che9 Metropolitan Borough of Chelsea. ANNUAL REPORT For 1902, OF THE Medical Officer of health, LOUIS C. PARKES, M.D.: D.P.H. Lond. Univ.; M.R.C.S. Eng. fellow of the sanitary institute ; fellow of the society of medical officers of health ; president of the metropolitan branch of the society of medical officers of health, 1902-3; member of council of the epidemiological society; lecturer on hygiene and public health at st. george's hospital medical school. TOWN HALL, KING'S ROAD, CHELSEA. 1903. TABLE OF CONTENTS. SEC. I. —Statistical page. Population of Chelsea 3 Births and Birth-rate 5 Deaths and Death-rate 5 Statistical Tables (Local Government Board Forms, I., II., III.. IV.) 9—12 SEC. II.:— Infectious Diseases— Small-pox in Chelsea 13 Vaccination 16 Quarantine 18 Small-pox in London 18 Scarlet Fever 19 Diphtheria 19 Enteric Fever 19 Prevalence of Scarlet Fever, Diphtheria, and Enteric Fever in West London Boroughs 20 The Case Mortality 21 Bemoval of Patients to Hospitals 21 The New Disinfecting Station 22 SEC.m.:— The Housing op the Working Classes— Onslow-dwellings 23 The Beaufort-street Scheme 23 Demolitions in 1902 27 SEC. IV. Reports presented to the Borough Council—. 28 SEC. V.:— The Sanitary Condition of the Borough— Restaurant Kitchens 29 Underground Bake-houses and the Factory and Workshop Act, 1901 30 Administration of the Factory and Workshop Act 31 SEC. VI.:— Summary of Nuisances, and other matters reported upon 33 Magisterial Proceeding during 1902 35 List of Bake-houses, Cow-houses, and Slaughter-houses 38 ANNUAL, REPORT op the MEDICAL OFFICER OF HEALTH For 1902. Section I.-STATISTICAL. POPULATION OF CHELSEA. The census population of the Borough of Chelsea for the year 1901 was 73,842. The following Table shows the population of each of the Wards of Chelsea, of the whole Borough, and of London, together with the percentages of males and females in each. Table I. Persons. Percentage of Males. Percentage of Females. Cheyne Ward 12,159 43.2 % 56 8 % Church 12,704 45.8 „ 54.2 „ Hans Town Ward 12,568 39.2 „ 60.8 „ Royal Hospital Ward 10,703 44.1 „ 55.9 „ Stanley Ward 25,708 47.2 „ 52.8 „ Chelsea North 42,514 43.3 „ 57.7 „ Chelsea South 31,328 46.0 „ 54 „ Chelsea 73,842 44.5 „ 55.5 „ London 4,536,541 47.2 „ 52.8 „ The excess of females over males is greatest in Hans Town Ward, and least in Stanley Ward, where the proportions are the same as those in London as a whole. 4 Table II. shows the changes in population effected by the transformation of Chelsea into a Borough. Table II. Population Received. Population Transfered. From Westminster 3,584 To Paddington 17,181 (Kensal Town) ,, Kensington 111 ,, Kensington 3,375 „ ,, Fulham 7 - 3,702 20,456 „ Kensington 858 (Home Dist.) „ Westminster 2,095 „ 23,409 5 BIRTHS AND BIRTH-RATE FOR 1902. Table IV. Number of Births. Birth-rate per 1,000. Males. Females. Total. Chelsea North 463 452 915 21.4 Chelsea South 388 382 770 24.5 Chelsea 851 834 1,685 22.4 London • •. ... 132,810 28.6 In 1901 the birth-rate of Chelsea Borough was 22.l per 1,000, The average birth-rate of the Home District of Chelsea Parish for the 5 years 1896-1900 was 24.1 per 1,000. DEA.THS AND DEATH-RATE FOR 1902. The total number of deaths registered in the Borough was 1,896. Of this total 716 were deaths, within the Borough, of non-parishioners —chiefly occurring in hospitals and in the St. George's Infirmary; and 175 deaths of parishioners of Chelsea occurred outside the Borough in various public institutions. There were, therefore, 1,355 deaths of parishioners of Chelsea. These 1,355 deaths are equivalent to a deathrate for the year of 18.0 per 1,000, as against a death-rate of 16.6 per 1,000 in 1901. Table V. gives the death-rates of the home district of Chelsea, of Chelsea Borough, and of London during the past 11 years. Table V.  Chelsea.* London. Death-rate. Death-rate. 1891 22.1 21.4 1892 21.9 20.7 1893 21.6 21.4 1894 17.6 17.8 1895 20.8 19.9 1896 19.0 18.6 1897 17.9 18.2 1898 18.1 18.7 1899 20.0 19.8 1900 18.1 18.7 1901 16.6 17.7 1902 18.0 17.7 *1891-1900, Chelsea Home District. 6 The death-rate for 1902 is rather higher than that of 1901, which is chiefly accounted for by higher mortalities from measles and diseases of_ the respiratory organs prevailing in the past year. Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 2 22 per 1,000 in 1902, the corresponding rate for London being 2.43 per 1,000. In 1901 the zymotic deathrate in Chelsea was only l.56 per 1,000. The increase in 1902 is due to the greater prevalence of measles, small-pox, scarlet fever, and diphtheria. Whooping-cough and diarrhœl diseases, were, however, less prevalent in 1902 than in 1901. Table VI.—For the year 1902. Zymotic death-rate. Diarrhoea death-rate. Phthisis death-rate. Other tubercular diseases death-rate. Respiratory diseases death-rate. Cancer death-rate. Influenza death-rate. Deaths under 1 year to 1,000 births. Percentage of deaths under 5 to total deaths[I###] Chelsea 2.22 0.69 1.48 0.39 4.14 1.01 0.27 145 29.2 London 2.43 0.74 1.61 0.59 3.45 0.99 0.23 141 34.7 Small-pox.— Seven deaths of Chelsea residents from small-pox were registered in 1902 (see " Report on Small-pox," p. 13). Measles.—This disease caused 68 deaths in 1902, as compared with 8 only in 1901. Forty-three of the deaths were registered in Chelsea North, and 25 in Chelsea South. Ten of the deaths were of infants under 1 year of age. Fifty-two were between the ages of 1 and 5, and 5 were between the ages of 5 and 15. Out of the 68 deaths, 60 occurred in the 2nd quarter of the year when the disease was epidemic. The epidemic was of remarkably short duration, being practically confined to the 13 weeks of the 2nd quarter. Scarlet Fever.—This disease caused 8 deaths in 1902, as compared with 5 in 1901. All the deaths were of fever hospital patients, 6 being of Chelsea North residents, and 2 of Chelsea South residents. Diphtheria.—This disease caused 13 deaths in 1902, as compared with 9 only in 1901. Of the 13 deaths, 5 were between 1 and 5 years of age, and 7 between 5 and 15; 10 were residents in Chelsea North, and 3 in Chelsea South. Eight of the deaths were of fever hospital patients, and 5 died at their own homes. Chelsea continues to be fairly free from diphtheria, as the following Table shows;— 7 Table VII.—Cases of, and Deaths from. Diphtheria and Membranous Croup in Chelsea* 1890-1902. Cases. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 1901. 1902. 172 162 163 200 207 273 429 242 153 136 150 106 131 Deaths. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 1901. 1902. 32 20 32 43 41 52 96 45 22 13 14 9 13 *1890-1900, Chelsea Home District. Whooping Cough.—This disease caused 13 deaths in 1902, as compared with 29 in 1901. Four only of the deaths occurred in Chelsea North, and 9 in Chelsea South. Eight of the fatal cases were infants under 1 year of age, and 5 were between the ages of 1 and 5. Table VIII.—Zymotic Disease Mortality in Chelsea, in 1903. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea, 1896-1901. Measles 68 38 37 Scarlet Fever 8 9 10 Diphtheria 13 19 33 Whooping Cough 13 30 31 Enteric Fever 6 9 9 Diarrhœa 52 55 86 Small-pox 7 21 - Enteric Fever.—The mortality from this disease was again below the average, of recent years. Three of the fatal oases occurred in hospital, and 3 at the patients' own homes. Diarrhoea.—The deaths in Chelsea in 1902 from diarrhœal diseases (diarrhcea, dysentery, cholera, gastro-enteritis, and enteritis) were 52 in number, as compared with 58 in 1901. Thirty-six of the deaths were of infants under 1 year of age, and 11 were between 1 and 5 years of age. The summer diarrhcea prevalence was small, as in 1901, the cold and wet weather of the end of July and of the whole of August effectually preventing any rise in the diarrhoea mortality. 8 Table IX.—Mortality from Diarrhœal Diseases. Year. Chelsea. London. Death-rate per Million. Death-rate per Million. 1896 1,037 1,112 1897 1,340 1,446 1898 1,258 1,556 1899 1,282 1,663 1900 1,187 1,251 1901 788 1,184 1902 692 737 Influenza.—The number of deaths attributed to influenza amounted to 20, as against 21 in 1901. Eleven deaths occurred in Chelsea North, and 9 in Chelsea South. Thirteen of the fatal cases occurred in the first quarter of the year. In London generally the disease was somewhat more prevalent than in 1901, 1,083 fatal cases occurring in 1902, as against 644 in 1901. Of the fatal cases, 639 occurred in the first quarter of the year. Respiratory Diseases.—The death-rate from these diseases in Chelsea in 1902 was 414 per 1,000, and is considerably higher than in 1901 (3.65 per 1,000). The excess is attributable to the prevalence of measles, and the very inclement weather of the late spring (April and May. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1902 was only l.87 per 1,000, as against 2.15 in 1901, and 2.2 per 1,000 in London in 1902. The average oi Chelsea for the 5 years, 1897-1901, is 2-38 per 1,000. Cancer.—Malignant cancerous diseases caused 76 deaths amongst Chelsea residents in 1902, the average of the past 6 years being 73 deaths. Alcoholism.—Twenty-six deaths were registered as being due to intemperance and cirrhosis of the liver, as against 31 deaths in each of the years 1900, 1901. Deaths in Lunatic Asylums.— Forty-three deaths of Chelsea parishioners occurred in lunatio asylums. The average of the 11 years, 1891-1901, is 31 deaths annually in lunatic asylums. Deaths in Public Institutions.—In 1902, 40.2 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 47 per cent, in 1901. In London generally, 34.l per cent. of the total deaths occurred in public institutions. The deaths in the Chelsea Infirmary in 1902 formed 21.9 per cent. of the total, as compared with 23.5 per cent. in 1901. 9 TABLE X. FOR WHOLE DISTRICT. Year. Population estimated to Aliddle of each Year. Births. Deaths under One Year of Age. Deaths at all Aoes. Total. Deaths in Public Institutions in sea. Deaths of residentsre (fistored in District. Deaths of Residents registered beyond District Deaths at all Aoes. Nett. No. Rate.* No. Rate per 1000 Births registd No. Rate.* No. Rate.* 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 1892 96,351 2784 28.9 462 165 2158 22.4 750 343 202 2017 20.9 1893 96,430 2854 29.6 456 160 2125 22.0 765 412 245 1958 20.3 1894 96,508 2700 28.0 356 132 1720 17.8 658 332 229 1617 16.8 1895 96,587 2723 28.2 464 170 2002 20.7 682 323 241 1920 19.9 1896 96,666 2651 27.4 443 167 1903 19.7 648 305 251 1849 19.1 1897 96,745 2549 26.3 410 161 1777 18.4 668 298 235 1714 17.7 1898 96,823 2332 24.1 410 176 1827 18.9 678 300 231 1758 18.2 1899 96,902 2381 24.6 391 164 1927 19.9 661 255 225 1900 19.6 1900 96,990 2245 23.1 333 148 1802 18.6 662 277 213 1737 17.9 Averages for years 1892-1900. 96,666 2580 267 414 160 1916 19.8 686 316 230 1830 18.9 1901 73,856 1626 22.1 226 139 1601 21.8 855 546 165 1220 16.6 1902 74,018 1685 22.4 244 145 1896 25.2 1086 716 175 1355 18.0 •Rates calculated per 1000 of estimated population. Note.-The deaths to be included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of illness, and dying there ; and by the term " Residents" is meant persons who have been taken out of the district on account of illness, and have died elsewhere. Area of District in acres (exclusive of area covered by water) 660 At Census of 1901. Total population at all ages 73,866 Number of inhabited houses . 9,063 Average number of persons per house 81 10 TABLE XI. Namks of Localities. CHELSEA. HOME DISTRICT. KENSAL TOWN. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 Year. Population 'estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 Year. Population estinated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 Year. (a.) (b.) (c.) (d) (a.) (b.) (c.) (d.) (a.) (b.) (c.) (<*•) 1892 96,351 2784 2017 462 74,648 2060 1631 349 21,702 724 386 113 1893 96,430 2854 1958 456 74,794 2128 1607 346 21,635 726 351 110 1894 96,508 2700 1617 356 74,940 2028 1315 271 21,568 672 302 85 1895 96,587 2723 1920 464 75,086 2028 1559 341 21,500 695 361 123 1896 96,666 2651 1849 443 75,233 1999 1453 323 21,433 652 396 120 1897 96,745 2549 1709 410 75,380 1902 1344 287 21,367 647 365 123 1898 96,823 2332 1758 410 75,527 1761 1360 283 21,300 571 398 127 1899 96,902 2381 1900 391 75,674 1772 1505 277 21,234 609 395 114 1900 96,990 2245 1737 333 75,822 1674 1373 243 21,168 571 364 90 Averages for years 1892-1900. 96,666 2580 1829 414 75,233 1928 1461 302 21,433 652 369 112 Chelsea North. Chelsea South. 1901 73,856 1626 1220 226 42,515 914 629 107 31,341 712 591 119 1902 74,018 1685 1355 244 42,615 915 736 139 31,403 770 619 105 Notes.—(a.) The separate localities adopted for this Table should be areas of which the populations are obtainable from the census returns, such as wards, parishes or groups of parishes, or registration sub-districts. Block 1 may, if desired, be used for the whole district; and blocks, 2, 3, &c., for the several localities. In small districts without recognised divisions of known population this Table need not be filled np. (6.) Deaths of residents occurring in public institutions beyond the district are to be included in subcolumns c of this Table, and those of non-residents registered in public institutions in the district excluded. [See note on Table I. as to meaning of terms "resident" and " non-resident."] (c.) Deaths of residents occurring in public institutions, whether within or without the district, are to be allotted to the respective localities according to the addresses of the deceased. (d.) Care should be taken that the gross totals of the several columns in this Table respectively equal the corresponding totals for the whole districts in Tables I. and IV.; thus, the totals of subcolumns a, b and c, should agree with the figures for the year in the columns 2, 3, and 12, respectively, of Table I.; the gross total of the sub-columns c should agree with the total of column 2 in Table IV., and the gross total of sub-columns d with the total of column 3 in Table IV. 11 TABLE XII. Cases of Infectious Disease notified during the Year 1902. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At AgU7st—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Chelsea North. Chelsea South. Chelsea North. Chelsea South. Whole Borough. Small-pox 38 1 • • 2 13 22 • • 23 15 22 15 37 Cholera .. .. .. .. .. .. .. .. .. .. .. •• Diphtheria 130 •• 36 69 16 9 • • 79 51 65 43 108 Membranous croup 1 •• •• 1 • • • • • • • • 1 •• 1 1 Erysipelas 59 4 2 3 4 38 8 31 28 •• •• •• Scarlet fever 204 1 60 105 23 14 1 95 109 80 103 183 Typhus fever .. .. .. .. .. .. .. .. .. .. .. •• Enteric fever 36 •• •• 4 15 17 •• 21 15 12 12 24 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 7 • • • • • • 5 2 •• 2 5 •• 1 1 Plague • • • • • • • • • • • • • • • • • • • • • • • • Chicken-pox 215 14 92 97 4 8 •• 115 100 •• •• •• Totals 690 20 190 281 80 110 9 366 324 179 175 354 Notes.—The localities adopted for this table should be the same as those in Tables II. and IV. State in space below the name of the isolation hospital, if any, to which residents in the district, suffering from infectious disease, are usually sent. Mark (h) the locality in which it is situated, or if not within the district, state where it is situated, and in what district. Mark (w) the locality in which a workhouse is situated. + These age columns for notifications should be filled up in all cases where the Medical Officer of Health, by inquiry or otherwise, has obtained the necessary information. TABLE XIII. Causes of, and Ages at, Death during Year 1902. Causes or Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages). Total Deaths in Public Institutions m the District. All Ages. Under 1 Year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards- Chelsea North. Chelsea South. Small-pox 7 1 • • 2 • • 4 • • 4 3 • • Measles 68 10 52 5 • • 1 • • 43 25 10 Scarlet Fever 8 • • 7 1 • • • • • • 6 2 2 Whooping-cough 13 8 5 • • • • • • • • 4 9 • • Diphtheria and Membranous Croup 13 • • 5 7 • • • • • • 10 3 • • Croup Fever .. • • • • • • • • • • • • • • • • • • Typhus • • • • • • • • • • • • • • • • • • • • Enteric 6 • • • • 1 2 3 • • 4 2 • • other continued • • • • • • • • • • • • • • • • • • • • Epidermic Influenza 20 3 1 1 • • • • 7 11 9 5 Cholera • • • • • • • • • • • • • • • • • • • • Plague • • • • • • • • • • • • .. • • • • • • Diarrhœa(See Notes at food) 44 32 8 • • • • • • 3 22 22 25 Enteritis (See Notes at foot) 8 4 3 •• • • • • 1 6 2 3 Puerperal Fever • • • • • • • • • • • • • • • • • • • • Erysipelas 6 1 1 • • • • 2 2 2 4 2 Other Septic Diseases 9 1 • • • • 1 5 2 5 4 6 Phthisis 111 • • 6 • • 8 89 8 61 50 191 Other Tubercular Diseases 29 7 12 3 • • 5 2 15 14 35 Cancer, Malignant Diseases 76 • • • • 1 1 47 27 39 37 152 Bronchitis 219 44 16 1 • • 54 104 122 97 150 Pneumonia 82 14 12 • • 1 38 17 46 36 65 Pleurisy 10 1 • • • • • • 5 4 6 4 6 Other Diseases of Respiratory Organs • • • • • • • • • • • • • • • • .. Alcoholism—Cirrhosis of Liver 26 • • • • • • • • 22 4 17 9 13 Venereal Diseases 5 • • 1 • • • • 4 .. 2 3 5 Premature Birth 35 35 .. .. .. • • • • 23 12 4 Diseases and Accidents of Parturition 3 • • • • • • • • 3 • • 2 1 1 Heart Diseases 127 • • 1 8 11 54 53 68 59 82 Accidents 41 9 1 • • 1 21 9 20 21 9 Suicides 11 • • • • • • • • 10 1 6 5 • • All other causes 378 74 20 8 7 121 148 192 18b 320 All causes 1355 244 151 38 32 498 392 736 619 1086 Notes.—(a) In this Table all deaths of "Residents" occurring in public institutions, whether within or without the district, are to be included with the other deaths in the columns for the several age groups (columns 2-8). They are, also, in columns 9-15, to be included among the deaths in their respective " Localities " according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non-residents " occurring in public institutions in the district are in like manner to be excluded from columns 2-8 and 9-15 of this Table. (b) See notes on Table I. as to meaning of "Residents" and " Non-residents," and as to the " Public Institutions " to be taken into account for the purposes of these Tables. The " localities" should be the same as those in Tables II. and III. (c) All deaths occurring in public institutions situated within the district, whether of " Residents or of " Non-residents, are, in addition to being dealt with as in note fa), to be entered in the last column of this Table. The total number in this column should equal the figures for the year in column 9. Table I. (d) The total deaths in the several "Localities" in columns 9-15 of this table should equal those for the year in the same localities in Table II., sub-columns c. The total deaths at all ages in column 2 of this Table should equal the gross total of columns 9-15, and the figures for the year in column 12 of Table I. (e) Under the heading of "Diarrhoea" are to be included deaths certified as from Diarrhoea, alone or in combination with some other cause of ill-defined nature; and also deaths certified as from Epidemic Enteritis; Zymotic Enteritis; Epidemic Diarrhoea. Summer Diarrhoea ; Dysentery and Dysenteric Diarrhea ; Choleraic Diarrhea. Cholera, Cholera nostras (in the absence of Asiatic Cholera). Under the heading of " Enteritis " are to be included those certified as from Gastroenteritis, Muco-enteritis, and Gastric Catarrh, unless from information obtained by enquiry from the certifying practitioner or otherwise, the Medical Officer of Health should have reason for including such deaths, especially those of infants, under the specific term " Diarrhoea?" Deaths from Diarrhoea secondary to some other well-defined disease should be included under the latter. In recording the facts under the various headings of Tables I., II., III. and IV., attention has been given to the notes on the Tables. 13 Section II. INFECTIOUS DISEASES. Small-Pox. During the year 1902, 37 cases of small-pox were notified in the Borough of Chelsea, including one case whioh was notified as smallpox, but after a stay of two days at the M.A.B. Isolation Wharf, was returned home as not suffering from Small-pox. In addition, 4 other cases were brought to my knowledge as having almost certainly been cases of the disease, but they were not recognized at the time of the illness, and were consequently not notified. Six cases were notified in the year 1901, between the 21st August and the end of the year, so that the total for the epidemic period, which may be taken as existing between August, 1901, and August, 1902, is 43 notified cases, and 47 cases in all brought to my knowledge. The following Table represents the facts as to the state of vaccination of the 47 patients so far as they could be obtained. Table XIV. Cases. Deaths. Fatality. Vaccinated in infancy 30 3 10% Never vaccinated 7 5 71 „ No information as to vaccination 7 0 0 „ Had small-pox previously 1 0 0 „ Vaccinated (primary, 10 days before onset) 1 0 0 „ Ee-vaccinated (successfully, 3 months before onset) 1 0 0 „ 47 8 17% In the case of the patient who had been successfully revaccinated 3 months before the onset of the illness, the latter was so mild as to be somewhat doubtful in character. The probabilities, however, were strongly in favour of the disease being modified small-pox. The case where primary vaccination was performed successfully 10 days before the onset of the disease, was that of a woman aged 18, never previously vaccinated, who visited the Hospital Ships on the 21st April to see her sister, who was ill there with small-pox. In this case the disease assumed a mild form, the patient being discharged after 29 days detention in hospital. 14 The ages of the patients were as below:— Under 1. 1-5. 5-10. 10-20. 20-30. 30-40. 40-50. 50-60. 60-70. 1 1 1 3 20 13 4 3 1 The ages of the Unvaccinated were 1 month, 3 years, 7 years, 13 years, 27 years, 28 years, and 34 years. All but two of these unvaccinated cases died of the disease. Of the two that recovered, one was the case of a little girl of 3 years, who was thought to be suffering from chicken-pox, and was not removed to hospital. The other case was that of a man of 28, who had a fairly mild attack, and was only detained in hospital 33 days. All but one of the 43 notified cases were removed to hospital. In this one case, the illness was practically over before the nature of the disease was recognised. Of 28 cases that recovered, the period of whose detention in hospital is known, the average duration of hospital isolation was 26½ days, the shortest period being 14 days, and the longest 59 days; of the 8 fatal cases the average duration of the disease was 10 days from the onset, the shortest being 7 days, and the longest 16 days. Of the 42 cases removed to hospital, the removals were effected in one case on the second day of the disease, i.e. second day from appearance of symptons; in 8 cases on the 3rd day; in 9 cases on the 4th day; in 11 cases on the 5th day; in 7 cases on the 6th day; in 3 cases on the 7th day ; and in one case each on the 8th, 10th, and 12th days of the disease. In this last case the patient was too ill to be removed on the day of notification, and had to be kept at home for two days subsequently. Of the 41 cases occurring in 1902, 5 occurred in January, 8 in February, 7 in March, 9 in April, 9 in May, and 3 in June. Three of the cases occurred in a common lodging house in Smithstreet (notifications on the 27th February, 4th and 7th March). Fortunately there was no spread from these cases, either in this common lodging house, or in other similar houses, or in the neighbourhood. In each case the patient was removed to hospital as soon as the eruption appeared on the 3rd day of the disease. In two out of the 47 cases, the patients were servants in large houses in the Borough. In the remainder, the patients were for the most part lodgers in tenement houses scattered about the Borough. Out of (he 47 cases, in 32 there was no definite history of infection ascertainable. In 15 cases there was a more or less definite history of exposure to infection. Seven of these cases were secondary to cases previously occurring in the Borough. In 8 cases the infection was 15 contracted outside the Borough, two of them being due to visits to the hospital ships to see relatives there ill with small-pox. In one of these cases the patient declined revacoination on the occasion of his visit; in the other, as previously stated, although the vaccination (primary) was successful, a mild attack of modified small-pox subsequently supervened. Of the 7 secondary cases, where the infection was contracted from a previous case within the Borough, in one case the patient was at work in a house where a man was ill with small-pox, but this information was withheld from me, so that he was not offered revacoination. In another case, an unvaccinated baby was infected by her father, who was an anti-vaccinator, and would not allow his child to be vaccinated. This child died in hospital, while the father was still detained there. In another case the infection was contracted by the patient standing in the street to watch the removal of a small-pox case, which occurred a few doors away in her street. The other four cases were traceable to two cases in one house (mother and unvaccinated child of 3 years), who were believed to be suffering from chicken-pox, until the occurrence of subsequent cases made the nature of their illness apparent. Excluding the common lodging house in Smith-street, where 3 cases occurred, there were altogether 35 houses where the small-pox patient had been in contact, or presumably might have been in contact, with other people residing in the house or with visitors to the house. It is very difficult to estimate correctly the exact number of these so called "contacts," but so far as could be ascertained, there were altogether 304 contacts in connection with these 35 houses. Out of the 304, 68 were either persons recently re-vaccinated or otherwise presumably protected against the small-pox, or children under 10 years of age who had been vaccinated in infancy. These were not offered re-vaccination by the Public Vaccinator, but the remaining 236 were offered re-vaccination by the Public Vaccinator, within as short a period as possible after the removal of the small-pox case to hospital. Out of this number (236), 134 or 57% availed themselves of the proffered protection, and 102 or 43% declined to do so. Notwithstanding the comparatively large per-centage, having regard to the circumstances, of persons refusing to avail themselves of the proffered protection, it is satisfactory to be able to record that the only secondary case in a house attacked, due to the neglect of this precaution, was that of the unvaccinated infant above alluded to. In all the other houses there was no spread of the disease after the first case had been notified and removed. The failure of the disease to spread in houses invaded, is very largely due to prompt and early notification and removal. In 29 out of the 43 oases, removal was effected before the end of the 5th day from onset, or the 3rd day from appearance of eruption. In 40 cases the removal was effected before the end of the first week of illness. The infectivity of small-pox is not notably great in the early stages of the illness; and if early removal is followed by efficient disinfection of the room and clothing of the patient, and all contacts are offered gratuitous vaccination, the experience of Chelsea seems to show that 16 the disease fails to spread. If, on the other hand, the disease is unrecognised, as in the case of the mother and her unvaccinated child before mentioned, numerous secondary cases are sure to arise, and infection is widely spread. In every case of small-pox every care has been taken to make the disinfection as complete and thorough as possible. In every case the bedding has either been disinfected by steam at the disinfecting station or destroyed by fire, in the latter event new bedding being supplied to replace that destroyed. During the epidemic period new bedding has been supplied in 20 instances at a cost to the Borough Council of £71 7s. 2d. In addition to the 47 cases occurring in the Borough, should be mentioned 28 cases in the St. George's Workhouse and Infirmary, which were notified in the first place to the Medical Officer of Health of the City of Westminster. Thirteen of these cases occurred in January, 10 in February, 2 in March, 2 in Juno, and 1 in July. The Chelsea Workhouse, Infirmary, and Casual Wards have been entirely free from small-pox during the whole period of the epidemic. Vaccination.—In addition to the vaccination and re-vaccination of contacts in small-pox invaded houses, which was carried out by the Public Yaccinators at the request of the Public Health Committee, Dr. Foster Palmer, the Public Yaccinator for the Borough, was requested by the Committee in October, 1901, to examine the arms of children in the Voluntary and Board Schools in the Borough, with a view to the detection of unvaccinated children, and the re-vacoination of children, primarily vaccinated, over 10 years of age. The instructions of the Committee to Dr. Foster Palmer were to offer re-vaccination to all children over 10 years, attending schools in the Borough, whether or not residing within the Borough, and also to offer re-vaccination to all employees in shops, workshops, and factories in the Borough, who had not been vaccinated within 10 years previously, whose homes were outside the Borough. The Committee very rightly considered that if distinctions were made in the Chelsea schools, shops, and workshops, between those who resided in the Borough and those who did not, very considerable numbers would fail to become protected, and the security of the public would be thereby endangered. In the Voluntary Schools in the Borough, Dr. Foster Palmer examined the arms of 3561 children, and in the Board Schools of 3218 children. The comparatively small number of Board School children examined, was, no doubt, the result of the School Board circular issued to the parents allowing them to prohibit the examination of their children's arms in the schools. About 500 persons, not strictly eligible for gratuitous vaccination or re-vaccination, were vaccinated by Dr. Foster Palmer in the course of the epidemic, in accordance with the instructions of the Public Health Committee, the large majority of these being children or shop employees attending schools or shops in the Borough, but residing outside the Borough boundaries. 17 For the further promotion of re-vaccination within the Borough, the Public Health Committee, early in February, issued a leaflet on the desirability of all persons seeking protection against small-pox by re-vaccination, and this leaflet was delivered by hand at every house in the Borough. The following Table shows the vaccinations and re-vacoinations carried out in the Borough, exclusive of the above, at the cost of the Rates, for the years ended 29th September, 1902, and 29th September, 1901. TABLE XV. Primary Vaccinations. Re-Vaccinations. Under 1 year of age. Over 1 year of age. Total. Total 1901 683 64 747 72 1902 799 682 1481 4514 No figures are available to show the number of vaocinations and re-vaccinations carried out by private medical practitioners, and not falling on the Rates. The numbers re-vaccinated amongst the wealthier classes in the Borough were, no doubt, large. In a house in the extreme east of the Borough, where one of the men-servants was attacked with small-pox, all the other inmates of the house, 11 in number, had been recently re-vaccinated. This man-servant was the only person in the house not re-vaccinated. His attack was a severe one and he died in hospital. By the kindness of a lady in Chelsea, who placed a sum of money at my disposal for the purpose of promoting vaccination in the Borough, it was possible to get a large number of the inmates of the common lodging houses in Chelsea re-vaccinated. This work was commenced on the 7th March, shortly after the occurrence of the 3 cases in the common lodging house in Smith-street, this being the first house taken in hand. The work was continued almost nightly for a fortnight, when it was found that 211 male inmates and 22 female inmates in Chelsea common lodging houses had been re-vaccinated. The cost per head worked out very close upon 2s. 6d., this including the initial monetary inducement, and compensation for disablement in a certain small proportion of oases (15 per cent.) The comparatively small sum spent in this way had, I think, a most beneficial effect. The spread of small-pox in the common lodging houses was arrested at a time when further cases might have been anticipated, and a class of people specially 18 liable to contract and carry infection, and very difficult of persuasion by ordinary methods, were thus, by private benevolence, induced to become proteoted at a comparatively very small cost, with great advantage to the interests of the Borough, and without cost to the ratepayers. Quarantine.—At the commencement of the epidemic, contacts in some of the small-pox invaded houses were requested not to continue their employments, and compensation for wages lost for a period of 14 days was awarded. It was soon made apparent that if this system was universally adopted, a very considerable outlay would be incurred without any definite advantage accruing, as it was quite impossible to keep the quarantined persons at home and prevent them from going into public places, although debarred from following their occupations. The system subsequently adopted, except in special cases, was that of permitting all contacts to continue their occupation, but making inquiry, as before, at intervals at the house as to the health of the occupants, until the expiration of the quarantine period of 14 days. Contacts residing in other Boroughs were always duly notified to the Medical Officer of Health of the Borough concerned. The total amount expended in quarantine was £29. Small-pox in London.—In London during the year 1902, 7797 cases of small-pox were notified, viz.:—4470 in the first quarter, 2929 in the second quarter, 356 in the third quarter, and 42 in the fourth. The epidemic reached its culminating point in the second week in March, in which week 465 cases were notified. A steady decline then set in, broken only by a rise in the fourth week of May. In the second week of July the notified cases had fallen below 50 a week, and the epidemic period may be considered to have come to an end by the latter end of August, the average of the last 3 months of the year being only 3 cases weekly. The cases notified in London in the third and fourth quarters of 1901 were 270 and 1416 respectively. The following Table exhibits the case-rates per 10,000 of the population for the 5 quarters ending Michaelmas, 1902, practically the period of epidemic prevalence in London. TABLE XYI.—Notified Cases of Small-pox. Case-rate per 10,000. Chelsea 5.8 Kensington 6.4 Fulham 7.4 Paddington 9.2 Hammersmith 12.3 Westminster 18.5 Western Boroughs 10.5 Southern „ 15.6 Northern „ 16.5 Central ,, 42.6 Eastern ,, 45.3 London County 20.6 19 The Boroughs that suffered most in the epidemic were Holborn with a case-rate of 74 4 per 10,000 of population, and Stepney with a case-rate of 51.5. Finsbury and the other Eastern Boroughs of Shoreditch, Bethnal Green and Poplar were also seriously involved. The Boroughs least affected were Hampstead (3.1), Chelsea (5.8), Kensington (6.4), Wandsworth (6.7), Fulham (7.4), and Lewisham (7.6). The arrangements made by the Metropolitan Asylums Board for dealing with the cases, so far as Chelsea is concerned, appear to have been in every respect satisfactory. During the past year the Board, in addition to the usual information previously supplied in regard to the patients received at the hospitals, supplied also a daily list of deaths and discharges, and notified to the Medical Officers concerned the names and addresses of persons visiting the hospitals to see relatives, and whether such visitors had been re-vaccinated at the hospital or not. All this information has proved most serviceable. Scarlet Fever.—This disease was slightly more prevalent in Chelsea in 1902 than in 1901, the case-rate per 10,000 of the population being 27.6 in 1902, as compared with 25.6 in 1901. The autumnal rise in prevalence of the disease in Chelsea was scarcely marked; and the closure of the schools in August did not appear to exert any influence on the disease as then prevailing. The per centage of cases of school age (3 to 13 years) in Chelsea was 64 per cent. The number of cases notified in North Chelsea was 95, and in South Chelsea 109. The number of cases notified in the first quarter of the year was 40; in the second quarter 52; in the third quarter 60; and in the fourth quarter 52. Three cases admitted to the M.A.B. hospitals were subsequently certified by the Medical Superintendents of those institutions not to be suffering from Scarlet Fever, or any other notifiable disease. Diphtheria.—The case-rate of this disease in Chelsea for 1902 was 17.7 per 10,000 of population, which is rather higher than the case-rate for 1901 (14.3 per 10,000). In the first quarter of the year 18 cases were notified; in the second quarter 29; in the third quarter 37; and in the fourth quarter 47. The percentage of cases of school age (3 to 13 years) was 66 per cent. Out of the 131 cases notified in the year, 62 were notified in the last four months. There were no outbreaks in the course of the year specially attributable to school infection. In North Chelsea 79 cases were notified, in South Chelsea 52. Eight cases admitted to the M.A.B. hospitals were subsequently certified by the MediGal Superintendents of these institutions not to be suffering from Diphtheria or any other notifiable disease. Enteric Fever.—The number of cases of Enteric Fever notified in Chelsea in 1902 was 36, the case-rate again being a low one, namely, 4.9 per 10,000 of the population, as against 5.3 in 1901, and 5.0 in 1900. Ten cases were notified in the 3rd quarter, and 12 in the fourth quarter of the year. In North Chelsea 21 cases were notified, in South Chelsea 15. 20 Of the 36 cases, 2 were subsequently certified by the Medical Superintendents of the Fever Hospitals to which they were removed, not to be suffering from Enteric Fever. In 12 cases (33.3 per cent.) the infection of the disease was in all probability acquired outside the Borough—in most of them outside London. In two cases the infection would appear to have been taken in Paris; in two other cases whilst away hop-picking; and in a third case the infection was probably contracted from eating cockles and oysters at Southend-on-Sea. Prevalence of Scarlet Fever, Diphtheria, and Enteric Fever, in West London. The following Table is based upon the notified cases of scarlet fever, diphtheria and membranous croup, and enteric fever, respectively, in each of the six boroughs constituting West London, the rates being calculated upon the estimated population of each district. TABLE XVII.—Notifications per 10,000 of Population in 1902. Scarlet Fever. Diphtheria. Enteric Fever. Chelsea 27.6 17.7 4.9 Kensington 21.0 10.4 4.5 Paddington 25.1 15.4 5.7 Hammersmith 30.8 15.9 4.5 Fulham 38.7 30.0 5.2 Westminster 26.2 15.9 7.3 West London 27.8 17.1 5.5 London 39.9 23.5 7.4 The Chelsea case-rates do not compare so favourably with the other boroughs as in 1901, when Chelsea was remarkably free from infectious diseases. The Borough of Fulham again has a comparatively high case-rate from diphtheria--3 times that recorded for Kensington— and its scarlet fever case-rate for 1902 also heads the list. The West London Boroughs again show a lesser prevalence of notifiable infectious disease than London as a whole. Case Mortality.—The Table shows the case mortality, or per centage of deaths to notifications of scarlet fever, diphtheria (including membranous croup), and enteric fever in Chelsea and in London, in each of the 13 years, 1890-1902. 21 TABLE XVIII.—Case Mortality in Chelsea, and in London, 1890-1902. Scarlet Fever. Diphthoria and Membranous Croup. Enteric Fever. Chelsea. London. Chelsea. London. Chelsea. London. 1890 7.0 5.7 17.6 24.1 17.4 23.0 1891 3.6 5.1 15.4 22.5 17.4 15.6 1892 5.3 4.3 22.9 23.9 13.6 17.2 1893 5.3 4.3 23.4 24.5 22.1 18.4 1894 5.1 5.2 21.7 23.6 14.7 18.1 1895 4.0 4.2 18.7 20.4 18.4 17.0 1896 4.9 3.7 22.9 19.3 14.7 17.7 1897 3.5 3.4 17.9 17.1 26.4 18.8 1898 4.2 3.4 15.1 14.8 25.0 19.3 1899 2.8 2.2 10.6 14.2 28.1 18.0 1900 3.0 2.6 9.9 12.8 24.4 17.5 1901 2.6 3.2 8.5 11.1 12.8 16.8 1902 4.0 3.1 10.0 11.0 16.6 16.3 The fatality rates of all these three diseases were slightly higher than they were in 1901. Removals to Hospitals.—Table XIX. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever, from their homes to hospitals, in each of the 13 years, 1890.1902, expressed as percentages of the total number of cases notified. TABLE XIX.—Percentage Removals to Hospitals. Scarlet Fever. Diphtheria. Enteric Fever. 1890 38 20 29 1891 40 15 22 1892 48 27 32 1893 50 41 38 1894 71 58 63 1895 55 62 51 1896 61 56 56 1897 76 67 54 1898 74 74 54 1899 77 76 69 1900 81 80 71 1901 78 63 72 1902 90 83 67 In 1902 the percentage of removals both of scarlet fever and of diphtheria cases was higher than in any previous year. There was no delay in effecting the removal of any Chelsea cases to the M.A.B. hospitals. 22 Disinfecting Station.—During the past year a new disinfecting station and shelter has been built and equipped for the Borough on the Council's new wharf in Lots-road by the Underground Electric Railways Company of London, Limited, at a cost of about £3500, the Company taking over the site of the old station, with the former wharf. The station is built on designs by myself and Mr. Grant, Chief Sanitary Inspector, and consists of the usual clean and infected "sides" and van sheds, together with an incinerator furnace for destroying infected bedding. There is a men's mess room, w.c. and bath room on the ground floor, whilst an upper storey over the van sheds, mess room, and incinerator, contains 2 bedrooms and a kitchen living room, to be used for the purposes of a shelter for people who are displaced from their homes owing to their rooms being fumigated. Appurtenant to the shelter rooms are a bath room, w.c. and sink room for the use of the occupants; whilst an additional bath room is provided for the use of persons who wish to avail themselves of the Cleansing of Persons Act, and have their verminous wearing apparel disinfected, whilst they cleanse their persons in a hot bath. The buildings have been well and strongly constructed, the walls of the disinfecting rooms, w.c.'s, and bath rooms being lined with opalite, whilst the floors are cemented. The Company has also provided white enamelled steel tube raoks for the station. The shelter has been furnished by the Council at a cost of about £100. 23 Section III. HOUSING OF THE WORKING CLASSES. Onslow Dwellings. In November, 1901, the Borough Council acquired the freehold of Onslow Dwellings, from Mr. Sloane Stanley, for the sum of £13,350, subject to a lease which expires at Christmas, 1909. A loan of £13,500 was obtained from the London County Council at 3½ per cent., repayable by equal annual instalments of £270 in 50 years. The facts relating to the property are set out in my Annual Report for 1901 (page 16). On the 22nd October, 1902, the Borough Council decided to purchase from the Freake Trustees the leasehold interest in Onslow Dwellings for the sum of £5,000. The London County Council has agreed to advance the sum of £5,000 on loan at 3£ per cent. for a period of 60 years. The following statement shows the financial position as regards Onslow Dwellings:— Onslow Dwellings, Pond-place. Loan of £13,500 for 50 years, at 3£%— Annual instalments for 10 years. £2,700 Interest for 10 years 4,725 £7,425 Loan of £5,000 for 60 years, at 3½%— Annual instalments for 10 years 833 Interest for 10 years 1,750 2,583 £10,008 Estimated net rentals for 10 years 8,820 £1,188 In 10 years a deficit of £1,118 will accrue, or £119 per annum, which must be defrayed from the rates. In the 10th year the net rental from the Dwellings will be sufficient to meet the instalments and interest on the loans, and the Dwellings will become remunerative. Beaufort Street Site. On the 16th July, 1902, the Borough Council agreed to purchase from Earl Cadogan, E.G., his freehold interest in l.6 acres of land on the east side of Beaufort-street, for the sum of £12,500, the market 24 value of the land for residential purposes being estimated by his Lordship's surveyor at £20,000. This site is 395 feet in length, with an average depth of 177.5 feet, and is situate between the Convent of Adoration Réparatrice and the vacant land on Cheyne-walk, formerly belonging to the London County Council, and now being built upon. The site being of an excellent oblong shape, and practically unhampered by restrictions as to ancient lights, is admirably adapted for a housing site. The land was cleared of old buildings at the date of completion of sale in the autumn. A loan has been obtained from the London County Council of the sum of ±'12,700 at per cent., repayable by equal annual instalments on each 28th August within the last 57 years of a term of 60 years from the 28th August, 1902; the first instalment being payable on the 28th August, 1906. On the 16th July the Borough Council authorised the Public Health Committee to prepare a scheme for the erection of blocks of industrial dwellings on the Beaufort-street site, and to invite architects to submit designs and plans with estimates of cost. On the 17th December, the Public Health Committee reported to the Borough Council on the plans submitted by architects under the terms of a limited completion, and recommended:— (1.) That the selection by the Public Health Committee of Scheme No. 2 submitted in competition by Messrs. Joseph, Son, and Smithem be approved and confirmed, subject to such alteration or amendment in detail as the Committee may hereafter approve. (2.) That Messrs. Joseph, Son, and Smithem be appointed the Architects to carry out the scheme on the Beaufort-street site, subject to the works proceeding, and the necessary sanction to the loan being obtained. (3.) That the Committee be authorised to appoint a Quantity Surveyor, and to arrange all details in connection with the plans and specifications with the Architects, to invite tenders in such manner as the Committee may consider desirable, either for the Avhole or any part of the works, from builders and contractors, for the erection and completion of the necessary works, buildings, and appurtenances, in accordance with the designs, plans, and specifications of the Architects. These recommendatione were approved by the Borough Council. The design submitted comprises 5 ranges of parallel buildings 6 storeys in height, including half-basement, placed at right angles with Beaufort-street, each range having forecourt with planted slopes in front, the building line being set back as required. The 5 parallel ranges of buildings, which are about 54 feet in height, are separated by courtyards, or private approach roads, each 40 feet in width. The accommodation provided consists of 261 tenements, namely:— 35 one-room tenements (14 per cent.), 130 two-room tenements (50 per cent.), and 96 three-room tenements (36 per cent.). The superficial area (excluding w.c.'s, sculleries, and balconies) of the one-room tenements is 175 square feet, of the two-room tenements 311 square 25 feet, and of the three-room tenements 468 square feet. All the rooms are 8 ft. 6 ins. in height. All the tenements are self-contained—that is to say, each has its own w.o., combined scullery and laundry, and balcony. In each scullery a washing trough and independent copper are provided, also a coal bunk and small gas cooking range. Each living room which is entered from a lobby, is provided with cupboards for the storage of food and household utensils, also with dresser and self-setting close kitchen range. The bedrooms are provide 1 with dress cupboards and fire-places with register stoves. Eight bath-rooms are provided in the basement of one of the blocks in connection with a boiler and stoke-hole. Adjacent to the baths is a special drying-room for drying clothes, kept hot by coils of hot-water pipes connected with the boiler. There is also in this block a hot-water room, where tenants can obtain boiling water from a range of kettles—the method adopted at all the Guinness Buildings. The design of the buildings will be simple, effect being chiefly obtained by the variety and treatment of windows and in the broken sky lines. All the elevations will be faced with red facings relieved by artificial stone dressings. The floors are fire-proof throughout, constructed of steel and concrete with floor boards laid direct thereon. The half-basement floors will be laid with solid wood block flooring on concrete. All partitions will be constructed of fire-proof material, 2 ins. thick. All stairs and landings will be composed of granolithic material; and the balconies, sculleries, hearths, playgrounds, and areas will be finished with the same material. The walls of all the rooms will be covered with plaster, finished with alabastine, and a dado will be formed of white glazed tiling on all walls of staircases, landings, and w.c.'s. Each tenant will be provided with a sanitary dust-pail, to be kept upon the outside balcony. All the sanitary fittings, pipes, and drainage will be of the strongest and best materials. The 261 tenements provide 583 rooms, which at 1.6 persons per room (the average for buildings of this class) will secure accommodation for 933 persons, or 583 to the acre. The Architects estimate the total inclusive cost of the buildings, private approach roads, courtyards, and boundaries will amount to £49,532, which works out at about £85 per room. In giving this estimate the Architects say that the cost of the buildings has been calculated at the same price per foot cube as the cost of the latest housing scheme carried out by them. The total capital outlay for this scheme would be:— Land (1.6 acres) £12,700 Buildings 49,532 Architects' commission 2,476 Clerk of Works' salary 292 £65,000 26 To produce a net rental that will meet the instalments and interest on the loans, it will be necessary to fix the rents of the various tenements as under: g. v. R. V. s. d. £ s. d. £ £ 35 1-room tenements at 3 6 6 2 6 210 175 130 2 „ 6 0 39 0 0 1,492 1,221 96 3 „ „ 8 6 40 16 0 1,483 1,186 Average rent per room 2 11½ 85 18 6 3,185 2,582 52 Gross Annual Rental £4,468 0 0 l. c. c. J. s. & s. Rents Receivable 4,468 4,468 Outgoings. l. c. c. J. s. & s. Empties and losses £134 £35 Two tenements 38 — Rates 724 724 Taxes 165 165 Water 103 103 Gas 91 91 Repairs and renewals 447 268 Supervision (local) 188 10 300 „ (head office) 86 10 Contingencies 111 30 £2,088 £1,716 £2,088 £1,716 (47%) (38%) £2,380 £2,752 The L.C.C. Housing Department estimate empties and losses at 3 per cent. of gross rentals, and repairs and renewals at 10 per cent. Messrs. Joseph, Son, and Smithem estimate empties and losses at under 1 per cent., and repairs and renewals at 6 per cent. The net rental taken as £2,380 will pay 3.7 per cent. on the total capital outlay of £65,000; taken as £2,752, will pay 4.2 per cent. on £65,000. Loan of £12,700 for land for 60 years, at 3£%— £ s. d. £ s. d. Interest 444 10 0 Instalment 222 16 2 667 6 2 Loan of £52,300 for building for 60 years, at 3£%— Interest and instalment in one sum on the annuity system 2,097 9 0 £2,764 15 2 27 If the loan of £52,300 for building be taken on (he instalment system, and the terms on which the loan is granted are the same as those securing the loan for £12,700 for the land, it will take 21 years from 1906—in which year the first instalment is due—before the Dwellings begin to be remunerative. In the year 1927 it is estimated that a net rental of £2,566 (mean of L.C.C. and J. S. & S. estimates) will meet approximately the annual instalments and interest on the loans. Subsequently to the year, 1927, the Dwellings will become moro and more remunerative year by year as the capital sum is paid off and the interest reduced. In 24 years—including 3 years as the period of payment of interest before the first instalment is due—a total sum of £70,161 will have been paid in instalments and interest, and the net rentals for 21 years will have produced a sum of £53,886, leaving a balance of £16,275, or £678 per annum to be defrayed from the rates, equivalent to a rate of 021 or one-fifth of a Id. in the £ on the rateable value of the Borough for the 24 years 1903-1927. HOUSES DEMOLISHED OR VACATED FOR DEMOLITION DURING THE YEAR 1902. houses. Brompton-road 3 Basil-street 5 Hooper's-court 6 Keppel-street 3 Lower Sloane-street 1 Marlborough-road 4 Pimlica-road 2 Sloane-square 11 Sloane-terrace 6 Beaufort-street 45 Church-street 2 houses. Upper Manor-street 12 Manor-gardens 32 Manor-buildings 31 King's-road 40 Park-walk 3 Manor-street 11 Lot's-road 6 223 Taking the average number of persons per house as 8,1,784 persons have been displaced during the year 1902 owing to demolitions. 28 Section IV. REPORTS PRESENTED TO THE BOROUGH COUNCIL. On the 18th June tho Public Health Committee submitted to the Borough Council a Report made by me on " The Saving of Life at Fires," in which I drew attention to the inadequacy of the arrangements of the Metropolitan Fire Brigade in the Borough for saving life from the upper storeys of mansions, flats, and business premises. It was resolved that the Report be approved, and a copy forwarded to the London County Council. On the 16th July the Public Health Committee submitted to the Borough Council Reports prepared by me on "The Housing of the Working Classes in Chelsea" and "The Results of the Census of London in 1901." The former Report gave the results of a special inquiry and investigation into the existing housing accommodation for the working classes in Chelsea, together with statistical tables. Tho latter Report supplemented the information contained in the "Housing" Report, with data obtained from the Census of 1901. 29 Section V. THE SANITARY CONDITION OF THE BOROUGH. The tabular statements prepared by the Sanitary Inspectors show that 1,546 separate premises were reported on by them during 1902, 677 of this number being with reference to cases of infectious disease (notifiable). In addition, 552 separate houses have been inspected in the course of house to house inspections made in certain of the poorer sheets in the Borough, and 42 restaurant kitchens have been inspected. It has been necessary to take legal proceedings in 21 cases (see. appended statement) to enforce the due carrying out of the Council's notices under the Public Health (London) Act. Drainage.—During the year 168 new drains for single houses have been reconstructed in accordance with the Council's drainage regulations. Combined Drainage.—Eighteen systems of combined drainage, for which the owners of the houses were responsible, were sanctioned by the Council in the course of 1902. In addition, 3 systems of combined drainage, which were sewers for which the Borough Council was responsible, were executed at the cost of the latter body, as follows:— 1902. £ s. d. January Nos. 31 and 33, College-place 20 0 0 May Nos. 5, 6 and 7, Wood-street 23 18 0 August Nos. 83, 85 and 87, Walton-street. 27 18 0 £71 16 0 The total amount previously expanded on similar works (1896-1901) was £368 9s. 2d. Inspection of Restaurant Kitchens. Number of restaurant kitchens inspected 42 „ inspections made 93 Number of Notices served for defective drains, soil-pipes, w.o.'s, and sinks 14 Number of Notices served for cleansing and whitewashing 14 Number of Notices served for dustbins 4 „ „ „ accumulation of refuse 2 30 UNDERGROUND BAKEHOUSES. The Public Health Committee have had under consideration the question of providing certificates of suitability for underground bakehouses, as required for all underground bakehouses after the 1st January, 1904, in accordance with Seotion 101 of the Factory and Workshop Act, 1901. Sub-section 4 of Section 101 enacts that "An underground bakehouse shall not be certified as suitable unless the District (or Borough) Council is satisfied that it is suitable as regards construction, light, ventilation, and in all other respects." The Public Health Committee has adopted the following as the requirement in every underground bakehouse, which must be fulfilled, before the Committee can recommend the Borough Council to grant a certificate in accordance with Section 101, Sub-section 4, of the Factory and Workshop Act, 1901. Every underground bakehouse must:— (1.) Have sufficient daylight illumination. (2.) Have adequate means for ventilation and exclusion of street dust. (3.) Have smooth, even, and impermeable walls and floor, and dust-tight ceiling. (4.) Have sufficient air space for the workers, and a height of not less than 8 feet throughout. (5.) Be provided with movable troughs and fittings on castors or wheels. (6.) Have proper places for the storage of flour, coal, and refuse material. (7.) Have no drain-inlet within the bakehouse that does not discharge into an intercepting gulley. (8.) If traversed by a drain, have such drain watertight, and properly constructed and ventilated. (9.) Have proper w.c. accommodation for the men employed therein. There are 40 underground bakehouses in the Borough, all but one being in actual or occasional use. Many of these underground bakehouses are cellars in very old houses, with low ceilings, insufficiently lighted by daylight, and badly ventilated, the ventilation openings in some cases being on the street level, and admitting much dust from the street. It is difficult to see how this class of bakehouse can be rendered suitable in accordance with the requirements of the Act, without very extensive structural alterations, involving considerable outlay. In some cases also the leases are short, so that there would be little prospect of recoupment for expenditure incurred. There is nothing in the Act which enables the Borough Council to make the certificates of suitability terminable, or to give them for a limited period only. Under these circumstances it appears that the Borough Council should only give certificates where the requirements of suitability have been adequately met, otherwise the Act will only perpetuate evils which are now recognised as detrimental to the health interests of the employees and the public. It seems inevitable that many bakery businesses will suffer loss as the result of the operation of the Act, but no scheme of compensation has been included in it. 31 ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT (1901) FOR THE YEAR 1902. Quarters. 1st. 2nd. 3rd. 4th. Year. Number of Workshops registered 295 30 38 52 415 Number of Inspections made 271 133 32 255 691 Notices under P.H.L. Act served 60 26 9 45 140 (a.) Overcrowding 2 — — — 2 (b.) Cleansing 30 15 2 19 66 (c.) Ventilation 1 — — 1 2 (d.) Water-closets and drains 20 17 4 15 56 (c.) Separate w.c.'s for the sexes 8 1 1 — 10 (f.) Drainage of floors — 2 — 3 5 (g.) Other nuisances 11 9 2 15 37 Number of complaints received from H.M. Inspectors — — — — — Number of new Workshops notified by H.M. Inspectors — 3 2 2 7 Outworkers. Returns from firms in Chelsea employing Outworkers — — — — 25 (a.) Number of Outworkers living in Chelsea employed by local and outside firms — — — — 87 (b.) Number of Outworkers living in other Boroughs employed by Chelsea firms — — — — 197 (c.) Outworkers in Chelsea notified by other Boroughs 29 — 6 — 35 Number of Outworkers homes inspected 39 50 7 — 96 Number of notices served for cleansing 8 6 1 — 15 Number of notices given to stop work on account of infectious disease in homes — — — 1 1 Number of Outworkers premises notified to other Boroughs 187 — — — 187 Water Supply.—During the year a daily examination of the water drawn from the Chelsea Waterwork's main has been made at the Town Hall, as regards its temperature and appearance in a 2-ft. tube. The highest temperature attained during the year was only 69°F on the 10th, 16th and 17th July. In 1901 the temperature of the water was 70° or over on 6 days in July, in 1900 for 16 days in July and August, and in 1899 for 31 days in these same months. This comparatively low temperature of the water supplied in the mains in 1902 coincides, as in 1901, with an unusually slight prevalence of summer diarrhœal disease. The lowest temperature reached was 37° on several days about the middle of February. At the end of December, 1902, the water temperature was 460—unusually high for the period of the year. The water was of good colour and practically free from any turbidity throughout the entire year. 32 Disinfection.—During the year 483 premises have been disinfected after cases of injectious disease, 53 of these being rooms which had been in occupation by persons suffering from phthisis, the disease ending fatally. WORK OF THE PUBLIC HEALTH DEPARTMENT. Appended are tabular statements which give information as to tho detailed work of the department during the year 1902. I am, Mr. Mayor and Gentleman, Your obedient Servant, LOUIS C. PARKES. Medical Officer of Health. 33 Section VI. PUBLIC HEALTH DEPARTMENT. Summary of Nuisances and other matters reported on and Work done during the Year 1902. Borough. Houses and Premises:— *Reported on respecting nuisances complained of 869 Reported on with reference to infectious cases 677 Cleansed, whitewashed, and repaired 281 Defective roofs repaired 93 Disinfected after zymotic diseases 483 Cases of overcrowding abated 26 Dust-bins, new, provided 134 „ repaired 3 Underground rooms reported as occupied contrary to Act 10 Houses closed as unfit for human habitation 31 Inspections of restaurant kitchens 93 Drainage:— Drains opened, cleansed, and made sound 595 ,, trapped with stoneware gullies 595 Water-closets cleansed and repaired 63 „ new pans and traps provided 319 Spout drains cleansed, repaired, or renewed 138 Sink, bath, and lavatory waste pipes provided and repaired 231 Drains and soil pipes ventilated or repaired 13 Soil pipes, new, provided 109 New drains laid, in accordance with Council's regulations (including 18 systems of combined drainage) 186 Additional w.c. accommodation provided 23 Water Supply:— For domestic purposes, provided where cut off by Water Company 15 For water-closets, or check cisterns provided and repaired 138 Main cisterns cleansed or repaired 30 „ new, provided 2 Nuisances abated arising from:— Keeping of animals 15 Accumulations of manure and other filth 71 Yards, areas, and wash-houses paved, or drained 260 Smoke 8 Dung-pits repaired, drained, &c., or cages, &c., provided . 7 Frying fish 4 •This does not include re-visits to premises to ascertain works in progress, or premises visited where no nuisances were found to exist, which, if added, would at least be treble the number of visits made. 34 Borough. Miscellaneous:— Dead bodies removed to public mortuary for sanitary reasons 6 Goods disinfected after infectious cases at stations 3247 Goods destroyed after infectious cases 360* Number of samples taken for analysis (Food and Drugs Act) 179 Unsound Food. Number of boxes of fruit, &c., condemned and destroyed 10† Library books destroyed at Librarian's request 50 Proceedings Taken:— Statutory notices issued 335 Intimations issued for sanitary works, &c., including infectious disease cases 964 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 21 Legal proceedings in respect of food adulteration 11 Correspondence:— Number of letters written in connection with sanitary matters, including those of Medical Officer of Health 1095 Daily returns of infectious cases sent to Metropolitan Asylums Board 202 Notification of infectious cases sent to School Authorities 522 Entries in Inspectors' Report Books 833 ,, Inhabitants' Complaint Book 36 Certificates of Disinfection given 348 Certificates of infectious diseases for removal cases 289 Notices sent to the Public Library 170 The cow-houses and slaughter-houses were inspected by the Medical Officer of Health prior to licenses being renewed in October last, and a list of the retail bakehouses under inspection in Chelsea forms a separate Appendix. There are 113 Dairies and Milkshops in the Borough. These have been registered and periodically inspected by the Sanitary Inspectors. Sanitary Inspectors. ALEXANDER GRANT (Chief). G. R. METZLER. J. W. KING. W. THORPE. *An additional van load of clothing, bedding, &o., was destroyed by the executors of the deceased. The articles being of too miscellaneous a character to allow of a correct inventory being taken. †This does not include unsound food condemned in the streets and destroyed, for which no condemn note was given. 35 MAGISTERIAL PROCEEDINGS DURING 1902, UNDER THE SALE OF FOOD AND DRUGS ACT. Streets where Purchased. Article Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Smith Street Milk 8% of added water Feb. 18th Fine £5 and 10s. 6d. costs. World's End Ditto Ditto Feb. 25th. Fine £3 and 10s. 6d. costs. Cremorne Road Ditto 7% of added water Feb. 25th Fine 10s. and 10s. 6d. costs. Ditto Ditto 10% of added water March 4th Adjourned for 1 month. Ditto Ditto Ditto April 1st Fine £5 and 10s. 6d. costs. Godfrey Street Coffee 40% of chicory March 18th Adjourned for 1 month. Ditto Ditto Ditto April 15 th Fine £5 and 10s. 6d. costs. Blenheim Street Ditto 47% of chicory March 18th Adjourned for 1 month. Ditto Ditto Ditto April 15th Fine £3 and 10s. 6d. costs. King's Road Ditto 16% of chicory March 18th Adjourned for 1 month. Ditto Ditto Ditto April 15th Fine £5 and 10s. 6d. costs. Christchurch Terrace Milk 16% of fat abstracted June 10th Fine £2 and 10s. 6d. costs. Oakley Crescent Butter 78% of foreign fat July 8th Fine £2 and 10s. 6d. costs. King's Road Tincture of Iodine 44% deficient in free Iodine and 45% deficient in Potassium Iodine July 8th Fine £5 and 10s. 6d. costs. Fulham Road Hydrocyanic Acid 47% below the B. P. standard July 8th Fine £5 and 10s. 6d. costs. Total, £40 10s. Fines, and £5 15s. 6d Costs. 36 37 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1901. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 10, Burnaby Street Defective drains, w.c., and rain water pipe Feb. 18th Closing order made. 16, Manor Gardens Want of a proper supply of water to the w.c. Feb. 18th Closing order made. 95, Arthur Street Want of water to premises Feb. 25th Work done; summons withdrawn. 96, Leader Street Want of a dustbin Mar. 11th Work done; summons withdrawn. 64, ditto Defective roof, want of a proper supply of water to the w.c., want of a dustbin Mar. 11th Work done; summons withdrawn. 37, Danvers Street Defective drains Mar. 18th Adjourned for one month. Ditto Ditto April 15th Dismissed. 71, Queen's Road Failing to comply with a prohibition order to abate smoke nuisance April 22nd Fine, £2. 146, King's Road Defective drains, soil pipe, sink waste pipe, and want of a dustbin May 6th Abatement and prohibition order 53, Leader Street Defective roofs ; defective drain inlet May 13 th Work done; summons withdrawn. 12, Cumberland place (occupier) Overcrowded state of top floor front room May 27th Premises vacated; summons withdrawn Ditto (owner) Ditto May 27th Ditto. 362, King's Road Defective drains, water closet, sink waste pipe, rain water pipe, and want of a dust bin June 10 th Fine £5, abatement and prohibition order made. Dartrey Terrace Removing offensive matter during prohibited hours William Bass (owner) June 17th Fine £2. 11, Cadogan Street Defective drains and soil pipe July 8th Abatement and prohibition order made for 14 days. The roadway, Grove Cottages An accumulation of stagnant liquid filth on roadway July 8th Work done ; summons withdrawn. 18, Radnor Street Failing to provide a proper and sufficient supply of water to the premises Oct. 21st Closing order made. Granby House, Vicat Street Defective sink waste pipe and an accumulation Oct. 28th Work done ; summons withdrawn. 10, Little College Street Want of a dustbin Nov. 11th Adjourned for 1 week. Work done; summons withdrawn. Nov. 18th 14, ditto Defective roof, check cistern, dampness, dilapidated condition of passage Nov. 11th Ditto. Nov. 18th 20, ditto Want of a dustbin, defective roof Nov. 11th Ditto. Nov. 18th 1, Tite Street Defective drains, soil pipe, and W.C.'s Dec. 16th . Abatement order for 14 days. Total, £9 Fines. 38 BAKEHOUSES IN USE ON JANUARY 1st, 1901. Street. Occupier. Above Ground. Below Ground. 74, Arthur-street Solomon Keppler Below. 93, Beaufort-street A. Coventry ,, 26, Blantyre-street Hetzler ,, 55, Burnaby-etreet Loe ,, 1, Cadogan-street Spells ,, 2, Cale-street H. Judkins Above. ,, 77, Cheyne-walk D. Mayo Below. 20, Church-street E. Bauer ,, 60, College-street Samuel Mills Vines ,, 17, Coulson-street Gerres ,, 3, Dartrey-terrace H. Kimpel ,, 67, Flood-street J. Venner ,, 95, „ C. Gass ,, 153, Fulham-road C. M. Nash ,, 187, E. Pinnock ,, 323, N. Martin ,, 15, Green-street Bott ,, 53, Godfrey-street H. Becker ,, 102, Keppel-street S. Stevens ,, 47, King's-road Pennycuick ,, 83, „ J. Humphry Above. ,,, 88, „ G. Nash Below. 134, Buckea ,, 39 Street. Occupier. Above Ground. Below Ground. 302, King's-road Win. Musgrove ...... Below. 351, ,, H. J. Mardon ...... ,, 399, ,, H. Kohler ...... ,, 414, ,, J. Brewer ...... ,, 488, ,, Matthaie ...... ,, 502, ,, W. Schafer ...... ,, 517, ,, S. McKay ...... ,, 1, Leader-street H. Southey Above. ,, 48, Lots-road M. & O. West ...... Below. 83, Lower Sloane-street Miles Above. ,, 43, Manor-street L. Lorenz ...... Below. 62, Marlborough-road Kremers ...... ,, 100, ,, Reitze ...... ,, 110, ,, Wordley Above. ,, 7, Pavilion-road Mason Above. ,, 23, Queen's-road G. Hilton ...... Below. 3, Pont-street Hue & Co ...... ,, 58, Rawlings-street Hannah ...... Not in use. 14, Riley-street W. E. Knee ...... Below. 150, Sloane-street Pennycuick ...... ,, 6, Symons-street Spiking & Co ...... ,, 43, Stayton-street H. Grassman Above. ,, 25, Walton-street Burrows ...... Below. 84, Westbourne-street Tilbury ...... ,, 40 SLAUGHTER-HOUSES. Street. Occupier. Crooked Usage Cridlan, P. and J. W. 169, Fulham Road Philp, J. 341, „ Vaughan, T. 52, King's Road Cobb, G. A. 54, „ ,, 413, ,, Chacksfield, E. C. 82, Marlborough Road Iggulden, F. 90, „ ,, COW-HOUSES. 54, Arthur Street Jennings, J. Church Street Emerton, J. 406, King's-road Jorden, G. 3a, Leverett Street Robinson, F.