AC 4353 Ak Miss Clsk STMARY 60 BOROUGH OF ST. MARYLEBONE REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1955 H. A. BULMAN, M.R.C.S., D.P.H. London: Vail &. Co., Ltd., 170 Farringdon Road, E.C.1 1 CONTENTS page Members of the Public Health Committee 3 Staff of the Public Health Department 3 Section A—Statistics and Social Conditions :— General Statistics 4 Extracts from Vital Statistics 4 Marriages 4 Deaths 4, 5 Infant Mortality 5 Section B — General Provision of Health Services :— Representation upon other Bodies 6 Conferences 6 Financial Contributions to Voluntary Organisations 6 Care of Old People 7 Special Laundry Service 7 Cleansing 7 St. Marylebone Old People's Welfare Association 7 Diseased or Infirm Persons 8 Staff Medical Examinations 8 New Legislation 8 Section C—Sanitary Circumstances :— Sanitary Inspection 9 Nuisances 9 Notices 9 Legal Proceedings 9 Noise 10 Pigeons 10 Water 10 Drainage 10 Legal Proceedings 10 Combined Drainage 11 Ventilation of Sewers 11 Rodent Control 11 Disinfestation 11 Verminous Persons 12 Shelter 12 Atmospheric Pollution 12 Factories 13 Inspections and Defects Found 13 Out-Workers 14 Offices and Shops 14 Fireguards 15 Inspection 15 Accidents in the Home 15 Hairdressers and Barbers 15 Pet Shops 15 Poisons 16 Rag Flock and Other Filling Materials 16 Public Conveniences 16 Public Cleansing and Salvage 16 page Burial or Cremation of the Dead 16 Crematorium 17 Dog Nuisance 17 Street Photographers 17 Section d—Housing :— Permanent Estates Pre-War Estates 17 Post-War Estates 17 St. Marylebone Housing Association 18 Slum Clearance Programme 18 Factory-Made Bungalows 18 Requisitioned Premises 18 Dwelling Houses—Inspection, etc. 18 Housing Repairs and Rents Act, 1954— Certificates 19 Re-housing 19 Immigrants 19 Common Lodging Houses 19 Section e—Food :— Food and Drugs Analysis 19 Legislation 20 Legal Proceedings 21 Unsound Food 21 Flaked Hen Egg Albumen 22 Milk 22 Ice-Cream 22 Preserved Food 22 Restaurants, etc. 22 Fried Fish Shops and Fish Curers 23 Wholesale and Retail Foodshops 23 Bakehouses 23 Butter and Margarine Premises 23 Horseflesh 23 Slaughter of Animals 23 St. Marylebone Clean Food Association 23 Section f—Infectious and Other Diseases :— Notifiable Diseases 24 Tuberculosis 24 New Cases and Deaths 24 Notifications 24 Food Poisoning Outbreaks 25 Impetigo 25 Scabies 25 Venereal Diseases 25 Disinfection 25 Exclusion from Work of Contacts of Infectious Disease 25 International Certificates of Vaccination and Inoculation 25 Bacteriological Examinations 26 2 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, The standard of health in the Borough throughout 1955 may be regarded as satisfactory although there was greater incidence of infectious disease. This was general throughout the country and in St. Marylebone notifications increased from the previous year's low record of 319 to 924. Of these, 588 were measles, a disease which is in special evidence in cycles of two years. Among diseases which also increased in incidence were poliomyelitis (from 3 to 14), tuberculosis (from 66 to 77), erysipelas (from 1 to 8). There were 117 cases of food poisoning as against 13 notified in 1954. These included one outbreak of 56 cases at an institution and another of 38 at a hospital where those affected were mainly members of the staff. There were 2 notifications each of typhoid and paratyphoid fever but it was established that 3 of these patients contracted the disease abroad. Again no diphtheria was reported—the last was in 1948—and the 18 cases of scarlet fever were all of a mild type. There were no deaths from notifiable diseases other than tuberculosis and pneumonia. The resident population, according to the estimate of the Registrar General, decreased from 73,930 to 73,440 but, although no figures are available, there are indications that the very large day population of the Borough is still tending to increase. Both the birth rate (11.02) and the death rate (15.51) were less favourable than in 1954 (11.59 and 14.27 respectively), but there was no maternal mortality and deaths of children under 1 year of age decreased from 27 to 12, giving a record low figure for the Borough of 14.83 per thousand live births. The weather was mainly dry and sunny except in June, which was especially dull, and May when it was unusually wet. Of all the Saturdays from April to November, on only four was there any measureable rainfall in central London. August was the hottest month although the highest temperatures of the year were reached during July. The coldest month was February but the lowest temperature at Kew was in March when -4.6°F. was recorded. Rainfall was only about four-fifths of the normal and there was a noteworthy freedom from fog. Thunder was rather more prevalent than usual. To His Worship The Mayor, to the Chairman, Councillor Dr. H. K. Ashworth, T.D., and to members of the Public Health Committee I offer my thanks for the kindness, consideration and encouragement which they have always given me. I thank also the staff of the Public Health Department for their loyalty and efficient support in the public health work of the Borough, and my colleagues in other departments of the Council for their continued co-operation and assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. A. BULMAN, Medical Officer of Health. 3 PUBLIC HEALTH COMMITTEE. 1955. HIS WORSHIP THE MAYOR : *Councillor Major Ronald Charles Orpen, J.P., A.C.A., L.C.C. †Councillor Cuthbert Denis Denis-Smith, J.P. ALDERMAN: Capt. R. G. Whitney, M.B.E., J.P. COUNCILLORS : Dr. H. K. Ashworth, T.D. (Chairman) *C. D. Denis-Smith Frederick Frame Herbert C. Garrard †B. Hawley Mrs. Carr Q. Henriques J. P. Honour (Vice-Chairman) * Until May. The Rev. Walter M. Long Mrs. L. Lyons Miss L. F. Nettlefold, M.A., LL.B., L.C.C. Mrs. S. Rivington †Miss L. B. West Russell Miss F. E. Wilson † From June. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Medical Referee for Cremation : H. Allen Bulman, M.R.C.S.(Eng.), L.R.C.P.(Lond-), D.P.H. Occasional Deputy Medical Officer of Health and Deputy Medical Referee for Cremation C. J. C. Britton, M.D., D.P.H. Public Analyst (Part-time) : T. McLachlan, A.C.G.F.C., F.R.I.C., 4, Hanway Place, W.l Bacteriologist (Part-time) : C. J. C. Britton, M.D., D.P.H., 35, Harley Street, W.l Administrative and Clerical Staff : H. G. E. Brown (Chief Assistant) D. H. Drewell P. C. Bedward S. P. Fleming F. W. Dines J. H. Manning F. V. Terry (from August) Miss M. L. Shaul Miss C. A. Cruickshank Sanitary Inspectors : H. E. Scoble, M.B.E. (a), (b)—-Senior Sanitary Inspector and Sampling Otficor. V. A. Bignell (o), (6), (c)—Drainage. J. R. Baily (a), (b)—Drainage. L. Pearson (a), (b), (c)—Food. L. Newland (a), (6)—Factories. J. E. Broadhead (a)—Rodent Control. H. Lawson (a), (6)—District No. 1 (until September). D. B. Hooper (a)—District No. 2. J. A. Cummins (a), (6)—District No. 3. G. A. Fraser (a), (b)—District No. 4. Miss M. M. Sharp (a), (d), (e), (/)—Care of Old People and Re-housing. Mrs. M. I. Tiplady (a), (6), (d), (/)—Restaurants. Miss B. Wilson (a), (b), (d), (e), (/)—Infectious Diseases. Streets Nuisance Inspector : D. Telford Outdoor Superintendent : R. G. Turner Mortuary Keeper 1 Disinfectors 3 Rodent Operatives 5 Medicinal Baths Attendants 4 Public Convenience Attendants 36 Van Driver 1 Urinal Flushers 2 Messenger-Handyman 1 (а) Certificate for Sanitary Inspector—The Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (b) Certificate for Inspector of Meat and Other Foods—The Royal Sanitary Institute. (c) Certificate for Smoke Inspector—The Royal Sanitary Institute. (d) Certificate for Health Visitor—The Royal Sanitary Institute. (e) Certificate of the Central Midwives' Board. (f) Certificate of State Registration for Nurses. 4 SECTION A.—STATISTICS AND SOCIAL CONDITIONS. GENERAL STATISTICS. Area of Borough : (a) excluding area covered by water, 1,427.8 acres; (b) including area covered by water, 1,473 acres. Rateable value of the Borough : £3,540,443. Sum represented by a penny rate : £14,230. Number of residential units (separate assessments) : 24,222. Population : 1951 census—75,764. Registrar General's estimate of the home population (which includes members of the armed forces stationed in the area and is used in calculating various rates in this report) : 1955—73,440. EXTRACTS FROM VITAL STATISTICS. Total M. F. Live Births—Legitimate 725 387 338 Birth-Rate per 1,000 estimated home population 11.02 Illegitimate 84 39 45 Stillbirths—Legitimate 9 4 5 Rate, per 1,000 total (live and still) birth 13.41 Illegitimate 2 2 — Deaths (all ages) 1,139 557 582 Death-Rate per 1,000 estimated home population 15.51 Maternal Mortality—Deaths from " Pregnancy, Childbirth, Abortion" Nil (Registrar General's Code No. 30) Total M. F. Deaths of Infants under one year of age—Legitimate 9 8 1 Illegitimate 3 2 1 Death-Rate of Infants under one year of age—All infants per 1,000 live births, 14.83 ; legitimate infants per 1,000 legitimate live births, 12.41 ; illegitimate infants per 1,000 illegitimate live births, 23.80. Marriages. The following table shows the number of marriages in St. Marylebone each year since the 1st January, 1945:— Year No. of Marriages Year No. of Marriages 1945 1,583 1951 1,415 1946 1,538 1952 1,358 1947 1,736 1953 1,290 1948 1,657 1954 1,262 1949 1,461 1955 1,298 1950 1,439 The 1955 figure is 36 above that for 1954 and 176 below the average (1,474) for the previous ten years. The marriage rate in 1955 was 35.25 per 1,000 of the estimated home population. Deaths. The total number of deaths (1,139) shown in Table 1 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, as also are those of members of the armed forces who were stationed in the area. Deaths in 1955 were 84 more than in 1954 and the principal causes were diseases of the heart and circulatory system, which accounted for 44 per cent. of the total deaths, malignant diseases 16 per cent., and respiratory diseases including tuberculosis 12 per cent. Seventy-two per cent. of the deaths registered were of persons of 65 years of age and over. The expectation of life at birth in England or Wales is now 67 years for a boy and 72 years for a girl, compared with 48 and 52 years respectively during the first decade of the present century. 5 TABLE 1.—Deaths—According to Age-Group and Sex. Cods No. CAUSE OF DEATH Net Deaths at the Sub-joined 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. 1 Tuberculosis, respiratory 7 2 - - - - - - 1 1 1 1 5 - 2 Tuberculosis, other - - - - - - - - - - - - - - 3 Syphilitic disease 3 - - - - - - - - - 3 - - - 4 Diphtheria - - - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - - - 9 Other infective and parasitic diseases 3 3 - - - - - - 1 - - 2 2 1 10 Malignant neoplasm, stomach 9 10 - - - - - - - - 5 4 4 6 11 Malignant neoplasm, lung, bronchus 31 9 - - - - - - - - 15 4 16 5 12 Malignant neoplasm, breast — 14 - — — — — — — 4 — 6 — 4 13 Malignant neoplasm, uterus — 6 - - — — — — — — — 5 — 1 14 Other malignant and lymphatic neoplasms 47 54 - - - - - - 6 5 14 16 27 33 15 Leukaemia, aleukaemia 3 1 - - - - - - 1 — 1 1 1 — 16 Diabetes 1 4 - — — - - — - - 1 1 — 3 17 Vascular lesions of nervous system 61 100 - - - - - - 2 2 8 18 51 80 18 Coronary disease, angina 107 70 - — — — — — 2 — 38 14 67 56 19 Hypertension with heart disease 44 47 - - - - - - - - 2 2 42 45 20 Other heart disease 70 109 - — — — — — 3 7 7 4 60 98 21 Other circulatory disease 21 34 - - - - - - 1 — 4 7 16 27 22 Influenza 6 5 - - - - - - - - - 2 6 3 23 Pneumonia 12 18 - - - - - - - - 1 1 11 17 24 Bronchitis 56 24 1 — 1 — - — 1 - 13 1 40 23 25 Other diseases of respiratory system 7 2 - - - - - - - - 1 — 6 2 26 Ulcer of stomach and duodenum 7 — - — — — - — 1 — 1 — 5 — 27 Gastritis, enteritis and diarrhoea 2 4 - - - - - - 1 1 1 1 — 2 28 Nephritis and nephrosis 2 1 - - - - - - - - 1 — 1 1 29 Hyperplasia of prostate 4 - - - - - - - - - - - 4 — 30 Pregnancy, childbirth, abortion - - - - - - - - - - - - - - 31 Congenital malformations 4 3 2 — — — 1 — — 1 1 1 — 1 32 Other defined and ill-defined diseases 33 43 7 1 - - - - - 4 13 13 13 25 33 Motor vehicle accidents 3 — — - 1 - - - 2 - - - — - 34 All other accidents 6 14 — 1 - - - - 3 3 1 3 2 7 35 Suicide 8 5 - - - - - - 1 1 5 4 2 - 36 Homicide and operations of war - - - - - - - - - - - - - - Totals 557 582 10 2 2 - 1 - 26 29 137 111 381 440 1,139 12 2 1 55 248 821 TABLE 2.—Infant Mortality—According to Age-Group and Sex. 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. Congenital malformation 2 - - - - - - - - - - - - - 2 - Premature birth 4 - 1 - - - - - - - - - - - 5 - Injury at birth 2 - - - - - - - - - - — - - 2 - Bronchitis - - - - - - 1 - - - - - - - 1 - Respiratory failure — 1 - - - - - - - - - - - - - 1 Accidental burning — — — — — — — - — — — — — 1 — 1 Totals 8 1 1 - - - 1 - - - - - - 1 10 2 6 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. Representation upon Other Bodies. The Council were represented upon the under-mentioned statutory and voluntary bodies as indicated : Body Representatives London County Council Health Committee. London County Council Divisional Health Committee (Division 2). London County Council Divisional Tuberculosis Care Committee (Division 2). St. Marylebone Chest Clinic. St. Marylebone Tuberculosis Care Committee. Western Ophthalmic Hospital—House Committee. Paddington Hospital Group House Committee, No. 4 Paddington Hospital Group House Committee, No. 5 Samaritan Hospital—House Committee. National Smoke Abatement Society. Paddington and St. Marylebone District Nursing Association—Executive Committee. St. Marylebone Youth Centre Committee—Management Committee. St. Marylebone Clean Food Association—Executive Committee. Department of Scientific and Industrial Research— Standing Conference of Co-operating Bodies dealing with Atmospheric Pollution. Alderman Capt. R. G. Whitney, M.B.E., J.P. Councillor Dr. Elizabeth Jacobs. Councillor Miss L. F. Nettlefold, M.A., LL.B., L.C.C. Councillor Miss L. West Russell. The Medical Officer of Health. Councillor Miss L. West Russell. Councillor Mrs. S. Rivington. Councillor Miss L. West Russell (until October). Councillor L. M. Laurance (from October). The Medical Officer of Health. Councillor F. Frame. Councillor Miss L. West Russell. Councillor Mrs. S. Rivington. Councillor the Hon. Mildred Lowther, O.B.E. The Chairman of the Public Health Committee. The Medical Officer of Health. Councillor Mrs. S. Rivington. Councillor R. T. Glenny. Councillor The Hon. Mildred Lowther, O.B.E. Councillor H. C. Garrard. Councillor Mrs. Carr Q. Henriques. The Chairman of the Public Health Committee. The Medical Officer of Health. 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—Bournemouth, 26th to Alderman Capt. R. G. Whitney, M.B.E., J.P. 29th April. Sanitary Inspectors' Association—Scarborough, Mr. L. Newland, Sanitary Inspector. 13th to 16th September. National Smoke Abatement Society—Southport, Councillor Dr. H. K. Ashworth, T.D. 3rd to 5th October. Financial Contributions to Voluntary Organisations. Payments to the funds of voluntary bodies were, on the recommendation of the Public Health Committee, made by the Council during 1955, as indicated below:— Organisation Amount Statutory Authority £ s. d. Central Council for Health Education 10 10 0 Public Health (London) Act, 1936, section 298. Family Welfare Association (Area 2) 100 0 0 Local Government Act, 1948, section 136. National Smoke Abatement Society 7 7 0 Public Health (London) Act, 1936, section 298. St. Marylebone Old People's Welfare Association"Meals on Wheels" Service, Foot Clinic, etc. 625 0 0 National Assistance Act, 1948, section 31. Assisted Holidays Scheme 250 0 0 do. St. Marylebone Housing Association and Trust—Meals for Old People 28 0 0 do. "Inner Wheel" Old People's Club—Rent of Hall 26 0 0 do. Women's Voluntary Services 40 0 0 do. 7 Care of Old People. Six hundred and sixteen old people were visited by one of the women sanitary inspectors. The frequency of the visits varied according to individual needs and, although sixty-four were married couples, the great majority lived alone and many required constant observation. The domestic help service of the London County Council continued to give valuable assistance. Special Laundry Service.—Under the scheme for laundering bed linen and clothing of acutely ill and incontinent old people, sixty-three cases were dealt with during 1955. Fifty-three of these were new and each was the subject of a certificate given by the Medical Officer of Health under the provisions of section 122 of the Public Health (London) Act, 1936. The work is done by the Council's staff at the Public Health Department laundry at 217, Lisson Grove, N.W.8. The service has been in operation since February, 1950, and its value is recognised by all who are concerned with the nursing of the aged in their own homes. Some of the old people who were assisted were awaiting admission to hospital but the scheme also helped to make it possible for others to continue to be cared for at home. Some required the service for short periods only but others needed assistance for a long time. Arrangements have now been made to extend the scheme to deal also with the effects of old people whose persons or whose rooms are found to be very dirty or verminous. Cleansing.—Under the provisions of section 43 of the London County Council (General Powers) Act, 1953, sanitary authorities are empowered to make arrangements for cleansing old people at their own request or with their consent, in their own homes, if necessary. There has, so far, been little or no demand for home bathing but, as was mentioned in the last annual report, in December, 1954, an experimental scheme was started for taking suitable old people to the Council's bathing centre at Lisson Grove. Here they are bathed under good conditions in warm and convenient surroundings, their clothing, if necessary, being treated at the same time. There are two sessions per week and four or five people are dealt with at each. They are brought to the centre from their homes in an ambulance of the sitting case type which has been fitted with extra seating, arm rests, special ventilation and a ramp which makes it easier to get the less active into the vehicle. The arrangements are supervised by one of the women sanitary inspectors who is also a State Registered Nurse and the bathing is done by trained assistants. The experiment shows signs of being very successful and justifies being extended as soon as practicable. St. Marylebone Old People's Welfare Association. The Executive Committee of the Association (Chairman—Mrs. L. Fewster; Hon. Secretary— Miss M. K. C. Macintosh, Room 103, Town Hall, St. Marylebone, W. 1), has kindly provided the following information on the work carried out during 1955 :— Meals on Wheels.—The service is operated by the W.V.S. five days a week. The new van and arrangements for obtaining the meals from the staff canteen of Messrs. Spencer, Turner and Boldero Ltd., worked smoothly, 5,687 meals being delivered during the year. The St. Marylebone Housewives Club continued their voluntary service of washing up. The W.V.S. Luncheon Club.—The Meals on Wheels van transports the meals for this Club at which 6,237 meals were served. The total membership is now 36, the W.V.S. having arranged a second sitting to take some of the old people who were displaced when the Cookshop of the St. Marylebone Housing Association was closed down. Clubs.—Each of the seven Darby and Joan Clubs has now developed its own distinct character and is no longer just an assemblage. Their activities all include Christmas parties, summer outings, and jumble sales to help raise funds. Their organisers are very hard-worked enthusiasts. Anyone who heard the singing and laughter of club members in Wilfred Pickles' " Have a Go" programme for Newstead (the St. Marylebone Old People's Home) in November must have realised from the delighted reaction of these old people how they respond if someone will only bother about them. Home Visiting.—The monthly Visitors' Meetings, under the guidance of Miss Sharp, continued to be an important feature of our work. They are attended by our own 26 voluntary visitors, and by liaison officers from the visiting groups of some of the churches. Regular friendly visits to lonely house-bound old people may be an unspectacular form of personal service but, in so far as it proves to them that they are still remembered and cared about, it can make a contribution to mental health which could equal the contribution to physical health made by the Home Helps' Service—than which no higher praise could be given. The Association would warmly welcome new volunteers. Home Chiropody.—The fourth monthly round, which was started in January, enabled us to clear the waiting list and keep pace with demand until the winter, when some of the older patients from the foot clinic are temporarily placed on the home service. A further 56 patients (7 men and 49 women) were added during the year making a total of 180 on the list in December. In all, 516 treatments were given, five free, ten at a reduced rate and the remaining 501 at the full fee of 2s. Twentyseven patients voluntarily made some additional contribution. 8 Foot Clinic.—At the end of the year there were 425 patients (including 86 new) on the register, and 27 on the waiting list ; 2,071 treatments were given. We had hoped that the two extra sessions started in July would enable us to keep the waiting list down to reasonable proportions, but by October it had to be closed temporarily, and at the end of the year it was decided that two more sessions should be started in January, 1956. The Borough Council have agreed to the addition of £50 to our block grant to cover the cost as from April, 1956. Until then it will be met from our own funds. From July the London County Council allowed us the use of the clinic premises free of charge. There are now 24 or 30 sessions a month, depending on the number of Tuesdays in the month. This is the full working capacity of our premises and equipment and any further development will have to be elsewhere. Members of the St. Marylebone Red Cross Society provide administrative staff, and we are grateful to them for facilitating such smooth working for this valuable service. Holidays.—The increased grant of £250 made by the Borough Council and an expenditure of £39 from our own funds enabled us to help 116 old people to have holidays. This was 32 more than in 1954. Three organised parties went to Brighton for a week, two in May and one in October. The Fourth Feathers Darby and Joan Club sent a party of 39 to Margate with the help of a grant of £20 from the Association. Fares were paid to enable several old people to have holidays with relatives, and individual holidays were arranged for infirm old people unsuitable for the organised parties. These individual cases are relatively very expensive, and it was decided that in 1956 we must, however reluctantly, confine ourselves to organised parties for the more able-bodied and so make the best use of our grant. Emergency Coal Service.—Forty-five deliveries were made during the year, 37 in the early months and 8 in the autumn, at the charge of 1s. 4½d. for 28 lbs. of coal. Wireless Sets.—The Wireless for the Bedridden Society kindly lent three more wireless sets for house-bound old people, bringing the total under Miss Sharp's supervision to nine. Prevention of Accidents.—Mrs. Fewster represents the Association on the St. Marylebone Road Safety Committee. Because of the danger of accidents in the home we were instrumental in having electricity installed in several rooms with no artificial lighting, and in having gas and electricity meters moved to accessible positions. Diseased or Infirm Persons. It was necessary to obtain Court Orders for the removal to hospital or a home of three infirm and physically incapacitated old people (all women of over eighty years of age), who were living alone under insanitary conditions and whose relatives or friends were unable to assist them. In one case, this action was taken under the National Assistance Act, 1948, and in the others under the National Assistance (Amendment) Act, 1951. Staff Medical Examinations. The Medical Officer of Health is medical adviser for the purposes of the Council's superannuation scheme. During 1955, one hundred and five examinations of members of the staff and new entrants were carried out. New Legislation. The following Acts, Orders and Regulations, etc., relating to the work of the Public Health Department, came into operation during the year :— Act, Order or Regulation Operative From L.C.C. (General Powers) Act, 1955 21.12.55 Transfer of Functions (Ministry of Food) Order, 1955 7.4.55 Food Standards (Table Jellies) (Amendment) Order, 1955 16.7.55 Transfer of Functions (Food and Drugs) Order, 1955 6.7.55 Poisons List Order, 1955 15.8.55 Food and Drugs Amendment Act, 1954 (Appointed Day) Order, 1955 16.12.55 Slaughter of Animals (Prevention of Cruelty) (Amendment) Regulations, 1955 1.7.55 Anthrax Disinfection Fee (Amendment) Rules, 1955 1.8.55 Poisons Rules, 1955 15.8.55 9 SECTION C.—SANITARY CIRCUMSTANCES. Sanitary Inspection. The number of complaints received (excluding those relating to rat and mouse infestations) was 1,278. Details of the various nuisances detected and remedied, to the total number of 1,695, are set out in Table 3 below:— TABLE 3.—Nuisances. Nuisance Abated or Defect Remedied Number Houses damp, dirty or dilapidated 394 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., defective 494 Insufficient and unsuitable water-closet accommodation 4 Drain, water-closet and waste pipe stoppages 135 Drains, water-closets and waste pipes defective 122 Yard, area and wash-house defects 9 Roofs, gutters and rainwater pipes defective 267 Insufficient water supplies 28 Water cisterns dirty or defective 24 Ashpits, dustbins, etc., defective 56 Rubbish accumulations 59 Animal nuisances 9 Miscellaneous 94 Total 1,695 Notices.—Intimation notices numbered 509, and 150 of these were followed by the service of a statutory notice to secure abatement of nuisances. In addition, twenty-nine notices were served under Byelaws made under the Housing, Metropolis Management or Public Health Acts. Legal Proceedings.—Table 4 below gives details of legal proceedings taken under the provisions of the Public Health (London) Act, 1936, and Byelaws made under the Public Health (London) Act, 1891 TABLE 4.—Legal Proceedings : Public Health (London) Act, 1936, Etc. Nature of Offence Fine Costs Remarks Failure to cleanse water storage cisterns or to maintain them in a cleanly state. Byelaws made under the Public Health (London) Act, 1891. - - After an adjournment summons was withdrawn, the work having been completed. Council received 2 guineas costs from defendants. Failure to comply with a Notice to secure abatement of a nuisance Public Health (London) Act, 1936. - - After several adjournments summons was withdrawn as the defendant had been removed to a London County Council home under the provisions of Section 47, National Assistance Act, 1948. do. £5 0 0 - Order made for work to be done within 28 days. do. £1 0 0 - Order made for work to be done within 3 months. do. £5 0 0 £2 0 0 Order made for work to be done within 28 days. Summons subsequently adjourned sine die, as defendant was no longer owner of premises concerned. Work was completed at a later date. do. £5 0 0 £2 2 0 Order made for work to be done within 28 days. do. £2 0 0 — Order made for work to be done within 28 days. do. - - Five separate summonses withdrawn—work completed. Council received 2 guineas costs from defendants in each of three cases. do. - - 10 Noise. Forty-three complaints of noise, involving thirty-one alleged nuisances, were received. A large proportion referred to machinery at factories and workshops, which special problem was mentioned in the Annual Report for 1954. The remainder concerned a wide variety of supposed causes, including radio, gramophones, garages, the repair of motor vehicles, building and engineering works, pneumatic road drills, the loading and handling of milk bottles, a refrigerator, night baking, boiler plant, noisy tenants and barking dogs. The complaints were not always justified but where, upon investigation, nuisances were found to exist these were nearly all abated or reduced after informal action by the sanitary inspectors or the Street Nuisance Inspector. In some cases the Department was unable to take direct action and the facts giving rise to the complaints were referred to other authorities possessing the necessary powers to deal with them. Pigeons. Section 121 of the Public Health (London) Act, 1936, empowers the Council, for the purpose of abating or mitigating nuisance, annoyance or damage, to arrange for the seizure or destruction of pigeons in excess of such numbers as the Council consider reasonable. Accordingly, an authorised pigeon catcher, who operates under the direction of the Medical Officer of Health, is retained to seize and dispose of pigeons congregating at places in the Borough to which he is directed. During 1955, four complaints of nuisance from these birds were investigated and referred to the pigeon catcher. Following one of these complaints, in the eastern part of the Borough, the Streets Nuisance Inspector found that a woman living in this area was feeding pigeons in the street. As a warning had already been given to this woman, legal proceedings were taken against her for two separate offences against the Council's byelaw of the 1st June, 1953, dealing with the deposit of litter on the highway. The cases were found proved and the defendant discharged absolutely on both summonses and ordered to pay three guineas costs. 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. In no case was it necessary to draw the attention of the Board to the quality or quantity of the water, but there were three complaints alleging that tap water had a peculiar taste. Upon investigation the water was found to be wholesome, although the storage tanks required cleansing. Notices were served upon the owners and the necessary work was done, although in one case, only after the institution of legal proceedings (see Table 4). In accordance with the provisions of the Public Health (London) Act, 1936, the Board notified six instances where water had been cut off in occupied premises, five for non-payment of rates and the other for waste of water. In all the supply was reinstated, in two instances after service of a notice. Further examinations of the private well waters from the twelve borings still in use (eight in full operation and four for emergency purposes only), were made by the Council's Bacteriologist, and these indicated that since the last survey, made in 1947 at the request of the Ministry of Health, there has been no appreciable change. The reports for 1955 were generally satisfactory, and no pathogenic contamination was found. It is the practice of the Department to keep the wells supplying water for drinking purposes under observation and sample their waters every six months. Twenty-five certificates relating to the provision of a proper and sufficient supply of water in dwelling-houses were granted under section 96 (2) of the Public Health (London) Act, 1936, in respect of newly-erected and rebuilt premises, including six blocks of municipal flats. Drainage. During the year, 299 drainage plans were approved. Thirty-five related to new buildings, including two Borough Council blocks comprising fifty-six flats. At the request of the Medical Officer of Health, the drains and/or sewer connections of twenty-five premises were examined by the staff of the Borough Engineer's Department. Defects which called for remedy were discovered at six premises and at the remaining nineteen the sewer connections were found to be serviceable and fit for continued use. The drainage inspectors made a total of 3,771 visits. Legal Proceedings.-—Table 5 below gives details of legal proceedings instituted with regard to drainage work carried out without notice. TABLE 5.—Legal Proceedings : Drainage Byelaws. Nature of Offence Fine Costs Remarks Installation of drainage works contrary to the provisions of the London County Council Drainage Byelaws. £2 10 0 £2 12 6 Pleaded guilty by letter. 11 Combined Drainage. Nine orders under seal for combined drainage were issued. Ventilation of Sewers. In the Annual Reports for 1953 and 1954, reference was made to the interim report of the working party representatives of the London County Council and the Metropolitan Boroughs' Standing Joint Committee on the causes of complaints of offensive smells from sewers and on probable ways to improve conditions. It was considered that adequate ventilation, preferably by a greater number of small ventilators rather than by a few large ones, was needed to disperse the concentrations of gases which are mainly responsible. It was suggested that this ventilation should be provided by way of the soil pipes of the drainage systems of suitable premises and as an experiment the intercepting chambers of the drains of some County Council and Borough Council properties in other districts were slightly altered for this purpose. No official information has been received of the results of this experiment although it is understood that the method is being continued and extended to include new County Council and municipal building works. The St. Marylebone Borough Council had hoped that it might be possible to ventilate selected lines of sewers in which there were known to be high concentrations of gases, by obtaining the co-operation of the owners of suitably sited premises draining into those sewers. Unfortunately, the necessary co-operation could not always be obtained so it has not been possible to proceed with this scheme. However, a survey was made of the London County Council flats and of premises owned or controlled by the Borough Council with a view to carrying out the basic suggestion of the County Council. It is intended to remove the stoppers of the intercepting traps and replace them with iron gratings at 81 suitable new or modern buildings. A meeting was held between the County Council's Chief Engineer and officers of the Borough Council, at which the ventilation of certain sewers was examined from both local and general view-points in an attempt to arrange a basis for wider co-operation but no further lead has yet been given by the County Council in respect of "sewer line" ventilation. It appears that the main difficulty is to ventilate, without causing nuisance, the deep level sewers which have no drain or branch sewers connections for very long distances. Rodent Control. During the year, 670 complaints were received and there were 517 infestations (ship rat 36, common rat 185, and mice 296). Infestation by the ship rat therefore fell by approximately two-thirds as compared with the previous year, while the incidence of the common rat and of mice was about the same. The source of common rat infestations is most often traced to some defect in the drainage system of premises in the vicinity which this year necessitated the service of 64 intimation and 7 statutory notices. The Council's staff undertook treatment at 517 premises. The scheme of block treatment commenced in 1949 was continued and 31 blocks involving 1,908 premises were dealt with. The original programme, which covered the whole of the Borough south of St. John's Wood Road, has now been completed. This brought to light many unsuspected infestations which, had they not been discovered early, would have become major problems. Although the work entailed is tedious and non-spectacular it has been most valuable and the number of rats in the Borough has now reached a relatively low level. It could not have succeeded, however, without the co-operation of the public and of the business community in the Borough. For the most part, owners and occupiers have willingly carried out rat-proofing work at their premises and have remedied defects and it was not necessary to take any formal action under the Prevention of Damage by Pests Act, 1949, in this regard. Known "black spots" will be given renewed attention and a further block survey programme has commenced. Owing to severe weather conditions the routine sewer baiting which should have taken place in January was cancelled but special treatment of sewers adjoining the Regent's Park area was carried out. This work was undertaken at the special request of the Ministry of Agriculture and Fisheries, who made a similar request to St. Pancras Borough Council with the object of securing a joint effort. Dlsinfestatlon. To rid dwelling houses of bugs, a spray of Kerosene with 5 per cent. D.D.T. and 0.1 per cent. pyrethrims is applied either by hand or under pressure from a motor compressor, according to the circumstances. This treatment is also given for flea and similar infestations which occur from time to time. During the year, 441 rooms were disinfested, including ten municipal flats and forty-five requisitioned premises. Altogether 122 requisitioned premises were inspected for vermin on becoming vacant. Furniture, more particularly that of people removing to fresh accommodation, is dealt with by hydrocyanic acid gas in specially constructed vans. The Council continued to have this work done by a contractor and during 1955 the furniture of 70 families, of whom 63 were being rehoused, was treated by this method. In addition, 3,443 verminous articles of bedding were disinfested by steam at the Council's premises in Lisson Grove, 12 Verminous Persons. The Council's Cleansing Station in Lisson Grove dealt with 918 verminous persons : adults 630 (men 535, women 95) ; children 288 (boys 54, girls 234). Shelter. It was not necessary during the year to make use of the shelter accommodation provided at No. 217, Lisson Grove, under section 195 (4) of the Public Health (London) Act, 1936, for families temporarily dispossessed of their homes. The room set aside for this purpose was, however, utilised for other public health work. Air Pollution. The Annual Report for 1954 contained some account of the work of the Department in the field of smoke abatement. This is a subject with which the Council have long been seriously concerned, more particularly since the disastrous fog of 1952, following which a Smoke Abatement Sub-Committee of the Public Health Committee was set up. General Policy.—The Council's policy has been to extend and strengthen co-operation with the Department of Scientific and Industrial Research, with neighbouring authorities and with other bodies dealing with the general problem. Representations were made jointly by St. Marylebone, Hampstead, Paddington and St. Pancras Borough Councils urging the British Transport Commission to accelerate their plans for the modernisation of the motive power on main lines approaching London termini. Replies were received from the three railway regions concerned drawing attention to the schemes for the introduction of diesel or electric traction contained in the Railway Development Plan announced earlier in the year and giving assurances that every attention would be given to keep smoke emissions to a minimum. When the Clean Air Bill came before Parliament the Council made special representations with a view to curtailing the exemptions in favour of railway engines and endeavoured to secure the amendment of clause 11 (2) so as to include hire purchase costs on the installation of smokeless fuel equipment in the expenditure ranking for grant provided that the deposit paid by the person entering into the hire purchase agreement should not be less than the amount of such grant. Pollution Recording Apparatus.—In addition to the two grit deposit gauges and three sulphur trioxide measuring instruments which the Council have maintained during the past two years, on the suggestion of the Department of Scientific and Industrial Research they set up two volumetric instruments for the daily recording of the amounts of smoke and sulphur dioxide in the air. These instruments came into operation from the beginning of June and in especially foggy periods readings are taken from them at three-hourly intervals throughout the day and night. The results are sent to the Department of Scientific and Industrial Research for collation and expert examination and are published in their monthly bulletin. St. Marylebone also, through the warden service and with the help of some of the members of the official staff, agreed to co-operate in a special scheme for taking readings of air pollution at various points in the Borough with portable apparatus during selected periods of fog. Publicity and Education.—A publicity campaign using posters and pamphlets was continued and the larger fuel consumers were urged to encourage their stokers to take special courses of instruction in boilerhouse practice given at technical schools. A further feature of the campaign was a Clean Air Week, the inaugural meeting of which was held at the Town Hall on the 3rd October under the chairmanship of the deputy Mayor. To this meeting, representatives of all the larger fuel users and property owners in the Borough were invited as well as fuel merchants and others particularly concerned with the problem of smokeless heating. They were addressed by Sir Hugh Beaver and Air Chief Marshal Sir Leslie Hollinghurst, C.B.E., K.C.B., D.F.C. The Solid Smokeless Fuels Federation co-operated by arranging for their mobile exhibition to tour the Borough and set up at sites including Montagu Square, Carlton Hill, Barrow Hill, Church Street and the John Lewis site in Oxford Street. The recorded number of visitors to the exhibition was 2,384 and 961 enquiries resulted. Inspection and Investigation of Complaints.—During the year there were 55 complaints alleging nuisance from smoke, grit or fumes. This was an increase of eight on the number in 1954. Although in recent years there has been a steady increase in the number of complaints, it is believed that this is due more to a growing public interest in air pollution rather than to any greater incidence of smoke emission. In all cases of complaint investigations were made and remedies effected by means of informal action. In some cases this consisted of drawing the attention of managements to defects in plant or instruments and in most cases advice was also given to boilerhouse staff. Where necessary, managements were also recommended to call in specialised technical assistance and, where circumstances warranted it, the installation of smoke warning systems was requested. In all, 669 inspections and observations were made, No legal proceedings were necessary and fuel consumers generally wer§ 13 co-operative and readily accepted advice and suggestions from the Department. Much good has resulted from this unspectacular work and several parts of the Borough where smoke and grit emission has in the past been particularly troublesome now enjoy improved conditions. Some owners have shown the greatest concern when nuisances have been reported to them and display a gratifying willingness to do anything practicable to effect a remedy. The management of one large establishment which had been giving trouble has been to very great expense to reduce smoke emission from their plant by entirely replacing their oil burning equipment and by carrying out research to reduce still further the possibility of nuisance from soot emission. Another has changed over from coal to oil. Factories. As required by section 128 of the Factories Act, 1937, a report on the administration by the Borough Council of the matters under Parts I and VIII of the Act is given in Tables 6 and 7. TABLE 6.—Factories : Inspections for Purposes of Provisions as to Health. Premises Registered Inspections Written notices Occupiers prosecuted Factories without mechanical power 271 370 31 — Factories with mechanical power 1,303 1,527 134 — Other premises* (excluding out-workers' premises) 195 425 — — Totals 1,769 2,322 165 - * Electrical stations, institutions, sites of building operations and works of engineering construction. TABLE 7.—Factories : Defects Found. Particulars Defects Found Remedied Referred In respect of which prosecutions were instituted To H.M. Inspector of Factories By H.M. Inspector of Factories Want of cleanliness 185 168 9 — - Overcrowding 2 2 6 — — Unreasonable temperature — — — — — Inadequate ventilation 6 4 7 — — Ineffective drainage of floors — — — — — Sanitary conveniences:— (a) insufficient 5 4 — 2 — (b) unsuitable or defective 103 71 — 8 — (c) not separate for sexes 12 7 — 3 — Other offences (excluding offences relating to outwork) 78 71 311 1 — Totals 391 317 333 14 — The defects and unsatisfactory conditions found (391) showed a further decrease on the numbers discovered in previous years, and the greater proportion again related to want of cleanliness of workrooms and sanitary accommodation. The general health sections of the Factories Acts administered by local authorities are : in factories where mechanical power is not used, provisions relating to cleanliness, overcrowding, temperature, ventilation, sanitary accommodation and drainage of floors, and in factories where mechanical power is used, provisions relating to sanitary accommodation only. It thus seems that the local authority is regarded as competent to deal with health matters in non-power factories, no matter how large the premises or how many are employed, but not competent to do so in premises, however small, where even the smallest power driven tool is used. It is only recently that use of mechanical power in factories has become the rule. When the Act became effective in 1937 most work-places had no power machinery. Consequently, the local authority was responsible for administering the health sections in the majority of factories and the factory 14 nspectorate administered them in the minority. It has always seemed illogical that use of power machinery alone should decide whether enforcement should be undertaken by either the local authority or factory inspectorate. Usually, it is in the smaller power factories that health conditions are unsatisfactory, and it has been estimated that of the 240,000 factories in this country, 221,000 employ fewer than 50 people, and 203,000 of these employ fewer than 25. The factory inspectorate consists of approximately 400 officers to deal with this vast number of factories. It must be realised that without regular and frequent inspection, bad habits of the few soon result in dirty and unhealthy conditions for the many. Obviously, with so few officers, the factory inspectorate is overburdened and at a disadvantage in administering the Act. Local authority Medical Officers of Health and Sanitary Inspectors have a wide and thorough knowledge of administering health legislation and are no strangers to factory inspection. They have functions, other than those of the Factories Acts, which take them into factories for a variety of duties in connection with Food and Drugs Acts and Regulations, Rag Flock Act, atmospheric pollution, hygiene in factory canteens, rodent control, and so on. The worker in industry is also a member of the local community and the effect upon his health of the conditions under which he works cannot be isolated from other factors, such as housing and general environment. The Medical Officer of Health and his staff are responsible for the environmental health of the community and it is a matter of great concern that adverse conditions are allowed to exist in factories because they have no power to stop them and the factory inspectorate has insufficient staff to detect and remedy them. Thus, to assist in the efficient administration of the Acts, and to safeguard the health of the worker, it is recommended that the local authority should be made responsible for administering in respect of all factories the sections of the Acts relating to overcrowding, temperature, ventilation, lighting, drainage of floors, sanitary accommodation, drinking water, washing facilities, and underground rooms (sections 1 to 7 inclusive, 41, 42 and 53). Far greater use could then be made of the specialised skill of the Medical Officer of Health and Sanitary Inspectors, and the overworked factory inspectorate could be released for duties more in their field, such as the regulations for special trades, accident prevention, toxic hazards, and the problems of the new atomic era in industry. As far as St. Marylebone is concerned, 1955 proved a good trading yekr, particularly in the clothing trade, and the number of factories registered increased to 1,769. Generally, conditions were quite good. Some instances were found of ill-lit and gloomy workrooms, mostly due to insufficient window cleaning, and, in some cases, bad artificial lighting. Apparently, some employers prefer to pay heavy electricity bills rather than have windows cleaned regularly, and fail to appreciate that a good standard of natural and artificial lighting would assist production, increase cleanliness, reduce accidents and ensure greater comfort for all concerned. Heating of workrooms now seems to be mostly satisfactory and, where possible, occupiers are requested to use heating appliances that do not burn smoke-producing fuel—thus, helping to reduce atmospheric pollution. Most occupiers readily agree to this suggestion, more especially when they realise that soot, etc., often has a harmful effect upon the materials they use, and that modern convector heating appliances reduce the risk of accidents, increase the comfort of employees and, again, aid production. Out-Workers. Ninety-eight employers submitted lists in respect of a total of 872 out-workers (243 contractors and 629 workpeople). Of these, fifty-six contractors and thirty workpeople operated in the Borough. The nature of the work upon which the out-workers were engaged is indicated below :— Wearing apparel 817 Buttons 17 Umbrellas 8 Household linen 7 Textile weaving 9 Curtains and furnishings 9 Furniture and upholstery 2 Lampshades 3 Total 872 Offices and Shops. It is estimated that 12 million people, almost half the working population, work in offices and shops in this country. In 1949, the Gowers Report was published and drew attention to the need for positive legislation concerning, in particular, offices. Shops Act legislation already in force deals with health 15 conditions in shops, although in London responsibility is divided between the County Council and the Metropolitan Borough Councils. The Gowers Committee recommended that section 10 (dealing with sanitary and other provisions in shops) of the Shops Act, 1934 should be enforced in London by the metropolitan boroughs, and although a further Shops Act was introduced in 1950, that recommendation has not yet been implemented. With regard to offices, there are no specific requirements as to lighting, temperature, or facilities for washing or for taking meals, all of which have a direct bearing on health. In London, it is even doubtful whether routine inspection of offices (as distinct from inspections based upon specific complaints) can be legally carried out under the Public Health (London) Act, 1936. It is therefore hoped that the recommendations of the Gowers Committee will soon be implemented to provide this vast body of workers with a standard of conditions, at least equal to that of the Factories Acts, to safeguard their health whilst at work. Fireguards. Inspection.—The Heating Appliances (Fireguards) Act, 1952 came fully into effect on the 1st October, 1954, and from that date all domestic heating appliances exposed for sale, sold or let under a hire purchase agreement or on hire must be fitted with a guard complying with regulations made under the Act. During the year, inspection under the provisions of the Act continued, not without some difficulty, however, because of the frequent absence of readily available power, fuel or gas supply, etc. at the traders' premises, the necessity for breaking manufacturers' seals and the fact that the lengthy process of a full test spoils to some extent the immaculate new appearance of the appliances. When the first tests were made, about half of the appliances were below the prescribed standard and traders were warned not to sell or otherwise dispose of them until adequate guards had been fitted and approved. As time went on there was a marked improvement so that by the end of the year comparatively few heaters were found not to comply with the requirements. Of eighteen which failed to satisfy the prescribed test all but five were second-hand and the main fault was inadequate guards. Accidents in the Home.—Although the Act now prohibits the sale of inadequately protected electric, gas and oil heaters, it is estimated that about five million such appliances were already in use before this legislation became effective. Most of these are dangerous and, in conjunction with an estimated twelve million unguarded solid fuel fires in use, present a constant menace, contributing to the high incidence of accidents and deaths from accidents which occur in the home. Apart from the vast number of people injured, an average of 24 people are killed in their homes every day ; that is, ten more than are killed on the roads. This startling state of affairs is one of which few people seem to be aware ; in 1954, there were 5,010 deaths on the roads whilst 7,723 deaths resulted from accidents in the home. Most of the latter could have been prevented and efforts should be made by the authorities concerned to make every householder realise the urgent need to take all possible precautions to reduce these appalling figures. Hairdressers and Barbers. Under section 18 of the London County Council General Powers Act, 1954, no person may carry on the business of a barber or hairdresser at premises in the Borough unless he and the premises are registered by the Borough Council. Byelaws governing the conduct of these establishments and designed to ensure cleanliness of the staff, equipment and premises made by the Borough Council under section 18 (4) of the Act came into operation on the 1st April, 1955. Notice was given in the Press and a letter explaining the new requirements was sent to all known hairdressers and barbers in the Borough. In the first instance, registration is automatic and by the end of the year 110 applications had been made. All the premises concerned were visited by the sanitary inspectors and conditions generally have been found to be reasonably satisfactory. Where necessary, however, advice and guidance have been given to the applicants and supervision will be kept to ensure that satisfactory standards are maintained. A large proportion of the registrations are in respect of women's hairdressers and these premises are normally visited by one of the women sanitary inspectors. Pet Shops. The Pet Animals Act, 1951, provides for a system of inspection and annual licensing of pet shops by local authorities, a fee of 10s. being payable for each licence, eleven of which were issued during the year. A few of the licensees keep puppies and other mammals for sale but mostly they deal in cage birds, goldfish and tropical fish. The premises concerned were kept under observation by the sanitary inspectors and the stalls licenced to sell pets in the street markets were inspected weekly. Conditions under which the livestock were kept appeared to be satisfactory. 16 Poisons. The names of seventy-three traders were on the Council's list of persons entitled to sell poisons included in Part II of the Poisons List (Pharmacy and Poisons Acts, IS52 to l!HI), the promises concerned numbering eighty-seven. Rag Flock and Other Filling Materials. The Rag Flock and Other Filling Materials Act, 1951 is intended to ensure that the fillings for upholstered and other stuffed articles shall be clean and wholesome. Standards of cleanliness are laid down in Regulations made under the Act, which also provides for licensing of premises where the fillings are manufactured or stored and registration by the local authority of all business premises where these materials are used. No premises in St. Marylebone are licensed for manufacture or storage but eleven premises, mainly those of upholsterers and manufacturers of cushions and pillows, are registered. Four samples of hair and other filling materials were taken during the year and submitted to a prescribed analyst who reported that all complied with the statutory requirements. Public Conveniences. The usual supervision was exercised over the public sanitary conveniences and urinals. There are in the Borough nine conveniences and five urinals for men and six conveniences for women. The free washing scheme, with paper towels and liquid soap, which was introduced to encourage personal hygiene and prevent the spread of disease, is now well established in its seventh year. It has become extremely popular with the general public and is a facility which they appear to expect as a matter of course. The staffing problem again caused concern but despite some difficulty the conveniences were manned during the usual opening hours throughout the year with the exception of Wellington Place (men and women) and St. John's Wood Road (men) which were left open but unattended for some hours during the staff holiday period. During this time no wilful damage of any kind occurred. A new public convenience for men and women on the Violet Hill Gardens site was opened on the 13th May. No full-time staff are attached to these premises and arrangements for their general cleansing and maintenance by the urinal flusher, who calls twice daily, with help from the woman attendant at Wellington Place once or twice a week, have been satisfactory. There was at first some minor damage to fittings, etc., caused by irresponsible persons but incidents of this kind have been stopped by the vigilance of the gardens caretaker. Public Cleansing and Salvage. The Director of Public Cleansing has kindly provided the following information on these services. The materials dealt with in 1955 were :— house and trade refuse, 35,445 tons; street sweepings and gully slop, 2,594 tons; salvaged materials, 1,866 tons. The sum of £13,865 was obtained from the sale of salvaged materials. In addition, £1,143 was received for the removal of trade refuse and green offal and for the cleansing of petrol interceptors. The Council ceased to separate and bale salvaged wastepaper, cardboard and fibreboard at their Wharf at Paddington as from the 31st October, 1955, for disposal under contract to Thames Board Mills Ltd., of Purfleet, Essex. With effect from that date all wastepaper, etc., collected in St. Marylebone was disposed of as loose cardboard and mixed paper in sacks to Phillips, Mills & Co., Ltd., at Battersea, S.W.I I, a subsidiary company of the Contractors. Two new diesel powered vehicles were put into service for the removal of portable containers from blocks of flats, etc. Refuse was removed from all premises within the Borough at least twice weekly and in many cases a thrice-weekly collection was provided. All street gullies were cleansed mechanically at least six times during the year and the minimum once-daily sweeping of streets was maintained, considerable use being made of the mechanical sweeping machines. The amount of time spent on washing streets by a watering tank was more than doubled last year, particularly because of the prolonged hot dry summer. 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 procedure set up when the section became operative on the 5th July, 1948, continued to work satisfactorily and during 1955 seven burials were undertaken by the Council. 17 Crematorium. The Medical Officer of Health is Medical Referee for the Council's Crematorium, situated in the St. Marylebone Cemetery at East Finchley. During 1955, 1,823 certificates authorising cremation were issued as compared with 1,671 certificates in 1954, 1,801 in 1953, 1,451 in 1952, 1,284 in 1951, 759 in 1950, 669 in 1949 and 360 in 1948. Since the Crematorium was opened in December, 1937, 11,634 cremations have taken place. Dog Nuisance. Contraventions of the bye-law relating to the fouling of footways by dogs reported by the street nuisance inspector resulted in twenty-three summonses. In all of these, convictions were secured and penalties imposed. Street Photographers. A local bye-law, made by the Council under section 146 of the London Government Act, 1924, came into operation on the 1st August, 1952, prohibiting the importuning by a street photographer of any person, in certain prescribed streets or public places, for the purpose of taking or selling any photograph. An offender against the bye-laws is liable on summary conviction to a fine not exceeding £5. As the administration and enforcement of most other "good rule and government " bye-laws have been referred to the Public Health Committee, a similar course was followed in regard to the new bye-law, more particularly as the officers of the Department, including the streets nuisance inspector, are continually about the streets. During 1955, the Council took out eight summonses but of these three could not be served and a fourth was withdrawn as the defendant was in prison. In respect of the others fines and costs amounting to £17 Is. Od. were imposed. SECTION D.—HOUSING. Permanent Estates. The Council had provided the following permanent housing accommodation up to the 31st December, 1955 :— No. of Flats Pre-War Estates— Crawford Place Dwellings 52 Fisherton Street 130 Post-War Estates— Barrow Hill 172 Church Street 140 Winchilsea House 23 Townshend (part) 152 Abbey Road/Boundary Road 54 Hamilton Terrace 52 Queen's Terrace 28 35/55, Boundary Road 48 Wellington Road 121 Abercorn Place 34 147-149, Gloucester Place 10 Total 1,016 At the close of the year, the following additional permanent accommodation had reached the stage indicated :— No. of Flats Townshend : Block 7—substantial progress made 28 Block 9—building works commenced 42 33-35, Townshend Road : Working drawings in preparation 8 Church Street Extension : Architect appointed. Plans in preparation 40 (approx.) 17/19, Balcombe Street : Building work reached first floor level., 4 18 No. of Flats 1-7, Aquila Street: Good progress made 6 22-30, Balcombe Street : Building work to commence shortly 14 147-165, Lisson Grove : Working drawings being prepared 12 Abercorn Place/Violet Hill : Leasehold interests acquired. Compulsory Purchase Order confirmed in respect of freehold interests 22 Pembroke Terrace : Sketch plans approved and planning consent awaited 10 57/73, Boundary Road : Sketch plans approved 36 Maisonettes In addition, proposals are under consideration for the re-development of one site now occupied by factory-made bungalows, and for two other small sites. St. Marylebone Housing Association. The Council agreed to co-operate under the Housing Acts, 1936-1949, with the St. Marylebone Housing Association in the development for housing purposes of a site at 8, Greville Place. By this arrangement the Council obtain the Exchequer subsidy in respect of the flats and transfer it to the Association. The Council also make a contribution from the general rate. It has been agreed to lend the Association the sum of £20,000 under Section 93 of the Housing Act, 1936, to enable development to proceed. Slum Clearance Programme. A joint slum clearance programme under the Housing Repairs and Rents Act, 1954, has been prepared by the Borough Council and the London County Council and has been submitted to the Minister of Housing and Local Government for approval. The programme contemplates the clearance of 250 unfit houses during the next five years, 124 of which will be dealt with by the Borough Council. Factory-Made Bungalows. Fifty-five families remain housed in factory-made bungalows. Requistioned Premises. The owners of requisitioned premises housing 456 families were asked if they wished to be afforded an opportunity of accepting the release of their properties from requisition and the transfer of the licensees (who would become statutory tenants) under Section 4 of the Requisitioned Houses and Housing (Amendment) Act, 1955. By the end of the year the owners of some 210 housing units had indicated their interest and the necessary further steps were being taken. Dwelling Houses. Inspection under Public Health or Housing Acts :— (1) (a) Inspected for housing defects 1,967 (b) Inspections made for the purpose 5,052 (2) Found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (3) Found not to be in all respects reasonably fit for human habitation 509 Defects remedied without service of formal Notices :— Defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 330 Action under Statutory Powers :— (a) Proceedings under Public Health Acts :— (1) Dwelling-houses in respect of which notices were served requiring defects to be remedied 179 (2) Dwelling-houses in which, after service of formal notices, defects were remedied :— (a) By owners 158 (b) By Local Authority in default of owners — 19 (b) Proceedings under section 12 of the Housing Act, 1936 :— (1) Underground rooms in respect of which Closing Orders were made 72 (2) Closing Orders determined, the tenement or room having been made fit 7 (3) Rooms affected by (2) above 16 Housing Repairs and Rents Act, 1954 Certificates. During the year, 101 applications for certificates were received by the Town Clerk and referred to the Medical Officer of Health for a recommendation on the issue or refusal of a certificate after considering a report by the sanitary inspector on the premises concerned. Twenty-one certificates were issued and twenty revoked. Eighty of the applications were from premises owned by two landlords and in the last half of the year only three applications were received. Re-housing. During the year, 332 enquiries were received from the Borough Council's Housing Director, the London County Council and other local authorities, regarding the circumstances of persons applying for re-housing. Nearly all requests necessitated investigation by a sanitary inspector before the enquirer could be provided with a report to assist him in assessing the order of priority of the various applicants. The Medical Officer of Health considered 251 confidential medical certificates submitted in support of applications for re-housing. The occupants of rooms upon which closing orders are made receive additional " points" which increase their degree of priority for re-housing, and until they obtain other accommodation the operation of the closing orders remains in abeyance. Immigrants. Under an arrangement which has operated for the past seven years, the London Commissioner of the Cyprus Government, with the object of avoiding possible overcrowding by sponsored immigrants from Cyprus, consulted the Medical Officer of Health on ten occasions regarding the suitability of accommodation offered by Cypriots residing in St. Marylebone to their compatriots. In nine of these cases (involving thirteen immigrants), the accommodation was of the standard required by the Housing Act, 1936, but in the other it was reported that overcrowding would result. Common Lodging Houses. Twenty-eight inspections were made of the two lodging houses, one of which is run by the Salvation Army at No. 2, Burne Street and premises in Lisson Street to accommodate 391 men ; the other, conducted by the Church Army at Portman House, No. 10, Daventry Street, is registered for 85 women. At the quarterly fire inspections it was found that the fire-fighting equipment provided and the precautions taken were satisfactory in both lodging houses. SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Analysis. Samples of one hundred and one different kinds of foodstuffs and ten varieties of drugs were taken and analysed under the Food and Drugs Act, 1938, the fee paid for analysis being £1 1s. 0d. for each milk sample and £1 15s. Od. for each other sample. The Public Analyst (Mr. Thomas McLachlan) has submitted the following report on the year's work :— "During the year 1955, 571 samples of foods and drugs were examined. Of these 519 were taken formally and 52 informally. The number adulterated or incorrectly labelled was 21. The incidence of adulteration may be classified as follows :— Number of samples Number incorrect examined Milk 113 2 Other foods 439 17 Drugs 19 2 These figures indicate that the samples submitted from St. Marylebone are better than last year. 20 Adverse reports were made on two samples of milk. One sample contained 10 per cent. and the other 8 per cent. of added water. A sample of stuffed roast pork consisted of 33 per cent. roast pork and 67 per cent. of sausage stuffing. These percentages are those of the sample submitted and may not have represented the proportion as originally present in the sample as sold. A follow-up sample taken formally was found to be satisfactory. Three samples of pork sausages were found to be deficient in meat content. One contained only 60 per cent. of total meat, being 9 per cent. deficient, another contained 62 per cent. of total meat and was 5 per cent. deficient, whilst the third sample contained 63 per cent. and was reported as inferior. Some sage and onion stuffing with shredded suet contained 4.3 per cent. of fat and the free fatty acids on the fat, calculated as oleic acid, were 17 per cent. The free fatty acid content should not be more than 2 per cent. The manufacturers of this product have requested the Research Laboratories of the Food Manufacturers' Federation to investigate the best method of preparing mixtures of this type for sale on the open market. Two samples of bread and butter, two buttered rolls, and two scones and butter were all spread with margarine, whilst a sample of buttered buns, and another of buttered rolls were spread with mixtures of margarine and butter. A sample of butter submitted because it was suspected of containing excess water, contained 16.3 per cent. of water which is 1.8 per cent. in excess of the permitted maximum of 16 per cent. A complaint was received regarding the odour and taste of the icing of a cake. The icing contained over 15,000,000 bacteria per gramme, showing that the egg albumen used in its manufacture must have been of very inferior quality. Some Honey Bake Biscuits contained only 5.6 per cent. of sugar as invert sugar. Honey biscuits must contain in the finished product not less than 7 per cent. of invert sugar derived from honey. Some confectionery sold as Coconut Macaroons was considered to be incorrectly named. No fault was found with the composition of the sweets but they were really chocolate coconut sweets and showed no resemblance to macaroons. Two samples of children's travel sickness tablets were examined and reported as badly prepared. They were reputed to contain 1£ grains of carbromal and 1 grain of potassium bromide. The first sample contained 13 per cent. excess carbromal and the second 12 per cent. excess of potassium bromide. Several samples submitted because of complaints by members of the public were examined, but these complaints were not found to be justified. Some sterilised bottled cream was alleged to taste of milk of magnesia, but it was genuine sterilised cream. If cream is to be sterilised it has to be homogenised before being heated, but many people dislike the resulting consistency and flavour and believe such cream to be contaminated with milk of magnesia. Some brown bread and butter thought to be spread with margarine was spread with genuine butter. A beefsteak thought to be horseflesh, consisted of genuine beef, and a foreign body found in soup, consisted of dried braised onion. Food and Drugs Legislation during 1955. There has been little actual increase in the amount of food and drug legislation during the year, though much has been introduced, including the Food and Drugs Act, 1955, and the Hygiene Regulations, 1955. The Food and Drugs Act is a consolidating Act which comes into operation in 1956, and it will not be discussed in this report, since the principal implications were mentioned in last year's report. Similarly, the Hygiene Regulations only come into force in 1956 and it remains to be seen how some of its articles are to be interpreted from the public analyst's standpoint. The Food Standards (Butter and Margarine) Regulations, 1955, and the Labelling of Food (Amendment) Order, 1955, also come into force in 1956. The Food Standards Committee issued a Supplementary Report on Colouring Matters in Foods. This proposed the inclusion of titanium oxide and ultramarine, as permitted dyes, and also the deletion of one "coal-tar" dye, Baking Brown AW, and the addition of Black PN to the List previously proposed. The earlier Report proposed that the addition of added colours to foods should be declared to the purchaser, but this Supplementary Report recognises that there are cases where this would be inadvisable. It is suggested that the presence of added colour to fish should be declared, but that it should not be declared in the case of bread, flour confectionery, butter, cheese, margarine, sugar confectionery, ice cream, and other frozen products. 21 It is pointed out in the Report that the identification of colours in foods will not be straightforward, but it is hoped that with the introduction of modern techniques it may be possible for analysts to develop methods for their identification. Reports of this type, taken with those on the addition of anti-oxidants to foods, and limits for lead, arsenic, copper, zinc and tin illustrate the increasing complexity of food analysis, when it is remembered that these are only one facet of the work involved." Legal Proceedings—Food. Table 8 below gives details of legal proceedings taken under the Food and Drugs Act, 1938 :— TABLE 8.—Legal Proceedings:Food and Drugs Act, 1938. Nature of Offence Fine Costs Remarks Piece of glass in Bun Food & Drugs Act, 1938. £10 0 0 £3 3 0 - Condition of premises where food is sold. Food & Drugs Act, 1938, Sec. 13 (1) (c), (d). (g), (h) & 13 (2) (b). £34 0 0 - There were five summonses against defendants. All five were proved. Fines of £10 on each of three charges and £2 on each of two. Selling Rolls spread with margarine as " Buttered Rolls." Food & Drugs Act, 1938, Sec. 3. £5 0 0 £5 5 0 Three different cases. £4 0 0 £3 3 0 £2 2 0 £1 0 0 Food preparation and service rooms not kept in proper state of repair. Food & Drugs Act, 1938, Sec. 13 (3). - - Summons withdrawn—work commenced. Selling Buns spread with margarine as "Buttered Buns." Food & Drugs Act, 1938, Sec. 3. £4 0 0 £3 3 0 - Selling Scones spread with margarine as "Buttered Scones." Food & Drugs Act, 1938, Sec. 3. £4 0 0 £4 4 0 - Selling Bread spread with margarine as " Bread & Butter." Food & Drugs Act, 1938, Sec. 3. £5 0 0 £5 5 0 Two separate cases. £5 0 0 £4 4 0 Selling Hot Milk with water added as " Hot Milk." Food & Drugs Act, 1938, Sec. 3. Food & Drugs (Milk, Dairies & Artificial Cream) Act, 1950, Sec. 9. £4 0 0 £4 4 0 Two separate cases. £5 0 0 £5 5 0 Failure to take reasonably necessary steps to prevent risk of contamination of food in a room by reason of cats and kittens. Food & Drugs Act, 1938, Sec. 13 (2) (b). £10 0 0 £2 2 0 - Exposing for sale Sausage and Egg Rolls unfit for human consumption. Food & Drugs Act, 1938, Sec. 9. - - Case dismissed. Unsound Food. The total quantity of food surrendered as being unsound and unfit for human consumption was approximately 23 tons, details of which are given on the following page :— 22 Food Condemned Quantity tons cwts. qtrs. lbs. Meat and offal — 11 2 1 Bacon and ham . 2 12 — 12 Poultry and game — 3 — 16 Fish — 12 1 14 Fruit and vegetables . 1 6 2 25 Canned meat 4 6 1 23 Canned food (other than meat) 10 18 — 14 Miscellaneous 1 19 1 4 In 1954, the quantity of unsound food surrendered was approximately 46 tons and the present reduction to some extent reflects the greater care being taken by the trade. Wholesalers and importers do not now accept financial responsibilities for loss indiscriminately. Consequently, retailers are more careful when purchasing and when examining food in course of delivery. Of unsound canned food a large proportion is unfit as a result of mishandling. The early removal of decomposing food was facilitated by the use of the Department's transport. During 1955 this work involved 194 journeys. Whenever possible unsound food was released for animal feeding, the remainder being destroyed. Flaked Hen Egg Albumen. A consignment of flaked hen egg albumen imported from China by a wholesaler in St. Marylebone was found to contain organisms of the salmonella group. Subsequently, the organism was typed as " Salmonella Thompson". The Medical Officers of Health of the districts to which supplies of the albumen had been distributed were notified by telephone or telegram and the Ministry of Health were informed of the circumstances. Unused stocks of the albumen were returned to the wholesaler leaving him with a total of 4,120 lbs. to be held pending an official decision as to the method of its disposal. Milk. There are 78 premises from which milk is sold and 12 milk roundsmen operate in the Borough from shops or depots elsewhere. A total of 162 inspections were made. During the year, 238 applications under the Milk (Special Designation) (Raw Milk) Regulations, 1949-1954 and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-1953, were received from seventy-five milk sellers, and licences were granted as follows :— Tuberculin tested milk 51 dealer's and 15 supplementary Pasteurised milk 1 pasteuriser's, 70 dealer's and 16 supplementary Sterilised milk 1 steriliser's, 69 dealer's and 15 supplementary The average composition of the 110 genuine samples of milk analysed was : total solids 12.42 per cent. ; fat 3.67 per cent. ; solids not fat 8.75 per cent. ; as compared with the legal minima, namely, 11.50 per cent.; 3.00 per cent. and 8.50 per cent. respectively. Twenty-two 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 89 other samples of milk examined by the Council's Bateriologist, all were found to comply with the requisite standards. Ice-Cream. The number of registered premises was 224, which includes three where ice-cream is manufactured ; 162 inspections were made and two notices were served in respect of defects. Preserved Food. There were 118 premises registered for the preparation or manufacture of sausages or potted, pickled, pressed or preserved food intended for sale. A total of 384 inspections were made and informal action was taken to remedy any unsatisfactory conditions found from time to time. Restaurants, etc. Premises in which meals are provided or food is sold already cooked or is prepared for sale numbered 789, including 327 restaurants and snack bars, 45 hotels, 231 staff and club canteens, 120 public houses, 32 other licensed premises, 18 school and nursery canteens and 6 coffee stalls ; 2,234 inspections were made and 32 notices served. 23 Fried Fish Shops and Fish Curers. Ten premises are used by fried fish sellers and one by a fish curer. Twenty-four inspections of fried fish shops and twenty-two inspections of the fish curer's premises were made. Conditions generally were found to be satisfactory and no notices were served. Wholesale and Retail Foodshops. Inspection of these premises, of which there are 620, involved 2,558 visits. Seven notices were served but many minor infringements of the Food and Drugs Act were dealt with either by letter or by verbal action. An increasing interest in food hygiene was noticed during the inspection of food shops. This was to some extent prompted by the prospect of new legislation and a greater degree of co-operation with the trade was achieved. Bakehouses. Most of the fourteen bakehouses maintained good standards and the comparatively few unsatisfactory conditions found were dealt with informally ; 94 inspections were made. Butter and Margarine Premises. Three dealers in margarine and two butter manufacturers are registered. Fifty-eight inspections of the premises were made. Horseflesh. Fourteen visits were paid to the only shop in the Borough selling horseflesh for human food. Slaughter of Animals. The only slaughterhouse in the Borough is a knacker's yard at the Zoological Society's premises in Regent's Park, where slaughtering is done occasionally to augment the food supply for the animals. Nine inspections were made during the year. St. Marylebone Clean Food Association. The Executive Committee of the Association (Chairman : Mr. H. A. Hale ; Hon. Secretary : Mr. W. C. Moss ; Hon. Treasurer : Mr. D. W. Moeran), have kindly provided the following information which is extracted from their report for the year 1955:— " Membership of the Association. The total number of members is 163. This is a reduction of six on the previous year. Of these, two premises have closed, four premises have changed hands and the new proprietors have not yet applied for membership. Code of Practice. We are again happy to record that no infringements of the Code of Practice by members of the Association have been reported by the public. Food Legislation. The Food and Drugs Act, 1955, for which we had waited so long, received the Royal Assent on the 22nd November, 1955 and The Food Hygiene Regulations, 1955, became law on the 1st January, 1956, with full effect from 1st July. It is gratifying to note that much of our Code of Practice has been included in the new Regulations. Many of our members report that the booklet explaining The Food Hygiene Regulations which the Medical Officer of Health sent to all food traders in the Borough has proved most useful. The Future. The Committee feel that in spite of the additional legal requirements imposed upon food traders generally, by the new Regulations, the Association still has something to offer and we are convinced that the public are becoming increasingly aware of the merits of the "clean food " badge and the high standard it proclaims. We recognise, and indeed continually emphasise, that to achieve the high standard necessary to qualify for membership of the Association is in itself not enough and that the all-important thing is that this standard should be maintained at all times." 24 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Table 9 gives information regarding notifications of infectious and other diseases notifiable in St. Marylebone received during 1955. Enquiries relating to these and to infectious disease contacts involved 1,433 visits by one of the women sanitary inspectors. TABLE 9.—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— Erysipelas 8 - - - - - - - - 1 1 3 4 - 8 Scarlet fever 18 - — — 3 — 11 3 — 1 — - - 1 17 Puerperal pyrexia 14 - — — — — — - 1 11 2 — - 14 - Poliomyelitis— Paralytic 8 - 3 2 — — 2 1 - - - - - 7 1 Non-paralytic 6 - — 1 1 — 1 - — 3 — — — 6 — Pneumonia 13 - — — — — — - — — 4 6 3 1 12 Dysentery 12 1 1 1 — — 4 1 — 1 1 1 1 4 8 Measles 588 16 54 83 99 89 220 8 6 11 2 - - 28 560 Whooping cough 37 5 1 8 4 3 14 - — — — 2 — 3 34 Scabies 19 — — — — — 1 1 1 14 1 1 - - 19 Meningococcal infection 2 - - - - - 1 - - 1 - - - 1 1 Ophthalmia neonatorium 1 1 - - - - - - - - - - - — 1 Tuberculosis— Pulmonary 75 -0 - - - - - 1 4 32 13 22 3 31 44 Non-pulmonary 2 — — — — — — - — 1 1 — — 2 — Food poisoning 117 — 3 — — — 2 1 9 19 16 11 56 3 114 Typhoid fever 2 — — — — — — - — 1 — 1 - 2 - Paratyphoid fever 2 - - - - - 1 - - 1 - - - 2 — Totals 924 23 62 95 107 92 257 16 21 96 41 47 67 105 819 * There were no cases in the Borough of the following diseases which are also notifiable : Smallpox, diphtheria, membranous croup, cholera, typhus fever, relapsing fever, continued fever, plague, leprosy, hydrophobia, glanders, farcy, anthrax, malaria, acute encephalitis (infective or post-infectious). Tuberculosis. Table 10 gives the age and sex distribution of new cases and of deaths from all forms of tuberculosis. TABLE 10.—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—5 - - - 1 - - - - 5—15 1 - - - - - - - 15—25 13 13 1 1 - - - - 25—35 19 18 2 - 1 - - - 35—45 15 9 1 2 - 1 - — 45—55 14 9 — - - — - — 55—65 11 2 1 1 1 1 - — 65 and upwards 6 2 — — 5 — - — Totals 79 53 5 5 7 2 — — ‡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 9 (above) gives information regarding notifications of pulmonary and nonpulmonary tuberculosis received during the year. Two hundred and twenty-two visits for enquiries into housing and sanitary conditions 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, 1955, was 887. 25 Food Poisoning Outbreaks. Details of cases of food poisoning notified during the year are given below in the form required by the Ministry of Health :— (a) Total number of cases notified.—117. (b) Outbreaks due to Identified Agents.—Three, as follows :— Cases Agent 2 B. Welchii. 2 Salmonella typhi-murium. 38 Salmonella typhi-murium. (c) Outbreaks of Unknown Cause.—Three unrelated outbreaks of two, five and fifty-six cases respectively. (d) Single Cases due to Identified Agents.—Three, as follows :— Cases Agent 2 Salmonella typhi-murium. 1 Salmonella enteritides. (e) Single Cases of Unknown Cause.—Nine. Impetigo. Three cases of impetigo in children, all girls, were treated at the Cleansing Station. Scabies. The Council's Cleansing Station in Lisson Grove dealt with 83 cases of scabies : adults 58 (men 49, women 9) ; children 25 (boys 16, girls 9). Eight patients were visited in their homes. 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. Disinfection. During the year, 197 rooms and 803 articles of bedding (mattresses, blankets, sheets, bolsters, pillows, etc.), together with 1,165 books, were disinfected, and 392 dressing drums from a local hospital were sterilised. The Department continued to be asked by residents in the Borough to certify that worn clothing intended for despatch to foreign countries was free from infection. Disinfection was carried out only when clothing had actually been in contact with infectious disease but, during the year, 253 certificates, relating to a total of 5,309 articles, were issued to indicate that no infectious disease had been reported for at least one month at the premises from which the clothing was purported to have come. Exclusion from Work of Contacts of Infectious Disease. Both by Regulations made under the National Insurance Act, 1946, and the Public Health Infectious Disease Regulations, 1953, persons may be excluded from work and qualify for National Health sickness benefit if, in the opinion of the Medical Officer of Health, they are contacts or carriers of disease and it is necessary to exclude them from work in order to prevent the spread of infection. These regulations apply particularly to food handlers in shops and to cooks, kitchen hands and others employed in cafes, canteens and restaurants. During the year four such certificates were issued. International Certificates of Vaccination and Inoculation. At the request of the Ministry of Health, arrangements were continued 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 going abroad. During 1955, 5,090 applications were dealt with as compared with 3,951 in 1954. 26 Bacteriological Examinations. Table 11 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 11.—Work of the Bacteriological Laboratory. Nature of Specimen and Examination Positive Negative Total Throat and nasal swabs for— B. diphtheriae — 27 27 Haemolytic streptococci 9 20 29 Vincent's organisms 6 14 20 Vaginal swabs for— Monilia - 1 1 Trichomonas - 3 3 Sputum for— Tubercle bacilli - 17 17 Finger swab for— Staphylococcal infection — 1 1 Cough plate for— H. pertussis — 2 2 Faeces for— Parasites 3 7 10 Typhoid, paratyphoid, dysentery and food poisoning organisms 14 155 169 Blood for— Glandular fever - 1 1 Malaria — 2 2 Typhoid — 1 1 Foods for— Food poisoning organisms 2 19 21 Urine for— Food poisoning organisms — 3 3 Urethral swabs for— Gonococci - 3 3 Totals 34 286 320