CHE 12. Metropolitan Borough of Chelsea. ANNUAL REPORT For 1905 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; Jenner Lecturer on Hygiene and Public Health at St. George's Hospital Medical School; Examiner in Hygiene and Public Health, Universities of London & Birmingham. TOWN HALL, KING'S ROAD, CHELSEA. 1906. TABLE OF CONTENTS. SEC. I.—Statistical page Population of Chelsea 3 Births and Birth-rate 3 Deaths and Death-rate 4 Death-rates of Special Classes of the Population 7 Infantile Mortality 11 Statistical Tables (L.G.B. Forms, L, II., III., IV., V.) 14 SEC. II.—Infectious Diseases Small-pox 19 Scarlet Fever 19 Diphtheria 20 Enteric Fever 20 The Case Mortality 20 Prevalence of Scarlet Fever, Diphtheria and Enteric Fever in West London Boroughs 21 Removal of Patients to Hospitals 22 Voluntary Notification of Phthisis 22 Puerperal Fever 23 SEC. III.—The Housing of the Working Classes:— Sir Thomas More Buildings 24 Onslow Dwellings 26 The Pond-place Dwellings 28 Demolitions in 1905 30 SEC. IV.—The Sanitary Condition of the Borough: Inspections made 32 Drainage 32 Disinfection and Verminous Houses 32 Action taken under the Sale of Foods and Drugs Acts 33 Water-supply 34 Basement Workrooms 35 Smoke Nuisance 36 Deposits of unconsumed Cinder Ash 37 Frozen Australian Rabbits 37 Reports presented to the Borough Council in 1905 39 Report of work done by the Lady Sanitary Inspector 41 Statistical Tables of action taken under the Factory and Workshop Act 46 Statistical Tables of action taken under the Public Health (London) Act 48 Summary of Nuisances and other matters reported upon in 1905 49 Magisterial Proceedings during 1905 51 List of Bake-houses, Cow-houses and Slaughter-houses 53 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For 1905. 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 1905 is 74,496; the population of each sub-district being as follows:— Chelsea North 42,890 Chelsea South 31,535 There is to be no quinquennial census of London this year, 1906, as was taken in 1896; consequently in boroughs where changes are taking place owing to building on unoccupied land, to demolitions and rebuilding, or to migratory movements of population, estimates of population between now and the next decennial census in 1911 are likely to be erroneous, and but little reliance can be placed on the calculated rates of mortality, etc. BIRTHS AND BIRTH-RATE FOR 1905. Table I. Number of Births. Birth-rate per 1000. Males. Females. Total. Chelsea North 413 418 831 19.4 Chelsea South 386 368 754 23.9 Chelsea 799 786 1,585 21.3 London ... ... 126,620 27.1 The average birth-rate of the Borough for the years 1901-1904 is 21.5 per 1,000, and of the Home District of Chelsea Parish for the b 2 4 5 years 1896-1900 24-l per 1,000. The lowest birth-rate was reached in 1903—20.5 per 1,000; since then there has been a small increase, namely, 1904, 20 9 per 1,000, and 1905, 21.3 per 1,000. During the past year copies of the Registers of Births have been forwarded weekly to this office, and later in this Report will be given information as to the birth-rates and infantile mortality of various classes of the community. During the year, 68 births were registered as having occurred in the Chelsea Workhouse, equivalent to 4.3 per cent. of the total number of births in the Borough. DEATHS AND DEATH-RATE FOR 1905. The total number of deaths registered in the Borough was 1,606. Of this number 663 were deaths, within the Borough, of nonparishioners—chiefly occurring in hospitals and in the St. George's Infirmary; and 163 deaths of parishioners of Chelsea occurred outside the Borough in various public institutions. There were, therefore, 1,106 deaths of parishioners of Chelsea. These 1,106 deaths are equivalent to a death-rate for the year of 14.9 per 1,000, as against a death-rate of 16.5 per 1,000 in 1904. Table II. gives the death-rates of the Home District of Chelsea Parish, of Chelsea Borough, and of London during the past 15 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 1905 14.9 15.0 * 1891-1900, Chelsea Home District. The death-rate of 14.9 in 1905 is the lowest rate as yet recorded in Chelsea. Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 119 per 1,000 in 1905, the corresponding 5 rate for London being 193. In 1904 the zymotic death-rate in Chelsea was 1.71 per 1,000. Table III.—For the year 1905. Zymotic death-rate. Diarrhoea death-rate. Phthisis death-rate. Other tubercular diseases deathrate. Respiratory diseases deathrate. Cancer death-rate. Influenza death-rate. Deaths under 1 year to 1000 births. Percentage of deaths under 5 to total deaths. Deaths in Public Institutions per cent. of total. Chelsea 1.19 0.62 1.51 0.30 3.47 0.97 0.20 116 22.5 46.3 London 1.93 0.95 1.46 0.54 3.02 1.00 0.15 131 34.0 37.5 Small-pox.—There was no small-pox in Chelsea in 1905. Measles.—This disease caused 5 deaths in 1905, as compared with 24 in 1904. One death was registered in North Chelsea, and 4 in South Chelsea. All the deaths were of children between 1 and 5 years of age. Measles was not at any time epidemic in 1905. Scarlet Fever.—This disease caused 9 deaths in 1905, as compared with 6 in 1904. Six were deaths of North Chelsea residents, and 3 of South Chelsea, all 9 being fever hospital patients. Scarlet fever was somewhat prevalent in Chelsea and most other Metropolitan Boroughs in the last quarter of 1905. Diphtheria.—This disease caused 5 deaths in 1905, the same number as in 1904. Two of the fatal cases were of residents in North Chelsea, and 3 in South Chelsea. Four of the deaths were of fever hospital patients, and one occurred at the patient's own home. 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,* 1890-1905. CASES. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 172 162 163 200 207 273 429 242 153 136 150 106 131 99 61 52 DEATHS. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 32 20 32 43 41 52 96 45 22 13 14 9 13 4 5 5 * 1890-1900. Chelsea Home District. Whooping Cough.—This disease caused 20 deaths in 1905, as compared with 26 in 1904. Eleven of the deaths were of North Chelsea residents, and 9 of South Chelsea. Eleven of the fatal cases 6 were infants under 1 year of age, and 9 were children between 1 and 5 years of age. Enteric Fever.—This disease caused 3 deaths in 1905, as compared with 2 in 1904. One was the death of a North Chelsea resident, the remaining 2 being South Chelsea people. All three deaths occurred in hospital. Table V.—Zymotic Disease Mortality in Chelsea in 1905. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea, 1895-1904. Measles 5 27 34 Scarlet Fever 9 9 10 Diphtheria 5 9 27 Whooping Cough 20 24 27 Enteric Fever 3 4 7 Diarrhœa 46 70 77 Diarrhœa.—The deaths in Chelsea in 1905 from diarrhœal diseases (diarrhœa 33, enteritis and gastro-enteritis 13) were 46 in number, as compared with 64 in 1904. Thirty-three of the deaths were of infants under 1 year of age, and 3 were between 1 and 5 years of age. Twenty-one of the deaths were of North Chelsea residents, and 25 of South Chelsea residents. The summer diarrhoea prevalence was considerably less than in 1904, the season of 1905 subsequent to July having a temperature below the average. Table VI.—Mortality from Diarrhoeal 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 1905 620 948 Influenza.—The number of deaths attributed to influenza in 1905 amounted to 15, as against 20 in 1904. Eight deaths occurred in North Chelsea, and 7 in South Chelsea. Seven of the fatal cases were of 7 persons aged 65 and upwards. In London generally the disease was but slightly prevalent, only 690 deaths occurring in 1905, as against 709 in 1904, 644 in 1903, and 1,083 in 1902. Of the fatal cases in London in 1905, 355 occurred in the first quarter of the year, 153 in the second, 37 in the third, and 145 in the fourth quarter. Respiratory Diseases.—The death-rate from these diseases in Chelsea in 1905 was 3.47 per 1,000, as against 3.58 per 1,000 in 1904, 272 per 1,000 in 1903, and 4.14 per 1,000 in 1902. The London death-rate from respiratory diseases in 1905 was 3.02 per 1,000. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1905 was 1.81 per 1,000, as against 230 per 1,000 in 1904. The death-rate in London in 1905 from these diseases was 2 0 per 1,000. Of the 112 deaths from phthisis in Chelsea in 1905, 60, or 53 per cent., occurred in the Chelsea Workhouse Infirmary, and 9, or 8 per cent., in other public institutions. Cancer.—Malignant cancerous diseases caused 72 deaths amongst Chelsea residents in 1905, the average of the past 9 years being 77 deaths, the death-rate for 1905 being 0.97 per 1,000. Thirty-eight of the cancer deaths were of North Chelsea residents, and 34 of South Chelsea ressdents. Alcoholism.—Twenty-six deaths were registered in 1905 as being due to intemperance or cirrhosis of the liver, as against 18 in 1904, 21 in 1903, 26 in 1902, and 31 in each of the years 1900 and 1901. These annual figures merely represent the deaths which are palpably and unmistakably the results of alcoholic excess, and take no account of the far larger numbers which are indirectly due to alcohol. Deaths in Lunatic Asylums.—Forty-four deaths of Chelsea parishioners occurred in 1905 in lunatic asylums. The average of the 14 years 1891-1904 is 32 deaths annually in lunatic asylums. Deaths in Public Institutions.—In 1905, 46.3 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 42.4 per cent. in 1904. In London generally, 37 5 per cent. of the total deaths occurred in public institutions. The deaths in the Chelsea Infirmary in 1905 formed 247 per cent. of the total deaths of Borough residents, as compared with 22 3 per cent. in 1904. DEATH-RATES OF SPECIAL CLASSES OF THE POPULATION. In considering the lowered death-rates characteristic of recent years, which have resulted from improvements in sanitary administration and other causes, it becomes important to inquire to what extent different classes of the population, and especially the working classes, have benefited in the general improvement in health noticeable in the Borough generally. The following Table shows the average death-rates of the home district of Chelsea Parish and of the Borough of Chelsea for three 8 4-year periods—namely, 1893-6, 1897-1900, and 1901-1904—together with the corresponding rates for the inhabitants of industrial dwellings in Chelsea, and for the dwellers in eleven of the streets inhabited by the poorest classes in the district. The industrial dwellings are— Chelsea Park Dwellings, Guinness' Buildings, Marlborough Buildings, Onslow Dwellings, and Peabody Buildings, with a total population of about 2327; and the poor class streets are—Dartrey-road, Francisstreet, Gillray-square, Ives-street, Little Keppel-street, Oakham-street, Pond-terrace, Riley-street, Slaidburn-street, Stayton-street, and World's End-passage and the courts adjacent, with a total population of about 4130. Table VIII.—Average Annual Death-rates for Periods, 1893-6, 1897-1900, 1901-4, and for year 1905. Total Death-rates. Zymotic Death-rates. Death-rates from Phthisis and other Tubercular Diseases. 1893-6. 18971900. 1901-4. 1905. 1893-6. 18971900. 1901-4. 1905. 1893-6. 1897. 1900. 1901-4. 1905. Chelsea 19.7 18.5 16.6 14.9 3.2 2.6 1.7 1.2 2.6 2.4 2.1 1.8 Industrial* Dwellings 22.5 16.4 16.9 14.6 4.8 3.3 2.4 0.6 3.5 3.0 2.8 1.6 11 Poor-class Streets 34.6 33.7 26.3 23.7 7.5 7.0 3.7 2.7 4.3 4.6 4.1 3.9 * Includes Sir Thomas More Buildings for year 1905. The zymotic diseases are—small-pox, measles, scarlet fever, diphtheria, whooping-cough, enteric fever, and diarrhoea. General Death-rates.—The Table shows that whereas the general death-rate of the inmates of industrial dwellings compares favourably with that of the population as a whole, the death-rate of the poor class streets is very much higher than the general death-rate of the community—1893-6, 76 per cent, in excess; 1897-1900, 82 per cent, in excess; 1901-4, 58 per cent, in excess. The fall in the industrial dwellings death-rate in the second period (1897-1900), as compared with the first (1893-6), is especially noticeable, amounting as it does to a percentage reduction of 27. The deathrate of the eleven poor class streets fell but slightly in the second period as compared with the first, but in the third period there is a notable reduction of 24 per cent, in the rate as compared with the first period. The rates for the year 1905 are included in the Table; and although too much importance should not be attributed to yearly rates when applied to small populations, still they indicate that the improvement of recent years is continuing. Deaths at Special Ages.—The following Table shows the deaths at ages under 1, 1 to 5, and over 5, in the industrial dwellings and the poor class streets in each of the three periods. 9 Table IX.—Deaths in 4-yearly periods. Under 1. 1 to 5. Over 5. 1893-6. 1897-00. 1901-4. 1893-6. 1897-00. 1901-4. 1893-6. 1897-00. 1901-4. Industrial Dwellings 56 40 34 49 24 23 104 89 100 Poor-class Streets 169 127 108 132 113 65 271 317 261 This Table shows that, taking the whole period from 1893 to 1904, whilst the population of the poor streets is only 78 per cent, in excess of the industrial dwellings population, yet the deaths of infants under one year in the poor streets are 211 per cent, in excess, the deaths of children aged 1 to 5 years are 223 per cent, in excess, and the deaths of persons over 5 are 190 per cent, in excess of those occurring in the industrial dwellings. The percentage reduction of deaths of infants under 1 in the industrial dwellings population in the third period as compared with the first is 39 per cent., and in the poor class streets 36 per cent. The percentage reduction of deaths between 1 and 5 in these two periods are 53 per cent, for industrial dwellings and 51 per cent, for the poor class streets. To some slight extent this diminution in the deaths of infants and young children may be accounted for by the lower birth-rate of recent years ; but, on the whole, the larger proportion of infants and children's lives saved in recent years is probably attributable to improved sanitaxy conditions and the lesser incidence of zymotic diseases on the population. Zymotic Death-rates.—Table VIII. shows that the death-rates from the seven zymotic diseases are very much in excess in the population of the poor class streets of those recorded for the community at large. In the industrial dwellings there is also an excess, but it is not nearly so great. The larger proportion of children at susceptible ages in the working class populations is no doubt accountable for a small part of the excess, but does not explain the very great disproportions exhibited in the Table. The years 1893 to 1896 were marked by excessive incidence of scarlet fever and diphtheria, whilst the period 1897-1900 had several hot summers, and diarrhoea was very prevalent in these hot seasons. The encouraging feature in the Table is the very great reduction (50 per cent.) in the zymotic death-rate of the period 1901-1904 amongst the poor class street population as compared with the earlier periods. This is partly due to cool summer seasons and absence of serious epidemics, and too much importance, therefore, should not be attached to it; but so much of the reduced death-rate as is due to decreased enteric fever mortality is probably of a more permanent nature and independent of varying climatic conditions. Phthisis and Tubercular Diseases.—In the industrial dwellings populations these diseases show a steady and satisfactory diminution; and, having regard to social conditions, the death-rates are not excessive. In the poor class street population, however, these diseases claim an 10 excessive number of victims; and the diminution of death-rate in the later period as compared with the first is only a slight one (4.1 per 1,000 as compared with 4.3 per 1,000). The following Table separates the death-rates into those from phthisis—consumption of the lungs, the disease of adults—and those from other forms of tuberculosis, chiefly affecting children of tender years (0—5 years). Table X.—Average Death-rates per 1,000 from, Phthisis and other Tubercular Diseases. Phthisis. Other Tubcrcular Diseases. 1893-6. 1897-1900. 1901-4. 1893-6. 1897-1900. 1901-4. Chelsea 2.0 1.9 1.6 0.6 0.5 0.5 Industrial Dwellings 2.1 2.1 1.9 1.4 0.9 0.9 11 Poor-class Streets 3.3 3.6 3.3 1.0 1.0 0.8 The Table shows a slight diminution in phthisis in recent years amongst the industrial dwellings population, but practically none amongst the poor class street dwellers. Amongst the general community there is a distinct reduction in phthisis mortality in recent years. For the tubercular diseases of children there is no marked reduction in mortality amongst any class of the community, except in the period 1897-1900 in the industrial dwellings population as compared with the earlier period. These figures are suggestive of the greater attention that should be given to tubercular diseases amongst the poor. There appear to be two directions in particular in which improvement might be effected— namely—(1). The teaching and training of the future mothers of the working classes in all that appertains to the healthy rearing of children; and (2) The adoption of some system by which the children of the poor who are suffering from tuberculosis in its various forms could be removed into the country, and so spend the greater portion of their lives out of doors, until recovery is effected. Country and sea-side convalescent homes are sadly needed for this purpose; but probably much could also be accomplished by sending these children into country lodgings for lengthened periods under the system now so successfully pursued by the various Children's Country Holiday Funds for the fortnight's summer outing. As regards the diminution of phthisis mortality, the provision of open-air sanatoria for gratuitous treatment of cases would, no doubt, be to a certain extent effective, not only by reason of the probable arrest of the disease in many cases taken at a sufficiently early stage, which now pass almost uninterruptedly to a fatal issue, but also by reason of the practical training in methods of preventing the spread of the disease, which sanatoria patients undergo during their period of treatment. The routine methods of open-air life and cleanliness acquired by the patient in the sanatorium, are continued when he returns to his home life, and there is a likelihood of the simple precepts instilled into the sanatorium 11 patient becoming diffused and appreciated in the circles in which he moves. The main difficulty amongst the poorer classes is the fact that the early stage of phthisis is very often insidious in its onset, and that the persons affected do not seek medical advice and treatment until the disease has already progressed beyond the initial stage, irreparable damage to the lungs having already occurred, and the patient being not only unable to continue his employment, but being also unsuitable for sanatorium treatment by reason of the stage of the disease attained, and the doubtful prognosis for cure or arrest. There is also the difficulty experienced in persuading the bread-winner of families to stay for a sufficiently long period in the sanatorium to obtain permanent benefit. The question of the provision of gratuitous open-air sanatoria by the Metropolitan Asylums Board is still under consideration by the Local Government Board—the Board being understood to be awaiting a report by its expert medical advisers on the results so far attained by open-air sanatoria in this country and abroad. Of the 112 deaths from phthisis in Chelsea in 1905, 60, or 53 per cent. of the total, occurred in the Chelsea Workhouse Infirmary, and 9, or 8 per cent.. in other public institutions, so that only 39 per cent, of the total deaths from this disease occurred at the patients' own homes. The later stages of this disease being generally acknowledged to be the most dangerous as regards the communicability of infection to other members of the family or household, it is evident that amongst the poor the ability of the consumptive to spend his last days in the Infirmary is as much a gain to the public health as it is a mitigation of suffering to the dying person. Births and Deaths of Infants under One Year.—During the year 1905, 30 births were registered as occurring amongst the occupants of industrial dwellings in Chelsea (including Sir Thomas More Buildings, Beaufort-street). This is equal to a birth-rate of 25.6 per 1,000, as compared with a birth-rate of 21.3 per 1,000 for the whole Borough. The deaths of infants under one year of age numbered 8, which is equivalent to 100 per 1,000 births, or 10 per cent., as compared with a rate of 116 per 1,000 for the Borough. In the 11 poor class streets, 127 births were registered, equivalent to a birth-rate of 30.8 per 1000, and the deaths of infants under one year numbered 25, or at the rate of 197 deaths to 1,000 births. It follows, therefore, that whilst the birth-rate in these streets was 17 per cent, in excess of the birth-rate in industrial dwellings in Chelsea, the rate of infantile mortality was very nearly double (97 per cent. in excess) that of the industrial dwellings. INFANTILE MORTALITY. During the past year, 1905, there has been a very satisfactory decrease in the rate of infantile mortality in Chelsea (deaths of infants under one year to 1,000 births), and also in the deaths of children aged 1 to 5 years, as shown in the following Table:— 12 Table VII. Year. Chelsea. London. Deaths under one to 1,000 births. Deaths 1—5 years. Deaths under one to 1,000 births. Deaths 1—5 years. 1901 139 146 101 112 150 142 9,514 9,209 1902 145 151 141 9,893 1903 144 94 131 8,514 1904 155 102 145 8,915 1905 116 (20%) 65 (42%) 131 (8%) 8,209 (11%) The rate of infantile mortality has probably never been so low before, as it was in Chelsea in 1905, the average of the 8 years, 1897— 1904, being 150 per 1,000 in Chelsea, and 153 per 1000 in London generally. The Table also shows that whilst the reduction in 1905 in London as a whole was 8 per cent, for deaths under one year, and 11 per cent, for deaths between 1 and 5 years; in Chelsea it was as much as 20 per cent, and 42 per cent, respectively. It is curious that this remarkable reduction in child mortality coincides with the adoption of the system of supplying this office with all records of births in the Borough, which commenced January 1st, 1905, so that the Lady Sanitary Inspector, Miss Richardson, is now enabled to visit the homes of mothers of the working classes, and thus give advice and distribute leaflets on infant rearing and management. I understand that lady visitors in connection with St. George's Hospital are also working amongst the poor in Chelsea, visiting the Hospital's out-door maternity cases, and there are probably other district visitors who pay attention to this subject. I have no doubt that the work of these ladies has contributed to the excellent result that has been attained in the reduction of child mortality in the Borough. How great a proportion of the infantile mortality amongst the lower wage-earning classes is preventible, is apparent on comparing the rates amongst the occupants of industrial dwellings and of certain streets inhabited by the poorer classes (see ante). That some knowledge of infant management on hygienic principles will eventually be attained by working class mothers cannot be doubted; and, when this knowledge is more universally applied, it will no longer be the usual thing for one-fifth of the children born of such parents to die in their first year. From Table XV. (Local Government Board Tables) it will be seen that out of the total of 184 deaths of infants under one year of age, in Chelsea, in 1905, 70, or 38 per cent., occurred in the first four weeks of life, and 43, or 23 per cent., in the first week of life. The majority of these deaths in the first month of life appear to be due to developmental defects and want of vitality on the part of the infant. For instance, the deaths of 32 infants are ascribed to premature birth, 6 to atrophy, debility, and marasmus (wasting), 5 to congenital defects of important organs, 4 to inability to suckle, and 5 to convulsions. Such causes of death point rather to weakness of stock, 13 or unfavourable conditions reacting upon the mother during the later months of pregnancy, e. g., poverty, defective nutrition, or having to go out to work to earn a living. Such conditions are almost inevitable under the present economic and social circumstances of the poor. Six deaths of infants from injuries at birth, and two from suffocation due to overlaying, are to some extent the effect of carelessness, ignorance, and want of attention, and therefore preventable. Between the ages of one month and 12 months 114 deaths, 62 per cent. of total, were registered in 1905, 26 of these being due to diarrhœa, and 5 to enteritis, 10 to whooping cough, 19 to bronchitis, 10 to pneumonia, 7 to convulsions, and 5 to congenital syphilis. A certain proportion of these deaths are doubtless those of infants of congenitally weak constitution, who have survived the first four weeks of life. But a considerable proportion represent the toll that is paid for parental ignorance, carelessness, and neglect, which are partly the result of those conditions of poverty that must hamper the best-intentioned mothers, when they are unable to provide either themselves or their offspring with suitable nourishment, or which compel them to leave their homes for the greater part of every day, in order to seek their livelihood, but which are also to some extent the result of ignorance as to how children should be healthily reared. Such ignorance is now being combatted by the visits to the homes of the mothers of recently-born children already alluded to. More good, perhaps, will in future be effected by teaching the elementary principles of health to girls in the public schools of the country. Whilst it is in the direction of education and sanitary enlightenment that the greatest progress will be made; still, well directed charitable effort might do more than it at present accomplishes to relieve those conditions of poverty and distress that press especially upon the expectant mother, and the mother who has both to earn a living and bring up a baby, duties which are incompatible, and from which the child is the principal sufferer. 14 TABLE XI.— (i.) FOR WHOLE DISTRICT. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions in Chelsea. Deaths of non-residents registered in District. Deaths of residents registered beyond District. Deaths at all Ages. Nett. No. Rate.* No. Rate per 1000 Births registered. No. Rate.* No. Rate.* 1. 2 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 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 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 Chelsea Borough. 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 Averages for years 1901-1904 74,093 1593 21.5 232 146 1689 22.8 971 622 165 1232 16.6 1905 74,496 1585 21.3 184 116 1606 21.6 1012 663 163 1106 14.9 * 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. At Census of 1901. Area of District in acres Total population at all ages 73,856 (exclusive of area covered Number of inhabited houses 9,063 by ater) 660 , Average number of persons per house 8.1 15 TABLE XII.—(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 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. (a.) (b.) (c.) (d.) (a.) (b.) (c.) (d.) (a.) (b.) (c.) (d.) 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 Chelsea Borough. 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 Averages of years 19011904. 74,093 1593 1232 232 42,656 873 658 126 31,436 720 574 106 1905 74,496 1585 1106 184 42,890 831 577 78 31,535 754 529 106 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 parjshes, 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 up. (b.) 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 sub-columns a, bt 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. 16 TABLE XIII.—(ill.) CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1905. Notifiable Disease. Cases notified in Whole District. Total cases notified in each Locality. No. of Cases removed to Hospital prom each Locality. At all Ages. At Agest—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. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 52 3 16 20 6 7 ... 19 33 13 32 45 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 76 ... 1 11 7 53 ... 36 40 ... ... ... Scarlet Fever 229 3 60 141 16 9 ... 127 102 114 97 211 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 16 ... 2 3 3 8 ... 11 5 11 4 15 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 11 ... ... ... 4 7 ... 4 7 3 2 5 Plague ... ... ... ... ... ... ... ... ... ... ... ... Totals 384 6 79 175 36 84 4 197 187 141 135 276 Note.—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. 17 TABLE XIV.—(iv.) CAUSES OF, AND AGES AT, DEATH DURING YEAR 1905. 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 5 ... 5 ... ... ... ... 1 4 ... Scarlet Fever 9 1 3 4 ... 1 ... 6 3 ... Whooping-cough 20 11 9 ... ... ... ... 11 9 2 Diphtneria and Membranous Croup 5 1 4 ... ... ... ... 2 3 ... Croup ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... Enteric 3 ... 1 ... 1 1 ... ... 2 1 Other continued ... ... ... ... ... ... ... ... ... Epidemic Influenza 15 2 1 ... ... 5 7 8 7 7 Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhoea (see Notes at foot) 33 26 2 ... ... 2 3 14 19 22 Enteritis (see Notes at foot) 13 7 1 ... ... 3 2 7 6 2 Puerperal Fever (see Notes at foot) 1 ... ... ... ... 1 ... ... 1 2 Erysipelas 2 ... ... ... ... 2 ... 2 ... 3 Other Septic Diseases 9 1 ... ... ... 6 2 2 7 5 Phthisis 112 ... ... 4 9 94 5 70 42 126 Other Tubercular Diseases 22 2 8 3 3 5 1 12 10 42 Cancer, Malignant Diseases 72 ... 1 ... ... 51 20 38 34 125 Bronchitis 153 18 14 1 1 30 89 84 69 75 Pneumonia 77 11 6 1 ... 38 21 31 46 35 Pleurisy 3 ... ... ... ... 1 2 ... 3 5 Other Diseases of Respiratory Organs 25 3 4 2 ... 12 4 13 12 15 Alcoholism—Cirrhosis of Liver 26 ... ... ... ... 21 5 18 8 6 Venereal Diseases 9 7 ... ... ... 2 ... 4 5 2 Premature Birth 32 32 ... ... ... ... ... 13 19 3 Diseases and Accidents of Parturition 1 ... ... ... ... 1 ... ... 1 ... Heart Diseases 116 2 ... 6 ... 57 45 70 46 53 Accidents 37 7 3 1 1 18 7 21 16 13 Suicides 11 ... ... ... 1 9 1 5 6 1 Appendicitis 6 ... ... ... 3 3 ... 4 2 4 Rheumatic Fever 1 ... ... ... ... 1 ... 1 ... ... Diabetes 7 ... 1 ... ... 6 ... 3 4 4 Tetanus ... ... ... ... ... ... ... ... ... 1 All other causes 281 53 2 2 7 99 118 136 145 191 All causes 1106 184 65 24 32 469 332 577 529 739 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 (rt), 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 "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 Diarrhœa. Summer Diarrhœa; Dysentery and Dysenteric Diarrhœa; Choleraic Diarrhoea, 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 Diarrhoea secondary to some other well-defined disease should be included under the latter. Under the headings of " Cancer" and " Puerperal fever" should be included all registered deaths from causes comprised within these general terms. 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. c 18 TABLE XV.—(v.) INFANTILE MORTALITY DURING THE YEAR 1905. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 1 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. Common Infectious Diseases— Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Diphtheria: Croup ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Whooping Cough ... ... ... 1 1 1 ... ... ... 1 2 2 1 1 2 ... 11 Diarrhoeal Diseases— Diarrhoea, all forms ... ... ... ... ... 5 2 2 2 4 2 2 1 3 3 26 Enteritis (not Tuberculous) ... 1 1 ... 2 ... ... 2 ... 1 1 ... ... 1 ... ... 7 Gastritis, Gastro-intestinal Catarrh ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... 2 Wasting Diseases— Premature Birth 24 4 3 1 32 ... ... ... ... ... ... ... ... ... ... ... 32 Congenital Defects 3 ... 2 ... 5 2 ... ... ... ... ... ... ... ... ... ... 7 Injury at Birth 6 ... ... ... 6 ... ... ... ... ... ... ... ... ... ... ... 6 Want of Breast-milk 4 ... ... ... 4 2 ... 1 ... ... ... ... ... ... ... ... 7 Atrophy, Debility, Marasmus 2 2 1 1 6 3 2 1 ... ... ... ... 1 ... ... ... 13 Tuberculous Diseases — Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 8 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... 1 ... 2 2 1 1 1 ... ... ... ... ... ... ... 7 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 3 Convulsions 2 2 1 ... 5 2 1 1 ... 2 ... 1 ... ... ... ... 12 Bronchitis ... ... 2 ... 2 1 2 3 2 2 3 ... 2 1 1 2 21 Laryngitis ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... 3 Pneumonia ... 1 ... ... 1 1 ... ... 1 1 1 2 2 ... ... 2 11 Suffocation, overlaying 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Other Causes ... ... 1 ... 1 2 ... 2 2 ... ... ... 1 1 ... ... 9 All Causes 43 10 13 4 70 23 9 15 9 13 9 8 8 9 6 5 184 Births in the year 1,585 Deaths from all Causes at all Ages 1,106 Population, estimated to middle of 1905 74,496 19 Section II. INFECTIOUS DISEASES. Small-pox.—There were no cases of small-pox in Chelsea in 1905. In London, during the year 1905, only 74 cases of the disease were notified, as against 492 in 1904, and 417 in 1903. The majority of the 74 cases were notified in the Eastern and Southern Boroughs, only four cases occurring in the Western Boroughs, namely—two in Paddington, and two in Westminster. Thirty-four cases were notified in the first quarter of the year, 33 in the second, 6 in the third, and 1 in the fourth quarter. The case mortality, or percentage of deaths to attacks of the 74 London cases, was 13.5 per cent., as compared with a fatality of 51 per cent. in 1904, 31 per cent. in 1903, and 16 4 per cent. during the epidemic period 1901-2. Scarlet Fever.—This disease was more prevalent in Chelsea in 1905, than it has been since 1898. As many as 229 cases were notified, equivalent to a case-rate of 30.7 per 10,000 of the population, as against only 145 per 10,000 in 1904. The number of cases notified in the first quarter of the year was 43, in the second quarter 49, in the third quarter 51, and in the fourth quarter 86. There was a marked autumnal rise in prevalence towards the end of September, the prevalence remaining high until the end of November. The number of cases notified during the year in North Chelsea was 127, and in South Chelsea 102. The percentage of cases at school ages (3 to 13 years) to the total number of cases in the Borough was 79 per cent., as compared with 72 per cent. in 1904. The average duration of the stay in hospital of 174 cases, of which the records are to hand, was 62 days, as against 65 in 1904. Twelve 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 12 cases was 21 days. Ten cases on discharge from the M.A.B. hospitals were stated to be still suffering from nasal discharge; but, so far as known, none of the cases of rhinorrhœa were the means of spreading infection. During the year there were three " return " cases of scarlet fever, the intervals elapsing between the return home from hospital of the infecting case and the onset of the disease in the secondary case being respectively two, four, and five days. There was no special incidence of scarlet fever upon any particular school or schools during the course of the year; but there was an outbreak in the children's wards of the Chelsea Infirmary during November of a somewhat anomalous character, eight children and five of the nursing staff being attacked and removed to the M.A.B. hospitals. Four of these 13 cases were subsequently certified by the M.A.B. c 2 20 Medical Superintendents not to be suffering from scarlet fever. One case, a child of one year, had a fatal termination. In several of these cases the symptoms were by no means distinctive of scarlet fever, but they were intermingled with other typical cases of the disease, and it seemed probable that all the cases had a common origin, and were due to scarlet fever infection. Diphtheria —Only 52 cases of diphtheria were notified in Chelsea in 1905, equivalent to a case-rate of 7.0 per 10,000 of the population, the lowest rate recorded since compulsory notification commenced. In 1904 the diphtheria case-rate was 8.2 per 10,000, and in 1903 13 4 per 10,000. In twenty weeks of the year not a single case of diphtheria was notified in the Borough. In the first quarter of the year 11 cases were notified, in the second quarter 9, in the third quarter 16, and in the fourth quarter 16. The percentage of cases of school age (3 to 13 years) to the total cases in the Borough was 58 per cent., as against 67 per cent, in 1904. In North Chelsea 19 cases were notified, and in South Chelsea 33. There were no outbreaks in the course of the year specially attributable to school infection. There was no autumnal increase in prevalence of the disease. The average duration of stay in hospital of 29 cases, of which the records are to hand, was 50 days, as against 54 in 1904. Five cases admitted to the M.A.B. hospitals were subsequently certified by the Medical Superintendents of those institutions not to be suffering from diphtheria or any other notifiable disease. The average duration of stay in hospital of these 5 cases was 19 days. During the year medical practitioners sent 12 throat swabbings to the Lister Institute for bacteriological diagnosis, the costs being defrayed by the Borough Council. Enteric Fever.—The number of cases of enteric fever notified in Chelsea in 1905 was 16, as against 13 in 1904, the case-rate again being a low one namely, 215 per 10,000 of the population. Two cases were notified in the first quarter of the year, 4 in the second, 4 in the third, and 6 in the fourth quarter. In North Chelsea 10 cases were notified, in South Chelsea 6 cases. Three out of the 16 cases had a fatal termination. Out of the 16 cases, in 3 the infection of the disease was contracted outside the Borough of Chelsea. None of the cases were attributed to the consumption of infected shell-fish. One case admitted to a M.A.B. hospital was subsequently certified by the Medical Superintendent of that institution not to be suffering from enteric fever or any other notifiable disease. The duration of stay in hospital in this case was 22 days. The duration of stay in hospital of 6 other cases, which had the disease and recovered, was respectively 95 days, 53 days, 64 days, 42 days, 51 days, and 41 days—average. 51 days. 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 16 years, 1890—1905. 21 Table XVI.—Case Mortality in Chelsea, and in London, 1890.1905. 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 23.9 136 17.2 1893 5.3 4.3 234 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 18.4 170 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 3.4 151 14.8 250 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 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 1905 4.0 2.8 9.6 8.5 18.8 15.7 The diphtheria case mortality in London in 1905 was the lowest on record, and is an indication of the success with which the anti-toxin treatment of this disease is now being applied. 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 borough. Table XVII.—Notifications per 10,000 of Population in 1905. Scarlet Fever. Diphtheria. Enteric Fever. Chelsea 30.7 7.0 2.1 Kensington 18.4 6.9 2.7 Paddington 18.9 6.6 3 0 Hammersmith 30.2 20.3 3.5 Fulham 49.6 18.2 3.6 Westminster 21.0 6.9 2.3 West London 27.5 10.8 2.9 London 41.6 13.9 3.3 22 As usual the prevalence of all these diseases was less in West London than in the Metropolis as a whole. Chelsea had the lowest enteric fever case-rate, but the rates in all the boroughs are exceptionally low for this disease in 1905. Chelsea's scarlet fever case-rate is below that of Fulham, but is equal to that of Hammersmith, and considerably above those of Kensington, Paddington, and Westminster. Chelsea's diphtheria case-rate is very nearly as good as those of Paddington, Kensington, and Westminster, and is very much below those of Hammersmith and Fulham. Last year Fulham, after for many years in succession holding the worst position amongst the Western boroughs for diphtheria, was slightly better than Hammersmith in this respect, but its scarlet fever prevalence was unusually high. Removals to Hospitals.—Table XVIII. exhibits the removals of patients suffering from scarlet fever, diphtheria, and enteric fever, to the M.A.B. and other hospitals, in each of the 16 years, 1890-1905, expressed as percentages of the total number of cases of each disease notified. Table XVIII.—Cases removed to Hospital per cent. of Total. 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 1905 92 87 94 There was no delay in effecting the removal of any Chelsea cases to the M.A.B. hospitals. Voluntary Notification of Phthisis.—During 1905, 24 cases of pulmonary tuberculosis were notified by medical practitioners, as against 16 in 1904. Fifteen of these cases were notified by one medical practitioner, 5 by another, 2 by another, and one each by two other practitioners. The Master of the Chelsea Workhouse has continued to supply information as to cases of phthisis leaving the Workhouse and Infirmary for their homes in the borough—to a 23 considerable extent common lodging-houses; and cases of the disease have also been notified by the Lady Almoner of St. George's Hospital. The cases were visited at their homes by the lady sanitary inspector, and leaflets of precautions, pocket spittoons, disinfectants, and fibre handkerchiefs were distributed where considered necessary. Puerperal Fever.—Eleven cases of this disease were notified in 1905, as against 7 in 1904, but in two cases the women, who lived in Chelsea, were confined in hospitals outside the Borough, and therefore did not contract the infection in Chelsea. Only one case proved fatal. Under an arrangement made with the London County Council, the authority for administering the Midwives Act, means are now provided by this Department for disinfecting the clothing and instruments of any certificated midwife that may be in attendance, as well as the bedding and room occupied by the patient. Instructions are also given to the midwife as to when she is at liberty to resume her avocation. 24 Section III. THE HOUSING OF THE WORKING CLASSES. Sir Thomas More Buildings. Winchester and Dacre Houses were opened respectively for occupation on the 16th January and the 6th February, 1905, Kingsley, Burleigh, and Cadogan Houses having been opened in November and December, 1904. The houses were fully occupied by the end of February, the total number of persons, excluding staff, being 798, of whom 220, or 27'5 per cent., were children under the age of 10 years. The present density of population is about 500 persons per acre ; and there is an average of 1.4 persons per room, the average amongst working class families in Chelsea being 15 to 16 persons per room. Out of the total number of 259 tenants or heads of families, 150, or 58 per cent., previously resided in the Borough, when their applications for tenancies were made. Of the remainder, 25, or 10 per cent., although actually non-resident, were working in Chelsea, so that 175, or 68 per cent., of the total number of tenants were connected with the Borough, either by residence, work, or both combined, before they became the Borough Council's tenants. Out of the total number of tenants or heads of families, 196, or 76 per cent., were married on commencing their tenancies. The average weekly earnings of the tenants, as computed from their application forms, are £1 10s. 10d.; the average weekly earnings of the 37 one-room tenants being 18s. 9d, of the 128 tenants of two rooms £1 10s., and of the 94 tenants of three rooms £1 16s. 10d. The tenants of one and two roomed tenements, therefore, each pay on an average 21 per cent. of their weekly earnings in rent, the tenants of the three-roomed tenements paying 24 per cent. Cost of Land and Buildings.—The costs of land and buildings as finally settled, and of other items properly chargeable to capital account, are as follows:— £ s. d. Land 12,500 0 0 Costs of Conveyance 200 0 0 Buildings 51,704 14 5 Ancient Lights Settlement 221 0 0 Cost of Architectural Competition 105 0 0 Architect's Commission at 5 per cent. 2,585 4 7 Clerk of Works' Salary 379 15 0 Costs of Loan of £57,000 220 0 0 £67,915 14 0 The gross annual rental of the Buildings should produce £4,690 on the rents now being charged, after deducting the rents of the rooms in the Buildings occupied by the Superintendent and the two Porters. 25 The net annual rental, after deducting 39 per cent, of the gross rental for outgoings (£1,847) is estimated to produce £2,843. This amount will pay £4 3s. 6d. per cent. on the total capital outlay of £67,915 14s. The assessment of the Buildings for rating purposes is £3,355 gross and £2,580 rateable value. From a statement prepared by the Borough Treasurer it is estimated that in the year 1926 the estimated net rental will be sufficient to meet the annual instalments and interests on the loans; and the Buildings subsequent to 1926 will become year by year increasingly remunerative. The total estimated deficiency for the years 1904 to 1925 inclusive is £10,057, equivalent to an average annual sum of £457, which will be a charge on the general rate of the Borough. Owing to the net cost of the Buildings being less than the estimate by the sum of £2,300, the final instalment of the loan of £57,000 from the Prudential Assurance Company was reduced by this amount, so that the loan as finally settled stands at £54,700. A statement showing the income of and expenditure upon the Buildings for the year ended the 31st March, 1905, is given:— For the Year ended the 31st March, 1905. Expenditure. Income. £ s. d. £ s. d. General Charges 518 3 4 Rents 1,281 3 1 *Ancient Lights Compensation 221 0 7 Balance, being charge on General Rate 598 10 10 Interest on Loans 915 10 0 Repayment of Loans 225 0 0 £1,879 13 11 £1,879 13 11 The Year 1905. On the 28th June, Mr. F. Shorey, the Superintendent of the Buildings, was dismissed for irregularities in his accounts, and he was subsequently prosecuted for embezzlement of the Council's moneys and sentenced to two months' imprisonment. On the 26th July, Mr. A. J. A. Cottrell was appointed Superintendent at a salary of 35s. per week, with gas and uniform, and three rooms in the Buildings. Since the opening of the Buildings in November, 1904, up to the 31st December, 1905, 32 tenants had voluntarily terminated their tenancies, and 9 tenancies had been terminated by the Committee by notice to quit—total 41. All the vacant tenements are at once re-let, there being still a very great demand for accommodation in the Buildings. Vital Statistics.—During the year 21 births (11 boys, 10 girls) have been registered amongst the occupants of the Buildings, which is * This amount might have been charged to Capital Account, but was provided for in the Annual Estimates. † Rents were first received on 7th November, 1904, for one house only; for the entire Buildings on 6th February, 1905. 26 equivalent to a birth-rate of 27.6 per 1,000, the birth-rate for the Borough being 213 per 1,000. Eight deaths of residents of the Buildings have occurred during the year, equivalent to a death-rate of 10 5 per 1,000, the death-rate of the Borough being 149 per 1,000. Deaths at Sir Thomas More Buildings in 1905. Age. Sex. Occupation. Disease. 14 hrs. F. D. of Billiard Marker Premature birth. 2 mos. M. S. of Plasterer Convulsions. 26 yrs. F. W. of Carman Pneumonia, Bright's disease. 35 „ M. Butler Nephritis, Cerebral haemorrhage. 38 „ M. Telegraph Wireman Fracture of skull, accidental. 42 „ M. Missionary Cerebral haemorrhage. 63 „ F. Wid. of Gas Labourer Chronic bronchitis. 80 „ M. Journeyman Tailor Bronchitis. The 2 deaths of infants under one year of age are equivalent to a rate of 95 per 1,000 births (Chelsea 116). Eight cases of scarlet fever were notified in the Buildings during the year, but not any of diphtheria, enteric fever, or other notifiable disease. Onslow Dwellings. The following statement shows the income of and expenditure on Onslow Dwellings during the year ended 31st March, 1905:— For the year ended 31st March, 1905. Expenditure. Income. £ s. d. £ s. d General Charges 544 0 0 Rents 1,426 13 6 Interest on Loans 620 4 2 Sales 0 2 0 Loans repaid 354 0 0 1,426 15 6 Balance, being charge on General Rate 91 8 8 £1,518 4 2 £1,518 4 2 In July, 1905, the Borough Council, on a report from the Housing Committee, resolved that certain structural alterations and improvements to the Dwellings should be carried out, as recommended by the architects, Messrs. Joseph and Smithem, who reported, as a result of a survey they were instructed to make, that the stone balconies giving access to the various tenements required strengthening, whilst the end wall of one of the Blocks would have to be underpinned and repaired owing to settlement. The buildings having been erected about the year 1860, and having been in continued occupation since that date by working class tenants, 27 had necessarily undergone some structural deterioration from wear and tear; and it was considered by the Housing Committee that such reparations should be carried out as were necessary to put the Dwellings in good structural repair and sound tenantable condition. In July, 1905, it was resolved by the Finance Committee of the Borough Council that the expenditure incurred in the execution of these repairs should be defrayed out of the current rate, and not raised by loan. As there was some doubt as to the stability of the balconies, it was considered advisable that they should be shored up with timber at the weaker spots, and this work was carried out during the summer at a cost of £53. The architects' estimate for the works approved by the Borough Council was as follows:— Strengthening and readjustment of balconies £ 450 Pointing of brickwork 320 External painting 100 Repairing joinery 30 General repairs 50 Internal painting 150 Rendering and distempering staircases 105 Repairing brickwork and underpinning. 120 £1,325 In January, 1906, the Borough Council accepted tenders for these repairs, as under:— For general repairs, Mr o. Craske £ 1,298 For plastering, Mr. J. Bickley 147 1,445 Less amount to be allowed for timber shoring of balconies 25 £1,420 The Year 1805.—At the end of October, Mr. Cottrell, the Superintendent of the Council's Dwellings, took over the duties of management and rent collection from Mr. Metzler, Sanitary Inspector, who had performed these duties since the Council acquired the Dwellings in April, 1903. Vital Statistics.— During the year 1905, 6 births were registered amongst the occupants of the Dwellings (1 boy, 5 girls), these births being equivalent to a birth-rate of 13.3 per 1,000. Seven deaths were registered during the year, equivalent to a death-rate of 15.6 per 1,000. 28 Deaths at Onslow Dwellings in 1905. Age. Sex. Occupation. Disease. 3 yrs. M. S. of Packer Tuberculosis. 6 „ F. D. of Postman Heart disease. 43 „ M. Postman ... Aortic aneurism. 52 „ F. W. of Club Porter Bronchitis. 53 „ M. Clerk Coal-gas poisoning: suicide. 58 „ M. Stableman Pleuropneumonia. 83 „ F. None Hemiplegia. Three cases of scarlet fever were notified during the year amongst children residing in the Dwellings, but there were no cases of diphtheria, enteric fever, or other notifiable disease. Pond Place. In June, 1905, the houses Nos. 21, 23, 25, 27, 29, and 31, Pondplace, the leasehold interests in which had been acquired in the year 1904 for the sum of £535, were by order of the Borough Council demolished, and the land cleared for building. In July, 1905, the Borough Council, upon the recommendation of the Housing Committee, resolved to erect dwellings on the Pond-place site, similar to the Sir Thomas More Buildings erected in Beaufort-street, and adopted the plans submitted by the architects, Messrs. Joseph and Smithem. Messrs. Joseph and Smithem's plans provide for the erection of a 4-storeyed building (including half-basement) on the site, which has an area of about 8,500 square feet, but of this area a certain proportion will have to be given up for the purpose of widening Pond-place. The design submitted provides for 8 two-room tenements, and 24 three-room tenements. The tenements will all be self-contained, i.e., each with its own kitchen-scullery and balcony with w.c. The superficial areas of the rooms will be as follows:— 2-room, tenement Living-room 170 feet. Bed-room133 „ 3-room tenement (small). Living-room 168 „ Bed-room125 „ Bed-room104 „ 3-room tenement (large). Living-room 170 „ Bed-room133 „ Bed-room 130 „ Every tenement will be entered from a lobby having a space for hanging hats and coats. Every living-room will be provided with a dresser, and every bed-room with a dress cupboard; and the kitchenscullery will be fitted up with a sink, cupboard, and copper for washing clothes. On the balcony a combined food cupboard and coal bunk is shown, properly ventilated into the external air. Every room will be provided with a fire-place. The building will be finished in the same manner as Sir Thomas More Buildings in Beaufort-street. 29 Estimated Cost. £ £ Land, Nos. 21-31, Pond-place, Freehold 2,300 „ „ „ Leases 535 2,835 Building ... 8,231 Architects' Commission ... 411 Clerk of Works' Salary ... 158 £11,635 Estimated Revenue. £ s. d. 8 2-room tenements at 7/6 per week ... 3 0 0 14 3-room „ „ 9/- „ ... 6 6 0 10 „ „ „ 9/6 ... 4 15 0 Average weekly rent per room 3s. 2d. 52 Gross rent per annum ... 730 12 0 Deduct 39% for outgoings ... 284 18 8 Net rent per annum ... £445 13 4 or sufficient to pay interest at the rate of £3 16s. 7¼per cent, per annum, on the total capital outlay of £11,635. The following Table will be of interest as showing some of the points of comparison between the suggested Pond-place scheme and the Beaufort-street scheme as carried out:— Pond-place. Beaufort-st. Cost of land per sup. ft. 6s. 8d. 3s. 7d. Cost of building (contracts) per room £93 10s. £88 13s* Number of tenements 32 261 Number of rooms 88 579† Total accommodation (adults) 141 992 Density of population per acre 723 620 Average superficial area of tenement per head 116.5 sq. ft. 107 sq. ft. Average cubic capacity of tenement per head 990 c. ft. 910 c. ft. Average weekly rent per room 3s. 2d. 3s. l£d. Average weekly rent per sup. ft. of tenement 0.2d. 0.2d. Return per cent. on total capital outlay £3 16s. 7d. £4 3s. 6d. The Pond-place scheme, as compared with the Beaufort-street scheme, is under the disadvantage that the cost of acquiring and clearing the land has been proportionally 86 per cent. in excess of Beaufort-street. • This includes Superintendent's Rooms and Office, Baths, Drying Room, Store Rooms and Shelters. † Not including Superintendent's Rooms and Office. 30 A statement prepared by the Borough Treasurer shows that, assuming a loan of £8,800 can be obtained for the building works at 3§ per cent., repayable by equal annual instalments in 60 years, in the year 1927 the net annual rental of the Buildings will be sufficient to meet the instalments and interests due on this loan (£8,800) and on the loan of £2,300 for the land (£2,300 at 3½ per cent. for 60 years). The Buildings subsequent to the year 1926 will become year by year increasingly remunerative. The total estimated deficiency for the years 1908-1926 inclusive is £1,153, equivalent to an average annual sum of £61. which will be a charge on the general rate of the Borough. In November, 1905, the Borough Council accepted tenders for the erection of the Buildings, as follows:— £ Messrs. Higgs & Hill, Ltd., Foundation and Superstructure 7,330 Messrs. Bickley, Artificial Stone and Plastering 1,232 £8,562 The Council appointed Mr. G. Farmer, Clerk of the Works, at a salary of £4 4s. per week, Mr. Farmer having been employed in a similar capacity at Sir Thomas More Buildings; and the contractors commenced work on the 4th December, 1905. HOUSES DEMOLISHED OR VACATED FOR DEMOLITION DURING THE YEAR 1905. HOUSES. Eden-place 7 Selah-place. 4 Pond-place 8 Hope Cottage, Pond-place 1 Leader-street 3 Beaufort-street 6 Marlborough-place 9 Camera-cottages 9 47 Taking the number of persons per house as 6, 282 persons have been displaced during 1905 as the result of demolitions. The houses Nos. 1-9, Camera-cottages, were closed by order of the Magistrates as unfit for human habitation, my attention having been specially called to the condition of these houses by the occurrence of two cases of enteric fever in one of the houses in the spring. The following description of the houses is of interest as representing a type of dwelling formerly very common, but now gradually being improved out of existence. Camera-cottages is a court entered by an archway from Little Camera-street, and contains 15 houses. The eight houses on the West side are one-storeyed, two-roomed cottages, back-to-back with the paper factory in Park-walk, and in consequence hav.e windows on one side 31 only, and no through light or ventilation. The lower rooms are only ft. in height, but the upper rooms are more lofty. The water-closets and wash-houses—one for each house—are in the court abutting on the front walls of the houses, and very close to the windows of the lower rooms. Owing to the neglect and carelessness of the tenants, the w.c.'s are frequently choked and overflowing. The house on the South side of the court is a two-roomed building, also without through light or ventilation, the w.c. being inside the house and without any window opening to the external air. The 6 houses on the East side of the court are also one-storeyed and two-roomed, but they have small back yards, and are not back-to-back with other buildings, consequently they have a certain amount of through ventilation. These houses are not included in the closing order. The houses scheduled for closure are old, worn out, and dilapidated. The walls are damp, the roofs defective, and the woodwork and plaster rotten. The rooms are dirty and verminous. Owing to the dilapidations and defective structural conditions, it is impossible to put the houses into a proper state of tenantable repair, that will be of anything but a very temporary character. The lease of the property has 9 years to run, expiring in 1914. The rents are 6s. per cottage per week, or 3s. for a single room, some of the houses being occupied by two families. After the houses were closed, they were demolished by the owner. 32 Section IV. THE SANITARY CONDITION OF THE BOROUGH. The tabular statements prepared by the Sanitary Inspectors show that 1,519 separate premises were reported on by them during 1905, 383 of this number being with reference to cases of notifiable infectious disease, and 492 in the course of house-to-house inspections made in certain of the poorer streets of the Borough. It has been necessary to take legal proceedings for breaches of the Public Health (London) Act in respect of 9 houses, and in one case of emission of black smoke. Drainage.—During the year 85 new drains for single houses have been reconstructed in accordance with the Council's drainage regulations. Combined Drainage.—Eleven systems of combined drainage, for which the owners of the houses were responsible, were sanctioned by the Council in the course of the year. The Borough Council was not called upon in 1905 to undertake the reconstruction of any systems of combined drainnge, which were sewers vested in the Council. The total amount expended by the Council in reconstructing systems of combined drainage, which were sewers vested in the Council, from 1896 to 1904 inclusive has been £495 0s. 8d., equivalent to an annual outlay of £55. School Drainage.—At the request of the Managers of St. Luke's Schools (King-street and Markham-street), the drains of these schools were examined and tested, and certificates were given by the Medical Officer of Health that the drains were watertight, as required by the School Authority, the London County Council. The drains of St. Mary's (Roman Catholic) Schools, Cadogan-street, were also very carefully examined and tested by the Medical Officer of Health and Chief Sanitary Inspector in the autumn, at the request of the School Managers; but as some of the drains were found to be defective, no certificate was given. A very careful report with plans was prepared and forwarded to the School Managers, showing the nature of the works required to make the drains watertight, as required by the London County Council. It does not appear that this work of reparation of drains has yet been carried out at St. Mary's Schools. Inspection of Restaurant Kitchens, 1905. Number of restaurant and hotel kitchens 68 „ inspections made 99 „ premises found satisfactory 44 „ premises with sanitary defects 24 „ notices served 24 Disinfection and Verminous Houses.—During the past year 379 premises have been disinfected after cases of infectious or other disease, 33 42 of these being rooms which had been in occupation by persons suffering from phthisis. In addition 30 rooms have been disinfected, and 37 have been stripped and cleansed by the owners, for the purpose of destroying vermin (lice, bugs, &c.), under the powers conferred by the London County Council (General Powers) Act, 1904. A larger number of verminous premises might have been disinfected during the year, had the disinfecting staff been capable of doing the work; but owing to the pressure of other work, when notifiable infectious diseases are at all prevalent, a staff of two disinfectors is incapable of coping with the large number of verminous premises still to be found in the Borough. How large this number is, may be realised when it is stated that the enormous number of 1,980 flock or straw mattresses—all in a filthy and verminous condition—were sent to the disinfecting station to be destroyed in the incinerator during the course of the past year. These 1,980 mattresses represent approximately an equal number of bedrooms. It appears to me to be very desirable in the interests of public health and education (in the case of children), that not only should the verminous bedding be destroyed, but that a strong effort should be made to cleanse and disinfect and purify the verminous houses from which all these filthy mattresses come. With the advancement of medical science it is every year becoming more recognised what an important part the parasites that prey upon human beings exert in the dissemination of disease. The Sale of Food and Drugs Acts. During the year 407 samples were taken for analysis, including samples taken on delivery as supplied under contract to the Chelsea Workhouse and Infirmary and St. George's Workhouse and Infirmary. Of the 407 samples, 178 were milks, 164 being returned by the Public Analyst as genuine samples, 7 as of inferior quality, and 7 as adulterated. A prosecution was undertaken in one case, but the summons was dismissed on the production of a warranty by the vendor (see Tabular Statement). In the remaining 6 cases of adulteration there were no proceedings; in two because the adulteration was very slight, and in four because the vendors were protected by warranties. In these four cases the Local Government Board and Board of Agriculture were informed as to the reasons for not taking legal proceedings. Nothing has been as yet done to remedy the present unsatisfactory state of the law as regards the "Warranty Defence." Of butter, 117 samples were taken. 107 being returned as genuine, and 10 as adulterated. Proceedings were taken in 6 cases (see Tabular Statement). In the remaining 4 cases, the vendors were either protected by labels, or the amount of adulteration certified was insufficient to warrant legal proceedings. Twenty-four samples of margarine were submitted to analysis, one being returned as having a slight excess of water (no proceedings). Of cheese, 18 samples were taken, all being genuine; of coffee 15 samples, one being very slightly adulterated (no proceedings); of spirits 20 samples, two being in excess under proof, but protected by notices of dilution in the places where sold (no proceedings); of cayenne D 34 pepper 6 samples, one adulterated (fined 10s. and 10s. 6d. costs); of orange wine 9 samples, all genuine. Ten samples of quinine wine and 10 samples of iron wine were taken for analysis—one of the former and five of the latter were not in accordance with the requirements of the British Pharmacopoeia, so far as such requirements are specified; but as there does not appear to be any definite standard for the composition of these wines, no legal proceedings were taken. The vendors were, however, informed of the results of the analyses. The cod-liver oil cases which commenced in 1904, were concluded in 1905, all three summonses being dismissed, the Bench not being satisfied that the colour test laid down in the British Pharmacopoeia for the differentiation of foreign fish oils from cod-liver oil was adequate, upon which test the Chelsea Public Analyst relied, his conclusions also being confirmed by the chemist for the Inland Revenue Commissioners at Somerset House. 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. during the last week of July—the same temperature that was attained in the summer of 1904. The lowest temperature reached was 39° F. during the last week of January. Throughout the year the water was clear and free from any turbidity, with the exception of two days—the 24th and 25th November—when it was slightly cloudy. Water Supply to Tenement Houses.—Early in the year the London County Council wrote to the Borough Council to call attention to the decision of a magistrate at the Woolwich Police Court to the effect that the supply of water from a tap in the yard to a house let out in tenements is not a proper and sufficient supply within the meaning of Section 48 of the Public Health (London) Act, and expressing the hope of the London County Council that the Borough Council would take all possible steps to secure the provision of a proper and sufficient supply of water for the tenants of every floor of a tenement house. I reported fully on this matter to the Public Health Committee— a report which was subsequently presented to the Council on the 8th March. Since that time a decision of the Marylebone metropolitan stipendiary magistrate has been given on the question, which is exactly the reverse of the decision of the Woolwich magistrate; and it is evident that before any steps can be taken—in the words of the London County Council—to secure the provision of a proper and sufficient supply of water for the tenants of every floor of a tenement house, it will be necessary to have an amendment of Section 48 of the Public Health (London) Act, requiring in terms the provision of water supply and water supply fittings to every floor of a tenement house, which is let in separate tenancies on the various floors. In the report above alluded to, I also pointed out that a plentiful supply of water within easy reach of the upper tenements of a house would not carry with it its full advantage, unless means were also 35 adopted for enabling the tenants to dispose of their dirty water and slops with the same facility that they obtain the clean water. This means the provision of slop-sinks for the discharge of foul water from the upper storeys, and would in many instances necessitate structural alterations to the houses, and, if enforced by the Borough Council, an important extension of the scope of the work undertaken by the Public Health Department. Basement Workrooms. During the year two basement workrooms in Sloane-street have ceased to be occupied as such, and three new basement workrooms have come into occupation—namely, one in Holbein-place, one in Symonsstreet, and one in Sloane-square. In addition, I was asked to inspect another basement, which it was proposed to utilise as a workroom, but the conditions as regards light and ventilation were so unsatisfactory, that I recommended that this basement should not be used for such a purpose. There are at present, so far as known, in the Borough 19 basement workrooms occupied by milliners and dressmakers, with accommodation for 167 workers. The sanitary conditions of these basement workrooms are by no means satisfactory in respect of lighting, warming, ventilation, and in some cases aerial disconnection from water-closets. As stated in my Annual Report for 1904, I am of opinion that regulations should be made by the Secretary of State for the Home Department, prohibiting the use of underground rooms for workshops unless they complied with certain conditions. If such regulations were in force, architects in designing new buildings for use as shops on the ground floor and residential flats or sets of chambers on the upper floors, 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 d 2 36 period, which allowed owners and occupiers to make the necessary alterations after due notice. Smoke Nuisance. In November, 1905, proceedings under the Public Health (London) Act, were taken against the Underground Electric Railways of London Company, Ltd., for the emission of black smoke from the chimneys of the Company's electricity generating station at Lots-road. The magistrates convicted, and inflicted a fine of £10 with £2 2s. costs. As this generating station is probably the forerunner of many that will be established in London or its vicinity for the supply of electric current in bulk for motive power, a short description may be of interest. The building is an immense structure of steel girders and brickwork on the North bank of the Thames at Lots-road. It contains 64 Babcock and Willcox furnaces with revolving endless cast-iron chain grates, and automatic overhead slotted stokers for supplying the furnaces with soft coal. Each furnace has an incandescent combustion chamber at its front, the coal being fed on to the hot plate over the clinker hearth. The boilers are multitubular with steam drum overhead, and are fed with water at about 270° F. from the vertical tubes of Green's economisers, over which the furnace gases pass before entering the chimney flues. The vertical tubes of the economisers are scraped automatically by ascending and descending scrapers to prevent soot accumulations on the tubes. The furnaces and boilers are on the two upper floors of the building—32 on each floor. From 700 to 1,000 tons of coal per day will be consumed when the station is at full work. There are four chimneys, each 275 feet in height and 19 feet internal diameter at chimney top. There are eight turbine steam engines for generating current. The draught in the furnaces is regulated by dampers at various points. The steam is condensed under vacuum in the basement, where the condensers are placed, the water for condensing being pumped in from intakes near the centre of the bed of the river, and discharged at the same spot. All coal is hoisted by machinery to the top of the building, and fed direct from the bunkers to the automatic stokers. It is evident from the description that this class of furnace is not designed for, nor can it use Welsh or any form of hard, smokeless, steam coal. The heat generated by the use of such fuel would rapidly destroy the cast-iron chain grates. Consequently, the Company use a soft coal, which, unless burned with the aid of smoke-preventing appliances, as at Lots-road, generates smoke in large quantities. Owing to the immense quantity of fuel required to run the works, coal is obtained from a variety of collieries; and as the quality of the coal from different pits varies, some descriptions being more suitable for the furnaces than others, it is probable that this fact to some extent accounts for the emission of black smoke at times from the chimneys. There is also the difficulty caused by the varying load, furnaces having to be kept banked in case of an emergency ; these have to be suddenly brought into action when required, necessarily generating much smoke, if quickly pressed to increase the head of steam. Although during the past year a great deal of black smoke, at times 37 in dense volumes, has been emitted from the Lots-road works, it seems probable that with increasing experience, both as to the quality of coal best suited for the work, and as to the best methods of working the furnaces, that a fairly satisfactory result, qua smoke, will in time be attained, and that immense consumers of fuel, such as these generating stations, will not materially add to the general smokiness of the air of London. By rendering unnecessary individual steam installations for generating power, they will of course diminish the amount of smoke from the chimneys of works of all kinds, that is now an appreciable factor in the pollution of the atmosphere, not to mention the purification of the atmosphere of the underground Metropolitan and District Railways, which has already been effected. Deposit of Unconsumed Cinder Ash. As complaints continued to be received from the inhabitants of Redburn-street and other streets in the neighbourhood of the works of the Chelsea Electricity Supply Company, Ltd., the Borough Council on the recommendation of the Public Health Committee decided to take the opinion of counsel as to the powers possessed by the Borough Council for dealing with this class of nuisance. The opinion of counsel being favourable to action by the Borough Council, if a sufficiently strong case of injury and nuisance to the inhabitants by the deposit of unconsumed cinder ash could be presented, the Public Health Committee caused the distribution amongst the complainants of sheets for recording the dates and other circumstances attending upon the deposits of ash on their premises, which would guide the Committee in deciding upon the action to be taken in the matter. Since this course was adopted with a view to the gathering of evidence, very few complaints have been received from the former complainants in the neighbourhood of the Chelsea Electricity Supply Company's works in Manor Street; but during the latter portion of the year, complaints of a similar character have been received from inhabitants of Gertrude-street and its neighbourhood as to the nuisance caused by deposits of unconsumed cinders given off by the chimneys of the St. George's Union Workhouse and Laundry. Similar action has been taken with a view to the collection of evidence in this case as in that of the Chelsea Electricity Supply Company, and the matter is still receiving the attention of the Public Health Committee. Frozen Australian Rabbits. In October, 1905, two boxes of frozen Australian rabbits, which had been purchased by a Chelsea costermonger in the Smithfield Market, were brought to the Town Hall, as being in a "spotted" condition, and were condemned as unfit for food. These rabbits formed part of a consignment that arrived in London from Australia in May, and had been placed in cold storage during the months intervening between arrival at the docks and sale in the market. As the white spotted condition of the organs of these rabbits was new to me, I sent some to the Lister Institute for examination. The report from the Institute stated that there was no evidence of coccidiosis or of tuberculosis, but that although the bacteriological 38 examination was difficult owing to putrefactive changes, yet some suspicious organisms isolated resembled those of hemorrhagic septicœmia of the lower animals, and that the opinion formed was that the rabbits had suffered from some form of infective septicœmia. If this was so, the matter was of some importance, as very large numbers of these Australian rabbits are now sent to the London market; and, if the septicœmic condition was at all widespread, as it very well might be, serious results to the public health might ensue. From later information there appeared to be some doubt as to whether the spotted condition of the rabbits' organs was not due to post-mortem changes, which had taken place probably during the months the rabbits were awaiting in cold storage delivery to the market. It was certainly a fact that the rabbits very quickly decomposed, when taken out of cold storage; and there would be considerable danger in consuming rabbits in the condition they were in, when brought by the costermonger to be condemned as unsound. Further information is required as to what is the effect of these long periods of cold storage on such articles of food as rabbits, poultry, and fish. 39 REPORTS PRESENTED TO THE BOROUGH COUNCIL BY THE PUBLIC HEALTH COMMITTEE. January 25th. Cod-liver oil prosecutions. March 8th. Water-supply to tenement houses. Book-keeping at Sir Thomas More Buildings. Opinion of counsel (Mr. C. A. Cripps, K.C., M.P.) as to the position and powers of the Borough Council in respect of nuisance caused by the deposit of unconsumed cinder-ash in the neighbourhood of Redburn-street. The decisions of the Metropolitan magistrates in cases under the Public Health (London) Act, 1891. March 22nd. Report on the number of tenants in Sir Thomas More Buildings, their conditions as to marriage, number of children, previous residences, occupations, and wages earned. Payment of fees to medical practitioners who may be summoned by midwives in case* of difficulty under the provisions of the Midwives Act. April 5th. Repairs to balconies at Onslow Dwellings. April 19th. The Sale of Whisky Bill. Drying-room hours at Sir Thomas More Buildings. June 7th. The disinfection of rooms and bedding after non- notifiable diseases, and for the destruction of vermin. The insanitary condition of Nos. 1—9, Camera-cottages, and the issue of notices to close the premises. June 28th. The dismissal of Mr. Shorey, Superintendent of Sir Thomas More Buildings. Repairs at Onslow Dwellings, and Housing Scheme for Pond-place. The disinfection of rooms and bedding after nonnotifiable diseases, and for the destruction of vermin. July 12th. Recommendations for adoption of Messrs. Joseph and Smithem's Housing Scheme for Pond-place, and for repairs to Onslow Dwellings. July 26th. Appointment of Mr. A. J. A. Cottrell as Superintendent of the Council's Dwellings. October 4th. Magistrate's orders for closure of Nos. 1—9, Cameracottages. 40 November 15th. Tenders for erection of Pond-place Dwellings, and for repairs to Onslow Dwellings. November 29th. Proceedings against the Underground Electric Railways Company of London, Ltd., for permitting a smoke nuisance at their generating station in Lotsroad. The Public Health Aspects of the proposed Thames Barrage at Gravesend. (Report by M.O.H. to Works Committee). LOUIS C. PARKES, Medical Officer of Health. January, 1906. 41 REPORT OF WORK DONE DURING 1905 BY MISS M. W. RICHARDSON, Lady Sanitary Inspector. The work done during 1905 has comprised the following:— (1) Inspection of workshops and laundries at which women are employed. (2) Inspection of outworkers' premises. (3) Investigating cases of infantile mortality. (4) Visiting 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 to give instruction re management of infants. (1) Inspection of Workshops and Laundries. At the end of 1904, there were 339 workshops on the register at which women were employed. During the year 1905, 70 have been added and 59 removed, making a total of 350. As before, the majority added were dressmaking and millinery workshops, the percentage of these on the register being nearly 80 per cent. of the total number. Laundries.—All the workshop laundries have been cleansed during the last thirteen months without notices being necessary. The occupiers have thus been able to suit their own convenience as regards the time of cleansing. No case of overcrowding was notified in any laundry during the year, due doubtless to the fact that the nature of the work is not such as can be done in limited space. Some of the laundries, which formerly were classed as "workshops," now rank as "domestic" only, owing to a reduction in the number of hands employed. Basement Workrooms. — Two basement workrooms have been closed during 1905, and three new ones opened, two of which had been formerly occupied as such. These were personally inspected by the Medical Officer of Health. There are now 19 on the register. Ventilation of Workrooms.—The standard of ventilation in some of the workrooms still leaves much to be desired, though some improvement may be noted in this respect. The employers themselves appear anxious to do what they can, but as many of them are not often in the workrooms, the matter is one which is generally left to the assistants. The question of ventilating gas iron heaters has received special attention. In one case a hood was provided communicating with a trap-door in the roof to carry off the fumes. In two doubtful cases the question was referred to the Medical Officer of Health, who personally visited the workshops. Overcrotvding.—During the year 121 workrooms were measured, and cards distributed, on which is stated the number of workers that may be employed. These are hung up in the workrooms. The employers rarely attempt to take the measurements themselves, and are generally glad to have the cards. Those cases of overcrowding which were noted occurred chiefly during the summer months. 42 Classification of Workshops. (Women Employes.) Trade. 1903. No. Added. No. Removed. Total. Art Needlework 2 ... l ... — ... 3 Blind Making 1 ... — ... — ... 1 Blouse Making 8 ... l ... l ... 8 Boot Closing 3 ... l ... — ... 4 Corset Making 1 ... — ... — ... 1 Dress Making 220 ... 49 ... 45 ... 224 Furrier 2 ... 1 ... — ... 3 Household Linen 1 ... — ... — ... 1 Lampshade Making 4 ... — ... — ... 4 Lace Making 1 ... — ... — ... 1 Laundries— Factory 5 ... — ... — ... 5 Workshop 17 ... 1 ... 2 ... 16 Domestic 18 ... 5 ... 5 ... 18 Millinery 41 ... 7 ... 2 ... 46 Outfitting 8 ... 2 ... 3 ... 7 Perfumes 1 ... — ... — ... 1 Tailoring (Men's) 4 ... 1 ... 1 ... 4 Upholstery 2 ... 1 ... — ... 3 — ... — ... — ... 339 70 ... 59 ... 350 (2) Outworkers. In compliance with Section 107 of the Factory and Workshop Act, 58 lists were received during the year from people who employ outworkers. The names and addresses of 517 outworkers were reported, of which number 119, or 23 per cent., were resident in Chelsea. While the majority live in adjacent Boroughs—i.e., Westminster 25 per cent., Fulham 16 per cent.—others come from all parts of London, the lists comprising addresses in 34 different districts. The kind of work given out to women is chiefly plain needlework, tailoring, or blouse making. With a very few exceptions, the rooms have generally been found in a satisfactory condition, the nature of the work being such as to render this imperative. From other Boroughs 57 outworkers were reported as living in Chelsea, but working for outside firms. The highest number of these was again received from Kensington. Jan. to June. July to Dec. Total. Number of Lists received 30 28 58 Total number of Outworkers 295 222 517 Number living in Chelsea 60 59 119 Number forwarded to other Boroughs 222 158 380 Received from other Boroughs 32 25 57 (3) Infantile Mortality Inquiry. During the year, 115 deaths of children under two years of age were investigated, as against 135 in 1904. This number does not include those upon whom inquests were held. The information received is valuable, as it enables some conclusions to be drawn with regard to 43 conditions affecting the health of infants in this district. Of the 115 cases, in twenty instances the family occupied one room only, while in eleven cases the family were living and sleeping in basement rooms. It is a noticeable fact that an undue proportion both of infantile deaths and of infectious cases reported by the schools occur in basement rooms. This is partially accounted for by the statement made by the occupiers of basements that many landlords will only give accommodation in basement rooms to families with several children. In twenty cases (17 per cent.), out of the total of 115, the deceased infant had been the first child, Of the remaining 95, in 46 cases the parents had previously lost children. The aggregate number of previous deaths for the 46 families amounted to 108, or an average of 2.34 per family. In one instance the parents had previously lost eight infants under twelve months old. In another family three children under one year (baby 11 months and twins one week) died within a period of three months. In ten cases the deceased infant was stated to be illegitimate. In eight cases out of the total number, the baby had been entirely handed over to the charge of others. In six other instances the infant had been left in the care of others while the mother went to work in the day. Of these latter, three children died of scarlet fever, whooping cough, and measles respectively, which the mothers each alleged they contracted in the house at which they had been left, previous cases having occurred there. (4) Phthisis Cases. All cases of phthisis voluntarily notified by medical practitioners have been visited, and are revisited from time to time as the circumstances may require. Some cases have now been on the list for over two years. In addition, those patients suffering from phthisis, who are discharged or discharge themselves from the Infirmary, are notified by the Master of the Workhouse. These are subsequently visited, but some come out for a short time only. Those who go to common lodging houses are visited by the Chief Inspector. A considerable number of cases have also been reported from various sources, such as the Charity Organization and the Lady Almoners of St. George's Hospital, and Brompton Hospital, district visitors, &c. Leaflets of instructions, pocket spittoons, disinfectants, fibre handkerchiefs, &c., are distributed when necessary. Owing to the proximity of the Brompton Hospital, the majority of consumptives in this district attend there, as the treatment is free, on production of a letter. These cases are not notified from the hospital. (5) School Cases. All non-notifiable infectious or contagious diseases, such as measles, whooping cough, chickenpox, &c., reported by the schools during the year have been visited. These amounted in all to 322, which number does not include duplicate notifications, nor more than one case at each house. In all 369 visits were paid. The voluntary schools now under control of the Council have latterly reported cases, which formerly they were not in the habit of doing. It has come to be generally known among the parents of children attending the schools that the cases are 44 reported to the Council and will subsequently be visited. This fact serves to impress upon them that precautions must be taken. The cases reported are classified as follows:— Measles 61 Whooping Cough 89 Chicken-pox 87 Mumps 11 Ringworm, &c. 69 Blight (conjunctivitis) 5 Total 322 Measles was much less prevalent during 1905 than in the previous year, only 61 cases being reported as against 231. Almost all cases of whooping cough were notified in the first five months of the year, chiefly in March and April. Six cases only have been reported since May. Chickenpox remained fairly constant throughout the year. Only five cases of blight were notified, but in all probability there were many more cases among children below school age. (6) Visits of Instruction re Infant Management. Copies of the birth returns are now sent weekly to the Public Health Department. Most of the houses are then visited in order to give instructions where it may be desirable to do so, and a leaflet or card with simple directions is given to the mother. Special attention is given to those cases where the baby is the first child, or where other children are known to have died. As parents are not compelled to register the births until the sixth week, they generally delay doing so until then. In several cases death had occurred by that time, and in some instances the families had removed before the birth wa3 registered, and could not be traced from the address given. Weekly lists have latterly been sent from the London County Council of those births which are attended by registered midwives. These have proved of great advantage as the information is received considerably in advance of that supplied by the local registrars. Eight such lists were obtained in 1905, with an average of nine cases per week. It would appear that about 25 per cent. of the births are attended by registered midwives, but as the available statistics cover a short period only, the conclusions can hardly be taken as final. The majority of the infants are breast fed, at all events for the first few weeks. Only a comparatively small number of mothers in this district go to work regularly and leave their children in charge of others. As there are few factories and laundries in the neighbourhood as compared with other districts further west, married women have limited opportunity of getting work other than as domestic servants or charwomen, so there would appear to be little inducement for them to do so. In some cases, however, mothers, who would otherwise have been able to nurse their infants, were obliged to partially wean them in order to go to work. The percentage of those who did so was increased during the winter quarter, the period which corresponded to the time when the 45 greatest number of men were out of employment. The mothers of illegitimate children are almost invariably obliged to go to work, so that the infants are usually weaned and brought up by hand, and are generally given over to the charge of others. Only a very small percentage of the infants sleep by themselves. This is not so much due to the inability to provide a cradle, or substitute for a cradle, than to fixed custom. Many of the mothers have cradles, but do not let their children sleep in them at night. The practice of giving soothing syrups and patent medicines to babies seems unfortunately fairly general. It is to be regretted that so many circulars advertising patent foods and medicines for infants are distributed by the trade amongst the poorer class of mothers. Tabulated, Statement of Work. (1) Number of New Workshops registered 70 Number of Workshop inspections 460 Visits of Inquiry re Employment of Women, &c. 215 Workrooms measured 121 Workroom Cards distributed 62 (2) Outworkers' premises visited 41 Visits of Inquiry re Outworkers 64 (3) Cases of Infantile Mortality investigated 115 Number of Visits paid 161 (4) Phthisis cases notified (all sources) 57 Number of visits paid (including visits of inquiry) 321 (5) School cases reported 322 Number of visits paid 369 (6) Visits of Instruction re Management of Infants, &c. 594 Speoial cases 39 46 ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901, IN CONNECTION WITH FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries.) 2 — — Workshops (including Workshop Laundries.) 471 7 — Workplaces 154 24 — Homeworkers' Premises 41 — — Total 1 668 31 — 2.—DEFECTS FOUND. particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.m. Inspector. Nuisances under the Public Health Acts :* Want of cleanliness 19 19 — — Want of ventilation — — Overcrowding 5 5 — — Want of drainage of floors 1 1 — — Other nuisances 4 4 — — Sanitary accommodation insufficient — — — unsuitable or defective 2 2 — — not separate for sexes — — — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) — — — — Failure as regards lists of outworkers (s. 107) — — — — Giving out work unwholesome to be done in pre (s. 108) — — — — mises which are infected (s. 110) — — — — Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (s 109) — — — — Other offences — — — — Total 31 31 — — • Including those specified in sections 2, 3, 7 and 8 of the Factory Act as remediable under the Public Health Acts. 47 3.—OTHER MATTERS. CLASS. NUMBER. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act, (s. 133) 25 Action taken in matters referred by H.M. Inspectors asreme diable under the Public Health Acts, but not unde the Factory Act (sec. 5) {Notified by H.M. Inspectors 6 { Reports (of action taken) sent to H.M. Inspectors 6 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 34 Number of Homework :— Lists of Outworkers* (s. 107) :— Lists. Outworkers. Lists received 58 517 Addresses of outworkers forwarded to other Authorities 380 received from other Authorities 57 Homework in unwholesome or infected premises:— Wearing Apparel ; Other. Notices prohibiting homework in unwholesome premises (s. 108) — — Cases of infectious disease notified in homeworker' premises — 1 Orders prohibiting homework in infected premises (sec. 110) — — Workshops on the Register (sec. 131) at the end of the year —. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 43 Laundries 34 Dressmaking and Millinery 270 Various 164 Total number of workshops on Register 511 * The Lists should be received twice in the year. The year's figures required in the Table are those obtained by adding together the two half-yearly totals. Note.—The Factory and Workshop Act, 1901 (s. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). 48 PROCEEDINGS DURING 1905. PREMISES. NUMBER OF PLACES. Number of inspections, 1905. Number of Notices, 1905. Number of prosecutions, 1905. On register at end of 1904. Added in 1905. Removed in 1905. On register at end of 1905. Milk premises 133 10 — 130 200 6 — Cowsheds 4 — — 4 58 — — Slaughter-houses 6 — — 6 84 — — Other offensive trade premises — — — — — — Ice cream premises 55 — 7 48 53 4 — Registered houses let in lodgings 602 — — 602 161 {(a)* {(b)* {(a)* {(b)* * (a) For overcrowdidg. * (b) For other conditions. Overcrowding, 1905— Number of dwelling rooms overcrowded 15 Number remedied. 15 Underground rooms— Illegal occupation dealt with during year 1 Number of rooms closed 1 Insanitary houses— Number closed under the Public Health (London) Act, 1891 13 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year: adults, 35 children, 50 85 Revenue Acts— Number of houses for which applications were received during year 7 Number of tenements comprised therein 23 Number of tenements for which certificates were granted 7 „ „ ,, ,, refused 16 Mortuary— Total number of bodies removed 18 Total number of infectious bodies removed 1 49 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING THE YEAR 1905. Houses and Premises:— House-to-house inspections 492 *Reported on respecting nuisances complained of 644 Reported on with reference to infectious cases 383 Cleansed, whitewashed, and repaired 222 Defective roofs repaired 108 Disinfected after communicable diseases 379 Rooms disinfected under London County Council (General Powers) Act, 1904 30 Cases of overcrowding abated 13 Dust-bins, new, provided 89 „ repaired 2 Underground rooms occupied contrary to Act Inspections of restaurant kitchens 1 80 Drainage:— Drains opened, cleansed, and made sound } 338 „ trapped with stoneware gullies } Water-closets cleansed and repaired ,, new pans and traps provided 70 219 Spout drains cleansed, repaired, or renewed 86 Sink, bath, and lavatory waste pipes provided and repaired 130 Drains and soil pipes ventilated or repaired 131 Soil pipes, new, provided 83 New drains laid, in accordance with Council's regulations (including 11 systems of combined drainage) 96 Additional w.c. accommodation provided 7 Water Supply:— For domestic purposes, provided where cut off by Water Board 10 For water-closets, or check cisterns provided and repaired 105 Main cisterns cleansed or repaired 60 „ new, provided 4 Water certificates, issued in respect of newly erected dwelling-houses 58 Nuisances abated arising from:— Keeping of animals 9 Accumulations of manure and other filth 28 Yards, areas, and wash-houses paved or drained 239 Smoke 3 Dung-pits repaired, drained, &c., or cages, &c., provided — * This 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. e 50 Miscellaneous:- Dead bodies removed to public mortuary for sanitary reasons 1 Goods disinfected after infectious cases at station 1293 Goods destroyed after infectious cases 78 Mattresses, beds, &c., received from Surveyor's Department and destroyed in the incinerator 1980 Number of samples taken for analysis (Food and Drugs Act), including samples taken on delivery at Chelsea Workhouse and Infirmary, and St. George's Infirmary and Workhouse 407 Unsound Food. Number of boxes of fruit, fish, rabbits, &c., condemned and destroyed 6t Library books destroyed at Librarian's request 28 Proceedings Taken:— Statutory notices issued, excluding notices under L.C.C. (General Powers) Act, 1904 277 Intimations issued for sanitary works, &c., including infectious disease cases 659 Certificates of M.O.H. for premises infested with vermin 67 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 2 Legal proceedings in respect of food adulteration 11 Correspondence:— Number of letters written in connection with sanitary matters 617* Daily returns of infectious cases sent to Metropolitan Asylums Board 130 Notification of infectious cases sent to School Authorities 343 Entries in Inspectors' Report Books 644 „ Inhabitants'Complaint Book 89 Certificates of Disinfection given 343 Certificates of infectious diseases for removal cases 180 Notices sent to Public Library of premises where infectious disease has occurred 117 The cow-houses and slaughter-houses were inspected by the Medical Officer of Health prior to licenses being renewed in October last, aud a list of the retail bakehouses under inspection in Chelsea forms a separate Appendix. There are 130 Dairies and Milkshops, and 48 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 Intpectors. 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 telephone, 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. 51 MAGISTERIAL PROCEEDINGS DURING 1905, UNDER THE SALE OF FOOD AND DRUGS ACT. Streets where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. King's-road Cod-liver oil 20% of foreign fish-oil Jan. 17th Adjourned from 6th Dec; dismissed without costs. ,, ,, 20% ,, ,, ,, Ditto. ,, ,, 10% ,, ,, ,, Ditto. Smith-terrace Batter 100% of margarine Mar. 7th Fine £1, and 10s. 6d. costs. ,, ,, 20.8% of foreign fat ,, Fine 10s. and 10s. 6d. costs. Sydney-street ,, 100% of margarine ,, Fine £2, and 10s. 6d. costs. Albert-place Cayenne pepper 20% of foreign matter April 18 th Fine 10s., and 10s. 6d. costs. King's-road Butter 10% of foreign fat June 6th Sample sent to Somerset House; case adjourned to 4th July and again to the 18th July. Fine £5, and £2 2s. costs. Analyst's fee, 10s. 6d.; Somerset House fee, £1 1s. First-street ,, 8% ,, ,, ,, Case adjourned to 4th July, and again to the 18th July. Fine £7, and 10s. 6d. costs. Marlborough-road ,, 5% ,, ,, ,, Case adjourned to 4th July, and again to the 18th July. Fine £7, and 10s. 6d. costs. Tadema-road Milk 5.5% of added water Nov. 21st Dismissed on warranty being proved. 52 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 1, 2, 3, 4, 5, 6, 7, 8 & 9, Cameracottages The premises in such a state as to be a nuisance or injurious or dangerous to health July 18th Adjourned to the 1st August, when closing orders were made. The Electrical Generating Station, Lots-road Emissions of black smoke Nov. 7th Fine £10, costs £2 2s., and an order made to abate the nuisance within a month. 53 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 ... ,, 145, King's-road J. Humphry & Son Above. ,, 88, „ G. Nash ... Below. 134, ,, Buckea ... ,, 351, ,, H. J. Mardon ... ,, 399 H. Kohler ... ,, 54 Street. Occupier. Above Ground. Below Ground. 414, King's-road J. Brewer ... Below. 488, „ Matthiae ... ,, 502, W. Schafer ... ,, 517, . „ Morgan ... ,, 1, Leader-street J. T. Pratt Above. ... 48, Lots-road M. & C. West ... Below. 83, Lower Sloane-street Burrows Above. ... 43, Manor-street L. Lorenz ,, Below. 62, Marlborough-road Kremers ... ,, 100, C Reitze ... ,, 110, William Herwig Above. ... 7, Pavilion-road Mason ,, ... 3, Pont-street Hue & Co ... Below. 14, Riley-street W. E. Knee ... ,, 29, „ F. W. Fox ... ,, 150, Sloane-street Pennycuick ... ,, 6, Symons-street. Spiking &e Co. ... Dis. baking 4/8/04. 43, Stayton-street E. Schindewolf Above. ... 25, Walton-street Burrows ... Below. 55 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, „ 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.