AC 4353 STMARY 62 BOROUGH OF ST. MARYLEBONE REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 J. H. BRISCOE-SMITH, M.B., Ch.B., 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—Infectious and other Diseases—Prevalence and Control 26 Appendix 39 Index 42 2 Public Health Department, Town Hall, St. Marylebone, W.1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, Although I have the honour to present to you the Annual Report on the health of the Borough during 1957, most of the material it contains refers to the period before I took up my duties in November when, first Dr. Bulman, and after his retirement Dr. Fenton, directed .the work of the Department. I shall, therefore, on this occasion confine myself in the main to a few comments of a general nature. The health of the Borough was on the whole satisfactory during the year. The only notifiable disease which reached epidemic proportions was measles, a disease which is coming to be regarded as almost trivial since modern treatment has made possible the prevention of many of the septic complications which previously led to so much subsequent ill-health. Only six of the 506 cases were admitted to hospital and there were no deaths. There were eight cases of poliomyelitis of whom four developed paralysis. Two of the paralytic cases did not live locally and contracted the disease outside the Borough. One of these, a man, had severe paralysis and was transferred to an Orthopaedic Hospital in Harrow. The other, a young woman, was only slightly affected. The two St. Marylebone residents, both children, also had only slight paralysis and it is pleasing to record that at the time of writing both have recovered completely. Although one death from poliomyelitis is recorded in Table 1, page 30, this refers to a young man who, while his home address was in St. Marylebone was, in fact, living and working outside London at the time. On the 11th June, 1957, the Ministry of Health issued a memorandum on the subject of the outbreaks of influenza which had recently occurred in the Far East. The covering letter to Medical Officers of Health stressed the importance of the early recognition of any outbreak which might follow introduction of the virus into this country, and the desirability of making arrangements for the examination of laboratory specimens from any suspected cases. On receipt of this communication an extract of the essential information contained therein was sent to general practitioners and hospitals in the Borough with an invitation to co-operate and requesting information of any case coming to their notice of influenza similar to those which had been occurring in the Far East. At the same time, arrangements were made with the Central Public Health Laboratory at Colindale for any appropriate specimens to be examined to identify the causal organism. On the 19th September, 1957, the Ministry of Health again wrote to Medical Officers of Health stating that as there was some public apprehension and considerable publicity about influenza, the Ministry were anxious to have immediate information of any outbreak of the disease and thereafter progress reports. Accordingly, and as influenza is not a notifiable disease, another letter was sent to general practitioners and hospitals inviting their further co-operation by reporting by telephone any sudden outbreak in their practice and by supplying the Medical Officer of Health with a note of the numbers of new cases of influenza which they had seen during each of the three weeks of the period ending 12th October. Similarly, seventy-eight of the larger firms and undertakings, including the Borough Council, were invited to inform the Medical Officer weekly of the percentage of staff reported absent with influenza. A simple note for completion and stamped addressed envelopes were sent in each case. The information obtained in this way was very valuable and sincere thanks are due to the practitioners, hospitals and undertakings who co-operated so willingly. The expected epidemic, when it came, affected London equally with the rest of the country, as judged by National Health Insurance claims for sickness, although it reached its peak here at the end of October, somewhat later than in the North. When death rates for influenza and notifications of acute pneumonia are examined, however, it would appear that the disease was considerably less severe in London than in some other areas which seems to have been equally true for St. Marylebone as for London as a whole. The infant mortality rate for the year deserves special mention. This rate of 31.29 per 1,000 live births is more than double that for 1956, which was 15.04. On page 6 I have discussed the statistical implications of this and advanced reasons to support the view that such an increase could be due to chance alone. It is also of interest to note that of the infant deaths in 1956 and 1957 all except four in each year were due to atelectasis, premature birth or congenital malformation of one sort or another; conditions which are all pre-natally determined and which, in our present state of knowledge, we can 3 do little to prevent. In each of the two years, three of the remaining deaths were due to infection. The fourth in 1956 was due to respiratory failure of unspecified causation while the fourth in 1957 was due to murder. Although I did not know him, it is, I think, proper that I should record the death in May, 1957, of Mr. H. E. Scoble, M.B.E., the Senior Public Health Inspector. Mr. Scoble had worked in the department for twenty-seven years and I know that all the members of the staff regarded his death as a personal bereavement as well as the loss of an experienced and valuable colleague. Mr. V. A. Bignell was appointed to replace him and is already proving himself a worthy successor. I have also to report that in December, Mr. C. Hepper, who had been your Mortuary Keeper for ten years, died in hospital where he had been admitted some time previously. Apart from his work at the Mortuary, Mr. Hepper drove the "Meals on Wheels" van and had endeared himself to many of the older residents in the Borough. To strike a happier note, it is with pleasure that I report that Miss Margaret Sharp, your Public Health Inspector, who is charged with the care of old people, had Membership of the Order of the British Empire conferred upon her in the 1957 New Year's Honours List. This is, I feel, a tribute not only to her selfless devotion in promoting the welfare of the elderly, but also to the Council who have so actively encouraged this aspect of the work of the department. To His Worship the Mayor, to the Chairman, Alderman C. D. Denis-Smith, and members of the Public Health Committee, and to the members of the Council, generally, I wish to express my gratitude for their kindness and consideration during these early months of my appointment. To my colleagues in other departments of the Council, I offer my sincere thanks for the help and co-operation they have so willingly given. Finally, I must pay tribute to the staff of the Public Health Department whose team spirit and initiative enabled them so successfully to bridge the gap between Dr. Bulman's retirement and my arrival, and whose loyalty and efficiency have since been invaluable. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. H. BRISCOE-SMITH, Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE 1957 HIS WORSHIP THE MAYOR : *Councillor R. H. Sharp, J.P., F.I.P.A. †Councillor J. E. Guest, J.P. ALDERMEN: C. D. Denis-Smith (Chairman) 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. The Rev. W. M. Long *Mrs. E. M. Brown S/Ldr. S. Stanley H. C. Garrard W. R. Willcocks †R. M. Dawe 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. (retired 31s/ July) J. H. Briscoe-Smith, M.B., Ch.B., M.R.C.S.(Eng.). L.R.C.P.(Lond.), D.P.H. (from Is/ November) 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., Ch.B., D.P.H. Public Analyst (Part-time) : T. McLachlan, D.C.M., A.C.G.F.C., F.R.I.C., M.I.Biol., 4, Hanvvay 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) (deceased May) V. A. Bignell (a, b, c) (Senior Inspector) (from July) Food Hygiene and Sampling: Rodent Control: L. Newland (a, b)" J. A. Cummins (a, b) Drainage: Care of Old People and Rehousing:* J. R. Baily (a, b) Miss M. M. Sharp, M.B.E. (a, d, e, f) J. E. Broadhead (a) District: Smoke Control : D. B. Hooper (a) L. Pearson (a, b, c) P. W. Jolly (a, b) Restaurants : J. E. Jones (a, b) (from February) Mrs. M. I. Tiplady (a, b, d, f) S. W. Wright (a, b) (from April) *Miss B. Wilson (a, b, d, e, f) Outdoor Superintendent : R. G. Turner Streets Nuisance Inspector : D. Telford Student Public Health Inspector : †R. C. Morton 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 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: £5,761,849. Sum represented by a penny rate: £22,500. Residential units (separate assessments): 24,301. 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-1957—72,530. Registrar General's estimate of the child population: mid-1957—under 1 year: 790; 1-4 years inclusive: 2,550; 5-14 years inclusive: 5,560. Total child population: 8,900 (approximately 12 per cent, of total population). It is estimated that approximately 68 per cent. of the Borough's population are aged between 15 and 65 years, and approximately 20 per cent. are over 65 years of age. EXTRACTS FROM VITAL STATISTICS Total M. F. Live Births—Legitimate 733 382 351 Birth-Rate per 1,000 estimated Illegitimate 66 36 30 home population 11.02 Stillbirths—Legitimate 13 9 4 Rate per 1,000 total (live and still) Illegitimate 2 — 2 births 18.77 Deaths (all ages) 1,121 593 528 Death-Rate per 1,000 estimated home population 15.46 Maternal Mortality—Deaths from "Pregnancy, Childbirth, Abortion" Nil (Registrar General's Code No. 30) Total M. F. Deaths of Infants under one year of age—Legitimate 21 10 11 Illegitimate 4 4 — Death-Rate of Infants under one year of age—All infants per 1,000 live births, 31.29; legitimate infants per 1,000 legitimate live births, 28.65; illegitimate infants per 1,000 illegitimate live births, 60.61. Area comparability factors: Births, 0.78; Deaths, 0.74 Marriages. The following table shows the number of marriages in St. Marylebone each year since the 1st January, 1947:— Year No. of Marriages Year No. of Marriages 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 1957 1,250 1952 1,358 The 1957 figure is 7 below that for 1956 and 167 below the average (1,417) for the previous ten years. The marriage rate in 1957 was 34.47 per 1,000 of the estimated home population. Deaths. The total number of deaths (1,121) shown in Table 1, 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 and 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 H.M. Forces who were stationed in the area. 6 Deaths in 1957 were 16 less than in 1956. The principal causes were diseases of the heart and circulatory system, which accounted for 41 per cent. of the total deaths; malignant diseases 17 per cent.; and respiratory diseases, including tuberculosis, 11.5 per cent. Deaths from lung cancer fell from 49 to 34 as compared with the previous year. Seventy-two per cent. of the deaths registered were of persons aged over 65 and twenty-one per cent. were aged between 45 and 65 years. Infant Mortality. Twenty-five infants died under 1 year of age (21 legitimate, 4 illegitimate), as compared with twelve last year (all legitimate), giving a death rate of 31.29 per 1,000 live births, as against 15.04 per 1,000 last year. Details showing causes of death according to age group and sex are given in Table 2, page 30. Although these figures are the highest since 1954, when they were 27 and 31.50 respectively, no special significance can be attached to the apparent large increase in 1957. Fluctuations of this kind are almost inevitable where comparatively small groups of population are involved and, as another example, it will be noticed from Table 1, page 30, that local deaths at all ages from lung cancer fell during the year from 49 to 34 despite the fact that the figures for England and Wales increased by more than 5 per cent. in 1957, thus underlining the general upward trend of deaths from this cause. Only by comparison of the average figures over several years can a true picture be gained. The average infant mortality rates for the five-year periods 1948-1952 and 1953-1957, in St. Marylebone, were respectively 24.06 and 22.76 per 1,000 live births. Maternal Mortality. For the fourth successive year there were no maternal deaths. Accidental Deaths. During the year, 21 residents died from accidents of all kinds, a decrease of 13 on the previous year. Of these, 6 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 an increase on the previous year (720), there having been 749 accidents in the Borough, resulting in 6 deaths, 111 serious injuries and 801 slight injuries. Weather. The following summary of the weather during the year and Table 3, page 31, are based upon information supplied by the Meteorological Office:— January.—Mild by day and night. Air temperatures fell to 32 degrees only once during the month. Less rainfall than average. Sunshine exceeded the normal quota by about 30 per cent. Winds were frequently strong. February.—Mildest February at Kew Observatory since 1946. London received more than twice its normal quota of rainfall. Sunshine, however, was above average. March.—Not quite as sunny as normal, but mildest March on record in London. Rainfall about 40 per cent. less than normal. Gales occurred on 20th. April.—Very dry and only 9 millimetres of rain was recorded. This is 24 per cent. of the normal rainfall for April. Colder than March, but temperatures were a little above average. Sunshine was 20 per cent. more than usual. Strong north-easterly winds during last week. May.—Sunshine a little above average, but mean monthly temperature 2 degrees below normal. Rainfall deficient by about 40 per cent. Strong north-easterly winds on 24th and 25th. June.—Sunniest June at Kew for more than 75 years. A total of 291 hours of sunshine passed the previous extreme of 277 hours in 1940. Temperature did not fall below 70 degrees on Air Ministry roof on night of 28th/29th, and the following day temperature reached 95 degrees at Northolt and 96 degrees at Camden Square, the latter being the highest temperature recorded during June in the British Isles since 1858. There was half the normal quota of rainfall. July.—Cloudy and wet with 90 per cent. of normal sunshine and 50 per cent. more rain than normal. Nights fairly warm, but mean day temperatures a little below normal. Thunder on 7 days. 7 August.—Although temperatures reached 80 degrees on 1st and the first few days were sunny and warm, the rest of the month was cool, cloudy and wet. Rainfall exceeded normal by 76 per cent. Day temperatures were 2.5 degrees below average and there was 10 per cent. less sunshine than normal. Gales on 25th with gusts to 42 m.p.h. at Croydon. September.—Rainfall above average by 28 per cent. Sunshine deficient by a quarter of normal monthly quota. October.—Only 68 per cent. of normal rainfall. Average sunshine. Quiet, dry first half of month. Changeable in second half with gales on 17th. November.—Most of rain fell in first 5 days, and monthly rainfall total was about average. Stormy weather at beginning of month brought gales with gusts of 70 m.p.h. at Croydon on 4th. A little more sunshine than average. No fog. Temperatures about average. December.—In spite of some hard frosts (with persistent fogs) in the first week of the month, and some heavy rainfalls (nearly an inch at Kew in 24 hours 12th-13th) during the stormy week of 7th-13th, London had temperatures at little above average by day and a little below by night, approximately 25 per cent. less than normal December rain, and 25 per cent. more than normal sunshine. Public Holiday Weather. Easter. (19th to 22nd April) Fine, sunny and warm, but becoming cloudier on Sunday with some rain, and on Monday cloudy and cooler with outbreaks of light rain. Whitsun. (8th to 10th June) Fine, sunny and rather warm on Saturday becoming cloudy with rain by Sunday evening, and this persisting through much of Monday, though it became brighter and dry on Monday evening. August. (3rd to 5th August) Dry, sunny and warm, averaging 8.4 hours sunshine daily, with temperatures reaching the upper 70s. Christmas. (24th to 27th December) Mostly dry, bright and mild—a good deal of cloud but sunny intervals and temperatures in the upper 40s by day and lower 40s or upper 30s by night : only a little light rain or drizzle at times. 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. Alderman Capt. R. G. Whitney, M.B.E., J.P. London County Council Divisional Health Com- Councillor Dr. Elizabeth Jacobs. mittee (Division 2). Councillor S/Ldr. S. Stanley. London County Council Divisional Tuberculosis Miss L. West Russell. Care Committee (Division 2). The Medical Officer of Health. St. Marylebone Tuberculosis Care Committee. Councillor L. M. Laurance. The Medical Officer of Health. Paddington Hospital Group House Committee, No. 4. Miss L. West Russell. Paddington Hospital Group House Committee, No. 5. Councillor Mrs. S. Rivington. National Smoke Abatement Society. The Chairman of the Public Health Committee. The Medical Officer of Health. Paddington and St. Marylebone District Nursing Councillor Mrs. S. Rivington. Association—Executive Committee. St. Marylebone Youth Centre Committee—Manage- Councillor Mrs. S. Rivington. ment Committee. Councillor The Hon. Mildred Lowther, O.B.E. St. Marylebone Clean Food Association—Executive Councillor H. C. Garrard. Committee. Councillor Miss F. E. Wilson. Department of Scientific and Industrial Research— The Chairman of the Public Health Committee. Standing Conference of Co-operating Bodies The Medical Officer of Health, dealing with Atmospheric Pollution, 8 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 Society of Health—Folkestone, 30th April to Alderman Capt. R. G. Whitney, J.P. 3rd May. Association of Public Health Inspectors—East- Mr. V. A. Bignell, Senior Public Health bourne, 17th to 20th September. Inspector. National Smoke Abatement Society—Hastings, 2nd Councillor Dr. H. K. Ashworth, T.D. to 4th October. The Medical Officer of Health. Central Consultative Committee on the Welfare of Councillor Miss F. E. Wilson and Old People—London, 5th April. Miss M. M. Sharp, M.B.E., Public Health Inspector. 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 1957, as indicated below :— Organisation Amount Statutory Authority £ s. d. Central Council for Health Education 1111 0 Public Health (London) Act, 1936, section 298. Family Welfare Association (Area 2) 100 0 0 Local Government Act, 1948, section 136. St. Marylebone Youth Committee 75 0 0 do. St. Marylebone Boy Scouts' Local Association 50 0 0 do. 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. 775 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 669 old people during the year. Although included in this figure were 57 married couples, most of these old people lived alone and many required constant observation. The St. Marylebone Old People's Welfare Association, acting voluntarily and in close co-operation with the department, continued to give invaluable service to the elderly. Some of the more important activities are mentioned in the extract from their Annual Report reproduced below. The London County Council's domestic help service and Department for the Handicapped, together with the District Nurses, likewise were of great assistance. Special Laundry Service.—Under the scheme started in 1950 for laundering bed linen and clothing of acutely ill and incontinent or very dirty and verminous old people, forty-one cases were dealt with. Thirty-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. Bathing.—Under the provisions of section 43 of the London County Council (General Powers) Act, 1953, sanitary authorities are empowered to make arrangements for bathing old people at their own request or with their consent. During the year, 355 baths were given to women and 175 to men under the scheme started in 1954 for bathing old persons at the Lisson Grove Centre. The total number of baths (530) is the highest so far and indicates the popularity of the scheme. A trained nurse is employed part-time, under the general direction of a woman public health inspector, to supervise the bathing and accompany the old people on their journeys between their homes and the Centre, 9 St. Marylebone Old People's Welfare Association. The Executive Committee of the Association (Chairman—Mrs. L. Fewster; Hon. Secretary—Miss M. K. C. Macintosh, Room 103, Town Hall, St. Marylebone, W.1) has kindly provided the following information, which has been extracted from the Association's Annual Report, on work carried out during 1957:— "One of the happiest features of our work is the close link which exists in the Borough between the statutory authorities and the voluntary workers. Our contacts ' at officer level' with the National Assistance Board, the Home Helps Service and the Public Health Department of the Borough Council could not be closer or more cordial. We have had three gratifying instances of this. The Area Officer of the National Assistance Board has visited all our Darby and Joan Clubs, and his informal talks on the work of the Board have done much to dispel some of the reluctance to apply even for much-needed help which still lingers from the old Poor Law days. He also gave up an evening to attend a meeting of the Visitors for Old People connected with All Souls', Langham Place, which have a very active group. His talk was enjoyed immensely. In the autumn we helped the L.C.C. in their 'Safety in the Home' campaign, and they in turn helped us with one of our most urgent problems, namely, giving us more facilities for our foot clinic service. This service had such a large waiting list that the list had to be closed for three months. Then in October the L.C.C. offered places, as vacancies occurred, at the Foot Clinic at the Maternity and Child Welfare Clinic, Lisson Grove, to Old People on our waiting list who had been visited by one of the L.C.C. Health Visitors. By the end of the year, the list had been reduced from 39 to 19 awaiting treatment, some of whom we have been able to admit since. Public Library Service.—With the kind co-operation of the Borough Librarian, a service for the delivery of books to the house-bound has been instituted, with the help of the Home Helps Service. Over 20 Old People are now being helped in this way. Our own direct contacts with Old People are through the eight Darby and Joan Clubs, the two Jewish Friendship Clubs, the Home Chiropody Service, the Luncheon Club, the Foot Clinic, the ' Meals on Wheels' service and the Assisted Holidays. To these should be added about 200 Old People who are house-bound visited by our own Visiting Service and the three Church Groups who work in conjunction with us. We can, if need be, reach many more through the Home Helps and the National Assistance Board, and the Borough Council's Home Bathing Service. There is also a constantly increasing number of those we know through their requests for invitations to treats. Entertainments.—There have been three special occasions this year. In June 100 Old People from St. Marylebone were invited to the special Evensong at St. Paul's Cathedral, organised by the Finsbury Old People's Welfare Committee. Over 2,000 Old People were there, and it was a most moving and impressive occasion. In July there were again two special Old People's Days at Lord's by the very kind permission of the M.C.C. The highlight of the year, however, was a truly wonderful Christmas Party given at the Seymour Hall by Mrs. Lew Grade, who invited 200 Old People from Paddington, 50 from Westminster, and 550 from St. Marylebone. We were delighted to be able to help by collecting the guests and providing stewards. Mrs. Lew Grade herself arranged what one of the guests described as 'a real Buckingham Palace tea' and a variety entertainment which culminated in the personal appearance of no less an artiste than Miss Gracie Fields. The numbers of Old People helped by our various grant-aided services are given below. The contribution which we, as an Association, believe we can make to the happiness of our Old People is based on the steady ' continuance in well-doing' of all our members. Very little of what we do is difficult, but it still needs time regularly given, patience, and a sense of humour, allied to deep compassion and sympathy. St. Marylebone is fortunate in having so many people willing to give that time, and if the Association helps by providing them with a forum and a focus, its Officers are well content. The Services Meals on Wheels.—During the year, 6,216 meals were delivered, including the special 'Frood' Christmas Dinners so kindly paid for by our President, the Mayor, and taken round by the W.V.S. on Christmas Eve. A new set of insulated containers for the dishes was bought with the help of an anonymous donation. This service lost a valuable helper through the death of Mr. Charles 10 Hepper, the driver of our van, seconded for this work by the Public Health Department. Mr. Hepper had driven our van for many years, and had become warmly interested in the Old People with whom he came in contact. The W. V.S. Luncheon Club.—This club has flourished and expanded in the new premises for which the Association pays the rent. The number of lunches served in the year was 7,514. The Foot Clinic.—The number of treatments given during the year was 2,602. This figure included 72 new patients. The Clinic, besides being of first-class professional standard, has become a centre of lively friendship, and we owe a debt of gratitude to our Chiropodists, and also to the members of the British Red Cross Society, St. Marylebone Division, who do so much to make this service operate so efficiently and happily. Home Chiropody.—During the year 280 visits were made, including 241 to women and 39 to men. These numbers include 14 new patients. Only two were treated at a reduced fee. All the others paid the 2s. we ask, and several patients paid more voluntarily. By the end of the year the waiting list had become so long that the Association arranged for an extra half-day (in addition to the four full days) in each month, to begin in January; 1958. We would like to thank one of the members of the Red Cross who drives our Chiropodists three times each month, only asking for the cost of the petrol. Holidays.—We sent 62 Old People to Brighton for a week in May in two organised parties. With the help of a contribution of £20 from our funds, the Fourth Feathers Darby and Joan Club sent 35 of its members to Margate for a week. The Barrow Hill Club sent 4 of their members with our parties (and helped them to pay their share of the cost) and sent a further 16 to Broadstairs. In addition, the Association arranged individual holidays for 11 Old People, and secured holidays for one blind person and one deaf and dumb through the appropriate agencies. The Mayor kindly gave £5 from his charitable funds towards the cost of the old lady who is deaf and dumb, as our grant of £250 was exhausted by that time, as were our own voluntary funds. Emergency Fuel.—Only 11 deliveries were made during the comparatively mild 1957 winter, but we had the pleasure of making gifts of coal from the last instalment of the Rotary Club's donation. Early in 1958 the Association were given a further £15 for the same purpose, part of which is being kept in reserve for next winter. Wireless for the Bedridden.—During the year 9 new sets were obtained from the Wireless for the Bedridden Society. The total number now regularly inspected on our behalf by Miss Sharp is 33. This is just one of the innumerable small acts of kindness Miss Sharp adds to her official services to the Old People of the Borough, and their debt to her, and also ours, is incalculable. The Clubs.—There has been an addition to the number of our affiliated Darby and Joan Clubs this year. The W.V.S. have opened a Recreation Centre at their headquarters in St. John's Wood Terrace, which is open two afternoons a week. Most of its members belong to other clubs as well, but it has enlisted several new helpers, and thus increased the number of personal contacts which are the foundation of all our work. All the clubs had summer outings and Christmas parties, and jumble sales to raise the necessary funds. Home Visiting.—During the year we were saddened by the death of one of our veteran visitors, Miss Berryman, and also by the serious illness of Captain Ticehurst, of the Church Army. Captain Ticehurst is now out of hospital, but has retired to live in the country. Also we have lost Miss Loughborough, who has retired to the country, after so many years of active life in this Borough. New recruits have joined us, however, namely, more visitors from All Souls' and St. Peter's, Langham Place, the Hinde Street Methodist Church, the Good Samaritan Group of the City Temple, and a group organised by the Central Office of Information. All these organisations work closely with our Association, but as the Central Office of Information will be soon leaving St. Marylebone, we should welcome more recruits for regular visiting of the house-bound Old People in this Borough. Finance.—As our own voluntary funds are almost exhausted the Association will be making an appeal in 1958. We need about £150 per annum in addition to the Borough Council's Grant, and our last appeal was in 1952," 11 Diseased or Infirm Persons—Compulsory Removal. 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. 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 1957, eighty-five examinations of members of the staff and new entrants were carried out. New Legislation. A list of the new Acts, Regulations and Orders, relating to the work of the Department, is given in Table 5, page 32. SECTION C.—SANITARY CIRCUMSTANCES Sanitary Inspection. The Borough is divided into four areas each of which is dealt with by a district public health inspector. Inspsction of dwelling-houses is dealt with on page 18 and in Table 13, page 35. Excluding rat and mouse infestations, 1,019 complaints were received and details of the 675 various nuisances detected and remedied are shown in Table 6, page 32. Notices.—Intimation notices numbered 301, and 94 of these were followed by the service of a statutory notice to secure abatement of nuisances. In addition, thirty-four notices were served under Byelaws made under the Metropolis Management or Public Health Acts. Legal Proceedings. No legal proceedings under the provisions of the Public Health (London) Act, 1936, were necessary. Noise. Thirty-six complaints of noise, involving twenty-eight alleged nuisances, were received. During the year extensive engineering works and operations on demolition and building sites were being undertaken in the Borough and most of the complaints were of noise coming from these, particularly late at night and during weekends. Large-scale works of this kind inevitably give rise to some noise but in general the building contractors and others involved were co-operative in their attempts to limit the amount of noisy work at night and weekends and to reduce nuisance to a minimum. The remaining complaints concerned a wide variety of supposed causes, including radio and speech amplifiers, loading and handling of milk bottle crates, noise from factories and workshops, motor vehicles, steam trains, a public house, an air compressor and an extractor fan. The complaints were not always justified but where, upon investigation, nuisances were found to exist these were nearly all abated or reduced after informal action by the 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. For the purpose of abating or mitigating nuisance, annoyance or damage caused by pigeons, Section 121 of the Public Health (London) Act, 1936, empowers the Council to arrange for the seizure or destruction of these birds in excess of such numbers as the Council consider reasonable. Accordingly, a pigeon catcher is authorised to operate under the direction of the Medical Officer of Health, at places in the Borough where nuisance is being caused. During 1957 seventeen complaints of this type of nuisance were investigated but it was only found necessary to refer two cases to the pigeon catcher. 12 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 three instances where water had been cut off in occupied premises, two for non-payment of rates and the other for waste of water. In all cases the supply was reinstated, one after service of a notice under section 26 (1) of the London County Council (General Powers) Act, 1955. This Act provides for the Council to carry out work necessary to secure reinstatement of water supply and recover reasonable expenses from the owner of the property, and this procedure was adopted. Two complaints were received regarding quality of water. On investigation the supply was found to be wholesome but the storage tanks required cleansing and in one case provision of a proper cover. The necessary work was done following service of notices. 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 1957 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. Fifty-two 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 or rebuilt premises, including four buildings comprising 36 flats. Drainage—Alterations and New Buildings. Of the 282 drainage plans approved during the year, 45 were in respect of new buildings. It would seem that the " credit squeeze " had the effect of reducing the amount of smaller building and conversion works undertaken but the erection of new buildings continued unabated. Amongst these was a multi-storage garage for Selfridges Holdings, Ltd., which, it is hoped, when completed will ease the car parking problem in the area. Most of the new buildings are for office accommodation, which seems to be let without any delay, and it has been proposed to erect some of seventeen and twenty stories. Upon request, the Borough Engineer examined 97 sewer connections and 45 of them were found to be defective and had to be renewed. The two drainage inspectors made 3,508 visits and no circumstances were found which necessitated legal proceedings. Combined Drainage. Seven orders under seal were issued in respect of combined drainage operations. Ventilation of Sewers. In the Annual Report for 1953, reference was made to the working party of representatives of the London County Council and the Metropolitan Boroughs' Standing Joint Committee, who were investigating the causes of complaints of offensive smells from sewers and means of improving conditions. Subsequent reports have mentioned the progress made. During the year now under review the London County Council agreed to erect ventilating shafts on the middle level sewer at St. John's Wood Circle and to fit baffle boards in branch sewers serving Wellington Road and St. John's Wood High Street. The sewers at all suitable Council properties are now ventilated through gratings in interceptor rodding arms but line ventilation has not been achieved. Town Planning. Observations were made on 85 plans submitted under the Town and Country Planning Act, 1947, and referred to the Department by the Council. Rodent Control. There were 354 notifications of rat infestations received regarding premises in the borough, a reduction of 36 on the previous year (390). The decline has continued from 1953, when the total was 595. Notifications of mouse infestations totalled 275, one more than during the previous year; this figure is also less than that for 1953 when it was 337. During the year, 8 blocks were surveyed and test-baited; 3 rat infestations and 11 mouse infestations, all of a localised and minor character, were discovered and treated. These rat infestations represent 0.7 per cent. of the premises concerned in 13 the survey and, like the infestations referred to above, show a decline when compared with 0.95 per cent, in 1953. Sewers throughout the borough were treated both in April and October on an extended baiting system which involves treatment over a period of eight days at each baiting point. In April the records of pre-bait take by rats showed an increase by comparison with the former method of a 3 day treatment period. In October, the new system was repeated and an improved pre-bait take was again recorded. As a result of rat infestations 69 underground drains were examined and it was necessary to serve 33 notices requiring remedy of the various defects found. It is gratifying to report that, with the exception of one case requiring the service of a statutory notice, the defects were remedied without formal action being taken. Occupiers and owners of premises visited by the Rodent Control Officer were co-operative in acting upon suggestions made to them and it was unnecessary to serve any notices under the Pests Act. A summary of infestations and treatments given is shown in Table 8, page 34. Disinfestation. To rid dwelling houses of bugs, a spray of Kerosene with 5 per cent. D.D.T. andO.l percent, pyrethrins 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, 307 rooms were disinfested, including twenty requisitioned premises. Altogether 55 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 1957 the furniture of 43 families, of whom 37 were being rehoused, was treated by this method. In addition 924 verminous articles of bedding were disinfested by steam. For many years the Council have maintained a large Manlove Alliott steam disinfecting chamber, capable of taking articles up to the size of a double mattress, at their premises in Lisson Grove. Steam for this purpose was supplied by the electricity generating station adjoining the premises but in August, 1956, the Central Electricity Authority gave notice terminating their agreement with the Council to supply steam from a date early in 1957. Possible alternative methods of generating steam were considered but in view of the heavy capital expenditure involved and comparatively high maintenance costs it was decided to discontinue operating the large Manlove Alliott installation and use only a small steam disinfector situated in the cleansing of persons section of Welfare Centre No. 2 for the treatment of all articles up to the size of a single mattress. At the same time arrangements were made with the Council of the Royal Borough of Kensington for articles above this size to be steam treated in their plant at Shepherd's Bush. The number of large articles which have to be dealt with is comparatively small and the arrangement has worked most satisfactorily. Verminous Persons. The Council's Cleansing Station in Lisson Grove dealt with 817 verminous persons : adults 560 (men 504, women 56); children 257 (boys 33, girls 224). 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. In February a public health inspector was seconded specially for the purpose of establishing smoke control areas under the Clean Air Act, 1956, some provisions of which came into force on 31st December, 1956. After the completion of a detailed survey of St. John's Wood Terrace Ward (Ward 3) by temporary assistants, an estimate of the cost of implementing a Smoke Control Order was prepared. On 4th July the Council declared, subject to confirmation by the Minister of Housing and Local Government, the whole of the Ward to be a smoke control area from the 1st October, 1958. In November a survey of Lord's Ward (Ward 2) was commenced with a view to establishing a second smoke control area. Public interest in Clean Air led to an increase in the number of complaints received. These totalled one hundred and twenty-two and appropriate action was taken whenever reasonable grounds for a complaint could be established. Some complaints related to the chimneys of private dwellings and 14 arose from circumstances tolerated without question in the past. Although it may be difficult to establish that the smoke from dwellings is a nuisance in law there are often justifiable grounds for complaint, especially in cases where the chimneys of low-built dwellings terminate at the same or a lower level than the windows of adjoining premises. In consequence of complaints about smoke emission from two electricity stations in the Borough and from steam locomotives standing in or on the approaches to Marylebone Railway Station special attention was given to these sources of pollution. Although there is no doubt that smoke from the electricity stations and from railway locomotives makes a considerable contribution towards the pollution of the air of the Borough, no evidence was found to show that there is a large degree of carelessness by the employees of the National Electricity Board or of British Railways. One of the electricity stations now operates only as a "peak load station" with a reducing output. It closes down during the summer months. The railway authorities willingly co-operated to prevent isolated offences by locomotive firemen. The measurement of local air pollution has continued at five sites in close co-operation with the Department of Scientific and Industrial Research. The readings for 1957 are given in Table 7, page 33. Factories. There were 1,898 factories on the register at the end of the year, 104 more than last year. A report on the administration by the Department of matters under Parts I and VIII of the Factories Act, 1937, is given in Tables 9 and 10, page 34. Outworkers. Seventy-five employers submitted lists in respect of a total of 706 outworkers (183 contractors and 523 workpeople). Of these, twenty-four contractors and twenty-eight workpeople operated in the Borough. The nature of the different classes of work and the numbers of outworkers engaged is indicated in Table 11, page 35. Fireguards. Inspection continued under the provisions of the Heating Appliances (Fireguards) Acts, 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. There are in the Borough 122 registered hairdressers and barbers and 55 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, twelve 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 eighty-five 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 12, page 35. Protective Helmets. The Motor Cycles (Protective Helmets) Regulations, 1957, came into operation on the 1st April, 1957. It is now an offence for any person to sell or hire or offer to sell or hire any helmet as a helmet affording protection to motor cyclists, in the event of an accident, which is neither of a type prescribed 15 nor of a type authorised under Regulations made by the Minister of Transport and Civil Aviation as being a helmet recommended as affording such protection. These Regulations prescribe the types of helmet which may be sold or hired to motor cyclists as helmets which are recommended as affording protection in the event of accident. Visits were made to five premises in the Borough where these helmets are sold, and stocks were inspected. In one instance helmets were found which did not comply with the British Standard Specifications but they were not being sold or displayed for sale. It seems that an overseas market was being sought and the attention of the Ministry was drawn to the matter. 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 fining 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 ninth year at all public conveniences where wash basins are provided, the free washing scheme, with paper towels and liquid soap, is maintaining its popularity with the general public. Public Cleansing and Salvage. The Director of Public Cleansing has kindly provided the following information:— "The following materials were dealt with during 1957: house and trade refuse, 34,717 tons, street sweepings and gully slop, 2,334 tons, salvaged materials 2,103 tons. The sum of £11,480 was obtained from the sale of salvaged materials. In addition, £1,415 was received for the removal of trade refuse and for the cleansing of petrol interceptors, etc. The Council, in common with other local authorities, were again required to restrict deliveries of wastepaper and cardboard to the mills, owing to the supply position, which resulted in reduced revenue from this source. A minimum twice-weekly refuse collection was maintained throughout the Borough, and in many cases a thrice-weekly service was provided. All street gullies were mechanically cleansed at least six times during the year, and the streets were swept at least once daily. Orders were placed for a fleet of eleven new diesel-powered tractors and ten trailer bodies for the refuse collection service, and most of these had been put into commission by the end of the year. A further diesel-powered refuse container vehicle of improved type was also purchased for the removal of portable containers from the increasing number of blocks of flats and offices being erected in St. Marylebone. A machine designed by the Department for spreading salt and grit on footways, etc., when snow or icy conditions are experienced, has been manufactured and successfully marketed by an engineering firm specialising in street cleansing equipment. Six of these machines, named ' The St. Marylebone Master Spreader,' have already been purchased by the Council and have proved most effective, enabling snow to be removed before consolidation, thereby considerably reducing labour and material costs." 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 such burials were arranged during the year. 16 Cremation. 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, 1,798 certificates authorising cremation were issued. Since December, 1937, when the Crematorium was opened, 15,354 cremations have taken place. The number of cremations authorised in 1957 (1,798) almost equals the combined totals (1,813) of those authorised during the eleven years following the opening of the crematorium in 1937. It will be realized, therefore, that the time spent in the Department on this work is ever increasing, as are the problems which daily confront the Medical Referee. The Association of Crematorium Medical Referees, referred to in last year's report, came into being on 1st June, 1957. The objects for which the Association is established are: " (i) To keep under review legislation so far as it applies to Medical Referees appointed pursuant to the Cremation Acts. (ii) To promote and encourage adoption of standard forms and uniform procedure under the provisions of cremation legislation. (iii) To consider matters coming within the purview of Crematorium Medical Referees, especially those newly appointed, and to advise and consult with other interested bodies and with Departments of State." Although the requirements of the Cremation Regulations appear to be clear and definite, their interpretation differs widely among doctors called upon to complete the necessary medical certificates. In an effort to obtain uniformity in the completion of these certificates, notes for the guidance of doctors were printed and attached to the forms. Although a few medical officers in hospitals objected to some of the requirements thus brought to their notice for the first time, on the whole the notes proved to be acceptable and led to the submission of fewer incorrectly completed forms. A special committee of the British Medical Association, on which the Association of Crematorium Medical Referees is to be represented, has been set up at the request of the Home Office to review the whole of the existing arrangements for cremation, in so far as they affect medical practitioners and medical referees, and it is hoped that one outcome of this will be the revising of the present medical certificates to eliminate as far as possible all ambiguities. Mortuary. Two male and two female bodies were received in the Public Mortuary in Chiltern Street. 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 two certificates were issued in respect of bodies being transported to Cyprus 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 Street Nuisance Inspector resulted in twenty-one 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 17 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 1957 the Council took out five summonses and in each case obtained convictions. Fines and costs amounting to £26 6s. 0d. were imposed although this was subsequently decreased as one defendant appealed to Quarter Sessions, where the original fine of £5 was reduced to £1. 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 222 Abbey Road/Boundary Road 54 Hamilton Terrace 52 Queen's Terrace 28 35/55, Boundary Road 48 Wellington Road 121 147/149, Gloucester Place 10 1/7, Aquila Street 6 Abercorn Place 34 Balcombe Street, 22-30 14 Balcombe Street, 17-19 4 1,110 At the close of the year, the following additional permanent accommodation had reached the stage indicated:— No. of Flats 57/73, Boundary Road 36* Twelve dwellings completed. Remainder approaching completion. 147/165, Lisson Grove 12 Half exterior shell completed. Pembroke Terrace 10 Foundation works in progress. 33/35, Townshend Road 8 Foundation works in progress. Aquila Street Extension 23 Site works commenced. Abercorn Place/Violet Hill 22 Plans approved and tenders received. Clearance of site completed. 40/47, Chapel Street 20† Majority of existing dwellings vacated. Plans submitted for approval. Newcourt Street 48 Sketch plans approved. Rehousing of present residents commenced. * Maisonettes. † With offices on ground floor. 18 Slum Clearance. The position at the close of the year in regard to the Council's slum clearance programme was as follows:— Cochrane Street, 9/11 Site scheduled for redevelopment with adjacent lands incorporated. Compulsory Purchase Order made. Public Inquiry held. Confirmation of Order awaited. Broadley/Penfold Street Site scheduled for redevelopment with additional lands Ashbridge Street (East) incorporated. A number of purchases have been made by Freshwater Place and Homer Row voluntary arrangement. Negotiations for remainder in progress. Mulready Street area Site inspections proceeding. Two premises purchased by voluntary negotiations. Wells Buildings Burne Street Clearance areas declared. Cato Street Abbey Gardens Mews Representations by Medical Officer of Health planned for Rathbone Street January, 1958. Thirteen further unfit dwellings included in the programme have been closed or demolished. Factory-made Bungalows. A further 8 factory-made bungalows were released during the year, leaving twenty-four families still in this type of accommodation. Requisitioned Premises. The Council provisionally approved a programme for securing the release of requisitioned premises in the Borough by exchanging their present interest for freehold or leasehold interests or, in some cases, by transferring the premises to the owners with the present occupiers remaining as private tenants. During the year, 24 premises and families were transferred to the owners, making a total over the years 1957/58 of 139 transferred premises. Negotiations are in progress for the purchase or lease of a substantial number of premises so as to comply with the provisions of the Requisitioned Houses and Housing (Amendment) Act, 1955, which terminates the Council's powers to retain requisitioned premises on the 31st March, 1960. The total number of requisitioned units held by the Council at the end of the year was 655. 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 13, page 35. Certificates of Disrepair. The Rent Act, 1957, came into operation on the 6th July. It provides for a tenant of a controlled tenancy to apply for a certificate of disrepair where a landlord has not remedied, or undertaken to remedy, defects specified in a notice served on him by the tenant. The procedure for issuing and cancelling certificates, although similar to that for the Housing Repairs and Rents Act, 1954, requires a local authority to send a landlord notice of a proposal to issue a certificate, and to notify the tenant of a proposal to cancel a certificate. In addition the local authority can accept a landlord's undertaking to remedy defects. Applications for the issue or cancellation of certificates were dealt with by the Town Clerk and referred to the Medical Officer of Health for attention. A public health inspector visited each of the premises concerned and on his report the Medical Officer of Health was able to recommend appropriate action. There were 31 applications for certificates and in 28 cases it was proposed to issue them. In fact, 9 certificates were issued and 19 undertakings accepted from landlords. There was one application by a landlord for cancellation of a certificate. During the earlier part of the year one application for a certificate of disrepair under the Housing Repairs and Rents Act was received, but the Medical Officer of Health was unable to recommend its issue. 19 Re-housing—Medical Certificates—Closing Orders. The Medical Officer of Health receives requests from 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 137; of these, 17 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 120 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 32 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. Housing Act, 1949—Improvements and Conversions. Two applications for improvement or conversion grants were referred to the Department for examination and report. Land Charges Act, 1925. The Town Clerk referred 1,305 enquiries to the Department requiring details of any outstanding notices, orders or other restrictions on the properties concerned. Immigrants. The south-east portion of the Borough is contiguous with Soho and, as might be expected, contains a cosmopolitan population. Immigrants from Cyprus and European countries predominate. So far, unlike neighbouring boroughs, St. Marylebone has had comparatively 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. The Public Analyst (Mr. Thomas McLachlan, D.C.M., 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 1957, 429 samples of food and drugs were examined. Of these, 94 were taken formally and 335 informally. The number adulterated or incorrect in some other manner was 55. The incidence of adulteration may be classified as follows :— Number of samples Number of samples examined adulterated Milk 98 2 Other foods 314 52 Drugs 17 1 Two samples of milk were reported as adulterated. One contained only 5.77 per cent. of solids not fat and therefore not less than 32 per cent. of added water, the freezing point —0.317 degrees C. indicating the presence of 38.3 per cent. of added water. The other contained 7.27 per cent. of solids not fat, and therefore not less than 14 per cent. of added water, the freezing point —0.438 degrees C. indicating 14 per cent. of added water. A complaint was received about an unopened bottle of milk. Whilst the bottle was dirty it had been sterilised and nothing was found which would have affected the composition of the milk. The bottle had passed through the washing plant, but the dirt adhering to the glass had not been removed nor had the bottle been rejected on inspection. 20 A milk bottle contained a toy dog and, owing to the clean condition of the toy and the absence of any curdled milk adhering to it, your analyst thought that the toy was probably present when the bottle was washed and filled, though it was impossible to be certain. A sample of national dried milk was reported as inferior because it contained a number of specks of slightly caramelised milk. Two milk shake powders were incorrectly labelled. The samples should not have been described as 'Pineapple' and 'Banana' respectively but as 'Pineapple Flavour' and 'Banana Flavour.' The list of ingredients was also slightly incorrect, and as a result of representations the manufacturers amended their labels. A sample of butter, which had been specially prepared for another country where it is permissible to add boric acid as a preservative, contained .25 per cent. of boric acid. It could not be sold in England. Two samples of margarine were reported as adulterated because of a rancid and cardboard taste on the outer surface. They gave slightly positive tests for rancidity by the Kreis test. Two other samples were reported as inferior as they showed tests for rancidity by Lea's peroxide test of 9.2 and 9.4 per cent. respectively. A sample of lard contained 0.5 per cent. of water and possessed an odour and taste of decomposing protein. Lard must not contain more than 0.1 per cent. of water and should preferably contain none. It should also be entirely free from meat extractives. It had been improperly refined and was unfit for use. A sample of canned boneless ham was reported as inferior on account of a discoloured patch in the centre, along the line where the bone had been removed, showing that putrefactive bacteria were developing. Insufficient care had been exercised during boning, and the ham had been improperly pasteurised so that it was unfit for human consumption. Some Irish stew contained only 20 per cent. of meat and was therefore deficient in meat. A can of beef steak with gravy contained only 65 per cent. of meat and was therefore 13 per cent. deficient in meat content, as beef steak with gravy must contain not less than 75 per cent. of meat. A sample of pork luncheon meat contained only 73 per cent. of meat and was therefore 19 per cent. deficient in meat. Some pork sausages contained 60 per cent. of total meat and were therefore 7.5 per cent. deficient in meat content. Pork sausages, in the opinion of your analyst, must contain not less than 65 per cent. of meat. A sample of dressed crab reputed to contain 95 per cent. of crab meat contained 4.25 per cent. of starch and added water, so that it could by no stretch of the imagination be called dressed crab. The crab meat in six cans of natural crab was discoloured and possessed a most unpleasant flavour. The iron content of the meat varied from 100 to 150 parts per million, whereas in normal dressed crab it is only 20 parts per million. The discolouration was therefore due to iron but as the top seams of the cans were faulty it was impossible to state whether the whole of this iron had been derived from the seams or partly from some other source. Some chicken cutlets contained only 21 per cent. of meat, and were considered to be 58 per cent. deficient in meat. Your analyst believes that the public expects to find at least 50 per cent. of chicken in a chicken cutlet. Two samples of nut cutlets contained only negligible quantities of nuts. The manufacturers stated that 40 per cent. of cashew nuts was present, but this amount was thought to be insufficient; there should be at least 80 per cent. Cashew nuts are difficult to identify due to the cotyledons of the cashew nut possessing no characteristic microscopic characters and being full of starch which is similar to wheat and barley starch. Formerly, larger quantities of ground nuts were used in making nut cutlets, but their flavour is inferior to that of cashew nuts. A soup powder, labelled in German and Hebrew only, further failed to comply with the Labelling of Food Order inasmuch as the ingredients did not appear to be given either in German or Hebrew. A sample of canned cat food was submitted for examination because the product was known to be used for human consumption. The food was found to be sterile, and, whilst it is impossible to prevent people eating it if they wish to do so, it would certainly be impossible to ask manufacturers to label the product ' Not for human consumption,' as this would virtually kill the trade amongst those people who think that animal food should be at least as good as that supplied to humans. A sample of effluent from a beef-boiling process was submitted for examination. It was really a sewage effluent which contained an excessive quantity of organic matter and was too strong to be discharged directly into the sewer, 21 Two samples of egg macaroni products made claims for the presence of vitamins without stating what quantities were present. The manufacturers submitted an amended label, which was satisfactory. Some uncooked strudel leaves contained hexamine which is a prohibited preservative. The manufacturers claimed that hexamine was absent but that propionic acid was present. Propionic acid is also a prohibited preservative within the meaning of the Preservatives Regulations, but its detection is extremely difficult and your analyst is not satisfied that hexamine was absent. A loaf of rye bread contained a cigarette end which had adhered to the bottom of the loaf and had been baked on to the outside of the loaf. A sponge mixture was reported adulterated because it would not make a satisfactory sponge, but this was not surprising as it was war-time manufacture and therefore about 15 years old ; Some chocolate covered honey cakes contained no honey and were incorrectly labelled. A jar of honey was reported as inferior on account of its dark colour. It appeared, however, to be a genuine honey as claimed by the vendor, but the bees must have obtained some of their nectar from a doubtful source. The syrup of a sample of canned yellow cling peaches in rich syrup was found on analysis to contain only 12 per cent. of sugar calculated as sucrose so that the description 'Rich Syrup' was incorrect. Four grades of syrup are recognised for canned fruits, light syrup, syrup, heavy syrup, and extra heavy syrup, and these contain 20 per cent., 30 per cent., 40 per cent. and 50 per cent. of sugar respectively, but the strength of the syrups are reduced somewhat by the fruit juice. A sample of scented orange Pekoe tea, about which a complaint had been received, was examined and found to be flavoured with about ten times the quantity of perfume used for the normal orange flavour. No doubt a mistake had been made in the addition of the perfume and the tea had probably been intended for blending with other tea before being sold. Seeds sold as black sesame were in reality nigella seeds. They were imported into this country from Greece as Glikanisso, the Greek word for aniseed which is the fruit of Anise, as we know it Pimpenella Anisum, and is the flavouring used in aniseed balls, but they were neither aniseeds nor black sesame. A tube of mayonnaise contained 0.4 per cent. of salt which was not declared on the label. As salt is not a spice within the meaning of the Labelling of Food Regulations its presence must be disclosed. A sample of whisky was only 55.6 per cent. proof and therefore contained at least 14.5 per cent. of excess water. The Food and Drugs Act requires spirits to contain not less than 65 per cent. proof spirit. Some buttered popcorns were flavoured with a quantity of coumarin which was objectionable, although when used in traces this helps to create the impression of the presence of butter. The use of coumarin as a flavouring is not prohibited in this country, but in the United States of America, where it is held to be toxic, its use is prohibited. Some sweets were examined at the request of a doctor because a child's urine possessed a fluourescent appearance. The child concerned had eaten some of the sweets and these were found to contain a red fluorescent dye, Rhodamine B. It was therefore probable that the confectionery was responsible for the fluorescent appearance of the urine. A sample of full dairy cream milk chocolate was reported adulterated. The flavour was more or less satisfactory but the fat appeared to consist almost entirely of palm kernel or coconut oil, probably hardened, and only a small quantity of cocoa butter and milk fat. Dairy cream milk chocolate must be made with cocoa butter and milk fat. Three samples of milk chocolate coated biscuits were incorrectly labelled as ' Milk Chocolate.' The manufacturers agreed to amend the label but further samples received still bore the old label. Some bread rolls with ham, and a piece of ham from the same premises, contained maggots and live larvae of the common bluebottle, and were unfit for sale. A breakfast cereal contained 8 beetles, some alive and some dead, and was unfit for consumption. A sample of mixed dried fruit, which was reported as adulterated, contained two maggots. A sample of stoned cleaned raisins weighing 83 grammes, equivalent to 3 ozs., contained 14 pieces of stalk and 24 stones. The raisins as such were not dirty, but so many pieces of stalk should not be present and the number of stones was rather high. The sample was reported as inferior. The label on some garlic pearles was considered to be misleading owing to the extravagant claims made for the small quantity of garlic oil present. The disclosure of the ingredients present also contravened the requirements of the Pharmacy and Medicines Act, 22 A milk slimming diet powder was incorrectly labelled according to both the Labelling of Food Order and the Pharmacy and Medicines Act, 1941. It failed to disclose its ingredients properly and claimed in advertisements that it contained no drugs, but it consisted chiefly of magnesium carbonate and tartaric acid. A sample of cider vinegar was otherwise satisfactory but the label of this product also claimed that it would promote slimming. The manufacturers stated that they had amended the label and that the new labels had been in use for two months. Food Legislation and Official Reports. The amount of new legislation and the number of official reports issued has again shown a decrease during the year. The Public Analysts Regulations have been re-issued in order to provide a new form of certificate to meet conditions resulting from the Food and Drugs Act, 1955. With the new Act it may be necessary for a public analyst if he is unable to carry out the whole of the work required to pass a sample to the public analyst for some other area for examination. This revised certificate provides at the same time for those cases where adverse comment may be made on a label, advertisement, or other matter, which may or may not be dependent on chemical analysis, but on which the public analyst is the most competent authority. The Colouring Matter in Food Regulations came into force in 1957 and revoked that part of the Preservatives, etc., in Food Regulations relating to the addition of colours to foods. Although the regulations came into force on the 30th June, 1957, they do not come into effective operation in the current year as regards sale of food by retail. This was essential if a smooth flow from the manufacturer of food colours to the retail sale of foods was to be obtained. The order therefore stipulated that the manufacturer of food colours or compounds for colouring and flavouring must comply with the order by the 30th September, 1957, whereas in general it may be stated that food sold by retail must comply with the requirements of the order by the 30th June, 1958. For over thirty years the Preservatives, etc., in Food Regulations have provided a short list of colours, whose addition to food was forbidden. Many colours have been found to be suspect of causing cancer and the new order permits the use of thirty organic chemical dyes together with a few more or less natural ones, which have been used over many years. It is hardly necessary to state that this order imposes much more work on the analyst for its efficient administration. The Pre-Packed Foods (Weights and Measures: Marking) Regulations were made under Sections 6 and 123 of the Food and Drugs Act, and are administered by Weights and Measures Authorities only and not by other Food Authorities. When there is a matter of the content of a particular food, mixed with other ingredients, one would have thought it better to handle the matter via the food inspector and the public analyst. Your analyst had submitted to him a tin marked to contain a definite weight of smoked salmon, but in which more oil (undeclared) was present than salmon, the declared weight being that of the total contents of the tin. While this matter can be handled in other ways one would have thought that this order would have been the simplest one. The Food Standards Committee issued a Report on a Standard for Ice-cream. Essentially this report proposes to maintain the present standards for ice-cream with the prohibition of the use of saccharin and other artificial sweeteners, except in the case of ice-cream made for diabetics, which could be suitably labelled. The Committee recommend, however, that provision should be made for 'dairy ice-cream,' of which the fat should be entirely milk fat, and 'milk ice' made on the basis of the old fashioned hokey-pokey, which is essentially a custard-type ice with a milk fat content of not less than 2.5 per cent. The Food Standards Committee also issued a revised Report on Fluorine. The previous report was issued in 1947 following the discovery of very large quantities of fluorine in phosphates used in baking powders resulting from the emergency conditions caused by the war. These circumstances have now disappeared and it is proposed to restrict drastically the quantities of fluorine permitted in acidic phosphates used for foods, in baking powders, and in flour products containing such phosphates. There is, however, a considerable delay between the issue of Reports by the Foods Standards Committee and ensuing legislation. Thus the following Reports have appeared:— Report on Antioxidants. The revised report appeared in 1954, but no legislation has followed so far. Now that the Colouring Matter in Food Order has removed colours from the orbit of the Public Health (Preservatives, etc., in Food) Regulations, the time is ripe for a fresh order. Second Report on Processed Cheese and Cheese Spread. This revised report appeared in 1956. Legislation is also required to control the descriptions of skimmed, partially skimmed, and so-called cream cheeses. Report on Emulsifying and Stabilising Agents. This report appeared in 1956, 23 Reports have been issued on Arsenic (Revised Report, 1955), Copper (1956), Lead (Revised Report, 1954), Tin (1952), and Zinc (1954), but no further action has ensued although it is believed that an Order controlling the quantity of arsenic in food may not be long delayed now. The Food Standards (Soft Drinks) Order was last revised in 1953 and it was immediately pointed out that the definition of drinks made from 'whole fresh oranges' was ambiguous and needed clarification, but no revised order has yet appeared. When delays of two years or more occur after the issue of Reports of the Food Standards Committee without any administrative action being taken by the Government, it places food administration by Local Authorities in a difficult position and manufacturers are left in a quandary. Reputable manufacturers hesitate to act merely on the recommendations of the Food Standards Committee, whilst others are prepared to take a risk. Public Analysts on the other hand are loath to condemn products, which comply with the proposals of a Standing Government Committee, because of the risk of caustic comments from the Courts. In spite of the continual pressure of Local Authorities and public analysts no order has yet been made to control the meat content of sausages, though one would have expected more regard to have been paid to the comments of the Lord Chief Justice on this point. Other products, such as stewed steak, stewed steak in gravy and luncheon meat show a continued deterioration in the quantity of meat present, but the Courts are unwilling to lay down standards when the Government seems unable to do so. There is much so-called chocolate on the market at the present time containing large quantities of hardened palm kernel oil instead of cocoa butter and milk chocolate containing separated milk powder. The year 1960 will mark the centenary of the passing of the first food and drugs act and the inaction of the Government at the present time reminds one strongly of the inertia shown by Governments of that time and the efforts made by Dr. Wakeley, in setting up the Lancet Commission, and others in order to force their hands. It is difficult to know to what extent the present position has arisen from the frequent changes taking place at the Ministry of Agriculture, Fisheries, and Food, where food administration appears, at the present time, to be a training ground for higher office either in the political field or in the administrative service. Looking to the future, Public Analysts are deeply concerned by the need to safeguard the public against the effects of radioactivity. The recent incident at Windscale brought the matter into prominence, but even before that a good deal of preliminary work had been done by Public Analysts. The task of monitoring pastures, crops, etc., in the vicinity of atomic installations is vested in the Ministry of Agriculture by the Atomic Energy Act, but the ultimate responsibility for the protection of the public must rest on the Public Analyst. Many foods are imported from abroad, from regions which may be affected by 'fall-out' from test explosions, or canned fish may come from seas into which radioactive effluents flow. Fish may concentrate radioactive elements up to two million times the amount in the sea water in which they live. As the complexity of the work has increased so has equipment of the analyst's laboratory. The crude adulteration of the earlier years demanded only the simplest equipment, but the tasks of today require the use of complex physical instruments such as absorptio-meters, flamephotometers, polarographs, etc. Without these instruments the determination of many essential factors, such as vitamins, would be impossible. As an example, your analyst has recently purchased a spectrophotometer which, with the ancillary equipment cost over £800. Not many years ago a large laboratory could have been equipped for such a sum. The use of such equipment moreover requires highly skilled staff, who are difficult to obtain when the demand for scientists exceeds the supply, and more lucrative fields are open to them. How the situation can best be handled is difficult to foresee, but it is one to which considerable thought must be given in the near future. Thomas McLachlan, Public Analyst." Food—Adulterated or Unsatisfactory Samples. The majority of the unsatisfactory samples referred to in the Analyst's report were in respect of technical faults in labelling or description. After consultation with the manufacturers concerned, in all cases the labels were revised or corrected. The remainder, which involved no very serious contraventions, or showed evidence of intended fraud, were dealt with informally, the goods being either withdrawn from sale or surrendered. It was in no case necessary to institute legal proceedings. Unsound Food. The total quantity of food surrendered as being unsound and unfit for human consumption was nearly 31 tons. The greater part again related to canned goods including a large proportion of imported boneless cooked ham and shoulders. Contamination of the meat often occurs during butchering but 24 the Public Analyst considers that more efficient processing might reduce the present number of failures. When destruction on the premises was impracticable, the food was sent via the Cleansing Department to a central refuse disposal depot at Westminster. Details of unsound food are given in Table 14, page 36. Milk. There are 84 registered premises from which milk is sold and 18 milk roundsmen operate in the Borough from shops or depots elsewhere. A total of 175 inspections were made. During the year, 270 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 eighty-four milk sellers. Details are given in Table 15, page 36. The average composition of the 96 genuine samples of milk analysed was: total solids 12.48 per cent.; fat 3.61 per cent.; solids not fat 8.87 per cent.; as compared with the legal minima, namely, 11.50 per cent.; 3.00 per cent.; and 8.50 per cent, respectively. Twenty-four samples of milk taken at the premises of two authorised wholesale firms operating heat treatment plants were submitted to the tests prescribed for the various designations; all were reported to be satisfactory. Of 105 other samples of milk examined by the Council's Bacteriologist, all were found to comply with the requisite standards. Ice-Cream. Two premises are registered for the manufacture of ice-cream and 222 for sale and storage. Details of the classes of premises are given in Table 16, page 36. Sixteen samples of ice-cream were examined by the Council's Bacteriologist, with the following results: Grade I—13, Grade II—1, Grade IV—2. Five samples submitted for chemical analysis were all satisfactory. The quantity of ice-cream sold in the United Kingdom increases each year and it was estimated that 100 million gallons of ice-cream were manufactured during 1957. Preserved Food. There are 122 premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale; 245 inspections were made and informal action was taken to remedy unsatisfactory conditions found from time to time. Details of the classes of premises registered are given in Table 16, page 36. Catering Establishments. There are 759 premises of this type in the Borough and during the year, 1,671 inspections were made. Details of the premises concerned appear in Table 17, page 37. Wholesale and Retail Food Premises. The 102 informal notices served regarding these premises was an increase of 58 over last year (44). The main fault is lack of cleanliness. The food trade is well aware that cleanliness helps sales and parts of the premises exposed to public view are usually reasonably clean and well lighted. Unfortunately a bright and shining exterior all too often hides unsatisfactory conditions behind the scenes and storage and food preparation rooms are quite the reverse, conditions there being dirty, untidy, cramped and ill-lit. The small shopkeeper is at a great disadvantage in relation to the multiple shop. To compete successfully he has to carry a very wide range of goods and brands leading to cramped food storage accommodation which in turn prevents the store room being properly cleansed. Television advertising also affects this problem. The housewife is so keen to buy goods which have been attractively "tele-advertised" that the shopkeeper is forced to stock them. But with so many advertisements the situation becomes chaotic and there is soon more stock than storage room. The result is that goods get sold out of rotation. New stock is sold first whilst old stock is left and often gives rise to complaint when it is eventually purchased. The multiple shops usually have more storage space available, better stock-keeping methods and are therefore not so concerned with this problem. Their greatest difficulty is in keeping premises clean. Food handlers too often adopt the attitude that cleaning is not part of their duties, and usually cleaners are employed who come in twice a week. They wash the floors of the shop, store-room, sanitary accommodation and rest room but rarely seem to give attention to the walls, ceilings, shelves and fittings. Another modem problem is disposal of containers and 25 similar refuse. In the past canned goods were delivered to the shops in wooden boxes and the boxes subsequently found a ready market as firewood. Now, these foods are delivered in cardboard cartons which, although collapsible, create a disposal problem often resulting in serious accumulations. Of the complaints received alleging lack of hygiene at food shops, many concern fishmongers and butchers with open-fronted shops or displays. Unfortunately, a recent legal decision has virtually prevented effective action being taken in this regard as it would seem first to be necessary to prove that there existed a risk of contamination injurious to public health—an almost impossible task. The public are not concerned with legal intricacies and express dismay at the apparent inaction of the health department upon what they consider to be a dangerous and unhygienic practice. It is gratifying to report that one fishmonger who agreed to alter his shop to a closed-front, and acted upon other recommendations made to him, wrote to say how much his trade had since increased and how glad he was to have accepted such advice. However, it is hoped that the long awaited Codes of Practice for specific trades will soon be issued and that these will assist local authorities in enforcing legislation, which at present is proving difficult. In fairness to butchers, it must be stated that their attitude towards the high standards required for their shops is largely conditioned by the apparent disregard for hygiene which they witness at the wholesale meat markets; particularly with regard to home-killed meat which is unwrapped. Food Stalls. During the year food was sold from 101 licensed stalls in street markets in the Borough and frequent inspections were made for compliance with the requirements relating to stalls in the Food Hygiene Regulations and the London County Council Byelaws for the Protection of Food. Basement Bakehouses. Regular inspections were made of the three basement bakehouses remaining in the Borough. The Food Hygiene Regulations require a more hygienic standard to be observed but it was felt that a comprehensive survey should be left until the review of certificates of suitability in 1958. Horseflesh. Six 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. Six inspections were made during the year. St. Marylebone Clean Food Association. The Executive Committee of the Association (Chairman: Mr. D. W. Moeran, Hon. Secretary : Mr. W. S. Moss, Hon. Treasurer : Mr. W. Bragg) have kindly provided the following information which is extracted from their report for the year 1957/58:— "Officers and Membership of the Committee. (a) At the commencement of the year, Mr. D. W. Moeran, a member of the Association since its inception, who has worked hard for its well-being and has held office, both as Hon. Secretary and Hon. Treasurer, was elected to the Chairmanship of the Committee in place of the late Mr. Hale and Mr. W. Bragg took over as Treasurer. We also welcomed two new members to the Committee, Mr. D. Poynter, a Manager of a Dairy Company and Mr. P. Phillips, a Licensed Caterer. (b) In November our Hon. Secretary disposed of his business and left the catering trade. He therefore sent in his resignation, but our Chairman asked him to remain in office until the end of the Association's year and this he has gladly done. Membership of the Association. The total number of members of the Association is now 166. Of these, 4 businesses to our knowledge have changed hands and these premises are at present on probation for six months. 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 of a small stick-on label on envelopes, bearing the slogan 'Insist on Clean Food,' 26 General Note. No meetings have been held during the year. Indeed, the record of attendances of members to meetings over the past few years has been so poor that your Committee have been reluctant to embark on any new schemes. That membership of the Association has its prestige value there seems to be no doubt but more positive action in the nature of lectures, discussions or films appears to be undesired and members seem to be content that the Association should function in this way. Your Committee have followed this policy during the past year." SECTION F.—INFECTIOUS AND OTHER DISEASES—PREVALENCE AND CONTROL The incidence of infectious diseases in the Borough during the year was greater than in 1956. This was mainly due to measles, a disease which seems to be especially prevalent in two-yearly cycles. Information regarding the 752 cases of notifiable diseases reported is given in Table 18, page 37. Enquiries relating to these and to infectious disease contacts involved 966 visits by the women public health inspectors. There were 8 cases of poliomyelitis (4 paralytic and 4 non-paralytic) as compared with 2 in 1956 and, again, there was no diphtheria. Tuberculosis. Table 18, page 37, gives information regarding primary notifications of pulmonary and nonpulmonary tuberculosis received during the year and Table 19, page 38, 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 247 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 962. Mass Miniature Radiography. During the year, apart from the closed surveys carried out by the Unit at various business premises within the borough, public sessions were held at two sites during April and May. These were very well attended and altogether 3,742 persons were X-rayed, of whom 1,847 had not previously been examined. Food Poisoning. During the year, nine cases of food poisoning were notified. One outbreak of undiscovered cause concerned two cases. Of the remainder, which were single cases, one was found to be due to Salmonella Newport, one to Salmonella Irumi, one to Salmonella typhi-murium and the other four to unknown causes. 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 74 cases of scabies: adults 44 (men 32, women 12); children, 30 (boys 25, girls 5). Venereal Diseases. Continued assistance was given to the propaganda campaign for drawing public attention to the dangers of these conditions and to the adequate facilities which exist for those in need of treatment. Disinfection. During the year, 76 rooms and 443 articles of bedding (mattresses, blankets, sheets, bolsters, pillows, etc.), and 645 books, were disinfected. 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, 262 certificates, relating to a total of 2,455 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. 27 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 two 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 5,785 of these certificates were authenticated. Bacteriological Examinations. Table 20, page 38 shows the number of specimens examined for the purposes of diagnosis and also indicates the organisms in relation to which the examinations were made. 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. |R M. F. M. F. 1 Tuberculosis, respiratory 9 3 - - - - - - 1 2 5 - 3 1 2 Tuberculosis, other — — — — — - — — — — — — — — 3 Syphilitic disease 4 2 - - - - - - - - 1 — 3 2 4 Diphtheria — — — — — — — — — — — — — 5 Whooping cough - - - - - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - - - 7 Acute poliomyelitis 1 - - - - - - - 1 - - - - - 8 Measles - - - - - - - - - - - - - - 9 Other infective and parasitic diseases 2 1 — — — - — — 1 — 1 1 — — 10 Malignant neoplasm, stomach 18 8 - - - - - - - 1 6 2 12 5 11 Malignant neoplasm, lung, bronchus 28 6 - - - - - - - 1 17 2 11 3 12 Malignant neoplasm, breast — 15 — — — - — — — 2 — 6 — 7 13 Malignant neoplasm, uterus — 8 — — — - — — — 3 — 1 — 4 14 Other malignant and lymphatic neoplasms 62 50 - - - - - 1 4 6 18 14 40 29 15 Leukaemia, aleukaemia 2 5 - - - - - - - 1 2 1 — 3 16 Diabetes 3 4 - - - - - - - - - - 3 4 17 Vascular lesions of nervous system 66 77 - - - - - - - 1 9 10 57 66 18 Coronary disease, angina 108 79 - - - - - - 2 — 36 12 70 67 19 Hypertension with heart disease 35 42 - - - - - - - - 2 1 33 41 20 Other heart disease 66 86 - - - - - - 1 2 10 7 55 77 21 Other circulatory disease 19 27 - - - - - - - - 5 2 14 25 22 Influenza 8 4 - - - - - - - - 2 1 6 3 23 Pneumonia 21 13 1 — 1 - - - - - 5 — 14 13 24 Bronchitis 48 24 - - - - - - - - 6 1 42 23 25 Other diseases of respiratory system 8 3 - - - - - - - - 2 1 6 2 26 Ulcer of stomach and duodenum 9 1 - - - - - - - - 4 — 5 1 27 Gastritis, enteritis and diarrhoea 2 4 - - - - - - - 1 1 1 1 2 28 Nephritis and nephrosis 5 2 - - - - - - - - 2 1 3 1 29 Hyperplasia of prostate 9 - - - - - - - - - - — 9 — 30 Pregnancy, childbirth, abortion - - - - - - - - - - - - - - 31 Congenital malformations 7 3 3 3 — - — — 2 — 1 — 1 — 32 Other defined and ill-defined diseases 30 47 9 8 — - — — 1 2 11 18 9 19 33 Motor vehicle accidents 4 3 — — - — 1 2 — — — 2 2 34 All other accidents 8 6 - - - - - - - - 7 — 1 6 35 Suicide 10 5 - - - - - - 2 2 4 2 4 1 36 Homicide and operations of war 1 — 1 - - - - - - - - - - - Totals 593 528 14 11 1 — - 2 17 24 157 84 404 407 1,121 25 1 2 41 241 811 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 4 2 - - - - - - - - - - - - 4 2 Premature Birth 3 6 - - - - - - - - - - - - 3 6 Bronchitis and Pneumonia - - - - - - - - - - - - - - 1 — Respiratory Failure - - - - - - - - - - - - - - - - Meningitis - - - - - - - - - - - - - - 2 — Congenital Malformation 2 2 - - - - - - - - - - - - 3 3 Murder 1 - - - - - - - - - - - - - 1 — Totals 10 10 1 — 1 — 1 — 1 - - 1 — — 14 11 TABLE 3.—Weather Statistics, Year 1957. Station: Regent's Park. Height of rain-gauge above mean sea level: 129 feet. 1957 Air Temperature in Degrees Fahrenheit Rainfall Weather Number of Days Bright Sunshine Means of Highest and Lowest Most in a day Precip'n .01 in. (0.2 mm.) or more .04 in. (1.0 mm.) or more 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* A Max. B Min. Mean of A and B Highest Max. Date Lowest Min. Date Lowest Max. Date Highest Min. Date Total Amt. Date °F. °F. °F. °F. °F. °F. °F. in. in. hr. hr. % Jan. 48.2 38.8 43.5 57 26 32 2,25 37 14 54 5 1.37 0.35 24 10 8 1 - 0 1 1 2 13 - 45.3 1.46 154 Feb. 49.0 39.6 44.3 57 3,4 31 16,18 38 19 51 1 3.04 0.57 5 14 12 1 - 0 0 0 3 13 - 61.1 2.18 136 Mar. 57.7 44.6 51.1 68 13 34 4 48 5 52 10, 17 1.17 0.28 26 11 9 0 - 0 0 3 0 7 - 93.2 3.01 101 April 57.4 42.4 49.9 68 5 33 12 48 9 49 18 .27 0.09 22 5 4 0 - 0 0 0 0 8 - 144.2 4.81 110 May 61.0 45.2 53.1 73 31 36 6 48 8 53 15 1.32 0.37 12 12 8 0 - 0 0 0 0 2 - 186.8 6.03 100 June 74.2 52.4 63.3 93 29 42 12 59 10 68 30 0.81 0.35 9 6 5 0 0 3 0 0 0 - 261.6 8.72 128 July 72.6 57.8 65.2 90 6 52 11, 21 65 14, 15 66 4 3.44 0.63 14 16 14 0 - 0 5 0 0 0 - 155.3 5.01 81 Aug. 69.8 55.4 62.6 81 1 47 30 60 15 63 8 2.68 1.21 12 15 9 0 - 0 1 0 0 0 - 142.1 4.58 81 Sept. 63.7 51.3 57.5 71 22 37 30 55 24, 30 60 22 2.27 0.50 24 15 11 0 - 0 1 0 0 1 — 92.1 3.07 73 Oct. 60.8 47.6 54.2 68 13, 14 39 20 55 22 56 26, 30 2.05 0.77 16 9 8 0 - 0 0 1 0 3 - 76.9 2.48 93 Nov. 49.0 41.1 45.1 56 4 30 24 43 15 48 12 2.25 0.79 3 7 5 0 - 0 0 0 2 2 - 56.9 1.90 139 Dec. 46.1 36.1 41.1 55 20 23 17 36 4, 16 44 21, 22, 23 1.76 0.75 12 11 10 0 0 0 1 8 11 — 28.3 0.91 106 Totals — - — — — - — — — — — 22.43 — — 131 103 — — - — 1343.8 — — * Average for years 1921-1950. 31 32 TABLE 4.—Diseased or Infirm Persons Removed to Hospital, etc., under Court Orders. Person Age Removed to Remarks Miss B. N. 76 L.C.C. Home Emergency Order for 6 weeks. Remained in home at expiration of Court Order as a voluntary patient. Mr. A. H. 92 Hospital Emergency Order for 3 weeks. Remained in hospital for 4 weeks as a voluntary patient after expiration of Order and then discharged. Three weeks later another Emergency Order obtained for removal to L.C.C. home, where he subsequently died. Miss F. H. 72 Hospital Emergency Order for 3 weeks. Died soon after admittance to hospital. TABLE 5.—New Legislation. Legislation Operative Date Housing Act, 1957 1.9.57 Rent Act, 1957 6.7.57 London County Council (General Powers) Act, 1957 31.7.57 Rent Restriction Regulations, 1957 6.7.57 Colouring Matter in Food Regulations, 1957 30.6.57 Food Hygiene (Amendment) Regulations, 1957 31.12.57 Pre-packed Food (Weights and Measures: Marking) Regulations, 1957 1.1.58 Public Analysts Regulations, 1957 27.5.57 Motor Cycles (Protective Helmets) Regulations, 1957 1.4.57 Smoke Control Areas (Exempted Fireplaces) Order, 1957 8.4.57 Diseases of Animals (Waste Food) Order, 1957 1.6.57 The Poisons Rules, 1957 1.4.57 TABLE 6.—Nuisances Remedied. Nuisance Abated or Defect Remedied Number Houses damp, dirty or dilapidated 140 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., defective 140 Drain, water-closet and waste pipe stoppages 36 Drains, water-closets and waste pipes defective 69 Yard, area and wash-house defects 1 Roofs, gutters and rainwater pipes defective 150 Insufficient water supplies 3 Water cisterns dirty or defective 14 Ashpits, dustbins, etc., defective 21 Rubbish accumulations 45 Animal nuisances 3 Miscellaneous 63 Total 675 33 TABLE 7.—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 tier so. mile (collected in deposit gauges) N.L. 27.9 14.8 17.8 12.1 13 2 12.2 14.1 12.6 13.3 13.0 6.8 15.9 T.H. 9.3 10.8 13.4 14.4 12.1 10.0 8.8 9.5 7.5 13.5 5.9 12.1 D.S. 10.3 12.1 20.7 7.5 17.3 15.0 9.4 11.5 10.3 8.3 9.6 4.7 Soluble Matter—Tons per sq. mile (collected in deposit gauges) N.L. 9.5 7.9 7.0 3.0 6.4 3.6 6.6 6.3 5.1 5.4 8.2 6.9 T.H. 6.7 9.1 7.8 4.2 6.9 5.6 9.0 7.0 8.0 6.5 6.1 8.7 D.S. 4.8 8.3 6.4 3.2 6.3 6.2 7.6 4.4 5.4 4.7 8.4 5.6 Sulphur Trioxide—Milligrams per Day Collected (per 100 sq. cm. of lead peroxide) N.L. 5.1 3.7 3.1 1.4 1.4 1.4 1.3 1.0 1.5 2.8 3.0 4.9 T.H. 4.9 5.4 5.1 2.8 2.4 2.1 2.2 2.0 2.9 4.5 4.9 7.0 E.R. 5.0 4.3 4.6 3.3 2.2 1.7 1.6 1.4 2.2 4.0 4.5 6.0 Smoke— Milligrams per 100 cubic metres of air average per day (Volumetric method) T.H. 30 35 42 19 10 8 10 8 13 34 26 43 G.P. — 39 41 24 11 6 9 7 12 34 30 48 Sulphur Dioxide—Parts per 100 million parts of air average per day (Volumetric method) T.H. 11 12 16 9 6 5 4 5 6 12 12 20 G.P. — 15 13 7 4 4 2 4 5 10 10 19 Annual Daily Average of Mean Concentration of Smoke and Sulphur Dioxide. Site 1957 1956 1955 Smoke mg./100m3 SO2 p.p. 100m. Smoke mg./100m3 so2 p.p. 100m. Smoke mg./100m3 so2 p.p. 100m. T.H. 23 9 34 11 39 9 G.P. 24 8 32 9 51 7 Annual Monthly Average of Deposited Matter and Sulphur Trioxide. Site 1957 1956 1955 Tons per sq. mile Mg. per 100 sq. cm. Pb02 Tons per sq. mile Mg. per 100 sq. cm. Pbo2 Tons per sq. mile Mg. per 100 sq. cm. Pb02 T.H. 17.7 3.9 19.22 3.9 19.02 4.03 N.L. 20.8 2.6 17.24 2.4 17.56 2.47 D.S. 17.3 - 18.9 - 19.3 - E.R. — 3.4 - 3.5 — 3.7 Notes to Table 7— 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. 34 TABLE 8.—Rodent Control. Complaints received 629 Dwellings 431 Business premises 198 Rats 354 Mice 275 Blocks surveyed 8 Premises involved, in blocks 360 Premises disinfected 583 Black rats 23 Brown rats 266 Mice 294 Treatments carried out 2,095 TABLE 9.—Factories: Inspections for Purposes of Provisions as to Health. Premises Registered Inspections Written notices Occupiers prosecuted Factories without mechanical power 271 214 7 - Factories with mechanical power 1,306 722 46 — Other premises* (excluding outworkers' premises) 321 448 — - Totals 1,898 1,384 53 — * Electrical stations, institutions, sites of building operations and works of engineering construction. TABLE 10.—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. 39 28 3 1 - Overcrowding — — 4 — — Unreasonable temperature — — — — — Inadequate ventilation 5 6 — — — Ineffective drainage of floors — — — — — Sanitary conveniences:— (a) insufficient 1 — — 2 — (b) unsuitable or defective 55 62 — 11 — (e) not separate for sexes 2 4 — 1 — Other offences (excluding offences relating to outwork) 26 15 61 — — Totals 128 115 68 15 — 35 TABLE 11.—Summary of Outwork. Description of Work Outworkers Employed Wearing apparel 664 Household linen 18 Textile weaving 7 Curtains and furniture hangings 7 Furniture and upholstery 7 Lampshades 3 706 TABLE 12.—Pharmacy and Poisons Acts, 1852-1941: Summary of Sellers of Part II Poisons. Type of Business Total Licensed Grocery and provision stores 31 Hardware and domestic stores 18 General stores 19 Hairdressers 9 Builders' merchants 2 Drug stores 2 Pest control contractor 1 Dental sundries 1 Photographic dealer 1 Veterinary products 1 85 TABLE 13.—Dwelling-Houses: Summary of Inspections, Conditions Found and Action Taken. Inspection under Public Health or Housing Acts:— (1) (a) Inspected for housing defects 1,132 (b) Inspections made for the purpose 4,201 (2) Found to be in a state so dangerous or injurious to health as to be unfit for human habitation 71 (3) Found not to be in all respects reasonably fit for human habitation 447 Defects remedied without service of formal Notices:— Defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 234 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 182 (2) Dwelling-houses in which, after service of formal notices, defects were remedied:— (a) By owners 164 (6) By Local Authority in default of owners 1 (6) Proceedings under section 12 of the Housing Act, 1936 (1) Underground rooms in respect of which Closing Orders were made 9 (2) Closing Orders determined, the tenement or room having been made fit 4 (3) Rooms affected by (2) above 7 36 TABLE 14.—Summary of Unsound Food Surrendered. Description Quantity tons cwts. qtrs. lbs. Meat and offal - 13 3 12 Bacon and ham 2 8 1 7 Poultry and game - 6 4 6 Fish — 7 — 4 Fruit and vegetables 1 1 2 21 Canned meat 6 3 — 27 Canned food (other than meat) 18 2 1 8 Miscellaneous 1 9 4 10 30 13 2 11 TABLE 15.—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 62 Pasteurised 80 Sterilised 78 Supplementary: Tuberculin tested 16 Pasteurised 17 Sterilised 15 TABLE 16.—Summary of Premises Registered for Storage and Sale of Ice-Cream or Preserving Food. Type of Business Preserving Food Ice Cream Butchers 80 2 Tobacconists, confectioners/newsagents — 89 Grocers and provision merchants 31 63 Fishmongers 4 3 General stores 7 19 Milk shops — 20 Greengrocers and fruiterers — 24 Public houses - 2 Ice-cream factories — 2 122 224 37 TABLE 17.—Summary of Food Premises. Type of Business Totals Restaurants, cafes and snack bars 323 Canteens and clubs 229 Grocers and provision merchants 198 Butchers 62 Greengrocers and fruiterers 62 Fishmongers 18 Bakers 37 Confectioners 162 Wine merchants 38 Public houses 118 Other licensed premises 13 Hotels 52 Coffee stalls and kiosks 4 Schools and nurseries 20 Stalls, street trading 101 1,437 TABLE 18.—Notifiable Diseases and Notifications. * Notifiable Disease Cases notified in whole Borough Cases removed to hospital Cases isolated at home At all ages At ages—years —1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Ophthalmia Neonatorum 1 1 - - - - - - - - - - - 1 - Erysipelas 6 - - - - - - - - 1 - 2 3 - 6 Scarlet fever 28 — — 1 3 2 14 5 1 - 1 1 - 3 25 Puerperal pyrexia 23 — — - - - - - 3 18 2 - - 23 - Poliomyelitis— Paralytic 4 — — — — 1 — 1 1 - 1 - - 3 1 Non-paralytic 4 — — — - - 1 - 1 1 1 - - 3 1 Pneumonia 8 - - - - - 1 1 - 1 1 2 2 4 4 Dysentery 18 1 3 — 1 - 4 2 1 1 1 3 1 6 12 Measles 506 9 31 64 71 81 229 11 1 6 2 1 - 6 500 Whooping cough 61 7 8 6 3 4 31 1 - - 1 - - 1 60 Scabies 10 — - - - 1 2 1 - 4 2 - - - 10 Malaria (contracted abroad) 1 - - - - - - - - - - - - 1 - Tuberculosis— Pulmonary 65 — — - - 1 - - 2 25 14 13 10 43 22 Non-pulmonary 6 - - - - - - 1 1 3 - - 1 3 3 Food poisoning 9 — — — - 1 1 - 3 3 - 1 - 1 8 Typhoid fever 1 — - - - - - - - 1 - - - 1 - Acute Encephalitis - - - - - - - - - - - - - - - (post-infectious) 1 - - - - - - - - - - - - 1 — Totals 752 18 42 71 78 91 283 23 14 66 26 23 17 100 652 * 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, meningococcal infection, paratyphoid fever. 38 TABLE 19.—Tuberculosis: New Cases and Deaths. At ages— years ‡ new cases deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0—1 1 - - - - - - - 1—5 - 1 - - - - - - 5—15 - - - 1 - - - - 15—25 9 12 - 3 - - — — 25—35 15 9 1 - - - - — 35—45 18 9 1 - 1 1 — — 45—55 13 4 — - 2 - - — 55—65 6 3 — - 3 - — — 65 and upwards 8 3 — 1 5 1 — — Totals 70 41 2 5 11 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 20.—Summary of Work of the Bacteriological Laboratory. Nature of Specimen and Examination Positive Negative Total Throat and nasal swabs for— B. diphtheriae — 22 22 Haemolytic streptococci 8 43 51 Vincent's organisms 2 - 2 Vaginal swabs for— Gonococci - 3 3 Sputum for— Tubercle bacilli - 7 7 Laryngeal swabs for— H. pertussis — 1 1 Faeces for— Parasites 1 - 1 Typhoid, paratyphoid, dysentery and food poisoning organisms 20 237 257 Cervical swabs for— Trichomonas 3 - 3 Urethral swabs for— Gonococci 2 5 7 Foods for— Food poisoning organisms 3 18 21 Totals 39 336 375 39 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. On Saturdays urgent cases are dealt with at 1, Tavistock Square, W.C.l. (Tel.: EUS. 8052). National Health Service.—All old people should be on a list of a doctor. This part of the service is controlled by the London Executive Council, Insurance House, Insurance Street, W.C.I. (Tel.: TER. 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.l. For Postal Areas, W.2 and N.W 36/38, Berkeley Square, W.l. 30, Euston Square, N.W.l. 5, Praed Street, W.2. Tel.: GRO. 6060. Tel.: EUS. 6451. Tel.: PAD. 3411. LONDON COUNTY COUNCIL. Homes.—Luxborough Lodge, 1, Luxborougli Street, W.1. (Tel.: WEL. 5619).—Apply to Admission Officer, 5, Princes Row, S.W.l. (Tel.: VIC. 0162).—9.15 a.m. to 5.15 p.m. Monday to Friday. Saturdays 9.15 a.m. to 12.15 p.m. After office hours urgent cases can be referred direct to Luxborough Lodge. 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.: CUN. 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.: WA T. 5000, Ext. 273); where possible this should be done through the patient's doctor. 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.l. (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 which are brought to her notice. A special laundry service for incontinent old people is run by the Council, and arrangements can be made for bathing old people, at their own request, at the Lisson Grove Centre. Public Baths, Seymour Place, W.l.—Monday to Friday up to 4.30 p.m. Old age pensioners pay Id. (soap and towels extra). Library Book Service.—This is operated by the Borough Council Library and delivery of books is made to the infirm or housebound each Tuesday. Arrangements must be made with the Borough Librarian at the Town Hall (Tel.: WEL. 7766). 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 Miss Sharp, who can arrange delivery of 281bs. 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 own homes; and (iii) may undertake burial or cremation where no other suitable funeral 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. to 12.30 p.m., 2.30 p.m. to 5 p.m. Mrs. K. M. Cowan, Secretary. At other times, for urgent messages, 121, Chiltern Court, N.W.I. (Tel.: WEL. 5544, Ext. 121). 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 liason 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 l0d. 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. 40 W.V.S. Luncheon Club, 134, Seymour Place, W.l. (Tel.: PAD. 5597).—Old age pensioners can obtain dinners for l0d. from Monday to Friday. Notice to attend must be given to W.V.S. beforehand. Home Nursing.—Paddington and St. Marylebone District Nursing Association, 117, Sutherland Avenue, W.9. (Tel.: CVN. 1462). Chiropody.—A clinic is run by the Old Peoples' Welfare Association and the British Red Cross Society in Room 115, Town Hall, St. Marylebone, W.l, every Tuesday 10 a.m. to 12.30 p.m. and 2.15 p.m. to 5.15 p.m. A charge of Is. 6d. is made. Treatment is by appointment which must be arranged on Tuesdays in Room 115. A Home Chiropody Service is also run by the Association on four Thursdays in each 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 and one recreation room:— 7, Wyndham Place, W.l, on Wednesdays, 2.30 to 4.30 p.m. 7, Wyndham Place, W.l, on Thursdays, 2.30 to 4.30 p.m. 60, Paddington Street, W.l, on Tuesdays, 2.30 to 4.30 p.m. Recreation Room.—104, St. John's Wood Terrace, N.W.8, on Mondays and Wednesdays, 2.15 to 4 p.m. Other "Darby and Joan" Clubs are:— 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 p.m. The "Inner Wheel" Club on Fridays, 2.30 to 4.30 p.m. in Christ Church Hall, Shroton Street, N.W.l. The Fourth Feathers Club, 28, Mulready Street, Church Street, N.W.8, on Thursdays, 2.30 to 4.30 p.m. The Barrow Hill Club, Community Centre, Barrow Hill Estate, Allitsen Road, N.W.8, alternate Thursdays, 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.%. (Tel.: PRI. 1051). Citizen's 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. 0049).—Wireless sets can be installed and maintained on loan to bedridden or housebound persons. Applications must be backed by some person or agency who has investigated the applicant's financial position, and who can also keep in touch with them. Family Welfare Association, 8, Kensington Park Road, W.ll. (Tel.: PAR. 6683). Sailors', Soldiers' and Airmans' Families Association (S.S.y4.F.A.), Room 103, Town Hall, St. Marylebone, W.l. (Tel.: WEL. 7766, Ext. 97).—Wednesdays and Fridays, 10 a.m. to 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.8. (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, 1ST, 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.IV. 6. (Tel.: MAI. 5711).—Maintained by the St. Marylebone Old People's Homes, Ltd., 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. 41 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.l 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.l WEL 3935 Marlborough Day Hospital, 38, Marlborough Place, N.W.8 MAI 8605 National Dental Hospital, Gt. Portland Street, W.l LAN 5361 National Heart Hospital, Westmoreland Street, W.l 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.l EUS 5070 St. Charles Hospital, Ladbroke Grove, W.IO ... LAD 2281 St. Marylebone Hospital for Psychiatry and Child Guidance, 48, Cosway Street, N.W.l PAD 8854 St. Mary's Hospital, Praed Street, W.2 AMB 1280 Samaritan Hospital, Marylebone Road, N.W.l PAD 6011 The Middlesex Hospital, Mortimer Street, W. MUS 8333 Western Ophthalmic Hospital, Marylebone Road, N.W.l PAD 1871 Clinics: Arthur Stanley Institute for Rheumatic Diseises and Allied Conditions, Peto Place, N.W.l WEL 1133 Charterhouse Rheumatism Clinic, 56-60, Weymouth Street, W.l WEL 1264 Chest Clinic, Town Hall, Marylebone Road, W.l WEL 7766 Temperance Clinic (Church of England), 14, Gloucester Place, W.l WEL 5222 The Tavistock Clinic (Psychiatric), 2, Beaumont Street, W.l WEL 5415 Vaccination (Smallpox) Clinic, The Middlesex Hospital, W.l MUS 8333 Vaccination (Smallpox) Clinic, Town Hall, Marylebone Road, W.l 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 42 INDEX Page Page Accidental Deaths 6 Food, Unsound 23, 36 Accidents 6 Fouling of Footways by Dogs 16 Adulterated Food Samples 19,23 Aged Persons 8,9, 39, 40 General Statistics 5, 29 to 38 Aged Persons—Services available39,40 Air Pollution 13,33 Hairdressers and Barbers 14 Ambulance Service 41 Heating Appliances (Fireguards) 14 Analysis of Food and Drugs 19 Horseflesh 25 Analyst, Public 4 Hospitals 41 Analyst, Public, Report 19 Housing 17 Housing, Certificates of Disrepair 18 Bacteriological Examinations 27,38 Housing, Closing Orders 19,35 Bacteriological Examination of Milk and Ice Cream 24 Housing, Factory-made Bungalows 18 Bacteriologist 4 Housing, Improvements and Conversions 19 Bakehouses, Basement 25 Housing, Inspection and Action taken 18,19 Barbers 14 Housing, Permanent Estates 17 Baths, Cleansing of Persons 13 Housing, Re-housing, Medical Certificates 19 Baths for Old People 8 Housing, Requisitioned premises 18 Bodies, Transportation Abroad 16 Housing, Slum Clearance 18 Books, Library 9,26 Hydrogen Cyanide Disinfestation 13 Bugs 13 Burial or Cremation of the Dead 15 IceCream24,36 Immigrants 19 Cancer 6 Impetigo 26 Care of Old People 8,9 Improvement and Conversions, Housing 19 Catering Establishments 24 Infant Mortality 2,5,6,30 Causes of, and Ages at, Death 30 Infectious Diseases, Exclusion from Work of Contacts 27 Census Population 5 Infectious Diseases, Notification 26,37 Certificates of Disrepair 18 Infectious Diseases, Prevalence and Control 26 Clean Air 15,33 Infectious Diseases, Statistics 37 Cleansing, Public 15 Influenza 2 Cleansing Station 13,26 Inspection, Sanitary 11 Cleansing of Verminous Persons 13 Inspection of Food 19 Clearance, Slum 18 Intimation Notices 11 Clinics 41 Closing Orders 19,35 Land Charges Enquiries 19 Combined Drainage 12 Laundry Service for Old People, etc. 8 Committee, Public Health 4 Legal Proceedings 11,26 Common Lodging Houses 19 Legislation, New 11,22,32 Compulsory Removal 11,32 Conditions, Social 5 Marriages 5 Conferences 8 Mass Miniature Radiography 26 Conveniences, Public 15 Maternal Mortality 5,6 Cremation 15,16 Measles 2,26 Medical Examinations, Staff 11 Dairies, Milkshops 24, 36 Medical Referee, Cremation 16 Deaths 2,5,6,30 Mice 12,34 Deaths, Infant Mortality 2, 5, 6, 30 Milk 19, 24 Deaths, Maternal Mortality 5,6 Milk, Bacteriological Examination 24 Deaths, Vital Statistics 5 Milk (Special Designations) Regulations 24,36 Diseased or Infirm Persons, Removal 11,32 Milk, Pasteurised 24,36 Diseases, Notifiable26,37 Milk, Sellers 24,36 Disinfection 26 Milk, Sterilised 24,36 Disinfestation 13 Milk, Tuberculin Tested 24,36 Disrepair Certificates 18 Mortality, Infant 2,5,6,30 Dog Nuisance 16 Mortality, Maternal 5,6 Drainage 12 Mortuary 16 Drainage, Combined 12 Drugs, Analysis 19 New Legislation 11,22,32 Dwelling-Houses 18,35 Noise 11 Notices, Intimation and Statutory 11 Exclusion from Work 27 Notification of Infectious Diseases 26,37 Nuisances 11,13,16,32 Factories 14,34 Nuisances, Noise 11 Factory-made Bungalows 18 Financial Contributions to Voluntary Organisations 8 Old People 8, 9, 39, 40 Fireguards 14 Old People, Services available 3,39,40 Flock, Rag and Other Filling Materials 15 Outworkers 14,35 Food, Adulterated, etc.19, 23 Food Analysis 19 Pasteurised Milk 24, 36 Food Inspection 19 Pet Shops 14 Food Poisoning 26 Pharmacy and Poisons Acts 14,35 Food Premises24,37 Photographers, Street 16 Food, Preserved, etc.24,36 Pigeons 11 Food Stalls 25 Poisoning, food 26 43 Page Page Poisons 14,35 Staff 3, 4 Poliomyelitis 2,26 Staff Medical Examinations 11 Population 5 Stalls, Food 25 Preserved, etc., food 24, 36 Statistics, General 5, 29 to 38 Private wells 12 Statistics, Infectious Disease 26,37 Protective helmets 14 Statistics, Tuberculosis 26,38 Public Analyst 4 Statistics, Vital 5 Public Analyst's Report 19 Statutory Notices 11 Public Cleansing 15 Sterilised Milk24, 3o Public Conveniences 15 Stillbirths 5 Public Health Committee 4 Street Cleansing 15 Public Health Department Staff 4 Street Photographers 16 Public Health Inspectors 4 Pulmonary Tuberculosis. 26,27,38 Town Planning 12 Transportation of Bodies Abroad 16 Radiography, Mass Miniature 26 Tuberculin Tested Milk24,36 Rag Flock and Other Filling Materials 15 Tuberculosis 26, 37,38 Rateable Value 5 Tuberculosis, New Cases and Deaths 38 Rats12,34 Tuberculosis, Notifications26,38 Referee, Medical (Cremation) 16 Refuse Collection and Disposal 15 Underground Bakehouses 25 Removal, Compulsory11,37 Underground Rooms19,35 Rent Act 18 Unsound Food 23, 36 Representation upon other Bodies 7 Requisitioned Premises (Housing) 18 Vaccination International Certificates 27 Restaurants 24, 37 Venereal Diseases 26 Rodent Control 12,34 Ventilation of Sewers 12 Vermin 13 St. Marylebone Clean Food Association 25 Verminous Persons, Cleansing 13 St. Marylebone Old People's Welfare Association 9, 39 Vital Statistics 5 Sanitary Circumstances 11 Sanitary Inspection11,35 Water 12 Scabies 26 Weather 6,31 Sewers, ventilation 12 Wells, Private 12 Shelter 13 Slaughter of Animals 25 X-ray Examination 26 Slum Clearance 18 Smoke Control 13,33 Zoological Society of London 25 Social conditions 5 Vail & Co. Ltd., Leeke Street, Kings Cross, W.C.l.