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night-time duties until 2 or 3 o'clock in the morning, and this necessitated very long hours of work
by the inspectors concerned. With the kind co-operation of the Director of Cleansing a special
smallpox clinic was opened in a room at the Marshall Street Baths in Soho, staffed by medical
officers, nursing staff, and public health inspectors, and contacts were examined there every day,
including Saturdays and Sundays.
The surveillance period passed uneventfully with no secondary cases occurring in Westminster,
and so the disease had been contained. An alert of this kind is fortunately a rare occurrence but
in these days of high speed travel it is now possible for a person to be in contact with smallpox
in a far country one day and to arrive in England within a matter of hours. Constant vigilance on
the part of all concerned continues to be necessary.
Typhoid Fever
The three cases of typhoid fever notified during the year were instances of isolated infection
occurring in persons returning from abroad who were admitted to hospital shortly after arrival in
this country. No secondary cases developed. There was only one case in 1967.
Tuberculosis
Table 3, page 80, gives information regarding primary notifications of pulmonary and nonpulmonary
tuberculosis received during the year, and Table 4, page 81, shows the age and sex
distribution of all new cases and deaths from all forms of the disease.
It will be seen from Table 4, that there has been a slight increase in the total number of new
cases which came to the knowledge of the Medical Officer of Health during 1968.
The tuberculosis visitors working from the chest clinics, or in some instances from the appropriate
health clinic, visit all tuberculous households to ascertain home conditions and to advise patients
on such matters as isolation, steps to be taken to avoid the spread of the disease, and diet. Home
contacts are urged to attend for x-ray examination or Mantoux testing and, where necessary,
B.C.G. vaccination, and to attend clinic sessions for the purpose of surveillance.
The tuberculosis visitor also follows up patients who do not visit the chest clinic as regularly
as required and, where rehousing is sought, her detailed report on the home conditions assists
with the pointing for priority of the family's application. Where insanitary conditions appear to
exist the matter is referred to the public health inspector for further investigation.
MASS MINIATURE RADIOGRAPHY
The North West and the South West London Mass X-ray Services have continued to provide regular
public sessions at numerous points within the City in addition to various closed surveys. The
South West London Service also provides a six-monthly survey in conjunction with the Westminster
Hospital Chest Clinic for the residents of the City Council Lodging House at Bruce House, Kemble
Street, W.C.2 and in this connection they act in close liaison with the City Council Health and
Welfare Departments. Twice yearly X-ray sessions incorporating a special service for the early
discovery of lung cancer in men over 45 years of age are now provided for all City Hall staff and
staff of adjacent office blocks, in addition to the sessions available for personnel at the Council's
Gatliff Road Depot.
INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION
Arrangements continued for the authentication by the Medical Officer of Health of International
Certificates of Vaccination and Inoculation completed by medical practitioners in Westminster.
These certificates are required by persons proceeding abroad from this country and the purpose of
the authentication is to provide proof to those health authorities abroad who desire it that the
signature of the person issuing the certificate is that of a registered medical practitioner. After
normal office hours, at weekends and on public holidays, certificates can be authenticated upon
application to the Duty Officer at City Hall.
During the year under review 18,336 (15,805) such certificates were authenticated, the demand
being largely due to people going abroad for holidays.
The Medical Officer of Health also issues, on request and in appropriate circumstances, certificates
to the effect that no cases of smallpox have occurred in the district during the preceding month.
These certificates, 13 (20) of which were issued during 1968, are sought mainly by persons proceeding
to the United States of America who do not wish to submit to vaccination. It is understood that
the United States immigration authorities reserve the right to place such persons under surveillance
notwithstanding the production of a certificate of this kind.