CHE 1 3 Metropolitan Borough of Chelsea. ANNUAL REPORT For 1907 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; Civilian Sanitary Member of Advisory Board for Army Medical Services ; Fellow of the Sanitary Institute ; Fellow of the Society of Medical Officers of Health ; jenner Lecturer on Hygiene and Public Health at St. George's Hospital Medical School ; Examiner in Hygiene and Public Health, University of London. TOWN HALL, KING'S ROAD, CHELSEA. 1908. 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 8 Infantile Mortality 8 Statistical Tables (L.G.B. Forms, I., II., III., IV., V.) 12 SEC. II.—Infectious Diseases: — Small-pox 17 Scarlet Fever 17 Diphtheria 18 Enteric Fever 18 The Case Mortality 19 Prevalence of Scarlet Fever, Diphtheria, and Enteric Fever in West London Boroughs 20 Removal of Patients to Hospitals 21 Cerebro-Spinal Fever 21 Voluntary Notification of Phthisis 22 Puerperal Fever 23 SEC. III.—The Housing of the Working Classes :— Sir Thomas More Buildings 24 Pond House 25 Onslow Dwellings 25 Earl Cadogan's offer of a Site 26 Demolitions in 1907 28 SEC. IV.—The Sanitary Condition of the Borough Drainage 29 Inspections made 29 Disinfection 29 Action taken under the Sale of Food and Drugs Act 30 Smoke Nuisance 30 Water Supply 31 Basement Workrooms 31 Reports presented to the Borough Council 33 Report of Work done by the Lady Sanitary Inspector 34 Statistical Tables of Action taken under the Factory and Workshop Act 41 Statistical Tables of Action taken under the Public Health (London) Act 41 Summary of Nuisances and other matters reported on in 1907 45 Magisterial Proceedings during 1907 47 Lists of Bakehouses, Cow-houses and Slaughter-houses 49 annual report OF THE MEDICAL OFFICER OF HEALTH For 1907. Section I.—STATISTICAL. POPULATION OF CHELSEA. The census population of the Borough of Chelsea for the vear 1901 was 73,842. The estimated population of the Borough for 1907 is 74,857; the population of each sub-district being as follows:— North Chelsea ... ... 43,099 South Chelsea ... ... 31,758 BIRTHS AND BIRTH-RATE FOR 1907. Table I. Number of Births. Birth-rate per 1000. Male. Female. Total. North Chelsea 356 375 731 17.0 South Chelsea 346 354 700 22.1 Chelsea 702 729 1,431 19.2 London 122,215 25.8 The above Table is founded upon the births registered in the Borough, and is comparable with the similar Tables of former years. In addition to the births above noted, information was received in 1907 of 62 births of Chelsea mothers in Lying-in-Hospitals and Homes outside the Borough. The inclusion of these 62 births will raise the birth-rate of the Borough to 20 0 per 1000. B 2 4 The average birth-rate of the Borough for the year 1901-1906 is 212, and of the Home District of the Parish of Chelsea for the 5 years 1896-1900, 24.1 per 1000. The birth-rate for 1907, 20.0, is 0.2 per 1000 lower than that of 1906, and is the lowest yet recorded. During the past year, as in 1905 and 1906, weekly copies of the Registers of Births and of births attended in the Borough by registered midwives have been forwarded to this office respectively by the Registrars of Births and Deaths and by the London County Council, and later in this Report will be given information as to the birth-rates and infantile mortality rates of various classes of the community. During the year 60 births were registered as having occurred in the Chelsea Workhouse, equivalent to 4.2 per cent. of the total number of births in the Borough. DEATHS AND DEATH-RATE FOR 1907. The total number of deaths registered in the Borough was 1688. Of this number 712 were deaths within the Borough of non-parishioners —chiefly occurring in hospitals and in the St. George's Infirmary ; and 142 deaths of parishioners of Chelsea occurred outside the Borough in various public institutions. There were, therefore, 1118 deaths of parishioners of Chelsea. These 1118 deaths are equivalent to a deathrate for the year of 15.0 per 1000, as against a death-rate of 15.7 per 1000 in 1906. Table IT. gives the death-rate of the Home District of Chelsea Parish, of Chelsea Borough, and of London during the past 17 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•6 1906 15•7 15•7 1907 15•0 15•2 * 1891-1900, Chelsea Home District. 5 Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 1.57 per 1000 in 1907, the corresponding rate for London being l.44. In 1906 the zymotic death-rate in Chelsea was 2.46 per 1000. Table III.—For the year 1907. 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•57 0•51 1•47. 0•46 2•87 1•02 0•27 124 25•9 47•3 London 1•44 0•54 1•45 0•52 3•06 1•03 0•19 118 31•7 39•8 Small-Pox.—There was no small-pox in Chelsea in 1907. Measles.—This disease caused 41 deaths in 1907, as compared with 58 in 1906. Twenty-five deaths were registered in North Chelsea, and 16 in South Chelsea. All the deaths, with two exceptions, were of children under 5 years of age, namely: 7 under one year of age, and 32 between one and five years of age. The prevalence of measles in Chelsea last year was somewhat unusual, as the disease had been epidemic in 1906, and it is characteristic of this complaint that the year succeeding an epidemic is usually very free from it. There were no deaths from measles in the first quarter of 1907, but the disease became prevalent in the spring, and continued throughout the summer and autumn. Possibly the cold and inclement summer was in part responsible for the continuance of measles at a time when it is usually but little prevalent. Scarlet Fever.— This disease caused only 2 deaths in 1907, as compared with 9 in 1906. Both were deaths of South Chelsea residents, and both were fever hospital patients. Scarlet fever was very prevalent in London, as a whole, in the latter half of 1907. Diphtheria.—This disease caused 8 deaths in 1907, as compared with 16 in 1906. Three of the fatal cases were residents of North Chelsea, and 5 of South Chelsea. All but one of the deaths occurred in hospital. Table IV.—Cases of, and Deaths from Diphtheria and Membranous Group in Chelsea,* 1890-1907. CASES. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 172 162 163 200 207 273 429 242 153 136 150 106 131 99 61 52 161 158 DEATHS. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 32 20 32 43 41 52 96 45 22 13 14 9 13 4 5 5 16 8 * 1890-1900, Chelsea Home District. 6 Whooping Cough.—This disease caused 25 deaths in 1907, as compared with 17 deaths in 1906. Nine of the deaths were of North Chelsea residents, and 16 of South Chelsea. Enteric Fever.—Three deaths were due to enteric fever in 1907. In 1906 there were no deaths from this disease. All three of the fatal cases resided in North Chelsea. Table V.—Zymotic Disease Mortality in Chelsea in 1907. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea, 1897-1906. Measles 41 28 30 Scarlet Fever 2 10 7 Diphtheria 8 13 15 Whooping Cough 25 28 25 Enteric Fever 3 3 6 Diarrhœa 38 41 73 Diarrhoea.—The deaths in Chelsea in 1907 from diarrhœal diseases (diarrhœa 30, enteritis 8) were 38 in number, as compared with 83 in 1906. Twenty-six of the deaths were of infants under one year of age, 8 were between 1 and 5 years of age, and 4 were adults. Twenty-three of the deaths were of North Chelsea residents, and 15 of South Chelsea. Owing to the cold and inclement summer of 1907, there were no diarrhœa deaths in Chelsea until the end of August. In the eight weeks ended the 19th October, 16 deaths from diarrhoea were registered, so that the slight epidemic prevalence of 1907 commenced late, and was continued later into the autumn months than is usually the case. The diarrhœa mortality in Chelsea and in London in 1907 is probably the lowest on record. Table vi.—Mortality from Diarrhœal Diseases. Year Chelsea. London. Death-rate per Million. Death-rate per Million. 1896 1,037 1,112 1897 1,340 1,446 1898 1,258 1,556 1899 1,282 1,663 1900 1,187 1,251 1901 788 1,184 1902 692 737 1903 541 837 1904 864 1,267 1905 620 948 1906 1,115 1,275 1907 509 544 7 Influenza.—The number of deaths attributed to influenza in 1907 was 20, as against 16 in 1906. Nine deaths occurred in North Chelsea, and 11 in South Chelsea. Twelve of the fatal cases were of persons aged 65 and upwards. In London generally the disease showed a similar prevalence to that of 1906, 907 deaths occurring in 1907, as against 897 in 1906. Of the fatal cases in London in 1907, 605 occurred in the first quarter of the year, 161 in the second quarter, 58 in the third quarter, and 143 in the fourth quarter. Respiratory Diseases.—The death-rate from these diseases in Chelsea in 1907 was 2 87 per 1000, as against 3'06 per 1000 in 1906. The London death-rate from respiratory diseases in 1907 was 3 06 per 1000. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1907 was 193 per 1000, as against 2 03 per 1000 in 1906. The death-rate in London from these diseases in 1907 was 1.97 per 1000. Of the 110 deaths from phthisis in Chelsea in 1907, 54, or 49 per cent. occurred in the Chelsea Workhouse Infirmary, and 24, or 22 per cent. in other public institutions, making a total of 71 per cent. of the cases dying in public institutions away from their own homes. The average for the 7 years, 1900-1906, is 43 4 per cent. in the Chelsea Infirmary, and 12 7 per cent. in other public institutions, making a total of 56.1 per cent. of the cases dying away from their homes in public institutions. There is, therefore, a notable increase during the past year of institutional deaths in this disease; and this fact appears to point to the spread of knowledge as to the possible infectivity of the later stages of phthisis, with the result that sufferers from this disease in its later manifestations, especially amongst the poor, are more ready to seek institutional relief than was formerly the case. Cancer.—Malignant cancerous diseases caused 76 deaths in Chelsea in 1907, the average of the past 16 years being 73 deaths annually. Forty-two of the cancer deaths were of North Chelsea residents, and 34 of South Chelsea residents. Alcholism.—Twenty-one deaths were registered in 1907 as being due to intemperance or cirrhosis of the liver, as against 25 in 1906. These annual figures merely represent the deaths which are palpably and unmistakeably the results of alcoholic excess, and take no account of the far larger numbers which are indirectly due to prolonged and excessive indulgence. Deaths in Lunatic Asylums.—Thirty-four deaths of Chelsea parishioners occurred in 1907 in lunatic asylums. The average of the 16 years, 1891-1906, is 33 deaths annually in lunatic asylums. Deaths in Public Institutions.—In 1907, 47.3 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 47.4 per cent. in 1906. In London generally, 39.8 per cent. of the total deaths occurred in public institutions in 1907. The deaths in the Chelsea Infirmary in 1907 formed 25.3 per cent. of 8 the total deaths of Borough residents, as compared with 24 per cent, in 1906. Deaths of Common Lodging House Inmates.—Twenty-four deaths of common lodging-house inmates occurred in Chelsea in 1907, all but one taking place in the Chelsea Infirmary. Twenty-one of the deaths were of males, and three of females. Twelve of the deaths (50 per cent. of the total) were due to tuberculosis, chiefly of the lungs. DEATH-RATES OF SPECIAL CLASSES OF THE POPULATION. The following Table gives the birth-rate, the general death-rate, the zymotic disease death-rate, the tubercular disease death-rate, and the deaths under 1 year to 1000 births, during the year 1907, for the Borough, 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 the Borough Council's Dwellings (Sir Thomas More Buildings, Pond House, and Onslow Dwellings), Marlborough Buildings (Improved Industrial Dwellings Co.), Guinness Buildings, Peabody Buildings, and Chelsea Park Dwellings, with a total population of about 3150 ; and the streets are Dartreyroad, Francis-street, Gillray-square, Ives-street, Little Keppel-street, Oakham-street, Pond-terrace, Riley-street, Slaidburn-street., Staytonstreet, World's End-passage and the courts adjacent, with a total population of about 4130. Table VII.—For the year 1907. Birthrate. Deathrate. Zymotic Death-rate. Tubercular Diseases Death-rate. Deaths under 1 to 1,000 births. Chelsea 20•0 15•0 1•6 1•9 122 Industrial Dwellings 31•1 12•4 1•9 1•6 71 11 Poor-class Streets 41•4 26•6 4•8 3•1 204 Sir Thomas More Buildings} 36•5 7•3 1•2 1•2 33 The above Table shows that, as in previous years, the vital and health statistics of the industrial dwellings population contrast most favourably with those of the lower class tenement-house population. INFANTILE MORTALITY. During the year 1907 there was a reduction in the rate of infantile mortality (deaths of infants under one year to 1000 births) as compared with the previous year; but, although circumstances were favourable in 1907, the very low rate of 1905 was not reached. 9 Table VIII. 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 65 131 8,209 1906 140 122 133 8,639 1907 122 101 118 8,435 It will be seen from the above table that the reduction of infantile mortality in Chelsea in 1907, as compared with 1906, corresponds very much with the reduction in London generally. The year 1905 was characterised in Chelsea by a reduction over previous years of an exceptional character, the causes of which are not very evident. There seems, however, to have set in a period of lowered infantile mortality, of which the explanation appears to lie in the efforts now being made to help and influence the mothers of the infants, these efforts having commenced in 1905, when the first reduction in the mortalitv rate is apparent. That there is still an enormous field open to philanthropic effort in this direction is shown by the fact that the rate of infantile mortality amongst the inhabitants of the industrial dwellings of Chelsea in 1907, was only one-third that of the inhabitants of the 11 poor-class streets (Table VII.)—7 out of every hundred infants born in industrial dwellings dying in their first year, as compared with 21 out of every hundred infants born in the 11 poor-class streets. Very similar differences are seen in the different wards of the Borough, for whereas in 1907 there were only 81 deaths of infants under one year to 1000 births in Royal Hospital Ward, in Church Ward the corresponding figure was 184, or more than double. Table IX. shows the birth-rates and infantile mortality rates for the year 1907 in the 5 wards of the Borough. Table IX. 1907. Birth-rate. Infantile Mortality Rate. Hans Town Ward 15•0 90 Royal Hospital „ 13•8 81 Church „ 19•3 184 Cheyne „ 18•8 96 Stanley „ 26•3 127 Chelsea Borough 20•0 122 10 The births occurring in the Chelsea Workhouse and the births occurring in outside institutions have been re-distributed amongst the various Wards. As in 1905, Stanley Ward had the highest birth-rate, whilst Church Ward had the highest infantile mortality-rate. From Table XV, (Local Government Board Table V.) it will be seen that out of the total of 182 deaths of infants under 1 year of age in Chelsea in 1907, 64, or 35 2 per cent. occurred in the first 4 weeks of life, as compared with 30 3 per cent. in 1906 ; and 32, or 17 6 per cent. occurred in the first week of life, as compared with 14.2 per cent. in 1906. The majority of these deaths in the first month of life are due to developmental defects, want of vitality, and injuries at birth. For deaths under a month the rate in 1907 is 43 per 1000 births, as against 42 in 1906. Between the ages of 1 month and 12 months, 118 deaths, 648 per cent. of the total, were registered in 1907, as compared with 70 per cent, in 1906 ; 29 of these deaths being due to diarrhoea, as compared with 52 in 1906. There were, besides, 7 deaths from measles, 14 from whooping cough, 27 from bronchitis, 11 from pneumonia, and 7 from convulsions. Illegitimate Births.—The following Table shows for each of the years 1905, 1906, and 1907, the number of illegitimate births belonging to the Borough, the number known to be alive at the end of each year, the number known to be dead at the end of each year, and the number unaccounted for at the end of each year. Table X.—Borough of Chelsea. Illegitimate Births. Year. Number. Per cent of total births. Alive at end of year. Dead at end of year. Unaccounted for. Deaths under 1 to 1 ,000 births. 1905 88 5•5 19 10 59 114 1906 73 4•8 21 7 45 96 1907 76 5•2 28 9 39 118 The infantile mortality rates in the above Table are evidently minimum rates, owing to the considerable numbers each year unaccounted for by change of residence, or other cause. Assuming that the illegitimate babies unaccounted for died at the same rate as those accounted for, then the average infantile mortality rate of the illegitimate children born in the 3 years 1905-7, is 312 per 1000, as compared with 127 per 1000 for all infants, legitimate and illegitimate. About 50 per cent. of the illegitimate births each year take place in the Chelsea Workhouse. In connection with illegitimate births, Miss Richardson, the Borough Council's Lady Sanitary Inspector, reports that the majority 11 of the mothers are obliged to go to work, and must therefore put the children out to nurse entirely, or leave them in charge of neighbours during working hours. The usual payment for nurse children, when boarded out, is between 5s. and 6s. per week. For day " minding " the average charge is 4d. per day, exclusive of food. The majority of illegitimate infants are, therefore, brought up by hand and bottle-fed. No supervision is exercised over women who receive only one nursechild, as the Infant Life Protection Act only extends to cases where two or more children are received. It would be of considerable advantage if the London County Council would furnish the various Public Health Departments with lists of women in their respective Boroughs who receive nurse-children. At present there is no systematic co-operation between the local Sanitary Authority and the Inspectors under the Infant Life Protection Act. From the registered occupations of the mothers of illegitimate children, it appears that, taking the three years 1905-6-7, 67 per cent. of the mothers, on an average, were domestic servants or charwomen. The report of the Lady Sanitary Inspector will indicate the work which she has performed in 1907 in the visitation of mothers of newlyborn infants, and the giving of advice on infant rearing and management. The lady visitors in connection with St. George's Hospital continue to visit the Hospital's outdoor maternity cases, and give much valuable advice and assistance to working-class mothers on the bringing-up of their infants. The association for providing dinners to nursing mothers (under the direction of Mrs. W. E. Gordon) has extended its operations during the year, and now has 3 centres, at which dinners are given at the nominal charge of Id., viz.: Sydney-street, Denyer-street, and St. John's Mission, World's End. During the year the total number of dinners provided was 6697, which were partaken of by 161 nursing mothers. 12 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 District. 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. 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 1905 74,496 1585 21•3 184 116 1606 21•6 1012 663 163 1106 14•9 1906 74,672 1506 20•2 211 140 1704 22•9 1089 699 163 1168 15•7 Averages for year 1901-1906 74,257 1577 21•3 220 140 1678 22•7 997 642 164 1200 16•2 1907 74,857 1474 19•7 182 124 1688 22•6 1099 712 142 1118 15•0 * Rates calculated per 1000 of estimated population. Note. —The deaths to be included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. Area of District in acres (exclusive of area covered by water) 660 At Census of 1901. Total population at all ages 73,842 Number of inhabited houses 9,063 Average number of persons per house 8.1 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.) 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 1905 74,496 1585 1106 184 42,890 831 577 78 31,606 754 529 106 1906 74,672 1506 1168 211 42,992 772 591 107 31,680 734 577 104 Averages of years 19011906. 74,257 1577 1200 220 42,751 849 633 115 31,505 728 567 106 1907 74,857 1431 1118 182 43,099 731 566 92 31,758 700 552 90 Notes.—(a.) The separate localities adopted for this Table should be areas of which the populations are obtainable from the census returns, such as wards, parishes or groups of parishes, or registration sub-districts. Block 1 may, if desired, be used for the whole district; and blocks 2, 3, &c., for the several localities. In small districts without recognised divisions of known population this Table need not be filled up. (/'.) 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, b, and c, should agree with the figures for the year in the columns 2, 3, and 12, respectively, of Table I. ; the gross total of the sub-columns c should agree with the total of column 2 in Table IV., and the gross total of sub-columns d with the total of column 3 in Table IV. 13 14 TABLE XIII.—(III.) CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1907. Cases Notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. Notifiable Disease. At all Ages. At Agest—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 6 5and upwards. North Chelsea. South Chelsea. North Chelsea. South Chelsea. Chelsea. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 158 1 55 83 8 11 ... 84 74 76 68 144 Erysipelas. 44 5 1 7 4 19 8 27 17 3 1 4 Scarlet Fever 220 3 54 120 27 16 ... 93 127 85 116 201 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 21 ... ... 7 6 8 ... 14 7 11 6 17 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... .... 2 2 ... 1 3 ... 3 3 Plague ... ... ... ... ... ... ... ... ... ... ... ... Totals 447 9 110 217 47 56 8 219 228 175 194 369 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. TABLE XIV.—(IV.) CAUSES OF, AND AGES AT, DEATH DURING YEAR 1907. 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. North Chelsea. South Chelsea. Small-pox ... ... ... ... ... ... ... ... ... ... Measles 41 7 32 1 1 ... ... 25 16 5 Scarlet Fever 2 ... 1 1 ... ... ... ... 2 1 Whooping-cough 25 14 10 1 ... ... ... 9 16 9 Diphtheria and Membranous Croup 8 ... 6 2 ... ... ... 3 5 2 Croup ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... .. ... ... ... ... ... .. Enteric 3 ... ... ... ... 3 ... 3 ... 2 Other continued ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 20 ... 1 ... ... 7 12 9 1 7 Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhœa (see Notes at foot) 30 21 7 ... ... 1 1 20 10 17 Enteritis (see Notes at foot) 8 5 1 ... ... 2 ... 3 5 13 Puerperal Fever (see Notes at foot) 3 ... ... ... 1 2 ... 1 2 3 Erysipelas 7 1 ... ... ... 2 4 5 2 5 Other Septic Diseases 10 ... 1 1 2 4 2 5 5 18 Phthisis (Pulmonary Tuberculosis) 110 ... 2 1 9 86 12 58 52 178 Other Tubercular Diseases 34 3 12 6 3 9 1 18 16 46 Cancer, Malignant Diseases (see Notes at foot) 76 ... ... 1 1 38 26 42 31 158 Bronchitis 155 30 14 2 ... 34 75 69 86 133 Pneumonia 54 11 8 1 2 18 14 23 31 68 Pleurisy 3 ... ... ... ... 3 ... 2 1 2 Other Diseases of Respiratory Organs 2 ... ... ... ... 1 1 ... 2 1 Alcoholism—Cirrhosis of Liver 21 ... ... ... ... 20 1 15 6 10 Venereal Diseases 7 4 1 ... ... 1 1 4 3 7 Premature Birth 28 28 ... ... ... ... ... 11 17 4 Diseases and Accidents of Parturition 4 ... ... ... ... 4 ... 1 3 ... Heart Diseases 133 ... ... 2 4 62 65 69 64 118 Accidents 44 13 ... 3 5 13 10 22 22 23 Suicides 12 ... ... ... ... 9 3 6 6 2 Meninigitis 9 6 1 1 1 ... ... 4 5 12 Diabetes 4 ... ... ... ... 2 2 2 2 6 Rheumatic Fever 4 ... ... 1 1 2 ... 1 3 ... Appendicitis 6 ... ... ... 2 4 ... 5 1 1 All other causes 255 39 4 1 5 78 128 13l 124 248 All causes 1118 182 101 25 37 405 368 566 552 1099 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-S). 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 2-3 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 ot of " Non-residents.'' are, in addition to being dealt with as in note (a), to be entered in the last column of this Table. The total number in this column should equal the figures for the year in column 9, Table I. (d) The total deaths in the several " Localities " in columns 9-15 of this Table should equal those for the year in the same localities in Table II., sub-columns c. The total deaths at all ages in column 2 of this Table should equal the gross total of columns 9-15, and the figures for the year in column 12 of Table I. (e) Under the heading of " Diarrhoea " are to be included deaths registered as due to Epidemic diarrhcea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Dysentery and Dysenteric diarrhoea, Choleraic diarrhoea. Cholera and Cholera Nostras. In addition, and as regards deaths of children under one year of age, under the heading " Diarrhoea" in column 3 of this Table, are to be included all deaths classified as " Diarrhoeal diseases" in Table V. Under the heading of " Enteritis " in this Table, are to be included only deaths over one year of age registered ns due to Enteritis, Muco-enteritis, Gastro-enteritis, Gastric catarrh, Gastritis, and Gastro-intestinal 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, under the specific term " Diarrhcea." 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. 1 hus : Under "Cancer" .should be included deaths from Cancer, Carcinoma, Malignant disease, Scirrhus, Epithelioma, Sarcoma, Villous tumour, and Papilloma of bladder. Rodent ulcer. Under " Puerperal Fever" are to be included deaths from Pyaemia, Septicaemia, Sapraemia, Pelvic peritonitis, Peri- and Endo-Metritis occurring in the Puerperium. (g) Under "Congenital Defects" in Table V., are to be included deaths from Atelectasis, Icterus neonatorum, Navel haemorrhage, Malformations and Congenital hydrocephalus. (A) Under " Tuberculous Meningitis " are to be included deaths from Acute hydrocephalus. (i) Under "Other Tuberculous Diseases" are to be included deaths from Tuberculosis, Tuberculosis of bones, joints and other organs, Lupus and Scrofulus. (j) All deaths certified by registered Medical Practitioners and all Inquest cases are to be classed as " Certified " ; all other deaths are to be regarded as " Uncertified." 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. 16 TABLE XV.—(v.) INFANTILE MORTALITY DURING THE YEAH 1907. 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. 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 ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 4 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 3 1 2 ... 1 2 1 1 1 1 1 14 Diarrhœal Diseases— Diarrhœa, all forms ... ... ... ... ... 3 2 2 3 1 1 2 1 1 4 1 21 Enteritis, Muco- &Gastro-enteritis ... ... ... 1 1 ... 1 ... ... ... 2 ... 1 ... ... ... 5 Gastritis, Gastro-intestinal Catarrh} ... ... ... ... ... 2 ... 1 ... ... 1 ... ... ... ... ... 4 Wasting Diseases— Premature Birth 14 5 4 4 27 1 ... ... ... ... ... ... ... ... ... ... 28 Congenital Defects 4 ... 1 ... 5 ... ... ... ... ... ... ... ... ... ... ... 5 Injury at Birth 6 1 ... ... 7 ... ... ... ... ... ... ... ... ... ... ... 7 Want of Breast-milk, Starvation 2 ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... 3 Atrophy, Debility, Marasmus. 2 2 ... 2 6 3 3 2 1 ... ... ... ... ... ... ... 15 Tuberculous Diseases — Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 2 Erysipelas ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Syphilis ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... 4 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... 1 ... ... 1 ... 2 ... ... 6 Convulsions ... 1 3 1 5 1 ... ... 1 ... ... ... ... ... ... ... 7 Bronchitis ... 1 1 1 3 3 2 7 1 ... 7 1 2 ... 3 1 30 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 2 ... ... ... 2 1 1 1 ... ... 1 1 2 1 1 ... 11 Suffocation, overlaying 2 ... ... 1 3 1 ... ... 2 ... ... ... ... ... ... ... 6 Other Causes ... ... 1 1 2 1 1 ... ... ... ... ... ... ... ... ... 4 All Causes 32 10 11 11 64 19 14 10 10 5 14 6 8 6 12 8 182 Births in the year, legitimate 1,398 „ ,, illegitimate 76 Deaths from all Causes at all Ages 1,118 Population, estimated to middle of 1907 74,857 Deaths in the year of legitimate Infants 173 „ „ illegitimate „ 9 17 Section II. INFECTIOUS DISEASES. Small-Pox.—There were no cases of small-pox in Chelsea in 1907. In London, during the year 1907, only 9 cases of the disease were notified, as against 31 in 1906, 74 in 1905, and 492 in 1904. The 9 cases in 1907 were sporadic, being distributed all over London, and separated by considerable intervals of time from each other. Scarlet Fever.—In 1907, 220 cases of scarlet fever were notified in Chelsea, equivalent to a case-rate of 29 4 per 10,000 of the population, as against 36 3 in 1906. The number of cases notified in the first quarter of the year was 47, in the second quarter 60, in the third quarter 36, and in the fourth quarter 77. The influence of the school holidays in August was inappreciable, the prevalence of the disease in July having been very slight. The maximum prevalence was reached in October and November, the usual December decline being but little marked. The number of cases notified during the year in North Chelsea was 93, and in South Chelsea 127. The percentage of cases of school ages (3 to 13 years) of the total number in the Borough was 70 per cent. as compared with 71 per cent.in 1906. The average duration of the stay in hospital of 191 cases, of which the records are to hand, was 61 days. as against 65 in 1906. Nine cases admitted to the M.A.B. hospitals were subsequently certified by the Medical Superintendents of those institutions not to be suffering from scarlet fever or any other notifiable disease. The average duration of the stay in hospital of these 9 cases was 16 days. Nine cases on discharge from the M.A.B. hospitals were stated to be still suffering from nasal or aural discharges, as against 19 cases in 1906. So far as known, none of these cases were the means of spreading infection after return to their homes. During the year there were 4 instances of possible " 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 3 days, 4 days (2), and 5 davs. Special school incidence in 1907 was shown in connection with Ashburnham and Christchurch Schools. In the former school 7 cases of scarlet fever were notified between the 23rd January and the 14th February in the persons of children—aged 5 to 11—attending this school. As the result of the inquiries made and the precautions taken, there was no further spread of the disease after the 14th February. In Christchurch School, 9 children attending the school were notified as suffering from scarlet fever in the month of November, the early cases c 18 apparently having some connection with an unrecognised case that was attending the Infant Department during the early stage of illness. Diphtheria.—In 1907, 158 cases of diphtheria (including 3 of membranous croup) were notified in Chelsea, equivalent to a case-rate of 211 per 10,000, as compared with 216 in 1906. In the first quarter of the year 33 cases were notified, in the second quarter 36, in the third quarter 41, and in the fourth quarter 48. The percentage of cases of school ages (3 to 13 years) of the total number in the Borough was 72 per cent., the same percentage as in 1906. In North Chelsea 84 cases were notified, and in South Chelsea 74. Contrary to what is usual, there were more cases of diphtheria notified in August (16) than in July (13), but this was due to special incidence of the disease at this time on the children of the St. George's Home, Milman-street. In this Home, in which there is accommodation for 70 children, aged 3 to 16 years, 5 cases of diphtheria were notified between the 26th July and the 30th August, and subsequently 6 cases were notified between the 27th November and the 4th December. The children attend the Cook's Ground School. The source of the infection in neither outbreak could be definitely traced. It may have been derived from attendance at the Cook's Ground School; or in the case of the first outbreak, it may have been acquired at a garden party at Putney, given by the Ministering Children's League on the 17th July, which was attended by 50 children, over 8 years of age, from St. George's Home. The sanitary condition of the Home is good, the building being only a few years old. There was no other special incidence of diphtheria upon any particular school or public institution in the Borough during the course of the year. The average duration of stay in hospital of 110 cases, of which the records are to hand, was 52 days, as against 49 in 1906. Fourteen cases admitted during the year 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 corresponding number in 1906 being 11. The average duration of the stay in hospital of 10 of these cases was 19 days. One case of diphtheria on discharge from a M.A.B. hospital was stated to be still suffering from rhinorrhœa, but free from diphtheria bacilli. During the year medical practitioners sent 90 throat swabbings to the Lister Institute for bacterioscopic diagnosis, the costs being defrayed by the Borough Council. Seventy-one of these swabs were sent by the medical staff of the Victoria Hospital in respect of Chelsea children. Of the total of 90 swabbings, 41, or 44 4 per cent., afforded positive evidence of the presence of the specific diphtheria bacillus, and 49, or 55.6 per cent. gave negative evidence. Four out of the 41 " positive " swabbings also showed the presence of Hoffman's pseudo-diphtheria bacillus, and 13 of the " negative " swabbings contained this bacillus. Enteric Fever.—The number of cases of enteric fever notified in Chelsea in 1907 was 21, as against 17 in 1906, the case-rate again being 19 a low one, namely, 2.8 per 10,000 of population. There were no cases notified in the first quarter of the year, 7 were notified in the second quarter, 4 in the third quarter, and 10 in the fourth. In North Chelsea 14 cases were notified, and in South Chelsea 7. Two cases ended fatally. Of the 21 cases notified, one was stated by the Medical Superintendent of the M,A.B. hospital to which the patient was removed, not to be a case of enteric fever, but of basal meningitis, which subsequently proved fatal. Of the remaining 20 cases, in 4 the infection was in all probability contracted outside the Borough of Chelsea, one of these cases being probably due to the consumption of infected oysters at Marseilles. There were, therefore, 16 cases of enteric fever in the Borough, which can be regarded as having contracted the disease in Chelsea. Specimens of the blood of 3 patients were sent to the Lister Institute for investigation as to the Widal reaction, and in two cases positive results were obtained. The average duration of stay in hospital of 8 cases, of which the records are to hand, was 31 days, the corresponding figure for 1906 being 47 days. In May, 5 cases of enteric fever were notified in a single day amongst a family living in the King's-road. All the occupants of the house were attacked with the exception of the male head of the family. In addition a married daughter of the family and her husband, residing in Fulham, were simultaneously attacked, they having been constant visitors at their parents' house in Chelsea. The circumstances of the outbreak pointed to the family having been infected through the medium of some food or drink (not water or milk, as there were no other cases brought to light either before or after the King's-road cases). Suspicion attached to some watercress that was partaken of by all the affected persons at a Sunday meal (8 days before the onset of symptoms in the first person attacked), with the exception of the servant, who had however, prepared it for table. If the watercress was in reality the infecting agent, the incubation periods in the 5 cases would be as follows:— 8 days (1), 9 days (2), 10 days (1), 12 days (1). It is to be noted that the longer incubation period of 12 days was seen in the mother of the family, the 4 shorter periods of 10 days and under characterising the attacks in the younger members of the family, aged 13 to 20 years. It was subsequently ascertained that the watercress was bought at Covent Garden Market, but it was impossible to trace the beds from which the cress was derived, as the supply of this vegetable to the market from the different localities is very irregular, depending on the ripening of the beds and their readiness for cutting, and no records appear to be kept by the market salesmen of the consignees and the dates of delivery of their goods. 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 18 years 1890-1907:— c 2 20 Table XVI.—Case Mortality in Chelsea, and in London, 1890-1907. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Chelsea. London. Chelsea. London. Chelsea. London. 1890 7•0 5•7 17•6 24•1 17•4 23•0 1891 3•6 5•1 15•4 22•5 17•4 15•6 1892 5•3 4•3 22•9 23•9 13•6 17•2 1893 5•3 4•3 23•4 24•5 22•1 18•4 1894 5•1 5•2 21•7 23•6 14•7 18•1 1895 4•0 4•2 18•7 20•4 18•4 17•0 1896 4•9 3•7 22•9 19•3 14•7 17•7 1897 3•5 3•4 17•9 17•1 26•4 18•8 1898 4•2 3•4 15•1 14•8 25•0 19•3 1899 2•8 2•2 10•6 14•2 28•1 18•0 1900 3•0 2•6 9•9 12•8 24•4 17•5 1901 2•6 3•2 8•5 11•1 12•8 16•8 1902 4•0 3•1 10•0 11•0 16•6 16•3 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 1906 3•3 2•6 10•0 8•8 0•0 16•9 1907 0•9 2•5 5•1 9•1 14•3 14•5 The case mortality of scarlet fever in Chelsea in 1907 was exceptionally low, and so was the diphtheria case mortality In the case of scarlet fever we can conclude that the disease exhibited a very mild type; whilst in the case of diphtheria the disease was also mild, and the cases that occurred must have received in an early stage the benefits of the anti-toxin treatment. 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 for the year 1907. Table XVII.—Notifications per 10,000 of Population in 1907. Scarlet Fever. Diphtheria. Enteric Fever. Chelsea 29•4 21•1 2•8 Kensington 28•7 12•9 2•2 Paddington 38•5 11•3 2•3 Hammersmith 47•6 17•6 3•3 Fulham 40•1 36•3 3•5 Westminster 24•3 8•4 3•0 West London 34•4 17•6 2•8 London 54•5 18•4 2•9 21 The above Table shows that scarlet fever was most prevalent in Hammersmith, and diphtheria in Fulham, during the year 1907. The prevalence of scarlet fever in the Western Boroughs of London was much less in 1907 than in the Eastern and Southern districts of the Metropolis. The greatest prevalence was in the Borough of Stepney, where scarlet fever became epidemic in the early summer, and continued in epidemic form for the remainder of the year. The Stepney case-rate per 10,000 of its population for the year 1907, is 102—double that of London generally, and 3½ times that of Chelsea. 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 18 years, 1890-1907, 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 1906 90 88 65 1907 91 91 81 Cerebrospinal Fever.—Three cases of this disease were notified in Chelsea in 1907, all proving fatal. In all three cases the diplococcus intracellularis of Weichselbaum was found in the cerebro-spinal fluid withdrawn by lumbar puncture. The ages and sex of the patients were as follows:—female, 2| years ; male, 4 months ; female, 2 months. All the children came from very poor homes, the familes in each case being practically destitute. Two of the deaths occurred in the Victoria Hospital, and one in the Chelsea Infirmary. Six other deaths were registered in Chelsea during the year as being due to non-tubercular meningitis, 4 of these being infants under one year of age. In one case of fatal meningitis that was reported, 22 the cerebrospinal fluid showed the presence of the pneumococcus and not of the diplococcus intracellularis. There was no spread of the disease from any of the notified or unnotified cases, so far as known ; and it is evident that the infectivity of cerebro-spinal fever in London during the past year was of very low degree, if it existed at all in the ordinary sense. In London during the year, 136 cases of cerebro-spinal fever were notified, notification having commenced in the second week in March ; and 24 deaths were registered in London as being due to this disease in a similar period. The case-mortality is, therefore, only 17.7 per cent. for the year; but it seems probable that many of the notified cases were not in reality true instances of the disease with which the meningococcus of Weichselbaum is associated, as this form of the disease is excessively fatal, no specific or serum treatment being as yet generally available. The serum prepared by Dr. Flexner, pathologist to the Rockefeller Institute of New York, has been used in Belfast during the past year, where the disease has been prevalent, with very gratifying results, the mortality case-rate in the Fever Hospital having been reduced to 27 per cent. in serum-treated cases, as compared with 80 per cent. prior to its use in the same institution. Voluntary Notification of Phthisis.—During 1907, 10 cases of pulmonary tuberculosis were notified by medical practitioners, as against 20 in 1906, and 24 in 1905. Only four medical practitioners notified cases in 1907. There were altogether 110 deaths from phthisis in Chelsea in 1907, of which number 78 died in public institutions, so that the 10 cases, voluntarily notified, form 31 per cent. of the 32 cases that terminated fatally at the patients' own homes. The sputa of 2 patients were sent to the Lister Institute for bacterioscopic diagnosis, results confirmatory of the presence of the tubercle bacillus being obtained in one case only. 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; and cases of the disease have also been notified by the Lady Almoner of St. George's Hospital, and by the Chelsea Branch of the Charity Organisation Society. 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. Since October, 1903, when voluntary notification of phthisis commenced, 167 cases of this disease have been inquired into by means of visits and revisits at the homes of patients. Of this number, 82 cases were reported by medical practitioners, and the remaining 85 cases were brought to my knowledge by other agencies. Of the 167 cases, fairly full information as to previous history and habits was obtained in 146; of the remaining 21 cases, in 7 a wrong address had been given, and the case could not, be traced, and in 14 the information obtainable was too slight or dubious to be reliable. 23 Of the 146 cases in which fairly full information was obtainable in 57, or 39 per cent, there was a previous history of consumption in the family, one or more near relatives having previously died of the disease. In 14 cases, or 9.6 per cent. of the total, there had been personal association with another case of consumption previous to the onset of the disease; but in some of these cases there is merely a history of illness from phthisis of a relative, with whom the patient might have been more or less in association, but no definite account of prolonged or continuous contact, such as is involved in the nursing of or sole care of a sick person. It seems very doubtful as to what precise value as a causative agent is to be attached to association with a person suffering from phthisis. It appears probable that some few cases of the disease may arise in this way—by what may be regarded as personal infection—but in the majority of cases investigated it has not been possible to trace out any history of infection by personal contact. The question as to which is the more important as a causative agent in tubercular disease—the seed or the soil—the bacillus of tubercle or the capacity of the bodily tissues to receive, harbour and nourish the bacillus—is still full of uncertainty, and will probably not be satisfactorilly decided until our knowledge of the intimate pathology of tubercle rests on much firmer ground than is at present the case. Puerperal Fever.—Four cases of this disease were notified in Chelsea in 1907, as against eleven in 1906. Under an arrangement made with the London County Council, the authority for administering the Midwives' Act, means are now provided by the Chelsea Public Health Department for disinfecting the clothing aud instruments of any certified midwife that may be in attendance on a case, 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. HOUSING OF THE WORKING CLASSES. Sir Thomas More Buildings. The income from, and expenditure upon the Buildings for the year ended the 31st March, 1907, are as under:— For the Year ended 31st March, 1907. Expenditure. Income. £ s. d. £ s. d. General Charges 1,424 12 3 Gross Rents 4,746 11 6 Interest on and Repayment of Loans 3,513 6 7 Less Empties and Porters' Rooms 79 12 0 £4,937 18 10 4,666 19 6 Perambulator, &c., sheds 22 16 3 Deficit Balance 248 3 1 £4,937 18 10 The amount received in rents was 9833 per cent. of the gross rental, which is practically the same as the previous year. The empties and bad debts amounted to £21 2s., or 0 44 per cent. of the gross rental, as against 052 per cent. in the previous year. The general charges amounted to £1,424 12s. 3d., or only 30 per cent. of the gross rental, as compared with 31 per cent. in the previous year. The deficit on the year's working was only £248 3s. Id., as compared with an estimated deficit of £789. The total sum expended on capital accounts, amounts to £67,402, and the amount of loans outstanding amounts to £65,257. The buddings have been fully occupied during the year, and the demand for tenements is still greater than can be supplied. The administration during the year has worked with smoothness and efficiency. During the year 1907, 39 tenants voluntarily terminated their tenancies, and 5 tenancies were terminated by the Committee by notice to quit—total 44. Vital Statistics.—During 1907, 30 births (14 boys and 16 girls) were registered as occurring in the Buildings, which is equivalent to a birth-rate of 35'4 per 1,000, the birth-rate of the Borough being 19 7 per 1,000. Six deaths of residents of the Buildings have occurred during the year, equivalent to a death-rate of 7.l per 1,000, the deathrate of the Borough being 15.0 per 1,000. 25 Deaths at Sir Thomas More Buildings in 1907. Age. Sex. Occupation. Disease. 4 years F. D. of Naval Pensioner Pneumonia. 3 „ F. D. of Storehouseman Diphtheria. 13 „ F. D. of Carpenter General Paralysis. Newly born F. D of Motor-fitter Asphyxia: want of air in bed. 3 years F. D. of Insurance Office Porter Tubercular Meningitis. 63 „ F. Wid. of Bricklayer Cancer of Stomach. Five cases of scarlet fever, 8 cases of diphtheria, and 1 case of enteric fever were notified in the Buildings during the year. Pond House. This house was opened for occupation in September, 1906, and the accounts are in respect of the first six months working only. The amount received in rents amounted to 96•86 per cent. of the gross rental, and the loss of rent from "empties" amounted to 0•72 per cent. of the gross rental. The general charges amounted to 34•5 per cent. of the gross rental. During the year 1907, Pond House was fully occupied, but there is a much larger demand for the 2-room tenements, than for the 3-room tenements. Eleven tenants voluntarily terminated their tenancies during the year. The defects to the kitchen boilers in the tenements were rectified during the year, and the boilers now work satisfactorily. The dust shoots on the staircases were closed, and a dust-bin was provided in the courtyard, and a dust-pail to every tenant. Six births (2 boys, 4 girls) were registered during the year. There were no deaths, nor were any cases of infectious desease notified amongst the occupants. Onslow Dwellings. The income and expenditure upon the Dwellings for the year ended the 31st March, 1907, are as under:— For the Year ended 31st March, 1907. Expenditure. Income. £ s. d. £ s. d. General Charges 521 17 8 Gross Rents 1,442 4 6 Special Repairs 1,727 14 3 Less Empties 9 9 6 Interest on and Repayment of Loans 949 8 5 1,432 15 0 Sundry Receipts 25 1 1 £3,199 0 4 Deficit Balance 1,741 4 3 £3,199 0 4 26 The amount received in rents amounted to 99 37 per cent. of the gross rental, and the empties and allowances amounted to 0 63 per cent. The general charges amounted to 34 25 per cent. of the gross rental. Exclusive of the cost of the special repairs, there was a surplus on the year's working of £13 7s. 9d. The administration of Onslow Dwellings and Pond House during the Year has worked with smoothness and efficiency. During 1907, eleven tenants voluntarily terminated their tenancies, and one was given notice to quit. in September, 1907, a child of one of the tenants, aged 2½ years, met with an accident by falling from the first floor balcony into the courtyard below, and the question of the liability of the Borough Council for this accident is at present under the consideration of the Housing Committee. Vital Statistics.—During the year 1907, 11 births (3 boys, 8 girls) were registered for the Dwellings, equivalent to a birth-rate of 30 6 per 1,000. Three deaths were registered during the year, equivalent to a death-rate of 8 3 per 1,000. Deaths at Onslow Dwellings in 1907. Age. Sex. Occupation. Disease. 76 years F. Wid. of Coachman Influenza, Bronchitis. 1½ „ F. D. of Postman (deed.) Tubercular Meningitis. 64 „ M. House-painter Pneumonia. No cases of infectious desease were notified during the year, in the Dwellings. Earl Cadogan's Offer of a Site for Working Class Dwellings in Grove Cottages, Manor Street. On the 7th March, 1907, the following letter was received from Mr. Cave, Earl Cadogan's Estate Agent:— Cadogan Estate Office, 120a, Sloane Street, London. 6th March, 1907. Dear Dr. Parkes, When you called upon me last week, you handed to me a copy of a resolution passed by the Borough Council on the 27th February, instructing the Public Health Committee to consider the practicability of acquiring a site for the erection of Working Class Dwellings on the Manor-street and Flood-street area. The provision of more Dwellings for the Working Class has, I know, been under consideration by Lord Cadogan on several occasions recently, and, but for the indisposition of himself, and the illness of Lady Cadogan, 27 the Council would have been approached on the subject immediately after Christmas. I saw his Lordship after you called upon me, and am now authorised to communicate to the Committee, through you, the offer which, but for the circumstances above mentioned, would have been made to the Council before now. His Lordship is willing to convey to the Council free of cost the piece of land on the South side of Grove Cottages, marked by the number 9 in red ink on the accompanying plan, for the purpose of the erection of Working Class Dwellings. I ought, however, to say that there are one or two conditions which he attaches to his gift. 1. That the Dwellings to be erected should be used for the poorer class of workman, whose total income does not exceed 25/- a week. 2. That the plans of the proposed buildings should be submitted to his Lordship's Surveyor, Mr. H. T. Steward. 3. That the northern line of the plot should be set back 5 feet, and that in addition the buildings to be erected should have a forecourt of some 5 feet. When the plot marked 3 on the plan comes to be dealt with, the southern boundary line of that plot will be set back such a distance as, with the 5 feet to be taken of plot 9, will make the roadway of Grove Cottages 40 feet wide. I understand that the Public Health Committee meet to-morrow, and perhaps you will lay my letter before them then, and let me hear from you in due course the views of the Council upon it. Believe me, Yours truly, (Signed) H. W. Cave. Dr. L. C. Parkes. The land offered as a gift by Earl Cadogan, K.G., to the Borough Council for the purpose of a housing scheme for the lower-wage earning classes, is freehold, and lies on the south side of the private approach road to Grove Cottages. It is now in the occupation of Messrs. Birch, cartage contractors to the Government Post Office, and there are 5 onestoreyed houses fronting Manor-street on the site. The land measures 292 feet in width with an average depth of 73 feet, the total area being about 21,316 square feet, or 0.489 acre (not quite half an acre). I prepared and submitted a scheme for the utilisation of the land offered by Lord Cadogan for the erection of Working Class Dwellings, which was approved by the Public Health Committee, and submitted to the Borough Council on the 27th March. The Council resolved to accept Lord Cadogan's generous offer, to abide by the conditions attaching to the gift, to provisionally approve of the scheme indicated in the Committee's report, to authorise the Housing Committee to prepare a scheme on the lines indicated in the report, and to refer the matter to the Finance Committee for consideration, and to bring up the necessary financial estimate. On the 1st May, the Finance Committee reported that they were unable to submit an estimate until they had some reliable figures to 28 work from, and recommended that an architect be employed to submit a rough sketch and an estimate of erecting a suitable building. The Public Health and Housing Committee subsequently invited 6 architects to submit plans with estimates of cost for the erection of Working Class Dwellings on the site, and these plans and estimates are still under consideration by the Committee. HOUSES DEMOLISHED OR VACATED FOR DEMOLITION DURING THE YEAR 1907 Houses. Christchurch-street 5 Church-street 4 College-street 1 Cumberland-place 4 Denyer-street 5 Eden-place 5 Fulham-road 6 Keppel-street 19 King's-road 4 Leverett-street 5 Little Keppel-street 1 Manor-street 3 Marlborough-street 2 Norman-street 4 Orford-street 4 Pond-place 4 Rawlings-street 4 Royal Hospital-road 2 Stay ton-street 2 Wood-street 15 99 Taking the number of persons per house as 6,594 persons have been displaced during 1907 as the result of demolitions. 29 Section IV. THE SANITARY CONDITION OF THE BOROUGH. The tabular statements prepared by the Sanitary Inspectors show that 1281 separate premises were reported on by them during 1907, 449 of this number being with reference to cases of notifiable infectious disease, and 326 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 five houses, and also for the emission of black smoke from the 4 chimneys of the Electric Generating Station, Lots-road. Drainage.—During the year 63 new drains for single houses have been reconstructed in accordance with the London County Council's drainage regulations. Combined Drainage.—Six systems of combined drainage, for which the owners of the houses were responsible, were sanctioned by the Borough Council in the course of the year. The Borough Council was not called upon in 1907 to reconstruct any systems of combined drainage, which were sewers vested in the Sanitary Authority. From 1896 to 1907 inclusive, the sum of £511 has been expended from the rates on the combined drainage of private property, equivalent to an annual outlay of £42 11s. Inspection of Restaurant Kitchens, 1907. Number of restaurant and hotel kitchens 61 „ inspections made 98 „ premises found satisfactory 57 „ premises with sanitary defects 4 „ notices served 4 Disinfection.—During the past year, 421 premises have been disinfected, after cases of infectious or other disease, 31 of these being rooms which had been in occupation by persons suffering from phthisis. During the year also, 267 rooms were disinfected for the presence of bugs and other vermin, and were subsequently stripped and cleansed by the owners of the premises. A large amount of work was done at the disinfecting station in 1907, 5247 separate articles being disinfected, and 1596 beds, mattresses, &c., being destroyed in the incinerator. Owing to the large amount of use to which the incinerator has been put in recent years, the internal parts are now becoming much worn, and it will be necessary to have the furnaces thoroughly renovated during the current year. 30 The Sale of Food and Drugs Acts. During the year 400 samples were taken for analysis. Of the 400 samples 191 were milk, 181 being returned by the Public Analyst as genuine samples, and 10 as adulterated. Prosecutions were undertaken in 7 cases with the following results:—10.6 per cent. of added water— fined 10s. and 10s. 6d. costs; 9.4 per cent. of added water—fined 10s. and 10s. 6d. costs; 87.6 per cent. of fat abstracted—fined £1 and 10s. 6d. costs; separated milk, 5 per cent. of added water—fined £2 and 10s. 6d. costs; 9.4 per cent. of added water—fined £1 and 10s. 6d. costs; 11.3 per cent. of added water—fined £1 and £3 3s. costs (Westminster Police Court); 17.6 per cent. of added water—fined £1 and 10s. 6d. costs. In the remaining 3 cases of adulteration there were no proceedings; in two, because the vendors were protected by warranties—3.5 and 7.4 per cent. of added water respectively; and in one case, because the adulteration was slight, viz., 2.4 per cent. of added water. Of butter 126 samples were taken, 123 being returned as genuine, and 3 as adulterated. Proceedings were taken in all these cases with the following results:—11.7 per cent. of excessive water—fined 10s. and 10s. 6d. costs ; 78 per cent. of foreign fat—fined £2 and 10s. 6d. costs ; 78 per cent. of foreign fat—fined £2 and 10s. 6d. costs. Of margarine 18 samples were taken, 17 being genuine, and one containing excessive water (20. 9 per cent.). No proceedings were taken in this case. Of cream 2 samples were analysed for private purchasers. Of bread 18 samples were taken, 4 being returned as inferior by reason of containing a slight excess of moisture. Of brandy 10 samples were taken, 9 being genuine, and one adulterated, as it contained 3 per cent. of excessive water. Of whisky 8 samples were taken, 6 being genuine, and 2 adulterated, each containing 5 per cent. of excessive water. No proceedings were taken in respect of the adulterated brandy and whiskies, as in all cases notices of dilution had been displayed at the places of sale. Of coffee 9 samples were taken, 8 being genuine and 1 adulterated, as it contained 47 per cent. of chicory, but this sample was sold as a mixture of coffee and chicory, and duly labelled, so no proceedings were taken. Of cheese 9 samples were taken, all being genuine. In 1907 the adulterated milks formed 5.2 per cent. of the total number of samples of milk analysed, as compared with 6.2 per cent. in 1906. In 1907 the adulterated butters formed only 2.4 per cent. of the total butter samples, as compared with 15 per cent, in 1906. Smoke Nuisance. Proceedings were again instituted against the Underground Electric Railways of London, Company, Ltd., for permitting black smoke to escape from each of their 4 chimnies in June, 1907, The case was heard at the Westminster Police Court, on 7 different days between the 4th July and the 2nd November, and the Magistrate, Mr. Curtis Bennett, dismissed the four summonses, on which the proceedings were founded, and granted 300 guineas costs to the defendant company. The learned 31 Magistrate said he gave his decision on the facts and not on the law of the case, and that he was not satisfied that the smoke complained of was black, or that there had been any nuisance. In considering the magisterial decision on the 13th November, the Borough Council resolved that application should be made to the London County Council to furnish a substantial contribution to the costs incurred, the prosecution having been instituted at the urgent request of the Public Control Committee of the London County Council, and the question of preventing the pollution of the atmosphere by smoke being one that affected the whole Metropolitan area. The London County Council in due course replied that they are advised that they have no authority to make any such contribution towards the costs of the litigation. Water Supply. During the year a daily examination of the water drawn from the King's Road main of the Metropolitan Water Board was made, until the beginning of September, when the old Town Hall building was vacated. The highest temperature attained during the year was 66° F., at the end of July, which is 4 degrees lower than the maximum of 1906. The lowest temperature recorded, 38° F., was reached early in February. Throughout the period of observation the water was clear and free from turbidity, but it was distinctly tinged a yellow-green after the heavy rains and floods of December. The London County Council (General Powers) Act, 1907, contains a section (No. 78) as follows:—" For the purposes of section 48 of the Public Health (London) Act, 1891, a tenement house shall be deemed to be a house without a proper and sufficient supply of water unless there shall be provided, on the storey or one of the storeys in which the rooms or lodgings in the separate occupation of each family occupying such house are situate, a sufficient provision for the supply of water for domestic purposes." The section contains a proviso that it shall not apply to any tenement house in respect of which it can be shown that any such provision for the supply of water as aforesaid, is not reasonably necessary. I have already reported fully on this matter (Minutes, 8th March, 1905), and I am of opinion that it is undesirable that there should be any general application of section 78 of the London County Council (General Powers) Act, 1907, to the tenement houses in Chelsea. Cases may, however, arise from time to time, in which the enforcement of the section may appear desirable. Basement Workrooms. During the year 1 new basement workroom has come into occupation, there being at the end of the year 22 basement workrooms in the Borough occupied by milliners and dressmakers, with accommodation for about 180 workers. 32 The sanitary conditons 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 Reports for 1904,1905, and 1906, 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 period, which allowed owners and occupiers to make the necessary alterations after due notice. 33 REPORTS PRESENTED TO THE BOROUGH COUNCIL. March 13th. Municipal Milk Depots, re L.C.C. General Powers Bill, 1907. March 27th. The Housing of the Working Classes, re Lord Cadogan's offer of a site in Grove Cottages, Manor Street. October 2nd. Application of the Port of London Sanitary Authority for the powers of a Sanitary Authority in Riparian Districts. October 16th Notification of Births Act, 1907. London County Council Bill (Sanitary Powers) for 1908. November 13th. Chelsea Borough Council v. Underground Electric Railways of London, Co., Ltd.—Smoke proceedings. December 11th. The causes of high Death-rates in streets inhabited by the lower wage-earning classes. D 34 REPORT OF WORK DONE DURING 1907 BY MISS M. W. RICHARDSON, Lady Sanitary Inspector. The work done during 1907 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. (5) Visiting cases of measles and other non-notifiable infectious cases notified by the school authorities. (6) Visiting to give instruction re management of infants. (7) Visiting special cases reported from hospitals, or other charitable agencies, &c. (1) Inspection of Workshops and Laundries. During 1907 there were 59 new workshops registered, and 56 were removed from the register, the total number at the end of the year being 360. Of this number 236 were dressmaking workshops. The number of assistants employed in this class of work varies considerably according to the time of year. In several workshops more than one hundred girls are employed during the season. Overcrowding.—During the year 97 workrooms were measured. As far as possible the measurements are taken when the workrooms are registered. Several cases of overcrowding were dealt with. Many of these were due to the assistants crowding together in one room instead of keeping to their allotted places. Basement Workrooms.—Three new workrooms were added and two were removed, making a total of twenty-two on the register. Considerable difficulty has been experienced with regard to the ventilation of these rooms, more especially during the winter months when artificial lighting is continually being used. Basement workrooms are generally large, but the means of ventilation and lighting are not in satisfactory proportion to the cubic space. It often happens, therefore, that more workers are allowed by law to be accommodated than is desirable. Laundries.—There were 15 workshop laundries on the register at the end of 1907, one being removed during the year. These were all visited by the Medical Officer of Health in December. In addition, there were also 4 factory and 15 domestic laundries. In the case of the latter the work done is often very irregular, generally one woman only being employed besides members of the family. All the workshop laundries were lime-washed during the year. 35 Classification of Workshops. ( Women Employees.) 1906. No. Added. No. Removed. Total 1907 Art Needlework 3 — — 3 Blind Making 2 — — 2 Blouses 6 1 l 6 Boot Closing 4 1 — 5 Corset Making — 1 — 1 Dress Making 234 46 44 236 Furrier 3 — 1 2 Household Linen 2 1 1 2 Lace Making 1 — — 1 Lampshades 4 1 2 3 Laundries— Factory 4 — 1 3 Workshop 16 — 1 15 Domestic 16 1 2 15 Millinery 44 4 3 45 Outfitting 9 3 1 11 Ostrich Feather Mounting — 1 1 Perfumes 1 — — 1 Tailoring (Men's) 4 — — 4 Upholstery 4 — — 4 357 60 57 360 (2) Outworkers. The total number of lists received during the year amounted to 72, containing the names and addresses of 680 outworkers. This was an increase of 16 lists on the number sent in during 1906. Of the total number of outworkers notified by Chelsea firms only 135 (i.e., about 20 per cent.) live in the Borough, which is the same proportion as for last year. The majority of the remaining outworkers live in adjoining Boroughs. Names and addresses were forwarded in all to 34 different Boroughs or District Councils, as follows:— City of Westminster 93 Fulham 74 Battersea 64 Marylebone 64 Kensington 30 Islington 18 Wandsworth 18 Paddington 15 Hammersmith 15 City 15 St. Pancras 14 Lambeth 13 Stepney 11 Camberwell and Hackney, each 10 20 Other Boroughs and District Councils 54 518 d 2 36 As comparatively few employers used the specified form when sending in their lists, a circular was sent out in July drawing attention to the fact that special forms are provided by the Secretary of State for these lists. Latterly many more employers have complied with the regulations in this respect. It is essential for statistical purposes that the specified form should be used, since the Secretary of State now requires detailed information as to whether the outworkers are employed as contractors or as workpeople. In addition, employers on a large scale often give out work to a considerable number of people in different trades, and returns must now be made up by the Public Health Department to indicate these sub-divisions. It frequently happens, of course, that the same outworkers are employed by different firms. As an instance of this, one outworker who himself employs others, has this year been notified as working for fourteen different firms, viz.:—three firms in Chelsea, three in Battersea, four in Kensington, two in Wandsworth, one in Fulham, and one in Westminster. From other Boroughs 92 outworkers were notified as living in Chelsea, but working for outside firms. Jan. to June. July to Dec. Total. Number of Lists received 40 32 72 Total number of Out-workers 320 360 680 Number living in Chelsea 68 67 135 Number forwarded to other Boroughs 230 288 518 Received from other Boroughs 31 61 92 (3) Infantile MotalitY Inquiry. During 1907 the deaths of 168 children under two years of age were investigated, as against 165 in 1906. This does not include those upon whom inquests were held. In five cases death was stated to be due to premature birth caused by shock or accidents to the mother. In several instances the mothers stated that they had been going to work shortly before the birth of the child. One mother was working at a laundry, another at a dressmaking workshop—in each case until the day before the birth of the baby. Another was employed as a scrubber at one of the hospitals until a fortnight before her confinement. In 21 cases the mothers, subsequent to confinement, went to work, leaving their babies at the creche or in charge of neighbours. In four instances both parents were stated to be consumptive. Of the total number of deaths investigated, in fourteen cases the baby was reported as illegitimate, seven of these having been born outside Chelsea. In eight cases the infants had been entirely put out to nurse. This had also been done in two cases where the mother was registered as a married woman. In the case of one child the birth was registered four weeks after death had occurred. 37 In 35 cases the deceased infant was the first child. Apart from these, in 61 instances out of the remaining 133, the parents had previously lost children, the aggregate number of deaths amounting to 128. This gives an average of two previous deaths in each family. In 40 cases the family occupied one room only. In eighteen cases they occupied basement rooms. A considerable number of the deaths were due to measles and whooping cough, both of which were prevalent for a considerable period of time in the year 1907. (4) Phthisis Cases. The majority of cases of phthisis reported are notified from the Hospitals, or from the Chelsea Workhouse when the patients are discharged. A considerable number of the cases attend Brompton Hospital. Others go to the Infirmary for a time, coming out for short periods when the weather is warmer, &c. Such cases are visited on their discharge, but the addresses are sometimes incorrect. The patients almost invariably welcome the visits which are made as informal as possible. As a general rule the patients understand and appear to observe ordinary precautions as regards ventilation, treatment of expectoration, &c. But on the other hand, owing to protracted illness, the family can rarely afford to pay for proper accommodation, with the result that the patient is seldom sleeping in a separate bed, still less in a separate room. As an instance of this the following may be cited :— Patient, wife, and four children, living in one room. Patient, wife, and two girls, aged respectively 13 and 11, living in one room. Patient, husband, and two girls, aged respectively 15 and 12, living in one room. All these patients had recently been in the infirmary, but discharged themselves contrary to advice. Disinfectants are supplied to patients who appear to require them, and pocket spittoons and fibre handkerchiefs are given by the Medical Officer of Health. (5) School Cases. During the year 671 cases of infectious complaints (non-notifiable) were reported from the schools. In spite of the fact that a severe outbreak of measles occurred in the previous year, a similar outbreak with a high rate of mortality occurred in 1907. In addition, whoopingcough was prevalent throughout the whole of the summer, which was probably attributable to the coldness of the weather. The number given (671) does not include duplicate notifications, nor more than one case at each house, and therefore indicates more nearly the number of houses at which cases occurred. Instances in which children were attending Chelsea Schools, but living in other Boroughs, were also excluded from the list. 38 The cases were classified thus :— Measles 289 Whooping Cough 142 Chicken-pox 114 Ringworm and Eczema 66 Mumps 42 Ophthalmia 18 671 As far as possible the cases were visited at their own homes, with the exception of those suffering from chickenpox and mumps. Simple instructions were given to the mothers, and they were urged to get medical advice for the children when possible. The notifications were received from the various Schools as follows:— The notifications were received from the various Schools as follows:— Ashburnham 211 Cook's Ground 145 Marlborough Road 117 Park Walk 77 Christchurch 46 Hortensia Road 34 Holy Trinity 19 Oratory 3 Walton Street 1 Other Schools outside Chelsea 18 671 Those Schools which are situated near the boundaries of Chelsea are naturally attended also by children living in adjoining Boroughs, and are therefore outside the scope of the present inquiry. It will be noted that hardly any notifications were received from the Roman Catholic Schools, viz.:—Oratory Schools, Servite, and St. Mary's, Cadogan Street, nor from St. Lukes Schools or Walton Street. There does not appear to be any reason why information should not be sent as to non-notifiable infectious diseases occurring in these schools, such as is given by the schools in the table above set out. (6) Visits of Instruction re Management of Infants. The number of births in Chelsea, registered during the year, amounted to 1431. including 14 twin-births as against 18 in 1906. Of the 14 twin-births, in four cases both infants died within the year. The total number of visits paid by me amounted to 697, the actual visits of instruction being approximately 474. The chief points emphasised are :—The importance of breast feeding, when the mother is healthy; care of bottles when used; necessity for cleanliness, and ventilation; how to contrive a cot or cradle at a nominal cost, &c. The number of births reported from St. George's Hospital amounted to 183. The women were visited, previous to confinement, in their own 39 homes by the lady visitors in connection with St. George's Maternity Society, who have given valuable help in this way, Subsequently the mothers are visited periodically until the infants reach the age of nine months. Other cases, amounting to 128, were also visited through the aid of this Society at my suggestion. The organisation for providing dinners for nursing mothers, at the cost of one penny, has considerably extended its work. There are now three centres in Chelsea, viz., in Sydney Street, Denyer Street, and the World's End. The mothers must attend for the dinners which must be eaten on the premises. They are also allowed to come for three months before confinement. The babies are weighed once a fortnight, and the mothers take great interest in the progress of their infants in this respect. In one case under my own observation a mother had already partly put her baby on the bottle through want of sufficient breast milk, when I sent her to the dinners. After attending for a short time, she was able to give up the bottle, and the baby was subsequently entirely breast fed. The scheme is also useful in other ways, since it provides an excellent opportunity of keeping in touch with the mothers, and also for ascertaining that the babies continue to thrive. In 1908 a special birth enquiry will be undertaken in Chelsea, in accordance with the instructions issued by the Home Secretary. Evidence is required as to the employment of women in domestic and industrial work, both before and after childbirth, with a view to ascertaining the effect of such employment. Observations are required to be made until the child attains the age of twelve months, so that the investigations will extend over a period of two years. (7) Visiting Special Cases. In addition to the visiting of cases already referred to, a considerable number are reported from various sources, such as the Lady Almoners of St. George's Hospital and of Brompton Hospital, Relief Committees, Society for Prevention of Cruelty to Children, District Visitors, and through other charitable Agencies. The cases thus reported are not necessarily "complaints" in the accepted sense of the word, but the circumstances are generally, in the opinion of those who send the information, such, that an informal visit of instruction might possibly be advantageous. The cases reported from the Hospitals, for example, generally refer to patients who are found to be suffering from want of cleanliness and fresh air, or improper feeding, rather than from any actual disease. Those reported by District Visitors are generally cases where the homes are very dirty, as regards domestic conditions, i.e., floors, furniture, &c. This branch of the work, therefore, comes more under the heading of Health Visiting than the work of an Inspector. The number of cases reported has increased considerably during the last two years. A register is now kept in which the names and addresses are entered together with notes of recurring visits. 40 Tabulated Statement of Work. (1) Number of New Workshops registered 57 Number of Workshop inspections 308 Visits of Inquiry re Employment of Women 88 Workrooms measured 97 Workroom Cards distributed 44 (2) Outworkers' premises visited 56 Visits of Inquiry re Outworkers 91 (3) Cases of Infantile Mortality investigated 168 Number of Visits paid 228 (4) Phthisis cases notified (all sources) 32 Number of visits paid (including visits of inquiry) 241 (5) School cases reported 671 Number of visits paid 350 (6) Houses visited to give instructions re Management of Infants 697 474 Number of visits paid (7) Special cases, number of visits 98 M. W. RICHARDSON. January, 1908. 41 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.) — — — Workshops (including Workshop Laundries.) 510 10 — Workplaces (other than Outworkers' premises included in Part 3 of this Report.) - - - Total 510 10 — 2.—DEFECTS FOUND. PARTICULARS. Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:* Want of cleanliness 9 9 — - Want of ventilation 1 1 — — Overcrowding 8 8 — — Want of drainage of floors — — — — Other nuisances 7 7 — — †Sanitary accommodation insufficient 2 2 — — unsuitable or defective - - - - 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) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 27 27 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. †For Districts not in London, state here whether section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the District Council; and if so what standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced. 3.—HOME WORK. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Prosecutions. Twice in the Year. Once in the Year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 110). Prosecutions (Sees. 109,110) Lists. Outworkers.† Lists. Outworkers.† Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Wearing Apparel — (1) making, &c. 58 37 594 8 — 20 90 507 - - - - - - - - - (2) cleaning and washing — — — — — — — — — — — — — — — — — Lace, lace curtains and nets — 3 - - - - - 2 - - - - - - - - - Artifical flowers — — — — — — — — — — — — — — — — — Nets, other than wire nets - - - - - - - - - - - - - - - - - Tents — — — — — — — — — — — — — — — — — Sacks — — — — — — — — — — — — — — — — — Furniture and Upholstery 4 2 9 2 — 4 2 - - - - - - - - - - Fur pulling — — — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — — — Umbrellas, &c. — 6 — — — — — 6 — — — — — — — — — Carding, &c. ,of buttons, &c. — 1 - - - - - 1 - - - - - - - - - Paper Bags and Boxes — 1 - - - - - 1 - - - - - - - - - Basket making - - - - - - - - - - - - - - - - - Brush making - - - - - - - - - - - - - - - - - Racquet and Tennis Balls - - - - - - - - - - - - - - - - - Stuffed Toys - - - - - - - - - - - - - - - - - File making - - - - - - - - - - - - - - - - - Electro Plate - 2 — — — — — — — — — — — — — — — Cables and Chains - - - - - - - - - - - - - - - - - Anchors and Grapnels - - - - - - - - - - - - - - - - - Cart Gear - - - - - - - - - - - - - - - - - Locks, Latches and Keys — — 1 — — — — 1 — — — — — — — — — Pea picking — — — — — — — — — — — — — — — — — Total 62 52 604 10 — 24 92 518 - - - - - - - - - *If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. †The figures required in colums 2, 3 and 4 are the total number of lists (received from employers who sent them both in February and August as required by the Act) and of the entries of names of outworkers in those lists. They will, therefore, usually be double of the number of such employers and (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 43 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Bakehouses 39 Laundries 30 Dressmaking and Millinery 281 Outfitting (Women's) 11 Various (Women) 38 Various (Men) 170 Workplaces 62 Total number of Workshops on Register 631 5.—OTHER MATTERS. CLASS. Number. (2) Matters notified to H.M. Inspector of Factories:- Failure to affix Abstract of the Factory and Workshop Act (s. 133) 22 Action taken in matters referred by H M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 15 Reports (of action taken) sent to H.M. Inspector 15 Other — Underground Bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 32 Note.—The Factory and Workshop Act, 1901 (s. 182), requires the Medical Officer of Health in his 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). If the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office the portions which do not relate to factories, workshops, laundries, workplaces or homework. The duties of Local Authorities and the Medical Officer of Health under the Act of 1901 are detailed in the Home Office Memorandum of December, 1904. A further Memorandum, on the Home Work Provisions of the Factory Act, was issued to all District Councils and Medical Officers of Health in October, 1906. 44 PROCEEDINGS DURING 1907. PREMISES. NUMBER OF PLACES. Number of inspections, 1907. Number of Notices, 1907. Number of prosecutions, 1907. On register at end of 1906. Added in 1907. Removed in 1907. On register at end of 1907. Milk premises 128 1 3 126 165 7 - Cowsheds 2 - — 2 48 — - Slaughter-houses 6 - — 6 148 — - Other offensive trade premises - - - - - - - Ice cream premises 39 - — 39 21 2 — Registered houses let in lodgings 602 — 5 597 337 (a)* 5 (b)*100 (a)* (b)* * (a) For overcrowding. • [6) For other conditions. Total number of Intimation Notices served for all purposes 506 Overcrowding, 1907— Number of dwelling rooms overcrowded 14 Number remedied 14 Number of prosecutions - 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 1 Number closed under the Housing of the Working Classes Act - Number of verminous rooms cleansed 267 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 53 Revenue Acts— Number of houses for which applications were received during year 9 Number of tenements comprised therein 62 Number of tenements for which certificates were (a) granted 20 „ „ „ „ „ (6) refused 42 „ „ „ „ „ (c) deferred - Mortuaries— Total number of bodies removed 157 Total number of infectious bodies removed 2 45 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING THE YEAR 1907. Houses and Premises. House-to-house inspections 326 *Reported on respecting nuisances complained of 506 Reported on with reference to infectious cases 449 Cleansed, whitewashed, and repaired 240 Defective roofs repaired 107 Disinfected after communicable diseases 421 Rooms disinfected for verminous conditions 267 Cases of overcrowding abated 26 Dust-bins, new, provided 103 „ repaired - Underground rooms occupied contrary to Act 1 Inspections of restaurant kitchens 96 Drainage :— Drains opened, cleansed, and made sound 1 ,, trapped with stoneware gullies Water-closets cleansed and repaired 55 „ new pans and traps provided 148 Spout drains cleansed, repaired, or renewed 103 Sink, bath, and lavatory waste pipes provided and repaired 109 Drains and soil pipes ventilated or repaired 32 Soil pipes, new, provided 65 New drains laid, in accordance with Council's regulations (including 6 systems of combined drainage) 69 Additional w.c. accommodation provided 14 Water Supply :— For domestic purposes, provided where cut off by Water Board 8 For water-closets, or check cisterns provided and repaired 127 Main cisterns cleansed or repaired 50 „ new, provided 1 Water certificates, issued in respect of newly erected dwelling-houses — Nuisances abated arising from : — Keeping of animals 3 Accumulations of manure and other filth 23 Yards, areas, and wash-houses paved or drained 133 Smoke - 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. 46 Miscellaneous :— Dead bodies removed to public mortuary for sanitary reasons 10 Goods disinfected after infectious cases at station 5247 Goods destroyed after infectious cases 54 Mattresses, beds, &c., received from Surveyor's Department and destroyed by the incinerator 1542 Number of samples taken for analysis (Food and Drugs Act) 400 *Unsound Food. Number of boxes of fruit, fish, rabbits, &c., condemned and destroyed 13 Library books destroyed at Librarian's request 39 Proceedings Taken :— Statutory notices issued, including notices under L.C.C. (General Powers) Act, 1904 199 Intimations issued for sanitary works, &c., including infectious disease cases 506 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 6 Legal proceedings in respect of food adulteration 10 Correspondence †Number of letters written in connection with sanitary matters 769 Daily returns of infectious cases sent to Metropolitan Asylums Board 140 Notification of infectious cases sent to School Authorities 417 Entries in Inspectors' Report Books 506 „ Inhabitants' Complaint Book 38 Certificates of Disinfection given 645 Certificates of infectious diseases for removal cases 206 Notices sent to Public Library of premises where infectious disease has occurred 140 The cow-houses and slaughter-houses were inspected by the Medical Officer of Health prior to licences being renewed in October last, and a list of the retail bakehouses under inspection in Chelsea forms a separate Appendix. There are 128 Dairies and Milkshops, and 36 Ice Cream vendors in the Borough. These have been registered and periodically inspected by the Sanitary Inspectors. All places where fish and potatoes are cooked have been periodically inspected. Sanitary Inspectors. ALEXANDER GRANT (Chief). G. R. METZLER. R. J. DAVIS. M. RICHARDSON (Lady). * This does not include unsound food condemned in the streets and destroyed, for which no condemn note was given. †The department is now connected with the telephone, and consequently the work in connection with the Infectious Diseases is done more expeditiously, and considerable time is also saved by its use in other matters. 47 MAGISTERIAL PROCEEDINGS DURING 1907, UNDER THE SALE OF FOOD AND DRUGS ACT. Streets where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Keppel-street Milk 11.3% of added water Mar. 4th Fine 20/- and 3 guineas cost. College-place „ ... 17.6% „ „ 5th Fine 20/- and 10/6 costs. Smith-terrace „ 9.4% „ „ Fine 20/- and 10/6 costs. Markham-street „ 5% „ Fine 40/- and 10/6 costs. King's-road Butter 78% of foreign fat June 4th Fine 40/- and 10/6 costs. Blantyre-street „ 78.1% „ Fine 40/- and 10/6 costs. Munro-terrace „ 11.7% of excessive amount of water Oct. 15th Fine 10/- and 10/6 costs. Manor-street Milk 87.6% of fat abstracted Nov. 19th Fine 20/- and 10/6 costs. Marl borough-road „ 10.6% of added water „ Fine 10/- and 10/6 costs. Denyer-street „ 9.4% „ Fine 10/- and 10/6 costs. £ s. d. Total — Fines 11 10 0 Costs 7 17 6 £19 7 6 48 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Date of Hearing. Result. 57, Uverdale-road Failing to comply with the Borough Council's notice to provide proper drains and water-closet, and repair kitchen ceiling Jan. 8th 42/- costs, and Order made for the work to be done in 14 days. 16, Wellington-square Failing to comply with the Borough Council's notice to provide a proper and sufficient supply of water to the premises Feb. 18th 42/- costs, and a Closing Order granted forthwith. 39, South-parade Failing to comply with the Borough Council's notice to provide a proper and sufficient supply of water to the premises Mar. 5th Closing Order granted. 73, Arthur-street Failing to comply with the Borough Council's notice to repair roof, provide water to the water closet, and remove accumulation of rubbish in the front area June 4th Closing Order granted unless work done in seven days. 75 Arthur-street Failing to comply with the Borough Council's notice to repair roof and provide a suppy of water to the water-closet „ Ditto. Underground Electric Railways Co., Lots Road Generating Station Failing to comply with the Borough Council's notice to abate the nuisance caused by the emission of black smoke in such quantity as to be a nuisance, from the four chimney shafts July 4th Adjourned from July to October and November, and summonses dismissed. 49 BAKEHOUSES IN USE ON JANUARY 1st, 1907. Street. Occupier. Above Ground. Below Ground. 74, Arthur-street Vacated ... Vacated, Dec., '06 Below. 93, Beaufort-street A. Coventry ... 26, Blantyre-street W. J. Smith ... „ 55, Burnaby-street Schmitt ... „ 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 Frank Andrea ... „ 3, Dartrey-terrace Führ ... „ 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, „ Hart ... „ 399, „ H. Kohler ... „ * Now used as a kitchen only. 50 Street. Occupier. Above Ground. Below Ground. 414, King's-road J. Brewer ... Below. 488, „ Matthiae ... „ 502, „ W. Schafer ... „ 517, „ J. Morgan ... „ 1, Leader-street J. T. Pratt Above. ... 48, Lots-road M. & C. West ... Below. 83, Lower Sloane-street Burrows Above. ... 43, Manor-street Empty ... Below. 62, Marlborough-road Emil Schuster ... „ 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 Reuben Jeffries ... „ 43, Stayton-street Vacated Above. ... 25, Walton-street Burrows ... Below. 51 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. Church-street Emerton, J. 406, King's-road Jorden, G.