CHE 17 Metropolitan Borough of Chelsea. ANNUAL REPORT For 1911 OF THE Medical Officer of Health, LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ. ; M.R.C.S. Eng. Consulting Sanitary Adviser to H.M. Office of Works and to the Metropolitan Police District; Civilian Sanitary Member of Advisory Board for Army Medical Services; Examiner in Public Health, Royal Colleges of Physicians and Surgeons; Fellow of the Royal Sanitary Institute; Fellow of the Society of Medical Officers of Health. TOWN HALL, KING'S ROAD, CHELSEA. LONDON: Shield & Spring, Printers, 26 & 28, Lancelot Place, Brompton Road. 1912. TABLE OF CONTENTS. SEC. I.—Statistical:— page. Population of Chelsea 3 Births and Birth-rate 3 Deaths and Death-rate 4 Death-rate of Special Classes of the Population 8 Infantile Mortality 9 Statistical Tables (L.G.B. Forms, I., II., III., IV.) 12 SEC. II.—Infectious Diseases:— Small-pox 17 Scarlet Fever 17 Diphtheria 17 School outbreak 18 Enteric Fever 18 Removal of Patients to Hospital 19 The Case Mortality 20 Other Infectious Diseases 21 Notifications of Phthisis 22 SEC. III.—The Housing of the Working Classes:— Sir Thomas More Buildings 25 Pond House 25 Onslow Dwellings 25 Grove Buildings 26 Housing and Town Planning Act, 1909 26 Demolitions in 1911 27 SEC. IV.—The Sanitary Condition of the Borough:— Drainage 28 Inspections made 28 Disinfection 28 Basement Workrooms 29 Action taken under the Sale of Food and Drugs Act 29 Water Supply 30 Reports presented to the Borough Council 30 Summary of Work done by the Lady Sanitary Inspector 31 The Chelsea Health Society 34 Statistical Tables of Action taken under the Factory and Workshop Act 35 Statistical Tables of Action taken under the Public Health (London) Act 35 Summary of Nuisances and other matters reported on in 1911 39 Magisterial Proceedings during 1911 41 List of Bakehouses, Cow-houses and Slaughter-houses 43 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For 1911. Section I.—STATISTICAL. POPULATION OF CHELSEA. The census population of the Borough of Chelsea for the year 1911 was 66,404, the census of 1901 showing a population of 73,842, so that there has been a decline in population in the 10 years of 7,438 persons. With few exceptions all the more centrally situated Boroughs of London show similar decreases. The reason of these decreases appears to be the movement of population out from the central districts to the suburbs following upon the improved facilities for travel and the building developments in the suburban areas, and the removal of industries formerly situated in Central London to extra-metropolitan situations. In Chelsea these general causes of exodus of population have been intensified by the demolition of small houses following upon the lapsing of leasehold interests, and the slow rate of progress made in the utilisation of land rendered vacant by demolitions. The estimated population of the Borough for the middle of the year 1911 is 66,228. As the Census Report for London is not yet issued, the population of North and South Chelsea and of the five wards of the Borough cannot at present be stated. BIRTHS AND BIRTH-RATE FOR 1911. Table I. Number of Births. Male. Female. Total. North Chelsea 312 303 615 South Chelsea 294 278 572 Chelsea 606 581 1,187 The above Table relates to births registered in the District. Excluding 13 births of non-parishioners, and including 64 births taking B 2 4 place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year is 1,238. The birth-rate for 1911 is 18.8 per 1,000. The average birthrate of the Borough for the years 1901-10 is 21.7 per 1,000. The average birth-rate of the Home District of Chelsea Parish for the 5 years 1896-1900 was 24.1 per 1,000. The birth-rate of the past year is the lowest yet recorded. During the year 1911, 50 births of parishioners were registered as having occurred in the Chelsea Workhouse, equivalent to 4 per cent, of the total number of births in the Borough, as compared with 4.1 per cent. in 1910. DEATHS AND DEATH-RATES FOR 1911. The total number of deaths registered in the Borough was 1,527. Of this number 709 were deaths within the Borough of non-parishioners —chiefly occurring in Hospitals and in the St. George's Infirmary; and 216 deaths of parishioners occurred outside the Borough in various public institutions. There were, therefore, 1,034 deaths of parishioners of Chelsea. These 1,034 deaths are equivalent to a death-rate for the year of 15.7 per 1,000, as against 14.2 in 1910. Table II. gives the death-rates of the Home District of Chelsea Parish, of Chelsea Borough, and of London during the past 21 years. Table II. Year. Chelsea.* London. Death-rate. Death-rate. 1891 22.1 21.4 1892 21.9 20.7 1893 21.6 21.4 1894 17.6 17.8 1895 20.8 19.9 1896 19.0 18.6 1897 17.9 18.2 1898 18.1 18.7 1899 20.0 19.8 1900 18.1 18.7 1901 16.6 17.6 1902 18.6 18.2 1903 15.7 15.9 1904 17.1 17.0 1905 15.7 15.5 1906 16.7 15.7 1907 16.2 15.3 1908 16.1 14.9 1909 16.1 14.9 1910 14.2 13.7 1911 15.7 15.0 *1891-1900, Chelsea Home District. 5 Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 1.65 per 1,000 in 1911, the corresponding rate for London being 2.38. In 1910 the zymotic death-rate in Chelsea was 0 99 per 1,000. Table III.—For the year 1911. Zymotic death-rate. Diarrhoea death-rate. Phthisis death-rate. Other tubercular diseases deathrate. Respiratory diseases deathrate. Cancer death-rate. Influenza death-rate. Deaths under 1 year to 1000 births. Percentage of deaths under 5 to total deaths. Deaths in Public Institutions per cent. of total. Chelsea 1.65 0.94 1.38 0.48 2.47 1.41 0.17 112 20.9 52.8 London 2.38 1.37 1.35 0.38 2.61 1.05 0.11 128 32.8 41.3 Small-Pox.—There was no small-pox in Chelsea in 1911. Measles.—This disease caused 30 deaths in 1911, as compared with 19 in 1910. Ten deaths were registered in North Chelsea, and 20 in South Chelsea. Four of the deaths were of infants under one year of age, 7 between one and 2 years, and 17 between two and 5 years. Eighteen of the deaths occurred in the first quarter of the year, eight in the second quarter, and four in the third quarter. Scarlet Fever.—This disease caused 2 deaths in 1911—one in North Chelsea and one in South Chelsea. The number of notifications of scarlet fever in the course of the year was 142. Diphtheria.—Five deaths were attributed to diphtheria in 1911, the same number as in 1910. Two cases resided in North Chelsea and 3 in South Chelsea. Four of the deaths occurred in hospitals, and one at the patient's own home. Table IV.—Cases of, and Deaths from Diphtheria and Membranous Croup in Chelsea,* 1890-1911. CASES. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 172 162 163 200 207 273 429 242 153 136 150 106 131 99 61 52 161 158 138 97 81 83 DEATHS. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 32 20 32 43 41 52 96 45 22 13 14 9 13 4 5 5 16 8 13 14 5 5 *1890-1900, Chelsea Home District. 6 Whooping Cough.—This disease caused 10 deaths in 1911, as compared with 12 in 1910. Eight deaths occurred in North Chelsea, and two in South Chelsea. Enteric Fever.—There were no deaths from enteric fever in Chelsea in 1911. Table V.—Zymotic Disease Mortality in Chelsea in 1911. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea,1901-1910. Measles 30 38 27 Scarlet Fever 2 3 5 Diphtheria 5 9 9 Whooping Cough 10 15 20 Enteric Fever 0 2 3 Diarrhœa 62 90 49 Diarrhœa.—The deaths in Chelsea in 1911 from diarrhœal diseases (diarrhœa and enteritis) were 62 in number, as compared with 28 in 1910. Forty-five of the deaths were of infants under one year of age, as compared with 19 in 1910; 8 were between one and two years of age, and 9 were old people. Twenty-nine of the deaths were of North Chelsea residents, and 33 of South Chelsea. Table VI.—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 1182 1902 714 756 1903 555 849 1904 897 1295 1905 652 977 1906 1188 1325 1907 550 570 1908 731 857 1909 443 588 1910 418 501 1911 939 1368 7 The summer prevalence of diarrhœa commenced about the middle of July and was continued until the end of September. Forty-eight deaths from diarrhoea were registered in the third quarter of the year, as compared with 11 only in 1910. The average temperature of the third quarter was as high as 65.8° F., which is almost a record. The average temperature of the third quarter of 1910 was only 59.3° F. Previous years of high summer diarrhœa mortality were 1906, when 48 deaths were registered in the third quarter, the same number as in 1911, and 1904, when 46 deaths occurred. But in neither of these years was the heat of the summer so excessive as in 1911, the average temperature of the third quarter of 1906 being 63.3° F., and of 1904 61.4° F. Having regard to the phenomenal heat last year, the summer diarrhœa mortality is quite moderate. As regards diarrhœa mortality Chelsea has for some years past been able to show more favourable figures than London, taken as a whole, as the above Table exemplifies. Influenza.—The number of deaths attributed to influenza in 1911 was 11, as against 13 in 1910. Six deaths occurred in North Chelsea, and 5 in South Chelsea. In London generally the disease was considerably less prevalent in 1911 than in 1910, 496 deaths being registered as due to this cause in 1911, as compared with 723 in 1910. Of the 496 fatal cases in London in 1911, 204 occurred in the first quarter of the year, 100 in the second, 31 in the third, and 161 in the fourth quarter. As usual, the month of greatest prevalence was February. Respiratory Diseases.—The death-rate from these diseases in Chelsea in 1911 was 2.47 per 1,000, as compared with 2.19 per 1,000 in 1910. The London death-rate from respiratory diseases, including pneumonia, in 1911 was 2.61 per 1,000. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1911 was 1.86 per 1,000, as against 1.63 per 1,000 in 1910. The death-rate in London from these diseases in 1911 was 1.73 per 1,000. Of the 91 deaths from phthisis in Chelsea in 1911, 45, or 49.5 per cent., occurred in the Chelsea Workhouse Infirmary, and 22, or 24.2 per cent., occurred in other public institutions, making a total of 73.7 per cent. of the total of 91 cases dying in public institutions away from their own homes. The average for the 10 years 1901-10 is 44 per cent. in the Chelsea Infirmary, and 15 per cent, in other public institutions, making a total of 59 per cent. of the total deaths. The large increased percentage of nearly 74 per cent, of phthisis cases dying in public institutions in 1911, as compared with the 59 per cent., the average of the previous 10 years, is probably due to the better recognition by the public of the dangers of infection to others attaching to consumptives in the final stages of their last illness. This knowledge is now being brought home to everyone by the visits of the municipal and other health visitors to the homes of notified cases of phthisis. From the humanitarian, no less than from the public health point of view, it is eminently desirable that the last stages of phthisis amongst the poorer classes should be passed in public institutions, where 8 good nursing and medical comforts are provided to all who are in need of them. Cancer.—Malignant cancerous disease caused 93 deaths in Chelsea in 1911, the average of the past 20 years being 74 deaths annually. Forty-six of the deaths were of North Chelsea residents, and 47 of South Chelsea. The mortality from cancer fluctuates from year to year, but, on the whole, shows a slow but steady increase in Chelsea, as in the country generally. Alcoholism.—Seventeen deaths were registered in 1911 as being due to intemperance or cirrhosis of the liver, as against 15 in 1910. These annual figures merely represent the deaths which are palpably and unmistakably the results of alcoholic excess, and take no account of the far larger numbers which are indirectly due to excessive drinking. Deaths in Lunatic Asylums.—Forty-two deaths of Chelsea parishioners occurred in 1911 in lunatic asylums. The average of the preceding 20 years is 34 deaths annually in asylums. Deaths in Public Institutions.—In 1911, 52 8 per cent, of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 48.3 per cent. in 1910. In London generally 41.3 per cent, of the total deaths occurred in public institutions in 1911. The deaths in the Chelsea Infirmary in 1911 formed 23.1 per cent, of the total deaths of Borough residents, as compared with 22.7 per cent in 1910. Deaths of Common Lodging House Inmates.—Twenty deaths of common lodging-house inmates occurred in Chelsea in 1911, all taking place in the Chelsea Infirmary. All were males. Eight of the deaths (40 per cent, of the total) were due to pulmonary tuberculosis. The common lodging-houses now open in Chelsea are No. 24, Smithstreet (50 beds for males), Nos. 25-27, Smith-street (112 beds for males), and Nos. 23 and 24, Lawrence-street (76 beds for males). Total, 238 beds. DEATH-RATE 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 1911,for the Borough, for the inhabitants of the Borough Council's Dwellings, for the inhabitants of other Industrial Dwellings in Chelsea, and for the inhabitants of ten of the streets occupied by the poorer classes in the Borough. The industrial dwellings are the Marlborough Buildings, Guinness Buildings, Peabody Buildings, and Chelsea Park Dwellings, with a total population of 1,748 ; and the streets are Dartrey-road, Francis-street, Gilray-square, Ivesstreet, Oakham-street, Pond-terrace, Riley-street, Slaidburn-street, Stayton-street, World's End-passage, and the courts adjacent, with a total population of 4,084. The Borough Council's Dwellings are Sir Thomas More Buildings, Pond House, Onslow Dwellings, and Grove Buildings, with a total population of 1,467. 9 Table VII.—For the Year 1911. Birthrate. Deathrate. Zymotic Deathrate. Tubercular Diseases Death-rate. Deaths under one year to 1,000 births. Chelsea 18.8 15.7 0.99 1.86 112 Borough Council Dwellings 25.9 9.5 2.05 0.68 53 Industrial Dwellings 22.3 13.7 1.72 0.57 180 10 Poor-class Streets 35.0 24.5 3.43 4.41 161 As in previous years, the death-rate in the Borough Council's Dwellings is again a very low one. The diseases included in the zymotic death-rate for these Dwellings are one fatal case of measles and two fatal cases of diarrhœa. The contrast between the health conditions prevailing in the Council's Dwellings and those characteristic of the 10 poor-class streets is a very striking one. INFANTILE MORTALITY. The year 1911 was notable for its high summer temperature, causing excessive prevalence of summer infantile diarrhœa. Chiefly owing to this cause the rate of infantile mortality (deaths of infants under one year of age to 1,000 births) rose from 102 in 1910 to 112 in 1911. Table VIII. Year. Chelsea. London. Deaths under one to 1,000 births. Deaths 1—5 years. Deaths under one to 1,000 births. Deaths 1—5 years. 1901 139 146 101 112 150 142 9,514 9,209 1902 145 151 141 9,893 1903 144 94 131 8,514 1904 155 102 145 8,915 1905 116 121 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 1910 102 63 102 6,807 1911 112 77 128 7,804 The figure 112 is, however, a very good one, having regard to the adverse conditions affecting infant life in the excessively hot summer of 1911, and also having regard to the prevalence of measles in the early part of the year. Table VIII. shows that in the years 1904 10 and 1906, which had warm summers, and high diarrhœa mortalities, the rates of infantile mortality were 155 and 140 respectively, although in point of heat the summers were much less trying than in 1911. It seems more certain now, with the experience of last year as a guide, that the visits of the health visitors to the homes of the working classes, and more especially the attention paid to the newly-born infants, and the advice and practical assistance given to the mothers, is bearing fruit in the direction of saving the lives of many infants who would formerly have died before reaching the end of their first year. This saving of life is undoubtedly accompanied by a saving of health to many infants who formerly suffered in physique and strength as the result of preventable illness. The rates of infantile mortality prevailing amongst different sections of the working classes vary enormously according to habits and modes of life (see Table VII.). In well-housed communities, where the population is practically one selected for steadiness, thrift and sobriety, 95 per cent, of the infants born may survive the first year of life; whereas in the streets inhabited by the more improvident and less steady grades of working people only 85 per cent. survive the first year of life. Table IX. Infantile Mortality Rate, 1911. Hans Town Ward 149 Royal Hospital „ 84 Church „ 119 Cheyne „ 79 Stanley „ 116 Chelsea Borough 112 The above Table shows the infantile mortality rates in the five wards of the Borough. The births occurring in the Chelsea Workhouse and in other maternity institutions have been distributed amongst the various wards. As the populations of the wards under the recent census are not yet known, it has been impossible to give the Ward birth-rates, as in previous years. From Table XV. (Local Government Board Table V.) it will be seen that out of a total of 139 deaths of infants under one year of age in 1911, 38, or 27.3 per cent., occurred in the first 4 weeks of life, as compared with 38.3 per cent, in 1910. Twenty deaths occurred in the first week of life, equal to 14.4 per cent, of the total, the corresponding figure for 1910 being 24.1. The majority of these deaths in the first month of life are due to premature birth, congenital defects, and inability to take nourishment. For deaths under the month the rate of mortality in 1911 is 31 per 1,000 births, as against 39 in 1910, the average rate for the 6 years 1905-10 being 40. 11 Between the ages of 1 month and 12 months, 101 deaths, or 72.7 per cent, of the total, were registered in 1911, as compared with 61.7 per cent, in 1910; 41 of these deaths being due to diarrhœal diseases, as compared with 19 in 1910. The principal causes of death amongst infants under one year in 1911 were:—Diarrhœal diseases, 45; premature birth, 16; atrophy and marasmus (wasting), 16; pneumonia, 12; bronchitis, 8; tubercular meningitis, 4; measles, 4; and whooping-cough, 3. Illegitimate Births.—The following Table shows, for each of the years 1905—1911, 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 X.—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 1910 80 5.8 63 8 9 100 1911 64 5.2 51 7 6 109 The infantile mortality rates in the above Table are evidently minimum rates from 1905 to 1908, owing to the considerable numbers each year unaccounted for by change of residence, or other cause. During the past two years it has been possible to trace the subsequent histories of the illegitimate infants with some approach to accuracy. The mortality rates of these infants in the past two years are by no means excessive, having regard to the conditions under which they are reared; and this lowered mortality may be due to the greater supervision now exercised over the places where so many of these children are put out to nurse. 12 TABLE XI.—(I.) VITAL STATISTICS OF WHOLE DISTRICT DURING 1911 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths,‡ Nett Deaths belonging to the District. Uncorrected Number Nett of Nonresi dents registered in the District † of not istered in the district † Under 1 Year of Age. At all Ages. Number t Rate. Number * Rate. Number * Rate per 1,000 Nett BIRTHS. Number * Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 69,839 1506 1506 21.6 1704 24.4 699 163 211 140 1168 16.7 1907 69,101 1431 1493 21.6 1688 24.4 712 142 182 122 1118 16.2 1908 68,371 1479 1540 22.5 1653 24.2 705 156 166 108 1104 16.1 1909 67,649 1330 1400 20.7 1625 24.0 740 202 150 107 1087 16.1 1910 66,935 1298 1376 20.6 1427 21.3 632 157 141 102 952 14.2 1911 66,228 1187 1238 18.8 1527 23.1 709 216 139 112 1034 15.7 Notes.—This Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 some of the corrected rates probably will not be available. The rates should be calculated per 1000 of the estimated gross population. In a district in which large Public Institutions for the sick or infirm seriously affect the statistics, the rates in Columns 5 and 13 may be calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in such institutions. *In Column 6 are to be included the whole of the deaths registered during the year as having actually occurred within the district. In Column 12 is to be entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are to be similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. †The Medical Officer of Health will be able from the returns made by him by the local Registrar of Deaths to fill in Column 8 in accordance with the rule in the next paragraph below. The Registrar-General, either directly or through the County Medical Officer of Health, will supply the Medical Officer of Health with the particulars of deaths to be entered in Column 9; and all such deaths must be included in this Column, unless an error is detected, and its correction has been accepted by the Registrar-General. For Column 4 the Registrar-General will furnish to the Medical Officer of Health, a Statement of the number of births needing to be added to or subtracted from the total supplied by the local Registrar. ‡"Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, must not be included in Columns 8 or 9, except in certain instances under 3 (b) below. The Medical Officer of Health will state in Column 8 the number of transferable deaths of "non-residents" which are to be deducted, and will state in Column 9 the number of deaths of "residents" registered outside the district which are to be added in calculating the nett death-rate of his district. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are to be referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known ; and (d) failing this, to the district where the body was found. Area of District in acres (exclusive of area covered by water) 660 Total population at all ages at Census of 1911 66,404 13 TABLE XII.—(II.) CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1911. Notifiable Disease. Number of Cases notified. Total Cases Notified in each Locality (e.g., Parish or Ward) of the District Total Cases removed to Hospital. At all Ages. At Agea†—Years. Under 1. 1 to 5. 5 to 15 15 to 25. 25 to 45. 45 to 65. 65 and upwards. North Chelsea. South Chelsea. Smallpox ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Mem branous Croup) 83 ... 25 44 5 8 1 ... 31 52 73 Erysipelas 51 ... ... 2 3 23 13 10 23 28 10 Scarlet Fever 142 1 36 80 11 13 1 ... 78 64 132 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 7 ... ... ... 4 2 ... 1 4 3 4 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 5 ... ... ... 2 3 ... ... 1 4 2 Plague ... ... ... ... ... ... ... ... ... ... ... Phthisis Under Tuberculosis Regulations, 1908 119 1 7 9 8 40 34 20 ... ... ... Under Tuberculosis Regulations, 1911 49 ... ... 3 15 25 6 ... ... ... ... Others 6 ... ... ... 1 4 ... 1 ... ... ... Totals 462 2 68 138 49 118 55 32 ... ... 221 †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. 14 TABLE XIII.—(III.) CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1911. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District (a). Total Deaths whether of "Residents" OR "nonResidents" in Institutions in the District (b). All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under . 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Enteric Fever .. .. .. .. .. .. .. .. .. 1 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 30 4 7 17 1 .. 1 .. .. 1 Scarlet Fever 2 .. .. .. 1 .. .. 1 .. .. Whooping Cough 10 3 3 4 .. .. .. .. .. 1 Diphtheria and Croup. See note (d) 5 1 .. 1 2 •• 1 • • .. 1 Influenza 11 .. 1 .. .. 2 1 3 4 4 Erysipelas 2 .. .. .. .. .. 1 1 •• 4 Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. Septic Diseases 17 .. 2 .. 1 .. 4 5 5 17 Phthisis (Pulmonary Tuberculosis) 91 .. 1 .. 3 4 41 27 15 152 Tuberculous Meningitis. See note (e) 17 4 1 6 4 .. 2 .. .. 25 Other Tuberculous Diseases 15 1 .. 2 4 .. 2 3 3 33 Rheumatic Fever 3 .. .. .. .. .. 3 .. .. 2 Cancer, malignant disease. See note (f). 93 .. .. .. 1 2 5 41 44 179 Bronchitis 83 8 2 .. .. .. 5 19 49 61 Broncho-Pneumonia 21 7 8 .. .. .. 2 2 2 43 Pneumonia (all other forms) 57 5 4 3 1 2 8 19 15 44 Other Diseases of Respiratory organs 2 1 .. .. .. .. .. 1 .. 6 Diarrhœa and Enteritis. See note (g) 62 45 8 .. .. .. .. 1 8 76 Appendicitis and Typhlitis 7 .. .. .. 3 1 1 2 .. 6 Alcoholism. See note (h) 2 .. .. .. .. .. .. 1 1 2 Cirrhosis of Liver 15 .. .. .. .. .. 1 11 3 6 Nephritis and Bright's Disease 28 .. .. .. 1 .. 3 16 8 23 Puerperal Fever. See note (i) 2 .. .. .. .. 1 1 .. .. .. Other accidents and diseases of Pregnancy and Parturition. 3 .. .. .. .. .. 3 .. .. 1 Congenital Debility and Malformation, including Premature Birth. See note (j). 40 40 .. .. .. .. .. .. .. 32 Violent Deaths, excluding Suicide 40 6 .. 1 6 1 11 8 7 14 Suicides 9 .. .. .. .. 1 2 4 2 1 Heart Disease 110 .. .. .. 3 1 16 49 41 79 Other Defined Diseases 162 9 5 1 1 4 18 61 63 135 Diseases ill-defined or unknown and Old Age. 95 5 .. .. .. .. .. 4 86 90 1034 139 42 35 32 19 132 279 356 1039 15 NOTES TO TABLE III. (a) All "Transferable Deaths" of residents, i.e., of persons resident in the District who have died outside it, are to be included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the district, are in like manner to be excluded from these columns. For the precise meaning of the term "transferable deaths" see footnote to Table I. The total deaths in column 2 of Table III. should equal the figures for the year in column 12 of Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, are to be entered in the last column of Table III. (c) 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." (d) This heading includes all deaths from croup except those certified as due to "spasmodic," "stridulous," "catarrhal," or " false " croup. (e) Under " Tuberculous Meningitis " are to be included deaths from Acute Hydro- cephalus. (f) Under "Cancer" should be included deaths under such headings as Carcinoma, Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. (f) Under this heading are to be included deaths registered as due to Epidemic diarrhœa, Epidemic enteritis, Infective enteritis. Zymotic enteritis, Summer diarrhœa, Choleraic diarrhœa, Cholera (other than Asiatic), Gastro-Enteritis, Gastro-Intestinal Catarrh, Muco-Enteritis, Colitis, &c. Deaths from Diarrhoea secondary to some other well-defined disease should be included under the latter. (h) Under this heading are to be included deaths from Delirium Tremens, acute and chronic alcoholism, &c., but not those certified as due to organic disease attributed to alcoholism. The number of the latter may with advantage be stated separately, though this statement cannot be included in Table III. (i) Under "Puerperal Fever" are to be included deaths under such headings as Pyaemia, Septicaemia, Sapræmia, Pelvic Peritonitis, Peri- and Endo-Metritis occurring in the Puerperium. (j) Under this heading are to be included also deaths from Atrophy and Marasmus of Infants, and want of Breast-Milk, but not from Atelectasis. In any case of doubtful classification of deaths, the Manual to be issued shortly by the Registrar-General should be followed. 16 TABLE XIV.—(IV.) INFANT MORTALITY.—1911. NETT DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. Cause of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 1 month. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total Deaths under 1 year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 3 4 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Whooping-cough .. .. .. .. .. 1 1 1 .. 3 Diarrhœa .. .. .. .. .. 6 7 6 5 24 Enteritis .. .. 3 1 4 .. 7 7 3 21 Tuberculous Meningitis .. .. .. .. .. 1 2 1 .. 4 Abdominal Tuberculosis (b) .. .. .. .. .. .. 1 .. .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Congenital Malformations (c) 2 .. 1 1 4 5 1 .. .. 10 Premature Birth 13 .. 2 1 16 .. .. .. .. 16 Atrophy, Debility & Marasmus 2 2 .. .. 4 6 3 2 .. 16 Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. .. 1 .. 1 1 .. l .. 3 Rickets .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) 1 .. .. .. 1 .. 1 .. .. 2 Convulsions 1 1 .. .. 2 .. .. .. .. 2 Gastritis .. .. .. .. .. 1 1 .. .. 2 Laryngitis .. .. .. .. .. .. 1 .. .. 1 Bronchitis .. .. 1 .. 1 .. 5 1 1 8 Pneumonia (all forms) .. .. .. 1 1 2 3 2 4 12 Suffocation, overlying .. .. .. .. .. 1 2 .. .. 3 Other causes .. .. 3 .. 3 1 .. .. 1 5 20 3 11 4 38 25 35 22 19 139 Nett Births legitimate 1174 in the year illegitimate 64 Nett Deaths legitimate infants 132 in the year of illegitimate infants 7 NOTES TO TABLE IV. (a) The total in the last column of Table IV. should equal the total in column 10 of Table I., and in column 3 of Table III. (b) Under Abdominal Tuberculosis are to be included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (c) The total deaths from Congenital Malformations, Premature Birth, Atrophy, Debility and Marasmus, should equal the total in Table III. under the heading Congenital Debility and Malformation including Premature Birth. Want of Breast Milk should be included under Atrophy and Debility. (d) For references to the meaning of any other headings, see notes attached to Table III. 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 Section II. INFECTIOUS DISEASES. Small Pox.—There were no cases of small pox in Chelsea in 1911. In London, during the year 1911, 73 cases of the disease were notified, as compared with 7 in 1910. Of the 73 cases 61 were notified in the 4 weeks terminating the 18th March, 39 of these occurring in Stepney. The outbreak was in fact practically confined to Stepney and neighbouring eastern boroughs. Scarlet fever.—In 1911, 142 cases of scarlet fever were notified in Chelsea, equivalent to a case rate of 21.4 per 10,000 of the population, as against 17.8 in 1910. The number of cases notified in the first quarter of the year was 34, in the second quarter 39, in the third quarter 33, and in the fourth quarter 36. The largest number of cases occurring in any one one month was 16 in March, and the lowest 4 in January. In December 5 of the 12 notified cases were children attending the Oratory Girls' School, and there was some reason to believe that the origin of these cases was a " missed " case of the disease, which was continuing to attend the school, but the actual individual was not identified. Two children of this school who had been absent for some time in November, were found on visiting their homes to exhibit signs of having had the disease in very mild form. There was no special school incidence of scarlet fever in respect of any other school in the Borough. In North Chelsea 78 cases were notified during the year, and in South Chelsea 64 cases. The percentage of cases of school age (3 to 13 years) of the total number in the Borough was 75, as compared with 66 in 1910. The average duration of the stay in hospital of 107 cases, of which the records are to hand, was 63 8 days, as against 668 in 1910. Seven cases admitted to the M.A.B. hospitals were subsequently certified by the Medical Superintendents of those institutions not to be suffering from scarlet fever or any other notifiable disease. The average duration of the stay in hospital of these 7 cases was 17.4 days, as against 22.8 days in 1910. Six cases on discharge from M.A.B. hospitals were stated to be still suffering from otorrhœa or rhinorrhœa, the same number as in 1910. So far as is known, none of these cases were the means of spreading infection after return to their homes. During the year there was only one instance of a possible "return" case of scarlet fever, the interval elapsing between the return home from hospital of the infecting case and the onset of the disease in the secondary case being 2 days. Diphtheria.—In 1911, 83 cases of diphtheria (including one of membranous croup) were notified in Chelsea, equivalent to a case-rate of 125 per 10,000 population, as compared with 121 in 1910. In the first quarter of the year 25 cases were notified, in the second quarter 14, in the third quarter 21, and in the fourth quarter 23. The percentage of cases of school-age (3 to 13 years) of the total number in the Borough was 71, as against 73 in 1910. In North Chelsea 31 cases were notified, and in South Chelsea 52. The months of greatest prevalence were March (14 cases) and November (13 cases). The average duration of stay in nospital of 58 cases, of which the records are to hand, was 59 days, as against 60 in 1910. Five cases c 18 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 ponding number in 1910 being 4. The average duration of the stay in hospital of these 5 cases was 19 days, as against 27 days in 1910. Two cases of diphtheria on discharge from hospital were stated to be still suffering from rhinorrhœa, but free from diphtheria bacilli. One case of chronic otorrhœa was discharged. So far as is known, there was no spread of infection from any of these cases after return to their homes. During the year medical practitioners sent 105 throat swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 122 in 1910, and 2 were sent from this department by myself, the entire cost being defrayed by the Borough Council. Sixty-six of the swabs (62 per cent, of the total) were sent by the medical staff of the Victoria Hospital in respect of Chelsea children. Of the total of 107 swabbings, 31, or 29 per cent., afforded positive evidence of the presence of the specific diphtheria bacillus, and 76, or 71 per cent., gave negative evidence. These are practically the same proportions as in 1910. Eight of the negative swabbings showed the presence of Hoffman's pseudo-diphtheria bacillus. No applications were made during the year by medical practitioners for anti-toxin, or for repayments for the supply of anti-toxin by chemists in the Borough for the use of the poorer class of patients prior to removal to the fever hospitals. School Outbreak of Diphtheria.—Special school incidence of diphtheria was shown in respect of the Infants' Department of the Cook's Ground School, six cases of the disease being notified amongst children attending this Department between the 20th October and the 30th November, the dates of notification being 20th October, 8th, 14th, 24th, 27th, and 30th November. In addition, a child not attending school, but one of a family where two brothers attending school were attacked, was also found to be suffering from diphtheria on the 29th November. All these cases were probably due to the presence of a chronic "carrier," a little girl of six years, who attended the infant department of the school. On the 13th November the father of this child was certified to be suffering from membranous croup, and he died the same day at the M.A.B. hospital to which he was removed. The little girl returned to school on the 29th November, and a swab of her throat was taken on the 1st December by the school doctor, other children of the class being swabbed at the same time. The little girl's throat was the only one which gave a positive result as regards the presence of the diphtheria bacillus, and she ceased attendance at school on the 4th December. No further cases occurred amongst those attending the school. On the 21st December a medical certificate was received at the office stating that the child's throat had been swabbed, and she was found to be no longer acting as a "carrier." Enteric Fever.—The number of cases of enteric fever notified in Chelsea in 1911 was 7, as against 16 in 1910, the case-rate being only 1.1 per 10,000 of the population. One case was notified in the first 19 quarter of the year, one in the second, 3 in the third, and 2 in the fourth quarter. In North Chelsea 4 cases were notified, and in South Chelsea 3 cases. Of the 7 cases notified two were mistaken diagnoses, one suffering only from senility without definite disease being assigned as the cause of death, which occurred subsequent to removal to hospital. The other was a case of appendicitis, which was retained in hospital for 19 days. Of the remaining 5 cases, in two the infection was contracted outside the Borough—one case returning ill from Singapore, and the other having contracted the disease by eating infected mussels at Ramsgate. Of the remaining 3 cases, two were on the staff of the Victoria Hospital for children, the illnesses commencing within a week of each other at the end of October. One patient was a ward nurse and the other an out-patient sister. In neither case was it possible to trace any specific source of infection. The remaining case was that of a student in St. Mark's College, and occurred a month after the case which was notified as enteric fever, but subsequently ascertained to be appendicitis, this patient also being a student at St. Mark's. There were no blood specimens sent to the Lister Institute in the course of the year for determining the Widal reaction. The examinations of excreta of enteric fever patients discharged from the M.A.B. hospitals, with a view to the discovery of the B. Typhosus, were not pursued in 1911. Removals to Hospital.—Table XV. 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 22 years 1890—1911, expressed as percentages of the total number of cases of each disease notified. Table XV.—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 1910 96 88 75 1911 93 88 57 c 2 20 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 22 years, 1890—1911:— Table XVI.—Case Mortality in Chelsea, and in London, 1890-1911. 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 4.6 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 2.2 14.4 9.1 16.7 14.2 1910 0 2.0 6.2 7.9 12.5 15.3 1911 1.4 6.0 0.0 Cerebro-spinal Fever.—No cases of this disease were notified in Chelsea in 1911. In London, during the year 1911, 102 cases were notified, as against 115 in 1910 and 110 in 1909. Eight deaths were registered as due to this disease during the year, the case-mortality being 7 8 per cent., as compared with 8.7 in 1910, and 13.6 in 1909. Acute Poliomyelitis.—This disease was notifiable in London from the week ending September 2nd, 1911. Sixty-nine cases were notified between that date and the end of the year. One case only was notified in Chelsea—that of a boy of 7 years, who was attending the Oratory School. The illness commenced in the middle of November. He was received as an in-patient into the Victoria Hospital on the 27th November, and notified on the 13th December. Inquiry failed to elicit any source of infection. Puerperal Fever.—Five cases of this disease were notified in Chelsea in 1911, as compared with 2 in 1910. Four cases resided in 21 South Chelsea, and one in North Chelsea. Two deaths were registered as due to the disease. Chicken-pox.—This disease was notifiable for 3 months from the 22nd March, 1911. Thirteen cases were notified in Chelsea during this period. Ophthalmia Neonatorum.—This disease was notifiable in London from the week ending 11th March, 1911. During the period between that date and the end of the year 680 cases were notified in London. Eight cases were notified in Chelsea. All the cases were visited by the Lady Sanitary Inspector, and steps were taken to insure that the affected eyes received appropriate treatment, with the result that, so far as known, no permanent injury to sight has been sustained by any of the cases notified. Altogether 66 visits were paid in respect of cases of ophthalmia neonatorum. Measles.—This disease was very prevalent in Chelsea during the first quarter of 1911, when 18 deaths out of a total of 30 for the year occurred. The disease, however, never got the same foothold in Chelsea that it did in some other parts of London. Orders of the Medical Officer (Education L.C.C.) for the exclusion from school of unprotected children attending certain classes in the Infants' Departments were issued in respect of 8 schools in Chelsea. Poor-law cases of measles were received into the M.A.B. Fever Hospitals during 1911; and by an order of the Local Government Board of 30th May, 1911, the Managers (M.A.B.) were required to receive cases of measles recommended by the Medical Officer of Health of the Borough in which the patient resides, provided that there is an excess of accommodation available in the hospitals above that required by the Poor-law cases. Under this order 3 cases of measles were recommended by me for removal to hospital, and were so removed. During the year 30 cases of measles were discharged from the M.A.B. hospitals, 2 having been removed from the Chelsea Infirmary, and 3 from St. George's Infirmary. The average duration of the stay in hospital of these 30 cases was 38 days. Whooping Cough.—Twenty-two cases of this disease were discharged from the M.A.B. hospitals during the course of 1911. The average duration of stay in hospital of these 22 cases was 74 days, which is nearly double the average stay in hospital of measles cases. Ten cases were removed from the Chelsea Infirmary to M.A.B. hospitals during the year, and 3 cases were so removed from St. George's Infirmary. 22 NOTIFICATIONS OF PHTHISIS. The following Table shows the number of notifications received under the Public Health (Tuberculosis) Regulations, 1908 (Poor Law):— Males. Females. Total. Form A.—First notifications by M.O., C.W.I. 63 36 99 Re-notifications — — 110 Notifications by M.O.'s, outside Infirmaries 7 6 13 Form B.—First notifications by District M.O.'s 22 20 42 Re-notifications — — 3 Form C.—Notifications by Master, C.W. — — 87 Notifications by Masters, outside Workhouses — — 11 92 62 365 The total number of first notifications by medical practitioners under the Poor-law in 1911 was, therefore, 154, as compared with 147 in 1910. The total number of first notifications in 1909 was 303, but this was the first year the regulations came into force, when practically every known case of phthisis receiving or seeking Poor-law treatment was notified. Of the total of 154 first notifications 119 were new cases. All these cases were paid a first visit, and in addition 10 new cases of tuberculosis in children notified from the schools were visited; 104 re-visits and 81 miscellaneous visits were made—the total of visits in respect of phthisis cases during the year being 314. The number of Common Lodging House cases was 8. As a result of the visits to the homes and the inquiries made, four cases of phthisis were recommended and admitted to open-air sanatoria and convalescent homes; 18 cases were given out-patient letters for the Brompton Hospital, and 20 cases were given letters for the Victoria Hospital for Children. Twenty pocket spittoons were given to patients needing them, and disinfectants and disinfectant soap where required. In all cases a leaflet of advice as to precautions, cleanliness, and ventilation is left with the patient. Twenty-five cases were reported by the Medical Officer for Education, L.C.C., of children attending school suspected to be suffering from tubercle of the lung. Of this number 12 were referred to the Invalid Children's Aid Association, and were sent away by the Association for sanatorium or convalescent treatment. Two were referred to the Guardians of the Poor. The remainder were given letters for hospital treatment, and are now attending school. No specimens of sputum were sent during the year by medical practitioners for free bacterioscopic diagnosis at the Lister Institute. 23 The following Table shows the number of notifications received under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, which came into force on the 1st May, 1911:— Males. Females. Total. First notifications by M.O., Brompton Hospital 18 12 30 „ „ „ Frimley Sanatorium 2 1 3 „ „ „ St. George's Hospital 1 4 5 „ „ „ Other Hospitals, &c. 8 7 15 29 24 53 Between the 1st May and the end of the year, 1563 notifications were received from the Brompton Hospital and other hospitals in Chelsea relating to patients (almost entirely out-patients) who were found on examination to be suffering from pulmonary tuberculosis, but who resided in places other than Chelsea. These 1563 notifications were allocated to their respective sanitary districts in London, greater London, or the provinces, as the case might be, and were sent on by post to the Medical Officers of Health of the districts in which the patients resided. Every week a list of these patients and the sanitary authorities from whom the notification fees should be collected, has been sent to the authorities of the Brompton and other hospitals notifying cases in this way. Owing to the out-patient department of the Brompton Hospital being situate in Chelsea—probably the largest out-patient department for consumptive patients of any hospital in the world—a very considerable addition to the clerical work of the Public Health Department of this Borough has accrued. It would have been much better if, in the first instance, all cases of pulmonary tuberculosis attending hospitals had been made notifiable to the County Medical Officer of Health, who would thus have been notified at first hand instead of by weekly returns as at present, and whose staff is much better adapted for the purposes of a Clearing House than the staff of the Chelsea Public Health Department, which has no clerical assistance to supplement the work of its statutory officers. THE ANTI-TUBERCULOSIS CAMPAIGN. In London Anti-Tuberculosis Dispensaries have already been established by means of charitable contributions in Paddington, North Kensington, St. Marylebone, Stepney, Bermondsey, Battersea, and Fulham. Under the National Insurance Act it will become necessary to decide what provision should be made for London generally to secure the Sanatorium benefits accruing under the Act. At the present time only 5 of the Metropolitan Boroughs have made any arrangements with open air Sanatoria for the provision of beds for selected consumptive cases. In no instance have more than 10 beds altogether been so allocated to the requirements of any one Borough. No provision has, so far, been made by any Borough, apart from the Poor-Law, for the institutional isolation and treatment of advanced and incurable cases. 24 It is evident that under the National Insurance Act a carefully designed and co-ordinated scheme dealing with London as a whole will be necessary. Otherwise there will be much over-lapping and wasted effort. It remains to be seen whether it will be possible to devise any scheme which will bring together voluntary charitable associations, and municipal and State undertakings, in such a manner that each may be assigned its allotted task, the whole being worked in such close co-operation as to secure the ultimate aims and objects which the various constituent bodies have primarily in view. In Chelsea no provision has so far been made by the Borough Council for Sanatorium treatment or Hospital accommodation in respect of pulmonary tuberculosis, nor are portable open air shelters or tents provided for such cases. 25 Section III. HOUSING OF THE WORKING CLASSES. Sir Thomas More Buildings. The buildings have been fully occupied during the year. During the year 30 tenants voluntarily terminated their tenancies, as against 54 in 1910, and two were given notice to quit. Vital Statistics.—During 1911, 19 births (10 boys and 9 girls) were registered as occurring in the Buildings, which is equivalent to a birth-rate of 24.8 per 1,000, the birth-rate of the Borough being 18.8. Seven deaths of residents in the Buildings occurred during the year, equivalent to a death-rate of 9.1 per 1,000, the death-rate of the Borough being 15.7. Deaths at Sir Thomas More Buildings in 1911. Age. Sex. Occupation. Disease. 2 years F. D. of Messenger Measles; Broncho-pneumonia. 1 ,, M. S. of Waiter Tubercular Meningitis. 84 „ F. Wid. of Bricklayer Senile Decay. 27 „ F. W. of Kitchen-porter Parturition; Acute Rheumatism ; Endocarditis. 52 „ M. Motor-driver Sarcoma of Lung. 44 „ F. W. of Clerk Cerebral Apoplexy. 8 months M. S. of Chauffeur Gastro-enteritis. One case of scarlet fever and two of diphtheria were notified in the Buildings during the year. Pond House. During the year Pond House was fully occupied. Five tenants voluntarily terminated their tenancies. Four births (3 boys and one girl) were registered during the year. There was no death. There were no cases of notifiable infectious disease. Onslow Dwellings. The Dwellings were fully occupied during the year. Sixteen tenants voluntarily terminated their tenancies, and two were given notice to quit. During the year 3 births (one boy and two girls) were registered, and two deaths. The deaths were:—Female, 62 years, aortic disease, bronchitis: Female, 68 years, cerebral haemorrhage. One case of scarlet fever was notified as occurring in the Dwellings. 26 Grove Buildings. During the year the Buildings were fully occupied. Forty tenants voluntarily terminated their tenancies, and 3 were given notice to quit Twelve births (5 boys and 7 girls) were registered during the year, equivalent to a birth-rate of 47.4 per 1,000, and 5 deaths, equivalent a death-rate of 19.8 per 1,000. Deaths at Grove Buildings in 1911. Age. Sex. Occupation. Disease. 57 years F. W. of Builder's Labourer Bronchitis; Pneumonia. 64 „ F. Wid. of Ostler Cerebral Hœniorrhage. 71 „ M. Tailor Bronchitis; Dilated Heart. 61 „ F. Wid. of Job-master Chronic Nephritis. 3 months F D. of Coach-painter Acute Enteritis. One case of scarlet fever and one case of diphtheria were notified in the Buildings during the course of the year. The following Table shows the population (Census, 1911) of the Council's Dwellings, including the resident staff and their families:— Sir Thomas More Buildings 767 Pond House 115 Onslow Dwellings 332 Grove Buildings 253 1,467 HOUSING AND TOWN PLANNING ACT, 1909, AND HOUSING OF THE WORKING CLASSES ACT, 1890. During the year 1911, 108 houses were inspected under the provisions of these Acts, of which number 29 were inspected by myself with the Chief Sanitary Inspector. No proceedings were taken during the year to enforce closure of any of these houses; but as the result of representations made to the owners, three houses were closed and demolished, and one house was temporarily closed. As a result of the 108 inspections, sanitary defects of one or another kind were found to exist in 69 of the houses, and notices requiring the remedying of the defects found were served upon the owners. 27 HOUSES DEMOLISHED OR VACATED FOR DEMOLITION DURING THE YEAR 1911. HOUSES. Alpha-place 5 Cale street 13 College-street 12 Draycott-avenue 11 Flood-street 3 Fulham-road 5 Green-street 1 Ives-street 10 King's-road 6 Leader-street 18 Marlborough-street 7 Marlborough-square 27 Pond-place 4 Pym-street 25 Wellington-street 24 171 28 Section IV. THE SANITARY CONDITION OF THE BOROUGH The tabular statements prepared by the Sanitary Inspectors show that 1,366 separate premises were reported on by them during 1911, 311 of this number being with reference to cases of notifiable infectious disease, and 506 in the course of house-to-house inspections made in certain of the poorer streets of the Borough. It has been necessary to take legal proceedings for breaches of the Public Health (London) Act, in respect of six houses. Drainage.—During the year 12 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. During the year a system of combined drainage, for which the Borough Council was responsible, was carried out in respect of four premises at a cost not yet ascertained. From 1896 to 1910 inclusive, the sum of £611 10s. Od. has been expended from the rates on the combined drainage of private property, equivalent to an average annual outlay of £40 15s. Od. Inspection of Restaurant Kitchens, 1911. Number of restaurant and hotel kitchens 64 „ inspections made 82 ,, premises found satisfactory 56 „ premises with sanitary defects 8 „ notices served 8 Bakehouses. Number of bakehouses 33 „ inspections 72 „ notices served 7 Disinfection.—During the past year, 319 premises have been disinfected after cases of infectious or other disease, 44 of these being rooms which had been in occupation by persons suffering from phthisis ending fatally. In addition, 240 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, 1,765 separate articles of bedding or clothing were disinfected, and 1,129 beds, mattresses, &c., were destroyed in the incinerator. The animals destroyed in the incinerator amounted to 1,014, practically the whole of these being dead cats received from Our Dumb Friends' League in Bywater-street. Other arrangements have now been made for the disposal of the dead bodies of these cats, and they are no longer brought to the Council's incinerator. 29 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. Smoke Nuisance.—The working of the Generating Station, Lotsroad, 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. Basement Workrooms.—During the year 5 new basement workrooms have come into occupation, and 3 were closed, there being at the end of the year 54 basement workrooms in the Borough, with accomodation for some 400 workers. As mentioned in my seven preceding Annual Reports, the sanitary conditions of these basement workrooms are by no means satisfactory in respect of lighting, warming, ventilation, and, in some cases, aerial disconnection of water-closets from workrooms. On behalf of the Women's Industrial Council a Bill to amend the Factory and Workshops Acts (1901 and 1907), in respect of underground premises used as Factories, Workshops, or Workplaces in which persons of either sex are employed, is to be introduced in the House of Lords by the Duke of Devonshire in the forthcoming session of Parliament. The Bill is drafted on lines similar to those contained in Section 101 of the Factory and Workshop Act, 1901, dealing with underground Bakehouses, and will, if it finds its way into the Statute Book, provide a remedy for the insanitary conditions now so often found to prevail in this class of workshop. The Sale of Food and Drugs Acts. During the year 1911, 400 samples were taken for analysis; of these 400 samples 159 were milk, 146 being returned by the Public Analyst as genuine samples, 5 as of inferior quality, and 8 as adulterated. Of the 8 adulterated samples, no proceedings were taken in 6 cases; in three because the Vendors purchased the milk under Warranties (4 6 per cent. added water; 67 per cent. fat abstracted; 11 percent. fat abstracted); and in three cases because the amount of adulteration was insufficient to justify proceedings (4.2 per cent. added water; 31 per cent. added water; 2.4 per cent. added water). In two cases proceedings were taken, both samples forming part of a consignment delivered at the Chelsea Infirmary, in pursuance of a contract between the Vendor and the Guardians. In one case, where the milk was certified to be adulterated with 33 per cent. of added water, a penalty of £10 was inflicted; the summons in respect of the other sample (8 per cent. added water) was dismissed. The adulterated milks in 1911 formed 5 per cent. of the total number of milks analysed, as compared with 15 per cent. in 1910. 30 Of butter, 130 samples were taken, 124 being returned as genuine, 2 as of inferior quality, and 4 (3 per cent.) as adulterated. The 4 adulterated samples were all purchased at one shop at short invervals of time, and were all certified to be margarine. The vendor was prosecuted and fined £3 and 10s. 6d. costs. Of margarine, 9 samples were taken, 7 being genuine, whilst in two cases the Public Analyst certified that the samples contained excess of butter fat (12.5 per cent. excess and 8.5 per cent. excess). No proceedings were taken in either of these cases. Of lard, 9 samples were taken, all being genuine. Of whisky, 18 samples were taken, 15 being genuine, and 3 adulterated. No proceedings were taken in these cases (21.2 per cent. added water; 2.5 per cent. added water; 2.6 per cent. added water), as notices of dilution were displayed at the places of sale in accordance with the Act. Of brandy, 9 samples were taken, all being genuine; of coffee, 11 samples, all genuine; of coffee and chicory mixtures, 15 samples, all genuine; of cheese, 9 samples, all genuine; of cocoa, 9 samples, all genuine; of mustard, 9 samples, all genuine. Ten samples of baking powder were analysed, 9 being genuine, and one was stated to contain an excess of calcium sulphate. Of two samples of cream analysed, one was found to be genuine, and the other, which was analysed for a private purchaser, was stated to contain 22.8 grains of boric acid per pint. Water Supply. From the reports of Dr. Houston, Director of Water Examinations, Metropolitan Water Board, it appears that for the year ending 30th November, 191], 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 90 per cent., when 100 c.c. of water are taken as the basis of bacterioscopic examination, the corresponding figure for the previous year being 92. The worst months of the year were January (27 per cent. of the samples gave a positive result as regards B. Coli), and December (21 per cent. gave positive results); and the best month was April, when all the examples 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. REPORTS PRESENTED TO THE BOROUGH COUNCIL. 5th April. The compulsory notification of all cases of Tuberculosis. 31 SUMMARY OF WORK DONE DURING 1911. By the Lady Sanitary Inspector. The work done during 1911 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 35 new workshops were registered, and 38 were removed from the register, the total number at the end of the year being 477. There were 22 laundries on the register at the end of the year, 3 being factory and 3 domestic laundries. Thirty-five inspections were made in connection with laundries. During the year 101 workrooms were measured, for which workroom cards were given. The total number of inspections made in connection with workrooms was 635. In 18 instances notices were served for cleansing workrooms, for overcrowding, or for deficient ventilation. Classification of Workshops. (Women Employees.) Dressmaking and Millinery 370 Outfitting 36 Embroidery 15 Various 34 Laundries— Factory 3 Workshop 16 Domestic 3 Total 477 Outworkers.—The two half-yearly returns are as follows:— Number of Lists received 58 Total number of Outworkers 805 Number living in Chelsea 108 Number forwarded to other Boroughs 590 Received from other Boroughs 133 The number of inspections made of outworkers' premises was 112. 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. 32 Notifications sent to— Notifications received from— Battersea 63 Kensington 84 City of London 31 Marylebone 13 Fulham 80 Westminster 12 Hammersmith 18 Other Boroughs 24 Islington 26 Kensington 30 Lambeth 19 Marylebone 54 Paddington 16 St. Pancras 18 Shoreditch 12 Stepney 18 Wandsworth 19 Westminster 82 Other Metropolitan Boroughs 44 District Councils 60 Total 590 133 School Cases.—There is an increase in the number of nonnotifiable infectious diseases reported by the schools, the total for 1911 being 956, as compared with 857 in 1910. There is still a great variation in the number of children notified by the different schools, as is shown by the following table. 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 continuing to attend school, who have not suffered from the disease notified. School Notifications. Cases notified from— Cases of Disease notified— Ashburnham 230 Chicken-pox 77 Christ Church 8 Eczema 6 Cook's Ground 199 Impetigo 2 Holy Trinity 42 Itch 1 Hortensia-road 33 Measles 616 Marl borough-road 104 Mumps 88 Oratory 25 Ophthalmia 35 Park-walk 166 Ringworm 55 St. Joseph's 51 Tubercle 1 St. Luke's 24 Verminous 6 Servite 41 Whooping Cough 63 Walton-street 6 Schools outside 27 956 956 33 The total number of visits in connection with school notifications was 324; of which number Measles accounted for 305 visits. In addition 19 visits were paid in respect of children reported by other agencies than the schools. Visits of Instruction re Management of Infants.—During the year 1911, the homes of 504 recently born infants were visited by the Lady Sanitary Inspector. In 428 cases re-visits were made. Altogether in connection with this work 1067 visits were paid with a view to giving simple instructions to the mothers in infant care and management. Dinner tickets for nursing mothers (Mrs. Gordon's Association), were given in suitable cases, and a very large number of babies were taken regularly to the Infants' Consultations, held one afternoon a week, in connection with the Chelsea Health Society. The mothers attend fortnightly at the consultations, if the babies maintain a good condition of health, and weekly if the baby is not thriving as well as could be desired. During the summer months, 62 cases of infantile diarrhoea were brought to the notice of the Lady Sanitary Inspector, and 213 visits were paid in connection with these cases. In all these cases advice was given as to the proper manner of following the directions given by the medical attendant. Of the 62 infants visited for summer diarrhoea, it is satisfactory to record that not one case ended fatally. The Notification of Births Act, 1907.—The notifications received during the year have been as follows:— Notification of Births, 1911. number. Living children 932 Still-born children 35 967 Notified by Medical Practitioners 249 „ St. George's Hospital 149 „ Midwives 436 „ Chelsea Workhouse 58 „ Parents 61 Dual Notifications 14 967 Total number of births registered 1187 From the above Table it will appear that the notifications under the 1907 Act fell short of the registrations by the number of 220. In 1910 the discrepancy was 242. In proportion to the number of births the notifications by midwives shewed an increase in 1911 as compared with 1910, whilst the notifications by medical practitioners showed a decrease. d 34 Chelsea Health Society.—This Society was formed at the end of the year 1910, under the patronage of Earl Cadogan, K.G., and commenced its work in the Borough early in 1911. The primary object of the Society is to promote the improvement of the health of mothers and infants in Chelsea by means of visits to the homes by voluntary Lady Health Visitors. Each family is visited periodically—infants once a month, as a general rule, but more frequently when necessary. Advice is given to the mothers as to the care and management of the infants, and practical demonstrations are afforded of the methods advocated. Visitors aim at checking illness by observing early symptoms of infantile disorders, and pointing out to the parents the necessity of prompt medical attention. Out-patients attending hospitals are also visited at their homes to ensure that the instructions given at the hospitals are being carried out as far as possible. Expectant mothers are advised as regards their health, and as to making suitable provision for their confinements. Infant consultations under the direction of a medical practitioner (Dr. Beckett-Overy) have been held weekly in a room at the Wesleyan Methodist Hall, King's-road, since July, 1911. The average attendance of mothers with infants has been 23. The total number of cases referred to the Society in 1911 was 504, and the total number of visits paid 3,692. Of the 504 cases, 216 were references from St. George's Hospital. Out of 250 infants visited during the summer months over 30 were attacked with infantile diarrhoea, but all made a good recovery. The Society has worked in co-operation with the Public Health Department and with the various charitable, relief, and district visiting organisations of the Borough, and has undoubtedly been the means of doing an immense amount of good work in the prevention of disease and suffering, and in enabling the poor to make the best use of their own means and of existing organisations for improving their own and their children's health. The work of the Society should tend not only to the reduction of infantile mortality, but to the rearing of children of better physique and constitutional stamina than is possible where the poorest class of mothers are left to their own unaided guidance. 35 Administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. premises. Number of Inspections. 2 Written Notices. 3 Prosecutions. 4 Factories (Including Factory Laundries.) 3 — — Workshops (Including Workshop Laundries.) 875 36 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) -- - - Total 878 36 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Nuisances under the Public Health Acts:—* Want of cleanliness 12 12 — — Want of ventilation 6 6 — — Overcrowding 5 5 — — Want of drainage of floors — — — — Other nuisances 36 36 — — Sanitary accommadation insufficient — — — — unsuitable or defective — — — — not separate for sexes — — — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 7 7 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 66 66 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 36 3.—HOME WORK. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Sending twice in the Year Sending once in the Year. Failing to keep or permit inspection of lists. Failing to send lists. Lists, Outworkers, f Lists. Outworkers. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Secs. 109,110) Contractors. Workmen. Contractors. Workmen. 0) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, &c. 56 213 465 2 1 4 71 — — — — — — — — (2) Cleaning and washing — — — — — — — — — — — — — — — Household linen — — — — — — — — — — — — — — — Lace, lace curtains and nets — 6 1 — — — — — — — — — — — — Curtains and furniture hangings — — — — — — — — — — — — — — — Furniture and upholstery — 14 6 — — — — — — — — — — — — Electro-plate — 7 4 — — — — — — — — — — — — — — — — — — — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Cables & chains ; Anchors & grapnels — — — — — — — — — — — — — — — Cart gear ; Locks, latches and keys — — — — — — — — — — — — — — — Umbrellas, &c. — 14 — — — — — — — — — — — — — Artificial flowers — — — — — — — — — — — — — — — Nets other than wire nets — — — — — — — — — — — — — — — Tents ; Sacks — — — — — — — — — — — — — — — Racquet and tennis balls — — — — — — — — — — — — — — — Paper bags and boxes — 1 1 — — — — — — — — — — — — Brush making — — — — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — Carding, &c., of buttons, &c. — 5 — — — — — — — — — — — — — Stuffed toys — — — — — — — — — — — — — Basket making — — 3 — — — — — — — — — — — Processes incidental to the above — 17 6 — — — — — — — — — — — — Total 56 277 486 2 1 4 71 — — — — — — — * If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (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 repealed. 37 4.-REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Bakehouses 33 Laundries 22 Dressmaking and Millinery 370 Outfitting (Women's) 36 Various (Women's) 49 Various (Men's) 212 Total number of workshops on Register 722 5.—OTHER MATTERS. CLASS. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — 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 8 Reports (of action taken) sent to H.M. Inspector 8 Other — 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 Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). 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, 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. 38 PROCEEDINGS DURING 1911. PREMISES. NUMBER OF PLACES. Number of inspections, 1911. Number of Notices, 1911. Number of prosecutions, 1911. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. Milk premises 115 10 11 114 152 7 — Cowsheds 1 — — 1 11 — — Slaughter-houses 6 — — 6 66 — — Other offensive trade premises — — Ice cream premises 33 4 3 30 20 2 — Registered houses let in lodgings 583 — 14 569 453 (a) 4 (b)190 (a)* (b)* Bakehouses 33 1 1 33 72 7 Restaurant Kitchens 64 1 1 64 82 8 — * (a) For overcrowding. * (b) For other conditions. Total number of Intimation Notices served for all purposes 616 Overcrowding, 1911— Number of dwelling rooms overcrowded 7 Number remedied 7 Number of prosecutions 4 Underground rooms— Illegal occupation dealt with during the year 5 Number of rooms closed 5 Insanitary houses— Number closed under the Public Health (London) Act, 1891 4 Number closed under the Housing of the Working Classes Act Number of verminous rooms cleansed 240 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accomodated during the year 40 Revenue Acts— Number of Houses for which applications were received during the year 6 Number of tenements comprised therein 63 Number of tenememts for which certificates were (a) granted 6 ,, ,, ,, ,, ,, (b) refused 57 ,, „ ,, ,, ,, (c) deferred — Common Lodging-houses—certificates granted — Mortuaries— Total number of bodies removed 115 Total number of infectious bodies removed 39 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING THE YEAR, 1911. Houses and Premises:— House-to-house inspections 506 *Reported on respecting nuisances complained of 549 Reported on with reference to infectious cases 311 Cleansed, whitewashed, and repaired 306 Defective roofs repaired 105 Disinfected after communicable diseases 224 *Disinfected for Tubercular and other diseases 95 Rooms disinfected for verminous conditions 240 Cases of overcrowding abated 7 Dust-bins, new, provided 80 Ashpits demolished 1 Underground rooms occupied contrary to Act 5 Inspections of restaurant kitchens 82 Drainage:— Drains opened, cleansed, and made sound 71 „ trapped with stoneware gullies Water-closets cleansed and repaired 93 Water-closets, new pans and traps provided 106 Spout drains cleansed, repaired, or renewed 34 Sink, bath, and lavatory waste pipes provided and repaired 83 Drains and soil pipes ventilated or repaired 129 Soil pipes, new, provided 34 Additional w.c. accommodation provided 11 Water Supply:— For domestic purposes, provided where cut off by Water Board 4 For water closets, or check cisterns provided and repaired 80 Main cisterns cleaned or repaired 20 ,, new covers provided 21 „ new, provided 1 Water certificates, issued in respect of newly erected dwelling-houses Nuisances Abated Arising From:— Keeping of animals 4 Accumulations of manure and other filth 34 Yards, areas, and wash-houses paved or drained 71 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. 40 Miscellaneous:— Dead bodies removed to public mortuary for sanitary reasons 6 Goods disinfected after infectious cases at station 1765 Goods destroyed after infectious cases 22 Mattresses, beds, &c., received from Surveyor's Department and destroyed by the Incinerator 1129 Number of samples taken for analysis (Food and Drugs Acts) 400 *Unsound Food. Number of boxes of fruit, fish, rabbits, &c., condemned and destroyed 40 Library books destroyed at Librarian's request 18 Animals destroyed in Incinerator 1014 Proceedings Taken:— Statutory notices issued 140 Intimations issued for sanitary works, &c., including infectious disease cases 616 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 6 Legal proceedings in respect of food adulteration 3 Correspondence:— †Number of letters written in connection with sanitary matters 588 Daily returns of infectious cases sent to Metropolitan Asylum Board 144 Notification of infectious cases sent to School Authorities 244 Entries in Inspectors' Report Books 518 Entries in Inhabitants' Complaint Book 31 Certificates of disinfection given 400 Certificates of infectious diseases for removal cases 115 Notices sent to Public Library of premises where infectious disease has occurred 104 Certificates transferred under Tuberculosis in Hospitals' Regulations 1563 Postcards sent re Samples under Sale of Food and Drugs Act 390 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 114 Dairies and Milkshops, and 30 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. J. H. BERRY. 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 connection with the Infectious Diseases is done more expeditiously, and considerable time is also saved by its use in other matters. 41 MAGISTERIAL PROCEEDINGS DURING 1911 UNDER THE SALE OF FOOD AND DRUGS ACT. Street where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Infirmary, Cale-street Milk (sample 300) 33% of added water 21st Nov. £10 fine. Notice of appeal given. Ditto Milk (sample 301) 8% „ „ ,, Dismissed. Radnor-street Butter Contained 100% of margarine. ,, Fine £3 ; 10s. 6d. costs. 42 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 22, Riley-street Failing to comply with the Borough Council's notices to clear the w.c. and provide water to the water closets, and exterminate vermin in ground floor bedroom. Kensington 4th April Withdrawn; work completed. 40, „ Failing to comply with the Borough Council's notice to abate overcrowding and thoroughly cleanse and repair the premises. ,, 17th October Closing order made. 41, ,, Ditto ,, ,, ,, ,, 42, ,, ,, ,, ,, ,, ,, 43, „ ,, ,, ,, ,, ,, 34, First-street To remove verminous filth, and cleanse the furniture and interior of top floor front room. ,, ,, Abatement order made. 43 BAKEHOUSES IN USE ON JANUARY 1st. 1911. Street. Occupier. Above Ground. Below Ground. 74, Arthur-street Vacated ... Vacated Dec.,'06. 93, Beaufort-street A. Coventry ... 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. Reitze ... ,, 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 ... ,, * Not used, bikes at 11, Motcomb-street. †Now used as kitchen only. 44 SLAUGHTER-HOUSES. Street. Occupier. Crooked Usage Cridlan, P. and J. W. 169, Fulham-road Philp, J. 341, „ Vaughan, T. 52, King's-road Cobb, G. A. 54, „ 413, „ Goulding, F. 82, Draycott-avenue Iggulden, F. COW-HOUSES. Church-street Walker, E. J.