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OCCUPATIONAL HEALTH
The City's Square Mile
(Excerpt from the papers read before the Health Congress of
the Royal Society of Health at Scarborough, 9-13 April 1962)
THE CITY of London, although its area is a little
larger than the proverbial square mile , has one of
the greatest densities of working population per
acre in the world. Although the night population is only
5,000, by day this swells to nearly half a million. They come
not only to offices (12,000 of these), but also to railway
premises, shops, restaurants, cafes, inns, livery halls,
banks, printers, newspaper premises, factories and warehouses.
It will surprise many to learn that there are
no less than 800 premises in the City, classified as factories
under the Factories Act. There is also one theatre.
Altogether there are some 18,000 workplaces of various
kinds within the "square mile."
The workers encountered in the City look healthy
enough, both mentally and physically. They walk
briskly and they nearly all seem to have a zest for living—
one seldom sees that expression of soulless boredom that
seems characteristic of so many young men today. All
this is a personal and general impression, and there is
little scientific evidence as to the state of health of City
workers as yet, but the City Corporation has just launched
an occupational health survey with a view to obtaining it.
There is no organized occupational health service for
all of the City workers. Many of the larger firms have
whole-time or part-time doctors (the biggest having
dentists, nurses, chiropodists and radiographers as well),
visiting regularly to attend to the health of their workers.
There are 40 medical practitioners working in the City.
Only two of these are general practitioners in the sense
that they will also undertake domiciliary visitation when
necessary. They are both in the National Health Service.
Some National Health Service doctors also cross the
borders to attend to City residents and these are included
in the 40.
About half the City doctors work office hours on a
five-day week and they should be included in the number
of City workers who may travel long distances to and
from their work. These doctors, as well as undertaking
a good deal of life insurance practice, may also see
patients who come to them or are referred to them from
neighbouring firms. None of them works in the National
Health Service, but some of the few dentists in private
practice in the City do sometimes take on National
Health Service patients. Allowing for the 20 doctors
employed whole-time or part-time by firms for ad hoc
occupational health services, as well as the 20 engaged in
private practice, there must be at least 130,000 City
workers without any kind of organized occupational
health facilities whatsoever, as well as many thousands
more for whom medical and nursing attention at work is
perfunctory compared with the services provided by the
big firms.
I am not, of course, forgetting the great teaching
hospitals in or very near the City, which cope nobly
all the time with emergencies. It is not their job to
run a City occupational health service, even though
it may be desirable to provide teaching to students in
occupational health. The "forgotten" 130,000 can
all, of course, use the great hospital services in
appropriate cases. Nor am I forgetting the relatively
small, though none the less important, contributions
to the ideal of a City occupational health service for
all, represented by our mass radiography service and
by the cancer diagnostic service for females, started
recently at St. Bartholomew's Hospital with financial
help from the City Corporation, and last but not least
the Billingsgate Dispensary voluntary scheme started
in 1879 in premises near Billingsgate Market to provide
medical and nursing care while at work for Billingsgate
Market workers. Its facilities are now available
to other workers in the neighbourhood as well.
Some firms too, although they do not arrange any
medical and nursing service for their employees, do set
aside the appropriate accommodation which is then
equipped by an ophthalmic optician who attends regularly
to undertake eye-testing and, if necessary, prescribe
spectacles for those who need them—all in the employer's
time.
But all these factors do not add up to a complete
occupational health service for all City workers in the
modern sense of the term. There are many difficulties
in the way of organizing one. Some firms are so small
that they may employ as few as five workers.
The Private Members' Offices Bill of Mr. Marsh,
and the Government legislation promised both to enlarge
its scope and to supersede it, have drawn attention
to the environmental working conditions of workers
other than factory workers. "Environment" can be given
Table I
Pilot Office Survey
Approximate age of Building:
Built prior to 1900, 61
Built between 1901 and 1945, 31
Built since 1945, 9
Location in building of floor
(front, rear, central): Basement Ground 1st 2nd 3rd
Offices 33 52 46 45 39
Location in building of floor
{front, rear, central): 4th 5th 6th 7th 13th
Offices 28 16 10 5 1
Number of rooms: 123456789
Number of Premises 915 9 10 11 4 5 4 8
Number of rooms: 10 11 12 13 16 18 20 22 23
Number of Premises 6 2 3 1 1 4 1 1 1
Number of rooms: 27 33 50 58 72 130 240
Number of Premises 1 1 1 1 1 1 1
Number of employees: under16 years 16 and 17years 18 yearsand over
Male 15 113 3,168
Female 37 378 2,263
There was also a total staff of 770 for which no details were
available
Is any room overcrowded or congested (400 c ft up to 14 ft height
only per person)?
No rooms were overcrowded; 2 rooms were congested
Cleanliness (standard): are cleaners employed, and by whom?
With the exception of 2 all offices were clean
State of repair: walls, floors, ceiling, woodwork, windows
With the exception of 8 all offices were in a satisfactory state of
repair
Ventilation:
(a) means
Mostly natural
(b) satisfactory—poor
3 poor
(c) mechanical?—describe
3 were completely mechanically ventilated; 25 were naturally
ventilated aided by fans
(d) draughts—opinion of staff
There were 25 instances of staff being conscious of draught
Temperature:
(a) in rooms
60/65°F = 29; 66/70°F = 48; 71/75°F = 25
(b) heating equipment effective in winter
All satisfactory, except in one case
Lighting:
(a) ft candles on desks furthest from windows
Varied from zero to 50 ft candles
(b) artificial lighting necessary most of the day
Yes in 62 cases; no in 43 cases
(c) sky visible from half-way in room
Yes in 57 cases; no in 60 cases
Outdoor clothing accommodation:
Yes in 83 cases; no in 22 cases
Rest room:
Yes in 30 cases; no in 71 cases
Facilities for taking meals other than at the desk where the employee
works and where food brought in by him may be eaten?
Yes in 16 cases; no in 84 cases
Where is tea made ?
In a variety of places. There were 31 instances of the canteen
being used, 3 in rest rooms, 43 in offices, 3 on landings, 3 outside
caterer, 3 in lobbies to water closets and 9 nondescript places
Main drinking water tap—location -
Same floor Next floor 2 floors away In toilet On landing
57 26 15 12 1
Washing facilities:
(a) separate
46
(b) in communal toilets
58
(c) towels and soap provided
Yes in 91 cases; no in 10 cases
(d) hot water
Yes in 92 cases; no in 9 cases
Sanitary accomodation:
(a) separate for tenancies
Yes in 44 cases; no in 59 cases
(b) separate for male and female
Yes in 99 cases; no in 3 cases
(c) standard
Fair in 21 cases; good in 81 cases
(d) sufficiency
All
Caretaker:
Is there a caretaker (resident or otherwise)?
Yes in 70 cases; no in 31 cases
Basement rooms:
There were 17 cases
(a) depth below ground
Varied at 6, 8, 9, 12, 15, 16 to 20 ft
(b) dampness
None observed
(c) environmental observations
Only one found to be unsatisfactory
(d) for what purpose used?
Offices and stockroom
Escape from fire:
Yes in 78 cases; no in 22 cases
First aid provision:
Yes in 67 cases; no in 33 cases
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