AC 4353 STMARY 68 BOROUGH OF ST. MARYLEBONE REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1963 HASTINGS E. A. CARSON, M.D., D.P.H., S.M.(Harv). CONTENTS 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 11 Section D—Housing 18 Section E—Inspection and Supervision of Food 21 Section F—Infectious and other Diseases—Prevalence and Control 26 Appendix of Statistical Tables and Supplementary Information 29 Index 43 WELbeck 7766 Public Health Department, Town Hall, St. Marylebone, W.1. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Marylebone. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report on the health of the Borough during 1963. At the request of the Minister of Health, the report retains its usual form and gives full details of the water supply, sewerage and common lodging houses in the Borough. Public health in St. Marylebone continued to be generally satisfactory, the incidence of infectious disease remaining unspectacular throughout the year. Although the overall number of notifications received rose from the record low figure of 277 in 1962 to 428—wholly attributable to the expected biennial increase in the cases of measles reported, which numbered 311 compared with 107 in the previous year—the Borough remained free from smallpox, diphtheria and poliomyelitis. Neither of the two cases of typhoid fever notified was connected with the Zermatt epidemic mentioned on page 27. That disastrous outbreak, involving many British tourists, served as a salutary reminder of the primacy of sanitation in relation to health, besides emphasizing the need for travellers abroad to be immunized against the enteric fevers. There was a slight decrease in the resident population during the year, although the standardized birth and general death rates remained virtually stationary and infant mortality again declined (the rate per thousand live births falling from 22.22 in 1962 to 18.04 in 1963). The stillbirth rate rose slightly from 11.63 to 12.72 per thousand total births and, unhappily, there was one maternal death, the first for two years. Another unwelcome feature was the increase in the number of deaths from cancer of the lung and bronchus, 53 being recorded, compared with 42 in 1962. On both sides of the Atlantic the evidence incriminating the smoking of cigarettes as the major cause of lung cancer mounted impressively. The main causes of death among adults, however, continued to be diseases of the cardiovascular and respiratory systems and cancer in various forms, a pattern particularly marked in an area where one in six of the inhabitants is of retirement age. On pages 6-9 of this report will be found details of the activities of the Public Health Department on behalf of the elderly, and of the St. Marylebone Old People's Welfare Association : particulars of the services available to old people are listed on pages 40 and 41. Thanks to the St. Marylebone Housing Association, plans for the establishment of a day centre at York Street Chambers took firm shape during the year and the Borough Council readily agreed to give generous financial support to this exciting venture. Another notable event was the purchase of a second "Meals-on-Wheels" van early in the summer, thus enabling the total number of meals delivered in 1963 to approach 11,000. The new vehicle offers scope for a further expansion during the current year of this essential service in regard to both the number of old people receiving meals and the frequency of delivery. It would not have been possible to operate the second van without the help and co-operation of the British Red Cross Society members, who have now joined the Women's Voluntary Service in staffing the vehicles. No praise is too high for these ladies and indeed for all those helpers who provide the elderly with that comfort and companionship which means so much in the evening of life. Comfort and companionship can only ease the ageing process, in which the eyes grow dim, hearing and smell become less acute and the balance more precarious. Hence the need to take these failing faculties into account in the home to prevent as far as possible those accidents to which the aged are so prone. To this end much effort is devoted to home safety propaganda and the importance attached to this aspect of public health practice is reflected in the account on page 10 of the work of the department in this field. The Borough Council co-operates closely with the Royal Society for the Prevention of Accidents and the London County Council in meeting the challenge presented by accidental injury at home. How formidable that challenge is can best be illustrated by the grim fact that far more fatal accidents occur in the home than on the roads. The need to be constantly on the alert in the cause of prevention is beyond dispute. Food hygiene is another field in which constant vigilance is necessary. In St. Marylebone there are more than 1,400 hotels, restaurants, retail food shops, and other premises where food is sold, and the proper surveillance of these premises and their food handling staffs entails much exacting work. An essential part of co-operation with the proprietors is the giving of advice and help on the many facets of hygienic storage, preparation and handling of food. This requires a comprehensive knowledge of the most up-to-date methods, techniques and equipment. In the last analysis, however, good premises and modern equipment are not enough. The food handler is paramount and his crucial (ii) role must be recognized. One dirty finger can cause widespread suffering. Thus the importance of health education in relation to food handling cannot be over-emphasized, neither can the vital part which the consumer has to play. To display indifference when confronted by examples of unsatisfactory food hygiene is to encourage the lowest standards. In this sphere protest is the handmaiden of progress. Once again it is a pleasure to report satisfactory progress towards the completion of the smoke control programme in the Borough. At the beginning of October the smoke control area embracing the Bryanston Square Ward came into operation and in November the Minister of Housing and Local Government confirmed the seventh smoke control order (covering the Dorset Square and Park Crescent Wards) to be made by the Council. A survey of the Church Street and Bell Street Wards, which will comprise the eighth and last smoke control area to be declared, was well under way by the end of the year. This final area contains the Lodge Road and Aberdeen Place power stations, which have been a source of local concern for many years from the standpoint of air pollution. The conversion of the boilers at Lodge Road to oil-firing during the summer was thus particularly timely. It is also a pleasure to reiterate the contribution to the clean air movement, and indeed to the public health as a whole, of the public cleansing service, and I am indebted to the Director of Public Cleansing for supplying the information about refuse collection and street cleansing which appears on page 16. The further extension of the "dustless" system, incorporating the quiet emptying of dustbins, is a welcome prospect. Of particular interest in view of the growing public sensitivity to noise was the appearance in July of the Final Report of the Wilson Committee on this complex subject. In mitigating the present unsatisfactory position, the Committee felt it essential to keep the public informed as to which noise nuisances are readily avoidable and to disseminate existing knowledge more widely amongst those dealing with the technical aspects of noise problems. Indicting road traffic as a major source of annoyance, the Report recommended statutory maximum noise levels for motor vehicles as well as the prohibition of the use of motor horns except in emergency. Industrial noise was also found to cause widespread nuisance and it was therefore suggested that planning authorities should consult the public health authority when considering applications for planning permission for new factories. In St. Marylebone the Department does have the opportunity to comment from a public health standpoint on all development plans submitted to the Council. A frequent cause of complaint in the Borough relates to construction and demolition works and the Report suggests that noise from such sites between, say, 7 a.m. and 7 p.m. should not exceed the level at which conversation in the nearest building would be too difficult with the windows shut. Clearly much more research is needed but in the meantime the findings of the Wilson Committee have given further impetus to the efforts of all concerned to meet the popular demand for a quieter environment. With the passage of the London Government Act, under which the Metropolitan Borough of St. Marylebone will shortly disappear, it is especially fitting that I should conclude this preface on a note of deep appreciation. I am indeed grateful to His Worship the Mayor, to the Chairman, Councillor Dr. H. K. Ashworth, and members of the Pu.blic Health Committee, and to members of the Council generally for their continuing help and encouragement. To my colleagues in other Departments of the Council I extend my sincere thanks for their ready assistance at all times. Lastly, I am very conscious of the debt of gratitude which I owe to the Staff of the Public Health Department for their constant cheerful and loyal support. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, HASTINGS E. A. CARSON, Medical Officer of Health. (iii) 1 PUBLIC HEALTH COMMITTEE 1963 HIS WORSHIP THE MAYOR : *Councillor G. J. Brown, O.B.E., J.P., M.I.Mech.E. †Councillor Leonard Pearl, J.P. ALDERMAN: C. D. Denis-Smith COUNCILLORS : R. H. S. Allen (Vice-Chairman) Dr. H. K. Ashworth, T.D. (Chairman) Miss P. D. Blackstone Mrs. R. M. Challis K. F. Dibben, B.Com., A.C.A. Mrs. F. E. Glenny Dr. L. Jacobs * until May. ** until June. *** until November. **The Rev. W. M. Long †††Mrs. P. Merriton ***Mrs. J. P. G. Nuttall E. R. Seaden, B.Sc. (Eng.), A.M.I.E.E., Assoc.I.Mech.E. Mrs. H. Shire ††The Hon. J. E. Silkin, M.P. † from June. †† from July until October. ††† from November. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health and Medical Referee for Cremation: Hastings E. A. Carson, M.D., D.P.H., S.M.(Harv.) 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.1 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 D. J. W. Rigg J. Bradley Miss M. L. Shaul R. F. Penfold Mrs. J. Chambers Public Health Inspectors: V. A. Bignell (a, b, c) (Chief Inspector) Food Inspection and Hygiene : Drainage : L. Newland (a, b) J. R. Baily (a, b) Mrs. M. Tiplady (a, b, d, f) (until September) J. E. Broadhead (a) J. R. Pritchard (a, b) (from January) Care of Old People : Smoke Control : Miss M. M. Sharp, M.B.E. (a, d, e, f) L. Pearson (a, b, c) *Miss B. Wilson (a, b, d, e, f) District Inspectors: D. B. Hooper (a) D. Hitchcock (a, b) S. W. Wright (a, b) K. G. Mahers (a, b, c) C, A. Chase (a) (from July) †Student Public Health Inspectors: C. A. Chase (until June) R. J. Crozier (a) Public Health Inspector's Certificate (b) Diploma for Inspectors of Meat and Other Foods. (c) Diploma for Smoke Inspectors. (d) Health Visitor's Certificate. (e) Central Midwives' Board Certificate. (f) State Registered Nurse's Certificate. * Also Infectious Diseases. † Appointed under a scheme of paid pupilage adopted by the Borough Council on 19th January, 1956. Outdoor Superintendent and Mortuary Keeper : R. G. Turner Streets Nuisance Inspector: D. Telford Messenger | Handyman: W. G. Sharwood Rodent Operatives 3 Disinfectors 3 Public Conveniences Staff 39 Cleansing Station Attendants 3 2 SECTION A.—STATISTICS AND SOCIAL CONDITIONS GENERAL STATISTICS Area of Borough, etc.: (a) excluding area covered by water, 1,427.8 acres; (b) including area covered by water, 1,472 acres; (c) roads—approximately 57 miles of public highway. There is a variation of approximately 100ft. in the elevation of the Borough from north to south, the highest point being at the junction of Finchley Road and Boundary Road, 173ft. above Mean Sea Level at Newlyn, and the lowest at the junction of Oxford Street and James Street, 70ft. 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: £7,284,995. Sum represented by a penny rate: £29,324. Residential units (separate assessments): 25,043. Population: 1961 census—Males 29,366; Females 39,679. Total: 69,045. Foreign-born residents: 1961 census—12,225 (approximately 17 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-1963—67,320. Registrar General's estimate of the child population: mid-1963—under 1 year: 740; 1—4 years inclusive: 2,360; 5—14 years inclusive: 4,800. Total child population: 7,900 (approximately 12 per cent. of total population). Approximately 72 per cent. of the Borough's population are aged between 15 and 65 years, and approximately 16 per cent. are over 65 years of age. Expectation of life at one year: Boys—68.8 years; Girls—74.4 years. EXTRACTS FROM VITAL STATISTICS Total M. F. Live Births—Legitimate 696 340 356 Live birth-rate per 1,000 population 11.53 Illegitimate 80 40 40 (Standardized) 8.76 Stillbirths—Legitimate 10 8 2 Stillbirth rate per 1,000 live and stillbirths 12.72 Illegitimate — — — Total live and stillbirths 786 388 398 Infant Deaths—Legitimate 10 8 2 Illegitimate 4 3 1 Legitimate Illegitimate Total Infant mortality rate per 1,000 live births 14.37 50.0 18.04 Neo-mortality rate (deaths under four weeks per 1,000 total live births) 15.46 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 12.89 Peri-natal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 25.45 Illegitimate live births per cent. of total live births 10.31 Maternal deaths (including abortions) 1 Total M. F. Deaths (all ages) 1,114 560 554 Death rate per 1,000 population (Standardized) 16.55 12.25 Area comparability factors: Births: 0.76; Deaths: 0.74 Marriages. The number of marriages in St. Marylebone during 1963 was 1,246, which is 26 more than for 1962 and 8 below the average (1,254) for the previous ten years. Deaths. The total number of deaths shown in Table 1, page 30, includes persons who, though normally resident in the Borough, died elsewhere in England and Wales but excludes 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 occurred in the Borough, as also are those of members of H.M. Forces who were stationed in the area. 3 Deaths registered in 1963 numbered 1,114 (16.55 per 1,000) compared with 1,135 (16.67 per 1,000) in 1962. The rate of 16.55 when standardized by the comparability factor gives a figure of 12.25; the rates for the County of London and for England and Wales were 13.1 and 12.2 respectively. The principal causes of death continued to be diseases of the heart and circulatory system, which accounted for 42 per cent. of the total; malignant diseases 18 per cent.; and respiratory diseases, including tuberculosis, 13 per cent. Deaths from lung cancer, compared with the previous year, rose from 42 to 53. Nine deaths were attributed to influenza. Seventy per cent. of the deaths registered were of persons aged 65 and over, whilst 23 per cent. were between 45 and 64 years. Accidental Deaths. During the year, 24 residents died from accidents of all kinds, two less than last year. Motor vehicle accidents accounted for seven deaths as compared with six in 1962. Road Accidents. The St. Marylebone Road Safety Committee, which was set up in 1946 to advise the Council as to the activities which should be undertaken locally in an effort to secure a reduction in the number of accidents occurring on the roads, consists of members of the Council and representatives of outside organisations with interests in this field of local government activity. In April, 1961, the Council appointed a Road Safety Officer whose duties include acting as a liaison between the Council and local organisations. The close personal contacts which have been established are valuable in ensuring that the road safety message is fully brought home to those to whom particular propaganda is directed. Three matters which receive special attention are: (i) active participation in the National Proficiency Scheme for Child Cyclists, which is particularly commended by the Minister of Transport; (ii) the arrangement of visits by school children, youth clubs and other local organisations to RoSPA House, to which the Borough Council contributes £594 per annum; (iii) regular visits to Old People's Clubs. The number of local road accidents, reported as 949, was less than in the previous year (956) and there were 3 deaths as against 6 in 1962. There were 133 (136) serious injuries and 1,021 (1,092) slight injuries. The figures in brackets relate to 1962, and a summary of the 1963 accidents is given in Table 4, page 32. Births. The total of live births registered during the year was 776 (380 males; 396 females), giving a live birth rate of 11.53 per 1,000 of population, equivalent to a standardized rate of 8.76, the comparable figure for the County of London being 17.2 and for England and Wales 18.2. Illegitimate live births numbered 80 (40 males; 40 females), representing 10.31 per cent. of the total live births, compared with 14.1 per cent. for the County of London. Stillbirths totalled 10, representing a rate of 12.72 per 1,000 total births, compared with 16.6 for the County of London and 18.1 for England and Wales. Infant Mortality. Deaths of infants under one year totalled 14 (10 legitimate; 4 illegitimate), giving a rate of 18.04 per 1,000 live births, as compared with 22.22 in 1962. The rate for England and Wales is 21.6 per 1,000 and 21.0 for the County of London. Details showing causes of death according to age group and sex are given in Table 2, page 30. Of the 14 infant deaths, 12 were under four weeks old, giving a neo-natal mortality rate of 15.46 per 1,000 live births, as compared with 15.69 in 1962. The neo-natal mortality rate for England and Wales was 15.1, and for the County of London 15.2. The early neo-natal mortality rate (deaths under one week per 1,000 total live births) was 12.89 (England and Wales 13.4; County of London 13.0) and the peri-natal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) was 25.45 (England and Wales 30.8); County of London 29.8). Maternal Mortality. One maternal death was reported during the year. This was of a married woman aged 30 years who died in hospital, the cause of death being given as obstetric shock from pregnancy. Weather. The following summary of the weather during 1963, and Table 3, page 31, are based upon information supplied by the Meteorological Office:— 4 January.—Exceptionally cold. The coldest January in London since 1838. Air frost (much of it severe) on at least 25 days in all of London Area and on 30 days at Hampstead; there were ice floes near London Bridge. Snow lying throughout month in most districts; 1 foot deep at Hampstead on 1st and still 9 inches on 31st. Equivalent rainfall 23% of average at London (Heathrow) Airport. Freezing fog for much of day in parts of London Area on 23rd, 24th and 25th. Sunshine 146% of average in the City. Gale force gusts on Air Ministry roof on 18th and 19 th. February.—Continuing very cold but dry. Air frost 28 days at Hampstead. Day temperatures rose sharply on 26th; maximum 8.4°C. (47.1°F.) at London (Heathrow) Airport on 28th and minimum -11.1°C. (12.0°F.) at Swanley (Kent) on 25th. Snow lying 28 days at Camden Square and snow or sleet fell on 20 days at Kew, Hampstead and London (Heathrow) Airport; driest January and February together since 1896. Sunshine 143% of average in the City. March.—Temperatures back to normal and wet. Mean temperature just above normal. Maxima above 0°C. (32°F.) every day; 16.7°C. (62.1°F.) at Regent's Park on 6th—highest temperature in United Kingdom this March. Winter's snow gone by beginning of month but 7 days with frost and 3 with sleet or snow at Hampstead. Rainfall 220% of average. Sunshine about average. Gale force gusts on Air Ministry roof on 9th and 25th. April.—Changeable—a typical April. Mean temperature near normal. Maximum 20.6°C. (69.1°F.) at Regent's Park on 27th. Rainfall very slightly above average. Sunshine 86% of average in Central London. No gales. May.—Changeable and rather cool. Mean temperature 1.9°C. (3.4°F.) below normal at Kensington Palace. Minimum 1.7°C. (35.1°F.) at Hampstead on 2nd. Rainfall near average in central London. Sunshine 112% of average in Kingsway. No thunder, fog or gales. June.—Warm and thundery, then rather cool. Mean temperature near average. No frost. Rainfall 151% of average at St. James's Park. Sunshine just below average. Dullest and wettest June at Kew since 1958 but 1st to 3rd was sunniest Whitsun week-end since 1949. Gale force gusts on Air Ministry roof on 19th. July.—Dry; cool at first but warm and sunny end of month. Rainfall 51% of average at London (Heathrow) Airport. Sunshine just above average. No frost or gales. August.-—Dull and cool. No temperatures above 25°C. (77°F.) after 2nd. Rainfall 132% of average at Hampstead. Sunshine 71% of average at Regent's Park. Dullest August Bank Holiday week-end since 1954. No fog, frost or gales. September.—Rather cool; dry spell mid-month. Rainfall 114% of average at Kew. Sunshine 88% of average at Hampstead. No gales or frost. October.—Dry; normal temperatures again. Mean temperature near average. Maximum 22.8°C. (73.0° F.) at Regent's Park on 12th, when it was the warmest October day on the Air Ministry roof since 1959. Rainfall 63% of average at Camden Square. Sunshine 95% of average in Regent's Park. No thunder or gales. November.—Wet and windy but one of mildest on record. Mean temperature 2.2°C. (4.0°F.) above normal at Kew; mildest November since 1938, which was the mildest on record. 7 ground frosts in Regent's Park; wettest November since 1951. 1 day with thunder. Sunshine 138% of average in the City. Fog 6th, 27th-28th and 30th. Gale force gusts 6 days on Air Ministry roof. December.—Dry but rather cold. Mean temperature 1.8°C. (3.2°F.) below normal at London (Heathrow) Airport. 14 days with air frost at Regent's Park. Light snow or sleet showers on 13th and 16th but none over Christmas. Sunshine about average, but fog in London Area on 16th, 23rd and 26th-28th. Rainfall about one third of average; most in a day 0.32 inches on Christmas Day at Regent's Park, where there were 22 days without measurable rainfall. SECTION B.—GENERAL PROVISION OF HEALTH SERVICES Representation upon Other Bodies. The Council were represented upon the undermentioned statutory and voluntary bodies as indicated:— Body Representatives London County Council Divisional Health Committee (Division 2) *Councillor Mrs. R. M. Challis. †Councillor Mrs. F. E. Glenny. Alderman Dr. E. Jacobs. St. Marylebone Tuberculosis Care Committee Councillor Mrs. F. E. Glenny. 5 Paddington Hospital Group House Committee No. 2 Councillor Dr. L. Jacobs. Paddington Hospital Group House Committee No. 3 Councillor Mrs. F. E. Glenny. National Society for Clean Air Councillor Dr. H. K. Ashworth, T.D. The Medical Officer of Health. St. Marylebone Clean Food Association—Executive Councillor Mrs. F. E. Glenny. Committee **Councillor Mrs. J. P. G. Nuttall. Department of Scientific and Industrial Research— Councillor Dr. H. K. Ashworth, T.D. Standing Conference of Co-operating Bodies The Medical Officer of Health. dealing with Atmospheric Pollution Mr. L. Pearson, Public Health Inspector. London and Home Counties Clean Air Advisory ffCouncillor R. H. S. Allen and the Medical Council Officer of Health. Area 10 Home Safety Committee of RoSPA †††Councillor Mrs. H. Shire. No. 2 Area Committee of the Family Welfare ***Councillor Mrs. R. M. Challis. Association ††Councillor Miss E. C. Adams. * Until April. †From, May. ** Until November. †† From June. *** Until June. ††† From December. Conferences. The Council were officially represented at the under-mentioned conferences dealing with matters within the purview of the Public Health Department:— Conference Royal Society of Health—Eastbourne, 29th April to 3rd May Association of Public Health Inspectors—Eastbourne, 24th to 27th September National Society for Clean Air—Scarborough, 8th to 11th October Conference of the Central Consultative Committee on the Welfare of Old People—London, County Hall, 28th June Royal Society for the Prevention of Accidents, National Home Safety Conference—Central Hall, Westminster, lOth-llth October Royal Institute of Public Health and Hygiene— Harrogate, 25th to 27th September Delegates Councillor Mrs. F. E. Glenny. The Medical Officer of Health. Mr. V. A. Bignell, Chief Public Health Inspector. Mr. L. Pearson, Public Health Inspector. Councillor Mrs. R. M. Challis. Miss M. M. Sharp, M.B.E., Public Health Inspector. Councillor Mrs. H. Shire. The Medical Officer of Health. Councillor Mrs. R. M. Challis. The Medical Officer of Health. 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 1963, as follows:— Organisation £ s. d. Statutory Authority Central Council for Health Education 12 14 0 Public Health (London) Act, 1936, section 298. Family Welfare Association (Area 2) 175 0 0 Local Government Act, 1948, section 136. St. Marylebone Youth Committee 125 0 0 do. National Society for Clean Air 10 10 0 Public Health (London) Act, 1936, section 298. St. Marylebone Old People's Welfare Association— "Meals on Wheels" Service, etc. 400 0 0 National Assistance Act, 1948, section 31. Assisted Holidays Scheme 600 0 0 do. "Inner Wheel" Old People's Club—Rent of Hall 30 0 0 do. Women's Voluntary Services 40 0 0 do. York Street Day Centre 300 0 0 do. Health Education. The aims of health education have been defined by an expert committee of the World Health Organisation as:— (i) To ensure that the community regards health as an asset. (ii) To equip the individual with skills, knowledge and attitudes to help him solve his own health problems. (iii) To promote the development of the health services. 6 It has been said that the health of a nation is the history of that nation. Health education can lead to social reform and in raising the standard of health it enhances national prosperity. Active health education is not the responsibility solely of the public health service, but should be shared by the health and social services, churches, schools, youth and other organisations. The national and local press can be of tremendous help, whilst radio and television are, to an ever increasing extent, most powerful means of influencing public opinion. The local authority public health department is the focus for health teaching and propaganda within its area and members of the staff, having close contact with the public, gain many opportunities for teaching and can provide a ready source of information and guidance. During the year this kind of personal contact continued to be the chief means employed in furthering health education locally, but wide use was also made of posters, pamphlets, bookmarks and other visual media. More than eight thousand pamphlets and an equal number of bookmarks were distributed via the public libraries, with special emphasis on the subjects of smoking and health and of venereal diseases. In the field of food hygiene a series of lectures was arranged to form a simplified course on this subject. There are many difficulties inherent in such schemes, particularly in obtaining the release of staff during working hours. However, a pilot scheme was arranged with the co-operation of a large Oxford Street store. This appeared to be very successful and a further series of talks, modified in the light of experience thus gained, has been planned. At the request of another large company with headquarters in the Borough, a food hygiene lecture, on rather specialised lines, was given to a group of Staff Nursing Sisters drawn from their various branches. Each year an opportunity is taken of circularising all food and catering premises, drawing attention to one particular aspect of hygiene. The subject this year was flies, and information was given regarding precautions to be taken to protect food from them and on methods of preventing fly infestation. The large number of injuries and fatalities resulting from accidents in and around the home is also a matter of great concern, and extensive education and propaganda on this subject is urgently required and must be given special importance in the programme of a public health department. Action taken in this regard during the year is described in the paragraph on Home Safety on page 10. Care of Old People. The number of old persons of whom the Department have particulars is as follows:— Bachelors or widowers 144 Single women or widows 1,419 Married persons living together 232 1,795 The majority of them (1,563) live alone and some require constant observation. During the year 4,359 visits were made to 964 old people, of whom 110 were married couples. In addition 45 visits were made by the two women public health inspectors to six infirm persons other than old age pensioners. Special Laundry Service.—The Department continued to operate the service, begun in 1950, for laundering bed linen and clothing of acutely ill and incontinent or very dirty and verminous old people. During the year, 55 cases were dealt with, some over long periods, others for a short while only. Forty-five of these were new cases 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 staff of the Department's 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 a total of 577 baths were given, 421 to women and 156 to men, under the scheme started in 1954 for bathing old persons at the Lisson Grove Centre. 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 in a Public Health Department vehicle between their homes and the Centre. 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 7 District Nurses, British Red Cross Society, W.V.S., and other voluntary societies, likewise continued to be of great assistance. Services available for old people are summarised on pages 40 and 41. St. Marylebone Old People's Welfare Association. The Executive Committee of the Association (Chairman—Councillor G. J. Brown, O.B.E., M.I.Mech.E.; 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 1963:— "Grants.—For the year beginning 1st April, 1963, the Borough Council granted £600 for holidays and agreed to make contributions of not more than £600 towards the cost of meals, etc. This covers insurance, licences for the vans, foil containers for meals, also rent and other small expenses for the Luncheon Club, the Council now paying directly for the maintenance of the vans instead of as hitherto refunding the Association's expenditure. The new basis for financial co-operation agreed with Council representatives resulted in a simpler procedure. They also agreed to contribute £125 towards administrative expenses in connection with holidays, etc. The grant for Chiropody was continued by the London County Council. General.—£200 was withdrawn from the Portman Building Society in January, for the purpose of welfare needs not met by grants. Donations and Gifts.—The Executive were much encouraged by welcome donations and expressed warmest gratitude for valuable help to the following: West London Synagogue Charitable Fund (£25); Miss Tassinari, £3 and clothing; Mrs. Brighten (£30), with special thought for extra fuel in cold weather; Hospital Sunday Fund, through B.R.C.S., £2 3s. 6d. for an elderly lady's electricity expenses; Anon., £5 for relief; Dorset House Restaurant Club (£2 10s. 0d); Mrs. Winslow and Mrs. Carr (£25); Rotary Club of St. Marylebone (£7 17s. 5d.); Miss Baker (£1); the Mayor (£20); Mrs. Barnett (£5); Artizans and General Properties Co., Ltd. (£10 10s. 0d.); St. Marylebone Parish Church (£15); Lyndhurst Club (£20); Mrs. Lew Grade, £40 and gifts in kind (groceries, china, etc.); Mrs. Fewster, £10 10s. 0d. for fuel (and also cost of a holiday for two pensioners); Mrs. Neville Blond, a TV set for a pensioner and £12 for the licence for 3 years; Anthony Jackson Stores, many parcels of various gifts from West London Synagogue Bazaar. Harvest Gifts were distributed to old people from the George Eliot Primary and Infants' Schools, and several Churches. Christmas gifts were more numerous this year and warmest thanks are expressed to the kindly donors who made it possible for parcels to go to all old people known to be housebound, and many others. St. Marylebone Centre for the Elderly.—Early in the year, following much discussion, negotiations were opened for premises for a centre in the basement of York Street Chambers. Thanks to the kindness of St. Marylebone Housing Association, when the necessary planning permissions had been obtained, a lease of 14 years at a rental of £500 per annum, exclusive, was offered to our Association. Proposals for alterations were in due course approved by the ground landlords. At a meeting in September of the Old People's Consultative Committee, the Association's representatives submitted a schedule of the estimated costs of converting and equipping the premises, together with an estimate of the annual running costs. A figure of £4,000 for capital outlay was suggested to the Council's representatives, maintenance estimated at £2,000 a year plus rent and rates. These figures were accepted by the Council's representatives, who recommended the Council to make a grant to the Association to cover these amounts. Other relevant committees supporting, the Council agreed. 'Meals on Wheels'.—As foreshadowed in the last Report, the Council agreed to make possible the hoped for extension of meals by giving a special grant for the provision of a second van, another Austin A.55 with four portable heated food containers (G.E.C.). This new van came into operation towards the end of June. As a result, 3,213 more meals were delivered than the previous year, 10,930 in all. Both vans were garaged and maintained by the Borough Council. One driver, ' Frank ' has been a reliable and helpful worker for nearly 3 years. With the coming of the second van, B.R.C.S. members joined the W.V.S. helpers under Mrs. Lush, and, as usual, much wider service was given than the delivery of hot meals, exacting though that can sometimes be. Good cheer and friendship are also taken into the homes. Luncheon Club.—5,228 mid-day meals were served. This Club has continued to be an immense benefit to those elderly folk who are provided with a hot meal and companionship in a cheerful, welcoming atmosphere. Some attend five days weekly, others less often. Most would not find it easy to cook a good meal at home. 8 The success of the meals services from their earliest days is very largely due to Mrs. Lush, to whom the Association cannot be sufficiently grateful for the generosity with which she has given her time and wonderful organising ability. Chiropody.—In another successful year the same three Chiropodists in Clinic 1, in the Town Hall, carried out 2,439 treatments (32 more than the previous year), Miss Cotsford (B.R.C.S.) continuing her valuable help as Appointments Clerk. At Clinic 2, held at All Souls' Church Club-house, by the kind hospitality of the Church, 391 treatments were given. Miss Lerner, the Chriopodist in charge, was grateful for the help of Mr. Vincent with the appointments, after Miss Hoogendoorn had been obliged for health reasons to give up helping. The L.C.C. Health Centre 2, at Lisson Grove, undertook 1,506 treatments for elderly women in 1963, 348 more than the previous year. It is gratifying to note how much higher this makes the total of elderly people now given this important help. Home Chiropody.—710 treatments were given, 73 more than in 1962, 49 new patients being visited. A waiting list of 24 at the end of the year was 8 more than at the beginning. This service is a very great comfort to housebound people in poor health and it is much regretted that so many are unavoidably kept waiting before treatment can start. A letter from a daughter of an old lady who died said: 'My sister and I would like to say how much we appreciated this chiropody treatment which we had been unable to arrange otherwise. We should be grateful if you would pass on our thanks to Miss Curran. Quite apart from the chiropody, she was a most welcome visitor and my mother loved to see her coming in. She is such a bright and cheerful person that I'm sure most of the old people must get great pleasure from her visits as my mother did.' Miss Reeves also did valuable work throughout the year, and later in the year, when it was learnt that the L.C.C. grant would be increased by £40 a year, Miss Lerner kindly undertook to visit in their homes some patients in the area near Clinic 2. Holidays.—The main assisted group holidays were again at Brighton and, as in previous years, were successfully arranged through Rutland Tours Ltd. One hundred and four people enjoyed a holiday in April-May, most of them for one week, though a few were helped to stay for a second week. In addition a little party of five had a similar week at Brighton in October. Twenty-five were enjoying these assisted holidays for the first time. The contribution from participants was again limited to £1 17s. 6d. a week, and several old people sponsored by All Souls' Church even had this amount met by the Church. Miss Sharp accompanied the parties on the coach drive to Brighton, and supervised the settling-in process, always a big contribution to the smooth running of the scheme. Every effort was made to meet special requirements for some who were unable to take part in the group holiday and 17 individual holidays were arranged or assisted. Five went to Woking for a fortnight's holiday at the Church Army short-stay home. The cost of each holiday was £9 14s. 0d., plus transport : four contributed £3 15s. 0d., one lady, by her own wish, contributing more. Two were assisted to go to a guest house at Cliftonville and one to Margate; three were helped financially to visit relatives and a couple were granted £10 towards a holiday at Ramsgate arranged for handicapped people. A grant of £34 was made to the Fourth Feathers Club towards the transport for their own holiday scheme. Social Visiting.—It is not easy to give a comprehensive picture of the number of people visited regularly in St. Marylebone, as the groups of visitors and individuals concerned are so numerous, but it is clear that there is a growing interest in this very important service, particularly among young people, e.g., 10 young people of the Parish Church visit the elderly and some of the students who have carried out decorating jobs continue to give pleasure by visiting the homes afterwards. The Visitors' Committee (30 to 45) fluctuated in numbers, largely owing to the 'turnover' in students. Some of the regular Visitors are never able to come to meetings but keep closely in touch ; others represent groups, the largest of which is that connected with All Souls' Church. The monthly meetings with Miss Sharp and Mrs. Cowan continue to provide an opportunity to report problems and keep in touch with developments. Decorating, etc.—Miss Pilkington's group of workers from Hinde Street Methodist Church were the first in the field and have continued their admirable work of decorating old people's rooms. Another Hinde Street group appeared later, under Mr. Andrews, one from St. Mary's Hospital and one from University College; further help has come from St. John's Wood Church Voluntary Service Group under Miss Hurst, the U.N. International Service, and Mr. A. Steen on behalf of youth clubs. 9 Both Miss Sharp and Miss Wilson gave much thought and care to deciding on the rooms most urgently needing attention and to dealing with offers of voluntary help for visiting and odd jobs. The National Assistance Board gave helpful consideration to applications for support and in a number of cases refunded money spent by the Association on paint and wallpaper. Relief.—Urgent needs, mostly for small items, are reported by Miss Sharp and Miss Wilson. The accounts show that the Association has been able to give an increasing amount of help. Clubs.—The Executive is able to keep in touch with club work through the leaders' reports of special activities, at Christmas-time or summer outings, and the office is continually reminded of the benefits to club members of the companionship of the regular meetings and the care extended to them by club leaders in time of trouble or illness. Entertainments.—Another splendid party for 800 elderly St. Marylebone residents was given at Christmas by Mrs. Lew Grade in the Seymour Hall, which again presented a wonderfully colourful and happy scene. This occasion was eagerly anticipated and talked about long afterwards as 'better than ever'. Thanks to Mrs. Grade's personal care for every detail of the gifts, decorations and the very cheerful show, this huge party went off once again without a hitch. The Association was happy to allocate the invitations and arrange for stewarding. The Y.M.C.A. in Great Russell Street repeated their delightful Christmas party for old people, and several other special parties were given, among which one arranged by Boy Scouts in St. John's Wood included a drive to see the Christmas lights. Library Service to Housebound Readers.—The Borough Librarian reports:—'The delivery of books to the housebound, instituted by the Public Libraries Committee in 1957, has been carried out regularly by the library, mainly to cases recommended by the Home Help Service. Thirty readers are at present receiving this service and 4,792 books were delivered to them in 1963. The readers deeply appreciate the service given and look forward very much to each fortnightly visit.' Radio.—Fourteen new sets on loan were issued on the Association's application to the Wireless for the Bedridden Society. This Society also generously supplied a number of licences. At the end of the year 38 sets remained under the supervision of the Association, and some other sets in the Borough were sponsored by different bodies. The Society started providing television sets in special cases. Television.—Through the Central Consultative Committee on the Welfare of Old People, the Association had the opportunity to apply for television sets on loan for housebound people living alone. An anonymous benefactor had offered 1,000 sets for people in London, with licences and maintenance covered. It was a great pleasure that the Association's application for sets met with a favourable response." 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, but distressing cases 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 1963 no cases occurred which required action under this heading. Public Baths and Laundry. The Seymour Hall, opened in April, 1937, covers an area of 37,000 square feet. The building is electrically heated and contains two indoor swimming pools, private baths, public laundry, squash racket court, changing and club rooms. Swimming, private bath and laundry facilities are available daily throughout the year. The large swimming pool, which is converted from October to April inclusive for use as a public hall, has a water area of 132 feet by 42 feet with depths from 3 feet to 12 feet, and the smaller pool a water area of 100 feet by 30 feet with depths from 2 feet 9 inches to 6 feet 6 inches. The number of swimmers, excluding school children, using the pools during 1963 was 170,316. Organised Swimming Instruction—Schools.—The number of school children receiving swimming instruction increased to 31,979 from 25,865 last year. 10 Public Laundry.—The Public Laundry facilities consist of a machine laundry comprising 8 fully automatic washing machines, 3 spin dryers and 4 tumbler air dryers; the hand laundry has 6 units for hand washing, 2 spin dryers and 2 tumbler air dryers. By means of a time control the tumbler dryers will dry all types of materials, including woollens. The rotary ironing machines have proved most successful, a 15 lb. load of domestic washing can be washed, dried and ironed in 1^ hours. This completely modern installation has resulted in an increased number of young married women using the laundry, and many expressions of appreciation have been received. Further improvements to lighting and layout and the replacement of existing washing machines will shortly be undertaken. Medical Examinations. Staff.—The Medical Officer of Health is medical adviser to the Council for staff purposes. During 1963, one hundred and six examinations of the Council's employees and new entrants to the superannuation scheme were carried out. Parking Meter Exemptions.—The Council are empowered in certain circumstances to give exemption from parking meter charges to a person who is severely disabled. During the year, fifty-one applications were referred to the Medical Officer of Health for observations and, if necessary, medical examination. Home Safety. The provisional statistics covering 1963 indicate that 7,754 people died in Great Britain as a result of an accident at home. Yet again these fatalities exceeded in total the number killed on the roads (6,922) but the resultant publicity has been so insignificant that public awareness still does not seem to have been aroused to the serious problem of preventing home accidents. In fact, it appears that the only extensive publicity given in the national press to the tragedy of home accidents is to incidents of death in fires associated with oil heaters. Four-fifths of home accident victims are young children of under five years and elderly people over 65 years of age. Three-fifths of the total deaths are amongst females, due mainly to the preponderance of women in the elderly age group. Of children under 15 years of age, more boys than girls are killed as a result of accidents in their homes and more die from this cause than from all other accidents elsewhere, including road accidents, or from any one infectious disease. This is a national problem which demands urgent attention. Means of prevention must be found to stop this single factor accounting for so much death and disablement. In addition to the fatalities, maiming, disfigurement and psychological effects caused by home accidents there is also the heavy burden they place on the hospital services. One badly burnt child may spend up to 400 days in hospital and in the early stages require constant attention and the skill of teams of doctors and nurses to save its life. The annual cost of hospital treatment for home accident victims is estimated at some five million pounds. In continued support of the national"Training for Home Safety Campaign" organised by RoSPA some 10,000 bookmarks and 3,000 safety handbooks were issued and 2,000 letters sent to residents, drawing attention to the need for adopting common-sense precautions in the home. In addition, copies of the London County Council home safety handbook were distributed via the public libraries. In the latter half of the year, RoSPA initiated a "Buying and Selling For Safety Campaign The object was to educate the public to buy articles for the home which were known to be safe and therefore carried the various"approval"symbols, and to seek co-operation of the retailers in only selling such articles. Accordingly a letter was sent to all relevant retailers in the Borough and to some 2,000 residents, drawing attention to this worthwhile policy, and the local press kindly co-operated by publishing a home safety feature prepared in the Department. The policy of giving lectures, aided by film or film-strips, was continued and six old people's clubs were visited for this purpose. Where an outbreak of fire in domestic premises is found to be attributable to an oil heater, the London Fire Brigade sends details of the heater and circumstances of the fire to the local public health department. Two such incidents were notified during the year. In one the heater was not constructed in accordance with the Oil Heaters Regulations, 1962. As the heater had been purchased in an adjoining borough, the matter was brought to the attention of the public health department concerned and, as a result, the remaining stock was withdrawn from sale. In the other the heater complied with the Regulations and it was not possible to identify the actual cause of the fire. In St. Marylebone these matters are dealt with by the Public Health Committee and at the invitation of RoSPA a member of the Committee has been appointed to serve on Area 10 (Greater London and Middlesex) Home Safety Committee which meets quarterly at Terminal House to discuss and co-ordinate work in the field of home safety throughout the area. 11 Personal Health Services The local health authority is responsible for either providing these services or arranging for them to be provided by some other organisation. In the Administrative County of London this matter is the responsibility of the London County Council, and the services provided include maternity and child welfare, vaccination and immunisation, health visiting, domestic help, day nurseries, midwifery, ambulance and mental health. The services available for the Borough are adequate and the majority of them are administered from the Divisional Health Office, 313, Harrow Road, W.9. New Legislation. A list of the new Acts, Regulations and Orders, relating to the work of the Department, is given in Table 25, page 39. 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 summarised in Table 5, page 32. Excluding rat and mouse infestations, 1,159 complaints were received and details of 1,024 various nuisances remedied are shown in Table 6, page 33. Notices.—Intimation Notices served under the Public Health (London) Act, 1936, numbered 388 and 59 of these were followed by the service of Statutory Notices to secure abatement of nuisances. In addition, nine other formal notices were served as follows: three for the cleansing of water storage cisterns and six for the provision of artificial lighting on common staircases—as required by the Borough Council's Byelaws. For offences under London County Council Byelaws, twenty-six notices were served, thirteen being in respect of water-closets, twelve for drainage defects, and one requiring proper maintenance of dustbins. Legal Proceedings. No legal proceedings under the provisions of the Public Health (London) Act, 1936, were necessary Noise Seventy-four complaints of noise were received and these concerned 43 alleged nuisances and necessitated 254 visits by the Public Health Inspectors. A substantial proportion of the complaints were of noise coming from building sites, demolitions, and engineering works and operations, which may be summarised as follows:— Pneumatic and other drills 8 Water pumps 2 Compressors 5 Crane 1 General works 6 Frequently the complaints were of noise from these sources occurring late at night and during week-ends but, as in recent years, it was found that the various contractors against whom complaint was made generally appreciated the situation and offered willing co-operation in seeking and applying noise reducing methods, even, to some extent, at the loss of efficiency or restriction of hours of working. The remainder of the supposed causes were as follows, namely:— Workshops 5 Garages 3 Social functions, parties and noisy neighbours 3 Loading and unloading of vans 2 Ventilating plant 2 Slamming of car doors 2 Hot water system 1 Jazz band 1 Record player 1 High-pitched hum 1 The complaints were not always well-founded but, where justified, they were followed up and the offending noise abated or reduced to a reasonable level. In certain cases where the Council had no legal powers, informal action taken by the Public Health Inspectors or the Streets Nuisance Inspector resulted in improved conditions. 12 Pigeons. Section 121 of the Public Health (London) Act, 1936, empowers the Council to arrange for the seizure or destruction of pigeons in excess of such numbers as the Council consider reasonable and, for this purpose, an authorised pigeon catcher is employed. Pigeons cause nuisance through fouling, defacement and damage. Where they congregate in flocks their droppings, apart from being unsightly, produce stench and fly nuisance, and walls and roofs of houses where these birds nest are similarly fouled. Almost invariably feeding by members of the public is the cause of pigeons congregating, whilst the remains of food fed to them attract rats, mice and flies. It is known that pigeons can be vectors of diseases affecting mankind, and their incessant cooing during nesting gives rise to noise nuisance. During the year, eight complaints were received. These involved fifty-five visits by the Public Health Inspectors but after investigation it was found necessary to refer only one case to the pigeon catcher. Water. Although at two blocks of flats and two office buildings water 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 to your Borough by the Board has been satisfactory both in hygienic quality and quantity during 1963. The supply is River Thames-derived filtered water from two main filtration works, namely Ashford Common and Hampton. There were no new sources of supply instituted by the Board during the year, nor any important extensions of trunk mains. The general scheme of supply was the same but 619 yards of service main were laid in the Borough during the year." The analytical results of the chemical and bacteriological examination of the water are set out in Tables 7 and 8, page 33. The severely cold weather which set in during the last few days of December, 1962, continued throughout the following January and February. Water service and communication pipes under the footway were frozen and streets of houses and several office buildings were without a water supply for weeks. Emergency stand-pipes were arranged in these localities but they too froze and burst. The Metropolitan Water Board made continuous efforts to de-freeze house supplies by electrically heating the pipes with direct current, but in some cases even this treatment was unsuccessful. In the event of a complaint of contaminated public mains water the Metropolitan Water Board is informed, investigations are made and, if necessary, samples are taken for examination. Complaints are few and normally refer to unusual taste—which is often due to temporary super-chlorination following works on the mains. However, one complaint was received of foreign matter in water and this was found on investigation to have arisen following the disturbance of scale in the pipes by freezing. This condition cleared quickly and no action was necessary. The Metropolitan Water Board notified four cases where water supply had been cut off at premises for failure to pay rates. Supplies were restored after payment had been made and the service of notices was not necessary. The number of dwellings supplied from public water mains is 24,781, with an estimated population of 66,883. No stand-pipes are in use and the remaining dwellings, namely, two blocks of flats comprising units with some 437 residents, obtain water from private wells. It is the practice of the Department to keep these wells under observation and sample the water every six months. The Council's Bacteriologist's reports for 1963 indicated the water to be satisfactory. In various properties in the Borough drinking water is derived from private storage tanks supplied with water from the public mains. A Borough Council Byelaw requires these tanks to protect water adequately from the risk of contamination and to be cleaned at least twice a year. During the year it was found necessary to serve three notices under this Byelaw. Two certificates relating to the provision of a proper and sufficient supply of water in dwelling houses were issued upon request under the provisions of Section 95 (2) of the Public Health (London) Act, 1936. In common with all other Metropolitan Borough Councils, the Council were in favour of the Metropolitan Water Board being asked to introduce fluorides into the water supply. Drainage—Alterations and New Buildings. Of the 283 drainage plans approved during the year, 40 were in respect of new buildings. Upon request, the Borough Engineer examined 7 sewer connections and 3 of them were found to be defective and had to be renewed. 13 The drainage inspectors made 3,752 visits and no circumstances were found which necessitated legal proceedings. During the year a re-drainage scheme was commenced at the premises of the Zoological Society of London, Regent's Park, which involves laying a new 24-inch diameter main drain under Regent's Canal to the London County Council Middle Level Sewer. When completed, the re-drainage will extend throughout the Zoological Gardens. Combined Drainage. Eight orders under seal were issued in respect of combined drainage operations. Sewerage. The Borough Council's sewers are controlled and maintained by the Borough Engineer and discharge into the main drainage system of the London County Council, who are responsible for the disposal of sewage. During the year the re-laying of the London County Council King's Scholars'Pond Sewer from Swiss Cottage to Wellington Place was commenced. The trunk sewer will eventually join up with the deviated line at Wellington Place/Cochrane Street. There are no disposal plants in the Borough. Town Planning. Observations were made by the Department on 177 plans submitted to the Council under the Town and Country Planning Act, 1947. Rodent Control. There were 205 notifications of rats at premises in the Borough, 46 more than in the previous year, and reports of mice declined from 366 to 314. It having become evident that block surveys no longer justified the time and labour involved, this routine procedure has been discontinued. Sewers are treated by the polythene bag system at approximately eight week intervals, the bait being applied at side entrances only. "Takes" at most points varied little from time to time but secondary baiting was carried out wherever they were consistently "good". By these means the residual numbers of rats in the sewers is kept to a minimum. Statistics of rodent control are shown in Table 9, page 34. Disinfestation. The insecticide used to rid dwelling houses of bugs is composed of kerosene with 5 per cent. D.D.T. and 0.1 per cent, pyrethrins applied as a spray 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, 241 rooms were disinfested and in this connection the Public Health Inspectors made 282 visits to the 198 premises involved. 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 1963 the furniture of 3 families, all of whom were being rehoused, was treated by this method. In addition 360 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 continued to work most satisfactorily. Verminous Persons. The Department's Cleansing of Persons Baths in Lisson Grove dealt with 332 verminous persons: adults 145 (men 131; women, 14); children 187 (boys 40; girls 147). 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. There was another substantial reduction in the number of complaints received, 43 compared with 84 in 1962; 108 in 1961 and 144 in 1960. Fewer contraventions of the Clean Air Act, 1956, were detected, 37 against 43 in 1962; 63 in 1961 and 48 in 1960. The institution of legal proceedings was not considered to be necessary and the offences were dealt with by verbal and written cautions or, when applicable, by Statutory Notice. 14 Dark smoke was timed on 55 occasions and in 13 cases the emissions exceeded the limits prescribed in the Dark Smoke (Permitted Periods) Regulations, 1958, thus infringing Section 1 of the Clean Air Act. Smoke from chimneys of buildings in Smoke Control Areas contravening Section 11 of the Act was observed on 10 occasions and smoke nuisances within the meaning of Section 16 were found 9 times. Notifications, under Section 3 of the Clean Air Act, of the intention to instal new furnaces totalled 40. A sixth Smoke Control Order, affecting all premises in Ward No. 7 (Bryanston Square), came into operation on the 1st October, 1963. A seventh Smoke Control Order, in respect of Ward No. 6 (Dorset Square) and Ward No. 9 (Park Crescent), was made by the Council in May, 1963, and confirmed without modification by the Minister of Housing and Local Government in November, 1963. At the end of the year Smoke Control Orders covering 30,154 premises in 1,270 acres of the Borough had been made and confirmed by the Minister. A survey of the remaining 203 acres in Wards No. 4 (Church Street) and No. 5 (Bell Street) was commenced in preparation for an eighth and final Order to complete the Council's Smoke Control Area programme. In support of the National Survey of Air Pollution, smoke and sulphur dioxide in the atmosphere was measured at four stations, two at new sites, and the concentrations are set forth in Table No. 10, page 34. Offices. There are some 3,612 office buildings in the Borough but there is at present no record of the number of individual offices. It has been estimated that almost half the working population in this country are employed in offices and shops. Although since 1924 there have been several attempts to introduce legislation in respect of the health, welfare and safety of office workers, until this year no substantial enactment has resulted. Consequently there have been no legal requirements as to lighting, temperature or facilities for washing or for taking meals, all of which have a direct bearing on health. In London, it is even doubtful whether routine inspection of offices, as distinct from inspections based upon specific complaints, can legally be carried out under the Public Health (London) Act, 1936. However, in 1949 a Committee was appointed to enquire into:— 1. The provisions of the Shops Act relating to closing hours (general and local) and to report as soon as possible whether any alterations were desirable. 2. To enquire into and make recommendations as to extending, strengthening or modifying: (a) The statutory provisions relating to the health, welfare and safety of employed persons in places of employment other than those regulated under the factories or mines and quarries Acts, and (b) the statutory regulation of the hours of employment of young persons. 3. To enquire into and make recommendations as to the machinery for enforcing statutory provisions within the scope of (1) and (2) above. The report of this Committee, known as the "Gowers Report", was presented to Parliament in March, 1949. The general agreement with which the Committee's recommendations were received found expression in draft legislation which was circulated for discussion. However, no apparent action was taken on the recommendations applicable to office workers and it was not until 1960 that a relative Act of any kind reached the statute book, and this was the result of a Private Member's Bill. Even so, the powers for making Regulations conferred by this Act were never used and it served practically no other purpose than to indicate by its promulgation that a positive need was felt for legislation in this field. Such legislation was finally achieved when the Offices, Shops and Railway Premises Act received the Royal Assent in July, 1963. This landmark in public health legislation will come into effect towards the middle of next year. Shops. There are 2,472 shops in the Borough which, apart from regular visits to food shops, necessitated 306 special inspections. Factories. There were 1,594 factories on the register at the end of the year, 29 less than last year. A report on the administration by the Department of matters under Parts I and VIII of the Factories Act, 1961, is given in Tables 11 and 12, page 35. Outworkers. Fifty-three employers submitted lists in respect of a total of 439 outworkers (182 contractors and 257 workpeople). Of these, seventeen contractors and sixteen 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 35. 15 Heating Appliances —Fireguards. The Consumer Protection Act, 1961, superseded the Heating Appliances (Fireguards) Act, 1952, but the Heating Appliances (Fireguards) Regulations, 1953, were re-enacted without amendment. In previous reports mention has been made of the fact that auctioneers can still legally sell heating appliances which do not comply with the Regulations, provided that they act on behalf of private individuals and not 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. The Council raised the matter with the Metropolitan Boroughs' Standing Joint Committee who made representations to the Home Office seeking to amend the legislation by including the sale of heating appliances by public auction. The Secretary of State, however, did not consider the introduction of amending legislation on this subject justifiable. Regular inspection was made of appliances exposed for sale by retailers. No new heaters were found which failed to comply with the statutory requirements but some thirty secondhand appliances were found to be defective and these were dealt with informally. Hairdressers and Barbers. The Council's Byelaws regulating these establishments came into operation on 18th December, 1955. There are in the Borough 157 registered hairdressers and barbers; regular inspections were made and conditions generally were found to be satisfactory. Pet Animals. 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, nine of which were issued during the year. A few of the licensees keep puppies and other mammals for sale but mostly they deal in cage birds, goldfish and tropical fish. The premises concerned were kept under observation by the public health inspectors, who made fourteen 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. The Animal Boarding Establishment Act, 1963, comes into operation on the 1st January, 1964, and requires animal boarding establishments to be licensed by the Council on payment of a fee. The Act allows the Council to specify on the licence such conditions as they deem necessary and grants powers of inspection to ensure that these conditions are observed by the licensee. At present none of these establishments exist in the Borough. Poisons. At the end of the year the names of fifty-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), the number of premises concerned being sixty-five. Details are given in Table 14, page 36. Protective Helmets. The Motor Cycles (Protective Helmets) Regulations, 1963, came into operation on the 18th November, 1963. These Regulations amend and consolidate previous legislation and prescribe the type of helmet which may be sold or hired to motor-cyclists. The sale or hire of a helmet not conforming with the Standard constitutes an offence under the Road Traffic Act, 1960. No sub-standard helmets were found at the five premises concerned in the Borough. Public Conveniences. There are in the Borough ten conveniences and three urinals for men and seven conveniences for women, a full list of which appears under Table 15, page 36. The hours of opening are from 7.40 a.m. until 10.0 p.m. except at Oxford Circus where the conveniences are normally open until 11.0 p.m. and until midnight during the Christmas shopping season, when large numbers of people come to see the Oxford Street and Regent Street illuminations at night. All conveniences have attendants, other than at Violet Hill public gardens and the three urinals which are cleansed by a"flusher"who visits them at least twice daily. The attendants work on a two-cycle shift system and an extra man and woman are employed on the morning shift at Oxford Circus so that if necessary they can be called upon for emergency duty elsewhere. The usual supervision was exercised over the conveniences and urinals, and the free washing scheme with paper towels and liquid soap, now well-established over the last 15 years, continued to be extremely popular with the general public. The Borough Council, having decided to abolish the penny charge for the use of water closets, the completely"free"service is due to come into operation on 1st April, 1964. Staff problems again caused concern, with shortages occurring during staff sickness and holiday 16 periods, necessitating some of the smaller conveniences being left unattended for short periods. Fortunately, incidents of vandalism have been few but minor damage to fittings, etc., has occurred at the unattended Violet Hill Gardens convenience. Public Cleansing and Salvage. The Director of Public Cleansing has kindly provided the following information:— "The refuse and salvage collected during 1963 were: house and trade refuse, 36,050 tons; street sweepings, market refuse and gully sludge, 2,431 tons; salvaged materials, 2,321 tons. An income of £16,524 was received from the sale of salvaged materials. In addition, £2,057 was received for the removal of trade and extra refuse and the cleansing of petrol interceptors, etc. Apart from a period at the beginning of the year, when heavy snowfalls occurred, a minimum twice-weekly refuse collection was maintained and about a quarter of all premises in the Borough received a thrice-weekly clearance. A daily collection was made at premises where this is necessary, such as hospitals, restaurants, hotels and blocks of flats. All street gullies were mechanically cleansed approximately four times during the year and, with the exception of the above-mentioned snow period, all streets were swept at least once daily. The year commenced with the most severe weather experienced in London for at least 80 years. Heavy snow fell on many occasions and the very low temperatures made removal difficult. Virtually all the street cleansing staff, assisted by large numbers of men from the Works Department, casual labour and volunteers from the refuse staff, were employed for many weeks on snow clearance and removal. Many of the Cleansing Department's vehicles, together with Works Department and hired vehicles, loading shovels and snowploughs, were in constant use during the period. Nearly 1,000 tons of salt were spread on roads and footways and considerably more would have been used if it had been obtainable from suppliers. The experience of the 1962/63 winter showed that there was a need for additional snow clearing equipment, to enable the Department to deal satisfactorily with snowfalls of similar intensity and duration. Consequently, two suitable secondhand vehicles were purchased for conversion to salt spreading machines and three additional modern-type snowploughs and more tools were obtained. In addition, salt storage facilities were greatly increased. The refuse collection service in the Borough was reorganised in the early part of the year and this, together with the introduction of new compression type vehicles, enabled a reduction to be made in the number of vehicles required. An evening and night collection service was introduced in the eastern end of the Borough, owing to the traffic difficulties involved in day time collection. There are many textile and other business premises in multi-occupation in this area, which produce a very large volume of bulky refuse but have insufficient storage accommodation. The new service has improved the amenities of the district, as formerly much of the refuse was placed outside premises overnight, which was unsightly and caused littering of the streets. A new emergency refuse loading bay has been built at the Department's main depot to enable refused to be transferred to large capacity vehicles for haulage to tips, at times when the normal means of transport by barge is not available. During the year, a further five new refuse compression vehicles were put into operation. The Department now has ten of these machines, all of which are capable of conversion to dustless refuse collection when this is extended to other parts of the Borough. For the street cleansing service, a new side-loading vehicle was purchased, to replace an old vehicle of similar type. It will be used in the collection of sweepings and market refuse. A new street-washing trailer was also purchased, for use in conjunction with an existing tractor, and this will enable more street washing to be carried out at night." Refuse Storage Accommodation. Section 24 of the London County Council (General Powers) Act, 1959, requires"inter aha"that new buildings, or buildings substantially altered or adapted, shall be provided with refuse storage accommodation approved by the Borough Council. The Department is concerned to ensure that suitable and sufficient accommodation shall be provided, and the Director of Public Cleansing that the refuse shall be easily accessible for collection. Twenty schemes were approved after consultation with the Director of Public Cleansing and during the year progress was also made with the abolition of some of the few remaining fixed ashpits. At Portman Buildings, Crawford Buildings, Ossington Buildings, Seymour Buildings, Wendover Court, and Wharncliffe Gardens, the replacement by stages of fixed ashpits with bins and later with large refuse containers is advancing well towards completion. 17 Radioactive Substances Act, 1960. This Act came into operation on the 1st December, 1963, and persons who keep or use radioactive materials are, unless exempted, required to register with the Minister of Housing and Local Government and to obtain his authorisation for the accumulation or disposal of radioactive waste. Certificates of registration issued under Section 1 and authorisation under Sections 6 and 7 of the Act have been issued by the Minister in respect of four premises in the Borough. 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 fourteen premises, mainly those of upholsterers and manufacturers of cushions and pillows, are registered. 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. Eleven burials and six cremations were arranged during the year. 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, where applicable, 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 had occurred in the district. During the year five certificates were issued in respect of bodies being transported abroad, three to Iraq, one to Italy, and one to Cyprus. Cremation. The Medical Officer of Health is Medical Referee for the Council's Crematorium, which is situated at the St. Marylebone Cemetery, East Finchley. During the year, 2,092 certificates authorising cremation were issued and since December, 1937, when the crematorium was opened, 27,096 cremations have taken place. Dog Nuisance. The Council's revised byelaw dealing with this nuisance came into operation on 31st May, 1960. It provides that:—"No person being in charge of a dog shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon." Contraventions reported by the Streets Nuisance Inspector during the year resulted in the issue of fourteen summonses, one of which could not be served. Thirteen convictions were secured with penalties and costs amounting to £37 7s. 6d. Street Photographers. A local byelaw, 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 byelaw is liable on summary conviction to a fine not exceeding £5 0s. Od. As the administration and enforcement of most other"good rule and government"byelaws have been referred to the Public Health Committee, a similar course was followed in regard to this byelaw, more particularly as the officers of the Department including the Streets Nuisance Inspector, are continually about the streets. During 1963 the Council applied for two summonses of which only one could be served. This resulted in conviction and a fine of £3 0s. Od. with one guinea costs. 18 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, 1963:— Pre-war Estates No. of Dwellings Crawford Place Dwellings 52 Fisherton Street 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 Wellington Road 121 147/149, Gloucester Place 10 1/7, Aquila Street 6 Abercorn Place 34 22-30, Balcombe Street 14 17-19, Balcombe Street 4 Townshend Road 8 147-165, Lisson Grove 12 57-73, Boundary Road 36 Aquila Street Extension 23 Violet Hill House 22 40-47, Chapel Street 20 Newcourt Street 48 Church Street Extension 76 9-25, Cochrane Street 32 Broadley/Penfold Street 30 1,427 Further Development Linked with Slum Clearance. The position at the end of the year was:— Ashbridge Street East (10 flats) This block is now approaching completion. Freshwater Place/Homer Row (9 maisonettes) This block is now approaching completion. Church Street Site No. 3 (Mulready Street) (175 dwellings) Architect's plans have been submitted to the Planning Authority. Church Street Site No. 4 (196 flats approx.) Sketch plans and estimates for this development are under consideration. Clipstone Street Area (246 flats) The consent of the Planning Authority is awaited to the outline proposals for the development of this area for housing with a limited amount of commercial user. Preservation of Lower Rented Accommodation 1. In November, in pursuance of the Council's policy of acquiring lower-rented properties which were in danger of losing their character, the purchase was completed of the 407 flats in Bronwen Court and Scott Ellis Gardens, comprising the Scott Ellis Estate, by agreement with the Howard de Walden Estates Ltd. The question of the possible transfer of these properties to approved Housing Associations is under consideration. 2. The Council are also negotiating for the acquisition of the freehold interest in Wharncliffe Gardens, a block of 539 flats. 19 Housing (Financial Provisions) Acts, 1958-59. (a) Loans.—The Council approved the making of 8 loans during the year, totalling £26,800, to enable applicants to acquire premises for owner-occupation. (b) Improvement Grants.—11 Discretionary Grants and 1 Standard Grant, totalling £5,764, were approved during the year, to convert and improve existing premises. Housing of Old People. Beaumont Street (29 flats for old people) Work on site has now recommenced after the engagement of a new Contractor became necessary. Old People's Consultative Committee. The Consultative Committee, composed of members of the Housing Committee, the Public Health Committee and representatives of the St. Marylebone Old People's Welfare Association, met during the year to review the provision of housing accommodation made in the Borough for old people. They also considered the proposals to set up a Day Centre for the Elderly, referred to in Section B of this report, under the heading " St. Marylebone Old People's Welfare Association," on page 7. 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 5, page 32. Certificates of Disrepair. Six applications for the issue or cancellation of certificates under the provisions of the Rent Act, 1957, were received during the year. Housing Act, 1961—Houses in Multiple Occupation. In the light of earlier experience, towards the end of 1962 a system was started whereby full information upon this aspect of Housing legislation was made available to owners of the type of property concerned. Upon initial inspection indicating that a house within the category had deficiencies under the Code of Practice, a copy of the Code, together with other pertinent information on overcrowding, etc., was sent to the owner or managing agent with an invitation to discuss the premises under consideration. This brought a good response, resulting in much useful informal work being done and many voluntary improvements made. Where, after a reasonable lapse of time, the invitation had not been accepted, the premises were re-visited to ascertain that conditions were as previously noted, and full particulars of all deficiencies were recorded so that a short schedule of specific requirements could be prepared and sent to the person responsible. The Code of Practice in respect of the provision of means of escape in case of fire became available from the London County Council in July, and joint inspections with the Borough Engineer's staff were subsequently made of multiple-occupied dwellings, so that schedules of works in respect of both amenities and means of escape could be despatched concurrently. The survey revealed that the greatest number of amenity deficiencies occurred in respect of (1) baths, (2) availability of hot water, and (3) proper food storage facilities. Means of escape from fire were frequently found to be sub-standard, and to remedy this could in many cases prove to be the most costly part of the total work required. The works so far have all been carried out by owners and in no case has the Council been required to authorise works in default. Land Charges Act, 1925. The Town Clerk referred to the Department 1,956 enquiries relating to details of any outstanding notices, orders or other restrictions on the properties concerned. Immigrants. In previous reports mention has been made of the fact that the south-eastern corner of the Borough, which is contiguous with Soho, contains a cosmopolitan population in which immigrants from Cyprus and European countries predominate. Very few immigrants from the West Indies, India or Pakistan appear to have settled in St. Marylebone. 20 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 twenty-eight 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. Two Closing Orders were made in respect of four underground rooms. Closing Orders on eight underground rooms were determined, and Orders on three rooms were varied. Common Lodging Houses There are two common lodging houses in the Borough. One accommodating 391 men is kept by the Salvation Army, at No. 2, Burne Street and premises in Lisson Street. The other, conducted by the Church Army, at Elgood House, No. 84, Bell Street, is registered for 85 women. Regular inspections were made and particular attention given to fire precautions, the numbers of lodgers accommodated, the possible presence of any verminous persons or articles, catering arrangements, sanitary and washing facilities, and to general conformity with Bye-law requirements. The Church Army lodging house is well-managed and has amenities which are above those usually found or expected at such premises. The building used by the Salvation Army as their Hostel for men was originally constructed for use as a hall and meeting place more than one hundred years ago. Prior to April, 1933, the hostel was licensed by the London County Council and accommodated some 514 lodgers. With the coming into operation of the Transfer of Powers (London) Order, 1933, the functions of the London County Council in this respect were transferred to the Borough Council. In reporting to the Public Health Committee upon the first application for renewal of the licence, received by the Borough Council, the Medical Officer of Health at that time, Dr. Charles Porter, stated: "I find it quite impossible to prepare anything which, in the ordinary sense, can be regarded as a specification. From the point of view of construction, these premises are so entirely unsuitable for use as a common lodging house that if application was being made for the first time for a licence, I should feel it to be my duty to recommend the Council to refuse." However, with the ready co-operation of the Salvation Army, improvements were made and a licence was subsequently issued and allowed for a maximum of 436 lodgers. Over the years various alterations were made at these premises, until the early 1950's, when some major structural alterations were accomplished and the permitted maximum number of lodgers was further reduced to 391. At present the average floor area and cubic capacity per person is 40 sq. ft. and 560 cu. ft. By present-day standards the natural lighting and ventilation are not good and the standard of artificial lighting is poor. Residents, of whom about 8% are old age pensioners, are barred from all rooms from 9 a.m. to noon, and from 2 p.m. until 4 p.m. The combined common and dining-room seats about 180 people and the cafeteria service provides meals and snacks, principal use being made of the breakfast meal. There are 14 water-closets and 13 urinals, equivalent to one water-closet for every 28 occupants. The 16 wash-basins have proved sufficient for the use made of them, and there are 12 deep sinks available for personal laundry. These unsuitable premises have been maintained on a very slender budget by a dedicated organisation which, despite rising costs and an increasingly difficult fight against dilapidations, has kept its charges for accommodation to an absolute minimum. It is not with regret that it has been learned that redevelopment schemes in this area indicate that this building will probably be demolished within the next year. 21 SECTION E.—INSPECTION AND SUPERVISION OF FOOD Food and Drug 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, 317 samples of food and drugs were examined. Seven of these were taken formally and 310 informally. The number adulterated or about which some comment was made was 54 or 17 per cent. The incidence of these criticisms may be classified as follows:— Number of Number of samples samples examined adulterated, etc. Milk 21 — Other Foods 288 54 Drugs 8 — The year began with many weeks of extremely cold weather and there was much snow on the ground, causing trouble in the feeding of cattle. This was reflected in the poor quality milk obtained during the months of February, March and April. Some goat's milk was quite a satisfactory product, but the name and address of the producer was not given on the label. A container of yoghourt was incorrectly labelled as no ingredients were disclosed, neither were the words " Registered Trade Mark " included after the name of the product. A whipped cream contained only 40.1 per cent. of fat and, since this was sold as thick cream, according to the Food Standards Cream Order, 1951, it must contain not less than 48 per cent, of milk fat. A product sold as 'Top of the Milk' contained only 18 per cent. of milk fat and your analyst, in agreement with most public analysts, maintains that this is canned cream and must, therefore, contain not less than 23 per cent. of milk fat, as required by the Food Standards Cream Order, 1951. The Food and Drugs Act, 1955, describes cream as' that part of milk rich in fat which has been separated by skimming or otherwise', but it is understood that the Ministry of Agriculture, Fisheries and Food have sent a letter to the vendors stating that as the product is not described as cream it is their view that it may legally be sold at a lower standard than is required for canned cream. Your analyst's opinion is based not merely on his interpretation of the Food and Drugs Act, but also on the object for which the product is sold. He has, moreover, sent two of his staff to separate shops to purchase tins of cream and they have been supplied with ' Top of the Milk '. In one case the assistant refused to take the product as it was not labelled cream and the floor manager, on being called, informed her that this was the only type of cream they were then selling. Another public analyst similarly sent one of his staff to a third shop and this assistant was again treated in the same way. Your analyst is very perturbed about this matter, since several Local Authorities were preparing to take legal action but were discouraged from doing so by the Ministry's letter, although officially the Ministry discontinued its food advisory service many years ago. It remains to be seen how this situation will develop. A sample of butter contained 17.5 per cent. of water and a follow-up sample contained 18.7 per cent., whereas the maximum permitted quantity of water is 16 per cent. The manufacturers stated they try to keep down the moisture content, but as they only deal with small amounts of butter, a more efficient plant would not be justified. A piece of glass submitted with an ice-cream was probably part of a wine glass and two other samples of ice-cream submitted at the same time contained no glass. It is unlikely that a wine glass would be present in an ice-cream factory and the glass had probably gained entrance in the restaurant where the ice-cream had been served. A piece of bread roll contained foreign matter, probably burnt wetted baking powder, due to carelessness in the bakehouse concerned, and some biscuits contained foreign matter which examination showed to consist of wool fibres derived from the felt travelling belt on which the uncooked biscuits had passed to the oven. The manufacturers agreed with your analyst's opinion and stated that they were putting in new felt to remedy the defect. Some chocolate eclairs and a follow-up sample were stated to contain fresh cream but, in fact, the filling consisted essentially of an artificial starch custard containing margarine fat. Some 22 chocolate coins contained 4 parts per million of lead, which is twice the official permitted quantity. The importers stated that they had withdrawn the stock and would investigate the matter. A sherry trifle with fresh cream contained only 0.1 per cent. of sherry, which was considered insufficient to justify the description. Crystals of Narigin were found in a can of grapefruit. Narigin is a glucoside found in grapefruit skin and to a lesser extent in grapefruit itself. It is present in larger quantities in unripe than in ripe fruit and it would appear that this grapefruit had been canned before it was fully ripe. The product was sterile but not very sweet. A tomato puree showed 70 per cent. of fields containing positive mould filaments and the can bore no label in English. Some canned beans had an unpleasant appearance. They contained cyanogenetic glucoside yielding 7.5 to 11 parts per million of prussic acid in different cans. It was, however, unlikely that a consumer would obtain sufficient prussic acid to make himself ill but the beans were not likely to be popular with the British consumer. The can of some Bulgarian whole peeled tomatoes was badly feathered on the sides and the bottom was badly corroded. The tomatoes contained 196 parts per million of tin, which is excessive. The sample was reported as inferior and not adulterated because the Ministry recommend that 250 parts per million of tin be accepted, but your analyst is not in agreement with this. A green and red pepper sauce contained 150 parts per million of tin and was reported as inferior. Three samples of pickles—lemon pickle, mango pickle and chilly pickle—all contravened the Labelling of Food Order, as the ingredients were listed in the wrong order. A hydrolysed protein sauce contained crystals of sodium chloride, but this is not surprising, since the protein used to form the sauce is hydrolysed with hydrochloric acid, neutralised with caustic soda and concentrated. If the concentration of salt is over 30-35 per cent., it will crystallize on keeping. A concentrated cheese sauce was also incorrectly labelled. It consisted of skimmed milk cheese, flour, emulsifying salts and spices and the declaration of ingredients as' Swiss Cheese, milk, flour and spices' was incorrect. It could be described as a cheese sauce but not as a' concentrated' cheese sauce. A truffle sauce contained only 0.4 per cent. of truffles, which was insufficient to warrant the description truffle sauce. Truffles were listed as thirteenth in order of quantity, showing that your analyst's estimate was probably correct. According to the Report of the Food Standards Committee on Canned Meat, a hamburger is classed as canned meat with cereal and should contain not less than 80 per cent. of meat, but a sample submitted was described as a' pure meat burger' and should therefore have contained not less than 95 per cent. of meat. In reality it contained only 65 per cent. of meat and was, therefore, 30 per cent. deficient. A 'ham and beef roll' contained 59 per cent. total meat, whereas it should contain not less than 65 per cent. of meat, and some' minced steak' contained only 84 per cent, of total meat and, therefore, should have been sold as 'minced steak with gravy '. Similarly, a 'stewed steak' contained only 80.4 per cent. of meat but, unless sold as' stewed steak with jelly ' or ' stewed steak in jelly it must contain not less than 95 per cent. of meat. A canned 'minced beef with onion and gravy' contained only 46 per cent. of meat. The Food Standards Committee of the Ministry of Agriculture, Fisheries and Food recommended that canned meat with gravy should contain not less than 75 per cent. of meat but canned meat with vegetables should contain not less than 35 per cent. of meat. In the sample examined, the onion was present only as a flavouring ingredient and would not make the minced beef and gravy into a product containing vegetables as a substantial part of a meal. This type of product shows that some clarification of descriptions is required. 'Ham and minced chicken in jelly' contained only 65 per cent. of meat, whereas the standard agreed between the Association of Public Analysts and the Food Manufacturers Federation is 70 per cent. A product labelled 'Venison Steak in Burgundy Sauce' contained carrots, peas, potatoes, onions, and tomato puree, and the meat content was about 35 to 37 per cent. It should, therefore, have been described as ' Venison Steak with Vegetables in Burgundy Sauce '. On opening a can of luncheon meat, the contents were found to be soft and mushy and contained 2,000 gram positive aerobic bacteria and spore forming bacilli per gram. Some chicken pies contained a total of 15.7 per cent. meat, whereas the Food Standards Committee of the Ministry of Agriculture, Fisheries and Food have recommended a minimum of 25 per cent. 23 of meat, so that this sample was approximately 38 per cent. deficient. The follow-up sample contained 25 per cent. of meat and was satisfactory. A pork pie contained only 20 per cent, of meat but the follow-up sample contained 29 per cent. and was satisfactory. Apart from the recommendation of the Food Standards Committee, Public Analysts have for a long time maintained that meat pies should contain not less than 25 per cent. of meat. The sausage filling of some sausage rolls was 20 per cent. deficient in meat content. It contained 33 per cent. of meat and, allowing for the fat absorbed into the pastry, the meat content of the filling could not have been more than 40 per cent. The manufacturers suggested that sausages used in the manufacture of sausage rolls should be of a poorer quality than sausages not intended for this purpose, but this view was not shared by your analyst. Three samples of ravioli examined were deficient in meat, containing respectively 30 per cent., 31 per cent., and 38 per cent. on the fillings, or 12.45 per cent., 14.9 per cent., and 15.6 per cent. on the whole ravioli respectively. The meat fillings must contain not less than 60 per cent. meat. A sample of Cannelloni was not labelled with its ingredients in accordance with the requirements of the Labelling of Food Order. Three snack meal products were considered to bear misleading illustrations. These implied the presence of more meat than was actually the case and that mushrooms were present as half or whole mushrooms. Two contained 29 per cent. each, and the other 37 per cent. of meat, and the mushroom had been minced. The labels gave the impression that the spaghetti, macaroni and noodles were separate from the meat, whereas the whole had been mixed together. A complaint was received about some Scotch eggs which contained only 7.6 per cent. of egg, whereas Scotch egg should consist of about 50 per cent. of egg. The description 'Scotch Egg' was considered to be incorrect, but the product might be described as ' minced pork and egg'. A canned mulligatawny soup contained only 7.5 per cent. of total solid matter, including 0.75 per cent. of protein and 0.32 per cent. of fat. When there were standards for soups during the war, mulligatawny soup had to contain 13 per cent. of total solid matter, including 2 per cent. of protein and 2 per cent. of fat, whilst the' Advertising, Labelling and Composition of Food' booklet required not less than 6 per cent. of meat, excluding bone and fat. A canned turkey soup contained 8.76 per cent. of total solid matter and 0.818 per cent. of protein and was, therefore, 20 per cent. deficient in protein matter. Of two further samples examined one was still low and stated to be from an old batch, the other was satisfactory. An olive oil was reported as inferior because the free acid, calculated as oleic acid, was 1.15 per cent. and the oil had a definitely rancid flavour. A sample of mustard oil was also slightly rancid. It was a satisfactory cold pressed oil from mustard seed and although popular among Indians, for the British market it should be labelled 'Mustard and Seed Oil,' as in this country we understand oil of mustard to be the volatile oil, a fact that was recognised in the Food Standards (Mustard) Order. A malt beverage was incorrectly labelled. It was stated to contain milk, whereas this should have been described as ' milk solids An artificially coloured and flavoured cordial was sold as 'Rose Cordial', whereas it should be labelled 'Rose Flavoured Cordial'. It did not contain any rose juice and, as 'Rose Cordial' is a non-citrus fruit squash within the meaning of the Soft Drinks Order, it would have to contain not less than 10 per cent. of fruit juice, a quantity which would be prohibitive. Two food colours contained an excess of lead with 31 parts and 150 parts per million respectively, calculated on the total solids. The permitted limit is 20 parts per million, calculated on the dry matter. A follow-up sample contained 31 parts per million of lead and a further sample received much later contained 52 parts per million, calculated on the total solids. A product submitted as 'Mezap' bore no declaration of ingredients but appeared to consist of roast ground sesame seed. No definition of the word ' Mezap ' could be found. A vitamin diet supplement was incorrectly labelled as the general ingredients were incorrectly declared and the quantities of vitamins and minerals were not given. Some gin was only 60.9 per cent. proof and therefore contained 11.2 per cent. of added water. The dilution was due to the gin being placed in a glass previously used for gin and tonic. The contents of a packet containing Turkish Coffee consisted of finely ground coffee without a label but, as it was a prepacked article, it must be labelled in accordance with the requirements of the Labelling of Food Order. A product stated to consist of eggplant ashes and sea salt was stated to cure and prevent tooth decay. In reality it contained ash 95.1 per cent., acid-insoluble ash 0.179 per cent, salt 85.6 per 24 cent., and fluorine 4 parts per million. Egg plant ash and sea salt are not known to cure dental decay but, if sold as a drug, the quantities of the active ingredients must be stated. Legislation Issued or Proposed During 1963. The year was a comparatively quiet one regarding the issue of food regulations but the following are of interest:— The Bread and Flour Regulations, 1963.—These Regulations largely reinforce the provisions of the Flour (Composition) Order, 1956, with improvements, but with restrictions on the sale of bread for dietetic purposes. It is now permissible to add iron to flour, either as reduced iron or as iron and ammonium citrate. This provision has been found necessary as, during manufacture, magnets used to remove nails and any other particles of metal which may have got into the flour also remove any reduced iron which may be present. In future, therefore, iron or iron and ammonium citrate can be added after the flour has passed under the magnets. It is no longer necessary to add chalk to self-raising flours prepared with a calcium-containing baking powder. Milk bread and skimmed milk bread must contain not less than 6 per cent. of milk powder or skimmed milk powder, as the case may be, calculated on the dry weight of the bread. Protein enriched bread must contain not less than 20 per cent. of protein, calculated on the dry weight, and starch-reduced bread, biscuits, rusks and breakfast foods must not contain more than 50 per cent. of starch similarly calculated. No claims are permitted for slimming properties unless these are accompanied by a statement to the effect that the food forms part of a diet of which the calories intake is controlled. The Liquid Egg (Pasteurisation) Regulations, 1963, have been issued as a result of the number of food poisoning cases which have been traced to the use of raw liquid or frozen egg. The test relies on the fact that an enzyme, amylase, which is present in fresh eggs, is destroyed by pasteurisation. The Ice Cream (Heat Treatment, etc.) (Amendment) Regulations, 1963, have been issued to permit the addition of sugar as well as water to an ice-cream mix which has been prepared according to the requirements of the main regulations. The Milk (Special Designations) Regulations, 1963, follow the main lines of previous regulations but now introduce a test for the efficiency of the heating of so-called sterilised milk. This test depends on the coagulation of a protein, lactalbumen, during the heating of the milk. The Soft Drinks Regulations, 1963, increase the quantity of fruit juice or comminuted fruit required to be present in fruit drinks and permit the sale of comminuted fruit drinks made from citrus fruits other than oranges. They increase the quantity of sugar required to be present in soft drinks and reduce the permitted amount of saccharin. It is now necessary to declare the presence of saccharin on the label of any soft drink. Unfortunately, it is still permissible to use acetic acid or phosphoric acid in soft drinks so long as they are not described as fruit squashes, fruit crushes, or comminuted citrus drinks, but it is now illegal to use any pictorial device or any wording to suggest the presence of fruit which is not represented in the flavouring of the drink. The Weights and Measures Act, 1963, and the Weights and Measures Regulations, 1963, mainly affect Weights and Measures Authorities, though attention will have to be paid to the net contents of pre-packed foods when examining such articles. Report of the Food Standards Committee on Meat Pies.—This report was issued during the year and, at the beginning of 1964, draft regulations were issued based on the recommendations as modified in view of comments received by the Minister. Essentially the proposals are that meat pies should contain not less than 25 per cent. of meat, though pies weighing between 4 and 5J ounces need contain only one ounce of meat and those weighing up to 3 ounces need contain only 5/8 ounce of meat. It is further suggested that in the event of the quality of larger pies, i.e., those over 8 ounces, declining as a result of any regulations, it might be necessary to issue regulations for the larger meat pies. Suggestions were included in the report regarding the analysis of meat pies and in the opinion of your analyst the Committee was incorrectly advised regarding the absorption of fat from the meat of a meat pie into the surrounding pastry. Recommendations have been made to allow for fat in the pastry, in excess of certain figures, as having been derived from the meat. Circular FSH 12/63, issued by the Ministry of Agriculture, Fisheries and Food, advised Local Authorities that the Customs and Excise are no longer testing for arsenic glucose or invert sugar used in brewing and that this duty now devolves on the Local Authorities for areas in which breweries are situated. Speaking generally, manufacturers of these products ensure that they comply with the regulations because of the great value of the trade which they have with brewers. Thomas McLachlan. Public Analyst." 25 Food—Adulterated or Unsatisfactory Samples. Twenty-eight of the fifty-four unsatisfactory samples referred to in the Analyst's report concerned technical faults in labelling or description. After consultation with the manufacturers or importers the labels were revised or corrected. The remainder of the other samples adversely reported upon were dealt with informally. Unsound Food. Approximately six tons of food were voluntarily surrendered for destruction and certified as being unsound and unfit for human consumption. Details are given in Table 16, page 36. No large consignments calling for special action were involved and when destruction of the unsound food on the premises was impracticable, or the material was unfit for animal feeding, it was sent in bulk to a central refuse disposal depot at Westminster. Merchandise Marks. During the year, one stallholder was found to be selling imported tomatoes as " English " ; he was warned of the offence. Milk. There are 97 registered premises from which milk is sold and 17 milk roundsmen operate in the Borough from shops or depots elsewhere. A total of 114 licences are extant under The Milk (Special Designation) Regulations, 1960, for the five-year period ending 31st December, 1965. The average percentage composition of the 16 genuine samples of milk analysed was : total solids 12.64, fat 3.90, solids not fat 8.74, the legal minima being 11.50, 3.00 and 8.50 respectively. Of the 40 samples of milk examined by the Council's Bacteriologist, five were found to be unsatisfactory. These failures were in respect of milk supplied by a farm in Sussex. The matter was referred to the Area Milk Officer of the Ministry of Agriculture, Fisheries and Food, who took appropriate action, and subsequent samples were found to be satisfactory. Ice Cream. Two premises are registered for the manufacture of ice-cream and 191 for its sale and storage. Details of the classes of premises are given in Table 17, page 37. Twenty-six samples of ice-cream were examined by the Council's Bacteriologist, with the following results : Grade I—17; Grade II—2; Grade III—6; Grade IV—1. Samples reported as Grade III are considered as "borderline" and the supplier is warned of the need to exercise greater care in methods of manufacture, storage and sale and advised as may be necessary. Grade IV is an unsatisfactory result and the matter was taken up with the manufacturer of the one sample thus reported. Follow-up samples from this source were found to be satisfactory. Preserved Food. Fifty-eight premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale; regular 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 17, page 37. Inns, Refreshment Houses, etc.—Provision of Sanitary Conveniences. Section 25 of the London County Council (General Powers) Act, 1959, enables a borough council to require the owner or occupier of any "refreshment house or place of public entertainment " to provide and maintain sanitary conveniences for the use of persons frequenting the premises. Section 25 of the London County Council (General Powers) Act, 1962, defined" refreshment house " as any building in which food or drink is sold to and consumed by the public. There are 921 premises within this category in the Borough and, at present, it would not be practicable to visit for the sole purpose of deciding which of them should be required to provide sanitary accommodation. The policy is to deal with this aspect during routine visits. In addition, opportunity is taken to secure the provision when the premises are altered or rebuilt and to draw attention to the Council's powers on any land charge enquiries regarding catering premises. During the year the proprietors of two restaurants were required to provide sanitary accommodation for their customers. Food Catering Premises. There are 1,543 of these premises in the Borough, details of which are given in Table 18, page 37, and during the year 2,691 visits were made. In addition to the large number of defects dealt with 26 informally, the service of 189 notices was found necessary. The majority related to dirty conditions arising from the lack of simple domestic cleaning of floors and equipment and the attitude that walls can be ignored until the need for redecoration arises. Unfortunately the number of visits has been limited by the staff position, as undoubtedly the most effective spur to the maintenance of a good standard of hygiene in food premises is the knowledge that a public health inspector will be making regular visits. These visits should not be too brief and should allow time for not only examining the structure of the premises and environmental conditions but also inspecting items of equipment, however small, and observing personal habits of the food handlers. Apart from any other consideration, the food handler's personal pride requires that he should not be found to be at fault—particularly in the presence of fellow workers. Education of the food handler remains the most positive and enduring aid to hygiene and every opportunity is taken to further this by personal contact during routine visits. The greatest barrier to improved standards of hygiene arises from limitations imposed by the attitude and short-comings of the staff, a state of affairs which seems to be getting progressively worse. It has also been found that because of the shortage of suitable staff some catering managers cannot effectively control their kitchen staff and fear losing them to such an extent that they avoid visiting the kitchen to the point of neglect. When faced with the findings of an inspector's visit they are amazed that such adverse conditions exist in premises under their control. Complaints are occasionally received from members of the public about the way in which " ready to serve "foods are displayed on open counters. The requirements of the Food Hygiene Regulations are limited in this respect and securing the protection the public expects is largely a matter of" encouragement " rather than enforcement. The belief is still held in some sections of the food industry that enclosing food in open-back glass cases is a sales deterrent, although the experience of some of the more progressive firms suggests otherwise. Another recurring complaint is of nuisance caused to nearby occupiers by cooking smells. All too often these smells are discharged without any means of filtering at low level in congested areas, whereas the point of discharge should be above main roof level. Although the Regulations provide for effective ventilation of the kitchen, they have no concern for the means of discharging the cooking smells and action cannot be taken under the Public Health (London) Act, 1936, nuisance clause. This aspect receives attention when plans of proposed alterations or reconstruction of catering premises are submitted to the Council, but in existing premises the solution can involve a good deal of expensive alteration and adaptation. Much remains to be done in the field of food hygiene before a completely satisfactory standard is reached beyond any possible risk to health. Licensing Act, 1961. Applications for registration certificates in respect of club premises are made to the Magistrate's Court and the Council have the right to make objections on the grounds set out in Section 27 (2) of the Act within 28 days from the date of application. Thirty-nine applications were referred to the Department and a public health inspector visited the premises to report on their suitability in regard to the requirements of public health and food hygiene legislation. Food Stalls. During the year food was sold from 86 licensed stalls in street markets in the Borough and regular 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. Horseflesh. There are no shops in the Borough selling horseflesh for human consumption. Slaughter of Animals. There are no slaughterhouses in the Borough but in the grounds of the Zoological Society of London for many years there has been a knacker's yard, licensed by the Council, where animals are slaughtered for feeding purposes. Fourteen inspections were made and conditions found to be satisfactory. SECTION F.—INFECTIOUS AND OTHER DISEASES—PREVALENCE AND CONTROL There was an increase in the number of cases of infectious diseases reported in the Borough, 428 notifications being received against 277 the previous year. Of the total, measles accounted for 311, the figures for 1962 and 1961 being 107 and 422 respectively. There were increases also in whooping 27 cough, 11 cases against 2 in 1962, and in puerperal pyrexia, with 22 cases against 8 the previous year. Two cases of typhoid were reported, the first since 1958, but there was no poliomyletis and again no diphtheria. Table 19, page 37, gives details of notifications and the age groups concerned. Tuberculosis. Table 19, page 37, gives information regarding primary notifications of pulmonary and non-pulmonary tuberculosis received during the year. Table 20, page 38, shows the age and sex distribution of new cases and of deaths from all forms of the disease, and Table 21, page 38, 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 rcspect of new cases, transfers, deaths inwards and outwards and removals due to cases cured and deceased. Enquiries into housing and sanitary conditions involved 104 visits by one of the women public health inspectors to all new cases and those moving into the Borough from other areas. Typhoid Fever. (a) The two cases of typhoid fever notified during the year under review occurred in a man of 30 and a woman of 58. The first was a visitor from the Middle East and the disease had been contracted abroad, whilst the other was an instance of isolated infection, the source of which could not be traced. No other cases developed. (b) Zermatt Outbreak.—This outbreak, which received wide publicity, commenced in February and developed into a major episode. In all, 69 cases resulted in England and Wales and although none was reported in this area, 27 contacts were kept under surveillance. A letter was sent to all general medical practitioners in the Borough, giving them special information supplied by the Ministry of Health about the outbreak. Food Poisoning. During the year, twelve notifications were received and four of these concerned instances where more than one member of the same family was involved. In one other case persons other than the patient notified were found to be also suffering from the illness, although they were not of the same family. The remaining seven notifications were all of single cases. Particulars of these food poisoning outbreaks and of the causative agents, where identified, are given in Table 22, page 38 and Table 23, page 39. Impetigo. No cases of impetigo wire referred to the Cleansing Station for treatment daring the year. Scabies. The Council's Cleansing Station in Lisson Grove dealt with 46 cases of scabies : adults 22 (men 11, women 11) ; children 24 (boys 13, girls 11). Disinfection. During the year, 51 rooms, 749 articles of bedding (mattresses, blankets, sheets, bolsters, pillows, etc.) and 342 books, were disinfected. The Department continued to be asked by residents to certify that clothing intended for despatch to foreign countries, mainly in central and eastern Europe, was free from infection. Disinfection was carried out only when the articles concerned had actually been in contact with infectious disease. 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, 146 certificates relating to a total of 1,685 articles, were issued. Exclusion from Work of Contacts or Carriers of Infectious Diseases. With a view to preventing the spread of a notifiable infectious disease, or certain other diseases as provided in Section 26 of the London County Council (General Powers) Act, 1959, if a Medical Officer of Health for a borough requests in writing a person to discontinue his employment, the Borough Council are empowered by the Act to compensate such person for any loss occasioned by his compliance with the request. Similarly, both by Regulations made under the National Insurance Act, 1946, and the Public Health (Infectious Disease) Regulations, 1953, persons may be excluded from work and qualify for National Health sickness benefit if in the opinion of the Medical Officer they are contacts or carriers. These provisions apply particularly to food handlers in shops, to cooks, kitchen hands and others employed in cafes, canteens and restaurants and to persons in charge of young children. During the year three certificates were issued in this connection. 28 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 7,157 of these certificates were authenticated. In addition, eighteen certificates were issued, upon request, to the effect that no cases of smallpox had been reported in the district during the preceding three months. Applicants for these certificates are usually travelling to America and do not wish to submit to vaccination but the American immigration authorities reserve the right to place such persons under surveillance despite the production of this certificate. The Public Health (Aircraft) (Amendment) Regulations, 1963, and The Public Health (Ships) (Amendment) Regulations, 1963, which came into force on 1st August, 1963, were made as a result of recommendations by the Public Health Committee of the Council of Europe. They are intended to increase the safeguards against the importation of smallpox into the " excepted areas " and as a result, national health administrations should normally require from travellers from locally infected areas and " endemic areas " a valid International Certificate of Vaccination. The " endemic areas " are now defined as consisting of Africa, Asia and the Americas (excluding Canada and the United States of America). During 1963, forty-nine travellers from such areas who had arrived in the Borough without valid International Certificates of Vaccination were seen and kept under surveillance. Bacteriological Examinations. Table 24, page 39, shows the number of specimens examined for the purposes of diagnosis and also indicates the organisms in relation to which the examinations were made. 29 APPENDIX OF STATISTICAL TABLES AND SUPPLEMENTARY INFORMATION 30 TABLE 1.—Deaths—According to Age-Group and Sex. Code No. Net Deaths at the Sub-joined Ages of Residents (Male and Female) whether occurring within or without the Borough cause of death All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards M. f. M. f. M. f. M. f. M. f. M. f. M. f. M. f. 1 Tuberculosis, respiratory 4 1 - - - - - - - - 1 - 2 1 1 - 2 Tuberculosis, other 3 1 - - - - - - 1 - 1 - 1 - - 1 3 Syphilitic disease 1 - - - - - - - - - - 1 - - - 4 Diphtheria - - - - - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - - - - - 6 Meningococcal infections 1 - - - - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - - - - - 9 Other infective and parasitic diseases - 1 - - - - - - - - - - - 1 - - 10 Malignant neoplasm, stomach 10 10 - - - - - - - - - - 6 3 4 7 n Malignant neoplasm, lung, bronchus 44 9 - - - - - - - - 2 - 18 1 24 8 12 Malignant neoplasm, breast - 13 - - - - - - - - - 2 - 7 - 4 13 Malignant neoplasm, uterus - 7 - - - - - - - - - - - 4 - 3 14 Other malignant and lymphatic neoplasms 52 55 - - - - 1 - - 1 4 2 18 17 29 35 15 Leukaemia, aleukaemia 2 4 - - - - - - - - - 1 - 1 2 2 16 Diabetes 1 7 - - - - - - - - - 1 - 2 1 4 17 Vascular lesions of nervous system 49 94 - - - - - - - - 1 1 9 13 39 80 18 Coronary disease, angina 136 96 - - - - - - - - 3 - 69 14 74 82 19 Hypertension with heart disease 18 22 - - - - - - - - - - 2 - 16 22 20 Other heart disease 60 92 - - - - - - 1 - 1 2 8 6 50 84 21 Other circulatory disease 21 23 - - - - - - - - 1 - 7 3 13 20 22 Influenza 3 6 - - - - - - - - - - - 1 3 5 23 Pneumonia 30 30 - 1 - 1 - - - - 1 - 5 2 24 26 24 Bronchitis 43 21 - - - - - - - - - - 8 1 35 20 25 Other diseases of respiratory system 4 2 - - - - - - - - - 1 - - 4 1 26 Ulcer of stomach and duodenum 6 1 - - - - - - - - - - 1 - 6 1 27 Gastritis, enteritis and diarrhoea 3 3 - - - - - - - - 1 - - 1 2 2 28 Nephritis and nephrosis 2 5 - - - - - 1 - - - 1 - 1 2 2 29 Hyperplasia of prostate 4 - - - - - - - - - - - - 4 - 30 Pregnancy, childbirth, abortion - 1 - - - - - - - - - 1 - - - - 31 Congenital malformations 1 1 - - 1 - - - - - - - - - - - 32 Other defined and ill-defined diseases 39 26 9 2 - 1 - 1 1 - 2 - 12 6 15 16 33 Motor vehicle accidents 4 3 - - - - - - 1 1 2 1 - 1 1 - 34 All other accidents 8 9 1 - - - - - 1 - 2 - 2 1 2 8 35 Suicide 10 11 - - - - - - - 2 6 3 4 4 - 2 36 Homicide and operations of war 1 - 1 - - - - - - - - - - - - - Totals 560 554 11 3 2 2 1 2 5 4 28 17 163 91 350 435 1,114 14 4 3 9 45 254 785 TABLE 2.—Infant Mortality—According to Age-Group and Sex. CAUSE OF DEATH Under 1 week 1 and under 2 weeks 2 and under 4 weeks 1 and under 3 months 3 and under 6 months 6 and under 9 months 9 and under 12 months Total m. F. m. F. m. F. m. F. m. F. m. F. m. F. m. F. Atelectasis 1 - - - - - - - - - - - - - 1 - Premature Birth 6 - - - - - - - - - - - - - Bronchitis - - - - - - - - - 1 - - - - - 1 Meningitis - - - - - - 1 - - - - - - - 1 - Septicaemia - - - - - 1 - - - - - - - - - 1 Respiratory Failure 1 - - - - - - - - - - - - - 1 - Cerebral Contusion (accidental) - - - - 1 - - - - - - - - - 1 - Homicide (strangulation) 1 - - - - - - - - - - - - - 1 - Unascertainable - 1 - - - - - - - - - - - - - 1 Totals 9 1 - - 1 1 1 - 1 1 - - - - 11 3 10 - 2 1 1 - - 14 31 TABLE 3.—Weather Statistics. Station : Regent's Park. Height of rain-gauge above mean sea level : 129 feet. 1963 Air Temperature Rainfall Weather Number of Days Bright 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 °C. °C. °C. °C. °c. in. in. hrs. hrs. % Jan 0.7 -3.8 -1.5 5.0 26 -11.1 23 .86 .28 2 7 10 - 15 25 29 - 37.4 1.21 117 Feb 2.2 - - 6.7 26, 28 - - .31 .10 1 5 10 - 14 27 - - 61 0 2.18 122 Mar 10.7 4.1 7.4 16.7 6 -3.3 3 2.75 .44 9 17 - - 4 5 9 - 89.2 2.88 96 April 13.9 6.1 10.0 20.6 27 -0.6 1 1.93 .40 15 17 - - 0 1 4 - 123.3 4.11 86 May 16.4 7.4 11 9 26.7 31 2.8 2 1.79 .28 1 10 - - 0 0 2 - 194.9 6.29 105 June 20.8 11.4 16.1 26.1 7,9,10,12 7.2 15 2.01 .30 18 14 - - 0 0 0 - 184.6 6.15 92 July 21.8 11.9 16.9 27.8 23 9.4 4, 26, 27 1.33 .92 6 10 - - 0 0 0 - 204.9 6.61 110 Aug 19.9 11.9 15.9 25.0 1.2 6.7 29 2.29 .40 17 16 - - 0 0 0 - 123.5 3.98 71 Sept 18.2 10.4 14.3 23.9 15,17 5.6 28 2.36 .49 1 10 - - 2 0 0 - 120.6 4.03 92 Oct 15.0 8.7 11.9 22.8 12 5.0 2,14, 30 1.67 .36 5 14 - - 0 0 1 - 81.3 2.62 95 Nov 12.2 6.8 9.5 17.2 10 0.6 21 4.78 1.13 17 22 - - 1 0 7 - 53.5 1.78 123 Dec 5.8 0.6 3.2 10.0 29.30 -5.0 21.24 .68 .32 25 9 - - 1 14 19 - 37.9 1.22 142 * Average for years 1931-1960 32 Table 4. —Summary of Road Accidents. Month Number of Accidents Fatal Injuries— Serious Slight January 66 10 73 February 70 - 10 77 March 79 - 11 82 April 71 - 6 79 May 90 - 12 92 June. 88 1 17 84 July 90 1 14 98 August 66 - 10 70 September 76 - 9 84 October 82 1 7 98 November 93 - 8 103 December 78 - 19 81 Totals 949 3 133 1,021 TABLE 5.—Dwelling-Houses : Summary of Inspections, Conditions Found and Action Taken. Inspection under Public Health or Housing Acts:— (1) (a) Inspected for housing defects 1,237 (6) Inspections made for the purpose 4,156 (2) Found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (3) Found not to be in all respects reasonably fit for human habitation 525 Defects remedied without service of formal Notices:— Defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 471 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 388 (2) Dwelling-houses in which, after service of formal notices, defects were remedied:— (a) By owners 56 lb) By Local Authority in default of owners ... - (6) Proceedings under the Housing Act, 1957:— (1) Rooms in respect of which Closing or Demolition Orders were made:— Underground rooms 4 Other rooms - (2) Closing Orders determined, the tenement or room having been made fit 6 (3) Rooms affected by (2) above 8 (4) Closing Orders varied 2 (5) Undertakings accepted in respect of underground rooms - 33 TABLE 6.—Nuisances Remedied. Nuisance Abated or Defect Remedied Number Houses damp, dirty or dilapidated 179 Doors, windows, floors, ceilings, sash cords, grates and flues, etc., defective 219 Drain, water-closet and waste pipe stoppages 100 Drains, water-closets and waste pipes defective 92 Insufficient or unsuitable W.C. accommodation 23 Yard, area and wash-house defects 5 Roofs, gutters and rainwater pipes defective 115 Insufficient water supplies 95 Water cisterns dirty or defective 51 Ashpits, dustbins, etc., defective 22 Rubbish accumulations 71 Animal nuisances 4 Miscellaneous 48 Total 1,024 TABLE 7.—Chemical Examination of Water supplied to St. Marylebone- Average Results. Milligrammes per Litre (unless otherwise stated) Analysis data Source of Supply Hampton Ashford Common No. of samples 52 52 Ammoniacal Nitrogen 0.165 0.22 Albuminoid Nitrogen 0.076 0.083 Nitrate 3.9 3.9 Chlorides as CI. 32 32 Oxygen abs. from Permanganate 4 hrs. at 27° C. 1.22 1.26 Turbidity units 0.3 0.2 Colour m.m. brown 2 ft. Tube Burgess's Tintometer 11 11 Hardness (total) 276 284 Hardness (non-carbonate) 68 66 pH. Value 7.8 7.9 Phosphate as P04 1.3 1.3 Silicate as Si02 12 12 Sulphate as S04 62 60 Natural Fluoride as F 0.25 0.30 Magnesium as Mg. 5 5 Sodium as Na 25 25 Potassium as K 5.2 5.2 Surface active material as manoxol 0.08 0.08 Electrical Conductivity (micromhos) 560 570 TABLE 8.—Bacteriological Examination of Water supplied to St. Marylebone— Average Results after Treatment. Source of supply Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Hampton 1 091 10.6 - 100.0 100.0 Ashford Common 768 13.6 - 99.87 99.87 34 TABLE 9.—Rodent Control. Complaints : Complaints of rats received 205 Complaints of mice received 314 Total premises involved 519 Infestations by Council's staff: Premises rid of brown rats 146 Premises rid of black rats - Premises rid of mice 307 Total premises disinfested 453 Total visits to such premises 6,329 Notices: Intimation notices served 11 Statutory notices served - 35 TABLE 11.—Factories : Inspections for Purposes of Provisions as to Health. Premises Registered Inspections Written notices Occupiers prosecuted Factories without mechanical power 199 49 4 - Factories with mechanical power 1,021 619 28 - Other premises* (excluding outworkers' premises) 374 504 - - Totals 1,594 1,172 32 - * Electrical stations, institutions, sites of building operations and works of engineering construction. TABLE 12.—Factories : Defects. Defects Particulars 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 1 3 2 Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary conveniences:- (a) insufficient - - - - - (b) unsuitable or defective 35 45 - 18 - (c) not separate for sexes Other offences (excluding offences relating to outwork) 36 37 4 - - Totals 72 85 6 18 - TABLE 13.—Summary of Outwork. Description of Work Outworkers Employed Wearing apparel 413 Textile weaving... 16 Curtains and furniture hangings 9 Furniture and upholstery 1 439 36 TABLE 14.—Pharmacy and Poisons Acts, 1852-1941 : Summary of Sellers of Part II Poisons. Type of Business Total Licensed Grocery and provision stores 19 Hardware and domestic stores 16 General stores 20 Hairdressers 6 Builders' merchants 2 Dental sundriesman 1 Photographic dealer 1 65 TABLE 15. —Public Conveniences. Convenience Urinals W.C's. Free W.C's. Wash basins (free) Additional Information Underground: Oxford Circus (Men) 26 11 1 7 Changing Room (Is.), 1 Lavatory basin, Electric razor (6d.) Oxford Circus (Women) - 8 1 4 Rest Room (free), 1 Lavatory basin and sink. Foley Street (Men) 8 3 1 3 - Gt. Portland Street (Men) 6 4 1 3 - Gt. Portland Street (Women) - 4 1 3 - Marylebone Road (Men) 12 7 1 8 - Marylebone Road (Women) - 3 1 5 - St. John's Wood Road (Men) 6 3 1 3 - Barrett Street (Men) 11 3 1 3 - A hove ground: Paddington Street (Men) 6 2 1 3 - Paddington Street (Women) - 2 1 2 - Salisbury Street (Men) 6 3 I 3 - Salisbury Street (Women) - 4 2 2 - Wellington Place (Men) 6 1 1 1 - Wellington Place (Women) - 2 1 1 - Violet Hill (Men) 2 1 1 1 Unattended. Violet Hill (Women) - 1 1 1 do. Lisson Grove—Urinal 4 - - - Open Day and Night. *Red House Public House, Park Road—Urinal 4 - - - - *†Exeter Arms Public House, Ashmill Street Urinal 4 - - - Open 9 a.m. to 11 p.m. * Cleansed by the Borough Council but maintained by brewers. † Closed to public in December, brewers having incorporated toilet accommodation inside the premises. 37 17.—Summary of Premises Registered for Preserving Food or for the Manufacture, Storage or Sale of Ice-Cream. Type of Business Preserving Food Ice Cream Butchers 35 Tobacconists, confectioners/newsagents - 86 Grocers and provision merchants . 21 69 Fishmongers 2 3 General stores - 9 Greengrocers and fruiterers - 19 Ice-cream factories - 2 Miscellaneous - 5 58 193 TABLE 18.—Summary of Food Premises. Type of Business Totals Hotels and boarding houses 321 Restaurants, cafes and snack bars 304 Grocers and provision merchants 167 Canteens and clubs 160 Public houses and wine bars 136 Confectioners 104 Stalls, street trading 86 Greengrocers and fruiterers 58 Schools and nurseries 52 Butchers 48 Wine merchants (off-licence) 31 Bakers 28 Chemists 19 Fishmongers 12 Coffee stalls and kiosks 10 Milk depots 5 Ice-cream manufacturers 2 1,543 TABLE 19.—Notifiable Diseases and Notifications. * Notifiable Disease Cases notified in whole Borough At ages—years Cases removed to hospital Cases isolated at home At all ages -1 1- 2- 3- 4- 5- 10- 15- 20- 35 45- 65- Scarlet fever 9 - - - 1 1 6 1 - - - - - - 9 Puerperal pyrexia 22 - - - - - - - 2 18 2 - - 20 2 Pneumonia 1 - - - - - - - - - - - 1 1 - Dysentery 11 1 1 - - 1 2 - 1 3 - 1 1 4 7 Measles 311 5 24 38 44 50 123 10 9 4 2 1 1 8 303 Whooping cough 11 - 2 1 - 1 4 3 - - - - - - 11 Scabies ... 9 - - - - - - - 2 6 - - 1 - 9 Tuberculosis— Pulmonary 37 - - - - - - - 3 6 5 19 4 21 16 N on-pulmonary 3 - - - - - - - - - - - 1 3 - Food poisoning 12 1 - - - - 1 1 1 6 1 - 1 4 8 Typhoid fever ... 2 - - - - - - - - 1 - 1 - 2 - Totals 428 7 27 39 45 53 136 15 18 46 10 22 10 63 365 * 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, ophthalmia neonatorum, meningcoccal infection, erysipelas, acute encephalitis, acute poliomyelitis. 38 TABLE 20.—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 - - - - - - - 5-15 - - - - - - 15-25 2 5 1 - - - 1 - 25-35 8 6 3 1 - - 1 - 35-45 6 2 - - - - - - 45-55 2 4 - - 1 - - - 55-65 12 6 - - 5 1 - - 65 and upwards 6 - - 1 2 1 - 1 Totals 36 23 4 2 8 2 2 1 * 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 21.—Tuberculosis: Summary of Register. Pulmonary Non-Pulmonary Total M. F. Total M. F. Total M Number of cases of tuberculosis on the Register at the beginning of the year 497 347 844 28 45 73 917 (6) Number of cases notified to the Medical Officer of Health under the Regulations for the first time during the year 22 15 37 2 1 3 40 to Number of cases removed from the Register during a preceding year which have been restored to the Register during the year 2 1 3 - - - 3 (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 14 8 22 2 1 3 25 to Number of cases removed from the Register during the year 89 63 152 19 18 37 189 (/) Number of cases remaining on the Register at the end of the year 446 308 754 13 29 42 796 TABLE 22.—Food Poisoning—Family and Other Outbreaks. Causative Agent Family Outbreaks Other Outbreaks Total number of cases Number of cases Number of cases Number Notified Otherwise ascertained Number Notified Otherwise ascertained Salmonella-type: Westerstede 1 1 1 - - - 2 Typhimurium 1 2 - - - 2 Tenessee - - - 1 1 3 4 Causative Agent not identified 1 1 1 - - - 2 Totals 3 4 2 1 1 3 10 39 TABLE 23.—Food Poisoning—Single Cases Causative Agent Number of cases Notified Otherwise ascertained Total Salmonella—type: Typhimurium 1 - 1 Causative Agent not identified 6 - 6 Totals 7 - 7 TABLE 24.—Summary of Work of the Bacteriological Laboratory. Nature of Specimen and Examination Positive Negative Total Throat and nasal swabs for— B. diphtheriae - 8 8 Haemolytic streptococci - 8 8 Vincent's organisms - 2 Sputum for— Tubercle bacilli - 12 12 Faeces for— - Parasites, typhoid, paratyphoid, dysentery and food poisoning organisms 6 241 247 Urine for— Typhoid - 48 48 Foods for— Food poisoning organisms - 26 26 Swabs for— Food poisoning organisms 12 20 32 Totals 18 365 383 TABLE 25.—New Legislation. Legislation Operative Date Rivers (Prevention of Pollution) Regulations, 1963 1.3.63 Alkali, etc., Works Order, 1963 1.4.63 London County Council Byelaws for Removal, etc., of Refuse, 1963 1.6.63 Ice Cream (Heat Treatment, etc.) (Amendment) Regulations, 1963 18.6.63 London County Council (General Powers) Act, 1963 10.7.63 Smoke Control Areas (Authorised Fuels) Regulations, 1963 29.7.63 Soft Drinks Regulations, 1963 29.7.63 Public Lavatories (Turnstiles) Act, 1963 31.7.63 Public Health (Aircraft) (Amendment) Regulations, 1963 1.8.63 Public Health (Ships) (Amendment) Regulations, 1963 1.8.63 Poisons List Order, 1963 2.9.63 Poisons Rules, 1963 2.9.63 Meat Inspection Regulations, 1963 1.10.63 Motor Cycle (Protective Helmets) Regulations, 1963 18.11.63 National Assistance (Powers of Inspection) (Amendment) Regulations, 1963 1.1.64 Animal Boarding Establishments Act, 1963 1.1.64 Liquid Egg (Pasteurisation) Regulations, 1963 1.1.64 Bread and Flour Regulations, 1963 1.9.64 London Government Act, 1963 Various Offices, Shops and Railway Premises Act, 1963 Various 40 SERVICES AVAILABLE FOR OLD PEOPLE NATIONAL. National Assistance Board, 177, Tottenham Court Road, W.l. (Tel.: MUS. 7032).—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 the Manager. On Saturdays urgent cases are dealt with at 1, Tavistock Square, W.C. 1. (Tel.-. EUS. 8052). National Health Service.—All old people should be on a list of a doctor. This part of the service is controlled by the London Executive Council, Insurance House, Insurance Street, W.C.I. (Tel.: TER. 7833). A complete list of doctors can be seen at any Post Office, or advice can be obtained from the Public Health Department at the Town Hall. National Insurance : Local Offices— For Postal Area, W.l. For Postal Area, N.W.l. For Postal Areas, W.2 and N. IV.S Colquhoun House, 30, Euston Square, N.W.l 5, Praed Street, W.2. Broadwick Street, W.l. Tel. : EUS. 6451. Tel. : PAD. 3411. Tel. : REG. 7010. LONDON COUNTY COUNCIL. Homes.—Luxborough Lodge, 1, Luxborough Street, W.l. (Tel. : WEL. 0966).—Apply to Admission Officer, 10, Warwick 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.—Apply to the " Welfare of the Blind " Department, 10, Warwick 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.—Apply to Local Office, 313-319, Harrow Road, W.9. (Tel. : CUN. 4815) through the patient's doctor, Monday to Friday 9.15 a.m. to 5.15 p.m. Emergency calls during the night and at weekends, apply to the County Hall, Westminster Bridge Road, S.E.I. (Tel. : WAT. 5000, Ext. 7005). 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, 10, Warwick Row, S.W.I. (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). Chiropody.—A clinic is run by the L.C.C. at Health Centre 2, 217, Lisson Grove, N.W.8, on Mondays 9.30 a.m. to 12.30 p.m., 1.30 p.m. to 4.30 p.m., Tuesdays 1.30 p.m. to 4.30 p.m. and Fridays 9 a.m. to 12 noon. Treatment is by appointment which must be made at the above address. No charge to pensioners. See also under " Voluntary Societies." ST. MARYLEBONE BOROUGH COUNCIL. Public Health Department, Town Hall, St. Marylebone, W.l. (Tel. : WEL. 7766, Ext. 105)..—Miss Sharp, M.B.E. and Miss B. Wilson, Public Health Inspectors, deal with any public health matters among old people which are brought to their 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. Similarly, arrangements can be made to cleanse verminous persons at the Cleansing Station at Lisson Grove or, if they are enfeebled, in their own homes. Under various statutory powers the Council may :— (i) 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 incapable, are living in insanitary conditions and are unable to devote to themselves, AND are not receiving from others, proper care and attention ; (ii) Arrange for the burial of the body of anyone who has died or been found dead in the Borough where no other suitable funeral arrangements are being made. Public Baths, Seymour Place, W.l.—Monday to Friday up to 4.30 p.m. Old age pensioners pay Id. (soap and towels extra). Library Book Service.—This is operated by the Borough Council Library and delivery of books is made to the infirm or housebound each Tuesday. Arrangements must be made with the Borough Librarian at the Town Hall. (Tel.: WEL. 7766). Holidays.—The Borough Council's grant towards the cost of holidays for old age pensioners is administered by the Old People's Welfare Association. Fuel.—Old people without coal or smokeless fuel owing to delayed delivery should be notified to Miss Sharp, who can arrange delivery of 28 lbs. of coal or smokeless fuel to tide over until the coalman calls. VOLUNTARY SOCIETIES. * St. Marylebone Old People's Welfare Association,* Room 103, Town Hall, St. Marylebone, W.l. (Tel.: WEL. 7766, see 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. below Visiting.—The Old People's Welfare Association has a panel of voluntary visitors, men and women, who pay page 41. regular friendly visits to old people. Eight 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. 41 Meals on Wheels. (Dinners).—This service for the housebound 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. and British Red Cross Society. Hot dinners can be taken to the home, price l1d. for two courses. Apply either to the Old People's Welfare Association or to the W.V.S. SEE W. V.S. Luncheon Club* 134, Seymour Place, W.l. (Tel.-. PAD. 5597).—Old age pensioners can obtain dinners NOTE BELOW for l1d- from Monday to Friday. Notice to attend must be given to the W.V.S. beforehand. on this Home Nursing.—Paddington and St. Marylebone District Nursing Association, 117, Sutherland Avenue, W.9. page (Tel.-. CUN. 1462). * Chiropody.—A clinic is run by the Old People's Welfare Association and the British Red Cross Society in *Room SEE 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. No charge. BELOW Treatment is by appointment which must be arranged on Tuesdays in Room 115. Another clinic is run by the Old on this People's Welfare Association at All Souls' Church Hall, Greenwell Street, W.l, on Mondays 10 a.m. to 1 p.m. page. No charge. Applications for appointments to be made to the clinic on Monday mornings or by letter. A Home Chiropody Service is also run by the Association on five days in each month. Bookings to be made with the Secretary, Old People's Welfare Association. No charge. Clubs.—There are three W.V.S. Clubs for the Elderly :— St. Mary's Church Hall, Crawford Street, W.l, on Wednesdays and Thursdays, 2.30 to 4.30 p.m. 60, Paddington Street, W.l, on Tuesdays, 2.30 to 4.30 p.m. Other Clubs are:— The St. John's Wood Darby and Joan Club, 28, St. John's Wood Road, N.W.8, on Wednesdays 2.30 to 4 p.m. The Inner Wheel Club on Fridays, 2.30 to 4.30 p.m. in Christ Church Hall, Shroton Street, N.W.l. The Fourth Feathers Club, 28, Mulready Street, Church Street, N.W.8, on Thursdays, 2.30 to 4.30 p.m. The Barrow Hill Club, De Walden Rooms, Charlbert Street, N.W.8, alternate Thursdays, 2.30 to 4.30 p.m. The Evergreen Club, Salvation Army Hall, Bell Street, N.W.l, Thursdays, 2.30 to 4 p.m. The Good Companions Club, Greenwell Street, W.l, on Mondays, 3 to 5 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, 374, Edgware Road, W.2. Monday to Friday, 10 a.m. to 5 p.m. (Tel.-. PAD. 7842). The "Wireless for the Bedridden" Society, 20, Wimpole Street, W.l. (Tel. : WEL. 0949).—Wireless and television 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 need, and who can also keep in touch with them. Family Welfare Association, 8, Kensington Park Road, W. 11. (Tel.: PAR. 6683). Sailors', Soldiers' and Airmen's Families Association (S.S.A.F.A.), Room 103, Town Hall, St. Marylebone, W.l. (Tel.: WEL. 7766, Ext. 97).—Wednesdays and Fridays, 10 a.m. to 12.30 p.m. Salvation Army, 236, Portman Buildings, Lisson Grove, N.W.l. (Tel.: PAD. 8553). Church Army, 185, Marylebone Road, N.W.l. (Tel.: AMB. 3211). British Red Cross Society, 106, Crawford Street, W.l. (Tel.: WEL. 3416). National Association for Mental Health, 39, Queen Anne Street, W.l. (Tel.: WEL. 1272). The Horder Centres for Arthritics, 17, Rugby Mansions, Bishop King's Road, W. 14. (Tel. : FUL. 0593). The Chest and Heart Association, Tavistock House North, Tavistock Square, W.C.I. (Tel.: EUS. 3102). 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 Lodging House for Women, 84, Bell Street, N.W.l. (Tel.: PAD. 0447).—Elderly able-bodied women, still at work, can be admitted although the hostel is not specially for the aged. The Ladies' Home, 41, Abbey Road, N.W.8. (Tel.: MAI. 6831).—For elderly ladies in reduced circumstances. "Newstead", 17-19, Greville Place, N.W.6. (Tel.: MAI. 5711).—Maintained by the St. Marylebone Old People's Homes, for the aged of either sex in need of care and attention. Old People's Homes Committee, 296, Vauxhall Bridge Road, S.W.I. (Tel.: VIC. 9977). Details of old people's homes in London and provinces. CINEMAS. The following local cinemas admit old age pensioners on weekdays (excluding Saturdays) as follows:— The Odeon, Edgware Road, until 4 p.m., charge 9d. The Regal, Harrow Road, until 4 p.m., charge 9d. The Classic, Baker Street, until 3 p.m., charge 2s. 6d. * NOTE.—It is intended that by the Autumn of 1964 these services will operate from " The Day Centre ", York Street Chambers, York Street, W.l. Further information can be obtained from the Public Health Department, telephone Welbeck 7766 between 9 a.m. and 5 p.m., from Monday to Friday. 42 SUMMARY OF HOSPITALS AND CLINICS SERVING THE BOROUGH Ambulance Service : Emergency Bed Service (to all hospitals in Greater London) HOP 7181 Normal Removals ( do. )WAT 3311 Hospitals : Florence Nightingale Hospital, 19, Lisson Grove, N.W.l. PAD 2341 Hospital for Nervous Diseases, 4, Maida Vale, W.9 CUN 5172 Hospital of St. John and St. Elizabeth, 60, Grove End Road, N.W.8 CUN 5126 King Edward VII Hospital, Beaumont Street, W.l. HUN 4411 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. Mary's Hospital, Praed Street, W.2 AMB 1280 Samaritan Hospital, Marylebone Road, N.W.l . PAD 6011 The Middlesex Hospital, Mortimer Street, W.l MUS 8333 Western Ophthalmic Hospital, Marylebone Road, N.W. 1871 Clinics : Arthur Stanley Institute for Rheumatic Diseases and AlUed Conditions, Peto Place, N.W.l LAN 6778 Carter Foundation (Temperance Clinic), 34, Seymour Street, W.l. AMB 6689 Charterhouse Rheumatism CUnic, 56-60, Weymouth Street, W. 1 WEL 1264 Chest Clinic, Town Hall, Marylebone Road, W.l WEL 7766 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 MEDICAL AND NURSING, ETC. INSTITUTIONS IN THE BOROUGH British Institute of Radiology, 32, Welbeck Street, W.l WEL 6867 General Medical Council, 44, Hallam Street, W.l LAN 2J27 General Nursing Council for England and Wales, 23, Portland Place, W.l LAN 8334 Institute of Cardiology, 35, Wimpole Street, W.l HUN 3043 Institute of Medical Laboratory Technology, 74, New Cavendish Street, W.l LAN 2752 Institute of Orthopaedics, 234, Gt. Portland Street, W.l EUS 5070 Medical Society of London, 11, Chandos Street, W.l LAN 1043 Royal College of Midwives, 15, Mansfield Street, W.l LAN 6523 Royal College of Nursing, la, Henrietta Place, W.I LAN 2646 Royal College of Obstetricians and Gynaecologists, 27, Sussex Place, Regent's Park, N.W.l AMB 5425 Royal Institute of Public Health and Hygiene, 28, Portland Place, W. 1 LAN 2731 Royal Medico-Psychological Association, 11, Chandos Street, W.l LAN 1495 Royal Society of Medicine, 1, Wimpole Street, W.l LAN 2070 Royal Society of Tropical Medicine and Hygiene, 26, Portland Place, W.l LAN 2127 43 INDEX Page Accidental Deaths 3,30 Accidents : Home 10 Road 3,30,32 Adulterated Food Samples 21 25 Aged Persons 6,7,40 Aged Persons—Services available 40 Air Pollution 13,34 Ambulance Service 42 Analysis of Food and Drugs 21 Analyst, Public 1,21 Analyst, Public, Report 21 Bacteriological Examinations 28, 33, 39 Bacteriological Examination of Milk and Ice Cream 25 Bacteriologist 1 Barbers 15 Baths : Cleansing of Persons 13 For Old People 7 Public 9 Swimming 9 Births 3 Bodies, Transportation Abroad 17 Books, Library 9,27 Bugs 13 Burial or Cremation of the Dead 17 Cancer 3,30 Care of Old People 6, 7, 40 Catering Establishments 25 Causes of, and Ages at. Death 30 Census Population 2 Certificates of Disrepair 19 Clean Air 13, 34 Cleansing, Public 16 Cleansing Station 13 Cleansing of Verminous Persons 13 Clearance, Slum 18 Clinics 42 Closing Orders 20, 33 Combined Drainage 13 Committee, Public Health 1 Common Lodging Houses 20 Compulsory Removal 9 Conditions, Social 2 Conferences 5 Consumer Protection 15 Conveniences, Public 15, 36 Cremation 17 Deaths : Accidental 3, 30, 32 General 2, 3, 30 Infant Mortality 2, 3, 30 Maternal Mortality 3, 30 Vital Statistics 2 Diseased or Infirm Persons, Removal 9, 37 Diseases, Notifiable 26, 27, 37 Disinfection 27 Disinfestation 13 Disrepair Certificates 19 Dog Nuisance 17 Drainage 12 Drugs, Analysis. 21 Dwelling-Houses 13, 32 Exclusion from Work 27 Factories 14, 35 Financial Contributions to Voluntary Organisations 5 Fireguards 15 Food : Adulterated, etc. 20, 25 Analysis 21 Inspection 21 Legislation 24, 39 Poisoning 27, 38, 39 Premises 25, 37 Page Food : Preserved, etc. 25, 37 Stalls 26 Unsound 25, 36 Fouling of Footways by Dogs 17 General Statistics 2 Hairdressers and Barbers 15 Health Education 5, 6 Health Services, personal 11 Heating Appliances (Fireguards) 15 Home Accidents 10 Horseflesh 26 Hospitals 42 Houses in Multiple Occupation 19 Housing : Certificates of Disrepair 19 Closing Orders 20, 32 Improvements and Conversions 19 Inspection and Action taken 32 Of Old People 19 Old People's Consultative Committee 19 Permanent Estates 18 Re-housing, Medical Certificates 20 Slum Clearance 18 Hydrogen Cyanide Disinfestation 13 Hygiene—Food Premises 26 Ice Cream 25,37 Immigrants 19 Impetigo 27 Improvement and Conversions, Housing 19 Infant Mortality 2, 3, 30 Infectious Diseases : Exclusion from Work of Contacts 27 Notification 26, 37 Prevalence and Control 26 Statistics 37 Inns, Refreshment Houses, etc. 25 Inspection, Sanitary 32 Institutions, Medical and Nursing, etc. 42 International Certificates of Vaccination 28 Intimation Notices 11 Knacker's Yard 26 Land Charges Enquiries 19 Laundry : Public 9 Service for Old People, etc. 6 Legal Proceedings 11 Legislation, New 11, 24, 39 Library books 9 Licensed Premises 25 Lung Cancer 3, 30 Marriages 2 Maternal Mortality 2, 3 Measles 2,27 Medical Examinations : Staff 10 Parking Meter Exemptions 10 Medical and Nursing, etc., Institutions 42 Medical Referee, Cremation 1, 17 Merchandise Marks Act 25 Mice 13. 34 Milk : Bacteriological Examination 25 Sellers 25 (Special Designations) Regulations 25 Mortality : Infant 2, 3, 30 Maternal 2, 3, 30 Multiple Occupation, Houses in 19 New Legislation 11, 24, 39 Noise 11 Notices, Intimation and Statutory 11 Notification of Infectious Diseases 26,37 Nuisances 7, 33 44 Page Offices 14 Old People : Care of 6 Housing—Consultative Committee 6,19 St. Marylebone Welfare Association 7, 40 Services Available 40 Outworkers 14,35 Parking Meter Exemptions—Medical Examination 10 Personal Health Services 11 Pet Animals 15 Pharmacy and Poisons Acts 15,36 Photographers, Street 17 Pigeons 12 Poisoning, Food 27, 38, 39 Poisons 15 Poliomyelitis 27 Population 2 Preserved Food 25, 37 Protective Helmets 15 Public Analyst 1,21 Public Analyst's Report 21 Public Baths 9 Public Cleansing 16 Public Conveniences 15,36 Public Health Committee 1 Public Health Department Staff 1 Public Health Inspectors 1 Public Laundry 9 Public Swimming Baths 9 Pulmonary Tuberculosis 27, 37, 38 Radioactive Substances 17 Rag Flock and Other Filling Materials 17 Rateable Value 2 Rats 13,34 Referee, Medical (Cremation) 1 Refreshment Houses 25 Refuse Collection and Disposal, Storage 16 Removal, Compulsory 9 Rent Act 19 Representation upon other Bodies 4 Restaurants 25 Road Accidents 3,32 Rodent Control 13,34 Page St. Marylebone Old People's Welfare Association 7, 8, 9 Sanitary Circumstances 11 Sanitary Inspection 11 Scabies 27 Sewerage 13 Shelter 13 Shops 14 Slaughter of Animals 26 Slum Clearance 18 Smallpox Contacts 26 Smoke Control 13, 34 Social Conditions 2 Staff : of Department 1 Medical Examinations 10 Stalls, Food 26 Statistics : General and Vital 2 Tables 30 Statutory Notices 11 Stillbirths 2, 3 Street Cleansing 16 Street Photographers 17 Swimming Baths 9 Town Planning 13 Transportation of Bodies Abroad 17 Tuberculosis : General 27 New Cases and Deaths 27,38 Notifications 27, 37 Register 27, 38 Typhoid Fever 27 Unsound Food 25, 36 Vaccination, International Certificates 28 Vermin 13 Verminous Persons, Cleansing 13 Vital Statistics 2 Water 12, 33 Weather 3, 4, 30 Wells, Private 12 Zoological Society of London 26 Vail & Co. Ltd., Leeke Street, King's Cross, W.C.I.