AC 4353 STMARY 61 BOROUGH OF ST. MARYLEBONE REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 H. A. BULMAN, M.R.C.S., D.P.H. 1 CONTENTS page Members of the Public Health Committee 4 Staff of the Public Health Department 4 Section A—Statistics and Social Conditions 5 Section B—General Provision of Health Services 7 Section C—Sanitary Circumstances 11 Section D—Housing 17 Section E—Inspection and Supervision of Food 19 Section F—Prevalence of, and Control over, Infectious and other Diseases 27 Appendix 29 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, I have pleasure in presenting my Annual Report for 1956, which follows lines similar to those of its immediate predecessors. The general standard of public health in St. Marylebone may be regarded as having been satisfactory throughout the year and the birth and death rates at 10.93 and 15.57 respectively remained almost the same as for the previous year. The rate for stillbirths, however, which fluctuates a good deal from year to year, at 26.83 was the highest since 1945. There were no major epidemics and infectious disease notifications fell from 924 in 1955 to 419, due mainly to 1956 not having been a " measles year." Of poliomyelitis there were only 2 cases and again no diphtheria was notified, the last having been in 1948. Amongst the more important legislation, the long-awaited Clean Air Act, 1956, was passed during the year and the Food and Drugs Act, 1955, and the Food Hygiene Regulations, 1955, came into operation. By Act of Parliament as from the 2nd August the time-honoured title " sanitary inspector " was changed to " public health inspector." The year under review marks the centenary of an important event in local history, the first medical officer of health for St. Marylebone, Dr. Robert Dundas Thomson, F.R.S., having been appointed to this office by the Vestry in 1856. He prefaced his annual report for that year as follows :— '"To point out the existence of any nuisance, or other local causes, which are likely to originate and maintain diseases increasing the rate of mortality, and injuriously affect the health of the inhabitants,' is the compendious definition which the Act of Parliament supplies of the duties of the Medical Officer of Health. But what a vast field of inquiry does this brief sentence open up ! The various conditions of the air we breathe, and everything calculated to alter its normal condition, the water which we use for domestic purposes, and the stagnating influence of moisture upon the ambient atmosphere ; the nature of the earth, and its contaminations by retrograde civilization, and, even, moral influences, are all included in the category embraced by this benevolent sanitary law." These remarks hold good today. Many of the same problems with which Dr. Dundas Thomson was faced still remain and there is a special topicality about his reference to " the air we breathe." Nevertheless, great changes have taken place and he would not now recognise much of St. Marylebone. The district has grown vastly in commercial and industrial importance and former residential areas have been given over to these purposes. Although the daytime population is probably something approaching half a million, the number of residents has reduced from 175,441 to 73,040. The death rate has fallen from 20 (the average for the previous 10 years was 24) to 15.57 per thousand and, although no figures are given in his report for births or infant mortality, there has undoubtedly been a great reduction in the proportion of deaths of children under 5 years of age. Expressed as a percentage of total deaths the rate for this group has fallen from 42 per cent. to just under 1 per cent. in 1956. Little statistical information of housing conditions is given in that early report but the general picture conveyed is of the poorer inhabitants in some quarters of the Borough living in a state of great squalor and overcrowding, many of them huddled together in cellars and other underground dwellings. This was probably one of the worst problems that faced the original medical officer of health and his inspectors. Sickness and disease were rife and infectious conditions appear to have accounted for over one-fifth of the total deaths. One of the main sources of disease was thought to be the domestic water supply. There were 44 street pumps and Dr. Thomson refers many times to the impurity of these waters. He considered pump water as totally unfit for public consumption and recommended that it should be used only for washing or watering the streets. Today, domestic water is supplied through the mains of the Metropolitan Water Board and is invariably beyond reproach. There were 120 slaughterhouses in the Borough and a large, though unspecified, number of cowhouses for a milk supply which was undoubtedly extremely unsatisfactory. 3 In the middle of the 19th century, health services, as we know them, hardly existed at all. The main problem then was one of providing medical and welfare facilities of the kind which have since been gradually developed. Today the emphasis has changed and the need is rather for more effective health education and encouragement of proper use of services which now exist. As this is the last report covering a full year I shall be privileged to submit, I should like to take the opportunity of acknowledging all the kindness and help I have received from members of the Borough Council and from those with whom I have been associated in public health work in St. Marylebone since I joined the staff in 1930 and particularly since my appointment as medical officer of health in 1939. I am especially grateful to the chairmen of the Public Health Committee who have held office during this period. They have not only shown themselves seriously concerned to perform the important functions and carry out the powers and duties delegated to them by the Council but they have also given me great encouragement and consideration. I have enjoyed most happy relationships with my colleagues in other departments but it is naturally to the staff of the Public Health Department that my debt is greatest. Throughout the years they have invariably given me loyal and most efficient support. They are a staff of whom any chief officer might well be proud. I would also like to pay particular tribute to the good work of the Old People's Welfare Association and its honorary officers who have built up such a splendid service for the older residents of the Borough. Finally, I would like to express my special thanks to His Worship the Mayor and to the present Chairman of the Public Health Committee, Alderman C. D. Denis-Smith, and members of the Public Health Committee for their kindness and consideration to me during this past year and particularly during my period of illness. It is to me a matter of deep regret that my health will not permit me to continue to carry out the duties of my office and that my career as medical officer of health is to be cut short but 1 shall carry into retirement very happy memories of my work in St. Marylebone. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. A. BULMAN, Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE 1956 HIS WORSHIP THE MAYOR : •Alderman C. D. Denis-Smith, J.P. (Chairman†) †Councillor R. H. Sharp, F.I.P.A. ALDERMEN: Miss L. F. Nettlefold, M.A., LL.B., L.C.C. Capt. R. G. Whitney, M.B.E., J.P. COUNCILLORS : †R. H. S. Allen †Dr. L. Jacobs Dr. H. K. Ashworth, T.D. (Chairman*) The Rev. W. M. Long †Mrs. E. M. Brown *Mrs. L. Lyons *F. Frame *Mrs. S. Rivington H. C. Garrard †S. Stanley *B. Hawley *Miss L. B. West Russell Mrs. C. Q. Henriques (deceased 7.2.1956) fW. R. Willcocks *J. P. Honour Miss F. E. Wilson *until May †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 Officers of Health and Deputy Medical Referees for Cremation C. J. C. Britton, M.D., D.P.H. James Fenton, C.B.E., M.D., M.R.C.P., D.P.H. (frojn October) Public Analyst (Part-time) : T. McLachlan, A.C.G.F.C., F.R.I.C., M.I.Biol., 4, Hanwav Place, W.l Bacteriologist {Part-time) : C. J. C. Britton, M.D., D.P.H., 35, Harley Street, W.l Administrative and Clerical Assistants : H. G. E. Brown (Chief Assistant) D. H. Drewell P. C. Bedward S. P. Fleming F. W. Dines J. H. Manning F. V. Terry Miss M. L. Shaul Miss C. A. Cruickshank Public Health Inspectors H. E. Scoble, M.B.E. (a, b) (Senior Inspector) Drainage : Rodent Control : V. A. Bignell (a, b, c) J. E. Broadhead (a) J. R. Baily (a, b) Care of Old People and Rehousing : Factories : Miss M. M. Sharp, M.B.E. (a, d, e, f) L. Newland (a, b) District : Food : J . A. Cummins (a, b) L. Pearson (a, b, c) G. A. Fraser (a, b) (until July) Restaurants : D. B. Hooper (a) Mrs. M. L Tiplady (a, b, d, f) P. W. Jolly (a, b) (from March) •Miss B. Wilson (a, b, d, e, f) Outdoor Superintendent : R. G. Turner Streets Nuisance Inspector : D. Telford Student Public Health Inspector : fR. C. Morton (from March) Messenger I Handyman : W. G. Sharwood Mortuary Keeper 1 Disinfectors 3 Rodent Operatives 4 Cleansing Station Attendants 3 Public Conveniences Staff 36 Van Driver 1 (a) Public Health Inspectors' Certificate (b) Meat and Other Foods Inspectors' Certificate (c) Smoke Inspectors' Certificate (d) Health Visitors' Certificate (e) Central Midwives' Board Certificate (f) State Registered Nurses' Certificate * Also Infectious Diseases. †Appointed as student sanitary inspector under a scheme of paid pupilage adopted by the Borough Council on the 19th January, 1956, 5 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 : £6,679,740. Sum represented by a penny rate: £26,180. Residential units (separate assessments) : 23,942. Population : 1951 census—Males : 31,649, Females : 44,172. Total : 75,821. Foreign-born residents : 1951 census—8,872 (approximately 12 per cent. of total population). 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) : mid-1956—73,040. Registrar General's estimate of the child population : mid-1956—under 1 year : 810 ; 1-4 years inclusive: 2,590 ; 5-14 years inclusive : 5,400. Total child population: 8,800 (approximately 12 per cent. of total population). It is estimated that 49,740 (approximately 68 per cent.) of the Borough's population are aged between 15 and 65 years, and 14,500 (approximately 20 per cent.) over 65 years of age. EXTRACTS FROM VITAL STATISTICS Total M. F. Live Births—Legitimate 725 364 361 Birth-Rate per 1,000 estimated home population 10.93 Illegitimate 73 35 38 Stillbirtlis—Legitimate 15 6 9 Rate per 1,000 total (live and still) births 26.383 Illegitimate 7 2 5 Deaths (all ages) 1,137 581 556 Death-Rate per 1,000 estimated home population 15.57 Maternal Mortality—Deaths from " Pregnancy, Childbirth, Abortion " (Registrar General's Code No. 30) Nil Total M. F. Deaths of Infants under one year of age—Legitimate 12 7 5 Illegitimate — - - Death-Rate of Infants under one year of age—All infants per 1,000 live births, 15.04; legitimate infants per 1,000 legitimate live births, 16.55 ; illegitimate infants per 1,000 illegitimate live births, nil. Area comparability factors : Births, 0.78; Deaths, 0.71. Marriages. The following table shows the number of marriages in St. Marylebone each year since the 1st January, 1946:— Year No. of Marriages Year No. of Marriages 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 1956 1,257 1951 1,415 The 1956 figure is 41 below that for 1955 and 188 below the average (1,445) for the previous ten years. The marriage rate in 1956 was 34.12 per 1,000 of the estimated home population. Deaths. The total number of deaths (1,137) shown in Table 1 on page 30 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. 6 Deaths in 1956 were 2 less than in 1955. The principal causes were diseases of the heart and circulatory system, which accounted for 42 per cent. of the total deaths; malignant diseases 18 per cent. ; and respiratory diseases, including tuberculosis, 12 per cent. Deaths from lung cancer rose from 40 to 49 as compared with the previous year. One death from diphtheria was recorded. This was in respect of a woman who contracted the disease in 1945 in France, recovered and later came to live in England. The disease affected her heart and the primary cause of death was mitral stenosis due to diphtheria. Seventy-six per cent. of the deaths registered were of persons of 65 years of age and over. Infant Mortality. The twelve deaths of infants under 1 year of age which occurred were all of legitimate children. This was the same total as last year (9 legitimate, 3 illegitimate) giving a death rate of 15.04 per 1,000 live births. Nine of these deaths were of children under 1 week and two between 1 and 2 weeks. Details showing causes of death according to age group and sex are given in table 2 on page 30. \ Maternal Mortality. For the third successive year there were no maternal deaths. Accidental Deaths. During the year, 34 residents died from accidents of all kinds, an increase of 11 on the previous year. Of these, 7 were due to road accidents. National figures show that children under 5 years and elderly people account for 80 per cent. of accidental deaths. Year after year far more deaths result from accidents in the home than from road accidents and every effort must be made to make householders realise the urgent need to take all possible precautions and by avoiding carelessness reduce this appalling toll of life and unnecessary suffering. Local road accident figures show a slight decrease on the previous year, there being 720 accidents in the Borough resulting in 5 deaths, 88 serious injuries and 767 slight injuries. Weather. The following summary of the weather during the year and Table 3 on page 31 are based upon information supplied by the Meteorological Office :— January.—Wet and changeable. Little snow. Rainfall totals about twice normal. Much fog in first week. Temperature fell over 20 degrees during the 31st. February.—Exceptionally cold. Second coldest February of the century and fourth coldest since 1841. Snow or sleet was frequent but falls were light. Little fog. March.—Dry and sunny. Sunshine well above average. Little fog. April.—Rather cold. May.—Very dry and sunny. Sunshine well above normal. No completely sunless days. June.—Cold and dull. There were several thunderstorms and the first half was particularly wet and thundery, but monthly totals were not much above normal. July.—Cool, rather dull and very wet. Rainfall mostly more than twice normal with thunderstorms on several days. On the 29th gales were widespread. Sunshine was between 80 and 90 per cent. of normal. August.—Very cool, mostly very wet. Sunshine was between 80 and 90 per cent. of normal. September.—Dull; very wet at first. Sunshine was only about 75 per cent. of normal and it was the fourth successive dull month. October.—Rather cold; mainly dry. During heavy hail just after midday on the 1st there was a partial " blackout." Very foggy period 9th—16th. Several days with thunder. November.—Very dry; cold towards end. The 14th was the only really wet day. On the 29th there were very scattered light sleet or snow showers. 7 December.—Changeable but exceptionally dull. The first 10 days were very dry but by the end of the month rainfall totals were a little above average. Thick fog formed on 19th and persisted into 20th, becoming dense ; some fog on 21st, 22nd and 23rd. Snow on 26th but it cleared on the 28th. Public Holiday Weather. Easter. (30th March to 2nd April) Dry and mostly dull but a very pleasant holiday. Whitsun. (19th to 21st May) Dry and sunny but mostly rather cool. 14 hours of sunshine on the Monday. August. (4th to 6th August) Cool and thundery. Christmas. (24th to 26th December) Dull and cold with keen frost overnight on 24th. Snow on 26th. 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. Paddington Hospital Group House Committee, No. 4. Paddington Hospital Group House Committee, No. 5. 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. Alderman Miss L. F. Nettlefold, M.A., LL.B., L.C.C. (until July). Councillor Dr. Elizabeth Jacobs. Councillor S./Ldr. S. Stanley (from July). Councillor Miss L. West Russell. The Medical Officer of Health. Councillor Miss L. West Russell. Councillor Mrs. S. Rivington. Councillor L. M. Laurance. The Medical Officer of Health. Councillor Miss L. West Russell. Councillor Mrs. S. Rivington. 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 (deceased 1th February, 1956). Councillor Miss F. E. Wilson (from August). 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 Delegate Royal Sanitary Institute—Blackpool, 24th to Alderman Capt. R. G. Whitney, M.B.E., J.P. 27th April. Sanitary Inspectors' Association—Bournemouth, Mr. H. E. Scoble, M.B.E., Senior Public Health 18th to 21st September. Inspector. National Smoke Abatement Society—Southport, Councillor Dr. H, K. Ashworth, T.D. 3rd to 5th October. 8 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 1956, as indicated below :— Organisation Amount Statutory Authority £ s. d. Central Council for Health Education 11 11 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. 675 0 0 National Assistance Act, 1948, section 31. Assisted Holidays Scheme 250 0 0 do. " Inner Wheel " Old People's Club—Rent of Hall 26 0 0 do. Women's Voluntary Services 40 0 0 do. Care of Old People. The women public health inspectors visited 584 old people during the year. Frequency of the visits varied according to individual needs and, although sixty-six were married couples, the majority lived alone and many required constant observation. As will be seen from their Annual Report, the St. Marylebone Old People's Welfare Association continued their invaluable activities and worked in close co-operation with the Department. Both the London County Council domestic help service and the District Nurses also continued to give valuable assistance. A list of services available for old people in St. Marylebone is on page 41. Special Laundry Service.—Under the scheme for laundering bed linen and clothing of acutely ill and incontinent or very dirty and verminous old people, fifty-four cases were dealt with during the year. Forty-two 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. Bathing.—Under the provisions of section 43 of the London County Council (General Powers) Act, 1953, sanitary authorities are enabled to make arrangements for bathing 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 during the year the scheme started in 1954 for bathing old persons at the Lisson Grove Centre continued with steady progress. The first groups of bathers have spread amongst their contemporaries news of their satisfaction and given reassuring accounts of " afternoon outings " to the bathing centre which have helped to dispel any misgivings or prejudices. At present an old person in need of the service can have a bath once in three weeks and it is hoped to increase the frequency to once a fortnight. Because of other commitments at the Cleansing Station only two sessions each week have been practicable and the number of baths given at each session, usually six, depends upon the condition of the old people. During the cold months of January and February bathing is usually postponed. To ensure continuity of the scheme throughout the year a trained nurse is employed to supervise bathing in any absence of the woman Public Health Inspector who is normally in charge. During the year, 180 women and 101 men used the scheme. Towards the end of the year the Council purchased a new general purpose vehicle for use by the Public Health Department. It is of the " autobus " type with well-upholstered seats, sliding windows throughout and rear entrance doors. Among other duties it serves to convey bathers to and from the centre, a purpose for which it has proved ideal and, as with the vehicle it replaced, a ramp is provided to assist the infirm to get in and out. 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.l) has kindly provided the following information, which has been extracted from the Association's Annual Report, on work carried out during 1956:— 9 "St. Marylebone is not large, but it has an unusually high proportion of ' elderly persons ' among its citizens. At the time of the 1951 census the percentage was 17.7 per cent., the third highest of all the London Boroughs. They do not all need our service, but through our 100 voluntary workers, all very busy people, we do try to help the old people who come to our notice. Imperfect as our 'coverage' still is, we are the only channel of communication with old people comparable to the network of schools for children, and the Maternity and Child Welfare Clinics for mothers and babies. For this reason, we were asked for help in their Home Safety Campaign by the L.C.C. in the Autumn, and by the St. Marylebone Road Safety Committee, on whose behalf we distributed hundreds of pension book wallets with the Safety Slogans on them. We have also supplied to the North Thames Gas Board as comprehensive lists as we could prepare of all the over-eighties in the Borough with gas appliances. These people have all been visited by the Board's officers and their appliances inspected as part of the Board's effort to avert dangers. We have been instrumental in having both gas and electricity meters moved to safe positions. Meals on Wheels. This service now operates from the new premises of the W.V.S. Luncheon Club in Seymour Place, which are conveniently near the staff canteen of Messrs. Spencer Turner & Boldero in Lisson Grove, where the meals are prepared. Their chef takes a genuine interest in the work and his meals are both excellent and varied. It has been possible to maintain the charge to the old people at only lOd. owing to the welcome increase of 2d. a meal in the L.C.C. subsidy. The insulated containers in which the hot dishes are transported had to be replaced during the year, and the Association is deeply grateful to the generous anonymous donors who defrayed the cost. The Mayor very kindly supplied " Frood " Christmas Dinners which the W.V.S. took to all the old people on the " Meals on Wheels " list. This service operates five days a week, and the W.V.S. deliver over 500 meals a month. W.V.S. Luncheon Clu . Our Association is now more intimately concerned with this club, because when it had to move from its former home in November (owing to the transfer of the W.V.S. Centre to smaller accommodation in St. John's Wood Terrace) we made ourselves responsible for the running costs as well as for the supply of the meals. The new club room was offered by the Church Army at a purely nominal rent, and we are deeply grateful for their generous collaboration. The Borough Council have increased our annual grant accordingly. The Luncheon Club has nearly doubled its membership since the move, and now serves over 600 lunches a month. Chiropody. The Foot Clinic holds nine sessions a week and has a long waiting list. It cannot expand further in the present quarters and it is becoming increasingly clear that our next development must be a second clinic somewhere else in the Borough. We are deeply indebted to the members of the British Red Cross Society, St. Marylebone Division, and to the three chiropodists for this invaluable service. Apart from the contribution to the health of the old people, this service brings us into touch with many old folk whom we should not otherwise know. The number of treatments for the year was 2,350, and 52 new patients were admitted. The fee remained at Is. 6d. The Home Service also has a long waiting list. It operates once a week, and our chiropodists, who are supposed to do ten visits a day, frequently now do 12 or more. The British Red Cross provide a car and a driver three times a month. In the fourth week our chiropodist uses her own car for which she only accepts the actual cost of the petrol. This gesture also applies to the Red Cross driver, and we do thank them both for their grand help for our chiropody service. During the year, 537 treatments were given. There were 39 new patients (8 men and 31 women). Four treatments were given free, and nine at a reduced fee. For the remainder, the patients paid 2s. and 18 of them voluntarily paid extra. There are about 182 old people on our books, some of whom attend the Foot Clinic in the summer months, but have the Home Service in the winter. Clubs. All seven of our affiliated Darby and Joan Clubs had a flourishing year. The W.V.S. Tuesday Club had to leave its premises in Cleveland Street when Trinity Church Hall was sold, but found an attractive new club room at the St. Marylebone Youth Centre in Paddington Street. 10 The Association do feel there is a great need for a social centre for the old men in this Borough where they could meet together on their own. So far, the Association have not been able to find suitable premises, but the problem is constantly before us. During the year we have made fresh contact with the two Jewish Friendship Clubs which are doing such good work. Holidays. This year the Association used the special annual grant for holidays made by the Borough Council to arrange a week's holiday at Brighton for 89 old people and also to make a contribution to the holiday fund of the Fourth Feathers Darby and Joan Club to enable them to send 29 old people to Margate for a week. The Barrow Hill Darby and Joan Club sent 16 of their members to Broadstairs. In addition, the Association arranged individual holidays for four old people not suitable for inclusion in organised parties. Each year we are asked for many more holidays than our funds will allow. Probably all the 13,000 old people in this Borough would benefit from a change of air away from their domestic routine, but we can only touch the fringe of their need. However, we are intensely grateful to the Borough Council for even making our present efforts possible. Emergency Fuel Service. Two successive mild winters have resulted in a comparatively small demand for this service, but we were none the less grateful to the St. Marylebone Rotary Club for their gift of £30 to be spread over three winters for presents of coal. The donation had originally been meant to pay for our new concrete coal bunker ; but the firm which supplied it were so much troubled at the six months' delay in fulfilling our order that in the end they gave it to the Association free of charge. We have bought new scales and the bunker is full. Entertainments. We were invited to co-operate in two new forms of amusement for our old people this year. The first was the Inter-Borough Talents Competition for Elderly Persons organised by the Civic Recreation Officers' Association. Our Borough Council contributed to the cost of hiring the St. Pancras Town Hall in which the finals were held in June. They asked us to choose the St. Marylebone candidate. After preliminary heats at the clubs the St. Marylebone finals were held at the Town Hall in May. The judges selected a blind old lady aged 84, now a resident of Luxborough Lodge. Her recitation won her a special prize in the finals but on the whole we decided that our entries were not up to the standard of other Boroughs where there must be more retired music-hall artists than our researches have discovered in St. Marylebone. The second was Old People's Day at Lord's, which was such an outstanding success that we hope it may become an annual event. Two members of Lords obtained the permission of the M.C.C. to invite hundreds of old age pensioners from the Borough to tea on the two days of the annual cricket match between the Royal Artillery and the Royal Engineers. The regimental bands played, the weather was brilliant, and a delicious tea was provided in the Garden Court. We gladly helped by providing an Hon. Sec. for the small organising Committee and by enlisting the W.V.S. Visiting. This has been our basic activity for nearly ten years, and each year we are more convinced of its value. The number of the group reporting directly to Miss Sharp, the Woman Public Health Inspector, remains at about twenty. A development which has given us great satisfaction is that of groups of old people's visitors from local churches which appoint a Liaison Officer to attend our monthly Visitors' Meetings. There are now three. All Souls, Langham Place, with St. Peters, Vere Street; the Hinde Street Methodist Church ; and the Good Samaritan League of the City Temple from the Presbyterian Church in George Street. We are also linked with the housebound by our close liaison with the Home Helps Service of the L.C.C., and by an increasing number of requests for friendly visitors made by the officers of the National Assistance Board." Diseased or Infirm Persons. Section 47 of the National Assistance Act, 1948, as amended by the National Assistance (Amendment) Act, 1951, empowers the Council to apply to the Courts for Orders for the removal to a hospital or institution, for the purposes of securing the necessary care and attention, of persons who— (a) are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions, and, (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. 11 It is seldom necessary to follow this procedure, except in distressing cases which sometimes occur of old persons who, although no longer able to look after themselves and living in conditions which make it impossible for them to be nursed at home, refuse to enter a home or hospital voluntarily. During the year it was necessary to obtain Orders and remove to hospital three such old persons, particulars of whom are given in Table 4, page 32. Staff Medical Examinations. The Medical Officer of Health is medical adviser for the purposes of the Council's superannuation scheme. During 1956, one hundred and eight examinations of members of the staff and new entrants were carried out. New Legislation. Details of the Acts, Orders and Regulations, relating to the work of the Department, which came into operation during the year are given in Table 5, page 32. SECTION C.—SANITARY CIRCUMSTANCES Sanitary Inspection. The borougli is divided into four areas each of which is dealt with by a district public health inspector. During the last few years the numbers of complaints received and notices served for sanitary defects have decreased, probably due to the fact that repairs and maintenance, which were neglected during the war and afterwards because of shortage of labour and difficulty in obtaining materials, are now receiving more proper attention. In addition, many of the more badly housed families, who were naturally a frequent source of complaint, have now been found other accommodation, thus giving owners the opportunity of bringing the vacated houses or rooms, if not demolished or closed, up to a satisfactory standard of repair. In administering public health legislation it is essential to try to preserve a fair and proper balance between tenants' complaints, not all of which can be justified, and landlords' responsibilities, not all of which they fully recognise. Most owners have co-operated with the department, not only in dealing witli matters brought to their attention by notice but sometimes by carrying out work which, although not legally enforceable, would help maintain their property in a better condition. Many owners now realise that the inspectors in interpreting the law regarding public health nuisances are not unreasonable in their requirements and, furthermore, that early compliance with a notice may prevent the necessity for more extensive repairs at a later date. Prosecutions were taken against owners only when it was obvious that there was no intention of complying with notices and where all other attempts at getting the work done had proved unsuccessful. Most of the summonses were withdrawn as the work required had been carried out after they had been served and, generally, before the hearing. Although the principal objective has been achieved, this procedure can hardly be regarded as satisfactory, particularly in view of the long delays caused when an owner constantly ignores the requirements of all notices until he receives a summons. One persistent offender has now been formally warned that, in future, compliance with a notice will not automatically ensure the withdrawal of an outstanding summons. Excluding rat and mouse infestations, 1,278 complaints were received and details of the 1,048 various nuisances detected and remedied are shown in Table 6, page 32. Notices.—Intimation notices numbered 470, and 156 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. Legal proceedings under the provisions of the Public Health (London) Act, 1936, were taken in 13 cases. Details of the premises and outcome of proceedings are shown in Table 7, page 33. Noise. Thirty-five complaints of noise, involving twenty-seven alleged nuisances, were received. A large proportion referred to demolition and building sites. The remainder concerned a wide variety of supposed causes, including night baking, motor vehicle repairs, radio, gramophone, amplifier, factories and workshops, dogs, loading and handling milk bottle crates, a refrigerator and a water storage tank. The complaints were not always justified but where, upon investigation, nuisances were found to 12 exist these were nearly all abated or reduced after informal action by the public health inspectors or the streets 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, the services of an authorised pigeon catcher are retained. He operates under the direction of the Medical Officer of Health who requests him to seize and dispose of pigeons congregating at places in the Borough where nuisance is being caused. During 1956 seven complaints of this type of nuisance were investigated and five referred to the pigeon catcher. Water. Although at a small number of blocks of flats and offices water for domestic purposes is obtained from private wells, 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. In accordance with the provisions of the Public Health (London) Act, 1936, the Board notified ten instances where water had been cut off in occupied premises, six for non-payment of rates and the other four for waste of water. In all cases the supply was reinstated, in four 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. 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 1956 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. Fourteen 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 buildings comprising 53 flats. Drainage—Alterations and New Buildings. During the year, 259 drainage plans were approved. Of these, 36 related to new premises and at the present time there is a good deal of building activity in the Borough. Many of the new structures are large blocks of offices which are tending to greatly alter the appearance of familiar sites, particularly in the Oxford Street and Baker Street areas. To avoid further traffic congestion a Town Planning requirement in respect of some of the larger premises is that they shall be provided with internal underground car parking facilities. The M.C.C. have begun the construction of a new stand on the site of the old coach mound at Lord's Cricket Ground and broadcasting and television relay studios will be incorporated. A planetarium in the course of construction at Madame Tussaud's premises is providing an unusual sight in Marylebone Road and should be completed and open to the public by the end of 1957. The British Broadcasting Corporation have started work on the foundations of their long-awaited extension to Broadcasting House in Portland Place. At the request of the Medical Officer of Health the drains and/or sewer connections of 30 premises were examined by the Borough Engineer's Department. Defects requiring remedy were discovered at 8 and at the remaining 22 premises connections to the sewer were found to be serviceable and fit for continued use. The drainage inspectors made 3,752 visits. Details of five cases of legal proceedings with regard to drainage works which did not comply with the requirements of the London County Council Byelaws are shown in Table 8, page 33. Combined Drainage. Thirteen orders under seal for combined drainage were issued. Ventilation of Sewers. No practicable solution appears yet to have been found to the problem of the effective ventilation of deep level sewers without causing nuisance. However, the Council have started to put into operation the scheme for ventilating higher level sewers through suitable house drains and, as indicated in the Annual Report for 1955, all new connections serving municipally-owned premises were designed to carry out this function. Similarly, at their estates within the Borough the London County Council 13 have opened up the intercepting trap rodding-arms and inserted wire balloons in lieu of stoppers. The older post-war estates owned by the Borough Council have been surveyed, and during next year the scheme will be extended to these properties wherever suitable. Rodent Control. As a result of 664 complaints, 540 premises were disinfested during the year. These infestations comprised 35 ship rat, 216 common rat and 289 mice. Common rat infestations show an increase of 16 per cent. over last year whereas ship rat and mice infestations were about the same. " Block surveys " were continued on a limited scale, particular attention being paid to known " black spots." During the year, 13 blocks involving 938 premises were surveyed. Most owners and occupiers of premises concerned continued to co-operate with the Council but during the year, 55 informal and 8 statutory notices were served. Only 2 notices were served under The Prevention of Damage by Pests Act, 1949. Adverse weather conditions again prevented routine sewer baiting in January, and owing to labour and transport difficulties only sewers north of Marylebone Road were baited during July. Other authorities apparently had similar experiences and in an effort to avoid these and other difficulties it has been arranged, through the Ministry of Agriculture, Fisheries and Food, for sewer treatments to be changed from January and July to April and October. A summary of the work is shown in Table 9, page 33. Disinfestation. 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, 366 rooms were disinfested, including twenty-one requisitioned premises. Altogether 207 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 1956 the furniture of 36 families, of whom 31 were being rehoused, was treated by this method. In addition, 1,620 verminous articles of bedding were disinfested by steam at the Council's premises in Lisson Grove. Verminous Persons. The Council's Cleansing Station in Lisson Grove dealt with 795 verminous persons: adults 550 (men 483, women 67) ; children 245 (boys 47, girls 198). 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. Last year's intensive Clean Air Campaign was followed by further action, wherever possible, on the lines indicated in the Annual Report for 1955 and by preparations to implement with a minimum of delay the provisions of the Clean Air Act when it came into force. Co-operation with the Department of Scientific and Industrial Research in the measurement of local air pollution was continued. Measurements of solid deposited matter are taken monthly from gauges sited at the Town Hall and at Nuffield Lodge and of sulphur dioxide concentrations from lead peroxide apparatus at the same two stations and at a site at the northern end of Edgware Road by Orchardson Street. Volumetric apparatus, from which daily readings of smoke and sulphur dioxide concentrations are taken, is installed at the Town Hall and at the old people's home in Greville Place. Summaries of the readings from these various sets of apparatus which for some years have been maintained by the Council and from a deposit gauge maintained by the Department of Scientific and Industrial Research at Devonshire Street are given in Table 10 on page 34. The figures for deposited matter show very little change from last year but there was a slight reduction of smoke, as measured volumetrically, and a slight increase in sulphur dioxide compared with 1955. It will be noted that the 14 average concentration of smoke during the 72 hours continuous period of fog in 1956 was, as might be expected, very much higher than the average for 24 hours, the longest continuous period experienced in 1955, though the difference in sulphur dioxide concentration was not nearly so marked. In order to obtain information upon which the Council might decide their policy regarding smoke control areas, it was arranged for a " sample survey" to be made of existing furnaces and fireplaces and of the types of fuel used. For this purpose, in December, two temporary assistants were engaged and, working under the general direction of a Public Health Inspector, they visited representative premises in the proportion of about 1 in 10 in those parts of the Borough which appeared to be the most suitable for a smoke control area. Now that the problem of atmospheric pollution is so much to the fore and, at long last, this menace to health is fully recognised and measures are being taken to combat it on a nation-wide scale, it is interesting to note that in the report of Dr. Thomson, the first Medical Officer of Health of St. Marylebone, referred to on page 2, he writes of a dense fog which occurred on the 29th October, 1856. " It was characterized by a nearly freezing temperature which condensed the atmospheric vapour— a yellow tinge, due, as was obvious to the sense of smell, in some measure to the presence of smoke and a thorough cessation of all currents of air. It is much to be desired that the excellent invention of Dr. Arnott, the open fire-place without smoke, should be generally adopted, as it would banish this impurity from the atmosphere." During the year, 39 complaints of smoke, grit or fumes were received. Inspection was made of 113 premises, either because of a complaint or as routine, and after informal personal contact with managements or boilerhouse staff cessation or reduction of smoke emission was effected in nearly all cases. There seemed to be a growing realisation on the part of those concerned with the operation of furnaces and boilers of their responsibilities for ensuring a minimum of smoke emission. Boilerhouse personnel seemed to be aware of the seriousness of causing air pollution and managements, who were generally very co-operative, were, where appropriate, recommended to seek assistance from the National Industrial Fuel Efficiency Service. Factories. A report on the administration by the Department of matters under Parts I and VIII of the Factories Act, 1937, is given in Tables 11 and 12 on page 35. The number of factories on the register at the end of the year was 1,794, an increase of 25 over last year. The defects and unsatisfactory conditions found (265) showed a further decrease on the numbers discovered in recent years, and again the greater proportion related to want of cleanliness of workrooms and unsuitable or defective sanitary accommodation. There were still many complaints about noise from industrial premises, most of which related to building and demolition work. Once again, by unofficial action and with the willing co-operation of the contractors concerned, most of the difficulties were overcome. Offices and Shops. In the Annual Report for last year attention was drawn to the unsatisfactory state of legislation affecting working conditions in offices and shops and reference was made to the recommendations of the Gowers Committee. These recommendations concerned particularly the introduction of standards, mainly on the lines of the Factories Act, for sanitary accommodation, space, ventilation, temperature, lighting, cleanliness, accommodation for clothing, seats, safeguards against dangerous machinery, first aid equipment, escape from fire, restriction as to the use of underground rooms as workplaces, facilities for washing and for taking meals, the prohibition of the employment of women within seven weeks after childbirth and the prohibition of the lifting of excessive weights by women. Whilst there is no evidence that the general standards observed in offices and shops in St. Marylebone is lower than in other comparable districts, the absence of adequate legislation makes it difficult to ensure satisfactory conditions for all those engaged in this class of occupation. It is, for example, doubtful whether routine inspection of offices, as distinct from enquiries based upon specific complaints, can legally be made under the Public Health (London) Act, 1936. The division of responsibility regarding conditions in shops, between the London County Council and the Metropolitan Borough Councils, also has serious disadvantages. For these reasons it is regretted that the recommendations of the Gowers Committee have not been implemented and that the many thousands of workers in offices and shops are still not legally protected, to at least Factory Acts standards, in matters of health, welfare and safety whilst at work. 15 Out-Workers. Eighty-six employers submitted lists in respect of a total of 819 out-workers (216 contractors and 603 workpeople). Of these, forty-nine contractors and twenty-two workpeople operated in the Borough. The nature of the different classes of work and the numbers of out-workers engaged is indicated in Table 13, page 35. Fireguards. Inspection continued under the provisions of The Heating Appliances (Fireguards) Act, 1952. Of the comparatively few heaters that were found not to comply with the requirements, the majority were second-hand and the main fault was inadequate guards. In all cases, however, on receipt of a letter pointing out an offence, vendors have immediately withdrawn appliances from sale, fitted new guards and sought approval before again displaying for sale. In no case, so far, has it been necessary to institute legal proceedings. Hairdressers and Barbers. The Council's Byelaws regulating these establishments came into operation on 18th December, 1955, and are reprinted on page 40. There are in the Borough 118 registered hairdressers and barbers and 140 inspections were made. Conditions generally were found to be satisfactory. 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, thirteen 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 public health inspectors and the stalls licensed to sell pets in the street markets were inspected weekly. Conditions under which the livestock was kept appeared to be satisfactory. Poisons. At the end of the year the names of seventy-eight 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, 1933-1941). Details of the premises concerned are given in Table 14, page 36. 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 ten premises, mainly those of upholsterers and manufacturers of cushions and pillows, are registered. Samples of hair and other filling materials taken during the year 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. Staff shortages and other difficulties were experienced during the year and in order to maintain the services it was found necessary to leave some of the conveniences temporarily unattended. However, no vandalism was suffered at any of these conveniences. Now established in its eighth year at all public conveniences where wash basins are provided, the free washing scheme, with paper towels and liquid soap, is still increasing in popularity with the general public. Public Cleansing and Salvage. The Director of Public Cleansing has kindly provided the following information :— "The materials dealt with in 1956 were:—house and trade refuse, 35,556 tons, street sweepings and gully slop, 2,499 tons, salvaged materials, 2,089 tons. A sum of £11,151 was obtained from the sale of salvaged materials. In addition, £1,320 was received for the removal of trade refuse and green offal and for the cleansing of petrol interceptors. From the 1st July, 1956, the Council, in common with other local authorities, were required to restrict deliveries of waste-paper and cardboard to the mills, owing to the supply position, which resulted in reduced revenue from this source, 16 A minimum twice-weekly refuse collection was maintained throughout the Borough and, in many cases, a thrice-weekly clearance was provided. All street gullies were mechanically cleansed at least six times during the year, and all streets were swept at least once daily. In April His Worship the Mayor opened a new Welfare Block in North Wharf Road for the staff of the Cleansing Department. Drying rooms and shower baths are provided, together with a modern canteen and recreation rooms." Burial or Cremation of the Dead. Under section 50 of the National Assistance Act, 1948, it is the responsibility of the Council to arrange for the burial or cremation of any person who has died or been found dead in the Borough, and for whom no suitable arrangements for disposal of the body have been or are being made. Nine persons were buried or cremated under the provisions of the Act during 1956. Crematorium—Medical Referee. The Medical Officer of Health is Medical Referee for the Council's Crematorium which is situated in the St. Marylebone Cemetery at East Finchley. During the year, 1,966 certificates authorising cremation were issued, an increase of 143 compared with the previous year. Since December, 1937, when the Crematorium was opened, 13,556 cremations have taken place. National statistics for 1956 continued to show an upward trend which has proceeded unbroken for the past twenty-one years. There seems to be diversity in the practice of medical referees for crematoria in different parts of the country. This was emphasised at a Special Seminar for Referees held during the Conference of the Cremation Society at Weston-super-Mare in June, when the desirability of setting up a consultative body of medical referees with wide experience in administering cremation legislation was urged with the idea that one of their first actions would be to produce a standard Code of Practice for general adoption. It was decided that such a permanent consultative body should be formed and five medical referees, of whom the Medical Officer of Health of St. Marylebone was one, were appointed " to consider the precise form this body shall take." Mortuary. Two male bodies were received in the Public Mortuary in Chiltern Street. No post-mortem examinations were carried out. In addition, 95 bodies were deposited at the Mortuary pending reburial after exhumation, details of which are given in the following paragraph. Exhumations. Holy Trinity Church, Marylebone Road.—In connection with the conversion of certain parts of Holy Trinity Church for use as administrative offices by a religious society, it was found necessary to remove the remains of some 95 persons and re-inter them. Removal took place in accordance with the terms of an Exhumation Licence granted by the Home Secretary, the work of a local undertaker being supervised by the Medical Officer of Health and staff of the Department. The coffins were mainly lead lined and many, because of age—they were all over 100 years old—were in poor condition and needed special care in handling. Strict precautions to safeguard public health were taken during the whole operation. The coffins were removed from the Church in batches of six or seven daily to the public mortuary in Chiltern Street and the remains transferred to new elm shells to which nameplates were affixed prior to burial in the Council's cemetery at Finchley. Vaults Beneath Paddington Street Carriageway.—During excavations of the Paddington Street carriageway alongside the disused burial ground, which was enclosed by brick walls in 1771-72, a coffin was found buried in earth at a depth of about eight feet. Upon inspection of the site it became apparent that there might be other coffins in the immediate vicinity and, indeed, further excavations revealed four burial vaults. These contained coffins in earth at a similar depth below the carriageway and an Exhumation Licence was obtained by the contractors concerned. Because of the distorted, fragile and corroded state of the lead coffins it was necessary to carry out all the work below ground in the restricted space available. New wooden shells were lowered into position alongside the old coffins and the remains transferred to them by the light of torches and candles. Sixteen bodies were exhumed and re-interred at St. Marylebone Cemetery, East Finchley, the work, as in the previous case, beinf conducted under the supervision of the Medical Officer of Health and staff of the Department. 17 Transportation of Bodies Abroad. In certain cases where bodies are transported overseas, the Medical Officer of Health of the district in which death has taken place is asked to furnish a certificate to the effect that the deceased did not die from any infectious or contagious disease and that no recent epidemic of dangerous infectious disease has occurred in the district. During the year three certificates were issued in respect of bodies being transported to France, Italy and Iraq. Dog Nuisance. The Council's bye-law dealing with this nuisance provides that :— " No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway." Although it has been shown that dogs can carry and excrete germs capable of producing illness in man, cases of human disease can seldom be positively related to infection from this source. However, there are many obvious objections to fouling of the footway by dog excreta and not least amongst them is the attraction to flies and blowflies with the consequent hazards to health. During the year, contraventions reported by the Streets Nuisance Inspector resulted in twenty 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-law 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 this bye-law, more particularly as the officers of the Department, including the Streets Nuisance Inspector, are continually about the streets. During 1956, the Council took out eight summonses, but of these two could not be served and a third was adjourned sine die as a warrant issued for previous summonses had not been executed. In respect of the others, fines and costs amounting to £18 3s. Od. were imposed. SECTION D.—HOUSING Permanent Estates. The Town Clerk has kindly supplied the following information regarding housing accommodation provided by the Council up to 31st December:— No. of Flats Pre-War Estates— Crawford Place Dwellings 52 Fisherton Street Housing Estate 130 Post-War Estates— Barrow Hill 172 Church Street 140 Winchilsea House 23 Townshend (Part) 180 Abbey Road/Boundary Road 54 Hamilton Terrace 52 Queen's Terrace (Block 1) 28 35/55, Boundary Road 48 Wellington Road 121 147/149, Gloucester Place 10 1/7, Aquila Street 6 Abercorn Place 34 1,050 18 At the close of the year, the following additional permanent accommodation had reached the stage indicated :— No. of Flats Townshend (Block 9) 42 Final block reached the plastering stage. 17/19, Balcombe Street 4 These flats were approaching completion 22/30, Balcombe Street 14 Construction at roof level. 57/73, Boundary Road 36* Construction work above ground level. Church Street Extension 65 Compulsory Purchase Order No. 2 confirmed and sketch plans being prepared. Abercorn Place/Violet Hill 22 Sketch plans being prepared. 40/47, Chapel Street 20 Compulsory Purchase Order confirmed. 33/35, Townshend Road 8 Pembroke Terrace 10 147/165, Lisson Grove 12 Tenders have been received for these three schemes and Ministry approval is awaited. Aquila Street Extension 23† Sketch plans have been approved and progress is being made towards the invitation of tenders. *Maisonettes, †Includes 14 maisonettes. St. Marylebone Housing Association. The Association completed the scheme referred to in last year's report for erecting 15 flats at 8, Greville Place with the assistance of an Exchequer Subsidy. Slum Clearance Programme. In pursuance of the approved slum clearance programme, the Borough Council have adopted proposals for the redevelopment of six areas containing unfit houses. The proposals envisage the provision of more than 200 new dwellings. The London County Council have made Clearance Orders in respect of 119 unfit dwellings. Factory-Made Bungalows. A further 23 factory-made bungalows were released during the year, leaving thirty-two families still housed in this type of accommodation. Requisitioned Premises. In accordance with the provisions of Section 4 of the Requisitioned Houses and Housing (Amendment) Act, 1955, 115 dwellings in requisitioned premises were released, the former licensees becoming statutory tenants of the owners. The Council will, until 1965, pay to the owners such sums as will, when added to the rents paid, produce the full controlled rent. Housing of Old People. The Council are seeking an opportunity to assist the preservation and/or extension of accommodation for old people, particularly in connection with the St. John's Wood Almshouses, which are becoming increasingly expensive to maintain. Dwelling Houses. Statistics regarding the inspection of dwelling houses under the Public Health or Housing Acts, defects remedied and action taken under statutory powers are contained in Table 15, page 36. Housing Repairs and Rents Act, 1954—Certificates. Only 2 applications for certificates of disrepair 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 on the premises concerned by the public health inspector, both applications were refused. 19 Re-housing. Special reference is made to the Medical Officer of Health by the Borough Council's Housing Director, the London County Council and other local authorities for reports and advice on the housing conditions and, in some cases, the health of persons applying for re-housing. Such enquiries totalled 324 ; of these, 185 referred only to living conditions and necessitated further investigation by a public health inspector before the enquirer could be provided with a report to assist in assessing the order of priority of the various applicants. The 139 confidential medical certificates referred to the Medical Officer of Health were considered in conjunction with reports from the public health inspectors on environmental circumstances and, where justified, suggestions were made for additional points. Closing orders were made on 37 rooms and where the occupiers could not be given alternative accommodation immediately they received additional points increasing their degree of priority for re-housing. Until they can be provided with other accommodation the operation of the closing orders remains in abeyance. Immigrants. During the past eight years it has been the practice of the London Commissioner of the Cyprus Government to consult the Medical Officer of Health regarding the suitability of accommodation offered by Cypriots residing in St. Marylebone to sponsored immigrants. The object has been to avoid possible overcrowding. During the year, only one such approach was made and in August the Commissioner intimated that, following changes in the arrangements for immigration to the United Kingdom from Cyprus, he would not in future be making enquiries. The south-east portion of the Borough is contiguous with Soho and, as might be expected, contains a cosmopolitan population. Immigrants from Cyrpus and European countries predominate. So far, unlike neighbouring boroughs, St. Marylebone has had little influx of people from the West Indies. Common Lodging Houses. There are two common lodging houses in the Borough. One 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 eighty-five different kinds of foodstuffs were taken and analysed under the Food and Drugs Act, 1955, the fee paid for analysis being £1 8s. Od. for each milk sample and £2 10s. Od. for each other sample. The Public Analyst (Mr. Thomas McLachlan, A.C.G.F.C., F.R.I.C., M.I.Biol.) has submitted the following report on the year's work :— " During the year, 376 samples of foods and drugs were examined. Of these 185 were taken formally and 191 informally. The number of samples adulterated or incorrectly labelled was 40 and the incidence of adulteration may be classified as follows :— Number of samples Number incorrect examined Milk 103 — Other foods 273 40 The percentage of samples, other than milk, upon which adverse reports were made is higher than it has been for some years. The quality of milk sold in London still shows steady improvement. A sample of butter contained free fatty acids calculated as oleic acid 4.23 per cent. and gave a strong Kreis reaction for rancidity. It was unfit for sale in the normal way but could be sold for cooking purposes. Another sample of butter was reported as inferior because it contained 16.3 per cent. of moisture, which is slightly above the permitted limit of 16 per cent. A sponge cake was examined because of a complaint that it possessed an objectionable flavour. The fat used in its manufacture contained palm kernel or coconut oil which was rancid, the free fatty acids being 2.8 per cent. 20 A gateau submitted as a complaint contained a grain beetle and a pupa of a dermestes species. Grain beetles are found in cereals and cereal products of many kinds and the dermestes species is common in bone factories, skin warehouses, and dog biscuit factories. It was difficult to understand how the dermestes pupa came to be present in a cake bought at the shop from which it was obtained and it was remarkable that there was one specimen only of each of two very dissimilar types of insect. A bread roll contained dirt which was believed to result from a piece of burnt bread. A sliced white loaf, stated to have caused diarrhoea and vomiting, contained several small pieces of material consisting of brown bread due to brown dough having been mixed in through carelessness. Your analyst ate a slice without any ill effects. Another loaf was examined because of a complaint that it possessed an odour of disinfectant. The bottom half of the loaf was contaminated with a phenolic odour due probably to the loaf having been placed on a shelf on which there had previously been disinfectant. Under the Food Hygiene Regulations, 1955, contamination includes contamination by odour, so that this bread was " adulterated " under the new Food and Drugs Act. A complaint was received that some rabbit purchased by a member of the public was not rabbit. On examination it proved to be hare, and illustrates one result of the scarcity of rabbits due to myxomatosis. A sample submitted as " sliced roast pork " contained 1 oz. 5 drams of pork meat, 8 drams of crackling and 15£ drams of sausage stuffing. If this sample was representative of the sliced meat as sold it will be realized that the quantity of pork meat was only 45 per cent. Four samples of pork luncheon meat were deficient in meat content. They contained 80 per cent., 78 per cent., 75 per cent., and 53 per cent. of total meat respectively and were therefore 11 per cent., 13 per cent., 16 per cent., and 40 per cent. deficient in meat content. Pork luncheon meat must not contain less than 90 per cent. of pork. In conjunction with other public analysts throughout the country, your analyst carried out an investigation into the quantity of meat present in sausage rolls and St. Marylebone kindly supplied five samples. These were found to contain 25.2, 18.9, 18.4, 17.0 and 13.5 per cent. of meat respectively, the last sample being reported as adulterated. The percentage and weight of meat in sausage rolls appears to bear no relationship to the price paid. The sample with the largest percentage of meat was not the largest sausage roll, but it contained 12.8 grammes of meat and cost 4£d. Rolls which cost only 4d. each weighed on average 80 grammes and contained 13.6 grammes of meat, whereas the sample reported as adulterated cost 5d. and contained only 8.1 grammes of meat. Altogether your analyst examined 46 samples of sausage rolls and the quantity of meat contained in them varied from 3.9 to 18.7 grammes, indicating that some rolls contain about five times as much meat as others whilst the price paid ranged from 3d. to 5d. each. The total meat content in rolls ranged from 10.0 to 38.5 per cent. The nutritional value of a food such as a sausage roll does not depend solely on one factor alone. Flavour, appearance, and the quality of the pastry play some part, but this small piece of work indicates to some extent the profit made by some manufacturers compared with others, even allowing for differences in cost of rent, rates, and other overheads. A product labelled " Steakettes " consisted of minced beef which was satisfactory as regards bacterial purity, but the minced meat was pressed to form small round slabs and the label did not state that minced beef had been used. The description " Steakettes " indicated that the purchaser could expect a small steak, whereas minced beef is generally cheaper than steak because it is prepared from inferior cuts. The manufacturers agreed to amend the label accordingly. Some tenderised beef flake steak possessed a badly tainted flavour due to decomposition. The manufacturers stated they did not use a chemical tenderiser but kept the meat for some time before freezing as this caused the meat to become more tender. It also allowed bacteria to develop and ruin the meat. The label on a product stated to be a bio-chemically balanced salt contravened the Labelling of Food Order, inasmuch as there was no statement regarding the ingredients present, and the salt was not a bio-chemically balanced salt. An egg submitted as "new laid" was found to have been preserved. It was coated with a film of oil and showed a pale yellow fluorescence under ultra-violet light. Whereas the shell of a normal unpreserved egg is alkaline, the shell of this egg was very slightly acid. A sample of blended chocolate hazelnut wafer did not contain more than 2 per cent. of hazelnut and this was considered to be insufficient hazelnut to warrant the description. Another hazelnut wafer contained only a small quantity of hazelnut, the bulk of which consisted of hazelnut skin and not of the nut itself. 21 Some nut milk chocolate contained signs of larva excrement but no insect larva could be found. It was impossible to say from what insect the dirt had been derived but very likely it was from the larva of a cocoa moth. A jelly sweet with a liquid centre was examined and a honey bee was found embedded in the liquid centre. Some canned pineapple pieces contained a species of a tropical fly. A sample of orange curd contained only 62 per cent. of soluble solids whereas the Food Standards (Preserves) Order, 1953, requires orange curd to contain not less than 63 per cent. of soluble solids. Of two samples of potato crisps, one contained a live earwig larva and the other a dead beetle. The beetle had not been cooked with the crisps and it was thought that the packets had probably become infested either in the retail shop or in the purchaser's household. Some Italian pears were contaminated with copper arsenate. The arsenic was 2.5 parts per million and the copper 9 parts per million calculated on the whole fruit. It was thought that this fruit would be satisfactory if washed before sale. Italian fruit has for many years caused trouble due to the presence of copper arsenate. Some brown sherry contained 0.8 per cent. of ferric alum, calculated as Fe2(S04)3. K2S04. 24H20, but it was impossible to say how this contamination had occurred. A sample of vermouth was 0.5 per cent. deficient in proof spirit and was therefore considered to be inferior. Another sample of vermouth contained a dead house-fly and twelve dead fruit-flies. The alcohol content was 23.65 per cent. proof and, as that of an unopened bottle was 23.96 per cent. proof, it was thought that the bottle must have been left uncorked and contamination occurred thereby. Three miniature bottles of egg liqueur were deficient in proof spirit. They were stated to contain 30 per cent. proof spirit but were only 23.5 per cent., 24.43 per cent. and 29 per cent. proof spirit respectively. The closure of all the bottles was unsatisfactory and alcohol had obviously evaporated. A jelly cream in a carton was considered to be incorrectly labelled. The front panel did not inform the purchaser that milk was required, and the word " flavour " should have been included after the name of the fruit, since the flavour was essentially artificial. Some canned butter beans were reported as inferior because they were badly overcooked and contained too large a proportion of brine to beans. Two samples of canned coconut in syrup were examined because of the complaint that they had an odour and taste of bad meat. Your analyst did not agree with the complainant, but the product had been slightly burnt in cooking. The syrups were cloudy, the cans slightly corroded and the contents of both tins contained 120 parts per million of tin. The Ministry of Food recommendation is that canned products be allowed to contain 250 parts per million of tin. The label of quick frozen cooked haddock and chips completely ignored the requirements of the Labelling of Food Order. The product was contained in a carton designed to give the impression that the wrapping was a piece of old newspaper. The disclosure of contents was in smaller lettering than most of the other print and was bent so that part of the wording appeared on one panel and the remainder on another panel of the carton. The Labelling of Food Order requires the disclosure to be clearly legible. Members of the public are becoming much more critical of the food sold to them and the number of complaints received by the Medical Officer of Health increases each year. Food suppliers frequently complain that they would be only too pleased to deal with many of these complaints if the articles were returned. Unfortunately, experience indicates that many food suppliers adopt this attitude when their attention has been drawn to a complaint by a local authority or when they are prosecuted but that when they are given the opportunity to right the matter in the first place they are very high-handed in their treatment of the purchaser. That not all complaints are by any means justified is illustrated by the number of complaint samples submitted to your analyst through the Medical Officer of Health. A currant bun and later a doughnut were stated to contain glass, but your analyst could not detect any. The "pieces of glass" were probably crystals of sugar. Some canned salmon was suspected of having caused food poisoning, but your analyst could find no fault with it. Some sweets were sold in old anti-gas ointment tins and were therefore thought to be contaminated with anti-gas ointment, but, whilst the method of presentation and the actual appearance of the sweets 22 left much to be desired, the actual confectionery was harmless. Another complaint was made that a yeast loaf caused burning of the throat, but members of your analyst's staff ate the bread without any ill-effect. Garden peas were reported as unfit for consumption, but your analyst could find no fault with them, and grapefruit sections were thought to be mouldy, whereas in fact there was no sign of mould growth. Complaints of mouse dirt in sausages were found to be caused by dyes used in manufacture. The bone attached to a piece of meat stated by the complainant not to be chicken was found to be chicken bone and the skin was that of a fowl. One person objected that some tea was contaminated with oil because it did not sink in boiling water. No oil was found to be present, but it is interesting to note that a tea-taster insists on water used in his tests being freshly boiled so that the tea does not sink to the bottom of the cup. Finally, some crab sandwiches were examined because of a complaint that they had been made with paste and not with crab meat, but, on examination it was clear that dressed crab had been employed and that no paste was present. Food vendors should thus realize that it is in their own interests that members of the public take their complaints to an unprejudiced specialist for examination. The Public Analyst is unaware of the identity of the shop from which any complaint arises. At the present time he finds that probably not more than half of the complaints made by members of the public are justified. Nevertheless this high proportion of unjustified complaints received from the public serves to indicate that the Analyst frequently supports the manufacturer and that therefore their allegations in Court that the Public Analyst is not qualified to speak on what the public is entitled to expect are unfair. Food Legislation and Recommendations during 1956. On the 1st January the new Food and Drugs Act, 1955, came into operation. It is a consolidating Act and repeals The Food and Drugs Act, 1938, The Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, and The Food and Drugs Amendment Act, 1954. The last-mentioned Act was passed with the knowledge that it would never come into force as such, but that it would provide material for consolidation into the present Act. Whether such a procedure was wise or not is doubtful; if the Food and Drugs Act, 1954, had been allowed to operate for a few years before the whole Act was consolidated an opportunity would have been provided to discover whether all its provisions were workable. From the public analyst's standpoint there are several weaknesses. The definition of food in Section 135 is not as good as that in the Food and Drugs Act, 1938. With the new Act one finds that a food includes " article and substance used as an ingredient in the preparation of food or drink," but sections 91 and 92 of the Act also provide for "substances capable of being used in the preparation of food," and it remains for the High Court to decide what is the difference, if any, between an article or substance used as an ingredient in the preparation of food and a substance capable of being used in the preparation of food. This point could have been resolved during the course of the Bill through Parliament and, in your analyst's opinion, it should have been settled. The first Food and Drugs Act was passed in 1860, but there is still no legal definition of a medicine, although the definition of a drug states that it includes medicine for internal or external use. The definition of a "substance recommended as a medicine" given in the Pharmacy and Medicines Act, 1941, is unsatisfactory as it is difficult to know exactly what constitutes an ailment, infirmity, or injury affecting the human body. The new Act states that a food does not include articles or substances used only as drugs but, whilst this may be comprehensive, it is far from clear. Patent and proprietary medicines, however, are no longer exempt from the provisions of the Food and Drugs Act. From the public analyst's point of view one of the chief advantages of the new Act is that a part-time public analyst, when acting in that capacity, now enjoys the protection of the local authority. Previously a part-time public analyst has been personally liable to penalties, in the event of a mistake having been made by him either in his analysis or in his recommendations or actions to support his views. One point entirely new to Food and Drug administration is that provision has been made whereby a public analyst, who is unable to carry out an effective analysis of a sample because he lacks the necessary apparatus or knowledge, may pass it to the public analyst for another area who possesses such apparatus or knowledge. Unfortunately expensive physical apparatus is being introduced at such a rate that soon it may be impossible to carry out the whole analysis of a sample in one laboratory, but as the Act has been worded the whole analysis must be carried out under the control of one analyst only. From the general administrative angle, the period during which proceedings may be commenced for samples, other than milk, has been extended from 28 days to two months and the time during which proceedings for giving a false warranty may be commenced has been increased to twelve months. 23 It is not made clear in the Act that the Food and Drags Amendment Act, 1954, repealed The Defence (Sale of Food) Regulations, 1943. This Act never came into force as such, but only in the consolidated Act of 1955, and the repeal of numerous Orders which has thus taken place may easily be overlooked. It would have been useful had the 1955 Act re-enumerated repeals brought about by the Act of 1954. The Food Hygiene Regulations, 1955, are not, in the main, the concern of the public analyst; but during the year several Statutory Instruments controlling the composition of foods under the new Food and Drugs Act came into force. The Food Standards (Butter and Margarine) Regulations, 1955, prescribed standards for butter and margarine similar generally to those previously given in the Food and Drags Act, 1938, by which it was forbidden to sell butter or margarine containing more than 16 per cent. of water, or margarine containing more than 10 per cent. of butter fat. The Labelling of Food (Amendment) Regulations, 1955, re-enacted the provisions of Sections 32 and 33 of the Food and Drugs Act, 1938, regarding the labelling of margarine and margarine-cheese and for the amendment of the Regulations by substituting the words "Imitation Cream" for "Synthetic Cream," wherever they appeared in the Order. At the same time this amendment made provision for the labelling of margarine making claims for cream or milk-fat and requiring these to be stated as "milk-fat, equivalent to (y) per cent. of butter per cent." where 'y' represents the actual butter equivalent of the milk or cream. Your analyst is unhappy about these last provisions. At one time it was common to advertise that margarine contained butter, so that it became necessary with the Butter and Margarine Act, 1907, to stipulate that a road must separate factories used for the manufacture of butter and margarine. Later in the Food and Drugs (Adulteration) Act, 1928, it was made illegal to label margarine except with the word "margarine" together with a descriptive name approved by the Minister of Agriculture and Fisheries. With the advent of the Food and Drags Act, 1938, a retrograde step was made which permitted the label to state the percentage of butter-fat present. Advantage of this was first taken by an overseas importer some four or five years ago, when the permission granted by the 1938 Act had been completely forgotten by most food and drug authorities. Shortly after, vendors of margarine began to claim the presence of cream in margarine and, instead of supressing this, the Ministry has attempted to regularise the position. In consequence there are now on the market cheese spreads and processed cheeses containing cheese made from separated milk with claims for the presence of "cream" although the total milkfat is less than the quantity of milk-fat which would be present naturally if a full-cream milk cheese had been employed for their manufacture. The position has become even worse with the introduction of shortenings, which claim to "be enriched with 10 per cent. of butter" and to be "richer," so that one can use less. The Mineral Oil in Food (Amendment) Regulations, 1955, permit any chewing compound to contain up to 12.5 per cent. of microcrystalline wax, but public analysts do not approve this order, especially since only a few years ago the Ministry of Food pressed them to endeavour to supress completely the use of paraffin wax in chewing gum. There is no real difference between paraffin wax and microcrystalline wax from the food aspect or that of detection. The Bread (Amendment No. 2) Order, 1956, abolished all price control on bread, and also abolished definitions of national flour, national bread, national brown bread, and national milk bread. With this Order came the Flour (Composition) Order, 1956, which prescribes requirements for calcium, iron, vitamin B1 and nicotinic acid in all types of flour and it is left to Food and Drug Authorities to enforce the Order. The Milk and Dairies (Channel Islands and South Devon Milk) Order, 1956, now made under the Food and Drugs Act, requires those milks to contain not less than 4 per cent. of milk-fat. Previously no action could be taken under the Food and Drugs Act if such milk did not contain 4 per cent. of fat. The Sale of Food (Weights and Measures: Bacon and Ham) Regulations, 1956, and the Pre-Packed Food (Weights and Measures: Marking) (Amendment No. 2) Regulations require bacon and ham to be sold only by weight and any pre-packed bacon and ham to have a mark on the outer container showing the weight contained in the package. The Food Standards (Curry Powder) (Amendment) Regulations, 1956, and the Food Standards (Tomato Ketchup) (Amendment) Regulations, 1956, permit curry powder to contain up to 20 parts per million of lead, and permit tomato ketchup, catsup, sauce or relish to contain up to 20 parts per million of copper instead of 50 parts per million calculated on the dry solids. These small quantities are hardly likely to have an adverse effect on the health of the consumers. During the year the Food Standards Committee of the Ministry issued several Reports:— 24 The Report on processed cheese and cheese spread recommends that processed Cheddar or Cheshire cheese shall contain not more than 42 per cent. of moisture and that the butter-fat content of the dry matter shall not be less than 48 per cent. In the case of other processed cheese it is recommended that the moisture shall be not more than 45 per cent. and the butter-fat not less than 45 per cent. of the dry matter. For cheese spreads it is recommended that the maximum moisture content shall be 60 per cent. and that the minimum butter-fat content of the product as sold shall be not less than 20 per cent. The Report on sausages recommends that pork sausages shall contain not less than 65 per cent. of meat, whilst sausages made from beef, mutton, bacon, ham, lamb, veal, edible offals, poultry, game, rabbit, hare, and venison shall contain not less than 50 per cent. of meat and that the quantity of fat shall be not more than 50 per cent. of the total meat in any type of sausage. A majority of the Committee recommended that with pork and beef sausages the pork or beef content of the meat portion shall be not less than four-fifths of the total meat. A minority thought that the meat should be solely that by which the sausage is named. Your analyst agrees with the minority view. The Report on the addition of emulsifying and stabilising agents is comprehensive and recommends that some twenty substances, which may or may not occur naturally in foods, are so commonly used that they do not require legislation and further recommends that legislation be introduced to control the use of super-glycerinated fats, synthetic lecithin, propylene glycol, or stearate, methyl cellulose, methylethylcellulose, sodium carboxymethyl cellulose, stearyl tartrate, the diacetyl tartaric acid esters of super-glycerinated fats, monostearin sodium sulphoacetate, or sorbitan esters of fatty acids. Other substances, such as brominated oils and silicones, it is recommended, should be banned. Finally a revised Report was issued giving recommendations for limits of the copper contents in foods. The general recommendations are that ready-to-drink beverages should contain not more than 2 parts per million of copper, other beverages 10 parts per million, and that foods generally should contain not more than 20 parts per million. There are, however, certain recommended exceptions, which need not be mentioned in this report. It will suffice to mention that some authorities have been pressing to introduce legislation to prohibit the use of any chemicals in food, whose presence cannot be detected. Your analyst feels that the Council will offer him their sympathy should such legislation be enacted. In conclusion it may not be out of place to mention that, as the chairman of the Standards Committee of the Association of Public Analysts, your analyst has had the opportunity to see much behind the scenes and he looks forward to the not far distant future when most matters regarding the composition, description, and advertising of foods will be arranged by friendly negotiation with trade organisations and when the threat of legal action will be a thing of the past except for the few, who think only of themselves. Most manufacturers and caterers are honest and they realize that food administration protects them from frivolous and even wrongful complaints because, after all, the real aim of society, whatever be one's walk in life, is to serve the public interest." Food and Drugs Act, 1955, and Food Hygiene Regulations, 1955. This Act, which consolidates the Food and Drugs Act, 1938, and certain other food legislation, is dealt with in the Public Analyst's report on page 22. It came into operation on the 1st January, 1956, as did also the major part of the Food Hygiene Regulations, 1955. These Regulations have as their principal object improvement in conditions under which food is stored and handled so as to minimise the incidence and spread of food poisoning. They replace Section 13 of the Food and Drugs Act, 1938, and add new provisions in respect of the hygienic handling of food and the construction and maintenance of food premises, including stalls, and vehicles used for the transport of food. With regard to vehicles carrying meat, the Regulations replace numbers 19, 20 and 21 of the Public Health (Meat) Regulations, 1924. The new Regulations contain requirements for (1) the cleanliness of food premises, stalls, apparatus and equipment, (2) the hygienic handling of food, (3) the personal habits and cleanliness of persons engaged in the handling of food, the condition of their clothing, and the action to be taken while they suffer from certain infections or are carriers thereof, (4) the construction, repair and maintenance of food premises, the condition of stalls, vehicles, etc., and the facilities to be provided, and (5) the temperature at which foods particularly liable to transmit disease are to be kept in food premises. Especially noteworthy are the prohibition of the use of newspaper for wrapping open foodstuffs and of the use of tobacco by persons handling open food or working in rooms where such food is exposed. The provisions in the new Regulations against "risk of contamination" are also an advance on former legislation which only dealt with "contamination" of foodstuffs. 25 When the Regulations were first issued it was obviously desirable that before they came into operation they should be given the widest possible publicity among food traders and others engaged in the handling or preparation of food. It was also felt that the traders would welcome some simple explanation of how the Regulations would affect them, and the Central Council for Health Education were therefore asked if they could produce suitable publicity material. As a result, they designed and published an excellent pamphlet on the lines suggested and a copy of this was sent with a covering letter by the Department to the management of every food handling establishment in the Borough. The scheme proved very successful and the vast majority of the occupiers of food premises are co-operating in carrying out the new requirements. Legal Proceedings—Food. Details of legal proceedings taken under the Food and Drugs Act, 1955, are given in Table 16, page 36. Unsound Food. The total quantity of food surrendered as being unsound and unfit for human consumption was nearly 34 tons. The greater part related to canned foods. When destruction on the premises was impracticable condemned food was sent via the Cleansing Department to a central refuse disposal depot at Westminster. Details of condemned food are given in Table 17, page 37. Flaked Hen Egg Albumen. In the Annual Report for 1955 reference was made to the presence of organisms of the salmonella group in samples of flaked hen egg albumen imported from China. Comparatively large consignments of this infected material had reached this country and the Ministry of Health decided to set up an Albumen Advisory Committee to investigate the practicability of rendering the stocks sterile and useable. After a series of experiments a method of treatment was evolved which gave satisfactory results. In the meantime, arrangements had been made with a St. Marylebone firm who had been dealing in this albumen to recall supplies held by their customers for retention in bulk at their warehouse. Eventually batches of infected albumen were sent by wholesalers and others in various parts of the country to certain specified centres for processing under the supervision of the local Medical Officer of Health. A total of 4,120 lbs. of albumen was sent from this Borough for treatment. Milk. There are 78 registered premises from which milk is sold and 19 milk roundsmen operate in the Borough from shops or depots elsewhere. A total of 153 inspections were made. During the year, 236 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. Details are given in Table 18, page 37. The average composition of the 103 genuine samples of milk analysed was : total solids 12.27 per cent.; fat 3.53 per cent.; solids not fat 8.73 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 83 other samples of milk examined by the Council's Bacteriologist, all were found to comply with the requisite standards. Ice-Cream. The number of registered premises was 229, which includes three where ice-cream is manufactured ; 150 inspections were made. Details of premises licensed to sell ice-cream are given in Table 19, page 37. Preserved Food. There were 119 premises registered for the preparation or manufacture of sausages or potted, pickled, pressed or preserved food intended for sale. Inspections totalling 231 were made and informal action was taken to remedy any unsatisfactory conditions found from time to time. Details are given in Table 19, page 37. 26 Catering Establishments. There are 784 premises of this type in the Borough. During the year, 1,661 inspections were made and 12 notices served. Details of the premises concerned appear in Table 20, page 38. Fried Fish Shops and Fish Curers. Ten premises are used by fried fish sellers and one by a fish curer. Twenty-two inspections of fried fish shops and twenty-four 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. Because of new requirements under the Food Hygiene Regulations, 1955, the number (44) of informal notices served during the year exceeded the figure (7) for 1955. Nevertheless, it was generally observed during the 1,540 inspections of food shops that there was an increasing interest in food hygiene. Details of types of businesses are given in Table 20, page 38. Food Stalls. Apart from isolated pitches, most of the 110 food stalls in the Borough are sited in street markets, namely, Church Street, Bell Street, Aybrook Street and Great Titchfield Street. During the year, 287 inspections were made of the markets. Bakehouses. Most of the fourteen bakehouses maintained good standards and the comparatively few unsatisfactory conditions found were dealt with informally; 66 inspections were made. Horseflesh. Four visits were paid to the only shop in the Borough selling horseflesh for human food. Slaughter of Animals. There are in the Borough no slaughterhouses where animals are killed for human consumption but there is a knacker's yard situated in the gardens of the Zoological Society of London. This establishment is licensed by the Council for the slaughter of animals to provide food for the carnivores in the menagerie. Two inspections were made during the year. St. Marylebone Clean Food Association. The Executive Committee of the Association (Chairman: Mr. H. Hale—until his death in December; Hon. Secretary: Mr. W. S. Moss; Hon. Treasurer: Mr. D. W. Moeran) have kindly provided the following information which is extracted from their report for the year 1956/57:— " Chairmanship of the Executive Committee. We have to record with profound regret the death, early in December, of our Chairman, Mr. H. A. Hale. He had been a member of the Association since its inception and Chairman of the Executive Committee since 1954. He had shown great interest in our work and was always keen to further our aims. In his passing, the Association has suffered a great loss. Since December our Vice-Chairman, Councillor H. C. Garrard, has acted in his stead and we would like to thank him for so willingly and ably presiding over our affairs. Membership of the Association. The total number of members of the Association is now 168, seven applications for membership having been granted during the year under review, three of which were in respect of premises taken over by new proprietors. Publicity. We acknowledge with thanks the notice which the local press have given to our Association from time to time. We are also grateful to the Borough Council for allowing the continued use on envelopes of a small stick-on label bearing the slogan ' Insist on Clean Food.' 27 New Food Legislation and the Association. Early in the year we felt perhaps the time had come to wind up the Association. It was thought that the recent food legislation which incorporates much of our Code of Practice, had reduced the need for an organisation such as ours, but a strong majority were not in favour of this suggestion. Our members appreciate the value of the badge and what it stands for and would be reluctant to remove it. There is no doubt, too, that the public are becoming much more aware of its significance but there is still much to be done to educate them in this direction. Your Committee would emphasise, however, that we must ensure that our high standards are maintained at all times. We ask the public to ' Insist on Clean Food ' and we, the members of the Association, are leaders among the traders who insist that they get it." SECTION F— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES The incidence of infectious diseases in the Borough during the year was much less than in 1955. This was mainly due to a drop in measles, a disease which seems to be especially prevalent in twoyearly cycles; and 1956 was not a "measles year." Information regarding the 419 cases of notifiable diseases reported is given in Table 21, page 38. Enquiries relating to these cases and to infectious disease contacts involved 724 visits by the women public health inspectors. Scarlet fever increased, 31 cases being reported, as compared with 18 in 1955, but they were scattered and generally of a mild type. In the spring there was a small outbreak of Sonne dysentery amongst young children, especially in the east end of the Borough and apparently unrelated cases of the disease continued to occur throughout most of the year and notifications totalled 57. There were 13 instances of food poisoning as against 117 the previous year. Fortunately there were only two cases of poliomyelitis (1 paralytic and 1 non-paralytic) and there was no diphtheria. Tuberculosis. Table 21, page 38 gives information regarding primary notifications of pulmonary and non-pulmonary tuberculosis received during the year and Table 22 on page 39 shows the age and sex distribution of new cases and of deaths from all forms of this disease. Enquiries into housing and sanitary conditions involved 91 visits by one of the women public health inspectors to all new cases and those moving into the Borough from other areas. The total number of cases remaining on the register at the end of the year was 926. Mass Miniature Radiography. During the year a Mass X-Ray Unit was stationed at 25 different sites in the Borough. Many of those X-rayed were not St. Marylebone residents and of the 29 active cases reported only 6 were living in the Borough. Statistics provided by Dr. Mikhail, the Medical Director of the Unit, are summarized in Table 23, page 39. Food Poisoning. During the year, 13 cases of food poisoning were notified. One outbreak was found to be due to salmonella enteritidis and involved two cases. The other outbreaks were of unknown cause. Of the single cases, three were found to be due to salmonella typhi-murium, one to staphylous toxin and one to Morgans No. 1 bacilli. The three remaining single cases were of unknown cause. Impetigo. No cases of impetigo were referred to the Cleansing Station for treatment during the year. Scabies. The Council's Cleansing Station in Lisson Grove dealt with 127 cases of scabies: adults, 61 (men 46, women 15); children, 66 (boys 35, girls 31). Nine 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, 28 Disinfection. During the year, 178 rooms and 596 articles of bedding (mattresses, blankets, sheets, bolsters, pillows, etc.), together with 900 books, were disinfected, and 326 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, 235 certificates, relating to a total of 3,058 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 three certificates were issued. International Certificates of Vaccination. Persons travelling to most countries abroad have to produce evidence of recent vaccination against certain prescribed diseases. For this purpose an international certificate of vaccination is used in respect of smallpox, cholera and yellow fever. Methods of protection previously known as " inoculation " are now described internationally as vaccination. Under the terms of Ministry of Health circulars Nos. 60/48 and 20/52 the Medical Officer of Health is required to authenticate the signatures on certificates issued by doctors practising within his district. During the year signatures on 5,011 of these certificates were authenticated. Occasionally certificates signed by doctors practising in other districts (as far distant as Eire and Scotland) are submitted by travellers due to leave for abroad the same day and in such cases great inconvenience and delay would be caused to them by sending the certificates to the local Medical Officer of Health for authentication. To avoid this, the doctor concerned is contacted by telephone and, upon his assurance that the certificate has in fact been signed by him, the documents are authenticated. Telephone charges are paid by the traveller. Bacteriological Examinations. Table 24, page 39 shows the number of specimens examined for the purposes of diagnosis and also indicates the organisms in relation to which the examinations were made. 29 APPENDIX OF STATISTICAL TABLES AND SUPPLEMENTARY INFORMATION 30 TABLE 1.—Deaths—According to Age-Group and Sex. Code 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 5 3 - - - - - - - 2 2 - 3 1 2 Tuberculosis, other — 1 - - - - - - - 1 - - - - 3 Syphilitic disease 5 4 - - - - - - - - - - 5 4 *4 Diphtheria — 1 - - - - - - - - - 1 - - 5 Whooping cough - - - - - - - - - - - - - - 6 Meningococcal infections — 1 - - - 1 - - - - - - - - 7 Acute poliomyelitis - - - - - - - — - - - - - - 8 Measles - - - - - - - - - - - - - - 9 Other infective and parasitic diseases 1 4 - - - - - - 1 - - 2 — 2 10 Malignant neoplasm, stomach 11 4 - - - - - - - - 1 1 10 3 11 Malignant neoplasm, lung, bronchus 40 9 — — —- — — — 2 — 18 5 20 4 12 Malignant neoplasm, breast — 20 - - - - - - - 2 — 5 — 13 13 Malignant neoplasm, uterus — 11 - - - - - - - 1 — 4 — 6 14 Other malignant and lymphatic neoplasms 55 52 - - - - - - 2 2 20 19 33 31 15 Leukaemia, aleukaemia 2 1 — — — — — — — — 2 1 — — 16 Diabetes 2 4 - - - - - - - - 1 — 1 4 17 Vascular lesions of nervous system 80 59 - - - - - - 1 2 14 8 65 49 18 Coronary disease, angina 111 91 - - - - - - 5 1 34 10 72 80 19 Hypertension with heart disease 32 39 - - - - - - 1 - - - 31 39 20 Other heart disease 71 90 - - - - - - - 1 3 3 68 86 21 Other circulatory disease 16 26 - - - - - — - - 3 2 13 24 22 Influenza — — — — — — — - — — — — — — 23 Pneumonia 17 19 1 - - - - - - - 4 2 12 17 24 Bronchitis 50 27 1 - - - — — - - 4 4 45 23 25 Other diseases of respiratory system 11 2 - - - - - - - - 3 2 8 — 26 Ulcer of stomach and duodenum 8 3 - - - - - - - - 4 — 4 3 27 Gastritis, enteritis and diarrhoea — 7 — — — — — — — 1 — 1 — 5 28 Nephritis and nephrosis 4 5 - - - - - - - 1 3 — 1 4 29 Hyperplasia of prostate 9 — — — — — — — — — 1 — 8 — 30 Pregnancy, childbirth, abortion - - - - - - - - - - - - - - 31 Congenital malformations 3 6 2 1 — — — 1 — 2 — 1 1 1 32 Other defined and ill-defined diseases 29 36 3 4 — 1 1 — 4 — 12 5 9 26 33 Motor vehicle accidents 4 3 — — — — — — 3 — 1 1 — 2 34 All other accidents 9 18 - - - - - - 2 1 1 2 6 15 35 Suicide 6 10 - - - - - - 1 3 2 5 3 2 36 Homicide and operations of war - - - - - - - - - - - - — - Totals 581 556 7 5 - 2 1 1 22 20 133 84 418 444 1,137 12 2 2 42 217 862 * See paragraph on page 6. 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. Atelectasis 1 3 - - - - - - - - - - - - 1 3 Congenital Heart Disease 2 - - - - - - - - - - - - - 2 — Premature Birth 2 - - - - - - - - - - - - - 2 — Bronchitis and Pneumonia - - 1 - - - - - - - 1 - - - 2 — Respiratory Failure — 1 - - - - - - - - - - - - - 1 Meningitis - - - 1 - - - - - - - - - - - 1 Totals 5 4 1 1 - - - - - - 1 - - - 7 5 31 TABLE 3.—Climatological Summary, Year 1956. Station: Regent's Park. Height of rain-gauge above mean sea level: 129 feet. 1956 Air Temperature in Degrees Fahrenheit Rainfall Weather Number of Days Bright Sunshine Means of Mean of A and B Highest and Lowest Total Most in a day Precip'n Snow or Sleet Snow lying at 9h. G.M.T. Hail Thunder heard Fog (9h. G.M.T.) Air Frost Ground Frost Gale, force 8 or more Total Daily Mean Per cent. of Average* .01 in. (0.2 mm.) or more .04 in. (1.0 mm.) or more A Max. B Min. Highest Max. Date Lowest Min. Date Lowest Max. Date Highest Min. Date Amt. Date °F. °F. °F. °F. °F. °F. °F. in. in. hr. hr. % Jan. 45.3 35.3 40.3 54 1, 26 29 19, 25 34 31 43 12 3.47 0.79 30 16 14 4 - 0 0 3 9 13 — 35.6 1.15 121 Feb. 36.7 26.4 31.5 54 28 16 2 25 1 44 29 0.50 0.16 12 8 6 13 - 0 0 0 23 25 — 48.5 1.67 104 Mar. 52.0 38.3 45.1 65 26 29 16 39 13 49 3 1.06 0.52 3 5 5 1 - 0 0 0 9 11 — 112.4 3.63 122 April 53.5 37.5 45.5 66 10 32 20 42 14 44 13 1.13 0.43 13 5 5 0 - 0 0 0 1 15 — 126.4 4.21 96 May 67.7 46.8 57.3 80 28 40 20 60 13, 18 54 9, 29 0.36 0.26 29 4 3 0 - 0 0 0 0 0 227.3 7.33 121 June 65.1 50.4 57.7 75 25 43 15 50 8 57 24 2.43 0.52 11 14 9 0 - 0 2 0 0 0 132.6 4.42 65 July 70.0 56.3 63.1 84 25 50 12 59 13 62 8, 9 6.51 2.21 8 14 14 0 - 0 3 0 0 0 - 162.1 5.23 84 Aug. 65.8 52.8 59.3 72 8, 9 46 29 58 4 60 10 4.43 0.53 1 25 19 0 - 0 4 0 0 0 - 147.4 4.75 84 Sept. 67.0 54.0 60.5 77 22,24 48 1 59 1 59 23 2.00 0.49 4 11 10 0 - 0 1 1 0 0 - 98.2 3.11 74 Oct. 57.1 44.9 51.0 64 23 34 26 47 30 56 17,18 2.05 1.13 1 8 5 0 - 0 3 2 0 5 - 94.0 3.03 113 Nov. 49.1 39.3 44.2 59 8 26 23 37 23 48 9 0.39 0.23 14 7 3 1 - 0 0 0 5 17 - 40.2 1.34 98 Dec. 47.9 40.4 44.1 56 12, 16 30 22 35 25 49 6, 16 2.78 0.61 23 16 13 1 - 0 0 3 5 9 - 7.6 0.25 29 Totals 27.11 133 106 20 - 0 13 9 52 95 — 1227.2 Means or Extremes 56.4 43.5 49.9 84 July 25 16 Feb. 2 25 Feb. 1 62 July 8, 9 2.21 July 8 3.35 92 *Average for years 1921-1950. 32 TABLE 4.—Diseased or Infirm Persons removed to Hospital etc., under Court Orders. Person Age Removed to Remarks Mrs. K. F. 82 Hospital Emergency Order for 3 weeks. Removed to Mental Hospital. Died. Mr. M. T. 78 Hospital Emergency Order for 3 weeks. Remained in Hospital after expiration of Court Order as voluntary patient. Died. Miss I. M. 78 Hospital Emergency Order for 3 weeks. Further Order for 3 months. Court adjourned Council's application to vary existing Order to admit patient to L.C.C. Home. Patient transferred to another Hospital after expiration of Order. TABLE 5.—New Legislation. Legislation Operative Date Clean Air Act, 1956 Various London County Council (General Powers) Act, 1956 2.8.56 Sanitary Inspectors (Change of Designation) Act, 1956 2.8.56 Clean Air Act (Appointed Day) Order, 1956 31.12.56 Poultry Premises and Vehicles (Disinfection) Order, 1956 12.1.56 Smoke Control Areas (Authorised Fuel) Regulations, 1956 31.12.56 Rent Restriction Regulations, 1956 1.4.56 Housing (Form of Orders and Notices) (Amendment) Regulations, 1956 10.8.56 Food Hygiene (Amendment) (No. 1) Regulations, 1956 30.6.56 Food Hygiene (Amendment) (No. 2) Regulations, 1956 31.12.56 Flour (Composition) Regulations, 1956 30.9.56 Food Standards (Curry Powder) (Amendment) Regulations, 1956 2.8.56 Food Standards (Tomato Ketchup) (Amendment) Regulations, 1956 2.8.56 Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956 1.7.56 TABLE 6.—Nuisances Remedied. Nuisance Abated or Defect Remedied Number Houses damp, dirty or dilapidated 238 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., defective 190 Insufficient and unsuitable water-closet accommodation 47 Drain, water-closet and waste pipe stoppages 49 Drains, water-closets and waste pipes defective 146 Yard, area and wash-house defects 11 Roofs, gutters and rainwater pipes defective 196 Insufficient water supplies 49 Water cisterns dirty or defective 20 Ashpits, dustbins, etc., defective 30 Rubbish accumulations 36 Animal nuisances 6 Miscellaneous 30 Total 1,048 33 TABLE 7.—Legal Proceedings: Public Health (London) Act, 1936. Date of Hearing Non-compliance with nuisance notice regarding: Result Fine Costs £ £ s. d. 17 Feb. 15, Carton Street 21 day abatement order - l 15 6 13 July 48, Gloucester Place Mews Summons withdrawn—work completed - — 27 July 10, Cramer Street Summons withdrawn—agreed costs received by the Council - - 27 July 7, Aybrook Street Summons withdrawn—agreed costs received by the Council - - 27 July 22, Aybrook Street Summons withdrawn - — 10 Aug. 20, Linhope Street Summons withdrawn—work completed - 2 15 6 2 Nov. 21, Aybrook Street Summons withdrawn—work completed - 10 6 2 Nov. 10, Moxon Street Summons withdrawn—work completed - 10 6 2 Nov. 12, Cramer Street Summons withdrawn—work completed - 10 6 2 Nov. 18, Linhope Street Summons withdrawn—work completed - — 28 Dec. 12, Aybrook Street Summons withdrawn—work completed - — 28 Dec. 1, St. Vincent Street Summons withdrawn—work completed - — 28 Dec. 2, St. Vincent Street Summons withdrawn—work completed - — TABLE 8.—Legal Proceedings : London County Council Drainage and Water-Closet Byelaws. Date of Hearing Premises Result Fine Costs £ £ s. d. 20 Jan. 13, Upper Berkeley Street Guilty l l 1 0 2 Nov. 8, Aybrook Street Summons withdrawn—work completed - 10 6 14 Dec. 9, St. Edmund's Terrace Guilty on seven summones 14 7 7 0 28 Dec. 20, Cramer Street Summons withdrawn—work completed - - 28 Dec. 1, St. Vincent Street Summons withdrawn—work completed — — TABLE 9.—Rodent Control. Summary of Complaints, Infestations and Surveys Residential Premises Business and other Premises Totals Complaints received 466 198 664 Concerning: Rats 283 107 390 Mice 183 91 274 Black rat infestations 7 28 35 Brown rat infestations 169 47 216 Mice infestations 215 74 289 Treatments given: Rats 730 290 1,020 Mice 810 274 1,084 Blocks surveyed — — 13 Premises involved in blocks 517 421 938 Infestations found in blocks Rats 2 2 4 Mice 5 3 8 34 TABLE 10.—Air Pollution. Readings from Deposit Gauges and Other Apparatus for Measuring Air Pollution Site Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Insoluble Matter—Tons per sq. mile (collected in deposit gauges) N.L. 16.1 3.3 16.4 9.2 9.7 12.4 10.7 10.6 12.9 10.2 7.3 18.8 T.H. 12.8 11.0 17.7 10.4 9.1 11.5 13.5 8.0 10.3 10.7 12.6 17.9 D.S. 14.7 15.1 18.6 16.0 9.4 11.7 — 10.9 14.1 10.3 10.2 15.2 Soluble Matter—Tons per sq. mile (collected in deposit gauges) N.L. 9.0 1.8 6.0 4.7 3.1 5.7 9.2 5.9 5.6 6.2 3.5 8.3 T.H. 9.6 6.5 8.6 6.7 3.8 7.3 8.1 6.9 7.2 6.8 5.5 8.4 D.S. 9.0 5.9 5.4 6.0 1.9 6.1 — 6.1 7.0 4.8 2.7 6.5 Sulphur Trioxide—Milligrams per Day Collected (per 100 sq. cm. of lead peroxide) N.L. 4.9 2.9 3.3 2.3 1.2 1.3 1.1 0.9 1.5 1.9 2.8 4.3 T.H. 6.4 5.3 5.2 4.1 2.2 1.9 1.8 1.9 2.7 4.3 5.3 5.6 E.R. 5.2 6.4 5.8 3.6 1.4 1.3 1.5 1.5 3.1 3.6 4.4 4.5 Smoke— Milligrams per 100 cubic metres of air average per day (Volumetric method) T.H. 106 50 39 40 11 12 9 7 11 33 47 41 G.P. 84 54 36 42 9 7 7 7 10 35 49 44 Sulphur Dioxide—Parts per 100 million parts of air average per day (Volumetric method) T.H. 20 15 16 12 6 4 4 4 7 11 15 15 G.P. 17 12 13 9 4 2 2 3 5 9 13 15 Annual Daily Average of Mean Concentration of Smoke and Sulphur Dioxide Site 1956 1955 †Fog (72 hrs.) 1956 Fog (24 hrs.) 1955 Smoke mg-/ 100m3 so2 p.p.100m. Smoke mg./ 100m3 SO2 p.p. 100m. Smoke mg./ 100m3 SO2 p.p. 100m. Smoke mg./ 100m3 so2 p.p. 100m. T.H. 34 11 39 9 725 58 110 41 G.P. 32 9 51 7 516 45 76 32 Annual Monthly Average of Deposited Matter and Sulphur Trioxide. Site 1956 1955 Tons per sq. mile Mg. per 100 sq. cm. Pb02 Tons per sq. mile Mg. per 100 sq. cm. Pb02 T.H. 19.22 3.9 19.02 4.03 N.L. 17.24 2.4 17.56 2.47 D.S. 18.9 — 19.3 — E.R. — 3.5 — 3.7 Notes to Table 10— Sites : N.L. Nuffield Lodge T.H. Town Hall E.R. Edgware Road G.P. Greville Place D.S. Devonshire Street (maintained by the D.S.I.R.) *The figures given for 1955 are based upon the average for six months—July to December inclusive—as recording apparatus was not used before that date, † During fog, recordings are taken at three-hourly intervals. 35 TABLE 11.—Factories: Inspections for Purposes of Provisions as to Health. Premises Registered Inspections Written notices Occupiers prosecuted Factories without mechanical power 264 313 29 - Factories with mechanical power 1,209 988 73 - Other premises* (excluding out-workers' premises) 231 416 - - Totals 1,794 1,717 102 — * Electrical stations, institutions, sites of building operations and works of engineering construction. TABLE 12.—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 101 91 3 2 - Overcrowding — — 2 — — Unreasonable temperature — — — — — Inadequate ventilation 9 2 — — — Ineffective drainage of floors — — — — — Sanitary conveniences:— (a) insufficient 2 3 — 1 — (b) unsuitable or defective 95 100 — 16 — (c) not separate for sexes 4 2 — 1 — Other offences (excluding offences relating to outwork) 54 45 103 1 — Totals 265 243 108 21 — TABLE 13.—Summary of Outwork. Description of Work Outworkers Employed Wearing apparel 770 Buttons 4 Umbrellas 17 Household linen 9 Textile weaving 6 Electro Plate 6 Furniture and upholstery 3 Lampshades 3 Basket making 1 819 36 TABLE 14.—Pharmacy and Poisons Acts, 1852-1941: Summary of Sellers of Part II Poisons. Type of Business Total Licensed Grocery and provision stores 39 Hardware and domestic stores 19 General stores 14 Hairdressers 9 Builders' merchants 2 Drug stores 2 Pest control contractor 1 Horticultural sundries 1 Dental sundries 1 Photographic dealer 1 Veterinary products 1 90 TABLE 15.—Dwelling-Houses. Summary of Inspections, Conditions Found and Action Taken. Inspection under Public Health or Housine Acts:— (1) (a) Inspected for housing defects 1,280 (b) Inspections made for the purpose 4,738 (2) Found to be in a state so dangerous or injurious to health as to be unfit for human habitation 21 (3) Found not to be in all respects reasonably fit for human habitation 470 Defects remedied without service of formal Notices:— Defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 286 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 184 (2) Dwelling-houses in which, after service of formal notices, defects were remedied:— (a) By owners 178 (b) By Local Authority in default of owners (6) Proceedings under section 12 of the Housing Act, 1936:— (1) Underground rooms in respect of which Closing Orders were made 40 (2) Closing Orders determined, the tenement or room having been made fit 7 (3) Rooms affected by (2) above 18 TABLE 16.—Legal Proceedings: Food and Drugs Act, 1955. Date of Hearing Nature of Offence Result Fine Costs £ £ s. d. 19 Oct. Selling wrapped sliced loaf, the outside crust being dirty, and the loaf containing flour beetles. Section 2 (1) Food and Drugs Act, 1955. Not guilty—dirty crust. Guilty—beetles in loaf. 15 6 6 0 37 TABLE 17.—Summary of Unsound Food Condemned. Food Condemned Quantity tons cwts. qtrs. lbs. Meat and offal 11 0 8 Bacon and ham 1 9 3 13 Poultry and game — 3 3 15 Fish — 2 2 26 Fruit and vegetables 1 0 2 15 Canned meat 5 10 2 27 Canned food (other than meat) 23 8 2 8 Miscellaneous 1 7 3 1 33 15 1 1 TABLE 18.—Milk (Special Designation) Regulations: Summary of Licences Issued. Type of. Licence, and Designation Number Issued Pasteuriser's 1 Steriliser's 1 Dealer's: Tuberculin tested 54 Pasteurised 68 Sterilised 66 Supplementary: Tuberculin tested 16 Pasteurised 17 Sterilised 15 TABLE 19.—Summary of Premises Registered for Storage and Sale of Ice-Cream or Preserving Food. Type of Business Preserving Food Ice Cream Butchers 79 2 Catering Establishments 2 38 Tobacconists, confectioners/newsagents — 86 Grocers and provision merchants 28 35 Fishmongers 3 2 General stores 7 17 Milk shops — 20 Greengrocers and fruiterers — 25 Public houses — 2 Ice-cream factories — 2 119 229 * Where ice-cream is stored or sold, or food is preserved, for consumption off the premises. 38 TABLE 20.—Summary of Food Premises. Type of Business Totals Restaurants, cafes and snack bars 334 Canteens and clubs 235 Grocers and provision merchants 213 Butchers 79 Greengrocers and fruiterers 70 Fishmongers 20 Bakers 36 Confectioners 176 Wine merchants 48 Public houses 120 Other licensed premises 18 Hotels 54 Coffee stalls and kiosks 4 Schools and nurseries 19 Stalls, street trading 110 1,536 TABLE 21.—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 2 2 - - - - - - - - - - - 1 1 Paratyphoid fever 2 - - - - 1 - - - - - 1 — 1 1 Erysipelas 3 — — — — — — — — — 1 — 2 — 3 Scarlet fever 31 — — 1 3 5 16 1 2 1 — 2 — 8 23 Puerperal pyrexia 47 - - - - - - - 2 42 3 — — 46 1 Poliomyelitis— Paralytic 1 - - - - - - - - 1 - - - 1 — Non-paralytic 1 - - - - - 1 - - - - - - 1 — Pneumonia 9 — — — — — — — — — 4 3 2 3 6 Dysentery 57 2 8 4 9 7 12 6 — 5 2 2 — 10 47 Measles 116 2 14 9 12 17 57 4 — — — 1 — 2 114 Whooping cough 43 2 4 6 7 2 18 3 — — 1 — — — 43 Scabies 18 — — 1 2 — — 1 4 6 — 2 2 — 18 Meningococcal infection 2 1 - - - - - - - 1 - - - 2 — Malaria (contracted abroad) 1 - - - - - - - - - 1 - - 1 Tuberculosis— Pulmonary 66 — 1 — — — 2 1 4 20 14 18 6 25 41 Non-pulmonary 5 - - - - - - - 1 2 2 — — 5 — Food poisoning 13 1 — — 1 — — — — 5 4 — 2 3 10 Typhoid fever 1 - - - - - - - - - 1 - - 1 — Acute Encephalitis (infective) 1 - - - - - - - - - 1 - - 1 — Totals 419 10 27 21 34 32 106 16 13 83 34 29 14 111 308 * 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, induced malaria. 39 TABLE 22.—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 2 — - - — — — 15—25 5 11 1 — - - — — 25—35 9 16 — 2 - 1 — — 35—45 19 9 1 1 - — — — 45—55 14 5 — - 2 — — — 55—65 12 2 — - 2 — — — 65 and upwards 8 2 1 - 4 1 — — Totals 68 48 3 3 8 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. TABLE 23.—Mass Miniature Radiography Surveys : Summary of Results. Persons examined Active disco cases /ered Cases recommended for occasional supervision M F. M. F. M. F. 6,530 8,074 18 11 11 7 *14,604 29 18 (1.98 per thousand) (1.23 per thousand) * Includes 6,206 persons not previously X-rayed (42.49%) TABLE 24.—Summary of Work of the Bacteriological Laboratory. Nature of Specimen and Examination Positive Negative Total Throat and nasal swabs for— B. diphtheriae — 20 20 Haemolytic streptococci 3 25 28 Vincent's organisms 8 1 9 Vaginal swabs for— Gonococci — 2 2 Sputum for— Tubercle bacilli — 17 17 Laryngeal swabs for— H. pertussis 1 1 Faeces for— Parasites 1 — 1 Typhoid, paratyphoid, dysentery and food poisoning organisms 21 223 244 Cervical swabs for— Trichomonas 2 2 Urethral swabs for— Gonococci 1 1 2 Foods for— Food poisoning organisms 3 33 36 Urine for— Dysentery 1 1 Swabs (various) for— Staphylococcal infections 1 11 12 Totals 38 337 375 40 HAIRDRESSERS AND BARBERS Byelaws as to hairdressers and barbers made by the St. Marylebone Metropolitan Borough Council under section 18 (4) of the London County Council (General Powers) Act, 1954 1.—(1) In these byelaws, unless the context otherwise requires— "hairdresser or barber" means any person carrying on the business of a hairdresser or barber on premises registered under section 18 (1) of the London County Council (General Powers) Act, 1954; "day" means a day on which business is carried on. (2) The Interpretation Act, 1889, applies to the interpretation of these byelaws as it applies to the interpretation of an Act of Parliament. 2.—For the purpose of securing the cleanliness of the premises, a hairdresser or barber shall comply with the following provisions:— (а) all internal walls, partitions and ceilings shall be painted, distempered, whitewashed, papered, decorated, furnished or otherwise treated and shall be capable of being kept clean, kept in good repair and cleansed as necessary; (b) the floor and any coverings shall be kept in good repair, and shall be cleansed at least once a day and swept as necessary to prevent the accumulation of hair clippings, neck wool or other litter ; (c) all such sweepings and all other litter shall be placed in suitable covered receptacles, which shall be emptied as necessary and at least once a day, and kept clean; (d) every chair or seat shall be cleansed as necessary; (e) every shelf, table, cabinet, washbasin and other fitting shall be kept clean. 3.—-For the purpose of securing the cleanliness of any instruments, towels, materials and equipment used in the premises, a hairdresser or barber shall comply with the following provisions:— (а) before use in connection with any customer— (i) any gown, wrap, overall or other protective clothing shall be clean ; (ii) any paper or other covering placed on the back of a chair and any towel, cloth, hairnet, neck wool or other article which is applied to the face, head or neck shall be clean, and shall not previously have been used in connection with any other customer unless it consists of a material (other than paper or wool) which can be, and has been, adequately cleansed ; (iii) any metal instrument shall have been sterilised or otherwise adequately cleansed; (iv) any hairbrush, comb or similar instrument shall be clean, and shall have been sterilised, or otherwise adequately washed or cleansed, at least once a day; (v) any soap in solid form shall have been adequately rinsed; (b) a fresh supply of water shall be used for purposes of shaving, shampooing or washing each customer, and all articles used for purposes of shaving (including any styptic in solid form) shall be adequately cleansed immediately after use; (c) there shall be provided washing facilities which are adequate for the purposes of any cleansing carried out in pursuance of this byelaw. 4.—For the purpose of securing the cleanliness of persons employed in the premises, in regard to both themselves and their clothing, a hairdresser or barber shall— (а) cause every such person to keep his hands and clothes in a clean condition; (б) provide and maintain suitable and sufficient washing facilities for the use of such persons; (c) cause any overalls worn to be clean; (d) cause every such person who has an open boil or sore on an exposed part of the body to keep such open boil or sore effectively covered by an impermeable dressing while attending to any customer. S. J. RUTTY, Town Clerk. Notes—(a) These byelaws operate from 1st December, 1955. (b) A copy of the byelaws must be displayed on the premises. (c) The maximum penalty for non-compliance with a byelaw is £5 and the Court may order suspension or revocation of the registration as a hairdresser or barber. Town Hall, St. Marylebone, W.l. 41 SERVICES AVAILABLE FOR OLD PEOPLE NATIONAL. National Assistance Board, 177, Tottenham Court Road, W.L (Tel.: MUS. 7002).—This Office assists old age pensioners whose income is insufficient for their needs, by financial grants and special grants for clothing, blankets, etc. Letters to be addressed to Area Officer. National Health Service.—All old people should be on the list of a doctor. This part of the service is controlled by the London Executive Council, Insurance House, Insurance Street, W.C.I. (Tel: TEH. 7833). A complete list of doctors can be seen at any Post Office, or advice can be obtained from the Public Health Department at the Town Hall. National Insurance : Local Offices— For Postal Area, W.L For Postal Area, N.W. 1. For Postal Areas, W.2 and N.W.8. 36/38, Berkeley Square, W.l 30, Euston Square, N.W.I. 5, Praed Street, W.2. Tel.: GRO. 6060. Tel. : EUS. 6451 Tel.: PAD. 3411, LONDON COUNTY COUNCIL. Homes.—Luxborough Lodge, 1, Luxborough Street, W.l. (Tel.: WEL. 5619).—Apply to Admission Officer. The L.C.C. also have a number of small homes for old people in the London Area. Apply through Admission Officer as above. Welfare of the Blind.—This is the responsibility of the L.C.C. Apply to The Welfare of the Blind Department, 5, Princes Row, S.W.L (Tel.: VIC. 0162, Ext. 22). Recuperative Holidays and Loan of Sick-Room Equipment, 313-319, Harrow Road, W.9. (Tel. : C.UN. 4815). Mental Illness.—Dealt with at County Hall, Westminster Bridge Road, S.E.L This service is available for urgent cases at all times. Apply to Duly Authorised Officer. (Tel. : WAT. 5000, Ext. 273). Home Helps Service, Room 91, Town Hall, St. Marylebone, W.l. (Tel.: WEL. 7766, Ext. 30).—The organiser can send domestic helps to old people who by reason of age or infirmity can no longer manage all their own domestic work. Department for Handicapped, 5, Princes Row, S.W. 1 (Tel. : VIC 0162).—Assistance and advice for the handicapped. ST. MARYLEBONE BOROUGH COUNCIL. Public Health Department, Town Hall, St. Marylebone, W.L (Tel.: WEL. 7766, Ext. 105).—Miss Sharp, M.B.E., Public Health Inspector, deals with any public health matters among old people whicb. are brought to her notice. A special laundry service for incontinent old people is run by the Council. Public Baths, Seymour Place, W.L—Monday to Friday up to 4.30 p.m. Old age pensioners pay Id. (soap and towels extra). Holidays.—The Borough Council's grant towards the cost of holidays for old age pensioners is administered by the Old People's Welfare Association. Fuel.—Old people without coal owing to delayed delivery should be reported to the Fuel Office (Tel. : TER. 7070, Ext. 126) or to Miss Sharp. The Fuel Office can give an order to the coalman for priority delivery within 48 hours. Miss Sharp can arrange an immediate delivery of 28 lbs. of coal to tide over until the coalman calls. Other Services.—The Council under various statutory powers (i) may apply to the Courts for Orders for the removal to suitable premises of persons who are suffering from grave chronic diseases or, being aged, infirm or physically incapacitated, are living in insanitary conditions AND are unable to devote to themselves, and are not receiving from other persons, proper care and attention; (ii) may cleanse verminous persons at the Cleansing Station in Lisson Grove or, if they are enfeebled, in their homes; and (iii) may undertake burial or cremation where no other suitable arrangements are being made. VOLUNTARY SOCIETIES. St. Marylebone Old People's Welfare Association, Room 103, Town Hall, St. Marylebone, W.L (Tel. : WEL. 7766, Ext. 97).—Tuesdays and Thursdays 10.30 a.m.—12.30 p.m., 2.30—4.30 p.m. Miss M. K. C. Macintosh, Hon. Secretary. At other times, 38, Clarence Gate Gardens, N.W.l. (Tel.: PAD. 5266). Visiting.—The Old People's Welfare Association has a panel of voluntary visitors, men and women, who pay regular friendly visits to old people. Three of these visitors are liaison officers between the Association and groups of lay visitors attached to churches. This is in addition to the visiting done by the Clergy and Church workers of all denominations. Meals on Wheels. (Dinners).—This service is financed by the Old People's Welfare Association (aided by a grant from the Borough Council and L.C.C.), and operated by the W.V.S. Hot dinners can be taken to the home, price lOd. for two courses. It is at present restricted to the ill or infirm. Apply either to the Old People's Welfare Association or to the W.V.S. W.V.S. Luncheon Club, 134, Seymour Place, W.L (Tel.: PAD. 5597).—Old age pensioners can obtain dinners for lOd. from Monday to Friday. Notice to attend must be given to W.V.S. beforehand 42 Home Nursing.—Paddington and St. Marvlebone District Nursing Association, 117, Sutherland Avenue, W.9. (Tel.: CUN. 1462). Chiropody.—A clinic is run by the Old People's Welfare Association and the British Red Cross Society in Room 115, Town Hall, St. Marylebone, W.l, every Tuesday from 10 a.m.—12.30 p.m. and from 2.15—5.15 p.m. Bookings to be made on the day in Room 115. A charge of Is. 6d. is made. A Home Chiropody Service is also run by the Association, on the first three Thursdays in the month. Bookings to be made with the Secretary, Old People's Welfare Association. A charge of 2s. is made. Clubs.—There are three W.V.S. "Darby and Joan" Clubs:— (1) at 7, Wyndham Place, W.l, on Wednesdays, 2.30 to 4.30 p.m. (2) at 7, Wyndham Place, W.l, on Thursdays, 2.30 to 4.30 p.m. (3) at 60, Paddington Street, W.l, on Tuesdays, 2.30 to 4.30 p.m. Other " Darby and Joan " Clubs are :— (4) The Liberal Jewish Women's Club, St. John's Wood Road, N.W.8 (for old people of all denominations) on Wednesdays, 2.30 to 4.00 p.m. (5) The " Inner Wheel " Club on Fridays, 2.30 to 4.30 p.m. in Christ Church Hall, Shroton Street, N.W.I. (6) The Fourth Feathers Club, 28, Mulready Street, Church Street, N.W.8, on Thursdays, 2.30 to 4.30 p.m. This Club is open during the mornings from Monday to Friday between 9.30 and 12.30 as a reading and games room. (7) The Barrow Hill Club. Alternate Thursdays at 2.30 to 4.30 p.m. The women's organisations of Churches in the Borough have large numbers of old age pensioners among their members. Women's Voluntary Services, 104, St. John's Wood Terrace, N.W.8. (Tel.: PRI. 1051). Citizens' Advice Bureau, 60, Paddington Street, W.l. (Tel.: WEL. 8614 and WEL. 8708). The Wireless for the Bedridden Society, 55a, Welbeck Street, W.l. (Tel.: WEL. 0949).—Wireless sets can be installed on loan to bedridden or housebound persons, and maintenance paid if necessary. Applications must be backed by some person or agency who has investigated the applicant's financial position. Family Welfare Association, 8, Kensington Park Road, W. 11. (Tel.: PAR. 6683). Sailors' Soldiers' and Airmen's Families Association (S.S.A.F.A.), Room 103, Town Hall, SI. Marylebone, W.l. (Tel.: WEL. 7766, Ext. 97).—Mondays, Wednesdays and Fridays, 10.00 a.m.—12.30 p.m. Salvation Army Headquarters, 236, Portman Buildings, Lisson Grove, N.W.I (Tel.: PAD. 8553). Church Army, 55, Bryanston Street, W.l. (Tel.: PAD. 9211). British Red Cross Society, 106, Crawford Street, W.l. (Tel.: WEL. 3416). National Association for the Paralysed, 1, York Street, W.l. (Tel.: WEL. 8373). National Association for Mental Health, 39, Queen Anne Street, W.l. (Tel.: WEL 1272). HOMES. St. Marylebone Almshouses, St. John's Wood Terrace, N.W.H. (Tel.: PRI. 0696).—For St. Marylebone residents of either sex, aged 65 or over and still able-bodied. Applications to the Secretary. Christian Union Almshouses, 21, Crawford Place, W.l. (Tel.: PAD. 7579).—This is a Church of England charity. Applications to the Secretary. Church Army Home for Men, 187, Marylebone Road, N.W.I. (Tel.: PAD. 6649).-—This Home has some beds for old men. Apply Secretary. Church Army Lodging House for Women, 10, Daventry Street, N.W.I. (Tel.: PAD. 4855).—Elderly able-bodied women, still at work, can be admitted although the hostel is not specially for the aged. The Ladies' Home, 41, Abbey Road, N.W.8. (Tel.: MAI. 6831).—For elderly ladies in reduced circumstances. Newstead, 17-19, Greville Place, N.W.6. (Tel.: MAI.'5711).—Maintained by the St. Marylebone Old People's Homes for the aged of either sex in need of care and attention. Old People's Homes Committee, 296, Vauxhall Bridge Road, S.W.l. (Tel.: VIC. 9977).—Details of old people's homes in London and provinces. CINEMAS. The following local cinemas admit old age pensioners for 9d. on weekdays (excluding Saturdays) up to 3 p.m. The Gaumont, Edgware Road. The Odeon, Edgware Road. The Regal, Harrow Road. 43 SUMMARY OF HOSPITALS AND CLINICS SERVING THE BOROUGH Ambulance Service : Removals, Emergency Bed Service (to all hospitals in Greater London) HOP 7181 Hospitals : Florence Nightingale Hospital, 19, Lisson Grove, N.W.1 PAD 2341 Hospital for Nervous Diseases, 4, Maida Vale, W.9 CUN 5172 Hospital of St. John and St. Elizabeth, 60, Grove End Road, N.W.8 CUN 5126 King Edward VII Hospital, Beaumont Street, W.1 VVEL 3935 Marlborough Day Hospital, 38, Marlborough Place, N.W.8 MAI 8605 National Dental Hospital, Gt. Portland Street, W.1 LAN 5361 National Heart Hospital, Westmoreland Street, W.1 HUN 0824 Paddington General Hospital, Harrow Road, W.9 CUN 4884 Paddington Green Children's Hospital, Paddington Green, W.2 PAD 1081 Royal National Orthopaedic Hospital, 234, Gt. Portland Street, W.1 EUS 5070 St. Charles Hospital, Ladbroke Grove, W.10 LAD 2281 St. Marylebone Hospital for Psychiatry and Child Guidance, 48, Cosway Street, N.W.1 PAD 8854 St. Mary's Hospital, Praed Street, W.2 AMB 1280 Samaritan Hospital, Marylebone Road, N.W.1 PAD 6011 The Middlesex Hospital, Mortimer Street, W.1 MUS 8333 Western Ophthalmic Hospital, Marylebone Road, N.W.1 PAD 1871 Clinics : Arthur Stanley Institute for Rheumatic Diseases and Allied Conditions, Peto Place, N.W.1 WEL 1133 Charterhouse Rheumatism Clinic, 56-60, Weymouth Street, W.1 WEL 1264 Chest Clinic, Town Hall, Marylebone Road, W.1 WEL 7766 Temperance Clinic (Church of England), 14, Gloucester Place, W.1 WEL 5222 The Tavistock Clinic (Psychiatric), 2, Beaumont Street, W.1 WEL 5415 Vaccination (Smallpox) Clinic, The Middlesex Hospital, W.1 MUS 8333 Vaccination (Smallpox) Clinic, Town Hall, Marylebone Road, W.1 WEL 7766 The Maternity and Child Welfare services for the Borough are administered by the London County Council, Division 2, 313-319, Harrow Road. W.9 CUN 4815