AC 4344 WES 62 City of Westminster. REPORT OF THE MEDICAL OFFICER OF HEALTH FOB THE YEAR 1952 ANDREW J. SHENNIE, O.B.E., M.D., D.P.H., (LOND.). Medical Officer of Health. LONDON: harrison and sons, ltd., printers to the late king george vi, st. martin's lane, w .c.2. City of Westminster. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1952 ANDREW J. SHINNIE, O.B.E., M.D., D.P.H., (LOND.). Medical Officer of Health. LONDON: harrison and sons, ltd., printers to the late king george vi, st. martin's lane, w.c.2. CONTENTS. Page Abstracts—Factories Act 28 Aged and Infirm—care of 20 Area of the City 14 Atmospheric Pollution 41 Bacteriological Examinations 20 Births 14 British Red Cross Society 21 Burial or Cremation of the Dead 45 Bylaws for Food Protection 32 Catering Establishments 29 Civil Defence 47 Clean Pood Campaign 45 Cleansing of Persons 45 Closing Orders 25 Common Lodging Houses 25 Coroner's Court and Mortuary 46 Deaths 14, 18 Disinfection and Disinfestation 45 Drainage 38 Dwelling Houses 23 Factories, Workplaces, Shops and other Premises 26 „ Defects and Nuisances 27 Food, Inspection and Supervision 29 „ Legal Proceedings 44 „ Poisoning 35 „ Shops and Premises 31 „ Unsound 35 German Measles 17 House to House Inspection 55 Houses, number of 14 ,, unfit 24 Housing 24 „ Informal and Voluntary Action 25 Ice Cream 33 Infantile Mortality 15 Infectious Diseases 15 Influenza, Investigation of 17 International Certificates of Inoculation and Vaccination 22 Introduction 9 (6889) A 2 Page Legal Proceedings 43 Medical Inspection of Aliens 22 Milk and Dairies 34 Mobile Meals Service (" Meals on Wheels ") 21 Nuisances 24, 28, 30,31 „ Noise 41 Notices 23,27, 29, 31 „ Statutory 23 Outworkers 27 Overcrowding 25 Paddington Group Hospital Management Committee 22 Pet Animals Act 38 Pharmacy and Poisons Act 35 Pigeons 40 Poliomyelitis 16 Population 14 Premises 26 Private Deep Wells 44 Public Health Committee 5 Public Health Staff 6 Rag Flock and other Filling Materials Act 39 Rateable Value 14 Rat and Mice Repression 38 Rodents destroyed 38 Samples, food 32 Sanitary Circumstances 23 Slaughterman's Licences 22 Smallpox 16 Smoke Abatement 43 Staff, Public Health Department 6 Starlings 40 Statistics and Social Conditions 14 Tuberculosis 20 Underground Rooms 24 Unfit Premises 24 Unsound Food 35 Water 44 „ addition supplies to premises 24 Welfare of Old People 20 Westminster Old People's Welfare Association 21 Workplaces, Shops, etc. 26 5 PUBLIC HEALTH COMMITTEE. The Mayor (ex-officio): Councillor Lt.-Col. H. Norman Edwards, M.B.E., J.P. The Deputy Mayor (ex-officio): Councillor Albert Sciver, B.Sc., F.R.I.C. Chairman: Councillor C. R. Purnell. Vice-Chairman: Councillor Miss P. C. Paton Walsh. Members: Alderman G. F. Jerdein, D.L. Councillor Dr. T. Anwyl-Davies. „ A. L. Burton. „ 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.LArb. „ D. E. Havinden. „ L. E. Johnson. ,, Mrs. Arthur Rye. ,, 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.H., &c. (To 18.8.52.) D. N. Keys, M.B., B.S., D.P.H. (18.8.52 to 21.12.52.) 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: (and with special duties relating to Theatres, Cinemas and other places of amusement), W. G. J. Sutton. Sanitary Inspectors: District: A. G. Bates. J. M. Burbridge. W. J. Davies. J. E. Drake. D. W. Saunders. F. E. Siddle (Inspector for Rodent Control). W. L. French (Inspector, with special duties relating to the care of old people, for Disinfection, Disinfestation, &c.). 7 Housing: C. F. Brockett (Inspector in Charge). J. W. Baxter. J. Beagle (from 1.10.52). A. R. Cook. J. W. M. Meston (to 26.7.52). Food: J. J. Coveney. P. A. Lloyd. Catering Establishments: J. H. Brownlee. R. F. Stubbs. Atmospheric Pollution: R. Roper, Women's Factories: Miss C. Hughesdon. Clerical Staff: R. L. Booker. S. J. Chamberlain. C. E. Clark. A. H. Cole. P. Cox (temporary). Mrs. P. M. Crump. Miss R. M. Fitzgerald (from 16.6.52). P. J. R. Fricker. W. F. C. King. D. Levitton. G. Lyness (temporary). L. J. Nunn. J. M. Shotbolt. B. Shrensky. W. E. F. Simmons. W. H. Smith. E. A. Taylor. E. W. Tyler. B. S. Weaver (to 17.5.52). 8 Coroner's Court and Mortuary. Superintendent: A. W. Nicholls. 1st Mortician: L. M. Swanston. Mortuary Staff. H. W. Allam (from 11.8.52). S. J. Buckingham (to 3.5.52). S. E. Salisbury Miss E. S. Dunford (S.R.N.). Mrs. E. Williamson (Cleaner). Disinfecting Staff: N. Heathcote (Foreman), L. C. Clarke. C. J. Daniels. J. R. Doyle (Motor Driver). Miss H. Mac William (S.R.N.). Miss I. M. Newman (Woman Attendant). G. Lawrence. J. A. Lovelock. J. Shillingford. Rodent Staff: Rodent Officer: J. W. Brown. H. J. Felstead (Foreman). H. Brown. D. G. Cadlock (to 9.2.52). J. Vidal. J. J. Devine. G. Murray. F. C. Smellie. 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. Mr. Mayor, Aldermen and Councillors, Annual Report for 1952. I submit for your consideration my twenty-eighth report on the health and sanitary conditions of the City of Westminster. This report has been prepared in accordance with Circular 2/53 of the Ministry of Health for the report has likewise to be presented to the Minister. The winter of 1952-53 was one of the most unpleasant for fully fifty years. Fog, tempest and flood, characterised a period singularly free from severe frost but the abnormal rainfall of 9 inches in twenty-four hours at Lynmouth and surrounding areas on 15th August followed by catastrophic floods will long be remembered. In London and the Home Counties in the month of December occurred one of the most damaging fogs of the last fifty or sixty years. It accounted for a very high death rate among the elderly, particularly those afflicted by chronic diseases of the heart and lungs. In the first week of February of the current year abnormally high spring tides whipped by North East gales caused immense devastation along most of the Eastern seaboard of England and in the Thames Estuary. So far as 1952 is concerned, apart from floods of August and the fog in December, the weather of the year was not unusual. There was no prolonged brilliant summer nor an abnormally severe winter but the average rainfall was higher than in 1951. The Registrar General's estimate of population of the City has risen from 100,000 to 100,800. The general death rate has fallen from 11.87 to 10.05 and this in spite of the increase in deaths in the two weeks following the December fog. As compared with the two weeks prior to the fog, the number of deaths from cardiac and respiratory causes increased respectively from 7 to 38 and 9 to 44. The birth rate has fallen slightly from 12.35 to 12.33 per thousand of the population and this is in accord with the tendency in London and the country generally. Infantile mortality was considerably lower than in 1951, 24.93 per thousand infants born and up to the age of one year. This is the lowest death rate for infants ever recorded in the City and compares with 23.8 for London as a whole. There were 1,243 births during the year and 31 deaths of infants under one year of age in the same period. One maternal death occurred as a result of internal haemorrhage following tubal pregnancy. Deaths from cancer in its various forms numbered 238 compared with 232 last year. Those from cancer of the lung and bronchus 42, the same as in 1951, but while the male deaths were fewer those among women increased from 5 to 11. Disease of the heart and circulation, including vascular lesions of the nervous system, claimed 464 deaths compared with 484 in 1951, and with very few exceptions among those well over middle age. There were a few more deaths from tuberculosis of the lungs, 46 compared with 35 in 1951, and again mostly among males and those over 45 years of age. Throughout the country generally there has been during the past few years a steady decline in the number of (6889) A 3 10 deaths from tuberculosis, a decline so pronounced as to warrant the hope that if it continues tuberculosis will be conquered within the next twenty-five years. The advances in the early diagnosis of this disease by X-ray examination, the progress of immunization by B.C.G. vaccine in those exposed to infection but not already infected, the application of modern surgical procedures ranging from artificial pneumothorax to the excision of diseased lung and the discovery and application of such therapeutic substances as Streptomycin have established a marked ascendancy over this age-long enemy once eligible for the melancholy title " Captain of the Men of Death The incidence of notifiable infectious diseases was again low. Measles with 781 and whooping cough with 241 provided the largest number but even these were fewer than in former years. Five cases of diphtheria were notified but in all cases the diagnosis was not confirmed on bacteriological examination. As no cases were notified in 1951 it looks as if for the time being diphtheria has disappeared from our midst but unless immunization of infants continues to be actively practised this disease so dangerous to young children may again assert itself. Fourteen cases of poliomyelitis were notified, three of them in children of school age. The diagnosis of four was revised on removal to hospital leaving ten confirmed cases, of which one died. Influenza as such is not notifiable but influenzal pneumonia and acute primary pneumonia are, eleven of the latter being notified. Three deaths from influenza were certified and 53 from pneumonia. The inference is that in 1952 there was no serious outbreak of influenza. As regards the typhoid fever group of infections, there were only two cases, both of whom survived. Notifications of food poisoning cover a wide variety of infections, particularly as a medical practitioner is entitled to notify " suspected cases Some of the cases may turn out to be those of sonne dysentery, an infection likely to spread quickly in schools, day nurseries and rest centres, where numbers of individuals are living in contact. It is generally spread through a carrier or a patient who has recovered but is still carrying the infective germ. Sixty-eight notifications were received during the year. While not generally giving rise to serious illness it causes much inconvenience in the conduct of, say, a school or day nursery and, where the source of infection happens to be a person employed in the handling of food, the implications are still more troublesome and far reaching. Other types of food poisoning may be caused by organisms of the staphylococcal group. The toxins of these germs may develop in food previously cooked and left to cool slowly. But the food such as a cooked joint must have been infected in the process of preparation by someone harbouring this type of germ. The symptoms of the sufferers resemble those of sea sickness with vomiting, diarrhoea and collapse within a few hours after the meal. Other types of food poisoning are less sudden in onset, symptoms appearing about 24 hours after eating the infected food. They are generally caused by germs of intestinal type called " Salmonella " and may be conveyed through human agency or by 11 animals. It is true to say that in all three types of food poisoning the suspected food usually appears quite wholesome to sight, smell and taste. During 1952 twelve outbreaks of food poisoning were reported, some one hundred and thirty persons being affected. Forty notifications were received in Westminster, 8 of the sufferers being removed to hospital. In no case was the illness of more than a transitory nature. In 38 instances the notifications were subsequently confirmed, and in 2 cases a revised diagnosis made. In my report for 1948 somewhat full reference was made to the small incidence of food poisoning in relation to the immense number of meals eaten away from home throughout the country and particularly in this City. A survey was carried out in 1951-52 and a detailed register made of all premises where food and drink were provided and consumed on the premises. Licensed premises are included in the register and the total comes to 3,001, exclusive of all wholesale and retail food and provision shops. It must be noted, however, that the register cannot remain static. Some small restaurants and cafes seem to close down suddenly, the premises being reopened for other types of business, while new cafes open quite unobtrusively in the same neighbourhood. The problem of those at work in the City who are contacts of infectious cases in their own homes in other districts is a constant source of inquiry, mainly by telephone. Employers in the City naturally feel anxious about other members of their staff and the conduct of their business and they turn to the Medical Officer of Health for advice; this is specially so when poliomyelitis is in the ascendant. These inquiries take up a good deal of time but it is an important part of the duties of the Medical Officer of Health. One advantage of having held the post of Medical Officer of Health so long is that one has got to know intimately many of the general medical practitioners in the City. Their co-operation and assistance have been of the utmost value, not only in relation to infectious disease but in other matters, such as housing, the care of the aged, etc. The war and the needs of civil defence drew even closer together the medical practitioners in the City and the Council's medical staff as all were engaged in a common task. We had our regular meetings of the local medical war committee of the British Medical Association in my office and that committee, though no longer a war committee, meets here even now. Another close association in which I have been privileged to play some part is that of the teaching and other hospitals in the City, of which there are thirteen. With Westminster Hospital in particular there has been a specially close link for more than thirty years. This hospital and medical school, where I have been a member of the teaching staff for more than twenty-five years, have for many years been Carrying out on behalf of the Council various medical services to the great benefit of the people of Westminster. No closer union between a municipal body and a teaching hospital can be found anywhere in London. The hospital has also rendered personal services of inestimable value to members and staff of the Council, which are warmly appreciated and (6889) A 4 12 have still further knit together the ties existing between the two bodies. A very close relationship with St. George's and Charing Cross Hospitals was built up during the war because these two played an essential part in dealing with air raid casualties. In the early stages of the war First Aid Posts were set up at St. John's Skin Hospital, at the Children's Hospital, Vincent Square, and at the Women's Hospital, Soho Square, while a larger First Aid Post and Decontamination Centre were instituted at Westminster Hospital itself. The City Council was responsible for the first aid services and found the authorities of the various hospitals most willing and helpful agents. The community of interests then established has left behind a friendly atmosphere which has engendered ease of co-operation in the public service. This, the twenty-eighth annual report which I have submitted to the City Council as its Medical Officer of Health will be my last and I beg leave to introduce a personal note. At the end of this present month of July I shall have completed forty years in the public health service, thirty-seven of them in the service of the City Council. To serve this Council has been an honour and a privilege and is so regarded far outside the confines of its own City Hall. I consider myself indeed fortunate in having been for so long the adviser on public health to this renowned Corporation and in being the executive officer administering the many measures designed to safeguard the health of the community. I cannot imagine a company of more considerate and understanding civic masters. I do not propose to pass in retrospect the changes in the health and housing conditions of the City during this period. This was the subject of special comment in my annual reports for 1949 and 1950, the period of the Jubilee of the City as one of the Metropolitan Boroughs. My only comment is that it has been a time of steady and well ordered progress in the City's public health. The City Council, while eschewing proposals of ephemeral repute, has left nothing undone which seemed worth doing for the health and welfare of its citizens. While the rateable value of the City has risen by a half there have been developments in the Council's services in all of which I have been an interested observer. They include the remarkable expansion of new housing; the ever widening responsibilities in the legal and administrative spheres ; the evolution of civil engineering and the influence of town planning ; the increasing complexity of municipal finance ; the modernization of methods in public cleansing ; and the growing appetite of the public for the varied fare provided by the libraries. These services are sharing in the broad purposes of fostering the well being of the citizens and thereby enhancing the good name of the City. In all my years of service I have been sustained by a staff whose devotion and competence have long been to me a source of pride. Of those in the department when I entered the Council's service thirty-seven years ago none remains, though five are in retirement; and only three of those who were serving when I became Medical Officer of Health in 1924 are still officers of the Council. Most of their older colleagues have passed 13 on in the years between. I remember them with deep gratitude. How eager they were to help and how much do I owe to their experience so freely placed at my disposal when I took up my responsibilities. I have served the Public Health Committee under ten successive Chairmen, from all of whom I have received so much kindness that they transformed an essentially official relationship into one of warm friendship. From all the members of the Council's staff with whom I have been in contact I have likewise been treated with so much goodwill and when help was needed it was forthcoming in good measure. I look back on a very happy association with my colleagues among the Chief and other officers, including those of the past. In our work for the Council problems arise from time to time in which we seek the advice and help of each other. I can affirm that I appreciate very highly all that I have received. We have been " a happy ship " and a ship can only be happy when it is so inspired from the " bridge ". To all I bid a grateful farewell. I have the honour to be Your obedient Servant, Andrew J. Shinnie, Medical Officer of Health. July, 1953. *6899) A 6 14 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,502.7 Population (Registrar General's Estimate, mid-year, 1952) 100,800 Number of inhabited houses (Census, 1931) 22,536 Rateable Value £11,148,000 Births. Live Births (registered)— Total. Males. Females. Legitimate 1,107 547 560 Illegitimate 136 72 64 1,243 619 624 Births Notified—1,226. Birth rate per 1,000 of the estimated resident population 12.33 (Rate for London, 17.6; for England and Wales, 15.3) Number of stillbirths (males, 14; females, 13) 27 Rate of stillbirths per 1,000 (live and still) births 21.26 Deaths. Net deaths (males, 594; females, 501) 1,095 Death-rate per 1,000 of the estimated resident population 10.86 (Rate for London, 12.6; for England and Wales, 11.3) Deaths from puerperal causes 1 Rate per 1,000 total (live and still) births 0.78 Deaths of infants under 1 year (males, 16; females, 15) 31 Death-rate of infants under 1 year- All infants per 1,000 live births 24.93 Legitimate infants per 1,000 legitimate live births 20.77 Illegitimate infants per 1,000 illegitimate live births 58.82 Rate for London for infants under 1 year 23.8 Deaths (all ages) from measles 1 ,, „ whooping cough Nil „ „ gastritis, diarrhoea and enteritis 11 ,, „ cancer 238 15 Infantile Mortality. Causes of Death Total. Legitimate. Illegitimate. Pneumonia 4 4 — Bronchitis 2 2 — Gastritis, Enteritis and Diarrhoea 1 1 — Congenital Malformations 8 7 1 *Other defined and ill-defined diseases 13 9 4 All other accidents (other than motor vehicles) 3 — 3 31 23 8 * 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. Disease. Original Notifications. Removed to Hospital. Re- diagnosed. Corrected Notifications. Diphtheria 5 5 5 — Dysentery 68 43 21 47 Erysipelas 15 6 2 13 Food Poisoning 40 8 2 38 Malaria (origin abroad) 1 1 — 1 Measles 786 88 5 781 Meningococcal Infection 2 2 2 — Paratyphoid 1 1 — 1 Pneumonia— Acute Primary 11 — — 11 Influenzal 20 — — 20 Poliomyelitis— Paralytic 6 6 3 7 Non-Paralytic 8 7 5 3 Puerperal Pyrexia 24 9 — 24 Scabies 49 — — 49 Scarlet Fever 53 19 8 45 Typhoid Fever 1 1 1 — Whooping Cough 241 40 8 233 No cases of the following diseases were notified during the year: Anthrax; Cholera; Continued Fever; Encephalitis; Glanders; Hydrophobia; Membranous Croup; Ophthalmia Neonatorum; Plague; Relapsing Fever; Smallpox; Typhus Fever. (6889) A 5 16 Smallpox. On four separate occasions during the year, the Medical Officer of Health investigated suspected cases of smallpox. Fortunately the disease was excluded in every case. On three occasions, information was received that contacts of cases of smallpox or suspected smallpox were arriving in Westminster. These contacts numbering 18 were kept under surveillance by officers of the department until the period of 16 days from the last day of contact was over. For some years the first line of defence against the entry of smallpox into this country has been the Medical Officer at the Port or Airport. The advent of air travel has introduced new problems by bringing persons from areas of the world, such as India, where smallpox is still relatively common, to within one day's travelling time of this country with the result that they now arrive well within the incubation period of 12 days. Whereas in the days of sea travel there would be ample time for the disease to develop and be diagnosed on board or at the port of entry, nowadays an apparently well person, who is actually incubating the disease, may enter undetected and develop it days later when he may possibly have put many miles between himself and the Medical Officer at the Airport. The only answer found so far to this comparatively new problem has been therefore to vaccinate if necessary and keep a close watch on the movements and health of the contacts until after the 12-day incubation period is over, usually about 16 days to be on the safe side. Thus we see how the ever increasing speed of air travel has increased the importance of this second line of defence which is the province of the Medical Officer of Health of the area where the contact has taken up residence. Lastly, but probably most important of all the defences, is the vaccination state of the population. The more babies, children and adults in this country who are or have been vaccinated, the more stony the ground on which the scourge of smallpox would fall should it by any mischance be introduced. Any outbreak would thus be halted before it could get a hold, which would not be the case if the population were allowed to become unprotected by vaccination. The importance of vaccination in infancy cannot thus be over emphasised. Poliomyelitis. There were 14 notifications of poliomyelitis received during the year. Of these however, four were subsequently rediagnosed after admission to hospital as not suffering from the disease, leaving 10 confirmed cases as compared with one case last year and 28 cases in the peak year in 17 1949. Three of the 10 cases were non-paralytic and 7 paralytic. There was one death in a girl of 16 years. Particulars of all these cases were sent by the Medical Officer of Health to the Medical Research Council who are carrying out investigations as to whether there is any connection between the onset and course of the disease and prophylactic inoculations and tonsil operations. Two of the cases in the City had previously had inoculations, one of anti-tetanus and one B.C.G. The search for a more effective way of controlling poliomyelitis is gathering momentum both in this country and the United States, where recently it has been found possible to grow the virus on artificial media in sufficient quantities for a more accurate study of its properties to be made than has hitherto been possible. Consequently there is hope that a vaccine capable of immunizing the population against this crippling disease may be found in the not too distant future. Arrangements for Investigation of Influenza. During the year, the City Council authorised its Medical Officer of Health to co-operate with the Ministry of Health and the Central Public Health Laboratory, in compiling information for the investigation of outbreaks of influenza. A scheme was accordingly set up for the early detection of cases in the City. Under this scheme, two medical practitioners, two medical officers in charge of staff at two hospitals, and a medical officer of a large industrial concern, agreed to act as "spotters" and to inform the Medical Officer of Health as soon as any signs of an influenza epidemic became known to them and to collect specimens from the patients for laboratory investigation. The object of this investigation was to obtain early information in order to determine the source and nature of an impending epidemic and the isolation of the causative virus. Nothing in the nature of an epidemic occurred during the year. German Measles. The City Council also authorised the Medical Officer of Health to assist the Central Public Health Laboratory in their investigation of German Measles. Accordingly, early information was transmitted to the Laboratory of cases of this disease occurring in the City. In conjunction with the family doctors and with the permission of the patients, specimens were obtained for laboratory investigation. The object of this research into German Measles is to discover effective preventive measures against the possible occurrence of ill effects in infants, whose mothers develop the disease in early pregnancy. 18 Deaths, 1952. 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 1525 2545 4565 6575 75+ All Causes M. 594 16 4 4 11 41 210 172 136 F. 501 15 1 — 4 26 97 131 227 Grand Totals 1,095 31 5 4 15 67 307 303 363 Tuberculosis, Respiratory M. 41 — — — 2 6 19 10 4 F. 5 — — — — 2 2 — 1 Tuberculosis, Other M. 1 — — — — 1 — — — F. 1 — — — — 1 — — — Syphilitic Disease M. 11 — — — — 1 4 6 — F. 1 — — — — — — — 1 Diphtheria M. — — — — — — — — — F. — — — — — — — — — Whooping Cough M. — — — — — — — — — F. — — — — — — — — — Meningococcal Infections M. — — — — — — — — — F. — — — — — — — — — Acute Poliomyelitis M. — — — — — — — — — F. 1 — — — 1 — — — — Measles M. 1 — 1 — — — — — — F. — — — — — — — — — Other Infective and Parasitic Diseases M. 3 — — — — 1 2 — — F. 2 — — — — — 2 — — Malignant Neoplasm, Stomach M. 24 — — — 1 1 11 8 3 F. 13 — — — — — 8 3 2 Malignant Neoplasm, Lung, Bronchus M. 31 — — — — 3 15 11 2 F. 11 — — — — — 6 4 1 Malignant Neoplasm, Breast M. — — — — — — — — — F. 22 — — — — 3 7 6 6 Malignant Neoplasm, Uterus M. — — — — — — — — — F. 6 — — — — — 3 3 — Other Malignant and Lymphatic Neoplasms M. 75 — — — 2 7 18 29 19 F. 56 — — — — 2 13 16 25 Leukaemia, Aleukaemia M. 3 — — 1 — — — — 2 F. 4 — — — 1 1 — 1 1 Diabetes M. 2 — — — — — 1 — 1 F. 6 — — — — 1 1 3 1 Vascular Lesions of Nervous System M. 44 — — — — 1 17 12 14 F. 63 — — — — 1 7 18 37 Coronary Disease, Angina M. 102 — — — — 4 46 31 21 F. 55 — — — — — 6 21 28 19 Deaths, 1952 —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+ Hypertension, with Heart Disease M. 6 — — — — — 1 2 3 F. 14 — — — — — 3 7 4 Other Heart Disease M. 49 — — — — 2 13 6 28 F. 75 — — — 1 2 9 13 50 Other Circulatory Disease M. 28 — — — — — 7 15 6 F. 28 — — — — 2 5 7 14 Influenza M. 2 — — — — 1 — — 1 F. 1 — — — — — — — 1 Pneumonia M. 22 1 2 — — 2 5 7 5 F. 31 3 1 — — — 3 5 19 Bronchitis M. 41 1 — — — — 16 14 10 F. 24 1 — — — 1 3 7 12 Other Diseases of Respiratory System M. 8 — — — — 1 2 2 3 F. 1 — — — — — — — 1 Ulcer of Stomach and Duodenum M. 10 — — — — — 6 3 1 F. 7 — — — — — 1 4 2 Gastritis, Enteritis and Diarrhoea M. 3 — — — — — 1 1 1 F. 8 1 — — — — — 4 3 Nephritis and Nephrosis M. 3 — — — — — 1 — 2 F. 3 — — — — — — 3 — Hyperplasia of Prostate M. 4 — — — — — — 2 2 F. — — — — — — — — — Prcgnancy, Childbirth, Abortion M. — — — — — — — — — F. 1 — — — — 1 — — — Congenital Malformations M. 8 5 — 2 — 1 — — — F. 4 3 — — — — 1 — — Other Defined and IllDefined Diseases M. 39 8 1 — 2 3 13 7 5 F. 40 5 — — — 5 12 4 14 Motor Vehicle Accidents M. 5 — — 1 — 1 — 2 1 F. 3 — — — — 2 — — 1 All other Accidents M. 16 1 — — 2 3 6 2 2 F. 9 2 — — — 1 1 2 3 Suicide M. 11 — — — 2 1 6 2 — F. 6 — — — 1 1 4 — — Homicide and Operations of War M. 1 — — — — 1 — — — F. — — — — — — — — — 20 Bacteriological Examinations. Negative. Positive. Nasal and Throat Swabs 157 2 Faeces 54 8 Urine 6 Nil Skin Swabs 8 4 Tuberculosis 381 79 Vomit 1 Nil 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 2 2 1 1 — — — — 5 to 15 years — — — 1 — — — — 15 to 25 years 36 14 3 3 2 — — — 25 to 45 years 63 30 1 3 6 2 1 1 45 to 65 years 49 12 — 2 19 2 — — 65 to 75 years 12 — 1 — 10 — — — 75 and over 4 1 — — 4 1 — — 166 59 6 10 41 5 1 1 New Cases. Pulmonary—225 new cases, including 71 transfers and 16 non-notified deaths. Non-Pulmonary—16 new cases, including 4 transfers. (1951—Pulmonary, 247 new cases; Non-Pulmonary, 14 new cases.) Deaths from Tuberculosis. Pulmonary—46 (41 males, 5 females). Non-Pulmonary—2 (1 male, 1 female). Welfare of Old People. Aged Persons in need of care and attention. Under the provisions of the National Assistance Acts, a Medical Officer of Health is empowered to apply to the Courts for an order for the compulsory removal to a hospital or other suitable place, of persons who are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions and unable to devote to themselves, and are not receiving from others, proper care and attention. Fortunately it has not been found necessary to invoke these powers during the year. 21 The Westminster Old People's Welfare Association. This Association formed in 1948 continued its activities for the welfare of aged persons in the City. These activities include eight Old People's clubs in different parts of the City where recreation and light refreshments are provided. Two of these clubs are organised by the W.V.S., one by the British Red Cross Society, and another at St. Martin-in-theFields in co-operation with the Association. Holidays at seaside resorts are provided for the aged as well as summer outings, Christmas parties, and other entertainments. A library service is provided by the City Librarian. The chiropody service provided by the Association has proved of immense benefit to the old people who are affected with foot troubles. The Association have arrangements with two clinics in different parts of the City where the aged can attend for treatment, and home treatment is arranged for those who are home bound. The charge to the elderly patients varies from 1s. per foot per treatment to 2s., the balance of cost which varies from 3s. to 6s. per treatment is borne by the Association. Under the provisions of the National Assistance Act, 1948, a local authority may make contributions to the funds of any voluntary organisation whose activities consist in or include provision of recreation or meals for old people. The City Council under this authority make an annual grant to the Association and office accommodation is provided for them in the Public Health Department. British Red Cross Society—Mobile Meals Service. The Westminster Division of the British Red Cross Society has continued this service which it established in the City in 1945 for the delivery to their homes of hot mid-day meals to aged people who are themselves unable to prepare meals of this sort. The service is operated with two vans provided by the City Council and loaned to the Society. The City Council also makes a grant to the Society of 75 per cent. of the running costs of the vans. During the year the Council explored the possibility of establishing an Invalid Kitchen in Westminster where meals could be prepared on prescribed diets for aged persons and for others on invalid diets for consumption where the food is prepared or for delivery to the elderly at their homes. Consultations with the London County Council, the British Red Cross Society and the Westminster Old People's Welfare Association took place but in the result it was found that the cost of preparation, transport and other overhead charges would be relatively high and the proportion to be paid by the recipients beyond their means. It appeared also that even further expense would arise because of the special equipment for the vans necessary for the delivery of different individual meals to the homes of those for whom they were prescribed. It was considered that on simpler lines greater variety could be obtained in the meals delivered to the old people by the use of individual containers. The London County Council having agreed to co-operate 22 in the serving of a variety of meals at their Civic Restaurant, the Council made a grant for the purchase of the necessary equipment and this improved service became available towards the end of July and has given much satisfaction to the consumers. The cost of the meal is 1s. 6d., the old people are charged 10d. the London County Council bearing the difference of 8d. per meal. Some 8,478 meals were delivered by this service during the year. This was accomplished by the British Red Cross Society with the service of one paid driver-organiser and a band of enthusiastic voluntary workers. 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 1.574 certificates were authenticated during the year. Medical Inspection of Aliens. The arrangement between the City Council and the Ministry of Health whereby the Medical Officer of Health was responsible for the medical inspection of Aliens arriving at Victoria Station by the Dover-Dunkirk ferry train, came to an end on the 30th April, 1952. From the 1st January, 1952, up to the 30th April, 1952, some 3,597 aliens arriving by this service were medically inspected. A new procedure was introduced after that date dispensing with the necessity for the attendance of a medical inspector daily at the Station, medical examinations of aliens being carried out by a medical practitioner in the vicinity of the station where the Immigration Officer considered such a course necessary. Slaughter of Animals Act, 1933—Slaughterman's Licences. The Council during the year granted Slaughterman's licences to twenty-nine men who had been accepted by the Royal Society for the Prevention of Cruelty to Animals to act as their inspectors in different parts of the country. These licences are required to be held by the pupils while undergoing training in humane slaughtering as inspectors of the R.S.P.C.A. Paddington Group Hospital Management Committee. The Council at the invitation of the Paddington Group Hospital Management Committee appointed Councillor Havinden to serve on House Committee No. 1. 23 SANITARY CIRCUMSTANCES. Duties Performed by the Sanitary Inspectors. The following statistics show the work of the Sanitary Inspectors daring the year:— Dwelling Houses. Analysis of Inspections— Complaint 1,502 House to House (by Housing Inspectors) 555 Routine 464 Infectious disease 507 Underground rooms 611 Other parts 4 Housing applications 428 Building licences and permits 84 Drainage—voluntary 1,081 Drainage—under notice 1 Sanitary defects—voluntary 13 Sanitary defects—under notice0 8 Aged and infirm 170 Common lodging houses 20 Rodent control 704 Other reasons 582 6,734 Included in the above totals— Requisitioned properties 158 Houses let in lodgings 515 Council properties 162 8,971 Re-inspections were made following the above inspections. Notices served. Public Health (London) Act 347 London County Council (Drainage) Bylaws, 1934 14 London County Council (Water Closet) Bylaws, 1930 4 Prevention of Damage by Pests Act, 1949 32 397 Statutory notices 34 24 Nuisances, Defective and Unsatisfactory Conditions Found. Defective, dirty internally 66 Damp 278 Inadequate underfloor ventilation 1 Defective drainage 108 „ roofs 109 „ area paving, &c. 21 „ exteriors 7 Waterclosets—insufficient ventilation and light 7 „ defective or dirty 50 „ insufficient 7 „ direct approach 2 „ unsuitable 1 Water supply insufficient 4 „ cisterns dirty, uncovered 3 Absence of food storage accommodation 12 „ ventilation, food storage accommodation 7 „ washing accommodation 2 Smells 69 Rubbish 92 Animals 5 Other nuisances 38 Staircase lighting, tenements 7 Ventilation 31 Verminous 49 Overcrowding 10 Water supply in tenement houses. Under the provisions of the Public Health (London) Act, 1936, four 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 B.—Parts of Buildings Unfit for Human Habitation. (a) Number of basements represented for closure 26 (82 rooms) Number of Closing Orders made in respect of underground rooms 29 (88 rooms) (6) Number of other parts of buildings represented for closure Nil Number of Closing Orders made in respect of other parts of buildings Nil 25 (c) Number of specifications submitted and approved 17 (d) Number of Closing Orders determined in respect of underground rooms 19 (43 rooms) Number of Closing Orders determined in respect of other parts of buildings Nil (e) Number of applications made for modification of Closing Orders to permit approved use 31 (51 rooms) Number of applications approved 29 (46 rooms) (/) Number of cancellations of Closing Orders (Houses demolished) 3 (3 rooms) (g) Number of cancellations of Undertakings 2 (5 rooms) C.—Informal Action in Respect of Parts of Buildings Unfit for Human Habitation. Number of instances of informal action initiated to secure requirements of the Housing Acts and Regulations made thereunder:— (a) in respect of underground rooms 90 (b) in respect of other parts of buildings 1 Number of instances of informal action included in (a) and (b) above:— (a) as a result of applications for Building Licences 30 (b) on the initiative of the owner 26 (c) at the suggestion of the Medical Officer of Health 35 D.—Contraventions of Closing Orders. Number of contraventions of Closing Orders reported Nil Number of legal proceedings instituted Nil Overcrowding (Housing Act, 1936, Part IV). Cases coming to the notice of the Public Health Department during the year 63 Cases in which overcrowded families have been rehoused during 1952. Westminster City Council 49 London County Council 27 Common Lodging Houses. There are three common lodging houses in the City, two for men and one for women licensed by the City Council under the Public Health (London), Act, 1936. Seventy-one visits were made to these lodging houses during the year, including those of a routine character, or following the notification of infectious disease or other illness arising amongst the occupants. 26 Inspection of Factories, Workplaces, Shops, Offices and other Premises (other than Food Premises). Factories Act, 1937. Public Health (London) Act, 1936. Shops Act, 1950. Total Number of Visits.[/##] Factories—Power 902 Factories—Non-power 814 Workplaces, &c. 2,459 Offices 2,605 Shops (other than Food) 826 7,606 Analysis of Inspections. Complaint 471 Routine 1,034 Infectious disease 178 Building Licences and permits 3 Drainage—Voluntary 1,143 Drainage—Under Notice 9 Sanitary defects—Voluntary 12 Sanitary defects—Under Notice 8 Outworkers 99 Rodent control 678 Other reasons 48 3,683 3,923 re-inspections were made following the above inspections. Types of premises inspected,. Places of Public Entertainment 277 Carpentry, joinery, &c. 41 Wearing apparel 1,328 Furriers 110 Garages, motor tyres and rubberworks 61 Electricity sub-stations 11 Boots and shoes and other leather goods 105 Jewellers, precious and other metal workers 102 Cigar and cigarette manufacturers 1 27 Hairdressers 162 Laundries and dry cleaners 22 Printers and publishers 120 Warehouses and packers 97 Shops (other than Food) 826 Upholstery and Carpets 35 Photographers, film renters 124 Opticians 1 Florists 7 Chocolate manufacturers 3 Offices 2,605 Stables and mews 4 Surgical goods 7 Various (schools, hospitals, halls, stations, &c.) 1,557 7,606 Factories Act, 1937 (Section 110). Outworkers. Inspections 537 Number of outworkers (includes workers living in areas outside the City) 3,739 Notices—Summary. Factories—Power 38 Factories—Non-power 43 Workplaces, offices, shops (other than food) 69 150 Notices Served. Factories, Power. Factories, Non-power. Workplaces, Offices, Shops, he. Public Health (London) Act, 1936 8 9 15 Factories Act, 1937 20 27 6 London County Council (Drainage) Bylaws __ 1 London County Council (Water Closet) Bylaws 7 4 4 Shops Act, 1950 — 1 — Prevention of Damage by Pests Act, 1949 3 2 43 23 Nuisances, defective and unsatisfactory conditions found. Factories, Power. Factories, Non-Power Workplaces, Offices, Shops, &c. Defective, dirty internally 13 30 8 Verminous — — 5 Damp 3 5 21 Defective drainage — 5 56 „ roofs 2 — 2 „ area paving — — 1 Sanitary accommodation— Insufficient 6 1 8 Insufficient ventilation and light 6 3 5 Defective or dirty 9 28 26 Direct approach 4 2 — Not separate for sexes 3 8 2 Unsuitable 2 — — No indicating notices on doors of waterclosets 15 10 – Water supply insufficient — — 3 „ supply, absence of in upper floors – – 2 „ cisterns dirty — — 3 „ cisterns uncovered — — 1 „ taps not off main — — 1 Smells — 1 55 Rubbish 1 2 51 Other nuisances — 2 24 Temperature — 4 3 Inadequate ventilation — 1 6 Overcrowding — 7 1 Failure to fix abstracts 75 47 — Factories Act, 1937 (Section 114). Reports were made to the Factory Inspector of 122 instances for failure to display the appropriate abstracts of the Factories Act, 1937. 29 Food and Drugs Act, 1938 (Section 13). Inspection of All Types of Food Premises Analysis of inspections. Complaint 441 Routine 1,419 Infectious diseases 74 Building licences and permits 20 Drainage—Voluntary 295 Drainage—Under Notice 2 Sanitary defects—Voluntary 23 Sanitary defects—Under notice 3 Food licences 13 Catering licences 190 Rodent control 367 Catering licence transfer 1 Other reasons 62 2,938 Re-inspections were made following the above inspections. Catering Establishments. A register has been compiled giving particulars of all the Catering Establishments in the City, including Hotels, Restaurants, Clubs, Cafes, Tea shops, Canteens, Public Houses, &c. At the end of the year 3,001 such premises were included in the register. Summary of Inspections. Hotels, restaurants, clubs 2,272 Cafes, teashops, &c. 753 Staff canteens 218 Public houses 471 Notices served. Public Health (London) Act, 1936 36 Food and Drugs Act, 1938 83 London County Council (Drainage) Bylaws, 1934 4 London County Council (Water closet) Bylaws, 1930 4 Prevention of Damage by Pests Act, 1949 12 Shops Act, 1950 2 30 Nuisances, defective and unsatisfactory conditions found. Dirty and dilapidated internally 74 Defective internally 26 „ externally 13 ,, drainage 45 „ area paving, &c. 2 „ floors 31 Preparation tables and equipment worn and insanitary 6 Food storage accommodation inadequate and unsuitable 12 Vegetable preparation and washing up facilities— Worn and insanitary 19 Insufficient 15 Ventilation insufficient 39 Staff washing facilities, insufficient and unsuitable 7 Staff, changing rooms insufficient and unsuitable 9 Fuel, rubbish and other extraneous materials in food preparation rooms 36 Accommodation unsuitable (re-designing and re-siting of equipment necessary), &c. 5 Vermin— Cockroaches 21 Rats/Mice 12 Water closets— Insufficient 16 Insufficient ventilation and 1 ight 8 Defective 12 Dirty and dilapidated 13 Direct approach 4 Not separate for sexes 4 Unsuitable 8 31 Food Shops and Other Food Premises (other than Catering Establishments). Summary of Inspections. Visits. Bakehouses (underground included) 132 Dairies and milkshops 198 Ice cream premises 113 Meat shops 242 Other meat shops (preserved food, &c.) 34 Stalls 60 Confectioners 146 Fruit and greengrocery 237 Provision shops 379 Fish and poultry 94 *Other food premises 499 Included in the above totals are 33 visits in connection with the sale of horseflesh, and 60 inquiries in relation to food poisoning outbreaks. *Other Food Premises. Under this heading are included:— (1) Off-Licences. (2) Food factories. (3) Bonded warehouses. (4) Chemist's 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 of inquiry regarding adulterated samples. Notices Served. Food and Drugs Act, 1938 16 Factories Act, 1937 2 Prevention of Damage by Pests Act, 1949 1 Nuisances and defective conditions found. Dirty and dilapidated internally 4 Defective internally 5 „ floors 1 Preparation tables and equipment worn and insanitary 1 Ventilation insufficient 2 Temperature 2 Staff washing facilities, insufficient, unsuitable 5 Water closets— Insufficient 1 Defective 1 Dirty and dilapidated 2 32 Food and Drugs Act, 1938. Visits for the Purpose op Obtaining Samples and Inspecting Foodstuffs. Sampling. Inspection of Food. Bakehouses 1 19 Dairies and milkshops 145 144 Fried fish shops 3 3 Ice cream premises 22 27 Meat shops and stalls 4 197 Confectioners 10 25 Fruit and greengrocery 6 182 Provision shops 69 578 Other food premises 64 309 Staff canteens 2 103 Hotels, restaurants, clubs 30 194 Cafes, teashops, &c. 9 88 Public houses 54 57 Fish and poultry 3 28 422 1,954 Bylaws for the Protection of Food. Bylaws under Section 15, Food and Drugs Act, 1938, were made by the London County Council with effect from November, 1952, for securing the observance of sanitary and cleanly conditions and practice in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. The requirements of the Bylaws have beet) brought to the attention of the Traders concerned. Samples Purchased, &c., under the Food and Drugs Act, 1938, Showing Result of Analysis for the Year 1952. Article of Food. Number of Samples Adulterated. Submitted. Genuine. Bacon 3 — 3 Baking powder 7 — 7 Bread, &c. 8 4 4 Butter 9 — 9 Biscuits, cakes, cake and pudding mixtures, &c. 70 8 62 Cereals 33 — 33 33 Cheese 21 6 15 Cocoa 3 — 3 Coffee preparations and essences 32 — 32 Condiments and spices 65 2 63 Confectionery 54 4 50 Cooking fats 13 2 11 Culinary flavours and colourings 37 — 37 Custard and blancmange powders 54 — 54 Dried fruit 11 1 10 Drugs 37 2 35 Fish and fish preparations 41 4 37 Flour 16 1 15 Fruit, fresh, canned and preserved 13 2 11 Gelatine 5 — 5 Herbs 12 — 12 Jams, marmalades and preserves 93 3 90 Margarine 8 — 8 Milk 532 8 524 Milk, condensed and evaporated 4 — 4 Milk, beverages 4 — 4 Pickles and sauces 50 — 50 Meat and meat preparations 50 14 36 Salad oils and dressings. 10 — 10 Sandwich spread 6 — 6 Sausages 8 — 8 Soft drinks, beers, cordials, &c. 71 — 71 Synthetic cream, &c. 3 — 3 Soups 43 — 43 Spirits 100 8 92 Suet 3 — 3 Sugar 8 — 8 Tea 14 1 13 Vegetables, dried and tinned 30 2 28 Vinegar 15 1 14 Wines 7 2 5 Ice cream 65 1 64 Miscellaneous 2 — 2 1,670 76 1,594 Food and Drugs Act, 1938 (Section 14). Registration of Premises used in Connection with the Manufacture, Sale or Storage of Ice Cream. On the 1st January, 1952, 188 premises were registered for the sale and storage of ice cream. During the course of the year applications were received in respect of 19 further premises, and these were duly 34 registered, making a total of 207 registered premises. By reason of one removal during the year, the total number now registered is 206. There are nine premises registered for the manufacture of ice cream. Ice Cream (Heat Treatment) Regulations, 1947. During the year 75 samples of ice cream were submitted for examination by the methylene blue test. The samples were classified in provisional grades, as follows:— Grade 1 18 Grade 2 20 Grade 3 28 Grade 4 9 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 4 hours. Grade 2 Between 2 and 4 hours. Grade 3 Between ½ and 2 hours. Grade 4 Under ½ hour. Milk and Dairies Regulations, 1949. At the 31st December, 1952, the following were entered in the City Council's Register of Dairies and Distributors of Milk:— Distributors of milk with premises registered as Dairies 44 Distributors of milk with premises not registered as Dairies 77 Distributors of milk with premises situate outside Westminster 39 Milk (Special Designation) (Pasteurised and Sterilised) Regulations, 1949 and Milk (Special Designation) (Raw Milk) Regulations, 1949. The following are particulars of licences granted during 1952 to Dealers in respect of the sale of milk under prescribed or special designations:— Principal Licences. Supplementary Licences. Tuberculin tested 76 29 Pasteurised 115 35 Sterilised 98 33 36 Pharmacy and Poisons Act, 1933. At the end of the year the number entered on the List of Persons entitled to sell poisons such as hair dyes containing phenylene diamines zinc phosphide used in the preparation of products for the destruction of rats and mica, and disinfectants, 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 removed from the City, and 11 new applications had been duly entered on the list. Food and Drugs Act, 1938, (Section 9). 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. Amount Destroyed. Amount salvaged. Total. Tons Cut. Lb. Tons Cwt. Lb. Tons Cwt. Lb. Canned food 23 10 109 .— — — 23 10 109 Meat — 19 1 — 8 105 1 7 106 Fats — — 24 — 1 79 — 1 103 Fruit and vegetables 97 3 91 1 3 74 98 7 53 Fish 1 4 69 — — — 1 4 69 Cereals — — — — 4 99 — 4 99 Confectionery — 1 72 1 1 5 1 2 77 Miscellaneous — 6 107 — 4 97 — 11 92 Totals 123 7 25 3 5 11 126 12 36 Food and Drugs Act, 1938, (Section 18). Food Poisoning. A total of 12 outbreaks of suspected food poisoning occurred in the City during the year. Of this number five concerned single cases, and only in two cases was it possible to identify the causative agent. Of the other seven outbreaks concerning groups of people, the causative agent was traced in three instances. Details of these seven are as follows— (1) This outbreak affected three members of a family in Pimlico, two of whom suffered severe abdominal pain, diarrhoea and vomiting following an evening meal at home. Faecal specimens from the patients showed the presence of sonne dysentery organisms. Specimers from the son subsequently proved that he was a carrier. The only common article of food eaten by all three was meat pie—and it was on this article that suspicion rested. Unfortunately 36 none of the pie from the meal remained for bacteriological examination, but a portion of the same pie remaining at the retailer's shop was obtained and this was submitted for examination, but no pathogenic organisms were found. (2) A further case of food poisoning occurred at an hotel where periodical outbreaks took place last year. This outbreak, affecting three persons, was similar in character to previous occurrences. The food concerned was again a prepared sauce which had been made for service with an evening meal and had become enterotoxic due to the multiplication in it of staphylococci. It was ultimately established that the source of the contamination was an abrasion on the hand of a relief sauce chef. In consequence of the outbreak consultations were held with the management of the hotel in company with a bacteriologist and means were devised to obviate, if possible, any farther outbreaks of this nature occurring. As an interim measure, however, it was decided to discontinue the routine preparation of this particular type of sauce and to have it made only when requested when it would be used immediately after preparation. No further outbreaks have occurred. (3) A further family in Pimlico were affected by vomiting and diarrhoea which, they alleged, occurred after eating sausages given by a friend. None of the sausages remained from the meal nor was it possible to determine the source from whence they were obtained. No conclusions could be reached in this instance. (4) A prompt notification was received from a Westminster doctor of suspected food poisoning affecting a total of 70 members of a staff of a large departmental store in Victoria who were suffering from diarrhoea, vomiting and muscular weakness. All the persons affected had eaten lunch the previous day prepared in the staff kitchen. Of the persons affected 10 were confined to bed, but the remainder were only slightly affected. Samples of meat, milk and stock were submitted to the bacteriologist for examination, but none revealed any causative organisms. Faecal specimens were taken from patients but these also proved to be negative. In spite of a thorough investigation into this outbreak and a close examination of the food storage conditions, etc., it was not possible to determine the cause of the outbreak. (5) Information was received of a suspected outbreak of food poisoning amongst 20 members of a Society who had held their annual dinner in a restaurant some 14 days previously. The symptoms complained of had been sickness, diarrhoea, headache and abdominal pain. The informant stated that four members of the Society had had to seek medical attention but no notification of food poisoning was received in this Department relative to these cases. The restaurant concerned was inspected and the kitchen staff interviewed. The restaurant was found to be quite satisfactory and reasonably clean and there was no record of recent sickness amongst the staff. Due to the lateness of the information 37 it was not possible to obtain samples of the suspected meal for examination nor arrange for the taking of faecal specimens from those alleged to have been affected. (6) An outbreak occurred during the year at a large Hospital involving 24 in-patients, 1 nurse and 1 ward maid. Stools were taken by the Hospital authorities from all patients and from some salmonella typhimurium was isolated. By the time the outbreak was recognised as food poisoning some time had elapsed since the suspected meal was eaten and in consequence no food remained from this meal for examination. A cook who had been unwell for some 2 or 3 days before the outbreak was suspended from duty in case he was a carrier, but rectal swab and faecal specimens taken from him all proved negative. (7) Notification was received from the Medical Officer of Health of a suburban authority of two persons residing within his area who were suffering from suspected food poisoning after allegedly eating a meal in a Westminster restaurant. The patients were suffering from the usual symptoms associated with food poisoning. The restaurant was visited and found satisfactory; no food remained from the suspected meal. The staff were interviewed and it was found that the Chef and some of the Restaurant staff had been unwell two or three days previous to the outbreak. Faecal specimens were taken but these were negative, except that one did grow bacilli of a salmonella type, but this was obtained from a non food handler. The innumerable factors involved in nearly every food poisoning outbreak necessitate thorough and patient investigation. Early notification on the slightest suspicion that a case might be food poisoning remains perhaps the most important factor in reaching a satisfactory conclusion. It often enables the investigation to commence before vital evidence as to the source of the infection has been obliterated for all time. It is only by discovering the source of the infection that effective steps may be taken to prevent its recurrence. 38 Public Health (London) Act, 1930. London County Council, (Drainage) Bylaws, 1934. Drainage. Drainage plans submitted 451 Combined Drainage Orders made 45 Prevention of Damage by Pests Act, 1949. Rat and Mice Repression. Complaints received 1,044 Treatments carried out 888 Inspections by Sanitary Inspectors and Rodent Officer 5,306 Notices served 93 Rodents destroyed: Black rats 5,075 Brown rats 1,847 Mice 4,955 11,877 The Act imposes a duty on occupiers to give notification of infestation by rodents. It also provides that it shall be the duty of the Local Authority to ensure, as far as practicable, that their district is kept free from rats and mice. The Ministry of Agriculture and Fisheries reimburse to the City Council, in the form of a grant, 50 per cent. of the approved expenditure on work carried out under the Act, except for expenditure incurred in commercial premises. This expenditure is recovered from the occupiers utilising the Council's rat catching services. Pet Animals Act, 1951. The provisions of this Act came into force in April, 1952, and from this date no person may carry on the business of a pet shop without a licence granted by a local authority. In granting a licence the local authority impose conditions relating to a number of matters referred to in the Act, such as steps to prevent the spread of infectious diseases, and may also impose other relevant conditions which it may consider necessary. With a view to securing uniformity in the conditions imposed in the County of London, the City Council adopted model conditions prepared by the Metropolitan Boroughs' Standing Joint Committee on the advice of the Borough Medical Officers of Health Committee and the Royal Society for the Prevention of Cruelty to Animals. 39 Five licences were issued by the Council during the year to the following premises:— 11, Francis Street. 39, Wardour Street. 6, Lansdowne Row. 244, Vauxhall Bridge Road. 84, Brompton Road. The conditions with which the proprietors are asked to comply are as follows:— (1) No animal shall be kept under conditions which are liable to have an adverse effect upon its health. (2) No animal shall be displayed so as to expose it to interference or annoyance by persons or animals outside the shop. (3) Every animal shall at all times be kept in accommodation suitable (for the species of animal) as respects size, temperature, lighting, ventilation and cleanliness and no animal likely to be affected by inclement weather shall be exposed to such weather. (4) All animals shall be adequately supplied with suitable food and drink and visited at suitable intervals. (5) No suckling, being a mammal, shall be sold apart from its mother or foster mother unless it can be satisfactorily fed artificially. (6) No animal which is suffering from or could reasonably be suspected of having been in contact with any other animal suffering from an infectious disease shall be brought or kept on the premises unless it is properly isolated, and all reasonable precautions shall be taken to prevent the spread among animals of infectious diseases. (7) Stock shall not be so crowded into the shop as to render ingress and egress difficult, and all stock which is kept outside the premises during business hours must not be placed at night so as to cause obstruction in the event of fire or other emergency. (8) A supply of water and sand and/or an efficient fire extinguisher must always be available on the premises. In the case of lock-up premises, the licensee shall appoint a responsible person residing within a reasonable distance of the premises to have custody of the key outside business hours. The name and address of such person shall be displayed in legible characters on the front door or windows of the premises, and be notified to the local fire brigade and the police. (9) Animals shall not be handed to customers in paper bags or other unsuitable containers. Rag Flock and. Other Filling Materials Act, 1951. Under the provisions of this Act various types of premises concerned with the upholstery trade or with the provision of materials for that trade must be registered or licensed with the local authority. At the end of the year 7 premises had been registered by the City Council and 2 premises licensed for storage purposes. 40 The Act applies to premises where filling materials, including rag flock, hair, feathers, down, fibre, etc., etc., are used in manufacturing bedding, toys, baby carriages and other articles of upholstery. Provisions of the Act also refer to premises where rag flock is manufactured or stored for distribution for use in the aforementioned manufacturing processes. The Act unfortunately does not apply to the remaking or reconditioning of articles of furniture, upholstery, etc. 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 5 Visits made 17 Pigeons destroyed 326 Starlings. Observations and experiments have been carried out during the year in an endeavour to find means to mitigate the nuisance caused by the large flocks of starlings which roost on the ledges of buildings within the City—a nuisance that is local in character but not confined to Westminster. As a result of questions asked in the House, the Minister of Agriculture and Fisheries, Sir Thomas Dugdale, arranged for the problem to be examined in consultation with the Departments and interests most closely concerned. Kepresentatives of the Ministries of Agriculture and Fisheries, Housing and Local Government and Works, the Association of Municipal Corporations, and Metropolitan Boroughs' Standing Joint Committees, Birmingham and Westminster City Councils and the National Farmers' Union, met on a number of occasions to exchange experiences and information. As a result of these talks it was decided to try trapping the starlings at the places where the nuisances occur. This, however, brings in many practical difficulties owing to the inaccessibility of ledges, the prohibition of the use of poisons, and primarily because the birds rarely, if ever, feed near these dormitories on the City's buildings. A humane cage trap was designed and a number of models made. Four of these were made available to the City Council and four to the Ministry of Works, others being placed in the feeding grounds in rural areas. Considerable success was achieved with the traps placed in the rural areas, but only three birds were caught in those traps placed on the roofs of buildings in the Trafalgar Square area. In fact, although different baits were used—and 41 on occasions bait was placed outside the traps, the birds did not, and apparently will not, feed near the roosting places. During the course of the observations, it was found bhat birds roosted less frequently on buildings that were painted externally, or which had a glazed surface on the copings and ledges. Recently small portions of one of the ledges on the City Hall on which starlings normally roost, have been treated with different types of paint. Observabion over a considerable period will be required before the results of this experiment can be assessed. Noise Nuisance. Complaints 45 Investigations made 86 The type of noise of which complaint has been made varies considerably and has included noise created by machinery of several kinds, electric fans from ventilating plants, dance bands and amplifiers, radio sets, and various noises arising from the demolition of buildings, pneumatic drills, compressors, etc. In all cases the Sanitary Inspector has been able to make suggestions and offer advice which has led to the cessation or reduction of the noise. Atmospheric Pollution. Investigation into atmospheric pollution in the City was continued during the year at three sites, Mayfair, Pimlico and Charing Cross, where deposit gauges, which measure deposited pollution, and lead peroxide cylinders, which measure the sulphur activity, are sited. The following tables give the results of the monthly analyses. Deposit Gauges. Month. Monthly Deposits of Impurities—Tons per square mile. Mayfair. Pimlico. Charing Cross. Insol. Sol. Total. Insol. Sol. Total. Insol. Sol. Total. January 8.49 17.70 26.19 9.78 21.32 31.10 11.98 26.68 38.86 February 3.82 8.80 12.62 5.68 10.60 16.28 4.64 14.04 18.68 March 13.03 31.06 44.09 14.09 25.19 39.28 10.46 30.53 40.99 April 10.10 21.86 31.96 9.82 17.08 26.90 9.75 20.78 30.53 May 8.15 18.82 26.97 7.53 9.48 17.01 4.87 14.21 19.08 June 4.88 15.75 20.63 9.10 11.80 20.90 9.09 16.63 25.72 July 4.20 6.03 10.23 4.69 5.91 10.60 4.51 5.90 10.41 August 10.57 16.13 26.70 11.80 15.23 27.03 11.28 16.13 27.41 September 9.24 12.69 21.93 11.91 11.98 23.89 11.82 13.21 25.03 October 9.21 12.68 21.89 13.00 12.73 25.73 14.93 15.07 30.00 November 10.84 16.63 27.47 14.13 16.22 30.35 12.88 16.79 29.67 December 9.34 15.41 24.75 14.17 18.37 32.54 16.10 23.83 39.93 42 The most striking phenomenon of the year was the lethal fog which occurred in London in December. Between the 5th and 8th December, an anticyclonic system of relatively cool air became established over the London basin, and at the same time an almost complete calm existed. This blanket of cold air, extending some 200 to 500 feet above ground level became overlaid by a stratum of warmer air with a defined ceiling between the two layers. The natural fog as well as the smoke became trapped and the whole mass was unable to ascend and little, if any, lateral drift occurred owing to the absence of wind. The concentrated effect on the health of the population living in the fog bound areas was violent and most alarming. The deaths from cardiac and respiratory diseases occurring in the City amounted to 82 in the fortnight during which the fog occurred against 21 deaths from these causes in the same period in 1951 and 26 in the two weeks prior to the fog. Estimation of Sulphur Activity by the Lead Peroxide Method, The cylinders for the estimation of sulphur activity are situated at Alhambra House, Farm Street Depot, and Bessborough Street Clinic, The following table gives the date of sulphation expressed in milligrams of sulphor trioxide per 100 sq. cms. per day. Sulphur Trioxide in Milligrams per 100 sq. cms. per day. Mayfair Pimlico. Charing Cross 1952. January 3.36 3.41 4.32 February 3.76 4.16 4.60 March 3.28 3.86 3.52 April 2.13 2.53 2.58 May 1.43 1.91 1.56 June 1.28 1.30 1.62 July 1.02 1.41 1.09 August 1.21 1.77 1.52 September 2.36 2.51 2.40 October 2.90 3.49 3.89 November 4.34 5.98 4.34 December 8.60 5.59 5.02 43 Owens Automatic Air Filter. The Owens Air Filter which records hourly the suspended impurities in the atmosphere was in continuous operation at Monck Street Laboratory. Estimation of Sulphur Dioxide by the Hydrogen Peroxide Method. Estimations of Sulphur Dioxide by the volumetric method were made three times weekly, at the Monck Street Laboratory. Smoke Abatement—Results of Observations and Action Taken. 1947. 1948. 1949. 1950. 1951. 1952. Complaints Received 31 48 80 85 130 79 Observations Taken 531 670 720 1,374 1,371 1,565 Notices Issued:— Preliminary 6 1 4 37 15 11 Statutory – – – – 1 1 Legal Proceedings. Prosecutions instituted 19 Convictions 10 Cases withdrawn on completion of work, etc. 3 Cases dismissed on payment of Costs 4 Cases dismissed 2 Analysis of Legal Proceedings. Fines. Costs. £ s. d. £ s. d. Dwellings. Public Health (London) Act, 1936. Failing to abate nuisances— Four convictions (Abatement Orders made) 18 18 0 Three Appeals to Quarter Sessions dismissed on payment of costs 28 7 0 Two cases withdrawn on completion of work (with costs) 10 10 0 One case withdrawn. Failing to comply with Order to abate a nuisance— One conviction 15 0 0 5 5 0 44  Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1936, and L.C.C. (Drainage) Bylaws— One case dismissed on payment of costs 1 1 0 Prevention of Damage by Pests Act, 1949. Failing to take steps necessary to keep premises free from rats— One conviction 5 0 0 3 3 0 Food. Food and Drugs Act, 1938. Selling food intended for, but unfit for, human consumption— One conviction 7 0 0 3 3 0 One case dismissed on payment of costs 3 3 0 One case dismissed. Selling food not of the nature demanded by the purchaser— Two convictions 7 0 0 3 3 0 Selling ice cream from a container which did not bear the name and address of the dealer— One conviction 5 0 Selling milk below the standard prescribed by the Sale of Milk Regulations— Two cases dismissed on payment of costs 11 11 0 One case dismissed. £34 5 0 £88 4 0 45 Disinfection and Disinfestation. Rooms. Articles. Articles Destroyed Articles Washed. Vehicles. Books. Disinfection 393 21,447 3,436 1,778 24 1,558 Disinfestation 3,405 1,730 3,814 — 5 — Laundry towels – – – 6,227 – – Cleansing of Persons. 1952. Scabies. Head Lice. Body Lice. Cases. Treatments. Cases. Treatments. Cases. Treatments. Men 50 90 – – 436 436 Women 28 83 21 26 16 19 Children (including those under school age) 23 63 233 247 — — 13,739 articles of bedding, clothing, etc., were disinfected, and 531 articles destroyed. Apart from the normal disinfection and washing of clothing, bedding, etc., following infectious disease, assistance has been given to elderly and infirm people being nursed by the District Nurses, by arranging for the cleansing of bed linen which had become fouled and unwholesome through illness. Arrangements have also been carried out for the washing and disinfestation of the clothing of old people prior to their being admitted into homes. Vagrants who come voluntarily to the Cleansing Station or who are brought by the Police are cleansed and their clothes disinfested and washed. 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. 46 The Council is empowered to recover the cost of burial from the estate of the deceased, and 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. Where persons without knowD relatives die in the City, it is frequently necessary not only to arraDge 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 40 burials were undertaken by the City Council in its cemetery at Harwell, the requests for such burials being received from the following sources H.M. Coroner's Officer 17 Relatives of the deceased 11 Friends of the deceased 6 Hospitals in the City 6 40 Coroner's Court and Mortuary. During 1952, 291 bodies were received in the Mortuary on Coroner's Warrants, etc. Four bodies were admitted to await burial. Number of Cases. Inquest cases 112 Non-inquest cases 179 Post mortem examinations held 226 Causes of death in the foregoing were as under:— Accidental drowning 2 Found drowned 12 Suicide by drowning 3 „ by other means 22 Accidents— Street 13 Domestic 10 Others 19 Natural causes 187 Misadventure 9 Murder — Miscellaneous cases 14 47 Civil Defence in 1952. While awaiting information on any recent research relating to decontamination and salvage of food, cleansing of contaminated persons and health and medical services in public shelters, the principal activity of the department was, perforce, the training of numbers of the Council's staff' in the administrative work of war-time mortuaries. Three courses of lectures and demonstrations were presented and some thirty-six members of the staff attended. The search for more and better premises has continued but very special requirements have to be satisfied and it has become increasingly difficult to find really appropriate premises that have not already been earmarked for some other potential war-time purpose. In the meantime a comprehensive scheme based on the experience of civil defence requirements in the late war as regards decontamination and salvage of food has been drawn up. Such a scheme is capable of ready adaptation and expansion in the light of topical knowledge and demands. A site for a treatment centre has been earmarked and the City Council's Public Analysts have agreed to serve in the same capacity in relation to the examination of contaminated foods.