STMARY 63 BOROUGH OF ST. MARYLEBONE REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1958 J. H. BRISCOE-SMITH, M.B., Ch.B., D.P.H. CONTENTS page Members of the Public Health Committee 1 Staff of the Public Health Department 1 Section A—Statistics and Social Conditions 2 Section B—General Provision of Health Services 4 Section C—Sanitary Circumstances 8 Section D—Housin 13 Section E—Inspection and Supervision of Food 15 Section F—Infectious and other Diseases—Prevalence and Control 22 Appendix of Statistical Tables and Supplementary Information 27 Index 40 WELbeck 7766 Public Health Department, Town Hall, St. Marylebone, W.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report on the health of the Borough for the year 1958. The vital statistics for the year, in general, shew no variations which can be considered significant when compared with 1957 and they are not unfavourable in relation to those for London as a whole, except in respect of the infant mortality rate. This rate has been somewhat higher than usual for the last two years; 31.29 per thousand live births for 1957 and 33.42 for 1958; but even so this could be, and probably is, due to chance alone since examination of the average infant mortality rates for the two five-year periods prior to 1958 shew a downward trend. The incidence of the notifiable diseases was on the whole low during the year. There was one sharp outbreak of food poisoning which is fully reported on page 23 involving two schools in which 62 pupils and staff were affected. The cases were spread over 17 local authorities and the investigation was further complicated by the fact that apart from verbal notification of the original case only three of the remaining 61 cases were notified. These figures may well be indicative of the proportion of such cases which normally come to official notice and if so they serve to emphasize the amount of undisclosed ill-health which results from this cause. Many of those infected do not seek medical attention and in the case of those who do it seems probable that notification is confined in the main to the more severely ill among them. The degree of severity of symptoms has no relation to the infectiousness of the patient; in fact the mild case which continues to move freely in the population is a greater danger than the severely ill patient confined to bed. In the outbreak which I have described it was possible to trace all those who had been affected. Had it occurred as a result of food eaten in a restaurant it may well have gone undetected or, at best, the investigation may have linked together the four notified cases. This is especially true of restaurants and hotels in St. Marylebone where few of the customers live locally. If the premises upon which I have based my argument are accepted then it is obvious that the control of detected cases of food poisoning and their contacts, though essential, is much less likely to be effective than a direct attack on the source of the infection by the close supervision of every place where food is produced, prepared, handled or eaten to ensure that every precaution is taken against its contamination. In this Borough, with approximately 1,341 food premises, including some 740 restaurants, hotels, canteens and clubs, feeding a considerable proportion of the visitors to London in addition to the local population and those who work here, this work is of paramount importance. Since anyone can open a food business without informing the Council, the utmost vigilance is necessary to keep track of the numerous small restaurants, coffee bars and clubs which are constantly springing up. Again, the introduction of deep-frozen foods is tempting many small shopkeepers to sell these commodities as a sideline. The registration of all food premises is long overdue and it is a sad commentary on the present state of the law that while one shopkeeper selling packaged ice-cream from a refrigerator is required to register with the local authority, his next door neighbour selling frozen foods is not required to do so. Many of these foods such as made up meat and fish dishes, some of which may be prepared as far afield as Italy, are, if not stored properly, potentially at least as dangerous as ice-cream and are much more liable to contamination during manufacture. During the year there has been a rise in the number of complaints of noise from the many building sites in the Borough. With greater use of mechanisation, although the total time required to erect a building may be reduced, noise level is considerably increased. In addition there is a tendencyto work longer hours and at weekends to exploit the expensive mechanical equipment to the full. In most cases the firms concerned have been co-operative and have been willing to adopt measures suggested for the reduction of noise or have limited working hours so that it has been possible for residents in the neighbourhood to have a reasonable- period of quiet each day. It has also proved helpful to advise building contractors to keep local residents, the police and the Public Health Department informed of the circumstances should it be necessary to carry out any particularly noisy operation or when continuous working is essential for a limited period. Most people will tolerate a fair degree of noise if they feel that the firm concerned is aware of their discomfort and that the operation is one designed to shorten the total length of the job or is the result of an emergency which could not be foreseen. Even more important is that they should know how long the nuisance will last. These measures are only palliative and there is no doubt that a great deal of distress is being caused by the use of machinery on building sites. Some kinds of equipment, such as mechanical hammers, by the nature of their operation are noisy, but in other cases much can be done by modification and method of operation to reduce noise. The driver of a crane or mechanical shovel by exercising reasonable care can avoid unnecessary noise. Electricity as opposed to diesel power, although somewhat more expensive, is much quieter. Even such simple measures as substitution of a cable for a chain or the use of a rubber tyre as a buffer can remove cause for complaint. There would appear to be a need for investigation of the sources of noise on these sites and research to determine how it can be reduced. Although it might be difficult to introduce legislation for the regulation of the types of machines and power units permissible on sites in close proximity to occupied dwellings, it should be possible to bring pressure to bear so that designers and manufacturers of this equipment are compelled to give due consideration to the need for quietness in operation even at the expense of some loss of efficiency. It is with regret that I have to report that Mr. William David Jones, a leading disinfector who had some 25 years' service with the Council, died during the year as the result of an unfortunate accident at home. Mr. Jones gave excellent service to the Department and had endeared himself to many of his colleagues who felt his loss keenly. The work of the Department has proceeded efficiently during the year and I have nothing but praise for the staff who have given me such invaluable assistance. I would also like to thank my colleagues in other departments of the Council and the many others in the medical services who have given me so much help during this my first complete year as Medical Officer of Health. This also applies to the officers and members of the voluntary associations with whom I have come in contact in the course of my work. To His Worship the Mayor, to the Chairman, Alderman C. D. Denis-Smith, and members of the Public Health Committee I offer my thanks for their many kindnesses and for the consideration and encouragement they have given me. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. H. BRISCOE-SMITH, Medical Officer of Health. 1 PUBLIC HEALTH COMMITTEE 1958 HIS WORSHIP THE MAYOR: *Councillor J. E. Guest, J.P. † Councillor A. D. H. Plummer, T.D., J P., F.A.I. 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 H. C. Garrard *S/Ldr. S. Stanley *R. M. Dawe W. R. Willcocks † 0L. M. Laurance Miss F. E. Wilson † H. Levitt *until May †from June STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health and Medical Referee for Cremation: J. H. Briscoe-Smith, M B., Ch.B., M.R.C.S.(Eng ), L.R.C.P.(Lond.), D.P.H. Occasional Deputy Medical Officer of Health and Deputy Medical Referee for Cremation: C. J. C. Britton, M.D., D.P.H. Public Analyst (Part-time): T. McLachlan, D.C.M., A.C.G.F.C., F.R.I.C., M.I.Biol., 4, Hanway Place, W.l Bacteriologist (Part-time): C. J. C. Britton, M.D., D.P.H., 35, Harley Street, W.l Administrative and Clerical 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: V. A. Bignell (a, b, c) (Senior Inspector) 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) Mrs. M. I. Tiplady (a, b, d, f) S. W. Wright (a, b) *Miss B. Wilson (a, b, d, e, f) E. W. J. Miller (a) (from January) Outdoor Superintendent and Mortuary Keeper: R. G. Turner Streets Nuisance Inspector: D. Tei.ford Student Public Health Inspectors: fR- C. Morton, A. J. Bithrey Messenger I Handyman : W. G. Sharwood Rodent Operatives 4 Disinfectors 3 Public Conveniences Staff 36 Cleansing Station Attendants 3 Van Driver 1 (а) Public Health Inspector's Certificate (b) Meat and Other Foods Inspector's Certificate (c) Smoke Inspector's Certificate (d) Health Visitor's Certificate (e) Central Midwives' Board Certificate (f) State Registered Nurse's Certificate * Also Infectious Diseases. † Appointed as student inspectors under a scheme of paid pupilage adopted by the Borough Council on the 19th January, 1956. 2 SECTION A.—STATISTICS AND SOCIAL CONDITIONS GENERAL STATISTICS Area of Borough: (a) excluding area covered by water, 1,427.8 acres; (6) including area covered by water, 1,473 acres. There is a variation of approximately 100 ft. in the elevation of the Borough from north to south, the highest point being at the junction of Finchley Road and Boundary Road, 173 ft. above Mean Sea Level at Newlyn, and the lowest at the junction of Oxford Street and James Street, 70 ft. above Mean Sea Level at Newlyn. The sub-soil consists generally of clay with various pockets of gravel, hoggin and sand. Rateable value of the Borough: £5,818,515. Sum represented by a penny rate: £23,800. Residential units (separate assessments): 24,412. 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-1958—71,410. Registrar General's estimate of the child population: mid-1958—under 1 year: 780; 1-4 years inclusive: 2,470; 5-14 years inclusive: 5,200. Total child population: 8,450 (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 709 368 341 Live birth-rate per 1,000 population 10.89 Illegitimate 69 35 34 (Standardized) 8.49 Stillbirths—Legitimate 6 1 5 Stillbirth rate per 1,000 live and stillbirths 10.18 Illegitimate 2 1 1 Total live and stillbirths 786 405 381 Total Legitimate Illegitimate Infant Deaths—Legitimate 23 12 11 Illegitimate 3 3 - Infant mortality rate per 1,000 live births 33.42 32.44 43.48 Neo natal mortality rate per 1,000 live births 24.42 22.57 43.43 Illegitimate live births per cent. of total live births 8.87 Illegitimate live births per cent. of total live births 1 Maternal mortality rate per 1,000 live and stillbirths 1.27 Total M. F. Deaths (all ages) 1,171 580 591 Death rate per 1,000 population 16.40 Area comparability factors . Births, 0.78; Deaths, 0.69. (Standardized) 11.32 Marriages. The following table shows the number of marriages in St. Marylebone each year since the 1st January, 1948:— Year No. of Marriages Year No. of Marriages 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 1958 1,227 1953 1,290 The 1958 figure is 23 below that for 1957 and 141 below the average (1,368) for the previous ten years. The marriage rate in 1958 was 34.36 per 1,000 of the estimated home population. 3 Deaths. The total number of deaths (1,171) shown in Table 1, page 28, 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. Deaths in 1958 were 50 more than in 1957. The principal causes were diseases of the heart and circulatory system, which accounted for 40 per cent. of the total deaths; malignant diseases 18 per cent.; and respiratory diseases, including tuberculosis, 13 per cent. Deaths from lung cancer rose from 34 to 58 as compared with the previous year. Nearly seventy-five per cent. of the deaths registered were of persons aged over 65 and nearly twenty per cent. were aged between 45 and 65 years. Infant Mortality. Twenty-six infants died under 1 year of age (23 legitimate, 3 illegitimate), as compared with twenty-five last year (21 legitimate, 4 illegitimate), giving a death rate of 33.42 per 1,000 live births, as against 31.29 per 1,000 last year. Details showing causes of death according to age group and sex are given in Table 2, page 28. The number of deaths under one year of age was the highest since 1954, when it was 27 but no special significance can be attached to the increase. Fluctuations of this kind are almost inevitable where comparatively small groups of population are involved and 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. There was one maternal death, the first for five years. Accidental Deaths. During the year, 30 residents died from accidents of all kinds, an increase of 9 on the previous year. Of these, 11 were due to motor vehicle 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 (749), there having been 887 accidents in the Borough, resulting in 7 deaths, 109 serious injuries and 959 slight injuries. Weather. The following summary of the weather during 1958 and Table 3, page 29, are based upon information supplied by the Meteorological Office:— January.—Sunshine near normal; mean temperatures and rainfall mainly near or a little below normal. Cold spells from 19th-25th and some snow from 21st-24th. Then temperatures rose rapidly reaching 57 degrees F. in many places. The month closed foggy. February.—Sunshine about 80 per cent. of normal. Mean temperature 2 degrees F. above normal with maximum of 59 degrees F. and minimum 26 degrees F. Rainfall about 150 per cent. of normal with most between 22nd and 25th. Sleet or snow on 6 days—heaviest snowfall on 25th. Little fog. Faint Aurora on 11th. March.—Mean temperature about 4 degrees F. below normal. Rainfall variable, about 80 per cent. of normal. The 4th consecutive dry March. Sunshine near average. April.—Moderate to heavy falls of rain and snow on 4th and 5th. Rainfall was about 75 per cent. of normal. The 5th consecutive dry April. Sunshine 103 per cent. Mean temperature about 2 degrees F. below normal due to cold start—2/3 of month below normal. May.—Mainly dry and mild at first, cooler and wet later. No air frost. Normal sunshine; rainfall 123 per cent. of average. No snow or hail but two days with thunder. 4 June.—Apart from 1903, wettest June at Kew (4.08 ins.) since records began in 1856. Regent's Park had 6.35 inches, including 2.01 inches on 9th. Well over an inch fell generally on 26th. Monthly rainfall variable, about 270 per cent. of average. Four days with thunder. Sunshine about 70 per cent. of normal. Temperature 1.1 degrees below average. July.—Little rain from 4th-15th. Rain 93 per cent. of average. Sunshine 95 per cent. of average. Two warm and three cool spells with mean temperatures 0.6 degrees F. below normal. August.—Generally unsettled. Very heavy thunderstorm on 22nd. Month's rain 154 per cent. of average. 62 per cent. average sunshine. Dullest August at Kew since 1912, the only duller year since records began in 1880. Cool by day, but warm nights brought mean temperatures only a little below average. September.—Mainly very wet, but month's rainfall variable, 163-264 per cent. of normal. (Mean 205 per cent.). Wettest September at Kew since 1927. Heavy rain in places on 3rd, 5th and 23rd. Sunshine 104 per cent. of average. Temperature 2.5 degrees above normal. Nights particularly warm with no ground or air frost. Maximum of 82 degrees F. on the 5th and minimum of 41 degrees F. on 27th. October.—Changeable at first, with scattered thunderstorms but little rain from 14th to 19th. Month's rainfall 85-125 per cent. average (Mean 108 per cent.). Sunshine near or a little above normal. Temperatures 1.6 degrees F. above average. Only 1 ground frost and no air frost, with night minima near normal day maxima from 21st-24th. Maximum 65 degrees F. Minimum 35 degrees F. Mean Sea Level pressure at Kew rose to 1040.6 mb. (30.73 inches) on 23rd, the highest recorded there in October since records began in 1869. November.—Most of the month's rain fell on 1st and 2nd. Little rain after 12th. Month's rainfall about 73 per cent. average. Much mist and fog later in month, with dull weather. Sunshine about 83 per cent. average—dullest November at Kew since 1946. Mean temperature near average. First air frosts of the year. December.—Wet spells from 9th to 19th and after 26th, otherwise dry with much mist and fog. Mainly mild, especially by night, after a rather cold start. Temperatures 1.0 degrees above normal. Maximum of 55 degrees F. on 27th and 28th. Public Holiday Weather. Easter. (4th to 7th April) Coldest Easter weekend on record. No colder Good Friday since 1917. Other days coldest this century. Sleet during early hours of Good Friday gave way to sunny periods but rain returned late evening, became heavy at times, turning to sleet or snow before dawn on Easter Eve, then back to rain around midday. Cloudy and misty with fog patches later. Easter Sunday cloudy after early morning rain and drizzle: bright intervals and occasional light showers on Monday. Whitsun. (24th to 26th May) Windy with sunny periods and isolated showers on Saturday. Similar but less windy and less bright on Sunday. Wet at first on Monday but brighter later. August. (2nd to 4th August) Long sunny periods on Saturday but also scattered showers and local thunder after midday. Then cloudy with a little rain late Sunday and very early Monday. Christmas. (24th to 26th December) Apart from bright intervals on Christmas Eve, sunless. Mist and fog, thick at times, on 24th and 25th. A little rain and drizzle late Christmas evening and at times on Boxing Day. 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 Committee (Division 2). Councillor Dr. Elizabeth Jacobs. Councillor S/Ldr. S. Stanley. St. Marylebone Tuberculosis Care Committee. Councillor L. M. Laurance. The Medical Officer of Health. 5 Body Representatives Paddington Hospital Group House Committee, No. 1. Councillor H. C. Garrard. Paddington Hospital Group House Committee, No. 5. Councillor Mrs. S. Rivington. National Society for Clean Air. 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—Management Committee. Councillor Mrs. S. Rivington. Councillor Miss O. M. Stone. St. Marylebone Clean Food Association—ExecutiveCommittee. Councillor H. C. Garrard. Councillor Miss F. E. Wilson. Department of Scientific and Industrial Research—Standing Conference of Co-operating Bodies dealing with Atmospheric Pollution. The Chairman of the Public Health Committee. The Medical Officer of Health. Conferences. The Council were officially represented at the under-mentioned conferences dealing with matters within the purview of the Public Health Department:— Conference Delegates Royal Society of Health—Eastbourne, 28th April to 2nd May. Alderman Capt. R. G. Whitney, M.B.E., J.P. The Medical Officer of Health. Association of Public Health Inspectors—Blackpool, 16th to 19th September. Mr. J. E. Broadhead, Public Health Inspector. National Society for Clean Air—Llandudno, 1st to 3rd October. Councillor Dr. H. K. Ashworth, T.D. The Medical Officer of Health. National Conference on the Care of the Elderly— London, 17th and 18th April.Alderman Miss L. F. Nettlefold, M.A., L.L.B., L.C.C. 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 1958, as follows:— Organisation £ s. d. Statutory Authority Central Council for Health Education 11 11 0 Public Health (London), Act, 1936, section 298. Family Welfare Association (Area 2) 100 0 0 Local Government Act, 1948, section 136. St. Marylebone Youth Committee 75 0 0 do. National Society for Clean Air 7 7 0 Public Health (London) Act, 1936, section 298. St. Marylebone Old People's Welfare Association— "Meals on Wheels" Service, Foot Clinic, etc. 975 0 0 National Assistance Act, 1948, section 31. Assisted Holidays Scheme "Inner Wheel" Old People's Club—Rent of Hall 250 0 0 do. 26 0 0 do. Women's Voluntary Services 40 0 0 do. Care of Old People. The women public health inspectors visited 679 old people during the year. Although included in this figure were 72 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, sixty-two cases were dealt with. 6 Forty-nine 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, 392 baths were given to women and 142 to men under the scheme started in 1954 for bathing old persons at the Lisson Grove Centre. The total number of baths (534) 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 the journeys between their homes and the Centre. St. Marylebone Old People's Welfare Association. The Executive Committee of the Association (Chairman—Mrs. L. Fewster; Hon. Secretary—Mrs. K. M. Cowan, Room 103, Town Hall, St. Marylebone, W.l) has kindly provided the following information, which has been extracted from the Association's Annual Report, on work carried out during 1958 :— "The Committee has been kept in touch with the latest developments and trends in welfare, through representatives at the National Old People's Welfare Council 9th National Conference in April, through Miss Macintosh's most comprehensive reports from the Central Consultative Committee on the Welfare of the Old and through the Secretary's attendance at meetings of Secretaries of Old People's Welfare Committees in London, as well as by the useful Bulletin of the National Old People's Welfare Council. A party of Doctors studying Industrial and Public Health visited the Association in April, to study Old People's Welfare in St. Marylebone under the guidance of Miss Macintosh and Miss Sharp. It is difficult to calculate the number of old people with whom we have contact; our constituent bodies are in touch with so many and our office records cannot take into account all the people helped by the Public Health Department or the Home Help Service. Meals on Wheels.—6,058 meals were delivered during 1958, still at a charge of only lOd. a meal. An idea of the value of this work may be shown by one letter which read: 'May I as one of the very many participators of this wonderful service, send you my grateful thanks for the wonderful dinners and to the distributors who so unselfishly bring them to us no matter how vile the weather. The driver who drives the Van is of course included. I appreciate and thank you all very much for all you do for me.' 'Frood' Christmas dinners were once again kindly donated by the Mayor, and taken round on Christmas Eve by the W.V.S. to house-bound old people, who might otherwise have faced a very lonely Christmas. In October the Committee requested the Council to undertake the regular servicing and maintenance of the Van, and it soon became apparent that this change, particularly as the drivers of the Van are Council employees, would mean better service and greater economy. Luncheon Club.—The Club, managed by the W.V.S. under the leadership of Mrs. Lush, in the premises still kindly provided at a most modest rent by the Church Army, has continued to function happily and efficiently. 6,920 Luncheons were served, at a charge to the old people of lOd. each. The members enjoyed a free Christmas dinner and presents once again given to them by the helpers, whose unselfish work makes this cheerful centre a real boon to many who would otherwise find it difficult to get a hot meal. Chiropody.—2,445 treatments were given at the Foot Clinic, at a charge to the patients of Is. 6d. per treatment. We have been happy in the continued co-operation of our three Chiropodists, who always show such kindness, as well as professional efficiency, towards their patients. We also thank most sincerely Miss Cotsford, a member of the British Red Cross Society, who has dealt with the appointments for the Clinic since it opened. The Association wishes to record thanks to the L.C.C. Lisson Grove Clinic which has given 130 treatments for old ladies, thereby reducing our waiting list. 7 Home Chiropody.—591 home visits were made to people unable to get to the Clinic. 44 new patients were accepted. There is always a waiting list, but our thanks are due to Mrs. Baird and Miss Curran for all they do to make this service such a worth-while work, and also to Mrs. Simmons, of the British Red Cross Society, who acts as 'Transport.' Holidays.—During May 62 elderly people were sent in two parties for a week's holiday at Brighton. Each contributed £1 17s. 6d. towards the cost of residence in a Guest House, transport by coach and entertainments in Brighton. The balance of expense was met by the Association from the Borough Council's grant for holidays. The smooth working of this scheme owed a great deal to Miss Sharp, who accompanied the two parties and helped them settle, and to the kindness of the landladies. The Soroptimist Club of Mayfair took special interest in one old lady, enabling her to have an extra week's holiday. In addition, arrangements were made for several people to go for individual holidays to Cliftonville and elsewhere, and others were helped with fares. £20 was again contributed to the Fourth Feathers Club for their holiday at Margate, and £10 was given to St. Mark's Church, Marylebone Road, towards another holiday for old people. Clubs.—A welcome addition in 1958 was the 'Evergreen' Club started in Bell Street by the Salvation Army. The other Clubs have all had a successful year, with summer outings and Christmas parties as a popular part of their programme. Home Visiting.—An average of ten visitors attend the monthly meetings with Miss Sharp and the Secretary, when exchange of news and views is invariably useful. We have welcomed four new visitors, but have lost two old friends who have moved away from London. The co-operation of local Churches in this field is invaluable in ensuring a complete approach to old Peoples' needs. The Church of All Souls still has the largest group of Visitors. Fuel.—20 deliveries were made from the emergency service of delivering 28 lbs. of coal. £5 10s. of gift money was also spent on providing fuel direct from the merchants. Relief.—Owing to the need for economy, it was not possible to do quite so much in relief as during the previous year, although each emergency was met. Most items of help were small, e.g., fares, locks and keys, wireless repairs, but a gas fire was provided in one case and in another instance help was given with a coal bill in arrears. Wireless.—11 new sets were obtained from the ' Wireless for the Bedridden' Society, who also kindly provided the first licences in some cases. In other cases the Mayor generously gave the licences. 26 sets were on loan at the end of the year; some had been returned because of the death of old people. Miss Sharp supervises the care of sets on loan, which are of course a source of untold pleasure. Fireguards.—As a result of the L.C.C.'s offer to lend and fit proper fireguards to necessitous households, on the recommendation of appropriate organisations, the Association has been able to arrange for the provision of several guards for old people. Entertainments.—The Distillers Drama Club invited 30 of our old people to a play at the Rudolf Steiner Hall. The Berkshire Association of Mixed Clubs also sent tickets for their Drama Festival. The Sports and Social Club of the Central Office of Information gave a most enjoyable show and tea party for 100 old people in April. In July, by kind permission of the M.C.C., two days' 'Cricket at Lords' were again arranged, and about 300 old people attended each day. These arrangements were undertaken by Miss Macintosh, with the wonderful help of the W.V.S., who coped with all the teas, the money for these having been collected by a member of the M.C.C. The Women's Institute of Wye, Kent, entertained a coachload of our old folk for a delightful visit, sending them home laden with country produce. In December, Lady Colwyn invited 18 old people to tea and a Dress Rehearsal of the Coliseum pantomime, which was immensely enjoyed. Just before Christmas, Mrs. Lew Grade repeated her wonderful Christmas party, inviting 500 old people to a Tea and Cabaret show at the Seymour Hall. Everyone had a carrier bag full of presents, plus a slice of Christmas pudding which had been presented by Australian Fruitgrowers through the Lord Mayor of London. The Association provided the names for the party and once again the W.V.S. and other helpers at the various Clubs assisted with the tea. 8 Library.—The delivery of books to the housebound, instituted by the Public Libraries Committee last year, has been carried out regularly by library staff, with the co-operation of the Home Help Service. Eighteen old people are now receiving this service and some 2,500 books were delivered to them during the Council's year 1958/59." 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. Fortunately during 1958 there were no such cases. Staff Medical Examinations. The Medical Officer of Health is medical adviser to the Council for staff purposes. During 1958, one hundred and five examinations of the Council's employees and new entrants to the superannuation scheme 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 22, page 36. SECTION C.—SANITARY CIRCUMSTANCES Sanitary Inspection. The Borough is divided into five areas each of which is dealt with by a district public health inspector. Inspection of dwelling-houses is dealt with on page 15 and in Table 4, page 30. Excluding rat and mouse infestations, 1,030 complaints were received and details of the 1,120 various nuisances detected and remedied are shown in Table 5, page 30. Notices.—Intimation notices numbered 297, and 105 of these were followed by the service of a statutory notice to secure abatement of nuisances. In addition, seventeen notices were served under Byelaws made under the Metropolis Management or Public Health Acts, and one under the Prevention of Damage by Pests Act, 1949. Legal Proceedings. No legal proceedings under the provisions of the Public Health (London) Act, 1936, were necessary. Noise. Forty-three complaints of noise, involving thirty-four 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. 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, an extractor fan, noisy dogs, night baking, an electrical transformer and generator, low-flying aircraft and a water waste preventor. 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 9 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 1958 fourteen complaints of this type of nuisance were investigated but it was only found necessary to refer four cases to the pigeon catcher. Water. Although at a small number of blocks of flats and offices water for domestic purposes is obtained from private wells, the chief source of a constant supply throughout the Borough is from the mains of the Metropolitan Water Board whose Director of Water Examination has kindly provided the following information:— "The water supplied by the Board to the borough is derived from the River Thames. It is purified in the Board's reservoirs at Littleton, Staines and Walton and filtered and chlorinated at the Board's Works at Hampton, Barnes and Barn Elms. Samples are collected at every stage of purification, at least five days a week, and the water has been of satisfactory hygienic quality throughout 1958." In no case was it necessary to draw the attention of the Board to the quality or quantity of the water, although one complaint was made of the quality of the water at a dwelling house. On inspection, however, it was found that the supply was wholesome but that it came via a storage tank which required cleansing. A notice was served on the owner of the house who decided to dispense with the tank and had the supply connected directly to the mains. Twelve other storage tanks at various premises were found to require cleansing and in all cases the necessary work was done following service of notices. There were no notifications by the Board under the provisions of the Public Health (London) Act, 1936, of instances where it had been necessary to withdraw the supply of water from occupied premises. 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 1958 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. Drainage—Alterations and New Buildings. Of the 243 drainage plans approved during the year, 32 were in respect of new buildings. Upon request, the Borough Engineer examined 71 sewer connections and 14 of them were found to be defective and had to be renewed. The two drainage inspectors made 3,229 visits and no circumstances were found which necessitated legal proceedings. Combined Drainage. Six orders under seal were issued in respect of combined drainage operations. Town Planning. Observations were made on 96 plans submitted to the Council under the Town and Country Planning Act, 1947 and referred to the Department. Rodent Control. There were 343 notifications of rat infestations at premises in the Borough, a reduction of 11 on the previous year's figure of 354. Although only slight, this reduction follows the trend of a gradual annual decline in the incidence of rats since the year 1953 when the total was 595. Notifications of mice totalled 287,12 more than during the previous year, but taken over a period of the last five years there has been a slight decline, the total figure for 1953 being 337. Block surveys were continued throughout the year as a measure of control and to guard against possible failure of occupiers to notify the presence of rats. Thirty-four blocks were surveyed and test baited. This involved 1,023 premises and 11 rat and 4 mouse infestations were discovered and dealt with. All were localised and of a minor character. 10 In April, as in previous years, sewers throughout the Borough were baited for rats and the results indicated that there was little change in the numbers of the rat population. It was felt, however, that more should be done to reduce this apparently static infestation to a lower level. During the summer season, therefore, in co-operation with the Borough Engineer, experiments were carried out in the sewers of a selected small area with the object of evolving improved anti-rat methods. During the course of these experiments the Ministry of Agriculture, Fisheries and Food who were consulted from time to time, showed much interest in the work and especially in a cheap type of covered bait container designed specifically for use in sewers. Early results would seem to justify an extension of these new methods to sewers throughout the Borough but as experimental work was still in progress at the end of the year no definite conclusions could be given and it will be necessary to wait until after April, 1959, before making a final assessment of the value of the scheme. Occupiers and owners of premises visited by the rodent control officer were co-operative in acting on suggestions he made to them and it was necessary to serve only one statutory notice and 23 informal written notices. A summary of infestations and treatments given is shown in Table 10, page 32. Disinfestation. To rid dwelling houses of bugs, a spray of Kerosene with 5 per cent. D.D.T. and 0.1 per cent. 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, 276 rooms were disinfested, including ten 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 1958 the furniture of 56 families, of whom 53 were being rehoused, was treated by this method. In addition 741 verminous articles of bedding were disinfested by steam. A small steam disinfector situated in the cleansing of persons section of Welfare Centre No. 2 is used for the treatment of all articles up to the size of a single mattress. Arrangements 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 have worked most satisfactorily. Verminous Persons. The Council's Cleansing Station in Lisson Grove dealt with 861 verminous persons: adults 626 (men 566, women 60); children 235 (boys 44, girls 191). 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. Clean Air continued to be a subject of public interest and there was another increase in the number of complaints received. These totalled 158. During 1,299 casual observations dark smoke necessitating timed observation was seen on 41 occasions. Offenders were served with informal notices, warned by letter or cautioned verbally. Some complaints were occasioned by the smoke arising from garden bon-fires and from burning timber and refuse on building sites. Not only are such practices traditional but the burning of infested or infected materials has been encouraged in the past. It is only when smoke arising from fires of this nature becomes a nuisance to the inhabitants of the neighbourhood within the meaning of the Clean Air Act, 1956, and the Public Health (London) Act, 1936, that an offence is committed. The first Smoke Control Order came into operation on 1st October. It was well supported by the residents of the district concerned, St. John's Wood Terrace Ward, and no complaints regarding infringements of the Order were received. The procedure for paying grants to owners and occupiers operated smoothly but in consequence of late application or delays in carrying out necessary work all claims were not settled by the end of the year. 11 On 5th June, 1958, the Council made a second Smoke Control Order in respect of Lord's Ward, operative as from 1st October, 1959. A survey of Hamilton Terrace Ward was commenced in preparation for the consideration by the Council of a third Order during 1959. Section 3 of the Clean Air Act, 1956, requires that the Council be notified of proposals to install new furnaces. Sixteen such notifications were received and in eight cases application was made for the Council's approval of the appropriate plans and specifications. Approval was given in two instances and six applications were outstanding at 31st December. Atmospheric pollution was continuously measured at five sites within the Borough and the information obtained was sent regularly to the Department of Scientific and Industrial Research. The statistics are shown in Tables 7, 8 and 9, page 31. Factories. There were 1,927 factories on the register at the end of the year, 29 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 11 and 12, page 32. Outworkers. Seventy-seven employers submitted lists in respect of a total of 737 outworkers (140 contractors and 597 workpeople). Of these, thirty-four contractors and twenty-four workpeople operated in the Borough. The nature of the different classes of work and the numbers of outworkers engaged is indicated in Table 13, page 33. Fireguards. Inspection continued under the provisions of the Heating Appliances (Fireguards) Act, 1952. Of the comparatively few heaters that were found not to comply with the requirements, the majority were second-hand and the main fault was inadequate guards. Four notices were served and in each case the vendors immediately withdrew appliances from sale or fitted new guards and sought approval before again displaying for sale. No legal proceedings were necessary. It is to be noted, however, that auctioneers can still legally sell heating appliances which do not comply with the Regulations unless they do so as agents for someone whose normal business is the selling of heating appliances. This loophole in the Act leads to administrative difficulties and in some degree defeats the aim of legislation designed to safeguard the users of these appliances from accidents. Hairdressers and Barbers. The Council's Byelaws regulating these establishments came into operation on 18th December, 1955. There are in the Borough 132 registered hairdressers and barbers and 97 inspections were made. One notice was served but otherwise 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, eleven of which were issued during the year. A few of the licensees kept 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 who made 27 visits and inspected weekly the stalls licensed to sell pets in the street markets. Conditions under which the livestock was kept were reported as satisfactory. Poisons. At the end of the year the names of eighty-four traders were on the Council's list of persons entitled to sell poisons included in Part II of the Poisons List (Pharmacy and Poisons Acts, 1933-1941). Details of the premises concerned are given in Table 14, page 33. Protective Helmets. The Motor Cycles (Protective Helmets) Regulations, 1957, makes it 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 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. 12 Five premises in the Borough where these helmets are sold were kept under observation but no sub-standard helmets were found. 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. Because of staff shortages and other difficulties and in order to maintain the services it was sometimes found necessary to leave some of the conveniences temporarily unattended, but no vandalism occurred. Now established in its tenth 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 materials dealt with during 1958 were: house and trade refuse, 34,710 tons, street sweepings and gully slop, 2,551 tons, salvaged materials, 2,037 tons. A sum of £11,050 was obtained from the sale of salvaged materials. In addition, £1,440 was received for the removal of trade refuse and for the cleansing of petroi interceptors, etc. 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 all streets swept at least once daily. The remaining vehicles of a fleet of eleven diesel-powered tractors and ten trailer bodies for the refuse collection service, some of which had been put into commission at the end of 1957, were brought into service. An additional diesel-powered refuse container vehicle of improved type was purchased for the removal of portable containers from new blocks of flats and offices which continue to be erected in the Borough. Two new diesel-powered mechanical sweeping machines of modern design were also purchased to replace obsolete machines and put into operation during the year. The new machines are very compact and their short wheel base gives increased manoeuvrability which is of great benefit in the heavy traffic experienced in some parts of the Borough. In addition, they are able to sweep narrow streets and mews in which the previous machines could not be used. Radio transmitting and receiving apparatus has been installed in certain vehicles, ensuring prompt action during emergencies, such as road accidents and snowfalls, and resulting in a reduction in the size of the vehicle fleet." Rag Flock and Other Filling Materials. The Rag Flock and Other Filling Materials Act, 1951, is intended to ensure that the fillings for upholstered and other stuffed articles shall be clean and wholesome. Standards of cleanliness are laid down in Regulations made under the Act, which also provides for licensing of premises where the fillings are manufactured or stored, and registration by the local authority of all business premises where these materials are used. No premises in St. Marylebone are licensed for manufacture or storage but ten premises, mainly those of upholsterers and manufacturers of cushions and pillows, are registered. Samples of hair and other filling materials taken during the year complied with the statutory requirements. 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 the body of any person who has died or been found dead in the Borough, where no other suitable arrangements for disposal have been or are being made. Sixteen burials and five cremations were arranged during the year. Mortuary. Four bodies were received into 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. 13 During the year two certificates were issued in respect of bodies being transported to Italy and Iraq. 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, 1,845 certificates authorising cremation were issued. Since December, 1937, when the Crematorium was opened, 17,199 cremations have taken place. Dog Nuisance. The Council's bye-law dealing with this nuisance provides that:— "No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway." Although it has been shown that dogs can carry and excrete germs capable of producing illness in man, cases of human disease can seldom be positively related to infection from this source. However, there are many obvious objections to fouling of the footway by dog excreta and not least amongst them is the attraction to flies and blowflies with the consequent hazards to health. During the year, contraventions reported by the Streets Nuisance Inspector and the Police resulted in eleven summonses. In ten of these, convictions were secured and penalties imposed and in the other, a Police case, the summons was not served. Street Photographers. A local bye-law, made by the Council under section 146 of the London Government Act, 1924, came into operation on the 1st August, 1952, prohibiting the importuning by a street photographer of any person, in certain prescribed streets or public places, for the purpose of taking or selling any photograph. An offender against the bye-law is liable on summary conviction to a fine not exceeding £5. As the administration and enforcement of most other "good rule and government" bye-laws have been referred to the Public Health Committee, a similar course was followed in regard to this bye-law, more particularly as the officers of the Department, including the Streets Nuisance Inspector, are continually about the streets. During 1958 the Council took out nine summonses and in each case obtained convictions. Fines and costs amounting to £33 8s. Od. were imposed. SECTION D.—HOUSING Permanent Estates. The Town Clerk has kindly supplied the following information regarding housing accommodation provided by the Council up to 31st December:— No. of Flats Pre-War Estates— Crawford Place Dwellings 52 Fisherton Street Housing Estate 130 Post-War Estates— Barrow Hill 172 Church Street 140 Winchilsea House 23 Townshend 222 Abbey Road/Boundary Road 54 Hamilton Terrace 52 Queen's Terrace/Pembroke Terrace 38 35/55, Boundary Road 48 55/73, Boundary Road 36 Wellington Road 121 147/149, Gloucester Place 10 1/7, Aquila Street 6 Abercorn Place 34 17-19, Balcombe Street 4 22-30, Balcombe Street 14 Townshend Road 8 147/165, Lisson Grove 12 1,176 14 At the close of the year, the following additional sites were in course of redevelopment for housing purposes:— No. of Flats Church Street Extension 76* Demolition work commenced during the latter part of the year. Aquila Street Extension 23 Structure completed; Internal work in progress. Abercorn Place/Violet Hill 22 Approaching completion. 40/47, Chapel Street 20 † Newcourt Street 48‡ Demolition works completed and tenders accepted for these schemes. 9/25, Cochrane Street 32 Sketch plans approved. Broadley Street/Penfold Street 28 Preparation of plans in progress. * With shops below. † With offices on ground floor. ‡ One-room flats. Slum Clearance. The position at the close of the year in regard to the Council's slum clearance programme was as follows:— Ashbridge Street.—One property purchased by voluntary negotiations. Compulsory Purchase Order for remainder to be made in January, 1959. Freshwater Place and Homer Row.—Two premises purchased by voluntary negotiation. Compulsory Purchase Order for remainder to be made during 1959. Mulready Street Area.—Compulsory Purchase Order made and submitted to Minister of Housing and Local Government for confirmation. Wells Buildings Burne Street Abbey Gardens Mews Rathbone Street Clearance Orders to be submitted to the Minister of Housing and Local Government early in 1959. Clipstone Street.—The possibility of developing part of the area bounded by Carburton Street, Cleveland Street, Clipstone Street and Gt. Titchfield Street is being examined. Three unfit dwellings in the area, which were included in the slum clearance programme, were closed. Factory-made Bungalows ("Prefabs"). Twenty-four families are still in this type of accommodation. Requisitioned Premises. The number of residential units held under requisition continued to decline in accordance with the approved programme which envisages the end of requisitioning by 31st March, 1960, the statutory date for the expiry of the Council's powers. The total number of units held at the end of the year was 364. Ten units formerly requisitioned were purchased or leased and 99 premises (176 families) were transferred to the owners. The total number of requisitioned units released during the year was 160. Housing of Old People. It is proposed to utilise a proportion of the one-room flats to be erected at Newcourt Street for old people. Discussions are proceeding (a) with representatives of the St. Marylebone Almshouses with a view to co-operation in the modernisation of the Almshouses and (b) in respect of improvement grants with representatives of (i) the Christian Union Almshouses for modernisation; (ii) the W.V.S. for the conversion of Dorset Chambers, Chagford Street into 16 self-contained flats; and (iii) the Ladies' Home for Gentlewomen at 41, Abbey Road, N.W.8, for improving, modernising and extending the premises. 15 Housing Acts, 1949-58. Loans.—The Council have continued to use their powers during the year by agreeing to make loans to approved applicants. Two loans have been granted, totalling £4,345 to enable the applicants to purchase a house each for their own occupation. Improvement Grants.—The Council have also offered grants to private owners for the conversion and improvement of existing houses and grants totalling £1,203 were made (i) to the St. Marylebone Housing Association in respect of three properties to enable them to improve the premises by providing additional amenities and (ii) to an approved applicant for the conversion of a property into two maisonettes. 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 4, page 30. Certificates of Disrepair. Applications for the issue or cancellation of certificates under the provisions of the Rent Act, 1957, were dealt with by the Town Clerk and referred to the Medical Officer of Health for investigation. 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. Statistics relating to these matters are shown in Table 6, page 30. Rehousing—Medical Certificates—Closing Orders. The Medical Officer of Health receives requests from the Borough Council's Housing Director for reports and advice on the housing conditions and the health of persons applying for rehousing. One hundred and eighteen 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, additional points were recommended. Closing orders were made on 30 rooms and where the occupiers could not be given alternative accommodation immediately they received additional points increasing their degree of priority for rehousing. Until they can be provided with other accommodation the operation of the closing orders remains in abeyance. Land Charges Act, 1925. The Town Clerk referred 1,520 enquiries to the Department requiring details of any outstanding notices, orders or other restrictions on the properties concerned. This was an increase of more than 200 on the previous year's figure. 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 1958, 378 samples of food and drugs were examined. Of these 23 were taken formally and 355 informally. 16 The number adulterated or incorrect in some other manner was 56. The incidence of adulteration may be classified as follows:— Number of samples examined Number of samples adulterated Milk 51 4 Other foods 308 45 Drugs 19 7 A sample of milk was reported as inferior because it possessed a faint taste of disinfectant, although this could not be detected by chemical tests. It was thought possible that the milk may have been placed near some disinfectant. A milk bottle was found to contain portions of disintegrated advertisements, and the milk was tinged slightly blue. The milk contained 80,000 bacteria per ml. but B. Coli were absent from 0.1 ml. In view of this low count it was probable that the advertisement slips had been in the bottle when it was washed. Another milk bottle contained a deposit of plaster of Paris at the base which had not been washed out before filling the bottle. Three samples of milk contained less than 8.5 per cent. of milk solids not fat. The results were respectively 7.86 per cent., 8.34 per cent., and 8.35 per cent. of solids not fat. A sample of Cheese Spread which was stated to be prepared from cheese, non-fatty milk solids and emulsifying salts was incorrectly labelled. It contained 50.0 per cent. total solids, and the fat on the total solid matter was only 43.8 per cent. less than the fat contained in a full cream milk cheese. The claim that the spread contained cheese and butter implied that the milk fat should be greater than that of ordinary cheese. The ingredients should have been declared as 'partially skimmed milk cheese, butter, non-fatty milk solids and emulsifying salts.' A Buttered Cheese Spread contained 29.1 per cent. of fat, and assuming that it contained 15 per cent. of added butter, the original cheese spread could have contained only 19.4 per cent. of fat. The spread was claimed to contain 15 per cent. of butter over and above the fat contained in the spread sold by the same name without the addition of butter. A sample was labelled as 'Triple-Creme Chambourcy 75 per cent. M.G.' 'M.G.' is the abbreviation of the French for 'fatty matter' and in France is claimed to mean 'Calculated on the dry matter.' The average Englishman would not know this and it is doubtful whether the French public realise the intention. Examination showed 75.2 per cent. of fat on the dry matter, but, as the cheese also contained 56.2 per cent. of water, the fat was in reality only 33 per cent. in the cheese as sold. Some Valmeuse Cheese was labelled as 50 per cent. 'm.g.' It contained 49.6 per cent. of fat on the dry matter, but again the label should have specified that the 50 per cent. of fat was calculated on the dry matter. Another sample of Cheese with Ham was labelled only in German. The illustration represented a cheese and ham only, whereas the product contained cheese, beef, and ham. This sample was stated to contain 30 per cent. 'fett i.T.', the 'i.T.' being also an abbreviation for 'on the dry matter.' Some Mainzer Cheese contained only 0.85 per cent. of fat, 30.8 per cent. protein, and 62.2 per cent. water, and should, therefore, have been labelled as a Skimmed or Separated Milk Cheese. Formerly Mainzer Cheese was made from partially skimmed milk only. A product was submitted as 'Smatana,' but this name could not be traced among the literature on foods, although it was thought to be a well known product in Poland sold as 'Soured Cream.' If this was intended to be soured cream it must comply with the requirements of the Cream Order and contain not less than 18 per cent. of butter fat, whereas only 13.4 per cent. of fat was found. Moreover as Smatana is not a recognised name in England the ingredients must be disclosed. The ingredients of a Sandwich Spread were not in the correct order, and one of them was described as 'Glutamate' instead of as 'Sodium Glutamate.' A sample of Butter Zwieback was claimed to contain 9.1 per cent. of butter, whereas only 7.1 per cent. of butter was present. Two samples of Chocolate Biscuits were incorrectly labelled as 'Milk Chocolate.' The manufacturers had previously agreed to change their label. A Chocolate Cake Coating had the composition correctly declared, but it was prepared with another vegetable fat, which is not a constituent of chocolate, instead of cocoa butter. The manufacturers must therefore call it 'Cocoa Cake Coating,' or alternatively the fat must be changed to consist of a mixture of cocoa butter and milk fat. 17 A Milk Diet Supplementary Food powder failed to comply with the Labelling of Food Order inasmuch as the ingredients were not properly disclosed. A Sauce contained 700 parts per million of benzoic acid, whereas the maximum quantity permitted in a pickle or sauce is 250 parts per million. A Cake called 'Coffee Jap Pastry' contained no caffeine. It was coloured essentially to resemble a coffee colour, but contained insufficient flavouring to warrant the description. A Loaf contained large holes lined with brownish matter from which it appeared that the yeast had been mixed with wholemeal flour and then not kneaded properly into the dough. Some Honey was incorrectly labelled. On one label it was described as 'Jamaican Honey' and on another as 'Product of England.' Two samples of Rice possessed an objectionable odour and flavour and were considered unsuitable for sale, but no mould mycelium could be detected by microbiological examination. It was thought that the rice might have been stowed on board ship with some highly flavoured material, or that it might have become slightly moulded before being processed, when the visible signs would disappear. Some Majoram Powder contained 22 per cent. of ash and 7.3 per cent. of sandy matter, indicating that the percentage of adherent earth was far too great. The total ash should not be more than 10 per cent. A sample of Coarse Oatmeal was labelled as 'Hoobergritz,' one of Buckwheat as 'Kasha,' and a fish cake as 'Gefilte fish.' All three samples therefore contravened the Labelling of Food Order which requires food to be labelled with its common or usual name. Some Apples contained 3.5 parts per million of arsenic and 12.5 parts per million of lead, both of which quantities are excessive. Some canned Apricots were examined because of a complaint that they contained black material at the base of the can. The syrup and the apricots had been overheated in contact with the tinned iron of the can, and in burning some of the tin from the tinplate had been taken up into the charred sugar. A sample of Peaches was stated to be canned in Rich Syrup, but the sugar in the syrup was 12.4 per cent w/w only, and the description 'Rich Syrup' was therefore incorrect. A Blackcurrant Syrup contained only 4 milligrams of vitamin C per 100 grams of syrup, and was therefore 90 per cent. deficient in vitamin C. Another sample of Blackcurrant Syrup was labelled 'Dilute 1 part syrup with 4/5 parts soda water or water. Diluted with hot water makes a delicious winter drink or a sleep inducing nightcap.' As these samples were labelled 'Blackcurrant Syrup' without any qualification your analyst feels that they must comply with the requirements of Blackcurrant Syrups of the British Pharmaceutical Codex and contain about 40 per cent. of blackcurrent juice and not less than 55 milligrams of vitamin C per 100 grams of syrup instead of complying merely with the Soft Drinks Order. A portion of Meat Pie contained a dark area which was due to the use of meat probably derived from the muscle tissue at the entrance to the mouth of the animal. It is not illegal to use any part of the head of an animal in open meat products, nor does the Prohibited Offals Order apply to cooked meat products, but it is felt that this discoloured meat was not of the quality expected. A pork pie contained a greenish discoloured area which was thought to be due to some coloured material picked up during manufacture. A foreign object stated to have been found in a mushroom pie consisted of a piece of chalk. According to the Preservatives in Food Regulations minced beef must not contain a preservative, but five samples examined contained respectively 140, 200, 930, 1,060 and 4,420 parts per million of sulphur dioxide. The description 'Steaklets' for a Vienna steak type of product was considered to be unsatisfactory. Some canned 'American Hamburgers' with Gravy contained 7 per cent. of filler, as packed, but without the gravy, or between 10 and 12 per cent. as calculated on the weight of meat present American law and Canadian law are much the same, the Canadian definition of a hamburger is that it shall consist of comminuted beef with flavouring, and it is illegal in the States to add to a hamburger more cereal than will produce 4 per cent. of reducing sugars. The contents of a can of luncheon meat, which was bulging at the sides before opening, were unfit for consumption and contained 100,000,000 bacteria per gramme. Another luncheon meat contained only 56 per cent. of total meat. In your analyst's opinion luncheon meats must contain not less than 80 per cent. of meat. 18 Two samples of sausage rolls contained respectively 15.5 and 8.5 per cent. of meat only. Your analyst is of the opinion that sausage rolls must contain not less than 20 per cent. of meat. Some sausages in a cellophane wrapper were badly contaminated with a growth of Aspergillus glaucus mould and also of yeast on the surface. The active ingredients only of a sample of liver pills were declared as though they were the total constituents thus contravening the Pharmacy and Medicines Act. Several samples of homoeopathic preparations were examined and the claims made for them were considered to be misleading. The declarations of ingredients were given according to homoeopathic nomenclature and system, but claims were made for food supplements which were not present in the quantities necessary for the claims. The declaration of the mineral constituents was not in accordance with the requirements of the Labelling of Food Order. New Food Legislation. The year 1958 probably witnessed less fresh legislation for food and drug administration than any year since the outbreak of the 1939 war. The Public Health (Preservatives, etc., in Food) Regulations. The most important changes affected the Preservatives Regulations. The Public Health (Preservatives, etc., in Food) (Amendment) Regulations, 1958, and The Public Health(Preservatives, etc., in Food) (Amendment No. 2) Regulations, 1958, permit the treatment of certain fruit with anti-mould agents. Fruit has for long caused trouble owing to its perishable nature and consequent attack by moulds between collection and consumption. With greater dependence on foreign imports and with the food laws of other countries permitting what are considered to be harmless quantities of preservatives on the skins of fruits this country has been more or less forced to come into line. As a result the fruit named below may now contain the following preservatives:— Citrus fruits— Diphenyl not more than 100 parts per million or Orthophenylphenol not more than 70 parts per million or proportionate quantities of the two together. Orthophenylphenol in Apples, Pears and Pineapples not more than 10 parts per million Peaches not more than 20 parts per million Melons not more than 125 parts per million. and foods made with any of these fruits may contain proportionate quantities of these permitted preservatives, except that foods containing melon may not contain more than 10 parts of orthophenylphenol for every million parts of melon in the food. It is difficult to understand why melons are permitted to be treated with 125 parts per million of orthophenylphenol. The skin of melons, like that of the related squash families, is hard, and therefore more resistant to attack than that of many other fruits, but the melon is a very juicy fruit and many consumers of melon are apt to spoon up the juice from their plates, thereby consuming a large proportion of the preservative. It does not seem to have been realised, moreover, that the area of the skin of a fruit is proportional to the square of the radius, whereas the weight, or volume, is more or less proportional to the cube of the radius, so that the larger the fruit the less should be the quantity of preservative in parts per million required to cover the area of the skin. The Anti-oxidant in Food Regulations, 1958. These regulations provide for the sale and importation of certain foods, which contain propyl, octyl, and dodecyl gallates, butylated hydroxyanisole and butylated hydroxytoluene within certain limits. Essentially these regulations permit the addition of these compounds to anhydrous edible oils and fats, to vitamin oils and concentrates, to butter for manufacturing purposes, and to essential oils and their flavouring constituents. Since ingredients are allowed to contain anti-oxidants provision is made for the resultant foods to do so. With our present knowledge it is extremely difficult to determine the quantity of anti-oxidants in oils and the difficulty of doing so in prepared foods is much greater. There has been a considerable amount of discussion as to whether legislation should or should not be enacted before it is capable of being fully implemented, but if one were always to adopt the practice that legal requirements must follow the development of scientific knowledge to enable their ready enforcement, food laws would lag even further behind than they do at the present time. It is generally found that science manages to catch up with legislation and public analysts owe much to the willing help received from their colleagues in industrial laboratories for information on some of these delicate matters. 19 Labelling of Food (Amendment) Regulations, 1958. This amendment revokes Article 8 (d) of the Labelling of Food Order, so that alcoholic cocktails need no longer contain 40 per cent. of Proof Spirit, but they will need to be labelled with the quantity of spirit which is present. Copper in Foods. The Ministers of Agriculture, Fisheries and Food, and of Health duly considered the Report of the Food Standards Committee and decided not to issue any fresh Regulation, but recommended limits, which they hope will be adopted. In general it has been found that recommendations of this type are accepted for enforcement purposes and are not disputed by trade interests. Tea Examination. Greater vigilance is necessary regarding the purity of tea following the issue of Circular FSH 16/58, informing Local Authorities that H.M. Customs and Excise have discontinued sampling tea on importation for adulteration and unfitness, but it is not anticipated that this will cause any inconvenience to normal sampling and analysis. The Therapeutic Substances (Supply of Substances for Analysis) Regulations, 1958. These regulations came into force as the result of an oversight in the drafting of the Therapeutic Substances Act, 1956, and enable public analysts and others likely to be responsible for testing products containing antibiotics, to obtain samples for control and for test. 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 and after consultation with the manufacturers concerned the labels were revised or corrected in all cases. The remainder, which involved no very serious contraventions, nor showed evidence of intended fraud, were dealt with informally, the goods being either withdrawn from sale or surrendered. It was not necessary to institute any legal proceedings. Unsound Food. The total quantity of food surrendered as being unsound and unfit for human consumption was approximately 30 tons. A large part again consisted of canned goods including imported meats, fish and crab. The Public Analyst considers that more efficient processing might reduce the present number of failures. No very large consignments which called for special action were involved. When destruction on the premises was impracticable, the food was sent to a central refuse disposal depot at Westminster. Milk. There are 84 registered premises from which milk is sold and 19 milk roundsmen operate in the Borough from shops or depots elsewhere. A total of 205 inspections were made. During the year, 280 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. Details are given in Table 15, page 33. The average composition of the 47 genuine samples of milk analysed was: total solids 12.38 per cent.; fat 3.66 per cent.; solids not fat 8.72 per cent.; as compared with the legal minima, namely, 11.50 per cent.; 3.00 per cent.; and 8.50 per cent. respectively. Seven 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. Other samples of milk examined by the Council's Bacteriologist numbered 58 and all were found to comply with the requisite standards. Ice-Cream. 1 wo premises are registered for the manufacture of ice-cream and 233 for sale and storage. Details of the classes of premises are given in Table 16, page 34. Seven samples of ice-cream were examined by the Council's Bacteriologist, with the following results: Grade I—5, Grade II—2; seven samples submitted for chemical analysis were also reported to be satisfactory. 20 The quantity of ice-cream sold in the United Kingdom increases each year and it is estimated that more than 100 million gallons of ice-cream are now manufactured annually. Preserved Food. There are 126 premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale; 268 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 34. Catering Establishments. There are in the borough 740 premises of this type, details of which appear in Table 17, page 34. During the year 1,642 inspections were made and, generally, the caterers concerned were co-operative with the officers of the department in their efforts to maintain improved conditions in the storage, preparation and serving of foodstuffs. There was evidence among some proprietors and staff of these establishments of a growing realisation of the need for good hygiene. Unfortunately, however, there were many instances of failure to maintain satisfactory standards within a short period of such standards having been achieved by some special effort, and constant supervision by the Public Health Inspectors is necessary. In one particularly bad case, after due warning, legal proceedings, under the provisions of the Food Hygiene Regulations, 1955, were taken against the proprietor for running a food business in insanitary premises. The Court made an order disqualifying the defendant from using the premises as a catering premises for a period of two years and imposed fines (on 15 summonses) totalling £62. Food Inspection and Hygiene. Fifty years ago the Council, on the advice of the then Medical Officer of Health, Dr. Meredith Young, decided it was necessary to appoint a Sanitary Inspector "to give undivided attention to the safeguarding of the public food supply." Since that time, among the many changes which have taken place is the great increase both of the number of premises where food is sold or handled and of the legislation to control its composition, production, marketing and handling has greatly increased. Over the years adulteration ot food, in its more audacious forms, became less common and the enforcement of minimum legal standards removed public anxiety. Following this, the public gradually awakened to the need for clean food, and the recent Food Hygiene Regulations were designed to secure this end. The Regulations were made under the Food and Drugs Act, 1955, but are primarily concerned with the protection of the public health. Even at this early stage, the temper of opinion on food hygiene indicates that there exists a growing impatience among the public. They want food to be produced, stored, handled and sold in a clean environment for the sake of cleanliness itself but achieving these conditions is sometimes impeded by having to prove that the public health is endangered. The number of cases of food poisoning notified nationally is still very high and probably only represents a small proportion of those actually occurring. Education of food handlers in the reasons for observing hygienic practices can make a worthwhile contribution in curbing this high incidence. Unfortunately, however, much of the work in the food industry, particularly the retail trade, is so unrewarding and unattractive that many of the employees are below the standard desirable for food handlers. Many of them display little sense of responsibility and seem incapable of appreciating their obligations under the Regulations. Therefore, our principal weapons in the fight against food poisoning are still regular inspection and supervision to ensure the maintenance of a high standard in all food premises. In St. Marylebone the day-to-day enforcement of food hygiene requirements is the duty of three Inspectors. Two are responsible for supervising the catering establishments and the other is both food sampling officer and hygiene inspector for all retail, wholesale and manufacturing food premises. It is necessary for them to make regular visits to the 1,341 food premises and failure to do this results in a rapid deterioration in conditions while regular visits by Inspectors are found to stimulate proprietors to sustain their efforts. The number of visits is, however, limited by the detailed inspection necessary and the need to observe operations in progress in a food room, both time-consuming tasks, and by the fact that discussions can often only be held during brief spells between customers. Self-service shops have increased nationally from approximately ten in 1947 to probably more than 10,000 now. This trend has resulted in the majority of foods being pre-packed with the attendant hygienic advantages. The small grocer in the side street, in a desperate attempt to maintain his trade, often introduces self-service in a modified form. The introduction of deep-freeze display cabinets enables him to extend his scope to fresh meat and fish products. Together with the growth of pre-packaging there has developed amongst the purchasing public an individual brand preference in almost every labelled product. It is often the attempt by the small trader to cope with this selective 21 purchasing that makes his stock-keeping so complex. Too frequently the stock room is found to be congested with boxes and cartons stacked to the ceiling and leaving little or no passage room ; this situation makes cleaning impossible and impairs lighting and ventilation. The condensation units of the deep-freeze cabinets generate considerable heat and when the units are sited in the stock room they further detract from the ideal of a cool, well lighted and ventilated place for the storage of food. Unfortunately, these circumstances are often to be found in the basements of grocers' premises where the remedy presents real problems. Display for sale of open food without adequate protection, particularly cooked meat and products containing eggs and milk, though obviously undesirable, present difficulty in proving risk of contamination. These aspects, together with the alleged sales resistance that glass screens are said to offer, continue to be subjects of contention between inspector and shopkeeper. Food Stalls. During the year food was sold from 95 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. Under the provisions of section 54 of the Factories Act, 1937, a local authority is required to examine, every fifth year, all basement bakehouses for which a certificate of suitability has been issued. For this purpose a special survey was made of the three basement bakehouses remaining in the Borough, in addition to the routine inspections made periodically throughout the year. As a result, one certificate of suitability was renewed, after certain work had been done, and the proprietors of the other two establishments were given notice of the Council's intention not to issue further certificates of suitability in respect of their premises. Fifty years ago there were 75 basement bakehouses in St. Marylebone and until just before the last war there were still 49. Among the reasons for their gradual disappearance is the fact that no new ones have been permitted to be established since 1904 and with the passage of time costly structural repairs have become necessary to maintain a satisfactory standard of hygiene. Rather than face this, occupiers have preferred to discontinue baking and obtain supplies of bread and cakes from bakeries elsewhere. In certain other instances, owing to the growth of the amount of business done and the physical impossibility of extending the underground bakeries, the proprietors have dispensed with them in favour of new bakehouses above ground. Horseflesh. The only shop in the Borough selling horseflesh for human food closed down during the year. Slaughter of Animals. There are in the Borough no slaughterhouses where animals are killed for human consumption but there is a knacker's yard in the grounds of the Zoological Society of London, who are licensed by the Council for the slaughter of animals for feeding purposes. Ten 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. P. Phillips, Hon. Treasurer: Mr. W. Bragg) have kindly provided the following information which is extracted from their report for the year 1958/59:- "Membership of the Association. The total number of members of the Association is 160, nine being on probation, the businesses having changed hands. Six members have resigned or otherwise left the Association during the past year owing to retirement, death, or removal from the district. Mass Radiography. In view of the difficulties the catering industry experiences in having employees X-rayed during working hours (this applies particularly to small businesses) the Medical Director of the Mass X-ray Unit arranged in October for a special survey for catering staff employed in the Borough of St. Marylebone. Dr. Briscoe-Smith asked the Association to support this project and a letter was sent to all members urging them to grant facilities for their staff to participate. 22 Appreciation. We would like to thank the officers of the Association for their continued support and the Medical Officer of Health and his staff for their guidance and help. The past and the future. The Food and Drugs Act, 1938, laid down certain standards for food shops but, owing to the war, these were never fully implemented. After the war a new awareness of the need for a higher standard of food hygiene came into being and Clean Food Associations were formed up and down the country with Codes of Practice in advance of the minimum requirements as then laid down. There is no doubt that this leadership in Clean Food eventually helped to stimulate the introduction of new legislation in the form of the Food and Drugs Act, 1955, and the Food Hygiene Regulations, 1955. These new Regulations incorporated much of the Codes of Practice of the Clean Food Associations. All food shops have now to reach a much higher minimum standard than before as the Borough Council is empowered to require a degree of improvement in food handling techniques and of food premises which previously could only be attained by persuasion. The Clean Food Association has thus largely achieved its original aim and many of its functions, although of great value in the past, would now seem to have lost much of their former purpose. It is, however, proposed that the Association should continue, at least, for a time and any suggestions or comments by the Members would be welcomed at the Annual General Meeting." SECTION F.—INFECTIOUS AND OTHER DISEASES—PREVALENCE AND CONTROL The total number of cases of infectious disease reported in the Borough during 1958 was nearly 300 less than in the previous year. Much of this reduction was due to a falling off in the incidence of measles. This disease tends to be especially prevalent in two-yearly cycles and 1958 was not a "peak" year, although the number notified, 246, was nearly twice that of 1956, the previous low incidence year. Dysentery showed an increase of 26 cases over 1957 but no apparent cause for this could be ascertained. The cases were scattered throughout the Borough and most of those affected were children. There was one case of typhoid fever. The cause could not be ascertained but it is thought that the patient may have become infected whilst on holiday in Spain. No cases of acute poliomyelitis were notified during the year and again there was no diphtheria. Tuberculosis. Table 18, page 34, gives information regarding primary notifications of pulmonary and non-pulmonary tuberculosis received during the year. Table 19, page 35, shows the age and sex distribution of new cases and of deaths from all forms of the disease, and Table 20, page 35, sets out the number of cases on the Tuberculosis Register at the beginning and end of the year with details of the adjustments made in respect of new cases, transfers, deaths inwards and outwards and removals due to cases cured and deceased. Enquiries into housing and sanitary conditions involved 200 visits by one of the women public health inspectors to all new cases and those moving into the Borough from other areas. Mass Miniature Radiography. During the year the Unit continued to work in the Borough from time to time, mainly by way of closed surveys, and this included the Council's staff. With the exception of the Town Hall and Depot employees, statistics relating exclusively to St. Marylebone are not available. Of 293 members of the Council's staff examined, 3 were recalled for large films but it was necessary to refer only one of them to the Chest Clinic for further observation. In "home surveys," the Unit gives the overall incidence rate for active pulmonary tuberculosis as about 1.5 per 1,000, which is in keeping with general experience in unselective miniature radiography, more cases being found in men than women. With regard to policy, the officer in charge of the Unit states that "During 1958 no changes in the policy of the Unit were made. In addition to routine visits to a certain number of large establishments, numerous surveys were arranged to cover one-man, small and medium sized firms situated in central London, which had been circularised within circumscribed areas by means of Kelly's Post Office Directory. However, only 10 per cent. of small firms respond to circulars and, on analysis, more cases of active tuberculosis are discovered in larger firms—even on repeat 23 examinations—than in small firms." This is not what one would have expected and it would be most interesting to know whether the employees of the 10 per cent. of such firms who responded are typical of workers in small firms generally. Food Poisoning. Of eighteen cases of food poisoning notified during the year, seven were associated with five outbreaks involving more than one member of the family and two with minor outbreaks involving more than one person not of the same family. In three of the family outbreaks pathogenic organisms were discovered in the patients' faeces, namely Salmonella typhi-murium, Salmonella untyped and B. Morgan No. 1. In the other two outbreaks no probable agent was discovered. Of the nine single cases notified, the organism presumed to have caused the illness was discovered in seven, namely Salmonella typhi-murium (4 cases), Salmonella type "C" (1 case), Salmonella untyped (1 case) and B. Morgan No. 1 (1 case). Although from time to time several different kinds of food came under suspicion, it was not possible to establish that any of them were definitely responsible for causing the illnesses. Outbreak of Food Poisoning at two schools. As the result of a telephone call to the office by a general practitioner on Saturday, 20th September, it was discovered that an outbreak of food poisoning had occurred at two schools in the Borough on or about the 18th September. Both the school dining rooms concerned were supplied with meals from the same kitchen. In all, 62 pupils, staff and food handlers out of a total of approximately 230 diners were reported to have had symptoms and, of these, 29 were found to have salmonella organisms in their stools. Of the 24 specimens typed, 17 were reported to be of the Newport group, 6 probably Newport and 1 typhi-murium. The cases were spread over 17 different local authorities and none of the notified cases lived in St. Marylebone. The symptoms in most cases consisted of severe headache, abdominal pain, diarrhoea, vomiting, and a temperature of about 103 degrees, accompanied in one or two cases by dizziness. Only a few of the attacks were severe though in some patients the excretion of organisms persisted for some weeks after treatment had been completed and they had become symptomless. In view of the length of time these cases were being kept from school and also taking into consideration that those involved were all older children, it was decided on 21st October after consultation with the School Medical Officer that they should be allowed to return to school, provided the Medical Officer of Health concerned was satisfied that the home conditions were satisfactory and the child understood the principles of elementary hygiene. From information received it appeared that the onset in three cases, all positive for salmonella infection, was between 10 a.m. and 12 noon on 18th September. The organism in one of these was typed as Newport. A further 10 cases occurred before 6 p.m. on the same day. Of these, 8 were positive for salmonella infection and of 6 which were typed 4 proved to be Newport and 2 "probably" Newport. The remainder of the cases occurred in diminishing numbers throughout the evening of the 18th and the following day. This clearly demonstrated that infection in at least some of the cases must have occurred before the midday meal on Thursday, 18th September, which was originally suspected as the possible source of infection. Attention was thus directed to the midday meal served on the Wednesday, 17th September, which consisted, among other things, of cold meat cut from the remainder of a joint of beef used for the previous day's meal and from a joint of pork also cooked on the 16th. Unfortunately, in accordance with her instructions, the supervisor had destroyed samples of the Wednesday meal after 48 hours. Examination of specimens of the meal eaten on 18th September revealed the presence of no pathogenic organisms. It was noted during the investigations that the menus recorded had not been strictly adhered to. Meat cooked on Tuesday, 16th September had been used not only on the 17th but also on the 18th, both as an ingredient of shepherd's pie and as cold meat. Thus the Thursday meal was confirmed as a potential source of infection and evidence of this was provided by the occurrence of some cases more than 48 hours after the Wednesday meal. Swabs were taken from the wash-up sink in kitchen, w.c. pan used by the kitchen staff, rim of drinking water tap, door handle of w.c., w.c. chain and seat, and from the vegetable preparation sink, but no pathogenic organisms were isolated. The kitchen where the school meals were prepared was found to be of a good standard of cleanliness. 24 No history of illness prior to the outbreak was obtained from any of the food handlers, although subsequently the cook and her assistant both suffered from symptoms. The cook first felt ill on Friday, 19th September but remained at work that day. She called her doctor in on Monday, 22nd September and salmonella Newport was isolated from her faeces. The assistant cook submitted a specimen on 22nd September which proved negative, but on 24th September she became unwell and was reported to be absent from work on the following day. She also was later diagnosed as suffering from salmonella Newport infection. As a result of this, a second faecal specimen from all the remaining food handlers was examined with negative results in each case. The origin of the infection in this outbreak could not be definitely established. As all the patients had taken school meals on Wednesday 17th or Thursday 18th, it seemed probable that one or both of these meals gave rise to infection and on balance likely that some cases were infected at each of the meals. The assistant cook's illness appeared to have started on 24th September. With this exception the onset of all cases positive for salmonella was reported to have occurred within the normal incubation period of up to 48 hours of either the Wednesday or Thursday meals. The later onset of the assistant cook's illness is difficult to explain unless she became infected from some other source. The points that emerged were:— (1) Specimens of meals should be kept for at least 24 hours beyond the recognised maximum incubation period to allow for late reporting by G.P.s. (2) Menus should be complete and specimens of every item of food should be kept. (3) One patient reported that his G.P. had said "We had better call this Gastro Enteritis or we shall have to keep you away from school, notify the Medical Officer of Health and have all the trouble of taking specimens." This appears to have been a typical reaction as, apart from the verbal notification of the original case, only 3 of the remaining 61 cases were notified. (4) When notice of the outbreak was first reported to this department on Saturday morning 20th September, the Public Health Inspector who immediately visited the school kitchen was unable to collect the meal specimens for examination as the key to the refrigerator was not available. It is suggested that a spare key held by the school caretaker for emergency use would be an advantage. 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 128 cases of scabies: adults 59 (men 37, women 22); children 69 (boys 41, girls 28). 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 38 rooms and 413 articles of bedding (mattresses, blankets, sheets, bolsters, pillows, etc.), and 363 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, 197 certificates, relating to a total of 2,725 articles, were issued to indicate that no infectious disease had been reported for at least one month at the premises from which the clothing was purported to have come. Exclusion from Work of Contacts of Infectious Disease. Both by Regulations made under the National Insurance Act, 1946, and the Public Health 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 one certificate was issued. 25 International Certificates of Vaccination. Travellers 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 5,815 of these certificates were authenticated. Bacteriological Examinations. Table 21, page 35, shows the number of specimens examined for the purposes of diagnosis and also indicates the organisms in relation to which the examinations were made. 27 APPENDIX OF STATISTICAL TABLES AND SUPPLEMENTARY INFORMATION 28 TABLE 1.—Deaths—According to Age-Group and Sex. Code No. CAUSE OF DEATH Net Deaths at the Sub-joined Ages of Residents (Male and Female) whether occurring within or without the borough All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1 Tuberculosis, respiratory 4 3 - - - - - - - - 3 1 1 2 2 Tuberculosis, other — — — — — — — — — — — — — — 3 Syphilitic disease 4 1 - - - - - - - - 1 — 3 1 4 Diphtheria — — — — — — — — — — — — — — 5 Whooping cough - - - - - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - - - 7 Acute poliomyelitis — — — — — — — — — — — — — — 8 Measles - - - - - - - - - - - - - - 9 Other infective and parasitic diseases 1 1 — — — — — — — 1 1 - - - 10 Malignant neoplasm, stomach 11 8 - - - - - - 1 — 4 1 6 7 11 Malignant neoplasm, lung, bronchus 48 10 — — — - — — — — 23 5 25 5 12 Malignant neoplasm, breast — 22 — — — — — — — 2 — 10 — 10 13 Malignant neoplasm, uterus — 15 — — — — — — — 1 — 9 — 5 14 Other malignant and lymphatic neoplasms 54 40 - - — — - - 5 2 13 14 36 24 15 Leukaemia, aleukaemia 3 4 - - - - - - - - - 1 3 3 16 Diabetes 3 4 — — — — — — — — 3 — — 4 17 Vascular lesions of nervous system 56 96 — — — — — — 2 1 9 9 45 86 18 Coronary disease, angina 101 74 — — — — — — 2 — 28 10 71 64 19 Hypertension with heart disease 35 35 - - - - - - - - - 2 35 33 20 Other heart disease 77 103 - - - - - - - 1 7 3 70 99 21 Other circulatory disease 20 26 - - - - - - 1 — 6 1 13 25 22 Influenza 1 10 - - - - - - - - - - 1 10 23 Pneumonia 14 29 — — — — — — — — 2 2 12 27 24 Bronchitis 54 33 - - - - - - 1 — 9 3 44 30 25 Other diseases of respiratory system 4 5 - - - - - - - 1 — 1 4 3 26 Ulcer of stomach and duodenum 8 5 - - - - - - - - 5 1 3 4 27 Gastritis, enteritis and diarrhoea 2 6 1 1 - - - - - - - 1 1 4 28 Nephritis and nephrosis 3 2 - - - - - - — — 2 1 1 1 29 Hyperplasia of prostate 4 — — — — — — — — — 1 — 3 — 30 Pregnancy, childbirth, abortion - 1 - - - - - - - 1 - - - - 31 Congenital malformations 4 4 3 2 — — — — — 1 1 — — 1 32 Other defined and ill-defined diseases 36 37 11 8 — — — — 2 3 13 4 10 22 33 Motor vehicle accidents 9 2 — — 1 — — — 1 — 4 1 3 1 34 All other accidents 9 10 — — — 1 — — — 1 4 1 5 7 35 Suicide 15 4 - - - - - - 6 — 7 3 2 1 36 Homicide and operations of war — 1 - - - - - - - 1 - - - - Totals 580 591 15 11 1 1 - - 21 16 146 84 397 479 1,171 26 2 - 37 230 876 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 5 1 - - - - - - - - - - - - 5 1 Premature Birth — 6 - - - - - - - - - - - - - 6 Bronchitis and Pneumonia 1 — — — — — — 1 1 — 1 — — — 3 1 Respiratory Failure 1 - - - - - - - - - - - - 1 1 Gastro Enteritis — — — — — — 1 1 — — — — — — 1 Congenital Heart Defect 1 - - - - - - - - 1 - - - - 1 1 Cerebral Haemorrhage 1 - - - - - - - - - - - - - 1 - Haemoptysis 1 - - - - - - - - - - - - - 1 - Congenital Hydrocephalus - - - - - - - - - - 1 - - - 1 - Tentorial Tears (Forceps) 1 - - - - - - - - - - - - - 1 - Atresia of Duodenum — 1 - - - - - - - - - - - - - 1 Totals 11 8 — — — — 1 2 1 1 2 — — - 15 11 TABLE 3.—Weather Statistics, Year 1958. Station: Regent's Park. Height of rain-gauge above mean sea level: 129 feet. 1958 Air Temperature in Degrees Fahrenheit Rainfall Weather Number of Days Sunshine Means of Mean of A and B Highest and Lowest Most in a day Rain Snow or Sleet 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. Highest Max. Date Lowest Min. Date Total Amt. Date °F. °F. °F. °F. °F. in. in. hrs. hrs. % Jan 44.7 35.5 40.1 57 27 25 23, 24 2.18 0.48 28 10 3 - 4 9 12 - 31.5 1.01 106 Feb 48.6 36.7 42.7 58 14 28 7,8 2.71 1.00 24 12 5 — 1 10 10 - 42.1 1.50 94 Mar 46.1 34.9 40.5 57 27, 28 24 9 1.10 0.18 27 9 3 — — 12 18 — 99.0 3.19 107 April 54.1 39.5 46.8 73 30 30 2,3 1.71 0.67 5 8 1 — — 2 7 — 138.5 4.62 105 May 62.9 47.3 55.1 76 2 40 4 2.23 0.76 29 12 — 1 — — — — 181.9 5.87 97 June 67.2 51.7 59.5 78 16 45 13 6.35 2.01 9 16 - 1 - - - - 127.8 4.26 63 July 71.3 55.8 63.5 82 8 46 23 2.40 0.64 16 14 - 3 - - - - 169.1 5.45 88 Aug. 69.9 56.3 63.1 82 10 50 3 3.98 0.98 24 19 — 4 — — — — 103.4 3.34 59 Sept. 69.1 54.2 61.7 82 5 42 27 8.90 1.04 23 11 — 3 1 — — — 130.7 4.36 104 Oct 59.5 48.1 53.8 64 1, 10, 14 40 6 2.66 0.58 12 13 — 4 — — — — 93.8 3.03 113 Nov. 49.5 40.9 45.2 57 3, 6 33 14 1.56 0.66 2 9 — — 3 — 11 — 31.2 1.04 76 Dec 47.3 38.8 43.1 56 27 34 2 to 7 3.11 0.51 29 15 5 13 — 18.4 0.59 69 *Average for years 1921-1950. 29 30 TABLE 4.—Dwelling-Houses: Summary of Inspections, Conditions Found and Action Taken. Inspection under Public Health or Housing Acts:— (I) (a) Inspected for housing defects 1,258 (b) Inspections made for the purpose 4,324 (2) Found to be in a state so dangerous or injurious to health as to be unfit for human habitation 91 (3) Found not to be in all respects reasonably fit for human habitation 438 Defects remedied without serVice of formal Notices:— Defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 324 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 297 (2) Dwelling-houses in which, after service of formal notices, defects were remedied:— (a) By owners 141 (b) By Local Authority in default of owners - (b) Proceedings under the Housing Act, 1957:— (1) Rooms in respect of which Closing Orders were made:— Underground rooms 11 Other rooms 19 (2) Closing Orders determined, the tenement or room having been made fit 6 (3) Rooms affected by (2) above 9 (4) Closing Orders varied 2 (5) Undertakings accepted in respect of underground rooms 5 TABLE 5.—Nuisances Remedied. Nuisance Abated or Defect Remedied Number Houses damp, dirty or dilapidated 119 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., defective 288 Drain, water-closet and waste pipe stoppages 103 Drains, water-closets and waste pipes defective 126 Yard, area and wash-house defects 26 Roofs, gutters and rainwater pipes defective 214 Insufficient water supplies 6 Water cisterns dirty or defective 13 Ashpits, dustbins, etc., defective 18 Rubbish accumulations 67 Animal nuisances 16 Miscellaneous 124 Total 1,120 TABLE 6.—Rent Act, 1957. Applications for Certificates of Disrepair 34 Notices served on landlords of Proposal to issue Certificate of Disrepair 36 Undertakings received from landlords 23 Certificates of Disrepair issued 16 Applications for Certificates as to Remedying of Defects 27 Certificates as to Remedying of Defects issued 25 Applications for cancellation of Certificates of Disrepair 5 Certificates of Disrepair cancelled 6 (one by County Court) 31 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 MatterN.L. 16.27 18.75 9.42 11.24 36.19 27.41 13.70 15.56 12.49 8.79 6.51 11.71 t.h. 11.43 14.67 11.96 11.79 16.74 10.43 10.06 6.84 13.42 9.65 9.49 18.25 Soluble MatterN.L. 7.77 8.36 6.04 5.81 6.60 8.00 5.69 6.29 7.49 5.74 4.43 7.14 t.h. 8.90 9.94 8.88 7.08 6.30 13.36 7.04 7.34 9.77 8.00 8.53 9.57 Sulphur TrioxideN.L. 4.32 4.10 6.16 2.17 1.54 1.29 0.95 0.98 1.12 1.53 5.48 3.69 t.h. 6.73 5.36 5.48 3.29 2.38 2.63 2.10 2.25 3.24 4.34 5.50 6.57 E.R. 5.00 Nil 4.79 3.30 1.88 2.10 1.67 1.61 2.78 3.34 2.54 5.40 Smoket.h. 19 32 35 21 8 9 5 5 11 14 47 38 G.P. 26 29 33 21 7 7 3 1 4 15 57 44 Sulphur Dioxide t.h. 16 12 13 8 5 6 4 4 7 11 16 17 G.P. 14 10 10 6 5 5 4 2 4 8 15 16 TABLE 8.—Air Pollution. Annual Daily Average of Mean Concentration of Smoke and Sulphur Dioxide. Site 1958 1957 1956 1955‡ Smoke mg./100m3 SO2 p.p. 100m. Smoke mg./100m3 SO2 p.p. 100m. Smoke mg./100m3 SO2 p.p. 100m. Smoke mg./100m3 SO2 p.p. 100m. t.h. 20 10 23 9 34 11 39 9 G.P. 20 8 24 8 32 9 51 7 TABLE 9.—Air Pollution. Annual Monthly Average of Deposited Matter and Sulphur Trioxide. Site 1958 1957 1956 1955‡ Tons per sq. mile Mg. per 100 sq cm. PbO2 Tons per sq. mile Mg. per 100 sq. cm. Pb02 Tons per sq. mile Mg. per 100 sq. cm. Pb02 Tons per sq. mile Mg. per 100 sq. cm. Pb02 t.h. 20.87 4.16 17.7 3.9 19.22 3.9 19.02 4.03 N.L. 22.28 2.78 20.8 2.6 17.24 2.4 17.56 2.47 D.S. 21.9† — 17.3 — 18.9 — 19.3 — E.R. — 3.13 — 3.4 — 3.5 — 3.7 Notes to Tables 7, 8 and 9— Sites: N.L. Nuffield Lodge E.R. Edgware Road T.H. Town Hall G.P. Greville Place D.S. Devonshire Street (maintained by the D.S.I.R.) *Apparatus damaged by snowfall. ‡ 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. † Average for three months only. 32 TABLE 10.—Rodent Control. Complaints received 630 Dwellings 405 Business premises 225 Rats 343 Mice 287 Blocks surveyed 34 Premises involved 1,023 Premises disinfested 606 Black rats 13 Brown rats 285 Mice 308 Treatments carried out 1,766 TABLE 11.—Factories: Inspections for Purposfes of Provisions as to Health. Premises Registered Inspections Written notices Occupiers prosecuted Factories without mechanical power 244 151 5 — Factories with mechanical power 1,271 482 24 — Other premises* (excluding outworkers' premises) 412 466 — — Totals 1,927 1,099 29 — *Electrical stations, institutions, sites of building operations and works of engineering construction. TABLE 12.—Factories : Defects Found. Particulars Defects Found Remedied Referred In respect of which prosecutions were instituted To H.M. Inspector of Factories By H.M. Inspector of Factories Want of cleanliness 4 5 — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary conveniences:— (a) insufficient 2 — — 3 — (b) unsuitable or defective 22 18 — 3 — (c) not separate for sexes 2 1 — 1 — Other offences (excluding offences relating to outwork) 2 6 — — — Totals 32 30 — 7 — 33 TABLE 13.—Summary of Outwork. Description of Work Outworkers Employed Wearing apparel 724 Textile weaving 9 Curtains and furniture hangings 1 Furniture and upholstery 2 Umbrellas 1 737 TABLE 14.—Pharmacy and Poisons Acts, 1852-1941: Summary of Sellers of Part II Poisons. Type of Business Total Licensed Grocery and provision stores 33 Hardware and domestic stores 18 General stores 16 Hairdressers 8 Builders' merchants 3 Drug stores 2 Pest control contractor 1 Dental sundriesman 1 Photographic dealer 1 Veterinary sundriesman 1 84 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 64 Pasteurised 80 Sterilised 73 Supplementary: Tuberculin tested 20 Pasteurised 22 Sterilised 19 34 TABLE 16.—Summary of Premises Registered for Preserving Food or for the Manufacture, Storage or Sale of Ice-Creav:. Type of Business Preserving Food Ice Cream Butchers 82 2 Tobacconists, confectioners/newsagents — 95 Grocers and provision merchants 33 66 Fishmongers 4 3 General stores 7 19 Milk shops — 20 Greengrocers and fruiterers — 25 Public houses — 3 Ice-cream factories — 2 126 235 TABLE 17.—Summary of Food Premises. Type of Business Totals Restaurants, cafes and snack bars 321 Canteens and clubs 216 Grocers and provision merchants 182 Butchers 55 Greengrocers and fruiterers 64 Fishmongers 16 Bakers 38 Confectioners 115 Wine merchants (off licence) 36 Public houses and wine bars, etc. 124 Hotels and boarding houses 50 Coffee stalls and kiosks 4 Schools and nurseries 25 Stalls, street trading 95 1,341 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 2 — — — — — — — — — — 1 1 — 2 Scarlet fever 20 — — 2 — 1 13 3 — 1 — — — — 20 Puerperal pyrexia 13 — — — — — — — 1 11 1 — — 12 1 Pneumonia 21 1 — — — — 3 — — 1 1 11 4 4 17 Dysentery 44 1 4 6 5 4 16 1 — 3 1 2 1 2 42 Measles 246 4 24 25 35 36 112 3 2 5 — — 4 242 Whooping cough 11 1 2 2 1 i 3 1 — — — — — — 11 Scabies 6 — — — — — 2 2 — 2 — — — — 6 tuberculosis— Pulmonary 62 — — — — — 1 — 4 22 7 25 3 30 32 Non-pulmonary 9 — — — 1 1 — 1 — 4 2 — — 9 — Food poisoning 18 1 3 1 — 1 2 2 1 2 2 3 — 4 14 Typhoid fever 1 — — — — — — — — — — 1 — 1 — Meningococcal infection 2 1 — — — — — — — 1 — — — 2 — Totals 456 10 33 36 42 44 152 13 8 52 14 43 9 68 388 *There were no cases in the Borough of the following diseases which are also notifiable: Smallpox, diphtheria, membranous croup, cholera, typhus fever, relapsing fever, continued fever, plague, leprosy, hydrophobia, glanders, farcy, anthrax, malaria, induced malaria, paratyphoid fever, acute poliomyelitis, acute encephalitis. 35 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—5 — — 1 1 — — — — 5—15 2 — 1 — — — — — 15—25 7 10 1 — — — — — 25—35 22 21 1 3 — — — — 35—45 7 5 1 1 — — — — 45—55 24 4 — — 1 — — — 55—65 14 3 — — 3 1 — — 65 and upwards 6 1 — — 3 2 — — Totals 82 44 5 5 7 3 — — * 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.—Tuberculosis: Summary of Register. Pulmonary Non-Pulmonary M. f. Total M. f. Total Total (a) Number of cases of tuberculosis on the Register at the beginning of the year 508 377 885 31 46 77 962 (b) Number of cases notified to the Medical Officer of Health under the Regulations for the first time during the year 39 23 62 4 5 9 71 (c) Number of cases removed from the Register during a preceding year which have been restored to the Register during the year 5 5 10 1 1 11 (d) Number of cases added to the Register during the year which have been brought to the notice of the Medical Officer of Health otherwise than by notification under the Regulations 43 21 64 1 — 1 65 (e) Number of cases removed from the Register during the year 60 35 95 1 1 9 97 (f) Number of cases remaining on the Register at the end of the year 535 391 926 35 51 86 1,012 TABLE 21.—Summary of Work of the Bacteriological Laboratory. Nature of Specimen and Examination Positive Negative Total Throat and nasal swabs for— 13. diphtheriae — 9 9 Haemolytic streptococci 14 58 72 Vincent's organisms 3 1 — Vaginal swabs for— Gonococci — 1 1 Sputum for— Tubercle bacilli 1 16 17 Cough plates for— H. pertussis — 1 1 Faeces for— Parasites 1 1 Typhoid, paratyphoid, dysentery and food poisoning organisms 32 382 414 Cervical swabs for— Trichomonas 1 — 1 Urethral swabs for— Gonococci 1 1 2 Foods for— Food poisoning organisms — 58 58 Swabs for— Food poisoning organisms — 19 19 Totals 52 547 599 36 TABLE 22.—New Legislation. Title Operative Date Labelling of Food (Amendment) Regulations, 1958 3.5.58 Dark Smoke (Permitted Periods) Regulations, 1958 1.6.58 Factories (Cleanliness of Walls and Ceilings) Order, 1958 16.6.58 Poisons List Order, 1958 1.7.58 Poisons Rules, 1958 1.7.58 London County Council (General Powers) Act, 1958 7.7.58 Slaughterhouses Act, 1958 1.8.58 Litter Act, 1958 7.8.58 Public Health (Preservatives, etc., in Food) (Amendment) Regulations, 1958 14.8.58 Anti-oxidant in Food Regulations, 1958 6.9.58 Poisons List (No. 2) Order, 1958 1.1.59 Poisons (No. 2) Rules, 1958 1.1.59 Public Health (Preservatives, etc., in Food) (Amendment No. 2) Regulations, 1958 1.1.59 Slaughterhouses (Hygiene) Regulations, 1958 1.1.59 Slaughter of Animals (Prevention of Cruelty) Regulations, 1958 1.1.59 Slaughter of Animals Act, 1958 18.1.59 37 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.I. (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. Colquhoun House, Broadwick Street, W. 1. Tel.: REG. 0911. For Postal Area, N.W.I. 30, Euston Square, N.W. 1. Tel.: EUS. 6451. For Postal Areas, W.2 and N.W.8. 5, Praed Street, W.2. Tel.: PAD 3411. LONDON COUNTY COUNCIL. Homes.—Luxborough Lodge, I, Luxborough Street, W.l. (Tel.: WEL. 5619).—Apply to Admission Officer, 5, Princes Row, S.W.I. (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.I. (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.1. This service is available for urgent cases at all times. Apply to Duly Authorised Officer. (Tel.: W AT. 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.1. (Tel.: VIC. 0162)—Assistance and advice for the handicapped. Fireguards.—These appliances can be provided and fixed free of charge in necessitous cases. Apply to the Secretary, St. Marylebone Old People's Welfare Association. (See below.) 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.1.—Monday to Friday up to 4.30 p.m. Old age pensioners pay 1d. (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.1. (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 liaison officers between the Association and groups of lay visitors attached to churches. This is in addition to the visiting done by the Clergy and Church workers of all denominations. Meals on Wheels. (Dinners).—This service is financed by the Old People's Welfare Association (aided by a grant from the Borough Council and L.C.C.), and operated by the W.V.S. Hot dinners can be taken to the home, price 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. 38 W.V.S. Luncheon Club, 134, Seymour Place, W.1. (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. Marvlebone District Nursing Association, 117, Sutherland Avenue, W.9. (Tel.: CUN. 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.1. 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 Evergreen Club, Salvation Army Hall, Bell Street, N.W.1, Thursdays, 2.30 to 4 p.m. The women's organisations of churches in the Borough have large numbers of old age pensioners among their members. Women's Voluntary Services, 104, St. John's Wood Terrace, N.W.8. (Tel.: PRI. 1051). Citizens' Advice Bureau, 60, Paddington Street, W.l. (Tel.: WEL. 8614 and WEL. 8708). The "Wireless for the Bedridden" Society, 55a, Welbeck Street, W.l. (Tel.: WEL. 0949).—Wireless sets can be installed 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 Airmens' Families Association (S.S.A.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.l. (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, 187, Marylebone Road, N.W.1. (Tel.: PAD. 6649).—This Home has some beds for old men. Apply Secretary. Church Army Lodging House for Women, 10, Daventry Street, N.W.1 (Tel.: PAD. 4855).—Elderly able-bodied women, still at work, can be admitted although the hostel is not specially for the aged. The Ladies' Home, 41, Abbey Road, N.W.8. (Tel.: MAI. 6831).—For elderly ladies in reduced circumstances "Newstead", 17-19, Greville Place, N.W.6. (Tel.: MAI. 5711).—Maintained by the St. Marylebone Old People's Homes, Ltd., for the aged of either sex in need of care and attention. Old People's Homes Committee, 296, Vauxhall Bridge Road, S.W.1. (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. 39 SUMMARY OF HOSPITALS AND CLINICS SERVING THE BOROUGH Ambulance Service: Removals, Emergency Bed Service (to all hospitals in Greater London) HOP 7181 Hospitals: Florence Nightingale Hospital, 19, Lisson Grove, N.W.1 PAD 2341 Hospital for Nervous Diseases, 4, Maida Vale, W.9 CUN 5172 Hospital of St. John and St. Elizabeth, 60, Grove End Road, N.W.8 CUN 5126 King Edward VII Hospital, Beaumont Street, W.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.10 LAD 2281 St. Marylebone Hospital for Psychiatry and Child Guidance, 48, Cosway Street, N.W.1 PAD 8854 St. Mary's Hospital, Praed Street, W.2 AMB 1280 Samaritan Hospital, Marylebone Road, N.W.1 PAD 6011 The Middlesex Hospital, Mortimer Street, W.l MUS 8333 Western Ophthalmic Hospital, Marylebone Road, N.W.1 PAD 1871 Clinics : Arthur Stanley Institute for Rheumatic Diseases and Allied Conditions, Peto Place, N.W.1 WEL 1133 Charterhouse Rheumatism Clinic, 56-60, Weymouth Street, W.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 40 INDEX Page Accidental Deaths 3 Accidents 3 Adulterated Food Samples 16, 19 Aged Persons 5,6,8,14,37 Aged Persons—Services available 37 Air Pollution 10,31 Ambulance Service 39 Analysis of Food and Drugs 15 Analyst, Public 1 Analyst, Public, Report 15 Bacteriological Examinations 25,35 Bacteriological Examination of Milk and Ice Cream 19 Bacteriologist 1 Bakehouses, Basement 21 Barbers 11 Baths, Cleansing of Persons 10 Baths for Old People 6 Bodies, Transportation Abroad 12 Books, Library 8,24 Bugs 10 Burial or Cremation of the Dead 12,13 Cancer 3 Care of Old People 5,6,8,37 Catering Establishments 20 Causes of, and Ages at, Death 3, 28 Census Population 2 Certificates of Disrepair 15, 30 Clean Air 10,31 Cleansing, Public 12 Cleansing Station 10, 24 Cleansing of Verminous Persons 10 Clearance, Slum 14 Clinics 39 Closing Orders 15,30 Combined Drainage 9 Committee, Public Health 1 Common Lodging Houses 15 Compulsory Removal 8 Conditions, Social 2 Conferences 5 Conveniences, Public 12 Cremation 12, 13 Dairies, Milkshops 19,33 Deaths 2, 3, 28 Deaths, Infant Mortality 2,3,28 Deaths, Maternal Mortality 2,3 Deaths, Vital Statistics 2 Diseased or Infirm Persons, Removal 8 Diseases, Notifiable 22, 34,35 Disinfection 24 Disinfestation 10 Disrepair Certificates 15 Dog Nuisance 13 Drainage 9 Drainage, Combined 9 Drugs, Analysis15 Dwelling-Houses 15,30 Exclusion from Work 24 Factories 11,32 Factory-made Bungalows 14 Financial Contributions to Voluntary Organisations 5 Fireguards 11 Flock, Rag and Other Filling Materials 12 Food, Adulterated, etc. 15, 19 Food Analysis 15 Food Inspection 20 Food Poisoning 23 Food Premises20,34 Food, Preserved, etc.20,34 Food Stalls 21 Page Food, Unsound19 Fouling of Footways by Dogs 13 General Statistics 2 Hairdressers and Barbersh 11 Heating Appliances (Fireguards) 11 Horseflesh 21 Hospitals 39 Housing 13 Housing, Certificates of Disrepair 15,30 Housing, Closing Orders 15,30 Housing, Factory-made Bungalows 14 Housing, Improvements, Conversions and 15 Housing, Inspection and Action taken 15,30 Housing of Old People 14 Housing, Permanent Estates 13 Housing, Re-housing, Medical Certificates 15 Housing, Requisitioned premises 14 Housing, Slum Clearance 14 Hydrogen Cyanide Disinfestation 10 Ice Cream 19,34 Immigrants 15 Impetigo 24 Improvement and Conversions, Housing 15 Infant Mortality 2,3,28 Infectious Diseases, Exclusion from Work of Contacts 24 Infectious Diseases, Notification .. 22,34,35 Infectious Diseases, Prevalence and Control 22 Infectious Diseases, Statistics 34,35 Influenza I nspection, Sanitary 8,30 Inspection of Food 15 Intimation Notices 8 Land Charges Enquiries 15 Laundry Service for Old People, etc. 5 Legal Proceedings 8, 19 Legislation, New 8, 18, 36 Marriages 2 Mass Miniature Radiography 21,22 Maternal Mortality 2,3, 28 Measles 22,34 Medical Examinations, Staff 8 Medical Referee, Cremation 1, 13 Mice 9,32 Milk 16,19,33 Milk, Bacteriological Examination 19 Milk (Special Designations) Regulations 19,33 Milk. Pasteurised19, 33 Milk, Sellers 19,33 Milk, Sterilised 19,33 Milk, Tuberculin Tested 19,33 Mortality, Infant 2,3,28 Mortality, Maternal 2,3,28 Mortuary 12 New Legislation 8, 18, 36 Noise 8 Notices, Intimation and Statutory 8 Notification of Infectious Diseases 22, 34, 35 Nuisances 8,9,10,13,30 Old People 5,6,8,14,37 Old People, Services available 37 Outworkers 11,33 Pasteurised Milk 19,33 Pet Shops 11 Pharmacy and Poisons Acts 11,33 Photographers, Street 13 Pigeons 8 Poisoning, food 23 41 Page Poisons 11,33 Poliomyelitis 22, 34 Population 2 Preserved, etc., food 20,34 Private wells 9 Protective helmets 11 Public Analyst 1 Public Analyst's Report 15 Public Cleansing 12 Public Conveniences 12 Public Health Committee 1 Public Health Department Staff 1 Public Health Inspectors 1 Pulmonary Tuberculosis 22,34,35 Radiography, Mass Miniature 21,22 Rag Flock and Other Filling Materials 12 Rateable Value 2 Rats 9, 32 Referee, Medical (Cremation) 13 Refuse Collection and Disposal 12 Removal, Compulsory 8 Rent Act 15,30 Representation upon other Bodies 4 Requisitioned Premises (Housing) 14 Restaurants 23, 34 Rodent Control 9, 32 St. Marylebone Clean Food Association 21 St. Marylebone Old People's Welfare Association 5, 6, 37 Sanitary Circumstances 8 Sanitary Inspection 8, 30 Scabies 24 Shelter 10 Slaughter of Animals 21 Slum Clearance 14 Smoke Control 10,31 Social conditions 2 Page Staff 1 Staff Medical Examinations 8 Stalls, Food 21 Statistics: General 2,28-35 Infectious Disease 22, 23, 24, 34, 35 Tuberculosis 22,34,35 Vital 2 Statutory Notices 8 Sterilised Milk 19,33 Stillbirths 2 Street Cleansing 12 Street Photographers 13 Town Planning 9 Transportation of Bodies Abroad 12 Tuberculin Tested Milk 19,33 Tuberculosis: General 22,34,35 New Cases and Deaths 35 Notifications 34 Underground Bakehouses 21 Underground Rooms 30 Unsound Food 19 Vaccination International Certificates 25 Venereal Diseases 24 Vermin 10 Verminous Persons, Cleansing 10 Vital Statistics 2 Water 9 Weather 3,29 Wells, Private 9 X-ray Examination 21,22 Zoological Society of London 21 Vail & Co. Ltd., Leeke Street, Kings Cross, W.C.1.