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the addition of preservatives, either the use of preservatives should be prohibited or, if they
were to be allowed, the amount to be used and the food in which such preservative could be
used should be prescribed by regulation. Definite regulations have been framed and will
soon be operative.
The standardisation of food products is still far from complete but in the matter of dried
and condensed milks, subjects which have formed the basis of recommendations, definite
official regulations are now in force.
OTHER MATTERS OF INTEREST.
Venereal Diseases.—The work at the Centre for the treatment of venereal diseases has
continued in the past but a reference to the number of attendances, set out on page 32. will
show that the use which is made of this institution, as judged by these criteria, is not so
great as in the past. The time has now arrived to consider whether a cheaper and equally
efficient way of meeting this requirement cannot be devised, in substitution for that which
now exists. The Sanitary Committee and the Authorities of St. Bartholomew's Hospital
are now jointly considering the position.
Tuberculosis Dispensary.—Ho extension of this work has been undertaken but a closer
co-operation has been developed between the City Dispensary and the Out-patients' Department
of St. Bartholomew's Hospital. The resources of St. Bartholomew's Hospital were
always available for patients under treatment at the Tuberculosis Dispensary, but to-day
the Hospital authorities use the centre much more freely as an actual working department of
the Hospital. This is all to the good and is a considerable factor in the development of the
relationship between preventive and curative medicine.
In relation to the preventive work against tuberculosis, I have to refer to the excellent
report by Dr. Young, City Tuberculosis Officer, on the value and conduct of Workshops for
Tuberculous Patients which is given on page 29 of this report.
Vital Statistics.—The vital statistics for the City are unreliable ; this results from
the fewness of the totals which have to be compared ; the peculiar age constitution of
the residents ; and the fact that in respect of certain persons who die outside the City area,
and whose place of residence is not accurately known, the indefinite term " London " is
occasionally used and in certain instances such deaths are allocated to the City. In addition,
there is a large re-arrangements of persons dying in the City and non-resident therein, as
will be gathered from the fact that in 1924 the deaths of 656 persons were so transferred from
the City area to outside districts. Further, 88 persons died outside the City but were stated
to have been usually resident therein, and were allotted to the City. These totals compare
with a comparatively small net number of deaths, 117. Errors must occasionally arise. The
infant mortality rate also shows considerable variation, a fact which is also observed when
totals are small. The chief indication of unreliability, however, is seen in the birth rate which
in the five years under review has varied between 15 and 7 per 1,000.
A reasonable test of salubrity may be gathered from the consideration of the notifications
of Enteric Fever and Puerperal Fever. Of the former disease only five have been
reported in five years, and of the latter only one, and that was a doubtful case.
The table of death distribution among the age groups shows that the deaths of persons
over 65 years of age comprise from two-fifths to over one-half of the entire total.
The only reasonable deduction from the consideration of the vital statistics is that the
recorded rates in the City, whilst obviously irregular and probably in excess of the real
rates, do not indicate that insanitary conditions are affecting the resident population to
an extent in excess of that observed over the average of London.
Infectious Diseases.—In connection with the subject of infectious diseases I should like
to take the opportunity at this point of expressing my appreciation of the highly efficient
service which is maintained by the Metropolitan Asylums Board in respect of the removal
and treatment of cases of infectious disease. The general public is, I rather believe, not sufficiently
acquainted either with the responsibilities which devolve upon the Board or of the
part the organisation plays in the preventive work of London's local authorities.
PROGRAMME FOR THE FUTURE.
Unless new legislation imposes additional powers and responsibilities on Local Authorities
in the realm of preventive medicine, I do not contemplate any new developments but
attention will require to be given to the following matters which here are simply recapitulations
of what has already been suggested :—
(1) The unsatisfactory residences in the City will require to be closed and the occupants
if possible transferred to more suitable tenements under Corporation control. For this purpose