CHE 18 Metropolilan Borough of Chelsea. ANNUAL REPORT For 1912, 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; 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. 73912 Metropolitan Borough of Chelsea. ANNUAL REPORT For 1912, 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; 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 : Pite & Thynne, Printers, 278a, King's Road, Chelsea, S.W. 1913. TABLE OF CONTENTS. SEC. I.—Statistical :— page Population of Chelsea 3 Births and Birth-rate 4 Deaths and Death-rate 4 Death-rate of Special Classes of the Population 9 Infantile Mortality 10 Statistical Tables (L.G.B. Forms I., II., III., IV.) 14 SEC. II.—Infectious Diseases :— Small-pox 19 Scarlet Fever 19 Diphtheria 19 Enteric Fever 20 Removal of Patients to Hospital 21 The Case Mortality 22 Other Infectious Diseases 22 Notifications of Phthisis 23 SEC. III.—The Housing of the Working Classes :— Sir Thomas More Buildings 26 Pond House 26 Onslow Dwellings 26 Grove Buildings 27 Sutton Trust Dwellings 27 Lewis Trust Dwellings 27 Demolitions in 1912 28 SEC. IV.—The Sanitary Condition of the Borough :— Drainage 29 Inspections made 29 Disinfection 29 Basement Workrooms 29 Action taken under Sale of Food and Drugs Act 30 Water Supply 30 Reports presented to the Borough Council 30 Summary of Work done by the Lady Sanitary Inspector 31 Verminous School Children 33 Notifications of Births 34 The Chelsea Health Society 35 Statistical Tables of Action taken under the Factory and Workshop Act 36 Statistical Tables of Action taken under the Public Health (London) Act 36 Summary of Nuisances and other matters reported on in 1912 40 Magisterial Proceedings during 1912 42 List of Bakehouses, Cow-houses and Slaughter-houses 43 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For 1912. Section I.-STATISTICAL. POPULATION OF CHELSEA. The following Table shows the population of each of the Wards, of the Registration Districts, and of the whole Borough at the Census of 1901 and 1911, together with the percentage proportions of males and females in 1911. Table I. Persons 1901. Persons 1911. Decrease per cent. Percentage of Males, 1901 and 1911. Percentage of Females, 1901 and 1911. 1901 1911 1901 1911 Hans Town Ward 12,568 10,997 12•5 39•2 37•6 60•8 62•4 Royal Hospital „ 10,703 9,306 13•0 44•1 35•7 55•9 64•4 Church ,, 12,704 10,498 17•4 45•8 46•5 54•2 53•5 Cheyne ,, 12,159 10,491 13•7 43•2 41•1 56•8 58•9 Stanley ,, 25,708 25,093 2•4 47•2 47•1 52•8 52•9 North Chelsea 42,514 37,437 11•9 43•3 42•5 56•7 57•5 South Chelsea 31,328 28,948 7•6 46•0 43•3 54•0 56•7 Chelsea 73,842 66,385 10•1 44•5 42•9 55•5 57•1 London 4,536,267 4,521,658 0•3 47•2 47•0 52•8 53•0 4 From the above Table it will be seen that the greatest decrease in population has been in Church Ward, whilst Stanley Ward has had the smallest. The effect of the demolitions of small houses in Hans Town and Cheyne Wards has been to increase the relative proportions of females to males, as the larger houses remaining have a relatively larger number of females (servants) than the working-class property that has been pulled down. In Eoyal Hospital Ward the larger number of females in 1911 is probably accounted for by the removal of the Duke of York's School to Dover. The estimated population of the Borough for the middle of the year, 1912, is 65,397. BIRTHS IN 1912. Table II. Number of Births. Male. Female. Total. North Chelsea 299 276 575 South Chelsea 316 269 585 Chelsea 615 545 1,160 The above Table relates to births registered in the District. Excluding 19 births of non-parishioners, and including 69 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year is 1,210. The birth-rate for 1912 is 18•6 per 1,000. The average birth-rate of the Borough for the years 1901-11 is 21•4 per 1,000. The average birth-rate of the Home District of Chelsea Parish for the 5 years 18961900 was 24•1 per 1,000. The birth-rate of 1912 is the lowest yet recorded. The birth-rate for London in 1912 was 25•0 per 1,000. During the year 1912, 48 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, the same proportion as in 1911. DEATHS AND DEATH-BATES FOB 1912. The total number of deaths registered in the Borough was 1,449. Of this number 668 were deaths within the Borough of non-parishioners —chiefly occurring in Hospitals, and in the St. George's Infirmary; and 186 deaths of parishioners occurred outside the Borough in various public institutions. There were, therefore, 967 deaths of parishioners of Chelsea. These 967 deaths are equivalent to a death-rate for the year of 14•8 per 1,000, as against 15 7 in 1911. Table III. gives the death-rates of the Home District of Chelsea Parish, of Chelsea Borough, and of London during the past 22 years. 5 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•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 1912 14•8 13•8 * 1891-1900. Chelsea Home District. Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 0.8 per 1,000 in 1912, the corresponding rate for London being 1.16. In 1911 the zymotic death-rate in Chelsea was 1.65 per 1,000. Table IV.—For the year 1912. 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 0.80 0.15 1.35 0.98 2.90 1.50 0.20 70 14.7 53.5 London 1.16 0.39 1.35 0.31 2.62 1.11 0.12 92 25.6 43.4 Small-pox.—There was no small-pox in Chelsea in 1912. Measles.—This disease caused 21 deaths in 1912, as compared with 30 in 1911. Six deaths were registered in North Chelsea, and 15 in South Chelsea. Two of the deaths were of infants under one year of age, 8 between one and 2 years, 9 between 2 and 5 years, and 2 between 5 and 15 years. Eight of the deaths occurred in the third quarter of the year, and 12 in the fourth quarter. 6 Scarlet Fever.—This disease caused 2 deaths in 1912—one in North Chelsea and one in South Chelsea. Both of the deaths occurred in M.A.B. hospitals. Diphtheria.—Four deaths were the result of Diphtheria in 1912—one in North Chelsea and 3 in South Chelsea. Three of the deaths occurred in hospital, and one at the patient's own home. Table V.— Cases of, and Deaths from Diphtheria and Membranous Group in Chelsea,* 1890-1912. cases. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908|1909 1910 1911 1912 172 162 163 200 207 273 429 242 153 136 150 106 131 99 61 52 161 158 138 97 81 83 89 deaths. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 32 20 32 43 41 52 96 45 22 13 14 9 13 4 5 5 16 8 13 14 5 5 4 * 1890-1900, Chelsea Home District. Whooping Cough.—This disease caused 14 deaths in 1912, as compared with 10 in 1911. Five were deaths of infants under one year, and 9 were between 2 and 5 years. Eight of the deaths occurred in North Chelsea, aud 6 in South Chelsea. Enteric Fever.—There was one death from enteric fever, of a man, aged 23, the death occurring in St. George's Hospital. Table VI.—Zymotic Disease Mortality in Chelsea in 1912. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea, 1901-1911. Measles 21 26 28 Scarlet Fever 2 2 5 Diphtheria 4 6 9 Whooping Cough 14 14 19 Enteric Fever 1 2 3 Diarrhæa 10 26 50 Diarrhæa.—The deaths in Chelsea in 1912 from diarrhceal diseases (diarrhoea and enteritis) were only 10 in number, as compared with 62 in 1911. Eight of the deaths were of infants under one year of age, as compared with 45 in 1911; one was between 2 and 5 years of age, and one was an aged person over 65 years. Seven of the deaths were of North Chelsea residents, and 3 of South Chelsea. 7 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 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 1912 153 395 In 1912 there was no summer prevalence of diarrhoea, owing to the absence of any summer weather. Only 2 deaths from diarrhoea occurred in the third or summer quarter, as against 3 in the second or spring quarter, and 4 in the fourth or autumn quarter. In 1911, 48 deaths from diarrhoea were registered in the third quarter of that year, when the average temperature was 65.8° F., which was almost a record. In 1912 the average temperature of the third quarter was only 58.9° F., which is 0.4° less than the very low temperature of 1910. Last year, 1912, is probably the first year in the history of Chelsea as an urban district, in which there has been absolutely no prevalence of summer diarrhoea. Influenza.—The number of deaths attributed to influenza in 1912 was 13, as against 11 in 1911. Three deaths occurred in North Chelsea, and 10 in South Chelsea. In London generally, the disease was slightly more prevalent than in 1911, 535 deaths being registered as due to this cause in 1912, as compared with 496 in 1911. Of the 535 fatal cases in London, 231 occurred in the first quarter of the year, 100 in the second, 43 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 1912 was 2.9 per 1,000, as compared with 2.47 per 1,000 in 1911. The London death-rate from respiratory diseases, including pneumonia, in 1912 was 2.62 per 1,000. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1912 was 1.63 per 1,000, as against 1.86 per 1,000 in 1911 The death-rate in London from these diseases in 1912 was 1.66 per 1,000. Of the 88 deaths from phthisis in Chelsea in 1912, 49, or 55.7 per cent., occurred in the Chelsea Workhouse Infirmary, and 15, or 17 per cent., occurred in other public institutions, making a total of 72.7 per cent. 8 of the total of 88 fatal cases dying in public institutions away from their own homes. The average for the 11 years 1901-11 is 44.5 per cent. in the Chelsea Infirmary and 15.8 per cent. in other public institutions, making a total of 60.3 per cent. of the total deaths. In 1911 the percentage dying away from home was 73.7 per cent. It will be interesting to observe what will be the influence of the sanatorium benefit provisions of the National Health Insurance Act upon these figures in future years. Of the 88 deaths from phthisis in Chelsea in 1912, 61 were deaths of males and 27 deaths of females. Other tubercular diseases caused 10 deaths in males and 8 in females. The death-rate of males from all tubercular diseases in Chelsea in 1912 was 2.5 per 1,000, the corresponding rate for females being only 0 9 per 1,000. In May, 1912, there were 45 male phthisical patients in the Chelsea Infirmary, and 26 female phthisical patients. Diseases of the Heart and Blood-vessels.—These diseases caused 125 deaths in Chelsea in 1912. There does not appear to be any ground, so far as Chelsea is concerned, for the belief that these diseases are increasing as the result of the competitive stress and strain of modern life. The average number of annual deaths in the 6 years 1901-6 was 125, and in the 6 years 1907-12 119 deaths, the corresponding average death-rates being 1.76 per 1,000 (1901-6) and 1.78 per 1,000 (1907-12)—an almost neglible increase. Cancer.—Malignant cancerous disease caused 98 deaths in Chelsea in 1912. Forty-five of the fatal cases were North Chelsea residents, and 53 were South Chelsea. The average number of deaths from cancer in Chelsea in the past 4 quinqueunial periods has been as follows :— Table VIII.— Cancer Mortality in Quinquennia. Average Annual Number of Deaths. Average Anuual Death-rate. 1891-5 66 0•87 per 1,000 1896-1900 74 1•00 „ „ 1901-5 78 1•08 „ „ 1906-1 79 1•16 „ „ 1911-12 96 1•44 „ ,, Prom the above figures it will be seen that cancer as a cause of death is steadily increasing, the increase during the past two years having been a rapid one. Some part of this increase, however, may be due to greater precision in diagnosis, and to the relatively larger number of old people in the population owing to the continuous decrease in the birth-rate during the past 22 years. Alcoholism.—Twenty deaths were registered in 1912 as being due to alcoholism or cirrhosis of the liver, as against 17 in 1911. These figures merely represent the deaths which are palpably and unmistakably the results of alcoholic excess. Probably far larger numbers are indirectly due to excessive drinking; but until the system of death certification is amended, definite allocation of disease to its effective cause, in such cases as these, cannot be expected. 9 Deaths in Lunatic Asylums.—Fifty-one deaths of Chelsea parishioners occurred in 1912 in lunatic asylums. The average number of annual deaths in the four preceding quinquennial periods are as follows:— 1891-5, 31; 1896-1900, 30; 1901-5, 39; 1906-10, 38; 1911-12, 46. It is evident that the number of Chelsea persons dying in lunatic asylums is now considerably greater than it was 15 and 20 years ago ; but this may not be due so much to an increase of insanity, as to a larger number of the insane now being relegated to asylums for institutional treatment. Deaths in Public Institutions.—For 1912, 53.5 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 52.8 per cent. in 1911. In London generally 43.4 per cent. of the total deaths occurred in public institutions in 1912. The deaths in the Chelsea Infirmary in 1912 formed 23.6 per cent. of the total deaths of borough residents, as compared with 23.1 per cent. in 1911. Deaths of Common Lodging House Inmates.—Twenty-one deaths of inmates in common lodging houses occurred in Chelsea in 1912. All were males with one exception, this being the wife of a "deputy," residing at a common lodging house. Six of the deaths (29 per cent. of the total) were due to pulmonary tuberculosis. The common lodging houses now open in Chelsea are No. 24, Smith-street (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. It is very seldom, however, that these beds are all fully occupied. The common lodging house population in Chelsea is certainly decreasing. 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 1912, 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 seven 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, Gillray-square, Ives-street, Riley-street, Slaidburn-street, World's End-passsage, and the courts adjacent, with a total population of 3,480. The Borough Council's Dwellings are Sir Thomas More Building, Pond House, Onslow Dwellings and Grove Buildings, with a total population of 1,467. Table IX.—For the Year 1912. Birthrate. Deathrate. Zymotic Deathrate. Tubercular Diseases Death-rate. Deaths under one year to 1,000 births. Chelsea 18•6 14•8 0•8 1•6 70 Borough Council Dwellings 25•9 12•3 0•7 0•7 79 Industrial Dwellings 19•5 11•5 2•3 1•1 118 7 Poor-class Streets 37•1 22•4 2•6 3•7 101 10 The very favourable conditions prevailing in the Borough Council's Dwellings and in the other Industrial Dwellings in the Borough, as compared with the tenement houses of the poorer streets, are well displayed by the above table. The infantile mortality rate was very low in the seven poor streets, having regard to the usually prevailing rate in this particular area. Of 129 infants born, only 13 died within a year of birth. INFANTILE MORTALITY. The following Table shows the chief causes of mortality of infants under one year of age in Chelsea, the figures being based upon the eight years 1905-1912. Table X.—Proportion of Total Mortality of Infants under one year contributed by Various Diseases (average of 1905-12). Per cent. Per cent. Infectious Diseases:— Scarlet Fever and Diphtheria 1 Measles 3 Whooping Cough 5 9 Diarrhœal Diseases 20 20 Developmental and Wasting:— Premature Birth 16 Congenital Defects 6 Injury at Birth 2 Debility and Wasting 9 — 33 Other Causes:— Tubercle 2 Syphilis 3 Meningitis (not Tubercular) 2 Convulsions 4 Bronchitis and Pneumonia 20 Overlaying 2 Other Causes 5 38 100 From the above Table it will be seen that on an average Premature Birth and Congenital Defects account for 22 per cent. of the total mortality of infants under one year of age; Diarrhoœl Diseases account for 20 per cent.; Bronchitis and Pneumonia for 20 per cent., and Debility and Wasting for 9 per cent. Table XI. shows the average mortality rates per 1,000 births for each of the four classes of disease, set out in Table X., for each of the fouryearly periods from 1901 to 1912. 11 Table XI.—Mortality Rates per 1,000 Births, 1901-4, 1905-8, 1909-12. 1901-4. 1905-8. 1909-12. Infectious Diseases 10•0 11•5 8•0 Diarrhceal Diseases 23•5 26•0 18•0 Developmental Defects and Wasting 48•0 37•0 34•5 Other Causes 58•0 44•0 36•0 Total Rate 139•5 118•5 96•5 This Table shows that the recent drop in the Infantile Mortality Eate has affected all the chief divisions of mortality, even such causes as Premature Birth and Developmental Defects showing a diminution of mortality in recent years. Table XII. 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 98 85 71 107 107 7,555 6,928 1910 102 63 102 6,807 1911 112 77 128 7,804 1912 70 57 92 5,544 The year 1912 was remarkable for its low summer temperature, and the almost complete absence of summer diarrhœa amongst infants. The drop in the infantile mortality rate from 112 in 1911 to only 70 in 1912 is a remarkable one, and although to some extent attributable to the diminished fatality from diarrhœal diseases, is not wholly accounted for by this fact. There was also a considerable diminution in the deaths due to debility and wasting and to congenital defects. The attention paid to newly-born infants by the Lady Sanitary Inspector and by the Lady Visitors of the Chelsea Health Society, and the advice and practical assistance given to the mothers by the home visits and by the weekly "infant consultations" held under the management of the Health Society, is evidently becoming more and more effective in the saving of 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 survive the first year, but who formerly suffered in strength and physique as the result of preventable illness. 12 Table XIII.—For the Year 1912. Birth Rate. Infantile Mortality Rate. Hans Town Ward 13•5 60 Royal Hospital ,, 12•8 67 Church ,, 17•9 76 Cheyne ,, 15•9 36 Stanley ,, 23•4 82 Chelsea Borough 18•6 70 The above Table shows the infantile mortality rates and the birth-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. From Table XVII. (Local Government Board, Table IV.) it will be seen that out of a total of 85 deaths of infants under one year of age in 1912, 32 or 37.6 per cent. occurred in the first four weeks of life, as compared with 27.3 per cent. in 1911, and 38.3 per cent. in 1910. Eighteen deaths occurred in the first week of life equal to 21.2 per cent. of the total, the corresponding figure for 1911 being 14.4 per cent., and for 1910 24.1 per cent. The majority of these deaths in the first month of life are due to premature birth, congenital defects, and injury at birth. For deaths under one month the rate of mortality in 1912 was 26 per 1,000 births, as against 31 in 1911, the average rate for the 7 years 1905-11 being 39. Between the ages of 1 month and 12 months, 53 deaths, or 62.4 per cent. of the total, were registered in 1912, as compared with 72.7 per cent. in 1911, only 7 of these deaths being due to diarrhoea, as compared with 41 in 1911. The principal causes of death amongst infants under one year in 1912 were:—Pneumonia, 16; premature birth, 13; bronchitis, 8; diarrhœa, 8; whooping cough, 5; atelectasis, 5; congenital malformations, 5; and wasting, 5. Illegitimate Births.—The following Table shows, for each of the years 1905—1912, 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. 13 Table XIV.—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 1912 59 4•9 49 9 5 153 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 three years it has been possible to trace the subsequent histories of the illegitimate infants with some approach to accuracy. 14 TABLE XV.—(I.) VITAL STATISTICS OF WHOLE DISTRICT DURING 1912 AND PREVIOUS YEARS. Births. Total Deaths Registered in the District. Transferable Deaths ‡ Nett Deaths belonging to the District. Year. Population estimated to Middle of each year. Uncorrected No. Nett. of nonresid ents registered in the District + of Residents not registered in the District + Under 1 year of Age. At all Ages. No. + Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1912 65,397 1160 1210 18•6 1449 22•2 668 186 85 70 967 14•8 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 collected 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 b\ 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 to 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 requiring 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 distinct 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 and 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 a 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; (6) 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 15 TABLE XVI.—(II.) CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1912. 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 Ages+—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. North Chelsea. South Small-pox .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 89 3 20 48 13 3 2 .. 39 50 80 Erysipelas 30 1 1 3 3 8 9 5 17 13 4 Scarlet Fever 126 1 33 67 13 12 .. .. 76 50 114 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 10 .. .. 1 5 4 .. .. 5 5 9 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 7 .. .. .. 1 6 .. .. 2 5 .. Cerebro spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 1 .. 1 .. .. .. .. .. .. 1 1 Pulmonary Tuberculosis 192 .. 1 16 28 88 50 9 .. .. .. Totals 455 5 56 135 63 121 61 14 139 124 208 † 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. 16 TABLE XVII.—(III.) CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1912. 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 "Non-Residents" 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. 15 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Enteric Fever 1 .. .. .. .. 1 .. .. .. 1 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 21 2 8 9 2 .. .. .. .. 4 Scarlet Fever 2 .. 1 1 .. .. .. .. .. .. Whooping Cough 14 5 6 3 .. .. .. .. .. 2 Diphtheria and Croup 4 1 •• .. 2 1 .. .. .. .. Influenza 13 .. .. .. .. 1 2 5 5 5 Erysipelas 4 .. .. .. .. .. 2 2 5 Phthisis (Pulmonary Tuberculosis) 88 .. 1 .. .. 7 38 29 13 146 Tuberculous Meningitis 8 .. 1 2 4 .. 1 .. .. 23 Other Tuberculous Diseases 10 2 1 .. 1 1 2 3 .. 23 Cancer, malignant disease 98 .. .. .. .. 1 12 43 42 180 Rheumatic Fever .. .. .. .. .. .. .. .. .. .. Meningitis. See note (d.) 5 2 1 1 1 .. .. .. .. 9 Organic Heart Disease 125 .. .. .. 5 2 8 40 70 101 Bronchitis 90 9 1 .. .. 1 9 18 52 81 Pneumonia (all forms) 90 16 8 3 4 1 13 22 23 67 Other Diseases of Respiratory Organs. 9 .. .. .. .. .. .. 4 5 9 Diarrhœa and Enteritis. See note (e). 10 8 .. 1 .. .. .. .. 1 21 Appendicitis and Typhlitis 5 .. 1 .. .. .. 3 .. 1 5 Cirrhosis of Liver 14 .. .. .. .. 1 2 8 3 9 Alcoholism 6 .. .. .. .. .. 1 3 2 2 Nephritis and Bright's Disease 23 .. .. .. 1 2 1 8 11 23 Puerperal Fever .. .. .. .. .. .. .. .. .. .. Other accidents and diseases of Pregnancy and Parturition. 3 .. .. .. .. .. 3 .. .. 3 Congenital Debility and Malformation, including Premature Birth. 27 27 .. .. .. .. .. .. .. 20 Violent Deaths, excluding Suicide 40 6 .. 3 3 2 8 9 9 23 Suicides 10 .. .. .. .. .. 4 3 3 1 Other Defined Diseases 143 5 .. .. 1 5 16 42 74 134 Diseases ill-defined or unknown and Old Age. 92 1 3 2 .. .. .. 5 81 85 Septic Diseases 11 1 .. .. 1 .. 2 5 2 17 Poliomyelitis 1 .. .. .. .. .. .. 1 .. .. 967 85 32 25 25 26 125 250 399 999 17 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) Exclusive of "Tuberculous Meningitis" (to), but inclusive of Cerebro-Spinal Meningitis. (e) Title 19 should be used for deaths from Diarrhoea and Enteritis at all ages. (In the "Short List" deaths from Diarrhoea and Enteritis under two years are included under Title 19; those at two years and over being placed under Title 28.) 18 TABLE XVIII.—(iv.) INFANT MORTALITY.—1912. 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 One Year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 1 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. 1 1 2 1 5 Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis (b) .. .. .. .. .. 1 1 .. .. 2 Other Tuberculous Diseases .. .. .. .. .. .. .. 1 .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. 2 .. .. 2 Convulsions .. .. .. .. .. 2 1 .. .. 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 2 2 4 2 .. 1 1 8 Pneumonia (all forms) .. .. .. 2 2 5 2 2 5 16 Diarrhœa .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. 1 1 4 3 .. .. 8 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. 1 1 .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 1 .. .. .. 1 1 1 .. .. 3 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis 5 .. .. .. 5 .. .. .. .. 5 Congenital Malformations (c) 1 .. .. .. 1 3 1 .. .. 5 Premature Birth 9 1 3 .. 13 .. .. .. .. 13 Atrophy, Debility & Marasmus .. 2 1 .. 3 2 .. .. .. 5 Other causes .. .. .. .. .. 1 1 .. .. 2 18 3 6 5 32 23 14 8 8 85 Nett Births legitimate 1,151 Nett Deaths I legitimate infants 76 in the year illegitimate 59 in the year of illegitimate infants 9 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. 19 Section II. INFECTIOUS DISEASES. Small.Pox.—There were no cases of small.pox in Chelsea in 1912. In London, during the year 1912, 6 cases only of the disease were notified, as compared with 73 in 1911, and 7 in 1910. Of the six cases 3 were in Woolwich, one in Poplar, one in St. Pancras, and one in the Port of London. There has been no case notified in London since the end of August, 1912. Scarlet Fever.—In 1912, 126 cases of scarlet fever were notified in Chelsea, equivalent to a case.rate of 19.3 per 10,000 of the population, as against 21.4 in 1911. The number of cases notified in the first quarter of the year was 41, in the second quarter 25, in the third quarter 30, and in the fourth quarter 30. January, March, and November were the months of greatest prevalence (15 cases in each of these months), and the least prevalence was in June (6 cases). There was no special school incidence of scarlet fever in respect of any school in the Borough. In North Chelsea 76 cases were notified during the year, and in South Chelsea 50 cases. The percentage of cases of school age (3 to 13 years) of the total number in the Borough was 72, as compared with 75 in 1911. The average duration of the stay in hospital of 112 cases, of which the records are to hand, was 58.8 days, as against 63.8 days in 1911. Only two cases admitted to M.A.B. hospitals were subsequently certified by the Medical Superintendents of the institutions not to be suffering from scarlet fever or any other notifiable disease. The duration of stay in hospital of one of these cases was 22 days. Four cases on discharge from M.A.B. hospitals were stated to be still suffering from otorrhoea or rhinorrhoea, as compared with 6 in 1911. 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 7 days. Diphtheria.—In 1912, 89 cases of diphtheria were notified in Chelsea, equivalent to a case.rate of 13.6 per 10,000 of population, as compared with 12.5 in 1911. In the first quarter of the year 26 cases were notified, in the second quarter 32, in the third quarter 18, and in the fourth quarter 13. The percentage of cases of school age (3 to 13 years) of the total number in the Borough was 67, as against 71 in 1911. In North Chelsea 39 cases were notified, and in South Chelsea 50. The months of greatest prevalence were May (14 cases) and March (11 cases). 20 The average duration of stay in hospital of 64 cases, of which the records are to hand, was 58 days, as against 59 in 1911. Ten 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 1911 being 5. The average duration of the stay in hospital of these 10 cases was 27 days, as against 19 in 1911. During the year medical practitioners sent 160 throat swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 105 in 1911. Five were sent by myself from this department. The entire cost was defrayed by the Borough Council. Of the total swabs, 121, or 76 per cent., were sent by the medical staff of the Victoria Hospital in respect of Chelsea children. Of the total of 160 swabbings, 44, or 27.5 per cent., afforded positive evidence of the presence of the specific diphtheria bacillus, and 116, or 72.5 per cent., gave negative evidence. These proportions are nearly similar with those of previous years. Nine 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. There was no special school incidence of diphtheria in 1912 in respect of any of the schools in the Borough. In July, the children attending a class at Ashburnham School were swabbed by the L.C.C. school medical officer, as a child attending this class had been at school with a sore throat, and subsequently developed paralysis of the soft palate, pointing to the disease having been diphtheria. Only one of the children who had been swabbed gave a positive reaction for the diphtheria bacillus. Several other children were absent from school at the time, but this was on account of mumps. The child that gave a positive reaction was again swabbed two days later, the reaction being a negative one. Three other diphtheria "carrier'' cases, amongst children, were brought to light in the course of the year, but, so far as known, there was no spread of infection from any of them. Enteric Fever.—The number of cases of enteric fever notified in Chelsea was 10, as against 7 in 1911, the case.rate being 1.5 per 10,000 of population. Pour cases were notified in the first quarter of the year, 2 in the second, one in the third, and 3 in the fourth quarter. The cases were equally divided between North and South Chelsea. Of the 10 eases notified, two were mistaken diagnoses. In one case the Widal reaction proved negative on the 10th day of illness, this being probably a case of septic poisoning. In the other case a diagnosis of pneumonia was eventually made. Of the remaining 8 cases, in three the infection was contracted outside the Borough—one at Bamsgate (probably from eating infected mussels); one at Six Mile Bottom, Cambridgeshire ; and the third case in Kensington, the patient being a nurse at the Children's Hospital there. 21 There were, therefore, only 5 cases in which it is probable that the infection was contracted in the Borough. In one of these cases, the patient—a lady of 32 years—was in the habit of consuming oysters at restaurants in London. Three blood specimens were sent to the Lister Institute in the course of the year for determining the Widal reaction, and all gave positive reactions. Removals to Hospital.—Table XIX. 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 23 years, 1890—1912, expressed as percentages of the total number of cases of each disease notified. Table XIX.—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 1912 90 90 90 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 23 years, 1890—1912:— 22 Table XX.—Case Mortality in Chelsea, and in London, 1890.1912. 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 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 1.6 6.0 8.3 0.0 14.1 1912 1.6 4.5 10.0 Cerebrospinal Fever.—No cases of this disease were notified m Chelsea in 1912. In London, during the year 1912, 103 cases were notified, as against 102 in 1911. Four deaths were registered as due to this disease during the year, the case-mortality being 4.0 per cent., as compared with 7.8 in 1911, 8.7 in 1910, and 13.6 in 1909. Acute Poliomyelitis.. .One case only of this disease was notified in Chelsea in 1912. The patient was a girl of four years, not attending any school. She was removed to the Chelsea Infirmary. Nothing was ascertained as to any source of infection. Two other younger children in the same family were not affected. In London 136 cases were notified during the year, 69 being notified in the three summer months—July, August and September—this being in accordance with what is known as to the summer prevalence of the disease. Ophthalmia Neonatorum.—In London during 1912, 699 cases were notified. In the previous year (1911) 680 cases were notified between the 11th March aud the end of December. Five cases were notified in Chelsea. All the cases were visited by the Lady Sanitary Inspector, and steps were taken to ensure that the affected eyes received appropriate treatment, with the result that all made complete recoveries, with no injury to the sight. Altogether 16 visits were paid in respect of cases of ophthalmia neonatorum. Puerperal Fever.—Seven cases of this disease were notified in Chelsea in 1912. None of these cases ended fatally. Three of the cases were 23 attended by midwives in their confinements, and three by medical practitioners. The other case was that oi' a patient in a nursing home, who was operated on for a fibroid tumour of the uterus, which had induced a miscarriage. Measles —This disease was again prevalent in Chelsea during the latter half of 1912, 20 out of 22 deaths for the year occurring in the last two quarters. Orders of the Medical Officer (L.C.C. Education) for the exclusion from school of unprotected children attending certain classes in the Infants' Departments were made in respect of most of the schools in the Borough. During the year, 233 children attending Chelsea Schools were notified to the Public Health Department by the teachers of the schools as actually suffering from measles, whilst some 230 children, who were "contacts," i.e , living in houses invaded by measles, were excluded from school attendance for longer or shorter periods. Seventy cases of measles were removed to M.A.B. hospitals during the course of the year, all being severe cases, or the circumstances of the home being such that proper nursing was impossible, or there was imminent risk of infection spreading to unprotected children in the house. The average duration of stay in hospital of 34 cases, of which records are to hand, was 35 days, as against 38 in 1911. Two cases were sent from the Chelsea Infirmary to hospital, and 9 cases from St. George's Infirmary. There can be no question that the provision of hospital accommodation for a certain proportion of the more severe cases of measles has had a notable effect in diminishing its fatality. It is impossible to express any opinion as to whether the removal of severe cases to hospital tends to limit the spread of infection, as so many centres of infection still remain in the persons of children suffering from mild and unrecognised attacks. Whooping Cough.—Thirty-eight cases of this disease were admitted to the M.A.B. hospitals in 1912, namely, 7 from the Chelsea Infirmary, 10 from St. George's Infirmary, 6 from the Cheyne Hospital, and 15 from private addresses. The average duration of stay in hospital of 24 cases, of which the records are to hand, was 91 days, as against 74 days in 1911. The whooping.cough cases are detained in hospital more than twice as long as the measles cases. 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. 56 21 77 ,, Re-notifications — — 127 „ Notifications by M.O.'s, outside Infirmaries 0 4 4 Form B.—First notifications by District M.O.'s 25 13 38 „ Re-notifications — — 4 Form C.—Notifications by Master, C.W. — — 100 ,, Notifications by Masters, outside Workhouses — — 9 81 38 359 24 The following Table shows the number of notifications received under the Public Health (Tuberculosis in Hospitals) Regulations, 1911:- Males. Females. Total. First notifications by M.O., Brompton Hospital 17 21 38 „ „ „ „ St. George's Hospital 14 4 18 „ „ „ „ Mount Vernon Hospital 5 2 7 „ „ „ „ other Hospitals and Sanatoria 25 12 37 61 39 100 The following Table shows the number of notifications received under the Public Heath (Tuberculosis) Regulations, 1911: — Males. Females. Total. Notifications by private Medical Practitioners 38 32 70 ,, „ L.C.C. School Medical Officer 0 2 2 38 34 72 During the year 3912, 1,691 notifications of pulmonary tuberculosis were received from the Brompton and 14 notifications from other hospitals in Chelsea relating to patients who were found on examination at the hospitals to be suffering from this disease, but who resided in places other than Chelsea. These 1,705 notifications were allocated to their respective sanitary districts in London, greater Loudon, or the provinces, as the case might be, and were sent on by post to the Medical Officers of Health for 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 the cases. The new regulations of the Local Government Board (The Public Health (Tuberculosis) Regulations, 1912) come into force on the 1st February, 1913, when the system hitherto prevailing will be altered, and the Medical Officers of Hospitals will be required to notify the patients direct to the district in which they reside. Sixteen specimens of sputum were seut during the year by medical practitioners to the Lister Institute for free bacterioscopic diagnosis. Of these, six showed the presence of tubercle bacilli and ten did not. Of the notified cases of phthisis on the register, 23 died in the course of the year. Seven of these patients managed to keep at work until within a very short period before their deaths. Three of these cases were not notified until a day, or two days, before a fatal termination of the illness. One of the notified cases had been on the register 2½ years, two had been on l½ years, and the remainder had beeu on for periods varying between 3 weeks and 8 months. Of the 92 cases on the register, of which fairly full notes have been obtained as the result of visits made by the Lady Sanitary Inspector, in 24 there was a history of tuberculosis in the family of the patient, and in some of these cases the patient may have been directly infected from his tuberculous relative. In 27 cases the tuberculous illuess appears to have been preceded by an attack of bronchitis, pleurisy, pneumonia, or merely neglected catarrhs following upon exposure to wet and cold. Many of these cases were men following outdoor occupations. In nine cases the 25 tuberculosis may be regarded as having been induced by working for long hours in badly ventilated workrooms and offices. A previous attack of influenza appears to have been responsible for four cases; poverty and want of proper nourishment for three cases ; alcoholic excess for two cases; living in damp basements for two cases ; and one case each is attributed to association with a consumptive fellow-workman at work, to nursing a case of pulmonary tuberculosis, and to a previous attack of measles. Of the 92 cases on the register, 47 were found on the date of the first visit by the Lady Sanitary Inspector to be sleeping alone (with a bed to him or herself), and 44 were sleeping in bed with some other person. In about half of the latter cases the patients were induced subsequently to make arrangements to sleep alone. Three beds with bedding have been provided for this purpose by the Chelsea Borough Council, and are lent to necessitous cases as occasion arises. About two.thirds of the cases visited are found to be able and willing to carry out proper sanitary precautions as regards disposal of sputa, burning of infected rags, having the windows open, and keeping the rooms clean and free from infected dust. About one.third of the cases are somewhat unsatisfactory to deal with owing to carelessness, scepticism as to infection and the necessity for fresh air, and general laziness. But in nearly every case some improvement is effected as the results of the personal visits of the Lady Sanitary Inspector. Arrangements were made for the domiciliary treatment by local medical practitioners of six cases under the sanatorium provisions of the National Health Insurance Act, these being "insured persons,'' and one insured person was sent by the Insurance Committee for Loudou to an open-air sanatorium. The Chelsea Borough Council has made no arrangements for the reservation of beds for cases of phthisis in any sanatorium or hospital, nor have any arrangements of any kind been made for the dispensary treatment of phthisis cases in the borough. No portable open-air shelters or tents have been provided by the Chelsea Borough Council for the use of phthisis patients in the borough. The number of new cases of phthisis visited in the course of the year was 175, and the total number of visits in respect of phthisis cases in the year was 756. Five of the patients were sent to open-air sanatoria through the agency of the Charity Organisation Society, and four eases were sent by private charitable effort. Sixteen patients were sent to convalescent homes in the country through private sources. Fourteen out.patient letters were given to patients for the Brompton Hospital, and five for the Victoria Hospital for children. Twenty-three pocket spittoons were given to patients requiring them. Three iron truckle beds with hair mattress and hair bolster were obtained by the Borough Council, and have been lent out to necessitous cases, where the phthisical patient was not sleeping alone, and could not afford the expense of an additional bed. Of two tubercular children reported by the School Medical Officer, one was referred to the Invalid Children's Aid Society, who provided convalescent treatment in the country. Two tubercular children were reported by Poor Law Medical Officers. Five " contacts " were sent to the Brompton Hospital for examination, and three of them were found to have received the tubercular infection. 26 Section III. HOUSING OF THE WORKING CLASSES. Sir Thomas Moke Buildings. The Buildings have been fully occupied during the year. During the year 25 tenants voluntarily terminated their tenancies, as against 30 in 1911, and two were given notice to quit, the same number as in 1911. Vital Statistics.—Duriug 1912, J9 births (13 boys and 6 girls) were registered as occurring in the Buildings, which is equivalent to a birthrate of 24.8 per 1,000, the birth-rate of the Borough being 18.6. Ten deaths of residents in the Buildings occurred during the year, equivalent to a death-rate of 13'0 per 1,000, the death-rate of the Borough being 14.8 Deaths at Sir Thomas More Buildings in 1912. Age. Sex. Occupation. Disease. 57 years M. Coachman Acute bronchitis. 1 month M. S. of Police Constable Marasmus. 71 years M. Army Pensioner Cancer of Tongue. 43 „ F. W. of Tailor Cancer; secondary deposits. 65 „ F. W. of Packer Pneumonia; Nephritis. 51 „ M. Pensioned Valet Septic Peritonitis; Perforation of Bowel. 65 „ F. W. of Schoolmaster Fracture of base of skull; accident. 69 „ F. W. of Road-man Cirrhosis of Liver. 5 „ M. S. of Butcher's Asst. Diphtheria. 5 „ F. D. of Naval Pensioner Tubercular Meningitis. One case of scarlet fever and three cases of diphtheria were notified in the Buildings during the year. Pond House. During the year Pond House was fully occupied. Eight tenants voluntarily terminated their tenancies. Three births (one boy and two girls) were registered during the year. There was no death. One case of scarlet fever was notified in the year. Onslow Dwellings. The Dwellings were fully occupied during the year. Nine tenants voluntarily terminated their tenancies, and three were given notice to quit. During the year 6 births (2 boys and 4 girls) were registered and 4 deaths. The deaths were Male, 82 years, cerebral haemorrhage; Male, 65 years, sclerosis of spinal cord ; Female, 72 years, abdominal cancer; Female, 17 davs, premature birth. There were no cases of notifiable infectious disease. 27 Gbove Buildings. The Buildings were fully occupied throughout the year, Thirty-three tenants voluntarily terminated their tenancies, and one was given notice to quit. Ten births (7 boys and 3 girls) were registered during the year, and 4 deaths. The deaths were:—Male, 67 years, cerebral apoplexy; Female, 57 years, mitral heart disease; Male, 20 months, measles, pneumonia ; Female, 1 day, fracture of skull at birth. 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 The Sutton Model Dwellings. These Dwellings are now (January, 1913) approaching completion. They are sited on an area of about 3¼ acres, bounded by College-street, Marlborough-street, Leader-street and Cale-street. Fourteen blocks will be erected, each 5 storeys in height, without basements, containing in all 683 tenements, and 53 lock-up shops with basements. The total number of rooms is 1,468, and the population of the Dwellings, at 1½ persons per room, will be about 2,200. There will be 115 one-room tenements, and the remainder will be two and three-room tenements. The tenements are to be all " self-contained," with a bath in each scullery, and w.c. on an open balcony. Lewis Trust Buildings. A site has been acquired during the past year for the erection of i artizans' dwellings by the Sam Lewis Trust. This site, which is roughly , a parallelogram, faces upon Pond-place, Leader-street, and College-street. I am informed by Messrs. Joseph and Smithem, the architects, that 9 parallel blocks will be erected on the site, with ends pointing to LeaderI street. The blocks will be 5 storeys high, without basements, and (separated by courtyards 40 ft. in width. The tenements will be of the "self-contained" type, with open balcony, w.c., drying space, scullery and bathroom combined. The kitchen range will be in the scullery, and there will be a combination fireplace for the kitchen and living-room, with a sliding fireclay shutter. A gas cooker will be fixed also in the scullery. There will be 5 four-room tenements. 155 three-room ,, 190 two-room ,, 40 one-room ,, 'IThere will, therefore, be 925 rooms in the Dwellings, which, at 1½ persons ieper room, gives a population of 1,387. 28 The living-rooms will have a superficial area of 180 feet, with bow windows; the bedrooms of the three-room tenements will have a superficial area of 110 and 100 feet; and the bedrooms of the two-room tenements will have 130 feet. All rooms will be 8½ feet high. When the Sutton Trust and Lewis Trust Buildings are completed and occupied, there will be accommodation in artzans' dwellings in Chelsea approximately for the numbers as under:— Population. Borough Council Dwellings : — Sir Thomas More Buildings 770 Pond House 130 Onslow Dwellings 350 Grove Buildings 300 1580 Sutton Model Dwellings 2200 Lewis Trust Dwellings 1390 Marlborough Buildings 500 Guinness Buildings 940 Peabody Buildings 200 Chelsea Park Dwellings 170 6980 Probably there are but few places in the United Kingdom where so many people of the wage-earning class, in proportion to population, will be able to find so much accommodation in artizans' dwellings as in the Chelsea that will be in two years time. HOUSES DEMOLISHED OR VACATED FOE DEMOLITION DURING THE YEAR 1912. HOUSES. Arthur-street 23 Blenheim-street 2 Britten-street 2 Christchurch-street 5 College-street 7 Church-street 3 Crooked-usage 5 Cale-street 22 Francis-street 5 Fulham-road 4 King's-road 6 Keppel-street 22 Leader-street 26 Milman-street 2 Marlborough-place 4 Oakham-street 22 Pond-terrace 31 Stayton-street 27 Walton-street 3 Whiteheads-grove 1 222 29 Section IV. THE SANITAEY CONDITION OF THE BOROUGH. The tabular statements prepared by the Sanitary Inspectors show that 1,251 separate premises were reported on by them during 1912, 268 of this number being with reference to cases of notifiable infectious disease, and 470 in the course of house-to-house inspections made in certaiu 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 one house only. Drainage.—During the year 15 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. Inspection of Restaurant Kitchens, 1912. Number of restaurant and hotel kitchens 68 „ inspections made 82 „ premises found satisfactory 64 „ premises with sanitary defects 4 „ notices served 4 Bakehouses. Number of bakehouses 33 „ inspections 48 „ notices served 6 Disinfection.—During the past year, 277 premises have been disinfected after cases of infectious or other disease, 33 of these being rooms which had been in occupation by persons suffering from phthisis ending fatally. In addition, 354 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, 1,279 separate articles of bedding or clothing were disinfected, and 21 beds, mattresses, &c., were destroyed in the incinerator. 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, no complaints having been received. Basement Workrooms.—During the year seven new basement workrooms have come into occupation, and three were closed, there being at the end of the year 58 basement workrooms in the Borough, with accomodation for some 400 workers. As mentioned in my eight 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. 30 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 is employed, was introduced in the House of Lords and read a third time, but failed to pass through the House of Commons. The Bill is drafted on lines similar to those contained in Section 101 of the Factory and Workshop Act, 1901, dealing with underground Bakehouses. The Sale of Food and Druqs Acts. During the year 1912, 400 samples were taken for analysis ; of these 400 samples 136 were milk, 130 being returned by the Public Analyst as genuine samples, two as of inferior quality, and four as adulterated. Of the four adulterated samples no proceedings were taken in three cases, the amount of adulteration being insufficient to justify proceedings (5 per cent, 4.7 per cent., and 4.2 per cent, of added water). In the other adulterated sample there was 14.2 per cent, of added water, and the vendor was convicted and fined £1 10s. and 10s. 6d. costs. The adulterated milks in 1912 formed 3 per cent, of the total number of milk samples analysed, as compared with 5 per cent, in 1911. Of butter, 137 samples were taken, 134 being returned as genuine, and three as adulterated. No proceedings were taken in respect of two of the adulterated samples (4.4 per cent, of foreign fat; 5.4 per cent. excess of water, disclosed by label). The third adulterated sample (100 per cent, of margarine) was not taken under the Act. Of coffee, 26 samples were taken, all being genuine; of mixed coffee and chicory, one sample, genuine ; of mustard, 18 samples, all genuine ; of pepper, nine samples, all genuine ; of cheese, 18 samples, all genuine ; of cocoa, nine samples, all genuine; of baking powder, 10 samples, all genuine; of lard, nine samples, all genuine; of whisky, 18 samples, all genuine ; and of brandy, nine samples, all genuine. Water Supply. From the reports of Dr. Houston, Director of Water Examinations, Metropolitan Water Board, it appears that for the year ending 30th November, 1912, 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 91 per cent., when 100 c.c. of water are taken as the basis of bacterioscopic examination, the corresponding figure for the previous year being 90. The worst months of the year were February (37 per cent. of the samples gave a positive result as regards B. Coli), and January (31 per cent, gave positive results); and the best months were April, July, September and October, 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. 31 REPORTS PRESENTED TO THE BOROUGH COUNCIL. 19th June. The National Insurance Act, 1911 : the Treatment of Tuberculosis Cases. 17th July. Elementary School Children—Verminous Conditions. llth December. The Prevention of Excessive Infantile Mortality. SUMMARY OF WORK DONE DURING 1912. By the Lady Sanitary Inspetor. The work done during 1912 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 33 new workshops were registered, and 22 were removed from the register, the total number at the end of the year being 488. There were 20 laundries on the register at the end of the year, 3 being factory and one a domestic laundry. Twenty inspections were made in connection with laundries. During the year 97 workrooms were measured, for which workroom cards were given. The total number of inspections made in connection with workrooms was 702. In 21 instances notices were served for cleansing workrooms, for overcrowding, or for deficient ventilation. Classification of Workshops. Women Employees. Dressmaking and Millinery 376 Outfitting 37 Embroidery 16 Various 39 Laundries— Factory 3 Workshop 16 Domestic 1 488 Outworkers.—The two half-early returns are as follows :— Number of Lists received 56 Total number of Outworkers as per Lists 645 Number living in Chelsea 123 Number forwarded to other Boroughs 648 Received from other Boroughs 135 The number of inspections made of outworkers' premises was 122, The names and addresses of outworkers living in other districts, but working for Chelsea firms, were forwarded to their respective Boroughs 32 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. Notifications sent to— Notifications received from— Battersea 73 Kensington 77 City of London 28 Marylebone 13 Fulham 79 Westminster 21 Hammersmith 15 Other Boroughs 24 Islington 32 Kensington 31 Lambeth 18 Marylebone 61 Paddington 21 St. Pancras 21 Stepney 14 Wandsworth 28 Westminster 77 Other Metropolitan Boroughs 72 District Councils 78 Total 648 135 School Cases—There is au increase in the number of non-notifiable infectious diseases reported by the schools, the total for 1912 being 1,055, as compared with 956 in 1911. 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. Altogether 111 visits were paid, in connection with measles and mumps. Non-Notifiable Diseases. School Notifications. Cases notified from — Ashburnham 120 Christ Church 43 Cook's Ground 157 Holy Trinity 63 Hortensia-road 44 Marlborough-road 349 Oratory 27 Park-walk 140 St. Joseph's 21 St. Luke's 15 Servite 57 Walton-street 5 Schools outside 14 1,055 33 Cases of Disease and Contacts notified from Schools. Suffering from. Excluded as Contacts. Scarlet fever 27 49 Diphtheria 27 58 Chicken-pox 46 43 Eczema 9 - Impetigo 6 — Itch 12 — Measles 233 247 Mumps 122 — Ophthalmia 53 — Ringworm 53 — Whooping-cough 122 109 710 506 Verminous School Children.—During the year 1912, 242 children attending elementary schools in the Borough, were reported by the School Medical Officer for the County of London, as being found by the School Nurses to be in a verminous condition as regards their heads, their bodies, or both heads and bodies. Of the total of 242 children, 198 were reported once only in the course of the year, 27 were reported twice, 12 were reported 3 times, 2 were reported 4 times, and 3 were reported 6 times. The homes of these children were visited by the Lady Sanitary Inspector; altogether 493 visits were paid in connection with this work. The following Table shows the action taken as the result of these visits:— HOMES. No action necessary, or rooms and bedding cleansed voluntarily by the parents 73 Disinfected by the Public Health Department 40 Rooms cleansed and limewashed after service of notices on owners of houses 30 Bedding destroyed and new bedding provided by the Borough Council 9 Families removed out of Borough before any action could be taken 12 Houses demolished 7 Tenants ejected by landlords 3 Unable to obtain admission 3 Little or no improvement effected by visiting 8 A considerable number of the families visited were found to be living under conditions of extreme poverty. In these cases it is doubtful if the children ever have their day clothing entirely removed, or ':go to bed " at all in the ordinary meaning of the words. In such families the mattresses and palliasses are so dilapidated and filthy, that the only possible course is to destroy them, and, where the people, through abject poverty, are unable to provide new bedding, for the Borough Council to do so. This was done in nine instances. In numerous other cases the old ticking was taken out and washed by the mother, or new was bought and the bedding remade in this way. In these very poor homes blankets and sheets are unknown luxuries, and consequently the operation of undressing for bed is not done either by children or adults. In eases a little above the stage of abject poverty, blankets and sheets may be in 34 use, but from their appearance it is doubtful if they ever make acquaintance with the wash.tub from one year's end to the other. Under such circumstances as these it is not surprising that so many elementary school children are found to be in a verminous condition. The very bad examples from the destitute home of the out-of-work, workshy, or alcoholic parent or parents infect at school the children from the more decent houses, and only constant inspection and re-inspection by school nurses can cope with the evil. In some cases the neglect of the children appears to be due, not to extreme poverty, but to the mother being out at work most of the day, so that the children are not properly looked after. Some of the worst cases of neglect and apathy on the part of the parents have been prosecuted by the London County Council, but it does not appear to be much use to inflict small fines on people who are living a hand.to.mouth life on the verge of destitution. From the point of view of the education of the rising generation, apart from home conditions, which must go far to destroy all the benefit they derive from their school training, the only practicable course is to remove the children from such homes as these, and to educate them in the Poor Law Schools at the cost of the rates. How to deal with the fathers and mothers of these neglected children is, however, a far more difficult problem. The Notification of Births Act, 1907.—The notifications received during the year have been as follows:— Notification of Births, 1912. NUMBER. Living children 932 Still-born children 25 957 Notified by Medical Practitioners 248 „ St. George's Hospital 143 „ Midwives 402 „ Chelsea Workhouse 56 „ Parents 76 Dual Notifications 7 932 Total number of births registered 1160 From the above Table it will appear that the notifications under the 1907 Act fell short of the registrations by the number of 203. In 1911 the discrepancy was 220. In proportion to the number of births the notifications by the midwives shewed a slight decrease in 1912 as compared with 1911, whilst the notifications by medical practitioners were practically the same. Visits of Instruction re Management of Infants.—During the year 1912, the homes of 470 recently born infants were visited by the Lady 35 Sanitary Inspector. In 173 cases re-visits were made. Altogether in connection with this work 828 visits were paid wi'h a view to giving simple instructions to the mothers in infant, care and management. Dinner tickets for nursing moihers (Mrs. Gordon's Association) were given in suitable cases, and a large number of babies were taken regularly to the Infants' Consultations, held one afternoon a week, in connection with the Chelsea Health Society. The mo hers 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, 25 cases of infantile diarrhoea were brought to the notice of the Lady Sanitary Inspector, and 47 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 25 infants visited for summer diarrhoea, it is satisfactory to record that only one case ended fatally. 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. From 20 to 30 babies are seen weekly. The total number of cases referred to the Society in 1912 was 398. Of the 398 cases, 187 were references from St. George's Hospital. Out of 350 infants visited, 20 deaths occurred in the course of the year, corresponding to an infantile mortality rate of 57, as compared with 70 for the entire Borough. From St. George's Hospital 145 maternity cases were referred to the Society, and 1,554 visits were paid in connection with these cases. Six of the infants were still-born, and six died in the course of the year. 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. 36 Administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1.—INSPECTION OP FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. premises. Number of Inspections. Written Notices. Prosecutions. 1 2 3 4 Factories (including Factory Laundries.) 3 — — Workshops (including Workshop Laundries.) 890 30 — Workplaces (other than Outworkers' premises included in Part 3 of this Report.) - - - Total 893 30 — 2.-DEFECTS FOUND IN FACTORIES, WORKSHOPS AND 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 17 17 - - Want of ventilation 1 1 - - Overcrowding 7 7 - - Want of drainage of floors — — - - Other nuisances 27 27 - - Sanitary accommodation insufficient 1 1 - - unsuitable or defective 3 3 - - 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) 5 5 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 63 63 — — "Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 3.-HOME WORK. NATURE OF WORK.* (1) 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 of lists. (8) Prosecutions. Sending twice in the year Sending once in the Year. Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) Lists.† (2) Outworkers.† Lists. (5) Outworkers.† Instances. (11) Notices served. (12) Prosecutions. (13) Instances (14) Orders made (Sec. 110). (15) Prosecutions (Secs. 109,110) (16) Contractors (3) Workmen. (4) Contractors (6) Workmen. (7) Wearing Apparel— (1) Making, &c. 56 169 404 1 — 1 51 — — — — — — — — (2) Cleaning and washing — — — — — — — — — — — — — — — Household linen — — — — — — — — — — — — — — — Lace, lace curtains and nets — 6 2 — — — — — — — — — — — — Curtains and furniture hangings — — — — — — — — — — — — — — — Furniture and Upholstery — 10 1 — — — — — — — — — — — — Electro-plate — 7 — — — — — — — — — — — — — File making; brass and brass articles — — — — — — — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Cables & chains; anchors & grapnels — — — — — — — — — — — — — — — Cart gear; locks, latches and keys — — — — — — — — — — — — — — — Umbrellas, &c. — 11 — —. — — — — — — — — — — — Artificial flowers — — — — — — — — — — — — — — — Nets, other than wire nets — — — — — — — — — — — — — — — Tents; sacks — — — — — — — — — — — — — — — Racquet and Tennis Balls — — — — — — — — — — — — — — — Paper bags and boxes — 4 1 — — — — — — — — — — — — Brush making — — — — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — Carding, &c., of buttons, &c. — 4 — — — — — — — — — — — — — Stuffed toys — — — — — — — — — — — — — — — Basket making - — 1 — — — — — — — — — — — — Processes incidental to the above — 17 7 - — — — — — — — — — — — Total 56 228 416 1 — 1 51 — — — — — — — 37 * 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 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 he 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 repeated. 38 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Bakehouses 33 Laundries 20 Dressmaking and Millinery 376 Outfitting (Women's) 37 Various (Women's) 55 Various (Men's) 205 Total number of Workshops on Register 726 5.—OTHER MATTERS. CLASS. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 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 6 Reports (of action taken) sent to H.M. Inspector 6 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. 39 PROCEEDINGS DURING 1912. PREMISES. NUMBER OF PLACES. Number of inspections, 1912. Number of Notices, 1912. Number of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Milk premises 114 8 10 112 122 8 - Cowsheds 1 — — 1 9 — — Slaughter-houses 6 — l 5 51 — — Other offensive trade premises - - - - - - - Ice cream premises 30 - 2 28 19 1 1 Registered houses let in lodgings — — — — — (a)* — (a)* (b) — (b)* Bakehouses 33 2 2 33 48 6 — Restaurant Kitchens 64 6 2 68 82 4 - * (a) For overcrowding. * (b) For other conditions. Total number of Intimation Notices served for all purposes .1073 Overcrowding. 1912— Number of dwelline rooms overcrowded 13 Number remedied 13 Number of prosecutions Underground rooms— Illegal occupation dealt with during the year Number of rooms closed 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 354 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 33 Revenue Acts— Number of Houses for which applications were received during the year 7 Number of tenements comprised therein 37 Number of tenements for which certificates were (a) granted 23 „ „ „ „ (6) refused 14 ,, ,, ,, ,, (c) deferred — Common Lodging.houses—certificates granted ... — Mortuaries— Total number of bodies removed 114 Total number of infectious bodies removed 40 SUMMARY OF NUISANCES AND OTHEE MATTERS REPORTED ON AND WORK DONE DURING THE YEAR, 1912. Houses and Pkemises :— House.to.house inspections ... .. ... 470 '■'•'Reported on respecting nuisances complained of 513 Reported on with reference to infectious cases 268 Cleansed, whitewashed, aud repaired 209 Defective roofs repaired 107 Disinfected after communicable diseases 216 *Disiufected for Tubercular and other diseases 61 Rooms disinfected for verminous conditions 354 Cases of overcrowding abated 13 Dust.bins, new, provided 56 Ashpits demolished U nderground rooms occupied contrary to Act Inspections of restaurant kitchens 82 Drainage :—. Drains opened, cleansed, and made sound ,, trapped with stoneware gullies Water.closets cleansed and repaired 61 Water.closets, new pans and traps provided 97 Spout drains cleansed, repaired, or renewed 52 Sink, bath, and lavatory waste pipes provided and repaired 131 Drains and soil pipes ventilated or repaired 34 Soil pipes, new, provided 31 Additional w.c. accommodation provided 8 Water Supply :— Eor domestic purposes, provided where cut off by Water Board ... ... ... .. ... 12 For water.closets, or check cisterns provided and repaired ... ... ... ... ... ... 98 Main cisterns cleaned or repaired ... ... 17 „ new covers provided ... ... ... 13 ,, new, provided ... ... ... ... — Water certificates, issued in respect of newly erected dwelling.houses ... ... ... .. ... — Nuisances abated arising from :— Keeping of animals ... ... ... ... ... 9 Accumulations of manure and other filth ... ... 33 Yards, areas, and wash.houses paved or drained ... 60 Smoke ... ... ... ... . . ... ... — Miscellaneous :— Dead bodies removed to public mortuary for sanitary reasons 5 Goods disinfected after infectious cases at station 1279 •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. 41 Miscellaneous (continued) :— Goods destroyed after infectious cases 31 Mattresses, beds, &c., received from Surveyor's Department and destroyed by the Incinerator 21 Number of samples taken for analysis (Food and Drugs Act) 400 *Unsound Food. Number of boxes of fruit, fish, rabbits, &c., condemned and destroyed 4 Library books destroyed at Librarian's request 18 Animals destroyed in Incinerator — Proceedings Taken : — Statutory notices issued 162 Intimations issued for sanitary works, &c., including infectious disease cases 1073 Legal proceedings in respect of defective sanitary arrangements, nuisances, &c. 1 Legal proceedings in respect of food adulteration 1 Correspondence : — Number of letters written in connection with sanitary matters 572 Daily returns of infectious cases sent to Metropolitan Asylums Board 108 Notification of infectious cases sent to School Authorities Entries in Inspectors' Report Books 486 Entries in Inhabitants'Complaint Book 27 Certificates of disinfection given 415 Certificates of infectious diseases for removal cases 103 Notices sent to Public Library of premises where infectious disease has occurred 71 Certificates transferred under Tuberculosis in Hospitals Regulations 1705 Postcards sent re Samples under Sale of Food and Drugs Act 311 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 28 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. W. F. HORNIBLOW. F. TETTENBORN (Lady). •This doea not include unsound food condemned in the streets and destroyed, for which no condemn note was given. tTho 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. 42 MAGISTERIAL PROCEEDINGS DURING 1912 UNDER THE SALE OF FOOD AND DRUGS ACT. Street where purchased. Articles purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Cale-street Milk 14.2% of added water 4th June Fine £ 1 10s.; 10s. 6d. costs. MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 52, Blantyre-street Failing to comply with the Borough Council's notices to repair and cleanse the premises, exterminate vermin, provide a waste pipe to sink, and repair w.c. Kensington 4th June Summons withdrawn; work done. 43 BAKEHOUSES IN USE ON JANUARY 1st, 1912. 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 J. Humphry & Son Above. ... 77, Cheyne-walk H. Judkins ... 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-aveuue 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, bakes at 11, Motcomb-street. †Now used as kitchen only. 44 SLAUGHTER.HOUSES. Street. Occupier. 169, Fulham-road Philp, J. 341, „ Vaughan, T. 52, King's-road Cobb, G. A. 54, „ 413, „ Gouldiug, F. 82, Draycott-avenue Igguldeu, F. COW-HOUSES. Church-street Walker, E. J.