CHE 15 Metropolitan Borough of Chelsea. ANNUAL REPORT For 1909, OP 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 Royal Sanitary Institute; Fellow of the Society of Medical Officers of Health. TOWN HALL, KING'S ROAD, CHELSEA. LONDON : Pite and Thynne, Printers, 278a, King's Road, Chelsea, S.W. 1910. TABLE OF CONTENTS. SEC. I.—Statistical:— page Population of Chelsea 3 Births and Birth-rate 3 Deaths and Death-rates 4 Death-rates of Special Classes of the Population 9 Infantile Mortality 9 Statistical Tables (L.G.B. Forms, I., II., III., IV., V.) 12 SEC. II.—Infectious Diseases:— Small-pox 18 Scarlet Fever 18 Milk Epidemic 19 Diphtheria 19 Enteric Fever 20 Removal of Patients to Hospitals 21 The Case Mortality 22 Diarrhœa outbreak 22 Cerebro-Spinal Fever 23 Puerperal Fever 23 Measles 23 Notification of Phthisis 23 SEC. III.—The Housing of the Working Classes:— Sir Thomas More Buildings 26 Pond House 27 Onslow Dwellings 28 Grove Buildings 29 Sutton Trust Scheme for Industrial Dwellings 30 Sun-court, Cheyne-walk 30 Demolitions in 1909 31 SEC. IV.—The Sanitary Condition op the Borough:— Drainage 32 Inspections made 32 Disinfection 32 Smoke Nuisance 33 Basement Workrooms 33 Action taken under the Sale of Food and Drugs Act 33 Water Supply 34 Reports presented to the Borough Council 35 Report of Work done by the Lady Sanitary Inspector 36 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 1909 45 Magisterial Proceedings during 1909 47 Lists of Bakehouses, Cow-houses and Slaughter-houses 48 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For 1909. Section I.—STATISTICAL. POPULATION OF CHELSEA. The census population of the Borough of Chelsea for the year 1901 was 73,842. The estimated population of the Borough for 1909 is 75,249; the population of each sub-district being as follows:— North Chelsea 43,324 South Chelsea 31,925 There is considerable reason, however, for believing that the population of the Borough is now over-estimated on account of the closing of houses and demolitions in Church and Cheyne Wards and the increasing proportion of empty houses in the Borough as a whole. As the accuracy of the birth and death-rates depends on the correctness of the estimation of population, the current rates must be regarded as liable to correction when the census figures for 1911 are known. BIRTHS AND BIRTH-RATE FOR 1909. Table I. Number of Births. Male. Female. Total. North Chelsea 348 332 680 South Chelsea 310 320 630 Chelsea 658 652 1,330 The above Table relates to births registered in the District. Excluding 6 births of non-parishioners, and including 90 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year is 1,400. 4 Table II. Birth-rate per 1000. North Chelsea 17.0 South Chelsea 20.9 Chelsea 18.7 London 24.4 The average birth-rate of the Borough for the years 1901-1908 is 21.0, and of the Home District of the Parish of Chelsea for the 5 years 18961900, 24.1 per 1,000. The birth-rate for the past year is the lowest yet recorded. During the year, 58 births were registered as having occurred in the Chelsea Workhouse, equivalent to 4.1 per cent. of the total number of births in the Borough, as compared with 5.4 per cent. in 1908. DEATHS AND DEATH-RATE FOR 1909. The total number of deaths registered in the Borough was 1,625. Of this number 740 were deaths within the Borough of non-parishioners —chiefly occurring in Hospitals, and in the St. George's Infirmary ; and 202 deaths of parishioners of Chelsea occurred outside the Borough in various public institutions. There were, therefore, 1,087 deaths of parishioners of Chelsea. These 1,087 deaths are equivalent to a deathrate for the year of 14.5 per 1,000, the same as in 1908. Table III. gives the death-rates of the Home District of Chelsea, of Chelsea Borough, and of London during the past 19 years. Table III. 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 1908 14.5 14.4 1909 14.5 14.0 *1891-1900, Chelsea Home District. 5 Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 12 per 1,000 in 1909, the corresponding rate for London being 1.52. In 1908 the zymotic death-rate in Chelsea was 1.4 per 1,000. Table IV.—For the year 1909. * 1890-1900, Chelsea Home District. Whooping Cough.—This disease caused 13 deaths in 1909, as compared with 18 in 1908. Five of the fatal cases were residents of North Chelsea, and eight of South Chelsea. Enteric Fever.—Two deaths were due to enteric fever in 1909, as compared with five in 1908. One death occurred in each sub-district. 6 Table VI.—Zymotic Disease Mortality in Chelsea in 1909. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea, 1899-1908. Measles 24 36 27 Scarlet Fever 7 6 6 Diphtheria 14 9 10 Whooping Cough 13 19 25 Enteric Fever 2 2 5 Diarrhœa 30 41 62 Diarrhœa.—The deaths in Chelsea in 1909 from diarrhœal diseases (diarrhœa 13, enteritis 17) were 30 in number, as compared with 50 in 1908. Eighteen of the deaths were of infants under one year of age, six were between one and five years of age, and six were adults. Twelve of the deaths were of North Chelsea residents, and 18 of South Chelsea. The summer prevalence of the disease was very late in commencing, no deaths being registered until the fourth week in August; but the prevalence continued unusually late into the autumn, deaths from diarrhœa being registered every week up to the third week in October. Table VII.—Mortality from Diarrhœal Diseases. Year. Chelsea. London. Death-rate per million. Death-rate per million. 1896 1037 1112 1897 1340 1446 1898 1258 1556 1899 1282 1663 1900 1187 1251 1901 788 1184 1902 692 737 1903 541 837 1904 864 1267 1905 620 948 1906 1115 1275 1907 509 544 1908 656 796 1909 400 552 The diarrhœa death-rate in Chelsea in 1909 is probably the lowest as yet recorded. In London the 1909 rate is only very slightly above the exceptionally low rate of 1907. How far these favourable results are due to cold and wet summers, and how far they are attributable to the efforts —municipal and philanthropic—now being made with a view to the conservation of infant life, it is impossible as yet to determine. Influenza.—The number of deaths attributed to influenza in 1909 was 25, as against 31 in 1908. Twelve deaths occurred in North Chelsea, and 13 in South Chelsea. Fifteen of the fatal cases were of persons aged 7 65 years and upwards. In London generally the disease had a slightly lesser prevalence in 1909 than in 1908, 1,213 deaths being registered as due to this cause in 1909, as compared with 1,350 in 1908. Of the fatal cases in London in 1909, 685 occurred in the first quarter of the year, 305 in the second, 43 in the third, and 180 in the fourth quarter. The month of greatest prevalence was March, 471 deaths being registered in the four weeks at the end of the first quarter of the year. Respiratory Diseases.—The death-rate from these diseases in Chelsea in 1909 was 3.15 per 1,000, as compared with 2.68 per 1,000 in 1908. The London death-rate from respiratory diseases (including pneumonia) was 3.10 per 1,000. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1909 was 1.89 per 1,000, as against 1.56 per 1,000 in 1908. The death-rate in London from these diseases in 1909 was 182 per 1,000. Of the 108 deaths from phthisis in Chelsea in 1909, 51, or 47.2 per cent., occurred in the Chelsea Workhouse Infirmary, and 21, or 19.4 per cent., occurred in other public institutions, making a total of 66.6 per cent. of the total cases dying in public institutions away from their own homes. The average for the nine years, 1900-1908, is 43.7 per cent, in the Chelsea Infirmary, and 14.2 per cent. in other public institutions, making a total of 57.9 per cent. of the total cases. Table VIII. Average Death-rates per million in quinquennial periods (1891-1909) from Phthisis and other Tubercular Diseases amongst Males and Females, at 8 Age-Periods. Males. 0-5 5-15 15-25 25-35 35-45 45-55 55-65 Over 65 All ages 1891-5 5555 891 1819 3718 5347 5231 4621 1873 3369 1896-1900 5108 1096 1482 3032 6830 7035 3243 2809 3527 1901-5 4023 308 1112 2527 4853 4630 4788 2247 2699 1906-9 2808 728 1011 2391 4156 5262 4155 3394 2620 Whole Period 4470 757 1374 2944 5357 5554 4203 2538 3077 Females. 1891-5 4532 1223 1128 1857 2917 2489 1501 699 1946 1896-1900 4467 863 1080 1300 2265 2584 2073 1165 1751 1901-5 3575 719 528 1579 2094 2680 1144 1243 1536 1906-9 3112 495 660 987 1673 1735 2144 1457 1298 Whole Period 3965 843 859 1454 2267 2405 1693 1125 1650 8 Table VIII. shows that during the past 19 years in Chelsea the average death-rate of females from tuberculosis has only been 54 per cent. of the male rate. The female rates are lower than the male rates at all the age-periods, except that of 5-15 years; and the differences are specially marked in all the age-periods after the age of 25. In the Annual Report for 1908, these differences between the male and female death-rates from tuberculosis were the subject of comment. Under the age of five years there has been a satisfactory decrease in the mortality from tuberculosis during the past 19 years, both amongst males and females—the mortality at this age being chiefly due to tubercular meningitis and the abdominal forms of tuberculosis. At the next three age-periods (5-15, 15-25, and 25-35) the table also shows a decided tendency in successive quinquennia towards a diminished mortality from tuberculosis in both sexes; and this tendency is also noticeable in females up to the age of 45 years. In males, however, between the ages of 35 and 65, and in females between the ages of 45 and 65, there would appear to be no very decided tendency to a decrease in recent years; whilst above the age of 65, in both sexes, an actual increase in tuberculosis mortality is indicated. It will also be seen that, taking all ages together, the death-rate of females from tuberculosis has exhibited a steady decline in each successive quinquennium ; whilst that of males rose in the second quinquennium as compared with the first, and although a sharp fall occurred in the third quinquennium, the rates for 1906-9 and 1901-5 are practically identical. There are evidently causes at work affecting males over the age of 35, which are of a temporary or variable nature, and do not appear to influence females to the same extent. The figures, however, on which the table is based are not sufficiently numerous to warrant any very definite conclusions being drawn. Cancer.—Malignant cancerous disease caused 82 deaths in Chelsea in 1909, the average of the past 18 years being 73 deaths annually. Fortytwo of the deaths were of North Chelsea residents, and 40 of South Chelsea. Alcoholism.—Sixteen deaths were registered in 1909 as being due to intemperance or cirrhosis of the liver, as against 24 in 1908. 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 excessive drinking. Deaths in Lunatic Asylums.—Forty-nine deaths of Chelsea parishioners occurred in 1909 in lunatic asylums. The average of the preceding 18 years is 34 deaths annually in lunatic asylums. Deaths in Public Institutions.—In 1909, 50.9 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 46.4 per cent. in 1908. In London generally, 40.2 per cent. of the total deaths occurred in public institutions in 1909. The deaths in the Chelsea Infirmary in 1909 formed 22.7 per cent. of the total deaths of Borough residents, as compared with 23.1 per cent. in 1908. Deaths of Common Lodging House Inmates.—Nineteen deaths of common lodging house inmates occurred in Chelsea in 1909, all but one taking place in the Chelsea Infirmary. Sixteen of the deaths were of males, and 3 of females. Nine of the deaths (47 per cent. of the total) 9 were due to pulmonary tuberculosis. During the past year the Common Lodging House for men, known as Beauclerc Buildings, 44 and 46, College-place (100 beds), and the Common Lodging House for Women, 5 and 7, Pym-street (49 beds), have been closed. The Borough Council, on application from the owners of Beauclerc Buildings, resolved not to consent to the premises being reopened as a common lodging house (1 Dec., 1909). The premises in Pym-street will shortly be demolished for the erection of the Sutton Trust Buildings. DEATH-BATE 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 1,000 births, during the year 1909, for the Borough, for the inhabitants of Industrial Dwellings in Chelsea, and for the dwellers in ten 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 3,160; and the streets are Dartrey-road, Francisstreet, Gillray-square, Ives-street, Oakham-street, Pond-terrace, Rileystreet, Slaidburn-street, Stayton-street, World's End-passage, and the courts adjacent, with a total population of about 4,000. Table IX.—For the year 1909. Birthrate. Deathrate. Zymotic Deathrate. Tubercular Diseases Death-rate. Deaths under one to 1,000 births. Chelsea 18.7 14.5 1.2 1.9 107 Industrial Dwellings 31.3 16.5 1.6 3.2 81 10 Poor-class Streets 40.0 24.2 3.2 4.0 138 Sir Thomas More Buildings 36.5 9.7 1.2 2.4 100 The above table shows that, as in previous years, the vital statistics of the industrial dwellings population contrast very favourably with those of the lower class tenement house population. The rather high deathrate from tuberculosis amongst the Industrial Dwellings population in 1909 is due to 7 deaths from this disease, out of a total of 10 for the year, occurring in the Council's dwellings (5 in Onslow Dwellings, 2 in Sir Thomas More Buildings). INFANTILE MORTALITY. During the year 1909 there was a slight reduction in the rate of infantile mortality (deaths of infants under one year to 1000 births) as compared with 1908, the rate for 1909 (107), being the lowest yet recorded in Chelsea. 10 TABLE X. 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 116 121 65 88 131 124 8,209 8,122 1906 140 122 133 8,639 1907 122 101 118 8,435 1908 108 64 115 7,207 1909 107 85 107 7,555 The year 1909, like the year 1908, was on the whole favourable to a low rate of infantile mortality, there being no great prevalence of measles, whooping cough, diarrhœa, or other complaints which tend to raise the infantile death-rate. The contrast between the rates of infantile mortality in the Industrial Dwellings and in the poorest class of streets in the Borough is still apparent (see Table IX.), although less marked than in 1908. The rate for the 10 poor-class streets (138 per 1,000) is an improvement upon that of 1908 (148 per 1,000), and a very great improvement upon that of 1907 and of previous years, when the average was about 200 per 1,000. TABLE XI. 1909. Birth-rate. Infantile Mortality Rate. Hans Town Ward 13.0 74 Royal Hospital 13.9 107 Church 20.1 149 Cheyne 17.0 92 Stanley 24.2 104 Chelsea Borough 18.7 107 The above Table shows the birth-rates and infantile mortality rates in the five wards of the Borough. The births occurring in the Chelsea Workhouse and in outlying institutions have been distributed amongst the various wards. As in 1908, Stanley Ward had the highest birth-rate. The highest rate of infantile mortality is seen to be in Church Ward, and the lowest in Hans Town. 11 From Table XVII. (Local Government Board Table V.) it will be seen that out of a total of 150 deaths of infants, under 1 year of age, in Chelsea in 1909, 56, or 37.3 per cent., occurred in the first 4 weeks of life, as compared with 52, or 33.8 per cent. of the total, in 1908 ; and 35, or 23.3 per cent. occurred in the first week of life, as against 35, or 21.1 per cent. of the total in 1908. The majority of these deaths in the first month of life are due to premature birth of the infants and congenital defects. For deaths under the month the rate of mortality, in 1909, is 40 per 1,000 births, as against 31 per 1,000 in 1908. Between the ages of 1 month and 12 months, 94 deaths, 62.7 per cent. of the total, were registered in 1909, as compared with 114, 68.7 per cent. of the total in 1908; 17 of these deaths being due to diarrhœal diseases, as compared with 36 in 1908. There were, besides, 3 deaths from measles, 1 from scarlet fever, 3 from diphtheria, 9 from whooping cough, 4 from tuberculous meningitis, 28 from bronchitis, 8 from pneumonia, and 2 from overlaying amongst infants under one year of age. Illegitimate Births.—The following Table shows, for each of the years 1905—1909, 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, and the number unaccounted for. Table XII.—Borough of Chelsea. Year. Illegitimate Births. 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 1908 96 6.2 37 11 48 115 1909 74 5.3 44 13 17 176 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 5 years 1905—9, is 256 per 1,000, as compared with 119 per 1,000 for all infants, legitimate and illegitimate. About 50 per cent. of the illegitimate births each year take place in the Chelsea Workhouse. Miss Tettenborn, the Borough Council's Lady Sanitary Inspector, reports that of the 74 illegitimate infants only 10 were breast-fed. Some of the births were registered incorrectly, the birth not taking place at the address given. 12 TABLE XIII.—(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 nonresid ents registered in District. Deaths of Residents registered beyond District Deaths at all Ages Nett No. Rate.* No. Rate per 1000 Births regist'd No. Rate.* No. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1907 74,857 1493 20.0 182 122 1688 22.6 1099 712 142 1118 15.0 1908 75,049 1540 20.2 166 108 1653 21.7 1061 705 156 1104 14.5 Averages for years 1901-1908. 74,431 1562 21.0 209 134 1676 22.5 1018 658 160 1178 15.8 1909 75,249 1400 18.7 150 107 1625 21.7 1091 740 202 1087 14.5 • Rates calculated per 1000 of estimated population. Note.—The deaths to be included in column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to 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 13 TABLE XIV.—(II.) Names of Localities. Chelsea Borough. North Chelsea. South Chelsea. 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.) 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 1907 74,857 1493 1118 182 43,099 766 566 92 31,758 727 552 90 1908 75,049 1540 1104 166 43,209 803 566 97 31,840 737 538 69 Averages for Years 1901-1908 74,431 1562 1178 209 42,852 833 616 110 31,579 729 561 99 1909 75,249 1400 1087 150 43,324 734 556 73 31,925 666 531 77 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. (b.) Deaths of residents occurring in public institutions beyond the district are to be included in subcolumns c of this Table, and those of non-residents registered in public institutions in the district excluded. [See note on Table I. as to meaning of terms "resident" and " non-resident."] (c.) Deaths of residents occurring in public institutions, whether within or without the district, are to be allotted to the respective localities according to the addresses of the deceased. (d.) Care should be taken that the gross totals of the several columns in this Table respectively equal the corresponding totals for the whole districts in Tables I. and IV.; thus, the totals of subcolumns a, b, and c, should agree with the figures for the year in the columns 2, 3, and 12, respectively, of Table I. ; the gross total of the sub-columns c should agree with the total of column 2 in Table IV., and the gross total of sub-columns d with the total of column 3 in Table IV. 14 TABLE XV.—(III.) CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1909. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages†—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. North Chelsea. South Chelsea. North Chelsea. South Chelsea. Chelsea. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 97 3 29 49 7 9 .. 48 49 43 43 86 Erysipelas 38 2 .. .. 1 28 7 19 19 1 2 3 Scarlet Fever 306 8 73 168 36 21 .. 171 135 165 123 288 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 12 .. 1 5 3 3 .. 5 7 4 7 11 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 1 .. .. .. .. 1 .. 1 .. 1 .. 1 Puerperal Fever 2 .. .. .. .. 2 .. 1 1 .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Totals 456 13 103 222 47 64 7 245 211 214 175 389 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. 15 TABLE XVI.—(IV.) CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1909. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages). Deaths in Public Institutions in the District. All Ages. Under 1 Year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Chelsea North. Chelsea South. Small-pox ... ... ... ... ... ... ... ... ... ... Measles 24 3 18 2 ... ... 1 19 5 5 Scarlet Fever 7 1 4 2 ... ... ... 3 4 ... Whooping-cough 13 9 4 ... ... ... ... 5 8 7 Diphtheria and Membranous Croup 14 3 6 3 1 1 ... 9 5 4 Croup ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... Enteric 2 ... ... 1 1 ... ... 1 1 1 Other continued ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 25 ... ... ... ... 10 15 12 13 9 Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhœa (See Notes on next page) 13 9 1 ... ... 1 2 2 11 17 Enteritis (See Notes on next page) 17 9 5 ... ... 1 1 10 7 32 Gastritis (See Notes on next page) 4 3 ... ... ... ... 1 2 2 1 Puerperal Fever (See Notes on next page) 1 ... ... ... ... 1 ... 1 ... ... Erysipelas 1 ... ... ... ... 1 ... 1 ... ... Other Septic Diseases 10 3 2 ... ... 2 3 7 3 19 Phthisis (Pulmonary Tuberculosis) 108 1 2 ... 13 79 13 59 49 163 Other Tubercular Diseases 34 6 14 11 1 1 1 19 15 61 Cancer, Malignant Diseases (See Notes on next page) 82 ... ... ... ... 48 34 42 40 174 Bronchitis 165 30 12 1 1 40 81 81 84 135 Pneumonia 66 8 8 3 4 25 18 30 36 45 Pleurisy 1 ... ... ... ... ... 1 ... 1 1 Other Diseases of Respiratory Organs 4 ... ... ... ... 3 1 2 2 4 Alooholism—Cirrhosis of Liver 16 ... ... ... ... 14 2 10 6 9 Venereal Diseases 1 1 ... ... ... ... ... ... 1 1 Premature Birth 34 34 ... ... ... ... ... 12 22 2 Diseases and Accidents of Parturition 3 ... ... ... 1 2 ... ... 3 3 Heart Diseases 107 1 ... 3 2 50 51 52 55 91 Accidents 28 2 3 1 3 11 8 14 14 26 Suicides 11 ... ... ... ... 9 2 7 4 4 Meningitis 11 2 5 2 1 ... 1 5 6 6 Rheumatic Fever 3 ... ... 1 1 1 ... 1 2 ... Diabetes 10 ... ... ... ... 9 1 4 6 3 All other causes 272 25 1 3 4 74 165 146 126 268 All causes 1087 150 85 33 34 383 402 556 531 1091 16 Notes.—(a) In this Table all deaths of "Residents" occurring in public institutions, whether within or without the district, are to be included with the other deaths in the columns for the several age groups (columns 2-8). They are, also, in columns 9-15, to be included among the deaths in their respective "Localities according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non-residents " occurring in public institutions in the district are in like manner to be excluded from columns 2-8 and 9-15 of this Table. (b) See notes on Table I. as to meaning of " Residents" and " Non-residents," and as to the " Public Institutions " to be taken into account for the purposes of these Tables. The " localities" should be the same as those in Tables II. and III. (c) All deaths occurring in public institutions situated within the district, whether of " Residents" or of " Non-residents," are, in addition to being dealt with as in note (a), to be entered in the last column of this Table. The total number in this column should equal the figures for the year in column 9, Table I. (d) The total deaths in the several "Localities" in columns 9-15 of this Table should equal those for the year in the same localities in Table II., sub-columns c. The total deaths at all ages in column 2 of this Table should equal the gross total of columns 9-15, and the figures for the year in column 12 of Table I. (e) Under the heading of " Diarrhœa " are to be included deaths registered as due to Epidemic diarrhœa, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Hummer diarrhœa, Dysentery and Dysenteric diarrhœa, Choleraic diarrhœa, Cholera (other than Asiatic or epidemic), and Cholera Nostras. Deaths from diarrhœa secondary to some other well-defined disease should be included under the latter. Deaths from Enteritis, Muco-enteritis, Gastro-enteritis, and Gastritis (see under the heading Diarrhœal diseases in Table V.) in Tables IV. and V. should be placed immediately below, but separately from, those enumerated under the heading Diarrhœa as defined byenumeration above. This is particularly important for deaths under one year of age, as many of the deaths in infancy returned as due to Enteritis are really caused by Epidemic Diarrhœa. In the course of years, by the adoption of this recommendation, it will be practicable to ascertain the probable amount of transfer between these different headings. (f) Under the headings of " Cancer" and "Puerperal fever" should be included all registered deaths from causes comprised within these general terms. Thus: 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 Pyæmia, Septicæmia, Sapræmia, 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 Hæmorrhage, Malformations and Congenital hydrocephalus. (h) 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. 17 TABLE XVII.—(v.) INFANTILE MORTALITY DURING THE YEAR 1909. 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 ... 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 3 Whooping Cough ... ... ... ... ... ... ... ... 1 1 1 ... ... 3 1 2 9 Diarrhœal Diseases — Diarrhœa, all forms ... ... 1 1 2 2 1 ... 1 1 1 ... ... 1 ... ... 9 Enteritis, Muco- and Gastro-enteritis ... ... ... ... ... ... 2 2 1 1 ... 1 ... 1 ... ... 8 Gastritis, Gastro-Intestinal Catarrh ... 1 ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... 3 Wasting Diseases- Premature Birth 25 ... 4 2 31 1 ... ... 1 ... ... ... ... ... ... ... 33 Congenital Defects 4 1 2 ... 7 3 ... ... 1 ... ... ... 1 ... ... ... 12 Injury at Birth 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Want of Breast-milk, Starvation 1 ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... 2 Atrophy, Debility, Marasmus ... ... 1 2 3 ... ... 1 1 ... ... ... ... 1 ... ... 6 Tuberculous Diseases— Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... 1 4 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... 3 Convulsions 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 2 Bronchitis ... ... ... 3 3 6 5 2 1 3 4 1 2 ... ... 1 28 Laryngitis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Pneumonia ... ... ... ... ... 1 ... 1 ... 3 2 ... ... ... 1 ... 8 Suffocation, overlaying 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Other Causes 1 1 1 ... 3 3 ... ... ... ... ... 1 1 ... ... 1 9 All Causes 35 3 9 9 56 18 8 8 9 10 10 5 5 12 3 6 150 Births in the year, legitimate 1,326 „ „ illegitimate 74 Deaths from all Causes at all Ages 1,087 Population, estimated to middle of 1909 75,249 Deaths in the year of legitimate Infants 137 Deaths in the year of illegitimate Infants 13 18 Section II. INFECTIOUS DISEASES. Small Pox.—There were no cases of small-pox in Chelsea in 1909. In London, during the year 1909, 23 cases of the disease were notified, as compared with 4 in 1908, 9 in 1907, 31 in 1906, 74 in 1905, and 492 in 1904. Fourteen of the 23 cases occurring in 1909 were notified in the last quarter of the year, and of this number 8 occurred in Stepney. Scarlet Fever.—In 1909, 306 cases of Scarlet Fever were notified in Chelsea, equivalent to a case-rate of 40.7 per 10,000 of the population, as against 22.8 in 1908. The number of cases notified in the first quarter of the year was 71, in the second quarter 132, in the third quarter 63, and in the fourth quarter 40. Scarlet Fever began to be prevalent in March (25 cases), increasing through April and May (32 cases in each month) to June, when 68 cases were notified. In July (26 cases) prevalence diminished, and in August only 13 cases were notified; but in September there was some renewal of prevalence (29 cases), which, however, was not continued during the three subsequent months. The unusual prevalence of scarlet fever in March, April and May, was largely due to incidence on children of school age, and during these months the Duke of York's Royal Military School contributed no fewer than 32 cases to the total of 85. By the middle of May the Duke of York's School outbreak was over. There was also excessive prevalence of the disease amongst children attending the Marlborough Road School during the whole of June and the first half of July—15 cases being notified in this period amongst children attending the school (chiefly in the Infants' Department); whilst from the middle of June until the school holidays in July, 9 cases occurred amongst children attending Holy Trinity School. The excessive prevalence of scarlet fever in June (68 cases) was, therefore, in part due to incidence on school children, but 20 out of the total of 68 cases were due to specific contamination of a particular milk supply. The total number of cases notified during the year was 171 in North Chelsea, and 135 in South Chelsea. The percentage of cases of school ages (3 to 13 years) of the total number in the Borough was 68, as compared with 70 in 1908. The average duration of the stay in hospital of 273 cases, of which the records are to hand, was 59.5 days, as against 61 in 1908. Nineteen 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 19 duration of the stay in hospital of these 19 cases was 21 days, as against 23 in 1908. Five cases on discharge from M.A.B. hospitals were stated to be still suffering from otorrhœa or rhinorrhœa, the same number as in 1908. So far as is known, none of these cases were the means of spreading infection after return to their homes. During the year there were 5 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 2, 6, 8, 10 and 14 days. Milk Epidemic.—Twenty cases of scarlet fever occurred in Chelsea in June, 1909, which formed part of the extensive milk epidemic of scarlet fever, which affected some of the boroughs and some of the western and south-western suburbs of London. All the Chelsea cases derived their milk from one retail dealer in the Borough, whose supply was received from the same farm in Wiltshire, that was subsequently proved to be the cause of the outbreak. The onsets of 2 of the Chelsea cases were on the 15th June, of 10 on the 16th, of 5 on the 17th, of 1 on the 18th, of 1 on an unknown date, and of 1 on the 26th. This latter case was probably secondary to 2 others in the some house, which were not recognised as scarlet fever until the 30th June. The Chelsea milk retailer received 5 or 6 churns daily (about 400 quarts) from the Wiltshire farm, and had a large milk round in the neighbourhood of his dairy, supplying from 200 to 300 customers. This supply was stopped on the 18th June, on representations made by me to the manager of the dairy that there was reason to believe that an infective quality attached to the milk. The local investigations into the cause of the outbreak made by the Medical Officers of Health of the Counties of London, Surrey and Wiltshire, failed to identify any human source of origin of the disease on any of the farms, but an ulcerated condition of the udders of some of the cows on the farm to which the infected milk was traced, was believed to have some causal connection with the outbreak. From a perusal of the report on the outbreak compiled by Drs. Hamer and Jones, it would appear to be impossible to exclude the possibility of the milk being infected from a human source; and the evidence pointing to the diseased conditions of the udders of certain cows as being causative of the epidemic is very far from conclusive. The average duration of the stay in hospital of 11 milk scarlet fever cases, of which the records are to hand, was 46 days, as compared with the general average of 59.5 days for all cases. This fact would seem to indicate that the milk cases were of quite a mild character. The longest stay of any case in hospital was only 63 days. Diphtheria.—In 1909, 97 cases of diphtheria (including 3 of membranous croup) were notified in Chelsea, equivalent to a case-rate of 12.9 per 10,000 of population, as compared with 181 in 1908. In the first quarter of the year 22 cases were notified, in the second quarter 30, in the third quarter 16, and in the fourth quarter 29. The percentage of cases of school ages (3 to 13 years) of the total number in the Borough was 68, as against 70 in 1908. In North Chelsea 48 cases were notified, and in South Chelsea 49. 20 The influence of school closure in August upon the prevalence of the disease was well marked, only 3 cases being notified during the entire month. In September there were only 4 cases, but the number rose to 15 in October, falling again to 8 in November and 5 in December. Special school incidence was shown in respect of the Christchurch Infants' School in October, 6 cases being notified amongst children attending that school in the second week of the month. The action taken in respect of these cases was effective in preventing any further extension of the disease. The average duration of stay in hospital of 64 cases, of which the records are to hand, was 55 days, as against 53 in 1908. Six 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 1908 being 9. The average duration of the stay in hospital of these 6 cases was 17 days, as against 21 in 1908. Three cases of diphtheria on discharge from M.A.B. hospitals were stated to be still suffering from rhinorrhœa, but free from diphtheria bacilli. During the year medical practitioners sent 93 throat swabbings to the Lister Institute for bacterioscopic diagnosis, the cost being defrayed by the Borough Council. Sixty-two of these swabs were sent by the medical staff of the Victoria Hospital in respect of Chelsea children. Of the total of 93 swabbings, 20, or 21.5 per cent., afforded positive evidence of the presence of the specific diphtheria bacillus, and 73, or 78.5 per cent., gave negative evidence. Nine of the "negative" swabbings showed [the presence of Hoffman's pseudo-diphtheria bacillus, but none of the " positive " swabbings contained this bacillus. Enteric Fever.—The number of cases of enteric fever notified in Chelsea in 1909 was 12, as against 17 in 1908, the case-rate being 1.6 per 10,000 of population. This is the lowest rate yet recorded. Four cases were notified in the first quarter of the year, 5 in the second, 2 in the third, and 1 in the fourth quarter. In North Chelsea 5 cases were notified, and in South Chelsea 7 cases. Two cases ended fatally. Of the 12 cases notified, one was stated by the Medical Superintendent of the M.A.B. hospital to which the patient was removed, not to be suffering from enteric fever or any other notifiable disease. This case was kept in hospital for 18 days. The average duration of stay in hospital of 5 cases, of which the records are to hand, was 85 days, the corresponding figure for 1908 being 49 days. Out of the 11 verified cases, in 3 the infection was in all probability contracted outside the Borough of Chelsea. There would appear, therefore, to have been only 8 cases in 1909, which can be regarded as having contracted the disease in Chelsea, as against 12 in 1908, and 16 in 1907. One blood specimen was sent during the year to the Lister Institute for the Widal reaction, the result being negative. During the year Dr. Theodore Thomson, on behalf of the Local Government Board, introduced a scheme by which in cases of enteric fever, where it is found necessary to discharge a patient from a M.A.B. 21 hospital whilst the stools or urine are still infective, from containing the bacillus typhosus, the Medical Officer of Health of the borough in which the discharged patient resides, would undertake to send monthly to Dr. Ledingham, of the Lister Institute, a sample of stools and a sample of urine during the first six months after discharge from hospital. If the results, on examination of these samples, should all prove negative, monthly samples need no longer be sent; but a sample of both stools and urine should be sent at the end of the next period of six months. If these also prove negative, no more samples to be sent. This scheme has since been extended to include all enteric fever patients discharged from M.A.B. hospitals. During the year one patient—a female, 5 years of age—was notified on discharge from hospital as still showing the bacillus typhosus in the stools. Two subsequent monthly examinations of the stools gave negative results, and the patient then left Chelsea to reside in Fulham, the Medical Officer of Health of that Borough being duly informed. The object of the scheme is to ascertain what proportion of enteric fever patients subsequent to recovery from the disease continue to discharge the infective agent in their excreta, and for what periods of time such infectivity may be prolonged. Incidentally the research should throw some light on the capacity of these " chronic carriers " to originate enteric fever either sporadically or in epidemics. 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 20 years, 1890—1909, 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 1908 95 91 71 1909 94 89 87 22 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 20 years 1890-1909 :— Table XIX.—Case Mortality in Chelsea, and in London, 1890-1909. 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 1908 4.0 2.5 9.4 9.2 29.4 18.1 1909 2.3 14.4 16.7 Diarrhœa Outbreak.—In September, 1909, an acute outbreak of diarrhœa occurred in a Rescue Home for Women in the Borough, 23 of the inmates being affected, and one case having a fatal termination. In this institution resided 31 inmates, the matron, 3 officers, and 4 servants. At 12.30 a.m. on the 29th September, 3 of the inmates were attacked with severe diarrhœa and sickness; 9 more were taken ill with similar symptoms during the course of the day, 8 on the 30th September, and 3 on the 1st October—23 in all. All the cases were inmates of the Home, none of the officers or servants being attacked. The probable cause of the illness was some infective organism or its toxines in the food partaken of during Tuesday, the 28th September. On enquiry it appeared that cold mutton and cold gammon of bacon were partaken of at the mid-day meal on the 28th by all persons residing in the institution, both these dishes having been cooked on Saturday the 25th. The food was apparently in good condition when cooked on the 25th, and when eaten on the 28th, as nothing wrong was noticed by the cook, nor were any complaints made by those who consumed the food. One of the patients, a girl of 16, who was one of the first to be taken ill, died on the 1st October, and an inquest was held, when a verdict of "accidental death" was returned. Bacteriological investigation of the blood and internal organs of the deceased girl, showed the presence in 23 large numbers of the bacillus of Gaertner. It would appear probable that this organism was present in the mutton or the bacon when cooked, without there being any naked eye signs indicative of its presence. The temperature applied during the process of cooking must have failed to destroy the bacillus, which in all probability multiplied extensively whilst the meat was stored, between the cooking on the 25th and its consumption on the 28th September. It is possible to account for the fact that all those who partook of the implicated food were not rendered ill, by the supposition that the infective organisms were not equally distributed throughout, portions of the meat having escaped bacillary invasion. A careful inspection of the Home on the 2nd October revealed nothing to indicate that the bacilli of Gaertner were introduced into the meat subsequent to its reception from the tradesmen supplying it. There had been no diarrhœal or any other kind of illness in the institution prior to the outbreak on the 29th September. The sanitary arrangements of the Home are modern and kept in good order, and the premises generally are clean, airy, and well ventillated, the supervision and management being very capably performed. Cerebrospinal Fever.—No cases of this disease were notified in Chelsea in 1909. Eleven deaths were registered amongst Chelsea residents as being due to non-tubercular meningitis, 7 of these being of children under 5 years of age. In 1908 only 4 deaths were attributed to this cause. In London, during the year 1909, 110 cases of cerebro-spinal fever were notified, as against 85 cases in 1908. Fifteen deaths were registered as due to this disease during the year, the case-mortality being 13.6 per cent., as compared with 11.8 per cent. in 1908. Puerperal Fever.—Two cases of this disease were notified in Chelsea in 1909, as compared with 3 in 1908. Only 1 death was registered as due to this disease. 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 and instruments of any certified midwife that may be in attendance on a case, as well as the bedding and room occupied by the patient. Measles.— In February, by order of the Medical Officer (Education, L.C.C.), all the unprotected children in Class-room I. of the Marlboroughroad School were excluded for a week ; in June, a similar order was made for four days in respect of Class-room B in the same school; and on the 5th July all unprotected children in Class-room I. of the School were excluded until after the summer holidays. Holy Trinity School in Upper George-street was also closed during part of February on account of the prevalence of measles. Notification of Phthisis. During the year 1909, 5 cases of phthisis were voluntarily notified by private medical practitioners. The following Table shows the number of notifications received under the Public Health (Tuberculosis) Regulations, 1908. 24 Form A—First Notifications by M.O., C.W.I. 226 Re-notifications 56 Notifications by M.O.'s, outside Infirmaries 4 Form B—Notifications by District M.O.'s 73 Form C—Notifications by Master, C.W. 70 Notifications by Masters, outside Workhouses 13 442 In addition 26 notifications have been received during the year from the Brompton Hospital. The number of males notified was 191, of females 81—total 272 ; 195 patients were notified once only, 51 were notified twice, 16 thrice, 6 four times, 3 five times, and 1 case was notified altogether seven times in the year. In 12 cases patients changed their address during the year, and in 8 cases the address was changed twice in the year. The total number of patients visited during the year was 124—the males from Common Lodging Houses and Casual Wards, who go in and out of the Chelsea Infirmary, not being visited as a rule. The remainder —the difference between the number notified and the number visited— are patients received into the Infirmary from the Workhouse, and re-transferred on leaving the Infirmary. The number of Common Lodging House cases was 44. The number of visits paid by the Lady Sanitary Inspector, including revisits, was 242. Fifty-one deaths from phthisis occurred in the Chelsea Workhouse Infirmary, and 9 at the patients own home—total 60, so that some 22 per cent, of the notified cases have died in the course of the year. Five cases have removed from the Borough, 2 have been sent to Convalescent Homes, hospital letters have been given to 10 cases, and pocket spittoons to 30. Disinfectants and soap are given where required, and the leaflet of advice is given in all cases. With regard to the work of visiting phthisical cases at their homes, the Lady Sanitary Inspector reports that the work is beset with certain difficulties, of which the most important are:—1. The great poverty of the majority of the cases, which renders them unable to provide sufficient food, clothing, or the firing which is needed to maintain a healthy existence. In many cases, even, separate sleeping accommodation for the patient cannot be provided. 2. The necessity for continuous medical treatment after leaving the Chelsea Infirmary with a view to arrest of the disease. The present arrangements for Poor Law medical attendance on phthisical cases discharged from the Infirmary are very inadequate from the point of view of "following up" such cases with medical care and supervision, so that the benefits derived from Infirmary treatment may not be lost. Under the existing system the patient derives undoubted benefit by the rest and medical treatment in the Infirmary, but on return home the patient is very apt to lose ground, and the expenditure involved in the course of Infirmary treatment is to a great extent thrown away by the absence of any system of after-care and supervision. The same remarks apply very much to hospital treatment, except that in these cases the discharged patient can usually attend the hospital as an out-patient. This is not, however, as valuable to the patient as home visits and advice. Some of the Poor Law cases, on discharge from the Infirmary, have been 25 supplied with letters for out-patient treatment at the Brompton Hospital. All these are progressing well, and some are now able to follow their employment. It would be a considerable help to the work of the department if we could receive more Brompton Hospital letters, as they are in great demand. 3. The difficulty as regards " contacts " in the same family or house. Most of the " contacts'' are willing to be medically examined, if this can be done without recourse to the Poor Law. The revisits to patients are found to be more useful than the first visits, but the number of revisits has to be seriously curtailed on account of the pressure of other duties. These visits stimulate and encourage the patients in their home treatment. Not only is the home kept cleaner and better ventilated, but the patient is rendered more cheerful by the knowledge that some one is interested in him. The following are instances where good results have been obtained by constant visiting:—1. Mother (a widow) in the last and most infectious stage of phthisis, found sleeping in the same bed with three sons, aged 17, 11 and 7 years. The family occupied two rooms, but had furniture only for one. With the kind aid of the Chelsea Branch of the Charity Organisation Society, the boys were supplied with beds and bedding so that the mother could occupy a separate bed. 2. Child of 9 years, suffering from tuberculosis and sleeping in the same bed with both parents and three young brothers and sisters—the family occupying a single room. After a few visits the mother was persuaded to make up a bed for the patient on two chairs, so that she could sleep apart from the rest of the family. 26 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, 1909, are as under :— For the Year ended 31st March, 1909. Expenditure. Income. £ s. d. £ s. d. General Charges 1,651 14 9 Gross Rents 4,746 6 0 Interest on and Re payment of Loans 3,431 12 8 Less Empties and Porters' Rooms 70 13 6 4,675 12 6 Tax Retained on Interest on Loant 114 17 0 Rents of Sheds 22 5 7 Deficiency on Year's Working 270 12 4 ₤5,083 7 5 ₤5,083 7 5 The amount received in rents was 98.51 per cent, of the gross rental, which is practically the same as in the three previous years. The empties and bad debts amounted to £12 3s. 6d., or 0.26 per cent, of the gross rental, as against 0.34 per cent, in the previous year. The general charges amounted to £1,651 14s. 9d., or 34-8 per cent, of the gross rental, as against 30 per cent, in the two previous years. The increase in the general charges was due to the Council entering into a contract for the cleansing and distempering of all tenements, which had not been cleansed during the previous three years—the total cost being £198 3s. 6d. The deficiency on the year's working was £270 12s. 4d. In the previous year there had been a small surplus on the year's working of £186 3s., the tax retained on interest on loans for the years 1905-6-7-8 (£388 5s.) being charged to the income of that year. The total sum expended on capital account amounts to £67,402, and the loans outstanding to £62,987. On October 1st, 1909, Porter Marlow was obliged to leave his work on account of illness, and was reported to be suffering from pulmonary tuberculosis. He was kept on the staff at full pay until December 18th, when his appointment was terminated, as he was not in a fit condition to return to work. Under the provisions of Section 6 of the Superannuation (Metropolis) Act, 1866, the Council granted Marlow a gratuity of £55, such sum being equivalent to three month's pay for every two years of service. Marlow had been in the service of the Council for just five years. 27 The buildings have been fully occupied during the year. During the year 39 tenants voluntarily terminated their tenancies, as against 52 in 1908, and 2 were given notice to quit. The walls and ceilings of 34 tenements, which had not been cleansed during the preceding three years, were distempered at a cost of £57 17s. Vital Statistics.—During 1909, 30 births (17 boys and 13 girls) were registered as occurring in the Buildings, which is equivalent to a birthrate of 36'5 per 1,000, the birth-rate of the Borough being 18-7. Eight deaths of residents iu the Buildings have occurred during the year, equivalent to a death-rate of 9'7 per 1,000, the death-rate of the Borough being 14.5 per 1,000. Deaths at Sir Thomas More Buildings in 1909. Age. Sex. Occupation. Disease. 63 years F. Nurse (domestic) Pulmonary Tuberculosis. 46 „ F. W. of Motor-'bus Driver Pulmonary Tuberculosis. 50 „ M. Steam Boiler Driver ... Cancer of Stomach. 1 month M. S. of Postman ... Epidemic Diarrhoea. 70 years M. Army Pensioner Broncho-pneumonia. 2 months M. S. of Carrier's Clerk ... Broncho-pneumonia. 14 days F. D. of Boad Sweeper ... Congenital Malformation of Spinal Cord. 60 years F. Day Governess Mania : Fatty Degeneration of Heart. Two cases of scarlet fever were notified in the Buildings during the year, but no other compulsorily notifiable infectious diseases. Pond House. The income from, and expenditure upon Pond House for the year ended the 31st March, 1909, are as under :— For the Year ended 31st March, 1909. Expenditure. Income. £ s. d. £ s. d. General Charges 213 18 0 Gross Rents 769 12 0 Interest on and Repayment of Loans... 613 13 2 Less Empties and Porters' Rooms 21 9 6 748 2 6 Tax Retained on Interest on Loans... 21 5 8 Other Receipts 7 0 Deficiency on Year's Working 57 16 0 £827 11 2 £827 11 2 28 The amount received in rents was 97.3 per cent, of the gross rentals, as against 96-7 per cent, in the previous year. The empties amounted to £1 19s. 6d. or 0.26 per cent, of the gross rental, as against 0.7 per cent, in the previous year. The general charges amounted £213 18s., or 27-8 per cent, of the gross rentals, as against 30 3 per cent, in the previous year. The deficit on the year's working was £57 16s., as against a surplus of £15 18s. 8d. in the previous year, when the tax retained on interest on loans (1905-8) amounted to £28 4s. 10d., and other receipts to £30 10s. The total sum expended on capital account amounts to £11,242, and the loans outstanding to £10,747. During the year Pond House was fully occupied. Six tenants voluntarily terminated their tenancies. Four births (2 boys, 2 girls) were registered during the year. Two deaths occurred, namely :—Male, 59 years: cause of death, bronchopneumonia ; Male, 4 months : cause of death, premature birth, marasmus. There were no cases of infectious disease notified amongst the occupants. Onslow Dwellings. The income from, and expenditure upon the Dwellings for the year ended the 31st March, 1909, are as under : — For the Year ended 31st March, 1909. Expenditure. Income. £ s. d. Gross Rents £ s. d. General Charges 528 7 8 1,469 6 0 Interest on and Repay ment of Loans 924 12 5 Less Empties 2 3 0 Surplus on Year's Working ... 47 0 0 1,467 3 0 Tax Retained on Interest on Loans 28 10 7 Other Receipts 4 6 6 £1,500 0 1 £1,500 0 1 The amount received in rents was 99'9 per cent, of the gross rental, which is the same as in the four previous years. The empties and bad debts amounted to 0'14 per cent, of the gross rental, the same as in the previous year. The general charges amounted to £528 7s. 8d., or 36 per cent, of the gross rental, as against 34-8 per cent, in the previous year. There was a surplus on the year's working of £47, as compared with a surplus in the previous year of £57 19s., when the tax retained on interest on loans (1905-8) amounted to £120 6s. 7d. The total sum expended on capital account amounts to £18,635, and the loans outstanding amount to £16,106. During the year 15 tenants voluntarily terminated their tenancies. The Dwellings have been fully occupied during the year- Vital Statistics.—During 1909, 8 births (5 boys, 3 girls) were registered in the Dwellings, equivalent to a birth-rate of 22.7 per 1,000. Eleven deaths were registered during the year, equivalent to a death-rate of 31-5 per 1,000. 29 Seven cases of scarlet fever and one case of diphtheria were notified during the year in the Dwellings, but two of the scarlet fevers proved subsequently to be cases of mistaken diagnosis. Deaths at Onslow Divellings in 1909. Age. Sex. Occupation. Disease. 69 years F. Cook (domestic) Phthisis : Bronchitis. 44 „ F. W. of Clockmaker Pulmonary Tuberculosis. 42 „ M. Stableman Pulmonary Tuberculosis. 25 „ M. Ex-soldier Pulmonary Tuberculosis. 73 „ F. W. of Bricklayer Bronchitis : Heart Disease. 69 „ F. Wid. of Labourer Cirrhosis of Liver. 3 „ M. S. of Builder's Labourer Diphtheria. 32 „ M. Builder's Labourer Pulmonary Tuberculosis. 62 „ F. W. of Gas Fitter Hemiplegia. - 65 „ F. Cook Bronchitis. 2 days M. S. of Builder's Labourer Congenital Defects. The following Table shows the population of the Council's Dwellings, including the staff and their families:— Sir Thomas More Buildings. Year. Over 10 years. Uuder 10 years. Total. 1905 578 220 798 1906 586 237 823 1908 609 214 823 Pond House. 1906 84 18 102 1908 82 24 106 Onslow Dwellings. 1906 282 65 347 1908 282 67 349 TOTAL POPULATION IN 1908 1,278 Grove Buildings, Manor Street. During the past year, Messrs. Gathercole Bros., the contractors, have proceeded with the erection of these buildings, under the direction of Messrs. Wills & Anderson, the Architects. Messrs. Gathercole's tender was for £14,688, but in the work of excavation for the foundations, it was found that over a very considerable part of the site the sandy soil on which it was proposed to build would not, owing to its loose and friable condition, carry so heavy a building. It became necessary to excavate to a considerably greater depth at places, so as to reach a firmer, gravelly stratum, and to form piers of concrete which would carry the walls on arches, the piers resting on the solid ground at the greater depth. All this additional work has involved on extra cost of £646 to the contract price. 30 A slight alteration to the original plan has been made by providing the two w.c's for men on the half-landings ; the two w.c's for women being on the balconies of each landing. The tenements will be lighted by gas on the automatic (Id. in the slot) system, and each tenement will have a movable gas griller over the kitchen range. It is expected that the Buildings will be completed and ready for occupation early in March. The scheme of rents fixed by the Borough Council provides for rents of 3s. per week for single-room tenements on the half-basement and third floors, and 3s. 6d. per week for single-room tenements on the ground, first and second floors. The corresponding rents for two-room tenements will be 5s. and 5s. 6d. SUTTON TRUST SCHEME FOR INDUSTRIAL DWELLINGS. During the year the Borough Council agreed to the closing of the several streets on which the Trust proposed to erect Industrial Dwellings, and certificates were obtained from the magistrates. Notices of appeal to Quarter Sessions in opposition to the enrollment of the certificates were given by various adjoining owners of property, but these were withdrawn before the appeal was heard, and the orders were duly made. In October I made an inspection of some of the houses in the streets which will be closed for the erection of the new Dwellings, and the following table shews approximately the number of empty houses in these streets, and the structural conditions of the houses then in occupation. Scheduled Area. Street. Empty Houses. Occupied Houses. Dilapidated and worn out. In fair condition. Total. Pym-street 11 11 6 17 Marlborough-street 3 — 10 10 Marlborough-square 9 3 15 18 College-street 5 1 8 9 Cale-street 12 15 15 Whole Area 40 30 39 69 SUN COURT, CHEYNE WALK. During the past year this court was closed by the owners after the service of notices under the Public Health (London) Act. The houses were also scheduled under the Housing of the Working Classes Act, 1890, Part II., Section 32, and the Borough Council resolved that the necessary proceedings be taken under the Act to obtain the closing of the premises (26th May, 1909). This course of procedure was, however, rendered unnecessary by the action of the owners already referred to, and there did not appear any likelihood of the premises being re-occupied. 31 The court consists of eight houses in a cul-de-sac off Cheyne-walk. The houses are only one-room deep, and without thorough light or ventilation. Two of the houses are two-roomed, and six are three-roomed, —total twenty-two rooms. They were let out in tenements—usually a family in each room. Four w.c's and one water tap in the yard were available for the use of the tenants, who might number as many as twentytwo families. The whole of the houses were in a very dilapidated condition, damp, dirty and neglected, the whole of the woodwork and plastering being in a very bad condition. At the time of the closing of the premises, when Police Court proceedings were taken by the owners for the ejectment of the tenants, only one or two of the tenants had been resident for any length of time, the great majority being of the " roving " class, who come in, stay a few weeks, and then move again elsewhere. HOUSES DEMOLISHED OR VACATED FOR DEMOLITION DURING THE YEAR 1909. HOUSES. Arthur-street 6 Church-street 7 College-place 6 Danvers-street 4 Flood-street 1 Fulham-road 9 Keppel-street 13 King's-road 14 Leader-street 12 Lots-road 3 Manor-street and Read's-place 21 Wellington-street and Jones'-cottages 18 114 Taking the number of persons per house as six, 684 persons have been displaced during 1909 as the result of actual or intended demolitions. 32 Section IV. THE SANITARY CONDITION OF THE BOROUGH. The tabular statements prepared by the Sanitary Inspectors show that 1,432 separate premises were reported on by them daring 1909, 454 of this number being with reference to cases of notifiable infectious disease, and 487 in the course of house-to-house inspections, made in certain of the poorer streets in the Borough. It has been necessary to take legal proceedings for breaches of the Public Health (London) Act, in respect of four premises only. Drainage.—During the year 18 transferences were made to the Surveyor's Department, in accordance with the Council's resolution of the 15th April, 1908, of premises where re-drainage works were required. There was no demand in 1909 upon the Borough Council to reconstruct any combined systems of drainage, for which the Council is responsible. From 1896 to 1909 inclusive, the sum of £565 has been expended from the rates on the combined drainage of private property, equivalent to an annual outlay of £40 7s. Inspection of Restaurant Kitchens, 1909. Number of restaurant and hotel kitchens 60 „ inspections made 75 ,, premises found satisfactory 55 „ premises with sanitary defect 5 ,, notices served 5 Bakehouses. Number of bakehouses 34 „ inspections 52 ,, notices served 6 Disinfection.—During the past year, 497 premises have been disinfected after cases of infectious or other disease, 92 of these being rooms which had been in occupation by persons suffering from phthisis ending fatally. In addition, 118 rooms were disinfected for the presence of bugs and other vermin, and were subsequently stripped and cleansed by the owners of the property. At the disinfecting station 4,968 separate articles of bedding or clothing were disinfected, and 1,118 bed, mattresses, &c., were destroyed in the incinerator. The animals destroyed in the incinerator amounted to 749, practically the whole of these being dead cats received from Our Dumb Friends' League in Bywater-street. There has been during the past year almost a complete absence of any demand by the Education Authority for the cleansing of the persons or disinfection of the clothing of elementary school children, nor have any similar requests been received from inmates of common lodging houses in the Borough. 33 Smoke Nuisance.—The working of the Generating Station, Lots-road, for the supply of electric current to the Underground Electric Railways of London, has continued to be satisfactory during the year, so far as the emission of smoke is concerned, very few complaints having been received. The alleged discharge of unconsumed cinder ash from the chimneys of the Chelsea Electricity Supply Company's works in Flood-street, has been the subject of complaint from time to time by residents in the neighbourhood of the works, but no action has been possible in reference to these allegations. Basement Workrooms.—During the year 29 new basement workrooms have come into occupation, and 26 were closed, there being at the end of the year 55 basement workrooms in the Borough, with accommodation for about 400 workers. The sanitary conditions of these basement workrooms are by no means satisfactory in respect of lighting, warming, ventilation, and in some cases aerial disconnection from water closets. As stated in my Annual Reports for 1904-1908, 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 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. The Sale of Food and Drugs Acts. During the year 1909, 400 samples were taken for analysis; of these 400 samples 177 were milk, 167 being returned by the Public Analyst as genuine samples, and 10 as adulterated. A prosecution was undertaken in one case, where the sample was certified to contain 6 per cent, of added water. The sample was referred to the Commissioners of Inland Revenue 34 for analysis, and the Government chemists certified that the results of their analysis were not inconsistent with the milk being a genuine sample. The magistrates accepted the Somerset House certificate, and dismissed the summons. In four cases of adulteration (added water 103 per cent., added water 7-2 per cent., skimmed milk 13.4 per cent., skimmed milk 10 per cent.) no proceedings were taken because the vendors were protected by warranties, and in the remaining 6 cases of adulteration (fat abstracted 7 per cent, and added water 2-1 per cent., added water 2.4, 2.1, 4.2, and 7.l per cent, respectively) no proceedings were taken owing to the slight amount of adulteration, or to the very small business carried on and the absence of previous convictions. The adulterated milks formed 5.65 per cent, of the total number of samples analysed, as compared with 7.6 per cent, in 1908. Of butter, 163 samples were taken, 160 being returned as genuine and 3 (18 per cent.) as adulterated. No proceedings were taken in 2 cases owing to the slight extent of adulteration—8.8 and 8 per cent, of foreign fat; whilst the third sample, which was pure margarine, was purchased by a private person and brought to the office for analysis. Of margarine, 5 samples were taken, all being genuine. Of cream, 1 sample was analysed ; it was genuine cream, but contained 13 grains of boric acid per pound. Of cheese, 9 samples were taken, all being genuine. Of coffee, 18 samples were taken, 15 being genuine and 3 adulterated. Two of the adulterated samples were sold as " mixtures " (38 and 40 per cent, of chicory), and 1 sample was certified to contain 5 per cent, of chicory only. No proceedings were taken in any of these cases. Of pepper, 9 samples were taken, all being genuine. Of brandy, 9 samples were taken, all being genuine ; and of whisky, 9 samples, 7 samples being genuine and 2 adulterated. The adulterated samples contained 6 and 8 per cent, of added water respectively. No proceeding were taken, as notices of " dilution " had been displayed at the places of sale of the spirits. Water Supply. From the reports of Dr. Houston, Director of Water Examinations, Metropolitan Water Board, it appears that for the year ending 31st October, 1909, on an average the number of samples of Chelsea filtered water yielding negative results as regards typical Bacillus Coli (the common intestinal micro-organism), was 93, when 100 c.c. of water are taken as the basis of bacterioscopic examination, the corresponding figure for the previous year being 96. The worst months of the year were January (30 per cent, of the samples gave a positive result as regards B. Coli), and March (22 per cent, gave positive results); and the best months were February, April and May, when all the samples examined proved negative to the B. Coli test. The results, as regards the Chelsea water, are quite equal to those given by any of the other filtered waters of the Thames, but are suggestive of the excretal pollutions the Thames is liable to as a source of supply of drinking water. In a water which is perfectly unpolluted by sewage or excremental bacteria, typical Bacillus Coli should be invariably absent from every 100 c.c. of water examined. 35 REPORTS PRESENTED TO THE BOROUGH COUNCIL. May 26th. Sun-court, Cheyne-walk (Housing of the Working Classes Act, 1890), Part II., Section 32. July 14th. Scarlet Fever in Chelsea. The Letting of Furnished Rooms at Daily Rentals. October 13th. Municipal Dwellings, Manor-street: Suggested Scheme of Rentals. 36 SUMMARY OF WORK DONE DURING 1909, By the Lady Sanitary Inspector. The work done during 1909 has comprised the following :— (1) Inspection of workshops and laundries at which women are employed. (2) Inspection of outworkers' premises. (3) Visiting cases of phthisis. (4) Visiting cases of measles and other non-notifiable infectious cases notified by the school authorities. (5) Visiting special cases reported from hospitals, and other agencies, &c. (6) Visiting to give instruction re management of infants. Workshops and Laundries.—During the year 113 new workshops were registered, and 112 were removed from the register, the total number at the end of the year being 335. There were 27 laundries on the register at the end of the year, 5 being factory and 6 domestic laundries. Forty-seven inspections were made in connection with laundries. During the year 142 workrooms were measured, for which workroom cards were given. The total number of inspections made in connection with workrooms was 678. In only 11 instances had notices to be served for cleansing workrooms. Classification of Workshops (Women Employees). Dressmaking 239 Perfumes ... 1 Millinery 31 Lampshades 2 Outfitting 12 Boxmaking 1 Laundries— Furrier 1 Factory 5 Florist ... ... 1 Workshop... 16 Cigarette-making ... 1 Domestic ... 6 Lace-making 1 Art Needlework 5 Tailoring (Men's)... 6 Upholstery ... 2 Corset-making 2 Boot-closing... 2 Bottle-washing 1 335 Outworkers.—The half-vearlv returns are as follows :— Jan. to June. July. to December. Total. Number of Lists received 43 38 81 Total number of Outworkers ... 424 404 828 Number living in Chelsea 106 108 214 Number forwarded to other Boroughs... 325 299 624 Received from other Boroughs... 58 53 111 The number of inspections made of outworkers' premises was 93, and the number of miscellaneous visits in connection with outworkers' inspections was 78. The names and addresses of outworkers living in other districts, but working for Chelsea firms, were forwarded to their respective Boroughs or District Councils, as stated in the first column of the Table below. The number of notifications received from other Boroughs, of Chelsea residents working for outside firms are given in the second column. 37 Notifications sent to— Notifications received from— Westminster 84 Kensingston 93 Fulham 73 City of London 5 Battersea 61 Wandsworth 5 Marylebone 56 Fulham 3 City of London 35 Battersea 2 Kensington 29 Marylebone 2 Islington 25 Paddington 2 Paddington 20 Finsbury 1 Camberwell 18 Stepney 15 Wandsworth 15 Hammersmith 14 Lambeth 13 St. Pancras 13 Shoreditch 10 Hackney 9 Bethnal Green 7 Holborn 6 Finsbury 5 Stoke Newington 3 Hampstead 2 Hornsey 1 District Councils 36 Total 550 113 School Cases.—There is a considerable increase in the number of nonnotifiable infectious diseases reported by the Schools, as compared with 1908, but there is still great variation in the number of children notified by the different Schools, as the following table shows. In most cases the homes are visited, and advice is given to the parent, when there is no medical practitioner in attendance. Information is also given to the various Schools, if there are contacts attending, who have not SCHOOL NOTIFICATIONS. 1st qr. 2nd qr. 3rd qr. 4th qr. Total. Cases notified from— I. Marlborough Boad 156 31 17 11 215 II. Ashburnham 136 22 33. 23 214 III. Park Walk 99 8 0 4 131 IV. Cook's Ground 20 16 7 15 58 V. Christ Church 46 7 1 54 VI. Holy Trinity 39 4 3 46 VII. Hortensia Boad 16 15 31 VIII. Oratory (Middle) 19 3 — 3 25 IX. Servite 1 3 _ 4 X. Other Schools outside Chelsea 19 9 1 2 31 551 103 71 84 809 38 CASES OF DISEASE NOTIFIED. 1st qr. 2nd qr. 3rd qr. 4th qr. Total. Measles 225 47 27 33 332 Mumps 238 27 1 19 285 Ringworm 22 23 9 16 70 Pertussis 39 3 12 2 56 Varicella 18 6 11 20 55 Eczema 3 3 2 0 8 Ophthalmia 1 1 2 545 110 63 90 808 Visits of Instruction re Management of Infants.—During the year 1909, the homes of 300 recently-born infants were visited by the Lady Sanitary Inspector. In 74 cases, re-visits were made. Altogether in connection with this work 427 visits were paid with a view to giving simple instructions to the mothers in infant care and management. The majority of the infants are breast-fed entirely. A majority of the artifically fed infants are brought up on cow's milk and water. Most of the mothers, especially those with first babies, are grateful for the advice given and anxious to carry out the instructions. The chief difficulties the Health Visitor has to encounter are irregularities in feeding, the use of infant's " comforters," and the absence of cots for the infants. Dinner tickets for nursing mothers were given in 30 instances, and 40 of the little books on the " Care of Infants " were given away. On the 30th November, 1909, the Notification of Births Act, 1907, came into force in Chelsea under an Order o£ the Local Government Board. The work of providing good nourishing dinners for Chelsea Nursing Mothers at the nominal payment of Id. per head, has continued throughout the year under the direction of Mrs. W. E. Gordon and her friends. The total number of dinners provided was 13,241, the mothers being eligible three months before confinement, and 9 months after, if still nursing. Very satisfactory results have been obtained, both as regards the health of the mothers and of the infants. Employment of Married Women in relatioti to Child-birth—It will be remembered that, as far back as 1907, several communications were received from the Home Office with regard to a proposed enquiry into the employment of married women both before and after child-birth, which was about to be organised throughout the various districts of England and Wales; and the Home Secretary expressed a hope that the Public Heatlh Department of this Borough would be able to co-operate. In order that the Inquiry throughout the country should be of a uniform character, it was decided that investigations should only extend to births registered in 1908; but since it was desirable to complete the records of the first year of life, the enquiry could not be concluded before the end of 1909. In accordance, therefore, with the instructions issued by the Home Office, a systematic inquiry has been carried on in Chelsea for the past two years with a view to ascertaining to what extent married women go out to work, either before or after the birth of a child, and the possible influence of such employment on the health of the infant during the first years of life. 39 The total number of cases selected for investigation amounted to 176. The official forms were duly filled up, re-visits being paid from time to time during the twelve months subsequent to the birth of the child, in order that the necessary observations might be recorded. A considerable amount of information has, therefore, been collected which furnishes some interesting data. A detailed report is in course of preparation for the Home Secretary. Of the 176 cases, in 140 instances, the infants completed one year of life; 13 died before they reached that age ; one was still-born; and the remaining 32 had moved away before the expiration of the twelve months, so that their final records could not be included. There were comparatively few women who were industrially employed, doubtless owing to the absence of any large factories in this Borough. A few women worked in laundries, but the majority of those who went to work were employed as charwomen or daily servants. The increase of flats in Chelsea, in which the accommodation for in-door servants is limited, affords considerable occupation for respectable women who sleep at home but are engaged at a weekly wage to do general house-work. Of all forms of work which women undertake while pregnant, this possibly is the least injurious, since good food is often provided, which is a very considerable advantage, whilst domestic house-work is usually capable of some modification to suit particular circumstances. In the cases under consideration, therefore, there is not much evidence to show that the employment of women before childbirth has had in this neighbourhood much influence upon the infantile mortality rate. It is a matter for regret that before the expiration of the year several families had moved and could not be traced; more especially as this number included seven infants who were illegitimate. In each of these latter instances the mothers, with one exception, had been to work both before and after the birth of their children. In these cases the mothers usually put the infant out to nurse and go into service, a course of procedure which renders it difficult to obtain first hand information at the end of the year. In only 36 cases, out of the 176 investigated, had the women been to work within six months previous to their confinements, a large proportion of these, however, only ceasing their employment a few weeks before—in three cases the day before—the birth of the child; while many resumed their work shortly afterwards. The following examples may be quoted :— No. 15. Woman resumed work as charwoman three weeks after confinement. Wages 2/6 per day; work heavy. No. 41. Woman employed as charwoman up to two weeks before confinement, and resumed work six weeka afterwards. Husband out of employment. No. 52. Employed at a dressmaker's until three months before confinement; resumed work six weeks afterwards, in order to support child. Infant died in its fifth month (illegitimate). No. 140. Employed as a charwoman until the day before confinement. Infant died a few hours after birth. 40 No. 141. Worked as ironer in laundry until 2|-inonths before confinement; resumed work eight weeks afterwards. ' Husband never works.' No. 79. Worked as a charwoman, two hours a day regularly, until the day of confinement. No. of Women. Within 1 week of Birth 4 „ 2 „ 2 „3 „ 1 Industrial work „ 4 „ 8 discontiuued before „ 8 „ 1 confinement. „ 12 „ 6 „ 26 „ 12 Over 26 „ 1 35 No. of Women. Within 4 weeks of Birth 1 Industrial work „ 6 „ 4 resumed after ,, 8 „ 3 confinement. „ 12 „ 3 „ 52 „ 10 21 The whole of this investigation into the employment of married women in relation to child-birth was undertaken by Miss Richardson, late Sanitary Inspector, who resigned her appointment in March, 1909. Miss Richardson desires to acknowledge the great assistance she received from Mrs. Ogilvie, Miss Ferard, and other ladies in carrying through many of the inquiries involved in the investigation. Tabulated Statement of Work. Factories and Workshops inspections 678 Outworkers premises inspections 93 Laundries inspections 50 Phthisis cases—visits and re-visits 242 Infants visited re instruction of mothers 300 Infants re-visited 74 Visits re School notifications 141 Special cases (all sources) 92 Cases of Infantile Mortality investigated 30 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 op Nuisances. premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries.) 7 — — Workshops (including Workshop Laundries.) 1063 46 — Workplaces (other than Outworkers' premises included in Part 3 of this Beport.) Total 1070 46 — 2.—DEFECTS FOUND. PARTICULARS. Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts: * Want of cleanliness 30 30 Want of ventilation — — — — Overcrowding 1 1 — — Want of drainage of floors 1 1 Other nuisances 12 12 __ insufficient — — — — †Sanitary accommoda- tionI unsuitable or defective 2 2 — — not separate for sexes 2 2 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) 6 6 Other offences — — (Excluding offences relating to outwork which are included in Part 3 of this Beport.) Total 54 54 — — •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 bo, what standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced. 3.—HOME WORK* OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. NATURE OF WORK.* Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Notices served on Occupiers as to sending lists. Prosecutions. Twice in the if ear. Once in the Year. Failing to keep or permit inspection of lists. to send lists. Outworkers. + Outworkers.+ In stances. Notices served. Prosecutions. Instances. Orders made (Sec. 110). Prosecutions (Sees. 109,110) Lists.+ Contractors Workmen. Lists.+ Contractors Workmen. a> (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) Wearing Apparel— (1) making, &c 81 100 630 2 3 105 507 25 — — 119 2 2 (2) cleaning and washing 8 — — — .. . — __ . Lace, lace curtains and nets Artificial flowers Nets, other than wire nets.. Tents Sacks Furniture and Upholstery .. 11 6 Fur pulling .. Feather sorting 14 Umbrellas, &c. 12 2 2 2 Carding, &c., of buttons, &c. 2 — — — 4 — — — — — Paper Bags and Boxes 2 2 2 6 Basket making .. 4 2 Brush making • Racquet and Tennis Balls Stuffed Toys File making Electro-plate 11 2 Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Pea picking Total 81 150 648 2 — 3 111 550 25 — — 119 2 2 — — — — * If an occupier gives outwork 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 columns 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 workshop, such as workshop bake-house, may be enu- merated here. Bakehouses 34 Laundries 27 Dressmaking and Millinery 270 Outfitting (Women's) 12 Various (Women) 26 Various (Men) 140 Workplaces 61 Total number of Workshops on Register 570 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) 11 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 9 Reports (of action taken) sent to H.M. Inspector 5 Other 5 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 28 Note.—The Factory and Workshop Act, 1901 (s. 132), 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 1909. PREMISES. NUMBER OF PLACES. Number of inspections, 1909. Number of Notices, 1909. Number of prosecutions, 1909. On register at end of 1908. Added in 1909. Removed in 1909. On register at end of 1909. Milk premises 121 16 24 113 196 8 Cowsheds 2 1 1 36 Slaughter-houses 6 6 99 Other offensive trade premises Ice cream premises 38 5 33 21 1 Registered houses let in lodgings 589 — 6 583 147 | (a)*8 (a)* (b)*124 (b)* Bakehouses 38 4 34 52 6 Restaurant Kitchens 63 3 60 75 5 * (a) For overcrowding;. • (b) For other conditions. Total number of Intimation Notices served for all purposes 750 Overcrowding, 1909— Number of dwelling rooms overcrowded 20 Number remedied 20 Number of prosecutions — Underground rooms— Illegal occupation dealt with during the year 4 Number of rooms closed 4 Insanitary houses— Number closed under the Public Health (London) Act, 1891 — Number closed under the Housing of the Working Classes Act — Number of verminous rooms cleansed 118 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 58 Revenue Acts— Number of Houses for which applications were received during the year 4 Number of tenements comprised therein 24 Number of tenements for which certificates were (a) granted 6 „ „ „ „ (b) refused — „ „ „ „ (c) deferred 18 Mortuaries— Total number of bodies removed159 Total number of infectious bodies removed 3 45 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING THE YEAR, 1909. Houses and Premises. House-to-house inspections 487 *Reported on respecting nuisances complained of 491 Reported on with reference to infectious cases 454 Cleansed, whitewashed, and repaired 217 Defective roofs repaired 109 Disinfected after communicable diseases 405 *Disinfected for Tubercular and other diseases 92 Rooms disinfected for verminous conditions 118 Cases of overcrowding abated 20 Dust-bins, new, provided 90 Ashpits cleansed and repaired 2 Underground rooms occupied contrary to Act 4 Inspections of restaurant kitchens 75 Drainage :— Drains opened, cleansed, and made sound 180 „ trapped with stoneware gullies Water-closets cleansed and repaired 81 Water-closets, new pans and traps provided 91 Spout drains cleansed, repaired, or renewed 53 Sink, bath, and lavatory waste pipes provided and repaired 131 Drains and soil pipes ventilated or repaired 56 Soil pipes, new, provided 36 Additional w.c. accommodation provided 23 WATER SUPPLY:— For domestic purposes, provided where cut off by Water Board 13 For water-closets, or check cisterns provided and repaired 125 Main cisterns cleaned or repaired 13 „ new covers provided 19 „ new, provided 5 Water certificates, issued in respect of newly erected dwelling-houses Nuisances abated arising from :— Keeping of animals 2 Accumulations of manure and other filth 15 Yards, areas, and wash-houses paved or drained 99 Smoke — •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 9 Goods disinfected after infectious cases at station 4968 Goods destroyed after infectious cases 73 Mattresses, beds, &c., received from Surveyor's Department and destroyed by the incinerator 1118 Number of samples taken for analysis (Pood and Drugs Act) 398 *Unsound Pood. Number of boxes of fruit, fish, rabbits, &c., condemned and destroyed 19 Library books destroyed at Librarian's request 22 Animals destroyed in Incinerator 749 Proceedings Taken Statutory notices issued 168 Intimations issued for sanitary works, &c., including infectious disease cases 750 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c 4 Legal proceedings in respect of food adulteration 1 Correspondence : — fNumber of letters written in connection with sanitary matters 542 Daily returns of infectious cases sent to Metropolitan Asylums Board 182 Notification of infectious cases sent to School Authorities 369 Entries in Inspectors' Report Books 491 Entries in Inhabitants' Complaint Book 41 Certificates of disinfection given 610 Certificates of infectious diseases for removal cases 172 Notices sent to Public Library of premises where infectious disease has occurred 169 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 113 Dairies and Milkshops, and 33 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. H. H. CLAY. F. TETTENBORN (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 connecion with the Infectious Diseases is done more expeditiously, and considerable time is also saved by its use in other matters. 47 MAGISTERIAL PROCEEDINGS DURING 1909, UNDER THE SALE OF FOOD AND DRUGS ACT. Street where purchased. Article Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Sydney-street Milk 6-0% of added water 7th Dec Adjourned to 21st December. Sample submitted to Somerset House : result of Analyst not upheld. Summons dismissed. MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 7, World's Endpassage Premises in such a state as to be a nuisance or injurious or dangerous to health Kensington 16th March Order made for the works to be done within 14 days. Cranly House, Vicat-street Failing to provide a proper soil-pipe in accordance with L.C.C. Bye-laws 11 91 Fine £2. 171, Fulham-rd.... Want of a proper and sufficient supply of water to the premises „ 4th May Closing Order made. 46, Limerston-st. Do. do. „ „ Water provided before day of hearing ; summons withdrawn. Total Fines £2. 48 BAKEHOUSES IN USE ON JANUARY 1ST, 1909. Street. Occupier. Above Ground. Below Ground. 74, Arthur-street Vacated Vacated, 93, Beaufort-street A. Coventry Dec.,'06. Below. 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 G. M. Weiss ... „ 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 „ 145, King's-road J. Humphry & Son Above. +88 G. Nash Below. 134, Buckea ... „ 351 Hart „ 399, H. Kohler ... „ 488, Matthiae „ 502 W. Schafer ... „ 517, W. James ... „ 48, Lots-road M. & C. West „ 83, Lower Sloane-street Burrows Above. 62, Draycott-avenue Emil Schuster ... Below. 100, C. Reitz ... „ 110, William Herwig Above. ... 7, Pavilion-road Mason ... 3, Pont-street Hue & Co Below. 29, Riley-street F. W. Fox ... „ 150, Sloane-street Reuben Jeffries ... „ 25, Walton-street Burrows ... „ *ot used, bakes at 11, Motcomb-street. †Now used as kitchen only. 49 SLAUGHTEE-HOUSES. Street. Occupier. Crooked Usage Cridlau, P. and J. W. 169, Fulham-road Philp, J. 341, „ Vaughau, T. 62, King's-road 54, „ Cobb, G. A. 413 Gouldiug, F. 82, Draycott-avenue Igguldeu, F. COW-HOUSES. Church-street E. J. Walker.