AC4353 Pu STMARY 54 BOROUGH OF ST. MARYLEBONE REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1949 H. A. BULMAN, M.R.C.S., D.P.H. London: Vail & Co,, Ltd,, 170 Farringdon Road, E.C.J 2 CONTENTS page page Members of the Public Health Committee 4 Section D—Housing :— Section A—Statistics and Social Conditions :— Permanent Schemes 13 General Statistics 4 Grading of Housing Estates and Rents 14 Extracts from Vital Statistics 4 Fisherton Street Housing Estate 14 Maternal Mortality 4 Crawford Place Dwellings . 14 Marriages 4 Requisitioned Premises . 14 Deaths 4 " Half-Way" Houses 14 Infantile Mortality 5 St. Marylebone Housing Association 14 Mortuary 6 Inspection of Dwelling-houses 14 Crematorium . 6 Underground Rooms 14 Re-housing . 14 Section B—General Provision of Health Housing of Persons from Abroad 14 Services :— Common Lodging Houses 15 Staff 6 Rent Restriction Acts 15 Staff Medical Examinations 6 Laboratory Facilities 6 Representation upon other Bodies 6 Section E—Food:— Conferences 6 Clean Food Campaign 15 Government Properties—Exemption from Food Analysis 16 Legal Requirements 6 Milk . 17 Care of Old People . 7 Butter and Margarine Premises 18 Ice-Cream 18 Section C—Sanitary Circumstances :— Preserved Food . 18 Sanitary Inspection 9 Fried Fish Vendors and Fish Curers 18 Sanitary Accommodation at Public Houses 9 Bakehouses . 19 Sewer Emanations—St. John's Wood 10 Restaurants, etc. 19 Water 10 Whalemeat 19 Drainage . 10 Horseflesh 19 Combined Drainage 10 Slaughter of Animals 19 Sealing-off Disused House Drains 10 Unsound Food 19 Building Licences 10 Public Conveniences 10 Public Cleansing and Salvage 11 Section F—Infectious and other Diseases:— Shops 11 Notifications .. 20 Sales from Slot Machines—Contraceptives 11 Smallpox 20 Diseased or Infirm Persons. 11 International Certificates of Vaccination and Burial or Cremation of the Dead 11 Inoculation . 20 Disinfestation 12 Food Poisoning Outbreaks 20 Verminous Persons 12 Tuberculosis :— Shelter 12 New Cases and Mortality 22 Rodent Control 12 Notifications 22 Dog Nuisance 12 Venereal Diseases 22 Pigeons 12 Scabies ... 22 Mosquitoes 12 Impetigo 22 Noise 12 Disinfection 22 Atmospheric Pollution 12 Bacteriological Examinations 22 Poisons 13 Factories 13 3 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, my Lord, Ladies and Gentlemen, The general standard of health in the Borough throughout 1949 may be regarded as satisfactory. Notifications of infectious and other diseases rose from 732 (1948) to 851, due mainly to a greater prevalence of scarlet fever and to food poisoning outbreaks, though, fortunately, no death resulted from either of these causes. No case of diphtheria was reported during the year. The birth-rate declined from 12.87 (1948) to 11.44, and the death-rate of 12.00 showed an increase over the 1948 figure (10.48). The infantile mortality rate of 22.39 reached a new record low level. The civilian population of 78,050, as estimated by the Registrar-General, showed an upward trend, being over 2,000 more than the estimate (75,980) for the previous year. Food hygiene continued to receive special attention, and the preliminary steps taken to establish a Clean Food Association in the Borough are described in Section E of this report. Related to this campaign for cleanliness was the decision of the Council to provide free washing facilities in all public conveniences to encourage personal hygiene and to prevent the spread of disease. Rodent control measures were greatly intensified, more especially in an endeavour to combat the menace of the black rat. The number of operatives employed was increased from three to six, and special attention was directed to "block control" in the eastern part of the Borough. In the majority of infestations the owners or occupiers of the premises involved took advantage of the rodent destruction service provided by the Council. A considerable amount of useful work in the care of old people was again carried out by the Department—much of it outside the limited statutory powers possessed by the Council. The local Old People's Welfare Association also reported a year of great activity in various directions, and more particularly in the establishment of a home for the aged inhabitants of the Borough. An innovation that created general interest was the introduction of an emergency laundry service for old people which is proving successful in meeting a long-felt want. The work of the sanitary inspectors showed a marked increase, and towards the close of the year a complete survey of factories was commenced. As regards weather, the year 1949 was the sunniest since observations were first made in 1880, the sun shining for 300 hours above the average. The long dry spell began in September, 1948, and lasted thirteen months, and the lack of rain caused anxiety in many districts before relief came in October. My thanks are due to the Chairman (Councillor Captain Robert Whitney, M.B.E., J.P.) and members of the Public Health Committee for the consideration and encouragement they gave me throughout 1949 ; to my colleagues in other Departments of the Council for their co-operation and assistance ; and to the staff of the Public Health Department for their continued loyalty and support in the public health work of the Borough. I am, Mr. Mayor, my Lord, Ladies and Gentlemen, Your obedient Servant, H. A. BULMAN, Medical Officer of Health, 4 PUBLIC HEALTH COMMITTEE. 1949. HIS WORSHIP THE MAYOR : *Councillor A. E. Reneson Coucher, F.R.I.C.S., F.A.I., l.C.C., J.p. Councillor Charles Henry Press, J.P. ALDERMAN *Mrs. V. A. L. Freeman, J.P. COUNCILLORS : F. Y. Bright (January only). †Stafford Lorie. *E. Carew-Shaw, F.R.C.S. †The Hon. Mildred Lowther, O.B.E. T. K. Creamer. The Rt. Hon. Lord Mancroft, M.B.E., T.D. (†Vice-Chairman). *Mrs. H. I. H. Feiling (Vice-Chairman). †Mrs. Angus Maude. *Mrs. L. H. Fewster. †B. J. Owen. Frederick Frame. *E. R. Rawdon Smith, O.B.E., M.A. †Herbert C. Garrard. *Miss D. A. Sharpe, F.R.C.S., M.R.C.O.G. †R. T. Glenny. *L. Shilling. †B. Hawley. *H. Norman Toomey, L.D.S., R.C.S.(Eng.). †Mrs. Henderson-Begg. †Miss L. West Russell. †j. P. Honour. Capt. Robert Whitney, M.B.E., J.P. (Chairman). *Mrs. Carr Q. Henriques. *G. T. Hesketh (from February). Dr. Elizabeth Jacobs. *Until May. †From June. SECTION A.—STATISTICS AND SOCIAL CONDITIONS. GENERAL STATISTICS. Area of Borough: (a) exclusive of area covered by water, 1,427.8 acres ; (b) including area covered by water, 1,473 acres. Resident population : 1921 census—104,173 ; 1931 census—97,620. Registrar-General's estimate of civilian population (used in calculating various rates in this report) : 1949—78,050, including 3,979 children under 5 years and 5,102 children 5-15 years. EXTRACTS FROM VITAL STATISTICS. Total M. F. Live Births—Legitimate 794 395 399 Birth Rate per 1,000 estimated civilian population11.44 Illegitimate. 99 46 53 Stillbirths—Legitimate 19 9 10 Rate per 1,000 total (live and still) births 27.23 Illegitimate 6 3 3 Deaths (all ages) 937 432 505 Death Rate per 1,000 estimated civilian population 12.00 Deaths. Rate per 1,000 total (live and still) births. Maternal Mortality—Deaths from " Puerperal and Post-Abortive Sepsis "and" Other Maternal Causes " (Registrar-General's Code Nos. 29 and 30) Nil — Total M. F. Deaths of Infants under one year of age—Legitimate . 19 11 8 Illegitimate . 1 — 1 Death Rate of Infants under one year of age—All infants per 1,000 live births, 22.39; legitimate infants per 1,000 legitimate live births, 23.93; illegitimate infants per 1,000 illegitimate live births, 10.10. Marriages.—The total number of marriages was 1,461, being 196 below the number for 1948 and 33 above the average for the previous 10 years. The rate for persons married in 1949 was 37 per 1,000 of the estimated civilian population. Deaths.—The total number of deaths (937) shown in the following table is inclusive of persons who, though normally resident in the Borough, died elsewhere in England and Wales, but exclusive of persons who, though they died in St. Marylebone, were ordinarily resident in other parts of England or Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the St. Marylebone figures if they occur in the Borough. 5 TABLE 1.—Deaths—According to Age-Group and Sex. Code No. CAUSE OF DEATH Net Deaths at the Subjoined Ages of Residents (Male and Female) whether occurring within or without the Borough. All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards M F. M. f. m. F. m. f. m. F. m. F. m. F. 6 Tuberculosis of respiratory system ... 20 8 - - - - - - 6 5 11 3 3 — 8 Syphilitic disease 7 4 - - - - - - - - 2 3 5> 1 9 Influenza 3 9 - - - - — - - - 1 1 - 8 11 Acute poliomyelitis and polioencephalitis I 1 - - - - - - - 1 1 - - - 13m Cancer of buccal cavity and oesophagus (males only) 4 - - - - - - - - - 2 - 2 - 13f Cancer of uterus — 10 - - - - - — — 2 — 7 — 1 14 Cancer of stomach and duodenum 9 13 - - - - - - 1 — 5 4 3 9 15 Cancer of breast — 24 - — - - - — — 4 — 9 — 11 16 Cancer of all other sites 56 58 - - - - - - 3 2 22 31 34 17 Diabetes 2 8 - - - - - - - - 1 3 1 5 18 Intra-cranial vascular lesions 22 58 - - - - - - - 1 6 10 16 47 19 Heart disease 118 138 - - - - - - 2 4 32 15 84 119 20 Other diseases of the circulatory system 21 34 - - - - - - - 1 7 5 14 28 21 Bronchitis 48 19 - - - - - - 1 1 10 1 37 17 22 Pneumonia 30 24 2 — - 1 - — 1 — 12 6 15 17 23 Other respiratory diseases 6 5 - - - - - - - 1 3 3 3 1 24 Ulceration of the stomach or duodenum 8 8 - - - - - - I — 2 2 5 6 25 Diarrhoea (under 2 years of age) 1 1 1 1 - - - — — — — — — — 27 Other digestive diseases 12 8 - - - - - - - 1 3 3 9 4 28 Acute and chronic nephritis . 10 15 - - - - - - 4 — 4 8 2 7 31 Premature birth 2 5 2 5 - - - - - - - - - - 32 Congenital malformations, birth injury, infantile disease 6 4 6 2 - - - - - - 2 - - 33 Suicide 10 9 - - - - - - 6 5 1 4 3 — 34 Road traffic accidents 4 — — — — - - — 2 — — — 2 — 35 Other violent causes 15 16 — 1 1 1 - — 4 — 2 3 8 11 36 All other causes 17 26 — — — - 1 1 4 2 1 8 11 15 Totals 432 505 11 9 1 2 1 1 35 30 128 122 256 341 937 20 3 2 65 250 597 No death occurred from the following causes not shown in the table ; Typhoid and paratyphoid fevers, cerebro-spinal fever, scarlet fever, whooping cough, diphtheria (Code Nos. 1-5), other forms of tuberculosis (No. 7), measles (No. 10), acute infectious encephalitis (No. 12), appendicitis (No. 26), puerperal and post-abortive sepsis, other maternal causes (Nos. 29-30). TABLE 2.—Infantile Mortality—According to Age-Group and Sex. Code No. CAUSE OF DEATH Under 1 week 1 and under 2 weeks 2 and under 4 weeks 1 and under 3 months 3 and under 6 months 6 and under 9 months 9 and under 12 months Total M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 7 Diarrhoea - - - - - - - - 1 - - 1 - - 1 1 8 Enteritis 12 Congenital malformation 3 1 — — 1 1 — — — — — — — — 4 2 13 Premature birth 6 — — — — — — — — — — — — 2 5 15 Atelectasis 2 - - - - - - - - - - - - - 2 — 25 Pneumonia (all forms) - - - - 1 - - - 1 - - - - - 2 — 27 Other causes - - - - - - - 1 - - - - - - - 1 Totals 7 6 — — 2 1 — 1 2 — - 1 — — 11 9 13 — 3 1 2 1 — 20 No infantile death occurred from the following causes not shown in the table : Small-pox, chicken-pox, measles, scarlet fever, diphtheria and membranous croup, whooping cough (Code Nos. 1—6), tuberculous meningitis, abdominal tuberculosis, other tuberculous diseases (Nos. 9—11), atrophy, debility and marasmus (No. 14), injury at birth, erysipelas, syphilis, rickets, meningitis (not tuberculous), convulsions, gastritis, laryngitis, bronchitis (Nos, 16—24), suffocation, overlying (No. 26). 6 Mortuary.—Three bodies (1 male, 2 female) were received at the Public Mortuary, Chiltern Street. No post-mortem examinations were carried out. Crematorium.—The Medical Officer of Health is Medical Referee in connection with the Council's Crematorium, situated in the St. Marylebone Cemetery at East Finchley. During 1949, 669 certificates authorising cremation were issued, as compared with 360 certificates for 1948—an increase of 85 per cent. SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Staff.—Only two changes in staff occurred during the year. Miss B. Wilson commenced duty as an additional sanitary inspector on the 1st June, 1949, and Mr. A. W. P. Robinson resigned his appointment as sanitary inspector on the 30th November, 1949, to take up a similar position under the Widnes Corporation. Staff Medical Examinations.—The Medical Officer of Health is the Council's medical adviser for the purposes of the superannuation scheme. During 1949, 280 examinations of members of the staff and new entrants were carried out. Laboratory Facilities.—Dr. C. J. C. Britton is the Council's Bacteriologist and the work is carried out at No. 35, Harley Street, W.l. Mr. Thomas McLachlan, A.C.G.F.C., F.R.I.C., whose laboratory is situated at No. 4, Hanway Place, W.l, is the Public Analyst for the Borough. Representation upon other Bodies.—The Council were represented upon the under-mentioned statutory and voluntary bodies as indicated :— Body. Representatives. London County Council Divisional Health Committee (Division 2). The Chairman of the Public Health Committee. Councillor Miss D. A. Sharpe, F.R.C.S., M.R.C.O.G. (until May). Councillor Dr. Elizabeth Jacobs (from July). National Smoke Abatement Society The Chairman of the Public Health Committee. The Medical Officer of Health. Paddington and St. Marylebone District Nursing Association (Executive Committee). Councillor Dr. Elizabeth Jacobs (until October). Councillor the Hon. Mildred Lowther, O.B.E. (from October). St. Marylebone Youth Centre Committee (Manage- Councillor F. Frame, ment Committee). Conferences.—The Council were officially represented at the under-mentioned conferences dealing with matters within the purview of the Public Health Department :— Conference. Delegates. Royal Sanitary Institute. Brighton. 23rd to 27th May. The Chairman of the Public Health Committee and the Medical Officer of Health. Royal College of Nursing—" The Home Life of Old People." London. 20th and 21st July. Miss M. M. Sharp, Sanitary Inspector. London County Council-—" Juvenile Delinquency." London. 22nd July. Councillor The Hon. Mildred Lowther, O.B.E. Sanitary Inspectors'Association. Eastbourne. 12th to 16th September. Mr. V. A. Bignell, Sanitary Inspector. National Old People's Welfare Committee—" Care of Old People." London. 13th and 14th October. The Chief Administrative Assistant and Miss M. M. Sharp, Sanitary Inspector. Government Properties—Exemption from Legal Requirements.—For some time it has been found increasingly difficult to carry out certain functions and duties of the Public Health Department owing to the immunity from strict compliance with the law which appears to be available to various classes of persons and properties. Special privileges are given to Government Departments which indirectly represent the Crown and accordingly affect premises either permanently or temporarily occupied by them. In other cases this immunity attaches to the Crown Estates and covers not only properties directly owned and occupied by departments of the Crown but extends to private lessees and tenants who should not be treated differently from any other individual or firm. Some difficulty has, for example, been experienced in carrying out routine inspections of staff canteens operated by 7 Government Departments and the right of the Council's Inspector to have access thereto has beeil denied. Similarly, it is not possible to make closing orders under the Housing Acts or to enforce compliance with the Drainage Byelaws made under the Public Health Acts, where Crown properties are concerned, even though the occupation is by private individuals claiming through the Crown. These exemptions, which now cover an ever-widening class of persons and properties, particularly in St. Marylebone, are undesirable and may lead to grave dangers to the public health—quite apart from the difficulty in taking enforcement action against private firms and individuals as this apparent partiality is likely to receive adverse comment and cause administrative embarrassment. Being convinced that the work of its officers concerned with the maintenance of the public health is frequently hampered or frustrated in many directions by the exemptions claimed by the bodies and individuals mentioned, the Council asked the Metropolitan Boroughs' Standing Joint Committee to consider (i) the advisability of making a full investigation into the extent of the real or apparent immunity, enjoyed by Government Departments representing the Crown and by certain other leaseholders and occupiers of Crown lands, from the strict observance of the ordinary legal requirements of the Food and Drugs Acts, the Public Health Acts and the Housing Acts, together with ancillary byelaws, rules and orders ; and (ii) making representations in the appropriate quarter in order to secure a limitation of these exemptions in the interests of the public health. Care of Old People.—Two hundred and seventy-seven old people were visited by one of the women sanitary inspectors. Apart from 27 married couples included in the number, the great majority were living alone and required constant observation, particularly where they were awaiting admission to hospital. The domestic help service continued to render valuable assistance to a large number of the aged inhabitants of the Borough. Special Laundry Service.—From time to time difficulty and distress are caused by the inability of old persons who are acutely ill and suffering from incontinence to get their bed linen and night-wear washed. These cases generally arise because of the lack of sufficient hospital accommodation, the fact that many old people who are living alone have no reserve of bed linen, and to the unwillingness of laundries to deal with badly soiled sheets and clothing. Wherever it is possible, efforts are made to tide over the emergency by borrowing sheets from the District Nursing Association but the laundry problem still remains. The Council therefore decided to take advantage of section 122 of the Public Health (London) Act, 1936, which states, inter alia, that on a report from the Medical Officer of Health that any article in a house is in such a filthy, dangerous or unwholesome condition that health is affected or endangered thereby, the Sanitary Authority may cause the article to be cleansed and removed for that purpose. Special arrangements were accordingly made at the Council's Cleansing Station to deal in appropriate cases with the bed linen, etc., of old people, and for the service to commence to operate early in 1950. St. Marylebone Old People's Welfare Association.—This voluntary body, established in May, 1947, and supported by representatives of various organisations, religious bodies and statutory authorities, carried out another useful year's work in the interests of the aged inhabitants of the Borough, and the pooling of knowledge and experience at the monthly meetings of the Executive Committee has led to new developments in all branches of the work. The Committee also serves as a channel of communication with similar committees in other areas with whom information and ideas are exchanged, and with the National Old People's Welfare Committee, which keeps the Association informed of changes in legislation affecting old people and of the trends of thought in the country as a whole. The Association's delegates attend the quarterly conferences of Old People's Welfare Committees in the London Region, and the annual conference of the National Committee. Knowledge of what can be done and what should be done has grown steadily since the Association was formed. A public meeting was held in November, 1949, and those who attended it were surprised by the scope and variety of the activities of the constituent organisations. It is their members who do the work ; the Executive Committee of the St. Marylebone Old People's Welfare Association is the link between them. One of the Association's major pre-occupations has been the need for a home for old people who can no longer manage life alone. A beginning of modern specialised housing for old people in St. Marylebone has been made by the St. Marylebone Housing Association and Trust, and their block of old people's flats and converted houses may be regarded as models of their kind. Of older foundations the Borough has two, namely, the St. Marylebone Almshouses, St. John's Wood Terrace, and the Christian Union Almshouses, Crawford Place. But all these are for the able-bodied elderly. There are also the Ladies' Home in Abbey Road, St. John's Wood, the special ward for old men established by the Church Army in Marylebone Road, and the Home for Old People maintained by the Swedish Church in Enford Street. These last, however, are not limited to the aged of St. Marylebone. The need for a home for them is acute. The Association spent nearly two years trying to find suitable premises and, when they had found them, trying to raise the necessary finance. Finally, it was 8 realised that the proper course was to found a separate housing society for the purpose. This was done in August, 1949, under the name of "St. Marylebone Old People's Homes, Limited." This new body is an independent organisation, responsible for its own policy and finance; but the Association is strongly represented on its Committee and the two bodies have for the moment the same Chairman and Secretary. With the help of a loan from the London County Council, the Home Committee have raised enough money to buy two houses in Greville Place. A Christmas appeal launched at the public meeting arranged by the Association brought in £1,000. Plans for the necessary alterations to the houses and for raising the further money required to complete the scheme are in hand. The three "Darby and Joan" Clubs of the Women's Voluntary Services still flourish, and three new clubs have come into existence. One was organised by the Women's Committee of the Liberal Jewish Synagogue, St. John's Wood Road, another by the Inner Wheel of the St. Marylebone Rotary Club, and the third, for deaf old people, by a member of the League for the Hard of Hearing. All six arranged summer outings and Christmas parties, and hold weekly meetings with an average attendance of 50. The members pay 1d. a week into the Club funds, and run jumble sales to augment them. A "meals on wheels" service is operated by the Women's Voluntary Services on five days a week, serving 5,000 meals annually, at a charge of 8d. per meal, to ill and infirm old people in their own homes. Transport is provided by the Association and consists of a van equipped with properly insulated individual meal containers. The financing and running of this service provide a good example of the co-operation between voluntary and statutory bodies recently urged afresh by the Ministry of Health. The Borough Council, under the powers conferred by section 31 of the National Assistance Act, 1948, made a grant, to cover costs of transport, of £300 for the year, and have renewed it for a second year. The W.V.S. workers who take the meals round keep a watchful eye on their quality and variety, and members of the Housewives Club undertake the not inconsiderable task of washing-up. It has not been possible to provide special invalid diets; nevertheless, frequent calls on the service are made by hospitals on behalf of old people discharged from their wards who need meals for a few weeks until they are strong enough to manage for themselves again, and these calls are being met. In addition to the two luncheon clubs at the Fourth Feathers Club and the Cookshop of the St. Marylebone Housing Association, which between them serve 10,000 dinners a year at special prices to old age pensioners, a third has been started by the Women's Voluntary Services at the St. Marylebone Centre premises, No. 196, Marylebone Road. As in the case of the "meals on wheels" service, the meals for the new club come from the London County Council Restaurant in Chiltern Street, and the Association has been able to help by transporting the containers in their van, thus adding another 4,000 or 5,000 meals a year to the van's usefulness. To meet the initial expenditure and running costs incurred by the W.V.S. in this new venture, the Borough Council made a further grant, not exceeding £80, under section 31 of the National Assistance Act, 1948. Visiting of old people, the first of the Association's undertakings, remains the most important. Twelve visitors report to the Hon. Secretary, usually at the monthly visitors' meeting. In addition, the thirteen parish visitors of St. Peter's Church, Vere Street, have chosen one of their number as liaison officer to attend the Association's meetings, make reports and discuss the problems of their old people. This has proved a fruitful method of co-operation, and the Executive Committee would welcome similar arrangements with other churches. There were over 11,000 people of pensionable age in St. Marylebone at the end of 1947, the latest year for which figures are available. A large proportion of them obviously do not need welfare work, but the number who do is great and increasing. There are not enough visitors to send to those known to the Association and there must be many lonely old folk of whom there is no knowledge until they fall into the kind of distress which brings them into contact with the Home Helps Service or the Public Health Department. The Association issued an urgent appeal to anyone who could spare even two afternoons a month to help in this simple service of paying a few friendly visits. Personal friendships with individual people are considered the basis of all useful welfare work, which no theories or generalisations can replace. Through the kindness of the Mayors who have been successive Presidents of the Association it has been possible to put forward the names of old people as recipients of gift parcels from abroad. The local Fuel Overseer takes immediate action on any report from the Association of difficulty over the delivery of coal, and the Borough Engineer has arranged to supply wood blocks at reduced prices to old people. No account of the work done on behalf of the old people in the Borough would be complete without a tribute to the tireless devotion of Miss M. M. Sharp, one of the Council's sanitary inspectors, to this aspect of the Department's activities in an official capacity and to the St. Marylebone Old People's Welfare Association as a voluntary worker in her spare time. As already indicated, the extension of the various services provided by the Association is entirely dependent upon more helpers, and offers of assistance will be welcomed by the Honorary Secretary, Miss M. K. C. Macintosh, Room 103, Town Hall, St. Marylebone, W.l. (Telephone : WELbeck 7766.) 9 SECTION C.—SANITARY CIRCUMSTANCES. Sanitary Inspection.—Complaints were received in respect of 1,324 premises. Details of the various nuisances detected and remedied, to the total number of 4,857, are set out in Table 3. In 1,096 cases a preliminary (intimation) notice was issued, and in 276 instances this was followed by the service of a statutory notice to secure abatement of nuisances. In addition, 72 notices were served under the London County Council Byelaws made under the Housing or Public Health Acts, and one notice under the local byelaw with respect to the cleansing of cisterns. Legal proceedings were instituted in 23 cases under the Public Health (London) Act, 1936, in respect of failure to comply with statutory notices. In 9 instances penalties amounting to £23 0s. Od. were imposed and costs awarded to the Council. Costs without the imposition of a fine were allowed in a further 4 instances. Three cases were dismissed and in the remaining cases abatement orders were made or the summonses were withdrawn, the necessary work having in the meantime been completed. Legal proceedings under the County Council Byelaws were taken in two instances, in both of which convictions were obtained and fines amounting to £3 5s. Od. imposed. Costs were awarded to the Council in one case. TABLE 3.—Nuisances Detected and Remedied. Nature of Nuisance Districts The Borough No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Houses clamp, dirty or dilapidated remedied 51 94 225 160 143 295 968 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., repaired 26 82 140 86 64 43 441 Verminous dwellings disinfested 80 59 134 167 106 84 630 Verminous furniture and bedding disinfested 69 40 55 42 22 88 316 Overcrowding abated 34 11 27 19 10 9 110 Water closet defects remedied 22 - 38 56 75 74 265 Insufficient and unsuitable water closet accommodation remedied - - 3 4 8 22 37 Urinal defects remedied 1 — — 2 — 5 8 Drain and water closet stoppages cleared 4 21 19 5 8 27 84 Drains relaid or amended — 5 12 12 1 6 36 Soilpipes and ventilating shafts repaired or renewed 1 3 8 1 1 33 47 Waste pipe defects remedied 5 8 17 11 10 45 96 Yard defects remedied — — 5 6 — 6 17 Wash-house defects remedied 2 7 1 16 — 3 29 Area defects remedied — — — 1 — 15 16 Roofs and gutters repaired 21 91 104 65 47 87 415 Water supply to houses reinstated 1 — 9 5 1 4 20 Water supply laid on to upper storeys — 9 12 5 — 8 34 Water cistern defects remedied — 12 6 10 1 15 44 Dung or dust receptacles repaired or renewed 2 — 15 10 8 41 76 Rubbish, manure, etc., accumulations removed — 3 15 20 22 55 115 Animal nuisances abated — 2 — 3 — 3 8 Rat and mouse infestations dealt with 48 57 108 165 197 265 840 Bakehouses cleansed 2 1 2 1 4 1 11 Smoke nuisances abated — 3 — 1 .— 17 21 Shops—sanitary defects remedied 4 — 1 1 — 5 11 Miscellaneous 5 15 53 13 7 69 162 Totals 378 523 1,009 887 735 1,325 4,857 Sanitary Accommodation at Public Houses.—From time to time serious nuisance is committed in certain parts of the Borough which would seem to have a direct connection with the absence of suitable sanitary accommodation in nearby public houses. A survey of licensed premises revealed the existence of the following conditions as to sanitary accommodation for the public :— Adequate 81 Inadequate 40 Installations in hand 6 No sanitary accommodation 1 128 The general standard of accommodation was found to be satisfactory in 77 instances and unsatisfactory in 51. The Council have no power to compel publicans to provide sanitary accommodation for the use of the public in connection with licensed premises, but the attention of the licensing justices was drawn to those public houses where conditions were unsatisfactory in the hope 10 that the need for improvement in this direction might be borne in mind when the question of renewal of licences was next under consideration. Sewer Emanations—St. John's Wood.—From time to time for a great many years, and particularly during spells of dry weather, complaints have been received from residents in the St. John's Wood district of offensive smells coming from the street ventilators of the London County Council's sewers which pass under this area. In 1929, and again in 1934, for example, large numbers of complaints were made and the attention of the London County Council was drawn to the nuisance. Since that time the complaints have persisted in greater or lesser degree, and during the first two months of 1949 numerous complaints were received in the Department by letter or telephone from persons residing in Finchley Road, Wellington Road, St. John's Wood Road and adjacent thoroughfares. These complaints, after substantiation by the sanitary inspector, were referred to the Borough Engineer who took the matter up with the Chief Engineer of the London County Council. In view of the long-standing nature of this widespread nuisance, a formal communication was addressed by the Borough Council to the London County Council pointing out once more the existence of a serious nuisance in the Borough and pressing for remedial measures of a permanent character to be undertaken. Water.—Although water for domestic purposes is obtained from private wells at a small number of blocks of flats and offices, the chief source of a constant supply throughout the Borough is from the mains of the Metropolitan Water Board. One complaint as to quality was received during the year and this was referred to the Board. In accordance with the provisions of the Public Health (London) Act, 1936, the Board notified five instances where water had been cut off in occupied premises for nonpayment of rates or for the use of irregular fittings. In all cases the supply was reinstated, in some instances after service of a notice. Further examinations of the private well waters from the ten borings still in use were made by the Public Analyst and the Council's Bacteriologist and these indicated that chemically there was no appreciable change since a report was submitted in 1947. No pathogenic contamination was found and reports generally were very satisfactory. Drainage.—The number of plans approved was 320, of which 18 related to new buildings. The drainage inspectors made a total of 3,089 visits. Combined Drainage.—Nine orders under seal for combined drainage were issued. Sealing-off Disused House Drains.—The London County Council considered the desirability of sealing-off all disused house drains and repairing faulty drains, which, by providing safe nesting places for rats, tend seriously to nullify disinfestation work carried out by the County Council in its sewers, and also cause obstruction to the flow in the sewers by soil and gravel entering through the broken drains. The County Council offered to co-operate with the Borough Council by advising them from time to time of any connections which appear to be faulty or disused and by allowing the Borough Council's representatives to examine any of the County Council's sewers where connections are defective or are thought to be disused. Under the Public Health (London) Act, 1936, the Borough Council have the power, where any drain appears to be in bad order and condition or to require cleansing, alteration, repair or filling up, to execute the necessary works and to recover the expenses from the owner or occupier of the premises. As wider powers in this connection are available to extra-metropolitan authorities under the Public Health Act, 1936, whereby costs and administrative expenses can be secured as a charge on the land affected, the Metropolitan Boroughs' Standing Joint Committee requested the London County Council to include provision in a General Powers Bill to secure the application to London of powers of recovery of expenses similar to those contained in the Public Health Act, 1936. Building Licences.—During the year 237 applications for building licences were passed to the Department by the Borough Engineer for observations in relation to proposals concerning drainage, ventilation and underground rooms, and also in cases where work had been called for by sanitary notices. Public Conveniences.—The usual supervision was exercised over the 15 public sanitary conveniences (11 for men, 4 for women). Extensive repairs were carried out at Barrett Street Convenience which was damaged by enemy action during the war. As from the 2nd May, 1949, linen towels and tablet soap, for which a charge had been made, were completely withdrawn from all public conveniences, and free washing facilities, with paper towels and liquid soap, provided instead to encourage personal hygiene in the interests of the public health and to prevent the spread of disease. At the same time, the words "Now wash your hands, 11 please" were printed on every sheet of toilet paper. The whole scheme proved a success, and during the remaining eight months of the year there were approximately 146,000 free washes. In the corresponding period of 1948 the number of paid washes was 56,855. Public Cleansing and Salvage.—The Director of Public Cleansing has kindly provided the following information on these services. The approximate amounts dealt with during 1949 were : house and trade refuse, 34,460 tons ; street sweepings and gully slop, 3,040 tons ; salvaged materials, 4,670 tons, including 1,715 tons of kitchen waste for pig and poultry feeding collected from 550 bins placed at intervals in the streets for the reception of this material. A sum of £9,997 7s. 8d. was obtained from the sale of salvaged materials. In addition, £938 19s. 11d. was received for the removal of trade refuse, green offal and the cleansing of petrol interceptors. During the year delivery was taken of two new vacuum gully-emptying machines and six lowloading vehicles for the collection of street sweepings. Orders were also placed for 50 new street orderly trucks and 60 sand and ballast bins. Shops.—Inspections under the Shops Act, 1934, numbered 647. In 11 instances service of notice was necessary. Sales from Slot Machines—Contraceptives.—On the 8th November, 1949, the London County Council made a byelaw under section 146 of the London Government Act, 1939, prohibiting the sale of contraceptives from slot machines so placed as to be used by persons in the street. This byelaw, which follows the model form prepared by the Secretary of State, was confirmed by the Home Secretary on the 7th January, 1950, and came into operation on that date. Diseased or Infirm Persons.—Only once was it necessary to resort to action under section 47 of the National Assistance Act, 1948. In this case a spinster, aged 81 years, was living alone in a very neglected state in an insanitary basement room. She was quite incapable of looking after herself. The only known relative was a niece in Northern Ireland who stated she was unable to help her aunt in any way. All possible assistance was rendered by the domestic help service and by visitors from the Public Health Department and a local church. Eventually it became imperative in her own interests that she should be removed to hospital. As she refused to leave her room voluntarily, application to Court was made and the period named in the order issued was three months. The woman, however, died from myocardial degeneration and senility after two months in the Paddington (General) Hospital. Private burial was arranged by the church authorities, and the meagre effects left by the deceased were dealt with by the Welfare Department of the London County Council. Burial or Cremation of the Dead.—Under the provisions of section 50 of the National Assistance Act, 1948, it is a duty of the Council to cause to be buried or cremated the body of any person who has died or been found dead in the Borough where no other suitable arrangements for disposal of the body have been or are being made. The arrangements set up when the section became operative on the 5th July, 1948, continued to work satisfactorily and during 1949 the burial of 14 bodies was undertaken by the Council. The total expenditure incurred in dealing with these cases was £98 6s. 6d., of which £32 12s. 5d. had been recovered by the end of the year. During the year regional hospital boards were requested by the Minister of Health to arrange and pay for the burial or cremation of patients who die in hospitals within the National Health Service scheme, in cases where relatives of the deceased (i) were not, immediately before the patient's death, liable for his or her maintenance under section 42 (1) of the National Assistance Act, 1948, and are not willing to arrange for the burial; (ii) are unable to obtain a death grant under the National Insurance Act, 1946, and cannot otherwise afford to arrange for burial; or (iii) cannot be traced. The Minister considered that the foregoing categories would include the majority of patients dying in hospital whose relatives did not undertake to arrange for burial. Hospital authorities were, however, advised that, in the exceptional case where a "liable" relative fails to carry out his responsibility, the matter should be referred to the local authority, upon whom the residual duty rests under the Act of 1948, and who have in appropriate cases the power to recover funeral expenses from the person legally responsible therefor. Consideration was given to the position arising in cases where the Borough Council are requested to arrange for the burial of stillborn children. As the Act refers to the burial of "persons" and it was established that a stillborn child, having had no separate existence, was not a "person," the Council were probably not strictly liable to arrange for the disposal of the body. Not wishing to avoid liability on a technicality such as this, the Council gave instructions that in cases where no other suitable arrangements were being made, the burial of the bodies of stillborn children should be carried out by the Council without prejudice to their rights to recover the cost from any responsible person, 12 Disinfestation.—The campaign against the bed-bug was continued on the lines described in detail in last year's report, 578 dwellings, involving 1,329 rooms, being treated with D.D.T. by means of the special van containing a petrol-driven compressor unit and the necessary hosing and spraying apparatus. Included in the 578 dwellings were 118 requisitioned premises and 33 municipal flats where bugs were found. Treatment of verminous furniture by hydrocyanic acid gas (HCN) which has been carried out, in specially constructed vans, under contract by the Council for many years, has been continued, more particularly in the case of removals to fresh housing accommodation. In 1949 the furniture of 237 families (of whom 225 were being rehoused) was dealt with by this method. Verminous Persons.—The Council's Cleansing Station in Lisson Grove dealt with 1,632 vermin-infested persons : adults 484 (men 440, women 44) ; children 1,148 (boys 268, girls 880). Shelter.—The shelter accommodation provided at 217, Lisson Grove, under section 195(4) of the Public Health (London) Act, 1936, for families temporarily dishoused was used for one night by one person while disinfestation of her dwelling was being carried out. Rodent Control.—Complaints received numbered 1,035, and 73 food and 767 other premises were found to be infested. Of the 73 food premises, 33 were shops, 36 hotels and restaurants and 4 clubs ; the 767 other premises included 389 dwelling houses, 99 shops, 120 warehouses and stores, 25 factories, 19 hospitals and institutions, 98 offices, 8 garages and 9 bombed sites. In the majority of cases the owners or occupiers of infested premises were glad to take advantage of the Council's rat destruction service, in connection with which the rodent operatives made a total of 10,710 visits. Treatments were given in accordance with the recommendations of the Ministry of Agriculture and Fisheries and were charged for at the rate of 5s. per treatment in the case of private dwellings and 10s. per treatment for most business premises. Higher charges were made in a small number of instances where the size of the premises necessitated more extensive work. In order to combat the spread of rats, and more particularly of the ship or black rat, the rodent control staff was increased by one operative in August and by two operatives in October, making a total of six operatives, one of whom was given the status of "leading rodent operative." At the same time one of the sanitary inspectors was designated "Rodent Officer." In November a scheme of re-organization was inaugurated and a beginning was made in the application of "block control," which involves a survey of all buildings in island blocks where the presence of rats is suspected. The half-yearly treatment of sewers was continued and it was computed that 2,324 rats were killed in January and 710 in July as a result of this action. The Council's publicity material was improved by the addition of an attractive pictorial poster and leaflet urging those troubled with rats or mice to get into touch with the Public Health Department. Dog Nuisance.—Contraventions of the bye-law relating to the fouling of footways by dogs reported by the Streets Nuisance Inspector resulted in summonses in 27 cases. One further offence was notified by the police. In all of these convictions were secured and penalties imposed, costs being awarded to the Council in five cases. The total number of prosecutions since the bye-law came into operation in 1928 is 431, the amount of fines imposed being £177 14s. 6d. In addition to the formal printed notices, pictorial posters, urging dog owners to keep the pavement clean and warning offenders of the consequences of failure to do so, were prepared and exhibited during the year. Smaller reproductions were issued as leaflets. Pigeons.—Nuisance from these birds was the subject of two complaints relating to a church and a public building. Both complaints were dealt with satisfactorily by an approved pigeon catcher to whom the complainants were referred. Mosquitoes.—Complaints of mosquitoes were received during the summer months from residents in the neighbourhood of the Grand Union Canal. While it was not at all certain that the insects came from the canal water itself, there was evidence that mosquitoes were breeding in bilge water in moored canal boats and this matter was taken up with the Docks and Inland Waterways Executive who made representations to the owners of the craft concerned. No further trouble was experienced. Noise.—Complaints of nineteen noise nuisances were received. They were concerned with such diverse matters as dogs, radio, costermongers' barrows, bands, street musicians, hospital hooter, machinery of various kinds, demolition operations, shoe-repairing shops, and a social gathering. The majority of these nuisances were abated after action by the sanitary inspector and streets nuisance inspector. In other cases, where upon investigation it appeared that the Department had no power to take direct action, the complaints were referred to the Town and Country Planning Authority and to the Police. In no case was legal action necessary by the Council. Atmospheric Pollution.—For many years emissions from the Aberdeen Place and Lodge Road Electricity Generating Stations have been a source of serious nuisance. From time to time 13 representations have been made to the authorities concerned, and in May, 1949, a conference took place between the Group Engineer of the British Electricity Authority, the two Generating Station Superintendents, and the Medical Officer of Health and other officers of the Public Health Department. The Medical Officer of Health referred to repeated complaints, especially with regard to the emission of grit which caused great nuisance in the neighbourhood. On behalf of the British Electricity Authority it was said that it was their intention to do everything possible with the plant at present at their disposal to prevent atmospheric pollution. Both stations were equipped with grit extraction apparatus, but this was twenty years old and could not be considered 100 per cent, efficient by modern standards. The Authority had a very large over-all construction programme and new stations would be provided with the most up-to-date plant. The trouble with the two stations in question was in some degree due to overloading, but as new stations came into operation this would ease. It would be four or five years before the St. Marylebone stations could be dealt with ; meanwhile the Authority were not prepared to divert energy from their big scale programme to gain some comparatively small local advantage. It was arranged that the Public Health Department would notify the Generating Station Superintendents of serious smoke emissions immediately they were observed in order that preventive measures could at once be taken. The actual emission of grit, however, it was almost impossible to detect. Elsewhere observations were made regularly throughout the year, and complaints were received in respect of smoke nuisances arising from fifteen premises, relating to commercial undertakings, blocks of flats, private houses and a public institution. In most cases the nuisance, recurrent in some instances, was abated after informal action. Variation in the grades of coal available gave rise to difficulties in operating a number of boiler installations. Legal proceedings were instituted in respect of smoke emanations from a large commercial building and the firm were convicted and fined £5 0s. 0d. with £3 3s. 0d. costs. Poisons.—The names of 79 traders were on the Council's list of persons entitled to sell poisons included in Part 11 of the Poisons List (Pharmacy and Poisons Acts, 1852 to 1941), the premises concerned numbering 93. Factories.—As indicated in the report for 1948, it was intended to carry out this year a complete survey of all factories in St. Marylebone, involving the inspection of some 2,000 premises, approximately 75 per cent. of which have mechanical power. Owing to staffing and other difficulties, however, it was not possible to commence this task until near the close of the year. Following 446 inspections carried out during 1949, conditions were remedied in 70 instances (want of cleanliness, 29; insufficient or unsuitable sanitary conveniences, 35; overcrowding, 4; inadequate ventilation, 1; unreasonable temperature, 1). Outworkers lists were received from 80 employers in respect of 160 contractors and 1,131 workpeople. Of these, 76 contractors and 385 workpeople carried out the work in the Borough. SECTION D.—HOUSING. Permanent Schemes.—Six blocks of flats and maisonettes on the Church Street Estate (comprising 89 of the 140 under construction) were ready for occupation at the end of the year. Twenty-nine of the 172 flats under construction on the Barrow Hill Estate were also completed during the year; the maternity and child welfare centre on this estate will be ready for use early in 1950. Communal laundry facilities were available at the Church Street Estate at the end of 1949, and similar accommodation is being provided at the Barrow Hill Estate. The estimated total cost of the Church Street scheme is £452,260, and the Barrow Hill £510,693. The demolition of properties on the southern section of the Townshend Cottages site was commenced and tenders were accepted for building the first block of 70 flats at a cost of approximately £85,9000. The estate, when completed, will comprise 221 dwellings at an estimated cost of £578,340. The building of 23 flats at a cost of approximately £41,016 at St. John's Wood Road was commenced during the year. The Council made compulsory purchase orders for four further sites, namely :— Site Estimated Site No. Area capacity total cost £ 4 35/55, Boundary Road 58 flats 123,560 6 75/77/79, Boundary Road, and 74/76, Abbey Road, extended to include 70/72, Abbey Road and 2/4 Springfield Road . 55 flats 138,124 14 152/158, Hamilton Terrace and 77/83, Carlton Hill and land at rear 76 flats 189,500 15a 69/71, Marlborough Place and land in Abbey Gardens at rear of old St. Mark's Church School 38 flats 112,310 14 The Council have also entered into a lease of sites Nos. 30, 31 and 32 comprising 1.85 acres in Wellington Road, Circus Road and Kingsmill Terrace, with a view to development for housing purposes. Grading of Housing Estates and Rents.—During the year the Council accepted the principle of grading their permanent housing estates according to the amenities and to utilise the exchequer subsidies earned by the higher-graded (and higher-rented) estates in reducing the rents charged at the lowergraded estates. The Housing Committee were requested to draft a scheme on these lines for implementation early in 1950 ; in the meantime the available flats at the Barrow Hill and Church Street Estates have been let at provisional rents. Fisherton Street Housing Estate.—Works of repair and redecoration, etc., were carried out at a cost of approximately £2,600, in addition to the day-to-day running repairs. A tender was accepted for the modernisation of the first stage of the hot water plant at a cost of £3,534 and the work will commence early next year. Crawford Place Dwellings.—The work of reinstating four basement flats, formerly used as an air-raid shelter, was completed and the flats were occupied early in the year. Repairs and decorations were carried out to the value of £575. Requisitioned Premises.—Internal and external re-decorations were carried out at a cost of £35,808. Adaptation works to further suitable premises have been executed during the year to provide additional housing accommodation. The total number of residential units held by the Council in requisitioned premises at 31st December, 1949, was 1,044. "Half-Way" Houses.—Works for the conversion of Nos. 45-49, Beaumont Street and Nos. 39-41, Nottingham Street into " half-way " houses will be completed early next year. St. Marylebone Housing Association.—The Association completed the erection of 64 flats at Cochrane Street in November, 1949, with the assistance of an exchequer subsidy. The tenants were nominated by the Council. Inspection of Dwelling-houses.—Number of houses inspected for defects under the Public Health or Housing Acts—4,858; number of inspections made—11,118; number of houses found not to be in all respects reasonably fit for human habitation—906; number of defective houses rendered fit in consequence of informal action—690; number of houses in which defects were remedied by owners after service of formal notices under the Public Health (London) Act, 1936—276. Underground Rooms.—Closing orders under section 12 of the Housing Act, 1936, were made in respect of 17 rooms, and three closing orders, affecting six basement rooms, were determined. Several undertakings from owners not to use or permit to be used underground rooms for human habitation were accepted by the Public Health Committee during the year. Re-housing.—During the year 450 enquiries were received from the Council's Housing Director, the County Medical Officer of Health and the Director of Housing of the London County Council, and from other authorities, regarding the circumstances of persons applying for re-housing. Each case necessitated investigation by a sanitary inspector before the enquirer could be provided with a report to assist him in assessing the degree of priority to be given to the various applicants. Housing of Persons from Abroad.—In view of the great shortage of housing accommodation in this country and the need for preventing overcrowding wherever possible, the Borough Council last year drew the attention of the Metropolitan Boroughs' Standing Joint Committee to the desirability of some procedure to ensure that a local authority was given an opportunity of expressing views on the adequacy or otherwise of accommodation proposed to be offered to persons who intended entering this country from abroad. Representations of the Standing Joint Committee on this matter were duly considered by the Minister of Health who stated that the procedure agreed in the case of sponsored immigration from Cyprus (whereby the Commissioner for Cyprus consults the relative local authority before the families are permitted to take up residence in England) would involve much practical difficulty, particularly as it is not possible to prevent British subjects from coming here if they wish to do so. The Minister also contended that aliens, whose entry into this country is strictly controlled, can only cause overcrowding in a few isolated instances and, as regards workmen from Eire, applicants for work in England are now advised of the difficulties of obtaining accommodation for their families in this country. The Minister added that further discussions on the general problems of the matter were being held with other Government Departments and that the difficulties of metropolitan borough councils would be borne in mind. 15 Common Lodging Houses.—There are two lodging houses in the Borough : one, accommodating 436 men, owned by the Salvation Army and situated at No. 2, Burne Street and premises in Lisson Street ; the other, registered for 100 women, conducted by the Church Army at Portman House, No. 10, Daventry Street. The attention of the owners of both establishments was drawn to the necessity for fairly extensive alterations in the premises. In the case of the men's lodging house these involve additional natural lighting and ventilation to certain of the dormitories, the replacement of old sanitary accommodation by new water-closets, urinals and washing facilities in various parts of the building, and the re-planning of the kitchen in a position adjacent to the dining room. These works were in hand at the close of the year. At the women's lodging house, sanitary accommodation, baths and washing facilities are to be provided on the four floors where dormitories are situated, and it is anticipated that this much-needed improvement will be made next year. The sanitary inspectors made 117 visits to the common lodging houses during 1949. Rent Restriction Acts.—A question arose as to the desirability of advising tenants of their rights under these Acts where a sanitary notice had been served in respect of their dwellings. In view of the complexity of the statutes it was arranged that the sanitary inspector would, in appropriate cases, inform the tenant that a sanitary notice had been served upon the owner and, in cases where the issue of a disrepair certificate appeared to be justified, suggest that the tenant should enquire of the Town Clerk's Department whether he was eligible to derive benefit by the issue of such a certificate. If, in the opinion of the Town Clerk's Department, this was the case the tenant would be advised to make application to the Medical Officer of Health for a certificate, for which a fee of one shilling is payable. During the year three disrepair certificates were granted. SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Clean Food Campaign.—The Food and Drugs Acts require that a certain minimum standard of hygiene and cleanliness shall be maintained in premises where food is prepared, sold or stored, and model byelaws to be issued shortly will further strengthen these requirements. Whilst these powers go a long way towards ensuring a clean and safe food supply it is essential that legislation should be observed not only in the letter but in the spirit. Public interest in the cleanliness of the food supply has greatly increased since the war. People are becoming more fastidious and, moreover, realise that disease is spread by unclean food. A steady improvement in conditions in the Borough has resulted from special attention recently given to this question, but the Public Health Committee felt that traders might be encouraged to attain something more than the minimum standard required by law if they themselves could take a more active part in dealing with the problem. Accordingly the Committee suggested the formation of a "St. Marylebone Clean Food Association" to embrace not only the proprietors of restaurants, cafes and canteens but also butchers, grocers, fishmongers, greengrocers and all other traders engaged in the handling or preparation of food, whether cooked or uncooked. Applicants for membership would be required to undertake to comply with a Code of Practice and, subject to a satisfactory report from the Medical Officer of Health, would be issued with a certificate and badge of membership in respect of the premises to which their application related. A breach by any member of the Code of Practice would, if established by investigation and subject to certain safeguards, lead to the withdrawal of the certificate and badge and deletion of the offender's name from the register of members. It was decided that in the first instance all proprietors of establishments engaged in food handling and preparation should be invited to attend a meeting at the Town Hall when the aims and objects of the Association would be broadly outlined. At this meeting a Working Committee would be elected to draw up Articles of Association and draft a Code of Practice. In these matters the Medical Officer of Health and the staff of the Public Health Department would help and advise but the final details would be settled by the Working Committee, who would subsequently be replaced by an Executive Committee, to be elected annually, whose duties would include consideration of applications for membership, authorisation of the issue or withdrawal of certificates and badges, and the organisation of demonstrations, lectures and discussions on various aspects of food handling and hygiene. The scheme has the full support of the Borough Council, but it is intended that the Association shall be run as an independent body by members of the trades concerned. At the close of the year arrangements were in hand for preparing a complete list of food traders in the Borough in order that the inaugural meeting of the Association could be convened. At the eastern end of the Borough and over the borders in St. Pancras, Holborn and Westminster there are a number of restaurants owned and controlled by Cypriots where the language difficulty often stands in the way of imparting to these traders instruction and advice on the need for cleanliness in the handling, preparation, cooking and serving of food to the public. To overcome this obstacle the St. Pancras Health Department arranged, through the good offices of the Commissioner of Cyprus, for a lecture in Greek to be given on a Sunday afternoon in Soho to Cypriot restaurateurs and their staffs trading in the Tottenham Court Road area. The Medical Officer of Health of St. Pancras 16 kindly suggested that Cypriot food traders in St. Marylebone might be invited to the meeting. This suggestion was gladly adopted. A total attendance of over 75 was secured, and full opportunity was taken by these traders to hear and discuss, in their own language, information on a subject which closely affects them in the conduct of their businesses. It is understood that the St. Pancras Health Department hopes to be able to arrange further similar lectures. During the year special attention was given to retail shops in which food is manufactured, prepared, stored or sold in order that a higher hygienic standard in the handling and, so far as existing powers allow, in the wrapping of all foodstuffs, more especially fish and meat, may be secured. Food Analysis.—The scope of sampling under the Food and Drugs Act, 1938, was considerably widened in 1949 to include a large variety of new products coming on the market, and no fewer than 197 different kinds of foodstuffs and drugs were submitted for analysis. The 700 samples (63 formal, 637 informal) taken during the year included: milk 75, butter 38, margarine 37, cooking fat 31, cheese 21, ice cream 37, confectionery 34. The sum paid in respect of each analysis was £1 1s. Od. The 43 samples reported as adulterated or otherwise irregular are referred to by the Public Analyst (Mr. Thomas McLachlan) in the following report: "The percentage of adulterated samples is higher this year than it was last year in St. Marylebone, 6.1 per cent, of the samples submitted being reported as adulterated. Milk in London is not usually adulterated, but this year one formal sample contained 14 per cent. of added water, and another formal sample contained 1 per cent. of added water; one informal sample contained 3 per cent. of added water, and another informal sample 1 per cent. of added water, the added water being calculated in each case according to the Sale of Milk Regulations, 1939. A sample of tomato sauce was found to contain 100 parts per million of benzoic acid, but was labelled to the effect that it contained less than 409 parts per million of benzoic acid. The latter amount would have been in excess of the permitted maximum quantity of 250 parts per million. A sample of tomato puree and one of tomato cocktail contravened the Labelling of Food Regulations as no retail price was shown and the contents were not given in fluid ounces. A sample of tomato paste contained 3.25 grains of tin per pound of puree. Your analyst received as complaint samples a Neapolitan slice contaminated with animal faecal matter, the hairs in which appeared to be from a cat, and a currant bun which contained a mass of smashed and dirty currants indicating that the currants had not been properly washed before use: had they been washed the currants would have separated. A roll and cheese were reported as inferior on account of dirt in the rind of the cheese. A stale jam sponge roll was received which, though still wholesome, was not of the quality a customer is entitled to expect, and a sample of cake flour mixture was also very stale and contained rancid fat. These were both purchased from a dirty shop. Some lemon curd also sent as a complaint sample contained pieces of paper and other matter, probably due to the jar not being properly cleaned before filling or to the contents of a broken jar being filled into the jar submitted. A packet of junket powder was found to be 75 per cent. deficient in rennet. A bottle of concentrated green ginger wine flavouring was submitted which gave directions on the label for sweetening with saccharin. This contravened the Soft Drinks Order and the question was taken up with the Ministry of Food. A sample labelled " rum flavoured coffee and chicory essence—rum non-excisable " was received. This label contravened the Labelling of Food Order and the attention of the Ministry of Food was drawn to the matter. A sample of apple puree was labelled "artificially sweetened." It was insufficiently sweetened and such sweetening as may have been added was not sugar, so that the label was misleading. A sample of blackcarrant syrup was received containing 450 parts per million of sulphur dioxide instead of 250 parts per million, the maximum amount permissible. Two samples of white pepper contained excessive quantities of lead, namely 100 and 150 parts per million. A sample sold as salad oil contained only 17 per cent. of oil with 83 per cent. of water. Chewing plugs consisted of paraffin wax, slightly coloured and flavoured. A sample of toffees made with malt extract was repotted as inferior, but the Ministry of Food considered that no action could be taken unless the sweets were bad enough to be declared unfit for human consumption. A sample of very rancid malted soya cream which was unfit for human consumption had been purchased from a dirty shop. A sample of clotted spread was received incorrectly labelled, the ingredients not being placed together on the label in the order of quantity in which they were present, and the presence of added salt was not declared. A sample of salad cream was fermenting vigorously when received, due to a deficiency in salt and acetic acid. A sample of horseradish relish was received and found to be improperly labelled. The description on the label "synthetic cream" without any disclosure of ingredients contained in the synthetic cream contravened the Labelling of Food Order. A sample labelled as almond cream should have been described as almond butter. Almond cream is a name well known for hair preparations, whereas almond butter is the name given to pastes prepared from whole ground almonds used for food. The lid of the jar containing this sample was labelled "peanut butter," which was misleading, and your analyst suggested this matter should be taken up with the manufacturers. A tin of sardines which were a very old pack had a flavour of oxidised oil and contained 1 grain per lb. of tin. It was suggested they could be used for manufacturing purposes but should not be sold direct to the public. 17 An opened can and an unopened one of corned mutton were received which, though sterilised during canning, had begun to decompose before being canned and were therefore unacceptable to human beings. A sample of pork brawn was received with the complaint that a high percentage of the cans was blown and customers objected to the strong smell on opening, but there had been no complaints of illness. This can was found to contain clotted blood, bristles and other dirt from the slaughterhouse floor; it had been prepared under insanitary conditions and had been improperly sterilised. A sample of canned Danish preserved sausage was fermenting and possessed a sour odour and taste. When cut open the sausages showed patches of pale yellowish-brown material indicating bacterial reduction of the pink-coloured nitrosohaemoglobin. The hydrogen ion concentration was about 4.0 indicating the formation of acid. A sample of lemon-flavour culinary essence was found to consist of flavoured dilute soap solution, with a taste of soap rather than lemon, and had probably been flavoured with citronellol. A sample of vitamin tablets contravened the Labelling of Food Order. They were claimed to contain vitamin B2 equal to 2.5 grammes of fresh brewer's yeast or about onesixteenth only of vitamin B2 requirements for the day. A sample of teething jelly was received and, in the opinion of your analyst, this is a food. All ingredients other than water must therefore be declared in the order of the percentages in which they are present. Only 32.42per cent. of the ingredients were disclosed and, as these were described as the "formula," the " formula " requires all ingredients disclosed to add up to 100 per cent. Several samples of drugs failed to comply with the labelling requirements of the Pharmacy and Medicines Act. Some bile beans were incorrectly labelled, the descriptions "extract of jalap," "extract of leptranda," and "sapo cast" requiring amendment. Your analyst suggested that this case should be passed to the Pharmaceutical Society with the request that they attend to the label. Cough pastilles and cough tablets are medicines within the meaning of the Pharmacy and Medicines Act and the medicinal ingredients must be disclosed. A cough mixture was stated to contain "acetum fusc" which is not a term used in the British Pharmacopoeia or the British Pharmaceutical Codex, and the drug must be disclosed in full. A sample of compound aspirin tablets contained an excessive amount of acetic and salicylic acids and should not have been sold in that condition. A sample stated to be fruit laxative tablets owed their laxative properties to the phenolphthalein contained in them and should, therefore, not have been described as fruit laxative tablets. A sample described as Friar's balsam tablets contained too small an amount of Friar's balsam to warrant the description." Legal proceedings were not advised in respect of any of the samples adversely reported upon by the Public Analyst, and the matters were taken up, with satisfactory results, with the manufacturers, wholesalers or retailers concerned. Milk.—There are 159 premises from which milk is sold. Inspections made numbered 246. During the year 53 applications under the Milk (Special Designations) Regulations, 1936-1946, were received from 23 milk purveyors and licences were granted as follows: 1 pasteurising, 26 dealers' and 3 supplementary in the case of pasteurised milk; 1 bottling, 19 dealers' and 3 supplementary in respect of tuberculin tested milk. The average composition of the 71 genuine samples of milk analysed was: total solids, 12.19 per cent.; fat, 3.45 per cent.; solids not fat, 8.74 per cent., as compared with the legal minima, namely, 11.50 per cent., 3.00 per cent. and 8.50 per cent. respectively. Twenty-four samples of milk taken at the premises of two authorised wholesale firms operating heat treatment plants were submitted to the tests prescribed for the various designations. All were reported to be satisfactory. Of 62 other samples of milk examined by the Council's Bacteriologist, all but one, which was stated to be a border-line case, were found to comply with the requisite standards. On the 1st October, 1949, a number of legislative measures affecting milk and dairies came into operation. By virtue of the Food and Drugs (Milk and Dairies) Act, 1944 (Appointed Day) Order, 1949, this Act was brought into force on that date, together with three sets of Regulations: (1) the Milk and Dairies Regulations, 1949, re-enacting, with amendments, the Milk and Dairies Regulations, 1926-1943, and containing a number of minor changes relating to buildings, the cleansing of vessels and utensils, the distribution of milk and its protection against contamination and infection, the use of mechanical refrigeration for cooling, and the use of approved chemical agents for the cleansing of appliances; (2) the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, re-enacting, with amendments, the Milk (Special Designations) Regulations, 1936-1948, so far as they relate to pasteurised milk, establishing a new special designation, namely, "sterilised milk," prescribing the procedure to be followed in the pasteurisation and sterilisation of milk, and providing for the use of the special designations "tuberculin tested milk (pasteurised)" and "tuberculin tested milk (sterilised)" ; (3) the Milk (Special Designation) (Raw Milk) Regulations, 1949, re-enacting, with amendments, the Milk (Special Designations) Regulations, 1936-1948, so far as they relate to raw milk, and providing that after the 1st October, 1954, the designation "accredited" shall no longer be 18 permitted and that no new application to use that designation will be granted after the 30th September, 1952. It is of interest to note that under the new regulations the payment of fees for licences has been abolished. Butter and Margarine Premises.—At the end of the year there were on the register 15 dealers in margarine and 2 butter manufacturers. Fifty-three inspections were made. Ice Cream.—The number of premises on the register was 122, and 275 inspections were made. Two applications for registration were refused as the premises in each case were considered to be unsuitable for the sale of ice cream. Seventeen samples of ice cream were examined bacteriologically. Of these, seven were found to be satisfactory and ten were below standard. The question of the unsatisfactory samples was in each case taken up with the manufacturers either direct or through the medical officer of health of the district in which the factory was situated. In addition, 37 samples were submitted to the Public Analyst and all were returned as genuine. The Council agreed to co-operate with the Ministry of Food in securing the observance of undertakings given by manufacturers of ice cream under a scheme made by the Ministry whereby an increased allocation of sugar with a corresponding allocation of fat would be made available to such manufacturers on the understanding that the fat content of their products would not fall below 2½ per cent. In this connection the Ministry were subsequently supplied with particulars of the under-mentioned ice cream analyses which showed that the fat content of none of these samples fell below the percentage required by the Ministry. TABLE 4.—Ice Cream Analyses. Sample No. Per cent. Fat Per cent. Solids not Fat 1 10.3 25.2 2 8.3 25.9 3 9.9 24.0 4 6.2 23.4 5 10.5 26.8 6 12.2 10.0 7 8.8 22.9 8 5.2 28.5 9 10.3 27.0 10 7.1 28.0 11 10.8 18.7 12 9.4 21.3 13 8.9 25.5 14 6.5 25.1 15 9.1 24.5 16 6.9 23.0 17 10.7 33.5 18 6.2 20.0 19 10.4 24.4 20 12.4 27.8 21 8.4 19.9 22 5.6 31.1 23 11.2 11.2 24 9.2 21.0 25 8.8 20.4 On a number of occasions during the year the Food Standards Committee of the Ministry of Food was urged by the Council to prescribe a standard of composition for ice cream or at least a provisional minimum standard. The Committee, however, whilst agreeing that a standard was in principle desirable, were of opinion that action should be deferred for the time being because, in view of the scarcity of ingredients, especially fats and milk solids, a satisfactory standard could be prescribed only at the expense of a reduction of supplies. Preserved Food.—There were 111 shops, etc., on the register of premises approved for the preparation or manufacture of preserved foods (sausages mainly) intended for sale, and 260 inspections were made. Fried Fish Vendors and Fish Curers.—The number of premises used by vendors of fried fish is 10 and by fish curers 3. Twenty-six inspections of fried fish shops and 36 inspections of fish curers' premises were carried out. 19 Bakehouses.—There are 18 basement bakehouses on the register; 115 inspections were made. At the adjourned hearing of a summons, issued in 1948, in respect of a basement brought into use as a bakehouse, contrary to the provisions of section 54 of the Factory Act, 1937, the defendant was fined 10s. Acceptable alternative accommodation had in the meantime been provided above ground. Restaurants, etc.—Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 845, including 306 restaurants, snack bars and railway refreshment rooms, 50 hotels, 312 staff and club canteens, 140 public houses, 14 fish caterers and cooked meat retailers, and 23 school and nursery canteens : 1,099 inspections were made and 57 notices served. During the year the kitchens of 14 restaurants, 10 canteens, 3 fish restaurants and 2 hotels were reconstructed. Legal proceedings were taken under section 13 of the Food and Drugs Act, 1938, against five caterers in respect of the dirty condition of premises used for the preparation and cooking of food for sale to the public. Fines respectively of £20, £30, £4, £30 and £15 were imposed and costs awarded to the Council. In a further case the proprietor of a grocery and general stores was prosecuted, under section 9 of the Act for having in her possession, for the purpose of sale, food intended but unfit for human consumption, and under section 13 for not observing cleanliness in regard to the shop and all articles, apparatus and utensils therein, and for failing to take steps reasonably necessary to prevent risk of contamination of food in the shop. The defendant was fined a total of £10, with £5 5s. Od. costs. Whalemeat.—The Food and Drugs (Whalemeat) Regulations, 1949, made jointly by the Ministers of Food and Health, came into operation on the 20th March, 1949. Part II of these Regulations prohibits the importation into England and Wales of whalemeat and whalemeat products intended for sale for human consumption unless accompanied by a "veterinary certificate," certifying that the whalemeat, including that used in the manufacture of whalemeat products, has been inspected and was produced in accordance with criteria and conditions satisfactory to the Minister of Food. The Regulations also contain provisions for preventing the contamination of whalemeat on stalls (Part III); in shops, stores, etc. (Part IV); and during transport and handling in wholesale markets, cold stores and elsewhere (Part V). The enforcement of Parts II and V of the Regulations is the responsibility of the Port Health Authorities, and Parts III and IV are enforceable, in London, by the metropolitan borough councils. Horseflesh.—Thirty-six visits were paid to two shops selling horseflesh for human food. One of these shops was subsequently closed as being unsuitable for the purpose. There are no shops selling horseflesh other than for human consumption. Legal proceedings were taken against a restaurateur for possessing horseflesh for the purpose of sale for human consumption without displaying the requisite notice, but the case was dismissed. Slaughter of Animals.—The only licensed slaughterhouse in the Borough is that at the Zoological Society's premises in Regent's Park, where slaughtering is done occasionally to augment the food supply for the animals in the menagerie. Humane killers are used, and the licence granted to the Society's skilled slaughterman was renewed. Sixteen inspections were made during the year. Unsound Food.—Some 40 tons of food condemned as unfit for human consumption included the following : meat 6 tons, 15 cwts. 2 qtrs. 3 lbs.; fish, 2 tons, 3 qtrs. 3 lbs.; poultry and rabbits, 1 ton, 3 cwts. 3 qtrs. 6 lbs.; cereals, 6 tons, 8 cwts. 2 qtrs. 5 lbs.; fruit, 1 ton, 13 cwts. 3 qtrs. 25 lbs.; vegetables, 6 cwts. 3 qtrs. 8 lbs.; canned goods, 48,097 tins. Practically all this unsound food was salvaged and diverted to other uses. SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Infectious and other diseases notifiable in St. Marylebone are listed in Table 5, which gives also information regarding notifications (civilians) received during 1949. As from the 1st June, 1949, enquiries relating to cases of infectious disease, formerly made by the district sanitary inspectors, were carried out by one of the women sanitary inspectors who paid 586 visits in this connection during the last seven months of the year. 20 TABLE 5.—Notifiable Diseases and Notifications. *Notifiable Disease Cases notified in whole Borough Cases removed to hospital Cases isolated at home At all ages At ages—years —1 1— 2 3— 4— 5— 10— 15— 20— 35— 45— 65— Ophthalmia neonatorum 1 1 - - - - - - - - - - - 1 - Erysipelas 14 — — — 1 — — — 3 1 o 4 6 8 Scarlet fever 106 — 3 6 11 13 50 16 2 3 2 — — 39 67 Puerperal pyrexia 11 ■— — — — — — — — 11 — — — 9 2 Acute poliomyelitis 13 1 2 — 1 — 2 1 2 2 — 2 — 10 3 Cerebro-spinal fever 1 - - - — - - - 1 - - - - 1 — Typhoid fever 1 - - - - - - - - - 1 - - 1 — Pneumonia 48 — 1 3 1 1 2 3 1 7 3 16 10 21 27 Dysentery 7 — — — —' — 4 — — 1 1 1 — 3 4 Measles 316 9 46 62 43 42 92 8 2 7 4 1 — 77 239 Whooping cough 112 15 16 25 14 11 27 1 1 2 — 30 82 Scabies 26 — 1 i — — 0 2 1 10 3 5 1 9 24 Malaria 1 - - - - - - - - 1 - - - 1 - Tuberculosis— Pulmonary 86 — — — 1 1 2 2 1 43 8 24 4 38 48 Non-pulmonary 13 — — — 1 1 1 — 3 5 — 1 1 10 3 Food poisoning 95 1 — 1 1 2 1 22 55 3 5 4 4 91 Totals 851 27 69 98 73 70 184 34 35 149 28 60 24 253 598 * There were no cases of the following diseases, which are also notifiable in the Borough : Smallpox, diphtheria, cholera, typhus fever, paratyphoid fever, relapsing fever, continued fever, plague, glanders, farcy, anthrax, induced malaria, polio-encephalitis, encephalitis lethargica. Smallpox.—The S.S. "Mooltan" from Australia arrived in the Port of London on the 2nd April, 1949, with the body of a person who had died of smallpox at sea. All passengers, after being offered vaccination, disembarked on the 3rd April, 1949. Twelve cases of confirmed or doubtful smallpox were subsequently removed to hospital in the London area (none of them from St. Marylebone) of whom three died. Four cases were also isolated in hospital in the provinces and two of these proved fatal. Four of the fatal cases were persons who were unvaccinated at the time of infection, the fifth being a man of 61 who was vaccinated in infancy. In other cases the Ministry of Health reported that there was evidence that vaccination had produced considerable modification of the disease, and this had sometimes given rise to difficulty in diagnosis. Twenty-five passengers proceeded to addresses in the Borough, and all had been vaccinated either on board or within recent months. One of these contacts developed spots and as a precautionary measure a member of the panel of smallpox consultants, formed by the Metropolitan Regional Hospital Boards, was called in, but the case proved to be not smallpox. All 25 contacts were kept under surveillance for the requisite period and this involved many visits and close contact with the medical officers of health of other areas where movements out of the Borough took place. A number of passengers on the " Mooltan " were nurses, and several of them after disembarkation visited the premises of the Royal College of Nursing and the General Nursing Council, both situated in the Borough. At the request of these bodies arrangements were made for the vaccination of 160 nurses and staff. No case of smallpox occurred in St. Marylebone. International Certificates of Vaccination and Inoculation.—In accordance with the request of the Ministry of Health, arrangements were made for the authentication by the Medical Officer of Health of certificates of vaccination and inoculation issued by medical practitioners in St. Marylebone in respect of persons proceeding abroad. Food Poisoning Outbreaks.—Food poisoning was more prevalent during 1949 than for some years, and details of the cases notified are given below :— (a) Number of outbreaks.—One outbreak of 71 cases ; one of 10 cases ; two of 2 cases each ; and 10 single cases. (b) Total number of cases.—Ninety-five. (c) Deaths.—None. (d) Organisms or other agents responsible, with number of outbreaks attributable to each. Salmonella typhi-murium—-One outbreak (71 cases). Salmonella aertrycke—One outbreak (10 cases) and one single case. Salmonella group—One case. Not ascertainable—Two outbreaks of two cases each and eight single cases, 21 (e) Foods involved, with number of outbreaks associated with each food. In no case was it possible definitely to identify a particular foodstuff as being the source of infection. Investigation into the two largest outbreaks, involving 71 and 10 cases respectively, pointed to the possibility of a human carrier being responsible. The most extensive outbreak occurred at the nurses' home of a large hospital, where 71 cases reported sick and were treated in bed. Four more were known to have been taken ill at home. The causative organism was salmonella typhi-murium. With two exceptions all the cases had taken food prepared in the nurses' home kitchen at either lunch or supper on the 24th September. The two exceptions had eaten from the same kitchen on the 23rd September, but had had no meals there on the following day. Conversely, many of those taken ill had not taken food on the 23rd September, so the inference was that there was minor contamination of the food served on the 23rd September, and gross contamination on the 24th September. In addition to the cases that reported sick, there were many who had minor symptoms not sufficient to cause them to report sick. No item of food, however, could be discovered which was common to the meals on both days other than such commodities as dried milk, flour and rice. The overwhelming majority of cases reported sick early on the 26th September, having been taken ill during the previous night. Many had felt slightly unwell on the afternoon of the 25th September. The kitchen was inspected on the morning of the 26th September, but all food prepared on the 24th September had either been consumed or thrown away. Samples of it were therefore not available for laboratory investigations. Food served on the 24th September included shepherd's pie and rissoles at lunch and supper respectively and trifle at both meals, and it seemed likely from enquiry of the patients that one of these main dishes was the vehicle of infection. The meat from which the dishes were prepared was fresh and bought in bulk from Smithfield and supplies of it had gone to the other kitchens of the hospital, none of which was affected by the outbreak. The evidence pointed overwhelmingly to contamination of food by some agent in the nurses' home kitchen itself. Specimens of dried milk, flour and rice and swabs from pots and pans were examined at the Public Health Laboratory at Colindale and all proved to be negative. Dried milk was also tested in the hospital laboratory with a similar result. Search was made for rodent droppings in both the kitchen and the corridors adjoining but none was seen. It therefore seemed likely that a human carrier in the kitchen may have been the cause of the outbreak. All 22 persons employed there submitted stools for laboratory investigation and no fewer than six were found to carry salmonella typhi-murium. None admitted to having had diarrhoea or illness previous to the outbreak or to having been in contact with a diarrhoea case at their home. Unfortunately, however, all the kitchen staff had the same meals as the affected nurses and although none of the 22 had symptoms it is possible that the six referred to were contaminated by those meals but were thus not the original carriers. All were temporarily suspended from working in the kitchens until they ceased to be carriers. As to the clinical features of the outbreak, the common onset was profuse diarrhoea and some vomiting associated with pyrexia up to a temperature of 103°, often with intense headache and severe lumbo-sacral pain. The majority became afebrile in 2-3 days and symptom-free inside a week. Six cases, including four who showed signs of severe toxaemia, were treated with Chloromycetin, in the dosage recommended for typhoid fever, with what appeared to be marked beneficial effect. The pyrexia, diarrhoea and headache all ceased within 24-36 hours of administration of the drug and did not recur. Precautions to prevent spread and recurrence of the outbreak were taken. For example, stocks of dried foods in the larder of the nurses' home were taken out of use until proved bacteriologically harmless. Kitchen staff were tested as already indicated, and the need for care and cleanliness was emphasised in general instructions to all nurses and kitchen workers. All nurses who showed the slightest symptoms were suspended from work in the maternity and children's wards and employed on other duties ; this mainly because nurses in these departments have to undertake bottle and infant feeding duties. It so happened that the hospital sub-basements had been de-ratted with good effect about a week prior to the outbreak, since when no rats had been found. No fresh cases of food poisoning were subsequently reported. The outbreak involving 10 cases occurred among the guests at a wedding reception held in May at an address outside the Borough, at which about 250 people (mainly Cypriots) were present. Ten cases were notified from the eastern end of the Borough, and cases were also reported in other areas. Three of the St. Marylebone cases were removed to hospital, and bacteriological examination of faeces subsequently showed that all three patients—a woman aged 70 years, her grandson aged 7 months, and a boy aged 2½ years—were harbouring organisms of the salmonella aertrycke type. The food provided at the wedding breakfast was contributed by various persons attending the reception and was all consumed except some cake which was examined bacteriologically and proved to be sterile. In view of this and the fact that some of the guests, including the bride's mother, returned to Cyprus, there was little prospect of identifying the source of the outbreak, though there appeared to be a possibility that one of the persons who prepared fcod may have carried the infection. 22 Twenty-five visits of enquiry into food poisoning cases were paid by one of the women sanitary inspectors. Tuberculosis—New Cases and Mortality.—Table 6 contains information with regard to age and sex distribution of, and mortality from, all forms of tuberculosis. TABLE 6.—Tuberculosis : New Cases and Deaths. At ages— years ‡NEW CASES DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 1 - - - - - - - 1—5 2 2 2 — — — — — 5—15 3 2 — 1 — — — — 15—25 12 21 4 3 — — — — 25—35 28 22 1 2 2 3 — — 35—45 13 2 — — 4 2 — — 45—55 17 4 — — 6 2 — — 55—65 16 2 — 1 5 1 — — 65 and upwards 7 — —- 1 3 — — — Totals 99 55 7 8 20 8 — — ‡Including all primary notifications and also any other new cases of tuberculosis which came to the knowledge of the Medical Officer of Health during the year. Notifications—Table 5 (p. 20) gives information regarding notifications of pulmonary and nonpulmonary tuberculosis received during the year. Eighty-five visits from the housing and sanitary viewpoints were paid by one of the women sanitary inspectors to new cases and those moving into the Borough from other areas. The total number of cases of tuberculosis remaining on the register at the 31st December, 1949, was 874. This was 100 more than at the end of the previous year. Venereal Diseases.—Continued assistance was given to the propaganda campaign for drawing public attention to the dangers of these conditions, and to the adequate facilities which exist for those in need of treatment. Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 252 cases of scabies : adults 42 (men 19, women 23) ; children 210 (boys 110, girls 100). Domiciliary visits paid in connection with St. Marylebone cases numbered 33. Impetigo.—Twelve boys and 43 girls received treatment for this condition at the Cleansing Station. Disinfection.—During the year, 1,628 rooms and 13,294 articles (including 625 books) were disinfected after infectious diseases generally. In addition, 3,641 dressing drums from a local hospital were sterilised. Bacteriological Examinations.—Table 7 shows the number of specimens examined for the purposes of diagnosis and indicates also the organisms in relation to which the examinations were made. TABLE 7.—Work of the Bacteriological Laboratory. Nature of Specimen and Examination Positive Negative Total Throat and nasal swabs for— B. diphtheriae — 94 94 HaemolytiG streptococci 12 43 55 Monilia 2 3 5 Vincent's organisms 3 4 7 Sputa—-for tubercle bacilli 53 327 380 Faeces—for parasites 2 3 5 Faeces—for dysentery and food poisoning organisms 19 60 79 Blood—for typhoid, paratyphoid and Brucella abortus 1 5 6 Urine—for organisms 2 14 16 Foods—for food poisoning organisms — 25 25 Cooking utensils—for food poisoning organisms — 10 10 Totals 94 588 682