CHE 11 Metropolitan Borough of Chelsea. ANNUAL REPORT . • For 1904, OF THE medical Officer of health, LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ.; M.R.C.S. Eng. consulting sanitary adviser to H.M. office of works and to the metropolitan police district; fellow of the sanitary institute; fellow of the society of medical officers of health member of council of the epidemiological society; lecturer on hygiene and public health at st. george's hospital medical school; examiner in hygiene and public health, university of birmingham. TOWN HALL, KING'S ROAD, CHELSEA. 1905. TABLE OF CONTENTS. SEC. I.—Statistical:— page. Population of Chelsea 3 Births and Birth-rate 3 Deaths and Death-rate 3 Statistical Tables (L.G.B. Forms, I., II., III., IV.) 8—11 SEC. II.:— Infectious Diseases — Small-pox 12 Scarlet Fever 12 Diphtheria 12 Enteric Fever 13 The Case Mortality 13 Prevalence of Scarlet Fever, Diphtheria, and Enteric Fever in West London Boroughs 14 Bemoval of Patients to Hospitals 14 Voluntary Notification of Phthisis 15 SEC. III.:— The Housing of the Working Classes— Sir Thomas More Buildings 16 Onslow Dwellings 18 Nos. 21—31, Pond-place 18 The Cadogan and Hans-place Estate, No. 3 19 Demolitions in 1904 19 SEC. IV.:— The Sanitary Condition op the Borough— Drainage 20 Disinfection 21 Water Supply 22 Dairies, Milk-shops, Restaurants and Bake-houses 22 The Warranty Defence under the Sale of Food and Drugs Acts 23 Basement Workrooms 23 London County Council (General Powers) Act, 1904—Verminous Premises 24 Report of work done by the Lady Sanitary Inspector 26 Reports presented to the Borough Council 30 Statistical Tables of action taken under the Factory and Workshop Act 31—33 Statistical Tables of action taken under the Public Health (London) Act 34 Summary of Nuisances and other matters reported upon in 1904 35 & 36 Magisterial Proceedings during 1904 37—40 List of Bake-houses, Cow-houses and Slaughter-houses 41 — 43 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For 1904. Section I.-STATISTICAL. POPULATION OF CHELSEA. The census population of the Borough of Chelsea for the year 1901 was 73,842. The estimated population of the Borough for 1904 is 74,329; the the population of each sub-district being as follows:— Chelsea North 42,794 Chelsea South 31,535 BIRTHS AND BIRTH-RATE FOR 1904. Table I. Number of Births. Birth-rate per 1,000. Males. Females. Total. Chelsea North 393 424 817 19.2 Chelsea South 379 351 730 23.2 Chelsea 772 775 1,547 20.9 27.9 London . . . . 129,335 In 1903 the birth-rate of Chelsea Borough was 20.5 per 1,000, in 1902, 22.4 per 1,000, and in 1901, 22.l per 1,000. The average birt-rate of the Home District of Chelsea Parish for the 5 years 1896-1900 was 24.1 per 1,000. DEATHS AND DEATH-RATE FOR 1904. The total number of deaths registered in the Borough was 1682. Of this number 612 were deaths, within the Borough, of non parishioners—chiefly occurring in hospitals and in the St. George's Ifirmry; and 152 deaths of parishioners of Chelsea occurred outside 4 the Borough in various public institutions. There were, therefore, 1222 deaths of parishioners of Chelsea. These 1222 deaths are equivalent to a death-rate for the year of 16.5 per 1,000, as against a death-rate of 15.3per 1,000 in 1903. Table II. gives the death-rates of the Home District of Chelsea, of Chelsea Borough, and of London during the past 14 years. Table II. Year. 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 1903 15.3 15.7 1904 16.5 16.6 * 1891-1900, Chelsea Home District. Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 1.71 per 1,000 in 1904, the corresponding rate for London being 2.39. In 1903 the zymotic death-rate in Chelsea was only 1.26 per 1,000. Table III.—For the year 1904. Zymotic Death-rate. Diarrhœa 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 Deaths in Public Institutions % of total. Chelsea 1.71 0.86 1.81 0.49 3.58 1.16 0.27 155 28.0 42.4 London 2.39 1.27 1. 67 0.57 3.01 1.00 0.15 145 36.0 35.0 5 Small-pox.—There was no small-pox in Chelsea in 1904. Measles.—This disease caused 24 deaths in 1904 as compared with 14 in 1903. Seventeen of the deaths were registered in North Chelsea, and 7 in South Chelsea. Six of the deaths were of infants nnder 1 year of age, and 16 were of children between 1 and 5 years. Although 1904 was an epidemic year for measles, the mortality has been slight as compared with previous epidemic years, and was chiefly confined to the first quarter of the year. Scarlet Fever.—This disease caused 6 deaths in 1904, as compared with 2 in 1903. All the 6 deaths were of fever hospital patients, 4 being residents of North Chelsea and 2 of South Chelsea. Diphtheria.—This disease caused 5 deaths in 1904, as compared with 4 in 1903. Two of the fatal cases were of residents in North Chelsea, and 3 in South Chelsea. Three of the deaths were of fever hospital patients, and 2 occurred at the patients' own homes. i Chelsea continues to remain free from epidemic diphtheria, as the following Table shows:— Table IV.— Cases of, and Deaths from Diphtheria and Membranous Croup in Chelsea,* 1890-1904. Cases. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 172 162 163 200 207 273 429 242 153 136 150 106 131 99 61 Deaths. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 32 20 32 43 41 52 96 45 22 13 14 9 13 4 5 * 1890-1900, Chelsea Home District. Whooping Cough.—This disease caused 26 deaths in 1904, as compared with 29 in 1903. Seventeen of the deaths were of North Chelsea residents, and 9 of South Chelsea residents. Eleven of the fatal cases were infants under 1 year of age, and 14 were of children between 1 and 5 years of age. Enteric Fever.—This disease caused 2 deaths, both being of North Chelsea residents, and occurring in hospital. 6 Table V.—Zymotic Disease Mortality in Chelsea in 1904. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea* in 1896-1903. Measles 24 36 37 Scarlet Fever 6 6 9 Diphtheria 5 12 27 Whooping Cough 26 24 28 Enteric Fever 2 5 8 Diarrhoea 64 94 76 * 1896-1900, Chelsea Home District. Diarrhœa.—The deaths in Chelsea in 1904 from diarrhœal diseases (diarrhoea, dysentery, cholera, enteritis, and gastro-enteritis) were 64 in number, as compared with 40 in 1903. Forty-seven of the deaths were of infants under 1 year of age, and 8 were between 1 and 5 years of age. Thirty-eight of the deaths were of North Chelsea residents, and 26 were of South Chelsea residents. The summer diarrhoea prevalence of 1904 was considerably in excess of the prevalences in the two previous years, 1903 and 1902, which were unusually small owing to the cold and wet summer seasons of these years. Table VI.—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 1903 541 837 1904 864 1,267 Influenza.—The number of deaths attributed to influenza amounted to 20, as against 6 in 1903. Thirteen deaths occurred in North Chelsea, and 7 in South Chelsea. In London generally the disease was but slightly prevalent, only 709 deaths occurring in 1904, as against 644 deaths in 1903, and 1,083 in 1902. Of the fatal cases in London in 1904, 338 occurred in the fourth quarter of the year. 7 Respiratory Diseases.—The death-rate from these diseases in Chelsea in 1904 was 3.58 per 1,000, as against 2.72 per 1,000 in 1903, and 4.14 per 1,000 in 1902. The London death-rate from respiratory diseases in 1904 was 3.01 per 1,000. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1904 was 2.30 per 1,000, as against 1.99 per 1,000 in 1903. The death-rate in London in 1904 from these diseases was 2.24 per 1,000. Cancer.—Malignant cancerous diseases caused 86 deaths amongst Chelsea residents in 1904, the average of the past 8 years being 76 deaths. Fifty-three of the cancer deaths were of North Chelsea residents, and 33 of South Chelsea residents. Alcoholism.—Eighteen deaths were registered as being due to intemperance or to cirrhosis of the liver, as against 21 in 1903, 26 in 1902, and 31 in each of the years 1900-1901. Deaths in Lunatic Asylums.— Thirty-four deaths of Chelsea parishioners occurred in 1904 in lunatic asylums. The average of the 13 years, 1891-1903, is 32 deaths annually in lunatic asylums. Deaths in Public Institutions.—In 1904, 42.4 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 45.6 per cent, in 1903. In London generally, 35.0 per cent. of the total deaths occurred in public institutions. The deaths in the Chelsea Infirmary in 1904 formed 22.3 per cent. of the total deaths of Borough residents, as compared with 23 2 per cent. in 1903. 8 TABLE VII.—(x.) FOR WHOLE DISTRICT. Year. Population estimated to Middle of each year. Births. Deaths under One Year or Age. Deaths at all Ages. Total. Deaths in Public Institutions in Chel- sea Deaths of nonresid ents registered in District. Deaths of Residents registered beyond District Deaths at all Ages. Nett. No. Rate. No. Rate per 1000 Births No. Rate.* No. Rate.* 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 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 1819 19.1 1897 96,745 2549 26.3 410 161 1777 18.4 668 298 235 1709 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 1894-1900. 96,746 2512 26.0 401 160 1851 19.1 665 299 232 1785 18.5 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 1903 74,169 1516 20.5 218 144 1579 21.4 964 615 167 1131 15.3 1904 74,329 1547 20.9 240 155 1682 22.7 978 612 152 1222 16.5 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 bo 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 60O At Census of 1901. Total population at all ages 73,866 Number of inhabited houses 9,063 Average number of persons per house 8.1 9 TABLE VIII.—(ii.) Names 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 t«» 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. (a.) (6.) (c.) (d.) (a.) (6.) (c.) (a.) (6.) (c.) (d.) 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 1894-1900. 96,746 2512 1785 401 75,380 1881 1416 289 21,367 631 369 112 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 1903 74,169 1516 1131 218 42,702 846 588 113 31,467 670 543 105 1904 74,329 1547 1222 240 42,794 817 679 144 31,535 730 543 96 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. («/.) 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. 10 TABLE IX.—(III.) Cases of Infectious Disease notified during the Year 1904. 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 Ages+—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 . . . . . . . . . . . . . . . . . . . . . . . . Cholera . . . . . . . . . . . . . . . . . . . . . . . . Diphtheria 60 . . 22 25 7 6 . . 31 29 25 23 48 Membranous croup 1 . . 1 . . . . . . . . . . 1 . . 1 1 Erysipelas 45 2 1 2 1 33 6 24 21 . . . . . . Scarlet fever 108 1 30 58 10 9 . . 57 51 47 46 93 Typhus fever . . . . . . . . . . . . . . . . . . . . . . . . Enteric fever 13 . . . . 3 3 7 . . 8 5 6 4 10 Relapsing fever . . . . . . . . . . . . . . . . . . . . . . . . Continued fever . . . . . . . . . . . . . . . . . . . . . . . . Puerperal fever 7 . . . . . . 1 6 . . 2 5 . . . . . . Plague . . . . . . . . . . . . . . . . . . . . . . . . Chicken-pox 69 6 29 31 2 1 . . 29 40 . . . . . . Totals 303 9 83 119 24 62 6 151 152 78 74 152 Notes.—The localities adopted for this Table should be the same as those in Tables II. and IV. + 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 X.—(iv.) Causes of, and Ages at, Death during Year 1904. Causes of 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 in 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 . . . . . . . . . . . . . . . . . . . . Measles 24 6 16 2 . . . . . . 17 7 7 German Measles 1 . . 1 . . . . . . . . . . 1 . . Scarlet Fever 6 . . 2 1 9 1 . . 4 9 . . Whooping-cough 26 11 14 1 . . . . . . 17 9 8 Diphtheria and Membranous Croup 5 . . 2 3 . . . . . . 2 3 . . Croup . . . . . . . . . . . . . . . . . . . . Fever Typhus . . . . . . . . . . . . . . . . . . . . nteric 2 . . . . . . 1 1 . . 2 . . . . Other continued . . . . . . . . . . . . . . . . . . . . Epidemic Influenza 20 4 . . . . 1 6 9 11 9 2 Cholera . . . . . . . . . . . . . . . . . . . . Plague . . . . . . . . . . . . . . . . . . . . Diarrhoea (Sec Notes at foot) 44 36 5 . . . . 1 2 25 19 21 Enteritis (See Notes at foot) 20 11 3 . . . . 2 4 13 7 7 Puerperal Fever 4 . . . . . . . . 4 . . 1 3 1 Erysipelas 5 . . . . . . . . 5 . . 1 4 2 Other Septic Diseases 4 1 . . 2 . . 1 . . 1 3 9 Phthisis 134 1 4 3 12 110 4 96 48 170 Other Tubercular Diseases 30 9 12 3 3 7 2 15 21 38 Cancer, Malignant Diseases 86 . . 1 . . . . 53 32 53 33 134 Bronchitis 196 33 19 2 1 45 96 109 87 151 Pneumonia 63 16 8 2 2 21 14 33 30 31 Pleurisy 1 . . . . . . . . . . 1 1 . . . . Other Diseases of Respiratory Organs 5 . . 1 2 . . 1 1 3 2 2 Alcoholism—Cirrhosis of Liver 18 . . . . . . . . 12 6 9 9 9 Venereal Diseases 4 3 . . . . . . 1 . . 3 1 1 Premature Birth 31 31 . . . . . . . . . . 20 11 6 Diseases and Accidents of Parturition 2 . . . . . . . . 2 . . 1 1 . . Heart Diseases 110 . . 1 3 1 51 54 4 53 57 87 Accidents 44 11 5 3 2 19 98 16 17 Suicides 5 . . . . . . . . 4 1 2 3 3 All other causes 326 67 8 7 7 108 129 169 157 272 All causes 1222 240 102 34 32 455 359 679 543 978 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 (a), 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 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 "Diarrhœa " are to be included deaths certified as from Diarrhœa, 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 Diarrhœa ; Dysentery and Dysenteric Diarrhœa ; Choleraic Diarrhæa. Cholera, Cholera nostras (in the absence of Asiatic Cholera). Under the heading of "Enteritis" are to be included those certified as from Gastro-enteritis, 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 "Diarrhœa?" Deaths from Diarrhœa 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. 12 Section II. INFECTIOUS DISEAES. Small-pox.—There were no cases of small-pox notified in Chelsea in 1904. In London, during the year 1904, 492 cases of small-pox were notified, as against 417 in 1903. Of the 492 cases 127 occurred in Bethnal Green, 89 in Stepney, and 42 in Poplar, so that the disease was chiefly manifested in the Eastern Boroughs of London. The greatest prevalence was in March, April, and May, 335 cases being notified in these three months. The prevalence declined rapidly in June and July. At the end of the year there was a slight recurrence of small-pox, principally in Deptford and Woolwich. The case mortality, or percentage of deaths to attacks of the 492 London cases was 5.1 per cent. in 1904, as compared with a fatality of 31 per cent. in 1903, and 16.4 per cent. during the epidemic period 1901-2. Scarlet Fever.—This disease was less prevalent in Chelsea in 1904 than in any year since 1891, when compulsory notification commenced. Only 108 cases were notified, equivalent to a case-rate of 14.5 per 10,000 of the population, as against 27.9 per 10,000 in 1903. In 12 weeks of the year not a single case of scarlet fever was notified in the Borough, three out of the 12 being consecutive weeks in September, when scarlet fever is usually increasing. The autumnal rise did not commence until the middle of October. The number of cases notified in the first quarter of the year was 35, in the second quarter 17, in the third quarter 9, and in the fourth quarter 47. The number of cases notified in North Chelsea was 57, and in South Chelsea 51. The percentage of cases of school age (3 to 13 years) in the whole Borough was 72 per cent. The average duration of the stay in hospital of 50 cases, of which the records are to hand, was 65 days. Sixteen cases admitted to the M.A.B. hospitals were subsequently certified by the Medical Superintendents of these Institutions not to be suffering from scarlet fever or any other notifiable disease. The average duration of the stay in hospital of these 16 cases was 24 days. Twelve cases of scarlet fever were notified amongst children attending the Oratory School, Oratory Lane, between the 23th October and the 26th December. Eight of these cases were of children attending the Infants' Department, the average number attending school in this department being 180. The head teacher was advised as to the precautions to be taken to prevent the possibility of any children attending the school whilst in an infective condition. Diphtheria.—Only 60 cases of diphtheria and one of membranous croup were notified in Chelsea in 1904, equivalent to a case-rate of 8.2 per 10,000 of the population, the lowest rate recorded since compulsory notification commenced. In 1903 the diphtheria case-rate was 13.4 per 10,000. In 21 weeks of the year not a single case of diphtheria was notified in the Borough, 5 out of the 21 being consecutive weeks in November and December, when diphtheria is generally most prevalent. In the first quarter of the year 15 cases were notified, in the second 13 quarter 18, in the third quarter 10, and in the fourth quarter 18. The percentage of cases of school age (3 to 13 years) for the whole Borough was 67 per cent. There were no outbreaks in the course of the year specially attributable to school infection. In North Chelsea 31 cases were notified, and in South Chelsea 30 cases. There was no autumnal increase in prevalence of the disease. The average duration of the stay in hospital of 37 cases, of which the records are to hand, was 54 days. Six cases admitted to the M.A.B. hospitals were subsequently certified by the Medical Superintendents of these Institutions not to be suffering from diphtheria or any other notifiable disease. The average duration of the stay in hospital of 4 of these cases was 19 days. Enteric Fever.—The number of cases of enteric fever notified in Chelsea in 1904 was 13, the same number as in 1903, the case-rate again being an exceedingly low one, namely, 175 per 10,000 of the population. Four cases were notified in the first quarter of the year, 1 in the second, 5 in the third, and 3 in the fourth quarter. In North Chelsea 8 cases were notified, in South Chelsea 5 cases. Two out of the 13 cases had a fatal termination. Out of the 13 cases, in 3 the infection of the disease was probably contracted outside the Borough of Chelsea. In one of these cases the consumption of infected oysters at Yarmouth in September was regarded as the cause of the illness. Case Mortality.—The following Table shows the case mortality, or percentage of deaths to notifications of scarlet fever, diphtheria (including membranous croup), and enteric fever in Chelsea and in London, in each of the 15 years, 1890-1904. TABLE XI.—Case Mortality in Chelsea, and in London, 1890.1904. Scarlet Fever. Diphtheria 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 1998 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 30 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 1903 1.0 2.9 4.0 9.7 31.0 16.6 1904 5.6 2.7 8.2 10.1 15.4 15.6 14 The case mortality of Chelsea scarlet fever cases—5.6 per cent.—is higher than for many previous years. The case mortality of Chelsea diphtheria cases—8.2 per cent.—is also higher than in 1903, when the very low rate of 4.0 per cent, was recorded. The reduction in fatality of London diphtheria cases from 23.6 per cent. in 1894 to 10.1 per cent. in 1904 is largely the result of the almost universal treatment of these cases with diphtheria antitoxine. Prevalence of Scarlet Fever, Diphtheria, and Enteric Fever, in West London Boroughs. 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 XII.—Notifications per 10,000 of Population in 1904. Scarlet Fever. Diphtheria. Enteric Fever. Chelsea 14.5 8.2 1.7 Kensington 14.6 10.4 2.6 Paddington 24.8 9.7 3.3 Hammersmith 24.3 17.4 3.5 Fulham 19.3 19.7 2.6 Westminster 17.6 8.2 2.9 West London 19.2 12.3 2.8 London 28.9 15.5 4.1 As usual the prevalence of all these diseases was less in the six boroughs constituting West London than in the Metropolis as a whole. Chelsea had the lowest scarlet fever and enteric fever rates, and its diphtheria rate was with that of Westminster, also lower than the 4 other boroughs. Chelsea, during the past year, took the premier position amongst the West London boroughs for freedom from infectious diseases of the compulsory notifiable order. Fulham again, as for many years past, had the highest diphtheria case-rate in 1904. Removals to Hospitals.—Table XIII. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever, from the M.A.B. and other hospitals, in each of the 15 years, 1890.1904, expressed as percentages of the total number of cases of each disease notified. 15 TABLE XIII.—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 1903 91 88 62 1904 86 80 77 There was no delay in effecting the removal of any Chelsea cases to the M.A.B. hospitals. Voluntary Notification of Phthisis.—During 1904 sixteen cases of pulmonary tuberculosis were notified by medical practitioners. These cases were visited at their homes by the lady sanitary inspector, and precautionary leaflets, pocket spittoons, disinfectants, and fibre handkerchiefs were distributed where necessary. By the kindness of the Chelsea Guardians information is now being supplied by the Master of the Workhouse as to cases of Phthisis which have been in the Workhouse and Infirmary, and are returning to their homes in the borough. The number of cases voluntarily notified by medical practitioners is very small, and it is a matter of regret that greater advantage has not been taken of the opportunities offered for bringing these cases to the notice of the Public Health Department. 16 Section III. THE HOUSING OF THE WORKING CLASSES. Sir Thomas More Buildings. During the year 1901 the London County Council sanctioned the loan of £57,000 for the erection of these buildings, the period of repayment being fixed at 60 years, instead of 80 as asked for by the Borough Council, the principal to be repaid by equal yearly, half-yearly, or quarterly instalments. The loan was obtained from the Prudential Assurance Company, Limited, with interest at the rate of £3 12s. 6d. per cent. per annum, £17,000 being taken up at once, and the remainder in four sums of £10,000 each, when called for, the principal sum to be repaid by 120 equal half-yearly instalments, with interest on the balance for the time being unpaid. The question of ancient lights rights appertaining to certain houses in Danvers-street was settled by agreements entered into between the Chelsea Borough Council and Mr. Roger Cyril Hans Sloane Stanley, and between the Borough Council and the executors of the will of Thomas Richards, deceased, lessee of Stanley Cottage, 35, Danversstreet (Minutes 1904, p. 98), the sum of £150 being paid to the executors of Thomas Richards in full satisfaction of their claim in respect of Stanley Cottage, and in full satisfaction of any claims made by any under-lessee or tenant of the lessees. The costs of the settlements amounted to £71. The Council resolved that the dwellings should be designated Sir Thomas More Buildings, and that the names of the five blocks, proceeding from the north, should be Cadogan House, Winchester House, Dacre House, Burleigh House, and Kingsley House. The accommodation provided consists of 37 one-room tenements at rents of from 3s. 6d. to 4s. per week, 130 two-room tenements at rents of from 6s. to 7s. per week, and 94 three-room tenements at rents of from 8s. 6d. to 9s. 6d. per week. The average rent per room per week is 3s. 1½d. The prices per foot super. per week are as follows:— One-room tenements (240 s. ft.) 0.17d. to 0.20d. Two-room tenements (372 and 384 s. ft.) 0.17d. to 0.22d. Three-room tenements (525 s. ft.) 0.19d. to 0.22d. The above superficial measurements include in each case the areas of the lobby, scullery, balcony, and w.c., as well as the living and bedrooms. The following Table shows the superficial areas of the living and bedrooms in the different classes of tenement, the maximum number of persons allowed, and the cubic capacity per head (two children under 10 count as one adult or person over 10). The rooms are 8-ft. 6-in. in height. 17 Day Room. Bed-room. Bed-room. Occupants Cub. Cap. per head. S. Area. C. Cap. S. Area. C. Cap. S. Area. C. Cap. 1-room tenements 176 1496 — — — — 2 748 2-room tenements in Cadogan House 192 1632 122 1037 — — — 762 2-room tenements in other houses 177 1504 123 1045 — — 3½ 728 3-room tenements 216 1836 128 1088 106 901 5 765 Assuming that 20 per cent. of the population of the Buildings consists of children under 10 years of age, then the Buildings will accommodate 1,400 persons of all ages, equivalent to 2.4 persons per room, and 875 persons per acre. The gross annual rental of the Buildings is estimated to produce £4,690; the net annual rental, after deducting 39 per cent. for outgoings, is estimated to produce £2,855. The cost of land and buildings, so far as can be judged at present, are as follows:— Land £ 12,700 Buildings as per Contracts 53,756 Architect's Commission at 5 per cent 2,688 Clerk of Works Salary 380 Other Costs and Charges 546 Total Capital outlay £70,070 The net annual rental of £2,855 will pay 4 per cent. on the total capital outlay. The total assessments are as follows:— Gross. Rateable Value. £ £ Cadogan House 649 505 Winchester House 679 521 Dacre House 656 503 Burleigh House 686 526 Kingsley House 685 525 18 On the 3rd November, Kingsley House was formally opened by the Mayor, and the tenancies of this house commenced on the 7th November, 18 months having elapsed since the commencement of the work on the foundations (tenders for foundations accepted by the Borough Council on 22nd April, 1903), and 15 months having elapsed since the commencement of the work on the superstructure (tenders for superstructure accepted by the Borough Council on the 22nd July, 1903). Burleigh House was ready for occupation on the 14th November, and Cadogan House on the 19th December. Winchester and Dacre Houses were opened respectively on the 16th January, 1905, and the 6th February, 1905. The tenements in all the houses have been very quickly taken up by a good class of tenants, and there can be no doubt that the Sir Thomas More Buildings offer accommodation of a kind, which is not easily obtainable elsewhere, and at rents of a moderate nature. A resident superintendent and two resident porters have been appointed to the Buildings, the former with a salary of 30s. per week, with three rooms, an office, gas, and uniform, and the latter with salaries of 24s. per week, with two rooms, gas, and uniform. The Buildings have been insured for a total sum of £42,000 in the Alliance Assurance Co., Ltd., with an additional sum of £2,380 for 6 months rent of the Buildings. No charge is made to the tenants for the use of the baths, dryingroom, or hot-water (urn) room. Onslow Dwellings. The result of the first year's working (31st March, 1903, to 31st March, 1904) was most satisfactory. The rents and deposits received amounted to £1,456, the full letting value of the entire premises being only £1,427. The total income from the Dwellings for the year was £1,462 5s. 9d., and the outgoings (rates and taxes, gas, water, insurance, salary of rent collector, wages, printing and stationery, and repairs) amounted to £691 1s. 4d. Of this amount £135 was a special expenditure incurred for replacing worn-out kitchen ranges in a majority of the tenements. Deducting this item, the outgoings were only £556 1s. 1d. or 38 per cent. of the gross rental, which is a fair figure, having regard to the fact that this was the first year of the Council's management, and that the Dwellings required considerable repairs to bring them up to a proper standard of tenantable condition. The interest on loans and the instalments of loans repaid amounted to £1,025 7s. 7d., so that the balance of loss on working was a charge on the general rate of £254 3s. 2d., equivalent to a rate of 0.08d. in £1 on the rateable value of the Borough. Nos. 21, 23, 25, 27, 29 and 31, Pond Place. During the year negotiations were undertaken and carried through for the purchase of the leasehold interests in these houses, and the obtaining of vacant possession, for the sum of £535. 19 Cadogan and Hans Place Estate (No. 3) Ltd. During the year 1904 communications passed between this estate Company and the Chelsea Borough Council as to the development of the estate of which the reversionary interests had been purchased by the Company from the ground-landlord, Earl Cadogan. The estate is situated in the northern portion of the Borough, and is bounded by Fulham-road, Marlborough-road, and Green-street on the North; Rawlings-street, Cadogan-street, and Marlborough-road on the East; Cumberland-place and College-place on the South ; and College-street, Marlborough-street, and Leader-street on the West. The total number of inhabited houses on this estate is about 790, the area of the private land, excluding public streets, being some 20 acres. The population of the area is about 6,300 persons. The majority of the leases expire at Christmas, 1908. A large proportion of the 6,300 people inhabiting the area, who will be displaced during the development of the estate, are of the artizan and labourer or small trader class. As the result of representations made to the Company by the Borough Council with regard to the re-housing of a portion of the displaced working population, the Company replied that they were unable to sell any of the land on the estate to the London County Council at a housing value, and that they would be unable to make any provision for re-housing persons, who are now living on the estate, and will be displaced when the leases expire. The Borough Council subsequently considered the question of extending the provisions of Section 3 of the Housing of the Working Classes Act, 1903, to cover the case of demolitions of houses by private individuals or companies, so as to bring such cases within the Schedule of the Act, in like manner as is required where demolitions are undertaken under the powers given by the Act, by any local Act, or by Provisional Order. The Borough Council resolved to take no action, having regard to the difficulties that would arise if Section 3 of the Housing of the Working Classes Act, 1903, was extended in the manner indicated. HOUSES DEMOLISHED OR VACATED FOR DEMOLITION DURING THE YEAR 1904. houses. Durham-terrace 12 Ormond-row 15 Manor-street 5 Selah-place 1 Pond—place 1 34 Taking the number of persons per house as 6, 204 persons have been displaced during 1904 as the result of demolition. 20 Section IV. THE SANITARY CONDITION OF THE BOROUGH. The tabular statements prepared by the Sanitary Inspectors show that 1,346 separate premises were reported on by them during 1904, 313 of this number being with reference to cases of infectious disease (notifiable). In addition 431 separate houses have been inspected in the course of house-to-house inspections made in certain of the poorer streets in the Borough. It has been necessary to take legal proceedings for breaches of the Public Health (London) Act in only 6 cases in 1904. Drainage.—During the year 81 new drains for single houses have been reconstructed in accordance with the Council's drainage regulations. Combined Drainage.—Six systems of combined drainage, for which the owners of the houses were responsible, were sanctioned by the Council in the course of 1904. In addition, two 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:— 1904. £ s. d. April Nos. 1 and 2, Paulton-street 2 0 0 December Nos. 9 and 10, Paulton-street, and 33, Paulton-square 37 15 6 The total amount previously expended on similar works (1896-1903) was £455 5s. 2d. Inspection of Restaurant Kitchens, 1904. Number of restaurant and hotel kitchens. 63 „ inspections made 136 „ premises found satisfactory 53 „ premises with sanitary defects 10 „ notices served 10 Underground Bakehouses.—During the past year the works required in 2 underground bakehouses, in order that certificates of suitability in accordance with Section 101, Sub-section 4, of the Factory and Workshop Act, 1901, might be obtained, were completed. Sanitary Accommodation at Licensed Premises.—During the year the Chief Sanitary Inspector made an inspection of 96 licensed premises in the Borough, where drink is sold to be consumed on the premises. In 88 of these premises there is urinal accommodation for the use of customers, 31 of these urinals being entered from the street, and 57 21 being entered from the premises of the licensee. Eight licensed premises were found to be without urinal accommodation, but in nearly all these cases public street urinals are closely contiguous to the licensed premises. All the urinals inspected were found to be kept in a cleanly condition. With regard to w.c. accommodation, on inquiry it was found that in no instance was there any w.c. accessible to the customers without the asking of permission. In 66 out of the 96 premises visited it was stated that customers were allowed the use of a w.c. on applying at the bar. These w.c.'s were inspected and found to be kept clean and in good condition. Disinfection.—During the year 213 premises have been disinfected after cases of infectious or other disease, 55 of these being rooms which had been in occupation by persons suffering from phthisis. The articles disinfected at the disinfecting station numbered 3,559, as compared with 7,354 in 1903, when a large number of articles were received from the Duke of York's School on account of scarlet fever. During 1904, 1,036 articles, chiefly filthy and verminous beds and mattresses were received from the Surveyor's Department, and were burned in the incinerator by the Public Health Department. Water Supply.—During the year a daily examination of the water drawn from the King's-road main of the Metropolitan Water Board has been made at the Town Hall, as regards the temperature of the water and its appearance in a 2-ft. tube. The highest temperature attained during the year was 71° F on the 4th, 5th, and 6th August. This is 3 degrees higher than the highest temperature in 1903. The lowest temperature reached was 39.5° F on the 25th and 26th January. Throughout the year the water was clear and free from any turbidity. Dairies, Milk shops, Restaurants, and, Bakehouses. Early in the summer of 1904 I made an inspection of the following premises in the Borough, and was acoompanied by the chief Sanitary Inspector:— Dairies and milkshops, having milk rounds and serving customers in shop, the principal business being the sale of milk 41 Grocers and small general shops, selling a few quarts of milk a day over the counter, but having no rounds 80 Confectioners and others selling ice creams 39 Restaurants and coffee shops— Kitchens above ground 29 „ under ground 19 - 48 Fried fish shops • • • • 12 Bakehouses—Under ground 34 „ Above ground 7 41 22 On the 29th June, 1904, a report made by me to the Public Health Committee on the subject was approved by the Borough Council, and it was resolved that the Local Government Board and the London County Council be asked to initiate legislation to the effect that all new dairies, milkshops, restaurants, and bakehouses should be registered with the local Sanitary Authority, before such premises can be used for trade purposes; the local Sanitary Authority being given power to refuse registration, if the premises are found to be unsuitable for the purpose for which they are intended. It was also resolved that the Agricultural Department, the Local Government Board, and the London County Council be asked to consider the question of the amendment of the Milk Regulations, made in pursuance of Section 13 of the Dairies, Cowsheds, and Milkshops Order of 1885, with a view to their being brought up to a standard consonant with modern knowledge on the constitution and properties of cows' milk. The Warranty Defence under the Sale of Food and Drugs Acts, 1875-1899. On the 27th July, 1904, a report made by me to the Public Health Committee on the above subject was approved by the Borough Council, and it was resolved that a copy of the report and of the legal proceedings against the vendor of an adulterated milk, and against a wholesale dairy company for giving a false warranty in respect of a consignment of milk which was alleged to be adulterated, be sent to the Local Government Board, the Agricultural Department, the London County Council, and each of the Metropolitan Borough Councils. It was also resolved that the Local Government Board and the Agricultral Department be requested to introduce a Bill in Parliament next Session (1905), having for its object the repeal of the Warranty Sections of the Sale of Food and Drugs Acts, 1875, 1879 and 1899, and the insertion of such clauses as would enable the vendor, who has a warranty, to recover the penalties and costs of a conviction by simple civil process from the warrantor. Basement Workrooms. In the much frequented, fashionable, and highly rented streets of London, as the existing leases fall in, the old houses are being replaced by buildings containing shops on the ground floor, workrooms and storerooms in the basement, and suites of flats on all the upper floors. West End milliners and dressmakers rent the shops and basements in such streets, as their trade lies in the fashionable thoroughfares; and they are unable now, as formerly, to rent upstairs rooms as workshops. In Chelsea there are at present some twenty basement workrooms for milliners and dressmakers; and this number will be continually added to as the leases of the old houses fall in. The basement workrooms are almost invariably badly lighted for daylight illumination, are defectively ventilated by bulkhead fanlights, 23 put in to replace the shop stall-boards, and are frequently unprovided with an open fireplace and flue, so that they have to be warmed by flueless gas stoves of what is known as the "condensing" pattern. The workroom is sometimes a front room, with no communication with a back room; but in some of this class of workrooms there is a door opening into a back room, which may be also used as a workroom, this room being lighted by a window opening into an enclosed courtyard, very dark by reason of the height of the enclosing buildings, the room itself being often also unprovided with any fireplace or flue. In again another classs, there may be no wall separating the front of the workroom from the area under the pavement lights, and the w.o. in the vault ventilates directly into the workroom. If regulations were made by the Secretary of State for the Home Department, prohibiting the use of underground rooms for workshops unless they complied with certain conditions, architects in designing new buildings of this class would cause the underground rooms to conform with the regulations, so that the shops and basements might be let at the full rental value. I would suggest that the regulations to be framed should require (1) a certain proportion of glazed fanlight area (above the street level), according to the floor surface of the basement room, a certain proportion of this fanlight area to be made to open for ventilation; (2) that no room should be used as a workroom, which has not some means of through ventilation, either by a window, or through a door and adjoining room with window, to the back area or courtyard; (3) that the w.c. should not be in a vault under the street ventilating directly into the workroom, or into an area which is only top-lighted, without means of ventilation, and which either is part of the workroom or has a window from the workroom opening into it; (4) that the w.c. should not open directly or be ventilated into an underground workroom; (5) that there should be an open fireplace and flue in every basement workroom ; or, if a gas stove is to be used, a proper flue should be provided to carry off the products of combustion. It probably would not be possible to make existing underground workshops comply at once with the regulations to be framed; but it might be feasible to apply the regulations to existing workshops after a certain period, in the same manner as the Factory and Workshops Act Sections were made to apply to underground bakehouses after a certain period, which allowed owners and occupiers to make the necessary alterations after due notice. London County Council (General Powers) Act, 1904. Under Part IV. (Sanitary) of this Act, which came into force in 1904, power is given to the London Sanitary Authorities on the certificate of the Medical Officer of Health (1) to cleanse, purify, or destroy any articles in any house that are in such a filthy, dangerous, on unwholesome condition that health is affected or endangered thereby, 24 or the cleansing, purifying, or destruction of which is requisite to prevent risk of or to check infectious disease; (2) to serve notice upon tho owner or occupier of any house or part of a house which is infested with vermin, calling upon him to cleanse such house or part of a house, to remove the wall papers from the walls, and to take such other steps for the purpose of destroying and removing vermin as the case may require. These powers supplement those contained in the Public Health (London) Act, 1891, and will undoubtedly prove of service in dealing with conditions which are unfortunately of far too common occurrence in the tenement houses occupied by the lower wage-earning classes. Already action is being taken by the Elementary School Authorities in refusing to allow children to attend school, who are in a verminous condition ; and the powers now possessed by the Borough Councils in dealing with verminous premises should prove valuable in supplementing the crusade against personal uncleanliness that the action of the Public Elementary School Authorities has initiated. 25 REPORT OF WORK DONE DURING 1904, BY MISS M. W. RICHARDSON, Lady Sanitary Inspector. The work done during 1904 has comprised the following:— (1) Inspection of all Workshops and Laundries at which women are employed. (2) Inspection of Out-workers' premises. (3) Investigating cases of Infantile Mortality. (4) Visiting all cases of Phthisis voluntarily notified by Medical Practitioners. (5) Visiting cases of Measles and other non-notifiable infectious cases reported by the School Authorities. (6) Visiting special cases for the purpose of giving instruction in cleanliness, ventilation, infant feeding, &c. Inspection of Workshops and Laundries. At the end of 1903 there were 293 workshops on the register at which women were employed. During the year 1904, 82 have been added, and 36 removed, making a total of 339 on the register at the end of the year. Those added wero found chiefly through the directory by noting advertisements for apprentices in the newspapers, and through private enquiries. From the classification of trades appended, it will be seen that tho majority of the workshops are dressmakers and milliners, being together 79 per cent. of the whole. The number of these is steadily increasing, as the district is particularly suitable for this class of business, but much of the work is season trade only. The number of laundries on the other hand is gradually decreasing. During the last eighteen months seven laundries, employing in the aggregato about 48 persons, have either given up work or removed from the district. These are being largely replaced by receiving offices. Five new depots have been established during the year for steam laundries in the suburbs. A special report was made of all the basement workrooms in the district. These were subsequently visited by the Medical Officer of Health. 26 Classification of Workshops. (Women Employe's). Trade. 1903. No. Added. No. Removed. Total. Art Needlework 2 - - 2 Blind Maker 1 - 1 1 Blouse Maker 8 1 1 8 Boot Close 2 1 — 3 Corset Maker — 1 — 1 Dressmaker 185 60 25 220 Furrier 1 1 - 2 Household Linen — 1 - 1 Lampshades 3 1 — 4 Lace Making 1 — — 1 Laundries— Factory 5 — — 5 Workshops 22 — 5 17 Domestic 16 3 1 18 Milliner 36 8 3 41 Outfitting 6 2 — 8 Perfumes 1 - - 1 Tailoring (Men's) 2 2 — 4 Upholstery 2 — — 2 293 82 36 339 Cleanliness.—In a few cases only was it found necessary to serve notices for cleansing. Those workshops and laundries which shortly required cleansing were visited before the busy time, and the attention of the occupier drawn to Section 2 of the Factory and Workshop Act, 1901. The obvious advantage was pointed out of doing the work without waiting for a formal notice, if they wished to choose a time least likely to cause interruption to the business. The employers show increasing willingness to act on verbal instructions only. This was especially the case with regard to the laundries, as eighteen were cleansed in this way, without notice being served. In several cases, where intimations were sent last year, the work was done voluntary this year. Ventilation.—The workrooms, on the whole, are provided with sufficient means of ventilation, but the ventilation itself still leaves much to be desired. It is a matter for regret that the workers themselves do not help as they ought in this respect. The statement is continually being made that the windows are constantly opened, and always during mealtimes. As it is not desirable to rely upon evidence obtained in single visits that this is so, some attempt has been made to take observations from the street, which is often possible. In some cases after notices had been served for insufficient ventilation, observations were made at intervals to ascertain that the improvement was being maintained. It is proposed to extend this method in order to exercise more supervision in this respect, without making too frequent inspections. 27 Overcrowded.—Several eases of overcrowding were noted, all being in dressmaking or millinery workrooms. In six eases notices were served. The majority were, however, dealt with at the time of inspection, being largely due to unequal distribution of workers rather than to actual want of space. The workers themselves are sometimes to be blamed for this, as they do not always keep to their allotted rooms. A large number of workroom cards have been filled in and distributed. These have proved to be of great advantage, as they specify the number of workers allowed in each room. When tho full number is employed, the managers are usually reminded that no extra workers must be taken on, unless further accommodation is provided. In one case after warning was given, the occupier enlarged the workroom by knocking down part of the partition wall, in order to be able to accommodate more workers in the coming season. Outworkers—Under Section 107 of the Factory and Workshop Act, 1901, all persons employing outworkers must forward their names and addresses to the Local Authority twice a year, on or before the 1st February and the 1st August. At the last return 26 lists were received with a total of 287 outworkers. Of this number only 63 (or 22 per cent.) live in Chelsea. The nature of the work carried on by outworkers consists chiefly of tailoring, outfitting, or boot-making. With the exception of those in the last-named trade, the majority are women. Those have all been visited. Several of the outworkers employ assistants, when the premises are registered as a workshop. In a few cases the outworkers give out the work to others, but information on this point is difficult to obtain. The majority of the outworkers in other Boroughs who work for Chelsea firms come from Westminster (chiefly tailors), Fulham (chiefly bootmakers), or Battersea. According to the returns only a small number of Chelsea residents work for firms in other Boroughs. The greatest number of names and addresses being again received from Kensington. Jan. to June. June to Deo. Number of Lists received 27 26 Total number of Outworkers 61 287 Number living in Chelsea 52 63 Number of Inspections made 47 47 Number forwarded 206 208 Received from other Boroughs 43 24 Infantile Mortality Inquiry. Investigation have also been made with regard to cases of Infantile Mortality. Particulars are obtained from the mother as to length of illness, cause of death, whether other children have previously died, condition of the premises, &c. The information received is tabulated and kept for reference. The number of deaths investigated during the year amounted to 135. In 28 30 cases (22 per cent.) the family occupied one room only. In 26 cases (19 per cent.) the deceased infant had been the first child. Excluding the latter, in 46 cases out of the remaining 101, previous infantile deaths had occurred. In one family ten children had previously died under two years of age. In four cases, two infantile deaths (one in one instance twins) occurred in the same family within the year. Of the deoeased infants 15 (11 per oent.) were stated to be illegitimate, two of which had been entirely handed over to the charge of other people. Since much of the mortality among infants may be traced to improper feeding and ignoranoe on the part of the mother, a leaflet containing simple instructions has been drawn up. In future where it seems desirable, those houses at which a birth has ocourred will be visited and a leaflet given to the mother. Phthisis. All cases of phthisis voluntarily notified by Medical Practitioners have been visited. A few cases have also been unofficially reported from other sources, such as the Charity Organization, and the Hospital Almoner. Inquiries were made in eaoh case as to the probable cause of the disease, the conditions under which the patient was living, and whether due precautions were being taken to prevent other members of the same family being infected, &c. Simple instructions were given as regards ventilation, cleanliness, and treatment of expeotoration. Where it seemed desirable, pocket spittoons, fibre handkerchiefs, leaflets of instructions, and disinfectants were distributed. The visits, which are repeated at intervals, are paid as far as possible in a friendly manner rather than officially, in order that the patients and their friends may understand that all information is voluntary on their part; also that they may be encouraged to state their difficulties (if any) in carrying out the necessary precautions. Other oases suspicious of phthisis have been noted in house to house visiting. It would seem that in the earlier stages of consumption, many amongst the very poor neglect to get medical treatment until such time as the symptoms become acute, and there is inability to follow the usual employment. The danger of delay is then pointed out. School Cases. Measles remained prevalent throughout the summer, especially in West Chelsea. All premises at which cases of measles were reported by the schools during the year have been visited, amounting to 251. This number does not include duplicate notifications, nor more than one case at each house. The actual number of cases would therefore be considerably greater. The total number of visits paid was 585. Since September, all non-notifiable infeotious or contagious cases have been visited, such as mumps, whooping cough, chicken-pox (when nonnotifiable), and ringworm. 29 Advice was given as regards isolation of tho patient, and other precautions to be taken. There is a tendency to look upon measles and whooping cough as very slight complaints, in which little care is needed; and it would seem that the value of the visits lay chiefly in counteracting this idea, and emphasizing the need for special precautions and often for medical treatment. Inquiries were also made as to whether other children in the house were excluded from school. In cases where children of the same family are sent to different schools, those attending one will perhaps be kept at home, and those attending another will be sent as usual, or all kept from day schools but allowed to go to Sunday schools. Tabulated Statement of Work. (1) Number of Workshop inspections 667 Number of New Workshops registered 82 Workrooms measured 147 Workroom Cards distributed 97 Visits of Inquiry re Employment of Women, &c. 483 Number of Notices served 13 (2) Number of inspections of Outworkers' premises. 94 Visits of inquiry re Outworkers 106 (3) Cases of Infantile Mortality investigated 135 Number of visits paid 204 (4) Phthisis cases voluntary notified 17 Number of visits paid (including visits of inquiry) 179 (5) School cases notified 251 Number of visits paid 585 (6) Visits of instruction 89 30 REPORTS PRESENTED TO THE BOROUGH COUNCIL BY THE PUBLIC HEALTH COMMITTEE. February 10th. The appointment of Public Analyst. Resignation of the appointment by Dr. Louis Parkes. The distritribution of leaflets of precautions to consumptives. February 24th. The seizure of turkeys. The Mansion House proceedings re condemned turkeys. The inspection of milk supplies. March 9th. The disinfecting station. A Metropolitan street ambulance service. March 23rd. Underground bakehouses. April 27th. Combined drainage, Nos. 1 and 2, Paulton-street. May 11th. Onslow Dwellings income and expenditure for the year ended 31st March, 1904. June 1st. Agreements re ancient lights in Beaufort-street. June 15th. Compensation for quarantine in small-pox outbreaks. June 29th. Inspection of dairies, milkshops, restaurants, and bakehouses. July 13th. Soheme of rents for Sir Thomas More Buildings, rules and regulations and application form for tenancies in Sir Thomas More Buildings. July 27th. Cadogan and Hans Place Estate (No. 3) Ltd. The appeal of the Great Western and Metropolitan Dairies, Ltd. Sale of Food and Drugs Acts, 18751899; the warranty defence. The acquisition of the leasehold interests in 21-31, Pond-place. September 28th. The appointment of a superintendent for Sir Thomas More Buildings. October 12th. The voluntary notification of phthisis. The Cadogan and Hans Place Estate (No. 3) Ltd. November 9th. Insurance of Sir Thomas More Buildings against fire. The appointment of a porter for Sir Thomas More Buildings. Underground bakehouses. November 23rd. Detailed returns of births. The demolition of working-class houses. December 7th. Combined drainage at Nos. 9 and 10, Paulton-street, and 33, Paulton-square. Modification of bye-laws for the deposit of drainage plans. Leaflet on the management of infants. 31 Form for Tabulation of Report required by s. 131 of the Factory and Workshop Act, 1901. INSPECTION OP FACTORIES, WORKSHOPS AND WORKPLACES. CLASS OF WORKS. NUMBER OF PLACES: Numb'r of Inspections 1904. Numbe of Notices, 1904. Numbe of Prosecutions, 1904. On Regist'r at end. of 1903 Added in 1904. Removed in 1904. On Register at end of 1904. Premi's Rooms. Factories Factory Laundries 1 4 — 5 29 5 — — Factory Bakehouses 1 — — 1 2 2 — — Other Factories 6 1 — 7 11 4 — — Workshops.* WorkshopLaundri's 38 8 6 35 87 92 1 — Workshop Bake'ses 41 2 - 43 86 108 — — Other Workshops.. 457 90 4 543 713 795 — — Workplaces Places where Food is prepared for sale† 50 15 2 63 63 136 12 — Workplaces other than the above 17 - - 17 25 46 — — Home-workers' premises || 66 25 4 87 91 94 — — Total 677 140 16 801 1107 1282 13 - * In a separate Table the more important classes of workshop industry should be distinguished, each in a separate line. ‡ A Register is required by s. 131 in the case of Workshops only. † Under this head should be included the Kitchens of Hotels, Restaurants, Eating Houses of all sorts, Tripe, Fried Fish and Eel Shops, and other places where food is prepared. || Not being factories or workshops, domestic or otherwise, and in which the occupations carried on are limited to those specified in s 107. N.B.—It is not necessary, for the purposes of this return, to distinguish between Domestic Factories, Domestic or Tenement Workshops, and other Workshops, with which, therefore, they should be included. 32 MATTERS DEALT WITH. PARTICULARS. NUMBER OF DEFECTS. Notices Issued. Prosecutions. Found. Notified by Home Office. Remedied Notified to Home Office. Matters under the Public Health (London) Act, 1891. Want of Cleanliness 10 4 13 — 12 — Want of Ventilation 3 3 4 — 4 — Want of Air Space: Overcrowding 6 1 1 — 7 — Sanitary Accommodation (s. 38) Absent or Insufficient 2 1 3 — 3 — Unsuitable or Defective 3 - 3 - 3 Not Separate for Sexes 1 1 1 — Want of Drainage of Floors — — — — — — Other Nuisances 6 — 6 — 6 — Contraventions of Factory and Workshop Act, 1891. Illegal Occupation of Underground Bakehouse — — — — — — Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) - - - - - - Failure as regards Lists of Outworkers (s. 107) - — - — — — Giving out work to be done in premises which' are Unwholesome (s. 108) Infected (s. 110) — — — — — — Allowing Wearing Apparel to be made in Premises infected by Scarlet Fever or Small Pox (s. 109) Other Contraventions — - — — — — Total 31 9 31 — 36 — 33 LIST OF OUTWORKERS (S.107). CLASS OF HOMEWORK. 1904. NO. OF LISTS RECEIVED. NUMBER OF ADDRESSES OF OUTWORKERS. Up to Feb. 1st. Up to Aug. 1st. Forwarded to Other Authorities. Received from Other Authorities. No. of Lists. No.of Outworkers. No. of Lists. No.of Outworkers. Wearing Apparel* Dressmaking 5 17 5 16 25 2 Tailoring 10 46 10 62 66 33 Bootmaking 2 71 1 61 116 14 Outfitting 7 114 8 130 184 15 Millinery 1 2 — - 2 — Lace — — — — — — Cabinet making — — — — — — Fur pulling — — — . — — — Other 2 11 2 18 15 3 Total 27 261 26 287 408 67 • The more important branches of homework wearing apparel should be distinguished, each in a separate line; e.g., dressmaking, tailoring. Number of outworkers (persons) on register at end of year 1904 287 „ „ premises „ „ „ 87 Total number of outworkers (persons) dealt with during the year... 548 „ „ premises „ „ 182 Number of Orders prohibiting homework in infected premises (s. 110) 1 34 PROCEEDINGS DURING 1904. PREMISES. NUMBER OF PLACES. Number of inspections, 1904. Number of Notices, 1904. Number of prosecutions, 1904. On register at end of 1903. Added in 1904. Removed in 1904. On register at end of 1904. Milk premises 123 10 - 133 315 16 - Cowsheds 4 — - 4 65 1 — Slaughter-houses 8 —. 2 6 71 — — Other offensive trade premises - - - - - - - Ice cream premises 60 — 5 55 68 - - Registered houses let in lodgings 602 — — 602 180 (a)* (b)* (a)* (b)* • (a) For overcrowding. • (b) For other conditions. Overcrowding, 1903— Number of dwelling rooms overcrowded 11 Number remedied 11 Underground rooms— Illegal occupation dealt with during year 2 Number of rooms closed 2 Insanitary houses— Number closed under the Public Health (London) Act, 1891 1 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year: adults, 10, children, 9 19 Revenue Acts— Number of houses for which applications were received during year 13 Number of tenements comprised therein 190 Number of tenements for which certificates were granted 11 ,, „ „ „ refused 2 Mortuaris— Total number of bodies removed 112 Total number of infectious bodies removed 2 35 summary of nuisances and other matters reported on and work done during the year 1904. Houses and Premises:— Reported on respecting nuisances complained of 602 Reported on with reference to infectious cases 313 Cleansed, whitewashed, and repaired 236 Defective roofs repaired 55 Disinfected after communicable diseases 213 Cases of overcrowding abated 18 Dust-bins, new, provided 148 „ repaired — Underground rooms occupied contrary to Act 2 Inspections of restaurant kitchens 136 Drainage:— Drains opened, cleansed, and made sound 244 ,, trapped with stoneware gullies Water-closets cleansed and repaired 65 „ new pans and traps provided 202 Spout drains cleansed, repaired, or renewed 66 Sink, bath, and lavatory waste pipes provided and repaired 156 Drains and soil pipes ventilated or repaired 125 Soil pipes, new, provided 68 New drains laid, in accordance with Council's regulations (including 6 systems of combined drainage) 87 Additional w.c. accommodation provided 12 Water Supply:— For domestic purposes, provided where cut off by Water Board 12 For water-closets, or check cisterns provided and repaired 66 Main cisterns cleansed or repaired 37 „ new, provided 4 Water certificates, issued in respect of newly erected dwelling-houses 36 Nuisances abated rising from:— Keeping of animals 2 Accumulations of manure and other fifth 50 Yards, areas, and wash-houses paved or drained 170 Smoke 4 Dung-pits repaired, drained, &c., or cages, &c., provided 1 *his does not include re-visits to premises to ascertain works in progress, or premises visited where no nuisances are found to exist, which, if added, would at least be treble the number of visits made. 38 Miscellaneous:— Dead bodies removed to public mortuary for sanitary reasons 2 Goods disinfected after infectious cases at station 3559 Goods destroyed after infectious cases 2 Mattresses, beds, &c., received from Surveyor's Department and destroyed in the incinerator 1036 Number of samples taken for analysis (Food and Drugs Act), including 31 samples taken on delivery at St. George's Infirmary, Workhouse and Home 389 Unsound Food. Number of boxes of fruit, fish, birds, &c., condemned and destroyed 57† Library books destroyed at Librarian's request 19 Proceedings Taken:— Statutory notices issued 246 Intimations issued for sanitary works, &c., including infectious disease cases 682 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 6 Legal proceedings in respect of food adulteration 24 Correspondence:— Number of letters written in connection with sanitary matters 712* Daily returns of infectious cases sent to Metropolitan Asylums Board 97 Notification of infectious cases sent to School Authorities 237 Entries in Inspectors' Report Books 602 ,, Inhabitants' Complaint Book 50 Certificates of Disinfection given 160 Certificates of infectious diseases for removal cases 117 Notices sent to Public Library of premises wherein infectious disease has occurred 79 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 128 Dairies and Milkshops, and 68 Ice Cream vendors in the Borough. These have been registered and periodically inspected by the Sanitary Inspectors. All places where fish and potatoes are cooked have been periodically inspected. Sanitary Inspectors. ALEXANDER GRANT (Chief). G. R. METZLER. R. J. DAVIS. M. RICHARDSON (Lady). †This does not include unsound food condemned in the streets and destroyed, for which no condemn note was given. *The department is now connected with the teiephone, and consequently the work in connection with Infectious Diseases is done more expeditiously, and considerable time is also saved by its use in other matters. 37 MAGISTERIAL PROCEEDINGS DURING 1904, UNDER THE SALE OP FOOD AND DRUGS ACT. Streets where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. King's-road Milk 7% of added water Feb. 9th Fine £5, and 10s. 6d. costs. Markham-street ,, 40% of fat abstracted ,, Adjourned to 1st March and dismissed; warranty proved, and summons granted against the farmer for hearing, 15th March, 1904. Fine £2 and 10s. 6d. costs. King's-road ,, 7% of added water March 1st Henry W. Justice, the farmer from Oxford, re Markham-street milk case, was summoned for giving a false warranty with respect to milk consigned on 17th January, 1904 March 15th Fine £2 and £1 1s. costs. Gunter-grove Milk 6% of added water May 17th Dismissed; warranty proved; summons granted against the Great Western and Metropolitan Dairy Co., Ltd. Dismissed; warranty proved; contract out of time. King's-road ,, 20% of fat abstracted ,, Eedesdale-street ,, 9% of added water ,, Dismissed; summons not served with copy of analyst's certificate. Collingwood-street ,, 14% of added water June 7th Fine £5 and 10s. 6d. costs. 38 MAGISTERIAL PROCEEDINGS DURING 1904, UNDER THE SALE OF FOOD AND DRUGS ACT—continued. Streets where Purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Royal-avenue Milk of added water June 7th Fine £1 and 10s. 6d. costs. The Great Western and Metropolitan Dairies Ltd., of Paddington, was summoned for giving a false warranty in respect of a consignment of milk on 11th April, 1904 ,, Adjourned to 21st June, 1904. Do. do. do. do. June 21st £2 fine and £5 5s. costs; appeal to Quarter Sessions; conviction quashed. Flood-street Whiskey 28.2% under proof ,, Dismissed; notice of dilution displayed. Royal Hospital-road ,, 33.3% under proof ,, £2 fine and 10s 6d. costs. Lower Sloane-street ,, 26.7% under proof ,, £2 fine and 10s. 6d. costs. Britten-street ,, 31.1% under proof ,, Dismissed; notice of dilution displayed. Lots-road Brandy 28.7% under proof ,, Dismissed; noticeof dilution displayed. 39 MAGISTERIAL PROCEEDINGS DURING 1904, UNDER THE SALE OF FOOD AND DRUGS ACT—continued. Streets where Purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Kings-road Cod liver oil 20% of foreign fish oil Nov. 15th Adjourned to 6th Dec., and sample sent to Somerset House. ,, ,, ,, ,, ,, Dec. 6th Adjourned to 17th January, 1905. ,, ,, ,, ,, ,, Nov. 15th Adjourned to 6th Dec., and sample sent to Somerset House. ,, ,, ,, ,, ,, Dec. 6th Adjourned to 17th January, 1905. Marlborough-road ,, 10% ,, ,, Nov. 15th Adjourned to 6th Dec, and sample sent to Somerset House. ,, ,, ,, ,, ,, Dec. 6th Adjourned to 17th January, 1905. First-street . Milk 7% of added water Nov. 15th 1s. fine and 10s. 6d. costs. Collingwood-street milk seller committed in default of payment of balance of fine inflicted 7th June, 1904 ,, Fourteen day's imprisonment. Fines, £21 1s.; Costs, £9 19s. 6d. Total, £31 0s. 6d. 40 MAGISTERIAL PROCEEDINGS UNDER PUBLIC HEALTH (LONDON) ACT, 1901. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 4, Cheyne-row Want of a proper and sufficient supply of water to the premises 9th Feb., '04 Time allowed by magistrate, and water provided in seven days. King's-road John Nixon, of Leadenhall Market, was summonsed for selling turkeys unfit for the food of man 17th Feb. Heard at Mansion House Police Court; dismissed; the owner did not know the state of the turkeys when sold by 337, King's-road Want of a proper and sufficient supply of water to the premises 21st June him in the market. Withdrawn; water supply provided on date of hearing. 482, King's-road Defective main, wash-house, and W.C. roofs; dirty, damp, and dilapidated premises; want of a dust receptacle, and dirty cistern. Defective guttering and stackpipes 19th July Abatement order granted; works to be executed within fourteen days; works completed. Flats 57 to 64, Beaufort-street Defective branch drains and soil pipes at rear of the flats 18th Oct. Fine £3; abatement order for work to be executed within seven days. King's-road George Adams, of Fulham, was summoned for selling 10 barrels of grapes unfit for the food of man 20th Dec. '04 £5 fine, and £2 2s. costs. Total, £8 fines, and £2 2s. costs. 41 BAKEHOUSES IN USE ON JANUARY 1st, 1905. Street. Occupier. Above Ground. Below Ground. 74, Arthur-street Solomon Keppler ...... Below. 93, Beaufort-street A. Coventry ...... ,, 26, Blantyre-street Hetzler ...... ,, 55, Burnaby-street Loe ...... ,, 1, Cadogan-street S. 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, „ W. H. Summers ...... ,, 53, Godfrey-street H. Becker ,, 102, Keppel-street C. Stoehl ...... ,, 47, King's-road Pennycuick ...... ,, 145, J. Humphry & Son Above. ...... 88, „ G. Nash ...... Below. 134, Buckea ...... ,, 42 Street. Occupier. Above Ground. Below Ground.  351, King's-road H. J. Mardon ...... Below. 399, ,, H. Kohler ...... ,, 414, ,, J. Brewer ...... ,, 488, ,, Matthiae ...... ,, 502, ,, W. Schafer ...... ,, 517, ,, J. Morgan ...... ,, 1, Leader-street J. T. Pratt Above. ...... 48, Lots-road M. & C. West ...... Below. 83, Lower Sloane-street Miles Above. ...... 43, Manor-street L. Lorenz ...... Below. 62, Marlborough-road Kremers ...... ,, 100, ,, C. Reitze ...... ,, 110, ,, William Herwig Above. ...... 7, Pavilion-road Mason Above. ...... 3, Pont-street Hue & Co ...... Below. 14, Riley-street W. E. Knee ...... ,, 29, „ F. W. Fox ...... ,, 150, Sloane-street Pennycuick ...... ,, 6, Symons-streiet Spiking & Co. ...... Dis. baking 4/8/04. 43, Stayton-street E. Schindewolf Above. ...... 25, Walton-street Burrows ...... Below. 43 SLAUGHTER-HOUSES. Street. Occupier. Crooked Usage Cridlan, P. and J. W. 169, Fulhara-road Philp, J. 341, „ Vaughan, T. 52, King's-road Cobb, G. A. 54, „ 413, „ Goulding, F. 82, Marlborough-road Iggulden, F. COW-HOUSES. 54, Arthur-street Jennings, J. Church-street Emerton, J. 406, King's-road Jorden, G. 3a, Leverett-street Robinson, F.