AC4345 Che 20 Metropolitan Borough of Chelsea ANNUAL REPORT For 1914 of the Medical Officer of Health LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ. ; M.R.C.S. Eng. Consulting Sanitary Adviser to H.M. Office of Works, and to the Metropolitan Police District; Fellow of the Royal Sanitary Institute; Fellow of the Society of Medical Officers of Health. TOWN HALL, KING'S ROAD, CHELSEA, S.W. Metropolitan Borough of Chelsea ANNUAL REPORT For 1914 of the Medical Officer of Health LOUIS C. PARKES, M.D.; D.P.H. Lond. Univ. : M.H.C.S. Eng. Consultiny Sanitary Adviser to H.M. Office of Works, and to the Metropolitan Police District; Fellow of the Royal Sanitary Institute ; Fellow of the Society of Medical Officers of Health. TOWN HALL KING'S ROAD, CHELSEA, S.W. LONDON: Shield & Spring, Printers, 26-28, Lancelot Plage, Brompton Road, S.W. 1915. 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.) 13 SEC. II.—Infectious Diseases:— Small-pox 18 Scarlet-Fever 18 Diphtheria 18 Enteric Fever 19 Other Infectious Diseases 20 Notifications of Tuberculosis 21 Pulmonary Tuberculosis 23 Non-pulmonary Tuberculosis 24 Scheme for a Tuberculosis Dispensary 25 SEC. III.—The Housing or the Working Classes:— Sir Thomas More Buildings 26 Pond House 20 Onslow Dwellings 26 Grove Buildings 27 Sutton Trust Buildings 27 Lewis Trust Dwellings 28 Demolitions in 1914 28 SEC. IV.—The Sanitary Condition of the Borough:— Drainage 29 Inspections made 29 Disinfection 29 Water Supply to Tenement Houses 30 Underground Sleeping Places (Regulations) 30 Water Supply from Metropolitan Water Board 31 Reports presented to the Borough Council 31 Action taken under Sale of Food and Drugs Act 32 Public Health (Milk and Cream) Regulations, 1912 33 Summary of Work done by the Lady Sanitary Inspector 33 Verminous School Children 36 Notifications of Births 37 Infant Health Visiting 38 Statistical Tables of Action taken under the Factory and Workshop Act 39 Statistical Tables of Action taken under the Public Health (London) Act 42 Summary of Nuisances and other matters reported on in 1914 43 Magisterial Proceedings during 1914 46 List of Bakehouses and Slaughter-houses 47 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For 1914. Section I.—STATISTICAL. POPULATION OF CHELSEA. The estimated population of the Borough for the middle of the year 1914 is 67,400. An increase of 1,000 over the estimated population of 1913 has been assumed, as a considerable proportion of the population of Sutton Dwellings came into occupation in 1914, and new houses have become tenanted on the Vale Estate. BIRTHS IN 1914. Table I. Number of Births. Male. Female. Total. North Chelsea 335 353 688 South Chelsea 293 292 585 Chelsea 628 645 1,273 The above Table relates to births registered in the Borough. Excluding 56 births of non-parishioners, and including 75 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year is 1,292, the corresponding figure for 1913 being 1,210. The birth-rate for 1914 is 19.2 per 1,000. The average birth-rate of the Borough for the years 1901-13 is 21.0 per 1,000. The average birthrate of the Home District of Chelsea for the 5 years, 1896-1900, was 24.1 per 1,000. The rate for 1914 is rather higher than the rate for 1913, which was the lowest on record ; and this is due to the new population in Sutton Dwellings, which contributed 97 births during the year 1914. The birth-rate for London in 1914 was 24.6 per 1,000. 4 During the year 1914, 41 births of parishioners were registered as having occurred in the Chelsea Workhouse, equivalent to 3.25 per cent. of the total number of births in the Borough, as compared with 5.4 per cent. in 1913. DEATHS AND DEATH-RATES FOR 1914. The total number of deaths registered in the Borough was 1,603. Of this number 891 were deaths within the Borough, of non-parishioners— chiefly occurring in Hospitals and in the St. George's Infirmary; and 185 deaths of parishioners occurred outside the Borough in various public institutions. There were, therefore, 897 deaths of parishioners of Chelsea. These 897 deaths are equivalent to a death-rate of 13.3 per 1,000 as against 13.5 in 1913. The death-rate for 1914 is the lowest yet recorded in Chelsea. Table II. gives the death-rates of the Home District of Chelsea Parish, of Chelsea Borough, and of London, during the past 24 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 161 14.1 1910 14.2 13.7 1911 15.7 15.0 1912 14.8 13.8 1913 13.5 14.0 1914 13.3 14.4 * 1891-1900, Chelsea Home District. Zymotic Death-rate.—The death-rate in Chelsea from the seven principal zymotic diseases was 0.76 per 1,000 in 1914, the corresponding rate for London being 1.57. In 1913 the zymotic death-rate in Chelsea was 0.87 per 1,000. 5 Table III.—For the year 1914. Zymotic death-rate. Diarrhœa 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 0.76 0.41 1.25 0.24 2.67 1.41 0.19 67.3 14.4 54.2 London 1.55 0.80 1.42 0.33 2.67 1.18 0.14 103.5 26.8 45.8 Small-pox.—There was no small-pox in Chelsea in 1914. Measles.—This disease caused only one death in 1914, as compared with 17 in 1913, and 21 in 1912. The single death was that of a South Chelsea infant under one year of age. Scarlet Fever.—This disease caused 4 deaths in 1914, 3 being North Chelsea and 1 a South Chelsea case. All the deaths occurred in Hospitals. Diphtheria.—Eight deaths were attributed to diphtheria in 1914, 3 being North Chelsea and 5 South Chelsea cases. Six of the deaths occurred in Hospitals, and 2 at the patients' homes. Table IV.—Cases of, and Deaths from Diphtheria and Membranous Croup in Chelsea,* 1890-1914. cases. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 172 162 163 200 207 273 429 242 153 136 150 106 131 99 61 52 161 158 138 97 81 83 89 59 76 deaths. 1890 1891 1892 1895 1894 1895 189G 1897 1898 1899 1900 1901 1902 1903 1901 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 32 20 32 43 41 52 96 45 22 13 14 9 13 4 5 5 16 8 13 14 5 5 4 1 8 * 1890-1900, Chelsea Home District. Whooping Cough.—This disease caused 7 deaths in 1914, as compared with 4 in 1913. Five were between 1 and 2 years of age, and two between 2 and 5 years. Four of the deaths were in North Chelsea, and 3 in South Chelsea. Enteric Fever.—There were 3 deaths from this disease, 1 being a North Chelsea, and 2 South Chelsea cases. Two of the deaths occurred in Hospital. One of the fatal cases was that of a girl of 17 years, who was not notified until she was moribund; and another was a man who arrived in Chelsea from Canada, being ill on his arrival. 6 Table V.—Zymotic Disease Mortality in Chelsea in 1914. Actual number of deaths in Chelsea. Chelsea's proportion of total London deaths according to its population. Average number of deaths annually in Chelsea, 1901-1913. Measles 1 21 26 Scarlet Fever 4 5 5 Diphtheria 8 11 8 Whooping Cough 7 14 18 Enteric Fever 3 2 2 Diarrhoea 28 54 46 Diarrhœa.—The deaths in Chelsea in 1914 from diarrhœal diseases (diarrhoea and enteritis) were 28 in number, as compared with 32 in 1913. Nineteen of the deaths were of infants under one year of age, and 2 were between 1 and 2 years. Eleven of the deaths were of North Chelsea residents, and 17 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 1912 153 395 1913 482 788 1914 415 799 Eleven deaths from diarrhoea occurred in the third or summer quarter of the year, as compared with 13 in 1913, 2 in 1912. and 48 in 1911. The 7 average temperatures of the summer quarters of these 4 years are as follows: 1911, 65°.8F.; 1912, 58°.9F.; 1913, 60°.2F.; and 1914, 63°.2F.; Considering that the average temperature of the summer quarter of 1914 was 3°F. above that of 1913, it is a very satisfactory feature that the diarrhoea mortality of the summer quarter of 1914 was actually two less than in 1913. In London, summer diarrhoea mortality commenced to rise early in August, and reached its maximum by the middle of September. Influenza.—The number of deaths attributed to Influenza in 1914 was 13, as against 12 in 1913. Eight deaths occurred in North Chelsea, and 5 in South Chelsea. In London generally, the disease was less prevalent than in 1913, 624 deaths being registered as due to this cause in 1914, as compared with 840 in 1913. Of the 624 fatal cases in London, 273 occurred in the first quarter of the year, 154 in the second, 54 in the third, and 143 in the fourth quarter. Respiratory Diseases.—The death-rate from these diseases in Chelsea in 1914 was 2.67 per 1,000, as compared with 2.65 per 1,000 in 1913. The London death-rate from respiratory diseases in 1914 was the same as in Chelsea, namely 2.67 per 1,000. Tubercular Diseases.—The death-rate from phthisis and other tubercular diseases in Chelsea in 1914 was 1.49 per 1,000, as against 1.46 per 1,000 in 1913. The death-rate in London from these diseases in 1914 was 1.75 per 1,000. Of the 84 deaths from Phthisis in Chelsea in 1914, 40, or 47.6 per cent., occurred in the Chelsea Workhouse Infirmary, and 13, or 15.5 per cent., occurred in other public institutions, making a total of 63.1 per cent. of the total 84 fatal cases dying in public institutions away from their own homes. In 1913, 62.8 per cent. of the fatal cases died in public institutions, whilst in 1912, 72.7, and in 1911, 73.7 per cent. died in institutions. There is some reason to believe that the decline in the past two years from the figures of 1911 and 1912 may be due to the domiciliary treatment of insured persons suffering from phthisis, under the sanatorium benefit provisions of the National Insurance Act, which began to operate fully in 1913. Of the 84 deaths from phthisis in Chelsea in 1914, 57 were deaths of males, and 27 of females. Other tubercular diseases caused 8 deaths in males, and 8 in females. The death-rate of males from all tubercular diseases in Chelsea in 1914 was 2.24 per 1,000, the corresponding rate for females being 0.91 per 1,000. These are very nearly identical with the rates for 1913. The average rates for the 5 years, 1906-10 in Chelsea, were 2.10 per 1,000 for males, and 1.02 per 1,000 for females. Diseases of the Heart.—These diseases caused 112 deaths in Chelsea in 1914. The average number of deaths annually from heart disease during the period 1901.13 was 120. Cancer.—Malignant cancerous diseases caused 96 deaths in Chelsea in 1914. Fifty-four of the fatal cases were North Chelsea residents, and 42 were South Chelsea. 8 Table VII.—Cancer Moiiality in Quinquennia. Average Annual Number of Deaths. Average Annual Death-rate. 1891-5 66 0.87 per 1,000 1896-1900 74 1.00 „ 1901-5 78 1.08 1906-10 79 1.16 „ 1911-13 96 1.44 „ 1914 96 1.41 „ The above Table shows the serious increase of Cancer as a cause of death during the past 24 years. Alcoholism.—Fifteen deaths were registered in 1914 as being due to alcoholism or cirrhosis of the liver, as against 26 in 1913. The diminution is a satisfactory one, but many more deaths are really due to alcoholic excess than are registered under these headings. Deaths in Lunatic Asylums'—Forty-three deaths of Chelsea parishioners occurred in 1914 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; 1911-13, 45 The deaths in Lunatic Asylums form about 5 per cent. of the total deaths. Deaths in Public Institutions—In 1914, 54.2 per cent. of the total deaths of parishioners of Chelsea occurred in public institutions, as compared with 52.1 per cent. in 1913. In London generally 45.8 per cent. of the total deaths occurred in public institutions in 1914. The deaths in the Chelsea Infirmary in 1914 formed 25.8 per cent. of the total deaths of Borough residents, as compared with 20.9 per cent. in 1913. Deaths of Common Lodging House Inmates.—Fifteen deaths of inmates of common lodging houses occurred in Chelsea in 1914. All were males. Six of the deaths (40 per cent. of total), were due to pulmonary tuberculosis. Thirteen of the deaths occurred in the Workhouse Infirmary. The common lodging house accommodation in Chelsea is the same as in 1913. DEATH-RATES OF SPECIAL CLASSES OF THE POPULATION. The following Table gives the birth-rate, the general death-rate, the zymotic disease death-rate, the tubercular disease death-rate, and the deaths under 1 year to 1,000 births, during the year 1914, 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 Borough Council's Dwellings are Sir Thomas Wore Buildings, Pond House, Onslow Dwellings, and Grove Buildings, with a total population of 1,467. The industrial dwellings are the Marlborough Buildings, Guinness Buildings, Peabody Buildings, Chelsea Park Dwellings, and Sutton Trust Dwellings, with a total population of 3,984; and the seven streets are Dartrey-road, Francis-street, Gilray-square, Ives-street, Riley-street, Slaidburn-street, World's Endpassage, and the courts adjacent, with a total pupolation of 3,480. 9 Table VIII.—For the Year 1914. Birthrate. Deathrate. Zymotic Deathrate. Tubercular Diseases Death-rate. Deaths under one year to 1,000 births. Chelsea 19.2 13.3 0.8 1.5 67 Borough Council Dwellings 25.2 12.3 0.7 0.7 27 Industrial Dwellings 36.4 9.5 1.2 2.8 48 7 Poor-class Streets 39.1 18.4 1.7 2.6 96 The death-rates of the selected poor-class streets are now very much lower than they were 10 to 20 years ago, as is shown by the following Table: Table IX. Years. Birthrate. Deathrate. Zymotic Death-rate. Tubercular Diseases Death-rate. Deaths under one year to 1,000 births. 1893-6. - 34.6 7.5 4.3 - 1897-1900 - 33.7 7.0 4.6 - 1901-4 - 26.3 3.7 4.1 - 1905-8 38.0 24.4 4.2 3.4 183 *1909-12 36.8 24.1 3.0 3.8 137 *1913 33.9 15.2 2.6 1.1 59 *1914 39.1 18.4 1.7 2.6 96 1893-1908 statistics based on populations of 11 streets. *1909-1911 „ „ „ 10 ,, *1912-1914 „ „ „ 7 „ *In consequence of demolitions. INFANTILE MORTALITY. Chelsea. Table X.—Mortality Bates per 1,000 Births, 1901-4. 1905-8, 1909-12, 1913, and 1914. 1901-4. 1905-8. 1909-12. 1913. 1914 Infectious Diseases 10.0 11.5 8.0 4.1 0.8 Diarrhœal Diseases 23.5 26.0 18.0 18.2 14.7 Developmental Defects and Wasting 48.0 37.0 34.5 33.8 31.7 Other Causes 58.0 44.0 36.0 36.4 20.1 Total Rate 139.5 118.5 96.5 92.5 67.3 10 This Table shows the fall that has taken place in the Infantile Mortality Rate since 1901. The infectious diseases concerned in infantile mortality are principally measles and whooping cough. Developmental defects include premature birth, congenital defects of the infant, and injury at birth. Other causes include tubercle, syphilis, meningitis, convulsions, overlaying, bronchitis, and pneumonia. Table. XI. 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 139 140* 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 116 119* 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 97* 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 1913 92 44 105 5,716 1914 67 42 103 5,914 * Corrected for outside Births. The infantile mortality rate of Chelsea for 1914 was the lowest yet recorded, and compares favourably with the rates prevailing in many high class residential and suburban districts. The saving of life in infancy is undoubtedly accompanied by a saving of health and life in children between the ages of 1 and 5 years, as is shown by the following Table:— Table XII.—Average number of annual deaths. 1-5 years. Infectious Diseases. Diarrhœa and Enteritis. T uberculosis Bronchitis and Pneumonia. Other Causes. Total. 1901-5 36 7 15 27 18 103 1906-10 38 7 12 19 11 87 1911-14 22 4 7 12 10 55 The following Table shows the infantile mortality rates and the birthrates in the five wards of the Borough. The births occurring in the Chelsea Workhouse and other maternity institutions have been distributed amongst the various Wards. 11 Table XIII.—For the Year 1914. Wards. Birth-rate. Infantile Mortality Rate. Hans Town Ward 13.5 47 Royal Hospital Ward 13.7 55 Church Ward 21.2 66 Cheyne Ward 17.1 95 Stanley Ward 23.7 67 Chelsea Borough 19.2 67 From Table XVIII. (Local Government Board, Table IV.), it will be seen that out of a total of 87 deaths of infants under one year of age in 1914, 36, or 41.4 per cent. occurred in the first four weeks of life, as compared with 41.1 per cent. in 1913. Twenty-one deaths occurred in the first week of life, equal to 24.1 per cent. of the total, the corresponding figure for 1913 being 26.8 per cent. The majority of these deaths in the first month of life are due to prematurity, congenital defects, injury at birth, and wasting. For deaths under one month the rate of mortality in 1914 was 27.9 per 1,000 births, as against 38 in 1913, and 26 in 1912, the average rate for the 9 years, 1905-13 being 37. Between the ages of 1 month and 12 months, 51 deaths, or 58.6 per cent. of the total, occurred in 1914, as compared with 58.9 per cent. in 1913, 19 of these deaths being due to diarrhoea and enteritis, as compared with 22 in 1913. The principal causes of death amongst infants under one year of age in 1914 were:—Diarrhœa and enteritis, 19; wasting, 16; prematurity, 15; pneumonia, 12; congenital malformations, 8; and suffocation by overlaying, 5. 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 1,0f 0 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 1913 87 7.2 73 10 4 115 1914 74 5.7 51 14 9 189 12 Illegitimate Births.—The preceding Table shows, for each of the years 1905-1914, 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. 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 five years it has been possible to trace the subsequent histories of the illegitimate infants with some approach to accuracy. 13 TABLE XV.—(i.) VITAL STATISTICS OF WHOLE DISTRICT DURING 1914 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 Residents not registered in the District † Under 1 Year of Age. At all Ages. N umber † Kate. Number * Rate. Number * Rate per 1,000 Nett N umber * Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1913 66,400 1170 1210 18.2 1444 21.7 743 194 112 92 895 13.5 1914 67,400 1273 1292 19.2 1603 23.8 891 185 87 67 897 13 .3 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 corrections as to transferable deaths probably will not be available. The rates should be calculated per 1000 of the estimated gross population as stated in Col. 2, without the use of the standardising factor for the district given in the Annual Report of the Registrar-General. 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 to him by the local Registrar of Deaths, as well as from the quarterly lists furnished by the Registrar-General, 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; (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 (land and inland water) 660 Total population at all ages 66,404 Total families or separate occupiers... 15,936/ At Census, 1911. 14 TABLE XVI.—(II.) CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1914. Notifiable Disease. At all Ages. Number of Cases notified. Total Cases Notified in each Locality (e.g., Parish or Ward) of the District Total Cases removed to Hospital. At Agest—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. Small-pox ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 76 ... 15 37 16 7 ... 1 38 38 71 Erysipelas 37 ... 1 ... 3 13 14 6 15 22 10 Scarlet Fever 281 ... 49 183 28 21 ... ... 148 133 253 Typhus Fever 1 ... ... ... ... 1 ... ... 1 ... 1 Enteric Fever 23 ... ... 3 10 7 3 ... 14 9 17 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 8 ... ... ... 2 6 ... ... 4 4 6 Cerebro-spinal Meningitis 1 ... ... ... ... 1 ... ... 1 ... 1 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... 2 3 ... Pulmonary Tuberculosis (Primary) 157 ... 2 13 25 68 36 13 ... ... ... Other forms of Tuberculosis (Primary) 49 1 11 18 7 8 4 ... ... ... ... Totals 638 6 78 254 91 132 57 20 223 209 359 †These age columns for notifications should be filled up in all cases where the Medical Officer of Health, by inquiry or otherwise, has obtained the necessary information. 15 TABLE XVII.—(III.) CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1914. 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 1 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Enteric Fever 3 .. .. .. .. 2 1 .. .. 5 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 1 1 .. .. .. .. .. .. .. 2 Scarlet Fever 4 .. .. 2 1 .. 1 .. .. 1 Whooping Cough 7 .. 5 2 .. .. .. .. .. 6 Diphtheria and Croup 8 .. 1 1 4 1 .. .. 1 1 Influenza 13 .. .. .. .. ..1 .. .. 10 .. Erysipelas 1 .. .. .. .. .. .. .. 1 3 Phthisis (Pulmonary Tuberculosis) 84 .. .. .. 1 6 30 34 13 187 Tuberculous Meningitis 8 2 1 2 2 1 .. .. .. 29 Other Tuberculous Diseases 8 .. 1 1 1 .... 2 3 .. 25 Cancer, malignant disease 96 .. .. .. .. .. 5 46 45 181 Rheumatic Fever 1 .. .. .. .. .. .. 1 .. 2 Meningitis. See note (d) 4 1 .. .. 1 1 1 .. .. 2 Organic Heart Disease 112 .. .. .. 1 2 12 35 62 103 Bronchitis 96 1 1 1 .. 3 22 68 139 Pneumonia (all forms) 78 11 4 5 1 2 11 19 25 82 Other Diseases of Respiratory organs 6 1 1 .. 2 2 .. 4 Diarrhœa and Enteritis. See note(e) 28 19 2 .. .. 1 .. 2 4 37 Appendicitis and Typhlitis 4 .. .. .. .. 3 .. 1 .. 1 Cirrhosis of Liver 12 .. .. .. .. .. 1 5 6 9 Alcoholism 3 .. .. .. .. .. 1 1 1 6 Nephritis and Bright's Disease 35 .. .. .. 1 2 3 17 12 34 Puerperal Fever 2 .. .. .. .. .. 2 .. .. 5 Other accidents and diseases of Pregnancy and Parturition. 2 .. .. .. 2 •• 1 Congenital Debility and Malformation, including Premature Birth 33 33 .. .. .. .. .. .. .. 18 Violent Deaths, excluding Suicide 35 6 1 4 3 6 3 6 6 39 Suicide 6 .. .. .. .. 1 2 3 1 2 Other Defined Diseases 98 2 2 2 5 6 16 22 43 125 Diseases ill-defined or unknown 76 9 2 4 24 37 80 Old Age 30 .. .. .. .. .. .. .. 30 62 Cerebro-Spinal Meningitis 1 .. .. 1 .. .. .. .. .. .. Tetanus 1 .. .. .. .. .. 1 .. .. 1 Kala Azar 1 .. .. .. .. .. 1 •• .. Totals 897 87 21 21 22 35 103 243 365 1192 16 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. Tho 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 bo regarded as "Uncertified." (d.) Exclusive of "Tuberculous Meningitis' (10), but inclusive of Cerebro-Spinal Meningitis. (e.) Title 19 should be used for deaths from Diarrhæa 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.) 17 TABLE XVIII.—(iv.) INFANT MORTALITY.—1914. 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 4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total Deaths under 1 year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. 1 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. 1 1 2 Abdominal Tuberculosis (b) .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. 2 .. .. 2 Convulsions .. .. .. .. .. .. 1 .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. 1 1 .. 2 Pneumonia (all forms) .. .. .. .. .. 4 2 3 3 12 Diarrhœa .. .. 2 .. 2 4 4 3 1 14 Enteritis .. .. .. .. .. 1 2 1 1 5 Gastritis .. .. .. .. .. .. 1 .. .. 1 Syphilis .. .. .. .. .. 1 .. .. .. 1 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. 1 1 2 1 1 .. 5 Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 1 .. .. .. 1 .. .. .. .. 1 Congenital Malformations (c) 4 3 1 .. 8 .. .. .. .. 8 Premature Birth 13 1 1 .. 15 .. .. .. .. 15 Atrophy, Debility & Marasmus 2 2 3 1 8 7 .. .. 1 16 Other causes .. .. .. .. .. .. .. .. .. .. Totals 21 6 7 2 36 19 14 10 8 87 Nett Births in the year legitimate 1199 illegitimate 74 Nett Deaths in the year of legitimate infants 73 illegitimate infants 14 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. for ages under 1 year, 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. 18 Section II. INFECTIOUS DISEASES. Small-pox.—There were no cases of small-pox in Chelsea in 1914. In London, during 1914, only 3 cases of the disease were notified, as compared with 5 in 1913, 6 in 1912, and 73 in 1911. Of the 3 cases 1 was in Westminster, 1 in the City, and 1 in the Port of London. There was not a case notified in London after the third week of February, 1914. Scarlet Fever.—In 1914, 281 cases of scarlet fever were notified in Chelsea, equivalent to a case-rate of 41.7 per 10,000 of the population, as against 30 in 1913. The number of cases notified in the first quarter of the year was 67, in the second quarter 49, in the third quarter 96, and in the fourth quarter 69. The increased prevalence of scarlet fever in Chelsea, as in London, commenced in June 1913. There was some diminution in Chelsea in 1914, from February to May inclusive, but the prevalence increased again in June, and remained at a high level until the end of September. In October and November there was some decline, but in December there was again an increase. There was little or no intermission in August, during the school holidays, but, owing to the war, the schools re-opened two weeks before the usual date. The disease was widely spread throughout the Borough, there being no special school incidence attaching to any school or schools in the Borough. The disease was of very mild type, only 4 deaths from scarlet fever being registered throughout the entire year, which gives a case mortality of only 1.4 per cent. The percentage of cases of school age (3 to 13 years) of the total number notified in the Borough was 76, the same as in 1913. The average duration of the stay in hospital of 238 cases, of which the records are to hand, was 58.7 days, as against 55.4 days in 1913. Only 4 cases admitted to M.A.B. hospitals were subsequently certified by the Medical Superintendents of the hospitals not to be suffering from scarlet fever or any other notifiable disease. The average duration of stay in hospital of 3 of these cases was 30 days. Three cases on discharge from hospital were stated to be still suffering from otorrhæa, and 3 from rhinorrhæa. There were 3 "return" cases of scarlet fever in 1914, the intervals elapsing between the return home of the infecting cases and the onset of illness in the "return" cases being 4 days, 4 days, and 7 days in these 3 cases. There was some delay in the removal of cases to M.A.B. hospitals in the latter part of the year, but all cases for whom applications were made were eventually removed after delays of 1 to 3 or 4 days. During the year 90 per cent. of the cases notified were removed to hospital, as compared with 91 per cent. in 1913. Diphtheria.—In 1914, 76 cases of diphtheria were notified in Chelsea, equivalent to a case-rate of 11.3 per 10,000 of population, as compared with 8.9 in 1913. In the first quarter of the year 24 cases were notified, in the second quarter 14, in the third quarter 20, and in the fourth quarter 18. 19 The percentage of cases of school age (3 to 13 years) of the total number notified in the Borough was 58, as against 69 in 1913. The month of greatest prevalence was July (11 cases), and the month of least prevalence August (2 cases). Taking the year as a whole, diphtheria was but little prevalent at any time; and there was no special incidence on any school in the Borough. The type of the disease was of average severity, the casemortality, or percentage of deaths to cases being 10.5 per cent. The average duration of stay in hospital of 50 cases, of which the records are to hand was 49.9 days, as against 52 in 1913. Eight cases admitted to M.A.B. hospitals were subsequently certified by the Medical Superintendents of the hospitals not to be suffering from diphtheria or any other notifiable disease. The average duration of stay in hospital of 6 of these cases was 20.7 days. There were 2 "return" cases of diphtheria in 1914, the intervals elapsing between the return home of the infecting case and the onset of illness in the "return" case being respectively 9 days and 11 days. During the year medical practitioners sent 115 throat swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 134 in 1913. Three were sent by myself from this department. The entire cost was defrayed by the Borough Council. Of the total diphtheria swabs 71, or 62 per cent. were sent by the medical staff of the Victoria Hospital for children, in respect of Chelsea children. Of the total of 115 swabs, 22, or 19.1 per cent., afforded positive evidence of the presence of the specific KlebsLœtt'ler bacillus, and 93, or 80.9 per cent., gave negative evidence. In 1913 the positives were 17.2 per cent., and the negatives 82.8 per cent. The presence of Hoffmann's pseudo-diphtheria bacillus was recorded on 7 occasions in the negative samples. Antitoxin was ordered for one case of diphtheria during the year by the medical practitioner in attendance prior to the removal of the child to hospital, the charge for the serum being borne by the Borough Council. During the year 93 per cent. of the diphtheria cases notified were removed to hospital, the corresponding figure for 1913 being 81 per cent. Enteric Fever.—The number of cases of enteric fever notified in Chelsea in 1914 was 23, as against only 7 in 1913, the case-rate being 3.4 per 10,000 of the population, as against 1.05 in 1913. Three cases were notified in the first quarter of the year, 2 in the second quarter, 7 in the third quarter, and 11 in the fourth quarter. Of the 23 cases notified, 6 were soldier patients at No. 2 General Military Hospital, St. Mark's College. Five of these men had returned from the British Expeditionary Force, and one was a Territorial quartered at Harpenden. There was also one case of a Territorial quartered at the Duke of York's Headquarters. Of the remaining 16 cases, two were patients at a Nursing Home in Chelsea, and resided ordinarily in Boroughs outside Chelsea. Of the remaining 14 cases, in two the diagnosis of enteric fever was not confirmed at the hospitals to which the patients were removed. In two cases the patients were infected prior to arrival in Chelsea, one case being infected at St. Buryan, Cornwall, and the other in Canada. In two other 20 cases, the diagnosis of enteric fever was probably incorrect. There were, therefore, only 8 cases of enteric fever out of the 28 notified, in which it seems probable that the infection was contracted within the Borough. Of these 8 cases one proved fatal. Seven of the cases were removed to hospital. Four specimens of blood from supposed enterics were sent to the Lister Institute in the course of the year, for determining the Widal reaction. Three gave positive results and one a negative result. Typhus.—A case of typhus was notified early in November, from No. 2 General Military Hospital. The patient was a Belgian soldier, who had been fighting in Flanders. He was removed to a M.A.B. hospital, and nearly 3 weeks later was notified by the Medical Superintendent as suffering from enteric fever and not from typhus. Venereal Diseases.—One sample of blood was sent by a medical practitioner to the Lister Institute for the Wasserman reaction for syphilis, the result being negative. A specimen was also sent for determination of gonococci, but none were found. Cerebrospinal Fever.—One case of this disease was notified from St. George's Hospital in October, the patient being a man of 26 years. No information was obtainable about this case. A death occurred at St. George's Hospital in October from cerebro-spinal meningitis and acute hydrocephalus. The patient was a female child, aged 2 years. She was a patient in the hospital in January, 1914, suffering from cerebro-spinal fever. The meningococcus was isolated, and serum was given, resulting in recovery and discharge from hospital, but the foramina subsequently became blocked setting up acute hydrocephalus. The case was never notified. In London, during the year 1914, 75 cases of cerebro-spinal fever were notified, as against 91 in 1913. Forty-six of the cases were notified in the first two quarters of the year, and 29 in the last two quarters. Twentythree deaths were registered in London as due to this disease during the year, whereas only 5 were so registered during 1913. Either the casemortality was very high last year (30.7 per cent.), and the type very severe, or else a considerable number of cases were not notified. The average case-mortality in London for 1910-13 was only 6.5 per cent., and if this proportion held good for 1914, 354 cases should have been notified instead of 75. Acute Foliomystitis.—No cases of this disease were notified in Chelsea in 1914. In 1913, 3 cases were notified. In London 97 cases were notified during the year, namely, 10 in the first quarter, 5 in the second quarter, 51 in the third quarter, and 31 in the fourth quarter, so that 82, or 85 per cent. of the total cases occurred in the second half of the year. In 1913, 80 per cent. of the cases occurred in the second half of the year. These figures are of some interest as bearing upon the alleged transmission of the virus of the disease by the biting stable-fly (Stomoxys Cahitraus). 21 Ophthalmia Neonatorum.—In London during 1914, 905 cases were notified, as compared with 627 in 1913, and 699 in 1912. Sixteen cases were notified in Chelsea, as compared with 14 in 1918, and 5 in 1912. Of these 16 cases, 12 made complete, recoveries, one lost entirely the use of one eye, one was left with some weakness of both eyes, one died from other causes, and one removed out of the Borough and could not be traced. Three of the cases were severe, 3 were of moderate severity, and 10 were slight cases. Besides the notified cases, the Lady Sanitary Inspector visited quite 30 cases which were not notified. None of these cases lost their sight. Steps were taken in every case to ensure that the affected eyes received appropriate treatment. Altogether 43 visits were paid in respect of notified cases of the disease. Puerperal Fever.—Eight cases of this disease were notified in Chelsea in 1914, the same number as in 1913. Two of these cases ended fatally. Seven of the cases were attended in their confinements by medical practitioners, and one by a midwife. Six of the cases were removed from their homes to hospitals. Measles.—This disease was very little prevalent in Chelsea in 1914. During the year only 42 children attending Chelsea schools were notified to the Public Health Department by the teachers of the schools as actually suffering from measles; and 23 children who were "contacts," i.e., living in houses invaded by measles, were excluded from school attendance for varying periods. Only one class room in one school was closed temporarily on account of measles in 1914. No cases of the disease were removed during the year to M.A.B. hospitals. Whooping Cough.—In 1914, 64 children attending schools in Chelsea were notified to the Public Health Department by the teachers of the schools as actually suffering from whooping cough, and 24 "contacts" were excluded from school. Only 3 cases during the year were removed to M.A.B. hospitals. Notifications of Tuberculosis. The following Table shows the number of notifications of males and females at 11 different age-periods, from pulmonary and non-pulmonary tuberculosis, that were received under the Public Health (Tuberculosis) Regulations, 1912, during the year 1914. 22 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 4th January, 1914, to the 2nd January, 1915. No. of Notifications on Form A. No. of Notifications on Form B. No. of Notifications on Form C. Primary Notification. Total Notifications on Form A. Primary Notification. Total Notifications on Form B. Poor Law Institutions Sanatoria including Brompton Hospital. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 05 and over. Total. 0 to 5 5 to 10 10 to 15 Total. Pulmonary Males — 1 2 3 7 6 13 25 15 7 7 86 94 — — — — — 116 30 Females — 1 6 2 6 6 14 16 10 4 6 71 92 — 1 — 1 1 24 10 Non-Pulmonary Males 1 10 8 2 1 1 — — 3 — — 26 32 — — — — — 3 2 Females — 1 6 2 1 4 8 — — 1 — 23 23 — 1 — 1 1 — — 1 13 22 9 15 17 35 41 28 12 13 206 241 — 2 — 2 2 143 42 28 Pulmonary Tuberculosis. During the year 1914, 157 new cases of pulmonary tuberculosis were notified, as compared with 160 in 1913. Eighty-six of the cases were males and 71 females. The age-incidence of the cases is given in the preceding Table. Seventy specimens of sputum were sent during the year, by medical practitioners, to the Lister Institute for free bacterioscopic diagnosis. Of these 26, or 37 per cent., showed the presence of tubercle bacilli, and 44, or 63 per cent., did not. The corresponding figures in 1913 were 32 per cent. positive, and 68 per cent. negative, of the total of 41 specimens. Of the notified cases of pulmonary tuberculosis on the register, 52 died during the course of the year. Cases notified less than 10 days before death 5 „ 10 days to 1 month before death 3 ,, 1 to 8 months before death 15 „ 3 to 6 months before death 8 „ 6 to 9 months before death 4 „ 9 to 12 months before death 3 „ 1 to 2 years before death 10 „ 2 to 3 years before death 3 „ 3 to 4 years before death 1 52 The number of cases notified as re-admissions to the Chelsea Infirmary in 1914 were males, 116; females, 24. A considerable number of chronic cases amongst males are constantly seeking admission into the Infirmary for rest and treatment. Many of them take their discharges when they feel better, to be again re-admitted after varying periods at their own homes. Of 111 new cases of pulmonary tuberculosis (mostly adults), entered in the register for the year 1914, of which fairly full notes have been obtained as the result of visits to, and inquiries made at the homes of the patients by the Lady Sanitary Inspector, in 39 there was a history of tuberculosis amongst near relatives. Infection from relatives was probable in 6 cases. In 52 cases the tubercular infection appears to have been preceded at varying intervals by an attack of bronchitis (12); pleurisy (6); influenza(18); or neglected nasal and bronchial catarrh (20). In 2 cases in children an attack of measles was regarded as the exciting cause. In 7 cases the illness was attributed to continued cold and exposure. Badly ventilated or dusty workrooms and offices are associated with 10 cases; alcoholic excess with 4 cases; poverty and deficient food with 6 cases; living in damp basements with 2 cases; nursing a consumptive patient with 3 cases; working with consumptive fellow-workmen with 3 cases; and one case is associated with previous injury to chest, tubercular glands in neck, and a previous attack of enteric fever. Of these 111 cases, 46 were found on the date of the first visit of the Lady Sanitary Inspector to be sleeping alone (with a bed to him or herself), and 65 were sleeping in bed with some other person. In about two-thirds 24 of the latter cases the patients were subsequently induced to make arrangements to sleep alone. Four beds with the necessary bedding have been provided for this purpose by the Chelsea Borough Council, and were lent to necessitous cases during the year, with great advantage to the sufferers. About three-fifths of the cases visited are found to be able and willing to carry out sanitary precautions as regards collection and disposal of sputa, burning of infected rags, having windows open, and keeping the rooms occupied clean and free from dust and dirt. Fully a quarter of the cases are somewhat unsatisfactory to deal -with, owing to carelessness and scepticism as to infection, and the necessity for fresh air and cleanliness. In nearly every case, however, some improvement is effected as the result of the visits made. During the year 1914, 25 cases of notified pulmonary tuberculosis have been discharged from open air, etc., Sanatoria, in which they had received institutional treatment as "insured persons," under the sanatorium benefit provided by the Insurance Committee of the London County Council. The average duration of stay of these 25 persons in the sanatoria has been 3.2 months, as against only 2.5 months in 1913. Three of the patients died whilst undergoing sanatorium treatment. Ten of the cases have been treated at the Downs Sanatorium, 6 at Winchmore Hill, 2 at the Royal Sea Bathing Hospital, Margate, and one each at various other sanatoria. Five cases, in addition to the above, have had hospital treatment, the average duration of stay in hospital being 5.9 months. A good deal of work and correspondence has been carried on in the Public Health Depatrment in respect of advising and putting the patients in the way of obtaining sanatorium benefit, corresponding with panel doctors and the Insurance Committee, and obtaining grants for extra nourishment for cases in which such was advised as being ancillary to medical treatment. No portable open-air shelters or tents have been provided by the Council for the use of phthisical patients in the Borough. The number of new cases of phthisis visited in the course of the year was 154, and of non-pulmonary tuberculosis 44. The total number of visits paid in respect of pulmonary and non-pulmonary tuberculosis was 754. Eight phthisical patients have been lent beds and bedding by the Borough Council in the course of the year; 38 pocket spittoons were given to persons requiring them. Eight out-patient and 2 in-patient letters were given for Brompton Hospital, and several out-patient letters for the Victoria Hospital. Two "contacts" of tuberculous cases were sent for medical examination to the Brompton Hospital, one of these cases being subsequently notified. Twelve "contacts" were sent for examination to the Tuberculin Dispensary, No. 1, Manor-street, about half of these cases being subsequently notified. Non-Pulmonary Tuberculosis. The majority of cases of non-pulmonary tuberculosis notified were children. Of 38 cases about which fairly full information was obtained as the result of home visits, 16 were helped to obtain proper surgical 25 ment in hospitals, and 35 were sent at one time or another to country or seaside homes. A great deal of this work was carried out, as in previous years, by the Invalid Children's Aid Association, which has done so much for the cure and relief of this class of sufferer. Of the 57 cases of non-pulmonary tuberculosis entered in the register during 1914, 26 were cervical gland cases, 17 of which were children under 15 years of age; 13 were bone and joint cases, 6 being under 15 years; 6 were abdominal cases, of which 5 were under 15 years; 4 were cases of tubercular meningitis, of which 3 were under 15 years; 3 were skin cases, all under 15; and the remainder were generalised tuberculosis, 2 cases; testicles, eyes, and bronchial glands, one case each. Of the total of 57 cases, 20 were over 15 years of age, and 27 under 15. The predominance of cervical gland cases is very much the same as in 1913, when non-pulmonary tuberculosis cases first became compulsorilv notifiable. Tuberculosis Dispensary. The scheme for the establishment of a Tuberculosis Dispensary in connection with the Brompton Hospital for consumption did not come into operation owing to delays caused by negotiation with the London Insurance Committee and the other bodies whose approval was necessary in order to secure the grants in aid. The scheme will probably come into operation in 1915. 26 Section III. HOUSING OF THE WORKING CLASSES. Sir Thomas More Buildings. The Buildings have been fully occupied during the year. During the year 40 tenants voluntarily terminated their tenancies, as against 41 in 1913. There were no notices to quit. During the year 17 births were registered, and 7 deaths. The deaths were as follows :— Age. Sex. Disease. 3 mths. Female Influenza: Meningitis. 29 years Male Enteric Fever (contracted in Canada). 64 „ Male Acute Bronchitis. 72 „ Female Cerebral Hœmorrhage. 76 „ Male Senile decay. 78 „ Male Hæmaturia. 79 „ Female Bronchitis: Old age. Eight cases of scarlet fever and one of enteric fever were notified in the Buildings during the year. Pond House. During the year Pond House was fully occupied. Three tenants voluntarily terminated their tenancies. One birth was registered during the year, and one death, namely:— Male. 38 years, pulmonary tuberculosis. One case of scarlet fever and one of diphtheria were notified during the year. Onslow Dwellings. The dwellings were fully occupied during the year. Only 7 tenants voluntarily terminated their tenancies. There were no notices to quit. During the year 8 births were registered, and 8 deaths. 27 The deaths were as follows :— Age. Sex. Disease. 32 years Female Heart disease. 38 „ Female Fatty heart. 46 „ Female Cerebral hœmorrhage. 68 „ Male Cancer of tongue. 69 „ Female Pneumonia. 71 „ Male Bronchitis. 81 „ Female Cancer of uterus. 82 „ Female Bronchitis: Heart and kidney disease. Two cases of scarlet fever were notified during the year. Grove Buildings. The Buildings were fully occupied throughout the year. Twenty tenants voluntarily terminated their tenancies. There were no notices to quit. Eleven births and two deaths were registered during the year. The deaths were :—Male, 40 years, cirrhosis of kidney; and Male, 68 years, Heart and kidney disease. Four cases of scarlet fever were notified during the year. The external painting of the Buildings and of the staircases was carried out at a cost of £152, by Messrs. A. G. Pole. 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 Sutton Dwellings.—These dwellings were fully occupied during the year, and house a population of 2,236, of whom 715 are under 10 years of age, and 1,521 over 10 years. The proportion under 10 years (32 per cent.) is considerably higher than in the Borough Council's Dwellings, where the proportion under 10 years of age is only 28 per cent. The number of tenements in the dwellings is 674, containing 1461 rooms, and 674 sculleries. The average population per room is 1.5, as against 1.3 in the Borough Council's dwellings, so that the density of population is slightly greater. There were 97 births in the Dwellings during the year, equivalent to a birth-rate of 43.4 per 1,000, and 19 deaths, equivalent to a death-rate of 8.5 per 1,000. There were 22 cases of scarlet fever and 4 of diphtheria notified in the Dwellings during the course of the year. 28 The Lewis Trust Buildings are still in course of erection. Owing to the Building Strike or Lock-out in 1914, nothing was done on the Buildings from February to August inclusive. The Buildings should be completed in the autumn of 1915. During the year 1914, closing orders were made by the Borough Council in respect of 4 houses in Riley-street, under the provisions of the Housing and Town Planning Act, 1911. Owing to the War, it was considered undesirable to close the houses and disperse the tenants, and minor repairs were carried out by the owner of the houses during the autumn. HOUSES DEMOLISHED OR VACATED, 1914. Street. Houses. Arthur-street 2 Beaufort-street 7 Camera-square 43 Cheyne-walk 1 Church-street 6 Flood-street 4 Fulham-road 1 Johnsons-cottages 2 King's-road 1 Little Camera-street 8 Riley-street 2 Upper Cheyne-row 1 Total 78 29 Section IV. THE SANITARY CONDITION OF THE BOROUGH. The tabular statements prepared by the Sanitary Inspectors show that 1,341 separate premises were reported on by them during 1914, 415 of this number being with reference to cases of notifiable infectious disease, and 425 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 breach of the Public Health (London) Act, in respect of one premises only. Drainage.—During the year 16 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, 1914. Number of restaurant and hotel kitchens 65 „ inspections made 91 „ premises found satisfactory 63 „ premises with sanitary defects 2 „ notices served 2 Bakehouses. Number of bakehouses 32 „ inspections 54 „ notices served 6 Disinfection.—During the past year, 471 premises have been disinfected after cases of infectious or other disease, 115 of these being rooms which had been in occupation by persons suffering from tuberculosis. In addition 265 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, 1645 separate articles of bedding or clothing were disinfected, and 59 articles were destroyed in the incinerator. Of the total of 1645 articles disinfected, 582 were blankets, clothing, uniforms, etc., sent by the military authorities, viz., 466 from the Duke of York's Headquarters; 105 from No. 2 General Military Hospital at St. Mark's College; and 11 from the R.A.M.C. Sanitary Company, in Manor-street. No charge was made to the Military Authorities for any of this work. Of the 582 articles disinfected, 456 were for pediculi (vermin); 64 for scarlet fever; 46 for enteric fever; 6 for scabies; and 10 for other diseases. Most of these articles of clothing were the belongings of soldiers who had been in contact with cases of infectious disease, or with vermin, in addition to those actually verminous; and as a precautionary measure a considerable number of articles taken out of government store were disinfected at the request of the Military Authorities. 30 Water Supply to Tenement Houses.—Under the powers conferred by the London County Council (General Powers) Act, 1907, Section 78, a water supply on one of the upper floors has been fixed by the owners in 54 houses during the year 1914, namely 41 houses in Stanley Ward, and 13 in Church Ward. All these houses have 3 storeys or more above the ground level, the majority being what are known as 2-storey houses. The water taps have been for the most part fixed on a half landing of the stairs, and in the majority of them a small drip sink has been supplied with a waste-pipe to carry off waste and leakage. It was not found necessary in any instance to enforce the notices served under the Act by legal proceedings. Underground Sleeping Places.—During the year the following Regulations have made by the Borough Council under Section 17 (7) of the Housing, Town Planning, etc., Act, 1909. These Regulations have now received the formal approval of the Local Government Board. Regulations prescribed by the Council, of the Metropolitan Borough of Chelsea under Section 17 (7) of the Housing, Town Planning, etc., Act, 1909. Underground Sleeping Places. Every room habitually used as a sleeping place the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, shall comply with the following Regulations, namely :— 1. The floor, walls, and ceiling of such room shall be dry and present no evidence of dampness, whether such arises from the soil under the room, the ground adjoining such room, or from any other cause. The room shall be effectually protected against the rising of any effluvium or exhalation by means of a layer of asphalt, or of good cement concrete at least six inches thick, or four inches if properly grouted, laid upon the ground of the site of the entire room, or in some equally effectual manner, wherever the condition of the site or of its immediate surroundings renders such protection necessary. 2. The floor, walls, and ceiling of such room shall be structurally in good repair. 3. Unless the room is provided with a fireplace and a flue properly constructed and properly connected with such fireplace, it shall be provided with special and adequate means of ventilation by one or more suitably placed apertures or air shafts. 4. The average level of the top of the window of the room shall not be below the surface of the part of the street or ground adjoining or nearest to the room. 5. An area or open space properly paved with impervious material and effectually drained by means of a trapped gulley connected to a drain, shall adjoin one side of the room, and extend along the entire 31 frontage thereof, from 3 inches below the surface of the floor of the room, up to the surface of the part of the street adjoining or nearest to the room. 6. Such area shall not he less than 2 feet 6 inches wide in every part thereof, and shall be open throughout its entire length. Provided (a) that where a bay window in the room having side lights overlooks such an area, the width thereof in front of such window may be 1 foot 6 inches at the least; and (b.) that any steps necessary for access to any part of the building comprising the room may be placed in or over such an area or open space, if they are so placed as not to be over or across any window of the room required by the Regulation in that behalf. 7. (1.) The room shall be effectually lighted by means of one of more windows opening directly into the external air. (2.) Every such window shall be so constructed that onehalf at the least may be opened, and that the opening may extend to the top of the window. (3.) The total area of such window or windows clear of the sash frames shall be at least one eighth the floor area of the room. (4.) Any such window or windows shall overlook the area or open space provided in pursuance of the Regulation in that behalf. (5.) In estimating the area of a window or windows for the purpose of this Regulation, no account shall be taken of any part of any such window which is above the mean level of the ceiling of the room. Supply from Metropolitan Water Board. From the reports of Dr. Houston, Director of Water Examinations, Metropolitan Water Board, it appears that for the 12 months ending 30th November, 11)14, on an average the number of samples of filtered water supplied to Chelsea yielding negative results as regards the presence of typical Bacillus Coli (the common intestinal micro-organism) was 97.9 per cent., when 100 c.c. of water were taken as the basis of bacterioscopic examination, the corresponding figures for 1913 and 1912 being 90.9 and 91 per cent., so that the results for 1914 were more favourable than for the two previous years. In February and March, and in September and October, all the samples examined proved negative to the B. Coli test. The percentage of negative results in the remaining 8 months of the year varied from 94.3 (August) to 98.2 (January). REPORTS PRESENTED TO THE BOROUGH COUNCIL. 20th January—The Presence of Talc in Rice. 17th June.—Nos. 40, 41, 42, 43, Riley-street. 17th June.—As to additional Staff required in the Public Health Department. 17th June.—Underground Rooms and Regulations as to Underground Sleeping Places. 32 THE SALE OF FOOD AND DRUGS ACTS. During the year 1914, 400 samples were taken for the ordinary purposes under the Acts, and 12 samples of cream were taken under the Milk and Cream Regulations. Milk.—Of the 400 samples, 170 were milk, 160 being returned by the Public Analyst as geniune samples, and 10 as adulterated, equivalent to 6 per cent. of the total samples, as compared with 5.5 per cent. in 1913. Of the 10 adulterated samples proceedings were only taken in one case, in which 14.7 per cent. of the original fat had been abstracted, the vendor being fined 10s. and 10s. 6d. costs. In 3 cases the amounts of adulteration (fat abstracted, 3 per cent.; added water, 2.6 per cent.; added water, 3.7 per cent.), were insufficient to warrant legal proceedings. In 6 cases the vendors were protected by warranties from the wholesale dealers, and no proceedings were taken. In these 6 cases the amounts of adulteration were as follows : added water, 3.7 per cent., 5.1 per cent., 5.2 per cent., 8.3 per cent., and 12.3 per cent.; fat abstracted, 13 per cent. Butter.—Of butter 175 samples were taken, 171 being returned as genuine, and 4 as adulterated. No proceedings were taken in any of these cases, in 3 there being only excesses of water (0.8 per cent., 3 per cent., and 4.4 per cent.), and in one case 56.5 per cent. of foreign fat. This sample was not taken under the Acts. A later sample taken from the same vendor under the Acts proved to be genuine. All the samples of butter were examined for preservatives. Preservatives in Butter. No. of Samples. Per cent. Boric acid less than 04 per cent. 38 22 ,, from 0.1 to 0.2 per cent. 39 22 ,, from 0.2 to 0.3 „ 50 28 „ from 0.3 to 0.4 „ 43 25 „ from 0.4 to 0.5 „ 5 3 175 100 The Departmental Committee of the Local Government Board recommended that butter should not contain more than 0.5 per cent. of boric acid. All the butters examined were, therefore, within this limit. Margarine.—Of margarine 18 samples were taken, all being returned as geniune. Of these 18 samples, 15, or 83 per cent., contained less than 0.1 per cent. of boric acid: one sample contained from 0.1 to 0.2 per cent., and two samples from 0.2 to 0.3 per cent. Of Coffee, 9 samples were taken, all being genuine; of Mustard, 9 samples, all genuine; and of Pepper, 9 samples, 7 being genuine, and 2 of inferior quality. 33 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Milk.—Of the 170 samples of milk analysed during the year, 52 were specifically stated by the Public Analyst to be free from boric acid and formaldehyde perservatives. With regard to the remaining 118 samples, it is understood from the Public Analyst that they were also free from preservatives. Cream.—Twenty-two samples of cream were submitted for analysis. With one exception, which was sent for analysis by a private individual, all were taken under the procedure of the Sale of Food and Drugs Acts. In 14 samples no preservatives were found. The remaining 8 samples contained preservatives, but all the samples were labelled as preserved cream, in accordance with the requirements of the Regulations. These 8 samples contained boric acid in amounts as follows :— Less that 0.1 per cent. 3 samples. From 0.1 to 0.2 per cent. 4 „ From 0.2 to 0.3 per cent. 1 „ In 12 samples examined for percentages of contained milk fat and for thickening substances or " stiffeners," in all " stiffeners " were absent. The percentages of milk fat were as follows :— 40 to 45 per cent. 1 sample. 45 to 50 „ 4 samples 50 to 55 „ 5 „ 55 to 60 ,, 2 „ SUMMARY OF WORK DONE DURING 1914. By the Lady Sanitary Inspector. The work done during 1914 has comprised the following :— (1.) Inspection of workshops and laundries at which women are employed. (2.) Inspection of outworkers' premises. (3.) Visiting cases of pulmonary and non-pulmonary tuberculosis. (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, etc. (6.) Visiting to give instruction re management of infants. 34 Workshops and Laundries.—During the year 16 new workshops were registered, and 34 were removed from the register, the total number at the end of the year being 515. There were 19 laundries on the register at the end of the year, 5 being factory laundries. During the year 68 workrooms were measured, for which workroom cards were given. The total number of inspections made in connection with workrooms was 452. In 2 instances notices were served for cleansing workrooms. The effect of the War.—Inquiries made at 50 Dressmakers' establishments in November, 1914, showed that 51-2 per cent. of the usual number of employees in the autumn season had been discharged in consequence of loss of business due to the War, and 85-6 per cent. of those remaining were on short time. Milliners businesses were not much affected. The approximate number of dressmakers' employees in the 50 establishments who were discharged was 976, and those working short time 798. The businesses affected were chiefly in Sloane-street and its neighbourhood. Basement Workrooms.—During the year one new basement workroom has come into occupation, and 5 were closed, there being at the end of the year 69 basement workrooms in the Borough, mostly occupied by dressmakers and milliners. Classification of Workshops. (Women Employees). Dressmaking and Millinery 396 Outfitting 38 Embroidery 16 Various 46 Laundries :— Factory 5 Workshop 14 515 Outworkers.—The two half-yearly returns are as follows :— Number of Lists received 60 Total number of Outworkers as per Lists 719 Number living in Chelsea as per Lists 72 Number forwarded to other Boroughs 664 Received from other Boroughs 128 The number of inspections made of outworker's premises was 39. 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. 35 Notifications sent to :— Battersea 67 City of London 31 Fulham 77 Hammersmith 17 Islington 25 Kensington 40 Lambeth 17 Marylebone 74 Paddington 27 St. Pancras 22 Stepney 17 Wandsworth 20 Westminster 86 Other Metropolitan Boroughs 83 District Councils 61 Total 664 Notifications received from :— Kensington 66 Marylebone 16 Westminster 27 Other Boroughs 19 Total 128 School Cases.—The number of notifiable and non-notifiable cases of infectious diseases reported by the schools in 1914 was 897. There is still a great variation in the number of children notified by the different schools, as is shown by the following Table. In some 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 of Infectious Diseases. Numbers of Children notified from :— Ashburnham School 182 Christ Church School 39 Cook's Ground School 135 Holy Trinity School 27 Hortensia School 3 Marlborough-road School 163 Oratory School 19 Park-walk School 152 St. Mark's College School 5 St. Joseph's School 42 St. Luke's School 43 Servite School 50 Tadema-road School 29 Whitelands School 0 Schools outside Borough 8 897 36 Numbers of Cases of Disease, Contacts, and Suspects notified from Schools. Suffering from Excluded as Contacts Excluded as Suspects Scarlet Fever 95 164 39 Diphtheria 20 32 3 Chicken-pox 98 34 — Eczema 1 — — Impetigo 25 — — Itch 6 — — Measles 42 23 — Mumps 98 9 — Ophthalmia 27 — — Ringworm 60 — — Whooping Cough 64 24 — Sore Throat 23 — — Tubercle 1 — — Other Diseases 9 — — 569 286 42 897 Verminous School Children.—During the year 1914, 266 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. The corresponding number reported in 1913 was 187 children The increase in 1914 was due to a larger number of children reported as having verminous heads. Of the total of 266 children in 1914, 243 were reported once, 12 twice, 8 three times, and 3 four times. The homes of children reported more than twice in a year are usually found in a deplorable condition, and it seems almost impossible to make the parents in these cases to realise their responsibilities for their children. All the houses of the verminous children reported were visited by the Lady Sanitary Inspector; altogether 211 visits were paid in connection with this work. To aid the mothers of the children in cleansing the heads and freeing them from vermin, the Public Health Committee in 1913 authorised the purchase of tooth-combs of the best quality, which are too expensive for the very poor to buy. These are given to necessitous cases with careful instructions as to how they are to be used. In 1914, 21 of these toothcombs were given to families requiring them. The following Table shows the action taken as the result of these visits to verminous homes :— Homes. No action necessary, or rooms and bedding cleansed voluntarily by the parents 120 Disinfected by the Public Health Department 16 Rooms cleansed after service of notices on owners of the houses 11 Bedding destroyed and new bedding provided by the Council - Unable to obtain admission 3 Incorrect addresses 6 Little or no improvement effected 8 Prosecutions of parents by London County Council 11 37 The Notification of Births Act, 1907— The notifications received during the year have been as follows :— Notification of Births, 1914. Number. Living Children .. 1087 Still-born Children .. 35 1122 Notified by Medical Practitioners .. 329 „ St. George's Hospital .. 140 „ Midwives— Private Practice 330 Institutional 180 510 „ Chelsea Workhouse 42 „ Parents 76 „ Westminster Infirmary 34 1131 Dual Notifications—deduct 9 1122 Total number of births registered 1273 From the above Table it will appear that the notifications under the 1907 Act fell short of the registrations by the number of 151. In 1913 the discrepancy was 127, and in 1912, 203. The total number of births registered in 1914 which actually belonged to Chelsea was 1217, so that the actual discrepancy between notifications and births of parishioners registered in Chelsea in 1914 was only 95. The following are the records of births of Chelsea children which occurred in outside institutions in 1914. :— Queen Charlotte's Hospital 32 General Lying-in Hospital 20 Clapham Maternity Hospital 17 Middlesex Hospital 4 St. Thomas's Hospital 2 City of London Lying-in Hospital 2 St. Bartholomew's Hospital 1 78 In proportion to the number of births, there was in 1914 a slight decrease in notifications by medical practitioners, an increase in notifications by midwives, and a large increase in notifications from St. George's Hospital extern maternity department. The previous year there had been a decrease in the St. George's Hospital notifications, which was attributed at the time to the operation of the maternity benefit under the National Health Insurance Act. 38 Visits of Instruction re Management of Infants. During the year 1914, the homes of 616 recently-born infants were visited by the Lady Sanitary inspector. One hundred and fifteen re-visits were made., and there were 77 miscellaneous calls at houses in connection with this work. During the summer months 64 cases of infantile diarrhœa were discovered by the Lady Sanitary Inspector, and 180 visits were paid in connection with these cases to give advice as to suitable nursing and the obtaining of proper medical advice where necessary. All the cases made a satisfactory recovery. With regard generally to the Infant Health Work, it may be said that great improvement has been effected of recent years in home conditions, and in the care and proper upbringing of the infants. The practice of breast feeding from birth up to 9 to 12 months of age has decidedly increased, and all the worst features of artificial feeding, as formerly practised, have disappeared. Separate cots for infants are now used, instead of being the exception as in former years; and the clothing of the infants in warm and suitable material is now generally the rule, even in very poor households. The greatly lowered infantile mortality rate and the improved health of the children under school age are, no doubt, largely attributable to the sensible methods now employed by the mothers from earliest infancy in the rearing of their babies. 39 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. Written Notices. Prosecutions. 1 2 3 4 Factories (Including Factory Laundries.) 12 1 1 Workshops (Including Workshop Laundries.) 633 24 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) — — — Total 645 25 1 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS & WORKPLACES. particulars. 1 Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 2 3 4 5 Nuisances under the Public Health Acts:—* Want of cleanliness 7 7 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors 1 1 — — Other nuisances 9 9 — — Sanitary accommodation insufficient 1 — 1 1 unsuitable or defective — — — — not separate for sexes — — — — Offences under the Factory and shop Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 6 6 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 24 23 1 1 *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act. 1901, as remediable under the Public Health Acts. 40 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. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sees. 109, 110) Lists.† Outworkers.† Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, &c. 60 228 414 — — — — — — — — — — — — (2) Cleaning and washing — — — — — — — — — — — — — — — Household linen — — — — — — — — — — — — — — — Lace, lace curtains and nets — 5 3 — — — — — — — — — — — — Curtains and furniture hangings — — — — — — — — — — — — — — — Furniture and upholstery — 5 2 — — — — — — — — — — — — Electro-plate — 8 — — — — — — — — — — — — — File making; Brass & brass articles — 2 — — — — — — — — — — — — — Fur pulling — 1 — — — — — — — — — — — — — Cables & chains; Anchors & grapnels — — — — — — — — — — — — — — — Cart gear; Locks, latches and keys — — — — — — — — — — — — — — — Umbrellas, &c. — 12 — — — — — — — — — — — — — Artificial flowers — — — — — — — — — — — — — — — Nets other than wire nets — — — — — — — — — — — — — — — Tents; Sacks — — — — — — — — — — — — — — — Racquet and tennis balls — — — — — — — — — — — — — — — Paper, etc., boxes, paper bags — 2 — — — — — — — — — — — — — Brush making — — — — — — — — — — — — — — — Pea picking — 1 — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — Carding, &c., of buttons, Ac. — 4 — — — — — — — — Stuffed toys — — — — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — Processes incidental to the above . — 27 — — — — — — — — — — — — — Total 60 295 424 — — — — — — — — — — — — *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 some out worker's will often be repeated. 41 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 32 Laundries 19 Dressmaking and Millinery 399 Outfitting (Women's) 40 Various (Women's) 60 Various (Men's) 132 Total number of workshops on Register 682 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, 1901) — 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, 1901) Notified by H.M. Inspector 14 Reports (of action taken) sent to H.M. Inspector 14 Other — Underground Bakehouses (s. 101):— In use at the end of the year 27 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 March, 1912. 42 PROCEEDINGS DURING 1914. PREMISES. NUMBER OF PLACES. Number of inspections, 1914. Number of Notices, 1914. Number of prosecutions, 1914. On register at end of 1913. Added in 1914. Removed in 1914. On register at end of 1914. Milk premises 105 11 9 107 150 17 1 Cowsheds 1 — 1 0 6 — — Slaughter-houses 5 — 1 4 36 — — Other offensive trade premises — — — — — — — Ice cream premises 27 0 0 27 32 0 — Registered houses let in lodgings — — — — — {(a)* — {(a)* {(b)* — {(b)* Bakehouses 33 0 1 32 54 6 — Restaurant Kitchens 69 0 4 65 91 2 — * (a) For overcrowding. * (b) For other conditions. Total number of Intimation Notices served for all purposes 768 Overcrowding, 1914 :— Number of dwellings rooms overcrowded 7 Number remedied 7 Number of prosecutions — Underground Rooms :— Illegal occupation dealt with during the year 1 Number of rooms closed 1 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 265 Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 49 Revenue Acts ::— Number of Houses for which applications were received during the year 5 Number of tenements comprised therein 385 Number of tenements for which certificates were (a.) granted 385 „ „ (b.) refused — „ „ (c.) deferred — Common Lodging-houses—certificates granted Mortuaries :— Total number of bodies removed 185 Total number of infectious bodies removed — 48 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING THE YEAR 1914. Houses and Premises :— House-to-house inspections 425 * Reported on respecting nuisances complained of 501 Reported on with reference to infectious cases 415 Cleansed, whitewashed, and repaired 242 Defective roofs repaired 74 Disinfected after communicable diseases 356 Disinfected for Tubercular and other diseases 115 Rooms disinfected for verminous conditions 265 Cases of overcrowding abated 7 Dust-bins, new, provided 92 Ashpits demolished — Underground rooms occupied contrary to Act 1 Inspections of restaurant kitchens 65 Drainage :— Drains opened, cleansed, and made sound} 79 Drains trapped with stoneware gullies} Water closets cleansed and repaired 97 Water-closets, new pans and traps provided 118 Spout drains cleansed, repaired, or renewed 41 Sink, bath, and lavatory waste pipes provided and repaired 128 Drains and soil pipes ventilated or repaired 42 Soil pipes, new, provided 36 Additional w.c. accommodation provided 2 Anti-Syphonage pipes provided to w.c 30 Water Supply :— To Tenement Houses (upper storeys) 54 For domestic purposes, provided where cut off by Water Board 4 For water-closets, or check cisterns provided and repaired 77 Main cisterns cleaned or repaired 21 „ new covers provided 17 „ new, provided 2 Water certificates, issued in respect of newly erected dwelling-houses — Nuisances abated arising From :— Keeping of animals 14 Accumulations of manure and other filth 39 Yard, areas, and wash-houses paved or drained 54 Smoke 1 *This does not include re-visits to the 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. 44 Miscellaneous :— Dead bodies removed to public mortuary for sanitary reasons 8 Goods disinfected after infectious cases at station 1645 Goods destroyed after infectious cases 59 Number of samples taken for analysis (Food and Drugs Act) 400 Special Cream samples (Milk and Cream Regulations) 12 *Unsound Food. Number of boxes of fruit, fish, rabbits, etc., condemned and destroyed 4 Library books destroyed at Librarian's request 53 Animals destroyed in Incinerator — Proceedings taken :— Statutory notices issued 147 Intimations issued for sanitary works, etc., including infectious disease cases 768 Water supply to tenement houses 108 Legal proceedings in respect of defective sanitary arrangements, nuisances, etc. 1 Legal proceedings in respect of food adulteration 1 Correspondence :— †Number of letters written in connection with sanitary matters 750 Daily returns of infectious cases sent to Metropolitan Asylums Board 154 Notification of infectious cases sent to School Authorities 396 Entries in Inspectors' Report Books 469 Entries in Inhabitants' Complaint Book 32 Certificates of disinfection given 696 Certificates of infectious diseases for removal cases 193 Notices sent to Public Library of premises where infectious disease has occurred 77 Postcards sent re Samples under Sale of Food and Drugs Act 179 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 107 Dairies and Milkshops, and 30 Ice Cream vendors in the Borough. These have been registered and periodically inspected by the Sanitary Inspectors. *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. 45 AH places where fish and potatoes are cooked have been periodically inspected. Sanitary Inspectors : ALEXANDER GRANT (Chief). G. R. METZLER. F. C. COOK. F. TETTENBORN (Lady). 46 MAGISTERIAL PROCEEDINGS DURING 1914 UNDER THE SALE OF FOOD AND DRUGS ACT. Street where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Lots-road Milk 14% of cream abstracted 3rd March Adjourned for 14 days. 17th March Fine 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. 29a, Riley-street Failing to comply with the Borough Council's notices to provide sufficient and suitable sanitary accommodation for the workmen employed. Kensington 3rd March Summons adjourned for 14 days. 17 th March Dismissed. 47 BAKEHOUSES IN USE ON JANUARY 1ST, 1914. Street. Occupier. Above Ground. Below Ground 93 Beaufort-street A. Coventry ... Below. 55, Burnaby-street H. Smith ... „ 1, Cadogan-street Tidmarsh & Son ... „ 77, Cheyue-walk H. Judkins ... „ 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 Yenner ... „ 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, George Beaton ... „ 351, „ Hart ... „ 399, „ H. Kohler ... „ 488, „ Matthiae ... „ 502, „ 517, „ W. Schafer „ F. Freiburger ... „ 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, bakes at 11, Motcomb-street. † Now used as kitchen only. 48 SLAUGHTER-HOUSES. Street. Occupier. 169, Fulham-road Philp, J. 341, Fulham-road Vanghan, T. 52, King's-road Cobb, G. A. 54, King's-road Cobb, G. A. 413, King's-road Goulding, F.