1964 KING, K.W. Inspector (Part time) Apr. 1965 GUBBINS, V.O. Inspector July. 1968 RODENT STAFF MASON, G.A. Foreman Rodent Operative Dec. 1946 BERRY, P.M. Rodent Operative June 1967 . PEGRAM, J. Rodent Operative Sept.1967 HARRIS, R.C. Rodent Operative Dec. 1967 KIDDY, J.E. Rodent Operative Sept. 1968 MORTUARY AND DISINFECTING STATION LAWRENCE, F.H. Superintendent of the City Mortuary May 1936 and Disinfecting Station SUNNICK, J.W.T. Disinfection Apparatus Attendant May 1950 MANUAL WORKERS 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) Jan, 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 CONNON,,W, (General Duties at Smithfield Market) Dec. 1968 PURL1C ANALYST WILLIAMS, H.A., Ph.D.(Lond.)., F.C.G.I., F.R.I.C., F.R.S.H., Jan.1958 3 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1968 To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. Guildhall. b.c.2. Telephone: 01-606 3030. My Lord Mayor Lady and Gentlemen, I have the honour to submit the following report on the work of my Department for the year ending the 31st December, 1968. I wish to express my appreciation of the collaboration and assistance rendered by the Ministry of Agriculture, Fisheries and Food, the medical and nursing staff of St. Bartholomew's Hospital, the staff of the other Corporation Departments and all those who have so generously and willingly helped in every aspect of the Department's work during the year particularly the Chairman, Members and Staff of the Port and City of London Health Committee. I have the honour to be, Lady and Gentlemen, Your obedient Servant, W.G. SWANN, M.D., B.Sc. Medical Officer of Health, Port and City of London. HOUSING Housing Acts 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:— 3 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:— 1 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 9. Number of inspections of housing accommodation:- 95 4 During the year 228 families were rehoused leaving 448 families on the Housing Register at the end of December, 1968. The first phase of the Middlesex Street Redevelopment continued and it is anticipated will be completed in the Spring of 1969 providing 21 flats and 9 shops. When completed the Redevelopment will provide a shopping and residential precinct of 181 flats and 38 shops. The first 107 flats in the redevelopment of the Barbican residential area were completed and work is in progress on a further 1,770 flats. EXAMINATION OF WATER SUPPLIES AM) SWIMMING BATH WATER Regular sampling of drinking water is carried out in the City in order to ensure its purity and potability, and of swimming bath water to ensure that proper bacteriological standards are maintained. At the present time, there are 282 deep wells in the City area; 114 of these are used for commercial and domestic purposes, and the remaining 168 are disused. Bacteriological sampling of drinking water is carried out on a routine basis, and samples are submitted to the Public Health Laboratory Service for analysis. 147 such samples were taken during the year, all of which 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. Six samples of water were taken for chemical analysis during the course of the year, following complaints to this department. Details of these complaints are enumerated below:— No. Source Supply Use Condition of Water Remarks 1. Drinking Point M.W.B. Drinking Clear, bright without sediment, odourless, colourless and tasteless. No oily appearance of surface. Water consistent with M.W.B. supply in City of London. Complaint of sediment and oily appearance. Not found in sample. 2. Coffee Vending Machine M.W.B. via Roof Storage Tanks. Drinki ng Bacteriological ly satisfactory. Chemically clear almost odourless but not very bright. Minute amount of sediment. Water consistent with M.W.B. supply in City of London. Storage tanks dirty and turbid affecting quality of water and require cleaning. 3. Drinking Point M.W.B. Drinking Bacteriologically satisfactory. Chemically clear, odourless. Normal colour and taste. Free from appreciable sediment. Consistent in character with M.W.B. supply in City of London. 4. Storage tank. Deep Well 320 ft. to water level. Drinking Bacteriologically satisfactory. High free residual chlorine accounting for unpleasant taste. Consistent in character with deep well, supply in City. Unpalatable due to over chlorination. 5. Well Deep Well 480 ft. to water level. Drinking Water brown and turbid, and deposited iron hydroxide on standing. Odourless and after filtration colourless and tasteless. Otherwise consistent in character with water from a deep well in the City of London. Removal of deposited iron by filtration or other means necessary before use for drinking purposes. 5 [???]No. Source Supply Use Condition of Water Remarks 6. Kitchen Sink. Deep Well Drinking Bacteriologically satisfactory. Chemically clear, bright, free from sediment, colourless and odourless. Taste consistent with deep well water in City of London. Consistent with deep well water in City. High proportion of mineral salts in this type of water account for difference in taste to that of M.W.B. supply. The difference might be noticeable to a person accustomed to the latter source. There are at the present time, three swimming baths within the City and samples of the water from these swimming baths are taken at regular intervals throughout the year. Fifty such samples were taken, three of which were found to be unsatisfactory. In each case the swimming pools concerned were temporarily closed down, cleaned, and were re-opened only after further satisfactory bacteriological examinations had been carried out. Tests of swimming bath water for the effectiveness of chlorination are made on the site, and of forty tests, all were found to be satisfactory. The Metropolitan Water Board have supplied the following Report:"1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1968. (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, 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 population supplied direct according to the Registrar General's estimates at 30th June, 1968, was 4,090. (ii) No houses were permanently supplied by standpipe. (d) No artificial 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 group) 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 below. (b) On account of their hardness content and alkaline reaction the Board's river andwellwater supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Special tests for lead have been carried out during 1968 on 100 pemises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. Two samples were collected from each premises; one was the first running of water standing in the lead pipe overnight and 6 the other was a sample of water after running the tap for a few minutes. The results are set out in the accompanying table:— Lead content of water from main taps in consumers' premises Lead content (mg/1 Pb) Samples of water standing in lead pipe overnight Samples of water after running the tap Less than 0.01 10 37 0.01 31 57 0.02 21 4 0.03 8 1 0.04 9 0 0.05 5 0 0.06 5 0 0.07 4 1 0.08 1 0 0.09 3 0 0.10 1 0 0.12 1 0 0.16 1 0 100 premises 100 premises The above results are very satisfactory and the figures are within the limits of the World Health Organisation European Standards for Drinking Water Quality. This states that the upper limit for lead in running water in the supply should not be more than 0.1 mg/1 (Pb); but where water undertakings continue to use lead piping the concentration of lead (as Pb) should not exceed 0.3 mg/1 after 16 hours contact with the pipes." <1 METROPOLITAN WATER BOARD — Water Examination Department BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1968 OF WATER SUPPLIED TO THE CORPORATION 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 1,931 10.8 99.79 100.0 Stoke Newington 257 18.9 100.0 100.0 METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF THE WATER SUPPLIED TO THE CORPORATION OF LONDON DURING 1968 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27 °C. B.O.D. 5 days at 20°C. Hardness (total) CaC03 Hardness (noncarbonate ) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as C1 Phosphate as P04 Silicate as Si02 Sulphate as SO4 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) R. Thames, South of River 156 0.023 0.081 4.0 1.22 271 73 4 22.9 5.3 33 2.0 10 62 0.30 0.02 0.1 14 7.9 560 Stoke Newington 52 0.014 0.062 4.8 0.69 308 78 5 29.9 5.2 40 1.7 10 66 0.30 0.01 0.1 7 8.0 630 8 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." NOISE CONTROL Undoubtedly the public are making known their views on noise in a more specific manner. Perhaps this is an instance of people being patient for a long time and then saying in no uncertain terms "thus far and no further". They have had enough of this type of encroachment into their lives. During the year, 380 complaints of noise were received and this necessitated 892 visits by the Public Health Inspectors. Many complaints related to noise occurring at night and during weekends. As in previous years, a substantial proportion of the complaints were of noise coming from building sites, demolition, civil engineering works, and office machinery, ventilation plants and computer cooling systems. It will be appreciated that the large daytime population of the City are often irritated or annoyed by the volume of noise already experienced in the congested environs of the City, and any additional clangour brings sharp reaction. It seems inevitable, apart from any action local authorities may have to take, that much more attention will have to be paid to the sound-proofing of offices and other buildings. Sooner or later it may be necessary to establish, even by resort to legal processes, that noise which is not considered a nuisance at midday can be a nuisance at midnight or at other times when residents expect to have some period of quietness. In some instances, particularly where statutory undertakers were involved and where the City Corporation had no legal powers, amelioration of noise nuisance was brought about by informal action by the Public Health Inspectors. COMMON LODGING HOUSES The one remaining common lodging house within the City is situated at 116, Middlesex Street. The premises are owned and managed by the Salvation Army. They are rather old, factory-type premises, adapted to their present purpose, and consist of six floors and a basement providing a canteen, and accommodation for four hundred men. A clothing store and laundry are also available. During the year under review, a small reduction of the number of beds has been made, because some accommodation on the first floor has been converted into open-plan units with room for six beds in each enclosure. The cleansing and disinfection of persons and clothing are carried out at the Corporation's Cleansing Station at Milton Court. The bathroom has been substantially improved during the year and with the adoption of improved cleaning measures, it is felt that better overall results will be shown. The Public Health Inspectors have carried out twenty-four inspections during the year and all matters relating to environmental health in these premises were dealt with by consultation with the authorities at the Salvation Army, whose willing co-operation with this Department is appreciated. OFFICES SHOPS AND RAILWAY PREMISES ACT, 1963 The year under review has been significant in showing a substantial increase in the number of inspections carried out under this legislation. This increase is most marked in the field of office inspections, the number being quadrupled over those of the previous year (2,209 in 1968 as compared with 549 during the year 1967). This is a direct result of the recruitment of additional staff. In all, the department carried out 3,141 general inspections, and a total of 8,095 visits of various kinds were made to registered premises. 9 The number of registered premises at the end of the year was 8,722 this owing to cancellations, being slightly less that the previous year. The number of new registrations during the year was 410 as compared with 317 in 1967, and although this is numerically greater, as a percentage of inspections carried out, it is 12% as compared with 30% in 1967. This tends to indicate that the total number of registerable premises in the City is about 11,500 as compared with the 14,000 registerable premises previously estimated. In the majority of cases it has been found that the simpler provisions of the Act give rise to the largest number of contraventions i.e. the want ofa firstaidkit, an abstract and/or a thermometer. A number of instances of overcrowding were found, usually relating to individual rooms but in a few cases relating to particular premises as a whole. In the latter case the firms concerned were usually aware of the problem as it impeded their own efficiency. As quite a number of accidents also appear to involve people either falling over, or after falling, striking against furniture and other fittings, it could indicate that the statutory standard might not be satisfactory. The standard laid down in the Act is (a) that each person shall have 400 cubic feet of air space, any height above 10 feet being disregarded for the purpose and no allowance being made for fixtures and fittings, or, (b) that, having regard to furniture, and fittings, machinery plant and other things, a room should not be so overcrowded as to cause risk of injury to health. In practice only the "400 cubic feet per person" standard can be effectively used and in some cases this has not in our view been found to be satisfactory. It is felt that the minimum square footage per person should be in the region of 50 square feet per person rather than 40 i.e. height above 8 ft. being discounted,, and an amendment to the existing legislation would be welcome. Heating and ventilation continue to be a problem particularly in buildings constructed for speculative purposes. With regard to heating it is usually a case of the temperature being too high rather than too low and the minimum temperature of 60.8 F. (16°C) has been achieved in all but a very few cases even in the severest winter conditions. The tendency not to have through ventilation in offices leads to an inadequate circulation of air. The Association of Heating and Ventilation Engineers have suggested standards of air change per hour having regard to the type of use to which rooms, or parts of premises are put, but these have not in all circumstances been found to be sufficient and so far there has not been a legal standard set. This year saw the publication of a local Authority Circular giving standards of lighting in registered premises according to the type of work being carried on there. The recommended levels are much below the values given by the Illuminating Engineering Society which are published in the same Circular. Past experience indicated that minimum standards usually tend to become maximum standards and as a result no doubt difficulty will be experienced in securing any improvement to lighting in registered premises particularly those of an older type. At the end of the year an Advisory leaflet by the Department of Employment and Productivity was produced giving guidance on the provision of washing facilities and accommodation for clothing. This will make the enforcement of these particular Sections of the Act easier in the future. Many instances are still found of office machinery being unguarded. Usually it is the hand operated knife guillotine which the main offender, but addressing machines, duplicators, etc. still account for a large number of contraventions. Many of these machines are available on the open market without suitable means of guarding. This appears to be a loophole in the legislation and it would be helpful if the Minister introduced Regulations prohibiting the sale, or letting for hire, for use in premises in Great Britain of such machinery without the relevant guard being attached. Section 20 (3) (c) gives him power to do this. The attitude of some manufacturers is that they will fit these safety devices as an optional extra but employers in general seem to be unaware that such machinery is intrinsically dangerous and a number of accidents still occur each year from the absence of effective guards. However, the Minister did make Regulations with regard to lifts and hoists in registered premises and these will come into full effpct in the early part of 1969. Lifts are usually inspected each year for insurance purposes and the insurance companies' maintenance or engineering departments will be given the power to carry out these inspections. If defects are found they will serve a copy of the report on the Local Authority who will ensure that the necessary repairs are carried out. The total number of accidents notified to the Corporation during the course of the year was 328. This is similar to the previous years and the majority of them were of a minor nature, again mainly due to people slipping on staircases and in passages. As a matter of interest a statistical analysis was made of such accidents and it was found that girls between the age of 15 and 20 and men of the age between 55 and 60 were particularly vulnerable age groupings. A distribution curve of accidents was also made and it appears that the majority of accidents occur in the afternoon rising to a peak round about 2.30 and again at 4.00 and just after 5.00 in the evening. The inference of the 4.00 to 5.00 p.m. peaks is obvious and there seems to be no easy answer to 'human nature. The 2.30 peak is interesting as there is no apparent reason why this should 10 occur, but two possible explanations are: (1) The drowsy feeling people tend to get after a reasonably large midday meal, or possibly the lack of it. (2) The fact that this is the period of the day when fatigue begins to set in. There was one fatal accident during the year. This occurred when a group of men were engaged on maintaining a lift at first floor level. A box of chains resting at 5th floor level came down striking one of the two men standing on the lift cage killing him instantly and injuring another. The increase in the amount of work carried out during the year made apparent several shortcomings in the existing legislation. Under the terms of the Act in accordance with Local Authority Circular Number 8, it is not necessary to report an accident occurring in the common parts of a shared office block although employers are encouraged to do so. Neither is it necessary for the employer to report accidents occurring to staff engaged on work away from the office premises, but as both the persons employed and the common parts fall within the main purview of the Act, this is an omission which should be remedied and the employers and/or owners required by legislation to report all accidents occurring within the curtilage of the premises and to staff employed by them on their official duties. There are several anomalies under the "definitions" in the Act. For example, a more suitable definition of the term "employed" could be embodied into the Act. During a recent inspection of office premises an employer claimed that a young lady of foreign extraction, engaged at the time of visit in typing, was not "employed" as she did not receive any salary, did not work any regular or fixed hours and resorted to the office where she carried out any typing works available purely as part of her programme for increasing her facility in the English language. In this specific case there was no infringment of the welfare requirements of the Act involved and the ensuing discussion was mainly of academic interest But as it can be readily envisaged that this situation could occur in other circumstances and having regard to the arguments that could be applied both for and against counting a person as being employed, a more suitable definition of "employed" could with advantage be incorporated into the Act. A further problem in this respect has arisen with the increased employment of temporary clerical staff. As a result of illness or the inability to fill vacancies, firms resort to agencies to carry out their work for them. This usually results in the clerical staff resorting to the registered premises and carrying on office work there. But they are not employed by the person who is required to register under the Act, and no money is paid to them, the fee being paid direct to the agency and the agency paying the employee's salary. As a result it could be said that the person working in the office is not employed by the person occupying the premises and therefore would not fall under the purview of this legislation. An interesting problem of demarcation also arose during the course of the year. A Public Health Inspector carrying out general routine inspections came across premises registered as an office which were in fact a non-power factory. As these office premises were inside the curtilage of the factory the responsibility for the inspection of the office premises devolved upon the District Factories Inspectorate. However, as it was a non-power factory, Sections 1-7 of the Factories Act, 1961 came within the jurisdiction of this Department. The Health, Safety and Welfare provisions of that part of the Factories Act and that part of the Offices, Shops and Railway Premises Act, 1963 are basically similar in regard to the provisions of sanitary accommodation, washing facilities, lighting, ventilation, drinking water, etc. Thus, in order to "have a look" at the wash hand basins in the premises which were shared by both office and factory staff, the Factory Inspector and the Public Health Inspector would each have to make a visit. This seems rather pointless in view of the local authority circular defining the terms of enforcement by the Factories Inspectorate of offices within the curtilage of Factories, and inspection of other offices falling under the purview of the local authority. In order to avoid just such duplication it is felt that this matter should be looked into more closely and an amendment made where appropriate. During the year there has been an increase in the number of estate agents, owners, employers of persons, consultant engineers etc., who have approached this Department with a view to obtaining prior approval of the intended works in order to secure compliance with the Act and a large volume of the Inspectorate's time has been spent on this aspect of the work. In order to make greater use of the Inspector's time a new and more abbreviated type of inspection form was devised in late 1968 and it is hoped to bring this into operation during early 1969 thus reducing the amount of work involved in the recording of defects and conditions of premises. It is hoped that the new format will help the Inspectorate to have in addition a clearer view of conditions as a whole in premises in multiple occupation. This year, more than any previously, the Inspectorate have been able to get to grips with the 11 problem of Offices, Shops and Railway premises in the City. However, as some five years have elapsed since the introduction of the Act and the attendant publicity at the time has died away, on initial inspection being made some difficulty is experienced in the educating of employers of persons, particularly those smaller companies who have not got access to large well-equipped administrative departments with the relevant knowledge of their duties to secure compliance with the legislation. The department is also hampered by the great deal of re-development which is occurring involving many older premises, the defects of which the owners or occupiers are reluctant to remedy, as the premises are likely to be re-developed within "a few months". However, the Inspectors are usually treated with a great deal of consideration and co-operation usually ensues and the department can look back with some gratification over this year's work. 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 264 6,399 2,209 Retail shops 76 975 344 Wholesale shops, warehouses 44 812 138 Catering establishments open to the public, canteens 26 536 450 Fuel storage depots NIL NIL NIL TOTALS 410 8,722 3,141 TABLE B NUMBER OF VISITS OF ALL KINDS (INCLUDING GENERAL INSPECTIONS) TO REGISTERED PREMISES 8,095 TABLE C ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES AT END OF YEAR Class of workplace Number of persons employed Offices 244,170 Retail shops 5,169 Wholesale departments, warehouses 6,375 Catering establishments open to the public 6,657 Canteens 4,369 Fuel storage depots NIL Total 266,740 Total Males 158,976 Total Females 107,764 Zl 13 HYGIENE IN HA1RDRESS1NG 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 51 inspections were made. As a consequence of these inspections it was necessary to serve 2 Intimation Notices. 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. During the year 68 hairdressers and barbers were registered in respect of their premises. FAC TORIES 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 73 (incl. 2 bakehouses) 125 10 _ (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 594 (incl. 2 bakehouses) 387 18 _ (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 155 76 — _ TOTAL 822 (incl. 4 bakehouses) 588 28 — 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.) 12 10 _ _ _ Overcrowding (S.2.) _ — — — — Unreasonable temperature (S.3.) — — — — — Inadequate ventilation (S.4.) 4 4 — — — Ineffective drainage of floors (S.6.) — — — — — Sanitary Conveniences (S.7.) (a) insufficient 7 5 — — — (b) unsuitable or defective 27 21 — — — (c) not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to Outwork) 38 28 1 5 _ TOTAL 89 69 2 5 _ 14 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.) 311 - - - - - TOTAL 311 - - - - - Outwork and the inspection of outworkers' premises etc. Lists received from City Firms employing outworkers 31 Names, and addresses of outworkers resident in the City received from other Authorities 10 Names and addresses of outworkers resident outside the City, employed by City firms, transmitted to other Authorities., 311 No case of infectious disease was reported in connection with outworkers' premises in the City. SAN ITAR Y CI RCUMSTANCES The general sanitary supervision has been maintained and in this connection 11,470 inspections have been made. As a consequence of these inspections, it was necessary to serve 470 Intimation Notices. Tenement Houses were inspected and the only common lodging house in the City was kept under regular supervision. ATMOSPHERIC POLLUTION City of London (Various Powers) Act, 1954 Clean Air Act, 1956 During the year 904 visits were made in connection with observed smoke emissions, routine boilerhouse inspections and the National Survey. Of these, 430 were carried out under the nuisance section of the Clean Air Act, 1956, mainly in connection with the burning of debris on sites where demolition is taking place and on building sites. The remaining visits were made as a result of observed smoke emissions and complaints and the necessary following up re-inspections. With regard to the contraventions of the City of London (Various Powers) Act, 1954 which stipulates that "no smoke shall be emitted from any premises in the City" the investigations showed that in many cases the smoke alarm equipment had not been effectively maintained or that the settings had been wrongly adjusted and informal action on the part of the Corporation Staff was sufficient to effect the necessary improvements. Smoke nuisances from the burning of debris, particularly by demolition contractors, do give cause for concern. Whilst the difficulties of contractors are appreciated, it must nevertheless be pointed out that the people in charge of the site operations will require to prevent this nuisance as the Corporation is amending its procedure in order that more rapid and efficient action can be taken against offenders. Measurement of Atmospheric Pollution The measurement of atmospheric pollution has continued during 1968. Daily readings are taken at the two volumetric stations to enable the concentration of sulphur dioxide to be found, by the volumetric measurement of sulphuric acid which is produced when air containing S02 is bubbled through a solution of Hydrogen Peroxide. Air is drawn from the atmosphere, though a filter paper, thus collecting small smoke particles. This produces a grey coloured stain which by its density can give the quantity of smoke in the atmosphere. 15 TABLE I The rainwater collected at Guildhall during the year was more than the average for the past five years. Whilst the insoluble deposits have increased, the soluble deposits have decreased, compared to the last five years. TABLE II The concentration of smoke recorded during 1968 was less than the average for the past five years. TABLE III There has been a very slight decrease in the amounts of SO2 averaged over the year and less than the average for the past five years. Under the amended Clean Air Act chimneys come within a stricter control with regard to their heights. The height of the chimney is related in terms of the dispersal of SO2, so that the sulphur content of a fuel becomes a significant factor in the design of chimneys. TABLE 1 — Results obtained in 1968 of the monthly observations of rainfall and deposited matter by means of the deposit gauge MONTH Rainfall collected in deposit gauge at Guildha11 DEPOSITS Equivalent to Insoluble Soluble Total Millimetres Inches of rain Tons per square mile January 64 2.50 23.89 10.37 34.26 February 26 1.01 32.87 21.58 54.45 March 24 0.93 32.70 4.35 37.05 April 42 1.66 19.37 6.87 26.24 May 48 1.90 13.44 6.10 19.54 June 54 2.13 39.32 6.93 46.24 July 67 2.63 13.09 5.99 19.09 August 87 3.43 23.24 8.18 31.42 September 145 5.73 14.03 10.36 24.39 October 64 2.54 15.69 7.83 23.52 November 42 1.64 13.13 8.90 22.03 December 69 2.71 15.59 8.76 24.35 Averages: 1968 61 2.40 21.36 8.85 30.22 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 1963-1967 48 1.91 16.76 10.91 27.67 16 TABLE II — Results obtained in 1968 of the daily observations of the concentration of SMOKE by the volumetric method MONTH Rainfall collected in deposit gauge at Guildhall Public Services Building Snow Hill Police Station Equivalent to Monthly Average Monthly Average Millimetres Inches of Rain Microgrammes per cu. metre Microgrammes per cu. metre January 64 2.50 77 80 February 26 1.01 69 75 March 24 0.93 44 50 April 42 1.66 47 36 May 48 1.90 36 27 June 54 2.13 30 30 July 67 2.63 27 23 August 87 3.43 25 12 September 145 5.73 34 39 October 64 2.54 61 59 November 42 1.64 73 59 December 69 2.71 91 84 Averages: 1968 61 2.40 51 48 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 1963 - 1967 48 1.91 73 67 TABLE III — Results obtained in 1968 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 64 2.50 404 443 February 26 1.01 397 447 March 24 0.93 303 328 April 42 1.66 291 301 May 48 1.90 209 218 June 54 2.13 136 154 July 67 2.63 142 111 August 87 3.43 124 84 September 145 5.73 206 157 October 64 2.54 280 245 November 42 1.64 369 305 December 69 2.71 467 368 Averages: 1968 61 2.40 277 263 1967 54 2.13 271 292 1966 49 1.94 284 328 (Golden Lane) 1965 54 2.12 286 341 1964 44 1.71 316 383 1963 41 1.63 300 345 1963 - 1967 48 1.91 291 338 17 RODENT CONTROL Prevention of Damage by Pests Act, 1949 Activity under this Act followed the well established principles, of, firstly, routine inspection of the district combined with following up complaints as received, and secondly, destruction of rats in the sewers. Resulting from routine visits and complaints, infestations requiring treatment were dealt with as follows:— House mouse infestations 738 Rat infestations (Major) 4 Rat infestations (Minor) 99 Total infestations treated 841 Infestations of rats and mice not requiring separate treatment 68 Number of baits laid in connection with house mouse infestations 10,070 Results of treatment- Bodies of house mice recovered 898 Bodies of rats recovered 224 Estimated kill of rats recorded by the amount of poison taken. 532 Total operational visits 4,909 All work was combined with advising occupiers on preventive measures including proofing and, particularly the protection of foodstuffs. Sewers Four periodical treatments were carried out in the sewers i.e. March, June, September and December. The June period required, as always, a test baiting treatment (which amounts to test baiting with a sausage rusk on a two day period) followed by poison being administered where takes were recorded. A total number of direct poison baits laid amounted to 1,096 in the periods March, September and December. Of the June pre-bait and poison period, a total of 358 pre-baits were laid comprised of wet sausage rusk. Of these, 53 were full takes and 24 were half takes. These takes were consequently replaced by poison baits. The poison used on all sewer treatments was Fluoroacetamide (1081). CITY MORTUARY Bodies received 174 Post Mortem Examinations made 174 Inquests on bodies 30 Inquests held at Holloway Prison NIL Inquests on fires 1 Inquests on Treasure Trove NIL DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, etc. Articles, by weight 1 ton 12 cwt. No. of articles disinfected 653,280 Cases of horsehair 164 Fees received £2,816 6s. Od. General Disinfection, Infectious Diseases, etc. Premises disinfected after cases of infectious disease NIL Lockers at Post Offices disinfected 14 Verminous premises disinfected 3 Beds and bedding disinfected 703 Cleansing of Persons No. of verminous persons bathed 639 No. of persons with scabies bathed 4 No. of articles disinfected 6,430 18 CATERING ESTABLISHMENTS Before establishing a catering business, application is made for planning approval and applications are referred by the City Architect to the Medical Officer of Health, with a view to advising the developers on whether the premises will be suitable from a public health aspect. Although this is purely an advisory service, it is useful to both caterers and the Health Department, in that future difficulties can be avoided by co-operative effort. During the year, 77 intending caterers obtained the advice of this Department before deciding to proceed with their ventures. OBSERVATIONS ON CATC RING ESTABLISHMENTS IN THE CITY OF LONDON Almost everything that can be usefully said concerning the hygiene of catering establishments has been mentioned in previous annual reports and has been written up at great length by many authorities. Nevertheless, one cannot escape the unpalatable fact that it is becoming increasingly difficult to ensure that even minimum standards of cleanliness are maintained in some City restaurants. The cleaning of both premises and equipment is a task for which nobody wishes to acoept responsibility, and one is approaching a state of affairs where it is becoming well nigh impossible to hire labour to carry out this essential part of catering activity. These difficulties have been increased by the continued relative unprofitability of the catering industry in the City, and the necessity for economy in the use of labour. Invariably, expenditure on labour for cleaning and hygiene is the first saving to be made. However, increasing emphasis is being placed on the hygiene of food premises and at the end of the year three Public Health Inspectors were engaged full time on this work. Although no general sense of satisfaction can be expressed at the conditions found to exist in many restaurants, there is some consolation to be gained from the improvements which have resulted from the energetic efforts of the inspectors concerned and the more concientious caterers. Altogether 1,672 inspections of catering establishments were carried out during the year under review, and 171 written communications were sent to individual proprietors drawing their attention to a variety of unsatisfactory conditions. In most instances, all the necessary improvements were effected without resource to legal action, and whilst no legal proceedings were actually instituted during 1968, there was at the end of the year a residual number of unsatisfactory premises in respect of which it was subsequently found necessary to initiate legal action. The Corporation's procedure for dealing with such cases has been re-examined and expedited,, and it is anticipated that unless there is a radical improvement in the present trend of neglecting restaurant premises, legal action will be taken more frequently and more speedily than has been the practice heretofore. Certain caterers must be made to realise that they can no longer hope to continually ignore their statutory obligations with impunity. Unfortunately, the lack of prosperity in the industry is resulting in the gradual withdrawal from the City by the large multiple caterers. For example, for this very reason, a large firm which is a household name has actually closed down five catering premises within the City during a period of six months. It is perhaps unfortunate that the emphasis over the years on "dirty" restaurants tends to obscure the fact that a very determined effort has been made and is being made to achieve a higher standard of construction and design in City restaurants, and these efforts have, to a degree, borne fruit in the many truly excellent catering establishments which at the present time can be found within the square mile. Furthermore, the justified criticism which has been made of defaulters should not prevent an appreciation of the first class service rendered by the more responsible City caterers. THE FOOD AND DRUGS ACT, 1955 During the year the work of the Sampling Officer has been directed mainly to obtaining informal samples of food which the housewife would normally buy regularly or be tempted to purchase as a consequence of modern marketing methods. Of the 397 samples purchased, only 13 (3.27%) were the subject of an adverse report by the Public Analyst. The irregularities mostly referred to infringements of the Labelling of Food Orders, and these were resolved after consultation with the manufacturers or packers concerned. It should be pointed out that these infringements were mainly of a technical nature, or were due to an unawareness of the various implications of the Regulations, rather than a deliberate attempt to evade them. Particular attention was again paid to the sampling of made-up foods such as fresh mince meat, sausage meat, sausages, scotch eggs and pies of all descriptions. Where possible, these commodities were purchased at the beginning of the week, preferably as soon as the premises opened for business, so that an indication of the freshness or otherwise of food offered for sale 19 during the early part of the week, could be obtained. 25 formal samples of milk were purchased from roundsmen in the City area. These were taken to the Public Analyst for examination and all proved satisfactory. Formal samples of spirits, purchased from Public Houses in the City and examined by the Public Analyst were all found to conform to the legal standard. It was not found necessary to initiate legal action in respect of any of the samples referred to above. However, during the course of the year a number of complaints were again received from members of the public regarding various articles of food alleged to be unfit for human consumption, or alternatively containing extraneous material. All these complaints were investigated and, as a result, legal proceedings were instituted in five cases resulting in the imposition of fines varying from £5 to £50. ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY [Article Informal or Formal Sample Nature of adulteration or irregularity Action Biscuits (Ratafias) Informal The biscuits had an objectionable taste due to rancid fat and were unfit for consumption. Appropriate representations were made to the manufacturers. Bread Pudding Informal Contained a sharp fragment of brown glass weighing one gramme and measuring ½ inch across. A cautionary letter was sent to the caterer concerned. Carrot Juice Informal The sample did not consist of carrot juice but of a diluted carrot puree containing water, 3 parts, carrot, 2 parts, with a little sugar and salt. All stocks of this commodity have been withdrawn from sale until an amended label has been prepared. *Cheese and Pickle Sandwich Informal Contained a thin splinter of glass, nearly ½ inch long. Appropriate representations were made, to the caterer concerned. *Cheese Roll Informal Contained baked in the bread was a small piece of white cotton material. Appropriate representations were made to the baker concerned. Cheese (Rahm Brie) Informal The sample, which consisted of full fat soft cheese, was not labelled in the manner required by the Cheese Regulations, Representations were made to the firm concerned. An assurance was received that in future all cheese would be labelled in accordance with the provisions of the Cheese Regulations, 1965, Cheese Processed (VollfettSchmelkase Canned) Informal The sample was not labelled in the manner required by the Cheese Regulations, Representations were made to the firm concerned. An assurance was received that in future all cheese would be labelled in accordance with the provisions of the Cheese Regulations, 1965. *Cheese and Tomato Roll Informal Contained under some webbing in a depression in the crust was a small live caterpillar. Notwithstanding a detailed investigation it was impossible to determine whether the caterer or the baker was responsible. Because of this uncertainty it was deemed inadvisable to initiate legal action. *Welsh Rarebit Informal Contained in the cheese covering was a greenish patch which was due to the presence of a small quantity of a compound of iron. Appropriate representations were made to the caterer concerned. Cream Slices Informal The slices contained an imitation cream made from emulsified fat, sugar and water. These cakes are known as French pastries and in this instance the cake in question was mistakenly labelled in the tray. Appropriate representations were made to the retailer concerned. 20 [???]Article Informal Formal Sample Nature of adulteration or irregularity Action *Custard Pie Informal Contained baked in the pastry the damaged remains of a small moth. Legal proceedings were instituted against the manufacturer of the custard pie. The defendant pleaded guilty and was given an absolute discharge but was ordered to pay £5 5s. 0d., towards the costs of the prosecution. (Fish) Thon a la Provencale Informal The label did not include the common or usual English name of the food nor any statement of ingredients. Retailer requested to print labels indicating the English name and ingredients of the commodity. Milk Informal Contained fat, 2.69% Solids-notfat, 8.51% corresponding to the abstraction of 10% of the milk fat. Appropriate representations were made to the firm concerned. After a thorough investigation no explanation could be found as to the cause of the fat extraction, All further samples proved genuine. Mustard Oil Informal The sample was not Mustard Oil but consisted of flavoured mineral oil, coloured with an artificial colour (consistant with Oil Orange E) not permitted by the Colouring Matter in Food Regulations, All stock of this commodity was surrendered by the merchant and destroyed by the Cleansing Department of the City. Corporation, *Nut Ring Informal Consisted of four broken pieces of nut brittle and contained moulded in two of the pieces two strands of jute, 4 and 2½ inches long. Appropriate representations were made to the manufacturer. Salad Dress ing Mix Informal Consisted of a Salad Dressing Preparation inadequately labelled, To make a salad dressing this preparation required the addition of salad oil and vinegar. It is therefore an incomplete mix and the fact that other ingredients need to be added should in my opinion be clearly stated in close association with the description of the article on the label. The existing stock of this commodity has been withdrawn from sale until amended labels have been prepared. Soupe Pistou, Canned Informal The label of the can was in French and did not include any statement in English of the common or usual name or of the ingredients of the food. Retailer requested to have statement in English printed on the label. Sausages Informal Contained Sulphur Dioxine, 240 parts per million. Sausages may not contain preservative unless its presence is declared. Notice now displayed in shop indicating that all sausages contain preservative. Pork Sausages Informal Contained sulphur dioxide, 270 parts per million. Sausages may not contain preservative unless its presence is declared. Notice now displayed in shop indicating that all sausages contain preservative. Pork Sausages Informal Contained Meat, 61%; sulphur dioxide 340 parts per million. (1) Pork sausages ordinarily contain at least 65% of meat. (2) Sausages should not contain preservative unless its presence is declared. Representations have been made to the company marketing this commodity, who agreed to withdraw the sausages from sale to the Public. Pork Pies Informal One of the pies contained a small growth of green mould on the meat filling. Appropriate representations were made to the caterer concerned. Mixed Grill Informal The ingredients included sausages which contained sulphur dioxide, 260 parts per million. The label did not bear any declaration of preservative or other ingredients. Notice now displayed in shop indicating that all sausages and sausage meat contain preservative.. 21 [???]Article Article Informal Former Sample Nature of adulteration or irregularity Action *Corned Beef Canned Informal Contained a large bur (the seed capsule of a species of Burdock) which had been introduced with the meat prior to canning. This was an imported commodity obtained by the wholesalers concerned, from Government reserve stocks. The attention of the Ministry of Agriculture, Fisheries and Food was drawn to this complaint. *Corned Beef roll and piece of corned beef Informal The corned beef, both in the piece and in the roll, was putrefying and unfit for consumption. Appropriate representations were made to the catering firm concerned. Because of the small demand for this type of roll and sandwich filling the use of corned beef was subsequently discontinued. *Cheese burger Informal Consisted of part of a fried meat and tomato sauce roll, and contained lying on the meat, a filter tip from a smoked cigarette. The evidence of how, when and where the cigarette end became embedded in the "cheeseburger" was not entirely clear, A letter of caution was sent to the caterer concerned. Suet (Shredded Beef) Informal Contained — Fat, 81.6% Flour, 18.4% Shredded suet should contain at least 83% of fat. Appropriate representations were made to the manufacturers. Sugar coated sweets Informal The colouring matters included a blue coal-tar colour, Blue VRS, not permitted in food by the Colouring Matter in Food Regulations, 1966. These sweets were withdrawn from sale. *Yoghurt (Apricot) Informal The specimen had an onjectionable musty smell and contained a thick, paper-like skin of Penicillium mould. It was unfit for consumption. A cautionery letter was sent to the caterer concerned. The Caterer has agreed to keep all future stocks in the refrigerator and to use dummy cartons for display purposes. * These samples were examined as a result of complaint by members of the Public. FOOD AND DRUGS ACT 1955 AND FOOD REGULATIONS Article Samples Purchased and Submitted for Analysis Informal Formal Informal Formal Article Bacon 5 Fish, Cakes 4 Beetroot 1 Canned 5 Biscuits 16 Dressing 4 Bread 6 Fresh 5 Butter - Rum flavoured 1 Frozen 1 Butter 6 Potted 3 Cakes & Pastries 40 Shell 1 Cake Mix 2 Smoked 2 Candied Peel 1 Fruit, Canned 6 Canelloni 1 Dried 6 Cereals 2 Fresh 4 Cheese 8 Frozen 2 Cheese Spread 4 Juice 5 Chicken Croquettes 3 Pies 1 Chicken - Barbecued 1 Horlicks 1 Chicken Livers 1 Jam Chicken Pie 1 Jellied Cranberry Sauce 1 Christmas Pudding 1 Jelly — Quick Jel 1 Complan 1 Indian Tonic Water 1 Condiments 1 Lard 1 Cooking Fat 2 Lemon Pie Filling 1 Cream, Dairy 6 Lentils 1 Canned 2 Margarine 1 Confectionery 17 Meat, Canned 9 Crispbread 1 Cooked 2 Cultered Buttermilk 1 Fresh 5 Drinks, Fruit 5 Prepacked, Frozen 3 Faggots 1 Pies 8 Meat Products 28 22 [???]Article Informal Formal Article Informal Formal Milk, Canned 3 Sauces 5 Fresh 6 25 Sausages 14 Long Life 1 Sausages, Canned 2 Mince Pies 3 Sausage Rolls 5 Mincemeat 1 Scotch Eggs 4 Nuts 1 Soups, Canned 7 Pastes and Pates 3 Spices and Herbs 5 Pizza Napolitan 1 Spirits 3 Peanut Butter 1 Sponge Pudding 1 Potato, Canned 1 Suet 1 Crisps 2 Sugar 1 Instant 1 Tea 7 Rice, Pkt. 1 Tomatoes 2 Canned 1 Vegetables, Canned 3 Rolls & Sandwiches 23 Vinegar 1 Salad Oil 1 Yoghurt 4 Dressing 3 369 28 OTHER SAMPLES SUBMITTED FOR ANALYSIS Aubergines 5 Potato, Instant 1 Biscuits 1 Pumpkin Meat 1 Bread fruit (Canned) 1 Pumpkin Soup 1 Bread Pudding 1 Rolls 3 Cakes & Pastries 1 Sandwiches 2 Capers in wine vinegar 1 Sauces 1 Cheese, piece 1 Soups 2 Coffee, instant 1 Tea 1,414 Corn, whole kernal 1 Tomato Puree 1 Corned Beef (Canned) 2 Juice 3 Custard Pie 1 Canned 1 Chicken in curry 1 Vegetables, Canned 3 Egg Albumen 7 Juice 1 Fish, Kippers 1 Vine leaves, Canned 1 Canned 9 Vinegar 2 Herring Fillets 1 Welsh Rarebit 1 Fruit, Canned 6 Wimpy 1 Juice 4 Yams 2 Dried 46 Yoghurt 1 Gooseberries in Syrup 1 Total 1,546 Macaroni 1 Meat, Canned 5 Tested for Contamination Milk, Fresh 1 Toys Mustard Oil 2 Toy panda on motor cycle 1 Nut Ring 1 100 pieces cowboys 1 Onion Powder 1 Kibbled 1 2 BACTERIOLOGICAL EXAMINATIONS Albumen, egg white solids, granular, flake or crystals 41 Coffee, Instant 1 Crab, canned 1 Cream, fresh 3 Egg noodles 2 Faggots 1 Saveloys 1 50 23 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 49 tons, 7 cwts., 1 qr., 26 lbs., which was deposited of as follows: — Tons Cwts. Qrs. Lbs. Destroyed 43 7 1 22 Disposed of to Contractors 3 13 2 26 Re-exported 2 6 1 6 1 ton, 17 cwts., 2 qrs., 0 lbs., of food were placed under stop and subsequently dealt with under supervision of other local authorities. FOOD AND DRUGS ACT, 1955 (SECTION 16) The 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 Brining of Meat 16 Boiling of Shellfish 5 Cooking of Meats and Poultry 9 Cooking of Meats and Poultry for resale 4 Manufacture of Dripping 8 Manufacture of Ice Cream 2 Manufacture of Pies 2 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 Sale and storage of Prepacked Ice Cream 47 Selecting and testing Sausage Casings 4 Sale of Ice Cream/Prepacked 26 Cooking of prepacked Frozen Pies 1 TOTAL 147 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. 66 firms were registered under this Act, 61 of which were re-registrations. No contraventions were noted. 89 inspections were made in connection with the administration of the Act. PHARMACY AND MEDICINES ACT, 1941 This Act has continued to have the attention of the Inspector. It aims to protect the public from misleading claims by advertisements or by labels on medicine bottles. 28 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. 31 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. 24 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". 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. The Trade Descriptions Act, 1968 which came into force on the 30th November 1968 repeals the Merchandise Marks Act, 1926. However, Orders in Council made under Section 2 of the Act of 1926 and requiring indication of origin shall continue for three years. 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 82,100 tons 261 tons 0.31% MEAT AND FOOD INSPECTION - SMITHFIELD MARKET Deliveries of meat and poultry etc. to Smithfield Market dropped from 343,619 tons in 1967 to 318,257 tons in 1968. Meat Inspection Regulations, 1963 Meat from England and Wales surrendered for diseased condition amounted to 0.03% of the 86,425 tons of such meat delivered to Smithfield Market. Local Authorities were notified of significant losses due to disease from carcases bearing their legible inspection stamp and were also immediately informed of any instance, for example, unstamped carcases, where meat from their area had apparently left the slaughterhouses in contravention of these Regulations. Some enquiries were received from local authorities concerning unstamped meat from Smithfield. All were found to refer to meat coming from Scotland where meat marking is not a requirement. Abscess formation was the most frequently found manifestation of disease in pigs from all sources. Pyaemia or multiple abscesses accounted for 61% of pork carcases condemned. Emaciation with oedema etc. accounted for 80% of all carcases of mutton from the United Kingdom condemned. Six carcases of beef and offals in which localised infestation with cysticercus bovis had been found on routine examination in the slaughterhouse were, by arrangement with local authorities, received in Smithfield and detained in cold storage for the prescribed period. Imported Food Regulations, 1968 Meat from the Republic of Ireland became "Imported Meat" for the purpose of these Regulations which came into force on the 1st August, 1968. This meat and offals etc. arrived in Smithfield and the City Cold Stores in rail containers from various ports of entry. Examination for the purposes of these Regulations is not made at the ports but deferred until the containers reach their destination. The Meat Inspectors were faced with the time consuming task of tracing 25 and checking contents of containers which some Port Health Authorities had difficulty in notifying in accordance with Regulation 5 (3). From 1st August to 31st December, 1968 2,270 containers from the Republic of Ireland were notified as destined for Smithfield. Small regular consignments of meat in containers from Europe were also notified under Regulation 5 (3) and examined on arrival at Smithfield. Imported chilled meat affected with bacterial slime or mould fungi figured largely in the total of unsound meat condemned. Poultry Inspection The examination of uneviscerated poultry for disease continued to be an important task of the Meat Inspectors and accounted for fairly regular and consistent quantities of poultry condemned throughout the year. Statistics Samples sent for histological examination 1 Samples sent for pathological examination 13 Samples sent for analytical examination 4 Samples taken for Government Chemist investigation 90 Number of demonstrations and lectures given 138 Number of exportation certificates issued 5 26 Table showing the amount of meat surrendered to or seized by Meat Inspectors in the City of London for DISEASED Condition, 1968. January lbs February lbs March lbs April lbs May lbs June lbs July lbs August lbs September lbs October lbs November lbs December lbs TOTAL 1968 lbs TOTAL 1967 lbs Argentine 11 168 179 1,371 Denmark 15 46 7 16 84 9 Eire 454 881 652 666 638 1,545 322 596 785 1,940. 918 511 9,908 1,949 Finland 375 402 559 335 338 730 664 490 115 4,008 2,444 Great Britain 96,876 England & Wales 7,066 6,038 4,601 3,559 7,704 5,365 5,891 3,761 3,878 4,288 3,603 4,137 59,891 — N. Ireland 81 63 204 27 4 69 47 26 52 573 — Scotland 883 761 464 186 696 15 170. 15 309 283 402 457 4,641 — Hungary 13 13 New Zealand 16 50 24 39 50 16 3 198 69 Poland 12 59 71 87 Rumania 73 73 Sweden 20 16 42 32 110 337 Uruguay 100 85 185 Yugoslavia 33 86 392 247 758 1968. 8,875 8,145 6,512 4,823 9,515. 7,802 7,227 5,045 5,340 6,950 5,298 5,160 80,692 — 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 27 Table showing the amount of meat surrendered to or seized by Meat Inspectors in the City of London for UNSOUND condition, 1968 Country January lbs February lbs March lbs April lbs May lbs June lbs July lbs August lbs September lbs October lbs November lbs December lbs TOTAL 1968 lbs TOTAL 1967 lbs Argentine 14,777 393 11,882 485 145 64 127 5,177 900 1,664 4,854 474 40,942 451,092. Australia 52 61 70 62 29 274 562 Brazil 433 2,308 283 264 116 3,404 Canada 35 42 30 107 Denmark 13 36 16 58 7 371 20 521 144 Eire 6,647 5,315 8,054 3,934 6,020 2,851 7,144 5,640 2,435 11,907 2,601 2,797 65,345 39,124 Finland 107 255 194 60 151 845 1,475 789 42 3,918 26,795 France 1,033 1,033 Great Britain 247,760 England & Wales 9,464 26,273 4,269 6,587 8,387 8,879 30,235 21,209 10,557 17,960 5,505 4,001 153,326 N. Ireland 206 543 8,376 186 173 241 352 1,739 967 672 735 451 14,641 Scotland 721 2,103 547 827 900 4,608 2,915 3,824 5,231 1,691 536 491 24,394 Holland 56 5 2,772 37 2,870 1,514 New Zealand 176 182 24 37 904 2,826 1,167 202 80 138 29 5,765 4,226 Poland 13 14 45 61 147 845 216 1,004 76 76 423 2,920 6,010 Rhodesia 80 Rumania 20 8 8 36 989 S. Africa 62 12 55 57 62 248 913 Sweden 25 1,519 16 35 34 1,629 15,335 U.S.A. 14 Uruguay 94 5,151 1.850 1,830 158 92 101 17,095 1,403 27,774 46,975 Yugoslavia 84 28,594 235,055 26,017 32,163 8,693 12,062 1,727 194 344,599 21,419 1968 32,281 35,113 -33,453 12,400 50,294 260,433 75,743 73,488 30,645 46,250 33,383 10,263 693,746 — 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 Table showing the amount of meat, poultry and other foods surrendered to, or seized by, meat Inspectors in the City of London. 1968. Smithfield Market Leadenhall Market and City Shops Cold Stores TOTAL T C Q L T C Q L T C Q L T C Q L Meat (Diseased) 35 19 1 19 2 16 1 17 36 0 1 24 Meat (Unsound) 307 14 3 26 1 14 1 2 4 3 18 309 14 0 18 Offal 66 15 0 0 6 2 15 1 7 2 5 68 9 0 20 Poultry and Feathered Game 55 0 2 10 3 14 0 9 58 14 2 19 Rabbits and Hares 2 0 0 2 2 0 9 2 2 0 11 Tinned Meat 2 16 3 13 3 1 16 3 0 1 1 Other Tinned Goods 1 12 3 13 11 1 12 3 24 Frozen Fish 1 16 3 8 1 16 3 8 Other Frozen Foods 13 0 24 13 0 24 Cheese 2 0 16 2 0 16 Salami 2 2 6 2 2 6 1968 474 11 3 19 6 1 0 22 1 15 1 18 482 8 2 3 1967 581 2 3 7 3 19 1 26 1 11 2 11 586 13 3 16 1968 1967 Tons Tons Meat, Poultry and other Foods 318,257 343,619 Delivered at Smithfield Market. FOOD HYGIENE (GENERAL) REGULATIONS 1960 AND 1962 FOOD HYGIENE (MARkET STALLS & DELIVERY VEHICLES) REGULATIONS, 1966 There are 357 stalls on Central Markets occupied by 110 firms. All food businesses have now been fitted with sinks and with hot and cold water for washing utensils as required by Part IV, Section 18B of the Food Hygiene (Market Stalls & Delivery Vehicles) Regulations, 1966. The general cleanliness of the stalls has been maintained and where faults have been found they have been remedied. Carrier companies' and private butchers' vehicles have also kept a good standard of cleanliness. There has been a large increase in the number of foreign cafe and restaurant owners buying supplies from the market and a correspondingly large number of infringements necessitating a considerable amount of work and time spent on each individual case. This has been due to the difficulty of explaining the Regulations to owners of cafes and restaurants and vehicle drivers who speak very little English, and who appear not to appreciate the necessity of clean handling and transporting of supplies between the market and their premises. In a large number of cases the vehicles were entirely unsuitable for carrying food, they were dirty and there was a grave risk of contamination. The personnel themselves were not equipped with protective clothing. In such cases the meat has been transferred to market transport. The local authority, in whose area the premises are located, has been notified by telephone of the condition of the vehicle and the infringement of the Regulation and its co-operation sought in remedying the defects. This is proving very effective. The cleanliness and maintenance of protective clothing at Smithfield Market still remains a difficulty and constant supervision is kept to ensure that clothing is kept clean and changes are made when necessary. Laundry facilities are still very limited. During the year 695 infringements were noted and suitable warnings were given including 367 in writing as listed below: — Infringements Warnings Despatched 70 in connection with clothing 50 25 in connection with containers 17 56 in connection with head coverings 52 91 in connection with meat contamination 59 232 in connection with premises and equipment 38 97 in connection with incidents of smoking 77 19 regarding trucks 3 105 regarding vans and cars 71 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". 28 some 200 pitchers who arrive at the Market with the various meat vans, unload the vehicles and leave the Market again on the vans. tenants' staffs, buyers and their staffs. there are 357 stalls on the Market occupied by approximately 110 tenants. DISEASES OF ANIMALS ACT 1950 & ASSOCIATED ACTS Mr. G.S. Wiggins M.R.C.V.S. Veterinary Officer for the City of London, has submitted the following report:— "Under the terms of the London Government Act, 1963 the Corporation of London is the authority for the administration of the Diseases of Animals Act 1950, in regard to the importation of animals, for the whole of Greater London. The remainder of the functions under the Diseases of Animals Act and associated Acts are the responsibility of the individual London Boroughs, but the Corporation carries out duties for 18 London Boroughs on an agency basis. 1968 was the third year in which agency arrangements have been in operation and a total of 2,211 visits of inspection were made. The work carried out under these Acts and Orders included the following:— Psittacosis or Ornithosis Order,1953 Enquiries were carried out under the terms of this Order on behalf of three London Boroughs following reports of two persons suffering from psittacosis. The cases concerned budgerigars and, more significantly, imported South American parrots. Foot and Mouth Disease Due to the development of an epizootic in October 1967 the whole of England and Wales was declared a 'controlled area' by the Ministry of Agriculture, Fisheries and Food on 18th November 1967. This prevented all movements of cloven-hoofed animals unless under licence by the local authority. In this respect your department issued 1,058 licences from 1st January to 4th March 1968 when the control was lifted bringing the total number to 1,958 during the whole of the outbreak. On 26th January 1968 the Foot and Mouth Disease (Imported Meat) Order, 1968 came into force in an effort to prevent further outbreaks of disease. This prevented the distribution of meat etc. imported from countries where the disease is enzootic. One contravention of the Order resulted in a prosecution. Anthrax Order,1938 One case of anthrax occurred on a farm in the Corporation's agency area. The animal concerned was a heifer and your officers arranged for the disposal of the body and the cleaning and disinfection of the farm. Riding Establishments Act,1964 Visits of inspection were made to 36 riding establishments in eleven of the London Boroughs. Some were for the obligatory annual veterinary inspections for licencing and others to investigate incidents which had been reported from time to time. Pet Animals Act,1951 There is one pet shop in the City of London to which regular visits of inspection were made during the year and in addition such visits were carried out in four London Boroughs with a view to the re-licencing of pet shops, while the services of your officers were used in several Boroughs on a consultative basis or to investigate complaints. Animal Boarding Establishments Act, 1963 25 reports were issued on establishments in the Corporation's agency area for consideration when re-licencing. Again the service was used on a consultative basis and to investigate complaints. Performing Animals (Regulations) Act, 1925 3 certificates of registration were issued. Several visits were made to television studios concerning animals used in television productions and to circuses at Clapham Common and Blackheath. Live Poultry (Restrictions) Order,1957 Six licences were issued to enable the holding of live poultry shows. Your Officers carried out inspections at the shows to see that the terms of the Order were adhered to. Agriculture (Miscellaneous Provisions) Act,1968 This Act, which received the Royal Assent on 3rd July 1968 deals with livestock whilst on 29 agricultural land. Section 2 of the Act provides that the Minister of Agriculture, Fisheries and Food may, after consulting the interests concerned,, make regulations to safeguard the welfare of livestock. This may well have an affect on the agency arrangements of the Corporation. Import and Export Details of visits and action taken in connection with the undermentioned Act and Orders and in respect of the issue of export certificates may be found in this Authority's annual report for the Port of London. Diseases of Animals Act, 1950 — Importations Importation of Dogs and Cats Order, 1928 Rabies Order, 1938 Animals (Sea Transport) Order, 1930 Horses (Sea Transport) Order, 1952 I should like to take this opportunity of expressing my great appreciation to the staff of this department who are often called upon to work in difficult circumstances out of normal office hours, in particular during the early part of the year when the foot and mouth epizootic brought about special problems, the staff more than adequately coped with many trying situations without demur." PERSONAL HEALTH AND WELFARE SERVICES IN THE CITY (Comparable figures for 1967 are given in brackets (where appropriate) The total number of births occurring in the City (St. Bartholomew's Hospital and domiciliary births) was 996 (967). Births (to City Residents) 1967 1968 Hospital Live Births 21 25 Domiciliary Live Births 2 — Number of these born with congenital malformations NIL — Stillbirths 1 — NATIONAL HEALTH SERVICE ACT, 1946 The Corporation of London is responsible for services as set out in Sections 21 to 29 (excluding Section 27) 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. There were no notified cases of congenital defects occurring in infants born of City residents. There was one perinatal death due to respiratory distress and prematurity. Maternal Deaths 1967 1968 NIL NIL 30 SECTION 22 — CARE OF MOTHERS AND YOUNG CHILDREN There were no (—) notified cases of congenital defects recorded during the year. Infant Deaths 1967 1968 Stillbirths NIL NIL Neo Natal NIL NIL Perinatal NIL 1 Others under 5 years NIL NIL Maternal and Child Care Clinic Attendance of Children under 5 years 1967 1968 Attendances 553 547 Medical Examinations 266 205 Hearing Tests 4 17 Phenylketonuria Tests 20 31 Child Health Clinic The clinic continues to be held in St. Bartholomew's Hospital Outpatients Department. A slight yearly decrease in clinic attendances has occurred since 1965 and investigations show a corresponding fall in the resident child population of the City. The routine vaccination and immunisation schedule has now been extended to include measles vaccination. Almost all parents have accepted this additional protection of their children's health. An analysis has shown that more than a quarter of the families had moved out of the City before smallpox vaccination was due. Dr. A. White Franklin, Senior Paediatrician, St. Bartholomew's Hospital and Paediatric Consultant to the Corporation of London, reports as follows:— "The Child Health Clinic meets twice weekly at St. Bartholomew's Hospital. Routine medical examinations are performed periodically, tests are made for early signs of deafness and the Phenistix test for phenylketonuria is still used pending arrangements for the Guthrie test to replace it. Most families are keen to have the routine immunisations, although several suggested changes of programme during recent times have made this somewhat confusing for the staff. Smallpox vaccination, now advised in the second year of life is less easy to control. Attendance, related presumably to what the Mother gets out of it, is less in the second year when she 'has overcome her need for support." Vaccinations and Immunisations at Child Health Clinic 1967 1968 Diphtheria/Tetanus/Whooping Cough 28 5 Poliomyelitis 16 14 Smallpox 12 6 Measles — 61 At Risk Register 1967 1968 Children under 5 years of age 4 5 The names of fourteen children have been placed on the register since April, 1965, nine of whom have been transferred to other local health authority areas. Of the five children on the register at the end of the year one child has been referred for heart surgery, one child is receiving treatment for a mild degree of deafness and the other three children are making normal progress. Day Nurseries 1967 1968 Kingsway Creche City children in attendance at end of year 2 1 City children on waiting list 1 1 Other Nurseries City children in attendance at end of year — 3 City children on waiting list — 2 There has been a steady increase in the demand for day nursery placements, on both medical and social grounds. Registered Child Minders 1967 1968 Applications for registration NIL 1 One application has been received but after consultation with the City Architect and Planning Officer it was decided by the applicant not to proceed in the matter. 31 Fireguards One (—) request for the loan of a fireguard was received from a family with 3 children under 5 years of age. Unmarried Mothers and their Children The Diocesan Moral Welfare Worker has advised and assisted 10 (40) cases during the year, only one of these was a City resident. Three (—) mothers, all City cases, were advised and helped throughout their ante natal period by the Assistant Health and Welfare Officers who continued to support the mothers after the birth of their babies. Welfare Foods The sale of Welfare Foods continues at the Child Health Clinic, St. Bartholomew's Hospital, and at the Health Department Office. SECTION 23 – MIDWIFERY SERVICE The Metropolitan District Nursing Association continued to provide domiciliary midwifery services in the City. There were no (2) home confinements during the year. No request for midwifery services within the Temples was 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 1967 1968 Home Visits to Children under 5 years Successful visits 237 321 Unsuccessful visits 55 60 Primary visits to children under 1 year 17 22 The Assistant Health and Welfare Officers, who are both qualified Health Visitors have continued to held and advise mothers with children in all aspects of family health maintenance. Closer liaison is being built up with the General Practitioners who have registered patients living in the City. Regular meetings have continued for discussion and work allocation with the two doctors whose surgery is within the City. The location of the Child Health Clinic and the City of London Chest Clinic within the Outpatients' Department of St. Bartholomew's Hospital enables the Assistant Health and Welfare Officers to have close contact with many of the medical, nursing and social work staff. One Assistant Health and Welfare Officer joins the Sisters of the Maternity Department in giving a series of talks to expectant mothers booked for hospital confinements. The links with St. Bartholomew's Hospital are growing. In 1968 it was a great pleasure to receive both Departmental and Ward sisters from the hospital into the domiciliary field of the Health Department's work and to plan special visits of observation for them. The sisters have expressed their great interest and the benefit they have derived in seeing the services in function and being able to ask questions at first hand will, they feel, enable them to help their patients return to the community with better understanding of the provision of local authority health and welfare services. The number of children under 5 years of age living in the City at the end of 1968 was 79, new births and new child residents numbered 36, but 42 children moved to other boroughs or reached school age. Generally the health of the children has been good and no serious handicaps have been found. Mothers frequently comment on the lack of safe play places for young children and this may be the reason for the large number of families who move from the City. Among the elderly members of the community there is a high proportion within the 80+ age group. Many live alone and are handicapped by chronic disease, the main causes being heart disease, diabetes, bronchitis, rheumatism and arthritis. Much help and advice is needed to help them maintain their maximum standard of health and mobility. The Assistant Health and Welfare Officers with the District Nurses devote many hours to visiting the older citizens to encourage them and assess their needs for supportive services. 32 Tuberculosis Health Visiting 1967 1968 Cases notified (residents) 3 9 Home visits 5 42 Shops and offices contact tracing. No. of investigations 64 142 One Assistant Health and Welfare Officer attends the Chest Clinic at St. Bartholomew's Hospital and also visits in their own homes all City residents who attend the clinic. A large proportion of the work is the "follow-up" of contacts of diagnosed cases amongst staff of shops and offices within the City. Many visits are also made to known clinic patients living in the Salvation Army Hostel within the City, to encourage them to adhere to their drug therapy, if ordered, and to urge them to keep their hospital appointments. SECTION 25 - HOME NURSING The home nursing service is provided by the Metropolitan District Nursing Association. Over 90% of visits have been to those persons over 65 years of age, who are suffering from long term illnesses. Details are as follows:— 1967 1968 Visits to children under 5 years – 5 Visits to age group 5 years to 64 years 208 228 Visits to persons aged 65 or over 2505 2713 Type of Nursing Care and Treatment Injections only 344 429 Injections plus nursing treatment 12 — Nursing care and treatment 2357 2517 Total of Nursing visits 2713 2946 Number of patients at the end of the year 19 14 SECTION 26 – VACCINATION AND IMMUNIZATION (See School Health Section for vaccination and immunization of school children) Adults Children under five years Smallpox 130 (41) 6 (15) Poliomyelitis — 14 (16) (primary courses and booster doses) Diptheria/Whooping Cough/Tetanus — 5 (28) (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 practise, arrangements were made, commencing in June 1967 for the vaccine to be distributed to City doctors. During 1968, 4,992 (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 2550 (3260) 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. 33 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 education 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. Dr. Neville C. Oswald, the Chest Physician, has reported as follows:- "During 1968 we have had referred to us seven newly diagnosed patients with active tuberculosis in City offices, six of whom were either infectious or potentially so. In connection with these patients, we examined 138 contacts altogether and found no fresh case of tuberculosis although one man had a haematoma which was surgically removed in St. Bartholomew's Hospital. During 1968 we have had 14 new referrals of cases of tuberculosis from the Salvation Army. All of these had been diagnosed previously and two had active infectious disease and were admitted to hospital. It is extremely difficult to follow up this migrant population. We do our best to treat them as long as they arepreparedto attend, but sooner or later we lose sight of them." The men resident in this hostel continue to present a problem in so far as adequate follow-up care and supervision is concerned. The period of residence in any one area is usually too brief to complete a course of treatment. All referrals from the hostel had attended other clinics at some time, two had active tuberculosis and were admitted to hospital and one was admitted to hospital for observation and found non-active. Mass x-ray examinations revealed the need for further investigation of seven men, four of whom could not be traced, two were given appointments at the Chest Clinic. One attended, was non-active and failed appointments after a second visit. One other man, who was probably active, was seen in the Emergency Medical Department and referred to the Chest Physician but did not attend. Ma ss 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 In the year under review Unit 6D continued to serve the City of London as heretofore. The total number examined in the year was 52,429, of which 40,906 attended at the Unit's centre in Public Services Building, Milton Court, E.C.2. The remaining 11,523 were examined at their places of work (six organisations were visited for this purpose). Male examinees numbered 31,622 and females 20,807 the usual proportions in our experience. There were no major interruptions of work through mechanical breakdowns, reflecting the high standard of day to day maintenance achieved by the technical staff. 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. Tuberculosis: Tuberculous infection was detected in 400 examinees. Eighteen (11 males and 7 females) had significant lesions requiring treatment giving an overall rate for active disease of 0.343 per 1,000 compared with 0.453 per 1,000 for the previous year. The rate for males was 0.348 and for females 0.336. Equivalent figures for the previous year were 0.593 and 0.217 respectively. The highest incidence (though representing few cases) was noted in the 60+ age group (1.423 per mille). It is again noted that the incidence of active tuberculosis in those not previously X-rayed is significantly higher than in those previously examined i.e. 0.673 per 1,000, compared with 0.213 per 1,000. LUNG CANCER Nine cases of carcinoma of bronchus were disclosed, all in males of the 45 and over age groups, giving a rate of 8.8 oer 10,000, for the 10,297 examinees in this category. The majority 34 of the cases proved amenable to surgical intervention. Other important conditions, such as sarcoidosis, cardiovascular disease, chronic non-specific lung disease, etc. were detected in fair numbers but showed no significant divergence in incidence from previous years. GENERAL COMMENTS I mentioned in last year's report that consideration was being given to the possibility of providing a special service for men in the lung cancer age group. On further reflexion, however, and having regard to the fact that active cases of tuberculosis continue to turn up, I feel that any divergence of the Mass Radiography Service from its present function, at this point in time, would be premature. Amalgamation of this Unit with Unit 6B has not given rise to any significant operational or administrative difficulties. The Unit under report continues to meet the requirements of the City of London with the helpful guidance of Dr. W.G. Swann, Medical Officer of Health for the City, and his department. The Unit staff, as always, carried out their duties most efficiently and I am happy to acknowledge my indebtedness to them. I would like to express my thanks, on behalf of myself and all members of the staff of the Mass Radiography Service, to Thames Group Hospital Management Committee and Regional Hospital Board for their readily forthcoming assistance and advice on many occasions." Special Hoslels for Tuberculous Men 1967 1968 Men resident during the year 2 2 Loan of Nursing Aids 1967 1968 Supplied by Health Department 33 26 Supplied by British Red Cross Society — 15 7 City Branch 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:— 1967 1968 Domiciliary Treatment 151 156 Clinic Treatments 81 81 Salvation Army Surgery Treatments 52 83 School Inspections 135 291 School Treatments — 81 Mrs. A.M. Sierienkowska who is employed part time as Chiropodist has reported as follows:— "The chiropody service as planned for the City of London came into full practice in 1968. It is comprised of four parts, hoping thus to give treatment to all who need it, while being unable to pay the private practitioner's fees. A few words on each follows:- (1) Milton Court A clinic is held there once a month. This enables the attending patients to receive treatment at monthly or two monthly intervals. (2) The Salvation Army Clinic at Middlesex Street Hostel. This clinic, after a rather difficult beginning, is now running adequately. The residents while often in great need of treatment were seldom present on the right day. (In spite of the fact that it was a regular monthly date, of which they were also notified). But time has trained them and latterly the attendance has improved considerably. 35 (3) The Domiciliary Service Most of the patients receiving treatment at home are the very old residents of the Stoney Lane area. But some are younger though unable to go out very much as a result of physical disabilities. Patients are usually seen at 6/8 weekly intervals although when necessary monthly treatment is given. Likewise lighter cases are sometimes left for 10/12 weeks. (4) Sir John Cass's Foundation School 1968 was the first full year of chiropody at the school. It worked out very much according to plan. There were talks, inspections and numerous treatments. The children, as foreseen, return after intial inspections if they have developed some condition needing attention, often bringing their younger brothers and sisters for treatment as well. In one case this happened in reverse a six year old who had been treated for a verruca a while back brought in her ten year old sister who, according to her, had developed the same complaint. (She was right!) By the end of 1968 all the children in the school had been seen but as the ideal is to see each one annually, the second round of inspections has already started. These are much easier to carry out as the children are by now familiar with the procedure and co-operative with the result that more time can be given to those needing actual treatment." Recuperative Holidays 1967 1968 Adults 2 7 Children NIL NIL There was a slight increase in the number of requests for recuperative holidays following illnesses during 1968. All the elderly sick persons were provided with suitable holiday accommodation according to their needs and it was a pleasure to note the improvement in their health when they returned home. 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 Laundry Service (Public Health Act, 1936). 1967 1968 Persons receiving service at end of the year 10 14 Items washed 4886 5187 Patients supplied with Incontinence Pads at end 2 2 of the year 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 3510 (4064) doses of vaccine were distributed. International Certificate of Vaccination 1967 1968 No. authenticated 2824 2140 No. returned as doctor did not practice in City 40 18 V.D. Contact Tracing 1967 1968 Requests received for assistance in follow up City Cases NIL 1 Non City Cases 6 6 The one case required investigation within the City to find and advise a person thought to be a contact and, therefore, at risk. The investigations proved unsuccessful. 36 Health Education Subject Place and Audience Attendances No. of Lectures Baby Care Expectant Mothers. St. Bartholomew's Hospital. 73 (31) 7 (3) Emergency Home Corporation Staff C.D. Headquarters. – (83) – (13) Care Course Child Care Grammar Schoolgirls Duke of Edinburgh's Award Scheme. 95 (92) 7 (6) Health and Hygiene Sir John Cass's Foundation School. – (107) – (4) 1st Aid Residents Salvation Army Hostel. 115 (–) 11 (–) Corporation Staff 15 (–) 1 (–) Organisation of Link Group Occupational Centre Trainees. 12 (–) 1 (–) Use of Voluntary Workers in the Welfare Services Toc H Mobile Action Group. 30 (–) 1 (–) Health & Welfare Services RCN Administration Public Health Students 13 (–) 1 (–) Toc H. Members 23 ( –) 1 (–) Welfare B.R.C.S. Members 232 (–) 8 (–) The development in the field of Health Education continues. It is of interest to note the increased number of requests for talks on Health and Welfare Services, which have been asked for by both professional and voluntary organisations. General topics of health maintenance are now an acceptable part of training for the younger age groups whereas the older generations appear to seek out information over a very wide range of subjects. The Citizen's Advice Bureau in the City continues to display posters and leaflets on various aspects of health, constant demand is made for leaflets on nutrition, slimming diets, care of diabetic patients, care of the eyes, asthma, the social services and home safety. Greater contact with medical, nursing and welfare officers in offices in the City is being made and posters and leaflets continue to be circulated to them for display and dissemination amongst employees. Family Planning Rent free premises are provided for the Family Planning Association at Milton Court where two lunch time and two evening sessions are held each week for City Workers and residents. The Corporation meet the cost of supplies and treatment for City residents referred on medical grounds. Due regard has been given to the implementation of the National Health Service (Family Planning) Act, 1967. The following report has been received from the Central London Branch of the Family Planning Association in respect of the City of London Family Planning Centre at Milton Court:- "People living and working in the City have continued to make good use of the family planning clinic at Milton Court. So much so, in fact, that the number of sessions held had to be increased and by the end of the year 3—4 sessions were being held each week. During the year 152 sessions were held (105 in 1967) and 962 patients of whom 560 had never attended a family planning clinic before, made a total of 2,636 visits. This increase of approximately 50% in the number of patients attending is very encouraging and points to the fact that the clinic services are fulfilling a very real need in the City. As always patients were able to discuss with the doctors the varying methods of birth control and were helped to find that most acceptable to them. Of the 560 new patients, 410 chose oral contraception, 123 were fitted with the cap and 27 decided on other methods. As can be imagined news of the clinic is spread by satisfied clients and the greatest number of patients come referred by friends. St. Bartholomew's Hospital continued to read cervical smears taken from patients attending the clinic and during the year 451 were taken. Two of these were positive and the women were referred immediately through their respective General Practttioners for treatment. Two patients with marital difficulties were referred to the special sessions for psychophysical difficulties held at Islington Family Planning Centre and were greatly helped by their consultations with the specially trained doctors who staff these sessions." During the year the National Health Service (Family Planning) Act 1967, was implemented. Married residents or other City residents seeking pre-marital family planning advice on social grounds could be given such advice free of charge and in addition to the provision already agreed for married women residents referred on medical grounds to receive advice and supplies free. 37 1967 1968 No. of sessions during the year 105 152 No. of new patients 344 962 Total visits made by new and old patients 1,582 2,636 No. of new City patients included above 23 16 No. of cervical smears taken 162 451 Cytology Clinic — Mammography Survey The following report has been submitted by R.A. Kemp Harper Esq., M.D., M.B., Ch.B., D.R., F.R.C.P., F.F.R., F.R.F.P.S.:- "As a result of the generosity of the Council of the City of London a radiographic survey of the breasts of all women attending the above Clinic was commenced in August, 1964. As, however, the Clinic is held on one afternoon only, it was found that the special X-ray tube necessary for this type of examination was over heating as a result of so many X-ray exposures during the course of the afternoon. The examination was therefore limited to patients aged 40 years or over and by July, 1969, 2,000 patients had been examined, this being considered as a suitable number on which to report on the results of the survey. The apparatus was sited in the Women's Out-patient Department where the Cytology Clinic is held, as a result of which all women asked to co-operate by having this additional examination agreed to do so. The apparatus was also used to examine women with known or suspected pathology in the breast whenever requested to do so by a clinician and over 400 patients in this category were also examined. The results of these surveys are as follows:— Cytology' Clinic Survey Patients examined 2,000 Proved cancer found 2 One recent case as yet unproved 2 cases = .1% 3 cases would = .15% (The latter figure is in accord with the results from the Mayo Clinic over a series of 5,000 similar cases.) Benign tumour found 140 = 7% Re-examination was requested in 2.3% in all of which patients no malignant tumour was found with one exception. On a basis of Ministry of Health statistics on costing of work done in X-Ray Departments, the cost of finding one cancer in presumed healthy subjects was £4,500, if the third case is proved, and £6,750 if only two have been found. Of patients with known or suspected lesions in the breast, the statistics are as follows:— Number of patients examined = 600 Number of malignant tumours found = 166 Number of benign tumours found = 163 % Accuracy in malignant tumours = 84.2% % Accuracy in benign tumours = 88.6% Overall accuracy = 86.4% The number of malignant tumours found in the survey is fairly similar to those in the few recorded surveys carried out elsewhere, mostly in the United States of America, and it is apparent that the cost of and time which has to be devoted to these surveys gives an inadequate reward for the energy expended. The time and money would be better utilised in examining at regular intervals, those women who have already had a cancer of one breast, as the probability of a tumour developing in the other breast is about 7 — 10%. I am of the opinion that the survey be discontinued but that the apparatus be used for the purpose I suggest and for the examination of women with known or suspected tumours. Since the project was started in 1964, more sophisticated equipment giving much less radiation dose to the patient and withmuch improvement in thequality of the radiographs has been developed. This new equipment costing just over £5,000 would be ideal for detecting early malignancy in the other breast of a patient who has already had a cancer of one breast. No such survey has so far been undertaken in this country and very few elsewhere, so that this would be an extremely valuable field of investigation in the early detection of cancer. I am extremely grateful to the Council for the interest taken in providing the equipment for this project and to them I wish to convey my sincere thanks and appreciation." 38 Domiciliary Physiotherapy During the year the Metropolitan District Nursing Association employed a sessional domiciliary physiotherapist to assist, under general practitioner supervision, those persons who could usefully benefit from this type of service which may not be provided by a local health authority under the Act. Patients treated during the year 2 Visits made by physiotherapist in seeing patients, visiting G.P's., hospitals and so on. 150 MENTAL HEALTH ACT, 1959 and NATIONAL HEALTH SERVICE ACT, 1946 Mental H ealth 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 Six patients (4) seen at Court by a Mental Welfare Officer and escorted to Fyschiatric Hospitals. One of these cases was exceptional in that the patient had to be escorted by two Mental Welfare Officers, by train, to St. George's Hospital, Morpeth, Northumberland, in the afternoon of a Friday. Thames Court (for information—not included in Court Referral Figures). One patient dealt with at this Court, and escorted to hospital. His address at time of his arrest was given as the Salvation Army Hostel, Middlesex Street, E.l. Police Cases Two patients (1) dealt with by City of London Police, pursuant to Section 136 Mental Health Act, 1959. St. Bartholomew's Hospital Ten patients (15) visited at request of hospital doctors and dealt with pursuant to Mental Health Act, 1959. Patients visited at Private addresses Eight patients (14) were visited at request of various agencies, for investigation, action under the Mental Health Act, or follow-up. British Transport Police, Liverpool Street Station No patients referred for Mental Health Action during the year. Many requests for advice and guidance, duly given. Salvation Army Hostel, Middlesex Street Eight (28) patients seen as new referrals, for varied reasons, such as suitability for Day Centre attendance, psychiatric out-patient appointments, advice, etc. Tower Hamlets Day Centre for Mentally Ill and Psycho-geriatric patients 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, feature Bingo, Records, Table Tennis, Darts, Billiards, Film Show, etc. A quiet room is set apart for those patients who prefer such an environment. Outings are arranged when finances permit. Other facilities available at the Centre are:— (1) Personal interviews at the centre by disablement resettlement Officer. (2) Full time services of Social Worker at least 2 days a week for consultation, ment, employment placement, etc. (3) Laundry facilities. (4) Services of government training centres hairdressers — (male) by kind permission of the manager, men's hair being cut free of charge once in three weeks. (5) Emergency clothing replaced. (6) Daily newspapers, small library and "Centre View" — the centre's own magazine. 39 Reactivation by Social activities of Day Centre patients is an integral part of the centre policy and extra to the normal day time industrial work and training undertaken. This work ranges from assembling and packing skipping ropes, paint boxes, egg cups, chess sets, etc. etc. Each worker receives an ex-gratia payment. Mid-day meals and light refreshments are served free. The centre also provides separate facilities for attendance of psycho-geriatric patients on two days a week. These patients are collected and returned to their homes in transport provided by the Council, an escort is also provided. These elderly patients have, in most instances, attended the pyscho-geriatric unit at St. Clement's Hospital, and not any longer requiring nursing attention, are well able to fit into the centre routine. An occupational therapist is in attendance for all elderly patients. An incidental object of the day centre is to provide some relief to relatives from the care of mentally ill patients. Psychiatric Recuperative Holidays Three patients interviewed with reference to an application for a holiday submitted by a medical practitioner. Maintained in Hostels One patient (1) enjoyed two weeks at Herne Bay. During the year one (1) patient was being maintained at Corporation expense. Mentally Subnormal in Community Care Two patients (1) regularly seen by a Mental Health Social Worker. One patient receives home training as agreed to, prior to the family moving into the City, from Middlesex, and does not attend a training centre. One patient attends the Whitechapel TrainingCentre, and also a club for the subnormals. This patient also enjoyed a holiday at the Dymchurch, Kent, holiday camp." Admission to Hospital pursuant to Mental Health Act, 1959 Courts Sec. 29 M.H.A. Sec. 25 M.H.A. Sec. 5 M.H.A. Sec. 136 M.H.A. Sec.66 Sec. 25 4 2 1 12 (not including Court cases) 3 2 Admission to Hospital pursuant to Mental Health Act, 1959 — continued (Address patients admitted from) St. Bart's Hospital Private Addresses Salvation Army Hostel Sec. 29 Sec. 25 Sec. 25 Sec. 5 (Informal) Sec. 5 (Informal) 1 9 3 2 1 40 41 SUPPLEMENTARY INFORMATION CLIENTS IN COMMUNITY CARE PSYCHIATRIST OUT-PATIENT APPOINTMENTS MADE NUMBER OF DOMICILIARY VISITS BY "APPROVED" DOCTORS ARRANGED NUMBER OF VISITS TO NEW REFERRALS (NOT INCLUDING COURTS) NUMBER OF VISITS TO KNOWN CLIENTS PRIVATE ADDRESS S.A.HOSTEL PRIVATE ADDRESS S.A.HOSTEL PRIVATE ADDRESS S.A.HOSTEL PRIVATE ADDRESS S.A.HOSTEL PRIVATE ADDRESS S.A.HOSTEL M.I. S.N. M.I. S.N. M.I. S.N. M.I. S.N. M.I. S.N. M.I. S.N. M.I. S.N. M.I. S.N. M.I. S.N. M.I. S.N. 5 2 4 NIL 5 NIL 3 NIL 6 NIL 1 NIL 8 NIL 8 NIL 69 64 79 NIL 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 men seek advice regarding their health or social needs, e.g. alcoholism, pension claims, extra nourishment allowance, homelessness, part III accommodation, clothing, alternative accommodation, surgical fitting and artificial aids, family and marital problems and general health matters. SECTION 29 - DOMESTIC HELP There were 24 (12) new cases, 17 (12) chronic sick, 3 (1) under 65 years of age, 2 family help, 1 maternity and 1 other. 10 (22) cases were removed for various reasons. No. of home helps employed on 31st December, 1968:-- Full time 3 (1) Part time 6 (8) No. of clients in receipt of service 60 (57). All applicants for home help service had their needs met. The employment of an additional home help to cover periods of holidays and sickness was particularly beneficial. There is now a stable nucleus of home helps who manage to give some service to clients even in difficult and busy periods. In order to carry out assessments of need and to ensure that the service was running smoothly 479 (341) visits were paid by the Metropolitan District Nursing Association Superintendent and Nursing Staff. In July, new assessment scales (as recommended by the London Boroughs Association) were brought into use and the cost to clients paying the full amount rose to 8/2d. per hour. Of 60 clients in receipt of the service 52 received free service and the others paid a reduced sum. 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. One Assistant Health and Welfare Officer carries out the duties of School Nurse. During the year the following school medical inspections were carried out:- Routine 78 (86) children inspected Special 6 (75) children inspected Re-inspection 80 (52) children inspected Comprehensive Health Survey 456 (241) children inspected Selective Survey 226 (228) children inspected The Comprehensive and Selective inspections are conducted by the School Nurse. The general standard of hygiene amongst the school children was good. No head nor body infestation occurred during the year. 12 home visits were made to the City parents to follow up matters arising from the medical inspections. During the year extensive building alterations were carried out which created difficult working conditions, but with willing co-operation from the staff it was possible, with one exception, to maintain routine school health services. A medical room has been provided in the new administrative block, which is now in use and greatly facilitates the work carried out. School Dental Service (The statistics given here complement the Dental Officer's Report). 1967 1968 Sessions at Dental Centre 71 61 New cases given appointments 253 184 New cases attended by appointments 212 162 42  1967 1968 On treatment cases given appointments 245 306 Emergency attendances 3 1 Total attendances 452 469 1st inspections carried out at school 303 187 1st inspections carried out at clinic 4 1 Percentage requiring treatment 53.8 45.7 Dental Officer — whole time equivalent 0.25 0.1 Special Clinics A school clinic is 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 1968, 1 (5) such clinic was held, and 3 (17) children examined. Audiometry During the year no tests were held at the school because of the excessive noise caused by building alterations but all children will be tested during 1969. Vaccination and Immunisation of School Children 1967 1968 Poliomyelitis 63 18 B.C.G. School Children tested) Students tested ) 222 347 No. vaccinated Not 211 termined Diptheria, Whooping Cough and Tetanus 69 69 Measles — 19 Infectious Diseases Reported from Schools 1967 1968 Chickenpox 9 1 Measles 1 2 Mumps – 8 Impetigo 1 — Conjunctivitis 2 — Whooping Cough — 1 German Measles 5 1 Chiropody service in School (See Report under Section 28 National Health Service). REPORT OK THE DENTAL OFFICER, CITY OF LONDON Once again it has unfortunately to be recorded that the dental state of the very young children, locally, is far from satisfactory. That it is considerably worse this year, is indicated by the substantial increase in the amount of dental disease found at examinations, as compared with last year. Of those entering school i.e. five year-olds, 68% were found to require treatment. Similarly, 75% of those examined who had not started school (the under fives) needed attention. On the bright side the overall figure of those requiring treatment continues to fall, so that it can be seen in tangible form, that regular inspections, treatment and dental health education, undoubtedly do have their impact. The point to be observed here is that, we seem to be failing to put over to the parent of the pre-school child, the necessity for observing the simple rules of oral hygiene and diet. At least, one assumes that this must be the point, since pre-school children arrive at school, in a very poor state of dental health, but seem to improve as their school life proceeds. Put another way, one can communicate with the child, — and the parent through their child — once it gets to school, but it looks as though some form of national publicity is required to get at the parent in those important early years before school. 43 Another factor which emerges from inspections, is that some of the worst mouths seen are generally from those who live in the City, as distinct from those who come to school in the City, but live outside it. One rather suspects that these children when left to themselves probably have nothing much else to do, than watch the television with a box of sweets. A factor which, not too remotely, may induce this situation, is that the City children are somewhat at a disadvantage as compared with children in other localities, in that they do not have grassed play areas, or except in one instance, just outside the City boundary, any play areas at all. It would be a tremendous boon for these children one feels, if it were possible to have a floor in a building or buildings, set aside as recreation areas, associated perhaps with an indoor running-track/gymnsaium for the younger City workers. Dental Health Education This has not been easy this year, due to rebuilding problems, but it is hoped to get back to normal very shortly. Fluoridation Although the Corporation has decided in favour of increasing the level of fluoride in the water supply, the time when we might expect to see this implemented would seem to be as remote as ever. The water suppliers, The Metropolitan Water Board, currently state that it must wait until all Authorities in its area are unanimously in favour of increasing the fluoride level of water supplied. This means in effect that whilst 7½ million people wish to receive this water, they cannot do so because 1½ million object. The situation could arise where only one Authority could prevent the measure being taken. All this means that our most potent means of attack on decay, in small children's teeth, is, at the moment denied to us. Adults, National Health Service The numbers seen continue to increase. It is being found difficult, on occasions, to recall all adults for routine examinations. In practice, an attempt is made to recall those unfortunate enough to have poor mouths at 6 monthly intervals, and those more fortunate in their dental health have to wait for 9—12 months, for a check. However, anyone asking for an examination may have one on request. St. Bartholomew's Hospital As usual one is very conscious of the tremendous assistance given by manydepartments and especially the Dental Department. Apart from the high order of skill and kindness received by patients attending any of the departments, one is continually impressed by the courtesy exhibited by all members of the staff. WALFARE SERVICES NATIONAL ASSISTANCE VCT, 1918 PART III Section 21 (i) (a) — Residential accommodation Residential care and accommodation is provided by the allocation of 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. In April 1968 the Salvation Army "Booth House" hostel in Whitechapel Road, E.1., was opened by Her Majesty the Queen. Immediately following on this Her Majesty opened "Rawson Home", which is situated on the upper floors of the hostel. The latter accommodation was financed by the Corporation of London but is administered by the Salvation Army as a voluntary home under part III of the National Assistance Act, 1948 and was planned to accommodate 40 men. Some of the residents are men from the Salvation Army Hostel in the City, admission being controlled by the Medical Officer of Health of the City, whilst other residents are accepted from 44 elsewhere at the recommendation of the Salvation Army and also at the direction of the Medical Officer of Health of the City. Subsequent to Her Majesty's opening of the Home the Lord Mayor unveiled a plaque to commemorate the event. By this time 5 men were resident and gradually other men were accepted and have settled into their new surroundings. They all showed marked improvement in health visits within a few weeks of admission in spite of handicapping infirmities. Social adjustment took longer; nevertheless gratifying results have been recorded. Residential Accommodation for the Elderly 'Hillside' The number of residents at 'Hillside was gradually reduced in accordance with the Islington Borough Scheme to close the home in 1973. 1967 1968 Persons accommodated at the end of the year 17 9 Voluntary Homes 1967 1968 Persons accommodated at the end of the year Rawson Home – 22 Other Homes 10 10 Of the eight families referred to above, temporary accommodation was provided in 5 cases. No homelessness occurred in families resident in the City. Temporary Accommodation for Homeless Persons arising from a Peace-time Emergency A Peace-time Emergency Plan had been drawn up and this would have been put into action if such a disaster occurred. It involved the provision of a rest centre for persons rendered homeless. Voluntary organisations and the statutory services were thus organised to provide a necessary service for people in special need in an emergency. The plan was tested during the year when a combined Fire Brigade, Ambulance, Police, Hospital and Local Authority "disaster" exercise was held. It is pleasing to note that only minor modifications were necessary to the plan already drawn up. SECTIONS 29 and 30 Welfare Services for the Handicapped 1967 1968 Blind 5 4 Partially Sighted 1 1 No. of people in Residential Homes for the Blind 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. Two men received braille books and another was aided in obtaining clothing. At the end of the year one further person was under investigation with a view to registration as either blind or partially sighted. The Deaf and Hard of Hearing 1967 1968 Deaf without Speech 1 4 Deaf with Speech 3 5 Hard of Hearing 5 3 Welfare Services for the Deaf and Hard of Hearing It has taken longer to make contact with deaf persons and in the main their response to the 45 offer of services is slower. They all appear to have enjoyed the social visits made by an Assistant Health and Welfare Officer. Handicapped Persons General Register 1967 1968 Under 65 years of age 17 26 Over 65 years of age 111 103 Aged persons at risk 33 39 Welfare Services for the Aged and Infirm and Handicapped Persons In four years, 80 handicapped or aged persons at risk have been removed from the register due to removal to other accommodation or death. In the main the handicapped were elderly persons and required many of the Health and Welfare services to support them. They desired strongly to remain in their own homes and persisted in managing in some instances until admission to hospital was inevitable. Some of the other old folk needed frequent visits as concern was frequently felt regarding their wellbeing. Holidays for the Physically Handicapped Up to the present time, holidays for handicapped persons had been more suitably provided as recuperative holidays on medical recommendation. It is anticipated that 1969 will see a change in this situation. Sheltered Employment for the Handicapped and Elderly No requests were made. Day Centres and Clubs Two (3) elderly and infirm women attended the Day Social Club at St. Matthew's Hospital twice weekly. 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:— "The library service for home bound persons was continued during 1968 operating from the Bishopsgate Library. At three-weekly intervals during the year a senior member of the library staff visited on average 9 (12) home bound readers and issued in all some 930 (903) books. The service remained on much the same level as in the previous year but it had been found expedient to let readers choose as many books as they desire for each three week period as their reading capacities varied considerably. Where necessary, large print books were issued to readers who found difficulty in reading books printed in the avergae size type. Although the service was somewhat limited the recipients were very appreciative of the books they received." City of London Old People's Welfare Association The Honorary Secretary of the Association has submitted the following report on the work of the Association during the year:— "The Association by resolution of a Special Committee will be dissolved by 31st March, 1969, and although this will sadden many of those who have received benefits etc. provided since 1950 by the Association as a voluntary organisation, it is hoped they will feel recompensed in the knowledge that the appropriate Committees of the Corporation will continue to provide chiropody and other services to the over 60's in the Square Mile. It would seem inappropriate in these circumstances to submit a detailed list of the Association's activities but I think that the City of London Old People's Welfare Association can look back with pride in its past achievements and feel confident that with the introduction of the London Government Act, 1963 the assessed needs of the elderly in the City will be met by the Corporation of London. The Association is grateful to the forty-two voluntary workers who by regular visits have made the lives of many of the homebound elderly less dreary and to those who by their generosity have provided T.V. sets and other amenities and to all who since 1950 have assisted in the work of the Association." SECTION 31 - MEALS ON WHEELS SERVICE The arrangements for providing Meals on Wheels five days a week from the Staff Association Luncheon Room continued. At the end of the year 2404 (1558) meals had been supplied and delivered. Thirteen persons were in receipt of this service. On request, meals are also supplied from the Kosher Meals on Wheels Service and 972 (364) 46 meals were served during the year. Four parents were in receipt of this service. 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. Matthew's Hospital Day Social Club and also to assist with the delivery of Meals on Wheels. CORPORATION STAFF Opthalmic Optician Service Since the beginning of March 1959, a firm of Opthalmic 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 116 members of the staff had their eyes tested, 48 of these had not previously had an eye test under the National Health Service and 43 were found to have visual defects which required correction and were supplied with spectacles. 68 had been examined previously and were already using spectacles. Of these, 62 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 680 persons were medically examined. The reasons for medical examinations are shown in Table I. 393 persons were medically examined for admission to the Superannuation Scheme; 2 were rejected as unfit and 11 were deferred. 52 persons were medically examined owing to prolonged absence on sick leave. At the time of examination, 13 were reported as fit for duty, 21 were reported unfit for duty, and 18 were reported unfit for further service. 109 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. 45 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 62 persons were examined in connection with applications for exemption from parking fees. 28 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 Reasons for Examination Results Male Female Total Admission to Superannuation Fit 253 140 393 Scheme Unfit 1 1 2 Deferred 8 3 11 Referred for Excessive sick Fit for Duty 12 1 13 Absenteeism or retirement Still Unfit Unfit for further service 18 3 21 15 3 18 Over 65 years of age Fit 74 35 109 Unfit 0 0 0 Special 90 23 113 TOTALS 471 209 680 47 STATISTICAL INFORMATION Area — 678 acres (including the Temple and foreshore) Population — Census 1961, 4,711; Estimated mid-year 1968, 4,210 Annual Rateable Value — as at 1st April, 1968, £46,365,052 Annual Sum Received from Penny General Rate — £199,411 VITAL STATISTICS COMPILED FROM REGISTRAR GENERAL'S RETURN 1967 1968 Live Births Number 25 23 Rate per 1,000 population 5.52 5.46 Illegitimate Live Births Number 5 1 Illegitimate live births per cent of total live births 20.00 4.34 Stillbirths Number 1 nil Rate per 1,000 total live and still births 38.46 nil Total Live and Still Births 26 23 Infant Deaths (deaths under 1 year) NIL 1 Infant Mortality Rates Total infant deaths per 1,000 total live births NIL 43.48 Legitimate infant deaths per 1,000 legitimate live births NIL 44.45 Illegitimate infant deaths per 1,000 illegitimate live births NIL NIL Neo-Natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) NIL 43.48 Early Neo-Natal Mortality Rate (deaths under 1 week per 1,000 total live births) NIL 43.48 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births) 38.46 43.48 Maternal Mortality (including abortion) Number NIL NIL Rate per 1,000 total live and still births NIL NIL Deaths (all ages) Number 49 40 Rate per 1,000 resident population 10.82 9.5 48 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1967 CAUSES OF DEATH 1 NETT DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT ALL AGES 2 Under 4 weeks 3 4 weeks and under 1 year 4 1 and under 5 years 5 5 and under 15 years 6 1 5 and under 25 years 7 2 5 and under 35 years 8 35 and under 45 years 9 45 and under 55 years 10 5 5 and under 65 years 11 65 and under 75 years 12 75 and upwards 13 All Causes 40 1 — — 1 1 — 2 7 11 6 11 B5 Tuberculosis of Respiratory System M 2 — — — — — — — — — 1 — F — — — — — — — — — — — — B19(l) Malignant Neoplasm-Stomach M 2 — — — — — — — 4 1 — — F — — — — — — — — — — — — B19(2) Malignant Neoplasm-Lung, Bronchus M 1 — — — — — — — — 1 — — F — — — — — — — — — — — — B19(6) Other Malignant Neoplasms, etc. M 4 — — — 1 — — 1 — 1 1 — F 1 — — — — — — — — 1 — — B20 Benign and Unspecified Neoplasms M 1 — — — — — — — — 1 — — F — — — — — — — — — — — — B46(4) Other Diseases of Nervous System M 1 — — — — — — — — — — 1 F 1 — — — — 1 — — — — — — B26 Chronic Rheumatic Heart Disease M 1 — — — — — — — 1 — — — F 1 — — — — — — — — — — 1 B27 Hypertensive Disease M — — — — — — — — — — — — F 3 — — — — — — — — — 3 B28 Ischaemic Heart Disease M 6 — — — — — — — — 4 4 1 F 3 — — — — — — 1 — — — 2 B30 Cerebrovascular Disease M 2 — — — — — — — 1 — 1 — F 1 — — — — — — — — — 1 _ B32 Pneumonia M — — — — — — — — — 1 — 2 F — — — — — — — — — — — — B46(6) Other Diseases of Respiratory System M 1 — — — — — — — — — — 1 F — — — — — — — — — — — — B34 Peptic Ulcer M 1 — — — — — — — 1 — — — F — — — — — — — — — — — — B36 Intestinal Obstruction or Hernia M 1 — — — — — — — — — 1 — F — — — — — — — — — — — — B46(7)OtherDiseases of Digestive System M — — — — — — — — — — — — F 1 — — — — — — — — 1 — — B43 Birth Injury, Difficult Labour etc. M 1 1 — — — — — — — — — — F — — — — — — — — — — — — BE48 All Other Accidents M 1 — — — — — — — 1 — — — F — — — — — — — — — — — — BE49 Suicide and Self-Inflicted Wounds etc. M 1 — — — — — — — 1 — — — F — — — — — — —- — — — — — TOTALS M 29 1 _ _ 1 1 7 9 5 5 F 11 — — — — 1 — 1 — 2 1 6 INFECTIOUS DISEASES City Residents Non-Residents Total 1967 1968 1967 1968 1967 1968 Dysentery 0 1 9 8 9 9 Food Poisoning 0 1 18 7 18 8 Infective Hepatitis 0 1 0 1 0 2 Leptospirosis 0 0 0 1 0 1 Measles 2 2 3 0 5 2 Meningococcal Meningitis 0 0 0 1 0 1 Ophthalmic Neonatorum 0 0 2 0 2 0 Puerperal Pyrexia (not notifiable after 30.9.68) 0 0 14 9 14 0 Pulmonary Tuberculosis 7 5 0 4 7 9 Tuberculosis — other 0 0 0 1 0 1 Whooping Cough 1 0 1 0 2 0 Total 10 10 47 32 57 42 49 NEW LEGISLATION DURING THE YEAR The following enactments, which affect the work of the department, were made during the year:— Agriculture (Miscellaneous Provisions) Act, 1968. Health Services and Public Health Act, 1968. Medicines Act, 1968. Children (Performances) Regulations, 1968. Clean Air (Measurement of Grit and Dust) Regulations, 1968. Fees for Registration of Nursing and Residential Homes (Variation) Order, 1968. Fertilisers and Feeding Stuffs Regulations, 1968. Foot and Mouth Disease (Controlled Areas Restriction) (Amendment) Order, 1968. Foot and Mouth Disease (Imported Meat) Order, 1968. Foot and Mouth Disease (Imported Meat) (No. 2) Order, 1968. Health Services and Public Health Act, 1968 (Commencement No. 1) Order, 1968. Health Services and Public Health Act, 1968 (Commencement No. 2) Order, 1968. Imported Food Regulations, 1968. Labelling of Food Regulations, 1968. Offices, Shops and Railway Premises Act, 1963 (Exemption No. 7) Order, 1968. Performing Animals Rules, 1968. Poisons List (No. 2) Order, 1968. Poisons (No. 2) Rules, 1968. Public Health (Fees for Notification of Infectious Disease) Order, 1968. Public Health, (Infectious Diseases) Regulations, 1968. Public Health (Infective Jaundice) Regulations, 1968. Rag Flock and Other Filling Materials (Variation) Order, 1968. Rates Support Grants (Health Authorities) (Pooling Arrangements) Regulations, 1968. School Health Service (Amendment) Regulations, 1968. Skimmed Milk with Non-Milk Fat (Amendment) Regulations, 1968. Welfare Foods Order, 1968. Welfare Foods (Amendment) Order, 1968. PUBLICATIONS (1) Handbook of Poultry Inspection. (2) Clean Food Handling.