AC. 4344 Cits of Westmnister WES 60 REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 195O ANDREW J. SHINNIE, O.B.E., M.D., D.P.H. (Lond.). Medical Officer of Health. LONDON: harrison and sons, ltd., printers to his majesty the king, st. martin's lane, w.c.2. City of Westminster. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1950 ANDREW J. SHINNIE, O.B.E., M.D., D.P.H. (Lond.). Medical Officer of Health. LONDON: harrison and sons, ltd., printers to his majesty the king, st. martin's lane, w.c.2. CONTENTS. Page Aged and Infirm, care of Atmospheric Pollution 42 Bacteriological Examinations 18 Basement Bakehouses 32 Births 14 Birth Rates 14 Bornholm Disease 19 British Red Cross Society 20 Burial or Cremation of the Dead 46 Catering Establishments 29, 34 „ „ Defects 35 Common Lodging Houses 29 Coroner's Court and Mortuary 46 Staff 8 Deaths 14 „ Analysis 16 „ Causes of 16, 17 „ Statistics 14 Disinfecting Staff 8 Disinfection and Disinfestation 45 „ „ Treatment 45 Drainage Orders 22 „ Plans 22 Dwelling Houses 23 „ „ Analysis of Inspections 23 „ „ Defects 24 Factories, Workplaces, Shops and other Premises 26 „ Defects 28 Food, Inspection and Supervision of 33, 36 „ Legal Proceedings 44 „ Poisoning 38 „ Sampling and Inspection 33, 36 „ Shops and Premises 32 „ „ Defects 34 „ Unsound 38 House to House Inspection 26 Houses Unfit 24 „ partly Unfit 25 Ice Cream 37 Infantile Mortality—Causes 15 Infectious Diseases 15 (7095) 2 Page Infectious Diseases, Analysis 15 International Certificates of Vaccination and Inoculation 19 Introduction 9 Legal Proceedings 43 „ Analysis 44 Medical Inspection of Aliens 21 Milk and Dairies 37 Mobile Meals Service 20 Noise Nuisances 41 Notices 23, 24, 27-29, 34, 41, 43 „ Statutory 23, 24 Outworkers 26, 27 Overcrowding 24 Pharmacy and Poisons Act. 38 Pigeons 41 Poliomyelitis 15 Population 14 Premises—Analysis of Inspections 23, 26, 27 Private Deep Wells 45 Public Health Committee 5 Rats and Mice Repression 41 Rodent Staff 8 Samples purchased 36 Sanitary Circumstances 22 Smallpox Investigations 18 Smoke Abatement 43 Staff—Public Health Department 6, 7 Statistics and Social Conditions 14 Tuberculosis Analysis 18 Underground Rooms 25 „ „ Illegal Occupation 25 Unfit Premises 24 Unsound Pood 38 Water „ Additional Supplies to Premises 24 Welfare of Old People 19 Westminster Old People's Welfare Association 20 Workplaces, Shops, &c. 26 5 PUBLIC HEALTH COMMITTEE. The Mayor (ex-officio): Councillor Wilfred Eric Rice, C.B.E., J.P. The Deputy Mayor (ex-officio) : Aideiman Col. James Allan Mulholland, M.B.E., M.C. Chairman : Councillor C. R. Purnell. Vice-Chairman: Councillor Lt.-Col. H. Norman Edwards, M.B.E. Members: Alderman G. F. Jerdein, D.L. Councillor G. F. Davies. , J. C. R. Durran, J.P. J. G. Elsworthy, F.R.I.C.S., F.A.I., M.R.San. I. ,, R. L. Everest, F.R.I.C.S., F.I.Arb. ,, D. E. Havinden. W. Charles Norton, M.B.E., M.C. ,, Miss P. C. Paton Walsh. ,, Dr. G. Rewcastle, O.B.E. ,, Mrs. Arthur Rye. ,, A. Sciver, B.Sc., F.R.I.C. ,, Mrs. Francis Storrs. ,, The Countess Winterton. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: Andrew J. Shinnie, O.B.E., M.D., D.P.H., &c. Assistant Medical Officer of Health : (jointly for Westminster and Holborn), P. G. Roads, M.D., D.P.II., &c. (Appointed 1.4.50). Public Analysts : (Part time) F. W. Edwards, F.I.C. T. McLachlan, A.C.G.F.C., F.I.C. Chief Sanitary Inspector : H. E. White. Chief Clerk : W. D. Sambrook. Deputy Chief Sanitary Inspector : W. G. J. Sutton. (Theatres, Cinemas and other places of amusement). Sanitary Inspectors: District: S. G. Bennett (Inspector for Rodent Control). (Seconded to Civil Defence 16.11.50.) J. M. Burbridge. W. J. Davies. W. L. French (Inspector for Disinfection, Disinfestation, &c.). D. W. Saunders. F. E. Siddle. R. F. Stubbs. 7 Housing: C. F. Brockett (Inspector in Charge). A. G. Bates. J. W. Baxter. J. J. Coveney. J. E. Drake. Food: P. A. Lloyd. H. D. Luke. Catering Establishments: J. H. Brownlee. M. J. Flynn. Atmospheric Pollution: R. Roper. Women's Factories: Miss C. Hughesdon. Clerical Staff: J. W. Anderson. R. L. Booker. S. J. Chamberlain (to 23.4.50). C. E. Clark. A. H. Cole. A. R. Cook. P. Cox (temporary). Miss P. M. Illman. W. F. C. King. D. Levitton. G. Lyness (temporary). L. J. Nunn. J. M. Shotbolt. W. E. F. Simmons. W. H. Smith. E. A. Taylor. E. W. Tyler (from 15.5.50). B. S. Weaver. 8 Coroner's Court and Mortuary. Superintendent: A. W. Nicholls. 1st Mortician: L. M. Swanston. Morticians: C. H. Lorraine. N. J. Marchant. A. E. Mould (to 28.3.50). Miss E. S. Dunford (Nurse Attendant). Mrs. E. Williamson (Cleaner). Disinfecting Staff: N. Heathcote (Foreman). L. C. Clarke. C. J. Daniels. J. R. Doyle (Motor Driver). G. Lawrence. J. A. Lovelock. J. Shillingford. Miss H. McWilliam (State Registered Nurse). Miss I. M. Newman (Woman Attendant). Rodent Staff: Rodent Officer: J. W. Brown. H. J. Felstead (Foreman). H. Brown (from 20.3.50). D. G. Cadlock. J. Carter (to 18.3.50). A. C. Dale. J. J. Devine (from 2.10.50). A. Howell (to 1.9.50). G. Murray. F. C. Smellie. J. Vidal. H. Wise (to 31.10.50). Assistants in the Department: A. J. Jones A. Murkin Assistants to Sanitary Inspectors. J. Byworth J. W. Spooner Messengers. 9 To the Right Worshipful the Mayor, Aldermen and Councillors of the City of Westminster,. Ladies and Gentlemen. Annual Report for 1950. I beg to present my twenty-sixth Annual Report on the health and sanitary conditions of the City of Westminster. The Report is prepared in accordance with Ministry of Health Circular 112/50 in which it is stated that the information to be supplied should be on similar lines to that specified for the Annual Report for 1949. In a preamble to that report written in August, 1950, reference was made to the Jubilee of the Metropolitan Boroughs then being celebrated and the opportunity seemed appropriate to comment on the changes that had taken place in the City over the previous fifty years. For this purpose records such as the Annual Reports of my predecessor for 19001924 were consulted, followed by the results of my own observations of the past twenty-five years. The planning of the City in some areas had undergone such fundamental changes as to be unrecognisable from the City of 1900. The Kingsway and Aldwych improvement had swept away acres of decrepit properties while in the Millbank area, acres of municipal dwellings, together with lofty office buildings and privately owned flats had replaced the old cottage properties abounding in that district. The transformation is still proceeding in another district of the City. There, between Lupus Street and the river whole streets of terraced houses will be cleared to make room for the new estate of 1,621 flats to be known as Churchill Gardens. 151 of these have already been completed, and are now occupied. These terrace houses are in the main obsolescent in structure and layout. The basements in all of them are unsatisfactory for living in and the houses generally speaking are sadly lacking in essential amenities. But the whole of this 33 acre site was not occupied by dwelling houses; approximately one-third was taken up with industrial buildings most of them war damaged or otherwise dilapidated. Therefore while ultimately the families from the cleared site will be offered accommodation, there will be available new housing for a number of families already living in the City but inadequately housed or in conditions otherwise unsatisfactory. The Registrar General's mid-year estimate of population 105,100 has since to be amended for the preliminary report of the Census has been issued while this Report was being prepared. This gives a population of 98,895 (46,061 males and 52,834 females), a percentage fall of 23.7 as compared with 1931. In the neighbouring City of London the population has been halved. As has frequently been stated the predominating activities of life in this City, both business and social, are centred on its day to day nonresidential population. In 1948 a rough estimate of the non-resident population was submitted based on the number of main meals provided in catering premises in the City. No other method of measurement seems in any degree practicable, for the day population consists primarily (7095) a 3 10 of those who though living in other districts have their place of work in Westminster. There is also the considerable and fluctuating body of tourists and other visitors which, with those who come into the City for occasions such as shopping not being regarded as "non-resident citizens," should not figure in any estimate of the day population. The numbers who flock into Westminster for amusement and pleasure in the evenings or at week-ends are likewise so variable and so variously distributed that no attempt to compute them is possible. Nevertheless the Public Health service of the City has definite responsibilities towards these non-residents as it has towards the resident population. It is important that good standards should be maintained in the restaurants where these thousands of people have meals and, equally important, that the food consumed should be wholesome and of good quality. It is also a duty of the Public Health Department to ensure that conditions in places of amusement, including catering arrangements, are satisfactory as regards hygiene and sanitation. The birth rate has fallen again from 12.2 to 11.9. This corresponds to the falling birth rate throughout the country after the high peak of the first three post-war years. Infantile mortality at 35.17 is slightly higher than in 1949 (33.7). Whereas the death rate for legitimate infants had improved slightly over 1949, 33.12 per thousand as compared with 33.3. There was a higher mortality among the illegitimate, namely 52.2, compared with 36.8 in 1949. One hundred and thirty-four illegitimate infants were born in 1950, but during that year seven died. In 1949, 136 illegitimate children were born and 4 infants under one year of age died. This accounts for the rise in the illegitimate infantile mortality from 36.8 to 52,2. The general death rate at 10.16 is again lower than in the previous year (10.9). Diseases of the heart and blood vessels accounted for 344 deaths as compared with 412 in 1949. In this group 233 were persons of 65 years and over; the corresponding figure for 1949 was 279. Deaths from malignant disease were 241, last year 218, and more than half occurred in persons of 65 years and over. The tuberculosis death rate .37 per 1,000 was less than that for 1949 (.5 per 1,000). Maternal Mortality: Last year two women died from puerperal causes (the result of illegal abortion). In 1950 one woman, aged 42 years, died. The death certificate was in these terms, "uraemia, malignant hypertension following toxaemia of pregnancy in 1945." Five years seems a long time for this to be attributable to her confinement. Apart from this case there were no deaths recorded following childbirth. Measles notifications numbered 356, about half of those notified in 1949 which was a measles year. Six cases of diphtheria were notified, but of those four were re-diagnosed as tonsillitis and as regards the remaining two, a man of 60 years and a child of 5 years, there was no record of immunisation. There were no fatalities. Two hundred and forty-two confirmed cases of whooping cough were notified and one child under one year of age died. Nineteen cases of poliomyelitis were notified, but of these six were subsequently rediagnosed as not suffering from this infection. Last year there were 11 29 notifications. Of the 13 remaining confirmed cases 8 were paralytic and 5 were non-paralytic. All were removed to hospital and none died. A further 8 cases were removed to hospital as suspect poliomyelitis but were not notified. In none of these cases was information received that the diagnosis was confirmed. Gastro enteritis accounted for 71 cases. This disease is not officially notifiable, and the number of cases is generally ascertained through notices of removal to hospital or other information. There were six deaths, three of them among infants under one year of age. Food Poisoning: During the year information was received of 15 separate outbreaks of food poisoning in which the total number of persons affected was 324. Most of those were only mildly affected, and among the total only six were officially notified, three of whom were removed to hospital. There were no deaths from food poisoning. As a result of the changes imposed by the National Health Service Act, 1946, the Council's Deputy Medical Officer of Health was transferred to the Regional Hospital Board as Chest Physician. This has naturally added to the work of your Medical Officer of Health who had no deputy for more than a year. The situation has been to some extent eased by the appointment of an Assistant Medical Officer of Health in conjunction with the Borough of Holborn. Dr. P. G. Roads who is joint Assistant Medical Officer of Health to the City of Westminster and to the Borough of Holborn took up his appointment in April, 1950. He has added this note on some of the aspects of Public Health and its future, viewed generally and locally. During the era preceding 1900 the emphasis of English public health had been on the control of epidemic diseases by improvements in environmental hygiene. As a result much progress was made in the provision cf a safe water supply, paving and cleaning the streets, disposal of sewage and the prevention of nuisances In fact without the reforms advocated by sanitary science, large urban populations would have had constantly recurring epidemics. It might even have been impossible to have had such a conurbanisation as London. Without the intensive industralisation thereby made possible, the economic condition of the country would not have developed to its present position. In Westminster this tradition of sanitary reform resulted in improvements which are noted in the foreword and referred to in greater detail in last year's report. But public interest throughout the country had begun to focus on individual health for the limitations of such environmental improvements were becoming apparent. The high rejection rate of Army recruits on medical grounds during the South African war had created concern in many quarters and there were those who doubted whether public health as then understood was fulfilling its full obligation to the community. It was realised by progressive committees and individual pioneers that Public Health had responsibilities beyond those of 12 environmental hygiene and that many persons were missing the benefits which the expanding medical sciences were able to bestow. An Inter-Departmental Committee on Physical Deterioration was appointed. This Committee reported in 1904 and made recommendations from which the personal health services developed. Their value is seen in the falls in the infantile and maternal mortality rates and the attack rates of infectious disease (e.g., Diphtheria). The booklet, "The Personal Health Services of the Westminster City Council, 1903-1948," describes their evolution in Westminster. In this it can be seen how rapidly and fully the City Council met its responsibilities. Simultaneously with the development of the personal health services, the sanitary condition of the City was continuously being improved. With the advances of technology and the extension of legal safeguards the standards of the environmental health services have continued to rise. This can be seen in the comparison between the Council's first housing scheme of Regency Street and their post-war schemes of Russell House and Churchill Gardens, both in the quality and the size of the undertakings. There are many other examples, improvements in restaurant kitchens, factories, street cleanliness, dairies, bakehouses, and the great decrease in food adulteration, particularly milk. All this has not been achieved without hard and continuous work on the part of many people. Just as the benefits of earlier sanitary reform were not at first obvious, so the value of the later improvements is not always realised now. During the past quarter of a century the peoples in many lands have suffered much affliction both physical and psychological. The fever of ideological warfare and nationalist aspirations does not tend to further the promotion of public health and well being in the countries so affected. Fortunately in this country a freer atmosphere has enabled measures for improving public health to develop steadily. Social legislation has created a framework by which the economic consequences to the individual of sickness, continued incapacity, bereavement and unemployment can be mitigated. Such misfortunes have a retarding influence on public health as well as the psychological disturbance caused by the fears of war, and the associated threats of physical and moral destruction. In this country the fall in the birthrate and the very success of preventive medicine has resulted in an ageing population with a rapidly increasing proportion of old people. Meanwhile in some other countries the populations are rapidly increasing but without comparable increases in food production. This situation is ominously occurring in countries where many people already live on a starvation diet. In addition to these problems, great social changes are accompanying the economic and industrial 13 development of almost all countries. It is therefore not surprising that the ordinary man reacting to these changes shows many signs of stress and strain. Sanitary reform and improvement will continue to require much patient and unobtrusive work not only to maintain standards but to incorporate advances in knowledge and resources. Only when hygiene has removed the various causes of diseases attributable to defective environment will sanitarians come in sight of their Utopia. The personal health services will need further development not only to extend and improve its present activities, but to integrate them more closely with the other branches of the National Health Service. The promotion of health is the certain way of reducing the mounting expenditure of the Medical Services. As so often in the past, voluntary agencies are mapping out channels through the seas of human unhealthiness and unhappiness where the more ponderous galleons of governmental action may eventually sail. And now, in addition to the many voluntary societies who have traditionally charted the passage ahead, there are a number of official bodies which are slowly exploring these seas. In common with many other local authorities Westminster has lost some of its functions during the last few years. As a consequence a pessimistic view has sometimes been taken of its future as a public health authority. This view does however leave out of account certain aspects. Even without local government reform Westminster will remain a great City and fortunately possesses high traditions of municipal enterprise, a strong civic sense and the resources necessary to execute any reasonable projects. These present problems of our civilisation affect the citizens of the City in common with the rest of their countrymen. P.G.R. The City Council by the death of Lord Jessel in 1950 lost a very distinguished Alderman of great experience in local government and who always evinced a special interest in public health. The sudden death of Alderman W. Stanley Edgson likewise deprived the Council of one of its leading and most enterprising members. One has also to record with regret the death of two retired members of the staff who had played notable parts in the public health service of the City for more than forty years, namely, John Sanderson, Senior Inspector, and Alex Wheal, Superintendent of Disinfection. In conclusion I would wish to express my gratitude and appreciation of the kind consideration and help always given me by the Chairman, Councillor C. R. Purnell, and the Vice-Chairman, Lt.-Col. Norman Edwards, M.B.E., and my warm thanks to a most loyal and industrious staff. (7095) a 5 14 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,502.7 Population (Registrar General's Estimate, mid-year, 1950) 105,100 Number of inhabited houses (Census, 1931) 22,536 Rateable Value £10,839,372 Births. Live Births (registered)— Total. Males. Females. Legitimate 1,117 576 541 Illegitimate 134 70 64 1,251 646 605 Births Notified—1,246. Birth rate per 1,000 of the estimated resident population 11.9 (Rate for London, 17.8; for England and Wales, 15.8) Number of stillbirths (males, 24; females, 12) 36 Rate of stillbirths per 1,000 (live and still) births 27.9 Deaths. Net deaths (males, 554 ; females, 514) 1,068 Death-rate per 1,000 of the estimated resident population 10.16 (Rate for London, 11.8; for England and Wales, 11.6) Deaths from puerperal causes 1 (Rate per 1,000 total (live and still) births) 0.7 Deaths of infants under 1 year (males, 30 ; females, 14) 44 Death-rate of infants under 1 year— All infants per 1,000 live births 35.17 Legitimate infants per 1,000 legitimate live births 33.12 Illegitimate infants per 1,000 illegitimate live births 52.2 Rate for London for infants under 1 year 26.3 Deaths (all ages) from measles Nil ,, ,, whooping cough 1 ,, ,, gastritis, diarrhoea and enteritis 6 ,, ,, cancer 241 15 Infantile Mortality. Causes of Death. Total. Legitimate. Illegitimate. Whooping Cough 1 1 — Bronchitis 1 1 — Other diseases of Respiratory System 2 2 — Gastritis, Enteritis and Diarrhoea 3 3 — Congenital Malformations 9 7 2 *Other defined and ill-defined diseases 26 22 4 All other Accidents (other than motor vehicles) 1 1 — Homicide 1 — 1 44 37 7 *This is the Registrar-General's classification; but such conditions as prematurity, birth injuries and other fatal conditions relating to the process of birth are included under this heading. Infectious Disease. Notifications. Removed to Hospital. Deaths. Cerebro-Spinal Meningitis 4 4 — Diphtheria 2 2 — Dysentery 38 38 — Enteric Fever 3 3 — Erysipelas 8 2 — Food Poisoning 6 3 — Malaria 1 — — Measles 356 43 — Ophthalmia Neonatorum 2 2 — Paratyphoid 1 1 — Pneumonia 12 — — Poliomyelitis 13 13 — Puerperal Pyrexia 13 11 — Scabies 17 — — Scarlet Fever 75 47 — Whooping Cough 242 44 1 The above table includes correction on revision of diagnosis. (7095) a 6 16 Deaths, 1950. Causes of Death at Different Periods of Life in the City. Causes of Deaths. Years of Age. Sex All Ages. 0-1 1-5 5-15 15- 25 2545 4565 6575 75+ All Causes M. 554 30 5 3 5 46 172 146 147 F. 514 14 2 2 3 27 124 115 227 Grand Totals 1,068 44 7 5 8 73 296 261 374 Tuberculosis, Respiratory M. 30 — — — — 8 11 9 2 F. 7 — — — — 3 4 — — Tuberculosis, Other M. — — — — — — — — — F. 2 — — — — — 2 — — Syphilitic Disease M. 3 — — — — — 3 — — F. 1 — — — — — 1 — — Diphtheria M. — — — — — — — — — F. — — — — — — — — — Whooping Cough M. 1 1 — — — — — — — F. — — — — — — — — — Meningococcal Infections M. — — — — — — — — — F. — — — — — — — — — Acute Poliomyelitis M. — — — — — — — — — F. — — — — — — — — — Measles M.— — — — — — — — — — F. — — — — — —— — — — Other Infective and Parasitic Diseases M. 3 — — — — 1 1 — 1 F. — — — — — — —— — — Malignant Neoplasm, Stomach M. 17 — — — — 3 7 6 1 F. 14 — — — — 1 4 5 4 Malignant Neoplasm, Lung, Bronchus M. 27 — — — — — 17 6 4 F. 8 — — — — — 4 1 3 Malignant Neoplasm, Breast M. — — — — — — — — — F. 26 — — — — 2 13 3 8 Malignant Neoplasm, Uterus M. — — — — — —— — — — F. 12 — — — — 2 8 2 — Other Malignant and Lymphatic Neoplasms M. 77 — 1 — 1 6 22 26 21 F. 60 — 1 — — 2 22 14 21 Leukaemia, Aleukaemia M. 7 — 1 — 1 2 1 2 — F. 3 — — — * — 1 1 1 Diabetes M. 1 — — — — — — 1 — F 5 — 1 — 1 — — 2 1 17 Deaths, 1950 —continued. Causes of Death at Different Periods of Life in the City—continued. Causes of Deaths. Years of Age. Sex. All Ages. 0-1 1-5 5-15 1525 2545 4565 6575 75+ Vascular Lesions of Nervous System M. 41 — — — — 1 11 10 19 F. 58 — — — — — 9 25 24 Coronary Disease, Angina M. 92 — — — — 5 34 28 25 F. 43 — — — — — 11 12 20 Hypertension, with Heart Disease M. 16 — — — — 1 7 6 2 F. 17 — — — — — 4 1 12 Other Heart Disease M. 56 — — 1 — 1 9 11 34 F. 83 — — — — 1 9 18 55 Other Circulatory Disease M. 13 — — — — 1 3 7 2 F. 24 — — — — — 7 4 13 Influenza M. 2 — — — — — 1 — 1 F. 3 — — — — 1 — 1 1 Pneumonia M. 17 — — — — 1 3 8 5 F. 28 — — — — — 5 4 19 Bronchitis M. 25 — — — — — 7 7 11 F. 22 1 — — — — 1 2 18 Other Diseases of Respiratory System M. 9 1 — — — 1 2 2 3 F. 6 1 — — — I 2 — 2 Ulcer of Stomach and Duodenum M. 11 — — — — 1 7 2 1 F. 4 — — — — — — 3 1 Gastritis, Enteritis and Diarrhoea M. 4 3 — — — — 1 — — F. 2 — — — — — — — 2 Nephritis and Nephrosis M. 8 — — — — — 5 — 3 F. 3 — — — — — 1 — 2 Hyperplasia of Prostate M. 13 — — — — — 1 6 6 F. — — — — — — — — — Pregnancy, Childbirth, Abortion M. — — — — — — — — — F. 1 — — — — 1 — — — Congenital Malformations M. 9 6 — 1 — — 1 1 — F. 3 3 — — — — — — — Other Defined and III Defined Diseases M. 34 17 1 1 — 3 3 4 5 F. 52 9 — — 1 7 10 10 15 Motor Vehicle Accidents M. 6 — 1 — 2 — 2 1 — F. 6 — — 1 1 3 — — 1 All other Accidents M. 14 1 1 — 1 5 3 2 1 F. 11 — — 1 — — 2 5 3 Suicide M. 17 — — — — 6 10 1 — F. 10 — — — — 3 4 2 1 Homicide and Operations of War M. 1 1 — — — — — — — F. — — — — — — — — — 18 Bacteriological Examinations. Diphtheria—-Negative, 142; positive, Nil. Tuberculosis—Negative, 184; positive, 73. Tuberculosis. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1 to 5 years 5 7 1 — — — — — 5 to 15 years 5 2 4 2 — — — — 15 to 25 years 32 24 1 3 — — — — 25 to 45 years 70 40 2 1 8 3 — — 45 to 65 years 43 5 — 3 11 4 — 2 65 to 75 years 7 — — — 9 — — — 75 and over 1 1 — — 2 — — — 163 79 8 9 30 7 — 2 New Cases. Pulmonary—242 new cases, including 74 transfers and 13 non-notified deaths. Non-Pulmonary—17 new cases, including 3 transfers and 1 nonnotified death. (1949 - Pulmonary, 219 new cases; Non-Pulmonary, 16 new cases.) Deaths from Tuberculosis. Pulmonary—37 (30 males, 7 females). Non-Pulmonary—2 (2 females). Smallpox Investigations. On five separate occasions during the year, general practitioners asked the Medical Officer of Health for advice on cases which they suspected might be smallpox. Such requests are given priority and the Medical Officer of Health, or his Assistant, immediately visited the suspect. In three instances, the services of a Regional Smallpox Consultant was called for a confirmatory opinion; in two of these cases the patients were removed, as a precautionary measure, to an Isolation Hospital for observation and investigation. Fortunately, in every case, smallpox was finally excluded. On five occasions information was received that passengers, who were coming to Westminster, had been in contact with a case or suspected case of smallpox, whilst travelling by sea or by air to this country. All these contacts, in one instance numbering 60, were traced by officers of the Department, who kept in daily touch with them until the period of danger was passed. 19 Bornholm Disease. During June and July, a small outbreak occurred of Bornholm Disease (Epidemic Pleurodynia) which is not a notifiable condition. This disease was first fully described in 1932 following an outbreak on the Is land of Bornholm. The disease has an acute onset with symptoms which may simulate severe cardiac, pulmonary or abdominal disease. It fortunately has a rapid course with a low mortality and the patients are usually fully recovered within a few days. Twenty-two cases were reported amongst the patients, staff and their families of a children's hospital. The Medical Officer of Health informed the general practitioners in that area of the presence of the disease. Some further cases were reported but there was no general epidemic. International Certificates of Vaccination and Inoculation. Arrangements continued during the year for the authentication by the Medical Officer of Health of International Certificates of Vaccination and Inoculation completed by medical practitioners in Westminster. These certificates are required by passengers proceeding abroad from this country, and the purpose of the authentication 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 1,344 certificates were authenticated during the year. Care of the Aged and Infirm. There were 60 new cases brought to the notice of the Department during the year by medical practitioners, district nurses and others, on account of illness, inability to care for themselves and insanitary conditions. Altogether, 327 old people living alone have been the subject of visits by Sanitary Inspectors. There were no cases in which it was necessary to invoke the provisions of the National Assistance Act in regard to compulsory removal. Welfare of Old People. The Minister of Health in Circular 11/50 outlined suggestions for developing better collaboration between local authorities and local voluntary organisations in promoting the welfare of old people. The Minister referred to the provision under the National Assistance Act, 1948, of residential accommodation for old people by County and County Borough Councils and by voluntary organisations, but stated that the great majority of old people will continue to prefer to live ordinary lives in their own homes, and that many of them cannot do so in reasonable comfort without help and interest from outside. The Minister pointed out that the Act of 1948 encouraged the provision of this help and interest. He mentions the great value to the old people of mobile meals services and social and recreational clubs and that 20 local authorities were enabled to contribute to the funds of voluntary organisations providing these amenities. The Minister stated that further services not covered by statute can best be provided by voluntary workers, such as regular visiting of old people in their homes and helping them with their shopping, obtaining books and magazines from local libraries, with letter writing and mending, and generally in solving minor domestic difficulties. Home Visiting can mitigate the sense of isolation and loneliness, and can draw attention benefits of other voluntary and local authority services. The Minister added that all local authorities should do everything in their power to encourage further voluntary efforts to meet the needs of old people, especially those living in their own homes. In Westminster, the City Council has worked in close association with voluntary bodies catering for the welfare of its aged citizens, namely- The British Red Cross Society—Mobile Meals Service. The Westminster Division of the British Red Cross Society have for some years been operating a service for the delivery of hot mid-day meals to the homes of aged people who are themselves unable to provide hot mid-day meals. The service has hitherto been operated by two vans provided by the Society, and in order to meet the increasing demand for the service, a third van and equipment was purchased by the City Council for the Society and brought into use during the year. The City Council in addition makes a grant to the Society of 75 per cent. of the running costs of the three vans. The meals are purchased by the Society from a Londoners' Meal Service Centre at a special price of 8d. per meal. The meals consist of meat or fish and two. vegetables, and a sweet. The cost of the meal is recovered by the British Red Cross Society from the recipients at the time of delivery. Some 7,243 hot meals were delivered by the Society during the year, and the service is much appreciated by the old people. The Westminster Old People's Welfare Association. This voluntary association formed in 1948 receives an annual grant from the City Council and is provided with office accommodation in the Public Health Department . During the year the number of Darby and Joan Clubs throughout the City increased from 7 to 8. Apart from the recreational facilities provided at these Clubs, the old people are provided with light refreshments, summer outings and Christmas parties organised by the Association which has also successfully organised holidays at seaside resorts for the aged during out-of-season periods, while the regular home visiting by the members of the Association has brought a measure of comfort to the lonely. The Association also started a weekly foot clinic for the elderly, and for those unable to attend the clinic, treatment at their own homes is arranged. 21 The City Librarian conducts a mobile library service for the benefit of the aged and the increasing use made of this service is the measure of its success. Medical Inspection of Aliens. By agreement with the Minister of Health, the City Council continued during the year the arrangements for the medical inspection of aliens arriving at Victoria Station by through sleeping car service from Paris. The inspection is carried out by the Assistant Medical Officer of Health and by the medical staff from Westminster Hospital. This necessitates daily attendance at Victoria Station to inspect aliens arriving by the ferry train and to carry out medical examinations where necessary. The Government reimburse the Council the cost of this service. During 1950, 10,511 aliens were inspected, 29 were medically examined. 22 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. Summary of Inspections of all Types of Premises. Primary. Reinspection. Dwellings 4,665 8,934 Factories, workplaces and shops (other than food), &c 2,293 3,501 Catering establishments and food premises 2,115 3,172 9,073 15,607 • Number of Visits. Sampling of food 594 Inspection of food 1,090 Smoke 1,374 Noise 67 Rat and mice repression 3,873 6,998 Drainage plans submitted 623 Combined Drainage Orders made 69 23 Summary of Notices Served. Dwellings. Factories, . Workplaces, &c. Food. Catering. Tota's. Public Health (London) Act, 1936 482 86 9 114 691 Food & Drags Act, 1938 — — 25 191 216 Factories Act, 1937 — 67 — — 67 London County Council (Drainage) By-laws, 1934 9 11 1 5 26 London County Council (Watercloset) By-laws, 1930 6 6 2 2 16 Shops Act, 1934 — 2 3 2 7 London County Council Houses let in Lodgings By-laws, 1938 4 — — — 4 501 172 40 314 1,027 Total Notices served under the above Acts 1,027 Statutory Notices 77 Dwelling Houses. Primary. Re-inspection. Analysis of Inspections— Complaint 1,560 794 House to house 426 360 Routine 294 251 Infectious disease 379 72 Underground rooms 294 707 Other parts 12 5 Housing applications 489 387 Building licences and permits 121 211 Drainage—voluntary 454 1,779 Drainage under notice — 87 Sanitary defects—voluntary — 53 Sanitary defects under notice 10 2,858 Aged and infirm 93 241 Common Lodging Houses 14 41 Other reasons 519 1,088 4,665 8,934 Included in the above totals— Requisitioned properties 94 98 Houses let in lodgings 720 3,469 24 Notices served. Public Health (London) Act, 1936 482 London County Council (Drainage) Bylaws, 1934 9 London County Council (Watercloset) Bylaws, 1930 6 London County Council Houses let in Lodgings Bylaws, 1938 4 • 501 Statutory notices 71 Defects found. Defective, dirty internally 243 Damp 154 Inadequate underfloor ventilation 10 Defective drainage 102 „ roofs 102 „ area paving, &c. 20 ,, exteriors 23 Waterclosets—insufficient ventilation and light 11 „ defective 97 Water supply insufficient 3 „ absence of in upper floors 3 „ cisterns dirty, uncovered 4 Absence of food storage accommodation 2 Staircase lighting, tenements 4 Ventilation 2 Smells 41 Rubbish 47 Other nuisances 1 Overcrowding (Housing Act, 1936, Section IV). Cases coming to the notice of the Public Health Department during the year 124 Cases in which overcrowded families have been rehoused during 1950. Westminster City Council, 5; London County Council, 42 47 Water supply in tenement houses. Under the powers of the Public Health (London) Act, 1936, 14 additional water supplies were provided to working class tenement houses during the year. Housing Acts, 1936 to 1949. A.—Individual Houses Unfit for Human Habitation. Number of houses represented for demolition Nil Number of Demolition Orders made Nil 25 B.—Parts of Buildings Unfit for Human Habitation. (a) Number of underground rooms represented for closure 34 (97 rooms) Number of Closing Orders made in respect of underground rooms 32 (91 rooms) (b) Number of other parts of buildings represented for closure 1 (3 rooms) Number of Closing Orders made in respect of other parts of buildings 1 (3 rooms) (c) Number of specifications submitted and approved 9 (d) Number of Closing Orders determined in respect of underground rooms 10 (28 rooms) Number of Closing Orders determined in respect of other parts of buildings 1 (1 room) (e) Number of applications made for modification of Closing Orders to permit approved use 30 (68 rooms) Number of applications approved 26 (61 rooms) C.—Informal Action in respect of Paris of Buildings Unfit for Human Habitation. Number of instances of informal action taken to secure requirements of the Housing Act and Regulations made thereunder:— (a) in respect of underground rooms 61 (b) in respect of other parts of buildings 3 Number of instances of such informal action taken included in (a) and (b) above:— (a) as a result of applications for Building Licences 32 (6) on the initiative of the owner 21 (c) at the suggestion of the Medical Officer of Health 11 D.—Contraventions of Closing Orders. Number of contraventions of Closing Orders reported Nil Number of legal proceedings instituted Nil Public Health (London) Act, 1936. A.—Illegal Separate Occupation of Underground Rooms. Number of instances of formal action taken to secure compliance with Section 132 Nil Number of instances of informal action taken to secure compliance with Section 132 40 26 House to House Inspection. During the year 432 properties, involving 508 dwellings, were inspected. Of these properties 225 were residential, 85 part residential, 116 business premises and 6 bombed, derelict, &c , buildings. Inspections. Primary inspections 424 Re-inspections 3,025 Notices served. Public Health (London) Act, 1936 161 London County Council (Drainage) Bylaws, 1934 1 Defects found. Defective roofs 21 Dampness 56 Dirty, defective, dilapidated internally 145 Defective drainage 21 Verminous 1 Insufficient water supply 8 Families overcrowded 8 Factories, Workplaces, Shops and Other Premises (other than Food Premises). Summary of Inspections. Primary. Re-inspections. Factories—Power 541 362 Factories—Non-power 308 460 Workplaces, &c 1,202 2,397 Shops (other than food) 242 282 2,293 3,501 Analysis of Inspection. Complaint 311 151 Routine 1,013 425 Infectious disease 146 10 Building licences and permits 21 2 Drainage—voluntary 452 2,173 Drainage—under notice — 1 Sanitary defects under notice — 502 Outworkers 44 171 Other reasons 306 66 2,293 3,501 27 Types of premises inspected. Laundries 78 Boot and shoe trades 27 Carpentry 16 Woodworkers (various) 8 Cigar and cigarette manufacturers 5 Dress and milliners 392 Furriers 98 Shirt makers 18 Hairdressers 60 Garages 27 Dry cleaners 10 Metalworkers (excluding gold and silver) 5 Printers and publishers 75 Packers 12 Cinemas, concert halls 32 Shops (other than food) 524 Dance halls 11 Leather goods 13 Cabinet makers 7 Upholstery and carpets 7 Corset makers 6 Embroiderers 15 Lingerie 17 Tailors 614 Film renters, &c 8 Warehouses 48 Jewellers and silversmiths 31 Opticians 4 Photographers 80 Florists, &c 5 Offices 1,980 Theatres and music halls 92 Stables and mews 15 Hat and cap makers 9 Motor tyres and rubberworks 1 Surgical goods 4 Various 1,140 Outworkers. Inspections 372 Number of outworkers (includes workers living in areas outside the City) 3,515 Notices—Summary. Intimation. Statutory. Factories—Power 53 — Factories—Non-power 66 — Workplaces, shops (other than food) 53 1 172 1 28 Abstracts. Reports were made to the Factory Inspector of 121 instances for failure to display the appropriate abstracts of the Factories Act, 1937. Notices—Analysis. Factories. Power. Factories. Non-Power Workplaces. Shops &c. Public Health (London) Act, 1936 21 24 41 Factories Act, 1937 28 39 — London County Council (Drainage) Bylaws, 1934 2 2 7 London County Council (Watercloset) Bylaws, 1930 2 1 3 Shops Act, 1934 — — 2 53 66 53 Total 172 Defects found. Factories. Power. Factories. Non-Power Workplaces, . Shops, &c. Dirty, defective internally 11 36 37 Dampness — 1 2 Drainage defective 4 12 27 Roofs, defective — 3 1 Sanitary accommodation insufficient 3 3 5 Sanitary accommodation, insufficient ventilation and light 22 15 7 Sanitary accommodation defective 29 30 16 Sanitary accommodation, direct approach 11 6 — Sanitary accommodation not separate for sexes 14 3 1 Sanitary accommodation unsuitable 2 No indicating notices on doors of waterclosets 26 14 — Overcrowding — 1 — Smells — — 2 Rubbish 2 13 105 Ventilation, want of — 13 11 Failure to fix abstracts 73 48 — Water supply insufficient 1 1 1 Absence of washing accommodation — 2 1 Temperature — 1 — 29 Common Lodging Houses. There are three common lodging houses in the City, two for men and one for women. Fifty-five visits were made during the year, and conditions were reported satisfactory. Catering Establishments and Other Food Premises. Summary of Inspections. Primary. Re-inspections. Catering establishments 1,468 2,690 Food shops and other food premises 647 482 2,115 3,172 Analysis of Inspections. Primary. Re-inspections. Complaint 334 167 Routine 1,310 237 Infectious disease 47 14 Building licences and permits 27 5 Drainage—voluntary 172 489 Drainage—under notice — 52 Sanitary defects—voluntary —— 1 Sanitary defects—under notice 4 1,723 Food licences 1 — Catering licences 212 473 Other reasons 8 11 2,115 3,172 Summary of Notices Served. Food Shops and other food premise Catering establishments. Food and Drugs Act, 1938 25 191 Shops Act, 1934 3 2 Public Health (London) Act, 1936 9 114 London County Council (Drainage) Bylaws, 1934 1 5 London County Council (Watercloset Bylaws, 1930 2 2 40 314 Catering Establishments. During the year, two Inspectors continued to devote all their time to the supervision of catering establishments, licensed premises and bakehouses. Both the amount and the complexity of the work involved 30 in this section of public health administration has had the effect of reducing the number of regular routine visits to restaurants. This rather regrettable circumstance is due to a variety of causes, some of which are outlined below:— (а) The continuous flow of applications for new catering licences, which must necessarily receive prior consideration. The gradual transformation of Mayfair into a business area has resulted in the construction of many new staff canteens where, in every instance, the inspectors of the department have been called to give advice on the best practicable layout, design and construction. Examples of different problems put to them especially in the smaller canteens, include the technical details of the installation of considerable mechanical ventilation plant, and the efficient arrangements for the supply of adequate running hot water. (b) Owing to a change in the law, the old type "bottle party" has developed into the "members' club," where in order to comply with the new statute meals must be provided, and this in turn requires a catering licence. This evolution has, fortunately, been the cause of comprehensive improvements in these premises; particularly encouraging results have been, in every case, the provision of efficient kitchen arrangements. (c) As many of the alterations and improvements required in existing restaurants have proved to be very costly (in some cases exceeding £20,000), the work involved has often extended over a period of ten to twelve months. The nature and extent of the work has inevitably limited the number of premises with which it has been possible to deal. In some other instances the standard of workmanship has not been quite satisfactory, and has proved to have been a retarding factor in securing speedy compliance with notices. In several instances work has had to be repeated and restaurant proprietors have had occasion to take action in the County, and even the High Court, mainly because of duplicated costs. This is mentioned because the sanitary inspector dealing with the work is invariably sub-poenaed to give evidence, and many hours of his time are spent waiting for the cases to be heard. (d) The proprietors of now restaurants encounter many difficulties in obtaining building licences for work specified by the inspector before the restaurant is opened for business. The Regional Food Office, though fully appreciative of the need for the licence, cannot always, because of national financial restrictions imposed on them, endorse the full extent of the proposed work. In consequence, sometimes "make-shift" 31 arrangements have had to be made by reducing the amount of work originally required. This no doubt has been unavoidable under present supply conditions, but it is unfortunate because the high standard originally striven for has not always been attained. The Ministry of Works, so far as it concerns that department, have also been co-operative in issuing building licences for work considered essential in catering establishments. Again, occasional lengthy delays, involving considerable correspondence, have occurred before the Ministry were satisfied that the case for "essentiality" had been made out for the issue of a licence in any given ca3e. It will be seen, therefore, that the combined effect of those various factors (most of which are inevitable at the present time) has been markedly to interfere with routine inspection of catering establishments, and has to some extent retarded the degree of improvement which could reasonably have been effected had circumstances been more propitious. On the whole, the Catering Trade has been very co-operative, as is shown by the fact that during the year under review it was not necessary to institute legal proceedings in a single case. Whenever attention has been drawn to unsatisfactory conditions there has been a genuine desire and attempt to meet the criticisms made, and one is glad to record that in some instances, caterers themselves have taken the initiative in effecting very desirable improvements in unsatisfactory conditions. The difficulties of the trade are fully realised, particularly in regard to the frequently changing and untrained staffs carrying out certain kitchen duties. The inspectors, during their visits, have noted in some cases, staff engaged on washing-up operations, unable to read the indicating thermometer attached to the washing-up machine. Nevertheless, it is felt that there is a greater interest, perception and growing appreciation of the importance of hygiene by the higher executive staff, resulting in the regular inspection of kitchens and staff quarters by responsible personnel of the management staff. If this practice were more widely adopted the beneficial results would be obvious. Another difficulty which affects some of the smaller establishments is the incidence of heavy purchase tax for such essential equipment as refrigerators, water heaters, &c. This acts as a discouragement to those willing and anxious to comply with the requirements of the Food and Drugs Act. Whilst further improvements are still necessary and desirable in many establishments, supervision of conditions under which food is prepared and stored must continue to exercise the active attention of your inspectors. But it should nevertheless be borne in mind that the number of cases of food poisoning which have been notified during the year is infinitesimal in relation to the number of meals served in the City each day. 32 Food Shops and Other Food Premises (other than Catering Establishments). Primary. Re-inspections. Bakehouses 40 78 Dairies and milkshops 227 55 Fried fish shops 3 7 Ice cream premises—Sale 40 23 Ice cream premises—Manufacture 31 25 Meat shops 37 29 Other meat shops (preserved food, &c.) 4 3 Stalls 28 32 Confectioners 28 12 Fruit and greengrocery 20 17 Provision shops 60 118 Other food premises 111 74 Fish and poultry 18 9 647 482 Included in the above totals are visits in connection with the sale of horseflesh and inquiries into food poisoning outbreaks. Other Food Premises. Under this heading are included:— (1) Off-licences. (2) Food factories. (3) Bonded warehouses. (4) Chemists' shops. (5) Visits made in connection with applications for entry on the List of Persons entitled to sell poisons included in Part II of the Poisons List. (6) Visits to various offices in connection with inquiries regarding adulterated samples. Basement Bakehouses. There now remain only nine underground bakehouses in respect of which Certificates of Suitability have been renewed. Of the nineteen reviewed, at the end of the quinquennium, ten had been closed. 33 Visits for the Purpose of Obtaining Samples and Inspecting Foodstuffs. Sampling. Inspection of Food. Bakehouses — 2 Dairies and milkshops 211 18 Ice cream premises—Sale 36 5 Ice cream premises—Manufacture 13 2 Meat shops 6 134 Other meat shops — 1 Confectioners 7 7 Fruit and greengrocery 15 198 Provision shops 173 449 Other food premises 57 94 Staff canteens 4 26 Hotels, restaurants, clubs 8 79 Cafes, teashops, &c. 1 17 Public houses 62 5 Fish and poultry 1 53 594 1,090 34 Food Shops and Other Food Premises. Notices served. Food and Drugs Act, 1938 25 Shops Act, 1934 3 Public Health (London) Act, 1936 9 London County Council (Drainage) Byelaws, 1934 1 London County Council (Watercloset) Bylaws, 1930 2 Defects found. 40 Dirty and dilapidated internally 5 Defective internally 2 „ externally 1 ,, drainage 3 ,, floors 3 Preparation tables and equipment—worn and insanitary 1 Food storage accommodation inadequate, unsuitable, &c. 2 Ventilation insufficient 2 Washing facilities for staff, insufficient, unsuitable 5 Rubbish, fuel and other extraneous materials in food preparation rooms 1 Waterclosets, insufficient 3 ,, insufficient ventilation and light 2 „ defective 1 ,, direct approach 2 Catering Establishments. Analysis of Inspections. Primary. Re-inspections. Hotels, restaurants, clubs 1,029 1,597 Cafes, teashops, &c. 284 664 Staff canteens 93 109 Public houses 62 320 1,468 2,690 Notices served. Public Health (London) Act, 1936 114 Food & Drugs Act, 1938 191 Shops Act, 1934 2 London County Council (Drainage) Bylaws, 1934 5 London County Council (Watercloset) Bylaws, 1930 2 314 35 Defects found. Dirty and dilapidated internally 154 Defective internally 80 „ externally 26 ,, drainage 45 „ area paving 10 „ floors 56 Preparation tables and equipment, worn and insanitary 69 Food storage, inadequate, unsuitable 42 Vegetable preparation and washing up facilities— Worn and insanitary 69 Insufficient 34 Ventilation insufficient 76 Staff washing facilities, insufficient, unsuitable 48 Staff changing rooms, insufficient, unsuitable 16 Fuel, rubbish and other extraneous materials in food preparation rooms 26 Accommodation unsuitable (re-designing and re-siting of equipment necessary), &c. 12 Vermin— Cockroaches 8 Rats 14 Fuel storage accommodation insufficient 1 Waterclosets— Insufficient 17 Insufficient ventilation and light 30 Defective 31 Dirty and dilapidated 33 Direct approach 9 Not separate for the sexes 6 Unsuitable 4 Dampness 10 Water supply inadequate 2 Lighting 3 36 Samples Purchased under the Food and Drugs Act, 1938, Showing Results of Analysis for the Year 1950. Articles of Food. Number of Samples Purchased. Adulterated. Genuine. Bacon 5 1 4 Baking powder 11 — 11 Butter 15 — 15 Cake and pudding mixture 69 8 61 Cereals 42 6 36 Cheese 11 — 11 Cocoa 1 — 1 Coffee preparations and essences 17 — 17 Condiments and spices 17 1 16 Confectionery 80 9 71 Cooking fat 9 — 9. Culinary flavours 52 — 52 Dried fruit 5 — 5 Drugs 28 — 28 Fish preparations 92 11 81 Fruit (canned and preserved) 36 5 31 Gelatine 14 2 12 Jams and preserves 61 1 60 Margarine 10 — 10 Milk 632 4 628 Milk, condensed and evaporated 33 — 33 Milk, dried 1 — 1 Pickles and sauces 45 1 44 Meat and meat preparations 55 2 53 Salad oils and dressings 24 6 18 Sandwich spread 1 — 1 Sausages 20 3 17 Soft drinks, cordials, &c. 34 2 32 Soup 32 1 31 Spirits 187 2 185 Suet 3 — 3 Sugar 2 — 2 Tea 9 — 9 Vegetables 55 3 52 Vinegar 24 4 20 Wines 6 2 4 Ice cream 62 — 62 Totals 1,800 74 1,726 37 Registration of Premises used in Connection with the Manufacture, Sale or Storage of Ice Cream. On 1st January, 1950, 151 premises were registered for the sale and storage of ice cream. During the course of the year applications were received in respect of 22 further premises and these were duly registered, making a total of 173 registered premises at the end of the year. At the commencement of the year 12 premises were registered for the manufacture of ice cream. There were no further registrations during the course of the year. Ice Cream (Heat Treatment, etc.) Regulations, 1947. During the year 82 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 51 Grade 2 7 Grade 3 20 Grade 4 4 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. Milk and Dairies Regulations, 1949. At the 31st December, 1950, the following were entered in the City Council's Registers of Dairies and Distributors of Milk:— Premises used as dairies 59 Distributors of milk (premises in Westminster) 51 Distributors of milk (premises outside Westminster) 21 Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. Milk (Special Designation) (Raw Milk) Regulations, 1949. The following are particulars of licences granted during 1950 to dealers in respect of the sale of milk under prescribed or special designations:— Principal. Licence. Supplementary. Licence. Tuberculin tested 20 14 Pasteurised 100 20 Sterilised 76 20 38 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 167. During the year 14 persons had been removed from the List, because they were no longer in business or had moved out of the City, and 11 new applicants 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 1950:— Articles. Amount Amount Tons. Cwt. Lb. Tons. . Ct vt. Lb. Tons . Cwt . Lb. Destroyed. Salvaged. Total. Canned food 16 10 66 1 8 29 17 18 95 Meat 1 3 59½ — 5 103 1 9 50½ Fats — — 60½ — 1 41 — 1 101½ Fish 1 19 40 — — — 1 19 40 Fruit and vegetables 329 16 96 — — 30 329 17 14 Cereals — 4 67 — 12 69 — 17 24 Confectionery — 6 26½ — 6 35 — 12 61½ Miscellaneous 2 0 58 — 6 4 2 6 62 Total 352 2 25½ 3 0 87 355 3 0½ Food Poisoning. During the year 15 incidents of food poisoning occurred in the City. In 9 of the outbreaks only one or two people were affected, but nevertheless thorough investigations as to the cause were made in each. The other 6 outbreaks affected larger numbers of people, and the following details are given in regard to these particular incidents. Unfortunately, delay often occurs before any notification is received. During this interval, any remainder of the meal is usually thrown away and the patient becomes well again, so that no specimens of vomit and other discharges can be obtained. Here are notes of six outbreaks which indicate some of the difficulties encountered in trying to trace the causes of food poisoning. (1) This outbreak involved some 95 people who had partaken of lunch in a staff canteen in the City. The suspected food was the meat pudding prepared at the canteen the evening before. A specimen of this meat was recovered and submitted for bacteriological examination. Fifteen stool specimens were submitted from various persons, but these were only obtained after the persons concerned had recovered from the illness. Four members of the kitchen staff were swabbed in an effort to isolate the possible cause. In all cases the specimens failed to show 39 the cause. The illness was of very short duration and occurring as it had, just before the week-end, it was not possible to obtain vomit and stool specimens from patients during their illness. (2) An outbreak occurred at a residential hostel and restaurant where 15 residents, two members of the hostel staff and one member of the kitchen staff were affected. The organisms responsible for this outbreak of food poisoning could not be isolated despite the fact that 28 stool specimens were submitted to the bacteriologist. It was not therefore possible to determine the immediate cause of this outbreak. Examination of the kitchen staff revealed that two food handlers w'th lesions on their hands were infected with proteus vulgaris and staphylococcus pyogenes respectively. Both were employed as general kitchen hands and, as a precautionary measure, were referred for treatment. Suggestions were made for many improvements in kitchen management and there has since been no recurrence. (3) An outbreak occurred in a public restaurant where 16 members of the staff and 9 customers were known to be affected. No food remained from the suspected meal. Seventeen specimens of urine and 18 of faeces from persons affected were examined but no causative organism was isolated. Only in one case were the symptoms very severe, and that case was notified as dysentery, and removed to hospital. The diagnosis was subsequently amended to that of non-specific enteritis. Attention was called to unsatisfactory conditions in the kitchen, and no further outbreak has occurred. (4) A series of small outbreaks affecting in all 21 people occurred at an hotel. The information was collected as opportunity presented, and it is summarised here under three headings relating to the patients, the food, the kitchens and the staff of food handlers. The investigations of each outbreak were inconclusive individually ; but in March, 1951, another outbreak occurred when nine persons were affected. The information derived from this outbreak, taken in conjunction with the shreds of evidence from the previous outbreaks, enabled the cause to be identified with reasonable certainty. Most of the patients had severe vomiting and diarrhoea; but they recovered quickly, usually within 12 hours. The recovery was so rapid that on only very few occasions was a specimen of vomit obtained and from one of these a staphylococcus of a recognised enterotoxogenic phage type was isolated. Sauces, either hollandaise or mushroom, were suspected both because they were consumed by all affected persons and because they were a very suitable medium for staphylococcal growth. Such of the suspected foods as remained were examined bacteriologically. A staphylococcus was isolated on two occasions from sauces and identified as belonging to the same phage type. The kitchens are large and have recently been renovated and are kept in a good state of general cleanliness. Fifteen chefs are employed and these were swabbed for bacterial cultures. The investigations of these food handlers, simultaneously conducted, yielded these results. 40 Several as might be anticipated, carried staphylococci and this group included the two sauce chefs. None of the staphylococci carried by the ordinary chefs belonged to the enterotoxogenic phage types, and the staphylococci from one of the sauce chefs were found to be of an indefinite phage type. The other sauce chef was found on two occasions to be carrying the same phage type as was found in the sauces or vomit. On the first occasion he had a septic finger. This man was kept off food handling until he had recovered and until three subsequent examinations failed to show staphylococci. The second occasion followed an outbreak in March, 1951, and is included to complete the story. The same chef was taken off food handling and referred to hospital and bacteriological laboratory for clearance of his staphylococci by antibiotics and chemotherapy and for simultaneous bacteriological control of this treatment. This was done with the concurrence of his own general medical practitioner who had throughout given the most helpful co-operation. At the time of writing this report the man is apparently clear of enterotoxogenic staphylococci. As noted in the Catering Trade Working Party Report, carriers of the food poisoning staphylococcus are not covered by any present regulations. In this case, the hotel management and the chef concerned co-operated in all the many tests and precautions. If, however, such co-operation had not been forthcoming, it would have been difficult to reach a satisfactory solution. (5) At a large Government department canteen 96 people were affected by food poisoning following the mid-day meal. Approximately 180 lunches were served in the canteen, but only 96 consumers were traced, and the only article of food on the menu which had been eaten by all the sufferers was a meat pudding. None of the meat pudding was left, but some of the meat and pastry was recovered from the waste bin. This was submitted to the bacteriologist but the result of his examination did not reveal the presence of any causative organisms. All the food handlers in the canteen were swabbed and stool specimens were taken with a view to finding a possible carrier. The results, however, were negative. It was therefore not possible to establish the actual cause of this outbreak. The history of the outbreak and the clinical cause of the attack in this instance suggested the presence in the boiled meat of a bacterial toxin at the time of consumption. Advice was given for the proper storage of boiled meat for future consumption. (6) Approximately 60 members of the staff of a large commercial undertaking suffered from an attack of diarrhoea after eating a meal consisting of beef steak and mushroom pie. The pie was made at the canteen from fresh meat and mushrooms. On investigation the following day nothing of the original pie remained but two samples were taken from another pie which had been made from the same consignment of meat. The bacteriologist reported that the two specimens submitted were bacteriologically satisfactory. With no further material available the cause of this outbreak remained undetected. 41 Rats and Mice Repression. Complaints received 1,316 Visits made 10,662 Inspections by the Rodent Officer 3,873 Inspections by the Sanitary Inspectors 150 Notices served to 31st March, 1950 93 Notices served from 31st March to 31st December, 1950 1 Undertakings received from 31st March to December, 1950 279 Rodents destroyed. Black rats 5,302 Brown rats 924 Mice 7,463 13,689 Pigeons. Under the provisions of Section 121 of the Public Health (London) Act, 1936, the City Council as a Sanitary Authority is empowered for the purpose of abating or mitigating any nuisance, annoyance or damage caused by the congregation of pigeons in the City, having no owner, or for preventing or minimising any such nuisance, annoyance or damage to reduce the number of such pigeons. The following action was taken during the year in this connection:— Premises visited 23 Visits made 221 Pigeons destroyed 639 Noise Nuisances. Complaints were received in respect of 36 nuisances arising from very varied causes. 67 investigations were made and the co-operation of the persons concerned in all cases was obtained and the nuisances abated. 42 Atmospheric Pollution. Investigation of atmospheric pollution in the City was continued throughout the year at the Pimlico and Mayfair Stations, and an additional deposit gauge was installed in the Charing Cross district at Alhambra House. The following tables give the results of the monthly analysis of the impurities collected in the deposit gauges. Analyses of Deposited Impurities (tons per square mile). 1950. Mayfair. Pimlico. Charing Cross. Total Solids. Sulphates. Total Solids. Sulphates. Total Solids. Sulphates. January 24.64 3.03 34.07 3.82 - - February 24.07 2.62 30.12 3.90 - - March 19.84 1.84 19.38 1.75 - - April 35.47 2.80 31.16 3.22 - - May 22.40 2.44 19.46 2.49 - - June 14.90 1.70 22.34 2.77 21.56 2.16 July 17.56 2.37 21.95 3.40 - - August 16.47 1.50 22.34 1.79 20.00 1.81 September 14.87 1.74 21.97 2.05 21.67 2.44 October 19.30 2.21 20.80 2.60 22.47 2.69 November 46.51 5.45 45.72 5.59 55.03 5.74 December 20.94 2.15 28.16 2.74 40.59 3.22 Estimation of Sulphur Activity by the Lead Peroxide Method. The lead peroxide cylinders for the estimation of sulphur activity are sited at Farm Street Depot, Mayfair, Bessborough Street Clinic, Pimlico and Alhambra House, Charing Cross Road. The following tables indicate the daily absorption of sulphur clue to active sulphurous gases in the atmosphere. 43 Sulphur Dioxide in Milligrammes per 100 sq. cms. per day. Mayfair. Pimlico. Charing Cross. 1950. January 3.55 3.62 3.17 February 3.15 3.63 2.90 March 2.57 2.46 2.62 April 1.97 2.28 2.42 May 1.68 1.98 2.01 June 1.66 1.30 1.79 July 1.09 1.62 1.59 August 1.28 1.54 1.46 September 1.40 1.74 2.07 October 2.62 3.46 3.12 November 4.12 4.81 4.82 December 3.54 4.83 4.78 Owens Automatic Smoke Recorder. An hourly record of suspended impurities in the air was continued by the Owens Method at the laboratory, Monck Street. Estimation of Sulphur Dioxide by the Hydrogen Peroxide Method. An estimation of sulphur gases in the atmosphere was made on alternative days, at the laboratory, Monck Street. Smoke Abatement. Observations were continued throughout the year, and the following table summarises the action taken in mitigation of smoke nuisances:— Complaints 85 Observations 1,374 Notices issued 37 Legal Proceedings. Prosecutions instituted 40 Convictions 30 Cases dismissed on plea of guilty and payment of costs by defendant 3 Cases withdrawn on plea of guilty by consent 2 Cases withdrawn 3 Cases dismissed 2 44 Analysis of Legal Proceedings. Fines. Costs. £ s. d. £ s. d. Dwellings. Public Health (London) Act, 1936. Failure to comply with an Abatement Order— One conviction 35 0 0 15 15 0 Failure to abate a nuisance— Six convictions 20 0 0 17 13 0 Catering. Food and Drugs Act, 1938. Failing to take precautions against the contamination of food One conviction 8 0 0 2 0 0 Selling food intended for, but unfit for, human consumption One conviction Food. Food and Drugs Act, 1938. Selling milk deficient in fat- One conviction 10 0 0 15 15 0 Merchandise Marks Act, 1887. Defence (Sale of Food) Regulations, 1943. Labelling of Food Order, 1946. Applying a false description and label to wine. Plea of guilty entered, but defendant discharged absolutely on three summons on payment of costs, under provisions of Criminal Justice Act, 1948 - 31 0 0 Twelve convictions 1,200 0 0 42 0 0 Three cases withdrawn. Defence (Sale of Food) Regulations, 1943. Labelling of Food Order, 1946. Applying a false label to wine. Two summonses withdrawn on plea of guilty by consent. Food and Drugs Act, 1938. Selling ice cream from a container without having name and address of vendor legibly and conspicuously displayed thereon. Eight convictions 11 10 0 4 13 0 Two summonses dismissed. £1,284 10 0 £128 16 0 45 Water. Water for drinking and commercial purposes is supplied by the Metropolitan Water Board, and has proved throughout the year to be satisfactory in quality and quantity. Six complaints of contaminated drinking water were received, and all concerned the presence of algae or other foreign matter in the storage cisterns. In all cases the tanks were cleansed. The resident population (enumerated in 1951 at 98,895) in 22,695 houses receive water from the Metropolitan Water Board's mains or from deep wells. Ninety deep wells were in use at 31st December, 1950, and 90 bacteriological and 26 chemical reports of analysis were received on supplies drawn from these sources. Only one such report indicated an unsatisfactory supply bacteriologically. Chlorinating equipment is being installed at the premises concerned. Seven bores were sealed off owing to the supplies being insufficient, and their pumping machinery removed during the year. One new bore was sunk, this being at premises maintaining a 24-hour national service. There were already two wells at these premises just maintaining the necessary supplies. This third installation, which has been sunk to a total depth of 560 feet, has a standing water level of 239 feet although this level drops to 321 feet during pumping operations. This enables essential maintenance work on pumping equipment being undertaken without diminution of supply. In all but 3 of these 90 deep wells, 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. Disinfection and Disinfestation. Rooms. Articles. Articles Destroyed. Articles Washed. Vehicles. Books. Disinfection 524 13,445 1,064 — 34 493 Disinfestation 1,212 4,018 1,977 — 5 — Laundry towels — — — 6,860 — — 1,736 17,463 3,041 6,860 39 493 Treatments. Men. Women. Children (under school age). Children (School). Articles. Scabies 46 33 22 81 2,667 Head lice — 18 9 356 399 Body lice 326 41 — — 6,696 372 92 31 437 9,762 46 Burial or Cremation of the Dead. Under the provisions of Section 50 of the National Assistance Act, 1948, it is the duty of the City Council as a Sanitary Authority to cause to be buried or cremated the body of any person who has died or is found dead in the area, where no other arrangements have been made for the disposal of the body. The Council is empowered to recover the cost of burial from the estate of the deceased, and as from the 5th July, 1949, is eligible to receive payments in respect of the cost of such burial from death grants payable under the provisions of the National Insurance Act, 1946. Some 70 per cent. of the cost of all burials carried out during the year has been recovered from these sources. Where persons without known relatives die in the City, it is frequently necessary not only to arrange for their burial, but to dispose of the contents of their homes. This course is necessary to enable the proceeds to be applied towards the cost of burial and also to avoid rent accruing and to release the accommodation for housing purposes as early as possible. During the year 36 burials were undertaken by the City Council in its cemetery at Hanwell, the requests for such burials being received from the following sources:— H.M. Coroner's Officer 22 Relatives of the deceased 7 Hospitals in the City 7 36 Coroner's Court and Mortuary. In all 317 bodies were received in the Mortuary on Coroner's Warrants by Police or Undertakers. There were 4 bodies admitted to await burial. 47 Number of Cases. Inquest cases 89 Non-inquest cases 228 Post mortem examinations held 290 Causes of death in the foregoing were as under:— Accidental drowning 2 Found drowned 7 Suicide by drowning 4 „ by other means 25 Accidents— Street 15 Domestic 12 Others 13 Natural causes 229 Misadventure 2 Murder Nil Miscellaneous cases 8