WES 58 AC 4344 City of Westminster. ack REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 ANDREW J. SHINNIE, M.D., D.P.H. (Lond.). Medical Officer of Health and Administrative Tuberculosis Officer LONDON: HARRISON AND SONS, LTD. PRINTERS TO HIS MAJESTY THE KING, ST. MARTIN'S LANE, W.C.2. 3 CONTENTS. Page Aged and Infirm, case of 29 Ante- and Post-Natal Clinics 24 Atmospheric Pollution 47 Bacteriological Examinations 21, 44 Births 16 Burial or Cremation of the Dead 48 Catering Establishments 8, 9, 37, 40 Child Life Protection 25 Common Lodging Houses 37 Confinements 23 Convalescent Treatment for Mothers and Children 24 Coroner's Court and Mortuary 48 Dairymen and Dairies, Registration of 45 Day Nurseries 23 Deaths, Causes of and Ages at 17,18,19 Dental Treatment 26 Diphtheria Immunisation 26 Disinfection 47 Domestic and Home Help Service 27 Dwelling Houses 30, 33 Factories 11, 36 Food, Inspection and Supervision of 11, 37, 38 Food Poisoning 6, 12,45 Health Visitors, Visits by 24 Home Nursing 27 House to House Inspection 35 Ice Cream 44 Illegitimate Children 25 Infant Clinics 24 Infantile Mortality 17 Infectious Diseases 11, 20 International Certificates of Vaccination and Innoculation 28 Introduction 5 Legal Proceedings 31, 32 (8407) A 2 4 Page Mass Miniature Radiography 22 Maternity Beds 23 Maternity and Child Welfare 23 Maternity and Child Welfare Centres 23 Medical Inspection of Aliens 28 Mobile Meal Service 28 Mothercraft Classes 24 Noise Nuisances 47 Notices 32 Overcrowding 34 Pharmacy and Poisons Act 45 Pigeons 47 Population 16 Premature Infants 25 Preserved Meat Premises 38 Premises 30, 32, 33, 35 Private Deep Wells 47 Rats and Mice 46 Sanitary Circumstances 29 Schick Testing 26 Sheets for Expectant Mothers 26 Statistics and Social Conditions 16 Tuberculosis 21 Tuberculosis Dispensary 21 Tuberculosis Maintenance Allowances 22 Unsound Food 12 Vaccination 20, 45 Water 47 Welfare Foods 26 Westminster Old People's Welfare Association 29 Workplaces, Shops, &c. 36 5 To the Right Worshipful the Mayor, Aldermen and Councillors of the City of Westminster. My Lords, Ladies and Gentlemen, I beg to submit my report on the public health and sanitary conditions of the City for the year 1948. The Ministry of Health in Circular 3/49 issued on 17th January, 1949, indicated the lines on which this report should be prepared, namely, on those similar to the report for 1947. The Ministry appreciates that for authorities such as the City of Westminster certain aspects of the report will relate only to the first half of the year for on 5th July, 1948, Maternity and Child Welfare, Day Nurseries, Home Help Service, Vaccination and Immunisation, Tuberculosis Dispensary service, were by the provisions of the National Health Service Act of 1946 transferred from the control of the City Council to that of the London County Council and to the Regional Hospital Board. In many areas of the country, County Councils, designated Local Health Authorities under the Act, while preserving their new rights and powers have left the Maternity and Child Welfare, &c., duties, to a considerable extent in the hands of those who administered these prior to the new Act. This procedure has not been followed in London, where a new ad hoc divisional administrative machine has been set up in each of nine areas into which the county has been divided, the London County Council being in direct control of staff and premises. It will be appreciated that to submit an account of services which remained under the City Council only for the first half of the year is not very satisfactory and not a little confusing. The writer has to keep adjusting his mind and his pen between past and present tenses; while reporting vital statistics such as Infant Mortality rates for the whole year he can only report on services and measures to combat infant mortality for the first half of the year. So it is necessarily half the story. There is good reason to believe that the London County Council and its officers appreciate the high standard of the services which the City Council has had to hand over, and this applies likewise to the Regional Hospital Board. An experienced and efficient staff with unrivalled knowledge and understanding of the area and its inhabitants, premises specially built and equipped for the purpose of these services and in a state of fresh decoration and repair were first rate assets. The City Council always welcomed distinguished visitors and others specially interested in Maternity and Child Welfare from home and overseas to its newest Welfare Centre and Day Nursery at Bessborough Street and it is gratifying that the County Council is continuing this tradition as this building by its design and planning merits study as an example of the enterprise of a progressive municipality. 6 On the eve of the transfer of the services to the London County Council the Mayor at the time, Councillor Hal Gutteridge, J.P., M.I.Mech.E., entertained members of the City Council associated with the work of Maternity and Child Welfare and other personal health services, the Chairman of the London County Council Public Health Committee and his senior officers, and all members of the staff who were leaving the service of the City Council to enter that of the London County Council. In reply to the Mayor's speech of farewell to the City Council's staff, the Chairman welcomed them as new members of the London County Council staff, and said he felt sure that no one would be conscious of the change over ; everything would continue as before and so far as the service to the public is concerned, that hope has been fulfilled by the conscientiousness and continued devotion of those who had dedicated themselves to this work. So far as the position of your Medical Officer of Health is concerned in these London County Council services, the situation is ill-defined and perhaps somewhat anomalous. He has offered advice and when called on has gladly given such assistance as might help the smooth and efficient conduct of the services, while his personal relationships with the Divisional Medical Officer and his staff have been most cordial. The Minister asks specially for information relating to Section 47 of the National Assistance Act, 1948. This section relates to the compulsory removal from their homes of aged and infirm persons unable to care for themselves because of chronic grave illness or other cause and living in insanitary conditions. This is not a new power. It was contained in Section 224 of the Public Health (London) Act, 1936, a section now repealed. But the procedure has been somewhat altered and made no easier to administer. Fortunately, during the year no such compulsory orders had to be applied for. Among other matters the Minister wishes to be informed about is water supplies. This applies most directly to rural areas. Special mention must be made of inspection of meat and other foods, shops, stalls, &c., and places where food is prepared. Stress is laid on the inspection of animals both before and after slaughter, but—as there are no slaughter houses in the City, the need for these returns does not apply. Food Poisoning.—Details are required of the number of outbreaks and cases, any deaths, bacteriological findings and the nature of foods involved and related to such outbreaks. Population of the City in terms of the Registrar General's mid-year estimate has fallen from 103,440 in 1947 to 100,900 in 1948. If the population has fallen slighly the birth rate has fallen with it, 13.8 as compared with 15.4 in 1947. It looks as if the exuberant birth rate of the late war years and afterwards had begun to wane. The general death rate had again fallen and is below that of London generally, but the number of children dying under the age of 1 year was 53, the same as in 1947, and as there were fewer births the infant mortality rate is slightly higher, 38.1 compared with 33.2. 7 One maternal death following a surgical operation was recorded. Of the causes of death at all ages those of the heart and blood vessels claimed the most, 381, and those mainly above 65 years of age. Deaths from malignant disease were next at 203 and likewise occurred chiefly among those over 65 years. As regards infectious disease, no outbreaks of any importance occurred. In 1948 the biennial incidence of measles was expected and 376 cases were notified, less than half the numbers which used to be recorded in the "measles" years before the war. There was one death of an infant under 1 year from measles. Although there was an increase in the notified cases of whooping cough, 184 as compared with 178, there were no deaths. The number of cases of poliomyelitis and polioencephalitis notified was 16 compared with 21 in 1947 when so many cases occurred elsewhere in the country. During 1948 the cases occurred as in 1947 in the late summer and autumn. The fall in the incidence of diphtheria in the country generally is a signal triumph for immunization. In Westminster the number had fallen from 16 in 1947 to 8 in 1948, but there were 3 deaths of persons who had never been immunized. Gastro-enteritis caused 14 deaths all of them among children up to 5 years of age. The nature of this infection, so dangerous to child life, and its prevention remain the subject of constant investigation by the Medical Research Council and other bodies. In 1945 your Medical Officer of Health was invited by the Secretary of State for Home Affairs, and the Secretary of State for Scotland, to serve on a Committee to be presided over by Sir Ernest Gowers. The Reference to the Committee was as follows:— "(1) To enquire into the provisions of the Shops Act relating to closing hours (general or local) and to report as soon as possible whether any alterations are desirable. (2) To enquire into and make recommendations as to extending, strengthening or modifying:— (a) the statutory provisions relating to the health, welfare and safety of employed persons at places of employment other than those regulated under the Factories or Mines and Quarries Acts, and (b) the statutory regulations of the hours of employment of young persons. (3) To enquire into and make recommendations as to the machinery for enforcing statutory provisions within the scope of (1) and (2) above." The City Council gave its consent to his joining the Committee. Having held 55 meetings between January, 1946, and January, 1949, the Committee issued its report in March, 1949. In this report, which covers a wide field, two points seem of special interest to the City Council 8 as a sanitary authority; the first that in any legislation which may be introduced relating to offices, it is recommended that the duty of inspection and enforcement of standards of hygiene in London shall lie with the Metropolitan Boroughs as sanitary authorities. In regard to the Shops Act, 1934, it is recommended that the administration of the whole of Section 10 relating to ventilation, temperature, lighting, sanitary conveniences, washing and meal facilities shall be carried out by the Metropolitan Borough Councils as sanitary authorities. It seemed to the Committee that lighting and washing facilities being requirements related to the welfare of employees should also be the care of the sanitary, authorities, just as temperature, ventilation and sanitary accommodation are already their province. This would mean that the present anomaly by which the London County Council is responsible for lighting and washing facilities in shops, while the Borough Council dealt with w.c. accommodation, ventilation and temperature, would be removed so that the Borough Councils would become responsible for all those conditions of welfare. Your Medical Officer of Health in October, 1948, was also invited to be a member of a Working Party set up by the Minister of Health and the Minister of Food, the reference being:- "To make recommendations to the Ministers of Food and Health and the Secretary of State for Scotland as to precautions which are considered practicable and desirable with a view to securing the observance of sanitary and cleanly conditions in the catering trade." The City Council was again good enough to consent to his serving oh this Working Party, particularly in view of the fact that Westminster is the home of the catering industry; there are some 3,000 catering establishments in this City working under licence from the Ministry of Food. This Working Party began its meetings in November, 1948. One of the factors which has induced the Ministers to set up this inquiry is the apparent increase in the incidence of outbreaks of food poisoning. It must be remembered that cases of food poisoning or "suspected" cases first became notifiable in 1939. Owing to the profound changes created by war-time conditions and movements of population no settled interpretation could be made of the implications of notifications until conditions had become more stabilized. It appears from the returns in the report of the Chief Medical Officer for 1947 that outbreaks of food poisoning reported to the Ministry since the war have increased as follows:— 1945—422; 1946—598; 1947—765. While it is true that much leeway needs to be made up in the practice and conduct of some catering establishments because of improvisation in the war years—for wayfarers beleagured in war time when bombs 'were falling it was more often a question of where food could be obtained 9 rather than how it was cooked or handled—good progress has been made. The proprietors themselves are, on the whole, becoming acutely aware of any shortcomings and most are anxious to raise the standards of their equipment and restaurant practice. So much publicity has been given to the need for improved methods of preparing and handling food, that the impression may get abroad that in this country we are very far behind, and to have a meal away from home involves a certain amount of risk. Such an impression would be utterly misleading and a dangerous distortion of the truth. When it is realized that the number of meals consumed in this country cannot be fewer than 140 millions per day and the known outbreaks of food poisoning widely differing in importance and dimensions, many affecting mildly only two or three people, reveal themselves as, say, 1,000 a year, or just over 2½ per day, the true relationship of the incidence is clear. In Westminster alone with some 3,000 main restaurants, cafes and canteens selling rationed food and providing over 360 million meals of all kinds in a year (according to the assessment of the Local Food Office), the number of persons known to have been affected with food poisoning during 1948 was 106. The percentage of the total number of meals consumed in such establishments, which may have been the cause of food poisoning, is therefore infinitesimal. Surely then there are no grounds for crying "stinking fish" which might well discourage intending visitors from overseas and even intimidate those already here. When the changes envisaged by the National Health Service Act were first discussed it was suggested that the duties of a public health department would be greatly reduced, and that in fact, if the personal health services were transferred to the control of the London County Council little of importance would remain the responsibility of the City Council. This is far from being the case. The importance of these personal health services in relation to other public health work in districts of a suburban or semi-suburban character with extensive vistas of small dwellings and a large child population cannot be gainsaid. Such services, however, never assumed a major part of the work of the Medical Officer of Health and his department in Westminster which is not such an area and never was. Within its boundaries are the great departments of State, it is the focus of the social and entertainment world and the home of the learned and scientific societies. Before and since the war it has tended to become the headquarters of many business corporations. It is therefore in the main "adult" in character. That being so much of the work of the public health department has been concerned with the lives and conditions of people at work or at leisure, and the nature and conditions of premises where they congregate. It must be remembered that although the Registrar General gives the resident population of Westminster as 100,900, the population of non-residents in that constant inward and outward flux which continues till late in the day must be at least five times as much. (8407) A 3 10 One may take a rough guide from the average number of main meals served daily in the catering establishments serving this type of meal throughout the City. These premises number at least 3,000 and estimating the average number of main meals served at these establishments to be not less than 250 daily, a reasonable computation is a day population in the neighbourhood of 750,000. These figures are not guess work, but are deduced from estimates kindly supplied by the local Food Office. While emphasising this aspect of public health service of particular application to Westminster and central London generally, it must not be inferred that work for the resident population, though different in character, is not equal in importance. There are housing problems, overcrowding, defective and worn out dwellings as elsewhere, many and varied sanitary complaints, the incidence of infectious disease, problems of the old people common to all districts but perhaps more concentrated in an old built-up area than in one spread out in new suburbs with extensive open space. Much credit is due to the City Council for the efforts it has made during the past 25 years and the still greater enterprise it has undertaken since the war to improve housing conditions and to provide new flats on costly land for the benefit of many of its citizens. When the new Pimlico Scheme is completed (1,621 flats) the Council will have provided over 3,250 dwellings, apart from requisitioned houses. Many of the existing flats are supplied with the amenities Jn vogue up to 1939 and those to be completed from 1949 onwards will complying with every postwar standard of comfort and convenience. The work of the public health department in a City of this character, in no sense a dormitory one, covers a varied field, and it may be well in view of the changes resulting from the National Health Service Act to indicate some of the duties still the obligation of the City Council and carried out by the Medical Officer of Health and his staff. Housing.—The following is a summary of headings and figures. Routine inspection of 1,275 dwellings during the year occupied by or of a type suitable for occupation by members of the working classes. Measures to remedy defects found on inspection. Representation of areas of insanitary houses for clearance (Section 25, Housing Act, 1936), 12 represented and 11 cleared or partially cleared from 1931 to 1939, a procedure to be resumed as soon as official sanction permits. Representation and procedures for closing parts of buildings (e.g., underground rooms) found to be unfit for habitation. Closing Orders numbering 844 have already been made. Nuisances to be dealt with under Public Health Act procedure : These include defects of structure and repair in dwelling houses of all grades, similar defects in other buildings, business premises, offices, workshops, hotels, restaurants, &c. Such matters of nuisances also include defects in water supply, heating and ventilation systems, sanitary conveniences, drainage, &c., besides specific nuisances caused by smells, noise, smoke, deposit of refuse on the many open sites in the City and other matters. Some 1,291 notices were served in 1948 for remedy of such defects. 11 Factories Act, 1937.—The sanitary authority is concerned with the provision and adequacy of sanitary conveniences in power factories. These and conditions of temperature, ventilation, cleanliness and drainage in non-power factories. Overcrowding is also its reference in non-power factories and all conditions of hygiene in workplaces. There are 1,624 power factories, and 1,061 non-power factories, and many hundreds of workplaces in the City to which in 1948, 5,546 visits were made and 298 notices served for defects or contraventions of the Factories Act. Bakehouses including underground bakehouses, come under the Factories Act. No new underground bakehouses are permitted under the Act and those existing which do not fulfill certain standards of hygiene must be discontinued. Of the 19 underground bakehouses still in business at the end of the war, eight called for condemnation under the Act, but the owners have a right of appeal and can institute such improvements as must justify such appeal. In Westminster there are at least 14,000 office premises. These include banks, shipping and insurance and other commercial offices and an infinite variety of smaller concerns. At present there is no specific authority in London for the routine inspection of these premises and the Gowers Committee took note of this. Inspections are made on the occurrence of infectious disease, complaints, e.g., overcrowding, and when alterations are being made to sanitary apparatus and drainage. Some 3,140 visits were made in 1948. Infectious Disease.—The investigation of cases and measures to prevent spread of infection remains a duty of the City Council. While the Medical Officer of Health makes certain personal investigations and is called on by hospitals and medical practitioners to assist in diagnosis, most of the visits are paid by Sanitary Inspectors who made 553 special visits of enquiry to premises of every description, including dwelling houses. Disinfection under the supervision of a Sanitary Inspector was carried out in 603 rooms, while 13,663 moveable effects were disinfected at the Council's Disinfecting Station. Food and Drugs Act, 1938.—It has already been mentioned there are some 3,000 catering establishments in the City in addition to some 1,200 shops selling food of every description. Nowhere in the country is there such a concentration in an area of similar extent. Food sampling and analysis safeguard the interests of consumers and this has always been regarded as a highly important duty. In time of shortages the tendency to exploit substitutes for the commonly accepted article of food and drink requires careful and patient investigation. Conditions are safeguarded as far as possible by food and drink standards introduced by the Ministry of Food by Orders and Regulations made during the war and since. The labelling of articles laid down by Order is complicated and often requires tracing back to the wholesaler, consignor and even to the shipper to find out who was responsible for designating the article and specifying its contents. In these times the researches imposed on (8407) a 4 12 a "sampling officer" are onerous in the extreme and bear no comparison with the simple procedures of a generation ago when milk and butter were the chief articles for examination, and any question of adulteration was simply answered by the certificate of the public analyst. In 1948 cases justifying legal proceedings numbered 29. Findings of the Courts in favour of the City Council were 28. Section 13 of the Food and Drugs Act lays down certain principles of hygiene to be observed in premises where food is sold, prepared and stored for the purposes of sale. The Act gives power for routine inspection. Two inspectors devote all their time to this work and even so it will take some time before inspection of all these very numerous premises can be overtaken. The defects and deficiencies of the war years has already been mentioned, also the difficulty of obtaining and retaining capable and efficient staff. Nevertheless advice and persuasion, together with assistance in obtaining licences for remedial work are exercising a favourable effect and legal proceedings have been resorted to only in 13 cases when proprietors have persistently failed to initiate necessary improvements. Any legal proceedings which may involve the security and future position of the individual responsible are authorised by the Public Health Committee, and it is the invariable practice for the Chairman and the Medical Officer of Health and Chief Inspector to pay a personal visit to premises in relation to this statute or any other public health statute in like circumstances. Unsound Food.—During and since the war this has become a matter of great importance. There is the universal tendency to conserve food. Conservation may not be practicable nor can it be extended as much as one would wish. The point is reached when food admits of no reprieve. Accordingly, considerable quantities are surrendered as unfit, or failing surrender are seized by the Food Inspectors for salvage for animal feeding or processed for other purposes than food, or if too decomposed, for destruction. Hardly a day passes that these procedures are not being practised. It rarely happens that the person responsible is either so unperceiving or so recalcitrant that food has to be seized under his very nose, taken before a Magistrate and condemned. In such cases, and there were only four in 1948, legal proceedings must be undertaken, fines usually being substantial. Some 78 tons of food were dealt with by surrender or seizure and disposed of and it can well be imagined that this can be a time consuming job for the Food Inspectors. Food Poisoning.—In 1948 there were 18 cases investigated, some four of those could be classified as outbreaks because they concerned several individuals taken ill at the same time. Fortunately, there was no case of really serious illness, but the preliminary investigations carried out by the Food Inspectors entailed immediate and full concentration on the problem. Any suspected food left over must be submitted to expert examination and analysis. Inquiries must be made of all food consumed and scheduled and correlated with those persons affected and those 13 unaffected. Patients themselves, where practicable, must be bacteriologically examined as regards blood, urine, faeces; even contacts may require similar investigation in case a carrier of food infection is suspected. It may be that one engaged in handling food, although apparently healthy or with some tiny superficial focus of infection may be the unconscious cause. Proposed structural work—new buildings, drainage plans. Application for building licence?—Schemes of improvements to old premises and contemplated new buildings, much held in check for the first three years after the war are now coming forth in surprising numbers. At each meeting of the Public Health Committee the Chairman submits some 80-100 of these proposals to the Committee. Each scheme of adaptation, alteration, new building work and drainage has to be reported on and that implies previous consultation with architects and builders and visits to the site of proposed new works. The reason for all this work, necessary but lengthy in operation, is that structural and sanitary work must comply with certain standards laid down in Statute and By-laws. Gerontology.—The world of today loves new terms. A flavour of erudition is achieved by substituting new names for old. All this word means is the care and welfare of old people. It was the revelation during the war of the plight of old people, the need for uprooting them from their homes and transporting them away from the bombs into safe areas that stirred public interest. Some of them grieve in loneliness, others cherish it. In 1945 at a meeting of the war-time Westminster War Needs Committee it was suggested by me that this Committee instead of winding up should transfer its activities to the care of the aged and friendless in the City. Throughout the whole country the movement has gathered momentum. Perhaps it was, as in Westminster, that the domestic help service begun during the war was disclosing the plight of many who had hitherto strenuously concealed their existence from any curious eyes. But even before the war the condition of infirm aged people had become a problem to this department. Neighbours, some less compassionate than others, complained of insanitary conditions. For those who were willing to be cared for in hospital or other institution, there was no great difficulty before the war in obtaining admission. For those who merited removal for well defined reasons, but who steadfastly refused to go, compulsory removal had to be undertaken, a singularly unpleasant and embarrassing duty for the Sanitary Inspector who had to resort to this measure after the Medical Officer of Health had satisfied the Magistrate that compulsory removal was the only resort. These powers under Section 224 of the Public Health (London) Act, 1936, were only exercised on one or two occasions before and during the war. In recent years the problem has greatly intensified. The number of old people who would benefit by nursing and care in an institution has risen in Westminser as follows:— 65—1945; 94—1946; 132—1947; 221—1948. (8407) a 5 14 But at present accommodation for such cases is almost impossible to obtain for those willing to be removed and that answers the question for the unwilling. In the care of old people the Sanitary Inspectors work in close association with the domestic help service, medical practitioners, the district nurses, and of course, the Westminster Old People's Welfare Association, the Medical Officer of Health being a member of its executive committee. The British Red Cross Society by their mobile meals service working under the direction of the public health committee have brought much material as well as social comfort to those who are handicapped in the struggle for existence. The whole problem arises from the success of society in extending the expectation of life. We have many more old people on our hands who by reason of the falling birth rate of the last fifty years, have few willing relatives to care for them. Much of the responsible care of these old people falls on the sanitary inspectors who extend much sympathy and patience in their varied problems. A tradition of genuine solicitude practised by one of the most experienced, Mr. French, has been followed by his colleagues who make it a point of honour to maintain that tradition. I have endeavoured in the above account to submit an outline of the principal public health duties of the City Council and some relevant details indicating the scope of the work in carrying them out. Other responsibilities which deserve mention are the unceasing campaign to keep the City free from rats in which eight trained men are engaged under the direction of a rodent officer. His staff also take part in reducing the number of pigeons. The collation of scientific data in estimating atmospheric pollution and dealing with smoke nuisances occupy most of the time of one Inspector. The regulation and inspecting of common lodging houses are duties usually performed in the evening. Other varied statutes which fall to be administered by the public health department are those relating to poisons and pharmacy, the new provisions of the National Assistance Act relating to the burial and disposal of effects of those who die with no known relatives. These duties come under Section 50 and entail a good deal of investigation and considerable responsibility. In the six months from 5th July, 1948, since these duties were imposed, some 32 deceased persons have been buried by the City Council and their effects sold to offset the cost of burial as permitted by the Act. In July, 1948, the City Council considered the changes brought about by the new Act and the consequent transfer of some of its responsibilities to the London County Council and Regional Hospital Board. It was felt that in view of the extent and nature of responsibilities still remaining the City Council considers that a whole-time deputy Medical Officer of Health was still required, particular regard being paid to the daily duty of inspection under the Aliens Act at Victoria Station. Since the transfer of my deputy, Dr. I. S. Thomson, to the Regional Hospital Board I have felt the increasing strain of being deprived of his experience and cooperation. Besides taking charge in my absence, he relieved me of 15 many duties which only a medical man fully qualified in public health could do. It was of undoubted advantage to be able to discuss various problems with a colleague so experienced and of such ability. His loss to the department has naturally thrown much greater responsibility on the Senior Inspector and Chief Clerk. In my absence it is they who must make decisions based on their long experience and intimate knowledge of public health administration. But in present day conditions when the general public appear so well informed on medical matters the prestige of the City of Westminster seems to call for the services of one possessing medical qualifications if he has to act for the Medical Officer of Health. This foreword is more lengthy than usual, but the year under review, 1948, seemed to merit an assessment of the effect of the operations of the National Health Service Act on the public health services of this City. I have endeavoured to comment on the nature and extent of the services which remain and appear essential for the efficient health administration of the City. I wish to thank the Chairman, Councillor Albert Sciver, B.Sc., F.R.I.C., &c., of the Public Health Committee from 1945 to 1949, for his unfailing support and for the expert and useful advice on certain aspects of the work which he often gave to the Committee. In presenting this twenty-fourth annual report I wish also to thank the members of the Council, the members of the Public Health Committee, my colleagues, and in particular the staff of the department for their loyal and willing assistance. ANDREW J. SHINNIE, Medical Officer of Health. August, 1949. (8407) A 6 16 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,502.7 Population (Registrar General's Estimate, 1948) 100,900 „ „ „ at 31st December, 1948 103,500 Number of inhabited houses (Census, 1931) 22,536 Rateable Value, March, 1949 £10,350,000 Births. Live Births— Total. Males Females. Legitimate 1,227 588 639 Illegitimate 163 82 81 1,390 670 720 Births notified—1,379. Birth rate per 1,000 of the estimated resident population 13.8 (Rate for London, 20.1 ; for England and Wales, 17.9) Number of stillbirths 17 Rate of stillbirths per 1,000 (live and still) births 12.1 Deaths. Net deaths (males 569, females 462) 1,031 Death-rate per 1,000 of the estimated resident population 10.2 (Rate for London, 11.6 ; for England and Wales, 10.8) Deaths from puerperal causes 1 Rate per 1,000 total (live and still) births 0.71 Deaths of infants under 1 year (males 33, females 20) 53 Death-rate of infants under 1 year:— All infants per 1,000 live births 38.1 Legitimate infants per 1,000 legitimate live births 34.2 Illegitimate infants per 1,000 illegitimate live births 67.5 Rate for London for infants under 1 year 31 Deaths from measles (all ages) 1 „ whooping cough Nil „ diarrhœa and enteritis 14 ,, cancer 203 17 Infantile Mortality. Causes of Death. Total. Legitimate Illegitimate. Meningitis and convulsions 4 3 1 Diarrhœa and Enteritis 14 10 4 Congenital malformation, prematurity and other neo-natal causes 12 12 — Want of attention 1 — 1 Broncho-pneumonia 14 11 3 Accident 2 2 — Other causes 6 4 2 53 42 11 Causes of Death (at all Ages). Males. Females. Totals. Influenza — — — Meningitis and convulsions 4 2 6 Diarrhœa 10 4 14 Septic Diseases 3 1 4 Syphilis 2 — 2 Diabetes 5 2 7 Tuberculosis of the lungs 43 16 59 Non-pulmonary Tuberculosis 1 1 2 Malignant Growths 109 94 203 Congenital Debility, Malformation, Prematurity, etc. 7 10 17 Old Age 17 27 44 Locomotor Ataxia and General Paralysis 1 — 1 Diseases of Nervous System 1 — 1 Circulatory Diseases 200 181 381 Bronchitis 23 20 43 Broncho-pneumonia 48 29 77 Pneumonia 7 7 14 Other Respiratory Diseases — — — Alcholism — — — Appendicitis — — — Digestive Diseases 17 19 36 Bright's Disease, Nephritis, &c. 21 14 35 Cystitis 4 — 4 Accidents and Negligence 21 20 41 Suicide and Murder 16 11 27 Other Violent Causes — — — Other Defined Diseases 3 — 3 Puerperal Causes other than Sepsis — — — Diphtheria 3 — 3 Cirrhosis 2 3 5 Enteric Fever — — — Measles 1 — 1 Polio-myelitis and Encephalitis — 1 1 569 462 1,031 18 Among the causes of death, those of the heart and blood vessels hold the highest place; a long way behind comes malignant disease. There was one maternal death during the year. The three deaths from diphtheria during the year were those of two children aged 5 and 8 years respectively and a male aged 26 years. There is no record of any of these three persons having been immunized against the disease. Deaths, 1948. Causes of Death at Different Periods of Life in the City. Causes of Deaths. Sex. All Ages. Years of Age. 0-1 1-2 2-5 5-15 1525 2545 4565 65+ All Causes M. 569 34 3 1 3 9 45 176 298 F. 462 21 — 2 3 10 34 101 291 Grand Totals 1,031 55 3 3 6 19 79 277 589 Influenza M. — — — — — — — — — F. — — — — — — — — — Meningitis and Convulsions M. 4 3 — 1 — — — — — F. 1 — — — — — — — 1 Diarrhoea and Enteritis M. 10 10 — — — — — — — F. 4 4 — — — — — — — Septic Diseases M. 3 — — — — — — — 3 F. 1 — — — — — — — 1 Syphilis M. 2 — — — — — 1 — 1 F. — — — — — — — — — Diabetes M. 5 — — — — — — 3 2 F. 2 — — — — — — — 2 Tuberculosis of Lungs M. 43 — — — — 2 10 19 12 F. 16 — — — — 4 6 5 1 Non-pulmonary Tuberculosis M. 1 — — — — — — — 1 F. 1 — — — 1 — — — — Malignant Growths M. 109 — — — — 1 8 50 50 F. 94 — — — — 1 8 32 53 Congenital Debility, &c.Malformation, Prematurity M. 7 7 — — — — — — — F. 10 9 — — — — 1 — — Old Age M. 17 — — — — — — — 17 F. 27 — — — — — — — 27 Locomotor Ataxia M. 1 — — — — — — — 1 F. 1 — — — — 1 — — — Diseases of the Nervous System M. 1 — — — — 1 — — — F. — — — — — — — — Circulatory Diseases M. 200 2 1 — 1 — 11 60 125 F. 180 1 — — — — 6 36 137 19 Deaths, 1948—continued. Causes of Death at Different Periods of Life in the City—continued. Causes of Deaths. Sex. All Ages. Years of Age. 0-1 1-2 2-5 5-15 15-25 2545 4565 65+ Bronchitis M. 23 — — — — — 1 6 16 F. 20 1 — — — — — 3 16 Broncho-pneumonia M. 48 8 — — — 1 1 9 29 F. 29 2 — — — 1 1 3 22 Pneumonia M. 7 2 — — — — 1 3 1 F. 7 — — — — — — 4 3 Respiratory Diseases M. — — — — — — — — — F. — — — — — — — — — Alcholism M. — — — — — — — — — F. — — — — — — — — — Appendicitis M. — — — — — — — — — F. — — — — — — — — — Digestive Diseases M. 17 — — — — — 3 5 9 F. 19 1 — — — 3 2 2 11 Brights Disease, Nephritis, &c. M. 21 — — — — — 1 5 15 F. 14 1 — — 1 — 2 4 6 Cytitis M. 4 — — — — — — — 4 F. — — — — — — — — — Occidents and Negligence M. 21 1 1 — — 1 3 7 8 F. 20 — — 2 1 — 3 5 9 Suicide and Murder M. 16 — — — — 2 3 8 3 F. 11 2 — — — — 5 4 — Other Defined Diseases M. 3 — 1 — — 1 1 — — F. — — — — — — — — — Rheumatic Fever M. — — — — — — — — — F. 2 — — — — — — 1 1 Diphtheria M. 3 — — — 2 — 1 — — F. — — — — — — — — — Cirrhosis M. 2 — — — — — — 1 1 F. 3 — — — — — — 2 1 Abortion M. — — — — — — — — — F. — — — — — — — — — Measles M. 1 1 — — — — — — — F. — — — — — — — — — 20 Infectious Disease. Notifications. Removed to Hospital. Deaths. Polio-Encephalitis — — — Encephalitis Lethargica — — — Polio-Myelitis 16 14 1 Diphtheria 8 8 3 Erysipelas 8 3 — Scarlet Fever 55 14 — Enteric Fever 3 3 — Paratyphoid 1 1 — Puerperal Fever — — — Puerperal Pyrexia 9 6 — Cerebro-Spinal Meningitis 2 2 — Ophthalmic Neonatorum 6 1 — Measles 376 30 1 Pneumonia 8 1 14 Dysentery 8 4 — Whooping Cough 184 17 — Malaria 1 — — Scabies 61 — — Food Poisoning 2 — — Anthrax — — — Corrected Diagnosis—Scarlet Fever, 1; Measles, 1; Polio-Myelitis, 1. Non-notifiable diseases—removed to Hospital— German Measles 1 Chickenpox 13 Mumps 17 Gastro-Enteritis 35 Lobar Pneumonia 1 Vaccination. Compulsory vaccination in this Country ceased with the coming into force on 5th July, 1948, of the National Health Service Act, 1946. The particulars of vaccination given below therefore cover the period from 1st January to 4th July, 1948, only. Number of certificates of successful primary vaccination of children under 14 years of age received from 1st January, 1948, to 4th July, 1948 971 Number of persons vaccinated by the Public Vaccinators for the City up to 4th July, 1948— Primary 357 Secondary 15 21 Bacteriological Examinations. Diphtheria—Negative 306, positive 5. Tuberculosis—Negative 114, positive 54. Tuberculosis. Age Periods. New Cases and Deaths. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — 1 1 — — — — 1 to 2 years — — — — — — — — 2 to 5 „ 3 2 2 2 — — — — 5 to 10 „ 3 1 3 2 — — — — 10 to 15 „ 3 1 — 1 — — — 1 15 to 20 „ 5 7 — 4 — — — — 20 to 25 „ 24 19 1 1 2 3 — — 25 to 35 „ 33 26 — 3 7 4 — — 35 to 45 „ 18 10 — 1 3 3 — — 45 to 55 „ 16 1 — — 11 3 — — 55 to 65 „ 8 4 2 — 10 2 1 — 65 to 75 „ 9 — 1 — 10 1 — — 75 and upwards 3 3 2 — — — — — 125 74 12 15 43 16 1 1 New Cases. Pulmonary—199 new cases, including 32 transfers and 13 non-notified deaths. Non-Pulmonary—27 new cases, including 4 transfers and 3 non-notified deaths. (1947—Pulmonary, 245 new cases; Non-Pulmonary, 34 new cases.) Deaths from Tuberculosis. Pulmonary 59 (43 males, 16 females). Non-Pulmonary—2 (1 male, 1 female). Work of the Tuberculosis Dispensary from 1st January, 1948, to 4th July, 1948. The control of the Tuberculosis Dispensary service passed from the City Council to the Regional Hospital Board on the 5th July, 1948, under the provisions of the National Health Service Act, 1946. The particulars of this service given below relate to the period from the 1st January, 1948, to the 4th July, 1948 only. During this period 262 new cases attended, 132 males and 130 females. These included 71 examined as contacts. Total attendances numbered 1,307. 22 Eighty of the new patients were found to be suffering from pulmonary tuberculosis, though not all in an active stage of the disease. Six suffered from other forms of tuberculosis. Nineteen were recommended for sanitorium treatment and 26 for admission to hospital. Six hundred and two reports were made to public authorities and 131 to medical practitioners. During this period 556 X-ray films were taken and 92 specimens submitted for bacteriological examination. Tuberculosis—Maintenance A llowances. 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 period under review :— Applications received 29 Applications granted 26 Allowances stopped during this period for the following reasons:— (a) Returned to work 9 (b) Refused treatment 1 (c) Died 8 (d) Left the district 4 (e) End of period 1 (f) In Institutions and receiving National Health Insurance 2 (g) In receipt of Army pension An average of 52 patients are drawing allowances at any given time. Mass Miniature Radiography. Reference was made in last year's report to the arrangements made with the London County Council for their Miniature Radiography Unit to operate in one of the City Council's Depots, where residents and persons employed in the City could be examined, and for a mobile unit to visit the premises of firms where large numbers of persons were employed. These units were available for this purpose from November, 1947, to March, 1948. Some 20,775 persons were examined during this period, 9,195 of these were women and 11,580 men. Twenty thousand five hundred and eight persons were found to show satisfactory results of chest X-ray. The remainder consisted of 228 (140 men and 88 women) whose films showed some evidence of tuberculous infection (1.09 per cent.), and 39 where some abnormality of lungs or heart not of a tuberculous nature was noted. Whilst the main object of the examination is the early detection of tuberculosis of the lungs, other conditions are sometimes revealed. 23 Maternity and Child Welfare from 1st January to 4th July, 1948. Maternity Beds for Westminster Mothers. The arrangements for maternity beds in Westminster, Charing Cross, St. George's and the General Lying-in-Hospital which the City Council had built up since 1919, have now come to an end and are the responsibility of the Regional Hospital Board. Confinements in Hospital and at Home. The number of Westminster babies born in Hospitals and Nursing Homes during the period referred to numbered 564 as compared with 146 born at home. Day Nurseries Day nurseries provided by the City Council are situated at the undermentioned premises:— 1, Bessborough Street, S.W.1, with accommodation for 70 children 0 to 5 years of age. 37-39, Bloomfield Terrace, S.W.1, with accommodation for 59 children 0 to 5 years of age. Regency Street, S.W.1, with accommodation for 60 children 0 to 5 years of age (opened on 8th June, 1948). The average number of children accommodated daily in the nurseries during the period referred to were:— Bessborough Street Day Nursery 51 Bloomfield Terrace Day Nursery 50 Regency Street Day Nursery 36 The City of Westminster Health Society, a voluntary organisation performing Maternity and Child Welfare services in the St. Margaret and St. John Wards, also conducted a part-time Day Nursery for 30 children at 121, Marsham Street. The City Council made a grant of £1,200 to this society during the financial year 1948-49. The society remains as a voluntary body not transferable to the London County Council but receiving a large annual grant from the latter in respect of its Maternity and Child Welfare services for the inhabitants of this part of the City. Maternity and Child Welfare Centres. The four maternity and child welfare centres in the City, three built by the City Council and one by the City of Westminster Health Society are situated as follows:— 1, Bessborough Street, S.W.1; 1, Ebury Bridge Road, S.W.1; Marshall Street, W.1; and The Health Society Centre, at 121, Marsham Street, S.W.1. 24 In addition Infant Clinics are held once a week in hired accommodation at:— The German Church, 19, Montpelier Place, S.W.1; and The London Medical Mission, Short's Gardens, Endell Street, W.C.2. Visits by Health Visitors during the period 1st January to 4th July, 1948, were:— To expectant mothers 1,141 (3,438) * To children under 1 year 2,997 To children between 1 and 5 years 3,605 Ante- and Post-Natal Clinics. Number of clinics held weekly 7 A.N. P.N. Number of women attending 1,056 108 Weekly clinics were also held at Westminster Hospital, Charing Cross Hospital, St. George's Hospital and the General Lying-in-Hospital, Lambeth, for mothers who had made arrangements for their confinements in those hospitals. * The figures in brackets refer to the full year 1947 in contrast to the current numbers for half of 1948. Infant Clinics. Number of clinics held weekly 10 Attendances 3,623 Mothcrcraft Classes. Number of mothercraft instruction classes held weekly 6 Attendances 1,648 Convalescent Treatment for Mothers and Children. The City Council as a Welfare Authority was empowered to provide convalescent treatment for expectant and nursing mothers and children under 5 years of age. This work has for some years been undertaken by the St. Henry Convalescent Fund. Mothers and children requiring convalescence were recommended by the Maternity and Child Welfare Centres to the Fund who arranged the convalescence and paid the expenses, recovering from the family such reasonable contribution as they could afford to pay, the City Council making a contribution towards the balance of cost. During the period under review some 23 cases were sent away for convalescence in this way, the City Council contributing £62 17s. towards the cost. It is now a statutory duty of the London County Council to provide recuperative holidays and for the Regional Hospital Board to provide convalescence. In neither case have they adequate facilities and the St. Henry Fund continues to provide these services as their agents. 25 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 pediatrician whose services are available for consultant visits in the home where premature infants are being nurtured. His services were not called upon during the half year, the reason being that all these infants were born in hospital. This has generally been the case since 1944. Other recommendations of the Minister have been observed. Of the 12 premature births notified in Westminster up to 4th July, 1948, all were born in hospital. All 12 survived the first 24 hours of life, but one died before reaching the age of one month. This child died in hospital. (These figures do not include infants born to Westminster mothers outside the City. The Ministry of Health requires these to be returned by the local authority in whose area the birth took place.) Care of Illegitimate Children. The Council's Health Visitors and Child Protection Visitor continued to work in close association with the voluntary organisations in the City in the welfare of illegitimate children. The Council had a scheme of augmented payments to foster mothers who were prepared to undertake the care and maintenance of illegitimate children in the City. Payment for this service was increased from 21s. per week to 30s. per week. When this service was transferred to the London County Council one foster mother was enrolled under this scheme. A number of illegitimate children were also cared for in the Council's Day Nurseries enabling the natural mother to go out to work during the day and have the care of her child at night and during week ends. Child Life Protection. The Council was responsible for the supervision of children under nine years of age whose care and maintenance was undertaken for reward by persons other than their natural parents. This work was carried out by a whole-time Child Protection Visitor who paid regular visits to the homes where the foster children resided. Number of foster mothers at 4th July, 1948 10 Number of foster mothers who relinquished the care of children during the half-year 9 Number of children in the care of foster mothers at the 4th July, 1948 17 Number of children in the care of foster mothers during the half-year 19 Number of children returned to their natural parents in Westminster from foster mothers in other areas 42 26 Supply of Sheets for Expectant Mothers. By arrangement with 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 confined in their own homes. These were issued through the Maternity and Child Welfare Centres and 89 dockets and 291 coupon equivalent certificates were issued to expectant mothers during the first half of 1948 as compared with 576 for the previous whole year. Supply of Welfare Foods. By arrangement with the Ministry of Food, national dried milk, fruit juices, vitamin tablets and cod liver oil were distributed to expectant mothers and children at the Maternity and Child Welfare Centres in the City. The City Council as a Welfare Authority had for many years also supplied food accessories in the way of dried milk, cod liver oil, &c., to necessitous mothers and children, and have continued to do so under the direction of the Clinic doctors. Dental Treatment—Clinic Reports. New Cases. Reappoint ments. Extractions. Fillings. Other operations. Anaesthetics. Local. General. 1947 226 819 617 343 547 51 130 Half year 1948 41 191 111 74 128 11 26 Dental Clinics, 1st January to 4th July, 1948. Nursing and Expectant Mothers. Children under 5 years. T.B. Patients. Total. Treatment carried out 923 66 19 1,008 Total number examined 985 97 22 1,104 Number requiring treatment , 923 70 19 1,012 Number treated 923 66 19 1,008 Number made dentally fit 923 66 19 1,008 Diphtheria Immunization and Schick Testing. The following are particulars of children under five years of age who have been immunized against diphtheria in the City. 27 Number of children who have completed a full course of Immunization at any time up to 31 st December, 1948. Age at 31.12.48. Under 1 1 2 3 4 i.e., born in year 1948. 1947. 1946. 1945. 1944. Number immunized 174 507 567 662 723 Estimated mid-year population 1948 of children 0 to 5 years of age 4,676 Children immunized in 1948— Under five years of age 1,083 School children over five years of age immunized by City Council's Medical Staff to 4th July, 1948 98 1,181 Children Schick tested during the first half of 1948 Negative 264 Positive 7 371 There were three deaths from diphtheria during the year as reported earlier in this report, none of whom appeared to have been immunised against diphtheria. Home Nursing. The City Council had arrangements 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 paid the Association 2s. 6d. per visit for this service. During the half year the District Nurses made 955 nursing visits under these arrangements. The City Council made supplementary grants of £100 to the Westminster District Nursing Association and of £200 to the Chelsea, Pimlico and Belgravia District Nursing Association to assist these Associations in meeting the greatly increased cost of their services up to the 4th July, 1948, and to leave them with a reasonable working balance at that date and as a farewell gesture of appreciation for the selfdenying devotion of the Nurses freely given to the people of Westminster for many years. Domestic and Home Help Service. The Domestic Help Service inaugurated in 1945 has continued throughout the half year. The object of the scheme was to provide help in the home for sick and infirm who are in need of such assistance and unable themselves to obtain it. A scale was in force for the assessment of contributions by the persons assisted based on their income and outgoings. The cost of this service was reimbursable by the Government. 28 During the half year some 72 persons were assisted under the scheme. In 31 cases they were aged persons unable to attend to their household duties on account of such infirmity as paralysis, rheumatism, arthritis, &c. These received regular assistance each week. The remaining 41 cases were not aged persons, but suffered from such disabilities as blindness, heart trouble, tuberculosis, limb injuries and temporary illnesses. In addition to the above, assistance was also given in the home under the Council's Maternity and Child Welfare scheme during the confinement of the mother or where the mother was otherwise incapacitated and where there were young children in the home. Some 76 households were assisted in this way during the half year. Mobile Meal Service. The Westminster Division of the British Red Cross Society were able in December, 1946, to start a meals delivery service for aged people and others who are unable to provide themselves with cooked hot meals. The meals are purchased by the British Red Cross Society from a Londoners' Meal Service Centre at a special price of 8d. per meal for aged people and 1s. 2d. for others, and delivered in a mobile van to the homes. The cost of the meal is recovered by the British Red Cross Society from the recipients. The names and addresses of those requiring the delivery of hot meals are submitted to the Society by the Medical Officer of Health weekly. Some 210 hot meals per week were being delivered by the Society under this arrangement at the end of the year, by which time the Society was using two vans. Medical Inspection of Aliens. At the request of the Minister of Health, the City Council in 1947 made arrangements to resume the medical inspection of aliens arriving at Victoria Station by through sleeping car service from Paris, which arrangement had ceased on the outbreak of war. The actual inspection is carried out by medical staff from Westminster Hospital under the supervision of the Medical Officer of Health, and includes daily attendance at Victoria Station by medical inspectors to inspect aliens arriving by this ferry train and carry out medical examination where necessary. The Government reimburse the Council the cost of this service. During 1948 359 inspections of aliens were made, 46 being referred by the Immigration Officers for medical examination. International Certificates of Vaccination and Innoculation. Arrangements continued during the year for the authentification by the Medical Officer of Health of International Certificates of Vaccination and Innoculation completed by medical practitioners in Westminster. These certificates are required by passengers proceeding abroad from this country and the purpose of the authentification is to provide proof to those health authorities abroad who desire it that the signature of the person issuing the certificate is that of a registered medical practitioner. Some 1,880 certificates were authenticated during the year. 29 Care of the Aged and Infirm. The problem of the aged and infirm, living on their own has been a matter of increasing concern to the Department during the year. Some 93 cases came to the notice of the Sanitary Insepctors, who paid 262 visits to premises where the elderly resided. The Council's powers with regard to the aged and infirm are contained in the National Assistance Act, 1948, which provides that for the purpose of securing the necessary care and attention for persons who (a) are suffering from grave chronic disease or being aged, infirm or physically incapacitated, are living in insanitary conditions; (b) are unable to devote to themselves and are not receiving from other persons proper care and attention. The Council may if the Medical Officer of Health certifies in writing that in the interests of such person, or for preventing injury to the health of or serious nuisance to other persons, it is necessary to remove such persons, apply to the Court for an order for the removal to a suitable hospital or other place. It has not been found necessary during the year to exercise these powers, every endeavour is made to persuade the patients voluntarily to consent to such removal, and this course has invariably been successful. Difficulties have, however, been experienced in securing bed accommodation in the hospitals for these cases. Full use has been made of the services of the District Nurses for the nursing of the patients in their own homes, coupled with the assistance of the Home Help Service in attending to the domestic requirements in the home, together with the provisions of hot cooked meals when the Home Help is not for the time being available. Westminster Old People's Welfare Association. Valuable work has been performed during the year by the Westminster Old People's Welfare Association in ministering to the needs and comfort of elderly people living in Westminster. Their activities include the conduct of six Darby and Joan Clubs in different parts of the City, the provision of Library facilities through the City Librarian, the visiting of the old people in their homes and the organising of Christmas parties and outings. The City Council, under powers conferred by Section 31 of the National Assistance Act, 1948, made a grant of £1,000 for the year ended 31st March, 1949, towards the expenses of the Association. Sanitary Circumstances. Duties Performed by the Sanitary Inspectors. The following statistics show the work of the Sanitary Inspectors during the year, these figures are divided under the headings, Housing, Factories and Workplaces, Catering and Food. 30 Summary of Inspections of all Types of Premises. Primary. Reinspection. Dwellings 4,591 9,417 Factories, workplaces, and shops (other than food), &c. 2,312 3,234 Catering establishments and food premises 1,918 4,312 8,821 16,963 Number of Visits. Sampling of food 798 Inspection of food 1,142 Smoke and noise 740 Rats and mice repression 1,350 4,030 Drainage plans submitted 572 Combined Drainage Orders made 49 Summary of Notices Served. Factories. Dwellings. Workplaces, &c. Food. Catering. Totals. Public Health (L) Act, 1936 947 179 12 153 1,291 Housing Act, 1936 1 — — — 1 Food and Drugs Act, 1938 — — 131 423 554 Shops Act, 1934 — 9 24 11 44 Factories Act, 1937 — 95 — — 95 London County Council (Drainage) Bylaws, 1934 30 10 2 2 44 London County Council (Watercloset) Bylaws, 1930 14 5 16 15 50 Ice Cream (Heat Treatment) Regulations, 1947 — — 4 — 4 Milk and Dairies Regulations, 1926-43 — — 9 — 9 Public Health (Meat) Regulations, 1924-35 — — 2 — 2 London County Council Houses let in Lodgings Bylaws, 1937 23 — — — 23 Totals 1,015 298 200 604 2,117 Total Notices served under the above Acts 2,117 Statutory Notices 116 31 Legal Proceedings. Prosecutions instituted 55 Convictions 46 Cases withdrawn upon completion of work 2 Cases dismissed under the Probation of Offenders Act 6 Cases dismissed 1 Analysis of Legal Proceedings. Catering. Failing to take precautions against the contamination of food:— Fines. Costs. £ s. d. £ s. d. 11 convictions 377 0 0 155 7 0 1 case withdrawn (work having been completed) (with costs) — — 1 conviction (nuisance) Public Health (London Act.) (Work completed) — 3 3 0 Food. Food unfit for human consumption— 3 convictions 120 0 0 46 15 0 1 case dismissed Sale of horseflesh— 17 convictions 316 0 0 70 0 0 1 case dismissed under the Probation of Offenders Act (with costs) Adulterated gin— 1 conviction 5 0 0 44 2 0 5 cases dismissed under the Probation of Offenders Act (with costs) Labelling (gin)—misleading label 2 convictions 4 0 0 15 15 0 Ice Cream Vehicles (no proprietor's name)— 4 convictions 2 17 6 — In four instances, proceedings were taken jointly with the Food Committee. Fines and costs in respect of these cases amounting to £380 and £60 10s. respectively have not been included in this summary as the Magistrate marked the Summonses "Joint Penalty, not separately dealt with." 32 Dwellings. Public Health (London) Act, (Nuisances)— Fines. Costs. £ s. d. £ s. d. 5 convictions (Abatement Orders made) - 16 13 0 1 case withdrawn upon completion of work (with costs) - - Factories. Public Health (London) Act (Nuisance)— 1 conviction (Abatement Order made) - 3 3 0 Factories Act— 1 conviction (overcrowding) 10 0 0 5 0 0 £834 17 6 £359 18 0 Dwellings. Analysis of Inspections— Primary. Re-inspection. Complaint 1,638 669 House to house 412 875 Routine 156 146 Infectious disease 306 43 Underground rooms 193 223 Housing applications 438 323 Building licences and permits 255 175 Drainage—Voluntary 502 1,580 Drainage under notice — 194 Sanitary defects—Voluntary 43 174 Sanitary defects—Under notice — 3,895 Aged and infirm 84 178 Common lodging houses 42 7 Other reasons 522 935 4,591 9,417 Included in the above totals- Requisitioned properties 168 225 Houses let in lodgings 456 2,057 Notices Served. Public Health (London) Act, 1936 969 Housing Act, 1936 1 London County Council (Drainage) Bylaws, 1934 30 London County Council (Watercloset) Bylaws, 1930 14 London County Council Houses let in Lodgings Bylaws, 1938 23 1,037 33 Defects Found. Defective, dirty internally 635 Damp 401 Inadequate underfloor ventilation 35 Defective drainage 335 „ roofs 249 „ area paving, &c. 16 „ exteriors 68 Water closets insufficient 6 „ insufficient ventilation and light 7 „ defective 80 „ direct approach 1 „ unsuitable 5 Water supply insufficient 16 „ absence of, in upper floors 51 „ cisterns dirty, uncovered 12 „ taps not off main supply 1 Illegal occupation of underground rooms 3 Absence of food storage accommodation 3 „ cooking accommodation 3- „ washing accommodation 3 „ means of heating 3 Staircase lighting, tenements 11 Ventilation 17 Smells 11 Rubbish 50 Other nuisances 20 Overcrowding (Housing Act, 1936, Section IV). Cases coming to the notice of the Public Health Department during the year 97 Cases in which overcrowded families have been rehoused— Westminster City Council, 29 ; London County Council, 39 68 Notices served to abate overcrowding 7 Water Supply in Tenement Houses. Under the powers of the Public Health (London) Act, 1936, 67 additional water supplies were provided to working class tenement houses during the year. Housing Act, 1936. Closure of Parts of Buildings as Unfit for Human Habitation. Underground rooms represented for closure 37 Other rooms represented for closure 7 Closing Orders made 32 34 House to House Inspection. During the year 629 properties, involving 1,275 dwellings were inspected. Of these properties 265 were residential, 163 part residential, 162 business premises and 39 bombed, derelict, &c., buildings. Inspections. Primary inspections 629 Re-inspections 3,402 Notices Served. Public Health (London) Act, 1936 330 London County Council (Drainage) Bylaws, 1934 4 Defects Found. Defective roofs 127 Dampness 168 Dirty, defective, dilapidated internally 308 Defective drainage 166 Verminous 21 Insufficient water supply 44 „ w.c. accommodation 1 „ food storage accommodation 3 Families overcrowded 24 Factories, Workplaces, Shops and Other Premises (other than Food Premises). Summary of Inspections. Primary. Re-inspections. Factories—Power 451 373 Factories—Non-power 422 583 Workplaces, &c. 1,203 1,937 Shops (other than food) 236 341 2,312 3,234 Analysis of Inspection. Complaint 580 219 Routine 920 748 Infectious disease 158 9 Building licences and permits 94 37 Drainage voluntary 304 1,322 Drainage under notice — 91 Sanitary defects—Voluntary 5 23 Sanitary defects—Under notice — 627 Water supply 5 1 Other reasons 246 157 2,312 3,234 35 Types of Premises Inspected. Boot and shoe trades 35 Carpentry 7 Woodworkers (various) 19 Cigar and cigarette manufacturers 5 Dress and milliners 267 Furriers 60 Shirt makers 16 Hairdressers 39 Garages 62 Dry cleaners 7 Metalworkers (excluding gold and silver) 18 Printers and publishers 59 Packers 2 Cinemas, concert halls 24 Shops (other than food) 577 Dance halls 4 Leather goods 35 Cabinet makers 5 Upholstery and carpets 2 Corset makers 7 Embroiderers 10 Lingerie 5 Tailors 608 Film renters, &c. 9 Electric sub-stations 5 Jewellers and silversmiths 45 Opticians 6 Photographers 64 Florists, &c. 10 Offices 1,706 Theatres and music halls 80 Stables and mews 85 Various 1,660 Outworkers. Inspections 393 Number of outworkers (includes workers living in areas outside the City) 4,158 Notices—Summary. Intimation. Statutory. Factories—Power 83 - Factories—Non-power 107 - Workplaces, shops (other than food) 108 4 298 4 36 Abstracts. Reports were made to the Factory Inspector of 93 instances for failure to display the appropriate abstracts of the Factories Act, 1937. N otices—Analysis. Factories Power. Factories Non-Power. Workplaces Shops, &c. Public Health (London) Act, 1936 41 46 92 Shops Acts, 1934 — — 9 Factories Act, 1937 39 56 — London County Council (Drainage) Bylaws, 1934 2 4 4 London County Council (Watercloset) Bylaws, 1930 1 1 3 83 107 108 Total 298 Defects Found. Factories Power Factories Non-Power. Workplaces, Shops, &c. Dirty, defective, internally 17 43 13 Dampness 1 1 5 Drainage defective 4 10 16 Foofs defective 5 2 4 Area paving, &c., defective — — 1 Exteriors defective — — 2 Water closets insufficient 2 2 2 „ insufficient ventilation and light 26 13 8 „ defective 17 9 17 „ direct approach 10 4 4 „ not separate for sexes 1 4 2 „ unsuitable 5 1 2 Water supply insufficient — 2 1 Washing accommodation, absence of, inadequate — 3 2 Smells 2 — 21 Rubbish 1 — 52 Other nuisances 20 — 7 Flood drainage, want of — 2 1 Temperature 1 — — Ventilation, want of 1 5 7 Gas rings, ventilation — 2 — Failure to fix abstracts 52 41 — 37 Common Lodging Houses. There are three common lodging houses in the City, two for men and one for women. Forty-nine visits were made during the year. Catering Establishments and Other Food Premises. Summary of Inspections. Primary. Re-inspection. Catering establishments 1,312 3,196 Food shops and other food premises 606 1,116 1,918 4,312 Analysis of Inspections. Primary. Re-inspection. Complaint 436 153 Routine 724 263 Infectious disease 28 9 Building licences and permits 160 46 Drainage voluntary 131 306 Drainage—under notice — 69 Sanitary defects—Voluntary work 31 48 Sanitary defects—Under notice — 2,927 Food licences 30 36 Food licence transfers 17 3 Catering licences 277 353 Catering Licences transfers 83 95 Other reasons 1 4 1,918 4,312 38 Summary of Notices Served. Food Shops and Other Food Premises. Catering Establishments. Food and Drugs Act, 1938 131 423 Shops Act, 1934 24 11 Public Health (London) Act, 1936 12 153 London County Council (Drainage) Bylaws, 1934 2 2 London County Council (Watercloset) Bylaws, 1930 16 15 Ice Cream (Heat Treatment) Regulations, 1947 4 – Milk and Dairies Regulations, 1926-43 9 – Public Health (Meat) Regulations, 1924-35 2 – 200 604 Food Shops and Other Food Premises (other than Catering Establishments) Primary. Re-inspection. Bakehouses 47 63 Dairies and milkshops 114 180 Fried fish shops 18 37 Ice cream premises 60 105 Meat shops 68 164 Meat stalls 1 — Other meat shops (preserved food, &c.) 6 10 Other stalls 50 45 Confectioners 24 58 Fruit and greengrocery 40 67 Provision shops 81 256 Other food premises 65 56 Fish and poultry 32 75 606 1,116 Included in the above totals are visits in connection with the sale of horseflesh and enquiries into food poisoning outbreaks, &c. 39 Other Food Premises. Under this heading is included— (1) Off-licences. (2) Food factories. (3) Bonded warehouses. (4) Chemists' shops. (5) Visits made in connection with applications for entry on the Lists of Persons entitled to sell Poisons included in Part II of the Poisons List. (6) Visits to various offices in connection with enquiries regarding adulterated samples. Visits for the Purpose of Obtaining Samples and inspecting Foodstuffs. Sampling. Inspection of Food. Bakehouses 1 3 Dairies and milkshops 403 17 Fried fish shops — 1 Ice cream premises 74 13 Meat shops 11 111 Other meat shops 1 — Other stalls — 62 Confectioners 2 13 Fruit and greengrocery 1 47 Provision shops 121 431 Other food premises 25 108 Staff canteens 2 15 Hotels, restaurants, clubs 34 166 Cafes, teashops, &c. 8 24 Public houses 115 10 Fish and poultry — 121 798 1,142 Food Shops and Other Food Premises. Notices Served. Food and Drugs Act, 1938 131 Shops Act, 1934 24 Public Health (London) Act, 1936 12 London County Council (Drainage) Bylaws, 1934 2 London County Council (Watercloset) Bylaws, 1930 16 Ice Cream (Heat Treatment) Regulations, 1947 4 Milk and Dairies Regulations, 1926-43 9 Public Health (Meat) Regulations, 1924-35 2 200 40 Defects Found. Dirty and dilapidated internally 91 Defective internally 71 „ externally 12 „ drainage 26 „ area paving, &c. 6 „ floors 34 Preparation tables and equipment— Worn and insanitary 13 Food storage accommodation inadequate, unsuitable &c. 19 Vegetable preparation and washing up facilities— Insufficient 10 Worn, insanitary 15 Ventilation insufficient 34 Temperature unsuitable . 2 Lighting inadequate 5 Washing facilities for staff, insufficient, unsuitable 54 . Staff changing rooms insufficient, unsuitable 5 Rubbish, fuel and other extraneous materials in food preparation rooms 14 Arrangements in premises unsuitable (redesigning and resiting of equipment), &c., necessary 7 Vermin— Cockroaches 2 Rats 1 Water closets— Insufficient 11 „ ventilation and light 18 Defective 13 Dirty and dilapidated 29 Direct approach 5 Not separate for the sexes 4 Unsuitable 6 Catering Establishments. During the year under review, good progress has again been made in the improvement of conditions in catering establishments throughout the City. 1,312 primary inspections, and 3,196 reinspections were made of catering establishments which included cafes, restaurants, hotels, snack bars, public houses, schools and civic restaurants, staff canteens, clubs, theatres and cinemas or any other premises. Six hundred and four Notices were served under the provisions of the various statutes dealing with this type of premises, and legal proceedings were instituted in respect of 12 premises ; in addition, proceedings were taken against three restaurant proprietors as the result of unsound food seized upon their premises. The legal action initiated by the City Council was successful in every case and fines and costs amounting to approximately £700 were imposed. Whilst it has been found necessary to have 41 recourse to legal proceedings in some cases, there is generally no necessity for such action, as the majority of caterers in large and small businesses have been willing to listen to and act upon the advice and suggestions given by the Sanitary Inspectors concerned. Two Inspectors have again devoted the whole of their time to the inspection of catering establishments, and much of the time of these Inspectors has inevitably been taken up dealing with premises which have been the subject of an application to the Ministry of Food for catering licences. Of the 1,312 primary visits made during the year, 277 were in respect of new catering licences, mostly in connection with new staff canteens. Whilst this aspect of the work has absorbed much of the Inspectors' time, it is considered of paramount importance that no effort should be spared to ensure that all premises brought into use for the purpose of preparation of food should comply with statutory requirements. An arrangement with the local Food Control Committee is in operation as a result of which no catering licence is actually issued until a certificate of suitability in respect of the premises has been issued by the Medical Officer of Health. This arrangements has proved to be of great assistance to the Department and this is a suitable opportunity to thank the Westminster Food Control Committee for their helpful co-operation in this very important matter. Following legal action taken by the Council against occupiers of dirty kitchens, three enquiries were instituted by the Divisional Food Office to consider whether the catering licences in respect of those premises should be revoked. Warning letters from the Ministry of Food were sent in several other cases of this sort. Many of the Notices served have necessitated complete reconstruction, re-equipment and re-design of the internal arrangement of the premises. Whilst the trade as a whole has been co-operative and is generally aware of the importance of effecting and maintaining a satisfactory standard of hygiene and cleanliness in the handling of food, proprietors and managers of the many varying types of establishments appear to be handicapped by the mobility of the labour employed, and in some cases with a certain irresponsibility and disinterestedness on the part of some employees. Attempts to enforce a higher standard of discipline are rendered futile by the difficulty in replacing them. In some instances of flagrant irresponsibility on the part of employees it may be appropriate to take legal proceedings against the individual offender. Analysis of Inspections. Primary. Re-inspection. Hotels, restaurants, clubs 622 1,518 Cafes, teashops, &c. 351 1,057 Staff canteens 159 210 Public houses 180 411 1,312 3,196 42 Notices Served. Public Health (London) Act, 1936 J53 Food and Drugs Act, 1938 423 Shops Act, 1934 11 London County Council (Drainage) Bylaws, 1934 2 London County Council (Watercloset) Bylaws, 1930 15 604 Defects Found. Dirty and dilapidated internally 272 Defective internally 202 „ externally 37 „ drainage 54 „ area paving, &c. 12 „ floors 124 Preparation tables and equipment, worn and insanitary 58 Food storage, inadequate, unsuitable 63 Vegetable preparation and washing up facilities— Worn and insanitary 147 Insufficient 65 Ventilation insufficient 146 Temperature 24 Lighting 27 Staff washing facilities, insufficient, unsuitable 110 Staff changing rooms, insufficient, unsuitable 37 Fuel, rubbish and other extraneous materials in food preparation rooms 65 Accommodation unsuitable (re-designing and re-siting of equipment necessary), &c. 30 Vermin— Cockroaches 16 Rats 8 Fuel storage accommodation insufficient 6 Animals kept in food stores 2 Water closets— Insufficient 31 Insufficient ventilation and light 28 Defective 45 Dirty and dilapidated 55 Direct approach 9 Not separate for the sexes 18 Unsuitable 15 43 Samples Purchased under the Food and Drugs Act, 1938. Showing Results of Analysis for the year 1948. Article of Food. Number of Samples Purchased. Adulterated. Genuine. Baking powder 30 — 30 Butter 23 2 21 Cake and pudding mixtures 50 4 46 Cereals 18 1 17 Cheese 15 4 11 Cocoa 11 — 11 Coffeee preparations and essences 32 4 28 Condiments and spices 48 4 44 Confectionery 20 5 15 Cooking fat 16 2 14 Cream synthetic 1 — 1 Culinary flavours 44 — 44 Drugs 60 4 56 Eggs, dried 2 1 1 Fish preparations 66 7 59 Fruit (canned and preserved) 24 5 19 Gelatine 10 — 10 Jams and preserves 40 3 37 Margarine 20 2 18 Milk 701 2 699 Milk, condensed and evaporated 16 2 14 Milk, dried 3 2 1 Pickles and sauces 92 4 88 Meat and meat preparations 45 10 35 Salad oils and dressings 15 3 12 Sandwich spreads 21 — 21 Sausages 14 4 10 Soft drinks, cordials, &c. 22 — 22 Soup 30 — 30 Spirits 208 32 176 Suet 3 — 3 Sugar 8 — 8 Tea 12 1 11 Vegetables, canned and preserved 33 1 32 Vinegar 41 2 39 Wines 8 3 5 Totals 1,802 114 1,688 44 Registration of Premises used in Connection with the manufacture, sale or' storage of ice cream. On the 1st January, 1948, 109. premises were registered for the sale and storage of ice cream. During the course of the year applications were received in respect of 10 further premises, and these were duly registered making a total of 119 registered premises at the end of the year. At the commencement of the year 17 premises were registered for the manufacture of ice cream, but at only 8 premises was ice cream actually being manufactured. During the year two of these factories were, completely modernised. A further two factories were represented to the Public Health Committee as being unsuitable and were subsequently removed from the Register. With the consent of the occupiers the Committee removed four premises from the Register of Manufacturers on the grounds that the use of the premises in this connection had been discontinued and that the present business carried on therein rendered the premises unsuitable. Ice Cream (Heat Treatment, &c.) Regulations, 1947. During the year 131 samples of ice cream were submitted for examination by the methylene blue test. The samples were classified in the provisional grades, as follows Grade 1 42 Grade 2 28 Grade 3 26 Grade 4 35 The above grading is based upon the method of examination recommended by the Ministry of Health. In this test the grading is consequent upon the time taken for a measured volume of the ice cream to reduce the colour of a measured volume of methylene blue dye. Grade 1 Over 4½ hours. Grade 2 Between 2 and 4½ hours. Grade 3 Between ½ and 2 hours. Grade 4 Under ½ hour. Bacteriological Examination of Ice Cream. Thirty-eight samples of ice cream were submitted to the Bacteriologist for a plate count and coliform test. The results obtained were as follows:— Standard "A" 26 Standard "B" 1 Unsatisfactory 11 Standard "A" is the standard to aim for in assessing the purity of ice cream and samples falling within this category may be considered good. Ice creams which satisfy Standard "B" may be accepted although they cannot be considered very satisfactory. 45 Milk and Dairies Regulations, 1926-43. At the 31st December, 1948, the following were entered in the City Council's Registers of Dairies and Dairymen Premises used as dairies 77 Dairymen (premises in Westminster) 52 Dairymen (premises outside Westminster) 36 Milk (Special Designations) Regulations, 1936-46. The following are particulars of licences granted during 1948 to dealers in respect of the sale of milk under prescribed or special designations:— Principal. Licence. Supplementary.Licence. Tuberculin tested 16 5 Pasteurised 31 6 Pharmacy and Poisons Act, 1933. At the end of the year the number entered on the List of Persons entitled to sell poisons included in Part II of the Poisons List was 173. During the year 10 persons had been removed from the List, because they were no longer in business or had moved out of the City, and 15 new applications had been duly entered on the List. Unsound Food. The following table shows the amount, and method of disposal, of food condemned by the Inspectors as unfit for human consumption during the year 1948:— Articles. Amount Destroyed. Amount Salvaged. Total. Tons. Cwt. Lbs. Tons. Cwt. Lbs. Tons. , Cwt. Lbs. Canned food 15 15 55 8 4 17 23 19 72 Meat 2 0 17½ 0 2 50 2 2 67½ Fats 0 0 77 0 6 75 0 7 40 Fish 9 5 12½ — 9 5 12½ Fruit and vegetables 20 19 5 1 19 28 22 18 33 Cereals 0 16 20 7 2 48 7 18 68 Confectionery 0 9 31¼ 1 0 91 1 10 10¼ Miscellaneous 6 13 65½ 3 11 38 10 4 103½ Total 55 19 59¾ 22 7 11 78 6 70¾ Food Poisoning. During the year 18 investigations were made in regard to suspected food poisoning. In 14 of the cases only one or two people were affected and although thorough investigation was made immediately, in one instance only was some of the food (tinned salmon) found to be under suspicion. The bacteriologist reported that proteus vulgaris had been isolated from the sample. 46 Three small outbreaks affecting a number of people were notified. In the first case about 20 employees of a commercial firm in the City had mild symptoms of food poisoning after consuming a meal in the staff canteen but as a total of 350 had also had lunch at the same time it was not possible to trace the cause. In no case was an affected employee absent from work. A second small outbreak occurred amongst the staff of a club canteen in the City—12 persons being affected. This also was a mild attack and was attributed to the consumption of soup prepared from stock the previous day, but none was available for the bacteriological examination. The third minor outbreak affected 14 persons out of a total of 23 forming a party who attended a theatre and afterwards dined in a restaurant in the City. Following the examination of specimens obtained from the patients the Medical Officer of Health of the district in which the people resided came to the conclusion that there was no evidence of bacterial food poisoning. One outbreak of a more serious character was investigated in which some 40 people were taken ill after partaking of a centenary luncheon at a restaurant in Westminster at which 1,000 people were present. Three of the number affected subsequently died but following the inquests two were returned as having died from natural causes and one from the effects of food poisoning. Details of this outbreak will no doubt be dealt with by the Medical Officer of Health for the District in which the affected persons resided. A very thorough investigation was made and samples of all foodstuffs still available were submitted to the bacteriologist together with specimens of faeces, &c., from food handlers at the restaurant, but no pathogenic organisms were isolated. It was a significant fact that there was something left of every single article of food served at the lunch and the resident staff of 35 partook of this food for their evening meal without any detrimental effect. Despite the very full investigations made, including those by the Medical Officers of Health in the districts were some of the food was manufactured, no causal agent was identified. Rat and Mice Repression. Complaints received 1,365 Visits made 17,123 Inspections by the Rodent Officer 1,350 Inspections by Sanitary Inspectors 102 Notices served 324 Rodents Destroyed. Black rats 6,499 Brown rats 1,807 Mice 1,450 9,756 324 Notices were served on owners or occupiers under the provisions of the Rats and Mice (Destruction) Act, 1919. 47 Pigeons. Premises visited 19 Visits made 130 Pigeons destroyed 208 Public Health (London )Act, 1936, Section 121. Twelve complaints of nuisance caused by pigeons were received from occupiers of business and residential premises. Action was taken by the Rodent Officer resulting in the destruction of 208 pigeons, mostly aged or infirm birds. Atmospheric Pollution. Complaints dealt with 48 Observations recorded 670 Notices served 1 Noise Nuisance. Complaints dealt with 22 Water. Water for drinking and commercial purposes is supplied throughout the district by the Metropolitan Water Board, and has proved throughout the year to be satisfactory in quality and quantity. Four complaints were received in relation to drinking water, and in each case it was found that the storage tanks had become dirty, and conditions were remedied by the cleansing and protection of these tanks. It is estimated that some 100,900 persons resident in 22,536 houses received water direct from the Metropolitan Water Board's mains. All dwelling houses, apart from those blocks of flats supplied from deep wells, derive their piped supplies from the Metropolitan Water Board. There are some 96 deep wells still actively used and 27 reports were received on the supplies drawn from these sources. In all but 3 of these 96, the water is used for domestic purposes, in those 3— 1 supply is used for cooling purposes ; 1 for supplying boilers ; and 1 is a stand by in case of fire. Four reports in relation to one building showed unsatisfactory conditions, but these were rectified by cleansing the storage and supply systems. Disinfection and Disinfestation (Vermin). Rooms. Articles. Articles Destroyed Articles Washed. Vehicles. Books. Disinfection 603 11,534 1,314 — 163 652 Disinfestation 807 5,607 739 — 6 — Laundry towels — — — 5,035 — — 1,410 17,141 2,053 5,035 169 652 48 Treatments. Men. Women. Children (under school age). Children (School). Articles. Scabies 123 147 57 221 8,971 Head lice — 14 6 492 277 Body lice 203 37 — — 4,062 326 198 63 713 13,310 Burial or Cremation of the Dead. Section 50 of the National Assistance Act, 1948, which came into force on 5th July, 1948, provides that it shall be the duty, in London, of Sanitary Authorities to cause to be buried or cremated the body of any person who has died or been found dead in their area, where no other arrangements have been made for the disposal of the body. Power is also given to recover the cost of the burial from the estate of the deceased person or from a liable relative. This was a duty formerly carried out in London by the London County Council. The City Council accordingly made arrangements for the burial of of such persons in their cemetery at Hanwell. Up to the end of the year some 32 bodies were buried by the City Council under these arrangements. Coroner's Court and Mortuary. In all 394 bodies were received in the Mortuary on Coroner's warrants by Police or Undertakers. There were 12 cases admitted "to await burial." Number of Cases. Inquest cases 124 Non inquest cases 270 Post mortem examinations held 361 Cause of death in the foregoing cases were as under:— Accidental drowning 2 Found drowned 14 Suicide by drowning „ other means 30 Accidents. Street 17 Domestic 9 Others 17 Natural causes 277 Misadventure 11 Murder 3 Miscellaneous causes 14