Ac 4344 WE555 CITY OF WESTMINSTER REPORT of the MEDICAL OFFICER OF HEALTH for the year 19-15 ANDREW J. SHINNIE, M.D., D.P.H., (Lond.) Medical Officer of Health and Administrative Tuberculosis Officer. My Lord, Ladies and Gentlemen, I beg to submit my report for the year 1945, on the Public Health and sanitary condition of the City of Westminster. This report, in accordance with the requirements of Circular 49/45 of the Ministry of Health, is compiled in abbreviated form as have been all the annual reports of the Medical Officer of Health during the war years. It is hoped that if paper restriction is removed within the next twelve months it may be possible to compile a report for 1946 on the wider and more informative linos of the pre-war reports. The war ended less than a year ago and in reviewing 1945, so quickly do events fade in significance, it is difficult to realise that rocket bombs were still falling in the spring of the year in the London Region on the night of March 28th. This Public Health Department remained on a war footing until the end of June, the staff remaining on their rotas of night duty. Civil Defence personnel, Fire Guards and Anti-gas Squads kept watch until the stand down order. A record of the work performed in civil defence under the direction of the Medical Officer of Health has already been submitted to the Ministry of Health at their request. It is not intended here to do more than touch upon a few of the aspects as they came under ones observation. There had already in 1938 been a rehearsal for what was to come and much had been learnt of the usefulness of improvisation and of its defects. The evacuation of mothers and children was one of the earliest events after the declaration of war. The Health Visitors and staff of the Welfare Centres registered those who wished for evacuation, advised them as to luggage and feeding arrangements and in the case of expectant mothers accompanied the convoys to their destination. The figure laid down by the Government for recruitment to the casualty services was as follows:- First Aid Posts - 270 Mobile Aid Posts - 36 Light Rescue Parties - 500 With these services in the Council's Casualty Depots were housed those sections of the London County Council's Ambulance Service and Heavy Rescue Service which were under the operational control of the City Council. Before September 3rd, the grave concern was whether enough volunteers would be forthcoming. That doubt was quickly dispelled. Men and women enrolled in great numbers but a large proportion although eager to help had received little or no training. The Council had been wise in linking its fortunes with the two great voluntary societies of St. John and the British Red Cross quite eighteen months before the war. They trained many hundreds of First Aid workers and what is much more important had nominated many of their expert members for work in Westminster. Thus there were ready a body of experienced man and women distributed in 10 First Aid Pests in the City. Four of these posts were in what were designed as underground garages of large modern buildings. The other posts wore in the Council's Welfare Centres or in Hospitals. In the underground garages were stationed Mobile Aid Posts, Ambulance services, Heavy and Light Rescue Parties and complete decontamination facilities for wounded and unbounded casualties and for the first aid personnel themselves. General Air Raid Precautions and special instruction for the Civil Defence services, as well as training in First Aid, was given under the direction of the Medical Officer of Health and later basic training for all personnel, including 40,000 Fire Guards, the latter receiving practical training in fire fighting. Some 24,082 persons were trained while 1,279 were awarded certificates as Instructors. Members of the public numbering. 49,529 received general training by lectures and demonstrations. The Civil Defence Mortuary Service was organised in four war-time Mortuaries. The staff consisting of skilled and unskilled mortuary assistants were in the charge of the Sanitary Inspectors who volunteered for this service. Too high a tribute cannot bo paid to these officers, for apart from them, volunteers for this particular service were a very scarce commodity. The framework of the Council's Casualty Services naturally followed the lines laid down in Circulars and Handbooks issued by various Government Departments, varied to meet the particular needs of the City. It is of interest to note, however, that at many points the local effort outstripped the central guidance. Thus a shelter medical service, frith the willing aid of medical practitioners and of volunteers from St. John and the British Red Cross Societywas in operation before the Government instructions were received. The combined Depot, later advocated by the Government, was in operation from the beginning of the war on very extensive lines. So much so, that it was possible not only to house all the Council's casualty services in four large Depots, but to offer accommodation to the Ambulance and Heavy Rescue Services provided by the London County Council. It may be said that the detailed development of the Mortuary Service also was fully worked out in advance of control instructions. Bombing of Westminster began on September 7th, 1940,and continued intermittently until May 1941. After a period of comparative lull, bombing recurred in 1943, in the early part of 1944 and from June, 1944, until March, 1945 fly bombs and rocket bombs were the final form of air warfare. Information supplied by the Ministry of Home Security indicates that more bombs per acre fell in the City of Westminster than in any other area of the country. Night bombing soon proclaimed the need for shelters other than those surface shelters erected in the street or under open spaces. The tube stations and basements of strong buildings seemed safer places to many people than their homes. In 1941, some 30,000 were occupying such public shelters speedily authorised or requisitioned by the Government. There then arose the need for medical and nursing services for the occupants. Medical supplies and equipment were provided by the Government while doctors and trained nurses ably augmented by auxiliaries of St. John and British Red Cross were on duty each night in the large shelters. Nurses from the principal hospitals undertook a nursing patrol of the smaller shelters visiting from one to the other during the nigh despite bombing and anti-aircraft fire. There were some 172 public shelters in the City with roughly 36,000 occupants on specially severe night raids. The number of cases seen by the shelter medical officers at the Medical Aid Posts in the shelters was 1,826. The nurses dealt with 41,912 cases of minor complaints. Some 23 part-time medical officers were engaged in this service and 35 wholetime and 49 part-time nurses. As regards air raid casualties those of a serious nature removed to hospital were 2,495? while those treated at First Aid Posts numbered 2,744. There were 1,104 fatal casualties some of when died after removal to hospital. The removal to the mortuaries of those killed on the spot proceeded immediately after a raid had occurred but in some instances many days elapsed before bodies could be recovered from heaped ruins. The total number brought in to the mortuaries was 1,104 and the greatest number following a single night's raiding was 165, after the night of l6/l7th April, 1941. The reception of the. dead, identification, collection "aid checking of personal effects including valuables, preparation for viewing by relatives were duties, the highly responsible nature of which requires no emphasis, carried out by the staff of this Department in a manner beyond praise. During the war 63 members of the Civil Defence Casualty Services lost their lives by enemy action. Ho member of the Public Health Department suffered wounds or death although all were on active duty throughout. Two of the First Aid Medical Officers in charge of Mobile Aid Posts were awarded the M.B.E. for meritorious conduct. Even throughout the period of the most intensive bombing the number of casualties did not by any means approach the original officially estimated figure, Miner injuries were comparatively few and this may well be accounted for by the substantial nature of shelter accommodation provided. Of 1,212 serious casualties requiring operative treatment, 1,035 recovered. The remaining 177 who died had sustained head injuries, penetrating wounds of chest or abdomen or crushed limbs. The high mortality of this last class was carefully studied by the authorities and during the last two years of the war special measures were devised for the early treatment of these cases at the site of the incident, particularly those pinned down for some time. This treatment went a considerable way in reducing the delayed mortality from crush injuries. It had been not unusual for a person on being released from under a beam to appear quite cheerful and comfortable and still to become moribund within 48 hours. This was believed to be due to toxic products in the crushed limb being released into the blood stream with consequent complete interference with the kidney function. The elaborate measures organised for the decontamination of food were fortunately not required although the salvage of food damaged, or apparently damaged, as a result of air warfare, was an almost const at activity. Some 462 tons from food premises and private houses were saved and according to the nature of the food, or its condition on inspection, was passed as fit for human consumption; disposed of for animal feeding or consigned to industrial purposes. damage to buildings, particularly dwelling houses, resulted in 1,720 houses totally destroyed, some 3,000 so damaged that they were uninhabitable, and over 17,000 of lesser degree where repairs according to extent of damage had to be undertaken urgently in order to restore reasonably comfortable conditions to the occupiers. There is no doubt that the fly bomb raids of 1944 have acutely aggravated the housing problem of to-day. Before they took place, housing repairs and the housing of families could keep pace with the results of recurring damage and the current, demands for housing. Since the end of the war the problem ha3 become accentuated by the return of families from evacuation and the setting up of now households by young men and women released from war service and married or about to be married. In many cases at the outbreak of war they had not long left school in VJestminster where they spent their childhood. In spite of all difficulties tho work of providing housing has proceeded without intermission during the war and since. Until the extensive scheme of new housing undertaken by the City Council is begun, homes are being provided by requisitioning unoccupied houses and adapting them to meet the needs of separate families. Up to date some 1,225 households, rendered homeless or inadequately housed, have been accommodated. Such then is a very brief and inadequate summary of the Civil Defence work in which your Public Health Department was engaged during the six years of war against Germany. I have the honour to be, Your obedient Servant, ANDREV,' J. SIIINNIE. August, 1946. 1 STATICTICS AND SOCIAL CONDITIONS Area (acres): 2,502.7 Population (Registrar General's Estimate 1915) 72,850 Number of inhabited houses (Census 1931) 22,536 Rateable value, March 1946. £9,750,000 BIRTHS Live Births Total Males Females Legitimate 728 399 329 Illegitimate 208 102 106 936 501 435 Births notified 976 Birth rate per 1,000 of the estimated resident population 12.3 Rate for London: 15.7; for England & Vales: l6.1 Number of Stillbirths 21 Rate of Stillbirths per 1,000 (live & .still) births 21.9 The birth rate for 1945 has,risen substantially. In 1935 it was 8.3. While the Registrar General's estimate of population for 1935 was 124,400, his figure for 1945 is only 72,850. These comparisons indicate that for the time being; the population has become remarkably more fertile. DEATHS " Net deaths 1,046 (miles 571; females 475) Death rate per 1,000 of the estimated resident population: 14.3 (Rate for London: '13.8;- for England & Wales: 11.4) Deaths from puerperal causes 1 (Rate per 1,000 total (live & still births) 0.95) Deaths of infants under 1 year 67 males 38; females 29) Death rate of infants under 1 year:- All infants per 1,000 live births 71.5 Legitimate infants per 1,000 legitimate live births 60.4 Illegitimate infants per 1,000 illegitimate live births 110.6 Rate for London 53 Deaths from measles (all'ages) " " whooping cough 2 " " diarrhoea 7 " " cancer 186 INFANT MORTALITY - Causes of Death Total Legitimate Illegitimate Diarrhoea & Enteritis 11 6 5 Congenital malformation, Prematurity and other neo-natal causes 29 22 7 Want of attention 6 - 6 Broncho-pneumonia 10 6 4 Accident - - - Other causes 9 5 4 Syphilis - - - Whooping cough 2 2 — 67 41 26 2 while stillbirths are fewer, infantile; mortality shows an increase largely due to prematurity, congenital malformations and other no -natal causes. Of forty three premature infants born, thirty six survived. In spite of the shortage of maternity bods and nursing staff additional hospital accommodation has been secured for westminstar mothers. This has been of much comfort to young married women whose home has been with relatives or in furnished rooms. In 1944, 6l? births were in hospital and in 1945, 753. By arrangement with the London County Covin oil resorved accommodation increased from 6 to 3 bods. CAUSES or DEATH (At all aces) Males Females Total Influenza 2 2 Meningitis & Convulsions 3 3 6 Diarrhoea 7 6 13 Septic Diseases 3 - 3 Syphilis 3 1 4 Diabetes l 1 2 Tuberculosis of Lungs 35 7 42 Non-pulmonary Tuberculosis 2 3 5 Malignant growths 103 83 186 Congenital debility) Malformation etc. ) 23 13 36 01d. age 5 7 12 Locomotor ataxia & general paralysis 1 2 3 Diseases of nervous system 7 9 16 Circulatory diseases 213 214 427 Bronchitis 33 30 63 Broncho-pneumonia 25 23 43 Pneumonia 14 5 19 Respiratory diseases 6 5 11 Alcoholism 1 1 2 Appendicitis - 1 1 Digestive diseases 21 10 31 Brights disease .7 7 14 Cystitis 2 2 4 Accidents & Negligence 30 18 48 Suicide & Murder 14 9 23 Other defined diseases 9 8 17 Rheumatic Fever - - - Other violent, causes - - - Diphtheria - - - Cirrhosis 3 2 5 Abortion. - 1 1 Whooping Cough - 2 2 571 475 1,046 Among the causes of death, those of the heart and blood vossels, hold highest place; a long way behind comes malignant disease. Tuberculosis, Bronchitis, Broncho-pneunonia, Pneumonia and other respiratory diseases, taken together, account for a total of only two in excess of those caused by cancer. .3 INFECTIOUS DISEASES Notification Removal to Hospital Deaths Polio-myelitis 1 1 - Diphtheria 19 18 - Erysipelas 9 5 - Scarlet Fever 55 43 -- Enteric Fever . — - - Paratyphoid - — - Puerperal Fever 3 3 - Puerperal Pyrexia 7 6 - Cerebro Spinal MerJnrttis 6 6 - Ophthalmia Neonatorum 1 - -- Measles 474 68 - Pneumonia 12 2 19 Dysentery 16 12 2 Whooping Cough 56 23 2 Malaria 2 - . - scabi.es 323 — — Corrected diagnosis: Scarlet Fever 3. Non-notifiable diseases - removed to hospital:- German Measles 2 Chick or pox 2 Mump 1 1 Gastro-Enteritis 11 The incidence of Diphtheria was markedly loss while Measleshad its usual binomial epidemic. No cases of the Enteric group were notified. VACCINATION Persons vaccinated by Public Vaccinator: Primary ?68 Secondary 29 The number of primary vaccinations were doubled ov:ing to the return of families. * BACTEFTCHor.Tg.YL EXAMINATIONS Diptheria- negative 157; positive 5 Tuberculosis- negative 106; positive 52 Tuberculosis Pulmonary: 193 new cases, including 17 transfers and 8 non-notified deaths. Non-pulmonary: 24 new cases, including 3 transfers and 2 non-notified deaths. (1944 - Pulmonary: 170 new cases; Non-pulmonary: 1.9 now cases). New Cases and Deaths Age Periods New Cases Pulmonary N on-pulmonary Deaths Pulmonary Non-pulmonary M. F. M. F. M. F. M. - F, Under 1 year - — 1 - - - - - 1 to 5 years 2 2 2 1 - - - - 5 " 10 " — 2 3 1 - - - - 10 " 15 " - 3 3 1 - - - - 15 " 20 " 10 5 2 - - - e ■ - 20 " 25 " 11 19 1 1 1 - - - 25 " 35 " 25 24 2 2 3 2 - 2 35 " 45 " 14 12 2 - 6 2 1 - 45 " 55 " 25 7 - 1 8 1 - - 55 " 65 " 18 6 1 - 10 1 1 - 65 & upwards 5 3 — — 7 1 — 1 110 83 17 7 35 7 2 3 4 Deaths from Tuberculosis:- Pulmonary: 42 (35 miles; 7 females) Non-pulmonary: 5 ( 2 males; 3 females) Increased notifications of tuberculosis cases is again accounted for by the returned population. There were however fewer deaths. WORK OF THE TUBERCULOSIS DISPENSARY. 1945 The work has been continued on the lines indicated in previous reports although, owing to the temporary. shortage of beds in institutions for the treatment of tuberculosis, it has often been difficult to obtain vacancies for patients without delay. During the year 48l new patients attended, 228 males and 253 females. Total attendances numbered 1,867. 160 of the new patients were found to be suffering from pulmonary tuberculosis, and 8 from other forms of the disease. 64 patients were recommended for Sanatorium treatment and 80 for admission to Hospital. 833 reports were made to public authorities and 269 to medical practitioners. The number of war pensions under Dispensary supervision is increasing and National Service Boards are continuing to refer patients for fuller examination, During the year 683 X-ray films were taken and 154 specimens submitted for bacteriological examination. TUBERCULOSIS - ALLOWANCES The Ministry of Health treatment allowances continued to be of value to patients who fall into the categories eligible and the following applications were dealt with during the year- Applications received 55 Applications granted 49 Allowances stopped during the year for following reasons:- a) Returned to work 24 b) Refused treatment 1 Died 4 d) Left District 6 e) End of period 3 f) In Institutions and receiving National Health Insurance 4 42 An average of 35 patients are drawing allowances at any given time. MINIATURE RADIOGRAPHY For the convenience of Westminster firms, arrangements were made for the London County Council Unit to operate for some weeks at the Hospital for Women, Soho Square. In these arrangements the authorities of the Hospital were very helpful and co-operative. As the period arranged fell just at the close of the war in Europe many firms were too occupied with re-adjustments to take full advantage of the facilities made available. Nevertheless the results were satisfactory, 10,744 persons being examined. Of these 334 were referred for further investigation. MATERNITY AND CHILD WELFARE The welfare scheme during 1945 was as sot out in the report of 1938. 5 WAR-TIME DAY NURSERIES The three war-time Day Nurseries in the City continued to operate throughout the year at the following promises- (a) No. 1 Bossborough Street, S.U.1., with accommodation for 50 children. (b) Westminster Training Collage, Horseferry Road, S.U.1., with accommodation for 60 children. (c) 37/39 Bloomfield Terrace, S.U.1., with accommodation for 59 children. VISITS BY HEALTH VISITORS To expectant mothers 1,893 To children under 1 3,890 To children between 1 and 5 4,827 ANTE AND POST NATAL CLINICS Number of clinics held weekly 7 A.N P.N Number of women attending 2,070 461 infants clinics Number of clinics hold weekly 8 Attendances 2,244 MOTHERCRAFT CLASSES Number of mothorcraft instruction classes hold weekly 6 The increasing demands of the Maternity rod Child Welfare was only to bo expected from a marked increase in the birth rate. The need for more Maternity Hospital beds has already been referred to. NEW INFANT WELFARE CLINICS In order to meet the convenience of the increasing number of mothers in tho Knightsbridge area, the City Council established a weekly Infant Welfare Clinic in the German Church, Montpelier Place, Knightsbridge. The Clinic has been held regularly each week rod has proved very acceptable to mothers living in these western districts. Before the war the circumstances of the mothers living in the north eastern district of the City had been considered. Although the child population in this district is small it was felt that the Centre in Marshall Street was not easily accessible to them. Several busy traffic streets had to be crossed to reach it. With the return of families and the greatly increased motor traffic the problem again presented itself. Various inquiries were made and finally discussion with the adjoining Borough of Holborn resulted in the use for one half day per week of a building belonging to the London Medical Mission in Shorts Gardens, where the Holborn Borough Council also hold a weekly clinic. The arrangements were nearing completion before the end of the year. It necessarily follows that with the time devoted to additional clinics there has been less time available for home visiting. There have also been shortages of staff ponding the return of those on military nursing service and the filling of vacancies caused by retirement. Arrangements are being made to make good any deficiencies in staff. 6 CARE OF PREMATURE INFANTS The Ministry of Health issued a Circular in March, 1944, on the subject of the care of premature infants and the problem of neo-natal mortality. The Minister suggested that a weight at birth of 5½ lbs. or less should be recorded on the notification of birth cards. This was put into operation in the City. The City Council in accordance with the Minister's recommendation also appointed a paediatrician whose services are available for consultant visits in the homo where premature infants are being nurtured. His service wore not called upon during the year. Other recommendations of the Minister have been carried out. There wore 43 premature infants bora in the City during 1945, all but 3 of whom were born in hospital, 7 however failed to survive and died in hospital, CAPE OF ILLEGITIMATE CHILDREN A joint Committee of representatives of the Metropolitan Borough Councils, the London County Council and voluntary organisations set up to consider this important question for the London area have continued to give the matter their close attention. The voluntary organisations who have dealt with this problem for so many years, were able to improve their services with the aid of increased financial assistance from the Metropolitan Boroughs. The City Council's contribution, based on rateable value, being £972. The Council's Health Visitors have continued to work in close association with the voluntary organisations for the welfare of illegitimate children. In addition the City Council has made, provision for a scheme of guaranteed payments to foster mothers undertaking the care and maintenance of illegitimate children. CHILD LIFE PROTECTION There were 15 women on the Council's register of foster mothers at the end of the year. Those foster mothers and the children in their care are regularly visited by the Council's Health Visitors. This subject is necessarily much bound up with the care of illegitimate children. Foster mothers suitable in all respects are difficult to find. The scheme of guaranteed payments will it is hoped ensure that the fifteen foster mothers will not be out of pocket in the care of the child. The City Council consider that the duties concerned in the welfare of children lacking the care of its own parents are so important that a Child Protection Visitor should be appointed to give her whole time to this and related problems. SUPPLY OP SHEETS FOR EXPECTANT MOTHERS By arrangement between the Ministry of Health and the Board of Trade, Priority Dockets for utility sheets, on production of a medical certificate, are issued to expectant mothers who are to be confined in their own homes. These are being issued through the Maternity and Child Welfare Centres and 344 dockets were issued to expectant mothers in 1945. SUPPLY OF FOOD ACCESSORIES By arrangement with the Ministry of Food, national dried milk, fruit juices, vitamin tablets and cod liver oil have been distributed to expectant mothers and children at the Maternity and Child Welfare Centres in the City. 7 DENTAL TREATMENT - Clinic Report- Now Cases Reappoint ments Extractions Fillings Other Operations Anaesthetics Local General 1944 141 512 283 304 373 17 66 1945 161 560 328 271 435 61 72 DIPHTHERIA IMMUNISATION TREATMENT AND SCHICK TESTING The following are particulars of children under five years of ago who have been immunised against diphtheria in the City. Number of children who had completed a full course of immunisation at any time up to 31st December, 1945. • . Age at 31.12.45 i.e. Bom in year Under 1 1915 . 1 1944 2 1943 3 1942 4 1941 Number Immunised 70 460 408 425 317 Estimated mid-year population 1945 • . 2,980 Children Immunised in 1945:- Under five years of age 58O Over fivo years of age 31 L.C.C. School Children- (Immunised by City Council's Medical Staff) 23 634 Children Schick Tested in 1945:- Negatives 232 Positives 3 235 Of children living in Westminster over one year and under five years of age at 31st December, 1915, some 71.5% had been immunised. There were no deaths from diphtheria during the year. HOME NURSING The City Council has an arrangement with three District Nursing Associations for the nursing in the homes of children under five years of age suffering from various ailments and for certain conditions in adults. The City Council pay the Associations 2/6d. per visit for this service. During the year the District Nurses made 796 visits under this scheme. 8 INFLUENZA - NURSING AND DOMESTIC ASSISTANCE IN THE HOME Mention was made in tho Annual Report for last year of a scheme formulated by the City Council for providing voluntary nursing and domestic assistance in the homes of inhabitants where there was sickness due to the incidcnce of influenza. This schema continued in operation throughout the year, the voluntary nursing assistance being provided by members of the British Red Cros3 Society and the St. John Ambulance Brigade, Hon-nursing assistance being provided by members of the Women's Voluntary Services. Some 19 cases were dealt with under this voluntary scheme during the year, DOMESTIC AND HOME HELP SERVICE The City Council following the receipt of Circular 179/44 from the Ministry of Health decided to set up a scheme for the provision of domestic help for sick and infirm persons living in the City who were in need of and unable to obtain such assistance. The Ministry undertaking to reimburse reasonable expenditure incurred thereon. Difficulties ware experienced in obtaining suitable women as helpers, and only when the rate of pay offered was increased from l/6d. an hour to 2/- an hour were the Council able to engage a few women sufficient to start the scheme in March, 1945. All sources in touch with householders needing assistance such as doctors, district nurses, hospitals, the Assistance Board, etc., were notified of the facilities available. The Council's Woman Welfare Officer was placed in charge of the scheme, and on receipt of a request for assistance, visits the household in order to asses the degree of urgency, the nature -and extent of the assistance needed and allocate the most suitable holder to the case. At the on of the year nine women helpers were employed on a part-time basis and 55 cases had received, assistance. Those comprised the aged rod infirm, patients discharged from hospital rod unable immediately to resume their household duties, others suffering from such disabilities as heart trouble, paralysis, rheumatoid arthritis, blindness, disseminated sclerosis, influenza, limb injuries, etc. The Council under its Maternity an: Child Welfare Scheme also provides assistance in the home during confinement or where there are young children rod the mother is incapacitated through illness. Difficulties were experienced in obtaining suitable women for this work-. -Two whole-time helpers resigned and could not be replaced and the part-time assistance of domestic helpers was utilised. Thirty eases received assistance in this way. GOVERNMENT EVACUATION SCHEME- RETURN OF CHILDREN FROM RESIDENTIAL NURSERIES During the year arrangements were made for the return to their homes of children under 5 years of ago who had been evacuated to residential nurseries in the country under the Government's evacuation scheme. Before the children wore returned, however, the City Council by arrangement with the London County Council carried out investigations through its Health Visitors to determine whether the parent or guardian could receive the child. Of the 87 Westminster children concerned, 48 were returned to their homes. Thirty children could not be returned for the reasons that the parents had separated or could not afford to support the child or from lack of suitable accommodation. Those children unable to be returned to their homes were retained in the Government nurseries. In the remaining 9 cases the parents could not be traced. 9 GOVERNMENT EVACUATION SCHEME - RETURN OF CHILDREN FROM RESIDENTIAL NURSERIES (Counted) The Government arranged for the provision of bedding, cots and small beds where necessary for the returning children, either on free or at reduced cost. Twelve families availed themselves of this arrangement, INSULIN TREATMENT AND DIABETIC PATIENTS During the year the Council provided, free of charge, insulin treatment for two diabetic patients in the City at a cost of £13, 6. 6d. DISINFESTION - Head Lice, Body Lice, Scabies The number of persons treated during the year at the Disinfecting Station for head lice, body lice or scabies wore- Children 548 Adults 939 Total 1,397 Number of treatments given- 2,247 The proposed extension of the Disinfecting Station to meet the increasing needs of the service and particularly to provide a greater degree of privacy for women and girls has not yet been effected because of other priorities. Requests for the disinfe3tation of military personnel have, owing to demobilisation, been becoming fewer. With the return of the children and re-opening of schools, the numbers cleansed are greater than during the war. Notifications under the Scabies Order, 1941, were fewer. No occasion arose for the service of a formal notice on any person. Personal visits in the case of women and children by the woman Sanitary Inspector after notification, succeeded in securing treatment for the patients, while all contacts were carefully examined. The Council employs a trained nurse to supervise all the work of disinfestation of women 'and. children. Schoolchildren are dealt with by the school nurses, but co-ordination between the staff of the City Council and those of the London County Council is very satisfactory so that families cm be dealt with at one time. The Health Visitors have continued to give the. subject of personal hygiene, including the infestation by head lice, special observation and instruction both in the home and at the Centres, where necessary suitable combs for use at home have been supplied. It is noteworthy that the existence of the Scabies Order has created a wider interest among medical practitioners, hospital authorities and social workers in infestation and thei increasing co-operation in referring cases and in methods of prevention's of undoubted benefit to the community. DISINFESTATION OF PREMISES Tie cyanide treatment of furniture and effects of families to be rehoused has been resumed but not on the routine scale carried out before the war owing to labour shortage. Occupied rooms are disinfested by spray methods, insecticides containing D.D.T. being found effective. The bedding and other fabrics are submitted to steam disinfection. Fifty' five cases wore dealt with in this manner luring the year. 10 SANITARY CIRCUMSTANCES As may well bo imagined, the sanitary circumstances for the year 1945, relates to a very marked decree in housing conditions - the effect of war damage on dwellings and the necessary repairs and restoration, the provision of additional houses by adaptation of the larger houses and the conditions to be achieved in them in order to provide reasonable standards of housing. The Sanitary Inspectors have therefore dealt with the following aspects of the housing problem. (1) Survey and inspection of empty properties with a view to requisitioning 540 inspections and 207 re-inspections of properties. (2) 2,367 inspections of premises for certification of building licences and essentiality certificates, mostly arising from war damage, all in relation to the provision of housing or business premises of special character e.g. catering establishments. (3) Special inspections relating to plans of drainage and sanitary fittings. For the first two of these categories the Inspectors were organised in groups as the work is extensive and requires continuous attention. The difficulties and delays in the execution of any work where builders' labour and materials were required during 1945 needs no emphasis. Water: The quality and quantity of the water sup. lied by the Metropolitan Water Board is In safe hands. No cases arose of any complaints in premises where drinking water was drawn from intervening storage tanks. On the other hand no fewer than 101 premises, mostly large buildings, flats, offices, etc., are supplied from private wells. Periodic examination and • analysis of Water from these sources are made. The owners generally submit the reports of their own analyst. In a few cases confirmatory analysis are obtained by the City Council. During 1945, 84 certificates were submitted by owners, all of them being satisfactory. In a number of instances, particularly the older well supplies, chlorination is in use mainly as a result of conditions found during the war years. No question of plumbo solvency arises in the deep well water arising from the London Basin. All the dwelling houses in the area apart from those blocks of flats supplied from deep wells derive their piped supplies from the Water Board. All are provided with internal water taps. The static water tanks in the City were not infrequently a cause of complaint as breeding places for mosquitoes. They required frequent inspection necessitating l6l visits by the Inspectors, but co-operative measures with the National Fire Service kept this source of infestation under control. Now that the tanks have boon emptied they unfortunately provide a convenient dump for varieties of rubbish and garbage, thus encouraging rats. DRAINAGE AND SANITARY WORKS Plane submitted 173 Combined Drainage Orders made 16 Applications for Building Licences 2,300 DISTRICT SANITARY INSPECTION Inspection of Dwelling Houses 10,299 " " other promises 4,704 " " sanitary works 1,591 NUISANCES Intimation notices sorvod 1,123 Statutory " " 38 Prosecutions 5 Orders made 2 Fincs: £25.O.Od. Costs: £11.6.0d. 11 SHOPS ACT. 1934 Inspections made 658 Notices served 57 FACTORIES AND WORKPLACES No. of visits to Factories and Workplaces 109 defacts under the Public Health Acts wore found. All wore remedied without legal proceedings. 663 Visits to Outworkers' premises other than factories 116 Workrooms measured 9 Visits of enquiry re employment of women 24 Outworkers 149 RATS Rat complaints 1,085 Total number of rats destroyed 10,335 Total number of visits to premises re rat infestation etc. 2,918 During the year the work of clearing rats from the City continued actively. It is the statutory duty of the owner to clear his promises of rats. Even so the Council resolved some years ago to deal with rats in houses of the tenement and industrial type generally free of charge while making a charge for work done in business and other buildings. In the latter the occupier has the choice of throe alternatives, to undertake the work himself, to empty a rat servicing contractor or by default to allow the City Council to enter and disinfest. CATERING ESTABLISHMENTS Total number of Catering Establishments inspected 1,601 Number of notices served 266 Legal Proceedings : £56*0.Od. Costs: £46.15»Od. Like the railways the intensive war time use and claimant needs of the public have caused undue wear and tear of premises and equipment. Maintenance and restoration have boon at a minimum. Good progress has boon made towards recovery of peace time standards but inspections have necessarily to be very detailed to comply with the requirements of the Food and Drugs Act. Much time is taken in consultation with the proprietors and their builders. The usual restrictive factors of labour and materials cause delays and much remains to be done. Although one Inspector is giving all his time to this work it is becoming clear that it is increasing beyond the capacity of one individual. INSPECTION AND SUPERVISION OF FOOD Samples purchased for analysis 1,825 Visits to premises 2,067 Notices served 111 Samples found to be adulterated 115 Prosecutions 35 Convictions 31 Fines: £660.10.0d. Costs: £228.3.Od. INSPECTION OF MEAT On the outbreak of war the wholesale distribution of meat from the Central Market in the Metropolis was decentralised. Various 'distributing depots ware opened, including one in Westminster Daily visits of inspection were made by the Council's Inspectors to this depot during the year. 12 ICE CREAM PREMISES Promises on Register at 31st December, 1945. 142 PRESERVED MEAT ETC. PREMISES Premises on Register at.31st December, 1945 86 MILK (SPECIE DESIGNATIONS) ORDER. 1936 & 1938 Licences issued 40 REGISTRATION OF DAIRYMEN & DAIRIES Premises Persons On Register at 31st December, 1945 83 61 Registered during the year 1 — Inspections made 160 - Notices served 18 — The brevity of those war time reports with summaries of statistics gives no indication of the rapid developing scope and complexity of food administration Before the war legal standards of quality were applicable only to milk, butter, margarine and spirits. Since the Ministry of Food was instituted standards of ingredients have been applied to an increased range of food and drinks as for example salad cream, mayonnaise, liquid coffee essence, etc. Under Defence (Sale of Food) Regulations, 1943, which for the time being supersedes Section 6 of the Food and Drugs Act, the correct labelling of articles of food and drink is required. Heavy fines for the offence of "misleading labels" may be imposed. Thin partly explains the enormous increase in amount of the fines in 1945£660.10.0d.,, as compared with £46.19.Od. in 1944, the other reason being penalty imposed for the illegal sale of horseflesh. NUISANCE FROM PIGEONS - i Complaints: 17; Pigeons destroyed: 228. DISINFECTION Rooms: 350, Articles: 65,382. Articles washed: 15,652. Articles destroyed: 1,598. Books disinfected: 276. Vehicles: 11. ATMOSPHERIC POLLUTION The City Council decided to resume its pre-war activities regarding the recording and measuring data of atmospheric pollution and authorised the settings up of the necessary apparatus at three sites in the City for the purpose. One oil the Public Analysts has undertaken the analysis of certain of the gases and rainwater. CORONER'S COURT AND MORTUARY Bodies received 361 Causes of death:- Drowning •9 Street accidents 23 Other accidents 17 Murder 3 Suicide 32 Natural causes 215 Misadventure 7 Miscellaneous causes 35 Inquests held 154 Post-inortom examinations 311