LON 95 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1969 To be presented '26th November, 1970. PORT AND CITY OF LONDON HEALTH COMMITTEE AND WELFARE COMMITTEE (as at 31st December, 1969) Christopher Selwyn Priestley Rawson, J, P. Herbert Twyneham Pike, Deputy The Rt. Hon. The Lord Mayor, Lt. Col. Sir Ian Frank Bowater, Kt., D.S.O., T.D., D.Sc. Sir Denis Henry Truscott, G.B.E., T.D. Alan Pearce Greenaway Robin Danvers Penrose Gillett, R.D. Anthony Wallinger Goodinge Ernest Gorden Duffett, T.D. Arthur Patrick Mills Samuel Sheppard, O.B.E. Charles George Hayes, Deputy Thomas Cuthbert Harrowing, Deputy Thomas Hugh Clifford Amies Arthur John Osborn James Mansfield Keith, T.D. Lt. Col. Charles George Surtees Shill Eric Frederick Wilkins, C.B.E., Deputy Sir Stanley Graham Rowlandson, Kt., M.B.E., J.P., G.L.C. Matthew Henry Oram, T.D., M.A. Dennis Gordon Fisher William Ian Baverstock Brooks Charles Wheeler Baker Alan Francis Gordon Stanham, Deputy Henry Wimborn Horlock, M.A. William Harold Wylie-Harris, Deputy Stanley Edward Cohen, C.B.E. Dr. James Cope William George Alfred Harries Major Henry Duckworth, J.P. William Samuels, Deputy Percy John Dyter Cyril Edward Baylis David Ivor Evans, T.D., J.P., Deputy Ronald Arthur Ralph Hedderwick Victor Allcard, Deputy Sir Thomas Kingsley Collett, Kt., C.B.E., Deputy Lady Donaldson, J.P. Donald Eustace Erlebach, Deputy. Chairman Deputy Chairman Aldermen Commoners Mrs. Iris D. Chandler Mrs. Rita Cohen, M.B.E. Miss Marie Annie Westermann Specially added as members of the Welfare Committee. STAFF (As at 31st December, 1969) 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., D.P.A.. F.R.I.P.H.H. Jan. 1964 DEPUTY MEDICAL OFFICER OF HEALTH (for the Port and City of London) JONES. Dilwyn Treharne, B.Sc., M.B., B.Ch., D.C.H., D.P.H., D.C.T. Jun 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. D.P.H. Mar. 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. (Child Welfare Clinic) (Part time) Apr. 1965 DENTAL OFFICER WALLACE. Lionel John, L.D.S., R.C.S. jun 1965 ADMINISTRATIVE STAFF (Port and City of London) R.C. RATLIFF Chief Clerk Mar 1930 E.V.SMITH Deputy Chief Clerk Oct 1938 C.W.R. BETTS First Assistant Clerk Apr 1926 F.B. OSBORN, A.M.R.S.H. Senior Assistant May 1952 R.H. COLLINS, L.M.R.S.H. Senior Assistant jan 1963 D.J. FLOOD Senior Assistant Mar 1963 A.J.G. MOORE Senior Assistant Apr 1964 Mrs. D.M. SHEPHERD First Class Assistant Apr 1965 S.C. DARLISON First Class Assistant Apr 1964 Miss M.L. GURNEY First Class Assistant May 1939 R.G. HEMING First Class Assistant Aug 1965 R.G. RUTTER First Class Assistant Jul 1968 D.M. HADDON First Class Assistant Nov 1968 R.G. FARRELL First Class Assistant Jul 1965 Mrs. |.H. HAMBLIN General Grade Assistant Oct 1957 Miss J.M. DOVE General Grade Assistant Mar 1968 Mrs. E.J .A. MORROW General Grade Assistant Mar 1968 Miss J.E. NEWSON General Grade Assistant jun 1966 Miss M.J. GOOLD General Grade Assistant Oct 1969 Miss S.C. DUNN Shorthand Typist Aug 1967 Miss H.E. FOX Shorthand Typist Aug 1969 Miss B. LOVATT Shorthand Typist Nov 1969 A.W. THREADGOLD Senior Asst. (Meat Inspectors' Office) Nov 1923 E.J. PETERS Clerical Asst. (Meat Inspectors' Office) Nov 1935 J.E. CASH Clerical Asst. (Meat Inspectors' Office) Mar 1954 J.T. HADLEY, A.M.R.S.H. Senior Asst. (Diseases of Animals Act) Jun 1965 Mrs. W.A.A. SCHOFIELD Clerical Asst. (Diseases of Animals Act) Aug 1967 Mrs. J. LYONS Clinic Clerk (Part time) Apr 1965 H.T.LLOYD Senior Messenger Nov 1968 J.A LAMBERT Messenger/Driver Nov 1968 G. HAMMOND Messenger/Driver Mar 1968 PUBLIC HEALTH INSPECTION STAFF E. THOMPSON, M.A.P.H.I. Chief Public Health Inspector Sep 1948 M.J. FLYNN, M.A.P.H.I. Deputy Chief Public Health Inspector Jul 1951 J.H. RILEY, M.A.P.H.I. Senior Public Health Inspector Aug 1962 J.B. WELLDON, M.A.P.H.I., Senior Public Health Inspector Aug 1962 A.R.S.H. H.L. SHEPLEY, M.A.P.H.I. Senior Public Health Inspector May 1964 J.A. HOARE, M.A.P.H.I. Senior Public Health Inspector May 1964 Date of Appointment PUBLIC HEALTH INSPECTION STAFF (contd.) W.J. BAXENDALE, M.A.P.H.I. Public Health Inspector jan 1964 D.F. CORFIELD Public Health Inspector jun 1964 D. HITCHCOCK. M.A.P.H.I., Public Health Inspector Nov 1967 M.R.S.H. T.B. MEANEY, M.A.P.H.I. Public Health Inspector Mar 1968 F.R.S.H. B.L. NUNN, M.A.P.H.I. Public Health Inspector Apr 1968 A.G.WILLIAMS,M.A.P.H.I. Public Health Inspector May 1968 G.L. PAGE, M.A.P.H.I. Public Health Inspector Jul 1968 M.R.S.H. B.J. DAWSON, M.A.P.H.I. Public Health Inspector Feb 1969 M.C.J. ELKINGTON, M.A.P.H.I. Public Health Inspector Feb 1969 P.G. FAIRBAIRN, M.A.P.H.I. Public Health Inspector Aug 1969 D.T.W. FREEMAN Technical Assistant Mar 1968 MEAT INSPECTION STAFF W.R. LEE, M.lnst.M., M.A.P.H.I. Chief Meat Inspector Jul 1930 S.S. GARRARD, M.A.P.H.I. Deputy Chief Meat Inspector Sep 1946 W.L. MORRIS, M.lnst.M. Senior Meat Inspector Sep 1946 K.S. SEYMOUR, M.lnst.M. Senior Meat Inspector Jul 1935 M.A.P.H.I., M.A .M.I. J.C. WILSON, M.lnst.M.. M.A.M.I. Senior Meat Inspector jan 1936 J.T. COX, M.A.P.H.I. Meat Inspector Aug 1954 H. FIELD, M.A.P.H.I. Meat Inspector Aug 1954 G. GINGELL, A.R.S.H., M.A.P.H.I. Meat Inspector Aug 1954 B.G.F. PAYNE, D.F.C., M.A.P.H.I. Meat Inspector Dec i960 F.E. ELSEY. M.A.P.H.I. Meat Inspector jan 1964 D.R. BERNHARDT Technical Assistant (Authorised) May 1931 R. HUDSON Senior Porter May 1963 HEALTH AND WELFARE SECTION Miss G.L. BENFIELD, S.R.N., Health and Welfare Officer Apr 1965 S.C.M., H.V., Nursing Admin.P.H. Cert., M.R.S.H. Miss M.T. DOWD, R.F.N., S.R.N., Asst. Health and Welfare Officer Mar 1967 C.M.B. Part I, H.V. Miss S.M. BERGSTROM, S.R.N., Asst. Health and Welfare Officer Apr 1967 S.C.M., H.V. Mrs. P.A. MIMMS Clerk/Dental Surgery Assistant Sep 1965 Mrs. A.M. SIERANKOWSKA Chiropodist (Part time) Nov 1966 R. JONES Chiropodist (Part time) Apr 1969 9 Home Helps DISEASES OF ANIMALS ACT G.S. WIGGINS, M.R.C.V.S., Veterinary Officer Oct 1964 F.R.S.H. R.J. HAYHURST, D.F.C. Inspector Oct 1964 K.W. KING, A .M.R.S.H. Inspector Apr 1965 V.O. GUBBINS Inspector (Part time) Jul 1968 RODENT STAFF G.A. MASON Foreman Rodent Operative Dec 1946 P.M. BERRY Rodent Operative jun 1967 J. PEG RAM Rodent Operative Sep 1967 R.C.HARRIS Rodent Operative Dec 1967 J.E. KIDDY Rodent Operative Sep 1968 F.H. PRIEST Rodent Operative Mar 1969 MORTUARY AND DISINFECTING STATION F.H. LAWRENCE Superintendent of the City Mortuary and Disinfecting Station May 1936 J.W.T. SUNNICK Disinfection Apparatus Attendant May 1950 MANUAL WORKERS R.H. I'ANSON (General Duties at Smithfield Market) Feb|964 W.T. STEELE (General Duties at Mortuary) Aug 1958 C.E. PEARCE (General Duties at Smithfield Market) jan 1964 E.A. HIGLEY (General Duties at Smithfield Market) Sep 1967 Mrs. M.M. SHEEHAN (Bath Attendant and Cleaner) Oct 1962 G.W.JACOBS (General Duties at Mortuary) Dec 1966 W. CONNON (General Duties at Smithfield Market) Dec 1968 PUBLIC ANALYST H.A. WILLIAMS, Ph.D. (Lond.)., M.Chem A., F.R.I.C., A.C.G.F.U., F.C.G.I., Jan 1958 F.R.S.H. 3 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON FOR THE YEAR 1969 To the Right Honourable The Lord Mayor, Aldermen and Commoners of the Corporation of London. GUILDHALL, E.C.2. Telephone: 01-606 3030. My Lord Mayor, Lady and Gentlemen, I have the honour to submit the following report on the work of my Department during the year ending 31st December 1969. I am grateful to all those who have contributed to the work during the year especially the Chairman and Members of the Port and City of London Health and Welfare Committees, and the Staff of the Department. Cooperation on the part of the medical and nursing staff of St. Bartholomew's Hospital has continued in a most generous manner. 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. 4 HOUSING Housing Acts 1. Number of houses which on inspection were considered to be unfit for human habitation:- I 2. Number of houses in which defects were remedied in consequence of informal action by the Local Authority or their Officers:- 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:- NiI 5. Number of houses which were rendered fit after service of formal notices:- NiI 6. Number of demolition or closing orders made:- NiI 7. Number of houses in respect of which an undertaking was accepted under subsection (4) of section 16 of the Housing Act, 1957:- NiI 8. Number of houses demolished:- I 9. Number of inspections of housing accommodation:- 47 During the year 321 families were rehoused leaving 480 families on the housing register at the end of December 1969. The first phase of the Middlesex Street redevelopment was completed in April 1969 providing 20 flats and 9 shops. When completed the redevelopment will provide a shopping and residential precinct of 181 flats and 38 shops. A further 306 flats were completed in the redevelopment of the Barbican residential area bringing the total to 413. Work is in progress on a further 1700 flats. EXAMINATION OF WATER SUPPLIES AND SWIMMING BATH WATER It is the duty of the local authority to ensure that a pure and potable supply of drinking water is available to its inhabitants. These powers are contained in various enactments, which include the Public Health Act, 1936, the Water Acts of 1945, 1948 and 1955 and the Offices, Shops and Railway Premises Act, 1963. In the City there are two sources of supply — (1) From the statutory water authority — in the case of the City, the Metropolitan Water Board, and (2) From deep wel Is, of which there are 114 in use, owned by various business houses in the City. In the case of the Metropolitan Water Board the supply is completely safe and satisfactory when delivered to the premises concerned and all examination up to this point is carried out by the Board's own staff. The supply, however, is often stored in cisterns and tanks which may become contaminated and are, therefore, the responsibility of the Health Department. The various office staffs in the City now have a right to expect a pure supply of drinking water to be provided by their employers in accordance with the provisions of the Offices, Shops and Railway Premises Act. 1963. City Byelaws require that tanks be cleaned out at six-monthly intervals and be properly covered to protect the supply from bird and rodent contamination. Routine inspections are carried out to see that this work is done and that the supply is kept in a satisfactory state. Duringthe year 102 bacteriological samples were taken from drinking water points, 12 of which were found to be contaminated. If other than bacterial contamination is suspected a chemical sample is also taken. Seven samples were taken upon complaint and subjected to bacteriological and chemical examination. A table of the results is shown below:- 5 No. Source Supply Use Condition of water Remarks 1 Coffee Vending Well Drinking Clear, colourless Water is alkaline Machine and tasteless. and contains a Small amount of high proportion brown sediment. of dissolved solids, particularly sodium salts. Organic matter high. 2 Well Deep Well Drinking Clear, bright, Water is alkaline odourless, colour- and contains a less and taste- high proportion less. Bacterio-logically of dissolved satisfactory solids, particulraly sodium salts. Could have an aperient effect. 3 Storage Tank MWB Drinking Clear, bright, Water is hard but odourless and consistent with colourless. Bacteriologiclly MWB supply to City of London, satisfactory. Trace of chlorine could indicate a high original concentration. No cause for complaint of Gastric disorder found. 4 Storage Tank Deep Well Drinking Clear, bright, Water is alkaline odourless and and contains a colourless. Bacteriologically high proportion of dissolved solids satisfactory. particularly sodium salts. Could have an aperient effect. 5 Drinking point MWB Drinking Clear, bright, Water is alkaline, without sediment, containing high Odourless, col- proportion of ourless and dissolved solids tasteless. Bacteriologically particularly sodium salts. satisfactory. Could have an aperient effect. No cause for complaint of headache and dizziness. 6 Tank Supply MWB Drinking Clear, bright. Water consistent odourless, taste- with MWB supply less and colour- to City of Londonless. Bacteriologically. No cause satisfactory for complaint of staff sickness. 7 Storage Tank MWB via Drinking Clear, bright, Water consistent storage odourless, taste- with MWB supply tank less and colour- to City of London less. Bacteriologically. satisfactory. Swimming Baths During the year 41 bacteriological water samples were drawn from the three City swimming pools. Free Chlorine, Residual Chlorine and p.H. value were recorded on each occasion. 6 The following table shows details of bacteriological examinations of both drinking water supplies and swimming bath water. Source of Supply Number of samples Number of Samples giving results above 0 per 100 mls. Number of Samples giving plate counts above 0 Cols/ml after 24 hours at 37°C. Coliform Count Bact. Coli (type 1) (1) Deep Wells within the City Area 67 6 - 7 (2) Metropolitan Water Board 35 - - 5 (3) Swimming Pools within the City 41 - — 4 TOTAL 143 6 – 16 The Metropolitan Water Board have supplied the following Report:- 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1969. (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, 1969, was 4,226. (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 New River - derived from Stoke Newington Works. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies arenot considered to be plumbo-solvent.lt should, however.be appreciated that all types of water pick up varying amounts of metal from the material ofwater piping, particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement. 7 METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF THE WATER SUPPLIED TO THE CITY OF LONDON FOR 1969. Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal 1 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 CI Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Stoke Newington 53 0.015 0.059 4.7 0.62 314 84 5 30.8 5.3 41 1.7 10 68 0.25 0.02 0.0 7 7.9 630 R.Thames — Derived 371 0.024 0.083 4.4 1.05 282 79 5 24.0 5.4 32 2.1 9 58 0.25 0.02 0.1 1 1 7.9 550 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES. 1969. WATER SUPPLIED TO THE CITY OF LONDON Source of Supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22° C. Per cent, samples negative in 1 00 ml. Count per 1 00 ml. Per cent, samples negative in 100 ml. Count per 1 00 ml. 20-24 hours at 37 °c. 3 days at 22° C. Per cent, samples negative in 100 ml. Per cent, samples negative in 100 ml. Stoke Newington 752 38.7 59.31 2.6 75.27 0.6 257 18.0 100.0 100.0 River Thames — derived 8.196 66.5 39.79 19.0 53.97 7.0 3,698 12.9 99.89 100.0 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 General 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 It has now become accepted that noise is one of the forms of pollution of the environment which will need a concentrated effort over the next few years if it is to be controlled. Where previously only high intensity industrial noise was considered to be a hazard the following categories have now emerged- (1) The high intensity industrial noise already referred to. (2) The high intensity non-industrial noise such as that caused by pop music. Recent work has demonstrated that the increased load of noise borne by young people may well be the cause of the increasing numbers of young people found to have measurable hearing loss in their late teens. Most of this work has been done in the United States of America but there is no reason to believe that the same thing would not apply in this country under the same condition. (3) Low intensity noise which, it is now contended by a number of workers in this field, can cause physical changes in the body, such as changes in blood pressure and other autonomically controlled systems. It is undeniable that noise at intensities well below the 90 dbA limit which is normally regarded as "safe" can cause increased nervous stress and a loss of efficiency and accuracy, especially in the carrying out of complex selective tasks. (4) Some of the above contentions are arguable. What is not arguable is that noise can be, and very often is, an infernal nuisance. All of the above categories are of importance in the City of London. High intensity industrial noise occurs on building sites. High intensity non-industrial noise may well affect, during their leisure hours, those thousands of young people who work in the City. Low intensity noise is probably the form of environmental pollution which affects most people during the greater part of each day of their lives. This is certainly so in the City. Mention has been made of noise from building and demolition sites. Traffic of all sorts, aeroplanes and helicopters are other external sources. Inside some City offices there is |ust as much cause for concern. When one considers the vast contribution towards the maintenance of the Country's economy which is made in invisible exports by the City of London, one realises how important a decrease in efficiency and accuracy even as small as only one quarter of 1% could mean. If one is distracted by noise for a quarter of a minute in every hour and a half (and where in the City could one claim such ideal conditions?) this degree of loss of efficiency has been exceeded. Realising the extent of these problems and with the ready and willing co-operation of the Corporation's Public Relations Officer and his staff, a campaign has been waged against noise in the City for many years. Advice on noise abatement techniques has always been freely available and persuasion has been used wherever possible. Compulsion, which is possible under the Noise Abatement Act and which is unfortunately the only course left open in some cases, is difficult because of the loopholes left in the Act and because of the essentially subjective nature of an individual's response to noise. After all, it is easy to define noise as unwanted sound, but it has to be accepted that, in practice, what is objectionable noise to one person is music (sometimes literally) to another. Therefore this work has required an immense amount of tact and forbearance on the part of the staff of the Health Department and has also needed a determination to push on without any expectation of spectacular or immediate results. During 1969 the campaign was intensified by the following measures:- (1) In service training was provided for 3 public health inspectors at Noise Control Courses, (2) The Health Education programme was increased, anti-noise information being made freely available both as literature and in the form of personal advice. (3) A Quiet City campaign was held from the 7th to I3th July. This campaign, opened by the 9 Right Honourable The Lord Mayor, had the following aims — (a) To show City workers and residents why they should reduce the noise which assailed them and the methods by which this could be done; (b) To assist employers in increasing the efficiency of the City worker by reducing the noise in which he worked; and (c) To examine the various types of response to the campaign literature with a view to assessing the relative value of future noise abatement work. A report on the campaign was submitted by the Port and City of London Health Committee to the Court of Common Council and received national and international press and radio coverage, as a result of which several most useful links have been forged with other agencies at home and abroad concerned with the same work. COMMON LODGING HOUSES This Department has been closely involved in the problems which have arisen during the year at the Salvation Army Hostel in Middlesex Street. Close supervision by this Department has been necessary because acceptable standards of personal hygiene are not maintained by the inmates. The Salvation Army authorities have found it either impossible or unacceptable to impose better standards on their occupants. This absence of personal hygiene on the part of some lodgers has brought about severe infestations of lice in recent years, and the year under review has been no exception. It is inevitable that the plight of those who find it necessary to use this type of accommodation will receive increasing publicity. Whilst there is general concern that such premises should be improved, so long as they remain in use the problems facing the Keeper will compel this Department not to relax its efforts. Vermin infestation in the form of lice presents the biggest problem. Lice are introduced into the premises by the casual overnight lodger who, especially on warmer nights, sleeps rough, and a reservoir of infestation is set up in the regular occupants, who pick up these insects and who are not sufficiently regular in their bathing and washing habits. Regular early morning inspections of beds have been carried out. On one occasion 40 beds out of 82 were found to be infested with vermin and this convinced the Salvation Army authorities of the gravity of the situation. It is inevitable that for the time being systematic inspections of bedding will have to be continued. The van purchased for the purpose of transporting verminous men and articles has proved invaluable. It has enabled a large quantity of bedding to be reliably disinfested and has promoted a greater zest for cleanliness on the part of hostel workers. Following discussions between this Department and the local and headquarters staff of the Salvation Army, mechanical cleaning equipment has been provided and its use soon proved its worth. There was a noticeable and rapid improvement in the state of cleanliness of the wooden floors. The personal cleanliness aspect cannot be over-stressed where lice are involved. This objectionable vermin will persist while men go unbathed for weeks on end and remain in their same clothing day and night. It would certainly seem that each man should be provided with personal locker accommodation for his clothing and as a condition of tenancy be required to have a weekly bath. For the most part men keep all their personal belongings on themselves. These premises can be compared to army barracks, but without the accompanying discipline of personal and corporate hygiene. Finally, it may be said that the problem is not only one of beds and lice but of unfortunate men who for various reasons have to make such premises their home. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 During the year under review (1969) much time and energy has been devoted, among other things, to the problem of ventilation in order to secure compliance with the provisions of Section 7 of the Act of 1963. Inquiries made at various office blocks support the view that in the basic designs of the mechanical ventilating systems of office blocks, tall or squat, priority is given to the control of temperature in the spaces used as offices. Therefore, some ventilation systems are primarily heat control units, certain ventilating factors being introduced secondary to the basic heat control design. As such designs have different methods of control resulting from the different priorities given to economy, heat control and ventilation by prospective owners and architects, the problems to be dealt with in heat loss and gain from a variety of types of building and construction are dealt with differently by various heating and ventilating engineers,, 10 Within the City of London the ventilating systems range from the simple arrangements such as the room with its openable window with an air shaft communicating directly to the open air together with a single heating unit, to mechanical systems of:- (a) Through passage of atmospheric air which, after some form of treatment is used in the offices and then exhausted to atmosphere — in other words, fresh air is used; (b) Varying degrees of recirculation of air taken from atmosphere — treated and then recirculated continuously, fresh air being introduced only to make up any air lost from the spaces in use, which constitutes almost 100% recirculation. The inspection of various installations using recirculation, and discussions with engineers and designers, support the opinion that the majority of existing plants are capable of being adjusted to 100% fresh air with, no doubt, an increase in the cost of running the plants to control temperature. There would appear to be greater consideration needed in building design to the control of heat loss/gain and the glazing and size of windows in offices, and more flexibility in ventilation unit size, i.e. small units instead of one large unit, in order to facilitate the control of conditions in different parts of a large office block. As there is no legal requirement for prior approval of office development to meet the requirements of the Offices, Shops and Railway Premises Act, 1963, there seems to be insufficient appreciation by architects, designers and ventilating engineers of the fact that when the office is occupied it must comply with the requirements of the Act. During the year the question of prior approval was dealt with simply by making it known to professional people and owners that they were welcome to visit the Guildhall and discuss their projects whilst in the planning stage. Towards the end of the year a steady stream of technical advisers were being interviewed on all the provisions of the Act. Conditions appeared to vary between the following extremes:- (a) That a building and its services should be constructed and maintained to meet all the requirements of the employee; or (b) That the employee is secondary in consideration to building construction, especially where economy is stressed. The Act is to make fresh provision for securing the health, safety and welfare of persons employed to work in office or shop premises. This has been interpreted, and it is hoped correctly, to mean that people should have the primary consideration. When it came to the question of ventilation in high rise development, it was found that where tall buildings are erected with fixed windows and every effort is made to effectively seal the building from fortuitous entry of external air, the pertinent points were: (I) Are there any ventilation standards? (2) If so, how were they arrived at and on what data were they based. With fixed windows, the occupant of the rooms has to endure or enjoy what form of ventilation is provided. There is a general impression, fondly held on the part of the public at large, that all mechanical ventilation is good, and owners of property do not seem to question the true effectiveness of any mechanical ventilation installed. In the absence of any standards known to have a scientific basis the question was posed as to what is adequate ventilation. Along with this problem was considered the problem of what is fresh air. The view is expressed that recirculation of vitiated air is undesirable and furthermore it would still seem to be the intention of the Act to ensure that adequate supplies of fresh air or artificially purified air shall be available to the occupants. What constitutes the proper means of meeting these requirements seems to raise many conflicting views and the grounds on which some of these varying standards are proposed appear to be of a dubious nature. We are, therefore, left with a distinct feeling of unease that the "person" is not receiving the prime consideration. In these circumstances, we have come to the conclusion that, to maintain conditions which promote the well-being of the staff, ventilation by means of fresh air or artificially purified air, supplied at the rate of not less than 3,000 cubic feet per person per hour, would be considered suitable in any room in which persons are employed to work. It is suggested that the surroundings should be such that an employee can work without any impairment to his health or well-being and not merely survive. In practice it is sometimes found that a building is erected with openable windows but the staff are not allowed to open them.There is a recirculatory air heating system for temperature control which would be out of balance if the windows were open. In such situations the ventilation is by recirculation, even though physically the windows can be opened. 11 The employee's lungs can be considered as gaseous exchange units basically inspiring atmosphere made up volumetrically of oxygen 20.96%. nitrogen 79%, carbon dioxide 0.04%; alveolar air contains oxygen 14%. nitrogen 80%, carbon dioxide 6% and expired air contains oxygen 16.03%, nitrogen 79% and carbon dioxide 4.4%. On an average this chemical exchange takes place sixteen times each minute with an average inspiration and expiration, at rest, of approximately thirty cubic inches, Simple mathematics show that at rest each person converts, on average three-quarters of a cubic foot of oxygen to three-fifths of a cubic foot of carbon dioxide each hour Attention is now drawn to other factors or reasons tor changing air in an enclosed space. Such considerations are body odours, scents, smoking and other contaminants known to the process of living and working bacteria-carrying particles, viruses and products of combustion, and the control of humidity and temperature have to be taken into account. In years past the office was an enclosed space with a window a fire-place and a chimney flue. Modernisation brought, first, central heating by water pipes, and then atmosphere was blown into the enclosed spaces pre-heated or pre-chilled. Finally, in recent years in order to save monev the recirculation of air/mixture back to the offices after use was introduced. This recirculation is usually achieved by a split duct in the plant room, by means of which a proportion of the vitiated air is exhausted to atmosphere and the remainder is re-used There are two aspects of this recirculation system of importance. Knowing that people give off a known quantity of waste gases (carbon dioxide) it is impossible to avoid an increase in the carbon dioxide content of the mixture, whatever volume of atmosphere is mixed with it in the plant room. Mathematically, this increase can be calculated when the volumes and percentage of recirculation are known, as well as the decrease of the oxygen. Furthermore, where a recirculation system is installed, usually the plant provided has the capacity to deliver adequate quantities of fresh air as the designers usually give the volumes of mixture up to and above the ventilation recommendations of the Corporation. Great care is devoted to ensuring that we have a pure water supply and no one would suggest that in the interests of economy we should be doomed to drink polluted water even though the pollution which has taken place cannot always be proved to be deleterious to health. In the interests of economy, are lower ventilation standards to be permitted In the City which has a very large daytime population and upwards of five thousand in a single building, the standard set out above, for the reasons given, has been advanced as being desirable and complying with the provisions of Section 7 of the Act of 1963. At the same time, it has been made known that the Health Department is prepared to discuss the above standard with anyone. On a combined atmosphere heating/ventilation scheme the approximate cost is made up as follows:- Ventilation 7% - 20% Heating 93% - 80% of whole scheme Section 6 of the Act provides for a temperature of 16° C or 60.8° F after the first hour. In practice the operative temperature is normally set at 21.1° C or 70° F without any real reason given for such a level of temperature. This central-heating setting is approximately 10° F above the requirements of the Act of 1963. With heating/cooling requirements using so great a proportion of running costs there would appear to be grounds for investigation as to what is a reasonable setting of thermostats in central heating systems. This factor is of increased importance as the only objection so far advanced against the 3000 cubic feet of atmosphere "through"-type of ventilation has been the cost factor. It is very important to place in their true perspective the responsibilities set out in the Act between occupiers and owners. As an example; the occupier is responsible for ventilation of premises in which persons are employed to work. How is the occupier of a suite of offices in a tower block to effect improvement in ventilation if so required by the enforcing authority? This does emphasise the desirability of consulting with a Local Authority before embarking on a major project. It is difficult to appreciate the extent of the work of the department purely in statistical form when emphasis has been placed on prevention rather than cure. For example,one Inspector was engaged exclusively on ventilation problems within the City for the second half of the year. 12 Where a building may eventually have five thousand employees therein it seems preferable to have discussions in the design state rather than wait to discoverdeficiencies after a development has been completed, Whilst 310 written communications have been sent regarding a multitude of unsatisfactory conditions varying from lack of routine cleaning and decoration to overcrowding and inadequate sanitary accommodation and washing facilities, no great problems were encountered in securing compliance with statutory requirements. Indeed, there is a general willingness to attend to contraventions of the Act when the attention of occupiers and owners has been drawn thereto. So far as the City is concerned, the task of making a general inspection of each occupied offices is proving to be one of gigantic proportions and the initial survey has not yet been completed, notwithstanding the fact that the enhanced rate of inspection achieved during 1968 has been maintained during the year under review. The Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968 came into operation on the 28th May, 1969 and the effective enforcement of these regulations has also proved to be time-absorbing, but the experience gained so far would emphasis the necessity for this particular statutory enactment. In conclusion, it may be said that whilst a great effort has been made to enforce and to advise upon all the requirements of the Act it is in the field of ventilation that the greatest problems have arisen and are likely to continue. 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 535 6694 2241 Retail shops 68 957 122 Wholesale shops, warehouses 15 803 70 Catering establishments open to the public, canteens 22 549 365 Fuel storage depots NIL NIL NIL TOTALS 640 9003 2798 TABLE B NUMBER OF VISITS OF ALL KINDS (INCLUDING GENERAL INSPECTIONS) TO REGISTERED PREMISES 7292 13 TABLE C ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED BY REGISTERED PREMISES AT END OF YEAR Class of workplace Number of persons employed Offices 267,006 Retail shops 5.153 Wholesale departments, warehouses 6.057 Catering establishments open to the public 6.752 Canteens 4.571 Fuel storage depots NIL Total 289.539 Total Males 173,679 Total Females 115.860 14 TABLE D—EXEMPTIONS M/c. Line No. Class of premises (1) No. of exemptions current at end of year (2) During the year M/c. Line No. No. of exemptions No. of applications Appeals to Court against refusal to grant or extend an exemption or against the withdrawal of an exemption newly granted (3) extended (4) expired or withdrawn (5) refused (6) opposed by employees (7) No. made (8) No. allowed 0) Part I—-Space (sec. 5(2) 1 Offices 1 1 NIL NIL NIL NIL 1 2 Retail shops 2 3 Wholesale shops, warehouses - 3 4 Catering establishments open to public, canteens 4 5 Fuel storage depots 5 Part II—Temperature (sec. 6) 11 Offices Nil 11 12 Retail shops 12 13 Wholesale shops, warehouses 13 14 Catering establishments open to public, canteens Nil 14 15 Fuel storage depots 15 Part III—Sanitary Conveniences (sec. 9) 21 Offices 21 22 Retail shops 22 23 Wholesale shops, warehouses Nil 23 24 Catering establishments open to public, cantcens 24 25 Fuel storage depots 25 Part IV—Washing Facilities (sec. 10(1) ) 31 Offices 31 32 Retail shops 32 33 Wholesale shops, warehouses 33 34 Catering establishments open to public, canteens 34 35 Fuel storage depots 35 TABLE E—PROSECUTIONS Prosecutions instituted of which the hearing was completed in the year Section of Act or title of Regulations or Order (1) No. of informations laid (2) No. of informations leading to a conviction (3) Nill No. of persons or companies prosecuted Nil No. of complaints (or summar applications) made under section 22 Nil No. of interim orders granted TABLE F—STAFF No. of inspectors appointed under section 52 (1) or (5) of the Act 3 Full time 10 Part time No. of other staff employed for most of their time on work in connection with the Act 2 SUMMARY OF DEFECTS FOUND AND NOTICES SENT 1. Cleanliness — Dirty conditions 90 Accumulations of Refuse 1 2. Overcrowding 55 3. Temperature - Unreasonable 2 Absence of Thermometer 95 Absence of Warming Facilities 2 4. Ventilation — Inadequate 162 5. Lighting Inadequate 60 6. Sanitary Conveniences- Insufficient 5 Unsatisfactory/Defective 172 - Not separate for sexes 4 7, Washing Facilities - Insufficient 10 - Unsatisfactory/Defective 37 - No Hot water 18 - Soap/Drying facilities 9 8. Drinking Water - Inadequate supply 12 - Disposable vessels/Rinsing facilities 2 9. Clothing - Inadequate accommodation 21 - Inadequate drying facilities 10 10. Seating - Inadequate 6 II. Floors, Stairs. Passages - Unsound construction 28 - Obstruction/slipping 62 - Handrail (lack of) 83 - Protection of Openings 4 12. Machinery - Inadequate guarding 100 13. First Aid - Inadequate Provision 96 14. Information - No Handbook available 124 15. Dangerous Practices 5 16. Miscellaneous 27 1302 I 6 HYGIENE IN HAIRDRESSING AND BARBERS SHOPS Section 77 of the Public Health Act, 1961, empowers local authorities to make Byelaws dealing with hygienic conditions in Hairdressers' and Barbers' shops. During the year 42 inspections were made. As a consequence of these inspections, it was necessary to serve Intimation Notice. The Greater London Council (General Powers) Act, 1967 requires all persons who wish to carry on the business of a hairdresser or barber to be registered in respect of their premises. During the year, 6 hairdressers and barbers were so registered bringing the total on the Register to 70. FACTORIES ACT, 1961 Factory premises have been under such supervision as is necessary, and the following gives details of the work carried out:— Part 1 of the Act 1. — INSPECTIONS for the purposes of provisions as to health. PREMISES Number on Regi ster 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 69 (incl. 1 bakehouse) 1 18 20 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 583 (incl. 2 bakehouses) 17 6 — (lii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 5 1 41 31 — TOTAL 803 (incl. 3 bakehouses) 176 57 - 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. I.) 11 10 _ _ _ Overcrowding (S.2-) _ _ _ _ Unreasonable temperature (S.3.) _ _ _ Inadequate ventilation (S.4.) 5 4 _ _ Ineffective drainage of floors (S.6 ) _ _ _ _ Sanitary Conveniences (S.7.) _ _ _ _ _ (a) insufficient 8 7 _ (b) unsuitable or defective 33 29 _ _ (c) not separate for sexes 3 3 Other offences against the Act (not including offences relating to Outwork) 47 41 3 9 - TOTAL 107 94 3 9 - 17 Part VIII of the Act Outwork (Sections 133 and 134) Section 133 Section 134 Nature of Work 1 No. of outworkers in August Iist required by Section 133 (1) (c) 2 No. of cases of defauIt in sending lists to the Council 3 No. of prosecutions for failure to supply Iists 4 No. of instances of work in unwholesome premises 5 Notices served 6 Prosecutions 7 Wearing apparel (Making, etc.) 289 - - - - - TOTAL 289 — — — — - Outwork and the inspection of outworkers' premises etc. Lists received from City Firms employing outworkers 25 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. 289 No case of infectious disease was reported in connection with outworkers' premises in the City. SANITARY CIRCUMSTANCES The general sanitary supervision has been maintained and in this connection 15,969 inspections have been made. As a consequence of these inspections, it was necessary to serve 1,914 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 CLEAN AIR ACT. 1968 The above-mentioned Acts provide the legal basis for controlling atmospheric pollution in the City and this legislation is enforced by the City's Public Health Inspectors, who carried out 1,504 inspections during the year. The following statistics indicate the extent of the work carried out:— (1) Initial Inspections — 346 visits (2) Re-Inspections — 283 visits (3) Observations Made — 758 (4) Contraventions Noted — 69 (5) Verbal Intimations — 60 (6) Notices Served — 9 Special note has been taken of the sulphur dioxide ground-level concentration in the City and concern is felt that this form of pollution is at a level which ought to be substantially reduced. There has, however, been some reduction in this form of pollution over the last five years. Users of oil-fired boilers are encouraged to use the lower sulphur content group of oils, i.e. those with less than one per cent sulphur content. This measure, though not enforceable, has no doubt been instrumental in bringing about the reduction of sulphur dioxide mentioned above. The number of bonfires on the City's redevelopment sites was again a source of serious concern and the situation has been worsened by the passing of the 1968 Clean Air Act and the Dark Smoke Exemption Regulations, 1969, which allow bonfires to be burnt subject to certain conditions. This has tended to make the prohibition of such bonfires impossible. A new development has now been noticed as a result of the Chimney Height Regulations, 1968. Various conversions of plant have been carried out in which gas has become the chosen 18 fuel. In some of these instances a method of diluting the flue gases has been installed and the products of combustion have been discharged near ground level. As this does not affect the ground-level concentration of sulphur dioxide it is not generally realised that other forms of pollutants can be increased. These are in the form of oxides of nitrogen, some carbon monoxide and an increase of carbon dioxide. There may also be a vapour nuisance. These pollutants when discharged at low level in large quantities are likely to be prejudicial to health and this situation is being kept under close observation with a view to preventing this kind of increase in atmospheric pollution. Obviously this low-level diluted discharge has a specious appeal, in so far as it enables some architectural problems of chimneys and costs to be pushed under the proverbial carpet, but it is felt that this type of solution to a tedious problem should be viewed with a fair degree of c?ution. So far, those appliances that burn more than 1¼ million British Thermal Units per hour have to comply with the Chimney Height Regulations, whilst those under this figure must be judged on their merits and are subject, after their installation, to Public Health Act legislation It is a fairly simple matter under the Chimney Height Regulations to ensure that large quantities of flue gases are discharged at the proper dispersal height, but it can be seen that smallerappliances present some difficulty as they can be dealt with only after their installation. Measurement of Atmospheric Pollution The measurement of atmospheric pollution has continued during 1969. Daily readings are taken at the two volumetric stations to enable the concentration of sulphur dioxide to be found, by the volumetric measurement of sulpheric acid which is produced when air containing SO2 is bubbled through a solution of Hydrogen Peroxide. Air is drawn from the atmosphere, through 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. TABLE I Results obtained in 1969 of the monthly observations of rainfall and deposited matter by means of the deposit gauge at Guildhall. Month Rainfall collected in the deposit gauge Deposited Matter (Tons per square mile) Millimetres Inches Insoluble Soluble Total January 55 2.16 18.50 7.31 25.81 February 40 1.59 16.77 7.07 23.83 March 60 2.37 33.32 8.94 42.26 April 20 0.77 42.85 5.30 48.15 May 45 1.76 47.39 6.17 53.55 June 28 1.12 12.82 4.26 17.08 July 88 3.47 22.69 4.75 27.43 August 81 3.18 17.04 5.99 23.04 September 4 0.17 16.35 3.50 19.85 October 5 0.19 21.13 4.68 25.81 November * - - - - - December 52 2.05 20.40 8.80 29.20 Averages 1969 43 1.71 24.48 6.08 30.55 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 1964-1968 52 2.06 18.54 10.66 29.20 * Deposit gauge inoperative during this period. 19 TABLE II Monthly summary of the results obtained in 1969 of the daily observations of the concentration of SMOKE by the volumetric method at the Public Services Building and at Snow Hill Police Station. The results obtained by means of the deposit gauge at Guildhall are included for comparison. Month Concentration of Smoke (microgrammes per cubic metre) Rainfall collected in the deposit gauge Public Services BuiIding Snow Hill Police Station Millimetres Inches January 79 82 55 2.16 February 77 7 1 40 1.59 March 77 69 60 2.37 April 43 47 20 0.77 May 36 39 45 1.76 June 31 35 28 1.12 July 32 39 88 3.47 August 37 47 81 3.18 September 39 38 4 0.17 October 65 63 5 0.19 November 55 82 * * December 79 100 52 2.05 Averages 1969 54 60 43 1.71 1968 51 48 61 2.40 1967 50 50 54 2.13 1966 59 56 49 1.94 1965 70(Golden Lane) 64 54 2.12 1964 88 77 44 1.71 1964-1968 63 59 52 2.06 * Deposit gauge inoperative during this period. TABLE III Monthly summary of the results obtained in 1969 of the measurement of SULPHUR DIOXIDE by the volumetric method, at the Public Services Building and at Snow Hill Police Station. The results obtained by means of the deposit gauge at Guildhall are included for comparison. Month Concentration of Smoke (microgrammes per cubic metre) Rainfall collected in the deposit gauge Public Services Building Snow Hill Police Station Millimetres Inches January 453 397 55 2.16 February 435 450 40 1.59 March 408 467 60 2.37 April 279 340 20 0.77 May 234 225 45 1.76 June 155 131 28 1.12 July 173 141 88 3.47 August 170 162 81 3.18 September 239 146 4 0.17 October 296 248 5 0.19 November 326 312 * * December 417 430 52 2.05 Averages 1969 299 287 43 1.71 1968 277 263 61 2.40 1967 271 292 54 2.13 1966 284 328 49 1.94 1965 286(Golden Lane) 341 54 2.12 1964 3I6(Golden Lane) 383 44 1.7 I 1964-1968 287 321 52 2.06 * Deposit gauge inoperative during this period. 20 RODENT CONTROL For the purpose of implementing the Prevention of Damage by Pests Act (1949) the procedure has been similar to previous years, comprising inspections of properties to ascertain the presence of rats and/or mice, treatment of properties found to be infested, recommendation and supervision of structural and incidental proofing, and periodical control measures for the destruction of rats in the City sewers. Premises Inspected (routine or on complaint) — 3,282 Complaints Received — 1,236 House Mouse Infestations — 909 Rat Infestation (Minor) — 96 Initial Baiting Sites Selected — 11,062 Results of Treatment:— Bodies of Mice Recovered — 1,882 Bodies of Rats Recovered — 94 Total Operational Visits — 5,914 Every assistance was given concerning the disposal of waste food, and the attraction to mice caused by leaving food scraps in drawers and uncovered bins and containers was also explained. The importance of eliminating harbourage for rats, and particularly mice, in neglected parts of premises such as cupboards etc. was also strongly emphasised. As will be observed from the figures shown above, mice now present the major problem in the City as far as rodents are concerned. They are mercurial creatures in their habits and way of life, and this is why co-operation is required by everyone experiencing difficulties in this direction. Destruction of rats in sewers Four periodical treatments at 3 monthly intervals were carried out during the year. During this period 3 direct poison treatments i.e. March, June and September, were carried out, the toxic agent being Fluoroacetamide (1081). The fourth treatment (i.e. December) consisted of test baiting, and where necessary, poisoning, the toxic agent in this case being Zinc Phosphide. The test baits which provide evidence of the results of the previous direct treatments were left down for 2 days, and where takes were recorded, were replaced by poison baits. Altogether 364 entrances were test baited, which resulted in 44 full takes and 49 half takes being recorded. These were subsequently replaced by poison baits. CITY MORTUARY Bodies received 186 Post Mortem Examinations made 186 Inquests on bodies 30 DISINFECTION AND CLEANSING OF VERMINOUS PERSONS, ETC. Export of Clothing, etc. No. of Articles Disinfected 370292 No. of Operations 1234 Fees received £1560.17s.0d. General Disinfection, Infectious Diseases, etc. Lockers at Post Offices disinfected 19 Verminous premises disinfected 9 Beds and bedding disinfected 1096 Cleansing of Persons No. of verminous persons bathed 970 No. of persons with scabies bathed 4 No. of articles disinfected 9740 21 CATERING ESTABLISHMENTS 2321 inspections have been made of premises where catering is carried on — restaurants, cafes, canteens and licensed houses. This has resulted in the service of 325 Written Notices. In addition verbal representations have been made regarding infringements of the Food Hygiene Regulations in 147 instances. Work necessary to comply with notices previously served has become completed in respect of 125 premises. Before establising 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 86 intending caterers obtained the advice of this Department before deciding to proceed with their ventures, and 255 inspections of premises were made in this connection. Observations on catering establishments in the City of London Whilst the procedure outlined above is generally carried out for new developments, some difficulty has been experienced where planning approval is not required, such as the conversion of already existing shop properties for catering purposes. In some instances attempts have been made to use premises which by their very nature are inherently unsuitable and incapable of meeting even rudimentary hygiene requirements. Where attempts of this nature are discovered in time they are severely discouraged. Fortunately, the majority of more responsible proprietors and architects seek prior consultation with the Public Health Inspectors and this goes a long way to ensuring that new and renovated premises not only reach minimal requirements but provide units which are hygienic, efficient, and, as far as possible, advanced in design. It is undoubtedly true to say that within the City of London there are more well-designed, well-constructed kitchens and efficiently run catering units than are likely to be found elsewhere concentrated in such a small area. There are still to be found within the City a number of well-run, top quality restaurants which not only set a high degree of catering excellence but provide a model of hygienic efficiency, giving an operation which is at once streamlined, hygienic and fully geared to the needs of the customer. There are also many smaller family establishments which are well-run and their proprietors, in spite of present difficulties, still manage to achieve and maintain a commendable standard. In addition, many staff restaurants are well-managed, hygienic, and provide a very good service, although they are of necessity restricted to staff members and do not cater for the general public. To most unsubsidised City caterers low profitability is a daily fact of life. With steady rises in costs, wages, rents, rates and taxation, ever-increasing competition and the difficulty of inducing City workers to pay more for their lunch than the minimum daily luncheon voucher allowance, there is less margin available for improvements or additions to catering premises. Only the most efficient of these establishments are capable of providing a service up to the hygiene standards required, and some proprietors, faced with the need to improve and re-equip, have been unable to meet the expense and have voluntarily closed their doors. Furthermore, lack of prosperity in the industry is resulting in some large traditional multiple caterers continuing their policy of deliberate and gradual withdrawal from the City. With this background in mind the unfortunate truth is that it has become increasingly more difficult to ensure that even minimum standards of cleanliness are maintained in some City restaurants. There is a continuing decrease'in the number of suitable persons available and willing to work in the catering industry. The "casual" or "kitchen porter" type of job is becoming more and more difficult to fill, with, consequently, still further falling away in standards of kitchen hygiene. The accumulated result of neglect, skimped cleaning routines and low hygienic awareness is all too often evident in some City restaurants, where the build-up of filth reaches such proportions that it becomes merely "part of the scenery". In these circumstances it is generally not difficult to persuade caterers to carry out thorough and essential cleaning work once their attention has been drawn to the unsatisfactory conditions, but it is well-nigh impossible to ensure that thorough cleaning of both premises and equipment is carried out as an essential routine measure. 22 The pattern of eating habits in the City continues to change, with a greater emphasis on specialised catering and on snack lunches. There is a steady growth in the numbers of sandwich bars and large sales of "take-away" foods such as soups, pies, etc. Many of these establishments by their nature are smaller catering units with lower overheads than conventional restaurants. Where sandwiches and meals are made on site they are comparatively easy to control, but there is a move towards central sandwich and food preparation delivered to smaller individual premises where control is rather more difficult and where unsatisfactory conditions if occurring could have wider consequences. There is also an increase in the number of public houses serving platter-type foods on the bar counter. This practice presents a high risk, particularly where they are of the self-service type. Some brewers still retain the attitude that they are simply brewers and sellers of beer and much of the catering is left to the individual talents of the Managers or tenants of their houses, in some instances with poor facilities. However, strong representation by the Public Health Inspectors has ensured that facilities, where seriously lacking, have been installed. Determined efforts by the Public Health Inspectors concerned in attempting to speed up the cycle of routine inspections of catering establishments have resulted in very gratifying results and there is a very definite general increase in standards in the majority of premises. Much of this increased effort, however, has been absorbed by additional legislation and essential special projects. Concurrently with inspections to ensure compliance with Food Hygiene Regulations the requirements of the Offices, Shops and Railway Premises Act, 1963, are also borne in mind. The enforcement of requirements under this Act, though necessary and complementary to the enforcement of requirements under the Food Hygiene Regulations, is nevertheless time-absorbing. Four Public Health Inspectors are engaged full-time on the inspection of catering establishments and during the year 2,904 inspections were carried out and 360 written communications were sent to individual proprietors, drawing their attention to a variety of unsatisfactory conditions. These written communications resulted in works of renovation, improvement, repair and reorganisation in 153 cases. During the year under review legal proceedings were instituted in 6 instances where exceptionally filthy conditions and unhygienic practices were found. These proceedings resulted in fines and costs totalling £478. lOs.Od. In addition 4 other official representations were pursued and satisfactorily completed without recourse to court appearances. Full preliminary discussions and initial inspections were necessary in premises occupied by the G.P.O., which became a public corporate body during the year and came for the first time under the jurisdiction of the City Corporation. A special environmental survey of Billingsgate Fish Market was commenced involving nearly three months of a Public Health Inspector's time. In conclusion, it may be said that sustained effort by this Department over the year has ensured not only the maintenance of existing standards but a steady increase in the good design and layout of new and some existing premises and an all-round increase in the general standard of hygiene in catering establishments throughout the City. The work of this Department, combined with the first-class service rendered by the more responsible caterers, has ensured that good clean wholesome food has been available to City workers during the year. FOOD AND DRUGS ACT, 1955 During the year the work of the Sampling Officer has been directed to obtaining samples of food which the housewife would normally buy regularly or be tempted to purchase as a consequence of modern marketing methods. Of the 391 samples purchased, only 11 (2.8%) 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 packers and manufacturers concerned. It should be pointed out that these infringements were mainly of a technical nature, and 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 mince meat, sausage meat, sausages 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 during the early part of the week, could be obtained. 23 Twenty formal samples of milk were purchased from roundsmen in the City area and all proved to be satisfactory. It was not found necessary to initiate legal action in respect of any of the samples referred to above, but as the result of complaints made direct to this Department by members of the public, legal proceedings were instituted in six cases in respect of articles of food which were either unfit for human consumption, or alternatively contained some extraneous material. The resultant fines and costs totalled £l48.0s.0d. 24 ADMINISTRATIVE ACTION REGARDING ADULTERATION OR OTHER IRREGULARITY Article Informal or Formal Sample Nature of adulteration or irregularity Action *Bread Informal Comprised baked in the bread a small dark brown, elongated foreign body composed of a mixture of grease, flour, sawdust, rust and fragments of poppy seeds. A letter of warning was sent to the bakers of the bread. Butter Informal Consisted of three 80z. blocks of butter, each of which showed evidence of attack by mice. A thorough investigation was carried out by a Public Health Inspector who advised on measures necessary for Rodent Control. As all these measures have been undertaken by the merchant concerned no further action was considered necessary. *Cheese Informal The cheese was stale and unsuitunsuitable for sale. Appropriate representations made to the manager of the public house from where the cheese was purchased. Cake/Pastry *Blackcurrent and Apple Pie Informal Contained baked in the pie a five inch length of human hair. A letter of warning was sent to the manufacturer concerned. *Fresh Cream Slice Informal The cream was souring and undergoing decomposition. A cautionary letter was sent to the retailer. Cream Slices Informal The slices were filled with an imitation cream made from emulsified fat, sugar and water. The cakes were mistakenly labelled in the tray. Appropriate representations were made to the retailer concerned. *Danish Pastry Informal Contained embedded in the pastry a gritty brown mass composed of sand, minerals and lime, similar to mortar. A letter of warning was sent to the retailer and manufactuer concerned. *Souflette Sponge Informal The cake was mouldy, rancid and unfit for human consumption. Legal proceedings were instituted against the Caterer concerned. The defendant pleaded guilty and was fined £20 plus £8 costs. Fish * Kipper fillets Informal The kippers had an unpleasant, stale smell and were not fit for consumption. Appropriate representations were made to the retailer and the wholesaler whose premises were within the City. Written representations were also made to the manufacturers whose premises were outside the City. Shrimps, canned Informal The can was only half filled with liquor, suggesting a fault in the canning. The shrimps were badly broken up and had a strong "fishy" taste; although not necessarily unfit for consumption they were below normal quality and were unappetizing. Details of the Analyst's findings were sent to the Importers. Further subsequent samples were found to be satisfactory. Fruit Dried Figs Informal The figs had been attacked and contaminated by mice, mites and insects. The whole consignment was disposed of for animal food. Stuffed Olives Informal The proportion of acetic acid (0.5) was insufficient to prevent decomposition and the sample rapidly deteriorated after being opened. The attention of the supplier has been brought to the remarks of the Public Analyst. California Prunes Informal Contained mineral hydrocarbon 0.25, the presence of which was not disclosed on the label. The matter was brought to the attention of the packers who agreed to have present and future stocks re-labelled so as to conform with the Regulations. Choc Ice Bars Informal The sample has a slight, unpleasant smell of stale fat suggesting storage in a contaminated refrigerator. An investigation indicated that the storage arrangements were unsatisfactory. Suitable advice was given as to the proper storage of this commodity. 25 Article Informal or Formal Sample Nature of adulteration or irregularity Action Meat Gammon Informal The gammon was discoloured by streaks of black within the flesh and connective tissues which was found to consist of lead sulphide. The whole consignment was surrendered for destruction. Pork Sausages Informal Contained sulhur dioxide, 310 parts per million. Sausages may not contain preservative unless its presence is declared. A notice is now displayed in the shop indicating the sausages contain preservatives. *Pork Sausages Informal The sausages were mouldy and unfit for consumption. Legal proceedings were instituted against the retailer concerned. The defendant pleaded not guilty but was fined £25 plus £8 costs. *Roast Beef Informal The beef had an unpleasant "high" smell, due to incipient decomposition, and was unfit for consumption. Legal proceedings were instituted against the retailer concerned. The defendant pleaded guilty and was fined £25 plus £6 costs. Meat (Silverside) Informal The meat had an unpleasant, stale smell and taste and was unfit for consumption. In view of the very high standard maintained at these premises in the past it was decided that legal proceedings should not be instituted on this occasion but that a letter of warning as to future sales should be sent to the company concerned. Steak and Kidney pie Informal Contained a cut end of a fiat, coppered iron staple. The staple bore adhering to it several microscopic particles of a baked flour and fat product which had been masticated or otherwise wetted. Legal proceedings were instituted against the manufacturer of this commodity who pleaded guilty and was fined £10 and ordered to pay £6.6s.0d. costs. *Steak and Mushroom pie Informal The pie was mouldy inside and unfit for consumption. A cautionary letter was sent to the caterer concerned. Minced Beef with Onions and Gravy, canned Informal Contained Meat 46%. Canned meat with onion and gravy should have a meat content of not less than 50%. Written assurance has been received from the supplier that future deliveries of this product will comply with the Regulations. Melton Mowbray Pork Pies Informal One of the pies contained several growths of green mould on the meat filling. In view of the very high standard maintained at these premises in the past it was decided that legal proceedings should not be instituted on this occasion but that a letter of warning as to future sales should be sent to the company concerned. Pizza (Ham Garnished) Informal Consisted of Mushroom Garnished Pizza, inadequately labelled. Appropriate representations were made to the manufacturers of these commodities, who have given an undertaking that all future products will be labelled in accordance with the requirements of the Labelling of Food Order. *Ham Sandwiches Informal The sandwiches were stale and unfit for consumption. A letter of caution was sent to the caterering company concerned. *Ham and Lettuce Roll Informal Contained on the lettuce leaf and on the buttered surface of the roll twelve black aphids and one small dead fly. A letter of caution was sent to the caterering company concerned. *Sausage Rolls Informal The sausage rolls were mouldy inside and unfit for consumption. A letter of caution was sent to the catering company concerned. *Cheese and Tomato Roll Informal Contained embodied in the butter spread on the roll a small, black, elongated foreign body consisting of mouse excrement. Legal proceedings were instituted against the caterer concerned. The defendant was found guilty and fined £25 plus £5 costs. *Cheese Roll Informal Contained a filter tip from a fully smoked cigarette which had been masticated with bread, removed and allowed to dry. A letter of caution was sent to the catering company concerned. *Salad Roll Informal Contained two small splinters of glass. A letter of caution was sent to the catering company concerned. 26 Article Informal or Formal Sample Nature of adulteration or irregularity Action *Remnants of a Mushroom Omelette Informal Contained a small mass of brown hairy matter which comprised a tangle of vegetable fibres resembling jute. The foreign matter was consistent with debris from a mushroom bed. An investigation indicated that tinned mushrooms were used in the preparation of this omelette, and appropriate representations were made to the canners. Pizza (Mushroom Garnished) Informal Consisted of Mushroom Garnished Pizza, inadequately labelled. Appropriate representations were made to manufacturers of the commodities, who have given an undertaking that all future products will be labelled in accordance with the requirements of the Labelling of Food Order. Chicory Hearts Informal Partly rotten and unfit for consumption. A letter of caution was sent to the retailer. *Low Fat Spread Informal The specimen possessed a marked fishy smell and taste, consistent with the use of a proportion of oil derived from fish or whale. A detailed investigation failed to account for the fishy smell and taste of this commodity. Iced Lemon Tea Mix Informal Contained sulphur dioxide, 70 parts per million, the presence of which was not disclosed on the label. No lemon juice was found, but the sample contained lemon flavouring. A more appropriate description would therefore be Lemon-Flavoured Tea Mix. Appropriate representations were made to the retailer and subsequently arrangements were made for an amended label to be used. Milk Informal The milk was sour when received (Acidity, 0.63% lactic acid). An investigation indicated that the carton of milk was part of ols stock sold in error. Appropriate representations were made to the retailer concerned. Quick Tips Tea Informal Consisted of fine, blended tea, incorrectly labelled. The term "Tip" as applied to tea denotes the tip or bud of a growing tea shoot, and the description "Quick Tips" for an ordinary blend containing only a minute proportion of tip is incorrect. Appropriate representations were made to the retailer and arrangements have since been made for amended labels to be used. *These samples were examined as a result of complaint by members of the Public 27 FOOD AND DRUGS ACT 1955 AND FOOD REGULATIONS Samples purchased and submitted for Analysis Article Informal Formal Article Informal Formal Apple Fritters 1 Meat, canned 14 Bacon 1 fresh 1 Beetroot, pickled 1 frozen 2 Biscuits 15 minced 10 Black Pudding 1 pies (pork) 9 Bread 6 Puddings & Pies (Steak & Kidney) 11 Bread Crumbs 1 Butter 5 Meat and Potato Pie 1 Cakes & Pastries 29 Meat Products 22 Cake Mix 2 Meat, prepacked 5 Calcium Drink with vitamin "C" 1 Milk, canned 5 fresh 14 20 Candied Peel 2 dried 1 Cereals 3 long life 2 Cheese 4 Milo 1 Cheese Nuts 1 Milk Puddings 2 Cheese Spread 2 Milk Shakes 1 Chestnut Puree 1 Mousse 2 Chicken 1 Nuts 1 Chicken Portion 1 Olives, stuffed 1 Chicken Croquettes 5 Onions, Pickled 1 Chicory 1 Ovaltine 1 Chocolate, Drinking 1 Pasta Shells 1 Chop Suey with Sweet and Sour Sauce 1 Pastes & Pates 9 Pease Pudding 3 Coffee 2 Pizza 3 Coffee, Dandelion 1 Potato, canned 2 Colslaw 1 instant 1 Confectionery 8 Rice, packet 2 Condiments 4 Rolls 4 Cooking Fat 1 Rolls, starch reduced 1 Cornflour 1 Sandwiches 3 Cornish Pasties 6 Salad, dressing 3 Cream, Dairy 7 Russian 2 Curry Paste 1 Sauces 4 Custard, canned 1 Sausages 8 Faggots 2 Sausages, bottled 1 Fish, cakes 3 Sausage Meat 1 canned 6 Sausage Rolls 3 crab 1 Scotch Eggs 7 shell 2 Semolina, pkt. 1 Flour, self-raising 1 Soups, canned 2 Frankfurters 3 Spaghetti, canned 1 Fruit, canned 4 Spices and Herbs 1 dried 2 Sponge Pudding 2 drinks 3 Stuffed Vine Leaves with Rice in Oil 1 fillings 2 juice 1 Sweet Casava 1 prepacked 5 Tea 11 pies 8 Tea Bags 1 Hamburgers 1 Tomatoes 1 Iced Lemon Tea Mix 1 Top of the Milk 1 Jam 2 Tripe 1 Jelly 2 Vegetables, canned 2 Junior Egg Custard with Rice 1 dried 1 Vegetable Oil 1 Lard 1 Walnuts, pickled 1 Macaroni 2 Whole Kernel Corn I Margarine 2 Wines 2 TOTALS 371 20 28 Other Samples submitted for Analysis Article Informal Formal Article Informal Formal Albumen-Egg 2 Fruit, dried 40 Blackcurrent Pie 1 drink 4 Bread 1 Juice 16 Butter 1 packet 17 Cakes & Pastries 5 Omelettes 1 Cake & Pudding Mix 3 Low Fat Spread 1 Cereals 2 Rolls 6 Cheese 3 Sandwiches 2 Chicken, canned 1 Sauce 4 Confectionery 9 Sausages 1 Cooking Oil 1 Sausage Rolls 1 Coffee 2 Steak & Kidney Pie 2 Curry Chicken Steak & Mushroom Pie 1 Spread 1 Tea 488 Fish, canned 27 Tomatoes, canned 11 fresh 1 juice 4 Fry Mix 1 Puree 15 Jam 2 Vegetables, canned 18 Loose Cherry Granules 1 Walnut Halves 1 Walnut Pieces 1 Mango Pickle 1 Water, coffee vending machine 1 Maple Syrup 1 Meat, fresh 2 Water, drinking 4 canned 21 Water, tank 1 Mineral Water 1 Water, well 1 Moong, Black 1 Fertillisers 1 Green 1 Dust from floor of lodging House 1 Fruit, canned 32 TOTAL 767 Bacteriological Examinations Cream 2 Egg, Albumen 41 Minced Beef 1 Chilled Beef 1 Steak and Kidney (cooked) 1 Steak and Kidney (uncooked) 1 Steak and Kidney pudding 1 Water (including 41 from swimming baths) 143 Faecal specimens 33 TOTAL 224 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 47 tons, 5 cwt. 0 qrs., 11 lbs., which was disposed of as follows;— Tons Cwts. Qrs. Lbs. Destroyed 35 II 2 26 Disposed of to Contractors 6 4 0 9 Released for Manufacture 15 0 0 Re-exported 4 14 I 4 1 ton 18 cwts. 2 qrs. 14 lbs. of food was placed under stop and subsequently dealt with under supervision of other local authorities. 29 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 & Poultry 9 Cooking of Meats & Shellfish for resale 4 Manufacture of dripping 8 Manufacture of ice cream 2 Manufacture of pies 2 Manufacture of Sausages *9 Pickling & Bottling of Shellfish 3 Preparation & Bleaching of Tripe 1 Preparation of Jellied Eels & Shellfish 8 Preparation of Poultry 2 Sale & Storage of Prepacked ice cream 48 Selecting & Testing Sausage Casings 4 Sale of ice cream-prepacked 26 Cooking of prepacked frozen pies. 1 TOTAL 148 PHARMACY AND POISONS ACT, 1933 This Act provides for registration by the Local Authority of persons not already registered in respectof poisons in Part I of the Poisons List who desire to sell poisons included in Part I I. 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 I I includes the less dangerous poisons such as phenols, hair dyes, etc. 55 firms were registered under this Act, 51 of which were re-registrations. 47 inspections were made in connection with the administration of the Act, and one contravention was noted and effectively dealt with. 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. 11 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. 8 inspections were made. No contraventions were noted. ITINERANT FOOD VENDORS Constant inspections of barrows and of itinerant food vendors have been maintained and no difficulty has been experienced in connection with this class of trade. AGRICULTURE PRODUCE (GRADING AND MARKING) ACTS, 1928-1931 Regulations made under these Acts prescribe designations referred to as "Grade designations" indicating the quality of certain articles of agricultrual 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 30 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. 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 78,221 tons 287 tons 0.37% MEAT AND FOOD INSPECTION - SMITHFIELD MARKET Meat, Poultry and Other Foods delivered at Smithfield Market: — 1969 316,178 tons 1968 318,257 tons The above weights do not include 14 tons 2 cwts of pork sides which in December were exported from the United Kingdom to Europe, were rejected and returned owing to bacterial slime and decomposition and two containers containing 25 tons 13 cwts of beef from Europe in July. These three containers were, after examination, diverted to the Corporation of London contractor for destruction. Spoilage developing on meat in transit was responsible for the bulk of unsound meat surrendered, although a consignment of beef from one establishment in South America during June was found to have abnormal odour which resulted in losses. The Meat Inspection Regulations, 1963. These Regulations apply to meat slaughtered in England and Wales. Deliveries of meat from these sources to Smithfield during 1969 were as follows: (1968 figures in parenthesis) Beef & Veal Mutton & Lamb Pork Tons 18,447 (26,250) 14,509 (17,241) 41,424 (42,934) 28 tons 3 qrs. 16 lbs. was surrendered for disease and amounted to 0.038% of deliveries (1968 0.031%). Local Authorities continued to be notified of significant losses by reason of disease from carcases bearing their legible inspection stamps and close liason was maintained on matters concerning the Meat Inspection Regulations and Food Hygiene Regulations. Poultry Inspection Poultry carcases continued to be closely scrutinised and suspect items of uneviscerated poultry examined for disease. In addition to diseases in individual birds, flock diseases in the form of coliform septicaemia and forms of mycoplasmosis were encountered and occasional consignments of old hens were found to have a high incidence of avian tuberculosis. Imported Food Regulations, 1968. Supplies of meat from the Republic of Ireland and Europe arriving in Smithfield by road and rail containers and unexamined at ports of entry were examined and appropriate action taken where necessary. Acknowledgement is made to the British Rail, Smithfield Freight Office for the information they supply regularly of containers en route to Smithfield. Sampling Samples sent for analytical examination 3 Samples sent for bacteriological examination 5 Samples sent for histological examination 2 Samples sent for pathological examination 5 Samples collected for Government Chemist 159 (Pesticide Research) Exports Number of exportation certificates issued 8 31 32 TABLE SHOWING THE AMOUNT OF MEAT SURRENDERED TO OR SEIZED BY MEAT INSPECTORS IN THE CITY OF LONDON FOR DISEASED CONDITION. 1969. January lbs February lbs March lbs April lbs May lbs June lbs July lbs August lbs September lbs October lbs November lbs December lbs 1969 lbs 1968 lbs Argentine 95 48 43 71 99 356 179 Brazil 110 110 - Denmark 15 15 84 Eire 854 802 1,167 1,724 900 689 1,796 822 1,273 1,607 720 484 12,838 9,908 England & Wales 6,755 3,641 7978 5,305 5,045 6,224 5,144 5,056 5,211 4,372 4,376 3,713 62,820 59,891 Finland 426 181 351 146 274 84 1,462 4,008 Hungary - 13 New Zealand 12 10 7 1 1 19 - 59 198 N. Ireland 18 46 119 32 141 18 24 19 21 24 462 573 Poland 34 12 23 22 91 71 Rumania 40 24 64 73 Scotland 357 200 395 152 218 147 103 64 189 632 551 641 3,649 4.641 Sweden — 1 10 Uruguay 5 15 20 185 Yugoslavia 153 48 20 221 758 1969 7,996 4,842 10.071 7,568 6,689 7,288 7.536 6,279 6,716 6,652 5,668 4,862 82,167 - 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 33 TABLE SHOWING THE AMOUNT OF MEAT SURRENDERED TO OR SEIZED BY MEAT INSPECTORS IN THE CITY OF LONDON FOR UNSOUND CONDITION. 1969. J anuary lbs February lbs March lbs Apri 1 lbs May lbs June lbs July lbs Au gust lbs September lbs October lbs November lbs December lbs TOTAL 1969 lbs TOTAL 1968 lbs Argentine 14,841 2,700 5,516 12,717 5,828 12 416 16,391 17,213 12,737 6,444 826 1,184 108,813 40,942 Australia 232 60 89 381 274 Belgium 14 14 — Brazil 2,209 1,576 428 466 10 372 100 126 370 36 5.693 3,404 Canada 102 102 107 Denmark 18 971 485 50 1.524 521 Eire 3,162 1,956 1,738 2,645 1,443 3,171 8,270 14,697 8,622 13,153 5,649 4,602 69,108 65,345 England & Wales 6,349 2,943 4,881 4,053 8,996 6,886 48,621 1 1,188 18,590 19,936 4,722 37,836 175.001 153,326 Finland 48 44 570 982 305 25 1.974 3,918 France 50 731 781 1,033 Hoi land 56 40 96 2,870 Hungary 16 16 — New Zealand 53 15 469 129 706 362 223 593 227 506 98 3,381 5,765 N. Ireland 165 202 469 229 214 362 193 260 49 71 2 214 14,641 Poland 51 99 42 660 310 5,295 62,883 483 293 59 16 10 70,201 2,920 Rumania 3 70 30 103 36 Scotland 785 611 7 14 587 1,324 1,889 1,808 12, 195 3,522 6,263 937 374 31,009 24,394 S. Africa 1.123 42 230 24 1.419 248 S.W. African Federation 14 14 — Sweden 47 184 231 1,629 Uruguay 46,126 4,752 1,950 1,910 107 257 18 55,120 27,774 Yugoslavia 1 12 1,450 369 421 4.884 834 3,229 222 773 1,754 158 385 14,591 344,599 1969 73,853 16. 105 17.162 24,603 25,043 32,850 142,734 56,804 45,761 48,185 13,327 45.359 541,786 - 1968 32,28 1 35,113 33,453 12,400 50,294 260,433 75,743 73,488 30,645 46,250 33,383 10,263 - 693,746 TABLE SHOWING THE AMOUNT OF MEAT, POULTRY AND OTHER FOODS SURRENDERED TO OR SEIZED BY MEAT INSPECTORS IN THE CITY OF LONDON, 1969 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) 36 12 2 25 3 18 36 13 2 15 Meat (Unsound) 241 0 3 26 10 1 16 6 0 0 241 17 | 14 Offal 43 13 2 21 3 1 13 43 17 0 6 Poultry & Feathered Game 44 10 1 2 2 2 3 3 46 13 0 5 Rabbits and Hares .. 1 5 1 20 20 1 5 2 12 Tinned Meat 3 14 0 14 9 3 14 4 4 0 0 Other Tinned Goods 3 1 0 23 1 0 14 3 2 1 9 Frozen Fish 1 2 14 3 16 2 2 2 Other Frozen Foods 2 19 2 19 Cheese 1 12 1 12 Dripping 1 2 18 1 2 18 1969 374 2 2 26 3 8 2 12 6 3 18 377 18 1 0 1968 474 11 3 19 6 1 0 22 1 15 1 18 482 8 2 3 FOOD HYGIENE The Food Hygiene (Market Stalls & Delivery Vehicles) Regulations, 1966, are enforced in Smithfield Market, which at the 31st December 1969 comprised of 329 stalls occupied by 112 tenants. Changing trade mainly caused by the cessation of bone in meat supplies from Argentina from the 1st October gave rise to more tenancy changes than normal. It is estimated that within Smithfield approximately 3,000 manual workers are employed, including 440 porters licensed by the Clerk and Superintendent. Each business is equipped with facilities for personal washing in accordance with Regulation I6and with facilities for washing equipment in accordance with Regulation 18 of these Regulations. Meat vehicles owned by meat carrier firms and those owned by butchers maintained a good standard of cleanliness and internal construction. The cleanliness and equipment of vehicles used by owners of small restaurants and cafes who seem to attend Smithfield in increasing numbers were often below desirable standards of cleanliness and equipment. The use of meat carriers in place of unsuitable vehicles and information to the 'home' local authority is not only a preventive measure but has proved effective. The supply of clean protective clothing still remains a difficulty. During the year laundry facilities have not improved, in fact one laundry which served the market has closed down. During the year 300 official warning letters were despatched, viz:— In connection with clothing 39 head covering 39 containers 27 meat contamination 48 premises & equipment 62 smoking 28 trucks 3 vehicles 54 At the end of the year two prosecutions were pending in connection with offences under the Food & Drugs Act, 1955 and the Food Hygiene (Market Stalls & Delivery Vehicles) Regulations, 1966. The Food Hygiene (General) Regulations, I960. Around Smithfield, in Leadenhall Market and in the City including Billingsgate area there are 31 businesses dealing in meat, poultry and game. Number of premises 31 Number of premises fitted to comply with Regulation 16 31 Number of premises to which Regulation 19 applies 30 Number of premises fitted to comply with Regulation 19 27 * *Of the three not complying, one after demolition is now temporarily housed in the Fish Market at Billingsgate. 34 The Food Hygiene (Docks & Carriers) Regulations, I960. There are 5 Public Cold Stores in the City who handle meat reserves, four in the Smithfield area and one on the riverside at Blackfriars in which these regulations are enforced. An instructional course for trainee cold store managers organised by one company included a talk on these Regulations by Mr. S.S. Garrard. The following is a table of the categories of workers employed in the Market:— Category Numbers Employed workers Adult poultry shopmen 64 Retailers' porters 47 Adult meat shopmen 1,015 Carrier' porters 269 Carriers' drivers 206 Bookers 45 Regular pullers-back 12 Regular pitchers 32 Self-employed workers Casual pitchers (meat market) 70 Casual pitchers (poultry market) 23 Casual pullers-back 28 Bummarees 118 This does not include juvenile employees, salesmen and administrative staff. 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:— "The administration of the Diseases of Animals Act 1950 in regard to the importation of animals is the responsibility of the Corporation for the whole of Greater London under the terms of the London Government Act 1963. 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 acts, on an agency basis, for 17 London Boroughs. During 1969, the fourth year in which agency arrangements have been in operation, a total of 2,451 visits of inspection were made to various premises including riding establishments, animal boarding establishments, pet shops, kosher and orthodox butchers and poulterers, slaughterhouses, farms, piggeries, theatres, circuses, poultry and cattle shows etc. The work carried out under these Acts and Orders included the following:— Psittacosis or Ornithosis Order 1953 Enquiries were carried out on behalf of three London Boroughs following reports of persons and birds having or suspected of having psittacosis. In each case imported parrots were concerned and consignments were traced and examined. In one case a monkey also died and specimens were submitted to the Central Veterinary Laboratory. It was later ascertained that a psittacosis agent had been isolated. Fowl Pest Order 1938 « An outbreak of fowl pest occured in March, in the London Borough of Bromley for whom the Corporation acts. Eight farms were affected involving 138,500 poultry which had to be disposed of. A close liason was maintained with the Ministry of Agriculture, Fisheries and Food to control the outbreak and all the farms in the surrounding area were visited and farmers advised as to precautions to be taken and concerning vaccination of their poultry. Anthrax Order 1938 In June a case of anthrax was reported on a farm in the Corporation's agency area. The animal concerned was a sow and arrangements were made for the carcase to be destroyed by burning. Form 'A' and a notice to cleanse and disinfect were served and subsequently withdrawn. Riding Establishments Act 1964 Inspections were carried out at 42 riding establishments in eleven London Boroughs. These were mainly for the annual veterinary inspections for re-licencing purposes as required under the 35 terms of the Act, but also investigations and enquiries were made following reports of incidents occuring at the establishments and complaints from members of the public which are received 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. Such visits were also made to 104 pet shops in six of the London Boroughs. Recommendations were submitted to the Boroughs concerning the re-licencing of these shops. Certain London Boroughs required the services of Officers in a consultative capacity and to investigate complaints concerning pet shops and pet animals on sale in markets. Animal Boarding Establishments Act 1963 26 animal boarding establishments were visited on behalf of five London Boroughs for whom the Corporation acts. Reports were submitted concerning re-licencing of these establishments and again the services was used on a consultative basis and to investigate complaints. Live Poultry (Restrictions) Order 1957 Three licences were issued under the term of this Order, to enable the holding of poultry shows and exhibitions. Inspections were carried out to ensure that the terms and conditions of the Order were conformed to. Diseases of Animals (Waste Foods) Order 1957 Two licences were issued to owners of plant and equipment for the boiling of waste foods. Boiling plants are inspected regularly. Performing Animals (Regulation) Act 1925 Three certificates of registration were issued under the terms of this Act. Regular visits were made to theatres, television studios, circuses etc., in the Corporation's agency area concerning the use of animals in productions. Advice was sought by the administrators of the London Palladium and Roundhouse Theatres with regard to animal acts which were appearing at these theatres. At the Palladium five bears were appearing and at the Roundhouse Robert Brothers Circus was presented. Instructions were given concerning the size, material and placing of animals quarters. Regulation Movement of Swine Order 1959 Under the terms of this Order animals moved under the authority of a licence to premises other than a bacon factory or slaughterhouse must be kept on the premises, separate from other animals, for a period of 28 days. Animals moved to a bacon factory or slaughterhouse must be detained there until slaughtered. 319 licences were received and verified. This service was carried out on behalf of the London Boroughs of Bromley, Bexley and Greenwich. Post Mortems Officers are frequently requested to carry out post mortem examinations on animals which arrive dead or die at slaughterhouses or are found dead on farms, public highways etc. During the year such examinations were carried out on 58 pigs and one sheep. I should like to take this opportunity of expressing my gratitude to the staff of this Department who throughout the year have carried out their duties so efficiently with the utmost cooperation and help to all concerned." PERSONAL HEALTH AND WELFARE SERVICES IN THE CITY (Comparable figures for 1968 are given in brackets where appropriate) The total number of births occurring in the City (St. Bartholomew's Hospital and domiciliary births) was 913 (967). Births (to City Residents) 1968 1969 Hospital Live Births 25 22 Domiciliary Live Births NIL I Number of these born with congenital malformations NIL NIL Stillbirths NIL NIL 36 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. SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN There were no (NIL)notified cases of congenital defects recorded during the year either to City residents or to non-City residents. Infant Deaths 1968 1969 Stillbirths NIL NIL Neo Natal NIL NIL Perinatal I NIL Others under 5 years NIL NIL Maternal Deaths 1963 1969 NIL NIL Child Health Clinic Clinic Attendance of Children under 5 years. 1963 1969 Attendances 547 419 Medical Examinations 205 165 Hearing Tests 17 7 Phenylketonuria Tests 31 15 Dr. A. White Franklin, the Paediatrician, has reported as follows: "The routine work of the Child Welfare Clinic continues to be satisfactory, with most babies being brought for routine medical examination at set periods. The machinery for screening for Phenylketonuria now works well.Many babies are still being tested by the Guthrie method in Maternity Wards. Those born at St,. Bartholomew's and those nst so tested before attending the Clinic have their blood samples examined for Phenylalanine levels in the Department of Chemical Pathology at St. Bartholomew's. This estimation with a critical upper limit of normal at 6 mgm per cent is really a specific test rather than a screening test. The number of false positives is, therefore, minimal, and fortunately, though not unexpectedly, no true positives have yet been identified. The Triple and Polio Vaccinations are well accepted. The problem of population movement still impedes the success of smallpox vaccination as now recommended officially in the second year of life. Measles vaccination has suffered a setback owing to Press comment on the potential danger of using one of the vaccines. The recognition of the relatively high incidence of German Measles in causing congenital defects greatly increases the need for a Rubella vaccine. The population attending has the great benefit of easily arranged consultation with the Specialists at St. Bartholomew's Hospital." Vaccinations and Immunisations at Child Health Clinic 1968 I 969 Diptheria/Tetanus/Whooping Cough 5 21 Poliomyelitis 14 15 Smallpox 6 II Measles 61 2 At Risk Register 1968 1969 Children under 5 years of age 5 4 At the end of the year four children remained on the Observation At Risk Register.One child's name had been removed following successful heart surgery and a general improvement in health. 37 Day Nurseries I968 1969 Kingsway Creche City children in attendance at end of year I 4 City children on waiting list I NIL Other Nurseries City children in attendance at end of year 3 2 City children on waiting list 2 NIL Registered Child Minders 1968 1969 Application for registration I NIL Applications for day nursery placements continue to be received. Many parents, particularly those employed in City businesses or public houses, find playgroup facilities unsuitable and the search for vacancies in day nurseries is often a lengthy procedure. There are no registered minders in the City area. Unmarried Mothers and their Children The Diocesan Moral Welfare Worker has advised and assisted 8 (10) cases during the year. Only one of these was aCity resident. There were no referrals to Corporation staff during theyear. 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 was I (0) home confinement during the year, and 2 planned early disdischarges from hospital. No request was received for midwifery services within the Temples. Midwives Act, I 951 The Corporation, as the supervising Authority for the City of London, received 26 (25) notifications from midwives of intentions to practise during the year. SECTION 24 - HEALTH VISITING 1968 1969 Home Visits to Children under 5 years Successful visits 321 545 Unsuccessful visits 60 119 The Assistant Health and Welfare Officers, who are both qualified Health Visitors have continued to help and advise mothers with children in all aspects of family health matters. A few families with children under 5 years have been located in the occpuied flats in the Barbican. Blood samples for phenylalanine levels (the test for detection of Phenylketonuria) are taken by the Assistant Health and Welfare Officers, either in the clinic or in the babies' homes. Preliminary screening of hearing ability is also carried out by the staff. Visits to the elderly and infirm in their own homes or in hospital has enabled the staff to assess carefully a patient's requirments, and to ensure that all the necessary supportive services are given. This has proved to be of great benefit to the aged chronic sick. The staff have continued to foster close team work with St. Bartholomew's Hospital staff in relation to patients being discharged from hospital. 10 administrative and ward sisters have each spent one day observing the Corporation of London Health and Welfare Services. One nursing officer from Yugoslavia, studying Public Health Nursing Administration at the Royal College of Nursing was received for a series of observation visits. One Health Visitor student was received from the Royal College of Nursing for three months practical training. The Health and Welfare Officer gave lectures on "Combined Health and Welfare Services" to administration students and Field Work Instructor students from the Royal College of Nursing. 38 Tuberculosis Health Visiting Home visits have been made to all City residents who attend the Chest Clinic at St. Bartholomew's Hospital. These visits provide valuable contact and support to the clinic patients known to be living in the Salvation Army Hostel. Patients continue to be regularly visited as frequent supervision is often needed to ensure satisfactory progress. 1968 1969 Cases notified (residents) 9 I Home visits. Old and new cases 42 52 Shops and office contact tracing No. of investigations 142 71 SECTION 25 - HOME NURSING The Home Nursing service is provided by the Metropolitan District Nursing Association. Approximately 75% of visits have been to those persons over 65 years of age, who are suffering from long term illnesses. Details are as follows:- 1968 1969 Visits to children under the age of 5 years 5 4 Visits to age group 5 to 64 years 228 956 Visits to persons aged 65 or over 2713 2505 Type of Nursing Care and Treatment 1963 I969 Injections only 429 765 Injections plus nursing treatment NIL 16 Nursing care and treatment 2517 2668 Total of Nursing visits 2946 3449 Number of patients at the end of the year 14 20 SECTION 26 - VACCINATION AND IMMUNISATION (See School Health Section for vaccinations and immunizations of school children) Adults Children under five years Smallpox 63 (130) II (6) Poliomyelitis NIL 12(19) (primary courses and booster doses) Diptheria/Whooping Cough/Tetanus NIL 17 (5) (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 1969, 6099 (4992) 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, 2933 (2550) 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 AFTERCARE Advice, and the provision of supportive services for the prevention of illness, and the care and after-care of the sick embrace many factors which require careful assessment of initial need and later developments, so that adjustments may be made as the patient progresses or deteriorates. The Assistant Health and Welfare Officers, with the District Nurses, undertake this duty,acting as the links between the general practitioners, hospitals and other statutory and voluntary organisations providing health and welfare services. 39 City of London Chest Clinic The City of London Chest Clinic is incorporated within the St. Bartholomew's Hospital Chest Clinic and so provides services for investigation and medical treatment for a wide range of diseases of the chest. To supplement the medical treatment and advice given to patients by the Chest Physician and 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 disease of the chest 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 1969 we have had referred to us six patients with Tuberculosis; all these had been seen elsewhere previously. Of the six, two required immediate Hospital treatment and were admitted. Eight known cases have been seen regularly during the year. One City child was given BCG vaccination because of close contact with a tuberculous relative. Ten other residents referred for investigation were diagnosed as follows, Asthma three, Bronchitis five, Carcinoma Lung one. We received nine notifications of infectious Tuberculosis among City workers. Follow up of contacts resulted in fifty two examinations at the Chest Clinic and twelve attended the Mass X-Ray examination. No defects were found. Six residents who had been in close contact with Tuberculosis were examined and no defects found. The total figures for 1970, were 74 first attendances and 56 follow up attendances." Mass Miniature Radiography A Mass Miniature Radiography Unit of the North East Metropolitan Regional Hospital Board is established at Milton Court. Dr. R. Shoulman, 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 amounted to 56,803, an increase of 4,374 compared with the previous year's total. The Unit operated for the greater part of the year at Public Services Building, Milton Court, E.C.2. where a total of 50,692 persons were X-rayed. A survey was carried out in Farringdon Street during the month of September, mainly for the employees of the Newspaper groups, and a total of 6,111 individuals were X-rayed. Premises for this survey were kindly lent to us by Messrs. C. & E. Layton Ltd. Male examinees numbered 34,972 and females, 21,831. 303 persons were recalled for large film examination, and of these 93 were referred on for further examination. There were no interruptions of work through mechanical breakdowns, again reflecting the high standard of day to day maintenance achieved by the technical staff. Medical procedures No alteration was made in procedure during 1969. 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 is gratefully acknowledged. T uberculosis Tuberculosis infection was detected in 439 examinees, of these 424 were healed lesions requiring no further action — 5 requiring occasional supervision only. Ten (nine males and one female) had significant lesions requiring treatment, giving an overall rate for active disease of 0.176 per 1000 examined, compared with 0.343 per 1000 for the previous year. The rate for males was 0.229 and for females 0.092. The highest incidence rates fell in the males 60-64 age group (1.172 per 1000) and in the male 65 plus age group (2.092 per 1000). As usual the incidence rate of active tuberculosis was higher in those not previously x-rayed i.e. 0.218 per 1000 compared with 0.156 per 1000. 40 Lung Cancer Nine cases of carcinoma of the bronchus were disclosed; 8 males and 1 female. Of the males 7 were in the 45-and-over age group, giving a rate of 6.25 per 1000 examined in this category.The majority of cases proved amenable to surgical intervention. Other chest conditions were detected in fair numbers as in previous years. General comments During the year under review the Unit was under the directorship of the late Dr. D.J. Lawless, and it is sad to have to record his sudden death in February 1970. The future of this Unit is dependent on the outcome of the recommendations made by the Department of Health under H.M. Circular (69) 97, and any comments on policy at this stage would be premature. The Unit staff, as usual, carried out their duties most efficiently, and my thanks are Jue to them. I am happy to acknowledge the ready co-operation of Dr. W.G. Swann, Medical Officer of Health for the City. The advice and assistance of the Thames Group Hospital Management Committee and the Regional Hospital Board has been much appreciated." Special Hostels for Tuberculous Men 1968 1969 Men resident during the year 2 4 Loan of Nursing Aids 1968 1969 Supplied by Health Department 26 44 Supplied by British Red Cross Society City Branch 7 2 The increase in the number of nursing aids loaned to City residents in 1969 reflects the degree of chronic illness in the aged population. Wheelchairs, commodes and back rests are in frequent demand but the variety of articles increases as the number of disabilities increase. Meals for Invalids and Sick Persons Meals, and in some instances, special diabetic meals are delivered five days a week by the Meals on Wheels Service. Chiropody Service During the year the Corporation in addition to continuing the service already well established in the City became responsible for the chiropody service formerly operated by the City of London Old Peoples' Welfare Association at the Three Score Club. The following reports have been received from Mrs. A.M. Sierankowska, M.Ch.S., S.R.Ch., and Mr. R. Jones, M.Ch.S., S.R.Ch., respectively. "There were no special changes in the Chiropody Service in the year 1969. It was run along the pattern of the two previous years, ensuring that foot treatment was available to those in greatest need living within the boundaries of the City of London. The service is given through four channels which are as follows:- (1) Clinics held at Milton Court for those ambulant enough to be able to attend there; these numbered thirteen in 1969 and a total of almost one hundred treatments was given. (2) The Clinic held monthly at the Salvation Army Hostel in Middlesex Street, for the residents. This is proving a disappointing venture; instead of there being an increase in the number of patients requesting treatment it seems that the number is declining. The total attendances for the year were fifty seven, about half of the Milton Court number. The Brigadier at the Hostel does much to encourage the men to attend the clinic. If the number of those interested rises sufficiently the clinic will, of course, be retained. (3) About onehundred and fifty domiciliary visits were made to those who are housebound because of ill-health or advanced age. (4) Finally, Sir John Cass's Foundation School; the sessions held there average five a term. This year 303 inspections were carried outand 105 treatments given.This is very satisfactory and ensures that all the children's feet are examined annually. Those in need of treatment receive it, of course, as need arises. The school gives great co-operation and special thanks are due to both Mr. Jarvis and his secretary." 41 'Three Score Club Chiropody Clinic At the end of 1969 there were 42 patients receiving treatment at the above clinic. Three quarters of the patients are over 70 years of age and in need of regular treatment. Each patient on average, had treatment once a month and this was greatly appreciated. Two of the patients are diabetics and advice was given on general foot care and types of shoes to wear. I feel that this service, particularly for the elderly, is now an essential feature of community care." Recuperative Holidays 1968 1969 Adults 7 NIL Children NIL NIL Pads for Incontinent Persons No charge is made for this service, which greatly helps not only the individual concerned, but also the family and those providing nursing care Incontinent Laundry Service (Public Health Act, 1936) I963 1969 Persons receiving service at end of year 14 13 Items washed 5187 5481 Patients supplied with Incontinence Pads at end of the year 2 3 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 thedesignated centre atUnilever 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 4460 (3510) doses of vaccine were distributed,. International Certificates of Vaccination against Smallpox 1968 1969 No. authenticated 2140 2964 No. returned as doctor did not practise in the City 18 20 V.D. Contact Tracing 1968 1969 Requests received for assistance in follow up City Cases: 1 NIL Non City Cases: 6 9 Health Education Subject Place and Audience No. of Lectures Attendances Heal th and Welfare Student nurses 16 442 Services Inner Wheel Groups Fieldwork instructors Church Womens Guild Occupational Health nurses and others Social aspects of Student nurses and 2 40 disease medical students Health and Hygiene School children 8 277 The Health Visitor Nurses and medical 1 20 students Healthy living in Old age pensioners 1 40 retirement Links between hospital Nursing sisters and 1 60 and community hospital administrators servi ces 42 Subject Baby Care Use of voluntary Place and Audience Ante natal mothers Toc H No. of Lectures 7 1 Attendances 90 10 workers in welfare services Publicity and talks on positive good health have continued. Informal talks and formal lectures have been delivered to both professional and voluntary organisations. Lectures have been given to Public Health Nursing Administration Students and Fieldwork Instructor Students from the Royal College of Nursing. The Health and Welfare Officer was invited to talk to nursing sisters and Administrators at a study day held at St. Bartholomew's Hospital. Talks to expectant mothers at St. Bartholomews Hospital are now a regular feature of the Assistant Health and Welfare Officers' work. The talks on Health and Hygiene to school children took place in the Sir John Cass's Foundation Junior and Primary School. Posters and leaflets are supplied for display in St. Bartholomew's Hospital Out Patients Department and at the Citizens Advice Bureau,. Family Planning Rent free premises are provided for the Family Planning Association at Milton Court where three lunch-time and one evening sessions are held each week for City Workers and residents The Corporation continues to underwrite the cost of consultations and supplies to married women residents referred on medical grounds. Following the National Health Service (Family Planning) Act, 1967, the Corporation also underwrites the cost of consultations to married women residents or other residents who seek advice on social grounds. The Corporation has also agreed to give a grant to the Family Planning Association. The Association has submitted the following report on their work in the City:- "During 1969 the Clinic for family planning continued to expand and by the end of the year the four weekly sessions were always fully booked. Three of these are lunch-time sessions which seem to be greatly appreciated by those working in the City. The total number of sessions held in the year was 181, against 152 last year, and 1315 patients (962 in 1968) of whom 642 were new to FPA clinics (560 in 1968), made a total of 37 59 visits (2636 in 1968). The number of City residents attending the clinic was 17. The majority of those attending the clinics are youngpeople under the age of 24.Most of them learn about the service from their friends, but an increasing number come because of greater publicity given to the subject through the press, radio, television, etc.. Many learn about the clinic when they visit the neighbouring Mass Radiography clinic. Our doctors have continued to offer as full a service as possible, giving couples the opportunity to discuss methods together, taking cervical smears — (561 were screened during the year, all of which were negative) — helping with early problems and referring to special sessions those with deeper marital difficulties. A crisis occurred in December following the publication of the Scowen Committee's report on high-risk oral contraceptives without prior warning to doctors. Alarmed and worried patients jammed the telephone lines at clinic, branch and national level. The City clinic, which held a session on the Friday following this publication, was no exception, and both medical and lay staff worked long and hard to allay fears and to see that patients were changed to lower-risk pills or alternative methods as soon as possible. The work of the clinic is carried on in a very friendly atmosphere andwe find those attending are appreciative and make full use of the service offered." Well-Women's Clinic The clinic, set up in 1958 with Corporation funds, is established at St. Bartholomews Hospital. The following report on the work of the clinic during 1969 has been received from Mr. D.K. Williams, F.R.C.S., M.R.C.O.G. 43 "557 patients were seen and there were 2 patients with Class 5 smears. One of these patients came in for a cone biopsy, but carcinoma-in-situ was not confirmed. Another patient had a Class 5 smear, but the patient would not come in for further investigation as her doctor had another smear done at a local clinic and this was negative. There were 2 patients with Class 3 smears and one of these had treatment for an in-situ carcinoma. As usual the incidental findings were quite numerous. Cervical polypi 27 patients Cervical erosion 15 " Uterine myomata 29 " Benign swelling in the breast 5 " Fissure in ano 4 " Monilial vaginitis 10 " Ovarian cyst 1" Solid ovarian tumour 1 " Bank of England cervical smear scheme The following report on the work of the clinic during the year has been received from Dr. I. D„ MacDonald, M.D. "The first series of examinations, which started in 1967, has recently been completed. 756 examinations have been made and 3 cases of carcinoma-in-situ have been treated by hysterectomy. In addition the clinic has provided a valuable means of detecting many minor gynaecological disorders which needed treatment. No more examinations are being done at present but it is hoped to resume in the Autumn when the second series of examinations is due to begin." Domiciliary Physiotherapy During the year the Metropolitan District Nursing Association continued to employ a sessional domiciliary physiotherapist to assist, under general practitioner and hospital supervision, those persons who are usefully benefitting from this type of service which may not be provided by a local health authority under the Act. 1968 1969 Patients treated during the year 2 12 Visits made by physiotherapist in seeing 150 257 patients, visiting G.P.'s., hospitals and so on. MENTAL HEALTH ACT, 1959 and NATIONAL HEALTH SERVICE ACT, 1946 Mental Health Services Mental Health services in the City are provided on an agency basis by the London Borough of Tower Hamlets and the following information has been given by Dr. R.W. Watton, Medical Officer of Health of that Borough:- City Courts Eleven patients seen at Court by a Mental Welfare Officer and escorted to Psychiatric Hospitals. One patient escorted to Saxondale Hospital, Nottingham, from Guildhall Court, twice in one month. One patient returned to Holloway Prison from Central Criminal Court, for a further period of remand. Police Cases Three patients dealt with by City of London Police, pursuant to Section 136 Mental Health Act 1959. 44 St. Bartholomew's Hospital Eighteen patients visited at request of hospital doctors, and dealt with pursuant to Mental Health Act, 1959. Patients visited at Private addresses Six patients were visited at request of various agencies, for investigation, action under the Mental Health Act, or follow-up. British Transport Police No patients referred for Mental Health Action during the year. Many requests for advice and guidance, duly given. City Offices Four patients were visited at request of various agencies, for action under the Mental Health Act. Aboard Ship, MillwalI Dock One patient seen aboard ship and admitted to St,. Clement's Hospital informally. The Samaritans, St. Stephens Church, Walbrook, E.C.4. Two patients were visited and admitted to hospital pursuant to Mental Health Act 1959. Numerous requests are received for help and guidance, for example, one patient said to be "High on Drugs". It was arranged for the patient to be taken to the Drug Unit at St. Clement's Hospital, and examined. The arrangement was complied with, the patient being admitted to hospital for one day. Tower Hamlets Day Centre for Mentally III and Psycho-geriatric patients During the year, tentative arrangements were made for the introduction of five patients to the centre; unfortunately, only one of the five attended, and he only attended for one day; these five patients have since left the Middlesex Street Hostel. One patient commenced attendance in 1967 and continues regular attendance. One patient commenced attendance in 1967. He still regularly attends. He ceasedto be a City resident in May 1968, on moving from the Salvation Army Hostel, Middlesex Street, to the Salvation Army Hostel, Victoria Homes, Whitechapel. One patient commenced attendance in 1967 and continues to attend regularly. This patient was accepted for residence in the Rawson Home, Booth House, Whitechapel in March 1969. One patient commenced attendance in September 1968 and continues regular attendance. One patient commenced attendance in November 1968 and continues regular attendance. 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 programmes of entertainment and activities feature Bingo, Records, Table Tennis, Darts, Billiards, Film Shows, 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; assessment, employment placement, etc. (3) Laundry facilities. (4) Services of government training centre 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 libary and "Centre View" — the centre's own magazine. 45 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 the attendance of pyscho-geriatric patients on three 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 persons. Salvation Army Hostel Ten patients seen as new referrals, included in the ten referrals, are patients already known, but who were again medically referred becuase of marked deterioration in their mental health. One patient already known to mental health, was examined by a consultant Psychiatrist at the hostel, with a view to his long term admission to Long Grove Hospital. No formal action was taken after his examination. Later, the patient was again examined by a Consultant Psychiatrist, and his own Medical Practitioner, and admitted to Long Grove Hospital pursuant to Section 26 Mental Health Act, 1959. One patient already known was informally admitted to St. Clement's Hospital.On his discharge from hospital, a place was found for him at the Salvation Army Victoria Home Hostel, Whitechapel. One patient, with the approval of Dr. Swann, City of London Medical Officer of Health, was given accommodation in the Rawson Home, Booth House, Whitechapel. Five patients had tentative arrangements made for psychiatric out-patient appointments and/or attendance at Tower Hamlets Day Centre, of the five, one patient did attend the Day Centre for one day only. On follow-up, the five patients had left the hostel without trace. One patient was found alternative accommodation at Tower Bridge Hostel, Tower Bridge Road, S.E.I. One patient expressed the wish to return to his home in Ireland. This was successfully arranged with the Ministry of Social Security. Psychiatric Recuperative Holidays One patjent offered such a holiday but refused to accept. Maintained in Hostels in Tower Hamlets Council None. Mentally sub-normal in Community Care Two patients 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 need a training centre. One patient attends the Whitechapel Training Centre, and also a club for the sub-normals. This patient also enjoyed a holiday at the Dymchurch, Kent, holiday camp. 46 Admission to Hospital pursuant to Mental Health Act 1959 Courts Section 29. M.H.A. Section 25. M.H.A. Sec. 26 MHA Sec. 5. M.H.A. (Informal) Sec. 136. M.H.A. (Police) Sec. 60 Sec. 25 7 3 10 10 (Not including Court Cases) 1 8 3 Admission to Hospital pursuant to Mental Health Act 1959 - Contd. (Address patient admitted from) St. Bart's Hospital Private Address Salvation Army Hostel No action per Mental Health Act Sec. 29 MHA Sec. 25 MHA Sec. 25. M.H.A. Informal Sec. 26 MHA Informal 4 (After Examination by Psychiatrist) 8 9 1 1 1 2 SUPPLEMENTARY INFORMATION PATIENTS IN COMMUNITY CARE PSYCHIATRIC 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 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. 2 1 NIL 4 NIL 8 NIL 5 NIL 3 NIL 6 NIL 11 NIL 65 72 80 NIL SECTION 29 - DOMESTIC HELP There were 16 (24) new cases, 11 (17) chronic sick, 7 (3) under 65 years of age, I family help, 2 maternity and 2 others. 24 (10) cases were removed for various reasons. Number of home helps employed on 31 st December, 1969:- Full time 4 (3) Part time 4 (6) Number of clients in receipt of service: 52 (60) All applicants for home help service had their needs met. There is now a stable nucleus of home helps who have managed to give service to clients even during difficult period, i.e. staff holidays and sickness. In order to carry out assessments of need and to ensure that the service was running smoothly 362 (479) visits were paid by the Metropolitan District Nursing Association Superintendent and Nursing Staff. In December, due to a rise in salary for Home Helps, the cost of the service was revised to IO/9d. per hour. Of the 52 clients receiving the service 45 received free service, 2 paid the full cost, and 5 others paid a reduced sum. EDUCATION ACT, 1944 SCHOOL HEALTH SERVICE The School Health Service functions are provided at Sir John Cass's Foundation School by doctors from the Department. One Assistant Health and Welfare Officer continues to perform the duties of school nurse. During the year the following school medical inspections were carried out:- Routine 67 (78) children inspected Special 8 (6) children inspected Re-inspection 87 (80) children inspected Comprehensive Health 223(456) children inspected Survey Selective Survey 55 (226) chiIdren inspected The Comprehensive and Selective inspections are conducted by the School Nurse. The general standard of hygiene amongst the school children was good, and no head nor body infestation occurred during the year. Home visits were made to the City parents to follow up matters arising from the medical inspections. School Dental Service. (The statistics given here complement the Dental Officer's Report) 1968 1969 Sessions at Dental Centre 61 59 New cases attended by appointment 162 195 On treatment cases given appointments 306 203 Emergency attendances 1 1 Total attendances 469 398 1st inspections carried out at school 187 191 1st inspections carried out at clinic 1 2 Percentage requiring treatment 45.7 34.3 Dental Officer — whole time equivalent 0.1 0.1 Special Clinics A clinic is held at the Sir John Cass's Foundation School from time to time for those pupils who have been examined at school medical inspections for whom further investigation is felt to be necessary. During 1969, 7 (I) such clinics were held, and 30 (3) children examined. 48 Audiometry 41 children were tested during the year at the school. Vaccination and Immunisation of School Children 1968 I969 Poliomyelitis 18 36 B.C.G. School Children and 347 242 Students tested No. vaccinated 211 103 Diptheria/Tetanus 69 49 Infectious Diseases Reported from Schools 1968 1969 Chickenpox 1 21 Measles 2 Mumps 8 2 Impetigo - 1 Conjunctivitis Whooping Cough 1- German Measles 1- Tonsillitis - 2 Chiropody Service in School (See Report under Section 28 National Health Service). REPORT OF THE DENTAL OFFICER, CITY OF LONDON A full year has now been completed, in which the Dental Officer has done only three days clinical work per week in the Corporation Surgery, (on the remaining two days he is on secondment to the I.L.E.A. at County Hall). So far as school children are concerned, there has been no reduction in the service provided for them, but, in the case of the adults on the Corporation Staff, it has meant that it has not been possible to operate a recall service This is regrettable, but the pressure forurgent treatment is too continuous and too great to permit routine maintenance checks The considerable turnover in Corporation Staff being experienced presently, accounts for the high demand for urgent treatment. i.e. new members, who have probably not had treatment for some considerable time. An examination can always be arranged within a reasonable time on request. Sir John Cass's Foundation School At last one can move out of the gloomy depths of recent dental reports and state that a measure of stability has been achieved regarding the health of the children's mouths. This means that although the incidence of decay is only fractionally down, the treatment has caught up with it, and by and large, children leave Sir John Cass's School, for senior schools, with reasonable mouths. It has unfortunately to be stated once again, that children who reside in the City, (as distinct from those who come to school from outside it), have, on the whole, very much worse mouths. New school entrants, i.e. 5 year-olds, showed a reduction in the number requiring treatment, compared with last year. A considerable amount of orthodontic treatment has been done during the year with good results. Orthodontic treatment, is a complete waste of time and money, unless there is complete co-operation from both child and parent and it is pleasant to state that, this is increasing very slowly—but surely—among these children and their parents. City of London School, City of London School for Girls A considerable number of those seen have attended for orthodontic treatment, and on the whole they have co-operated well with good results. The mouths of those seen are slightly above the national average, so far as the incidence of decay is concerned. 49 Dental Health Education For the second year running, it has not been possible to do much in the way of group dental health education, because of the school rebuilding programme. This has now been completed, with resulting excellent improvements in amenities, including the medical room. Individual instruction has of course been carried out in the surgery during this time and in 1970 it should be possible to return to group dental health education with associated projects. F luoridation Despite government encouragement, fluoridation remains but a distant objective on the horizon. Meanwhile, millions of school hours are lost and much anguish incurred, both of which could have been avoided. In the meantime, year succeeds year, in which fluoridated water has been drunk by millions throughout the world, without any independently substantiated ill effects, and surely, these if they exist, would have become apparent by now. Government legislation would seem to be the only means by which the majority of persons throughout the Country, can be given the benefit of fluoridation, at present denied to them by a minority. St. Bartholomew's Hospital As in previous years, it can be stated that it would be difficult to provide the service which is given here without the highly skilled assistance so freely and courteously given by all departments, and in particularly by the Dental Department, at St. Bartholomew's. WELFARE SERVICES NATIONAL ASSISTANCE ACT 1948 PART III Section 21 (i)(a) - Residential accommodation Residential care and accommodation continue to be provided to a Iimited extent at "Hillside'', St. John's Way, N.I9 (owned by the London Borough of Islington) in accordance with the planned reduction in numbers, necessary because of its forthcoming closure. Other placements are sought in voluntary residential homes, including the Salvation Army Rawson Home. The number of applications for accommodation is small, but steady, and no change in this pattern is anticipated in the near future, but the possibility of increased demand as the population of the City increases must be borne in mind. 'Hillside' 1968 1969 Persons accommodated at end of the year 9 6 Voluntary Homes 1968 1969 Persons accommodated at the end of year Rawson Home 22 22 Other homes 10 9 Section 21 (i)(b) — Temporary Accommodation for Homeless Families During the year the following cases were helped:- 1968 1969 Families referred to the department 8 Families comprising 8 Families comprising 24 persons 29 persons Families (of those above) accepted for rehousing NIL 2 Other homeless persons given advice or referred to hostels 8 14 Of the 8 families above temporary accommodation was provided in 5 cases 5 cases 50 One family consisting of 5 persons, originally accommodated in August, 1968, continued to be provided with accommodation, but by the end of the year the mother and children had returned to the North. No homelessness occurred in families originally resident in the City, but once again there has been a steady flow of wanderers into the City, more frequently at night, requesting accommodation as homeless families. Those provided with emergency accommodation have later been redirected according to their original place of domicile. Homeless Persons There was an increase in the number of homeless persons requiring accommodation during 1969 and they were assisted in finding temporary accommodation in hostels. SECTIONS 29 AND 30 Welfare Services for the Handicapped Numbers on the register at the end of the year. 1968 1969 Blind 4 3 Partially sighted 1 2 No. of people in Residential Homes for the Blind — — Clients are visited regularly by the Tower Hamlets Social Welfare Officer for the Blind who is employed on an agency basis for this service. One active man takes part in swimming club activities and goes on holiday each year. The other cases are elderly and in poor health, but have been helped as far as possible. The Deaf and Hard of Hearing (On register at end of year) 1968 1969 Deaf without speech 4 4 Deaf with speech 5 4 Hard of Hearing 3 3 Handicapped Persons General Register 1968 1969 Under 65 years of age 26 36 Over 65 years of age 103 98 Aged persons at risk 39 29 Welfare Services for the Aged and Infirm and Handicapped Persons The number of persons on the register has decreased, due to transfers to other accommodation outside the City or through deaths. Our oldest resident is now 98 years of age, but failing health has entailed admission to hospital. Most of the handicapped persons registered are over 80 years of age. Whilst trying to remain independent, they are appreciative of the many Welfare Services provided to aid them remain active and mobile as long as possible. They also benefit socially from the visits by the staff. Holidays for the Physically Handicapped 24 aged and handicapped residents were taken in three parties to Cliftonville where, according to the letters of thanks received, they spent an excellent holiday. Sheltered Employment for the Handicapped and Elderly No requests were made. Day Centres and Clubs The average numberof elderlyand infirm persons who attended the Social Club at St.Matthews Hospital twice weekly was 5, although at times 8 have attended. This Club has given the less mobile handicapped members the advantage of being in a geriatric hospital setting and Dr. Silva, the consultant geriatrician, has shown continued interest in their welfare. 51 Library Service for the homebound and partially sighted The following report has been received from Mr. E.W., Padwick, F.L.A., Principal Lending Librarian: — "There is little to report concerning the library service for home-bound persons for 1969. The number of readers visited has fluctuated a little during the year but the average number visited at three-weekly intervals with books has been 7. During the year a total of 664 books were issued and on each visit the library staff leave 5 or 6 books at each house. It cannot be denied that we are serving a very limited number of readers by this service, but the visits are much appreciated not only for the books but for the social occasion and we consider its continuation to be well worthwhile". SECTION 31 - MEALS ON WHEELS SERVICE The arrangements for providing meals on five days a week from the Staff Association Luncheon Room continued until 1st April. After that date, meals were provided from the kitchen of the Three Score Club, on the Middlesex Street Housing Estate Additionally from 1st April, the Corporation took over the running of the meals club itself, which was formerly organised by the City of London Old People's Welfare Association. Meals provided were as follows:- Meals delivered to housebound persons Provided by Staff Luncheon Room up to 31st March only — 809 ) (2404) Provided from Three Score Club from 1st April — 1923 ) Meals served to ambulant persons at the Three Score Club - 2021 The whole service has been provided to an average of 24 persons each day. In addition, the Kosher meals service delivers meals to housebound patients and 913 (972) such meals were provided during the year, three persons receiving them at the end of the year. Voluntary Services in the City The Branch Director of the British Red Cross Society 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. This arrangement continued until July when the Society had to withdraw their help. The Womens Royal Voluntary Services were contacted and commenced duties later in the year but at 31st December there were difficulties in W.R.V.S. recruiting for this work and the Health and Welfare Officers were often having to perform the escort duties. CORPORATION STAFF Ophthalmic Optician Service Since March 1959, a firm of Ophthalmic Opticians have been operating a weekly eye testing service for members of the staff. This service is operated under the National Health Service, and examinations are therefore free, although charges are made, in the usual way, for the dispensing of prescriptions. 52 Examinations carried out during the year are shown in the following table:- Total examinations carried out 104 Number of staff who had not previously, had an eye test 56 Visual defects found and corrected 49 Re-examinations of persons already using spectacles 48 Further correction needed and carried out 45 Medical Examinations During the year, 751 staff have been medically examined, as shown in the following table:- Reason for Examination Result Male Female Total Admission to Superannuation Scheme Fit 321 129 450 Unfit 5 2 7 Deferred 12 1 13 Referred for excessive sick absenteeism Fit for duty 14 3 17 Still unfit 16 6 22 Unfit for further service 12 3 15 Staff over 65 years of age continuing in employment Fit to continue 87 38 125 Unfit to continue 1 0 1 Special examinations 87 14 101 Exemption from parking meter fees Monument employees Temporary appointments etc. TOTALS 555 196 751 53 STATISTICAL INFORMATION Area — 678 acres (including the Temple and foreshore) Population — Census 1961, 4,711; Estimated mid-year 1969, 4,350 Annual Rateable Value — as at 1st April, 1969, £48,451,201 Annual Sum Received from Penny General Rate — £198,000 VITAL STATISTICS COMPILED FROM REGISTRAR GENERAL'S RETURN 1968 1 969 Live Births Number 23 27 Rate per 1,000 population 5.46 6.2 Illegitimate Live Births Number 1 1 Illegitimate live births per cent of total live births 4.34 3.7 Stil births Number NIL NIL Rate per 1,000 total live and still births NIL NIL Total Live and Still Births 23 27 Infant Deaths (deaths under 1 year) Infant Mortality Rates 1 NIL Total infant deaths per 1,000 total live births 43.48 NIL Legitimate infant deaths per 1,000 legitimate live births 44.45 NIL 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) 43.48 NIL Early Neo-Natal Mortality Rate (deaths under 1 week per 1,000 total live births) 43.48 NIL Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 43.48 NIL Maternal Mortality (including abortion) Number NIL NIL Rate per 1,000 total live and stillbirths NIL NIL Deaths (all ages) Number 40 38 Rate per 1,000 resident population 9.5 8.7 54 NUMBERS OF DEATHS BY CAUSE, SEX AND AGE GROUPS (Statistics supplied by the General Register Office on Form S.D.25) Sex All Ages Under 4 weeks 1 weeks & under 1 year AGE IN YEARS CAUSES OF DEATH 1 -4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over BI9(3) Malignant Neoplasm. Stomach M 1 - - - - - - - - - 1 - F _ _ _ _ _ . _ - - - - BI9(6) Malignant Neoplasm Lung, Bronchus M 3 - . - _ _ _ _ _ 1 1 1 F • - - - - - - - - - - B 19(10) Luekaemia M 1 - - - - - - - - 1 - - F 3 - - - 1 - - - 1 - 1 - B19( 1 1) Other Malignant Neoplams M 2 - - - - - - - - 1 - 1 F - - - - - - - - - - - B46(3) Mental Disorders M - - - - - - - - - - - - F 1 - - - - - - - - - - i B26 Chronic Rheumatic Heart Disease M - - - - - - - - - - - _ F 1 . - . - - - - - - 1 - B27 Hypertensive Disease M 1 - - - " - - 1 - - - F - - - - - - - - " - - - B28 Ischaemic Heart Disease M 4 - - - - - - - - 1 2 1 F - - - - - - - - - - - - B29 Other forms of Heart Disease M 1 - - - - - - - _ 1 _ _ F 1 - - - - - - - - - - 1 B30 Cerebrovascular Disease M 2 - - - - - - - - - 1 1 F 1 - - - - - - - - * - 1 B46(5) Other Diseases of Circulatory System M 1 - - - - - - . - . 1 _ F 1 - - - - - - - - - 1 B32 Pneumonia M 2 - - - - - - - - 2 - - F 1 - - - - - - - - - - 1 B33(l) Bronchitis and Emphysema M 3 - - - - - - - - 1 2 - F - - - - - - - - - - - - B34 Peptic Ulcer M 1 - - - - - - - - - - - F - - - - - - - - - - - - B37 Cirrhosis of Liver M - _ - _ . . . . . - . - F 1 - - - - - - - 1 - - - B46(7) Other Diseases of Digestive System M 1 - - - - - - - - - - 1 F _ _ _ . _ _ . . . . . B38 Nephritis and Nephrosis M 1 . - - - - - - - 1 - - F - - - - - - - - - - - B46(8) Other Diseases, Genitourinary System M 1 - - - - - - - - 1 - - F 1 * - - - - - - 1 - - - BE48 All other Accidents M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - BE49 Suicide and Self-inflicted Injuries M 1 - - - - - - . . 1 - - F - " " ~ " " - - - TOTAL M 27 _ - - _ . - - 1 12 8 6 F 11 - - - 1 - - - 3 - 2 5 55 INFECTIOUS DISEASES City Residents Non-Residents Total 1968 19 69 1968 1969 1968 1969 Dysentery — Shigella sonne 1 3 8 4 9 7 Food Poisoning 1 6 7 12 8 1.8 Infective-Hepatitis 1 1 1 0 2 1 Leptospirosis 0 0 1 0 1 0 Measles 2 3 0 0 2 3 Meningitis 0 0 1 3 1 3 Malaria 0 0 0 1 0 1 Puerperal Pyrexia (not notifiable after 30.9.68) 0 0 9 0 9 0 Pulmonary Tuberculosis 5 2 4 15 9 17 Tuberculosis — other 0 0 1 8 1 8 Whooping Cough 0 0 0 0 0 0 TOTAL 10 15 32 43 42 58 NEW LEGISLATION DURING THE YEAR The following enactments, which affect the work of the Department, were made during the year- Artificial Sweeteners in Food Regulations 1969 Children and Young Persons Act 1969. Children and Young Persons Act 1969 (Commencement No, I) Order 1969. Children and Young Persons Act 1969 (Commencement No, 2) Order 1969. Clean Air Act 1968 (Commencement No, 2) Order 1969 Clean Air ( Arrestment Plant) (Exemption) Regulations 1969 Clean Air (Emission of Dark Smoke) (Exemption) Regulations 1969. Clean Air (Height of Chimneys) (Exemption) Regulations 1969. Clean Air (Height of Chimneys) (Prescribed Forms) Regulations 1969 Equine Animals (Importation) Order 1969, Exotic Animals (Importation) Order 1969 Export of Horses (Excepted Cases) Order 1969 Export of Horses (Protection) Order 1969 Food (Control of Irradiation) (Amendment) Regulations 1969. Foot and Mouth Disease (Amendment) Order 1969 Foot and Mouth Disease (Controlled Areas Restrictions) (Amendment) Order 1969. Foot and Mouth Disease (Infected Areas Restrictions) (Amendment) Order 1969. Health Services and Public Health Act 1968 (Commencement No. 3) Order 1969. Health Services and Public Health Act 1968 (Commencement No. 4) Order 1969. Housing Act 1969. Importation of Dogs and Cats (Amendment) Order 1969, Meat (Sterilization) Regulations 1969. Midwifes (Disciplinary Committee) Rules Approval Instrument 1969. Offices, Shops and Railway Premises Act 1963 (Exemption No. 8) Regulations 1969. Public Health (Recurring Nuisances) Act 1969 Slaughter of Poultry Act 1967 (Commencement) Order 1969 Smoke Control Areas (Authorised Fuels) Regulations 1969 Soft Drinks (Amendment) Regulations 1969. Transport (London) Act 1969. Transport (London) Act 1969 (Commencement No. 2) Order 1969. PUBLICATIONS (1) Handbook of Poultry Inspection. (2) Clean Food Handling. 56